Rune Bruhn Jakobsen

• Tirta, Maria; Eikrem-Holsæter, Amalie; Holt, Eline Borg; Olsson, Richard; Jakobsen, Rune Bruhn & Randsborg, Per-Henrik (2026). Should we remove flexible intramedullary nails after diaphyseal forearm pediatric fracture? A cohort study of 288 patients. Acta Orthopaedica. ISSN 1745-3674. 97, s. 665–671. doi: 10.2340/17453674.2026.46804. Fulltekst i vitenarkiv
• Aae, Tommy Frøseth; Jakobsen, Rune Bruhn; Dahl, Mai Britt; Årøen, Asbjørn; Randsborg, Per-Henrik & Hoel, Myrthle Slettvåg [Vis alle 7 forfattere av denne artikkelen] (2025). Physical activity and diurnal variation have no impact on plasma microRNA-140 expression levels in patients with knee osteoarthritis and healthy controls. Osteoarthritis and Cartilage Open. 8(1). doi: 10.1016/j.ocarto.2025.100720. Fulltekst i vitenarkiv Vis sammendrag

  Objective This study aimed to determine whether physical activity or diurnal variation influence circulating microRNA-140-3p (miR-140-3p) and miR-140-5p expression levels in patients with knee osteoarthritis (OA) compared to healthy controls. Method Twenty-one patients with knee OA and ten healthy controls ran on a treadmill for 20 ​min and blood samples were taken prior to and after running. To assess diurnal variation, blood samples were drawn at six different times during a 24-h period. RNA was extracted from plasma and used for cDNA synthesis. Expression levels were assessed with real-time quantitative polymerase chain reaction and compared between patients and controls. Results All participants had detectable expression levels of miR-140-3p and miR-140-5p. A paired analysis could not demonstrate statistically significant differences between the groups. Conclusions Plasma miR-140-3p and miR-140-5p expression levels were found in all samples; however, the expression levels were not affected by physical activity and did not show diurnal variation. The observation of stable miR-140 expression supports its potential as a reliable biomarker for OA, providing a methodological foundation for future diagnostic and translational studies.

• Andresen, Tor Kristian Molstad; Randsborg, Per-Henrik; Myhrvold, Ståle & Jakobsen, Rune Bruhn (2025). Compensation Claims After Treatment of Achilles Tendon Ruptures in Norway From 2010 to 2020. Foot & Ankle Orthopaedics. 10(3). doi: 10.1177/24730114251361475. Fulltekst i vitenarkiv Vis sammendrag

  Background: Compensation claims caused by medical treatment errors provide valuable insights into patients' experiences with received medical treatment and can help identify injuries and disabilities that might be preventable through optimized care. The objective of this retrospective descriptive study was to characterize accepted compensation claims filed after treatment for acute Achilles tendon rupture (ATR) in Norway, and to explore whether claim outcomes were associated with treatment modality or institutional catchment area. Methods: All claims filed to the Norwegian System of Patient Injury Compensation (NPE) after treatment of ATR between 2010 and 2020 were collected and categorized. The claims were organised based on whether they were accepted or denied, the initial treatment given, patient demographics, the reasons given by patients for filing claims, and the rationale provided by the NPE for accepting or rejecting compensation claims. Additionally, hospital patient catchment population were analyzed in relation to accepted claims. Results: One hundred forty-six compensation claims were received, of which 61 (41.8%) were accepted. Most accepted claims were related to surgical treatment (n = 30, 49%) or insufficient treatment (n = 22, 36%). The most frequent reason for claim acceptance was delayed diagnosis and/or treatment (15/61, 25%), followed by postoperative infections (10/61, 16%). There was no statistically significant correlation between accepted claims and institutional catchment area population. Conclusion: Delayed or missed diagnosis was the most common reason for accepted compensation claims following treatment for ATR. The study found no correlation between accepted claims and the catchment area population of the institution delivering the treatment.

• Berge, Kristian; Wisløff, Torbjørn; Lippestad, Kristine; Jakobsen, Rune Bruhn; Gjestland, Johanna & Lenvik, Olav [Vis alle 10 forfattere av denne artikkelen] (2025). Pragmatic, quasi-experimental, pseudo-randomized clinical trial to assess the impact of patient safety monitors on clinical and patient safety outcomes: The Akershus Clinical Trial (ACT) 1. PLOS ONE. 20(10). doi: 10.1371/journal.pone.0335052. Fulltekst i vitenarkiv Vis sammendrag

  Background The Norwegian National Action Plan for Patient Safety and Quality Improvement recommends implementing electronic patient safety monitors (PSM) in Norwegian hospitals. We hypothesized that PSM implementation would reduce hospital length of stay, with secondary endpoints related to clinical and patient safety outcomes. Methods We performed a retrospective single-center, pragmatic, quasi-experimental, pseudo-randomized controlled trial assessing differences in endpoints for patients admitted before (control group: years 2019–2020) and after PSM implementation (intervention group: years 2021–2022) in two orthopedic bays in a Norwegian teaching hospital. To account for temporal changes unrelated to PSM, we assessed the same endpoints for 2019–2020 vs. 2021–2022 in two orthopedic bays that did not implement PSM. Data extraction from the local data warehouse was controlled according to internal standards, and we predefined all statistical analyses. Results The intervention group (n = 2786) and the control group (n = 2610) were evenly distributed for baseline characteristics, including age (median 73 [quartile 1–3 55–83] vs. 72 [55–83] years, p = 0.29), female sex (76.2% vs. 76.4%, p = 0.96), and Charlson Comorbidity Index (p = 0.24). Median hospital length of stay was 4.4 (2.1–7.7) days after implementation of PSM compared to 4.3 (2.0–7.2) days in the control group (p = 0.046 for difference between the groups). Nutritional screening and fall screening within 24 hours were lower in the intervention group compared to the control group, while medical reconciliation during the hospital stay was higher in the intervention group. We found no differences between the groups in 30-day or 1-year readmission or mortality rates. Hospital length of stay was similar in 2021–2022 vs. 2019–2020 for the bays that did not implement PSM. Conclusion The implementation of PSMs in this study did not improve clinical or patient safety outcomes. Hospital length of stay was statistically longer after PSM implementation, although the difference was not clinically relevant.

• Tveiten, Caroline Emilie Van Woensel Ko; Jakobsen, Rune Bruhn; Fenstad, Anne Marie; Persson, Andreas; Engebretsen, Lars & Moksnes, Håvard [Vis alle 7 forfattere av denne artikkelen] (2025). Non-operative treatment of anterior cruciate ligament injuries: two-thirds avoid surgery at 2-year follow-up in a nationwide cohort. British Journal of Sports Medicine. ISSN 0306-3674. 59(24), s. 1743–1751. doi: 10.1136/bjsports-2025-109890. Fulltekst i vitenarkiv Vis sammendrag

  Objective To describe the nationwide population of anterior cruciate ligament (ACL) injured patients initially managed non-operatively, quantify the proportion undergoing delayed ACL reconstruction (ACLR) and describe both intraoperative findings and patient-reported outcomes. Methods Primary ACL injuries treated non-operatively were prospectively registered in the Norwegian Knee Ligament Register (2017–2023). We collected baseline characteristics, injury details, surgical details if delayed ACLR was performed and patient-reported outcomes (Knee injury and Osteoarthritis Outcome Score, KOOS). Treatment survival was analysed with Kaplan-Meier curves, and factors associated with ACLR were assessed with Cox regression. Results Of 485 patients included (mean age at injury (SD) 35 (12), 25%<25 years), 93% (n=452) were physically active in sports preinjury. At 2 years, 63% remained non-operatively treated. Of the delayed ACLR patients (n=178), 56% underwent concurrent meniscal repair, and 18% partial resection. Instability was the main reason for ACLR (85%). Patients younger than 25 years, those active in pivoting sports preinjury and those with meniscal injuries at baseline were more likely to undergo delayed ACLR (HR (95% CI) 1.95 (1.2 to 3.2), 1.54 (1.1 to 2.2) and 1.63 (1.2 to 2.2), respectively. Both non-operative and delayed ACLR patients showed moderate impairment on KOOS Sport/Recreation and Quality of Life subscales at 2-year follow-up (mean scores 69.8 vs 61.0 and 68.6 vs 63.4), with no statistically significant between-group differences. Conclusion In this active population of ACL injured patients treated non-operatively, two-thirds remained non-operatively treated at 2 years. Younger patients, those engaged in pivoting sports preinjury and those with baseline meniscal injuries had higher risks of undergoing delayed ACLR. KOOS scores were similar between non-operative and delayed ACLR patients.

• Wikerøy, Annette Konstanse Bordewich; Randsborg, Per-Henrik; Aas, Eline; Fuglesang, Hendrik Frølich & Jakobsen, Rune Bruhn (2025). Cost-effectiveness analysis of locking nail compared with locking plate for displaced 3- and 4-part proximal humerus fractures: a secondary analysis of a randomized trial comparing the Multiloc nail and PHILOS plate. Acta Orthopaedica. ISSN 1745-3674. 96, s. 806–813. doi: 10.2340/17453674.2025.44881. Fulltekst i vitenarkiv Vis sammendrag

  Background and purpose: Previous studies show no clear difference in functional outcomes between locking nails and plates for proximal humerus fractures (PHFs). Economic evaluations provide valuable insights into cost-effectiveness to guide healthcare decisions. We aimed to conduct a cost-effectiveness analysis based on a semidouble-blinded randomized controlled trial comparing nailing and plating for displaced 3- and 4-part PHFs with 2-year follow-up.Methods: 79 patients with displaced 3- or 4-part PHFs were randomized to undergo open reduction and internal fixation using either a nail or a plate. Patients were followed for 2 years, with costs tracked for the index surgery, hospital stay, additional healthcare services, and secondary procedures. Quality-adjusted life years (QALYs) were calculated using EQ-5D, and incremental cost-effectiveness ratios (ICERs) were used to compare treatments.Results: 38 patients in each group were eligible for analysis. Mean total costs were €21,654 (standard deviation [SD] 10,448) for nails and €16,374 (SD 3,886) for plates, with a mean difference of €5,296 (95% confidence interval [CI] 1,989–8,603). Extra costs for reoperations and other non-regular follow-ups were €3,746 (SD 10,448) for nails and €265, (SD 1,217) for plates, resulting in a mean difference of €3,480 (CI –868 to 7,829) extra costs for nails. The mean QALY showed no statistical difference between groups of 0.09 (CI –0.003 to 0.17) (1.65 in the nail group and 1.74 in the plate group).Conclusion: Plates were more cost-effective compared with nails but did not result in a statistically significant difference in QALY.

• Wikerøy, Annette Konstanse Bordewich; Fuglesang, Hendrik Frølich; Jakobsen, Rune Bruhn; Thomas, Owen Matthew Truscott & Randsborg, Per-Henrik (2025). Intramedullary Nail Versus Locking Plate for Displaced 3- and 4-Part Fractures of the Proximal Humerus Two-Year Results From a Semidouble-Blind Randomized Trial. JBJS Open Access. 10(1). doi: 10.2106/JBJS.OA.24.00078. Fulltekst i vitenarkiv Vis sammendrag

  Background: This is a semidouble-blind randomized controlled trial comparing the clinical and radiographic outcomes of fixation of displaced 3- and 4-part proximal humerus fractures with an intramedullary nail versus a locking plate. Methods: Seventy-nine patients aged 45 to 81 years (mean 66.5 years) were randomized to open reduction and osteosynthesis with either locking nails or plates. The primary outcome was the Disabilities of the Arm, Shoulder, and Hand (DASH) score at 2 years after surgery. The secondary outcomes were the Constant score (CS), Oxford shoulder score (OSS), visual analog scale for pain at rest and during activity, and complication and reoperation rates. The patients were assessed at 6 weeks, 12 weeks, 6 months, 1 year, and 2 years after inclusion. Physiotherapists who were blinded to the choice of implant performed assessments at 6 months and 2 years. Patients were also blinded to the choice of implant. Results: Three patients were lost to follow-up, leaving data from 38 patients in each group available for analysis. There were no statistically significant differences in the DASH score, CS, OSS, or pain score at any time. The DASH score at 2 years was 12.7 (95% confidence interval [CI] 8.8-17.0) for the nail group and 10.0 (95% CI 5.6-16.1) for the plate group (p = 0.48). Twelve (32%) patients underwent reoperation in the nail group, whereas 2 (5%) patients underwent reoperation in the plate group (p = 0.006). Fourteen (37%) patients in the nail group and 4 (11%) patients in the plate group experienced complications (p = 0.05). Conclusions: There were no statistically significant differences in patient-reported outcomes or function 2 years after surgery for fixation of displaced 3- and 4-part part proximal humerus fractures with nails or plates. However, there were more complications and reoperations in the nail group. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

• Grundnes, Ingrid Bergerud; Alhaug, Ole Kristian; Reis, Joao André Barroso Pereira Roque Dos & Jakobsen, Rune Bruhn (2024). Expectations in patients undergoing spine surgery are high and unmet. The spine journal. ISSN 1529-9430. 24(12), s. 2224–2231. doi: 10.1016/j.spinee.2024.09.004. Fulltekst i vitenarkiv Vis sammendrag

  BACKGROUND CONTEXT Defining success in spine surgery lacks a standardized approach, and all existing concepts are based on registrations after surgery. PURPOSE To examine patients’ expectations before spine surgery assessed by a modified Oswestry Disability Index (ODI) and Numeric Rating Scale (NRS). The authors asked: how do the expectations align with actual outcomes and can a patient's individual expectations be used as a success criterion in itself? STUDY DESIGN /SETTING Prospective single-center study. PATIENT SAMPLE Patients scheduled for spine surgery at Akershus University Hospital (AHUS) were included in the study. They underwent 1 of 3 procedures: decompression for spinal stenosis, disc removal for lumbar disc herniation, or spinal fusion for degenerative disc disease. OUTCOME MEASURES Modified and standard version of ODI and NRS (back and leg pain). METHODS Preoperatively, the patients were given a modified ODI and NRS questionnaire in which they were asked to register the minimum acceptable functional impairment and pain they anticipated to have postsurgery. The patients’ expectations were compared with 3-and 12-month follow-up data from the Norwegian Registry for Spine Surgery (NORspine) with ODI, NRS and Global Perceived Effect (GPE) scale. We used simple descriptive statistics. RESULTS A total of 93 patients completed the preop questionnaire. Of these, 65 responded to the 3-month follow-up and 53 at 12-month follow-up. The mean (95%CI) ODI before surgery was 38.3 (34.2–42.3), the mean (95% CI) preoperative NRS back pain was 6.34 (5.81–6.88), and leg pain was 6.67 (6.08–7.26). The patients expected a mean (95% CI) ODI of 10.5 (7.5–13.5), mean (95%CI) NRS back pain of 2.5 (2.1–3.0), and NRS leg pain of 1.8 (1.5–2.2). The actual clinical outcome after 12 months were a mean (95% CI) ODI of 21.7 (17.0–26.5), NRS back pain of 3.4 (2.8–4.1), and leg pain of 2.8 (2.0–3.5). Only 12 (30.8%) patients achieved their expected ODI, while 26 (65.0%) classified themselves as significantly better according to GPE. CONCLUSIONS Patients seem to have high expectations before spine surgery, and the expectations may exceed the clinical outcome. Only 30.8% had their ODI expectations met, but perceived benefit was higher. High expectations may be due to inadequate preoperative information and/or the unsuitability of ODI for capturing expectations.

• Mikaelsen, Jan Rune; Jakobsen, Rune Bruhn; Røtterud, Jan H & Randsborg, Per-Henrik (2024). Body Mass Index Did Not Affect the Risk of Revision 3-9 Years After Total Knee Replacement Surgery. Arthroplasty Today. 27. doi: 10.1016/j.artd.2024.101376. Fulltekst i vitenarkiv Vis sammendrag

  Background There are conflicting reports in the literature regarding the risk of revision after primary total knee replacement (TKR) in obese patients. The purpose of this study was to investigate if body mass index (BMI) influences the risk of revision 3-9 years after primary TKR. Methods All patients undergoing a primary TKR in our institution from 2014 to 2018 were included in a retrospective study. The effect of BMI on all-cause revision was estimated in a logistic regression analysis. A directed acyclic graph was created to identify variables affecting the primary endpoint (revision). According to the directed acyclic graph, adjustment was only needed for age and smoking. However, we also included variables thought to influence the revision risk based on clinical experience and previous research. The final logistic regression analysis was therefore adjusted for age, sex, smoking status, diabetes mellitus and the American Society of Anesthesiologists classification. Results One thousand fifty-nine primary TKR patients with a mean age of 68.1 (standard deviation 9.4) years were included. There were 609 (57.5%) women, and the median follow-up time was 5.6 (range 3.0-9.0) years. There were 41 (3.9%) revisions. BMI did not affect the risk of revision when adjusted for relevant covariates in a multivariate logistic regression analysis (odds ratio 0.99, 95% confidence interval 0.93-1.05, P = .6). Conclusions BMI did not influence the risk of revision rate 3-9 years after TKR.

• Tveiten, Caroline Emilie Van Woensel Ko; Bache-Mathiesen, Lena Kristin; Jakobsen, Rune Bruhn; Engebretsen, Lars; Persson, Andreas & Myklebust, Grethe [Vis alle 8 forfattere av denne artikkelen] (2024). Rehabilitation, Decision Making, and Return to Pivoting Sports in Athletes 1-3 Years After ACL Reconstruction: A Nationwide Study. Journal of Orthopaedic & Sports Physical Therapy Open (JOSPT Open). 3(1), s. 45–58. doi: 10.2519/josptopen.2024.0087. Fulltekst i vitenarkiv Vis sammendrag

  OBJECTIVE: To describe rehabilitation and decision making from anterior cruciate ligament (ACL) reconstruction to return to sport (RTS), characteristics, and RTS proportions for pivoting sport athletes undergoing usual care. DESIGN: Cross-sectional study. METHODS: We invited people with ACL reconstruction (ACLR) aged 16-40 years, who were injured during soccer, handball, or basketball and registered in the Norwegian Knee Ligament Register to complete a study-specific questionnaire at 1-3 years post-surgery. We reported descriptive statistics and RTS proportions for return to participation, sport, and performance. RESULTS: Of 1 875 individuals, 631 (34%) responded. The physical therapist–led rehabilitation ceased before 9 months in 52% (n = 268), and a physical therapist was most frequently involved in RTS decisions (n = 462, 77%). Fifty-five percent (n = 353) of the participants underwent physical testing prior to RTS. At a mean of 2.3 years (SD = 0.8) after ACLR, 62% (n = 391) returned to participation, 50% (n = 312) returned to sport, and 17% (n = 93) returned to preinjury performance, with higher rates for those under 20 years old. The main reasons for nonreturn were fear of reinjury (35%, n = 27) and knee problems (35%, n = 27). Median time to RTS was 12 months (interquartile range, 10-15 months), and 16% (n = 102) had sustained a new ACL injury at follow-up. CONCLUSION: This nationwide study found that half of pivoting sport athletes ceased rehabilitation within 9 months and half performed physical testing to inform RTS, with physical therapists most frequently involved in the RTS decision. Half of the athletes returned to sport, and 1 in 6 returned to performance. RTS proportions were highest in athletes younger than 20 years

• Randsborg, Per-Henrik; Aae, Tommy Frøseth; Bukholm, Ida Rashida Khan & Jakobsen, Rune Bruhn (2024). Compensation After Surgical Treatment for Hallux Valgus: A Review of 369 Claims to the Norwegian System of Patient Injury Compensation 2010–2020. Journal of patient safety. ISSN 1549-8417. 20(7), s. e104–e108. doi: 10.1097/PTS.0000000000001268. Fulltekst i vitenarkiv Vis sammendrag

  Purpose: The aim of the study is to identify the most common avoidable patient injuries related to hallux valgus surgery. Methods: We assessed the claims reported to the Norwegian System of Patient Injury Compensation (NPE) following surgery for hallux valgus in light of hospital volume. Data from NPE was categorized according to age, sex, reason for claim, and reason for accepted/rejected claim. The institutions were grouped by catchment population into low volume (<150,000), middle volume (150,000–300,000), and high volume (>300,000) institutions. The effect of hospital volume on the likelihood of an accepted claim was estimated. Results: NPE received 369 claims of which 173 (46.9%) were accepted. The main reason for accepted claims was recurrence of the deformity, wrong level osteotomy or insufficient fixation. A quarter of the claims were accepted because of lack of indication and one in 5 accepted claims was due to a postoperative infection. Patient treated at low-volume institutions had a higher fraction of accepted claims (P < 0.01). The odds ratio for an accepted claim in the low volume hospitals was 5.8 (95% confidence interval 4.1–8.3) compared with the middle- and high-volume institutions. Conclusions: The likelihood of a treatment error that leads to compensation was higher in low-volume institutions. Level of Evidence: Level II Prospective cohort study

• Tveiten, Caroline Emilie Van Woensel Ko; Jakobsen, Rune Bruhn; Fenstad, Anne Marie; Persson, Andreas; Visnes, Håvard & Engebretsen, Lars [Vis alle 7 forfattere av denne artikkelen] (2023). Major Increase in Incidence of Pediatric ACL Reconstructions From 2005 to 2021: A Study From the Norwegian Knee Ligament Register. American Journal of Sports Medicine. ISSN 0363-5465. 51(11), s. 2891–2899. doi: 10.1177/03635465231185742. Fulltekst i vitenarkiv Vis sammendrag

  Background: The incidence of pediatric and adolescent anterior cruciate ligament reconstruction (ACLR) is increasing in several countries. It is uncertain whether this trend applies to countries that traditionally prefer an initial nonoperative treatment approach whenever possible, like Norway. Nationwide, long-term patient-reported outcomes and revision rates after ACLR in the pediatric population are also lacking. Purpose: To determine the incidence of pediatric ACLR in Norway since 2005, as well as to detect trends in surgical details and describe patient-reported outcomes up to 10 years after ACLR. Study Design: Descriptive cohort study. Methods: This study is based on prospectively collected data on girls ≤14 years and boys ≤16 years, registered in the Norwegian Knee Ligament Register at the time of their primary ACLR, between 2005 and 2021. The main outcome was the incidence of ACLR, adjusted to the corresponding population numbers for each year. The time trend was analyzed by comparing the mean of the first and last 3-year period (2005-2007 and 2019-2021). Patient-reported outcomes were assessed using the Knee injury and Osteoarthritis Outcome Score preoperatively and at 2, 5, and 10 years postoperatively. Results: A total of 1476 patients (1484 cases) were included, with a mean follow-up of 8.1 years (range, 1-17). The incidence of pediatric ACLRs per 100,000 population increased from 18 to 26, which corresponds to an increase of 40% for boys and 55% for girls. Concurrent meniscal procedures increased significantly from 45% to 62%, and the proportion of meniscal repairs increased from 19% to 43% when comparing the first and last time period. The mean Knee injury and Osteoarthritis Outcome Score values for the Sport and Recreation and Quality of Life subscales were between 72 and 75 at the 2-, 5- and 10-year follow-up. The 5-year revision rate was 9.9%. Conclusion: There was a major increase in incidence of pediatric ACLR in Norway during the study period. There was a shift in the approach to concomitant meniscal procedures from resection to repair, with more than a doubling of the proportion of meniscal repairs. Patient-reported outcomes revealed long-lasting reduced knee function.

• Lian, Ola; Randsborg, Per-Henrik; Jakobsen, Rune Bruhn; Bukholm, Ida Rashida Khan & Aae, Tommy Frøseth (2023). Prevalence of malpractice claims after arthroscopic shoulder surgery: analysis of 69,097 procedures from a national registry in Norway. Patient Safety in Surgery. 17, s. 1–6. doi: 10.1186/s13037-023-00378-5. Fulltekst i vitenarkiv Vis sammendrag

  Background Systematic analysis of compensation claims following patient injuries is helpful in improving patient safety. The objective of the current study was to assess compensation claims after arthroscopic treatment of rotator cuff ruptures, impingement, and acromioclavicular joint osteoarthritis reported to the Norwegian System of Patient Injury Compensation and evaluate if there was regional variation on the risk of patient injuries leading to an accepted compensation claim. Methods Data from the Norwegian System of Patient Injury Compensation and the Norwegian Patient Registry (NPR) from 2008 to 2018 were collected. Demographics (age and sex) and type of claim and reasons for accepted claims were obtained from the Norwegian System of Patient Injury Compensation, while the number of arthroscopic procedures was collected from NPR. The treating institutions were grouped on geography according to Norway’s four regional Health Trusts and private institutions and the effect of geography on the probability of an accepted claim was estimated. Results NPR registered 69,097 shoulder arthroscopies during the study period, of which 216 (0.3%) compensation claims were filed for patient injury. A total of 38% of the claims were accepted, representing 0.1% of the arthroscopic procedures. Infection (37.8%) was the most common reason for accepted claim, followed by no surgical indication (15.9%) and wrong surgical technique (12.2%). We found a statistically significantly increased odds ratio for a claim being accepted in both the smallest and largest regional Health Trusts compared to the other regional Health Trusts and private institutions. Conclusions Compensation claims due to patient injury following shoulder arthroscopy are rare (0.3% of patients file a claim, of which a third is accepted (0.1% of all shoulder arthroscopy patients)). The most common reason for accepted claim was infection followed by lack of indication.

• Hoseth, John Magne; Aae, Tommy Frøseth; Jakobsen, Rune Bruhn; Fenstad, Anne Marie; Bukholm, Ida Rashida Khan & Gjertsen, Jan-Erik [Vis alle 7 forfattere av denne artikkelen] (2023). Compensation Claims After Hip Fracture Surgery in Norway 2008-2018. Geriatric Orthopaedic Surgery & Rehabilitation (GOS). ISSN 2151-4585. 14, s. 1–7. doi: 10.1177/21514593231188623. Fulltekst i vitenarkiv Vis sammendrag

  Background Surgical complications contribute to the significant mortality following hip fractures in the elderly. The purpose of this study was to increase our knowledge of surgical complications by evaluating compensation claims following hip fracture surgery in Norway. Further, we investigated whether the size and location of performing institutions would influence surgical complications. Methods We collected data from the Norwegian System of Patient Injury Compensation (NPE) and the Norwegian Hip Fracture Register (NHFR) from 2008 to 2018. We classified institutions into 4 categories based on annual procedure volume and geographical location. Results 90,601 hip fractures were registered in NHFR. NPE received 616 (.7%) claims. Of these, 221 (36%) were accepted, which accounts for .2% of all hip fractures. Men had nearly a doubled risk of ending with a compensation claim compared to women (OR: 1.8, CI, 1.4-2.4, P < .001). Hospital-acquired infection was the most frequent reason for accepted claims (27%). However, claims were rejected if patients had underlying conditions predisposing to infection. Institutions treating fewer than 152 hip fractures (first quartile) annually, had a statistically significant increased risk (OR: 1.9, CI, 1.3-2.8, P = .005) for accepted claims compared to higher volume facilities. Discussion The fewer registered claims in our study could be due to the relatively high early mortality and frailty in this patient group, which may decrease the likelihood of filing a complaint. Men could have undetected underlying predisposing conditions that lead to increased risk of complications. Hospital-acquired infection may be the most significant complication following hip fracture surgery in Norway. Lastly, the number of procedures performed annually in an institution influences compensation claims. Conclusions Our findings indicate that hospital acquired infections need greater focus following hip fracture surgery, especially in men. Lower volume hospitals may be a risk factor.

• Årøen, Asbjørn; Brinchmann, Jan Engelsen; Engen, Cathrine N.; Randsborg, Per-Henrik; Engebretsen, Lars & Jakobsen, Rune Bruhn (2023). The Need for Pragmatic Registry-Based Trials in Cartilage Research. Cureus - Journal of Medical Science. doi: 10.13140/RG.2.2.28582.29767. Fulltekst i vitenarkiv
• Lunde, Lene; Moen, Anne; Jakobsen, Rune Bruhn; Møller, Britta; Rosvold, Elin Olaug & Brænd, Anja Maria (2022). A preliminary simulation‑based qualitative study of healthcare students’ experiences of interprofessional primary care scenarios. Advances in Simulation. 7(1). doi: 10.1186/s41077-022-00204-5. Fulltekst i vitenarkiv Vis sammendrag

  Background: Introducing interprofessional education (IPE) in healthcare curricula can prepare students for healthcare practices that have become increasingly complex. The use of simulation is promoted to support IPE. This study explores healthcare students’ experiences of participating in common, sub-acute patient scenarios that routinely occur in clinical practice in primary care. More specifically, it looks at how sub-acute patient scenarios from primary care can help develop interprofessional collaborative competence. Methods: Medical students (N=10), master’s students in advanced geriatric nursing (N=8) and bachelor’s students in nursing (N=9) participated in the simulations. The students were in their last or second-to-last year of education. We conducted five semi-structured focus group interviews with the participants’ directly after the simulation training to elicit experiences related to the scenarios, the simulation and interprofessional collaboration. The transcripts were analysed using systematic text condensation. To supplement the focus group interviews, the students also completed the interprofessional collaborative competency attainment survey (ICCAS), which measures the students’ self-assessed interprofessional competence. Results: Three main themes emerged from the analysis of the focus group interviews: Realism, Uncertainty, and Reflection. The students emphasised the importance of authentic and recognisable scenarios. They said the vague and unspecific patient symptoms created uncertainty in the situation, making it difficult to understand the patient’s diagnosis. Despite that uncertainty, they described the experience as positive. Further, the students expressed that the simulation increased their confidence in interprofessional collaboration and prepared them for future work. The results from the ICCAS questionnaire showed that the students reported a subjective positive change in their interprofessional competence after participating in the scenarios. Conclusions: This study showed that simulation-based IPE with sub-acute primary care scenarios contributes to develop interprofessional collaborative competence in healthcare education. Sub-acute scenarios can supplement the more common approaches with acute-care scenarios and aid in developing the collaborative competence required to work in healthcare teams.

• Clementsen, Ståle; Jakobsen, Rune Bruhn; Hammer, Ola-Lars & Randsborg, Per-Henrik (2022). The Effect of Ulnar Styloid Fractures on Patient-Reported Outcomes After Surgically Treated Distal Radial Fractures. JBJS Open Access. 7(3). doi: 10.2106/JBJS.OA.22.00021. Fulltekst i vitenarkiv Vis sammendrag

  Background: Ulnar styloid fractures (USFs) are often associated with distal radial fractures (DRFs). When unstable DRFs are treated surgically, any associated USF is most commonly left untreated. The purpose of this study was to evaluate the effect of a concomitant USF on outcome after surgical stabilization of a DRF. Methods: Data from 2 randomized controlled trials on the treatment of unstable DRFs were pooled. The effect of a USF on the QuickDASH, EQ-5D, pain, and range of motion at 2 years was evaluated. Results: Two hundred and eighty-one patients were included; 177 (63%) had an associated, untreated USF. An unadjusted analysis demonstrated no significant difference in functional or patient-reported outcome measures (PROMs) at 2 years between patients with or without a concomitant USF. When controlling for confounding factors, the presence of a USF did not predict change in any of the PROMs from baseline to 2 years. A concomitant USF also did not predict change in grip strength or range of motion, except for a small effect on extension (−4.1°; 95% confidence interval, −7.5° to −0.8°; p = 0.02), which probably does not have clinical relevance. Conclusions: A USF in combination with a DRF does not affect PROMs, range of motion, or grip strength. We recommend that concomitant USFs be left untreated when treating a DRF with surgical fixation.

• Hammer, Ola-Lars; Jakobsen, Rune Bruhn; Benth, Jurate Saltyte & Randsborg, Per-Henrik (2021). Can Generic Outcome Questionnaires Replace QuickDASH in Monitoring Clinical Outcome Following Surgical Treatment of Distal Radius Fractures? Journal of Hand Surgery-American Volume. ISSN 0363-5023. 47(1), s. 92.e1–92.e9. doi: 10.1016/j.jhsa.2021.03.024. Fulltekst i vitenarkiv Vis sammendrag

  Purpose In contrast to region-specific patient-reported outcome measures (PROMs), generic PROMs can be argued to have an added benefit of enabling cost-utility analyses and allowing for comparisons to be made across different conditions. The aim of this study was to assess the responsiveness and strength of the association between region-specific and generic PROMs in patients treated operatively for a displaced intra-articular distal radius fracture. Methods Over a 4-year period, 166 patients aged 18–70 years with a displaced intra-articular fracture of the distal radius were treated with either a volar locking plate or external fixation augmented by K-wires and followed-up prospectively for 2 years. The main outcome measure was the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, but EuroQol-5D (EQ-5D) and 36-Item Short Form Survey (SF-36) were also employed. The associations between the QuickDASH score and EQ-5D and between the QuickDASH score and SF-36 were assessed using a linear mixed model. Results There was a significant positive association between the QuickDASH score and EQ-5D and between the QuickDASH score and SF-36 throughout the follow-up period, although wide dispersion existed for the outcome measures at an individual level. However, the association between the QuickDASH score and SF-36 was significantly weaker at 6 weeks and 3 months than that at baseline, indicating that EQ-5D more closely mirrors changes in the QuickDASH score in the early postoperative period. Conclusions The study demonstrates that the QuickDASH score and EQ-5D correlate well on a group level, but large individual variations exist. The SF-36 had decreased sensitivity for the changes in the QuickDASH score at 6 weeks and 3 months. Clinical relevance Our findings indicate that generic PROMs cannot fully replace the region-specific QuickDASH score when evaluating the outcomes of distal radius fractures.

• Ludwig, Johanna; Jakobsen, Rune Bruhn; Charles, Yann Philippe; Seifert, Julia; Incoll, Ian & Wood, Melissa Lillian [Vis alle 8 forfattere av denne artikkelen] (2021). What it takes to become an orthopaedic surgeon: A comparison of orthopaedic surgical training programmes in 10 countries focusing on structure and fellowship requirements. International Journal of Surgery (IJS). ISSN 1743-9191. 95. doi: 10.1016/j.ijsu.2021.106150. Fulltekst i vitenarkiv
• Wang, Katherine; Eftang, Cathrine Nørstad; Ulstein, Svend; Årøen, Asbjørn & Jakobsen, Rune B. (2021). Concomitant full-thickness cartilage lesions do not affect patient-reported outcomes at minimum 10-year follow-up after ACL reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy. ISSN 0942-2056. doi: 10.1007/s00167-021-06757-8. Fulltekst i vitenarkiv Vis sammendrag

  Purpose: To compare patients with a concomitant full-thickness cartilage lesion and anterior cruciate ligament (ACL) injury to patients with an isolated ACL injury at 10–15 years post ACL reconstruction. Methods: This is a longitudinal follow-up of a cohort of 89 patients that were identified in the Norwegian National Knee Ligament Registry and included in the index study in 2007. The study group consisted of 30 patients that underwent ACL reconstruction and had a concomitant, isolated full-thickness cartilage lesion (International Cartilage Repair Society [ICRS] grade 3–4). Each study patient was matched with two control patients who underwent ACL reconstruction but had no cartilage lesions (ICRS grade 1–4) (n = 59). At a median follow-up of 10.2 years (range 9.9–15.6), 65 patients (74%) completed the Knee Injury and Osteoarthritis Outcome Score (KOOS), which was the main outcome measure, resulting in 23 pairs after matching. Results: At a follow-up of 10–15 years after ACL reconstruction, no significant differences in KOOS were found between patients with a concomitant full-thickness cartilage lesion and patients without cartilage lesions. There was also no significant difference between the two groups when comparing the change over time in KOOS scores from preoperative to follow-up. Both groups showed significant improvement in all KOOS subscales from preoperative to follow-up, except for in the Symptoms subscale for the control group. The greatest improvement was in the QoL subscale for the study group. Conclusion: ACL-reconstructed patients with a full-thickness cartilage lesion did not report worse outcomes at 10–15 years after surgery compared with patients with an isolated ACL injury. Our findings support that there is no long-term negative effect of a concomitant cartilage lesion in an ACL-reconstructed knee. These findings should be considered when discussing treatment and informing about the expected long-term outcome after ACL reconstruction to patients with such combined injuries.

• Leta, Tesfaye Hordofa; Gjertsen, Jan-Erik; Dale, Håvard; Hallan, Geir; Lygre, Stein Håkon Låstad & Fenstad, Anne Marie [Vis alle 26 forfattere av denne artikkelen] (2021). Antibiotic-loaded bone cement in prevention of periprosthetic joint infections in primary total knee arthroplasty: A register-based multicentre randomised controlled non-inferiority trial (ALBA trial). BMJ Open. 11:e41096, s. 1–8. doi: 10.1136/bmjopen-2020-041096. Fulltekst i vitenarkiv Vis sammendrag

  Introduction The current evidence on the efficacy of antibiotic-loaded bone cement (ALBC) in reducing the risk of periprosthetic joint infections (PJI) after primary joint reconstruction is insufficient. In several European countries, the use of ALBC is routine practice unlike in the USA where ALBC use is not approved in low-risk patients. Therefore, we designed a double-blinded pragmatic multicentre register-based randomised controlled non-inferiority trial to investigate the effects of ALBC compared with plain bone cement in primary total knee arthroplasty (TKA). Methods and analysis A minimum of 9,172 patients undergoing full-cemented primary TKA will be recruited and equally randomised into the ALBC group and the plain bone cement group. This trial will be conducted in Norwegian hospitals that routinely perform cemented primary TKA. The primary outcome will be risk of revision surgery due to PJI at 1-year of follow-up. Secondary outcomes will be: risk of revision due to any reason including aseptic loosening at 1, 6, 10 and 20 years of follow-up; patient-related outcome measures like function, pain, satisfaction and health-related quality of life at 1, 6 and 10 years of follow-up; risk of changes in the microbial pattern and resistance profiles of organisms cultured in subsequent revisions at 1, 6, 10 and 20 years of follow-up; cost-effectiveness of routine ALBC versus plain bone cement use in primary TKA. We will use 1:1 randomisation with random permuted blocks and stratify by participating hospitals to randomise patients to receive ALBC or plain bone cement. Inclusion, randomisation and follow-up will be through the Norwegian Arthroplasty Register.

• Aae, Tommy Frøseth; Jakobsen, Rune Bruhn; Bukholm, Ida Rashida Khan; Fenstad, Anne Marie; Furnes, Ove Nord & Randsborg, Per-Henrik (2021). Compensation claims after hip arthroplasty surgery in Norway 2008–2018. Acta Orthopaedica. ISSN 1745-3674. 92(3), s. 311–315. doi: 10.1080/17453674.2021.1872901. Fulltekst i vitenarkiv Vis sammendrag

  Background and purpose — Orthopedic surgery is one of the specialties with most compensation claims, therefore we assessed the most common reasons for complaints following total hip arthroplasty (THA) reported to the Norwegian System of Patient Injury Compensation (NPE) and viewed these complaints in light of the data from the Norwegian Arthroplasty Register (NAR). Patients and methods — We collected data from NPE and NAR for the study period (2008–2018), including age, sex, and type of complaint, and reason for accepted claims from NPE, and the number of arthroplasty surgeries from NAR. The institutions were grouped by quartiles into quarters according to annual procedure volume, and the effect of hospital procedure volume on the risk for accepted claim was estimated. Results — 70,327 THAs were reported to NAR. NPE handled 1,350 claims, corresponding to 1.9% of all reported THAs. 595 (44%) claims were accepted, representing 0.8% of all THAs. Hospital-acquired infection was the most common reason for accepted claims (34%), followed by wrong implant position in 11% of patients. Low annual volume institutions (less than 93 THAs per year) had a statistically significant 1.6 times higher proportion of accepted claims compared with higher volume institutions. Interpretation — The 0.8% risk of accepted claims following THAs is 1.6 times higher for patients treated in low-volume institutions, which should consider increasing the volume of THAs or referring these patients to higher volume institutions.

• Wang, Katherine; Esbensen, Qin Ying; Karlsen, Tommy Aleksander; Eftang, Cathrine Nørstad; Owesen, Christian & Årøen, Asbjørn [Vis alle 7 forfattere av denne artikkelen] (2021). Low-Input RNA-Sequencing in Patients with Cartilage Lesions, Osteoarthritis, and Healthy Cartilage. Cartilage. ISSN 1947-6035. 13(Supplement 1), s. 550S–562S. doi: 10.1177/19476035211057245. Fulltekst i vitenarkiv Vis sammendrag

  Objective: To analyze and compare cartilage samples from 3 groups of patients utilizing low-input RNA-sequencing. Design: Cartilage biopsies were collected from patients in 3 groups (n = 48): Cartilage lesion (CL) patients had at least ICRS grade 2, osteoarthritis (OA) samples were taken from patients undergoing knee replacement, and healthy cartilage (HC) was taken from ACL-reconstruction patients without CLs. RNA was isolated using an optimized protocol. RNA samples were assessed for quality and sequenced with a low-input SmartSeq2 protocol. Results: RNA isolation yielded 48 samples with sufficient quality for sequencing. After quality control, 13 samples in the OA group, 9 in the HC group, and 9 in the CL group were included in the analysis. There was a high degree of co-clustering between the HC and CL groups with only 6 genes significantly up- or downregulated. OA and the combined HC/CL group clustered significantly separate from each other, yielding 659 significantly upregulated and 1,369 downregulated genes. GO-term analysis revealed that genes matched to cartilage and connective tissue development terms. Conclusion: The gene expression profiles from the 3 groups suggest that there are no major differences in gene expression between cartilage from knees with a cartilage injury and knees without an apparent cartilage injury. OA cartilage, as expected, showed markedly different gene expression from the other 2 groups. The gene expression profiles resulting from this low-input RNA-sequencing study offer opportunities to discover new pathways not previously recognized that may be explored in future studies.

• Randsborg, Per-Henrik; Aae, Tommy Frøseth; Bukholm, Ida Rashida Khan; Fenstad, Anne Marie; Furnes, Ove Nord & Jakobsen, Rune Bruhn (2021). Compensation claims after knee arthroplasty surgery in Norway 2008–2018. Acta Orthopaedica. ISSN 1745-3674. 92(2), s. 189–193. doi: 10.1080/17453674.2020.1871187. Fulltekst i vitenarkiv Vis sammendrag

  Background and purpose — Orthopedic surgery is one of the specialties with most compensation claims. We assessed the claims following knee arthroplasty surgery reported to the Norwegian System of Patient Injury Compensation (NPE) in light of institutional procedure volume. Patients and methods — We collected data from NPE and the Norwegian Arthroplasty Register (NAR) for the study period (2008–2018). Age, sex, type of claim, and reason for compensation were collected from NPE, while the number of arthroplasty surgeries was collected from NAR. The treating hospitals were grouped by quartiles according to annual procedure volume. The effect of hospital volume on the likelihood of an accepted claim was estimated. Results — NAR received 64,241 reports of arthroplasty procedures, of which 572 (0.9%) patients filed a claim for treatment injury. 55% of the claims were accepted, representing 0.5% of all knee arthroplasties. The most common reason for accepted claim was a hospital-acquired infection, in 28% of the patients, followed by misplaced implant (26%) and aseptic loosening (13%). The hospitals with the lowest annual volume (57 or fewer arthroplasties per year, first quarter) had a statistically significantly larger fraction of granted claims per procedures compared with other institutions. Interpretation — The overall risk of ending up with compensation due to treatment error following knee arthroplasty was 0.5%. The risk of accepted claim was greater for patients operated in the lowest volume hospitals.

• Lunde, Lene; Moen, Anne; Jakobsen, Rune Bruhn; Rosvold, Elin Olaug & Brænd, Anja Maria (2021). Exploring healthcare students' interprofessional teamwork in primary care simulation scenarios: collaboration to create a shared treatment plan. BMC Medical Education. 21. doi: 10.1186/s12909-021-02852-z. Fulltekst i vitenarkiv Vis sammendrag

  Background Primary care providers assume responsibility for patients with increasingly complex problems requiring interprofessional collaboration. Introducing interprofessional education in healthcare curricula prepares healthcare students for this reality. Solving simulation scenarios as an educational strategy is promoted to support interprofessional education in health care, and is mostly used in acute clinical situations. This paper aims to explore how healthcare students’ actions influence interprofessional collaboration and treatment plan identification when they solve common, sub-acute patient scenarios in primary care situations. Methods Interaction analysis of video recordings from the simulation scenarios was performed with a focus on the students’ joint actions; specifically how these actions unfold and how productive the students were in terms of developing treatment plans. Results We found variation in the groups’ interactions, the paths they followed, and the quality of their knowledge output in their shared treatment plan. The groups with the capacity to collaborate and engage in sharing information, and explain and elaborate on concepts, were more successful in developing comprehensive treatment plans. Furthermore, these groups managed the duality of defining and solving the immediate problem and collaboratively preparing for future care. Conclusions Analysis of the activities in our scenarios showed the students’ potential to practice interprofessional collaboration. Our study illustrates that simulation of sub-acute scenarios in primary care is an underexplored but suitable arena to train communication and teamwork in complex situations. The simulation scenarios are also feasible for use on-site in an educational facility or in practice with minimal equipment and resources.

• Temmesfeld, Max; Gorzkowska-Sobas, Agnieszka A; Hedlund, Kenny; Øyen, Martin Øhlund; Kanten, Lars & Grant, Johan Peter [Vis alle 7 forfattere av denne artikkelen] (2021). Surgical helmets can be converted into efficient disinfectable powered air-purifying respirators. American Journal of Infection Control. ISSN 0196-6553. doi: 10.1016/j.ajic.2021.12.002. Fulltekst i vitenarkiv Vis sammendrag

  BackgroundFiltering facepiece respirators often fail to provide sufficient protection due to a poor fit. Powered air-purifying respirators (PAPRs) are not designed for healthcare personnel, and are challenging to disinfect. Surgical helmets (SH) are available in many United States hospitals but do not provide respiratory protection. Several modifications to SH have been suggested, but none are sufficiently compliant with safety and efficiency standards. The purpose of this investigation was the development of a filter adaptor, which converts SHs into efficient, safe, and disinfectable PAPRs. MethodsFour critical features were investigated close to regulatory requirements: total inward leakage of particles, CO2 concentrations, intra-helmet differential pressure, and automated disinfection. ResultsThe average total inward leakage in the 2 independent tests were 0.005% and 0.01%. CO2 concentrations were lower than in the original SH. The modification generates a positive differential pressure. The filter's performance was not compromised after 50 cycles in a sterilization machine. DiscussionThe modified SH provides several hundred times better protection than FFP-3 masks. ConclusionsSurgical helmets can be modified into safe, efficient, and disinfectable PAPRs, suitable for HCP and the operating room in particular. They can play a role in the preparedness for upcoming events requiring efficient respiratory protection.

• Temmesfeld, Max; Jakobsen, Rune Bruhn & Grant, Peter (2020). Does a surgical helmet provide protection against aerosol transmitted disease? Acta Orthopaedica. ISSN 1745-3674. doi: 10.1080/17453674.2020.1771525. Fulltekst i vitenarkiv Vis sammendrag

  Background and purpose — The COVID-19 pandemic caused by infection with SARS-CoV-2 has led to a global shortage of personal protective equipment (PPE). Various alternatives to ordinary PPE have been suggested to reduce transmission, which is primarily through droplets and aerosols. For many years orthopedic surgeons have been using surgical helmets as personal protection against blood-borne pathogens during arthroplasty surgery. We have investigated the possibility of using the Stryker Flyte surgical helmet as a respiratory protective device against airborne- and droplet-transmitted disease, since the helmet shares many features with powered air-purifying respirators. Materials and methods — Using an aerosol particle generator, we determined the filtration capacity of the Stryker Flyte helmet by placing particle counters measuring the concentrations of 0.3, 0.5, and 5 µm particles inside and outside of the helmet. Results — We found that the helmet has insufficient capacity for filtrating aerosol particles, and, for 0.3 µm sized particles, we even recorded an accumulation of particles inside the helmet. Interpretation — We conclude that the Stryker Flyte surgical helmet should not be used as a respiratory protective device when there is a risk for exposure to aerosol containing SARS-CoV-2, the virus causing COVID-19, in accordance with the recommendation from the manufacturer

• Kjennvold, Stian; Randsborg, Per-Henrik; Jakobsen, Rune Bruhn & Årøen, Asbjørn (2020). Fixation of acute chondral fractures in adolescent knees. Cartilage. ISSN 1947-6035. s. 1–9. doi: 10.1177/1947603520941213. Fulltekst i vitenarkiv
• Kjennvold, Stian; Randsborg, Per-Henrik; Jakobsen, Rune Bruhn & Årøen, Asbjørn (2020). Fiksasjon av akutte chondrale frakturer i kne. I Hansen, Ann Kristin (Red.), Høstmøteboka 2020. Norsk Ortopedisk Forening. ISSN 9788299427524. s. 31–31. Fulltekst i vitenarkiv
• Hammer, Ola-Lars; Jakobsen, Rune Bruhn; Clementsen, Ståle; Fuglesang, Hendrik Frølich; Bjørnelv, Gudrun Maria Waaler & Randsborg, Per-Henrik (2020). Cost-Effectiveness of Volar Locking Plate Compared with Augmented External Fixation for Displaced Intra-Articular Wrist Fractures. Journal of Bone and Joint Surgery. American volume. ISSN 0021-9355. 102(23), s. 2049–2059. doi: 10.2106/JBJS.19.01288. Fulltekst i vitenarkiv
• Wang, Katherine; Engen, Cathrine Nørstad; Jakobsen, Rune Bruhn & Årøen, Asbjørn (2020). Review of response rates over time in registry-based studies using patient-reported outcome measures. BMJ Open. 10(8). doi: 10.1136/bmjopen-2019-030808. Fulltekst i vitenarkiv Vis sammendrag

  Objectives: Gain an overview of expected response rates (RRs) to patient-reported outcome measures (PROMs) in clinical quality registry-based studies and long-term cohorts in order to better evaluate the validity of registries and registry-based studies. Examine the trends of RRs over time and how they vary with study type, questionnaire format, and the use of reminders. Design: Literature review with systematic search. Data sources: PubMed, MEDLINE, EMBASE, kvalitetsregistre. no, kvalitetsregister. se and sundhed. dk. Eligibility criteria: Articles in all areas of medical research using registry-based data or cohort design with at least two follow-up time points collecting PROMs and reporting RRs. Annual reports of registries including PROMs that report RRs for at least two time points. Primary outcome measure: RRs to PROMs. Results: A total of 10 articles, 12 registry reports and 6 registry articles were included in the review. The overall RR at baseline was 75%±22.1 but decreased over time. Cohort studies had a markedly better RR (baseline 97%±4.7) compared with registry-based data at all time points (baseline 72%±21.8). For questionnaire formats, paper had the highest RR at 86%±19.4, a mix of electronic and paper had the second highest at 71%±15.1 and the electronic-only format had a substantially lower RR at 42%±8.7. Sending one reminder (82%±16.5) or more than one reminder (76%±20.9) to non-responders resulted in a higher RR than sending no reminders (39%±6.7). Conclusions: The large variation and downward trend of RRs to PROMs in cohort and registry-based studies are of concern and should be assessed and addressed when using registry data in both research and clinical practice.

• Clementsen, Ståle; Hammer, Ola-Lars; Benth, Jurate Saltyte; Jakobsen, Rune Bruhn & Randsborg, Per-Henrik (2019). Early Mobilization and Physiotherapy Vs. Late Mobilization and Home Exercises After ORIF of Distal Radial Fractures. JBJS Open Access. 4(3). doi: 10.2106/JBJS.OA.19.00012. Fulltekst i vitenarkiv Vis sammendrag

  Background: Volar locking plates have permitted early mobilization, omitting the need for prolonged cast immobilization, after distal radial fractures (DRFs). However, the type of rehabilitation following plate fixation of DRFs remains an unresolved issue. The purpose of this study was to evaluate the effect of physiotherapy after volar plate fixation of DRFs. At a 2-year follow-up, we compared the results of immediate physiotherapy (early mobilization) with those of home exercises following 2 weeks in a dorsal plaster splint (late mobilization). Methods: Patients with an extra-articular DRF scheduled for open reduction and internal fixation (ORIF) with a volar locking plate were evaluated for eligibility for enrollment in the study. The patients were randomized into 2 groups: (1) early mobilization and physiotherapy and (1) late mobilization and home exercise. In the early mobilization group, the plaster splint was removed after 2 to 3 days. During the first 3 months, the patients met with the institution’s physiotherapist every other week. The late mobilization group wore the dorsal splint for 2 weeks and only met with our physiotherapist once, when the splint was removed. This group was provided with a home physiotherapy program and instructed to perform home exercises on their own. Results: One hundred and nineteen patients were included in the study. The 2 groups had similar demographics with respect to age, sex, and baseline values. Seven patients were lost to follow-up. No clinically relevant difference in scores on the shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire was found between the 2 groups at any of the follow-up evaluations. The largest difference in the QuickDASH score was found at 6 weeks, when the early mobilization group had a mean score of 30 compared with a mean of 37 in the late mobilization group (p = 0.05). Conclusions: Early mobilization and multiple physiotherapy visits did not improve wrist function compared with standard treatment of 2 weeks in a dorsal plaster splint, a single physiotherapy visit, and home exercises. Early mobilization following ORIF of an extra-articular DRF is safe.

• Clementsen, Ståle; Hammer, Ola-Lars; Engebretsen, Erik; Jakobsen, Rune Bruhn & Randsborg, Per-Henrik (2018). Compensation after distal radial fractures. A review of 800 claims to the Norwegian system of patient injury compensation 2000-2013. The Open Orthopaedics Journal. doi: 10.2174/1874325001812010419. Fulltekst i vitenarkiv
• Jakobsen, Rune Bruhn; Gran, Sarah Frandsen; Grimsmo, Bergsvein; Arntzen, Kari; Fosse, Erik & Frich, Jan C [Vis alle 7 forfattere av denne artikkelen] (2018). Examining participant perceptions of an interprofessional simulation-based trauma team training for medical and nursing students. Journal of Interprofessional Care. ISSN 1356-1820. 32(1), s. 80–88. doi: 10.1080/13561820.2017.1376625. Fulltekst i vitenarkiv Vis sammendrag

  High quality care relies on interprofessional teamwork. We developed a short simulation-based course for final year medical, nursing and nursing anaesthesia students, using scenarios from emergency medicine. The aim of this paper is to describe the adaptation of an interprofessional simulation course in an undergraduate setting and to report participants’ experiences with the course and students’ learning outcomes. We evaluated the course collecting responses from students through questionnaires with both closed-ended and open-ended questions, supplemented by the facilitators’ assessment of students’ performance. Our data is based on responses from 310 students and 16 facilitators who contributed through three evaluation phases. In the analysis, we found that students reported emotional activation and learning outcomes within the domains self-insight and stress management, understanding of the leadership role, insight into teamwork, and skills in team communication. In subsequent questionnaire studies students reported having gained insights about communication, teamwork and leadership, and they believed they would be better leaders of teams and/or team members after having completed the course. Facilitators’ observations suggested a progress in students’ non-technical skills during the course. The facilitators observed that nursing anaesthesia students seemed to be more comfortable in finding their role in the team than the two other groups. In conclusion, we found that an interprofessional simulation-based emergency team training course with a focus on leadership, communication and teamwork, was feasible to run on a regular basis for large groups of students. The course improved the students’ team skills and received a favourable evaluation from both students and faculty.

• Randsborg, Per-Henrik; Bukholm, Ida Rashida Khan & Jakobsen, Rune Bruhn (2017). Compensation after treatment for anterior cruciate ligament injuries: a review of compensation claims in Norway from 2005 to 2015. Knee Surgery, Sports Traumatology, Arthroscopy. ISSN 0942-2056. 26(2), s. 628–633. doi: 10.1007/s00167-017-4809-y. Fulltekst i vitenarkiv Vis sammendrag

  Purpose To assess the most common reasons for complaints following anterior cruciate ligament (ACL) injuries reported to the Norwegian System of Patient Injury Compensation (NPE), and to view these complaints in light of the ACL reconstructions (ACL-Rs) reported to the Norwegian Knee Ligament Registry (NKLR). Method Data from the NPE and the NKLR were collected for the study period (2005–2015). The age and gender and type of complaint and reason for granted compensation were collected from the NPE, while the graft choice and total number of ACL-R were collected from the NKLR. Risk for successful grant was estimated for graft type. Results 18,810 primary ACL-Rs were reported to the NKLR during the study period. A hamstring graft was used in 12,437 (66.1%) but the bone-patellar tendon-bone (BPTB) became the graft of choice at the end of the study period. 240 patients filed a complaint to the NPE, of which 101 were granted compensation. The odds ratio for a claim being granted following a hamstring graft was 2.9 compared to that of a BPTB graft (p = 0.002) The most common reason for compensation was a hospital-acquired infection in 39 patients (38.6%) followed by inadequate surgical technique (27, 26.7%) and delayed diagnosis (13, 12.9%). Of the 39 patients with infection, 27 had received a hamstring graft and six a BPTB graft (two patients were not reconstructed, data missing for three patients). Of the 27 patients who were granted compensation due to inadequate surgical technique, 24 had received a hamstring graft and three a BPTB graft. Conclusion Infection and inadequate surgical technique are the most common causes for granted compensation from the NPE following ACL injury. Hamstring grafts have a threefold risk of complication that yields compensation from the NPE compared to BPTB grafts. This information is relevant for patients and surgeons when choosing graft type. The trend of increased use of BPTB grafts is warranted based on the results from this study.

• Foldager, Casper B.; Bendtsen, Michael; Berg, Lise C.; Brinchmann, Jan E.; Brittberg, Mats & Bunger, Cody [Vis alle 38 forfattere av denne artikkelen] (2016). Aarhus Regenerative Orthopaedics Symposium (AROS): Regeneration in the ageing population. Acta Orthopaedica. ISSN 1745-3674. 87, s. 1–5. doi: 10.1080/17453674.2017.1297918. Fulltekst i vitenarkiv
• Brænd, Anja Maria; Straand, Jørund; Jakobsen, Rune Bruhn & Klovning, Atle (2016). Publication and non-publication of drug trial results: A 10-year cohort of trials in Norwegian general practice. BMJ Open. 6(4). doi: 10.1136/bmjopen-2015-010535. Fulltekst i vitenarkiv Vis sammendrag

  Objectives Previously, we identified a 10-year cohort of protocols from applications to the Norwegian Medicines Agency 1998–2007, consisting of 196 drug trials in general practice. The aim of this study was to examine whether trial results were published and whether trial funding and conflicts of interest were reported. Design Cohort study of trials with systematic searches for published results. Setting Clinical drug trials in Norwegian general practice. Methods We performed systematic literature searches of MEDLINE, Embase and CENTRAL to identify publications originating from each trial using characteristics such as test drug, comparator and patient groups as search terms. When no publication was identified, we contacted trial sponsors for information regarding trial completion and reference to any publications. Main outcome measures We determined the frequency of publication of trial results and trial characteristics associated with publication of results. Results Of the 196 trials, 5 were never started. Of the remaining 191 trials, 71% had results published in a journal, 11% had results publicly available elsewhere and 18% of trials had no results available. Publication was more common among trials with an active comparator drug (χ2 test, p=0.040), with a larger number of patients (total sample size≥median, p=0.010) and with a longer trial period (duration≥median, p=0.025). Trial funding was reported in 85% of publications and increased over time, as did reporting of conflicts of interest among authors. Among the 134 main journal articles from the trials, 60% presented statistically significant results for the investigational drug, and the conclusion of the article was favourable towards the test drug in 78% of papers. Conclusions We did not identify any journal publication of results for 29% of the general practice drug trials. Trials with an active comparator, larger and longer trials were more likely to be published.

• Karlsen, Tommy Aleksander; Jakobsen, Rune Bruhn; Mikkelsen, Tarjei S. & Brinchmann, Jan E. (2014). microRNA-140 Targets RALA and Regulates Chondrogenic Differentiation of Human Mesenchymal Stem Cells by Translational Enhancement of SOX9 and ACAN. Stem Cells and Development. ISSN 1547-3287. 23(3), s. 290–304. doi: 10.1089/scd.2013.0209. Fulltekst i vitenarkiv
• Jakobsen, Rune Bruhn; Østrup, Esben; Xiaolan, Zhang; Mikkelsen, Tarjei S. & Brinchmann, Jan E. (2014). Analysis of the effects of five factors relevant to in vitro chondrogenesis of human mesenchymal stem cells using factorial design and high throughput mRNA-profiling. PLOS ONE. 9(5). doi: 10.1371/journal.pone.0096615. Fulltekst i vitenarkiv
• Gordeladze, Jan Oxholm; Reseland, Janne Elin; Karlsen, Tommy Aleksander; Jakobsen, Rune Bruhn; Stunes, Astrid Kamilla & Syversen, Unni [Vis alle 9 forfattere av denne artikkelen] (2013). Engineering of Inflammation-Resistant Osteochondral Cells. I Andrades, Jose A. (Red.), Regenerative Medicine and Tissue Engineering. IntechOpen. ISSN 9789535111085. doi: 10.5772/55544. Fulltekst i vitenarkiv
• Boulland, Jean-Luc; Mastrangelopoulou, Maria; Boqest, Andrew Craig; Jakobsen, Rune Bruhn; Noer, Agate & Glover, Joel [Vis alle 7 forfattere av denne artikkelen] (2013). Epigenetic Regulation of Nestin Expression during Neurogenic Differentiation of Adipose Tissue Stem Cells. Stem Cells and Development. ISSN 1547-3287. 22(7), s. 1042–1052. doi: 10.1089/scd.2012.0560. Fulltekst i vitenarkiv
• Gordeladze, Jan Oxholm; Reseland, Janne Elin; Karlsen, Tommy Aleksander; Jakobsen, Rune Bruhn; Engebretsen, Lars & Lyngstadaas, Ståle Petter [Vis alle 9 forfattere av denne artikkelen] (2011). Bone and Cartilage from Stem Cells: Growth Optimalization and Stabilization of Cell Phenotypes. I Eberli, Daniel (Red.), Bone and Cartilage from Stem Cells: Growth Optimalization and Stabilization of Cell Phenotypes. IntechOpen. ISSN 9789533076638. s. 23–56. doi: 10.5772/19826. Fulltekst i vitenarkiv
• Jakobsen, Rune Bruhn & Jakobsen, BW (2011). Posterior Cruciate Ligament Injury. I Bhandari, M (Red.), Evidence-based Orthopedics. Wiley-Blackwell. ISSN 9781405184762. s. 822–832. doi: 10.1002/9781444345100.ch96. Fulltekst i vitenarkiv
• Jakobsen, Rune Bruhn; Shahdafar, Aboulghassem; Reinholt, Finn P. & Brinchmann, Jan E. (2010). Chondrogenesis in a hyaluronic acid scaffold: comparison between chondrocytes and MSC from bone marrow and adipose tissue. Knee Surgery, Sports Traumatology, Arthroscopy. ISSN 0942-2056. 18(10), s. 1407–1416. doi: 10.1007/s00167-009-1017-4. Fulltekst i vitenarkiv
• Watsend, AME; Osestad, TMO; Jakobsen, Rune Bruhn & Engebretsen, Lars (2009). Clinical studies on posterior cruciate ligament tears have weak design. Knee Surgery, Sports Traumatology, Arthroscopy. ISSN 0942-2056. 17(2), s. 140–149. Fulltekst i vitenarkiv
• LaPrade, RF; Heikes, c; bakker, aj & Jakobsen, Rune Bruhn (2008). The reproducibility and repeatability of varus stress radiographs in the assessment of isolated fibular collateral ligament and grade-III posterolateral knee injuries. An in vitro biomechanical study. Journal of Bone and Joint Surgery. American volume. ISSN 0021-9355. 90(10), s. 2069–2076. Fulltekst i vitenarkiv
• Løken, Sverre Bertrand; Jakobsen, Rune Bruhn; Årøen, Asbjørn; Heir, Stig; Shahdafar, Aboulghassem & Brinchmann, Jan E. [Vis alle 8 forfattere av denne artikkelen] (2008). Bone marrow mesenchymal stem cells in a hyaluronan scaffold for treatment of an osteochondral defect in a rabbit model. Knee Surgery, Sports Traumatology, Arthroscopy. ISSN 0942-2056. 16, s. 896–903. doi: 10.1007/s00167-008-0566-2. Fulltekst i vitenarkiv
• Jakobsen, Rune Bruhn; Engebretsen, Lars & Slauterbeck, J.R. (2005). An analysis of the quality of cartilage repair studies. Journal of Bone and Joint Surgery. American volume. ISSN 0021-9355. 87(10), s. 2232–2239. Fulltekst i vitenarkiv

Se alle arbeider i NVA

• Jakobsen, Rune Bruhn (2025). Basic Cartilage anatomy/physiology for the ortho surgeon. Fulltekst i vitenarkiv
• Årøen, Asbjørn; Straume-Næsheim, Truls Martin; Visnes, Håvard; Engebretsen, Lars & Jakobsen, Rune Bruhn (2025). Number of meniscus sutures for a bucket handle meniscus in the ACL injured knee – a real-life review from nklr-data. Fulltekst i vitenarkiv
• Tveiten, Caroline Emilie Van Woensel Ko; Jakobsen, Rune Bruhn; Fenstad, Anne Marie; Persson, Andreas; Engebretsen, Lars & Moksnes, Håvard [Vis alle 7 forfattere av denne artikkelen] (2025). The other side of the ACL injury story – a nationwide, prospective cohort of non-operated patients and their outcomes. Fulltekst i vitenarkiv
• Jakobsen, Rune Bruhn; Tveiten, Caroline Emilie Van Woensel Ko; Løken, Sverre Bertrand; Persson, Andreas; Moksnes, Håvard & Grindem, Hege [Vis alle 7 forfattere av denne artikkelen] (2024). Siste nytt om fremre korsbånd hos idrettsutøvere. Fulltekst i vitenarkiv
• Mikaelsen, Jan Rune; Jakobsen, Rune Bruhn; Fenstad, Anne Marie & Randsborg, Per-Henrik (2023). EFFEKTEN AV KROPPMASSEINDEKS (KMI) PÅ REVISJONSRATEN 2 – 7 ÅR ETTER KNEPROTESE. Fulltekst i vitenarkiv
• Randsborg, Per-Henrik; Aae, Tommy Frøseth; Bukholm, Ida Rashida Khan & Jakobsen, Rune Bruhn (2023). Pasientskadeerstatninger etter hallux valgus korreksjon i Norge fra 2010 til 2020. Fulltekst i vitenarkiv
• Tveiten, Caroline Emilie Van Woensel Ko; Jakobsen, Rune Bruhn; Bache-Mathiesen, Lena Kristin; Persson, Andreas; Myklebust, Grethe & Engebretsen, Lars [Vis alle 7 forfattere av denne artikkelen] (2023). Kommer utøvere på alle nivåer tilbake til vridningsidrett etter ACL rekonstruksjon? Fulltekst i vitenarkiv
• Wikerøy, Annette Konstanse Bordewich; Jakobsen, Rune Bruhn; Fuglesang, Hendrik Frølich & Randsborg, Per-Henrik (2023). Tittel Intramedullær nagling versus Platefiksasjon av dislokerte 3 og 4 parts proksimale humerusfrakturer, en single senter randomisert kontrollert studie. Fulltekst i vitenarkiv
• Tveiten, Caroline Emilie Van Woensel Ko; Jakobsen, Rune Bruhn; Bache-Mathiesen, Lena Kristin; Persson, Andreas; Myklebust, Grethe & Engebretsen, Lars [Vis alle 7 forfattere av denne artikkelen] (2023). Kommer utøvere på alle nivåer tilbake til vridningsidrett etter ACL rekonstruksjon? Fulltekst i vitenarkiv
• Jakobsen, Rune Bruhn (2023). Femuroacetabular impingement hos unge idrettsutøvere (15-30 år): Epidemiologi og patogenese? Fulltekst i vitenarkiv
• Jakobsen, Rune Bruhn (2022). Improving the treatment of anterior cruciate ligament tears in Norway with register-RCTs. Fulltekst i vitenarkiv
• Jakobsen, Rune Bruhn (2022). Ortopediske kvalitetsregistres rolle og nytte i fremtiden. Fulltekst i vitenarkiv
• Jakobsen, Rune Bruhn (2022). Hamstringsskader i idrett. Hvor sitter skaden - på tuber ischii, senen, sene muskelovergang eller i muskelbuken? Fulltekst i vitenarkiv
• Lunde, Lene; Brænd, Anja Maria; Jakobsen, Rune Bruhn; Moen, Anne & Rosvold, Elin Olaug (2020). Simulation strengthens interprofessional collaboration for healthcare students in primary care. Fulltekst i vitenarkiv Vis sammendrag

  Background Primary healthcare providers are responsible for patients with increasingly complex problems. Introducing interprofessional collaboration in healthcare curricula prepares students to meet these challenges. Simulation-based learning may be a powerful facilitator for active and safe learning, but is mostly used in acute clinical situations. We explore simulation as a strategy to train students in interprofessional collaboration in sub-acute clinical scenarios in primary healthcare. Summary of work We tested two low-fidelity simulation scenarios with common, sub-acute patient situations from primary healthcare: An older patient stays at a nursing home after having a hip fracture and surgery, and he develops a urinary tract infection or a pneumonia. Healthcare students (n=27) in their final stage of education (medical students, master students in advanced geriatric nursing and bachelor students in nursing) were allocated to ten groups. The groups were assigned to do a clinical assessment, agree on a probable diagnosis and develop a treatment plan during both scenarios. The facilitators guided the groups from briefing through to debriefing with focus on collaboration and communication. The study is an exploratory, qualitative study with interaction analysis of segments from video recordings of the simulations. Summary of results Different forms of interaction and communication affected interprofessional collaboration, especially during the development of a care plan. The content and structure of the care plan and the team’s efficiency in settling a plan as a team depended on 1) the ability to recognize each other’s contribution, 2) mutual knowledge development and 3) the awareness of setting and roles. This emerged through dialogue, gestures, gaze and body language. During debriefing, several groups reflected on clarifying concepts such as close monitoring and deterioration of the patient. Discussion and conclusions The sub-acute scenarios show potential to identify interactions and communication affecting collaboration. Using the scenarios in healthcare education may help students to develop productive interactions strengthening interprofessional collaboration. Furthermore, the simulation scenarios are feasible to use on-site in an education facility with minimal technical equipment. Take home message Low-fidelity, on-site simulation scenarios based on common, sub-acute clinical situations shows promise in training students in interprofessional collaboration preparing for the complexity of primary healthcare.

• Lunde, Lene; Moen, Anne; Jakobsen, Rune Bruhn; Brænd, Anja Maria & Rosvold, Elin Olaug (2020). Simulering styrker tverrfaglig samarbeid i helsefaglig utdanning. Fulltekst i vitenarkiv
• Lunde, Lene; Moen, Anne; Jakobsen, Rune Bruhn & Rosvold, Elin Olaug (2019). Using simulation to train interprofessional collaboration for healthcare students in primary care. Fulltekst i vitenarkiv
• Wang, Katherine; Esbensen, Qin Ying; Karlsen, Tommy Aleksander; Årøen, Asbjørn & Jakobsen, Rune Bruhn (2019). Low-input RNA-sequencing in patients with cartilage lesions, osteoarthritis, and healthy cartilage - a reference for tissue engineering. Fulltekst i vitenarkiv
• Randsborg, Per-Henrik; Jakobsen, Rune Bruhn & Bukholm, Ida Rashida Khan (2018). Compensation after treatment for ACL injuries. Fulltekst i vitenarkiv
• Karlsen, Tommy Aleksander; Jakobsen, Rune Bruhn & Brinchmann, Jan E. (2017). Early molecular events during in vitro chondrogenesisi. I Atkinson, Kerry (Red.), The biology and therapeutic Application of mesenchymal cells. Wiley-Blackwell. ISSN 9781118907511. s. 167–190. Fulltekst i vitenarkiv
• Randsborg, Per-Henrik; Bukholm, Ida & Jakobsen, Rune Bruhn (2017). KOMPENSASJON ETTER BEHANDLING FOR KORSBÅNDSSKADER. GJENNOMGANG AV KLAGER BEHANDLET AV NORSK PASIENTSKADEERSTATNING 2005-2015. Fulltekst i vitenarkiv
• Dolatowski, Filip Celestyn; Randsborg, Per-Henrik; Utvåg, Stein-Erik & Jakobsen, Rune Bruhn (2017). Comment on the article: Hemiarthroplasty versus internal fixation in super-aged patients with undisplaced femoral neck fractures: a 5-year follow-up of randomized controlled trial. Archives of Orthopaedic and Trauma Surgery. ISSN 0936-8051. 137(9), s. 1269–1270. doi: 10.1007/s00402-017-2746-3. Fulltekst i vitenarkiv
• Jakobsen, Rune Bruhn; Gran, Sarah Frandsen; Grimsmo, Bergsvein; Arntzen, Kari; Frich, Jan C & Hjortdahl, Per (2015). Interprofessional simulation-based team training for medical and nursing students. Fulltekst i vitenarkiv
• Arntzen, Kari & Jakobsen, Rune Bruhn (2015). Transition to practise, Student BEST - Team trening mellom sykepleierstudenter og medisin studenter. Fulltekst i vitenarkiv
• Jakobsen, Rune Bruhn; Shahdafar, Aboulghassem; Reinholt, Finn P. & Brinchmann, Jan E. (2014). Erratum to Chondrogenesis in a hyaluronic acid scaffold: Comparison between chondrocytes and MSC from bone marrow and adipose tissue (Knee Surg Sports Traumatol Arthrosc, (2010), 18, (1407-1416), 10.1007/s00167-009-1017-4). Knee Surgery, Sports Traumatology, Arthroscopy. ISSN 0942-2056. 22(7), s. 1711–1714. doi: 10.1007/s00167-014-2938-0. Fulltekst i vitenarkiv
• Jakobsen, Rune Bruhn (2014). Mesenchymal Stem Cells in Cartilage Repair Studies of Chondrogenesis In Vitro and In Vivo. Universitetet i Oslo. Fulltekst i vitenarkiv

Se alle arbeider i NVA