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  • Aasa, Mikael, et al. (creator_code:aut_t)
  • Cost and health outcome of primary percutaneous coronary intervention versus thrombolysis in acute ST-segment elevation myocardial infarction-Results of the Swedish Early Decision reperfusion Study (SWEDES) trial.
  • 2010
  • record:In_t: American heart journal. - : Elsevier BV. - 1097-6744 .- 0002-8703. ; 160:2, s. 322-8
  • swepub:Mat_article_t (swepub:level_refereed_t)abstract
    • BACKGROUND: In ST-elevation myocardial infarction, primary percutaneous coronary intervention (PCI) has a superior clinical outcome, but it may increase costs in comparison to thrombolysis. The aim of the study was to compare costs, clinical outcome, and quality-adjusted survival between primary PCI and thrombolysis. METHODS: Patients with ST-elevation myocardial infarction were randomized to primary PCI with adjunctive enoxaparin and abciximab (n = 101), or to enoxaparin followed by reteplase (n = 104). Data on the use of health care resources, work loss, and health-related quality of life were collected during a 1-year period. Cost-effectiveness was determined by comparing costs and quality-adjusted survival. The joint distribution of incremental costs and quality-adjusted survival was analyzed using a nonparametric bootstrap approach. RESULTS: Clinical outcome did not differ significantly between the groups. Compared with the group treated with thrombolysis, the cost of interventions was higher in the PCI-treated group ($4,602 vs $3,807; P = .047), as well as the cost of drugs ($1,309 vs $1,202; P = .001), whereas the cost of hospitalization was lower ($7,344 vs $9,278; P = .025). The cost of investigations, outpatient care, and loss of production did not differ significantly between the 2 treatment arms. Total cost and quality-adjusted survival were $25,315 and 0.759 vs $27,819 and 0.728 (both not significant) for the primary PCI and thrombolysis groups, respectively. Based on the 1-year follow-up, bootstrap analysis revealed that in 80%, 88%, and 89% of the replications, the cost per health outcome gained for PCI will be <$0, $50,000, and $100,000 respectively. CONCLUSION: In a 1-year perspective, there was a tendency toward lower costs and better health outcome after primary PCI, resulting in costs for PCI in comparison to thrombolysis that will be below the conventional threshold for cost-effectiveness in 88% of bootstrap replications.
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  • Aasa, Mikael, et al. (creator_code:aut_t)
  • Risk Reduction for Cardiac Events After Primary Coronary Intervention Compared With Thrombolysis for Acute ST-Elevation Myocardial Infarction (Five-Year Results of the Swedish Early Decision Reperfusion Strategy [SWEDES] Trial).
  • 2010
  • record:In_t: The American journal of cardiology. - : Elsevier BV. - 1879-1913 .- 0002-9149. ; 106:12, s. 1685-91
  • swepub:Mat_article_t (swepub:level_refereed_t)abstract
    • Primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction compares favorably to thrombolysis. In previous studies the benefit has been restricted to the early postinfarction period with no additional risk decrease beyond this period. Long-term outcome after use of third-generation thrombolytics and modern adjunctive pharmaceutics in the 2 treatment arms has not been investigated. This study was conducted to compare 5-year outcome after updated regimens of PPCI or thrombolysis. Patients with ST-elevation myocardial infarction were randomized to enoxaparin and abciximab followed by PPCI (n = 101) or enoxaparin followed by reteplase (n = 104), with prehospital initiation of therapy in 42% of patients. Data on survival and major cardiac events were obtained from Swedish national registries after 5.3 years. PPCI resulted in a better outcome with respect to the composite of death or recurrent myocardial infarction (hazard ratio 0.54, confidence interval 0.31 to 0.95) compared to thrombolysis. This was attributed to a significant decrease in cardiac deaths (hazard ratio 0.16, confidence interval 0.04 to 0.74). The difference evolved continuously over the 5-year follow-up. After adjustment for covariates, a significant benefit remained with respect to cardiac death or recurrent infarction but not for the composite of total survival or recurrent myocardial infarction (p = 0.07). The observed differences were not seen in patients in whom therapy was initiated in the prehospital phase. In conclusion, PPCI in combination with enoxaparin and abciximab compares favorably to thrombolysis in combination with enoxaparin with a risk decrease that stretches beyond the early postinfarction period. Prehospital thrombolysis may, however, match PPCI in long-term outcome.
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  • Abarenkov, Kessy, et al. (creator_code:aut_t)
  • PlutoF—a web based workbench for ecological and taxonomic research, with an online implementation for fungal ITS sequences
  • 2010
  • record:In_t: Evolutionary Bioinformatics. - 1176-9343. ; 6, s. 189-196
  • swepub:Mat_article_t (swepub:level_refereed_t)abstract
    • DNA sequences accumulating in the International Nucleotide Sequence Databases (INSD) form a rich source of information for taxonomic and ecological meta-analyses. However, these databases include many erroneous entries, and the data itself is poorly annotated with metadata, making it difficult to target and extract entries of interest with any degree of precision. Here we describe the web-based workbench PlutoF, which is designed to bridge the gap between the needs of contemporary research in biology and the existing software resources and databases. Built on a relational database, PlutoF allows remote-access rapid submission, retrieval, and analysis of study, specimen, and sequence data in INSD as well as for private datasets though web-based thin clients. In contrast to INSD, PlutoF supports internationally standardized terminology to allow very specific annotation and linking of interacting specimens and species. The sequence analysis module is optimized for identification and analysis of environmental ITS sequences of fungi, but it can be modified to operate on any genetic marker and group of organisms. The workbench is available at http://plutof.ut.ee.
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  • Abbas, Abdul-Karim, 1959 (creator_code:aut_t)
  • Evidence based medicine: a critical inquiry. Seminar Lecture
  • 2010
  • record:In_t: The 5th Annual Meeting of International Iraqi Medical Association, April 1-3, 2010, Sharjah, UAE.
  • swepub:Mat_conferencepaper_t (swepub:level_scientificother_t)abstract
    • Evidence-based medicine and practice (EBM/EBP) have since their inception in the early 1990s had widespread impact on the teaching and practice of medicine and health care. While the western societies are becoming more postmodernist, the medical system remains increasingly modernist in its outlook, this may make it increasingly irrelevant to the needs of a changing society. However, criticism is essentially a changing process of our realities. Hence, the prominence given to EBM can not be seen as a solely attempt to reassert modernism within the field, but as an improved paradigm reviewing itself in lights of challenges it faces. Relevant to my topic here is that the debate, which took sometimes, unfortunately, metaphorical and aggressive directions, has contributing effect on both the EBM and its critics moderating both methodologies and epistemes especially the introducing of other kinds of researches, than randomized controlled trails (RCT), systematic reviews or meta-analysis of RCTs, like user-led research and qualitative researches which focus on personal experience of both the patient and clinician. In the developing countries there are many challenges, whether technical, social or epistemological, facing practicing and using them. Although few Arab countries have recently developed either centers or associations for EBM, Iraq still lacks such kind of practice. Presenting an outlook of EMB from within the current intellectual debate and examining the environment and essential aspects of this debate between the EMB and its postmodernist critics might be helpful in not a merely dogmatic promotion of its practice nor a blind call for adopting and applying its guidelines and techniques but in enforcing the discussion and dialogue between the current disputable paradigms in the one hand and improve the possibilities and resources to use it as the “best” paradigm in medical practices and education. A conclusion has drawn on here that EBM paradigm does not only improve the decision-making in health services and provides a serious attempt to invent a new language that might reunite the Babel of doctors and patients, managers and consumers, but also it understands medical care in both the closed and open systems. Epistemological, methodological, ethical and social questions about the patient/subject are addressed here aiming to encourage the health and educational authorities in Iraq to take this paradigm seriously and introduce it in their future programs.
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  • Abbas, Abdul-Karim, 1959, et al. (creator_code:aut_t)
  • Long-term potentiation and insult conditioning in hippocampal slices from young rats: a role for protein synthesis under chemical stress?
  • 2010
  • record:In_t: The 10th Biennial Meeting of the Asia-Pacific Society for Neurochemistry (APSN), October 17-20, 2010, Phuket, Thailand.
  • swepub:Mat_conferencepaper_t (swepub:level_scientificother_t)abstract
    • We have previously demonstrated that in young rats (12-20-day-old) a sustained long-term potentiation (LTP) can still be induced under conditions of protein synthesis inhibition. It was therefore suggested that sufficient and necessary proteins were already available at the induction time to accomplish LTP maintenance for several hours. Against this background, we have questioned whether hippocampal slices subjected to certain insult conditions might be more sensitive to protein synthesis inhibitors. High K+ concentration has previously been reported to cause an amnesic effect in vivo as well as increasing protein turnover in vitro. We have here employed a K+ insult model under conditions when protein synthesis was inhibited. Recordings were obtained from hippocampal slices for up to 9 h, with or without a cocktail of protein synthesis inhibitors, containing cycloheximide (60 µM) and anisomycin (25 µM). High potassium (50 mM) was transiently applied (5-15 min) shortly after inducing LTP in one of two separate pathways stimulated alternatively. Additionally, an NMDA-receptor antagonist AP5 was supplied after LTP induction to minimize effects related to depolarization-induced glutamate release. Following elimination of all responses for about 30 min, both test and control responses partly recovered. The degree of remaining LTP, defined as test/control ratio, was reduced in both groups of slices (NMDA-independent depotentiation) but was significantly smaller in the drug-treated ones. We are also running an insult model based on oxidative stress, applying hydrogen peroxide (4-5 mM) before or after LTP induction; however, the results are still insufficient for a final conclusion. The potency of cycloheximide, anisomycin or cocktail of the drugs was verified by measurement of incorporation of [3H]-leucine into trichloracetic acid (TCA) precipitable macromolecules. Cycloheximide, anisomycin or cocktail, at concentrations used here caused 95%, 97% and 95% blocking effect, respectively. Our data confirm the idea that sufficient and necessary constitutive proteins are available in the young hippocampus to maintain LTP under conditions of protein synthesis inhibition. They also reveal that LTP in slices subjected to certain insult conditions early after the induction is sensitive to protein synthesis inhibition, probably due to increase in constitutive proteins turnover.
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