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- Eriksson, Bengt G, 1949-, et al.
(författare)
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User experiences of Different Treatment Cultures in Mental Health
- 2009
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Ingår i: Ethical Human Psychology and Psychiatry. - : Springer. - 1559-4343 .- 1938-9000. ; 11:2, s. 97-111
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Tidskriftsartikel (refereegranskat)abstract
- Background: Clients have mixed experiences with mental health services. Historically there have been quite different and also incompatible approaches to treatment in mental health care. Some antagonisms may have been overcome, but clients’ experiences still seem to mirror approaches that are in contrast to each other. Aim: To describe different treatment approaches as clients experience them, discuss essential factors in, and differences between the approaches and the degree to which they appear corresponding or antagonistic. Method: Qualitative content analysis of stories from approximately 492 users dealing with positive, negative, or both positive and negative experiences with the health service system. Results: Clients experience different treatment cultures side by side within the mental health care system. The cultures exist on a continuum where monologue and dialogic cultures represent endpoints. Conclusion: It is important to acknowledge the contrasts clients have experienced between different treatment cultures. Realizing the contrast between approaches, it emerges as important that clients are given a choice and can get the kind of treatment they prefer.
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- Eriksson, Bengt I., 1946, et al.
(författare)
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Comparative pharmacodynamics and pharmacokinetics of oral direct thrombin and factor xa inhibitors in development
- 2009
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Ingår i: Clin Pharmacokinet. - 0312-5963. ; 48:1, s. 1-22
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Tidskriftsartikel (refereegranskat)abstract
- For the past five decades, there has been little progress in the development of oral anticoagulants, with the choices being limited to the vitamin K antagonists (VKAs). The situation is changing with the development of orally active small molecules that directly target thrombin or activated factor X (FXa). The two agents in the most advanced stages of development are dabigatran etexilate and rivaroxaban, which inhibit thrombin and FXa, respectively. Both are approved in the EU and Canada for venous thromboprophylaxis in patients undergoing elective hip- or knee-replacement surgery. Other agents in the early stages of development include several FXa inhibitors (apixaban, DU 176b, LY 517717, YM 150, betrixaban, eribaxaban [PD 0348292] and TAK 442) and one thrombin inhibitor (AZD 0837). With a predictable anticoagulant response and low potential for drug-drug interactions, these new agents can be given in fixed doses without coagulation monitoring. This renders them more convenient than VKAs. While the anticoagulant effect of the new thrombin and FXa inhibitors is similar, differences in the pharmacokinetic and pharmacodynamic parameters may influence their use in clinical practice. Here, we compare the pharmacokinetic and pharmacodynamic features of these new oral agents.
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- Eriksson, Bengt I., 1946, et al.
(författare)
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Dabigatran Etexilate: Pivotal Trials for Venous Thromboembolism Prophylaxis After Hip or Knee Arthroplasty
- 2009
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Ingår i: Clinical and Applied Thrombosis/Hemostasis. - : SAGE Publications. - 1076-0296 .- 1938-2723. ; 15:1S
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Tidskriftsartikel (refereegranskat)abstract
- Dabigatran etexilate, an oral direct thrombin inhibitor, was investigated in 3 large phase III trials for the prevention of venous thromboembolism (VTE) after total hip arthroplasty (RE-NOVATE, N = 3494) or total knee arthroplasty (RE-MODEL, N = 2076 and RE-MOBILIZE, N = 2615). RE-NOVATE and RE-MODEL were conducted mainly in Europe, and RE-MOBILIZE was conducted predominantly in the United States and Canada. This review discusses the results of these trials. In all 3 trials, 2 doses, 220 mg and 150 mg once daily, were compared with enoxaparin. Both RE-MODEL and RE-NOVATE demonstrated noninferiority for the primary outcome (a composite of total VTE events and all-cause mortality), P = .0003 and P < .0001, respectively, for these trials. In 2008, these data formed the basis for European and Canadian approval. While RE-MOBILIZE did not demonstrate noninferiority for the primary outcome (25.3% for enoxaparin vs 31.1% for 220 mg, risk difference +5.8%, 95% CI, 0.8-10.8; P = .02 and 33.7% for 150 mg, risk difference +8.4%, 95% CI, 3.4-13.3; P = .0009), both treatments were similar for the secondary composite outcome (major VTE plus VTE-related mortality; 3.4% with 220 mg, 3.0% with 150 mg, and 2.2% with enoxaparin) and symptomatic deep vein thrombosis (0.8%, 0.7%, and 0.6%). There were no differences in the bleeding rates, hepatic enzyme elevations, or acute coronary syndrome events between the 2 treatments. With the practical advantages of once-daily oral dosing, dabigatran etexilate can be considered an attractive alternative to conventional thromboprophylaxis regimens in patients undergoing elective total hip and knee arthroplasty.
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- Eriksson, Bengt I., 1946, et al.
(författare)
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Oral rivaroxaban for the prevention of symptomatic venous thromboembolism after elective hip and knee replacement
- 2009
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Ingår i: Journal of Bone and Joint Surgery. - 0301-620X. ; 91:5, s. 636-44
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Tidskriftsartikel (refereegranskat)abstract
- A once-daily dose of rivaroxaban 10 mg, an oral, direct Factor Xa inhibitor, was compared with enoxaparin 40 mg subcutaneously once daily for prevention of venous thromboembolism in three studies of patients undergoing elective hip and knee replacement (RECORD programme). A pooled analysis of data from these studies (n = 9581) showed that rivaroxaban was more effective than enoxaparin in reducing the incidence of the composite of symptomatic venous thromboembolism and all-cause mortality at two weeks (0.4% vs 0.8%, respectively, odds ratio 0.44; 95% confidence interval 0.23 to 0.79; p = 0.005), and at the end of the planned medication period (0.5% vs 1.3%, respectively; odds ratio 0.38; 95% confidence interval 0.22 to 0.62; p < 0.001). The rate of major bleeding was similar at two weeks (0.2% for both) and at the end of the planned medication period (0.3% vs 0.2%). Rivaroxaban started six to eight hours after surgery was more effective than enoxaparin started the previous evening in preventing symptomatic venous thromboembolism and all-cause mortality, without increasing major bleeding.
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- Hössjer, Ola, et al.
(författare)
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Assessing individual unexplained variation in non-life insurance.
- 2009
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Ingår i: Astin Bulletin. - 0515-0361 .- 1783-1350. ; 39:1, s. 249-273
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Tidskriftsartikel (refereegranskat)abstract
- We consider variation of observed claim frequencies in non-life insurance, modeled by Poisson regression with overdispersion. In order to quantify how much variation between insurance policies that is captured by the rating factors, one may use the coefficient of determination, R2, the estimated proportion of total variation explained by the model. We introduce a novel coefficient of individual determination (CID), which excludes noise variance and is defined as the estimated fraction of total individual variation explained by the model. We argue that CID is a more relevant measure of explained variation than R2 for data with Poisson variation. We also generalize previously used estimates and tests of overdispersion and introduce new coefficients of individual explained and unexplained variance.Application to a Swedish three year motor TPL data set reveals that only 0.5% of the total variation and 11% of the total individual variation is explained by a model with seven rating factors, including interaction between sex and age. Even though the amount of overdispersion is small (4.4% of the noise variance) it is still highly significant. The coefficient of variation of explained and unexplained individual variation is 29% and 81% respectively.
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- Nilsson-Helander, Katarina, 1957, et al.
(författare)
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High incidence of deep venous thrombosis after Achilles tendon rupture: a prospective study
- 2009
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Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 17:10, s. 1234-8
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Tidskriftsartikel (refereegranskat)abstract
- Deep venous thrombosis (DVT) is common after lower limb injury, but the effect of prophylactic treatment has not been documented in large randomised trials or meta-analyses. As a result, evidence-based recommendations have not been established. The purpose of this study was to evaluate the incidence of venous thromboembolism in patients with Achilles tendon rupture. A total of 100 consecutive patients with an acute Achilles tendon rupture were included in a prospective study and randomised to either surgical or non-surgical treatment. At 8 weeks after the initiation of treatment, 95/100 patients were screened for DVT using colour duplex sonography (CDS) with blinded interpretation by two experienced examiners and adjudication in cases of disagreement by a third person. A total of 95 patients (79 male and 16 female) with a median (range) age of 41 (24-63) years were screened for CDS at 8 weeks. Of the 95 patients, 32 had a CDS-verified thrombosis, 5 proximal and 27 distal, whereas 3 had non-fatal pulmonary embolism. Surgical treatment was performed in 49 patients, non-surgical in 46. There were no significant differences in DVT frequency between the two treatment groups. The incidence of asymptomatic and symptomatic deep venous thrombosis is high after Achilles tendon rupture and there is a need to define the possible benefit of thromboprophylaxis.
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