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Biomedical subjects

H Melsom

Publications and source records attributed to H Melsom.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1991

[Breast-preserving surgery in breast carcinoma. 10-year experiences].

From 1979-89, 211 women with cancer mammae were irradiated at the Norwegian Radium Hospital after breast-conserving surgery performed at different hospitals in Norway. 181 of these patients were called in for re-examination to check the procedures for treatment and the cosmetic results. Only 37% of the patients had undergone mammography prior to surgery and 48% of the patients had had two or more operations before the irradiation. The cosmetic results were not very satisfactory in 45% of the patients. Reduced cosmesis was mainly due to less than optimal surgery. We propose better standardisation of the treatment programme for breast preservation. Optimal results require close collaboration between radiologists, surgeons, oncologists and pathologists. The treatment must be organized in a way that facilitates this collaboration.

Adult↗
PubMed1991

The effect on pulmonary function of tangential field technique in radiotherapy for carcinoma of the breast.

Twenty-five patients treated by lumpectomy and radiotherapy for Stage I breast cancer were enrolled in a prospective study to measure the effects of tangential field irradiation on pulmonary function. Fractional doses of 2 Gy to a total of 50 Gy were administered with the tangential technique. An additional 10 Gy (2 Gy x 5) was given as direct booster. Dynamic and static lung volumes, distribution of ventilation and gas transfer were measured before irradiation and at varying intervals up to 1 year after the completion of therapy. There was a small, but statistically significant decrease in the forced vital capacity (mean 63 ml) and the forced expiratory volume in 1 second (mean 79 ml) measured 3 months after irradiation (p less than 0.05). These changes were reversed within 1 year. The reduction in total lung capacity (mean 240 ml) after 3 months was nearly significant (p = 0.06). The remaining variables did not change to a significant degree. We conclude that a slight restrictive ventilatory impairment may occur when a combined tangential and direct booster technique is applied. The changes are, however, small and reversible, and imply no clinical importance.

Adult↗
PubMed1990

[Locally advanced breast cancer--primary treatment with tamoxifen].

Tamoxifen was given as primary systemic treatment to 28 patients with locally advanced breast cancer. In all tumours, receptors for estrogen (ER) and/or progesterone (PGR) were positive. All patients (15) with high levels of hormone receptors (ER greater than or equal to 100 mumols/g protein and/or PGR greater than or equal to 200 mumols/g protein) were alive after two years of observation as against 60% of the patients (13) with lower hormone receptor values.

Adult↗
PubMed1990

[Evaluation of sick leave notification II--a certificate for more than eight weeks sick leave. From the project Evaluation of follow-up of long-term sick leave patients].

An increase in sick leave has been registered by both the National Insurance Administration and by the Confederation of Norwegian Business and Industry. In 1988, expenditure on sick leave was NOK 20.7 billion. The same year the National Insurance Institution found that the average length of each sick leave was 49 days. An arrangement for notification of sick leave was enforced in order to strengthen follow up of persons in receipt of sick pay who had been off work for more than eight weeks. Our survey in Skedsmo shows that this arrangement is not commonly known among the public. In view of the increasing public consciousness about national insurance in general, the doctors who are required to submit notification of sick leave are of the opinion that this arrangement is a useful venture. It is difficult to conclude, however, that this arrangement has been of any benefit to the individual patient. The national insurance office has registered a decrease in expenditure on sick leave, but the work load of officials in the administration has increased.

Absenteeism↗
PubMed1990

[The sick leave notification II system. From the project Evaluation of follow-up of long-term sick leave patients].

In 1988 the National Insurance Administration in Norway introduced a compulsory sickness certificate to be issued by the doctor after eight weeks of incapacity of work (sickness certificate II). The form contains 25 specified items to be filled in by the doctor. We registered and analysed the sickness certificates received by the local National Insurance offices in five municipalities during the last three months of 1988 (n = 735). The patients included a slight majority of males. 1/3 of the patients were younger than 30 years old and 2/3 younger than 50. 1/4 of the items had not been filled in by the doctors. The most frequent diagnostic groups were musculo-skeletal/connective tissue diseases (46.4%), mental disorders (11.2%), and complications related to pregnancy and birth (9.6%). Sickness certificate II included a five-level prognosis scheme. 68.3% of the patients were allocated to prognosis A, i.e. full recovery as a result of medical treatment only. Few doctors noted that cooperation with other health and social welfare personnel was desirable. The level of unemployment was reported as being higher in patients who were certified sick for greater than or equal to 8 weeks than in the general population of the countries included in the study. The extra costs of introducing sickness certificate II are estimated to equal one day's sickness allowance for each of the 735 patients.

Absenteeism↗
PubMed1990

[Palliative radiotherapy].

Only 25% of cancer patients in Norway receive megavoltage irradiation. Many patients live for months and years with symptomatic metastatic disease, and could derive great benefit from radiotherapy. We briefly review indications and use of palliative radiotherapy.

Humans↗