Implementing structured functional assessments in general practice for persons with long-term sick leave: a cluster randomised controlled trial

<p>Abstract</p> <p>Background</p> <p>The increasing attention on functional assessments in medical and vocational rehabilitation requires a focus change for the general practitioners (GP) into paying attention to patient resources, possibilities and coping instead of symptoms, problems and limitations. The GPs report difficulties in performing the requested explicit functional assessments. The purpose of this study was to implement a structured method in general practice for assessing functional ability in persons with long-term sick leave. The study aim was to evaluate intervention effects on important GP parameters; knowledge, attitudes, self-efficacy towards functional assessments and knowledge about patient work factors.</p> <p>Methods</p> <p>Fifty-seven GPs were randomly assigned to an intervention or a control group. The intervention group GPs attended an introductory one-day work-shop and implemented structured functional assessments during an eight months intervention period. GP knowledge, GP attitudes, and GP self-efficacy towards functional assessments, as well as GP knowledge of patient work factors, were collected before, after and six months after the intervention period started. Evaluation score-sheets were filled in by both the intervention GPs and their patients immediately after the consultation to evaluate the GPs' knowledge of patient work factors.</p> <p>Results</p> <p>The intervention GPs reported increased knowledge (B: 0.56, 95% CI (0.19, 0.91)) and self-efficacy (B: 0.90, 95% CI (0.53, 1.26)) towards functional assessments, and increased knowledge about their patients' workplace (B: 0.75, 95% CI (0.35, 1.15)) and perceived stressors (B: 0.55, 95% CI (0.23, 0.88)) with lasting effects at the second follow-up. No intervention effect was seen in relation to GP attitudes. Both before and after the intervention, the GPs were most informed about physical stressors, and less about mental and work organisational stressors (Guttman's reproducibility coefficient: 0.95 and 1.00). After the consultation, both the intervention GPs and their patients reported that the GPs' knowledge about patient work factors had increased (GP B: 0.60 (95% CI: 0.42, 0.78); patient B: 0.50 (95% CI: 0.34, 0.66)).</p> <p>Conclusion</p> <p>Introducing and implementing structured functional assessments in general practice made the GPs capable to assess functional ability of their patients in a structured manner. Intervention effects of increased GP knowledge and GP self-efficacy sustained at the second follow-up.</p

Carfilzomib and dexamethasone maintenance following salvage ASCT in multiple myeloma: A randomised phase 2 trial by the Nordic Myeloma Study Group

Objective: We investigated the efficacy and safety of carfilzomib-containing induction before salvage high-dose melphalan with autologous stem-cell transplantation (salvage ASCT) and maintenance with carfilzomib and dexamethasone after salvage ASCT in multiple myeloma.Methods: This randomised, open-label, phase 2 trial included patients with first relapse of multiple myeloma after upfront ASCT who were re-induced with four cycles of carfilzomib, cyclophosphamide and dexamethasone. Two months after salvage, ASCT patients were randomised to either observation or maintenance therapy with iv carfilzomib 27 -> 56 mg/sqm and p.o. dexamethasone 20 mg every second week. The study enrolled 200 patients of which 168 were randomised to either maintenance with carfilzomib and dexamethasone (n = 82) or observation (n = 86).Results: Median time to progression (TTP) after randomisation was 25.1 months (22.5-NR) in the carfilzomib-dexamethasone maintenance group and 16.7 months (14.4-21.8) in the control group (HR 0.46, 95% CI 0.30-0.71; P = .0004). The most common adverse events during maintenance were thrombocytopenia, anaemia, hypertension, dyspnoea and bacterial infections.Conclusion: In summary, maintenance therapy with carfilzomib and dexamethasone after salvage ASCT prolonged TTP with 8 months. The maintenance treatment was in general well-tolerated with manageable toxicity.</p

Functional ability in a population: normative survey data and reliability for the ICF based Norwegian Function Assessment Scale

Background The increasing focus on functional ability assessments in relation to sickness absence necessitates the measurement of population functional levels. This study assessed the reliability of the Norwegian Function Assessment Scale (NFAS) and presents normative population data. Methods All inhabitants in seven birth cohorts in Ullensaker municipality in 2004 were approached by means of a postal questionnaire. The NFAS was included as part of The Ullensaker Study 2004. The instrument comprises 39 items derived from the activities/participation component in the International Classification for Functioning, Disabilities and Health (ICF). Based on the results of principal component analysis, these items comprise seven domains. Non-parametric tests for independent samples were used to compare subgroups. Internal consistency was assessed by Cronbach's alpha. Two-week test-retest reliability was assessed by total proportions of agreement, weighted kappa, and intraclass correlation coefficient (ICC). Results The response rate was 54% (1620 persons) and 75.4% (101 persons) for the retest. Items had low levels of missing data. Test-retest reliability was acceptable with high proportions of absolute agreement; kappa and ICC values ranged from 0.38 to 0.83 and 0.79 to 0.83, respectively. No difficulty on all 39 functional activities was reported by 33.1% of respondents. Females, older persons and persons with lower levels of education reported more functional problems than their respective counterparts (p < 0.05). The age gradient was most evident for three of the physical domains. For females aged 24–56 and males aged 44–76, a clear education gradient was present for three of the physical domains and one mental domain after adjusting for age and gender. Conclusion This study presents population based normative data on functional ability, as measured by the NFAS. These data will serve as basis for the development of national population norms and are necessary for score interpretation. Data quality and test-retest reliability of the NFAS were acceptable

Therapeutic Options in the Treatment of Multiple Myeloma: Pharmacoeconomic and Quality-of-Life Considerations

A review of current treatment options in multiple myeloma is presented, including data on health-related quality of life and pharmacoeconomics. For induction chemotherapy, no combination of cytostatic drugs has been shown to be consistently superior to the simple cyclic oral treatment with melphalan and prednisone that has been available for 30 years. The total resource consumption and direct costs per patient treated with melphalan and prednisone is approximately $US10 000 (1995 values). As median survival is prolonged from less than a year in untreated patients to 30 to 36 months, this treatment must be considered cost effective. Interferon-alpha has a modest effect on progression-free and overall survival when added to chemotherapy regimens. However, the high cost and toxicity of this drug results in an unfavourable cost-utility ratio, estimated to be between$US50 000 to $US100 000 per quality-adjusted life-year gained. Clinical trials suggest that high dose chemotherapy followed by autologous stem cell support administered to patients who have achieved disease stabilisation or objective response to conventional induction chemotherapy, prolongs median survival by about 1.5 years. Preliminary cost-utility analyses suggest a cost per life-year gained of$US30 000 to $US40 000. Further potential improvements of this therapeutic modality are under way. Several bisphosphonates have been tested for the ability to prevent the skeletal complications of multiple myeloma. Monthly infusions of pamidronate have been shown in 1 randomised trial to significantly reduce the rate of skeletal complications. Unfortunately, the rapid and widespread acceptance of this therapy seems to preclude further prospective, placebo-controlled trials with cost-utility evaluation.Reviews-on-treatment, Multiple-myeloma, Antineoplastics, Interferon-alpha, Stem-cell-transplant, Cost-analysis, Bone-marrow-transplant, Cost-analysis, Quality-of-life, Immunoglobulins, Epoetin-alfa, Bisphosphonates

Monoklonal gammopati av klinisk betydning

Monoklonal gammopati er hyppig og kan være assosiert med alvorlig sykdom, men målrettet behandling kan gi betydelig helsegevinst. Det er godt kjent at funn av monoklonal gammopati bør føre til en vurdering om pasienten kan ha myelomatose eller annen B-lymfoproliferativ sykdom, men at det monoklonale immunglobulinet direkte kan føre til sykdom, er langt mindre kjent

Interaktiv mattelæring for grunnskolen

Gruppen har utviklet et samlet opplæringsverktøy i matematikk for Ekeberg Skole. Produktet består av en CD-ROM, en webside og et hefte. Målgruppen for produktet er skoleelever i 2. og 3. klasse. Verktøyet skal være et supplement til den daglige undervisningen i matematikk, og gi elever muligheter til å bruke teorikunnskap i et interaktivt læringsmiljø. CD-ROMen er utformet som et dataspill, med to kjente gjennomgangsfi gurer. Poenget med spillet er å styre fi gurene gjennom en magisk skog. Målet for ferden er et fj ell der en stor skatt skjuler seg. For å ta seg gjennom skogen må brukerne innom fi re ulike poster. Her skal det løses matematiske oppgaver innen forskjellige emner og vanskelighetsgrader. Til slutt må brukerne benytte den nye kunnskapen til å vinne skatten. Målet med CD-ROMen er å øke kompetansen til brukerne gjennom interaktivitet og underholdning. Websiden inneholder matematikkoppgaver i samme brukergrensesnitt som CD-ROMen, men med økt vanskelighetsgrad. Meningen bak nettstedet er å gi brukerne muligheten til å jobbe videre med interaktiv matematikk på bakgrunn fra spilllet. Websiden kan også brukes uavhengig fra skolen, og gir brukerne økt tilgang til verktøyet. Heftet er hovedsakelig ment som en veiledning til den interaktive mattelæringen. I tillegg inneholder heftet et eventyr som skal gjøre brukerne kjent med spillets virtuelle verden. Tekstene er illustrert med bilder fra CD-ROMen. Heftet er trykket i A5 format og er på 12 sider

Early Gender Differences in Pain and Functional Recovery Following Thoracolumbar Spinal Arthrodesis

Background: To analyze gender differences regarding the recovery experience (pain, function, complications) after spinal arthrodesis surgery. Methods: Pre-operative and post-operative gender-based differences in patient-reported outcomes for open posterior spinal arthrodesis at 6 weeks, 3 months, 6 months, and 1 year were studied, including age, comorbidities, body mass index (BMI), diagnosis, number of vertebrae fused, type of surgery, primary vs. revision surgery, and complications. Statistical analysis included the use of Student’s t-test, Chi square, linear regression, Mann–Whitney U test, and Spearman’s rho. Results: Primary or revision posterior arthrodesis was performed on 1931 consecutive adults (1219 females, 712 males) for deformity and degenerative pathologies. At surgery, females were older than males (61.7 years vs. 59.7 years, p &lt; 0.01), had slightly more comorbidities (1.75 vs. 1.5, p &lt; 0.01), and were more likely to undergo deformity correction (38% vs. 22%, p &lt; 0.01). Females described more pre-op pain (female VAS = 6.54 vs. male VAS = 6.41, p &lt; 0.01) and lower pre-op function (female ODI = 49.73 vs. male ODI = 46.52, p &lt; 0.01). By 3 months post-op, there was no significant gender difference in VAS or ODI scores. Similar pain and function scores between males and females continued through 6 months and 12 months. Conclusion: Although females have more pain and dysfunction before undergoing spinal surgery, the differences in these values do not reach the Minimum Clinically Important Difference (MCID). Post-operatively, there is no difference in pain and function scores among males and females at 3, 6, and 12 months

Interaktiv mattelæring for grunnskolen

Gruppen har utviklet et samlet opplæringsverktøy i matematikk for Ekeberg Skole. Produktet består av en CD-ROM, en webside og et hefte. Målgruppen for produktet er skoleelever i 2. og 3. klasse. Verktøyet skal være et supplement til den daglige undervisningen i matematikk, og gi elever muligheter til å bruke teorikunnskap i et interaktivt læringsmiljø. CD-ROMen er utformet som et dataspill, med to kjente gjennomgangsfi gurer. Poenget med spillet er å styre fi gurene gjennom en magisk skog. Målet for ferden er et fj ell der en stor skatt skjuler seg. For å ta seg gjennom skogen må brukerne innom fi re ulike poster. Her skal det løses matematiske oppgaver innen forskjellige emner og vanskelighetsgrader. Til slutt må brukerne benytte den nye kunnskapen til å vinne skatten. Målet med CD-ROMen er å øke kompetansen til brukerne gjennom interaktivitet og underholdning. Websiden inneholder matematikkoppgaver i samme brukergrensesnitt som CD-ROMen, men med økt vanskelighetsgrad. Meningen bak nettstedet er å gi brukerne muligheten til å jobbe videre med interaktiv matematikk på bakgrunn fra spilllet. Websiden kan også brukes uavhengig fra skolen, og gir brukerne økt tilgang til verktøyet. Heftet er hovedsakelig ment som en veiledning til den interaktive mattelæringen. I tillegg inneholder heftet et eventyr som skal gjøre brukerne kjent med spillets virtuelle verden. Tekstene er illustrert med bilder fra CD-ROMen. Heftet er trykket i A5 format og er på 12 sider

Assessment of species listing proposals for CITES CoP17. Opinion of the Panel on Alien Organisms and Trade in Endangered Species (CITES) of the Norwegian Scientific Committee for Food Safety

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Assessment of the risks associated with the import and release of hand-reared mallards for hunting purposes. Opinion of the Panel on Alien Organisms and Trade in Endangered Species (CITES) of the Norwegian Scientific Committee for Food Safety, VKM Report 2017:23

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