| 1. |
- Munch, Andreas, et al.
(författare)
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Lack of effect of methotrexate in budesonide-refractory collagenous colitis
- 2013
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Ingår i: Clinical and Experimental Gastroenterology. - : Dove Medical Press. - 1178-7023. ; 6, s. 149-152
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:In most cases, collagenous colitis can be treated effectively with budesonide. However, some patients develop side effects or have chronic symptoms refractory to budesonide. This paper reports an open case series of patients intolerant or refractory to budesonide who were treated with methotrexate (MTX).METHODS AND PATIENTS:Nine patients (seven women) with a median (range) age of 62 (44-77) years were studied. Bowel movements were registered during 1 week prior to baseline and after 6 and 12 weeks' treatment, enabling calculation of the mean bowel movements/day. All patients underwent colonoscopy with biopsies before inclusion to confirm diagnosis. Open treatment with MTX was given 15 mg subcutaneously weekly for 6 weeks and was increased to 25 mg for a further 6 weeks if symptoms were unresponsive to the first 6 weeks' treatment. The endpoint was clinical remission, which was defined as a mean <3 stools/day and mean <1 watery stool/day/week at Week 12. The Short Health Scale was used at baseline and Week 12 to assess health-related quality of life.RESULTS:Five patients fulfilled the treatment according to the protocol and four patients discontinued the study after 3-6 weeks because of adverse events. No patient achieved clinical remission at Week 12. The mean stool frequency/day at baseline was 6.0 stools/day, thereof 5.4 watery stools/day and after 12 weeks treatment 6.4 stools/day, thereof 5.7 watery/day. No patient appreciated an improvement of health-related quality of life.CONCLUSION:Short-term treatment with MTX had no clinical effect in collagenous colitis patients intolerant or refractory to budesonide. Alternative therapies should be investigated in these patients.
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| 2. |
- Davidson, Sanna, et al.
(författare)
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Microscopic colitis in Denmark and Sweden : incidence, putative risk factors, histological assessment and endoscopic activity
- 2018
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 0036-5521 .- 1502-7708. ; 53:7, s. 818-824
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The significantly higher incidence rates of microscopic colitis (MC) in Denmark compared to Sweden remains unexplained. Methods: Consecutive patients with newly diagnosed MC in the neighbouring regions of Skåne in 2011–2015 and Zealand in 2010–2016 were prospectively identified. Data on large bowel endoscopies and biopsies rates were retrieved. Information on putative factors were obtained from registers and literature. Interobserver agreement between pathologists from both regions on 40 blinded hematoxylin and eosin (H&E)-stained colon biopsies (collagenous colitis (CC), lymphocytic colitis (LC), non-specific inflammation and normal) was evaluated using kappa statistics. Results: The mean annual incidence per 105 inhabitants in Skåne and Zealand 2010–2015 was 5.9 (95% CI 4.6–7.3) versus 16.4 (95% confidence intervals (95% CI) 13.6–19.2) for CC and 2.7 (95% CI 1.0–4.3) versus 11.1 (95% CI 8.8–13.4) for LC, respectively. Number of endoscopies with biopsy per 1000 and the rate of MC per endoscopy with biopsy was higher in Zealand (34–52/1000) than in Skåne (12–21/1000). The kappa value for overall agreement between pathologists was good (0.72; 95% CI 0.64–0.79). Prescription of proton pump inhibitors and selective serotonin reuptake inhibitors was higher in Skåne in the relevant age groups and prescription of non-steroidal anti-inflammatory drugs and smoking rate higher in Zealand. Alcohol consumption was higher in Denmark than in Sweden. Conclusion: The incidence of MC and number of cases per colonic biopsy was higher in Zealand and could not be readily explained by endoscopy or biopsy rates, differences in histological assessment or putative risk factors.
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| 3. |
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| 4. |
- Entezarjou, Artin, et al.
(författare)
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Antibiotic Prescription Rates After eVisits Versus Office Visits in Primary Care : Observational Study
- 2021
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Ingår i: JMIR Medical Informatics. - : JMIR Publications Inc.. - 2291-9694. ; 9:3
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Direct-to-consumer telemedicine is an increasingly used modality to access primary care. Previous research on assessment using synchronous virtual visits showed mixed results regarding antibiotic prescription rates, and research on assessment using asynchronous chat-based eVisits is lacking.OBJECTIVE: The goal of the research was to investigate if eVisit management of sore throat, other respiratory symptoms, or dysuria leads to higher rates of antibiotic prescription compared with usual management using physical office visits.METHODS: Data from 3847 eVisits and 759 office visits for sore throat, dysuria, or respiratory symptoms were acquired from a large private health care provider in Sweden. Data were analyzed to compare antibiotic prescription rates within 3 days, antibiotic type, and diagnoses made. For a subset of sore throat visits (n=160 eVisits, n=125 office visits), Centor criteria data were manually extracted and validated.RESULTS: Antibiotic prescription rates were lower following eVisits compared with office visits for sore throat (169/798, 21.2%, vs 124/312, 39.7%; P<.001) and respiratory symptoms (27/1724, 1.6%, vs 50/251, 19.9%; P<.001), while no significant differences were noted comparing eVisits to office visits for dysuria (1016/1325, 76.7%, vs 143/196, 73.0%; P=.25). Guideline-recommended antibiotics were prescribed similarly following sore throat eVisits and office visits (163/169, 96.4%, vs 117/124, 94.4%; P=.39). eVisits for respiratory symptoms and dysuria were more often prescribed guideline-recommended antibiotics (26/27, 96.3%, vs 37/50, 74.0%; P=.02 and 1009/1016, 99.3%, vs 135/143, 94.4%; P<.001, respectively). Odds ratios of antibiotic prescription following office visits compared with eVisits after adjusting for age and differences in set diagnoses were 2.94 (95% CI 1.99-4.33), 11.57 (95% CI 5.50-24.32), 1.01 (95% CI 0.66-1.53), for sore throat, respiratory symptoms, and dysuria, respectively.CONCLUSIONS: The use of asynchronous eVisits for the management of sore throat, dysuria, and respiratory symptoms is not associated with an inherent overprescription of antibiotics compared with office visits.TRIAL REGISTRATION: ClinicalTrials.gov NCT03474887; https://clinicaltrials.gov/ct2/show/NCT03474887.
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| 5. |
- Entezarjou, Artin, et al.
(författare)
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Health care utilization following "digi-physical" assessment compared to physical assessment for infectious symptoms in primary care
- 2022
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Ingår i: BMC Primary Care. - : Springer Science and Business Media LLC. - 2731-4553. ; 23
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Tidskriftsartikel (refereegranskat)abstract
- Background: The use of chat-based digital visits (eVisits) to assess infectious symptoms in primary care is rapidly increasing. The "digi-physical" model of care uses eVisits as the first line of assessment while assuming a certain proportion of patients will inevitably need to be further assessed through urgent physical examination within 48 h. It is unclear to what extent this approach can mitigate physical visits compared to assessing patients directly using office visits.Methods: This pre-COVID-19-pandemic observational study followed up "digi-physical" eVisit patients (n = 1188) compared to office visit patients (n = 599) with respiratory or urinary symptoms. Index visits occurred between March 30th 2016 and March 29th 2019. The primary outcome was subsequent physical visits to physicians within two weeks using registry data from Skåne county, Sweden (Region Skånes Vårddatabas, RSVD).Results: No significant differences in subsequent physical visits within two weeks (excluding the first 48 h) were noted following "digi-physical" care compared to office visits (179 (18.0%) vs. 102 (17.6%), P = .854). As part of the "digital-physical" concept, a significantly larger proportion of eVisit patients had a physical visit within 48 h compared to corresponding office visit patients (191 (16.1%) vs. 19 (3.2%), P < .001), with 150 (78.5%) of these eVisit patients recommended some form of follow-up by the eVisit physician.Conclusions: Most eVisit patients (68.9%) with respiratory and urinary symptoms have no subsequent physical visits. Beyond an unavoidable portion of patients requiring urgent physical examination within 48 h, "digi-physical" management of respiratory and urinary symptoms results in comparable subsequent health care utilization compared to office visits. eVisit providers may need to optimize use of resources to minimize the proportion of patients being assessed both digitally and physically within 48 h as part of the "digi-physical" concept.Trial registration: Clinicaltrials.gov identifier: NCT03474887.Supplementary Information: The online version contains supplementary material available at 10.1186/s12875-021-01618-2.
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| 6. |
- Eriksson, Carl, 1981-, et al.
(författare)
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Clinical effectiveness of golimumab in ulcerative colitis : a prospective multicentre study based on the Swedish IBD Quality Register, SWIBREG
- 2021
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 0036-5521 .- 1502-7708. ; 56:11, s. 1304-1311
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Clinical trials demonstrated that golimumab is effective in anti-TNF naïve patients with ulcerative colitis. We aimed to assess the clinical effectiveness of golimumab in a real-world setting. Materials and methods: This was a prospective cohort study, conducted at 16 Swedish hospitals. Data were collected using an electronic case report form. Patients with active ulcerative colitis, defined as Mayo endoscopic subscore ≥2 were eligible for inclusion. The primary outcomes were clinical effectiveness at 12 weeks and 52 weeks, i.e. response (defined as a decrease in Mayo score by ≥3 points or 30% from baseline) and remission (defined as a Mayo score of ≤2 with no individual subscores >1). Results: Fifty patients were included. At study entry, 70% were previously exposed to anti-TNF, 16% to vedolizumab, and 96% to immunomodulators. The 12 and 52-week drug continuation rates were 37/50 (74%) and 23/50 (46%), respectively. The 12-week response rate was 14/50 (28%), the remission rate, 8/50 (16%) and the corresponding figures at week 52 were 13/50 (26%) and 10/50 (20%). Among patients who continued golimumab, the median Mayo score decreased from 7 (6–9) at baseline to 1 (0–5) at 52 weeks (p <.01) and the faecal calprotectin decreased from 862 (335–1759) µg/g to 90 (34–169) µg/g (p <.01). Clinical response at week 12 was highly predictive of clinical remission at week 52 (adjusted OR: 73.1; 95% CI: 4.5‒1188.9). Conclusions: The majority of golimumab treated patients represented a treatment refractory patient-group. Despite this, our results confirm that golimumab is an effective therapy in ulcerative colitis.
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| 7. |
- Eriksson, Carl, 1981-, et al.
(författare)
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Long-term effectiveness of vedolizumab in inflammatory bowel disease : a national study based on the Swedish National Quality Registry for Inflammatory Bowel Disease (SWIBREG)
- 2017
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Ingår i: Scandinavian Journal of Gastroenterology. - : Taylor & Francis. - 0036-5521 .- 1502-7708. ; 52:6-7, s. 722-729
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Clinical trials have demonstrated the efficacy of vedolizumab in inflammatory bowel disease (IBD). However, these findings may not reflect the clinical practice. Therefore, we aimed to describe a vedolizumab-treated patient population and assess long-term effectiveness.Materials and methods: Patients initiating vedolizumab between 1 June 2014 and 30 May 2015 were identified through the Swedish National Quality Registry for IBD. Prospectively collected data on treatment and disease activity were extracted. Clinical remission was defined as Patient Harvey Bradshaw index<5 in Crohn's disease (CD) and Patient Simple Clinical Colitis Activity index<3 in ulcerative colitis (UC).Results: Two-hundred forty-six patients (147CD, 92 UC and 7 IBD-Unclassified) were included. On study entry, 86% had failed TNF-antagonist and 48% of the CD patients had undergone1 surgical resection. After a median follow-up of 17 (IQR: 14-20) months, 142 (58%) patients remained on vedolizumab. In total, 54% of the CD- and 64% of the UC patients were in clinical remission at the end of follow-up, with the clinical activity decreasing (p<.0001 in both groups). Faecal-calprotectin decreased in CD (p<.0001) and in UC (p=.001), whereas CRP decreased in CD (p=.002) but not in UC (p=.11). Previous anti-TNF exposure (adjusted HR: 4.03; 95% CI: 0.96-16.75) and elevated CRP at baseline (adjusted HR: 2.22; 95% CI: 1.10-4.35) seemed to be associated with discontinuation because of lack of response. Female sex was associated with termination because of intolerance (adjusted HR: 2.75; 95% CI: 1.16-6.48).Conclusion: Vedolizumab-treated patients represent a treatment-refractory group. A long-term effect can be achieved, even beyond 1 year of treatment.
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| 8. |
- Hadid, Lina Z, et al.
(författare)
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Ring Shadowing Effects on Saturn's Ionosphere : Implications for Ring Opacity and Plasma Transport
- 2018
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Ingår i: Geophysical Research Letters. - : AMER GEOPHYSICAL UNION. - 0094-8276 .- 1944-8007. ; 45:19, s. 10084-10092
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Tidskriftsartikel (refereegranskat)abstract
- We present new results obtained by the Radio and Plasma Wave Science Langmuir probe on board Cassini during the Grand Finale. The total direct current sampled by the Langmuir probe at negative bias voltage is used to study the effect of the ring shadows on the structure of the Kronian topside ionosphere. The D and C rings and the Cassini Division are confirmed to be optically thin to extreme ultraviolet solar radiation. However, different responses from the opaque A and B rings are observed. The edges of the A ring shadow are shown to match the A ring boundaries, unlike the B ring, which indicates variable responses to the B ring shadow. We show that the variable responses are due to the ionospheric plasma, more precisely to the longer chemical lifetime of H+ compared to H-2(+) and H-3(+), suggesting that the plasma is transported from the sunlit region to the shadowed one in the ionosphere. Plain Language Summary As Saturn's northern hemisphere experienced summer during the Grand Finale, the planet's northern dayside hemisphere and its rings were fully illuminated by the Sun. However, the southern hemisphere was partly obscured because of the shadows cast by the A and B rings. Using the in situ measurements of the Langmuir probe part of the Radio and Plasma Wave Science investigation on board the Cassini spacecraft, we study for the first time the effect of the ring shadows on Saturn's ionosphere. From the ring shadows signatures on the total ion current collected by the Langmuir probe, we show that the A and B rings are optically thicker (to the solar extreme ultraviolet radiation) than the inner C and D rings and the Cassini Division to the solar extreme ultraviolet radiation. Moreover, we reproduce the boundaries of the A ring and the outer edge of the B ring. Furthermore, observed variations with respect to the inner edge of the B ring imply a delayed response of the ionospheric H+ because of its long lifetime and suggest that the ionospheric plasma is transported from an unshadowed region to a shadowed one in the ionosphere.
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| 9. |
- Hadid, Lina Z, et al.
(författare)
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Saturn's Ionosphere : Electron Density Altitude Profiles and D-Ring Interaction From The Cassini Grand Finale
- 2019
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Ingår i: Geophysical Research Letters. - 0094-8276 .- 1944-8007. ; 46:16, s. 9362-9369
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Tidskriftsartikel (refereegranskat)abstract
- We present the electron density (n(e)) altitude profiles of Saturn's ionosphere at near-equatorial latitudes from all 23 orbits of Cassini's Grand Finale. The data are collected by the Langmuir probe part of the Radio and Plasma Wave Science investigation. A high degree of variability in the electron density profiles is observed. However, organizing them by consecutive altitude ranges revealed clear differences between the southern and northern hemispheres. The n(e) profiles are shown to be more variable and connected to the D-ring below 5,000 km in the southern hemisphere compared to the northern hemisphere. This observed variability is explained to be a consequence of an electrodynamic interaction with the D-ring. Moreover, a density altitude profile is constructed for the northern hemisphere indicating the presence of three different ionospheric layers. Similar properties were observed during Cassini's final plunge, where the main ionospheric peak is crossed at similar to 1,550-km altitude. Plain Language Summary The Cassini Langmuir probe measured directly the uppermost layer of Saturn's atmosphere, the ionosphere, during its Grand Finale. The observations revealed a layered electron density altitude profile with evidence in the southern hemisphere of an electrodynamic type of interaction with the planet innermost D-ring. Moreover, the main peak of the ionosphere is observed for the first time in the final plunge around 1,550 km.
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| 10. |
- Hjortswang, Henrik, et al.
(författare)
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Health-related quality of life is impaired in active collagenous colitis
- 2011
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Ingår i: Digestive and Liver Disease. - : Elsevier BV. - 1590-8658 .- 1878-3562. ; 43:2, s. 102-109
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The characteristic clinical symptoms of collagenous colitis are non-bloody diarrhoea, urgency and abdominal pain. Treatment is aimed at reducing the symptom burden and the disease impact on patients' health-related quality of life. The objective of this study was to analyse health-related quality of life in patients with collagenous colitis. Methods: In a cross-sectional, postal HRQL survey, 116 patients with collagenous colitis at four Swedish hospitals completed four health-related quality of life questionnaires, two disease-specific (Inflammatory Bowel Disease Questionnaire and Rating Form of IBD Patient Concerns), and two generic (Short Form 36, SF-36, and Psychological General Well-Being, PGWB), and a one-week symptom diary. Demographic and disease-related data were collected. Results for the collagenous colitis population were compared with a background population controlled for age and gender (n = 8931). Results: Compared with a Swedish background population, patients with collagenous colitis scored significantly worse in all Short Form 36 dimensions (p < 0.01), except physical function. Patients with active disease scored worse health-related quality of life than patients in remission. Co-existing disease had an impact on health-related quality of life measured with the generic measures. Lower education level and shorter disease duration were associated with decreased well-being. Conclusion: Health-related quality of life was impaired in patients with collagenous colitis compared with a background population. Disease activity is the most important factor associated with impairment of health-related quality of life. Patients in remission have a health-related quality of life similar to a background population. (C) 2010 Published by Elsevier Ltd on behalf of Editrice Gastroenterologica Italiana S.r.l.
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