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Early trauma-focused cognitive-behavioural therapy to prevent chronic post-traumatic stress disorder and related symptoms. A systematic review and meta-analysis.
No full textABSTRACT: BACKGROUND: Early trauma-focused cognitive-behavioural therapy (TFCBT) holds promise as a preventive intervention for people at risk of developing chronic post-traumatic stress disorder (PTSD). The aim of this review was to provide an updated evaluation of the effectiveness of early TFCBT on the prevention of PTSD in high risk populations. METHODS: We performed a systematic literature search in international electronic databases (MEDLINE, EMBASE, PsycINFO, CENTRAL, CINAHL, ISI and PILOTS) and included randomised controlled trials comparing TFCBT delivered within 3 months of trauma, to alternative interventions. All included studies were critically appraised using a standardised checklist. Two independent reviewers selected studies for inclusion and assessed study quality. Data extraction was performed by one reviewer and controlled by another. Where appropriate, we entered study results into meta-analyses. RESULTS: Seven articles reporting the results of five RCTs were included. All compared TFCBT to supportive counselling (SC). The study population was patients with acute stress disorder (ASD) in four trials, and with a PTSD diagnosis disregarding the duration criterion in the fifth trial. The overall relative risk (RR) for a PTSD diagnosis was 0.56 (95 % CI 0.42 to 0.76), 1.09 (95 % CI 0.46 to 2.61) and 0.73 (95% CI 0.51 to 1.04) at 3-6 months, 9 months and 3-4 years post treatment, respectively. A subgroup analysis of the four ASD studies only resulted in RR = 0.36 (95% CI 0.17 to 0.78) for PTSD at 3-6 months. Anxiety and depression scores were generally lower in the TFCBT groups than in the SC groups. CONCLUSIONS: There is evidence for the effectiveness of TFCBT compared to SC in preventing chronic PTSD in patients with an initial ASD diagnosis. As this evidence originates from one research team replications are necessary to assess generalisability. The evidence about the effectiveness of TFCBT in traumatised populations without an ASD diagnosis is insufficient
Improving the reporting of pragmatic trials: an extension of the CONSORT statement.
No full textBACKGROUND: The CONSORT statement is intended to improve reporting of randomised controlled trials and focuses on minimising the risk of bias (internal validity). The applicability of a trial's results (generalisability or external validity) is also important, particularly for pragmatic trials. A pragmatic trial (a term first used in 1967 by Schwartz and Lellouch) can be broadly defined as a randomised controlled trial whose purpose is to inform decisions about practice. This extension of the CONSORT statement is intended to improve the reporting of such trials and focuses on applicability. Methods At two, two-day meetings held in Toronto in 2005 and 2008, we reviewed the CONSORT statement and its extensions, the literature on pragmatic trials and applicability, and our experiences in conducting pragmatic trials. Recommendations We recommend extending eight CONSORT checklist items for reporting of pragmatic trials: the background, participants, interventions, outcomes, sample size, blinding, participant flow, and generalisability of the findings. These extensions are presented, along with illustrative examples of reporting, and an explanation of each extension. Adherence to these reporting criteria will make it easier for decision makers to judge how applicable the results of randomised controlled trials are to their own conditions. Empirical studies are needed to ascertain the usefulness and comprehensiveness of these CONSORT checklist item extensions. In the meantime we recommend that those who support, conduct, and report pragmatic trials should use this extension of the CONSORT statement to facilitate the use of trial results in decisions about health care
Institutional Policy for Open Access to Scientific Publications
No full textThe Centre’s compliance to open access principles \ud
The Norwegian Knowledge Centre for the Health Services (NOKC) encourages communication and exchange of the research results from our institutional activities, to increase their visibility and impact in the whole scientific community and to enable the development of new standards for research evaluation. This intent is achieved by compliance with the principles of Open Access to research literature and through the most advanced techniques of registration and dissemination of digital data. \ud
The NOKC is a signatory of the Berlin Declaration on open access to scientific knowledge (http://oa.mpg.de/openaccess-berlin/berlin_declaration.pdf) and of the Petition to the European Commission in support of the open and free access to the results of research supported by public funds (http://www.ec-petition.eu/).\ud
Open Access to the research literature can be achieved in two complementary ways: \ud
1) publication in OA journals, and 2) archiving of publications in digital repositories compliant with the OAI-PMH specifications. \ud
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HeRA – Helsebiblioteket’s Research Archive \ud
In compliance with OA principles, Helsebiblioteket.no, drifted by NOKC, has created an online digital repository (http://hera.helsebiblioteket.no/) which functions as the institutional archive for NoKC’s publications, guaranteeing Open Access and long term preservation of research results
Agreement, reliability and validity in 3 shoulder questionnaires in patients with rotator cuff disease.
No full textBACKGROUND: Self-report questionnaires play an important role as outcome measures in shoulder research. Having an estimate of the measurement error of these questionnaires is of importance when assessing follow-up results after treatment and when planning intervention studies. The aim of this study was to cross-culturally adapt the Norwegian version of the OSS and WORC questionnaire and examine and compare agreement, reliability and construct validity of the disease-specific shoulder questionnaire WORC with two commonly used shoulder questionnaires, SPADI and OSS, in patients with rotator cuff disease. METHODS: 74 patients with rotator cuff disease were recruited from the outpatient clinic of the Physical Medicine and Rehabilitation Department at Ullevaal University Hospital in Oslo, Norway. A test-retest design was used, and the questionnaires were filled out by the patients at the clinic, with a one week interval between test administrations. Agreement (repeatability coefficient), reliability (ICC) and construct validity were examined and compared for WORC, SPADI and OSS. RESULTS: Reliability analysis was restricted to the 55 patients (51 +/- 10 yrs) who reported no change between test administrations according to scoring on a global scale. The agreement, reliability and construct validity was moderate for all three questionnaires with ICC ranging from 0.83 to 0.85, repeatability coefficient from 16.1 to 19.7 and Spearman rank correlations between total scores from r = 0.57 to 0.69. There was a lower degree of floor and ceiling effects in SPADI compared to WORC and OSS. CONCLUSION: We conclude that the agreement and reliability of the three shoulder questionnaires examined, WORC index, SPADI and OSS are acceptable and that differences between scores were small. The Norwegian version of the questionnaires is acceptable for assessing Norwegian-speaking patients with rotator cuff disease. The moderate agreement and construct validity should be taken into consideration when assessing follow-up results after treatment and in the planning of prospective studies
Bruk av data fra kunnskapsoppsummeringer til å identifisere forskningsbehov
No full textNotatet er utarbeidet på Kunnskapssentrets initiativ, men i tråd med tilsvarende tiltak\ud
fra andre organisasjoner.\ud
Det oppsummerer de relevante synspunkter og informasjon om fremtidig forskningsbehov\ud
som er avdekket i forbindelse med oppsummeringer av eksisterende\ud
forskning. Notatet omhandler 23 kunnskapsoppsummeringer publisert i 2007
Effekt og sikkerhet av angiotensin reseptorblokkere med og uten diuretika hos pasienter med hypertensjon, hjertesvikt eller diabetisk nefropati
No full textProject 405. Responsible for searching litteratur to the review: Sigrun Espelien Aasen1-PAGE KEY MESSAGES\ud
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Background\ud
Hypertension increases the risk of developing cardiovascular dis-eases, in particular myocardial infarction and stroke. Several types of drugs lower blood pressure and angiotensin receptor blockers (ARB) constitute one drug class. These drugs are also found in combination with thiazide diuretics. This report aimed to compare the different drugs within the ARB class with regard to efficacy and safety in patients with hypertension, heart failure and diabetic nephropathy.\ud
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Method\ud
The report is an overview of systematic reviews. We have examined the effect of ARB on clinical endpoints like death, cardiovascular events (myocardial in-farct, stoke) and end stage renal disease. We performed systematic searches in Cochrane Library, Centre for Reviews and Dissemination databases, Medline (Ovid) and Embase (Ovid).\ud
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Results\ud
We did not identify systematic reviews where drugs within the ARB class were directly compared. Neither did we find systematic reviews in which the combi-nation drugs were compared. This applied to all clinical endpoints and all patient populations examined in this report. Studies that compared the different ARBs with other active drug treatments or with placebo, with use of hard endpoints (death, cardiovascular events, end stage renal failure), are present but few. For most compari-sons with other active treatments significant differences with regard to efficacy have not been reported. Thus these studies could not be used as a basis for trying to undertake an indirect comparison between the different drugs within the ARB class. ARBs appeared to be well tolerated. The adverse events related to the ARBs varied between studies, and there were not sufficient data to determine whether differences existed between the different ARBs concerning specific adverse drug reactions.\ud
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Conclusion\ud
It has not been documented that one or several drugs within the class of ARB are more efficacious or safer than the others in patients with hypertension, heart failure or diabetic nephropathy
”Mens vi venter ….” – forsvarlig pasientbehandling i akuttmottakene? Oppsummering av landsomfattende tilsyn i 2007 med forsvarlighet og kvalitet i akuttmottak i somatisk spesialisthelsetjeneste
No full textNORSK SAMMENDRAG:\ud
Oppsummering av landsomfattende tilsyn i 2007 med forsvarlighet og kvalitet i akuttmottak i somatisk spesialisthelsetjeneste \ud
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Helsetilsynet i fylkene gjennomførte i 2007 tilsyn med forsvarlighet og kvalitet i 28 av landets 54 akuttmottak i somatisk spesialisthelsetjeneste. \ud
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Ledelsen i helseforetaket har ansvar for å sikre at daglige arbeidsoppgaver blir planlagt, organisert, utført og forbedret i samsvar med krav i helselovgivningen. Det er en forutsetning for at mottak, prioritering, undersøkelse, diagnostisering, overvåking og behandling av pasienter i akuttmottak skal være faglig forsvarlig. Hovedmålet med dette landsomfattende tilsynet var å undersøke om og hvordan helseforetakene ivaretar ansvaret sitt. \ud
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Statens helsetilsyn har funnet et totalbilde som viser at mangelfull styring og ledelse preger hverdagen i disse akuttmottakene. I de fleste av akuttmottakene som er omfattet av tilsynet, henger for mye av den daglige driften på at kompetente enkeltpersoner i akuttmottaket ”bretter opp ermene” og strekker seg svært langt for å løse kinkige situasjoner, hverdagskriser og flaskehalsproblematikk. Det synes å være et mønster at ad hoc-løsninger snarere enn systematisk styring redder pressede situasjoner fra å utvikle seg til uønskede hendelser og svikt.SUMMARY IN ENGLISH:\ud
Summary of countrywide supervision in 2007 of accident and emergency units in specialized health services – are services of adequate quality and do they meet legislative requirements?\ud
In 2007 the Norwegian Board of Health Supervision in the Counties carried out supervision of 28 of the 53 accident and emergency units within specialized health services in Norway. The theme of supervision was whether the quality of these services is adequate, and whether these services are provided in accordance with legislative requirements.\ud
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The management of the health trusts have responsibility for ensuring that daily tasks are planned, organized, carried out and improved in accordance with legislative requirements. Reception, prioritization, examination, diagnosis, monitoring and treatment of patients in accident and emergency units shall be in line with sound professional standards. The main aim of supervision of these services was to investigate whether health trusts fulfil their responsibilities, and how they do this.\ud
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The Norwegian Board of Health Supervision has found that, in general, inadequate management and leadership affects the day-to-day running of these services. In most of the accident and emergency units where supervision was carried out, much of the day-to-day activities depended on competent individuals who “rolled up their sleeves” and stretched themselves to the limit to find solutions to problems related to awkward situations, everyday crises and bottlenecks in the system. The general picture seems to be that ad-hoc solutions rather than systematic management prevent stressful situations from developing into adverse events and deficiencies in the services
The human ABC transporter pseudogene family: Evidence for transcription and gene-pseudogene interference.
No full textBACKGROUND: Pseudogenes are an integral component of the human genome. Little attention, however, has so far been paid to the phenomenon that some pseudogenes are transcriptionally active. Recently, we demonstrated that the human ortholog of the rodent testis-specific ATP-binding cassette (ABC) transporter Abca17 is a ubiquitously transcribed pseudogene (ABCA17P). The aim of the present study was to establish a complete inventory of all ABC transporter pseudogenes in the human genome and to identify transcriptionally active ABC transporter pseudogenes. Moreover, we tested the hypothesis that a regulatory interdependency exists between ABC transporter pseudogenes and their parental protein coding equivalents. RESULTS: Systematic bioinformatic analysis revealed the existence of 22 ABC transporter pseudogenes within the human genome. We identified two clusters on chromosomes 15 and 16, respectively, which harbor almost half of all pseudogenes (n = 10). Available information from EST and mRNA databases and RT-PCR expression profiling indicate that a large portion of the ABC transporter pseudogenes (45%, n = 10) are transcriptionally active and some of them are expressed as alternative splice variants. We demonstrate that both pseudogenes of the pseudoxanthoma elasticum gene ABCC6, ABCC6P1 and ABCC6P2, are transcribed. ABCC6P1 and ABCC6 possess near-identical promoter sequences and their tissue-specific expression profiles are strikingly similar raising the possibility that they form a gene-pseudogene dual transcription unit. Intriguingly, targeted knockdown of the transcribed pseudogene ABCC6P1 resulted in a significant reduction of ABCC6 mRNA expression levels. CONCLUSION: The human genome contains a surprisingly small number of ABC transporter pseudogenes relative to other known gene families. They are unevenly distributed across the chromosomes. Importantly, a significant portion of the ABC transporter pseudogenes is transcriptionally active. The downregulation of ABCC6 mRNA levels by targeted suppression of the expression of its pseudogene ABCC6P1 provides evidence, for the first time, for a regulatory interdependence of a transcribed pseudogene and its protein coding counterpart in the human genome