| 1. |
- Hartman, E. A. R., et al.
(författare)
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Decisions on antibiotic prescribing for suspected urinary tract infections in frail older adults: a qualitative study in four European countries
- 2022
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Ingår i: Age and ageing. - : Oxford University Press (OUP). - 0002-0729 .- 1468-2834. ; 51:6
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Tidskriftsartikel (refereegranskat)abstract
- Background a suspected urinary tract infection (UTI) is the most common reason to prescribe antibiotics in a frail older patient. Frequently, antibiotics are prescribed unnecessarily. To increase appropriate antibiotic use for UTIs through antibiotic stewardship interventions, we need to thoroughly understand the factors that contribute to these prescribing decisions. Objectives (1) to obtain insight into factors contributing to antibiotic prescribing for suspected UTIs in frail older adults. (2) To develop an overarching model integrating these factors to guide the development of antibiotic stewardship interventions for UTIs in frail older adults. Methods we conducted an exploratory qualitative study with 61 semi-structured interviews in older adult care settings in Poland, the Netherlands, Norway and Sweden. We interviewed physicians, nursing staff, patients and informal caregivers. Results participants described a chain of decisions by patients, caregivers and/or nursing staff preceding the ultimate decision to prescribe antibiotics by the physician. We identified five themes of influence: (1) the clinical situation and its complexity within the frail older patient, (2) diagnostic factors, such as asymptomatic bacteriuria, (3) knowledge (gaps) and attitude, (4) communication: interprofessional, and with patients and relatives and (5) context and organisation of care, including factors such as availability of antibiotics (over the counter), antibiotic stewardship efforts and factors concerning out-of-hours care. Conclusions decision-making on suspected UTIs in frail older adults is a complex, multifactorial process. Due to the diverse international setting and stakeholder variety, we were able to provide a comprehensive overview of factors to guide the development of antibiotic stewardship interventions.
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| 2. |
- Rindner, Lena, 1959, et al.
(författare)
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Prognostic factors for future mental, physical and urogenital health and work ability in women, 45-55 years: a six-year prospective longitudinal cohort study.
- 2020
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Ingår i: BMC women's health. - : Springer Science and Business Media LLC. - 1472-6874. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- Impaired health due to stress is a common cause of long-term illness in women aged 45-55years. It is a common cause for visits to primary health care (PHC) and may influence work-ability. The aim of this study was to investigate prognostic factors for future mental, physical and urogenital health as well as work-ability in a population of average women aged 45-55years.This longitudinal cohort study initially assessed 142 women from PHC centers in southwestern Sweden. One houndred and ten accepted participation and were followed for 6years. They were assessed using the self-reported questionnaires: the Menopause Rating Scale (MRS), the Montgomery-Asberg Depression Rating Scale (MADRS-S), the Short-Form Health Survey (SF-36). Descriptive data are presented of health, education, relationships and if they are working. Multicollinearity testing and logistic regression were used to test the explanatory variables.Severity of symptoms in the MRS somatic and urogenital domains decreased while they increased in the psychological and depressive domains. Having tertiary education was associated with decreased overall mental health, vitality and social role functioning. Living with a partner was associated with increased physical role functioning, social role functioning and emotional role functioning.Quality of life seems to be enhanced by a good relationship with the partner, social support and work/life balance. Therefore, to improve women health women should early discuss ways in which these issues can be incorporated as they pursue their academic or career goals. Hence, we emphasize the importance of supporting women to gain increased awareness about a healthy life balance and to have realistic goals in work as well as in their social life.
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| 3. |
- Cristaudo, A. T., et al.
(författare)
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Development and validation of a multivariable prediction model in open abdomen patients for entero-atmospheric fistula
- 2022
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Ingår i: ANZ Journal of Surgery. - : Wiley. - 1445-1433 .- 1445-2197. ; 92:5, s. 1070-1084
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Tidskriftsartikel (refereegranskat)abstract
- Background: Laparostomy or Open Abdomen (OA) has matured into an effective strategy in the management of abdominal catastrophe. Single prognostic factors have been identified in a previous systematic review regarding entero-atmospheric fistula (EAF). Unfortunately, no prognostic multivariable model for EAF exist. The aim was to develop and validate a multivariable prediction model from a retrospective cohort study involving three hospital's databases. Methods: Fifty-seven variables were evaluated to develop a multivariable model. Univariate and multivariable logistic regression analyses were performed for on a developmental data set from two hospitals. Receiver operator characteristics analysis with area under the curve (AUC) and 95% confidence intervals (CI) were performed on the developmental data set (internal validation) as well as on an additional validation data set from another hospital (external validation). Results: Five-hundred and forty-eight patients managed with an OA. Two variables remained in the multivariable prediction model for EAF. The AUC for EAF on internal validation were 0.74 (95% CI: 0.58–0.86) and 0.79 (95% CI: 0.67–0.92) on external validation. Conclusions: A multivariable prediction model for EAF was externally validated and an easy-to-use probability nomogram was constructed using the two predictor variables. Level of evidence: III; prognostic. © 2022 The Authors. ANZ Journal of Surgery published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Surgeons.
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| 4. |
- Finnie, G. S., et al.
(författare)
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Characterization of an 'Amyloid Only' Transgenic (B6C3-Tg(APPswe,PSEN1dE9)85Dbo/Mmjax) Mouse Model of Alzheimer's Disease
- 2017
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Ingår i: Journal of Comparative Pathology. - : Elsevier BV. - 0021-9975. ; 156:4, s. 389-399
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Tidskriftsartikel (refereegranskat)abstract
- The spatiotemporal pattern of cerebral amyloid deposition, detectable as light microscopically recognizable aggregates in an 'amyloid only' transgenic mouse model of Alzheimer's disease, B6C3Tg(APPswe,PSEN1dE9)85Dbo/Mmjax, is reported for the first time in this strain. Monoclonal and polyclonal antibodies were used to detect amyloid deposition immunohistochemically in brains collected from these mice at 3-12 months of age. Amyloid aggregates (20-200 mu m) were first found in serial, whole coronal sections of brain at 4 months of age and these increased progressively, plateauing at 11-12 months. They were most abundant in the cerebral cortices, hippocampus, olfactory bulbs, some white matter tracts and the cerebellar molecular layer; no amyloid aggregates were found in the midbrain, brainstem or spinal cord, or in an equivalent number of brains from wild-type mice. Since the parahippocampal gyrus is severely damaged early in the clinical course of human Alzheimer's disease, amyloid aggregates were also assessed in this brain region and a similar temporal course of amyloid deposition was observed. Moreover, in this gyrus, the amount of aggregated amyloid showed no significant difference between left- and right-sided gyri. However, the polyclonal antibody detected a significantly greater amyloid burden than the monoclonal antibody at 3-10 months of age and the reverse was seen at 11-12 months of age. The pattern of amyloid deposition in the parahippocampal gyrus also resembled that found in the entire brain over time, when the latter was quantified by the colour deconvolution method, suggesting that this gyrus is a good marker for more widely distributed cerebral amyloid deposition. This neuropathological characterization will permit better use of the B6C3-Tg(APPswe,PSEN1dE9)85Dbo/Mmjax transgenic mouse strain in future studies of Alzheimer's disease pathogenesis, prevention and treatment. Crown Copyright (C) 2017 Published by Elsevier Ltd. All rights reserved.
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| 5. |
- Firth, N., et al.
(författare)
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Safety and efficacy of recovery-promoting drugs for motor function after stroke: A systematic review of randomized controlled trials
- 2019
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Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977. ; 51:5, s. 319-330
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Tidskriftsartikel (refereegranskat)abstract
- - Objective: To investigate the efficacy and safety of drug interventions to promote motor recovery poststroke. Data sources: CENTRAL, CINAHL, Embase, MEDLINE, SCOPUS and Web of Science. Study selection: Published human randomized controlled trials in which the primary intervention was a drug administered to promote motor recovery poststroke, vs placebo. Data extraction: Standardized pro forma used to extract safety and efficacy data; Cochrane Collaboration risk of bias assessment tool performed to assess risk of bias. Data synthesis: Fifty randomized controlled trials from 4,779 citations were included. An overall trend of high risk of attrition (n=27) and reporting bias (n=36) was observed. Twenty-eight different drug interventions were investigated, 18 of which demonstrated statistically significant results favouring increased motor recovery compared with control intervention. Forty-four studies measured safety; no major safety concerns were reported. Conclusion: Candidate drug interventions promoting motor recovery post-stroke were identified, specifically selective serotonin reuptake inhibitors and levodopa; however, the high risk of bias in many trials is concerning. Drugs to improve motor function remain an important area of enquiry. Future research must focus on establishing the right drug intervention to be administered at an optimal dose and time, combined with the most effective adjuvant physical therapy to drive stroke recovery. © 2019 Foundation of Rehabilitation Information.
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| 6. |
- Greenwood, A. M., et al.
(författare)
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Clinical presentation, treatment and outcome of focal segmental glomerulosclerosis in Far North Queensland Australian adults
- 2017
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Ingår i: Nephrology. - : Wiley. - 1320-5358. ; 22:7, s. 520-530
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Tidskriftsartikel (refereegranskat)abstract
- AimThe aim is to describe the clinical features, treatment and outcomes in Australian adults with focal segmental glomerulosclerosis and identify predictors of disease progression and all-cause mortality. MethodsThe study included all patients with biopsy confirmed focal segmental glomerulosclerosis between January 1997 and June 2014 at participating hospitals. Clinical factors, histopathological findings, biochemical markers and treatments were analysed and potential predictors of doubling serum creatinine, end stage kidney disease or death identified. ResultsA total of 98 patients were included with a median follow up of 4.3years. Thirty-four (35%) patients were Aboriginal or Torres Strait Islander. Focal segmental glomerulosclerosis not-otherwise-specified was the most common variant. Seventeen (59%) patients initially treated with immunosuppression experienced an improvement in renal function. At the end of follow up, 43 (44%) patients had progressed to the composite outcome. Baseline tubulointerstitial scarring and lower haemoglobin predicted shorter time to doubling serum creatinine. Dual diagnosis, higher serum creatinine, lower estimated glomerular filtration rate and doubling creatinine were associated with shorter time to end stage kidney disease with remission the only protective factor. Age was the only variable associated with all-cause mortality. ConclusionFocal segmental glomerulosclerosis holds serious implications for patients. Concomitant diabetic nephropathy, higher serum creatinine and lower estimated glomerular filtration rate at renal biopsy were associated with poorer renal prognosis. Indigenous people had a female predominance and are over-represented in relation to their population size, however, were not associated with poorer prognosis. Remission was the only modifiable variable and thus should be at the forefront of patient management goals and future studies.
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| 7. |
- Gunnarsson, Maria S., et al.
(författare)
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In primary health care, never prescribe antibiotics to patients suspected of having an uncomplicated sore throat caused by group A beta-haemolytic streptococci without first confirming the presence of this bacterium
- 2012
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Ingår i: Scandinavian Journal of Infectious Diseases. - : Informa UK Limited. - 0036-5548 .- 1651-1980. ; 44:12, s. 915-921
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Tidskriftsartikel (refereegranskat)abstract
- Background: There are several consensus-describing decision rules for patients in primary health care with a sore throat. The objective of this study was to estimate the number of unnecessary antibiotic prescriptions in primary health care given to patients with a sore throat, due to these different decision rules. A further aim was to suggest revised rules for decision-making in primary health care, when a sore throat caused by group A beta-haemolytic streptococci (GAS) is suspected. Methods: The design was a reanalysis of previously published articles describing the prevalence of GAS and physician behaviour when treating patients with a sore throat. The risk of unnecessary antibiotic prescribing in different situations was estimated and applied to the Swedish population. Results: Introducing the rule of never prescribing antibiotics without first confirming the presence of GAS would result in an annual reduction in Sweden of 20,360-25,192 unnecessary antibiotic prescriptions in children and 65,311-98,160 in adults. Conclusions: The single most important rule in primary health care to minimize the risk of unnecessary antibiotic prescription to patients with an uncomplicated sore throat, and where an infection with GAS is suspected, is to never prescribe antibiotics at the first visit without first confirming the presence of this bacterium. Adding more decision rules may to some extent further reduce the number of unnecessary antibiotic prescriptions.
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| 8. |
- Hendy, K., et al.
(författare)
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Growth rates of small abdominal aortic aneurysms assessed by computerised tomography - A systematic literature review
- 2014
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Ingår i: Atherosclerosis. - : Elsevier BV. - 0021-9150. ; 235:1, s. 182-188
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Forskningsöversikt (refereegranskat)abstract
- Background: Most current evidence examining abdominal aortic aneurysm (AAA) growth is based on ultrasound surveillance. Objective: This review aimed to systematically analyse studies which have assessed small AAA growth using computed tomography (CT) to monitor outcome. Method: Studies investigating small AAA expansion rates using CT images were identified by searching the PubMed database and hand searching article reference lists. Eligible studies must have focused on monitoring small AAA growth using CT and included patients with baseline AAA diameters <55 mm for which growth rates were reported. Results: Ten studies including 845 patients met eligibility with average baseline AAA diameters ranging from 36.2 to 50.5 mm. AAA growth was assessed using axial (n = 1), orthogonal (n = 2), anterior to posterior (n = 4), and unspecified (n = 3) measurement methods. One study reported the reproducibility of their assessment method. Mean AAA diameter growth rates ranged from 2.6 to 5.2 mm/year. Factors reported to be associated with increased AAA expansion included: large AAA thrombus size (n = 3 studies), large baseline AAA diameter (n = 2), high AAA wall stress, elevated plasma concentration of matrix metalloproteinase-9 and presence of carotid artery disease (n = 1 study each). Factors reported to be negatively associated with AAA growth included presence of diabetes mellitus and chronic limb ischaemia (n = 1 study each). Conclusion: Many currently reported studies assessing small AAA growth on CT fail to report consistent use of reproducible measurement methods. CT offers the opportunity to assess orthogonal diameter and perform central reading which could be an advantage of this form of imaging. Crown Copyright (C) 2014 Published by Elsevier Ireland Ltd. All rights reserved.
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| 9. |
- Hendy, K., et al.
(författare)
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Infra-renal abdominal aortic calcification volume does not predict small abdominal aortic aneurysm growth
- 2015
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Ingår i: Atherosclerosis. - : Elsevier BV. - 0021-9150. ; 243:1, s. 334-338
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Tidskriftsartikel (refereegranskat)abstract
- Background: Vascular calcification is a common finding in abdominal aortic aneurysms (AAA) however whether it predicts aneurysm expansion is controversial. Objectives: 1) To establish a reproducible method of assessing AAA calcification using computed tomography (CT); 2) To investigate the association between AAA calcification and growth. Method: Patients were identified from a prospectively maintained small AAA surveillance database. To be included patients required at least two CT scans a minimum of 6 months apart. All patients had a maximal AAA diameter of <= 55 mm on their initial scan. Infra-renal aortic calcification volume, total infra-renal aortic volume and maximal AAA diameter were measured. Reproducibility was assessed from repeat scans performed on 31 patients. AAA growth, estimated by volume change per year, was compared between patients with baseline infra-renal aortic calcification volumes< and >= median. Results: 95% agreement limits (lower, upper) for intra and inter-observer error in measuring infra-renal aortic calcification volume were 0.68, 97 mm(3) and - 140, 5.8 mm(3), respectively. Concordance correlation coefficients for inter and intra-observer variability in measuring infra-renal aortic calcification volume were 0.99 and 0.99, respectively. Patients with infra-renal aortic calcification volume < median (n = 44) and >= median (n = 44) had an infra-renal aortic volume increase of 6.0 cm(3)/yr and 7.8 cm(3)/yr, respectively (p = 0.66). Mean percentage infra-renal aortic volume increase/yr was found to be 4.2 +/- 6.4 and 8.9 +/- 6.2 for patients with and without diabetes, respectively (p = 0.003). Conclusion: Infra-renal aortic calcification volume can be assessed reproducibly from CT images. Infrarenal aortic calcification volume did not predict small AAA growth. Crown Copyright (C) 2015 Published by Elsevier Ireland Ltd. All rights reserved.
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| 10. |
- Jonasson, Grethe, 1945, et al.
(författare)
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Cervical thickness of the mandibular alveolar process and skeletal bone mineral density.
- 1999
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Ingår i: Acta odontologica Scandinavica. - 0001-6357. ; 57:3, s. 155-61
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Tidskriftsartikel (refereegranskat)abstract
- Much effort has been devoted to finding methods for detecting individuals with low bone mass and risk of osteoporotic fractures. The aim of the present study was to investigate whether there is a relationship between the thickness of the alveolar process and the bone mineral density (BMD) of the distal forearm. In 24 women (38-65 years), the BMD of the distal forearm, obtained by dual X-ray absorptiometry, was correlated to the difference between two measures of the thickness of the mandibular alveolar process in the region of the first premolar. A highly significant correlation (r = 0.95, P< 0.001) was found. The method was cross-validated by using the equation obtained from the linear regression analysis above to predict BMD in two other groups. In both groups, the correlation between the measured BMD of the forearm and the predicted BMD was highly significant (r = 0.91, P< 0.001). The interdental thickness between the canine and the second incisor was also correlated to BMD, but with lower predictive value (r = 0.67, P<0.001). Measurements of the mandibular alveolar process can be used as one of several parameters to predict skeletal bone density.
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