Cardiovascular disease (CVD) in the Norwegian Arctic. Air ambulance operations 1999-2009 and future challenges in the region

Background. Air ambulance operations in the Arctic have to deal with remote locations, long distances, rough weather conditions, seasonable darkness, and almost no alternative for landing. Despite these challenges, people expect high quality, specialist health care. Objective. This study aimed to analyse air ambulance operations due to cardiovascular disease (CVD) in the Arctic and employ the result as an instrument for future suggestions. Melting ice in the Arctic Sea opens new prospects for shipping, adventures, and oil/gas industry. Material and methods. In February 2010 all air ambulance operations performed in the Arctic during the period 1999 to 2009 were analysed. The population of this study covered patients with CVD. The state of emergency, state of seriousness (the National Advisory Committee on Aeronautics (NACA) scale was used), flight time, destination, and flying time were the main outcome measures. A total of 45 patients (myocardial infarction 31, angina pectoris 11, and heart failure 4 patients) were identified. There were 39 Norwegians and 6 people of other nationalities. The mean age was 57 years (range 43-83 years) Results. Thirteen cardiac incidents occurred in June and July. Most cases (26 patients) were considered urgent or emergent, and the mean NACA score was 4 (range 3-6). The adjusted female/male ratio was 0.222, and the median flying time (one way) was 3 h 25 min (range 1 h-6 h 40 min). Four flights were delayed, and one fifth of patients were transported during the night (midnight to 8.00 AM). Conclusions. Air ambulance operations in the Arctic experience significant challenges. In the near future more shipping and polar adventure operations together with new oil and gas installations will increase the demand for health care support. Telemedical installations onboard vessels and rigs will be important for remote consultation and treatment

Have Changes in Systemic Treatment Improved Survival in Patients with Breast Cancer Metastatic to the Brain?

Newly developed systemic treatment regimens might lead to improved survival also in the subgroup of breast cancer patients that harbour brain metastases. In order to examine this hypothesis, a matched pairs analysis was performed that involved one group of patients, which were treated after these new drugs were introduced, and one group of patients, which were treated approximately 10 years earlier. The two groups were well balanced for the known prognostic factors age, KPS, extracranial disease status, and recursive partitioning analysis class, as well as for the extent of brain treatment. The results show that the use of systemic chemotherapy has increased over time, both before and after the diagnosis of brain metastases. However, such treatment was performed nearly exclusively in those patients with brain metastases that belonged to the prognostically more favourable groups. Survival after whole-brain radiotherapy has remained unchanged in patients without further active treatment. It has improved in prognostically better patients and especially patients that received active treatment, where the 1-year survival rates have almost doubled. As these patient groups were small, confirmation of the results in other series should be attempted. Nevertheless, the present results are compatible with the hypothesis that improved systemic therapy might contribute to prolonged survival in patients with brain metastases from breast cancer

Presentation and course of brain metastases from breast cancer in a paranoid-schizophrenic patient: A case report

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Towards Improved Prognostic Scores Predicting Survival in Patients with Brain Metastases: A Pilot Study of Serum Lactate Dehydrogenase Levels

Accurate prognostic information is desirable when counselling patients with brain metastases regarding their therapeutic options and life expectancy. Based on previous studies, we selected serum lactate dehydrogenase (LDH) as a promising factor on which we perform a pilot study investigating methodological aspects of biomarker studies in patients with brain metastases, before embarking on large-scale studies that will look at a larger number of candidate markers in an expanded patient cohort. For this retrospective analysis, 100 patients with available information on LDH treated with palliative whole-brain radiotherapy were selected. A comprehensive evaluation of different LDH-based variables was performed in uni- and multivariate tests. Probably, the most intriguing finding was that LDH kinetics might be more important, or at least complement, information obtained from a single measurement immediately before radiotherapy. LDH and performance status outperformed several other variables that are part of prognostic models such as recursive partitioning analyses classes and graded prognostic assessment score. LDH kinetics might reflect disease behaviour in extracranial metastatic and primary sites without need for comprehensive imaging studies and is a quite inexpensive diagnostic test. Based on these encouraging results, confirmatory studies in a larger cohort of patients are warranted

Diagnostic accuracy of left ventricular longitudinal function by speckle tracking echocardiography to predict significant coronary artery stenosis. A systematic review

Background Patients evaluated for acute and chronic chest pain comprise a large, heterogeneous group that often provides diagnostic challenges. Although speckle tracking echocardiography (STE) has proved to have diagnostic value in acute coronary syndrome it is not commonly incorporated in everyday practice. The purpose of the present systematic review was to assess the diagnostic accuracy of left ventricular (LV) longitudinal function by STE to predict significant coronary artery stenosis (CAD+) or not (CAD-) verified by coronary angiography in patients with chest pain suspected to be of cardiac ischemic origin. Methods 4 electronic databases; Embase, Medline, Cochrane and PubMed ahead-of print were searched for per 19.05.14. Only full-sized articles including > 40 patients were selected. Results A total of 166 citations were identified, 16 full-size articles were assessed of which 6 were found eligible for this review. Of 781 patients included 397 (60 %) had CAD+. The overall weighted mean global longitudinal strain (GLS) was −17.2 % (SD = 2.6) among CAD+ vs. -19.2 % (SD = 2.8) in CAD- patients. Mean area under curve in 4 studies for predicting CAD+ ranged from 0.68 to 0.80. The study cut-off levels for prediction of CAD+ in the ROC analysis varied between −17.4 % and −19.7 % with sensitivity from 51 % to 81 % and specificity between 58 % and 81 %. In 1 study GLS obtained during dobutamine stress echocardiography (DSE) had the best accuracy. Regional strain measurements were not uniform, but may have potential in detecting CAD. Conclusions GLS measurements at rest only have modest diagnostic accuracy in predicting CAD+ among patients presenting with acute or chronic chest pain. The results from regional strain, layer specific strain and DSE need to be verified in larger studies

A prospective analysis of false positive events in a National Colon Cancer Surveillance Program

BACKGROUND: The survival benefits of colon cancer surveillance programs are well delineated, but less is known about the magnitude of false positive testing. The objective of this study was to estimate the false positive rate and positive predictive value of testing as part of a surveillance program based on national guidelines, and to estimate the degree of testing and resource use needed to identify a curable recurrence. METHODS: Analysis of clinically significant events leading to suspicion of cancer recurrence, false positive events, true cancer recurrences, time to confirmation of diagnosis, and resource use (radiology, blood samples, colonoscopies, consultations) among patients included in a randomised colon cancer surveillance trial. RESULTS: 110 patients surgically treated for colon cancer were followed according to national guidelines for 1884 surveillance months. 1105 tests (503 blood samples, 278 chest x-rays, 209 liver ultrasounds, 115 colonoscopies) and 1186 health care consultations were performed. Of the 48 events leading to suspicion of cancer recurrence, 34 (71%) represented false positives. Thirty-one (65%) were initiated by new symptoms, and 17 (35%) were initiated by test results. Fourteen patients had true cancer recurrence; 7 resections of recurrent disease were performed, 4 of which were successful R0 metastasis Resections. 276 tests and 296 healthcare consultations were needed per R0 resection; the cost per R0 surgery was £ 103207. There was a 29% probability (positive predictive value) of recurrent cancer when a diagnostic work-up was initiated based on surveillance testing or patient complaints. CONCLUSION: We observed a high false positive rate and low positive predictive value for significant clinical events suggestive of possible colorectal cancer relapse in the setting of a post-treatment surveillance program based on national guidelines. Providers and their patients should have an appreciation for the modest positive predictive value inherent in colorectal cancer surveillance programs in order to make informed choices, which maximize quality of life during survivorship. Better means of tailoring surveillance programs based on patient risk would likely lead to more effective and cost-effective post-treatment follow-up. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT00572143. Date of trial registration: 11(th) of December 2007

Mammographic screening in Sami speaking municipalities and a control group. Are early outcome measures influenced by ethnicity?

Objectives. Female citizens of Sami (the indigenous people of Norway) municipalities in northern Norway have a low risk of breast cancer. The objective of this study was to describe the attendance rate and outcome of the Norwegian Breast Cancer Screening Program (NBCSP) in the Sami-speaking municipalities and a control group. Study design. A retrospective registry-based study. Methods. The 8 municipalities included in the administration area of the Sami language law (Sami) were matched with a control group of 11 municipalities (non-Sami). Population data were accessed from Statistics Norway. Data regarding invitations and outcome in the NBCSP during the period 2001–2010 was derived from the Cancer Registry of Norway (CRN). The NBCSP targets women aged 50–69 years. Rates and percentages were compared using chi-square test with a p-value<0.05 as statistical significant. Results. The attendance rate in the NBCSP was 78% in the Sami and 75% in the non-Sami population (p< 0.01). The recall rates were 2.4 and 3.3% in the Sami and non-Sami population, respectively (p<0.01). The rate of invasive screen detected cancer was not significantly lower in the Sami group (p=0.14). The percentage of all breast cancers detected in the NBCSP among the Sami (67%) was lower compared with the non-Sami population (86%, p=0.06). Conclusion. Despite a lower risk of breast cancer, the Sami attended the NBCSP more frequently than the control group. The recall and cancer detection rate was lower among the Sami compared with the non-Sami group

Air ambulance flights in northern Norway 2002-2008. Increased number of secondary fixed wing (FW) operations and more use of rotor wing (RW) transports

Air ambulance service in Norway has been upgraded during the last years. European regulations concerning pilots’ working time and new treatment guidelines/strategies have called for more resources. The objective was to describe and analyse the two supplementary air ambulance [fixed wing (FW) and rotor wing (RW)] alternatives’ activity during the study period (2002-2008). Furthermore we aimed to compare our findings with reports from other north European regions. This is a retrospective analysis. The air ambulance fleet’s activity according to the electronic patient record database of “Luftambulansetjenesten ANS” (LABAS) was analysed. The subject was the fleet’s operations in northern Norway, logistics, and patients handled. Type of flight, distances, frequency, and patients served were the main outcome measures. A significant increase (45%) in the use of RW and a shift in FW operations (less primary and more secondary) were revealed. The shift in FW operations reflected the centralisation of several health care services [i.e. percutaneous cardiac intervention (PCI), trauma, and cancer surgery] during the study period. Cardiovascular disease (CVD) and injuries were the main diagnoses and constituted half of all operations. CVD was the most common cause of FW operations and injuries of the RW ones. The number of air ambulance operations was 16 per 1,000 inhabitants. This was more frequent than in other north European regions. The use of air ambulances and especially RW was significantly increased during the study period. The change in secondary FW operations reflected centralisation of medical care. When health care services are centralised, air ambulance services must be adjusted to the new settings

PET-CT in the-subarctic region of Norway 2010-2013. At the edge of what is possible?

Published version. Source at http://doi.org/10.1186/s12880-015-0073-0.Background It is challenging to obtain a similar access to positron emission tomography/computed tomography (PET-CT) within the whole region served. In the subarctic and arctic region of Norway, significant distances, weather conditions and seasonable darkness have been challenging when the health care provider has aimed for a high quality PET-CT service with similar availability to all inhabitants. Methods The PET-CT service at the University Hospital of North Norway (UNN) was established in May 2010. The glucose analogue tracer fluorine-18 fluorodeoxyglucose (FDG) was delivered from Helsinki, Finland. An ambulatory PET-CT scanner was initially employed and a permanent local one was introduced in October 2011. In March 2014, we analysed retrospectively all data on the PET-CT exams performed at the Section of Nuclear Medicine, Department of Radiology during a 32 months time period 2010–13. The following patient data were recorded: gender, age, diagnosis, residence and distance of travelling. There were in total 796 exams in 706 patients. Results Four hundred sixty-one PET-CT exams per million inhabitants were, on average, performed per year. Lung cancer (32.7 %), malignant melanoma (11.3 %), colorectal cancer (10.9 %) and lymphoma (9.7 %) constituted two-thirds of all exams. Three-fourths were males and the median age was 63.5 years (range 15.2–91.4 years). The access to PET-CT exam varied within the region. The southern county (Nordland) experienced a significantly less access (p < 0.0001) to the regional service. Except for malignant melanoma, this finding was observed in all major cancer subgroups. In colorectal cancer and lymphoma a lower consumption of PET-CT was also observed in the northeastern county (Finnmark). Patients’ mean distance of travelling by car (one way) was 373 km (median 313 km, range 5–936 km). Conclusion PET-CT was not similarly available within the region. Especially, inhabitants in the southern county experienced less access to the regional service. National and regional standards of care, new scanners and improved collaboration between hospital trusts may alter this situation