| 1. |
- Ahmadi, Shilan Seyed, et al.
(författare)
-
Effect of liraglutide on anthropometric measurements, sagittal abdominal diameter and adiponectin levels in people with type 2 diabetes treated with multiple daily insulin injections: evaluations from a randomized trial (MDI-liraglutide study 5)
- 2019
-
Ingår i: Obesity Science and Practice. - : Wiley. - 2055-2238. ; 5:2, s. 130-140
-
Tidskriftsartikel (refereegranskat)abstract
- Aim Use of the glucagon-like peptide 1 receptor agonist liraglutide has been shown to reduce weight. Different types of anthropometric measurements can be used to measure adiposity. This study evaluated the effect of liraglutide on sagittal abdominal diameter, waist circumference, waist-to-hip ratio and adiponectin levels in people with type 2 diabetes (T2D) treated with multiple daily insulin injections (MDI). Materials and methods In the multicentre, double-blind, placebo-controlled MDI-liraglutide trial, 124 individuals with T2D treated with MDI were randomized to either liraglutide or placebo. Basal values of weight, waist circumference, waist-to-hip ratio, sagittal abdominal diameter and adiponectin were compared with measurements at 12 and 24 weeks after randomization. Results Baseline-adjusted mean weight loss was 3.8 +/- 2.9 kg greater in liraglutide than placebo-treated individuals (p < 0.0001). Waist circumference was reduced by 2.9 +/- 4.3 cm and 0.2 +/- 3.6 cm in the liraglutide and placebo groups, respectively, after 24 weeks (baseline-adjusted mean difference: 2.6 +/- 4.0 cm, p = 0.0005). Corresponding reductions in sagittal abdominal diameter were 1.1 +/- 1.7 cm and 0.0 +/- 1.8 cm (baseline-adjusted mean difference: 1.1 +/- 1.7 cm, p = 0.0008). Hip circumference was reduced in patients randomized to liraglutide (baseline-adjusted mean difference between treatment groups: 2.8 +/- 3.8 cm, p = 0.0001), but there was no significant difference between the groups in either waist-to-hip ratio (baseline-adjusted mean difference: 0.0 +/- 0.04 cm, p = 0.51) or adiponectin levels (baseline-adjusted mean difference: 0.8 +/- 3.3 mg L-1, p = 0.17). Lower HbA1c and mean glucose levels measured by masked continuous glucose monitoring at baseline were associated with greater effects of liraglutide on reductions in waist circumference and sagittal abdominal diameter. Conclusions In patients with T2D, adding liraglutide to MDI may reduce abdominal and hip obesity to a similar extent, suggesting an effect on both visceral and subcutaneous fat. Liraglutide had greater effects on reducing abdominal obesity in patients with less pronounced long-term hyperglycaemia but did not affect adiponectin levels.
|
|
| 2. |
- Boeters, Debbie M., et al.
(författare)
-
The prevalence of ACPA is lower in rheumatoid arthritis patients with an older age of onset but the composition of the ACPA response appears identical
- 2017
-
Ingår i: Arthritis Research and Therapy. - : Springer Science and Business Media LLC. - 1478-6354 .- 1478-6362. ; 19:1, s. 1-10
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Rheumatoid arthritis (RA) consists of two syndromes, one autoantibody-positive and one autoantibody-negative. Existing data on the relation between age of onset and prevalence of autoantibodies were conflicting. Therefore this multicohort study assessed the age of onset in relation to the presence of autoantibodies. The association with characteristics of the anti-citrullinated protein antibodies (ACPA) response was also explored. Methods: The 1987 criteria-positive RA patients included in the Leiden EAC, BARFOT, ESPOIR, Umeå and Lund cohorts (n = 3321) were studied at presentation for age of onset and the presence of ACPA, rheumatoid factor (RF) and anti-carbamylated protein (anti-CarP) antibodies. Logistic regression analyses were performed; effect sizes were summarized in inverse-weighted meta-analyses. Within ACPA-positive RA, ACPA level was studied in all cohorts; ACPA isotypes, ACPA fine specificity and ACPA avidity index and clinical characteristics were studied in the Leiden EAC. Results: From the age of 50 onward, the proportion of ACPA-negative RA patients increased with age in the five cohorts. Similar observations were made for RF and anti-CarP. The composition of the ACPA response did not change with increasing age of onset with respect to titer, isotype distribution, fine specificity and avidity index. With increasing age of onset, RA patients smoked less often, had higher acute phase reactants and more often had a sub(acute) symptom onset. Conclusions: Data of five cohorts revealed that with older age of onset ACPA-negative RA is more frequent than ACPA-positive RA, while characteristics of ACPA-positive RA as judged by the composition of the ACPA response appeared not age dependent. Further biologic studies are needed to characterize the pathogenesis of ACPA-negative polyarthritis at older age and to promote personalized treatment decisions in ACPA-negative patients in daily practice.
|
|
| 3. |
- Johansson, Elin, 1978, et al.
(författare)
-
Inter-professional teamwork in emergency care: pedagogical use of video in post-simulation debriefings
- 2014
-
Ingår i: SESAM 2014, 20th Anniversary SESAM Meeting Poznań 12-14 June 2014.
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- MAIN ABSTRACT Background: The use of video for feedback in debriefings is widespread and considered to be essential for the effective use of simulations. However, empirical studies that focus on how video can be optimized as a pedagogical means in debriefings are still rare. Objective: The study aims to investigate how video can be used to encourage reflection and discussion on scenarios in subsequent debriefings. Methods: The data consists of forty video recorded debriefings following interprofessional team training scenarios for medical and nursing students. First, a number of video sequences were selected from the debriefings in which the facilitators used video-clips from the scenario as a basis for discussion. These represented a variation of the ways in which video clips were introduced. The video sequences then served as basis for a focus group interview with three facilitators. The interview explored the variation in introducing the video clips and what implications this had for subsequent discussions. Results: Different strategies for introducing video clips were identified, ranging from very specific to very open-ended. Whilst the specific ones were characterized by detailed information about the situation and what parts of the clip to focus on, the open-ended introductions were characterized by brief information about the situation without instructions for what aspects to focus on. The interview resulted in a model involving four interrelated factors – moment of time in training, complexity of the situation, group characteristics and purpose ¬– that are important to take into account when choosing between open-ended versus specific introductions. Conclusions: The proposed model provides a conceptual tool for discussing and planning successful use of video recordings for feedback purposes in post-simulation debriefings. It can also be used to increase awareness of how the selection and introduction of video clips affect subsequent discussions.
|
|
| 4. |
- Karlsson, Anette, 1986-, et al.
(författare)
-
The effect on precision and T1 bias comparing two flip angles when estimating muscle fat infiltration using fat-referenced chemical shift-encoded imaging
- 2021
-
Ingår i: NMR in Biomedicine. - : John Wiley & Sons. - 0952-3480 .- 1099-1492. ; 34:11
-
Tidskriftsartikel (refereegranskat)abstract
- Investigation of the effect on accuracy and precision of different parameter settings is important for quantitative Magnetic Resonance Imaging. The purpose of this study was to investigate T1-bias and precision for muscle fat infiltration (MFI) using fat-referenced chemical shift magnetic resonance imaging at 5° and 10° flip angle. This [MB1] experimental study was done on forty postmenopausal women using 3T MRI test and retest images using 4-point 3D spoiled gradient multi-echo acquisition including real and imaginary images for reconstruction acquired at Flip angles 5° and 10°. Post-processing included T2* correction and fat-referenced calibration of the fat signal. The mean MFI was calculated in six different automatically segmented muscle regions using both the fat-referenced fat signal and the fat fraction calculated from the fat and water image pair for each acquisition. The variance of the difference between mean MFI from test and retest was used as measure of precision. The SNR characteristics were analyzed by measuring difference of the full width half maximum of the fat signal distribution using Student’s t-test.There was no difference in the mean fat-referenced MFI at different flip angles with the fat-referenced technique, which was the case using the fat fraction. No significant difference in the precision was found in any of the muscles analyzed. However, the full width half maximum of the fat signal distribution was significantly lower at 10° flip angle compared to 5°. Fat-referenced MFI is insensitive to T1 bias in chemical shift magnetic resonance imaging enabling usage of a higher and more SNR effective flip angle. The lower full-width-at half-maximum in fat-referenced MFI at 10° indicates that high flip angle acquisition is advantageous although no significant differences in precision was observed comparing 5° and 10°.
|
|
| 5. |
- Lind, Marcus, 1976, et al.
(författare)
-
Design and Methods of a Randomized Trial of Continuous Glucose Monitoring in Persons With Type 1 Diabetes With Impaired Glycemic Control Treated With Multiple Daily Insulin Injections (GOLD Study).
- 2016
-
Ingår i: Journal of diabetes science and technology. - : SAGE Publications. - 1932-2968. ; 10:3, s. 754-61
-
Tidskriftsartikel (refereegranskat)abstract
- The majority of individuals with type 1 diabetes today have glucose levels exceeding guidelines. The primary aim of this study was to evaluate whether continuous glucose monitoring (CGM), using the Dexcom G4 stand-alone system, improves glycemic control in adults with type 1 diabetes treated with multiple daily insulin injections (MDI).Individuals with type 1 diabetes and inadequate glycemic control (HbA1c ≥ 7.5% = 58 mmol/mol) treated with MDI were randomized in a cross-over design to the Dexcom G4 versus conventional care for 6 months followed by a 4-month wash-out period. Masked CGM was performed before randomization, during conventional treatment, and during the wash-out period to evaluate effects on hypoglycemia, hyperglycemia, and glycemic variability. Questionnaires were used to evaluate diabetes treatment satisfaction, fear of hypoglycemia, hypoglycemia confidence, diabetes-related distress, overall well-being, and physical activity during the different phases of the trial. The primary endpoint was the difference in HbA1c at the end of each treatment phase.A total of 205 patients were screened, of whom 161 were randomized between February and December 2014. Study completion is anticipated in April 2016.It is expected that the results of this study will establish whether using the Dexcom G4 stand-alone system in individuals with type 1 diabetes treated with MDI improves glycemic control, reduces hypoglycemia, and influences quality-of-life indicators and glycemic variability.
|
|
| 6. |
|
|
| 7. |
- Lind, Marcus, 1976, et al.
(författare)
-
Sustained Intensive Treatment and Long-term Effects on HbA(1c) Reduction (SILVER Study) by CGM in People With Type 1 Diabetes Treated With MDI
- 2021
-
Ingår i: Diabetes Care. - Arlington, VA, United States : American Diabetes Association. - 0149-5992 .- 1935-5548. ; 44:1, s. 141-149
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE Continuous glucose monitoring (CGM) reduces HbA(1c) and time spent in hypoglycemia in people with type 1 diabetes (T1D) treated with multiple daily insulin injections (MDI) when evaluated over shorter time periods. It is unclear to what extent CGM improves and helps to maintain glucose control, treatment satisfaction, diabetes distress, hypoglycemic concerns, and overall well-being over longer periods of time. RESEARCH DESIGN AND METHODS The GOLD trial was a randomized crossover trial performed over 16 months of CGM treatment in people with T1D treated with MDI. People completing the trial (n = 141) were invited to participate in the current SILVER extension study in which 107 patients continued CGM treatment over 1 year along with the support of a diabetes nurse every 3 months. RESULTS The primary end point of the change in HbA(1c) over 1.0-1.5 years of CGM use compared with previous self-monitoring of blood glucose during GOLD showed a decrease in HbA(1c) of 0.35% (95% CI 0.19-0.50, P < 0.001). Time spent in hypoglycemia <3.0 mmol/L (54 mg/dL) and <4.0 mmol/L (72 mg/dL) decreased from 2.1% to 0.6% (P < 0.001) and from 5.4% to 2.9% (P < 0.001), respectively. Overall well-being (World Health Organization 5-item well-being index, P = 0.009), treatment satisfaction (Diabetes Treatment Satisfaction Questionnaire, P < 0.001), and hypoglycemic confidence (P < 0.001) increased, while hypoglycemic fear (Hypoglycemia Fear Survey-Worry, P = 0.016) decreased and diabetes distress tended to decrease (Problem Areas in Diabetes Scale, P = 0.06). From randomization and screening in GOLD, HbA(1c) was lowered by 0.45% (P < 0.001) and 0.68% (P < 0.001) after 2.3 and 2.5 years, respectively. CONCLUSIONS The SILVER study supports beneficial long-term effects from CGM on HbA(1c), hypoglycemia, treatment satisfaction, well-being, and hypoglycemic confidence in people with T1D managed with MDI.
|
|
| 8. |
- Ljung, Lotta, et al.
(författare)
-
Response to biological treatment and subsequent risk of coronary events in rheumatoid arthritis
- 2016
-
Ingår i: Annals of the Rheumatic Diseases. - : BMJ. - 0003-4967 .- 1468-2060. ; 75:12, s. 2087-2094
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives Whether the increased risk of comorbidities, such as cardiovascular disease, in rheumatoid arthritis (RA) can be reverted by particular antirheumatic therapies, or response to these, is unclear but of critical clinical importance. We wanted to investigate whether response to tumour necrosis factor inhibitors (TNFi) translates into a reduced risk for acute coronary syndrome (ACS). Methods A cohort of patients with RA initiating a first TNFi 2001-2012 was identified in the Swedish Biologics Register. The association between European League Against Rheumatism (EULAR) response after 3-8 months of treatment (assessed using the first, the best and the measurement closest to 5 months, respectively), and the risk of incident ACS during the subsequent year was analysed in Cox regression models. Adjustments included cardiovascular risk factors, joint surgery, RA duration, education and work disability. Results During 6592 person-years among TNFi initiators (n=6864, mean age 55 years, 77% women), 47 ACS occurred. The adjusted HRs (95% CI), which were similar to the crude HRs, of the 1-year risk of ACS among EULAR good responders compared with non-responders were 0.5 (0.2 to 1.4), 0.4 (0.2 to 0.9) and 0.5 (0.2 to 1.2), for the first, the best and the evaluation closest to 5 months, respectively. EULAR moderate responders had equal risk to that of EULAR non-responders, who, compared with the general population referents (n=34 229), had a more than twice the risk of ACS. For good responders, there was no statistically significant difference in risk versus the general population. Conclusions Optimised RA disease control has the potential to revert otherwise increased risks for ACS in RA.
|
|
| 9. |
|
|
| 10. |
|
|
