Det usikre mellomrommet. Sykepleiernes utfordringer i vurdering av den akutte geriatriske pasienten i akuttmottak.En hermeneutisk studie

Masteroppgave i klinisk sykepleie - Nord universitet, 201

Health-related quality of life in patients with advanced melanoma treated with ipilimumab: prognostic implications and changes during treatment

Background: We have previously reported that the safety and efficacy of ipilimumab in real-world patients with metastatic melanoma were comparable to clinical trials. Few studies have explored health-related quality of life (HRQL) in real-world populations receiving checkpoint inhibitors. This study reports HRQL in real-world patients receiving ipilimumab and assesses the prognostic value of patient-reported outcome measures. Patients and methods: Ipi4 (NCT02068196) was a prospective, multicentre, interventional phase IV trial. Real-world patients (N = 151) with metastatic melanoma were treated with ipilimumab 3 mg/kg intravenously as labelled. HRQL was assessed by the European Organisation of Research and Treatment of Cancer Quality of Life Questionnaire at baseline and after 10-12 weeks. Results: The European Organisation of Research and Treatment of Cancer Quality of Life Questionnaire was completed by 93% (141/151 patients) at baseline, and by 82% at 10-12 weeks. Poor performance status and elevated C-reactive protein (CRP) were associated with worse baseline HRQL. Clinically relevant and statistically significant deteriorations in HRQL from baseline to weeks 10-12 were reported (P <0.05). Baseline physical functioning [hazard ratio (HR) 1.96, P = 0.016], role functioning (HR 2.15, P <0.001), fatigue (HR 1.60, P = 0.030), and appetite loss (HR 1.76, P = 0.012) were associated with poorer overall survival independent of performance status, lactate dehydrogenase (LDH), and CRP. We further developed a prognostic model, combining HRQL outcomes with performance status, LDH, and CRP. This model identified three groups with large and statistically significant differences in survival. Conclusions: Systemic inflammation is associated with impaired HRQL. During treatment with ipilimumab, HRQL deteriorated significantly. Combining HRQL outcomes with objective risk factors provided additional prognostic information that may aid clinical decision making.publishedVersio

Ipilimumab in a real-world population: A prospective Phase IV trial with long-term follow-up

Ipilimumab was the first treatment that improved survival in advanced melanoma. Efficacy and toxicity in a real-world setting may differ from clinical trials, due to more liberal eligibility criteria and less intensive monitoring. Moreover, high costs and lack of biomarkers have raised cost-benefit concerns about ipilimumab in national healthcare systems and limited its use. Here, we report the prospective, interventional study, Ipi4 (NCT02068196), which aimed to investigate the toxicity and efficacy of ipilimumab in a real-world population with advanced melanoma. This national, multicentre, phase IV trial included 151 patients. Patients received ipilimumab 3 mg/kg intravenously and were followed for at least 5 years or until death. Treatment interruption or cessation occurred in 38%, most frequently due to disease progression (19%). Treatment-associated grade 3 to 4 toxicity was observed in 28% of patients, and immune-related toxicity in 56%. The overall response rate was 9%. Median overall survival was 12.1 months (95% CI: 8.3-15.9); and progression-free survival 2.7 months (95% CI: 2.6-2.8). After 5 years, 20% of patients were alive. In a landmark analysis from 6 months, improved survival was associated with objective response (HR 0.16, P = .001) and stable disease (HR 0.49, P = .005) compared to progressive disease. Poor performance status, elevated lactate dehydrogenase and C-reactive protein were identified as biomarkers. This prospective trial represents the longest reported follow-up of a real-world melanoma population treated with ipilimumab. Results indicate safety and efficacy comparable to phase III trials and suggest that the use of ipilimumab can be based on current cost-benefit estimates.publishedVersio

Dechloranes and chlorinated paraffins in sediments and biota of two subarctic lakes

Our understanding of the environmental behavior, bioaccumulation and concentrations of chlorinated paraffins (CPs) and Dechloranes (Dec) in the Arctic environment is still limited, particularly in freshwater ecosystems. In this descriptive study, short chain (SCCPs) and medium chain (MCCPs) CPs, Dechlorane Plus (DP) and analogues, and polychlorinated biphenyls (PCBs) were measured in sediments, benthic organisms, three-spined stickleback (Gasterosteus aculeatus), Arctic char (Salvelinus alpinus) and brown trout (Salmo trutta) in two Sub-Arctic lakes in Northern Norway. Takvannet (TA) is a remote lake, with no known local sources for organic contaminants, while Storvannet (ST) is situated in a populated area. SCCPs and MCCPs were detected in all sediment samples from ST with concentration of 42.26–115.29 ng/g dw and 66.18–136.69 ng/g dw for SCCPs and MCCPs, respectively. Only SCCPs were detected in TA sediments (0.4–5.28 ng/g dw). In biota samples, sticklebacks and benthic organisms showed the highest concentrations of CPs, while concentrations were low or below detection limits in both char and trout. The congener group patterns observed in both lakes showed SCCP profiles dominated by higher chlorinated congener groups while the MCCPs showed consistency in their profiles, with C14 being the most prevalent carbon chain length. Anti- and syn-DP isomers were detected in all sediment, benthic and stickleback samples with higher concentrations in ST than in TA. However, they were only present in a few char and trout samples from ST. Dec 601 and 604 were below detection limits in all samples in both lakes. Dec 603 was detected only in ST sediments, sticklebacks and 2 trout samples, while Dec 602 was the only DP analogue found in all samples from both lakes. While there were clear differences in sediment concentrations of DP and Dec 602 between ST and TA, differences between lakes decreased with increasing δ15N. This pattern was similar to the PCB behavior, suggesting the lake characteristics in ST are playing an important role in the lack of biomagnification of pollutants in this lake. Our results suggest that ST receives pollutants from local sources in addition to atmospheric transport

Supporting doctor-patient communication in oncology: Providing communication aids to cancer patients in an outpatient clinic

Communication aids can assist patients in obtaining the necessary information about their disease and treatment options. In this study, we explored the effect of two such communication aids: A question prompt list (QPL) and a consultation audio record (CAR) for the patients to bring home. A QPL is a list of suggested questions patients might want to ask their doctor. The Australian QPL “So you have cancer” was translated into Norwegian, and then culturally adjusted after feedback from focus groups consisting of Norwegian cancer patients, as well as a survey. The QPL was provided to patients as part of an explorative study, either alone or in combination with a CAR. Results from these intervention groups were compared to a previous control group. In the control group, we found that patients with a higher level of anxiety asked more questions and expressed a higher amount of emotional cues or concerns. The majority of questions asked by the control group related to treatment and practical issues, and neither question asking nor the expression of emotional cues and concerns were found related to physician SDM behavior. Few questions were raised about prognosis and treatment options, which are deemed essential for patients to participate in SDM. Patients that were provided a QPL asked significantly more questions about their prognosis, the disease and the quality of treatment. The study did not find any relationship between the provision of a QPL and physician SDM, nor did it find any difference in the level of anxiety, depression or quality of life between the patients who were provided a QPL alone, a combined QPL and CAR, or the control group. Providing patients with the QPL increased the consultation length significantly. However, patients rated both the QPL and the CAR positively

Det usikre mellomrommet. Sykepleiernes utfordringer i vurdering av den akutte geriatriske pasienten i akuttmottak.En hermeneutisk studie

Masteroppgave i klinisk sykepleie - Nord universitet, 201

Pasientundervisning: hvordan kan sykepleier benytte den didaktiske relasjonsmodellen i møte med pasienter med insulinavhengig diabetes?

NORSK: Hovedtemaet i denne bacheloroppgaven er sykepleierens pedagogiske funksjon i møte med den kronisk syke pasienten. Vi har fordypet oss i pasientundervisning til pasienter med insulinavhengig diabetes. Hensikten med oppgaven er å vise hvordan sykepleier kan benytte den didaktiske relasjonsmodellen i pasientundervisning i møte med diabetespasienten. Oppgaven er en litteraturstudie hvor vi har gjennomført en kritisk gjennomgang av eksisterende litteratur på emnet. Søkeord som blant annet «patient education», «insulin dependent diabetes mellitus», «self care» og «nurs*» er benyttet. Forskning viser at sykepleiere ivaretar sin pedagogiske funksjon i varierende grad. Mange pasienter er ikke fornøyd med den undervisningen som blir gitt. Vi konkluderer med at sykepleier kan benytte den didaktiske relasjonsmodellen som et hjelpemiddel for å individualisere og strukturere planlegging, gjennomføring og vurdering av pasientundervisning. Ved bevisst bruk av modellen vil pasientundervisningen ta utgangspunkt i den enkelte pasient, og pasienten får et best mulig utgangspunkt for læring

Establishment and Characterization of a Novel Gill Cell Line, LG-1, from Atlantic Lumpfish (Cyclopterus lumpus L.)

publishedVersio

Establishment and Characterization of a Novel Gill Cell Line, LG-1, from Atlantic Lumpfish (Cyclopterus lumpus L.)

publishedVersio

Salmon Erythrocytes Sequester Active Virus Particles in Infectious Salmon Anaemia

Infectious salmon anaemia virus (ISAV) binds circulating Atlantic salmon erythrocytes, but the relevance of this interaction for the course of infection and development of disease remains unclear. We here characterise ISAV-erythrocyte interactions in experimentally infected Atlantic salmon and show that ISAV-binding to erythrocytes is common and precedes the development of disease. Viral RNA and infective particles were enriched in the cellular fraction of blood. While erythrocyte-associated ISAV remained infectious, erythrocytes dose-dependently limited the infection of cultured cells. Surprisingly, immunostaining of blood smears revealed expression of ISAV proteins in a small fraction of erythrocytes in one of the examined trials, confirming that ISAV can be internalised in this cell type and engage the cellular machinery in transcription and translation. However, viral protein expression in erythrocytes was rare and not required for development of disease and mortality. Furthermore, active transcription of ISAV mRNA was higher in tissues than in blood, supporting the assumption that ISAV replication predominantly takes place in endothelial cells. In conclusion, Atlantic salmon erythrocytes bind ISAV and sequester infective virus particles during infection, but do not appear to significantly contribute to ISAV replication. We discuss the implications of our findings for infection dynamics and pathogenesis of infectious salmon anaemia