Institutt for klinisk medisin

Growing up with chronic arthritis: the confusing matter of classification

2017-05-09T00:00:00Z

Nordal, Ellen Berit; Guillaume-Czitrom, Severine; Sibilia, Jean
Disease classification in rheumatology is a matter of debate, in paediatrics between International League Against Rheumatism (ILAR) classification ‘pros and cons’, as well as between paediatric and adult rheumatologists. Indeed, there is no consensus yet about how we should name the disease of adults with juvenile idiopathic arthritis (JIA) in childhood. The non-concordance of adult and paediatric classifications for chronic inflammatory rheumatic diseases is confusing for caregivers, and above all for our patients. Will they be ‘lost in transition’, as phrased by McDonagh and Viner, when their disease stays the same, but gets a new name? Will their treatment be modified according to this new name and the corresponding recommendations for adult disease management? Yes, it is definitely time to think about a thorough modification of the ILAR categories of childhood chronic arthritis.
Source at http://dx.doi.org/10.1136/rmdopen-2016-000417

mHealth technologies for chronic disease prevention and management

2015-12-01T00:00:00Z

Laranjo, Liliana; Lau, Annie Y.S.; Oldenburg, B.; Gabarron, Elia; O'Neill, A.; Chan, S.; Coiera, E.
Aims and background: The aim of this rapid review is to examine the evidence relating to the benefits, uptake and operationalisation of mHealth technologies for chronic disease management and prevention. In a context of rapidly emerging technologies, it is important to understand what evidence is available to inform policy interventions designed to integrate technology for health service delivery, especially for services that are accessed by people of varying socio-economic status (SES). For the purpose of this review, mHealth technologies refer to Short Message Service (SMS)/Multimedia Message Service (MMS), mobile devices (e.g. Personal Digital Assistant [PDA]), mobile apps, wearable devices and sensors. Excluded from this review are telehealth and telephone-based services. The literature from 2005 was reviewed, with a focus on developed countries.

Key findings: The majority of studies included in this review were published after 2010, indicating the relative infancy of this technology and the need for further evaluation of its long-term effectiveness. Of all the mHealth technologies, SMS is the most commonly evaluated in the literature, and that with the strongest evidence of effectiveness. Evidence for interventions containing more innovative technologies, such as those involving smartphone apps and/or wearable devices, has been generated predominately from feasibility and usability studies, with few published randomised controlled trials (RCTs) evaluating effectiveness. For studies focusing on benefits for self-management, diabetes was the most common chronic disease studied. Significant improvements were found in glycaemic control through the use of mobile phones, SMS, internet, and/or wireless devices. For studies focusing on behaviour change, significant improvements were found in physical activity measures, weight loss outcomes, and smoking cessation, among others. The evidence regarding socio-economic and demographic factors of mHealth, as well regarding implementation aspects of mHealth interventions, were generally of lower quality.

Concluding remarks: SMS is the most commonly studied mHealth technology, with the strongest evidence of effectiveness. mHealth interventions can promote significant improvements in glycaemic control (for diabetes patients), as well as in physical activity, weight loss, and smoking cessation, among other outcomes. However, benefits appear dependent upon the characteristics of the intervention (e.g. bundle of features, use of behaviour change theories) and the specific patient population (e.g. age, digital literacy). One important marker of the success of an mHealth intervention is its integration into healthcare as part of a service (and not as a standalone system). One of the greatest barriers to mHealth uptake in healthcare is the existence of competing health system priorities, combined with a lack of evaluation studies and cost-effectiveness analysis to guide decisions. Improving the uptake and impact of an mHealth service will require the following elements: i) integration into a health service, ii) bundles of features to facilitate action (e.g. decision support, followed by task support), iii) application of appropriate use of theories and behavioural change strategies underpinning program design, iv) strategies employed to maintain participant interest and minimise dropout, and v) ensuring mHealth service fidelity (i.e. the accurate delivery, receipt, and enactment of the service). Strategies to increase uptake of mHealth should address the main barriers for each stakeholder as part of this process: payers, providers and, most importantly, patients. Relevant to Healthdirect Australia, opportunities may arise in providing personalisation and tailoring offered by these emerging mHealth technologies, situating these technologies in the existing ecosystem of Healthdirect Australia, and identifying bundles of mHealth and eHealth features that function together as a service in this ecosystem.

Antimicrobial susceptibility and body site distribution of community isolates of coagulase-negative staphylococci

2016-09-07T00:00:00Z

Cavanagh, Jorunn Pauline; Wolden, Runa; Heise, Philipp; Esaiassen, Eirin; Klingenberg, Claus; Aarag, Elizabeth
The primary aim of this study was to determine antimicrobial resistance in coagulase-negative staphylococci (CoNS) from healthy adults in the community. Healthy adults (n = 114) were swabbed on six body sites; both armpits, both knee pits and both sides of the groin. Species determination was performed using Matrix Assisted Laser Desorption Ionization – Time of Flight (MALDI-TOF) and susceptibility testing for 11 relevant antimicrobials was performed by the disc diffusion method and minimal inhibitory concentration gradient test. In total, 693 CoNS isolates were identified. Susceptibility testing was done on 386 isolates; one CoNS from each species found on each participant from the different body sites. The prevalence of antimicrobial resistance in the CoNS isolates were; erythromycin (24.6%), fusidic acid (19.9%), tetracycline (11.4%), clindamycin (7.8%), gentamicin (6.2%) and cefoxitin (4.1%). Multidrug resistance was observed in 5.2% of the isolates. Staphylococcus epidermidis and S. hominis were the first and second most prevalent species on all three body sites. We conclude that CoNS isolates from healthy adults in the community have a much lower prevalence of antimicrobial resistance than reported in nosocomial CoNS isolates. Still, we believe that levels of resistance in community CoNS should be monitored as the consumption of antimicrobials in primary care in Norway is increasing.
Manuscript. Published version available in APMIS, Volume 124, Issue 11, November 2016, pp 973–978

Elevated blood pressure is not associated with accelerated glomerular filtration rate decline in the general non-diabetic middle-aged population

2016-05-14T00:00:00Z

Eriksen, Bjørn Odvar; Stefansson, Vidar Tor Nyborg; Jenssen, Trond Geir; Mathisen, Ulla Dorte; Schei, Jørgen; Solbu, Marit Dahl; Wilsgaard, Tom; Melsom, Toralf
Although hypertension is a risk factor for end-stage renal disease, this complication develops in only a minority of hypertensive patients. Whether non-malignant hypertension itself is sufficient to cause reduced glomerular filtration rate (GFR) is unclear. We investigated whether elevated blood pressure (BP) was associated with accelerated GFR decline in the general population. The study was based on the Renal Iohexol-clearance Survey in Tromsø 6 (RENIS-T6), which included a representative sample of 1594 subjects aged 50 to 62 years from the general population without baseline diabetes, kidney or cardiovascular disease. GFR was measured as iohexol clearance at baseline and follow-up after a median observation time of 5.6 years. BP was measured according to a standardized procedure. The mean (standard deviation) GFR decline rate was 0.95 (2.23) mL/min/year. In multivariable adjusted linear mixed regressions with either baseline systolic or diastolic BP as the independent variable, there were no statistically significant associations with GFR decline. We conclude that elevated BP is not associated with accelerated mean GFR decline in the general middle-aged population. Additional genetic and environmental factors are probably necessary for elevated BP to develop manifest chronic kidney disease in some individuals.
Manuscript version. Published version at http://dx.doi.org/10.1016/j.kint.2016.03.021

Perforator-guided drug injection at the point of nerve entrapment

2017-02-14T00:00:00Z

Weum, Sven; de Weerd, Louis
Letter to the Editor
Accepted manuscript version. Published version at https://doi.org/10.1093/pm/pnw328.

Perforator-guided drug injection in the treatment of abdominal wall pain

2015-11-25T00:00:00Z

Weum, Sven; de Weerd, Louis
Background. Pain from the abdominal wall can be caused by nerve entrapment, a condition called abdominal cutaneous nerve entrapment syndrome (ACNES). As an alternative to surgery, ACNES may be treated with injection of local anesthetics, corticosteroids, or botulinum toxin at the point of maximal pain. Method. The point of maximal pain was marked on the abdominal skin. Using color Doppler ultrasound, the corresponding exit point of perforating blood vessels through the anterior fascia of the rectus abdominis muscle was identified. Ultrasound-guided injection of botulinum toxin in close proximity to the perforator’s exit point was performed below and above the muscle fascia. Results. The technique was used from 2008 to 2014 on 15 patients in 46 sessions with a total of 128 injections without complications. The injection technique provided safe and accurate administration of the drug in proximity to the affected cutaneous nerves. The effect of botulinum toxin on ACNES is beyond the scope of this article. Conclusion. Perforator-guided injection enables precise drug administration at the location of nerve entrapment in ACNES in contrast to blind injections.
Accepted manuscript version. Published version at http://doi.org/10.1093/pm/pnv011.

Reply: Form Stability of the Style 410 Implant: Definitions, Conjectures, and the Rest of the Story

2011-01-01T00:00:00Z

Weum, Sven Magne; Weerd, Louis de; Kristiansen, Bente
Accepted manuscript version. Published version at http://doi.org/10.1097/PRS.0b013e318222173a.

The Sensate Medial Dorsal Intercostal Artery Perforator Flap as an Option for Treatment of Dorsal Cervicothoracic Midline Defects

2010-01-01T00:00:00Z

Weum, Sven Magne; De Weerd, Louis
Letter to the Editor
Accepted manuscript version. Published version at http://doi.org/10.1097/PRS.0b013e3181e3b76d.

The butterfly design as an alternative to the "double-A" bilateral flaps for the treatment of sacral defects

2008-04-01T00:00:00Z

Weum, Sven Magne; De Weerd, Louis
Letter to the Editor
Accepted manuscript version. Published version at http://doi.org/10.1097/01.prs.0000305367.78154.a6.

Ambulance helicopter contribution to search and rescue in North Norway

2016-09-13T00:00:00Z

Glomseth, Ragnar; Gulbrandsen, Fritz I.; Fredriksen, Knut
Background: Search and rescue (SAR) operations constitute a significant proportion of Norwegian ambulance helicopter missions, and they may limit the service’s capacity for medical operations. We compared the relative contribution of the different helicopter resources using a common definition of SAR-operation in order to investigate how the SAR workload had changed over the last years. Methods: We searched the mission databases at the relevant SAR and helicopter emergency medical service (HEMS) bases and the Joint Rescue Coordination Centre (North) for helicopter-supported SAR operations within the potential operation area of the Tromsø HEMS base in 2000–2010. We defined SAR operations as missions over land or sea within 10 nautical miles from the coast with an initial search phase, missions with use of rescue hoist or static rope, and avalanche operations. Results: There were 769 requests in 639 different SAR operations, and 600 missions were completed. The number increased during the study period, from 46 in 2000 to 77 in 2010. The Tromsø HEMS contributed with the highest number of missions and experienced the largest increase, from 10 % of the operations in 2000 to 50 % in 2010. Simple terrain and sea operations dominated, and avalanches accounted for as many as 12 % of all missions. The helicopter crews used static rope or rescue hoist in 141 operations. Discussion: We have described all helicopter supported SAR operations in our area by combining databases. The Tromsø HEMS service had taken over one half of the missions by 2010. Increased availability for SAR work is one potential explanation. Conclusions: The number of SAR missions increased during 2000-2010, and the Tromsø HEMS experienced the greatest increase in workload.
Published version. Source at http://doi.org/10.1186/s13049-016-0302-8. License CC BY-NC-SA 4.0.