BACKGROUND: In May 2000, the Norwegian Medical Association appointed a working group to propose guidelines for the practice of palliative sedation to dying patients (terminal sedation). The present study is part of this work. The aim of the study was to register to what extent this form of palliation is used in Norwegian hospitals, on what indications, how decisions are reached, and whether the treatment is considered necessary. The definition of palliative sedation given was: induction and maintenance of sleep for the relief of pain or other types of suffering in a patient close to death. The intention is exclusively to relieve intractable pain, not to shorten the patient's life. MATERIAL AND METHODS: An anonymous questionnaire was sent to 364 Norwegian hospital departments that might have experience with palliative sedation. Results are reported partly as free text comments and partly as frequencies of predetermined response alternatives. RESULTS: 58% of the questionnaires were returned. 22% of the respondents had given palliative sedation to a dying patient during the last 12 months, and more than half of the physicians found this intervention sometimes necessary. Pain was the most frequent indication; none of the respondents claimed to haven given sedation exclusively based on depression/anxiety. Lack of resources still seems to be an obstacle to optimal palliative care in Norway. CONCLUSION: Though it has some methodological weaknesses, this study confirms the need for national guidelines.
First-episode psychosis (FEP) patients show structural brain abnormalities. Whether the changes are progressive or not remain under debate, and the results from longitudinal magnetic resonance imaging (MRI) studies are mixed. We investigated if FEP patients showed a different pattern of regional brain structural change over a 1-year period compared with healthy controls, and if putative changes correlated with clinical characteristics and outcome.
MRIs of 79 FEP patients [SCID-I-verified diagnoses: schizophrenia, psychotic bipolar disorder, or other psychoses, mean age 27.6 (s.d. = 7.7) years, 66% male] and 82 healthy controls [age 29.3 (s.d. = 7.2) years, 66% male] were acquired from the same 1.5 T scanner at baseline and 1-year follow-up as part of the Thematically Organized Psychosis (TOP) study, Oslo, Norway. Scans were automatically processed with the longitudinal stream in FreeSurfer that creates an unbiased within-subject template image. General linear models were used to analyse longitudinal change in a wide range of subcortical volumes and detailed thickness and surface area estimates across the entire cortex, and associations with clinical characteristics.
FEP patients and controls did not differ significantly in annual percentage change in cortical thickness or area in any cortical region, or in any of the subcortical structures after adjustment for multiple comparisons. Within the FEP group, duration of untreated psychosis, age at illness onset, antipsychotic medication use and remission at follow-up were not related to longitudinal brain change.
We found no significant longitudinal brain changes over a 1-year period in FEP patients. Our results do not support early progressive brain changes in psychotic disorders.
Norwegian hospitals and their leaders are required by law to engage in quality assurance. We wanted to study to what extent the heads of hospital departments were actually engaged in such activities.
Data were collected by questionnaires sent to heads of hospital departments in Norway (n = 657), of whom 567 (86%) responded.
Only 23% of those interviewed prior to their appointment had been asked about experience in quality assurance, less than 30% had written instructions for their work, and only about 40% received regular follow-up from the hospital administration. The majority registered complaints and mistakes, and was engaged in teaching quality assurance. 58% of the heads of small departments and 73% of those of large departments reported that quality in general suffered because of the demands for higher clinical productivity.
Most heads of hospital departments in Norway are engaged in quality assurance work, but the study indicates that hospital administration attaches little importance to this type of work.
In Norway, as in other countries, questions regarding medical leadership in hospital departments are much discussed. The purpose of this study was to determine how much time medical heads of hospital departments spend on various leadership tasks.
Information was collected by a questionnaire survey in 1996.
567 out of 657 (86%) completed the questionnaire. 71% shared the departmental leadership with a nurse, and 48% of these were content with such co-leadership. Nearly all the respondents were clinically active. 49% of heads of large departments used more than half their working hours on administration, compared with 7% of heads of small departments.
Selection criteria for heads of hospital departments should be adjusted to the work they actually do. Clinical competence is of importance for all heads of clinical departments; the importance of administrative competence varies with the size of the department.
BACKGROUND: More than 30% of Norwegian physicians have graduated from medical schools outside Norway, and the number of Norwegian students that attend medical schools abroad is increasing, particularly in Hungary, Poland and the Czech republic. There is a need to know more about these future Norwegian doctors, what their motives and plans are, and how they differ from students at home. MATERIAL AND METHODS: A postal survey was carried out among all 1,198 Norwegian medical students that were in the files of the State Education Loan Fund by August 1998. The questions covered reasons for going abroad, academic and non-academic outcome, satisfaction, specialty and job preferences, possible motives for career choices, personality characteristics, smoking status and alcohol use. Comparable data were available from previous studies of medical students in Norway. RESULTS: There were 756 responses (63%). Surgery, internal medicine and paediatrics were the most popular specialties. Family medicine and psychiatry seem to be less likely specialties for students abroad than for students at home. Traditional gender differences, e.g. interest in aiming for a leadership position, were present and did not differ from those seen among students in Norway. Students abroad were more oriented towards leadership and prestigious specialties, less preoccupied with the possibility of making medical mistakes, and less interested in medico-policial issues than their counterparts at home. Their personality profiles seemed more robust than those of students in Norway. On the other hand, they smoked much more frequently and had a higher risk of alcohol-related problems. INTERPRETATION: Norwegian medical students abroad do not particularly prefer specialties like general practice and psychiatry, where the demand for medical manpower is highest. They seem to have quite traditional preferences according to gender.
Comment In: Tidsskr Nor Laegeforen. 2001 Jun 30;121(17):209311875909
BACKGROUND: More than 30% of Norwegian physicians have graduated from medical schools outside Norway, and the number of Norwegian students that attend medical schools abroad is increasing, particularly in Hungary, Poland and the Czech republic. It is of interest to know more about these future Norwegian doctors: where they come from, and how they cope with studying abroad. MATERIAL AND METHODS: A postal survey was carried out among all 1,198 Norwegian medical students that were in the files of the State Education Loan Fund by August 1998. There were 756 responses (63%). The questions covered reasons for going abroad, academic and non-academic outcome, satisfaction, specialty and job preferences, possible motives for career choices, personality traits, smoking status and alcohol use. Comparable data were available from previous studies of medical students in Norway. RESULTS: The social background of students abroad is similar to that of students at home, and their high school grade level is only slightly below. The main reasons for studying abroad is that they were not admitted at a Norwegian university and have a strong wish of becoming a doctor. Language, financial situation, and a number of pragmatic reasons determine which country to go to, choice of university is often incidental. Students abroad spend more time on their studies than students at home do. They are generally satisfied with the academic quality, but satisfaction with how the study is organised is lower in Central and Eastern-European countries. INTERPRETATION: Norwegians who are highly motivated but excluded from Norwegian universities increasingly attend medical schools abroad and are by and large satisfied with the quality of the curriculum.
Comment In: Tidsskr Nor Laegeforen. 2001 Jun 30;121(17):209311875909
To determine if the Beliefs about Medicines Questionnaire (BMQ) has satisfactory psychometric properties in patients with severe mental disorders and if their scores differ from those of patients with severe medical disorders. To investigate if the scores are related to medication adherence.
Two hundred and eighty psychiatric patients completed the BMQ and reported how much of their medication they had taken the past week. Serum concentrations of medications were analyzed. BMQ scores were compared with those of patients with chronic medical disorders.
Cronbach's alpha was satisfactory for all subscales. The psychiatric group scored lower on the necessity of taking medication than the medical group. Non-adherent patients felt medication to be less necessary and were more concerned about it than adherent patients. The necessity subscale predicted adherence fairly well.
The BMQ has satisfactory psychometric properties for use in patients with severe mental disorders. The constructs measured by the BMQ are related to adherence in these patients.
In this study we examine to what extent hospital specialists would recommend their children or grandchildren to choose a medical career and the sort of working conditions that influence their recommendation. During the spring of 1996 we issued a questionnaire to 664 hospital specialists who qualified in 1970 (107 specialists). 1980 (260 specialists) and 1990 (297 specialists). One out of three specialists would advise his or her children or grandchildren against choosing a medical career. Retired doctors have a more positive attitude than those in employment. 45% of specialists working in hospitals were overworked, and among these 58% of doctors with little scope for decision-making would not recommend a medical career whereas 15% of doctors with greater decision-making responsibilities would advise against a medical career. Job satisfaction contributes positively to hospital specialists recommending a medical career.
Comment In: Tidsskr Nor Laegeforen. 2002 Aug 20;122(19):186312362706
Open and supportive communication is probably one of the most important promotors of learning, coping and satisfaction at the workplace. The aim of this paper is to describe and predict the communication atmosphere between Norwegian physicians. Twenty statements describing communication, as perceived by the physicians themselves, were presented to a random sample of the members of the Norwegian Medical Association of which more than 90% of the physicians in the country are members (N = 2628). In general, this investigation indicates that the communication atmosphere among Norwegian physicians is characterised by support and mutual respect. More than half of the respondents fully agreed that communication between colleagues in the workplace is marked by solidarity, and that experienced colleagues show respect for the less experienced in both personal and professional matters. Physicians working in hospitals described the communication atmosphere as substantially more selfish and competitive than non-hospital physicians, whilst general practitioners considered the atmosphere between colleagues to be more supportive than non-specialists. In addition, high perceived stress was associated with the perception of a less supportive atmosphere. However, the strongest predictor of the communication atmosphere was clearly the physician's perceived autonomy. The comprehensive retrenchment programmes implemented in Norwegian hospitals during recent years have increased stress and restricted professional autonomy among both physicians and other occupational groups. Our findings indicate that the communication atmosphere necessary to secure continuity of knowledge within the medical profession may have been jeopardised by this process. In the long term, this may prove hazardous to the quality of medical care.
We have explored continuing medical education among Norwegian dermatologists, especially their use of medical journals and the Internet.
In April 2001, a questionnaire was sent to 170 dermatologists, including junior doctors in specialist training. 129 questionnaires (76%) were returned, of which 16 were excluded from the analysis.
Mean time used per week reading articles in medical journals was 149 minutes (95% confidence interval (CI) 129-168 minutes). 90% of the respondents had Internet access at work and/or at home. Hospital consultants used the Internet for medical purposes for significantly more time per week than doctors in private practice (146 minutes (CI 98-195 minutes) versus 72 minutes (CI 52-93 minutes)). More hospital doctors had difficulties in getting or taking time off to attend courses and congresses (p