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Biomedical subjects

Kari J Kvaerner

Publications and source records attributed to Kari J Kvaerner.

10 recordsLinked to original sources
PubMed2005

[Hospital discharge information as a communication tool].

BACKGROUND: The main objective of the list patient health reform has been to improve the quality of local medical service. In European healthcare systems, there has been a need for coordination between primary and secondary care. It has been claimed that the communication between GPs and specialised health care is insufficient, particularly for patients with an extended need of care. MATERIAL AND METHODS: Data on collaboration and satisfaction with specialised health services was collected in a cross-sectional questionnaire survey comprising all Norwegian GPs in 2004 (N = 633); the response rate was 48%. RESULTS: Median delay in receiving patient information was one week or more for inpatient and outpatient treatment. Overall, GPs were satisfied with the hospitals' discharge reports, except for patients needing extended follow up by GPs after discharge. In these patients, GPs more frequently needed to contact the hospital because of insufficient data or unacceptable delays. Female GPs were less satisfied with information services in patients with increased needs. There were also geographical differences in satisfaction. INTERPRETATION: In patients with an increased need for follow up, GPs are less satisfied with hospital information service.

Attitude of Health Personnel↗
PubMed2005

[Use of incentives to enhance response rates in questionnaire surveys].

BACKGROUND: The purpose of this article is to relate response rates in surveys among GPs to the use of conditional and non-conditional incentives. MATERIAL AND METHOD: The data were gathered during a nation-wide survey among all Norwegian general practitioners. RESULTS: There was a higher response rate among respondents who received non-conditional incentives. Although not significant at the 5 percent level, the effect is sufficiently strong to be characterised as interesting. INTERPRETATION: The results indicate that non-conditional incentives are effective in enhancing the response rate in surveys among GPs.

Attitude of Health Personnel↗
PubMed2005

[General practitioners' views on the cooperation with nursing homes].

BACKGROUND: In addition to the coordination between primary and secondary health care, the collaboration between the general practitioner (GP) and the community-based nursing services is a challenge. While the GPs are responsible for his or her list patients' needs, the organisational structure and resource allocation of nursing home services is a community-based responsibility. MATERIAL AND METHODS: Data on GPs' view on collaborative aspects of nursing home services was collected in a cross-sectional questionnaire survey among all Norwegian list-patient GPs in 2004 (N=1633). RESULTS: Out of the 1637/3338 (48%) responding GPs, 1180 (72%) performed community-based services; 462 (37%) of the latter as nursing home physicians. Four out of five GPs found physician-based services for their list patients satisfactory. The GPs had an influence on the provision of nursing and care services in approximately 50% of cases. The less satisfied GPs were less frequently informed when their list patients received nursing home beds and less frequently asked to contribute patient information when the need for nursing home facilities was assessed. These latter GPs were more often of the opinion that GPs should play a major role in the decision for home-based versus nursing home services. INTERPRETATION: Although there is a potential for improvement in the exchange of information between nursing homes and GPs, 80% of the GPs were satisfied with physician-based services in nursing homes.

Attitude of Health Personnel↗
PubMed2004

[Thought-provoking adaptation of otorhinolaryngologic surgery].

BACKGROUND: Global budgeting was partially replaced by activity-based funding in 1999 in order to improve productivity and reduce waiting lists. The aim of this study is to estimate otolaryngologic surgery rates after the introduction of Diagnosis Related Groups funding. MATERIAL AND METHOD: National data on outpatient and inpatient otolaryngologic surgical procedures over the period 1999 to 2002 were provided by the Norwegian Patient Register; an estimate was made of the proportion undergoing uvuloplasty for sleep apnea or snoring. RESULTS: From 1999 to 2002, there was an overall increase in otolaryngologic procedures of 12%. Inter-procedural variation ranged from a 110% increase in uvuloplasties to a 12 % decrease in tonsillectomies. There was a particular increase in procedures requiring neither general anaesthesia nor a highly specialised surgeon. In spite of the increased rates of uvuloplasty, the proportion of patients selected for surgery remained unchanged. INTERPRETATION: The substantial increase in certain procedures may give rise to several interpretations: better medical technology, reallocation of surgical resources to disorders that had been inadequately covered, or a shift towards procedures for which marginal costs do not exceed treatment costs.

Ambulatory Surgical Procedures↗
PubMed2004

Patient discomfort in polysomnography with esophageal pressure measurements.

The reference method for measuring respiratory effort and for differentiating between obstructive and central apneas in the diagnosis of sleep-related breathing disorders is overnight monitoring of esophageal pressure. Despite this being the reference method, it is not widely used because it is considered invasive and uncomfortable for the patients. The aim of this study was to assess patient discomfort and insertion difficulty when using an esophageal catheter during polysomnography. We have performed a prospective questionnaire-based clinical study in 799 consecutive patients where polysomnography with an esophageal catheter was routinely performed in the diagnosis of sleep-related breathing disorders. The main outcome measures were the catheter-related discomfort experienced by the patient and difficulty of catheter insertion reported by the sleep technician. Ninety-six percent of the patients accepted the insertion of the catheter, and most of the patients considered it acceptable to sleep with the catheter. Correspondingly, in most of the patients, the catheter was easily inserted, and there were difficulties in only a few patients. Specifically, no complications or side effects were reported when using the catheter. To optimize the diagnosis of sleep-related breathing disorders, an esophageal sensor catheter can be used during polysomnography, without causing major patient discomfort.

Adolescent↗
PubMed2004

Otitis media: genetic factors and sex differences.

Although genetic factors are recognised as major contributors to otitis media, the presence of sex differences in heritability needs clarification. The aim of this study was to estimate the relative contribution of genetic and environmental effects in otitis media liability with particular focus on sex differences. Data from a cohort of Norwegian twins born between 1967 and 1979 with repeated measures on recurrent childhood otitis media were analysed. Altogether the sample included 4247 twin pairs. The tetrachoric correlations for monozygotic twins were .71 and .65 for males and females respectively. In dizygotic twins the correlations were .35 and .25 for males and females, respectively, and was.34 in opposite sexed pairs. The contribution of genetic and environmental effects was analyzed using structural equation modeling. The best fitting model showed that additive genetic effects explained 72% and 61% of the variance in males and females, respectively. The remaining variance was attributed to individual environmental effects. A model specifying equal heritability estimates for males and females yielded an almost equivalent fit. We found substantial genetic effects for liability to otitis media. There is no evidence that different sets of genes influence liability in males and females, but there may be sex differences in the relative importance of genetic effects.

Cohort Studies↗
PubMed2002

[Acupuncture--a complementary treatment in general practice].

BACKGROUND: Acupuncture is the complementary treatment most commonly used by general practitioners. This study describes the use of acupuncture among Norwegian general practitioners trained in acupuncture. MATERIAL AND METHODS: By telephone or mail, a questionnaire was presented to 212 general practitioners who had completed training in complementary acupuncture. They were asked to describe the use and effect of acupuncture and their attitude towards acupuncture. RESULTS: Of the 111 physicians who replied (53%), 67 (60%) used acupuncture in their clinical practice. 78% had acupuncture courses of less than four weeks' duration only. 52% stated that acupuncture was the preferred treatment in more than 5% of their patients. About 70-80% used acupuncture as a supplement to conventional treatment. Acupuncture was commonly used in patients with musculoskeletal pain (93%), migraine (66%), and headache (63%), less often in patients with nausea, allergy, anxiety, sleep disturbances and gastrointestinal disorders. Improvement was reported in approximately three out of four patients. Lack of time was regarded as the major limitation to the use of acupuncture. INTERPRETATION: Many general practitioners trained in complementary acupuncture use acupuncture as an integrated part of their clinical practice.

Acupuncture Therapy↗
PubMed2002

Pulseoximetry: sufficient to diagnose severe sleep apnea.

OBJECTIVES: To assess the clinical value of pulseoximetry in the diagnosis of sleep apnea when satisfactory agreement with polysomnography is obtained. METHODS: This was a prospective clinical study, set in the Department of Otorhinolaryngology, Ullevaal University Hospital, Oslo, Norway. One hundred consecutive patients were investigated for sleep related breathing disorders. The main outcome measurements were: measurement success rate, oxygen desaturation thresholds, sensitivity and specificity at apnea-hypopnea-index (AHI) thresholds of 5 and 15. RESULTS: Pulseoximetry was successfully performed in 93%. When different oxygen desaturation thresholds were calculated, optimal agreement with polysomnography was found at a 3% oxygen desaturation level. The sensitivity and specificity of diagnosing moderate/severe sleep apnea (AHI above 15) were 0.86 and 0.88, respectively. The corresponding figures for milder sleep apnea (AHI above 5) were 0.91 and 0.67. Good agreement was found between the AHI and the oxygen desaturation index (ODI) at the 3% level, with a mean AHI-ODI difference of 2.6 (SD, 7.3), a Pearson correlation of 0.95 and a weighted kappa of 0.86. The best agreement was found for AHI values below 15, where the estimated AHI-ODI difference was only -0.4 (SD, 3.3). CONCLUSIONS: Pulseoximetry is a simple, non-invasive procedure, which is easy to perform and well suited for outpatient registration. When adjusted to polysomnography with high sensitivity of hypopnea registrations, an ODI at the 3% level is optimal to diagnose sleep apnea. In patients with moderate/severe sleep apnea with AHI values above 15, it is sufficient to establish the diagnosis and subsequent treatment. A negative pulseoximetry does not rule out sleep disorders; the patients should complete a full examination.

Journal Article↗
PubMed2002

Otolaryngological surgery and upper respiratory tract infections in children: an epidemiological study.

The objective of the study was to assess the occurrence of different procedures of upper airway surgery and estimate their relationship to specific upper respiratory tract infections and constitutional factors. In a population-based cross-sectional study in Oslo. Norway, of 3,763 preschool children 3 to 4 years of age, the otolaryngological surgeries adenoidectomy, tonsillectomy, myringotomy, ventilation tube insertion, and combinations of these were the outcome measures. The results showed that by 4 years of age, 13% (n = 501) had undergone operation, and approximately two thirds of the operations involved middle ear surgery. Although surgery was related to the occurrence of upper respiratory tract infections, the type of surgery was not related to the specific infection. In the children with operations, the occurrence of recurrent otitis media (> or = 3 infections in the previous 12 months) was almost fivefold higher than in children without operations (adjusted adds ratio [ORadj] = 5.19 [3.15 to 8.54]). A low level of maternal education (ORadj = 1.61 [1.05 to 2.7] compared to the group with a high level of education) and atopy on the part of the child (ORadj = 1.58 [1.20 to 2.07]) increased the probability for upper airway surgery independently of the experience of infections. In conclusion, early pediatric otolaryngological surgery is common. The decisions for surgical treatment vary substantially and are not closely related to the specific infections. The influence of other factors such as maternal education indicates that decisions for surgery are not entirely based on medical evidence.

Adenoidectomy↗