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OBJECTIVE: To describe and evaluate organizational issues and handling of feedback reports in the Norwegian external quality assessment scheme (EQAS) for general practice laboratories. METHODS: Postal questionnaire survey including three EQAS feedback reports (one with acceptable analytical quality, one indicating a problem with precision and one indicating bias of the measurement method) to 535 randomly selected general practices. RESULTS: The response rate was 80%. Two-thirds of practices were group practices, and 16% of practices employed a medical technologist. Nearly all practices found the manual for analysing quality control material easy to understand, and samples seemed to be handled as part of routine laboratory work. Feedback reports were primarily studied by those responsible for laboratory work in the practice, and only in 60% of practices by doctors. Practice routines for follow-up of deviant results in the EQAS seemed to have been established. Internal quality control was performed in 90% of group practices and in 71% of solo practices. Concerning responses to feedback reports, there seemed to be a substantial need for assistance even for less deviant results, although most actions suggested by the practices were adequate. On the other hand, assistance was not always sought for "critical" problems. CONCLUSIONS: EQAS is feasible in primary care, but instructions must be clear and conclusions in the feedback reports made very explicit. Easy-to-reach assistance from medical technologists with expertise in general practice laboratory instruments and routines seems paramount.

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The Norwegian centre for external quality assurance of primary health care laboratories (Norwegian abbreviation: NOKLUS) was established in 1992. In 1997 about 1,800 practices participated in NOKLUS' quality assurance schemes, and 576 of these participated in the PT survey. Participation is voluntary and free of charge. The interlaboratory variation (CV%) was 17.7% in 1993 and 13.3% in 1997, and the percentage of results classified as "poor" has decreased from 7-8% in 1993 to 4% in 1997. These data indicate that participation in the scheme has led to a widespread improvement in laboratory performance. Norwegian primary health care practices now seem to analyse PT just as accurately as the Norwegian hospital laboratories. Logistic regression showed that the two most important factors for ensuring quality analysis were having a medical laboratory technician perform the PT analyses, and using an analyzer rather than a manual procedure.

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BACKGROUND: Kauppila and co-workers published in 1982 a detrusor instability score (DIS) for women with urinary incontinence. The aim of this study was to determine the validity of the DIS in an outpatient clinic for urogynecology. METHODS: The DIS questionnaire was incorporated as part of an independent history at the first consultation. The DIS was compared with clinical diagnosis in 250 patients consecutively referred for evaluation. Sensitivity, specificity. positive predictive value (PPV), negative predictive value (NPV) and overall accuracy of the DIS in diagnosing genuine stress incontinence (GSI) were calculated using the gynecologist's clinical diagnosis based on urodynamic findings as the gold standard. An ROC-curve was constructed for determining the optimum cut-off point for the DIS for women with GSI. RESULTS: A cut-off point at 7 for the DIS, yielded sensitivity = 0.77, specificity = 0.52, PPV = 0.74, NPV = 0.52 and an overall accuracy = 0.68. Optimum cut-off point for GSI according to the ROC-curve was at a DIS-value of 5, yielding sensitivity = 0.60, specificity = 0.77, PPV = 0.82, NPV = 0.52 and overall accuracy = 0.66. CONCLUSIONS: A cut-off point at 7 diagnosed 159 women (64%) as having GSI, 41 of them (16% of 250) having a false positive DIS. Similarly, a cut-off point at 5 diagnosed 112 women (45%) as having GSI, 20 of them (8% of 250) having a false positive DIS. These women, if otherwise feasible and indicated, might perhaps undergo continence surgery without preoperative urodynamics. A lower cut-off point than originally proposed ought therefore to be used if the DIS is to become a useful preoperative tool for this kind of surgery.

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In 1992 the Norwegian health authorities and the Norwegian Medical Association initiated a joint project to secure the quality of laboratory analyses performed in primary health care. Two coordinated activities were established: in each of the 19 Norwegian counties a medical laboratory adviser was engaged, linked to the central clinical chemistry laboratory in that county. These advisers assist general practitioners and primary care specialists in securing the quality of laboratory procedures performed on their own premises. In addition, a Norwegian centre for external quality assurance in primary care (Norwegian abbreviation NOKLUS) was established. In 1994 NOKLUS had about 1,600 participants (comprising 95% of the relevant general and specialist practices). Tolerated limits are based on target intervals combined with a percentage tolerated deviation. Fresh material is used for haemoglobin, and target values are determined by two independent laboratories using the reference method. The article describes the results of the surveys of glucose and haemoglobin tests in 1994.

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This article describes the findings in 228 women with urinary incontinence consecutively referred to the outpatient clinic at the University Hospital in Trondheim. A urotherapist used a structured questionnaire to record the history and also gathered other relevant information, prior to the examination by the specialist in urogynaecology. The mean age (+/- SEM) was 49 years (+/- 1), and 96 women (42%) had been incontinent for more than ten years. Urodynamic investigations revealed stress incontinence in 58%, sensory urgency in 19%, motor urgency in 17%, and positive urethral closing pressure in 21%. Normal cystometry was found in 55% of the women. The urogynaecologist's clinical diagnosis was pure stress incontinence in 45%, pure urgency in 21% and mixed incontinence in 32%. Using a severity index, we found that 7% had mild, 25% moderate, and 68% severe urinary incontinence. General practitioners seem to refer fewer old women than we consider to be appropriate. GPs themselves should handle the primary investigations and conservative measures for the majority of their patients with urinary incontinence. Specialist services should on the other hand take care of the doubtful cases and of patients where non-surgical and simple therapeutic management has failed to achieve a cure.

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