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- Palumbo, A., et al.
(författare)
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Prevention of thalidomide- and lenalidomide-associated thrombosis in myeloma
- 2008
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Ingår i: Leukemia. - : Springer Science and Business Media LLC. - 1476-5551 .- 0887-6924. ; 22:2, s. 414-423
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Tidskriftsartikel (refereegranskat)abstract
- The incidence of venous thromboembolism (VTE) is more than 1%omicron annually in the general population and increases further in cancer patients. The risk of VTE is higher in multiple myeloma (MM) patients who receive thalidomide or lenalidomide, especially in combination with dexamethasone or chemotherapy. Various VTE prophylaxis strategies, such as low-molecular-Weight heparin (LMWH), warfarin or aspirin, have been investigated in small, uncontrolled clinical studies. This manuscript summarizes the available evidence and recommends a prophylaxis strategy according to a risk-assessment model. Individual risk factors for thrombosis associated with thalidomide/lenalidomide-based therapy include age, history of VTE, central venous catheter, comorbidities (infections, diabetes, cardiac disease), immobilization, surgery and inherited thrombophilia. Myeloma-related risk factors include diagnosis and hyperviscosity. VTE is very high in patients who receive high-dose dexamethasone, doxorubicin or multiagent chemotherapy in combination with thalidomide or lenalidomide, but not with bortezomib. The panel recommends aspirin for patients with <= 1 risk factor for VTE. LMWH (equivalent to enoxaparin 40 mg per day) is recommended for those with two or more individual/myeloma-related risk factors. LMWH is also recommended for all patients receiving concurrent high-dose dexamethasone or doxorubicin. Full-dose warfarin targeting a therapeutic INR of 2-3 is an alternative to LMWH, although there are limited data in the literature with this strategy. In the absence of clear data from randomized studies as a foundation for recommendations, many of the following proposed strategies are the results of common sense or derive from the extrapolation of data from many studies not specifically designed to answer these questions. Further investigation is needed to define the best VTE prophylaxis.
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- Kyle, R. A., et al.
(författare)
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Monoclonal gammopathy of undetermined significance (MGUS) and smoldering (asymptomatic) multiple myeloma: IMWG consensus perspectives risk factors for progression and guidelines for monitoring and management
- 2010
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Ingår i: Leukemia. - : Springer Science and Business Media LLC. - 1476-5551 .- 0887-6924. ; 24:6, s. 1121-1127
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Forskningsöversikt (refereegranskat)abstract
- Monoclonal gammopathy of undetermined significance (MGUS) was identified in 3.2% of 21 463 residents of Olmsted County, Minnesota, 50 years of age or older. The risk of progression to multiple myeloma, Waldenstrom's macroglobulinemia, AL amyloidosis or a lymphoproliferative disorder is approximately 1% per year. Low-risk MGUS is characterized by having an M protein < 15 g/l, IgG type and a normal free light chain (FLC) ratio. Patients should be followed with serum protein electrophoresis at six months and, if stable, can be followed every 2-3 years or when symptoms suggestive of a plasma cell malignancy arise. Patients with intermediate and high-risk MGUS should be followed in 6 months and then annually for life. The risk of smoldering (asymptomatic) multiple myeloma (SMM) progressing to multiple myeloma or a related disorder is 10% per year for the first 5 years, 3% per year for the next 5 years and 1-2% per year for the next 10 years. Testing should be done 2-3 months after the initial recognition of SMM. If the results are stable, the patient should be followed every 4-6 months for 1 year and, if stable, every 6-12 months. Leukemia (2010) 24, 1121-1127; doi:10.1038/leu.2010.60; published online 22 April 2010
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- Busch, K., et al.
(författare)
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Sick leave and disability pension in patients with chronic hepatitis C compared with a matched general population: a nationwide register study
- 2020
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 10:9
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Tidskriftsartikel (refereegranskat)abstract
- Objective The objective of this study was to evaluate sick leave and disability pension in patients with chronic hepatitis C virus (HCV) infection as compared with a matched general population cohort. Design Retrospective register study. Setting Nationwide in Sweden. Participants This register-based study used the Swedish National Patient Register to identify working-age patients with HCV in 2012 (n=32 021) who were diagnosed between 1999 and 2007 (n=19 362). Sick leave and disability pension data were retrieved from Statistics Sweden (1994-2012), with up to five matched individuals from the general population. Primary and secondary outcome measures The primary outcome was workdays lost due to sick leave episodes (>14 days) and disability pension overall. The secondary outcome was workdays lost per subgroup of patients with chronic HCV. Results In 2012, 14% of the HCV patients had >= 1 registered sick leave episode compared with 10% in the matched comparator cohort. For disability pension benefits, results were 30% versus 8%, respectively. Overall, in 2012, 57% of patients with HCV did not have any registered workdays lost, whereas 30% were absent >= 360 days compared with 83% and 9% in the matched cohort, respectively. The mean total number of annual workdays lost in 2012 was 126 days in the HCV patient cohort compared with 40 days in the matched general population comparator cohort. Annual days lost increased from a mean of 86 days 5 years before diagnosis to 136 days during the year of diagnosis. Conclusions These results show that Swedish HCV patients used more sick days and have a higher frequency of disability pension compared with a comparator cohort from the general Swedish population. Whether earlier diagnosis of HCV and treatment might impact work absence in Sweden warrants further investigation.
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- Fonseca, Gregory J, et al.
(författare)
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Diverse motif ensembles specify non-redundant DNA binding activities of AP-1 family members in macrophages.
- 2019
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Ingår i: Nature Communications. - : Springer Science and Business Media LLC. - 2041-1723. ; 10:1
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Tidskriftsartikel (refereegranskat)abstract
- Mechanisms by which members of the AP-1 family of transcription factors play non-redundant biological roles despite recognizing the same DNA sequence remain poorly understood. To address this question, here we investigate the molecular functions and genome-wide DNA binding patterns of AP-1 family members in primary and immortalized mouse macrophages. ChIP-sequencing shows overlapping and distinct binding profiles for each factor that were remodeled following TLR4 ligation. Development of a machine learning approach that jointly weighs hundreds of DNA recognition elements yields dozens of motifs predicted to drive factor-specific binding profiles. Machine learning-based predictions are confirmed by analysis of the effects of mutations in genetically diverse mice and by loss of function experiments. These findings provide evidence that non-redundant genomic locations of different AP-1 family members in macrophages largely result from collaborative interactions with diverse, locus-specific ensembles of transcription factors and suggest a general mechanism for encoding functional specificities of their common recognition motif.
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- Hallencreutz, J., et al.
(författare)
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Important drivers for customer satisfaction : a Swedish crisis reflection
- 2024
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Ingår i: International Journal of Lean Six Sigma. - : Emerald Publishing. - 2040-4166 .- 2040-4174.
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The purpose of this study is to examine crisis effects on customer satisfaction and underlying drivers by adding a new set of data to previous research. The core questions are: are the findings from Hallencreutz and Parmler (2019, 2021) sustained or can new customer demands, needs, expectations and behaviours be traced in the wake of the ongoing crisis? Design/methodology/approach: A first study covering 2005–2017 was completed in 2018, published online in 2019 and in print in 2021 (Hallencreutz and Parmler, 2021). This new study adds the years 2018–2023 to the data set and reuses the partial least squares (PLS) approach to structural equation models, also known as PLS path modelling. Findings: This additional study sustains the results from the initial study (Hallencreutz and Parmler, 2019, 2021). The variable product quality has been substituted by service quality as one of the most crucial drivers for customer satisfaction together with brand image, and the current state of permacrisis has not changed that. Research limitations/implications: The study is built on Swedish data from the EPSI Rating Initiative (Eklöf and Westlund 2002) covering customer perceptions in banking, insurance (life and non-life), telco (mobile operators, broadband and Pay-tv) and energy (trade, distribution and heating) over the years 2005–2023. Practical implications: The study emphasizes the importance of understanding how customer satisfaction drivers evolve over time in different industries and societal sectors, especially during crises. This additional study sustains the paradigm shift in the studied industries – product quality has been substituted by service quality as one of the most crucial drivers for customer satisfaction, and the current state of economic downturn has not changed that. Social implications: Society will have to learn to live with political and economic instability and unpredictability for the foreseeable future. To recognize the increasing value deriving from firms’ intangible assets while providing flawless deliveries seems to be a way forward in troublesome times. This is also a catalyst for existing societal trends: the necessary reforms to master sustainable transformations will require an ongoing adaptation process, with both winners and losers across continents. Originality/value: The world has coped with a global pandemic, and Europe is currently experiencing a humanitarian, political and economic crises caused by a war in Ukraine. This extended period of global instability and insecurity could be called a permacrisis (Collins dictionary, 2022). This study offers a unique quantitative analysis built on Swedish data from EPSI Rating initiative.
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- Harbin, N. J., et al.
(författare)
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Does C-reactive protein predict time to recovery and benefit from oseltamivir treatment in primary care patients with influenza-like illness? A randomized controlled trial secondary analysis
- 2021
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 39:4, s. 527-532
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Tidskriftsartikel (refereegranskat)abstract
- Objective Recovery time and treatment effect of oseltamivir in influenza-like illness (ILI) differs between patient groups. A point-of-care test to better predict ILI duration and identify patients who are most likely to benefit from oseltamivir treatment would aid prescribing decisions in primary care. This study aimed to investigate whether a C-reactive protein (CRP) concentration of >= 30 mg/L can predict (1) ILI disease duration, and (2) which patients are most likely to benefit from oseltamivir treatment. Design Secondary analysis of randomized controlled trial data. Setting Primary care in Lithuania, Sweden and Norway during three consecutive influenza seasons 2016-2018. Subjects A total of 277 ILI patients aged one year or older and symptom duration of <= 72 h. Main outcome measures Capillary blood CRP concentration at baseline, and ILI recovery time defined as having 'returned to usual daily activity' with residual symptoms minimally interfering. Results At baseline, 20% (55/277) had CRP concentrations >= 30mg/L (range 0-210). CRP concentration >= 30 mg/L was not associated with recovery time (adjusted hazards ratio (HR) 0.80: 95% CI 0.50-1.3; p = 0.33). Interaction analysis of CRP concentration >= 30 mg/L and oseltamivir treatment did not identify which patients benefit more from oseltamivir treatment (adjusted HR 0.69: 95% CI 0.37-1.3; p = 0.23). Conclusion There was no association between CRP concentration of >= 30 mg/L and recovery time from ILI. Furthermore, CRP could not predict which ILI patients benefit more from oseltamivir treatment. Hence, we do not recommend CRP testing for predicting ILI recovery time or identifying patients who will receive particular benefit from oseltamivir treatment.
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| 21. |
- Jerkeman, Anna, et al.
(författare)
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Chronic hepatitis C in Swedish subjects receiving opiate substitution therapy-Factors associated with advanced fibrosis
- 2014
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Ingår i: Scandinavian Journal of Infectious Diseases. - : Informa Healthcare. - 0036-5548 .- 1651-1980. ; 46, s. 340-347
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Tidskriftsartikel (refereegranskat)abstract
- Background: Opiate substitution therapy (OST) reduces the risk of death from directly drug-related causes in heroin users, allowing other chronic health problems to emerge. People who inject drugs (PWID) are exposed to hepatitis C virus (HCV), with an associated risk of chronic liver disease. We investigated HCV prevalence and liver-related morbidity in a cohort of OST recipients, and analyzed factors associated with significant hepatic fibrosis. Methods: All patients registered on 1 April 2008 in 4 clinics providing OST in the 3 largest cities in Sweden were eligible for inclusion. HCV viremic subjects were evaluated for fibrosis stage by liver biopsy, transient elastometry (TE), and/or a biochemical fibrosis index (Göteborg University Cirrhosis Index; GUCI). Factors associated with severity of fibrosis were determined by logistic regression analysis. Results: Out of 524 eligible patients, 277 consented to enrolment. Two hundred and thirty-six subjects (88%) were anti-HCV-positive, and 162 of these were viremic (69%). Significant liver fibrosis (defined as Ishak stages F3-F6, TE value ≥ 8.85 kPa, or GUCI > 0.33) was found in 69 out of 103 (67%) tested viremic patients, and was associated with alcohol intake (p = 0.03), higher body mass index (BMI; p = 0.04), and the presence of anti-HBc antibodies (indicating exposure to hepatitis B virus (HBV); p = 0.02). Conclusions: Significant liver fibrosis was detected in two-thirds of HCV viremic OST recipients in this cohort, and was associated with alcohol use, high BMI, and exposure to HBV. These findings indicate that the management of HCV and associated risk factors should be emphasized in Swedish OST programs. © 2014 Informa Healthcare.
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| 22. |
- Jerkeman, A., et al.
(författare)
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Treatment for chronic hepatitis C in a cohort of opiate substitution therapy recipients in three Swedish cities - completion rates and efficacy
- 2014
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Ingår i: European Journal of Gastroenterology & Hepatology. - : Ovid Technologies (Wolters Kluwer Health). - 0954-691X. ; 26:5, s. 523-531
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Tidskriftsartikel (refereegranskat)abstract
- Objectives Opiate substitution treatment (OST) programs could provide opportunities for management of comorbidities, such as hepatitis C virus (HCV) infection, in people who inject drugs. We aimed to prospectively evaluate the real-life feasibility of interferon/ribavirin-based HCV treatment in OST recipients, with a special focus on psychiatric status and health-related quality of life. Patients from a cohort of OST recipients from three cities in Sweden were selected for HCV treatment on the basis of structured investigation for HCV-related liver disease. Therapy was delivered in collaboration between infectious disease and OST clinics, with monitoring for completion and adherence, treatment response, adverse events, health-related quality of life (HRQoL) (SF-36) and signs of depression (MADRS-S), or relapse into drug abuse. The primary endpoint was completion of prescribed treatment; the secondary endpoints were sustained virological response (SVR), adherence, and incidence of depression. Among 69 patients with an indication for antiviral therapy, 41 initiated treatment; 34/41 (83%) completed treatment and 19/41 (46%) achieved SVR. Adequate adherence was observed in 29/41 patients (71%). Two serious adverse events occurred, including one death because of liver failure. Baseline scores for self-assessed health were low, with a significant reduction during treatment. Seventy-one percent of patients (29/41) fulfilled the criteria for clinically significant depression at some time point during treatment. Baseline scores for HRQoL/MADRS-S were associated with treatment completion, SVR, and depression during treatment. Despite the low HRQoL and the high occurrence of depression, HCV treatment was feasible and showed satisfactory rates of completion in this cohort of unselected OST recipients.
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- Kronawitter, C. X., et al.
(författare)
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Titanium incorporation into hematite photoelectrodes : theoretical considerations and experimental observations
- 2014
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Ingår i: Energy & Environmental Science. - : Royal Society of Chemistry (RSC). - 1754-5692 .- 1754-5706. ; 7:10, s. 3100-3121
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Tidskriftsartikel (refereegranskat)abstract
- A theoretical and experimental perspective on the role of titanium impurities in hematite (alpha-Fe2O3) nanostructured photoelectrodes for solar fuel synthesis devices is provided. Titanium incorporation is a known correlate to efficiency enhancement in alpha-Fe2O3 cc photoanodes for solar water oxidation; here the relevant literature and the latest advances are presented and various proposed mechanisms for enhancement are contrasted. Available experimental evidence suggests that Ti incorporation increases net electron carrier concentrations in electrodes, most likely to the extent that (synthesis-dependent) charge compensating cation vacancies are not present. However, electron conductivity increases alone cannot quantitatively account for the large associated photoelectrochemical performance enhancements. The magnitudes of the effects of Ti incorporation on electronic and magnetic properties appear to be highly synthesis-dependent, which has made difficult the development of consistent and general mechanisms explaining experimental and theoretical observations. In this context, we consider how the electronic structure correlates with Ti impurity incorporation in alpha-Fe2O3 a from the perspective of synchrotron-based soft X-ray absorption spectroscopy measurements. Measurements are performed on sets of electrodes fabricated by five relevant and unrelated chemical and physical techniques. The effects of titanium impurities are reflected in the electronic structure through several universally observed spectral characteristics, irrespective of the synthesis techniques. Absorption spectra at the oxygen K-edge show that Ti incorporation is associated with new oxygen 2p-hybridized states, overlapping with and distorting the known unoccupied Fe 3d-O 2xp band of alpha-Fe2O3. This is an indication of mixing of Ti s and d states in the conduction band of alpha-Fe2O3. cc A comparison of spectra obtained with electron and photon detection shows that the effects of Ti incorporation on the conduction band are more pronounced in the near-surface region. Titanium L-2,L-3-edge absorption spectra show that titanium is incorporated into alpha-Fe2O3 as Ti4+ by all fabrication methods, with no long-range titania order detected. Iron L-2,L-3-edge absorption spectra indicate that Ti incorporation is not associated with the formation, of any significant concentrations of Fe2+, an observation common to many prior studies on this material system.
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| 25. |
- Kyle, RA, et al.
(författare)
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Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders: a report of the International Myeloma Working Group
- 2003
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Ingår i: British Journal of Haematology. - : Wiley. - 0007-1048. ; 121:5, s. 749-757
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Tidskriftsartikel (refereegranskat)abstract
- The monoclonal gammopathies are a group of disorders associated with monoclonal proliferation of plasma cells. The characterization of specific entities is an area of difficulty in clinical practice. The International Myeloma Working Group has reviewed the criteria for diagnosis and classification with the aim of producing simple, easily used definitions based on routinely available investigations. In monoclonal gammopathy of undetermined significance (MGUS) or monoclonal gammopathy, unattributed/unassociated (MG[u]), the monoclonal protein is < 30 g/l and the bone marrow clonal cells < 10% with no evidence of multiple myeloma, other B-cell proliferative disorders or amyloidosis. In asymptomatic (smouldering) myeloma the M-protein is greater than or equal to 30 g/l and/or bone marrow clonal cells greater than or equal to 10% but no related organ or tissue impairment (ROTI)(end-organ damage), which is typically manifested by increased calcium, renal insufficiency, anaemia, or bone lesions (CRAB) attributed to the plasma cell proliferative process. Symptomatic myeloma requires evidence of ROTI. Non-secretory myeloma is characterized by the absence of an M-protein in the serum and urine, bone marrow plasmacytosis and ROTI. Solitary plasmacytoma of bone, extramedullary plasmacytoma and multiple solitary plasmacytomas (+/- recurrent) are also defined as distinct entities. The use of these criteria will facilitate comparison of therapeutic trial data. Evaluation of currently available prognostic factors may allow better definition of prognosis in multiple myeloma.
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