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Biomedical subjects

K Malterud

Publications and source records attributed to K Malterud.

At least 55 records · Page 3Linked to original sources
PubMed1997

Iron supplementation in pregnancy: is less enough? A randomized, placebo controlled trial of low dose iron supplementation with and without heme iron.

BACKGROUND: The purpose of the present study was to evaluate the efficacy of low dose iron supplementation with and without a heme component, prescribed for women in the second half of pregnancy. METHOD: A randomized, double-blind, placebo controlled trial. Thirty-one women received a daily dose of 27 mg elemental iron in a product containing both heme iron and non-heme iron (Hemofer), 30 women received the same dose as pure non-heme iron with vitamin C (Collets jern med vitamin C), and 29 women received placebo. A double dummy technique was used to mask tablets. The women were tested for red cell indices and iron status markers (s-ferritin, s-iron, Total Iron Binding Capacity and erythrocyte protoporphyrin) throughout pregnancy and 8 and 24 weeks postpartum. The results were analyzed according to the 'intention to treat' principle. RESULTS: The hematological effects were equal in the two treatment groups. 25% of the supplemented women fell below 110 g/l in Hb vs 52% in the placebo group (p < 0.05); none fell below 100 g/l in the supplemented groups, 14% in the placebo group. Iron status was significantly better for all measured parameters in the heme iron group compared to placebo at the end of pregnancy. Differences between the other groups were only shown for some parameters, probably due to the small sample size. In the heme iron group there were fewer women with empty iron stores postpartum than at the start of pregnancy (from 14% to 8%), in the non-heme iron group there was a significant increase (from 3% to 27%), and in the placebo group the percentage of women with empty iron stores was more than doubled (from 21% to 52%). CONCLUSIONS: A daily dose of 27 mg elemental iron, containing a heme component, given in the second half of pregnancy, prevents depletion of iron stores after birth in most women. An equivalent dose of pure inorganic iron seems less effective, but the sample size in this study was too small to demonstrate significant differences between the two treatment groups.

Anemia, Iron-Deficiency↗
PubMed1997

Women's self-assessed personal health resources.

OBJECTIVE: To contribute to the development of a resource-oriented medical language by identifying self-assessed personal health resources in women. DESIGN: Key questions were developed to invite the patient to tell the general practitioner about such resources. Patients' answers were audiotaped and analysed qualitatively according to Giorgi's phenomenological approach. The theoretical frame of reference included salutogenesis, patient-centredness, and gender perspectives. SETTING: Two female general practitioners and their consultations. SUBJECTS: 37 consecutive female patients aged 24-85 years. MAIN OUTCOME MEASURES: Common aspects of personal qualities and strategies considered by women as their health resources. RESULTS: The material unveiled health resources related to 1) internal strength mobilized by external strain, 2) interactive networks within and outside the family, 3) lifestyle practices, 4) physical and social activity, 5) acceptance and facilitation of the natural course of Disease, and 6) constitution. CONCLUSION: Female patients have explicit and intelligible ideas about their self-assessed personal health resources, which can be identified and mobilized by the general practitioner and form part of potentially empowering strategies in medical practice.

Adaptation, Psychological↗
PubMed1997

New gateways to dialogue in general practice. Development of an illness diary to expand communication.

OBJECTIVE: To present the development of a clinical communicative method based on illness diaries. DESIGN: Action research with qualitative evaluation of experiences leading to the clinical method. SETTING: The practice of one of the authors. PATIENTS: 16 patients with long-standing illness without clinical findings. MAIN OUTCOME MEASURES: Description of the illness diary method grounded in patients' and doctor's experiences. RESULTS: The illness diary method includes the following approach: The patient presents his symptoms and the doctor may suggest the use of an illness diary. Together, they shape the format of the diary and identify items to be included. The patient uses the diary for home notes between consultations. The notes constitute the frame for a fresh dialogue about the complaints in the next consultation. The method has gradually been elaborated according to utilization experiences on an interactional level, leading to a more specific presentation of the method and how it can be used. CONCLUSION: An illness diary and the subsequent doctor-patient interaction can be a feasible tool to expand the gateways to dialogue in general practice.

Adolescent↗
PubMed1997

Focus groups as a path to clinical knowledge about the acutely and severely ill child.

OBJECTIVE: To identify elements of clinical information beyond the area of knowledge presented in medical textbooks, but used by the general practitioner when confronted with the acutely and severely ill child. DESIGN: Focus group approach. SETTING: A course for teachers in General Practice at the Division for General Practice, University of Bergen, Norway. SUBJECTS: 25 experienced general practitioners serving as clinical teachers at the Division for General Practice. MAIN OUTCOME MEASURES: Clinical descriptions arising from incident-based anecdotes and experiences. RESULTS: Issues were reported concerning the doctor's emotional reactions, cues from the parents of the child, atypical contact between doctor and child, cognitive discrepancies, and difficulties in acting on cues. CONCLUSION: This material identifies elements of tacit clinical knowledge which may provide a basis for further analysis and shared action.

Acute Disease↗
PubMed1997

[From risk factors to health resources. From theory to medical practice].

In this article, we emphasize some of the problems related to the choice of risk factor identification and intervention as the dominant medical strategy for diagnosis, treatment and prevention of disease. Knowledge about risk factors can provide hypotheses about origins of disease and predict disease at a group level. However, there are several pitfalls related to this perspective concerning causal factors, end points, informed consent, group level based possibilities and medicalization. A salutogenic perspective shifts the attention toward resources which might counteract risk of disease. Increased attention to people's personal health resources--assessed by the doctor as well as by the person herself--can contribute to a better balance in medical theory and practice by stimulating the strength of people rather than looking only for weaknesses.

Health Resources↗
PubMed1996

[Psychiatric group supervision in general practice. A project evaluated by group focusing].

A group supervision project in psychiatry in general practice was established in 1992. The aims were to increase competence and interest in psychiatry and to contribute to a supervision model in psychiatry among general practitioners in a sparsely populated area. The group leader, who was a psychiatrist with competence in group analysis met with seven physicians for a three hour evening meeting once a month over a period of two years. The meetings were structured with a planned session at the beginning followed by a more open session. A focus group approach was used as the evaluation method. This method showed its usefulness in enabling the group to adjust its structure after an evaluation conducted after one year had passed and the conclusion at the end of the project period was: Group supervision can contribute to increased competence in psychiatry among general practitioners. It seems to increase the doctors' confidence and endurance in relation to psychiatric problems in family practice and provides an important opportunity to share difficult experiences with colleagues.

Evaluation Studies as Topic↗
PubMed1995

[Better consultations with patients' help--a method for quality assurance in general practice].

The authors have developed an instrument which is intended to improve consultations in general practice through feedback from patients. The instrument consists of a set of questionnaires with identical questions to patient and physician regarding a recently accomplished consultation. The physician is also asked to fill in a summary evaluation form. The emphasis is placed on the issue of communication between patient and physician. The answers to these questionnaires are used to identify areas where the physician could improve future consultations. Experience has shown that the instrument is easy to use, and provides valuable knowledge. It can be used by physicians working in a one-physician practice or group practice. The benefit will be greatest if the physicians cooperate with colleagues.

Biofeedback, Psychology↗
PubMed1995

[Gender, work load and list profile in general practice. Experiences from a patient listing project].

A list patient project was carried out in four Norwegian municipalities in 1993. Female general practitioners from one of the involved communities soon showed frustration about the their experience that the new system had increased their work load. Although the new system was intended primarily to serve the needs of the population, the problems experienced by the female doctors were taken as warnings about future problems for the servants of the system. We therefore wanted to study relationships between experienced work load, list profiles and procedures for establishment of the patient lists among male and female doctors in Trondheim and Tromsø, the two largest project municipalities. Our data confirm the impression of increased work load and dissatisfaction with the list profiles. We find that female doctors have shorter lists and a higher proportion of female patients, and are less accessible. We discuss elements which might influence these problems in the future, especially as regards list profiles, the establishment of lists, and priorities related to people's free choice of doctor.

Appointments and Schedules↗
PubMed1995

[A simple survey of post-traumatic stress disorders among Bosnian war refugees in Norway].

150 Bosnian war refugees (100 men and 50 women) were followed for 12 months by means of a brief screening procedure to determine prevalence and course of symptoms of post-traumatic stress disorder. 88 men and 18 women had spent some time in Serbian concentration camps before arriving in Norway. A short check list for interview and a simple self-assessment questionnaire based on stressor and symptom criteria for post-traumatic stress disorders according to DSM-III-R were used three times. The number of persons with a diagnosis of post-traumatic stress disorder remained high throughout the period of observation. The presented diagnostic approach was compared with a comprehensive, standardized diagnostic test battery applied in a similar population of refugees by comparing the outcomes. For the majority of outcomes, no significant difference in prevalence was found. The experiences and results indicate that our approach is practicable, and can deliver diagnostic outcomes with acceptable validity.

Bosnia and Herzegovina↗
PubMed1995

[Clinical examination in general practice--a consulatation. Experiences after the first examination].

In 1994 the first examination in general practice was arranged for graduate students at the medical school in Bergen. The examination consisted of a written part, and an oral, clinical examination. We report some experiences and reflections concerning the latter. Patients with commonly occurring health disorders were recruited from the practices of internal and external examiners. The performance of the student was assessed according to the skills in respect of clinical issues, communication, consultation tasks, and theoretical matters. The correspondence between the assessment of different examinators was very good, and the marks were well distributed. The students' evaluation and our own experiences lead to the conclusion that this kind of examination seems to be suitable for differentiated testing of skills and knowledge in general practice.

Clinical Competence↗
PubMed1995

[Mass screening against cervical cancer--what are the viewpoints of female general practitioners?].

Female general practitioners play a central role in the national programme for organized cervical mass screening. The article presents results from a study among Norwegian female general practitioners (n = 720) on their view of the benefit of the screening programme and about the recommendations they give their patients regarding routine Pap-smear. The response rate was 95%. 93% found that the national programme was of great or some benefit. 70% gave recommendations in accordance with the programme. Only 14 physicians recommended longer intervals for routine Pap-smears than those recommended in the programme. However, a considerable proportion reported that Pap-smears are taken more often than recommended by the programme, usually among young women who are considered to be at risk, or who express a wish to have a smear taken. We identify possible misunderstandings and misleading expectations which should be approached by means of strategies for quality assurance of the national programme.

Attitude of Health Personnel↗
PubMed1995

The legitimacy of clinical knowledge: towards a medical epistemology embracing the art of medicine.

The traditional medical epistemology, resting on a biomedical paradigmatic monopoly, fails to display an adequate representation of medical knowledge. Clinical knowledge, including the complexities of human interaction, is not available for inquiry by means of biomedical approaches, and consequently is denied legitimacy within a scientific context. A gap results between medical research and clinical practice. Theories of knowledge, especially the concept of tacit knowing, seem suitable for description and discussion of clinical knowledge, commonly denoted "the art of medicine." A metaposition allows for inquiry of clinical knowledge, inviting an expansion of the traditional medical epistemology, provided that relevant criteria for scientific knowledge within this field are developed and applied. The consequences of such approaches are discussed.

Decision Making↗
PubMed1995

Shifting attention from objective risk factors to patients' self-assessed health resources: a clinical model for general practice.

The study was designed to present and apply theoretical and empirical knowledge for the construction of a clinical model intended to shift the attention of the general practitioner from objective risk factors to self-assessed health resources in male and female patients. Review, discussion and analysis of selected theoretical models about personal health resources involving assessing existing theories according to their emphasis concerning self-assessed vs. doctor-assessed health resources, specific health resources vs. life and coping in general, abstract vs. clinically applicable theory, gender perspective explicitly included or not. Relevant theoretical models on health and coping (salutogenesis, coping and social support, control/demand, locus of control, health belief model, quality of life), and the perspective of the underprivileged Other (critical theory, feminist standpoint theory, the patient-centred clinical method) were presented and assessed. Components from Antonovsky's salutogenetic perspective and McWhinney's patient-centred clinical method, supported by gender perspectives, were integrated to a clinical model which is presented. General practitioners are recommended to shift their attention from objective risk factors to self-assessed health resources by means of the clinical model. The relevance and feasibility of the model should be explored in empirical research.

Adaptation, Psychological↗
PubMed1995

Action research--a strategy for evaluation of medical interventions.

Medical intervention commonly addresses issues which can rarely be controlled and measured experimentally. The zeal for standardization of the intervention may lead to premature closure of a development process, in which the intervention method and its implementation are omitted from systematic evaluation. However, evaluation strategies other than the experimental ones do exist and can overcome these limitations. Action research is presented as an alternative approach for evaluation of medical interventions. This strategy denotes the study of a social situation, intended to improve the quality of action. The two central concerns--improvements in practice and increased knowledge and understanding--are linked together in an integrated and dynamic cycle of activities, in which each phase learns from the previous one and in turn shapes the next. The stages of research involve problem identification, planning, action and evaluation. A model for medical action research, intended to facilitate evaluation of every step, is presented and discussed, illustrated by an example from primary health care research. Evaluation must account for the following elements of the process: problem identification, summarizing previous experience, determining the aims of intervention, planning and development of the intervention method, design and articulation of the intervention strategy, implementation of action, and redefining the problem. Potentials and limitations of the action research strategy are discussed.

Bias↗
PubMed1995

Simulated patients for the practical examination of medical students: intentions, procedures and experiences.

This paper presents intentions, procedures and experiences related to a simple method for training simulated patients for undergraduate examinations set up as clinical consultations. The examinations took place in the final year of medical school, at the Division for General Practice, University of Bergen, Norway. Thirty-six medical students were assessed by the use of five primary-school teachers serving as simulated patients and 18 authentic patients. Field notes from the process, observations during the examinations, written evaluation from the students and transcript of audiotape from focus group setting with the simulants are presented. Simulants were trained and prepared to simulate common health problems during a brief procedure which seemed to be sufficient as long as standardization was not aimed for. Simulants were not detected from among the ordinary patients by the students. Even the authentic patients did some level of role playing, which must be accounted for in future preparation. Simulants may by means of brief preparatory instructions serve as useful and realistic supplements to authentic patients in the practical examination of undergraduate medical students.

Adult↗
PubMed1995

Patients' stories: science, clinical facts or fairy tales?

OBJECTIVE: To explore potentials and attributes of the qualitative research interview as a tool for acquiring knowledge about illness. DESIGN: A qualitative approach, comparing knowledge about consultations originating from 1) data from interviews with immigrant female patients, and 2) evaluative data from registration forms from the doctors. SETTING AND SUBJECTS: 24 Pakistani female patients, recruited from the appointment list at a primary health care centre in central Oslo were interviewed in their homes. Evaluation forms were filled in by the ten physicians consulted. MAIN OUTCOME MEASURES: Illness knowledge derived from different communicative contexts. Contextual prerequisites suggest potential roads to the inquiry of illness applicable in the clinical context. CASE STORIES: Patients' illness perspectives and resources were probably encouraged in the interview by means of discourse underlining the women's resources. This position may have emerged because the women were actually consulted by the interviewer. Dialogues actively seeking out the other person's illness perspective, as recommended in the qualitative interview, seem to encourage adequate exchange of medical information. CONCLUSION/IMPLICATIONS: Pursuing and modifying strategies from the qualitative interview for exploration of illness may contribute to clinical facts as well as scientific knowledge concerning illness.

Adult↗