Practice variation in surgical procedures and IUD-insertions among general practitioners in Norway – a longitudinal study

Published version. Source at http://doi.org/10.1186/s12875-017-0581-9. License CC BY-NC-SA 4.0.Background: Studies of Primary Health Care (PHC) reveal considerable practice variations in terms of the range of services provided. In Norway, general practitioners (GPs) are traditionally expected to perform IUD-insertions and several surgical procedures as a part of comprehensive PHC. We aimed to investigate variation in the provision of surgical procedures and IUD-insertions across GPs and over time and explore determinants of such variation. Methods: Retrospective registry study of Norwegian GPs. From a comprehensive database of GPs’ reimbursement claims, we obtained procedure codes and GP characteristics such as age, gender, list size and municipality characteristics from 2006 through 2013. Multivariable logistic regression models were fitted to explore determinants of practice variation. Results: We extracted data from 4,828 GPs. In 2013, 91.0, 76.1 and 74.8% were reimbursed at least once for minor and major surgical procedures and IUD-insertion, respectively. Female GPs had lower odds for performing major surgical procedures (OR 0.38, 95% CI 0.32–0.45) and higher odds for performing IUD-insertions (OR 6.28, 95% CI 4. 47–8.82) than male GPs. Older GPs and GPs with shorter patient lists were less likely to perform surgical procedures. GPs with longer patient lists had higher odds for performing IUD-insertions. The proportion of GPs performing surgical procedures increased over time, while the proportion decreased for IUD-insertions. The number of IUD-insertions in specialist care increased from 12,575 in 2011 to 15 216 (+21.0%) in 2014. Conclusion: We observed a large variation in the provision of surgical procedures and IUD-insertions amongst GPs in Norway. The GPs’ age, gender, list size and size of municipality were associated with performing the procedures. Our findings suggest a shift of IUD-insertions from primary to specialist care

Ganho ósseo apical a longo prazo após Instalação do implante combinado com elevação do seio maxilar sem enxerto.

Background: Assess changes in apical bone height / bone gain for up to 8 years after implant placement combined with simultaneous elevation of the internal sinus from the sinus floor (ISFE) without the use of a graft. Methods: 217 implants were placed in combination with ISFE without graft and successfully integrated into the posterior maxilla of 138 patients. Radiographs after surgery over an evaluation period of up to 8 years were analyzed. Changes in the apical and marginal bone height related to the implants were measured. Differences in bone height over the study period were assessed using the Wilcoxon test. To identify possible factors influencing apical bone gain and marginal bone loss, regressive linear regression selections and mixed linear regression models were performed. Results: In the apical aspects of the implants, significant mean vertical bone gain of 2.4 mm (mesial) and 2.6 mm (distal) was observed after 6 months (p <0.05). Radiographic analysis produced an additional bone gain of up to approximately 3.5 mm during the study period. The small initial bone height was crossed with a more pronounced apical bone gain (p <0.05). Conclusions: If the implants are placed in combination with the ISFE without a graft, a significant vertical bone gain can be expected, especially in the first postoperative year. Lower initial bone height is associated with a greater probability of greater bone gain.Fundo: Avaliar as alterações na altura óssea apical / ganho ósseo por até 8 anos após a colocação do implante combinada com elevação simultânea do seio interno do assoalho do seio (ISFE) sem o uso de enxerto. Métodos: 217 implantes foram colocados em combinação com ISFE sem enxerto e integrados com sucesso na maxila posterior de 138 pacientes. As radiografias após a cirurgia ao longo de um período de avaliação de até 8 anos foram analisadas. Alterações na altura óssea apical e marginal relacionadas aos implantes foram medidas. As diferenças na altura óssea ao longo do período do estudo foram avaliadas pelo teste de Wilcoxon. Para identificar possíveis fatores de influência no ganho ósseo apical e perda óssea marginal, foram realizadas seleções de regressão linear regressiva e modelos de regressão linear mista. Resultados: Nos aspectos apicais dos implantes, observou-se ganho ósseo vertical médio significativo de 2,4 mm (mesial) e 2,6 mm (distal) após 6 meses ( p  < 0,05). A análise radiográfica produziu ganho ósseo adicional de até aproximadamente 3,5 mm durante o período do estudo. A altura óssea inicial pequena foi cruzada com ganho ósseo apical mais pronunciado ( p  < 0,05). Conclusões: Se os implantes forem colocados combinados com o ISFE sem enxerto, pode-se esperar um ganho ósseo vertical significativo, especialmente no primeiro ano pós-operatório. Menor altura óssea inicial está associada a uma maior probabilidade de maior ganho ósseo

Emergency Thoracotomy Saves Lives in a Scandinavian Hospital Setting.

BACKGROUND:: Emergency thoracotomy (ET) is a life-saving procedure used to control hemorrhage and relieve cardiac tamponade. It has been in routine use at Ulleval University Hospital since 1987. Our objective was to see the outcome of patients subjected to ET in recent times. METHODS:: One hundred and nine consecutive ET performed in our emergency department during a 6-year period were analyzed. Data were drawn from the hospital's trauma registry. Demographics, mechanism of injury, anatomic injuries, physiologic status, interventions, time lapse, and outcome 30 days after injury were registered prospectively. RESULTS:: Ten of 27 patients with penetrating (37%) and 10 of 82 patients with blunt injuries (12%) survived, giving a total survival of 18%. Median (quartiles) for the following parameters were Injury Severity Score 38 (26-50), Revised Trauma Score 1.3 (0-3.9), Glasgow Coma Scale score 3 (3-6), and probability of survival 0.06 (0.001-0.22). Survivors from penetrating injuries had significantly lower Injury Severity Score (25 vs. 34, p = 0.003), higher Revised Trauma Score (3.92 vs. 0.00, p < 0.001), higher Glasgow Coma Scale score (8 vs. 3, p < 0.001), and higher probability of survival (0.74 vs. 0.01, p < 0.001) than nonsurvivors. Conversely, no such differences were found for patients with blunt injury. Multiple logistic regression analysis failed to reveal any predictors of survival. CONCLUSION:: An overall survival of 18% suggests that ET is a life saving procedure. It is difficult to find good predictors of survival from logistic regression analysis. It should, for a trained trauma team, be a liberal attitude toward performing the procedure on the agonal patient

Vaginal vask før keisersnitt for å forebygge postoperativ endometritt

Keisersnitt er den viktigste risikofaktoren for å utvikle postpartum endometritt, en komplikasjon som forlenger den postoperative tilhelingen og kan forstyrre etableringen av mor-barn-relasjonen i nyfødtperioden, samt i noen tilfeller ha et alvorlig forløp. Cochrane-samarbeidet har publisert systematiske oversikter som anbefaler antibiotikaprofylakse og vaginal desinfeksjon som infeksjonsforebyggende tiltak ved keisersnitt. Mens profylaktisk bruk av antibiotika er i varierende grad av bruk i norsk klinisk praksis, er det liten oppmerksomhet rundt preoperativ vaginal desinfeksjon. Vi tok for oss innføring av sistnevnte som kvalitetsforbedring

Diagnosing heart failure with NT-proBNP point-of-care testing: lower costs and better outcomes. A decision analytic study

Background: Afflicting 1–2% of the adult population, heart failure (HF) is a condition with considerable morbidity and mortality. While echocardiography may be considered the gold standard diagnostic test, GPs have relied on symptoms and clinical findings in diagnosing the condition. Aim: The aim of this study was to estimate 1-year health outcome and costs of three diagnostic strategies: 1) history and clinical findings ('clinical diagnosis'); 2) clinical diagnosis supplemented with NTproBNP point-of-care test ('POC test') in the GP’s surgery; or (3) in hospital laboratory ('hospital test'). Design & setting: A decision tree model was developed to simulate 1-year patient courses with each strategy in Norway. Method: Sensitivity and specificity of clinical diagnosis (56% and 68%), and of N-terminal pro B-type natriuretic peptide test ([NT-proBNP] 90% and 65%), were based on published literature. The probabilities of referral to hospital were based on a survey of Norwegian GPs (n = 103). The costs were based on various Norwegian fee schedules. Sensitivity analyses were conducted to examine the uncertainty of the results. Results: The 1-year per person societal costs were €543, €505, and €607 for clinical diagnosis, POC test, and hospital test, respectively. Even though POC entails higher laboratory costs, the total primary care costs were lower because of fewer re-visits with the GP and less use of spirometry. While 38% of patients had a delayed diagnosis with clinical diagnosis, the proportions were 22% with both POC test and hospital test. Results were most sensitive to the probability of use of spirometry. Conclusion: POC testing results in earlier diagnosis and lower costs than the other diagnostic modalities

Das Wärme- & Wohnen-Panel zur Analyse des Wärmesektors: Ergebnisse der ersten Erhebung aus dem Jahr 2021

Das neu etablierte Wärme- & Wohnen-Panel ermöglicht durch die Verknüpfung von Informationen zum Gebäudebestand, dem Endenergiebedarf, detaillierten Angaben zu den sozioökonomischen Charakteristika der Haushalte sowie durch wiederholte systematische Erhebungen eine fundierte Evaluierung der Effektivität klimapolitischer Maßnahmen im Wärmesektor in Deutschland. Dieser Beitrag präsentiert die wichtigsten deskriptiven Ergebnisse der ersten Panel-Erhebung unter ca. 15.000 privaten Haushalten aus dem Jahr 2021. Neben der unvermeidlichen umfassenden Abfrage der Gebäudecharakteristika und Heiztechnik lag der Schwerpunkt der ersten Erhebung auf den energetischen Modernisierungstätigkeiten privater Haushalte sowie auf der Bewertung und Akzeptanz von Klimaschutzinstrumenten im Gebäudesektor. Überdies wurde die Akzeptanz verschiedener Aufteilungsvarianten der Kostenbelastung der Anfang 2021 eingeführten CO2-Bepreisung auf Mieter und Vermieter untersucht. Zu den zentralen Resultaten gehören, dass die Aufteilung der Kostenbelastung der CO2-Bepreisung gemäß Bausubstanz die höchste Zustimmung unter den Befragten genießt. Bezüglich der Akzeptanz von Klimaschutzinstrumenten im Gebäudesektor ist bemerkenswert, dass ein Einbauverbot von Gaskesseln und eine Gebäudeklimaabgabe nur bei rund 30% der Befragten Zustimmung findet, während ein Einbauverbot von Ölkesseln von fast 70% der Befragten begrüßt wird. Dabei heizen nur 9% derjenigen, die dem Einbauverbot von Ölkesseln zustimmen, selbst mit Öl, während der Großteil der Zustimmung mit ca. 39% von denjenigen Befragten stammt, die mit Gas heizen. Befragt nach ihrer Informiertheit über die CO2-Bepreisung gibt fast die Hälfte aller Befragten an, eher nicht informiert zu sein, lediglich ein sehr geringer Teil von 3,4% der Befragten fühlt sich sehr gut informiert. Ähnlich verhält es sich bei energetischen Gebäudemodernisierungen: Knapp über die Hälfte der Eigentümer fühlt sich nicht gut über energetische Sanierungen informiert

Das Wärme- & Wohnen-Panel zur Analyse des Wärmesektors: Ergebnisse der 2. Erhebung aus dem Jahr 2022

Im Herbst 2022 fand die zweite Erhebung des im Rahmen des BMBF-geförderten Kopernikus-Projekts Ariadne etablierten Wärme- & Wohnen-Panels unter ca. 15.000 Haushalten statt. Das Panel verknüpft in bislang einzigartiger Weise Informationen zum Gebäudebestand und dem Endenergiebedarf mit Angaben zu den sozioökonomischen Charakteristika der Haushalte. Ein Schwerpunkt lag auf den Auswirkungen der durch den Angriff Russlands auf die Ukraine verursachten Energiepreiskrise auf die privaten Haushalte. So wurde gefragt, wie stark die Teilnehmenden von den steigenden Energiepreisen betroffen sind und welche Maßnahmen sie dagegen ergreifen würden. Lediglich 28% der Teilnehmenden planten jedoch, ihren Heizenergieverbrauch im Winter 2022/2023 stark oder sehr stark zu reduzieren. Ein bemerkenswertes Ergebnis ist auch, dass nur etwa 21% der Antwortenden angaben, die Informationskampagne der Bundesregierung mit dem Titel "80 Millionen gemeinsam für den Energiewechsel" wahrgenommen zu haben. Andererseits hat die überwältigende Mehrheit von etwa 88% der Befragten von der für Herbst 2022 geplanten, letztlich aber nicht eingeführten Gasumlage gehört. Als größten Hinderungsgrund in Bezug auf energetische Modernisierung wurden steigende Preise im Baugewerbe genannt, die Unsicherheit über die Preisentwicklung verschiedener Energieträger war ebenfalls von großer Bedeutung.In fall 2022, the second survey of the Heating & Living Panel, which was established as part of the BMBF-funded Kopernikus project Ariadne, was conducted among around 15,000 households. The panel combines information on the building stock and final energy demand with data on the socio-economic characteristics of households in a unique way. One focus was on the effects of the energy price crisis caused by Russia's attack on Ukraine on private households. Participants were asked how badly they were affected by rising energy prices and what measures they would take to counteract this. However, only 28% of participants planned to reduce their heating energy consumption significantly or very significantly in the winter of 2022/2023. Another notable result is that only around 21% of respondents stated that they had taken note of the German government's information campaign entitled "80 million together for the energy transition". On the other hand, the overwhelming majority of around 88% of respondents had heard about the gas levy planned for fall 2022 but ultimately not introduced. Rising prices in the construction industry were cited as the biggest obstacle to energy modernization, while uncertainty about the price development of various energy sources was also of great importance

FDZ data description: The German Heating and Housing Panel (GHHP) - Wave 1

Numerous measures have been taken in recent years to achieve climate protection targets in the building sector. With the newly established Ariadne German Heating and Housing Panel (GHHP), the prerequisite for a well-founded evaluation of the effectiveness, distribution effects and acceptance of climate policy measures in the heating sector has been created for the first time. The GHHP is an annual series of surveys on the heating transition with around 15,000 participating households in Germany. The survey, carried out as part of the Kopernikus project Ariadne funded by the Federal Ministry of Education and Research (BMBF), is made up of around 65% owner-occupied households and 35% renters. In addition to detailed information on the building stock, existing heating systems and heating costs as well as the socio-economic characteristics of the households, the survey also examines energy modernization measures that have already been carried out or are planned. The survey also records households' perception and acceptance of policy instruments in the building sector that are being discussed and have already been introduced. The first survey took place in 2021 and the surveys are to be continued until 2026. This data description provides a brief overview of the first wave of the GHHP in 2021. It explains the process and methodology of data collection as well as the socio-economic characteristics of the sample. Information on how to access the data can be found in section 5; a codebook is included in the appendix.Zur Erreichung der Klimaschutzziele im Gebäudesektor wurden in den vergangenen Jahren zahlreiche Maßnahmen ergriffen. Mit dem neu etablierten Ariadne Wärme- und Wohnen-Panel (German Heating and Housing Panel, GHHP) ist erstmals die Voraussetzung für eine fundierte Evaluierung der Effektivität, der Verteilungswirkungen und der Akzeptanz klimapolitischer Maßnahmen im Wärmesektor geschaffen worden. Das Wärme- und Wohnen-Panel ist eine sich jährlich wiederholende Erhebungsreihe zum Thema Wärmewende mit rund 15.000 teilnehmenden Haushalten in Deutschland. Die im Zuge des vom Bundesministerium für Bildung und Forschung (BMBF) geförderten Kopernikus-Projekts Ariadne durchgeführte Erhebung setzt sich aus ca. 65 % Eigentumshaushalten und 35 % Mietenden zusammen. Neben detaillierten Informationen zum Gebäudebestand, bestehenden Heizsystemen und Heizkosten sowie sozioökonomischen Charakteristika der Haushalte untersucht die Erhebung auch bereits durchgeführte oder geplante energetische Modernisierungsmaßnahmen. Darüber hinaus erfasst die Erhebung die Wahrnehmung und Akzeptanz der Haushalte zu diskutierten sowie bereits eingeführten Politikinstrumenten im Gebäudesektor. Die erste Erhebung fand 2021 statt und die Erhebungen sollen bis 2026 fortgeführt werden. Diese Datenbeschreibung gibt einen kurzen Überblick über die erste Welle des Ariadne Wärme- und Wohnen-Panel im Jahr 2021. Sie erläutert den Prozess und die Methodik der Datenerhebung sowie die sozioökonomischen Merkmale der Stichprobe. Informationen über den Zugang zu den Daten sind in Abschnitt 5 zu finden; ein Codebuch ist im Anhang enthalten