Early practice of use of video consultations in rehabilitation of hand injuries in children and adults: Content, acceptability, and cost-effectiveness.

BACKGROUND: Video consultation was implemented as a new service in a hospital hand therapy setting. PURPOSE: To describe the first year's practice of video consultations in the rehabilitation of upper extremity injuries, evaluate the acceptability, and investigate economic effects. STUDY DESIGN: Iterative design including economic evaluation. METHODS: Using the framework early health technology assessment, 13 hand therapists described characteristics of 99 video consultations, under predefined headlines: the patients' municipally, adult vs child, time use, technical, content, and usefulness compared to physical consultations. The text was coded and categorized according to 22 techniques or tools used by hand therapists, and challenges were identified. Acceptability was assessed on a three-graded adjectival scale. To illustrate the costs associated with video vs physical consultations, we drafted different scenarios based on the data and stakeholder insights. RESULTS: Of 99 planned video consultations (16 with children), 88 were completed. Techniques or tools most frequently used were the performance of exercises (n = 55), orthoses (n = 26), and daily activities (n = 23). Technical challenges were common, and observation of children could be difficult. Eleven of the completed consultations were rated as not acceptable and 77 as acceptable and as either useful (n = 28) or very useful (n = 49). Four drafted scenarios showed cost savings of video consultations for the health institution and society, highest at longer travel distances and in other cases where the patient could claim refunds related to travel and time away from work and home. CONCLUSIONS: The results show therapeutic possibilities and points to areas for improvements and illustrate settings where the use of video may save costs for the health institution and society.

Downgrading of referrals to breast cancer patient pathway. / Nedprioritering av henvisninger til pakkeforløp for brystkreft.

BACKGROUND: The purpose of the study was to investigate whether the downgrading of external referrals to breast cancer patient pathways was clinically justifiable and led to a more correct prioritisation of patients who are referred to the specialist health service. MATERIAL AND METHOD: The study included 214 external referrals to breast cancer patient pathways at the Breast Screening Centre, Oslo University Hospital, which were downgraded in 2020 since they did not meet the national criteria. The information obtained from electronic patient records included age, district of Oslo, name of referring doctor, outcome after investigation and treatment, as well as recommended timeframe for initiating the investigation. The quality of the referrals was also assessed. RESULTS: A total of 3 % (7/214) of patients were diagnosed with breast cancer. Five were in the age group 40-50 years (9 %, 5/56), one was over the age of 50 years (1/31) and one was in the age group 35-40 years (1/38). None were below the age of 35 years. A total of 95 doctors had their referrals downgraded. INTERPRETATION: The study indicated that the downgrading of referrals to breast cancer patient pathways led to a more correct prioritisation of patients who are referred to the specialist health service. The results indicated that the downgrading was clinically justifiable for the age groups under 35 years and over 50 years, but that caution must be exercised when downgrading referrals in the age group 40-50 years.

The effect of employment support integrated in substance use treatment: A health economic cost-effectiveness simulation of three different interventions.

Background: Unemployment rates for individuals in treatment for substance use disorder (SUD) are high, with Norwegian estimates in the range of 81%-89%. Although Individual Placement and Support (IPS) represents a promising method to improved vocational outcome, cross-disciplinary investigations are needed to document implementation benefits and address reimbursements needs. The aim of this study was to model the potential socioeconomic value of employment support integrated in SUD treatment. Methods: Based on scientific publications, an ongoing randomised controlled trial (RCT) on employment support integrated in SUD treatment, and publicly available economy data, we made qualified assumptions about costs and socioeconomic gain for the different interventions targeting employment for patients with SUD: (1) treatment as usual (TAU); (2) TAU and a self-help guide and a workshop; and (3) TAU and IPS. For each intervention, we simulated three different outcome scenarios based on 100 patients. Results: Assuming a 40% employment rate and full-time employment (100%) for 10 years following IPS, we found a 10-year socioeconomic effect of €18,732,146. The corresponding effect for the more conservative TAU + IPS simulation assuming 40% part-time positions (25%) for five years, was €2,519,906. Compared to the two alternative interventions, IPS was cost-effective and more beneficial after six months to two years. Discussion: This concept evaluation study suggests that integrating employment support in the health services is socioeconomically beneficial. Our finding is relevant for decision makers within politics and health. Once employment rates from our ongoing RCT is available, real-life data will be applied to adjust model assumptions and socioeconomic value assumptions.

Sustained reduction of tinnitus several years after sequential cochlear implantation.

OBJECTIVE: This study aimed to explore the short- and long-term effects of a second cochlear implant (CI-2) on the reduction of tinnitus annoyance and tinnitus handicap. DESIGN: In a combined retrospective and prospective cohort study, tinnitus annoyance was measured before receiving the CI-2 (Pre), more than two years after (Post1) and more than seven years after (Post2), using the Tinnitus Handicap Inventory (THI), the Visual Analog Scale for the assessment of perceived tinnitus loudness (VAS-L) and annoyance (VAS-A), and a self-report questionnaire. STUDY SAMPLE: Twenty sequentially bilaterally implanted adults with bothersome tinnitus. RESULTS: CI-2 implantation resulted in a statistically significant reduction of tinnitus handicap from severe at Pre to mild at Post1 (THI mean score reduced from 61.3 [SD = 19.4] to 29.3 [SD = 23.5]). The reduction in tinnitus annoyance was statistically significant from Pre to Post 2 (VAS-A reduced from 7.1 [SD = 1.5] to 3.4 [SD = 2.2]). The reduction in tinnitus loudness was not statistically significant. CONCLUSIONS: The provision of a CI-2 for severely and profoundly hearing-impaired individuals with bothersome tinnitus is an effective method of providing long-term tinnitus relief.

Enabling Guidelines for the Adoption of eHealth Solutions: Scoping Review.

BACKGROUND: Globally, public health care is under increasing pressure, an economic burden currently amplified by the COVID-19 outbreak. With the recognition that universal health coverage improves the health of a population and reduces health inequalities, universal health coverage has been acknowledged as a priority goal. To meet the global needs in a population with increased chronic illness and longer life expectancy, the health care system is in dire need of new, emerging technologies. eHealth solutions as a method of delivery may have an impact on quality of care and health care costs. As such, it is important to study methods previously used to avoid suboptimal implementation and promote general guidelines to further develop eHealth solutions. OBJECTIVE: This study aims to explore and thematically categorize a selected representation of early phase studies on eHealth technologies, focusing on papers that are under development or undergoing testing. Further, we want to assess enablers and barriers in terms of usability, scaling, and data management of eHealth implementation. The aim of this study to explore early development phase and feasibility studies was an intentional effort to provide applicable guidelines for evaluation at different stages of implementation. METHODS: A structured search was performed in PubMed, MEDLINE, and Cochrane to identify and provide insight in current eHealth technology and methodology under development and gain insight in the future potential of eHealth technologies. RESULTS: In total, 27 articles were included in this review. The clinical studies were categorized thematically by illness comparing 4 technology types deemed relevant: apps/web-based technology, sensor technology, virtual reality, and television. All eHealth assessment and implementation studies were categorized by their focus point: usability, scaling, or data management. Studies assessing the effect of eHealth were divided into feasibility studies, qualitative studies, and heuristic assessments. Studies focusing on usability (16/27) mainly addressed user involvement and learning curve in the adoption of eHealth, while the majority of scaling studies (6/27) focused on strategic and organizational aspects of upscaling eHealth solutions. Studies focusing on data management (5/27) addressed data processing and data sensitivity in adoption and diffusion of eHealth. Efficient processing of data in a secure manner, as well as user involvement and feedback, both throughout small studies and during upscaling, were the important enablers considered for successful implementation of eHealth. CONCLUSIONS: eHealth interventions have considerable potential to improve lifestyle changes and adherence to treatment recommendations. To promote efficient implementation and scaling, user involvement to promote user-friendliness, secure and adaptable data management, and strategical considerations needs to be addressed early in the development process. eHealth should be assessed during its development into health services. The wide variation in interventions and methodology makes comparison of the results challenging and calls for standardization of methods.

On the integration of early health technology assessment in the innovation process: reflections from five stakeholders.

Early health technology assessment (HTA), which includes all methods used to inform industry and other stakeholders about the potential value of new medical products in development, including methods to quantify and manage uncertainty, has seen many applications in recent years. However, it is still unclear how such early value assessments can be integrated into the technology innovation process. This commentary contributes to the discussion on the purposes early HTA can serve. Similarities and differences in the perspectives of five stakeholders (i.e., the hospital, the patient, the assessor, the medical device industry, and the policy maker) on the purpose, value, and potential challenges of early HTA are described. All five stakeholders agreed that integrating early HTA in the innovation process has the possibility to shape and refine an innovation, and inform research and development decisions. The early assessment, using a variety of methodologies, can provide insights that are relevant for all stakeholders but several challenges, for example, feasibility and responsibility, need to be addressed before early HTA can become standard practice. For early evaluations to be successful, all relevant stakeholders including patients need to be involved. Also, nimble, flexible assessment methods are needed that fit the dynamics of medical technology. Best practices should be shared to optimize both the innovation process and the methods to perform an early value assessment.

A Web-Based Communication Platform to Improve Home Care Services in Norway (DigiHelse): Pilot Study.

BACKGROUND: Home care service in Norway is struggling to meet the increasing demand for health care under restricted budget constraints, although one-fourth of municipal budgets are dedicated to health services. The integration of Web-based technology in at-home care is expected to enhance communication and patient involvement, increase efficiency and reduce cost. DigiHelse is a Web-based platform designed to reinforce home care service in Norway and is currently undergoing a development process to meet the predefined needs of the country's municipalities. Some of the main features of the platform are digital messages between residents and the home care service, highlighting information on planned and completed visits, the opportunity to cancel visits, and notifications for completed visits. OBJECTIVE: This study aimed to test the usability and economic feasibility of adopting DigiHelse in four districts in Oslo by applying registry and behavioral data collected throughout a one-year pilot study. Early health technology assessment was used to estimate the potential future value of DigiHelse, including the predictive value of behavior data. METHODS: Outcome measures identified by stakeholder insights and scenario drafting in the project's concept phase were used to assess potential socioeconomic benefits. Aggregated data were collected to assess changes in health consumption at baseline, and then 15 and 52 weeks after DigiHelse was implemented. The present value calculation was updated with data from four intervention groups and one control group. A quasi-experimental difference-in-difference design was applied to estimate the causal effect. Descriptive behavioral data from the digital platform was applied to assess the usability of the platform. RESULTS: Over the total study period (52 weeks), rates increased for all outcome estimates: the number of visits (rate ratio=1.04; P=.10), unnecessary trips (rate ratio=1.37; P=.26), and phone calls (rate ratio=1.24; P=.08). A significant gap was found between the estimated value of DigiHelse in the concept phase and after the one-year pilot. In the present pilot assessment, costs are expected to exceed potential savings by €67 million (US $75 million) over ten years, as compared to the corresponding concept estimates of a potential gain of €172.6 million (US $193.6 million). Interestingly, behavioral data from the digital platform revealed that only 3.55% (121/3405) of recipients actively used the platform after one year. CONCLUSIONS: Behavioral data provides a valuable source for assessing usability. In this pilot study, the low adoption rate may, at least in part, explain the inability of DigiHelse to perform as expected. This study points to an early assessment of behavioral data as an opportunity to identify inefficiencies and direct digital development. For DigiHelse, insight into why the recipients in Oslo have not made greater use of the Web-based platform seems to be the next step in ensuring the right improvement measures for the home care service.

Early assessment of innovation in a healthcare setting.

OBJECTIVES: Early assessment can assist in allocating resources for innovation effectively and produce the most beneficial technology for an institution. The aim of the present study was to identify methods and discuss the analytical approaches applied for the early assessment of innovation in a healthcare setting. METHODS: Knowledge synthesis based on a structured search (using the MEDLINE, Embase, and Cochrane databases) and thematic analysis was conducted. An analytical framework based on the stage of innovation (developmental, introduction, or early diffusion) was applied to assess whether methods vary according to stage. Themes (type of innovation, study, analysis, study design, method, and main target audience) were then decided among the authors. Identified methods and analysis were discussed according to the innovation stage. RESULTS: A total of 1,064 articles matched the search strategy. Overall, thirty-nine articles matched the inclusion criteria. The use of methods has a tendency to change according to the stage of innovation. Stakeholder analysis was a prominent method in the innovation stages and particularly in the developmental stage, as the introduction and early diffusion stage has more availability of data and may apply more complex methods. Barriers to the identified methods were also discussed as all of the innovation stages suffered from lack of data and substantial uncertainty. CONCLUSIONS: Although this review has identified applicable approaches for early assessment in different innovation stages, research is required regarding the value of the available data and methods and tools to enhance interactions between different parties at different stages of innovation.

Acceptability, usability and utility of a personalised application in promoting behavioural change in patients with osteoarthritis: a feasibility study in Norway.

OBJECTIVE: The dynamic and interactive mobile application Vett was designed to help change behaviour and is based on cognitive, motivational and visual techniques. Our aim is to investigate the acceptability, usability and utility of Vett as a personalised application for goal achievement. SETTING: The trial took place at the rheumatology clinic at Diakonhjemmet Hospital, Oslo, Norway from January to June 2015. PARTICIPANTS: Twelve participants with osteoarthritis were recruited from a 3.5-hour multidisciplinary group-based educational programme (osteoarthritis school). INTERVENTIONS: With the help of a physician, each participant followed a customised 12-week mixed-mode goal achievement plan with digital support based on preset goals, self-monitoring and individual feedback. Acceptability was measured as the perceived degree of goal achievement using a validated habit questionnaire scaled from 0 to 100. Utility and usability were assessed via 10 weekly questions and adherence by fulfilment of predetermined tasks. RESULTS: Mean goal achievement was 73 (95% CI 68 to 78), an increase of 22 (95% Cl 17 to 26, p<0.01), which equals 48% improvement (95% CI 32% to 59%). Mean user satisfaction was 81 (95% CI 76 to 85), and technical usability was 80 (95% CI 75 to 84), which both increased during the study period. CONCLUSION: The high levels of acceptability, usability and utility support the feasibility of the personalised application Vett as a viable goal achievement tool.

Prescribing antibiotics when the stakes are higher - do GPs prescribe less when patients are pregnant? A retrospective observational study.

BACKGROUND: Most oral antibiotics are prescribed by GPs, and they are therefore the most important influencers with regard to improving antibiotic prescription patterns. Although GPs' prescription patterns in general are well-studied, little is known about antibiotic prescription patterns in pregnancy. AIM: To study GPs' antibiotic prescriptions in respiratory tract infections (RTIs) during pregnancy, and assess differences, if any, between pregnant and non-pregnant patients. DESIGN & SETTING: Retrospective observational study combining prescription data from the Norwegian Peer Academic Detailing (Rx-PAD) study database, pregnancy data from the Norwegian birth registry, and pharmacy dispension data from the Norwegian Prescription Database (NorPD). METHOD: Records of patient contacts with 458 GPs, between December 2004 and February 2007, were screened for RTI episodes. Similar diagnoses were grouped together, as were similar antibiotics. Episodes were categorised according to whether the patient was pregnant or not, and included women aged 16-46 years. Logistic regression models were used to assess odds ratios (ORs), and calculated relative risks (cRRs) were produced. The authors also adjusted for clustering at various levels. RESULTS: Overall prescription rate for RTI episodes was 30.8% (n = 96 830). The cohort was reduced to include only episodes with women pregnant in the study period (n = 18 890). The antibiotic prescription rate in pregnancy was 25.9% versus 34.2% in the time before and after pregnancy (cRR = 0.66 [95% confidence intervals {CI} = 0.68 to 0.81]).During pregnancy, 83.0% of the antibiotic prescriptions were picked up at a pharmacy, compared to an 86.6% filling rate in non-pregnant patients. The difference was not significant when adjusting for clustering at the patient level. CONCLUSION: Norwegian GPs prescribe fewer antibiotics overall when patients are pregnant and, when they do prescribe, choose more narrow spectrum antibiotics for RTIs. This indicates a possible lower target rate for GP prescriptions to females. A low antibiotic dispension rate during pregnancy may represent a discussion topic in the consultation setting, to address possible reasons and avoid under-treatment.

An Evaluation of Motivational Interviewing for Increasing Hearing Aid Use: A Pilot Study.

BACKGROUND: Motivational interviewing (MI) has been used in consultation settings to motivate hearing aid users to increase hearing aid usage. However, the effect of MI on those who use their hearing aids only rarely or not at all has not been explored. PURPOSE: The aims of this pilot study were to evaluate the effect of MI counseling with elderly hearing aid recipients found to have low hearing aid use at a six-month follow-up appointment and to describe clients' subjective assessments of their perceived need for hearing aids three months after MI counseling. RESEARCH DESIGN: The study had a within-subjects pretest-posttest design. STUDY SAMPLE: Forty seven hearing aid recipients who had used their new hearing aids, an average of <90 min/day, were recruited at a follow-up appointment six months after hearing aid fitting. INTERVENTION: Thirty minutes of MI counseling was provided at the six-month follow-up appointment. If needed, hearing aid adjustments and technical support were also provided. DATA COLLECTION AND ANALYSIS: The effect of MI counseling in combination with adjustments and technical support was assessed in relation to datalogged hearing aid use, which was assessed immediately before (at the six-month follow-up) and three months after (at the nine-month follow-up) the intervention. Hearing aid experiences were also assessed three months after MI. RESULTS: Thirty seven participants (79%) returned for the nine-month follow-up visit and had modest but significant increases in datalogged hearing aid use in the three months following MI counseling. Of the 37 participants who returned, 51% had increased their hearing aid use to at least 2 h/day after the MI counseling. Most of the 37 participants who attended the nine-month follow-up reported increased need for (59%) or increased benefit and contentment with (57%) their hearing aid three months after MI; these participants also had significantly higher datalogged hearing aid use following MI. CONCLUSIONS: These findings suggest that follow-up appointments using MI counseling in conjunction with technical support may be useful for increasing hearing aid usage among low-users, and a randomized controlled trial is warranted.

Relationship between Maternal and First Year of Life Dispensations of Antibiotics and Antiasthmatics.

Antibiotics are the most frequent prescription drugs used by pregnant women. Our objective was to investigate if the dispensation of antibiotics and antiasthmatics in children less than 1 year of age is associated with prenatal antibiotic exposure. A secondary aim was to explore the incidence of dispensed antibiotics in pregnancy and dispensed antibiotics and antiasthmatics in children. We conducted an observational study using the Peer Academic Detailing study database to select patients eligible for match in the Medical Birth Registry of Norway, a total of 7747 mother-and-child pairs. Details on antibiotic and antiasthmatic pharmacy dispensations were obtained from the Norwegian Prescription Database. One quarter (1948 of 7747) of the mothers in the study had been dispensed antibiotics during pregnancy. In their first year of life, 17% (1289) of the children had had an antibiotic dispensation, 23% (1747) an antiasthmatic dispensation, and 8% (619) of the children had had both. We found a significant association between dispensed antibiotics in pregnancy and dispensed antibiotics to the child during their first year of life; OR = 1.16 (95% CI: 1.002⁻1.351). The association was stronger when the mothers were dispensed antibiotics at all, independent of the pregnancy period; OR = 1.60 (95% CI: 1.32⁻1.94). We conclude that the probability for dispensation of antibiotics was increased in children when mothers were dispensed antibiotics, independent of pregnancy. Diagnostic challenges in the very young and parental doctor-seeking behavior may, at least in part, contribute to the association between dispensations in mothers and children below the age of one year.

The Effectiveness of Smartphone Apps for Lifestyle Improvement in Noncommunicable Diseases: Systematic Review and Meta-Analyses.

BACKGROUND: Noncommunicable diseases (NCDs) account for 70% of all deaths in a year globally. The four main NCDs are cardiovascular diseases, cancers, chronic pulmonary diseases, and diabetes mellitus. Fifty percent of persons with NCD do not adhere to prescribed treatment; in fact, adherence to lifestyle interventions is especially considered as a major challenge. Smartphone apps permit structured monitoring of health parameters, as well as the opportunity to receive feedback. OBJECTIVE: The aim of this study was to review and assess the effectiveness of app-based interventions, lasting at least 3 months, to promote lifestyle changes in patients with NCDs. METHODS: In February 2017, a literature search in five databases (EMBASE, MEDLINE, CINAHL, Academic Research Premier, and Cochrane Reviews and Trials) was conducted. Inclusion criteria was quantitative study designs including randomized and nonrandomized controlled trials that included patients aged 18 years and older diagnosed with any of the four main NCDs. Lifestyle outcomes were physical activity, physical fitness, modification of dietary habits, and quality of life. All included studies were assessed for risk of bias using the Cochrane Collaboration`s risk of bias tool. Meta-analyses were conducted for one of the outcomes (glycated hemoglobin, HbA1c) by using the estimate of effect of mean post treatment with SD or CI. Heterogeneity was tested using the I2 test. All studies included in the meta-analyses were graded. RESULTS: Of the 1588 records examined, 9 met the predefined criteria. Seven studies included diabetes patients only, one study included heart patients only, and another study included both diabetes and heart patients. Statistical significant effect was shown in HbA1c in 5 of 8 studies, as well in body weight in one of 5 studies and in waist circumference in one of 3 studies evaluating these outcomes. Seven of the included studies were included in the meta-analyses and demonstrated significantly overall effect on HbA1c on a short term (3-6 months; P=.02) with low heterogeneity (I2=41%). In the long term (10-12 months), the overall effect on HbA1c was statistical significant (P=.009) and without heterogeneity (I2=0%). The quality of evidence according to Grading of Recommendations Assessment, Development and Evaluation was low for short term and moderate for long term. CONCLUSIONS: Our review demonstrated limited research of the use of smartphone apps for NCDs other than diabetes with a follow-up of at least 3 months. For diabetes, the use of apps seems to improve lifestyle factors, especially to decrease HbA1c. More research with long-term follow-up should be performed to assess the effect of smartphone apps for NCDs other than diabetes.

Panel 1: Epidemiology and Diagnosis.

Objective To create a literature review between 2011 and June 1, 2015, on advances in otitis media (OM) epidemiology and diagnosis (including relevant audiology studies). Data Sources Electronic search engines (PubMed, EMBASE, and Cochrane Library) with a predefined search strategy. Review Methods Articles with appropriate epidemiologic methodology for OM, including acute mastoiditis and eustachian tube dysfunction. Items included OM worldwide and in high-risk populations, OM-related hearing loss, news in OM diagnostics, prenatal risk factors and comorbidities, postnatal risk factors, genetics, microbiological epidemiology, guidelines, and quality of life. Conclusions Diagnostic evidence and genetic studies are increasing; guidelines are introduced worldwide; and there is evidence of benefit of pneumococcal conjugate vaccines. New risk factors and comordities are identified in the study period, and quality of life is affected in children and their families. Implications for Practice Chronic suppurative OM occurs worldwide and contributes to lifelong hearing loss. Uniform definitions are still lacking and should be provided. An association between HIV and chronic suppurative OM has been found. Tympanometry is recommended for diagnosis, with or without pneumatic otoscopy. Video otoscopy, algorithms, and validated questionnaires may assist clinicians. Childhood obesity is associated with OM. Heritability accounts for 20% to 50% of OM diagnoses. OM-prone children seem to produce weaker immunologic responses to pneumococcal conjugate vaccines. Clinicians tend to individualize treatment without adhering to guidelines.

Association of excessive daytime sleepiness with migraine and headache frequency in the general population.

BACKGROUND: Some previous studies have postulated an association between migraine and excessive daytime sleepiness (EDS). This study evaluated the association of EDS with migraine and headache frequency in a general population, after adjusting for potential confounding variables. METHODS: The study was a postal survey of a random age and gender-stratified sample of 40,000 persons aged 20 to 80 years old drawn by the National Population Register in Norway. The questionnaire included questions about migraine, headache, the Epworth sleepiness scale (ESS) and various comorbidities. EDS was defined as ESS > 10. The association of EDS and migraine/headache were analysed by bivariate and multivariable logistic regression analyses. RESULTS: A total of 21,177 persons responded to the ESS and were included in the analyses. The odds ratio (OR) for EDS was increased for migraineurs (1.42 (95% CI 1.31─1.54), p < 0.001) compared to non-migraineurs; however, this finding was not significant after adjustment for a number of possible confounders. EDS increased with increasing headache frequency, with an OR of 2.74 (95% CI 2.05─3.65), p < 0.001) for those with headache on >179 days per year compared to those without headache in multivariable analysis. CONCLUSIONS: In a general population, the odds for EDS increased significantly with the headache frequency, irrespective of migraine status. EDS was not associated with reported migraine in multivariable analysis.

Lack of ear care knowledge in nursing homes.

BACKGROUND: Rising life expectancy means an increase in the number of elderly people with hearing loss in the population. Many elderly people live in nursing homes, with varying care needs. A substantial proportion of these people will need help with their hearing aids and other hearing devices. OBJECTIVE: The objective of the study has been to assess the knowledge, experience, skills, competence, and need for information of staff at nursing homes in relation to residents' hearing loss and hearing aids. MATERIALS AND METHODS: One hundred and ninety-five employees at seven nursing homes participated in the study. The main approach was a descriptive study, using questionnaires. RESULTS: The main findings are that 73% of informants found that many residents need help with their hearing aids. Only one-tenth report that they know enough about the residents' hearing aids. Almost four out of five informants find that the residents become socially isolated as a result of hearing loss. Seventy-eight percent agree to some extent that more residents would benefit from hearing aids. CONCLUSION: Staff at nursing homes have insufficient knowledge about hearing loss and hearing aids. Increased focus on the elderly with hearing impairment in nursing homes is needed. Contact between nursing homes and audiological specialists should be improved to best followup hearing loss and hearing aids.

Improved Clinical Efficacy with Wound Support Network Between Hospital and Home Care Service.

OBJECTIVE: The aim of this study was to test the efficacy of a wound support network model between the primary home care service and the hospital. The impact on wound healing rate, cost benefit, and transfer of knowledge was investigated. INTERVENTION: The intervention group was exposed to a wound support network (n = 32), and the control group continued standard organization of treatment (n = 21). DESIGN: Nonrandomized controlled study; observations were made before (baseline) and after the implementation of the intervention (12 weeks). PATIENTS: Patients with chronic wounds (lasting >6 weeks and with wound area >1 cm) in Oslo, Norway. MAIN OUTCOME MEASURES: Closure of the observation wound; wound size; total number of wounds; presence of eczema, edema, and pain; number of dressings per week; time spent per dressing; and number of control appointments at the hospital. The economic impact is calculated for the hospital and for the community of Oslo, Norway. MAIN RESULTS: The number of control appointments (t = 3.80, P < .001) was significantly decreased, and the number of completed treatments (P = .02) was significantly increased after 12 weeks in the intervention group compared with the control group. A significant improvement was evident in the intervention group in terms of eczema (P = .02), edema (P = .03), and closing of the observational wound (46.7% cases in the intervention group versus 25.0% in the control group). CONCLUSIONS: A wound support network between the primary home care service and the hospital is cost-effective, improves clinical efficacy of the home care services' work, and reduces the need for consultations at the hospital.

Headache in sleep apnea syndrome: epidemiology and pathophysiology.

This review investigates the relation between obstructive sleep apnea and sleep apnea headache, migraine and tension-type headache. Focus is made on studies from the general population with interviews conducted by a physician and obstructive sleep apnea confirmed by polysomnography. Obstructive sleep apnea syndrome is observed in 3% of the middle-aged population. The prevalence of sleep apnea headache in this population is 12%-18%, while morning headache with similar symptomatology as sleep apnea headache occur in 5%-8% of the general population. People with sleep apnea headache did have significantly more minutes below 90% oxygen saturation (23.1 min vs. 1.9 min, p = 0.002), higher level of average oxygen desaturation (5.9% vs. 4.5%, p < 0.001) and lower average of the lowest oxygen saturation (80.9% vs. 88.5%, p < 0.001) than people with morning headache. A comparison of those with obstructive sleep apnea with or without sleep apnea headache showed no significant differences. Thus, oxygen desaturation alone cannot explain the pathophysiology of sleep apnea headache. Obstructive sleep apnea and migraine, and obstructive sleep apnea and tension-type headache are not related in the general population. The cause of sleep apnea headache remains to be elucidated.

Obstructive sleep apnea in younger school children with Down syndrome.

OBJECTIVE: We aimed to assess the prevalence of obstructive sleep apnea (OSA) in 8 year old school children with Down syndrome (DS). While the prevalence in otherwise healthy children is below 5%, the prevalence estimates in children with DS are uncertain (30-80%). OSA directly affects cognitive development and school performance. STUDY DESIGN: Population based cross sectional study in a limited geographical area. METHODS: Polysomnography (PSG) with video and audio recordings was performed in 8-year-old children with DS in a pediatric sleep unit according to the guidelines of American Academy of Sleep Medicine. Twenty-nine of all 32 children with DS within a restricted area comprising >50% of the Norwegian population and 54% of the children with DS born in Norway in 2002 were enrolled. RESULTS: This study reports an apnea hypopnea index AHI>1.5 in 28 of 29 children and an obstructive apnea index (OAI)>1 in 24 of 29 children. 19 children (66%) had an AHI>5 and 17 children (59%) had an OAI>5 which indicated moderate to severe OSA. No correlation was found between OSA and obesity or gender. CONCLUSION: The high prevalence of disease found in these previously undiagnosed 8-year-old children underlines the importance of performing OSA diagnostics in children with DS throughout childhood. These findings suggest that the prevalence of OSA remains high up to early school years. In contrast to earlier publications, this current study has the advantage of being population based, the study is performed on children of a narrow age band to estimate prevalence of disease and the diagnostic gold standard of PSG is applied.