Publications by authors named "Morten Aarflot"

9 Publications

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Comparison of peer assessment and faculty assessment in an interprofessional simulation-based team training program.

Nurse Educ Pract 2020 Jan 9;42:102666. Epub 2019 Nov 9.

Department of Health and Caring Sciences, Faculty of Health and Social Sciences, Western Norway University of Applied Science, Inndalsveien 28, 5063, Bergen, Norway. Electronic address:

Challenges related to limited clinical sites and shortage of clinical instructors may reduce the quality of clinical experiences, leading to increased demand for the establishment of simulation-based training programs in the curricula of educational institutions. However, simulation-based training programs in health education place great demands on faculty resources. It is interesting, therefore, to investigate peers contributions in formal assessment, and how this compares to faculty assessment. This paper report the results from the comparison of direct observation by peer observers who had received short rater training, and post-hoc video-based assessment by trained facilitators. An observation form with six learning outcomes was used to rate team performance. Altogether 262 postgraduate nursing students, bachelor of nursing students and medical students participated, organized into 44 interprofessional teams. A total of 84 peers and two facilitators rated team performance. The sum score of all six learning outcomes showed that facilitators were more lenient than peer observers (p = .014). The inter-rater reliability varied considerably when comparing scores from peer observers from the three different professions with those of the facilitators. The results indicate that peer assessment may support, but not replace, faculty assessment.
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http://dx.doi.org/10.1016/j.nepr.2019.102666DOI Listing
January 2020

Levonorgestrel-releasing intrauterine system use is associated with a decreased risk of ovarian and endometrial cancer, without increased risk of breast cancer. Results from the NOWAC Study.

Gynecol Oncol 2018 04 2;149(1):127-132. Epub 2018 Mar 2.

Department of Community Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway. Electronic address:

Objective: Women with ovarian cancer have poor survival rates, which have proven difficult to improve; therefore primary prevention is important. The levonorgestrel-releasing intrauterine system (LNG-IUS) prevents endometrial cancer, and recent studies suggested that it may also prevent ovarian cancer, but with a concurrent increased risk of breast cancer. We compared adjusted risks of ovarian, endometrial, and breast cancer in ever users and never users of LNG-IUS.

Methods: Our study cohort consisted of 104,318 women from the Norwegian Women and Cancer Study, 9144 of whom were ever users and 95,174 of whom were never users of LNG-IUS. Exposure information was taken from self-administered questionnaires, and cancer cases were identified through linkage to the Cancer Registry of Norway. Relative risks (RRs) with 95% confidence intervals (CIs) were estimated with Poisson regression using robust error estimates.

Results: Median age at inclusion was 52years and mean follow-up time was 12.5 (standard deviation 3.7) years, for a total of 1,305,435 person-years. Among ever users of LNG-IUS there were 18 cases of epithelial ovarian cancer, 15 cases of endometrial cancer, and 297 cases of breast cancer. When ever users were compared to never users of LNG-IUS, the multivariable RR of ovarian, endometrial, and breast cancer was 0.53 (95% CI: 0.32, 0.88), 0.22 (0.13, 0.40), and 1.03 (0.91, 1.17), respectively.

Conclusion: In this population-based prospective cohort study, ever users of LNG-IUS had a strongly reduced risk of ovarian and endometrial cancer compared to never users, with no increased risk of breast cancer.
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http://dx.doi.org/10.1016/j.ygyno.2018.02.006DOI Listing
April 2018

Lasting impact of an implemented self-management programme for people with type 2 diabetes referred from primary care: a one-group, before-after design.

Scand J Caring Sci 2017 Dec 31;31(4):789-795. Epub 2017 Jan 31.

Department of Nursing, Faculty of Health and Social Sciences, Bergen University College, Bergen, Norway.

Background: Research interventions in uniform clinical settings and in patients fulfilling well-defined inclusion criteria might show a more pronounced effect than implementing the same intervention in existing practice. Diabetes Self-Management Education (DSME) is complex, and should be assessed in existing practice as it is an intervention widely implemented.

Objectives: To examine the impact of an established group-based DSME in unselected people with type 2 diabetes referred from primary care.

Method: A one-group, before-after design was used for assessments before, immediately after, and 3 months after participation in a group-based DSME programme conducted at two Learning and Mastering Centres in Norway between November 2013 and June 2014. Participants completed a questionnaire before (n = 115), immediately after (n = 95) and 3 months after (n = 42) the DSME programme. Primary outcome measure was diabetes knowledge (Michigan Diabetes Knowledge Test). Also patient activation (Patient Activation Measure [PAM]) and self-efficacy (General Self-Efficacy scale [GSE]) were measured. Changes in outcome measures were analysed using paired t-tests for normally distributed data and Wilcoxon signed-rank test for skewed data.

Results: Mean knowledge improved significantly from baseline (p < 0.001). Changes persisted at the 3-month assessment. Mean PAM scores improved significantly from baseline (p < 0.001), and changes persisted for 3 months. Mean GSE scores improved from baseline (p = 0.022) and persisted for 3 months. However, when results were stratified for participants who responded at all three time points, GSE showed no change during the study period.

Conclusion: The complexity self-management in the individual is challenging to reflect in DSME. This implemented DSME programme for people with type 2 diabetes improved levels of diabetes knowledge and patient activation, persisting for at least 3 months. Hence, the DSME programme appears to be robust beyond standardised research settings, in educating unselected diabetes patients referred from primary care.
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http://dx.doi.org/10.1111/scs.12398DOI Listing
December 2017

Learning by viewing versus learning by doing: A comparative study of observer and participant experiences during an interprofessional simulation training.

J Interprof Care 2017 Jan 16;31(1):51-58. Epub 2016 Nov 16.

b Department of Anaesthesia & Intensive Care , Haukeland University Hospital , Bergen , Norway.

Larger student groups and pressure on limited faculty time have raised the question of the learning value of merely observing simulation training in emergency medicine, instead of active team participation. The purpose of this study was to examine observers and hands-on participants' self-reported learning outcomes during simulation-based interprofessional team training regarding non-technical skills. In addition, we compared the learning outcomes for different professions and investigated team performance relative to the number of simulations in which they participated. A concurrent mixed-method design was chosen to evaluate the study, using questionnaires, observations, and focus group interviews. Participants included a total of 262 postgraduate and bachelor nursing students and medical students, organised into 44 interprofessional teams. The quantitative data showed that observers and participants had similar results in three of six predefined learning outcomes. The qualitative data emphasised the importance of participating in different roles, training several times, and training interprofessionally to enhance realism. Observing simulation training can be a valuable learning experience, but the students' preferred hands-on participation and learning by doing. For this reason, one can legitimise the observer role, given the large student groups and limited faculty time, as long as the students are also given some opportunity for hands-on participation in order to become more confident in their professional roles.
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http://dx.doi.org/10.1080/13561820.2016.1233390DOI Listing
January 2017

Simulated settings; powerful arenas for learning patient safety practices and facilitating transference to clinical practice. A mixed method study.

Nurse Educ Pract 2016 Nov 13;21:75-82. Epub 2016 Oct 13.

Department of Anaesthesia & Intensive Care, Haukeland University Hospital, N 5021, Bergen, Norway. Electronic address:

Poor teamwork is an important factor in the occurrence of critical incidents because of a lack of non-technical skills. Team training can be a key to prevent these incidents. The purpose of this study was to explore the experience of nursing and medical students after a simulation-based interprofessional team training (SBITT) course and its impact on professional and patient safety practices, using a concurrent mixed-method design. The participants (n = 262) were organized into 44 interprofessional teams. The results showed that two training sequences the same day improved overall team performance. Making mistakes during SBITT appeared to improve the quality of patient care once the students returned to clinical practice as it made the students more vigilant. Furthermore, the video-assisted oral debriefing provided an opportunity to strengthen interprofessional teamwork and share situational awareness. SBITT gave the students an opportunity to practice clinical reasoning skills and to share professional knowledge. The students conveyed the importance of learning to speak up to ensure safe patient practices. Simulated settings seem to be powerful arenas for learning patient safety practices and facilitating transference of this awareness to clinical practice.
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http://dx.doi.org/10.1016/j.nepr.2016.10.003DOI Listing
November 2016

Diabetes knowledge in nursing homes and home-based care services: a validation study of the Michigan Diabetes Knowledge Test adapted for use among nursing personnel.

BMC Nurs 2016 29;15:40. Epub 2016 Jun 29.

Faculty of Health and Social Sciences, Centre for Evidence-Based Practice, Bergen University College, Post Box 7030, N-5020 Bergen, Norway.

Background: Providing high-quality diabetes care in nursing homes and home-based care facilities requires suitable instruments to evaluate the level of diabetes knowledge among the health-care providers. Thus, the aim of this study was to examine the psychometric properties of the Michigan Diabetes Knowledge Test adapted for use among nursing personnel.

Methods: The study included 127 nursing personnel (32 registered nurses, 69 nursing aides and 26 nursing assistants) at three nursing homes and one home-based care facility in Norway. We examined the reliability and content and construct validity of the Michigan Diabetes Knowledge Test.

Results: The items in both the general diabetes subscale and the insulin-use subscale were considered relevant and appropriate. The instrument showed satisfactory properties for distinguishing between groups. Item response theory-based measurements and item information curves indicate maximum information at average or lower knowledge scores. Internal consistency and the item-total correlations were quite weak, indicating that the Michigan Diabetes Knowledge Test measures a set of items related to various relevant knowledge topics but not necessarily related to each other.

Conclusions: The Michigan Diabetes Knowledge Test measures a broad range of topics relevant to diabetes care. It is an appropriate instrument for identifying individual and distinct needs for diabetes education among nursing personnel. The knowledge gaps identified by the Michigan Diabetes Knowledge Test could also provide useful input for the content of educational activities. However, some revision of the test should be considered.
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http://dx.doi.org/10.1186/s12912-016-0159-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4928289PMC
July 2016

Assessing fear of hypoglycemia in a population-based study among parents of children with type 1 diabetes - psychometric properties of the hypoglycemia fear survey - parent version.

BMC Endocr Disord 2015 Jan 19;15. Epub 2015 Jan 19.

Department of Nursing, Faculty of Health and Social Sciences, Bergen University College, Post Box 7030, N-5020 Bergen, Norway.

Background: In the treatment of childhood type 1 diabetes, being aware of the parents' fear of hypoglycemia is important, since the parents' fear may influence the management of treatment and the children's blood glucose regulation. The availability of proper instruments to assess the parents' fear of hypoglycemia is essential. Thus, the aim of this study was to examine the psychometric properties of the Hypoglycemia Fear Survey - Parent version (HFS-P).

Methods: In a Norwegian population-based sample, 176 parents representing 102 children with type 1 diabetes (6-15 years old) completed the HFS-P, comprising a 15-item worry subscale and a 10-item behavior subscale. We performed exploratory and confirmatory factor analysis and further analysis of the scales' construct validity, content validity and reliability.

Results: The Norwegian version of the HFS-P had an acceptable factor structure and internal consistency for the worry subscale, whereas the structure and internal consistency of the behavior subscale was more questionable. The HFS-P subscales were significantly correlated (from moderately to weakly) with symptoms of emotional distress, as measured by the Hopkins Symptom Checklist - 25 items. The mothers scored higher than fathers on both HFS-P subscales, but the difference was not statistically significant for the worry subscale.

Conclusions: The HFS-P worry subscale seems to be a valid scale for measuring anxiety-provoking aspects of hypoglycemia, and the validity of the HFS-P behavior subscale needs to be investigated further.
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http://dx.doi.org/10.1186/1472-6823-15-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4324848PMC
January 2015

Reliable classification of children's fractures according to the comprehensive classification of long bone fractures by Müller.

Acta Orthop 2013 Apr 18;84(2):207-12. Epub 2012 Dec 18.

Department of Orthopedic Surgery, Stavanger University Hospital, Stavanger, Norway.

Background And Purpose: Guidelines for fracture treatment and evaluation require a valid classification. Classifications especially designed for children are available, but they might lead to reduced accuracy, considering the relative infrequency of childhood fractures in a general orthopedic department. We tested the reliability and accuracy of the Müller classification when used for long bone fractures in children.

Methods: We included all long bone fractures in children aged < 16 years who were treated in 2008 at the surgical ward of Stavanger University Hospital. 20 surgeons recorded 232 fractures. Datasets were generated for intra- and inter-rater analysis, as well as a reference dataset for accuracy calculations. We present proportion of agreement (PA) and kappa (K) statistics.

Results: For intra-rater analysis, overall agreement (κ) was 0.75 (95% CI: 0.68-0.81) and PA was 79%. For inter-rater assessment, K was 0.71 (95% CI: 0.61-0.80) and PA was 77%. Accuracy was estimated: κ = 0.72 (95% CI: 0.64-0.79) and PA = 76%.

Interpretation: The Müller classification (slightly adjusted for pediatric fractures) showed substantial to excellent accuracy among general orthopedic surgeons when applied to long bone fractures in children. However, separate knowledge about the child-specific fracture pattern, the maturity of the bone, and the degree of displacement must be considered when the treatment and the prognosis of the fractures are evaluated.
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http://dx.doi.org/10.3109/17453674.2012.752692DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3639344PMC
April 2013

How reliable and accurate is the AO/OTA comprehensive classification for adult long-bone fractures?

J Trauma Acute Care Surg 2012 Jul;73(1):224-31

Department of Orthopedic Surgery, Stavanger University Hospital, Stavanger, Norway.

Background: Reliable classification of fractures is important for treatment allocation and study comparisons. The overall accuracy of scoring applied to a general population of fractures is little known. This study aimed to investigate the accuracy and reliability of the comprehensive Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association classification for adult long-bone fractures and identify factors associated with poor coding agreement.

Methods: Adults (>16 years) with long-bone fractures coded in a Fracture and Dislocation Registry at the Stavanger University Hospital during the fiscal year 2008 were included. An unblinded reference code dataset was generated for the overall accuracy assessment by two experienced orthopedic trauma surgeons. Blinded analysis of intrarater reliability was performed by rescoring and of interrater reliability by recoding of a randomly selected fracture sample. Proportion of agreement (PA) and kappa (κ) statistics are presented. Uni- and multivariate logistic regression analyses of factors predicting accuracy were performed.

Results: During the study period, 949 fractures were included and coded by 26 surgeons. For the intrarater analysis, overall agreements were κ = 0.67 (95% confidence interval [CI]: 0.64-0.70) and PA 69%. For interrater assessment, κ = 0.67 (95% CI: 0.62-0.72) and PA 69%. The accuracy of surgeons' blinded recoding was κ = 0.68 (95% CI: 0.65- 0.71) and PA 68%. Fracture type, frequency of the fracture, and segment fractured significantly influenced accuracy whereas the coder's experience did not.

Conclusions: Both the reliability and accuracy of the comprehensive Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association classification for long-bone fractures ranged from substantial to excellent. Variations in coding accuracy seem to be related more to the fracture itself than the surgeon.

Level Of Evidence: Diagnostic study, level I.
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http://dx.doi.org/10.1097/TA.0b013e31824cf0abDOI Listing
July 2012
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