Search PubMed⌕ Search

Biomedical subjects

E Nord

Publications and source records attributed to E Nord.

At least 55 records · Page 3Linked to original sources
PubMed1993

Toward quality assurance in QALY calculations.

The utility weights that are used in published scientific articles for assessing benefits in terms of quality-adjusted life-years gained often have a weak theoretical and empirical basis. To a large extent, the weights seem to be used without critical thought and sensible discussion. In a majority of cases, the sensitivity of the results to the weights that have been chosen is not demonstrated, and readers are not provided with information in a way that facilitates independent calculations. This paper calls for a standard for future publications.

Health Services Research↗
PubMed1993

Social evaluation of health care versus personal evaluation of health states. Evidence on the validity of four health-state scaling instruments using Norwegian and Australian surveys.

In most of the cost-utility literature, quality-adjusted life-year (QALY) gains are interpreted as a measure of social value. Given this interpretation, the validity of different multi-attribute health-state scaling instruments may be tested by comparing the values they provide on the 0-1 QALY scale with directly elicited preferences for person trade-offs between different treatments (equivalence of numbers of different patients treated). Norwegian and Australian public preferences as measured by the person trade-off suggest that the EuroQol Instrument assigns excessively low values to health states. This seems to be even more true of the McMaster Health Classification System. The Quality of Well-being Scale appears to compress states toward the middle of the 0-1 scale. By contrast, the Rosser/Kind index fits reasonably well with directly measured person trade-off data.

Adult↗
PubMed1993

The relevance of health state after treatment in prioritising between different patients.

In QALY-thinking, an activity that takes N people from a bad state (including 'dying') to the state of healthy for X years should have priority over an activity that takes N other people from the same bad state to a state of moderate illness for the same number of years (given equal costs). An empirical study indicates that this view may not be shared by the general public in Norway. Subjects tended to emphasise equality in value of life and in entitlement to treatment rather than level of health after treatment. The relevance of costs per QALY in prioritising between different health care programmes in Norway is thereby brought in to doubt. While the sample in the study is too small to support firm policy conclusions, the results should contribute to an increased interest among health economists in actually measuring people's ethical preferences in matters of prioritising, rather than taking it for granted that their own values are shared by the general public.

Adult↗
PubMed1993

Work content of Norwegian occupational physicians.

There is little empirical knowledge of the work done in occupational health services. In a study of the work of 50 Norwegian occupational physicians, their work on 249 workdays was recorded and classified into nine different categories according to the work content. Most (40%) of the work concerned work environment matters, 26% went to nonwork-related activities, 18% was for administration, 4% was for personal proficiency, and 12% went to various other activities. A total of 36% of the work concerned preventive activities, and 30% involved curative activities, of which two-thirds (22%) was for nonwork-related illnesses. This latter figure seems large in comparison with the preventive aims of occupational health services given by the Norwegian labor inspectorate. The physicians spent little time on educating employees about work environment matters and on new projects to ensure good work environment standards. The amount of activity involving occupational rehabilitation was fair.

Health Education↗
PubMed1992

[Bone density measurements in prevention of femoral neck fractures].

With a view to preventing hip fractures, bone mineral density measurements have been suggested as a means of selecting individuals at risk. We suggest two focuses in a preventive strategy: selection and information. The overlap in mineral density distributions among women who experience hip fractures and those who do not leads to a high number of inconclusive measurements as regards placing individuals into two such groups. The measurements should therefore be used primarily to inform individuals about their risk. In order to evaluate this technology, prospective studies on bone mineral density measurements prior to oestrogen hormone replacement therapy are highly desirable.

Aged↗
PubMed1992

[Quality adjustment of life years--possibilities, limitations, alternatives].

QALYs express the sum of individual utility gains from medical interventions. As such they are potentially a useful measure in deciding how to allocate resources. They should not, however, be equated with the overall value that society places on different health care programmes. The latter is determined not only by the number of QALYs gained, but also by a series of distributional and ethical considerations. This should be made clear in the presentation of QALY-calculations, particularly in cost-per-QALY league tables. More comprehensive measures of social value that may be used in cost-utility studies need investigating.

Cost-Benefit Analysis↗
PubMed1992

Methods for quality adjustment of life years.

Several valuation techniques are in use for quality adjusting life years in cost utility analysis. The paper gives an overview of the variability in results. A close inspection of a number of instruments with respect to their theme, instructions, decision framing and the phrasing of questions make many of the observed differences in results understandable. When judging the validity of the different techniques, three points should be kept in mind. One is that statements about validity should be made with respect to concrete versions rather than broad categories like 'the rating scale', 'time trade-off' etc. Another point is that a valuation technique that is valid in clinical decision analysis may not be valid in health program evaluation, and vice versa. The third point is that quality weights for life years are empirically more meaningful, in the sense that they are more amenable to empirical testing, if they are interpreted simply as preference weights rather than measures of amounts of well life in the utilitarian tradition. Time trade-off with a moderate time horizon is recommended in clinical decision analysis, while a combination of time trade-off and a variant of person trade-off is recommended in health program evaluation.

Attitude to Health↗
PubMed1991

EuroQol: health-related quality of life measurement. Valuations of health states by the general public in Norway.

The EuroQol instrument consists of a self administered questionnaire where subjects are asked to value health states on a visual analogue scale. The instrument is playing a role of linking cross-national data in the field of health status measurement. An experiment in Norway with an alternative lay out added little to the feasibility of the instrument. On the other hand, reducing the number of states to be valued did increase the response rate significantly. Valuations in a random sample of Norwegian subjects were quite similar to valuations made by subjects in England, Holland and Sweden. EuroQol valuations may have to undergo a radical transformation before being used as utility weights for life years, but the similarity in valuations across countries is a promising finding in itself. To the extent that these similarities are validated in later studies, authorities in any one of these four countries wishing to use health status indices in medical decision making, may in the future allow themselves to draw on results obtained in any of the other three countries. Particularly for a small country like Norway there is an obvious advantage in this.

Attitude to Health↗
PubMed1991

A simplified model for management of women with gestational diabetes at the primary care level.

A simplified model for management of women with gestational diabetes mellitus (GDM) that could be applied at the level of the primary antenatal care was evaluated. Two groups were compared: group I included 172 consecutive GDM subjects cared for at the hospital-based specialized antenatal clinic 1984-85. Group II included 149 consecutive GDM subjects cared for at the primary antenatal clinics 1985-86. Both groups were instructed in self-monitoring of blood glucose and were given dietary instructions. Insulin treatment was initiated if blood-glucose exceeded 9 mmol/l post-prandially three times a week. While women in group II mainly were cared for by midwives, following the routine antenatal program, women in group I were seen every two weeks by an obstetrician and non-stress tests were performed twice weekly from gestational week 35. There were no significant differences with respect to the number of women who required insulin treatment, rate of pregnancy complications or mode of delivery. There were two intrauterine deaths, one in each group, both were unrelated to GDM. There were no group differences regarding large-for-gestational-age infants, respiratory disturbances, neonatal hypoglycemia, hyperbilirubinemia or polycythemia. We conclude that an effective care of GDM-women can be achieved at the primary care level provided frequent self-monitoring of blood glucose is performed for early detection of insulin requiring diabetes.

Adult↗
PubMed1989

The significance of contextual factors in valuing health states.

QALY analysis consists of describing the effects of a programme in terms of a stream in a patient-time field after which the stream is evaluated. The stream concept represents a considerable advance compared to for instance describing the outcome of health care in terms of survival rates. The valuation task, on the other hand, poses difficult problems. Several contextual factors may significantly affect the social value assigned to a health improvement in a particular patient-year. None of these factors is included in the current algorithm for calculating social utility in terms of QALYs. The factors are set together in a model that may serve as a framework within which QALY calculations may be considered. Examples are given of how QALY calculations can be misleading if these factors are not taken into account.

Attitude to Health↗
PubMed1989

100 cases of external cephalic version, with special reference to fetomaternal transfusion.

The incidence of fetomaternal transfusion (FMT) and localization of the placenta was studied in 100 attempted external versions (ECV). In only one case could a significant FMT be detected with the Kleihauer-Betke test. No major complications occurred. Sixty per cent of the attempted versions were successful. Multiparity and either dorsal or fundal placental localization were found to be favorable factors. The determination of AFP was of no use for the detection of FMT.

Delivery, Obstetric↗
PubMed1983

An evaluation of early pregnancy HCG determination as a prognostic tool for fetal outcome.

In a retrospective study of 150 pregnant women with high or low serum HCG levels at the time they sought acute advice at the ward, two categories of women were found: a majority (n = 111) who had abdominal pain and/or vaginal bleeding, and a minor group (n = 39) who worried about their condition but were otherwise symptom free. The underlying reason for the difference in clinical outcome amongst 'bleeding' and 'concern' women with both high and low HCG serum values are discussed. It is concluded that women with abnormal HCG levels in early pregnancy deserved close attention in the 3rd trimester.

Abortion, Spontaneous↗