Search PubMed⌕ Search

Biomedical subjects

T Ostbye

Publications and source records attributed to T Ostbye.

At least 73 records · Page 4Linked to original sources
PubMed1993

Work force planning in the 90s, Part I: Efficiency, economy and political will--the need for a new approach.

Critical to health services management in today's economic climate is efficient utilization of our costly and sometimes limited supply of health care professionals. This two-part article gives an overview of current issues in health care work force planning in Canada. In Part I, the problems of estimating current supply are discussed. Needs-based and demand-based forecasting are contrasted. Comprehensive needs-based planning is recommended and changes needed in order to move toward this type of planning are discussed. In Part II, the maldistribution of health care professionals and various corrective measures within the context of needs-based comprehensive planning are discussed.

Canada↗
PubMed1993

An early 'clinical trial' as a teaching exercise: the Book of Daniel 1.1-15 (1.1-20).

This article discusses a very early clinical trial from the Old Testament. One of Daniel's and his companions' tribulations in Babylonia is explicated within the framework of the modern clinical trial. Even if many, or maybe even most, guidelines for good clinical trial practice are violated (it can even be argued that this is not really a clinical trial), a discussion of this biblico-historical episode in, for example, a problem-based course in (clinical) epidemiology or a course in the critical appraisal of the literature, can be a useful (and possibly entertaining) exercise.

Bible↗
PubMed1993

An evaluation of several biochemical markers for bone formation and resorption in a protocol utilizing cyclical parathyroid hormone and calcitonin therapy for osteoporosis.

Female patients (n = 20) with osteoporosis, aged 66 +/- 5 yr were studied during a 24-h infusion of parathyroid hormone (PTH [1-34]) at a rate of 0.5 IU equivalents/kg.h, and then during a 28-d period of subcutaneous injections, at a dose of 800 IU equivalents per day. Thereafter half the patients received subcutaneous injections of calcitonin, 75 U/d for 42 d, and all patients were followed to the end of a 90-d cycle. Biochemical markers of bone formation (serum alkaline phosphatase, osteocalcin, and the carboxy-terminal extension peptide of pro-collagen 1) and bone resorption (fasting urine calcium, hydroxyproline, and deoxypyridinoline) were compared during treatment by the intravenous and subcutaneous route of PTH administration, and subsequently during calcitonin therapy. During intravenous PTH infusion there were significant reductions in all three bone formation markers, despite expected rises in urinary calcium and hydroxyproline. By contrast, the circulating markers of bone formation increased rapidly by > 100% of baseline values during daily PTH injections (P < 0.001). Significant increases in bone resorption markers were only seen at the end of the 28 d of injections, but were < 100% over baseline values, (P < 0.05). Quantitative bone histomorphometry from biopsies obtained after 28 d of PTH treatment confirmed that bone formation at both the cellular and tissue levels were two to five times higher than similar indices measured in a control group of biopsies from untreated osteoporotic women. Subsequent treatment of these patients with calcitonin showed no significant changes in the biochemical markers of bone formation and only a modest attenuation of bone resorption. Thus, PTH infusion may inhibit bone formation, as judged by circulating biochemical markers, whereas daily injections confirm the potent anabolic actions of the hormone. Sequential calcitonin therapy does not appear to act synergistically with PTH in cyclical therapeutic protocols.

Aged↗
PubMed1993

Initial nonfunction in cadaveric renal transplantation.

Patients who receive a kidney transplant that does not function immediately have more complications and decreased graft survival than patients whose allografts function immediately. To determine the causes of initial nonfunction (INF), the authors reviewed 188 consecutive cadaveric kidney transplants performed between 1985 and 1988 at the University Hospital, London, Ont. Data were collected on 16 putative risk factors for INF, which were divided into three categories: donor, recipient and technical. INF was defined as the need for dialysis within 7 days of transplantation. Forty-eight (26%) of the 188 allografts had INF, 6 of which never functioned. Univariate analysis identified five variables associated with increased risk of INF: no donor dopamine use, back-table flush, single-organ retrieval, exchanged kidney and prolonged cold ischemic time. Multivariate analysis, however, identified only three variables associated with INF: cerebrovascular accident as the cause of donor death, no donor dopamine use and single-organ retrieval. The authors recommend (a) low-dose dopamine therapy for all donors and (b) multiorgan retrieval to produce quality kidneys for transplantation.

Cadaver↗
PubMed1992

Teaching statistics to health professionals: the legal analogy.

Despite the importance of statistical concepts to health professionals, the teaching of statistics to students from this field has generally been unrewarding. We feel that a few central concepts are crucial to all statistical thinking and that, for most health professionals, the communication of these is more important than learning about complex mathematical models. A device for demonstrating the parallels between a criminal legal trial and statistical hypothesis testing is presented. We feel that it can facilitate the learning of this central statistical concept.

Curriculum↗
PubMed1992

Family medicine education in Canada.

Within the sphere of health and welfare, Canada has more in common with the Scandinavian countries than with the United States. This article describes and discusses the unique role of the College of Family Physicians of Canada and the education and training for family medicine, both on the undergraduate and postgraduate levels in Canada. The development of the Master of Clinical Science in Family Medicine degree programme at the University of Western Ontario is considered to be an important vehicle for strengthening academic family medicine in Canada. The amalgamation of current knowledge not only from clinical sciences and educational research, but also from the social sciences, is seen as fundamental to the continued improvement of this discipline.

Canada↗
PubMed1992

The crack cocaine problem. A warning from North America.

This article describes crack cocaine and its adverse clinical and public health effects. Although crack cocaine does not yet constitute a major drug problem in the Nordic countries, heed should be paid to North America where crack cocaine has developed into a serious and widespread problem only a few years after its introduction. In spite of highly publicized efforts to limit its spread, after a small decline in 1990, the use of crack cocaine is once again increasing. Strong efforts should therefore be made to keep this substance away from the Nordic countries.

Acquired Immunodeficiency Syndrome↗
PubMed1992

The Oregon formula: a better method of allocating health care resources.

In Oregon, an important new mechanism for prioritizing health care resources is about to be introduced. It is based on a relatively simple cost/benefit formula, the best of available scientific knowledge as well as public opinion and sentiment. The formula is based on three factors: the cost of each treatment or procedure, the improvement in quality of life by giving the treatment and how long a patient would be healthy after treatment. The Oregon experiment may influence the delivery of health care not only in the United States. In modified form this approach may have even more wide-ranging implications in the Scandinavian countries where most of the health services are publicly funded.

Cost-Benefit Analysis↗
PubMed1991

Establishing an international computer network for research and teaching in public health and epidemiology.

Most universities and major research institutions in North America, Western Europe and around the Pacific are connected via computer communication networks. The authors have used these networks' accessible, low cost, electronic mail system to develop a network of public health researchers and teachers. Current and potential uses of this network are discussed. These networks can not only facilitate international cooperation within public health; they also make it possible to conduct international collaborative research projects that would be too cumbersome and time consuming to initialize and conduct without this communication facility. One participant from Hungary has been able to participate in the network by using telefax. This has some drawbacks compared to electronic mail. In this era of rapid change in Eastern Europe, we urge that electronic communication be made freely available to colleagues in Eastern Europe.

Computer Communication Networks↗
PubMed1991

The importance of class I and class II HLA in cadaveric renal transplantation.

The importance of avoiding mismatches (MM) at Class I and Class II HLA antigens in cyclosporine-treated renal allograft patients is controversial. In order to assess the role of HLA, 200 consecutive cadaveric renal allografts over a 4-year period were analysed. All patients received cyclosporine/predinisone immunosuppression and 75% were induced with ALG. Minimum follow-up period was one year. HLA A, B, DR, DQ, and DRw52/53 typing were available on 77-100% of allografts. A beneficial effect was noted at the HLA A locus. One-year survival was 87.2% in the 0 and 1 HLA A MM group combined vs 73.8% in the 2 HLA A MM group (p less than 0.05). The mean creatinine level at one year was also lower in the 0 plus 1 MM vs 2 MM group: 152.8 mumol/L vs 184.8 mumol/L, respectively (p less than 0.05). Significantly fewer rejection episodes occurred in the 0 and 1 HLA DQ MM group combined vs the 2 MM group. Steroid-resistant rejection episodes (SRRE) were not associated with the number of HLA MM. Patients who had an SRRE had significantly higher mean current and historical peak panel reactive antibodies (PRA) than patients who did not have SRRE. These results indicate that avoiding mismatches at the HLA A locus may improve renal allograft survival, and matching at HLA DQ may predispose patients to a more quiescent post-transplant course. The degree of preoperative sensitization may be an important etiologic factor in SRRE.

Cadaver↗
PubMed1989

[Medical expert systems. What are they and how should we organize our efforts?].

Medical expert systems have been developed for more than 20 years, in particular in the United States. Most existing systems are prototypes, and only a few commercial systems are available. The prototypes are generally limited in scope or functions (and have not been transferred to other users). However, in the near future we can expect useful applications to appear in special areas of medicine. In Norway we probably do not have the resources required to develop large commercial medical expert systems. If we want to develop medical expert systems, we should concentrate on limited areas. We must prepare the ground for future use of such systems in Norway. An important first step is to give health personnel basic education in the use of computers.

Expert Systems↗
PubMed1989

[Computer systems for general practitioners. Status and development].

Patient-administrative systems are becoming increasingly accepted in general practice. The market is now more mature than before. Many physicians are now purchasing computer systems for general practice the second time. Due to national characteristics of the health services the market for these systems is not truly international. In Norway this market is dominated by two makes: Infodoc and Profdoc. In future more physicians will use systems for general practice, and more functions will be added, although the usefulness of these may be a matter for discussion. Furthermore, the importance of telecommunications is expected to increase, and similarly, integration with other services. This development would be furthered by central government action for the purpose of harmonizing and standardizing data, systems and possibly user-interface.

Computer Systems↗
PubMed1989

[Electronic information bank for health services in Norway].

This article proposes the establishment of a central, on-line information bank for the Norwegian health services. The article discusses the potential content and functions of the information bank. It is concluded that, in addition to increasing the availability of health-related information, such an information bank might also improve communication at several levels of the health care system.

Health Services↗
PubMed1989

[Access to North American online libraries and networks from a medical practice].

This article gives an overview of North American electronic networks and on-line databanks containing medical and health-related information. It discusses costs and benefits for physicians and other health care personnel. The article concludes with practical information on ways to connect a Norwegian medical practice to these networks and databanks.

Canada↗