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Holten KIA, Bernklev T, Opheim R, Johansen I, Olsen BC, Lund C, Strande V, Medhus AW, Perminow G, Bengtson MB, Cetinkaya RB, Vatn S, Frigstad SO, Aabrekk TB, Detlie TE, Hovde Ø, Kristensen VA, Småstuen MC, Henriksen M, Huppertz-Hauss G, Høivik ML, Jelsness-Jørgensen LP. Fatigue in Patients with Newly Diagnosed Inflammatory Bowel Disease: Results from a Prospective Inception Cohort, the IBSEN III Study. J Crohns Colitis 2023; 17:1781-1790. [PMID: 37279652 PMCID: PMC10673818 DOI: 10.1093/ecco-jcc/jjad094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/11/2023] [Accepted: 06/02/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND AIMS Although fatigue is common in inflammatory bowel disease [IBD], its pathogenesis remains unclear. This study aimed to determine the prevalence of fatigue and its associated factors in a cohort of patients newly diagnosed with IBD. METHODS Patients ≥18 years old were recruited from the Inflammatory Bowel Disease South-Eastern Norway [IBSEN III] study, a population-based, observational inception cohort. Fatigue was assessed using the Fatigue Questionnaire and compared with data from a Norwegian general population. Univariate and multivariate linear and logistic regression analyses were performed to evaluate the associations of total fatigue [TF; continuous score] and substantial fatigue [SF; dichotomized score ≥4] with sociodemographic, clinical, endoscopic, laboratory, and other relevant patient data. RESULTS In total, 983/1509 [65.1%] patients with complete fatigue data were included (ulcerative colitis [UC], 68.2%; Crohn's disease [CD], 31.8%). The prevalence of SF was higher in CD [69.6%] compared with UC [60.2%] [p < 0.01], and in both diagnoses when compared to the general population [p < 0.001]. In multivariate analyses, depressive symptoms, pain intensity, and sleep disturbances were associated with increased TF for both diagnoses. In addition, increased clinical disease activity and Mayo endoscopic score were significantly associated with TF in UC, whereas all disease-related variables were insignificant in CD. Similar findings were observed for SF, except regarding the Mayo endoscopic score. CONCLUSIONS SF affects approximately two-thirds of patients newly diagnosed with IBD. Fatigue was associated with depressive symptoms, sleep disturbances, and increased pain intensity in both diagnoses, while clinical and endoscopic activity were associated factors only in UC.
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Affiliation(s)
- Kristina I Aass Holten
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Østfold Hospital Trust, Sarpsborg, Norway
| | - Tomm Bernklev
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Research and Development Department, Vestfold Hospital Trust, Tønsberg, Norway
| | - Randi Opheim
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ingunn Johansen
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Health Sciences, Østfold University College, Halden, Norway
| | - Bjørn C Olsen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Telemark Hospital Trust, Skien, Norway
| | - Charlotte Lund
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
| | - Vibeke Strande
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Unger-Vetlesen Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
- Department of Gastroenterology, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Asle W Medhus
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
| | - Gøri Perminow
- Pediatric Department, Oslo University Hospital, Oslo, Norway
| | | | | | - Simen Vatn
- Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway
| | | | - Tone B Aabrekk
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Medicine, Vestfold Hospital Trust, Tønsberg, Norway
| | - Trond Espen Detlie
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway
| | - Øistein Hovde
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Medicine, Innlandet Hospital Trust, Gjøvik, Norway
| | | | | | - Magne Henriksen
- Department of Gastroenterology, Østfold Hospital Trust, Sarpsborg, Norway
| | | | - Marte Lie Høivik
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
| | - Lars-Petter Jelsness-Jørgensen
- Department of Gastroenterology, Østfold Hospital Trust, Sarpsborg, Norway
- Department of Health Sciences, Østfold University College, Halden, Norway
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2
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Olsen BC, Opheim R, Kristensen VA, Høivik ML, Lund C, Aabrekk TB, Johansen I, Holten K, Strande V, Bengtson MB, Ricanek P, Detlie TE, Bernklev T, Jelsness-Jørgensen LP, Huppertz-Hauss G. Health-related quality of life in patients with newly diagnosed inflammatory bowel disease: an observational prospective cohort study (IBSEN III). Qual Life Res 2023; 32:2951-2964. [PMID: 37219727 PMCID: PMC10473983 DOI: 10.1007/s11136-023-03435-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2023] [Indexed: 05/24/2023]
Abstract
PURPOSE This unselected, population-based cohort study aimed to determine the level of health-related quality of life (HRQoL) in patients with Crohn's disease (CD) and ulcerative colitis (UC) at the time of diagnosis compared with a reference population and identify the demographic factors, psychosocial measures, and disease activity markers associated with HRQoL. METHODS Adult patients newly diagnosed with CD or UC were prospectively enrolled. HRQoL was measured using the Short Form 36 (SF-36) and Norwegian Inflammatory Bowel Disease Questionnaires. Clinical significance was assessed using Cohen's d effect size and further compared with a Norwegian reference population. Associations between HRQoL and symptom scores, demographic factors, psychosocial measures, and disease activity markers were analyzed. RESULTS Compared with the Norwegian reference population, patients with CD and UC reported significantly lower scores in all SF-36 dimensions, except for physical functioning. Cohen's d effect sizes for men and women in all SF-36 dimensions were at least moderate, except for bodily pain and emotional role for men with UC and physical functioning for both sexes and diagnoses. In the multivariate regression analysis, depression subscale scores ≥ 8 on the Hospital Anxiety and Depression Scale, substantial fatigue, and high symptom scores were associated with reduced HRQoL. CONCLUSION Patients newly diagnosed with CD and UC reported statistically and clinically significantly lower scores in seven of the eight SF-36 dimensions than the reference population. Symptoms of depression, fatigue, and elevated symptom scores were associated with poorer HRQoL.
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Affiliation(s)
- Bjorn Christian Olsen
- Department of Gastroenterology, Skien Hospital, Telemark Hospital Trust, Ulefossvegen 55, 3710, Skien, Norway.
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Randi Opheim
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
- Department of Nursing Science, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Vendel A Kristensen
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
- Unger-Vetlesen Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Marte Lie Høivik
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
| | - Charlotte Lund
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
| | - Tone Bergene Aabrekk
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Vestfold Hospital Trust, Research and Development, Tønsberg, Norway
| | - Ingunn Johansen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Faculty of Health, Welfare and Organisation, Østfold University College, Halden, Norway
| | - Kristina Holten
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Østfold Hospital Trust, Sarpsborg, Norway
| | - Vibeke Strande
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Unger-Vetlesen Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
| | | | - Petr Ricanek
- Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway
| | - Trond Espen Detlie
- Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway
| | - Tomm Bernklev
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Vestfold Hospital Trust, Research and Development, Tønsberg, Norway
| | - Lars-Petter Jelsness-Jørgensen
- Faculty of Health, Welfare and Organisation, Østfold University College, Halden, Norway
- Department of Gastroenterology, Østfold Hospital Trust, Sarpsborg, Norway
| | - Gert Huppertz-Hauss
- Department of Gastroenterology, Skien Hospital, Telemark Hospital Trust, Ulefossvegen 55, 3710, Skien, Norway
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Follin-Arbelet B, Cvancarova Småstuen M, Hovde Ø, Jelsness-Jørgensen LP, Moum B. Risk of Cancer in Patients With Crohn's Disease 30 Years After Diagnosis (the IBSEN Study). Crohns Colitis 360 2023; 5:otad057. [PMID: 37886706 PMCID: PMC10599393 DOI: 10.1093/crocol/otad057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Indexed: 10/28/2023] Open
Abstract
Background Patients with Crohn's disease (CD) are most often diagnosed as young adults; therefore, long-term studies are needed to assess the risk of cancer over their lifetime. Thus, the aims of the present study were to determine the risk of cancer in a Norwegian population-based cohort (the Inflammatory Bowel South Eastern Norway [IBSEN] study), 30 years after diagnosis, and to assess whether patients with CD were at an increased risk of specific cancer types. Methods The IBSEN cohort prospectively included all incident patients diagnosed between 1990 and 1993. Data on cancer incidence were obtained from the Cancer Registry of Norway. Overall and cancer-specific hazard ratios (HRs) for CD patients compared with age- and sex-matched controls were modeled using Cox regression. Standardized incidence ratios (SIRs) were estimated compared to the general population. Results In total, the cohort included 237 patients with CD, and 36 of them were diagnosed with cancer. Compared to the general Norwegian population, patients with CD had an increased overall risk of cancer (HR = 1.56, 95% CI: 1.06-2.28), particularly male patients (HR = 1.85, 95% CI: 1.08-3.16). The incidence of lung cancer and nonmelanoma skin cancer was increased; however, the difference was not statistically significant (SIR = 2.29, 95% CI: 0.92-4.27 and SIR = 2.45, 95% CI: 0.67-5.37, respectively). Conclusions After 30 years of follow-up, the risk of all cancers in patients with CD was increased compared to the general population.
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Affiliation(s)
- Benoit Follin-Arbelet
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
- Østfold University College, Halden, Norway
| | - Milada Cvancarova Småstuen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Public Health Oslo Metropolitan University, Oslo, Norway
| | - Øistein Hovde
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Innlandet Hospital Trust, Gjøvik, Norway
| | | | - Bjørn Moum
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Østfold Hospital Trust, Sarpsborg, Norway
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Johansen I, Småstuen MC, Løkkeberg ST, Kristensen VA, Høivik ML, Lund C, Olsen B, Strande V, Huppertz-Hauss G, Aabrekk TB, Bengtson MB, Ricanek P, Detlie TE, Frigstad SO, Jelsness-Jørgensen LP, Opheim R. Symptoms and symptom clusters in patients newly diagnosed with inflammatory bowel disease: results from the IBSEN III Study. BMC Gastroenterol 2023; 23:255. [PMID: 37501083 PMCID: PMC10373240 DOI: 10.1186/s12876-023-02889-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 07/17/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Patients with inflammatory bowel disease report multiple symptoms, but the relationships among co-occurring symptoms are poorly understood. This study aimed to examine the prevalence of symptoms and explore symptom clusters and possible associations between symptom clusters and socio-demographic and clinical variables in patients newly diagnosed with inflammatory bowel disease. METHODS The IBSEN III study is a prospective population-based inception cohort of patients with inflammatory bowel disease. This study used patient data from the three largest hospitals in the study catchment area. The Memorial Symptom Assessment Scale was used to assess the prevalence of symptoms. Symptom clusters were identified using principal component analysis. Possible associations between socio-demographic and clinical variables and symptom cluster membership were estimated using regression analysis. RESULTS Of the 573 patients (age, ≥18 years) diagnosed with inflammatory bowel disease, 350 (61.1%) completed the questionnaire (responders). Eleven symptoms were reported by >50% of the responders. The three most prevalent symptoms were bloating (84%), drowsiness (81%), and lack of energy (81%). Three symptom clusters were identified: psychological (56% of the patients), impaired energy (28%), and physical (16%) clusters. Multinomial regression analysis revealed that vitamin D deficiency was significantly associated with the impaired energy cluster (odds ratio=2.49, 95% confidence interval [1.00-6.2], p=0.05). CONCLUSIONS We found high symptom prevalence in patients newly diagnosed with inflammatory bowel disease. Three distinct symptom clusters were identified, and the psychological cluster includes >50% of the patients. Vitamin D deficiency is the only factor associated with cluster membership, namely the impaired energy cluster.
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Affiliation(s)
- Ingunn Johansen
- Department of Health, Welfare and Organization, Østfold University College, Fredrikstad, Norway
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | | | - Stine Torp Løkkeberg
- Department of Health, Welfare and Organization, Østfold University College, Fredrikstad, Norway
| | | | - Marte Lie Høivik
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Charlotte Lund
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bjørn Olsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Telemark Hospital Trust, Skien, Norway
| | - Vibeke Strande
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Unger-Vetlesen Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
- Department of Gastroenterology, Lovisenberg Diaconal Hospital, Oslo, Norway
| | | | - Tone Bergene Aabrekk
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Vestfold Hospital Trust, Tønsberg, Norway
| | - May-Bente Bengtson
- Department of Gastroenterology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Petr Ricanek
- Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway
| | - Trond Espen Detlie
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway
| | - Svein Oskar Frigstad
- Department of Medicine, Vestre Viken Hospital Trust, Baerum Hospital, Baerum, Norway
| | - Lars-Petter Jelsness-Jørgensen
- Department of Health, Welfare and Organization, Østfold University College, Fredrikstad, Norway
- Department of Gastroenterology, Østfold Hospital Trust, Fredrikstad, Norway
| | - Randi Opheim
- Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
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Follin-Arbelet B, Småstuen MC, Hovde Ø, Jelsness-Jørgensen LP, Moum B. Incidence of cancer in patients with ulcerative colitis 30 years after diagnosis (the IBSEN study). Scand J Gastroenterol 2023; 58:1264-1270. [PMID: 37337889 DOI: 10.1080/00365521.2023.2223709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/22/2023] [Accepted: 06/06/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVES Patients with ulcerative colitis (UC) have shown an increased risk for colorectal cancer, hepatobiliary, hematologic, and skin cancers, but updated long-term data is needed. This study aimed to estimate the risk of cancer in patients with UC compared to the general Norwegian population, in a population-based cohort (the IBSEN study), 30 years after diagnosis; and to identify possible risk factors associated with cancer. METHODS The IBSEN cohort prospectively included all incident patients between 1990 and 1993. Cancer incidence data were obtained from the Cancer Registry of Norway. The overall and cancer-specific hazard ratios (HR) were modelled using Cox regression. Standardized incidence ratios were estimated compared to the general population. RESULTS In total, the cohort included 519 patients, and 83 cases were diagnosed with cancer. There was no statistically significant difference in the overall cancer risk (HR = 1.01, 95% CI: [0.79-1.29]) and colorectal cancer risk (HR = 1.37, 95% CI: [0.75-2.47]) between patients and controls. The incidence of biliary tract cancer was higher than expected (SIR = 9.84, 95%CI: [3.19-20.15]), especially when UC patients suffered from primary sclerosing cholangitis. Male UC patients were also more at risk of being diagnosed with hematologic malignancies (HR = 3.48, 95% CI: [1.55-7.82]). Being prescribed thiopurines was associated with a higher risk of cancer (HR = 2.03, 95% CI: [1.02-4.01]). CONCLUSIONS At 30 years after diagnosis, the risk of all cancer in patients with UC was not significantly increased compared with the general population. However, the risks of biliary tract cancer and hematologic cancers were increased, particularly in male patients.
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Affiliation(s)
- Benoit Follin-Arbelet
- University of Oslo, Institute of Clinical Medicine, Oslo, Norway
- Østfold University College, Halden, Norway
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
| | - Milada Cvancarova Småstuen
- University of Oslo, Institute of Clinical Medicine, Oslo, Norway
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Øistein Hovde
- University of Oslo, Institute of Clinical Medicine, Oslo, Norway
- Innlandet Hospital Trust, Gjøvik, Norway
| | | | - Bjørn Moum
- University of Oslo, Institute of Clinical Medicine, Oslo, Norway
- Østfold Hospital Trust, Kalnes, Norway
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Ohnstad MO, Stensvold HJ, Pripp AH, Tvedt CR, Jelsness-Jørgensen LP, Astrup H, Eriksen BH, Lunnay ML, Mreihil K, Pedersen T, Rettedal SI, Selberg TR, Solberg R, Støen R, Rønnestad AE. Associations between unit workloads and outcomes of first extubation attempts in extremely premature infants below a gestational age of 26 weeks. Front Pediatr 2023; 11:1090701. [PMID: 37009293 PMCID: PMC10064049 DOI: 10.3389/fped.2023.1090701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 02/27/2023] [Indexed: 04/04/2023] Open
Abstract
Objective The objective was to explore whether high workloads in neonatal intensive care units were associated with short-term respiratory outcomes of extremely premature (EP) infants born <26 weeks of gestational age. Methods This was a population-based study using data from the Norwegian Neonatal Network supplemented by data extracted from the medical records of EP infants <26 weeks GA born from 2013 to 2018. To describe the unit workloads, measurements of daily patient volume and unit acuity at each NICU were used. The effect of weekend and summer holiday was also explored. Results We analyzed 316 first planned extubation attempts. There were no associations between unit workloads and the duration of mechanical ventilation until each infant's first extubation or the outcomes of these attempts. Additionally, there were no weekend or summer holiday effects on the outcomes explored. Workloads did not affect the causes of reintubation for infants who failed their first extubation attempt. Conclusion Our finding that there was no association between the organizational factors explored and short-term respiratory outcomes can be interpreted as indicating resilience in Norwegian neonatal intensive care units.
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Affiliation(s)
- Mari Oma Ohnstad
- Department of Master and Postgraduate Education, Lovisenberg Diaconal University College, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Hans Jørgen Stensvold
- Department of Neonatal Intensive Care, Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo, Norway
- Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Christine Raaen Tvedt
- Department of Master and Postgraduate Education, Lovisenberg Diaconal University College, Oslo, Norway
| | - Lars-Petter Jelsness-Jørgensen
- Department of Master and Postgraduate Education, Lovisenberg Diaconal University College, Oslo, Norway
- Department of Health and Welfare, Østfold University College, Halden, Norway
- Department of Internal Medicine, Østfold Hospital Trust, Kalnes, Norway
| | - Henriette Astrup
- Department of Pediatric and Adolescent Medicine, Sorlandet Hospital Trust, Kristiansand, Norway
| | - Beate Horsberg Eriksen
- Department of Pediatrics, Møre and Romsdal Hospital Trust, Ålesund, Norway
- Clinical Research Unit, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mai Linn Lunnay
- Department of Pediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Khalaf Mreihil
- Department of Pediatrics and Adolescence Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Tanja Pedersen
- Neonatal Intensive Care Unit, Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Siren Irene Rettedal
- Department of Pediatrics, Stavanger University Hospital, Stavanger, Norway
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Terje Reidar Selberg
- Department of Pediatrics and Adolescence Medicine, Østfold Hospital Trust, Kalnes, Norway
| | - Rønnaug Solberg
- Department of Pediatrics, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Pediatric Research, Oslo University Hospital, Oslo, Norway
| | - Ragnhild Støen
- Department of Neonatology, St Olavs - Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arild Erland Rønnestad
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Neonatal Intensive Care, Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- Research Group for Clinical Neonatal Medicine and Epidemiology, Department of Neonatal Intensive Care, Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
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Alvestad L, Jelsness-Jørgensen LP, Goll R, Clancy A, Gressnes T, Valle PC, Broderstad AR. Health-related quality of life in inflammatory bowel disease: a comparison of patients receiving nurse-led versus conventional follow-up care. BMC Health Serv Res 2022; 22:1602. [PMID: 36587197 PMCID: PMC9805028 DOI: 10.1186/s12913-022-08985-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 12/19/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Inflammatory bowel disease (IBD), consisting of Crohn's disease (CD) and ulcerative colitis (UC), is a chronic disorder with a considerable negative impact on health-related quality of life (HRQoL). During the past decade, IBD nurse specialists have been increasingly involved in follow-up care of IBD outpatients, in a consultative and coordinating role, closely cooperating with gastroenterologists. Whether patients' HRQoL differs between nurses' follow-up care (NF) and conventional follow-up care (CF) has not been widely researched and the aim of this study was to compare two different follow-up regimes with respect to patients' HRQoL. METHODS This cross-sectional, multicenter study involved seven centers; five organized as CF, two as NF. RESULTS A total of 304 patients aged 18-80 years, 174 females and 130 males, were included, of whom 140 received care under the NF model and 164 under the CF model. Participants in the NF group had a statistically significant higher median total score on the Inflammatory Bowel Disease Questionnaire (IBDQ) (p-value < .001). This pattern could also be seen in the sub-scores of the different IBDQ domains. Despite a trend of higher IBDQ score in all domains in the NF model, the overall result in our study did not reach the limit of 16 points, defined as clinically significant. A higher proportion of NF patients had IBDQ scores defined as remission, as well as a statistically significant higher frequency of outpatient check-ups during a two-year follow-up period. CONCLUSIONS Nurse-led models are not inferior to conventional models with regards to patient reported HRQoL except in the social domain where the model showed to be clinically significant better. Further studies are needed to advance efforts to implement these models and increase access to IBD care.
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Affiliation(s)
- Line Alvestad
- grid.10919.300000000122595234UiT, The Arctic University of Norway, Tromsø, Norway ,grid.412244.50000 0004 4689 5540University Hospital of North Norway, UNN Harstad, Tromsø, Norway
| | - Lars-Petter Jelsness-Jørgensen
- grid.446040.20000 0001 1940 9648Østfold University College, Fredrikstad, Norway ,grid.412938.50000 0004 0627 3923Department of Gastroenterology, Østfold Hospital Trust, Kalnes, Norway
| | - Rasmus Goll
- grid.412244.50000 0004 4689 5540University Hospital of North Norway, UNN Harstad, Tromsø, Norway ,grid.10919.300000000122595234UiT, The Arctic University of Norway, Tromsø, Norway
| | - Anne Clancy
- grid.10919.300000000122595234UiT, The Arctic University of Norway, Tromsø, Norway
| | - Thomas Gressnes
- grid.10919.300000000122595234UiT, The Arctic University of Norway, Tromsø, Norway
| | - Per Christian Valle
- grid.412244.50000 0004 4689 5540University Hospital of North Norway, UNN Harstad, Tromsø, Norway
| | - Ann Ragnhild Broderstad
- grid.412244.50000 0004 4689 5540University Hospital of North Norway, UNN Harstad, Tromsø, Norway ,grid.10919.300000000122595234UiT, The Arctic University of Norway, Tromsø, Norway
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Follin-Arbelet B, Milada SC, Hovde Ø, Jelsness-Jørgensen LP, Moum B. Mortality in patients with Inflammatory Bowel Disease: Results from 30 years of follow-up in a Norwegian inception cohort (the IBSEN study). J Crohns Colitis 2022; 17:497-503. [PMID: 36239614 PMCID: PMC10115228 DOI: 10.1093/ecco-jcc/jjac156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Patients with longstanding inflammatory bowel disease (IBD) may be at an increased risk of death compared to the general population, especially elderly patients. The Inflammatory Bowel South-Eastern Norway (IBSEN) study has previously detected a small but not statistically significant increase in mortality, 20 years after diagnosis. The aim of this study was to evaluate the overall and cause-specific mortality at 30 years of follow-up. METHODS The IBSEN cohort included 519 incident patients with ulcerative colitis (UC) and 237 patients with Crohn's disease (CD) between 1990 and 1993, each matched with five controls. Death certificate data were obtained from the Norwegian Cause of Death Registry. The underlying causes of death were categorised into five groups: all cancers, gastrointestinal cancers, cardiovascular diseases, infections, and all other causes. Hazard ratios (HR) were modelled using Cox regression. RESULTS There was no statistically significant difference in the overall mortality rates. However, in patients with CD, male sex (HR = 1.65 [1.04-2.62]), onset after 40 years of age (HR = 1.72 [95% CI: 1.19-2.48]), colonic disease (HR = 1.57 [1.05-2.35]), and penetrating behavior (HR = 3.3 [1.41-7.76]) were clinical factors associated with an increased mortality. IBD patients were at a higher risk of death due to cardiovascular disease; HR = 1.51 [1.10-2.08] for UC and 2.04 [1.11-3.77] for CD. When taking into account both the underlying and the immediate cause of death, infection was more frequent in patients with IBD. CONCLUSIONS Overall, all-cause mortality rates were similar between patients with IBD and controls. However, clinicians should remain alert to cardiovascular diseases and infections, particularly in specific subgroups of CD patients.
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Affiliation(s)
- Benoit Follin-Arbelet
- Oslo University Hospital, Department of Gastroenterology.,University of Oslo, Institute of Clinical Medicine
| | - Småstuen Cvancarova Milada
- University of Oslo, Institute of Clinical Medicine.,Oslo Metropolitan University, Department of Public Health
| | - Øistein Hovde
- University of Oslo, Institute of Clinical Medicine.,Innlandet Hospital Trust, Gjøvik
| | | | - Bjørn Moum
- Oslo University Hospital, Department of Gastroenterology.,University of Oslo, Institute of Clinical Medicine
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Lerang F, Holst R, Henriksen M, Wåhlberg H, Jelsness-Jørgensen LP. Antitumour necrosis factor alpha treatment in Crohn's disease: long-term efficacy, side effects and need for surgery. Scand J Gastroenterol 2022; 57:921-929. [PMID: 35188443 DOI: 10.1080/00365521.2022.2042592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To examine the long-term efficacy and side effects of antitumour necrosis factor alpha (anti-TNF) therapy in patients with Crohn's disease (CD), the need for surgery and the clinical outcome after discontinuing anti-TNF therapy. MATERIAL AND METHODS Data were collected from the inflammatory bowel disease (IBD)-TNF register at Østfold Hospital Trust. Clinical and sociodemographic data were recorded for patients initiating anti-TNF therapy from January 2000 until December 2011. Follow-up was conducted until December 2017. RESULTS Complete remission (CR) was achieved in 40/154 (26%) patients at the last follow-up (median follow-up time 10 years). A total of 40 (26%) patients had to discontinue treatment due to serious side effects, and malignancy was recorded in 10 (6.5%) patients. Surgical resection was performed in 55 (36%) patients during follow-up. Patients with Montreal phenotype B2 before anti-TNF therapy were estimated to have a 2.54-fold greater risk of surgery than patients with phenotype B1 (p = .001). Of those with phenotype B1 before anti-TNF therapy, 19 (24%) of them developed stenosis in need of surgical resection ('phenotype migration'). In patients followed up after discontinuing anti-TNF therapy (n = 89, median observational time six years), CR was achieved in most patients. CONCLUSIONS Long-term complete remission was achieved in only one in four patients receiving anti-TNF therapy, and one in four patients had to discontinue therapy due to side effects. Despite anti-TNF therapy, one in four patients with a baseline luminal disease phenotype needed subsequent surgical resection.
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Affiliation(s)
- Frode Lerang
- Department of Gastroenterology, Østfold Hospital Trust, Grålum, Norway
| | - René Holst
- Department of Research, Østfold Hospital Trust, Grålum, Norway.,Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Magne Henriksen
- Department of Gastroenterology, Østfold Hospital Trust, Grålum, Norway
| | - Henrik Wåhlberg
- Department of Gastroenterology, Østfold Hospital Trust, Grålum, Norway
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10
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Ohnstad MO, Stensvold HJ, Pripp AH, Tvedt CR, Jelsness-Jørgensen LP, Astrup H, Eriksen BH, Klingenberg C, Mreihil K, Pedersen T, Rettedal S, Selberg TR, Solberg R, Støen R, Rønnestad AE. Predictors of extubation success: a population-based study of neonates below a gestational age of 26 weeks. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2022-001542. [PMID: 36053650 PMCID: PMC9367191 DOI: 10.1136/bmjpo-2022-001542] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/19/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The aim of the study was to investigate first extubation attempts among extremely premature (EP) infants and to explore factors that may increase the quality of clinical judgement of extubation readiness. DESIGN AND METHOD A population-based study was conducted to explore first extubation attempts for EP infants born before a gestational age (GA) of 26 weeks in Norway between 1 January 2013 and 31 December 2018. Eligible infants were identified via the Norwegian Neonatal Network database. The primary outcome was successful extubation, defined as no reintubation within 72 hours after extubation. RESULTS Among 482 eligible infants, 316 first extubation attempts were identified. Overall, 173 (55%) infants were successfully extubated, whereas the first attempt failed in 143 (45%) infants. A total of 261 (83%) infants were extubated from conventional ventilation (CV), and 55 (17%) infants were extubated from high-frequency oscillatory ventilation (HFOV). In extubation from CV, pre-extubation fraction of inspired oxygen (FiO2) ≤0.35, higher Apgar score, higher GA, female sex and higher postnatal age were important predictors of successful extubation. In extubation from HFOV, a pre-extubation FiO2 level ≤0.35 was a relevant predictor of successful extubation. CONCLUSIONS The correct timing of extubation in EP infants is important. In this national cohort, 55% of the first extubation attempts were successful. Our results suggest that additional emphasis on oxygen requirement, sex and general condition at birth may further increase extubation success when clinicians are about to extubate EP infants for the first time.
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Affiliation(s)
- Mari Oma Ohnstad
- Department for Postgraduate Studies, Lovisenberg Diaconal University College, Oslo, Norway .,Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
| | - Hans Jørgen Stensvold
- Department of Neonatal Intensive Care, Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.,Norwegian Neonatal Network, Oslo University Hospital, Oslo, Norway
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo, Norway.,Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Christine Raaen Tvedt
- Department for Postgraduate Studies, Lovisenberg Diaconal University College, Oslo, Norway
| | - Lars-Petter Jelsness-Jørgensen
- Department for Postgraduate Studies, Lovisenberg Diaconal University College, Oslo, Norway.,Department of Health and Welfare, Østfold University College, Halden, Norway.,Department of Internal Medicine, Østfold Hospital Trust, Kalnes, Norway
| | - Henriette Astrup
- Department of Pediatric and Adolescent Medicine, Sorlandet Hospital Trust, Kristiansand, Norway
| | - Beate Horsberg Eriksen
- Department of Paediatrics, Møre og Romsdal Hospital Trust, Alesund, Norway.,Clinical Research Unit, Norwegian University of Science and Technology, Trondheim, Norway
| | - Claus Klingenberg
- Faculty of Health Sciences, University of Tromsø, Tromso, Norway.,Department of Pediatrics, University Hospital of North Norway, Tromso, Norway
| | - Khalaf Mreihil
- Department of Pediatric and Adolescent Medicine, Akershus University Hospital, Lorenskog, Norway
| | - Tanja Pedersen
- Neonatal Intensive Care Unit, Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Siren Rettedal
- Department of Paediatrics, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Terje Reidar Selberg
- Department of Pediatric and Adolescent Medicine, Ostfold County Hospital, Gralum, Norway
| | - Rønnaug Solberg
- Department of Paediatrics, Vestfold Hospital Trust, Tonsberg, Norway.,Department of Paediatric Research, Oslo University Hospital, Oslo, Norway
| | - Ragnhild Støen
- Department of Paediatrics, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway.,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arild E Rønnestad
- Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway.,Department of Neonatal Intensive Care, Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.,Norwegian Neonatal Network, Oslo University Hospital, Oslo, Norway.,Research group for clinical neonatal medicine and epidemiology, Institute of clinical medicine, Oslo, Norway
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11
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Jelsness-Jørgensen LP, Moum B, Grimstad T, Jahnsen J, Hovde Ø, Frigstad SO, Bernklev T. The multidimensional fatigue inventory (MFI-20): psychometrical testing in a Norwegian sample of inflammatory bowel disease (IBD) patients. Scand J Gastroenterol 2022:1-7. [PMID: 35076321 DOI: 10.1080/00365521.2022.2029939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 01/02/2022] [Accepted: 01/11/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To evaluate the psychometric properties of the Norwegian version of the multidimensional fatigue inventory (MFI-20) in patients with inflammatory bowel disease. METHODS Participants were recruited from nine hospitals in the southeastern and western parts of Norway. Clinical and sociodemographic data were collected, and participants completed the MFI-20, as well as the Fatigue Questionnaire (FQ). In addition to a confirmatory factor analysis, validity, reliability, test-retest and responsiveness were evaluated. RESULTS In total, 410 patients were included. The Norwegian MFI-20 had an acceptable model fit when compared to the original five-dimensional structure. A positive correlation was observed between the dimensions of MFI-20 and the FQ. MFI-20 scores increased according to subjective disease activity, but no differences were observed when using a calprotectin cut-off < or > =250 µg/g mg/kg. All MFI-20 dimensions except 'reduced motivation' in both ulcerative colitis (UC) and Crohn's disease (CD) patients had alpha Cronbach alpha values ≥70, and test-retest reliability revealed good to excellent values. Merely one dimension (Reduced activity) in UC patients reporting improvement did not reach the threshold for acceptable responsiveness according to Guyatt statistics. CONCLUSIONS The Norwegian version of MFI-20 is valid, reliable and responsive. The instrument can safely be used in studies using fatigue as an endpoint.
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Affiliation(s)
- Lars-Petter Jelsness-Jørgensen
- Faculty of Health, Welfare and Organisation, Østfold University College, Halden, Norway
- Department of Gastroenterology, Østfold Hospital Trust, Grålum, Norway
| | - Bjørn Moum
- Department of Gastroenterology, Oslo University Hospital, Nydalen, Norway
- Institute of Clinical Medicine, University of Oslo, Blindern, Norway
| | - Tore Grimstad
- Department of Gastroenterology, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Jørgen Jahnsen
- Institute of Clinical Medicine, University of Oslo, Blindern, Norway
- Department of Gastroenterology, Akershus University Hospital, Lillestrøm, Norway
| | - Øistein Hovde
- Institute of Clinical Medicine, University of Oslo, Blindern, Norway
- Department of Gastroenterology, Innlandet Hospital Trust, Gjøvik, Norway
| | - Svein Oskar Frigstad
- Institute of Clinical Medicine, University of Oslo, Blindern, Norway
- Department of Medicine, VestreViken Baerum Hospital, Gjettum, Norway
| | - Tomm Bernklev
- Institute of Clinical Medicine, University of Oslo, Blindern, Norway
- Vestfold Hospital Trust, Tønsberg, Norway
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Christensen I, Haug JB, Berild D, Bjørnholt JV, Skodvin B, Jelsness-Jørgensen LP. Factors Affecting Antibiotic Prescription among Hospital Physicians in a Low-Antimicrobial-Resistance Country: A Qualitative Study. Antibiotics (Basel) 2022; 11:antibiotics11010098. [PMID: 35052975 PMCID: PMC8773165 DOI: 10.3390/antibiotics11010098] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/05/2022] [Accepted: 01/11/2022] [Indexed: 02/05/2023] Open
Abstract
Antimicrobial resistance (AMR) is a threat to hospital patients. Antimicrobial stewardship programs (ASPs) can counteract AMR. To optimize ASPs, we need to understand what affects physicians’ antibiotic prescription from several contexts. In this study, we aimed to explore the factors affecting hospital physicians’ antibiotic choices in a low-resistance country to identify potential targets for future ASPs. We interviewed 14 physicians involved in antibiotic prescription in a Norwegian hospital. The interviews were audiotaped, transcribed verbatim, and analyzed using thematic analysis. The main factors affecting antibiotic prescription were a high work pressure, insufficient staff resources, and uncertainties regarding clinical decisions. Treatment expectations from patients and next of kin, benevolence towards the patients, suboptimal microbiological testing, and limited time for infectious disease specialists to offer advisory services also affected the antibiotic choices. Future ASP efforts should evaluate the system organization and prioritizations to address and manage potential time-pressure issues. To limit the use of broad-spectrum antibiotics, improving microbiology testing and the routines for consultations with infectious disease specialists seems beneficial. We also identified a need among the prescribing physicians for a debate on ethical antibiotic questions.
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Affiliation(s)
- Ingrid Christensen
- Department of Infection Control, Østfold Hospital Trust, Kalnes, 1714 Graalum, Norway; (J.B.H.); (L.-P.J.-J.)
- Faculty of Medicine, Ph.D. Program Medicine and Health Sciences, University of Oslo, 0315 Oslo, Norway
- Correspondence: ; Tel.: +47-9073-3113; Fax: +47-6986-4885
| | - Jon Birger Haug
- Department of Infection Control, Østfold Hospital Trust, Kalnes, 1714 Graalum, Norway; (J.B.H.); (L.-P.J.-J.)
| | - Dag Berild
- Department of Infectious Diseases, Oslo University Hospital, 0424 Oslo, Norway;
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, 0315 Oslo, Norway;
| | - Jørgen Vildershøj Bjørnholt
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, 0315 Oslo, Norway;
- Department of Microbiology, Oslo University Hospital, 0424 Oslo, Norway
| | - Brita Skodvin
- Norwegian Advisory Unit on Antibiotic Use in Hospitals, Department of Research and Development, Haukeland University Hospital, 5021 Bergen, Norway;
| | - Lars-Petter Jelsness-Jørgensen
- Department of Infection Control, Østfold Hospital Trust, Kalnes, 1714 Graalum, Norway; (J.B.H.); (L.-P.J.-J.)
- Faculty of Health and Social Studies, Østfold University College, 1671 Fredrikstad, Norway
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Christensen I, Berild D, Jelsness-Jørgensen LP, Bjørnholt JV, Haug JB. Skreddersydde tiltak gir bedre antibiotikastyring i norske sykehus. Tidsskriftet 2022; 142:22-0094. [DOI: 10.4045/tidsskr.22.0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Haukeland-Parker S, Hasvik E, Jelsness-Jørgensen LP, Birring S, Johannessen HH. Cross-cultural adaptation and validation of the Norwegian version of the Leicester Cough Questionnaire in chronic obstructive pulmonary disease. Physiother Theory Pract 2021; 38:2175-2184. [PMID: 33840375 DOI: 10.1080/09593985.2021.1911012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Cough is a common symptom among patients with chronic obstructive pulmonary disease (COPD), but there are currently no patient-reported outcome measures (PROM) for subjective cough symptoms in Norwegian.Objective: The objective was to translate and validated the most widely used PROM for chronic cough, the Leicester Cough Questionnaire (LCQ) from English to Norwegian (NLCQ) using established guidelines.Methods: Forward and backward translations were performed using external translators. All phases were discussed in an expert workgroup until consensus was achieved. Ten patients were interviewed about the pre-final version to assess understandability and ease to complete. The final NLCQ was externally proofread and tested for content and construct validity, internal consistency, test-retest reliability and measurement error.Results: Mean (SD) age was 67 (7.9) years, and 62% of the sample were female (n = 56/89). According to GOLD stages, 10% had mild, 27% moderate, 35% severe and 22% very severe COPD, respectively. GOLD stages were missing for five patients (6%). The NLCQ showed acceptable accordance with the original, acceptable understandability and ease to complete, satisfactory content reliability, total score construct validity, internal consistency and test-retest reliability. Test-retest bias was low, but measurement error was larger than previously reported. The standard error of measurement and smallest detectable change were 1.56 and 4.32, respectively. Construct validity and factor analysis raised concerns regarding the three subdomains.Conclusion: The present cross-cultural adaptation of the NLCQ showed satisfactory reliability and overall validity. Due to concerns for the validity of the three domains, we suggest use should be restricted to the NLCQ total score until these are reassessed.
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Affiliation(s)
| | - Eivind Hasvik
- Department of Physical Medicine and Rehabilitation, Østfold Hospital Trust, Grålum, Norway
| | - Lars-Petter Jelsness-Jørgensen
- Department of Internal Medicine, Østfold Hospital Trust, Grålum, Norway.,Department of Health and Welfare, Østfold University College, Halden, Norway
| | - Surinder Birring
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, Department of Respiratory Medicine, Denmark Hill, King's College London, London, UK
| | - Hege Hølmo Johannessen
- Department of Physical Medicine and Rehabilitation, Østfold Hospital Trust, Grålum, Norway.,Department of Health and Welfare, Østfold University College, Halden, Norway
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Olaussen C, Aase I, Jelsness-Jørgensen LP, Tvedt CR, Steindal SA. Supplementing Clinical Practice in Nursing Homes With Simulation Training: A Qualitative Study of Nursing Students' Experiences. SAGE Open Nurs 2020; 6:2377960820981786. [PMID: 35155765 PMCID: PMC8832293 DOI: 10.1177/2377960820981786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 11/03/2020] [Accepted: 11/27/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Limited access to nurse supervisors, insufficient learning support and staff with high workloads are well documented in the research literature as barriers to nursing students´ learning in clinical practice in nursing homes. Due to these barriers nursing students may benefit from additional learning support from nurse educators during their clinical practice period. Objective The study aimed to explore nursing students' experiences of supplementary simulation training as a tool to support learning during clinical practice in nursing homes. Methods A descriptive qualitative design was used. Twenty-seven first-year nursing students from a university college in Norway were interviewed after attending a seven-week practice period in nursing homes with supplementary simulation training. Three semi-structured focus group interviews were audio recorded, transcribed, and analysed using systematic text condensation. Findings Three categories of student experiences were identified: enhancing the reasoning behind care, transferring knowledge and experiences between the learning environments and enhancing the sense of mastery. Conclusion The supplementary simulation training seemed to complement clinical practice by consolidating the students' learning during the clinical practice period, enhance the students' motivation and sense of mastery, and consequently their efforts to seek out new challenges, explore and learn both in the clinical and the simulated environment.
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Affiliation(s)
- Camilla Olaussen
- Lovisenberg Diaconal University College, Oslo, Norway.,The University of Stavanger, Stavanger, Norway
| | - Ingunn Aase
- The University of Stavanger, Stavanger, Norway
| | - Lars-Petter Jelsness-Jørgensen
- Lovisenberg Diaconal University College, Oslo, Norway.,Department of Health and Social Studies, Østfold University College, Fredrikstad, Norway.,Østfold Hospital Trust, Kalnes, Norway
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Olaussen C, Jelsness-Jørgensen LP, Tvedt CR, Hofoss D, Aase I, Steindal SA. Psychometric properties of the Norwegian version of the clinical learning environment comparison survey. Nurs Open 2020; 8:1254-1261. [PMID: 33369249 PMCID: PMC8046064 DOI: 10.1002/nop2.742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/03/2020] [Accepted: 11/23/2020] [Indexed: 11/09/2022] Open
Abstract
Aim To translate The Clinical Learning Environment Comparison Survey (CLECS) into Norwegian and to evaluate the psychometric properties of the Norwegian version. Design A cross‐sectional survey including a longitudinal component. Methods The CLECS was translated into Norwegian following the World Health Organization guidelines, including forward translation, expert panel, back‐translation, pre‐testing and cognitive interviewing. Nursing students at a Norwegian university college were invited to participate in the study (psychometrical testing) based on informed consent. Reliability and validity of the translated version of CLECS were investigated using a confirmatory factor analysis (CFA), Cronbach's alpha and test–retest analysis. Results A total of 122 nursing students completed the questionnaire and Cronbach alphas for the CLECS subscales ranged from 0.69 to 0.89. CFA goodness‐of‐fit indices (χ2/df = 1.409, CFI = 0.915, RMSEA = 0.058) showed acceptable model fit. Test–retest ICC ranged from 0.55 to 0.75, except for two subscales with values below 0.5
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Affiliation(s)
- Camilla Olaussen
- Lovisenberg Diaconal University College, Oslo, Norway.,The University of Stavanger, Stavanger, Norway
| | - Lars-Petter Jelsness-Jørgensen
- Lovisenberg Diaconal University College, Oslo, Norway.,Department of Health and Social Studies, Østfold University College, Fredrikstad, Norway.,Østfold Hospital Trust, Kalnes, Norway
| | | | - Dag Hofoss
- Lovisenberg Diaconal University College, Oslo, Norway
| | - Ingunn Aase
- The University of Stavanger, Stavanger, Norway
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17
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Christensen I, Haug JB, Berild D, Bjørnholt JV, Jelsness-Jørgensen LP. Hospital physicians' experiences with procalcitonin - implications for antimicrobial stewardship; a qualitative study. BMC Infect Dis 2020; 20:515. [PMID: 32677903 PMCID: PMC7364625 DOI: 10.1186/s12879-020-05246-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/10/2020] [Indexed: 12/03/2022] Open
Abstract
Background Procalcitonin is an inflammatory biomarker that is sensitive for bacterial infections and a promising clinical decision aid in antimicrobial stewardship programs. However, there are few studies of physicians’ experiences concerning the use of PCT. The objective of this study was to investigate whether hospital physicians’ experience with procalcitonin after 18 months of use can inform the PCT implementation in antimicrobial stewardship programs. Materials/methods We deployed a qualitative approach using semi-structured interviews with 14 hospital physicians who had experience with procalcitonin in clinical practice. Interviews were audio-taped, transcribed verbatim and analysed using thematic analysis. Results Physicians reported a knowledge gap, which made them uncertain about the appropriate procalcitonin use, interpretation, and trustworthiness. Simultaneously, the physicians experienced procalcitonin as a useful clinical decision aid but emphasised that their clinical evaluation of the patient was the most important factor when deciding on antibiotic treatment. Conclusions Procalcitonin was regarded a helpful clinical tool, but the physicians called for more knowledge about its appropriate uses. Active implementation of unambiguous procalcitonin algorithms and physician education may enhance the utility of the test as an antimicrobial stewardship adjunct.
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Affiliation(s)
- Ingrid Christensen
- Department of INFECTION Control, Østfold Hospital Trust, Kalnes, Norway. .,Faculty of Medicine, University of Oslo, PhD Program Medicine and Health Sciences, Oslo, Norway.
| | - Jon Birger Haug
- Department of INFECTION Control, Østfold Hospital Trust, Kalnes, Norway
| | - Dag Berild
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway.,Oslo University, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway
| | - Jørgen Vildershøj Bjørnholt
- Oslo University, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway.,Department of Microbiology, Oslo University Hospital, Oslo, Norway
| | - Lars-Petter Jelsness-Jørgensen
- Faculty of Health and Social Studies, Østfold University College, Fredrikstad, Norway.,Department of Science, Østfold Hospital Trust, Kalnes, Norway
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Karlsvik TM, Borgenvik TL, Aadalen M, Utne K, Førsund E, Jørgensen CT, Holst R, Jelsness-Jørgensen LP, Ghanima W. Fatigue after initiating rivaroxaban for venous thromboembolism. Res Pract Thromb Haemost 2020; 4:582-585. [PMID: 32548556 PMCID: PMC7292653 DOI: 10.1002/rth2.12312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 01/05/2020] [Accepted: 01/07/2020] [Indexed: 11/16/2022] Open
Abstract
Background Rivaroxaban was the first new oral anticoagulant approved for treatment of venous thromboembolism (VTE). Clinical trials have shown that rivaroxaban is noninferior to conventional anticoagulation for VTE in efficacy and safety. Increased fatigue after the initiation of rivaroxaban has been observed in clinical practice, but data on this potential side effect are lacking. Objective The study aimed to evaluate development of fatigue in patients treated for VTE, comparing rivaroxaban to other anticoagulants. Methods Patients were prospectively recruited after a diagnosis of VTE. The Fatigue Questionnaire was used to determine the level of fatigue at baseline, at 3 weeks of treatment, and either at 1 month after the discontinuation of treatment if the treatment was discontinued after 3 months or at 6 months if treatment was continued beyond this time. Data was analyzed by a linear mixed model. Results A total of 126 patients were included. Mean age was 59 years; 77 (61%) were males. Fifty‐seven patients (45%) were diagnosed with deep vein thrombosis, 48 (38%) with pulmonary embolism, and 21 (17%) with both. Predicted changes in fatigue scores from baseline to the last measurement were −0.007 and −2.49 for the rivaroxaban and the other‐anticoagulants groups, respectively, neither of which were statistically significant. No difference was detected between rivaroxaban and the other‐anticoagulants group at any time point, including subgroup analysis comparing over and under 6 months of treatment duration. Conclusion In this small study, our results suggest no increase in the level of fatigue after the initiation of treatment with rivaroxaban for VTE.
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Affiliation(s)
| | | | - Mirjam Aadalen
- Department of Research Østfold Hospital Trust Grålum Norway.,Ulm University of Applied Science Ulm Germany
| | - Kristin Utne
- Department of Hematology-oncology Østfold Hospital Trust Grålum Norway
| | - Eli Førsund
- Department of Internal Medicine Østfold Hospital Trust Grålum Norway
| | | | - René Holst
- Department of Research Østfold Hospital Trust Grålum Norway
| | - Lars-Petter Jelsness-Jørgensen
- Department of Internal Medicine Østfold Hospital Trust Grålum Norway.,Department of Health Science Østfold University College Grålum Norway
| | - Waleed Ghanima
- Department of Internal Medicine Østfold Hospital Trust Grålum Norway.,Department of Research Østfold Hospital Trust Grålum Norway.,Department of Hematology Institute of Clinical Medicine University of Oslo Oslo Norway
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19
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Opheim R, Moum B, Grimstad BT, Jahnsen J, Prytz Berset I, Hovde Ø, Huppertz-Hauss G, Bernklev T, Jelsness-Jørgensen LP. Self-esteem in patients with inflammatory bowel disease. Qual Life Res 2020; 29:1839-1846. [PMID: 32144613 PMCID: PMC7295843 DOI: 10.1007/s11136-020-02467-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2020] [Indexed: 01/19/2023]
Abstract
Purpose The purpose of this study was to explore self-esteem and associations between self-esteem and sociodemographic, clinical, and psychological factors in patients with inflammatory bowel disease (IBD), a disease of chronic relapsing inflammation of the gastrointestinal tract. IBD symptoms, including pain, fatigue, and diarrhea, as well as potential life-long medical treatment and surgery, may be demanding, cause significant challenges, and influence self-esteem. Methods In this cross-sectional multicenter study, participants were recruited from nine hospitals in the southeastern and western regions of Norway from March 2013 to April 2014. Data were collected using self-report questionnaires. Self-esteem was assessed by the Rosenberg Self-Esteem Scale, fatigue was assessed by the Fatigue Questionnaire, self-efficacy was assessed by the General Self-Efficacy Scale, and disease activity was assessed by the Simple Clinical Colitis Activity Index for ulcerative colitis (UC) and Harvey Bradshaw Index for Crohn’s disease (CD). Multiple linear regression analysis was applied to examine associations between self-esteem and sociodemographic, clinical, and psychological factors. Results In total, 411 of 452 (91%) patients had evaluable data and were included in this study. The mean scores on self-esteem, self-efficacy, total fatigue, anxiety, and depression were similar between UC patients and CD patients. Male gender, being employed, and higher self-efficacy were independently associated with higher self-esteem, whereas anxiety and depression were independently associated with lower self-esteem. Neither disease activity nor fatigue were associated with self-esteem in the final multiple regression analyses. Conclusion Patient-centered interventions that improve self-esteem and reduce anxiety and depression seem to be important to optimize IBD management.
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Affiliation(s)
- Randi Opheim
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway. .,Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Bjørn Moum
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Bjørn Tore Grimstad
- Department of Internal Medicine, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Jørgen Jahnsen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway
| | - Ingrid Prytz Berset
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Medicine, Aalesund Hospital Trust, Aalesund, Norway
| | - Øistein Hovde
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Internal Medicine, Innlandet Hospital Trust, Gjøvik, Norway
| | | | - Tomm Bernklev
- Department of Research and Development, Vestfold Hospital Trust, Tønsberg, Norway
| | - Lars-Petter Jelsness-Jørgensen
- Department of Gastroenterology, Østfold Hospital Trust, Grålum, Norway.,Department of Health Sciences, Østfold University College, Fredrikstad, Norway
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20
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Frigstad SO, Høivik ML, Jahnsen J, Cvancarova M, Grimstad T, Berset IP, Huppertz-Hauss G, Hovde Ø, Bernklev T, Moum B, Jelsness-Jørgensen LP. Pain Severity and Vitamin D Deficiency in IBD Patients. Nutrients 2019; 12:nu12010026. [PMID: 31877637 PMCID: PMC7019855 DOI: 10.3390/nu12010026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 12/10/2019] [Accepted: 12/18/2019] [Indexed: 12/22/2022] Open
Abstract
Background: Pain and vitamin D deficiency are common in inflammatory bowel disease (IBD). Disease activity, fatigue, frequent relapses, prior surgery and psychological factors all seem to influence the experience of pain in IBD. Vitamin D deficiency has been associated with muscle and skeletal pain. This study aimed to determine whether there is an association between vitamin D deficiency and severity of pain in patients with IBD, and to investigate the influence of other socio-demographic and psychological variables on the experience of pain. Methods: Patients with IBD were recruited from nine hospitals in Norway in a multicenter cross-sectional study. The Brief Pain Inventory (BPI) questionnaire was used to measure pain. Disease activity was assessed using clinical disease activity indices, C-reactive protein (CRP) and fecal calprotectin. Regression models were fitted to explore a possible association between 25-hydroxyvitamin D and pain severity. Results: Of 407 patients included in the analyses, 229 (56%) had Crohn’s disease (CD) and 178 (44%) had ulcerative colitis (UC). Vitamin D deficiency was present in half (203/407) of patients. Presence of pain was reported by 76% (309/407). More severe pain was associated with female gender and increased disease activity scores, but not with increased CRP or fecal calprotectin. In CD, patients without prior intra-abdominal surgery reported more severe pain. In multivariate analyses, there was no association between 25-hydroxyvitamin D and pain severity. Conclusions: In this study, no significant association between pain severity and vitamin D deficiency was revealed in patients with IBD.
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Affiliation(s)
- Svein Oskar Frigstad
- Department of Research, Østfold Hospital, 1714 Grålum, Norway
- Department of Medicine, Vestre Viken Bærum Hospital, 1346 Gjettum, Norway
- Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway; (M.L.H.); (J.J.); (I.P.B.); (Ø.H.); (T.B.); (B.M.)
- Correspondence: ; Tel.: +47-6780-9587
| | - Marte Lie Høivik
- Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway; (M.L.H.); (J.J.); (I.P.B.); (Ø.H.); (T.B.); (B.M.)
- Department of Gastroenterology, Oslo University Hospital, 0424 Oslo, Norway;
| | - Jørgen Jahnsen
- Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway; (M.L.H.); (J.J.); (I.P.B.); (Ø.H.); (T.B.); (B.M.)
- Department of Gastroenterology, Akershus University Hospital, 1478 Nordbyhagen, Norway
| | - Milada Cvancarova
- Department of Gastroenterology, Oslo University Hospital, 0424 Oslo, Norway;
- Department of Biostatistics, Oslo Metropolitan University, 0130 Oslo, Norway
| | - Tore Grimstad
- Department of Gastroenterology, Stavanger University Hospital, 4068 Stavanger, Norway;
| | - Ingrid Prytz Berset
- Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway; (M.L.H.); (J.J.); (I.P.B.); (Ø.H.); (T.B.); (B.M.)
| | | | - Øistein Hovde
- Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway; (M.L.H.); (J.J.); (I.P.B.); (Ø.H.); (T.B.); (B.M.)
- Department of Medicine, Innlandet Hospital, 2819 Gjøvik, Norway
| | - Tomm Bernklev
- Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway; (M.L.H.); (J.J.); (I.P.B.); (Ø.H.); (T.B.); (B.M.)
- Department of Research and Development, Vestfold Hospital, 3103 Tønsberg, Norway
| | - Bjørn Moum
- Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway; (M.L.H.); (J.J.); (I.P.B.); (Ø.H.); (T.B.); (B.M.)
- Department of Gastroenterology, Oslo University Hospital, 0424 Oslo, Norway;
| | - Lars-Petter Jelsness-Jørgensen
- Department of Gastroenterology, Østfold Hospital, 1714 Grålum, Norway;
- Department of Health Sciences, Østfold University College, 1757 Halden, Norway
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21
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Jelsness-Jørgensen LP, Jensen Ø, Gibbs C, Bekkhus Moe R, Hofsø D, Bernklev T. Psychometric testing of the Norwegian Diabetes Health Profile (DHP-18) in patients with type 1 diabetes. BMJ Open Diabetes Res Care 2018; 6:e000541. [PMID: 30613400 PMCID: PMC6304096 DOI: 10.1136/bmjdrc-2018-000541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 09/14/2018] [Accepted: 11/08/2018] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The Diabetes Health Profile-18 (DHP-18) was developed to measure disease-specific health-related quality of life. It has been translated into Norwegian but remains invalidated. The purpose of this paper was to examine the psychometric properties of the Norwegian DHP-18. RESEARCH DESIGN AND METHODS Participants with type 1 diabetes were recruited from three outpatient clinics in Norway. Clinical and sociodemographic data were collected, and participants completed the DHP-18 and the Short-Form 36 (SF-36). Descriptive analysis, frequencies, t-tests and the chi-squared tests were used. Principal axis factoring (PAF) and confirmatory factor analysis (CFA) were used. Convergent validity was tested using Spearman's correlation between the DHP-18 and SF-36. Reliability was tested using Cronbach's alpha and intraclass correlation coefficient. RESULTS In total, 288 patients were included. No floor and ceiling effects were found. A forced PAF analysis revealed that three questions had an eigenvalue below 0.40. In the unforced PAF analysis, one question loaded below 0.40, while three questions loaded into a fourth factor. The correlation between the DHP-18 and SF-36 dimensions was low to moderate. Problematic internal consistency was observed for the disinhibited eating dimension in the forced PAF and in the suggested fourth dimension in the unforced PAF. CFA revealed poor fit. The test-retest reliability displayed good to excellent values, but responsiveness was limited. CONCLUSIONS Problematic issues were identified regarding factor structure, item loadings, internal consistency and responsiveness. Further evaluation of responsiveness is particularly recommended, and using a revised 14-item DHP version is suggested.
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Affiliation(s)
- Lars-Petter Jelsness-Jørgensen
- Department of Health and Welfare, Østfold University College, Halden, Norway
- Department of Internal Medicine, Østfold Hospital Trust, Grålum, Norway
| | - Øystein Jensen
- Department of Health and Welfare, Østfold University College, Halden, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Charlotte Gibbs
- Department of Endocrinology, Telemark Hospital Trust, Skien, Norway
| | | | - Dag Hofsø
- Morbid Obesity Centre and Section of Endocrinology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Tomm Bernklev
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Research and Development, Vestfold Hospital Trust, Tønsberg, Norway
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22
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Jelsness-Jørgensen LP, Bernklev T, Lundin KEA. Fatigue as an Extra-Intestinal Manifestation of Celiac Disease: A Systematic Review. Nutrients 2018; 10:nu10111652. [PMID: 30400298 PMCID: PMC6266448 DOI: 10.3390/nu10111652] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 10/24/2018] [Accepted: 10/26/2018] [Indexed: 12/30/2022] Open
Abstract
Celiac disease may present with a range of different symptoms, including abdominal problems in a broader sense, iron deficiency and “constant tiredness”. All of these symptoms should consequently lead the clinicians to consider celiac disease as a potential etiopathogenetic cause. Although the pathophysiology of celiac disease is well documented, the actual mechanisms for disease presentation(s) are less well understood. We here address the topic of fatigue in celiac disease. A systematic literature search identified 298 papers of which five met the criteria for full evaluation. None of the reviewed papers were of high quality and had several methodological weaknesses. We conclude that there is an unmet need to study the contributing factors and management of fatigue in celiac disease.
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Affiliation(s)
- Lars-Petter Jelsness-Jørgensen
- Department of Health Science, Østfold University College, N-1757 Halden, Norway.
- Department of Gastroenterology, Østfold Hospital Trust Kalnes, N-1714 Grålum, Norway.
| | - Tomm Bernklev
- Department of Research and Innovation, Vestfold Hospital Trust, N-3103 Tønsberg, Norway.
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, N-0318 Oslo, Norway.
| | - Knut E A Lundin
- K.G. Jebsen Coeliac Disease Research Centre, University of Oslo, N-0318 Oslo, Norway.
- Department of gastroenterology, Oslo University Hospital Rikshospitalet, N-0372 Oslo, Norway.
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23
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Jensen Ø, Bernklev T, Gibbs C, Moe RB, Hofsø D, Jelsness-Jørgensen LP. Fatigue in type 1 diabetes, prevalence, predictors and comparison with the background population. Diabetes Res Clin Pract 2018; 143:71-78. [PMID: 29969723 DOI: 10.1016/j.diabres.2018.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 05/29/2018] [Accepted: 06/13/2018] [Indexed: 11/15/2022]
Abstract
AIM Fatigue is scarcely studied in type 1 diabetes (T1D), and the aims were to investigate its prevalence compared to the background population, potential associations, and to validate the Fatigue Questionnaire (FQ) in type 1 diabetes. METHODS Persons with T1D were recruited from three outpatient clinics in Norway. Fatigue was measured using the FQ, and FQ data from the Norwegian background population were used for comparison. Socio-demographic and clinical variables were obtained by self-report, clinical investigation, medical records and laboratory tests. RESULTS Of 332 eligible patients, 288 (87%) were included. Mean age was 44.65/44.95 years (SD 13.34/13.38) for females/males, respectively. Total fatigue (TF) was 15.31 (SD 5.51) compared to 12.2 (SD 4.0) in the background population (p < 0.001). HADS ≥ 8, current menstruation, increased leukocytes and sleep problems were associated with increased TF. Chronic fatigue (CF) was reported in 26.4% compared to 11% in the background population (p < 0.001). HADS ≥ 8, increased time since diagnosis and decreased sleep quality were associated with CF. The validity, internal consistency and repeatability of the FQ was confirmed. CONCLUSIONS Fatigue was more common in T1D than in the background population, and associated with increased anxiety, depression and sleep problems. The FQ demonstrated satisfactory psychometric properties.
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Affiliation(s)
- Øystein Jensen
- Østfold University College, Dept of Health and Welfare, Pb 770, 1757 Halden, Norway; Institute of Clinical Medicine, University of Oslo, Klaus Torgårds vei 3, 0372 Oslo, Norway.
| | - Tomm Bernklev
- Vestfold Hospital Trust, Research and Development, Halfdan Wilhelmsens alle 17, 3116 Tønsberg, Norway; Institute of Clinical Medicine, University of Oslo, Klaus Torgårds vei 3, 0372 Oslo, Norway.
| | - Charlotte Gibbs
- Telemark Hospital Trust, Dept of Endocrinology, Ulefossvegen 55, 3710 Skien, Norway.
| | - Ragnar Bekkhus Moe
- Østfold Hospital Trust, Dept of Internal Medicine, Kalnesveien 300, 1714 Grålum, Norway.
| | - Dag Hofsø
- Vestfold Hospital Trust, Morbid Obesity Centre and Section of Endocrinology, Halfdan Wilhelmsens alle 17, 3116 Tønsberg, Norway.
| | - Lars-Petter Jelsness-Jørgensen
- Østfold University College, Dept of Health and Welfare, Pb 770, 1757 Halden, Norway; Østfold Hospital Trust, Dept of Internal Medicine, Kalnesveien 300, 1714 Grålum, Norway.
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Frigstad SO, Høivik ML, Jahnsen J, Cvancarova M, Grimstad T, Berset IP, Huppertz-Hauss G, Hovde Ø, Bernklev T, Moum B, Jelsness-Jørgensen LP. Fatigue is not associated with vitamin D deficiency in inflammatory bowel disease patients. World J Gastroenterol 2018; 24:3293-3301. [PMID: 30090009 PMCID: PMC6079290 DOI: 10.3748/wjg.v24.i29.3293] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/17/2018] [Accepted: 06/27/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate if vitamin D deficiency is associated with fatigue in patients with inflammatory bowel disease (IBD).
METHODS IBD patients were recruited from nine hospitals in the southeastern and western regions of Norway to participate in a multicenter cross-sectional study lasting from March 2013 to April 2014. Data were collected by interviews, from medical records and laboratory tests. The Fatigue Questionnaire (FQ) was used to measure fatigue. Linear and logistic regression models were applied to explore the possible association between vitamin D deficiency and total fatigue scores and chronic fatigue, respectively. The analyses were adjusted for age, gender, disease activity, depressive symptoms and sleep disturbance.
RESULTS In total, 405 patients were included in the analyses, of which 227 (56%) had Crohn’s disease (CD) and 178 (44%) had ulcerative colitis (UC). Vitamin D deficiency (< 50 nmol/L) was present in half (203/405) of the patients. Chronic fatigue was reported by 116 (29%) of all included patients with substantial fatigue reported by 194 (48%). Vitamin D levels were neither associated with total fatigue nor with chronic fatigue. Higher total fatigue scores and chronic fatigue were both associated with increased disease activity scores in patients with UC and CD, but not with increased CRP or fecal calprotectin. In UC patients, female gender was associated with fatigue in the univariate analysis, but no such difference was found when adjusted for elevated disease activity scores. Sleep disturbance and more depressive symptoms were associated with total fatigue scores in both UC and CD patients, but with chronic fatigue only in CD patients.
CONCLUSION In this study, no significant association between fatigue and vitamin D deficiency in IBD patients was revealed.
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Affiliation(s)
- Svein Oskar Frigstad
- Department of Medicine, Vestre Viken Bærum Hospital, Gjettum 1346, Norway
- Department of Research, Østfold Hospital Kalnes, Grålum 1714, Norway
| | - Marte Lie Høivik
- Department of Gastroenterology, Oslo University Hospital, Oslo 0424, Norway
| | - Jørgen Jahnsen
- Department of Gastroenterology, Akershus University Hospital, Lørenskog 1478, Norway
| | - Milada Cvancarova
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo 0130, Norway
| | - Tore Grimstad
- Department of Gastroenterology, Stavanger University Hospital, Stavanger 4068, Norway
| | | | | | - Øistein Hovde
- Department of Medicine, Innlandet Hospital Trust, Gjøvik 2819, Norway
| | - Tomm Bernklev
- Department of Research and Development, Vestfold Hospital Trust, Tønsberg 3103, Norway
| | - Bjørn Moum
- Department of Gastroenterology, Oslo University Hospital, Oslo 0424, Norway
| | - Lars-Petter Jelsness-Jørgensen
- Department of Gastroenterology, Østfold Hospital Kalnes, Grålum 1714, Norway
- Department of Health Sciences, Østfold University College, Halden 1757, Norway
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25
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Henriksen M, Høivik ML, Jelsness-Jørgensen LP, Moum B. Irritable Bowel-like Symptoms in Ulcerative Colitis are as Common in Patients in Deep Remission as in Inflammation: Results From a Population-based Study [the IBSEN Study]. J Crohns Colitis 2018; 12:389-393. [PMID: 29186372 DOI: 10.1093/ecco-jcc/jjx152] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 11/26/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS An increased prevalence of irritable bowel syndrome [IBS]-like symptoms has been reported in patients with ulcerative colitis [UC]. Whether ongoing inflammation increases the prevalence of such symptoms is unknown. The aims of this study were to determine the prevalence of IBS-like symptoms in a population-based cohort of UC patients 20 years after diagnosis, and to assess the possible association between such symptoms and ongoing inflammation. METHODS Patients diagnosed with UC between 1990 and 1994, in a geographically well-defined area, were included in a prospective follow-up study, and IBS symptoms according to Rome III criteria were recorded 20 years after diagnosis. The patients underwent colonoscopy with biopsies and/or the level of faecal calprotectin was analysed. RESULTS A total of 260 patients answered the Rome III questionnaire. The overall prevalence of IBS-like symptoms was 27%. In patients who had no signs of inflammation in colonic biopsies [n = 96] [deep remission], the prevalence was 29%. No difference in prevalence of IBS-like symptoms was found between patients with ongoing inflammation and patients in deep remission. CONCLUSIONS IBS-like symptoms in UC patients are frequent after 20 years of disease. Deep remission did not change the frequency of IBS-like symptoms.
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Affiliation(s)
- Magne Henriksen
- Østfold Hospital Trust, Department of Gastroenterology, Grålum, Norway
| | - Marte Lie Høivik
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
| | - Lars-Petter Jelsness-Jørgensen
- Østfold Hospital Trust, Department of Gastroenterology, Grålum, Norway.,Østfold University College, Department of Health Science, Halden, Norway
| | - Bjørn Moum
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Enden T, Bernklev T, Jelsness-Jørgensen LP, Amdal CD. Pasientene kjenner best egen helse. Tidsskriftet 2018; 138:17-1054. [DOI: 10.4045/tidsskr.17.1054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Leonardsen ACL, Del Busso L, Grøndahl VA, Jelsness-Jørgensen LP. Handovers in primary healthcare in Norway: A qualitative study of general practitioners' collaborative experiences. Health Soc Care Community 2018; 26:e173-e178. [PMID: 28872213 DOI: 10.1111/hsc.12497] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/15/2017] [Indexed: 06/07/2023]
Abstract
Worldwide demographic development increases the pressure on healthcare services. In Norway, municipal acute wards (MAWs) have been established as a 24-hr acute healthcare service as a primary healthcare alternative to hospitalisation. General practitioners (GPs) are key holders of referrals to different healthcare service levels, yet studies of GPs' experiences with these wards are sparse. Suboptimal handovers could lead to hospital readmissions, avoidable morbidity and even mortality. The aim of this study was to explore GPs' experiences with patient handovers to MAWs as well as to hospitals. A qualitative study including semi-structured interviews with 23 GPs in a county in south-eastern Norway was conducted. Data were analysed using thematic analysis. The results show that GPs preferred to collaborate with others in their own profession for patient handovers. The GPs had positive collaborative experiences with MAW doctors, while collaboration with doctors in hospitals was viewed more negatively, particularly as GPs had the impression that hospital doctors felt they had superior medical competence. After patient transfer, GPs felt uncertainty related to their own responsibilities for the patient. This study contributes new knowledge about GPs' experiences with collaboration and distribution of responsibility between primary and tertiary healthcare services. This information is essential when developing acceptable alternatives to general hospitals.
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28
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Leonardsen ACL, Grøndahl VA, Ghanima W, Storeheier E, Schönbeck A, Løken TA, Bakken NCM, Letting GS, Holst R, Jelsness-Jørgensen LP. Evaluating patient experiences in decentralised acute care using the Picker Patient Experience Questionnaire; methodological and clinical findings. BMC Health Serv Res 2017; 17:685. [PMID: 28962561 PMCID: PMC5622565 DOI: 10.1186/s12913-017-2614-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 09/12/2017] [Indexed: 11/20/2022] Open
Abstract
Background Decentralised acute care services have, through the establishment of municipality acute wards (MAWs), been launched in Norway. The aim is to provide treatment for patients who otherwise would need hospitalisation. Currently there is a lack of studies investigating patient experiences in such services. The aims of this study were therefore to a) translate and validate the Picker Patient Experience Questionnaire (PPE-15) in Norwegian, and b) assess patient experiences in decentralised acute care, and potential factors associated with these experiences. Methods Patients were recruited from five municipal acute wards in southeastern Norway during the period from June 2014 to June 2015. Data on socio-demographics, length of stay and comorbidity (Charlson comorbidity index (CCI)) were collected. Patients completed the Picker Patient Experience Questionnaire (PPE-15) and the EuroQOL 5-dimension, 3-level version. Convergent validity of the PPE-15 was assessed by correlation of items in PPE-15 and the Nordic Patient Experience Questionnaire (NORPEQ). A retest of the PPE-15 was performed in a subgroup of patients approximately 3 weeks after baseline assessment. Test-retest agreement was assessed with Cohens’ unweighted Kappa. Results A total of 479 patients responded, median age 78.0 years and 41.8% men. A total of 68 patients participated in the retest. Testing of convergent validity revealed an overall weak to moderate correlation. Kappa statistics showed from fair to good test-retest agreement. Most problems were related to continuity and transition, while fewest problems were related to respect for patient preferences. A higher Charlson comorbidity score was the only variable that was negatively associated with patient experience. Conclusion Patients reported problems in several items of the PPE-15 after discharge from decentralised acute wards. The findings from the current study may be helpful for planning ways to improve quality of care, e.g., by providing feedback to healthcare personnel or by using patient experience as a quality indicator.
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Affiliation(s)
| | | | - Waleed Ghanima
- Østfold Hospital Trust, University of Oslo, P.O. Box 300, NO-1714, Grålum, Norway
| | - Espen Storeheier
- Indre Østfold Kompetansesenter, Askim Municipality, Eventyrveien 2, NO-1807, Askim, Norway
| | - Anders Schönbeck
- Intermediæravdelingen, Halden Municipality, Kjærlighetsstien 28, NO- 1781, Halden, Norway
| | - Thor-Asbjørn Løken
- Peer Gynt Helsehus, Moss Municipality, Peer Gynts vei 86, NO- 1535, Moss, Norway
| | | | | | - Réné Holst
- Syddansk Universitet, Campusvej 55, DK-5230, Odense M, Denmark
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Ghanima W, Wik HS, Tavoly M, Enden T, Jelsness-Jørgensen LP. Late consequences of venous thromboembolism: Measuring quality of life after deep vein thrombosis and pulmonary embolism. Thromb Res 2017; 164:170-176. [PMID: 28760416 DOI: 10.1016/j.thromres.2017.07.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 07/14/2017] [Accepted: 07/21/2017] [Indexed: 01/07/2023]
Abstract
The identification of specific post-thrombotic complications as well as an increased appreciation of the importance of patient-reported outcome measures have triggered an interest in studying health-related quality of life (HRQoL) in patients with a history of venous thromboembolism (VTE). In order to enable a comprehensive assessment of HRQoL in clinical trials it is recommended that both generic and disease-specific questionnaires be used. SF-36 and EQ-5D are the most widely used generic questionnaires in VTE studies, whereas several disease-specific questionnaires have been developed to evaluate HRQoL following deep vein thrombosis (DVT) and in chronic venous disease (CVD). The most widely used of these is the VEINES-QOL/Sym, which was developed for CVD. VT-QOL and DVTQOL are both questionnaires developed to evaluate HRQoL after DVT, while PEmb-QoL is currently the only available disease-specific questionnaire developed specifically for pulmonary embolism (PE). Although studies show inconsistent results, patients who sustain DVT seem in general to report similar HRQoL compared to the general population. However, patients who develop PTS after DVT report poorer HRQoL using both generic and disease-specific questionnaires. HRQoL appears to be impaired in patients who sustain PE compared to the general population. In these patients, persistent dyspnea after PE has been shown to be a predictor of reduced HRQoL. Further work is needed to develop practical, patient-derived, valid, reliable and responsive disease-specific HRQoL instruments covering the specific aspects of these diseases.
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Affiliation(s)
- Waleed Ghanima
- Departments of Medicine, Østfold Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway; Department of Haematology, Oslo University Hospital, Norway.
| | | | - Mazdak Tavoly
- Departments of Medicine, Østfold Hospital, Norway; Department of Medicine, Sahlgrenska University Hospital, Sweden
| | - Tone Enden
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Norway
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Leonardsen ACL, Jelsness-Jørgensen LP. Patient experiences and predictors in an acute geriatric ward: A cross-sectional study. J Clin Nurs 2017; 26:4567-4573. [PMID: 28252824 DOI: 10.1111/jocn.13796] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2017] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To investigate older peoples' experiences with acute hospital treatment and care, and variables that may influence these experiences. BACKGROUND In the Nordic countries, research on older peoples' experiences with hospital care is sparse. METHODS Participants were recruited from an acute geriatric ward in a hospital in Norway during a 1-year period (n = 189). Patient experience was assessed using the Picker Patient Experience Questionnaire, self-rated health by Euro-QoL 5-dimension, three-level version and comorbidity by Charlson comorbidity index. RESULTS Responders' median age was 79 years, 48.7% male. Most of the problems were related to continuity and transition, while fewest problems were related to respect for patient preferences. Charlson comorbidity index score and the variables "still working," "in a relationship" and "living alone" negatively influenced patient experience. CONCLUSIONS A high amount of problems were identified among patients hospitalised in an acute geriatric ward. Findings from this study may provide important information about issues that need focus to increase the care experiences of older people. RELEVANCE TO CLINICAL PRACTICE Results from this study adds to existing knowledge, and emphasize the need for increased focus on discharge and continuity of care processes.
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Affiliation(s)
| | - Lars-Petter Jelsness-Jørgensen
- Østfold Hospital Trust, Department of Research, PO. Box 300, 1714, Grålum, Norway.,Østfold University College, Halden, Norway/Østfold
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Huppertz-Hauss G, Høivik ML, Jelsness-Jørgensen LP, Opheim R, Henriksen M, Høie O, Hovde Ø, Kempski-Monstad I, Solberg IC, Jahnsen J, Hoff G, Moum B, Bernklev T. Fatigue in a population-based cohort of patients with inflammatory bowel disease 20 years after diagnosis: The IBSEN study. Scand J Gastroenterol 2017; 52:351-358. [PMID: 27852169 DOI: 10.1080/00365521.2016.1256425] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Fatigue is a major concern for patients with ulcerative colitis (UC) and Crohn's disease (CD), but evidence from population-based studies regarding fatigue in long-standing inflammatory bowel disease (IBD) patients is scarce. Our aims were to assess fatigue scores and the prevalence of chronic fatigue in IBD patients 20 years after diagnosis and to identify variables associated with fatigue in this cohort. METHODS Twenty years after diagnosis, patients from a cohort with incident IBD were invited to a follow-up visit that included a structured interview, a clinical examination, laboratory tests and the Fatigue Questionnaire (FQ). Fatigue scores were obtained, and factors associated with fatigue were assessed via linear and logistic regression analyses. RESULTS Of the 599 invited patients, 440 (73.5%) completed the FQ. Among those with active disease, we found significantly higher fatigue scores than among those with quiescent disease (fatigue scores: UC 17.1 versus 12.4, p < .001, and CD 17.5 versus 13.3, p < .001). The fatigue scores of those with quiescent disease were comparable with those of the reference population. Chronic fatigue was more frequent among IBD patients than in the reference population. Factors associated with fatigue included self-perceived disease activity, poor sleep quality, anxiety and depression. CONCLUSION At 20 years after IBD diagnosis, fatigue scores were higher and chronic fatigue was more frequent among IBD patients with active disease than in the reference population and among those with quiescent IBD. Subjectively perceived disease activity, sleep quality, anxiety and depression were associated with fatigue in IBD patients.
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Affiliation(s)
| | - Marte Lie Høivik
- b Department of Gastroenterology , Oslo University Hospital Ullevål , Oslo , Norway
| | | | - Randi Opheim
- d Department of Gastroenterology , Oslo University Hospital Ullevål, and Institute of Health and Society, Faculty of Medicine, University of Oslo , Oslo , Norway
| | - Magne Henriksen
- e Department of Gastroenterology , Østfold Hospital Trust , Grålum , Norway
| | - Ole Høie
- f Department of Gastroenterology , Sørlandet Hospital , Arendal , Norway
| | - Øistein Hovde
- g Department of Gastroenterology , Innlandet Hospital Trust , Brumunddal , Norway
| | - Iril Kempski-Monstad
- h Department of Gastroenterology , Oslo University Hospital Ullevål , Oslo , Norway
| | | | - Jørgen Jahnsen
- i Department of Gastroenterology , Akershus University Hospital, and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo , Oslo , Norway
| | - Geir Hoff
- j Department of Research and Development , Telemark Hospital, and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo , Oslo , Norway
| | - Bjørn Moum
- k Department of Gastroenterology , Oslo University Hospital Ullevål, and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo , Oslo , Norway
| | - Tomm Bernklev
- l Department of Research and Development , Vestfold Hospital, and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo , Oslo , Norway
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Dibley L, Bager P, Czuber-Dochan W, Farrell D, Jelsness-Jørgensen LP, Kemp K, Norton C. Identification of Research Priorities for Inflammatory Bowel Disease Nursing in Europe: a Nurses-European Crohn's and Colitis Organisation Delphi Survey. J Crohns Colitis 2017; 11:353-359. [PMID: 27664273 DOI: 10.1093/ecco-jcc/jjw164] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 10/04/2016] [Indexed: 12/08/2022]
Abstract
BACKGROUND Robust research evidence should inform clinical practice of inflammatory bowel disease [IBD] specialist nurses, but such research is currently very limited. With no current agreement on research priorities for IBD nursing, this survey aimed to establish topics to guide future IBD nursing research across Europe. METHODS An online modified Delphi survey with nurse and allied health professional members of the Nurses European Crohn's and Colitis Organisation [n = 303] was conducted. In Round One, participants proposed topics for research. In Round Two, research topics were rated on a 1-9 scale and subsequently synthesised to create composite research questions. In Round Three, participants selected their top five research questions, rating these on a 1-5 scale. RESULTS Representing 13 European countries, 88, 90 and 58 non-medical professionals, predominantly nurses, responded to Rounds One, Two and Three, respectively. In Round One, 173 potential research topics were suggested. In Rounds Two And Three, responders voted for and prioritised 125 and 44 questions, respectively. Round Three votes were weighted [rank of 1 = score of 5], reflecting rank order. The top five research priorities were: interventions to improve self-management of IBD; interventions for symptoms of frequency, urgency and incontinence; the role of the IBD nurse in improving patient outcomes and quality of life; interventions to improve IBD fatigue; and care pathways to optimise clinical outcomes and patient satisfaction. CONCLUSIONS The prioritised list of topics gives clear direction for future IBD nursing research. Conducting this research has potential to improve clinical practice and patient-reported outcomes.
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Affiliation(s)
- Lesley Dibley
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Palle Bager
- Department of Gastroenterology and Hepatology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | | | - Karen Kemp
- Department of Gastroenterology, Manchester Royal Infirmary/University of Manchester, Manchester, UK
| | - Christine Norton
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
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Kristensen V, Lauritzen T, Jelsness-Jørgensen LP, Frigstad SO, Corwin C, Moum B. Patient-performed extraction of faecal calprotectin. Clin Chem Lab Med 2017; 54:1357-63. [PMID: 26812797 DOI: 10.1515/cclm-2015-1037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 12/10/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Faecal (f-) calprotectin is a widely used marker for intestinal inflammation. However, extraction procedure is time consuming and cumbersome. The main aim of this study was to evaluate patient-performed extraction of f-calprotectin compared to extraction performed in the laboratory. METHODS A total of 81 adult patients with an established diagnosis of inflammatory bowel disease provided two samples from the same bowel movement, one conventional faeces sample and one sample with a patient administered extraction device. A laboratory technician extracted the conventional faeces sample with the same extraction device. RESULTS F-calprotectin results from the laboratory-performed extraction and the patient-performed extraction correlated significantly, with a Spearman rank correlation coefficient of 0.92. Method comparison showed a slope of 1.20 (95% confidence interval 1.08-1.36) with intercept of -0.30 (95% confidence interval -9.00 to 4.62). This demonstrates a small proportional difference between the results from the home extracted samples and the results from the laboratory extracted samples, where the home extracted samples are slightly higher. However, six of the 81 patients had made obvious mistakes in the extraction process and their samples were excluded from the study. CONCLUSIONS Patient administered extraction of f-calprotectin can be a realistic alternative for selected patients. However, instructions must be very precise to avoid mistakes.
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Frigstad SO, Høivik M, Jahnsen J, Dahl SR, Cvancarova M, Grimstad T, Berset IP, Huppertz-Hauss G, Hovde Ø, Torp R, Bernklev T, Moum B, Jelsness-Jørgensen LP. Vitamin D deficiency in inflammatory bowel disease: prevalence and predictors in a Norwegian outpatient population. Scand J Gastroenterol 2017; 52:100-106. [PMID: 27603182 DOI: 10.1080/00365521.2016.1233577] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIM Vitamin D deficiency is common in inflammatory bowel disease (IBD). The aims of the present study were to determine the prevalence of vitamin D deficiency and to identify clinical and epidemiological variables associated with vitamin D deficiency in an outpatient population with IBD. METHODS Participants were recruited from nine hospitals in the southeastern and western regions of Norway as part of an observational, multicentre study from March 2013 to April 2014. Clinical and epidemiological data were collected by interview and from medical records. All analyses of serum 25-hydroxyvitamin D (25-OH-D) were performed in the same laboratory. RESULTS In total, 49% (200/408) of the patients had a 25-OH-D concentration <50 nmol/L, including 53% (122/230) of the Crohn's disease (CD) patients and 44% (78/178) of the ulcerative colitis (UC) patients. In CD patients, disease activity, measured as the HBI, was inversely associated with vitamin D deficiency. No such association was observed with the Simple Clinical Colitis Activity Index (SCCAI) scores in UC, but in UC patients, vitamin D deficiency was associated with elevated faecal calprotectin >100 mg/kg. In patients with CD, there were significantly more relapses during the previous year in patients with vitamin D deficiency. CONCLUSIONS Vitamin D deficiency was common, especially in CD, and was associated with increased disease activity, a relapsing disease course and higher inflammatory activity.
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Affiliation(s)
- Svein Oskar Frigstad
- a Department of Research , Østfold Hospital Trust , Grålum , Norway.,b Department of Medicine , Bærum Hospital, Vestre Viken Hospital Trust , Drammen , Norway.,c Institute of Clinical Medicine , University of Oslo , Norway
| | - Marte Høivik
- c Institute of Clinical Medicine , University of Oslo , Norway.,d Department of Gastroenterology , Oslo University Hospital , Oslo , Norway
| | - Jørgen Jahnsen
- c Institute of Clinical Medicine , University of Oslo , Norway.,e Department of Gastroenterology , Akershus University Hospital , Lørenskog , Norway
| | - Sandra Rinne Dahl
- f The Hormone Laboratory, Department of Medical Biochemistry , Oslo University Hospital , Oslo , Norway
| | - Milada Cvancarova
- c Institute of Clinical Medicine , University of Oslo , Norway.,g Department of Biostatistics , Oslo and Akershus University College , Oslo , Norway
| | - Tore Grimstad
- h Department of Gastroenterology , Stavanger University Hospital , Stavanger , Norway
| | | | - Gert Huppertz-Hauss
- j Department of Research and Development , Telemark Hospital Trust , Skien , Norway
| | - Øistein Hovde
- c Institute of Clinical Medicine , University of Oslo , Norway.,k Department of Medicine , Innlandet Hospital Trust , Gjøvik , Norway
| | - Roald Torp
- l Department of Medicine , Innlandet Hospital Trust , Hamar , Norway
| | - Tomm Bernklev
- c Institute of Clinical Medicine , University of Oslo , Norway.,m Department of Gastroenterology , Østfold Hospital Trust , Grålum , Norway
| | - Bjørn Moum
- c Institute of Clinical Medicine , University of Oslo , Norway.,d Department of Gastroenterology , Oslo University Hospital , Oslo , Norway
| | - Lars-Petter Jelsness-Jørgensen
- m Department of Gastroenterology , Østfold Hospital Trust , Grålum , Norway.,n Department of Health Sciences , Østfold University College , Fredrikstad , Norway
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Jensen Ø, Bernklev T, Jelsness-Jørgensen LP. Fatigue in type 1 diabetes: A systematic review of Observational studies. Diabetes Res Clin Pract 2017; 123:63-74. [PMID: 28002753 DOI: 10.1016/j.diabres.2016.11.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 11/04/2016] [Indexed: 01/10/2023]
Abstract
AIM To systematically review the literature on fatigue in people with type 1 diabetes. METHODS In the period from April to June 2015 and with an updated search in May 2016, eight electronic databases as well as the grey literature were searched. Studies of all types of design were included if they reported data on fatigue in adult people with type 1 diabetes. All studies were assessed for quality. RESULTS Out of 4259 references (including grey literature), 10 papers were reviewed in full. Three of these papers investigated fatigue as the primary endpoint, and one was assessed to be high quality. Two papers provided a definition of fatigue. Prevalence estimates ranged from 23 to 40%, dependent on the cut-off used. Six different questionnaires were used to measure fatigue/vitality and these were only validated to a limited extent in a diabetes population. Several demographic, personal and clinical factors were associated with fatigue, but the results were conflicting. CONCLUSIONS Few studies have been published that investigate fatigue in type 1 diabetes and there is a large variability in findings due to different measurement methods and factors investigated. There is still an unmet need to understand what contributes to fatigue in these patients through rigorous research.
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Affiliation(s)
- Øystein Jensen
- Østfold University College, Pb 770, 1757 Halden, Norway; Institute of Clinical Medicine, University of Oslo, Klaus Torgårds vei 3, 0372 Oslo, Norway.
| | - Tomm Bernklev
- Research and Development Department, Telemark Hospital Trust, Ulefossvegen, 3710 Skien, Norway; Institute of Clinical Medicine, University of Oslo, Klaus Torgårds vei 3, 0372 Oslo, Norway.
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Leonardsen ACL, Del Busso L, Grøndahl VA, Ghanima W, Jelsness-Jørgensen LP. General practitioners' perspectives on referring patients to decentralized acute health care. Fam Pract 2016; 33:709-714. [PMID: 27543796 DOI: 10.1093/fampra/cmw087] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Municipality acute wards (MAWs) have recently been introduced in Norway. Their mandate is to provide treatment for patients who otherwise would have been hospitalized. Even though GPs are key stakeholders, little is known about how they perceive referring patients to these wards. The aim of this study was to investigate GPs' perspectives on factors relevant for their decision-making when referring patients to MAWs. METHODS We used a qualitative approach, conducting semi-structured interviews with 23 GPs from five different MAW catchment areas in the southeastern part of Norway. The data were analysed using thematic analysis. RESULTS The GPs experienced challenges in deciding which patients were suitable for treatment at a MAW, including whether patients could be regarded as medically clarified, and whether these services were sufficient and safe. GPs were also under pressure from several other stakeholders when deciding where to refer their patients. Moreover, the MAWs were viewed not merely as an alternative to hospitals, but also as a service in addition to hospitals. CONCLUSION This study improves our understanding of how GPs experience decentralized acute health care services, by identifying factors that influence and challenge their referral decisions. For these services to be used as intended in the collaboration reform, integrating the perspectives of GPs in the development and implementation of these services may be beneficial.
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Affiliation(s)
| | - Lilliana Del Busso
- Faculty of Health and Social Studies, Østfold University College, Fredrikstad, Norway and
| | - Vigdis A Grøndahl
- Faculty of Health and Social Studies, Østfold University College, Fredrikstad, Norway and
| | - Waleed Ghanima
- Department of Research, Østfold Hospital Trust, Sarpsborg, Norway.,Department of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lars-Petter Jelsness-Jørgensen
- Department of Research, Østfold Hospital Trust, Sarpsborg, Norway.,Faculty of Health and Social Studies, Østfold University College, Fredrikstad, Norway and
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Abstract
OBJECTIVES The psychological effects of acute pulmonary embolism (PE) have scarcely been studied. The aims of this study were to evaluate health-related quality of life (HRQoL) in patients with a history of PE compared with that of the general population and buddy controls, and to explore factors that may predict impaired HRQoL. DESIGN Cross-sectional. SETTING Haematology and thrombosis unit in Fredrikstad, Norway. PARTICIPANTS 213 consecutive patients treated for PE were identified from hospital registries. Eligible patients were scheduled for a single study visit, including a functional capacity test (6 min walking test). HRQoL was assessed using the EuroQol 5D dimensions 3-level (EQ-5D-3L) questionnaire, of which the results were compared with Danish population norms and age-matched and sex-matched buddy controls. The buddy controls were recruited by asking every patient to hand over the EQ-5D questionnaire to 2 age-matched and sex-matched friends or relatives. Multivariable regression analyses were used to examine possible determinants of reduced HRQoL. RESULTS Mean age was 61 years (SD 15), 117 (55%) were males, and median time since diagnosis was 3.8 years (range 0.3-9.5). Mean EuroQol visual analogue scale (EQ VAS) was 67 in PE as compared with 81 in the general population (p<0.005) and corresponding EQ-5D index values were 0.80 and 0.86 (p<0.005). Patients reported more problems in all 5 EQ-5D compared with both the buddy controls and the general population, p<0.05. Shorter 6 min walking distance (β=0.09, p<0.005) and patient-reported dyspnoea (β=11.27, p<0.005) were independent predictors of lower EQ VAS scores. CONCLUSIONS Our findings show that patients with a history of PE have impaired HRQoL when compared with the general population and buddy controls. Reduced functional capacity and persistent dyspnoea were the main predictors of this impairment.
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Affiliation(s)
- Mazdak Tavoly
- Department of Medicine, Østfold Hospital Trust, Fredrikstad, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kristin Kornelia Utne
- Department of Medicine, Østfold Hospital Trust, Fredrikstad, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lars-Petter Jelsness-Jørgensen
- Department of Medicine, Østfold Hospital Trust, Fredrikstad, Norway
- Department of Health Science, Østfold University College, Fredrikstad, Norway
| | - Hilde Skuterud Wik
- Department of Haematology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Frederikus A Klok
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Per Morten Sandset
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Health Science, Østfold University College, Fredrikstad, Norway
| | - Waleed Ghanima
- Department of Medicine, Østfold Hospital Trust, Fredrikstad, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Jelsness-Jørgensen LP, Bernklev T, Hovde Ø, Prytz Berset I, Huppertz-Hauss G, Moum B, Lie Høivik M. Patients' perceptions of quality of care and follow-up in inflammatory bowel disease. Scand J Gastroenterol 2016; 51:434-41. [PMID: 26635189 DOI: 10.3109/00365521.2015.1102319] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Quality of care (QoC) has gained increased attention in IBD. A better QoC has, historically, been linked to improved treatment outcomes. Even so, factors of equal importance to patients may be quality of life (QoL), patient-physician communication and access to care. Recent surveys suggest that IBD care in Europe is suboptimal. METHODS Patients were recruited from nine hospitals in the south-eastern and western part of Norway as a part of an observational, multicenter study In addition to clinical and socio-demographic factors; a purposely designed 26 item questionnaire was used to quantify aspects related to IBD care, including QoC. Moreover, the Fatigue Questionnaire (FQ) was used to investigate fatigue. RESULTS In total, 411 patients were included. Of these, 231 were diagnosed with CD and 180 with UC. Furthermore, 86.1% (354/411) were satisfied with the quality of IBD follow-up and only 4.1% (17/411) were dissatisfied. Most dissatisfaction was related to: lack of focus on personal relations (18.2%), HRQoL (15.1%), general practitioner knowledge of IBD (13.9%), ability to talk about important topics (7.8%), and hospital discharge communication (9.4%). Higher age and longer disease duration was associated with improved QoC scores in both UC and CD. Fatigue was associated with decreased QoC scores in both diagnoses. CONCLUSIONS Patients are satisfied with quality of care in IBD. However, communication seems to be an important area of improvement - not only related to patient-physician communication, but also to transitional communication between different health-care levels.
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Affiliation(s)
- Lars-Petter Jelsness-Jørgensen
- a Østfold University College, Health Science , Halden , Norway ;,b Department of Gastroenterology, Østfold University College, Health Science/Østfold Hospital Trust , Fredrikstad , Norway
| | - Tomm Bernklev
- c Department of Research , Telemark Hospital Trust , Skien , Norway
| | - Øistein Hovde
- d Institute of Clinical Medicine, University of Oslo , Nydalen , Oslo , Norway ;,e Department of Gastroenterology , Innlandet Hospital Trust , Gjøvik , Norway
| | - Ingrid Prytz Berset
- f Department of Gastroenterology , Møre and Romsdal Hospital Trust Ålesund , Ålesund , Norway
| | | | - Bjørn Moum
- h Department of Gastroenterology/University of Oslo , Oslo University Hospital, Institute of Clinical Medicine , Nydalen , Oslo , Norway
| | - Marte Lie Høivik
- i Department of Gastroenterology , Oslo University Hospital , Nydalen , Oslo , Norway
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Jelsness-Jørgensen LP, Frigstad SO, Moum B, Grimstad T, Opheim R, Jahnsen J, Bernklev T. Pain may be an important factor to consider in inflammatory bowel disease patients troubled by fatigue. United European Gastroenterol J 2016; 5:687-693. [PMID: 28815032 DOI: 10.1177/2050640616674654] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 09/20/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Pain has been associated with fatigue in many chronic diseases, but data are not available for inflammatory bowel disease (IBD). The aim of this study was to investigate whether fatigue is associated with pain in IBD after adjusting for the relevant covariates. METHODS Participants were recruited from nine hospitals in the south-eastern and western part of Norway. Socio-demographic variables were self-reported by patients. Disease activity was assessed by disease activity indices and faecal calprotectin. Patient-reported outcomes (PROs) were collected using the Fatigue Questionnaire (FQ), Brief Pain Inventory (BPI), Hospital Anxiety and Depression Scale (HADS) and Basic Nordic Sleep Questionnaire. RESULTS From a total of 452 invited patients, 414 (91.6%) provided written informed consent. After excluding any missing data, 408 total patients were included in the analyses (ulcerative colitis = 180 and Crohn's disease = 228). In the crude analysis, substantial and chronic fatigue were associated with increased pain intensity regardless of the diagnosis. However, when controlling for relevant covariates in the ANCOVA, the differences in pain intensity among patients with and without substantial or chronic fatigue were insignificant. The Cohen's d effect size was small to moderate (>0.20) in patients with chronic fatigue. CONCLUSIONS Despite a tendency of elevated pain intensity scores among patients with fatigue, these differences were insignificant after controlling for the relevant covariates. However, based on Cohen's effect size, these differences may be of clinical importance in a subset of patients.
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Affiliation(s)
- Lars-Petter Jelsness-Jørgensen
- Østfold University College, Department of Health Sciences/Østfold Hospital Trust, Department of Gastroenterology, Fredrikstad, Norway
| | - Svein-Oskar Frigstad
- Vestre Viken Hospital Trust, Department of Gastroenterology/Østfold Hospital Trust, Department of Internal Medicine, Norway
| | - Bjørn Moum
- Oslo University Hospital, Department of Gastroenterology/University of Oslo, Oslo, Norway
| | - Tore Grimstad
- Stavanger University Hospital, Department of Gastroenterology, Stavanger, Norway
| | - Randi Opheim
- Oslo University Hospital, Department of Gastroenterology/University of Oslo, Oslo, Norway
| | - Jørgen Jahnsen
- Akershus University Hospital, Department of Gastroenterology, Lørenskog, Norway; University of Oslo, Institute of Clinical Medicine, Oslo, Norway
| | - Tomm Bernklev
- Telemark Hospital Trust, Department of Research/University of Oslo, Skien, Norway
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Linqvist Leonardsen AC, Del Busso L, Abrahamsen Grøndahl V, Ghanima W, Barach P, Jelsness-Jørgensen LP. A qualitative study of patient experiences of decentralized acute healthcare services. Scand J Prim Health Care 2016; 34:317-24. [PMID: 27559763 PMCID: PMC5036023 DOI: 10.1080/02813432.2016.1222200] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Municipality acute wards (MAWs) have recently been launched in Norway as an alternative to hospitalizations, and are aimed at providing treatment for patients who otherwise would have been hospitalized. The objective of this study was to explore how patients normally admitted to hospitals perceived the quality and safety of treatment in MAWs. DESIGN The study had a qualitative design. Thematic analysis was used to analyze the data. SETTING The study was conducted in a county in south-eastern Norway and included five different MAWs. PATIENTS Semi-structured interviews were conducted with 27 participants who had required acute health care and who had been discharged from the five MAWs. RESULTS Three subthemes were identified that related to the overarching theme of hospital-like standards ("almost a hospital, but…"), namely (a) treatment and competence, (b) location and physical environment, and (c) adequate time for care. Participants reported the treatment to be comparable to hospital care, but they also experienced limitations. Participants spoke positively about MAW personnel and the advantages of having a single patient room, a calm environment, and proximity to home. CONCLUSIONS Participants felt safe when treated at MAWs, even though they realized that the diagnostic services were not similar to that in hospitals. Geographical proximity, treatment facilities and time for care positively distinguished MAWs from hospitals, while the lack of diagnostic resources was stressed as a limitation. Key points Municipality acute wards (MAWs) have been implemented across Norway. Research on patient perspectives on the decentralization of acute healthcare in MAWs is lacking. • Patients perceive decentralized acute healthcare and treatment as being comparable to the quality they would have expected in hospitals. • Geographical proximity, a home-like atmosphere and time for care were aspects stressed as positive features of the decentralized services. • Lack of diagnostic resources was seen as a limitation.
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Affiliation(s)
- Ann-Chatrin Linqvist Leonardsen
- Department of Research, Østfold Hospital Trust, Sarpsborg, Østfold, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- CONTACT Ann-Chatrin Linqvist Leonardsen Department of Research, Østfold Hospital Trust, Sarpsborg, Østfold, Norway/Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lilliana Del Busso
- Faculty of Health and Social Studies, Østfold University College, Sarpsborg, Østfold, Norway
| | | | - Waleed Ghanima
- Department of Research, Østfold Hospital Trust, Sarpsborg, Østfold, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Paul Barach
- Wayne University School of Medicine, Detriot, MI, USA
| | - Lars-Petter Jelsness-Jørgensen
- Department of Research, Østfold Hospital Trust, Sarpsborg, Østfold, Norway
- Faculty of Health and Social Studies, Østfold University College, Sarpsborg, Østfold, Norway
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Jelsness-Jørgensen LP, Moum B, Grimstad T, Jahnsen J, Opheim R, Prytz Berset I, Hovde Ø, Torp R, Frigstad SO, Huppertz-Hauss G, Bernklev T. Validity, Reliability, and Responsiveness of the Brief Pain Inventory in Inflammatory Bowel Disease. Can J Gastroenterol Hepatol 2016; 2016:5624261. [PMID: 27446848 PMCID: PMC4930809 DOI: 10.1155/2016/5624261] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 04/24/2016] [Accepted: 05/29/2016] [Indexed: 01/24/2023] Open
Abstract
Background and Aims. No patient-reported outcome measures targeting pain have yet been validated for use in IBD patients. Consequently, the aim of this study was to test the psychometrical properties of the brief pain inventory (BPI) in an outpatient population with IBD. Methods. Participants were recruited from nine hospitals in the southeastern and western parts of Norway. Clinical and sociodemographic data were collected, and participants completed the BPI, as well as the Short-Form 36 (SF-36). Results. In total, 410 patients were included. The BPI displayed high correlations with the bodily pain dimension of the SF-36, as well as moderate correlations with disease activity indices. The BPI also displayed excellent internal consistency (Cronbach's alpha value of 0.91, regardless of diagnosis) and good to excellent test-retest values (intraclass correlation coefficient (ICC) 0.84-0.90 and Kappa values > .70). In UC, calculation of responsiveness revealed that only BPI interference in patients reporting improvement reached the threshold of 0.2. In CD, Cohen's d ranged from 0.26 to 0.68. Conclusions. The BPI may serve as an important supplement in patient-reported outcome measurement in IBD. There is need to confirm responsiveness in future studies. Moreover, responsiveness should ideally be investigated using changes in objective markers of inflammation.
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Affiliation(s)
- Lars-Petter Jelsness-Jørgensen
- Health Science, Østfold University College, Postboks 700, 1757 Halden, Norway
- Department of Gastroenterology, Østfold Hospital Trust, Fredrikstad, Norway
| | - Bjørn Moum
- Department of Gastroenterology, Oslo University Hospital, Postboks 4959 Nydalen, 0424 Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Postboks 1072 Blindern, 0316 Oslo, Norway
| | - Tore Grimstad
- Department of Gastroenterology, Stavanger University Hospital, Armauer Hansensvei 20, 4011 Stavanger, Norway
| | - Jørgen Jahnsen
- Institute of Clinical Medicine, University of Oslo, Postboks 1072 Blindern, 0316 Oslo, Norway
- Department of Gastroenterology, Akershus University Hospital, Postboks 1000, 1478 Lørenskog, Norway
| | - Randi Opheim
- Department of Gastroenterology, Oslo University Hospital, Postboks 4959 Nydalen, 0424 Oslo, Norway
- Institute of Health and Society, University of Oslo, Postboks 1072 Blindern, 0316 Oslo, Norway
| | - Ingrid Prytz Berset
- Department of Gastroenterology, Møre and Romsdal Hospital Trust, 6026 Ålesund, Norway
| | - Øistein Hovde
- Institute of Clinical Medicine, University of Oslo, Postboks 1072 Blindern, 0316 Oslo, Norway
- Department of Gastroenterology, Innlandet Hospital Trust, Kyrre Grepps Gate 11, 2819 Gjøvik, Norway
| | - Roald Torp
- Department of Gastroenterology, Innlandet Hospital Trust, Postboks 104, 2381 Brumunddal, Norway
| | - Svein Oskar Frigstad
- Department of Gastroenterology, Vestre Viken Hospital Trust, Postboks 800, 3004 Drammen, Norway
- Department of Internal Medicine, Østfold Hospital Trust, Postboks 300, 1714 Grålum, Norway
| | | | - Tomm Bernklev
- Institute of Clinical Medicine, University of Oslo, Postboks 1072 Blindern, 0316 Oslo, Norway
- O&U, Telemark Hospital Trust, 3710 Skien, Norway
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Jelsness-Jørgensen LP. Does a 3-week critical research appraisal course affect how students perceive their appraisal skills and the relevance of research for clinical practice? A repeated cross-sectional survey. Nurse Educ Today 2015; 35:e1-5. [PMID: 25459171 DOI: 10.1016/j.nedt.2014.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 09/15/2014] [Accepted: 09/22/2014] [Indexed: 05/06/2023]
Abstract
BACKGROUND Research utilisation is essential in developing evidence-based practices; although many students may be generally able to adopt such skills, there are reports of barriers related to critical appraisal skills. OBJECTIVES To explore how students perceive the relevance of research to future clinical practice and patients, and to what extent they read research (including reading pattern). Additionally, the objective was to explore whether a three-week intensive course in critical appraisal of research could affect these variables. DESIGN A cross-sectional survey design, with a pre- and post-test. SETTINGS One large university college in Southeastern Norway. PARTICIPANTS 196 multidisciplinary healthcare students at baseline and 147 after three weeks. METHODS A purposely-designed 21 item questionnaire was used to quantify students' attitudes towards using research and critical thinking. The questionnaire was based on themes emerging from prior focus group interviews with 10 nursing and social educator students as well as from the existing literature. RESULTS At baseline, 6.1% and 7.1% of respondents perceived the research to be of little or very little importance for their future work and patients, respectively. Furthermore, 83.2% reported that they seldom or very seldom read scientific papers. At baseline, 40 different patterns of reading a scientific paper were identified. Additionally, 7.1% of respondents reported to read the introduction, methods and conclusion in combination. Significantly improved scores were found after completing the three-week course related to a) relevance of research for future work (p<0.01), b) self-perceived skills in critical appraisal (p<0.001), c) ability to find scientific papers (p≤0.01), and d) relevance of research for patients and users (p≤0.001). CONCLUSIONS Teaching students' practical critical appraisal skills improved their view of the relevance of research for patients, future work as well as their own critical appraisal skills. Prospective studies are warranted to explore the effects of such teaching modules in the long-term.
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Winsvold Prang I, Jelsness-Jørgensen LP. Should I report? A qualitative study of barriers to incident reporting among nurses working in nursing homes. Geriatr Nurs 2014; 35:441-7. [PMID: 25305674 DOI: 10.1016/j.gerinurse.2014.07.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 07/16/2014] [Accepted: 07/19/2014] [Indexed: 10/24/2022]
Abstract
Adverse events, errors and acts of inadequate care have been shown to occur quite frequently in hospitals, and there is growing evidence that this poor care may also occur in nursing homes. Based on hospital studies, we know that incidents are only reported to a limited extent and that there may be a high number of unrecorded cases. Moreover, little is known about the barriers to incident reporting in nursing homes compared to hospitals. Consequently, the aim of this study was to explore the barriers to incident reporting in nursing homes. Thematic analysis of 13 semi-structured interviews with nurses revealed that unclear outcomes, lack of support and culture, fear of vilification and conflicts, unclear routines, technological knowledge and confidence, time and degree of severity were the main drivers of not reporting incidents. These findings may be important in planning quality and safety improvement interventions in nursing homes.
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Jelsness-Jørgensen LP, Lerang F, Sandvei P, Søberg T, Henriksen M. Magnetic endoscopic imaging during colonoscopy is associated with less pain and decreased need of analgesia and sedation--results from a randomized controlled trial. Scand J Gastroenterol 2013; 48:890-5. [PMID: 23721208 DOI: 10.3109/00365521.2013.800992] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Colonoscopy is the method of choice for examining patients with lower gastrointestinal symptoms. The procedure is, however, in many cases, associated with pain and impaired compliance. Magnetic endoscopic imaging (MEI) generates a three-dimensional image of the colonoscope on a computer screen which may enable the colonoscopist to avoid looping, and consequently improve patient satisfaction. MATERIAL AND METHODS In this randomized controlled trial, 200 outpatients referred to colonoscopy at Østfold Hospital Trust, Fredrikstad, Norway, were included. Patients were randomized to either the standard arm (using fluoroscopy on demand, n = 100), or the MEI arm (n = 100). End points were time to cecum, subjective pain experiences, and use of sedation or analgesics. RESULTS Out of a total of 200 patients, 54% were men. However, no significant differences between the groups according to gender were found. Fluoroscopy was applied in 23% of the cases in the standard group. Use of MEI was associated with decreased time to cecum (p < 0.05), decreased pain scores (Visual Analogue Scale, p < 0.05), decreased need of analgesia (p < 0.01), and decreased amount of administered midazolam and pethidin (p < 0.05 in both). CONCLUSIONS MEI during colonoscopy was associated with decreased pain and less on-demand requests for sedation and analgesia. In addition, the use of MEI reduced the cecal intubation time. Consequently the implementation of magnetic endoscopic imaging in the endoscopy suits may be beneficial, particularly in the clinically difficult cases.
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Jelsness-Jørgensen LP, Bernklev T, Moum B. Fatigue and disease-related worries among inflammatory bowel disease patients in remission; is it a reflection of coexisting IBS-like symptoms? A short report. J Psychosom Res 2012; 73:469-72. [PMID: 23148817 DOI: 10.1016/j.jpsychores.2012.08.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 08/10/2012] [Accepted: 08/15/2012] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Irritable bowel syndrome (IBS) like symptoms and fatigue are frequently reported in quiescent inflammatory bowel disease (IBD). We hypothesized that coexisting IBS-like symptoms might be associated with increased levels of fatigue and disease-related worries. METHODS A total of 140 IBD outpatients were assessed. Cut-off for remission was <4 and <3 on the disease activity indices SCDAI and SCCAI. In addition patients on current steroid treatment were excluded. A diagnosis of IBS was based on the Rome criteria. Fatigue was measured with the Fatigue Questionnaire (FQ), disease related worries with the Rating Form of IBD Patient Concerns (RFIPC). RESULTS Eighty-nine patients fulfilled the criteria for remission. Of these 89 patients, 21 and 30 were IBS positive according to the Rome II and III criteria, respectively. FQ scores were significantly elevated in IBS positive UC patients. Clinical significant differences were also found in relation to RFIPC scores. CONCLUSION Coexisting IBS-like symptoms among IBD patients in remission are associated with an increased level of fatigue and disease-related worries.
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Jelsness-Jørgensen LP, Bernklev T, Henriksen M, Torp R, Moum B. Is patient reported outcome (PRO) affected by different follow-up regimens in inflammatory bowel disease (IBD)? A one year prospective, longitudinal comparison of nurse-led versus conventional follow-up. J Crohns Colitis 2012; 6:887-94. [PMID: 22398072 DOI: 10.1016/j.crohns.2012.01.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 01/01/2012] [Accepted: 01/24/2012] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Specialist nurses have become increasingly involved in the management of Inflammatory Bowel Disease (IBD). The objectives of this study were to investigate the impact of nurse-led versus conventional follow-up on patient outcomes, such as quality of life, worries and time from relapse to start of treatment. METHODS Patients completed the Short Form 36 (SF-36), Inflammatory Bowel Disease Questionnaire (N-IBDQ) and the Rating Form of IBD Patient Concerns (RFIPC) at baseline and after 1 year. Socio-demographic and clinical variables were obtained at V1 and V2. In addition the amount of e.g., relapses, hospitalisations, time from relapse to start of treatment, sick-leave, unscheduled visits or telephone calls was recorded during the follow-up period. RESULTS A total of 140 patients were included; ulcerative colitis (UC) n=92, Crohn's disease (CD) n=48, mean age 46.9 and 40.0 years old, respectively. One hundred and thirty three patients attended the follow-up after 1 year. After 1 year there were no differences between the groups in relation to quality of life, worries, amount of relapse, sick-leave, hospitalisations or surgery. Participants in nurse-led follow-up had a significantly (p<0.05) shorter interval from the start of a relapse to the start of treatment. CONCLUSIONS Nurse-led follow-up of IBD patients produces PRO results comparable to that of gastroenterologists and may shorten the interval from the beginning of a relapse to the start of treatment.
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Jelsness-Jørgensen LP. Commentary on ST Houweling, N Kleefstra, KJJ van Hateren, KH Groenier, B Meyboom-de Jong & HJG Bilo (2011) Can diabetes management be safely transferred to practice nurses in a primary care setting? A randomised controlled trial. Journal of Clinical Nursi. J Clin Nurs 2012; 21:595-6. [DOI: 10.1111/j.1365-2702.2011.03902.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Jelsness-Jørgensen LP, Bernklev T, Moum B. Quality of life in patients with inflammatory bowel disease: translation, validity, reliability and sensitivity to change of the Norwegian version of the short health scale (SHS). Qual Life Res 2011; 21:1671-6. [PMID: 22146840 DOI: 10.1007/s11136-011-0081-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2011] [Indexed: 12/23/2022]
Abstract
PURPOSE The aims of this study were to investigate the psychometric properties of the Norwegian version of the short health scale (SHS), and to study the impact of socio-demographic and clinical data. METHODS A total of 140 patients without severe disease activity were included. The participants completed the SHS and three other well-validated HRQoL questionnaires short form 36, inflammatory bowel disease questionnaire and the rating form of inflammatory bowel disease patient concerns at the baseline. Sixty-three participants completed the SHS at a second visit after 6 months in order to calculate test-retest reliability and responsiveness. In addition, socio-demographic and clinical variables were obtained and entered into a linear regression analysis if they were found to be significantly associated with SHS outcome. RESULTS Validity was confirmed by good correlation with other similar HRQoL constructs and the ability to discriminate between IBD symptom scores. The reliability was strong (Cronbach's α 0.85). The test-retest reliability in three out of four SHS items was weak, but the questionnaire demonstrated a good responsiveness. Current IBD symptoms were the most important predictor of SHS outcome. CONCLUSIONS The Norwegian SHS demonstrated satisfactory psychometrical properties and is suitable for use in the follow-up of IBD patients.
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Jelsness-Jørgensen LP, Bernklev T, Henriksen M, Torp R, Moum BA. Chronic fatigue is more prevalent in patients with inflammatory bowel disease than in healthy controls. Inflamm Bowel Dis 2011; 17:1564-72. [PMID: 21674713 DOI: 10.1002/ibd.21530] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Accepted: 09/21/2010] [Indexed: 12/21/2022]
Abstract
BACKGROUND Fatigue is a common symptom in chronic disease. Few studies, however, have focused on fatigue related to inflammatory bowel disease (IBD). The aim was to determine the prevalence of fatigue in IBD and to identify demographic and clinical factors that influence fatigue. METHODS Patients in remission and with mild and moderate IBD completed the Fatigue Questionnaire (FQ). Higher FQ scores indicate greater levels of fatigue. In addition, demographic and clinical variables were obtained. Corresponding FQ data from healthy controls (HC) are based on 2287 Norwegian citizens. RESULTS In total, 140 patients were included, mean age 43.9 years (SD 16.4), male/female = 61/79, ulcerative colitis (UC) / Crohn's disease (CD) = 92/48. Total fatigue (TF) was 14.4, 14.7, and 12.2 for UC, CD, and HC, respectively. Chronic fatigue (CF), defined as substantial fatigue with duration more than 6 months, was reported in 29% (14/48) of CD and 22% (20/92) of UC compared to 11% (260/2287) of HC (P < 0.001 for both diagnoses). Linear regression analysis confirmed hemoglobin values, present gastrointestinal symptoms, and altered sleep to be the most important predictors of CF. CONCLUSIONS Chronic fatigue is more common in patients with UC and CD compared with healthy controls. IBD symptoms, hemoglobin values, and altered sleep patterns are significant predictors of CF.
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Affiliation(s)
- Lars-Petter Jelsness-Jørgensen
- Østfold Hospital Trust, Fredrikstad, Norway, Oslo University Hospital Aker, Oslo, Norway, University of Oslo, Institute of Clinical Medicine, Oslo, Norway.
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Jelsness-Jørgensen LP, Ribu L, Bernklev T, Moum BA. Measuring health-related quality of life in non-complicated diabetes patients may be an effective parameter to assess patients at risk of a more serious disease course: a cross-sectional study of two diabetes outpatient groups. J Clin Nurs 2011; 20:1255-63. [PMID: 21401763 DOI: 10.1111/j.1365-2702.2010.03554.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To describe health-related quality of life in diabetes outpatients and investigate the impact of diabetic foot ulcers, by comparing a group of patients with and without diabetic foot ulcers complications. Secondary to study the impact of sociodemographic and clinical variables in the two groups. DESIGN Cross-sectional study. METHODS The study involved 130 diabetes outpatients and 127 diabetic foot ulcers patients. Health-related quality of life was measured with the generic questionnaire Short Form-36, consisting of eight dimensional scores. All scores were adjusted for differences in age and gender (estimated marginal means). Differences were compared with anova calculations, by the use of Predictive Analytics Software, PASW (version 17.0). RESULTS This study confirms that health-related quality of life differs significantly between disease subgroups when measured with Short Form-36. Diabetic foot ulcers had a major negative impact on 7/8 subscales on the Short Form-36 compared to the diabetes outpatients group. health-related quality of life decreased with increasing amount of complications and comorbidity in the diabetes outpatients group, with cardiovascular complications being the most pronounced predictor of lower health-related quality of life scores. CONCLUSION Patients who have developed diabetic foot ulcers reports much poorer health-related quality of life than compared to diabetes outpatients. Factors linked to the development of late complications were not detected in the diabetic foot ulcers group, such as cardiovascular comorbidity and neuropathy. RELEVANCE TO CLINICAL PRACTICE Health-related quality of life measurement in early stages of disease may detect patients at risk of a more serious disease course and who consequently are in need of a more intensive follow-up.
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