| 1. |
- Asplund, Kjell, et al.
(författare)
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Etiska dilemman i strokevården : [Frequent ethical issues encountered in stroke care]
- 2023
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Ingår i: Läkartidningen. - : Sveriges läkarförbund. - 0023-7205 .- 1652-7518. ; 120
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Forskningsöversikt (refereegranskat)abstract
- We review some of the most frequent ethical issues encountered in stroke care. Priorities in stroke care should be based on the principles of the Swedish prioritization platform: human dignity, needs/solidarity, and cost-effectiveness. The prognosis is often uncertain very early after stroke. We therefore advocate time for careful assessment before taking decisions on treatment restrictions such as do-not-resuscitate orders. Swedish law permits acute treatment for patients unable to consent because of severe stroke. For selected patients already living in home-based medical care or institutional care when afflicted by stroke, it may be appropriate not to transfer them to an acute care hospital, provided that sufficient skills in acute evaluation and stroke care are available. Likewise, if a stroke patient is discharged from hospital with a percutaneous endoscopic gastrostomy, adequate competence is needed in home-based or institutional care. It is not ethically appropriate to continue advanced medical treatment that is without benefit for the patient during the last days of life.
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| 2. |
- Asplund, Kjell
(författare)
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Use of in vitro fertilization-ethical issues
- 2020
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Ingår i: Upsala Journal of Medical Sciences. - : Taylor & Francis. - 0300-9734 .- 2000-1967. ; 125:2, s. 192-199
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Forskningsöversikt (refereegranskat)abstract
- This report is an ethical analysis based on both facts and values. In in vitro fertilization (IVF), there is an intricate interaction between rapid scientific development and changing societal values. In most countries, the ethical discussion is no longer on whether or not IVF in itself is ethically justifiable. Therefore, in this review, I discuss other ethical aspects that have emerged since IVF was first introduced, such as upper age limits, 'ownership' of gametes and embryos, IVF in single women and same-sex couples, preimplantatory genetic testing, social egg freezing, commercialization, public funding, and prioritization of IVF. Despite secularization, since religion still plays an important role in regulation and practices of IVF in many countries, positions on IVF among the world religions are summarized. Decision-making concerning IVF cannot be based only on clinical and economic considerations; these cannot be disentangled from ethical principles. Many concerns regarding the costs, effects, and safety of IVF subtly transcend into more complex questions about what it means to society to bear and give birth to children.
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| 3. |
- Bergh, Anna, et al.
(författare)
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A systematic review of complementary and alternative veterinary medicine : "miscellaneous therapies"
- 2021
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Ingår i: Animals. - : MDPI. - 2076-2615. ; 11:12
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Forskningsöversikt (refereegranskat)abstract
- There is an increasing interest in complementary and alternative veterinary medicine (CAVM). There is, however, an uncertainty of the efficacy of these methods. Therefore, the aim of this systematic literature review is to assess the evidence for clinical efficacy of 24 CAVM therapies used in cats, dogs, and horses. A bibliographic search, restricted to studies in cats, dogs, and horses, was performed on Web of Science Core Collection, CABI, and PubMed. Relevant articles were assessed for scientific quality, and information was extracted on study characteristics, species, type of treatment, indication, and treatment effects. Of 982 unique publications screened, 42 were eligible for inclusion, representing nine different CAVM therapies, which were aromatherapy, gold therapy, homeopathy, leeches (hirudotherapy), mesotherapy, mud, neural therapy, sound (music) therapy, and vibration therapy. For 15 predefined therapies, no study was identified. The risk of bias was assessed as high in 17 studies, moderate to high in 10, moderate in 10, low to moderate in four, and low in one study. In those studies where the risk of bias was low to moderate, there was considerable heterogeneity in reported treatment effects. Therefore, the scientific evidence is not strong enough to define the clinical efficacy of the 24 CAVM therapies.
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| 4. |
- Bergh, Anna, et al.
(författare)
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A Systematic Review of Complementary and Alternative Veterinary Medicine in Sport and Companion Animals : Soft Tissue Mobilization
- 2022
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Ingår i: Animals. - : MDPI. - 2076-2615. ; 12:11
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Forskningsöversikt (refereegranskat)abstract
- Soft tissue mobilization is frequently used in the treatment of sport and companion animals. There is, however, uncertainty regarding the efficacy and effectiveness of these methods. Therefore, the aim of this systematic literature review was to assess the evidence for clinical effects of massage and stretching in cats, dogs, and horses. A bibliographic search, restricted to studies in cats, dogs, and horses, was performed on Web of Science Core Collection, CABI, and PubMed. Relevant articles were assessed for scientific quality, and information was extracted on study characteristics, species, type of treatment, indication, and treatment effects. Of 1189 unique publications screened, 11 were eligible for inclusion. The risk of bias was assessed as high in eight of the studies and moderate in three of the studies, two of the latter indicating a decreased heart rate after massage. There was considerable heterogeneity in reported treatment effects. Therefore, the scientific evidence is not strong enough to define the clinical efficacy and effectiveness of massage and stretching in sport and companion animals.
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| 5. |
- Boström, Anna, et al.
(författare)
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Systematic review of complementary and alternative veterinary medicine in sport and companion animals: extracorporeal shockwave therapy
- 2022
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Ingår i: Animals. - : MDPI. - 2076-2615. ; 12:22
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Forskningsöversikt (refereegranskat)abstract
- Background: Extracorporeal shockwave therapy (ECSWT) is increasingly used to treat different types of musculoskeletal conditions in sport and companion animals. To explore the scientific basis for the treatment, we conducted a systematic review of the literature on ECSWT used in horses, dogs, and cats. Methods: Relevant articles published in 1980–2020 were identified from three major databases. Each article was assessed for risk of bias. Results: The review identified 27 relevant articles on the effects of ECSWT in horses, nine in dogs, but none in cats. Typically, ECSWT involved one to three treatment sessions at 1- to 3-week intervals. We identified studies on bone mass and bone healing, wound healing, navicular disease, ligament injury, desmitis, sesamoiditis, tendon injury, osteoarthritis, and short-term analgesic effects. Common to all indications was that the scientific evidence was very limited. For each separate indication, there were relatively few studies, many of which had methodological flaws. Where favorable results were reported, they were usually not replicated in independent studies. A few encouraging results were found. Conclusions: In sport and companion animals, the scientific evidence for clinical effects of ECSWT in horses, dogs, and cats is limited. For some applications, notably short-term pain relief, ligament ailments, and osteoarthritis, the results seem promising and warrant further exploration in high-quality studies.
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| 6. |
- Boström, Anna, et al.
(författare)
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Systematic review of complementary and alternative veterinary medicine in sport and companion animals: therapeutic ultrasound
- 2022
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Ingår i: Animals. - : MDPI. - 2076-2615. ; 12:22
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Forskningsöversikt (refereegranskat)abstract
- Background: To explore the scientific evidence for therapeutic ultrasound (TU), we conducted a systematic review of the literature on TU in dogs, horses, donkeys, and cats. Methods: In three major databases, relevant articles published in 1980–2020 were identified. The risk of bias in each article was evaluated. Results: Twenty-four relevant articles on the effects of TU in dogs, nine in horses, two in donkeys, and one in cats were identified. TU usually involved 2–6 treatments weekly for up to 4 weeks. Articles on tendon, ligament, and bone healing, acute aseptic arthritis, osteoarthritis, paraparesis, hindquarter weakness, and back muscle pain were identified. In experimental bone lesions in dogs, there is moderate scientific evidence for enhanced healing. For the treatment of other musculoskeletal conditions, the scientific evidence is insufficient due to the high risk of bias. There is substantial evidence that continuous TU increases tissue temperature in muscles and tendons by up to 5 °C in healthy animals. For disorders in tendons, ligaments, muscles, and joints in sport and companion animals, there is insufficient evidence for the clinical effects of TU.
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| 7. |
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| 8. |
- Chroinin, Danielle Ni, et al.
(författare)
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Statin Therapy and Outcome After Ischemic Stroke : Systematic Review and Meta-Analysis of Observational Studies and Randomized Trials
- 2013
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Ingår i: Stroke. - 0039-2499 .- 1524-4628. ; 44:2, s. 448-456
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Forskningsöversikt (refereegranskat)abstract
- Background and Purpose-Although experimental data suggest that statin therapy may improve neurological outcome after acute cerebral ischemia, the results from clinical studies are conflicting. We performed a systematic review and meta-analysis investigating the relationship between statin therapy and outcome after ischemic stroke. Methods-The primary analysis investigated statin therapy at stroke onset (prestroke statin use) and good functional outcome (modified Rankin score 0 to 2) and death. Secondary analyses included the following: (1) acute poststroke statin therapy (<= 72 hours after stroke), and (2) thrombolysis-treated patients. Results-The primary analysis included 113 148 subjects (27 studies). Among observational studies, statin treatment at stroke onset was associated with good functional outcome at 90 days (pooled odds ratio [OR], 1.41; 95% confidence interval [CI], 1.29-1.56; P<0.001), but not 1 year (OR, 1.12; 95% CI, 0.9-1.4; P=0.31), and with reduced fatality at 90 days (pooled OR, 0.71; 95% CI, 0.62-0.82; P<0.001) and 1 year (OR, 0.80;95% CI, 0.67-0.95; P=0.01). In the single randomized controlled trial reporting 90-day functional outcome, statin treatment was associated with good outcome (OR, 1.5; 95% CI, 1.0-2.24; P=0.05). No reduction in fatality was observed on meta-analysis of data from 3 randomized controlled trials (P=0.9). In studies restricted to of thrombolysis-treated patients, an association between statins and increased fatality at 90 days was observed (pooled OR, 1.25; 95% CI, 1.02-1.52; P=0.03, 3 studies, 4339 patients). However, this association was no longer present after adjusting for age and stroke severity in the largest study (adjusted OR, 1.14; 95% CI, 0.90-1.44; 4012 patients). Conclusion-In the largest meta-analysis to date, statin therapy at stroke onset was associated with improved outcome, a finding not observed in studies restricted to thrombolysis-treated patients. Randomized trials of statin therapy in acute ischemic stroke are needed.
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| 9. |
- Farrokhnia, Nasim, et al.
(författare)
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Emergency Department Triage Scales and Their Components : A Systematic Review of the Scientific Evidence
- 2011
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Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - : Springer Science and Business Media LLC. - 1757-7241. ; 19, s. 42-
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Forskningsöversikt (refereegranskat)abstract
- Emergency department (ED) triage is used to identify patients' level of urgency and treat them based on their triage level. The global advancement of triage scales in the past two decades has generated considerable research on the validity and reliability of these scales. This systematic review aims to investigate the scientific evidence for published ED triage scales. The following questions are addressed: 1. Does assessment of individual vital signs or chief complaints affect mortality during the hospital stay or within 30 days after arrival at the ED? 2. What is the level of agreement between clinicians' triage decisions compared to each other or to a gold standard for each scale (reliability)? 3. How valid is each triage scale in predicting hospitalization and hospital mortality? A systematic search of the international literature published from 1966 through March 31, 2009 explored the British Nursing Index, Business Source Premier, CINAHL, Cochrane Library, EMBASE, and PubMed. Inclusion was limited to controlled studies of adult patients (>= 15 years) visiting EDs for somatic reasons. Outcome variables were death in ED or hospital and need for hospitalization (validity). Methodological quality and clinical relevance of each study were rated as high, medium, or low. The results from the studies that met the inclusion criteria and quality standards were synthesized applying the internationally developed GRADE system. Each conclusion was then assessed as having strong, moderately strong, limited, or insufficient scientific evidence. If studies were not available, this was also noted. We found ED triage scales to be supported, at best, by limited and often insufficient evidence. The ability of the individual vital signs included in the different scales to predict outcome is seldom, if at all, studied in the ED setting. The scientific evidence to assess interrater agreement (reliability) was limited for one triage scale and insufficient or lacking for all other scales. Two of the scales yielded limited scientific evidence, and one scale yielded insufficient evidence, on which to assess the risk of early death or hospitalization in patients assigned to the two lowest triage levels on a 5-level scale (validity).
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| 10. |
- Holmqvist, Marie, et al.
(författare)
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Stroke in systemic lupus erythematosus : a meta-analysis of population-based cohort studies
- 2015
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Ingår i: RMD Open. - : BMJ Publishing Group Ltd. - 2056-5933. ; 1:1
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Forskningsöversikt (refereegranskat)abstract
- Previous studies of stroke in systemic lupus erythematosus (SLE) have had limited statistical power, combined stroke subtypes into composite outcomes, and lacked a reference population estimate. Therefore, we conducted a systematic review and meta-analysis of cohort studies to summarise the stroke subtype-specific risk in patients with SLE compared to the general population. A systematic search of MEDLINE and EMBASE was performed for cohort studies examining the risk of stroke in SLE and including a general population comparator. Random effects models were used to pool the risk ratio (RR) for stroke. Subgroup analyses were carried out to investigate potential sources of heterogeneity. 10 studies were included which reported RRs for overall stroke (n=5), ischaemic stroke (n=6), intracerebral haemorrhage (n=3) and subarachnoid haemorrhage (n=3). The pooled RR for overall stroke was 2.53 (95% CI 1.96 to 3.26), ischaemic stroke 2.10 (95% CI 1.68 to 2.62), intracerebral haemorrhage 2.72 (95% CI 2.15 to 3.44) and subarachnoid haemorrhage 3.85 (95% CI 3.20 to 4.64). Significant heterogeneity among studies for ischaemic stroke was detected (p=0.002). Relative risk of stroke was highest among individuals younger than 50 years of age. Individuals with SLE have a twofold higher risk of ischaemic stroke, a threefold higher risk of intracerebral haemorrhage, and an almost fourfold higher risk of subarachnoid haemorrhage compared to the general population. Future studies should focus on whether comorbidity and disease flares are related to stroke, when individuals are at the highest risk, and how the targeting of specific groups of patients with SLE may reduce this risk.
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