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Solberg T.,University Hospital of Northern Norway | Johnsen L.G.,Norwegian University of Science and Technology | Grotle M.,University of Oslo | Grotle M.,Oslo University College
Acta Orthopaedica

Background and purpose A successful outcome after lumbar discectomy indicates a substantial improvement. To use the cutoffs for minimal clinically important difference (MCID) as success criteria has a large potential bias, simply because it is difficult to classify patients who report that they are "moderately improved". We propose that the criteria for success should be defined by those who report that they are "completely recovered" or "much better". Methods A cohort of 692 patients were operated for lumbar disc herniation and followed for one year in the Norwegian Registry for Spine Surgery. The global perceived scale of change was used as an external criterion, and success was defined as those who reported that they were "completely recovered" or "much better". Criteria for success for each of (1) the Oswestry disability index (ODI; score range 0-100 where 0 = no disability), (2) the numerical pain scale (NRS; range 0-10 where 0 = no pain) for back and leg pain, and (3) the Euroqol (EQ-5D; -0.6 to 1 where 1 = perfect health) were estimated by defining the optimal cutoff point on receiver operating characteristic curves. Results The cutoff values for success for the mean change scores were 20 (ODI), 2.5 (NRS back), 3.5 (NRS leg), and 0.30 (EQ-5D). According to the cutoff estimates, the proportions of successful outcomes were 66% for the ODI and 67% for the NRS leg pain scale. Interpretation The sensitivity/specificity values for the ODI and leg pain were acceptable, whereas they were very low for the EQ-5D. The cutoffs for success can be used as benchmarks when comparing data from different surgical units. Source

Ingul C.B.,Norwegian University of Science and Technology | Malm S.,University Hospital of Northern Norway | Refsdal E.,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

Background: The aim of this study was to investigate the changes and time course of recovery of regional myocardial function within the first week following successful primary coronary intervention in patients with first-time ST-segment elevation myocardial infarctions using myocardial deformation analysis, which is more quantitative and thus more objective than the wall motion score. Methods: Thirty-one consecutive patients admitted with ST-segment elevation myocardial infarctions were studied on days 1, 2, 3, and 7 using strain and strain rate tissue Doppler echocardiography. Results: The mean peak troponin T level was 7.0 μg/L, and 15 patients had anterior and 16 had inferior infarct localization. Peak systolic strain rate and end-systolic strain increased significantly on day 2, both in segments with moderately reduced function (-0.6 to -1.0 s-1 vs -8% to -15%, P < .001) and in severely reduced function (-0.2 to -1.0 s-1 vs 1% to -12%, P < .001), but there were no further changes. Mean wall motion score in infarct related segments decreased significantly from day 1 to day 2 (2.7 to 2.4, P = .001) and from day 3 to day 7 (2.3 to 2.2, P = .001). Conclusions: Recovery of regional function after ST-segment elevation myocardial infarction occurred within 2 days and could be detected by wall motion score, strain rate, and strain. However, strain and strain rate were better discriminative parameters for the changes in function as well as being better to assess near normalization on day 2. This could have a clinical impact on early management in patients who undergo percutaneous coronary intervention. © 2010 American Society of Echocardiography. Source

Horn M.A.,University of Oslo | Nilsen K.B.,University of Oslo | Nilsen K.B.,Norwegian University of Science and Technology | Jorum E.,University of Oslo | And 3 more authors.

Objective: To investigate the presence of small nerve fiber dysfunction in subjects with X-linked adrenoleukodystrophy. Methods: Cross-sectional study in which 11 Norwegian subjects (3 males, 8 females) with X-linked adrenoleukodystrophy, phenotypes ranging from asymptomatic to wheelchair-bound with adrenomyeloneuropathy, were investigated with neurophysiologic studies including EMG, nerve conduction velocities, quantitative sensory testing, tests of autonomic function, and skin biopsy for intraepidermal nerve fiber density measurements. Results: We found small nerve fiber dysfunction in 10 of 11 subjects, increasing with age and more pronounced in males. Low intraepidermal nerve fiber densities were found in 5 of 11 subjects, indicating a loss of thin unmyelinated nerve fibers peripherally. Five of 11 subjects showed small nerve fiber dysfunction despite normal nerve fiber densities, suggesting possible involvement of the spinothalamic tracts. Two subjects showed moderate abnormalities in autonomic function tests. Conclusions: Evidence of small nerve fiber dysfunction was widespread in this cohort of subjects with X-linked adrenoleukodystrophy, with findings indicating loss of peripheral small nerve fibers and possibly also fibers of the spinothalamic tracts. The results support the theory of primary axonal degeneration in adrenomyeloneuropathy. Evidence of nervous system involvement was found in all heterozygotes, with severity increasing with age. Clinicians caring for these patients should be alert to signs of small nerve fiber involvement. © 2014 American Academy of Neurology. Source

Silsand L.,University Hospital of Northern Norway | Ellingsen G.,Arctic University of Norway
Proceedings of the ACM Conference on Computer Supported Cooperative Work, CSCW

Clinical Decision Support (CDS) Systems are considered crucial for diagnosis, treatment and care of patients. However, practical benefits of such systems have been far below expectations. This paper explores how the evolving interdependencies in organizational, clinical, political, and behavioral terms influence the design and implementation of CDS. The paper discusses how these interdependencies complicate clinical use of CDS where cross-departmental patient pathways increasingly dominate approaches to dealing with patients with complex conditions. Empirically, we report from an acute geriatric patient pathway project. The aim was to design and implement a decision-support form for triage of elderly patients in the emergency unit. The study emphasizes the intertwined collaborative nature of healthcare work, and the resulting need to consider the whole context when designing and implementing CDS tools. The contribution is to emphasize the "extended design" perspective to capture how workplace technologies and practices are shaped across multiple contexts and prolonged periods. © 2016 ACM. Source

Fagerli K.M.,Deprtment of Rheumatology | Lie E.,Deprtment of Rheumatology | Van Der Heijde D.,Deprtment of Rheumatology | Van Der Heijde D.,Leiden University | And 6 more authors.
Annals of the Rheumatic Diseases

Background: Tumour necrosis factor inhibitors (TNFi) are efficacious in patients with psoriatic arthritis (PsA), but some patients do not respond or do not tolerate their first TNFi, and are switched to a different TNFi. Evidence supporting this practice is limited, and we wanted to investigate the effectiveness of switching to a second TNFi. Material and methods: From a longitudinal observational study (LOS) we selected patients with PsA who were starting their first TNFi, and identified patients who had switched to a second TNFi ('switchers'). Three-month responses and 3-year drug-survival were compared between switchers and non-switchers, and within switchers. Results: Switchers (n=95) receiving their second TNFi had significantly poorer responses compared with non-switchers (n=344) (ACR50 response: 22.5% vs 40.0%, DAS28 remission: 28.2% vs 54.1%). There was a trend towards poorer responses to the second TNFi compared with the first TNFi within switchers. Estimated 3-year drug-survival was 36% for the second TNFi compared with 57% for the first TNFi overall. Conclusions: 20-40% of patients had a response on a second TNFi after having failed one TNFi in this LOS. This observation highlights the need for treatments with other mechanisms of action than TNF inhibition in patients with PsA. Source

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