Helsebibliotekets Research Archive
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Health state values during the first year of drug treatment in early-stage Parkinson's disease: a prospective, population-based, cohort study.
No full textBACKGROUND: Parkinson's disease (PD) is a common neurodegenerative disorder in the elderly that may lead to both motor and non-motor symptoms with consequent severe impairment of quality of life. PD also represents a substantial economic burden on society because of the patient's decreased ability to work, increased need for care and need for costly treatment. Evaluation of quality-adjusted life-years (QALYs) is an important tool in cost-effectiveness analyses. To date, however, few data have become available about the utility gains or losses associated with the disease and its management. OBJECTIVES: To evaluate the changes in health state values in patients with newly diagnosed PD during their first year of drug treatment, and to calculate the gain in QALYs and the incremental cost-effectiveness ratio (ICER) for this patient group. METHODS: In this prospective, population-based, cohort study, 199 patients with incident PD and 172 controls were followed over 1 year. Clinical data, drug use and utility scores obtained from the Short Form 6D (SF-6D) health state questionnaire were documented. RESULTS: Patients with PD had lower SF-6D utility scores than controls at baseline. Patients started on antiparkinsonian drugs had an improvement in mean utility scores of 0.039 from 0.667 to 0.706 (p < 0.05). The ICER was euros 45,259 (2007 values) per QALY, of which two-thirds consisted of the costs of drugs and one-third represented the costs of clinical consultations. CONCLUSION: Drug treatment in patients with early-stage PD increases health state values, but the ICER is high. Further investigations will be necessary to capture the full consequences of treatment of PD and to evaluate the efficacy of disease management in this setting
Translating research into policy: lessons learned from eclampsia treatment and malaria control in three southern African countries
No full textAbstract Background Little is known about the process of knowledge translation in low- and middle-income countries. We studied policymaking processes in Mozambique, South Africa and Zimbabwe to understand the factors affecting the use of research evidence in national policy development, with a particular focus on the findings from randomized control trials (RCTs). We examined two cases: the use of magnesium sulphate (MgSO4) in the treatment of eclampsia in pregnancy (a clinical case); and the use of insecticide treated bed nets and indoor residual household spraying for malaria vector control (a public health case). Methods We used a qualitative case-study methodology to explore the policy making process. We carried out key informants interviews with a range of research and policy stakeholders in each country, reviewed documents and developed timelines of key events. Using an iterative approach, we undertook a thematic analysis of the data. Findings Prior experience of particular interventions, local champions, stakeholders and international networks, and the involvement of researchers in policy development were important in knowledge translation for both case studies. Key differences across the two case studies included the nature of the evidence, with clear evidence of efficacy for MgSO4 and ongoing debate regarding the efficacy of bed nets compared with spraying; local researcher involvement in international evidence production, which was stronger for MgSO4 than for malaria vector control; and a long-standing culture of evidence-based health care within obstetrics. Other differences were the importance of bureaucratic processes for clinical regulatory approval of MgSO4, and regional networks and political interests for malaria control. In contrast to treatment policies for eclampsia, a diverse group of stakeholders with varied interests, differing in their use and interpretation of evidence, was involved in malaria policy decisions in the three countries. Conclusion Translating research knowledge into policy is a complex and context sensitive process. Researchers aiming to enhance knowledge translation need to be aware of factors influencing the demand for different types of research; interact and work closely with key policy stakeholders, networks and local champions; and acknowledge the roles of important interest groups
SUPPORT Tools for evidence-informed health Policymaking (STP) 2: Improving how your organisation supports the use of research evidence to inform policymaking
No full textAbstract This article is part of a series written for people responsible for making decisions about health policies and programmes and for those who support these decision makers. In this article, we address ways of organising efforts to support evidence-informed health policymaking. Efforts to link research to action may include a range of activities related to the production of research that is both highly relevant to – and appropriately synthesised for – policymakers. Such activities may include a mix of efforts used to link research to action, as well as the evaluation of such efforts. Little is known about how best to organise the range of activity options available and, until recently, there have been relatively few organisations responsible for supporting the use of research evidence in developing health policy. We suggest five questions that can help guide considerations of how to improve organisational arrangements to support the use of research evidence to inform health policy decision making. These are: 1. What is the capacity of your organisation to use research evidence to inform decision making? 2. What strategies should be used to ensure collaboration between policymakers, researchers and stakeholders? 3. What strategies should be used to ensure independence as well as the effective management of conflicts of interest? 4. What strategies should be used to ensure the use of systematic and transparent methods for accessing, appraising and using research evidence? 5. What strategies should be used to ensure adequate capacity to employ these methods
Diagnostikk og behandling av spedbarn med mistanke om funksjonsforstyrrelser i øvre nakkeledd
No full textNORSK: Enkelte spedbarn har karakteristiske skjevheter i hode- og nakkeregionen. Tradisjonelt er slik holdningsasymmetri ofte blitt sett i sammenheng med muskulær dysfunksjon. Gjennom de siste tiårene har enkelte fagmiljø begynt å fokusere på ubalanse i de øvre nakkeledd som årsak til holdningsasymmetri, såkalte øvre nakkeleddsinduserte symmetriforstyrrelser. Manuellterapeuter, kiropraktorer og osteopater er blant fagmiljøene som i dag tilbyr behandling av spedbarn som mistenkes å ha øvre nakkeleddsinduserte symmetriforstyrrelser. Behandling kan bestå av spinal manipulasjon, avspennings- og mobiliseringsøvelser, og følges ofte opp hos fysioterapeut som vektlegger å stimulere til symmetri i bevegelsesutviklingen og opptrening av muskelstyrke.\ud
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Kunnskapssenteret har gått systematisk gjennom eksisterende forskningslitteratur for å undersøke nøyaktighet (validitet) ved ulike diagnostiske testmetoder, og for å studere effekt av tiltak som benyttes for å behandle øvre nakkeleddsinduserte symmetriforstyrrelser.\ud
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Resultatene viser at det per i dag ikke finnes en gullstandard eller standardiserte måter å diagnostisere spedbarn hvor det foreligger mistanke om øvre nakkeleddsinduserte symmetriforstyrrelser, men det er identifisert påbegynte prosjekter som kan gi resultater på sikt.\ud
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Det ble identifisert én randomisert kontrollert studie som viser at osteopati muligens kan bidra til å redusere graden av holdningsasymmetri hos spedbarn, men behandlingen så ikke ut til å påvirke barnas humør, gråtevaner, søvnvansker, spiseforstyrrelser eller lignende. Disse konklusjonene er basert på data fra én studie med et begrenset antall deltakere (n=32) og begrenset oppfølgingstid, og dokumentasjonsstyrken er således for lav til å kunne avgjøre om tiltaket har effekt.\ud
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Det ble ikke identifisert dokumentasjon som tyder på at manuellterapeutiske, osteopatiske eller kiropraktiske tiltak mot øvre nakkeleddsinduserte symmetriforstyrrelser hos spedbarn er forbundet med fare, men det presiseres at dokumentasjonsstyrken er svært lav.ENGLISH: -page key messages\ud
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KISS is an acronym for Kinematic Imbalance due to Suboccipital Strain, and a term being used to describe a possible causal relation between imbalance in the upper neck joints in infants and symptoms like postural asymmetry, development of asymmetric motion patterns, hip problems, sleeping and eating disorders. Several academic disciplines (e.g. manual therapist, chiropractors and osteopaths) are currently offering treatment to infants suspected to have KISS, a treatment typically consisting of spinal manipulation of the upper neck joints, relaxing- and mobilisation exercises. Treatment is often followed up by paediatric physiotherapists who stimulate development of a symmetric motion patterns and build muscular strength. \ud
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To make this report, several databases have been systematically searched to reveal research literature evaluating the effectiveness of different techniques used to treat infants with KISS. Databases were also searched for evidence of adverse effects and studies examining the accuracy (validity) of various diagnostic tests.\ud
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At the present there is no gold standard or standardized ways to diagnose infants suspected for KISS, but some commenced projects may provide valuable results in the future.\ud
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We identified one randomized controlled trial showing that osteopathy can potentially reduce the degree of postural asymmetry among infants, but the study did not reveal any changes in vegetative parameters following treatment. It has to be emphasized that these conclusions are based solely on one small study, suggesting that the strength of the evidence is too low to make reliable conclusions about treatment effects. \ud
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We did not find evidence suggesting that the use of manual therapeutic, osteopathic or chiropractic treatment strategies in infants is associated with risk of injuries or harmful side effects, but the level of evidence is very low
Har liggetid i sykehus eller valg av omsorgsnivå for behandling betydning for behandlingskvalitet og ressursbruk for ulike pasientkategorier?
No full textNORSK: Denne kartleggingen viser hva som finnes av en viss type forskning om eventuell effekt for behandlingskvalitet og ressursbruk av liggetid i sykehus og av behandling på ulike omsorgsnivå, på tvers av pasientkategorier. Utredningen ble bestilt av Senter for klinisk dokumentasjon i Helse Nord RHF vinteren 2009.\ud
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Nasjonalt kunnskapssenter for helsetjenesten har gjort et systematisk og omfattende søk i databasene Cochrane Library, Medline og EMBASE for tre forskjellige problemstillinger innen temaet organisering av helsetjenester. Søkene resulterte totalt i 6170 treff. Av disse valgte vi totalt ut 247 referanser i henhold til de fastsatte inklusjonskriteriene, på grunnlag av tittel og sammendrag.\ud
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Vi utformet én søkestrategi for hvert av de tre spørsmålene som ble stilt i bestillingen og de referansene som hvert søk resulterte i ble samlet under hvert spørsmål:\ud
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1. Hva er effekten av liggetider i sykehus for ressursbruk og medisinsk eller pasientopplevd behandlingskvalitet generelt eller ved ulike diagnoser?\ud
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2. Hva er effekten av ulike omsorgsnivåer (dagbehandling versus innleggelse) for ressursbruk og behandlingskvalitet generelt eller ved ulike diagnoser?\ud
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3. Hva er effekten av innleggelse ved sykehus sammenlignet med innleggelse på intermediært nivå for behandlingskvalitet, kostnader eller tilgjengelighet for pasientene for ulike diagnoser eller pasientkategorier? \ud
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Sammendraget av hver enkelt studie er presentert. Vi har ikke vurdert den metodologiske kvaliteten av studiene og derfor har vi heller ikke kunnet ta stilling til om resultatene er troverdige. Vi minner om at det på våre hjemmesider ligger sjekklister for å vurdere kvaliteten av flere typer studiedesign: http://kunnskapssenteret.no/Verktøy/2031.cm
Årsrapport fra persondosimetritjenesten ved Statens strålevern 2007
No full textÅrsrapport fra persondosimetritjenesten ved Statens strålevern for 2007. Rapporten inneholder\ud
dosestatistikk for arbeidstakere som gjennom sitt arbeid blir eksponert for ioniserende stråling.Annual report from the dosimetry service at the Norwegian Radiation Protection Authority.\ud
The report contains dose statistics for occupational exposure from ionizing radiation
Trauma and the acute care surgery model - should it embrace or replace general surgery?
No full textABSTRACT: The specialties dealing with emergency medicine and emergency surgery are in need for a new roadmap. While the medical and surgical management of emergency conditions very often go hand-in-hand, issues relating to emergency and trauma surgery have particular concerns, which are global in magnitude. Obviously, choosing a career dealing (solely) with emergencies and trauma is associated with concerns related to lifestyle issues and, for surgeons, maintenance of adequate operative experience with the increased non-operative management. Also, dealing with patients' whose outcome may be dismal with high associated morbidity and mortality is often not viewed as rewarding. The global flux of medical students away from general surgical training and trauma surgery in particular is an example of how recruitment to specialties dealing with uncomfortable, unpredictable, and "out-of-office-hours" work may be in dire straits. How surgeons around the world will deal with this challenge will likely be diverse and tailored according to the needs of any given region, be it North America, Europe, or Scandinavia. However, refurnishing the training in General Surgery in order to ensure proper care for acute surgical illness and trauma appears mandated in order to keep in line with the centennial words of Halstead that "every important hospital should have on its resident staff of surgeons at least one who is well and able to deal with any emergency that may arise"
High-fidelity DNA polymerase enhances the sensitivity of a peptide nucleic acid clamp PCR assay for K-ras mutations.
No full textSensitive detection of tumor-specific point mutations is of interest in both the early detection of cancer and the monitoring of treatment at a molecular level. Recently, peptide nucleic acid (PNA) clamp real-time PCR has provided a time-sparing and sensitive method for the detection of mutations in the presence of a large excess of wild-type DNA. We present the first report that the sensitivity of PNA clamp PCR is limited by the low fidelity of TaqDNA polymerase. Replication errors introduced by Taq polymerase in the PNA-binding site were amplified during PCR due to the resulting mismatches between PNA and DNA. To reduce the frequency of polymerase-induced errors, we developed a PNA clamp PCR assay for the detection of mutations in codons 12 and 13 of the K-ras gene based on a high-fidelity DNA polymerase. The sensitivity of our assay increased approximately 10-fold, significantly detecting mutant DNA diluted 20,000-fold in wild-type DNA (P = 0.025), compared with its detection at 2000-fold dilution (P = 0.039) when Taq polymerase was used. Our data suggest that the replication errors caused by Taq polymerase must be taken into consideration for PNA clamp PCR and for other methods based on selective PCR amplification, and that these assays can be enhanced by high-fidelity DNA polymerases
The disruptive positions in human G-quadruplex motifs are less polymorphic and more conserved than their neutral counterparts.
No full textSpecific guanine-rich sequence motifs in the human genome have considerable potential to form four-stranded structures known as G-quadruplexes or G4 DNA. The enrichment of these motifs in key chromosomal regions has suggested a functional role for the G-quadruplex structure in genomic regulation. In this work, we have examined the spectrum of nucleotide substitutions in G4 motifs, and related this spectrum to G4 prevalence. Data collected from the large repository of human SNPs indicates that the core feature of G-quadruplex motifs, 5'-GGG-3', exhibits specific mutational patterns that preserve the potential for G4 formation. In particular, we find a genome-wide pattern in which sites that disrupt the guanine triplets are more conserved and less polymorphic than their neutral counterparts. This also holds when considering non-CpG sites only. However, the low level of polymorphisms in guanine tracts is not only confined to G4 motifs. A complete mapping of DNA three-mers at guanine polymorphisms indicated that short guanine tracts are the most under-represented sequence context at polymorphic sites. Furthermore, we provide evidence for a strand bias upstream of human genes. Here, a significantly lower rate of G4-disruptive SNPs on the non-template strand supports a higher relative influence of G4 formation on this strand during transcription
Prediction of driving ability after inconclusive neuropsychological investigation.
No full textOBJECTIVE: The aim of the present study was to investigate the predictive value of neuropsychological tests for on-road evaluation outcome after inconclusive assessment. METHODS AND PROCEDURES: Thirty-five patients were assessed neurologically, neuropsychologically by traditional clinical tests and by on-road evaluation. Simple univariate tests, logistic regression and ROC-curve analysis were used to investigate the predictive power of different neuropsychological tests. MAIN OUTCOMES AND RESULTS: Six measures from the California Computerized Assessment Package (CalCAP) and the Digit-Symbol test from Wechsler Adult Intelligence Scale predicted the outcome of the on-road evaluation. A logistic regression analysis showed that a model with two variables from CalCAP and the Digit Symbol test predicted the results of the on-road driving evaluation with an overall accuracy of 84.8%. CONCLUSIONS: The findings indicate that the outcome of on-road assessment is most related to cognitive skills such as attention and processing speed in combination with cognitive flexibility