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Biomedical subjects

H Melsom

Publications and source records attributed to H Melsom.

At least 19 recordsLinked to original sources
PubMed1996

[Physicians' view on drug therapy for hypertension. A questionnaire in the county of Hordaland].

A questionnaire survey was conducted in Hordaland county to discover opinions on drug therapy for uncomplicated hypertensives with no other risk factors. The response rate was 66%; 179 general practitioners and 31 hospital doctors. The doctors were well informed about the documentation of the clinical benefit of various drugs. As regards the minimum blood pressure that was considered as warranting drug treatment, the majority of the doctors followed the recently issued national guidelines. For young patients the first choice drugs were beta-blockers (27%), ACE-inhibitors (25%) or calcium-blockers (20%). For older patients 65% of the doctors preferred diuretics or beta-blockers. The majority (80%) based their choice of drug primarily on documentation of clinical value or absence of side effects. The doctors underestimated the cost of the newer antihypertensive drugs.

Adult↗
PubMed1995

[The relation between patient volume and quality of care. Results of a survey].

A report on the relation between patient volume and quality of treatment has been evaluated by health administrators. The majority supports that adequate patient volume is important for quality of treatment and for quality assurance. The implementation of these concepts in the organizing of health services is advocated. There is a relation between every single administrator's attitude towards the volume-quality concept and the number of beds in their own hospital. Clinical audit by means of registers and more national control of the hospital service is supported.

Attitude of Health Personnel↗
PubMed1993

[Use of psychiatrists in security matters].

90 clients with uncertain symptoms and diagnosis, especially clients with pain in the musculoskeletal system or with minor neurotic symptoms, were examined by a psychiatrist ordered by Skedsmo Social Security Office. The number of clients with the diagnosis fibromyalgia was strongly reduced. The number of clients with somatic diagnosis increased from three to nine, and three cases of psychosis, not earlier diagnosed as such, were recorded. The number of clients on sick leave was reduced considerably. Rehabilitation for employment was proposed to many clients. The evaluation had little impact on clients applying for a disability pension. For 28 clients the examination resulted in necessary and important treatment. As a whole the examination produced the best results among clients under the age of forty.

Adult↗
PubMed1993

[The requirement to use the cheapest synonymous preparation--does it work as intended?].

A retrospective analysis of all prescriptions for hypersensitive drugs was undertaken at a pharmacy serving 20 general practitioners and 17 temporarily employed doctors. The analysis was carried out in 1992 over two three-month periods separated by an interval of five months. The Governmental regulations aimed at promoting use of the "cheapest synonymous drug" apparently had little impact on the doctors' prescriptions. During the 11 months concerned, the prescribed antihypersensitive drugs contained an increasing share of expensive alternatives with no documented ability to reduce cardiovascular morbidity or mortality.

Antihypertensive Agents↗
PubMed1992

[Cooperation between regional and central hospitals--how to achieve the best results?].

The authors reviews a recent governmental analysis of cooperation between third-line university clinics and local and central hospitals. The hospitals are owned by the government (mainly by the counties), and the various Acts and regulation permit the central authorities to make decisions on all aspects of highly specialized medicine. The analysis concludes that a limited number of problems should be solved by decision of the central government, but only those where national concerns are involved. The counties within a health region should cooperate within a Regional Health Policy Board, to create plans for flow of patients through the health care system, specified for each field of medicine. When such plans have been approved by the Regional Health Policy Board, each county should be willing to accept them. In the event of local disagreement, the central government should decide.

Health Policy↗
PubMed1992

[Highly specialized medicine. How to assign the tasks?].

Norway has four million inhabitants and five university hospitals, each serving one health region. The authors describe the work of a governmental medical committee, whose mandate is to advise on where to locate the various highly specialized medical services. Important questions have been the relationship between experience and quality, and the desire of each university clinic to be able to provide treatment within its own region for most health problems. Their reasons are concern about research and specialist training, and the preference of patients for treatment near to home. A list of proposed national and over-regional centers for certain treatments has been prepared on the basis of the experts' report and comments from all university clinics. These recommendations have provided a medical basis for later economic and political analyses prior to final decision by the Government. Norwegian legislation permits strong governmental regulation of the highly specialized health services.

Health Planning↗
PubMed1992

[Complaints of patients on medical treatment].

Complaints handled by the Directorate of Health about medical treatment have been registered and analysed for the years 1980, 1985 and 1990. The analysis shows that the number of complaints against government hospitals increased fourfold from 1985 to 1990. Compensation awarded in cases where medical negligence was proved rose sevenfold from NOK 3 million in 1985 to NOK 20 million in 1990. We have reason to believe that there has been a similar increase in the number of claims for compensation, and in the amount of compensation awarded in cases of proven negligence, also in cases not involving the Directorate of Health. It is important to note that our study demonstrates an increase in serious events leading to permanent functional impairment or death. A post hoc analysis suggests that some 80% of the failures might have been avoided if an adequate system of quality assurance had been established.

Humans↗
PubMed1992

[Sick-listing II--an evaluation of rehabilitation assistance].

Patients certified as sick for more than eight weeks qualify for sickness benefit scheme No. 2. 38 patients in this group who suffered from various indefinite diseases were called in to consultation with an advisory doctor. Patients with a high degree of motivation were later examined by a doctor specialized in occupational diseases. Information on all patients was obtained from the company medical service, personnel managers, and the doctors who had prescribed sick leave for the patients. The survey unveiled a low degree of cooperation and communication between the various personnel responsible for the patients. Furthermore, little was known about rehabilitation programmes at the different places of work. Only half of the employers knew about such opportunities. This lack of cooperation clearly indicates a need of greater involvement on the part of all parties concerned with these patients and for schemes of follow-up. The creation of such schemes might be the first step towards new and better relationships between the different kinds of personnel concerned.

Adolescent↗
PubMed1991

[Quality assurance in Norwegian somatic hospitals].

In 1990, 70 Norwegian hospitals were mailed a questionnaire asking about quality assurance (QA) activities in the departments of internal medicine, surgery, gynaecology/obstetrics and pediatrics. Responses from 173 departments at 58 hospitals showed a marked interest in improving quality and quality assurance. However, few departments had implemented QA to any noticeable extent in their clinical practices. There were few differences between surgical and non-surgical departments. Only 30% of the respondents had established routines aimed at ensuring complete medical records. 47% had not established committees to record and evaluate accidents, or report hazards to patients, in spite of the fact that only 5% assumed QA was of little usefulness. In 1990, little time was spent on specific QA activities; the most common estimate was one hour per week. In our estimate, full QA in clinical department would require 2-5% of the total contribution of work.

Hospital Departments↗
PubMed1991

[Small hospitals--future tasks and functions].

We review the small municipal hospitals included in our study of hospitals serving less than 50,000 persons. We identified the following problems: These hospitals are resource-intensive to a greater degree than expected, measured in terms of beds, doctors, health services and per capita costs in the area served by the hospital. Moreover, their quality is questionable, due to problems of recruitment and lack of continuity, a weak infrastructure, and insufficient patients to maintain a high level of competence, especially in taking care of patients with complicated and acute conditions. We foresee, and recommend, a new and different future for small hospitals, emphasizing closer links with primary health care and closer collaboration with the larger county hospitals. Key words are: Outpatient services, including perhaps ambulatory specialist services from the larger hospitals, elective services in fields of special competence, possibly covering a larger area, rehabilitation services, municipal psychiatric services; and finally, the traditional acute services should be changed to a first-aid service, preferably as part of emergency care in the municipality.

Hospitals, Municipal↗
PubMed1991

[Mammography--watch out for false negatives].

Patients with breast tumours should be examined by a combination of physical examination, mammography and fine needle aspiration biopsy. The authors discuss the history of four patients with palpable breast lesions. All of these patients had tumours which had not been discovered by mammography. The diagnosis was delayed 2,11,12 and 12 months respectively. Patients with palpable lesions must not be referred to mammography performed under "screening conditions", but must be examined in a clinical context, preferably by the "triple-test".

Adult↗