EOS - Environment & Oil Spill Response. An analytic tool for environmental assessments to support oil spill response planning: Framework, principles, and proof-of-concept by an Arctic example.

The Environment & Oil Spill Response tool (EOS), supports oil spill response planning and decision making. This tool is developed on a research basis, and is an index based, generic and open-source analytic tool, which environmentally can optimise the choice of oil spill response methods for a given spill situation and for a given sea area with respect to environment and nature. The tool is not linked to a particular oil spill simulation model, although it is recommended using oil spill simulation models to have detailed data available for the analysis. The EOS tool consists of an Excel workbook with formulas for calculations and scores followed by screening through decision trees. As case for the EOS tool proof-of-concept, the area of Store Hellefiskebanke, West Greenland, is used. The tool can be downloaded from the Aarhus University home page as a free-of-charge application and is accompanied by a handbook for guidance.

The Nordic governments' responses to the Covid-19 pandemic: A comparative study of variation in governance arrangements and regulatory instruments.

Government responses to the Covid-19 pandemic in the Nordic states-Denmark, Finland, Iceland, Norway, and Sweden-exhibit similarities and differences. This article investigates the extent to which crisis policymaking diverges from normal policymaking within the Nordic countries and whether variations between the countries are associated with the role of expertise and the level of politicization. Government responses are analyzed in terms of governance arrangements and regulatory instruments. Findings demonstrate some deviation from normal policymaking within and considerable variation between the Nordic countries, as Denmark, Finland, and to some extent Norway exhibit similar patterns with hierarchical command and control governance arrangements, while Iceland, in some instances, resembles the case of Sweden, which has made use of network-based governance. The article shows that the higher the influence of experts, the more likely it is that the governance arrangement will be network-based.

Balancing Governance Capacity and Legitimacy: How the Norwegian Government Handled the COVID-19 Crisis as a High Performer.

This essay addresses how the Norwegian government has handled the coronavirus pandemic. Compared with many other countries, Norway has performed well in handling the crisis. This must be understood in the context of competent politicians, a high-trust society with a reliable and professional bureaucracy, a strong state, a good economic situation, a big welfare state, and low population density. The Norwegian government managed to control the pandemic rather quickly by adopting a suppression strategy, followed by a control strategy, based on a collaborative and pragmatic decision-making style, successful communication with the public, a lot of resources, and a high level of citizen trust in government. The alleged success of the Norwegian case is about the relationship between crisis management capacity and legitimacy. Crisis management is most successful when it is able to combine democratic legitimacy with government capacity.

Developing a circumpolar programme for the monitoring of Arctic terrestrial biodiversity.

The Arctic is undergoing biological and environmental changes, and a coordinated effort to monitor is critical to detect these changes. The Circumpolar Biodiversity Monitoring Programme (CBMP) of the Arctic Council biodiversity working group, Conservation of Arctic Flora and Fauna (CAFF), has developed pan-Arctic biodiversity monitoring plans that aims to improve the ability to detect and report on long-term changes. Whilst introducing this special issue, this paper also presents the making of the terrestrial monitoring plan and discusses how the plan follows the steps required for an adaptive and ecosystem-based monitoring programme. In this article, we discuss how data on key findings can be used to inform circumpolar and global assessments, including the State of the Arctic Terrestrial Biodiversity Report, which will be the first terrestrial assessment made by the CBMP. Key findings, advice for future monitoring and lessons learned will be used in planning next steps of pan-Arctic coordinated monitoring.

Arctic terrestrial biodiversity status and trends: A synopsis of science supporting the CBMP State of Arctic Terrestrial Biodiversity Report.

This review provides a synopsis of the main findings of individual papers in the special issue Terrestrial Biodiversity in a Rapidly Changing Arctic. The special issue was developed to inform the State of the Arctic Terrestrial Biodiversity Report developed by the Circumpolar Biodiversity Monitoring Program (CBMP) of the Conservation of Arctic Flora and Fauna (CAFF), Arctic Council working group. Salient points about the status and trends of Arctic biodiversity and biodiversity monitoring are organized by taxonomic groups: (1) vegetation, (2) invertebrates, (3) mammals, and (4) birds. This is followed by a discussion about commonalities across the collection of papers, for example, that heterogeneity was a predominant pattern of change particularly when assessing global trends for Arctic terrestrial biodiversity. Finally, the need for a comprehensive, integrated, ecosystem-based monitoring program, coupled with targeted research projects deciphering causal patterns, is discussed.

Satellite-based decadal change assessments of pan-Arctic environments.

Remote sensing can advance the work of the Circumpolar Biodiversity Monitoring Program through monitoring of satellite-derived terrestrial and marine physical and ecological variables. Standardized data facilitate an unbiased comparison across variables and environments. Using MODIS standard products of land surface temperature, percent snow covered area, NDVI, EVI, phenology, burned area, marine chlorophyll, CDOM, sea surface temperature, and marine primary productivity, significant trends were observed in almost all variables between 2000 and 2017. Analysis of seasonal data revealed significant breakpoints in temporal trends. Within the terrestrial environment, data showed significant increasing trends in land surface temperature and NDVI. In the marine environment, significant increasing trends were detected in primary productivity. Significantly earlier onset of green up date was observed in bioclimate subzones C&E and longer end of growing season in B&E. Terrestrial and marine parameters showed similar rates of change with unidirectional change in terrestrial and significant directional and magnitude shifts in marine.

Pushing the Envelope: Laparoscopic Nephrectomy as Outpatient Surgery.

PURPOSE OF REVIEW: The purposes of this review were to identify the possible limiting factors prohibiting laparoscopic nephrectomy being performed as an outpatient surgery and optimize these limiting factors. RECENT FINDINGS: Laparoscopic nephrectomy for patients who have kidney cancer can be performed as an outpatient surgery in well-selected, well-educated, and well-informed patients in a well-prepared hospital culture. Patient confidence, pain, and hospital culture are the most important limiting factors to the performance of laparoscopic nephrectomy as an outpatient procedure. Controlling these factors leads to a high success rate for the outpatient procedure.

Hand-assisted laparoscopic versus laparoscopic nephrectomy as outpatient procedures: a prospective randomized study.

OBJECTIVES: The aims of this study were to discuss the hand-assisted laparoscopic nephrectomy (HALNo) outpatient procedure and compare it to the transperitoneal laparoscopic nephrectomy (LNo) outpatient procedure. MATERIALS AND METHODS: A prospective, randomized study of 30 patients with renal tumor who were recruited between November 2014 and February 2016 was performed. The primary endpoint of the study was length of hospital stay (LOS). RESULTS: Fifteen patients received HALNo and 15 received LNo, with a male to female ratio of 2:1. The mean age was 60 years for HALNo and 64 years for LNo (p = 0.62). All patients were discharged within 6 h after the operation. The mean ± SD operation time was 65 ± 24 min [95% confidence limits (CL) 51-79] and 69 ± 24 min (95% CL 56-83) for HALNo and LNo, respectively (p = 0.95). The mean time for which patients stayed at the postoperative care unit was 85 ± 53 min (95% CL 44-126) and 91 ± 66 min (95% CL 54-127) for HALNo and LNo, respectively (p = 0.14). The mean LOS was 220 ± 96 min (95% CL 155-284) and 272 ± 80 min (95% CL 224-320) for HALNo and LNo, respectively (p = 0.53). CONCLUSION: HALNo, when performed as an outpatient procedure, is safe and feasible for a well-informed, well-educated and well-selected patient group, and is comparable to LNo regarding postoperative LOS.

Laparoscopic Nephrectomy as Outpatient Surgery.

PURPOSE: We tested the feasibility and safety of performing laparoscopic nephrectomy as outpatient surgery in patients with renal cancer. MATERIALS AND METHODS: We performed a prospective, multicenter, descriptive study between April 2014 and February 2015 with postoperative followup at 30 days. A total of 140 patients were diagnosed with renal cancer during this period, of whom 50 met study inclusion criteria and agreed to participate. Reasons for exclusion from analysis included planned partial nephrectomy in 35 patients, lived alone without adequate home support in 17, advanced age or significant comorbid conditions in 33 and refusal to participate in 5. Pain, nausea, fatigue, operative time, bleeding, postoperative care unit stay and hospital stay were assessed. Continuous variables were compared by the paired t-test and categorical variables were compared by the Fisher exact test. RESULTS: Mean age of the 35 males (70%) and 15 females (30%) treated with planned outpatient surgery was 59.8 years. Of the patients 46 (92%) were discharged home within the first 6 hours after surgery. Four patients (8%) could not be discharged due to wrong medication in 2, fatigue in 1 and intestinal injury in 1. None of the 46 patients discharged early were readmitted to the hospital. In 2 patients with wound infection oral antibiotic treatment achieved good results without rehospitalization. CONCLUSIONS: Laparoscopic nephrectomy may be performed as outpatient surgery in carefully selected patients who meet inclusion criteria, representing greater than 40% of candidates for the surgery. Our study demonstrates that outpatient nephrectomy may be done safely and does not require hospital readmission.

Overtreatment of prostate cancer may be prevented by extended pelvic lymphadenectomy.

OBJECTIVE: Pelvic lymphadenectomy remains the gold standard for providing a diagnosis of lymph node metastasis (N1) in prostate cancer patients who may be candidates for curatively intended radiotherapy (RT). The limited lymphadenectomy technique (L-PLND) provides removal of only a minority of lymph nodes within the expected regions of lymph node drainage of the prostate. We describe our extended lymphadenectomy (e-PLND) and the pathological outcome with a modified template as described by Briganti and compare it with L-PLND. MATERIAL AND METHODS: This was a retrospective study of 44 patients who underwent e-PLND and 36 patients who underwent L-PLND. The lymph node dissection regions were divided into: I the external iliac field, II the obturator field and III the internal iliac field. RESULTS: The mean age was 70.2 years for e-PLND and 68.9 years for L-PLND. There was no significant difference in preoperative prostate-specific antigen (PSA), Gleason score or clinical stage between the two cohorts of patients. The mean operative time was 95 min. (range 75-140 min.) for e-PLND and 82 min. (range 30-145 min.) for L-PLND (p = 0.03). N1 was found in 18 (41%) and six (17%) in e-PLND versus L-PLND, respectively (p = 0.03). Six of the 44 (13.6%) patients who underwent e-PLND had N1 exclusively outside the region related to the limited dissection technique. CONCLUSION: e-PLND is safe and can prevent overtreatment of at least 13.6% of the prostate cancer patients who may be candidates for RT. Positive needle-core biopsies have a direct impact on N1. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.

Promising early results after hand-assisted laparoscopic partial nephrectomy in carefully selected patients.

INTRODUCTION: The incidence of the diagnosis of renal cell carcinoma has increased during the past two decades. Kidney damage occurring beyond 30 min of warm ischaemia is significant and mostly irreversible, even in completely normal renal systems. The aim of this study was to evaluate the role and safety of early removal of renal artery clamps and its influence on warm ischaemia time and renal function. MATERIAL AND METHODS: Data from 15 patients who underwent hand-assisted laparoscopic partial nephrectomy (HALPN) were collected retrospectively. The operative method was as follows. The kidney was dissected using hand-assisted laparoscopic technique, the gerotic fascia was dissected and a complete exploration of the kidney was achieved. A vascular bulldog clamp was removed from the renal artery immediately after the tumour resection bed had been closed with a running suture with Hem-o-Lok clips at either end. RESULTS: The size of tumours ranged between 2 cm and 7 cm. The mean warm ischaemia time was 11.2 min. The mean estimated glomerular filtration rate had decreased by 7.8 ml/min/1.73 m(2) metres (11%) six months after the operation. The estimated blood loss was less than 200 ml. The mean operating time was 119 min and the mean postoperative hospital stay was 3.2 days. There was no need for postoperative blood transfusions, and neither delayed bleeding nor urinary leakage occurred. CONCLUSION: Early removal of renal artery clamps during HALPN is associated with a considerable decrease in warm ischaemia time and renal function preservation and pre- and postoperative outcomes are acceptable. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.

Prolonged length of hospital stay in Denmark after nephrectomy.

INTRODUCTION: Implementation of the principles of a fast-track surgical programme resulted in a decrease in the length of hospital stay after open nephrectomies. The aim of this study was to describe the regional distribution of nephrectomies, postoperative hospital stay and mortality. MATERIAL AND METHODS: This study was based on data extracted from the Danish National Patient Registry for the 2000-2009-period. RESULTS: A total of 6,790 nephrectomies were performed. The mean postoperative stay and mortality decreased from 10.1 days and 2.6% during the 2000-2004-period to 8.3 days (p > 0.05) and 1.7% (p < 0.05) during the 2005-2009-period. A significant decrease in length of postoperative stay (6.4 versus 9.0 days; p < 0.05) and mortality (0.9% versus 2.1%; p < 0.05) was found between laparoscopic and open nephrectomies, respectively, during the 2005-2009-period. Nephrectomies performed by laparoscopic technique rose from 7.6% to 30.8% (p < 0.05) and laparoscopic nephroureterectomies from 1.7% to 10.3% (p < 0.05) from the 2000-2004-period to the 2005-2009-period. CONCLUSION: We recommend the implementation of fast-track surgery programmes to further decrease postoperative stay and mortality. A further increase in the use of laparoscopy is warranted.

Norwegians GPs' use of electronic patient record systems.

OBJECTIVE: To evaluate GPs use of three major electronic patient record systems with emphasis on the ability of the systems to support important clinical tasks and to compare the findings with results from a study of the three major hospital-wide systems. METHODS: A national, cross-sectional questionnaire survey was conducted in Norwegian primary care. 247 (73%) of 338 GPs responded. Proportions of the respondents who reported to use the EPR system to conduct 23 central clinical tasks, differences in the proportions of users of different EPR systems and user satisfaction and perceived usefulness of the EPR system were measured. RESULTS: The GPs reported extensive use of their EPR systems to support clinical tasks. There were no significant differences in functionality between the systems, but there were differences in reported software and hardware dysfunction and user satisfaction. The respondents reported high scores in computer literacy and there was no correlation between computer usage and respondent age or gender. A comparison with hospital physicians' use of three hospital-wide EPR systems revealed that GPs had higher usage than the hospital-based MDs. Primary care EPR systems support clinical tasks far better than hospital systems with better overall user satisfaction and reported impact on the overall quality of the work. CONCLUSION: EPR systems in Norwegian primary care that have been developed in accordance with the principles of user-centered design have achieved widespread adoption and highly integrated use. The quality and efficiency of the clinical work has increased in contrast to the situation of their hospital colleagues, who report more modest use and benefits of EPR systems.

[Endovascular treatment of dysfunctional haemodialysis fistulas]. / Endovaskulaer behandling af dysfungerende haemodialysefistle.

INTRODUCTION: A native AV-fistula (AVF) is the first choice of access for haemodialysis. An important complication is thrombosis, which typically results from an underlying stenosis. In 2001, we introduced a surveillance program measuring the access flow (Qa). At the same time percutaneous transluminal angioplasty (PTA) was introduced as the first choice of treatment. MATERIAL AND METHODS: Qa was conducted in a routine monitoring programme. Flow rates below a preset value indicated patient referral for angiography, and if the angiography revealed a significant stenosis, PTA was performed. In the period from August 2001 to March 2004, 71 angioplasties were performed in 52 patients. RESULTS: The technical success rate was 66/71 (93%). Clinically significant complications occurred at a rate of 3/71 (4%). The 2-year primary patency rate was 36% and the primary assisted patency rate was 67%. CONCLUSION: PTA in native haemodialysis fistulas was implemented. The rates of technical success, complications and patency were comparable with those recorded in the literature.

Metastatic interdigitating dendritic cell sarcoma masquerading as a skin primary tumor: a case report and review of the literature.

We report an unusual case of a lymph node interdigitating dendritic cell sarcoma (IDCS), metastatic to skin, in a 73-year-old patient. The patient initially presented as having a primary skin tumor with lymph node metastasis. The metastatic IDCS was initially read as an atypical fibroxanthoma. However, the morphology seen on the lymph node excision, paired with immunohistochemistry and electron microscopy studies, was diagnostic for an IDCS. Additional immunohistochemistry was performed on the shave biopsy, confirming that the skin tumor was a metastasis. IDCS is a rare tumor that belongs to the histiocytic and dendritic cell group of tumors. Diagnosing this entity is difficult without the aid of ancillary testing such as immunohistochemistry and electron microscopy. In the workup of a spindle cell neoplasm, IDCS should be included in the differential diagnosis.

Expectations for the next generation of electronic patient records in primary care: a triangulated study.

BACKGROUND: Although primary care physicians are satisfied users of electronic patient records (EPRs) in Norway today, EPR systems may not have reached their full potential. We studied primary care physicians' needs and experiences in relation to EPRs and analysed potential improvements for today's EPR systems. RESPONDENTS AND METHODS: This is a triangulated study that compares qualitative and quantitative data from focus groups, observations of primary care encounters and a questionnaire survey. RESULTS: General practioners (GPs) were not satisfied with the level of availability of information within EPR systems. They were especially concerned about follow-up for chronic disease and dealing with patients with multiple conditions. Many expressed a desire for reminders and easier access to clinical guidelines under normal working conditions, as well as the possibility of consultations with specialists from their EPR systems. GPs placed importance on the ability to communicate electronically with patients. CONCLUSIONS: Progress toward a problem-oriented EPR system based on episodes of care that includes decision support is necessary to satisfy the needs expressed by GPs. Further research could solve the problem of integration of functionality for consultation with specialists and integration with patient held records. Results from this study could contribute to further development of the next generation of EPRs in primary care, as well as inspire the application of EPRs in other parts of the health sector.

Instant availability of patient records, but diminished availability of patient information: a multi-method study of GP's use of electronic patient records.

BACKGROUND: In spite of successful adoption of electronic patient records (EPR) by Norwegian GPs, what constitutes the actual benefits and effects of the use of EPRs in the perspective of the GPs and patients has not been fully characterized. We wanted to study primary care physicians' use of electronic patient record (EPR) systems in terms of use of different EPR functions and the time spent on using the records, as well as the potential effects of EPR systems on the clinician-patient relationship. METHODS: A combined qualitative and quantitative study that uses data collected from focus groups, observations of primary care encounters and a questionnaire survey of a random sample of general practitioners to describe their use of EPR in primary care. RESULTS: The overall availability of individual patient records had improved, but the availability of the information within each EPR was not satisfactory. GPs' use of EPRs were efficient and comprehensive, but have resulted in transfer of administrative work from secretaries to physicians. We found no indications of disturbance of the clinician-patient relationship by use of computers in this study. CONCLUSION: Although GPs are generally satisfied with their EPRs systems, there are still unmet needs and functionality to be covered. It is urgent to find methods that can make a better representation of information in large patient records as well as prevent EPRs from contributing to increased administrative workload of physicians.

[Cystectomy in Denmark 2000-2005]. / Cystektomi i Danmark 2000-2005.

INTRODUCTION: The organization and results after cystectomy in Denmark are unknown. MATERIALS AND METHODS: Based upon the Danish National Hospital Register and discharge notes, postoperative hospitalization, readmission within 30 days, re-operations and mortality after cystectomy in Denmark in the period January 1, 2000-December 31, 2005 were assessed. RESULTS: There were 995 cystectomies with a median postoperative hospital stay of 18.9 days (including readmissions) and hospital mortality of 3.7%. The operations were performed in seven departments without difference in outcome between departments. Morbidity was observed in 58%, 16.8% of which were re-operated for wound or urinary diversion complications. CONCLUSION: It is concluded that cystectomy should be performed in only five departments in Denmark, and the results suggest that an intensified multicenter collaboration should be initiated to improve outcome.

[Nephrectomy in denmark 2002-2005]. / Nefrektomi i Danmark 2002-2005.

INTRODUCTION: Implementation of principles of fast-track surgery as well as laparoscopy may decrease hospital stay after nephrectomy to about 2-4 days. The aim of this study was to analyse the incidence, use of laparoscopic vs. open nephrectomy, hospital stay, morbidity and mortality in Danish hospitals within the period 2002-2005. METHODS: Extraction of information from the National Patient Register (LPR) and discharge notes from Jan. 1 2002 to Dec. 31 2004. RESULTS: In the 3-year period, 1968 nephrectomies were performed in a total of 45 departments, decreasing to 29 departments in 2004. Five departments performed > 100 operations during the 3 years, 10 departments performed between 50-100 operations and 30 departments <50 operations during the 3 years. The average length of hospital stay (primary and readmission) was 9.1 days. The total mortality rate was 2.2%; lower (1.5%) in departments with high activity vs. departments with low activity (4.3%, p < 0.01). Laparoscopic surgery was performed in 11 departments with a hospital stay of 5.2 vs. 9.5 days and with fewer surgical and medical complications and mortality (0.4% vs. 2.5%), compared with open operation. CONCLUSION: The organisation and results after nephrectomy are not optimal on a nationwide basis. This precludes further optimisation of the early perioperative results, including use of the laparoscopic approach combined with the principles of fast-track surgery. It is suggested that nephrectomy in the future is performed in fewer departments to fulfil these needs.

Development of functional requirements for electronic health communication: preliminary results from the ELIN project.

BACKGROUND: User participation is important for developing a functional requirements specification for electronic communication. General practitioners and practising specialists, however, often work in small practices without the resources to develop and present their requirements. It was necessary to find a method that could engage practising doctors in order to promote their needs related to electronic communication. MATERIALS AND METHODS: Qualitative research methods were used, starting a process to develop and study documents and collect data from meetings in project groups. Triangulation was used, in that the participants were organised into a panel of experts, a user group, a supplier group and an editorial committee. RESULTS: The panel of experts created a list of functional requirements for electronic communication in health care, consisting of 197 requirements, in addition to 67 requirements selected from an existing Norwegian standard for electronic patient records (EPRs). Elimination of paper copies sent in parallel with electronic messages, optimal workflow, a common electronic 'envelope' with directory services for units and end-users, and defined requirements for content with the possibility of decision support were the most important requirements. CONCLUSIONS: The results indicate that we have found a method of developing functional requirements which provides valid results both for practising doctors and for suppliers of EPR systems.