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Biomedical subjects

Dag Hofoss

Publications and source records attributed to Dag Hofoss.

14 recordsLinked to original sources
PubMed2004

The risk of "getting worse" after lumbar microdiscectomy.

A frequent concern among patients operated for lumbar disc herniation is the risk of "getting worse". To give an evidence-based estimate of the risk for worsening has been difficult, since previous studies have been more focused on unfavourable outcome in general, rather than on deterioration in particular. In this prospective study of 180 patients, we report the frequency of and the risk factors for getting worse after first time lumbar microdiscectomy. Follow-up time was 12 months. Primary outcome measure was the Oswestry disability index, assessing functional status and health-related quality of life. Of the patients 4% got worse. Independent risk factors of deterioration were a long duration of sick leave and a better functional status and quality of life prior to operation. We conclude that the risk of deterioration is small, but larger if the patient has been unable to work despite relatively small health problems. This study also demonstrates that changes in instrument scores should be reported, so that an accurate failure rate can be assessed.

Adult↗
PubMed2004

[Complications in ear-nose-throat day surgery].

BACKGROUND: More and larger operations are performed on an outpatient basis with patient leaving the hospital the same day and complications may remain unknown to the hospital unless the patients are asked explicitly. MATERIAL AND METHODS: Complications from 383 ear-nose-throat operations were registered continuously by the surgeon and supplemented with data from postoperative consultations and reports from other hospitals or doctors, and then compared with data from 328 (86%) postoperative patient interviews. RESULTS: According to the patient interviews, the rate of complications (16.7%) was much higher than the hospital was aware of (4.7%). Most unknown complications (40 out of 64) were mild but five were serious enough to require reoperation under general anesthesia. INTERPRETATION: Registration of surgical complications should include postoperative interviews with patients.

Adolescent↗
PubMed2004

Complications of cesarean deliveries: rates and risk factors.

OBJECTIVE: The purpose of this study was to determine complication rates after cesarean delivery and to identify independent risk factors for complications. STUDY DESIGN: In a prospective population-based cohort study in Norway, rates of predefined types of complications from 2751 cesarean deliveries were determined. The complications that were studied were intraoperative complications, blood loss, wound infection, cystitis, endometritis, hematoma, and reoperation. Independent risk factors were identified by stratification and multiple logistic regression analysis. RESULTS: Altogether, 21.4% of the women had > or =1 complications. The degree of cervical dilation, general anesthesia, low gestational age, and fetal macrosomia were independent risk factors. For operations that were performed at 9 to 10 cm cervical dilation, the complication rate was 32.6% versus 16.8% at 0 cm (odds ratio, 2.39; 95% CI, 1.77-3.22; P<.001). CONCLUSION: Cesarean delivery was associated with a high complication rate. Increasing cervical dilation and, in particular, cervical dilation of 9 or 10 cm at the time of operation, general anesthesia, low gestational age, and fetal macrosomia were identified as independent risk factors.

Adolescent↗
PubMed2004

Healthy living does not reduce life satisfaction among physically handicapped persons.

Smoking, drinking, over-eating and sedentary living may be regarded as ways of compensating for losses inflicted by physical handicaps. Therefore, promoting healthy life-styles among physically handicapped persons may amount to reducing their life satisfaction. This article examines the life-style and life satisfaction of all self-reported somatically handicapped respondents 25-50 years of age in a mid-Norwegian county. Persons with physical handicaps had more unhealthy habits than the general population. But life-style was not related to degree of physical handicap. And quality of life among the physically handicapped was not associated with life-style. Efforts to promote healthy living may not threaten the quality of life of physically handicapped persons.

Activities of Daily Living↗
PubMed2004

Patients' voices on satisfaction: unheeded women and maltreated men?

To capture the differences in female and male patients' hospital experiences, this article discusses the gendered nature of 699 free-text comments given in a survey of patient satisfaction at a Norwegian university hospital. The comments were analysed both quantitatively and qualitatively, and the impressions gained through the comments were then to a smaller extent compared with the patients' multiple choice questionnaire ticking. Female responders added free-text comments to their multiple-choice responses more often than male responders did. Male and female patients also drew attention to different aspects of what it was like to be hospitalized, and male and female patients also expressed themselves differently. The voices of the patients were mainly the voices of contextualizing experiences, reflecting differences in male and female patient's experiences and in the meaning the patients attached to their experiences. The rather clear gender differences in our data emphasizes the need for a gender-sensitive approach in the encounters between staff and patients as well as in the design of patient satisfaction research.

Adult↗
PubMed2003

[Patient experiences in Norwegian hospitals--changes over time?].

BACKGROUND: Patient experience has been identified as a national indicator of hospital quality. We describe the changes in patient experiences 1996-2000 for seven Norwegian hospitals. MATERIAL AND METHODS: A patient experience questionnaire was sent to medical and surgical patients in a stratified random sample of hospitals in 1996. The same questionnaire was used in similar surveys in 1998 and 2000. Responses from hospital wards included in all three surveys were compared on ten summated rating scales. Changes were identified by multiple linear regression. RESULTS: Responses from a total of 10 600 patients were analysed. For six scales no change was noted: general satisfaction, information on medication, information on examinations, nursing services, doctor services, and organization. Statistically significant improvement was found for three indices: communication, contact with next-of-kin, and information regarding future complaints. For one scale, scores changed for the worse: hospital and equipment. All changes were small. INTERPRETATION: Patient experiences with Norwegian hospitals did not change much between 1996 and 2000. On some indices, our data indicate slight improvement. Patient assessment of buildings and equipment changed negatively.

Communication↗
PubMed2003

Indications for cesarean deliveries in Norway.

OBJECTIVE: The purpose of this study was to investigate the indications for cesarean deliveries in Norway, related to type of operation, parity, and gestational age. STUDY DESIGN: This was a prospective survey that used information provided by clinicians at 24 maternity units. Two thousand seven hundred seventy-eight cesarean deliveries were included, which represents 69.7% of all cesarean deliveries in Norway during the study period. RESULTS: The cesarean delivery rate varied by maternal and gestational age, parity, and hospital of delivery. Seven indications accounted for 77.7% of the operations: fetal stress (21.9%), failure to progress (20.7%), previous cesarean delivery (8.9%), breech presentation >or=34 weeks of gestation (8.4%), maternal request (7.6%), preeclampsia (6.2%) and failed induction (4.0%). Of the total deliveries, 64.3% were emergency operations. CONCLUSION: Accurate information about indications for cesarean deliveries in Norway has been obtained. Two thirds of all deliveries were emergency operations; the most important indications were fetal stress and failure to progress. In the elective cesarean delivery group, the two most important indications were previous cesarean delivery and maternal request.

Adult↗
PubMed2003

Work characteristics and morbidity as predictors of self-perceived health status in Norwegian physicians.

AIMS: The purpose of this study was to assess whether work characteristics and morbidity are predictors of physical, psychological, and social functioning in physicians. METHODS: A cross-sectional study was undertaken of 1126 Norwegian physicians. For comparison of health status scores, the Short Form 36 questionnaire was used, adjusting for differences in age and gender where applicable. Somatic morbidity was classified on the basis of self-reported conditions and psychiatric morbidity with score on the 25-item Hopkins symptom checklist using a cut-off indicating clinical psychiatric disease. Multiple logistic regression analysis was used with SF-36 dimension score below/above the 10th percentile as the dependent variable. RESULTS: In the multivariate model, psychiatric comorbidity was a significant predictor in 7 of 8 dimensions of health status (odds ratio 0.17 to 0.49), and somatic comorbidity in 6 of 8 dimensions of health status (odds ratio 0.33 to 0.59). Working hours was a significant predictor of only one dimension of health status, general health, after adjustment for demographic and work-related variables. CONCLUSIONS: The most important predictors for most dimensions of health status among Norwegian physicians were the presence or absence of self-reported somatic or psychiatric morbidity, while working hours, choice of specialty, and position were less important.

Adult↗
PubMed2003

Patient experiences with information in a hospital setting: a multilevel approach.

BACKGROUND: Patients tend to be critical of poor communication and the provision of information from health professionals. One explanation may be related to organizational aspects characterizing the hospital unit. Studies have indicated quality of contact with nursing staff to be a major determinant of patients' experiences with information. Yet many studies do not simultaneously analyze the effects of patient and unit characteristics. OBJECTIVE: To explore the extent to which variation in patients' experiences with the provision of information from hospital staff are associated with differences between patients, and the extent to which they are associated with differences between hospital wards. RESEARCH DESIGN: Cross-sectional study of patients nested within hospital wards including hospital administrative data and survey data on patients' experiences with hospital care and nurses' assessments of working conditions and job satisfaction. RESULTS: Multilevel regression analysis indicated low intraward correlation and high within ward variability. In explaining variability in experiences with information, patients' sense of coherence was the most important patient-level characteristic. The percentage of nurses satisfied with their work contributed to an additional proportional reduction in variance between hospital wards. CONCLUSIONS: This study has illustrated the use of multilevel methods in analyzing patient perceptions of hospital care. Ward-level factors are at most modestly related to patients' experiences with information. The effect of hospital, department, and ward characteristics is likely to be mediated through the existence of microunits within hospital wards. Quality of contact with nursing staff may be a characteristic of the microunit rather than an organizational characteristic related to hospital wards.

Adolescent↗
PubMed2003

Multilevel analysis in health services research: a tutorial.

This article describes a well developed, but not yet widespread, statistical method. It presents its distinguishing characteristic (and pre-empts the misunderstanding that all it is about, is including predictors from more than one level). It walks the reader through a simplified example: how can multilevel analysis be used to explain variances in patient satisfaction with the way hospital work is organized. It also discusses the importance of the disciplinary setting for the extra benefit provided by multilevel analysis, as compared to traditional contextual analysis.

Analysis of Variance↗
PubMed2002

Effect of a scoring system and protocol for sedation on duration of patients' need for ventilator support in a surgical intensive care unit.

PROBLEM: Need for improved sedation strategy for adults receiving ventilator support. DESIGN: Observational study of effect of introduction of guidelines to improve the doctors' and nurses' performance. The project was a prospective improvement and was part of a national quality improvement collaborative. BACKGROUND AND SETTING: A general mixed surgical intensive care unit in a university hospital; all doctors and nurses in the unit; all adult patients (>18 years) treated by intermittent positive pressure ventilation for more than 24 hours. KEY MEASURES FOR IMPROVEMENT: Reduction in patients' mean time on a ventilator and length of stay in intensive care over a period of 11 months; anonymous reporting of critical incidents; staff perceptions of ease and of consequences of changes. STRATEGIES FOR CHANGE: Multiple measures (protocol development, educational presentations, written guidelines, posters, flyers, emails, personal discussions, and continuous feedback) were tested, rapidly assessed, and adopted if beneficial. EFFECTS OF CHANGE: Mean ventilator time decreased by 2.1 days (95% confidence interval 0.7 to 3.6 days) from 7.4 days before intervention to 5.3 days after. Mean stay decreased by 1.0 day (-0.9 to 2.9 days) from 9.3 days to 8.3 days. No accidental extubations or other incidents were identified. LESSONS LEARNT: Relatively simple changes in sedation practice had significant effects on length of ventilator support. The change process was well received by the staff and increased their interest in identifying other areas for improvement.

Adult↗