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Master in Business Administration - Nord universitet 201

Impact of the number of previous lumbar operations on patient-reported outcomes after surgery for lumbar spinal stenosis or lumbar disc herniation

Aims - Repeated lumbar spine surgery has been associated with inferior clinical outcomes. This study aimed to examine and quantify the impact of this association in a national clinical register cohort. Methods - This is a population-based study from the Norwegian Registry for Spine surgery (NORspine). We included 26,723 consecutive cases operated for lumbar spinal stenosis or lumbar disc herniation from January 2007 to December 2018. The primary outcome was the Oswestry Disability Index (ODI), presented as the proportions reaching a patient-acceptable symptom state (PASS; defined as an ODI raw score ≤ 22) and ODI raw and change scores at 12-month follow-up. Secondary outcomes were the Global Perceived Effect scale, the numerical rating scale for pain, the EuroQoL five-dimensions health questionnaire, occurrence of perioperative complications and wound infections, and working capability. Binary logistic regression analysis was conducted to examine how the number of previous operations influenced the odds of not reaching a PASS. Results - The proportion reaching a PASS decreased from 66.0% (95% confidence interval (CI) 65.4 to 66.7) in cases with no previous operation to 22.0% (95% CI 15.2 to 30.3) in cases with four or more previous operations (p Conclusion - We found a dose-response relationship between increasing number of previous operations and inferior outcomes among patients operated for degenerative conditions in the lumbar spine. This information should be considered in the shared decision-making process prior to elective spine surgery

The Norwegian registry for spine surgery (NORspine): cohort profile

Purpose - To review and describe the development, methods and cohort of the lumbosacral part of the Norwegian registry for spine surgery (NORspine). Methods - NORspine was established in 2007. It is government funded, covers all providers and captures consecutive cases undergoing operations for degenerative disorders. Patients’ participation is voluntary and requires informed consent. A set of baseline-, process- and outcome-variables (3 and 12 months) recommended by the International Consortium for Health Outcome Measurement is reported by surgeons and patients. The main outcome is the Oswestry disability index (ODI) at 12 months. Results - We show satisfactory data quality assessed by completeness, timeliness, accuracy, relevance and comparability. The coverage rate has been 100% since 2016 and the capture rate has increased to 74% in 2021. The cohort consists of 60,647 (47.6% women) cases with mean age 55.7 years, registered during the years 2007 through 2021. The proportions > 70 years and with an American Society of Anaesthesiologists’ Physical Classification System (ASA) score > II has increased gradually to 26.1% and 19.3%, respectively. Mean ODI at baseline was 43.0 (standard deviation 17.3). Most cases were operated with decompression for disc herniation (n = 26,557, 43.8%) or spinal stenosis (n = 26,545, 43.8%), and 7417 (12.2%) with additional or primary fusion. The response rate at 12 months follow-up was 71.6%. Conclusion - NORspine is a well-designed population-based comprehensive national clinical quality registry. The register’s methods ensure appropriate data for quality surveillance and improvement, and research

Integrating Offshore Wind Power and Multiple Oil and Gas Platforms to the Onshore Power Grid using VSC-HVDC Technology

This thesis investigates the possibilities of integrating oil and gas platforms and offshore wind power to the onshore power grid. The main motivation for this is to reduce the large greenhouse gas emissions associated with traditional oil and gas platforms. The oil and gas industry is responsible for 25 % of total greenhouse gas emissions from Norway. The major part of these emissions originates from the power generation on the platforms. By supplying the oil and gas platforms with renewable energy from the onshore power grid in combination with offshore wind power there will be little or no use for power generation on the platforms and greenhouse gas emissions can be greatly reduced. The feasibility of a hypothetical power system in the North Sea consisting of five oil and gas platforms and one offshore wind farm with a common connection to the onshore power grid is studied. The connection to the onshore grid is realized through a High Voltage Direct Current (HVDC) transmissions system based on Voltage Source Converter (VSC) technology The main goal of this thesis is to gain understanding of the system dynamics and the control of VSC-HVDC transmission system, offshore wind power, as well as offshore power systems.A dynamic simulation model of the system and a control system has been developed using SimPowerSystems in MATLAB®/Simulink. In order to save computation time aggregated models are used. The load on the platforms consists of a passive load, a fixed speed induction motor, and a constant power load representing variable speed drives on the platform. The wind farm consists of a wind turbine and a permanent magnet synchronous machine operating at variable speed using a back-to-back VSC. The converters in the VSC-HVSC transmission system and the wind farm are modeled using average models. Simulations are performed on system disturbances that are thought to be critical for the operation of the system. The simulation cases represent large and partly exaggerated disturbances in order to test the limitations of the system. The simulation results showed that the developed control system was able to keep the voltage and frequency variations within the grid code in IEC 61892 even during large disturbances. It was concluded that the system handles variations in the load very well and that the system configuration studied in this thesis is regarded as a feasible way of integrating oil and gas platforms and offshore wind power to the onshore grid. However more detailed studies are recommended including short circuit analysis

Integrating Offshore Wind Power and Multiple Oil and Gas Platforms to the Onshore Power Grid using VSC-HVDC Technology

This thesis investigates the possibilities of integrating oil and gas platforms and offshore wind power to the onshore power grid. The main motivation for this is to reduce the large greenhouse gas emissions associated with traditional oil and gas platforms. The oil and gas industry is responsible for 25 % of total greenhouse gas emissions from Norway. The major part of these emissions originates from the power generation on the platforms. By supplying the oil and gas platforms with renewable energy from the onshore power grid in combination with offshore wind power there will be little or no use for power generation on the platforms and greenhouse gas emissions can be greatly reduced. The feasibility of a hypothetical power system in the North Sea consisting of five oil and gas platforms and one offshore wind farm with a common connection to the onshore power grid is studied. The connection to the onshore grid is realized through a High Voltage Direct Current (HVDC) transmissions system based on Voltage Source Converter (VSC) technology The main goal of this thesis is to gain understanding of the system dynamics and the control of VSC-HVDC transmission system, offshore wind power, as well as offshore power systems.A dynamic simulation model of the system and a control system has been developed using SimPowerSystems in MATLAB®/Simulink. In order to save computation time aggregated models are used. The load on the platforms consists of a passive load, a fixed speed induction motor, and a constant power load representing variable speed drives on the platform. The wind farm consists of a wind turbine and a permanent magnet synchronous machine operating at variable speed using a back-to-back VSC. The converters in the VSC-HVSC transmission system and the wind farm are modeled using average models. Simulations are performed on system disturbances that are thought to be critical for the operation of the system. The simulation cases represent large and partly exaggerated disturbances in order to test the limitations of the system. The simulation results showed that the developed control system was able to keep the voltage and frequency variations within the grid code in IEC 61892 even during large disturbances. It was concluded that the system handles variations in the load very well and that the system configuration studied in this thesis is regarded as a feasible way of integrating oil and gas platforms and offshore wind power to the onshore grid. However more detailed studies are recommended including short circuit analysis