Waiting time and socioeconomic status - an individual–level analysis

Waiting time is a rationing mechanism that is used in publicly funded healthcare systems. From an equity viewpoint, it is regarded as preferable to co-payments. However, long waits are an indication of poor quality of service. To our knowledge, this analysis is the first to benefit from individual-level data from administrative registers to investigate the distribution of waiting time with respect to socioeconomic status. Furthermore, it makes use of an extensive set of medical information that serves as indicators of patient need. Differences in waiting time by socioeconomic status are detected. For men there is a statistically highly significant negative association between income and waiting time. More educated women, i.e., having an education above compulsory schooling, experience lower waiting time than their fellow sisters with the lowest level of education.Health

Translation and validation of the Alberta Context Tool for use in Norwegian nursing homes

Purpose: Organizational context is recognized as important for facilitating evidence-based practice and improving patient outcomes. Organizational context is a complex construct to measure and appropriate instruments that can quantify and measure context are needed. The aim of this study was to translate and cross-culturally adapt the Alberta Context Tool (ACT) to Norwegian, and to test the reliability and structural validity among registered nurses (RNs) and licenced practice nurses (LPNs) working in nursing homes. Methods: This study was a validation study utilizing a cross-sectional design. The sample consisted of n = 956 healthcare personnel from 28 nursing homes from a municipality in Norway. In the first stage, the ACT was translated before being administered in 28 nursing homes. In the second stage, internal consistency and structural validity were explored using Cronbach’s alpha and confirmatory factor analysis. Results: A rigorous forward-and-back translation process was performed including a team of academics, experts, professional translators and the copyright holders, before an acceptable version of the ACT was piloted and finalized. The Norwegian version of the ACT showed good internal consistency with Chronbachs alpha above .75 for all concepts except for Formal interactions where the alpha was .69. Structural validity was acceptable for both RNs and LPNs with factors loadings more than .4 for most items. Conclusions: The Norwegian version of the ACT is a valid measure of organizational context in Norwegian nursing homes among RNs and LPNs.publishedVersio

Shoulder instability surgery in Norway: The first report from a multicenter register, with 1-year follow-up

Background and purpose. In January 2008, we established the Norwegian Register for Shoulder Instability Surgery. We report on the establishment, the baseline data, and the results at 1-year follow-up. Methods. Primary and revision shoulder stabilization is reported by the surgeon on a 1-page paper form containing the patient's history of shoulder injury, clinical findings, and perioperative findings. The WOSI questionnaire for self-assessment of shoulder function is completed at baseline and at follow-up after 1, 2, and 5 years. To evaluate the completeness of registration, we compared our data with those in the Norwegian Patient Registry (NPR). Results. The NPR reported 39 hospitals performing shoulder stabilizations. 20 of these started to report to our register during 2009, and 464 procedures (404 primary, 59 revisions) were included up to December 31, 2009, which represented 54% of the procedures reported to NPR. Of the 404 primary procedures, 83% were operations due to anterior instability, 10% were operations due to posterior instability, and 7% were operations due to multidirectional instability. Arthroscopic soft tissue techniques were used in 88% of the patients treated for primary anterior instability and open coracoid transfer was used in 10% of such patients. At 1-year follow-up of 213 patients, we found a statistically significantly improved WOSI score in all types of instability. 10% of the patients treated with arthroscopic anterior labral repair and 16% treated with arthroscopic posterior labral repair reported recurrent instability. No statistically significant difference in functional improvement or rate of recurrence was found between these groups. Interpretation. The functional results are in accordance with those in previous studies. However, the incidence of recurrent instability 1 year after arthroscopic labral repair is higher than expected.publishedVersio

Samsvar mellom praksis og retningslinje for førebygging av fall og vurdering av medikamentordinasjon på sjukeheim

Artikkelen beskriver en studie hvor hensikten var å undersøke om praksis for forebygging av fall og vurdering av medikamentordinasjon på sykehjem er i tråd med det litteraturen beskriver som beste praksis.Bakgrunn: fall blant sjukeheimsbebuarar er eit stort problem. Det er ikkje kjent om der er eit gap mellom ønskja og reel praksis når det gjeld førebygging av fall på sjukeheim. Hensikt: føremålet med denne studien var å undersøke om praksis for førebygging av fall og vurdering av medikamentordinasjon på sjukeheim er i tråd med det litteraturen beskriv som beste praksis. Metode: gjennom klinisk audit vart bruken av medikament ved fall kartlagt, og det blei undersøkt om retningslinje for vurdering og førebygging av fall blant eldre menneske vart følgd. Dei tre første trinna i auditsyklusen blei utført. Deltakarar frå tre sjukeheimar var inkluderte i studien. Resultat: psykotropiske medikament vart nytta ved 88 prosent av falla. Medikamentordinasjonen vart vurdert for 28 prosent av falla der psykotropiske medikament var nytta. Seponering av psykotropiske medikament vart gjort for 1 prosent av falla. Konklusjon: resultata frå auditen syner at praksis ved sjukeheimane ikkje er i tråd med anbefalingar i litteraturen når det gjeld førebygging av fall og vurdering av medikamentordinasjon på sjukeheim

Associations between nurse–patient interaction and sense of coherence among cognitively intact nursing home residents

Aim: To investigate the association between nurse–patient interaction and sense of coherence among cognitively intact nursing home residents. Method: In a cross-sectional design, data were collected in 2017 and 2018 using the Nurse–Patient Interaction Scale (NPIS) and the 13-item Sense of Coherence Scale (SOC-13). Of the 204 cognitively intact nursing home residents who met the inclusion criteria, 188 (92%) participated, representing 27 nursing homes. Multiple regression in a general linear model estimated the possible effects of the 14 NPIS items on SOC-13 sum score, the possible effects of the NPIS (sum score) on SOC-13 (sum score) as well as on the subdimensions of SOC-13, comprehensibility, meaningfulness, and manageability (both without and with adjusting for sex and age). Results: Four of the 14 NPIS items revealed highly significant correlations with SOC-13 (sum score; unadjusted and adjusted for age and gender). Furthermore, the analysis adjusted for age and gender showed significant associations for NPIS (sum score) with SOC-13 (sum score), manageability, and comprehensibility. The correlation between NPIS and meaningfulness was not statistically significant. Conclusion: Nurse–patient interaction is significantly associated with SOC-13 and its subdimensions of comprehensibility and manageability but not meaningfulness. Nurse–patient interaction might be an important resource in relation to residents’ sense of coherence and its subdimensions.publishedVersio

Peak oxygen uptake and breathing pattern in COPD patients – a four-year longitudinal study

Background: Activities of daily living in patients with chronic obstructive pulmonary disease (COPD) are limited by exertional dyspnea and reduced exercise capacity. The aims of the study were to examine longitudinal changes in peak oxygen uptake (V̇O2peak), peak minute ventilation (V̇Epeak) and breathing pattern over four years in a group of COPD patients, and to examine potential explanatory variables of change. Methods: This longitudinal study included 63 COPD patients, aged 44-75 years, with a mean forced expiratory volume in one second (FEV1) at baseline of 51 % of predicted (SD = 14). The patients performed two cardiopulmonary exercise tests (CPETs) on treadmill 4.5 years apart. The relationship between changes in V̇ O2peak and V̇Epeak and possible explanatory variables, including dynamic lung volumes and inspiratory capacity (IC), were analysed by multivariate linear regression analysis. The breathing pattern in terms of the relationship between minute ventilation (V̇E) and tidal volume (VT) was described by a quadratic equation, VT = a + b∙V̇ E + c∙V̇E2, for each test. The VTmax was calculated from the individual quadratic relationships, and was the point where the first derivative of the quadratic equation was zero. The mean changes in the curve parameters (CPET2 minus CPET1) and VTmax were analysed by bivariate and multivariate linear regression analyses with age, sex, height, changes in weight, lung function, IC and inspiratory reserve volume as possible explanatory variables. Results: Significant reductions in V̇ O2peak (p < 0.001) and V̇ Epeak (p < 0.001) were related to a decrease in resting IC and in FEV1. Persistent smoking contributed to the reduction in V̇O2peak. The breathing pattern changed towards a lower VT at a given V̇ E and was related to the reduction in FEV1. Conclusion: Increasing static hyperinflation and increasing airway obstruction were related to a reduction in exercise capacity. The breathing pattern changed towards more shallow breathing, and was related to increasing airway obstruction.publishedVersio

Short-term outcome of 1,465 computer-navigated primary total knee replacements 2005–2008: A report from the Norwegian Arthroplasty Register

Background and purpose: Improvement of positioning and alignment by the use of computer-assisted surgery (CAS) might improve longevity and function in total knee replacements, but there is little evidence. In this study, we evaluated the short-term results of computer-navigated knee replacements based on data from the Norwegian Arthroplasty Register. Patients and methods: Primary total knee replacements without patella resurfacing, reported to the Norwegian Arthroplasty Register during the years 2005–2008, were evaluated. The 5 most common implants and the 3 most common navigation systems were selected. Cemented, uncemented, and hybrid knees were included. With the risk of revision for any cause as the primary endpoint and intraoperative complications and operating time as secondary outcomes, 1,465 computer-navigated knee replacements (CAS) and 8,214 conventionally operated knee replacements (CON) were compared. Kaplan-Meier survival analysis and Cox regression analysis with adjustment for age, sex, prosthesis brand, fixation method, previous knee surgery, preoperative diagnosis, and ASA category were used. Results: Kaplan-Meier estimated survival at 2 years was 98% (95% CI: 97.5–98.3) in the CON group and 96% (95% CI: 95.0– 97.8) in the CAS group. The adjusted Cox regression analysis showed a higher risk of revision in the CAS group (RR = 1.7, 95% CI: 1.1–2.5; p = 0.02). The LCS Complete knee had a higher risk of revision with CAS than with CON (RR = 2.1, 95% CI: 1.3–3.4; p = 0.004)). The differences were not statistically significant for the other prosthesis brands. Mean operating time was 15 min longer in the CAS group. Interpretation: With the introduction of computer-navigated knee replacement surgery in Norway, the short-term risk of revision has increased for computer-navigated replacement with the LCS Complete. The mechanisms of failure of these implantations should be explored in greater depth, and in this study we have not been able to draw conclusions regarding causation

Wear and Migration of Highly Cross-Linked and Conventional Cemented Polyethylene Cups with Cobalt Chrome or Oxinium Femoral Heads: A Randomized Radiostereometric Study of 150 Patients

ABSTRACT: This randomized study was performed to compare wear and migration of five different cemented total hip joint articulations in 150 patients. The patients received either a Charnley femoral stem with a 22.2 mm head or a Spectron EF femoral stem with a 28 mm head. The Charnley articulated with a g-sterilized Charnley Ogee acetabular cup. The Spectron EF was used with either EtOsterilized non-cross-linked polyethylene (Reflection All-Poly) or highly cross-linked (Reflection All-Poly XLPE) cups, combined with either cobalt chrome (CoCr) or Oxinium femoral heads. The patients were followed with repeated RSA measurements for 2 years. After 2 years, the EtO-sterilized non-cross-linked Reflection All-Poly cups had more than four times higher proximal penetration than its highly cross-linked counterpart. Use of Oxinium femoral heads did not affect penetration at 2 years compared to heads made of CoCr. Further follow-up is needed to evaluate the benefits, if any, of Oxinium femoral heads in the clinical setting. The Charnley Ogee was not outperformed by the more recently introduced implants in our study. We conclude that this prostheses still represents a standard against which new implants can be measured. Osteolysis induced by wear debris of ultra-high molecular weight polyethylene (UHMWPE) is considered the most common cause for failure of total hip arthroplasties (THA). 1 Sterilization technique and UHMWPE quality are related to wear. 2 Sterilization with gamma irradiation in air breaks the polymer chains and generates free radicals. Free radicals may combine with each other creating cross-links between adjacent molecules, which reduces abrasive wear. However, they entail the disadvantage of oxidative degradation of polyethylene (PE) when exposed to the body&apos;s oxidative environment, which may lead to deterioration of mechanical properties. 3 To address the problem, sterilization methods in inert environments with ethylene oxide (EtO) or gas plasma were introduced. However, these methods do not have the benefits of cross-linking, and an earlier report showed increase in early in vivo wear after EtO sterilization. 4 Highly cross-linked polyethylenes (HXLPE) provides a considerable reduction of wear compared to conventional polyethylene (PE). Concerns of PE wear have also been addressed by introducing alternative femoral head materials. Oxidized zirconium (Oxinium, Smith &amp; Nephew) was introduced in the last decade for use in THA. Radiostereometric analysis (RSA) enables in vivo measurement of relative 3D motion in the range of 0.1 mm and 0.058. Due to its accuracy, few patients are needed to obtain satisfactory statistical power. With RSA the degree of migration during the first years after surgery correlates with the implant&apos;s longterm performance. We wanted to evaluate wear and migration patterns of the cemented highly cross-linked Reflection All-Poly XLPE cup and its non-irradiated counterpart, the cemented Reflection All-Poly cup, when articulating with either Oxinium or traditional cobalt chrome (CoCr) femoral heads (Smith &amp; Nephew). Our null hypothesis was that wear and migration were equal to the Charnley Ogee prostheses (DePuy Intl