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Biomedical subjects

B Guldvog

Publications and source records attributed to B Guldvog.

At least 19 recordsLinked to original sources
PubMed1998

[PS-RESKVA (Patient Satisfaction, Results and Quality)--patient satisfaction in hospitals].

The reliability and acceptability of a 39-question patient-satisfaction questionnaire (PS-RESKVA) for use in hospitals is assessed. Postal questionnaires were sent to 19,395 patients, aged between 15 and 100 years, who were discharged from the medical, surgical, gynaecological, and neurological wards of two Norwegian hospitals; they were followed up with one reminder. The response rate was 59% for all patients, and 71% among those who were considered medically capable of answering. Six underlying factors were identified in the PS-RESKVA profile, which contained 11 different aspects satisfaction. The PS-RESKVA satisfied the psychometric criteria for internal consistency. Results indicate that the PS-RESKVA is a possible measure of patient satisfaction after discharge from hospital. It seems acceptable to patients in general, and is a reliable measure of satisfaction for a wide range of patients. Further studies on its validity are warranted.

Adolescent↗
PubMed1998

Stroke units versus general medical wards, I: twelve- and eighteen-month survival: a randomized, controlled trial.

BACKGROUND AND PURPOSE: The long-term effect on survival of treatment in stroke units is still under debate. The hypothesis that a stroke unit with short length of stay increases 1-year and 18-month survival rates was tested in this study. METHODS: A quasi-randomized, controlled study was undertaken among 802 patients > or =60 years old admitted to the Central Hospital of Akershus in Norway with a diagnosis of stroke between January 1, 1993, and February 1, 1995. All patients with onset of symptoms <24 hours before admittance were included and enrolled and were followed until death or to the end of the observation 18 months after stroke. Patients were allocated to a stroke unit (n=364) or a general medical ward (n=438). RESULTS: Case fatality within the first 10 days was 8.2% among patients in the stroke unit and 15.1% among patients in the general medical ward (P=.0019). One-year survival among patients treated in the stroke unit was 70.6% and in the general medical wards 64.6% (P=.026); 18-month survival rates were 65.1% and 58.0%, respectively (P=.021). Among patients with cerebral hemorrhage, 10-day case fatality was 24.5% and 51.6% (P=.004) in favor of the stroke unit. CONCLUSIONS: Stroke units increase survival rates among stroke patients compared with general medical wards. The effect on survival occurs early after the stroke and sustains during at least 18 months of observation.

Aged↗
PubMed1998

Stroke unit versus general medical wards, II: neurological deficits and activities of daily living: a quasi-randomized controlled trial.

BACKGROUND AND PURPOSE: The efficacy of stroke units has been extensively examined. It is unknown, however, whether the superiority of the stroke unit will remain after the increased focus on stroke treatment in general medicine. This study of patients admitted to the hospital early and with a short length of stay determines the effect and identifies certain important components of a stroke unit. METHODS: Five hundred fifty patients aged 60 years or older with acute stroke were allocated by a quasi-randomized design to a stroke unit or a general medical ward based on date of birth in the month. Patients admitted within 24 hours of onset were enrolled. Outcomes after 7 months were death, proportion needing long-term care, and change in neurological and functional state assessed by the Scandinavian Stroke Scale and Barthel Index. RESULTS: Seven months after admission there was a trend in favor of the stroke unit in all outcome measures, but no significant differences in clinical outcomes were found except for change in the Scandinavian Stroke Scale score. Recurrent stroke during hospitalization occurred more often in the general medical ward (P = .03). The stroke unit was significantly more aggressive in mobilization out of bed (P<.01) and use of parenteral fluid (P<.0001), aspirin (P<.0001), antipyretics (P<.0001), and antibiotics (P<.0001). CONCLUSIONS: Our study confirms the benefit of the stroke unit, but the effects on the most reliable clinical outcomes were modest and insignificant. Treatment in this stroke unit hastened recovery. More aggressive rehabilitation and use of parenteral fluid, aspirin, antipyretics, and antibiotics appeared in the stroke unit.

Activities of Daily Living↗
PubMed1998

Outcome of subacute stroke rehabilitation: a randomized controlled trial.

BACKGROUND AND PURPOSE: Organized acute stroke treatment reduces mortality, functional deficits, and the need of institutionalization after stroke. It is largely unknown whether the effects of treatment are due to early or subacute efforts. The aim of this randomized, controlled study was to test the hypothesis that rehabilitation of stroke patients in the subacute phase in a hospital rehabilitation unit is beneficial in reducing death and dependency and increasing health-related quality of life. METHODS: 251 patients initially treated in the hospital were randomized to subacute rehabilitation in a hospital rehabilitation unit (n = 127) or to the health services in the municipality (n = 124) and were followed up for 7 months. RESULTS: The combined outcome of patients being dead or dependent (Barthel Index score of < 75) was 23% in the hospital group and 38% in the municipality group (P=.01). Seven-month survival rates were 90.6% and 83.9% (P=.11), respectively. Dependency in activities of daily living was 12.6% in the hospital group and 25.0% in the municipality group (P=.07). Patients with a BI score of < 50 before rehabilitation had significantly better outcome in the hospital rehabilitation unit, with fewer patients becoming dependent (P=.005) and patients having higher Scandinavian Stroke Scale (P=.026) and BI scores (P=.005). No significant differences in health-related quality of life were found. Many patients treated in the municipalities (30%) did not receive any organized rehabilitation in this study. CONCLUSIONS: Subacute rehabilitation of stroke patients in a hospital-based rehabilitation unit improves outcome. Patients with moderate or severe stroke appear to benefit most.

Acute Disease↗
PubMed1997

[How do working conditions of hospital personnel affect patients?].

This study was performed to investigate to which extent job satisfaction and psychosocial working environment could explain variations in patient satisfaction with treatment and care. Questionnaires were mailed to nursing staff and to patients in 17 in-patient treatment units within two Norwegian hospitals. 2408 patients (61 per cent) replied on detailed questions concerning satisfaction with care, and 488 employees (78 per cent) replied on detailed questions concerning job satisfaction and psychosocial working conditions. Associations between 77 factors related to job satisfaction and 14 domains of patient satisfaction were assessed by simple correlations and multiple regression procedures using patient, employee and treatment ward as unit of analysis. Job satisfaction concerning bureucracy/organization, information from superiors, level of knowledge among leadership, economic constraints, collaboration, backup, stress, autonomy, skill, in-service training and fighting spirit were all significantly associated with various domains of patient satisfaction (all p values < 0.05). The study strengthens the hypothesis that job satisfaction play an important role for patient care and satisfaction. Leadership, organisation and continuity seem crucial.

Humans↗
PubMed1996

[Life expectancy in Norway. An international perspective--causes of death].

We have shown before that Norway is experiencing an unfavourable trend in life expectancy compared with Japan, France and several other OECD countries. In this article, we discuss the cause-specific differences in mortality that explain these contrasts. Heart infarction is the predominant cause of death in Norway, with a mortality five times higher than in Japan and three times higher than in France. Both Norway and France have three times higher mortality rates for breast cancer than found in Japan, and the mortality rate for cervical cancer is twice as high in Norway as in the two other countries. Norwegian women show a mortality rate for lung cancer that is twice as high as that of their French sisters. Suicide among young Norwegians is a rapidly growing problem, and twice as common among Norwegian men aged 20-24 than among Japanese men of the same age. We challenge the health authorities and the specialists in the relevant fields to reflect again on their preventive strategies, in light of these contrasts.

Adolescent↗
PubMed1996

[Life expectancy in Norway--an international perspective].

Contrasts in life expectancy among countries are an important input for defining targets for the health service and for setting priorities for disease prevention and health promotion. In this article, the trend in life expectancy in Norway is compared with the trend in a selection of other OECD countries. Standardised measures of life expectancy were collected from WHO and OECD statistics. In 1960 Norwegians ranged among the top three countries as regards life expectancy for both women and men. In 1990 Norwegians ranged tenth for women and ninth for men. Life expectancy was two years shorter for Norwegian than for Japanese women in 1990, corresponding to a 20% surplus mortality throughout life. Similar differences were found for men. If Japanese age specific death rates are applied to the Norwegian population, this corresponds to a reduction of 9,600 deaths this year. The relatively unfavourable trend in life expectancy in Norway relative to other OECD countries raises concern, and should be considered when designing the future health policy.

Adult↗
PubMed1996

[Costs of medical treatment of injuries in Norway].

The objective of this study was to estimate the cost of medical treatment of injuries in Norway. We analysed aggregated data from two sources, the National Hospital Discharge Register and the National Injury Register, in order to calculate such costs in 1994. Approximately 400,000 injuries treated in hospitals and emergency departments in 1994 cost NOK 1.7 billion in terms of medical treatment. Unintentional injuries accounted for 91%, self-inflicted injuries for 3%, and injuries stemming from violence for 6% of the costs. Injuries requiring hospitalisation accounted for 71% of the total costs. Persons aged 65 years or more constituted 14% of the cases but accounted for 46% of the cost of treating unintentional injuries. Injuries at home or during leisure time accounted for 75% of the costs of the unintentional injuries, while traffic injuries accounted for 7%, occupational injuries for 8%, and 10% of the costs could not be classified. Hip fractures alone accounted for 27% of the total costs. Traffic and occupational injuries remain important targets for prevention, but greater efforts are required to reduce risk of injuries in the home and during leisure time, injuries to elderly people, hip fractures, and injuries that stem from violence.

Accidents↗
PubMed1994

[Results of health care services. A tool for better decision making].

Until recently, post-war health care was characterized first by expansion and later by cost containment. We now appear to have entered a period focusing on assessment and accountability, often described as the outcomes movement. Patients' outcomes are regarded as the most important information on effectiveness and quality. The outcomes movement includes the traditional outcome measures of mortality and morbidity, as well as clinical endpoints, social, mental and physical well-being, general health, quality of life and patient satisfaction. Establishing the effectiveness of medical care in the "real world" is an important aspect of outcomes research. The article discusses the emergence of outcomes research, the central elements of outcomes management, and some critical views on the outcomes initiative.

Decision Making↗
PubMed1993

Time variations in injury incidence.

STUDY OBJECTIVE: to present time variations in the incidence of injuries on a community level. POPULATION AND METHODS: all injuries which occurred in a defined population of the municipality of Harstad were registered prospectively from 1 January 1986 to 31 December 1991. Variations over time in monthly incidence of seven types of injuries (home, traffic, street, sports, work, other, unknown) were analysed by the Autoregressive Integrated Moving Average Analysis (ARIMA). RESULTS: a total of 9,685 injuries was registered during the six year follow-up period. No significant secular trend was observed for any of the analysed types of injuries. Series of monthly incidence of traffic, street, and sports injuries showed seasonal-dependent variations. Incidence of traffic injuries was highest during the summer months, while incidence of sports and street injuries was highest during the winter months. CONCLUSIONS: both the existence of seasonal dependency in injury incidence and the relatively high random variations in monthly injury incidence imply that evaluation of community based injury control programmes should include incidence during at least a one year period before the intervention has started.

Community Health Services↗
PubMed1992

[Risk of injuries among older drivers].

In a population of 307,486 persons living in four Norwegian cities a total of 2,189 road traffic injuries requiring treatment in hospitals or casualty wards occurred in 1990. 4.4% of the injured were between 65-74 years of age, and 2.9% were older than 75. The incidence of injuries from road traffic accidents was greatest among the youngest group (18-24 years), and decreased with increasing age. We also analyzed the traffic accident risk per million kilometers driven. The driver's risk of injury was highest for adolescents (18-24 years), and decreased with increasing age (up to 75 years). The youngest driver runs the greatest risk of injury in traffic. Drivers in the 65-75 age group have a lower risk of injury per kilometers driven, in this group the incidence of traffic accidents is lower than the average for all drivers. The injury statistics provide no indication that older drivers should be required to renew their license more frequently.

Accidents, Traffic↗
PubMed1992

[A strategy of health for all--are we reaching our target to reduce mortality?].

In the late seventies the World Health Organization developed a strategy of Health for all towards year 2000, to which Norwegian health authorities have consented. This article presents and discusses the sub-goals for expectation of life and mortality, and analyzes the possibilities of reaching them. The desired reduction of at least 25% in accident mortality rates and cardiovascular mortality rates in relation to the reference period 1976-80 will probably be reached. In addition, the desired 15% reduction in cancer mortality is likely to be reached for persons under 40 years of age. Infant mortality does not appear to be declining, cancer mortality for people over 40 years of age is increasing, and the suicidal and homicidal rates are increasing faster than any other cause of death. The possibilities of reversing this development require a structured plan and comprehensive changes in the way society is organized, with more emphasis on care, social network planning and reduction of the multicausal risk load that modern life implies. Some of the sub-goals are not sufficiently founded on accessible information, and should be revised.

Adolescent↗
PubMed1992

Sogn and Fjordane county community-based injury prevention: evaluation design.

The Sogn and Fjordane Injury Prevention Programme is a community-based research and demonstration project located in the Sogn and Fjordane county (S&F county) in Western Norway. The aim of the project is: (i) to further effective intervention; (ii) to be cost-effective; (iii) to provide information about local community based injury intervention. Liaison groups on injury prevention will be organised in 24 communities participating in the project. Starting 1 April 1993 they will be supplied with local specific injury rates obtained from the all-injury registration of the National Injury Surveillance System. The intervention design includes feedback of three types of information: (1) home and traffic injury rates; (2) sports, occupational, school, and outdoor injury rates; (3) both (1) + (2). The liaison groups will be asked to concentrate their activities only on the information-related injury areas. The hypothesis is that the results will be information-related. The intervention protocol will last for two years, until 1 April 1995. Evaluation will be based on a hypothetical causal intervention model. The model includes three groups of independent influences, two groups of mediator attributes, and desired end-result. A variety of data sources will be used including national and local data sources, two cross-sectional surveys on awareness, knowledge, behaviour and attitudes, interviews, observations, and self-reports from individuals. A mixed-model ANOVA will be used to test the main information-related effects. A combination of multivariate analytical methods will be used to test the hypothesised causal intervention model.

Accident Prevention↗