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A Loft

Publications and source records attributed to A Loft.

54 records · Page 3Linked to original sources
PubMed1989

[Regional differences in the use of cholecystectomy in Denmark during the period 1977-1985].

In a register-based study of all cholecystectomized patients in Denmark during the period from 1977-85 (37,048 patients) an account is given of the regional variations observed in connection with the intervention. The cholecystectomy operation is sub-divided into four types of operation dependent on whether the intervention is merely a matter of cholecystectomy or it involves the choledocus, the duodenum, the small intestine or other organs. The variation analysis is based on a division of the country into 75 areas, each primarily served by a single hospital. The method highly reflects the differences in clinical treatment strategies. The summarized rate of cholecystectomy for this period of time was 8.2 per 10,000 persons. In areas with the highest and the lowest rates of operation the figures were 12.3 per 10,000 and 5.1 per 10,000, respectively. In 18 areas, the rates of operation were significantly higher than average and in 18 other areas significantly higher than average and in 18 other areas significantly below average. SCV-score (X100) 2.19. There is no systematic correlation between the degree of specialisation in the operating department and the frequency in employing the operation. Areas with an operation index significantly above average had the same rate of more complicated operations than simple cholecystectomy as the other areas. Possible causes of national as well as international variations in the use of cholecystectomy are discussed, and the need for a radical evaluation of this kind of treatment is emphasized.

Adult↗
PubMed1989

Clinical decision making and health care policy: what is the link?

The relationship between clinical decision making and health care policy is here considered in different ways. First, it is suggested at the most simple level that a key link between the two is that both are concerned with health. Second, the need for accepting the presence of uncertainty at both levels is highlighted: uncertainty related to inputs and outputs; to assessing weights for various outcomes; to attitudes to risk; etc. Third, the paper emphasises the desirability of looking beyond only the output 'health' at the two levels of decision making. Not that the relationship between clinical and health service decision making is taken to be constant across all health care systems in all countries. The paper suggests rather that just how clinical decision making is affected by the health care environment in which it finds itself needs more investigation than it has received to date. The authors indicate that the recent growth in the formal analysis of medical decision making is to be welcomed but stress the need to extend such analysis to consider the impact on clinical decision making of health care policy making.

Cross-Cultural Comparison↗
PubMed1989

A quasi-experimental design based on regional variations: discussion of a method for evaluating outcomes of medical practice.

A large proportion of common medical practices are subject to substantial regional variation resulting in numerous natural experiments. Opportunities are thereby provided for outcome evaluation through quasi-experimental design. If patients treated in different regions were comparable a natural experiment involving alternative treatments could be regarded as 'pseudo randomised', but empirical investigations are needed to verify this prerequisite. This paper discusses the role of quasi-experimental designs in assessment of medical care with evaluation of outcomes after hysterectomy in Denmark as an example. The design is developed and the comparability of selected groups of patients is elucidated from administrative data, while the outcome results are not presented in this context. One indication for hysterectomy is carcinoma in situ of the cervix uteri which may be treated with either hysterectomy, or conisation. A study group of patients was selected from departments where hysterectomy was the treatment of choice for this indication while the reference group was drawn from departments in which conisation was generally preferred. The comparability of the populations, effects and information for the two groups are elicited from administrative data. We conclude that it is possible to establish a quasi-experimental design based on regional variations and that the comparability of the groups included may be assessed through registry data. The importance of technology diffusion for the prospects of performing quasi randomised studies is emphasised. In this attempt to evaluate hysterectomy, it was not possible to identify groups of patients, which were sufficiently comparable to justify a study of soft outcomes.

Adult↗
PubMed1982

Superficial eosinophilic squamous epithelial cells in vaginal smears from postmenopausal women.

19 500 vaginal smears from women aged 20-90 years were examined from August 1976 to November 1979. 3 000 were from women more than 55 years of age. 146 of these had smears with an increased proportion of superficial eosinophilic squamous epithelial cells (SESEC). The smears were divided into four groups, A-D with 0-25%, 25-50%, 50-75% and 75-100% of SESEC of the examined squamous epithelial cells. 39% of the 146 with increased proportions of SESEC were either undergoing treatment with estrogenic hormones, or else the possibility of estrogenic influence could not be ruled out. In group D the possibility of an estrogenic influence was more pronounced, here found to be 67%. In 32% of the 146 cases we believe that these cells were possibly the result of changed anatomical conditions in the cervix/vagina. Such an explanation seems most frequently probable in groups A and B. In 5% of the 146 cases the cells appeared changed, as can be seen in trichomoniasis. In 21% the discovery of the cells could not be explained. Finally, no explanation could be found for 5% in group D.

Age Factors↗
PubMedDate not supplied

Coping with regional variations: the case of surgery in Denmark.

This article examines some of the key research and policy issues that are emerging as a result of recent analyses of regional variations in health care. The article presents a historical background to this important new field of health services' research, and indicates, using some Danish examples of research on hysterectomy, cholecystectomy, and prostatectomy, the relevance of this research to management and policy planning. Regional variations are not yet fully explained in terms of what causes them. What is clear and what is the primary focus of this article is that their very existence, whatever their explanation, creates a major challenge for the management and planning of future health services.

Cholecystectomy↗
PubMedDate not supplied

Discordance between prenatal cytogenetic diagnosis and outcome of pregnancy.

From 1.3.73 to 30.9.80 5580 women had an amniocentesis performed here or elsewhere; fetal chromosome analyses were carried out in this laboratory. We found 112 abnormal karyotypes (2 per cent) out of 5591 chromosome analyses. In 40 women (0.7 per cent) no cytogenetic diagnosis was obtained. Follow-up was successful in 99.5 per cent. Nine cases are reported in detail: Three cases had discrepancy between the karyotype in amniotic fluid and peripheral blood after delivery, two of these cases turned out to be 46,XX (male) while the third was prenatally determined as trisomy 21, but had a 46,XX karyotype at birth. Six cases had discrepancy between the karyotype in amniotic fluid and the phenotypic outcome at birth/abortion. One case was a prenatally undetected 45,X/46,XY mosaicism; one case was an unexplained 45,X male fetus; two cases were prenatally determined as trisomy 21, but at abortion a normal karyotype was determined and in two cases maternal cells were probably examined. The incidence of cytogenetic errors in this study was very low.

Adult↗
PubMedDate not supplied

Survival until 6 years after cholecystectomy: female population of Denmark, 1977-1983.

It has been a prevailing assumption that cholecystectomy patients by and large follow a pattern of survival similar to that of the normal population. This paper presents a population-based study of the long-term survival after cholecystectomy in order to reassess this assumption. Based on data available in the Danish National Hospital Register the records of all Danish women who were operated between 1977 and 1981 were examined and studied up to 6 years subsequent to surgery. Cholecystectomy patients who were free of diagnosed cancer and who had no major co-surgery (n = 11,123) were compared to both hysterectomy patients and a sample of the female population. Adjusting for age and other covariates, patients with psychiatric hospital admissions prior to surgery experienced a threefold risk of dying within 6 years after surgery. Patients with prior somatic admissions and patient with acute admissions had a relative risk (RR) of about 1.5. Cholecystectomy patients had a significantly increased mortality when compared to hysterectomy patients, RR = 1.3 (1.1-1.6), and to the population sample. Heart diseases and cancer occurred significantly more often as causes of death among cholecystectomy patients when compared to hysterectomy patients, but our data suggest that the occurrence of many other causes of death may be increased among cholecystectomy patients as well. The authors concluded that cholecystectomy patients are subject to relatively higher levels of mortality than previously assumed in parts of the literature. Furthermore, the increase seems to be attributable to a multitude of causes of death. The most likely explanation of the excess mortality among cholecystectomy patients is that gallbladder patients are relatively fragile.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Early postoperative mortality following cholecystectomy in the entire female population of Denmark, 1977-1981.

This paper assesses the risk of dying within 30 days of admission among 13,854 women who had a cholecystectomy performed as the principal operation from 1977 to 1981. The overall crude mortality rate was 1.2%. Women who had a simple elective cholecystectomy performed had a mortality rate similar to women who had a simple hysterectomy. The mortality was significantly higher than in the general female population (p less than 0.05). Increased age, acute admission, admissions to hospital within 3 months prior to the index admission, the number of discharge diagnoses, and the geographical region were significantly associated with increased mortality. Exploration of the common bile duct was associated with higher mortality in the bivariate analysis, but the association disappeared when the number of discharge diagnoses was taken into account. Type of hospital and the population based cholecystectomy rate of the patient's residential area was not associated with mortality. As regards early mortality, it is concluded that simple elective cholecystectomy is a safe procedure before the age of 50 to 60 years. Acute admissions and more than one diagnosis at discharge were associated with an increased mortality, whereas exploration of the common bile duct may not be as important an independent factor as previously assumed.

Adult↗