Loss of life years due to unavailable helicopter emergency medical service: a single base study from a rural area of Norway.

Background: Despite the potential benefits of physician-staffed Helicopter Emergency Medical Service (HEMS), many dispatches to primary HEMS missions in Norway are cancelled before patient encounter. Information is sparse regarding the health consequences when medically indicated HEMS missions are cancelled and the patients are treated by a GP and ambulance staff only. We aimed to estimate the potential loss of life years for patients in these situations. Method: We included all HEMS requests in the period 2010-2013 from Sogn and Fjordane County that were medically indicated but subsequently cancelled. This provided a selection of patients, with the purpose of studying cancellations independently of the patient's medical status A multidisciplinary expert panel retrospectively assessed each patient's potential loss of life years due to the lack of helicopter transport and intervention by a HEMS physician. Results: The study included 184 patients from 176 missions. Because of unavailable HEMS, seven patients (4%) were anticipated to have lost a total of 18 life years. Three patients suffered from myocardial infarction, three from stroke and one from abdominal haemorrhage. The main contribution from HEMS care in these seven cases might have been rapid transport to definitive care. The probability of a patient losing life years when in need of HEMS evacuation was found to be 0.2%. Conclusion: During the four years period seven patients lost 18 life years. Lack of rapid transport seems to be the primary cause of lost life years in this specific geographical area. Key Points Knowledge about to what extent HEMS contributes to an increased survival and a better outcome for patients is limited. Compared to similar studies on life years gained the estimated loss of life years was minor when HEMS evacuation was unavailable in this rural area. The findings indicates that lack of rapid HEMS transport was the primary cause of the estimated loss of life years.

Endometrial ablation; less is more? Historical cohort study comparing long-term outcomes from two time periods and two treatment modalities for 854 women.

BACKGROUND: Abnormal uterine bleeding needs surgical treatment if medical therapy fails. After introduction of non-hysteroscopic endometrial ablation as alternative to hysteroscopic endometrial resection, we aimed to compare short and long-term outcomes for women treated with these two minimally-invasive procedures. A secondary goal was comparing the present cohort to a previous cohort of women treated with hysteroscopic resection only. MATERIALS AND METHODS: Historical cohort study of women treated for abnormal uterine bleeding with hysteroscopic resection or endometrial ablation at Haukeland University Hospital during 2006-2014. Similar patient file and patient-reported outcome data were collected from 386 hysteroscopic resections in a previous cohort (1992-1998). Categorical variables were compared by Chi-square or Fisher´s Exact-test, linear variables by Mann-Whitney U-test and time to hysterectomy by the Kaplan-Meier method. RESULTS: During 2006-2014, 772 women were treated with endometrial resection or ablation, 468 women (61%) consented to study-inclusion; 333 women (71%) were treated with hysteroscopic resection and 135 (29%) with endometrial ablation. Preoperative characteristics were significantly different for women treated with hysteroscopic resection compared to endometrial ablation in the 2006-2014-cohort and between the two time-cohorts regarding menopausal, sterilization and myoma status (p≤0.036). The endometrial ablation group had significantly shorter operation time, median 13 minutes (95% Confidence Interval (CI) 12-14) and a lower complication rate (2%) versus operation time, median 25 minutes (95% CI 23-26) and complication rate (13%) in the hysteroscopy group, all p ≤0.001. The patient-reported rate of satisfaction with treatment was equivalent in both groups (85%, p = 0.955). The endometrial ablation group had lower hysterectomy rate (8% vs 16%, p = 0.024). Patient-reported satisfaction rate was higher (85%) in the 2006-2014-cohort compared with the 1992-1998-cohort (73%), p<0.001. CONCLUSIONS: Endometrial ablation has similar patient satisfaction rate, but shorter operation time and lower complication rate and may be a good alternative to hysteroscopic resection for treatment of abnormal uterine bleeding.

Immunological fingerprinting of group B streptococci: from circulating human antibodies to protective antigens.

Group B streptococcus is one of the most important pathogens in neonates, and causes invasive infections in non-pregnant adults with underlying diseases. Applying a genomic approach that relies on human antibodies we identified antigenic GBS proteins, among them most of the previously published protective antigens. In vitro analyses allowed the selection of conserved candidate antigens that were further evaluated in murine lethal sepsis models using several GBS strains. In active and passive immunization models, we identified four protective GBS antigens, FbsA and BibA, as well as two hypothetical proteins, all shown to contribute to virulence based on gene deletion mutants. These protective antigens have the potential to be components of novel vaccines or targets for passive immune prophylaxis against GBS disease.

Transcervical endometrial resection: long-term results of 390 procedures.

BACKGROUND: Hysteroscopic transcervical resection of the endometrium and submucous fibroids has been performed to treat excessive uterine bleeding as an alternative to hysterectomy. The present study aims to evaluate the treatment effect of this procedure at our department. METHODS: Retrospective record review and a questionnaire 4-10 years after surgery. Patients' characteristics, symptoms, medical treatment prior to surgery, uterine size, weight of resectate, blood loss, glycine loss, operative time, complications, procedures per surgeon, indications, frequency and time to hysterectomy, dysmenorrhea related to prior tubal ligation, the presence of adenomyosis related to later hysterectomy, and patient satisfaction. RESULTS: In the period 1992-1998, 386 patients had 390 procedures performed by six different surgeons. 49.5% of patients had fibroids and 46.9% had a prior tubal sterilization. During operations, 6% had a hemoglobin loss of more than 2.5 g/dl, and 2.1% had a glycine loss of more than 1.51. Uterine perforations were encountered in 31 cases (8%), of which only 2 led to a laparotomy. During the time of follow-up of 4-10 years, 16.6% of patients had a hysterectomy, usually because of pain or bleeding, and 50% of these were done within 2 years after the initial hysteroscopic procedure. Malignancy was found in the resectate in 6 of the patients (1.5%) despite a normal preoperative cytological or histological endometrial sample, and all these had a hysterectomy. Adenomyosis was not related to later hysterectomy and dysmenorrhea did not seem to increase after the procedure. CONCLUSIONS: For 83.4% of the patients, the problem of uterine bleeding was solved by the hysteroscopic resection, and major surgery was avoided. Long-term results did not correlate to surgeon's experience. Patient satisfaction was high.