Assessment of treatment services for intellectually disabled with psychiatric disorders in a specialized department of a regional hospital. Which measures and forms of cooperation are applied, and how is the cooperation with other providers evaluated?

Nasjonale og internasjonale studier viser at personer med utviklingshemming er mer utsatt for å utvikle psykiske lidelser enn øvrig befolkning. Pasientgruppen er likevel underrepresentert når det gjelder utredning, behandling og forskning. Hensikten med studien har vært å kartlegge behandlingstilbudet til pasienter med psykisk utviklingshemming, og samtidig psykiske lidelser. Resultatene viser at de mest anvendte tiltakene var tilrettelegging i skole/arbeid/hjem, deltakelse i ansvarsgrupper og personalveiledning. Det ble gitt individuell behandling i ca. en femtedel av sakene. Det var samarbeid med kommunen i nesten alle sakene, og med øvrig psykisk helsevern i litt over halvparten av sakene. Tjenesten var mest fornøyd med samarbeidet med psykiatrisk sykehus

Wideband Characteristic Basis Functions in Radiation Problems

In this paper, the use of characteristic basis function (CBF) method, augmented by the application of asymptotic waveform evaluation (AWE) technique is analyzed in the context of the application to radiation problems. Both conventional and wideband CBFs are applied to the analysis of wire and planar antennas

Forslag til endring av retningslinje for behandlingslengde av mild til moderat samfunnserverva pneumoni i sjukehus

BAKGRUNN Det eksisterer mange ulike retningslinjer for kor lang antibiotikabehandling av samfunnserverva pneumoni (SEP) i sjukehus bør vera. Kortare behandlingstid vil kunna ha fordeler økonomisk, helsemessig og med høve til resistensutvikling. Me ser i oppgåva på eksisterande retningslinjer for lengda av antibiotikabehandling av vaksne pasientar med mild til moderat SEP i norske sjukehus i dag, og vil gå gjennom det vitskaplege grunnlaget for desse. Me ser òg på behovet for å laga og implementera ny retningslinje på bakgrunn av ny kunnskap. METODE Søk i www.helsebiblioteket.no gav norske retningslinjer. Det vart funne to relevante metaanalysar om behandlingslengd via søk i Pubmed, likeeins artiklar som omhandla samfunnsmessige konsekvensar av kortare behandlingslengd. RESULTAT Norske retningslinjer tilrår alle behandling i 7-10 dagar ved mild til moderat SEP. Metaanalysane viser at kortare behandlingslengde (7 dagar eller mindre) er likeverdig med lengre (over 7 dagar) med omsyn til symptomfridom og tilbakefall. Me føreslår implementering av ny retningslinje med behandlingslengde 7 dagar eller mindre. FORSLAG TIL IMPLEMENTERING OG EVALUERING I implementering og evaluering av retningslinja i sjukehusavdeling føreslår me å bruka prosessindikator og registrera delen pasientar som får langtidsbehandling versus kortisdbehandling ved hjelp av sjekkliste, med evaluering etter 6 månader. Som organiseringsmodel for betringsprosjektet nyttar me Demings kvalitetshjul. KONKLUSJON Kortare behandklingstid er like effektiv som lang. Innføring av ei oppdatert retningslinje vil kunna bidra til å halda norske resistensforhold på eit lågt nivå, og gjev òg potensielt kortare liggetid, tidlegare mobilisering av pasienten og færre biverknader, med føremoner både samfunnet og for pasiengruppa

Medication management for patients with hip fracture at a regional hospital and associated primary care units in Norway: a descriptive study based on a survey of clinicians' experience and a review of patient records

Objective: Patients with hip fracture are at high risk of medication errors due to a combination of high age, comorbidities, polypharmacy and several care transitions after fracture. The aim was to study medication management tasks concerning patient safety: medication reconciliation, medication review and communication of key medication information in care transitions. Design: Descriptive study comprising a self-administered clinician survey (MedHipPro-Q) and a retrospective review of hospital medical records of patients with hip fracture. Setting: Regional hospital and the associated primary care units (South-Eastern Norway). Participants: The survey received responses from 253 clinicians, 61 medical doctors and 192 nurses, involved in the medication management of patients with hip fracture, from acute admittance to the regional hospital, through an in-hospital fast track, primary care rehabilitation and back to permanent residence. Respondents' representativeness was unknown, introducing a risk of selection and non-response bias, and extrapolating findings should be done with caution. The patient records review included a random sample of records of patients with hip fracture (n=50). Outcome measures: Medication reconciliation, medication review and communication of medication information from two perspectives: the clinicians' (ie, experiences with medication management) and the practice (ie, documentation of completed medication management). Results: In the survey, most clinicians stated they performed medication reconciliation (79%) and experienced that patients often arrived without a medication list after care transition (37%). Doctors agreed that more patients would benefit from medication reviews (86%). In the hospital patient records, completed medication reconciliation was documented in most patients (76%). Medication review was documented in 2 of 50 patients (4%). Discharge summary guidelines were followed fully for 3 of 50 patients (6%). Conclusion: Our study revealed a need for improved medication management for patients with hip fracture. Patients were at risk of medication information not being transferred correctly between care settings, and medication reviews seemed to be underused in clinical practice

Clinical pharmacist intervention to improve medication safety for hip fracture patients through secondary and primary care settings: a nonrandomised controlled trial

Background: Hip fracture patients face a patient safety threat due to medication discrepancies and adverse drug reactions when they have a combination of high age, polypharmacy and several care transitions. Consequently, optimised pharmacotherapy through medication reviews and seamless communication of medication information between care settings is necessary. The primary aim of this study was to investigate the impact on medication management and pharmacotherapy. The secondary aim was to evaluate implementation of the novel Patient Pathway Pharmacist intervention for hip fracture patients. Methods: Hip fracture patients were included in this nonrandomised controlled trial, comparing a prospective intervention group (n = 58) with pre-intervention controls who received standard care (n = 50). The Patient Pathway Pharmacist intervention consisted of the steps: (A) medication reconciliation at admission to hospital, (B) medication review during hospitalisation, (C) recommendation for the medication information in the hospital discharge summary, (D) medication reconciliation at admission to rehabilitation, and (E) medication reconciliation and (F) review after hospital discharge. The primary outcome measure was quality score of the medication information in the discharge summary (range 0-14). Secondary outcomes were potentially inappropriate medications (PIMs) at discharge, proportion receiving pharmacotherapy according to guidelines (e.g. prophylactic laxatives and osteoporosis pharmacotherapy), and all-cause readmission and mortality. Results: The quality score of the discharge summaries was significantly higher for the intervention patients (12.3 vs. 7.2, p Conclusion: The intervention steps were successfully implemented for hip fracture patients and contributed to patient safety through a higher quality medication information in the discharge summary, fewer PIMs and optimised pharmacotherapy

Spatial distribution of Dechlorane Plus and dechlorane related compounds in European background air

The highly chlorinated chemical Dechlorane Plus (DP) was introduced as a replacement flame retardant for Mirex, which is banned through the Stockholm Convention (SC) for its toxicity (T), environmental persistence (P), potential for bioaccumulation (B) and long-range environmental transport potential (LRETP). Currently, Dechlorane Plus is under consideration for listing under the Stockholm Convention and by the European Chemical Agency as it is suspected to also have potential for P, B, T and LRET. Knowledge of atmospheric concentrations of chemicals in background regions is vital to understand their persistence and long-range atmospheric transport but such knowledge is still limited for Dechlorane Plus. Also, knowledge on environmental occurrence of the less described Dechlorane Related Compounds (DRCs), with similar properties and uses as Dechlorane Plus, is limited. Hence, the main objective of this study was to carry out a spatial mapping of atmospheric concentrations of Dechlorane Plus and Dechlorane Related Compounds at background sites in Europe. Polyurethane foam passive air samplers were deployed at 99 sites across 33 European countries for 3 months in summer 2016 and analyzed for dechloranes. The study showed that synand anti-DP are present across the European continent (3 and 3 , respectively), including parts of the Arctic. This supports that these compounds have potential for long-range atmospheric transport to remote regions. The highest concentrations of Dechlorane Plus were observed in central continental Europe, with anti-DP fractions close to the commercial mixture of Dechlorane Plus. The only detected Dechlorane Related Compounds was Dechlorane-602, which was found in 27% of the samples (3 ). The measured concentrations and spatial patterns of Dechlorane Plus and Dechlorane-602 in air across Europe indicate the influence of primary sources of these compounds on background concentrations in European air. Future air monitoring efforts targeting dechloranes is needed in both background and source areas, including consistent temporal trends

Delirium, neurofilament light chain, and progressive cognitive impairment: analysis of a prospective Norwegian population-based cohort

Background: Previous population-based, longitudinal studies have shown that delirium is associated with an increased risk of dementia and cognitive decline. However, the underlying biological mechanisms are largely unknown. We aimed to assess the effects of delirium on both cognitive trajectories and any neuronal injury, measured via neurofilament light chain (NfL). // Methods: In this analysis of a prospective, 2-year follow-up, cohort study of participants aged 65 years or older living in Sandefjord municipality, Norway, we included cohort participants who were receiving domiciliary care services at least once per week between May 12, 2015, and July 8, 2016. Individuals with a life expectancy of less than 1 week, with Lewy body dementia, with psychiatric illness (except dementia), or for whom substance misuse was the principal indication for domiciliary services were excluded. Participants had a comprehensive assessment at 6-month intervals for 2 years, which included the Montreal Cognitive Assessment (MoCA) and a blood sample for NfL to measure neuronal injury. All information on clinical diagnoses and medications were cross-referenced with medical records. During any acute change in mental status or hospitalisation (ie, admission to hospital), participants were assessed once per day for delirium with Diagnostic and Statistical Manual of Mental Disorders, fifth edition criteria. We also measured NfL from blood samples taken from participants who were acutely hospitalised. // Findings: Between May 12, 2015, and July 8, 2016, 210 participants were eligible for inclusion and assessed at baseline (138 [66%] of whom were female and 72 [34%] of whom were male), 203 completed cognitive assessment, and 141 were followed up for 2 years. 160 (76%) of 210 had moderate or severe frailty and 112 (53%) were living with dementia. During the 2-year follow-up, 89 (42%) of 210 participants were diagnosed with one or more episodes of delirium. Incident delirium was independently associated with a decrease in MoCA score at the next 6-month follow-up, even after adjustment for age, sex, education, previous MoCA score, and frailty (adjusted mean difference –1·5, 95% CI –2·9 to –0·1). We found an interaction between previous MoCA score and delirium (β –0·254, 95% CI –0·441 to –0·066, p=0·010), with the largest decline being observed in people with better baseline cognition. Participants with delirium and good previous cognitive function and participants with a high peak concentration of NfL during any hospitalisation had increased NfL at the next 6-month follow-up. Mediation analyses showed independent pathways from previous MoCA score to follow-up MoCA score with contributions from incident delirium (–1·7, 95% CI –2·8 to –0·6) and from previous NfL to follow-up MoCA score with contributions from acute NfL concentrations (–1·8, –2·5 to –1·1). Delirium was directly linked with a predicted value of 1·2 pg/mL (95% CI 1·02 to 1·40, p=0·029) increase in NfL. // Interpretation: In people aged 65 years or older, an episode of delirium was associated with a decline in MoCA score. Greater neuronal injury during acute illness and delirium, measured by NfL, was associated with greater cognitive decline. For clinicians, our finding of delirium associated with both signs of acute neuronal injury, measured via NfL, and cognitive decline is important regarding the risk of long-term cognitive deterioration and to acknowledge that delirium is harmful for the brain

Impacts of a warming climate on concentrations of organochlorines in a fasting high arctic marine bird: Direct vs. indirect effects?

The present study examined how climate changes may impact the concentrations of lipophilic organochlorines (OCs) in the blood of fasting High Arctic common eiders (Somateria mollissima) during incubation. Polychlorinated biphenyls (PCBs), 1-dichloro-2,2-bis (p-chlorophenyl) ethylene (p,p′-DDE), hexachlorobenzene (HCB) and four chlordane compounds (oxychlordane, trans-chlordane and trans- and cis-nonachlor) were measured in females at chick hatching (n = 223) over 11 years (2007–2017). Firstly, median HCB and p,p′-DDE concentrations increased ~75 % over the study period, whereas median chlordane concentrations doubled (except for oxychlordane). PCB concentrations, in contrast, remained stable over the study period. Secondly, both body mass and clutch size were negatively associated with OC levels, suggesting that females with high lipid metabolism redistributed more OCs from adipose tissue, and that egg production is an important elimination route for OCs. Thirdly, the direct climate effects were assessed using the mean effective temperature (ET: air temperature and wind speed) during incubation, and we hypothesized that a low ET would increase redistribution of OCs. Contrary to expectation, the ET was positively correlated to most OCs, suggesting that a warmer climate may lead to higher OCs levels, and that the impact of ET may not be direct. Finally, potential indirect impacts were examined using the Arctic Oscillation (AO) in the three preceding winters (AOwinter 1–3) as a proxy for potential long-range transport of OCs, and for local spring climate conditions. In addition, we used chlorophyll a (Chla) as a measure of spring primary production. There were negative associations between AOwinter 1 and HCB, trans-chlordane and trans-nonachlor, whereas oxychlordane and cis-chlordane were negatively associated with Chla. This suggests that potential indirect climate effects on eiders were manifested through the food chain and not through increased long-range transport, although these relationships were relatively weak.Impacts of a warming climate on concentrations of organochlorines in a fasting high arctic marine bird: Direct vs. indirect effects?publishedVersio

CSF biomarkers in delirium a systematic review

OBJECTIVE: In recent years, there has been a blossoming of studies examining cerebrospinal fluid (CSF) as a method of studying the pathophysiology of delirium. We systematically reviewed the literature for CSF studies in delirium and provide here a summary of the implications for our understanding of delirium pathophysiology. We also summarise the methods used for CSF analysis and discuss challenges and implications for future studies.METHODS: In this systematic review, we screened MEDLINE, EMBASE, PsycINFO, Web of Science, PubMed and the Cochrane Library for articles on CSF biomarkers in delirium, published on 3 September 2016. Studies were required to use Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases criteria for delirium or a validated tool. We excluded case reports. There were no other restrictions on study type.RESULTS: We identified 3280 articles from our initial search, and 22 articles were included in this review. All studies were prospective, including over 400 patients with delirium and 700 controls. More than 70 different biomarkers were studied. Studies could not be compared with each other for meta-analysis because of their heterogeneity and varied widely in their risk of bias and quality assessments.CONCLUSIONS: The 22 studies identified in this review reveal a small but growing literature, in which many of the important hypotheses in delirium pathogenesis have been examined, but from which few firm conclusions can currently be drawn. Nevertheless, the overall interpretation of the literature supports the vulnerable brain concept, that is, that biomarker evidence of, for example, Alzheimer's disease pathology and/or neuroinflammation, is associated with delirium. Copyright © 2017 John Wiley &amp; Sons, Ltd.</p