| 11. |
- Aulchenko, Yurii S, et al.
(författare)
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Loci influencing lipid levels and coronary heart disease risk in 16 European population cohorts
- 2009
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Ingår i: Nature Genetics. - : Springer Science and Business Media LLC. - 1061-4036 .- 1546-1718. ; 41:1, s. 47-55
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Tidskriftsartikel (refereegranskat)abstract
- Recent genome-wide association (GWA) studies of lipids have been conducted in samples ascertained for other phenotypes, particularly diabetes. Here we report the first GWA analysis of loci affecting total cholesterol (TC), low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol and triglycerides sampled randomly from 16 population-based cohorts and genotyped using mainly the Illumina HumanHap300-Duo platform. Our study included a total of 17,797-22,562 persons, aged 18-104 years and from geographic regions spanning from the Nordic countries to Southern Europe. We established 22 loci associated with serum lipid levels at a genome-wide significance level (P < 5 x 10(-8)), including 16 loci that were identified by previous GWA studies. The six newly identified loci in our cohort samples are ABCG5 (TC, P = 1.5 x 10(-11); LDL, P = 2.6 x 10(-10)), TMEM57 (TC, P = 5.4 x 10(-10)), CTCF-PRMT8 region (HDL, P = 8.3 x 10(-16)), DNAH11 (LDL, P = 6.1 x 10(-9)), FADS3-FADS2 (TC, P = 1.5 x 10(-10); LDL, P = 4.4 x 10(-13)) and MADD-FOLH1 region (HDL, P = 6 x 10(-11)). For three loci, effect sizes differed significantly by sex. Genetic risk scores based on lipid loci explain up to 4.8% of variation in lipids and were also associated with increased intima media thickness (P = 0.001) and coronary heart disease incidence (P = 0.04). The genetic risk score improves the screening of high-risk groups of dyslipidemia over classical risk factors.
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| 12. |
- Eklund, Arne, 1957-, et al.
(författare)
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Low Recurrence Rate After Laparoscopic (TEP) and Open(Lichtenstein) Inguinal Hernia RepairA Randomized, Multicenter Trial With 5-Year Follow-Up
- 2009
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Ingår i: Annals of Surgery. - : Lippincott Williams & Wilkins. - 0003-4932 .- 1528-1140. ; 249:1, s. 33-38
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To compare a laparoscopic (totally extraperitoneal patch (TEP)) and an open technique (Lichtenstein) for inguinal hernia repair regarding recurrence rate and possible risk factors for recurrence. Summary Background Data: Laparoscopic hernia repair has been introduced as an alternative to open repair. Short-term follow-up suggests benefits for those patients operated with a laparoscopic approach compared with open techniques; ie, less postoperative pain and a shorter convalescence period. Long-term results, however, are less well known. Methods: The study was conducted as a multicenter randomized trial with a 5-year follow-up. A total of 1512 men aged 30 to 70 years, with a primary unilateral inguinal hernia, were randomized to either TEP or Lichtenstein repair. Results: Overall, 665 patients in the TEP group and 705 patients in the Lichtenstein group were evaluable. The cumulative recurrence rate was 3.5% in the TEP group and 1.2% in the Lichtenstein group (P = 0.008). Test for heterogeneity revealed significant differences between individual surgeons. The exclusion of 1 surgeon, who was responsible for 33% (7 of 21) of all recurrences in the TEP group, lowered the cumulative recurrence rate to 2.4% in this group, which was not statistically different from that of the Lichtenstein group. Conclusions: The recurrence rate for both TEP and Lichtenstein repair was low. A higher cumulative recurrence rate in the TEP group was seen at 5 years. Further analysis revealed that this could be attributable to incorrect surgical technique.
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| 17. |
- McEvoy, Brian P., et al.
(författare)
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Geographical structure and differential natural selection among North European populations
- 2009
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Ingår i: Genome Research. - : Cold Spring Harbor Laboratory. - 1088-9051 .- 1549-5469. ; 19:5, s. 804-814
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Tidskriftsartikel (refereegranskat)abstract
- Population structure can provide novel insight into the human past, and recognizing and correcting for such stratification is a practical concern in gene mapping by many association methodologies. We investigate these patterns, primarily through principal component (PC) analysis of whole genome SNP polymorphism, in 2099 individuals from populations of Northern European origin (Ireland, United Kingdom, Netherlands, Denmark, Sweden, Finland, Australia, and HapMap European-American). The major trends (PC1 and PC2) demonstrate an ability to detect geographic substructure, even over a small area like the British Isles, and this information can then be applied to finely dissect the ancestry of the European-Australian and European-American samples. They simultaneously point to the importance of considering population stratification in what might be considered a small homogeneous region. There is evidence from FST-based analysis of genic and nongenic SNPs that differential positive selection has operated across these populations despite their short divergence time and relatively similar geographic and environmental range. The pressure appears to have been focused on genes involved in immunity, perhaps reflecting response to infectious disease epidemic. Such an event may explain a striking selective sweep centered on the rs2508049-G allele, close to the HLA-G gene on chromosome 6. Evidence of the sweep extends over a 8-Mb/3.5-cM region. Overall, the results illustrate the power of dense genotype and sample data to explore regional population variation, the events that have crafted it, and their implications in both explaining disease prevalence and mapping these genes by association.
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| 18. |
- Montgomery, Anna, 1974-
(författare)
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Counselling in Swedish Community Pharmacies : Understanding the Process of a Pharmaceutical Care Service
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Community pharmacy practice is moving towards patient care and away from the mere dispensing of medicines. In this movement, which is guided by the philosophy of Pharmaceutical care (PC), new counselling services emerge. The purpose of the thesis was to add knowledge about the real-world provision of PC services by studying a defined PC service in Swedish pharmacies. Specific aims of this thesis were to investigate the experiences of professionals working with or close to the service and to describe the content of consultations, counselling behaviour and patterns of follow-up. Further aims were to characterise patients receiving the service and describe their perceived outcomes, in relation to standard service. Data were collected via focus groups, telephone interviews, observations, a patient medication record database and a cross-sectional survey. The practitioners reported greater use of their pharmaceutical knowledge and provision of more thorough patient support. Perceived barriers in delivering the service included difficulties in documenting and getting commitment from colleagues, managers and prescribers. Doctors working close to PC pharmacies held varying opinions about the service. Consultations dealt with issues potentially improving the outcomes of medical treatment, but the level of patient centredness varied and was limited by the practitioners’ focus on the computer screen. The rate of follow-up evaluations was modest, but was higher at pharmacies with a high volume of patients receiving the service. PC patients were mostly elderly and female, using about 10 prescription drugs. In comparison to patients receiving standard service, they were more worried, vulnerable and information-seeking. At the same time, their feelings of safety following the pharmacy visit were more pronounced than those of patients receiving standard service. They also felt better prepared for doctor visits. In order for community pharmacy to better meet patients’ needs and optimise PC services, increased attention should be given to implementation strategies, interprofessional collaboration and educational efforts focusing on patient centredness.
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| 19. |
- Montgomery, Anna, et al.
(författare)
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Implementation of a pharmaceutical care service : prescriptionists', pharmacists' and doctors' views
- 2007
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Ingår i: Pharmacy World & Science. - : Springer Science and Business Media LLC. - 0928-1231 .- 1573-739X. ; 29:6, s. 593-602
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Tidskriftsartikel (refereegranskat)abstract
- Objective To identify prescriptionists’, pharmacists’ and doctors’ perceptions and experiences of a pharmaceutical care service supported by patient medication records (PMRs). Method Qualitative study employing focus group interviews with 16 prescriptionists and five pharmacists, and semi structured telephone interviews with 11 doctors. Main outcome measures Prescriptionists’, pharmacists’ and doctors’ views, experiences and perceptions of a pharmaceutical care service on Swedish community pharmacies. Results The provision of pharmaceutical care aided by PMRs had a positive influence on the prescriptionists’ and pharmacists’ daily work, and on their view of their professional role. They assumed greater professional responsibility, and described greater use of their pharmaceutical knowledge, greater confidence in practice and an increased awareness of their counselling role. They appreciated that the pharmaceutical care service provided an over-all picture of patients’ drug use, allowed for follow-up on counselling and made the prescriptionists’ and pharmacists’ competence tangible for patients. Perceived problems with the pharmaceutical care service included being time-consuming, record keeping being difficult, difficulty in getting understanding/support from colleagues and managers, and difficulty involving doctors. The majority of the doctors reported that they had not taken an active interest in the project, and their opinions of the pharmaceutical care service varied. Conclusion When prescriptionists and pharmacists apply the pharmaceutical care concept and work with PMRs, the patients are more likely to meet confident professionals that are more aware of the individual behind the drug therapy. This will hopefully contribute to informed, motivated medicine users that feel secure in their interactions with their pharmacy and receive, not only drugs, but treatment support. For such a service to be effective, however, it is vital to ensure that the doctors are fully co-operative.
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| 20. |
- Montgomery, A. T., et al.
(författare)
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Follow-up of patients receiving a pharmaceutical care service in Sweden
- 2008
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Ingår i: Journal of clinical pharmacy and therapeutics. - : Hindawi Limited. - 0269-4727 .- 1365-2710. ; 33:6, s. 653-62
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUNDPharmaceutical care (PC) services are increasingly provided in community pharmacies in the western world. Evaluations are often conducted as trials in highly controlled conditions measuring the efficacy of the service in terms of the economical, clinical and humanistic outcomes. Little is known about the real world provision of PC services and the factors associated with follow-up.OBJECTIVETo characterize patients receiving a PC service, to explore factors associated with follow-up evaluations, and to describe the results of pharmacists' interventions.METHODSA non-experimental, retrospective study using the Swedish national patient medication records data base. Patients receiving follow-up evaluations or one consultation within the service were compared using logistic regression.RESULTSA total of 3298 patients received the PC service at 240 community pharmacies. Patient characteristics included: 66.3% female, mean age 71.1 years, mean number of prescription drugs used 10.5, with 86.2% of patients using >or=1 cardiovascular drugs. A quarter (25.8%) of patients had >or=1 drug-related problems, most commonly side effects. Follow-up evaluations were carried out for 46.6% of the patients, who were more likely to use a compliance aid. Patients receiving the PC service at pharmacies that had enrolled more than the mean number of patients (13.7) had twice as high a chance of receiving follow-up than those registered with pharmacies with fewer patients (i.e. below the mean) enrolled. Followed-up interventions led to a better perceived outcome in 46.3% of cases, no change in 48.5% and a worse outcome in 5.2%.CONCLUSIONSThis study demonstrates that the total number of patients enrolled in a PC service predicts whether follow-up evaluations will take place or not more than do patient characteristics.
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