Erik Torgeir Fosse

• Basso, Trude; Bjerke, Lars Martin; Bretthauer, Michael; Christiansen, Ola; Dahl, Torbjørn & Fosse, Erik Torgeir [Show all 14 contributors for this article] (2026). Towards sustainable implementation of robotic surgery: an interregional strategic framework from Norway. Journal of Robotic Surgery. ISSN 1863-2483. 20(1), p. 1–5. doi: 10.1007/s11701-026-03521-3. Full text in Research Archive Show summary

  Robot‑assisted soft‑tissue surgery (RAS) is embedded in many healthcare systems, yet large‑scale adoption has often proceeded without coordinated governance, resulting in variation in access, training standards, and outcome reporting. This policy perspective summarises the findings and recommendations of an interregional expert group commissioned by Norway's four Regional Health Authorities to develop a strategic framework for sustainable implementation of RAS within a publicly funded specialist healthcare system. Key challenges identified include unclear indication selection, heterogeneous training standards, fragmented procurement practices, incomplete lifecycle costing, and limited systematic outcome monitoring. Core recommendations comprise prioritisation of procedures with demonstrated clinical value, standardised lifecycle cost assessment, coordinated procurement, accredited training pathways, and mandatory data registration. The Norwegian framework illustrates how governance, evidence generation, and workforce planning can be aligned to promote sustainable implementation of robotic surgery. Although developed within a public health system, several principles are transferable to other healthcare contexts.

• Holmen, Heidi & Fosse, Erik Torgeir (2026). “I Want to Spend My Time Living”—Experiences With a Digital Outpatient Service With a Mobile App for Tailored Care Among Adults With Long-Term Health Service Needs: Qualitative Study Using Thematic Analysis. Journal of Medical Internet Research (JMIR). ISSN 1439-4456. 28, p. 1–12. doi: 10.2196/79155. Full text in Research Archive Show summary

  Background: Digital health services are increasingly used in hospital-based outpatient care, offering remote monitoring, patient-reported outcomes, information sharing, and asynchronous communication. While expected to improve self-management, timeliness, and efficiency, the success of digital health interventions relies on patients’ health literacy and digital health literacy. While some research has addressed potential associations between digital health interventions and patients’ health outcomes, research on patients’ experiences remains limited. Objective: The aim of this study was to explore and gain in-depth knowledge about the experiences of patients with chronic or long-term conditions enrolled in a 6-month digital outpatient care intervention for tailored care and health literacy. Methods: We conducted an exploratory qualitative interview study with 17 strategically recruited adult patients with cancer, interstitial lung disease, epilepsy, or complicated pain who used a digital outpatient service for 6 months. Individual telephone interviews were conducted using a semistructured guide, transcribed verbatim, and analyzed with thematic analysis to generate codes and themes. Participants had a median age of 62 years (minimum-maximum 36-83 years), with 8 females and 9 males. Results: The thematic analysis led to 1 main theme “Digital outpatient care as a flexible service supporting patients’ self-management,” informed by 3 subthemes “The ongoing nature of managing a chronic condition and how the digital service meet the patients’ desire for autonomy in their care,” “Digital tools flexibly address the patients’ unique needs, but reliability depends on patient interaction,” and “Digital services enhance the patients’ sense of safety through easy access to a relation with competent healthcare workers.” The themes highlight patients’ appreciation for greater flexibility in their care and their desire to self-manage with the support of easily accessible health care workers, ultimately supporting their health literacy. Patients recognized the importance of actively engaging with the digital solution to fully benefit from its opportunities and emphasized the critical role of health care workers in fostering their sense of security. Conclusions: Digital outpatient care was experienced as flexible and supportive for patients with long-term conditions. The increased possibility of interacting with health care workers was welcomed by the patients, and the combination of flexibility, self-monitoring, and addressing concerns regarding their self-management may increase the patients experience of autonomy. As health literacy likely plays a role in patients’ ability to effectively engage with digital tools and self-manage their conditions, future research should explore how varying levels of health literacy influence these outcomes. In addition, research should address whether such digital outpatient clinics are positive for a wider range of patients, associated health outcomes, and any positive effects on a health system level. Trial Registration: ClinicalTrials.gov NCT05068869; https://clinicaltrials.gov/ct2/show/NCT05068869

• Holmen, Heidi; Holm, Are Martin; Falk, Ragnhild Sørum; Kilvær, Thomas Karsten; Ljoså, Tone Marte & Ekholdt, Christopher [Show all 7 contributors for this article] (2025). A Digital Outpatient Service With a Mobile App for Tailored Care and Health Literacy in Adults With Long-Term Health Service Needs: Multicenter Nonrandomized Controlled Trial. Journal of Medical Internet Research (JMIR). ISSN 1439-4456. 27. doi: 10.2196/60343. Full text in Research Archive Show summary

  Background: Patients with long-term health needs are often expected to actively participate in outpatient care, assuming that they have appropriate health literacy and digital health literacy. However, the association between participation in a digital outpatient service and health literacy remain unclear.<p> <p>Objective: This study aims to evaluate whether digital outpatient care for 6 months improved health literacy, health-related quality of life (HRQoL), digital/eHealth literacy, and the use of health care services compared with usual care.<p> <p>Methods: We conducted a multicenter nonrandomized trial with 1 intervention arm and 1 control arm. Patients aged ≥18 years receiving outpatient care in the pain, lung, neurology, or cancer departments at 2 Norwegian university hospitals were allocated in a 1:2 ratio, favoring the intervention arm. The intervention arm received digital outpatient care using tailored patient-reported outcome measures, self-monitoring, and chats for timely contact with the outpatient clinic. Patient responses were assessed by health care workers via a dashboard with a traffic light system to draw attention to the most urgent reports. The control arm received usual care. The data were collected at baseline and after 3 and 6 months. The primary outcome was the change in health literacy according to the Health Literacy Questionnaire domain understanding health information well enough to know what to do from baseline to 6 months. The mean difference in change between the 2 treatment arms was the effect measure. The secondary outcomes were additional domains from the Health Literacy Questionnaire, digital/eHealth literacy, HRQoL, acceptability of the digital intervention, and health service use.<p> <p>Results: Overall, 162 patients were recruited, 55 (34%) in the control arm and 107 (66%) in the intervention arm, with a 17.3% attrition rate after 6 months. There was no statistically significant difference in the primary outcome, “understanding health information well enough to know what to do,” between the arms at 6 months (mean difference –0.05, 95% CI –0.20 to 0.10; P=.53). After 3 months, the health literacy domains actively managing my own health (–0.15, 95% CI –0.30 to –0.00; P=.048) and understanding health information well enough to know what to do (–0.17, 95% CI –0.34 to –0.00; P=.03), as well as both physical (–3.29, 95% CI –5.62 to –0.96; P=.006) and mental HRQoL (–3.08, 95% CI –5.64 to –0.52; P=.02), improved in the digital outpatient intervention arm compared with the control arm.<p> <p>Conclusions: This study explored digital outpatient care. Although no statistical differences were observed in patients’ health literacy after 6 months, our data indicate an improvement in health literacy domains and HRQoL at 3 months. The participants reported high satisfaction with the digital outpatient care intervention, and our findings highlight the potential of digital interventions in outpatient care.

• Mahmood, Salman; Schostek, Sebastian; Schurr, Marc O.; Bergsland, Jacob; Balasingham, Ilangko & Fosse, Erik (2022). Robot-assisted magnetic capsule endoscopy; navigating colorectal inclinations. MITAT. Minimally invasive therapy & allied technologies. ISSN 1364-5706. 31(6), p. 930–938. doi: 10.1080/13645706.2022.2032181. Full text in Research Archive Show summary

  Purpose: To investigate the interaction of a robot assisted magnetically driven wireless capsule endoscope (WCE) with colonic tissue, as it traverses the colorectal bends in the dorsal and ventral directions, relying only on the feedback from a 3D accelerometer. We also investigate the impact of shell geometry and water insufflation on WCE locomotion. Methods: A 3D printed incline phantom, lined with porcine colon, was used as the experimental platform, for controlled and repeatable results. The tilt angle of WCE was controlled to observe its influence on WCE locomotion. The phantom was placed underwater to observe the effects of water insufflation. The experiments were repeated using the two capsule shell geometries to observe the effect of shell geometry on WCE locomotion. Results: Friction between WCE and intestinal tissue increased when the tilt angle of the WCE was lower than the angle of the incline of the phantom. Increasing the WCE tilt angle to match the angle of the incline reduced this friction. Water insufflation and elliptical capsule shell geometry reduced the friction further. Conclusion: Tilting of the WCE equal to, or more than the angle of the incline improved the WCE locomotion. WCE locomotion was also improved by using elliptical capsule shell geometry and water insufflation. Abbreviations: CRC: colorectal cancer; GI: gastrointestinal; MRI: magnetic resonance imaging; WCE: wireless capsule endoscope

• Zimmo, Mohammed; Laine, Katariina; Hassan, Sahar J. A.; Bottcher, Bettina; Fosse, Erik & Ali, Hadil [Show all 10 contributors for this article] (2022). Exploring the impact of indication on variation in rates of intrapartum caesarean section in six Palestinian hospitals: a prospective cohort study. BMC Pregnancy and Childbirth. 22:892, p. 1–8. doi: 10.1186/s12884-022-05196-8. Full text in Research Archive Show summary

  Background Caesarean section rates are rising globally. No specific caesarian section rate at either country-level or hospital-level was recommended. In Palestinian government hospitals, nearly one-fourth of all births were caesarean sections, ranging from 14.5 to 35.6%. Our aim was to assess whether variation in odds for intrapartum caesarean section in six Palestinian government hospitals can be explained by differences in indications. Methods Data on maternal and fetal health were collected prospectively for all women scheduled for vaginal delivery during the period from 1st March 2015 to 30th November 2016 in six government hospitals in Palestine. Comparisons of proportions in sociodemographic, antenatal obstetric characteristics and indications by the hospital were tested by χ2 test and differences in means by one-way ANOVA analysis. The odds for intrapartum caesarean section were estimated by logistic regression. The amount of explained variance was estimated by Nagelkerke R square. Results Out of 51,041 women, 4724 (9.3%) underwent intrapartum caesarean section. The prevalence of intrapartum caesarean section varied across hospitals; from 7.6 to 22.1% in nulliparous, and from 5.8 to 14.1% among parous women. The most common indications were fetal distress and failure to progress in nulliparous, and previous caesarean section with an additional obstetric indication among parous women. Adjusted ORs for intrapartum caesarean section among nulliparous women ranged from 0.42 (95% CI 0.31 to 0.57) to 2.41 (95% CI 1.70 to 3.40) compared to the reference hospital, and from 0.50 (95% CI 0.40–0.63) to 2.07 (95% CI 1.61 to 2.67) among parous women. Indications explained 58 and 66% of the variation in intrapartum caesarean section among nulliparous and parous women, respectively. Conclusion The differences in odds for intrapartum caesarean section among hospitals could not be fully explained by differences in indications. Further investigations on provider related factors as well as maternal and fetal outcomes in different hospitals are necessary.

• Schalit, Itai; Espinoza, Andreas Westenvik; Pettersen, Fred-Johan; Skulstad, Helge; Fosse, Erik & Fiane, Arnt Eltvedt [Show all 7 contributors for this article] (2022). Improved Detection of Thromboembolic Complications in Left Ventricular Assist Device by Novel Accelerometer-Based Analysis. ASAIO journal (1992). ISSN 1058-2916. 68(9), p. 1117–1125. doi: 10.1097/MAT.0000000000001654. Full text in Research Archive
• Krogh, Magnus Reinsfelt; Halvorsen, Per Steinar; Grymyr, Ole-Johannes Holm Nielsen; Bergsland, Jacob; Elle, Ole Jakob & Fosse, Erik [Show all 7 contributors for this article] (2021). Continuous Estimation of Acute Changes in Preload Using Epicardially Attached Accelerometers. IEEE Transactions on Biomedical Engineering. ISSN 0018-9294. 68(7), p. 2067–2075. doi: 10.1109/TBME.2020.3020358. Full text in Research Archive
• Johannessen, Karl-Arne; Comtet, Hans & Fosse, Erik (2021). A drone logistic model for transporting the complete analytic volume of a large‐scale university laboratory. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 18(9), p. 1–19. doi: 10.3390/ijerph18094580. Full text in Research Archive Show summary

  We present a model for drone transport of the complete annual analytic volume of 6.5 million analyses—(routine and emergency) between two inner-city university laboratories at Oslo University Hospital located 1.8 km apart and with a time restriction for the analyses of no more than 60 min. The total laboratory activity was analyzed per min for the complete year of 2018. The time from the clinical ordering of tests to the loading of the drone, drone transport time, and analysis time after the sample arrived at the analyzing laboratory were assessed using the lead time of emergency analyses of C-reactive protein, troponin, and the international normalized ratio. The activity had characteristic diurnal patterns, with the most intensive traffic between 8 and 12 a.m. on weekdays and there being considerably less traffic for the rest of the day, at night and on weekends. Drone schedules with departures 15–60 min apart were simulated. A maximum of 15 min between flights was required to meet the emergency demand for the analyses being completed within 60 min. The required drone weight capacity was below 3.5 kg at all times. In multiple simulations, the drone times were appropriate, whereas variations in the clinic- and laboratory-related time intervals caused violations of the allowed time 50% of the time. Drone transport with regular schedules may potentially improve the transport time compared with traditional ground transport and allow the merging of large laboratories, even when the demand for emergency analyses restricts the maximum transport time. Comprehensive economic evaluations and robust drone technology are needed before such solutions can be ready for implementation.

• Storm, Benjamin; Halvorsen, Per Steinar; Skulstad, Helge; Dybwik, Knut Gustav; Schjalm, Camilla & Christiansen, Dorte [Show all 11 contributors for this article] (2021). Open chest and pericardium facilitate transpulmonary passage of venous air emboli. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 65(5), p. 648–655. doi: 10.1111/aas.13796. Full text in Research Archive Show summary

  Background Transpulmonary passage of air emboli can lead to fatal brain- and myocardial infarctions. We studied whether pigs with open chest and pericardium had a greater transpulmonary passage of venous air emboli than pigs with closed thorax. Methods We allocated pigs with verified closed foramen ovale to venous air infusion with either open chest with sternotomy and opening of the pleura and pericardium (n = 8) or closed thorax (n = 16). All pigs received a five-hour intravenous infusion of ambient air, starting at 4-6 mL/kg/h and increased by 2 mL/kg/h each hour. We assessed transpulmonary air passage by transesophageal M-mode echocardiography and present the results as median with inter-quartile range (IQR). Results Transpulmonary air passage occurred in all pigs with open chest and pericardium and in nine pigs with closed thorax (56%). Compared to pigs with closed thorax, pigs with open chest and pericardium had a shorter to air passage (10 minutes (5-16) vs. 120 minutes (44-212), P < .0001), a smaller volume of infused air at the time of transpulmonary passage (12 mL (10-23) vs.170 mL (107-494), P < .0001), shorter time to death (122 minutes (48-185) vs 263 minutes (248-300, P = .0005) and a smaller volume of infused air at the time of death (264 mL (53-466) vs 727 mL (564-968), P = .001). In pigs with open chest and, infused air and time to death correlated strongly (r = 0.95, P = .001). Conclusion Open chest and pericardium facilitated the transpulmonary passage of intravenously infused air in pigs.

• Johannessen, Karl Arne; Wear, Nina Kristin Steen; Toska, Karin; Hansbø, Morten; Berg, Jens Petter & Fosse, Erik (2021). Pathologic Blood Samples Tolerate Exposure to Vibration and High Turbulence in Simulated Drone Flights, but Plasma Samples Should be Centrifuged after Flight. IEEE Journal of Translational Engineering in Health and Medicine. doi: 10.1109/JTEHM.2021.3053172. Full text in Research Archive Show summary

  Objective. Most of the previous studies of drone transport of blood samples examined normal blood samples transported under tranquil air conditions. We studied the effects of 1- and 2-hour drone flights using random vibration and turbulence simulation (10-30 g-force) on blood samples from 16 healthy volunteers and 74 patients with varying diseased. Methods: Thirty-two of the most common analytes were tested. For biochemical analytes, we used plasma collected in lithium heparin tubes with and without separator gel. Gel samples were analyzed for the effect of separation by centrifugation before or after turbulence. Turbulence was simulated in an LDS V8900 high-force shaker using random vibration (range, 5-200 Hz), with samples randomly allocated to 1- or 2-hour flights with 25 or 50 episodes of turbulence from 10 to 30 G. Results: For all hematologic and most biochemical analytes, test results before and after turbulence exposure were similar (bias <; 12%, intercepts <; 10%). However, aspartate aminotransferase, folate, lactate dehydrogenase and lipid index increased significantly in samples separated by gel and centrifugation prior to vibration and turbulence test. These changes increased form 10 G to 30 G, but were not observed when the samples were separated after vibration and turbulence. Conclusions: Whole blood showed little vulnerability to turbulence, whereas plasma samples separated from blood cells by gel may be significantly influenced by turbulence when separated by spinning before the exposure. Centrifugation of plasma samples collected in tubes with separator gel should be avoided before drone flights that could be subject to turbulence.

• Larsson, Christopher; Groote, Inge Rasmus; Vardal, Jonas; Kleppestø, Magne Mørk; Odland, Audun & Brandal, Petter [Show all 13 contributors for this article] (2020). Prediction of survival and progression in glioblastoma patients using temporal perfusion changes during radiochemotherapy. Magnetic Resonance Imaging. ISSN 0730-725X. 68, p. 106–112. doi: 10.1016/j.mri.2020.01.012. Full text in Research Archive Show summary

  Background The aim of this study was to investigate changes in structural magnetic resonance imaging (MRI) according to the RANO criteria and perfusion- and permeability related metrics derived from dynamic contrast-enhanced MRI (DCE) and dynamic susceptibility contrast MRI (DSC) during radiochemotherapy for prediction of progression and survival in glioblastoma. Methods Twenty-three glioblastoma patients underwent biweekly structural and perfusion MRI before, during, and two weeks after a six weeks course of radiochemotherapy. Temporal trends of tumor volume and the perfusion-derived parameters cerebral blood volume (CBV) and blood flow (CBF) from DSC and DCE, in addition to contrast agent capillary transfer constant (Ktrans) from DCE, were assessed. The patients were separated in two groups by median survival and differences between the two groups explored. Clinical- and MRI metrics were investigated using univariate and multivariate survival analysis and a predictive survival index was generated. Results Median survival was 19.2 months. A significant decrease in contrast-enhancing tumor size and CBV and CBF in both DCE- and DSC-derived parameters was seen during and two weeks past radiochemotherapy (p < 0.05). A 10%/30% increase in Ktrans/CBF two weeks after finishing radiochemotherapy resulted in significant shorter survival (13.9/16.8 vs. 31.5/33.1 months; p < 0.05). Multivariate analysis revealed an index using change in Ktrans and relative CBV from DSC significantly corresponding with survival time in months (r2 = 0.843; p < 0.001). Conclusions Significant temporal changes are evident during radiochemotherapy in tumor size (after two weeks) and perfusion-weighted MRI-derived parameters (after four weeks) in glioblastoma patients. While DCE-based metrics showed most promise for early survival prediction, a multiparametric combination of both DCE- and DSC-derived metrics gave additional information.

• Jensen, Kristin; Hagemo, Guro; Tingberg, Anders; Reisse, Claudius; Mynarek, Georg & Rivero, Jezabel Rodriguez [Show all 8 contributors for this article] (2020). Evaluation of Image Quality for 7 Iterative Reconstruction Algorithms in Chest Computed Tomography Imaging: A Phantom Study. Journal of computer assisted tomography. ISSN 0363-8715. 44(5), p. 673–680. doi: 10.1097/RCT.0000000000001037. Full text in Research Archive
• Wendt, Kjersti; Mørk, Bjørn Erik; Berg, Ole Trond & Fosse, Erik (2020). Medicine and interest politics a study of decision-making processes in the area of vascular surgery in Norway. Journal of Health Organisation and Management. ISSN 1477-7266. 34(4), p. 427–447. doi: 10.1108/JHOM-04-2019-0103. Full text in Research Archive Show summary

  Purpose – The purpose of this paper is to increase the understanding of organizational challenges when decision-makers try to comply with technological developments and increasing demands for a more rational distribution of health care services. This paper explores two decision-making processes from 2007–2019 in the area of vascular surgery at a regional and a local level in Norway. Design/methodology/approach – The study draws upon extensive document analyses, semi-structured interviews and field conversations. The empirical material was analyzed in several steps through an inductive approach and described and explained through a theoretical framework based on rational choice (i.e. bounded rationality), political behavior and institutionalism. These perspectives were used in a complementary way. Findings – Both decision-making processes were resource-intensive, long-lasting and produced few organizational changes for the provision of vascular services. Stakeholders at both levels outmaneuvered the health care planners, though by different means. Regionally, the decision-making ended up in a political process, while locally the decision-making proceeded as a strategic game between different departments and professional fields.Practical implications –Decision-makers need to prepare thoroughly for convincing others of the benefits of new ways of organizing clinical care. By providing meaningful opportunities for public involvement, by identifying and anticipating political agendas and by building alliances between stakeholders with divergent values and aims decision-makers may extend the realm of feasible solutions. Originality/value – This paper contributes to the understanding of why decision-making processes can be particularly challenging in a field characterized by rapid technological development, new treatment options and increasing demands for more rational distribution of services.

• Goderstad, Jeanne Mette; Fosse, Erik; Sandvik, Leiv & Lieng, Marit (2020). Development and validation of a curriculum for laparoscopic supracervical hysterectomy. Facts, views & vision in ObGyn.. ISSN 2032-0418. 12(2), p. 83–90. Full text in Research Archive
• Schalit, Itai; Espinoza, Andreas Westenvik; Pettersen, Fred-Johan; Snartland, Steinar; Ringdal, Mari-Anne I Lindstein & Nilsen-Hoel, Tom [Show all 10 contributors for this article] (2020). Detection of thromboembolic events and pump thrombosis in heartware HVAD using accelerometer in a porcine model. ASAIO journal (1992). ISSN 1058-2916. p. 38–48. doi: 10.1097/MAT.0000000000000954. Full text in Research Archive
• Goderstad, Jeanne Mette; Sandvik, Leiv; Fosse, Erik & Lieng, Marit (2019). Development and validation of a general and easy assessable scoring system for laparoscopic skills using a virtual reality simulator. European Journal of Obstetrics, Gynecology, and Reproductive Biology. ISSN 0301-2115. 4, p. 1–5. doi: 10.1016/j.eurox.2019.100092. Full text in Research Archive
• Pischke, Søren; Hestenes, Siv Merete; Johansen, Harald Thidemann; Fure, Hilde; Bugge, Jan F & Espinoza, Andreas Westenvik [Show all 12 contributors for this article] (2019). Sepsis causes right ventricular myocardial inflammation independent of pulmonary hypertension in a porcine sepsis model. PLOS ONE. 14:e0218624(6). doi: 10.1371/journal.pone.0218624. Full text in Research Archive Show summary

  Introduction Right ventricular (RV) myocardial dysfunction is a common feature in septic shock. It can worsen outcome, but the etiology is poorly understood. Pulmonary artery hypertension (PAH) plays a part in the pathogenesis of the right heart dysfunction in sepsis but its importance is unknown. In pigs, PAH in sepsis is substantial and the translational value of porcine sepsis models therefore questioned. We hypothesized that porcine sepsis causes a myocardial inflammatory response which leads to myocardial dysfunction independent of PAH. Materials and methods Sepsis was induced by Escherichia coli-infusion in 10 pigs resulting in PAH and increased right ventricular pressure (RVP). The same degree of RVP was achieved by external pulmonary artery banding (PAB) in a consecutive series of 6 animals. Results Sepsis, but not PAB, led to increase in endothelial damage marker PAI-1 and cytokines TNF and IL-6 (all p<0.05) in plasma. In myocardium, TNF and IL-6 were significantly elevated in sepsis, TNF in both ventricles and IL-6 mostly in RV, while IL-1β, IL-18 and C5a were significantly higher in RV compared to LV after PAB (all p<0.05). Myocardial mRNA levels of IL-1β, IL-6, IL-18, IP-10, E-selectin and PAI-1 were significantly elevated in RV and LV during sepsis compared to PAB, while Caspase-1 was decreased in septic compared to PAB animals (all p<0.05). Cathepsin L activity was increased in RV by PAB, while sepsis inhibited this response. Escherichia coli-induced sepsis caused myocardial inflammation independent of PAH. Conclusion Prominent PAH should therefore not exclude porcine sepsis models to further our understanding of human sepsis.

• Mortensen, Berit; Diep, Lien My; Lukasse, Mirjam; Lieng, Marit; Dwekat, Ibtesam & Elias, Dalia [Show all 7 contributors for this article] (2019). Women's satisfaction with midwife-led continuity of care: An observational study in Palestine. BMJ Open. 9(11), p. 1–9. doi: 10.1136/bmjopen-2019-030324. Full text in Research Archive Show summary

  Abstract Objectives A midwife-led continuity model of care had been implemented in the Palestinian governmental health system to improve maternal services in several rural areas. This study investigated if the model influenced women’s satisfaction with care, during antenatal, intrapartum and postnatal period. Design An observational case-control design was used to compare the midwife-led continuity model of care with regular maternity care. Participants and setting Women with singleton pregnancies, who had registered for antenatal care at a rural governmental clinic in the West Bank, were between 1 to 6 months after birth invited to answer a questionnaire rating satisfaction with care in 7-point Likert scales. Primary outcome The mean sum-score of satisfaction with care through the continuum of antenatal, intrapartum and postnatal period, where mean sum-scores range from 1 (lowest) to 7 (highest). Secondary outcome Exclusive breastfeeding. Results Two hundred women answered the questionnaire, 100 who received the midwife-led model and 100 who received regular care. The median time point of interview were 16 weeks postpartum in both groups. The midwife-led model was associated with a statistically significant higher satisfaction with care during antenatal, intrapartum and postnatal period, with a mean sum-score of 5.2 versus 4.8 in the group receiving regular care. The adjusted mean difference between the groups’ sum-score of satisfaction with care was 0.6 (95% CI 0.35 to 0.85), p<0.0001. A statistically significant higher proportion of women who received the midwife-led continuity model of care were still exclusively breastfeeding at the time point of interview, 67% versus 46% in the group receiving regular care, an adjusted OR of 2.56 (1.35 to 4.88) p=0.004. Conclusions There is an association between receiving midwife-led continuity of care and increased satisfaction with care through the continuum of pregnancy, intrapartum and postpartum period, and an increased duration of exclusive breastfeeding.

• Hassan, Sahar J. A.; Laine, Katariina; Fosse, Erik; Abu-Rmeileh, Niveen M.E.; Ali, Hadil & Zimmo, Mohammed [Show all 9 contributors for this article] (2019). Induction of labor among singleton pregnancies in six palestinian governmental hospitals: A population-based cohort study. International Journal of Women's Health. 11, p. 597–605. doi: 10.2147/IJWH.S215781. Full text in Research Archive Show summary

  Objective: To explore rates and review practices regarding induction of labor (IOL) among singleton pregnancies in Palestine. Design: A prospective population-based cohort study. Setting: Six secondary and tertiary governmental hospitals located in the two regions of Palestine: West Bank and Gaza. Participants: Singleton pregnancies who had IOL in participating units during the study period were included (n=8290). Women having multiple gestations (1004), planned cesarean births (703), those admitted with cervical dilation >6cm (11228), and pregnancies with no record of cervical dilation and/or gestational age on admission (219) were excluded. Primary outcome measure: Rates of IOL in participating units and regions. Results: There were a total of 33,402 singleton births during the study period with an IOL rate of 24.8%. Rates of IOL significantly varied between units, ranging from 12.9% to 45.6% (P-value <0.05). The majority of women with no previous uterine scar were induced at gestational ages ≤40 weeks where 43.8% were induced at 39–40 gestational weeks (29.9% multiparous; 13.9% nulliparous) and 17.7% were induced between 37 and 38 gestational weeks (11.9% multiparous; 5.8% nulliparous). Conclusion: Significant variations in IOL practices between Palestinian hospitals and regions suggest overuse of IOL among singleton pregnancies in some units with the majority of these being performed before 40 weeks’ gestation. These findings indicate a gap between implementation of best evidence and current clinical practice.

• Mortensen, Berit; Lieng, Marit; Diep, Lien My; Lukasse, Mirjam; Atieh, Kefaya & Fosse, Erik (2019). Improving Maternal and Neonatal Health by a Midwife-led Continuity Model of Care ? An Observational Study in One Governmental Hospital in Palestine. EClinicalMedicine. 10, p. 84–91. doi: 10.1016/j.eclinm.2019.04.003. Full text in Research Archive Show summary

  Background:From 2013 a midwife-led continuity model of care was implemented in the Nablus region in occu-pied Palestine, involving a governmental hospital and ten rural villages. This study analysed the relation betweenthe midwife-led model and maternal and neonatal health outcomes.Method:A register-based, retrospective cohort design was used, involving 2201 singleton births betweenJanuary 2016 and June 2017 at Nablus governmental hospital. Data from rural women, with singleton preg-nancies and mixed risk status, who either lived in villages that offered the midwife-led continuity modeland had registered at the governmental clinic, or who lived in villages without the midwife-led modeland received regular care, were compared. Primary outcome was unplanned caesarean section. Secondaryoutcomes were other modes of birth, postpartum anaemia, preterm birth, birthweight, and admission toneonatal intensive care unit.Findings:Statistically significant less women receiving the midwife-led model had unplanned caesareansections, 12·8% vs 15·9%, adjusted risk ratio (aRR) 0·80 (95% CI 0·64–0·99) and postpartum anaemia,19·8%vs 28·6%, aRR 0·72 (0·60–0·85). There was also a statistically significant lower rate of preterm births withinthe exposed group, 13·1% vs 16·8, aRR 0·79 (0·63–0·98), admission to neonatal intensive care unit, 7·0% vs9·9%, aRR 0·71 (0·52–0·98) and newborn with birth weight 1500 g and less, 0·1% vs 1·1%, aRR 0·13(0·02–0·97).Interpretation:Receiving the midwife-led continuity model of care in Palestine was associated with severalimproved maternal and neonatal health outcomes. Thefindings support further implementation of the model.Implementation research, including randomised studies, would be useful to further investigate the effect andfeasibility of the model in a low resource setting.Funding:This study was partly funded by the Research Council of Norway through the Global Health andVaccination Program (GLOBVAC), project number 243706. The implementation received public funding throughNorwegian Aid Committee (NORWAC)

• Zimmo, Mohammed; Laine, Katariina; Hassan, Sahar J. A.; Böttcher, Bettina; Fosse, Erik & Ali, Hadil [Show all 10 contributors for this article] (2018). Caesarean section in Palestine using the Robson Ten Group Classification System: A population-based birth cohort study. BMJ Open. 8:e022875(10), p. 1–8. doi: 10.1136/bmjopen-2018-022875. Full text in Research Archive Show summary

  Objective: To analyse the current situation of caesarean section in Palestine using the Robson Ten Group Classification System (TGCS). Methods: The contributions of each group to the study population and to the overall rate of caesarean section were calculated, as well as the rate of caesarean section in each TGCS group. Differences in proportions between study hospitals were assessed by χ2 test. Results: The overall rate of caesarean section was 22.9% (4337 of 18 908), ranging from 20.6% in hospital 1 to 24.6% in hospital 3. The largest contributors to the overall caesarean section rate were multiparous women with single cephalic full-term pregnancy who had undergone at least one caesarean section (group 5, 42.6%), women with multiple pregnancies (group 8, 11.6%) and those with single cephalic preterm labour (group 10, 8.1%). Statistically significant differences in caesarean section rates between the study hospitals were observed in group 1 (nulliparous women with single cephalic full-term pregnancy and spontaneous labour), group 4 (multiparous with single cephalic full-term pregnancy with induced labour or prelabour caesarean section), group 5 (multiparous with single cephalic full-term pregnancy with previous caesarean section) and in group 7 (multiparous with breech presentation). Conclusion: Women in groups 5, 8 and 10 were the largest contributors to the overall caesarean section rate in the study hospitals. Efforts to reduce the differences in obstetrical care between hospitals need to be directed towards increasing the proportion of vaginal births after caesarean section and by reducing primary caesarean section in multiple pregnancies and preterm labour.

• Schalit, Itai; Espinoza, Andreas Westenvik; Pettersen, Fred-Johan; Thiara, Amrit Paul Singh; Karlsen, Hilde & Sørensen, Gro [Show all 9 contributors for this article] (2018). Accelerometer Detects Pump Thrombosis and Thromboembolic Events in an In vitro HVAD Circuit. ASAIO journal (1992). ISSN 1058-2916. 64(5), p. 601–609. doi: 10.1097/MAT.0000000000000699. Full text in Research Archive
• Bergan, Harald Arne; Halvorsen, Per Steinar; Espinoza, Andreas Westenvik; Kerans, Viesturs; Skulstad, Helge & Fosse, Erik [Show all 7 contributors for this article] (2018). Left ventricle function during therapeutic hypothermia with beta&lt;sub&gt;1&lt;/sub&gt;-adrenergic receptor blockade. Therapeutic Hypothermia and Temperature Management. ISSN 2153-7658. 8(3), p. 156–164. doi: 10.1089/ther.2017.0051. Full text in Research Archive
• Ali, Hadil; Hassan, Sahar J. A.; Fosse, Erik; Zimmo, Kaled; Zimmo, Mohammed & Ismail, Khaled M.K. [Show all 8 contributors for this article] (2018). Impact of electronic and blended learning programs for manual perineal support on incidence of obstetric anal sphincter injuries: A prospective interventional study. BMC Medical Education. 18:258, p. 1–10. doi: 10.1186/s12909-018-1363-3. Full text in Research Archive Show summary

  Background Obstetric anal sphincter injuries (OASIS) are associated with anal incontinence, dyspareunia and perineal pain. Bimanual perineal support technique (bPST) prevents OASIS. The aim of this study was to assess the effect of two different bPST training-methods on OASIS incidence. Methods This is a prospective-interventional quality improvement study conducted in two Palestinian maternity units between June 1 2015 and December 31 2016. Women having spontaneous or operative vaginal-delivery at ≥24 gestational-weeks or a birthweight of ≥1000 g (n = 1694) were recruited and examined vaginally and rectally immediately after vaginal birth by a trained assessor. Data on baseline OASIS incidence were collected during Phase-1 of the study. Subsequently, birth attendants in both maternity units were trained in bPST using two training modalities. A self-directed electronic-learning (e-learning) using an animated video was launched in phase-2 followed by a blended learning method (the animated e-learning video+ structured face-to-face training) in phase-3. OASIS incidence was monitored during phases-2 and 3. Variations in OASIS incidence between the three phases were assessed using Pearson-χ2-test (or Fisher’s-Exact-test). The impact of each training-method on OASIS incidence was assessed using logistic-regression analysis. Results A total of 1694 women were included; 376 in phase-1, 626 in phase-2 and 692 in phase-3. Compared to Phase-1, OASIS incidence was reduced by 45% (12.2 to 6.7%, aOR: 0.56, CI; 0.35–0.91, p = 0.018) and 74% (12.2 to 3.2%, aOR, 0.29, CI; 0.17–0.50, p < 0.001) in phases-2 and 3, respectively. There was also a significant reduction in OASIS incidence by 52% from phase-2 to phase-3 (6.7% (42/626) to 3.2% (22/692), p = 0.003). These reductions reached statistical significance among parous-women only (aOR: 0.18, CI; 0.07–0.49, p = 0.001) after the first training method tested in phase-2. However, the reduction was significant among both primiparous (aOR: 0.39, CI; 0.21–0.74, p = 0.004) and parous-women (aOR: 0.11, CI; 0.04–0.32, p < 0.001) after implementing the blended learning method in phase-3. Conclusion The animated e-learning video had a positive impact on reducing OASIS incidence. However, this reduction was enhanced by the use of a blended learning program combining both e- learning and face-to-face training modalities. Study registration number ClinicalTrialo.gov identifier: NCT02427854, date: 28 April 2015.

• Aarsnes, Anette; Dahle, Gry; Fosse, Erik; Rein, Kjell Arne; Aaberge, Lars & Martinsen, Anne Catrine Trægde (2018). Evaluation of occupational radiation dose in transcatheter aortic valve implantation. Radiation Protection Dosimetry. ISSN 0144-8420. 179(1), p. 9–17. doi: 10.1093/rpd/ncx184. Full text in Research Archive
• Zimmo, Mohammed; Laine, Katariina; Hassan, Sahar; Fosse, Erik; Lieng, Marit & Ali, Hadil [Show all 11 contributors for this article] (2018). Differences in rates and odds for emergency caesarean section in six Palestinian hospitals: A population-based birth cohort study. BMJ Open. 8(3). doi: 10.1136/bmjopen-2017-019509. Full text in Research Archive Show summary

  Objective To assess the differences in rates and odds for emergency caesarean section among singleton pregnancies in six governmental Palestinian hospitals. Design A prospective population-based birth cohort study. Setting Obstetric departments in six governmental Palestinian hospitals. Participants 32 321 women scheduled to deliver vaginally from 1 March 2015 until 29 February 2016. Methods To assess differences in sociodemographic and antenatal obstetric characteristics by hospital, χ2 test, analysis of variance and Kruskal-Wallis test were applied. Logistic regression was used to estimate differences in odds for emergency caesarean section, and ORs with 95% CIs were assessed. Main outcome measures The primary outcome was the adjusted ORs of emergency caesarean section among singleton pregnancies for five Palestinian hospitals as compared with the reference (Hospital 1). Results The prevalence of emergency caesarean section varied across hospitals, ranging from 5.8% to 22.6% among primiparous women and between 4.8% and 13.1% among parous women. Compared with the reference hospital, the ORs for emergency caesarean section were increased in all other hospitals, crude ORs ranging from 1.95 (95% CI 1.42 to 2.67) to 4.75 (95% CI 3.49 to 6.46) among primiparous women. For parous women, these differences were less pronounced, crude ORs ranging from 1.37 (95% CI 1.13 to 1.67) to 2.99 (95% CI 2.44 to 3.65). After adjustment for potential confounders, the ORs were reduced but still statistically significant, except for one hospital among parous women. Conclusion Substantial differences in odds for emergency caesarean section between the six Palestinian governmental hospitals were observed. These could not be explained by the studied sociodemographic or antenatal obstetric characteristics.

• Hauge, Karoline Kråkmo; Dahle, Gry; Bendz, Bjørn; Halvorsen, Per Steinar; Abdelnoor, Michael & Mollnes, Tom Eirik [Show all 7 contributors for this article] (2018). Reduced inflammatory response by transcatheter, as compared to surgical aortic valve replacement. Scandinavian Cardiovascular Journal. ISSN 1401-7431. 52(1), p. 43–50. doi: 10.1080/14017431.2017.1416157. Full text in Research Archive Show summary

  Objectives. The inflammatory response to on-pump cardiac surgery is well known. Systemic inflammatory response syndrome after transcatheter valve implantation (TAVI) has been reported. The objective of this study was to study the inflammatory response during TAVI, and compare with the response during surgical aortic valve replacement. Methods. Eighteen patients undergoing transcatheter implantation, either by a transfemoral (n = 9) or transaortal (n = 9) approach were compared with eighteen patients admitted for surgical replacement. Blood samples per- and postoperatively were analysed for C3bc, terminal complement complex, myeloperoxidase, macrophage inflammatory protein-1β, monocyte chemo-attractant peptide-1, eotaxin, IL-6 and troponin-T. All markers were measured at defined time points and the areas under the curve were compared. Results. Activation of complement, granulocytes, monocytes and eosinophils were significantly lower in the transcatheter group as compared to the surgical group (<0.01). There was no difference in generation of troponin T and IL-6. A small difference in complement activation was observed between the transfemoral and transaortal placement of TAVI. There was no significant difference in clinical outcomes between the TAVI and surgical groups. Discussion. Activation and release of inflammatory markers was significantly less during with TAVI as compared to SAVR, particularly for markers associated with extracorporeal circulation. TAVI and SAVR generated the same degree of IL-6 and troponin T, indicating that the burden on the myocardial tissue was the same.

• Ali, Hadil; Sahar, Hassan; Zimmo, Kaled; Zimmo, Mohammed; Ismail, Khaled & Fosse, Erik [Show all 9 contributors for this article] (2018). Evaluation of Accuracy of Episiotomy Incision in a Governmental Maternity Unit in Palestine: An Observational Study. Obstetrics and Gynecology International. ISSN 1687-9589. doi: 10.1155/2018/6345497. Full text in Research Archive Show summary

  Episiotomy should be cut at certain internationally set criteria to minimize risk of obstetric anal sphincter injuries (OASIS) and anal incontinence. The aim of this study was to assess the accuracy of cutting right mediolateral episiotomy (RMLE). An institution-based prospective cohort study was undertaken in a Palestinian maternity unit from February 1, to December 31, 2016. Women having vaginal birth at gestational weeks ≥24 or birthweight ≥1000 g and with intended RMLE were eligible (). Transparent plastic films were used to trace sutured episiotomy in relation to the midline within 24-hour postpartum. These were used to measure incisions’ distance from midline, and suture angles were used to classify the incisions into RMLE, lateral, and midline episiotomy groups. Clinical characteristics and association with OASIS were compared between episiotomy groups. A subanalysis by profession (midwife or trainee doctor) was done. Less than 30% were RMLE of which 59% had a suture angle of <40° (equivalent to an incision angle of <60°). There was a trend of higher OASIS rate, but not statistically significant, in the midline (16%, OR: 1.7, CI: 0.61–4.5) and unclassified groups (16.5%, OR: 1.8, CI: 0.8–4.3) than RMLE and lateral groups (10%). No significant differences were observed between episiotomies cut by doctors and midwives. Most of the assessed episiotomies lacked the agreed criteria for RMLE and had less than optimal incision angle which increases risk of severe complications. A well-structured training program on how to cut episiotomy is recommended.

• Jensen, Kristin; Andersen, Hilde Kjernlie; Smedby, Ørjan; Østerås, Bjørn Helge; Aarsnes, Anette & Tingberg, Anders [Show all 8 contributors for this article] (2018). Quantitative Measurements Versus Receiver Operating Characteristics and Visual Grading Regression in CT Images Reconstructed with Iterative Reconstruction: A Phantom Study. Academic Radiology. ISSN 1076-6332. 25(4), p. 509–518. doi: 10.1016/j.acra.2017.10.020. Full text in Research Archive
• Zimmo, Kaled; Laine, Katariina; Fosse, Erik; Zimmo, Mohammed; Ali-Masri, Hadil & Böttcher, Bettina [Show all 9 contributors for this article] (2018). Impact of animated instruction on tablets and hands-on training in applying bimanual perineal support on episiotomy rates: an intervention study. International Urogynecology Journal. ISSN 0937-3462. p. 1–8. doi: 10.1007/s00192-018-3711-6. Full text in Research Archive Show summary

  Introduction and hypothesis In Palestine, episiotomy is frequently used among primiparous women.This study assesses the effect of training birth attendants in applying bimanual perineal support during delivery by either animated instruction on tablets or hands-on training on episiotomy rates among primiparous women. Methods An interventional cohort study was performed from 15 October 2015 to 31 January 2017, including all primiparous women with singletons and noninstrumental vaginal deliveries at six Palestinian hospitals. Intervention 1 (animated instructions on tablets) was conducted in Hospitals 1, 2, 3, and 4. Intervention 2 (bedside hands-on training) was applied in Hospitals 1 and 2 only. Hospitals 5 and 6 did not receive interventions. Differences in episiotomy rates in intervention and nonintervention hospitals were assessed before and after the interventions and presented as p values using chi-square test, and odds ratios (OR) with 95% confidence intervals (CI). Differences in the demographic and obstetric characteristics were presented as p values using the Kruskal–Wallis test. Results Of 46,709 women, 12,841 were included. The overall episiotomy rate in the intervention hospitals did not change significantly after intervention 1, from 63.1 to 62.1% (OR = 0.96, 95% CI 0.84–1.08), but did so after intervention 2, from 61.1 to 38.1% (OR = 0.39, 95% CI 0.33–0.47). Rates after Intervention 2 changed from 65.0 to 47.3% (OR = 0.52, 95% CI 0.40–0.67) in Hospital 1 and from 39.4 to 25.1% (OR = 0.49, 95% CI 0.35–0.68) in Hospital 2. Conclusions Hands-on training of bimanual perineal support during delivery of primiparous women was significantly more effective in reducing episiotomy rates than animated instruction videos alone.

• Zimmo, Kaled; Laine, Katariina; Fosse, Erik; Zimmo, Mohammed; Ali, Hadil & Zucknick, Manuela [Show all 8 contributors for this article] (2018). Episiotomy practice in six Palestinian hospitals: a population-based cohort study among singleton vaginal births. BMJ Open. 8(7). doi: 10.1136/bmjopen-2018-021629. Full text in Research Archive Show summary

  Objective To explore the rates, characteristics and indications for episiotomy among women delivering vaginally for the first time, as well as parous women. Study design A prospective, population-based birth cohort study. Setting Obstetric departments in six Palestinian government hospitals. Participants All women with singleton vaginal births (n=29 165) from 1 March 2015 until 1 March 2016. Methods All women were divided into two groups: first vaginal birth group (n=9108), including primiparous women and women with their first vaginal birth after one caesarean section, and the parous group (n=20 057). Each group was analysed separately. Data were presented as numbers and percentages or range. Differences in rates were assessed by the p values of χ2 test, or Fisher’s exact test if there are cell counts less than 5. Main outcome measures Episiotomy rates and indications among women of singleton births. Results The overall episiotomy rate was 28.7%: 78.8% for women with first vaginal birth (range 56.6%–86.0%) and 5.9% for parous women (range 1.0%–9.5%). The most common indications for episiotomy were ‘primiparity’ in the first vaginal birth group (69.9%) and ‘protecting the perineum’ in the parous group (59.5%). The least common indications were prolonged second stage (1.5%) and fetal distress (6.9%), respectively. Conclusion In Palestine, the majority of women who delivered vaginally for the first time had an episiotomy. Education of birth attendants, clinical audits, educational interventions and adherence to the updated guidelines may help to decrease the routine overuse of episiotomy.

• Ali, Hadil; Hassan, Sahar J. A.; Ismail, Khaled; Zimmo, Kaled; Zimmo, Mohammed & Fosse, Erik [Show all 8 contributors for this article] (2018). Enhancing recognition of obstetric anal sphincter injuries in six maternity units in Palestine: An interventional quality improvement study. BMJ Open. 8:e020893(6), p. 1–10. doi: 10.1136/bmjopen-2017-020983. Full text in Research Archive Show summary

  Objective To explore the impact of a training intervention on obstetric anal sphincter injuries’ (OASIS) detection rate. Design Prospective quality improvement interventional study. Setting Six secondary and tertiary maternity units in Palestine. Population Women having singleton vaginal births ≥23 weeks’ gestation or babies weighing ≥500 g (n=22 922). Caesarean births (n=5431), multiple gestations (n=443) and vaginal births of unregistered perineum status (n=800) were excluded. Interventions Training programme for enhancing OASIS detection was conducted between 31 January and 31 December 2015. International experts delivered 2-day standardisation workshop teaching OASIS diagnosis and repair to each maternity unit. They also provided additional training to three research fellows employed in three of the maternity units. This was followed by 13-week period of data collection (phase 1). Research fellows then delivered training intervention over 15-week interval (phase 2), including theoretical teaching and ‘onsite’ training in perineal trauma assessment within the six maternity units. Finally, 13-week postintervention observation (phase 3) followed. Primary outcome measure OASIS rates were used as surrogate for OASIS recognition. OASIS rates were compared between different phases and between the two maternity unit groups (research fellow and non-research fellow based) using Pearson’s χ² test. Results A total 22 922 women were included. Among primiparous women, OASIS rate was higher in phase 2 (2.8%, p<0.001) and phase 3 (3.1%, p<0.001) than phase 1 (0.5%). However, no significant differences were detected in the rates of severe OASIS (third-degree 3c and fourth-degree tears) between phase 1 and 2 (0.5% vs 0.3%), because this would have required at least 103 women with severe OASIS to be included in each phase. Among parous women, OASIS rate was significantly higher in phase 2 (0.6%, p=0.002) but not in phase 3 (0.4%, p=0.071) compared with phase 1 (0.2%). Research fellows’ maternity units showed higher OASIS rates among primiparous women in phase 2 (3.6% vs 1.4%, p=0.001) and phase 3 (4.3% vs 0.8%, p<0.001) than non-research fellows’ maternity units. Conclusions This work is basically an epidemiological study which has identified the prevalence of perineal lacerations and their severity on a large sample of women representative of an entire geographical ethnic region. The quality improvement intervention improved OASIS detection mainly in the research fellows’ maternity units. Regular mandatory national programmes in obstetric perineal trauma assessment and management by local champions are essential to mitigate the risk of missing significant degrees of trauma.

• Andresen, Brith; Døhlen, Gaute; Diep, Lien My; Lindberg, Harald L; Fosse, Erik & Andersen, Marit Helen (2018). Psychosocial and clinical outcomes of percutaneous versus surgical pulmonary valve implantation. Open heart. 5(1). doi: 10.1136/openhrt-2017-000758. Full text in Research Archive
• Zimmo, Kaled; Laine, Hely Katariina; Fosse, Erik; Zimmo, Mohammed; Ali-Masri, Hadil Y. & Zucknick, Karola Manuela [Show all 8 contributors for this article] (2018). Episiotomy practice in six Palestinian hospitals: a population-based cohort study among singleton vaginal births. BMJ Open. doi: 10.1136/bmjopen-2018-021629. Full text in Research Archive
• Jakobsen, Rune Bruhn; Gran, Sarah Frandsen; Grimsmo, Bergsvein; Arntzen, Kari; Fosse, Erik & Frich, Jan C [Show all 7 contributors for this article] (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), p. 80–88. doi: 10.1080/13561820.2017.1376625. Full text in Research Archive Show summary

  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.

• Mortensen, Berit; Lukasse, Mirjam; Diep, Lien My; Lieng, Marit; Abu-Awad, Amal & Suleiman, Munjid [Show all 7 contributors for this article] (2018). Can a midwife-led continuity model improve maternal services in a low-resource setting? A non-randomised cluster intervention study in Palestine. BMJ Open. 8(3). doi: 10.1136/bmjopen-2017-019568. Full text in Research Archive Show summary

  Objectives: To improve maternal health services in rural areas, the Palestinian Ministry of Health launched a midwife-led continuity model in the West Bank in 2013. Midwives were deployed weekly from governmental hospitals to provide antenatal and postnatal care in rural clinics. We studied the intervention’s impact on use and quality indicators of maternal services after 2 years’ experience. Design: A non-randomised intervention design was chosen. The study was based on registry data only available at cluster level, 2 years before (2011and2012) and 2 years after (2014and2015) the intervention. Setting All 53 primary healthcare clinics in Nablus and Jericho regions were stratified for inclusion. Primary and secondary outcomes Primary outcome was number of antenatal visits. Important secondary outcomes were number of referrals to specialist care and number of postnatal home visits. Differences in changes within the two groups before and after the intervention were compared by using mixed effect models. Results: 14 intervention clinics and 25 control clinics were included. Number of antenatal visits increased by 1.16 per woman in the intervention clinics, while declined by 0.39 in the control clinics, giving a statistically significant difference in change of 1.55 visits (95% CI 0.90 to 2.21). A statistically significant difference in number of referrals was observed between the groups, giving a ratio of rate ratios of 3.65 (2.78–4.78) as number of referrals increased by a rate ratio of 3.87 in the intervention group, while in the control the rate ratio was only 1.06. Home visits increased substantially in the intervention group but decreased in the control group, giving a ratio of RR 97.65 (45.20 - 210.96) Conclusion: The Palestinian midwife-led continuity model improved use and some quality indicators of maternal services. More research should be done to investigate if the model influenced individual health outcomes and satisfaction with care.

• Hyler, Stefan; Espinoza, Andreas Westenvik; Skulstad, Helge; Fosse, Erik & Halvorsen, Per Steinar (2018). Corrigendum to ‘Left ventricular function can be continuously monitored with an epicardially attached accelerometer sensor’ [Eur J Cardiothorac Surg 2014;46:313–20]. European Journal of Cardio-Thoracic Surgery. ISSN 1010-7940. 54(5), p. 968–968. doi: 10.1093/ejcts/ezy340. Full text in Research Archive
• Ali, Hadil; Vikanes, Åse Vigdis; Anti, Marit; Hassan, Sahar J. A.; Ismail, Khaled M. & Zimmo, Kaled [Show all 9 contributors for this article] (2017). Evaluation of an animated instructional video as a training tool for manual perineum support during vaginal delivery. International Journal of Gynecology & Obstetrics. ISSN 0020-7292. 137(2), p. 213–219. doi: 10.1002/ijgo.12115. Full text in Research Archive
• Zimmo, Kaled; Laine, Katariina; Vikanes, Åse Vigdis; Fosse, Erik; Zimmo, Mohammed & Ali, Hadil [Show all 9 contributors for this article] (2017). Diagnosis and repair of perineal injuries: Knowledge before and after expert training-a multicentre observational study among Palestinian physicians and midwives. BMJ Open. 7:e014183(4), p. 1–8. doi: 10.1136/bmjopen-2016-014183. Full text in Research Archive Show summary

  Objective: To assess whether a 2 days training with experts teaching on diagnosis and repair of perineal injuries among Palestinian midwives and physicians could change their level of knowledge towards the correct diagnosis and treatment. Methods: A questionnaire comprising of 14 questions on the diagnosis and repair of perineal tears was distributed to all participants before the training (n=150; 64 physicians and 86 midwives) and 3 months after the training (n=124, 53 and 71, respectively). Characteristics, differences of the study population and level of knowledge before and after the training were presented as frequencies and percentages. Consistency in responses was tested by estimating the p value of McNemar test. Results: Among physicians only 11.4% had accurate knowledge on perineal anatomy before the training compared with 78.85% after the training (p<0.001). For midwives, the corresponding numbers were 9.8% and 54.2%, respectively (p<0.001). Before the training, 5.8% of the physicians were aware that rectal examination is mandatory before and after suturing of episiotomies compared with 45.8% after the training (p<0.001). The corresponding numbers for midwives were 0% and 18% (p<0.001), respectively. Physicians knowledge of best practice of skin repair following episiotomy improved from 36.5% to 64.5% (p=0.008) and among midwives from 26.1% to 50.7% (p<0.001). Physicians knowledge of the overlap technique in the repair of full thickness external anal sphincter tears improved from 28.5% to 42.8% (p=0.05), whereas knowledge of repairing torn internal anal sphincter separately improved from 12.8% to 86.8% (p<0.001). Conclusions: Improvement in the level of knowledge on diagnosis and repair of perineal tears was observed for all physicians and midwives who attended the 2 days' expert training. Regular ongoing training will serve to maintain the newly acquired knowledge.

• Hassan, Sahar; Vikanes, Åse Vigdis; Laine, Katariina; Zimmo, Kaled; Zimmo, Mohammed & Bjertness, Espen [Show all 7 contributors for this article] (2017). Building a research registry for studying birth complications and outcomes in six Palestinian governmental hospitals. BMC Pregnancy and Childbirth. 17(1). doi: 10.1186/s12884-017-1296-6. Full text in Research Archive Show summary

  Background Electronic-health (e-health) provides opportunities for quality improvement of healthcare, but implementation in low and middle income countries is still limited. Our aim was to describe the implementation of a registration (case record form; CRF) for obstetric interventions and childbirth events using e-health in a prospective birth cohort study in Palestine. We also report the completeness and the reliability of the data. Methods Data on maternal and fetal health was collected prospectively for all women admitted to give birth during the period from 1st March 2015 to 31st December 2015 in three governmental hospitals in Gaza and three in the West Bank. Essential indicators were noted in a case registration form (CRF) and subsequently entered into the District Health Information Software 2 (DHIS 2) system. Completeness of registered cases was checked against the monthly hospital birth registries. Reliability (correct information) of DHIS2 registration and entry were checked for 22 selected variables, collected during the first 10 months. In the West Bank, a comparison between our data registration and entry and data obtained from the Ministry of Health patient electronic records was conducted in the three hospitals. Results According to the hospital birth registries, a total of 34,482 births occurred in the six hospitals during the study period. Data on the mothers and children registered on CRF was almost complete in two hospitals (100% and 99.9%); in the other hospitals the completeness ranged from 72.1% to 98.7%. Eighty birth events were audited for 22 variables in the three hospitals in the West Bank. Out of 1760 registrations in each hospital, the rates of correct data registration ranged from 81% to 93.2% and data entry ranged from 84.5% to 93.1%. Conclusions The registered and entered data on birth events in six hospitals was almost complete in five out of six hospitals. The collected data is considered reliable for research purposes.

• Andresen, Brith; Mishra, Vinod Kumar; Lewandowska, Milena; Andersen, Jack Gunnar; Andersen, Marit Helen & Lindberg, Harald L [Show all 8 contributors for this article] (2017). In-hospital cost comparison between percutaneous pulmonary valve implantation and surgery. European Journal of Cardio-Thoracic Surgery. ISSN 1010-7940. 51(4), p. 747–753. doi: 10.1093/ejcts/ezw378. Full text in Research Archive Show summary

  OBJECTIVES: Today, both surgical and percutaneous techniques are available for pulmonary valve implantation in patients with right ventricle outflow tract obstruction or insufficiency. In this controlled, non-randomized study the hospital costs per patient of the two treatment options were identified and compared. METHODS: During the period of June 2011 until October 2014 cost data in 20 patients treated with the percutaneous technique and 14 patients treated with open surgery were consecutively included. Two methods for cost analysis were used, a retrospective average cost estimate (overhead costs) and a direct prospective detailed cost acquisition related to each individual patient (patient-specific costs). RESULTS: The equipment cost, particularly the stents and valve itself was by far the main cost-driving factor in the percutaneous pulmonary valve group, representing 96% of the direct costs, whereas in the open surgery group the main costs derived from the postoperative care and particularly the stay in the intensive care department. The device-related cost in this group represented 13.5% of the direct costs. Length-of-stay-related costs in the percutaneous group were mean $3885 (1618) and mean $17 848 (5060) in the open surgery group. The difference in postoperative stay between the groups was statistically significant (P<0.001). CONCLUSIONS: Given the high postoperative cost in open surgery, the percutaneous procedure could be cost saving even with a device cost of more than five times the cost of the surgical device. Keywords: Congenital pulmonary heart disease • Innovative techniques • Cost analysis • In-hospital costs

• Wendt, Kjersti; Kristiansen, Ronny; Krohg-Sørensen, Kirsten; Gregersen, Fredrik Alexander & Fosse, Erik (2017). Norwegian trends in numbers of lower extremity revascularisations and amputations including regional trends in endovascular treatments for peripheral arterial disease: a retrospective cross-sectional registry study from 2001 to 2014. BMJ Open. 7(11). doi: 10.1136/bmjopen-2017-016210. Full text in Research Archive Show summary

  Objective The numbers of lower extremity revascularisations and amputations are insufficiently reported in Norway. To support future policy decisions regarding the provision of vascular treatment, knowledge of such trends is important. Methods This retrospective cross-sectional study from 2001 to 2014 used data from the Norwegian Patient Registry. The revascularisation treatments were categorised in multilevel, aortoiliac, femoral to popliteal and popliteal to foot levels and sorted as open, endovascular and hybrid. The sessions in amputations were divided in major (thigh and below knee) and minor (ankle, foot or digit). Incidence rates were assessed per 100 000 for patients in the age group >60 years. The diabetic prevalence was calculated and the endovascular numbers at the South-Eastern, Western, Central and Northern Norway Regional Health Authority were compared. Results The overall revascularisation rates increased from 308.7 to 366.8 (p=0.02). Open revascularisations decreased from 158.9 to 98.7 (p

• Grymyr, Ole-Johannes; Beitnes, Jan Otto; Eidet, Jo; Tølløfsrud, Stein G.; Fiane, Arnt E & Skulstad, Helge [Show all 8 contributors for this article] (2017). Detection of intraoperative myocardial dysfunction by accelerometer during aortic valve replacement. Interactive Cardiovascular and Thoracic Surgery. ISSN 1569-9293. 24(2), p. 188–195. doi: 10.1093/icvts/ivw326. Full text in Research Archive
• Jensen, Kristin; Andersen, Hilde Kjernlie; Tingberg, Anders; Reisse, Claudius; Fosse, Erik Torgeir & Martinsen, Anne Catrine Trægde (2016). Improved liver lesion conspicuity with iterative reconstruction in CT imaging. Current problems in diagnostic radiology. ISSN 0363-0188. doi: 10.1067/j.cpradiol.2015.11.004. Full text in Research Archive
• Jensen, Kristin; Aaløkken, Trond Mogens; Tingberg, Anders; Fosse, Erik Torgeir & Martinsen, Anne Catrine Trægde (2016). Image quality in oncologic chest computerized tomography with iterative reconstruction. A phantom study. Journal of computer assisted tomography. ISSN 0363-8715. doi: 10.1097/RCT.0000000000000364. Full text in Research Archive
• Jensen, Kristin; Aaløkken, Trond Mogens; Tingberg, Anders; Fosse, Erik & Martinsen, Anne Catrine Trægde (2016). Image quality in oncologic chest computerized tomography with iterative reconstruction: A phantom study. Journal of computer assisted tomography. ISSN 0363-8715. 40(3), p. 351–356. doi: 10.1097/RCT.0000000000000364. Full text in Research Archive
• Eidet, Jo; Dahle, Gry; Bugge, Jan F; Bendz, Bjørn; Rein, Kjell Arne & Aaberge, Lars [Show all 10 contributors for this article] (2016). Intraoperative improvement in left ventricular peak systolic velocity predicts better short-term outcome after transcatheter aortic valve implantation. Interactive Cardiovascular and Thoracic Surgery. ISSN 1569-9293. 22(1), p. 5–12. doi: 10.1093/icvts/ivv277. Full text in Research Archive
• Bergan, Harald Arne; Halvorsen, Per Steinar; Skulstad, Helge; Fosse, Erik & Bugge, Jan F (2016). Does therapeutic hypothermia during extracorporeal cardiopulmonary resuscitation preserve cardiac function? Journal of Translational Medicine. 14(1). doi: 10.1186/s12967-016-1099-y. Full text in Research Archive Show summary

  Background Extracorporeal cardiopulmonary resuscitation (E-CPR) is increasingly used as a rescue method in the management of cardiac arrest and provides the opportunity to rapidly induce therapeutic hypothermia. The survival after a cardiac arrest is related to post-arrest cardiac function, and the application of therapeutic hypothermia post-arrest is hypothesized to improve cardiac outcome. The present animal study compares normothermic and hypothermic E-CPR considering resuscitation success, post-arrest left ventricular function and magnitude of myocardial injury. Methods After a 15-min untreated ventricular fibrillation, the pigs (n = 20) were randomized to either normothermic (38 °C) or hypothermic (32–33 °C) E-CPR. Defibrillation terminated ventricular fibrillation after 5 min of E-CPR, and extracorporeal support continued for 2 h, followed by warming, weaning and a stabilization period. Magnetic resonance imaging and left ventricle pressure measurements were used to assess left ventricular function pre-arrest and 5 h post-arrest. Myocardial injury was estimated by serum concentrations of cardiac TroponinT and Aspartate transaminase (ASAT). Results E-CPR resuscitated all animals and the hypothermic strategy induced therapeutic hypothermia within minutes without impairment of the resuscitation success rate. All animals suffered a severe global systolic left ventricular dysfunction post-arrest with 50–70% reductions in stroke volume, ejection fraction, wall thickening, strain and mitral annular plane systolic excursion. Serum concentrations of cardiac TroponinT and ASAT increased considerably post-arrest. No significant differences were found between the two groups. Conclusions Two-hour therapeutic hypothermia during E-CPR offers an equal resuscitation success rate, but does not preserve the post-arrest cardiac function nor reduce the magnitude of myocardial injury, compared to normothermic E-CPR. Trial registration FOTS 4611/13 registered 25 October 2012

• Wendt, Kjersti; Kristiansen, Ronny; Krohg-Sørensen, Kirsten; Gregersen, Fredrik Alexander & Fosse, Erik (2016). Trends in abdominal aortic and iliac aneurysm repairs in Norway from 2001 to 2013. European Journal of Vascular and Endovascular Surgery. ISSN 1078-5884. 51(2), p. 194–201. doi: 10.1016/j.ejvs.2015.08.015. Full text in Research Archive
• Jensen, Kristin; Andersen, Hilde Kjernlie; Tingberg, Anders; Reisse, Claudius; Fosse, Erik & Martinsen, Anne Catrine Trægde (2016). Improved Liver Lesion Conspicuity With Iterative Reconstruction in Computed Tomography Imaging. Current problems in diagnostic radiology. ISSN 0363-0188. 45(5), p. 291–296. doi: 10.1067/j.cpradiol.2015.11.004. Full text in Research Archive
• Goderstad, Jeanne Mette; Sandvik, Leiv; Fosse, Erik & Lieng, Marit (2016). Assessment of surgical competence: Development and validation of rating scales used for laparoscopic supracervical hysterectomy. Journal of Surgical Education. ISSN 1931-7204. 73(4), p. 600–608. doi: 10.1016/j.jsurg.2016.01.001. Full text in Research Archive
• Eidet, Jo; Dahle, Gry; Bugge, Jan F; Bendz, Bjørn; Rein, Kjell Arne & Aaberge, Lars [Show all 10 contributors for this article] (2016). Long-term outcomes after transcatheter aortic valve implantation: The impact of intraoperative tissue Doppler echocardiography. Interactive Cardiovascular and Thoracic Surgery. ISSN 1569-9293. 23(3), p. 403–409. doi: 10.1093/icvts/ivw159. Full text in Research Archive
• Eidet, Jo; Dahle, Gry; Bugge, Jan F; Bendz, Bjørn; Rein, Kjell Arne & Fosse, Erik [Show all 8 contributors for this article] (2015). Transcatheter aortic valve implantation and intraoperative left ventricular function: A myocardial tissue Doppler imaging study. Journal of Cardiothoracic and Vascular Anesthesia. ISSN 1053-0770. 29(1), p. 115–120. doi: 10.1053/j.jvca.2014.10.016. Full text in Research Archive
• Pischke, Søren Erik; Hyler, Stefan; Tronstad, Christian; Bergsland, Jacob; Fosse, Erik & Halvorsen, Per Steinar [Show all 8 contributors for this article] (2015). Myocardial tissue CO2 tension detects coronary blood flow reduction after coronary artery bypass in real-time. British Journal of Anaesthesia. ISSN 0007-0912. 114(3), p. 414–422. doi: 10.1093/bja/aeu381. Full text in Research Archive
• Grymyr, Ole-Johannes; Remme, Espen W.; Espinoza, Andreas Westenvik; Skulstad, Helge; Elle, Ole Jakob & Fosse, Erik [Show all 7 contributors for this article] (2015). Assessment of 3D motion increases the applicability of accelerometers for monitoring left ventricular function. Interactive Cardiovascular and Thoracic Surgery. ISSN 1569-9293. 20(3), p. 329–337. doi: 10.1093/icvts/ivu404. Full text in Research Archive
• Zahid, Wasim; Bergestuen, Deidi Ann; Haugaa, Kristina; Ueland, Thor; Thiis-Evensen, Espen & Aukrust, Pål [Show all 8 contributors for this article] (2015). Myocardial Function by Two-Dimensional Speckle Tracking Echocardiography and Activin A May Predict Mortality in Patients with Carcinoid Intestinal Disease. Cardiology. ISSN 0008-6312. p. 81–90. doi: 10.1159/000431076. Full text in Research Archive
• Espinoza, Andreas Westenvik; Neumann, Kirill; Halvorsen, Per Steinar; Sundset, Arve; Kongerud, Johny & Fosse, Erik (2015). Critical airway obstruction: Challenges in airway management and ventilation during therapeutic bronchoscopy. Journal of Bronchology & Interventional Pulmonology. ISSN 1944-6586. 22(1), p. 41–47. doi: 10.1097/LBR.0000000000000127. Full text in Research Archive
• Hyler, Stefan; Pischke, Søren Erik; Halvorsen, Per Steinar; Espinoza, Andreas Westenvik; Bergsland, Jacob & Tønnessen, Tor Inge [Show all 8 contributors for this article] (2015). Continuous monitoring of regional function by a miniaturized ultrasound transducer allows early quantification of low-grade myocardial ischemia. Journal of the American Society of Echocardiography. ISSN 0894-7317. 28(4), p. 486–494. doi: 10.1016/j.echo.2014.12.014. Full text in Research Archive
• Bergsland, Jacob; Mirtaheri, Peyman; Hiorth, Nikolai & Fosse, Erik (2015). Review of the endovascular approach to mitral valve disease. MITAT. Minimally invasive therapy & allied technologies. ISSN 1364-5706. 24(5), p. 282–288. doi: 10.3109/13645706.2015.1065891. Full text in Research Archive
• Grymyr, Ole-Johannes; Thai, Anh Tuan Nguyen; Tjulkins, Fjodors; Espinoza, Andreas Westenvik; Remme, Espen W. & Skulstad, Helge [Show all 9 contributors for this article] (2015). Continuous monitoring of cardiac function by 3-dimensional accelerometers in a closed-chest pig model. Interactive Cardiovascular and Thoracic Surgery. ISSN 1569-9293. 21(5), p. 573–582. doi: 10.1093/icvts/ivv191. Full text in Research Archive Show summary

  OBJECTIVES Cardiac wall motions reflect systolic and diastolic function. We have previously demonstrated the ability of a miniaturized three-axis (3D) accelerometer to monitor left ventricular function in experimental models and in patients. The main aim of this study was to investigate the clinical utility of the method for monitoring the left and right ventricular function during changes in global and regional cardiac function in a postoperative closed-chest situation. METHODS In 13 closed-chest pigs, miniaturized 3D accelerometers were placed on the left ventricle in the apical and basal regions and in the basal region of the right ventricle. An epicardial 3D motion vector was calculated from the acceleration signals in each heart region. Peak systolic velocity along this 3D vector (3D Vsys) was compared with the positive time derivative of the left and right ventricular pressure and with cardiac index during changes in global LV function (unloading, fluid loading, esmolol, dobutamine) and with ultrasound during regional left ventricular dysfunction (3-min occlusion of the left anterior descending coronary artery). RESULTS Significant and typical changes in accelerometer 3D Vsys were seen in all heart regions during changes in global cardiac function. 3D Vsys reflected the left and right ventricular contractility via significant correlations with the positive time derivative of the left and right ventricular pressure, r = 0.86 and r = 0.72, and with cardiac index r = 0.82 and r = 0.73 (all P < 0.001), respectively. The miniaturized accelerometers also detected regional dysfunction, but showed reduced ability to localize ischaemia as the 3D Vsys in all heart regions showed similar reductions during coronary artery occlusion. CONCLUSIONS Miniaturized 3D accelerometers placed on the heart can assess global and regional function in a closed-chest model. The technique may be used for continuous postoperative monitoring after cardiac surgery.

• Bergan, Harald Arne; Halvorsen, Per Steinar; Skulstad, Helge; Edvardsen, Thor; Fosse, Erik & Bugge, Jan F (2015). Successful ECMO-cardiopulmonary resuscitation with the associated post-arrest cardiac dysfunction as demonstrated by MRI. Intensive Care Medicine Experimental. 3. doi: 10.1186/s40635-015-0061-2. Full text in Research Archive Show summary

  Background Veno-arterial extracorporeal membrane oxygenation (ECMO-CPR) is a life-saving rescue for selected patients when standard cardiopulmonary resuscitation fails. The use is increasing although the treatment modality is not fully established. Resuscitated patients typically develop a detrimental early post-arrest cardiac dysfunction that also deserves main emphasis. The present study investigates an ECMO-CPR strategy in pigs and assesses early post-arrest left ventricular function in detail. We hypothesised that a significant dysfunction could be demonstrated with this model using magnetic resonance imaging (MRI), not previously used early post-arrest. Methods In eight anaesthetised pigs, a 15-min ventricular fibrillation was resuscitated by an ECMO-CPR strategy of 150-min veno-arterial ECMO aiming at high blood flow rate and pharmacologically sustained aortic blood pressure and pulse pressure of 50 and 15 mmHg, respectively. Pre-arrest cardiac MRI and haemodynamic measurements of left ventricular function were compared to measurements performed 300-min post-arrest. Results All animals were successfully resuscitated, weaned from the ECMO circuit, and haemodynamically stabilised post-arrest. Cardiac output was maintained by an increased heart rate post-arrest, but left ventricular ejection fraction and stroke volume were decreased by approximately 50 %. Systolic circumferential strain and mitral annular plane systolic excursion as well as the left ventricular wall thickening were reduced by approximately 50–70 % post-arrest. The diastolic function variables measured were unchanged. Conclusions The present animal study demonstrates a successful ECMO-CPR strategy resuscitating long-lasting cardiac arrest with adequate post-arrest haemodynamic stability. The associated severe systolic left ventricular dysfunction could be charted in detail by MRI, a valuable tool for future cardiac outcome assessments in resuscitation research.

• Solberg, Lars Erik; Aardal, Øyvind; Berger, Tor; Balasingham, Ilangko; Fosse, Erik & Hamran, Svein-Erik (2015). Experimental investigation into radar-based central blood pressure estimation. IET Radar, Sonar & Navigation. ISSN 1751-8784. 9(2). doi: 10.1049/iet-rsn.2014.0206. Full text in Research Archive Show summary

  To assess whether radar technology can be used for monitoring blood pressure via information from the aorta, two experiments were performed: (i) measurements on a phantom model and (ii) acquisitions on a human subject for in vivo experiments. A linear dependency of phase on radius in the radar echoes in the phantom model showed that the information regarding the radius of a circular, cylindrical object depended on the clutter environment: in a low-clutter case two distinct reflections were identified, whereas in the high-clutter case it was possible to extract a proxy. Radar echoes from antennas strapped to the back of a human subject showed a clear signature from a discernible, distinct reflector believed to be the aorta. However, as for the high-clutter case, only a proxy for aortic radius is available as basis for estimation, which is most likely coupled with aortic displacements.

• Hestenes, Siv Merete; Halvorsen, Per Steinar; Skulstad, Helge; Remme, Espen; Espinoza, Andreas Westenvik & Hyler, Stefan [Show all 10 contributors for this article] (2014). Advantages of strain echocardiography in assessment of myocardial function in severe sepsis: An experimental study. Critical Care Medicine. ISSN 0090-3493. 42(6), p. e432–e440. doi: 10.1097/CCM.0000000000000310. Full text in Research Archive
• Hyler, Stefan; Espinoza, Andreas Westenvik; Skulstad, Helge; Fosse, Erik & Halvorsen, Per Steinar (2014). Left ventricular function can be continuously monitored with an epicardially attached accelerometer sensor. European Journal of Cardio-Thoracic Surgery. ISSN 1010-7940. 46(2), p. 313–320. doi: 10.1093/ejcts/ezt653. Full text in Research Archive
• Øyri, Karl; Chavez-Santiago, Raul; Støa, Stig; Martinsen, Ørjan Grøttem; Balasingham, Ilangko & Fosse, Erik (2014). Wireless vital signs from a life-supporting medical device exposed to electromagnetic disturbance. MITAT. Minimally invasive therapy & allied technologies. ISSN 1364-5706. 23(6), p. 341–349. doi: 10.3109/13645706.2014.931869. Full text in Research Archive
• Bergsland, Jacob; Elle, Ole Jakob & Fosse, Erik (2014). Barriers to medical device innovation. Medical devices : evidence and research.. 7(1), p. 205–209. doi: 10.2147/MDER.S43369. Full text in Research Archive
• Courivaud, Fredric A A; Kazaryan, Airazat M.; Lund, Alice; Orszagh, Vivian C; Svindland, Aud & Marangos, Irina Pavlik [Show all 11 contributors for this article] (2014). Thermal fixation of swine liver tissue after magnetic resonance-guided high-intensity focused ultrasound ablation. Ultrasound in Medicine and Biology. ISSN 0301-5629. 40(7), p. 1564–1577. doi: 10.1016/j.ultrasmedbio.2014.02.007. Full text in Research Archive
• Zahid, Wasim; Eek, Christian; Remme, Espen W.; Skulstad, Helge; Fosse, Erik & Edvardsen, Thor (2014). Early systolic lengthening may identify minimal myocardial damage in patients With non-ST-elevation acute coronary syndrome. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. p. 1152–1160. doi: 10.1093/ehjci/jeu101. Full text in Research Archive
• Andresen, Brith; Andersen, Marit Helen; Lindberg, Harald L; Døhlen, Gaute & Fosse, Erik (2014). Perceived health after percutaneous pulmonary valve implantation: In-depth interviews of patients and next-of-kin. BMJ Open. 4(7). doi: 10.1136/bmjopen-2014-005102. Full text in Research Archive
• Jensen, Kristin; Martinsen, Anne Catrine Trægde; Tingberg, Anders; Aaløkken, Trond Mogens & Fosse, Erik (2014). Comparing five different iterative reconstruction algorithms for computed tomography in an ROC study. European Radiology. ISSN 0938-7994. 24(12), p. 2989–3002. doi: 10.1007/s00330-014-3333-4. Full text in Research Archive
• Neumann, Kirill; Sundset, Arve; Espinoza, Andreas Westenvik; Kongerud, Johny & Fosse, Erik (2013). Changes in Quality of Life, Dyspnea Scores, and Lung Function in Lung Cancer Patients With Airway Obstruction After a Therapeutic Bronchoscopy. Journal of Bronchology & Interventional Pulmonology. ISSN 1944-6586. 20(2), p. 134–139. doi: 10.1097/LBR.0b013e3182917280. Full text in Research Archive
• Zahid, Wasim; Johnson, Jonas; Westholm, Carl; Eek, Christian; Haugaa, Kristina & Smedsrud, Marit Kristine [Show all 10 contributors for this article] (2013). Mitral Annular Displacement by Doppler Tissue Imaging May Identify Coronary Occlusion and Predict Mortality in Patients with Non-ST-Elevation Myocardial Infarction. Journal of the American Society of Echocardiography. ISSN 0894-7317. 26(8), p. 875–884. doi: 10.1016/j.echo.2013.05.011. Full text in Research Archive
• Øyri, Karl; Støa, Stig; Balasingham, Ilangko & Fosse, Erik (2013). Short-range wireless sensor network for critical care monitoring. International Journal of Autonomous and Adaptive Communications Systems. ISSN 1754-8632. 6(3), p. 225–239. doi: 10.1504/IJAACS.2013.054826. Full text in Research Archive
• Espinoza, Andreas Westenvik; Kerans, Viesturs; Opdahl, Anders; Skulstad, Helge; Halvorsen, Per Steinar & Bugge, Jan F [Show all 8 contributors for this article] (2013). Effects of Therapeutic Hypothermia on Left Ventricular Function Assessed by Ultrasound Imaging. Journal of the American Society of Echocardiography. ISSN 0894-7317. 26(11), p. 1353–1363. doi: 10.1016/j.echo.2013.06.021. Full text in Research Archive
• Halvorsen, Fredrik Herman; Småstuen, Milada Cvancarova; Fosse, Erik & Mjåland, Odd (2013). Effect of Computer Game Playing on Baseline Laparoscopic Simulator Skills. Surgical laparoscopy, endoscopy & percutaneous techniques. ISSN 1530-4515. 23(4), p. 394–399. doi: 10.1097/SLE.0b013e31828e3c54. Full text in Research Archive
• Dorenberg, Eric Jürgen; Courivaud, Fredric A A; Ring, Eva Kristina; Hald, Kirsten; Jakobsen, Jarl Åsbjørn & Fosse, Erik [Show all 7 contributors for this article] (2013). Volumetric ablation of uterine fibroids using Sonalleve high-intensity focused ultrasound in a 3 Tesla scanner - first clinical assessment. MITAT. Minimally invasive therapy & allied technologies. ISSN 1364-5706. 22(2), p. 73–79. doi: 10.3109/13645706.2012.702672. Full text in Research Archive
• Dahle, Gry; Rein, Kjell Arne; Fiane, Arnt E; Fosse, Erik; Kushi, Ishtiaq & Hagen, Terje P. [Show all 7 contributors for this article] (2012). Innovative technology-transcatheter aortic valve implantation: Cost and reimbursement issues. Scandinavian Cardiovascular Journal. ISSN 1401-7431. 46(6), p. 345–352. doi: 10.3109/14017431.2012.724177. Full text in Research Archive

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• Fosse, Erik (2013). Med livet i hendene - Stemmer fra krigssonen. Gyldendal Norsk Forlag A/S. ISBN 9788205406964. 430 p. Full text in Research Archive

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• Røise, Olav; Fosse, Erik Torgeir; Aukrust, Pål; Emblem, Ragnhild; Bjøro, Kristian & Johansen, Stian Øby [Show all 9 contributors for this article] (2025). Ny lov om helseforskning kan true sikkerheten til pasientene. Full text in Research Archive Show summary

  Forskning er viktig for at vi skal kunne gi best mulig behandling. Men forslaget til ny helseforskningslov kan bidra til dårligere kvalitet på forskningen og svekket pasientsikkerhet.

• Fosse, Erik Torgeir (2023). Språk, datamaskin og helsepersonell. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 143(9). doi: 10.4045/tidsskr.23.0160. Full text in Research Archive
• Fosse, Erik Torgeir (2023). Pasientjournal, kunstig intelligens og språkteknologi. In Nylenna, Magne; Hem, Erlend & Husom, Nina (Ed.), Pasientjournalen - språk, dokumentasjon og helsekompetanse. Det norske medicinske Selskab. ISSN 9788292871737. p. 87–96. Full text in Research Archive
• Fosse, Erik Torgeir (2023). Autonomi i saniteten. In Cooper, Camilla Guldahl & Henriksen, Dag (Ed.), Autonomi i militære operasjoner. Cappelen Damm Akademisk. ISSN 9788202791445. p. 183–209. Full text in Research Archive
• Holmen, Heidi; Holm, Are Martin; Kilvær, Thomas Karsten; Ljoså, Tone Marte; Granan, Lars-Petter Ness & Ekholdt, Christopher [Show all 8 contributors for this article] (2023). Digital Outpatient Services for Adults: Development of an Intervention and Protocol for a Multicenter Non-Randomized Controlled Trial. JMIR Research Protocols. 12. doi: 10.2196/46649. Full text in Research Archive Show summary

  Background: Health care services are being challenged by an increasing number of patients and limited resources. Hence, research investigating options to reduce costs and increase effectiveness is warranted. Digital outpatient services can provide flexible and tailored follow-up, improve patients’ health literacy, and facilitate the identification of adverse courses of disease. However, previous research largely focused on disease-specific contexts and outcomes. Therefore, research on digital services investigating generic outcomes such as health literacy is warranted.<p> <p>Objective: This article aims to describe the “digital outpatient service” intervention and present the protocol for an ongoing multicenter, nonrandomized trial evaluating this intervention.<p> <p>Methods: Based on previous experiences and evidence-based knowledge, we developed this intervention through patient-journey maps in collaboration with each clinical specialty. The patients gain access to a mobile app for self-monitoring and patient-reported outcomes and a chat for contact between the patients and health care workers. The health care workers’ dashboard includes a traffic light system to draw attention to the most urgent patient reports. In this multicenter, non–randomized controlled trial, patients are allocated to the control group receiving standard care or the 6-month intervention. Eligible patients are aged 18 years or older who receive outpatient care at the neurology, lung, pain, or cancer departments at 2 university hospitals in Norway. Our evaluation will include patient-reported outcomes, qualitative interviews, and clinical measures. The primary outcome will be health literacy using the Health Literacy Questionnaire. A sample size of 165 participants is split into a 1:2 ratio in favor of the intervention. We will analyze quantitative data in SPSS (IBM Corp) using descriptive statistics and logistic regression, and qualitative data using thematic analysis.<p> <p>Results: This trial started in September 2021, and the intervention started in January 2022. Recruitment has ended, with 55 patients in the control group and 107 patients in the intervention group. Follow-up is expected to end in July 2023, with results expected to be obtained in December 2023.<p> <p>Conclusions: This study will evaluate an intervention facilitated by an already certified digital multicomponent solution, with intervention content based on patient-reported outcomes, health literacy, and self-monitoring. The intervention is specifically tailored to each participating center and the needs of their patients using patient journey maps. The comprehensive and generic evaluation of this digital outpatient service intervention is a strength as it targets a heterogeneous sample of patients. Thus, this study will provide important knowledge about the applicability and effects of digital health care services. As a result, patients and health care workers will gain a new, evidence-based understanding of whether and how digital tools may be used in clinical care.Background: Health care services are being challenged by an increasing number of patients and limited resources. Hence, research investigating options to reduce costs and increase effectiveness is warranted. Digital outpatient services can provide flexible and tailored follow-up, improve patients’ health literacy, and facilitate the identification of adverse courses of disease. However, previous research largely focused on disease-specific contexts and outcomes. Therefore, research on digital services investigating generic outcomes such as health literacy is warranted.<p>

• Holmen, Heidi; Hurrød, Anna; Ekholdt, Christopher; Holm, Are Martin; Kilvær, Thomas Karsten & Larsen, Lotte Sandberg [Show all 8 contributors for this article] (2022). Digital outpatient services: development of an intervention and a multicenter controlled trial. Full text in Research Archive
• Holmen, Heidi; Hurrød, Anna; Ekholdt, Christopher; Holm, Are Martin; Overgaard, Saida Alfrida Martinez & Larsen, Lotte Sandberg [Show all 8 contributors for this article] (2022). Digital poliklinikk - utvikling av en intervensjon og en multisenterstudie. Full text in Research Archive
• Anderssen, Hans; Larsen, Lotte Sandberg; Kakad, Meetali; Hurrød, Anna & Fosse, Erik Torgeir (2022). Ny digital poliklinikk har fått sine første pasienter. [Internet]. Health Talk . Full text in Research Archive
• Fosse, Erik (2019). Gjennombrudd i helsevesenet: Operasjonene som forsvant. In Rolstadås, Asbjørn; Krokan, Arne; Schiefloe, Per Morten; Sand, Gunnar & Dyrhaug, Lars Thomas (Ed.), Det Nye Digitale Norge. John Grieg Forlag. ISSN 9788253303741. p. 39–49. Full text in Research Archive
• Wendt, Kjersti; Kristiansen, Ronny; Krohg-Sørensen, Kirsten; Gregersen, Fredrik Alexander & Fosse, Erik (2019). Corrigendum to “Trends in Abdominal Aortic and Iliac Aneurysm Repairs in Norway from 2001 to 2013” (Trends in Abdominal Aortic and Iliac Aneurysm Repairs in Norway from 2001 to 2013 (2016) 51(2) (194–201), (S1078588415006267), (10.1016/j.ejvs.2015.08.015)). European Journal of Vascular and Endovascular Surgery. ISSN 1078-5884. 58(3), p. 468–468. doi: 10.1016/j.ejvs.2019.01.021. Full text in Research Archive
• Mortensen, Berit; Lukasse, Mirjam; Diep, Lien My; Lieng, Marit; Abu-Awad, Amal & Suleiman, Munjid [Show all 7 contributors for this article] (2018). CAN A MIDWIFERY-LED CONTINUITY MODEL IMPROVE MATERNAL SERVICES IN A LOW RESOURCE SETTING? – A NON-RANDOMIZED CLUSTER INTERVENTION STUDY IN PALESTINE. Full text in Research Archive
• Mortensen, Berit; Lukasse, Mirjam; Diep, Lien My; Lieng, Marit; Abu-Awad, Amal & Suleiman, Munjid [Show all 7 contributors for this article] (2017). How a Continuity of Midwifery Care Model affect the usage and quality of maternal services in rural Palestine. Full text in Research Archive Show summary

  For the Lancet Palestinian Health Alliance (LPHA) conference 2017: How a Continuity of Midwifery Care Model affect the usage and quality of maternal services in rural Palestine Authors: Berit Mortensen MSc (beritmor@me.com) and Erik Fosse MD, Phd Medical Faculty, University of Oslo, and the Intervention Center Oslo University Hospital, Oslo, Norway Abstract 465 words: Background: The Palestinian Ministry of Health provided care for 45,6% of the pregnant women in the occupied West Bank in 2013. No report described the difference between urban and rural areas; nevertheless, private service providers are more available to women in urban areas. Women living in remote areas are vulnerable because Israeli armed soldier and settlers make it dangerous to move. Abdul Rahim et al. described governmental maternal services with poor quality and antenatal-visits lacking content, short consultation time and dissatisfaction with care. In 2013 the Ministry of Health started a stepwise implementation of a Continuity of Midwifery Care Model in rural areas on the West Bank in cooperation with Norwegian aid Committee (NORWAC). The model entailed deploying midwives from the local governmental hospital to ante-and postnatal care in rural clinics. This study explored if the model increased the usage and the quality of health services after two years’ experience in Nablus and Jericho regions. Methods: The study was based on registry data at cluster level. Data from 14 clinics offering the new model was compared with data from 25 clinics offering standard care. Primary outcome was: mean number of antenatal visits per woman, number of pregnant referred to higher level of care, number of women receiving postnatal home visits. We compared the change in outcomes two years before with two years after the implementation. Multilevel Poisson regression was used to examine difference between the intervention and standard care groups and testing the change. Findings: A statistical significant difference was found between the intervention and control group (p-value < 0.001) in all primary outcomes. In clinics with the new model the mean number of ante-natal visits per woman increased from 3.7 to 4.7, while in the clinics with standard care a decline was observed from 4.6 to 4.2 visits. The percentage of pregnant women referred to higher level of care increased from 7% to 25,6% in the intervention clinics. No such increase was observed in the control clinics. The percentage of postnatal home visits increased from 2% to 42% at the intervention clinics, while at the control clinics the visits dropped from 1.5% to 0.7%. Interpretation: The continuity model improved the usage and quality of maternal services in rural clinics in the West Bank. Continuity of care allows building a relationship where women experience respect and gain trust in the health care provided. The findings indicate that this relationship, as well as the care being provided by midwives from the hospitals, near the women`s home, increased usage of care and quality of service.

• Mortensen, Berit; Lukasse, Mirjam; Diep, Lien My; Lieng, Marit & Fosse, Erik (2017). Does outreaching Continuity of Midwifery-care improve usage and quality of services in Palestine? Full text in Research Archive Show summary

  Does outreaching Continuity of Midwifery-care improve usage and quality of services in Palestine? Abstract: Background: The Palestinian Ministry of Health (PMoH) provides care for 54% of the pregnant women in the occupied West Bank. Women living in remote areas are vulnerable because the distance and Israeli military presence hinders them to reach central health-facilities. In 2013 PMoH implemented an outreaching Continuity of Midwifery Care Model, deploying midwives from the hospitals, to give ante- and postnatal care to women in selected remote villages in Palestine. Objective: Our study aims to assess the acceptability and quality of care of this model. Design: A pragmatic cluster-non-randomised controlled trial, comparing register-data from 14 intervention-clinics with 28 control-clinics (with various professionals and no continuity), in Nablus and Jericho district. We will measure the change before (baseline) and after the implementation, and compare the change in the intervention cluster with the control cluster. We hypothesize an increase in the number of pregnant women registering and increase in number of visits per woman at the intervention-clinics. We hypothesize increased identification of pregnancy complications requiring higher level of care, and an increase in postnatal home visits at the intervention-clinics Discussion: Continuity of care allows for the building of a relationship. A relationship where women experience respect and thus gain trust in the health care provided. We believe that this relationship, as well as the care being provided in the near vicinity of the home of the women, increases women’s usage of care. Meta-studies support continuum of care and more research regarding developing midwifery-led models in low-income countries are requested : We believe this study is an important contribution as such.

• Mortensen, Berit; Lukasse, Mirjam; Diep, Lien; Lieng, Marit; Abu-Awad, Amal & Suleiman, Munjid [Show all 7 contributors for this article] (2017). Kan kontinuitet i jordmoromsorgen forbedre helsetjenesten for gravide og barselkvinner i et lavinntektsland? – En ikke-randomisert intervensjonsstudie i Palestina. Full text in Research Archive Show summary

  Kan kontinuitet i jordmoromsorgen forbedre helsetjenesten for gravide og barselkvinner i et lavinntektsland? – En ikke-randomisert intervensjonsstudie i Palestina Innledning: For å bedre helsetilbudet for gravide og barselkvinner på landsbygda lanserte palestinsk helsedepartement i 2013 en modell for kontinuitet i jordmoromsorgen på den israel-okkuperte Vestbredden, i samarbeid med Norwegian Aid Committee (NORWAC). Modellen innebærer at jordmødre fra offentlige sykehus drar ut til landsbyer for å drive svangerskaps- og barselomsorg. Den samme jordmoren besøker samme landsby hver uke. De fleste føder ved det sykehuset jordmoren jobber. Mål: Studien undersøkte virkningen modellen hadde på bruken av tjenesten og noen kvalitetsforbedringsindikatorer etter to års erfaring. Materialer og metode: Intervensjonen var allerede i gang og en ikke-randomisert intervensjons design ble valgt. Studiet er basert på registerdata, kun tilgjengelig på institusjonsnivå (cluster), to år før (2011 & 2012) og to år etter (2014 & 2015) intervensjonen startet. Totalt ble 53 primærhelse klinikker i regionene Nablus og Jeriko, stratifisert for inkludering. Primærutfallet var gjennomsnittlig antall svangerskapskontroller. Viktige sekundære utfall var antall henvisninger til spesialisthelsetjenesten og antall hjemmebesøk etter fødsel. Forskjellen I endring før og etter intervensjonen ble sammenlignet mellom klinikker som hadde jordmormodellen og klinikker med ordinær svangerskaps- og barselomsorg. Resultater: Det ble inkludert 14 intervensjons-klinikker og 25 kontroll-klinikker i studien. Antall svangerskapskontroller økte med 1.16 per kvinne i klinikker med jordmormodellen, mens antall kontroller ble redusert med 0.39 kontroller per kvinne i klinikkene som ikke hadde jordmormodell. Dette ga en signifikant forskjell i endring på 1.55 kontroller [95% CI 0.90 – 2.21]. En signifikant forskjell i endring av antall henvisninger ble også observert mellom gruppene med en endringsratio på 3.65 [2.78 – 4.78]. Antall henvisninger økte med en rate ratio på 3.87 I klinikker med jordmormodellen, mens det ikke var noen signifikant endring i kontrollgruppen som hadde en ratio på 1.06. Jordmormodellen førte til at hjemmebesøk ble gjennomført i stor grad, mens klinikker med ordinær tjeneste nesten ikke utfører hjemmebesøk, en forskjell i endrings ratio på 97.65 (45.20 - 210.96) Konklusjon: Den palestinske modellen for kontinuitet i jordmoromsorgen økte kvinnenes bruk av helsetjenesten og noen kvalitetsindikatorer for svangerskaps og barselomsorg. Mer forskning bør utføres for å undersøke modellens innvirkning på individuelle helseutfall for mor og barn og på brukertilfredshet.

• Jensen, Kristin; Andersen, Hilde Kjernlie; Smedby, Ørjan; Østerås, Bjørn Helge; Aarsnes, Anette & Tingberg, Anders [Show all 8 contributors for this article] (2017). Quantiative measurements versus receiver operating chacteristics and visual grading regression in iterative reconstruction. Full text in Research Archive
• Halvorsen, Per Steinar; Espinoza, Andreas Westenvik; Fiane, Arnt E & Fosse, Erik (2013). Continuous Monitoring of Right Ventricular Function with a 3-Axis Accelerometer during Left Ventricular Assist Device Implantation. The Journal of Heart and Lung Transplantation. ISSN 1053-2498. 32(4), p. S161–S162. Full text in Research Archive
• Imenes, Kristin; Andersen, Mona Helene; Nguyen, Anh Tuan Thai; Tjulkins, Fjodors; Aasmundtveit, Knut E. & Hoivik, Nils [Show all 8 contributors for this article] (2012). Implantable MEMS acceleration sensor for heart monitoring : recent development and outlook. Full text in Research Archive
• Bekkelund, Anne Siri Koksrud; Lovett, Hilde; Tennøe, Tore; Nassehi, Damoun; Brøgger, Helga M. & Riegler, Michael [Show all 8 contributors for this article] (2021). KUNSTIG INTELLIGENS I KLINIKKEN - Seks trender for fremtidens helsetjeneste. Teknologirådet. Full text in Research Archive
• Vallevik, Vibeke Binz; Zaka, Alia; Brekke, Pål Haugar; Fosse, Erik Torgeir & Ray-Sannerud, Bobbie (2021). Reflections on the clinical implementation of precision medicine – Experiences from BigMed, a Norwegian ICT Lighthouse project. Oslo University Hospital. Full text in Research Archive Show summary

  The BigMed project was funded by The Research Council of Norway (RCN) as an ICT lighthouse project to address the barriers to clinical implementation of precision medicine and pave the way for big data analytics. The consortium, hosted by Oslo University Hospital, was a cooperation of more than 20 partners from industry, academia, and the clinic. In the four years BigMed operated, the multidisciplinary teams developed solutions on infrastructure, quality assurance, data sharing and clinical decision support based on needs identified through three clinical areas: rare diseases, sudden cardiac death, and colorectal cancer. In developing a framework for addressing different types of implementation barriers, BigMed considered legal issues, organisational and governance issues, ICT infrastructure, as well as the life cycle of secondary use of data through data capture, analysis, and application. The project found data is a resource that is seldom reused for clinical decision support. Clinical genomics is an exception and serves as a good example of how data can be reused to support clinical decisions. This can be a model for future development of other areas, to see how data can be used for patient similarity analysis and to speed up knowledge development to the benefit of our patients. BigMed contributed to reducing the genetic analysis time for critically ill newborns at (OUH) from 8 weeks to 5 days by developing tools to support the implementation and automatisation of high throughput sequencing pipelines. To monitor quality, BigMed explored quality control needs and specific tools, and developed and implemented solutions for sharing of genomic data. The legal aspects of sharing genomic data were interpreted and clarified to make implementation possible. The project developed patient similarity tools for colorectal cancer, building on data from external sources like the Cancer Registry of Norway. These analytic tools supporting clinical decisions were coupled with genomic reporting tools in a dashboard to gather all relevant patient information in a timeline. This clinical case demonstrates the need for data mobility and the benefit of reusing data for clinical decisions. Based on the case of sudden cardiac death and the need for early identification of patients at risk, we demonstrated the use of Natural language processing (NLP) to pull relevant information from Electronic Health Records (EHR) in order to populate analysis tools and automate risk estimation. Synthetic data proved successful for the first phase of training tools. Our experiences reveal a need to develop strategies on how best to use data and what infrastructure needs to be in place. Data must be captured in formats that allow for reuse. Raw data should be saved as well, as a lot of value may get lost in the translation from raw data to structured variables. NLP will provide a useful tool to interpret the information hidden in clinical text, yet need to be developed in one area at a time. Data must be allowed to flow between systems to allow for the successful development and implementation of tools and processes that support a precision medicine approach. This flow will be facilitated by defined standards, APIs, and suitable open platforms. There is a significant technology debt in the existing infrastructure that needs to be addressed as we move forward. Adoption of precision medicine is best executed with an iterative approach and incremental changes. This is best accomplished through an agile management approach and establishment of a clear path from innovation to implementation, rather than a hierarchical decision structure. This innovation ecosystem requires the hospitals and technology providers to work together towards a common goal. New models for clinical studies are needed to adapt to the precision medicine paradigm, and health economic models must be revised to reflect the individual rather than a group approach. The current healthcare regulations a

• Tennøe, Tore; Lovett, Hilde; Fosse, Erik; Hatlen, Siri B; Madsen, Steinar & Nassehi, Damoun [Show all 8 contributors for this article] (2019). Kunstig Intelligens og Norske Helsedata. Teknologirådet. Full text in Research Archive
• Fosse, Erik; Andersen, Marit Helen; Lindberg, Harald & Døhlen, Gaute (2018). Percutaneous pulmonary valve implantation impact on clinical outcome, patients self-reported health, psychosocial function and hospital costs in patients with congenital heart disease. Universitetet i Oslo. Full text in Research Archive
• Lovett, Hilde; Nassehi, Damoun; Fosse, Erik; Hatlen, Siri B; Madsen, Steinar & Melberg, Hans Olav [Show all 7 contributors for this article] (2018). Kunstig Intelligens - Muligheter, Utfordringer og en Plan for Norge. Teknologirådet. ISSN 9788292447956. Full text in Research Archive

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