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Skaga E, Trewin-Nybråten CB, Niehusmann P, Johannesen TB, Marienhagen K, Oltedal L, Schipman S, Skjulsvik AJ, Solheim O, Solheim TS, Sundstrøm T, Vik-Mo EO, Petter Brandal, Ingebrigtsen T. Stable glioma incidence and increased patient survival over the past two decades in Norway: a nationwide registry-based cohort study. Acta Oncol 2024; 63:83-94. [PMID: 38501768 DOI: 10.2340/1651-226x.2024.24970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/08/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Surveillance of incidence and survival of central nervous system tumors is essential to monitor disease burden and epidemiological changes, and to allocate health care resources. Here, we describe glioma incidence and survival trends by histopathology group, age, and sex in the Norwegian population. MATERIAL AND METHODS We included patients with a histologically verified glioma reported to the Cancer Registry of Norway from 2002 to 2021 (N = 7,048). Population size and expected mortality were obtained from Statistics Norway. Cases were followed from diagnosis until death, emigration, or 31 December 2022, whichever came first. We calculated age-standardized incidence rates (ASIR) per 100,000 person-years and age-standardized relative survival (RS). Results: The ASIR for histologically verified gliomas was 7.4 (95% CI: 7.3-7.6) and was higher for males (8.8; 95% CI: 8.5-9.1) than females (6.1; 95% CI: 5.9-6.4). Overall incidence was stable over time. Glioblastoma was the most frequent tumor entity (ASIR = 4.2; 95% CI: 4.1-4.4). Overall, glioma patients had a 1-year RS of 63.6% (95% CI: 62.5-64.8%), and a 5-year RS of 32.8% (95% CI: 31.6-33.9%). Females had slightly better survival than males. For most entities, 1- and 5-year RS improved over time (5-year RS for all gliomas 29.0% (2006) and 33.1% (2021), p < 0.001). Across all tumor types, the RS declined with increasing age at diagnosis. INTERPRETATION The incidence of gliomas has been stable while patient survival has increased over the past 20 years in Norway. As gliomas represent a heterogeneous group of primary CNS tumors, regular reporting from cancer registries at the histopathology group level is important to monitor disease burden and allocate health care resources in a population.
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Affiliation(s)
- Erlend Skaga
- Vilhelm Magnus Laboratory for Neurosurgical Research and Department of Neurosurgery, Oslo University Hospital, Oslo, Norway; Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA.
| | - Cassia B Trewin-Nybråten
- Department of Registration, Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway
| | - Pitt Niehusmann
- Department of Pathology, Oslo University Hospital, Oslo, Norway
| | - Tom Børge Johannesen
- Department of Registration, Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Leif Oltedal
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Stephanie Schipman
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway; Medical Faculty, University Hospital Muenster, Germany
| | - Anne Jarstein Skjulsvik
- Department of Pathology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ole Solheim
- Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway; Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tora Skeidsvoll Solheim
- Cancer Clinic, St. Olavs University Hospital, Trondheim, Norway; Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Terje Sundstrøm
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Einar O Vik-Mo
- Vilhelm Magnus Laboratory for Neurosurgical Research and Department of Neurosurgery, Oslo University Hospital, Oslo, Norway; Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Petter Brandal
- Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway; Institute for Cancer Genetics and Informatics, Oslo University Hospital, Oslo, Norway
| | - Tor Ingebrigtsen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway; Department of Neurosurgery, Otorhinolaryngology and Ophthalmology, University Hospital of North Norway, Tromsø, Norway
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Danielsen E, Ingebrigtsen T, Gulati S, Salvesen Ø, Johansen TO, Nygaard ØP, Solberg TK. Patient Characteristics Associated With Worsening of Neck Pain-Related Disability After Surgery for Degenerative Cervical Myelopathy: A Nationwide Study of 1508 Patients. Neurosurgery 2024:00006123-990000000-01043. [PMID: 38323820 DOI: 10.1227/neu.0000000000002852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/17/2023] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Functional status, pain, and quality of life usually improve after surgery for degenerative cervical myelopathy (DCM), but a subset of patients report worsening. The objective was to define cutoff values for worsening on the Neck Disability Index (NDI) and identify prognostic factors associated with worsening of pain-related disability 12 months after DCM surgery. METHODS In this prognostic study based on prospectively collected data from the Norwegian Registry for Spine Surgery, the NDI was the primary outcome. Receiver operating characteristics curve analyses were used to obtain cutoff values, using the global perceived effect scale as an external anchor. Univariable and multivariable analyses were performed using mixed logistic regression to evaluate the relationship between potential prognostic factors and the NDI. RESULTS Among the 1508 patients undergoing surgery for myelopathy, 1248 (82.7%) were followed for either 3 or 12 months. Of these, 317 (25.4%) were classified to belong to the worsening group according to the mean NDI percentage change cutoff of 3.3. Multivariable analyses showed that smoking (odds ratio [OR] 3.4: 95% CI 1.2-9.5: P < .001), low educational level (OR 2.5: 95% CI 1.0-6.5: P < .001), and American Society of Anesthesiologists grade >II (OR 2.2: 95% CI 0.7-5.6: P = .004) were associated with worsening. Patients with more severe neck pain (OR 0.8: 95% CI 0.7-1.0: P = .003) and arm pain (OR 0.8: 95% CI 0.7-1.0; P = .007) at baseline were less likely to report worsening. CONCLUSION We defined a cutoff value of 3.3 for worsening after DCM surgery using the mean NDI percentage change. The independent prognostic factors associated with worsening of pain-related disability were smoking, low educational level, and American Society of Anesthesiologists grade >II. Patients with more severe neck and arm pain at baseline were less likely to report worsening at 12 months.
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Affiliation(s)
- Elisabet Danielsen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tor Ingebrigtsen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Neurosurgery and the Norwegian Registry for Spine Surgery (NORspine), University Hospital of North Norway, Tromsø, Norway
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Sasha Gulati
- Department of Neurosurgery, St. Olavs Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- National Advisory Unit on Spinal Surgery, St. Olavs Hospital, Trondheim, Norway
| | - Øyvind Salvesen
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Tonje O Johansen
- Department of Neurosurgery, St. Olavs Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Øystein P Nygaard
- Department of Neurosurgery, St. Olavs Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- National Advisory Unit on Spinal Surgery, St. Olavs Hospital, Trondheim, Norway
| | - Tore K Solberg
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Neurosurgery and the Norwegian Registry for Spine Surgery (NORspine), University Hospital of North Norway, Tromsø, Norway
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Karlberg A, Pedersen LK, Vindstad BE, Skjulsvik AJ, Johansen H, Solheim O, Skogen K, Kvistad KA, Bogsrud TV, Myrmel KS, Giskeødegård GF, Ingebrigtsen T, Berntsen EM, Eikenes L. Diagnostic accuracy of anti-3-[ 18F]-FACBC PET/MRI in gliomas. Eur J Nucl Med Mol Imaging 2024; 51:496-509. [PMID: 37776502 PMCID: PMC10774221 DOI: 10.1007/s00259-023-06437-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/06/2023] [Indexed: 10/02/2023]
Abstract
PURPOSE The primary aim was to evaluate whether anti-3-[18F]FACBC PET combined with conventional MRI correlated better with histomolecular diagnosis (reference standard) than MRI alone in glioma diagnostics. The ability of anti-3-[18F]FACBC to differentiate between molecular and histopathological entities in gliomas was also evaluated. METHODS In this prospective study, patients with suspected primary or recurrent gliomas were recruited from two sites in Norway and examined with PET/MRI prior to surgery. Anti-3-[18F]FACBC uptake (TBRpeak) was compared to histomolecular features in 36 patients. PET results were then added to clinical MRI readings (performed by two neuroradiologists, blinded for histomolecular results and PET data) to assess the predicted tumor characteristics with and without PET. RESULTS Histomolecular analyses revealed two CNS WHO grade 1, nine grade 2, eight grade 3, and 17 grade 4 gliomas. All tumors were visible on MRI FLAIR. The sensitivity of contrast-enhanced MRI and anti-3-[18F]FACBC PET was 61% (95%CI [45, 77]) and 72% (95%CI [58, 87]), respectively, in the detection of gliomas. Median TBRpeak was 7.1 (range: 1.4-19.2) for PET positive tumors. All CNS WHO grade 1 pilocytic astrocytomas/gangliogliomas, grade 3 oligodendrogliomas, and grade 4 glioblastomas/astrocytomas were PET positive, while 25% of grade 2-3 astrocytomas and 56% of grade 2-3 oligodendrogliomas were PET positive. Generally, TBRpeak increased with malignancy grade for diffuse gliomas. A significant difference in PET uptake between CNS WHO grade 2 and 4 gliomas (p < 0.001) and between grade 3 and 4 gliomas (p = 0.002) was observed. Diffuse IDH wildtype gliomas had significantly higher TBRpeak compared to IDH1/2 mutated gliomas (p < 0.001). Adding anti-3-[18F]FACBC PET to MRI improved the accuracy of predicted glioma grades, types, and IDH status, and yielded 13.9 and 16.7 percentage point improvement in the overall diagnoses for both readers, respectively. CONCLUSION Anti-3-[18F]FACBC PET demonstrated high uptake in the majority of gliomas, especially in IDH wildtype gliomas, and improved the accuracy of preoperatively predicted glioma diagnoses. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov ID: NCT04111588, URL: https://clinicaltrials.gov/study/NCT04111588.
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Affiliation(s)
- Anna Karlberg
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, N-7030, Trondheim, Norway.
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
| | | | - Benedikte Emilie Vindstad
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anne Jarstein Skjulsvik
- Department of Pathology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medical and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Håkon Johansen
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, N-7030, Trondheim, Norway
| | - Ole Solheim
- Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
| | - Karoline Skogen
- Department of Radiology and Nuclear Medicine, Oslo University Hospitals, Oslo, Norway
| | - Kjell Arne Kvistad
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, N-7030, Trondheim, Norway
| | - Trond Velde Bogsrud
- PET-Centre, University Hospital of North Norway, Tromsø, Norway
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Aarhus, Denmark
| | | | - Guro F Giskeødegård
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tor Ingebrigtsen
- Department of Neurosurgery, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Erik Magnus Berntsen
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, N-7030, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Live Eikenes
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
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Kristensen EK, Müller K, Ingebrigtsen T, Lindekleiv H, Kloster R, Isaksen JG. Reoperation-requiring postoperative intracranial haemorrhage after posterior fossa craniotomy: Retrospective case-series. Brain Spine 2023; 4:102741. [PMID: 38510625 PMCID: PMC10951772 DOI: 10.1016/j.bas.2023.102741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/14/2023] [Accepted: 12/28/2023] [Indexed: 03/22/2024]
Abstract
Introduction Studies report rates of treatment-requiring postoperative intracranial haemorrhage after craniotomy around 1-2%, but do not distinguish between supratentorial and posterior fossa operations. Reports about intracranial haemorrhages' temporal occurrence show conflicting results. Recommendations for duration of postoperative monitoring vary. Research question To determine the rate, temporal pattern and clinical presentation of reoperation-requiring postoperative intracranial posterior fossa haemorrhage. Material and methods This retrospective case-series identified cases operated with posterior fossa craniotomy or craniectomy between January 1, 2007 and December 31, 2021 by an electronic search in the patient administrative database, and collected data about patient- and treatment-characteristics, postoperative monitoring, and the occurrence of haemorrhagic and other serious postoperative complications. Results We included 62 (n = 34, 55% women) cases with mean age 48 (interquartile range 50) years operated for tumours (n = 34, 55%), Chiari malformations (n = 18, 29%), ischemic stroke (n = 6, 10%) and other lesions (n = 3, 5%). One (2%) 66-year-old woman who was a daily smoker operated with decompressive craniectomy and infarct resection, developed a reoperation-requiring postoperative intracranial haemorrhage after 25.5 h. In four (6%) cases, other serious complications requiring reoperation or transfer from the post anaesthesia care unit or regular bed wards to the intensive care unit occurred after 0.5, 6, 9 and 54 h, respectively. Discussion and conclusion Treatment-requiring postoperative intracranial haemorrhage and other serious complications after posterior fossa craniotomies occur over a wide timespan and are difficult to capture with a standardized postoperative monitoring time. This indicates that the duration of monitoring should be individualized based on assessment of risk factors.
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Affiliation(s)
- Elise K. Kristensen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Kay Müller
- Department of Clinical Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
- Department of Neurosurgery, Ophthalmology and Otorhinolaryngology, University Hospital of North Norway, Tromsø, Norway
| | - Tor Ingebrigtsen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
- Department of Neurosurgery, Ophthalmology and Otorhinolaryngology, University Hospital of North Norway, Tromsø, Norway
| | - Haakon Lindekleiv
- Department of Clinical Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
- Department of Radiology, University Hospital of North Norway, Tromsø, Norway
| | - Roar Kloster
- Department of Clinical Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
- Department of Neurosurgery, Ophthalmology and Otorhinolaryngology, University Hospital of North Norway, Tromsø, Norway
| | - Jørgen G. Isaksen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
- Department of Neurosurgery, Ophthalmology and Otorhinolaryngology, University Hospital of North Norway, Tromsø, Norway
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Tjomsland O, Thoresen C, Ingebrigtsen T, Søreide E, Frich JC. Reducing unwarranted variation: can a 'clinical dashboard' be helpful for hospital executive boards and top-level leaders? BMJ Lead 2023:leader-2023-000749. [PMID: 38053259 DOI: 10.1136/leader-2023-000749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 11/03/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND/AIM In the past decades, there has been an increasing focus on defining, identifying and reducing unwarranted variation in clinical practice. There have been several attempts to monitor and reduce unwarranted variation, but the experience so far is that these initiatives have failed to reach their goals. In this article, we present the initial process of developing a safety, quality and utilisation rate dashboard ('clinical dashboard') based on a selection of data routinely reported to executive boards and top-level leaders in Norwegian specialist healthcare. METHODS We used a modified version of Wennberg's categorisation of healthcare delivery to develop the dashboard, focusing on variation in (1) effective care and patient safety and (2) preference-sensitive and supply-sensitive care. RESULTS Effective care and patient safety are monitored with outcome measures such as 30-day mortality after hospital admission and 5-year cancer survival, whereas utilisation rates for procedures selected on cost and volume are used to follow variations in preference-sensitive and supply-sensitive care. CONCLUSION We argue that selecting quality indicators of patient safety, quality and utilisation rates and presenting them in a dashboard may help executive hospital boards and top-level leaders to focus on unwarranted variation.
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Affiliation(s)
- Ole Tjomsland
- Helse Sor-Ost RHF, Hamar, Norway
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | | | - Tor Ingebrigtsen
- Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
- Australian Institute of Health Innovation, Centre for Clinical Governance Research, University of New South Wales, Sydney, New South Wales, Australia
| | - Eldar Søreide
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Critical Care and Anaesthesiology Research Group, Helse Stavanger HF, Stavanger, Norway
| | - Jan C Frich
- Universitetet i Oslo Avdeling for samfunnsmedisin, Oslo, Norway
- Diakonhjemmet Hospital, Oslo, Norway
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Mikkelsen E, Ingebrigtsen T, Thyrhaug AM, Olsen LR, Nygaard ØP, Austevoll I, Brox JI, Hellum C, Kolstad F, Lønne G, Solberg TK. The Norwegian registry for spine surgery (NORspine): cohort profile. Eur Spine J 2023; 32:3713-3730. [PMID: 37718341 DOI: 10.1007/s00586-023-07929-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/28/2023] [Accepted: 08/28/2023] [Indexed: 09/19/2023]
Abstract
PURPOSE To review and describe the development, methods and cohort of the lumbosacral part of the Norwegian registry for spine surgery (NORspine). METHODS NORspine was established in 2007. It is government funded, covers all providers and captures consecutive cases undergoing operations for degenerative disorders. Patients' participation is voluntary and requires informed consent. A set of baseline-, process- and outcome-variables (3 and 12 months) recommended by the International Consortium for Health Outcome Measurement is reported by surgeons and patients. The main outcome is the Oswestry disability index (ODI) at 12 months. RESULTS We show satisfactory data quality assessed by completeness, timeliness, accuracy, relevance and comparability. The coverage rate has been 100% since 2016 and the capture rate has increased to 74% in 2021. The cohort consists of 60,647 (47.6% women) cases with mean age 55.7 years, registered during the years 2007 through 2021. The proportions > 70 years and with an American Society of Anaesthesiologists' Physical Classification System (ASA) score > II has increased gradually to 26.1% and 19.3%, respectively. Mean ODI at baseline was 43.0 (standard deviation 17.3). Most cases were operated with decompression for disc herniation (n = 26,557, 43.8%) or spinal stenosis (n = 26,545, 43.8%), and 7417 (12.2%) with additional or primary fusion. The response rate at 12 months follow-up was 71.6%. CONCLUSION NORspine is a well-designed population-based comprehensive national clinical quality registry. The register's methods ensure appropriate data for quality surveillance and improvement, and research.
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Affiliation(s)
- Eirik Mikkelsen
- Department of Neurosurgery, Ophthalmology and Otorhinolaryngology, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tor Ingebrigtsen
- Department of Neurosurgery, Ophthalmology and Otorhinolaryngology, University Hospital of North Norway, Tromsø, Norway.
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
- The Norwegian Registry for Spine Surgery, University Hospital of North Norway, Tromsø, Norway.
| | - Anette M Thyrhaug
- The Norwegian Registry for Spine Surgery, University Hospital of North Norway, Tromsø, Norway
| | - Lena Ringstad Olsen
- Centre for Clinical Documentation and Evaluation, Northern Norway Regional Health Authority, Tromsø, Norway
| | - Øystein P Nygaard
- The Norwegian Registry for Spine Surgery, University Hospital of North Norway, Tromsø, Norway
- Department of Neuromedicine and Movement Science, The Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neurosurgery, St. Olav's University Hospital, Trondheim, Norway
| | - Ivar Austevoll
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Jens Ivar Brox
- Department of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Christian Hellum
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Frode Kolstad
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Greger Lønne
- Department of Neuromedicine and Movement Science, The Norwegian University of Science and Technology, Trondheim, Norway
- Department of Orthopaedic Surgery, Innlandet Hospital Trust, Lillehammer, Norway
| | - Tore K Solberg
- Department of Neurosurgery, Ophthalmology and Otorhinolaryngology, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- The Norwegian Registry for Spine Surgery, University Hospital of North Norway, Tromsø, Norway
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7
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Hindenes LB, Ingebrigtsen T, Isaksen JG, Håberg AK, Johnsen LH, Herder M, Mathiesen EB, Vangberg TR. Anatomical variations in the circle of Willis are associated with increased odds of intracranial aneurysms: The Tromsø study. J Neurol Sci 2023; 452:120740. [PMID: 37517271 DOI: 10.1016/j.jns.2023.120740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 07/06/2023] [Accepted: 07/23/2023] [Indexed: 08/01/2023]
Abstract
PURPOSE Studies on patients suggest an association between anatomical variations in the Circle of Willis (CoW) and intracranial aneurysms (IA), but it is unclear whether this association is present in the general population. In this cross-sectional population study, we investigated the associations between CoW anatomical variations and IA. METHODS We included 1667 participants from a population sample with 3 T MRI time-of-flight angiography (40-84 years, 46.5% men). Saccular IAs were defined as protrusions in the intracranial arteries ≥2 mm, while variants of the CoW were classified according to whether segments were missing or hypoplastic (< 1 mm). We used logistic regression, adjusting for age and IA risk factors, to assess whether participants with incomplete CoW variants had a greater prevalence of IA and whether participants with specific incomplete variants had a greater prevalence of IA. RESULTS Participants with an incomplete CoW had an increased prevalence of IA (OR, 2.3 [95% CI 1.05-5.04]). This was mainly driven by the variant missing all three communicating arteries (OR, 4.2 [95% CI 1.7-1 0.3]) and the variant missing the P1 segment of the posterior cerebral artery (OR, 3.6 [95% CI 1.2-10.1]). The combined prevalence of the two variants was 15.4% but accounted for 28% of the IAs. CONCLUSION The findings suggest that an incomplete CoW is associated with an increased risk of IA for adults in the general population.
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Affiliation(s)
- Lars B Hindenes
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; PET Imaging Center, University Hospital of North Norway, Tromsø, Norway
| | - Tor Ingebrigtsen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; Department of Neurosurgery, Ophthalmology, and Otorhinolaryngology, University Hospital of North Norway, Tromsø, Norway
| | - Jørgen G Isaksen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; Department of Neurosurgery, Ophthalmology, and Otorhinolaryngology, University Hospital of North Norway, Tromsø, Norway
| | - Asta K Håberg
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Radiology and Nuclear Medicine, St. Olav University Hospital, Trondheim, Norway
| | - Liv-Hege Johnsen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; Department of Radiology, University Hospital of North Norway, Tromsø, Norway
| | - Marit Herder
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; Department of Radiology, University Hospital of North Norway, Tromsø, Norway
| | - Ellisiv B Mathiesen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; Department of Neurology, University Hospital of North Norway, Tromsø, Norway
| | - Torgil R Vangberg
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; PET Imaging Center, University Hospital of North Norway, Tromsø, Norway.
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8
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Hammer L, Ingebrigtsen T, Gulati S, Hara S, Nygaard Ø, Hara KW, Solberg T. Prospects of returning to work after lumbar spine surgery for patients considering disability pension: a nationwide study based on data from the Norwegian Registry for Spine Surgery. Occup Environ Med 2023; 80:447-454. [PMID: 37423749 PMCID: PMC10423536 DOI: 10.1136/oemed-2023-108864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/14/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVES To assess the odds for not returning to work (non-RTW) 1 year after treatment among patients who had applied for or were planning to apply for disability pension (DP-applicant) prior to an operation for degenerative disorders of the lumbar spine. METHODS This population-based cohort study from the Norwegian Registry for Spine surgery included 26 688 cases operated for degenerative disorders of the lumbar spine from 2009 to 2020. The primary outcome was RTW (yes/no). Secondary patient-reported outcome measures (PROMs) were the Oswestry Disability Index, Numeric Rating Scales for back and leg pain, EuroQoL five-dimension and the Global Perceived Effect Scale. Logistic regression analysis was used to investigate associations between being a DP-applicant prior to surgery (exposure), possible confounders (modifiers) at baseline and RTW 12 months after surgery (outcome). RESULTS The RTW ratio for DP-applicants was 23.1% (having applied: 26.5%, planning to apply 21.1%), compared with 78.6% among non-applicants. All secondary PROMs were more favourable among non-applicants. After adjusting for all significant confounders (low expectations and pessimism related to working capability, not feeling wanted by the employer and physically demanding work), DP-applicants with under 12 months preoperative sick leave had 3.8 (95% CI 1.8 to 8.0) higher odds than non-applicants for non-RTW 12 months after surgery. The subgroup having applied for disability pension had the strongest impact on this association. CONCLUSION Less than a quarter of the DP-applicants returned to work 12 months after surgery. This association remained strong, also when adjusted for the confounders as well as other covariates related RTW.
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Affiliation(s)
- Lovise Hammer
- Department of Clinical Medicine, University of Tromsø, Faculty of Health Sciences, Tromso, Norway
| | - Tor Ingebrigtsen
- Department of Clinical Medicine, University of Tromsø, Faculty of Health Sciences, Tromso, Norway
- Department of Neurosurgery, University Hospital of North Norway, Tromso, Norway
| | - Sasha Gulati
- Department of Neurosurgery, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sozaburo Hara
- Department of Neurosurgery, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Øystein Nygaard
- Department of Neurosurgery, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Karen Walseth Hara
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neurosurgery, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tore Solberg
- Department of Clinical Medicine, University of Tromsø, Faculty of Health Sciences, Tromso, Norway
- Department of Neurosurgery, University Hospital of North Norway, Tromso, Norway
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9
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Riksaasen AS, Kaur S, Solberg TK, Austevoll I, Brox JI, Dolatowski FC, Hellum C, Kolstad F, Lonne G, Nygaard ØP, Ingebrigtsen T. Impact of the number of previous lumbar operations on patient-reported outcomes after surgery for lumbar spinal stenosis or lumbar disc herniation. Bone Joint J 2023; 105-B:422-430. [PMID: 36924173 DOI: 10.1302/0301-620x.105b4.bjj-2022-0704.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Repeated lumbar spine surgery has been associated with inferior clinical outcomes. This study aimed to examine and quantify the impact of this association in a national clinical register cohort. This is a population-based study from the Norwegian Registry for Spine surgery (NORspine). We included 26,723 consecutive cases operated for lumbar spinal stenosis or lumbar disc herniation from January 2007 to December 2018. The primary outcome was the Oswestry Disability Index (ODI), presented as the proportions reaching a patient-acceptable symptom state (PASS; defined as an ODI raw score ≤ 22) and ODI raw and change scores at 12-month follow-up. Secondary outcomes were the Global Perceived Effect scale, the numerical rating scale for pain, the EuroQoL five-dimensions health questionnaire, occurrence of perioperative complications and wound infections, and working capability. Binary logistic regression analysis was conducted to examine how the number of previous operations influenced the odds of not reaching a PASS. The proportion reaching a PASS decreased from 66.0% (95% confidence interval (CI) 65.4 to 66.7) in cases with no previous operation to 22.0% (95% CI 15.2 to 30.3) in cases with four or more previous operations (p < 0.001). The odds of not reaching a PASS were 2.1 (95% CI 1.9 to 2.2) in cases with one previous operation, 2.6 (95% CI 2.3 to 3.0) in cases with two, 4.4 (95% CI 3.4 to 5.5) in cases with three, and 6.9 (95% CI 4.5 to 10.5) in cases with four or more previous operations. The ODI raw and change scores and the secondary outcomes showed similar trends. We found a dose-response relationship between increasing number of previous operations and inferior outcomes among patients operated for degenerative conditions in the lumbar spine. This information should be considered in the shared decision-making process prior to elective spine surgery.
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Affiliation(s)
- Anniken S Riksaasen
- Faculty of Health Sciences, Department of Clinical Medicine, University of Tromsø - the Arctic University of Norway, Tromsø, Norway
| | | | - Tore K Solberg
- Faculty of Health Sciences, Department of Clinical Medicine, University of Tromsø - the Arctic University of Norway, Tromsø, Norway.,Department of Neurosurgery and the Norwegian Registry for Spine Surgery, University Hospital of North Norway, Tromsø, Norway
| | - Ivar Austevoll
- Orthopedic Department, Kysthospitalet in Hagevik, Haukeland University Hospital, Bergen, Norway
| | - Jens-Ivar Brox
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | | | - Christian Hellum
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Frode Kolstad
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Greger Lonne
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,Innlandet Hospital Trust, Brumunddal, Norway.,Department of Neurosurgery, St. Olavs Hospital and the National Advisory Unit on Spinal Surgery, Trondheim, Norway
| | - Øystein P Nygaard
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurosurgery, St. Olavs Hospital and the National Advisory Unit on Spinal Surgery, Trondheim, Norway
| | - Tor Ingebrigtsen
- Faculty of Health Sciences, Department of Clinical Medicine, University of Tromsø - the Arctic University of Norway, Tromsø, Norway.,Department of Neurosurgery and the Norwegian Registry for Spine Surgery, University Hospital of North Norway, Tromsø, Norway.,Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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10
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Schipmann-Miletic S, Sivakanesan S, Rath DS, Brandal P, Vik-Mo E, Bjørås M, Solheim O, Ingebrigtsen T, Sund F, Bjerkvig R, Miletic H, Johannessen TCA, Sundstrøm T. Glioblastom hos voksne. Tidsskr Nor Laegeforen 2023; 143:22-0314. [PMID: 36718891 DOI: 10.4045/tidsskr.22.0314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Glioblastoma is the most common form of primary brain cancer in adults, and the disease has a serious prognosis. Although great progress has been made in molecular characteristics, no major breakthroughs in treatment have been achieved for many years. In this article we present a clinical review of current diagnostics and treatment, as well as the challenges and opportunities inherent in developing improved and more personalised treatment.
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Affiliation(s)
| | | | | | - Petter Brandal
- Avdeling for kreftbehandling, og, Institutt for kreftgenetikk og informatikk, Oslo universitetssykehus
| | - Einar Vik-Mo
- Nevrokirurgisk avdeling, Oslo universitetssykehus
| | - Magnar Bjørås
- Avdeling for mikrobiologi, Det medisinske fakultet, Universitetet i Oslo, og, Institutt for klinisk og molekylær medisin, Fakultet for medisin og helsevitenskap, NTNU
| | - Ole Solheim
- Institutt for nevromedisin og bevegelsesvitenskap, Fakultet for medisin og helsevitenskap, NTNU, og, Nevrokirurgisk avdeling, St. Olavs hospital
| | - Tor Ingebrigtsen
- Institutt for klinisk medisin, Det helsevitenskapelige fakultet, UiT Norges arktiske universitet, og, Nevrokirurgisk avdeling, Universitetssykehuset Nord-Norge
| | - Fredrik Sund
- Kirurgi-, kreft- og kvinnehelseklinikken, Universitetssykehuset Nord-Norge
| | - Rolf Bjerkvig
- Institutt for biomedisin, Det medisinske fakultet, Universitetet i Bergen
| | - Hrvoje Miletic
- Institutt for biomedisin, Det medisinske fakultet, Universitetet i Bergen, og, Patologisk avdeling, Haukeland universitetssjukehus
| | | | - Terje Sundstrøm
- Nevrokirurgisk avdeling, Haukeland universitetssjukehus, og, Klinisk institutt 1, Det medisinske fakultet, Universitetet i Bergen
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11
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Ingebrigtsen T, Aune G, Karlsen ME, Gulati S, Kolstad F, Nygaard ØP, Thyrhaug AM, Solberg TK. Non-respondents do not bias outcome assessment after cervical spine surgery: a multicenter observational study from the Norwegian registry for spine surgery (NORspine). Acta Neurochir (Wien) 2023; 165:125-133. [PMID: 36539647 PMCID: PMC9840578 DOI: 10.1007/s00701-022-05453-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The Norwegian registry for spine surgery (NORspine) is a national clinical quality registry which has recorded more than 10,000 operations for degenerative conditions of the cervical spine since 2012. Registries are large observational cohorts, at risk for attrition bias. We therefore aimed to examine whether clinical outcomes differed between respondents and non-respondents to standardized questionnaire-based 12-month follow-up. METHODS All eight public and private providers of cervical spine surgery in Norway report to NORspine. We included 334 consecutive patients who were registered with surgical treatment of degenerative conditions in the cervical spine in 2018 and did a retrospective analysis of prospectively collected register data and data on non-respondents' outcomes collected by telephone interviews. The primary outcome measure was patient-reported change in arm pain assessed with the numeric rating scale (NRS). Secondary outcome measures were change in neck pain assessed with the NRS, change in health-related quality of life assessed with EuroQol 5 Dimensions (EQ-5D), and patients' perceived benefit of the operation assessed by the Global Perceived Effect (GPE) scale. RESULTS At baseline, there were few and small differences between the 238 (71.3%) respondents and the 96 (28.7%) non-respondents. We reached 76 (79.2%) non-respondents by telephone, and 63 (65.6%) consented to an interview. There was no statistically significant difference between groups in change in NRS score for arm pain (3.26 (95% CI 2.84 to 3.69) points for respondents and 2.77 (1.92 to 3.63) points for telephone interviewees) or any of the secondary outcome measures. CONCLUSIONS The results indicate that patients lost to follow-up were missing at random. Analyses of outcomes based on data from respondents can be considered representative for the complete register cohort, if patient characteristics associated with attrition are controlled for.
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Affiliation(s)
- Tor Ingebrigtsen
- Department of Clinical Medicine, UiT The Arctic University of Norway, Postbox 6050 Langnes, 9037, Tromsø, Norway.
- Department of Neurosurgery and Norwegian Registry for Spine Surgery (NORspine), University Hospital of North Norway, Tromsø, Norway.
| | - Grethe Aune
- Department of Clinical Medicine, UiT The Arctic University of Norway, Postbox 6050 Langnes, 9037, Tromsø, Norway
| | - Martine Eriksen Karlsen
- Department of Clinical Medicine, UiT The Arctic University of Norway, Postbox 6050 Langnes, 9037, Tromsø, Norway
| | - Sasha Gulati
- Department of Neurosurgery and National Advisory Unit on Spinal Surgery, St. Olav's University Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Frode Kolstad
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Øystein P Nygaard
- Department of Neurosurgery and National Advisory Unit on Spinal Surgery, St. Olav's University Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anette Moltu Thyrhaug
- Department of Neurosurgery and Norwegian Registry for Spine Surgery (NORspine), University Hospital of North Norway, Tromsø, Norway
| | - Tore K Solberg
- Department of Clinical Medicine, UiT The Arctic University of Norway, Postbox 6050 Langnes, 9037, Tromsø, Norway
- Department of Neurosurgery and Norwegian Registry for Spine Surgery (NORspine), University Hospital of North Norway, Tromsø, Norway
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12
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Danielsen E, Gulati S, Salvesen Ø, Ingebrigtsen T, Nygaard ØP, Solberg TK. Clinical outcomes after surgery for cervical radiculopathy performed in public and private hospitals : a nationwide relative effectiveness study. Bone Joint J 2023; 105-B:64-71. [PMID: 36587250 PMCID: PMC9948431 DOI: 10.1302/0301-620x.105b1.bjj-2022-0591.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
AIMS The number of patients undergoing surgery for degenerative cervical radiculopathy has increased. In many countries, public hospitals have limited capacity. This has resulted in long waiting times for elective treatment and a need for supplementary private healthcare. It is uncertain whether the management of patients and the outcome of treatment are equivalent in public and private hospitals. The aim of this study was to compare the management and patient-reported outcomes among patients who underwent surgery for degenerative cervical radiculopathy in public and private hospitals in Norway, and to assess whether the effectiveness of the treatment was equivalent. METHODS This was a comparative study using prospectively collected data from the Norwegian Registry for Spine Surgery. A total of 4,750 consecutive patients who underwent surgery for degenerative cervical radiculopathy and were followed for 12 months were included. Case-mix adjustment between those managed in public and private hospitals was performed using propensity score matching. The primary outcome measure was the change in the Neck Disability Index (NDI) between baseline and 12 months postoperatively. A mean difference in improvement of the NDI score between public and private hospitals of ≤ 15 points was considered equivalent. Secondary outcome measures were a numerical rating scale for neck and arm pain and the EuroQol five-dimension three-level health questionnaire. The duration of surgery, length of hospital stay, and complications were also recorded. RESULTS The mean improvement from baseline to 12 months postoperatively of patients who underwent surgery in public and private hospitals was equivalent, both in the unmatched cohort (mean NDI difference between groups 3.9 points (95% confidence interval (CI) 2.2 to 5.6); p < 0.001) and in the matched cohort (4.0 points (95% CI 2.3 to 5.7); p < 0.001). Secondary outcomes showed similar results. The duration of surgery and length of hospital stay were significantly longer in public hospitals. Those treated in private hospitals reported significantly fewer complications in the unmatched cohort, but not in the matched cohort. CONCLUSION The clinical effectiveness of surgery for degenerative cervical radiculopathy performed in public and private hospitals was equivalent 12 months after surgery.Cite this article: Bone Joint J 2023;105-B(1):64-71.
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Affiliation(s)
- Elisabet Danielsen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway,Correspondence should be sent to Elisabet Danielsen. E-mail:
| | - Sasha Gulati
- Department of Neurosurgery, St. Olavs Hospital, Trondheim, Norway,Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway,National Advisory Unit on Spinal Surgery, St. Olavs Hospital, Trondheim, Norway
| | - Øyvind Salvesen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tor Ingebrigtsen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway,Department of Neurosurgery and the Norwegian Registry for Spine Surgery (NORspine), University Hospital of North Norway, Tromsø, Norway,Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Øystein P. Nygaard
- Department of Neurosurgery, St. Olavs Hospital, Trondheim, Norway,Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway,National Advisory Unit on Spinal Surgery, St. Olavs Hospital, Trondheim, Norway
| | - Tore K. Solberg
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway,Department of Neurosurgery and the Norwegian Registry for Spine Surgery (NORspine), University Hospital of North Norway, Tromsø, Norway
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13
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Anke P, Kjelsberg Pedersen L, Mathiesen EB, Ingebrigtsen T. Decompressive hemicraniectomy for space-occupying brain infarction: Nationwide population-based registry study. J Stroke Cerebrovasc Dis 2022; 31:106831. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 10/09/2022] [Indexed: 11/05/2022] Open
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14
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Holsen M, Hovind V, Bedane HK, Osvoll KI, Gjertsen JE, Furnes ON, Walsh ME, Ingebrigtsen T. Geographical variation in orthopedic procedures in Norway: Cross-sectional population-based study. Scand J Surg 2022; 111:92-98. [DOI: 10.1177/14574969221118488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Standardized surgery rates for common orthopedic procedures vary across geographical areas in Norway. We explored whether area-level factors related to demand and supply in publicly funded healthcare are associated with geographical variation in surgery rates for six common orthopedic procedures. Methods: The present study is a cross-sectional population-based study of hospital referral areas in Norway. We included adult admissions for arthroscopy for degenerative knee disease, arthroplasty for osteoarthritis of the knee and hip, surgical treatment for hip fracture, and decompression with/without fusion for lumbar disk herniation and lumbar spinal stenosis in 2012–2016. Variation in age and sex standardized rates was estimated using extremal quotients, coefficients of variation, and systematic components of variation (SCV). Associations between surgery rates and the socioeconomic factors urbanity, unemployment, low-income, high level of education, mortality, and number of surgeons and hospitals were explored with linear regression analyses. Results: Knee arthroscopy showed highest level of variation (SCV 10.3) and decreased in numbers. Variation was considerable for spine surgery (SCV 3.8–4.9), moderate to low for arthroplasty procedures (SCV 0.8–2.6), and small for hip fracture surgery (SCV 0.2). Higher rates of knee arthroscopy were associated with more orthopedic surgeons (adjusted coefficient 24.8, 95% confidence interval (CI): 2.7–47.0), and less urban population (adjusted coefficient −13.3, 95% CI: −25.4 to −1.2). Higher spine surgery rates were associated with more hospitals (adjusted coefficient 22.4, 95% CI: 4.6–40.2), more urban population (adjusted coefficient 2.1, 95% CI: 0.4–3.8), and lower mortality (adjusted coefficient −192.6, 95% CI: −384.2 to −1.1). Rates for arthroplasty and hip fracture surgery were not associated with supply/demand factors included. Conclusions: Arthroscopy for degenerative knee disease decreased in line with guidelines, but showed high variation of surgery rates. Socioeconomic factors included in this study did not explain geographical variation in orthopedic surgery.
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Affiliation(s)
- Maria Holsen
- Healthcare Atlas ServicesHelse Førde Health Trust Førde , Postboks 1000, Helse Førde, Førde 6807, Norway
| | - Veronica Hovind
- Helgeland Hospital, Mo i Rana, Norway Center for Clinical Documentation and Evaluation (SKDE), Tromsø, Norway Department of Clinical Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Haji K. Bedane
- Healthcare Atlas Services, Helse Førde Health Trust, Førde, Norway
| | - Knut I. Osvoll
- Healthcare Atlas Services, Helse Førde Health Trust, Førde, Norway
| | - Jan-Erik Gjertsen
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ove N. Furnes
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Mary E. Walsh
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Tor Ingebrigtsen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway Department of Neurosurgery, Ophthalmology and Otorhinolaryngology, University Hospital of North Norway, Tromsø, Norway Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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15
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Johnsen LH, Herder M, Vangberg T, Kloster R, Ingebrigtsen T, Isaksen JG, Mathiesen EB. Prevalence of unruptured intracranial aneurysms: impact of different definitions - the Tromsø Study. J Neurol Neurosurg Psychiatry 2022; 93:902-907. [PMID: 35688631 DOI: 10.1136/jnnp-2022-329270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/10/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Management of incidental unruptured intracranial aneurysms (UIAs) remains challenging and depends on their risk of rupture, estimated from the assumed prevalence of aneurysms and the incidence of aneurysmal subarachnoid haemorrhage. Reported prevalence varies, and consistent criteria for definition of UIAs are lacking. We aimed to study the prevalence of UIAs in a general population according to different definitions of aneurysm. METHODS Cross-sectional population-based study using 3-dimensional time-of-flight 3 Tesla MR angiography to identify size, type and location of UIAs in 1862 adults aged 40-84 years. Size was measured as the maximal distance between any two points in the aneurysm sac. Prevalence was estimated for different diameter cutoffs (≥1, 2 and 3 mm) with and without inclusion of extradural aneurysms. RESULTS The overall prevalence of intradural saccular aneurysms ≥2 mm was 6.6% (95% CI 5.4% to 7.6%), 7.5% (95% CI 5.9% to 9.2%) in women and 5.5% (95% CI 4.1% to 7.2%) in men. Depending on the definition of an aneurysm, the overall prevalence ranged from 3.8% (95% CI 3.0% to 4.8%) for intradural aneurysms ≥3 mm to 8.3% (95% CI 7.1% to 9.7%) when both intradural and extradural aneurysms ≥1 mm were included. CONCLUSION Prevalence in this study was higher than previously observed in other Western populations and was substantially influenced by definitions according to size and extradural or intradural location. The high prevalence of UIAs sized <5 mm may suggest lower rupture risk than previously estimated. Consensus on more robust and consistent radiological definitions of UIAs is warranted.
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Affiliation(s)
- Liv-Hege Johnsen
- Department of Radiology, University Hospital of North Norway, Tromso, Norway .,Department of Clinical Medicine, UiT The Arctic University, Tromso, Norway
| | - Marit Herder
- Department of Radiology, University Hospital of North Norway, Tromso, Norway.,Department of Clinical Medicine, UiT The Arctic University, Tromso, Norway
| | - Torgil Vangberg
- Department of Clinical Medicine, UiT The Arctic University, Tromso, Norway.,PET Imaging Center, University Hospital of North Norway, Tromso, Norway
| | - Roar Kloster
- Department of Clinical Medicine, UiT The Arctic University, Tromso, Norway.,Department of Neurosurgery, Ophthalmology, and Otorhinolaryngology, University Hospital of North Norway, Tromso, Norway
| | - Tor Ingebrigtsen
- Department of Clinical Medicine, UiT The Arctic University, Tromso, Norway.,Department of Neurosurgery, Ophthalmology, and Otorhinolaryngology, University Hospital of North Norway, Tromso, Norway
| | - Jørgen Gjernes Isaksen
- Department of Clinical Medicine, UiT The Arctic University, Tromso, Norway.,Department of Neurosurgery, Ophthalmology, and Otorhinolaryngology, University Hospital of North Norway, Tromso, Norway
| | - Ellisiv B Mathiesen
- Department of Clinical Medicine, UiT The Arctic University, Tromso, Norway.,Department of Neurology, University Hospital of North Norway, Tromso, Norway
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16
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Danielsen E, Mjåset C, Ingebrigtsen T, Gulati S, Grotle M, Rudolfsen JH, Nygaard ØP, Solberg TK. A nationwide study of patients operated for cervical degenerative disorders in public and private hospitals. Sci Rep 2022; 12:12856. [PMID: 35896806 PMCID: PMC9329342 DOI: 10.1038/s41598-022-17194-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 07/21/2022] [Indexed: 11/16/2022] Open
Abstract
During the last decades, there has been an increase in the rate of surgery for degenerative disorders of the cervical spine and in the use of supplementary private health insurance. Still, there is limited knowledge about the differences in characteristics of patients operated in public and private hospitals. Therefore, we aimed at comparing sociodemographic-, clinical- and patient management data on patients operated for degenerative cervical radiculopathy and degenerative cervical myelopathy in public and private hospitals in Norway. This was a cross-sectional study on patients in the Norwegian Registry for Spine Surgery operated for degenerative cervical radiculopathy and degenerative cervical myelopathy between January 2012 and December 2020. At admission for surgery, we assessed disability by the following patient reported outcome measures (PROMs): neck disability index (NDI), EuroQol-5D (EQ-5D) and numerical rating scales for neck pain (NRS-NP) and arm pain (NRS-AP). Among 9161 patients, 7344 (80.2%) procedures were performed in public hospitals and 1817 (19.8%) in private hospitals. Mean age was 52.1 years in public hospitals and 49.7 years in private hospitals (P < 0.001). More women were operated in public hospitals (47.9%) than in private hospitals (31.6%) (P < 0.001). A larger proportion of patients in private hospitals had high education (≥ 4 years of college or university) (42.9% vs 35.6%, P < 0.001). Patients in public hospitals had worse disease-specific health problems than those in private hospitals: unadjusted NDI mean difference was 5.2 (95% CI 4.4 – 6.0; P < 0.001) and adjusted NDI mean difference was 3.4 (95% CI 2.5 – 4.2; P < 0.001), and they also had longer duration of symptoms (P < 0.001). Duration of surgery (mean difference 29 minutes, 95% CI 27.1 – 30.7; P < 0.001) and length of hospital stay (mean difference 2 days, 95% CI 2.3 – 2.4; P < 0.001) were longer in public hospitals. In conclusion, patients operated for degenerative cervical spine in private hospitals were healthier, younger, better educated and more often men. They also had less and shorter duration of symptoms and seemed to be managed more efficiently. Our findings indicate that access to cervical spine surgery in private hospitals could be skewed in favour of patients with higher socioeconomic status.
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Affiliation(s)
- Elisabet Danielsen
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
| | | | - Tor Ingebrigtsen
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.,Department of Neurosurgery and the Norwegian Registry for Spine Surgery (NORspine), University Hospital of North Norway, Tromsø, Norway.,Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Sasha Gulati
- Department of Neurosurgery, St. Olavs Hospital, Trondheim, Norway.,Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Margreth Grotle
- Centre for Intelligent Musculoskeletal Health, Faculty of Health Science, Oslo Metropolitan University, Oslo, Norway.,Communication Unit for Musculoskeletal Disorders (FORMI), Oslo University Hospital, Oslo, Norway
| | - Jan Håkon Rudolfsen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Øystein P Nygaard
- Department of Neurosurgery, St. Olavs Hospital, Trondheim, Norway.,Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,National Advisory Unit on Spinal Surgery, St. Olavs Hospital, Trondheim, Norway
| | - Tore K Solberg
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.,Department of Neurosurgery and the Norwegian Registry for Spine Surgery (NORspine), University Hospital of North Norway, Tromsø, Norway
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Rautalin I, Kaprio J, Ingebrigtsen T, Jousilahti P, Løchen ML, Romundstad PR, Salomaa V, Vik A, Wilsgaard T, Mathiesen EB, Sandvei M, Korja M. Obesity Does Not Protect From Subarachnoid Hemorrhage: Pooled Analyses of 3 Large Prospective Nordic Cohorts. Stroke 2022; 53:1301-1309. [PMID: 34753302 PMCID: PMC10510796 DOI: 10.1161/strokeaha.121.034782] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 08/04/2021] [Accepted: 08/20/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Several population-based cohort studies have related higher body mass index (BMI) to a decreased risk of subarachnoid hemorrhage (SAH). The main objective of our study was to investigate whether the previously reported inverse association can be explained by modifying effects of the most important risk factors of SAH-smoking and hypertension. METHODS We conducted a collaborative study of three prospective population-based Nordic cohorts by combining comprehensive baseline data from 211 972 adult participants collected between 1972 and 2012, with follow-up until the end of 2018. Primarily, we compared the risk of SAH between three BMI categories: (1) low (BMI<22.5), (2) moderate (BMI: 22.5-29.9), and (3) high (BMI≥30) BMI and evaluated the modifying effects of smoking and hypertension on the associations. RESULTS We identified 831 SAH events (mean age 62 years, 55% women) during the total follow-up of 4.7 million person-years. Compared with the moderate BMI category, persons with low BMI had an elevated risk for SAH (adjusted hazard ratio [HR], 1.30 [1.09-1.55]), whereas no significant risk difference was found in high BMI category (HR, 0.91 [0.73-1.13]). However, we only found the increased risk of low BMI in smokers (HR, 1.49 [1.19-1.88]) and in hypertensive men (HR, 1.72 [1.18-2.50]), but not in nonsmokers (HR, 1.02 [0.76-1.37]) or in men with normal blood pressure values (HR, 0.98 [0.63-1.54]; interaction HRs, 1.68 [1.18-2.41], P=0.004 between low BMI and smoking and 1.76 [0.98-3.13], P=0.06 between low BMI and hypertension in men). CONCLUSIONS Smoking and hypertension appear to explain, at least partly, the previously reported inverse association between BMI and the risk of SAH. Therefore, the independent role of BMI in the risk of SAH is likely modest.
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Affiliation(s)
- Ilari Rautalin
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Finland (I.R., M.K.)
- Department of Public Health, University of Helsinki, Finland (I.R., J.K.)
| | - Jaakko Kaprio
- Department of Public Health, University of Helsinki, Finland (I.R., J.K.)
- Institute for Molecular Medicine FIMM, Helsinki, Finland (J.K.)
| | - Tor Ingebrigtsen
- Department of Clinical Medicine, Faculty of Health Sciences (T.I.), UiT the Arctic University of Norway, Tromsø
- Department of Neurosurgery, Ophthalmology and Otorhinolaryngology (T.I.), University Hospital of North Norway, Tromsø
| | - Pekka Jousilahti
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland (P.J., V.S.)
| | - Maja-Lisa Løchen
- Department of Community Medicine (M.-L.L., T.W.), UiT the Arctic University of Norway, Tromsø
| | - Pål Richard Romundstad
- Department of Public Health and Nursing (P.R.R., M.S.), Norwegian University of Science and Technology, Trondheim, Norway
| | - Veikko Salomaa
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland (P.J., V.S.)
| | - Anne Vik
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences (A.V.), Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Norway (A.V.)
| | - Tom Wilsgaard
- Department of Community Medicine (M.-L.L., T.W.), UiT the Arctic University of Norway, Tromsø
| | - Ellisiv B. Mathiesen
- Department of Clinical Medicine (E.B.M.), UiT the Arctic University of Norway, Tromsø
- Department of Neurology (E.B.M.), University Hospital of North Norway, Tromsø
| | - Marie Sandvei
- Department of Public Health and Nursing (P.R.R., M.S.), Norwegian University of Science and Technology, Trondheim, Norway
- The Cancer Clinic, St Olav’s University Hospital, Trondheim, Norway (M.S.)
| | - Miikka Korja
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Finland (I.R., M.K.)
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18
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Austin Wæhler T, Ingebrigtsen T. Health risks, emergency preparedness and Norwegian-Russian cooperation on Svalbard. A systematic review. Int J Circumpolar Health 2022; 81:2049055. [PMID: 35285421 PMCID: PMC8920391 DOI: 10.1080/22423982.2022.2049055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Turid Austin Wæhler
- Department of Social Sciences and Education, UiT The Arctic University of country,Norway
- Australian Institute of Health Innovation,Macquarie University, Sydney, Australia
| | - Tor Ingebrigtsen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of country, Norway
- Department of Neurosurgery, Otorhinolaryngology and Ophthalmology, University Hospital of Northcountry, Tromsø,Norway
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19
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Ingebrigtsen T, Guldhaugen KA, Kristiansen JA, Kloster R, Grotle M, Solberg TK. Cervical spine surgery in the Northern Norway Regional Health Authority area in 2014-18. Tidsskr Nor Laegeforen 2022; 142:21-0628. [PMID: 35239272 DOI: 10.4045/tidsskr.21.0628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Knowledge about the variation in treatment rates is needed to assess whether the access to health services is equitable. The objective of this study was to investigate the rates of surgical treatment of degenerative cervical spine disease in Norway and the Northern Norway Regional Health Authority area and the local coverage in the Northern Norway Regional Health Authority area, and to assess the activity in the region. MATERIAL AND METHOD We included cervical spine procedures recorded in the Norwegian Patient Registry from the years 2014-18 and estimated age-standardised treatment rates for Norway, the health regions and health trusts in Northern Norway Regional Health Authority. We estimated the local coverage as the proportion of patients resident in the Northern Norway Regional Health Authority area who had undergone surgery at the University Hospital of North Norway in Tromsø. RESULTS The treatment rate remained stable at an average of 29.6 surgical procedures per 100 000 inhabitants (aged 18-105) per year. The rate for residents in the Northern Norway Regional Health Authority area was 23.0 procedures per 100 000 inhabitants per year (78 % of the national average). The rates in Finnmark and the areas of residence served by the University Hospital of North Norway were close to the national average. Residents in the Nordland and Helgeland areas had lower rates in each year of the study period, with an average of 16.6 and 18.1 procedures per 100 000 inhabitants per year respectively. This corresponds to 56 % and 61 % of the national average. Local coverage in the Northern Norway Regional Health Authority area increased from 69 % in 2014 to 91 % in 2018. INTERPRETATION The treatment rate for degenerative cervical spine disease was lower in the Northern Norway Regional Health Authority area than in the rest of Norway. For this to be compensated and the local coverage to be increased to 100 %, we have estimated that the activity needs to be increased by approximately 35 surgical procedures per year.
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20
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Ingebrigtsen T. Ten-year tenure as a physician CEO at a Nordic university hospital: five lessons learnt. leader 2022; 7:3-6. [PMID: 37013875 DOI: 10.1136/leader-2021-000558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 02/01/2022] [Indexed: 11/03/2022]
Abstract
BackgroundI was a 42-year-old neurosurgeon with experience as department head when I took chair as chief executive officer (CEO) at the University Hospital of North Norway to lead a comprehensive organisational and financial restructuring. This article aims to develop lessons learnt during my 10-year tenure.MethodsI restructured the organisation and hired a new executive team. We developed a new strategy and measures to implement it. I describe the results, a strategic disagreement that developed and my resignment, and reflect critically over my actions as a leader.ResultsMeasures of safety and quality in clinical processes, cost-effectiveness and financial equity improved. We expedited investments in medical equipment, information technology and hospital facilities. Patient satisfaction was stable, but employees’ job satisfaction decreased. After 9 years, a politicised strategic disagreement with superior authorities developed. I was criticised for attempting to influence inappropriately, and resigned.Lessons learnt(1) Data-driven improvement works, but comes at a cost. Healthcare organisations should consider to prioritise resilience over efficiency. (2) It is inherently difficult to recognise when and how an issue changes from a professional to a political logic. I should have used contacts in politics and surveilled local media better. (3) During conflict, role clarity is crucial. (4) CEOs should be prepared to resign when strategically unaligned with superior authorities. (5) A CEO tenure should not last more than 10 years.ConclusionMy experiences as a physician CEO was intense and immensely interesting, but some of the lessons were painfully learnt.
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Affiliation(s)
- Tor Ingebrigtsen
- Clinical Medicine, UiT The Arctic University of Norway, Tromso, Norway
- Neurosurgery, Ophthalmology and Otorhinolaryngology, University Hospital of North Norway, Tromso, Norway
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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21
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Weber C, Myrseth E, Kurz KD, Fric R, Ingebrigtsen T, Helseth E, Nygaard ØP, Kvistad KA. Weight-bearing magnetic resonance imaging of the neck? Tidsskr Nor Laegeforen 2021; 141:21-0284. [PMID: 34423961 DOI: 10.4045/tidsskr.21.0284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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22
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Akre KAT, Ingebrigtsen T. Adherence to the Scandinavian guidelines for initial management of minimal, mild and moderate head injuries in adults. Tidsskr Nor Laegeforen 2021; 141:20-0986. [PMID: 33950660 DOI: 10.4045/tidsskr.20.0986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND The Scandinavian guidelines for initial management of minimal, mild and moderate head injuries in adults aim to identify patients at risk of developing intracranial haematoma, while also avoiding unnecessary computed tomography (CT) scans and hospital admissions. We examined compliance with the guidelines at the University Hospital of North Norway, Tromsø. MATERIAL AND METHOD A search in the patient administration system identified 448 patients with a diagnosis code for head injury. We excluded 298 who met one or more exclusion criteria, and included 150 with minimal, mild or moderate injuries in a retrospective study. Management was categorised as being either compliant or non-compliant with the guidelines. We defined non-compliance as overtesting (unnecessary CT scan and/or hospital admission) or undertesting (omission of necessary CT scan and/or hospital admission). RESULTS Management was in accordance with the guidelines for 96/150 (64 %) patients. This proportion increased with the severity of the injury (minimal 4/12 (33 %), mild 76/119 (64 %) and moderate 16/19 (84 %)). A total of 54/150 (36 %) patients were not managed in accordance with the guidelines. This was due to unnecessary CT scans and/or hospitalisation in 39/54 (72 %) patients and undertesting in 15/54 (28 %). Among patients with low-risk mild head injuries, 35/57 (61 %) underwent analysis of the brain injury marker S100B, as per the recommendations. INTERPRETATION Compliance with the Scandinavian guidelines could be improved.
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Ingebrigtsen T, Balteskard L, Guldhaugen KA, Kloster R, Uleberg B, Grotle M, Solberg TK. Treatment rates for lumbar spine surgery in Norway and Northern Norway Regional Health Authority 2014-18. Tidsskr Nor Laegeforen 2020; 140:20-0313. [PMID: 33231397 DOI: 10.4045/tidsskr.20.0313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND The objective of this study was to investigate whether the service provision for lumbar spine surgery within the Northern Norway Regional Health Authority area complies with the distribution of functions that has been decided for the hospitals in the region, and whether there are any geographical variations in service provision. We therefore studied the treatment rates in Norway as a whole and in the Northern Norway Regional Health Authority area, and assessed the activity in the region. MATERIAL AND METHOD We included lumbar spine procedures in the Norwegian Patient Registry from the years 2014-2018 in a retrospective analysis and estimated treatment rates standardised by sex and age for Norway as a whole, the health regions and the health enterprises in Northern Norway Regional Health Authority. We estimated the local coverage as the proportion of patients who had undergone surgery in a hospital within their own area of residence. RESULTS The treatment rate for lumbar spine surgery in Norway amounted to approximately 120 procedures per 100 000 inhabitants per year for the entire period. The number of spine procedures nationwide increased from 5 995 in 2014 to 6 494 in 2018 because of a general population growth. The treatment rates for fractures and simple spine procedures were approximately identical throughout Norway, but the rate for complex spine procedures among residents within the area of Northern Norway Regional Health Authority amounted to 57 % of the national average. Local coverage within the Northern Norway Regional Health Authority area increased from 60 % to 84 % during the period. The local hospital functions for simple spine procedures at Nordland and Helgeland hospitals (approximately 30 %) and the regional function for complex spine surgery at the University Hospital of North Norway (55 %) had a low degree of local coverage. INTERPRETATION The treatment rate for complex spine procedures and the local coverage for all surgical procedures for degenerative lumbar spine disease were lower within the Northern Norway Regional Health Authority area than in the country as a whole. For this to be compensated in this region, we have estimated that the activity needs to be increased by approximately 170 procedures per year.
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Bågenholm A, Løvhaugen P, Sundset R, Ingebrigtsen T. DIAGNOSTIC IMAGING AND IONIZING RADIATION EXPOSURE IN A LEVEL 1 TRAUMA CENTRE POPULATION MET WITH TRAUMA TEAM ACTIVATION: A ONE-YEAR PATIENT RECORD AUDIT. Radiat Prot Dosimetry 2020; 189:35-47. [PMID: 32060518 DOI: 10.1093/rpd/ncaa010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/10/2020] [Accepted: 01/15/2020] [Indexed: 06/10/2023]
Abstract
This audit describes ionizing and non-ionizing diagnostic imaging at a regional trauma centre. All 144 patients (males 79.2%, median age 31 years) met with trauma team activation from 1 January 2015 to 31 December 2015 were included. We used data from electronic health records to identify all diagnostic imaging and report radiation exposure as dose area product (DAP) for conventional radiography (X-ray) and dose length product (DLP) and effective dose for CT. During hospitalization, 134 (93.1%) underwent X-ray, 122 (84.7%) CT, 92 (63.9%) focused assessment with sonography for trauma (FAST), 14 (9.7%) ultrasound (FAST excluded) and 32 (22.2%) magnetic resonance imaging. One hundred and sixteen (80.5%) underwent CT examinations during trauma admissions, and 73 of 144 (50.7%) standardized whole body CT (SWBCT). DAP values were below national reference levels. Median DLP and effective dose were 2396 mGycm and 20.42 mSv for all CT examinations, and 2461 mGycm (national diagnostic reference level 2400) and 22.29 mSv for a SWBCT.
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Affiliation(s)
- Anna Bågenholm
- Department of Radiology, University Hospital of North Norway, Tromsø N-9038, Norway
- Department of Clinical Medicine, Faculty of Health Science, UiT-The Arctic University of Norway, Tromsø N-9037, Norway
| | - Pål Løvhaugen
- PET-Imaging Center, University Hospital of North Norway, Tromsø N-9038, Norway
| | - Rune Sundset
- Department of Clinical Medicine, Faculty of Health Science, UiT-The Arctic University of Norway, Tromsø N-9037, Norway
- PET-Imaging Center, University Hospital of North Norway, Tromsø N-9038, Norway
| | - Tor Ingebrigtsen
- Department of Clinical Medicine, Faculty of Health Science, UiT-The Arctic University of Norway, Tromsø N-9037, Norway
- Department of Neurosurgery, ENT and Ophthalmology, University Hospital of North Norway, Tromsø N-9038, Norway
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Rudolfsen JH, Solberg TK, Ingebrigtsen T, Olsen JA. Associations between utilization rates and patients' health: a study of spine surgery and patient-reported outcomes (EQ-5D and ODI). BMC Health Serv Res 2020; 20:135. [PMID: 32087710 PMCID: PMC7036171 DOI: 10.1186/s12913-020-4968-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 02/07/2020] [Indexed: 02/06/2023] Open
Abstract
Background A vast body of literature has documented regional variations in healthcare utilization rates. The extent to which such variations are “unwarranted” critically depends on whether there are corresponding variations in patients’ needs. Using a unique medical registry, the current paper investigated any associations between utilization rates and patients’ needs, as measured by two patient-reported outcome measures (PROMs). Methods This observational panel study merged patient-level data from the Norwegian Patient Registry (NPR), Statistics Norway, and the Norwegian Registry for Spine Surgery (NORspine) for individuals who received surgery for degenerative lumbar spine disorders in 2010–2015. NPR consists of hospital administration data. NORspine includes two PROMs: the generic health-related quality of life instrument EQ-5D and the disease-specific, health-related quality of life instrument Oswestry Disability Index (ODI). Measurements were assessed at baseline and at 3 and 12 months post-surgery and included a wide range of patient characteristics. Our case sample included 15,810 individuals. We analyzed all data using generalized estimating equations. Results Our results show that as treatment rates increase, patients have better health at baseline. Furthermore, increased treatment rates are associated with smaller health gain. Conclusion The correlation between treatment rates and patients health indicate the presence of unwarranted variation in treatment rates for lumbar spine disorders.
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Affiliation(s)
- Jan Håkon Rudolfsen
- Department of Community Medicine, UiT - The Arctic University of Norway, Tromsø, Norway.
| | - Tore K Solberg
- Department of Neurosurgery, University Hospital of Northern Norway, and the Norwegian Registry for Spine Surgery (NORspine), Tromsø, Norway.,Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Tor Ingebrigtsen
- Department of Neurosurgery, University Hospital of Northern Norway, and the Norwegian Registry for Spine Surgery (NORspine), Tromsø, Norway.,Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Jan Abel Olsen
- Department of Community Medicine, UiT - The Arctic University of Norway, Tromsø, Norway.,Division of Health Services, Norwegian Institute of Public Health, Oslo, Norway.,Centre for Health Economics, Monash University, Melbourne, Australia
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Bågenholm A, Dehli T, Eggen Hermansen S, Bartnes K, Larsen M, Ingebrigtsen T. Clinical guided computer tomography decisions are advocated in potentially severely injured trauma patients: a one-year audit in a level 1 trauma Centre with long pre-hospital times. Scand J Trauma Resusc Emerg Med 2020; 28:2. [PMID: 31924242 PMCID: PMC6954603 DOI: 10.1186/s13049-019-0692-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 11/26/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The International Commission on Radiological Protection's (ICRP) justification principles state that an examination is justified if the potential benefit outweighs the risk for radiation harm. Computer tomography (CT) contributes 50% of the radiation dose from medical imaging, and in trauma patients, the use of standardized whole body CT (SWBCT) increases. Guidelines are lacking, and reviews conclude conflictingly regarding the benefit. We aimed to study the degree of adherence to ICRP's level three justification, the individual dose limitation principle, in our institution. METHODS This is a retrospective clinical audit. We included all 144 patients admitted with trauma team activation to our regional Level 1 trauma centre in 2015. Injuries were categorized according to the Abbreviated Injury Scale (AIS) codes. Time variables, vital parameters and interventions were registered. We categorized patients into trauma admission SWBCT, selective CT or no CT examination strategy groups. We used descriptive statistics and regression analysis of predictors for CT examination strategy. RESULTS The 144 patients (114 (79.2%) males) had a median age of 31 (range 0-91) years. 105 (72.9%) had at least one AIS ≥ 2 injury, 26 (18.1%) in more than two body regions. During trauma admission, at least one vital parameter was abnormal in 46 (32.4%) patients, and 73 (50.7%) underwent SWBCT, 43 (29.9%) selective CT and 28 (19.4%) no CT examination. No or only minor injuries were identified in 17 (23.3%) in the SWBCT group. Two (4.6%) in the selective group were examined with a complement CT, with no new injuries identified. A significantly (p < 0.001) lower proportion of children (61.5%) than adults (89.8%) underwent CT examination despite similar injury grades and use of interventions. In adjusted regression analysis, patients with a high-energy trauma mechanism had significantly (p = 0.028) increased odds (odds ratio = 4.390, 95% confidence interval 1.174-16.413) for undergoing a SWBCT. CONCLUSION The high proportion of patients with no or only minor injuries detected in the SWBCT group and the significantly lower use of CT among children, indicate that use of a selective CT examination strategy in a higher proportion of our patients would have approximated the ICRP's justification level three, the individual dose limitation principle, better.
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Affiliation(s)
- Anna Bågenholm
- Department of Clinical Medicine, Faculty of Health Science, UiT-The Artic University of Norway, PO box 6050 Langnes, N-9037 Tromsø, Norway
- Department of Radiology, University Hospital of North Norway, Sykehusveien 38, PO box 103, N-9038 Tromsø, Norway
| | - Trond Dehli
- Department of Clinical Medicine, Faculty of Health Science, UiT-The Artic University of Norway, PO box 6050 Langnes, N-9037 Tromsø, Norway
- Department of Gastrointestinal Surgery, University Hospital of North Norway, PO box 103, N-9038 Tromsø, Norway
| | - Stig Eggen Hermansen
- Department of Cardiothoracic and Vascular Surgery, University Hospital of North Norway, PO box 103, N-9038 Tromsø, Norway
| | - Kristian Bartnes
- Department of Clinical Medicine, Faculty of Health Science, UiT-The Artic University of Norway, PO box 6050 Langnes, N-9037 Tromsø, Norway
- Department of Cardiothoracic and Vascular Surgery, University Hospital of North Norway, PO box 103, N-9038 Tromsø, Norway
| | - Marthe Larsen
- Centre for Quality Improvements and Development, University Hospital of North Norway, PO box 103, N-9038 Tromsø, Norway
| | - Tor Ingebrigtsen
- Department of Clinical Medicine, Faculty of Health Science, UiT-The Artic University of Norway, PO box 6050 Langnes, N-9037 Tromsø, Norway
- Department of Neurosurgery, ENT and Ophthalmology, University Hospital of North Norway, PO box 103, N-9038 Tromsø, Norway
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27
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Bågenholm A, Lundberg I, Straume B, Sundset R, Bartnes K, Ingebrigtsen T, Dehli T. Injury coding in a national trauma registry: a one-year validation audit in a level 1 trauma centre. BMC Emerg Med 2019; 19:61. [PMID: 31666018 PMCID: PMC6820947 DOI: 10.1186/s12873-019-0276-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 10/03/2019] [Indexed: 11/10/2022] Open
Abstract
Background Hospitals must improve patient safety and quality continuously. Clinical quality registries can drive such improvement. Trauma registries code injuries according to the Abbreviated Injury Scale (AIS) and benchmark outcomes based on the Injury Severity Score (ISS) and New ISS (NISS). The primary aim of this study was to validate the injury codes and severities registered in a national trauma registry. Secondarily, we aimed to examine causes for missing and discordant codes, to guide improvement of registry data quality. Methods We conducted an audit and established an expert coder group injury reference standard for patients met with trauma team activation in 2015 in a Level 1 trauma centre. Injuries were coded according to the AIS. The audit included review of all data in the electronic health records (EHR), and new interpretation of all images in the picture archiving system. Validated injury codes were compared with the codes registered in the registry. The expert coder group’s interpretations of reasons for discrepancies were categorised and registered. Inter-rater agreement between registry data and the reference standard was tested with Bland–Altman analysis. Results We validated injury data from 144 patients (male sex 79.2%) with median age 31 (inter quartile range 19–49) years. The total number of registered AIS codes was 582 in the registry and 766 in the reference standard. All injuries were concordantly coded in 62 (43.1%) patients. Most non-registered codes (n = 166 in 71 (49.3%) patients) were AIS 1, and information in the EHR overlooked by registrars was the dominating cause. Discordant coding of head injuries and extremity fractures were the most common causes for 157 discordant AIS codes in 74 (51.4%) patients. Median ISS (9) and NISS (12) for the total population did not differ between the registry and the reference standard. Conclusions Concordance between the codes registered in the trauma registry and the reference standard was moderate, influencing individual patients’ injury codes validity and ISS/NISS reliability. Nevertheless, aggregated median group ISS/NISS reliability was acceptable.
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Affiliation(s)
- Anna Bågenholm
- Department of Radiology, University Hospital of North Norway, Sykehusveien 38 -, PO box 103, N-9038, Tromsø, Norway. .,Department of Clinical Medicine, Faculty of Health Science, UiT-The Artic University of Norway, Tromsø, Norway.
| | - Ina Lundberg
- Division of Cardiothoracic and Respiratory Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Bjørn Straume
- Centre for quality improvement and development, University Hospital of North Norway, Tromsø, Norway.,Department of Community Medicine, Faculty of Health Science, UiT-The Artic University of Norway, Tromsø, Norway
| | - Rune Sundset
- Department of Clinical Medicine, Faculty of Health Science, UiT-The Artic University of Norway, Tromsø, Norway.,PET imaging Centre, University Hospital of North Norway, Tromsø, Norway
| | - Kristian Bartnes
- Department of Clinical Medicine, Faculty of Health Science, UiT-The Artic University of Norway, Tromsø, Norway.,Division of Cardiothoracic and Respiratory Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Tor Ingebrigtsen
- Department of Clinical Medicine, Faculty of Health Science, UiT-The Artic University of Norway, Tromsø, Norway.,Department of Neurosurgery, ENT and Ophthalmology, University Hospital of North Norway, Tromsø, Norway
| | - Trond Dehli
- Department of Clinical Medicine, Faculty of Health Science, UiT-The Artic University of Norway, Tromsø, Norway.,Department of Gastrointestinal Surgery, University Hospital of North Norway, Tromsø, Norway
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Ingebrigtsen T. Komplett om araknoidale cyster. Tidsskriftet 2018. [DOI: 10.4045/tidsskr.18.0362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Sjåvik K, Bartek J, Solheim O, Ingebrigtsen T, Gulati S, Sagberg LM, Förander P, Jakola AS. Venous Thromboembolism Prophylaxis in Meningioma Surgery: A Population-Based Comparative Effectiveness Study of Routine Mechanical Prophylaxis with or without Preoperative Low-Molecular-Weight Heparin. World Neurosurg 2016; 88:320-326. [DOI: 10.1016/j.wneu.2015.12.077] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 12/19/2015] [Accepted: 12/21/2015] [Indexed: 01/25/2023]
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Lindekleiv H, Ingebrigtsen T. Response. J Neurosurg 2015; 123:630. [PMID: 26561673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Lindekleiv H, Mathiesen EB, Førde OH, Wilsgaard T, Ingebrigtsen T. Hospital volume and 1-year mortality after treatment of intracranial aneurysms: a study based on patient registries in Scandinavia. J Neurosurg 2015; 123:631-7. [DOI: 10.3171/2014.12.jns142106] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
The object of this study was to examine the relationship between hospital volume and long-term mortality after treatment of intracranial aneurysms.
METHODS
The authors identified patients treated for intracranial aneurysms between 2002 and 2010 from patient registries of Denmark, Norway, and Sweden, and linked to data on 1-year mortality from the population registry of each country. Cox regression models were used to relate hospital volume to the risk of death and adjusted for potential confounders (age, sex, year of treatment, Charlson comorbidity index, country, and surgical treatment).
RESULTS
The authors identified 5773 patients with ruptured and 1756 patients with unruptured intracranial aneurysms, treated at 15 hospitals. One-year mortality rates were 15.6% for patients with ruptured aneurysms and 2.7% for patients with unruptured aneurysms. No consistent relationship was found between hospital volume and 1-year mortality for ruptured aneurysms in the unadjusted analyses, but higher hospital volume was associated with increased mortality in the analyses adjusted for potential confounders (hazard ratio [HR] per 10-patient increase 1.04, 95% CI 1.00–1.07). There was a trend toward a lower mortality rate in higher-volume hospitals after treatment for unruptured intracranial aneurysms, but this was not statistically significant after adjustment for potential confounders (HR per 10-patient increase 0.69, 95% CI 0.42–1.10). There were large variations in mortality after treatment for both ruptured and unruptured intracranial aneurysms across hospitals and between the Scandinavian countries (p < 0.01).
CONCLUSIONS
The findings in this study did not confirm a relationship between higher hospital volume and reduced long-term mortality after treatment of ruptured intracranial aneurysms. Prospective registries for evaluating outcomes after aneurysm treatment are highly warranted.
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Affiliation(s)
| | - Ellisiv B. Mathiesen
- 2Clinical Medicine, Faculty of Health Sciences, University of Tromsø; and
- 3University Hospital of North Norway, Tromsø, Norway
| | | | | | - Tor Ingebrigtsen
- 2Clinical Medicine, Faculty of Health Sciences, University of Tromsø; and
- 3University Hospital of North Norway, Tromsø, Norway
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Bartek J, Sjåvik K, Förander P, Solheim O, Gulati S, Weber C, Ingebrigtsen T, Jakola AS. Predictors of Severe Complications in Intracranial Meningioma Surgery: A Population-Based Multicenter Study. World Neurosurg 2015; 83:673-8. [DOI: 10.1016/j.wneu.2015.01.022] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 01/07/2015] [Accepted: 01/19/2015] [Indexed: 10/24/2022]
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Iversen T, Solberg TK, Wilsgaard T, Waterloo K, Brox JI, Ingebrigtsen T. Outcome prediction in chronic unilateral lumbar radiculopathy: prospective cohort study. BMC Musculoskelet Disord 2015; 16:17. [PMID: 25887469 PMCID: PMC4326298 DOI: 10.1186/s12891-015-0474-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 01/22/2015] [Indexed: 11/23/2022] Open
Abstract
Background Identification of prognostic factors for persistent pain and disability are important for better understanding of the clinical course of chronic unilateral lumbar radiculopathy and to assist clinical decision-making. There is a lack of scientific evidence concerning prognostic factors. The aim of this study was to identify clinically relevant predictors for outcome at 52 weeks. Methods 116 patients were included in a sham controlled clinical trial on epidural injection of glucocorticoids in patients with chronic unilateral lumbar radiculopathy. Success at follow-up was ≤17.5 for visual analogue scale (VAS) leg pain, ≤22.5 for VAS back pain and ≤20 for Oswestry Disability Index (ODI). Fifteen clinically relevant variables included demographic, psychosocial, clinical and radiological data and were analysed using a logistic multivariable regression analysis. Results At follow-up, 75 (64.7%) patients had reached a successful outcome with an ODI score ≤20, 54 (46.6%) with a VAS leg pain score ≤17.5, and 47 (40.5%) with a VAS back pain score ≤22.5. Lower age (OR 0.94 (CI 0.89–0.99) for each year decrease in age) and FABQ Work ≥34 (OR 0.16 (CI 0.04-0.61)) were independent variables predicting a successful outcome on the ODI. Higher education (OR 5.77 (CI 1.46–22.87)) and working full-time (OR 2.70 (CI 1.02–7.18)) were statistically significant (P <0.05) independent predictors for successful outcome (VAS score ≤17.5) on the measure of leg pain. Lower age predicted success on ODI (OR 0.94 (95% CI 0.89 to 0.99) for each year) and less back pain (OR 0.94 (0.90 to 0.99)), while higher education (OR 5.77 (1.46 to 22.87)), working full-time (OR 2.70 (1.02 to 7.18)) and muscle weakness at baseline (OR 4.11 (1.24 to 13.61) predicted less leg pain, and reflex impairment at baseline predicted the contrary (OR 0.39 (0.15 to 0.97)). Conclusions Lower age, higher education, working full-time and low fear avoidance beliefs each predict a better outcome of chronic unilateral lumbar radiculopathy. Specifically, lower age and low fear avoidance predict a better functional outcome and less back pain, while higher education and working full-time predict less leg pain. These results should be validated in further studies before being used to inform patients. Trial registration Current Controlled Trials ISRCTN12574253. Registered 18 May 2005.
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Affiliation(s)
- Trond Iversen
- Bindal Legekontor, Terråk, Norway. .,Department of Physical Medicine and Rehabilitation, University Hospital of North Norway, Tromsø, Norway.
| | - Tore K Solberg
- Department of Ophthalmology and Neurosurgery, University Hospital of North Norway, Tromsø, Norway. .,The Norwegian Registry for Spine Surgery (NORspine), North Norway Regional Health Authority, Tromsø, Norway.
| | - Tom Wilsgaard
- Department of Community Medicine, Faculty of Health Sciences, UiT The Artic University of Norway, Tromsø, Norway.
| | - Knut Waterloo
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway. .,Department of Psychology, Faculty of Health Sciences, UiT The Artic University of Norway, Tromsø, Norway.
| | - Jens Ivar Brox
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, University of Oslo, Oslo, Norway.
| | - Tor Ingebrigtsen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Artic University of Norway, Tromsø, Norway.
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Ingebrigtsen T, Kloster R, Solberg T, Munch-Ellingsen J, Hennig R. MINNEORD. Tidsskriftet 2015. [DOI: 10.4045/tidsskr.15.0907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Ingebrigtsen T, Georgiou A, Clay-Williams R, Magrabi F, Hordern A, Prgomet M, Li J, Westbrook J, Braithwaite J. The impact of clinical leadership on health information technology adoption: systematic review. Int J Med Inform 2014; 83:393-405. [PMID: 24656180 DOI: 10.1016/j.ijmedinf.2014.02.005] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 02/21/2014] [Accepted: 02/24/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To conduct a systematic review to examine evidence of associations between clinical leadership and successful information technology (IT) adoption in healthcare organisations. METHODS We searched Medline, Embase, Cinahl, and Business Source Premier for articles published between January 2000 to May 2013 with keywords and subject terms related to: (1) the setting--healthcare provider organisations; (2) the technology--health information technology; (3) the process--adoption; and (4) the intervention--leadership. We identified 3121 unique citations, of which 32 met our criteria and were included in the review. Data extracted from the included studies were assessed in light of two frameworks: Bassellier et al.'s IT competence framework; and Avgar et al.'s health IT adoption framework. RESULTS The results demonstrate important associations between the attributes of clinical leaders and IT adoption. Clinical leaders who have technical informatics skills and prior experience with IT project management are likely to develop a vision that comprises a long-term commitment to the use of IT. Leaders who possess such a vision believe in the value of IT, are motivated to adopt it, and can maintain confidence and stability through the adversities that IT adoptions often entail. This leads to proactive leadership behaviours and partnerships with IT professionals that are associated with successful organisational and clinical outcomes. CONCLUSIONS This review provides evidence that clinical leaders can positively contribute to successful IT adoption in healthcare organisations. Clinical leaders who aim for improvements in the processes and quality of care should cultivate the necessary IT competencies, establish mutual partnerships with IT professionals, and execute proactive IT behaviours to achieve successful IT adoption.
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Affiliation(s)
- Tor Ingebrigtsen
- Australian Institute of Health Innovation, The University of New South Wales, Sydney, Australia; Institute of Clinical Medicine, Faculty of Health Sciences, The University of Tromsø, Tromsø, Norway; CEO's Office, University Hospital of North Norway, Tromsø, Norway
| | - Andrew Georgiou
- Australian Institute of Health Innovation, The University of New South Wales, Sydney, Australia.
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, The University of New South Wales, Sydney, Australia
| | - Farah Magrabi
- Australian Institute of Health Innovation, The University of New South Wales, Sydney, Australia
| | - Antonia Hordern
- Australian Institute of Health Innovation, The University of New South Wales, Sydney, Australia
| | - Mirela Prgomet
- Australian Institute of Health Innovation, The University of New South Wales, Sydney, Australia
| | - Julie Li
- Australian Institute of Health Innovation, The University of New South Wales, Sydney, Australia
| | - Johanna Westbrook
- Australian Institute of Health Innovation, The University of New South Wales, Sydney, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, The University of New South Wales, Sydney, Australia
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Abstract
OBJECTIVE Lean interventions aim to improve quality of healthcare by reducing waste and facilitate flow in work processes. There is conflicting evidence on the outcomes of lean thinking, with quantitative and qualitative studies often contradicting each other. We suggest that reviewing the literature within the approach of a new contextual framework can deepen our understanding of lean as a quality-improvement method. This article theorises the concept of context by establishing a two-dimensional conceptual framework acknowledging lean as complex social interventions, deployed in different organisational dimensions and domains. The specific aim of the study was to identify factors facilitating intended outcomes from lean interventions, and to understand when and how different facilitators contribute. DESIGN A two-dimensional conceptual framework was developed by combining Shortell's Dimensions of capability with Walshes' Domains of an intervention. We then conducted a systematic review of lean review articles concerning hospitals, published in the period 2000-2012. The identified lean facilitators were categorised according to the intervention domains and dimensions of capability provided by the framework. RESULTS We provide a framework emphasising context by relating facilitators to domains and dimensions of capability. 23 factors enabling a successful lean intervention in hospitals were identified in the systematic review, where management and a supportive culture, training, accurate data, physicians and team involvement were most frequent. CONCLUSIONS In the absence of evidence, the two-dimensional framework, incorporating the context, may prove useful for future research on variation in outcomes from lean interventions. Findings from the review suggest that characteristics and local application of lean, in addition to strategic and cultural capability, should be given further attention in healthcare quality improvement.
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Affiliation(s)
- Hege Andersen
- University Hospital of North Norway, Tromsø, Norway
- Department of Sociology, Political Science, and Community Planning, Faculty of Humanities, Social Sciences, and Education, University of Tromsø, Tromsø, Norway
| | - Kjell Arne Røvik
- Department of Sociology, Political Science, and Community Planning, Faculty of Humanities, Social Sciences, and Education, University of Tromsø, Tromsø, Norway
| | - Tor Ingebrigtsen
- University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
- Centre for Clinical Governance research, Australian Institute of Health Innovation, University of New South Wales, Sydney, Australia
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Iversen T, Solberg TK, Romner B, Wilsgaard T, Nygaard Ø, Waterloo K, Brox JI, Ingebrigtsen T. Accuracy of physical examination for chronic lumbar radiculopathy. BMC Musculoskelet Disord 2013; 14:206. [PMID: 23837886 PMCID: PMC3716914 DOI: 10.1186/1471-2474-14-206] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Accepted: 06/28/2013] [Indexed: 11/22/2022] Open
Abstract
Background Clinical examination of patients with chronic lumbar radiculopathy aims to clarify whether there is nerve root impingement. The aims of this study were to investigate the association between findings at clinical examination and nerve root impingement, to evaluate the accuracy of clinical index tests in a specialised care setting, and to see whether imaging clarifies the cause of chronic radicular pain. Methods A total of 116 patients referred with symptoms of lumbar radiculopathy lasting more than 12 weeks and at least one positive index test were included. The tests were the straight leg raising test, and tests for motor muscle strength, dermatome sensory loss, and reflex impairment. Magnetic resonance imaging (n = 109) or computer tomography (n = 7) were imaging reference standards. Images were analysed at the level of single nerve root(s), and nerve root impingement was classified as present or absent. Sensitivities, specificities, and positive and negative likelihood ratios (LR) for detection of nerve root impingement were calculated for each individual index test. An overall clinical evaluation, concluding on the level and side of the radiculopathy, was performed. Results The prevalence of disc herniation was 77.8%. The diagnostic accuracy of individual index tests was low with no tests reaching positive LR >4.0 or negative LR <0.4. The overall clinical evaluation was slightly more accurate, with a positive LR of 6.28 (95% CI 1.06–37.21) for L4, 1.74 (95% CI 1.04–2.93) for L5, and 1.29 (95% CI 0.97–1.72) for S1 nerve root impingement. An overall clinical evaluation, concluding on the level and side of the radiculopathy was also performed, and receiver operating characteristic (ROC) analysis with area under the curve (AUC) calculation for diagnostic accuracy of this evaluation was performed. Conclusions The accuracy of individual clinical index tests used to predict imaging findings of nerve root impingement in patients with chronic lumbar radiculopathy is low when applied in specialised care, but clinicians’ overall evaluation improves diagnostic accuracy slightly. The tests are not very helpful in clarifying the cause of radicular pain, and are therefore inaccurate for guidance in the diagnostic workup of the patients. The study population was highly selected and therefore the results from this study should not be generalised to unselected patient populations in primary care nor to even more selected surgical populations.
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Undén J, Ingebrigtsen T, Romner B. Scandinavian guidelines for initial management of minimal, mild and moderate head injuries in adults: an evidence and consensus-based update. BMC Med 2013; 11:50. [PMID: 23432764 PMCID: PMC3621842 DOI: 10.1186/1741-7015-11-50] [Citation(s) in RCA: 251] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 02/25/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The management of minimal, mild and moderate head injuries is still controversial. In 2000, the Scandinavian Neurotrauma Committee (SNC) presented evidence-based guidelines for initial management of these injuries. Since then, considerable new evidence has emerged. METHODS General methodology according to the Appraisal of Guidelines for Research and Evaluation (AGREE) II framework and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Systematic evidence-based review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology, based upon relevant clinical questions with respect to patient-important outcomes, including Quality Assessment of Diagnostic Accuracy Studies (QUADAS) and Centre of Evidence Based Medicine (CEBM) quality ratings. Based upon the results, GRADE recommendations, guidelines and discharge instructions were drafted. A modified Delphi approach was used for consensus and relevant clinical stakeholders were consulted. CONCLUSIONS We present the updated SNC guidelines for initial management of minimal, mild and moderate head injury in adults including criteria for computed tomography (CT) scan selection, admission and discharge with suggestions for monitoring routines and discharge advice for patients. The guidelines are designed to primarily detect neurosurgical intervention with traumatic CT findings as a secondary goal. For elements lacking good evidence, such as in-hospital monitoring, routines were largely based on consensus. We suggest external validation of the guidelines before widespread clinical use is recommended.
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Affiliation(s)
- Johan Undén
- Department of Intensive Care and Perioperative Medicine, Institute for Clinical Sciences, Södra Förstadsgatan 101, 20502 Malmö, Sweden.
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Ingebrigtsen T, Waterloo K, Egge A, Kloster R, Hennig R. Minneord. Tidsskriftet 2013. [DOI: 10.4045/tidsskr.13.1058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Sundstrøm T, Wester K, Enger M, Melhuus K, Ingebrigtsen T, Romner † B, Undén J. Nye retningslinjer for hodeskader. Tidsskriftet 2013; 133:2342-3. [DOI: 10.4045/tidsskr.13.1291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Sundstrøm T, Wester K, Enger M, Melhuus K, Ingebrigtsen T, Romner † B, Undén J. Skandinaviske retningslinjer for akutt håndtering av voksne pasienter med minimal, lett eller moderat hodeskade. Tidsskriftet 2013; 133:E1-6. [DOI: 10.4045/tidsskr.13.0916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Sørlie A, Moholdt V, Kvistad KA, Nygaard ØP, Ingebrigtsen T, Iversen T, Kloster R, Solberg TK. Modic type I changes and recovery of back pain after lumbar microdiscectomy. Eur Spine J 2012; 21:2252-8. [PMID: 22842978 DOI: 10.1007/s00586-012-2419-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 05/27/2012] [Accepted: 06/18/2012] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate whether the presence of Modic changes type I (MC I) found on preoperative MRI scans represent a risk factor for persistent back pain 12 months after surgery amongst patients operated for lumbar disc herniation. METHODS Cohort study of 178 consecutive patients operated with lumbar microdiscectomy. Preoperative MRI scans were evaluated by two independent neuroradiologists. Primary outcome measure was the visual analogue scale (VAS) for back pain. Secondary outcome measures were; VAS for leg pain, physical function (Oswestry disability index), and health-related quality of life (EQ-5D), self-reported benefit of the operation and employment status. The presence of MC I was used as exposition variable and adjusted for other risk factors in multivariate analyses. RESULTS The Modic classification showed a high inter-observer reproducibility. Patients with MC I had less improvement of back pain 12 months after surgery, compared to those who had no or other types of MC, but this negative association no longer showed statistical significance when adjusted for smoking, which remained the only independent risk factor for persistent back pain. CONCLUSIONS Patients with preoperative MC I can expect less but still significant improvement of back pain 1 year after microdiscectomy, but not if they smoke cigarettes.
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Affiliation(s)
- Andreas Sørlie
- Department of Neurosurgery, University Hospital of North-Norway, 9038, Tromsø, Norway.
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Lindekleiv H, Sandvei MS, Romundstad PR, Wilsgaard T, Njølstad I, Ingebrigtsen T, Vik A, Mathiesen EB. Joint Effect of Modifiable Risk Factors on the Risk of Aneurysmal Subarachnoid Hemorrhage. Stroke 2012; 43:1885-9. [DOI: 10.1161/strokeaha.112.651315] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Haakon Lindekleiv
- From the Departments of Clinical and Community Medicine (H.L., T.W., I.N., T.I., and E.B.M.), Faculty of Health Sciences, University of Tromsø, Tromsø, Norway; Divisions of Neurosurgery and Neurology (H.L., T.I, E.B.M.), University Hospital of North Norway, Tromsø, Norway; Departments of Public Health and Community Medicine (P.R.R.) and Neuroscience (M.S.S., A.V.), Norwegian University of Science and Technology, Trondheim, Norway; Department of Neurosurgery (A.V.), St Olavs University Hospital,
| | - Marie S. Sandvei
- From the Departments of Clinical and Community Medicine (H.L., T.W., I.N., T.I., and E.B.M.), Faculty of Health Sciences, University of Tromsø, Tromsø, Norway; Divisions of Neurosurgery and Neurology (H.L., T.I, E.B.M.), University Hospital of North Norway, Tromsø, Norway; Departments of Public Health and Community Medicine (P.R.R.) and Neuroscience (M.S.S., A.V.), Norwegian University of Science and Technology, Trondheim, Norway; Department of Neurosurgery (A.V.), St Olavs University Hospital,
| | - Pål R. Romundstad
- From the Departments of Clinical and Community Medicine (H.L., T.W., I.N., T.I., and E.B.M.), Faculty of Health Sciences, University of Tromsø, Tromsø, Norway; Divisions of Neurosurgery and Neurology (H.L., T.I, E.B.M.), University Hospital of North Norway, Tromsø, Norway; Departments of Public Health and Community Medicine (P.R.R.) and Neuroscience (M.S.S., A.V.), Norwegian University of Science and Technology, Trondheim, Norway; Department of Neurosurgery (A.V.), St Olavs University Hospital,
| | - Tom Wilsgaard
- From the Departments of Clinical and Community Medicine (H.L., T.W., I.N., T.I., and E.B.M.), Faculty of Health Sciences, University of Tromsø, Tromsø, Norway; Divisions of Neurosurgery and Neurology (H.L., T.I, E.B.M.), University Hospital of North Norway, Tromsø, Norway; Departments of Public Health and Community Medicine (P.R.R.) and Neuroscience (M.S.S., A.V.), Norwegian University of Science and Technology, Trondheim, Norway; Department of Neurosurgery (A.V.), St Olavs University Hospital,
| | - Inger Njølstad
- From the Departments of Clinical and Community Medicine (H.L., T.W., I.N., T.I., and E.B.M.), Faculty of Health Sciences, University of Tromsø, Tromsø, Norway; Divisions of Neurosurgery and Neurology (H.L., T.I, E.B.M.), University Hospital of North Norway, Tromsø, Norway; Departments of Public Health and Community Medicine (P.R.R.) and Neuroscience (M.S.S., A.V.), Norwegian University of Science and Technology, Trondheim, Norway; Department of Neurosurgery (A.V.), St Olavs University Hospital,
| | - Tor Ingebrigtsen
- From the Departments of Clinical and Community Medicine (H.L., T.W., I.N., T.I., and E.B.M.), Faculty of Health Sciences, University of Tromsø, Tromsø, Norway; Divisions of Neurosurgery and Neurology (H.L., T.I, E.B.M.), University Hospital of North Norway, Tromsø, Norway; Departments of Public Health and Community Medicine (P.R.R.) and Neuroscience (M.S.S., A.V.), Norwegian University of Science and Technology, Trondheim, Norway; Department of Neurosurgery (A.V.), St Olavs University Hospital,
| | - Anne Vik
- From the Departments of Clinical and Community Medicine (H.L., T.W., I.N., T.I., and E.B.M.), Faculty of Health Sciences, University of Tromsø, Tromsø, Norway; Divisions of Neurosurgery and Neurology (H.L., T.I, E.B.M.), University Hospital of North Norway, Tromsø, Norway; Departments of Public Health and Community Medicine (P.R.R.) and Neuroscience (M.S.S., A.V.), Norwegian University of Science and Technology, Trondheim, Norway; Department of Neurosurgery (A.V.), St Olavs University Hospital,
| | - Ellisiv B. Mathiesen
- From the Departments of Clinical and Community Medicine (H.L., T.W., I.N., T.I., and E.B.M.), Faculty of Health Sciences, University of Tromsø, Tromsø, Norway; Divisions of Neurosurgery and Neurology (H.L., T.I, E.B.M.), University Hospital of North Norway, Tromsø, Norway; Departments of Public Health and Community Medicine (P.R.R.) and Neuroscience (M.S.S., A.V.), Norwegian University of Science and Technology, Trondheim, Norway; Department of Neurosurgery (A.V.), St Olavs University Hospital,
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Ingebrigtsen T, Lind M, Krogh T, Lægland J, Andersen H, Nerskogen E. Merging of three hospitals into one university hospital. Tidsskr Nor Laegeforen 2012; 132:813-7. [PMID: 22511092 DOI: 10.4045/tidsskr.11.0920] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND The merging of hospitals into health enterprises ensued from the Norwegian hospital reform of 2002. A complex restructuring process lasting from 2007 to 2009 resulted in the merger of three hospitals into the University Hospital of North Norway. MATERIAL AND METHOD Clinical activities were reorganised into fewer and larger units (divisions) and changed from in-patient to day treatment. Leadership was established across geographic units, and a programme for improving patient care pathways was launched. The experience gained is described by means of activity data from January 2006 to April 2011. RESULTS The number of patient contacts in the somatic sector was temporarily reduced by 7 % in 2009. The mean waiting period increased from 80 days in 2006 to 108 days in 2010, but fell to 85 days in 2011. In psychiatry and specialised cross-disciplinary addiction therapy, the number of patient contacts increased, and waits were unchanged or shortened. National quality indicators showed unchanged or improved results. The number of scientific publications increased by 62 %. Productivity (DRG points per employee-month) increased from 0.73 to 0.79. The annual financial outcome was improved by NOK 537 million (12 % of the 2006 budget). 81 % of the employees were satisfied with their jobs after the restructuring. INTERPRETATION We maintained activity and the quality of patient treatment at a high level through the change period, and the hospital's financial position has improved. The methods used do not allow conclusions on possible causal relationships between the change process and the results achieved in core activities.
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Affiliation(s)
- Tor Ingebrigtsen
- University Hospital of North Norway and Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Norway.
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Sandvei MS, Lindekleiv H, Romundstad PR, Müller TB, Vatten LJ, Ingebrigtsen T, Njølstad I, Mathiesen EB, Vik A. Risk factors for aneurysmal subarachnoid hemorrhage - BMI and serum lipids: 11-year follow-up of the HUNT and the Tromsø Study in Norway. Acta Neurol Scand 2012; 125:382-8. [PMID: 21793808 DOI: 10.1111/j.1600-0404.2011.01578.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Life-style factors have been associated with the risk for aneurysmal subarachnoid hemorrhage (aSAH), but it is not clear whether body mass index (BMI) and serum lipids are associated with risk. We prospectively assessed these associations in two large population studies. METHODS A total of 65,526 participants in the Nord-Trøndelag Health Study (1995-1997) and 26,882 participants in the Tromsø Study (1994-1995) were included. Studies included measurements of body weight and height, serum lipids, and self-administered questionnaires. Participants who experienced aSAH were identified, and hazard ratios (HRs) were estimated using Cox regression analysis. RESULTS During 11 years of follow-up, aSAH was diagnosed in 122 participants. Overweight (BMI 25-29.9) was negatively associated with the risk of aSAH (HR 0.7, 95% CI 0.4-1.0). There was no over all association of total serum cholesterol, HDL cholesterol, or triglycerides with the risk of aSAH, but in participants younger than 50 years, HDL cholesterol was inversely associated with the risk (HR per standard deviation increase 0.6, 95% CI 0.4-0.9). CONCLUSIONS Overweight may be associated with reduced risk of aSAH, but there was no over all association of total serum cholesterol, HDL cholesterol, or triglycerides with the risk of aSAH in this prospective study.
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Affiliation(s)
- M S Sandvei
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.
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Heskestad B, Waterloo K, Ingebrigtsen T, Romner B, Harr ME, Helseth E. An observational study of compliance with the Scandinavian guidelines for management of minimal, mild and moderate head injury. Scand J Trauma Resusc Emerg Med 2012; 20:32. [PMID: 22510221 PMCID: PMC3352311 DOI: 10.1186/1757-7241-20-32] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Accepted: 04/17/2012] [Indexed: 11/10/2022] Open
Abstract
Background The Scandinavian guidelines for management of minimal, mild and moderate head injuries were developed to provide safe and cost effective assessment of head injured patients. In a previous study conducted one year after publication and implementation of the guidelines (2003), we showed low compliance, involving over-triage with computed tomography (CT) and hospital admissions. The aim of the present study was to investigate guideline compliance after an educational intervention. Methods We evaluated guideline compliance in the management of head injured patients referred to the University Hospital of Stavanger, Norway. The findings from the previous study in 2003 were communicated to the hospitals physicians, and a feed-back loop training program for guideline implementation was conducted. All patients managed during the months January through June in the years 2005, 2007 and 2009 were then identified with an electronic search in the hospitals patient administrative database, and the patient files were reviewed. Patients were classified according to the Head Injury Severity Scale, and the management was classified as compliant or not with the guideline. Results The 1 180 patients were 759 (64%) males and 421 (36%) females with a mean age of 31.5 (range 0-97) years. Over all, 738 (63%) patients were managed in accordance with the guidelines and 442 (37%) were not. Compliance was not significantly different between minimal (56%) and mild (59%) injuries, while most moderate (93%) injuries were managed in accordance with the guidelines (p < 0.05). Noncompliance was caused by overtriage in 362 cases (30%) and undertriage in 80 (7%). Guideline compliance was 54% in 2005, 71% in 2007, and 64% in 2009. Conclusions This study shows higher guideline compliance after an educational intervention involving feed-back on performance. A substantial number of patients are exposed to over-triage, involving unnecessary radiation from CT examinations, and unnecessary costs from hospital admissions.
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Affiliation(s)
- Ben Heskestad
- Department of Neurosurgery, Oslo University Hospital-Ullevål, Oslo, Norway
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Ingebrigtsen T. Visjonært og nyttig om leger som ledere. Tidsskriftet 2012. [DOI: 10.4045/tidsskr.12.0900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Sandvei MS, Mathiesen EB, Vatten LJ, Müller TB, Lindekleiv H, Ingebrigtsen T, Njølstad I, Wilsgaard T, Løchen ML, Vik A, Romundstad PR. Incidence and mortality of aneurysmal subarachnoid hemorrhage in two Norwegian cohorts, 1984-2007. Neurology 2011; 77:1833-9. [PMID: 22049205 DOI: 10.1212/wnl.0b013e3182377de3] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The incidence of aneurysmal subarachnoid hemorrhage (aSAH) ranges from 4 to 10 per 100,000 person-years in most countries, and 30-day case fatality is high. The aim of this study was to estimate the incidence and case fatality of aSAH and to assess preictal predictors of survival in 2 large Norwegian population-based cohort studies. METHODS A total of 94,976 adults (≥20 years) in the Nord-Trøndelag Health Study and 31,753 participants (aged ≥20 years) in the Tromsø Study were included. During follow-up, aSAHs were identified, incidence rates were estimated, and predictors of survival were assessed using Cox and Poisson regression analysis. RESULTS A total of 214 patients with aSAH were identified during 2,077,927 person-years of follow-up from 1984 to 2007. The incidence rate was 10.3 per 100,000 person-years: 13.3 for women and 7.1 for men. The incidence increased by 2% (95% confidence interval [CI] 0-4) per 5-year time period. Case fatality at 3, 7, and 30 days was 20%, 24%, and 36%. Thirty-day case fatality remained stable during follow-up (odds ratio 1.01, 95% CI 0.97-1.06 per year). Never smokers had poorer survival after aSAH than current and former smokers combined (hazard ratio 1.6, 95% CI 0.9-2.9). CONCLUSIONS The slight increase in incidence of aSAH over time may be explained by differences in diagnostic procedures. Case fatality remained stable during 23 years of follow-up.
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Affiliation(s)
- M S Sandvei
- Institutt for nevromedisin, Medisinsk teknisk forskningssenter, Trondheim, Norway.
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Iversen T, Solberg TK, Romner B, Wilsgaard T, Twisk J, Anke A, Nygaard O, Hasvold T, Ingebrigtsen T. Effect of caudal epidural steroid or saline injection in chronic lumbar radiculopathy: multicentre, blinded, randomised controlled trial. BMJ 2011; 343:d5278. [PMID: 21914755 PMCID: PMC3172149 DOI: 10.1136/bmj.d5278] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To assess the efficacy of caudal epidural steroid or saline injection in chronic lumbar radiculopathy in the short (6 weeks), intermediate (12 weeks), and long term (52 weeks). DESIGN Multicentre, blinded, randomised controlled trial. SETTING Outpatient multidisciplinary back clinics of five Norwegian hospitals. PARTICIPANTS Between October 2005 and February 2009, 461 patients assessed for inclusion (presenting with lumbar radiculopathy >12 weeks). 328 patients excluded for cauda equina syndrome, severe paresis, severe pain, previous spinal injection or surgery, deformity, pregnancy, ongoing breast feeding, warfarin therapy, ongoing treatment with non-steroidal anti-inflammatory drugs, body mass index >30, poorly controlled psychiatric conditions with possible secondary gain, and severe comorbidity. INTERVENTIONS Subcutaneous sham injections of 2 mL 0.9% saline, caudal epidural injections of 30 mL 0.9% saline, and caudal epidural injections of 40 mg triamcinolone acetonide in 29 mL 0.9% saline. Participants received two injections with a two week interval. MAIN OUTCOME MEASURES Primary: Oswestry disability index scores. Secondary: European quality of life measure, visual analogue scale scores for low back pain and for leg pain. RESULTS Power calculations required the inclusion of 41 patients per group. We did not allocate 17 of 133 eligible patients because their symptoms improved before randomisation. All groups improved after the interventions, but we found no statistical or clinical differences between the groups over time. For the sham group (n = 40), estimated change in the Oswestry disability index from the adjusted baseline value was -4.7 (95% confidence intervals -0.6 to -8.8) at 6 weeks, -11.4 (-6.3 to -14.5) at 12 weeks, and -14.3 (-10.0 to -18.7) at 52 weeks. For the epidural saline intervention group (n = 39) compared with the sham group, differences in primary outcome were -0.5 (-6.3 to 5.4) at 6 weeks, 1.4 (-4.5 to 7.2) at 12 weeks, and -1.9 (-8.0 to 4.3) at 52 weeks; for the epidural steroid group (n=37), corresponding differences were -2.9 (-8.7 to 3.0), 4.0 (-1.9 to 9.9), and 1.9 (-4.2 to 8.0). Analysis adjusted for duration of leg pain, back pain, and sick leave did not change this trend. CONCLUSIONS Caudal epidural steroid or saline injections are not recommended for chronic lumbar radiculopathy. Trial registration Current Controlled Trials ISRCTN No 12574253.
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Affiliation(s)
- Trond Iversen
- Department of Rehabilitation, University Hospital of North Norway, 9038 Tromsø, Norway
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