Trender i pasientlogistikk i akuttmottakene ved et norsk universitetssykehus etter innføring av akuttleger

Bakgrunn Økning av pasienter til akuttmottak er en global utfordring. I norske akuttmottakene innførte man en ny spesialitet i akutt- og mottaksmedisin som tiltak for å håndtere økt press på logistikk og ressursutnyttelse. Denne studien så på trender i pasientlogistikken i akuttmottakene ved St. Olavs hospital i lys av innføring av akuttleger.    Materiale og metode Data fra alle pasienter i akuttmottakene ved St. Olavs hospital i perioden fra 1. januar 2012 til 31. desember 2021 ble inkludert. Rådata ble eksportert og logistiske data om blant annet pasientantall, oppholdstider og behandlingsnivå ble bearbeidet og analysert.   Resultater Akutten i Trondheim har hatt en økt pasienttilstrømming tilsvarende 51% fra 2012 til 2021. Andelen pasienter som hjemsendes etter ferdighåndtering akuttmottaket økte i samme periode fra 11% til 35%, mens antallet innleggelser var relativt stabilt. Oppholdstidene i akuttmottaket i Trondheim økte med 57% til 3 timer 38 minutter.   Fortolkning Det blir økende press på akuttmottakene i framtiden på grunn av økt pasienttilstrømming. Innføring av akuttleger har en rolle for optimalisering av pasientlogistikken og bidrar til økt andel ferdighåndterte pasienter, og følgelig muligheter for mer utredende og behandlende akuttmottak

Prehospital Stressors: A Cross-sectional Study of Norwegian Helicopter Emergency Medical Physicians

Objective Personnel working in helicopter emergency medical services (HEMS) and search and rescue (SAR) are exposed to environmental stressors, which may impair performance. The aim of this survey was to study the extent HEMS and SAR physicians report the influence of specific danger-based and non–danger-based stressors. Methods The study was performed as a cross-sectional, anonymous, Web-based (Questback AS, Bogstadveien 54, 0366 Oslo, Norway) survey of Norwegian HEMS and SAR physicians between December 2, 2019, and February 25, 2020. Results Of the recipients, 119 (79.3%) responded. In helicopter operations, 33.6% (n = 40) reported involvement in a minor accident and 44.5% (n = 53) a near accident. In the rapid response car, 26.1% (n = 31) reported near accidents, whereas 26.9% (32) reported this in an ambulance. Of physicians, 20.2% (n = 24) received verbal abuse or threats during the last 12 months. When on call, 50.4% (n = 60) of physicians reported sometimes or often being influenced by fatigue. Conclusion This study shows that Norwegian HEMS and SAR physicians are exposed to several stressors of both a danger-based and non–danger-based nature, especially regarding accidents, threatening patient behavior, and fatigue. Very serious incidents appear to be seldom, and job satisfaction is high.publishedVersio

The effect of emergency department delays on 30-day mortality in Central Norway

publishedVersionPaid Open Acces

Clinical Characteristics and Management of Patients with a Suspected COVID-19 Infection in Emergency Departments : A European Retrospective Multicenter Study

Background: Our aim is to describe and compare the profile and outcome of patients attending the ED with a confirmed COVID-19 infection with patients with a suspected COVID-19 infection. Methods: We conducted a multicentric retrospective study including adults who were seen in 21 European emergency departments (ED) with suspected COVID-19 between 9 March and 8 April 2020. Patients with either a clinical suspicion of COVID-19 or confirmed COVID-19, detected using either a RT-PCR or a chest CT scan, formed the C+ group. Patients with non-confirmed COVID-19 (C− group) were defined as patients with a clinical presentation in the ED suggestive of COVID-19, but if tests were performed, they showed a negative RT-PCR and/or a negative chest CT scan. Results: A total of 7432 patients were included in the analysis: 1764 (23.7%) in the C+ group and 5668 (76.3%) in the C− group. The population was older (63.8 y.o. ±17.5 vs. 51.8 y.o. +/− 21.1, p < 0.01), with more males (54.6% vs. 46.1%, p < 0.01) in the C+ group. Patients in the C+ group had more chronic diseases. Half of the patients (n = 998, 56.6%) in the C+ group needed oxygen, compared to only 15% in the C− group (n = 877). Two-thirds of patients from the C+ group were hospitalized in ward (n = 1128, 63.9%), whereas two-thirds of patients in the C− group were discharged after their ED visit (n = 3883, 68.5%). Conclusion: Our study was the first in Europe to examine the emergency department’s perspective on the management of patients with a suspected COVID-19 infection. We showed an overall more critical clinical situation group of patients with a confirmed COVID-19 infection.publishedVersionPeer reviewe

Glutamate and GABA Transporters in Mesial Temporal Lobe Epilepsy

GABA and glutamate transporter proteins are important in relation to epilepsy because they represent the mechanisms that keep the extracellular concentrations of GABA and dicarboxylic amino acids low. GABA and glutamate are the major inhibitory and excitatory neurotransmitters, respectively, in the brain. Consequently, these transporters are major players in enabling the brain to balance inhibition and excitation. In fact, by microdialysis it has been reported changes in extracellular glutamate and GABA levels prior to and during seizures, and it has been postulated that changes in the expression or function of glutamate and GABA transporters may be the cause of the extracellular glutamate excess. Papers 1 and 2 investigate the expression and distribution of GABA transporters (GAT1 and GAT3) and glutamate transporters (GLAST and GLT-1) in the hippocampus from humans with temporal lobe epilepsy (TLE). Epilepsy comprises a heterogeneous group of disorders reflecting underlying brain dysfunction. Temporal lobe epilepsy (TLE) is one of the most common chronic seizure disorders and is the most intensely studied subtype. Temporal lobe epilepsy is divided into mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE), mass-associated temporal lobe epilepsy (MaTLE), and paradoxical temporal lobe epilepsy (PTLE). Hippocampal sclerosis is believed to play a key role in the increased extracellular glutamate concentration and generation of seizures in MTLE. However, it is not known precisely which cell populations, when lost due to sclerosis, cause the network imbalance. As shown in the present thesis, there was no significant overall change in the expression of the main GABA transporters GAT1 and GAT3, but immunohistochemical staining showed regional differences in GAT1 immunoreactivity within the hippocampus. Similarly, the main glutamate transporters, GLAST and GLT-1, showed no overall significant difference in the expression between the non-MTLE and MTLE hippocampi in Paper 2. However, there was a difference in the pattern of immunolabeling for GLAST and GLT- 1. This study does not support the role of glutamate transporters as a cause of elevated levels of extracellular glutamate in the epileptogenic hippocampi, but undetected changes in the splice variants of the transporters or unexpected antibody cross-activity may lead to biased or even false results (Paper 4). In Paper 3 we investigated the glutamate homeostasis in mice lacking the GLT-1 protein. 13C magnetic resonance spectroscopy (MRS) of cortical tissue from GLT-1 knockout mice was performed following intraperitoneal injection of 13C-labeled glucose and acetate. Metabolite levels were analyzed from the neocortex and cerebellum. Compared with wild-type mice, GLT-1 knockout mice had normal levels of glutamate and glutamine in the cerebellum, but they exhibited decreased levels in the neocortex. The findings suggest that GLT-1 in cortical nerve terminals may contribute significantly to the replenishment of the pool of transmitter glutamate thereby short-circuiting the glutamate-glutamine cycle. In conclusion, we did not observe any significant overall changes in the expression of glutamate or GABA transporters in human sclerotic hippocampi, but did observe regional changes. Further, the findings suggesting that GLT-1 in nerve terminals is a major player that needs to be followed up when conditional knockout mice become available. The role of glutamate and GABA transporters in temporal lobe epilepsy remains elusive

Glial Glutamate Transporters in Human Epileptic Hippocampus

The overall interest in Professor Danbolt’s research group at the Department of Anatomy, University of Oslo, is the control of neurotransmitter concentrations and diffusion in the extracellular space in between synapses in the central nervous system. My research has focused on the transporter proteins moving the transmitter amino acids (GABA and glutamate) across cell membranes, and on the roles of these transporter proteins in normal brain physiology and temporal lobe epilepsy. Changes in transporter function and expression have been reported in all neurological diseases, and these changes appear to be part of the pathogenetic processes ultimately leading to nerve cell damage and neurological and psychological disabilities (for review see: Danbolt, 2001). In 1999 I applied for a summer research scholarship that was announced by the Norwegian Research Council. Professor Jon Storm-Mathisen at the Department of Anatomy was my lecturer and I had talked to him about starting research. I did not get the scholarship, but Professor Storm-Mathisen wanted students in his lab and he gave me economic compensation for doing research in his lab that summer. My project was to study changes in expression of glutamate and GABA injection of amphetamine. For an inexperienced researcher like me it turned out to be a project way over my head, but that summer I really got a good introduction to basic lab techniques. After that summer I started to work as a Medical Student Research Fellow under Professor Niels Chr. Danbolt and gradually during my year at Medical School I felt more competent as a researcher. I have contributed on different projects that involved transporter expression after immobilization stress, corticosterone injections (see abstract 1), and worked on developing an ELISA procedure using a immobilization stress project was presented as a poster on the International Society for Neurochemistry 18th Biennial Meeting, Buenos Aires, Argentina, and the ELISA procedure was later used to test antibody specificity (Paper 2). My main project at Professor Danbolt’s lab was later localization and quantification of the two GABA transporters in the rat brain (unpublished). This research project is in collaboration with Prof. D. Furness form Keele, UK