Impact of Psychotherapy in Psychosis: A Retrospective Case Control Study

Background: The need for psychological therapies for psychosis has become apparent since long-term antipsychotic drug treatment has a range of adverse side effects, with moderate therapeutic effects at best.Aims: To investigate whether the psychotherapeutic approach, dialogue therapy (DT) is associated with improvements of symptoms and functioning beyond standard psychiatric treatment (ST) in both schizophrenia and other psychosis.Methods: A retrospective case-control design, comparing 54 patients with different psychoses who received DT with 54 patients in a control group receiving ST was carried out. The groups were matched on diagnosis, age, sex, and treatment start. Outcome measures were Global assessment of functioning (GAF) scores, medications at follow up, and hospital stays after completed outpatient treatment.Results: Mean time in treatment from inclusion to follow-up was 3 years and 5 months. At follow-up, GAF functioning (GAF-F) and GAF symptom (GAF-S) scores both were significantly higher in the DT group than the ST group. Effect sizes (Cohen's d) were large; 1.8 for GAF-S and 2.1 for GAF-F. At follow-up, the use of psychoactive drugs was significantly reduced despite a shorter time in psychotherapy in the DT group compared to the ST group. Days of hospitalizations after end of treatment in the study period were significantly reduced in both groups compared to the period before start of treatment.Conclusions: The findings from this exploratory study are consistent with the possibility that dialogue therapy may lead to improvements in symptoms and functioning compared to standard treatment in psychosis

Orale Candida albicans-infeksjoner og deres betydning for utvikling av orale plateepitelkarsinom

Bakgrunn: Formålet med denne prosjektoppgaven er å undersøke sammenhengen mellom orale C. albicans-infeksjoner og utvikling av munnhulekreft, og knytte dette opp mot viktigheten av behandling av soppinfeksjoner i odontologisk praksis. Metode: Vi har gjort et systematisk litteratursøk i databasen Pubmed for å samle inn relevante artikler som omfatter både orale soppinfeksjoner og munnhulekreft. Gjennom avansert søk fikk vi et treff på 505 artikler, hvorav vi plukket ut 15 artikler basert på våre valgte inklusjons- og eksklusjonskriterier. Videre har vi sett på histologiske vevssnitt av soppinfeksjon fra munnslimhinnen diagnostisert ved Avdeling for Patologi, Haukeland universitetssykehus. I tillegg har vi samlet informasjon (personlig kommunikasjon), om påvisning og behandlingsprosedyrer ved soppinfeksjoner ved Institutt for klinisk odontologi, Universitetet i Bergen. Resultat: Flere studier viser høyere tilstedeværelse av sopp i orale lesjoner med dysplasi og utvikling av plateepitelkarsinom. Det er derimot omdiskutert om den økte forekomsten skyldes at det er enklere for soppen å infisere det dysplastiske epitelet eller om soppen i seg selv har bidratt til utvikling av dysplasi. Det er en rekke ulike mekanismer som kan knytte tilstedeværelse av C. albicans til utvikling av orale plateepitelkarsinom, - deriblant produksjon av acetaldehyd, nitrosaminer og stimulering av inflammatoriske mediatorer. Konklusjon: Det er omdiskutert om årsaken til høy forekomst av C. albicans i kreftlesjoner og forandringer med dysplasi i munnslimhinne er relatert til den endrede overflatestrukturen i slike lesjoner, eller om det er soppens egenskaper som er årsaken til at disse oppstår. På grunn av usikkerheten rundt dette bør en behandle alle orale soppinfeksjoner, spesielt ved tilstedeværelse av andre kjente risikofaktorer som tobakksrøyking og høyt alkoholkonsum. Både rutinekontroller av munnslimhinnen og tidlig behandling av soppinfeksjoner kan være viktig for å redusere risikoen for kreftutvikling, eller for å kunne stille en diagnose på et tidlig stadium.Background: The aim of this project is to evaluate the correlation between oral C. albicans infections and the development of oral squamous cell carcinoma, in relation to the importance of treatment of oral fungal infections. Methods: We have carried out a systematic literature search in the database Pubmed and collected relevant publications that include both oral candidiasis and oral cancer. Through an advanced search we found a total of 505 publications, from which we selected 15 to be included in our study, based on our chosen inclusion and exclusion criteria. Additionally, we have looked at diagnostic histological sections of oral candidiasis from department of Pathology, Haukeland University Hospital, and collected information (personal communication) about diagnostic and treatment procedures for oral fungal infections at the Department of Clinical Dentistry, University of Bergen. Results: Several studies show a higher presence of fungi in oral lesions with either dysplasia or malignant transformation. However, it is questioned whether the increased incidence is due to the fact that it is easier for the fungus to infect the dysplastic epithelium or whether the fungus itself has promoted dysplastic or malignant transformation. Several different mechanisms that can link the presence of C. albicans to the development of oral squamous cell carcinoma have been suggested, - including its ability to produce acetaldehyde, nitrosamines, and stimulation of inflammatory mediators. Conclusion: It is debated whether the reason for the high occurrence of C. albicans in cancer lesions and dysplastic lesions in oral mucosa is related to changes in the surface structure of the lesions, or if the properties of the C. albicans are causing these transformations. Since the role of C. albicans is not well-defined, all oral candidiasis lesions should be treated, especially if other known risk factors for oral cancer, such as smoking or high alcohol consumption, are also present. Both routine check-ups of the oral mucosa and early treatment of oral candidiasis can be important factors to reduce the risk of cancer development, or to confirm a diagnosis at an early stage, and thereby improve the prognosis.Prosjektoppgave / Integrert masteroppgaveOD3PROSJMAOD-ODON

Medisinske diagnoser og prosedyrer – det viktigste å lære i praksisstudier?

Hensikten med studien er å belyse skriftlige tilbakemeldinger til sykepleiestudenter relatert til læringsutbytter i praksisstudier. Studien har et kvalitativt deskriptivt design. Datagrunnlaget er 100 vurderingsskjemaer fra praksisstudier i spesialisthelsetjenesten. Det gis en oversikt over hvilke læringsutbytter som kommenteres mest. Det er gjennomført en tematisk analyse av friteksten i vurderingsskjemaene, inspirert av Braun og Clarke. Temaene som presenteres i funnene er pasientkunnskap og sykepleiehandlinger, individualisering av læringsutbytter og studentenes profesjonelle egenskaper. Pasientvurderinger og sykepleiehandlinger vektlegger i hovedsak medisinske diagnoser og sykepleieprosedyrer. Vi finner også at studentene beskrives i positive vendinger som kunnskapsrike, flinke og aktive. Læringsutbyttene konkretiseres og individualiseres gjennom progresjonskrav, det vil si hva studentene skal jobbe videre med etter midtvurdering og eventuelt til neste praksisperiode, noe som tyder på kontinuitet i læring

Effectiveness of Internet-Based Cognitive Behavioral Therapy with Telephone Support for Noncardiac Chest Pain: Randomized Controlled Trial

Background: Noncardiac chest pain has a high prevalence and is associated with reduced quality of life, anxiety, avoidance of physical activity, and high societal costs. There is a lack of an effective, low-cost, easy to distribute intervention to assist patients with noncardiac chest pain. Objective:In this study, we aimed to investigate the effectiveness of internet-based cognitive behavioral therapy with telephone support for noncardiac chest pain. Methods: We conducted a randomized controlled trial, with a 12-month follow-up period, to compare internet-based cognitive behavioral therapy to a control condition (treatment as usual). A total of 162 participants aged 18 to 70 years with a diagnosis of noncardiac chest pain were randomized to either internet-based cognitive behavioral therapy (n=81) or treatment as usual (n=81). The participants in the experimental condition received 6 weekly sessions of internet-based cognitive behavioral therapy. The sessions covered different topics related to coping with noncardiac chest pain (education about the heart, physical activity, interpretations/attention, physical reactions to stress, optional panic treatment, and maintaining change). Between sessions, the participants also engaged in individually tailored physical exercises with increasing intensity. In addition to internet-based cognitive behavioral therapy sessions, participants received a brief weekly call from a clinician to provide support, encourage adherence, and provide access to the next session. Participants in the treatment-as-usual group received standard care for their noncardiac chest pain without any restrictions. Primary outcomes were cardiac anxiety, measured with the Cardiac Anxiety Questionnaire, and fear of bodily sensations, measured with the Body Sensations Questionnaire. Secondary outcomes were depression, measured using the Patient Health Questionnaire; health-related quality of life, measured using the EuroQol visual analog scale; and level of physical activity, assessed with self-report question. Additionally, a subgroup analysis of participants with depressive symptoms at baseline (PHQ-9 score ≥5) was conducted. Assessments were conducted at baseline, posttreatment, and at 3- and 12-month follow-ups. Linear mixed models were used to evaluate treatment effects. Cohen d was used to calculate effect sizes. Results: In the main intention-to-treat analysis at the 12-month follow-up time point, participants in the internet-based cognitive behavioral therapy group had significant improvements in cardiac anxiety (–3.4 points, 95% CI –5.7 to –1.1; P=.004, d=0.38) and a nonsignificant improvement in fear of bodily sensations (–2.7 points, 95% CI –5.6 to 0.3; P=.07) compared with the treatment-as-usual group. Health-related quality of life at the 12-month follow-up improved with statistical and clinical significance in the internet-based cognitive behavioral therapy group (8.8 points, 95% CI 2.8 to 14.8; P=.004, d=0.48) compared with the treatment-as-usual group. Physical activity had significantly (P<.001) increased during the 6-week intervention period for the internet-based cognitive behavioral therapy group. Depression significantly improved posttreatment (P=.003) and at the 3-month follow-up (P=.03), but not at the 12-month follow-up (P=.35). Participants with depressive symptoms at baseline seemed to have increased effect of the intervention on cardiac anxiety (d=0.55) and health-related quality of life (d=0.71) at the 12-month follow-up. In the internet-based cognitive behavioral therapy group, 84% of the participants (68/81) completed at least 5 of the 6 sessions. Conclusions: This study provides evidence that internet-based cognitive behavioral therapy with minimal therapist contact and a focus on physical activity is effective in reducing cardiac anxiety and increasing health related quality of life in patients with noncardiac chest pain.publishedVersio

Factors influencing employment after minor stroke and NSTEMI

Aim: To study the effect of cognitive function, fatigue and emotional symptoms on employment after a minor ischemic stroke compared to non-ST-elevation myocardial infarction (NSTEMI). Material and methods: We included 217 patients with minor ischemic stroke and 133 NSTEMI patients employed at baseline aged 18–70 years. Minor stroke was defined as modified Rankin scale (mRS) 0–2 at day seven or at discharge if before. Included NSTEMI patients had the same functional mRS. We applied a selection of cognitive tests and the patients completed questionnaires measuring symptoms of anxiety, depression and fatigue at follow up. Stroke patients were tested at three and 12 months and NSTEMI at 12 months. Results: The patients still employed at 12 monthswere significantly younger than the unemployed patients and the NSTEMI patients employed were significantly older than the stroke patients (59 vs 55 years, p < .001). In total, 82 % of stroke patients and 90 % of the NSTEMI patients employed at baseline were still employed at 12 months (p = 06). Stroke patients at work after 12 months had higher education than unemployed patients. There were no difference between employed and unemployed patients in risk factors or location of cerebral ischemic lesions. Cognitive function did not change significantly in the stroke patients from three to 12 months. For stroke patients, we found a significant association between HADS-depression and unemployment at 12 months (p = 04), although this association was not present at three months. Lower age and higher educational level were associated with employment at 12 months for all patients. Discussion and conclusion: Age and education are the main factors influencing the ability to stay in work after a minor stroke. Employed stroke patients were younger than the NSTEMI patients, but there was no difference in the frequencies in remaining employed. The employment rate at 12 months was high despite the relatively high prevalence of cognitive impairment in both groups.publishedVersio

Clinical and cost-effectiveness of adapted cognitive behaviour therapy for non-cardiac chest pain: a multicentre, randomised controlled trial

Objective: To investigate the cost-effectiveness of a modified form of cognitive behaviour therapy for recurrent non-cardiac chest pain. Methods: We tested the effectiveness and cost-effectiveness of a modified form of cognitive behaviour therapy for chest pain (CBT-CP)(4-10 sessions) in patients who attended cardiology clinics or emergency medical services repeatedly. Patients were randomised using a remote web-based system to CBT-CP or to standard care in the clinic. Assessments were made at baseline and at six and 12 months. The primary outcome was the change in the Health Anxiety Inventory score at six months. Other clinical measures, social functioning, quality of life, and costs of services were also recorded. Results: 68 patients were randomised with low attrition rates at 6 and 12 months with 81% of all possible assessments completed at 6 and 12 months. Although there were no significant group differences between any of the outcome measures at either 6 or 12 months, patients receiving CBT-CP had between two and three times fewer hospital bed days, outpatient appointments, and A&E attendances than those allocated to standard care and total costs per patient were £1496.49 lower, though the differences in costs were not significant. There was a small non-significant gain in quality adjusted life years (QALY's) in those allocated to CBT-CP compared with standard care (0.76 vs 0.74). Conclusions: It is concluded that CBT-CP in the context of current hospital structures is not a viable treatment, but is worthy of further research as a potentially cost-effective treatment for non-cardiac chest pain

Weave

The texts in the book describe rather than conclude, and I have worked with them in a way similar to the way I relate to my other artistic works. Among other things the texts have a formal framework that has helped to determine how they have developed. The book was presented in the exhibition "The format can be time without being a timeline. The format can be a distance. The format can be a distance experienced over time" at Edvard Munch’s Studio in Oslo 11 – 27 October 2019

Rutearksamling

Fotodokumentasjon. Foto: Istvan Virag og Tina Jonsbu. For beskrivelse av verk se vedlegg/ fil 38.Rutearksamling (1997–) Rutearksamling besto per 10.10.19 av en samling på 725 ruteark der ingen er like. Jeg tegner blyantsirkler rundt linjenes skjæringspunkter. 300 ark er fylt med sirkler og 425 står igjen. Arkene er i størrelser fra A7 til A2. Rutearksamling har fått et digitalt register der alle arkene er sortert i kategorier utfra størrelse, innbinding og om det har hull eller ikke. Hvert ark har en betegnelse i form av en kode som angir kategori og nummer. I registeret er det lagt inn informasjon om kjennetegn som hull, farger og tekst trykket på boken / heftet/ blokken som arket kommer fra. Der det er kjent, er sted og tid for anskaffelse av arket, og sted og tid for tegning på arket, skrevet inn. Det er også tittel på eventuelle andre arbeider som er laget av samme type ark. Det digitale registeret er søkbart og i stadig forandring ettersom nye ark og ny informasjon kommer til. Rutearkene er sortert i 37 ulike kategorier. Hver kategori er samlet i én folder. Hvert ark har vedlagt et kort med koden det har i registeret, samt en markering for om tegnearket er tegnet på (X) eller ikke (O), og en markering (A) om det ligger ved et ekstra arkivark. Bøkene, heftene, blokkene er sortert i samme kategorier som rutearkene, og har fått koder som samsvarer med koden på arkene som stammer fra dem. Rutearksamling ble presentert i utstillingen Formatet kan være tid, uten å være en tidslinje. Formatet kan være en strekning. Formatet kan være en strekning opplevd over tid i Edvard Munchs Atelier i Oslo 11. – 27. oktober 2019