An analysis was made of 2416 consecutive patients who underwent a double-contrast barium enema at the Central Roentgen Institute in Oslo. Age, sex, and radiological findings were registered. The age and sex distribution among patients consulting in general practice and in our study was surprisingly similar. This suggests that age as a risk factor for colorectal neoplasms did not play a prominent role among the referring doctors. Colorectal cancer was more frequent in males (4%) than females (2%) (p = 0.03). Odds ratio adjusted for age was 2.1 (1.3-3.8). This may be due to few examinations performed in old age, and different patient behaviour when experiencing colorectal symptoms. The overall polyp frequency was 11%. The frequency increased significantly from the age group 40-49.
OBJECTIVE: This study evaluated the effects of a group learning program on patients with chronic musculoskeletal pain and high absenteeism and investigates what characterizes those patients who may benefit from such a program. The learning program was based on personal construct theory. The theory included the following: (1) participation in an educational program is related to a favorable outcome across the outcome measures (pain, pain coping, management of daily life, absenteeism, and use of health care), (2) patients with high agency orientation (i.e., inner-directed) cope with their pain and manage daily life in a better manner than do patients with low agency orientation (i.e., outer-directed), and (3) patients with high personal control, measured in terms of agency orientation, in terms of health locus of control, or in both terms, will benefit more from the educational program than will patients with low personal control. DESIGN: The study was a randomized controlled study. PATIENTS: One hundred and sixteen patients with chronic musculoskeletal pain and high absenteeism answered a questionnaire before and after the intervention program. The intervention group (n = 61) consisted of nine subgroups geographically spread through the eastern part of Norway and met for four hours every 2 weeks from February 1997 to October 1997. A total of 12 meetings were held. RESULTS: The intervention group reported a significantly higher score for the variable "management of everyday life" (p
We compared the efficacy of penicillin V and amoxycillin treatment with placebo in 70 adult patients from Norwegian family practice with a clinical diagnosis of acute sinusitis and mucosal thickening on CT, but without fluid level or total opacification. The study was randomized and double-blind. Three different outcomes were evaluated; subjective status after 10 days of treatment, difference in clinical score between day 0 and day 10, and duration of the illness episode. Amoxycillin and penicillin V gave no better response to treatment than placebo, evaluated by all three outcome measures. The median duration of the sinusitis episode was 10 days in the amoxycillin- and placebo groups and 13 days in the penicillin-V group. In patients with a clinical diagnosis of acute sinusitis, fluid level and total opacification on CT are good criteria to differentiate between groups of patients that need or do not need antibiotic treatment.
The purpose of the present study was to examine general practitioners' abilities to make a correct estimation of the risk of coronary heart disease (CHD). A 10% random sample of Norwegian primary care physicians (n = 288) received a questionnaire that presented 10 case histories containing information about five CHD risk factors. The respondents' risk estimation was compared with a composite score computed from epidemiologic data. The observed general tendency was towards underestimating the CHD risk. However, 'high-risk' histories were recognized as CHD risk persons. Assessment of CHD risk due to multiple marginal abnormalities was only exceptionally correct. Hypercholesterolaemia and hypertension in men were acknowledged as contributing to clinically significant CHD risk only by a minority of GPs. Heavy smoking and a positive family history were associated with a more accurate estimation of CHD risk. Forty per cent of the physicians did not recognize the sex dependency of cholesterol as a CHD risk factor. None of the physician characteristics could predict variation in correct risk assessment.
The objectives of the present study were: (i) to compare clinical assessment of coronary heart disease (CHD) risk with risk estimation faced with simulated, written case histories; (ii) to observe the risk assessment performed by general practitioners (GPs) in their clinical setting. Thirty-one GPs participating in a multicentre study were asked to invite 20 consecutive male patients aged 30-59 years to an opportunistic screening of CHD risk factors. They assessed the risk status of these patients and of 10 written case histories containing information about corresponding CHD risk factors. A composite 'infarction score' computed from epidemiologic data was used as a gold standard. Diagnostic performance in the clinical setting was compared with that in the simulated setting by Pearson's correlation. A weak, but statistically significant positive correlation was demonstrated when comparing correct estimation in the two settings. No correlation was found for over- and underestimation. Sensitivity was increased faced with clinical patients at the sacrifice of specificity compared to the simulated setting. The impact of a positive family history on clinical assessment parallels the epidemiological estimate. Due to lack of sensitivity, the other factors had a lower impact on risk estimation than an epidemiological estimate would presuppose. We advocate the application of a formal risk estimation to improve risk assessment accuracy. The synergistic effect of multiple risk factors should be emphasized in medical training to improve the clinical risk estimation.
An attempt was made to rehabilitate 67 employees with chronic musculoskeletal pain at 20 different work sites in Norway by means of an educational model. Nine groups were each counselled by two specially trained occupational health personnel. They met for 2-3 hours during working hours at intervals of two to three weeks for one year. Key words in the educational model are: Change of focus from pain and disability to resources and potentials, Higher degree of self-awareness, Development of inner authority. The results indicate that group participation reduces pain and dysfunction and increases everyday coping abilities. In this uncontrolled study 41% had less pain (p = 0.025), 68% coped better with the pain (p
OBJECTIVE--To evaluate the influence of continuity of care on patient satisfaction with consultations. DESIGN--Direct and episodic specific evaluation of patient satisfaction with recent consultation. SETTING AND SUBJECTS--A representative sample of 3918 Norwegian primary care patients were asked to evaluate their consultations by filling in a questionnaire. The response rate was 78%. MAIN OUTCOME MEASURES--The patient's overall satisfaction with the consultation was rated on a six point scale. Continuity of care was recorded as the duration and intensity of the present patient-doctor relationship and as patients' perception of the present doctor being their personal doctor or not. RESULTS--The multivariate analysis indicated that an overall personal patient-doctor relationship increased the odds of the patient being satisfied with the consultation sevenfold (95% confidence interval 4.9 to 9.9) as compared with consultations where no such relationships existed. The duration of the patient-doctor relationship had a weak but significant association with patient satisfaction, while the intensity of contacts showed no such association. CONCLUSION--Personal, continuous care is linked with patient satisfaction. If patient satisfaction is accepted as an integral part of quality health care, reinforcing personal care may be one way of increasing this quality.
Five patients with primary hyperparathyroidism (surgically verified) and one patient with probable normocalcaemic hyperparathyroidism were diagnosed in a series of 93 recurrent stone formers in general practice. The six case histories are presented. The initial diagnosis was based on repeated albumin corrected total serum calcium determinations. The condition had previously not been diagnosed in four of the six patients, despite one or more hospital admissions. The urinary calcium excretion index ad modum Peacock & Nordin is not recommended as a routine test for use in general practice. Serum immunoreactive parathyroidal hormone related to simultaneous serum calcium values did not give any further diagnostic information in 48 of these patients with, or without, formation of new stones during a mean follow-up period of 3.2 years. The clinical spectrum of primary HPT has apparently shifted during the last three decades from bone disease and renal calculi to more general symptoms.
A doctor's ability to assess to what degree his patients are satisfied may indicate how well the patient and the doctor communicate. The main intention of this study was to evaluate the doctor's ability to register a patient's level of satisfaction after a consultation. 19 doctors from six medical centres in Eastern Norway participated. In 50% of the 216 consultations the doctors were able to state exactly how satisfied the patients were. In most of the cases with a mismatch between the doctor's and his patient's ratings the patients were more satisfied than the doctors realized. In some of these cases, however, the doctors failed to observe that the patients were dissatisfied. Male doctors were able to state the patients' level of satisfaction more accurately than female doctors were. Doctors with more experience were also more accurate in their assessments. The method of research used in this area can be problematic. A more reliable and valid questionnaire should be developed.