Implementering av fast-track pasientforløp til hoftebruddpasienter- har vi fått til det vi sa vi skulle?

Formål: Hensikten med denne masteroppgaven er å evaluere implementeringen av et nytt pasientforløp kalt fast-track for hoftebrudd på Oslo universitetssykehus (OUS), Ullevål. Teoretisk forankring: Det ble tatt utgangspunkt i litteratur som omhandlet hoftebrudd, pasientforløp, fast-trackforløp, osteoporose, samt litteratur om implementering og kvalitetsforbedring. Metode: Dette var en tverrsnittstudie der hoftebruddpasienter fra to perioder ble inkludert. Inklusjonskriteriene var proksimale hoftebrudd operert på OUS, Ullevål. Pasienter < 50 år med hoftebrudd og patologiske brudd (grunnet metastatisk svekket bein) ble ekskludert. Utvalget bestod av de første 150 pasientene fra henholdsvis mai 2014 (periode 1) og mai 2016 (periode 2). Det ble valgt ut syv kvalitetsindikatorer; fast-trackinnleggelse, preoperativ ventetid til operasjon, preoperativ smertelindring med nerveblokade, osteoporosebehandling, antall liggedøgn, tidlig seponering av urinkateter og mobilisering første postoperative dag. Etterlevelsen av kvalitetsindikatorene ble sammenliknet mellom de to periodene, og mellom de to pasientgruppene fast-track og fast-track light. Resultater: Det var signifikant økning i antall fast-trackinnleggelser (innenfor fast-track åpningstid) og antall pasienter som fikk osteoporosebehandling i periode 2. Pasientene innlagt via fast-track ventet kortere på operasjon og fikk oftere osteoporosebehandling sammenliknet med fast-track light i periode 1. I periode 2 var det ikke lenger en sammenheng mellom innleggelse i fast-track og etterlevelse av kvalitetsindikatorene. Imidlertid fikk flere fast-trackpasienter signifikant mer preoperativ nerveblokade enn fast-track light i periode 2. Det var ingen signifikant forskjell på antall liggedøgn, tidlig seponering av urinkateter eller tidlig mobilisering. Konklusjon: Etterlevelsen av kvalitetsindikatorene har ligget jevnt i de to periodene. De største forskjellene er sett når fast-track og fast-track light ble sammenliknet. I periode 1 var det større sannsynlighet for at kvalitetsindikatorene i det nye pasientforløpet ble etterlevd til fast-trackpasientene sammenliknet med pasientene i fast-track light. I periode 2 var det ikke lenger forskjell mellom de to gruppene

Methane Oxidising Bacteria as Environmental Indicators

This report focuses on methane oxidising bacteria (methanotrophs). The key function of methanotrophs as methane consumers and degraders of halogenated hydrocarbons bring them in the perspective of being useful indicators of environmental perturbations. Effects of climate on diversity and temperature adaptation as well as the capacity of different methanotrophs to degrade two atmospheric pollutants (chlorofluoromethanes) was investigated. None of the methanotrophs were found to be adapted for growth at permanently low temperatures although type I methanotrophs grew better at lower temperatures than the type II methanotrophs. Some of the methanotrophs were able to degrade dichlorofluoromethane while chlorodifluoromethane degradation was not demonstrated. No correlation was found between the degradation capacity and the origin of the isolates (landfill or wetland soil), or characteristics of their methane monooxygenase enzymes.The project did not identify a simple correlation between climatic variation or environmental stress and the variation in composition of the methanotroph community. More knowledge about temperature dependent interactions between type I and type II methanotrophs is needed before the composition of methanotrophs can be implemented as an indicator revealing ecological consequences of e.g. changes in climate

Vitamin D status and complications, readmissions, and mortality after hip fracture

Summary Low vitamin D in patients with hip fracture is common. In the present study, 407 of 872 (47%) patients had serum calcidiol less than 50 nmol/L. Patients with low vitamin D had more delirium, more new hip fractures, and more medical readmissions, but not more orthopedic complications after 1 year. Introduction We wanted to study the relation between vitamin D level and postoperative orthopedic and medical complications in patients with hip fracture. In addition, we investigated the effect of giving a single-dose cholecalciferol 100.000 IU. Methods Data were taken from the local hip fracture register. Logistic regression analyses including vitamin D level and potentially confounding variables were performed for complications and readmissions. Results A total of 407 (47%) of 872 included hip fractures had low vitamin D at baseline. A total of 155 (18%) developed delirium, and the risk was higher in vitamin D-deficient patients (odds ratio (OR) 1.48, 95% confidence interval (CI) 1.04 to 2.12; p = 0.03). A total of 261 (30%) were readmitted for non-hip-related conditions. Low vitamin D was associated with a higher risk of medical readmissions within 30 days (OR 1.64 (1.03 to 2.61); p = 0.036) and 12 weeks (OR 1.47 (95% CI 1.02 to 2.12); p = 0.039). There was a higher risk of a new hip fracture (OR 2.84 (95% CI 1.15 to 7.03) p = 0.024) in vitamin D-deficient patients. A total of 105 (12%) developed at least one orthopedic complication, with no correlation to baseline vitamin D. Among vitamin D-deficient patients, those receiving a single-dose of 100.000 IU cholecalciferol had fewer orthopedic complications (OR 0.32 (95% CI 0.11 to 0.97) p = 0.044) the first 30 days after surgery. Conclusion Low vitamin D at admission for hip fracture increased the risk of delirium, a new hip fracture, and medical readmissions, but not orthopedic complications. The role of vitamin D supplementation to prevent orthopedic complications requires further study

Genome sequence of the arctic methanotroph Methylobacter tundripaludum SV96.

International audienceMethylobacter tundripaludum SV96(T) (ATCC BAA-1195) is a psychrotolerant aerobic methane-oxidizing gammaproteobacterium (Methylococcales, Methylococcaceae) living in High Arctic wetland soil. The strain was isolated from soil harvested in July 1996 close to the settlement Ny-Ålesund, Svalbard, Norway (78°56'N, 11°53'E), and described as a novel species in 2006. The genome includes pmo and pxm operons encoding copper membrane monooxygenases (Cu-MMOs), genes required for nitrogen fixation, and the nirS gene implicated in dissimilatory nitrite reduction to NO but no identifiable inventory for further processing of nitrogen oxides. These genome data provide the basis to investigate M. tundripaludum SV96, identified as a major player in the biogeochemistry of Arctic environments