Biomedical subjects

Torhild Heggestad

Publications and source records attributed to Torhild Heggestad.

5 recordsLinked to original sources

PubMed2003

[The epidemic of Caesarean section: has it reached Norway?].

BACKGROUND: Women's right to decide on the mode of delivery is discussed, as well as the management of term breech deliveries. Obstetric practice may have changed as a consequence of ongoing debates. National caesarean section rates were stable at 12-13% during the 1990s, but no information has been provided about the development over the last two years. MATERIAL AND METHODS: Information about deliveries in obstetrical units in Norway, 1999 to 2002, was extracted from the Norwegian Patient Register. The number of deliveries was validated against information from Statistics Norway. The numbers of caesarean sections in 1999 and 2000 were validated against information from the Medical Birth Registry of Norway. RESULTS: The caesarean section rate increased slightly from 12.8% in 1999 to 13.0% in 2000. In 2001, there was a considerable increase to 14.9%; during the first 8 months of 2002, the rate was 15.1%. The change in practice appeared in the last months of 2000, coinciding with the publication of the term breech trial. However, only about one third of the increase can be attributed to a change in breech delivery. COMMENTS. Caesarean section is the most frequent major surgical procedure performed on hospitalised patients. In times of rapid changes in obstetric practice, monitoring of the development without time delay is called for.

Breech Presentation↗

PubMed2003

Measuring readmissions: focus on the time factor.

OBJECTIVE: To assess the effects of choosing different time-intervals of observation when using unplanned readmissions as an outcome indicator. DESIGN: A conceptual model was developed based on the risk curve. The model assigned readmissions above a background level as 'related' to the earlier episode of illness. The characteristics of the hazard curve were used to estimate how the rates of related and unrelated readmissions varied with time. SETTING: Patients living in a region of Middle Norway served by eight acute-care hospitals and discharged in the year 1996. MAIN OUTCOME MEASURE: The conditional risk (hazard rate) of having an unplanned readmission. The information gathered allowed inclusion of readmissions to all hospitals in the area, and to make risk corrections for deaths. RESULTS: The identified proportion of readmissions judged as related to the earlier episode of illness was found to be very sensitive to changes in the time interval. With the commonly used interval of 30 days, 0.5 of all related readmissions were identified, while 0.7 of the readmissions included at this time were estimated as related ones ('true positives'). The hazard curve was different for medical and surgical patients, but the corresponding proportions of related and unrelated readmissions were relatively similar. Adjusting for deaths in the observation period did not result in significantly different risk curves. CONCLUSION: When unplanned readmissions are used as an outcome indicator, the measure is susceptible to the choice of time interval. The operative characteristics must be interpreted in the context of where it is intended that the indicator should be used.

Female↗

PubMed2002

[Compulsory admissions].

Explore the source record for details and available documents.

Commitment of Persons with Psychiatric Disorders↗

PubMed2002

Do hospital length of stay and staffing ratio affect elderly patients' risk of readmission? A nation-wide study of Norwegian hospitals.

OBJECTIVE: To test whether there is an association between hospital operating conditions such as average length of stays (LOS) and staffing ratio, and elderly patients' risk of readmission. DATA SOURCES: The main data source was a national patient database of admissions to all acute-care Norwegian hospitals during the year of 1996. STUDY DESIGN: It is a cross-sectional study, where Cox' regression analysis was used to test the factors acting on the probability of early unplanned readmission (within 30 days), and later occuring ones. The principal hospital variables included average hospital LOS and staffing ratio (discharges per man-years of personnel). Adjusting patient variables in the model included age, gender, and cost-weights of the Diagnosis Related Groups (DRGs). DATA EXTRACTION METHODS: The selected material included discharges from 59 hospitals, and 113,055 elderly patients (> or = 67 years). Multiple admissions to the same hospital were linked together chronologically, and additional hospital data were matched on. To maximize the association between the index stay and the defined outcome (unplanned readmission), no intervening planned admission was accepted. PRINCIPAL FINDINGS: Being admitted to a hospital with relatively short average LOS increased the patient's risk of early readmission significantly. In addition it was found that more intensive care (more staff) could have a compensatory effect. Furthermore, the predictive factors were shown to be time dependent, as hospital variables had much less impact on readmissions occurring late (within 90-180 days). CONCLUSIONS: The results give support to the assumption of a link between hospital operating conditions and patient outcome.

Acute Disease↗

PubMedDate not supplied

Accessibility and distribution of the Norwegian National Air Emergency Service: 1988-1998.

OBJECTIVE: To evaluate the accessibility and distribution of the Norwegian National Air Emergency Service in the 10-year period from 1988 to 1998. MATERIAL AND METHODS: The primary material was annual standardized activity data that included all helicopter missions. A multivariate model of determinants for use of the helicopter service was computed by linear regression. Accessibility was measured as the percentage of the population reached in different flying times, and we evaluated the service using a simulation of alternative locations for the helicopter bases. RESULTS: The helicopter service (HEMS) has short access times, with a mean reaction time of 8 minutes and a mean response time of 26 minutes for acute missions. Nearly all patients (98%) are reached within 1 hour. A simulation that tested alternative locations of the helicopter bases compared with current locations showed no increase in accessibility. The use of the service shows large regional differences. Multivariate analyses showed that the distances of the patients from the nearest helicopter base and the nearest hospital are significant determinants for the use of HEMS. CONCLUSION: Establishment of a national service has given the Norwegian population better access to highly qualified prehospital emergency services. Furthermore, the HEMS has a compensating effect in adjusting for differences in traveling distances to a hospital. Safety, cost-containment, and gatekeeper functions remain challenges.

Air Ambulances↗