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Spiral drawing during self-rated dyskinesia is more impaired than during self-rated Off.

https://arctichealth.org/en/permalink/ahliterature116386
Source
Parkinsonism Relat Disord. 2013 May;19(5):553-6
Publication Type
Article
Date
May-2013
Author
Mevludin Memedi
Jerker Westin
Dag Nyholm
Author Affiliation
School of Technology and Business Studies, Computer Engineering, Dalarna University, Borlänge, Sweden.
Source
Parkinsonism Relat Disord. 2013 May;19(5):553-6
Date
May-2013
Language
English
Publication Type
Article
Keywords
Aged
Diagnostic Self Evaluation
Dyskinesias - diagnosis - physiopathology - psychology
Female
Humans
Italy - epidemiology
Longitudinal Studies
Male
Middle Aged
Motor Skills - physiology
Parkinson Disease - diagnosis - physiopathology - psychology
Sweden - epidemiology
Telemedicine - methods
Abstract
The purpose of this study was to examine repeated measures of fine motor function in relation to self-assessed motor conditions in Parkinson's disease (PD).
One-hundred PD patients, 65 with advanced PD and 35 patients with different disease stages have utilized a test battery in a telemedicine setting. On each test occasion, they initially self-assessed their motor condition (from 'very off' to 'very dyskinetic') and then performed a set of fine motor tests (tapping and spiral drawings).
The motor tests scores were found to be the best during self-rated On. Self-rated dyskinesias caused more impaired spiral drawing performance (mean = 9.8% worse, P 
PubMed ID
23402993 View in PubMed
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Short-term cost and health consequences of duodenal levodopa infusion in advanced Parkinson's disease in Sweden: an exploratory study.

https://arctichealth.org/en/permalink/ahliterature148212
Source
Appl Health Econ Health Policy. 2009;7(3):167-80
Publication Type
Article
Date
2009
Author
Ivar Sønbø Kristiansen
Kerstin Bingefors
Dag Nyholm
Dag Isacson
Author Affiliation
Department of Health Management and Health Economics, University of Oslo, Oslo, Norway. ivarsk@c21.net
Source
Appl Health Econ Health Policy. 2009;7(3):167-80
Date
2009
Language
English
Publication Type
Article
Keywords
Aged
Antiparkinson Agents - administration & dosage - economics - therapeutic use
Cost-Benefit Analysis
Cross-Over Studies
Decision Trees
Drug Costs
Duodenum - physiology
Female
Humans
Levodopa - administration & dosage - economics
Male
Middle Aged
Parkinson Disease - drug therapy - economics
Quality-Adjusted Life Years
Sweden
Abstract
Levodopa is the cornerstone treatment for Parkinson's disease, but the short half-life of levodopa limits its usefulness in late stages of the disease. Duodenal levodopa infusion (DLI) allows more stable plasma levels and better motor symptom control. To explore the costs and health benefits of replacing conventional oral polypharmacy with DLI in patients with advanced Parkinson's disease, from a Swedish healthcare payer perspective. Based on a clinical, randomized, crossover study with 24 patients (DIREQT), a decision analytic model predicted 2-year drug costs and QALYs for conventional oral therapy and for DLI. Health-related quality of life (HR-QOL) was recorded using a 15-dimensional (15D) utility instrument at baseline and during the two 3-week trial periods, and then at eight follow-up visits during the subsequent 6 months. Use of medication was based on data from DIREQT and previous studies. Unit costs were based on market prices (drugs) and customary charges in Sweden. All costs were expressed in Swedish kronor (SEK), year 2004 values euro 1.00 approximately SEK9.17, $US1.00 = SEK7.47). Future costs and outcomes were discounted at 3%. One-way and probabilistic sensitivity analyses were conducted. The mean utility scores were 0.77 for DLI and 0.72 for conventional therapy (p = 0.02). A considerable variation in the scores was observed during the study. The expected per-patient 2-year cost of DLI was SEK562 000 while it was SEK172 000 for conventional therapy. The mean number of QALYs was 1.48 and 1.42, respectively, representing an incremental cost of SEK6.1 million per QALY for DLI (all values discounted at 3%). Using other assumptions in sensitivity analyses, the cost per QALY could be as low as SEK456 000. This analysis can be considered exploratory only; it is based on very limited data. Nevertheless, our findings suggest that DLI results in a significant improvement in HR-QOL. However, the cost per QALY is likely to be higher than customary cost-effectiveness thresholds. Whether these benefits justify the additional costs depends on how the health benefits are measured and how these benefits are valued by society.
PubMed ID
19799471 View in PubMed
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A web application for follow-up of results from a mobile device test battery for Parkinson's disease patients.

https://arctichealth.org/en/permalink/ahliterature131834
Source
Comput Methods Programs Biomed. 2011 Nov;104(2):219-26
Publication Type
Article
Date
Nov-2011
Author
Mevludin Memedi
Jerker Westin
Dag Nyholm
Mark Dougherty
Torgny Groth
Author Affiliation
Department of Economy and Society, Computer Engineering, Dalarna University, Borlänge, Sweden. mmi@du.se
Source
Comput Methods Programs Biomed. 2011 Nov;104(2):219-26
Date
Nov-2011
Language
English
Publication Type
Article
Keywords
Follow-Up Studies
Humans
Internet
Parkinson Disease - physiopathology
Sweden
Abstract
This paper describes a web-based system for enabling remote monitoring of patients with Parkinson's disease (PD) and supporting clinicians in treating their patients. The system consists of a patient node for subjective and objective data collection based on a handheld computer, a service node for data storage and processing, and a web application for data presentation. Using statistical and machine learning methods, time series of raw data are summarized into scores for conceptual symptom dimensions and an "overall test score" providing a comprehensive profile of patient's health during a test period of about one week. The handheld unit was used quarterly or biannually by 65 patients with advanced PD for up to four years at nine clinics in Sweden. The IBM Computer System Usability Questionnaire was administered to assess nurses' satisfaction with the web application. Results showed that a majority of the nurses were quite satisfied with the usability although a sizeable minority were not. Our findings support that this system can become an efficient tool to easily access relevant symptom information from the home environment of PD patients.
PubMed ID
21872355 View in PubMed
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Pharmacokinetics of levodopa, carbidopa, and 3-O-methyldopa following 16-hour jejunal infusion of levodopa-carbidopa intestinal gel in advanced Parkinson's disease patients.

https://arctichealth.org/en/permalink/ahliterature118230
Source
AAPS J. 2013 Apr;15(2):316-23
Publication Type
Article
Date
Apr-2013
Author
Dag Nyholm
Per Odin
Anders Johansson
Krai Chatamra
Charles Locke
Sandeep Dutta
Ahmed A Othman
Author Affiliation
Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden.
Source
AAPS J. 2013 Apr;15(2):316-23
Date
Apr-2013
Language
English
Publication Type
Article
Keywords
Aged
Antiparkinson Agents - administration & dosage - adverse effects - blood - chemistry - pharmacokinetics
Biotransformation
Carbidopa - administration & dosage - adverse effects - blood - chemistry - pharmacokinetics
Chemistry, Pharmaceutical
Drug Combinations
Female
Gels
Germany
Humans
Infusion Pumps
Intestinal Absorption
Intubation, Gastrointestinal - instrumentation
Jejunum - metabolism
Levodopa - administration & dosage - adverse effects - blood - chemistry - pharmacokinetics
Male
Middle Aged
Parkinson Disease - blood - diagnosis - drug therapy
Sweden
Tyrosine - analogs & derivatives - blood - pharmacokinetics
Abstract
Motor complications of Parkinson's disease (PD) are a consequence of pulsatile dopaminergic stimulation from standard oral levodopa therapy. Levodopa-carbidopa intestinal gel (LCIG) is infused continuously via an intrajejunal percutaneous gastrostomy tube. This was the first study designed to characterize the full pharmacokinetic profiles of levodopa, carbidopa, and levodopa metabolite, 3-O-methyldopa (3-OMD) with 16-h LCIG infusion. Nineteen advanced PD patients (mean age, 65 years) who were on LCIG therapy for =30 days were enrolled. Patients received their individualized LCIG infusion doses, and serial pharmacokinetic samples were collected. Eighteen patients completed the study; 19 were assessed for safety. Mean (SD) total levodopa and carbidopa doses were 1,580 (403) and 395 (101) mg, respectively. Mean (SD) C(avg) (µg/mL) were 2.9 (0.84) for levodopa, 17.1 (4.99) for 3-OMD, and 0.22 (0.08) for carbidopa. The degree of fluctuation [defined as (C(max)-C(min))/C(avg)] in levodopa, 3-OMD, and carbidopa plasma concentrations was very low (0.52, 0.21, and 0.96, respectively) during hours 2-16 of infusion. Accordingly, the within-subject coefficients of variation in levodopa, 3-OMD, and carbidopa concentrations were low (13%, 6%, and 19%, respectively). Three patients (16%) reported =1 treatment-emergent adverse event; none were considered severe. Continuous intrajejunal LCIG infusion maintained stable plasma levodopa levels over 16 h. Consistent exposure has been shown to reduce motor and nonmotor complications associated with oral medications. LCIG was well tolerated, consistent with previous reports.
Notes
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PubMed ID
23229334 View in PubMed
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