| 1. |
- Eriksson, Anders, et al.
(författare)
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Diagnostic accuracy of postmortem imaging vs autopsy : a systematic review
- 2017
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Ingår i: European Journal of Radiology. - : ELSEVIER IRELAND LTD. - 0720-048X .- 1872-7727. ; 89, s. 249-269
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Forskningsöversikt (refereegranskat)abstract
- Background Postmortem imaging has been used for more than a century as a complement to medico-legal autopsies. The technique has also emerged as a possible alternative to compensate for the continuous decline in the number of clinical autopsies. To evaluate the diagnostic accuracy of postmortem imaging for various types of findings, we performed this systematic literature review. Data sources The literature search was performed in the databases PubMed, Embase and Cochrane Library through January 7, 2015. Relevant publications were assessed for risk of bias using the QUADAS tool and were classified as low, moderate or high risk of bias according to pre-defined criteria. Autopsy and/or histopathology were used as reference standard. Findings The search generated 2600 abstracts, of which 340 were assessed as possibly relevant and read in full-text. After further evaluation 71 studies were finally included, of which 49 were assessed as having high risk of bias and 22 as moderate risk of bias. Due to considerable heterogeneity - in populations, techniques, analyses and reporting - of included studies it was impossible to combine data to get a summary estimate of the diagnostic accuracy of the various findings. Individual studies indicate, however, that imaging techniques might be useful for determining organ weights, and that the techniques seem superior to autopsy for detecting gas Conclusions and Implications In general, based on the current scientific literature, it was not possible to determine the diagnostic accuracy of postmortem imaging and its usefulness in conjunction with, or as an alternative to autopsy. To correctly determine the usefulness of postmortem imaging, future studies need improved planning, improved methodological quality and larger materials, preferentially obtained from multi-center studies.
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| 2. |
- Heintz, Emelie, et al.
(författare)
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FRAMEWORK FOR SYSTEMATIC IDENTIFICATION OF ETHICAL ASPECTS OF HEALTHCARE TECHNOLOGIES: THE SBU APPROACH
- 2015
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Ingår i: International Journal of Technology Assessment in Health Care. - : Cambridge University Press. - 0266-4623 .- 1471-6348. ; 31:3, s. 124-130
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Assessment of ethical aspects of a technology is an important component of health technology assessment (HTA). Nevertheless, how the implementation of ethical assessment in HTA is to be organized and adapted to specific regulatory and organizational settings remains unclear. The objective of this study is to present a framework for systematic identification of ethical aspects of health technologies. Furthermore, the process of developing and adapting the framework to a specific setting is described. Methods: The framework was developed based on an inventory of existing approaches to identification and assessment of ethical aspects in HTA. In addition, the framework was adapted to the Swedish legal and organizational healthcare context, to the role of the HTA agency and to the use of non-ethicists. The framework was reviewed by a group of ethicists working in the field as well as by a wider set of interested parties including industry, interest groups, and other potential users. Results: The framework consists of twelve items with sub-questions, short explanations, and a concluding overall summary. The items are organized into four different themes: the effects of the intervention on health, its compatibility with ethical norms, structural factors with ethical implications, and long term ethical consequences of using the intervention. Conclusions: In this study, a framework for identifying ethical aspects of health technologies is proposed. The general considerations and methodological approach to this venture will hopefully inspire and present important insights to organizations in other national contexts interested in making similar adaptations.
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| 3. |
- Hultcrantz, Monica, et al.
(författare)
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Interferons induce an antiviral state in human pancreatic islet cells
- 2007
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Ingår i: Virology. - : Elsevier BV. - 0042-6822 .- 1096-0341. ; 367:1, s. 92-101
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Tidskriftsartikel (refereegranskat)abstract
- Enterovirus infections, in particular those with Coxsackieviruses, have been linked to the development of type 1 diabetes (T1D). Although animal models have demonstrated that interferons (IFNs) regulate virus-induced T1D by acting directly on the beta cell, little is known on the human pancreatic islet response to IFNs. Here we show that human islet cells respond to IFNs by expressing signature genes of antiviral defense. We also demonstrate that they express three intracellular sensors for viral RNA, the toll like receptor 3 (TLR3) gene, the retinoic acid-inducible gene I (RIG-I) and the melanoma differentiation-associated gene-5 (MDA-5), which induce type I IFN production in infected cells. Finally, we show for the first time that the IFN-induced antiviral state provides human islets with a powerful protection from the replication of Coxsackievirus. This may be critical for beta cell survival and protection from virus-induced T1D in humans.
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| 4. |
- Jacobson, Stella, et al.
(författare)
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Top Ten Research Priorities For attention Deficit/Hyperactivity Disorder Treatment
- 2016
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Ingår i: International Journal of Technology Assessment in Health Care. - : Cambridge University Press. - 0266-4623 .- 1471-6348. ; 32:3, s. 152-159
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The aim of this project was to identify the ten most important research questions for attention deficit/hyperactivity disorder (ADHD) treatment as identified by people with ADHD together with personnel involved in the treatment of ADHD in school, health, and correction services. Methods: A working group consisting of consumers and personnel was established. The method for prioritization was primarily based on James Lind Alliance's guidebook, consisting of an interim priority setting exercise and a workshop. Results: The top ten list includes the risk of drug dependency later in life when treated with methylphenidate as a child, teacher support, multimodal therapy, comparisons between atomoxetine and methylphenidate, methylphenidate treatment in substance abusers, parental support programmes, supported conversation, computer-aided working memory training, psychoeducative treatment, and melatonin. Conclusions: We have shown that consumers and personnel can reach consensus on research priorities for treatments for ADHD. We encourage researchers and funders to consider the list for future studies.
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| 5. |
- Jacobson, Stella
(författare)
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Type 1 diabetes : the autoimmune process and islet transplantation
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Type 1 diabetes (T1D) is an autoimmune disease characterized by the selective loss of the insulin-producing β-cells residing in the islets of Langerhans in the pancreas. Cytokines are involved in diabetes development in the nonobese diabetic (NOD) mouse model. NOD mice over-expressing the suppressor of cytokine signaling (SOCS-1) specifically in the β-cells are protected from T1D. Previous studies showed that immune cells infiltrated the pancreas of SOCS-1-transgenic (tg) mice, however, infiltrating T cells were less pathogenic than those infiltrating the islets in non-tg NOD mice. In this thesis one of the aims was to further dissect the infiltrating T cell populations in SOCS-1-tg mice in order to gain further insight into the mechanisms behind disease protection. In paper I the main finding was that specific autoreactive T cells were strongly reduced in the pancreas of SOCS-1-tg mice compared to non-tg mice. Previous studies have shown that autoreactive T cells are recruited to the pancreas by cytokine-induced CXCL10 expression by the islets. The receptor for CXCL10 is CXCR3, which was more frequently expressed on autoreactive T cells than bulk T cells. Since SOCS-1-tg mice have reduced expression of CXCL10, autoreactive T cells are less likely to migrate to the pancreas of these mice and pose one possible explanation for this finding. This study shows that the β-cell response to cytokines plays a major role in the accumulation of autoreactive T cells to the pancreas. Blood glucose metabolism in patients with T1D can only be restored by islet transplantation. Unfortunately, the benefits of islet transplantation are only short-term since the graft is lost over time. Therefore, exposing T1D patients to the risks associated with the immunosuppressive therapy cannot be motivated in most cases. In the second part of this thesis the aim was to evaluate new methods to prevent islet allograft rejection. In paper II it was shown that the mesenchymal stromal cell (MSC)-line MBA-1 suppressed T cell proliferation in vitro and slowed down rejection of allogeneic islets in Balb/c mice. This indicates the possible use of MSCs as cell therapy in islet transplantation. Another method to avoid immunosuppressive treatment is to encapsulate the islet allografts inside immunoprotective membranes (TheraCyteTM devices) preventing immune cells from interacting with the grafts. In paper III it was shown that the TheraCyteTM device completely protected islet allografts from rejection in both naive and immunized recipient rats. This is an important finding since many patients are sensitized prior to transplantation for example due to a previous transplant. Finally, graft loss is difficult to study in humans and small animal models do not always reflect the human situation. Therefore, the final aim of this thesis was to evaluate so-called humanized mice for their potential use to study human islet rejection mechanisms. In paper IV human immune system (HIS) mice were established and transplanted with human islets. However, no signs of rejection were detected in the HIS mice questioning the usefulness of this model as a tool to study human islet transplantation. This highlights the need for more robust humanized mouse models.
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| 6. |
- Johansson, Unn-Britt, et al.
(författare)
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Insulinpumpar vid diabetes
- 2013
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- God kontroll av blodglukosnivån är viktig för att undvika följdsjukdomar av diabetes. Vid typ 1-diabetes och en del fall av typ 2-diabetes krävs så kallad intensiv insulinbehandling med flera injektioner per dag. Den vanligaste komplikationen vid denna behandling är lågt blodglukos (hypoglykemi) vilket kan få allvarliga följder [1,2]. Ett alternativ till intensiv insulinbehandling med injektioner är kontinuerlig insulintillförsel med pump, så kallad kontinuerlig subkutan insulininfusion (CSII).
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| 7. |
- Johansson, Unn-Britt, et al.
(författare)
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Kontinuerlig subkutan glukosmätning vid diabetes
- 2013
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- God kontroll av blodglukosnivån är viktig för att undvika följdsjukdomar av diabetes. Blodglukos kan mätas av patienten själv med teststickor (self monitoring of blood glucose, SMBG) eller via en subkutan sensor (kontinuerlig subkutan glukosmätning, CGM). Vid typ 1-diabetes behövs rutinmässigt upprepade blodglukosmätningar varje dygn för att uppnå god glukoskontroll.SBU har utvärderat nytta och risk av behandling med kontinuerlig glukosmätning utan eller med insulinpump (SAP) vid diabetes hos barn, ungdomar och vuxna. I utvärderingen ingår också en hälsoekonomisk och etisk analys, samt en stor praxisundersökning som omfattade samtliga diabeteskliniker i Sverige
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