Akershus University Hospital Research Articles

Prevalence of insomnia and feasibility of a nurse-administered digital cognitive behavioural therapy two years after corona virus disease hospitalisation

BackgroundDisturbed sleep is prevalent after corona virus disease (COVID-19). However, little is known of post infectious prevalence, course, predictors and treatment of chronic insomnia. AimTo estimate the prevalence of chronic insomnia three and twelve months after hospitalisation for COVID-19, to identify predictors of chronic insomnia, and to evaluate the feasibility of a nurse-administered digital cognitive behavioural therapy for insomnia (dCBTi) protocol. MethodPatients hospitalised at Akershus University Hospital (Norway) for COVID-19 between February–June 2020 were eligible. The 94 patients that consented to participate were contacted by phone and interviewed with a modified DUKE structured interview three- and twelve months after discharge. Participants with chronic insomnia after twelve months were offered a nurse-administered dCBTi treatment protocol. Outcome measurements were sleep efficiency (SE) calculated by standard formulas (0-100 %) and the Bergen Insomnia Scale (BIS) (0-42). ResultsAt three-month follow-up, 22 persons (23 %) fulfilled the diagnostic criteria for chronic insomnia. At twelve-month follow-up, 23 fulfilled the diagnostic criteria. The odds ratios for chronic insomnia after twelve months were 0.857 (0.742–0.989) for body mass index (BMI), and 0.239 (0.069–0.821) for male sex. Ten participated in the dCBTi feasibility study. Five completed the treatment protocol. SE improved, but not significantly. The BIS score improved significantly from 24 to 12 (p-value = 0.036). ConclusionChronic insomnia remained stable three- and twelve months post COVID-19 hospitalisation. Female sex and low BMI were independent predictors of chronic insomnia twelve months post infection, but only 50 % of participants completed the protocol. Completers significantly reduced insomnia symptoms.

Neuronal plasma biomarkers in acute ischemic stroke.

Early imaging-based detection of acute ischemic stroke (AIS) has improved in the era of reperfusion therapy. Despite of this, prognosis of outcome after AIS remains a challenge. Therefore, parameters that support clinical decision making are sought. Blood-based biomarkers have the potential to provide valuable information in addition to the established prognostic factors. Neuronal biomarkers of acute or degenerative neuronal injury have shown to be reliably detected in plasma. These biomarkers are well-established in neurodegenerative pathology, such as Alzheimer's disease. In this study, we explored the association between stroke diameter and plasma biomarkers for neuronal injury and tau pathophysiology (brain-derived tau [BD-tau], phosphorylated-tau-217 [p-tau21] and neurofilament light [NfL]) in patients (n = 193) admitted to the acute ward, Akershus University Hospital. All patients received a final diagnosis of AIS, transient ischemic attack or stroke mimics. Blood samples were obtained the day after admission. We find that levels of BD-tau (p = .004) and NfL (p = .011) were higher after AIS than in patients with stroke mimics. The cortical stroke diameter correlated with BD-tau (tau-b = 0.64, p < .001) and p-tau217 (tau-b = 0.36, p = .003). Linear regression confirmed BD-tau to be the strongest variable associated with stroke diameter, pointing to the potential clinical value of plasma BD-tau in outcome prediction after AIS.

Associations between Chest Pain, Diagnosis, and Clinical Outcome in Patients Hospitalized with Acute Dyspnea: Data from the ACE 2 Study

Introduction: Patients hospitalized due to dyspnea sometimes also report concomitant chest pain. Whether co-existing chest pain in patients with acute dyspnea associates with specific diagnosis and clinical outcome is not known. Method: We included 313 patients admitted to Akershus University Hospital with acute dyspnea and asked the patients directly on hospital admission whether they had experienced chest pain during the last 24 h. We examined the associations between chest pain and (1) diagnosis of the index hospitalization and (2) clinical outcome during follow-up. The diagnosis for the index hospitalization was adjudicated as acute heart failure (HF) or non-HF etiology of acute dyspnea by two experts working independently. Non-HF patients were further sub-grouped into chronic obstructive pulmonary disease (COPD) or non-COPD etiology. Results: In total, 143 patients were admitted with acute HF (46% of the population), 83 patients with COPD (26% of the population), and 87 patients with non-HF, non-COPD-related dyspnea (28% of the population). Ninety-six patients (31%) with acute dyspnea reported chest pain during the last 24 h prior to hospital admission. The prevalence of chest pain was not statistically different for patients who were hospitalized with acute HF (n = 42, 44%), acute exacerbation of COPD (n = 22, 23%), or non-HF, non-COPD-related dyspnea (n = 32, 33%), p > 0.05 for all comparisons between groups. During median of 823 days follow-up, 114 patients died (36%). Patients with dyspnea and concomitant chest pain did not have different outcome compared to patients with dyspnea and no chest pain (log-rank test: p = 0.09). Chest pain prior to admission was neither associated with all-cause mortality in any of the adjudicated diagnosis groups. Conclusions: Chest pain was reported in 31% of patients hospitalized with acute dyspnea but the prevalence did not differ according to adjudicated diagnosis. Patients with dyspnea and chest pain did not have worse outcome compared to patients with dyspnea and no chest pain.

T cell responses to repeated SARS-CoV-2 vaccination and breakthrough infections in patients on TNF inhibitor treatment: a prospective cohort study

Understanding cellular responses to SARS-CoV-2 immunisations is important for informing vaccine recommendations in patients with inflammatory bowel disease (IBD) and other vulnerable patients on immunosuppressive therapies. This study investigated the magnitude and quality of T cell responses after multiple SARS-CoV-2 vaccine doses and COVID-19 breakthrough infection. This prospective, observational study included patients with IBD and arthritis on tumour necrosis factor inhibitors (TNFi) receiving up to four SARS-CoV-2 vaccine doses. T cell responses to SARS-CoV-2 peptides were measured by flow cytometry before and 2-4 weeks after vaccinations and breakthrough infection to assess the frequency and polyfunctionality of responding cells, along with receptor-binding domain (anti-RBD) antibodies. Between March 2, 2021, and December 20, 2022, 143 patients (118 IBD, 25 arthritis) and 73 healthy controls were included. In patients with either IBD or arthritis, humoral immunity was attenuated compared to healthy controls (median anti-RBD levels 3391 vs. 6280 BAU/ml, p=0.008) after three SARS-CoV-2 vaccine doses. Patients with IBD had comparable quantities (median CD4 0.11% vs. 0.11%, p=0.26, CD8 0.031% vs. 0.047%, p=0.33) and quality (polyfunctionality score: 0.403 vs. 0.371, p=0.39; 0.105 vs. 0.101, p=0.87) of spike-specific T cells to healthy controls. Patients with arthritis had lower frequencies but comparable quality of responding T cells to controls. Breakthrough infection increased spike-specific CD8 T cell quality and T cell responses against non-spike peptides. Patients with IBD on TNFi have T cell responses comparable to healthy controls despite attenuated humoral responses following three vaccine doses. Repeated vaccination and breakthrough infection increased the quality of T cell responses. Our study adds evidence that, in the absence of other risk factors, this group may in future be able to follow the general recommendations for COVID-19 vaccines. South-Eastern Norway Regional Health Authority, Coalition for Epidemic Preparedness Innovations (CEPI), Norwegian Institute of Public Health, Akershus University Hospital, Diakonhjemmet Hospital.

Expectations in patients undergoing spine surgery are high and unmet

BACKGROUND CONTEXTDefining success in spine surgery lacks a standardized approach, and all existing concepts are based on registrations after surgery. PURPOSETo examine patients’ expectations before spine surgery assessed by a modified Oswestry Disability Index (ODI) and Numeric Rating Scale (NRS). The authors asked: how do the expectations align with actual outcomes and can a patient's individual expectations be used as a success criterion in itself? STUDY DESIGN /SETTINGProspective single-center study. PATIENT SAMPLEPatients scheduled for spine surgery at Akershus University Hospital (AHUS) were included in the study. They underwent 1 of 3 procedures: decompression for spinal stenosis, disc removal for lumbar disc herniation, or spinal fusion for degenerative disc disease. OUTCOME MEASURESModified and standard version of ODI and NRS (back and leg pain). METHODSPreoperatively, the patients were given a modified ODI and NRS questionnaire in which they were asked to register the minimum acceptable functional impairment and pain they anticipated to have postsurgery. The patients’ expectations were compared with 3-and 12-month follow-up data from the Norwegian Registry for Spine Surgery (NORspine) with ODI, NRS and Global Perceived Effect (GPE) scale. We used simple descriptive statistics. RESULTSA total of 93 patients completed the pre-op questionnaire. Of these, 65 responded to the 3-month follow-up and 53 at 12-month follow-up. The mean (95%CI) ODI before surgery was 38.3 (34.2–42.3), the mean (95% CI) preoperative NRS back pain was 6.34 (5.81–6.88), and leg pain was 6.67 (6.08–7.26). The patients expected a mean (95% CI) ODI of 10.5 (7.5–13.5), mean (95%CI) NRS back pain of 2.5 (2.1–3.0), and NRS leg pain of 1.8 (1.5–2.2). The actual clinical outcome after 12 months were a mean (95% CI) ODI of 21.7 (17.0–26.5), NRS back pain of 3.4 (2.8–4.1), and leg pain of 2.8 (2.0–3.5). Only 12 (30.8%) patients achieved their expected ODI, while 26 (65.0%) classified themselves as significantly better according to GPE. CONCLUSIONSPatients seem to have high expectations before spine surgery, and the expectations may exceed the clinical outcome. Only 30.8% had their ODI expectations met, but perceived benefit was higher. High expectations may be due to inadequate preoperative information and/or the unsuitability of ODI for capturing expectations.

Pelvic floor symptoms according to the severity of second-degree perineal tears within 12 months post-partum: Alongitudinal prospective cohort study.

Second-degree perineal tears following vaginal birth are common and presumed to be of little clinical importance. However, the extent of damage to the perineal body varies widely, and there is reason to believe that larger second-degree tears may be associated with more pelvic floor symptoms, compared to lesser form. Therefore, the aim of this study was to assess differences in pelvic floor symptoms according to the severity of second-degree perineal tears up to 12 months post-partum, stratified by parity. This was a prospective cohort study conducted at Akershus University Hospital, a tertiary referral hospital in Norway. The study sample consisted of 409 primiparas and 394 multiparas with vaginal births. Perineal tears were classified using the classification system recommended by the Royal College of Obstetricians and Gynecologists. Further, second-degree tears were subclassified as 2A, 2B, or 2C, depending on the percentage of damage to the perineal body. Episiotomies were analyzed as a separate group. Pelvic floor symptoms were assessed using the Karolinska Symptoms After Perineal Tear Inventory (KAPTAIN). A linear mixed model was estimated to assess the trend in pelvic floor symptom scores according to perineal tear category and stratified by parity. The primary and secondary outcome measures were the mean sum scores of the KAPTAIN-Inventory, measured in pregnancy (at 18 weeks of gestation), at 3-and 12 months post-partum, and the reported impact of genital discomfort on quality of life measured in pregnancy and at 12 months post-partum. There were no significant differences in pelvic floor symptom scores over time, or at any timepoint, between no tear, first-degree tear, or second-degree tear subcategories, for primi-, and multiparas. Pelvic floor symptoms increased from pregnancy to 3 months post-partum and remained higher at 12 months post-partum compared to pregnancy in all perineal tear categories. Compared to primiparas, multiparas reported a significantly higher impact of genital discomfort on quality of life in pregnancy and at 12 months post-partum. There were no statistically significant differences in pelvic floor symptoms according to the severity of second-degree perineal tears.

Brief Intervention as a Method to Reduce Z-Hypnotic Use by Older Adults: Feasibility Case Series.

Z-hypnotics or z-drugs are commonly prescribed for insomnia and sleep difficulties in older adults. These drugs are associated with adverse events and dependence and are not recommended for long-term use. Despite evidence of older adults being more sensitive to a wide array of adverse events and clinical guidelines advocating limiting use, inappropriate use in this population is still prevalent. Previous intervention studies have focused mainly on prescriber information. Simple, individually focused intervention designs are less studied. Brief intervention (BI) is a simple, easily transferable method mainly used to treat patients at risk of alcohol overuse. Our objective was to design and test the feasibility and acceptability of a BI intervention adapted to address individual, inappropriate use of z-hypnotics among older adults. This preparatory study aimed to optimize the intervention in advance of a quantitative randomized controlled trial investigating the treatment effect in a larger population. This feasibility case series was conducted at Akershus University Hospital, Norway, in autumn 2021. We included 5 adults aged ≥65 years with long-term (≥4 weeks) use of z-hypnotics and 2 intervening physicians. Additionally, 2 study investigators contributed with process evaluation notes. The BI consists of information on the risk of inappropriate use and individualized advice on how to reduce use. The focus of the intervention is behavioral and aims, in cooperation with the patient and based on shared decision-making, to change patient behavior regarding sleep medication rather than physician-based detoxification and termination of z-hypnotic prescriptions. Qualitative and descriptive quantitative data were collected from intervening physicians, study investigators, and participants at baseline, immediately after the intervention, and at the 6-week follow-up. Data were obtained from 2 physicians, 2 study investigators, and 5 participants (4 women) with a median age of 84 years. The average time spent on the BI consultation was 15 minutes. All 5 participants completed the intervention without problems. The participants and 2 intervening physicians reported the intervention as acceptable and were satisfied with the delivery of the intervention. After the intervention, 2 participants stopped their use of z-hypnotics completely and participated in the follow-up interview. Study investigators identified logistical challenges regarding location and time requirements. Identified aspects that may improve the intervention and reduce dropouts included revising the intervention content, focusing on rebound insomnia, adding an information leaflet, and supporting the patient in the period between the intervention and follow-up. The notion that the intervention should best be located and conducted by the patient's own general practitioner was supported by the participants. We identified important aspects to improve the designed intervention and found that the BI is feasible and acceptable for incorporation into a larger randomized trial investigating the treatment effect of BI for reducing z-hypnotic use by older adults. ClinicalTrials.gov NCT03162081; http://tinyurl.com/rmzx6brn.

Mortality and health-related quality of life in older adults with long-term use of opioids, z-hypnotics or benzodiazepines: a prospective observational study at 5 years follow-up

ObjectivesDisease and medication use in older age is a consequence of age-related declining health. Multimorbidity followed by polypharmacy is common. Central nervous system depressing (CNSD) drugs such as opioids, benzodiazepines...

Global, regional, and national burden of HIV and other sexually transmitted infections in older adults aged 60–89 years from 1990 to 2019: results from the Global Burden of Disease Study 2019

Sexually active older adults are often more susceptible to HIV and other sexually transmitted infections (STIs) due to various health conditions (especially a weakened immune system) and low use of condoms. We aimed to assess the global, regional, and national burdens and trends of HIV and other STIs in older adults from 1990 to 2019. We retrieved data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 on the incidence and disability-adjusted life-years (DALYs) of HIV and other STIs (syphilis, chlamydia, gonorrhoea, trichomoniasis, and genital herpes) for older adults aged 60-89 years in 204 countries and territories from 1990 to 2019. Estimated annual percentage changes in the age-standardised incidence and DALY rates of HIV and other STIs, by age, sex, and Socio-demographic Index (SDI), were calculated to quantify the temporal trends. Spearman correlation analysis was used to examine the relationship between age-standardised rates and SDI. In 2019, among older adults globally, there were an estimated 77 327 (95% uncertainty interval 59 443 to 97 648) new cases of HIV (age-standardised incidence rate 7·6 [5·9 to 9·6] per 100 000 population) and 26 414 267 (19 777 666 to 34 860 678) new cases of other STIs (2607·1 [1952·1 to 3440·8] per 100 000). The age-standardised incidence rate decreased by an average of 2·02% per year (95% CI -2·38 to -1·66) for HIV and remained stable for other STIs (-0·02% [-0·06 to 0·01]) from 1990 to 2019. The number of DALYs globally in 2019 was 1 905 099 (95% UI 1 670 056 to 2 242 807) for HIV and 132 033 (95% UI 83 512 to 225 630) for the other STIs. The age-standardised DALY rate remained stable from 1990 to 2019, with an average change of 0·97% (95% CI -0·54 to 2·50) per year globally for HIV but decreased by an annual average of 1·55% (95% CI -1·66 to -1·43) for other STIs. Despite the global decrease in the age-standardised incidence rate of HIV in older people from 1990 to 2019, many regions showed increases, with the largest increases seen in eastern Europe (average annual change 17·84% [14·16 to 21·63], central Asia (14·26% [11·35 to 17·25]), and high-income Asia Pacific (7·52% [6·54 to 8·51]). Regionally, the age-standardised incidence and DALY rates of HIV and other STIs decreased with increases in the SDI. Although the incidence and DALY rates of HIV and STIs either declined or remained stable from 1990 to 2019, there were regional and demographic disparities. Health-care providers should be aware of the effects of ageing societies and other societal factors on the risk of HIV and other STIs in older adults, and develop age-appropriate interventions. The disparities in the allocation of health-care resources for older adults among regions of different SDIs should be addressed. Natural Science Foundation of China, Fujian Province's Third Batch of Flexible Introduction of High-Level Medical Talent Teams, Science and Technology Innovation Team (Tianshan Innovation Team) Project of Xinjiang Uighur Autonomous Region, Cure Alzheimer's Fund, Helse Sør-Øst, the Research Council of Norway, Molecule/VitaDAO, NordForsk Foundation, Akershus University Hospital, the Civitan Norges Forskningsfond for Alzheimers Sykdom, the Czech Republic-Norway KAPPA programme, and the Rosa Sløyfe/Norwegian Cancer Society & Norwegian Breast Cancer Society.

Integrated Health Care for frail elderly people with complex needs.

Background: Demographic changes will lead to an increase in older, frail and complex patients. This place a high demand on health care systems and requires the care system to work more preventively, user-driven and coherent. For the most efficient use of resources, it becomes important to identify patients with the greatest potential to benefit. Digital aids may help to identify such patients.&#x0D; Design, implementation and monitoring of the initiative: In this pilot project the patient group is frail elderly people with complex long-term needs who face multiple care providers. These patients are especially vulnerable to care fragmentation. This group also dominates the 5-10% top spenders who account for 2/3 of high-level health care spending both in Norway and internationally.&#x0D; Intervention: Akershus University Hospital (Ahus), a 1098 beds hospital has with 6 associated municipalities developed a model for closer interdisciplinary collaboration around the frail elderly with complex needs and high consumption of health care services. This model is called Integrated Health Care (IHT).&#x0D; We designed a computer application that uses deidentified health care data to identify risk patients based on age (&gt;65) and number of emergency admissions the last six months (&gt;3) spread over two or more different specialist departments. When a patient is included in IHT a multidisciplinary team (IHT-team) across primary and secondary care visit the patient at home. The IHT-team consists of a nurse and geriatrician from the hospital and a nurse and general practitioner from the municipality. In the conversation during the home visit, emphasis is placed on what is important to the patient. The team map risk areas and need for assistance. An individual treatment plan is created based on this conversation. The patient gets a contact person in the hospital and one in the municipality. If the patient is admitted to hospital, the IHT-team will receive an automatic notification and thus follow the patient during the hospital stay. Every 6 months there will be a follow-up conversation and opportunity to adjust the treatment plan. &#x0D; Results: The first patient was included in 2020 and so far 63 patients have been included (40 of these have been followed for longer than 12 months) and the feedback is good. The patients and relatives highlight the importance of a patient-centered approach. They feel that the IHT-project provides increased security and predictability. We have seen a dramatic decrease in acute hospital admission for those patients included in the program; from on average 3 acute admissions the 6 months prior to inclusion, and 1,25 acute admission the 6 months following inclusion in IHT. There has also been a decrease in use of short-term stays in the municipalities.&#x0D; Conlusion: Our IHT method is effective in identifying patients at risk of frequent hospital admissions. Offering targeted and multidisciplinary services to frail patients seems to be effective in reducing acute admissions and use of health care services in the muncipalities.&#x0D; Next steps: We are now about to expand our project to more municipalities, and aim to calculate health care costs.&#x0D; &#x0D; &#x0D; &#x0D;

Measuring pain intensity in older adults. Can the visual analogue scale and the numeric rating scale be used interchangeably?

ObjectivesVisual analogue scale (VAS) and numeric rating scale (NRS) are two commonly used instruments for measuring pain intensity. Both instruments are validated for use in both clinical and research settings, and share a range of similar aspects. Some studies have shown that the two instruments may be used interchangeably, but the results are conflicting. In this study we assessed whether the VAS and the NRS instruments may be used interchangeably when measuring pain intensity in older adults. MethodsData were collected in a cross-sectional study, as part of the follow-up in a larger longitudinal study conducted at the Akershus University Hospital, Norway 2021 to 2022 and included 39 older adults aged ≥65. Participants were regarded as a normal older adult population as they were not recruited on basis of a specific condition or reports of pain. The participants were asked to rate their pain intensity on an average day using VAS and NRS. Bland-Altman analysis was performed to assess agreement between the two instruments. ResultsThirty-seven participants with mean (SD) age of 77 (5.9) were included in the analysis. Mean (SD) pain assessed by VAS and NRS was 2.8 (1.8) and NRS 4.7 (2.2), respectively. A mean difference (SD) of 2.0 (1.9) between the scores of the two instruments was statistically significantly different from zero (p < 0.001) confirming bias. The 95% limits of agreement were estimated to be −1.7 to 5.7. A post-hoc analysis, removing an outlier, resulted in similar conclusions. ConclusionThere was poor agreement between the VAS and NRS scale for measuring pain intensity in older adults. This suggests that the two instruments should not be used interchangeably when assessing pain intensity in this population. Ethical approvalRegional Committees for Medical and Health Research Ethics [2016/2289].Trial registration.NCT03162081, 22 May 2017.

Use and safety of peripherally inserted central catheters and midline catheters in palliative care cancer patients: a retrospective review

PurposeSome cancer patients in palliative care require intravenous administration of symptom relieving drugs. Peripherally inserted central catheters (PICCs) and midline catheters (MCs) provide easy and accessible intravenous access. However, limited evidence supports the use of these devices in palliative care. The aim was to assess the use, safety, and efficacy of PICC and MC in this patient population.MethodsA retrospective study of all palliative care cancer patients who received PICC or MC at the Department of Palliative Medicine at Akershus University Hospital between 2020 and 2022.ResultsA total of 374 patients were included; 239 patients received a PICC and 135 an MC with a total catheterization duration of 11,698 days. The catheters remained in place until death in 91% of patients, with a median catheter dwell time of 21 days for PICCs and 2 days for MCs. The complication rate was 3.3 per 1000 catheter days, with minor bleeding and accidental dislocation as the most common. The catheters were utilized primarily for opioids and other symptom directed treatments, and 89% of patients received a patient or nurse-controlled analgesia pump. Patients with PICC or MC discharged to home or nursing homes spent 81% of their time out of hospital.ConclusionPICC and MC provide safe parenteral access for palliative care cancer patients where intravenous symptom treatment is indicated. Their use can facilitate intravenous symptom treatment beyond the confines of a hospital and supplement the traditional practice relying on subcutaneous administration.

Cause of death certificates in nursing homes: Does quality matter? A retrospective review from two counties in Norway.

One half of Norwegians die in nursing homes, where death certificates (DCs) are completed by two types of physicians: in-house physicians or physicians on call. The aims of this study were to examine differences in the quality of DCs due to type of physician and to uncover possible implications of errors for the public statistics. DCs from the year 2013 from nursing homes in the catchment area of Akershus University Hospital were examined with regard to logical deficiencies, garbage code diagnoses and type of certifying physician. In one third of cases, the registered causes of death were compared to information in the medical records. A total of 873 DCs from 24 nursing homes were evaluated. Physicians on call certified 46% of all deaths. Logical deficiencies were found in 34% of all DCs and were more common in DCs from physicians on call. Garbage code diagnoses were used in every third DC, with 'sudden death' or 'cause of death unknown' preferred by physicians on call and 'unspecified pneumonia' preferred by in-house physicians. Comparisons against medical records uncovered missing information in 49% and 35% of DCs from physicians on call and in-house physicians, respectively. A dementia diagnosis was frequently overlooked by both physician types. Garbage code diagnoses were more common in DCs with missing information from medical records. Error rates in DCs in nursing homes in Norway are high. The results raise concerns about the validity of public cause of death statistics.

Increased incidence and reduced mortality after first attack of acute pancreatitis over an 18-year period

Aims To determine time trends in the incidence and etiology of acute pancreatitis and identify predictors for in-hospital mortality. Patients and methods Retrospective study of 1722 patients with acute pancreatitis admitted to Akershus University Hospital between January 2000 and December 2017. Data were obtained from electronic patient files and computed tomography scans. We estimated a logistic regression model to assess differences in associations between patient characteristics and in-hospital mortality in two time periods, 2000–2009 (first period) and 2010–2018 (second period). Results First attack of acute pancreatitis (FAAP) was identified in 1579 patients (91.7%). The incidence of FAAP increased from 20.1/100,000 during the first period to 27.7/100,000 in the second period (p = .011). Etiology showed no differences between the two time periods. Gallstone was the most frequent etiology (47.2%). In total, 187 patients (11.8%) had necrotizing pancreatitis; more in the second period compared to the first (14.2 vs. 7.7%; p < .001). The overall mortality rate was 3.9%. Mortality rates decreased for both inflammatory and necrotizing pancreatitis during the study period. Age and comorbidity according to Charlson Comorbidity Index (CCI) were predictors of in-hospital mortality (OR 1.07, 95% CI 0.07; 0.40 and 13.58, 95% CI 3.88; 47.52), as were alcohol and organ failure (OR 7.20, 95% CI 2.02; 25.67 and OR 34.15, 95% CI 8.94; 130.53, respectively). Conclusions The incidence of FAAP is increasing in southeast Norway. The etiology has remained unchanged over an 18-year period, with gallstones being the most frequent cause. The outcomes for both inflammatory and necrotic pancreatitis are improving.

Cardiac troponin T, NT-proBNP and GDF-15 associate with future focal myocardial scar types, but not diffuse fibrosis assessed by cardiac magnetic resonance

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Akershus University Hospital Trust, Vestre Viken Hospital Trust, South-Eastern Norway Regional Health Authority, Roche Diagnostics provided reagents for hs-cTnT analyses Background In cardiovascular risk prediction, there is growing evidence that imaging and circulating cardiac biomarkers provide incremental prognostic value compared to single biomarkers or traditional risk factors. In patients with suspected or established cardiovascular disease (CVD), cardiac troponin T (cTnT) and N-terminal pro B-type natriuretic peptide (NT-proBNP) associate with focal and diffuse fibrosis assessed by cardiac magnetic resonance (CMR) imaging. There is limited data on the associations between established and emerging circulating cardiac biomarkers with subsequent myocardial fibrosis in subjects without CVD recruited from the general population. Purpose Assess the associations between biomarkers of cardiac injury (cTnT), stress (NT-proBNP) and fibrosis and inflammation (growth differentiation factor-15, GDF-15), and subsequent focal and diffuse myocardial fibrosis assessed by CMR imaging. Methods We recruited 200 study participants born in 1950 from the general population. All participants were without known coronary artery disease or renal dysfunction. cTnT, NT-proBNP, and GDF-15 were measured in samples collected at baseline in 2012–2015, and CMR was performed 4–7 years later. Presence and type (ischemic/non-ischemic) of focal myocardial fibrosis were assessed by late gadolinium enhancement (LGE) imaging. Diffuse fibrosis was assessed by the extracellular volume (ECV) in the midventricular septum. Logistic regression analysis was used to examine relationships between log transformed concentrations of cardiac biomarkers and CMR parameters. Results The median age was 63.9 (63.4–64.5) and 52% were male (Table 1). cTnT was associated with presence of any LGE scar adjusted for common cardiovascular risk factors (OR 1.85, 95% CI 1.25–2.72), but this association was attenuated when left ventricular mass was added to the model (Table 2). NT-proBNP (OR 1.66, 95% CI 1.10–2.72) and GDF-15 (OR 4.45, 95% CI 1.29–15.27) were associated with presence of any LGE scar in the fully adjusted models (Table 2). cTnT (OR 1.90, 95% CI 1.06–3.39) and NT-proBNP (OR 2.72, 95% CI 1.29–5.76) were associated with ischemic scars. Only GDF-15 (OR 4.52, 95% CI 1.09–18.72) associated with non-ischemic scars in adjusted models. None of the biomarkers were significantly associated with ECV. Conclusion(s) In a general population cohort, biomarkers of myocardial injury and stress associate with ischemic type scars, but not diffuse fibrosis. GDF-15, an emerging circulating biomarker of fibrosis and inflammation, associates with non-ischemic type scars.

Cardiac troponin T predicts future lower left ventricular systolic function and synchrony assessed by cardiac magnetic resonance

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Akershus University Hospital Trust and Vestre Viken Hospital Trust. Roche Diagnostics provided reagents for high sensitivity cardiac troponin T analyses free of charge. Background In the general population, higher concentrations of cardiac troponin T (cTnT) are associated with risk of cardiovascular (CV) disease even within the normal range. Cardiac magnetic resonance (CMR) offers state-of-the-art assessment of the left ventricle with recently developed techniques allowing assessment of myocardial strain and synchrony. There is little prospective observational data describing the association between cTnT and future left ventricular (LV) function assessed by CMR. Purpose To investigate whether cTnT is predictive of future lower LV systolic function and synchrony in the general population. Methods The cohort included 186 participants from the general population who underwent cTnT measurements at baseline followed by CMR feature-tracking 4–7 years later. All participants were born in year 1950, had no overt coronary artery disease and normal kidney function at inclusion. Outcomes were LV global longitudinal, circumferential and radial strain (GLS, GCS and GRS), as well as mechanical dispersion (MD). MD was calculated as the standard deviation of time to peak longitudinal strain of 16 left ventricular segments adjusted for heart rate. Associations between cTnT concentrations and outcomes were evaluated using linear regression with cTnT modeled as (1) a continuous variable and (2) dichotomized at the level of detection (≥ 3.0 ng/L). Models adjusted for a priori selected confounders influencing CV risk and cTnT concentrations were obtained (model 1: sex, age and estimated glomerular filtration rate; model 2: additionally, hypertension, body mass index, diabetes mellitus and daily smoking). An extended adjustment model included metrics affecting LV loading conditions (model 3: systolic blood pressure, heart rate and end diastolic volume indexed by body surface area at the time of CMR), as well as QRS duration for MD. Results Participants with detectable cTnT had significantly lower absolute GLS, GCS and GRS and higher MD than those with undetectable cTnT (Table 1). The detectable cTnT group had a greater proportion of males, a higher prevalence of hypertension, lower kidney function and was slightly younger at inclusion. Higher cTnT concentrations were independently associated with lower absolute GLS, GCS and GRS and higher MD in both risk factor adjusted models (table 2). For detectable cTnT, similar associations were found in model 1 but the association between detectable cTnT and MD was attenuated in model 2. In the fully adjusted model 3 both detectable and continuous cTnT concentrations remained associated with lower absolute GLS, whereas only detectable cTnT was associated with lower absolute GCS and GRS. Conclusion Higher cTnT, largely within the normal range, is predictive of future lower LV systolic function and synchrony assessed by CMR in a general middle-aged population.

O.27.3 - Formulations used by doctors to provide information to patients: A video-based study: Presenter(s): Julia Menichetti, Akershus University Hospital, Norway

O.27.3 - Formulations used by doctors to provide information to patients: A video-based study: Presenter(s): Julia Menichetti, Akershus University Hospital, Norway

Four SARS-CoV-2 vaccine doses or hybrid immunity in patients on immunosuppressive therapies: a Norwegian cohort study.

Data on response and safety of repeated vaccinations and hybrid immunity in patients with immune-mediated inflammatory diseases on immunosuppressive therapy is needed to further develop vaccination strategies in this vulnerable population. This study aimed to evaluate hybrid immunity and humoral immune response and safety of four SARS-CoV-2 vaccine doses in patients with immune-mediated inflammatory diseases on immunosuppressive therapy. This prospective observational Norwegian study of vaccine response to COVID-19 (Nor-vaC) included adult patients aged 18 years and older with immune-mediated inflammatory diseases (rheumatoid arthritis, spondyloarthritis, psoriatic arthritis, Crohn's disease, or ulcerative colitis) on immunosuppressive therapy, who had received four SARS-CoV-2 vaccine doses (vaccine group) or three vaccine doses followed by COVID-19 (hybrid group), and healthy controls receiving three vaccine doses (control group). Patients were recruited from the Division of Rheumatology at Diakonhjemmet Hospital, Oslo, and the Department of Gastroenterology at Akershus University Hospital, Lørenskog. Patients who had COVID-19 before the third vaccine dose, and patients with allergies or intolerances to elements of the vaccine were excluded. Antibodies to the receptor-binding domain of SARS-CoV-2 spike protein (anti-RBD antibodies) were assessed 2-4 weeks following vaccination or COVID-19. This study is registered at Clinialtrials.gov, NCT04798625. Between Nov 12, 2021, and April 19, 2022, 1458 participants with immune-mediated inflammatory diseases provided post-vaccination samples at 2-4 weeks following a third vaccine dose. After 544 participants were excluded, 715 (78%) of the remaining 914 participants received the fourth dose of the vaccine, and of these, 536 (75%) provided post-vaccination samples 2-4 weeks after their fourth vaccination (vaccine group). 199 (22%) of the 914 had COVID-19 after their third dose of the vaccine and of these, 167 (84%) provided samples (hybrid group). 256 of the eligible 703 patients had rheumatoid arthritis, 107 had spondyloarthritis, 115 had psoriatic arthritis, 130 had Crohn's disease, and 95 had ulcerative colitis). Median age was 56 years [IQR 45-65], 398 (57%) were women, and 305 (43%) were men. Patients in the vaccine group had higher anti-RBD antibody concentrations following the fourth vaccine dose (median 6192 BAU/ml [IQR 2878-11 243]) than after the third dose (median 5087 BAU/ml [1250-9081]; p< 0·0001), but lower antibody concentrations than the control group following the third dose (median 7595 BAU/ml [5916-12 001]; p< 0·0001). Antibody concentrations were higher in the patients in the hybrid group (23 548 BAU/ml [IQR 11 440-35 935]) than in the vaccine group (p<0·0001). No difference was found in antibody concentrations between the fourth dose of BNT162b2 (full-dose) and mRNA-1273 (half-dose). Patients and controls had a comparable safety profile after both three and four vaccine doses. Vaccine boosters improve humoral immune responses and are safe in patients with immune-mediated inflammatory diseases on immunosuppressive therapy, and administration should be considered regularly in this patient group. Hybrid immunity with omicron induces a strong humoral response suggesting longer intervals between booster doses in this patient group. The South-Eastern Norway Regional Health Authority, The Coalition for Epidemic Preparedness Innovations, Akershus University Hospital.

Diagnostic yield, complications, pathology and anatomical features in CT-guided percutaneous needle biopsy of mediastinal tumours.

This study presents the experiences of percutaneous CT-guided needle biopsy at a university hospital in Norway. A retrospective examination of all mediastinal biopsy procedures between April 2015 and August 2019 was performed at Akershus University Hospital in Norway. We registered patient and procedure characteristics, along with lesion pathology and characteristics including localization according to anatomical and Felson mediastinal compartments. The study included 48 procedures, conducted in 45 patients (29 men and 16 women) with a mean age of 60,5 years. Pneumothorax occurred in 12 procedures (60% of the transpulmonary procedures) and pneumomediastinum in 18 procedures (38%). Pneumothorax was only seen in procedures with transpulmonal access. Four of the pneumothorax cases required pleural drainage. Diagnostic yield was 96%. We found significant (p = 0,006), moderate to high association between anatomical compartment localization and histopathological diagnosis (Cramér's V = 0,49) for tumours selected for CT-guided percutaneous biopsy. Felson's compartment division on the other hand, did not show any significant associations. We found CT-guided percutaneous needle biopsy of mediastinal tumours to be an effective and safe procedure with a diagnostic yield of 96%. The main complications were pneumothorax and pnumomediastinum, with a relatively low chest drainage rate. Anatomical mediastinum compartment showed a significant, moderate to high association with the histopathological diagnosis for tumours selected for percutaneous CT-guided biopsies, where most malignancies were seen in the anterior compartment.

Lessons learned: use of WGS in real-time investigation of suspected intrahospital SARS-CoV-2 outbreaks

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has been a continuing source of hospital-acquired infection and outbreaks. At Akershus University Hospital in Norway, traditional contact tracing has been combined with whole-genome sequencing (WGS) surveillance in real-time to investigate potential hospital outbreaks. To describe the advantages and challenges encountered when using WGS as a real-time tool in hospital outbreak investigation and surveillance during the SARS-CoV-2 pandemic. Routine contact tracing in the hospital was performed for all healthcare workers (HCWs) who tested positive for SARS-CoV-2. Viral RNA from all positive patient and HCW samples was sequenced in real-time using nanopore sequencing and the ARTIC Network protocol. Suspected outbreaks involving five or more individuals with viral sequences were described. Nine outbreaks were suspected based on contact tracing, and one outbreak was suspected based on WGS results. Five outbreaks were confirmed; of these, two outbreaks were supported but could not be confirmed by WGS with high confidence, one outbreak was found to consist of two different lineages, and two outbreaks were refuted. WGS is a valuable tool in hospital outbreak investigations when combined with traditional contact tracing. Inclusion of WGS data improved outbreak demarcation, identified unknown transmission chains, and highlighted weaknesses in existing infection control measures.