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Sökning: LAR1:gu > (2010) > Tidskriftsartikel

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  • Aasa, M, et al. (författare)
  • Cost and health outcome of primary percutaneous coronary intervention versus thrombolysis in acute ST-segment elevation myocardial infarction-Results of the Swedish Early Decision reperfusion Study (SWEDES) trial.
  • 2010
  • Ingår i: American heart journal. - 1097-6744. ; 160:2, s. 322-8
  • Tidskriftsartikel (refereegranskat)abstract
    • Background In ST-elevation myocardial infarction, primary percutaneous coronary intervention (PCI) has a superior clinical outcome, but it may increase costs in comparison to thrombolysis. The aim of the study was to compare costs, clinical outcome, and quality-adjusted survival between primary PCI and thrombolysis. Methods Patients with ST-elevation myocardial infarction were randomized to primary PCI with adjunctive enoxaparin and abciximab (n = 101), or to enoxaparin followed by reteplase (n = 104). Data on the use of health care resources, work loss, and health-related quality of life were collected during a 1-year period. Cost-effectiveness was determined by comparing costs and quality-adjusted survival. The joint distribution of incremental costs and quality-adjusted survival was analyzed using a nonparametric bootstrap approach. Results Clinical outcome did not differ significantly between the groups. Compared with the group treated with thrombolysis, the cost of interventions was higher in the PCI-treated group ($4,602 vs $3,807; P = .047), as well as the cost of drugs ($1,309 vs $1,202; P = .001), whereas the cost of hospitalization was lower ($7,344 vs $9,278; P = .025). The cost of investigations, outpatient care, and loss of production did not differ significantly between the 2 treatment arms. Total cost and quality-adjusted survival were $25,315 and 0.759 vs $27,819 and 0.728 (both not significant) for the primary PCI and thrombolysis groups, respectively. Based on the 1-year follow-up, bootstrap analysis revealed that in 80%, 88%, and 89% of the replications, the cost per health outcome gained for PCI will be andlt;$0, $50,000, and $100,000 respectively. Conclusion In a 1-year perspective, there was a tendency toward lower costs and better health outcome after primary PCI, resulting in costs for PCI in comparison to thrombolysis that will be below the conventional threshold for cost-effectiveness in 88% of bootstrap replications.
  • Aasa, M, et al. (författare)
  • Risk Reduction for Cardiac Events After Primary Coronary Intervention Compared With Thrombolysis for Acute ST-Elevation Myocardial Infarction (Five-Year Results of the Swedish Early Decision Reperfusion Strategy [SWEDES] Trial).
  • 2010
  • Ingår i: The American journal of cardiology. - 1879-1913. ; 106:12, s. 1685-91
  • Tidskriftsartikel (refereegranskat)abstract
    • Primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction compares favorably to thrombolysis. In previous studies the benefit has been restricted to the early postinfarction period with no additional risk decrease beyond this period. Long-term outcome after use of third-generation thrombolytics and modern adjunctive pharmaceutics in the 2 treatment arms has not been investigated. This study was conducted to compare 5-year outcome after updated regimens of PPCI or thrombolysis. Patients with ST-elevation myocardial infarction were randomized to enoxaparin and abciximab followed by PPCI (n = 101) or enoxaparin followed by reteplase (n = 104), with prehospital initiation of therapy in 42% of patients. Data on survival and major cardiac events were obtained from Swedish national registries after 5.3 years. PPCI resulted in a better outcome with respect to the composite of death or recurrent myocardial infarction (hazard ratio 0.54, confidence interval 0.31 to 0.95) compared to thrombolysis. This was attributed to a significant decrease in cardiac deaths (hazard ratio 0.16, confidence interval 0.04 to 0.74). The difference evolved continuously over the 5-year follow-up. After adjustment for covariates, a significant benefit remained with respect to cardiac death or recurrent infarction but not for the composite of total survival or recurrent myocardial infarction (p = 0.07). The observed differences were not seen in patients in whom therapy was initiated in the prehospital phase. In conclusion, PPCI in combination with enoxaparin and abciximab compares favorably to thrombolysis in combination with enoxaparin with a risk decrease that stretches beyond the early postinfarction period. Prehospital thrombolysis may, however, match PPCI in long-term outcome.
  • Abarenkov, Kessy, et al. (författare)
  • PlutoF—a web based workbench for ecological and taxonomic research, with an online implementation for fungal ITS sequences
  • 2010
  • Ingår i: Evolutionary Bioinformatics. - 11769343. ; 6, s. 189-196
  • Tidskriftsartikel (refereegranskat)abstract
    • DNA sequences accumulating in the International Nucleotide Sequence Databases (INSD) form a rich source of information for taxonomic and ecological meta-analyses. However, these databases include many erroneous entries, and the data itself is poorly annotated with metadata, making it difficult to target and extract entries of interest with any degree of precision. Here we describe the web-based workbench PlutoF, which is designed to bridge the gap between the needs of contemporary research in biology and the existing software resources and databases. Built on a relational database, PlutoF allows remote-access rapid submission, retrieval, and analysis of study, specimen, and sequence data in INSD as well as for private datasets though web-based thin clients. In contrast to INSD, PlutoF supports internationally standardized terminology to allow very specific annotation and linking of interacting specimens and species. The sequence analysis module is optimized for identification and analysis of environmental ITS sequences of fungi, but it can be modified to operate on any genetic marker and group of organisms. The workbench is available at http://plutof.ut.ee.
  • Abbott, AD, et al. (författare)
  • Early Rehabilitation Targeting Cognition, Behavior, and Motor Function After Lumbar Fusion A Randomized Controlled Trial
  • 2010
  • Ingår i: SPINE. - 0362-2436. ; 35:8, s. 848-857
  • Tidskriftsartikel (refereegranskat)abstract
    • Study Design - Open label randomized controlled trial with 3-, 6-, 12-month, and 2- to 3-year follow-up.Objective - To investigate the effectiveness of a psychomotor therapy focusing on cognition, behavior, and motor relearning compared with exercise therapy applied during the first 3 months after lumbar fusion.Summary of Background Data - Postoperative management after lumbar fusion commonly focuses on analgesic pain control and activities of daily living. After 3 months, exercise therapy is often implemented. No randomized controlled trial has investigated early rehabilitation techniques conducted during the first 3 months after surgery.Methods - The study recruited 107 patients, aged 18 to 65 years, selected for lumbar fusion because of 12 months of symptomatic spinal stenosis, spondylosis, degenerative/isthmic spondylolisthesis, or degenerative disc disease. The exercise therapy group received a home program focusing on pain contingent training of back, abdominal, and leg muscle functional strength and endurance, stretching, and cardiovascular fitness. The psychomotor therapy group received a home program and 3 outpatient sessions focusing on modifying maladaptive pain cognitions, behaviors, and motor control. Rated questionnaires investigating functional disability, pain, health-related quality of life, functional self-efficacy, outcome expectancy, fear of movement/(re)injury, and coping were assessed at 3, 6, 12 months, and 2 to 3 years after surgery.Results - Follow-up rates were 93% at 12 months and 81% at 2 to 3 years after surgery. Psychomotor therapy improved functional disability, self-efficacy, outcome expectancy, and fear of movement/(re)injury significantly more than exercise therapy at respective follow-up occasions. Similar results occurred for pain coping but group differences were nonsignificant at 2 to 3 years follow-up. Potentially clinical relevant higher reoperation rates occurred after psychomotor therapy but rates were within normal ranges.Conclusion - The study shows that postoperative rehabilitation can be safely implemented during the first 3 months after lumbar fusion and should include measures to modify psychological as well as motor functions.
  • Abbott, AD, et al. (författare)
  • The influence of psychological factors on pre-operative levels of pain intensity, disability and health-related quality of life in lumbar spinal fusion surgery patients.
  • 2010
  • Ingår i: Physiotherapy. - 1873-1465. ; 96:3, s. 213-21
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVES:To assess the extent to which perceived pain and psychological factors explain levels of disability and health-related quality of life (HRQOL) in patients scheduled for lumbar fusion surgery, and to test the hypothesis that relationships between pain intensity, mental health, fear of movement/(re)injury, disability and HRQOL are mediated by cognitive beliefs and appraisals.DESIGN:Cross-sectional, correlation study.SETTING:Orthopaedic outpatient setting in a tertiary hospital.PARTICIPANTS:One hundred and seven chronic back pain patients scheduled for lumbar fusion surgery.MEASURES:Visual analogue scale for pain intensity, Short Form 36 mental health subscale, Tampa Scale for Kinesiophobia, Back Beliefs Questionnaire, Self-efficacy Scale, Coping Strategy Questionnaire, Oswestry Disability Index and European Quality of Life Questionnaire.RESULTS:The group effect of multiple mediators significantly influenced the relationships between pain intensity and mental health, fear of movement/(re)injury, functional disability and HRQOL. Pain catastrophising significantly mediated the relationship between pain intensity and mental health, control over pain significantly mediated the relationship between mental health and functional disability, self-efficacy and pain outcome expectancy significantly mediated the relationship between mental health and HRQOL, and self-efficacy also significantly mediated the relationship between pain intensity, fear of movement/(re)jury and functional disability. The model explained 28, 30, 52 and 42% of the variation in mental health, fear of movement/(re)injury, functional disability and HRQOL, respectively.CONCLUSIONS:This study highlights the strong influence and mediation roles of psychological factors on pain, mental health, fear of movement/(re)injury, disability and HRQOL in patients scheduled for lumber fusion. Future research should focus on screening as well as pre- and post-operative interventions based on these psychological factors for the potential improvement of lumber fusion surgery outcomes.Copyright 2010 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.
  • Abdalrahim, Maysoon S, 1962-, et al. (författare)
  • Jordanian surgical nurses' experiences in caring for patients with postoperative pain
  • 2010
  • Ingår i: APPLIED NURSING RESEARCH. - 0897-1897. ; 23:3, s. 164-170
  • Tidskriftsartikel (refereegranskat)abstract
    • This qualitative study aimed to describe surgical nurses' experiences in caring for patients with postoperative pain. Twelve expert Jordanian surgical nurses participated to provide data for this study. Texts were analyzed using Kvale's guidelines for analyzing qualitative data. Five themes emerged from the texts: being faced with patients' suffering, being caught between ideals and work conditions, facing neglect and misconceptions, being confronted with families' concerns and hostility, and facing the feelings of the necessity to change. Results suggested that health care organizations need to understand and empower nurses so that effective quality care can be delivered to patients.
  • Abdeldaim, Guma, 1969-, et al. (författare)
  • Multiplex quantitative PCR for detection of lower respiratory tract infection and meningitis caused by Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitidis
  • 2010
  • Ingår i: BMC Microbiology. - 1471-2180 .- 1471-2180. ; 10, s. 310
  • Tidskriftsartikel (refereegranskat)abstract
    • Background. Streptococcus pneumoniae and Haemophilus influenzae cause pneumonia and as Neisseria meningitidis they are important agents of meningitis. Although several PCR methods have been described for these bacteria the specificity is an underestimated problem. Here we present a quantitative multiplex real-time PCR (qmPCR) for detection of S. pneumoniae (9802 gene fragment), H. influenzae (omp P6 gene) and N. meningitidis (ctrA gene). The method was evaluated on bronchoalveolar lavage (BAL) samples from 156 adults with lower respiratory tract infection (LRTI) and 31 controls, and on 87 cerebrospinal fluid (CSF) samples from meningitis patients.Results. The analytical sensitivity was not affected by using a combined mixture of reagents and a combined DNA standard (S. pneumoniae/H. influenzae/N. meningitidis) in single tubes. By blood- and BAL-culture and S. pneumoniae urinary antigen test, S. pneumoniae and H. influenzae were aetiological agents in 21 and 31 of the LTRI patients, respectively. These pathogens were identified by qmPCR in 52 and 72 of the cases, respectively, yielding sensitivities and specificities of 95% and 75% for S. pneumoniae, and 90% and 65% for H. influenzae, respectively. When using a cut-off of 105 genome copies/mL for clinical positivity the sensitivities and specificities were 90% and 80% for S. pneumoniae, and 81% and 85% for H. influenzae, respectively. Of 44 culture negative but qmPCR positive for H. influenzae, 41 were confirmed by fucK PCR as H. influenzae. Of the 103 patients who had taken antibiotics prior to sampling, S. pneumoniae and H. influenzae were identified by culture in 6% and 20% of the cases, respectively, and by the qmPCR in 36% and 53% of the cases, respectively. In 87 CSF samples S. pneumoniae and N. meningitidis were identified by culture and/or 16 S rRNA in 14 and 10 samples and by qmPCR in 14 and 10 samples, respectively, giving a sensitivity of 100% and a specificity of 100% for both bacteria.Conclusions. The PCR provides increased sensitivity and the multiplex format facilitates diagnosis of S. pneumoniae, H. influenzae and N. meningitidis and the assay enable detection after antibiotic treatment has been installed. Quantification increases the specificity of the etiology for pneumonia.
  • Abdelkader, Amal F., 1969-, et al. (författare)
  • Prolonged salt stress alters the ratios of protochlorophyllide spectral forms in dark-grown wheat (Triticum aestivum) and influences chlorophyll a accumulation following irradiation
  • 2010
  • Ingår i: ACTA PHYSIOLOGIAE PLANTARUM. - 0137-5881. ; 32:5, s. 971-978
  • Tidskriftsartikel (refereegranskat)abstract
    • To examine the effects of salt stress on darkgrown wheat (Triticum aestivum), seedlings of the salt-tolerant cultivar Sids 1 and the susceptible cultivar Giza 168 were grown in darkness for 14 days in nutrient solution with and without 200 mM of supplementary salt (100 mM of NaCl and 100 mM of KCl). During this time, we monitored their protochlorophyllide (Pchlide) contents, ratios of photoactive to non-photoactive forms of Pchlide (from 655/633-nm emission ratios in their 77 K fluorescence emission spectra) and (following flash irradiation) ratios of newly formed chlorophyllide (Chlide) to non-photoactive Pchlide. In addition, the accumulation of chlorophyll a in leaf sections was monitored during prolonged (24 h) irradiation. The results depended on the developmental state of the seedlings. However, the salt stress treatment caused marked increases in both Pchlide contents in dark-grown leaves and in Chlide contents following irradiation of leaf sections of both cultivars. The ratio of phototransformable to non-phototransformable Pchlide and the abundance of newly formed Chlide were also increased by the salt stress. Further, leaves of salt-stressed seedlings consistently accumulated more chlorophyll a than leaves of unstressed seedlings when floating on the nutrient solution (with or without supplementary salt) in continuous white light. The findings are consistent with the hypothesis that increased levels of the long-wavelength form of Pchlide contribute to protective mechanisms against salt stress.
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