Helse Møre og Romsdal HF

Background and objectivesPersistent headache has emerged as a symptom following acute COVID-19 and, to a lesser extent, after SARS-CoV-2 vaccination. However, the underlying mechanisms remain poorly understood. This study aimed to evaluate plasma levels of amyloid-related biomarkers in patients experiencing persistent headaches after COVID-19 or SARS-CoV-2 vaccination.MethodsIn this prospective observational cohort, patients presenting with severe headache as the dominating symptom after COVID-19 (n=29) or SARS-CoV-2 vaccination (n=31) had neurological assessments with reassessments after 6 months. Plasma levels of amyloid precursor protein (APP), pregnancy zone protein (PZP), cathepsin L1 (CTSL) and serum Amyloid A (SAA1) were measured using ELISA and compared with levels in healthy controls (n=16).ResultsWe found a strong and persistent upregulation of APP in patients with headache after COVID-19 as compared with the two other groups. Notably, APP levels remained elevated at both inclusion and after 6 months in individuals with accompanying cognitive symptoms. In contrast, PZP levels were increased in patients with headache after SARS-CoV-2 vaccination at both time points relative to healthy controls. CTSL was only elevated in the post-COVID-19 at baseline, whereas SAA1 showed levels comparable across all groups.ConclusionAltered plasma levels of soluble markers, potentially reflecting changes in amyloid processing, were found in patients with persistent headache following SARS-CoV-2 vaccine, particularly in those with persistent headache after COVID-19. In the latter group, we also found some association with cognitive symptoms.Trial registration numbersNCT04576351 and NCT05235776.

PurposeBloodstream infections (BSI) and sepsis are important causes of hospitalization, loss of health, and death globally. Targetable risk factors need to be identified to improve prevention and treatment. In this study, we aimed to evaluate the association of chronic kidney disease (CKD) and risk of and mortality from BSI and sepsis in the general population during a 22-year period.MethodsWe conducted a prospective cohort study among participants in the population-based Norwegian HUNT Study, where 68,438 participated. The median follow-up time was 17.4 years. The exposures were estimated glomerular filtration rate (eGFR) and albumin–creatinine ratio (ACR) in urine. The outcomes were hazard ratios (HR) of hospital admission or death due to BSI or sepsis. The associations were adjusted for age, sex, diabetes, obesity, systolic blood pressure, smoking status, and cardiovascular disease.ResultsParticipants with eGFR < 30 ml/min/1.732 had HR 3.35 for BSI (95% confidence intervals (CI) 2.12–5.3) and HR 2.94 for sepsis (95% CI 1.82–4.8) compared to normal eGFR (≥ 90 ml/min/1.732). HRs of death from BSI and sepsis were 4.2 (95% CI 1.71–10.4) and 4.1 (95% CI 1.88–8.9), respectively. Participants with severely increased albuminuria (ACR > 30 mg/mmol) had HR 3.60 for BSI (95% CI 2.30–5.6) and 3.14 for sepsis (95% CI 1.94–5.1) compared to normal albumin excretion (ACR < 3 mg/mmol). HRs of death were 2.67 (95% CI 0.82–8.7) and 2.16 (95% CI 0.78–6.0), respectively.ConclusionIn this large population-based cohort study, CKD was clearly associated with an increased risk of BSI and sepsis and related death.

Lyme disease after a tick bite often presents as erythema migrans, yet less frequent variants of this disease, such as Borrelia lymphocytoma, multiple erythema migrans and neuroborreliosis, are also seen occasionally. We report a case of a tick-bitten child who first presented with an indistinct macular erythema around the left eye and a more distinct macular erythema on and around the left ear. The next day, she developed a facial palsy. The case was interpreted as facial multiple erythema migrans and Borrelia lymphocytoma on the ear, followed by neuroborreliosis. The diagnosis of lymphocytoma was made from clinical findings and PCR of skin biopsy. She recovered quickly after intravenous ceftriaxone and is now healthy.

This chapter addresses the complex, cross-border ’Kurdish question’, framing Kurdistan as a contact zone, as defined by Mary Pratt. It posits that the contact zone concept is particularly relevant to understanding the transboundary nature of the ‘Kurdish question’ and the political dynamics of Kurdistan. This relevance is demonstrated through an examination of Iraq during the 1980s and Turkey after 2015, providing insights into the applicability and significance of the contact zone concept in these contexts. Furthermore, the chapter highlights instances where state policies within a contact zone may intentionally seek to dismantle the social space entirely. In such scenarios, we encounter ‘death zones’ rather than contact zones. This is because a contact zone inherently requires the presence of a social space where different cultures meet and engage with one another.

Abstract PurposeStudies on aetiology of community-acquired pneumonia (CAP) vary in terms of microbial sampling methods, anatomical locations, and laboratory analyses, since no gold standard exists. In this large, multicentre, retrospective, regional study from Norway, our primary objective was to report the results of a strategic diagnostic stewardship intervention, targeting diagnostic yield from lower respiratory tract sampling. The secondary objective was to report in-hospital CAP aetiology and the diagnostic yield of various anatomical sampling locations.MethodsMedical records from cases diagnosed with in-hospital CAP were collected retrospectively from March throughout May for three consecutive years at six hospitals. Between year one and two, we launched a diagnostic stewardship intervention at the emergency room level for the university teaching hospital only. The intervention was multifaceted aiming at upscaling specimen collection and enhancing collection techniques. Year one at the interventional hospital and every year at the five other emergency hospitals were used for comparison.ResultsOf the 1280 included cases of in-hospital CAP, a microbiological diagnosis was established for 29.1 % among 1128 blood cultures and 1444 respiratory tract specimens. Blood cultures were positive for a pathogenic respiratory tract microbe in 4.9 % of samples, whereas upper and lower respiratory tract samples overall provided a probable microbiological diagnosis in 21.3 % and 47.5 %, respectively. Expectorated or induced sputum overall provided aetiology in 51.7 % of the samples. At the interventional hospital, diagnostic yield from expectorated or induced sputum was significantly enhanced from 41.2 % to 62.0 % after the intervention. Non-typeable Haemophilus influenza and Streptococcus pneumoniae accounted for 25.3 % and 24.7 % of microbiologically confirmed cases, respectively.ConclusionExpectorated or induced sputum outperformed other sampling methods in providing a reliable microbiological diagnosis for in-hospital CAP. A diagnostic stewardship intervention significantly improved diagnostic yield of lower respiratory tract sampling.

Studiens hensikt var å finne ut om samarbeidsdager mellom studenter, praksisveiledere og praksislærere kan gi læring som har betydning for studentenes utvikling av klinisk kompetanse. Stedet, rommet og sosiale samspill har betydning for læreprosesser, ifølge Etienne Wenger og Kari Martinsen. «Det tredje rommet» er brukt som en metafor om rommet der mennesker med kompetanse i teoretisk kunnskap og praksiskunnskap møtes sammen med studenter. Samarbeidsdager mellom studenter, praksisveiledere og praksislærere ble gjennomført for fire andreårs studentgrupper (N=23). Fokusgruppeintervju ble brukt for å samle inn data. De transkriberte intervjuene ble analysert gjennom meningsfortetning basert på Amedeo Giorgis fenomenologiske analysemetode. Essensen fra studentenes erfaringer fra samarbeidsdagene er at «Det tredje rommet» er en trygg arena der studentenes kliniske kompetanse ble stimulert og økt. Fire temaer beskriver studentenes erfaring: praksisforberedthet, trygghet, refleksjon og samarbeidslæring. Et styrket samarbeid mellom akademia og helseforetak gjennom arbeidsfellesskap i «Det tredje rommet» kan fremme sykepleiestudenters læring.&#x0D; Abstract&#x0D; Is a common learning arena a "Room of Possibility” that gives nursing students increased clinical competence?&#x0D; The aim of the study was to find out whether collaboration days between students, practice supervisors and nurse teachers can provide learning that facilitates students' development of clinical competence. The place, space and social interaction are important for learning processes, according to Etienne Wenger and Kari Martinsen. "The Third Room" is used as a metaphor about the room where people with competence in theoretical knowledge and practical knowledge collaborate with students. Collaboration days between students, practical nurse supervisors and nurse teachers were conducted for four second-year student groups (N=23). Focus groups were used to collect data. The transcribed interviews have been analyzed through meaning condensation. An essential structure of the students 'experiences from the collaboration days describes The Third Room as a good arena where the students' clinical competence was stimulated and increased. Four themes describe the student’s experiences; preparedness for practice, confidence, reflection and collaborative learning. A strengthened collaboration between universities and hospitals through working communities in The Third Room can facilitate nursing students' learning.

Most patients with endometrial cancer with localized disease are effectively treated and survive for a long time. The primary treatment is hysterectomy, to which surgical staging procedures may be added to assess the need for adjuvant therapy. Longitudinal data on patient-reported outcomes comparing different levels of primary treatment are lacking, especially when adjuvant radiotherapy is omitted. We assessed the impact of lymphadenectomy and adjuvant chemotherapy on patient-reported symptoms, function, and quality of life. We hypothesized that these treatment modalities would substantially affect patient-reported outcomes at follow-up. We prospectively included patients with endometrial cancer enrolled in the ongoing MoMaTEC2 study (ClinicalTrials.gov Identifier: NCT02543710). Patients were asked to complete the patient-reported outcome questionnaires European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire EN24 preoperatively and at 1 and 2 years of follow-up. Functional domains and symptoms were analyzed for the whole cohort and by treatment received. To assess the effect of the individual treatment modifications, we used mixed regression models. Baseline data were available for 448 patients. Of these patients, 339 and 219 had reached 1-year follow-up and 2-year follow-up, respectively. Treatment included hysterectomy (plus bilateral salpingo-oophorectomy) alone (n=177), hysterectomy and lymph node staging without adjuvant therapy (n=133), or adjuvant chemotherapy irrespective of staging procedure (n=138). Overall, patients reported improved global health status and quality of life (+9 units; P<.001), increased emotional and social functioning, and increased sexual interest and activity (P<.001 for all) from baseline to year 1, and these outcomes remained stable at year 2. Means of functional scales and quality of life were similar to age- and sex-weighted reference cohorts. Mean tingling and numbness and lymphedema increased after treatment. The group who received adjuvant chemotherapy had a larger mean reduction in physical functioning (-6 vs+2; P=.002) at year 1, more neuropathy (+30 vs+5; P<.001; year 1) at years 1 and 2, and more lymphedema at year 1 (+11 vs+2; P=.007) than the group treated with hysterectomy and salpingo-oophorectomy only. In patients not receiving adjuvant chemotherapy, patient-reported outcomes were similar regardless of lymph node staging procedures. Adjuvant chemotherapy independently increased fatigue, lymphedema, and neuropathy in mixed regression models. Patients with endometrial cancer receiving adjuvant chemotherapy reported significantly reduced functioning and more symptoms up to 2 years after treatment. For patients treated by surgery alone, surgical staging did not seem to affect the quality of life or symptoms to a measurable degree at follow-up. Therefore, subjecting patients to lymph node removal to tailor adjuvant therapy seems justified from the patient's viewpoint; however, efforts should increase to find alternatives to traditional chemotherapy.

ObjectiveThe purpose of this study was to identify important functional problems among individuals with shoulder pain using the Patient-Specific Functional Scale (PSFS) and to investigate differences between individuals receiving primary care and individuals receiving secondary care.MethodsIn this cross-sectional study located in a primary and secondary care outpatient clinic, a total of 177 individuals seeking care for shoulder pain (84 from primary care and 93 from secondary care) were recruited. Background variables, pain, physical activity, and PSFS responses were collected using a questionnaire software package. Meaningful concepts were linked from the PSFS responses to the International Classification of Functioning, Disability and Health (ICF) according to established rules. Frequencies for the ICF categories were estimated separately for primary care and secondary care. Differences between primary care and secondary care were investigated by calculating CIs for the sample proportions at ICF chapter level.ResultsThe primary care sample reported functional problems linked to 226 ICF categories, whereas the secondary care sample reported functional problems linked to 337 ICF categories. Of the linked ICF categories, 87.7% belonged to the Activities and Participation component of the ICF. Seventeen categories were identified in >3% of the individuals; of those, the most frequent categories were recreation and leisure, lifting and carrying objects, doing housework, hand and arm use, and remunerative employment. Categories included in the ICF chapters of self-care and domestic life were significantly more frequent in the secondary care sample, whereas there was a trend that neuromusculoskeletal and movement-related functions were more frequent in primary care.ConclusionThe present findings indicate that individuals with shoulder pain report a wide range of functional problems, from basic functions related to mobility to activities related to work and leisure. This study also discovered differences between patients in primary care and secondary care. The large variation in the experiences between people supports the use of an individualized measure in assessments.ImpactThis study adds new knowledge about problems in functioning among people with shoulder pain and how the individual experience varies between primary care and secondary care settings. Moreover, the content analyses used in this study showed the full potential of the ICF classification and should have potential for further application.