Search

High-degree stenosis of the internal carotid artery is a significant risk factor for cerebral infarction. It has been clearly demonstrated that endarterectomy reduces this risk if perioperative complications are maintained on a low level.We studied the files of all patients undergoing carotid surgery in our hospital from 1985 through 2001. We also mailed questionnaires to all who were still alive in 2002.Over the period, 195 operations were performed on 168 patients (mean 12 operations per year). Their mean age was 63; 67% were men. In 30 cases (15%) the stenosis was asymptomatic. Within 30 days after surgery four patients had a disabling stroke, one had a retinal infarction and one patient died. The rate of perioperative stroke or death was 6.1%, while the rate for disabling stroke or death was 2.6%. Peripheral nerve injury, most often transitory, occurred in 5.7%.The risk of moderate or serious perioperative complications is comparable to the multicentre studies that provide the rationale for the treatment (NASCET and ECST). Carotid endarterectomy in our hospital is safe in preventing stroke and should still be offered patients presenting to our centre.

The objective of this study was to register the frequency of statin prescription during the initial hospitalization for acute myocardial infarction and therapeutic intensity at follow-up.A retrospective study among patients aged below 70 of both sexes with acute myocardial infarction, who survived the initial hospitalization at the University Hospital of Tromsø during 1995-1998.473 patients with acute myocardial infarction, 76% men, mean age 57.4 (range 33-70 yrs) were included. Statin treatment was started in 55% of the patients within discharge from the hospital. Total cholesterol (odds ratio 0.51, 0.41-0.64; 95% CI) and decreasing age (1.60, 1.21-2.10) were significant predictors for statin prescription. Statin treatment started during hospitalization increased gradually from 42% in 1995 to 91% in 1998 (p0.001) among patients with total cholesterol above 5.0 mmol/l at admission. 54% of the statin users achieved the treatment goal at their first outpatient control 8-12 weeks after discharge.The proportion of statin users has increased satisfactory during 1995-98, but the therapeutic intensity is unsatisfactory compared to guidelines for cholesterol-lowering treatment of patients with acute myocardial infarction.

During the first decade of 2000, significant increase of radiotherapy capacity in Norway will take place, as the number of linear accelerators will increase from 24 to 36. In Norway, radiotherapy departments are traditionally located only in university hospitals. However, six of the new accelerators will not be installed in existing radiotherapy centres, but in small, new radiotherapy units, set up in selected county hospitals and organized as satellites of the university hospitals, in order to secure the treatment quality. The university hospital is responsible for both medical and technical standards in the satellite, while the county hospitals have the financial responsibility.The satellite model combines two important aspects of hospital management; treatment is geographically decentralized, while treatment quality is centralized. The first radiotherapy satellite was established in the town of Kristiansand in January 2001. We report our experience with this new concept in radiotherapy.The satellite model should be evaluated also for other medical specialties within the university hospitals.

In Norway, patients with severe head injuries are transported to a regional, neurosurgical department for surgery, but some are operated on by surgeons without neurosurgical training in local hospitals.Data were retrospectively collected from the records of all patients (n = 161) hospitalised alive with a severe head injury occurring within Vestfold County (1987-96).Overall lethality was 27%. 54 patients (34%) underwent decompressive surgery. 31 patients were operated in the local hospital, by 13 different surgeons. 30 of these patients had extracerebral haematomas. These patients had a significantly worse outcome than the 23 patients operated in a regional neurosurgical department. Patients with an epidural haematoma had a better outcome than patients with an acute subdural haematoma. We retrospectively classified ten operations in the local hospital as inadequate.In Norway and countries with a similar hospital system, local hospitals should establish guidelines for safe and swift transport of head injury patients to the nearest neurosurgical department, and should not try to perform neurosurgical decompression in such patients.

Lillehammer is a town with almost 24,000 inhabitants. During the 16 days of the XVII Olympic Winter Games in February 1994, approximately 1.9 million spectators visited the area. Theextrapopulation during that period, led to 50 people being admitted for treatment in the Medical Department at Lillehammer County Hospital, i.e. 2.6 per 100,000 spectators. The number of admissions of persons from the resident population was lower than during the same period in previous years.

The article describes a follow-up study extending over a period of two years (1992-93) of patients admitted with a diagnosis of acute myocardial infarction to a Norwegian district hospital. The mortality was 13.8%. In Norway, treatment of acute myocardial infarction is generally standardized, with only minor variations between hospitals. This follow-up illustrates that patients with uncomplicated acute myocardial infarction who do not require emergency surgical intervention can be safely treated in a district hospital.

A survey among the 13 general county hospitals and the five regional neurosurgical units in Norway showed that 263 patients were operated on for acute head injuries in 1993. More than 80% of these operations took place in a neurosurgical unit, and most county hospitals had only 1-2 such surgical procedures each year. Most county hospitals also limited their surgical activities to extradural conditions. Data from 68 patients operated on for epidural haematomas in our neurosurgical department were therefore analysed. The outcome of these operations was good in 83.8%, and only 5.9% showed a poor result. One patient died. It is concluded that these good results probably reflect the standard of handling, diagnostic work and transport of the patient prior to surgery, rather than the surgery itself. It seems unreasonable to continue the infrequent practice of treating these conditions surgically in local hospitals.

At the local hospital in Laerdal a geriatric team has been established since May 1991, and is organized as a project. Instead of a specialist in geriatrics the hospital has used a general practitioner with some geriatric experience and an interest in elderly patients. The team has also included a nurse, a physiotherapist and an occupational therapist. The services offered by the team have been well received by patients, general practitioners and other health workers in the region. It has now been decided that the team shall continue on a permanent basis from 1994.

During the period January 1985 to May 1993, 129 patients were hospitalized for abdominal aortic aneurysms at the hospital in Haugesund. Of these patients, 93 underwent surgery at our hospital. Acute operations were performed in 33 patients with a perioperative (30 days) mortality of 45%. 60 patients underwent elective surgery with no perioperative (30 days) mortality. 14 patients were sent to a regional/university hospital. For various reasons, 22 patients were not operated on.

We review our experience from a stroke unit run as a project in a county hospital serving a population of 95-100,000. The average length of stay in hospital was 33.5 days. The mortality rate was low (10%). 73% of the patients were discharged to their homes, either directly or after a short stay of less than three months in nursing homes. A questionnaire sent to the patients after the end of the project period confirmed that about 70% were living at home 1-15 months after discharge. These findings are in accordance with the results from other stroke units, and support the conclusions of other investigators that treatment in stroke units improves the outcome for patients with acute stroke. We also briefly discuss complications, follow-up after discharge, and the implications for the patients' families.

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.

We present an analysis of all psychiatric consultations with inpatients in the somatic wards at the Central Hospital in Alesund over a period of three years. About 1% of the patients were referred for psychiatric consultation. Most of these patients had no previous experience of psychiatry. Mean age was 45 years (range 16-90), and 56% were females. The reasons for referral were assessment of suicidal behaviour (47%), depression (16%) and psychosis (11%). The most common psychiatric diagnoses were personality disorders (16%), affective disorders (14%) and alcohol and drug abuse and dependence (14%). About 10% were admitted to psychiatric wards, and 21% were referred to psychiatric outpatient clinics. The referring physicians were satisfied with the psychiatric consultation service.

The new national hospital, "Rikshospitalet", is to be built in the northwestern part of Oslo in 1993. It is not only words when the planners talks about humane architecture. The national hospital is a training hospital for Oslo university, and the various consequent functions are arranged according to a logical plan. The most important feature of the hospital is its main "street", an open construction under a glass roof. It will bustle with life, since it will house both public services and outpatient reception. The street delimits different zones, with causal traffic at street level and hospital traffic between the wards and operating theatres and X-ray departments (which are collected in blocks in a central square) on gangways crossing the "street" at higher levels. The wards are formed as pavillions which project from the main building. In this way each ward will be of reasonable size, and the patients will be in close contact with the beautiful surroundings. The hospital will cover about 120,000 square meters, and its estimated capacity is 25,000 in-bed patients and 100,000 outpatient consultations per year.

In 1988 there were 179 emergency admissions to the Department of Paediatrics, Regional Hospital, Trondheim, because of asthma. These comprised 22% of the total number of 812 admissions to the emergency unit this year. 178 of the 179 patients' records were found and used in this registration. 46% of the admissions referred to children who had previously been admitted for asthma. Half of the 179 admissions referred to children under 2.5 years of age, and 69% were boys. The main precipitating cause of the admissions was preceding respiratory infection. In 71% of the admissions the child had a family history of atopy. 125 patient records with information about the home environment showed that in 50% of these cases, the children were exposed to cigarette smoking and 34% had domestic animals at home. In 67% of the admissions the patients were taking antiasthmatic medication prior to hospitalization. The most frequently used drugs were Beta-2-agonists in mixture formulas. Less than 7% of the drugs used were corticosteroids. Management of childhood asthma may be improved and emergency admissions prevented by motivating parents to avoid potent allergens and exposure to tobacco smoke at home, supplemented by better education of patient and parents in antiasthmatic medication.

Sentralsykehuset i Akershus is a county hospital serving a population of approximately 400,000 citizens. In 1984 a survey on smoking among the employees disclosed that 72% wanted a smoke-free working environment. According to an accepted three-year strategy the goal was a totally smoke-free hospital in 1990. This goal was not accomplished, and in 1990 a new survey (83% responders) indicated that among the 27% daily smokers only 49% were loyal to the non-smoking regulations. 76% however, wanted a smoke-free working environment. A large majority found it unrealistic to achieve a totally smoke-free hospital, and 70% wanted smoking areas for patients as well as for employees. The lack of success in achieving a totally smoke-free hospital has been analyzed. Important measures include better motivation, a well planned motivation process and various smoking cessation activities. Even more important are attitudes among leaders at different levels. They should identify with the goal "smoke-free hospital" on behalf of the hospital administration.

As a consequence of the regionalization of the health services in Norway hospitals were given either local, central or regional responsibility. This system was intended to improve the availability of expertise and costly equipment, and at the same time reduce the growth of expenditures on health care. In the last few years, however, many of the smaller hospitals have improved their technical and medical skills to such an extent that this classification system has become less meaningful. Aker hospital in Oslo carries out local, central and regional functions. In a prospective study at this hospital we found that 88% of 980 consecutive medical admissions could be classified as local hospital admissions. Only 5% of the patients needed service at the central level, and 5% at the regional level. In our opinion it would suffice to have two types of hospital ("treatment levels"), standard hospitals and referral hospitals.

A questionnaire was used to study various aspects of the surgical treatment of cancer of the oesophagus, pancreas, stomach and colon/rectum in Norway. 48 of 51 departments replied. Half of the departments perform radical operations for oesophageal cancer and nearly all do total gastrectomies and low anterior resections for rectal cancer. Palliative surgery is seldom performed for oesophageal cancer, but is frequently performed for gastric cancer. Obstruction of the colon is relieved preferably by primary resection. Low anterior resection is usually performed when a free resection margin of 2 cm can be achieved. Jaundice is relieved palliatively preferably by endoscopy. University hospitals perform total gastrectomy to a greater extent than other hospital and have greater faith in radical operations for pancreatic cancer. Otherwise there are no conspicuous differences of opinion between the different categories of hospitals.

25 patients with fresh anterior cruciate ligament ruptures were followed up 36 months after primary suture. Every fourth knee was unstable and in 20/25 of the patients the level of activity was reduced. The study indicates that a county hospital can obtain results comparable with those of university clinics when performing primary suture. The results may be improved by means of augmentation techniques in ACL injuries in the young, active population. It is concluded that also county hospitals equipped with orthopedic specialists should be able to carry out augmentation procedures in ACL tears.