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Uleberg B, Bønaa KH, Govatsmark RES, Olsen F, Jacobsen BK, Stensland E, Hauglann B, Vonen B, Førde OH. Exploring variation in timely reperfusion treatment in ST-segment elevation myocardial infarction in Norway: a national register-based cohort study. BMJ Open 2024; 14:e081301. [PMID: 38367969 PMCID: PMC10875564 DOI: 10.1136/bmjopen-2023-081301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/02/2024] [Indexed: 02/19/2024] Open
Abstract
OBJECTIVES This study aimed to investigate determinants of reperfusion within recommended time limits (timely reperfusion) for ST-segment elevation myocardial infarction patients, exploring the impact of geography, patient characteristics and socio-economy. DESIGN National register-based cohort study. SETTING Multilevel logistic regression models were applied to examine the associations between timely reperfusion and residency in hospital referral areas and municipalities, patient characteristics, and socio-economy. PARTICIPANTS 7607 Norwegian ST-segment elevation myocardial infarction patients registered in the Norwegian Registry of Myocardial Infarction during 2015-2018. MAIN OUTCOME MEASURES The odds of timely reperfusion by primary percutaneous coronary intervention (PCI) or fibrinolysis. RESULTS Among 7607 ST-segment elevation myocardial infarction patients in Norway, 56% received timely reperfusion. The Norwegian goal is 85%. While 81% of the patients living in the Oslo hospital referral area received timely reperfusion, only 13% of the patients living in Finnmark did so.Patients aged 75-84 years had lower odds of timely reperfusion than patients below 55 years of age (OR 0.73, 95% CI 0.61 to 0.87). Patients with moderate or high comorbidity had lower odds than patients without (OR 0.81, 95% CI 0.68 to 0.95 and OR 0.61, 95% CI 0.44 to 0.84). More than 2 hours from symptom onset to first medical contact gave lower odds than less than 30 min (OR 0.63, 95% CI 0.54 to 0.72). 1-2 hours of travel time to a PCI centre (OR 0.39, 95% CI 0.31 to 0.49) and more than 2 hours (OR 0.22, 95% CI 0.16 to 0.30) gave substantially lower odds than less than 1 hour of travel time. CONCLUSIONS The varying proportion of patients receiving timely reperfusion across hospital referral areas implies inequity in fundamental healthcare services, not compatible with established Norwegian health policy. The importance of travel time to PCI centre points at the expanded use of prehospital pharmacoinvasive strategy to obtain the goals of timely reperfusion in Norway.
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Affiliation(s)
- Bård Uleberg
- Department of Community Medicine, UiT The Arctic University of Norway Faculty of Health Sciences, Tromso, Norway
- Centre for Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health Authority, Bodo, Norway
| | - Kaare Harald Bønaa
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology Faculty of Medicine and Health Sciences, Trondheim, Norway
- Clinic for Heart Disease, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway
| | - Ragna Elise Støre Govatsmark
- Department of Medical Quality Registers, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway
- Department of Public Health and Nursing, Norwegian University of Science and Technology Faculty of Medicine and Health Sciences, Trondheim, Norway
| | - Frank Olsen
- Centre for Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health Authority, Bodo, Norway
| | - Bjarne K Jacobsen
- Department of Community Medicine, UiT The Arctic University of Norway Faculty of Health Sciences, Tromso, Norway
- Centre for Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health Authority, Bodo, Norway
| | - Eva Stensland
- Department of Community Medicine, UiT The Arctic University of Norway Faculty of Health Sciences, Tromso, Norway
- Centre for Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health Authority, Bodo, Norway
| | - Beate Hauglann
- Centre for Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health Authority, Bodo, Norway
| | - Barthold Vonen
- Department of Community Medicine, UiT The Arctic University of Norway Faculty of Health Sciences, Tromso, Norway
- Centre for Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health Authority, Bodo, Norway
| | - Olav Helge Førde
- Department of Community Medicine, UiT The Arctic University of Norway Faculty of Health Sciences, Tromso, Norway
- Centre for Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health Authority, Bodo, Norway
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Olsen F, Uleberg B, Jacobsen BK, Heuch I, Tande PM, Bugge E, Balteskard L. Socioeconomic and geographic differences in ablation of atrial fibrillation in Norway - a national cohort study. BMC Public Health 2022; 22:303. [PMID: 35164725 PMCID: PMC8842863 DOI: 10.1186/s12889-022-12628-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this study was to analyse whether there are patient related or geographic differences in the use of catheter ablation among atrial fibrillation patients in Norway. Methods National population-based data on individual level of all Norwegians aged 25 to 75 diagnosed with atrial fibrillation from 2008 to 2017 were used to study the proportion treated with catheter ablation. Survival analysis, by Cox regression with attained age as time scale, separately by gender, was applied to examine the associations between ablation probability and educational level, income level, place of residence, and follow-up time. Results Substantial socioeconomic and geographic variation was documented. Atrial fibrillation patients with high level of education and high income were more frequently treated with ablation, and the education effect increased with increasing age. Patients living in the referral area of St. Olavs Hospital Trust had around three times as high ablation rates as patients living in the referral area of Finnmark Hospital Trust. Conclusions Differences in health literacy, patient preference and demands are probably important causes of socioeconomic variation, and studies on how socioeconomic status influences the choice of treatment are warranted. Some of the geographic variation may reflect differences in ablation capacity. However, geographic variation related to differences in clinical practice and provider preferences implies a need for clearer guidelines, both at the specialist level and at the referring level. Supplementary Information The online version contains supplementary material available at (10.1186/s12889-022-12628-9).
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Affiliation(s)
- Frank Olsen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway. .,Centre for Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health Authority, Tromsø, Norway.
| | - Bård Uleberg
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.,Centre for Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health Authority, Tromsø, Norway
| | - Bjarne K Jacobsen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.,Centre for Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health Authority, Tromsø, Norway.,Centre for Sami Health Research, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ivar Heuch
- Department of Mathematics, University of Bergen, Bergen, Norway
| | - Pål M Tande
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
| | - Einar Bugge
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.,Centre for Clinical Research and Education, University Hospital of North Norway, Tromsø, Norway
| | - Lise Balteskard
- Centre for Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health Authority, Tromsø, Norway
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Olsen F, Jacobsen BK, Heuch I, Tveit KM, Balteskard L. Equitable access to cancer patient pathways in Norway - a national registry-based study. BMC Health Serv Res 2021; 21:1272. [PMID: 34823515 PMCID: PMC8613926 DOI: 10.1186/s12913-021-07250-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 10/29/2021] [Indexed: 11/13/2022] Open
Abstract
Background In 2015, cancer patient pathways (CPP) were implemented in Norway to reduce unnecessary non-medical delay in the diagnostic process and start of treatment. The main aim of this study was to investigate the equality in access to CPPs for patients with either lung, colorectal, breast or prostate cancer in Norway. Methods National population-based data on individual level from 2015 to 2017 were used to study two proportions; i) patients in CPPs without the cancer diagnosis, and ii) cancer patients included in CPPs. Logistic regression was applied to examine the associations between these proportions and place of residence (hospital referral area), age, education, income, comorbidity and travel time to hospital. Results Age and place of residence were the two most important factors for describing the variation in proportions. For the CPP patients, inconsistent differences were found for income and education, while for the cancer patients the probability of being included in a CPP increased with income. Conclusions The age effect can be related to both the increasing risk of cancer and increasing number of GP and hospital contacts with age. The non-systematic results for CPP patients according to income and education can be interpreted as equitable access, as opposed to the systematic differences found among cancer patients in different income groups. The inequalities between income groups among cancer patients and the inequalities based on the patients’ place of residence, for both CPP and cancer patients, are unwarranted and need to be addressed. Supplementary Information The online version contains supplementary material available at (10.1186/s12913-021-07250-1).
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Affiliation(s)
- Frank Olsen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway. .,Centre for Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health Authority, Tromsø, Norway.
| | - Bjarne K Jacobsen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.,Centre for Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health Authority, Tromsø, Norway.,Centre for Sami Health Research, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ivar Heuch
- Department of Mathematics, University of Bergen, Bergen, Norway
| | - Kjell M Tveit
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lise Balteskard
- Centre for Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health Authority, Tromsø, Norway
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Abstract
OBJECTIVES To assess the impact of parental educational level on hospital admissions for children, and to evaluate whether differences in parents' educational level can explain geographic variation in admission rates. DESIGN National cohort study. SETTING The 18 hospital referral areas for children in Norway. PARTICIPANTS All Norwegian children aged 1-16 years in the period 2008-2016 and their parents. MAIN OUTCOME MEASURES Age- and gender-adjusted admission rates and probability of admission. RESULTS Of 1 538 189 children, 156 087 (10.2%) had at least one admission in the study period. There was a nearly twofold (1.9) variation in admission rates between the hospital referral areas (3113 per 100 000 children, 95% CI: 3056 to 3169 vs 1627, 95% CI: 1599 to 1654). Area level variances in multilevel analysis did not change after adjusting for parental level of education. Children of parents with low level of education (maternal level of education, low vs high) had the highest admission rates (2016: 2587, 95% CI: 2512 to 2662 vs 1810, 95% CI: 1770 to 1849), the highest probability of being admitted (OR: 1.18, 95% CI: 1.16 to 1.20), the highest number of admissions (incidence rate ratio: 1.05, 95% CI: 1.01 to 1.10) and admissions with lower cost (-0.5%, 95% CI: -1.2% to 0.3%). CONCLUSIONS Substantial geographic variation in hospital admission rates for children was found, but was not explained by parental educational level. Children of parents with low educational level had the highest admission probability, and the highest number of admissions, but the lowest cost of admissions. Our results suggest that the variation between the educational groups is not due to differences in medical needs, and may be characterised as unwarranted. However, the manner in which health professionals communicate and interact with parents with different educational levels might play an important role.
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Affiliation(s)
- Frank Olsen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Centre for Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health Authority, Tromsø, Norway
| | - Lise Balteskard
- Centre for Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health Authority, Tromsø, Norway
| | - Bård Uleberg
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Centre for Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health Authority, Tromsø, Norway
| | - Bjarne K Jacobsen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Centre for Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health Authority, Tromsø, Norway
- Centre for Sami Health Research, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ivar Heuch
- Department of Mathematics, University of Bergen, Bergen, Norway
| | - Atle Moen
- Department of Neonatology, Oslo University Hospital, Oslo, Norway
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Brainin P, Lindberg S, Olsen F, Pedersen S, Iversen A, Galatius S, Fritz-Hansen T, Gislason G, Soegaard P, Moegelvang R, Biering-Soresen T. Prognostic utility of early systolic lengthening by speckle tracking in patients undergoing coronary artery bypass graft. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Independent Research Fund Denmark
Background
Early systolic lengthening (ESL), a paradoxical stretch of myocardial fibers, has been linked to myocardial viability and contractile dysfunction. We assessed the long-term prognostic potential of ESL in coronary artery bypass graft (CABG) patients.
Methods
We retrospectively included patients (n = 709; mean age 68 years; 85% men) who underwent speckle tracking echocardiography (median 15 days) prior to CABG. Endpoints were cardiovascular death (CVD) and all-cause mortality. We assessed amplitude of ESL (%), defined as peak positive strain, and duration of ESL (ms), determined as time from Q-wave on the ECG to peak positive strain. We applied Cox proportional hazards models adjusted for the clinical risk tool, EuroSCORE II.
Results
During median follow-up of 3.8 years [IQR 2.7 to 4.9 years], 45 (6%) experienced CVD and 80 (11%) died. In survival analyses adjusted for EuroSCORE II, amplitude of ESL was associated with CVD (HR 1.37 [95%CI 1.13 to 1.66], P = 0.001) and all-cause mortality (HR 1.31 [95%CI 1.13 to 1.54], P = 0.001). Similar findings applied to duration of ESL and CVD (HR 1.17 [95%CI 1.08 to 1.26], P < 0.001) and all-cause mortality (HR 1.14 [95%CI 1.07 to 1.21], P < 0.001). The prognostic value of ESL amplitude was modified by sex (P interaction < 0.05), such that it was greater in women for both endpoints (Figure 1A-B). When adding ESL duration to EuroSCORE II, the net reclassification index improved significantly for both CVD and all-cause mortality.
Conclusions
Assessment of ESL provides independent and incremental prognostic information in addition to the EuroSCORE II for CVD and all-cause mortality in CABG patients. The prognostic value was greater in women.
Abstract Figure. Prognostic value of ESL amplitude by sex
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Affiliation(s)
- P Brainin
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - S Lindberg
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - F Olsen
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - S Pedersen
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - A Iversen
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - S Galatius
- Bispebjerg University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - T Fritz-Hansen
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - G Gislason
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - P Soegaard
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - R Moegelvang
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
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Rasmussen S, Olsen F, Pedersen S, Lindberg S, Nochioka K, Magnusson N, Bjerre M, Iversen K, Pareek M, Gislason G, Biering-Soerensen T. P4628A multiple biomarker approach for risk assessment after ST-segment elevation myocardial infarction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.1010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Several biomarkers independently predict outcome following ST-segment elevation myocardial infarction (STEMI). We hypothesized that combining information from multiple circulating biomarkers with numerous pathophysiological pathways may improve biomarker risk stratification following a STEMI.
Method
This was a prospective study of 735 patients with STEMI treated with primary percutaneous coronary intervention. Seventeen biomarkers were drawn before revascularization, including adrenalin, noradrenalin, C-reactive protein (CRP), neutrophil gelatinase-associated lipocalin (NGAL), pro-atrial natriuretic peptide (pro-ANP), alfa-defensin, adiponectin, troponin I, hemoglobin, thrombocyte, and total leukocyte count. The primary outcome was a composite of cardiovascular death or heart failure (CVD/HF) identified by national registries. In the effort to identify the best model, the population was randomly split into two equally sized groups, a derivation cohort and a validation cohort. We used classification and regression tree (CART) analysis to develop a risk model. The identified risk model was hereafter applied to the whole cohort.
Results
Mean age was 63 years, 74% were male and 33% had hypertension. During a median follow-up time of 5.0 years (3.2; 5.0), we observed 185 primary events. After including all biomarkers in the initial model, the CART analysis created a risk model including pro-ANP, NGAL, and CRP (Figure 1a). The risk of CVD/HF increased incrementally with increasing risk group (Figure 1b). The risk remained significantly higher in groups 3 and 4 after multivariable adjustments (hazard ratio (HR)=3.38 [95% confidence interval (CI): 1.60; 7.16] p=0.001 and HR=6.55 [95% CI: 2.73; 15.76] p<0.001, respectively) when compared with group 1.
Figure 1
Conclusion
We developed a risk model based on multiple biomarkers (NGAL, CRP, and pro-ANP) determined from a CART analysis which may ease risk stratification after STEMI.
Acknowledgement/Funding
Sif Rasmussen received a scholarship grant from Herlev & Gentofte Hospital and the P. Carl Petersens Fond during preparation of this manuscript.
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Affiliation(s)
- S Rasmussen
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - F Olsen
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - S Pedersen
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - S Lindberg
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - K Nochioka
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicin, Sendai, Japan
| | - N Magnusson
- Aarhus University, Department of Clinical Medicine, Aarhus, Denmark
| | - M Bjerre
- Aarhus University, Department of Clinical Medicine, Aarhus, Denmark
| | - K Iversen
- Herlev Hospital - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - M Pareek
- Hillerod Hospital, Department of Cardiology, Hillerod, Denmark
| | - G Gislason
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
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Søreide K, Nymo LS, Kleive D, Olsen F, Lassen K. Variation in use of open and laparoscopic distal pancreatectomy and associated outcome metrics in a universal health care system. Pancreatology 2019; 19:880-887. [PMID: 31395453 DOI: 10.1016/j.pan.2019.07.047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/16/2019] [Accepted: 07/31/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Universal health care (UHC) should ensure equal access to and use of surgery, but few studies have explored variation in UHC systems. The objective was to describe practice of distal pancreatectomy in Norway covered exclusively by an UHC. METHODS Data on all patients undergoing distal pancreatectomy from the Norwegian Patient Register over a 5-year period. Age- and gender-adjusted population-based resection rates (adj. per million/yr) for distal pancreatectomy were analysed across 4 regions and outcomes related to splenic salvage rate, hospital stay, reoperation, readmissions and 90-day mortality risk between regions. Risk is reported as odds ratio (OR) with 95% confidence interval (c.i.). RESULTS Regional difference exist in terms of absolute numbers, with the majority of procedures done in one region (n = 331; 59.7%). Regional variation persisted for age- and gender-adjusted population-rates, with highest rate at 23.8/million/yr and lowest rate at 13.5/mill/yr (for a 176% relative difference; or an absolute difference of +10.3 resections/million/yr). Overall, a lapDP instead of an open DP was 3.5 times more likely in SouthEast compared to all other regions combined (lapDP rate: 83% vrs 24%, respectively; OR 15.4, 95% c.i. 10.1-23.5; P < 0.001). The splenic salvage rate was lower in SouthEast (19.9%) compared to all other regions (average 26.5%; highest in Central-region at 37.0%; P = 0.010 for trend). Controlled for other factors in multivariate regression, 'region' of surgery remained significantly associated with laparoscopic access. CONCLUSION Despite a universal health care system, considerable variation exists in resection rates, use of laparoscopy and splenic salvage rates across regions.
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Affiliation(s)
- Kjetil Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | - Linn S Nymo
- Department of Gastrointestinal Surgery, University Hospital of Northern Norway, Tromsø, Norway; Institute of Clinical Medicine, the Arctic University of Norway, Tromsø, Norway
| | - Dyre Kleive
- Department of Hepatobiliary and Pancreatic surgery, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Frank Olsen
- Centre for Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health Authority, Tromsø, Norway
| | - Kristoffer Lassen
- Institute of Clinical Medicine, the Arctic University of Norway, Tromsø, Norway; Department of Hepatobiliary and Pancreatic surgery, Oslo University Hospital, Oslo, Norway
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Farley JE, McKenzie-White J, Bollinger R, Hong H, Lowensen K, Chang LW, Stamper P, Berrie L, Olsen F, Isherwood L, Ndjeka N, Stevens W. Evaluation of miLINC to shorten time to treatment for rifampicin-resistant Mycobacterium tuberculosis. Int J Tuberc Lung Dis 2019; 23:980-988. [PMID: 31615604 DOI: 10.5588/ijtld.18.0503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Achieving the 90-90-90 targets for tuberculosis (TB) will require interventions that enhance diagnosis, linkage, treatment and adherence to care. As a first step in the process, our team designed a suite of smartphone applications known as miLINC to improve time from diagnosis to treatment initiation in drug-resistant TB patients.SETTING: Three clinical locations in a large, peri-urban district in KwaZulu-Natal, South Africa.OBJECTIVE: To assess the acceptability, feasibility and impact of the miLINC mobile health applications as a solution to reducing the time from presentation to treatment initiation of rifampicin-resistant (RR) TB patients.METHODS: We used a prospective, observational quality improvement evaluation of miLINC's impact among newly diagnosed patients with RR-TB.RESULTS: A convenience sample comprising details of 6341 patients with presumptive TB were entered into miLINC. Of the 631 TB-positive sputum specimens, 41 (6.5%) were found to be RR-TB. The mean time from clinical presentation to RR-TB treatment initiation was 3 days, 21 h, 17 min.CONCLUSION: This is the first study to suggest that the time from presentation to diagnosis and to treatment initiation for patients with RR-TB can be significantly improved using an integrated approach combining technology with appropriate human resources.
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Affiliation(s)
- J E Farley
- REACH Initiative, Johns Hopkins University School of Nursing, Baltimore, MD, Department of Community Public Health, Johns Hopkins University School of Nursing, Baltimore, MD
| | - J McKenzie-White
- Johns Hopkins Center for Clinical Global Health Education, Baltimore, MD, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - R Bollinger
- Johns Hopkins Center for Clinical Global Health Education, Baltimore, MD, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - H Hong
- REACH Initiative, Johns Hopkins University School of Nursing, Baltimore, MD, Department of Community Public Health, Johns Hopkins University School of Nursing, Baltimore, MD
| | - K Lowensen
- REACH Initiative, Johns Hopkins University School of Nursing, Baltimore, MD, Department of Community Public Health, Johns Hopkins University School of Nursing, Baltimore, MD
| | - L W Chang
- Johns Hopkins Center for Clinical Global Health Education, Baltimore, MD, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - P Stamper
- REACH Initiative, Johns Hopkins University School of Nursing, Baltimore, MD, Department of Community Public Health, Johns Hopkins University School of Nursing, Baltimore, MD
| | - L Berrie
- National Health Laboratory Service, National Priority Programs Unit, Johannesburg
| | - F Olsen
- National Health Laboratory Service, National Priority Programs Unit, Johannesburg
| | - L Isherwood
- National Health Laboratory Service, National Priority Programs Unit, Johannesburg
| | - N Ndjeka
- South African National Department of Health, Pretoria
| | - W Stevens
- National Health Laboratory Service, National Priority Programs Unit, Johannesburg, University of the Witwatersrand, School of Clinical Medicine, Johannesburg, South Africa
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Søreide K, Olsen F, Nymo LS, Kleive D, Lassen K. A nationwide cohort study of resection rates and short-term outcomes in open and laparoscopic distal pancreatectomy. HPB (Oxford) 2019; 21:669-678. [PMID: 30391219 DOI: 10.1016/j.hpb.2018.10.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 09/10/2018] [Accepted: 10/07/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Distal pancreatectomy (DP) is increasingly done by laparoscopy but data from routine practise are scarce. We describe practise in a national cohort. METHODS Data from the Norwegian Patient Register of all patients undergoing DP from 2012 to 2016. National resection rates were analysed. Short-term outcomes include length of stay, reoperation, readmissions and 90-day mortality. Risk is reported as odds ratio (OR) with 95% confidence interval (c.i.). RESULTS Of 554 procedures, 327 (59%) were laparoscopic. Median age was 66 years (iqr 55-72) and 52% were women. Resection rates increased during the period for all DP (from 1.76 to 2.39 per 100.000/yr), and significantly for laparoscopic DP (adjusted R-square 0.858; P = 0.015). Elderly patients had more resection (r2 = 0.11; P = 0.019). Splenectomy (n = 427; 77%) was less likely with laparoscopy (laparoscopy 72% vs open 84%, respectively; OR 0.64, 95% c.i. 0.42-0.97; P = 0.035). Multivisceral resections occurred more often in open DP (5.3% vs 1.2% for laparoscopy, OR 4.51, 1.44-14.2; P = 0.008). Reoperation occurred in 34 (6%), readmission in 109 (20%), and mortality in 8 (1.4%). Hospital stay was shorter for laparoscopic DP. CONCLUSION Use of DP increases in the population, particularly in the elderly, with use of laparoscopic access and an association with a reduced hospital stay.
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Affiliation(s)
- Kjetil Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway; Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, UK; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | - Frank Olsen
- Centre for Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health Authority, Tromsø, Norway
| | - Linn S Nymo
- Department of Gastrointestinal Surgery, University Hospital of Northern Norway, Tromsø, Norway; Institute of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
| | - Dyre Kleive
- Department of Hepatobiliary and Pancreatic Surgery, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kristoffer Lassen
- Institute of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway; Department of Hepatobiliary and Pancreatic Surgery, Oslo University Hospital, Oslo, Norway
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Nymo LS, Søreide K, Kleive D, Olsen F, Lassen K. The effect of centralization on short term outcomes of pancreatoduodenectomy in a universal health care system. HPB (Oxford) 2019; 21:319-327. [PMID: 30297306 DOI: 10.1016/j.hpb.2018.08.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/21/2018] [Accepted: 08/29/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Centralization of pancreatic resections is advocated due to a volume-outcome association. Pancreatic surgery is in Norway currently performed only in five teaching hospitals. The aim was to describe the short-term outcomes after pancreatoduodenectomy (PD) within the current organizational model and to assess for regional disparities. METHODS All patients who underwent PD in Norway between 2012 and 2016 were identified. Mortality (90 days) and relaparotomy (30 days) were assessed for predictors including demographic data and multi-visceral or vascular resection. Aggregated length-of-stay and national and regional incidences of the procedure were also analysed. RESULTS A total of 930 patients underwent PD during the study period. In-hospital mortality occurred in 20 patients (2%) and 34 patients (4%) died within 90 days. Male gender, age, multi-visceral resection and relaparotomy were independent predictors of 90-day mortality. Some 131 patients (14%) had a relaparotomy, with male gender and multi-visceral resection as independent predictors. There was no difference between regions in procedure incidence or 90-day mortality. There was a disparity within the regions in the use of vascular resection (p = 0.021). CONCLUSION The short-term outcomes after PD in Norway are acceptable and the 90-day mortality rate is low. The outcomes may reflect centralization of pancreatic surgery.
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Affiliation(s)
- Linn S Nymo
- Department of Gastrointestinal Surgery, University Hospital of Northern Norway, Sykehusveien 38, 9019, Tromsø, Norway; Institute of Clinical Medicine, The Arctic University of Norway, Hansine Hansens Veg 18, 9019, Tromsø, Norway.
| | - Kjetil Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Postboks 8100, 4068, Stavanger, Norway; Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, 51 Little France Cres, Edinburgh, EH16 4SA, UK; Department of Clinical Medicine, University of Bergen, Jonas Lies Vei 65, 5021, Bergen
| | - Dyre Kleive
- Department of Hepatobiliary and Pancreatic Surgery, Oslo University Hospital, Postboks 4950 Nydalen, 0424, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Problemveien 7, 0315, Oslo, Norway
| | - Frank Olsen
- Centre for Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health Authority, Sykehusveien 38, 9019, Tromsø, Norway
| | - Kristoffer Lassen
- Department of Gastrointestinal Surgery, University Hospital of Northern Norway, Sykehusveien 38, 9019, Tromsø, Norway; Institute of Clinical Medicine, The Arctic University of Norway, Hansine Hansens Veg 18, 9019, Tromsø, Norway; Department of Hepatobiliary and Pancreatic Surgery, Oslo University Hospital, Postboks 4950 Nydalen, 0424, Oslo, Norway
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11
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Lassen K, Nymo LS, Olsen F, Brudvik KW, Fretland ÅA, Søreide K. Contemporary practice and short-term outcomes after liver resections in a complete national cohort. Langenbecks Arch Surg 2018; 404:11-19. [PMID: 30519886 DOI: 10.1007/s00423-018-1737-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 11/27/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Improved outcome after liver resections have been reported in several series, but outcomes from national cohorts are scarce. Our aim was to evaluate nationwide practice and short-term outcomes after liver surgery in a universal healthcare system. METHODS A complete 5-year cohort of all liver resections from the Norwegian Patient Registry (NPR). Short-term outcomes were aggregated length of stay (a-LoS), reoperation and 90-day mortality. RESULTS Of 2118 liver resections, 605 (28.6%) were major, median age was 65 years and 1184 (55%) were male. Most common indication was metastatic disease (n = 1554; 73.4%) and primary malignancy (n = 328; 15.3%). Laparoscopy was performed in 513 (33.9%) of minor and 37 (6.1%) of major liver resections and increased over time to 39.1% of minor resections in 2016. Median a-LoS was 12 days for major resections, 8 days for open minor and 3 days for laparoscopic minor resections. Reoperation was reported for 159 (7.4%) and 90-day mortality for 44 (2.1%). Primary malignancy, male gender, elderly patients and major resections were associated with poorer outcome. CONCLUSIONS In a national cohort, laparoscopy is used for a substantial proportion of minor resections and was associated with reduced a-LoS. Risk factors for reoperation and mortality were male gender, increased age and major resection for primary malignancy.
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Affiliation(s)
- Kristoffer Lassen
- Department of HPB Surgery, Oslo University Hospital at Rikshospitalet, Sognsvannsveien 20, 0372, Oslo, Norway. .,Department of Gastrointestinal Surgery, University Hospital of North Norway, Tromsø, Norway. .,Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway.
| | - Linn Såve Nymo
- Department of Gastrointestinal Surgery, University Hospital of North Norway, Tromsø, Norway.,Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway
| | - Frank Olsen
- Centre for Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health Authority, Bodo, Norway
| | - Kristoffer Watten Brudvik
- Department of HPB Surgery, Oslo University Hospital at Rikshospitalet, Sognsvannsveien 20, 0372, Oslo, Norway
| | - Åsmund Avdem Fretland
- Department of HPB Surgery, Oslo University Hospital at Rikshospitalet, Sognsvannsveien 20, 0372, Oslo, Norway.,The Intervention Centre, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kjetil Søreide
- Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK.,Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
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12
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Lassen K, Nymo LS, Olsen F, Søreide K. Benchmarking of aggregated length of stay after open and laparoscopic surgery for cancers of the digestive system. BJS Open 2018; 2:246-253. [PMID: 30079394 PMCID: PMC6069352 DOI: 10.1002/bjs5.67] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 03/07/2018] [Indexed: 12/15/2022] Open
Abstract
Background Length of hospital stay (LOS) may serve as a surrogate measure of healthcare quality and resource use, particularly when transfers of care and readmissions are accounted for. This study aimed to benchmark true hospital stay by measuring index, transfer and readmission stays across the range of digestive cancer surgery. Methods A cohort study of all patients undergoing resection for cancer of the oesophagus, stomach, liver, pancreas, colon or rectum in 2012–2016 was undertaken. Index LOS, transfer and readmission stays were merged into an ‘aggregated’ length of stay (a‐LOS), and compared between organ sites and between open and minimal‐access approaches. Results In total, 24 354 resections were reported (mean age of patients 68·3 years; 51·3 per cent were men). Resections were reported as laparoscopic for 9151 procedures (37·6 per cent), with a further 283 (3·0 per cent) described as converted to open surgery. Use of a‐LOS compared with standard LOS added a median of 5 days for pancreatoduodenectomy, 4 days for major liver resections, 3 days for oesophageal and gastric resections, and 2 days for minor liver, distal pancreatic and rectal resections. Conclusion Overall hospital stay across organ sites and procedures is better described by a‐LOS. The study benchmarks the use of total hospital days during the first 30 days in a universal healthcare system.
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Affiliation(s)
- K Lassen
- Department of Hepato-Pancreato-Biliary Surgery Oslo University Hospital Oslo Norway.,Department of Gastrointestinal Surgery University Hospital of North Norway Tromsø Norway.,Institute of Clinical Medicine University of Tromsø Tromsø Norway
| | - L S Nymo
- Department of Gastrointestinal Surgery University Hospital of North Norway Tromsø Norway.,Institute of Clinical Medicine University of Tromsø Tromsø Norway
| | - F Olsen
- Centre for Clinical Documentation and Evaluation Northern Norway Regional Health Authority Tromsø Norway
| | - K Søreide
- Department of Clinical Medicine University of Bergen Bergen Norway.,Department of Gastrointestinal Surgery Stavanger University Hospital Stavanger Norway.,Department of Clinical Surgery Royal Infirmary of Edinburgh, and University of Edinburgh Edinburgh UK
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13
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Norum J, Hovland A, Balteskard L, Trovik T, Haug B, Hansen FH, Alterskjær S, Madsen P, Olsen F. Treatment of acute myocardial infarction in the sub-arctic region of Norway. Do we offer an equal quality of care? Int J Circumpolar Health 2017; 76:1391651. [PMID: 29069984 PMCID: PMC5678493 DOI: 10.1080/22423982.2017.1391651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Patients, relatives, healthcare workers and administrators are concerned about the quality of care offered. We aimed to explore the treatment of acute myocatrdial infarction (AMI) in Northern Norway, compare it with the national figures, and document whether there is an equal quality of care or not. The retrospective study included data on patients' treatment for AMI. The following sources were employed. The Norwegian Patient Registry, National Quality of Care Database, Norwegian Myocardial Infarction Registry and data from the National Air Ambulance Services of Norway. The period 2012-2014/15 was studied and the variables were: incidence of AMI, gender and age adjusted rates of AMI and revascularization (PCI, CABG) based on patient's place of living (according to hospital catchment area) and 30-day survival rate. The annual incidence of AMI was 9% higher in the northern region. Significant incidence variations (2.7–5.9 AMI/1000 inhabitants) between the hospitals' catchment areas were revealed. The 30-day survival rate varied between 85.1–92.1% between hospitals. The variation in revascularization/AMI rate was 0.72–1.54. Air amublance services' availability varied through the day. In conclusion, significant variations in the AMI rate and an unequal service within the region was revealed.
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Affiliation(s)
- J Norum
- a Department of Surgery , Finnmark Hospital , Hammerfest , Norway.,b Department of Clinical Medicine, Faculty of Health Science , UiT - The Arctic University of Norway , Tromsø , Norway
| | - A Hovland
- b Department of Clinical Medicine, Faculty of Health Science , UiT - The Arctic University of Norway , Tromsø , Norway.,c Department of Cardiology , Nordland Hospital , Bodø , Norway
| | - L Balteskard
- d Centre for Clinical Documentation and Evaluation , Northern Norway Regional Health Authority trust , Tromsø , Norway
| | - T Trovik
- e Department of Cardiology , University Hospital of North Norway , Tromsø , Norway
| | - B Haug
- f Department of Medicine , Helgeland Hospital , Sandnessjøen , Norway
| | - F H Hansen
- g Northern Norway Regional Health Authority trust , Bodø , Norway
| | - S Alterskjær
- f Department of Medicine , Helgeland Hospital , Sandnessjøen , Norway
| | - P Madsen
- h National Air Ambulance Services of Norway , Bodø , Norway
| | - F Olsen
- d Centre for Clinical Documentation and Evaluation , Northern Norway Regional Health Authority trust , Tromsø , Norway
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14
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Aahlin EK, Olsen F, Uleberg B, Jacobsen BK, Lassen K. Major postoperative complications are associated with impaired long-term survival after gastro-esophageal and pancreatic cancer surgery: a complete national cohort study. BMC Surg 2016; 16:32. [PMID: 27193578 PMCID: PMC4870774 DOI: 10.1186/s12893-016-0149-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 05/11/2016] [Indexed: 02/13/2023] Open
Abstract
Background Some studies have reported an association between complications and impaired long-term survival after cancer surgery. We aimed to investigate how major complications are associated with overall survival after gastro-esophageal and pancreatic cancer surgery in a complete national cohort. Methods All esophageal-, gastric- and pancreatic resections performed for cancer in Norway between January 1, 2008, and December 1, 2013 were identified in the Norwegian Patient Registry together with data concerning major postoperative complications and survival. Results When emergency cases were excluded, there were 1965 esophageal-, gastric- or pancreatic resections performed for cancer in Norway between 1 January 2008, and 1 December 2013. A total of 248 patients (12.6 %) suffered major postoperative complications. Complications were associated both with increased early (90 days) mortality (OR = 4.25, 95 % CI = 2.78–6.50), and reduced overall survival when patients suffering early mortality were excluded (HR = 1.23, 95 % CI = 1.01–1.50). Conclusions Major postoperative complications are associated with impaired long-term survival after gastro-esophageal and pancreatic cancer surgery.
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Affiliation(s)
- Eirik Kjus Aahlin
- Department of GI and HPB surgery, University Hospital of Northern Norway, 9038 Breivika, Tromsø, Norway. .,Department of Clinical Medicine, University of Tromsø - The Arctic University of Norway, Tromsø, Norway.
| | - Frank Olsen
- Centre of Clinical Documentation and Evaluation, Northern Norway Regional Health Authority, Tromsø, Norway
| | - Bård Uleberg
- Centre of Clinical Documentation and Evaluation, Northern Norway Regional Health Authority, Tromsø, Norway
| | - Bjarne K Jacobsen
- Centre of Clinical Documentation and Evaluation, Northern Norway Regional Health Authority, Tromsø, Norway.,Department of Community Medicine, University of Tromsø - The Arctic University of Norway, Tromsø, Norway
| | - Kristoffer Lassen
- Department of GI and HPB surgery, University Hospital of Northern Norway, 9038 Breivika, Tromsø, Norway.,Department of Clinical Medicine, University of Tromsø - The Arctic University of Norway, Tromsø, Norway
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15
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Aahlin EK, Olsen F, Uleberg B, Jacobsen B, Lassen K. Major postoperative complications are associated with impaired long-term survival after upper abdominal cancer surgery: A complete national cohort study. Clin Nutr ESPEN 2016. [DOI: 10.1016/j.clnesp.2016.02.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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16
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Olsen F, Uleberg B, Jacobsen BK, Balteskard L. Norske pasienter med tykktarmskreft kommer for sent i gang med tilleggsbehandling. Tidsskriftet 2016; 136:27-31. [DOI: 10.4045/tidsskr.14.0812] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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17
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Poulsen T, Olsen F, Tsakos M. Npys-Mediated Elimination Reactions of Alcohols and Thiols: A Facile Route to Dehydroalanine and Dehydrobutyrine Building Blocks. Synlett 2015. [DOI: 10.1055/s-0035-1560537] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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18
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Page-Shipp L, Stevens W, Clark D, Scott L, Olsen F, Kisbey-Green H, Mametja D, Churchyard G. Successes, challenges and lessons from a novel deployment of Xpert(®) MTB/RIF at a major South African public event [Short Communication]. Int J Tuberc Lung Dis 2014; 18:438-40. [PMID: 24670699 DOI: 10.5588/ijtld.13.0638] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
In a mobile deployment of Xpert(®) MTB/RIF (Xpert) at the public event for 2012 South African World TB Day, Xpert testing was offered to tuberculosis (TB) symptomatic clients from gold mining and surrounding communities. Considerations before implementation included effective TB symptom screening; safe, effective sputum collection; uninterrupted electricity supply; stringent instrument verification and provision of on-site results. Public event Xpert testing is feasible; however, the case-finding rate was very low (0.7%). We recommend exploring enhanced symptom screening algorithms to improve pre-test probability, cost-effectiveness analysis, exploring alternate electrical fail-safes and on-site data connectivity and improving management of client expectations.
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Affiliation(s)
| | - W Stevens
- National Health Laboratory Service, Johannesburg, South Africa
| | - D Clark
- The Aurum Institute, Johannesburg, South Africa
| | - L Scott
- Department of Molecular Medicine and Haematology, University of the Witwatersrand, Cape Town, South Africa
| | - F Olsen
- National Health Laboratory Service, Johannesburg, South Africa
| | | | - D Mametja
- National Department of Health, Pretoria, South Africa
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19
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Olsen F, Kotyra M, Houltz E, Ricksten SE. Bone cement implantation syndrome in cemented hemiarthroplasty for femoral neck fracture: incidence, risk factors, and effect on outcome. Br J Anaesth 2014; 113:800-6. [PMID: 25031262 DOI: 10.1093/bja/aeu226] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Bone cement implantation syndrome (BCIS) is characterized by hypoxia, hypotension, and loss of consciousness occurring around the time of bone cementation. Using a recently proposed severity classification of BCIS, we estimated the incidence of and risk factors for BCIS and its impact on mortality in cemented hemiarthroplasty for femoral neck fractures. METHODS In this retrospective study, 1016 patients undergoing cemented hemiarthroplasty were included. Medical history and medication were obtained from medical records. Anaesthesia charts for all patients were reviewed for mean arterial pressure, arterial oxygen saturation, and heart rate before, during, and after cementation. Each patient was classified as having no BCIS (grade 0) or BCIS grade 1, 2, or 3, depending on the degree of hypotension, arterial desaturation, or loss of consciousness around cementation. RESULTS The incidence of BCIS grade 1, 2, and 3 were 21%, 5.1%, and 1.7%, respectively. Early mortality in BCIS grade 1 (9.3%) did not differ significantly from BCIS grade 0 (5.2%), while early mortality in BCIS grade 2 (35%) and grade 3 (88%) were significantly higher when compared with grades 0 and 1. Early mortality was also higher in BCIS grade 3 when compared with grade 2. Independent predictors for severe BCIS were: ASA grade III-IV, chronic obstructive pulmonary disease, and medication with diuretics or warfarin. Severe BCIS was associated with 16-fold increase in mortality. CONCLUSIONS BCIS is a commonly occurring phenomenon in cemented hemiarthroplasty and severe BCIS has a huge impact on early and late mortality.
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Affiliation(s)
- F Olsen
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - M Kotyra
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - E Houltz
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - S-E Ricksten
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
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Caiani E, Pellegrini A, Carminati M, Lang R, Auricchio A, Vaida P, Obase K, Sakakura T, Komeda M, Okura H, Yoshida K, Zeppellini R, Noni M, Rigo T, Erente G, Carasi M, Costa A, Ramondo B, Thorell L, Akesson-Lindow T, Shahgaldi K, Germanakis I, Fotaki A, Peppes S, Sifakis S, Parthenakis F, Makrigiannakis A, Richter U, Sveric K, Forkmann M, Wunderlich C, Strasser R, Djikic D, Potpara T, Polovina M, Marcetic Z, Peric V, Ostenfeld E, Werther-Evaldsson A, Engblom H, Ingvarsson A, Roijer A, Meurling C, Holm J, Radegran G, Carlsson M, Tabuchi H, Yamanaka T, Katahira Y, Tanaka M, Kurokawa T, Nakajima H, Ohtsuki S, Saijo Y, Yambe T, D'alto M, Romeo E, Argiento P, D'andrea A, Vanderpool R, Correra A, Sarubbi B, Calabro' R, Russo M, Naeije R, Saha SK, Warsame TA, Caelian AG, Malicse M, Kiotsekoglou A, Omran AS, Sharif D, Sharif-Rasslan A, Shahla C, Khalil A, Rosenschein U, Erturk M, Oner E, Kalkan A, Pusuroglu H, Ozyilmaz S, Akgul O, Aksu H, Akturk F, Celik O, Uslu N, Bandera F, Pellegrino M, Generati G, Donghi V, Alfonzetti E, Guazzi M, Rangel I, Goncalves A, Sousa C, Correia A, Martins E, Silva-Cardoso J, Macedo F, Maciel M, Lee S, Kim W, Yun H, Jung L, Kim E, Ko J, Enescu O, Florescu M, Rimbas R, Cinteza M, Vinereanu D, Kosmala W, Rojek A, Cielecka-Prynda M, Laczmanski L, Mysiak A, Przewlocka-Kosmala M, Liu D, Hu K, Niemann M, Herrmann S, Cikes M, Gaudron P, Knop S, Ertl G, Bijnens B, Weidemann F, Saravi M, Tamadoni A, Jalalian R, Hojati M, Ramezani S, Yildiz A, Inci U, Bilik M, Yuksel M, Oyumlu M, Kayan F, Ozaydogdu N, Aydin M, Akil M, Tekbas E, Shang Q, Zhang Q, Fang F, Wang S, Li R, Lee AP, Yu C, Mornos C, Ionac A, Cozma D, Popescu I, Ionescu G, Dan R, Petrescu L, Sawant A, Srivatsa S, Adhikari P, Mills P, Srivatsa S, Boshchenko A, Vrublevsky A, Karpov R, Trifunovic D, Stankovic S, Vujisic-Tesic B, Petrovic M, Nedeljkovic I, Banovic M, Tesic M, Petrovic M, Dragovic M, Ostojic M, Zencirci E, Esen Zencirci A, Degirmencioglu A, Karakus G, Ekmekci A, Erdem A, Ozden K, Erer H, Akyol A, Eren M, Zamfir D, Tautu O, Onciul S, Marinescu C, Onut R, Comanescu I, Oprescu N, Iancovici S, Dorobantu M, Melao F, Pereira M, Ribeiro V, Oliveira S, Araujo C, Subirana I, Marrugat J, Dias P, Azevedo A, Grillo MT, Piamonti B, Abate E, Porto A, Dell'angela L, Gatti G, Poletti A, Pappalardo A, Sinagra G, Pinto-Teixeira P, Galrinho A, Branco L, Fiarresga A, Sousa L, Cacela D, Portugal G, Rio P, Abreu J, Ferreira R, Fadel B, Abdullah N, Al-Admawi M, Pergola V, Bech-Hanssen O, Di Salvo G, Tigen MK, Pala S, Karaahmet T, Dundar C, Bulut M, Izgi A, Esen AM, Kirma C, Boerlage-Van Dijk K, Yamawaki M, Wiegerinck E, Meregalli P, Bindraban N, Vis M, Koch K, Piek J, Bouma B, Baan J, Mizia M, Sikora-Puz A, Gieszczyk-Strozik K, Lasota B, Chmiel A, Chudek J, Jasinski M, Deja M, Mizia-Stec K, Silva Fazendas Adame PR, Caldeira D, Stuart B, Almeida S, Cruz I, Ferreira A, Lopes L, Joao I, Cotrim C, Pereira H, Unger P, Dedobbeleer C, Stoupel E, Preumont N, Argacha J, Berkenboom G, Van Camp G, Malev E, Reeva S, Vasina L, Pshepiy A, Korshunova A, Timofeev E, Zemtsovsky E, Jorgensen PG, Jensen J, Fritz-Hansen T, Biering-Sorensen T, Jons C, Olsen N, Henri C, Magne J, Dulgheru R, Laaraibi S, Voilliot D, Kou S, Pierard L, Lancellotti P, Tayyareci Y, Dworakowski R, Kogoj P, Reiken J, Kenny C, Maccarthy P, Wendler O, Monaghan M, Song J, Ha T, Jung Y, Seo M, Choi S, Kim Y, Sun B, Kim D, Kang D, Song J, Le Tourneau T, Topilsky Y, Inamo J, Mahoney D, Suri R, Schaff H, Enriquez-Sarano M, Bonaque Gonzalez J, Sanchez Espino A, Merchan Ortega G, Bolivar Herrera N, Ikuta I, Macancela Quinonez J, Munoz Troyano S, Ferrer Lopez R, Gomez Recio M, Dreyfus J, Cimadevilla C, Brochet E, Himbert D, Iung B, Vahanian A, Messika-Zeitoun D, Izumo M, Takeuchi M, Seo Y, Yamashita E, Suzuki K, Ishizu T, Sato K, Aonuma K, Otsuji Y, Akashi Y, Muraru D, Addetia K, Veronesi F, Corsi C, Mor-Avi V, Yamat M, Weinert L, Lang R, Badano L, Minamisawa M, Koyama J, Kozuka A, Motoki H, Izawa A, Tomita T, Miyashita Y, Ikeda U, Florescu C, Niemann M, Liu D, Hu K, Herrmann S, Gaudron P, Scholz F, Stoerk S, Ertl G, Weidemann F, Marchel M, Serafin A, Kochanowski J, Piatkowski R, Madej-Pilarczyk A, Filipiak K, Hausmanowa-Petrusewicz I, Opolski G, Meimoun P, M'barek D, Clerc J, Neikova A, Elmkies F, Tzvetkov B, Luycx-Bore A, Cardoso C, Zemir H, Mansencal N, Arslan M, El Mahmoud R, Pilliere R, Dubourg O, Ikonomidis I, Lambadiari V, Pavlidis G, Koukoulis C, Kousathana F, Varoudi M, Tritakis V, Triantafyllidi H, Dimitriadis G, Lekakis I, Kovacs A, Kosztin A, Solymossy K, Celeng C, Apor A, Faludi M, Berta K, Szeplaki G, Foldes G, Merkely B, Kimura K, Daimon M, Nakajima T, Motoyoshi Y, Komori T, Nakao T, Kawata T, Uno K, Takenaka K, Komuro I, Gabric ID, Vazdar L, Pintaric H, Planinc D, Vinter O, Trbusic M, Bulj N, Nobre Menezes M, Silva Marques J, Magalhaes R, Carvalho V, Costa P, Brito D, Almeida A, Nunes-Diogo A, Davidsen ES, Bergerot C, Ernande L, Barthelet M, Thivolet S, Decker-Bellaton A, Altman M, Thibault H, Moulin P, Derumeaux G, Huttin O, Voilliot D, Frikha Z, Aliot E, Venner C, Juilliere Y, Selton-Suty C, Yamada T, Ooshima M, Hayashi H, Okabe S, Johno H, Murata H, Charalampopoulos A, Tzoulaki I, Howard L, Davies R, Gin-Sing W, Grapsa J, Wilkins M, Gibbs J, Castillo J, Bandeira A, Albuquerque E, Silveira C, Pyankov V, Chuyasova Y, Lichodziejewska B, Goliszek S, Kurnicka K, Dzikowska Diduch O, Kostrubiec M, Krupa M, Grudzka K, Ciurzynski M, Palczewski P, Pruszczyk P, Arana X, Oria G, Onaindia J, Rodriguez I, Velasco S, Cacicedo A, Palomar S, Subinas A, Zumalde J, Laraudogoitia E, Saeed S, Kokorina M, Fromm A, Oeygarden H, Waje-Andreassen U, Gerdts E, Gomez E, Vallejo N, Pedro-Botet L, Mateu L, Nunyez R, Llobera L, Bayes A, Sabria M, Antonini-Canterin F, Mateescu A, La Carrubba S, Vriz O, Di Bello V, Carerj S, Zito C, Ginghina C, Popescu B, Nicolosi G, Mateescu A, La Carrubba S, Vriz O, Di Bello V, Carerj S, Zito C, Ginghina C, Popescu B, Nicolosi G, Antonini-Canterin F, Pudil R, Praus R, Vasatova M, Vojacek J, Palicka V, Hulek P, Pradel S, Mohty D, Damy T, Echahidi N, Lavergne D, Virot P, Aboyans V, Jaccard A, Mateescu A, La Carrubba S, Vriz O, Di Bello V, Carerj S, Zito C, Ginghina C, Popescu B, Nicolosi G, Antonini-Canterin F, Doulaptsis C, Symons R, Matos A, Florian A, Masci P, Dymarkowski S, Janssens S, Bogaert J, Lestuzzi C, Moreo A, Celik S, Lafaras C, Dequanter D, Tomkowski W, De Biasio M, Cervesato E, Massa L, Imazio M, Watanabe N, Kijima Y, Akagi T, Toh N, Oe H, Nakagawa K, Tanabe Y, Ikeda M, Okada K, Ito H, Milanesi O, Biffanti R, Varotto E, Cerutti A, Reffo E, Castaldi B, Maschietto N, Vida V, Padalino M, Stellin G, Bejiqi R, Retkoceri R, Bejiqi H, Retkoceri A, Surdulli S, Massoure P, Cautela J, Roche N, Chenilleau M, Gil J, Fourcade L, Akhundova A, Cincin A, Sunbul M, Sari I, Tigen M, Basaran Y, Suermeci G, Butz T, Schilling I, Sasko B, Liebeton J, Van Bracht M, Tzikas S, Prull M, Wennemann R, Trappe H, Attenhofer Jost CH, Pfyffer M, Scharf C, Seifert B, Faeh-Gunz A, Naegeli B, Candinas R, Medeiros-Domingo A, Wierzbowska-Drabik K, Roszczyk N, Sobczak M, Plewka M, Krecki R, Kasprzak J, Ikonomidis I, Varoudi M, Papadavid E, Theodoropoulos K, Papadakis I, Pavlidis G, Triantafyllidi H, Anastasiou - Nana M, Rigopoulos D, Lekakis J, Tereshina O, Surkova E, Vachev A, Merchan Ortega G, Bonaque Gonzalez J, Sanchez Espino A, Bolivar Herrera N, Bravo Bustos D, Ikuta I, Aguado Martin M, Navarro Garcia F, Ruiz Lopez F, Gomez Recio M, Merchan Ortega G, Bonaque Gonzalez J, Bravo Bustos D, Sanchez Espino A, Bolivar Herrera N, Bonaque Gonzalez J, Navarro Garcia F, Aguado Martin M, Ruiz Lopez M, Gomez Recio M, Eguchi H, Maruo T, Endo K, Nakamura K, Yokota K, Fuku Y, Yamamoto H, Komiya T, Kadota K, Mitsudo K, Nagy AI, Manouras A, Gunyeli E, Shahgaldi K, Winter R, Hoffmann R, Barletta G, Von Bardeleben S, Kasprzak J, Greis C, Vanoverschelde J, Becher H, Hu K, Liu D, Niemann M, Herrmann S, Cikes M, Gaudron P, Knop S, Ertl G, Bijnens B, Weidemann F, Di Salvo G, Al Bulbul Z, Issa Z, Khan A, Faiz A, Rahmatullah S, Fadel B, Siblini G, Al Fayyadh M, Menting ME, Van Den Bosch A, Mcghie J, Cuypers J, Witsenburg M, Van Dalen B, Geleijnse M, Roos-Hesselink J, Olsen F, Jorgensen P, Mogelvang R, Jensen J, Fritz-Hansen T, Bech J, Biering-Sorensen T, Agoston G, Pap R, Saghy L, Forster T, Varga A, Scandura S, Capodanno D, Dipasqua F, Mangiafico S, Caggegi AM, Grasso C, Pistritto AM, Imme' S, Ministeri M, Tamburino C, Cameli M, Lisi M, D'ascenzi F, Cameli P, Losito M, Sparla S, Lunghetti S, Favilli R, Fineschi M, Mondillo S, Ojaghihaghighi Z, Javani B, Haghjoo M, Moladoust H, Shahrzad S, Ghadrdoust B, Altman M, Aussoleil A, Bergerot C, Bonnefoy-Cudraz E, Derumeaux GA, Thibault H, Shkolnik E, Vasyuk Y, Nesvetov V, Shkolnik L, Varlan G, Gronkova N, Kinova E, Borizanova A, Goudev A, Saracoglu E, Ural D, Sahin T, Al N, Cakmak H, Akbulut T, Akay K, Ural E, Mushtaq S, Andreini D, Pontone G, Bertella E, Conte E, Baggiano A, Annoni A, Formenti A, Fiorentini C, Pepi M, Cosgrove C, Carr L, Chao C, Dahiya A, Prasad S, Younger J, Biering-Sorensen T, Christensen L, Krieger D, Mogelvang R, Jensen J, Hojberg S, Host N, Karlsen F, Christensen H, Medressova A, Abikeyeva L, Dzhetybayeva S, Andossova S, Kuatbayev Y, Bekbossynova M, Bekbossynov S, Pya Y, Farsalinos K, Tsiapras D, Kyrzopoulos S, Spyrou A, Stefopoulos C, Romagna G, Tsimopoulou K, Tsakalou M, Voudris V, Cacicedo A, Velasco Del Castillo S, Anton Ladislao A, Aguirre Larracoechea U, Onaindia Gandarias J, Romero Pereiro A, Arana Achaga X, Zugazabeitia Irazabal G, Laraudogoitia Zaldumbide E, Lekuona Goya I, Varela A, Kotsovilis S, Salagianni M, Andreakos V, Davos C, Merchan Ortega G, Bonaque Gonzalez J, Sanchez Espino A, Bolivar Herrera N, Macancela Quinones J, Ikuta I, Ferrer Lopez R, Munoz Troyano S, Bravo Bustos D, Gomez Recio M. Poster session Friday 13 December - PM: 13/12/2013, 14:00-18:00 * Location: Poster area. Eur Heart J Cardiovasc Imaging 2013. [DOI: 10.1093/ehjci/jet206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Travis SG, Huang Y, Fujiwara E, Radomski A, Olsen F, Carter R, Seres P, Malykhin NV. High field structural MRI reveals specific episodic memory correlates in the subfields of the hippocampus. Neuropsychologia 2013; 53:233-45. [PMID: 24296251 DOI: 10.1016/j.neuropsychologia.2013.11.016] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 11/22/2013] [Accepted: 11/23/2013] [Indexed: 10/25/2022]
Abstract
The involvement of the hippocampus (HC) in episodic memory is well accepted; however it is unclear how each subfield within the HC contributes to memory function. Recent magnetic resonance imaging (MRI) studies suggest differential involvement of hippocampal subfields and subregions in episodic memory. However, most structural MRI studies have examined the HC subfields within a single subregion of the HC and used specialised experimental memory paradigms. The purpose of the present study was to determine the association between volumes of HC subfields throughout the entire HC structure and performance on standard neuropsychological memory tests in a young, healthy population. We recruited 34 healthy participants under the age of 50. MRI data was acquired with a fast spin echo (FSE) sequence yielding a 0.52×0.68×1.0 mm(3) native resolution. The HC subfields - the cornu ammonis 1-3 (CA), dentate gyrus (DG), and subiculum (SUB) - were segmented manually within three hippocampal subregions using a previously defined protocol. Participants were administered the Wechsler Memory Scale, 4th edition (WMS-IV) to assess performance in episodic memory using verbal (Logical Memory, LM) and visual (Designs, DE; visual-spatial memory, DE-Spatial; visual-content memory, DE-Content) memory subtests. Working memory subtests (Spatial Addition, SA; and Symbol Span, SSP) were included as well. Working memory was not associated with any HC volumes. Volumes of the DG were correlated with verbal memory (LM) and visual-spatial memory (DE-Spatial). Posterior CA volumes correlated with both visual-spatial and visual-object memory (DE-Spatial, DE-Content). In general, anterior subregion volumes (HC head) correlated with verbal memory, while some anterior and many posterior HC subregion volumes (body and tail) correlated with visual memory scores (DE-Spatial, DE-Content). In addition, while verbal memory showed left-lateralized associations with HC volumes, visual memory was associated with HC volumes bilaterally. This the first study to examine the associations between hippocampal subfield volumes across the entire hippocampal formation with performance in a set of standard memory tasks.
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Affiliation(s)
- S G Travis
- Centre for Neuroscience, University of Alberta, Edmonton, Alberta, Canada
| | - Y Huang
- Centre for Neuroscience, University of Alberta, Edmonton, Alberta, Canada
| | - E Fujiwara
- Centre for Neuroscience, University of Alberta, Edmonton, Alberta, Canada; Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - A Radomski
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - F Olsen
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada T6G 2V2
| | - R Carter
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - P Seres
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada T6G 2V2
| | - N V Malykhin
- Centre for Neuroscience, University of Alberta, Edmonton, Alberta, Canada; Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada; Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada T6G 2V2.
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Olsen F, Abelsen B, Olsen JA. Improving response rate and quality of survey data with a scratch lottery ticket incentive. BMC Med Res Methodol 2012; 12:52. [PMID: 22515335 PMCID: PMC3425082 DOI: 10.1186/1471-2288-12-52] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 04/19/2012] [Indexed: 11/21/2022] Open
Abstract
Background The quality of data collected in survey research is usually indicated by the response rate; the representativeness of the sample, and; the rate of completed questions (item-response). In attempting to improve a generally declining response rate in surveys considerable efforts are being made through follow-up mailings and various types of incentives. This study examines effects of including a scratch lottery ticket in the invitation letter to a survey. Method Questionnaires concerning oral health were mailed to a random sample of 2,400 adults. A systematically selected half of the sample (1,200 adults) received a questionnaire including a scratch lottery ticket. One reminder without the incentive was sent. Results The incentive increased the response rate and improved representativeness by reaching more respondents with lower education. Furthermore, it reduced item nonresponse. The initial incentive had no effect on the propensity to respond after the reminder. Conclusion When attempting to improve survey data, three issues become important: response rate, representativeness, and item-response. This study shows that including a scratch lottery ticket in the invitation letter performs well on all the three.
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Affiliation(s)
- Frank Olsen
- Institute of Community Medicine, Faculty of Health Sciences, University of Tromsø, Norway.
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Abstract
Whereas in most sectors, technology has taken over trivial and labour consuming tasks, this transformation has been delayed in the healthcare sector. Although appropriate technology is available, there is general resistance to substituting 'warm' hands with 'cold' technology. In the future, this may change as the number of elderly people increases relative to the people in the work force. In combination with an increasing demand for healthcare services, there are calls for efforts to increase productivity in the sector. Based on experience data from previous studies on information and communication technology efforts in the healthcare sector, we quantitatively assess the use of smart house technology and video visits in home care. Having identified healthcare providers, hospitals and relatives as the main affected groups, we show that smart house technology is cost-effective, even if only relatives gain from it. Video visits, which have higher implementation costs, demand effects on both relatives and health care providers in order to be a cost-effective tool in home care. As the analysis is purely quantitative, these results need to be complemented with qualitative effects and with more thorough discussions of the ethical, medical and legal aspects of the use of technology in home care.
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Aanesen M, Moilanen M, Olsen F. Economic gains from electronic message exchange: the importance of working procedures. Int J Med Inform 2010; 79:658-67. [PMID: 20621553 DOI: 10.1016/j.ijmedinf.2010.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Revised: 05/26/2010] [Accepted: 06/14/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND PURPOSE There are several cost-benefit evaluations of introducing new technology for administrative purposes in the health care sector. Whereas some of these recognise the importance of adapting the working procedures to the new technology, very few look into the consequences of delays in adaptation to the new technology. In this paper, we focus on the consequences of keeping old working procedures, although new technology is implemented. METHODS Based on on-site observations we have estimated the economic gains of implementing electronic message exchange in the health care sector depending on which working procedures are applied. Then we continue by using a dynamic cost-benefit analysis (CBA) in order to take into account that conversion to new working procedures takes place over time, and we demonstrate the loss in potential gains due to such a delay. RESULTS Keeping working procedures fit to old technology when new technology is implemented may imply that only between 40 and 50% of the potential time savings (benefits) are realised. In a dynamic perspective, the keeping of double procedures for 10 years and more will jeopardise the economic gains for surgeries, whereas hospitals still may have an economic gain. The delay in conversion to new working procedures implies that only 50% of the dynamic net present value of the gains is realised. The longer it takes before the old procedures are abandoned the lower is the dynamic net present value of the gains. This is due to the discounting of future gains. CONCLUSIONS These are all arguments for emphasising and putting resources into training and motivation programs for employees when new technology is being implemented. LIMITATIONS OF THE STUDY We have only considered quantifiable effects of electronic message exchange in the health care sector, and only for hospitals and surgeries.
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Affiliation(s)
- Margrethe Aanesen
- Institute of Economics, University of Tromso, Breivika, N-9037 Tromso, Norway.
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Olsen F. Penetration of circulating fluorescent proteins into walls of arterioles and venules in rats with intermittent acute angiotensin-hypertension. Acta Pathol Microbiol Scand 2009; 74:325-32. [PMID: 4305519 DOI: 10.1111/j.1699-0463.1968.tb03485.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Olsen F. Type and course of the inflammatory cellular reaction in acute angiotensin-hypertensive vascular disease in rats. Acta Pathol Microbiol Scand A 2009; 78:143-50. [PMID: 4316934 DOI: 10.1111/j.1699-0463.1970.tb00249.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Olsen F. Evidence for an immunological factor in the hypertensive vascular disease. Acta Pathol Microbiol Scand A 2009; 79:22-6. [PMID: 4322994 DOI: 10.1111/j.1699-0463.1971.tb00508.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Olsen F. The secondary and tertiary inflammatory cellular reaction in arterioles damaged by acute angiotensin-hypertension in rats. Acta Pathol Microbiol Scand A 2009; 78:451-7. [PMID: 4320018 DOI: 10.1111/j.1699-0463.1970.tb02525.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Olsen F. Correlation between infiltration of mononuclear cells and production of connective tissue in acute hypertensive vascular disease. Acta Pathol Microbiol Scand A 2009; 79:15-21. [PMID: 4100595 DOI: 10.1111/j.1699-0463.1971.tb00507.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Olsen F. Increased vascular permeability for plasma components during acute angiotensin hypertension. Acta Med Scand Suppl 2009; 602:13-5. [PMID: 1071941 DOI: 10.1111/j.0954-6820.1977.tb07633.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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MESH Headings
- Aged
- Anemia, Hemolytic, Autoimmune/blood
- Anemia, Hemolytic, Autoimmune/drug therapy
- Anemia, Hemolytic, Autoimmune/etiology
- Anemia, Hemolytic, Autoimmune/immunology
- Autoantibodies
- Blood Cell Count
- Coombs Test
- Erythrocytes/immunology
- Female
- Hemoglobins
- Hemolysis
- Humans
- Immunoelectrophoresis
- Immunoglobulins
- Leukocytes
- Prednisone/therapeutic use
- Reticulocytes
- Scleroderma, Systemic/blood
- Scleroderma, Systemic/complications
- Scleroderma, Systemic/immunology
- Serologic Tests
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Abstract
This study aimed to determine the relationship between improvement in lung function and changes in transthoracic electrical bioimpedance (TEB) after thoracentesis in patients with pleural effusions. Fifteen patients with pleural effusions due to either malignant (n = 8) or cardiac (n = 7) diseases were included. Pulmonary function was assessed before and after thoracentesis. During thoracentesis the patients were monitored with TEB. Using linear correlation analysis, the increases for each litre of aspirated thoracic fluid were: forced expiratory volume in 1 s (FEV1) 0.261; forced vital capacity (FVC) 0.331; total lung capacity (TLC) 0.58; and the lung diffusing capacity (DLCO); 2.4 ml min-1 mmHg-1. Baseline impedance increased by 2.3 Ohm l-1 aspirated thoracic fluid. The relative increase in baseline impedance was twice as high for patients with cancer as for patients with heart failure (P < 0.05). We found only minor changes in systolic blood pressure and mean arterial pressure. The improvements in diffusing capacity, airflow, and lung volumes after thoracentesis are correlated to an increase in baseline impedance, but changes are dependent on the primary disease.
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Affiliation(s)
- B Zerahn
- Department of Clinical Physiology and Nuclear Medicine, Herlev Hospital, University of Copenhagen, Denmark.
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Petersen JR, Jensen BV, Olsen F. [Impedance cardiography--non-invasive measurement of central hemodynamic data]. Ugeskr Laeger 1992; 154:255-60. [PMID: 1736457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The theory, method and apparatus behind a new computer technology for transthoracic electrical bioimpedance are described. Measurements and calculations of changes in the electrical conductivity of the thoracic segment during systolic upstroke provides the basis for non-invasive determination of stroke volume and cardiac output. Bioimpedance further offers a sensitive indicator of the content of thoracic fluid. Reports comparing measurements of cardiac output in various clinical conditions by bioimpedance versus invasive methods in general show good correlation. The field of applications and limitations of bioimpedance are described. Measurements are reproducible and the method can also be used in evaluating the cardiodynamic exercise response.
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Affiliation(s)
- J R Petersen
- Kardiologisk afdeling Y, Bispebjerg Hospital, København
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Clemmesen J, Errebo-Knudsen EO, Holma B, Hyllested K, Olsen F, Snorrason E. [Painter's syndrome or presenile dementia--an enormous overdiagnosing with high human and economic costs]. Ugeskr Laeger 1991; 153:123-4. [PMID: 1989370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Abstract
The agarose migration technique was used for demonstration of delayed-type hypersensitivity to arterial vessel wall antigens in patients suffering from chronic essential hypertension. By means of this technique, it was demonstrated that the migration indices from the hypertensive patients differed significantly from the normotensive control persons, P less than 0.005. The significant difference was abolished when anti-LIF was added to the migration tests. This means that a hypersensitivity of the delayed type had developed in the hypertensive patients and the results indicated that the hypersensitivity was an autoimmunity to arterial vessel wall antigens.
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Affiliation(s)
- F Olsen
- Institute of Hygiene, University of Copenhagen, Denmark
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Abstract
Single-chain human recombinant factor VII produced by transfected baby hamster kidney cells was purified to homogeneity in the presence of benzamidine. The amidolytic activity of single-chain recombinant factor VII with a peptidylnitroanilide substrate, methoxycarbonyl-D-cyclohexanylglycyl-L-arginine-p-nitroanilide, was less than 1% of that obtained with factor VIIa. Purified single-chain recombinant factor VII spontaneously activated in the absence of inhibitor. The activation reaction was enhanced by at least 2 orders of magnitude in the presence of a positively charged surface, provided either as an anion-exchange matrix or as poly(D-lysine). The progress curve for factor VIIa generation was sigmoidal. Benzamidine inhibits recombinant factor VIIa activity and factor VII activation with identical inhibition constants (Ki) of 11 mM. In contrast, benzamidine inhibition of bovine factor Xa and bovine factor IIa was observed at Ki values equal to 0.3 and 0.5 mM, respectively. Bovine factors Xa and IIa are known activators of factor VII and the most likely contaminants of our recombinant factor VII preparations. Single-chain recombinant factor VII purified from cells cultured in the absence of bovine serum activated at the same rate as factor VII from cells cultured in the presence of bovine serum. This also excluded the possibility that the activation reaction was caused by contaminating bovine proteases. On the basis of these observations, we propose that factor VII is autoactivated in vitro in the presence of a positively charged surface.
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Joffe P, Olsen F, Heaf JG, Gammelgaard B, Pödenphant J. Aluminum concentrations in serum, dialysate, urine and bone among patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Clin Nephrol 1989; 32:133-8. [PMID: 2791364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Aluminum (Al) concentration in serum, urine, and dialysate was estimated in 21 patients undergoing continuous ambulatory peritoneal dialysis (CAPD). In 12 of the patients bone Al concentration was measured as well. Mean serum Al level was 32.4 +/- 21.0 micrograms/l. The Al concentrations in the dialysate and urine were 9.1 +/- 4.1 micrograms/l and 52.5 +/- 47.3 micrograms/l, respectively. Bone Al concentration was 21.0 +/- 14.9 ppm and correlated significantly with concentrations of Al in serum (p less than 0.01) and dialysate (p less than 0.01). A mass transfer (MT) from the patients to the dialysate was observed in all patients (-44.0 +/- 28.8 micrograms/24 h). There was a highly significant correlation between peritoneal Al MT and serum Al (p less than 0.001), actual Al consumption (p less than 0.05) and bone Al concentration (p less than 0.005) supporting the existence of an overflow phenomenon. Despite very low Al levels in the dialysate, patients are at risk of elevated Al levels in the serum, dialysate, urine and bone because of consumption of Al-containing phosphate binders.
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Affiliation(s)
- P Joffe
- Department of Nephrology, Hvidovre Hospital, University of Copenhagen, Denmark
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Errebo-Knudsen EO, Olsen F. [Initial symptoms and social conditions among persons exposed to organic solvents]. Ugeskr Laeger 1988; 150:1486-7. [PMID: 3388555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Roistacher S, Olsen F, Tanenbaum D. Teaching the management of chronic face pain. J Dent Educ 1986; 50:734-5. [PMID: 3465779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Laybourn C, Drivsholm L, Olsen F. Duration of delayed-type autoimmunity against arterial vessel-wall antigens following acute hypertensive damage to arterial vessels in rats. Acta Pathol Microbiol Immunol Scand C 1986; 94:127-30. [PMID: 3751586 DOI: 10.1111/j.1699-0463.1986.tb02101.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Acute hypertensive damage to small arteries and arterioles in rats was induced by intravenous injections of Hypertensin. The in vitro immunological method of the agarose migration technique was used to demonstrate delayed-type autoimmunity against arterial vessel-wall antigens. By this technique the autoimmunity could be demonstrated for about 16 weeks after the acute hypertensive damage to the arterial vessels. The results of the autoimmunity were given as migration indices. These were lowest during the first 4-5 weeks after the damage to the vessels whereupon they showed higher and higher values, and finally the migration indices were identical with those of the control rats after about 16 weeks.
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Errebo-Knudsen EO, Olsen F. [The organic solvents syndrome]. Ugeskr Laeger 1986; 148:804-5. [PMID: 3705225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Olsen F, Schøtt P. [Institution--or home]. Sygeplejersken 1986; 86:10-2. [PMID: 3642798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Drivsholm L, Laybourn C, Olsen F. Further evidence of the development of delayed-type autoimmunity against arterial vessel-wall antigens following acute hypertensive damage to arterial vessels in rats. Acta Pathol Microbiol Immunol Scand C 1985; 93:105-10. [PMID: 3898720 DOI: 10.1111/j.1699-0463.1985.tb02930.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Acute hypertensive damage to arterial vessels was induced by intravenous injections of hypertension. The in vitro immunological method of the agarose migration technique was used for demonstration of delayed-type autoimmunity against arterial vessel-wall antigens following the damage of the arterial vessels. By means of this technique it was demonstrated that the migration indices from the rats with induced hypertension differed significantly from the control rats, P less than 0.005. This means that an autoimmunity of the delayed type had developed after the hypertensive damage to the arterial vessels. The autoimmunity was tissue specific.
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Olsen F. Induction of chronic arterial hypertension in rats by repeated transient hypertensive rises in blood pressure. Possible pathogenetic role of delayed hypersensitivity against arteries and arterioles. Acta Pathol Microbiol Scand C 1981; 89:105-9. [PMID: 7293777 DOI: 10.1111/j.1699-0463.1981.tb02672.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Repeated transient rises in blood pressure to hypertensive levels were induced by intravenous injections of angiotensin once or twice weekly. This procedure induced chronic arterial hypertension in five of fourteen rats (36%) within 4-6 weeks of starting the injections. Intracutaneous tests using homogenized common carotid arteries and histological examination of the kidneys gave support to the hypothesis that the transient rises in blood pressure to hypertensive levels resulted in a delayed hypersensitivity (DHS) reaction against components in small arteries and arterioles. This DHS reaction seemed to be responsible for an increased permeability of arterial vessels to plasma components causing exudative thickening of the walls of small arteries and arterioles and thereby narrowing of their lumina. When the lumina of small arteries and arterioles are narrowed, peripheral resistance to blood flow increases, and arterial hypertension results.
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Olsen F. Transfer of arterial hypertension by splenic cells from DOCA-salt hypertensive and renal hypertensive rats to normotensive recipients. Acta Pathol Microbiol Scand C 1980; 88:1-5. [PMID: 7376880 DOI: 10.1111/j.1699-0463.1980.tb00065.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Arterial hypertension was transferred from DOCA-salt hypertensive and renal hypertensive rats to normotensive rats by intravenous injection of splenic cells. Thirteen normotensive recipients were injected intravenously with splenic cells from the hypertensive donors. Eleven developed arterial hypertension (85%), that is, with a systolic blood pressure exceeding 140 mm Hg. Three of the recipients developed hypertensive levels up to 155-160 mm Hg, which was almost up to the levels in the donors. The increase of the blood pressure in the recipients was significant when compared to controls injected intravenously with splenic cells from normotensive donors (p less than 0.001). Skin tests, performed by intracutaneous injection of homogenized common carotid arteries in half of the recipients, showed positive reactions 24 hours after the injection. Microscopical examination of heart and kidney from the other half demonstrated mononuclear infiltration into arterial and arteriolar walls and exudative changes in these walls. Due to exudative thickening of the vessel walls the lumina were narrowed. The hypothesis is advanced that the recipient rats developed arterial hypertension as a result of a transferred delayed hypersensitivity directed against the arterial walls. This hypersensitivity reaction caused insudation of plasma components into the arterial walls, narrowing of their lumina and an increased peripheral resistance to the blood flow, so that arterial hypertension developed.
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Abstract
Experimentally-induced acute angiotensin hypertension has been shown to increase the permeability of cardial arteries and arterioles to plasma components within a few hours. Only in one of the coronary arteries was an increased and focal permeability for plasma components demonstrated, the penetration taking place into the entire thickness of the vessel wall. However, the permeability observed in intramyocardial small arteries and arterioles showed a distinct deposition of plasma components, both in the tunica intima and the tunica media and usually in the entire circumference of the vessels. The results support the view that an increased arterial permeability of the myocardial vessels for plasma components is an important initial stage in the development of hypertensive vascular disease of the heart.
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Olsen F. Increased permeability for plasma components of the cerebral vessels during acute angiotensin hypertension in rats. Acta Pathol Microbiol Scand A 1977; 85:572-6. [PMID: 920177 DOI: 10.1111/j.1699-0463.1977.tb00448.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Experimentally induced acute angiotensin hypertension has been shown to increase the permeability of cerebral arterioles, venules and veins to plasma components whthin a few hours. This increase in permiability was demonstrated by means of circulating homologous fluorescent serum proteins and colloidal carbon particles. The results support the view that an increased permeability of the cerebral vessels to plasma components is either a causal or an additional pathogenetic factor in the development of the hypertensive encephalopathy.
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Olsen F, Rasmussen S. Delayed hypersensitivity and borderline essential hypertension. Acta Pathol Microbiol Scand C 1977; 85:196-8. [PMID: 878880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
By means of the leucocyte migration technique, it has been demonstrated that the migration indices from 19 patients suffering from borderline essential hypertension are significantly different from those of 19 normal persons. These results support the view that delayed hypersensitivity directed against arterial wall components is a possible pathogenetic factor in patients suffering from essential hypertension.
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