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- Berntorp, Erik, et al.
(författare)
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Treatment of haemophilia A and B and von Willebrand's disease : summary and conclusions of a systematic review as part of a Swedish health-technology assessment
- 2012
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Ingår i: Haemophilia. - : Wiley. - 1351-8216 .- 1365-2516. ; 18:2, s. 158-165
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Forskningsöversikt (refereegranskat)abstract
- In an ongoing health-technology assessment of haemophilia treatment in Sweden, performed by the governmental agency Dental and Pharmaceutical Benefits Agency (TLV; tandvårds-och läkemedelsförmånsverket), the Swedish Council on Health Technology Assessment (SBU; statens beredning för medicinsk utvärdering) was called upon to evaluate treatment of haemophilia A and B and von Willebrand's disease (VWD) with clotting factor concentrates. To evaluate the following questions: What are the short-term and long-term effects of different treatment strategies? What methods are available to treat haemophilia patients that have developed inhibitors against factor concentrates? Based on the questions addressed by the project, a systematic database search was conducted in PubMed, NHSEED, Cochrane Library, EMBASE and other relevant databases. The literature search covered all studies in the field published from 1985 up to the spring of 2010. In most instances, the scientific evidence is insufficient for the questions raised in the review. Concentrates of coagulation factors have good haemostatic effects on acute bleeding and surgical intervention in haemophilia A and B and VWD, but conclusions cannot be drawn about possible differences in the effects of different dosing strategies for acute bleeding and surgery. Prophylaxis initiated at a young age can prevent future joint damage in persons with haemophilia. The available treatment options for inhibitors have been insufficiently assessed. The economic consequences of various treatment regimens have been insufficiently analysed. Introduction of national and international registries is important.
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| 4. |
- Wallert, J., et al.
(författare)
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Predicting adherence to internet-delivered cognitive behaviour therapy for comorbid symptoms of depression and anxiety after myocardial infarction
- 2018
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Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 39, s. 1112-1112
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: Psychotherapeutic treatment for the subgroup of patients with MI that also suffer from comorbid symptoms of anxiety and/or depression (MI-ANXDEP) is part of cardiac rehabilitation (CR). Adherence to a range of treatments and lifestyle advice is crucial for risk reduction in these patients. Understanding the relative importance of predictors of adherence to internet-delivered cognitive behaviour therapy (ICBT) for MI-ANXDEP could improve their targeted care.Purpose: We estimated the relative importance of a range of established and novel predictors of adherence to ICBT for MI-ANXDEP patients.Method: The study sample consisted of 90 MI-ANXDEP patients (58.4 years, 62% men) recruited from 25 hospitals in Sweden who were randomised to active treatment in the ICBT trial U-CARE Heart. Time-point of prediction was at completion of the first homework assignment (HWA), and adherence was gauged at the end of treatment (48% adherers). Adherence was defined as completing at least the first two HWAs within the 14-week treatment period. A supervised machine learning (ML) procedure, applying 3x10 cross-validated recursive feature elimination with a random forest model as internal classifier, estimated the relative importance of predictors for adherence from a range of patient demographic, clinical, and linguistic variables that were available at completion of the first HWA.Result: Out of 34 potential predictors, ML selected an optimal set of 19 predictors (Accuracy 0.64, 95% CI 0.61–0.68). The strongest predictors for being classified as adherent were in order of relative importance (1) higher self-rated cardiac fear (CAQ fear), (2) female sex, (3) more words used by the patient to answer the first homework assignment (Number of words), (4) higher self-rated general cardiac anxiety (CAQ total), and (5) a higher rate of words used by the patient that were identical with words prompted by the first homework assignment (Number of mutual words), as depicted in the figure.Conclusion(s): It is of clinical importance to understand poor adherence to ICBT treatment in the high risk MI-ANXDEP subpopulation. Higher cardiac anxiety and female sex were the strongest predictors for adherence. A novel finding was that linguistic variables were important for predicting adherence, particularly the number of words used may signify the degree of personal investment and motivation for treatment, and the number of mutual words used may be a proxy for therapeutic alliance within the treatment. Education had no predictive value. Future research should investigate potential causal mechanisms, and whether these findings replicate outside of Sweden, in larger samples, and for similar eHealth treatments.
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