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Background and Purpose: Few studies have assessed the influence of the organization of stroke care on health-related quality of life (HRQoL). The present study compared HRQoL 6 months after stroke between subjects who had been treated in an acute stroke unit (SU) and those treated in general medical wards (GMW)., Methods: In total 550 subjects > or = 60 years of age with acute stroke were prospectively allocated according to date of birth (day of the month) to treatment in an SU with short length of stay or GMWs. In the present study, 325 survivors at 5 days with Scandinavian stroke scale (SSS) orientation score > 5 and SSS speech score > 5 were included. We assessed HRQoL with the Short Form 36 (SF-36) questionnaire 6 months after stroke onset and estimated utility values from the SF-36 scores., Results: Of the 325 eligible subjects, 158 were allocated to an SU and 167 to GMWs. Among 296 survivors at 6 months, 115 subjects (79% of survivors) in the SU group completed the questionnaire and 121 (80%) in the GMW group. There was no statistically significant difference between the treatment groups on any of the 8 SF-36 scales or the 2 component summary scales. After integrating death in the comparison of HRQoL, there was still no difference in outcome between the groups., Conclusion: An acute SU with a short length of stay, offering early treatment and rehabilitation, could not show an improvement in the HRQoL of stroke patients > or = 60 years 6 months after stroke compared with initial treatment in GMWs., (Copyright 2007 S. Karger AG, Basel.)

To assess the association between nurses' practice environment and established measures of discharged patients' experiences during hospitalisation it is necessary to have a validated instrument to collect data on nurses' work environment in hospital wards. The purpose of this study was to assess the reliability and validity of a Norwegian version of the Ward Organisational Features Scales (WOFS), an instrument developed in the UK to describe environmental factors influential on the effectiveness of nursing services. After linguistic adaptation of the questionnaire, the reliability and validity were assessed in a sample of 99 nurses, of whom 46 (45%) responded. Most of the 12 tested scales showed acceptable internal consistency (10 had Cronbach's alpha > 0.70) and test-retest reliability (eight had intraclass correlation coefficient >0.70). The WOFS scales' correlations with external variables were in line with hypothesised correlations, thus supporting their validity. Scales describing nurses' influence on ward organisation and management did not perform well, probably due to differences in intraward organisation in the two countries. In spite of a limited sample size this study suggests that the majority of the scales of the WOFS showed satisfactory psychometric properties. They can be useful for assessing and describing aspects of nurses' work environment in Norwegian hospitals.

Background: The aim of the study was to validate the Norwegian version of a self-administered 43-item questionnaire designed to assess quality of life in kidney transplant recipients, the End-Stage Renal Disease Symptom Checklist--Transplantation Module (ESRD-SCL)., Methods: In total, 53 kidney transplant recipients from one university-affiliated hospital responded to a questionnaire including the ESRD-SCL and the Short Form 36 (SF-36). We assessed internal consistency reliability and test-retest reliability with 2 weeks between assessments. Construct validity was assessed by correlations of the ESRD-SCL subscales with related and unrelated SF-36 scales, demographic, and clinical characteristics., Results: Subscales of the ESRD-SCL showed good internal consistency reliability (Cronbach's = 0.72-0.81) and for the aggregate total scale alpha was 0.94. Test-retest reliability median 14 days apart was excellent with intraclass coefficients ranging from 0.87 to 0.95. The pattern of correlations of the ESRD-SCL scales with related and unrelated scales SF-36 scales and demographic and clinical characteristics gave support to the construct validity of the ESRD-SCL., Conclusion: The Norwegian translation of the ESRD-SCL showed satisfactory internal consistency reliability, test-retest reliability and construct validity, at the level of the original German version.

Study Objectives: To determine if the Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 0 (subjects at risk for COPD) provides information about long-term mortality risk., Design, Setting, and Participants: From 1972 to 1975, clinical, physiologic, and biochemical parameters including respiratory symptoms, spirometry, and physical fitness were measured in 1,999 healthy men aged 40 to 59 years in an occupational cohort, of whom 1,623 had acceptable spirometry findings. In a proportional hazards model with follow-up until 2000, we assessed all-cause mortality according to GOLD stage 0, I, II, and III compared with "normal" subjects, after adjusting for known risk factors and potential confounders., Results: After 26 years (range, 25 to 27 years), 615 men (38%) had died. In multivariate proportional hazards models, GOLD stage 0 subjects had a nonsignificantly increased hazard of death (hazard ratio [HR], 1.19; p = 0.21) after adjustment for age, smoking, physical fitness, body mass index, systolic BP, and serum cholesterol. Similarly, subjects in GOLD stage I (HR, 1.30; p = 0.05) and stage II (HR, 1.77; p < 0.0001) had increased all-cause mortality. When expanding GOLD stage 0 to comprise patients with any respiratory symptom in a sensitivity analysis, the HR for all-cause mortality increased (HR, 1.35; p = 0.03)., Conclusion: There probably is an excess mortality among GOLD stage 0 subjects compared to symptom-free subjects; however, this should be interpreted cautiously and the results vary with the definition of the GOLD stage 0. Subjects in GOLD stage I or stage II had higher mortality than symptom-free subjects.

Background: The Chronic Sinusitis Survey (CSS) is a valid, disease-specific questionnaire for assessing health status and treatment effectiveness in chronic rhinosinusitis. In the present study, we developed a Norwegian version of the CSS and assessed its psychometric properties., Methods: In the pooled data set of 65 patients from a trial of treatment for chronic sinusitis with long-standing symptoms and signs of sinusitis on computed tomography (CT), we assessed the reliability, validity and responsiveness of the CSS., Results: Test-retest reliability of the two CSS scales and the total scale ranged 0.87-0.92, while internal consistency reliability ranged 0.31-0.55. CSS subscale scores were associated with other items on sinusitis symptoms, and with the Mental health and Bodily pain scale of the SF-36. There was little association of the CSS scale scores with sinus CT findings. The patients with chronic sinusitis had worse scores on all three CSS scales than a healthy reference population (n = 42) (p < 0.001). The CSS sinus symptoms subscale and the total scale were sensitive to improvement in global symptoms during 12 weeks., Conclusion: The Norwegian version of the CSS had acceptable test-retest reliability, but lower internal consistency reliability than the accepted standard criteria. The results support the construct validity of the measure and the sinusitis symptoms subscale and the total scales were responsive to change. This supports the use of the questionnaire in interventions for chronic sinusitis, but points at problems with the internal consistency reliability.

Background: Health-related quality of life (HRQoL) improves after renal transplantation. However, it is unclear which variables are the strongest determinants of HRQoL following renal transplantation. In this study, we wanted to assess whether antihypertensive medication, donor type, human leukocyte antigen (HLA)-compatibility or other variables could predict HRQoL 6-12 months after transplantation., Methods: The study was a follow up of 124 patients recruited to a single center, randomized, double-blind clinical trial, comparing the effects of lisinopril and nifedipine in hypertensive renal transplant recipients. HRQoL was assessed with the Short Form 36 (SF-36) questionnaire. Bivariate and multiple linear regression analysis were used to assess the relationship between potential predictors and the physical component summary (PCS) and mental component summary (MCS) scales of the SF-36., Results: Average scores 6-12 months after transplantation did not differ between patients randomized to lisinopril or nifedipine, or between cadaveric and living donor recipients on any of the eight SF-36 scales, or the two summary scales. In multivariate analyses, recipient age (p = 0.01) and cold ischemia time >14.5 h (p = 0.04) were independent predictors of the PCS score. Recipient age (p = 0.05), 2-4 HLA-AB mismatches (p = 0.05) and donor age (p = 0.03) were independent predictors of the MCS score., Conclusions: There was no evidence of differences in HRQoL according to lisinopril or nifedipine, or living vs. cadaveric donor transplantation. HRQoL was significantly reduced with longer cold ischemia time and more than one HLA-AB mismatches, after adjusting for age. These donor kidneys related issues need confirmation.

Background: Phyllodes tumours are rare neoplasms of the female breast. Tumours range from the benign to the highly malignant. Based on histological growth pattern, number of mitoses, pleomorphism and stroma characteristics, tumours are classified as malignant, borderline, or benign. After surgical treatment of malignant phyllodes tumours, ten-year survival of 42% is reported. Metastatic tumours have a poor prognosis with no long-term survival., Material and Methods: We present the case history of a 59-year-old woman with a pulmonary metastasis from a malignant phyllodes tumour of the breast., Results: The patient presented with a rapidly growing tumour of the right lung. Because of suspected malignancy, bilobectomy of the right lung was performed. Microscopic examination of the resected specimen showed a metastasis from a malignant sarcomatous tumour. Review of the specimen from a mastectomy 14 months earlier, for what was then considered a benign phyllodes tumour, confirmed a diagnosis of a primary malignant phyllodes tumour with pulmonary metastases., Interpretation: Diagnosis and treatment of phyllodes tumours require close cooperation between the radiologist, the pathologist and the clinician.

In a postal survey of all orthopaedic surgery departments performing total hip or knee replacements in Norway, we inquired about the use of hip or knee scoring systems and their impact. All 63 eligible hospitals responded to the questionnaire. Thirteen (21%) reported routine use of hip clinical scoring systems, and five (9%) used knee clinical scoring systems. The Harris hip score and The Knee Society clinical rating system were the most prevalent. We received five different versions of the Harris hip score. The regional/university hospitals most commonly used clinical scoring systems. The adoption of clinical scoring systems did not differ with the annual procedure volumes of the hospitals.

Background: Hospitals in Norway are undergoing changes in structure and organisation. Patient experience has been selected as a national indicator of hospital quality. The objective of this study was to investigate the relationship between hospital size and patient experience., Material and Methods: A patient experience questionnaire was sent to a representative sample of patients after discharge from 46 somatic hospitals, which were classified by function and by annual number of patients admitted., Results: 10,975 patients (50%) responded. Generally, the patients expressed a positive attitude towards their hospitals. The patient experience was significantly more positive among those discharged from small hospitals than among those discharged from medium-sized or large hospitals, especially with regard to organisation., Interpretation: Our study shows that patient experience was significantly more positive among those discharged from small hospitals than from medium-sized or large hospitals, especially with regard to organisation. However, the score differences between hospitals are small and should be interpreted with caution.

Objective: This article compares preference-based utilities from the multiattribute utility instrument 15D with those derived from the EQ-5D and the Short Form 36 (SF-6D) in patients with HIV/AIDS. In particular, we wanted to examine if the finer descriptive system of the 15D would result in better discriminative capacity or responsiveness., Methods: In a prospective observational study of 60 Norwegian patients with HIV/AIDS from two hospitals, the authors compared scores, assessed associations with disease staging systems, and assessed test-retest reliability and responsiveness of the instruments., Results: On average, the 15D gave higher utility scores than the other two measures, the mean utility scores were: 15D--0.86, SF-6D--0.73, and EQ-5D Index--0.77. Test-retest reliability was acceptable for all measures, with intraclass correlation coefficients between 0.78 and 0.94. The correlation between scores of the 3 scales was substantial (p = 0.74-0.80). There was no major difference in responsiveness between the measures., Conclusions: The different measures gave different utility values in this sample of patients with HIV/AIDS, although many of the measurement properties were similar. There was no evidence for better discriminative capacity or responsiveness for the 15D, than for the two other multiattribute measures.

The aim of this study was to validate the Norwegian version of the Seattle Angina Questionnaire (SAQ), a self-administered 19-item questionnaire designed to assess health-related quality of life in patients with chest pain or coronary artery disease. In 885 patients with prior myocardial infarction (MI), we abstracted clinical data from the patients' medical records. Two to three years after the MI, we mailed a self-administered questionnaire including the SAQ, the Short Form 36 (SF-36), and questions about current medication, to the 548 patients still alive. The response rate was 74%. Internal consistency reliability of the SAQ, assessed with Cronbach's alpha, ranged 0.75-0.92. Test-retest reliability, tested with an intraclass correlation coefficient, ranged 0.29-0.84. The pattern of association between similar and dissimilar scales of the SAQ and SF-36 mainly supported the construct validity of the SAQ. Four of the five SAQ scales discriminated between patients with different medication regimens as a proxy for severity of angina pectoris. We conclude that the Norwegian version of the SAQ showed acceptable reliability and cross-sectional validity following MI, with properties in line with the original US version.

Background: The Kansas City Cardiomyopathy Questionnaire (KCCQ) is a recently developed disease-specific instrument for measuring health-related quality of life (HRQoL) in patients with chronic heart failure (CHF) regardless of aetiology., Aim: To assess the reliability and validity of the KCCQ in patients with previous myocardial infarction (MI)., Methods and Results: In 754 myocardial infarction patients who were discharged alive, we collected clinical data from the patients' medical records. Two and a half years after the acute myocardial infarction, we mailed a self-administered questionnaire to the 548 patients still alive. The response rate was 74%. Internal consistency reliability, assessed with Cronbach's alpha, ranged 0.66-0.95. Test-retest reliability, tested with an intraclass correlation coefficient (ICC), ranged 0.41-0.83. The pattern of association between similar and dissimilar scales of the KCCQ and Short Form 36 (SF-36) supported the convergent/divergent validity of the KCCQ. Four of the KCCQ scales and the two summary scores discriminated between patients with and without medication for heart failure, and between different levels of left ventricular ejection fraction (LVEF) supporting different groups validity., Conclusions: The Norwegian version of the KCCQ showed acceptable reliability and cross-sectional validity, which support the use of this questionnaire to measure health-related quality of life after myocardial infarction.

Aims: To contribute to improved programs for smoking cessation, the authors wanted to assess the relationships between age, gender and ex-smokers' quitting reasons and examine predictors of the most commonly reported quitting reasons., Methods: A questionnaire was mailed to 11,919 subjects in Akershus County, Norway. Among the 7,697 respondents (65%), self-reported reasons for smoking cessation in 1,715 ex-smokers were analysed. Using cross-tables and multivariate logistic regression, associations between age, gender, and reported quitting reasons were examined., Results: Men were more likely to have stopped smoking to improve physical fitness, or out of consideration for other family members than the children, and less likely to have quit out of consideration for their own children, or in solidarity with a spouse that stopped smoking. In multivariate logistic regression analysis, age was a predictor of all seven most common reasons to quit smoking. Gender, education, and the physical component of health status each predicted three of the seven quitting reasons., Conclusions: In the study sample, differences in smoking cessation behavior and reported quitting reasons were found according to both age and gender. Smoking cessation programs should be tailored to the relevant target groups, including stratification according to age and gender.

This study evaluates if there was a difference in long-term survival between epilepsy surgery patients, individually matched controls with intractable epilepsy, and controls from the general population. In a cohort study, we compared the survival of patients operated with epilepsy surgery in Norway 1948-1988 with: (1) a control group with prolonged medical treatment for intractable epilepsy individually matched for age, gender, and seizure type (n = 139), and (2) expected mortality for matched individuals in historical cohorts of the general population (n = 196). Survival was compared using Kaplan-Meier curves and stratified proportional hazards analysis. After on average 25 years of observation after surgery, there was no difference in survival between the epilepsy surgery group and the controls with intractable epilepsy (p = 0.18). The risk ratio for death after epilepsy surgery was 0.6 (95% CI 0.4-1.1; p = 0.08) compared with the control group. However, survival of epilepsy surgery patients was lower than that of a matching general population (p < 0.001), with a risk ratio for death of 6.2 (95% CI 3.1-12.6; p < 0.001). In this long-term study of a national cohort of epilepsy surgery patients, we found no beneficial effect of epilepsy surgery on survival compared with a control group of medically treated patients with intractable epilepsy. The mortality after epilepsy surgery was higher than expected in the general population.

Background: Few studies have focused on the association between the sociodemographic characteristics of a patient with the change in health-related quality of life (HRQOL) following invasive coronary procedures, and the results remain inconclusive. The objective of the present study was to measure the temporal changes in HRQOL of patients with coronary heart disease, and assess how these changes are associated with invasive coronary procedures and sociodemographic characteristics., Methods: This was a prospective study of 254 patients with angina pectoris and 90 patients with acute coronary syndrome. HRQOL was assessed with the multi-item scales and summary components of the SF-36, both 6 weeks and 2 years after baseline hospitalization in 1998. Paired t-tests and multiple regression analyses were used to assess temporal changes in HRQOL and to identify the associated factors., Results: Physical components of HRQOL had improved most during the 2 years following invasive coronary procedures. Our findings indicated that patients with angina pectoris who were younger, male, and more educated were most likely to increase their HRQOL following invasive coronary procedures. When adjusting for baseline HRQOL scores, invasive coronary procedures and sociodemographic characteristics did not explain temporal changes in patients with acute coronary syndrome, possibly due to higher comorbidity., Conclusion: Sociodemographic characteristics should be taken into account when comparing and interpreting changes in HRQOL scores in patients with and without invasive coronary procedures.

Objectives: To assess predictors of outcome of temporal lobectomy for intractable epilepsy., Material and Methods: In 63 adult patients operated with anterior temporal lobectomy during 198892, we used logistic regression analysis to assess predictors of being seizure-free (Engel's class I) 2 years after surgery. As potential predictors, we included the following variables: gender, age at operation, age at onset of seizures, epilepsy duration, etiology, generalized vs not generalized seizures, seizure frequency, intelligence quotient, ictal electroencephalography, magnetic resonance imaging (MRI), single-photon emission computed tomography (SPECT), side of resection, and extent of the resection., Results: About 44% of the surgery patients were seizure-free (Engel's class I) 2 years after surgery. In multivariate analysis (n = 55), MRI pathology defined as atrophy in the temporal lobe, angioma, tumor or mesial temporal sclerosis (odds ratio, OR 7.4, 95%CI: 1.7-32.9) and extent of the hippocampal resection (increase of 1 cm) (OR 2.2, 95%CI: 1.1-4.6) predicted being seizure-free., Conclusion: Focal pathology in preoperative MRI and the extent of the hippocampal resection were the only significant predictors of being seizure-free after 2 years.

The aim of this study was to validate the Norwegian version of a self-administered 30-item quality of life questionnaire designed to assess disorders of excessive sleepiness, the Functional Outcomes of Sleep Questionnaire (FOSQ). In total 226 patients previously evaluated for obstructive sleep apnea were included in the study. The patients received a postal questionnaire with the FOSQ, the Short Form 36 (SF-36) questionnaire, and a scale for assessment of excessive daytime sleepiness, the Epworth sleepiness scale (ESS). Among the 178 respondents, all five subscales of the FOSQ showed good internal consistency reliability (Cronbach's alpha = 0.84-0.93). Test-retest on average 18 days apart was satisfactory with intraclass correlation coefficients ranging from 0.61 to 0.86. The pattern of Spearman's rank correlation coefficients between FOSQ scales and related and unrelated scales SF-36 scales gave support to the construct validity of the FOSQ. In conclusion, the Norwegian translation of the FOSQ showed satisfactory internal consistency reliability, test-retest reliability and construct validity, in line with the original version.

Background: This is the first survey of therapeutic hemapheresis in Norway. The purpose was to collect data from all Norwegian dialysis and blood units performing hemapheresis treatment and stem cell collection for comparison with Swedish data., Materials and Methods: Questionnaires were sent to all regional and central hospitals in Norway including two specialized centres for stem cell apheresis. The questions included the number of hemapheresis procedures, patients, and indications., Results: All units responded to the questionnaire. There were 17 dialysis units; seven blood units and two special units who performed 2,141 procedures. 12 units did not carry out any hemapheresis treatment at all. There were five stem cell collections per 100,000 inhabitants and 42.5 therapeutic apheresis procedures per 100,000 inhabitants., Interpretation: Hemapheresis treatment is performed in all Norwegian health regions. The indications are quite similar to those reported from Sweden except for stem cell collections and erythrocytaphereses. The dominance of the dialysis units in the total number of procedures performed and the prominent use of filtration techniques are special features of the Norwegian practice of apheresis.

Background: As part of an evaluation of the lung cancer surgery at Akershus University hospital we wanted to describe the lung cancer surgery programme, assess 30-day mortality and review complications., Material and Method: We retrospectively examined medical records of all patients undergoing potentially curative surgery for non-small-cell lung cancer., Results: The 99 patients operated on were aged 37-83 years (mean 63 years). 31% were women. 30-day mortality was 5% in total; 4% for lobectomy and 8% for pneumonectomy. No complication was recorded in 68% of the cases., Interpretation: Age and gender distribution in the sample was in line with the experience of others. The results were in accordance with international recommendations, for example from the British Thoracic Society: 30-day mortality not in excess of 4% for lobectomy and 8% for pneumonectomy.

In a survey of therapeutic hemapheresis in Norway, we sent a questionnaire to all regional and central hospitals, asking about hemapheresis activities, patients, indications, and adverse events. All units responded to the questionnaire: 17 dialysis units, 7 blood units, and 2 specialized units for stem cell apheresis. In total, they performed 2141 procedures that is 5.0 stem cell collections and 42.5 therapeutic apheresis procedures per 100,000 inhabitants. The most frequent indications were Guillain-Barré syndrome, hypercholesterolemia, and myasthenia gravis. Adverse effects were frequent, but mild. Dialysis units performed a majority of the procedures, leading to an extensive use of filtration techniques.

Background: Stroke severity is an important determinant of outcome, however, quantitative data on the initial neurological status might be lacking in retrospective studies. We wanted to assess the reliability and validity of the retrospective use of the Canadian Neurological Scale (CNS)., Methods: In 181 patients with validated stroke, two raters scored the CNS based on medical record review. We assessed interrater reliability and construct validity of the CNS. Predictive validity was assessed by the ability of the CNS to predict 30-day and 1-year mortality., Results: Interrater reliability was high (kappa or weighted kappa 0.76-0.96). Correlations between similar items of prospective Scandinavian Stroke Scale scores and retrospective CNS scores ranged from 0.54 to 0.85. CNS total score was a strong predictor of death within 30 days and 1 year in multivariate models., Conclusions: The retrospective algorithm for the CNS had a high to substantial interrater reliability and predictive validity. Accordingly, in retrospective stroke studies using medical record information, the CNS can be a feasible instrument to adjust for differences in stroke severity., (Copyright 2003 S. Karger AG, Basel)

Aims: The purpose of this study was to assess whether work characteristics and morbidity are predictors of physical, psychological, and social functioning in physicians., Methods: A cross-sectional study was undertaken of 1126 Norwegian physicians. For comparison of health status scores, the Short Form 36 questionnaire was used, adjusting for differences in age and gender where applicable. Somatic morbidity was classified on the basis of self-reported conditions and psychiatric morbidity with score on the 25-item Hopkins symptom checklist using a cut-off indicating clinical psychiatric disease. Multiple logistic regression analysis was used with SF-36 dimension score below/above the 10th percentile as the dependent variable., Results: In the multivariate model, psychiatric comorbidity was a significant predictor in 7 of 8 dimensions of health status (odds ratio 0.17 to 0.49), and somatic comorbidity in 6 of 8 dimensions of health status (odds ratio 0.33 to 0.59). Working hours was a significant predictor of only one dimension of health status, general health, after adjustment for demographic and work-related variables., Conclusions: The most important predictors for most dimensions of health status among Norwegian physicians were the presence or absence of self-reported somatic or psychiatric morbidity, while working hours, choice of specialty, and position were less important.

Objective: In a system with implicit queue management, to examine gender and socioeconomic status as determinants of waiting time for inpatient surgery, after adjusting for other potential predictors., Methods: A cohort of 452 subjects was examined in outpatient clinics of a general hospital and referred to inpatient surgery. They were followed until scheduled hospital admission (n=396) or until the requested procedure no longer was relevant (n=56). We compared waiting time between groups from referral date until hospital admission, using Kaplan-Meier estimates of waiting times and log rank test. A Cox proportional hazards model was used for assessing the risk ratio (RR) of hospital admission for scheduled surgery., Results: Gender and socioeconomic status could not explain variations in waiting time. However, patients with suspected/verified neoplastic disease or a risk of serious deterioration without treatment had markedly shorter waiting times than the reference groups, with adjusted RR (95% confidence intervals (95%CI)) of time to receiving in-patient surgery of 2.3 (1.7-3.0) and 2.0 (1.3-3.0), respectively. Being on sick leave was associated with shorter waiting time, adjusted RR of 1.7 (1.2-2.5). Referrals from within the hospital or other hospitals had also shorter waiting times than referrals from primary health care physicians, adjusted RR=1.4 (1.1-1.8)., Conclusions: There was no evidence of bias against women or people in lower socioeconomic classes in this implicit queue management system. However, patients' access to inpatient surgery was associated with malignancy, prognosis, sick leave status, physician experience, referral pattern and the major diagnosis category.

Background: We wanted to assess the quality of coding of diagnoses and procedures, the resulting DRG classification and the financial consequences of coding errors for the hospital owner in patients with chronic obstructive pulmonary disease., Material and Methods: We identified 330 hospitalizations in the Central Hospital of Akershus 1 January to 30 November 1999 in DRG 088 (chronic obstructive pulmonary diseases) after an initial DRG classification. The patients' discharge summaries were reviewed for errors in coding of diagnoses and procedures and, where applicable, recoded. DRG classification was then redone and the changes analysed., Results: After review of 302 available discharge summaries (92%) and recoding, the most common primary diagnoses were chronic obstructive pulmonary disease (68%), respiratory failure (17%), and pneumonia (8%). The recoding led to change of the primary diagnosis in 16% of the patient stays, additional secondary diagnosis (18%) or both (18%). The coding was changed for 175 (58%) patients, of which 94 recodings (31%) led to changes in the resulting DRG. On average, the recoding led to an increase per hospitalization of 0.30 DRG points. Two of five coders frequently used respiratory failure as the primary diagnosis (37-43% for hospitalization)., Interpretation: The initial routine coding was incomplete. There was large variation in recoding between medically qualified coders; this may have considerable financial consequences for a hospital. There were several problems related to the interpretation of ICD-10 coding, creating opportunities for "upcoding".

The objective of the study was to assess the reliability and validity of the Dartmouth Primary Care Cooperative Information Project/World Organization of National Colleges, Academies, and Academic Associations of General Practice/Family Physicians (COOP/WONCA) questionnaire in outpatients with chronic obstructive pulmonary disease (COPD). The test-retest reliability of individual items of the COOP/WONCA questionnaire was assessed using a weighted kappa-statistic, and construct validity was assessed by correlating items of the COOP/WONCA with the EQ-5D health status measure. Discriminant validity was assessed by comparing scores for known groups, at the same time comparing the results with those of a lung-specific health status questionnaire. The individual items of the COOP/WONCA had test-retest reliabilities of 0.67-0.78 (weighted kappa). Spearman's rank correlations between COOP/WONCA single-item scores and corresponding EQ-5D ranged 0.45-0.72, which were generally higher than associations between non-corresponding items. Four of the five COOP/WONCA items did not discriminate between patient groups divided according to forced expiratory flow in 1 sec (FEV1) in percent of predicted and 6-min walking distance, while four of five items of the lung-specific questionnaire discriminated well between these groups. The COOP/WONCA chart system was reliable and showed properties supporting the construct validity of the measure. The items, however, did not discriminate well between known groups, indicating that this questionnaire is not very sensitive in patients with COPD. The reliability of the COOP/WONCA items was acceptable for use at group level, but lower than current recommendations for use in individual patients.

Setting: Willingness to pay (WTP) is a method frequently used to measure the benefits of health interventions in monetary terms., Objective: To assess the construct validity of the WTP method in patients with chronic obstructive pulmonary disease (COPD)., Design: Fifty-nine COPD patients (34 men, mean age 57 years) were asked about their maximum WTP for a theoretical cure for COPD. In addition, they reported utility scores using standard gamble, time trade-off, a multi-attribute utility instrument, and a rating scale. They also responded to the Short Form 36 (SF-36) questionnaire, dyspnea measures and had comprehensive pulmonary function tests., Results: The participants reported a median WTP of Norwegian kroner 200 000 (US $24 096) for a theoretical cure for COPD without side-effects. The associations of WTP with utility scores, dimensions of health status, dyspnea measures and lung function tests were low., Conclusion: The findings of this study question the validity of the WTP method in patients with chronic obstructive pulmonary disease.

This study assessed the relationship between time preference for health and age and disease severity. An implicit time preference for health was inferred in 59 patients with chronic obstructive pulmonary disease (COPD) using the time tradeoff method with 10-year and 30-year perspectives. The preference rate was calculated by solving the resulting nonlinear equation, solvable for 50 patients.Among the resulting rates, 4 were negative, 8 zero, and 38 positive. The time preference rate ranged from -10.8% to 75.0%, with a median of 6.6%, and a mean of 11.5%. In correlation analysis, the implicit time preference rate was associated with age;however, there was little association with markers of disease severity. In multivariate analysis, only age was a significant predictor of time preference rate after controlling for the other variables in the model.

Background: Recent meta-analyses have reported a beneficial effect of stroke units compared with traditional care, both on patient survival and on dependency after one year., Aim: To determine whether these results can be reproduced outside a clinical trial setting., Setting: A medium-sized general hospital., Methods: From 1993 to 1998, all patients aged >60 years with suspected acute stroke were allocated either to a stroke unit or general medical wards according to date of birth (day of the month). Patients were identified retrospectively, using a discharge diagnosis of ICD-9 codes 431, 434 and 436. We assessed 30-day and 1-year survival., Results: In the stroke unit, 926/1128 patients survived at 30 days, vs. 905/1141 in the general medical wards (p=0.08). Beyond the first 30 days, there was no difference in survival (p=0.27). Under Cox regression analysis, there was a 20% reduction in mortality in the stroke unit after 30 days compared with the general medical wards (RR 0.80, p=0.02) after adjusting for age, gender, stroke type and season of the year., Discussion: In this, the largest single-centre study to evaluate the survival benefit of a stroke unit, survival at 30 days was increased, although not significantly so. Survival at one year was unchanged.

Objectives: To assess to what extent patient, disease and referral characteristics influenced physicians' assessment of urgency of inpatient surgery., Methods: In total, 452 patients, mean age 50 years, were examined in surgical or gynaecological outpatient clinics in one hospital and referred for inpatient surgery. Data were collected by the examining physician, and the patients were either given a maximal waiting time or the waiting time was not specified. A stepwise logistic regression, with urgency for surgery within four weeks or less as the dependent variable, was used. The results are presented as adjusted odds ratios (OR) with 95% confidence intervals (CI)., Results: Of 452 patients, 181 (40%) were deemed urgent (four weeks or less). In multivariate logistic regression analysis, suspected or verified malignant disease (OR 3.45, 95% CI 2.11 to 5.64), risk of serious deterioration (OR 4.53, 95% CI 2.17 to 9.46), being on sick leave from work (OR 3.97, 95% CI 1.82 to 8.64) and being assessed by a physician undergoing specialist training (OR 1.99, 95% CI 1.24 to 3.21) were significant predictors of being assessed as needing inpatient surgery urgently., Conclusions: Physicians' judgements, in an informal way, internalize many of the public's concerns for fairness, such as the severity of a condition, the potential for improvement and aversion to inequalities in health. More research is needed to understand the difference in urgency ratings between junior and more experienced physicians.

Aims: To compare the self-perceived health status of a representative sample of Norwegian physicians with a general reference population; and to investigate differences in health status among groups of physicians., Methods: A cross-sectional postal survey was carried out of 1,126 Norwegian physicians and 1,742 subjects in a general reference population, using the widely used general health status questionnaire--Short Form 36 (SF-36). Scores were adjusted for differences in age, gender and education where applicable., Results: The health status of Norwegian physicians was better than that of subjects with a lower level of education in the four dimensions of the SF-36 related to physical health. Male physicians scored better on the physical functioning scale and lower on vitality and social functioning than comparable university graduates. Older physicians scored better than younger in dimensions related to mental health and social functioning. Norwegian general practitioners reported better health status than colleagues in Sweden and the UK., Conclusions: The self-perceived health status of Norwegian physicians was as good or better than that of the general population. The cross-national differences could be caused by cultural differences, or be related to practice style or job strain.

To perform economic evaluation studies in epilepsy using utilities, such as cost-utility analyses, it is necessary to have reliable and valid instruments for eliciting people's preferences. The objective of this study was to assess the reliability and validity of two multiattribute utility measures in a community sample of 397 people with epilepsy. We assessed the test-retest reliability of individual questionnaire items and aggregate scores. Additionally, construct validity was assessed by correlating items of the EQ-5D with items of the 15D health status questionnaire, and discriminant validity was assessed by comparing scores for known groups. The test-retest reliabilities for the individual items of the 15D (weighted kappa 0.59-0.90, except mobility with only 0.28) and the EQ-5D (weighted kappa 0.49-0.86) were acceptable. For the composite utility scores the test-retest reliability was better (intraclass correlation coefficient 0.93 for both 15D and the EQ-5D). Spearman's rank correlations between EQ-5D single item scores and corresponding 15D single item scores were high (rho 0.34-0.79) and generally higher than the associations between non-corresponding items. Some EQ-5D and 15D items discriminated well between patients according to seizure status, psychiatric comorbidity and working status; less well after antiepileptic drug use and neurologic comorbidity. Both the EQ-5D and 15D were reliable instruments and showed properties supporting the construct validity of both measures.

Objectives: Patients with stroke receiving organised inpatient (stroke unit) care after stroke are more likely to be alive and independent compared with patients offered conventional care. The objective was to determine the effect of an acute stroke unit on patients with primary intracranial haemorrhage., Methods: In a prospective controlled study, the effect of an acute stroke unit was examined on 30 day and 1 year mortality in patients with primary intracranial haemorrhage. Patients treated in general medical wards served as controls., Results: Of 121 patients included, 56 were allocated to an acute stroke unit and 65 to a general medical ward. The 30 day mortality rate was 39% in the acute stroke unit compared with 63% in the general medical wards, and the 1 year mortality rates were 52% and 69%, respectively. There was a difference between the 30 day and 1 year survival curves between the groups (p=0.007 and 0.013, respectively); however, there was no difference in survival between 30 and 365 days. There was no difference in risks of being discharged home or to long term care between the groups., Conclusions: In this study admission to an acute stroke unit reduced mortality 30 days and 1 year after primary intracranial haemorrhage, which could be attributed to a large difference in survival during the first 30 days.

The objective of this study was to assess the effect on health-related quality of life of acupuncture and sham acupuncture as adjunctive treatment in intractable epilepsy. We performed a randomized controlled trail with two parallel treatment arms at The National Center for Epilepsy in Norway, a comprehensive epilepsy center. Thirty-four patients with long-standing drug resistant epilepsy completed the study. The intervention consisted of 20 acupuncture treatments (bilateral needling of three acupoints plus one or two individually chosen points) or sham acupuncture (bilateral needling with smaller needles of three points outside the traditional meridians) over 8 weeks. The main outcome measures were changes in mean health-related quality of life scores for the two groups after 8 weeks, using the 89-item Quality of Life in Epilepsy (QOLIE-89) questionnaire. We found no difference between the acupuncture and sham acupuncture groups in score changes in any dimension of the QOLIE-89 questionnaire, despite testing a large number of dimensions. We also found no change in QOLIE-89 scores between baseline and 8 weeks in either groups. In conclusion, we could not demonstrate a significant effect of traditional acupuncture or sham acupuncture on the health-related quality of life of patients with intractable epilepsy., (Copyright 2000 BEA Trading Ltd.)

Insensitive lung-specific questionnaires may explain the poor association between arterial P(O2) and reported health-related quality of life. Conceivably, modern lung specific or generic quality of life measures might show a better association with arterial P(O2). Fifty-nine outpatients (34 men) with chronic obstructive pulmonary disease (COPD) who fulfilled the following criteria were studied: age 18-67 years, FEV1 < or = 70%, < or = 15% reversibility after beta2-agonist inhalation, and no other disabling disorders. All completed the Respiratory Quality of Life Questionnaire (RQLQ) and Short Form 36 (SF-36), and were tested with spirometry and arterial blood gases. In accordance with available COPD staging systems, patients were divided into those with an FEV1 of < 50% and 50-70% of predicted. Patients' characteristics were, [mean (SD)]: age: 57.0 years (9.0); FEV1: 1.46 (0.6). Spearman's rank correlations between arterial P(O2) and dimensions of the RQLQ ranged from 0.25-0.52, and were greater than for the SF-36 (0.14-0.36) in patients with moderate to severe COPD. The association between arterial P(O2) and quality of life scores in moderately to severely affected COPD patients was moderate, but higher than previously reported. The associations were higher with a lung-specific questionnaire than with a general health measure, indicating a higher sensitivity of the lung-specific measure in this patient group.

Scenarios are known from the film industry, as detailed descriptions of films. This has given name to scenario analysis, a method for long term planning using descriptions of composite future pictures. This article is an introduction to the scenario method. Scenarios describe plausible, not necessarily probable, developments. They focus on problems and questions that decision makers must be aware of and prepare to deal with, and the consequences of alternative decisions. Scenarios are used in corporate and governmental planning, and they can be useful and complementary to traditional planning and extrapolation of past experience. The method is particularly useful in a rapidly changing world with shifting external conditions.

This article examines two scenarios, published in 1987, for the future development of Norwegian health care towards the year 2000. The scenarios emphasize different external forces and priorities. The 1987 scenarios are then assessed in the light of actual developments during the period. Scenario I describes a picture characterised by reduced economic growth 1987-2000 compared to previous decades, resulting in a year 2000 health care system with limited resources and hard priorities, focus on cost containment, increased efficiency, and search for alternative solutions. In Scenario II, the year 2000 health care system had more resources; however, the demand for services was as high or higher than in the 1980s. Instead of improvements in efficiency, alternative modes of financing health care and social security had evolved. Increasing knowledge among consumers, dissatisfaction and new technology had driven up costs, and health care professions tried to take advantage of the situation. This scenario is characterized by people wanting more, and getting more.

Background: Studies on the health-related quality of life in lung transplantation have used general questionnaires, although lung-specific instruments might be more sensitive to small differences., Objectives: To compare the health-related quality of life of lung transplant recipients with lung transplant candidates, using lung-specific and general instruments, and to assess the reliability and validity of these questionnaires., Methods: The study is a cross-sectional postal survey of 31 lung transplant recipients and 15 candidates, using the following outcome measures: St. George's Respiratory Questionnaire (SGRQ), a lung-specific health status instrument; the Short Form 36 (SF-36), a general measure, and the Hospital Anxiety and Depression scale (HAD)., Results: The SGRQ showed a significantly better score (p < 0.05) for transplant recipients in the impacts and activity dimensions and the total score than for candidates. SF-36 scores showed a similar improvement in all subscales of the SF-36 except bodily pain. Cronbach's alpha for all dimensions of the SGRQ, SF-36, and HAD were 0.77-0.95., Conclusions: Patients surviving lung transplantations can expect a considerable improvement in most dimensions of health-related quality of life. This finding was consistent using both lung-specific and general measures. The reliability of the questionnaires was acceptable. The associations between scales support the validity of the questionnaires in this setting., (Copyright 2000 S. Karger AG, Basel.)

Purpose: To study the impact of epilepsy in a representative sample of people with epilepsy and compare with a normal reference population., Methods: We collected clinical and demographic data and information on health status by using the Short Form 36 (SF-36) questionnaire in two populations: (a) 397 patients with confirmed epilepsy attending a county hospital during a 7-year period, and (b) 1,663 patients from a random sample representative of the entire national population., Results: The respondents with epilepsy had well-regulated disease and showed the characteristics of a community sample: 70% had had no seizures during the last year, and 80% used antiepileptic drugs (AEDs). On six of eight SF-36 scales, patients with epilepsy had lower scores than the normal reference population, and they were less likely to be married, employed, or a full-time student. Seizure-free patients with epilepsy had scores close to those of the normal reference population, with higher scores on the social functioning and mental health scales and lower on the role--emotional scale. There were no differences in health status scores between seizure-free patients using and not using AEDs., Conclusions: Our results confirm that patients with well-regulated epilepsy have a health status at the level of a general reference population.

Purpose: To develop a Norwegian version of the Quality of Life in Epilepsy Inventory (QOLIE-89) and to confirm its psychometric properties., Methods: The QOLIE-89 was adapted to Norwegian language through a translation-backtranslation procedure. The assessment included 397 patients with epilepsy. We assessed internal consistency and test-retest reliabilities. Construct validity was assessed by correlating scales with items of the 15D health status questionnaire, and discriminant validity was assessed by comparing scores for known groups., Results: The internal consistency reliability (Cronbach's alpha, 0.76-0.92) and test-retest reliability (intraclass correlation coefficient, 0.67-0.96) for the individual domains were acceptable. Spearman's rank correlations between QOLIE-89 domain scores and corresponding 15D single-item scores were high (p, 0.47-0.76), and generally higher than the associations between noncorresponding items. Most QOLIE-89 items discriminated well between patients according to seizure status, psychiatric comorbidity, and working status; less well after antiepileptic drug use and neurologic comorbidity., Conclusions: In this cross-sectional survey, the Norwegian version of the QOLIE-89 was reliable and showed properties supporting construct validity, at a level comparable with the original U.S. version.

In a cost-minimization study, we compared tympanic and rectal body temperature measurement in inpatients in a department of internal medicine. At all measurement volumes in a sensitivity analysis, tympanic temperature measurement had markedly lower average cost than rectal measurement, indicating a large savings potential if the former technique is used.

The objective of this study was to compare the health-related quality of life (HRQL) of patients with epilepsy with populations suffering from different chronic diseases, using the short form 36 (SF-36) health profile measure. The populations to be compared were adult patients drawn from hospital based registers, with confirmed epilepsy (n = 397), angina pectoris (n = 785), rheumatoid arthritis (n = 1,030), asthma (n = 117) and chronic obstructive pulmonary disease (COPD) (n = 221). Health-related quality of life scores were compared using analysis of covariance (ANCOVA) for predicting mean scores adjusted for age, gender, education and comorbidity. Patients with epilepsy on average scored highest on all scales, reflecting that in our sample the majority had well-controlled epilepsy. Our results indicate that the HRQL of a representative sample of patients with epilepsy is good, when compared with other chronic disorders, although reduced in several dimensions compared with a general reference population. Patients with rheumatoid arthritis (RA) and COPD scored lowest on the physical function scales, while rheumatoid arthritis patients reported most pain.

The aim of our study was to identify predictors for recurrence of epileptic seizures in a large county hospital population. We identified 956 patients (18-67 years) with ICD 9 code 345 as primary diagnosis, seen at the Central Hospital of Akershus over 7 years (1987-1994). The diagnosis of epilepsy was confirmed for 696 of the patients. These were divided into two groups: (1) no seizures during the previous year (n = 485) and (2) seizures during the previous year (n = 184). To identify predictors for recurrence of seizures, we used neurologic deficit, number of AEDs used, CT-scan findings, EEG findings, aetiology, gender, age below and above 50 years and comorbidity as independent variables in a logistic regression model. In a univariate analysis, the strongest predictors for recurrence of seizures were: age above 50 years (OR = 5.2;P < 0.0001), known aetiology (OR = 1.4;P = 0.04) and use of two or more AEDs (OR = 5. 7;P < 0.0001). In the multivariate analysis age, more than 50 years (OR = 1.7;P = 0.0216) and use of two or more AEDs (OR = 5.6;P < 0.0001) were the only predictors for recurrence of epileptic seizures., (Copyright 1999 BEA Trading Ltd.)

Setting: A secondary hospital outside Oslo., Objective: To assess relationships between health status and measures of dyspnea, lung function and exercise capacity in patients with chronic obstructive pulmonary disease (COPD), to identify dimensions where lung-specific instruments associate and discriminate better than general measures., Design: We assessed health status in 59 out-patients with COPD, using the following instruments: Short Form 36 (SF-36)-a general health status measure, Respiratory Quality of Life Questionnaire (RQLQ)-a lung-specific measure, the Karnofsky performance scale, and a rating scale. All patients rated their dyspnea and had spirometry and exercise capacity measured., Results: Mean (SD) patient age was 57.3 (9.7) years, FEV1 47% (15%) of predicted, 6 minute walk distance 503 m (122 m). Dyspnea was the strongest predictor for health status. Both SF-36 and RQLQ had dimensions associating well with dyspnea and exercise capacity. The associations with FEV1 ranged from none to moderate., Conclusion: All RQLQ scales had a moderate to substantial association with indices of dyspnea and exercise capacity, while the SF-36 associated well only in dimensions related to physical health. The general measure has a broader scope and complements the lung-specific measure. These findings support the construct validity of both the SF-36 and the RQLQ, and justify using a general measure to supplement a lung-specific measure.

The objective of this study was to assess the performance of a lung-specific health status measure in patients with chronic obstructive pulmonary disease (COPD). We used the Respiratory Quality of Life Questionnaire (RQLQ), a modification of an Australian questionnaire intended for asthma patients and adapted in this study to fit patients with COPD also. For comparison we chose the general health profile measure Short Form 36 (SF-36). We assessed the five RQLQ scales and eight SF-36 scales for reliability, validity and responsiveness in 59 outpatients attending a Norwegian hospital for COPD. Statistical analysis included internal consistency, test-retest reliability and convergent validity between the two questionnaires. Responsiveness was assessed in patients reporting global change in health status over 1 year. All scales of the RQLQ showed good internal consistency (Cronbach's a = 0.85-0.94) and test-retest reliability (intraclass correlation coefficient = 0.86-0.94), as did the SF-36 scales (a = 0.66-0.90) and intraclass correlation coefficient = 0.60-0.86). Pearson correlations between scales with similar items ranged from 0.54 to 0.76, supporting the construct validity of both questionnaires. The RQLQ had responsive scales, showing significant changes in the expected direction over 1 year. We conclude that the RQLQ showed an acceptable reliability, construct validity and responsiveness in COPD patients, encouraging further use of this questionnaire.

Contingent valuation using willingness to pay (WTP) is one of the methods available for assessing the value of a new technology or treatment for a disease in monetary terms. Experience with this method is lacking in epilepsy. The objectives of this study were to assess the acceptability of the WTP method in epilepsy, the level of the responses, and to investigate its validity by comparison with other non-monetary preference measures. Among 397 patients with epilepsy responding to a comprehensive questionnaire, 82 were randomly selected for an interview. They were asked about their WTP for an imaginary new technology which could permanently cure their epilepsy. Fifty-nine patients participated and 57 completed the interview (32 women; mean age 44 years), the majority with well-controlled epilepsy. The patients indicated a median WTP of Norwegian Kroner (NOK) 150,000 (USD 20,000; GBP 11,800), interquartile range NOK 50,000-350,000 (USD 6, 667-46, 667; GBP 3,937-27,559) for this cure. Non-response was low, indicating high acceptability of this method. There was little association between WTP and other preference measures; the Spearman rank correlation coefficient was -0.09 and -0.12 with time trade-off and standard gamble respectively, questioning the validity of this method.

The objective of the study was to evaluate the reliability, validity and responsiveness of two generic multiattribute methods for measuring utility for health states: a 15-dimensional (15D) and a five-dimensional method (EuroQol and EQ-TTO). A self-administered questionnaire with both measures was used in 59 outpatients with chronic obstructive pulmonary disease and the findings compared with standard gamble (SG) and time trade-off (TTO) utilities, spirometry and arterial blood gases. Quality of life scores were smallest for EQ-TTO (median 0.73) and highest for SG and TTO (median 0.91 and 0.95 respectively), while 15D gave intermediate values (median 0.80). The test-retest reliability over 14 days was: 15D (p = 0.90) and EQ-TTO (p = 0.73), using Spearman's rank correlation. 15D was better than EQ-TTO at discriminating between groups of patients after reported global rating of change over 12 months (P = 0.004 versus P = 0.09), indicating that 15D was more responsive. The 15D instrument has many attractive properties when compared to the EQ-TTO method, including a better reliability and responsiveness. Validity depends on validation method. The findings in this study indicate that the different utility measures measure different aspects of health-related quality of life (HRQoL). Caution should be taken when choosing utility instruments in cost-utility studies, as this can strongly influence the results.

Several specific and general measures are available for the assessment of overall health related quality of life in epilepsy. Few of the commonly used measures provide utility weights for use in cost-utility analyses. This study compares four methods for measuring utility weights: time trade-off (TTO), standard gamble (SG), 15D, end the EuroQol visual analog scale. All patients aged 18-67 years with a diagnosis of epilepsy, who had been admitted to or attended the outpatient clinic at a large county hospital 1987-1994, received a comprehensive questionnaire. From 397 respondents, 82 patients were randomly selected. Most of the 57 patients completing the study generally had well-controlled epilepsy, but were still on anti-epileptic medication. Mean age was 44 years. Fourty-one percent were male and 59% female. The resulting utility weights differed considerably between the measures, both with regard to central tendency and dispersion. Median utility scores: EuroQol visual analog scale 0.75, 15D 0.90, TTO 0.98, SG 0.99. There was a good association between the EuroQol rating scale and the 15D, and a moderate association between SG and TTO. These preference instruments measure different aspects of health-related quality of life and thus yield different results. Caution should be taken when interpreting cost-utility studies, as results will depend on the choice of utility instrument.

Paracetamol is among the most common substances consumed in self-poisoning attempts. The recommended treatment is intravenous N-acetylcysteine. Adverse reactions to this treatment are relatively common, but are rarely serious. The article reports and discusses a patient who had an anaphylactoid reaction to N-acetylcysteine after an overdose of paracetamol. This reaction was most probably an acute toxic effect of N-acetylcysteine, and not a result of an immunologic hypersensitivity reaction. Reducing the infusion rate of the initial loading dose might reduce the risk of adverse reactions. Recent guidelines recommend giving the loading dose over 60 minutes, instead of 15 minutes.