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Biomedical subjects

J Jonsbu

Publications and source records attributed to J Jonsbu.

At least 19 recordsLinked to original sources
PubMed2001

[Acute alcoholic intoxication in hospital and drunk cell].

BACKGROUND: There are few epidemiological studies of the care for persons with acute ethanol intoxication. Most of them probable do not get into contact with neither the police nor the health care system. MATERIAL AND METHODS: We have studied the files from Romerike Police District and from the Central Hospital of Akershus for the years 1988, 1993, 1998 and 2000, i.e. over a 12-year period. RESULTS: Over these 12 years, the police took care of the vast majority of cases, 2,259 persons compared to the 293 that were admitted to hospital. From 1988 to 2000, there was a 40% reduction in the use of police custody and a 600% increase in the numbers admitted to hospital. Almost all hospital patients were aged 15 to 60 years. Those taken into custody were a slightly younger group; 45% were below 29. The age distribution remained constant throughout the period. Among those taken into custody, only 8% were women, compared to 37% among those hospitalized. There was a steady increase in hospitalized women from 1988 to 2000, especially in the below-20 age group. INTERPRETATION: A marked reduction in the use of police custody took place over this 12-year period. Hospitalization for ethanol intoxication remained constant in men, while there was a dramatic increase in the numbers of women admitted, especially of young women.

Adolescent↗
PubMed1993

Decision support by computer analysis of selected case history variables in the emergency room among patients with acute chest pain.

A computer system to be used in the emergency room has been developed for estimating the risk of acute coronary heart disease (ACHD). The system uses data on 38 case history and clinical variables collected consecutively over a year from 918 patients with acute chest pain. A statistical procedure based on Bayes' formula is used to estimate disease probabilities. A quadratic scoring rule was used for variable selection. The score increased markedly until 15-20 variables had been added, reached a maximum after inclusion of about 30 variables and then deteriorated slightly. Thus, the number of variables carrying additional information on the presence/absence of ACHD seems to be much larger than the number normally utilized by doctors and by other decision support systems. Reclassification into two groups, those with and without ACHD, gives a diagnostic accuracy of 89%. We conclude that analysing detailed case histories by computer is a promising decision support system for use in the emergency room as a supplement to ECG analysis.

Angina, Unstable↗
PubMed1993

Prospective evaluation of an EDB-based diagnostic program to be used in patients admitted to hospital with acute chest pain.

A recently designed computer based decision support system (DSP), almost exclusively based on case history data, was developed to facilitate immediate differentiation between patients with and without urgent need for coronary care unit (CCU) transferral from the emergency room, and additionally to distinguish between patients with and without acute myocardial infarction (MI). One-year's prospective testing in a consecutive series of 1252 patients with acute chest pain revealed that the DSP, used in addition to ECG and clinical examination, demonstrated a sensitivity of 96% in the detection of patients in need of CCU observation (MI-sensitivity of 98%), and a specificity of 56% in excluding patients who were not in need of CCU observation. The proportion of referrals to the CCU judged to be unnecessary was only 17% of the total number of patients seen in the emergency room.

Angina, Unstable↗
PubMed1992

[Cooperation between regional and central hospitals--how to achieve the best results?].

The authors reviews a recent governmental analysis of cooperation between third-line university clinics and local and central hospitals. The hospitals are owned by the government (mainly by the counties), and the various Acts and regulation permit the central authorities to make decisions on all aspects of highly specialized medicine. The analysis concludes that a limited number of problems should be solved by decision of the central government, but only those where national concerns are involved. The counties within a health region should cooperate within a Regional Health Policy Board, to create plans for flow of patients through the health care system, specified for each field of medicine. When such plans have been approved by the Regional Health Policy Board, each county should be willing to accept them. In the event of local disagreement, the central government should decide.

Health Policy↗
PubMed1992

[Highly specialized medicine. How to assign the tasks?].

Norway has four million inhabitants and five university hospitals, each serving one health region. The authors describe the work of a governmental medical committee, whose mandate is to advise on where to locate the various highly specialized medical services. Important questions have been the relationship between experience and quality, and the desire of each university clinic to be able to provide treatment within its own region for most health problems. Their reasons are concern about research and specialist training, and the preference of patients for treatment near to home. A list of proposed national and over-regional centers for certain treatments has been prepared on the basis of the experts' report and comments from all university clinics. These recommendations have provided a medical basis for later economic and political analyses prior to final decision by the Government. Norwegian legislation permits strong governmental regulation of the highly specialized health services.

Health Planning↗
PubMed1992

[Complaints of patients on medical treatment].

Complaints handled by the Directorate of Health about medical treatment have been registered and analysed for the years 1980, 1985 and 1990. The analysis shows that the number of complaints against government hospitals increased fourfold from 1985 to 1990. Compensation awarded in cases where medical negligence was proved rose sevenfold from NOK 3 million in 1985 to NOK 20 million in 1990. We have reason to believe that there has been a similar increase in the number of claims for compensation, and in the amount of compensation awarded in cases of proven negligence, also in cases not involving the Directorate of Health. It is important to note that our study demonstrates an increase in serious events leading to permanent functional impairment or death. A post hoc analysis suggests that some 80% of the failures might have been avoided if an adequate system of quality assurance had been established.

Humans↗
PubMed1992

Standardized use of simple criteria from case history improves selection of patients for cardiac-care unit (CCU) admission.

A simple algorithm, which improves the diagnostic performance in patients arriving with acute chest pain in the emergency room, has been developed. The algorithm is solely based on information immediately available to the physician and includes elements from ECG, clinical findings and case history. As postulated, a stepwise use of all these variables improved the diagnostic accuracy and reduced the false positive cardiac-care unit (CCU) referral rate in a prospective study of 1450 patients admitted with acute chest pain. Compared to previous hospital practice during a preceding control period, sensitivity in diagnosing patients with unstable ischaemic heart diseases increased from 86% to 94% (P < 0.01), and specificity increased from 44% to 56% (P < 0.001). Accordingly, accuracy increased from 67% to 81% (P < 0.001), and false positive CCU-admission rate decreased from 35% to 19%. The greatest improvement in physician's diagnostic decisions was observed among patients without clear-cut signs of acute ischaemic heart disease on admission.

Algorithms↗
PubMed1991

[Quality assurance in Norwegian somatic hospitals].

In 1990, 70 Norwegian hospitals were mailed a questionnaire asking about quality assurance (QA) activities in the departments of internal medicine, surgery, gynaecology/obstetrics and pediatrics. Responses from 173 departments at 58 hospitals showed a marked interest in improving quality and quality assurance. However, few departments had implemented QA to any noticeable extent in their clinical practices. There were few differences between surgical and non-surgical departments. Only 30% of the respondents had established routines aimed at ensuring complete medical records. 47% had not established committees to record and evaluate accidents, or report hazards to patients, in spite of the fact that only 5% assumed QA was of little usefulness. In 1990, little time was spent on specific QA activities; the most common estimate was one hour per week. In our estimate, full QA in clinical department would require 2-5% of the total contribution of work.

Hospital Departments↗
PubMed1991

[Small hospitals--future tasks and functions].

We review the small municipal hospitals included in our study of hospitals serving less than 50,000 persons. We identified the following problems: These hospitals are resource-intensive to a greater degree than expected, measured in terms of beds, doctors, health services and per capita costs in the area served by the hospital. Moreover, their quality is questionable, due to problems of recruitment and lack of continuity, a weak infrastructure, and insufficient patients to maintain a high level of competence, especially in taking care of patients with complicated and acute conditions. We foresee, and recommend, a new and different future for small hospitals, emphasizing closer links with primary health care and closer collaboration with the larger county hospitals. Key words are: Outpatient services, including perhaps ambulatory specialist services from the larger hospitals, elective services in fields of special competence, possibly covering a larger area, rehabilitation services, municipal psychiatric services; and finally, the traditional acute services should be changed to a first-aid service, preferably as part of emergency care in the municipality.

Hospitals, Municipal↗
PubMed1991

Rapid and correct diagnosis of myocardial infarction: standardized case history and clinical examination provide important information for correct referral to monitored beds.

The value of thorough examination of the case history as a diagnostic tool on hospitalization of patients with suspected myocardial infarction was investigated in three independent prospective studies. Use of a limited number of pain-related elements (= 'criteria'), that had already been obtained in the emergency room, could improve the decision on whether or not to admit patients to the coronary-care unit. As an example, in one of the studies, use of such criteria would have reduced the number of 'unnecessary' coronary-care-unit admissions from 298 to 162, a 46% reduction (P less than 0.001). In the same patient sample, use of the criteria could have reduced the number of patients with definite acute myocardial infarction, admitted to the general wards, from 47 to 22, a 53% reduction (P less than 0.01). These favourable results were confirmed in the two independent, smaller-scale studies.

Coronary Care Units↗
PubMed1991

First myocardial infarction: 5-year survival predicted from routine clinical, laboratory, and radionuclide findings during the acute stage.

Five-year survival amongst 485 consecutive patients with their first acute myocardial infarction (AMI) was 78.2%. Univariate survival analysis showed that the following variables during the acute stage were of prognostic significance for survival: signs of left ventricular heart failure, enlarged cardiac volume, pulmonary congestion on chest X-ray, anterior myocardial infarction on ECG, and low left ventricular ejection fraction (LVEF), whereas enzyme analysis and Q/non-Q signs on ECG were not. In the multivariate analysis two equivalent models were found. The first pinpointed age and LVEF as independent predictors of mortality, and the second age and left ventricular heart failure. Finally, our subcohort of patients aged less than the mean 63 years and with normal LVEF values of greater than or equal to 50%, or no left ventricular failure had an observed survival for 5 years close to an age- and sex-matched group from the Norwegian population.

Adult↗
PubMed1990

[Development of a computer program for early diagnosis of acute myocardial infarction].

A standardised case history was obtained for 1,163 patients admitted to the Central Hospital of Akershus due to suspected acute myocardial infarction. From this database, a computer program was developed for establishing early diagnosis of acute myocardial infarction. In a given patient the program calculates the probabilities of the different conditions giving rise to the particular chest pain history by applying Baye's conditional probability approach. The program proved valuable as a supportive clinical tool of decision in patients admitted with acute chest pain.

Diagnosis, Computer-Assisted↗
PubMed1990

[Testing of a computer program model for the diagnosis of suspected acute coronary disease].

A computerized diagnostic system to be used in patients with acute chest pain was recently developed in our department, and was tested prospectively in 213 consecutive patients with acute chest pain. In our study, the computer system almost invariably improved the decision as to whether or not admission to the coronary care unit was necessary. Thus, compared with decisions made by the emergency room physicians the computer system would have reduced by approximately 75% the number of patients with acute myocardial infarction who are incorrectly referred to the general ward. The system would also have reduced by the same figure the number of cases wrongly placed in the coronary care unit. Thus, in patients admitted with acute chest pain, the use of our computerized system would have improved both diagnostic accuracy and correct referral of patients from the emergency room.

Chest Pain↗
PubMed1990

[The importance of medical history taking in evaluating and monitoring needs in suspected myocardial infarction].

In patients referred to the hospital with a suspicion of acute myocardial infarctions immediate diagnostic accuracy is improved by using a strictly standardized case history upon admission. Thus, the number of patients with proven acute myocardial infarctions erroneously referred to a general ward instead of to the coronary care unit wound have been reduced by one third, and unnecessary referral to the coronary care unit of patients in whom acute myocardial infarctions were not diagnosed would have been reduced by the same amount. Our study emphasizes the important of obtaining a thorough, standardized case history in patients with suspected acute myocardial infarctions. This would improve both patient care and the optimal use of coronary care unit facilities.

Coronary Care Units↗
PubMed1989

Do X-ray determined cardiac volume and signs of congestive heart failure provide additional prognostic information after myocardial infarction if the left ventricular ejection fraction is known?

Cardiac volume (CV) was measured and indices of pulmonary congestion (PCG) were judged from routine chest films taken post myocardial infarction (AMI) in a consecutive series of 477 patients (340 first and 137 recurrent AMIs). Cardiac volume (CV) and signs of PCG were compared to left ventricular ejection fraction (LVEF), measured with isotope technique, and the prognostic value of all the parameters was assessed after 1 and 5 years. The accuracy of CV and PCG in predicting impaired LVEF was low (62% and 50% respectively). Although specificity is suboptimal, however, these parameters provided valuable prognostic information. For example, patients with signs of PCG had a very high 1 and 5 years' mortality, and two-thirds of those who died during the first year of observation had enlarged CV. The independent value of LVEF determination was mainly observed in re-AMI patients. A more restricted use of this expensive procedure may therefore be recommended.

Cardiac Volume↗