TECLA—an innovative technical approach for prostate cancer registries

The article has been peer-reviewed, but does not include the publisher’s layout, page numbers and proof-corrections.Citation for the published paper: Christiansen, O., Bratt, O., Haug, E. S., Vaktskjold, A., Selnes, A. & Jordhøy, M. S. (2019). TECLA—an innovative technical approach for prostate cancer registries. Scandinavian Journal of Urology and Nephrology, 53(4), 229-234. DOI: http://dx.doi.org/10.1080/21681805.2019.1634148Objective: To present a code-driven, electronic database for patients TrEated with robotic-assisted radiCaL prostAtectomy (TECLA), developed at Innlandet Hospital (IH), Trust, Norway, for research, local quality control and to deliver data to the National Cancer Registry of Norway (CRN). Clinical data are directly extracted from the structured documentation in the electronic medical record (EMR). Materials and methods: The urological department at IH treats about 200 patients with robotic-assisted radical prostatectomy (RARP) annually. All consenting patients registered with the procedure code for RARP are included in TECLA. Clinical data are obtained automatically from the EMR, by structured forms. Patient-reported outcome and experience measures (PROMs and PREMs) are filled in by the patients on an iPad or a smartphone. Results: The basic construct of TECLA is presented. From August 2017 to June 2018, 200 men were treated with RARP, of which 182 (91%) provided consent for inclusion in the register. Of these, 97% completed the PROM survey before treatment and 91% at 3 months follow-up. PREMs were completed by 78%. All clinical variables for the hospital stay and for the 6-week follow-up were more than 95% complete. Conclusion: This entirely electronic surgical quality register is easy to use, both for patients and clinicians, and has a high capture rate. The data collection is linked to the clinicians’ workflow, without double data entry, so entering data does not add any extra work. The register design can be used by other hospitals for various surgical procedures.acceptedVersio

Predictors of upgrading from low-grade cancer at prostatectomy in men with biparametric magnetic resonance imaging

Introduction: Prostate-specific antigen (PSA) density has previously been identified as a predictor of histological upgrading at radical prostatectomy, but how information from pre-treatment biparametric magnetic resonance imaging (bpMRI) contributes needs further clarification. The objective of this register-based study was to identify predictors of upgrading at prostatectomy in men with Grade group (GG) 1 and pre-treatment bpMRI. Material and methods: This single-center study included men with GG 1 cancer on prediagnostic biopsy, who underwent bpMRI and robotic-assisted radical prostatectomy (RARP) between March 2014 and September 2019. We estimated logistic regression models to explore predictors for upgrading. The explored potential predictors were age, PSA density, tumor stage and Prostate Imaging Reporting and Data System (PI-RADS) score (dichotomised 1-3 versus 4-5). Results: Upgrading was observed in 56% (73/130) of the men. PSA density was the only significant predictor for upgrading (unadjusted OR = 1.7, 95% CI 1.2; 2.4 adjusted OR = 1.7, 95% CI 1.2; 2.5). The probability of upgrading was lower for men with a PIRADS 1-3 than for PIRADS 4-5, but the difference was not statistically significant (adjusted OR 0.4, 95% CI 0.2; 1.1, p = 0.082). Among men with PI-RADS 1-3, the probability increased with increasing PSA density (p = 0.036). With PI-RADS 4-5 the probability of upgrading was high over the entire PSA density range. Conclusions: PSA density is a clinically important factor to predict upgrading from GG1 when bpMRI shows PI-RADS 1-3. In men with PI-RADS 4-5 on bpMRI, the probability of an undetected GG 2-5 cancer is high regardless of the PSA density.publishedVersio

Asthma and allergy in children : an epidemiological study of asthma and allergy in schoolchildren living in Northern Norway and Russia with respect to prevalence trends 1985-1995-2000, geographic differences in prevalence and biomarkers

The thesis has focused on asthma, AR and AD in children in a limited geographical region over a limited period of time and has studied the prevalence trends, geographical differences in prevalence and the biomarker s-ECP. These are the main findings in the five papers published: The prevalence of asthma and allergy in north Norwegian primary schoolchildren increased substantially between 1985 and 1995. By studying the prevalence trends in 9-11 years old children living in Troms and Finnmark over the period from 1985 to 2000, we found that overall prevalence of AR and prevalence of asthma in boys were continuously increasing. The prevalence of AD levelled from 1995 to 2000 and the prevalence of asthma in girls even showed declining trends over the last five years studied. In all studies that allowed a distinction between Sami and Norse ethnicity, generally a higher prevalence of asthma and allergy was found among children defined as Sami. Russian children on the Kola Peninsula have less asthma and allergy compared to their Norwegian neighbours. However, a high prevalence of respiratory symptoms in these children may represent undiagnosed, non-allergic asthma. In an unselected children population (similar to the population of children encountered in general practice) the occurrence of AD or AR was not reflected by an increased s-ECP level. Despite elevated serum levels in children with asthma, less than 20% of the children with high s-ECP values had asthma. We concluded that the associations between s-ECP and asthma and allergy are weak in an unselected population of children. </ul

Asthma and allergy in children : an epidemiological study of asthma and allergy in schoolchildren living in Northern Norway and Russia with respect to prevalence trends 1985-1995-2000, geographic differences in prevalence and biomarkers

The thesis has focused on asthma, AR and AD in children in a limited geographical region over a limited period of time and has studied the prevalence trends, geographical differences in prevalence and the biomarker s-ECP. These are the main findings in the five papers published: The prevalence of asthma and allergy in north Norwegian primary schoolchildren increased substantially between 1985 and 1995. By studying the prevalence trends in 9-11 years old children living in Troms and Finnmark over the period from 1985 to 2000, we found that overall prevalence of AR and prevalence of asthma in boys were continuously increasing. The prevalence of AD levelled from 1995 to 2000 and the prevalence of asthma in girls even showed declining trends over the last five years studied. In all studies that allowed a distinction between Sami and Norse ethnicity, generally a higher prevalence of asthma and allergy was found among children defined as Sami. Russian children on the Kola Peninsula have less asthma and allergy compared to their Norwegian neighbours. However, a high prevalence of respiratory symptoms in these children may represent undiagnosed, non-allergic asthma. In an unselected children population (similar to the population of children encountered in general practice) the occurrence of AD or AR was not reflected by an increased s-ECP level. Despite elevated serum levels in children with asthma, less than 20% of the children with high s-ECP values had asthma. We concluded that the associations between s-ECP and asthma and allergy are weak in an unselected population of children. </ul

Fripolise: En analyse av kundeavkastning og egenkapital for det potensielle produktet fripolise med garantert sluttverdi

Livselskapene har som oppgave å forvalte langsiktige pensjonsmidler. Et komplisert og omfattende regelverk gir insentiver til å tenke kortsiktig. Regelverket gjør det vanskelig å høste risikopremier gjennom langsiktig kapitalforvaltning for å oppnå høyere forventet avkastning. Hovedutfordringen for livselskapene er den årlige rentegarantien. Denne garantien hviler på avkastningen hvert enkelt år og strekker seg over kontraktens løpetid. Livselskapene har hele nedsiderisikoen som er knyttet til garantien, og manglende avkastning må i verste fall dekkes av selskapets egenkapital. I perioder med lavt rentenivå, øker derfor risikoen for livselskapene betydelig som følge av rentegarantien. Myndighetskravene til egenkapital har vært økende og fra 2016 ble Solvens II-regulativet innført for norske forsikringsselskap. De største konsekvensene av Solvens II for livselskapene er at de må ta hensyn til all kvantiserbar risiko. For produkter med garantier medfører dette at risiko både knyttet til eiendeler og forpliktelser skal kvantiseres med basis i markedsmessige vurderinger, i motsetning til tidligere regelverk hvor risiko ble beregnet uten å hensynta viktige risikofaktorer som rentenivå. I vår oppgave har vi bygget en modell for å sammenligne dagens fripolise med årlig garanti opp mot en potensiell fripolise med garantert sluttverdi. Vi har analysert tilfellene med både normal og aggressiv allokering. Vårt mål har vært å undersøke om det å endre garantien til en garantert sluttverdi vil ha betydning for både livselskapet og kunden. Våre analyser viser at et produkt med garantert sluttverdi vil gi livselskapet en høyere forventet avkastning på egenkapitalen, uansett durasjon og allokering på fripolisen. For kunden vil resultatet være avhengig av hvilken aktivaallokering livselskapet velger og tiden inntil fripoliseinnehaver går av med pensjon

Fripolise: En analyse av kundeavkastning og egenkapital for det potensielle produktet fripolise med garantert sluttverdi

Livselskapene har som oppgave å forvalte langsiktige pensjonsmidler. Et komplisert og omfattende regelverk gir insentiver til å tenke kortsiktig. Regelverket gjør det vanskelig å høste risikopremier gjennom langsiktig kapitalforvaltning for å oppnå høyere forventet avkastning. Hovedutfordringen for livselskapene er den årlige rentegarantien. Denne garantien hviler på avkastningen hvert enkelt år og strekker seg over kontraktens løpetid. Livselskapene har hele nedsiderisikoen som er knyttet til garantien, og manglende avkastning må i verste fall dekkes av selskapets egenkapital. I perioder med lavt rentenivå, øker derfor risikoen for livselskapene betydelig som følge av rentegarantien. Myndighetskravene til egenkapital har vært økende og fra 2016 ble Solvens II-regulativet innført for norske forsikringsselskap. De største konsekvensene av Solvens II for livselskapene er at de må ta hensyn til all kvantiserbar risiko. For produkter med garantier medfører dette at risiko både knyttet til eiendeler og forpliktelser skal kvantiseres med basis i markedsmessige vurderinger, i motsetning til tidligere regelverk hvor risiko ble beregnet uten å hensynta viktige risikofaktorer som rentenivå. I vår oppgave har vi bygget en modell for å sammenligne dagens fripolise med årlig garanti opp mot en potensiell fripolise med garantert sluttverdi. Vi har analysert tilfellene med både normal og aggressiv allokering. Vårt mål har vært å undersøke om det å endre garantien til en garantert sluttverdi vil ha betydning for både livselskapet og kunden. Våre analyser viser at et produkt med garantert sluttverdi vil gi livselskapet en høyere forventet avkastning på egenkapitalen, uansett durasjon og allokering på fripolisen. For kunden vil resultatet være avhengig av hvilken aktivaallokering livselskapet velger og tiden inntil fripoliseinnehaver går av med pensjon

TECLA—an innovative technical approach for prostate cancer registries

Objective: To present a code-driven, electronic database for patients TrEated with robotic-assisted radiCaL prostAtectomy (TECLA), developed at Innlandet Hospital (IH), Trust, Norway, for research, local quality control and to deliver data to the National Cancer Registry of Norway (CRN). Clinical data are directly extracted from the structured documentation in the electronic medical record (EMR). Materials and methods: The urological department at IH treats about 200 patients with robotic-assisted radical prostatectomy (RARP) annually. All consenting patients registered with the procedure code for RARP are included in TECLA. Clinical data are obtained automatically from the EMR, by structured forms. Patient-reported outcome and experience measures (PROMs and PREMs) are filled in by the patients on an iPad or a smartphone. Results: The basic construct of TECLA is presented. From August 2017 to June 2018, 200 men were treated with RARP, of which 182 (91%) provided consent for inclusion in the register. Of these, 97% completed the PROM survey before treatment and 91% at 3 months follow-up. PREMs were completed by 78%. All clinical variables for the hospital stay and for the 6-week follow-up were more than 95% complete. Conclusion: This entirely electronic surgical quality register is easy to use, both for patients and clinicians, and has a high capture rate. The data collection is linked to the clinicians’ workflow, without double data entry, so entering data does not add any extra work. The register design can be used by other hospitals for various surgical procedures

TECLA—an innovative technical approach for prostate cancer registries

Objective: To present a code-driven, electronic database for patients TrEated with robotic-assisted radiCaL prostAtectomy (TECLA), developed at Innlandet Hospital (IH), Trust, Norway, for research, local quality control and to deliver data to the National Cancer Registry of Norway (CRN). Clinical data are directly extracted from the structured documentation in the electronic medical record (EMR). Materials and methods: The urological department at IH treats about 200 patients with robotic-assisted radical prostatectomy (RARP) annually. All consenting patients registered with the procedure code for RARP are included in TECLA. Clinical data are obtained automatically from the EMR, by structured forms. Patient-reported outcome and experience measures (PROMs and PREMs) are filled in by the patients on an iPad or a smartphone. Results: The basic construct of TECLA is presented. From August 2017 to June 2018, 200 men were treated with RARP, of which 182 (91%) provided consent for inclusion in the register. Of these, 97% completed the PROM survey before treatment and 91% at 3 months follow-up. PREMs were completed by 78%. All clinical variables for the hospital stay and for the 6-week follow-up were more than 95% complete. Conclusion: This entirely electronic surgical quality register is easy to use, both for patients and clinicians, and has a high capture rate. The data collection is linked to the clinicians’ workflow, without double data entry, so entering data does not add any extra work. The register design can be used by other hospitals for various surgical procedures

Diffusion tensor and restriction spectrum imaging reflect different aspects of neurodegeneration in Parkinson's disease

To meet the need for Parkinson’s disease biomarkers and evidence for amount and distribution of pathological changes, MRI diffusion tensor imaging (DTI) has been explored in a number of previous studies. However, conflicting results warrant further investigations. As tissue microstructure, particularly of the grey matter, is heterogeneous, a more precise diffusion model may benefit tissue characterization. The purpose of this study was to analyze the diffusion-based imaging technique restriction spectrum imaging (RSI) and DTI, and their ability to detect microstructural changes within brain regions associated with motor function in Parkinson’s disease. Diffusion weighted (DW) MR images of a total of 100 individuals, (46 Parkinson’s disease patients and 54 healthy controls) were collected using b-values of 0–4000s/mm2. Output diffusion-based maps were estimated based on the RSI-model combining the full set of DW-images (Cellular Index (CI), Neurite Density (ND)) and DTI-model combining b = 0 and b = 1000 s/mm2 (fractional anisotropy (FA), Axial-, Mean- and Radial diffusivity (AD, MD, RD)). All parametric maps were analyzed in a voxel-wise group analysis, with focus on typical brain regions associated with Parkinson’s disease pathology. CI, ND and DTI diffusivity metrics (AD, MD, RD) demonstrated the ability to differentiate between groups, with strongest performance within the thalamus, prone to pathology in Parkinson’s disease. Our results indicate that RSI may improve the predictive power of diffusion-based MRI, and provide additional information when combined with the standard diffusivity measurements. In the absence of major atrophy, diffusion techniques may reveal microstructural pathology. Our results suggest that protocols for MRI diffusion imaging may be adapted to more sensitive detection of pathology at different sites of the central nervous system