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Sökning: WFRF:(Josephson A)

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  • [1]234567...9Nästa
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1.
  • Albert, J., et al. (författare)
  • Risk of HIV transmission from patients on antiretroviral therapy: A position statement from the Public Health Agency of Sweden and the Swedish Reference Group for Antiviral Therapy
  • 2014
  • Ingår i: Scandinavian Journal of Infectious Diseases. - : Informa Healthcare. - 0036-5548 .- 1651-1980. ; 46:10, s. 673-677
  • Tidskriftsartikel (refereegranskat)abstract
    • The modern medical treatment of HIV with antiretroviral therapy (ART) has drastically reduced the morbidity and mortality in patients infected with this virus. ART has also been shown to reduce the transmission risk from individual patients as well as the spread of the infection at the population level. This position statement from the Public Health Agency of Sweden and the Swedish Reference Group for Antiviral Therapy is based on a workshop organized in the fall of 2012. It summarizes the latest research and knowledge on the risk of HIV transmission from patients on ART, with a focus on the risk of sexual transmission. The risk of transmission via shared injection equipment among intravenous drug users is also examined, as is the risk of mother-to-child transmission. Based on current knowledge, the risk of transmission through vaginal or anal intercourse involving the use of a condom has been judged to be minimal, provided that the person infected with HIV fulfils the criteria for effective ART. This probably also applies to unprotected intercourse, provided that no other sexually transmitted infections are present, although it is not currently possible to fully support this conclusion with direct scientific evidence. ART is judged to markedly reduce the risk of blood-borne transmission between people who share injection equipment. Finally, the risk of transmission from mother to child is very low, provided that ART is started well in advance of delivery.
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  • Kasiske, Bertram L., et al. (författare)
  • KDIGO clinical practice guideline for the care of kidney transplant recipients: a summary
  • 2010
  • Ingår i: Kidney International. - : Nature Publishing Group. - 1523-1755. ; 77:4, s. 299-311
  • Tidskriftsartikel (refereegranskat)abstract
    • The 2009 Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guideline on the monitoring, management, and treatment of kidney transplant recipients is intended to assist the practitioner caring for adults and children after kidney transplantation. The guideline development process followed an evidence-based approach, and management recommendations are based on systematic reviews of relevant treatment trials. Critical appraisal of the quality of the evidence and the strength of recommendations followed the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach. The guideline makes recommendations for immunosuppression and graft monitoring, as well as prevention and treatment of infection, cardiovascular disease, malignancy, and other complications that are common in kidney transplant recipients, including hematological and bone disorders. Limitations of the evidence, especially the lack of definitive clinical outcome trials, are discussed and suggestions are provided for future research. This summary includes a brief description of methodology and the complete guideline recommendations but does not include the rationale and references for each recommendation, which are published elsewhere. Kidney International (2010) 77, 299-311; doi: 10.1038/ki.2009.377; published online 21 October 2009
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5.
  • Edén, Arvid, 1975, et al. (författare)
  • Differential effects of efavirenz, lopinavir/r, and atazanavir/r on the initial viral decay rate in treatment naïve HIV-1-infected patients.
  • 2010
  • Ingår i: AIDS research and human retroviruses. - 1931-8405. ; 26:5, s. 533-40
  • Tidskriftsartikel (refereegranskat)abstract
    • Initial viral decay rate may be useful when comparing the relative potency of antiretroviral regimens. Two hundred twenty-seven ART-naïve patients were randomized to receive efavirenz (EFV) (n = 74), lopinavir/ritonavir (LPV/r) (n = 77), or atazanavir/ritonavir (ATV/r) (n = 79) in combination with two NRTIs. The most frequently used NRTI combinations in the EFV and ATV/r groups were the nonthymidine analogues tenofovir and emtricitabine or lamivudine (70% and 68%, respectively) and, in the LPV/r group, lamivudine and the thymidine analogue zidovudine (89%). HIV-1 RNA was monitored during the first 28 days after treatment initiation. Phase 1 and 2 decay rate was estimated in a subset of 157 patients by RNA decrease from days 0 to 7, and days 14 to 28. One-way ANOVA and subsequent Tukey's post hoc tests were used for groupwise comparisons. Mean (95% CI) HIV-1 RNA reductions from days 0 to 28 were 2.59 (2.45-2.73), 2.42 (2.27-2.57), and 2.13 (2.01-2.25) log(10) copies/ml for the EFV-, LPV/r-, and ATV/r-based treatment groups, respectively, with a significantly larger decrease in the EFV-based group at all time points compared with ATV/r (p < 0.0001), and with LPV/r at days 7-21 (p < 0.0001-0.03). LPV/r gave a greater RNA decrease compared with ATV/r from day 14 (p = 0.02). Phase 1 decay rate was significantly higher in the EFV group compared with LPV/r (p = 0.003) or ATV/r (p < 0.0001). No difference was found in phase 2 decrease. EFV-based treatment gave a more rapid decline in HIV-1 RNA than did either of the boosted protease inhibitor-based regimens. The observed differences may reflect different inherent regimen potencies.
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6.
  • Eriksen, Jaran, et al. (författare)
  • Antiretroviral treatment for HIV infection: Swedish recommendations 2016.
  • 2017
  • Ingår i: Infectious diseases (London, England). - 2374-4243. ; 49:1, s. 1-34
  • Tidskriftsartikel (refereegranskat)abstract
    • The Swedish Medical Products Agency and the Swedish Reference Group for Antiviral Therapy (RAV) have jointly published recommendations for the treatment of HIV infection on seven previous occasions (2002, 2003, 2005, 2007, 2009, 2011 and 2014). In February 2016, an expert group under the guidance of RAV once more revised the guidelines. The most important updates in the present guidelines are as follows: Tenofovir alafenamide (TAF) has recently been registered. TAF has several advantages over tenofovir disoproxilfumarate (TDF) and is recommended instead of TDF in most cases. First-line treatment for previously untreated individuals includes dolutegravir, boosted darunavir or efavirenz with either abacavir/lamivudine or tenofovir (TDF/TAF)/emtricitabine. Pre-exposure prophylaxis (PrEP) is recommended for high-risk individuals. As in the case of the previous publication, recommendations are evidence-graded in accordance with the Oxford Centre for Evidence Based Medicine ( http://www.cebm.net/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/ ) ( Table 1 ). This document does not cover treatment of opportunistic infections and tumours. [Table: see text].
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  • Bonnevier, Anna, et al. (författare)
  • Potentialities for learning in medical students' ways of approaching a diagnostic task
  • 2012
  • Ingår i: Higher Education. - 0018-1560 .- 1573-174X. ; 64:3, s. 371-384
  • Tidskriftsartikel (refereegranskat)abstract
    • The study investigates medical students' ways of approaching a medical task. Fourteen medical students in their clinical years responded to a written patient case on chest pain. Variations in the students' responses to the task were analysed from a contextual and linguistic perspective. Students approached the task in two distinctly different ways. Either they treated the task as a problem situated within a purely academic context-listing concepts relevant to the symptom, applying the steps in the diagnostic process only once-or dealt with the task as a problem contextualised within a hypothetical clinical situation-testing alternative meanings of the symptom, elaborating on implications for the patient. It is not students' conceptualisations of medical theory that explain these outcomes but rather how students construct contexts in which these conceptualisations are embedded. The results highlight the importance of being sensitive to what students make of a given task, how their interpretations relate to what was intended by the teacher, the desired outcome of the curriculum, and the influences exercised upon students by the various educational settings confronting them in their studies.
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9.
  • Fochsen, G, et al. (författare)
  • Predictors of leaving nursing care: a longitudinal study among Swedish nursing personnel.
  • 2006
  • Ingår i: Occupational and environmental medicine. - 1470-7926. ; 63:3, s. 198-201
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVES: Despite extensive research on turnover among nursing personnel very little is known about the impact of physical workload and health on leaving. The aim of this study was to find predictors for leaving nursing care with special reference to physical working conditions and musculoskeletal problems. METHODS: This study is based on longitudinal data from a survey of nursing personnel who were employed at various county hospitals in Sweden from 1992-95. A self administrated follow up questionnaire was used to identify their present position in the labour market. The response rate was 73% (n = 1095). RESULTS: The results showed that nursing personnel reporting musculoskeletal problems of the neck/shoulder or knees and those who had limited use of transfer devices were more likely to leave nursing care. CONCLUSIONS: The study highlights the importance of taking musculoskeletal problems and use of transfer devices into consideration in order to retain nursing personnel.
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10.
  • Josephson, F., et al. (författare)
  • CYP3A induction and inhibition by different antiretroviral regimens reflected by changes in plasma 4beta-hydroxycholesterol levels
  • 2008
  • Ingår i: European Journal of Clinical Pharmacology. - 0031-6970. ; 64:8, s. 775-81
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE AND METHODS: A member of the major human cytochrome P450 superfamily of hemoproteins, CYP3A4/5, converts cholesterol into 4beta-hydroxycholesterol. We studied plasma 4beta-hydroxycholesterol levels prior to and 4 weeks after initiating antiretroviral therapy that included efavirenz, ritonavir-boosted atazanavir or ritonavir-boosted lopinavir with the aim of exploring the usefulness of plasma 4beta-hydroxycholesterol levels as an endogenous biomarker of CYP3A activity. Efavirenz is an inducer of CYP3A, whereas the ritonavir-boosted regimens are net inhibitors of CYP3A. RESULTS: In patients treated with efavirenz, the median plasma 4beta-hydroxycholesterol level increased by 46 ng/mL (p = 0.004; n = 11). In contrast, patients given ritonavir-boosted atazanavir showed a median decrease in plasma 4beta-hydroxycholesterol of -9.4 ng/mL (p = 0.0003; n = 22), and those given ritonavir-boosted lopinavir showed a median change from baseline of -5.8 ng/mL (p = 0.38; n = 19). There were significant between-group differences in the effects of antiretroviral treatment on plasma 4beta-hydroxycholesterol levels (p < 0.0001). CONCLUSION: Changes in plasma 4beta-hydroxycholesterol following the initiation of efavirenz- or atazanavir/ritonavir-based antiretroviral therapy reflected the respective net increase and decrease of CYP3A activity of these regimens. The plasma 4beta-hydroxycholesterol level did not indicate a net CYP3A inhibition in the lopinavir/ritonavir arm, possibly because of concomitant enzyme induction.
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