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Browsing Artikler, rapporter og annet (klinisk medisin) by Title
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Hellevik, Turid; Pettersen, ingvild; Berg, Vivian; Winberg, Jan-Olof; Moe, Bjørn Torvald Greve; Bartnes, Kristian; Paulssen, Ruth H; Busund, Lill-Tove; Bremnes, Roy M.; Chalmers, Antony; Martinez, Inigo Zubiavrre (Journal article; Tidsskriftartikkel; Peer reviewed, 2012)[+][-]
Abstract: BACKGROUND: Cancer-Associated Fibroblasts (CAFs) are significant components of solid malignancies and play central roles in cancer sustainability, invasion and metastasis. In this study we have investigated the invasive capacity and matrix remodelling properties of human lung CAFs after exposure to ablative doses of ionizing radiation (AIR), equivalent to single fractions delivered by stereotactic ablative radiotherapy (SART) for medically inoperable stage-I/II non-small-cell lung cancers. METHODS: CAFs were isolated from lung tumour specimens from 16 donors. Initially, intrinsic radiosensitivity was evaluated by checking viability and extent of DNA-damage response (DDR) at different radiation doses. The migrative and invasive capacities of CAFs were thereafter determined after a sub-lethal single radiation dose of 18 Gy. To ascertain the mechanisms behind the altered invasive capacity of cells, expression of matrix metalloproteinases (MMPs) and their endogenous inhibitors (TIMPs) were measured in the conditioned media several days post-irradiation, along with expression of cell surface integrins and dynamics of focal contacts by vinculin-staining. RESULTS: Exposing CAFs to 1x18 Gy resulted in a potent induction of multiple nuclear DDR foci (>9/cell) with little resolution after 120 hours, induced premature cellular senescence and inhibition of the proliferative, migrative and invasive capacity. AIR promoted MMP-3 and inhibited MMP-1 appearance to some extent, but did not affect expression of other major MMPs. Furthermore, surface expression of integrins α2, β1 and α5 was consistently enhanced, and a dramatic augmentation and redistribution of focal contacts was observed. CONCLUSIONS: Our data indicate that ablative doses of radiation exert advantageous inhibitory effects on the proliferative, migratory and invasive capacity of lung CAFs. The reduced motility of irradiated CAFs might be a consequence of stabilized focal contacts via integrins. URI: http://hdl.handle.net/10037/4935 File(s) in this item: 1
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Nieder, Carsten; Marienhagen, Kirsten; Geinitz, Hans; Grosu, Anca L. (Journal article; Tidsskriftartikkel; Peer reviewed, 2011)[+][-]
Abstract: We evaluated the performance of the new 4-tiered melanoma-specific graded prognostic assessment (GPA) score and the previously published general GPA score in patients with brain metastases from malignant melanoma managed with different approaches including best supportive care. Materials and Methods: Retrospective analysis of 51 patients. Compared with the original analysis of the melanoma-specific GPA score, these patients were more representative of the general population of patients with brain metastases from this disease. The present data confirmed that both scores identify patients with favorable prognosis who might be candidates for focal treatments. However, survival in the 2 unfavorable prognostic subgroups defined by the melanoma-specific GPA was not significantly different. Median survival in the melanoma-specific GPA classes was 3.1, 3.7, 7.5, and 12.7 months. Karnofsky performance status (KPS) and serum lactatdehydrogenase (LDH) level significantly predicted survival. In order to select the right patient to the right treatment and avoid overtreatment and suboptimal resource utilization in patients with very limited survival, improved prognostic tools are needed. The melanoma-specific GPA does not include extracranial disease extent or surrogate markers such as LDH. We suggest that a combination of KPS <70 and elevated LDH might better predict short survival than any of the GPA scores. This hypothesis should be confirmed in larger studies. URI: http://hdl.handle.net/10037/3950 File(s) in this item: 1
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Bolle, Stein Roald; Gilbert, Mads; Scholl, Jeremiah (Journal article; Tidsskriftartikkel; Peer reviewed, 2009)[+][-]
Abstract: Background: Because mobile telephones may support video calls, emergency medical dispatchers may now connect visually with bystanders during pre-hospital cardiopulmonary resuscitation (CPR). We studied the quality of simulated dispatcher-assisted CPR when guidance was delivered to rescuers by video calls or audio calls from mobile phones. Methods: One hundred and eighty high school students were randomly assigned in groups of three to communicate via video calls or audio calls with experienced nurse dispatchers at a Hospital Emergency Medical Dispatch Center. CPR was performed on a recording resuscitation manikin during simulated cardiac arrest. Quality of CPR and time factors were compared depending on the type of communication used. Results: The median CPR time without chest compression (‘hands-off time’) was shorter in the video-call group vs. the audio-call group (303 vs. 331 s; P50.048), but the median time to first compression was not shorter (104 vs. 102 s; P50.29). The median time to first ventilation was insignificantly shorter in the video-call group (176 vs. 205 s; P50.16). This group also had a slightly higher proportion of ventiliations without error (0.11 vs. 0.06; P50.30). Conclusion: Video communication is unlikely to improve telephone CPR (t-CPR) significantly without proper training of dispatchers and when using dispatch protocols written for audio-only calls. Improved dispatch procedures and training for handling video calls require further investigation. Description: Denne artikkelen er en del av doktorgradsavhandlingen til Stein Roar Bolle. Avhandlingen finnes i Munin http://hdl.handle.net/10037/3597 URI: http://hdl.handle.net/10037/3598 File(s) in this item: 1
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Steffensen, Linn Hofsøy; Jørgensen, Lone; Straume, Bjørn; Mellgren, Svein Ivar; Kampman, Margitta Theodora (Journal article; Tidsskriftartikkel; Peer reviewed, 2011)[+][-]
Abstract: Multiple sclerosis (MS) is a possible cause of secondary osteoporosis. In this phase II trial we assessed whether a weekly dose of 20,000 IU vitamin D3 prevents bone loss in ambulatory persons with MS age 18–50 years. ClinicalTrials.gov ID NCT00785473. All patients managed at the University Hospital of North Norway who fulfilled the main inclusion criteria were invited to participate in this double-blinded trial. Participants were randomised to receive 20,000 IU vitamin D3 or placebo once a week and 500 mg calcium daily for 96 weeks. The primary outcome was the effect of the intervention on percentage change in bone mineral density (BMD) at the hip, the spine, and the ultradistal radius over the study period. Of 71 participants randomised, 68 completed. Mean serum 25-hydroxyvitamin D [25(OH)D] levels in the intervention group increased from 55 nmol/L at baseline to 123 nmol/L at week 96. After 96 weeks, percentage change in BMD did not differ between groups at any site. BMD decreased at the hip, by 1.4% in the placebo group (95% CI -2.3 to -0.4, SD 2.7, p = 0.006) and by 0.7% in the treatment group (-1.6 to 0.2, 2.7, p = 0.118), difference 0.7% (-1.9 to 0.7, p = 0.332). Findings were not altered by adjustment for sex or serum 25(OH)D. Supplementation with 20,000 IU vitamin D3 a week did not prevent bone loss in this small population. Larger studies are warranted to assess the effect of vitamin D on bone health in persons with MS. URI: http://hdl.handle.net/10037/3956 File(s) in this item: 1
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Gilje, Fredricka; Fjelltun, Aud-Mari Sohini; Henriksen, Nils; Norberg, Astrid; Normann, Hans Ketil (Journal article; Tidsskriftartikkel; Peer reviewed, 2009)[+][-]
Abstract: Aim: The aim of this study was to explore experiences with overnight respite care (ORC) of Norwegian carers who provided care to frail elderly awaiting nursing home placement.
Background: In many Western countries respite care has become part of health care service provision, and various types of respite care are available. The intent with respite care can be twofold; caring for the care receiver and supporting the carer.
Methods: This is a descriptive qualitative study. Interviews were conducted with 15 carers, transcribed and analysed by qualitative content analysis.
Findings: The carers described various experiences with ORC. If ORC supported the whole family, it was welcomed by carers and experienced as supportive. If ORC did not support the whole family, many carers rejected ORC, and it was experienced as non-supportive. Two categories were constructed: ‘experiencing ORC as supportive for the family as a whole’ and ‘not experiencing ORC as supportive for the family as a whole’.
Conclusion: To support more carers, nurses have to listen to carers’ experiences about ORC. Nurses need to take responsibility for the family as a whole and provide more flexible ORC services based on both carers’ and elderly’s needs.URI: http://hdl.handle.net/10037/2159 File(s) in this item: 1
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Madry, Henning; Grün, Ulrich Wolfgang; Knutsen, Gunnar (Journal article; Tidsskriftartikkel; Peer reviewed, 2011)[+][-]
Abstract: Articular cartilage defects are most often caused by trauma and osteoarthritis and less commonly by metabolic disorders of the subchondral bone, such as osteonecrosis and osteochondritis dissecans. Such defects do not heal spontaneously in adults and can lead to secondary osteoarthritis. Medications are indicated for symptomatic relief. Slow-acting drugs in osteo - arthritis (SADOA), such as glucosamine and chondroitin, are thought to prevent cartilage degeneration. Reconstructive surgical treatment strategies aim to form a repair tissue or to unload compartments of the joint with articular cartilage damage. In this article, we selectively review the pertinent literature, focusing on original publications of the past 5 years and older standard texts. Particular attention is paid to guidelines and clinical studies with a high level of evidence, along with review articles, clinical trials, and book chapters. There have been only a few randomized trials of medical versus surgical treatments. Pharmacological therapies are now available that are intended to treat the cartilage defect per se, rather than the associated symptoms, yet none of them has yet been shown to slow or reverse the progres sion of cartilage destruction. Surgical débridement of cartilage does not prevent the progression of osteoarthritis and is thus not recommended as the sole treatment. Marrow-stimulating procedures and osteochondral grafts are indicated for small focal articular cartilage defects, while autologous chondrocyte implantationis mainly indicated for larger cartilage defects. These surgical reconstructive techniques play a lesser role in the treatment of osteoarthritis. Osteotomy near the knee joint is indicated for axial realignment when unilateral osteoarthritis of the knee causes axis deviation. Surgical reconstructive techniques can improve joint func tion and thereby postpone the need for replacement of the articular surface with an artificial joint. URI: http://hdl.handle.net/10037/3966 File(s) in this item: 1
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Nielsen, Kåre Nolde; Åm, Trond Grønli; Nydal, Rune (Journal article; Tidsskriftartikkel; Peer reviewed, 2011)[+][-]
Abstract: This work describes the nano field inNorway as currently emerging in the dynamics between two forms of nano research activities described along a centre-periphery axis. 1) There are strategic research initiatives committed to redeem the envisioned potential of the field by means of social and material reorganisation of existing research activities. This activity is seen as central as it is one of our premises that the standard circulating nano vision implies such a work of reorganisation. The fact that nano is often taken as a paradigmatic example of the shift from Mode-1 to Mode-2 research, supports this assumption. 2) In parallel to this activity, a wide variety of research projects pursuing nano strategies are being funded. We regard such research activity as peripheral in so far as the activity is not marked by being committed to the circulating nano vision, as may often be the case. In the process of reorganising, this article argues, the research activity at the periphery provides a crucial arena for discussing and validatingwhat is to be achieved through the work of reorganisation that takes place at the centre. Our analysis is informed by two Norwegian cases. We examine a major nano research initiative at a Norwegian university as a centre and a research project utilising nanoparticles in fish vaccines as a periphery. URI: http://hdl.handle.net/10037/3963 File(s) in this item: 1
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Engeseth, Kjersti H.; Obstfelder, Aud; Wynn, Rolf (Journal article; Tidsskriftartikkel; Peer reviewed, 27-Jul-2007)[+][-]
Abstract: Background: There has been an increased interest in the use of telemedical applications in clinical practice in recent years. Considerable effort has been invested in trials and experimental services. Yet, surprisingly few applications have continued beyond the research and development phase. The aim of this study is to explore characteristics of successfully implemented telemedical applications. Methods: An extensive search of telemedicine literature was conducted in order to identify relevant articles. Following a defined selection process, a small number of articles were identified that described characteristics of successfully implemented telemedical applications. These articles were analysed qualitatively, drawing on central procedures from Grounded Theory (GT), including condensation and categorisation. The analysis resulted in a description of features found to be of importance for a successful implementation of telemedicine. Subsequently, these features were discussed in light of Science and Technology studies (STS) and the concept of 'social negotiation'. Results: Telemedical applications introduced into routine practice are typically characterised by the following six features: 1) local service delivery problems have been clearly stated, 2) telemedicine has been seen as a benefit, 3) telemedicine has been seen as a solution to political and medical issues, 4) there was collaboration between promoters and users, 5) issues regarding organizational and technological arrangements have been addressed, and 6) the future operation of the service has been considered. Conclusions: Our findings support research arguing that technologies are not fixed entities moving from invention through diffusion and into routine use. Rather, it is the interplay between technical and social factors that produces a particular outcome. The success of a technology depends on how this interplay is managed during the process of implementation. URI: http://hdl.handle.net/10037/1153 File(s) in this item: 1
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Risberg, Terje; Chrisanthar, Ranjan; Knappskog, Stian; Løkkevik, Erik; Anker, Gun; Østenstad, Bjørn; Lundgren, Steinar; Mjaaland, I; Engebretsen, L; Lillehaug, Johan Richard; Lønning, Per Eystein; Mæhle, L; Berge, Elisabet (Journal article; Tidsskriftartikkel; Peer reviewed, 2008)[+][-]
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Chen, Wei; Lim, Chi Eung Danforn; Kang, Hong-Jun; Liu, Jianping (Journal article; Tidsskriftartikkel; Peer reviewed, 2011)[+][-]
Abstract: Chinese herbs are thought to be effective for type A H1N1 influenza. Series of Chinese herbs have been authorized recommended by the Chinese government, and until now a number of clinical trials of Chinese herbs for H1N1 influenza have been conducted. However, there is no critically appraised evidence such as systematic reviews or metaanalyses on potential benefits and harms of medicinal herbs for H1N1 influenza to justify their clinical use and their recommendation. CENTRAL, MEDLINE, EMBASE, CBM, CNKI, VIP, China Important Conference Papers Database, China Dissertation Database, and online clinical trial registry websites were searched for published and unpublished randomized controlled trials (RCTs) of Chinese herbs for H1N1 influenza till 31 August, 2011. A total of 26 RCTs were identified and reviewed. Most of the RCTs were of high risk of bias with flawed study design and poor methodological quality. The combination of several Chinese herbal medicines with or without oseltamivir demonstrated positive effect on fever resolution, relief of symptoms, and global effectiveness rate compared to oseltamivir alone. However, only one herbal medicine showed positive effect on viral shedding. Most of the trials did not report adverse events, and the safety of herbal medicines is still uncertain. Some Chinese herbal medicines demonstrated potential positive effect for 2009 type A H1N1 influenza; however, due to the lack of placebo controlled trial and lack of repeated test of the intervention, we could not draw confirmative conclusions on the beneficial effect of Chinese herbs for H1N1 influenza. More rigorous trials are warranted to support their clinical use. URI: http://hdl.handle.net/10037/3961 File(s) in this item: 1
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Øiesvold, Terje; Nivison, Mary; Hansen, Vidje; Sørgaard, Knut; Østensen, Line; Skre, Ingunn (Journal article; Tidsskriftartikkel; Peer reviewed, 2012)[+][-]
Abstract: Background This study has explored the classification of bipolar disorder in psychiatric hospital. A review of the literature reveals that there is a need for studies using stringent methodological approaches. Methods 480 first-time admitted patients to psychiatric hospital were found eligible and 271 of these gave written informed consent. The study sample was comprised of 250 patients (52%) with hospital diagnoses. For the study, expert diagnoses were given on the basis of a structured diagnostic interview (M.I.N.I.PLUS) and retrospective review of patient records. Results Agreement between the expert's and the clinicians' diagnoses was estimated using Cohen's kappa statistics. 76% of the primary diagnoses given by the expert were in the affective spectrum. Agreement concerning these disorders was moderate (kappa ranging from 0.41 to 0.47). Of 58 patients with bipolar disorder, only 17 received this diagnosis in the clinic. Almost all patients with a current manic episode were classified as currently manic by the clinicians. Forty percent diagnosed as bipolar by the expert, received a diagnosis of unipolar depression by the clinician. Fifteen patients (26%) were not given a diagnosis of affective disorder at all. Conclusions Our results indicate a considerable misclassification of bipolar disorder in psychiatric hospital, mainly in patients currently depressed. The importance of correctly diagnosing bipolar disorder should be emphasized both for clinical, administrative and research purposes. The findings questions the validity of psychiatric case registers. There are potential benefits in structuring the diagnostic process better in the clinic. URI: http://hdl.handle.net/10037/4436 File(s) in this item: 1
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Lenkin, A; Kirov, Mikhail; Kuzkov, Vsevolod; Paromov, KV; Smetkin, Alexey Anatolievich; Lie, Mons; Bjertnaes, Lars J. (Journal article; Tidsskriftartikkel; Peer reviewed, 2012)[+][-]
Abstract: Our aim was to compare the effects of goal-directed therapy guided either by pulmonary artery catheter (PAC) or by transpulmonary thermodilution (TTD) combined with monitoring of oxygen transport on perioperative hemodynamics and outcome after complex elective valve surgery. Measurements and Main Results. Forty patients were randomized into two equal groups: a PAC group and a TTD group. In the PAC group, therapy was guided by mean arterial pressure (MAP), cardiac index (CI) and pulmonary artery occlusion pressure (PAOP), whereas in the TTD group we additionally used global end-diastolic volume index (GEDVI), extravascular lung water index (EVLWI), and oxygen delivery index (DO2I). We observed a gradual increase in GEDVI, whereas EVLWI and PAOP decreased by 20–30% postoperatively (P < 0.05). The TTD group received 20% more fluid accompanied by increased stroke volume index and DO2I by 15–20% compared to the PAC group (P < 0.05). Duration of mechanical ventilation was increased by 5.2 hrs in the PAC group (P = 0.04). Conclusions. As compared to the PAC-guided algorithm, goal-directed therapy based on transpulmonary thermodilution and oxygen transport increases the volume of fluid therapy, improves hemodynamics and DO2I, and reduces the duration of respiratory support after complex valve surgery. URI: http://hdl.handle.net/10037/4939 File(s) in this item: 1
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Henriksen, Jørn Remi; Haug, Bjørn Helge; Büchner, Jochen; Tømte, Ellen; LØkke, cecilie; Flaegstad, Trond; Einvik, christer (Journal article; Tidsskriftartikkel; Peer reviewed, 2011)[+][-]
Abstract: Background: Neuroblastoma is a childhood cancer derived from immature cells of the sympathetic nervous system. The disease is clinically heterogeneous, ranging from neuronal differentiated benign ganglioneuromas to aggressive metastatic tumours with poor prognosis. Amplification of the MYCN oncogene is a well established poor prognostic factor found in up to 40% of high risk neuroblastomas. Using neuroblastoma cell lines to study neuronal differentiation in vitro is now well established. Several protocols, including exposure to various agents and growth factors, will differentiate neuroblastoma cell lines into neuron-like cells. These cells are characterized by a neuronal morphology with long extensively branched neurites and expression of several neurospecific markers.
Results: In this study we use retrovirally delivered inducible short-hairpin RNA (shRNA) modules to knock down MYCN expression in MYCN-amplified (MNA) neuroblastoma cell lines. By addition of the inducer doxycycline, we show that the Kelly and SK-N-BE(2) neuroblastoma cell lines efficiently differentiate into neuron-like cells with an extensive network of neurites. These cells are further characterized by increased expression of the neuronal differentiation markers NFL and GAP43. In addition, we show that induced expression of retrovirally delivered anti- MYCN shRNA inhibits cell proliferation by increasing the fraction of MNA neuroblastoma cells in the G1 phase of the cell cycle and that the clonogenic growth potential of these cells was also dramatically reduced.
Conclusion: We have developed an efficient MYCN-knockdown in vitro model system to study neuronal differentiation in MNA neuroblastomas.URI: http://hdl.handle.net/10037/3642 File(s) in this item: 1
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Nieder, Carsten; Pawinski, Adam; Dalhaug, Astrid (Journal article; Tidsskriftartikkel; Peer reviewed, 2012)[+][-]
Abstract: Research activity related to different aspects of prevention, prediction, diagnosis and treatment of brain metastases has increased during recent years. One of the major databases (Scopus) contains 942 scientific articles that were published during the 5-year time period 2006–2010. Of these, 195 (21%) reported on single patient cases and 12 (1%) were reports of 2 cases. Little is known about their influence on advancement of the field or scientific merits. Do brain metastases case reports attract attention and provide stimuli for further research or do they go largely unrecognized? Different measures of impact, visibility and quality of published research are available, each with its own pros and cons. For the present evaluation, article citation rate was chosen. The median number of citations overall and stratified by year of publication was 0, except for the year 2006 when it was 2. As compared to other articles, case reports remained more often without citation (p<0.05 except for 2006 data). All case reports with 10 or more citations (n = 6) reported on newly introduced anticancer drugs, which commonly are prescribed to treat extracranial metastases, and the responses observed in single patients with brain metastases. Average annual numbers of citations were also calculated. The articles with most citations per year were the same six case reports mentioned above (the only ones that obtained more than 2.0 citations per year). Citations appeared to gradually increase during the first two years after publication but remained on a generally low or modest level. It cannot be excluded that case reports without citation provide interesting information to some clinicians or researchers. Apparently, case reports describing unexpected therapeutic success gain more attention, at least in terms of citation, than others. URI: http://hdl.handle.net/10037/4943 File(s) in this item: 1
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Haavind, Anniken; Hevrøy, Olav; Hennig, rune; Bjertnaes, Lars J. (Journal article; Tidsskriftartikkel; Peer reviewed, 2011)[+][-]
Abstract: Pneumonia, severe sepsis, and acute respiratory distress syndrome (ARDS) are frequent complications after head trauma. Recombinant human activated protein C (APC) reportedly improves circulation and respiration in severe sepsis, but is contraindicated after head injury because of increased risk of intracranial bleeding. A 21-year-old man with severe head injury after a car accident was endotracheally intubated, mechanically ventilated, and hemodynamically stabilized before transfer to our university hospital. His condition became complicated with pneumonia, septic shock, ARDS, coagulation dysfunction, and renal failure. In spite of intensive therapy, oxygenation and arterial blood pressure fell to critically low values. Simultaneously, his intracranial pressure peaked and his pupils dilated, displaying no reflexes to light. His antibiotic regimen was changed and ventilation was altered to high frequency oscillations, and despite being ethically problematic, we added APC to his treatment. The patient recovered with modest neurological sequelae. URI: http://hdl.handle.net/10037/4679 File(s) in this item: 1
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Cavanagh, Jorunn Pauline; Klingenberg, Claus Andreas; Hanssen, Anne-Merethe; Aarag, Elizabeth; Francois, Patrice; Schrenzel, Jaques; Flægstad, Trond; Sollid, Johanna U Ericson (Journal article; Tidsskriftartikkel; Peer reviewed, 2012)[+][-]
Abstract: The notoriously multi-resistant Staphylococcus haemolyticus is an emerging pathogen causing serious infections in immunocompromised patients. Defining the population structure is important to detect outbreaks and spread of antimicrobial resistant clones. Currently, the standard typing technique is pulsed-field gel electrophoresis (PFGE). In this study we describe novel molecular typing schemes for S. haemolyticus using multi locus sequence typing (MLST) and multi locus variable number of tandem repeats (VNTR) analysis. Seven housekeeping genes (MLST) and five VNTR loci (MLVF) were selected for the novel typing schemes. A panel of 45 human and veterinary S. haemolyticus isolates was investigated. The collection had diverse PFGE patterns (38 PFGE types) and was sampled over a 20 year-period from eight countries. MLST resolved 17 sequence types (Simpsons index of diversity [SID] = 0.877) and MLVF resolved 14 repeat types (SID = 0.831). We found a low sequence diversity. Phylogenetic analysis clustered the isolates in three (MLST) and one (MLVF) clonal complexes, respectively. Taken together, neither the MLST nor the MLVF scheme was suitable to resolve the population structure of this S. haemolyticus collection. Future MLVF and MLST schemes will benefit from addition of more variable core genome sequences identified by comparing different fully sequenced S. haemolyticus genomes. URI: http://hdl.handle.net/10037/4354 File(s) in this item: 1
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Rezvyy, Grigory; Olstad, Reidun; Parniakov, Alexander; Fedulova, Elena (Journal article; Tidsskriftartikkel; Peer reviewed, 04-Apr-2008)[+][-]
Abstract: Background: A general education in psychiatry does not necessary lead to good diagnostic skills. Specific training programs in diagnostic coding are established to facilitate implementation of ICD-10 coding practices. However, studies comparing the impact of these two different educational approaches on diagnostic skills are lacking. The aim of the current study was to find out if a specific training program in diagnostic coding improves the diagnostic skills better than a general education program, and if a national bias in diagnostic patterns can be minimised by a specific training in diagnostic coding.
Methods: A pre post design study with two groups was carried in the county of Archangels, Russia. The control group (39 psychiatrists) took the required course (general educational program), while the intervention group (45 psychiatrists) were given a specific training in diagnostic coding. Their diagnostic skills before and after education were assessed using 12 written case-vignettes selected from the entire spectrum of psychiatric disorders.
Results: There was a significant improvement in diagnostic skills in both the intervention group and the control group. However, the intervention group improved significantly more than did the control group. The national bias was partly corrected in the intervention group but not to the same degree in the control group. When analyzing both groups together, among the background factors only the current working place impacted the outcome of the intervention.
Conclusion: Establishing an internationally accepted diagnosis seems to be a special skill that requires specific training and needs to be an explicit part of the professional educational activities of psychiatrists. It does not appear that that skill is honed without specific training. The issue of national diagnostic biases should be taken into account in comparative cross-cultural studies of almost any character. The mechanisms of such biases are complex and need further consideration in future research. Future research should also address the question as to whether the observed improvement in diagnostic skills after specific training actually leads to changes in routine diagnostic practice.URI: http://hdl.handle.net/10037/2100 File(s) in this item: 1
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Bærheim, Anders; Anvik, Tor; Risberg, Terje; Hjortdahl, Per; Holen, Are; Fasmer, Ole Bernt; Grimstad, Hilde; Gude, Tore; Vaglum, Per (Journal article; Tidsskriftartikkel; Peer reviewed, 10-Oct-2007)[+][-]
Abstract: Background: Communication training builds on the assumption that understanding of the concepts related to professional communication facilitates the training. We know little about whether students' knowledge of clinical communication skills is affected by their attendance of communication training courses, or to what degree other elements of the clinical training or curriculum design also play a role. The aim of this study was to determine which elements of the curriculum influence acquisition of knowledge regarding clinical communication skills by medical students. Methods: The study design was a cross-sectional survey performed in the four Norwegian medical schools with different curricula, spring 2003. A self-administered questionnaire regarding knowledge of communication skills (an abridged version of van Dalen's paper-and-pencil test) was sent to all students attending the four medical schools. A total of 1801 (59%) students responded with complete questionnaires. Results: At the end of the 1st year of study, the score on the knowledge test was higher in students at the two schools running communication courses and providing early patient contact (mean 81%) than in the other two medical schools (mean 69–75%, P ≤ 0.001), with students studying a traditional curriculum scoring the lowest. Their scores increased sharply towards the end of the 3rd year, during which they had been subjected to extensive patient contact and had participated in an intensive communication course (77% vs. 72% the previous year, P ≤ 0.01). All students scored generally lower in academic years in which there was no communication training. However, at the end of the final year the difference between the schools was only 5% (81% vs. 86%, P ≤ 0.001). Conclusion: The acquisition of knowledge regarding communication skills by medical students may be optimised when the training is given together with extensive supervised patient contact, especially if this teaching takes place in the initial years of the curriculum. URI: http://hdl.handle.net/10037/1247 File(s) in this item: 1
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Besada, Emilio; Koldingsnes, Wenche; Nossent, Johannes C (Conference object; Konferansebidrag, 2013)[+][-]
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Brodin, Ellen Elisabeth; Brækkan, Sigrid Kufaas; Vik, Anders; Brox, Jan; Hansen, John-Bjarne (Journal article; Tidsskriftartikkel; Peer reviewed, 2012)[+][-]
Abstract: Background Previous studies have shown an association between impaired kidney function, assessed by cystatin C-based estimated glomerular filtration rate, and venous thromboembolism. The aim of this study was to investigate whether serum cystatin C was associated with a risk of venous thromboembolism among subjects with normal kidney function in a prospective population-based study. Design and Methods Cystatin C was measured in serum from 3251 men and women with normal kidney function, aged 25–84 years, who participated in the Tromsø study in 1994–1995. Normal kidney function was defined as a creatinine-based estimated glomerular filtration rate greater than 90 mL/min/1.73 m2 and absence of microalbuminuria. Incident venous thromboembolism was registered from the date of inclusion through to the end of follow-up, September 1, 2007. Cox-regression models were used to calculate hazard ratios with 95% confidence intervals for venous thromboembolism. Results There were 83 incident venous thromboembolic events, of which 53 (63.9 %) were provoked, during a median of 12.3 years of follow-up. A one standard deviation (0.11 mg/L) increase in serum cystatin C levels was associated with a 43% (hazard ratio 1.43; 95% confidence interval 1.17–1.72) increased risk of total venous thromboembolism. Subjects with cystatin C levels in the top quartile (≥0.87 mg/L) had a 2.5-fold (hazard ratio 2.51; 95% confidence interval 1.27–4.96) increased risk of venous thromboembolism compared to those with levels in the bottom quartile (≤0.72 mg/L) in adjusted analysis. The risk estimates were even higher for provoked venous thromboembolism (hazard ratio 3.11; 95% confidence interval 1.23–7.86). Conclusions Serum cystatin C levels were associated with the risk of venous thromboembolism in subjects with normal kidney function. Our findings suggest that elevated serum cystatin C levels may promote venous thrombosis beyond reflecting impaired kidney function. URI: http://hdl.handle.net/10037/5040 File(s) in this item: 1
article.pdf (730.4Kb)
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