| 88261. |
- Krag, M., et al.
(författare)
-
Stress ulcer prophylaxis in the intensive care unit: an international survey of 97 units in 11 countries
- 2015
-
Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 59:5, s. 576-585
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Stress ulcer prophylaxis (SUP) may decrease the incidence of gastrointestinal bleeding in patients in the intensive care unit (ICU), but the risk of infection may be increased. In this study, we aimed to describe SUP practices in adult ICUs. We hypothesised that patient selection for SUP varies both within and between countries. MethodsAdult ICUs were invited to participate in the survey. We registered country, type of hospital, type and size of ICU, preferred SUP agent, presence of local guideline, reported indications for SUP, criteria for discontinuing SUP, and concerns about adverse effects. Fisher's exact test was used to assess differences between groups. ResultsNinety-seven adult ICUs in 11 countries participated (eight European). All but one ICU used SUP, and 64% (62/97) reported having a guideline for the use of SUP. Proton pump inhibitors were the most common SUP agent, used in 66% of ICUs (64/97), and H2-receptor antagonists were used 31% (30/97) of the units. Twenty-three different indications for SUP were reported, the most frequent being mechanical ventilation. All patients were prescribed SUP in 26% (25/97) of the ICUs. Adequate enteral feeding was the most frequent reason for discontinuing SUP, but 19% (18/97) continued SUP upon ICU discharge. The majority expressed concern about nosocomial pneumonia and Clostridium difficile infection with the use of SUP. ConclusionsIn this international survey, most participating ICUs reported using SUP, primarily proton pump inhibitors, but many did not have a guideline; indications varied considerably and concern existed about infectious complications.
|
|
| 88262. |
- Kragballe, K, et al.
(författare)
-
A 52-week randomized safety study of a calcipotriol/betamethasone dipropionate two-compound product (Dovobet((R))/Daivobet((R))/Taclonex((R))) in the treatment of psoriasis vulgaris
- 2006
-
Ingår i: British Journal of Dermatology. - : Oxford University Press (OUP). - 1365-2133 .- 0007-0963. ; 154:6, s. 1155-1160
-
Tidskriftsartikel (refereegranskat)abstract
- The calcipotriol/betamethasone dipropionate two-compound product Dovobet (R)/Daivobet (R)/Taclonex (R)(LEO Pharma A/S, Ballerup, Denmark) has been shown to be safe and effective in the treatment of psoriasis for up to 8 weeks. As psoriasis is a chronic disease, long-term treatment may be required, so there is a need to investigate the safety of its use over a longer period of time. To investigate the safety of two treatment regimens involving use of the two-compound product over 52 weeks in the treatment of patients with psoriasis. Patients (n = 634) were randomized double-blind to treatment with: (i) 52 weeks of the two-compound product (two-compound group); (ii) 52 weeks of alternating 4-week periods of the two-compound product and calcipotriol (alternating group); or (iii) 4 weeks of the two-compound product followed by 48 weeks of calcipotriol (calcipotriol group). Treatments in all groups were used once daily when required. Adverse drug reactions (ADRs) occurred in 45 (21.7%) patients in the two-compound group, 63 (29.6%) in the alternating group and 78 (37.9%) in the calcipotriol group. The odds ratio for an ADR in the two-compound group relative to the calcipotriol group was 0.46 (95% confidence interval 0.30-0.70; P < 0.001). ADRs of concern associated with long-term topical corticosteroid use occurred in 10 (4.8%) patients in the two-compound group, six (2.8%) in the alternating group and six (2.9%) in the calcipotriol group; those with the highest incidence were skin atrophy, occurring in four (1.9%), one (0.5%) and two (1.0%) patients, respectively, and folliculitis, in three (1.4%), one (0.5%) and no patients, respectively. Treatment with the two-compound product for up to 52 weeks appears to be safe and well tolerated whether used on its own or alternating every 4 weeks with calcipotriol treatment.
|
|
| 88263. |
- Kragballe, K., et al.
(författare)
-
Efficacy results of a 52-week, randomised, double-blind, safety study of a calcipotriol/betamethasone dipropionate two-compound product (Daivobet (R)/Dovobet (R)/Taclonex (R)) in the treatment of psoriasis vulgaris
- 2006
-
Ingår i: Dermatology. - : S. Karger AG. - 1421-9832 .- 1018-8665. ; 213:4, s. 319-326
-
Tidskriftsartikel (refereegranskat)abstract
- Background: The calcipotriol/betamethasone dipropionate two-compound product is safe and effective in the short-term treatment of psoriasis. Objective: The primary objective was to investigate the safety of two treatment regimens involving use of the two-compound product over 52 weeks. The efficacy results are presented here. Methods: Six hundred and thirty-four patients were randomised double-blind to treatment (once daily, when required) with either: 52 weeks of two-compound product (two-compound group), 52 weeks of alternating 4-week periods of two-compound product and calcipotriol (alternating group), or 4 weeks of two-compound product followed by 48 weeks of calcipotriol (calcipotriol group). Results: There was a trend towards a difference between treatments from the overall treatment effect for the percentage of satisfactory responses for each patient during the study (p = 0.071). This appeared to be due to the comparison of the two-compound and calcipotriol groups (p = 0.025). Conclusion: There was a trend towards the efficacy of the two-compound product used for up to 52 weeks being better than that of 4 weeks of the two-compound product followed by 48 weeks of calcipotriol.
|
|
| 88264. |
|
|
| 88265. |
- Kraggerud, SM, et al.
(författare)
-
Alterations of the fragile histidine triad gene, FHIT, and its encoded products contribute to testicular germ cell tumorigenesis
- 2002
-
Ingår i: Cancer Research. - 1538-7445. ; 62:2, s. 512-517
-
Tidskriftsartikel (refereegranskat)abstract
- The fragile histidine triad (FHIT) gene, located within chromosome arm 3p, is a potential target for testicular tumorigenesis. In the present study, 62 primary testicular germ cell tumors were analyzed for allelic imbalance (AI) at 10 loci mapping to chromosome bands 3p14.1-21.1. Twenty-seven tumors (44%) showed AI at one or more 3p loci. The chromosome 3 copy number was evaluated by fluorescence in situ hybridization with centromere and p-telomere probes onto interphase nuclei from 22 of the tumors. Sixteen of these (73%) presented three or more signals of each probe in at least one-third of the nuclei. The combined fluorescence in situ hybridization and AI results indicated that tumors with AI at all loci, in most cases (five of six), reflected an increased chromosome copy number, whereas tumors presenting AI only at some loci reflected interstitial chromosomal changes. A smallest region of overlapping changes could be delineated from tumors showing interstitial chromosomal changes (n = 16). The smallest region of overlapping changes was flanked by D3S1312 and D3S1234 and included parts of FHIT. In the second part of this study, expression analyses of FHIT were performed. Transcripts of aberrant lengths were found in 7 of 17 (41%) analyzed tumors and were identified by sequencing as splice variants. Three different types of transcripts were found, and all lacked exon 3. Immunohistochemical staining showed reduced Fhit protein expression, compared with normal testicular tissue, in 62% (40 of 65) of the testicular germ cell tumors. Although we found a significant association between FHIT mRNA alterations and AI (P = 0.006), altered protein expression did not correlate with AI. The nonepithelial components of teratomas showed strong association with reduced Fhit protein compared with the epithelial component (P < 0.001). Interestingly, reduced Fhit expression seems to be associated with metastasis in the patient at the time of diagnosis, although the association was not statistically significant.
|
|
| 88266. |
- Kragh, Annika M, et al.
(författare)
-
Bleeding and first-year mortality following hip fracture surgery and preoperative use of low-dose acetylsalicylic acid: an observational cohort study
- 2011
-
Ingår i: BMC Musculoskeletal Disorders. - : BioMed Central. - 1471-2474. ; 12:254
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Hip fracture is associated with high mortality. Cardiovascular disease and other comorbidities requiring long-term anticoagulant medication are common in these mostly elderly patients. The objective of our observational cohort study of patients undergoing surgery for hip fracture was to study the association between preoperative use of low-dose acetylsalicylic acid (LdAA) and intraoperative blood loss, blood transfusion and first-year all-cause mortality. less thanbrgreater than less thanbrgreater thanMethods: An observational cohort study was conducted on patients with hip fracture (cervical requiring hemiarthroplasty or pertrochanteric or subtrochanteric requiring internal fixation) participating in a randomized trial that found lack of efficacy of a compression bandage in reducing postoperative bleeding. The participants were 255 patients (andgt;= 50 years) of whom 118 (46%) were using LdAA (defined as andlt;= 320 mg daily) preoperatively. Bleeding variables in patients with and without LdAA treatment at time of fracture were measured and blood transfusions given were compared using logistic regression. The association between first-year mortality and preoperative use of LdAA was analyzed with Cox regression adjusting for age, sex, type of fracture, baseline renal dysfunction and baseline cardiovascular and/or cerebrovascular disease. less thanbrgreater than less thanbrgreater thanResults: Blood transfusions were given postoperatively to 74 (62.7%) LdAA-treated and 76 (54%) non-treated patients; the adjusted odds ratio was 1.8 (95% CI 1.04 to 3.3). First-year mortality was significantly higher in LdAA-treated patients; the adjusted hazard ratio (HR) was 2.35 (95% CI 1.23 to 4.49). The mortality was also higher with baseline cardiovascular and/or cerebrovascular disease, adjusted HR 2.78 (95% CI 1.31 to 5.88). Patients treated with LdAA preoperatively were significantly more likely to suffer thromboembolic events (5.7% vs. 0.7%, P = 0.03). less thanbrgreater than less thanbrgreater thanConclusions: In patients with hip fracture (cervical treated with hemiarthroplasty or pertrochanteric or subtrochanteric treated with internal fixation) preoperative use of low-dose acetylsalicylic acid was associated with significantly increased need for postoperative blood transfusions and significantly higher all-cause mortality during one year after surgery.
|
|
| 88267. |
- Kragh Ekstam, Annika
(författare)
-
Medication in older hip fracture patients. Falls, fractures, and mortality.
- 2017
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background and aim: Due to an increasingly ageing population, the number of hip fracture patients, often with multiple chronic diseases and multiple pharmacotherapy, is set to rise. The high risk of adverse outcomes that hip fractures lead to in older individuals is well described, including high first-year mortality. This thesis aim to improve our knowledge of older hip fracture patients’ treatment with drugs that potentially increases the risk of falls, fractures, bleeding, and death, in order to identify potentially effective interventions for preventing adverse outcome from the medication. Methods and results: Three general population-based cohort studies and one observational cohort study, on medication in hip fracture patients, are included. National registry data for 2,043 patients (I, II, III) and medical journals for 255 patients (IV) were analysed. Paper I aimed to describe the use of fall-risk-increasing drugs (FRID) and to analyse whether there were any changes in the prescribing six months after a hip fracture, compared to six months before. A majority was exposed to FRID prior to the fracture and an increase of thirty percentage-points in post-fracture prescribing was found. Anti-osteoporosis treatment increased only marginally, but in hospitals offering geriatric support the prescribing of anti-osteoporosis drugs increased significantly compared to hospitals without this support. In Paper II, first-year mortality was shown to be significantly higher in patients exposed to ≥4 FRID, polypharmacy, psychotropic and cardiovascular drugs. Regression analyses of treatment with FRID, adjusted for age, sex and any ≥ 4 drugs, showed higher mortality in patients exposed to ≥4 FRID compared to ≤3 FRID. In Paper III, exposure to potentially inappropriate medication (PIM) was found in 81% of the patients. Logistic regression, data adjusted for age, sex, and use of ≥5 drugs, indicated that exposure to any PIM and analgesic-PIM (tramadole, dextropropoxyphene) increased six months’ mortality significantly. Exposure to other categories of opioids did not indicate higher mortality, Patients with a length of in-hospital stay (LOS) ≥10 days had a higher six months’ mortality than patients with a LOS of ≤ 9 days. In Paper IV, regression analysis of hip fracture patients’ exposure to low-dose acetylsalicylic acid (LdAA), adjusted for multiple confounders, showed higher first-year mortality and that more blood transfusions were given to patients treated with LdAA compared to non-users. Levels of coagulation factors were also significantly higher in the blood of patients treated with LdAA compared to unexposed patients. Conclusions: The thesis proposes that older hip fracture patients are frequently exposed to FRID and PIM, that exposure to ≥ 4 FRID, any PIM, analgesic-PIM, LdAA, polypharmacy, and a LOS of ≥ 10 days are factors associated with higher mortality. Additionally was found that exposure to FRID increases significantly after the fracture and that anti-osteoporosis treatment is more frequently prescribed to orthopaedic patients when geriatric support is available. The overall conclusion lies in the identification of plausible ways to reduce adverse outcome and improve the care of hip fracture patients. Further studies on ways of improving the care of hip fracture patients should be explored by evaluating methods of preventing drug-related adverse outcome, as well as of strengthening the collaboration between orthopaedic and geriatric professionals.
|
|
| 88268. |
- Kragh Ekstam, Annika, et al.
(författare)
-
Older Adults' Medication Use 6 Months Before and After Hip Fracture: A Population-Based Cohort Study.
- 2011
-
Ingår i: Journal of the American Geriatrics Society. - : Wiley. - 0002-8614. ; 59, s. 863-868
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To study changes in use of fall-risk increasing drugs (FRIDs) and bone density-related medication in participants with hip fracture before and after the fracture and to analyze differences between five healthcare districts. DESIGN: Population-based cohort study. SETTING: Data retrieved from two national databases PARTICIPANTS: All 2,043 people with hip fracture aged 60 and older in a Swedish county in 2006. MEASUREMENTS: Changes in FRIDs and bone-active medications prescribed within 6 months before and 6 months after hip fracture and differences between health care districts. RESULTS: Before hip fracture, 1,308 participants (67.7%) received any FRIDs or combinations; after fracture, 97.7% were treated. Polypharmacy (≥5 drugs) increased 39.3%, excessive polypharmacy (≥10 drugs) increased 36.4%, and use of three or more psychotropic drugs increased 8.6%. After fracture, the use of all analyzed drugs including psychotropic, cardiovascular, opioid, and anticholinergic drugs increased significantly (P<.001). Treatment with calcium and vitamin D increased from 9% before to 27.7% after and with bisphosphonates from 3.5% to 7.6%. Variations in postfracture prescribing between the five health care districts were observed regarding opioids (range 85-64%), bisphosphonates (range 20-4%), and calcium and vitamin D (72-13%) (P<.001, for all comparisons). CONCLUSION: Two-thirds of participants with hip fracture were prescribed FRIDs before fracture, and the number increased significantly after fracture. Significant variations between healthcare districts in treating osteoporosis and pain were evident; geriatric support could be a contributing factor to the greater treatment in two districts.
|
|
| 88269. |
- Kragl, Gabriele, et al.
(författare)
-
Dosimetric characteristics of 6 and 10 MV unflattened photon beams
- 2009
-
Ingår i: Radiotherapy and Oncology. - : Elsevier BV. - 1879-0887 .- 0167-8140. ; 93:1, s. 141-146
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose: To determine dosimetric properties of unflattened megavoltage photon beams. Materials and methods: Dosimetric data including depth dose, profiles, output factors and phantom scatter factors from three different beam qualities provided by Elekta Precise linacs, operated with and without flattening filter were examined. Additional measurements of leaf transmission, leakage radiation and surface dose were performed. In flattening filter free (FFF) mode a 6-mm thick copper filter was placed into the beam to stabilize it. Results: Depths of dose maxima for flattened and unflattened beams did not deviate by more than 2 mm and penumbral widths agreed within 1 mm. In FFF mode the collimator exchange effect was found to be on average 0.3% for rectangular fields. Between maximum and minimum field size head scatter factors of unflattened beams showed on average 40% and 56% less variation for 6 and 10 MV beams than conventional beams. Phantom scatter factors for FFF beams differed up to 4% from the published reference data. For field sizes smaller than 15 cm, surface doses relative to the dose at d(max) increased for unflattened beams with maximum differences of 7% at 6 MV and 25% at 10 MV for a 5 x 5 cm(2) field. For a 30 x 30 cm(2) field, relative surface dose decreased by about 10% for FFF beams. Leaf transmission on the central axis was 0.3% and 0.4% lower for unflattened 6 and 10 MV beams, respectively. Leakage radiation was reduced by 52% for 6 MV and by 65% for 10 MV unflattened beams. Conclusions: The results of the study were independently confirmed at two radiotherapy centres. Phantom scatter reference data need to be reconsidered for medical accelerators operated without a flattening filter. (C) 2009 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 93 (2009) 141-146
|
|
| 88270. |
- Kragl, Gabriele, et al.
(författare)
-
Flattening filter free beams in SBRT and IMRT: Dosimetric assessment of peripheral doses
- 2011
-
Ingår i: Zeitschrift für Medizinische Physik. - : Elsevier BV. - 1876-4436 .- 0939-3889. ; 21:2, s. 91-101
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose: Recently, there has been a growing interest in operating medical linear accelerators without a flattening filter Due to reduced scatter, leaf transmission and radiation head leakage a reduction of out-of-field dose is expected for flattening filter free beams. The aim of the present study was to determine the impact of unflattened beams on peripheral dose for advanced treatment techniques with a large number of MUs. Material and methods: An Elekta Precise linac was modified to provide 6 and 10 MV photon beams without a flattening filter Basic beam data were collected and implemented into the TPS Oncentra Masterplan (Nucletron). Leakage radiation, which predominantly contributes to peripheral dose at larger distances from the field edge, was measured using a Farmer type ionisation chamber SBRT (lung) and IMRT (prostate, head&neck) treatment plans were generated for 6 and 10 MV for both flattened and unflattened beams. All treatment plans were delivered to the relevant anatomic region of an anthropomorphic phantom which was extended by a solid water slab phantom. Dosimetric measurements were performed with TLD-700 rods, radiochromic films and a Farmer type ionisation chamber The detectors were placed within the slab phantom and positioned along the isocentric longitudinal axis. Results: Using unflattened beams results in a reduction of treatment head leakage by 52% for 6 and 65% for 10 MV. Thus, peripheral doses were in general smaller for treatment plans calculated with unflattened beams. At about 20 cm distance from the field edge the dose was on average reduced by 23 and 31% for the 6 and 10 MV SBRT plans. For the IMRT plans (10 MV) the average reduction was 16% for the prostate and 18% for the head&neck case, respectively. For all examined cases, the relative deviation between peripheral doses of flattened and unflattened beams was found to increase with increasing distance from the field. Conclusions: Removing the flattening filter lead to reduced peripheral doses for advanced treatment techniques. The relative difference between peripheral doses of flattened and unflattened beams was more pronounced when the nominal beam energy was increased. Patients may benefit by decreased exposure of normal tissue to scattered dose outside the field.
|
|
