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Adherence to national diabetes guidelines through monitoring quality indicators--A comparison of three types of care for the elderly with special emphasis on HbA1c.

https://arctichealth.org/en/permalink/ahliterature271560
Source
Prim Care Diabetes. 2015 Aug;9(4):253-60
Publication Type
Article
Date
Aug-2015
Author
Ann-Sofie Nilsson Neumark
Lars Brudin
Thomas Neumark
Source
Prim Care Diabetes. 2015 Aug;9(4):253-60
Date
Aug-2015
Language
English
Publication Type
Article
Keywords
Aged, 80 and over
Biomarkers - blood
Blood Glucose - drug effects - metabolism
Cross-Sectional Studies
Diabetes Mellitus, Type 1 - blood - diagnosis - drug therapy - epidemiology
Diabetes Mellitus, Type 2 - blood - diagnosis - drug therapy - epidemiology
Female
Guideline Adherence - standards
Health Services for the Aged - standards
Hemoglobin A, Glycosylated - metabolism
Home Care Services
Homes for the Aged
Humans
Hypoglycemic Agents - adverse effects - therapeutic use
Independent living
Male
Nursing Homes
Practice Guidelines as Topic - standards
Practice Patterns, Physicians' - standards
Prevalence
Process Assessment (Health Care) - standards
Quality Indicators, Health Care - standards
Sweden - epidemiology
Treatment Outcome
Abstract
To compare adherence to Swedish guidelines for diabetes care between elderly people living at home with or without home health care, and residents of nursing homes.
Medical records of 277 elderly people aged 80 and older, with known diabetes in a Swedish municipality, were monitored using quality indicators to evaluate processes and outcomes.
Monitoring, in accordance to diabetes guidelines, of HbA1c, lipids, blood pressure and foot examinations was lower among residents of nursing homes (p
PubMed ID
25865853 View in PubMed
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Ante- and intrapartum risk factors for neonatal hypoxic ischemic encephalopathy.

https://arctichealth.org/en/permalink/ahliterature295085
Source
J Matern Fetal Neonatal Med. 2018 Jun; 31(12):1595-1601
Publication Type
Journal Article
Date
Jun-2018
Author
Cecilia Lundgren
Lars Brudin
Anna-Stina Wanby
Marie Blomberg
Author Affiliation
a Department of Obstetrics and Gynecology , Kalmar County Hospital , Kalmar , Sweden.
Source
J Matern Fetal Neonatal Med. 2018 Jun; 31(12):1595-1601
Date
Jun-2018
Language
English
Publication Type
Journal Article
Keywords
Adult
Female
Humans
Hypoxia-Ischemia, Brain - epidemiology
Incidence
Infant, Newborn
Pregnancy
Retrospective Studies
Risk factors
Sweden - epidemiology
Abstract
To identify obstetrical risk factors for the diagnosis of neonatal hypoxic ischemic encephalopathy (HIE). A secondary aim was to determine the incidence of HIE.
A retrospective cohort study including 36,086 women with singleton term pregnancies giving live births in Sweden between 2009 and 2013. Cases of HIE were identified from three different sources. Risk factors for HIE were evaluated using univariate and multivariate analyses. Cases of HIE were extracted from available Swedish Medical Health registers to determine incidence.
A diagnosis of HIE was associated with: acute obstetrical events, mode of delivery other than unassisted vaginal birth, abnormal CTG admission test, and nulliparity. The incidence of HIE was 1.7/1000 infants born.
Acute obstetrical events will always occur, and some of the risk factors for these events are not responsive to interventions, but a careful risk assessment could lower the risk associated with acute obstetrical events. By alertness to early symptoms and timely measures taken by a trained staff at the delivery unit, damage could be reduced.
PubMed ID
28486858 View in PubMed
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Antibiotic prescribing in primary care by international medical graduates and graduates from Swedish medical schools.

https://arctichealth.org/en/permalink/ahliterature270259
Source
Fam Pract. 2015 Jun;32(3):343-7
Publication Type
Article
Date
Jun-2015
Author
Thomas Neumark
Lars Brudin
Sigvard Mölstad
Source
Fam Pract. 2015 Jun;32(3):343-7
Date
Jun-2015
Language
English
Publication Type
Article
Keywords
Adult
Anti-Bacterial Agents - therapeutic use
Drug Utilization - standards - statistics & numerical data
Education, Medical - statistics & numerical data
Electronic Health Records
Female
Foreign Medical Graduates - standards - statistics & numerical data
Geography
Guideline Adherence - statistics & numerical data
Humans
Male
Middle Aged
Practice Patterns, Physicians' - standards - statistics & numerical data
Primary Health Care - methods - standards - statistics & numerical data
Retrospective Studies
Schools, Medical - statistics & numerical data
Sweden
Abstract
Studies of antibiotic prescribing related to diagnosis comparing prescribers trained abroad with those trained in Sweden are lacking.
To determine whether general practices (GPs) and GP residents trained abroad had different prescribing patterns for antibiotics for common infections than those trained in Sweden using retrospective data from electronic patient records from primary health care in Kalmar County, Sweden.
Consultations with an infection diagnosis, both with and without the prescription of antibiotics to 67 GPs and residents trained in Western Europe outside Sweden and other countries, were compared with a matched control group trained in Sweden.
For 1 year, 44101 consultations of patients with an infection diagnosis and 16276 prescriptions of antibiotics were registered. Foreign-trained physicians had 20% more visits compared with physicians trained in Sweden. The prescription of antibiotics per visit and physician in the respective groups, and independent of diagnosis, did not significantly differ between groups, when scaled down from number of consultations to number of prescribing physicians.
There were minor and non-significant differences in antibiotic prescribing comparing GPs and residents trained abroad and in Sweden, most likely the result of an adaptation to Swedish conditions. Nevertheless, no group prescribed antibiotics in accordance to national guidelines. The results suggest that interventions are needed to reduce irrational antibiotic prescribing patterns, targeting all physicians working in Swedish primary health care.
PubMed ID
25715961 View in PubMed
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Antipsychotics associated with pulmonary embolism in a Swedish medicolegal autopsy series.

https://arctichealth.org/en/permalink/ahliterature155667
Source
Int Clin Psychopharmacol. 2008 Sep;23(5):263-8
Publication Type
Article
Date
Sep-2008
Author
Anna K Jönsson
Lars Brudin
Johan Ahlner
Karin Hedenmalm
Anders Eriksson
Staffan Hägg
Author Affiliation
Faculty of Health Sciences, Division of Clinical Pharmacology, Linköping University, Linköping, Sweden. anna.k.jonsson@lio.se
Source
Int Clin Psychopharmacol. 2008 Sep;23(5):263-8
Date
Sep-2008
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Antipsychotic Agents - adverse effects - analysis
Autopsy
Cause of Death
Chromatography, Gas
Female
Humans
Logistic Models
Male
Middle Aged
Odds Ratio
Pulmonary Embolism - epidemiology - pathology
Sweden - epidemiology
Abstract
To determine the association between fatal pulmonary embolism and use of antipsychotic drugs in a Swedish medicolegal autopsy series. Persons aged 18-65 years and subjected to a medicolegal autopsy in 1992-2005 were selected. On the basis of external cause of death, determined by the forensic pathologist, unnatural deaths (including fatal intoxications) were excluded and participants in whom pulmonary embolism was the cause of death were identified. Use of antipsychotics was based on the results of the postmortem analyses and categorized as use of high-potency first-generation antipsychotics, low-potency first-generation antipsychotics, second-generation antipsychotics or no use of antipsychotics. Logistic regression analyses were performed. Use of antipsychotics was verified in 538 of the 14,439 included participants. Pulmonary embolism was recorded as the cause of death in 279 participants and 33 of these used antipsychotics. Use of low-potency first-generation antipsychotics and second-generation antipsychotics was significantly associated with fatal pulmonary embolism (adjusted odds ratio: 2.39; 95% confidence interval: 1.46-3.92 and 6.91; 95% confidence interval: 3.95-12.10, respectively). Out of 26 participants classified as high-potency first-generation antipsychotic drug users, none had pulmonary embolism as the cause of death. Pulmonary embolism was overrepresented among medicolegal autopsy cases identified as users of low-potency first-generation and second-generation antipsychotics.
PubMed ID
18703935 View in PubMed
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A comparative study of three methods to evaluate an intervention to improve empirical antibiotic therapy for acute bacterial infections in hospitalized patients.

https://arctichealth.org/en/permalink/ahliterature138499
Source
Scand J Infect Dis. 2011 Apr;43(4):251-7
Publication Type
Article
Date
Apr-2011
Author
Thomas Schön
Lisa Labbé Sandelin
Jonas Bonnedahl
Fredrika Hedebäck
Annika Wistedt
Lars Brudin
Per-Åke Jarnheimer
Author Affiliation
Department of Clinical Microbiology, Kalmar County Hospital, Sweden. thomassc@ltkalmar.se
Source
Scand J Infect Dis. 2011 Apr;43(4):251-7
Date
Apr-2011
Language
English
Publication Type
Article
Keywords
Anti-Bacterial Agents - therapeutic use
Bacteremia - drug therapy - mortality
Cephalosporins - therapeutic use
Clostridium Infections - epidemiology
Clostridium difficile - isolation & purification
Drug Therapy - methods - standards
Fluoroquinolones - therapeutic use
Guidelines as Topic
Hospitals
Humans
Incidence
Intervention Studies
Penicillin G - therapeutic use
Staphylococcal Infections - epidemiology
Staphylococcus aureus - isolation & purification
Sweden
Abstract
In order to limit the use of broad-spectrum antibiotics, standardized empirical therapy against acute bacterial infections has been advocated.
Guidelines for acute bacterial infections recommending increased usage of benzylpenicillin and restricted use of fluoroquinolones and cephalosporins have been implemented in Kalmar County, Sweden. We evaluated this strategy by recording therapy in patients with bacteraemia, antibiotic requisition, and point prevalence surveys prior to this intervention and at 6 and 12 months after.
Comparing the methods simultaneously, there was good agreement between them and an overall significant change in antibiotic usage. There was a significant shift from cefuroxime to cefotaxime and a borderline significant increase in the use of benzylpenicillin (p = 0.057). Based on the defined daily dose (DDD), a highly significant decrease in total cefotaxime and cefuroxime usage was observed that was not detected when applying the prescribed daily dose (PDD), which is adapted to local treatment practices. No change was found in mortality in Staphylococcus aureus bacteraemia or the incidence of Clostridium difficile infection.
We conclude that the implementation of the new guidelines has resulted in a significant change in antibiotic usage, which could be conveniently monitored by antibiotic requisition if PDD is used in addition to DDD.
PubMed ID
21171827 View in PubMed
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Cumulated time with low bispectral index values is not related to the risk of new cancer or death within 5 years after surgery in patients with previous or prevailing malignancy.

https://arctichealth.org/en/permalink/ahliterature104671
Source
Anesth Analg. 2014 Apr;118(4):782-7
Publication Type
Article
Date
Apr-2014
Author
Maj-Lis Lindholm
Lars Brudin
Rolf H Sandin
Author Affiliation
From the Departments for *Anesthesia and Intensive Care and †Clinical Physiology, Lanssjukhuset, Kalmar; Department of Medicine and Health Sciences, University Hospital Linköping, Linköping; and ‡Section for Anesthesiology and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden.
Source
Anesth Analg. 2014 Apr;118(4):782-7
Date
Apr-2014
Language
English
Publication Type
Article
Keywords
Adult
Aged
Anesthesia - methods
Anesthesia, General
Anesthetics, Inhalation
Cohort Studies
Consciousness Monitors
Female
Humans
Kaplan-Meier Estimate
Male
Methyl Ethers
Middle Aged
Neoplasms - epidemiology - mortality - surgery
Proportional Hazards Models
Prospective Studies
Registries
Risk
Survival Analysis
Sweden - epidemiology
Treatment Outcome
Abstract
Preclinical data indicate that anesthesia and surgery may promote cancer growth. We previously found no increased risk of malignant disease within 5 years regarding duration of general anesthesia (TANESTH) and time with Bispectral Index (BIS) under 45 (TBIS
PubMed ID
24651233 View in PubMed
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Directly measured free 25-hydroxy vitamin D levels show no evidence of vitamin D deficiency in young Swedish women with anorexia nervosa.

https://arctichealth.org/en/permalink/ahliterature294929
Source
Eat Weight Disord. 2018 Apr; 23(2):247-254
Publication Type
Journal Article
Date
Apr-2018
Author
Martin Carlsson
Lars Brudin
Pär Wanby
Author Affiliation
Department of Clinical Chemistry, County Hospital of Kalmar, Kalmar, Sweden.
Source
Eat Weight Disord. 2018 Apr; 23(2):247-254
Date
Apr-2018
Language
English
Publication Type
Journal Article
Keywords
Adult
Anorexia Nervosa - blood - complications
Female
Humans
Parathyroid Hormone - blood
Sweden
Vitamin D - analogs & derivatives - blood
Vitamin D Deficiency - blood - complications - diagnosis
Young Adult
Abstract
Anorexia nervosa (AN) is an eating disorder characterized by low fat mass complicated by osteoporosis. The role of circulating vitamin D in the development of bone loss in AN is unclear. Fat mass is known to be inversely associated with vitamin D levels measured as serum levels of total, protein-bound 25-hydroxyvitamin D, but the importance of directly measured, free levels of 25(OH)D has not been determined in AN. The aim of this study was to investigate vitamin D status, as assessed by serum concentrations of total and free serum 25(OH)D in patients with AN and healthy controls.
In female AN patients (n = 20), and healthy female controls (n = 78), total 25(OH)D was measured by LC-MS/MS, and free 25(OH)D with ELISA. In patients with AN bone mineral density (BMD) was determined with DEXA.
There were no differences between patients and controls in total or free S-25(OH)D levels (80 ± 31 vs 72 ± 18 nmol/L, and 6.5 ± 2.5 vs 5.6 ± 1.8 pg/ml, respectively), and no association to BMD was found. In the entire group of patients and controls, both vitamin D parameters correlated with BMI, leptin, and PTH.
The current study did not demonstrate a vitamin D deficiency in patients with AN and our data does not support vitamin D deficiency as a contributing factor to bone loss in AN. Instead, we observed a trend toward higher vitamin D levels in AN subjects compared to controls. Measurement of free vitamin D levels did not contribute to additional information.
Notes
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PubMed ID
28455680 View in PubMed
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Factors influencing the prescription of drugs of different price levels.

https://arctichealth.org/en/permalink/ahliterature116915
Source
Pharmacoepidemiol Drug Saf. 2013 Mar;22(3):286-93
Publication Type
Article
Date
Mar-2013
Author
Birgitta Semark
Sven Engström
Lars Brudin
Sven Tågerud
Kerstin Fredlund
Lars Borgquist
Göran Petersson
Author Affiliation
School of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden. birgitta.semark@lnu.se
Source
Pharmacoepidemiol Drug Saf. 2013 Mar;22(3):286-93
Date
Mar-2013
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Aged, 80 and over
Antidepressive Agents - economics
Bone Density Conservation Agents - economics
Cost-Benefit Analysis
Drug Costs
Drug Utilization - economics
Drug Utilization Review
Female
Humans
Hypoglycemic Agents - economics
Insurance, Health - economics
Logistic Models
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Pharmacoepidemiology
Physician's Practice Patterns - economics
Prescription Drugs - economics
Registries
Respiratory System Agents - economics
Sex Factors
Socioeconomic Factors
Sweden
Abstract
Socioeconomic factors have been suggested to influence the prescribing of newer and more expensive drugs. In the present study, individual and health care provider factors were studied in relation to the prevalence of differently priced drugs.
Register data for dispensed drugs were retrieved for 18?486 individuals in a county council in Sweden. The prevalence of dispensed drugs was combined with data for the individual's gender, age, education, income, foreign background, and type of caregiver. For each of the diagnostic groups (chronic obstructive pulmonary disease [COPD], depression, diabetes, and osteoporosis), selected drugs were dichotomized into cost categories, lower and higher price levels. Univariate and multivariate logistic regressions were performed using cost category as the dependent variable and the individual and provider factors as independent variables.
In all four diagnostic groups, differences were observed in the prescription of drugs of lower and higher price levels with regard to the different factors studied. Age and gender affected the prescription of drugs of lower and higher price levels more generally, except for gender in the osteoporosis group. Income, education, foreign background, and type of caregiver affected prescribing patterns but in different ways for the different diagnostic groups.
Certain individual and provider factors appear to influence the prescribing of drugs of different price levels. Because the average price for the cheaper drugs versus more costly drugs in each diagnostic group was between 19% and 69%, there is a risk that factors other than medical needs are influencing the choice of drug.
PubMed ID
23349104 View in PubMed
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Impact of comorbidity on survival in peripheral T-cell lymphomas: A Swedish Lymphoma Registry study.

https://arctichealth.org/en/permalink/ahliterature290401
Source
Hematol Oncol. 2018 Feb; 36(1):159-165
Publication Type
Journal Article
Date
Feb-2018
Author
Fredrik Ellin
Mats Jerkeman
Jenny Törnqvist
Lars Brudin
Thomas Relander
Author Affiliation
Department of Internal Medicine, Kalmar County Hospital, Kalmar, Sweden.
Source
Hematol Oncol. 2018 Feb; 36(1):159-165
Date
Feb-2018
Language
English
Publication Type
Journal Article
Keywords
Adolescent
Adult
Aged
Comorbidity
Female
Humans
Lymphoma, T-Cell, Peripheral - complications - mortality
Male
Middle Aged
Registries
Survival Analysis
Sweden
Treatment Outcome
Young Adult
Abstract
Comorbidity impacts survival in B-cell lymphoma patients, but the influence in peripheral T-cell lymphomas (PTCLs) has been little studied. To investigate the impact of comorbidity on outcome in PTCL, we identified adult patients with newly diagnosed PTCL from 2000 to 2009 in the Swedish Lymphoma Registry. Data on comorbidity at diagnosis were retrospectively collected according to the Charlson Comorbidity Index (CCI). Comorbid conditions were present in 263 out of 694 (38%) patients. A CCI score of =2 was associated with inferior overall survival (OS) (hazard ratio [HR] 1.63, P 0 was associated with inferior OS (HR 2.40, P = .013). Chemotherapy regimens were classified as curative or low-intensity treatments. Among patients aged =75 years (n = 214), low-intensity and curative treatment groups had similar OS (HR 0.8, P = .6), also when adjusted for CCI. In summary, our results demonstrate CCI to be independently associated with survival in PTCLs. Even limited comorbidity impacted survival after front-line auto SCT, which needs to be considered in treatment decisions. Intensive anthracycline-based chemotherapy in elderly PTCL patients might be of limited benefit.
PubMed ID
28474339 View in PubMed
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Improved survival in metastatic breast cancer 1985-2016.

https://arctichealth.org/en/permalink/ahliterature280805
Source
Breast. 2017 Feb;31:46-50
Publication Type
Article
Date
Feb-2017
Author
Marie Sundquist
Lars Brudin
Göran Tejler
Source
Breast. 2017 Feb;31:46-50
Date
Feb-2017
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antineoplastic Agents - therapeutic use
Breast Neoplasms - mortality - pathology - therapy
Disease-Free Survival
Female
Humans
Kaplan-Meier Estimate
Middle Aged
Neoplasm Metastasis
Proportional Hazards Models
Receptor, erbB-2 - analysis
Registries
Survival Rate - trends
Sweden - epidemiology
Trastuzumab - therapeutic use
Abstract
In the last 25 years new treatment options in breast cancer have evolved. We wanted to determine whether the survival of; patients with metastatic breast cancer have improved during this period.
Patients consecutively diagnosed with disseminated breast cancer 1985-2014 in the County of Kalmar, Sweden, were identified and followed to 2016. Survival was calculated for each successive 5 year interval. Separate analyses were performed for pts with ER and/or PR and HER2 positive tumours resp.
Median survival of the 784 patients increased successively from 13 to 33 months. Five year survival increased from 10 to 27%. Patients with high grade primary tumours had the shortest post recurrence survival time but their median survival increased significantly by time from 12 to 30 months, 3 year survival from 16 to 38% and 5 year from 5 to 20%. Median survival for patients with grade 2 tumours was 2 years and did not improve. Only 47 patients had grade 1 tumours and their median survival of 4 years did not change. Median survival for HER2 positive patients treated before the introduction of trastuzumab in year 2000 was 14 months and after 2000 29 months, 5 year survival improved from 2 to 31%.
Survival in metastatic breast cancer improved 1985-2016. For the first time a significant increase in survival time for patients with metastasis from fast-growing grade 3 tumours was seen. The most striking improvement was achieved in the HER2 positive subset.
PubMed ID
27810699 View in PubMed
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12 records – page 1 of 2.