Atle Klovning

• Skonnord, Trygve T.; Skjeie, Holgeir; Brekke, Mette; Klovning, Atle; Grotle, Margreth; Aas, Eline; Mdala, Ibrahimu & Fetveit, Arne (2020). Acupuncture for acute non-specific low back pain: a randomised, controlled, multicentre intervention study in general practice—the Acuback study. BMJ Open.  ISSN 2044-6055.  10 . doi: 10.1136/bmjopen-2019-034157 Fulltekst i vitenarkiv.
• Johansen, Inger; Klokkerud, Mari; Anke, Audny; Børke, Janne-Birgitte; Glott, Thomas; Hauglie, Uno; Høyem, Audhild; Klovning, Atle; Lande, Karin Anna; Larsen, Mona; Nordvik, Jan Egil; Wigers, Sigrid Hørven; Øyeflaten, Irene Larsen; Hagen, Kåre Birger & Kjeken, Ingvild (2019). A quality indicator set for use in rehabilitation team care of people with rheumatic and musculoskeletal diseases; Development and pilot testing. BMC Health Services Research.  ISSN 1472-6963.  19 . doi: 10.1186/s12913-019-4091-4 Fulltekst i vitenarkiv.
• Skjeie, Holgeir; Skonnord, Trygve T.; Brekke, Mette; Klovning, Atle; Fetveit, Arne; Landgren, Kajsa; Hallström, Inger Kristensson & Brurberg, Kjetil Gundro (2018). Acupuncture treatments for infantile colic: a systematic review and individual patient data meta-analysis of blinding test validated randomised controlled trials. Scandinavian Journal of Primary Health Care.  ISSN 0281-3432.  36(1), s 56- 69 . doi: 10.1080/02813432.2018.1426146 Fulltekst i vitenarkiv.
• Brænd, Anja Maria; Straand, Jørund & Klovning, Atle (2017). Clinical drug trials in general practice: how well are external validity issues reported?. BMC Family Practice.  ISSN 1471-2296.  18(1) . doi: 10.1186/s12875-017-0680-7
• Brænd, Anja Maria; Straand, Jørund; Jakobsen, Rune Bruhn & Klovning, Atle (2016). Publication and non-publication of drug trial results: A 10-year cohort of trials in Norwegian general practice. BMJ Open.  ISSN 2044-6055.  6(4) . doi: 10.1136/bmjopen-2015-010535 Fulltekst i vitenarkiv. Vis sammendrag

  Objectives Previously, we identified a 10-year cohort of protocols from applications to the Norwegian Medicines Agency 1998–2007, consisting of 196 drug trials in general practice. The aim of this study was to examine whether trial results were published and whether trial funding and conflicts of interest were reported. Design Cohort study of trials with systematic searches for published results. Setting Clinical drug trials in Norwegian general practice. Methods We performed systematic literature searches of MEDLINE, Embase and CENTRAL to identify publications originating from each trial using characteristics such as test drug, comparator and patient groups as search terms. When no publication was identified, we contacted trial sponsors for information regarding trial completion and reference to any publications. Main outcome measures We determined the frequency of publication of trial results and trial characteristics associated with publication of results. Results Of the 196 trials, 5 were never started. Of the remaining 191 trials, 71% had results published in a journal, 11% had results publicly available elsewhere and 18% of trials had no results available. Publication was more common among trials with an active comparator drug (χ2 test, p=0.040), with a larger number of patients (total sample size≥median, p=0.010) and with a longer trial period (duration≥median, p=0.025). Trial funding was reported in 85% of publications and increased over time, as did reporting of conflicts of interest among authors. Among the 134 main journal articles from the trials, 60% presented statistically significant results for the investigational drug, and the conclusion of the article was favourable towards the test drug in 78% of papers. Conclusions We did not identify any journal publication of results for 29% of the general practice drug trials. Trials with an active comparator, larger and longer trials were more likely to be published.

• Skonnord, Trygve T.; Steen, Finn; Skjeie, Holgeir; Fetveit, Arne; Brekke, Mette & Klovning, Atle (2016). Survey Email Scheduling and Monitoring in eRCTs (SESAMe): A Digital Tool to Improve Data Collection in Randomized Controlled Clinical Trials. Journal of Medical Internet Research.  ISSN 1438-8871.  18(11), s e311 . doi: 10.2196/jmir.6560 Fulltekst i vitenarkiv.
• Solberg, Mona; Alræk, Terje; Mdala, Ibrahimu & Klovning, Atle (2016). A pilot study on the use of acupuncture or pelvic floor muscle training for mixed urinary incontinence. Acupuncture in Medicine.  ISSN 0964-5284.  34(1), s 7- 13 . doi: 10.1136/acupmed-2015-010828
• Nyborg, Gunhild; Straand, Jørund; Klovning, Atle & Brekke, Mette (2015). The Norwegian General Practice-Nursing Home criteria (NORGEP-NH) for potentially inappropriate medication use: A web-based Delphi study. Scandinavian Journal of Primary Health Care.  ISSN 0281-3432.  33(2), s 134- 141 . doi: 10.3109/02813432.2015.1041833 Fulltekst i vitenarkiv.
• Pay, Aase Serine Devold; Wiik, Johanna; Backe, Bjørn; Jacobsson, Bo; Strandell, Annika & Klovning, Atle (2015). Symphysis-fundus height measurement to predict small-for-gestational-age status at birth: A systematic review. BMC Pregnancy and Childbirth.  ISSN 1471-2393.  15 . doi: 10.1186/s12884-015-0461-z Fulltekst i vitenarkiv.
• Brænd, Anja Maria Lyche; Jensen, Kaspar Buus; Klovning, Atle & Straand, Jørund (2013). Clinical drug trials in general practice: a 10-year overview of protocols. Trials.  ISSN 1745-6215.  14 . doi: 10.1186/1745-6215-14-162
• Klovning, Atle (2010). Hikke, I: Trygve Fjeldstad (red.),  Norsk legemiddelhåndbok for helsepersonell 2010.  Foreningen for utgivelse av norsk legemiddelhåndbok.  ISBN 9788290732108.  T19.5.  s 541 - 2
• Klovning, Atle (2010). Reise- og bevegelsessyke, I: Trygve Fjeldstad (red.),  Norsk legemiddelhåndbok for helsepersonell 2010.  Foreningen for utgivelse av norsk legemiddelhåndbok.  ISBN 9788290732108.  T19.3.  s 540 - 540
• Klovning, Atle; Avery, Kerry; Sandvik, Hogne & Hunskaar, Steinar (2009). Comparison of Two Questionnaires for Assessing the Severity of Urinary Incontinence: The ICIQ-UI SF Versus the Incontinence Severity Index. Neurourology and Urodynamics.  ISSN 0733-2467.  28(5), s 411- 415 . doi: 10.1002/nau.20674 Vis sammendrag

  Klovning, Atle: Også Centre for Medical Web Research, Oslo./tøf

• Klovning, Atle; Avery, Kerry; Sandvik, Hogne & Hunskår, Steinar (2009). Comparison of two questionnaires for assessing the severity of urinary incontinence: The ICIQ-UI SF versus the incontinence severity index. Neurourology and Urodynamics.  ISSN 0733-2467. . doi: 10.1002/nau.20674
• Klovning, Atle; Sandvik, Hogne & Hunskaar, Steinar (2009). Web-based survey attracted age-biased sample with more severe illness than paper-based survey. Journal of Clinical Epidemiology.  ISSN 0895-4356.  62(10), s 1068- 1074 . doi: 10.1016/j.jclinepi.2008.10.015
• Klovning, Atle; Sandvik, Hogne & Hunskår, Steinar (2009). Web-based survey attracted age-biased sample with more severe illness than paper-based survey. Journal of Clinical Epidemiology.  ISSN 0895-4356. . doi: 10.1016/j.jclinepi.2008.10.015
• Bjordal, Jan Magnus; Klovning, Atle & Slørdal, Lars (2008). Evaluering av medisinsk behandling hva vet vi, og hvordan bør kunnskapen håndteres?. Norsk Epidemiologi.  ISSN 0803-2491.  18(2), s 137- 146
• Bjordal, Jan Magnus; Klovning, Atle & Slørdal, Lars (2008). Evaluering av medisinsk behandling: hva vet vi, og hvordan bør kunnskapen håndteres? How do we evaluate knowledge about therapeutic efficacy?. Norsk Epidemiologi.  ISSN 0803-2491.  18(2), s 137- 146 Vis sammendrag

  Kunnskap om effekten av medisinsk behandling fremskaffes i kliniske studier. Godt planlagte og gjennomførte randomiserte, placebokontrollerte studier tillegges størst vekt når data skal vurderes. De datamengdene vi besitter når det gjelder forskjellige behandlinger kan oppsummeres i oversikter eller terapianbefalinger som ofte blir normative for klinisk praksis. Dette stiller store krav til evalueringsprosedyrene. I denne oversiktsartikkelen diskuteres i innledningen noen eksempler på at kunnskapsgrunnlaget er blitt feiltolket. Deretter omtales kvalitetskriterier som legges til grunn i vurderingen av data, og den metodologiske basis for meta-analyser. Usikkerhetsmomenter og potensielle fallgruver ved bruk av meta-analyser omtales. Meta-analysens fortrinn eksemplifiseres ved bruk av data om behandling av korsryggsmerter, hvor det nylig er utarbeidet kliniske retningslinjer som etter vår oppfatning er beheftet med feil eller mangler. Meta-analysen har vesentlige fortrinn fremfor mindre formaliserte metoder for oppsummering av kunnskap om terapi ved sykdom. Data on the effects of medical therapies are available from clinical studies. Well planned and executed randomised, placebo-controlled studies are given the highest level of evidence when study results are reviewed. The available body of data on different therapies lend themselves to synthesis in clinical overviews or therapy recommendations that regularly achieve status as normative for clinical practice. This warrants caution and rigour as far as the underlying procedures are concerned. The current review encompasses a brief discussion of previous failures of pharmacovigilance, including the thalidomide disaster and the COX-2 debacle. The quality criteria for data evaluation and the methodological basis for meta-analyses are presented. Possible sources of error in meta-analyses, such as different reporting of effects, publication bias, heterogeneity, conflicts of interest and problems with evaluation of side effects, are discussed. The advantages of meta-analysis are exemplified with data on therapy of lower back pain, which recently has been subjected to clinical practice guidelines that, in our view, have several shortcomings. Meta-analyses have significant advantages over less formalised methods for the evaluation of the current state of knowledge of therapeutic alternatives.

• Aarsand, Anne Karin; Alter, D; Frost, SJ; Kaplanis, Bob; Klovning, Atle; Price, Christopher; Sacks, David B.; Sandberg, Sverre; St John, Andrew; Swaminathan, Ramasamyiyer & Winther, William (2007). Diagnosis and Management of Diabetes Mellitus, In James h. Nichols (ed.),  The National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Evidence-Based Practice for Point-of-Care Testing.  AACC Press.  6.
• Bjordal, Jan Magnus; Klovning, Atle; Ljunggren, Anne Elisabeth & Slørdal, Lars (2007). Short-term efficacy of pharmacotherapeutic interventions in osteoarthritic knee pain: A meta-analysis of randomised placebo-controlled trials. European Journal of Pain.  ISSN 1090-3801.  11(2), s 125- 138 . doi: 10.1016/j.ejpain.2006.02.013 Vis sammendrag

  BACKGROUND: Pain is the most debilitating symptom in osteoarthritis of the knee (OAK). AIM AND METHODS: To determine the short-term pain-relieving effects of seven commonly used pharmacological agents for OAK pain by performing a systematic review of randomised placebo-controlled trials. RESULTS: In total, 14,060 patients in 63 trials were evaluated. Opioids and oral NSAIDs therapy in patients with moderate to severe pain (mean baseline 64.3 and 72.8mm on VAS respectively) had maximum efficacies compared to placebo at 2-4 weeks of 10.5mm [95% CI: 7.4-13.7] and 10.2mm [95% CI: 8.8-11.2] respectively. The efficacy of opioids may be inflated by high withdrawal rates (24-50%) and "best-case" scenarios reported in intention-to-treat analyses. In patients with moderate pain scores on VAS (mean range from 51 to 57mm), intra-articular steroid injections and topical NSAIDs had maximum efficacies at 1-3 weeks of 14.5mm [95% CI: 9.7-19.2] and 11.6 mm [95% CI: 7.4-15.7], respectively. Paracetamol, glucosamin sulphate and chondroitin sulphate had maximum mean efficacies at 1-4 weeks of only 4.7mm or lower. Heterogeneity tests revealed that best efficacy values of topical NSAIDs may be slightly deflated, while data for oral NSAIDs may be slightly inflated due to probable patient selection bias. CONCLUSION: Clinical effects from pharmacological interventions in OAK are small and limited to the first 2-3 weeks after start of treatment. The pain-relieving effects over placebo in OAK are smaller than the patient-reported thresholds for relevant improvement.

• Bjordal, Jan Magnus; Klovning, Atle; Ljunggren, Anne Elisabeth & Slørdal, Lars (2007). Short-term efficacy of pharmacotherapeutic interventions in osteoarthritic knee pain: a metaanalysis of randomised placebo-controlled trials. European Journal of Pain.  ISSN 1090-3801.  11(2), s 125- 138
• Bjordal, JM; Klovning, Atle; Ljunggren, Anne Elisabeth & Slørdal, Lars (2007). Short-term efficacy of pharmacotherapeutic interventions in osteoarthritic knee pain: A meta-analysis of randomised placebo-controlled trials. European Journal of Pain.  ISSN 1090-3801.  11(2), s 125- 38 Vis sammendrag

  BACKGROUND: Pain is the most debilitating symptom in osteoarthritis of the knee (OAK). AIM AND METHODS: To determine the short-term pain-relieving effects of seven commonly used pharmacological agents for OAK pain by performing a systematic review of randomised placebo-controlled trials. RESULTS: In total, 14,060 patients in 63 trials were evaluated. Opioids and oral NSAIDs therapy in patients with moderate to severe pain (mean baseline 64.3 and 72.8 mm on VAS respectively) had maximum efficacies compared to placebo at 2-4 weeks of 10.5 mm [95% CI: 7.4-13.7] and 10.2 mm [95% CI: 8.8-11.2] respectively. The efficacy of opioids may be inflated by high withdrawal rates (24-50%) and "best-case" scenarios reported in intention-to-treat analyses. In patients with moderate pain scores on VAS (mean range from 51 to 57 mm), intra-articular steroid injections and topical NSAIDs had maximum efficacies at 1-3 weeks of 14.5mm [95% CI: 9.7-19.2] and 11.6 mm [95% CI: 7.4-15.7], respectively. Paracetamol, glucosamin sulphate and chondroitin sulphate had maximum mean efficacies at 1-4 weeks of only 4.7 mm or lower. Heterogeneity tests revealed that best efficacy values of topical NSAIDs may be slightly deflated, while data for oral NSAIDs may be slightly inflated due to probable patient selection bias. CONCLUSION: Clinical effects from pharmacological interventions in OAK are small and limited to the first 2-3 weeks after start of treatment. The pain-relieving effects over placebo in OAK are smaller than the patient-reported thresholds for relevant improvement.

• Klovning, Atle (2007). Hikke, I: Astri Vilberg (red.),  Norsk legemiddelhåndbok for helsepersonell 2007.  Foreningen for utgivelse av Norsk Legemiddelhåndbok.  ISBN 978-82-90732-09-2.  T19.5.  s 489 - 489
• Klovning, Atle (2007). Reise- og bevegelsessyke, I: Astri Vilberg (red.),  Norsk legemiddelhåndbok for helsepersonell 2007.  Foreningen for utgivelse av Norsk Legemiddelhåndbok.  ISBN 978-82-90732-09-2.  T19.3.  s 487 - 8
• Klovning, Atle & Sandberg, Sverre (2007). Searching the Literature and Relevant databases, In Christopher Price & Robert Christenson (ed.),  Evidence Based Laboratory Medicine: from principles to outcome.  AACC Press.  ISBN 9781594250712.  Ch9.
• Bjordal, Jan Magnus; Lopes-Martins, RA & Klovning, Atle (2006). Is quality control of Cochrane reviews in controversial areas sufficient?. Journal of Alternative and Complementary Medicine.  ISSN 1075-5535.  12(2), s 181- 3 Vis sammendrag

  Conclusions: The results of this CDSR was not robust and seems to be colored by questionable selections or omissions. For alternative pain therapies, it should be considered if lack of expertise oil therapy mechanisms, or conflicts of interests with competing pain drug manufacturers, may bias conclusions. Review groups should recruit a balanced mix of current views and expertise and expand the use of sensitivity analyses to improve quality of CDSRs in areas of controversy.

• Bjordal, Jan Magnus; Lopes-Martins, Rodrigo Álvaro Brandao & Klovning, Atle (2006). Is quality control of Cochrane reviews in controversial areas sufficient?. Journal of Alternative and Complementary Medicine.  ISSN 1075-5535.  12
• Klovning, Atle (2006). Fagutvikling, I: Nina Misvær & Gunnar Oftedal (red.),  Håndbok for helsestasjoner 0-5 år.  Kommuneforlaget.  ISBN 82-446-1239-8.  2.  s 39 - 46
• Bjordal, Jan Magnus; Bogen, Bård Erik; Lopes-Martins, Rodrigo Alvaro Brandao & Klovning, Atle (2005). Can Cochrane Reviews in controversial areas be biased? A Sensitivity analysis based on the protocol of a Systematic Cochrane Review on low-level laser therapy in osteoarthritis. Photomedicine and Laser Surgery.  ISSN 1549-5418.  23(5)
• Bjordal, Jan Magnus; Bogen, B; Lopes-Martins, RA & Klovning, Atle (2005). Can Cochrane Reviews in controversial areas be biased? A sensitivity analysis based on the protocol of a Systematic Cochrane Review on low-level laser therapy in osteoarthritis. Photomedicine and Laser Surgery.  ISSN 1549-5418.  23(5), s 453- 8 Vis sammendrag

  OBJECTIVE: The aim of this study was to test if a conclusion in a systematic review of low-level laser therapy (LLLT) for osteoarthritis from the Cochrane Library was valid and robust. BACKGROUND DATA: Health policy decisions often rely on conclusions from the Cochrane Database of Systematic Reviews for approval of new therapies, although their validity for controversial non-pharmacological treatment has been questioned. METHODS: Validity was tested against a nine-item checklist for systematic reviews. Review selections were analyzed for possible discrepancies between trial and review reports, and omissions of relevant trials and data. Alternative data from discrepancies and omissions were then imputed in a sensitivity analysis, to test if review conclusions were robust. RESULTS: Only clinicians who had performed LLLT trials with negative results were invited into the review group. Review quality was sound in areas of literature search and methodological assessments, and some of the limitations were mentioned. The statistical analysis held 18 questionable selections such as omissions of trials, data, and subgroup analyses. These selections systematically favored the negative review conclusion. Without altering the review protocol, the sensitivity analysis of combined results changed to significantly positive for continuous and categorical data when data from all included trials were combined. Further sensitivity analyses with inclusion of valid non-included trials, performance of missing follow-up, and subgroup analyses revealed consistent and highly significant results in favor of active LLLT. CONCLUSIONS: In this example, the Cochrane review conclusion was neither robust nor valid. Representation of experts and different views on efficacy in the review group and extensive use of sensitivity analyses could probably improve quality control of reviews in areas of controversy

• Bjordal, Jan Magnus; Ljunggren, Anne Elisabeth; Klovning, Atle & Slordal, L (2005). NSAIDs, including coxibs, probably do more harm than good, and paracetamol is ineffective for hip OA.[comment]. Annals of the Rheumatic Diseases.  ISSN 0003-4967.  64(4), s 655- 6
• Bjordal, Jan Magnus; Ljunggren, Anne Elisabeth; Klovning, Atle & Slørdal, Lars (2004). Non-steroidal anti-inflammatory drugs, including cyclo-oxygenase-2 inhibitors, in ostcoarthritic knee pain: meta-analysis of randomised placebo controlled trials. BMJ. British Medical Journal.  ISSN 0959-8146.  329, s 1317- 1320D
• Bjordal, Jan Magnus; Ljunggren, Anne Elisabeth; Klovning, Atle & Slørdal, Lars (2004). Non-steroidal anti-inflammatory drugs, including cyclo-oxygenase-2 inhibitors, in osteoarthritic knee pain: meta-analysis of randomised placebo controlled trials. BMJ. British Medical Journal.  ISSN 0959-8146.  329(7478), s 1317- 1322 Vis sammendrag

  OBJECTIVE: To estimate the analgesic efficacy of non-steroidal anti-inflammatory drugs (NSAIDs), including selective cyclo-oxygenase-2 inhibitors (coxibs), in patients with osteoarthritis of the knee. DESIGN: Systematic review and meta-analysis of randomised placebo controlled trials. STUDIES REVIEWED: 23 trials including 10 845 patients, median age of 62.5 years. 7807 patients received adequate doses of NSAIDs and 3038received placebo. The mean weighted baseline pain score was 64.2 mm on 100 mm visual analogue scale (VAS), and average duration of symptoms was 8.2 years. MAIN OUTCOME MEASURE: Change in overall intensity of pain. RESULTS: Methodological quality of trials was acceptable, but 13 trials excluded patients before randomisation if they did not respond to NSAIDs. One trial provided long term data for pain that showed no significant effect of NSAIDs compared with placebo at one to four years. The pooled difference for pain on visual analogue scale in all included trials was 10.1 mm (95% confidence interval 7.4 to 12.8) or 15.6% better than placebo after 2-13 weeks. Theresults were heterogeneous, and the effect size for pain reduction was 0.32 (0.24 to 0.39) in a random effects model. In 10 trials that did not exclude non-responders to NSAID treatment the results were homogeneous, with an effect size for pain reduction of 0.23 (0.15 to 0.31). CONCLUSION: NSAIDs can reduce short term pain in osteoarthritis of the knee slightly better than placebo, but the current analysis does not supportlong term use of NSAIDs for this condition. As serious adverse effects are associated with oral NSAIDs, only limited use can be recommended

• Klovning, Atle & Sandberg, Sverre (2003). Searching the Literature and Relevant databases, In Christopher P. Price & Robert H. Christenson (ed.),  Evidence Based Laboratory Medicine: from principles to outcomes.  AACC Press.  ISBN 1-890883-90-5.  s 93 - 114
• Klovning, Atle & Lie, Kari Kveim (2002). Fagutvikling, I: Nina Misvær & Gunnar Oftedal (red.),  Håndbok for helsestasjoner 0-5 år.  Kommuneforlaget.  ISBN 82-446-0885-4.  *.
• Klovning, Atle & Norheim, Ole Frithjof (2000). Alendronat også til kvinner uten etablert osteoporose?. Tidsskrift for Den norske legeforening.  ISSN 0029-2001.  120(11), s 1347- 1351
• Klovning, Atle (1999). Evidensbasert håndtering av stafylokokk-hudinfeksjoner i allmennpraksis. Utposten.  ISSN 0800-5680.  (4), s 12- 15
• Klovning, Atle (1999). Finding answers to questions in EBHC. Nordic Newsletter.  3, s 19
• Klovning, Atle (1999). Teaching EBM to medical students. Nordic newsletter on evidence-based health care.  ISSN 0809-5272.  s 4- 5
• Gidske, Gro; Christensen, Nina Gade; Jevnaker, Marianne; Skurtveit, Kristi J; Thue, Geir; Klovning, Atle & Sandberg, Sverre (1998). Resultater fra NOKLUS' utsendelser 1993-97. Tidsskrift for Den norske legeforening.  ISSN 0029-2001.  118, s 1196- 1200
• Klovning, Atle (1998). EBM for medical students at the University of Bergen. Nordic newsletter on evidence-based health care.  ISSN 0809-5272.  2, s 4- 5
• Klovning, Atle (1998). Evidensbasert medisin (EBM): Paradigmeskifte eller bibliotekmetode?. Utposten.  ISSN 0800-5680.  5, s 11- 13
• Klovning, Atle (1998). Evidensbaserte retningslinjer i allmennpraksis- hvilke krav bør stilles til utformingen av retningslinjer?. Utposten.  ISSN 0800-5680.  7-8, s 19- 20
• Klovning, Atle; Hunskår, Steinar & Eriksen, Bjarne Christian (1996). Validity of a scored urological history in detecting detrusor instability in female urinary incontinence. Acta Obstetricia et Gynecologica Scandinavica.  ISSN 0001-6349.  75(10), s 941- 945 Vis sammendrag

  Background. Kauppila and co-workers published in 1982 a detrusor inst ability score (DIS) for women with urinary incontinence. The aim of t his study was to determine the validity of the DIS in an outpatient c linic for urogynaecology. Methods. The DIS questionnaire was incorpor ated as part of an independent history at the first consultation. The DIS was comparedwith clinical diagnosis in 250 patients consecutivel y referred for evaluation. Sensitivity, specificity, positive predict ive value (PPV), negative predictive value (NPV) and overallaccuracy of the DIS in diagnosing genuine stress incontinence (GSI) were calcu lated using the gynaecologist's clinical diagnosis based on urodynami c findings as the gold standard. AnROC- curve was constructed for det ermining the optimum cut-off point for the DIS for women with GSI. Re sults. A cut-off point at 7 for the DIS, yielded sensitivity=0.77, sp ecificity=0.52,PPV=0.74, NPV=0.52 and an overall accuracy=0.68. Optim um cut-off point for GSI according to the ROC-curve was at a DIS-valu e 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 dia gnosed 159 women (64%) as having GSI, 41 of them (16% of 250) having a false positive DIS. Similarly, a c ut-off point at 5 diagnosed 112 women (45%) as having GSI, 20 of them (8% of 250) having a false posi tive DIS. These women, if otherwise feasible and indicated, might per haps undergo continence surgery without preoperative urodynamics. A l ower cut-off point than originally proposed ought therefore to be use d if the DIS is to become a useful preoperative tool fo r this kind o f surgery.

• Sandberg, S.; Christensen, Nina Gade; Jevnaker, Marianne; Thue, Geir & Klovning, Atle (1996). Analysekvalitet av hemoglobin og glukose i almennpraksis. Tidsskrift for Den norske legeforening.  ISSN 0029-2001.  116, s 25- 29
• Sandberg, Sverre; Christensen, Nina Gade; Jevnaker, Marianne; Thue, Geir & Klovning, Atle (1996). Analysekvalitet av hemoglobin og glukose i allmennpraksis. Tidsskrift for Den norske legeforening.  ISSN 0029-2001.  116, s 25- 9
• Klovning, Atle; Hunskår, Steinar; Eriksen, B. C. & Vanvik, A. (1994). Spesialistpoliklinikk for utredning av urininkontinens hos kvinner. Tidsskrift for Den norske legeforening.  ISSN 0029-2001.  114(26), s 3068- 3070
• Sandberg, S.; Christensen, Nina Gade; Jevnaker, Marianne; Thue, Geir & Klovning, Atle (1994). NOKLUS - External quality assurance in Norwegian primary health care. EQAnews.  ISSN 0906-0588.  5, s 3

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• Bjørndal, Arild; Flottorp, Signe & Klovning, Atle (2013). Kunnskapshåndtering i medisin og helsefag. 3. utgave. Gyldendal Akademisk.  ISBN 9788205449893.  194 s.
• Øian, Pål; Blix, Ellen; Hanson, Toril; Huitfeldt, Anette S; Thorsen, Heide; Klovning, Atle; Roland, Brit & Skui, Hanne (2012). Retningslinje for hjemmefødsel. Svangerskap, fødsel og barseltid i trygge hender. IS-2012. Helsedirektoratet.  ISBN 978-82-8081-264-3.  53 s.
• Bjørndal, Arild; Flottorp, Signe & Klovning, Atle (2007). Kunnskapshåndtering i medisin og helsefag. Gyldendal Akademisk.  ISBN 978-82-05-33498-4.  195 s.
• Bjørndal, Arild; Flottorp, Signe & Klovning, Atle (2000). Medisinsk kunnskapshåndtering. Gyldendal Akademisk.  178 s.

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• Eskild, Anne; Klovning, Atle; Swensen, Elisabeth & Salvesen, Kjell Å (2019). Glukosebelastningstesting av de fleste gravide er en dårlig ide. Tidsskrift for Den norske legeforening.  ISSN 0029-2001.  139(2), s 131- 131 . doi: 10.4045/tidsskr.18.0898
• Skonnord, Trygve T.; Skjeie, Holgeir; Brekke, Mette; Klovning, Atle; Grotle, Margreth; Aas, Eline; Mdala, Ibrahimu & Fetveit, Arne (2019). Acupuncture for acute nonspecific low back pain: A randomised, controlled, multicentre intervention study in general practice — the Acuback study.
• Skonnord, Trygve T.; Skjeie, Holgeir; Brekke, Mette; Klovning, Atle; Grotle, Margreth; Aas, Eline; Mdala, Ibrahimu & Fetveit, Arne (2019). The ACUBACK study: Acupuncture for acute non-specific low back pain.
• Skonnord, Trygve T.; Skjeie, Holgeir; Brekke, Mette; Klovning, Atle; Grotle, Margreth; Aas, Eline; Mdala, Ibrahimu & Fetveit, Arne (2019). The ACUBACK study: Acupuncture for acute non-specific low back pain.
• Skonnord, Trygve T.; Skjeie, Holgeir; Brekke, Mette; Grotle, Margreth; Klovning, Atle & Fetveit, Arne (2018). ACUBACK-studien: Akupunktur for akutte korsryggsmerter – en randomisert, kontrollert multisenterstudie i allmennpraksis..
• Skonnord, Trygve T.; Skjeie, Holgeir; Brekke, Mette; Klovning, Atle; Grotle, Margreth & Fetveit, Arne (2018). ACUBACK-studien: Akupunktur for akutte korsryggsmerter – en randomisert, kontrollert multisenterstudie i allmennpraksis..
• Brænd, Anja Maria; Straand, Jørund & Klovning, Atle (2017). Clinical drug trials in general practice: How well are external validity issues reported?.
• Rosvold, Elin Olaug; Straand, Jørund; Ruths, Sabine; Klovning, Atle; Sigurdsson, Johann Agust; Melbye, Hasse & Rørtveit, Guri (2016). Research training in general practice. Experience from the Norwegian Research School in General Practice.
• Skonnord, Trygve T.; Steen, Finn; Fetveit, Arne; Brekke, Mette; Skjeie, Holgeir & Klovning, Atle (2016). Survey Email Scheduling And Monitoring in eRCTs (SESAMe): a digital tool to improve data collection in clinical trials..
• Brænd, Anja Maria; Straand, Jørund & Klovning, Atle (2015). Clinical drug trials in Norwegian general practice: Publication output and missing trial data.
• Nyborg, Gunhild; Straand, Jørund; Klovning, Atle; Klovning, Atle & Brekke, Mette (2015). The Norwegian General Practice Nursing Home criteria (NORGEP-NH) for potentially inappropriate medication use. A web based Delphi study..
• Skonnord, Trygve T.; Steen, Finn; Fetveit, Arne; Brekke, Mette & Klovning, Atle (2015). SESAMe: Opening doors to improved digital data collection, enabling large randomised controlled trials in general practice. An inductive software development process..
• Brænd, Anja Maria; Straand, Jørund & Klovning, Atle (2014). Non-publication of results from clinical drug trials in Norwegian general practice.
• Skonnord, Trygve T.; Steen, Finn & Klovning, Atle (2014). Development of the Survey Email Scheduler (SES) software: A research tool that may improve data collection in clinical trials in general practice.
• Skonnord, Trygve T.; Steen, Finn & Klovning, Atle (2014). Utvikling av Survey Email Scheduler (SES) software; et verktøy som kan forbedre datainnsamlingen i kliniske studier i allmennpraksis.
• Brænd, Anja Maria Lyche; Jensen, Kaspar Buus; Klovning, Atle & Straand, Jørund (2013). Clinical drug trials in Norwegian general practice: a ten-year overview of protocols.
• Skonnord, Trygve T.; Steen, Finn & Klovning, Atle (2013). Development of the Survey Email Scheduler (SES) software; A tool that can improve data collection in clinical trials in general practice.
• Skonnord, Trygve T.; Steen, Finn & Klovning, Atle (2013). Development of the Survey Email Scheduler (SES) software; A tool that can improve data collection in clinical trials in general practice.
• Klovning, Atle (2011). I hvilken grad er behandlingen av urininkontinens evidensbasert?.
• Klovning, Atle (2011). Validations of research methods for urinary incontinence in women. Scored urological questionnaires in clinical practice and epidemiological research.
• Klovning, Atle (2010). Grunnkurs A. Allmennmedisin.
• Klovning, Atle (2010). Grunnkurs D. Forskning i allmennmedisin.
• Klovning, Atle (2010). Grunnkurs D. Forskning i allmennmedisin.
• Klovning, Atle (2010). Hva er god svangerskapsomsorg?.
• Klovning, Atle (2010). Prøveforelesning. I hvilken grad er urininkontinensbehandlingen evidensbasert?.
• Klovning, Atle (2010). Validations of research methodes for urinary incontinence in women. Scored questionnaires in clinical practice and epidemiological research.
• Klovning, Atle (2010). Validations of research methods for urinary incontinence in women. Scored urological questionnaires in clinical practice and epidemiological research.
• Trovik, Ellen-Sofie; Huitfeldt, Anette S & Klovning, Atle (2010). Føderikets Brukerundersøkelse 2010 (fullversjon).
• Trovik, Ellen-Sofie; Huitfeldt, Anette S & Klovning, Atle (2010). Føderikets Brukerundersøkelse 2010 (kortversjon).
• Bjordal, Jan M.; Klovning, Atle & Slørdal, Lars (2008). Delte meninger om legemidler ved ryggsmerter. Tidsskrift for Den norske legeforening.  ISSN 0029-2001.  128(12), s 1423- 1424
• Bjordal, Jan Magnus; Klovning, Atle; Lopes-Martins, RA; Roland, Pål Didrik Hoff; Joensen, Jón & Slørdal, Lars (2008). Overviews and systematic reviews on low back pain. Annals of Internal Medicine.  ISSN 0003-4819.  (10), s 789- 790
• Bjordal, Jan Magnus; Klovning, Atle; Lopes-martins, Rodrigo; Lopes-Martins, Rodrigo Álvaro Brandão; Roland, Pål-Didrik Hoff; Joensen, Jon; Slordal, L & Slørdal, Lars (2008). Overviews and systematic reviews on low back pain. Annals of Internal Medicine.  ISSN 0003-4819.  148(10), s 789- 790
• Bjordal, Jan Magnus; Klovning, Atle & Slørdal, Lars (2008). Delte meninger om legemidler ved ryggsmerter. Tidsskrift for Den norske legeforening.  ISSN 0029-2001.  (128 (12)), s 1423- 1424 Vis sammendrag

  Kommentar til artikkelen: Flere medikamenter har effekt ved ryggsmerter / Erlend Hem. I: Tidsskrift for Den norske legforening. - Årg. 128, nr. 7 (2008). - S. 804

• Roland, Pål-Didrik Hoff; Bjordal, JM; Bjordal, jan Magnus; Klovning, Atle & Slørdal, Lars (2008). P-D. Hoff Roland og medarbeidere svarer. Tidsskrift for Den norske legeforening.  ISSN 0029-2001.  128(6), s 714
• Bjordal, JM; Klovning, Atle; Lopes-martins, Rodrigo; Slørdal, Lars; Joensen, Jon & Roland, Pål-Didrik Hoff (2007). Failing evidence behind first-line medication recommendations. Annals of Internal Medicine.  ISSN 0003-4819.  147, s 478- 91 . doi: http://www.annals.org/cgi/eletters/147/7/478#39478
• Bjordal, JM; Lopes-martins, Rodrigo; Klovning, Atle; Slørdal, Lars & Roland, Pål-Didrik Hoff (2007). Overviews are methodically inferior to systematic reviews and contribute to myths of effective drugs. Annals of Internal Medicine.  ISSN 0003-4819.  147 . doi: http://www.annals.org/cgi/eletters/147/7/505#36904 Vis sammendrag

  In a recent overview encompassing systematic reviews and randomized trials of pharmacotherapy in low back pain (LBP), the authors concluded that there is good evidence that acetaminophen, NSAID and muscle relaxants provide moderate pain relief in acute LBP (1). In another clinical guideline article in the same issue of the Annals (2), the recommended indications for acetaminophen and NSAIDs are extended to include chronic LBP, whereas tramadol, opiods, and benzodiazepines are recommended both in acute and chronic LBP despite the lack of “good” or even “fair” evidence. The methodology used by the authors to review the literature may be flawed in the sense that it merely reiterates what other reviewers have published previously. The current overview does not address crucial differences in focus and protocols of the included reviews, and fails to adequately assess the randomized controlled trials which are the primary sources for information. The criteria list which was used does not imply investigations of the primary sources (RCTs) or the correctness of the trial data cited in the systematic review. The quality assessment method here is inadequate to detect or handle data errors in the review. With multiple data errors, faulty method assessments or misclassification of trials, there is no operationalization of the consequences for method scores. Indeed, some reviewing errors may be grave enough to jeopardize the overreview conclusions completely, but the overview scoring system only opens for a reduction of a single point or two. Misinterpretation of data leads to erroneous conclusions, which in turn may propagate the myth of medication efficacy in LBP. Moreover, the involvement of individuals with industry relations in the making of guidelines is controverisal (3). Indeed, the declaration of conflicts of interest in the form of receiving honoraria from the pharmaceutical industry by principal authors of the clinical guidelines (2) is, in our view, of noteworthy and potentially derogatory significance. (Cont.)

• Roland, Per-Didrik Hoff; Bjordal, Jan Magnus; Klovning, Atle & Slørdal, Lars (2007). Glukosamin - den store sukkerpillebløffen. Tidsskrift for Den norske legeforening.  ISSN 0029-2001.
• Roland, Pål-Didrik Hoff; Bjordal, JM; Klovning, Atle & Slørdal, Lars (2007). Glukosamin - den store sukkerpillebløffen. Tidsskrift for Den norske legeforening.  ISSN 0029-2001.  127(16), s 2121- 2122 . doi: http://www.tidsskriftet.no/pls/lts/pa_lt.visSeksjon?vp_SEKS_ID=1571763
• Roland, Pål-Didrik Hoff; Bjordal, JM; Klovning, Atle & Slørdal, Lars (2007). P.D.H. Roland og medarbeidere svarer:. Tidsskrift for Den norske legeforening.  ISSN 0029-2001.  127(19), s 2556- 2557 . doi: http://www.tidsskriftet.no/pls/lts/PA_LT.VisSeksjon?vp_SEKS_ID=1596259
• Roland, Pål-Didrik Hoff; Bjordal, JM; Klovning, Atle & Slørdal, Lars (2007). P.-D.H. Roland og medarbeidere svarer:. Tidsskrift for Den norske legeforening.  ISSN 0029-2001.  127(22), s 2971 . doi: 1616106[pii]
• Bjordal, Jan Magnus; Ljunggren, Anne Elisabeth; Klovning, Atle & Slørdal, Lars (2006). SBU-rapport om smärtbehandling missvisande om effekt av NSAID. Läkartidningen.  ISSN 0023-7205.  103(44), s e54- e54
• Bjordal, Jan M; Ljunggren, Anne Elisabeth; Klovning, Atle & Slørdal, Lars (2005). NSAIDs, including coxibs, probably do more harm than good, and paracetamol in ineffective for hip OA. Annals of the Rheumatic Diseases.  ISSN 0003-4967.  64, s 655- 656
• Bjordal, Jan Magnus; Ljunggren, Anne Elisabeth; Klovning, Atle & Slordal, Lars (2005). NSAIDs, including coxibs, probably do more harm than good, and paracetamol is ineffective for hip OA. Annals of the Rheumatic Diseases.  ISSN 0003-4967.  64
• Bjordal, Jan Magnus; Ljunggren, Anne Elisabeth; Klovning, Atle; Slørdal, Lars; Bjordal, JM; Ljunggren, AE; Klovning, A & Slordal, L (2005). Managing osteoarthritis of the knee - Conclusions about use of NSAIDs are misleading - Authors' reply. BMJ. British Medical Journal.  ISSN 0959-8146.  330, s 672- 673 . doi: 10.1136/bmj.330.7492.672-c
• Klovning, Atle (red.) (2004). Retningslinjer for svangerskapsomsorgen IS-1179.
• Klovning, Atle (2003). Bokanmeldelse: Scrivener R. Mapping Health on the Internet Strategies for learning in an information age. Tidsskrift for Den norske legeforening.  ISSN 0029-2001.  123, s 360- 361
• Klovning, Atle & Eiring, Øystein (2003). Fire sprøyter årlig hindrer benskjørhet.
• Klovning, Atle; Sandvik, Hogne & Hunskår, Steinar (2003). Web-based epidemiology of urinary incontinence (The WEB-EPI UI study): A comparison of web-collected data with published data from The Norwegian EPINCONT study.
• Holtedahl, Knut; Meland, Eivind & Klovning, Atle (2002). Nye kritiske spørsmål til legemiddelindustrien. Tidsskrift for Den norske legeforening.  ISSN 0029-2001.  122, s 2309
• Klovning, Atle (2002). Nasjonalt senter for legevaktmedisin. Utdanning, FOU og kvalitetssikring med vekt på det faglige innholdet av legevakttjenesten i kommunene. En utredning etter oppdrag og mandat fra Sosial- og helsedepartementet i brev av 20. november 2001, avgitt til Sosial- og helsedirektoratet 20. mai 2002.
• Klovning, Atle & Johnsgård, Marianne Heen (2002, 04. mars). Urinveisplager kartlegges på nettet. Vis sammendrag

  VG FØLGER Helse og medisin Urinveisplager kartlegges på nettet    Av MARIANNE HEEN JOHNSGÅRD (VG Nett) Seksjon for allmennmedisin ved universitetet i Bergen går nye veier for å samle inn informasjon til forskningsprosjekter. Ved hjelp av en nettbasert helseundersøkelse skal norske kvinners urinveisplager nå kartlegges. Tips en venn om denne saken! -Se dagens mest populære tips! Atle Klovning. Foto: SCANPIX   Få nyhetene om Helse og medisin først - abonnér på VG Nett Nyhetsbrev! Trykk her! Ifølge forsker Atle Klovning slår han og kollegaene hans to fluer i en smekk ved å bruke internett til å gjennomføre «Kvinneundersøkelsen 2002»: - Samtidig som vi får samlet inn informasjon om vannlatingsproblemer, får vi også testet ut weben som forskningsmedium, sier Klovning til VG Nett. - Det er lite kunnskap om datainnsamling på nettet, så vi prøver ut forskjellige kanaler. Jo flere kanaler vi får prøvd oss på, jo klarere blir det hvilke nettsteder som er representative for befolkningen, forteller forskeren. - Gjør forskning enklere Dataene som samles inn på nettet, skal sammenlignes med data som tidligere er blitt samlet inn i Nord-Trøndelag. På den måten håper forskerne å få et klarer bilde av hvordan internett fungerer i forhold til tradisjonelle metoder. - Datainnsamling på nettet vil kunne innebære en veldig forenkling i forskningssammenheng. Alt er allerede tastet inn i en database, og man kan begynne rett på databehandlingen, sier Klovning. Forskerne ved seksjon for allmennmedisin er positivt overrasket over responsen siden nettundersøkelsen ble lansert forrige uke: Godt over 100 svar kom inn i løpet av de tre første dagene. - Undersøkelsen vil legge ute et par uker til, avhengig av den videre responsen, sier Klovning til VG Nett. Klikk her hvis du vil delta i undersøkelsen! 300 000 kvinner rammet Det er ikke tilfeldig at nettundersøkelsen fokuserer på urinveisplager. Ifølge Atle Klovning har 300 000 norske kvinner denne typen problemer - en plage som få liker å snakke om: - Dette er et spennende og betydelig allmennmedisinsk problem, som mange opplever som tabubelagt. - Vi ønsker å kartlegge enkle metoder for å bedre situasjonen for disse kvinnene, forteller Klovning, som samarbeider med professor Steinar Hunskår og forsker Hogne Sandvik om dette prosjektet. (VG NETT 04.03.02 kl. 13:17)

• Klovning, Atle (2001). Web-based data collection and processing in international medical research.
• Klovning, Atle (2000). "Evidence-based" kunnskap.
• Klovning, Atle (2000). Helse på web - nye roller for helsepersonell.
• Klovning, Atle (2000). How to perform a literature search in evidence based laboratory medicine.
• Klovning, Atle (2000). Pasientinformasjon: Er det så nøye da? Utfordringer for fag- og folkebibliotek?.
• Klovning, Atle (2000). Villedende veiledning. NettDoktor.no.
• Klovning, Atle (2000). Vinterdepresjoner og lysbehandling (intervju). [TV].
• Kamill, P & Klovning, Atle (1999). Modern drug treatment of chronic asthma. Should opinion based or evidence based guidelines be used in clinical practice? (Letter to the editor). BMJ. British Medical Journal.  ISSN 0959-8146.
• Klovning, Atle (1999). Behandling av urininkontinens. Dagens medisin.  ISSN 1501-4290.  s 28
• Klovning, Atle (1999). Betablokker og hjertesvikt. Dagens medisin.  ISSN 1501-4290.  s 26
• Klovning, Atle (1999). Bokanmeldelse: Greenhalgh, Trisha; Hurwitz, Brian: Narrative based medicine. Dialogue and discourse in clinical practice. Kundeblad fra Studia.
• Klovning, Atle (1999). Bokanmeldelse: Ridsdale, Leone (red.): Evidence-based practice in primary care. Kundeblad fra Studia.
• Klovning, Atle (1999). Bokanmeldelse: Ridsdale, Leone (red.): Evidence-based practice in primary care. Utposten.  ISSN 0800-5680.  (4), s 45
• Klovning, Atle (1999). Hvor alvorlig er urinlekkasjen? Bruk en validert indeks. Dagens medisin.  ISSN 1501-4290.  s 28
• Klovning, Atle (1999). Like bra og billigere med gamle medisiner. Dagens medisin.  ISSN 1501-4290.  s 22- 23
• Klovning, Atle (1999). Re: Two metaanalyses on acute bronchitis/cough with opposite conclusions about antibiotic treatment. BMJ. Electronic response.
• Klovning, Atle (1999). Rutinemessig ultralyd av gravide. Dagens medisin.  ISSN 1501-4290.  s 42- 43
• Klovning, Atle (1999). Syv tiltak som kan bedre folkehelsen. Dagens medisin.  ISSN 1501-4290.  s 23
• Klovning, Atle (1999). Urininkontinens. Dagens medisin.  ISSN 1501-4290.  s 27
• Klovning, Atle (1999). Utilstrekkelig hjertesviktbehandling. Dagens medisin.  ISSN 1501-4290.  s 26- 27
• Klovning, Atle & Bjørndal, A (1999). Dyr forebygging av benskjørhet. Dagens medisin.  ISSN 1501-4290.  s 18- 19
• Klovning, Atle & Bjørndal, A (1999). Ti års effekt av en times intervensjon. Dagens medisin.  ISSN 1501-4290.  s 26
• Klovning, Atle & Norheim, Ole Frithjof (1999). Alendronate and Fracture Prevention (Letter to the Editor). Journal of the American Medical Association (JAMA).  ISSN 0098-7484.  282, s 232
• Klovning, Atle; Sandvik, Hogne & Straand, Jørund (1999). Meningsløst og misvisende om HOT-studien. Tidsskrift for Den norske legeforening.  ISSN 0029-2001.  119, s 407- 407
• Klovning, Atle (1998). Altfor mange retningslinjer. Dagens medisin.  ISSN 1501-4290.  4, s 30- 30
• Klovning, Atle (1998). Aricept har svak dokumentert effekt. Dagens medisin.  ISSN 1501-4290.  1, s 39- 39
• Klovning, Atle (1998). Behandling av artrose. Dagens medisin.  ISSN 1501-4290.  4, s 30- 30
• Klovning, Atle (1998). Diagnostic methods in dyspepsia: the usefulness of upper abdominal ultrasound and gastroscopy. (Letter to the Editor). Scandinavian Journal of Primary Health Care.  ISSN 0281-3432.  16, s 63- 64
• Klovning, Atle (1998). Hjelp til selvhjelp: Bandolier. Dagens medisin.  ISSN 1501-4290.  1, s 40- 40
• Klovning, Atle (1998). What's in a name. On the choice of a Norwegian term for EBM & EBHC. Nordic newsletter on evidence-based health care.  ISSN 0809-5272.  2, s 4- 4
• Klovning, Atle; Sandvik, Hogne & Straand, Jørund (1998). HOT-studien: Kan økt behandlingsintensitet være farlig?. Tidsskrift for Den norske legeforening.  ISSN 0029-2001.  118, s 4405- 4406
• Klovning, Atle; Sandvik, Hogne & Straand, Jørund (1998). "Too HOT" blodtrykksbehandling?. Tidsskrift for Den norske legeforening.  ISSN 0029-2001.  118(19), s 3005- 3005
• Klovning, Atle (1997). Likelihood ratios to determine 'Does this patient have appendicitis?' Comment and clarification. (Letter to the editor). Journal of the American Medical Association (JAMA).  ISSN 0098-7484.  278, s 819- 819

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