Norwegian University Hospital Research Articles

Influence of external assessment on quality and safety in surgery: a qualitative study of surgeons’ perspectives

IntroductionTransparency about the occurrence of adverse events has been a decades-long governmental priority, defining external feedback to healthcare providers as a key measure to improve the services and reduce the...

Profiles of health literacy and digital health literacy in clusters of hospitalised patients: a single-centre, cross-sectional study

ObjectiveTo investigate health literacy (HL) and digital health literacy (eHL) among patients hospitalised in surgical and medical wards using a cluster analysis approach.DesignCross‐sectional study using Ward’s hierarchical clustering method to...

Pelvic floor disorders and impact on sexual function: a cross-sectional study among non-sexually active and sexually active women.

Pelvic floor disorders are common and associated with impaired sexual function in women. To assess women with pelvic floor disorders and describe factors associated with not being sexually active and those associated with sexual function in sexually active women. A cross-sectional study was conducted that included nonpregnant women with symptoms of pelvic floor disorders who were referred to the urogynecologic and surgical outpatient clinic at 2 Norwegian university hospitals: St Olavs Hospital, Trondheim University Hospital, and the University Hospital of Northern Norway, Tromsø. Women answered a questionnaire anonymously. Pelvic Organ Prolapse Incontinence Sexual Questionnaire-IUGA Revised. Of 157 respondents, 111 (71%) reported being sexually active (with or without a partner), and 46 (29%) reported not being sexually active. As compared with sexually active women, not sexually active women were older (mean ± SD, 60.2 ± 13.3 vs 51 ± 12.1 years; P < .001), more were menopausal (78% vs 47%, P = .001), and more had symptom debut <1year (31% vs 9%, P < .001). They reported more distress related to pelvic floor disorders, especially pelvic organ prolapse. In a multivariate logistic regression analysis, menopausal women and women with symptom debut <1year were 4 times more likely to be not sexually active than premenopausal women (odds ratio, 4.0; 95% CI, 1.7-9.2) and women with symptom debut ≥1year (odds ratio, 4.0; 95% CI, 1.5-10.7). In sexually active women, colorectal-anal distress was negatively associated with 5 of 6 domains of sexual function: arousal/orgasm (ß = -0.36; 95% CI, -0.02 to -0.005), partner related (ß = -0.28; 95% CI, -0.01 to -0.002), condition specific (ß = -0.39; 95% CI, -0.002 to -0.009), global quality (ß = -0.23; 95% CI, -0.02 to -0.002), and condition impact (ß = -0.34; 95% CI, -0.02 to -0.006). Health care professionals should discuss sexual function in patients with pelvic floor disorders, especially menopausal women and women with colorectal-anal symptoms. The study used condition-specific measures and recruited women from 2 university hospitals with wide range of age. Limitations include the small sample size and wide confidence intervals. The number of women who considered themselves not sexually active was low, and item nonresponse levels among these women where somewhat high. Of 625 eligible women, 200 (32%) answered the questionnaire. Sexual health and sexual function are still surrounded with taboo, and some women were probably not comfortable answering the questions. Menopausal women and women with recent onset of symptoms of pelvic floor disorders are more likely to be sexually inactive, and colorectal-anal symptoms have the most negative impact on sexual function in sexually active women.

In situ simulation training strengthened bachelor of nursing students’ experienced learning and development process– a qualitative study

BackgroundIn advanced clinical learning labs on campus, high-fidelity simulation has become an essential educational approach in the Bachelor of Nursing Education programme. However, simulation while in clinical placement, in situ, is rarely used in Bachelor of Nursing Education. The aim of the present study was to explore how in situ simulation training at a surgical hospital ward, according to Bachelor of Nursing students, influenced their learning and development process.MethodsA qualitative descriptive study was conducted. Data were collected through individual interviews with a sample of 21 s-year Bachelor of Nursing students who completed 40 in situ simulations during their eight-week clinical placement at a Norwegian University Hospital. Data were analysed using inductive content analysis.ResultsThe data analysis generated six subcategories constituting two descriptive categories: building professional confidence and internalising nursing knowledge. Although the students found in situ simulation stressful and uncomfortable for being assessed by student peers, the teacher and preceptor, the process of managing clinical situations in simulation helped build professional confidence. What the students had learned in the simulation was directly transferable to real clinical situations because they were in the hospital setting. The simulation sessions enabled them to connect theoretical knowledge and clinical skills. They could test their skills in a safe environment, performing procedures that made them aware of how their knowledge could be used in real life.ConclusionAccording to the Bachelor of Nursing students’ own experiences, in situ simulation supported the students’ learning process, connected theory and practice and contributed to developing confidence in the performance of clinical skills. Including simulation in clinical practice could prove to be an effective way of teaching and learning clinical skills in nursing regarding resources and learning outcomes.

Delirium is associated with low levels of upright activity in geriatric inpatients—results from a prospective observational study

BackgroundDelirium is common in geriatric inpatients and associated with poor outcomes. Hospitalization is associated with low levels of physical activity. Motor symptoms are common in delirium, but how delirium affects physical activity remains unknown.AimsTo investigate differences in physical activity between geriatric inpatients with and without delirium.MethodsWe included acutely admitted patients ≥ 75 years in a prospective observational study at a medical geriatric ward at a Norwegian University Hospital. Delirium was diagnosed according to the DSM-5 criteria. Physical activity was measured by an accelerometer-based device worn on the right thigh. The main outcome was time in upright position (upright time) per 24 h (00.00 to 23.59) on the first day of hospitalization with verified delirium status. Group differences were analysed using t test.ResultsWe included 237 patients, mean age 86.1 years (Standard Deviation (SD) 5.1), and 73 patients (30.8%) had delirium. Mean upright time day 1 for the entire group was 92.2 min (SD 84.3), with 50.9 min (SD 50.7) in the delirium group and 110.6 min (SD 89.7) in the no-delirium group, mean difference 59.7 minutes, 95% Confidence Interval 41.6 to 77.8, p value < 0.001.DiscussionLow levels of physical activity in patients with delirium raise the question if immobilization may contribute to poor outcomes in delirium. Future studies should investigate if mobilization interventions could improve outcomes of delirium.ConclusionsIn this sample of geriatric inpatients, the group with delirium had lower levels of physical activity than the group without delirium.

Prevalence of Triggers and Patient Harm Identified by Global Trigger Tool in Specialized Palliative Care.

Background: Global trigger tool (GTT) was developed for identification of patient harm. In palliative patients deterioration can be expected, and there are no data on whether cases classified as "patient harm" actually represents a potential for improved patient safety. Objectives: The primary aim was to test the performance and suitability of GTT in palliative care patients. The secondary aim was to pilot triggers for substandard palliative care. Design and Measurements: GTT was applied in 113 consecutive patients at a palliative ward at a Norwegian university hospital. Cases of patient harm were further evaluated to decide if the case was (a) a natural part of the disease trajectory or (b) a foreseeable consequence of treatment decisions. Potential triggers for substandard palliative care were tested. Results: Two hundred twelve triggers (1.9 per hospitalization) and 26 cases of patient harm were identified. The positive predictive value (PPV) for identifying patient harm was 0.12. The most prevalent harm was pressure ulcers (8.8%). Of the 26 cases of patient harm, 6 cases were a natural part of the disease trajectory and 10 consequences of treatment decisions. In 21 (18%) patients triggers being piloted for substandard palliative care were present, identifying 9 cases of substandard palliative care. The highest PPV (0.67) was observed for "Cessation of antibiotics less than 5 days before death." Conclusions: With the exception of pressure ulcers, GTT triggers were infrequent or had a very poor PPV for patient harm. Triggers related to overtreatment might be suitable for identifying substandard palliative care.

Evaluation of the nurse-assisted eHealth intervention ‘eHealth@Hospital-2-Home’ on self-care by patients with heart failure and colorectal cancer post-hospital discharge: protocol for a randomised controlled trial

BackgroundPatients with heart failure (HF) and colorectal cancer (CRC) are prone to comorbidity, a high rate of readmission, and complex healthcare needs. Self-care for people with HF and CRC after hospitalisation can be challenging, and patients may leave the hospital unprepared to self-manage their disease at home. eHealth solutions may be a beneficial tool to engage patients in self-care.MethodsA randomised controlled trial with an embedded evaluation of intervention engagement and cost-effectiveness will be conducted to investigate the effect of eHealth intervention after hospital discharge on the self-efficacy of self-care. Eligible patients with HF or CRC will be recruited before discharge from two Norwegian university hospitals. The intervention group will use a nurse-assisted intervention—eHealth@Hospital-2-Home—for six weeks. The intervention includes remote monitoring of vital signs; patients’ self-reports of symptoms, health and well-being; secure messaging between patients and hospital-based nurse navigators; and access to specific HF and CRC health-related information. The control group will receive routine care. Data collection will take place before the intervention (baseline), at the end of the intervention (Post-1), and at six months (Post-2). The primary outcome will be self-efficacy in self-care. The secondary outcomes will include measures of burden of treatment, health-related quality of life and 30- and 90-day readmissions. Sub-study analyses are planned in the HF patient population with primary outcomes of self-care behaviour and secondary outcomes of medication adherence, and readmission at 30 days, 90 days and 6 months. Patients’ and nurse navigators’ engagement and experiences with the eHealth intervention and cost-effectiveness will be investigated. Data will be analysed according to intention-to-treat principles. Qualitative data will be analysed using thematic analysis.DiscussionThis protocol will examine the effects of the eHealth@ Hospital-2-Home intervention on self-care in two prevalent patient groups, HF and CRC. It will allow the exploration of a generic framework for an eHealth intervention after hospital discharge, which could be adapted to other patient groups, upscaled, and implemented into clinical practice.Trial registrationClinical trials.gov (ID 301472).

Comment on: Beyond the transanal total mesorectal excision moratorium: local and distant recurrence among patients operated for low rectal tumours-5-year follow-up from a Norwegian University Hospital.

Comment on: Beyond the transanal total mesorectal excision moratorium: local and distant recurrence among patients operated for low rectal tumours-5-year follow-up from a Norwegian University Hospital.

Incidence, characteristics, and associated factors of pressure injuries acquired in intensive care units over a 12-month period: A secondary analysis of a quality improvement project

ObjectivesTo determine the 12-month cumulative incidence, characteristics, and associated factors of pressure injuries acquired in Intensive Care Units. SettingFour intensive care units in a Norwegian University Hospital. Research methodologyA prospective observational cohort study using data from daily skin inspections during a quality improvement project. We used descriptive statistics and logistic regression. Variables associated with the development of intensive care unit-acquired pressure injuries are presented with odds ratios (OR), and 95% confidence intervals. ResultsThe 12-month cumulative incidence of patients (N = 594) developing intensive care unit-acquired pressure injuries was 29 % (172/594) for all categories and 16 % (95/594) when excluding category I pressure injuries (no skin loss). Cumulative incidence for patients acquiring medical device-related pressure injuries was 15 % (91/594) and 11 % (64/594) for category II or worse. Compression stockings (n = 51) and nasogastric tubes (n = 22) were the most frequent documented medical devices related to pressure injuries. Development of pressure injuries category II or worse was significantly associated with vasoactive drug infusions (OR 11.84, 95 % CI [1.59; 88.13]) and longer intensive care unit length of stay (OR 1.06, 95 % CI [1.04; 1.08]). ConclusionThe 12-month cumulative incidence of intensive care unit-acquired pressure injuries was relatively high when category I pressure injuries were included, but comparable to other studies when category I was excluded. Some medical device-related pressure injuries were surprisingly frequent, and these may be prevented. However, associated factors of developing pressure injuries were present and deemed non-modifiable. Implications for clinical practiceAwareness about pressure injury prevention is needed in the intensive care unit considering high incidences. Nurses can detect category I pressure injuries early, which may be reversed. Our findings show several factors that clinicians can control to reduce the risk of pressure injuries in the intensive care unit.

Preliminary validity testing of the eHealth Literacy Questionnaire (eHLQ): a Confirmatory Factor Analysis (CFA) in Norwegian hospitalized patients

AimsTo perform the first psychometric analysis of the Norwegian version of the eHLQ using confirmative factor analysis (CFA) procedures in a population of patients admitted to hospital using a cross-sectional design. The eHLQ consists of 35 items capturing the 7-dimensional eHealth Literacy Framework (eHLF) which describes users' attributes, user's interaction with technologies and user's experience with digital health systems.MethodsThe 7 independent scales of the eHLQ was translated from Danish and culturally adapted into the Norwegian language following a standardised protocol. Assessment of construct validity of the eHLQ was undertaken using data from a cross-sectional survey of 260 patients hospitalized at a Norwegian University Hospital in the Oslo area during a two-week period in June 2021. The analysis included using correlation analysis (Pearsons R), internal consistency (Cronbach’s alpha) and confirmatory factor analysis (CFA).ResultsAll factor loadings were high to acceptable (i.e. > 0.6), except for five items which had somewhat lower loadings. Regarding internal consistency, alpha ranged from 0.73 to 0.90. For optimal CFA fit for the different scale models, correlated residuals were required for five of the seven scales. Overall our analysis shows an intermediate fit of the orginal construct. Scale intercorrelations were all below 0.8, indicating an overall acceptable discriminant validity between the 7 dimensions.ConclusionsThe results from the CFA analysis indicate that for almost all 7 eHLQ scales, an acceptable model fit was achieved. The 260 hospitalized patients included in this study represented a variety of diagnoses, recruited from a geographically limited area. Further studies on psychometric properties of the Norwegian version of eHLQ in larger samples, diverse settings and by using more comprehensive approaches are warranted.

Using registry data to determine actual cardiac rehabilitation participation after percutaneous coronary intervention

Abstract Background Comprehensive cardiac rehabilitation (CR) has proven beneficial effects, and is a class 1A recommendation in European Society of Cardiology guidelines. Still, CR is grossly underused globally. In Norway, few studies on CR participation exist, and the extent to which CR is underused is more uncertain. Using data from national quality registries provides an opportunity to estimate actual CR participation, and whether there are some groups that participate less often than others do. Aim To determine actual use of CR, comprehensive or single component, in patients after percutaneous coronary intervention (PCI), with a special attention on women, older people, patients with comorbidities and education level. Methods CONCARDPCI is a prospective multicentre cohort study including 1970 patients after PCI at three Norwegian university hospitals during 2017-2019. Socio-demographic characteristics were self-reported during the index hospitalization for PCI. Clinical data were collected from patients’ medical records and the Norwegian Registry on Invasive Cardiology. Data on CR participation were extracted from the Norwegian Control and Payment of Health Reimbursements Database, and measured at 2-, 6- and 12 months after index hospitalisation. Results One year after PCI, one out of six patients (16%) had received single- or multicomponent CR. At 2 months, 7% had participated in CR, from 2–6 months, 12% participated in CR and from 6–12 months, 2% participated in CR. Most patients were men (78%) with a mean age of 66 years (SD 11, range 20-96 years). At 6 months, fewer women than men had participated in CR (9% vs. 13%, p=0.020). During the 12 month period, 12% of women and 17% of men participated in CR (p=0.019). The patients participating in CR were significantly younger (60 vs. 67, p&amp;lt;0.001) at all measuring points. A sizeable proportion had previous cardiovascular comorbidities including hypertension (52%) and hypercholesterolemia (47%). Patients with hypercholesterolemia participated significantly less than those without at 2 months (6% vs. 8%, p=0.031) and 6 months (9% vs. 14%, p=0.001). Those with hypertension also participated less than those without at 2 months (5% vs. 9%, p=0.002) and 6 months (9% vs. 15%, p&amp;lt;0.001). Further, 26% had previous PCI, and those with a history of PCI participated less than those with no history at 2 months (3% vs. 9%, p&amp;lt;0.001) and 6 months (6% vs. 14%, p&amp;lt;0.001). Finally, those with a lower educational level participated less at 2 months (primary school 4% vs. college/university 10%, p=0.034) and 6 months (primary school 9% vs. college/university 15%, p=0.050). Conclusion Very few patients participated in comprehensive or single component CR. Those with a lower educational level and women participated less often in CR, and the proportion was even lower in patients with comorbidities. New modes of delivery for CR is needed to meet the large group of patients not receiving follow-up according to guidelines.

Diagnostic accuracy of the 5.07 monofilament test for diabetes polyneuropathy: influence of age, sex, neuropathic pain and neuropathy severity

IntroductionThere is a need for simple and cheap diagnostic tools for diabetic polyneuropathy (DPN). We aimed to assess the diagnostic accuracy of the 5.07/10 g monofilament test in patients referred...

Mortality and length of hospital stay after bloodstream infections caused by ESBL-producing compared to non-ESBL-producing E. coli

Objective To compare mortality and length of hospital stay between patients with ESBL-producing E. coli bloodstream infections (BSIs) and patients with non-ESBL E. coli BSIs. We also aimed at describing risk factors for ESBL-producing E. coli BSIs and time to effective antibiotic treatment for the two groups. Methods A retrospective case-control study among adults admitted between 2014 and 2021 to a Norwegian University Hospital. Results A total of 468 E. coli BSI episodes from 441 patients were included (234 BSIs each in the ESBL- and non-ESBL group). Among the ESBL-producing E. coli BSIs, 10.9% (25/230) deaths occurred within 30 days compared to 9.0% (21/234) in the non-ESBL group. The adjusted 30-day mortality OR was 1.6 (95% CI 0.7–3.7, p = 0.248). Effective antibiotic treatment was administered within 24 hours to 55.2% (129/234) in the ESBL-group compared to 86.8% (203/234) in the non-ESBL group. Among BSIs of urinary tract origin (n = 317), the median length of hospital stay increased by two days in the ESBL group (six versus four days, p < 0.001). No significant difference in the length of hospital stay was found for other sources of infection (n = 151), with a median of seven versus six days (p = 0.550) in the ESBL- and non-ESBL groups, respectively. Conclusion There was no statistically significant difference in 30-day mortality in ESBL-producing E. coli compared to non-ESBL E. coli BSI, despite a delay in the administration of an effective antibiotic in the former group. ESBL-production was associated with an increased length of stay in BSIs of urinary tract origin.

Beyond the transanal total mesorectal excision moratorium: local and distant recurrence among patients operated for low rectal tumours-5-year follow-up from a Norwegian University Hospital.

Beyond the transanal total mesorectal excision moratorium: local and distant recurrence among patients operated for low rectal tumours-5-year follow-up from a Norwegian University Hospital.

Patients reporting to be healthy and not needing to change lifestyle after percutaneous coronary intervention - a cause for action?

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): The Western Norway Health Authority, The Norwegian Nurses Association Background A substantial proportion of patients with coronary artery disease do not achieve risk factors control, and are subsequently readmitted to hospital. In addition to decreased longevity, this increases the burden to the healthcare system and already strained resources. Aim To determine lifestyle and clinical characteristics of patients reporting to be healthy and not needing to change their lifestyle after percutaneous coronary intervention (PCI). Methods CONCARDPCI is a prospective multicentre cohort study including 3417 patients after PCI at seven Norwegian and Danish university hospitals during 2017-2019. Socio-demographic characteristics were obtained by self-report during the index hospitalization for PCI, and self-report on perceived health and the need to do lifestyle changes were repeated after 12 months. Clinical data were collected from patients’ medical records and the Norwegian Registry on Invasive Cardiology. Descriptive statistics, as well as t-test and chi-square test, scrutinized the aim. Results At baseline, 18% reported to be healthy and not needing to change their lifestyle. This increased to 28% (p&amp;lt;0.001) at 12 months. Most patients were men (78%) with a mean age of 66 years (SD 11, range 20-96 years). A sizeable proportion had previous cardiovascular comorbidities, including history of myocardial infarction (21%), hypertension (52%) and hypercholesterolemia (47%). Further, 27 % were obese (BMI &amp;gt;=30), 17% were smoking, 26% had previous PCI, and 9% previous coronary artery bypass grafting (CABG). Patients reporting to be healthy and not needing to change their lifestyle were older (69 vs 65, p&amp;lt;0.001). At baseline, compared to the total study population, significantly fewer patients with history of: hypercholesterolemia 13% (p = 0.002), hypertension 12% (p = 0.001), previous PCI 11% (p&amp;lt;0.001), previous CABG 9% (p&amp;lt;0.001), obesity 6% (p&amp;lt;0.001) and smoking 4% (p&amp;lt;0.001) reported to be healthy and asserted not needing to change lifestyle. After 12 months, more patients with risk factors reported to be both healthy and not needing to change lifestyle: those having hypercholesterolemia 25% (p&amp;lt;0.001), hypertension 25% (p&amp;lt;0.001), obesity 17% (p&amp;lt;0.001) and smoking 11% (p&amp;lt;0.001), as well as those with history of previous PCI 19% (p&amp;lt;0.001) or CABG 18% (p&amp;lt;0.001). Although the proportion was less for those with history of risk factors than for the total study population at 12 months, the increase in this group was large and significant. Conclusion The proportion of patients reporting to be healthy and not needing to change their lifestyle increased significantly in the longer term. This applied especially to patients with risk factors such as hypercholesterolemia, hypertension, obesity and current smoking, as well as those with history of previous PCI or CABG. For patients to better understand the seriousness and implications of their disease, patient education and increased health literacy is important.

Learning from experience: a qualitative study of surgeons’ perspectives on reporting and dealing with serious adverse events

IntroductionIn surgery, serious adverse events have effects on the patient journey, the patient outcome and may constitute a burden to the surgeon involved. This study aims to investigate facilitators and...

Attitudes and self-efficacy towards infection prevention and control and antibiotic stewardship among nurses: A mixed-methods study.

To gain a comprehensive understanding of nurses' infection control practices, antibiotics stewardship attitudes and self-efficacy when caring for patients with multidrug-resistant bacterial infections in a hospital setting. Multidrug-resistant bacteria cause a substantial health burden by complicating infections and prolonging hospital stays. Attitudes and self-efficacy can inform professional behaviour. Nurses' attitudes and self-efficacy concerning multidrug-resistant bacteria, infection prevention and control and antibiotic stewardship are vital in keeping patients safe. A descriptive and convergent mixed-methods design involving quantitative and qualitative approaches was used. Two hundred and seventeen nurses working in clinical practice at seven different hospital wards (i.e., general medicine, surgical, haematological and oncology) at a Norwegian university hospital were invited to participate. Data were collected in February and March 2020 via two questionnaires: the Multidrug-Resistant Bacteria Attitude Questionnaire and the General Perceived Self-Efficacy Scale (n=131) and four focus group interviews (n=22). The data were analysed using descriptive statistics and systematic text condensation. Most nurses showed moderate knowledge, adequate behavioural intentions towards infection prevention and antibiotic stewardship, and high self-efficacy. However, they reported negative emotions towards their knowledge level and negative emotions towards nursing care. The nurses appeared uncertain about their professional influence and role in antibiotic stewardship practices. Organisational and relational challenges and ambivalent perceptions of nurses' role were potential explanations. Nurses report moderate attitudes and high self-efficacy when caring for patients with multidrug-resistant bacterial infections. This study suggests that nurses experience organisational and relational factors in their work environment that challenge their attitudes towards infection prevention and control and antibiotic stewardship practices. Measures that strengthen their knowledge and emotional response underpin correct infection prevention and control behaviour. A role clarification is needed for antibiotic stewardship. No Patient or Public Contribution. Measures to increase attitudes towards infection prevention and control, antibiotic stewardship and multidrug resistance is recommended. Measures should be taken to overcome organisational challenges. A clarification of the nurses' role in antibiotic stewardship is needed.

Return to work during first year after intensive care treatment and the impact of demographic, clinical and psychosocial factors

ObjectivesTo describe work participation in survivors during first year after intensive care unit discharge and examine the impact of selected demographic, clinical and psychosocial factors on return to work 12 months after discharge. Research methodology/DesignA predefined sub-study (prospective cohort study) of a randomised controlled trial. SettingA Norwegian single-centre university hospital. Medical and surgical adult intensive care survivors, working/on sick leave before admission, in the intensive care unit ≥24 h, were included. Main outcome measuresReturn to work three, six and 12 months after discharge, and impact of age, pre-existing comorbidities, previous serious life events, coping ability, hope and social support on return to work 12 months after discharge. ResultsIncluded were 284 patients, with mean age 47 years (SD 13.9) and 47 % women. One year after discharge, 69 % were back at work. In the regression analysis, with working at 12 months (yes/no) as the dependent variable, 178 patients, completing questionnaires at three as well as 12 months, were included. Lower age (OR 0.96, 95 % CI [0.93–0.99]), lower pre-existing comorbidities (OR 0.65, 95 % CI [0.43–0.97]), previous serious life events (OR 6.53, 95 % CI [2.14–19.94]), and greater hope at three months (OR 1.09, 95 % CI [1.01–1.17]) were all independently associated with higher odds of returning to work. ConclusionFollowing intensive care, age, pre-existing comorbidities, experience of previous serious life events and hope all have a significant impact on return to work, and are important variables to consider during intensive care treatment and rehabilitation. Implications for clinical practiceAttention must be paid to patients with prior working capability to ensure return to work after intensive care treatment. Older adults with pre-existing comorbidities might benefit from early, individualised rehabilitation to regain previous working capacity. In addition, there is also a need to support patients’ hope during and after critical illness.

But what do we mean by “health”? A critical perspective on the concept of health in the adolescent transition program of a Norwegian university hospital

BackgroundTo understand better what influences the practice of our transition program, we wanted to explore the underlying theory of health.MethodsWe performed a qualitative content analysis of the written material that guides the program, comprising a quality system guideline, two checklists, a guide to health professionals and managers, and three patient brochures.ResultsThe analysis resulted in the formulation of three themes; “Being on top of medical management”, “Ability to promote own health” and “Awareness of own goals and expectations”.ConclusionOur analysis indicates that the program content revolves mainly around medical management and that other dimensions of health are not emphasised. We question what the goals of the program are and if these goals are explicit and shared among the program stakeholders. An explicit program theory is vital and needs to be evident in material supporting transition programs.

Accuracy of neuropathic pain measurements in patients with symptoms of polyneuropathy: validation of painDETECT, Self-Completed Leeds Assessment of Neuropathic Symptoms and Signs, and Douleur Neuropathique 4.

Pain is a common symptom in patients referred to polyneuropathy assessment. Diagnostic evaluation and choice of treatment may depend on whether the pain is likely to be neuropathic or not. This study aimed to investigate the diagnostic accuracy of 3 tools commonly used to differentiate between neuropathic and nonneuropathic pain. To accomplish this, we included patients with bilateral distal lower extremity pain, referred to neurological outpatient clinics at 5 Norwegian University hospitals for polyneuropathy assessment. The patients filled in Norwegian versions of painDETECT, the Self-Completed Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS), and the clinician-rated Douleur Neuropathique 4 (DN4). All patients underwent a clinical examination and nerve conduction measurements and were classified according to the NeuPSIG neuropathic pain criteria (reference standard). In total, 729 patients were included, of which 63% had neuropathic pain by the reference standard. Only DN4 demonstrated high sensitivity (0.87), whereas all 3 tools had low specificity (≤0.65). Importantly, the tools' predictive ability was unsatisfactory; The probability of getting a correct test result was 3 quarters at best, and at worst, no better than two fifths. Consequently, we show that neither DN4, painDETECT, nor S-LANSS can be confidently used to assess neuropathic pain in a neurological outpatient population with symptoms of polyneuropathy.