Helsebibliotekets Research Archive
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Multidisciplinary and multifaceted outpatient management of patients with osteoarthritis: protocol for a randomised, controlled trial.
No full textABSTRACT: BACKGROUND: Osteoarthritis (OA) is a prevalent joint disorder with a need for efficient and evidence-based management strategies. OBJECTIVES: The primary purpose of this study is to compare the effects of a multidisciplinary outpatient clinic, including a brief group-based educational programme, with a traditional individual outpatient clinic for patients with hip, knee, hand or generalized OA. A secondary purpose is to investigate the effects of a telephone follow-up call. METHODS: This is a pragmatic randomised single-blind controlled study with a total of 400 patients with hip, knee, hand or generalized OA between 40 and 80 years referred to an outpatient rheumatology hospital clinic. The randomisation is stratified according to the diagnostic subgroups. The experimental group is exposed to a multidisciplinary and multifaceted intervention, including a 3.5 hour group-based patient education programme about OA in addition to individual consultations with members of a multidisciplinary team. The control intervention is based on regular care with an individual outpatient consultation with a rheumatologist (treatment as usual). Primary outcomes are patient satisfaction measured at 4 months and cost-effectiveness measured at 12 months. Secondary outcomes are pain and global disease activity measured on a numeric rating scales (NRS), generic and disease specific functioning and disability using Short Form-36 (SF-36) health survey, the Western Ontario and McMaster Universities Osteoarthritis Index 3 (WOMAC), the Australian/Canadian Osteoarthritis Hand Index (AUSCAN), and a patient-generated measure of disability (Patient-Specific Functional scale, PSFS). Global perceived effect of change in health status during the study period is also reported. At 4-month follow-up, patients in both groups will be randomly allocated to a 10-minute telephone call or no follow-up ("treatment as usual"). After additional 8 months (12-month follow-up) the four groups will be compared in a secondary analysis with regard to health outcomes and health care costs. DISCUSSION: This trial will provide results on how multidisciplinary and multifaceted management of patients with OA affects health outcomes and health care costs. TRIAL REGISTRATION: Current Controlled Trials ISRCTN25778426
Gjennomgang og forbedring av arbeidet med multidose i Larvik kommune
No full textNORSK: Pleie- og omsorgstjenesten i Larvik kommune startet innføring av multidosepakkede legemidler til sine brukere fra 2001. I 2005 var om lag 650 brukere inkludert i multidosesystemet. Fordi man opplevde at man ikke hadde tatt ut hele kvalitetsgevinsten som lå i ordningen, ble det startet et forbedringsprosjekt høsten 2005. \ud
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Helsemyndighetene oppfordrer til økt bruk av multidose som et tiltak for å sikre riktigere legemiddelbruk hos den enkelte bruker. Erfaringene fra Larvik kommune er at det er flere ting som må på plass for at multidose skal være et godt virkemiddel.\ud
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Alle aktører som omsorgstjenesten, fastleger og apotek må delta i utviklingen av multidosesystemet i kommunen. Ved dette bygges gjensidig respekt og tillit som gjør samhandlingen også på andre områder bedre til beste for brukerne.\ud
Jevnlige samhandlingsmøter mellom omsorgstjenesten og fastleger er et nyttig tiltak for å sikre god kommunikasjon og samhandling omkring legemiddelhåndteringen.\ud
Det er viktig at det utarbeides et helhetlig system for legemiddelhåndteringen i kommunen med nedskrevne rutiner for alle deler av prosessen. Aktørene må ha et eierforhold til rutinene. De fungerer ikke dersom det er en opplevelse av at rutinene er bestemt ensidig av andre aktører.\ud
Brukere som er i en ustabil situasjon og hvor det forventes hyppige medikamentendringer bør ikke tas inn i multidosesystemet før situasjonen er mer stabil.\ud
Inn- og utskrivninger bør som regel skje ved drøfting mellom pleie- og omsorgstjenesten og fastlege.\ud
Det er krevende å opprettholde god etterlevelse og stabilt god kvalitet på et så komplekst område som legemiddelhåndtering og multidose. Dette handler bl.a. om mange ulike aktører, utskifting av personell etc. Dette gjør det nødvendig at det utvikles en kultur hvor det er vanlig å melde fra når noe i systemet ikke fungerer som det skal (avviksmeldinger).\ud
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I rapporten beskrives erfaringer som antas å være nyttige for andre kommuner ved innføring og utvikling av multidoseordningen
Comparison of broad range 16S rDNA PCR and conventional blood culture for diagnosis of sepsis in the newborn: a case control study.
No full textBACKGROUND: Early onset bacterial sepsis is a feared complication of the newborn. A large proportion of infants admitted to the Neonatal Intensive Care Unit (NICU) for suspected sepsis receive treatment with potent systemic antibiotics while a diagnostic workup is in progress. The gold standard for detecting bacterial sepsis is blood culture. However, as pathogens in blood cultures are only detected in approximately 25% of patients, the sensitivity of blood culture is suspected to be low. Therefore, the diagnosis of sepsis is often based on the development of clinical signs, in combination with laboratory tests such as a rise in C-reactive protein (CRP). Molecular assays for the detection of bacterial DNA in the blood represent possible new diagnostic tools for early identification of a bacterial cause. METHODS: A broad range 16S rDNA polymerase chain reaction (PCR) without preincubation was compared to conventional diagnostic work up for clinical sepsis, including BACTEC blood culture, for early determination of bacterial sepsis in the newborn. In addition, the relationship between known risk factors, clinical signs, and laboratory parameters considered in clinical sepsis in the newborn were explored. RESULTS: Forty-eight infants with suspected sepsis were included in this study. Thirty-one patients were diagnosed with sepsis, only 6 of these had a positive blood culture. 16S rDNA PCR analysis of blinded blood samples from the 48 infants revealed 10 samples positive for the presence of bacterial DNA. PCR failed to be positive in 2 samples from blood culture positive infants, and was positive in 1 sample where a diagnosis of a non-septic condition was established. Compared to blood culture the diagnosis of bacterial proven sepsis by PCR revealed a 66.7% sensitivity, 87.5% specificity, 95.4% positive and 75% negative predictive value. PCR combined with blood culture revealed bacteria in 35.1% of the patients diagnosed with sepsis. Irritability and feeding difficulties were the clinical signs most often observed in sepsis. CRP increased in the presence of bacterial infection. CONCLUSION: There is a need for PCR as a method to quickly point out the infants with sepsis. However, uncertainty about a bacterial cause of sepsis was not reduced by the PCR result, reflecting that methodological improvements are required in order for DNA detection to replace or supplement traditional blood culture in diagnosis of bacterial sepsis
Ny barriere mot spredning av atomvåpen? IAEAs initiativ til multilateralisering av den kjernefysiske brenselsyklusen
No full textResymé:\ud
Rapporten beskriver et initiativ det internasjonale atomenergibyrået har tatt til å legge til rette for\ud
ekspansjon av kjernekraft i verden samtidig som man begrenser spredningen av sensitiv teknologi\ud
og kunnskap. Rapporten gjennomgår også den kjernefysiske brenselssyklusen.Abstract:\ud
The report describes an initiative taken by the International Atomic Energy Agency to arrange for\ud
expansion of nuclear power in the world and at the same time reduce the risk for proliferation of\ud
sensitive technology and knowledge. The report also describes the nuclear fuel cycle
Dosimetrikontroll med radiokromisk film : resultater og analyse fra 10 stråleterapisentra i Norge
No full textResymé:\ud
I forbindelse med et prosjekt i regi Statens Strålevern ble det foretatt målinger med radiokromisk\ud
film på alle 10 stråleterapisentra i Norge i løpet av høsten 2008 og våren 2009. Denne rapporten\ud
inneholder måleresultatene og analyse fra totalt 19 lineærakseleratorer.Abstract:\ud
As a part of a project at the NRPA measurements were performed using radiochromic film at all\ud
10 radiotherapy centres in Norway during the fall of 2008 and spring of 2009. This report\ud
contains measurement results and analysis from a total of 19 linear accelerators
Consequences in Norway of a hypothetical accident at Sellafield : potential release – transport and fallout
No full textResymé:\ud
Rapporten redegjør for nedfall over Norge fra en tenkt ulykke med atmosfærisk utslipp fra\ud
lagertankene for høyaktivt flytende radioaktivt avfall ved Sellafield-anlegget. Det er valgt å ta\ud
utgangspunkt i en utslippsmengde som svarer til 0,1 til 10 % av den totale mengden flytende\ud
radioaktivt avfall i tankene. Kun transport og nedfall av 137Cs er beregnet i denne studien. Med\ud
utgangspunkt i gitte værforhold viste beregningene at nedfallet over Vestlandet vil være fra en\ud
tiendedel til 10–50 ganger nedfallet i det mest kontaminerte området i Norge etter Tsjernobylulykken.Abstract:\ud
This report focuses on transport and fallout from “worst-case” scenarios based on a hypothetical\ud
accident at the B215 facility for storing Highly Active Liquors (HAL) at Sellafield. The scenarios\ud
involve an atmospheric release of between 0.1–10 % of the total HAL inventory; only transport\ud
and fallout of 137Cs is considered in this case study. Simulations resulted in between 0.1–50 times\ud
the maximum 137Cs fallout experienced in the most contaminated areas in Norway after the\ud
Chernobyl accident
Clinical characteristics of childhood Lyme neuroborreliosis in an endemic area of northern Europe.
No full textNeuroborreliosis may be caused by different species of Borrelia burgdorferi (BB) and the clinical presentation of neuroborreliosis in children may differ between geographical areas due to occurrence of different BB genospecies. The aim of this study was to evaluate the clinical characteristics in children with neuroborreliosis in an endemic area of Scandinavia. During 1996-2006, children with suspected neuroborreliosis referred to Stavanger University Hospital were investigated by a standard procedure including a lumbar puncture. A total of 143 children were diagnosed with neuroborreliosis, and all cases were diagnosed from April to December. The most common clinical presentations were symptoms of mild meningitis (75%) and/or facial nerve palsy (69%). Radicular pain was present in only 10 children. In all but 5 children, laboratory signs of meningitis were present. Erythema migrans preceded the neurological symptoms in only 27% of the children. In conclusion, we have found that in an endemic area of northern Europe, meningitis is present in the majority of children with neuroborreliosis, and that symptoms of a mild meningitis or facial nerve palsy are the most common presentations
The effect of alternative graphical displays used to present the benefits of antibiotics for sore throat on decisions about whether to seek treatment: a randomized trial.
No full textBACKGROUND: We conducted an Internet-based randomized trial comparing four graphical displays of the benefits of antibiotics for people with sore throat who must decide whether to go to the doctor to seek treatment. Our objective was to determine which display resulted in choices most consistent with participants' values. METHODS AND FINDINGS: This was the first of a series of televised trials undertaken in cooperation with the Norwegian Broadcasting Company. We recruited adult volunteers in Norway through a nationally televised weekly health program. Participants went to our Web site and rated the relative importance of the consequences of treatment using visual analogue scales (VAS). They viewed the graphical display (or no information) to which they were randomized and were asked to decide whether to go to the doctor for an antibiotic prescription. We compared four presentations: face icons (happy/sad) or a bar graph showing the proportion of people with symptoms on day three with and without treatment, a bar graph of the average duration of symptoms, and a bar graph of proportion with symptoms on both days three and seven. Before completing the study, all participants were shown all the displays and detailed patient information about the treatment of sore throat and were asked to decide again. We calculated a relative importance score (RIS) by subtracting the VAS scores for the undesirable consequences of antibiotics from the VAS score for the benefit of symptom relief. We used logistic regression to determine the association between participants' RIS and their choice. 1,760 participants completed the study. There were statistically significant differences in the likelihood of choosing to go to the doctor in relation to different values (RIS). Of the four presentations, the bar graph of duration of symptoms resulted in decisions that were most consistent with the more fully informed second decision. Most participants also preferred this presentation (38%) and found it easiest to understand (37%). Participants shown the other three presentations were more likely to decide to go to the doctor based on their first decision than everyone based on the second decision. Participants preferred the graph using faces the least (14.4%). CONCLUSIONS: For decisions about going to the doctor to get antibiotics for sore throat, treatment effects presented by a bar graph showing the duration of symptoms helped people make decisions more consistent with their values than treatment effects presented as graphical displays of proportions of people with sore throat following treatment. CLINICAL TRIALS REGISTRATION: ISRCTN58507086