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

Impact of systemic hypertension on the diagnostic performance of B-Type natriuretic peptide in patients with acute dyspnea

Hypertension may affect the diagnostic performance of B-type natriuretic peptide (BNP). The objective of the present study was to assess the impact of a history of hypertension or blood pressure elevation on admission on the diagnostic performance of BNP in the diagnosis of heart failure (HF) in patients with acute dyspnea. BNP levels were measured using a rapid point-of-care device in 1,586 patients with acute dyspnea. In patients with HF, BNP levels did not differ between those with and without histories of hypertension. Conversely, in patients without HF, a history of hypertension was associated with higher median BNP levels (38 pg/ml [interquartile range 13 to 119] vs 21 pg/ml [interquartile range 7 to 64], p <0.001). The areas under the receiver-operating characteristic curves were 0.88 and 0.93 for those with and without histories of hypertension, respectively (p <0.001). Blood pressure elevation on admission did not affect the diagnostic accuracy of BNP (areas under the curve 0.90 in the 2 groups). In conclusion, although a history of hypertension is associated with higher BNP levels in patients with acute dyspnea without HF, the impact on the overall diagnostic performance of BNP is modest. Accordingly, BNP performs well as an indicator of HF in patients presenting in emergency departments regardless of a history of hypertension or elevated blood pressure on admission

Hvorfor tar pasienten medisinen? : Et dokumentasjonsforbedringsprosjekt

Sammendrag Bakgrunn/emne: Egne erfaringer fra praksis har vært at mange har savnet lett og oversiktlig tilgang til informasjon om hvorfor pasienten står på de ulike medisinene, spesielt geriatriske pasienter med komorbide tilstander og polyfarmasi. Dersom medikamentindikasjon er lettere tilgjengelig for alle behandlende instanser, vil dette styrke dokumentasjonen i journalen. Positive ringvirkninger kan være at uheldige interaksjoner lettere oppdages og gjøre revisjon av medikamentlister enklere. 3000 dødsfall årlig i Norge kan skyldes uhensiktsmessig legemiddelbruk. Kunnskapsgrunnlag: Det ble foretatt systematiske søk i Pubmed/Medline, UpToDate og Cochrane, flere studier illustrerte behovet for bedre dokumentasjon av pasienters medikamentbruk for å sikre forsvarlige forskrivningsrutiner. Artiklene nevnte ikke direkte at omfanget av mangelfull medikamentindikasjon er stor, men det er nærliggende å tro at dokumentasjonsmangelen omfatter alle deler av journalsystemet, og at vår problemstilling derfor er meget aktuell. Forelesningene til J. Straand brukes også som en del av kunnskapsgrunnlaget. Juridisk sett, viser utvalgte kapitler i Hpl, Prl og Sphlsl at journalføring er lovpålagt, den skal inneholde nødvendige opplysninger om pasienten og begrunne helsehjelpen som ytes. Begrunnet tiltak og metode: Vårt tiltak er å føre indikasjon på medisinlisten på førstedagsnotatet på samme måte som dosering og styrke føres på nå. Prosessmålet blir førstedagsnotatet, mens resultatmålet og indikatoren er antall epikriser med påført medikamentindikasjon. Tiltaket skal innføres på geriatrisk avd., Ullevål, OUS. Alle pasienter på avdelingen inkluderes. Organisering: Ansvaret for å påføre indikasjon på medikamenter tillegges den enkelte legen på post. Overlegene har det overordnete ansvaret for å påse at tiltaket følges opp, mens assistentlegene vil ha ansvaret for å telle opp andel medisinlister med indikasjon påført, i hhv. førstedagsnotatet og den tilsvarende epikrisen. I 1 mnd før intervensjonen igangsettes vil man måle resultatmålet, andel epikriser med indikasjon, for å ha et sammenligningsgrunnlag. Resultater/vurdering: Tiltaket skal innføres på geriatrisk avd., Ullevål, OUS og vare 1 måned. Etter denne perioden skal andel førstedagsnotater og epikriser med medikamentindikasjon påført registreres. Dette tallet vil vise hvor godt tiltaket har blitt implementert på avdelingen. Man kan så sammenligne dette resultatet, med resultatmålet man fant 1 måned før intervensjonen startet

COVID-19 through Adverse Outcome Pathways: Building networks to better understand the disease - 3rd CIAO AOP Design Workshop

On April 28-29, 2021, 50 scientists from different fields of expertise met for the 3rd online CIAO workshop. The CIAO project “Modelling the Pathogenesis of COVID-19 using the Adverse Outcome Pathway (AOP) framework” aims at building a holistic assembly of the available scientific knowledge on COVID-19 using the AOP framework. An individual AOP depicts the disease progression from the initial contact with the SARS-CoV-2 virus through biological key events (KE) toward an adverse outcome such as respiratory distress, anosmia or multiorgan failure. Assembling the individual AOPs into a network highlights shared KEs as central biological nodes involved in multiple outcomes observed in COVID-19 patients. During the workshop, the KEs and AOPs established so far by the CIAO members were presented and posi­tioned on a timeline of the disease course. Modulating factors influencing the progression and severity of the disease were also addressed as well as factors beyond purely biological phenomena. CIAO relies on an interdisciplinary crowd­sourcing effort, therefore, approaches to expand the CIAO network by widening the crowd and reaching stakeholders were also discussed. To conclude the workshop, it was decided that the AOPs/KEs will be further consolidated, inte­grating virus variants and long COVID when relevant, while an outreach campaign will be launched to broaden the CIAO scientific crowd

COVID-19 through Adverse Outcome Pathways: Building networks to better understand the disease - 3rd CIAO AOP Design Workshop

On April 28-29, 2021, 50 scientists from different fields of expertise met for the 3rd online CIAO workshop. The CIAO project “Modelling the Pathogenesis of COVID-19 using the Adverse Outcome Pathway (AOP) framework” aims at building a holistic assembly of the available scientific knowledge on COVID-19 using the AOP framework. An individual AOP depicts the disease progression from the initial contact with the SARS-CoV-2 virus through biological key events (KE) toward an adverse outcome such as respiratory distress, anosmia or multiorgan failure. Assembling the individual AOPs into a network highlights shared KEs as central biological nodes involved in multiple outcomes observed in COVID-19 patients. During the workshop, the KEs and AOPs established so far by the CIAO members were presented and posi­tioned on a timeline of the disease course. Modulating factors influencing the progression and severity of the disease were also addressed as well as factors beyond purely biological phenomena. CIAO relies on an interdisciplinary crowd­sourcing effort, therefore, approaches to expand the CIAO network by widening the crowd and reaching stakeholders were also discussed. To conclude the workshop, it was decided that the AOPs/KEs will be further consolidated, inte­grating virus variants and long COVID when relevant, while an outreach campaign will be launched to broaden the CIAO scientific crowd

COVID-19 through Adverse Outcome Pathways:Building networks to better understand the disease - 3rd CIAO AOP Design Workshop

On April 28-29, 2021, 50 scientists from different fields of expertise met for the 3rd online CIAO workshop. The CIAO project “Modelling the Pathogenesis of COVID-19 using the Adverse Outcome Pathway (AOP) framework” aims at building a holistic assembly of the available scientific knowledge on COVID-19 using the AOP framework. An individual AOP depicts the disease progression from the initial contact with the SARS-CoV-2 virus through biological key events (KE) toward an adverse outcome such as respiratory distress, anosmia or multiorgan failure. Assembling the individual AOPs into a network highlights shared KEs as central biological nodes involved in multiple outcomes observed in COVID-19 patients. During the workshop, the KEs and AOPs established so far by the CIAO members were presented and posi­tioned on a timeline of the disease course. Modulating factors influencing the progression and severity of the disease were also addressed as well as factors beyond purely biological phenomena. CIAO relies on an interdisciplinary crowd­sourcing effort, therefore, approaches to expand the CIAO network by widening the crowd and reaching stakeholders were also discussed. To conclude the workshop, it was decided that the AOPs/KEs will be further consolidated, inte­grating virus variants and long COVID when relevant, while an outreach campaign will be launched to broaden the CIAO scientific crowd