Infeksiøs endokarditt ved Aker og Ullevål Universitetssykehus 2006-2008 : En retrospektiv studie.

Infective endocarditis at Ullevål and Aker University Hospitals in Oslo during 2006-2008. A retrospective study. By Eirin Sigurdsen and Solfrid Thunold ABSTRACT Background Infective endocarditis is a serious but often subtle condition were the cardiac valves and/or the adjacent cardiac tissues become colonised and destroyed by bacteria. The aim of this study was to examine the current etiology, outcome and patient characteristics of patients admitted to two university clinics in Oslo as quality control for standard of care. Material and methods This is a retrospective study of the patient records of 89 patiens with definite infective endocarditis hospitalised in Ullevål and Aker University Hospitals in the period of 2006-2008. Data were analysed in SPSS 16. We applied the Mann-Whitney-U and Chi-square tests for continuous and categorical data, respectively. Results The results will be submitted as a manuscript to a scientific journal with peer review. The median age was 66 years, 68.5% of the patients were men. The locations and the nature of the infected valves, the incidence of different host risk factors and microbes as well as the clinical handling and outcome were characterized. No differences between the two hospitals were found. Conclusion Infectious endocarditis is still a serious septic disease with a high mortality. Identification of current patient cohorts and outcome help the clinics as quality control of the current standard of care

Feilmedisinering: Håndtering av medikamenter ved Nedre Romerike Legevakt

Dette forslaget til forbedringsarbeid tar for seg temaet feilmedisinering med fokus på oppbevaring og datomerking av medikamenter, hovedsakelig multidose hetteglass (MDV) ved Nedre Romerike legevakt. Norske studier viser at feilmedisinering kan forekomme i opp til 20% av alle behandlingsforløp. Internasjonal litteratur viser at kontaminering av MDV forekommer i 0,3-5,7% ved sykehusavdelinger, og at alvorlige infeksjoner som meningitt og septisk artritt kan være en følge av dette. Studier viser også andre problemer med MDV; mangelfull merking av dato og klokkeslett ved åpning, mangelfull kasting av utgåtte medikamenter, og feil oppbevaring. Nedre Romerike Legevakt har fått merknad fra tilsynsfarmasøyt i forhold til oppbevaring og datomerking av diverse MDV medikamenter, her presenteres tiltak for å bedre rutinene ved legevakten. Ansatte ved legevakten skal i sin daglige rutine ved hjelp av en sjekkliste loggføre åpnede MDV og kaste de som er utgått på dato. Loggen inngår i en statistisk prosesskontroll og føres i P-diagram for å følge utviklingen av tiltaket. Et informasjonskort om de sentrale medikamentene skal henge lett tilgjengelig og informasjon om tiltaket skal gis til ansatte for øke fokuset på riktig medikamenthåndtering og administrering generelt, og dermed øke kvaliteten ved helsearbeidet og pasientsikkerheten

UV1 telomerase vaccine with ipilimumab and nivolumab as second line treatment for pleural mesothelioma - A phase II randomised trial

PURPOSE: The NIPU-trial investigates the effect of adding the telomerase vaccine UV1 to treatment with ipilimumab and nivolumab for patients with pleural mesothelioma (PM).METHODS: In this phase 2 open-label trial, patients with PM progressing after first-line chemotherapy were randomised to receive ipilimumab and nivolumab alone (arm B) or combined with UV1 (arm A). The primary endpoint was progression-free survival (PFS) as determined by BICR. It was estimated that 69 PFS events were needed to detect a hazard ratio (HR) of 0.60 with 80% power and a one-sided alpha level of 0.10.RESULTS: 118 patients were randomised. The median PFS determined by blinded independent central review (BICR) was 4.2 months (95%CI 2.9-9.8) in arm A and 4.7 months (95%CI 3.9-7.0) in arm B (HR 1.01, 80%CI 0.75-1.36 P = 0.979), after a median follow-up of 12.5 months (95%CI 9.7-15.6). The investigator-determined median PFS was 4.3 months (95%CI 3.0-6.8) in arm A and 2.9 months (95%CI 2.4-5.5) in arm B (HR 0.60, 80%CI 0.45-0.81 P = 0.025). Confirmed objective response rate (ORR) by BICR was 31% in arm A and 16% in arm B (odds ratio 2.44 80%CI 1.35-4.49 P = 0.056). After a median follow-up time of 17.3 months (95%CI 15.8-22.9), the OS was 15.4 months (95%CI 11.1-22.6) in arm A and 11.1 months (95%CI 8.8-18.1) in arm B, (HR 0.73, 80%CI 0.53-1.0, P = 0.197).CONCLUSION: The primary endpoint was not met. Predefined analyses of response rates are in favour of adding the vaccine.</p