Hospital of Southern Norway

The COVID-19 pandemic necessitated innovative approaches to medical education. This proposed a particular challenge for the teaching of practical skills, such as ultrasound (US) training. This study compared the effectiveness of traditional classroom-based US training with that of remote training using teleguided US (Tele-US) among students in the Prehospital Critical Care (PHCC) program at the University of Stavanger, Norway. A total of 44 students were divided into two groups: one received standard classroom training, and the other received remote training because of pandemic restrictions. Both groups underwent a comprehensive one-day US course, including theoretical lectures and hands-on training sessions. Pre-course and post-course tests were used to assess theoretical knowledge, image and video interpretation skills, practical scanning techniques, and clinical decision-making. There was no significant difference in educational outcomes between the tele-US and classroom groups across all areas of evaluation. Tele-US appears to be a viable alternative to traditional classroom-based US education, especially in contexts requiring physical distancing or in geographically remote settings. Not applicable.

PurposeTo determine the incidence and treatment strategy for patellar instability in the Norwegian healthcare system.MethodsClinicians from all regional health regions were invited to contribute to the development of a cross‐sectional survey of the current national clinical practices for managing this patient group. A tailored questionnaire was developed to determine how many hospitals in Norway performed patellar stabilization surgery and which surgical procedures and postoperative routines were used. Specifically, the following variables were included: number of procedures performed in 2023, types of procedures, treatment of children, choice of graft for primary MPFL reconstruction, routine use of orthoses and postoperative restrictions.ResultsA survey was conducted among 68 hospitals, of which 35 reported performing patellar stabilisation procedures. The total number of procedures recorded was 532, yielding an incidence rate of 9.6 per 100,000 people. The number of procedures varied significantly among hospitals, with most performing between five and 20. All hospitals conducted medial patellofemoral ligament reconstruction, while 28 included bony procedures, and only seven performed derotational osteotomies. The preferred graft was gracilis (89%), and the most common fixation method on the femur was intrerference screw (60%). Postoperatively, only 20% of hospitals routinely recommended orthoses, primarily after tibial tuberosity osteotomy (86%). Restrictions on knee flexion were advised by 86% of respondents for up to eight weeks, and weight‐bearing restrictions were recommended by all after tibial tuberosity osteotomy.ConclusionsThis study offers an overview of patellar instability incidence and treatment in Norway, revealing significant variability in surgeries, procedures, restrictions, and follow‐up practices. This underscores the need for standardized guidelines and a national registry to improve patient outcomes and care quality. Future research should focus on evaluating long‐term outcomes of various surgical approaches and protocols to inform best practices.Level of EvidenceLevel III.

Digestive high-grade neuroendocrine neoplasms (HG-NEN) are rare and classified as neuroendocrine carcinomas (NEC) or neuroendocrine tumours G3 (NET G3), and differ in clinical and molecular characteristics, response to treatment and prognosis. Prospective multicenter study registering clinical data on patients with digestive HG-NEN. Treatment outcome in patients with advanced disease was compared after centralized pathological re-evaluation. 427 NEC and 117 NET G3 received palliative chemotherapy. Immediate progression rate was 41% and 24%, progression-free survival (PFS) 3.4 m and 7.4 m, overall survival (OS) 7.4 m and 21.8 m for NEC and NET G3, respectively. Significant factors for OS in NEC were performance status (PS), Ki-67 > 55%, alkaline phosphatase (ALP), age, sex and for PFS colorectal primary and PS. NEC Ki-67 < 55% had similar OS comparing treatment. Significant factors for OS in NET G3 were platinum-based treatment, PS, age and ALP, and for PFS platinum-based treatment. Survival was shorter than expected in this unique population-based cohort of advanced digestive HG-NEN, likely due to inclusion of elderly and patients with poor PS. Several novel prognostic factors were identified for NEC and NET G3. An initial sub-effective platinum-based treatment for NET G3 could not be compensated by later-line treatment.

Preterm neonates are at risk for neurodevelopmental impairments, and there is a need to identify protective factors that can modify the harmful effects of preterm birth on the immature brain. To evaluate whether immediate skin-to-skin contact (SSC) for preterm neonates improves early childhood neurodevelopmental outcomes. This open-label randomized clinical trial was conducted in 3 Norwegian neonatal units between February 2014 and October 2020. Participants were preterm neonates born at 28 weeks 0 days' to 31 weeks 6 days' gestation with birth weight greater than 1000 g and no major congenital malformations or need for intubation or oxygen supplementation of more than 40%. Intention-to-treat analysis was conducted from July 2023 to July 2024. Neonates were randomized 1:1 to immediate SSC between mother and neonate in the delivery room for 2 hours or to standard care with direct transport to the neonatal unit in an incubator. The primary outcome was cognitive development at 2 to 3 years of age, measured by the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III). Secondary outcomes were language and motor neurodevelopment measured by the BSID-III, parental questionnaires at 3 and 12 months and 2 to 3 years, and breastfeeding practices up to 12 months. Of 108 included neonates (68 [63%] male; mean [SD] gestational age, 30 weeks 3 days [1 week 1 day]), 51 received SSC and 57 received standard care. Eighty-six (80%) had follow-up at 2 to 3 years, and 81 (75%) completed the BSID-III and were analyzed for the primary outcome. The mean difference in BSID-III cognitive composite scores was 0.21 (95% CI, -5.26 to 5.68; P = .94). There was no difference between the groups in the proportion at risk of developmental delay at 2 to 3 years: 21 of 41 (51%) and 22 of 45 (49%) in the SSC and standard care groups, respectively (odds ratio, 1.10 [95% CI, 0.47-2.56]; P = .83). More neonates in the SSC group were breastfed at hospital discharge (42 of 50 [84%] vs 36 of 54 [67%]; P = .04). In this randomized clinical trial, 2 hours of mother-neonate SSC in the delivery room did not enhance neurodevelopmental outcomes at 2 to 3 years of age. However, the SSC group demonstrated improved breastfeeding practices up to 12 months compared with standard care, suggesting that the feasible and low-cost SSC intervention should be encouraged in clinical practice. ClinicalTrials.gov Identifier: NCT02024854.

BackgroundImpaired impulse control is often seen in Parkinson’s disease (PD) patients using dopamine agonists.MethodsWe performed a therapeutic drug monitoring study of 100 PD patients using ropinirole or pramipexole extended release. Three blood samples were collected on the same day. Serum concentrations were measured, and 24 h area under the curve (AUC) calculated. The validated Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease-Rating Scale (QUIP-RS) was used for assessing impulse control.ResultsTotal ropinirole drug exposure showed weak, but significant correlation to the QUIP-RS score. No correlation between pramipexole serum concentrations and QUIP-RS was found. In ropinirole patients, both agonist dose and total dopaminergic treatment were correlated with QUIP-RS. Duration of ropinirole treatment correlated with impaired impulse control, and duration of dopaminergic treatment of any type correlated with QUIP-RS scores in both ropinirole and pramipexole patients.ConclusionsOur main finding is that impaired impulse control is correlated to both total drug exposure (AUC) and dopamine agonist dose for ropinirole, but not for pramipexole. These observations indicate that different strategies may be useful for treating PD patients with impaired impulse control: ropinirole dose reduction could be beneficial, whereas pramipexole treatment may have to be stopped.

BackgroundTo provide evidence-based, up-to-date recommendations for physicians in primary and specialist healthcare setting in diagnosing and treating patients with polymyalgia rheumatica (PMR).MethodsThe PMR working group conducted a narrative review of the available evidence in the field and wrote the draft guidelines. These guidelines were discussed and revised according to the standard operating procedures within the Norwegian Society of Rheumatology. The European Alliance of Associations for Rheumatology (EULAR) and American College of Rheumatology (ACR) recommendations for the management of PMR, the British Society for Rheumatology (BSR) guidelines for the management for PMR, the treat-to-target recommendations in giant cell arteritis and PMR and the 2023 recommendations for early referral of individuals with suspected polymyalgia rheumatica were used in particular for purpose of harmonization.ResultsA total of 10 recommendations have been formulated covering initial diagnostic investigations, comorbidity assessment, imaging, specialist referral criteria, treatment involving glucocorticoids and steroid-sparing agents and follow-up care.ConclusionNorwegian recommendations for diagnostics and treatment to improve management and outcome in patients with PMR were developed.

The clinical utility of regional strain measurements in echocardiography is challenged by suboptimal reproducibility. In this study, we aimed to evaluate the test-retest reproducibility of regional longitudinal strain (RLS) per coronary artery perfusion territory (RLSTerritory) and basal-to-apical level of the left ventricle (RLSLevel), measured by a novel fully automated deep learning (DL) method based on point tracking. We measured strain in a dual-centre test-retest data set that included 40 controls and 40 patients with suspected non-ST elevation acute coronary syndrome. Two consecutive echocardiograms per subject were recorded by different operators. The reproducibility of RLSTerritory and RLSLevel measured by the DL method and by three experienced observers using semi-automatic software (2D Strain, EchoPAC, GE HealthCare) was evaluated as minimal detectable change (MDC). The DL method had MDC for RLSTerritory and RLSLevel ranging from 3.6 to 4.3%, corresponding to a 33-35% improved reproducibility compared with the inter- and intraobserver scenarios (MDC 5.5-6.4% and 4.9-5.4%). Furthermore, the DL method had a lower variance of test-retest differences for both RLSTerritory and RLSLevel compared with inter- and intraobserver scenarios (all P < 0.001). Bland-Altman analyses demonstrated superior reproducibility by the DL method for the whole range of strain values compared with the best observer scenarios. The feasibility of the DL method was 93% and measurement time was only 1 s per echocardiogram. The novel DL method provided fully automated measurements of RLS, with improved test-retest reproducibility compared with semi-automatic measurements by experienced observers. RLS measured by the DL method has the potential to advance patient care through a more detailed, more efficient, and less user-dependent clinical assessment of myocardial function.