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Severe exercise-induced laryngeal obstruction treated with supraglottoplasty
Get PDFIntroduction: Exercise induced laryngeal obstruction (EILO) is relatively common in adolescents, with symptoms often confused with exercise induced asthma. EILO often starts with medial or inward rotation of supraglottic structures of the larynx, whereas glottic adduction appears as a secondary phenomenon in a majority. Therefore, surgical treatment (supraglottoplasty) is used in thoroughly selected and highly motivated patients with pronounced symptoms and severe supraglottic collapse. Aim: To investigate efficacy and safety of laser supraglottoplasty as treatment for severe supraglottic EILO by retrospective chart reviews. Methods: The EILO register at Haukeland University Hospital, Bergen, Norway was used to identify patients who had undergone laser supraglottoplasty for severe supraglottic EILO, verified by continuous laryngoscopy exercise (CLE) test, during 2013-2015. Laser incision in both aryepiglottic folds anterior to the cuneiform tubercles and removal of the mucosa around the top was performed in general anesthesia. Outcomes were questionnaire based self-reported symptoms, and laryngeal obstruction scored according to a defined scheme during a CLE-test performed before and after surgery. Results: Forty-five of 65 eligible patients, mean age 15.9 years, were included. Post-operatively, 38/45 (84%) patients reported less symptoms, whereas CLE-test scores had improved in all, of whom 16/45 (36%) had no signs of obstruction. Most improvements were at the supraglottic level, but 21/45 (47%) also improved at the glottic level. Two of 65 patients had complications; self-limiting vocal fold paresis and scarring/shortening of plica ary-epiglottica. Conclusion: Supraglottoplasty improves symptoms and decreases laryngeal obstruction in patients with severe supraglottic EILO, and appears safe in highly selected cases.Major funding institutions: Haukeland University Hospital and University of Bergen.publishedVersio
Prevalence and persistent use of psychotropic drugs in older adults receiving domiciliary care at baseline
Get PDFBACKGROUND:
Little is known about the use of psychotropic drugs in older adults receiving domiciliary care. The first aim was to describe the prevalence and persistency of use of psychotropic drugs in older adults (≥ 70 years) with and without dementia receiving domiciliary care. Furthermore, the second aim was to explore factors associated with persistent drug use at two consecutive time-points. Lastly, we aimed to examine if use of psychotropic drugs changed after admission to a nursing home.
METHODS:
In total, 1001 community-dwelling older adults receiving domiciliary care at inclusion participated in the study. Information about psychotropic drug use was collected at baseline, after 18 months and after 36 months. The participants' cognitive function, neuropsychiatric symptoms (NPS) and physical health were assessed at the same assessments. Participants were evaluated for dementia based on all gathered information. Formal level of care (domiciliary care or in a nursing home) was registered at the follow-up assessments.
RESULTS:
Prevalence and persistent use of psychotropic drugs in older adults receiving domiciliary care was high. Participants with dementia more often used antipsychotics and antidepressants than participants without dementia. The majority of the participants using antipsychotic drugs used traditional antipsychotics. Younger age was associated with higher odds for persistent use of antipsychotics and antidepressants, and lower odds for persistent use of sedatives. Severity of NPS was associated with persistent use of antidepressants. The odds for use of antipsychotics and antidepressants were higher in those admitted to a nursing home as compared to the community-dwelling participants at the last follow-up.
CONCLUSION:
There was a high prevalence and persistency of use of psychotropic drugs. The prevalence of use of traditional antipsychotics was surprisingly high, which is alarming. Monitoring the effect and adverse effects of psychotropic drugs is an important part of the treatment, and discontinuation should be considered when possible due to the odds for severe adverse effects of such drugs in people with dementia.Data collection was financed by the Norwegian Directorate of Health and Innlandet Hospital trust.publishedVersio
Arti Hurria and the progress in integrating the geriatric assessment into oncology: Young international society of geriatric oncology review paper
No full textDuMontier, C., et al. (2019). "Arti Hurria and the progress in integrating the geriatric assessment into oncology: Young international society of geriatric oncology review paper." J Geriatr Oncol.Abstract
Until recently, the progress in the diagnosis and management of cancer has not been matched by similar progress in the assessment of the increasing numbers of older and more complex patients with cancer. Dr. Arti Hurria identified this gap at the outset of her career, which she dedicated toward studying the geriatric assessment (GA) as an improvement over traditional methods used in oncology to assess vulnerability in older patients with cancer. This review documents the progress of the GA and its integration into oncology. First, we detail the GA's origins in the field of geriatrics. Next, we chronicle the early rise of geriatric oncology, highlighting the calls of early thought-leaders to meet the demands of the rapidly aging cancer population. We describe Dr. Hurria's early efforts toward meeting these calls though the implementation of the GA in oncology research. We then summarize some of the seminal studies constituting the evidence base supporting GA's implementation. Finally, we lay out the evolution of cancer-focused guidelines recommending the GA, concluding with future needs to advance the next steps toward more widespread implementation in routine cancer care. Throughout, we describe Dr. Hurria's vision and its execution in driving progress of the GA in oncology, from her fellowship training to her co-authored guidelines recommending GA for all older adults with cancer-published in the year of her untimely death.acceptedVersio
Outcome after iatrogenic esophageal perforation
Get PDFOBJECTIVES:
Iatrogenic perforations are the most common cause of esophageal perforation. We present our experience mainly based on a non-operative treatment approach as well as long-term outcome in these patients.
MATERIALS AND METHODS:
Twenty-one patients were treated for iatrogenic esophageal perforation at Oslo University Hospital, Ullevål from February 2007 to March 2014. The etiology of perforation was dilation of benign stricture in eight patients, either dilation, stenting or stent removal in four with malignant stenosis, during diagnostic endoscopy in four, removal of foreign body in two and by other causes in three patients, respectively. After median 82 months, 10 patients alive (47.6%) were sent questionnaires about dysphagia, HRQoL and fatigue.
RESULTS:
Median age at time of treatment was 66 years. Median in-hospital stay and mortality were 10.5 days and 4.8%, respectively. Initial treatment in 15 patients (71.4%) was non-surgical of whom one needed delayed debridement for pleural empyema. Initial treatment in six patients (28.6%) was surgical of whom three needed delayed stenting. Altogether 14 patients (66.7%) were stented. Eight (57.1%) had restenting. Median number of stents used was 1 (1-4). The stents were removed after median 36 days. The perforations healed after 2.5 months. After median 82 months, the patients reported reduced HRQoL. There was no significant difference regarding level of dysphagia and fatigue.
CONCLUSIONS:
We report satisfactorily short-term and long-term results of iatrogenic esophageal perforations. Mortality was low and HRQoL was deteriorated. Dysphagia and fatigue were comparable to a reference population.acceptedVersio
Role of telemedicine in multidisciplinary team meetings
Get PDFWe reviewed the role of telemedicine in multidisciplinary team (MDT) meetings, which play an important role in the provision of effective and tailored patient care in diverse clinical settings. This article is based on conducted search in PubMed. Search terms included "telemedicine," "multidisciplinary team," and "(telemedicine) and (multidisciplinary team)." Telemedicine provides an important advantage in the provision of MDT meeting comparing with traditional settings. Those include improved access to and collaboration of medical experts. This resulted in increased levels of medical competence and improved provisions of diagnosis, treatment, and follow-up to patients irrespective of location.Nil.
This review did not receive any specific grant from any funding
agency in the public or commercial.publishedVersio
Fargerikt og grønt - innvandrere og friluftsliv
Get PDFAktiviteter ute i naturen – friluftsliv – hører til norsk kultur. For personer som er nye i Norge kan dette være uvant. Ulike minoritetsgrupper har ulike oppfatninger av fritid, avslapping og rekreasjon. At innvandrere deltar i friluftslivet er en indikator på samfunnsengasjement, integrasjon og samtidig et viktig helsefremmende tiltak. Videre bidrar et sunt friluftsliv til inkludering, og til at Norge oppnår FNs bærekraftsmål knyttet til «god helse» og «mindre ulikhet»
The development and evaluation of TIME - Targeted Interdisciplinary Model for Treatment and Evaluation of Neuropsychiatric Symptoms: An effectiveness-implementation cluster randomised hybrid trial in nursing homes
Get PDFThis thesis describes how the use of TIME, a multicomponent interdisciplinary approach, reduced agitation in residents with dementia living in nursing homes, with a possible reduction in other neuropsychiatric symptoms (NPS) and an improvement in quality of life. It emphasizes that since NPS often represent complex problems with multifactorial causes, multicomponent interventions should allow for adaption and flexibility to various settings to ensure successful implementation. Using TIME, the nursing home staff’s way of learning shifted from a traditional to a more innovative and reflection-based learning process. This seemed to make translating knowledge into action easier. One important causal assumption of the effectiveness of TIME was staff members’ development of a new, shared, and situated knowledge about each individual resident. This new knowledge was created through systematic interdisciplinary group reflection based on principles from cognitive behavioural therapy and led to person-centred treatment actions.acceptedVersio
Effect of antenatal and infant micronutrient supplementation on middle childhood and early adolescent development outcomes in Tanzania
Get PDFBACKGROUND:
There is growing evidence that nutritional interventions in the first 1000 days of life may influence long-term health and development outcomes. Few studies have examined the effect of maternal and infant micronutrient supplementation on development outcomes in sub-Saharan Africa.
METHODS:
We conducted a follow-up study of two randomized trials of antenatal and infant micronutrient supplementation conducted in Dar es Salaam, Tanzania. We assessed the effect of maternal multiple micronutrient (MMN) supplementation in pregnancy on development of children at 11-14 years of age. We also examined the effect of infant zinc and MMN supplementation on development at 6-8 years of age. We used generalized linear models to assess standardized mean differences (SMDs) in general intelligence, executive function, and mental health scores.
RESULTS:
We followed up 446 children whose mothers were enrolled in the maternal MMN supplementation trial and 365 children who were enrolled in the infant zinc and MMN supplementation trial. We found no effect of maternal MMN supplementation on general intelligence (SMD: -0.03; 95% CI: -0.15, 0.09), executive function (SMD: 0.00; 95% CI: -0.11, 0.11), and mental health scores (SMD: 0.06; 95% CI: 10.10, 0.22). We also found no effect of either infant zinc or MMN supplementation on any of the three development domains (p-values > 0.05).
CONCLUSIONS:
We found that antenatal MMN supplementation and infant zinc and MMN supplementation did not have a large effect on development outcomes in middle childhood and early adolescence in Tanzania.The development follow-up study was funded by the Norwegian Research Council Grant number 234495. The
parent randomized trials were funded by the Eunice Kennedy Shriver National Institute of Child Health & Human
Development (NICHD) (R01 37701 and R01 HD048969–01). CPD was supported by K24DK104676 and P30
DK040561.acceptedVersio
A qualitative study of how inter-professional teamwork influences perioperative nursing
Get PDFAbstract Aim: To explore Norwegian operating room nurses’ perceptions of how team skills in the inter-professional operating room team influence perioperative nursing in rela-tion to patient safety. Design: A qualitative, descriptive study based on interviews. Methods: Ten operating room nurses (N = 10) employed in four Norwegian hospi-tals were interviewed individually. A qualitative inductive content analysis was con-ducted. The study was reported adhering to the Consolidated Criteria for Reporting Qualitative Research Checklist. Results: Three generic categories, containing three subcategories each, were identi-fied illuminate the operating room nurses’ perceptions. The operating room team's team skills influence on (a) the quality of perioperative nursing, about task perfor-mance, result for the patient and learning; (b) the progress of perioperative nursing, by keeping focus on the task, being prepared and task distribution and (c) the oper-ating room nurses’ work environment in the operating room, including confidence, stress and energy use and irritation or job satisfaction. KEYWORDS: operating rooms, patient safety, perioperative nursing, TeamSTEPPS®, teamworkThis study was supported by the Norwegian University of Science and Technology in Gjøvik.publishedVersio
Helpful Ingredients in the Treatment of Long-Term Substance Use Disorders: A Collaborative Narrative Study
Get PDFRelatively few individuals with a substance use disorder (SUD) seek or receive treatment, and knowledge about the effective ingredients in SUD treatment, from the perspective of those who receive it, is scarce. Our study purpose was to explore the experiences of those with long-term SUDs and the aspects they found helpful during treatment and long-term recovery. Semi-structured interviews were conducted with 18 participants, each of whom had been diagnosed with a long-term SUD, and who had been abstinent for at least 5 years. A resource group of peer consultants in long-term recovery from SUDs contributed to study planning, preparation, and initial analyses. Participants preferred individualized, long-term treatment, and support from both therapists and other clients. They further acknowledged the importance of their own sense of responsibility for their treatment and recovery success. Greater focus should be placed on viewing long-term SUD as a long-term condition, similar to somatic diseases, and SUD treatment services should place greater emphasis on developing partnership care models, long-term monitoring and support, and actively engaging recovered clients in the care of others in SUD treatment.This study was funded by Innlandet Hospital Trust, Norway.publishedVersio