CT-veiledet lungebiopsi ved radiologisk avdeling UNN: Komplikasjonsfrekvens og risikofaktorer for komplikasjoner. En retrospektiv kvalitetsstudie.

Objektiv: Dette er en retrospektiv kvalitetsstudie med formål å undersøke komplikasjonsfrekvens og risikofaktorer for komplikasjoner ved CT-veiledet lungebiopsi utført ved UNN Tromsø. Vi har også undersøkt diagnostisk treffsikkerhet ved prosedyren. Materiale og metode: Alle pasienter som hadde fått utført CT-veiledet lungebiopsi ved radiologisk avdeling, UNN Tromsø i løpet av perioden 17/11/2020 - 12/08/2021 ble identifisert via avdelingens PACS. ICW og AWB utførte søket, med søkeordene «CT biopsi lunge», «CT lab 7» og «CT lab 8». Ekskludert ble pasienter som fikk utført biopsi av andre thorax-nære strukturer / tumores og / eller der det ble benyttet ultralyd i tillegg til CT- veiledning. Informasjon vedrørende pasientenes alder, kjønn og underliggende sykdommer / medikasjon av betydning for en lungebiopsi, indikasjoner for lungebiopsien, lokalisasjon og størrelse av tumor, biopsi-tekniske forhold, samt komplikasjonsrate, type og behandling ble hentet fra RIS, PACS eller DIPS ved UNN. Kvalitetsstudien ble vurdert ikke fremleggingspliktig av REK-Nord (søknadsid 212651). Data ble registrert og analysert i SPSS ver.27. Resultater: 102 pasienter (57 kvinner) mellom 23 og 83 år, gjennomsnitt 69,3 år (SD 9,9 år) ble inkludert i studien. Ved histologisk prøve ga 95/102 (93,1%) biopsier sikker diagnose. Det oppsto 35 komplikasjoner hvorav ni behandlingstrengende, hos totalt 27 pasienter (26,5%). Den vanligste komplikasjonen var parenkymblødning >4 cm hos 14 pasienter (13,7%); av disse var alle selvbegrensende bortsett fra hos én pasient som fikk behandling med traneksamsyre. Pneumothorax oppsto hos ti pasienter (9,8%); av disse fikk seks pasienter behandling med pigtail-kateter og / eller thoraxdren (60,0% av alle pneumothorax-tilfellene; 5,9% av alle pasientene). Komplikasjonene medførte forlenget hospitalisering hos 9 / 27 (33,3%) pasienter (median 2 dager, spredning 1-7 dager). Lesjoner lokalisert i venstre lunge (p<0,001), økt avstand fra pleura til tumor (p=0,002), histologisk diagnose (p=0,015), lavere grad av lungekompresjon (høy kompresjonsratio mellom ende-areal / start-areal, p=0,010), økt prosedyretid (p=0,018) og bruk av spesialteknikker (p=0,042) var signifikant assosiert med økt forekomst av komplikasjoner. Lengre nåle- og prosedyretid, økt avstand pleura - lesjon og vinkel pleura - nål ≥80° var assosiert med økt forekomst av pneumothorax. Konklusjon: Vi har vist at CT-veiledet lungebiopsi ved UNN ga tilstrekkelig materiale for histologisk diagnose i de fleste prosedyrer, at komplikasjonsraten var relativt lav sammenlignet med andre studier og at forekomsten av komplikasjoner var assosiert med flere faktorer relatert til både tumor og til biopsi-teknikk

Gamer-parent identity: Positioning parenthood between fun screentime and ideals of responsibility

This paper is part of a project on Norwegian gamer-parents and how they domesticate digital games for their families (GAME). Here we explore how gamer-parents, that is, those who were gamers before becoming parents negotiate and position themselves. In this paper we explore the hybrid identity of two seemingly opposing identity categories, namely, gamer and parent. Gamer-parents can be said to have a double role, as they are doing parenting, however they also both position themselves- and are positioned by non-gaming parents as gamers. How do gamer-parents negotiate and position themselves in the tension between fun screentime and ideals of responsibility

The struggle and enrichment of play: Domestications and overflows in the everyday life of gamer parents

Gaming is a frequent source of conflict for families. Research on parents and gaming has identified a lack of gaming-related expertise, a general devaluation or fear of play, and authoritative and restrictive parenting styles as key sources of conflict. What happens when these deficits are addressed? What does mediation look like when parents are expert gam-ers, enjoy play, and encourage play for their children? Based on qualitative interviews with 29 parents who identify as gamers, we explore how gamer parents domesticate games. To explore the work of stabilising gaming as a wholesome and valued pastime, we combine domestication theory with overflows to address the struggles involved. The analysis inves-tigates how gamer parents mediate play, with an emphasis on how games are interpreted, the family’s player practices, and the role of gaming-related expertise in accordance with the three dimensions (symbolic, practice, cognitive) of domestication theory

The B-lymphocyte chemokine CXCL13 in the cerebrospinal fluid of children with Lyme neuroborreliosis: associations with clinical and laboratory variables

Background: The B-lymphocyte chemokine CXCL13 is increasingly considered as a useful early phase diagnostic marker of Lyme neuroborreliosis (LNB). However, the large variation in level of CXCL13 in the cerebrospinal fluid (CSF) observed in LNB patients is still unexplained. We aimed to identify factors associated with the level of CXCL13 in children with LNB, possibly improving the interpretation of CXCL13 as a diagnostic marker of LNB. Methods: Children with confirmed and probable LNB were included in a prospective study on CXCL13 in CSF as a diagnostic marker of LNB. The variables age, sex, facial nerve palsy, generalized inflammation symptoms (fever, headache, neck-stiffness and/or fatigue), duration of symptoms, Borrelia antibodies in CSF, Borrelia antibody index (AI), CSF white blood cells (WBC), CSF protein and detection of the genospecies Borrelia garinii by PCR were included in simple and multivariable regression analyses to study the associations with the CXCL13 level. Results: We included 53 children with confirmed and 17 children with probable LNB. CXCL13 levels in CSF were positively associated with WBC, protein and Borrelia antibodies in CSF in both simple and multivariable analyses. We did not find any associations between CXCL13 and age, sex, clinical symptoms, duration of symptoms, AI or the detection of Borrelia garinii. Conclusions: High levels of CSF CXCL13 are present in the early phase of LNB and correlate with the level of CSF WBC and protein. Our results indicate that CSF CXCL13 in children evaluated for LNB can be interpreted independently of clinical features or duration of symptoms

Alcohol consumption and risk of dementia up to 27 years later in a large, population-based sample: the HUNT study, Norway

The relationship between alcohol consumption and dementia risk is unclear. This investigation estimates the association between alcohol consumption reported in a population-based study in the mid-1980s and the risk for dementia up to 27 years later. The entire adult population in one Norwegian county was invited to the Nord-Trøndelag Health Study during 1984–1986 (HUNT1): 88 % participated. The sample used in this study includes HUNT1 participants born between 1905 and 1946 who completed the questionnaire assessing alcohol consumption. A total of 40,435 individuals, of whom 1084 have developed dementia, are included in the analysis adjusted for age, sex, years of education, hypertension, obesity, smoking, and symptoms of depression. When adjusting for age and sex, and compared to reporting consumption of alcohol 1–4 times during the last 14 days (drinking infrequently), both abstaining from alcohol and reporting consumption of alcohol five or more times (drinking frequently) were statistically significantly associated with increased dementia risk with hazard ratios of 1.30 (95 % CI 1.05–1.61) and 1.45 (1.11–1.90), respectively. In the fully adjusted analysis, drinking alcohol frequently was still significantly associated with increased dementia risk with a hazard ratio of 1.40 (1.07–1.84). However, the association between dementia and abstaining from alcohol was no longer significant (1.15, 0.92–1.43). Equivalent results for Alzheimer’s disease and vascular dementia indicated the same patterns of associations. When adjusting for other factors associated with dementia, frequent alcohol drinking, but not abstaining from alcohol, is associated with increased dementia risk compared to drinking alcohol infrequently

Using a period incidence survey to compare antibiotic use in children between a university hospital and a district hospital in a country with low antimicrobial resistance: a prospective observational study

Objectives To describe and compare antibiotic use in relation to indications, doses, adherence rate to guidelines and rates of broad-spectrum antibiotics (BSA) in two different paediatric departments with different academic cultures, and identify areas with room for improvement. Design Prospective observational survey of antibiotic use. Setting Paediatric departments in a university hospital (UH) and a district hospital (DH) in Norway, 2017. The registration period was 1 year at the DH and 4 months at the UH. Participants 201 children at the DH (mean age 3.8: SD 5.1) and 137 children at the UH (mean age 2.0: SD 5.9) were treated with systemic antibiotics by a paediatrician in the study period and included in the study. Outcome measures Main outcome variables were prescriptions of antibiotics, treatments with antibiotics, rates of BSA, median doses and adherence rate to national guidelines. Results In total, 744 prescriptions of antibiotics were given at the UH and 638 at the DH. Total adherence rate to guidelines was 75% at the UH and 69% at the DH (p=0.244). The rate of treatments involving BSA did not differ significantly between the hospitals (p=0.263). Use of BSA was related to treatment of central nervous system (CNS) infections, patients with underlying medical conditions or targeted microbiological treatment in 92% and 86% of the treatments, at the UH and DH, respectively (p=0.217). A larger proportion of the children at the DH were treated for respiratory tract infections (p<0.01) compared with the UH. Children at the UH were treated with higher doses of ampicillin and cefotaxime (p<0.05) compared with the DH. Conclusion Our results indicate that Norwegian paediatricians have a common understanding of main aspects in rational antibiotic use independently of working in a UH or DH. Variations in treatment of respiratory tract infections and in doses of antibiotics should be further studied