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Biomedical subjects

G Stene-Larsen

Publications and source records attributed to G Stene-Larsen.

At least 19 recordsLinked to original sources
PubMed1997

[The project Better Cancer Care in Buskerud].

A project called Better cancer care in Buskerud was started in 1991 in the county of Buskerud, in Norway. The main objective was to improve the out-patient services for cancer patients at the central hospital. In this article we describe the activities at the out-patient clinic during the period 1991-1993. The clinic was staffed by two oncologists and two cancer nurses. A total of 8060 consultations were held with patients during the period. Breast cancer patients comprised the largest group (30%), followed by patients with gastrointestinal cancer (24%) or malignant lymphoma (13%). The hospital's Department of Surgery was particularly relieved to hand over the administration of chemotherapy. The number of patients who received radiotherapy at the nearest cancer centre did not increase, however, during the period. We conclude that the project in Buskerud was a success, and that most of the objectives were achieved.

Adult↗
PubMed1995

[Time utilization in the preparation of medical records].

The time available for preparing a medical record may be of importance for the resulting quality. We studied the records of 166 patients admitted to a medical department during a fortnight. 24 doctors registered the time spent on history taking, clinical examination and emergency treatment, paper work and other patient-associated tasks. The doctors received a mean of seven patients each, spending a mean of 53 (range 20-120) minutes in all. The mean time spent on clinical examination was 27 minutes, on paper work 18 minutes and on other tasks 11 minutes. Time of the day or age of the patient did not influence the time spent on the tasks. Only rarely (7%) did the doctor experience shortage of time.

Age Factors↗
PubMed1995

[The medical record--content, interpretation and quality. Study of 100 medical records from a department of internal medicine].

An evaluation of the primary medical records of 100 patients admitted to a medical department showed that several elements in the journal often had been left out. Therefore all doctors working in the department were asked for their opinion of the necessity for each of the elements in a journal. A comparison of these doctors' opinions with our registrations indicated that the actual "shortening" of the journals was probably a result of choice rather than mere chance. Despite a considerable amount of work trying to establish relevant criteria, we did not succeed in developing a reliable method for measuring the quality of the medical record. The journals recorded at night were significantly shorter than those recorded during the day. A follow-up note (or discharge of the patient within one day), was found in 80% of the journals. Quality standards of the medical record are lacking and should be developed.

Evaluation Studies as Topic↗
PubMed1990

[Local, central and regional functions. Obsolete concepts?].

As a consequence of the regionalization of the health services in Norway hospitals were given either local, central or regional responsibility. This system was intended to improve the availability of expertise and costly equipment, and at the same time reduce the growth of expenditures on health care. In the last few years, however, many of the smaller hospitals have improved their technical and medical skills to such an extent that this classification system has become less meaningful. Aker hospital in Oslo carries out local, central and regional functions. In a prospective study at this hospital we found that 88% of 980 consecutive medical admissions could be classified as local hospital admissions. Only 5% of the patients needed service at the central level, and 5% at the regional level. In our opinion it would suffice to have two types of hospital ("treatment levels"), standard hospitals and referral hospitals.

Hospitals, County↗
PubMed1990

[The role of internal medicine in health services--time for retirement?].

Internal medicine is more than a hundred years old, even in Norway. Its intellectual fundament originates from nineteenth century medicine in Germany. Traditionally, these German physicians covered the entire field of medicine. However, due to lack of therapeutic remedies their main emphasis was on diagnosis and prognosis. During the last sixty years the tremendous increase in medical knowledge has led to a strong tendency towards organ specialization. The generalists in hospitals have met competition from general practitioners and specialists in geriatrics. At the same time their domain has steadily shrunk as the number of medical hospital beds has been reduced. Although not to the advantage of the patients, progress is wiping out the hospital generalists. Most (90%) hospital doctors are now organ specialists, although the majority of patients admitted to medical departments have diseases in more than one organ system. Therefore, generalists should be at least as equally appreciated as the organ specialists. To save the generalists the educational system must be changed. The two types of specialists should follow their own educational paths qualifying to separate and independent competence areas (general or organ-specific). Medical departments should be encouraged to maintain general sections in addition to the organ-specific sections. The generalist and the organ specialist should be professionally united in their efforts to develop internal medicine as a discipline.

Family Practice↗
PubMed1990

[Internal medicine--limited or wide medical specialty?].

980 consecutive admissions to the medical department of Aker Hospital were analyzed in order to determine the extent to which the department deals with problems not related directly to the field of internal medicine. 709 patients (72%) were admitted for purely medical conditions. These patients occupied 49% of the beds. In 121 cases (12%) the main reason for admission involved other specialities. 209 admissions (21%) involved conditions other than somatic disease. Patients waiting for transferral to permanent nursing homes occupied 16% of the beds. Most patients needed hospital care, and many suffered from complex medical conditions. These factors advocate a liberal admission policy. On the other hand, medical departments should be relieved of responsibility for patients whose primary requirement is long-term care.

Aged↗
PubMed1990

[Admissions to the medical wards. Are resources used in accordance to patients' needs?].

Medical and social data on 980 consecutive admissions to the Medical Department, Aker Hospital, Oslo, were recorded prospectively with emphasis on patients' requirements and the Department's use of available resources. 73% of the admissions were acute, 4% were considered unnecessary. Half were because of chronic illness. Although 88% of the patients' requirements could have been met at a local hospital, 59% were treated in specialized units. 12% were admitted to the day unit at reduced cost for an average stay of three days. 41% of the patients were over 70 years of age, 37% lived alone and 14% needed rehabilitation. A main reason for admission was the patient's inability to take care of him/herself at home, in nearly all cases the main reason being acute illness or deterioration. Therefore many of the patients seemed to need care in an acute geriatric unit. At any one time the reason for 20-25% of the patients being in the department was delay in providing care at home or in a nursing home.

Adult↗
PubMed1990

[Diagnostic related groups--testing of the system in a medical department].

In a prospective study we registered the lengths of stay for hospital care for diagnosis-related groups (DRG) for 980 consecutive admissions to a medium-sized medical department in Oslo. The DRG codes which should discriminate between high and low ages and between routine and complicated cases were found to differentiate well in an economic sense, based on the length of hospital stays. We conclude that the main principles of this American system can probably be used in Norway, although some modifications are necessary.

Adult↗
PubMed1990

[Accomplish more for less--a status report from Lovisenberg hospital].

In 1988 the local authorities increased the catchment area and reduced the budget for Lovisenberg hospital in Oslo. The hospital has met this challenge by improving its productivity. Despite a 20% cut in the acute bed capacity, the number of discharged patients was increased by 19 and 16%, and the length of stay for hospital care was shortened by 33 and 26%, at the medical and surgical departments respectively. The shorter period of hospitalization did not affect mortality or frequency of readmissions. We conclude that the present budget cuts have led to valuable changes at our hospital. The number of acute beds is now well balanced with the size of the catchment area (2.5 beds per 1000 inhabitants). However, further reduction is not advisable.

Budgets↗
PubMed1990

[Alcohol abuse as the cause of admission to a medical department].

In a prospective study at Aker hospital in Norway, chronic alcohol abuse was the cause of five per cent (48 of 980) of the medical admissions. The alcohol abusers were approximately ten years younger than the other patients. Eighty per cent were men, and fifty-four per cent were single. Most of the admissions (90%) were acute. Gastrointestinal diseases, psychiatric disorders and intoxications dominated among the alcohol abusers. The cost of treatment was lower, however, for the alcohol abusers than for other patients, because the former seldom needed expensive treatment and the stay in hospital was often short.

Adult↗
PubMed1990

[Treatment of myocardial infarction--current status at Norwegian hospitals].

Present routines for examination, treatment and follow-up of myocardial infarction were registered at all hospitals in Norway. Heparin and salicylic acid are given as standard treatment. Streptokinase is given regularly to patients with a short case-history, while beta-blockers are used mostly in secondary prevention. Patients with unstable angina pectoris are offered acute coronary by-pass operation in 90% of the hospitals. The hospitalization period is short, varying from approximately ten days for patients with large myocardial infarctions, to seven days for patients with small infarctions. Most hospitals have a progressive rehabilitation program which stimulates early discharge of the patients. In general, Norwegian hospitals follow "modern" principles in the treatment of myocardial infarction. The routines are fairly similar in small and large hospitals, and in various parts of the country.

Humans↗
PubMed1990

Misoprostol treatment exacerbates abdominal discomfort in patients with non-ulcer dyspepsia and erosive prepyloric changes. A double-blind, placebo-controlled, multicentre study.

One hundred and thirty-seven consecutive outpatients with non-ulcer dyspepsia (NUD) and erosive prepyloric changes (EPC) were randomly allocated to double-blind treatment with 400-micrograms misoprostol tablets twice daily or placebo for 4 weeks. Misoprostol had a significant worsening effect on epigastric pain, nausea, meteorism, lower abdominal pain, and diarrhoea, as compared with placebo. The fact that symptoms in patients with NUD and EPC were exacerbated by an antisecretory dose of misoprostol indicates that the symptoms are largely unrelated to gastric acid.

Adolescent↗