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- Gerdtham, Ulf, et al.
(författare)
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Värdet av nya läkemedel: en förstudie
- 2011
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Denna rapport redovisar en förstudie till SNS fleråriga forskningsprojekt som undersöker hur värdet av nya läkemedel kan bedömas ur ett brett samhällsperspektiv. En slutsats av förstudien är att det finns goda möjligheter att få bättre svar på många av de policyfrågor som ställs i läkemedelspolitiken, t ex om förskrivning och offentlig subventionering av nya läkemedel. De omfattande svenska patientregistren erbjuder unika möjligheter att studera det faktiska, realiserade värdet av läkemedel.
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| 3. |
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| 4. |
- Persson, Tomas, 1972-, et al.
(författare)
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Emissions and deposit properties from combustion of wood pellet with magnesium additives
- 2013
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Ingår i: Journal of Fuel Chemistry and Technology. - : Elsevier. - 1872-5813. ; 41:5, s. 530-539
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Tidskriftsartikel (refereegranskat)abstract
- This work studies the amount of gaseous and particle emissions and deposits on heat exchanger surfaces in a boiler fired with commercially available pellets and with pellets primed with magnesium oxide and magnesium hydroxide. The combustion experiments were performed on a residential boiler of 20 kW. Substrates placed in the heat exchanger was analysed with SEM-EDX-mapping to evaluate the chemical composition of the deposits. The results show that particle emissions (PM 2.5) using the additives increased by about 50% and the mass of the deposits in the flue gas heat exchanger (excluding loose fly ash) increased by about 25% compared to the combustion of pellets without additives. The amount of additives was found to be eight times higher than the amount of the main alkali metals potassium (K) and sodium (Na) which leads to the assumption that the additives were overdosed and therefore caused the problems reported. The SEM analysis of the substrates placed in the flue gas heat exchanger indicate that the deposits of sodium (Na), potassium (K), chlorine (Cl) and sulphur (S) decrease using the additives. If this was due to the expected chemical reactions or due to the loose fly ash covering the substrates after the test, could not be determined in this study.
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| 6. |
- Ahlstrand, Erik, 1974-, et al.
(författare)
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Alteration of the colonization pattern of coagulase-negative staphylococci in patients undergoing treatment for hematological malignancy
- 2012
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Ingår i: European Journal of Clinical Microbiology and Infectious Diseases. - New York, USA : Springer. - 0934-9723 .- 1435-4373. ; 31:7, s. 1679-1687
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Tidskriftsartikel (refereegranskat)abstract
- The aim was to prospectively describe the colonization pattern of coagulase-negative staphylococci (CoNS) and the relationship between colonizing and invasive CoNS isolates among patients undergoing treatment for hematological malignancy. Fourteen newly diagnosed patients were included with either multiple myeloma or acute leukemia. Patients were repeatedly sampled from nares, throat, axillae, and perineum, and the CoNS isolates obtained were phenotypically characterized together with blood isolates of CoNS using the PhenePlate system (PhP). During the treatment a gradual reduction in the heterogeneity of colonizing CoNS was observed as well as an inter-patient accumulation of phenotypically related and multi-drug-resistant CoNS. These clusters of CoNS persisted for 2–3 months after the end of therapy. Ten positive blood cultures of CoNS were obtained and in the majority of these cases CoNS of the same PhP type were found in superficial cultures collected prior to the blood culture sampling. In conclusion, the study shows that therapy for hematological malignancy is associated with a homogenization of colonizing CoNS isolates and that this acquired flora of CoNS is persistent several months after the end of therapy. Furthermore, the results suggest that the source of bloodstream infections of CoNS in hematological patients is colonizing CoNS of the skin and mucosa.
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| 7. |
- Ahlstrand, Erik, 1974-, et al.
(författare)
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Evaluation of a PCR method to determine the clinical significance of blood cultures with Staphylococcus epidermidis in patients with hematological malignancies
- 2014
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Ingår i: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS). - : Wiley-Blackwell. - 0903-4641 .- 1600-0463. ; 122:6, s. 539-544
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Tidskriftsartikel (refereegranskat)abstract
- The aim was to investigate whether the detection and quantification of Staphylococcus epidermidis DNA in blood could distinguish S. epidermidis blood stream infections (BSIs) from blood culture contaminations in patients with hematological malignancies. The hld gene was chosen to identify S. epidermidis DNA and DNA in blood samples was detected by real-time PCR. Blood samples were obtained simultaneously with blood cultures positive for S. epidermidis (n = 30), during blood culture-negative episodes (n = 10) and episodes of bacteremia with other bacteria than S. epidermidis (n = 4) and from healthy blood donors (n = 10). In addition, DNA from S. epidermidis and a selection of other bacterial species were analyzed. Three different sets of criteria were used to classify episodes with positive blood cultures with S. epidermidis as BSIs or contaminations. All DNA preparations from S. epidermidis (n = 48) were hld-positive, but other bacterial species (n = 13) were negative. Sixteen (53%) of 30 blood samples from patients with blood cultures positive for S. epidermidis were hld-positive, but none of the controls. There was no clear association between a positive hld PCR and episodes interpreted as BSIs. In conclusion, hld PCR failed to distinguish S. epidermidis BSIs from blood culture contaminations in patients with hematological malignancies.
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| 8. |
- Ahlstrand, Erik, et al.
(författare)
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Glycopeptide resistance in coagulase-negative staphylococci isolated in blood cultures from patients with hematological malignancies during three decades
- 2011
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Ingår i: European Journal of Clinical Microbiology and Infectious Diseases. - : Springer Science and Business Media LLC. - 0934-9723 .- 1435-4373. ; 30:11, s. 1349-1354
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to determine if there was a long-term increase in glycopeptide minimum inhibitory concentration (MIC) values, MIC creep, among bloodstream isolates of Staphylococcus epidermidis and S. haemolyticus isolated from patients with hematological malignancies. We conducted a retrospective single-center study where all positive blood cultures of S. epidermidis (n = 387) and S. haemolyticus (n = 19) isolated from patients with hematological malignancies during three decades, 1980 to 2009, were re-evaluated for the presence of reduced susceptibility to vancomycin and teicoplanin. Three different methods for the detection of reduced susceptibility to glycopeptides were used; standard Etest, macromethod Etest, and glycopeptide resistance detection (GRD) Etest. The median MIC value for vancomycin was 2 mg/L. MIC values for vancomycin and teicoplanin did not show any statistically significant increase during the study period. The presence of heterogeneously glycopeptide-intermediate staphylococci (hGIS) was analyzed among 405 coagulase-negative staphylococci (CoNS) isolates. hGIS were found in 31-45% of the CoNS isolates by the macromethod Etest and in 53-67% by the GRD Etest during the three decades. In conclusion, we did not observe any long-term glycopeptide MIC creep determined by the standard Etest, although a high and increasing proportion of heterogeneous vancomycin resistance was observed.
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| 9. |
- Aman, J., et al.
(författare)
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Increased Fat Mass and Cardiac Septal Hypertrophy in Newborn Infants of Mothers with Well-Controlled Diabetes during Pregnancy
- 2011
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Ingår i: Neonatology. - : S. Karger AG. - 1661-7800 .- 1661-7819. ; 100:2, s. 147-154
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Tidskriftsartikel (refereegranskat)abstract
- Background: Improved glycaemic control during pregnancy in mothers with type 1 diabetes (T1DM) and gestational diabetes (GDM) has resulted in a marked reduction of perinatal mortality and morbidity, but the prevalence of macrosomia is usually high. Objective: We used non-invasive anthropometric methods to estimate the body composition and the thickness of the interventricular heart septum in 18 infants of mothers with well-controlled T1DM, 10 infants of mothers with GDM and 28 infants of healthy control mothers matched for gestational age and mode of delivery. Methods: Skinfold measurements were obtained with a Harpenden calliper within 48 h after delivery. Echocardiography was also performed to measure the thickness of the interventricular septum. Cord blood was sampled for assays of C-peptide, leptin and IGF-I. Results: The rates of macrosomia (gestational age-adjusted birth weight >2 standard deviation score, SDS) were 56 and 30% in infants of mothers with T1DM and GDM, respectively, compared to 10% in control infants. The body fat content was 40% (0.2 kg) higher and the interventricular heart septum thickness was increased by 20% in both groups of infants of diabetic mothers. We found no associations between maternal levels of HbA1c during pregnancy and body composition or interventricular heart septum thickness. Cord levels of C-peptide and leptin were significantly higher in infants of T1DM mothers than in control infants. Cord leptin level was associated with birth weight SDS and percent body fat in infants of T1DM mothers. IGF-I was associated with percent body fat in infants of GDM mothers and control mothers. A multiple-regression analysis showed that 50% of the variation in body weight SDS could be determined, with IGF-I, leptin and C-peptide as independent variables. Conclusion: Both fat mass and cardiac septal thickness are increased in newborn infants of women with T1DM and GDM in spite of efforts to achieve good glycaemic control during pregnancy.
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| 10. |
- Andersson, Bodil, et al.
(författare)
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Acute pancreatitis - costs for healthcare and loss of production.
- 2013
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 1502-7708 .- 0036-5521. ; 48:12, s. 1459-1465
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Objective. Severity of acute pancreatitis (AP) can vary from a mild to a fulminant disease with high morbidity and mortality. Cost analysis has, however, hitherto been sparse. The aim of this study was to calculate the cost of acute pancreatitis, both including hospital costs and costs due to loss of production. Material and methods. All adult patients treated at Skane University Hospital, Lund, during 2009-2010, were included. A severity grading was conducted and cost analysis was performed on an individual basis. Results. Two hundred and fifty-two patients with altogether 307 admissions were identified. Mean age was 60 ± 19 years, and 121 patients (48%) were men. Severe AP (SAP) was diagnosed in 38 patients (12%). Thirteen patients (5%) died. Acute biliary pancreatitis was more costly than alcohol induced AP (p < 0.001). Total costs for treating mild AP (MAP) in patients ≤65 years old was lower (p = 0.001) and costs for SAP was higher (p = 0.024), as compared to older patients. The overall hospital cost and cost for loss of production was per person in mean €5,100 ± 2,400 for MAP and €28,200 ± 38,100 for SAP (p < 0.001). The costs for treating AP during the two-year-long study period were in mean €9,762 ± 19,778 per patient. Extrapolated to a national perspective, the annual financial burden for AP in Sweden would be ∼ €38,500,000; corresponding to €4,100,000 per million inhabitants. Conclusions. The costs of treating AP are high, especially in severe cases with a long ICU stay. These results highlight the need to optimize care and continue the identification and focus on SAP, in order to try to limit organ failure and infectious complications.
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