Helgeland Hospital

Mosjøen, Norway

Helgeland Hospital

Mosjøen, Norway
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Johnson E.L.,University of California at Berkeley | Dewar C.D.,University of California at Berkeley | Solbakk A.-K.,University of Oslo | Solbakk A.-K.,Helgeland Hospital | And 3 more authors.
Current Biology | Year: 2017

The ability to represent and select information in working memory provides the neurobiological infrastructure for human cognition. For 80 years, dominant views of working memory have focused on the key role of prefrontal cortex (PFC) [1–8]. However, more recent work has implicated posterior cortical regions [9–12], suggesting that PFC engagement during working memory is dependent on the degree of executive demand. We provide evidence from neurological patients with discrete PFC damage that challenges the dominant models attributing working memory to PFC-dependent systems. We show that neural oscillations, which provide a mechanism for PFC to communicate with posterior cortical regions [13], independently subserve communications both to and from PFC—uncovering parallel oscillatory mechanisms for working memory. Fourteen PFC patients and 20 healthy, age-matched controls performed a working memory task where they encoded, maintained, and actively processed information about pairs of common shapes. In controls, the electroencephalogram (EEG) exhibited oscillatory activity in the low-theta range over PFC and directional connectivity from PFC to parieto-occipital regions commensurate with executive processing demands. Concurrent alpha-beta oscillations were observed over parieto-occipital regions, with directional connectivity from parieto-occipital regions to PFC, regardless of processing demands. Accuracy, PFC low-theta activity, and PFC → parieto-occipital connectivity were attenuated in patients, revealing a PFC-independent, alpha-beta system. The PFC patients still demonstrated task proficiency, which indicates that the posterior alpha-beta system provides sufficient resources for working memory. Taken together, our findings reveal neurologically dissociable PFC and parieto-occipital systems and suggest that parallel, bidirectional oscillatory systems form the basis of working memory. © 2017 The Authors


Perry A.,University of California at Berkeley | Saunders S.N.,University of California at Berkeley | Stiso J.,University of California at Berkeley | Dewar C.,University of California at Berkeley | And 6 more authors.
Brain : a journal of neurology | Year: 2017

Humans are highly social beings that interact with each other on a daily basis. In these complex interactions, we get along by being able to identify others' actions and infer their intentions, thoughts and feelings. One of the major theories accounting for this critical ability assumes that the understanding of social signals is based on a primordial tendency to simulate observed actions by activating a mirror neuron system. If mirror neuron regions are important for action and emotion recognition, damage to regions in this network should lead to deficits in these domains. In the current behavioural and EEG study, we focused on the lateral prefrontal cortex including dorsal and ventral prefrontal cortex and utilized a series of task paradigms, each measuring a different aspect of recognizing others' actions or emotions from body cues. We examined 17 patients with lesions including (n = 8) or not including (n = 9) the inferior frontal gyrus, a core mirror neuron system region, and compared their performance to matched healthy control subjects (n = 18), in behavioural tasks and in an EEG observation-execution task measuring mu suppression. Our results provide support for the role of the lateral prefrontal cortex in understanding others' emotions, by showing that even unilateral lesions result in deficits in both accuracy and reaction time in tasks involving the recognition of others' emotions. In tasks involving the recognition of actions, patients showed a general increase in reaction time, but not a reduction in accuracy. Deficits in emotion recognition can be seen by either direct damage to the inferior frontal gyrus, or via damage to dorsal lateral prefrontal cortex regions, resulting in deteriorated performance and less EEG mu suppression over sensorimotor cortex. © The Author (2017). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oup.com.


Grane V.A.,Helgeland Hospital | Endestad T.,University of Oslo | Pinto A.F.,Helgeland Hospital | Solbakk A.-K.,Helgeland Hospital
PloS one | Year: 2014

We investigated performance-derived measures of executive control, and their relationship with self- and informant reported executive functions in everyday life, in treatment-naive adults with newly diagnosed Attention Deficit Hyperactivity Disorder (ADHD; n = 36) and in healthy controls (n = 35). Sustained attentional control and response inhibition were examined with the Test of Variables of Attention (T.O.V.A.). Delayed responses, increased reaction time variability, and higher omission error rate to Go signals in ADHD patients relative to controls indicated fluctuating levels of attention in the patients. Furthermore, an increment in NoGo commission errors when Go stimuli increased relative to NoGo stimuli suggests reduced inhibition of task-irrelevant stimuli in conditions demanding frequent responding. The ADHD group reported significantly more cognitive and behavioral executive problems than the control group on the Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A). There were overall not strong associations between task performance and ratings of everyday executive function. However, for the ADHD group, T.O.V.A. omission errors predicted self-reported difficulties on the Organization of Materials scale, and commission errors predicted informant reported difficulties on the same scale. Although ADHD patients endorsed more symptoms of depression and anxiety on the Achenbach System of Empirically Based Assessment (ASEBA) than controls, ASEBA scores were not significantly associated with T.O.V.A. performance scores. Altogether, the results indicate multifaceted alteration of attentional control in adult ADHD, and accompanying subjective difficulties with several aspects of executive function in everyday living. The relationships between the two sets of data were modest, indicating that the measures represent non-redundant features of adult ADHD.


Arntsberg Grane V.,Helgeland Hospital | Arntsberg Grane V.,University of Oslo | Endestad T.,University of Oslo | Farbu Pinto A.,Helgeland Hospital | And 2 more authors.
PLoS ONE | Year: 2014

We investigated performance-derived measures of executive control, and their relationship with self- and informant reported executive functions in everyday life, in treatment-naive adults with newly diagnosed Attention Deficit Hyperactivity Disorder (ADHD; n 536) and in healthy controls (n535). Sustained attentional control and response inhibition were examined with the Test of Variables of Attention (T.O.V.A.). Delayed responses, increased reaction time variability, and higher omission error rate to Go signals in ADHD patients relative to controls indicated fluctuating levels of attention in the patients. Furthermore, an increment in NoGo commission errors when Go stimuli increased relative to NoGo stimuli suggests reduced inhibition of task-irrelevant stimuli in conditions demanding frequent responding. The ADHD group reported significantly more cognitive and behavioral executive problems than the control group on the Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A). There were overall not strong associations between task performance and ratings of everyday executive function. However, for the ADHD group, T.O.V.A. omission errors predicted selfreported difficulties on the Organization of Materials scale, and commission errors predicted informant reported difficulties on the same scale. Although ADHD patients endorsed more symptoms of depression and anxiety on the Achenbach System of Empirically Based Assessment (ASEBA) than controls, ASEBA scores were not significantly associated with T.O.V.A. performance scores. Altogether, the results indicate multifaceted alteration of attentional control in adult ADHD, and accompanying subjective difficulties with several aspects of executive function in everyday living. The relationships between the two sets of data were modest, indicating that the measures represent non-redundant features of adult ADHD. © 2014 Grane et al.


Augestad K.M.,University of Tromsø | Norum J.,University of Tromsø | Norum J.,Northern Norway Regional Health Authority Trust | Dehof S.,Helgeland Hospital | And 7 more authors.
BMJ Open | Year: 2013

Objective: To assess whether colon cancer follow-up can be organised by general practitioners (GPs) without a decline in the patient' s quality of life (QoL) and increase in cost or time to cancer diagnoses, compared to hospital follow-up. Design: Randomised controlled trial. Setting: Northern Norway Health Authority Trust, 4 trusts, 11 hospitals and 88 local communities. Participants: Patients surgically treated for colon cancer, hospital surgeons and community GPs. Intervention: 24-month follow-up according to national guidelines at the community GP office. To ensure a high follow-up guideline adherence, a decision support tool for patients and GPs were used. Main outcome measures: Primary outcomes were QoL, measured by the global health scales of the European Organisation for Research and Treatment of Cancer QoL Questionnaire (EORTC QLQ C-30) and EuroQol-5D (EQ-5D). Secondary outcomes were cost-effectiveness and time to cancer diagnoses. Results: 110 patients were randomised to intervention (n=55) or control (n=55), and followed by 78 GPs (942 follow-up months) and 70 surgeons (942 follow-up months), respectively. Compared to baseline, there was a significant improvement in postoperative QoL (p=0.003), but no differences between groups were revealed (mean difference at 1, 3, 6, 9, 12, 15, 18, 21 and 24-month follow-up appointments): Global Health; Δ-2.23, p=0.20; EQ-5D index; Δ-0.10, p=0.48, EQ-5D VAS; Δ-1.1, p=0.44. There were no differences in time to recurrent cancer diagnosis (GP 35 days vs surgeon 45 days, p=0.46); 14 recurrences were detected (GP 6 vs surgeon 8) and 7 metastases surgeries performed (GP 3 vs surgeon 4). The follow-up programme initiated 1186 healthcare contacts (GP 678 vs surgeon 508), 1105 diagnostic tests (GP 592 vs surgeon 513) and 778 hospital travels (GP 250 vs surgeon 528). GP organised follow-up was associated with societal cost savings (£8233 vs £9889, p<0.001). Conclusions: GP-organised follow-up was associated with no decline in QoL, no increase in time to recurrent cancer diagnosis and cost savings.


Strom H.H.,Helgeland Hospital | Strom H.H.,University of Tromsø | Bremnes R.M.,University of Tromsø | Sundstrom S.H.,St Olavs Hospital | And 2 more authors.
Clinical Lung Cancer | Year: 2015

Background In a phase III trial of patients with unresectable, locally advanced, stage III non-small-cell lung cancer (NSCLC) with a poor prognosis, palliative concurrent chemoradiotherapy (CRT) provided a significantly better outcome than chemotherapy alone, except among performance status (PS) 2 patients. In the present subgroup analysis, we evaluated the effect on patients aged ≥ 70 years (42% of all included) compared with patients aged < 70 years enrolled in the trial. Patients and Methods All patients received 4 courses of intravenous carboplatin and oral vinorelbine. The experimental arm also received radiotherapy (42 Gy in 15 fractions). The included patients were required to have large tumors (> 8 cm), weight loss (> 10% within the previous 6 months) and/or PS 2. Results The overall survival was increased among the CRT patients in both age groups, but the difference was significant only in patients aged < 70 years (median survival, 14.8 vs. 9.7 months; P =.001; age ≥ 70 years, median survival, 10.2 vs. 9.1 months; P =.09). Patients aged ≥ 70 years experienced better preserved health-related quality of life (QOL) and significantly less hematologic toxicity. The 2- and 3-year survival was significantly increased in both age groups receiving CRT. Conclusion Elderly patients aged ≥ 70 years with unresectable, stage III, locally advanced, NSLCL and a poor prognosis can tolerate CRT with the doses adjusted to age and palliative intent. These results indicate that CRT can provide both survival and QOL benefits in elderly patients, except for those with PS 2 or worse. The male predominance in the ≥ 70-year-age group and the reduced chemotherapy intensity for the patients aged > 75 years might explain the lack of significant survival improvement among those patients aged ≥ 70 years. © 2015 The Authors.


Strom H.H.,Helgeland Hospital | Strom H.H.,University of Tromsø | Bremnes R.M.,University of Tromsø | Sundstrom S.H.,St Olavs Hospital | And 3 more authors.
British Journal of Cancer | Year: 2013

Background:The palliative role of chemoradiation in the treatment of patients with locally advanced, inoperable non-small-cell lung cancer stage III and negative prognostic factors remains unresolved.Methods:Patients not eligible for curative radiotherapy were randomised to receive either chemoradiation or chemotherapy alone. Four courses of intravenous carboplatin on day 1 and oral vinorelbin on days 1 and 8 were given with 3-week intervals. Patients in the chemoradiation arm also received radiotherapy with fractionation 42 Gy/15, starting at the second chemotherapy course. The primary end point was overall survival; secondary end points were health-related quality of life (HRQOL) and toxicity.Results:Enrolment was terminated due to slow accrual after 191 patients from 25 Norwegian hospitals were randomised. Median age was 67 years and 21% had PS 2. In the chemotherapy versus the chemoradiation arm, the median overall survival was 9.7 and 12.6 months, respectively (P<0.01). One-year survival was 34.0% and 53.2% (P<0.01). Following a minor decline during treatment, HRQOL remained unchanged in the chemoradiation arm. The patients in the chemotherapy arm reported gradual deterioration during the subsequent months. In the chemoradiation arm, there were more hospital admissions related to side effects (P<0.05).Conclusion:Chemoradiation was superior to chemotherapy alone with respect to survival and HRQoL at the expense of more hospital admissions due to toxicity. © 2013 Cancer Research UK.


Strom H.H.,Helgeland Hospital | Strom H.H.,University of Tromsø | Bremnes R.M.,University of Tromsø | Sundstrom S.H.,St Olavs Hospital | And 2 more authors.
Journal of Thoracic Oncology | Year: 2014

INTRODUCTION:: Poor prognosis patients with bulky stage III locally advanced non-small-cell lung cancer may not be offered concurrent chemoradiotherapy (CRT). Following a phase III trial concerning the effect of palliative CRT in inoperable poor prognosis patients, this analysis was performed to explore how tumor size influenced survival and health-related quality of life (HRQOL). METHODS:: A total of 188 poor prognosis patients recruited in a randomized clinical trial received four courses intravenous carboplatin day 1 and oral vinorelbine day 1 and 8, at 3-week intervals. The experimental arm (N = 94) received radiotherapy with fractionation 42 Gy/15, starting at the second chemotherapy course. This subset study compares outcomes in patients with tumors larger than 7 cm (N = 108) versus tumors 7 cm or smaller (N = 76). RESULTS:: Among those with tumors larger than 7 cm, the median overall survival in the chemotherapy versus CRT arm was 9.7 and 13.4 months, respectively (p = 0.001). The 1-year survival was 33% and 56%, respectively (p = 0.01). Except for a temporary decline during treatment, HRQOL was maintained in the CRT arm, regardless of tumor size. Among those who did not receive CRT, patients with tumors larger than 7 cm experienced a gradual decline in the HRQOL. The CRT group had significantly more esophagitis and hospitalizations because of side effects regardless of tumor size. CONCLUSION:: In patients with poor prognosis and inoperable locally advanced non-small-cell lung cancer, large tumor size should not be considered a negative predictive factor. Except for performance status 2, patients with tumors larger than 7 cm apparently benefit from CRT. Copyright © 2014 by the International Association for the Study of Lung Cancer.


Aasebo U.,University of Tromsø | Strom H.H.,Helgeland Hospital | Postmyr M.,University of Tromsø
Clinical Respiratory Journal | Year: 2012

Introduction: Patient flow during workup for lung cancer is often difficult to influence because of delay at many levels: patient delay, doctors' delay and waiting time for X-ray and CT scan, referral to specialist, and waiting time for chemotherapy and radiotherapy or surgery. A mean workup time of 4 months is not unusual. Objectives: To improve quality and shorten the workup time for patients with lung cancer. Methods: It was decided to employ a program designed by the Toyota car industry, the Lean process, as a tool to improve workup time. A Lean process implicates all levels of an institution with project and focus groups having workshops to analyse present status and suggest improvements. Results: Since introducing the Lean project, we have decreased the workup time from a mean of 64 days to 16 days, and the median time from diagnosis to surgery was reduced from 26.5 days to 15 days. Conclusion: It is feasible to improve patient flow for patients with lung cancer by employing the Lean method as a pathway instrument. Please cite this paper as: Aasebø U, Strøm HH and Postmyr M. The Lean method as a clinical pathway facilitator in patients with lung cancer. © 2011 Blackwell Publishing Ltd.


Aasen I.E.,Norwegian University of Science and Technology | Aasen I.E.,Helgeland Hospital | Brunner J.F.,Helgeland Hospital | Brunner J.F.,Norwegian University of Science and Technology
Psychophysiology | Year: 2016

The present study investigated how components of ERPs are modulated when participants optimize speed versus accuracy in a cued go/no-go task. Using a crossover design, 35 participants received instructions to complete the task prioritizing response speed in half of the task, and accurate responding in the other half of the task. Analysis was performed on the contingent negative variation (CNV), P3go, and P3no-go and the corresponding independent components (IC), as identified by group independent component analysis. After speed instructions, the IC CNVlate, P3goanterior, P3no-goearly, and P3no-golate all had larger amplitudes than after accuracy instructions. Furthermore, both the IC P3goposterior and IC P3goanterior had shorter latencies after speed than after accuracy instructions. The results demonstrate that components derived from the CNV and P3 components are facilitated when participants optimize response speed. These findings indicate that these ERP components reflect executive processes enabling adjustment of behavior to changing demands. © 2016 Society for Psychophysiological Research.

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