A Group-Based Training Programme for General Practitioners: A Norwegian Experience

Westin S, stensen A I, Lvslett K, Prytz J, Telje J, TelstadW and Lie A. A group-based training programme for general practitioners:a Norwegian experience. Family Practice 1988; 5: 244–252. There are approximately 3000 general practitioners in Norway,serving a population of slightly above four million people.A three year postgraduate education scheme for general practitionershas been in effect since 1973, to be replaced by a five yearvocational training programme from January 1985, making generalpractice a fully recognized specialty from that date. The educationalrequirements consist of one year of hospital training, fouryears of training in general practice, and a total of 400 hoursof course education, mainly in clinical subjects. The core elementof the training is attendance at a group-based structured educationalprogramme of two years' duration. This article describes theconcepts and content of this decentralized group-based education,as well as some of the conflicting considerations which eventuallyled to this new Norwegian model of general practice training.The first evaluation studies indicate that the educational programmehas met a long standing need among general practitioners.     

Estrogen receptor β– an independent prognostic marker in estrogen receptor α and progesterone receptor‐positive breast cancer?

Both subtypes of estrogen receptor (ER), ERα and ERβ, are normally present in the mammary gland. The role of ERα as a prognostic marker in breast cancer is well established due to the beneficial effect of providing tamoxifen as adjuvant therapy. The role of ERβ, however, is less clear. To gain insight into the importance of ERβ in breast cancer, 145 primary breast cancers were examined by immunohistochemistry for ERβ, and the expression level was compared with ERα and progesterone receptor (PR) status. Especially, we wanted to examine the significance of ERβ in the contrasting ERα+/PR+ and ERα?/PR? subgroups. In the ERα+/PR+ subgroup (dual positive), the survival difference between patients with low, medium and high ER β level was statistically significant (p = 0.004), with more than 70% of patients with medium and high ERβ levels surviving 100 months, compared with less than 30% in the group with low ERβ level. Further, for ERα+/PR+ patients there was a reduced risk of fatal outcome by multivariate analysis with increasing ERβ levels (p(trend) < 0.01 [univariate analysis]; p(trend) = 0.05 [multivariate analysis]). The risk was 31% and 27% for medium and high ERβ levels, respectively, compared with low ERβ level, adjusting for standard prognostic factors such as tumor diameter, nuclear tumor grade (quantified by mean nuclear area), lymph node status, and patient age at operation. For patients with ERα?/PR? tumors (dual negative), however, there was no association between ERβ levels and patient outcome. Our findings indicate that ERβ expression provides independent prognostic information for breast cancers with ERα/PR‐positive status, a feature typical among screen‐detected breast cancers. The role of ERβ needs to be further evaluated especially in this group of breast cancers.     

Randomized response estimates for the purchase of smuggled liquor in Norway

The randomized response technique is applied on a voluntary basis for estimating the purchase of smuggled liquor in Norway. Of a total sample of 2330 respondents, aged 15 and over, about one half chose the protective option of the RR-technique. The other half responded directly to the supposed sensitive questions. The estimates from the two groups were weighted together to give population estimates for the percentage of buyers, and the quantities bought, of smuggled liquor. The resulting estimates were found to be considerably higher than estimates from a contemporary survey based on direct response only.     

In vitro study of the giant tubule collagen formation in bovine dentin by [3H]- proline incorporation

Abstract – Unerupted permanent bovine incisors studied by routine autoradiography using radioactive proline incorporation revealed collagen formation within the giant tubules situated in the incisal dentin. A high [³H]-proline labeling was seen within the pulpal vascularized portion of the giant tubules, as well as in association with groups of cells immediately incisal to the blood vessel loops. The incisal portion of the giant tubules showed no or insignificant [³H] -proline labeling.     

Glycolate Causes the Acidosis in Ethylene Glycol Poisoning and is Effectively Removed by Hemodialysis

Abstract Six male patients with severe ethylene glycol poisoning were studied with respect to the origin of the metabolic acidosis. The plasma concentrations of ethylene glycol were 4–41 mmol/l and treatment included alkali, ethanol and hemodialysis. Plasma analysis by isotachophoresis and whole blood lactate determinations showed that glycolate (17.0–29.3 mmol/l), lactate (1.4–6.2 mmol/l) and β-hydroxybutyrate (≤1.8 mmol/l) were present in elevated concentrations contributing to the acidosis. Oxalate (≤0.33 mmol/l), glyoxylate (<0.2 mmol/l) and formate (<0.4 mmol/l) concentrations were negligible and did not contribute to any significant degree to the acidosis. The elevated plasma glycolate concentration was highly correlated to the anion gap (r=0.923) and the glycolate made up for 96.1% (n=6, range 84.7–108.8) of the increased anion gap. We conclude that glycolate accumulation is the main reason for the metabolic acidosis in ethylene glycol poisoning. The mean dialysator (1.6 m²) clearances of glycolate at a blood flow of 200 ml/min in two patients were 137 ml/min (n=9, SD±8, range 125–149) and 144 ml/min (n=11, SD±8, range 133–158). By applying first order kinetics during hemodialysis a volume of distribution of glycolate of 0.55 l/kg was found, assuming that the dialysator clearance equals the total body clearance of glycolate. Thus glycolate, the probable main metabolite of ethylene glycol, is efficiently removed by hemodialysis.     

Fetal Thymus Transplantations in Severe Combined Immunodeficiency

Two brothers with severe combined immunodeficiency were treated with repeated transplantations of fetal thymus tissue. The first patient was not treated until he was critically ill, and the intramuscular transplants had no effect. He died at 11 months of age of overwhelming pneumonia. At postmortem examination a transplanted thymus seemed viable. In the second patient an intramuscular transplant had no effect, but three subsequent intraperitoneal transplants led to transient increase in circulating T lymphocytes with a concomitant fall in B lymphocytes. The results suggested an additive effect of each transplant. However, delayed hypersensitivity skin tests and in vitro mitogen responses were not influenced. Initially, transfer factor was given, and fetal liver was administered intraperitoneally together with the last thymic transplant. Neither of these measures had any observed effect, and this patient, similarly, died of pneumonia at nearly 12 months of age.     

Population-based erythrocyte sedimentation rates in 3910 subjectively healthy Norwegian adults. A statistical study based on men and women from the Oslo area

Objectives. To establish age- and sex-specific reference limits for the erythrocyte sedimentation rate (ESR) in asymptomatic Norwegian adults.
Design. Single ESR recordings were obtained by the classical or a modified Westergren method from 2145 men and 1765 women (93% being blood donors) with age range 20–90 years, and analysed statistically.
Results. There was a significant positive association between ESR level and age, consistent with a parabolic pattern in men but a linear one in women. The mean values for men were about 3 mm h^-1 at 20 years, 6 mm h^-1 at 55 years, and 10 mm h^-1 at 90 years, and 6, 9, and 11 mm h^-1 respectively for women. These averages (predicted by regression lines) were significantly higher in women up to the age of 75 years, after which the estimated sex-specific 95% confidence limits for mean values were found to overlap.
Conclusions. The upper reference levels expected to be exceeded only by chance in 5% of single individual recordings at the ages of 20, 55 or 90 years, respectively, were estimated to be 12, 14 and 19 mm h^-1 for men, and 18, 21 and 23 mm h^-1 for women. Higher values should be controlled and, if confirmed, lead to a clinical check-up. However, about 76% of our overall material had ESR values lower than 9 mm h^-1. Knowledge of each person's baseline ESR value might increase the disease-predictive ability of the test. If several measurements over years reveal a steeper rise with age than depicted in our population-based curves, it should be taken seriously, even when each reading is below the population-based reference limits.     

Power and Temperature Guided Radiofrequency Catheter Ablation of the Right Atrium in Pigs

The aim of the present study was twofold: to assess the safety of ablating the atrial free wall using RF current; and to assess the effect of a single dose of intravenous beparin foUowed by aspirin once daily to prevent tbrombas formation after RF ablation. Temperature and power guided catheter ablation were evaluated. Twenty pigs were randomized to power or temperature guided unipolar RF catheter ablation. Ten animals received a bolus of beparin (150 U/kg) followed by 150-mg aspirin daily. and ten served as controls. A mid-sternal tboracotomy was performed 5–7 days later. the ability of a lesion to resist an increased transmural atrial pressure was examined by inflating a cuff around the palmonal artery. Transmurai lesions were found in all animals. Rigbt atrial pressure was increased from 5 to 30 mmHg witb no sign of perforation. In 11 of 20 (55%) animals, 1–3 lesions were foand in the lungs (diameter 4–18 mm). the localization of these lesions corresponded to the lesions in the atria. there were no differences in the energy delivery modes witb regard to the number of animals witb lung lesions. Lesions witb thrombus formation were found in four animals in the heparin/aspirin group and in nine animals in the control group. The incidence of thrombi was significantly smaller in the treatment group. there were no differences between temperature and power guided catheter ablation witb regard to the size of the atrial lesions or to the incidence of tbrombus formation. Transmural lesions induced in the rigbt atrium by RF energy are resistant to increases in transmural pressure. However, lung tissue overlying the ablated target may be injured by the RF energy delivered. The combination of a single dose intravenous beparin followed by aspirin daily may reduce the incidence of tbrombus formation.