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Holmes A.H.,Imperial College London | Moore L.S.P.,Imperial College London | Sundsfjord A.,University Hospital of North Norway | Sundsfjord A.,University of Tromsø | And 5 more authors.
The Lancet | Year: 2016

To combat the threat to human health and biosecurity from antimicrobial resistance, an understanding of its mechanisms and drivers is needed. Emergence of antimicrobial resistance in microorganisms is a natural phenomenon, yet antimicrobial resistance selection has been driven by antimicrobial exposure in health care, agriculture, and the environment. Onward transmission is affected by standards of infection control, sanitation, access to clean water, access to assured quality antimicrobials and diagnostics, travel, and migration. Strategies to reduce antimicrobial resistance by removing antimicrobial selective pressure alone rely upon resistance imparting a fitness cost, an effect not always apparent. Minimising resistance should therefore be considered comprehensively, by resistance mechanism, microorganism, antimicrobial drug, host, and context; parallel to new drug discovery, broad ranging, multidisciplinary research is needed across these five levels, interlinked across the health-care, agriculture, and environment sectors. Intelligent, integrated approaches, mindful of potential unintended results, are needed to ensure sustained, worldwide access to effective antimicrobials. © 2016 Elsevier Ltd.


Rusin M.,University of Zilina | Arsand E.,University Hospital of North Norway | Arsand E.,University of Tromsø | Hartvigsen G.,University Hospital of North Norway | Hartvigsen G.,University of Tromsø
International Journal of Medical Informatics | Year: 2013

Background: Increasing healthcare costs related to lifestyle-related chronic diseases require new solutions. Research on self-management tools is expanding and many new tools are emerging. Recording food intake is a key functionality in many of these tools. Nutrition monitoring is a relevant method to gain an overview of factors influencing health. However, keeping a food diary often constitutes a challenge for a patient, and developing a user-friendly and useful electronic food diary is not straightforward. Purpose: To gain insight into the existing approaches to recording food intake, and to analyze current functionalities and input methods. Methods: We searched digital libraries, vendor markets and social networks focusing on nutrition. Selection criteria were publications written in English, and patient-oriented tools that offered recording of food intake or nutrition. The system properties that we searched for were types of data, types of terminal, target population, and types of reports and sharing functionalities. We summarized the properties based on their frequency in the reviewed sample. Results: 31 publications met the selection criteria. The majority of the identified food recording systems (67%) facilitated entry of food type and the consumed quantity of food; 16% of the systems were able to record more than one type of data. The three most frequent target populations were people with obesity, diabetes and overweight. Mobile phones were used as terminals in 35% of the cases, personal computers (PCs) in 29%, and personal digital assistants in 23%. Only 10% supported both PCs and mobile phones. Data sharing was provided by 71% and reports by 51% of the systems. We searched for apps in Google Play and the Apple Store and tested 45 mobile applications that stored food intake data, of which 62% supported recording of types of food, 24% recording of carbohydrate intake and 15% recording of calorie intake. The majority of the mobile applications offered some kind of reports and data sharing, mainly via All of the tested social-network-enabled applications supported access from a personal computer and a mobile phone, search in a food database, reports, graphical presentation, listing of favorite foods, overview of own meals, and entering of consumed food type and quantity. Conclusion: The analyzed apps reflected a variety of approaches to recording food intake and nutrition using different terminals - mostly mobile phones (35%), followed by PCs (29%) and PDAs (23%) for older studies, designed mainly for users with obesity (45%), diabetes mellitus (42%) and overweight (32%), or people who want to stay healthy (10%). The majority of the reviewed applications (67%) offered only input of food type and quantity. All approaches (n= 31), except for two, relied on manual input of data, either by typing or by selecting a food type from a database. The exceptions (n= 2) used a barcode scanning function. Users of mobile phone applications were not limited to data recording, but could view their data on the screen and send it via email. The tested web applications offered similar functionalities for recording food intake. The systems studied provided some degree of personalization: users can access some systems via PCs or mobile phones and they can choose among various types of data input content for recording food intake. Many functions, such as search in a food database, reports, graphical presentation, listing of favorite foods, and overview of the user's own meals, are optimized to simplify the recording process and save time. Data sharing and reports are common features of the reviewed systems. However, none use the user's recorded food history to make suggestions on new nutritional intake, during the food recording process. This may be an area for future research. © 2013 Elsevier Ireland Ltd.


Kjeldsen-Kragh J.,Lund University | Skogen B.,University Hospital of North Norway | Skogen B.,University of Troms
Obstetrical and Gynecological Survey | Year: 2013

Transfusion only occasionally gives rise to antibody production, because blood cells per se are not markedly immunogenic. However, the immunological changes that occur during pregnancy increase the risk of alloimmunization against red blood cells, platelets, and/or leukocytes. Fetal-maternal bleeding during pregnancy or in relation to delivery is the antigenic stimuli for immunization against red blood cells, whereas other mechanisms, such as trophoblast-derived microparticles, may also play a role in the production of antibodies against platelets. Antibody-mediated immune suppression has for 4 decades successfully been used for prevention of RhD immunization. Result from a mouse model of fetal and neonatal alloimmune thrombocytopenia (FNAIT) suggests that the same principle may be applied for the prevention of FNAIT. A European Union-funded consortium is presently in the process of developing a hyperimmune anti-human platelet antigen 1a (HPA-1a) immunoglobulin G. The idea is to prevent HPA-1a immunization by administering the drug to nonimmunized HPA-1a-negative women after delivery of an HPA-1a-positive child. The anti-HPA-1a will be purified from plasma collected from women who previously have given birth to a child with FNAIT caused by anti-HPA-1a. If the results of the planned phase III trial are favorable, it is possible that a product for prevention of FNAIT will be available within this decade.Target Audience: Obstetricians and gynecologists, family physiciansLearning Objectives: After completing this CME activity, physicians should be better able to evaluate the immunological principles behind alloimmunization in pregnancy, compare the attributes of the 3 major hypotheses regarding how Rh prophylaxis works, and explain the most recent endeavors to develop a prophylaxis against fetal and neonatal alloimmune thrombocytopenia. Copyright © 2013 Lippincott Williams & Wilkins.


Vading M.,Karolinska University Hospital | Samuelsen O.,University Hospital of North Norway | Haldorsen B.,University Hospital of North Norway | Sundsfjord A.S.,University Hospital of North Norway | And 2 more authors.
Clinical Microbiology and Infection | Year: 2011

The aim of this study was to compare CLSI and EUCAST MIC and disk diffusion carbapenem breakpoints for the detection of carbapenemase-producing Klebsiella pneumoniae. K. pneumoniae strains with known KPC (n=31) or VIM (n=20) carbapenemases were characterized by disk diffusion (Oxoid) and Etest (bioMérieux) vs. imipenem, meropenem and ertapenem, and with VITEK2 (bioMérieux, five different cards). Extended-spectrum β-lactamase (ESBL) testing was performed with VITEK2 (bioMérieux), ESBL combination disks (Becton Dickinson) and the ESBL Etest (bioMérieux). With CLSI and EUCAST MIC breakpoints, respectively, 11 and seven of the strains were susceptible to imipenem, 12 and eight to meropenem, and seven and none to ertapenem. The EUCAST epidemiological cut-off (ECOFF) values for meropenem and ertapenem identified all carbapenemase producers, whereas the imipenem ECOFF failed in five strains. All carbapenemase producers were detected with EUCAST disk diffusion breakpoints for ertapenem and meropenem, and four strains were susceptible to imipenem. CLSI disk diffusion breakpoints characterized 18 (imipenem), 14 (meropenem) and three (ertapenem) isolates as susceptible. When cards with a single carbapenem were used, detection failures with VITEK2 were four for imipenem, none for meropenem and one for ertapenem. Cards containing all three carbapenems had one to two failures. With ESBL combination disks, 21/31 KPC producers and 2/20 VIM producers were positive. With VITEK2, no VIM producers and between none and seven KPC producers were ESBL-positive. All carbapenemase producers were detected with the meropenem MIC ECOFF, or the clinical EUCAST breakpoint for ertapenem. EUCAST disk diffusion breakpoints for meropenem and ertapenem detected all carbapenemase producers. VITEK2 had between none and four failures in detecting carbapenemase producers, depending on the antibiotic card. © 2010 The Authors. Clinical Microbiology and Infection © 2010 European Society of Clinical Microbiology and Infectious Diseases.


Ekeland A.G.,University Hospital of North Norway | Grottland A.,Norwegian Center for Integrated Care and Telemedicine
International Journal of Technology Assessment in Health Care | Year: 2016

Objectives: Model for ASsessment of Telemedicine Applications (MAST) is a health technology assessment (HTA) inspired framework for assessing the effectiveness and contribution to quality of telemedicine applications based on rigorous, scientific data. This study reports from a study of how it was used and perceived in twenty-one pilots of the European project RENEWING HEALTH (RH). The objectives of RH were to implement large-scale, real-life test beds for the validation and subsequent evaluation of innovative patient-centered telemedicine services. The study is a contribution to the appraisal of HTA methods. Methods: A questionnaire was administered for project leaders of the pilots. It included questions about use and usefulness of MAST for (i) preceding considerations, (ii) evaluation of outcomes within seven domains, and (iii) considerations of transferability. Free text spaces allowed for proposals of improvement. The responses covered all pilots. A quantitative summary of use and a qualitative analysis of usefulness were performed. Results: MAST was used and considered useful for pilot evaluations. Challenges included problems to scientifically determine alternative service options and outcome within the seven domains. Proposals for improvement included process studies and adding domains of technological usability, responsible innovation, health literacy, behavior change, caregiver perspectives and motivational issues of professionals. Conclusions: MAST was used according to its structure. Its usefulness in patient centered pilots can be improved by adding new stakeholder groups. Interdependencies between scientific rigor, resources and timeliness should be addressed. Operational options for improvements include process studies, literature reviews and sequential mini-HTAs for identification of areas for more elaborate investigations. Copyright © Cambridge University Press 2015 This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (.


Johansen M.V.,Copenhagen University | Lier T.,University Hospital of North Norway | Sithithaworn P.,Khon Kaen University
Acta Tropica | Year: 2015

Reaching the goal of control, elimination and eradication of the Neglected Tropical Disease in a foreseeable future provides significant challenges at the ground level especially regarding helminthiasis. Helminths are still mainly diagnoses by egg identification in stool, methods with low sensitivity and for most species low specificity. Cross-sectoral collaboration with regard to zoonoses is almost non-existing and cross-validation by inter-laboratory evaluation of diagnostic tests is not a common practice. The aim of this review was to elucidate the dilemma of helminth diagnosis using zoonotic trematodes as examples. Much progress has been made improving the diagnostic sensitivity of Opisthorchis and Clonorchis using DNA-based techniques but the specificity of these tests is still a challenge due to the many most common but neglected intestinal trematodes. The burden of these diseases and ways to control them remains to be elucidated. Although efficacious drugs are available, the effectiveness of mass drug administration remains to be assessed. The importance of animal reservoirs and ways to control the diseases in animals are yet unknown. Diagnostic challenges regarding Schistosoma japonicum and Schistosoma mekongi include the many light infections and the persisting influx from the animal reservoirs. The sensitivity of the faecal based techniques suited morbidity control but will be insufficient for elimination of the helminths. More accurate diagnostic tools are required and new algorithms for detection and progression of helminth elimination will be needed. Standardized inter-laboratory test validation, inter-sectoral collaboration and establishment of an international One Health diagnostic platform, sharing best practices on diagnosis of helminth zoonoses, could all significantly contribute to control and elimination of these diseases. © 2013 The Authors.


Serrano J.A.,University Hospital of North Norway
International Journal of E-Health and Medical Communications | Year: 2010

Participatory design has been widely accepted as an effective strategy for understanding and including users' needs in technology development. But the successful integration of user participation depends on the way it is carried out, that is, when and how are the users involved in the process, how are the users' needs and requirements transferred to the technologists, and how is it verified that these requirements have been satisfied in the developed prototypes? These questions can be summarized as, how can one make the users' voice heard across the development of complex ubiquitous healthcare services? Finding adequate answers to these questions normally is complex due to the challenges that arise when using new and untested technology, as is the case of ubiquitous healthcare services. This paper will present answers to such questions from experience gathered during European projects in the AAL (Ambient Assisted Living) area, in which qualified specialists collaborate to provide a pool of competences that are vital in guaranteeing the success of ubiquitous healthcare services. Copyright © 2010, IGI Global.


Wangberg S.C.,University Hospital of North Norway
Journal of medical Internet research | Year: 2011

Studies suggest that tailored materials are superior to nontailored materials in supporting health behavioral change. Several trials on tailored Internet-based interventions for smoking cessation have shown good effects. There have, however, been few attempts to isolate the effect of the tailoring component of an Internet-based intervention for smoking cessation and to compare it with the effectiveness of the other components. The study aim was to isolate the effect of tailored emails in an Internet-based intervention for smoking cessation by comparing two versions of the intervention, with and without tailored content. We conducted a two-arm, randomized controlled trial of the open and free Norwegian 12-month follow-up, fully automated Internet-based intervention for smoking cessation, slutta.no. We collected information online on demographics, smoking, self-efficacy, use of the website, and participant evaluation at enrollment and subsequently at 1, 3, and 12 months. Altogether, 2298 self-selected participants aged 16 years or older registered at the website between August 15, 2006 and December 7, 2007 and were randomly assigned to either a multicomponent, nontailored Internet-based intervention for smoking cessation (control) or a version of the same Internet-based intervention with tailored content delivered on the website and via email. Of the randomly assigned participants, 116 (of 419, response rate = 27.7%) in the intervention group and 128 (of 428, response rate = 29.9%) in the control group had participated over the 12 months and responded at the end of follow-up. The 7-day intention-to-treat abstinence rate at 1 month was 15.2% (149/982) among those receiving the tailored intervention, compared with 9.4% (94/999) among those who received the nontailored intervention (P < .001). The corresponding figures at 3 months were 13.5% (122/902) and 9.4% (84/896, P =.006) and at 12 months were 11.2% (47/419) and 11.7% (50/428, P = .91). Likewise, the intervention group had higher self-efficacy and perceived tailoring at 1 and 3 months. Self-efficacy was found to partially mediate the effect of the intervention. Tailoring an Internet-based intervention for smoking cessation seems to increase the success rates in the short term, but not in the long term.


Mortensen K.E.,University of Tromsoe | Revhaug A.,University Hospital of North Norway
European Surgical Research | Year: 2011

Methods/Aims: Despite improved preoperative evaluation, surgical techniques and perioperative intensive care, some patients still experience postoperative liver failure in part due to insufficient regeneration. The aim of this review is to give the reader a historical synopsis of the major trends in animal research on liver regeneration from the early experiments in 1877 up to modern investigation. A major focus is placed on the translational value of experimental surgery. Methods: A systematic review of the English literature published in Medline was undertaken with the search words 'pig, porcine, dog, canine, liver regeneration, experimental'. Results: The evolution of the various models tentatively explaining the process of liver regeneration is described. Conclusions: We conclude by emphasizing the importance of large-animal surgical research on liver regeneration as it offers a more integrated, systemic biological understanding of this complex process. Furthermore, in our opinion, a closer collaboration between the hepatologist, liver surgeon/transplant surgeon and the laboratory scientist may advance clinically relevant research in liver regeneration. Copyright © 2010 S. Karger AG, Basel.


Hasvold P.E.,University Hospital of North Norway | Scholl J.,University Hospital of North Norway
International Journal of Medical Informatics | Year: 2011

Purpose: The purpose of this study was to learn about factors that influence the design and implementation of situated computing solutions that support hospital work. This includes social and technical aspects of the actual systems that will be implemented, as well as the appropriate design methodology for developing these systems. Methods: Staff at a surgical department at a University hospital were engaged in a participatory design (PD) process to help solve a problem that was presented by the staff: scheduling of patients and surgery rooms, and creating awareness of the status of ongoing surgeries. The PD process was conceptually aided by a model that describes Medical Informatics Systems as comprising of three components, a service component, a technical component and a social component. The process included the use of ethnographic field work and iterative redesign of both technical and social components of the system after it had been implemented into day-to-day work practice. Results: The PD process resulted in the creation of a system that was iteratively created over a period of about 2 years, and which then handed over to the IT department of the hospital and used by the surgical department for a period of about 1 additional year. The first version of the prototype that was implemented contained usability flaws that made the system difficult to use in time critical situations. As a result of observations and a redesign of the technical component and social component of the system a new version was possible to implement that managed to overcome this problem. A key feature of this second version of the system was that some responsibility for data entry validation was shifted from the technical component of the system to the social component of the system. This was done by allowing users to input poor data initially, while requiring them to fix this data later on. This solution breaks from " traditional" usability design but proved to be quite successful in this case. A challenge with the solution, however, was that the IT department could not understand the concept of systems being described as comprising of both social components and technical components, and thus they had difficulty in understanding the overall design of the system during the handover process. Conclusions: Situated computing can present a number of design challenges that may not be easy for designers and hospital workers to understand before a system has been implemented. Situated computing development may thus need to be aided by PD that includes both ethnographic observations and iterative redesign of the system after it has been implemented. Traditional data validation mechanisms may create poor system performance in cases where users are rushed to input data into the computer due to pressures created by other more critical work activities. In this case it may be better to rely on social mechanisms for correcting errors later on, rather than error catching mechanisms that reject incorrect data. It can be challenging, however, to maintain such systems over time, as IT-departments may lack skills and interest in social components. © 2011 Elsevier Ireland Ltd.

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