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- Muller-Lissner, S A, et al.
(författare)
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Interobserver agreement in defecography--an international study
- 1998
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Ingår i: Zeitschrift für Gastroenterologie. - 0044-2771. ; 36:4, s. 273-279
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Defecography is considered to be an essential investigation in the evaluation of functional anorectal disorders, but the agreement between observers from different clinical centers has never been evaluated. METHODS: 14 defecographic studies were selected aimed to cover the most relevant defecographic findings responsible for disordered defecation. Eight studies were considered unequivocal, but six were thought to be controversial. All were sent to the ten participants in Europe and the US (five proctosurgeons, three radiologists, two gastroenterologists). They evaluated the studies using a previously agreed upon questionnaire. Interobserver agreement was quantified by kappa statistics and by the proportions of positive and negative agreement as compared to chance agreement, respectively. RESULTS: Overall, only the completeness of rectal emptying and the presence of a rectocele achieved acceptable kappa values above 0.4. When restricting the evaluation to the studies considered to be unequivocal, agreement improved considerably and was moderate to good for all items describing the images (kappa 0.43-0.63). However, whether proctosurgery should be performed and whether defecography contributed to the management of the particular patient remained controversial with very low kappa. CONCLUSIONS: It is doubtful whether defecography contributes substantially to the management of patients with disordered defecation.
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- Saarento, O, et al.
(författare)
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The Nordic comparative study on sectorised psychiatry : repeated emergency admissions to inpatient care during a 1-year follow-up.
- 1998
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Ingår i: European psychiatry. - 0924-9338 .- 1778-3585. ; 13:8, s. 385-91
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Tidskriftsartikel (refereegranskat)abstract
- The emergency admissions to hospital care in six psychiatric services in four Nordic countries were explored as a part of a Nordic comparative study on sectorised psychiatry. One year treated incidence cohorts were used, with the total cohort comprising 2,454 patients. Of the 803 patients who were admitted to inpatient care during a 1-year follow-up, 82% had at least one emergency admission and 23% repeated emergency admissions. The definition for the repeated emergency admissions was at least two admissions during the follow-up. The mean length of stay in emergency inpatient care per treatment episode for this patient subgroup was 28 days. Their emergency inpatient episodes constituted 30% of all inpatient days during the follow-up. However, the variations between the services and diagnostic subgroups were large. The results of a logistic regression analysis indicated that the following variables predicted repeated emergency admissions: inpatient care at index contact, emergency outpatient contacts or no planned hospital admissions during the follow-up, psychiatric service, age under 45 years, and a diagnosis of psychosis, personality disorder or dependency. The repeated emergency admissions were related to the existence of a special service unit for abusers but not to the rates of outpatient staff or acute beds in the services, to geographical distances, referral practice or existence of emergency services.
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- Wagstaff, A, et al.
(författare)
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Equity in the finance of health care: some further international comparisons
- 1999
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Ingår i: JOURNAL OF HEALTH ECONOMICS. - : ELSEVIER SCIENCE BV. ; 18:3
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- This paper presents further international comparisons of progressivity of health care financing systems. The paper builds on the work of Wagstaff et al, [Wagstaff, A., van Doorslaer E,, et al., 1992. Equity in the finance of health care: some internation
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