Roaldset J.O.,Alesund Hospital |
Roaldset J.O.,Norwegian University of Science and Technology |
Roaldset J.O.,University of Oslo |
Linaker O.M.,Norwegian University of Science and Technology |
And 2 more authors.
Archives of Suicide Research | Year: 2012
The aim of the study was to explore the predictive validity of the Suicidal Scale of the Mini-International Neuropsychiatric Interview as a screen for suicidal behavior and non-suicidal self-injury following discharge from an acute psychiatric ward. Using a prospective, naturalistic design, the patients were screened with the Suicidal Scale when discharged (n = 307). At 12 months post-discharge, the Suicidal Scale was a significant predictor of suicidal behavior (n = 48) and suicidal behavior+non-suicidal self-injury (n = 49) but not for non-suicidal self-injury (n = 15). For patients without any known previous suicide attempts (n = 180), the Suicidal Scale was a significant predictor of suicidal behavior (n = 21) and suicidal behavior+non-suicidal self-injury (n = 11). Further research is needed to determine the overall utility of the routine screening of self-harm. © 2012 Copyright International Academy for Suicide Research.
Hellebust T.P.,University of Oslo |
Hellebust T.P.,Norwegian Radiation Protection Authority |
Tanderup K.,Aarhus University Hospital |
Tanderup K.,University of Aarhus |
And 7 more authors.
Radiotherapy and Oncology | Year: 2013
Purpose and background: To study the dosimetric impact of interobserver delineation variability (IODV) in MRI-based cervical cancer brachytherapy. Materials and methods: MR images of six patients were distributed to 10 experienced observers worldwide. They were asked to delineate the target volumes and the organs at risk (OARs) for each patient. Two types of reference contours were created (Expert Consensus-EC and Simultaneous Truth and Performance Level Estimation-STAPLE). Optimised plans based on both EC- and STAPLE-contours were prepared. These plans were transferred to each of the observer contour sets and the resulting DVH parameters (D90 and D2cc) were calculated. For each patient the standard deviation (SD) for the 10 observers was calculated. Results: A mean relative SD of 8-10% was found for GTV and High Risk CTV (HR-CTV) D90 analysing one single fraction. For rectum and bladder the mean relative SD for D2cc was 5-8% while sigmoid was at 11%. For the whole treatment the IODV in HR-CTV caused an uncertainty of ±5 Gyα/β=10 (1SD). The corresponding figure for OARs was ±2-3 Gyα/β=3. The results were not sensitive as to which structure set was used for the optimisation. Conclusions: For the target volumes the dosimetric impact of IODV was smallest for the GTV and HR-CTV, while IODV had an even smaller impact on the bladder and rectum. © 2013 Elsevier Ireland Ltd. All rights reserved.
Fossa S.D.,University of Oslo |
Wiklund F.,Karolinska Institutet |
Klepp O.,Alesund Hospital |
Angelsen A.,Urology Clinical Center |
And 4 more authors.
European Urology | Year: 2016
Background: In high-risk prostate cancer (PCa), no study with observation times beyond 10 yr has demonstrated survival improvement after addition of prostatic radiotherapy (RAD) to endocrine treatment (ET) alone. Objective: To compare mortality rates in patients receiving ET alone versus ET + RAD. Design, settings, and participants: From 1996 to 2002, 875 Scandinavian patients with high-risk (90%) or intermediate PCa were randomized to ET or ET + RAD (The Scandinavian Prostate Cancer Group-7). After 3 mo with total androgen blockade in all patients, all individuals continued lifelong antiandrogen monotherapy. Those randomized to ET + RAD started prostate radiotherapy (70. Gy) at 3 mo. Outcome, measurements and statistical analysis: PCa-specific 15-yr mortality represented the primary endpoint. Assessment of the combination treatment effect and prognostic factors was performed in competing risk analyses and Cox proportional-hazard models. Intervention: RAD added to ET. Results and limitations: With a median observation time of 12 yr, the 15-yr PCa-specific mortality rates were 34% (95% confidence interval, 29-39%) and 17% (95% confidence interval, 13-22%) in the ET and ET + RAD arms respectively (p <. 0.001). Compared with the ET arm, the median overall survival in the ET + RAD arm was prolonged by 2.4 yr. Treatment with ET alone, age ≥65 yr and increasing histology grade independently increased the risk of PCa-specific and overall mortality. Limitations include nonformal evaluation of comorbidity, the inability to calculate progression-free survival, and lack of information about salvage therapy and toxicity. Conclusions: In patients with nonmetastatic locally advanced or aggressive PCa, ET + RAD reduces the absolute risk of PCa-specific death by 17% at 15 yr compared with ET alone; the comparable 15-yr PCa-specific mortality rates being 17% and 34%. The results warrant a phase 3 study comparing ET + RAD with radical prostatectomy in high-risk PCa. Patient summary: Adding prostatic therapy to lifelong antiandrogen therapy halves the absolute risk of death from prostate cancer from 34% to 17% 15 yr after diagnosis. In high-risk prostate cancer, radiotherapy (70 Gy) added to life-long oral antiandrogen monotherapy results in 91% cause-specific survival compared with 81% after antiandrogens alone. The results after combined treatment are similar to those after radical prostatectomy. © 2016 European Association of Urology.
Roaldset J.O.,Alesund Hospital |
Roaldset J.O.,Norwegian University of Science and Technology |
Hartvig P.,University of Oslo |
Bjorkly S.,University of Oslo |
Bjorkly S.,Molde University College
European Psychiatry | Year: 2011
Background: Current violence risk assessment instruments are time-consuming and mainly developed for forensic psychiatry. A paucity of violence screens for acute psychiatry instigated the development and validation of the V-RISK-10. The aim of this prospective naturalistic study was to test the predictive validity of the V-RISK-10 as a screen of violence risk after discharge from two acute psychiatric wards. Methods: Patients were screened with V-RISK-10 before discharge, and incidents of violence were recorded 3, 6, 9 and 12 months after discharge. A total of 381 of the 1017 patients that were screened completed the follow up. Results: The ROC-AUC values for any violent behaviour were 0.80 and 0.75 (p< 0.001) for the 3 and 12 months follow-up periods, respectively, and significant for both genders. The most accurate risk estimates were obtained for severe violence. For persons without a known history of violence prior to the screening, AUCs were 0.74 (p= 0.004) and 0.68 (p= 0.002). Conclusions: Results indicate that the V-RISK-10 is a valid and clinically useful screen for violence risk after discharge from acute psychiatry, and even significant for patients without a known previous history of violence. © 2010 Elsevier Masson SAS.
Berentsen S.,Haugesund Hospital |
Randen U.,University of Oslo |
Vagan A.M.,Alesund Hospital |
Hjorth-Hansen H.,Norwegian University of Science and Technology |
And 6 more authors.
Blood | Year: 2010
Most patients diagnosed with primary chronic cold agglutinin disease (CAD) have a clonal lymphoproliferative bone marrow disorder. Treatment with rituximab is the only well-documented effective therapy, leading to 45%-60% partial responses (PR). Complete responses (CR) are rare, and median response duration is only 11 months. In a prospective multicenter trial, 29 patients received rituximab 375 mg/m 2 on days 1, 29, 57 and 85; and fludarabine orally, 40 mg/m 2 on days 1-5, 29-34, 57-61 and 85-89. Twenty-two patients (76%) responded, 6 (21%) achieving CR and 16 (55%) PR. Among 10 patients nonresponsive to rituximab monotherapy, 1 achieved CR and 6 PR. Median increase in hemoglobin level was 3.1 g/dL among the responders and 4.0 g/dL in those who achieved CR. Lower quartile of response duration was not reached after 33 months. Estimated median response duration was more than 66 months. Grade 3-4 hematologic toxicity occurred in 12 patients (41%). In conclusion, fludarabine and rituximab combination therapy is very efficient in patients with CAD. Toxicity may be a concern, and benefits should be carefully weighed against risks in very old and comorbid patients. It remains to be established whether the combination should be first-line or an efficient second-line therapy in CAD patients requiring treatment. This study is registered at http://www. clinicaltrials.gov as NCT00373594. © 2010 by The American Society of Hematology.
Rognmo O.,Norwegian University of Science and Technology |
Moholdt T.,Norwegian University of Science and Technology |
Bakken H.,Roros Rehabilitation Center |
Hole T.,Alesund Hospital |
And 4 more authors.
Circulation | Year: 2012
Backround-: Exercise performed at higher relative intensities has been found to elicit a greater increase in aerobic capacity and greater cardioprotective effects than exercise at moderate intensities. An inverse association has also been detected between the relative intensity of physical activity and the risk of developing coronary heart disease, independent of the total volume of physical activity. Despite that higher levels of physical activity are effective in reducing cardiovascular events, it is also advocated that vigorous exercise could acutely and transiently increase the risk of sudden cardiac death and myocardial infarction in susceptible persons. This issue may affect cardiac rehabilitation. Methods and Results-: We examined the risk of cardiovascular events during organized high-intensity interval exercise training and moderate-intensity training among 4846 patients with coronary heart disease in 3 Norwegian cardiac rehabilitation centers. In a total of 175 820 exercise training hours during which all patients performed both types of training, we found 1 fatal cardiac arrest during moderate-intensity exercise (129 456 exercise hours) and 2 nonfatal cardiac arrests during high-intensity interval exercise (46 364 exercise hours). There were no myocardial infarctions in the data material. Because the number of high-intensity training hours was 36% of the number of moderate-intensity hours, the rates of complications to the number of patient-exercise hours were 1 per 129 456 hours of moderate-intensity exercise and 1 per 23 182 hours of high-intensity exercise. CONCLUSIONS-: The results of the current study indicate that the risk of a cardiovascular event is low after both high-intensity exercise and moderate-intensity exercise in a cardiovascular rehabilitation setting. Considering the significant cardiovascular adaptations associated with high-intensity exercise, such exercise should be considered among patients with coronary heart disease. © 2012 American Heart Association, Inc.
Christiansen S.C.,Leiden University |
Christiansen S.C.,Alesund Hospital |
Lijfering W.M.,Leiden University |
Helmerhorst F.M.,Leiden University |
And 2 more authors.
Journal of Thrombosis and Haemostasis | Year: 2010
Background: The risk of recurrent venous thrombosis is higher in men than in women, and this is so far unexplained. We set out to determine the influence of age, time between first and second event, type of first event, oral contraception, pregnancy and surgery. Methods: We performed a prospective follow-up study of 474 patients with a first objective diagnosis of deep vein thrombosis, aged 18-70 years (Leiden Thrombophilia Study cohort). Results: During 3477 person-years of follow-up, 90 recurrences occurred. The overall incidence rates of recurrence (IRs) were 40.9 per 1000 person-years in men and 15.8 per 1000 personyears in women. Men with an unprovoked first event had the highest risk of recurrence, with almost one-third experiencing a second unprovoked event within 8 years (IR 41.2 per 1000 person-years). This risk was three-fold lower in women [IR 14.2 per 1000 person-years; hazard ratio 2.8 (95% confidence interval 1.4-5.7)]. Age at diagnosis had little effect on recurrence rate, and nor had time elapsed since the first event. In women, almost half of the recurrences were provoked and were mainly related to oral contraceptive use or pregnancy. Conclusions: The higher recurrence rate in men than in women is not the result of differences in the environmental or transient risk factors that we studied. The risk profile for a second thrombotic event is clearly different from that of a first. © 2010 International Society on Thrombosis and Haemostasis.
Immervoll H.,University of Bergen |
Hoem D.,University of Bergen |
Steffensen O.J.,Alesund Hospital |
Miletic H.,University of Bergen |
Molven A.,University of Bergen
Journal of Histochemistry and Cytochemistry | Year: 2011
Tumor-initiating cells of pancreatic ductal adenocarcinoma (PDAC) have been isolated based on expression of either CD133 or CD44. The authors aimed to visualize pancreatic cells simultaneously expressing both these cell surface markers by employing the same antibodies commonly used in cell-sorting studies. Normal and diseased pancreatic tissue, including 51 PDAC cases, were analyzed. CD44 and CD133 expression was determined by immunohistochemical double staining on formalin-fixed material and subcellular protein distribution evaluated by immunofluorescence/confocal microscopy. In the normal pancreas, CD44 and CD133 were coexpressed in the centroacinar regions but in non-overlapping subcellular compartments. As expected, CD44 was found mainly basolaterally, whereas CD133 was present on the apical/endoluminal membrane. This was also the case in chronically inflamed/atrophic pancreatic tissue and in PDAC. In some malignant ducts, CD44 was found at the apical cell membrane adjacent to but never overlapping with CD133 expression. CD44 level was significantly associated with the patient's lymph node status. In conclusion, a CD44+/CD133+ cell population does exist in the normal and neoplastic pancreas. The preferentially centroacinar localization of the doubly positive cells in the normal parenchyma suggests that this population could be of particular interest in attempts to identify tumor-initiating cells in PDAC. This article contains online supplemental material at http://www.jhc.org. Please visit this article online to view these materials. © The Author(s) 2011.
Vegsundvag J.,Alesund Hospital |
Holte E.,Alesund Hospital |
Wiseth R.,Norwegian University of Science and Technology |
Hegbom K.,Norwegian University of Science and Technology |
And 2 more authors.
Journal of the American Society of Echocardiography | Year: 2011
Background: The purpose of this study was to evaluate the potential of combined use of transthoracic Doppler echocardiographic coronary flow velocity reserve (CFVR) measurements and findings of retrograde coronary flow in the three main coronary arteries for the assessment of borderline (angiographic diameter stenosis, 50%-75%) and high-grade (angiographic diameter stenosis, 76%-100%) coronary artery stenoses. Methods: A total of 108 patients scheduled for coronary angiography because of chest pain or acute coronary syndromes were studied. CFVR was measured during adenosine-induced hyperemia in the mid to distal segments of the left anterior descending coronary artery, the marginal branches of the left circumflex coronary artery, and the posterior descending coronary artery, with peak CFVR (pCFVR) <2.0 implying hemodynamic significant stenosis. CFVR results were compared with results from quantitative coronary angiography, with stenosis severity in the left main and three major coronary arteries divided into three groups: (1) diameter stenosis 0% to 49%, (2) diameter stenosis 50% to 75%, and (3) diameter stenosis 76% to 100%. Results: In patients with antegrade flow in the relevant coronary artery segment, CFVR was successfully measured in the mid to distal left anterior descending artery, the marginal branches of the left circumflex artery, and the posterior descending artery in 97%, 63%, and 75% of patients, respectively. CFVR was significantly different among the stenosis groups, with pCFVR of 2.79 ± 0.77 in group 1, 2.01 ± 0.72 in group 2, and 1.50 ± 0.69 in group 3 (P < .001 among groups). Angiography confirmed retrograde flow in seven of the nine arteries found by transthoracic echocardiography. Findings of pCFVR <2.0 or retrograde coronary artery flow correctly identified 42 of 49 patients with stenoses in group 3, with sensitivity, specificity, and positive and negative predictive values of 86%, 70%, 70%, and 85%, respectively. In group 2, pCFVR values were widely distributed above or below the defined pCFVR cutoff value. Conclusions: CFVR measurement in the mid to distal left anterior descending artery was feasible in almost all patients, and in the marginal branches of the left circumflex artery and the posterior descending artery in two thirds and three quarters of patients, respectively. Use of the combined echocardiographic criteria had high precision for diagnosing severe coronary stenoses (diameter stenosis, 76%-100%). The functional significance of angiographically borderline stenoses (diameter stenosis, 50%-75%) may be further differentiated by the use of CFVR measurements. Copyright 2011 by the American Society of Echocardiography.
Andersen F.H.,Alesund Hospital |
Andersen F.H.,Norwegian University of Science and Technology |
Kvale R.,University of Bergen
Acta Anaesthesiologica Scandinavica | Year: 2012
Background: The number of elderly (≥ 80 years) will increase markedly in Norway over the next 20 years, increasing the demand for health-care services, including intensive care. The aims of this study were to see if intensive care unit (ICU) resource use and survival are different for elderly ICU patients than for younger adult ICU patients. Materials and methods: A retrospective cohort study comparing ICU patients between 50 and 79.9 years (Group I) with patients over 80 years (Group II) registered in the Norwegian Intensive Care Registry from 2006 to 2009. A subgroup analysis of 5-year age groups was performed. Results: A total of 27,921 patients were analysed. The ICU/hospital mortalities were 14.3%/21.4% (Group I) and 19.8%/32.4% (Group II). Overall mortality increased with increasing age, and hospital mortality rate increased more than ICU mortality. The observed difference in admission categories could not explain the significant difference in median length of stay (LOS), 2.3 days (Group I) vs. 2.0 days (Group II). The elderly received less mechanical ventilatory support (40.6% vs. 56.1%) and had shorter median ventilatory support time, 0.8 days vs. 1.9 days. Median LOS dropped from around 80 years on, ventilator support time from around 65-70 years. Conclusion: Octogenarians had shorter ICU stays, had higher overall mortality, had a shift of dying at the ward rather than in the ICU, and received less and shorter mechanical ventilatory support. © 2012 The Acta Anaesthesiologica Scandinavica Foundation.