Kommunale verdier. En kvalitativ flercasestudie om hvordan politisk vedtatte verdier i norske kommuner blir utarbeidet, implementert og fulgt opp i det daglige.

Nyere ledelsesteorier peker i retning av transformasjonsledelse. Et fenomen av transformasjonsledelse er verdibasert ledelse. New Public Management er en reformbølge der prinsipper og metoder for organisering og styring av offentlig sektor baserer seg på markedet. Det har i løpet av de siste årene vært en økende interesse for transformasjonsledelse. Mange norske kommuner har i takt med moderne utvikling utarbeidet og vedtatt verdigrunnlag i sin organisasjon. Vår studie har hatt som formål å undersøke om vedtatte verdier kan spores igjen i sentrale HR-dokumenter. Vi ønsker å finne ut om de vedtatte verdiene praktiseres og implementeres i kommunenes drift. Vi har arbeidet ut fra følgende problemstilling: Finner vi empirisk uttrykk for praktisering av vedtatte verdier i sentrale HR-dokument i norske mellomstore kommuner? I gjennomføringen og analyse av data valgte vi å bruke en kvalitativ metode. Datainnsamlingen har basert seg på et spørreskjema og innsendte sentrale HR-dokument. Vår studie har i vært en dokumentstudie. Studien belyses i hovedsak med organisasjonsteori, ledelsesteori og implementeringsteori. Vi har også brukt egne erfaringer for å belyse problemstillingen. Vår første henvendelse gikk til 70 mellomstore kommuner. Til slutt satt vi igjen med fire kommuner vi kunne bruke i vår dokumentstudie. I de dokumentene vi har fått tilsendt, vises få eller ingen spor av de vedtatte verdiene. Sentralt i våre funn er at ingen av kommunene kunne sende oss dokumenter som sa noe om plan for prosessen med å utarbeide og vedta verdigrunnlaget. Det var i tillegg ingen plan på implementering og vedlikehold.

Rapid and sustained improvements in health-related quality of life, fatigue, and other patient-reported outcomes in rheumatoid arthritis patients treated with certolizumab pegol plus methotrexate over 1 year: results from the RAPID 1 randomized controlled trial

Abstract Introduction The objective of this study was to assess the impact of certolizumab pegol (CZP) treatment on health-related quality of life (HRQoL), fatigue and other patient-reported outcomes (PROs) in patients with rheumatoid arthritis (RA). Methods Patients with active RA (N = 982) were randomized 2:2:1 to subcutaneous CZP (400 mg at weeks 0, 2 and 4; followed by CZP 200 mg or 400 mg) plus methotrexate (MTX) every other week, or placebo (PBO) plus MTX. PRO assessments included HRQoL, fatigue, physical function, arthritis pain and disease activity. Adjusted mean changes from baseline in all PROs were obtained using analysis of covariance (ANCOVA) applying last observation carried forward (LOCF) imputation. The proportion of patients achieving clinically meaningful improvements in each PRO was obtained using logistic regression and by applying non-responder imputation to missing values after rescue medication or withdrawal. The correlations between PRO responses and clinical responses were also assessed by tetrachoric correlation using non-responder imputation. Results Patients treated with CZP plus MTX reported significant (P < 0.001), clinically meaningful improvements in HRQoL at the first assessment (week 12); reductions in fatigue, disease activity and pain and improvements in physical function were reported at week 1. In particular, CZP-treated patients reported improvements in mental health. Mean changes from baseline in the SF-36 Mental Component Summary (MCS) at week 52 for CZP 200 mg and 400 mg plus MTX, and PBO plus MTX were 6.4, 6.4 and 2.1, respectively (P < 0.001). In addition, mental health and vitality scores in CZP-treated patients approached age- and gender-adjusted US population norms. Improvements in all PROs were sustained. Similar benefits were reported with both CZP doses. Changes in SF-36 MCS scores had the lowest correlation with disease activity scores (DAS28) and American College of Rheumatology 20% improvement (ACR20) response rates, while improvements in pain showed the highest correlation. Conclusions Treatment with CZP plus MTX resulted in rapid and sustained improvements in all PROs, indicating that the benefits of CZP extend beyond clinical efficacy endpoints into areas that are more relevant and meaningful for patients on a daily basis. Trial Registration ClinicalTrials.gov NCT00152386

The changing landscape of biosimilars in rheumatology

Biosimilars remain a hot topic in rheumatology, and some physicians are cautious about their application in the real world. With many products coming to market and a wealth of guidelines and recommendations concerning their use, there is a need to understand the changing landscape and the real clinical and health-economic potential offered by these agents. Notably, rheumatologists will be at the forefront of the use of biosimilar monoclonal antibodies/soluble receptors. Biosimilars offer cost savings and health gains for our patients and will play an important role in treating rheumatic diseases. We hope that these lower costs will compensate for inequities in access to therapy based on economic differences across countries. Since approved biosimilars have already demonstrated highly similar efficacy, it will be most important to establish pharmacovigilance databases across countries that are adequate to monitor long-term safety after marketing approval

Sequential extraction and fractionation of four polysaccharides from cultivated brown algae Saccharina latissima and Alaria esculenta

Norway has a well-established seaweed industry based on extraction of alginates from wild harvested brown algae, Laminaria hyperborea (LH). However, further expansion of wild harvest is limited, and cultivated seaweed can contribute to meeting increasing demands for high value compounds in an environmentally sustainable manner. Herein, an integrated process for retrieving alginate, fucoidan, laminarin and cellulose was established for cultivated Saccharina latissima (SL) and Alaria esculenta (AE). Focus was to develop a process using mild chemical methods that do not compromise the molecular weights (MW) of the polysaccharides, particularly with respect to alginate. Response surface methodology (RSM) was applied to optimize the yield of fucoidan and laminarin and assess the effect of the applied extraction parameters: pH, temperature, and time, on the MW of subsequently extracted alginates. RSM confirmed that high yields of fucoidan and laminarin can be achieved while maintaining the alginate MW. Optimized conditions were applied in a pilot scale process, where all four polysaccharides were extracted. Purity (ranging from 40 up to 98 %) and composition of the components were evaluated combining several analytical techniques. Total yields of the polysaccharides were 23.4 % of the entering dry biomass from SL and 26.3 % from AE, representing around 55 % of the estimated maximal yield. However, all extractions were not optimized, and a mass balance revealed that <75 % more alginates could have been collected. The process can be adapted to simultaneously collect mannitol, which accounted for <15 % of the dry weight. The alginates were further examined by producing hydrogels, showing that the gel properties are comparable to alginates from LH fronds. The study demonstrated that mild chemical extraction techniques can be combined to extract all four polysaccharides from SL and AE, providing a foundation for a multicomponent biorefinery using cultivated brown algae.Sequential extraction and fractionation of four polysaccharides from cultivated brown algae Saccharina latissima and Alaria esculentaacceptedVersio

A Trial-Based Cost-Utility Analysis of a Medication Optimization Intervention Versus Standard Care in Older Adults

Background - Older adults are at greater risk of medication-related harm than younger adults. The Integrated Medication Management model is an interdisciplinary method aiming to optimize medication therapy and improve patient outcomes. Objective - We aimed to investigate the cost effectiveness of a medication optimization intervention compared to standard care in acutely hospitalized older adults. Methods - A cost-utility analysis including 285 adults aged ≥ 70 years was carried out alongside the IMMENSE study. Quality-adjusted life years (QALYs) were derived using the EuroQol 5-Dimension 3-Level Health State Questionnaire (EQ-5D-3L). Patient-level data for healthcare use and costs were obtained from administrative registers, taking a healthcare perspective. The incremental cost-effectiveness ratio was estimated for a 12-month follow-up and compared to a societal willingness-to-pay range of €/QALY 27,067–81,200 (NOK 275,000–825,000). Because of a capacity issue in a primary care resulting in extended hospital stays, a subgroup analysis was carried out for non-long and long stayers with hospitalizations Results - Mean QALYs were 0.023 [95% confidence interval [CI] 0.022–0.025] higher and mean healthcare costs were €4429 [95% CI − 1101 to 11,926] higher for the intervention group in a full population analysis. This produced an incremental cost-effectiveness ratio of €192,565/QALY. For the subgroup analysis, mean QALYs were 0.067 [95% CI 0.066–0.070, n = 222] and − 0.101 [95% CI − 0.035 to 0.048, n = 63] for the intervention group in the non-long stayers and long stayers, respectively. Corresponding mean costs were €− 824 [95% CI − 3869 to 2066] and €1992 [95% CI − 17,964 to 18,811], respectively. The intervention dominated standard care for the non-long stayers with a probability of cost effectiveness of 93.1–99.2% for the whole willingness-to-pay range and 67.8% at a zero willingness to pay. Hospitalizations were the main cost driver, and readmissions contributed the most to the cost difference between the groups. Conclusions - According to societal willingness-to-pay thresholds, the medication optimization intervention was not cost effective compared to standard care for the full population. The intervention dominated standard care for the non-long stayers, with a high probability of cost effectiveness

Rheumatoid arthritis - treatment: 180. Utility of Body Weight Classified Low-Dose Leflunomide in Japanese Rheumatoid Arthritis

Background: In Japan, more than 20 rheumatoid arthritis (RA) patients died of interstitial pneumonia (IP) caused by leflunomide (LEF) were reported, but many of them were considered as the victims of opportunistic infection currently. In this paper, efficacy and safety of low-dose LEF classified by body weight (BW) were studied. Methods: Fifty-nine RA patients were started to administrate LEF from July 2007 to July 2009. Among them, 25 patients were excluded because of the combination with tacrolimus, and medication modification within 3 months before LEF. Remaining 34 RA patients administered 20 to 50 mg/week of LEF were followed up for 1 year and enrolled in this study. Dose of LEF was classified by BW (50 mg/week for over 50 kg, 40 mg/week for 40 to 50 kg and 20 to 30 mg/week for under 40 kg). The average age and RA duration of enrolled patients were 55.5 years old and 10.2 years. Prednisolone (PSL), methotrexate (MTX) and etanercept were used in 23, 28 and 2 patients, respectively. In case of insufficient response or adverse effect, dosage change or discontinuance of LEF were considered. Failure was defined as dosages up of PSL and MTX, or dosages down or discontinuance of LEF. Last observation carried forward method was used for the evaluation of failed patients at 1 year. Results: At 1 year after LEF start, good/ moderate/ no response assessed by the European League Against Rheumatism (EULAR) response criteria using Disease Activity Score, including a 28-joint count (DAS28)-C reactive protein (CRP) were showed in 14/ 10/ 10 patients, respectively. The dosage changes of LEF at 1 year were dosage up: 10, same dosage: 5, dosage down: 8 and discontinuance: 11 patients. The survival rate of patients in this study was 23.5% (24 patients failed) but actual LEF continuous rate was 67.6% (11 patients discontinued) at 1 year. The major reason of failure was liver dysfunction, and pneumocystis pneumonia was occurred in 1 patient resulted in full recovery. One patient died of sepsis caused by decubitus ulcer infection. DAS28-CRP score was decreased from 3.9 to 2.7 significantly. Although CRP was decreased from 1.50 to 0.93 mg/dl, it wasn't significant. Matrix metalloproteinase (MMP)-3 was decreased from 220.0 to 174.2 ng/ml significantly. Glutamate pyruvate transaminase (GPT) was increased from 19 to 35 U/l and number of leukocyte was decreased from 7832 to 6271 significantly. DAS28-CRP, CRP, and MMP-3 were improved significantly with MTX, although they weren't without MTX. Increase of GPT and leukopenia were seen significantly with MTX, although they weren't without MTX. Conclusions: It was reported that the risks of IP caused by LEF in Japanese RA patients were past IP history, loading dose administration and low BW. Addition of low-dose LEF is a potent safe alternative for the patients showing unsatisfactory response to current medicines, but need to pay attention for liver function and infection caused by leukopenia, especially with MTX. Disclosure statement: The authors have declared no conflicts of interes

Successfully treating 90 patients with obsessive compulsive disorder in eight days: The Bergen 4-day treatment

Background: Oslo University Hospital, Norway, had by autumn 2016, accumulated a waiting list of 101 patients with obsessive-compulsive disorder (OCD) who had a legal right to receive treatment by a specialized OCD team. In this challenging situation, the Bergen OCD-team suggested to solve the problem by offering all patients an option for the rapid Bergen 4-day treatment (B4DT). The B4DT is an individual treatment delivered during four consecutive days in a group of six patients with the same number of therapists. The approach has previously shown a post-treatment response rate of 90% and a 3-month remission rate of 70%. Methods: Ninety-seven of the wait-list patients were available for the scheduled time slots, and 90 received the 4-day format during 8 days (45 patients each week). The therapists were recruited from 22 different specialized OCD-teams from all over Norway, and 44 (68%) had not previously delivered the 4-day format. Results: Post-treatment; 91.1% of the patients were classified as responders, and 72.2% were in remission. At 3-month follow-up; 84.4 were classified as responders and the remission rate was 67.7%. Oslo University Hospital now offers the 4-day treatment as standard treatment for OCD. Conclusions: We conclude that the B4DT is an acceptable and potentially effective OCD-treatment.publishedVersio

Rapport forprosjekt : Campus 4 Avdeling for økonomi, samfunnsfag og informatikk

I kapittel 1 tolkes oppdraget og vår mandatforståelse. Det legges stor vekt på dokumentasjon og datagrunnlag, slik det ble etterspurt i forstudien. I kapittel 3 drøftes forholdet til campus 3. Vi ser ikke konfliktområder som tilsier organisasjonsendringer. Kapittel 4 viser aktivitet og utfordringer innen våre virksomhetsområder. Markedssituasjonen for våre studier svinger mye, noe som krever kontinuerlig tilpassing og omstilling; en kan i liten grad vedta utviklingen. Videre vektlegges den regionale utfordringen i tillegg til nasjonale oppgaver. Det vises til målsettinger gitt i stasbudsjettet, og særlig til utfordringer gitt i ”En ledende kompetansenasjon”, en utreding fra UFD. I kapittel 4.2 belyses høgskolens markedsutvikling. Flere av studiene på ØSIR, særlig informatikk, er konjunkturutsatte utdanninger og det har vært, og en må forvente, store svingninger i søkertall. IT-utdanningene i HH har hatt samme relative søkerutvikling som ved andre statlige høgskoler. Økonomiutdanningene har også hatt store svingninger, men i 2005 er søkningen passert søkningen fra 1997 og er på samme relative nivå som snittet for alle studier, og høyere enn for andre økonomistudier i statlige høgskoler. Søkningen til samfunnsfag i Norge har fra 2002 økt kraftig og betydelig mer enn for snittet av alle studier. Samfunnsfagene ved avdelingen har ikke tatt del i denne veksten. Vi mener hele høgskolen har tapt relativ konkurransekraft. de siste 7 år. Ut i fra veksten i ungdomskullene må en kunne forvente 20 % økt søkermasse nasjonalt frem mot år 2010. Siden år 2000 har ØSIR hatt tap av måltall og studiepoengproduksjon. Det har også avdelinger i andre høgskoler med samme type fagportefølje. Høgskolen i Hedmark har samlet tapt måltall og studiepoengproduksjon. ØSIR har en meget høg eksternfinansiert utdanningsvirksomhet, på samme nivå som for ordinære studieplasser. Videre belyses avdelingen diversifiseringsstrategi for studieutvikling. I korthet består det av å markedsføre mange studier med utgangspunkt i en grunnstamme kurs og fag. Det påvises at dette er en strategi som er i bruk her og også hos de fleste andre konkurrenter. Selv om det administrativt kunne ha vært enklere med færre studier, så er diversifisering en konsekvens av markedsutsetting. Samordna opptak (SO) er en markedskanal i tillegg til et servicesenter. ”Music Management” versus ”Øk/adm. Mulighet til fordyping blant annet innen musikkarrangement” er vel et nærliggende eksempel. I kapittel 4.3 dokumenteres utviklingen av forskningsaktivitet: I Norge og Hedmark, og internt i høgskolen. Omfanget i Hedmark er betydelig lavere enn i snittet av fylker uten universitet, og enda lavere enn landsgjennomsnittet. I høgskolen er det ca. 2 forekomster av FoU+formidling pr. fast ansatt pr. år de tre siste årene, slik kriteriene for dette har vært frem til nå. Oppdragsomsetningen pr. fast ansatt blir også belyst. I kapittel 4.4 dokumenters eksternt finansiert virksomhet; omfang. typer, kunder, organisering, utfordringer. Avdelingen har satset meget høyt på å bidra til regional utvikling gjennom å tilby oppdragsutdanninger. Fordi Hedmark har en voksenbefolkning med lavt utdanningsnivå, har dette vært et adekvat bidrag til regional utvikling. I og med fylkets lave forskningsaktivitet er etterspørselen etter forskning innen våre fag begrenset. Forsvaret har etter hvert blitt vår største kunde for oppdragsutdanninger. Denne virksomheten har et nasjonalt nedslagsfelt som også har fått oppmerksomhet i Stortinget

Correction to: On-drug and drug-free remission by baseline symptom duration: abatacept with methotrexate in patients with early rheumatoid arthritis

Clinical outcomes in patients with early rheumatoid arthritis (RA) were assessed by baseline symptom duration in the Assessing Very Early Rheumatoid arthritis Treatment trial (ClinicalTrials.gov; NCT01142726). Patients with early, active RA were randomized to subcutaneous (SC) abatacept 125 mg/week plus methotrexate (MTX), SC abatacept alone, or MTX monotherapy for 12 months. All RA treatments were withdrawn after 12 months in patients with Disease Activity Score in 28 joints (C-reactive protein; DAS28-CRP)  3 to ≤ 6 months, or > 6 months) and treatment group. No clinically significant differences were seen in baseline demographics or characteristics across symptom duration groups. Irrespective of baseline symptom duration, a numerically higher proportion of abatacept plus MTX-treated patients achieved DAS-defined remission at month 12 and sustained remission at month 18 compared with MTX monotherapy. A numerically higher proportion of abatacept plus MTX-treated patients with symptom duration ≤ 3 months maintained DAS-defined remission after complete treatment withdrawal from 12 to 18 months compared with longer symptom duration groups. This subgroup also had the fastest onset of clinical response (DAS28-CRP < 2.6) after initiation of treatment. Health Assessment Questionnaire–Disability Index response was similar regardless of baseline symptom duration. Overall, symptom duration of ≤ 3 months was associated with a faster onset of clinical response and higher rates of drug-free remission following treatment with abatacept plus MTX