Patient Involvement in the Rehabilitation Process Is Associated with Improvement in Function and Goal Attainment: Results from an Explorative Longitudinal Study.

The objective was to explore the associations between patient involvement in the rehabilitation process and improvements in function and goal attainment in the first year after rehabilitation. The longitudinal multicenter study RehabNytte provided data from participants who had been referred to rehabilitation (n = 2113). Quality indicator (QI) pass rates (% yes) were used to assess patient involvement in the rehabilitation process. The Patient-Specific Functional Scale (PSFS) (10 = best possible) was used to assess function. The outcome QI on goal achievement (response options of yes/no) was used to assess goal attainment. Logistic regression and paired sample t-tests were used to examine associations and mean changes in function from rehabilitation admission up to 3, 6, and 12 months. Most participants (95%) were involved in goal-setting, which was positively associated with younger age (OR 0.97, 95% CI 0.95-0.99) and female sex (OR 1.87, 95% CI 1.15-3.02). Function improved over the follow-up period, with greater improvements in the active goal-setting group. Being involved in goal planning almost tripled the odds of goal attainment (OR 2.78, 95% CI 1.60-4.83) and involvement in the rehabilitation plan almost doubled it (OR 1.99, 95% CI 1.41-2.81). Most participants were involved in rehabilitation goal-setting/planning and being involved was associated with beneficial functional outcomes and greater goal attainment.

Work Ability in the Year after Rehabilitation-Results from the RehabNytte Cohort.

BACKGROUND: There is limited knowledge regarding the impact of rehabilitation on work ability. The aim of this study was to explore factors associated with work ability 12 months following a multidisciplinary rehabilitation program in a cohort with different diagnoses. METHODS: Of 9108 potentially eligible participants for the RehabNytte research project, 3731 were eligible for the present study, and 2649 participants (mean age 48.6 years, 71% female) consented to contribute with work-related data, and were included. Self-perceived work ability was assessed by the Work Ability Score (WAS) (0-10, 10 = best), during the follow-up period using paired t-tests and logistic regression to examine associations between demographic and disease-related factors and work ability at 12-month follow-up. RESULTS: The mean baseline WAS for the total cohort was 3.53 (SD 2.97), and increased significantly to 4.59 (SD 3.31) at 12-month follow-up. High work ability (WAS ≥ 8) at 12 months was associated with high self-perceived health at the baseline (OR 3.83, 95% CI 2.45, 5.96), while low work ability was associated with a higher number of comorbidities (OR 0.26, 95% CI 0.11, 0.61), medium pain intensity (OR 0.56, 95% CI 0.38, 0.83) and being married or cohabiting (OR 0.61, 95% CI 0.43, 0.88). There were no significant differences in work ability between participants receiving occupational and standard rehabilitation. CONCLUSIONS: Work ability increased significantly over the follow-up period. High work ability at 12-month follow-up was associated with high self-perceived health at baseline, while being married or cohabiting, having higher number of comorbidities, and experiencing medium baseline pain intensity was associated with lower work ability. Rehabilitation interventions targeting these factors may potentially enhance work ability, leading to a positive impact on work participation among people in need of rehabilitation.

Patient engagement in the development and delivery of healthcare services: a systematic scoping review.

BACKGROUND: Patient engagement (PE) is required to improve future healthcare services. PE in the development and delivery of healthcare services is likely to be complex but is scarcely described. OBJECTIVES: The objective of this scoping review was to summarise primary studies on mesolevel PE regarding structure, process and outcomes. More specifically, the aim was to explore barriers and facilitators to successful PE, how persons are engaged in the process and summarise reported consequences. METHOD: A systematic scoping review was conducted, searching the MEDLINE, EMBASE, Cochrane and PsycINFO databases. Primary studies, published between 7 July 2005 and 4 October 2022, were considered for inclusion. Two reviewers extracted data about PE (eg, attributes of PE settings, facilitators and barriers, and outcomes to PE) and the first author coded the extracted data into structural, processual and outcome themes. RESULTS: Of 8588 identified records, 37 studies were eligible. Most of the included studies were conducted in Europe (n=19; 51%) and North America (n=13; 35%). Structures that ensure sufficient stakeholder representativeness and PE knowledge through education may facilitate the PE process further, regardless of the environmental setting. Interpersonal relationships with uneven power dynamics were reported as noteworthy processual barriers to meaningful PE, while clearly described roles and tasks were reported as important facilitators. In contrast to hard outcomes with operationalised PE effects, the most noteworthy outcomes of PE were reported as soft processual consequences such as patient representatives improving their self-esteem and feeling valued. CONCLUSIONS: Unfortunately, there is a dearth of studies exploring hard and operationalised PE outcomes on healthcare services and patients receiving healthcare. The PE process may be facilitated by dedicated finances to PE education and by ensuring sufficient stakeholder representativeness.

Organisation, influence, and impact of patient advisory boards in rehabilitation institutions-an explorative cross-sectional study.

BACKGROUND: Patient participation is highlighted as an important facilitator for patient-centered care. Patient participation organised as patient advisory boards (PABs) is an integral part of health care institutions in Norway. More knowledge is needed on how PAB representatives experience patient engagement (PE) with regard to organisation, influence, and impact. The objective was to describe how PAB representatives experience their tasks, roles, and impact on decision-making processes and service delivery in the setting of rehabilitation institutions. METHODS: PAB representatives recruited from rehabilitation institutions completed the Norwegian version of the generic Public and Patient Engagement evaluation tool (Norwegian abbreviation EBNOR). EBNOR is tested for reliability and validity with good results and comprises 35 items within four main domains, policies and practices, participatory culture, collaboration, and influence and impact that provide responses about PE-levels. The domain items are scored from "strongly disagree" to "strongly agree" on a five-point scale, in addition to a don't know category. Items in the domain "influence and impact" are scored from "never" to "all of the time" on a four-point scale. Categorical data were summarized using frequencies and percentages, and response categories were collapsed into three PE-levels: barrier, intermediate, and facilitating level. Free-text responses were analysed according to principles of manifest content analysis, summed up, and used to elaborate the results of the scores. RESULTS: Of the 150 contacted PAB representatives, 47 (32%) consented to participate. The results showed that approximately 75% agreed that the organisation as a whole was strengthened as a result of patient participation. Four out of five domains were scored indicating a facilitating level; policies and practices (53%), participatory culture (53%), collaboration and common purpose (37%), and final thoughts (63%). The modal score in the domain influence and impact was in the intermediate PE-level (44%). Of a total of 34 codes from free text analyses, barriers to PE were coded 26 times, and PE facilitators were coded 8 times. CONCLUSIONS: The findings indicate that most PAB representatives are satisfied with how rehabilitation institutions organise their PAB, but they still experience their impact as limited.

Neutropenia caused by hairy cell leukemia in a patient with myelofibrosis secondary to polycythemia vera: a case report.

BACKGROUND: Polycythemia vera is a myeloproliferative disease that sometimes evolves to myelofibrosis, causing splenomegaly and neutropenia. In this case report, we describe a patient with polycythemia vera and unexplained neutropenia who later turned out to also have hairy cell leukemia. CASE PRESENTATION: A middle-aged Caucasian man with polycythemia vera presented to our hospital with chronic mouth ulcers. Later he developed leukopenia and pancytopenia. Bone marrow biopsies showed fibrosis. Further morphological analyses of bone marrow and blood smears revealed probable transformation into acute myeloid leukemia. However, there were also cells indicating hairy cell leukemia. Morphological and immunohistochemical analyses later confirmed the presence of hairy cell leukemia in biopsies that had been present for 3 years. Treatment with cladribine temporarily reversed the patient's neutropenia. CONCLUSIONS: Hairy cell leukemia may mimic development to myelofibrosis in patients with polycythemia vera.

The challenges of describing rehabilitation services: A discussion paper.

To apply the Classification of Service Organization in Rehabilitation (ICSO-R) classification of services to different target groups, include the user perspective, identify missing categories, and propose standardized descriptors for the categories from a Norwegian perspective. Expert-based consensus conferences with user involvement. Health professionals, stakeholders and users. Participants were divided into 5 panels, which applied the ICSO-R to describe the habilitation and rehabilitation services provided to children with cerebral palsy and people with Huntington's disease, acquired brain injuries (traumatic brain injuries and stroke) and painful musculoskeletal conditions. Based on the Problem/Population, Intervention, Comparison, Outcome (PICO) framework, the services were described according to the ICSO-R. Missing categories were identified. The ICSO-R was found to be feasible and applicable for describing a variety of services provided to different target groups in Norway, but the user perspective was lacking, categories were missing, and a need for standardized description of the categories was identified. The present work supports the need to produce an updated version of the ICSO-R and to encourage national and international discussion of the framework. The ICSO-R has the potential to become a tool for the standardized assessment of rehabilitation services. For such purposes, more standardized descriptions of subcategories are necessary.

Primary human glioblastomas - prognostic value of clinical and histopathological parameters.

BACKGROUND: Glioblastoma (GBM) is the most common primary malignant human brain tumor with a poor prognosis. The diagnosis of GBM is based on histological features, however, few studies have evaluated their prognostic relevance in light of the latest WHO classification of 2007. AIM: In this study we have evaluated the prognostic value of several clinical and histological characteristics encountered in human GBMs according to the WHO 2007 criteria. MATERIAL AND METHODS: 199 patients with primary GBM consecutively operated and histologically reviewed according to the 2007 WHO scheme, were included. Several clinical and histological features were recorded and related to survival. RESULTS: Mean age of the GBM patients at diagnosis was 62 years (range 21 - 84). Male/female ratio was 1.3/1, and the median survival was 8.0 months (95% CI: 7.1 - 9.0 months). In a multivariate COX analysis age, WHO performance score, subcortical localization, extent of surgery, radiation treatment, chemotherapy, and the presence of large necrosis had individual effect on overall survival (p < 0.05). In addition, females, tumors with angiocentric growth, with pseudopalisades, or without lymphocyte infiltration were related to shorter survival in univariate analyses (p < 0.05). CONCLUSION: Our findings confirm the strong prognostic value of age, treatment, performance score, and localization for glioblastoma patients. Amongst the histopathological features only large necrosis was an independent prognostic factor.

Proliferative activity and histopathological features in diffuse grade II astrocytomas.

Due to the heterogeneous histopathology of diffuse astrocytomas we wanted to investigate the frequency of various histological features in grade II tumours. Herein we present the results of a microscopical examination and revision of 109 consecutively operated grade II tumours. The most frequent subtype was fibrillary astrocytoma (87%), whereas the gemistocytic and protoplasmic subtypes constituted 12% and 1% respectively. Cell density was subjectively classified and ranged from low to high; most cases were judged as low to moderate (approx. 90%). Cellular/nuclear atypia was assessed as mild, moderate and severe, and was in the majority of cases mild to moderate (96%). Mitoses were observed in about 25% of the cases with a median of 0 (range 0-3). Apoptotic figures, microcystic changes, Rosenthal fibres, microcalcification and eosinophilic bodies were identified in approx. 45%, 38%, 7%, 5% and 2% of the cases respectively. In about 60% of the cases so called secondary changes of Scherer were seen. Significant correlations between features related to malignancy, such as mitotic activity, apoptoses and high cell density, were established. Further, Ki-67/MIB-1 proliferation indices corresponded significantly with mitoses, apoptoses, atypia and high cell density. Accordingly, the variegated histopathological appearance of diffuse astrocytomas makes the diagnosis of these tumours challenging. Accordingly, it is essential to know and be aware of this morphological diversity in the daily routine. The use of Ki-67/MIB-1 immunostaining may improve the diagnostic accuracy.

Prognostic value of histological features in diffuse astrocytomas WHO grade II.

The histopathological diagnosis of diffuse astrocytoma is challenging. As the WHO classification system is based on subjective assessments, the prognosis for the individual patient is somewhat uncertain. The aim of this study was therefore to investigate the prognostic value of various histological features, Ki-67/MIB-1 labeling index (LI), and clinical factors. The study was designed as a retrospective study of 109 patients consecutively operated for their primary diffuse astrocytoma WHO grade II. Clinical data was collected from patient files. All routine stained sections were revised, and 20 different histological features were recorded, including cell density, atypia, mitoses, apoptoses, secondary structures (of Scherer), microcysts, and lymphocytic infiltration. Ki-67/MIB-1 LI was determined by conventional immunohistochemistry. Using uni- and multivariate analyses, the prognostic value of these factors was assessed as well as clinical parameters. Median age at primary surgery was 40 years (range 18-75). The median overall survival was 70 months with a minimum follow-up of 3 months. Neither histopathological features nor Ki-67/ MIB-1 LI (median value of 4.5% (range 0.1-16%) indicated unfavorable prognosis. However, age > 40 years, gender (male), poor preoperative performance score, and biopsy rather than resection were significant negative prognostic factors in both uni- and multivariate analyses. Among diffuse grade II astrocytomas neither any histopathological trait nor Ki-67/MIB-1 LI achieved prognostic significance, whereas clinical parameters were shown to serve as the major prognostic factors for these patients.

Evaluation of the proliferation markers Ki-67/MIB-1, mitosin, survivin, pHH3, and DNA topoisomerase IIα in human anaplastic astrocytomas--an immunohistochemical study.

BACKGROUND: Histological malignancy grading of astrocytomas can be challenging despite criteria given by the World Health Organisation (WHO). Grading is fundamental for optimal prognostication and treatment, and additional biomarkers are needed to support the histopathological diagnosis. Estimation of proliferative activity has gained much enthusiasm, and the present study was designed to evaluate and compare novel immunohistochemical proliferative markers in human anaplastic astrocytomas. METHODS: Proliferative activity was determined in twenty-seven cases with antibodies reactive against the Ki-67 antigen, mitosin, survivin, pHH3, and DNA topoisomerase IIα, and they were mutually compared as well as related to mitotic activity. RESULTS: The markers correlated well with each other, but poorly with mitoses, probably because of small and squeezed tumour samples, in which identification of mitoses can be difficult. Positive association to overall survival was observed as well. CONCLUSIONS: Our data show that these markers may assist significantly in the evaluation of proliferative activity in anaplastic astrocytomas and even have prognostic value.