Privatsykehuset Haugesund

Die drucklose Messung der akustischen Immittanz (PLAI) ist eine neuartige Technologie, die frequenzbereichsbezogene, drucklose Messungen im offenen äußeren Gehörgang ermöglicht. Sie erfasst mehrere Parameter, darunter die Resonanzfrequenz und den Peak der Admittanz. Ziel: Ziel [zum vollständigen Text gelangen Sie über die oben angegebene URL]

AimsPatients with heart failure (HF) have increased risk of sudden cardiac death, and treatment with an implantable cardioverter defibrillator (ICD) has become standard treatment for selected patient groups. HF is associated with impaired quality of life (QoL), but studies on QoL in patients with HF and ICD attending follow-up in outpatient HF clinics is sparse. Hence, this study aimed to determine QoL over time in patients with HF with and without ICD using data from the first visit (baseline) and follow-up visit in 42 outpatient HF clinics.Methods and resultsLongitudinal real-world data from the National Norwegian Heart Failure Registry including 9274 patients, of which 1206 with ICD, were studied. QoL was assessed using the Minnesota Living with Heart Failure Questionnaire. Patients with ICD were younger, more often men, and had a higher frequency of coronary artery disease (all P < 0.001). At the first visit, no significant difference in QoL was found between patients with HF with and without ICD, and both groups had significant improvement in QoL from the first to the follow-up visit (P < 0.001). However, patients with HF and ICD reported significantly less improvement (P < 0.001).ConclusionQoL in patients with ICD improves after follow-up in an outpatient HF clinic, although not to the same extent as in patients without ICD. Thus, tailored interventions through a combined HF-ICD care programme are needed to improve QoL in this subgroup of patients with both HF and ICD.

ABSTRACTObjectivesTo report oral health‐related quality of life (OHRQoL) in a sample rehabilitated with dental implants and assess the influence of self‐reported implant complications and clinical peri‐implant status. A secondary aim was to investigate associations between OHIP‐14 scores and patient‐related variables.Materials and MethodsThe Norwegian National Insurance Scheme registry for implant rehabilitation in 2014 was searched, and patients (n = 3083) were mailed a survey including OHIP‐14, questions about peri‐implant status, and patient‐related variables. A subsample was examined clinically (n = 242). Associations of self‐reported implant complications and clinical peri‐implant status with OHIP‐14 scores were evaluated by the Kruskal–Wallis test and logistic regression models.ResultsThe OHIP‐14 mean sum score reported by the 1299 survey respondents was 4.1 (± 6.4). Self‐report of complications was associated with higher OHIP‐14 scores in a dose‐dependent manner. Lower education (OR 1.54, 95% CI 1.05–2.22), female sex (OR 1.75, 95% CI 1.23–2.56), technical complication(s) (OR 1.58, 95% CI: 1.07–2.34), biological complication(s) (OR 2.41, 95% CI 1.67–3.49) and poor cleansability (OR 2.94, 95% CI 1.64–5.37) were associated (p < 0.05) with higher OHIP‐14 mean sum scores in the adjusted regression model. For the 242 patients examined clinically, the OHIP‐14 mean sum score was 3.8 (± 6.5). Peri‐implant soft tissue dehiscence (OR 2.53, 95% CI 1.17–5.49) was associated with higher OHIP‐14 mean sum scores in the adjusted regression model.ConclusionsOHIP‐14 scores were low in this study, indicating good OHRQoL following implant rehabilitation in Norway. Complications lowered OHRQoL in a dose–response manner, confirmed by self‐reports of complications and by the presence of peri‐implant soft tissue dehiscence.

Aligning biomarker evidence with clinical presentation in early Alzheimer disease (AD) is essential for improving diagnosis, prognosis, and interventions. This study evaluates the relationship between cognitive impairment, future decline, and phosphorylated tau levels in plasma and CSF in predementia AD. This longitudinal observational study included predementia cases and controls from 2 independent cohorts: the Norwegian Dementia Disease Initiation (DDI) and Canadian Pre-Symptomatic Evaluation of Experimental or Novel Treatments for Alzheimer's Disease (PREVENT-AD). In DDI, cognitively normal (CN) and mild cognitive impairment (MCI) cases were classified using CSF Aβ42/40 ratio (A) and p-tau181 (T), whereas classification in PREVENT-AD (A) was based on amyloid PET scans. In DDI, we assessed CSF-plasma correlations for p-tau181, p-tau217, and p-tau231. Diagnostic accuracies were evaluated through receiver operating characteristic analyses. Linear mixed models evaluated p-tau associations with future memory decline. Between-group differences in plasma p-tau217 were assessed in both cohorts. In DDI (n = 431), participants were classified as CN A-/T- (n = 169), A+/T- (CN = 26, MCI = 24), A+/T+ (CN = 40, MCI = 105), and A-/T+ (CN = 34, MCI = 33), with a mean age of 64.1 years and 55.9% female. In PREVENT-AD (n = 190), participants were categorized as CN A- (n = 118), CN A+ (n = 49), and MCI A+ (n = 21), with a mean age of 67.8 years and 72.6% female. In DDI, plasma p-tau217 showed high accuracy in identifying A+ participants (areas under the curve [AUC]: 0.85) and a moderate correlation with CSF p-tau217 (rho = 0.65, p < 0.001). Diagnostic accuracy of plasma p-tau217 was greater in MCI A+ (AUC: 0.89) than in CN A+ (AUC: 0.79, p < 0.05) and in A+/T+ (AUC: 0.88) vs A+/T- (AUC: 0.78, p < 0.05). p-Tau181 and p-tau231 had weaker CSF-plasma correlations (rho = 0.47 and rho = 0.32, p < 0.001) and were less associated with cognitive status in A+ individuals. Higher plasma p-tau217 in A+ MCI vs A+ CN individuals (p < 0.001) was confirmed in PREVENT-AD. All CSF p-tau markers, but only plasma p-tau217, were associated with future memory decline (β = 0.05, p < 0.05). Our findings suggest that, unlike p-tau181 and p-tau231, plasma p-tau217 consistently aligns with cognitive status in A+ individuals and better reflects CSF biomarker abnormalities, reducing discrepancies between clinical and biochemical findings. Its association with baseline and future memory decline highlights its diagnostic and prognostic value, particularly when CSF analysis or PET is unavailable.

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.

Abstract Hospital building projects are highly complex and involve many different stakeholders. The physical lay-out of a hospital will affect the ability of healthcare personnel to perform their work and have consequences for patient safety, hence the involvement of end-users is crucial for project success. The inclusion and translation of perspectives and needs of end-users require a well-organized project planning process, with end-user involvement at every stage. However, earlier studies on end-user involvement are primarily based on the perspectives of designers, architects, contractors, facility and/or hospital management. This paper explores end-user involvement in a hospital building process from the end-user perspective in order to identify what barriers end-users face and concrete measures to overcome them. Data stems from interviews with 37 end-users of a hospital building project in Norway. The findings indicate that clarifying the role and level of end-user involvement, introducing a more agile and less fragmented project development strategy, interdisciplinary team building, and facilitation of input and feedback into project groups, are areas that can improve the value added by end-user involvement.

Cold-antibody mediated autoimmune hemolytic anemia (cAIHA) is subclassified as cold agglutinin disease (CAD), secondary cold agglutinin syndrome (CAS), and paroxysmal cold hemoglobinuria (PCH). This review aims to address the occurrence of neoplastic disorders with these three entities and analyze the impact of such neoplasias on treatment for cAIHA. "Primary" CAD is a distinct clonal B-cell lymphoproliferative disorder in probably all cases, although not classified as a malignant lymphoma. CAS is secondary to malignant lymphoma in a minority of cases. Recent findings allow a further clarification of these differential diagnoses and the therapeutic consequences of specific neoplastic entities. Appropriate diagnostic workup is critical for therapy in cAIHA. Patients with CAD should be treated if they have symptomatic anemia, significant fatigue, or bothersome circulatory symptoms. The distinction between CAD and CAS and the presence of any underlying malignancy in CAS have essential therapeutic implications.

BackgroundEMIT-1 is a national, observational, single-arm trial designed to assess the value of the Prosigna, Prediction Analysis of Microarray using the 50 gene classifier (PAM50)/Risk of Recurrence (ROR), test as a routine diagnostic tool, examining its impact on adjuvant treatment decisions, clinical outcomes, side-effects and cost-effectiveness. Here we present the impact on treatment decisions.Patients and methodsPatients with hormone receptor-positive, human epidermal growth factor receptor 2-negative pT1-pT2 lymph node-negative early breast cancer (EBC) were included. The Prosigna test and standard histopathology assessments were carried out. Clinicians’ treatment decisions were recorded before (pre-Prosigna) and after (post-Prosigna) the Prosigna test results were disclosed.ResultsOf 2217 patients included, 2178 had conclusive Prosigna results. The pre-Prosigna treatment decisions were: no systemic treatment (NT) in 27% of patients, endocrine treatment alone (ET) in 38% and chemotherapy (CT) followed by ET (CT + ET) in 35%. Post-Prosigna treatment decisions were 25% NT, 51% ET and 24% CT + ET, respectively. Adjuvant treatment changed in 28% of patients, including 21% change in CT use. Among patients assigned to CT + ET pre-Prosigna, 45% were de-escalated to ET post-Prosigna. Of patients assigned to ET, 12% were escalated to CT + ET and 8% were de-escalated to NT; of those assigned to NT, 18% were escalated to ET/CT + ET. CT was more frequently recommended for patients aged ≤50 years. In the subgroup with pT1c-pT2 G2 and intermediate Ki67 (0.5-1.5× local laboratory median Ki67 score), the pre-Prosigna CT treatment decision varied widely across hospitals (3%-51%). Post-Prosigna, the variability of CT use was markedly reduced (8%-24%). The correlation between Ki67 and ROR score within this subgroup was poor (r = 0.25-0.39). The median ROR score increased by increasing histological grade, but the ROR score ranges were wide (for G1 0-79, G2 0-90, G3 16-94).ConclusionThe Prosigna test result changed adjuvant treatment decisions in all EBC clinical risk groups, markedly decreased the CT use for patients categorized as higher clinical risk pre-Prosigna and reduced treatment decision discrepancies between hospitals.