Innføring av abdominal aortaaneurisme screening ved karkirurgisk avdeling - Ahus

Vi har sett på innføring av screening for aortaabdominal aneurisme (AAA) ved karkirurgisk avdeling på Ahus (Akershus Universitetssykehus). AAA er en utvidelse på abdominal aorta på mer enn 3 cm. Prevalens- og insidens data for AAA er usikre. Studier viser prevalens 8,9-16,9 % for menn og 2,2-3,5 % for kvinner.1,2 Aneurismet kan vokse uten å gi noen symptomer, men likevel kan den være dødelig siden den kan rumpere og forårsake massive indre blødninger. Det er for øyeblikket ingen organisert screening av AAA i Norge. De fleste AAA oppdages enten tilfeldig ved bildediagnostikk eller ved akutte symptomer for ruptur. Undersøkelser har vist at rupterte AAA har høy dødelighet ved akutt kirurgi og det er derfor ønskelig å oppdage AAA på et tidligere stadium, følge utviklingen av aneurismet og eventuelt behandle pasienten elektivt kirurgisk.3,4 For å finne artikler om emnet ble det brukt i hovedsak søkemotorene Pubmed/Medline, Cochrane, BMJ, Tidsskriftet for den norske Lægeforening, Norsk elektronisk legehåndbok (NEL) og Google. Store studier i mange land har foresøkt å undersøke kostnader og nytte av screening av AAA med én ultralydundersøkelse rundt 65 års alder.5,6 Det er blitt innført screening av menn i Sverige for AAA i 2006. I 2010 regner man med at 90 % av 65-årige svenske menn inkluderes i et screeningprogram. Liknende program er også blitt innført i England og i USA.7 Vi har bare vurdert ultralyd som screeningverktøy da dette er billig i drift, ikke er invasivt og er lett tilgjengelig. Vi har observert dagens praksis ved Ahus og diskutert problemstillinger med karkirurg Jarlis Wesche ved Karkirurgisk avdeling Ahus. Videre har vi sett på hvordan en screening kan gjennomføres ved Ahus og argumentert for og i mot dette

Har rød solhatt (Echinacea purpurea), råmelk fra ku (Bovine colostrum) eller c-vitamin effekt på forkjølelse?

This literature review examines if Echinacea purpurea, Bovine colostrum or Vitamin C has an effect on common cold infections. Effect is defined in this article as prevention, reduction of symptoms or decrease in duration of disease. The 9 clinical studies and 2 meta- analysis included in this literature review has not found statistically significant result by use of Echinacea purpurea, Bovine colostrums or Vitamin C versus placebo during common cold infection. Therefore I cannot recommend these products to patients, but since they have not shown serious side effects, I will not warn patients against using them

Improving public cancer care by implementing precision medicine in Norway: IMPRESS-Norway

Background Matching treatment based on tumour molecular characteristics has revolutionized the treatment of some cancers and has given hope to many patients. Although personalized cancer care is an old concept, renewed attention has arisen due to recent advancements in cancer diagnostics including access to high-throughput sequencing of tumour tissue. Targeted therapies interfering with cancer specific pathways have been developed and approved for subgroups of patients. These drugs might just as well be efficient in other diagnostic subgroups, not investigated in pharma-led clinical studies, but their potential use on new indications is never explored due to limited number of patients. Methods In this national, investigator-initiated, prospective, open-label, non-randomized combined basket- and umbrella-trial, patients are enrolled in multiple parallel cohorts. Each cohort is defined by the patient’s tumour type, molecular profile of the tumour, and study drug. Treatment outcome in each cohort is monitored by using a Simon two-stage-like ‘admissible’ monitoring plan to identify evidence of clinical activity. All drugs available in IMPRESS-Norway have regulatory approval and are funded by pharmaceutical companies. Molecular diagnostics are funded by the public health care system. Discussion Precision oncology means to stratify treatment based on specific patient characteristics and the molecular profile of the tumor. Use of targeted drugs is currently restricted to specific biomarker-defined subgroups of patients according to their market authorization. However, other cancer patients might also benefit of treatment with these drugs if the same biomarker is present. The emerging technologies in molecular diagnostics are now being implemented in Norway and it is publicly reimbursed, thus more cancer patients will have a more comprehensive genomic profiling of their tumour. Patients with actionable genomic alterations in their tumour may have the possibility to try precision cancer drugs through IMPRESS-Norway, if standard treatment is no longer an option, and the drugs are available in the study. This might benefit some patients. In addition, it is a good example of a public–private collaboration to establish a national infrastructure for precision oncology

Improving public cancer care by implementing precision medicine in Norway: IMPRESS-Norway

Background Matching treatment based on tumour molecular characteristics has revolutionized the treatment of some cancers and has given hope to many patients. Although personalized cancer care is an old concept, renewed attention has arisen due to recent advancements in cancer diagnostics including access to high-throughput sequencing of tumour tissue. Targeted therapies interfering with cancer specific pathways have been developed and approved for subgroups of patients. These drugs might just as well be efficient in other diagnostic subgroups, not investigated in pharma-led clinical studies, but their potential use on new indications is never explored due to limited number of patients. Methods In this national, investigator-initiated, prospective, open-label, non-randomized combined basket- and umbrella-trial, patients are enrolled in multiple parallel cohorts. Each cohort is defined by the patient’s tumour type, molecular profile of the tumour, and study drug. Treatment outcome in each cohort is monitored by using a Simon two-stage-like ‘admissible’ monitoring plan to identify evidence of clinical activity. All drugs available in IMPRESS-Norway have regulatory approval and are funded by pharmaceutical companies. Molecular diagnostics are funded by the public health care system. Discussion Precision oncology means to stratify treatment based on specific patient characteristics and the molecular profile of the tumor. Use of targeted drugs is currently restricted to specific biomarker-defined subgroups of patients according to their market authorization. However, other cancer patients might also benefit of treatment with these drugs if the same biomarker is present. The emerging technologies in molecular diagnostics are now being implemented in Norway and it is publicly reimbursed, thus more cancer patients will have a more comprehensive genomic profiling of their tumour. Patients with actionable genomic alterations in their tumour may have the possibility to try precision cancer drugs through IMPRESS-Norway, if standard treatment is no longer an option, and the drugs are available in the study. This might benefit some patients. In addition, it is a good example of a public–private collaboration to establish a national infrastructure for precision oncology. Trial registrations EudraCT: 2020-004414-35, registered 02/19/2021; ClinicalTrial.gov: NCT04817956, registered 03/26/2021

Improving public cancer care by implementing precision medicine in Norway: IMPRESS-Norway

Background Matching treatment based on tumour molecular characteristics has revolutionized the treatment of some cancers and has given hope to many patients. Although personalized cancer care is an old concept, renewed attention has arisen due to recent advancements in cancer diagnostics including access to high-throughput sequencing of tumour tissue. Targeted therapies interfering with cancer specific pathways have been developed and approved for subgroups of patients. These drugs might just as well be efficient in other diagnostic subgroups, not investigated in pharma-led clinical studies, but their potential use on new indications is never explored due to limited number of patients. Methods In this national, investigator-initiated, prospective, open-label, non-randomized combined basket- and umbrella-trial, patients are enrolled in multiple parallel cohorts. Each cohort is defined by the patient’s tumour type, molecular profile of the tumour, and study drug. Treatment outcome in each cohort is monitored by using a Simon two-stage-like ‘admissible’ monitoring plan to identify evidence of clinical activity. All drugs available in IMPRESS-Norway have regulatory approval and are funded by pharmaceutical companies. Molecular diagnostics are funded by the public health care system. Discussion Precision oncology means to stratify treatment based on specific patient characteristics and the molecular profile of the tumor. Use of targeted drugs is currently restricted to specific biomarker-defined subgroups of patients according to their market authorization. However, other cancer patients might also benefit of treatment with these drugs if the same biomarker is present. The emerging technologies in molecular diagnostics are now being implemented in Norway and it is publicly reimbursed, thus more cancer patients will have a more comprehensive genomic profiling of their tumour. Patients with actionable genomic alterations in their tumour may have the possibility to try precision cancer drugs through IMPRESS-Norway, if standard treatment is no longer an option, and the drugs are available in the study. This might benefit some patients. In addition, it is a good example of a public–private collaboration to establish a national infrastructure for precision oncology