Forslag til endring av retningslinje ved konservativ behandling av NSTEMI

Sammendrag Bakgrunn Studier gjort internasjonalt har vist at fondaparinuks gir lavere morbiditet og mortalitet på lang sikt, sammenlignet med det lavmolekylære heparinet enoksaparin, ved konservativ antitrombotisk behandling av NSTEMI. Med bakgrunn i dette har vi sett på nåværende praksis for slik behandling av denne pasientgruppen på hjerteavdelingen på Ullevål Universitetssykehus (UUS). Da det ikke er samsvar mellom praksis på UUS og internasjonale guidelines, ønsket vi å utarbeide en strategi for implementering av en ny retningslinje for antitrombotisk behandling ved NSTEMI, med bytte fra enoksaparin til fondaparinuks. Metode Kunnskapsgrunnlaget ble bekreftet ved søk i medline/pubmed, og det ble gjort en spørreskjemaundersøkelse for å avdekke gjeldende praksis. Videre ble det gjort litteratursøk i Medline/Ovid for å finne dokumenterte implementeringstiltak. Resultater Ved UUS brukes det i hovedsak dalteparin ved konservativ behandling av NSTEMI, hvilket samsvarer med de nasjonale retningslinjer. Flere tiltak for endring av den lokale retningslinjen ble vurdert, og følgende tiltak foreslås: 1. Avdelingsledelsen nedsetter en ansvarlig prosjektgruppe med en prosjektkoordinator. 2. Felles undervisningsmøter med utdeling av spørreskjemaer for tilbakemelding. 3. Muntlig orientering samt informasjonsskriv om det nye tiltaket til personalet. 4. Regelmessige møter i prosjektgruppen med evaluering av resultater samt tilbakemeldinger fra personalet. 5. Kontinuerlig oppdatering om resultatene av prosjektet til personalet både muntlig og via e-post, samt oppfordring til å gi respons på hvordan det fungerer. 6. Evaluering av prosjektet etter ett år. Her benyttes indikatoren ”andelen pasienter med NSTEMI som blir behandlet konservativt i akuttfasen med fondaparinuks ved hjerteavdelingen på UUS.” Konklusjon Kunnskapsgrunnlaget viser at et bytte til fondaparinuks er fordelaktig med tanke på redusert morbiditet og mortalitet på lang sikt, lettere administrasjon og reduserte kostnader. De tiltakene vi har kommet frem til kan være praktisk gjennomførbare i den aktuelle avdelingen, og kan være hensiktsmessige i innføringen av en ny retningslinje

Is there an association between food patterns and life satisfaction among Norway's inhabitants ages 65 years and older?

The lack of information regarding older adults' health and lifestyles makes it difficult to design suitable interventions for people at risk of developing unhealth lifestyles. Therefore, there is a need to increase knowledge about older adults’ food patterns and quality of life.Our aim was to determine associations among food patterns, anxiety, depression, and life satisfaction in Norwegian inhabitants ages 65+. The Nord-Trøndelag Health Study (The HUNT Study) is a large, population-based cohort study that includes data for 125 000 Norwegian participants. The cohort used for this study is wave three of the study, consisting of 11 619 participants age 65 and over. Cluster analysis was used to categorize the participants based on similarities in food consumption; two clusters were identified based on similarities regarding food consumption among participants. Significant differences between the clusters were found, as participants in the healthy food-patterns cluster had higher life satisfaction and lower anxiety and depression than those in the unhealthy food-patterns cluster.The associations among food patterns, anxiety, depression, and life satisfaction among older adults show the need for increased focus on interactions among food patterns, food consumption, and life satisfaction among the elderly in order to explore how society can influence these patterns

Dietary Patterns Characterized by High Meat Consumption Are Associated with Other Unhealthy Life Styles and Depression Symptoms

ObjectiveWe aimed to identify dietary patterns (DPs) of Portuguese adults, to assess their socioeconomic, demographic, lifestyle determinants, and to identify their impact on health.DesignEpiDoC 2 study included 10,153 Portuguese adults from the EpiDoC Cohort, a population-based study. In this study, trained research assistants using computer-assisted telephone interview collected socioeconomic, demographic, dietary, lifestyles, and health information from March 2013 to July 2015. Cluster analysis was performed, based on questions regarding the number of meals, weekly frequency of soup consumption, vegetables, fruit, meat, fish, dairy products, and daily water intake. Factors associated with DP were identified through logistic regression models.ResultsTwo DPs were identified: the “meat dietary pattern” and the “fruit & vegetables dietary pattern.” After multivariable adjustment, women (OR = 0.52; p < 0.001), older adults (OR = 0.97; p < 0.001), and individuals with more years of education (OR = 0.96; p = 0.025) were less likely to adopt the “meat dietary pattern,” while individuals in a situation of job insecurity/unemployment (OR = 1.49; p = 0.013), Azores island residents (OR = 1.40; p = 0.026), current smoking (OR = 1.58; p = 0.001), daily alcohol intake (OR = 1.46; p = 0.023), and physically inactive (OR = 1.86; p < 0.001) were positively and significantly associated with “meat dietary pattern.” Moreover, individuals with depression symptoms (OR = 1.50; p = 0.018) and the ones who did lower number of medical appointments in the previous year (OR = 0.98; p = 0.025) were less likely to report this DP.ConclusionOur results suggest that unhealthy DPs (meat DP) are part of a lifestyle behavior that includes physical inactivity, smoking habits, and alcohol consumption. Moreover, depression symptoms are also associated with unhealthy DPs

Paid work is associated with improved health-related quality of life in patients with rheumatoid arthritis

Numerous patients with rheumatoid arthritis (RA) end their working career due to consequences of the disease. No publication has reported whether there is an independent association between patients' health-related quality of life (HRQOL) and employment status. The objective of the study was to investigate the association of paid work and HRQOL in patients with RA whilst controlling for demographics and disease severity. This was a cross-sectional study. Three hundred and ten patients were consecutively recruited from two Norwegians hospitals when commencing disease modifying anti-rheumatic drug treatment. Data on demographics, employment status, disease activity (DAS28-3), physical functioning, pain, tiredness, and HRQOL (SF-36) were collected. HRQOL were compared between 123 patients working full- or part-time and 187 patients not working due to disability pension, retirement, being students or “home workers”. The regression analyses showed an independent positive association between paid work and the physical (p = 001) and the mental component (p = 012) of the SF-36 when controlling for demographics and disease severity. Paid work was statistically significantly associated with better HRQOL in patients with RA. The positive association of performing paid work and HRQOL imply that health care providers should thoroughly evaluate the possibilities for the patients to continue with paid work

Are We Transitioning Toward Person-centered Practice on Self-management Support? An Explorative Case Study Among Rheumatology Outpatient Clinic Nurses in Norway

Introduction: There are only a few studies investigating nurses’ views on self-management in the care of patients with rheumatic diseases. Objective: The aim of this study is to explore how Norwegian rheumatology outpatient nurses describe their ways of supporting patients’ self-management focusing on the core dimensions of person-centered self-management support. Methods: Ten individual semistructured interviews with rheumatology outpatient nurses were conducted in Norway from March to September 2017. The interviews were audiorecorded and transcribed verbatim. NVIVO was used to support a systematic analysis of themes and patterns. Results: Nurses’ views on self-management support fell into three approaches; (1) narrowly biomedically orientated, (2) biomedically and holistic, and (3) person-centered. The nurse’s views of self-management support varied and did not fully align with the core dimensions of person-centered practice. Conclusion: The findings indicate that the biomedical paradigm continues to influence Norwegian rheumatology outpatient clinic nurses’ approach to self-management support. If person-centered principles of self-management support are to be translated into standard nursing practice, including identifying and supporting patient-defined self-management goals and processes, there is a need to challenge established structures in health care systems

Chronic pain self-management interventions in primary care – does it make any difference? A qualitative study

Abstract Background Total recovery from chronic pain is difficult. It is therefore important for those who are suffering from chronic pain to find ways to self-manage their pain in daily life. Several chronic pain self-management interventions have been established, but more knowledge is needed to find out what and how it works. This study aimed to explore how the participants in two chronic pain self-management interventions in primary health care experienced the different components of the interventions, and whether the interventions induced any positive changes in the participants’ everyday lives. Methods A qualitative study nested within a randomized controlled study using semi-structured individual face-to-face interviews with 17 informants were conducted three months after the interventions. The data were analysed thematically using Systematic Text Condensation. Results The main finding was that the informants, from both interventions, self-managed their chronic pain differently in a positive way after they had participated in the self-management interventions. The participants gained new insight from lectures, learning from peers by sharing experiences and belonging to a group, and by recognizing the importance of being physically active. Conclusion This study shows that chronic pain self-management interventions consisting of components that learn the participants about chronic pain and include physical activity in a socially supportive environment, may contribute to a positive change in the lives of people living with chronic pain

A longitudinal study of educational needs among patients with inflammatory arthritis

Introduction Patient education is important in the follow-up and disease management for patients with chronic inflammatory arthritis. Patients’ needs for education and information varies, and it is important that the education is tailored to the individual patient. Hence, the aim of this study is to investigate whether patients’ educational needs change over time, and which demographic, disease-related or self-management characteristics that are associated with patients’ educational needs. Methods The Mann–Whitney U-test was used to study patients’ longitudinal educational needs and whether their needs change over time, while multivariable linear regression analyses were used to investigate associations between patients’ educational needs and demographic variables, disease-related and self-management characteristics. Results There were no changes in patients’ educational needs in the domains of managing pain, movement, feelings, arthritis process and treatment from health professionals during the study period of seven years. A small decrease in educational needs in the domains self-help measures (p-value 0.047) and support from others (p-value 0.010) was detected. The regression analyses showed that higher educational needs were associated with being female, lower educational level, shorter disease duration, and a lower level of patient activation. Conclusions Patients with chronic inflammatory arthritis have continual needs for patient education throughout their disease trajectory. Nurses and health care professionals must therefore ask their patients what kind of education they need at every follow-up throughout the disease course