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- Vallo Hult, Helena, 1976-, et al.
(författare)
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Egenmonitorering : evidenskartläggning genom sammanställning av systematiska översikter för utvalda diagnosgrupper
- 2023
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundIn Region Västra Götaland (VGR), the development of remote patient monitoring is given high priority, aiming for improvements for patients and reduction of healthcare costs. In this report we defined remote patient monitoring as continuous follow-up of relevant health-related parameters of patients located outside healthcare facilities (e.g. at home). Measurements taken by analogue or digital devices, objective and/or subjective assessments, are delivered digitally to the patient and to a healthcare professional. The healthcare professional provides the patient with feedback on the reported data (feedback may be automatically generated if data are within a predefined range). The plan in VGR is to introduce remote monitoring in selected diagnosis groups – some of which already started using remote monitoring.AimThe aim of this report was to provide an overview of systematic reviews regarding remote monitoring(as add on or replacement of visits in current standard of care) compared to standard of care in 25 selected diagnosis groups.MethodIn order to clarify how remote monitoring is intended to be used in the 25 diagnosis groups, representatives from the respective clinical areas were interviewed. As the scope of this project covered many diagnosis groups, the search was limited to systematic reviews (SRs) of randomised (RCTs) or non-randomised clinical trials. The relevance of each identified SR for our PICO(Population, Intervention, Comparator and Outcomes) was assessed by at least two project members (one clinical representative and one from HTA-centrum). Relevant SRs were assessed by at least two project members using SNABBSTAR, a tool developed by The Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU) for assessment of risk of bias/systematic errors in SRs. The tool consists of six steps and assessment of an SR is stopped as soon as the criteria for a specific level are not met.The steps are: 1. Definition of PICO and literature search; 2. Inclusion/exclusion according to PICO, listing of included studies; 3. Risk of bias assessments; 4. Evidence synthesis/meta-analyses; 5. Certainty of evidence consideration; 6. Documentation of excluded studies, conflicts of interest, and an a priori published SR protocol.SNABBSTAR evaluates how useful an SR is by assessing the methodology used in the SR. In the current project, SRs reaching at least SNABBSTAR level 4 were considered to provide relevant data synthesis. As reaching SNABBSTAR level 5 or 6 is considered necessary for reliable conclusions, we cited key conclusions only from SRs reaching these levels. We did not extract any data from the included SRs.ResultsThe literature search resulted in 3,332 hits. Of these, 279 were read in full text to assess their relevance for the PICO. Seventy-five SRs were considered relevant and were included; these were assessed by SNABBSTAR.
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| 2. |
- Magnusson, J, et al.
(författare)
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A kinetic study in adults with food hypersensitivity assessed as eosinophil activation in fecal samples
- 2003
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Ingår i: Clinical and Experimental Allergy. - : Wiley. - 0954-7894 .- 1365-2222. ; 33:8
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Immune-mediated food hypersensitivity affecting the gut is difficult to evaluate, and objective tools to diagnose local gastrointestinal (GI) inflammatory reactions are lacking. OBJECTIVES: To determine whether allergic manifestations in adults with a history of food-related GI symptoms could be assessed in feces during symptomatic and non-symptomatic periods, using the surrogate markers, eosinophil cationic protein (ECP), eosinophil protein X (EPX) and myeloperoxidase (MPO). METHODS: Thirteen subjects with food hypersensitivity-related GI symptoms, confirmed by a positive double-blind placebo-controlled food challenge (DBPCFC), were subjected to an open kinetic food challenge design for 6 weeks. Symptoms were recorded and scored during the 3-week study period and stool samples were obtained every day. The surrogate markers ECP, EPX and MPO were measured in the supernatants from feces samples. RESULTS: A significant increase in abdominal pain, distension and flatulence was observed during challenge, with a gradual decrease during elimination diet. Both between days and subjects, EPX levels were more frequently increased compared to ECP and MPO. Individuals with a history of a short duration of symptoms had significantly higher mean levels of EPX and MPO than those with a longer duration of symptoms. CONCLUSIONS: An overall increase in levels of eosinophil markers, in particular EPX, was observed in feces from patients with food-related GI symptoms. However, rather than being a tool to differentiate symptomatic from non-symptomatic periods, EPX might be used for detecting an ongoing clinical or subclinical chronic inflammation, that may have an impact on the patient's clinical course of GI symptoms.
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