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BACKGROUND Evidence-based practice (EBP) is regarded as part of the healthcare education curriculum. EBP teaching methods should be multifaceted, interactive, clinically integrated, and include assessment. A mobile app, the EBPsteps, was developed for students to learn and document their EBP skills. OBJECTIVE The aim of this study was to assess occupational therapy students' EBP skills as reported in the EBPsteps mobile app. METHODS A cross-sectional design was applied. Descriptive statistics were used to present frequencies, percentages, mean and range. Associations between formulating PICO/PICo elements and identifying research evidence were analysed with the chi-square test. RESULTS Of four cohorts with 150 students, 119 (79%) students chose to use the app and produced 240 Critically Appraised Topics (CATs). When assessing the students' EBP skills, the EBP steps reflection, searching, and critical appraisal were the steps that the students most often demonstrated an ability to perform correctly. Furthermore, a positive association was found between formulating the Population- and Interventions/Interest-elements of the PICO/PICo and identifying research evidence. Applying the evidence and evaluating practice change were the least frequently correctly reported steps. CONCLUSIONS The steps that proved most difficult to the students have implications and give directions for further development of the EBPsteps app and educational instruction in EBP. EBPsteps is a new and relevant app for students to learn and practice EBP and can be used for assessing the students' EBP skills objectively.

Aim: To investigate the association between nurse–patient interaction and sense of coherence among cognitively intact nursing home residents. Method: In a cross-sectional design, data were collected in 2017 and 2018 using the Nurse–Patient Interaction Scale (NPIS) and the 13-item Sense of Coherence Scale (SOC-13). Of the 204 cognitively intact nursing home residents who met the inclusion criteria, 188 (92%) participated, representing 27 nursing homes. Multiple regression in a general linear model estimated the possible effects of the 14 NPIS items on SOC-13 sum score, the possible effects of the NPIS (sum score) on SOC-13 (sum score) as well as on the subdimensions of SOC-13, comprehensibility, meaningfulness, and manageability (both without and with adjusting for sex and age). Results: Four of the 14 NPIS items revealed highly significant correlations with SOC-13 (sum score; unadjusted and adjusted for age and gender). Furthermore, the analysis adjusted for age and gender showed significant associations for NPIS (sum score) with SOC-13 (sum score), manageability, and comprehensibility. The correlation between NPIS and meaningfulness was not statistically significant. Conclusion: Nurse–patient interaction is significantly associated with SOC-13 and its subdimensions of comprehensibility and manageability but not meaningfulness. Nurse–patient interaction might be an important resource in relation to residents’ sense of coherence and its subdimensions. https://creativecommons.org/licenses/by/4.0/This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).

Objective To evaluate the effect of preoperative web-based information to parents of children undergoing elective ambulatory surgery performed with anesthesia. Outcome measures were parental anxiety, knowledge, and satisfaction. Method The review followed the PRISMA statement. A systematic search of six databases was conducted. Randomized controlled trials, cluster-randomized trials and quasi-randomized controlled trials were eligible for inclusion. Result Eight studies were included. An effect in favour of web-based information compared to standard information was observed for parental anxiety measured before separation from child (SMD=−0.66, 95% CI=−0.92 to −0.40) and after surgery (SMD=−0.55, 95% CI=−0.95 to −0.16), for parental knowledge measured in-hospital (SMD=1.10, Cl 95%=0.37–1.82), and parental satisfaction after discharge (SMD=1.03, 95% Cl=0.41–1.65). No effect was observed for anxiety at separation, and for satisfaction in-hospital. The certainty of the evidence varied from very low to moderate. Conclusion Depending on the timing of assessment, web-based information before pediatric surgery may reduce the level of parental anxiety and increase the level of parental knowledge and satisfaction more than standard care. Practice implications Web-based routines can be used to convey pre-operative information to parents before paediatric ambulatory surgery. Still, standardized research that enables further comparison across studies is needed.

Background and purpose - The optimal cementing technique for primary total knee arthroplasty (TKA) remains unclear. We therefore performed a scoping review based on available studies regarding cementation technique in primary TKA and unicondylar knee arthroplasty (UKA). Patients and methods - A search in 3 databases identified 1,554 studies. The inclusion criteria were literature that studied cementing technique in primary TKA or UKA. This included cement application methods, full or surface cementing, applying cement to the bone and/or prosthesis, stabilization of the implant during curing phase, bone irrigation technique, drilling holes in the bone, use of suction, and the timing of cementation. 57 studies met the inclusion criteria. Results - The evidence was unanimously in favor of pulsatile lavage irrigation, drying the bone, and drilling holes into the tibia during a TKA. All studies concerning suction recommended it during TKA cementation. 7 out of 11 studies favored the use of a cement gun and no studies showed that finger packing was statistically significantly better than using a cement gun. There is evidence that full cementation should be used if metal-backed tibial components are used. Applying the cement to both implant and bone seems to give better cement penetration. Interpretation - There are still many knowledge gaps regarding cementing technique in primary TKA. There seems to be sufficient evidence to recommend pulsatile lavage irrigation of the bone, drilling multiple holes, and drying the bone before cementing and implant insertion, and applying cement to both implant and on the bone. publishedVersion

As the population of divorced adults has increased, the number of remarriages has followed. Previous research has mainly compared first-time marriages with remarriages, whereas this study analyzes ...

Purpose Organizational context is recognized as important for facilitating evidence-based practice and improving patient outcomes. Organizational context is a complex construct to measure and appropriate instruments that can quantify and measure context are needed. The aim of this study was to translate and cross-culturally adapt the Alberta Context Tool (ACT) to Norwegian, and to test the reliability and structural validity among registered nurses (RNs) and licenced practice nurses (LPNs) working in nursing homes. Methods This study was a validation study utilizing a cross-sectional design. The sample consisted of n = 956 healthcare personnel from 28 nursing homes from a municipality in Norway. In the first stage, the ACT was translated before being administered in 28 nursing homes. In the second stage, internal consistency and structural validity were explored using Cronbach’s alpha and confirmatory factor analysis. Results A rigorous forward-and-back translation process was performed including a team of academics, experts, professional translators and the copyright holders, before an acceptable version of the ACT was piloted and finalized. The Norwegian version of the ACT showed good internal consistency with Chronbachs alpha above .75 for all concepts except for Formal interactions where the alpha was .69. Structural validity was acceptable for both RNs and LPNs with factors loadings more than .4 for most items. Conclusions The Norwegian version of the ACT is a valid measure of organizational context in Norwegian nursing homes among RNs and LPNs.

Background Quality in nursing documentation holds promise to increase patient safety and quality of care. While high-quality nursing documentation implies a comprehensive documentation of the nursing process, nursing records do not always adhere to these documentation criteria. The aim of this quality improvement project was to assess the quality of electronic nursing records in a residential care home using a standardized audit tool and, if necessary, implement a tailored strategy to improve documentation practice. Methods A criteria-based clinical audit was performed in a residential care home in Norway. Quantitative criteria in the N-Catch II audit instrument was used to give an assessment of electronic nursing records on the following: nursing assessment on admission, nursing diagnoses, aims for nursing care, nursing interventions, and evaluation/progress reports. Each criterium was scored on a 0–3 point scale, with standard (complete documentation) coinciding with the highest score. A retrospective audit was conducted on 38 patient records from January to March 2018, followed by the development and execution of an implementation strategy tailored to local barriers. A re-audit was performed on 38 patient records from March to June 2019. Results None of the investigated patient records at audit fulfilled standards for recommended nursing documentation practice. Mean scores at audit varied from 0.4 (95 % confidence interval 0.3–0.6) for “aims for nursing care” to 1.1 (0.9–1.3) for “nursing diagnoses”. After implementation of a tailored multifaceted intervention strategy, an improvement (p p = 0.6). The improvement did not lead to standards being met at re-audit, where mean scores varied from 0.9 (0.8–1.1) for “evaluation/progress reports” to 1.9 (1.5–2.2) for “nursing assessment on admission”. Conclusions A criteria-based clinical audit with multifaceted tailored interventions that addresses determinants of practice may improve the quality of nursing documentation, but further cycles of the clinical audit process are needed before standards are met and focus can be shifted to sustainment of knowledge use.

Healthcare professionals are increasingly expected to use research evidence to improve healthcare outcomes. The aim of this study was to examine change in beliefs and implementation of evidence-based practice (EBP) one year after participation in a 15 ECTS postgraduate educational program in EBP. We conducted a before-and-after study among 158 healthcare professionals in a postgraduate program in EBP. Participants completed the Norwegian version of the EBP Beliefs Scale and the EBP Implementation Scale at baseline and one year after the program. Results indicated increased scores from pre-test to one year follow up on the EBP Beliefs Scale and the EBP Implementation Scale. Participants in evidence-based network groups reported higher scores on the EBP Implementation Scale than those who did not participate in these groups. Further research should examine other factors that may facilitate implementation of evidence-based practice.

ObjectivesScientific literacy is assumed necessary for appraising the reliability of health claims. Using a national science achievement test, we explored whether students located at the lower quartile on the latent trait (scientific literacy) scale were likely to identify a health claim in a fictitious brief news report, and whether students located at or above the upper quartile were likely to additionally request information relevant for appraising that claim.DesignSecondary analysis of cross-sectional survey data.Setting and participants2229 Norwegian 10th grade students (50% females) from 97 randomly sampled lower secondary schools who performed the test during April–May 2013.Outcome measuresUsing Rasch modelling, we linked item difficulty and student proficiency in science to locate the proficiencies associated with different percentiles on the latent trait scale. Estimates of students’ proficiency, the difficulty of identifying the claim and the difficulty of making at least one request for information to appraise that claim, were reported in logits.ResultsStudents who reached the lower quartile (located at −0.5 logits) on the scale were not likely to identify the health claim as their proficiency was below the difficulty estimate of that task (0.0 logits). Students who reached the upper quartile (located at 1.4 logits) were likely to identify the health claim but barely proficient at making one request for information (task difficulty located at 1.5 logits). Even those who performed at or above the 90th percentile typically made only one request for information, predominantly methodological aspects.ConclusionsWhen interpreting the skill to request relevant information as expressing students’ proficiency in critical appraisal of health claims, we found that only students with very high proficiency in science possessed that skill. There is a need for teachers, healthcare professionals and researchers to collaborate to create learning resources for developing these lifelong learning skills.

Hanne Tuntland,1,2 Ingvild Kjeken,3,4 Eva Langeland,2,5 Bjarte Folkestad,2,6 Birgitte Espehaug,7 Oddvar Førland,2,8 Mona Kristin Aaslund1 1Department of Global Public Health and Primary Care, Faculty of Medicine and Dentistry, University of Bergen, 2Centre for Care Research Western Norway, Bergen University College, Bergen, 3National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, 4Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, 5Department of Nursing, Faculty of Health and Social Sciences, Bergen University College, 6Uni Research Rokkan Centre, 7Centre for Evidence-Based Practice, Bergen University College, 8Faculty of Health Studies, VID Specialized University, Campus Bergen, Bergen, Norway Background: Reablement is a rehabilitation intervention for community-dwelling older adults, which has recently been implemented in several countries. Its purpose is to improve functional ability in daily occupations (everyday activities) perceived as important by the older person. Performance and satisfaction with performance in everyday life are the major outcomes of reablement. However, the evidence base concerning which factors predict better outcomes and who receives the greatest benefit in reablement is lacking. Objective: The objective of this study was to determine the potential factors that predict occupational performance and satisfaction with that performance at 10weeks follow-up. Methods: The sample in this study was derived from a nationwide clinical controlled trial evaluating the effects of reablement in Norway and consisted of 712 participants living in 34 municipalities. Multiple linear regression was used to investigate possible predictors of occupational performance (COPM-P) and satisfaction with that performance (COPM-S) at 10weeks follow-up based on the Canadian Occupational Performance Measure (COPM). Results: The results indicate that the factors that significantly predicted better COPM-P and COPM-S outcomes at 10weeks follow-up were higher baseline scores of COPM-P and COPM-S respectively, female sex, having a fracture as the major health condition and high motivation for rehabilitation. Conversely, the factors that significantly predicted poorer COPM-P and COPM-S outcomes were having a neurological disease other than stroke, having dizziness/balance problems as the major health condition and having pain/discomfort. In addition, having anxiety/depression was a predictor of poorer COPM-P outcomes. The two regression models explained 38.3% and 38.8% of the total variance of the dependent variables of occupational performance and satisfaction with that performance, respectively. Conclusion: The results indicate that diagnosis, functional level, sex and motivation are significant predictors of outcomes following reablement. Keywords: home-based rehabilitation, Canadian Occupational Performance Measure, aged, sex, frailty

Family members are often the care providers of individuals with dementia, and it is assumed that the need for this will increase. There has been little research into the association between the burden of care and the caregiver’s sense of coherence or receipt of social support. This study examined the relationship between the social support subdimensions and sense of coherence and the burden of care among older people giving care to a partner with dementia. The study was a cross-sectional observation study of 97 individuals, ≥65 years old and living with a partner who had symptoms of dementia. We used the Informant Questionnaire on Cognitive Decline in the Elderly, the Relative Stress Scale, the Social Provisions Scale, the Sense of Coherence Scale, and a questionnaire on sociodemographic variables. We used multiple regression analysis in a general linear model procedure. We defined statistical significance as p

We report the five-year outcome of a randomised controlled trial which used radiostereometric analysis (RSA) to assess the influence of surface oxidised zirconium (OxZr, Oxinium) on polyethylene wear in vivo. A total of 120 patients, 85 women and 35 men with a mean age of 70 years (59 to 80) who were scheduled for primary cemented total hip arthroplasty were randomly allocated to four study groups. Patients were blinded to their group assignment and received either a conventional polyethylene (CPE) or a highly cross-linked (HXL) acetabular component of identical design. On the femoral side patients received a 28 mm head made of either cobalt-chromium (CoCr) or OxZr. The proximal head penetration (wear) was measured with repeated RSA examinations over five years. Clinical outcome was measured using the Harris hip score. There was no difference in polyethylene wear between the two head materials when used with either of the two types of acetabular component (p = 0.3 to 0.6). When comparing the two types of polyethylene there was a significant difference in favour of HXLPE, regardless of the head material used (p < 0.001). In conclusion, we found no advantage of OxZr over CoCr in terms of polyethylene wear after five years of follow-up. Our findings do not support laboratory results which have shown a reduced rate of wear with OxZr. They do however add to the evidence on the better resistance to wear of HXLPE over CPE. Cite this article: Bone Joint J 2015;97-B:1463–9.

BackgroundDepression and anxiety have been found to be predictors of poor health outcomes in diabetes, but mechanisms are still unclear.AimsTo examine whether symptoms of anxiety and depression were associated with timing of initiating insulin therapy.MethodsA cohort study of insulin-naive particpants with type 2 dabetes completed the Hospital Anxiey and Depression Scale, HADS-A (n = 731) and/or the HADS-D (n = 768) in the communy-based Nord-Trøndelag Health Study (1995-1997). Information on insulin initiation was retrieved from the Norwegian Prescription Database from January 1, 2004 to November 21, 2012. Cox regression analyses were used to estimate the association between symptoms of anxiety, depression and time to insulin initiation.ResultsAt baseline, 19% reported anxiety symptoms (score ≥ 8) and 18% depressive symptoms (score ≥ 8). After a mean follow-up of 4.4 (SD 3.6) years, 337 (40%) participants had started insulin therapy. After adjustment for sociodemographic and clinical variables, anxiety symptoms were associated with later initiation of insulin therapy (HR 0.70, 95% CI 0.49–0.99), while depressive symptoms were not. Considering groups simultaneously, having both elevated depressive and elevated anxiety symptoms was associated with later time to insulin initiation (HR 0.62, 95% CI 0.39–0.99), while having only anxiety symptoms (without depressive) HR 0.81, 95% CI 0.50–1.32) or only depressive symptoms (without anxiety) (HR 1.08, 95% CI 0.68–1.72) were not.ConclusionsAnxiety was associated with a later initiation of insulin, while depressive symptoms were not. Persons with both elevated levels of anxiety and depression were also less likely to start insulin therapy. These results need further testing in other prospective studies.Keywords: Anxiety, Depression, Insulin therapy, Insulin-naive people, Type 2 diabetes, Prospective study

Our aim was to assess the bacterial findings in infected total hip arthroplasties (THAs) in Norway. We also wanted to investigate the relationship between causal bacteria and hematological findings. Revisions reported to the Norwegian Arthroplasty Register (NAR) due to infection after total hip arthroplasty during the period 1993 through September 2007 were identified. One single observer visited ten representative hospitals where clinical history, preoperative blood samples and the bacterial findings of intraoperative samples were collected. Bacterial growth in two or more samples was found in 278 revisions, and thus included. The following bacteria were identified: Coagulase-negative staphylococci (CoNS) (41%),Staphylococcus aureus(S. aureus) (19%), streptococci (11%), polymicrobial infections (10%), enterococci (9%), Gram-negative bacteria (6%) and others (4%). CoNS were the most common bacteria throughout the period but in the acute postoperative infections (< 3 weeks)S. aureuswas the most frequent bacterial finding. We found no change in the distribution of the bacterial groups over time.S. aureusappears correlated with a higher C-reactive protein value (CRP) (mean 140 (95% Confidence interval (CI): 101-180)) than CoNS (mean 42 (CI: 31-53)).S. aureusalso correlated with a higher erythrocyte sedimentation rate value (ESR) (mean 67 (CI: 55-79)) than CoNS (mean 47 (CI: 39-54)).

Background: Compared with a patellar tendon autograft (PT), a hamstring tendon autograft (HT) has an increased risk of revision after anterior cruciate ligament reconstruction (ACLR). There are no studies analyzing whether this can be explained by inferior fixation devices used in HT reconstruction or whether the revision risk of ACLR with an HT or a PT is influenced by the graft fixation. Purpose: To compare the risk of revision and the revision rates between the most commonly used combinations of fixation for HTs with PTs. Study Design: Cohort study; Level of evidence, 2. Methods: This study included all patients registered in the Norwegian Knee Ligament Registry from 2004 through 2013 who underwent primary PT or HT ACLR with no concomitant ligament injury and known graft fixation. The 2-year revision rates were calculated using the Kaplan-Meier analysis. Hazard ratios (HRs) for revision at 2 years were calculated using multivariate Cox regression models. Results: A total of 14,034 patients with primary ACLR were identified: 3806 patients with PTs and 10,228 patients with HTs; the mean follow-up time was 4.5 years. In the HT group, 5 different combinations of fixation in the femur/tibia were used in more than 500 patients: Endobutton/RCI screw (n = 2339), EZLoc/WasherLoc (n = 1352), Endobutton/Biosure HA (n = 1209), Endobutton/Intrafix (n = 687), and TransFix II/metal interference screw (MIS) (n = 620). The crude 2-year revision rate for patients with PTs was 0.7% (95% CI, 0.4%-1.0%), and for patients with HTs, it ranged between the groups from 1.5% (95% CI, 0.5%-2.4%) for TransFix II/MIS to 5.5% (95% CI, 4.0%-7.0%) for Endobutton/Biosure HA. When adjusted for detected confounding factors and compared with patients with PTs, the HR for revision at 2 years was increased for all HT combinations used in more than 500 patients, and the combinations Endobutton/Biosure HA and Endobutton/Intrafix had the highest HRs of 7.3 (95% CI, 4.4-12.1) and 5.5 (95% CI, 3.1-9.9), respectively. Conclusion: The choice of fixation after ACLR with an HT has a significant effect on a patient’s risk of revision. In this study population, none of the examined combinations of HT fixation had a revision rate as low as that for a PT.

Aim: The aim of this study was to investigate if family background and attitudes in early adulthood contribute to postponement of parenthood. Postponement of parenthood is associated with increased need for artificial reproductive techniques, increased risk for adverse pregnancy outcomes and reduced fertility rates. Methods: This was a cohort study including 1000 women and men aged 22 years from the Swedish Young Adult Panel Study. Questionnaire data were linked to information from the Swedish Total Population Register 10 years later. Logistic regression analyses were conducted. Results: Background factors associated with being childless were: being second-generation Polish or Turkish (odds ratio [OR] 1.5; 95% confidence intervals [CI] 1.2–2.0), growing up in a large city (OR 1.5; 95% CI 1.1–2.0), well-educated mother (OR 1.5; 95% CI 1.1–1.9) or father (OR 1.4; 95% CI 1.1–1.9), no siblings (OR 1.9; 95% CI 1.1–3.2), living in parental home (OR 2.2; 95% CI 1.6–3.1), less than good assessment of own mother (OR 1.8; 95% CI 1.2–2.7) or father (OR 1.4; 95% CI 1.0–1.9) as a parent, and less than satisfactory relationship with own mother (OR 1.5; 95% CI 1.1–2.1). Attitudes associated with being childless were: not enjoying children (OR 2.7; 95% CI 2.0–3.6), finding that one could be satisfied in life without being a good parent (OR 2.3; 95% CI 1.7–3.0) and not assuming that one will have children in the future (OR 2.9; 95% CI 2.1–3.9). Conclusions: The findings suggest that postponement of parenthood to the age of 32 could partly be explained by family background and negative or ambivalent attitudes to children and parenthood in early adulthood.

Background Despite the recognition of integrating evidence-based practice (EBP) in educational programs, there is limited research about bachelor students’ EBP profiles (EBP knowledge, attitudes and behaviour) in the health disciplines nursing, occupational therapy, physiotherapy and radiography. The aim of this study was to assess EBP profiles among bachelor students in health disciplines, and explore differences between health disciplines, educational institutions, students’ assessment of EBP teaching and expectations of EBP performance. Methods A survey using the ‘Evidence-Based Practice Profile - Norwegian version’ (EBP2-N) was conducted among final year bachelor students in health disciplines from four educational institutions. The questionnaire consisted of five domains (Relevance, Terminology, Confidence, Practice and Sympathy) and assessed the five steps of EBP. We performed regression analyses to analyse mean differences in domain scores between health disciplines, Cohen’s d to illustrate the magnitude of the largest difference in each domain, Omega squared to describe portion of variance in domain scores, and Spearman’s rho (rs) to assess the monotonic relationship between EBP2-N domains and assessment of EBP teaching and expectations of EBP performance, respectively. Results Students reported highest overall mean score for Relevance, with an estimated standardized mean of 81.2 (CI 95% = 80.4–82.0). The other EBP2–N domains had estimated standardized means of 54 and less. Statistically significant differences (p

Aim To prospectively examine whether depressive symptoms increase the risk of diabetes and a diabetic foot ulcer. Methods The Nord-Trondelag Health Study (HUNT) is a community-based longitudinal study. The Hospital Anxiety and Depression Scale (HADS-D subscale) assessed depressive symptoms. We followed individuals with complete HADS-D data from HUNT2 (1995–97) and assessed whether they reported diabetes with or without a history of diabetic foot ulcer (DFU) in HUNT3 (2006–08) (n = 36,031). Logistic regression was used to investigate the effect of depressive symptoms on subsequent development of diabetes and of DFU. Results Unadjusted odds for reporting diabetes at follow-up was higher among individuals who reported a HADS-D score ≥ 8 at baseline (OR 1.30 95% CI, 1.07–1.57) than among those reporting a lower score. After adjusting for age, gender and BMI, this association was no longer significant. The odds of developing a DFU was almost two-fold (OR = 1.95 95% CI, 1.02–3.74) for those reporting a HADS-D score of 8–10, and 3-fold (OR = 3.06 95% CI, 1.24–7.54) for HADS-D scores ≥ 11, compared to HADS-D scores Conclusions Symptoms of depression at baseline are associated with an increased risk of a diabetic foot ulcer in a dose response manner during this 11-year follow-up.

Background and purpose - A large number of fixation methods of hamstring tendon autograft (HT) are available for anterior cruciate ligament reconstruction (ACLR). Some studies report an association between fixation method and the risk of revision ACLR. We compared the risk of revision of various femoral and tibial fixation methods used for HT in Scandinavia 2004-2011. Materials and methods - A register-based study of 38,666 patients undergoing primary ACLRs with HT, with 1,042 revision ACLRs. The overall median follow-up time was 2.8 (0-8) years. Fixation devices used in a small number of patients were grouped according to design and the point of fixation. Results - The most common fixation methods were Endobutton (36%) and Rigidfix (31%) in the femur; and interference screw (48%) and Intrafix (34%) in the tibia. In a multivariable Cox regression model, the transfemoral fixations Rigidfix and Transfix had a lower risk of revision (HR 0.7 [95% CI 0.6-0.8] and 0.7 [CI 0.6-0.9] respectively) compared with Endobutton. In the tibia the retro interference screw had a higher risk of revision (HR 1.9 [CI 1.3-2.9]) compared with an interference screw. Interpretation - The choice of graft fixation influences the risk of revision after primary ACLR with hamstring tendon autograft.

Introduction: Pulmonary hyperinflation contributes to dyspnea, morbidity and mortality in chronic obstructive pulmonary disease (COPD). The inspiratory-to-total lung capacity (IC/TLC) ratio is a measure of static hyperinflation and is strongly associated with dynamic hyperinflation and exercise tolerance. However, knowledge of its effect on longitudinal change in the 6-minute walk distance (6MWD) in COPD is scarce. Aim: We aimed to study if IC/TLC ratio predicted longitudinal change in 6MWD. Methods: This prospective observational cohort study included 389 patients aged 40-75 yrs with clinically stable COPD in GOLD stages II-IV. 6MWDs were measured at baseline, and after 1 and 3 yrs. Predictor variables at baseline included IC/TLC ratio, spirometry, fat mass index (FMI) and assessment of smoking habits and exacerbations by questionnaires. Generalized estimating equations (GEE) analyses were used to analyze predictors for change in 6MWD. Results: Mean (SE) 6MWD at baseline and after 1 and 3 yrs were 423 (5.7), 431 (6.1) and 400 (7.8) m, respectively. In the multivariable adjusted GEE analysis, there was a predicted annual decline of 59,5 m and the IC/TLC ratio also predicted decline in 6MWD over 3-yrs (interaction IC/TLC*Time, B=87 m, p=0.017). With a 0.1-unit decrease in baseline IC/TLC ratio, the annual decline of 6MWD increased with 8,7 m. Other predictors for reduced 6MWD were reduced FEV 1 (p=0.001), increased age (p=0.002), increased FMI (p=0.001), and >2 exacerbations within 12 months prior to inclusion (p=0.006). Conclusion: The level of static hyperinflation at baseline independently predicted longitudinal decline in functional capacity in COPD patients.

Background and purpose — Some studies have found high complication rates and others have found low complication rates after unicompartmental knee arthroplasty (UKA). We evaluated whether hospital procedure volume influences the risk of revision using data from the Norwegian Arthroplasty Register (NAR). Materials and methods — 5,791 UKAs have been registered in the Norwegian Arthroplasty Register. We analyzed the 4,460 cemented medial Oxford III implants that were used from 1999 to 2012; this is the most commonly used UKA implant in Norway. Cox regression (adjusted for age, sex, and diagnosis) was used to estimate risk ratios (RRs) for revision. 4 different volume groups were compared: 1–10, 11–20, 21–40, and > 40 UKA procedures annually per hospital. We also analyzed the reasons for revision. Results and interpretation — We found a lower risk of revision in hospitals performing more than 40 procedures a year than in those with less than 10 UKAs a year, with an unadjusted RR of 0.53 (95% CI: 0.35–0.81) and...

To examine how stable the sense of coherence (SOC) is over a five-year period among residents of nursing homes (NH) who are not cognitively impaired and whether components of social support influence SOC.Many studies have investigated the stability of SOC, and the findings have been inconsistent. Social support is a crucial resource in developing SOC. Few researchers have studied the stability of SOC and how various social support dimensions influence changes in SOC among older NH residents who are cognitively intact.The study was prospective and included baseline assessment and five-year follow-up.The sample comprised 52 cognitively intact NH residents (Clinical Dementia Rating score ≤0.5). We obtained data through direct interviews using the Social Provisions Scale and Sense of Coherence Scale.SOC increased statistically significantly from baseline to follow-up. The social support subdimension reassurance of worth predicted change in SOC after adjustment for sociodemographic factors. When controlled for baseline SOC, attachment was associated with change in SOC, but reassurance of worth was not.The study indicates that the change in SOC over time during the 5 years of follow-up and the social support dimension attachment appear to be important components of change in SOC. Nursing personnel should be aware of the residents' individual needs for attachment and the importance of emotional support for personal strength and ability to cope.

Background and purpose Physiotherapists are expected to practice in an evidence-based way. Evidence-based practice (EBP) should be an integral part of the curriculum to ensure use of the five EBP steps: asking clinical questions, searching for and appraising research evidence, integrating the evidence into clinical practice and evaluating this process. The aim of this study was to compare self-reported EBP behaviour, abilities and barriers during clinical placements reported by five cohorts of final year physiotherapy students' with different EBP exposure across the 3-year bachelor programme. Methods A cross-sectional study was conducted among five cohorts (2006–2010) with third year physiotherapy students at a University College in Norway. In total, 246 students were eligible for this study. To collect data, we used a questionnaire with 42 items related to EBP behaviour, ability and barriers. Associations were investigated using the Spearman's rho (r). Results In total, 180 out of 246 third year physiotherapy students, who had recently completed a clinical placement, filled out the questionnaire (73 %). The association between the level of EBP exposure and students' self-reported EBP behaviour, abilities and barriers was low for most items in the questionnaire. Statistically significant correlations were found for eight items, related to information need, question formulation, use of checklists, searching and perceived ability to search for and critically appraise research evidence. The strongest correlation was found between the level of EBP exposure and ability to critically appraise research evidence (r = 0.41, p

Summary Background The 6-min walk distance (6MWD) is widely used to evaluate functional capacity in patients with chronic obstructive pulmonary disease (COPD). Aim To examine predictors for longitudinal change in 6MWD including self-reported physical activity, smoking habits, body composition, exacerbations, comorbidity and lung function. Methods The cohort included 389 patients aged 44–75 years, with clinically stable COPD in GOLD stages II–IV. The follow-up time was 3 years. Measurements included 6MWD, spirometry, fat and fat free mass index (FMI and FFMI), and assessment of physical activity, smoking habits, comorbidities and exacerbations by questionnaires. Generalized estimating equations (GEE) regression analyses were used to analyze predictors for the change in 6MWD. Results There was a reduction in 6MWD from baseline to 3 years for patients in GOLD stages III and IV ( B = −36 m, 95% CI = −51 to −7, p = 0.009 and B = −79 m, CI = −125 to −20, p = 0.007). The unadjusted GEE analysis demonstrated that baseline self-reported physical activity level, forced expiratory volume in one second (FEV 1 ), forced vital capacity, FFMI, GOLD stages and age predicted change in 6MWD, but in the adjusted GEE analysis only self-reported physical activity level ( p = 0.001) and FEV 1 ( p = 0.019) predicted change over time. Conclusion Patients in GOLD stage II maintained their functional capacity assessed by 6MWD over 3 years, while it was significantly reduced for patients in GOLD stages III and IV. Level of physical activity and FEV 1 were predictors for longitudinal change in functional capacity.

Waiting time is a rationing mechanism that is used in publicly funded healthcare systems. From an equity viewpoint, it is regarded as preferable to co-payments. However, long waits are an indication of poor quality of service. To our knowledge, this analysis is the first to benefit from individual-level data from administrative registers to investigate the relationship between waiting time, income, and education. Furthermore, it makes use of an extensive set of medical information that serves as indicators of patient need. Differences in waiting time by socioeconomic status are detected. For men, there is a statistically highly significant negative association between income and waiting time, driven by men in the highest income group, which constitutes 12% of all men. More educated women, that is, those having an education above compulsory schooling, experience lower waiting time than their fellow sisters with the lowest level of education. Copyright © 2013 John Wiley & Sons, Ltd.

Background: The aim of this study was to assess which patient and procedure factors affected both the risk of infection as well as procedure duration. Additionally, to assess if procedure duration affected the revision risk due to deep infection in total knee arthroplasty (TKA) patients and in a subgroup of low-risk patients. Methods: 28,262 primary TKA with 311 revisions due to deep infection were included from the Norwegian Arthroplasty Register (NAR) and analysed from primary surgery from 2005 until 31st December 2015 with a 1 and 4 year follow up. The risk of revision due to deep infection was calculated in a multivariable Cox regression model including patient and procedure related risk factors, assessing Hazard Ratio (HR) with 95% confidence interval (CI). Results: Multivariate analysis showed statistically significant associations with revision due to deep infection and increased procedure duration for male patients, ASA3+ (American Society of Anesthesiologists) and perioperative complications. Procedure duration ≥110 min (75 percentile) had a higher risk of deep infection compared to duration

Background and purpose — The bone cement market for total knee arthroplasty (TKA) in Norway has been dominated by a few products and distributors. Palacos with gentamicin had a market share exceeding 90% before 2005, but it was then withdrawn from the market and replaced by new slightly altered products. We have compared the survival of TKAs fixated with Palacos with gentamicin with the survival of TKAs fixated with the bone cements that took over the market. Patients and methods — Using data from the Norwegian Arthroplasty Register for the period 1997–2013, we included 26,147 primary TKAs in the study. The inclusion criteria were TKAs fixated with the 5 most used bone cements and the 5 most common total knee prostheses for that time period. 6-year Kaplan-Meier survival probabilities were established for each cement product. The Cox proportional hazards regression model was used to assess the association between bone cement product and revision risk. Separate analyses were performed with revision for any reason and revision due to deep infection within 1 year postoperatively as endpoints. Adjustments were made for age, sex, diagnosis, and prosthesis brand. Results — Survival was similar for the prostheses in the follow-up period, between the 5 bone cements included: Palacos with gentamicin, Refobacin Palacos R, Refobacin Bone Cement R (Refobacin BCR), Optipac Refobacin Bone Cement R (Optipac Refobacin BCR), and Palacos R + G. Interpretation — According to our findings, the use of the new bone cements led to a survival rate that was as good as with the old bone cement (Palacos with gentamicin).