Nordland Hospital Trust

The aim of this study was to analyze the survival outcomes in different time periods (recent, 2016-2024; earlier, 2007-2015; historical, before 2007) for patients with brain metastasis managed with surgical resection and postoperative radiotherapy. Major changes in systemic therapy over time were hypothesized to translate into better survival. A retrospective analysis was performed that included 174 patients, largely with single brain metastasis and Karnofsky performance status (KPS) 80-100. Uni- and multivariate analyses of actuarial overall survival were performed. Three significant prognostic factors for survival emerged: KPS, primary tumor control, and administration of systemic therapy after treatment of brain metastasis. In all patients, and also those who received systemic therapy after treatment for brain metastasis, survival remained similar (median of 16 months) for all three time periods (recent, earlier, historical). In patients with controlled primary tumor, survival increased from 17.5 (historical) to 35.8 months, p=0.01. Patients with resected and postoperatively irradiated brain metastasis benefited from additional systemic therapy. Only one subgroup experienced major survival prolongation in more recent years: those with controlled primary tumor. Therefore, efforts to optimize primary tumor control, such as surgery and radical radiotherapy, may play an important role in multimodal treatment paradigms.

IntroductionParental mental illness is a major public health issue across the globe with well-known intergenerational impacts on children. There is a wide body of evidence supporting the effectiveness of a range of interventions supporting families, however, their implementation has rarely been sustained across public health systems. Systemic change is an important part of workforce development and known to be crucial to embed and sustain practice, policy and structural initiatives in services for families. While much is known about the barriers to implementing family focused approaches within organizations and systems, less is known about how systems change occurs and what supports systems change to improve outcomes for families.MethodsThis study uses a Delphi method, with 103 experts from 17 countries participating to identify systems change factors from their own experience and to build consensus about key strategies required across the globe to support systems change in health, education, social welfare and mental health services.ResultsThe findings identify that systems change can be defined as any workforce, policy, legislation or other mental health promotion strategy that collectively contributes to improving outcomes for parents with mental illness, their children and their families. A systems approach to improve outcomes for families where a parent has a mental illness requires partnerships and collaboration between services and sectors affecting families (mental health, welfare, primary health, education, social care, public health), social and health policy development, and families themselves. Success in system change requires a focus on change at all levels of the system for momentum building, leadership support, the use of relevant data and reporting mechanisms, establishing practice competency and collaborative care, and being able to reflect and adapt to changing conditions and structural barriers.DiscussionA focus on system change for supporting families where a parent has a mental illness appears to require the combination of many strategies and factors, with international approaches to knowledge sharing imperative to support implementing, resourcing and sustaining change.

The impact of surgical complications is substantial and multifaceted, affecting patients and their families, surgeons, and health care systems. Despite the remarkable progress in artificial intelligence (AI), there remains a notable gap in the prospective implementation of AI models in surgery that use real-time data to support decision-making and enable proactive intervention to reduce the risk of surgical complications. This scoping review aims to assess and analyze the adoption and use of AI models for preventing surgical complications. Furthermore, this review aims to identify barriers and facilitators for implementation at the bedside. Following PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines, we conducted a literature search using IEEE Xplore, Scopus, Web of Science, MEDLINE, ProQuest, PubMed, ABI, Embase, Epistemonikos, CINAHL, and Cochrane registries. The inclusion criteria included empirical, peer-reviewed studies published in English between January 2013 and January 2025, involving AI models for preventing surgical complications (surgical site infections, and heart and lung complications or stroke) in real-world settings. Exclusions included retrospective algorithm-only validations, nonempirical research (eg, editorials or protocols), and non-English studies. Study characteristics and AI model development details were extracted, along with performance statistics (eg, sensitivity and area under the receiver operating characteristic curve). We then used thematic analysis to synthesize findings related to AI models, prediction outputs, and validation methods. Studies were grouped into three main themes: (1) duration of hypotension, (2) risk for complications, and (3) decision support tool. Of the 275 identified records, 19 were included. The included models frequently demonstrated strong technical accuracy with high sensitivity and area under the receiver operating characteristic curve, particularly among studies evaluating decision support tools. However, only a few models were adopted routinely in clinical practice. Two studies evaluated the clinicians' perceptions regarding the use of AI models, reporting predominantly positive assessments of their usefulness. Overall, AI models hold potential to predict and prevent surgical complications as the validation studies demonstrated high accuracy. However, implementation in routine practice remains limited by usability barriers, workflow misalignment, trust concerns, and financial and ethical constraints. The evidence included in this scoping review was limited by the heterogeneity in study design and the predominance of small-scale feasibility studies, particularly for hypotension prediction. Future research should prioritize prospectively validated models that use other physiologic features and address clinicians' concerns regarding generalizability and adoption.

The presence of brain metastasis is often associated with clinical symptoms and reduced quality-of life scores, potentially triggering palliative care needs. Previous studies have employed the Edmonton symptom assessment system (ESAS) to this end. However, contemporary patient-reported ESAS data from cohorts managed with different radiotherapy techniques rather than whole-brain radiotherapy (WBRT) alone are scarce. Therefore, the aim of this study was to compare ESAS symptom severity before WBRT to that before stereotactic radiosurgery or fractionated radiotherapy (SRS/FSRT). This was a retrospective analysis (2013-2024, n=102) of patients with brain metastasis assessed with ESAS in routine clinical practice in Norway. Patients were stratified based on radiotherapy approach (WBRT±boost versus SRS/FSRT). ESAS scores of 0 correspond to absence of symptoms (maximum intensity: 10). For the whole study group, fatigue and overall wellbeing scores were highest (mean 3.9 and 3.4, respectively). The lowest scores were those for nausea and constipation (mean 1.2 and 1.4, respectively). Within the WBRT cohort, no significant differences were observed between ESAS scores of boost versus no boost patients. When comparing WBRT to SRS/FSRT, we found that WBRT patients reported significantly higher anxiety scores (mean 2.6 vs. 1.1, p=0.03). Similar trends emerged for fatigue (mean 4.1 vs. 2.7, p=0.056, i.e., not significant) and overall wellbeing (mean 3.7 vs. 2.5, p=0.087). The sum of symptom scores was significantly higher in the WBRT cohort (mean 31.7), compared to the SRS/FSRT cohort (mean 18.5), p=0.03. When employing ESAS screening to provide additional palliative care services to patients with brain metastasis who start radiotherapy, clinicians should be aware of the fact that patients undergoing WBRT may have worse symptom burden and higher needs than patients undergoing SRS/FSRT. This is particularly evident for anxiety, fatigue and overall wellbeing, and not explained by differences in number of brain metastasis and diagnostic setting (regular imaging surveillance versus clinical trigger).

BackgroundProlonged neurological symptoms following COVID-19 are common, yet few longitudinal studies describe brain MRI findings in this patient group. The use of contrast enhanced sequences is particularly lacking. We address this knowledge gap by reporting the frequency and longitudinal changes in brain MRI findings among patients with post COVID-19 condition exhibiting neurological symptoms.MethodsThis prospective multicenter study included 140 adult patients referred for persistent neurological symptoms following COVID-19. Brain MRI was performed at both 6 and 12 months after infection onset, reporting white matter hyperintensities, cerebral microbleeds, and additional pathological findings including contrast enhancement. White matter hyperintensities were compared with a healthy control group.ResultsThe prevalence of white matter hyperintensities was comparable to healthy controls, and microbleeds were found at rates comparable to population studies, with longitudinal changes being infrequent. Lesions consistent with inflammation or demyelination were present in 4% (5/120) of patients at 6 months. Cranial nerve enhancement was found in 7% (7/94) of patients, persisting up to 12 months, predominantly affecting the oculomotor nerve. However, enhancement occurred without clinically detected ocular muscle paresis.ConclusionOur findings indicate that brain MRI primarily serves to exclude differential diagnoses in post COVID-19 condition, with limited clinical benefit of repeated imaging in the absence of new symptoms. However, signs of long-term inflammatory processes can be observed, and detection is improved by contrast enhanced sequences.

Background: The Advanced Life Support guidelines (AHA, ERC) emphasize immediate resumption of chest compressions for 2 minutes after defibrillation for ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT). In the presence of undetected return of spontaneous circulation (ROSC), chest compressions may increase the risk of recurrent VF. Aim: To evaluate whether the novel, continuous, hands-free carotid Doppler ultrasound system, RescueDoppler, can detect successful defibrillation by identifying post-shock blood flow velocities indicative of ROSC. Research Questions: Can RescueDoppler reliably detect carotid blood flow immediately following defibrillation? Methods: Patients with pre- and in-hospital cardiac arrests are included from an ongoing multi-center study. The RescueDoppler probe was positioned over the left carotid artery by the cardiac arrest team. The team was blinded to the real-time ultrasound data. ECG recordings (Corpuls, Zoll, Lifepak) were synchronized with pulse-wave Doppler measurements of carotid blood flow velocity and analyzed using MATLAB. Informed consent was obtained post- cardiac arrest from relatives or the patient. ROSC was determined by observing post-shock ECG-synchronous carotid blood flow-velocity curves. The interval from shock to onset of peak systolic velocity (PSV) was measured. Results: Thirteen cardiac arrest patients (7 men; mean age 71.1 ± 11.7 years) were included, treated either pre-hospital (n=4) or in-hospital (n=9). Causes were cardiac (n=8), trauma, pulmonary embolism, hypothermia, hyperkalemia (each n=1), and one unknown. Initial rhythms were VF (n=5), pulseless electrical activity (n=3), asystole (n=3), and pVT (n=2). A total of 36 shocks (1–12 per patient) were analyzed. Spontaneous circulation—either systolic-flow-only or full temporary ROSC (systolic and diastolic flow)—was observed in 12 patients, with a median shock-to-PSV time of 154 ms (IQR: 107–604) (Figure 1-2). One patient showed no carotid flow post-shock (Figure 3). Chest compressions resumed at a median (IQR) of 3.2 (2.5–4.4) seconds post-shock. Sustained ROSC was achieved in 8 patients, but only one survived to 30 days. Conclusions: Hands-free, continuous monitoring of carotid blood flow may immediately detect ROSC, or the absence of blood flow following defibrillation. RescueDoppler could help identify successful defibrillation and delay resumption of chest compressions, potentially reducing the risk of recurrent arrhythmias.

Background The literature lacks user-based knowledge of young and midlife stroke survivors. This study aims to explore these survivors’ experiences regarding the interplay between bodily changes, everyday life and self-perception. Methods Stroke survivors were recruited in collaboration with Norwegian Vision in Stroke via closed online support networks, and participated in in-depth interviews. Data were transcribed and analysed via Malterud’s Systematic Text Condensation, informed by Gallagher’s Pattern Theory of Self, which includes bodily, interactional and environmental factors. Results Ten participants (aged 22–62 years, median age 42, IQR 30–49.75), 2–5 years post-stroke (IQR 4–5), were included. To main themes emerged: (1) The unfamiliar body: participants perceived visible and invisible bodily alterations, including sensory and motor disturbances, fatigue and changed appearance. These changes lead to bodily unreliability, heightened bodily awareness, negative emotions, reduced attractiveness and self-worth. (2) Re-orientation in everyday life: Persistent focus on bodily disturbances dominated daily life, resulting a focus on limitations and a withdrawn, home-centred lifestyle. Directing attention to the present, engaging in successful activities and discovering new life perspectives fostered a positive self-perception and enhanced everyday coping. Conclusions Impairments following stroke disrupt young and midlife persons self-perceptions as these bodily disturbances necessitate changes in their self-pattern, involving bodily, contextual and interactional factors. Therefore, reorganisation of self should be integrated into rehabilitation by addressing these factors tailored to the individual.