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Acute bronchiolitis in infancy as risk factor for wheezing and reduced pulmonary function by seven years in Akershus County, Norway.

https://arctichealth.org/en/permalink/ahliterature15027
Source
BMC Pediatr. 2005 Aug 18;5:31
Publication Type
Article
Date
Aug-18-2005
Author
Hans-Olav Fjaerli
Teresa Farstad
Gisle Rød
Gunn Kristin Ufert
Pål Gulbrandsen
Britt Nakstad
Author Affiliation
Faculty Division, Akershus University Hospital, University of Oslo, 1474 Nordbyhagen, Norway. h.o.fjarli@medisin.uio.no
Source
BMC Pediatr. 2005 Aug 18;5:31
Date
Aug-18-2005
Language
English
Publication Type
Article
Abstract
BACKGROUND: Acute viral bronchiolitis is one of the most common causes of hospitalisation during infancy in our region with respiratory syncytial virus (RSV) historically being the major causative agent. Many infants with early-life RSV bronchiolitis have sustained bronchial hyperreactivity for many years after hospitalisation and the reasons for this are probably multifactorial. The principal aim of the present study was to investigate if children hospitalised for any acute viral bronchiolitis during infancy in our region, and not only those due to RSV, had more episodes of subsequent wheezing up to age seven years and reduced lung function at that age compared to children not hospitalised for acute bronchiolitis during infancy. A secondary aim was to compare the hospitalised infants with proven RSV bronchiolitis (RS+) to the hospitalised infants with non-RSV bronchiolitis (RS-) according to the same endpoints. METHODS: 57 infants hospitalised at least once with acute viral bronchiolitis during two consecutive winter seasons in 1993-1994 were examined at age seven years. An age-matched control group of 64 children, who had not been hospitalised for acute viral bronchiolitis during infancy, were recruited from a local primary school. Epidemiological and clinical data were collected retrospectively from hospital discharge records and through structured clinical interviews and physical examinations at the follow-up visit. RESULTS: The children hospitalised for bronchiolitis during infancy had decreased lung function, more often wheezing episodes, current medication and follow-up for asthma at age seven years than did the age matched controls. They also had lower average birth weight and more often first order family members with asthma. We did not find significant differences between the RSV+ and RSV- groups. CONCLUSION: Children hospitalised for early-life bronchiolitis are susceptible to recurrent wheezing and reduced pulmonary function by seven years compared to age-matched children not hospitalised for early-life bronchiolitis. We propose that prolonged bronchial hyperreactivity could follow early-life RSV negative as well as RSV positive bronchiolitis.
PubMed ID
16109158 View in PubMed
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Doctors' prediction of certified sickness absence.

https://arctichealth.org/en/permalink/ahliterature52030
Source
Fam Pract. 2004 Apr;21(2):192-8
Publication Type
Article
Date
Apr-2004
Author
Harald Reiso
Pål Gulbrandsen
Sören Brage
Author Affiliation
Department of General Practice and Community Medicine, Section for Occupational Health and Social Insurance Medicine, University of Oslo, Norway. harald.reiso@samfunnsmed.uio.no
Source
Fam Pract. 2004 Apr;21(2):192-8
Date
Apr-2004
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Disability Evaluation
Family Practice - statistics & numerical data
Female
Health Care Surveys
Humans
Logistic Models
Male
Mental Disorders - therapy
Middle Aged
Musculoskeletal Diseases - therapy
Norway
Research Support, Non-U.S. Gov't
Respiratory Tract Diseases - therapy
Sensitivity and specificity
Sick Leave - statistics & numerical data
Wounds and Injuries - therapy
Abstract
BACKGROUND: Doctors' ability to predict the duration of their patients' certified sickness absence is important for follow-up efforts aimed at patients with increased probability of long-term absence. OBJECTIVES: The aim of this study was to examine the accuracy of doctors' predictions of their patients' sickness absence status 4 weeks ahead, and which factors were associated with it. METHODS: A questionnaire survey was carried out in primary health care concerning 796 patients certified sick within 140 days after the start of absence. The episodes of absence were labelled short-standing (up to 2 weeks) and long-standing (from 3 to 20 weeks), at the time of consultation. The doctors' prediction of the patients' absence status 4 weeks ahead, diagnoses, work ability, clinical information sources used and the presence of non-medical factors that could have influenced the doctors' work ability assessments were collected. The predictions were compared with the patients' absence status 4 weeks later by positive predictive values (PPVs) for the statements 'returned to work' and 'still certified sick'. Factors associated with the accuracy of the predictions were analysed by multiple logistic regression analyses. RESULTS: The doctors accurately predicted return to work in 84% [95% confidence interval (CI) 79-87] of the cases in short-standing episodes, and in 53% (43-62) in long-standing episodes. The corresponding PPVs for still certified sick were 72% (62-80) and 91% (85-94). In short-standing episodes, the doctors' probability of making accurate predictions was higher for respiratory disorders [odds ratio (OR) 2.84; 95% CI 1.36-5.90], than for the reference category 'all other disorders', and lower for mental disorders (0.46; 0.24-0.89). In long-standing episodes, the probability was lower for musculoskeletal disorders (0.33; 0.12-0.86) and injuries (0.12; 0.03-0.48). Neither the age nor gender of patients or doctors, nor the degree of work ability reduction, nor other factors were associated with the accuracy of the predictions. CONCLUSIONS: The doctors' predictions were highly accurate for return to work in short-standing episodes, and for still certified sick in long-standing episodes. Diagnoses were associated with the accuracy; other factors, including the doctors' work ability assessments, were not.
PubMed ID
15020391 View in PubMed
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Does improved access to diagnostic imaging results reduce hospital length of stay? A retrospective study.

https://arctichealth.org/en/permalink/ahliterature141019
Source
BMC Health Serv Res. 2010;10:262
Publication Type
Article
Date
2010
Author
Petter Hurlen
Truls Østbye
Arne S Borthne
Pål Gulbrandsen
Author Affiliation
Helse Sør-Øst Health Services Research Centre Akershus University Hospital, NO-1478 Lørenskog, Norway. petter@hurlen.no
Source
BMC Health Serv Res. 2010;10:262
Date
2010
Language
English
Publication Type
Article
Keywords
Computer Communication Networks - organization & administration
Databases, Factual
Diagnostic Imaging - utilization
Electronic Health Records
Female
Hospital Information Systems - utilization
Humans
Length of Stay - statistics & numerical data
Male
Norway
Outcome Assessment (Health Care)
Professional Competence
Program Evaluation
Radiology Information Systems - organization & administration
Retrospective Studies
Risk assessment
Time Factors
Tomography, X-Ray Computed - utilization
Abstract
One year after the introduction of Information and Communication Technology (ICT) to support diagnostic imaging at our hospital, clinicians had faster and better access to radiology reports and images; direct access to Computed Tomography (CT) reports in the Electronic Medical Record (EMR) was particularly popular. The objective of this study was to determine whether improvements in radiology reporting and clinical access to diagnostic imaging information one year after the ICT introduction were associated with a reduction in the length of patients' hospital stays (LOS).
Data describing hospital stays and diagnostic imaging were collected retrospectively from the EMR during periods of equal duration before and one year after the introduction of ICT. The post-ICT period was chosen because of the documented improvement in clinical access to radiology results during that period. The data set was randomly split into an exploratory part used to establish the hypotheses, and a confirmatory part. The data was used to compare the pre-ICT and post-ICT status, but also to compare differences between groups.
There was no general reduction in LOS one year after ICT introduction. However, there was a 25% reduction for one group - patients with CT scans. This group was heterogeneous, covering 445 different primary discharge diagnoses. Analyses of subgroups were performed to reduce the impact of this divergence.
Our results did not indicate that improved access to radiology results reduced the patients' LOS. There was, however, a significant reduction in LOS for patients undergoing CT scans. Given the clinicians' interest in CT reports and the results of the subgroup analyses, it is likely that improved access to CT reports contributed to this reduction.
Notes
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PubMed ID
20819224 View in PubMed
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Does PACS improve diagnostic accuracy in chest radiograph interpretations in clinical practice?

https://arctichealth.org/en/permalink/ahliterature140331
Source
Eur J Radiol. 2012 Jan;81(1):173-7
Publication Type
Article
Date
Jan-2012
Author
Petter Hurlen
Arne Borthne
Fredrik A Dahl
Truls Ostbye
Pål Gulbrandsen
Author Affiliation
Helse Sør-Øst Health Services Research Centre, Akershus University Hospital, Sykehusveien 27, NO-1478 Lørenskog, Norway. petter.hurlen@ahus.no
Source
Eur J Radiol. 2012 Jan;81(1):173-7
Date
Jan-2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Female
Humans
Male
Middle Aged
Norway
Observer Variation
Professional Competence
Radiography, Thoracic - statistics & numerical data
Radiology Information Systems - statistics & numerical data
Reproducibility of Results
Sensitivity and specificity
Young Adult
Abstract
To assess the impact of a Picture Archiving and Communication System (PACS) on the diagnostic accuracy of the interpretation of chest radiology examinations in a "real life" radiology setting.
During a period before PACS was introduced to radiologists, when images were still interpreted on film and reported on paper, images and reports were also digitally stored in an image database. The same database was used after the PACS introduction. This provided a unique opportunity to conduct a blinded retrospective study, comparing sensitivity (the main outcome parameter) in the pre and post-PACS periods. We selected 56 digitally stored chest radiograph examinations that were originally read and reported on film, and 66 examinations that were read and reported on screen 2 years after the PACS introduction. Each examination was assigned a random number, and both reports and images were scored independently for pathological findings. The blinded retrospective score for the original reports were then compared with the score for the images (the gold standard).
Sensitivity was improved after the PACS introduction. When both certain and uncertain findings were included, this improvement was statistically significant. There were no other statistically significant changes.
The result is consistent with prospective studies concluding that diagnostic accuracy is at least not reduced after PACS introduction. The sensitivity may even be improved.
PubMed ID
20888718 View in PubMed
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Double reading of current chest CT examinations: Clinical importance of changes to radiology reports.

https://arctichealth.org/en/permalink/ahliterature275183
Source
Eur J Radiol. 2016 Jan;85(1):199-204
Publication Type
Article
Date
Jan-2016
Author
Peter M Lauritzen
Knut Stavem
Jack Gunnar Andersen
Mali Victoria Stokke
Anne Lise Tennstrand
Gisle Bjerke
Petter Hurlen
Gunnar Sandbæk
Fredrik A Dahl
Pål Gulbrandsen
Source
Eur J Radiol. 2016 Jan;85(1):199-204
Date
Jan-2016
Language
English
Publication Type
Article
Keywords
Aged
Cross-Sectional Studies
Diagnostic Errors - prevention & control
Female
Humans
Male
Norway
Observer Variation
Quality Assurance, Health Care - methods
Radiography, Thoracic - standards
Radiology Department, Hospital
Radiology Information Systems - standards
Reproducibility of Results
Retrospective Studies
Tomography, X-Ray Computed - standards
Abstract
Misinterpretation of radiological examinations is an important contributing factor to diagnostic errors. Double reading reduces interpretation errors and increases sensitivity. Consultant radiologists in Norwegian hospitals submit 39% of computed tomography (CT) reports for quality assurance by double reading. Our objective was to estimate the proportion of radiology reports that were changed during double reading and to assess the potential clinical impact of these changes.
In this retrospective cross-sectional study we acquired preliminary and final reports from 1023 consecutive double read chest CT examinations conducted at five public hospitals. The preliminary and final reports were compared for changes in content. Three experienced pulmonologists independently rated the clinical importance of these changes. The severity of the radiological findings in clinically important changes was classified as increased, unchanged, or decreased.
Changes were classified as clinically important in 91 (9%) of 1023 reports. Of these: 3 were critical (demanding immediate action), 15 were major (implying a change in treatment) and 73 were intermediate (affecting subsequent investigations). More clinically important changes were made to urgent examinations and less to female first readers. Chest radiologist made more clinically important changes than other second readers. The severity of the radiological findings was increased in 73 (80%) of the clinically important changes.
A 9% rate of clinically important changes made during double reading may justify quality assurance of radiological interpretation. Using expert second readers and targeting a selection of urgent cases prospectively may increase the yield of discrepant cases and reduce harm to patients.
PubMed ID
26724666 View in PubMed
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Double reading rates and quality assurance practices in Norwegian hospital radiology departments: two parallel national surveys.

https://arctichealth.org/en/permalink/ahliterature261241
Source
Acta Radiol. 2015 Jan;56(1):78-86
Publication Type
Article
Date
Jan-2015
Author
Peter M Lauritzen
Petter Hurlen
Gunnar Sandbæk
Pål Gulbrandsen
Source
Acta Radiol. 2015 Jan;56(1):78-86
Date
Jan-2015
Language
English
Publication Type
Article
Keywords
Diagnostic Imaging - utilization
Health Care Surveys
Norway
Observer Variation
Physician's Practice Patterns - utilization
Quality Assurance, Health Care - statistics & numerical data
Radiology Department, Hospital - statistics & numerical data
Reproducibility of Results
Sensitivity and specificity
Unnecessary Procedures
Abstract
Double reading as a quality assurance (QA) tool is employed extensively in Norwegian hospital radiology departments. The practice is resource consuming and regularly debated.
To investigate the rates of double reading in Norwegian hospital radiology departments, to identify department characteristics associated with double reading rates, and to investigate associations between double reading and other quality improvement.
We issued two parallel national surveys to management and to consultant radiologists, respectively. Management was defined as the chief medical officer and/or the head of the radiology department. The management survey covered staffing, perceived resource situation, double reading, guidelines, and quality improvement. The radiologist survey served to validate management responses concerning double reading. Management survey items concerning practices of quality improvement were organized into three indices reflecting different quality approaches, namely: appropriateness of investigations; personal performance feedback; and system performance feedback.
The response rates of the surveys were 100% (45/45) for management and 55% (266/483) for radiologists. Of all exams read by consultants, 33% were double read. The double reading rate was highest in university hospital departments (59%), intermediate in other teaching departments (30%), and lowest in non-teaching departments (11%) (P?=?0.01). Among the quality indices, mean scores were highest on appropriateness index (68%), intermediate on the person index (56%), and lowest on system index (37%). There were no correlations between double reading rates and scores on any of the quality indices.
The rate of double reading in Norwegian hospital radiology is significantly correlated to department teaching status, but not to other practices of quality work.
PubMed ID
24425793 View in PubMed
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Effectiveness of a short course in clinical communication skills for hospital doctors: results of a crossover randomized controlled trial (ISRCTN22153332).

https://arctichealth.org/en/permalink/ahliterature139544
Source
Patient Educ Couns. 2011 Aug;84(2):163-9
Publication Type
Article
Date
Aug-2011
Author
Bård Fossli Jensen
Pål Gulbrandsen
Fredrik A Dahl
Edward Krupat
Richard M Frankel
Arnstein Finset
Author Affiliation
HØKH Research Centre, Akershus University Hospital, Lørenskog, Norway.
Source
Patient Educ Couns. 2011 Aug;84(2):163-9
Date
Aug-2011
Language
English
Publication Type
Article
Keywords
Adult
Clinical Coding - standards
Clinical Competence - standards
Communication
Cross-Over Studies
Education, Medical, Continuing - organization & administration
Female
Hospital Bed Capacity, 500 and over
Humans
Male
Middle Aged
Norway
Physician-Patient Relations
Physicians
Program Evaluation
Questionnaires
Videotape Recording
Abstract
To test the hypothesis that a 20-h communication skills course based on the Four Habits model can improve doctor-patient communication among hospital employed doctors across specialties.
Crossover randomized controlled trial in a 500-bed hospital with interventions at different time points in the two arms. Assessments were video-based and blinded. Intervention consisted of 20 h of communication training, containing alternating plenary with theory/debriefs and practical group sessions with role-plays tailored to each doctor.
Of 103 doctors asked to participate, 72 were included, 62 received the intervention, 51 were included in the main analysis, and another six were included in the intention-to-treat analysis. We found an increase in the Four Habits Coding Scheme of 7.5 points (p = 0.01, 95% confidence interval 1.6-13.3), fairly evenly distributed on subgroups. Baseline score (SD) was 60.3 (9.9). Global patient satisfaction did not change, neither did average encounter duration.
Utilizing an outpatient-clinic training model developed in the US, we demonstrated that a 20-h course could be generalized across medical and national cultures, indicating improvement of communication skills among hospital doctors.
The Four Habits model is suitable for communication-training courses in hospital settings. Doctors across specialties can attend the same course.
Notes
Comment In: Patient Educ Couns. 2011 Aug;84(2):141-221696909
PubMed ID
21050695 View in PubMed
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Emotional cues and concerns in hospital encounters with non-Western immigrants as compared with Norwegians: an exploratory study.

https://arctichealth.org/en/permalink/ahliterature133873
Source
Patient Educ Couns. 2011 Sep;84(3):325-31
Publication Type
Article
Date
Sep-2011
Author
Emine Kale
Arnstein Finset
Hanne-Lise Eikeland
Pål Gulbrandsen
Author Affiliation
Norwegian Centre for Minority Health Research, Oslo University Hospital, Oslo, Norway. emine.kale@nakmi.no
Source
Patient Educ Couns. 2011 Sep;84(3):325-31
Date
Sep-2011
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Communication
Cues
Cultural Competency
Databases as Topic
Emigrants and Immigrants - psychology
Emotions
Female
Geography
Humans
Inpatients
Kinesics
Language
Male
Middle Aged
Norway
Physician-Patient Relations
Statistics, nonparametric
Videotape Recording
Abstract
To identify potential barriers in communication with non-Western immigrant patients by comparing the frequency and nature of emotional cues and concerns, as well as physician responses during consultations, between ethnically Norwegian patients and immigrant patients in a general hospital setting.
Consultations with 56 patients (30 non-Western immigrants and 26 ethnic Norwegians) were coded using the Verona Coding Definitions of Emotional Sequences (VR-CoDES) and the Verona Codes for Provider Responses (Verona Codes-P).
There were no significant differences in frequencies of cues and concerns between immigrant and Norwegian patients. However, the immigrant patients with high language proficiency expressed more concerns compared to immigrant patients with language problems and Norwegian patients. Moreover, more concerns were expressed during consultations with female physicians than with male physicians.
Expression of cues and concerns in immigrant patients is dependent on the patient's language proficiency and the physician's gender.
Providers should recognize that immigrant patients may have many emotional cues and concerns, but that language problems may represent a barrier for the expression of these concerns.
PubMed ID
21652163 View in PubMed
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Five-point scales outperform 10-point scales in a randomized comparison of item scaling for the Patient Experiences Questionnaire.

https://arctichealth.org/en/permalink/ahliterature96623
Source
J Clin Epidemiol. 2010 Jun 19;
Publication Type
Article
Date
Jun-19-2010
Author
Andrew M Garratt
Jon Helgeland
Pål Gulbrandsen
Author Affiliation
National Resource Centre for Rehabilitation in Rheumatology (NRRK), Diakonhjemmet Hospital, PO Box 23 Vinderen, 0319 Oslo, Norway; Norwegian Knowledge Centre for the Health Services, PO Box 7004, St Olavs plass, 0130 Oslo, Norway.
Source
J Clin Epidemiol. 2010 Jun 19;
Date
Jun-19-2010
Language
English
Publication Type
Article
Abstract
OBJECTIVE: To assess the data quality of two approaches to scaling items within the Patient Experiences Questionnaire (PEQ); a five-point scale with descriptors for all scale points and a 10-point scale with descriptors only at the end points. STUDY DESIGN AND SETTING: The two versions were pretested through cognitive interviews with 14 patients. The PEQ was then mailed to 1,000 patients after inpatient treatment at a large university hospital in Norway, randomized to receive the 5- or 10-point scale versions. Response rates, missing data, item means, floor, and ceiling effects were assessed. Regression analysis was used to examine the impact of response scale on missing data, floor, and ceiling effects after controlling for age, education level, and health status. RESULTS: The five-point scale produced data with unimodal and fairly symmetric distributions in contrast to the highly skewed J- and U-shaped distributions for the 10-point scale. The five-point scale data had significantly lower item means, floor, and ceiling effects. Regression analysis showed that the type of scale explained a significant component of the variation in both floor and ceiling effects. CONCLUSION: The five-point scale performed better than the 10-point scale and is more suitable for assessing patient experiences. The revised PEQ will be used in Norwegian national surveys.
PubMed ID
20566267 View in PubMed
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"Four Habits" goes abroad: report from a pilot study in Norway.

https://arctichealth.org/en/permalink/ahliterature156206
Source
Patient Educ Couns. 2008 Sep;72(3):388-93
Publication Type
Article
Date
Sep-2008
Author
Pål Gulbrandsen
Ed Krupat
Jurate Saltyte Benth
Andrew Garratt
Dana Gelb Safran
Arnstein Finset
Richard Frankel
Author Affiliation
HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway. pal.gulbrandsen@ahus.no
Source
Patient Educ Couns. 2008 Sep;72(3):388-93
Date
Sep-2008
Language
English
Publication Type
Article
Keywords
Adult
Female
Focus Groups
Habits
Hospitalists - education
Humans
Male
Middle Aged
Norway
Patient satisfaction
Physician-Patient Relations
Pilot Projects
Principal Component Analysis
Questionnaires
Staff Development
Teaching - methods
Abstract
"Four Habits" is the first larger generic clinical communication program to have a documented effect. It has not been evaluated outside USA. In a pilot study, Norwegian hospital physicians assessed its usefulness, and we developed a questionnaire where patients reported "Four Habits"-specific physician behaviour.
We ran a 3-day course with 16 participants and three US facilitators. The questionnaire mapping "Four Habits" with 23 items was distributed by participating physicians to 210 patients. Participating physicians met in evaluative focus groups 3 months after the course.
The questionnaire was condensed to 10 items after factorial analysis. The resulting scale performed well. A large amount of missing data on some items suggested that patients found it difficult to evaluate details of "Four Habits"-specific physician behaviour. Participants found that the "Four Habits" short course led to improvement of their encounters. Some elements of the method were not perceived as relevant for all types of encounters (habits II and III).
"Four Habits" is applicable outside US with some adjustments. A shortened version of the questionnaire will be used in a planned randomized controlled trial.
PubMed ID
18619759 View in PubMed
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32 records – page 1 of 4.