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The cost of monitoring warfarin in patients with chronic atrial fibrillation in primary care in Sweden.

https://arctichealth.org/en/permalink/ahliterature78663
Source
BMC Fam Pract. 2007;8:6
Publication Type
Article
Date
2007
Author
Björholt Ingela
Andersson Stina
Nilsson Gunnar H
Krakau Ingvar
Author Affiliation
Institute of Clinical Sciences, Göteborg University, Göteborg, Sweden and Nordic Health Economic Research AB, Göteborg, Sweden. inb@nheresearch.se
Source
BMC Fam Pract. 2007;8:6
Date
2007
Language
English
Publication Type
Article
Keywords
Anticoagulants - economics - therapeutic use
Atrial Fibrillation - complications - epidemiology
Cerebrovascular Accident - prevention & control
Chronic Disease
Drug Monitoring - economics
Health Care Costs - statistics & numerical data
Humans
International Normalized Ratio - economics - statistics & numerical data
Prevalence
Primary Health Care - economics
Sweden - epidemiology
Time Factors
Warfarin - economics - therapeutic use
Abstract
BACKGROUND: Warfarin is used for the prevention of stroke in chronic atrial fibrillation. The product has a narrow therapeutic index and to obtain treatment success, patients must be maintained within a given therapeutic range (International Normalised Ratio;INR). To ensure a wise allocation of health care resources, scrutiny of costs associated with various treatments is justified. The objective of this study was to estimate the health care cost of INR controls in patients on warfarin treatment with chronic atrial fibrillation in primary care in Sweden. METHODS: Data from various sources were applied in the analysis. Resource consumption was derived from two observational studies based on electronic patient records and two Delphi-panel studies performed in two and three rounds, respectively. Unit costs were taken from official databases and primary health care centres. RESULTS: The mean cost of one INR control was SEK 550. The mean costs of INR controls during the first three months, the first year and during the second year of treatment were SEK 6,811, SEK 16,244 and SEK 8,904 respectively. CONCLUSION: INR controls of patients on warfarin treatment in primary care in Sweden represent a substantial cost to the health care provider and they are particularly costly when undertaken in home care. The cost may however be off-set by the reduced incidence of stroke.
PubMed ID
17324260 View in PubMed
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Dealing with sickness certification - a survey of problems and strategies among general practitioners and orthopaedic surgeons.

https://arctichealth.org/en/permalink/ahliterature84848
Source
BMC Public Health. 2007;7:273
Publication Type
Article
Date
2007
Author
Arrelöv Britt
Alexanderson Kristina
Hagberg Jan
Löfgren Anna
Nilsson Gunnar
Ponzer Sari
Author Affiliation
Department of Development in Health and Medical Services, FORUM, Box 175 33 Stockholm, Sweden. britt.arrelov@sll.se
Source
BMC Public Health. 2007;7:273
Date
2007
Language
English
Publication Type
Article
Keywords
Absenteeism
Adult
Certification
Cross-Sectional Studies
Family Practice - methods
Female
Humans
Male
Middle Aged
Odds Ratio
Orthopedics - methods
Physician's Practice Patterns
Physician-Patient Relations
Problem Solving
Questionnaires
Sick Leave - statistics & numerical data
Sweden
Work Capacity Evaluation
Abstract
BACKGROUND: In order to get sickness benefit a sick-listed person need a medical certificate issued by a physician; in Sweden after one week of self-certification. Physicians experience sick-listing tasks as problematic and conflicts may arise when patients regard themselves unable to work due to complaints that are hard to objectively verify for the physician. Most GPs and orthopaedic surgeons (OS) deal regularly with sick-listing issues in their daily practice. The aim of this study was to explore perceived problems and coping strategies related to tasks of sickness certification among general practitioners (GP) and orthopaedic surgeons (OS). METHODS: A cross-sectional study about sickness certification in two Swedish counties, with 673 participating GPs and 149 OSs, who answered a comprehensive questionnaire. Frequencies together with crude and adjusted (gender and working years) Odds ratios were calculated. RESULTS: A majority of the GPs and OSs experienced problems in sickness certification every week. To assess the patient's work ability, to handle situations when they and the patient had different opinions about the need for sickness absence, and to issue prolongation certificates when the previous was issued by another physician were reported as problematic by a majority in both groups. Both GPs and OSs prolonged sickness certifications due to waiting times in health care or at Social Insurance Office (SIO). To handle experienced problems they used different strategies; OSs issued sickness certificates without personal appointment more often than the GPs, who on the other hand reported having contact with SIO more often than the OSs. A higher rate of GPs experienced support from management and had a common strategy for handling sickness certification at the clinic than the OSs. CONCLUSION: Most GPs and OSs handled sickness certification weekly and reported a variety of problems in relation to this task, generally GPs to a higher extent, and they used different coping strategies to handle the problems.
PubMed ID
17910746 View in PubMed
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Endostatin overexpression inhibits lymphangiogenesis and lymph node metastasis in mice.

https://arctichealth.org/en/permalink/ahliterature85070
Source
Cancer Res. 2007 Dec 15;67(24):11528-35
Publication Type
Article
Date
Dec-15-2007
Author
Brideau Gaëlle
Mäkinen Markus J
Elamaa Harri
Tu Hongmin
Nilsson Gunnar
Alitalo Kari
Pihlajaniemi Taina
Heljasvaara Ritva
Author Affiliation
Collagen Research Unit, Biocenter Oulu and Department of Medical Biochemistry and Molecular Biology, University of Oulu, Oulu, Finland.
Source
Cancer Res. 2007 Dec 15;67(24):11528-35
Date
Dec-15-2007
Language
English
Publication Type
Article
Keywords
9,10-Dimethyl-1,2-benzanthracene
Animals
Apoptosis - drug effects
Endostatins - genetics
Female
Gene Expression Regulation, Neoplastic
Immunohistochemistry
Lymphatic Metastasis - prevention & control
Male
Mice
Mice, Transgenic
Neovascularization, Pathologic - prevention & control
Skin Neoplasms - blood supply - chemically induced - genetics - pathology
Abstract
Endostatin, a proteolytic fragment of collagen XVIII, is a potent inhibitor of angiogenesis and tumor growth. We studied the development of carcinogen-induced skin tumors in transgenic J4 mice overexpressing endostatin in their keratinocytes. Unexpectedly, we did not observe any differences in tumor incidence and multiplicity between these and control mice, nor in the rate of conversion of benign papillomas to malignant squamous cell carcinomas (SCC). We did find, however, that endostatin regulates the terminal differentiation of keratinocytes because the SCCs in the J4 mice were less aggressive and more often well differentiated than those in the control mice. We observed an inhibition of tumor angiogenesis by endostatin at an early stage in skin tumor development, but more strikingly, there was a significant reduction in lymphatic vessels in the papillomas and SCCs in association with elevated endostatin levels and also a significant inhibition of lymph node metastasis in the J4 mice. We showed that tumor-infiltrating mast cells strongly expressed vascular endothelial growth factor-C (VEGF-C), and that the accumulation of these cells was markedly decreased in the tumors of the J4 mice. Moreover, endostatin inhibited the adhesion and migration of murine MC/9 mast cells on fibronectin in vitro. Our data suggest that endostatin can inhibit tumor lymphangiogenesis by decreasing the VEGF-C levels in the tumors, apparently via inhibition of mast cell migration and adhesion, and support the view that the biological effects of endostatin are not restricted to endothelial cells because endostatin also regulates tumor-associated inflammation and differentiation, and the phenotype of epithelial tumors.
PubMed ID
18089781 View in PubMed
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Implementing a clinical decision-support system in practice: a qualitative analysis of influencing attitudes and characteristics among general practitioners.

https://arctichealth.org/en/permalink/ahliterature92847
Source
Inform Health Soc Care. 2008 Mar;33(1):39-54
Publication Type
Article
Date
Mar-2008
Author
Toth-Pal Eva
Wårdh Inger
Strender Lars-Erik
Nilsson Gunnar
Author Affiliation
Center for Family and Community Medicine, Department of Neurobiology, Health Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden. evatothpal@gmail.com
Source
Inform Health Soc Care. 2008 Mar;33(1):39-54
Date
Mar-2008
Language
English
Publication Type
Article
Keywords
Attitude
Decision Support Systems, Clinical
Diffusion of Innovation
Female
Humans
Interviews as Topic
Male
Physicians, Family - psychology
Prospective Studies
Residential Facilities
Sweden
Abstract
In order to obtain a better understanding of barriers to the implementation of clinical decision-support systems (CDSSs) in primary health care, we explored general practitioners' (GPs) handling of a CDSS during the implementation process. An Internet-based application for the management of chronic heart failure was used that was an adaptation of established clinical guidelines for computer use. The whole implementation process was followed closely, using a combination of different methods for data collection: repeated interviews with the five participating GPs, observations of patient visits, patient interviews, and detection of usage. We analysed the data using qualitative content analysis. The results showed that GPs' attitudes and characteristics constituted different profiles that seemed to be associated with the degree of acceptance of the CDSS. Those profiles were related to conceptions about the GPs' professional role and their attitudes towards the computer's function in disease management and in decision-making. Some additional barriers were insufficient level of computer skills and time constraints in everyday work. These findings can help us identify groups of GPs with definable needs during the implementation of a CDSS and make it easier to meet those needs with individually tailored interventions.
PubMed ID
18604761 View in PubMed
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[The mast cell--both evil and good. Time to reconsider the role of the mast cell in health and disease]

https://arctichealth.org/en/permalink/ahliterature88987
Source
Lakartidningen. 2009 Mar 18-24;106(12):845-9
Publication Type
Article
Author
Pejler Gunnar
Nilsson Gunnar
Author Affiliation
Institutionen för anatomi, fysiologi och biokemi, Sveriges Lantbruksuniversitet, Uppsala. gunnar.pejler@afb.slu.se
Source
Lakartidningen. 2009 Mar 18-24;106(12):845-9
Language
Swedish
Publication Type
Article
Keywords
Animals
Biomedical Research - history
Germany
History, 19th Century
History, 20th Century
Humans
Inflammation - immunology
Inflammation Mediators - immunology - physiology
Mast Cells - drug effects - immunology - physiology
Mice
Neoplasms - immunology
Sweden
Notes
Comment In: Lakartidningen. 2009 Apr 7-21;106(15-16):111719492685
PubMed ID
19452784 View in PubMed
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