Success factors for interventions to reduce low-value imaging. Six crucial lessons learned from a practical case study in Norway.

Background: Substantial overuse of health care services is identified and intensified efforts are incited to reduce low-value services in general and in imaging in particular.

Objective: To report crucial success factors for developing and implementing interventions to reduce specific low-value imaging examinations based on a case study in Norway.

Materials And Methods: Mixed methods design including one systematic review, one scoping review, implementation science, qualitative interviews, content analysis of stakeholders' input, and stakeholder deliberations.

Children had increased risks of impaired motor and visual-motor skills after prenatal exposure to opioid maintenance therapy.

Aim: Preschool children prenatally exposed to opioid maintenance therapy (OMT) have an increased risk of neurodevelopmental impairments. We aimed to investigate long-term motor and visual-motor integration outcome in children aged 5-13 Years, born to mothers in OMT.

Methods: From January 2018 to June 2021, 63 children prenatally exposed to OMT and 63 comparison children matched for age and gender, were examined at two Norwegian hospitals.

Digital breast tomosynthesis in mammographic screening: false negative cancer cases in the To-Be 1 trial.

Objectives: The randomized controlled trial comparing digital breast tomosynthesis and synthetic 2D mammograms (DBT + SM) versus digital mammography (DM) (the To-Be 1 trial), 2016-2017, did not result in higher cancer detection for DBT + SM. We aimed to determine if negative cases prior to interval and consecutive screen-detected cancers from DBT + SM were due to interpretive error.

Methods: Five external breast radiologists performed the individual blinded review of 239 screening examinations (90 true negative, 39 false positive, 19 prior to interval cancer, and 91 prior to consecutive screen-detected cancer) and the informed consensus review of examinations prior to interval and screen-detected cancers (n = 110).

Visual function in Norwegian children aged 5-13 years with prenatal exposure to opioid maintenance therapy: A case-control study.

Purpose: To assess various aspects of visual function in school children prenatally exposed to opioid maintenance therapy (OMT) and to explore possible outcome differences between prenatal methadone and buprenorphine exposure.

Methods: In a cross-sectional case-control study, 63 children aged 5-13 years with prenatal OMT exposure were compared with 63 age- and gender-matched, non-exposed controls regarding important visual parameters, such as visual acuity, orthoptic status, refractive state, colour vision, and visual field.

Results: The OMT-exposed children had significantly poorer visual acuity, both for the best eye, the worst eye and binocularly.

Quality indicators for the referral process from primary to specialised mental health care: an explorative study in accordance with the RAND appropriateness method.

Background: Communication between involved parties is essential to ensure coordinated and safe health care delivery. However, existing literature reveals that the information relayed in the referral process is seen as insufficient by the receivers. It is unknown how this insufficiency affects the quality of care, and valid performance measures to explore it are lacking.

Recommended content of referral letters from general practitioners to specialised mental health care: a qualitative multi-perspective study.

Background: In most Western countries, the referral letter forms the basis for establishing the priority of patients for specialised health care and for the coordination of care between the services. To be able to define the quality of referral letters, the potential impact of the quality on the organisation of care, and to improve the quality of the letters, we need a multidimensional definition of the ideal content. The study's aim was to explore what information is seen as most important and should be included in referral letters from primary care to specialised mental health care to facilitate prioritisation and planning of treatment and follow-up of the patients.

Patient experiences with interventions to reduce surgery cancellations: a qualitative study.

Background: The cancellation of planned surgery harms patients, increases waiting times and wastes scarce health resources. Previous studies have evaluated interventions to reduce cancellations from medical and management perspectives; these have focused on cost, length of stay, improved efficiency, and reduced post-operative complications. In our case a hospital had experienced high cancellation rates and therefore redesigned their pathway for elective surgery to reduce cancelations.

Sustainability of healthcare improvement: what can we learn from learning theory?

Background: Changes that improve the quality of health care should be sustained. Falling back to old, unsatisfactory ways of working is a waste of resources and can in the worst case increase resistance to later initiatives to improve care. Quality improvement relies on changing the clinical system yet factors that influence the sustainability of quality improvements are poorly understood.

A new pathway for elective surgery to reduce cancellation rates.

Background: The cancellation of planned surgeries causes prolonged wait times, harm to patients, and is a waste of scarce resources. To reduce high cancellation rates in a Norwegian general hospital, the pathway for elective surgery was redesigned. The changes included earlier clinical assessment of patients, better planning and documentation systems, and increased involvement of patients in the scheduling of surgeries.

The Western Norway mental health interface study: a controlled intervention trial on referral letters between primary care and specialist mental health care.

Background: Referral letters are the main communication means between Primary and Specialised Mental Health Care. However, studies of referral letters reveal that they lack important information, and how this lack of information affects the care for patients is unknown. This study aims to explore if and to what degree the quality of referral letters within Mental Health Care for adults can be improved and the potential improvement's impact on defined patient, professional and organisational related outcomes.

Improving the quality of palliative care for ambulatory patients with lung cancer.

Problem: Most patients with advanced lung cancer currently receive much of their health care, including chemotherapy, as outpatients. Patients have to deal with the complex and time consuming logistics of ambulatory cancer care. At the same time, members of staff often waste considerable time and energy in organisational aspects of care that could be better used in direct interaction with patients.

Magnetic resonance imaging of patients with increased blood pressure and altered blood pressure response to exercise after coarctation repair.

Objective: Patients successfully operated for coarctation of the aorta are frequently subjected to altered blood pressure (BP) at rest and BP response during exercise. The relationship between these variables and blood flow, peak velocity, restenosis and other morphological features of the thoracic aorta as revealed by magnetic resonance imaging (MRI) was evaluated.

Design: Fifty-one patients subjected to coarctectomy of the aorta were examined by MRI.

[How is the specialist training in radiology?].

Background: On the basis of results from a focus group interview showing that the specialist training in radiology was considered unsatisfactory, we performed a questionnaire survey among residents attending specialist training in Norwegian x-ray departments.

Material And Methods: A questionnaire on background and working and study conditions was mailed to 113 radiology residents.

Results: The response rate was 73%.

Impaired accommodation of the proximal stomach in children with recurrent abdominal pain.

Background: A new ultrasonographic method was applied in children with recurrent abdominal pain, to study accommodation of the proximal stomach to a meal.

Methods: After an overnight fast, 20 patients with recurrent abdominal pain (age, 7-14 years) and 23 healthy control subjects (age, 7-13 years), were scanned by a 5-MHz transducer positioned in the epigastrium, to monitor the size of the proximal stomach before and after a test meal of meat soup.

Results: Children with recurrent abdominal pain had a significantly smaller sagittal area of the proximal stomach at 10 and 20 minutes after the meal than in healthy control subjects (P = 0.

[Radiology--an exciting specialty, unsatisfactory training situation?].

Despite the medical and technological advances during the last decade, there have been problems in attracting new recruits for radiology specialization in Norway. The increasing number of vacancies is a cause for concern. To address this problem, we held interviews with six residents--three males and three females aged between 30 and 39 years.

Reliability of ultrasound in the early diagnosis of developmental dysplasia of the hip.

The purpose of this study was to determine inter- and intra-observer agreement in assessing hip morphology and stability by ultrasound. Three groups of infants, of 206, 74 and 78 newborns respectively, were examined. Morphology was classified into four categories (normal, immature, minor dysplastic and major dysplastic) according to subjective assessment, objective measurement (of the acetabular inclination angle alpha) or a combination of the two.

[Spontaneous esophageal rupture. Differential diagnosis from acute myocardial infarction].

Chest pain is a common cause of hospitalization. Occasionally, chest pain is due to spontaneous perforation of the oesophagus, a dangerous condition that is often misdiagnosed. This case illustrates different aspects of Boerhaave's syndrome.

Ultrasound measurement of the luminal diameter of the abdominal aorta and iliac arteries in patients without vascular disease.

Purpose: The purpose of this study was to establish ultrasonographic criteria for the normal size of the abdominal aorta and iliac arteries in patients without vascular disease.

Methods: The luminal diameters of the proximal and distal abdominal aorta and the common iliac arteries were measured by ultrasonography in 160 patients (15 to 89 years) who were without known vascular disease.

Results: In patients above 50 years of age the distal aorta, which most often is involved in aneurysmatic dilations, measured 16.

[Postrenal acute renal failure with deficient or minimal dilatation of the renal pelvis].

This article presents the clinical and radiological findings in three patients with acute obstructive renal failure. In a setting of typical clinical symptoms of acute postrenal obstruction, the lack of or only minimal ultrasonographic dilatation of the pelvicalyceal system should not lead to the conclusion that there is no obstruction until supplementary invasive procedures have demonstrated open urinary tracts. Minimal pelvic dilatation in acute obstructive renal failure is typically associated with malignant diseases encasing the distal parts of the ureters, retroperitoneal fibrosis, urinary calculi and urinary infections.