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Kindstedt J, Glader EL, Lövheim H, Lindkvist M, Gustafsson M. The impact of nursing home residency on psychotropic drug use in major neurocognitive disorder: A nationwide comparison. Int J Geriatr Psychiatry 2023; 38:e6018. [PMID: 37909144 DOI: 10.1002/gps.6018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 10/17/2023] [Indexed: 11/02/2023]
Abstract
INTRODUCTION Psychotropic drugs are utilized against neuropsychiatric symptoms among people with major neurocognitive disorder (NCD) despite well-documented risks, and older people in nursing homes are expected to be more frequently exposed to those medicines. This study compared psychotropic drug use and associated factors between older people with major NCD and matched references. METHODS This cross-sectional study included individuals from three national registries in Sweden. References were randomly matched 1:1 by age and sex from the Swedish Total Population Register. Drug use was defined as at least one prescription fill from 1 July to 31 December 2019 and presented as proportion of drug users. In addition, ORs regarding psychotropic drug use and associated factors use were analysed using generalized estimating equations. RESULTS There were 102,419 complete matching pairs alive on 31 December 2019. The proportions of psychotropic drug users were 59% in the population of people with major NCD and 28% in the reference group. Moreover, there was a substantial number of individuals in nursing homes who had been treated with antipsychotics but who, for unknown reasons, had not been diagnosed with major NCD. Psychotropic drug use was positively associated with both major NCD and nursing home residency. The difference in drug use in relation to major NCD was more pronounced among people living in ordinary homes. CONCLUSION Despite well-documented risks in people with cognitive impairment, psychotropic drug use was overall high and positively associated with both major NCD and nursing home residency. Taken together, interventions to better target neuropsychiatric symptoms in older people are warranted. Hypnotic drug use among older people in general as well as antipsychotic drug exposure among older people in nursing homes appear to be two important focus areas.
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Affiliation(s)
- Jonas Kindstedt
- Department of Integrative Medical Biology, Umeå University, Umeå, Sweden
| | - Eva-Lotta Glader
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Hugo Lövheim
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Marie Lindkvist
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Maria Gustafsson
- Department of Integrative Medical Biology, Umeå University, Umeå, Sweden
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Abramsson L, Backman A, Lövheim H, Edvardsson D, Gustafsson M. Use of heart failure medications in older individuals and associations with cognitive impairment. BMC Geriatr 2023; 23:524. [PMID: 37644427 PMCID: PMC10463854 DOI: 10.1186/s12877-023-04223-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 08/08/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND To achieve the best treatment of heart failure, it is important to use all recommended drugs at their target doses. Given that underuse of medications can occur in individuals with cognitive impairment, we investigated the filled prescriptions and target doses of heart failure medication for older individuals with and without cognitive impairment as well as associated factors. METHODS The study was based on two separate datasets. The first dataset, which was based on data from questionnaires sent to nursing homes in Sweden, included 405 individuals with heart failure. The data were linked with the Swedish Prescribed Drug Register and the National Patient Register to obtain information regarding filled prescriptions of heart failure medications and heart failure diagnoses among the population. In the second dataset, medical records of individuals aged 75 years or older admitted to a hospital in northern Sweden were reviewed and individuals with heart failure were identified. Target doses of heart failure medications were evaluated in 66 individuals who lived at home. RESULTS Filled prescriptions of mineralocorticoid receptor antagonists and loop diuretics were significantly more common in individuals without cognitive impairment (OR 1.087; 95% CI 1.026-1.152, p < 0.05) and (OR 1.057; 95% CI 1.017-1.098, p < 0.05), respectively. There were no significant differences between individuals with and without cognitive impairment in terms of achieving target doses for any of the drug classes. A higher age was associated with fewer filled prescriptions and less ability to reach the target doses of beta blockers (OR 0.950; 95% CI 0.918-0.984, p < 0.05) and (OR 0.781; 95% CI 0.645-0.946, p < 0.05), respectively. CONCLUSIONS Our results suggest that individuals with cognitive impairment are partly undertreated for heart failure in that they had fewer filled prescriptions of important heart medications. Separately, the relatively low proportion of older individuals reaching target doses is an important observation and indicates that treatment of heart failure could be further optimised among older individuals.
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Affiliation(s)
- Linnea Abramsson
- Department of Integrative Medical Biology, Umeå University, Umeå, 901 87, Sweden
| | - Annica Backman
- Department of Nursing, Umeå University, Umeå, 901 87, Sweden
| | - Hugo Lövheim
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
- Wallenberg Center for Molecular Medicine, Umeå, Sweden
| | - David Edvardsson
- School of Nursing and Midwifery, La Trobe University, Bundoora, Vic, 3084, Australia
| | - Maria Gustafsson
- Department of Integrative Medical Biology, Umeå University, Umeå, 901 87, Sweden.
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Sönnerstam E, Harlin F, Gustafsson M. Potentially inappropriate medications among elderly people with neurocognitive disorders - A nationwide register-based study using 3 different explicit criteria. Res Social Adm Pharm 2023; 19:758-763. [PMID: 36717339 DOI: 10.1016/j.sapharm.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/22/2022] [Accepted: 01/22/2023] [Indexed: 01/27/2023]
Abstract
BACKGROUND The use of potentially inappropriate medications (PIMs) is a problem since it might contribute significantly to adverse drug reactions and hospital admissions among elderly with major neurocognitive disorder (NCD). To assess the appropriateness of drug treatment, different explicit criteria have been developed. OBJECTIVES To investigate and compare the prevalence of PIM users among elderly with major NCD on a nationwide basis using 3 different explicit criteria. Furthermore, the study aimed to investigate factors associated with the use of PIMs. METHODS This nationwide register-based study included 35,212 people, 65 years or older, diagnosed with major NCD and registered in the Swedish registry for cognitive/dementia disorders up to June 30, 2017 and alive December 31, 2017. PIMs were identified using 3 different explicit criteria; the Swedish quality indicators, the EU(7)-PIM list and the AGS Beers Criteria. PIM use was defined as having collected a minimum of one PIM at least once between July 01 - December 31, 2017. RESULTS The numbers of people using one or more PIMs were 7629 (21.7%) according to the Swedish quality indicators, 11,838 (33.6%) according to the EU(7)-PIM list, and 12,002 (34.1%) according to AGS Beers Criteria. Antipsychotics, antithrombotic agents and anxiolytics were the most frequently used PIM class according to the different assessment tools, respectively. The use of PIMs was positively associated with vascular dementia and Lewy body dementia/Parkinson's disease dementia, regardless of the assessment tool used. However, the association between using at least one PIM and age, sex, MMT-value and frontotemporal dementia, differed depending on the criteria used. CONCLUSIONS The different results and included PIMs indicate the different perspectives on PIMs between criteria, which make it difficult to compare the results. However, psychotropic drug use requires further highlighting, as well as the association between PIM use and different types of major NCD.
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Affiliation(s)
- Eva Sönnerstam
- Department of Integrative Medical Biology, Umeå University, SE-901 87, Umeå, Sweden.
| | - Frida Harlin
- Department of Integrative Medical Biology, Umeå University, SE-901 87, Umeå, Sweden
| | - Maria Gustafsson
- Department of Integrative Medical Biology, Umeå University, SE-901 87, Umeå, Sweden.
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Kindstedt J, Andersson P, Westberg A, Glader EL, Lövheim H, Gustafsson M. Exploring medication-related hospital admissions and their association with cognitive impairment among acutely admitted older people. Res Social Adm Pharm 2023; 19:1048-1053. [PMID: 37105774 DOI: 10.1016/j.sapharm.2023.04.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/05/2023] [Accepted: 04/15/2023] [Indexed: 04/29/2023]
Abstract
INTRODUCTION Medication-related hospital admissions (MRAs) are common among older people. Persons with cognitive impairment are especially vulnerable to adverse drug effects. At the same time, increased home health care and social support could theoretically prevent medication-related problems. This study aims to estimate the proportion of MRAs and explore their relationship with cognitive impairment in a population of acutely admitted older people. METHODS This cross-sectional study comprised 300 individuals aged 75 years or older admitted to an acute medical ward. Two assessors identified possibly MRAs using the Assessment Tool for Hospital Admissions Related to Medications 10 (AT-HARM10). Screening for cognitive impairment was performed during ward stay using a 4-item test related to time orientation. Prevalence odds ratios between cognitive test scores and MRAs were analysed through logistic regression. RESULTS Using AT-HARM10, 108 out of 300 admissions (36%) were classified as possibly MRAs by both assessors. Moreover, MRAs were least common among patients with the lowest cognitive test scores. There was an association regarding MRAs when the lowest test score was treated as a cut-off and compared against a reference category comprising all other scores (OR, 0.31 [95% CI 0.10-0.93]; p = 0.037) in a logistic regression model adjusted for cohabitation and home health care. CONCLUSION Approximately one-third of the hospital admissions among acutely admitted older people were considered at least possibly medication-related. Hence, there is still a great need to manage medication-related problems and reduce MRAs in this vulnerable population. Using a 4-item instrument to screen for cognitive impairment, there was a negative association between MRA and lowest cognitive test score. Further exploration of the relationship between MRAs and cognitive impairment may indicate appropriate components and target populations for interventions that aims to reduce the risk of MRA.
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Affiliation(s)
- Jonas Kindstedt
- Department of Integrative Medical Biology, Umeå University, SE-901 87, Umeå, Sweden.
| | - Pernilla Andersson
- Department of Integrative Medical Biology, Umeå University, SE-901 87, Umeå, Sweden.
| | - Annica Westberg
- Department of Integrative Medical Biology, Umeå University, SE-901 87, Umeå, Sweden.
| | - Eva-Lotta Glader
- Department of Public Health and Clinical Medicine, Umeå University, SE-901 87, Umeå, Sweden.
| | - Hugo Lövheim
- Department of Community Medicine and Rehabilitation, Umeå University, SE-901 87, Umeå, Sweden.
| | - Maria Gustafsson
- Department of Integrative Medical Biology, Umeå University, SE-901 87, Umeå, Sweden.
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Norberg H, Håkansson Lindqvist M, Gustafsson M. Older Individuals' Experiences of Medication Management and Care After Discharge from Hospital: An Interview Study. Patient Prefer Adherence 2023; 17:781-792. [PMID: 36987497 PMCID: PMC10040160 DOI: 10.2147/ppa.s400039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 03/07/2023] [Indexed: 03/30/2023] Open
Abstract
PURPOSE To develop an in-depth understanding of older individuals' attitudes and perceptions of medication management and care after discharge from hospital-to-home. PATIENTS AND METHODS A qualitative study using semi-structured interviews with selected individuals 75 years and older, discharged from hospital within the last 6-12 months, living at home, and managing their own medications. Face-to-face interviews were audio-recorded, transcribed and analyzed with thematic analysis. RESULTS Among the 15 respondents, mean age was 83.5 years (range 75-95 years), 67% were women, and 60% lived alone. The majority (80%) managed their medications with a pill organizer or directly from the pill boxes, while 20% used dose dispensed medications. The analysis of the data led to six themes: Medication adherence, Personal responsibility, Transitions of care, Beliefs about medications, Participation (experience of participation, willingness to participate) and Accessibility (easier to reach hospital than primary care, navigating in the care system, continuity, personal chemistry). CONCLUSION The included respondents who were older individuals, living at home and managing their own medications, expressed that they were medical adherent and self-managing. Two important aspects which were seen were difficulties to reach primary care on their own initiative and the lack of continuity with the same physician over a longer period of time.
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Affiliation(s)
- Helena Norberg
- Department of Integrative Medical Biology, Umeå University, Umeå, Sweden
- Correspondence: Helena Norberg, Department of Integrative Medical Biology, Umeå University, Umeå, S-901 87, Sweden, Tel +46 90 786 68 21, Email
| | | | - Maria Gustafsson
- Department of Integrative Medical Biology, Umeå University, Umeå, Sweden
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Rangfast I, Sönnerstam E, Gustafsson M. Prevalence of potentially inappropriate medications among old people with major neurocognitive disorder in 2012 and 2017. BMC Geriatr 2022; 22:544. [PMID: 35773643 PMCID: PMC9245287 DOI: 10.1186/s12877-022-03240-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background The increased risk of adverse drug reactions due to age-related altered pharmacokinetics and pharmacodynamics is a challenge when prescribing medications to older people, and especially among older people with major neurocognitive disorder who are particularly sensitive to drug effects. The aim of this study was to investigate the use of potential inappropriate medications (PIMs) in 2012 and 2017 among old people with major neurocognitive disorder. A secondary aim was to investigate factors associated with PIM use. Methods This register-study was based on the Swedish registry for cognitive/dementia disorders and the Swedish prescribed drug register. Criteria from the National Board of Health and Welfare were used to identify PIMs between 1 July–31 December 2012 and 1 July-–31 December 2017 among people ≥ 65 years. Drug use was defined as one or more filled prescriptions during each timeframe. Results The total use of PIMs declined significantly between 2012 (28.7%) and 2017 (21.7%). All PIMs and PIM groups declined between these years, except for antipsychotic drugs, which increased from 11.6% to 12.3%. The results from the multiple regression model found that PIM use was associated with younger age (OR: 0.97 CI: 0.96–0.97), a lower Mini Mental State Examination score (OR: 0.99 CI: 0.99–1.00), the use of multi-dispensed drugs (OR: 2.05 CI: 1.93–2.18), and compared to Alzheimer’s disease, with the subtypes dementia with Lewy bodies and Parkinson’s disease dementia (OR: 1.57 CI: 1.40–1.75), frontotemporal dementia (OR: 1.29 CI: 1.08–1.54) and vascular dementia (OR: 1.10 CI: 1.03–1.16). Conclusions Overall, the use of PIMs decreased between the years 2012 and 2017. The increase of antipsychotic drugs and the association between PIM use and multi-dispensed drugs warrant concern. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03240-y.
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Affiliation(s)
- Iris Rangfast
- Department of Integrative Medical Biology, Umeå University, 901 87, Umeå, Sweden
| | - Eva Sönnerstam
- Department of Integrative Medical Biology, Umeå University, 901 87, Umeå, Sweden
| | - Maria Gustafsson
- Department of Integrative Medical Biology, Umeå University, 901 87, Umeå, Sweden.
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Hägglund P, Gustafsson M, Lövheim H. Oropharyngeal dysphagia and associated factors among individuals living in nursing homes in northern Sweden in 2007 and 2013. BMC Geriatr 2022; 22:421. [PMID: 35562667 PMCID: PMC9107260 DOI: 10.1186/s12877-022-03114-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Swallowing difficulties in the oral cavity or pharynx (i.e., oropharyngeal dysphagia) are a common problem in the aging population, which may result in severe consequences, such as malnutrition, aspiration pneumonia, and mortality. Identifying oropharyngeal dysphagia and its associated factors is essential for establishing better healthcare policies in nursing homes. In this study, we aimed to describe the oropharyngeal dysphagia prevalence among nursing home residents, and to investigate the association between dysphagia and potentially related factors in a large survey of nursing home residents in Sweden, including individuals with various degrees of cognitive impairment. A secondary aim was to compare findings between years on oropharyngeal dysphagia and its associated factors. METHODS This study is based on two cross-sectional surveys performed in 2007 and 2013, including 4,995 individuals living in nursing homes in the Region of Västerbotten, Sweden. Data were collected from caregivers' reports regarding swallowing ability, nutritional status, chewing ability, and other baseline characteristics, such as cognitive function and activity of daily living (ADL). Data were analyzed using logistic regression models to calculate the odds of the association between oropharyngeal dysphagia and associated factors. RESULTS Oropharyngeal dysphagia was reported in 14.9% (95% CI: 13.9-16.0) of the nursing home residents. An adjusted model revealed that oropharyngeal dysphagia was associated by severe cognitive impairment (OR: 1.56, 95% CI: 1.14-2.12) and ADL independence (OR: 0.81 95% CI: 1.82-2.66) among nursing home residents. We also identified the following as independently associated factors of dysphagia: reduced nutritional status (OR: 1.84, 95% CI: 1.49-2.27), artificial nutrition (OR: 6.33, 95% CI: 2.73-14.71), and clinical signs of aspiration (OR: 10.89, 95% CI: 8.40-14.12). CONCLUSIONS Oropharyngeal dysphagia was reported among approximately 15% nursing home residents and was associated with cognitive impairment and ADL capability. Furthermore, reduced nutritional status and artificial nutrition were also associated with oropharyngeal dysphagia. Implementing routine protocols in nursing homes may help detect oropharyngeal dysphagia and manage oropharyngeal dysphagia among residents.
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Affiliation(s)
- Patricia Hägglund
- Department of Clinical Sciences, Speech-Language Pathology, Umeå University, Umeå, Sweden.
| | - Maria Gustafsson
- Department of Integrative Medical Biology, Umeå University, Umeå, Sweden
| | - Hugo Lövheim
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden.,Wallenberg Centre for Molecular Medicine, Umeå, Sweden
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Norberg H, Sjölander M, Glader EL, Gustafsson M. Self-reported medication adherence and pharmacy refill adherence among persons with ischemic stroke: a cross-sectional study. Eur J Clin Pharmacol 2022; 78:869-877. [PMID: 35156130 PMCID: PMC9005421 DOI: 10.1007/s00228-022-03284-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/24/2022] [Indexed: 12/20/2022]
Abstract
Purpose To describe and compare self-reported medication adherence assessed with the 5-item version of Medication Adherence Report Scale (MARS-5) and pharmacy refill adherence based on data from the Swedish Prescribed Drug Register (SPDR) among persons with ischemic stroke, and to investigate independent predictors associated with respective assessments. Methods A study questionnaire was sent to persons with ischemic stroke registered in the Swedish Stroke Register between Dec 2011 and March 2012, and who lived at home 3 months after discharge. The primary outcome was dichotomized to adherent/non-adherent based on MARS-5 and SPDR and analyzed with multivariable logistic regression. Adherence according to MARS-5 was defined as score 23 or higher (out of 25). Adherence according to SPDR was defined as at least one filled statin prescription recorded in SPDR in each 6-month interval during 2 years of follow-up. Results Of 420 participants, 367 (87%) and 329 (78%) were adherent according to MARS-5 and SPDR, respectively, and 294 (70%) participants were adherent according to both assessments. A significant association was shown between medication adherence according to the two assessments (p = 0.020). Independent predictors associated with medication adherence according to MARS-5 were female sex, while factors associated with SPDR were male sex and being younger. Conclusions The majority of participants were classified as adherent, 87% according to MARS-5 and 78% based on data from SPDR. However, only 70% were adherent according to both MARS-5 and SPDR, and different predictors were associated with the different measurements, suggesting that these assessments are measuring different aspects of adherence. Supplementary information The online version contains supplementary material available at 10.1007/s00228-022-03284-4.
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Affiliation(s)
- Helena Norberg
- Department of Integrative Medical Biology, Umeå University, S-901 87, Umea, Sweden.
| | - Maria Sjölander
- Department of Integrative Medical Biology, Umeå University, S-901 87, Umea, Sweden
| | - Eva-Lotta Glader
- Department of Public Health and Clinical Medicine, Umeå University, S-901 87, Umea, Sweden
| | - Maria Gustafsson
- Department of Integrative Medical Biology, Umeå University, S-901 87, Umea, Sweden
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Sönnerstam E, Gustafsson M, Lövheim H. Potentially inappropriate medications in relation to length of nursing home stay among older adults. BMC Geriatr 2022; 22:70. [PMID: 35065614 PMCID: PMC8783464 DOI: 10.1186/s12877-021-02639-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 11/16/2021] [Indexed: 11/18/2022] Open
Abstract
Background To investigate the use of potentially inappropriate medications and their relation to the length of nursing home stay among older adults. Methods Questionnaire surveys using the Multi-Dimensional Dementia Assessment scale were sent out to all nursing homes in Västerbotten county in northern Sweden in 2007 and 2013. In total, 3186 adults (1881 from 2007 and 1305 from 2013) ≥65 years old were included and 71.8% of those had cognitive impairment. Potentially inappropriate medications were identified using drug-specific quality indicators according to Swedish National Board of Health and Welfare. Results Potentially inappropriate medications were used by 48.0% of the 2007 study sample and by 28.4% of the 2013 study sample. The prevalence of glibenclamide use 2007 and antipsychotic drug use 2013 increased linearly (β = 0.534E− 3, 95% CI: 0.040E− 3-0.103E− 2, p = 0.034 and β = 0.155E− 2, 95% CI: 0.229E− 3-0.288E− 2, p = 0.022, respectively) with the length of nursing home stay. No significant association was found between the prevalence of propiomazine, codeine, long-acting benzodiazepines, anticholinergics, NSAIDs, tramadol or the total use of potentially inappropriate medications and the length of stay in nursing homes in 2007 or 2013. Antipsychotics were the most commonly prescribed of the drug classes investigated and used by 22.6% of the residents 2007 and by 16.0% of the residents 2013. Conclusions These results indicate that treatment with potentially inappropriate medications is common among older adults living in nursing homes, but it seems to be related to the length of nursing home stay only to a smaller extent. Drug treatment should regularly be reviewed and followed-up among nursing home residents regardless of their length of nursing home stay, in order to prevent unnecessary adverse events. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02639-3.
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Westberg A, Sjölander M, Glader EL, Gustafsson M. Primary Non-Adherence to Preventive Drugs and Associations with Beliefs About Medicines in Stroke Survivors. Patient Prefer Adherence 2022; 16:343-352. [PMID: 35177898 PMCID: PMC8844454 DOI: 10.2147/ppa.s351001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/12/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Medication non-adherence is a common problem in clinical practice. Little is known about stroke survivors' primary non-adherence to preventive drugs, and we hypothesised that their beliefs about medicines are associated with primary non-adherence. The objective was to describe primary non-adherence among stroke survivors and to assess associations between primary non-adherence to preventive drugs and beliefs about medicines. METHODS Questionnaires were sent to 797 individuals 3 months after stroke to assess beliefs about medicines through the Beliefs about Medicines Questionnaire (BMQ). All participants were registered in the Swedish Stroke Register (Riksstroke), and prescriptions for new preventive drugs during the hospital stay were identified through data from Riksstroke. Primary non-adherers were those who failed to fill one or more new prescriptions within 1 month of hospital discharge based on data from the Swedish Prescribed Drug Register. Differences between primary non-adherers and adherers were assessed by 2 tests and associations between the BMQ subscales and primary non-adherence were analysed using independent two-sample t-tests and multivariable logistic regression models. RESULTS A total of 594 individuals responded to the survey, of which 452 received new prescriptions of preventive drugs. Overall, 53 (12%) participants were classified as primary non-adherent. Primary non-adherers were more often dependent on help or support from next of kin (p=0.032) and had difficulties with memory more often (p=0.002) than the primary adherent individuals. No statistically significant differences in BMQ subscale-scores were found between the two groups (p>0.05). CONCLUSION Primary non-adherence to preventive drugs was low, and no associations were found between primary non-adherence and beliefs about medicines. Associations with cognitive impairments such as difficulties with memory and need for help from next of kin suggest that more effort is needed to help stroke survivors to start important preventive drug treatments after discharge from hospital.
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Affiliation(s)
- Annica Westberg
- Department of Integrative Medical Biology, Umeå University, Umeå, 901 87, Sweden
| | - Maria Sjölander
- Department of Integrative Medical Biology, Umeå University, Umeå, 901 87, Sweden
| | - Eva-Lotta Glader
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, 901 87, Sweden
| | - Maria Gustafsson
- Department of Integrative Medical Biology, Umeå University, Umeå, 901 87, Sweden
- Correspondence: Maria Gustafsson, Department of Integrative Medical Biology, Umeå University, Umeå, SE-901 87, Sweden, Email
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Gustafsson M, Lövheim H, Sjölander M. Pharmacological Pain Treatment in 2012 and 2017 Among Older People with Major Neurocognitive Disorder. Drugs Aging 2021; 38:1017-1023. [PMID: 34664213 PMCID: PMC8593018 DOI: 10.1007/s40266-021-00897-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 11/29/2022]
Abstract
Background and Objective Pain is highly prevalent among older people, and treatment is complicated because of comorbidities and polypharmacy. Among people with major neurocognitive disorder additional difficulties might arise. The aim of this study was to describe analgesic drug use in 2012 and 2017 and associated factors among older people with major neurocognitive disorder. Methods In this register-based study, the Swedish Dementia Registry and the Swedish Prescribed Drug Register were combined in order to obtain data regarding analgesic drug use among older people with major neurocognitive disorder. One or more filled prescriptions during the timeframe of 6 months (1 July–31 December 2012 and 1 July–31 December 2017) defined drug use during the respective period. A comparison between 2012 and 2017 was made, including a total of 56,101 people (20,889 and 35,212 respectively) with a mean age of 81.9 and 82.7 years, respectively. Results The overall use of analgesic drugs increased significantly from 41.6% of individuals to 46.0% between the years 2012 and 2017. Users of opioid analgesics (15.2% vs 17.3%) and paracetamol (37.0% vs 42.3%) increased, while the users of non-steroidal anti-inflammatory drugs (4.9% vs 2.7%) declined between the two data collections. Multiple logistic regression analyses were performed for different drugs and drug classes, and it was found that the use of opioids and paracetamol was associated with older age and a longer time since diagnosis. In contrast, non-steroidal anti-inflammatory drugs were associated with younger age and a shorter time since diagnosis. Conclusions The results indicate that on a population level, pharmacological drug treatment has changed in line with guidelines between 2012 and 2017, with an increase in paracetamol and strong opioids and a decrease in non-steroidal anti-inflammatory drugs and tramadol. The relatively high prevalence of opioids warrants concern given the significant risk of adverse effects among older people with major neurocognitive disorder. Supplementary Information The online version contains supplementary material available at 10.1007/s40266-021-00897-9.
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Affiliation(s)
- Maria Gustafsson
- Department of Integrative Medical Biology, Umeå University, Umeå, Sweden.
| | - Hugo Lövheim
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Maria Sjölander
- Department of Integrative Medical Biology, Umeå University, Umeå, Sweden
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12
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Alm A, Falk LL, Bremer TW, Idholt G, Gustafsson M, Bergström EK. Parents' experiences of participating in health-promoting activities at a family centre for preschool children in Sweden. Community Dent Health 2021; 38:100-104. [PMID: 33507650 DOI: 10.1922/cdh_00150alm05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In Sweden, the family centre is a meeting place for families in a neighbourhood. It is a place for families to meet and exchange experiences and is a confidence-filled place for preschool children to play and develop. The staff at the family centre collaborate on early prevention strategies to promote health. Since 2014, the Public Dental Health Service in Södra Ryd, Skövde, has been a collaborative partner with the family centre. OBJECTIVES To explore and describe the parents' experiences of participating in health-promoting activities at the family centre. BASIC RESEARCH DESIGN A qualitative design based on interviews, analysed using a phenomenograpic approach. PARTICIPANTS Six focus groups with two to six participants in each group. RESULTS Three themes, all describing parents' experiences of visiting the family centre, emerged in the analysis. The themes were as follows; "Social fellowship", "A secure place" and "A learning environment". Each theme contained three categories, which represent the parents' different conceptions. CONCLUSIONS The present study showed that the parents who visit the family centre found that the collaboration is perceived as positive and has many benefits. The participants found that the family centre is an institution that increases social interaction. Furthermore, meeting dental professionals in an arena outside the clinic creates confidence and makes people feel secure. Parents also learn both from the staff and from each other. According to these findings, the family centre is a suitable arena to work on health-promotion activities.
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Affiliation(s)
- A Alm
- Department of Preventive and Community Dentistry, Public Dental Health Service, Västra Götaland Region, Sweden
| | - L Ljungkrona Falk
- Department of Preventive and Community Dentistry, Public Dental Health Service, Västra Götaland Region, Sweden
| | - T Wold Bremer
- Department of Social Sustainability, Västra Götaland Region, Sweden
| | - G Idholt
- Department of Social Sustainability, Västra Götaland Region, Sweden
| | - M Gustafsson
- Department of Social Sustainability, Västra Götaland Region, Sweden
| | - E-K Bergström
- Department of Preventive and Community Dentistry, Public Dental Health Service, Västra Götaland Region, Sweden
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13
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Gustafsson M, Wallman A, Mattsson S. Education Satisfaction among Pharmacy Graduates in Sweden. Pharmacy (Basel) 2021; 9:pharmacy9010044. [PMID: 33670619 PMCID: PMC7931050 DOI: 10.3390/pharmacy9010044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/12/2021] [Accepted: 02/15/2021] [Indexed: 11/16/2022] Open
Abstract
Education satisfaction is considered important for development of a professional identity and to increase learning. The aim was to investigate and compare education satisfaction over time among pharmacists who have graduated from the pharmacy programs at Umeå University, Sweden. Data concerning education satisfaction were collected using an alumni survey of pharmacists who graduated between 2015 and 2018. This was compared with pharmacists graduating between 2006 and 2014. The majority of the pharmacy graduates were very satisfied with their education (96%) and thought that the programs gave them a clear professional identity (92%). No differences in education satisfaction between graduation years 2015 and 2018 and 2006 and 2014 were found. A majority of the graduates considered that the knowledge and skills acquired during their education were useful in their present job (83%). Of the graduates who thought that the studies gave them a clear professional identity, a higher proportion were satisfied with their job (p < 0.001) and thought that their work duties reflected their studies (p = 0.005). Exploring education satisfaction may help educators to further develop the education and to better prepare the students for their professional working life.
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Elander A, Gustafsson M. Inhaler Technique and Self-reported Adherence to Medications Among Hospitalised People with Asthma and COPD. Drugs Real World Outcomes 2020; 7:317-323. [PMID: 33052539 PMCID: PMC7581666 DOI: 10.1007/s40801-020-00210-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Metered dose inhalers (MDIs) and dry powder inhalers (DPIs) are devices used for the treatment of asthma and chronic obstructive pulmonary disease (COPD). Inhaler technique is important since incorrect technique can lead to a poorer prognosis and hospitalization. Objective The objective of this study was to investigate the inhaler technique and overall adherence to medications in an adult population with asthma and COPD. Patients and Methods Those invited to participate were people admitted to Umeå University Hospital in northern Sweden in October, November and December 2018, with inhaled medication prescribed prior to admission. Inhaler technique was assessed using checklists and observations with placebo-inhalers were conducted. The Medication Adherence Report Scale (MARS)-5 was used to measure self-reported overall adherence to drug medication. Results Of the 23 people included in the study, 26.1% had one or more critical errors in inhaler technique and 30.4% were considered overall non-adherent to drug medication. Among the 23 participants, the mean age, and the number of regularly prescribed medications were higher among those with poor inhaler technique than among people with no error in their inhaler technique. Conclusion This study indicates that poor inhaler technique and overall non-adherence to medications occur among hospitalised people with asthma and COPD living in northern Sweden. Interventions to improve inhaler technique and adherence to drugs are needed. Electronic supplementary material The online version of this article (10.1007/s40801-020-00210-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Astrid Elander
- Department of Integrative Medical Biology, Umeå University, 90187, Umeå, Sweden
| | - Maria Gustafsson
- Department of Integrative Medical Biology, Umeå University, 90187, Umeå, Sweden.
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15
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Abstract
Understanding the role of pharmacists’ job satisfaction is important because a lack of job satisfaction might have negative impacts on patient care and safety. The aim of this cross-sectional study was to explore and compare job satisfaction among pharmacists graduating from the pharmacy programs at Umeå University, Sweden. Data concerning job satisfaction and associated factors were collected using an alumni survey conducted among pharmacists graduating between 2015 and 2018. Ethical committee approval is not required for this type of study in Sweden. A majority (92.6%) of the pharmacy graduates were female. A majority of the graduates (91.4%) were satisfied with their job most of the time or all of the time, which was similar to a previous investigation among pharmacists graduating between 2006 and 2014. High access to continuous professional development (CPD) was associated with higher job satisfaction (odds ratio (OR): 18.717 (95% confidence interval (CI): 1.685–207.871)). In total, 65.6% considered access to CPD to be high (i.e., satisfactory to very good). Variables like gender, age, employee category, workplace, years since graduation, and income did not affect job satisfaction. Knowledge regarding job satisfaction will enable employers to respond to employees’ needs, decrease turnover, and improve the work environment.
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Kindstedt J, Svahn S, Sjölander M, Glader EL, Lövheim H, Gustafsson M. Investigating the effect of clinical pharmacist intervention in transitions of care on drug-related hospital readmissions among the elderly: study protocol for a randomised controlled trial. BMJ Open 2020; 10:e036650. [PMID: 32345700 PMCID: PMC7213854 DOI: 10.1136/bmjopen-2019-036650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Drug-related problems (DRPs) are a major cause of unplanned hospital admissions among elderly people, and transitions of care have been emphasised as a key area for improving patient safety. We have designed a complex clinical pharmacist intervention that targets people ≥75 years of age undergoing transitions of care from hospital to home and primary care. The main objective is to investigate if the intervention can reduce the risk of unplanned drug-related readmission within the first 180 days after the person is discharged from hospital. METHODS AND ANALYSIS This is a randomised, controlled, superiority trial with two parallel arms. A total of 700 people ≥75 years will be assigned to either intervention or routine care (control). The intervention, which aims to find and manage DRPs, is initiated within a week of the person being discharged from hospital and combines repeated medical chart reviews, phone interviews and in some cases medication reviews. People in both study arms may have been the subject of a medication review during their ward stay. As the primary outcome, we will measure time until unplanned drug-related readmission within 180 days of leaving hospital and use log rank tests and Cox proportional hazard models to analyse differences between the groups. Further investigations of subgroup effects and adjustments of the regression models will be based on heart failure and cognitive impairment as prognostic factors. ETHICS AND DISSEMINATION The study has been approved by the Regional Ethical Review Board in Umeå (registration numbers 2017-69-31M, 2018-83-32M and 2018-254-32M). We intend to publish the results with open access in international peer-reviewed journals and present our findings at international conferences. The trial is expected to result in more than one published article and form part of two PhD theses. TRIAL REGISTRATION NUMBER NCT03671629.
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Affiliation(s)
- Jonas Kindstedt
- Department of Integrative Medical Biology, Umeå University, Umeå, Sweden
| | - Sofia Svahn
- Department of Integrative Medical Biology, Umeå University, Umeå, Sweden
| | - Maria Sjölander
- Department of Integrative Medical Biology, Umeå University, Umeå, Sweden
| | - Eva-Lotta Glader
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Hugo Lövheim
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Maria Gustafsson
- Department of Integrative Medical Biology, Umeå University, Umeå, Sweden
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Svahn S, Lövheim H, Isaksson U, Sandman PO, Gustafsson M. Cardiovascular drug use among people with cognitive impairment living in nursing homes in northern Sweden. Eur J Clin Pharmacol 2020; 76:525-537. [PMID: 31915846 DOI: 10.1007/s00228-019-02778-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 09/26/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study was to describe changes in the pattern of cardiovascular agents used in elderly people living in nursing homes between 2007 and 2013. Further, the aim was to analyse the use of cardiovascular drugs in relation to cognitive impairment and associated factors within the same population, where prescription of loop diuretics was used as a proxy for heart failure. METHODS Two questionnaire surveys were performed including 2494 people in 2007 and 1654 people in 2013 living in nursing homes in northern Sweden. Data were collected concerning drug use, functioning in activities of daily living (ADL) and cognition, using the Multi-Dimensional Dementia Assessment Scale (MDDAS). The use of different drugs and drug classes among people at four different levels of cognitive function in 2007 and 2013 were compared. RESULTS The proportion of people prescribed ASA and diuretics was significantly lower at all four levels of cognitive function in 2013 compared to 2007. Among people prescribed loop diuretics, the use of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEI/ARBs) increased from 37.8 to 45.6%, β-blockers from 36.0 to 41.8% and warfarin from 4.4 to 11.4%. The use of warfarin, ACEI/ARBs, β-blockers and mineralocorticoid receptor antagonists (MRAs) were less common among individuals with more severe cognitive impairment. CONCLUSION The results indicate that cardiovascular drug treatment has improved between 2007 and 2013, but there is room for further improvement, especially regarding adherence to guidelines for heart failure. Increasing cognitive impairment had an effect on treatment patterns for heart failure and atrial fibrillation.
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Affiliation(s)
- Sofia Svahn
- Department of Pharmacology and Clinical Neuroscience, Umeå University, SE-901 87, Umeå, Sweden.
| | - Hugo Lövheim
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, SE-901 87, Umeå, Sweden
| | - Ulf Isaksson
- Department of Nursing, Umeå University, SE-901 87, Umeå, Sweden.,Arctic Research Centre at Umeå University, SE-901 87, Umeå, Sweden
| | - Per-Olof Sandman
- Department of Nursing, Umeå University, SE-901 87, Umeå, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Maria Gustafsson
- Department of Pharmacology and Clinical Neuroscience, Umeå University, SE-901 87, Umeå, Sweden
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18
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Ivanenko Y, Nedic M, Gustafsson M, Jonsson BLG, Luger A, Nordebo S. Quasi-Herglotz functions and convex optimization. R Soc Open Sci 2020; 7:191541. [PMID: 32218971 PMCID: PMC7029951 DOI: 10.1098/rsos.191541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/22/2019] [Indexed: 06/10/2023]
Abstract
We introduce the set of quasi-Herglotz functions and demonstrate that it has properties useful in the modelling of non-passive systems. The linear space of quasi-Herglotz functions constitutes a natural extension of the convex cone of Herglotz functions. It consists of differences of Herglotz functions and we show that several of the important properties and modelling perspectives are inherited by the new set of quasi-Herglotz functions. In particular, this applies to their integral representations, the associated integral identities or sum rules (with adequate additional assumptions), their boundary values on the real axis and the associated approximation theory. Numerical examples are included to demonstrate the modelling of a non-passive gain medium formulated as a convex optimization problem, where the generating measure is modelled by using a finite expansion of B-splines and point masses.
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Affiliation(s)
- Y. Ivanenko
- Department of Physics and Electrical Engineering, Linnæus University, 351 95 Växjö, Sweden
| | - M. Nedic
- Department of Mathematics, Stockholm University, 106 91 Stockholm, Sweden
| | - M. Gustafsson
- Department of Electrical and Information Technology, Lund University, Box 118, 221 00 Lund, Sweden
| | - B. L. G. Jonsson
- School of Electrical Engineering and Computer Science, KTH Royal Institute of Technology, 100 44 Stockholm, Sweden
| | - A. Luger
- Department of Mathematics, Stockholm University, 106 91 Stockholm, Sweden
| | - S. Nordebo
- Department of Physics and Electrical Engineering, Linnæus University, 351 95 Växjö, Sweden
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19
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Lövheim H, Gustafsson M, Isaksson U, Karlsson S, Sandman PO. Gottfries' Cognitive Scale for Staff Proxy Rating of Cognitive Function Among Nursing Home Residents. J Alzheimers Dis 2019; 72:1251-1260. [PMID: 31683479 DOI: 10.3233/jad-190599] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND For research purposes, there is a need for tools to assess an individual's level of cognitive function. For survey-based investigations in nursing home contexts, proxy ratings allow the assessment also of individuals with severe cognitive impairment. OBJECTIVE The aim of this study was to describe the feasibility and psychometric properties of Gottfries' cognitive scale when used in a nursing home context for proxy rating of cognitive function. METHOD The psychometric properties of Gottfries' cognitive scale were investigated in a sample of 8,492 nursing home residents in Västerbotten County, Sweden, using item response theory and classic scale theory-based approaches. RESULTS Cognitive function could be scored in 97.1% of the assessed individuals. The scale had a negligible floor effect, it had items with a large spread in difficulties, it appeared linear, and it distributed the assessed individuals equally over the scale. Internal consistency (Cronbach's alpha) was 0.967, and an exploratory factor analysis revealed three factors of the scale - interpreted to represent orientation to time, to place, and to person. CONCLUSION Gottfries' cognitive scale is a feasible tool for grading cognitive function among nursing home residents using staff proxy ratings. The scale has excellent psychometric properties with a very high internal consistency, a favorable distribution of item difficulties producing an almost rectangular distribution of scores, and a negligible floor effect. The scale thus can be recommended for use in survey-based investigations in nursing home contexts.
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Affiliation(s)
- Hugo Lövheim
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
| | - Maria Gustafsson
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden.,Department of Pharmacology and Clinical Neuroscience, Clinical Pharmacology, Umeå University, Umeå, Sweden
| | - Ulf Isaksson
- Department of Nursing, Umeå University, Umeå, Sweden.,Arctic Research Centre, Umeå University, Umeå, Sweden
| | - Stig Karlsson
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Per-Olof Sandman
- Department of Nursing, Umeå University, Umeå, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden
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20
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Håkansson Lindqvist M, Gustafsson M, Gallego G. Exploring physicians, nurses and ward-based pharmacists working relationships in a Swedish inpatient setting: a mixed methods study. Int J Clin Pharm 2019; 41:728-733. [PMID: 30937695 PMCID: PMC6554255 DOI: 10.1007/s11096-019-00812-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 03/15/2019] [Indexed: 10/29/2022]
Abstract
Background In Sweden there has been limited work investigating the integration and nature of collaborative relationships between pharmacists and other healthcare practitioners. Objective To explore the working relationships of physicians, nurses and ward-based pharmacists in a rural hospital after the introduction of a clinical pharmacy service. Setting General medical ward in a rural hospital in northern Sweden. Method Mixed methods involving face-to-face semi-structured interviews with nurses, physicians and pharmacists, and a physician survey using the Physician-Pharmacist Collaboration Index to measure the extent of physician-reported collaborative working relationships. Main outcome measure Perceptions about collaborative working relationships between physician, nurses and pharmacists. Results All physicians (n = 9) who interacted with the clinical pharmacists completed the survey. The mean total score was 78.6 ± 4.7, total 92 (higher scores represent a more advanced relationship). Mean domain scores were highest for relationship initiation (13.0 ± 1.3, total 15), and trustworthiness (38.9 ± 3.4, total 42), followed by role specification (26.3 ± 2.6, total 30). The interviews (with nurses and physicians), showed how communication, collaboration and joint knowledge-exchange in the intervention changed and developed over time. Conclusion This study provides new insights into collaborative working relationships from the perspectives of physicians and nurses. The Physician-Pharmacist Collaboration Index scores suggest that physicians felt that clinical pharmacists were active in providing patient care; could be trusted to follow up on recommendations; and were credible. The interviews suggest that the team-based intervention provided good conditions for creating new ways to work to achieve commitment to professional working relationships.
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Affiliation(s)
| | - Maria Gustafsson
- Department of Pharmacology and Clinical Neuroscience, Umeå University, 90187, Umeå, Sweden
| | - Gisselle Gallego
- Department of Pharmacology and Clinical Neuroscience, Umeå University, 90187, Umeå, Sweden
- School of Medicine, The University of Notre Dame Australia, Sydney, NSW, Australia
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21
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Gerlofs-Nijland ME, Bokkers BGH, Sachse H, Reijnders JJE, Gustafsson M, Boere AJF, Fokkens PFH, Leseman DLAC, Augsburg K, Cassee FR. Inhalation toxicity profiles of particulate matter: a comparison between brake wear with other sources of emission. Inhal Toxicol 2019; 31:89-98. [PMID: 31066325 DOI: 10.1080/08958378.2019.1606365] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: There is substantial evidence that exposure to airborne particulate matter (PM) from road traffic is associated with adverse health outcomes. Although it is often assumed to be caused by vehicle exhaust emissions such as soot, other components may also contribute to detrimental effects. The toxicity of fine PM (PM2.5; <2.5 µm mass median aerodynamic diameter) released from brake pads was compared to PM from other sources. Materials and methods: PM2.5 of different types of brake pads (low-metallic, semi-metallic, NAO and ECE-NAO hybrid), tires and road pavement, poultry as well as the combustion of diesel fuel and wood (modern and old-fashioned stove technologies) were collected as suspensions in water. These were subsequently aerosolized for inhalation exposures. Female BALB/cOlaHsd mice were exposed for 1.5, 3, or 6 hours by nose-only inhalation up to 9 mg/m3. Results: Neither cytotoxicity nor oxidative stress was observed after exposure to any of the re-aerosolized PM2.5 samples. Though, at similar PM mass concentrations the potency to induce inflammatory responses was strongly dependent on the emission source. Exposure to most examined PM2.5 sources provoked inflammation including those derived from the poultry farm, wear emissions of the NAO and ECE-NAO hybrid brake pads as well as diesel and wood combustion, as indicated by neutrophil chemoattractant, KC and MIP-2 and lung neutrophil influx. Discussion and conclusions: Our study revealed considerable variability in the toxic potency of brake wear particles. Understanding of sources that are most harmful to health can provide valuable information for risk management strategies and could help decision-makers to develop more targeted air pollution regulation.
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Affiliation(s)
- M E Gerlofs-Nijland
- a National Institute for Public Health and the Environment (RIVM) , Bilthoven , Netherlands
| | - B G H Bokkers
- a National Institute for Public Health and the Environment (RIVM) , Bilthoven , Netherlands
| | - H Sachse
- b IDIADA Fahrzeugtechnik , Ingolstadt , Germany
| | - J J E Reijnders
- c Eindhoven University of Technology , Eindhoven , Netherlands
| | - M Gustafsson
- d Swedish National Road and Transport Research Institute (VTI) , Linköping , Sweden
| | - A J F Boere
- a National Institute for Public Health and the Environment (RIVM) , Bilthoven , Netherlands
| | - P F H Fokkens
- a National Institute for Public Health and the Environment (RIVM) , Bilthoven , Netherlands
| | - D L A C Leseman
- a National Institute for Public Health and the Environment (RIVM) , Bilthoven , Netherlands
| | - K Augsburg
- e Technical University Ilmenau , Ilmenau , Germany
| | - F R Cassee
- a National Institute for Public Health and the Environment (RIVM) , Bilthoven , Netherlands
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Stock M, Gora J, Perpar A, Georg P, Kragl G, Hug E, Vondracek V, Kubes J, Algranati C, Cianchetti M, Amichetti M, Kajdrowicz T, Kopec R, Olko P, Skowronska K, Sowa U, Gora E, Kisielewicz K, Sas-Korczynska B, Skora T, Bäck A, Gustafsson M, Sooaru M, Nyström PW, Eriksson TB. PO-0943 Harmonization of proton planning for head and neck cancer using PBS: First report of the IPACS collaboration. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31363-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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23
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Gustafsson M, Lämås K, Isaksson U, Sandman PO, Lövheim H. Constipation and laxative use among people living in nursing homes in 2007 and 2013. BMC Geriatr 2019; 19:38. [PMID: 30736737 PMCID: PMC6368797 DOI: 10.1186/s12877-019-1054-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 01/31/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Constipation is a common condition among older people, particularly among people living in nursing homes, and the use of drugs such as opioids is one of many factors that contribute to its high prevalence. The aim of this study was to compare the prevalence of constipation and the use of laxatives between 2007 and 2013, to analyze constipation and laxative use among people who are prescribed opioids, and to identify factors associated with constipation. METHODS In 2007 and 2013, two surveys were performed in the county of Västerbotten in Northern Sweden, comprising all those living in nursing homes. The Multi-Dimensional Dementia Assessment Scale was used to collect data regarding laxative, opioid and anticholinergic drug use, functioning in activities of daily living (ADL), cognition and symptoms of constipation. A comparison was made between 2820 people from 2007 and 1902 people from 2013. RESULTS The prevalence of symptoms of constipation among people living in nursing homes increased from 36% in 2007 to 40% in 2013. After controlling for age, sex, ADL, cognitive impairment and use of opioid and anticholinergic drugs, this difference was found to be statistically significant. When controlled for demographic changes, there was a statistically significant difference in the regular use of laxatives between the respective years, from 46% in 2007 to 59% in 2013. People prescribed opioids and anticholinergic drugs were at increased risk of constipation, while people with a higher ADL score were at decreased risk. Further, among people prescribed opioids and rated as constipated, 35% in 2007 and 20% in 2013 were not prescribed laxatives for regular use, a difference that was found to be statistically significant. CONCLUSIONS The prevalence of symptoms of constipation increased between 2007 and 2013. Although there was a decrease between the years, there were still a number of people being prescribed with opioids and rated as constipated who were not treated with laxatives. This study therefore indicates that constipation remains a significant problem among people in nursing homes and also indicates that those prescribed opioids could benefit from an increased awareness of the risk of constipation and treatment, if required.
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Affiliation(s)
- Maria Gustafsson
- Department of Pharmacology and Clinical Neuroscience, Umeå University, SE-901 87, Umeå, Sweden.
| | - Kristina Lämås
- Department of Nursing, Umeå University, 901 87, Umeå, Sweden
| | - Ulf Isaksson
- Department of Nursing, Umeå University, 901 87, Umeå, Sweden.,Arctic Research Centre at Umeå University, 901 87, Umeå, Sweden
| | - Per-Olof Sandman
- Department of Nursing, Umeå University, 901 87, Umeå, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Hugo Lövheim
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, 901 87, Umeå, Sweden
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Mattsson S, Gustafsson M, Svahn S, Norberg H, Gallego G. Who enrols and graduates from web-based pharmacy education - Experiences from Northern Sweden. Curr Pharm Teach Learn 2018; 10:1004-1012. [PMID: 30314534 DOI: 10.1016/j.cptl.2018.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 03/04/2018] [Accepted: 05/11/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION As a response to the shortage of prescriptionists in Northern Sweden, a web-based Bachelor of Science in Pharmacy program was introduced at Umeå University in 2003. This study explored who is likely to enrol and graduate from the web-based bachelor program and whether the program has addressed the shortage of prescriptionists in rural Northern Sweden. METHODS Data from three different sources were included in this study; the initial cohort including students admitted to the program in 2003 (survey), the entire cohort including all people admitted to the program between 2003 and 2014 (university's admissions data) and the alumni cohort including graduates who participated in an alumni survey in 2015. RESULTS A typical student of the web-based pharmacy program is female, over 30 years of age, married or in a de-facto relationship and has children. Furthermore, the students graduating before 2009 were more likely to live in Northern Sweden compared to those graduating later. DISCUSSION AND CONCLUSION The results indicate that the introduction of a web-based bachelor of pharmacy program at Umeå University was to some extent able to address the shortage of prescriptionists in Northern Sweden. Web-based education may potentially help address the maldistribution of health professionals by providing flexible education opportunities.
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Affiliation(s)
- Sofia Mattsson
- Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå SE-90187, Sweden.
| | - Maria Gustafsson
- Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå SE-90187, Sweden.
| | - Sofia Svahn
- Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå SE-90187, Sweden.
| | - Helena Norberg
- Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå SE-90187, Sweden.
| | - Gisselle Gallego
- School of Medicine, The University of Notre Dame, Sydney Campus, 140 Broadway, Chippendale, NSW, Australia.
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Sjölander M, Lindholm L, Pfister B, Jonsson J, Schneede J, Lövheim H, Gustafsson M. Impact of clinical pharmacist engagement in ward teams on the number of drug-related readmissions among older patients with dementia or cognitive impairment: An economic evaluation. Res Social Adm Pharm 2018; 15:287-291. [PMID: 29778344 DOI: 10.1016/j.sapharm.2018.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 05/06/2018] [Accepted: 05/08/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Clinical pharmacists play an increasing role in the pharmacological treatment of hospital-admitted older patients with dementia or cognitive impairment. In an earlier randomised controlled trial, clinical pharmacist involvement in the ward team could significantly reduce drug-related readmissions in patient subgroups. However, the economic impact of the intervention has not been addressed so far. OBJECTIVES To evaluate the economic impact of clinical pharmacist engagement in hospital ward teams for medication therapy management in older patients with dementia or cognitive impairments. METHODS Economic evaluation of a randomised controlled trial conducted in two hospitals in Northern Sweden between January 2012 and December 2014. Participants included 460 hospital-admitted older patients with dementia or cognitive impairments. Patients were randomly assigned to usual care, or usual care with pharmacist intervention; the intervention consisted of medication reconciliation, medication review, and participation in ward rounds. The outcomes were measured as drug-related readmissions to hospital as assessed by a group of external experts, 180 and 30 days after discharge. Costs included pharmacists' direct labour costs for the interventions, average costs for drug-related readmissions, and from this the total cost per person was calculated. RESULTS The effect of the intervention on drug-related readmissions within 180 days was significant in patients without heart failure (subgroup analysis), and the intervention resulted in cost savings of €950 per person in this subgroup. Drug-related readmissions within 30 days were reduced in the total sample (post-hoc analysis), and the cost-savings in this intervention group were €460 per person. CONCLUSIONS Post-hoc and subgroup analyses indicate that engagement of pharmacists in hospital ward teams reduced the number of drug-related readmissions, and that the cost per person was lower in the intervention group compared to the control group. Including clinical pharmacists created savings in the subgroups of older patients with dementia or cognitive impairments.
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Affiliation(s)
- Maria Sjölander
- Department of Pharmacology and Clinical Neuroscience, Clinical Pharmacology, Umeå University, Umeå, Sweden
| | - Lars Lindholm
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Bettina Pfister
- Department of Pharmacology and Clinical Neuroscience, Clinical Pharmacology, Umeå University, Umeå, Sweden
| | - Jeanette Jonsson
- Department of Pharmacology and Clinical Neuroscience, Clinical Pharmacology, Umeå University, Umeå, Sweden
| | - Jörn Schneede
- Department of Pharmacology and Clinical Neuroscience, Clinical Pharmacology, Umeå University, Umeå, Sweden
| | - Hugo Lövheim
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
| | - Maria Gustafsson
- Department of Pharmacology and Clinical Neuroscience, Clinical Pharmacology, Umeå University, Umeå, Sweden.
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Vinterflod C, Gustafsson M, Mattsson S, Gallego G. Physicians' perspectives on clinical pharmacy services in Northern Sweden: a qualitative study. BMC Health Serv Res 2018; 18:35. [PMID: 29361941 PMCID: PMC5781320 DOI: 10.1186/s12913-018-2841-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 01/15/2018] [Indexed: 12/27/2022] Open
Abstract
Background In many countries, clinical pharmacists are part of health care teams that work to optimize drug therapy and ensure patient safety. However, in Sweden, clinical pharmacy services (CPSs) in hospital settings have not been widely implemented and regional differences exist in the uptake of these services. Physicians’ attitudes toward CPSs and collaborating with clinical pharmacists may facilitate or hinder the implementation and expansion of the CPSs and the role of the clinical pharmacist in hospital wards. The aim of this study was to explore physicians’ perceptions regarding CPSs performed at hospital wards in Northern Sweden. Methods Face-to-face semi-structured interviews were conducted with a purposive sample of nine physicians who had previously worked with clinical pharmacists between November 2014 and January 2015. Interviews were digitally recorded, transcribed and analysed using a constant comparison method. Results Different themes emerged regarding physicians’ views of clinical pharmacy; two main interlinked themes were service factors and pharmacist factors. The service was valued and described in a positive way by all physicians. It was seen as an opportunity for them to learn more about pharmacological treatment and also an opportunity to discuss patient medication treatment in detail. Physicians considered that CPSs could improve patient outcomes and they valued continuity and the ability to build a trusting relationship with the pharmacists over time. However, there was a lack of awareness of the CPSs. All physicians knew that one of the pharmacist’s roles is to conduct medication reviews, but most of them were only able to describe a few elements of what this service encompasses. Pharmacists were described as “drug experts” and their recommendations were perceived as clinically relevant. Physicians wanted CPSs to continue and to be implemented in other wards. Conclusions All physicians were positive regarding CPSs and were satisfied with the collaboration with the clinical pharmacists. These findings are important for further implementation and expansion of CPSs, particularly in Northern Sweden. Electronic supplementary material The online version of this article (10.1186/s12913-018-2841-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Charlotta Vinterflod
- Department of Pharmacology and Clinical Neuroscience, Umeå University, SE-90187, Umeå, Sweden
| | - Maria Gustafsson
- Department of Pharmacology and Clinical Neuroscience, Umeå University, SE-90187, Umeå, Sweden.
| | - Sofia Mattsson
- Department of Pharmacology and Clinical Neuroscience, Umeå University, SE-90187, Umeå, Sweden
| | - Gisselle Gallego
- Department of Pharmacology and Clinical Neuroscience, Umeå University, SE-90187, Umeå, Sweden.,School of Medicine, The University of Notre Dame Australia, 160 Oxford Street, Darlinghurst, NSW, 2010, Australia
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Gustafsson M, Sjölander M, Pfister B, Schneede J, Lövheim H. Effects of Pharmacists' Interventions on Inappropriate Drug Use and Drug-Related Readmissions in People with Dementia-A Secondary Analysis of a Randomized Controlled Trial. Pharmacy (Basel) 2018; 6:pharmacy6010007. [PMID: 29337859 PMCID: PMC5874546 DOI: 10.3390/pharmacy6010007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 01/10/2018] [Accepted: 01/12/2018] [Indexed: 12/15/2022] Open
Abstract
Age-associated physiological changes and extensive drug treatment including use of potentially inappropriate medications (PIMs) pose a significant risk of drug-drug interactions and adverse drug events among elderly people with dementia. This study aimed at analysing the effects of clinical pharmacists' interventions on use of PIMs, risk of emergency department visits, and time to institutionalization. Furthermore, a descriptive analysis was conducted of circumstances associated with drug-related readmissions. This is a secondary analysis of data from a randomized controlled intervention study conducted in two hospitals in Northern Sweden. The study included patients (n = 460) 65 years or older with dementia or cognitive impairment. The intervention consisted of comprehensive medication reviews conducted by clinical pharmacists as part of a healthcare team. There was a larger decrease in PIMs in the intervention group compared with the control group (p = 0.011). No significant difference was found in time to first all-cause emergency department visits (HR = 0.994, 95% CI = 0.755-1.307 p = 0.963, simple Cox regression) or time to institutionalization (HR = 0.761, 95% CI = 0.409-1.416 p = 0.389, simple Cox regression) within 180 days. Common reasons for drug-related readmissions were negative effects of sedatives, opioids, antidepressants, and anticholinergic agents, resulting in confusion, falling, and sedation. Drug-related readmissions were associated with living at home, heart failure, and diabetes. Pharmacist-provided interventions were able to reduce PIMs among elderly people with dementia and cognitive impairment.
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Affiliation(s)
- Maria Gustafsson
- Department of Pharmacology and Clinical Neuroscience, Umeå University, SE-90187 Umeå, Sweden.
| | - Maria Sjölander
- Department of Pharmacology and Clinical Neuroscience, Umeå University, SE-90187 Umeå, Sweden.
| | - Bettina Pfister
- Department of Pharmacology and Clinical Neuroscience, Umeå University, SE-90187 Umeå, Sweden.
| | - Jörn Schneede
- Department of Pharmacology and Clinical Neuroscience, Umeå University, SE-90187 Umeå, Sweden.
| | - Hugo Lövheim
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, SE-90187 Umeå, Sweden.
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Lindbo A, Gustafsson M, Isaksson U, Sandman PO, Lövheim H. Dysphoric symptoms in relation to other behavioral and psychological symptoms of dementia, among elderly in nursing homes. BMC Geriatr 2017; 17:206. [PMID: 28882104 PMCID: PMC5590234 DOI: 10.1186/s12877-017-0603-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 08/30/2017] [Indexed: 11/10/2022] Open
Abstract
Background Behavioral and psychological symptoms of dementia (BPSD) are common and varied in the elderly. The aim of the current study was to explore associations between BPSD and dysphoric symptoms at different levels of cognitive impairment. Methods Assessments of 4397 elderly individuals living in nursing homes in Sweden were performed. Data on cognitive function and BPSD were collected using the Multi-Dimensional Dementia Assessment Scale (MDDAS). The relationships between dysphoria and eight BPSD factors were plotted against cognitive function to investigate how dysphoria affects BPSD throughout the dementia disease. Results Overall, dysphoric symptoms were most prevalent in persons with moderate cognitive impairment. However, moderate to severe dysphoric symptoms showed no clear variation with cognitive impairment. Furthermore, aggressive behavior, verbally disruptive/attention-seeking behavior, hallucinatory symptoms and wandering behavior were more common with concurrent dysphoria regardless of cognitive function. In contrast, passiveness was more common with concurrent dysphoria in mild cognitive impairment but not in moderate to severe cognitive impairment. Conclusions BPSD, including aggressive behavior and hallucinations, were more common with concurrent dysphoric symptoms, providing insight into behavioral and psychological symptoms among individuals with cognitive impairment. Apathy was more commonly associated with concurrent dysphoria at early stages of cognitive decline but not at later stages, indicating that apathy and dysphoria represent separate syndromes among elderly patients with moderate to severe cognitive impairment. Electronic supplementary material The online version of this article (10.1186/s12877-017-0603-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Agnes Lindbo
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, 901 87, Umeå, Sweden
| | - Maria Gustafsson
- Department of Pharmacology and Clinical Neuroscience, Division of Clinical Pharmacology, Umeå University, 901 87, Umeå, Sweden.
| | - Ulf Isaksson
- Department of Nursing, Umeå University, 901 87, Umeå, Sweden.,Arctic Research Centre at Umeå University, 901 87, Umeå, Sweden
| | - Per-Olof Sandman
- Department of Nursing, Umeå University, 901 87, Umeå, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.,Department of Health Sciences, University of Technology, Luleå, Sweden
| | - Hugo Lövheim
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, 901 87, Umeå, Sweden
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Gustafsson M, Mattsson S, Wallman A, Gallego G. Pharmacists' satisfaction with their work: Analysis of an alumni survey. Res Social Adm Pharm 2017; 14:700-704. [PMID: 28870444 DOI: 10.1016/j.sapharm.2017.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/16/2017] [Accepted: 08/28/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The level of job satisfaction among practicing pharmacists is important because it has been found to affect job performance and employee turnover. The Swedish pharmacy market has undergone major changes in recent years, and little is known about pharmacists' job satisfaction. OBJECTIVES The objective of this study was to investigate the level of job satisfaction and associated factors among graduates from the web-based pharmacy programs at Umeå University. METHODS Job satisfaction of pharmacists was measured as part of an alumni survey conducted with those who graduated from the pharmacy programmes between 2006 and 2014. Data analysis included descriptive statistics, and logistic regression was used to explore factors affecting job satisfaction. RESULTS The total number of graduates who completed the survey was 222 (response rate 43%.) The majority of respondents were female (95%), and most were employed at a community pharmacy (85%). The mean age was 39.7 years. The majority of graduates (91%) were satisfied with their job "most of the time" or "all of the time", and 87% of the respondents would "definitely" or "maybe" choose the same career again. The multivariate analysis showed that increasing years in the current position (OR: 0.672 (0.519-0.871)) was associated with lower job satisfaction. Older age (OR: 1.123 (1.022-1.234)), the perception that the knowledge and skills acquired during university education is useful in the current job (OR: 4.643 (1.255-17.182)) and access to continuing professional development (OR: 9.472 (1.965-45.662)) were associated with higher job satisfaction. CONCLUSION Most graduates from the web-based pharmacy programmes were satisfied with their current job. Access to continuing professional development seems to be important for the level of job satisfaction among pharmacists.
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Affiliation(s)
- Maria Gustafsson
- Department of Pharmacology and Clinical Neuroscience, Umeå University, SE-90187, Umeå, Sweden.
| | - Sofia Mattsson
- Department of Pharmacology and Clinical Neuroscience, Umeå University, SE-90187, Umeå, Sweden
| | - Andy Wallman
- Department of Pharmacology and Clinical Neuroscience, Umeå University, SE-90187, Umeå, Sweden
| | - Gisselle Gallego
- Department of Pharmacology and Clinical Neuroscience, Umeå University, SE-90187, Umeå, Sweden; School of Medicine, The University of Notre Dame Australia, NSW, Australia
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Gustafsson M, Englund C, Gallego G. The description and evaluation of virtual worlds in clinical pharmacy education in Northern Sweden. Curr Pharm Teach Learn 2017; 9:887-892. [PMID: 29233320 DOI: 10.1016/j.cptl.2017.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 02/27/2017] [Accepted: 06/02/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND PURPOSE The purpose of this article is to describe and evaluate the use of a three-dimensional virtual world (3DVW) in a clinical pharmacy course. EDUCATIONAL ACTIVITY AND SETTING Students are provided with training opportunities in simulated ward rounds and patient meetings in a 3DVW. The 3DVW enables students to practice communication with patients and colleagues in a professional manner. To evaluate the course and use of the 3DVW, an online course evaluation was completed by students after they had finished the clinical pharmacy course. FINDINGS Forty-two students completed the online course evaluation (62%). Most students (83%) reported that they could adopt the role of a clinical pharmacist in the 3DVW. Sixty percent reported that the environment felt authentic, although some noted that "it can never be quite the same as sitting next to a real person to talk". More than half of the students (66%) described the use of the 3DVW as a worthwhile exercise. The majority (93%) rated the overall quality of the course as good or very good, with 76% reporting that the pedagogical design of the course helped them with their studies. DISCUSSION AND SUMMARY Students at Umeå University valued the use of 3DVWs in clinical pharmacy teaching. However, there is a need to make the virtual environment more realistic and easier to use. The invaluable feedback gathered from students will help to improve the future use of virtual worlds in pharmacy education.
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Affiliation(s)
- Maria Gustafsson
- Department of Pharmacology and Clinical Neuroscience, Division of Clinical Pharmacology, Umeå University, SE-90187 Umeå, Sweden.
| | - Claire Englund
- Centre for Educational Development (UPL), Umeå University, SE-90187 Umeå, Sweden.
| | - Gisselle Gallego
- Department of Pharmacology and Clinical Neuroscience, Division of Clinical Pharmacology, Umeå University, SE-90187 Umeå, Sweden; School of Medicine, The University of Notre Dame, 160 Oxford Street, Darlinghurst, New South Wales 2010, Australia.
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Sjölander M, Gustafsson M, Gallego G. Doctors' and nurses' perceptions of a ward-based pharmacist in rural northern Sweden. Int J Clin Pharm 2017; 39:953-959. [PMID: 28547729 PMCID: PMC5541103 DOI: 10.1007/s11096-017-0488-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 05/13/2017] [Indexed: 12/02/2022]
Abstract
Background This project is part of the prospective quasi experimental proof-of-concept investigation of clinical pharmacist intervention study to reduce drug-related problems among people admitted to a ward in a rural hospital in northern Sweden. Objective To explore doctors' and nurses' perceptions and expectations of having a ward-based pharmacist providing clinical pharmacy services. Setting Medical ward in a rural hospital in northern Sweden. Method Eighteen face-to-face semi-structured interviews were conducted with a purposive sample of doctors and nurses working on the ward where the clinical pharmacy service was due to be implemented. Semi-structured interviews were digitally recorded, transcribed and analysed using thematic analysis. Main outcome measure Perceptions and expectations of nurses and doctors. Results Doctors and nurses had limited experience of working with pharmacists. Most had a vague idea of what pharmacists can contribute within a ward setting. Participants, mainly nurses, suggested inventory and drug distribution roles, but few were aware of the pharmacists' skills and clinical competence. Different views were expressed on whether the new clinical pharmacy service would have an impact on workload. However, most participants took a positive view of having a ward-based pharmacist. Conclusion This study provided an opportunity to explore doctors' and nurses' expectations of the role of clinical pharmacists before a clinical pharmacy service was implemented. To successfully implement a clinical pharmacy service, roles, clinical competence and responsibilities should be clearly described. Furthermore, it is important to focus on collaborative working relationships between doctors, nurses and pharmacists.
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Affiliation(s)
- Maria Sjölander
- Department of Pharmacology and Clinical Neuroscience, Umeå University, 90187, Umeå, Sweden.
| | - Maria Gustafsson
- Department of Pharmacology and Clinical Neuroscience, Umeå University, 90187, Umeå, Sweden
| | - Gisselle Gallego
- Department of Pharmacology and Clinical Neuroscience, Umeå University, 90187, Umeå, Sweden
- School of Medicine, The University of Notre Dame Australia, 160 Oxford Street, Darlinghurst, NSW, 2010, Australia
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Pfister B, Jonsson J, Gustafsson M. Drug-related problems and medication reviews among old people with dementia. BMC Pharmacol Toxicol 2017; 18:52. [PMID: 28655357 PMCID: PMC5488493 DOI: 10.1186/s40360-017-0157-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 06/16/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Drug-related problems, including medication errors and adverse drug events, are common among old people. Due to, for example, greater susceptibility to side effects, people with dementia are even more at risk of drug-related problems. The objectives of this study were to assess the occurrence and character of drug-related problems found among old people with dementia or cognitive impairment. METHODS Data from a randomized controlled clinical trial exploring the effects of a pharmacist intervention as part of a hospital ward team in patients 65 years and older with dementia or cognitive impairment were used. The study was conducted between 2012 and 2014 in the orthopedic and medicine wards in two hospitals located in Northern Sweden. Drug-related problems identified in this patient group were classified and described, and associations with different factors were investigated. RESULTS Clinical pharmacists identified at least one DRP in 66% (140/212) of participants in the intervention group, for a total of 310 DRPs. Ineffective drug/inappropriate drug and unnecessary drug therapy were the most common drug-related problems. Discontinuation of drug therapy was the most common action carried out. Drug-related problems were more common among people prescribed a larger number of drugs and among people with an earlier stroke. CONCLUSIONS Drug-related problems are common among people with dementia and cognitive impairment. Comprehensive medication reviews conducted by clinical pharmacists as part of a health care team might be important to prevent, identify and solve these problems.
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Affiliation(s)
- Bettina Pfister
- Department of Pharmacology and Clinical Neuroscience, Umeå University, SE-90187, Umeå, Sweden
| | - Jeanette Jonsson
- Department of Pharmacology and Clinical Neuroscience, Umeå University, SE-90187, Umeå, Sweden
| | - Maria Gustafsson
- Department of Pharmacology and Clinical Neuroscience, Umeå University, SE-90187, Umeå, Sweden.
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Gustafsson M, Sjölander M, Pfister B, Jonsson J, Schneede J, Lövheim H. Pharmacist participation in hospital ward teams and hospital readmission rates among people with dementia: a randomized controlled trial. Eur J Clin Pharmacol 2017; 73:827-835. [PMID: 28391409 PMCID: PMC5486919 DOI: 10.1007/s00228-017-2249-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 03/30/2017] [Indexed: 01/22/2023]
Abstract
Purpose To assess whether comprehensive medication reviews conducted by clinical pharmacists as part of a healthcare team reduce drug-related hospital readmission rates among people with dementia or cognitive impairment. Methods This randomized controlled trial was carried out between January 9, 2012, and December 2, 2014. Patients aged ≥65 years with dementia or cognitive impairment admitted to three wards at two hospitals located in Northern Sweden were included. Results Of the 473 deemed eligible for participation, 230 were randomized to intervention and 230 to control group by block randomization. The primary outcome, risk of drug-related hospital readmissions, was assessed at 180 days of follow-up by intention-to-treat analysis. During the 180 days of follow-up, 18.9% (40/212) of patients in the intervention group and 23.0% (50/217) of those in the control group were readmitted for drug-related reasons (HR = 0.80, 95% CI = 0.53–1.21, p = 0.28, univariable Cox regression). Heart failure was significantly more common in the intervention group. After adjustment for heart failure as a potential confounder and an interaction term, multiple Cox regression analysis indicated that pharmacist participation significantly reduced the risk of drug-related readmissions (HR = 0.49, 95% CI = 0.27–0.90, p = 0.02). A post-hoc analysis showed a significantly reduced risk of 30-day readmissions due to drug-related problems in the total sample (without adjustment for heart failure). Conclusion Participation of clinical pharmacists in healthcare team conducting comprehensive medication reviews did not significantly reduce the risk of drug-related readmissions in patients with dementia or cognitive impairment; however, post-hoc and subgroup analyses indicated significant effects favoring the intervention. More research is needed. Trial registration: Clinical trials NCT01504672. Electronic supplementary material The online version of this article (doi:10.1007/s00228-017-2249-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maria Gustafsson
- Department of Pharmacology and Clinical Neuroscience, Division of Clinical Pharmacology, Umeå University, SE-901 85, Umeå, Sweden. .,Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden.
| | - Maria Sjölander
- Department of Pharmacology and Clinical Neuroscience, Division of Clinical Pharmacology, Umeå University, SE-901 85, Umeå, Sweden
| | - Bettina Pfister
- Department of Pharmacology and Clinical Neuroscience, Division of Clinical Pharmacology, Umeå University, SE-901 85, Umeå, Sweden
| | - Jeanette Jonsson
- Department of Pharmacology and Clinical Neuroscience, Division of Clinical Pharmacology, Umeå University, SE-901 85, Umeå, Sweden
| | - Jörn Schneede
- Department of Pharmacology and Clinical Neuroscience, Division of Clinical Pharmacology, Umeå University, SE-901 85, Umeå, Sweden
| | - Hugo Lövheim
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
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Sönnerstam E, Sjölander M, Gustafsson M. An evaluation of the prevalence of potentially inappropriate medications in older people with cognitive impairment living in Northern Sweden using the EU(7)-PIM list. Eur J Clin Pharmacol 2017; 73:735-742. [PMID: 28246889 PMCID: PMC5423959 DOI: 10.1007/s00228-017-2218-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 02/13/2017] [Indexed: 02/03/2023]
Abstract
Purpose As people get older, their sensitivity to drugs and adverse drug reactions can increase due to pharmacokinetic and pharmacodynamic changes. Older people with dementia are a particularly vulnerable group of people. They are at an increased risk of being prescribed potentially inappropriate medications, which may lead to harmful consequences. The aim of this study was to investigate the prevalence of potentially inappropriate medications among older patients with cognitive impairment. Methods Medical records for patients aged ≥65 years admitted to two hospitals in Northern Sweden were reviewed. Potentially inappropriate medications were identified using the EU(7)-PIM list as an identification tool. Results Of 428 patients included in the study, 40.9% had one or more potentially inappropriate medication prescribed. The most commonly represented potentially inappropriate medication classes were hypnotics and sedatives, cardiovascular drugs and laxatives. The most commonly involved potentially inappropriate medications were zopiclone, digoxin and sodium picosulfate. There was an association seen between having a higher number of medications prescribed and having one or more potentially inappropriate medication. Conclusion Potentially inappropriate medications are prevalent among older people with cognitive impairment living in Northern Sweden. It is important to continuously evaluate the need for potentially inappropriate medications in this patient group, in order to prevent adverse drug reactions, especially among those who have a higher number of medications prescribed. Electronic supplementary material The online version of this article (doi:10.1007/s00228-017-2218-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eva Sönnerstam
- Department of Pharmacology and Clinical Neuroscience, Division of Clinical Pharmacology, Umeå University, SE-901 87, Umeå, Sweden
| | - Maria Sjölander
- Department of Pharmacology and Clinical Neuroscience, Division of Clinical Pharmacology, Umeå University, SE-901 87, Umeå, Sweden
| | - Maria Gustafsson
- Department of Pharmacology and Clinical Neuroscience, Division of Clinical Pharmacology, Umeå University, SE-901 87, Umeå, Sweden.
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Englund C, Gustafsson M, Gallego G. Pharmacy Students' Attitudes and Perceptions of "Virtual Worlds" as an Instructional Tool for Clinical Pharmacy Teaching. Pharmacy (Basel) 2017; 5:pharmacy5010005. [PMID: 28970417 PMCID: PMC5419380 DOI: 10.3390/pharmacy5010005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 12/07/2016] [Accepted: 01/23/2017] [Indexed: 01/19/2023] Open
Abstract
The objectives of this study were to explore pharmacy students’ perceptions and experiences of three-dimensional virtual worlds (3DVWs) as an instructional tool for clinical pharmacy teaching. Semi-structured interviews were carried out with Master of Science in Pharmacy students who had participated in communicative exercises in a 3DVW. Interviews were digitally recorded, transcribed and analyzed using thematic analysis. More than half of the students were positive to using 3DVWs for educational purposes and see the advantages of having a setting where communication can be practiced in an authentic but ‘safe’ environment available online. However, many students also reported technical difficulties in using the 3DVW which impacted negatively on the learning experience. Perceived ease of use and usefulness of 3DVWs appears to play an important role for students. The students’ level of engagement relates to not only their computer skills, but also to the value they place on 3DVWs as an instructional tool.
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Affiliation(s)
- Claire Englund
- Center for Educational Development (UPL), Umeå University, SE-90187 Umeå, Sweden.
| | - Maria Gustafsson
- Department of Pharmacology and Clinical Neuroscience, Umeå University, SE-90187 Umeå, Sweden.
| | - Gisselle Gallego
- Department of Pharmacology and Clinical Neuroscience, Umeå University, SE-90187 Umeå, Sweden.
- School of Medicine, The University of Notre Dame, Australia, New South Wales 2010, Australia.
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Fernlund E, Österberg AW, Kuchinskaya E, Gustafsson M, Jansson K, Gunnarsson C. Novel Genetic Variants in BAG3 and TNNT2 in a Swedish Family with a History of Dilated Cardiomyopathy and Sudden Cardiac Death. Pediatr Cardiol 2017; 38:1262-1268. [PMID: 28669108 PMCID: PMC5514196 DOI: 10.1007/s00246-017-1655-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 06/08/2017] [Indexed: 12/26/2022]
Abstract
Familial dilated cardiomyopathy is a rare cause of dilated cardiomyopathy (DCM), especially in childhood. Our aim was to describe the clinical course and the genetic variants in a family where the proband was a four-month-old infant presenting with respiratory problems due to DCM. In the family, there was a strong family history of DCM and sudden cardiac death in four generations. DNA was analyzed initially from the deceased girl using next-generation sequencing including 50 genes involved in cardiomyopathy. A cascade family screening was performed in the family after identification of the TNNT2 and the BAG3 variants in the proband. The first-degree relatives underwent clinical examination including biochemistry panel, cardiac ultrasound, Holter ECG, exercise stress test, and targeted genetic testing. The index patient presented with advanced DCM. After a severe clinical course, the baby had external left ventricular assist as a bridge to heart transplantation. 1.5 months after transplantation, the baby suffered sudden cardiac death (SCD) despite maximal treatment in the pediatric intensive care unit. The patient was shown to carry two heterozygous genetic variants in the TNNT2 gene [TNNT2 c.518G>A(p.Arg173Gln)] and BAG3 [BAG3 c.785C>T(p.Ala262Val)]. Two of the screened individuals (two females) appeared to carry both the familial variants. All the individuals carrying the TNNT2 variant presented with DCM, the two adult patients had mild or moderate symptoms of heart failure and reported palpitations but no syncope or presyncopal attacks prior to the genetic diagnosis. The female carriers of TNNT2 and BAG3 variants had more advanced DCM. In the family history, there were three additional cases of SCD due to DCM, diagnosed by autopsy, but no genetic analysis was possible in these cases. Our findings suggest that the variants in TNNT2 and BAG3 are associated with a high propensity to life-threatening cardiomyopathy presenting from childhood and young adulthood.
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Affiliation(s)
- Eva Fernlund
- Department of Pediatrics, Department of Clinical Experimental Medicine, Linköping University, Linköping, Sweden. .,Pediatric Heart Center, Lund University, S-22185, Lund, Sweden.
| | - A. Wålinder Österberg
- Department of Pediatrics, Department of Clinical Experimental Medicine, Linköping University, Linköping, Sweden
| | - E. Kuchinskaya
- Department of Clinical Genetics, Department of Clinical Experimental Medicine, Linköping University, Linköping, Sweden
| | - M. Gustafsson
- Department of Cardiology, Linköping University, Linköping, Sweden
| | - K. Jansson
- Department of Cardiology, Linköping University, Linköping, Sweden ,Department of Clinical Physiology, Linköping University, Linköping, Sweden
| | - C. Gunnarsson
- Department of Clinical Genetics, Department of Clinical Experimental Medicine, Linköping University, Linköping, Sweden ,Centre for Rare Diseases in South East Region of Sweden, Linköping University, Linköping, Sweden
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Abstract
BACKGROUND Older people are more sensitive to drugs and adverse drug reactions than younger people because of age-related physiological changes such as impaired renal function. As people with dementia are particularly vulnerable to the effects of drugs, it is especially important to evaluate the dosages of renally cleared medications in this group. OBJECTIVE The aim of this study was to estimate the prevalence of impaired renal function and inappropriate prescriptions on the basis of renal function among older patients with dementia or cognitive impairment. METHODS The medical records of 428 patients aged ≥65 years who were admitted to two hospitals in northern Sweden were reviewed and renally cleared medications were identified. The Cockcroft-Gault equation was used to evaluate renal function. Doses were evaluated according to the Geriatric Dosage Handbook. RESULTS Renal function was impaired (estimated glomerular filtration rate <60 ml/min) in 65.4 % of the study population. Impaired renal function was associated with increasing age. Among 547 prescriptions identified as renally cleared medications, 9.1 % were inappropriate based on the patient's renal function; 13.5 % of the 326 patients prescribed renally cleared medications had inappropriate prescriptions. Inappropriate prescriptions were more common among patients living in nursing homes. CONCLUSIONS Impaired renal function is common and inappropriate prescription is prevalent among old people with cognitive impairment in northern Sweden. Continuous consideration of renal function is important when prescribing medications to this group.
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Affiliation(s)
- Eva Sönnerstam
- Department of Pharmacology and Clinical Neuroscience, Umeå University, 901 87, Umeå, Sweden
| | - Maria Sjölander
- Department of Pharmacology and Clinical Neuroscience, Umeå University, 901 87, Umeå, Sweden
| | - Maria Gustafsson
- Department of Pharmacology and Clinical Neuroscience, Umeå University, 901 87, Umeå, Sweden.
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Gustafsson M, Sjölander M, Pfister B, Jonsson J, Schneede J, Lövheim H. Drug-related hospital admissions among old people with dementia. Eur J Clin Pharmacol 2016; 72:1143-53. [DOI: 10.1007/s00228-016-2084-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 06/20/2016] [Indexed: 10/21/2022]
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Gustafsson M, Isaksson U, Karlsson S, Sandman PO, Lövheim H. Behavioral and psychological symptoms and psychotropic drugs among people with cognitive impairment in nursing homes in 2007 and 2013. Eur J Clin Pharmacol 2016; 72:987-94. [DOI: 10.1007/s00228-016-2058-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 04/01/2016] [Indexed: 10/22/2022]
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Ackermann M, Albert A, Anderson B, Atwood WB, Baldini L, Barbiellini G, Bastieri D, Bechtol K, Bellazzini R, Bissaldi E, Blandford RD, Bloom ED, Bonino R, Bottacini E, Brandt TJ, Bregeon J, Bruel P, Buehler R, Caliandro GA, Cameron RA, Caputo R, Caragiulo M, Caraveo PA, Cecchi C, Charles E, Chekhtman A, Chiang J, Chiaro G, Ciprini S, Claus R, Cohen-Tanugi J, Conrad J, Cuoco A, Cutini S, D'Ammando F, de Angelis A, de Palma F, Desiante R, Digel SW, Di Venere L, Drell PS, Drlica-Wagner A, Essig R, Favuzzi C, Fegan SJ, Ferrara EC, Focke WB, Franckowiak A, Fukazawa Y, Funk S, Fusco P, Gargano F, Gasparrini D, Giglietto N, Giordano F, Giroletti M, Glanzman T, Godfrey G, Gomez-Vargas GA, Grenier IA, Guiriec S, Gustafsson M, Hays E, Hewitt JW, Horan D, Jogler T, Jóhannesson G, Kuss M, Larsson S, Latronico L, Li J, Li L, Llena Garde M, Longo F, Loparco F, Lubrano P, Malyshev D, Mayer M, Mazziotta MN, McEnery JE, Meyer M, Michelson PF, Mizuno T, Moiseev AA, Monzani ME, Morselli A, Murgia S, Nuss E, Ohsugi T, Orienti M, Orlando E, Ormes JF, Paneque D, Perkins JS, Pesce-Rollins M, Piron F, Pivato G, Porter TA, Rainò S, Rando R, Razzano M, Reimer A, Reimer O, Ritz S, Sánchez-Conde M, Schulz A, Sehgal N, Sgrò C, Siskind EJ, Spada F, Spandre G, Spinelli P, Strigari L, Tajima H, Takahashi H, Thayer JB, Tibaldo L, Torres DF, Troja E, Vianello G, Werner M, Winer BL, Wood KS, Wood M, Zaharijas G, Zimmer S. Searching for Dark Matter Annihilation from Milky Way Dwarf Spheroidal Galaxies with Six Years of Fermi Large Area Telescope Data. Phys Rev Lett 2015; 115:231301. [PMID: 26684107 DOI: 10.1103/physrevlett.115.231301] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Indexed: 06/05/2023]
Abstract
The dwarf spheroidal satellite galaxies (dSphs) of the Milky Way are some of the most dark matter (DM) dominated objects known. We report on γ-ray observations of Milky Way dSphs based on six years of Fermi Large Area Telescope data processed with the new Pass8 event-level analysis. None of the dSphs are significantly detected in γ rays, and we present upper limits on the DM annihilation cross section from a combined analysis of 15 dSphs. These constraints are among the strongest and most robust to date and lie below the canonical thermal relic cross section for DM of mass ≲100 GeV annihilating via quark and τ-lepton channels.
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Affiliation(s)
- M Ackermann
- Deutsches Elektronen Synchrotron DESY, D-15738 Zeuthen, Germany
| | - A Albert
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - B Anderson
- Department of Physics, Stockholm University, AlbaNova, SE-106 91 Stockholm, Sweden
- The Oskar Klein Centre for Cosmoparticle Physics, AlbaNova, SE-106 91 Stockholm, Sweden
| | - W B Atwood
- Santa Cruz Institute for Particle Physics, Department of Physics and Department of Astronomy and Astrophysics, University of California at Santa Cruz, Santa Cruz, California 95064, USA
| | - L Baldini
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
- Università di Pisa and Istituto Nazionale di Fisica Nucleare, Sezione di Pisa I-56127 Pisa, Italy
| | - G Barbiellini
- Istituto Nazionale di Fisica Nucleare, Sezione di Trieste, I-34127 Trieste, Italy
- Dipartimento di Fisica, Università di Trieste, I-34127 Trieste, Italy
| | - D Bastieri
- Istituto Nazionale di Fisica Nucleare, Sezione di Padova, I-35131 Padova, Italy
- Dipartimento di Fisica e Astronomia "G. Galilei", Università di Padova, I-35131 Padova, Italy
| | - K Bechtol
- Dept. of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin, Madison, Wisconsin 53706, USA
| | - R Bellazzini
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, I-56127 Pisa, Italy
| | - E Bissaldi
- Istituto Nazionale di Fisica Nucleare, Sezione di Bari, I-70126 Bari, Italy
| | - R D Blandford
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - E D Bloom
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - R Bonino
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, I-10125 Torino, Italy
- Dipartimento di Fisica Generale "Amadeo Avogadro", Università degli Studi di Torino, I-10125 Torino, Italy
| | - E Bottacini
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - T J Brandt
- NASA Goddard Space Flight Center, Greenbelt, Maryland 20771, USA
| | - J Bregeon
- Laboratoire Univers et Particules de Montpellier, Université Montpellier, CNRS/IN2P3, Montpellier, France
| | - P Bruel
- Laboratoire Leprince-Ringuet, École polytechnique, CNRS/IN2P3, Palaiseau, France
| | - R Buehler
- Deutsches Elektronen Synchrotron DESY, D-15738 Zeuthen, Germany
| | - G A Caliandro
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
- Consorzio Interuniversitario per la Fisica Spaziale (CIFS), I-10133 Torino, Italy
| | - R A Cameron
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - R Caputo
- Santa Cruz Institute for Particle Physics, Department of Physics and Department of Astronomy and Astrophysics, University of California at Santa Cruz, Santa Cruz, California 95064, USA
| | - M Caragiulo
- Istituto Nazionale di Fisica Nucleare, Sezione di Bari, I-70126 Bari, Italy
| | - P A Caraveo
- INAF-Istituto di Astrofisica Spaziale e Fisica Cosmica, I-20133 Milano, Italy
| | - C Cecchi
- Istituto Nazionale di Fisica Nucleare, Sezione di Perugia, I-06123 Perugia, Italy
- Dipartimento di Fisica, Università degli Studi di Perugia, I-06123 Perugia, Italy
| | - E Charles
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - A Chekhtman
- College of Science, George Mason University, Fairfax, Virginia 22030, USA
| | - J Chiang
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - G Chiaro
- Dipartimento di Fisica e Astronomia "G. Galilei", Università di Padova, I-35131 Padova, Italy
| | - S Ciprini
- Istituto Nazionale di Fisica Nucleare, Sezione di Perugia, I-06123 Perugia, Italy
- Agenzia Spaziale Italiana (ASI) Science Data Center, I-00133 Roma, Italy
- INAF Osservatorio Astronomico di Roma, I-00040 Monte Porzio Catone (Roma), Italy
| | - R Claus
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - J Cohen-Tanugi
- Laboratoire Univers et Particules de Montpellier, Université Montpellier, CNRS/IN2P3, Montpellier, France
| | - J Conrad
- Department of Physics, Stockholm University, AlbaNova, SE-106 91 Stockholm, Sweden
- The Oskar Klein Centre for Cosmoparticle Physics, AlbaNova, SE-106 91 Stockholm, Sweden
- Wallenberg Academy Fellow
| | - A Cuoco
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, I-10125 Torino, Italy
- Dipartimento di Fisica Generale "Amadeo Avogadro", Università degli Studi di Torino, I-10125 Torino, Italy
| | - S Cutini
- Istituto Nazionale di Fisica Nucleare, Sezione di Perugia, I-06123 Perugia, Italy
- Agenzia Spaziale Italiana (ASI) Science Data Center, I-00133 Roma, Italy
- INAF Osservatorio Astronomico di Roma, I-00040 Monte Porzio Catone (Roma), Italy
| | - F D'Ammando
- INAF Istituto di Radioastronomia, I-40129 Bologna, Italy
- Dipartimento di Astronomia, Università di Bologna, I-40127 Bologna, Italy
| | - A de Angelis
- Dipartimento di Fisica, Università di Udine and Istituto Nazionale di Fisica Nucleare, Sezione di Trieste, Gruppo Collegato di Udine, I-33100 Udine
| | - F de Palma
- Istituto Nazionale di Fisica Nucleare, Sezione di Bari, I-70126 Bari, Italy
- Università Telematica Pegaso, Piazza Trieste e Trento, 48, I-80132 Napoli, Italy
| | - R Desiante
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, I-10125 Torino, Italy
- Università di Udine, I-33100 Udine, Italy
| | - S W Digel
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - L Di Venere
- Dipartimento di Fisica "M. Merlin" dell'Università e del Politecnico di Bari, I-70126 Bari, Italy
| | - P S Drell
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - A Drlica-Wagner
- Center for Particle Astrophysics, Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - R Essig
- C.N. Yang Institute for Theoretical Physics, State University of New York, Stony Brook, New York 11794-3840, USA
| | - C Favuzzi
- Istituto Nazionale di Fisica Nucleare, Sezione di Bari, I-70126 Bari, Italy
- Dipartimento di Fisica "M. Merlin" dell'Università e del Politecnico di Bari, I-70126 Bari, Italy
| | - S J Fegan
- Laboratoire Leprince-Ringuet, École polytechnique, CNRS/IN2P3, Palaiseau, France
| | - E C Ferrara
- NASA Goddard Space Flight Center, Greenbelt, Maryland 20771, USA
| | - W B Focke
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - A Franckowiak
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - Y Fukazawa
- Department of Physical Sciences, Hiroshima University, Higashi-Hiroshima, Hiroshima 739-8526, Japan
| | - S Funk
- Erlangen Centre for Astroparticle Physics, D-91058 Erlangen, Germany
| | - P Fusco
- Istituto Nazionale di Fisica Nucleare, Sezione di Bari, I-70126 Bari, Italy
- Dipartimento di Fisica "M. Merlin" dell'Università e del Politecnico di Bari, I-70126 Bari, Italy
| | - F Gargano
- Istituto Nazionale di Fisica Nucleare, Sezione di Bari, I-70126 Bari, Italy
| | - D Gasparrini
- Istituto Nazionale di Fisica Nucleare, Sezione di Perugia, I-06123 Perugia, Italy
- Agenzia Spaziale Italiana (ASI) Science Data Center, I-00133 Roma, Italy
- INAF Osservatorio Astronomico di Roma, I-00040 Monte Porzio Catone (Roma), Italy
| | - N Giglietto
- Istituto Nazionale di Fisica Nucleare, Sezione di Bari, I-70126 Bari, Italy
- Dipartimento di Fisica "M. Merlin" dell'Università e del Politecnico di Bari, I-70126 Bari, Italy
| | - F Giordano
- Istituto Nazionale di Fisica Nucleare, Sezione di Bari, I-70126 Bari, Italy
- Dipartimento di Fisica "M. Merlin" dell'Università e del Politecnico di Bari, I-70126 Bari, Italy
| | - M Giroletti
- INAF Istituto di Radioastronomia, I-40129 Bologna, Italy
| | - T Glanzman
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - G Godfrey
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - G A Gomez-Vargas
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma "Tor Vergata", I-00133 Roma, Italy
- Departamento de Fisíca, Pontificia Universidad Católica de Chile, Avenida Vicuña Mackenna 4860, Santiago, Chile
| | - I A Grenier
- Laboratoire AIM, CEA-IRFU/CNRS/Université Paris Diderot, Service d'Astrophysique, CEA Saclay, F-91191 Gif sur Yvette, France
| | - S Guiriec
- NASA Goddard Space Flight Center, Greenbelt, Maryland 20771, USA
- NASA Postdoctoral Program Fellow, USA
| | - M Gustafsson
- Georg-August University Göttingen, Institute for theoretical Physics-Faculty of Physics, Friedrich-Hund-Platz 1, D-37077 Göttingen, Germany
| | - E Hays
- NASA Goddard Space Flight Center, Greenbelt, Maryland 20771, USA
| | - J W Hewitt
- University of North Florida, Department of Physics, 1 UNF Drive, Jacksonville, Florida 32224, USA
| | - D Horan
- Laboratoire Leprince-Ringuet, École polytechnique, CNRS/IN2P3, Palaiseau, France
| | - T Jogler
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - G Jóhannesson
- Science Institute, University of Iceland, IS-107 Reykjavik, Iceland
| | - M Kuss
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, I-56127 Pisa, Italy
| | - S Larsson
- The Oskar Klein Centre for Cosmoparticle Physics, AlbaNova, SE-106 91 Stockholm, Sweden
- Department of Physics, KTH Royal Institute of Technology, AlbaNova, SE-106 91 Stockholm, Sweden
| | - L Latronico
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, I-10125 Torino, Italy
| | - J Li
- Institute of Space Sciences (IEEC-CSIC), Campus UAB, E-08193 Barcelona, Spain
| | - L Li
- The Oskar Klein Centre for Cosmoparticle Physics, AlbaNova, SE-106 91 Stockholm, Sweden
- Department of Physics, KTH Royal Institute of Technology, AlbaNova, SE-106 91 Stockholm, Sweden
| | - M Llena Garde
- Department of Physics, Stockholm University, AlbaNova, SE-106 91 Stockholm, Sweden
- The Oskar Klein Centre for Cosmoparticle Physics, AlbaNova, SE-106 91 Stockholm, Sweden
| | - F Longo
- Istituto Nazionale di Fisica Nucleare, Sezione di Trieste, I-34127 Trieste, Italy
- Dipartimento di Fisica, Università di Trieste, I-34127 Trieste, Italy
| | - F Loparco
- Istituto Nazionale di Fisica Nucleare, Sezione di Bari, I-70126 Bari, Italy
- Dipartimento di Fisica "M. Merlin" dell'Università e del Politecnico di Bari, I-70126 Bari, Italy
| | - P Lubrano
- Istituto Nazionale di Fisica Nucleare, Sezione di Perugia, I-06123 Perugia, Italy
- Dipartimento di Fisica, Università degli Studi di Perugia, I-06123 Perugia, Italy
| | - D Malyshev
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - M Mayer
- Deutsches Elektronen Synchrotron DESY, D-15738 Zeuthen, Germany
| | - M N Mazziotta
- Istituto Nazionale di Fisica Nucleare, Sezione di Bari, I-70126 Bari, Italy
| | - J E McEnery
- NASA Goddard Space Flight Center, Greenbelt, Maryland 20771, USA
- Department of Physics and Department of Astronomy, University of Maryland, College Park, Maryland 20742, USA
| | - M Meyer
- Department of Physics, Stockholm University, AlbaNova, SE-106 91 Stockholm, Sweden
- The Oskar Klein Centre for Cosmoparticle Physics, AlbaNova, SE-106 91 Stockholm, Sweden
| | - P F Michelson
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - T Mizuno
- Hiroshima Astrophysical Science Center, Hiroshima University, Higashi-Hiroshima, Hiroshima 739-8526, Japan
| | - A A Moiseev
- Department of Physics and Department of Astronomy, University of Maryland, College Park, Maryland 20742, USA
- Center for Research and Exploration in Space Science and Technology (CRESST) and NASA Goddard Space Flight Center, Greenbelt, Maryland 20771, USA
| | - M E Monzani
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - A Morselli
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma "Tor Vergata", I-00133 Roma, Italy
| | - S Murgia
- Center for Cosmology, Physics and Astronomy Department, University of California, Irvine, California 92697-2575, USA
| | - E Nuss
- Laboratoire Univers et Particules de Montpellier, Université Montpellier, CNRS/IN2P3, Montpellier, France
| | - T Ohsugi
- Hiroshima Astrophysical Science Center, Hiroshima University, Higashi-Hiroshima, Hiroshima 739-8526, Japan
| | - M Orienti
- INAF Istituto di Radioastronomia, I-40129 Bologna, Italy
| | - E Orlando
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - J F Ormes
- Department of Physics and Astronomy, University of Denver, Denver, CO 80208, USA
| | - D Paneque
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
- Max-Planck-Institut für Physik, D-80805 München, Germany
| | - J S Perkins
- NASA Goddard Space Flight Center, Greenbelt, Maryland 20771, USA
| | - M Pesce-Rollins
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, I-56127 Pisa, Italy
| | - F Piron
- Laboratoire Univers et Particules de Montpellier, Université Montpellier, CNRS/IN2P3, Montpellier, France
| | - G Pivato
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, I-56127 Pisa, Italy
| | - T A Porter
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - S Rainò
- Istituto Nazionale di Fisica Nucleare, Sezione di Bari, I-70126 Bari, Italy
- Dipartimento di Fisica "M. Merlin" dell'Università e del Politecnico di Bari, I-70126 Bari, Italy
| | - R Rando
- Istituto Nazionale di Fisica Nucleare, Sezione di Padova, I-35131 Padova, Italy
- Dipartimento di Fisica e Astronomia "G. Galilei", Università di Padova, I-35131 Padova, Italy
| | - M Razzano
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, I-56127 Pisa, Italy
| | - A Reimer
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
- Institut für Astro- und Teilchenphysik and Institut für Theoretische Physik, Leopold-Franzens-Universität Innsbruck, A-6020 Innsbruck, Austria
| | - O Reimer
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
- Institut für Astro- und Teilchenphysik and Institut für Theoretische Physik, Leopold-Franzens-Universität Innsbruck, A-6020 Innsbruck, Austria
| | - S Ritz
- Santa Cruz Institute for Particle Physics, Department of Physics and Department of Astronomy and Astrophysics, University of California at Santa Cruz, Santa Cruz, California 95064, USA
| | - M Sánchez-Conde
- Department of Physics, Stockholm University, AlbaNova, SE-106 91 Stockholm, Sweden
- The Oskar Klein Centre for Cosmoparticle Physics, AlbaNova, SE-106 91 Stockholm, Sweden
| | - A Schulz
- Deutsches Elektronen Synchrotron DESY, D-15738 Zeuthen, Germany
| | - N Sehgal
- Physics and Astronomy Department, Stony Brook University, Stony Brook, New York 11794, USA
| | - C Sgrò
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, I-56127 Pisa, Italy
| | - E J Siskind
- NYCB Real-Time Computing Inc., Lattingtown, New York 11560-1025, USA
| | - F Spada
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, I-56127 Pisa, Italy
| | - G Spandre
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, I-56127 Pisa, Italy
| | - P Spinelli
- Istituto Nazionale di Fisica Nucleare, Sezione di Bari, I-70126 Bari, Italy
- Dipartimento di Fisica "M. Merlin" dell'Università e del Politecnico di Bari, I-70126 Bari, Italy
| | - L Strigari
- Texas A&M University, Department of Physics and Astronomy, College Station, Texas 77843-4242, USA
| | - H Tajima
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
- Solar-Terrestrial Environment Laboratory, Nagoya University, Nagoya 464-8601, Japan
| | - H Takahashi
- Department of Physical Sciences, Hiroshima University, Higashi-Hiroshima, Hiroshima 739-8526, Japan
| | - J B Thayer
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - L Tibaldo
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - D F Torres
- Institute of Space Sciences (IEEC-CSIC), Campus UAB, E-08193 Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - E Troja
- NASA Goddard Space Flight Center, Greenbelt, Maryland 20771, USA
- Department of Physics and Department of Astronomy, University of Maryland, College Park, Maryland 20742, USA
| | - G Vianello
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - M Werner
- Institut für Astro- und Teilchenphysik and Institut für Theoretische Physik, Leopold-Franzens-Universität Innsbruck, A-6020 Innsbruck, Austria
| | - B L Winer
- Department of Physics, Center for Cosmology and Astro-Particle Physics, The Ohio State University, Columbus, Ohio 43210, USA
| | - K S Wood
- Space Science Division, Naval Research Laboratory, Washington, DC 20375-5352, USA
| | - M Wood
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - G Zaharijas
- Istituto Nazionale di Fisica Nucleare, Sezione di Trieste, and Università di Trieste, I-34127 Trieste, Italy
- Laboratory for Astroparticle Physics, University of Nova Gorica, Vipavska 13, SI-5000 Nova Gorica, Slovenia
| | - S Zimmer
- Department of Physics, Stockholm University, AlbaNova, SE-106 91 Stockholm, Sweden
- The Oskar Klein Centre for Cosmoparticle Physics, AlbaNova, SE-106 91 Stockholm, Sweden
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Drlica-Wagner A, Albert A, Bechtol K, Wood M, Strigari L, Sánchez-Conde M, Baldini L, Essig R, Cohen-Tanugi J, Anderson B, Bellazzini R, Bloom ED, Caputo R, Cecchi C, Charles E, Chiang J, Angelis AD, Funk S, Fusco P, Gargano F, Giglietto N, Giordano F, Guiriec S, Gustafsson M, Kuss M, Loparco F, Lubrano P, Mirabal N, Mizuno T, Morselli A, Ohsugi T, Orlando E, Persic M, Rainò S, Sehgal N, Spada F, Suson DJ, Zaharijas G, Zimmer S, Abbott T, Allam S, Balbinot E, Bauer AH, Benoit-Lévy A, Bernstein RA, Bernstein GM, Bertin E, Brooks D, Buckley-Geer E, Burke DL, Rosell AC, Castander FJ, Covarrubias R, D’Andrea CB, Costa LND, DePoy DL, Desai S, Diehl HT, Cunha CE, Eifler TF, Estrada J, Evrard AE, Neto AF, Fernandez E, Finley DA, Flaugher B, Frieman J, Gaztanaga E, Gerdes D, Gruen D, Gruendl RA, Gutierrez G, Honscheid K, Jain B, James D, Jeltema T, Kent S, Kron R, Kuehn K, Kuropatkin N, Lahav O, Li TS, Luque E, Maia MAG, Makler M, March M, Marshall J, Martini P, Merritt KW, Miller C, Miquel R, Mohr J, Neilsen E, Nord B, Ogando R, Peoples J, Petravick D, Pieres A, Plazas AA, Queiroz A, Romer AK, Roodman A, Rykoff ES, Sako M, Sanchez E, Santiago B, Scarpine V, Schubnell M, Sevilla I, Smith RC, Soares-Santos M, Sobreira F, Suchyta E, Swanson MEC, Tarle G, Thaler J, Thomas D, Tucker D, Walker AR, Wechsler RH, Wester W, Williams P, Yanny B, Zuntz J. SEARCH FOR GAMMA-RAY EMISSION FROM DES DWARF SPHEROIDAL GALAXY CANDIDATES WITH
FERMI
-LAT DATA. ACTA ACUST UNITED AC 2015. [DOI: 10.1088/2041-8205/809/1/l4] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Ajello M, Gasparrini D, Sánchez-Conde M, Zaharijas G, Gustafsson M, Cohen-Tanugi J, Dermer CD, Inoue Y, Hartmann D, Ackermann M, Bechtol K, Franckowiak A, Reimer A, Romani RW, Strong AW. THE ORIGIN OF THE EXTRAGALACTIC GAMMA-RAY BACKGROUND AND IMPLICATIONS FOR DARK MATTER ANNIHILATION. ACTA ACUST UNITED AC 2015. [DOI: 10.1088/2041-8205/800/2/l27] [Citation(s) in RCA: 147] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Leo Swenne C, Cederholm K, Gustafsson M, Arakelian E. Postoperative health and patients' experiences of efficiency and quality of care after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, two to six months after surgery. Eur J Oncol Nurs 2015; 19:191-7. [PMID: 25667124 DOI: 10.1016/j.ejon.2014.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 05/11/2014] [Accepted: 05/20/2014] [Indexed: 11/17/2022]
Abstract
PURPOSE To study post-discharge health after Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC), and to analyse patients' experiences of in-hospital efficiency and quality of care. METHODS In-depth individual telephone interviews using an interview guide with open-ended questions were performed with 19 patients with peritoneal carcinomatosis between April and October, 2012. Data were analysed with systematic text condensation. RESULTS Four themes were identified: 1) Coming home was an essential step in the recovery process and the focus was on getting well physically despite mental stress, uncertainty about the medical rehabilitation plan and the future. 2) Health was affected negatively by postoperative chemotherapy and its side effects. 3) Stoma - a necessary evil affecting the patient's social life. 4) Quality of care and efficiency were defined in patient-centred terms and inter-personal care from the patient's perspectives on micro level. Despite all, 32% of the patients described being fully recovered and had started to study or work two months after surgery. CONCLUSIONS The study gives insights into some real-life experiences described by patients. The study results can be used to prepare written information, to design a postoperative rehabilitation plan for future patients with Peritoneal Carcinomatosis (PC) and to create a home-page through which patients can receive support from both health care professionals and other fellow patients.
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Affiliation(s)
- Christine Leo Swenne
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 22 Uppsala, Sweden.
| | - Karin Cederholm
- Department of Surgical Sciences, Uppsala University, Uppsala University Hospital, Entrance 70, 1st Floor, Sweden.
| | - Maria Gustafsson
- Department of Surgical Sciences, Uppsala University, Uppsala University Hospital, Entrance 70, 1st Floor, Sweden.
| | - Erebouni Arakelian
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 22 Uppsala, Sweden; Department of Surgical Sciences, Uppsala University, Uppsala University Hospital, Entrance 70, 1st Floor, Sweden.
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Nestor CE, Dadfar E, Ernerudh J, Gustafsson M, Björkander J, Benson M, Zhang H. Sublingual immunotherapy alters expression of IL-4 and its soluble and membrane-bound receptors. Allergy 2014; 69:1564-6. [PMID: 25130266 DOI: 10.1111/all.12505] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2014] [Indexed: 01/12/2023]
Abstract
Seasonal allergic rhinitis (SAR) is a disease of increasing prevalence, which results from an inappropriate T helper cell, type 2 (Th2) response to pollen. Specific immunotherapy (SIT) involves repeated treatment with small doses of pollen and can result in complete and lasting reversal of SAR. Here, we assayed the key Th2 cytokine, IL-4, and its soluble and membrane-bound receptor in patients with SAR before and after SIT. Using allergen-challenge assays, we found that SIT treatment decreased IL-4 cytokine levels, as previously reported. We also observed a significant decrease in the IL-4 membrane-bound receptor (mIL4R) at the level of both mRNA and protein. SIT treatment resulted in a significant increase in the inhibitory soluble IL-4 receptor (sIL4R). Reciprocal changes in mIL4R and sIL4R were also observed in patient serum. Altered mIL4R and sIL4R is a novel explanation for the positive effects of immunotherapy with potential basic and clinical research implications.
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Affiliation(s)
- C. E. Nestor
- Department of Clinical and Experimental Medicine; Linkoping University; Linkoping Sweden
- CIMed, Centre for Individualised Medicine; Faculty of Health Sciences; Linkoping University; Linkoping Sweden
| | - E. Dadfar
- Department of Clinical and Experimental Medicine; Linkoping University; Linkoping Sweden
- CIMed, Centre for Individualised Medicine; Faculty of Health Sciences; Linkoping University; Linkoping Sweden
| | - J. Ernerudh
- Department of Clinical and Experimental Medicine; Linkoping University; Linkoping Sweden
| | - M. Gustafsson
- Department of Clinical and Experimental Medicine; Linkoping University; Linkoping Sweden
- CIMed, Centre for Individualised Medicine; Faculty of Health Sciences; Linkoping University; Linkoping Sweden
| | - J. Björkander
- Department of Clinical and Experimental Medicine; Linkoping University; Linkoping Sweden
- Department of Internal Medicine; Ryhov County Hospital; Jonkoping Sweden
| | - M. Benson
- Department of Clinical and Experimental Medicine; Linkoping University; Linkoping Sweden
- CIMed, Centre for Individualised Medicine; Faculty of Health Sciences; Linkoping University; Linkoping Sweden
| | - H. Zhang
- Department of Clinical and Experimental Medicine; Linkoping University; Linkoping Sweden
- CIMed, Centre for Individualised Medicine; Faculty of Health Sciences; Linkoping University; Linkoping Sweden
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Gawel DR, Rani James A, Benson M, Liljenström R, Muraro A, Nestor CE, Zhang H, Gustafsson M. The Allergic Airway Inflammation Repository--a user-friendly, curated resource of mRNA expression levels in studies of allergic airways. Allergy 2014; 69:1115-7. [PMID: 24888382 DOI: 10.1111/all.12432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2014] [Indexed: 11/28/2022]
Abstract
Public microarray databases allow analysis of expression levels of candidate genes in different contexts. However, finding relevant microarray data is complicated by the large number of available studies. We have compiled a user-friendly, open-access database of mRNA microarray experiments relevant to allergic airway inflammation, the Allergic Airway Inflammation Repository (AAIR, http://aair.cimed.ike.liu.se/). The aim is to allow allergy researchers to determine the expression profile of their genes of interest in multiple clinical data sets and several experimental systems quickly and intuitively. AAIR also provides quick links to other relevant information such as experimental protocols, related literature and raw data files.
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Affiliation(s)
- D. R. Gawel
- Department of Clinical and Experimental Medicine; Centre for Individualised Medicine; Linköping University; Linköping Sweden
| | - A. Rani James
- Department of Clinical and Experimental Medicine; Centre for Individualised Medicine; Linköping University; Linköping Sweden
| | - M. Benson
- Department of Clinical and Experimental Medicine; Centre for Individualised Medicine; Linköping University; Linköping Sweden
| | - R. Liljenström
- Department of Clinical and Experimental Medicine; Centre for Individualised Medicine; Linköping University; Linköping Sweden
| | - A. Muraro
- Department of Women and Child Health; Referral Centre for Food Allergy Diagnosis and Treatment; Veneto Region; Padua University Hospital; Padua Italy
| | - C. E. Nestor
- Department of Clinical and Experimental Medicine; Centre for Individualised Medicine; Linköping University; Linköping Sweden
| | - H. Zhang
- Department of Clinical and Experimental Medicine; Centre for Individualised Medicine; Linköping University; Linköping Sweden
| | - M. Gustafsson
- Department of Clinical and Experimental Medicine; Centre for Individualised Medicine; Linköping University; Linköping Sweden
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47
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Ackermann M, Ajello M, Albert A, Allafort A, Baldini L, Barbiellini G, Bastieri D, Bechtol K, Bellazzini R, Blandford RD, Bloom ED, Bonamente E, Bottacini E, Bouvier A, Brandt TJ, Brigida M, Bruel P, Buehler R, Buson S, Caliandro GA, Cameron RA, Caraveo PA, Cecchi C, Charles E, Chaves RCG, Chekhtman A, Chiang J, Chiaro G, Ciprini S, Claus R, Cohen-Tanugi J, Conrad J, Cutini S, Dalton M, D'Ammando F, de Angelis A, de Palma F, Dermer CD, Digel SW, Di Venere L, do Couto e Silva E, Drell PS, Drlica-Wagner A, Favuzzi C, Fegan SJ, Ferrara EC, Focke WB, Franckowiak A, Fukazawa Y, Funk S, Fusco P, Gargano F, Gasparrini D, Germani S, Giglietto N, Giordano F, Giroletti M, Glanzman T, Godfrey G, Gomez-Vargas GA, Grenier IA, Grove JE, Guiriec S, Gustafsson M, Hadasch D, Hanabata Y, Harding AK, Hayashida M, Hayashi K, Hewitt JW, Horan D, Hou X, Hughes RE, Inoue Y, Jackson MS, Jogler T, Jóhannesson G, Johnson AS, Kamae T, Kawano T, Knödlseder J, Kuss M, Lande J, Larsson S, Latronico L, Longo F, Loparco F, Lovellette MN, Lubrano P, Mayer M, Mazziotta MN, McEnery JE, Mehault J, Michelson PF, Mitthumsiri W, Mizuno T, Moiseev AA, Monte C, Monzani ME, Morselli A, Moskalenko IV, Murgia S, Nemmen R, Nuss E, Ohsugi T, Okumura A, Orienti M, Orlando E, Ormes JF, Paneque D, Panetta JH, Perkins JS, Pesce-Rollins M, Piron F, Pivato G, Porter TA, Rainò S, Rando R, Razzano M, Razzaque S, Reimer A, Reimer O, Ritz S, Roth M, Schaal M, Schulz A, Sgrò C, Siskind EJ, Spandre G, Spinelli P, Strong AW, Takahashi H, Takeuchi Y, Thayer JG, Thayer JB, Thompson DJ, Tibaldo L, Tinivella M, Torres DF, Tosti G, Troja E, Tronconi V, Usher TL, Vandenbroucke J, Vasileiou V, Vianello G, Vitale V, Werner M, Winer BL, Wood KS, Wood M, Yang Z. Inferred cosmic-ray spectrum from Fermi large area telescope γ-ray observations of Earth's limb. Phys Rev Lett 2014; 112:151103. [PMID: 24785023 DOI: 10.1103/physrevlett.112.151103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Indexed: 06/03/2023]
Abstract
Recent accurate measurements of cosmic-ray (CR) species by ATIC-2, CREAM, and PAMELA reveal an unexpected hardening in the proton and He spectra above a few hundred GeV, a gradual softening of the spectra just below a few hundred GeV, and a harder spectrum of He compared to that of protons. These newly discovered features may offer a clue to the origin of high-energy CRs. We use the Fermi Large Area Telescope observations of the γ-ray emission from Earth's limb for an indirect measurement of the local spectrum of CR protons in the energy range ∼90 GeV-6 TeV (derived from a photon energy range 15 GeV-1 TeV). Our analysis shows that single power law and broken power law spectra fit the data equally well and yield a proton spectrum with index 2.68±0.04 and 2.61±0.08 above ∼200 GeV, respectively.
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Affiliation(s)
- M Ackermann
- Deutsches Elektronen Synchrotron DESY, D-15738 Zeuthen, Germany
| | - M Ajello
- Space Sciences Laboratory, 7 Gauss Way, University of California, Berkeley, California 94720-7450, USA
| | - A Albert
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - A Allafort
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - L Baldini
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, I-56127 Pisa, Italy
| | - G Barbiellini
- Istituto Nazionale di Fisica Nucleare, Sezione di Trieste, I-34127 Trieste, Italy and Dipartimento di Fisica, Università di Trieste, I-34127 Trieste, Italy
| | - D Bastieri
- Istituto Nazionale di Fisica Nucleare, Sezione di Padova, I-35131 Padova, Italy and Dipartimento di Fisica e Astronomia "G. Galilei", Università di Padova, I-35131 Padova, Italy
| | - K Bechtol
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - R Bellazzini
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, I-56127 Pisa, Italy
| | - R D Blandford
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - E D Bloom
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - E Bonamente
- Istituto Nazionale di Fisica Nucleare, Sezione di Perugia, I-06123 Perugia, Italy and Dipartimento di Fisica, Università degli Studi di Perugia, I-06123 Perugia, Italy
| | - E Bottacini
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - A Bouvier
- Santa Cruz Institute for Particle Physics, Department of Physics and Department of Astronomy and Astrophysics, University of California at Santa Cruz, Santa Cruz, California 95064, USA
| | - T J Brandt
- NASA Goddard Space Flight Center, Greenbelt, Maryland 20771, USA
| | - M Brigida
- Dipartimento di Fisica "M. Merlin" dell'Università e del Politecnico di Bari, I-70126 Bari, Italy and Istituto Nazionale di Fisica Nucleare, Sezione di Bari, 70126 Bari, Italy
| | - P Bruel
- Laboratoire Leprince-Ringuet, École polytechnique, CNRS/IN2P3, Palaiseau, France
| | - R Buehler
- Deutsches Elektronen Synchrotron DESY, D-15738 Zeuthen, Germany
| | - S Buson
- Istituto Nazionale di Fisica Nucleare, Sezione di Padova, I-35131 Padova, Italy and Dipartimento di Fisica e Astronomia "G. Galilei", Università di Padova, I-35131 Padova, Italy
| | - G A Caliandro
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA and Consorzio Interuniversitario per la Fisica Spaziale (CIFS), I-10133 Torino, Italy
| | - R A Cameron
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - P A Caraveo
- INAF-Istituto di Astrofisica Spaziale e Fisica Cosmica, I-20133 Milano, Italy
| | - C Cecchi
- Istituto Nazionale di Fisica Nucleare, Sezione di Perugia, I-06123 Perugia, Italy and Dipartimento di Fisica, Università degli Studi di Perugia, I-06123 Perugia, Italy
| | - E Charles
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - R C G Chaves
- Laboratoire AIM, CEA-IRFU/CNRS/Université Paris Diderot, Service d'Astrophysique, CEA Saclay, 91191 Gif sur Yvette, France
| | - A Chekhtman
- Center for Earth Observing and Space Research, College of Science, George Mason University, Fairfax, Virginia 22030, USA
| | - J Chiang
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - G Chiaro
- Dipartimento di Fisica e Astronomia "G. Galilei", Università di Padova, I-35131 Padova, Italy
| | - S Ciprini
- Agenzia Spaziale Italiana (ASI) Science Data Center, I-00044 Frascati (Roma), Italy and Istituto Nazionale di Astrofisica - Osservatorio Astronomico di Roma, I-00040 Monte Porzio Catone (Roma), Italy
| | - R Claus
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - J Cohen-Tanugi
- Laboratoire Univers et Particules de Montpellier, Université Montpellier 2, CNRS/IN2P3 Montpellier, France
| | - J Conrad
- Department of Physics, Stockholm University, AlbaNova, SE-106 91 Stockholm, Sweden and The Oskar Klein Centre for Cosmoparticle Physics, AlbaNova, SE-106 91 Stockholm, Sweden and The Royal Swedish Academy of Sciences, Box 50005, SE-104 05 Stockholm, Sweden
| | - S Cutini
- Agenzia Spaziale Italiana (ASI) Science Data Center, I-00044 Frascati (Roma), Italy and Istituto Nazionale di Astrofisica - Osservatorio Astronomico di Roma, I-00040 Monte Porzio Catone (Roma), Italy
| | - M Dalton
- Centre d'Études Nucléaires de Bordeaux Gradignan, IN2P3/CNRS, Université Bordeaux 1, BP120, F-33175 Gradignan Cedex, France
| | - F D'Ammando
- INAF Istituto di Radioastronomia, 40129 Bologna, Italy
| | - A de Angelis
- Dipartimento di Fisica, Università di Udine and Istituto Nazionale di Fisica Nucleare, Sezione di Trieste, Gruppo Collegato di Udine, I-33100 Udine, Italy
| | - F de Palma
- Dipartimento di Fisica "M. Merlin" dell'Università e del Politecnico di Bari, I-70126 Bari, Italy and Istituto Nazionale di Fisica Nucleare, Sezione di Bari, 70126 Bari, Italy
| | - C D Dermer
- Space Science Division, Naval Research Laboratory, Washington, D.C. 20375-5352, USA
| | - S W Digel
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - L Di Venere
- Dipartimento di Fisica "M. Merlin" dell'Università e del Politecnico di Bari, I-70126 Bari, Italy
| | - E do Couto e Silva
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - P S Drell
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | | | - C Favuzzi
- Dipartimento di Fisica "M. Merlin" dell'Università e del Politecnico di Bari, I-70126 Bari, Italy and Istituto Nazionale di Fisica Nucleare, Sezione di Bari, 70126 Bari, Italy
| | - S J Fegan
- Laboratoire Leprince-Ringuet, École polytechnique, CNRS/IN2P3, Palaiseau, France
| | - E C Ferrara
- NASA Goddard Space Flight Center, Greenbelt, Maryland 20771, USA
| | - W B Focke
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - A Franckowiak
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - Y Fukazawa
- Department of Physical Sciences, Hiroshima University, Higashi-Hiroshima, Hiroshima 739-8526, Japan
| | - S Funk
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - P Fusco
- Dipartimento di Fisica "M. Merlin" dell'Università e del Politecnico di Bari, I-70126 Bari, Italy and Istituto Nazionale di Fisica Nucleare, Sezione di Bari, 70126 Bari, Italy
| | - F Gargano
- Istituto Nazionale di Fisica Nucleare, Sezione di Bari, 70126 Bari, Italy
| | - D Gasparrini
- Agenzia Spaziale Italiana (ASI) Science Data Center, I-00044 Frascati (Roma), Italy and Istituto Nazionale di Astrofisica - Osservatorio Astronomico di Roma, I-00040 Monte Porzio Catone (Roma), Italy
| | - S Germani
- Istituto Nazionale di Fisica Nucleare, Sezione di Perugia, I-06123 Perugia, Italy and Dipartimento di Fisica, Università degli Studi di Perugia, I-06123 Perugia, Italy
| | - N Giglietto
- Dipartimento di Fisica "M. Merlin" dell'Università e del Politecnico di Bari, I-70126 Bari, Italy and Istituto Nazionale di Fisica Nucleare, Sezione di Bari, 70126 Bari, Italy
| | - F Giordano
- Dipartimento di Fisica "M. Merlin" dell'Università e del Politecnico di Bari, I-70126 Bari, Italy and Istituto Nazionale di Fisica Nucleare, Sezione di Bari, 70126 Bari, Italy
| | - M Giroletti
- INAF Istituto di Radioastronomia, 40129 Bologna, Italy
| | - T Glanzman
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - G Godfrey
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - G A Gomez-Vargas
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma "Tor Vergata", I-00133 Roma, Italy and Departamento de Física Teórica, Universidad Autónoma de Madrid, Cantoblanco, E-28049 Madrid, Spain and Instituto de Física Teórica IFT-UAM/CSIC, Universidad Autónoma de Madrid, Cantoblanco, E-28049 Madrid, Spain
| | - I A Grenier
- Laboratoire AIM, CEA-IRFU/CNRS/Université Paris Diderot, Service d'Astrophysique, CEA Saclay, 91191 Gif sur Yvette, France
| | - J E Grove
- Space Science Division, Naval Research Laboratory, Washington, D.C. 20375-5352, USA
| | - S Guiriec
- NASA Goddard Space Flight Center, Greenbelt, Maryland 20771, USA
| | - M Gustafsson
- Service de Physique Theorique, Universite Libre de Bruxelles (ULB), Bld du Triomphe, CP225, 1050 Brussels, Belgium
| | - D Hadasch
- Institut für Astro- und Teilchenphysik and Institut für Theoretische Physik, Leopold-Franzens-Universität Innsbruck, A-6020 Innsbruck, Austria
| | - Y Hanabata
- Institute for Cosmic-Ray Research, University of Tokyo, 5-1-5 Kashiwanoha, Kashiwa, Chiba 277-8582, Japan
| | - A K Harding
- NASA Goddard Space Flight Center, Greenbelt, Maryland 20771, USA
| | - M Hayashida
- Institute for Cosmic-Ray Research, University of Tokyo, 5-1-5 Kashiwanoha, Kashiwa, Chiba 277-8582, Japan
| | - K Hayashi
- Institute of Space and Astronautical Science, JAXA, 3-1-1 Yoshinodai, Chuo-ku, Sagamihara, Kanagawa 252-5210, Japan
| | - J W Hewitt
- NASA Goddard Space Flight Center, Greenbelt, Maryland 20771, USA
| | - D Horan
- Laboratoire Leprince-Ringuet, École polytechnique, CNRS/IN2P3, Palaiseau, France
| | - X Hou
- Centre d'Études Nucléaires de Bordeaux Gradignan, IN2P3/CNRS, Université Bordeaux 1, BP120, F-33175 Gradignan Cedex, France
| | - R E Hughes
- Department of Physics, Center for Cosmology and Astro-Particle Physics, The Ohio State University, Columbus, Ohio 43210, USA
| | - Y Inoue
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - M S Jackson
- The Oskar Klein Centre for Cosmoparticle Physics, AlbaNova, SE-106 91 Stockholm, Sweden and Department of Physics, KTH Royal Institute of Technology, AlbaNova, SE-106 91 Stockholm, Sweden
| | - T Jogler
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - G Jóhannesson
- Science Institute, University of Iceland, IS-107 Reykjavik, Iceland
| | - A S Johnson
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - T Kamae
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - T Kawano
- Department of Physical Sciences, Hiroshima University, Higashi-Hiroshima, Hiroshima 739-8526, Japan
| | - J Knödlseder
- CNRS, IRAP, F-31028 Toulouse cedex 4, France and GAHEC, Université de Toulouse, UPS-OMP, IRAP, 31028 Toulouse, France
| | - M Kuss
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, I-56127 Pisa, Italy
| | - J Lande
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - S Larsson
- Department of Physics, Stockholm University, AlbaNova, SE-106 91 Stockholm, Sweden and The Oskar Klein Centre for Cosmoparticle Physics, AlbaNova, SE-106 91 Stockholm, Sweden and Department of Astronomy, Stockholm University, SE-106 91 Stockholm, Sweden
| | - L Latronico
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, I-10125 Torino, Italy
| | - F Longo
- Istituto Nazionale di Fisica Nucleare, Sezione di Trieste, I-34127 Trieste, Italy and Dipartimento di Fisica, Università di Trieste, I-34127 Trieste, Italy
| | - F Loparco
- Dipartimento di Fisica "M. Merlin" dell'Università e del Politecnico di Bari, I-70126 Bari, Italy and Istituto Nazionale di Fisica Nucleare, Sezione di Bari, 70126 Bari, Italy
| | - M N Lovellette
- Space Science Division, Naval Research Laboratory, Washington, D.C. 20375-5352, USA
| | - P Lubrano
- Istituto Nazionale di Fisica Nucleare, Sezione di Perugia, I-06123 Perugia, Italy and Dipartimento di Fisica, Università degli Studi di Perugia, I-06123 Perugia, Italy
| | - M Mayer
- Deutsches Elektronen Synchrotron DESY, D-15738 Zeuthen, Germany
| | - M N Mazziotta
- Istituto Nazionale di Fisica Nucleare, Sezione di Bari, 70126 Bari, Italy
| | - J E McEnery
- NASA Goddard Space Flight Center, Greenbelt, Maryland 20771, USA and Department of Physics and Department of Astronomy, University of Maryland, College Park, Maryland 20742, USA
| | - J Mehault
- Centre d'Études Nucléaires de Bordeaux Gradignan, IN2P3/CNRS, Université Bordeaux 1, BP120, F-33175 Gradignan Cedex, France
| | - P F Michelson
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - W Mitthumsiri
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA and Department of Physics, Faculty of Science, Mahidol University, Bangkok 10400, Thailand
| | - T Mizuno
- Hiroshima Astrophysical Science Center, Hiroshima University, Higashi-Hiroshima, Hiroshima 739-8526, Japan
| | - A A Moiseev
- Department of Physics and Department of Astronomy, University of Maryland, College Park, Maryland 20742, USA and Center for Research and Exploration in Space Science and Technology (CRESST) and NASA Goddard Space Flight Center, Greenbelt, Maryland 20771, USA
| | - C Monte
- Dipartimento di Fisica "M. Merlin" dell'Università e del Politecnico di Bari, I-70126 Bari, Italy and Istituto Nazionale di Fisica Nucleare, Sezione di Bari, 70126 Bari, Italy
| | - M E Monzani
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - A Morselli
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma "Tor Vergata", I-00133 Roma, Italy
| | - I V Moskalenko
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - S Murgia
- Center for Cosmology, Physics and Astronomy Department, University of California, Irvine, California 92697-2575, USA
| | - R Nemmen
- NASA Goddard Space Flight Center, Greenbelt, Maryland 20771, USA and Center for Research and Exploration in Space Science and Technology (CRESST) and NASA Goddard Space Flight Center, Greenbelt, Maryland 20771, USA and Department of Physics and Center for Space Sciences and Technology, University of Maryland Baltimore County, Baltimore, Maryland 21250, USA
| | - E Nuss
- Laboratoire Univers et Particules de Montpellier, Université Montpellier 2, CNRS/IN2P3 Montpellier, France
| | - T Ohsugi
- Hiroshima Astrophysical Science Center, Hiroshima University, Higashi-Hiroshima, Hiroshima 739-8526, Japan
| | - A Okumura
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA and Solar-Terrestrial Environment Laboratory, Nagoya University, Nagoya 464-8601, Japan
| | - M Orienti
- INAF Istituto di Radioastronomia, 40129 Bologna, Italy
| | - E Orlando
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - J F Ormes
- Department of Physics and Astronomy, University of Denver, Denver, Colorado 80208, USA
| | - D Paneque
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA and Max-Planck-Institut für Physik, D-80805 München, Germany
| | - J H Panetta
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - J S Perkins
- NASA Goddard Space Flight Center, Greenbelt, Maryland 20771, USA
| | - M Pesce-Rollins
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, I-56127 Pisa, Italy
| | - F Piron
- Laboratoire Univers et Particules de Montpellier, Université Montpellier 2, CNRS/IN2P3 Montpellier, France
| | - G Pivato
- Dipartimento di Fisica e Astronomia "G. Galilei", Università di Padova, I-35131 Padova, Italy
| | - T A Porter
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - S Rainò
- Dipartimento di Fisica "M. Merlin" dell'Università e del Politecnico di Bari, I-70126 Bari, Italy and Istituto Nazionale di Fisica Nucleare, Sezione di Bari, 70126 Bari, Italy
| | - R Rando
- Istituto Nazionale di Fisica Nucleare, Sezione di Padova, I-35131 Padova, Italy and Dipartimento di Fisica e Astronomia "G. Galilei", Università di Padova, I-35131 Padova, Italy
| | - M Razzano
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, I-56127 Pisa, Italy
| | - S Razzaque
- Department of Physics, University of Johannesburg, PO Box 524, Auckland Park 2006, South Africa
| | - A Reimer
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA and Institut für Astro- und Teilchenphysik and Institut für Theoretische Physik, Leopold-Franzens-Universität Innsbruck, A-6020 Innsbruck, Austria
| | - O Reimer
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA and Institut für Astro- und Teilchenphysik and Institut für Theoretische Physik, Leopold-Franzens-Universität Innsbruck, A-6020 Innsbruck, Austria
| | - S Ritz
- Santa Cruz Institute for Particle Physics, Department of Physics and Department of Astronomy and Astrophysics, University of California at Santa Cruz, Santa Cruz, California 95064, USA
| | - M Roth
- Department of Physics, University of Washington, Seattle, Washington 98195-1560, USA
| | - M Schaal
- National Research Council Research Associate, National Academy of Sciences, Washington, D.C. 20001, USA
| | - A Schulz
- Deutsches Elektronen Synchrotron DESY, D-15738 Zeuthen, Germany
| | - C Sgrò
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, I-56127 Pisa, Italy
| | - E J Siskind
- NYCB Real-Time Computing Inc., Lattingtown, New York 11560-1025, USA
| | - G Spandre
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, I-56127 Pisa, Italy
| | - P Spinelli
- Dipartimento di Fisica "M. Merlin" dell'Università e del Politecnico di Bari, I-70126 Bari, Italy and Istituto Nazionale di Fisica Nucleare, Sezione di Bari, 70126 Bari, Italy
| | - A W Strong
- Max-Planck Institut für extraterrestrische Physik, 85748 Garching, Germany
| | - H Takahashi
- Department of Physical Sciences, Hiroshima University, Higashi-Hiroshima, Hiroshima 739-8526, Japan
| | - Y Takeuchi
- Research Institute for Science and Engineering, Waseda University, 3-4-1, Okubo, Shinjuku, Tokyo 169-8555, Japan
| | - J G Thayer
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - J B Thayer
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - D J Thompson
- NASA Goddard Space Flight Center, Greenbelt, Maryland 20771, USA
| | - L Tibaldo
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - M Tinivella
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, I-56127 Pisa, Italy
| | - D F Torres
- Institut de Ciències de l'Espai (IEEE-CSIC), Campus UAB, 08193 Barcelona, Spain and Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - G Tosti
- Istituto Nazionale di Fisica Nucleare, Sezione di Perugia, I-06123 Perugia, Italy and Dipartimento di Fisica, Università degli Studi di Perugia, I-06123 Perugia, Italy
| | - E Troja
- NASA Goddard Space Flight Center, Greenbelt, Maryland 20771, USA and Department of Physics and Department of Astronomy, University of Maryland, College Park, Maryland 20742, USA
| | - V Tronconi
- Dipartimento di Fisica e Astronomia "G. Galilei", Università di Padova, I-35131 Padova, Italy
| | - T L Usher
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - J Vandenbroucke
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - V Vasileiou
- Laboratoire Univers et Particules de Montpellier, Université Montpellier 2, CNRS/IN2P3 Montpellier, France
| | - G Vianello
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - V Vitale
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma "Tor Vergata", I-00133 Roma, Italy and Dipartimento di Fisica, Università di Roma "Tor Vergata", I-00133 Roma, Italy
| | - M Werner
- Institut für Astro- und Teilchenphysik and Institut für Theoretische Physik, Leopold-Franzens-Universität Innsbruck, A-6020 Innsbruck, Austria
| | - B L Winer
- Department of Physics, Center for Cosmology and Astro-Particle Physics, The Ohio State University, Columbus, Ohio 43210, USA
| | - K S Wood
- Space Science Division, Naval Research Laboratory, Washington, D.C. 20375-5352, USA
| | - M Wood
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94305, USA
| | - Z Yang
- Department of Physics, Stockholm University, AlbaNova, SE-106 91 Stockholm, Sweden and The Oskar Klein Centre for Cosmoparticle Physics, AlbaNova, SE-106 91 Stockholm, Sweden
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Muraru D, Addetia K, Veronesi F, Corsi C, Mor-Avi V, Yamat M, Weinert L, Lang R, Badano L, Faita F, Di Lascio N, Bruno R, Bianchini E, Ghiadoni L, Sicari R, Gemignani V, Angelis A, Ageli K, Ioakimidis N, Chrysohoou C, Agelakas A, Felekos I, Vaina S, Aznaourides K, Vlachopoulos C, Stefanadis C, Nemes A, Szolnoky G, Gavaller H, Gonczy A, Kemeny L, Forster T, Ramalho A, Placido R, Marta L, Menezes M, Magalhaes A, Cortez Dias N, Martins S, Almeida A, Pinto F, Nunes Diogo A, Botezatu CD, Enache R, Popescu B, Nastase O, Coman M, Ghiorghiu I, Calin A, Rosca M, Beladan C, Ginghina C, Grapsa J, Cabrita I, Durighel G, O'regan D, Dawson D, Nihoyannopoulos P, Pellicori P, Kallvikbacka-Bennett A, Zhang J, Lukaschuk E, Joseph A, Bourantas C, Loh H, Bragadeesh T, Clark A, Cleland J, Kallvikbacka-Bennett A, Pellicori P, Lomax S, Putzu P, Diercx R, Parsons S, Dicken B, Zhang J, Clark A, Cleland J, Vered Z, Adirevitz L, Dragu R, Blatt A, Karev E, Malca Y, Roytvarf A, Marek D, Sovova E, Berkova M, Cihalik C, Taborsky M, Lindqvist P, Tossavainen E, Soderberg S, Gonzales M, Gustavsson S, Henein M, Sonne C, Bott-Fluegel L, Hauck S, Lesevic H, Hadamitzky M, Wolf P, Kolb C, Bandera F, Pellegrino M, Generati G, Donghi V, Alfonzetti E, Castelvecchio S, Menicanti L, Guazzi M, Buchyte S, Rinkuniene D, Jurkevicius R, Smarz K, Zaborska B, Jaxa-Chamiec T, Maciejewski P, Budaj A, Santoro A, Federico Alvino F, Giovanni Antonelli G, Roberta Molle R, Matteo Bertini M, Stefano Lunghetti S, Sergio Mondillo S, Henri C, Magne J, Dulgheru R, Laaraibi S, Voilliot D, Kou S, Pierard L, Lancellotti P, Szulik M, Stabryla-Deska J, Kalinowski M, Sliwinska A, Szymala M, Lenarczyk R, Kalarus Z, Kukulski T, Yiangou K, Azina C, Yiangou A, Ioannides M, Chimonides S, Baysal S, Pirat B, Okyay K, Bal U, Muderrisoglu H, Popovic D, Ostojic M, Petrovic M, Vujisic-Tesic B, Arandjelovic A, Petrovic I, Banovic M, Popovic B, Vukcevic V, Damjanovic S, Velasco Del Castillo S, Onaindia Gandarias J, Arana Achaga X, Laraudogoitia Zaldumbide E, Rodriguez Sanchez I, Cacicedo De Bobadilla A, Romero Pereiro A, Aguirre Larracoechea U, Salinas T, Subinas A, Elzbieciak M, Wita K, Grabka M, Chmurawa J, Doruchowska A, Turski M, Filipecki A, Wybraniec M, Mizia-Stec K, Varho V, Karjalainen P, Lehtinen T, Airaksinen J, Ylitalo A, Kiviniemi T, Gargiulo P, Galderisi M, D' Amore C, Lo Iudice F, Savarese G, Casaretti L, Pellegrino A, Fabiani I, La Mura L, Perrone Filardi P, Kim JY, Chung W, Yu J, Choi Y, Park C, Youn H, Lee M, Nagy A, Manouras A, Gunyeli E, Gustafsson U, Shahgaldi K, Winter R, Johnsson J, Zagatina A, Krylova L, Zhuravskaya N, Vareldzyan Y, Tyurina T, Clitsenko O, Khalifa EA, Ashour Z, Elnagar W, Jung I, Seo H, Lee S, Lim D, Mizariene V, Verseckaite R, Janenaite J, Jonkaitiene R, Jurkevicius R, Sanchez Espino A, Bonaque Gonzalez J, Merchan Ortega G, Bolivar Herrera N, Ikuta I, Macancela Quinones J, Gomez Recio M, Silva Fazendas Adame PR, Caldeira D, Stuart B, Almeida S, Cruz I, Ferreira A, Freire G, Lopes L, Cotrim C, Pereira H, Mediratta A, Addetia K, Moss J, Nayak H, Yamat M, Weinert L, Mor-Avi V, Lang R, Al Amri I, Debonnaire P, Van Der Kley F, Schalij M, Bax J, Ajmone Marsan N, Delgado V, Schmidt FP, Gniewosz T, Jabs A, Munzel T, Jansen T, Kaempfner D, Hink U, Von Bardeleben R, Jose J, George O, Joseph G, Jose J, Adawi S, Najjar R, Ahronson D, Shiran A, Van Riel A, Boerlage - Van Dijk K, De Bruin - Bon H, Araki M, Meregalli P, Koch K, Vis M, Mulder B, Baan J, Bouma B, Marciniak A, Elton D, Glover K, Campbell I, Sharma R, Batalha S, Lourenco C, Oliveira Da Silva C, Manouras A, Shahgaldi K, Caballero L, Garcia-Lara J, Gonzalez-Carrillo J, Oliva M, Saura D, Garcia-Navarro M, Espinosa M, Pinar E, Valdes M, De La Morena G, Barreiro Perez M, Lopez Perez M, Roy D, Brecker S, Sharma R, Venkateshvaran A, Dash PK, Sola S, Barooah B, Govind SC, Winter R, Shahgaldi K, Brodin LA, Manouras A, Saura Espin D, Caballero Jimenez L, Gonzalez Carrillo J, Oliva Sandoval M, Lopez Ruiz M, Garcia Navarro M, Espinosa Garcia M, Valdes Chavarri M, De La Morena Valenzuela G, Gatti G, Dell'angela L, Pinamonti B, Benussi B, Sinagra G, Pappalardo A, Hernandez V, Saavedra J, Gonzalez A, Iglesias P, Civantos S, Guijarro G, Monereo S, Ikeda M, Toh N, Oe H, Tanabe Y, Watanabe N, Ito H, Ciampi Q, Cortigiani L, Pratali L, Rigo F, Villari B, Picano E, Sicari R, Yoon J, Sohn J, Kim Y, Chang H, Hong G, Kim T, Ha J, Choi B, Rim S, Choi E, Tibazarwa K, Sliwa K, Wonkam A, Mayosi B, Oryshchyn N, Ivaniv Y, Pavlyk S, Lourenco MR, Azevedo O, Moutinho J, Nogueira I, Fernandes M, Pereira V, Quelhas I, Lourenco A, Sunbul M, Tigen K, Karaahmet T, Dundar C, Ozben B, Guler A, Cincin A, Bulut M, Sari I, Basaran Y, Baydar O, Kadriye Kilickesmez K, Ugur Coskun U, Polat Canbolat P, Veysel Oktay V, Umit Yasar Sinan U, Okay Abaci O, Cuneyt Kocas C, Sinan Uner S, Serdar Kucukoglu S, Zaroui A, Mourali M, Ben Said R, Asmi M, Aloui H, Kaabachi N, Mechmeche R, Saberniak J, Hasselberg N, Borgquist R, Platonov P, Holst A, Edvardsen T, Haugaa K, Lourenco MR, Azevedo O, Nogueira I, Moutinho J, Fernandes M, Pereira V, Quelhas I, Lourenco A, Eran A, Yueksel D, Er F, Gassanov N, Rosenkranz S, Baldus S, Guedelhoefer H, Faust M, Caglayan E, Matveeva N, Nartsissova G, Chernjavskij A, Ippolito R, De Palma D, Muscariello R, Santoro C, Raia R, Schiano-Lomoriello V, Gargiulo F, Galderisi M, Lipari P, Bonapace S, Zenari L, Valbusa F, Rossi A, Lanzoni L, Canali G, Molon G, Campopiano E, Barbieri E, Ikonomidis I, Varoudi M, Papadavid E, Theodoropoulos K, Papadakis I, Pavlidis G, Triantafyllidi H, Anastasiou - Nana M, Rigopoulos D, Lekakis J, Sunbul M, Tigen K, Ozen G, Durmus E, Kivrak T, Cincin A, Ozben B, Atas H, Direskeneli H, Basaran Y, Stevanovic A, Dekleva M, Trajic S, Paunovic N, Simic A, Khan S, Mushemi-Blake S, Jouhra F, Dennes W, Monaghan M, Melikian N, Shah A, Maceira Gonzalez AM, Lopez-Lereu M, Monmeneu J, Igual B, Estornell J, Boraita A, Kosmala W, Rojek A, Bialy D, Mysiak A, Przewlocka-Kosmala M, Popescu I, Mancas S, Mornos C, Serbescu I, Ionescu G, Ionac A, Gaudron P, Niemann M, Herrmann S, Hu K, Liu D, Wojciech K, Frantz S, Bijnens B, Ertl G, Weidemann F, Maceira Gonzalez AM, Cosin-Sales J, Ruvira J, Diago J, Aguilar J, Igual B, Lopez-Lereu M, Monmeneu J, Estornell J, Cruz C, Pinho T, Madureira A, Lebreiro A, Dias C, Ramos I, Silva Cardoso J, Julia Maciel M, De Meester P, Van De Bruaene A, Herijgers P, Voigt JU, Budts W, Franzoso F, Voser E, Wohlmut C, Kellenberger C, Valsangiacomo Buechel E, Carrero C, Benger J, Parcerisa M, Falconi M, Oberti P, Granja M, Cagide A, Del Pasqua A, Secinaro A, Antonelli G, Iacomino M, Toscano A, Chinali M, Esposito C, Carotti A, Pongiglione G, Rinelli G, Youssef Moustafa A, Al Murayeh M, Al Masswary A, Al Sheikh K, Moselhy M, Dardir M, Deising J, Butz T, Suermeci G, Liebeton J, Wennemann R, Tzikas S, Van Bracht M, Prull M, Trappe HJ, Martin Hidalgo M, Delgado Ortega M, Ruiz Ortiz M, Mesa Rubio D, Carrasco Avalos F, Seoane Garcia T, Pan Alvarez-Ossorio M, Lopez Aguilera J, Puentes Chiachio M, Suarez De Lezo Cruz Conde J, Petrovic MT, Giga V, Stepanovic J, Tesic M, Jovanovic I, Djordjevic-Dikic A, Generati G, Pellegrino M, Bandera F, Donghi V, Alfonzetti E, Guazzi M, Piatkowski R, Kochanowski J, Scislo P, Opolski G, Zagatina A, Zhuravskaya N, Krylova L, Vareldzhyan Y, Tyurina T, Clitsenko O, Bombardini T, Gherardi S, Leone O, Picano E, Michelotto E, Ciccarone A, Tarantino N, Ostuni V, Rubino M, Genco W, Santoro G, Carretta D, Romito R, Colonna P, Cameli M, Lunghetti S, Lisi M, Curci V, Cameli P, Focardi M, Favilli R, Galderisi M, Mondillo S, Hoffmann R, Barletta G, Von Bardeleben S, Kasprzak J, Greis C, Vanoverschelde J, Becher H, Machida T, Izumo M, Suzuki K, Kaimijima R, Mizukoshi K, Manabe-Uematsu M, Takai M, Harada T, Akashi Y, Martin Garcia A, Arribas-Jimenez A, Cruz-Gonzalez I, Nieto F, Iscar A, Merchan S, Martin-Luengo C, Brecht A, Theres L, Spethmann S, Dreger H, Baumann G, Knebel F, Jasaityte R, Heyde B, Rademakers F, Claus P, D'hooge J, Lervik Nilsen LC, Lund J, Brekke B, Stoylen A, Giraldeau G, Duchateau N, Gabrielli L, Penela D, Evertz R, Mont L, Brugada J, Berruezo A, Bijnens B, Sitges M, Kordybach M, Kowalski M, Hoffman P, Pilichowska E, Zaborska B, Baran J, Kulakowski P, Budaj A, Wahi S, Vollbon W, Leano R, Thomas A, Bricknell K, Holland D, Napier S, Stanton T, Teferici D, Qirko S, Petrela E, Dibra A, Bajraktari G, Bara P, Sanchis Ruiz L, Gabrielli L, Andrea R, Falces C, Duchateau N, Perez-Villa F, Bijnens B, Sitges M, Sulemane S, Panoulas V, Bratsas A, Tam F, Nihoyannopoulos P, Abduch M, Alencar A, Coracin F, Barban A, Saboya R, Dulley F, Mathias W, Vieira M, Buccheri S, Mangiafico S, Arcidiacono A, Bottari V, Leggio S, Tamburino C, Monte IP, Cruz C, Lebreiro A, Pinho T, Dias C, Silva Cardoso J, Julia Maciel M, Spitzer E, Beitzke D, Kaneider A, Pavo N, Gottsauner-Wolf M, Wolf F, Loewe C, Mushtaq S, Andreini D, Pontone G, Bertella E, Conte E, Baggiano A, Annoni A, Cortinovis S, Fiorentini C, Pepi M, Gustafsson M, Alehagen U, Dahlstrom U, Johansson P, Faden G, Faggiano P, Albertini L, Reverberi C, Gaibazzi N, Taylor RJ, Moody W, Umar F, Edwards N, Townend J, Steeds R, Leyva F, Mihaila S, Muraru D, Piasentini E, Peluso D, Casablanca S, Naso P, Puma L, Iliceto S, Vinereanu D, Badano L, Ciciarello FL, Agati L, Cimino S, De Luca L, Petronilli V, Fedele F, Tsverava M. Poster Session Saturday 14 December - AM: 14/12/2013, 08:30-12:30 * Location: Poster area. Eur Heart J Cardiovasc Imaging 2013. [DOI: 10.1093/ehjci/jet207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Garcia Martin A, Fernandez Golfin C, Salido Tahoces L, Fernandez Santos S, Jimenez Nacher J, Moya Mur J, Velasco Valdazo E, Hernandez Antolin R, Zamorano Gomez J, Veronesi F, Corsi C, Caiani E, Lamberti C, Tsang W, Holmgren C, Guo X, Bateman M, Iaizzo P, Vannier M, Lang R, Patel A, Adamayn K, Tumasyan LR, Chilingaryan A, Nasr G, Eleraki A, Farouk N, Axelsson A, Langhoff L, Jensen M, Vejlstrup N, Iversen K, Bundgaard H, Watanabe T, Iwai-Takano M, Attenhofer Jost CH, Pfyffer M, Seifert B, Scharf C, Candinas R, Medeiros-Domingo A, Chin JY, Yoon H, Vollbon W, Singbal Y, Rhodes K, Wahi S, Katova TM, Simova II, Hristova K, Kostova V, Pauncheva B, Bircan A, Sade L, Eroglu S, Pirat B, Okyay K, Bal U, Muderrisoglu H, Heggemann F, Buggisch H, Welzel G, Doesch C, Hansmann J, Schoenberg S, Borggrefe M, Wenz F, Papavassiliu T, Lohr F, Roussin I, Drakopoulou M, Rosen S, Sharma R, Prasad S, Lyon A, Carpenter J, Senior R, Breithardt OA, Razavi H, Arya A, Nabutovsky Y, Ryu K, Gaspar T, Kosiuk J, Eitel C, Hindricks G, Piorkowski C, Pires S, Nunes A, Cortez-Dias N, Belo A, Zimbarra Cabrita I, Sousa C, Pinto F, Baron T, Johansson K, Flachskampf F, Christersson C, Pires S, Cortez-Dias N, Nunes A, Belo A, Zimbarra Cabrita I, Sousa C, Pinto F, Santoro A, Federico Alvino F, Giovanni Antonelli G, Raffaella De Vito R, Roberta Molle R, Sergio Mondillo S, Gustafsson M, Alehagen U, Johansson P, Tsukishiro Y, Onishi T, Chimura M, Yamada S, Taniguchi Y, Yasaka Y, Kawai H, Souza JRM, Zacharias LGT, Pithon KR, Ozahata TM, Cliquet AJ, Blotta MH, Nadruz WJ, Fabiani I, Conte L, Cuono C, Liga R, Giannini C, Barletta V, Nardi C, Delle Donne M, Palagi C, Di Bello V, Glaveckaite S, Valeviciene N, Palionis D, Laucevicius A, Hristova K, Bogdanova V, Ferferieva V, Shiue I, Castellon X, Boles U, Rakhit R, Shiu MF, Gilbert T, Papachristidis A, Henein MY, Westholm C, Johnson J, Jernberg T, Winter R, Ghosh Dastidar A, Augustine D, Cengarle M, Mcalindon E, Bucciarelli-Ducci C, Nightingale A, Onishi T, Watanabe T, Fujita M, Mizukami Y, Sakata Y, Nakatani S, Nanto S, Uematsu M, Saraste A, Luotolahti M, Varis A, Vasankari T, Tunturi S, Taittonen M, Rautakorpi P, Airaksinen J, Ukkonen H, Knuuti J, Boshchenko A, Vrublevsky A, Karpov R, Yoshikawa H, Suzuki M, Hashimoto G, Kusunose Y, Otsuka T, Nakamura M, Sugi K, Rosner S, Orban M, Lesevic H, Karl M, Hadamitzky M, Sonne C, Panaro A, Martinez F, Huguet M, Moral S, Palet J, Oller G, Cuso I, Jornet A, Rodriguez Palomares J, Evangelista A, Stoebe S, Tarr A, Pfeiffer D, Hagendorff A, Gilmanov D, Baroni M, Cerone E, Galli E, Berti S, Glauber M, Soesanto A, Yuniadi Y, Mansyur M, Kusmana D, Venkateshvaran A, Dash PK, Sola S, Govind SC, Shahgaldi K, Winter R, Brodin LA, Manouras A, Dokainish H, Sadreddini M, Nieuwlaat R, Lonn E, Healey J, Nguyen V, Cimadevilla C, Dreyfus J, Codogno I, Vahanian A, Messika-Zeitoun D, Lim YJ, Kawamura A, Kawano S, Polte C, Gao S, Lagerstrand K, Cederbom U, Bech-Hanssen O, Baum J, Beeres F, Van Hall S, Boering Y, Zeus T, Kehmeier E, Kelm M, Balzer J, Della Mattia A, Pinamonti B, Abate E, Nicolosi G, Proclemer A, Bassetti M, Luzzati R, Sinagra G, Hlubocka Z, Jiratova K, Dostalova G, Hlubocky J, Dohnalova A, Linhart A, Palecek T, Sonne C, Lesevic H, Karl M, Rosner S, Hadamitzky M, Ott I, Malev E, Reeva S, Zemtsovsky E, Igual Munoz B, Alonso Fernandez Pau P, Miro Palau Vicente V, Maceira Gonzalez Alicia A, Estornell Erill J, Andres La Huerta A, Donate Bertolin L, Valera Martinez F, Salvador Sanz Antonio A, Montero Argudo Anastasio A, Nemes A, Kalapos A, Domsik P, Chadaide S, Sepp R, Forster T, Onaindia J, Arana X, Cacicedo A, Velasco S, Rodriguez I, Capelastegui A, Sadaba M, Gonzalez J, Salcedo A, Laraudogoitia E, Archontakis S, Gatzoulis K, Vlasseros I, Arsenos P, Tsiachris D, Vouliotis A, Sideris S, Karistinos G, Kalikazaros I, Stefanadis C, Ancona R, Comenale Pinto S, Caso P, Coppola M, Arenga F, Cavallaro C, Vecchione F, D'onofrio A, Calabro R, Correia CE, Moreira D, Cabral C, Santos J, Cardoso J, Igual Munoz B, Maceira Gonzalez A, Estornell Erill Jordi J, Jimenez Carreno R, Arnau Vives M, Monmeneu Menadas J, Domingo-Valero D, Sanchez Fernandez E, Montero Argudo Anastasio A, Zorio Grima E, Cincin A, Tigen K, Karaahmet T, Dundar C, Sunbul M, Guler A, Bulut M, Basaran Y, Mordi I, Carrick D, Berry C, Tzemos N, Cruz I, Ferreira A, Rocha Lopes L, Joao I, Almeida A, Fazendas P, Cotrim C, Pereira H, Ochoa JP, Fernandez A, Filipuzzi J, Casabe J, Salmo J, Vaisbuj F, Ganum G, Di Nunzio H, Veron L, Guevara E, Salemi V, Nerbass F, Portilho N, Ferreira Filho J, Pedrosa R, Arteaga-Fernandez E, Mady C, Drager L, Lorenzi-Filho G, Marques J, Almeida AMG, Menezes M, Silva G, Placido R, Amaro C, Brito D, Diogo A, Lourenco MR, Azevedo O, Moutinho J, Nogueira I, Machado I, Portugues J, Quelhas I, Lourenco A, Calore C, Muraru D, Melacini P, Badano L, Mihaila S, Puma L, Peluso D, Casablanca S, Ortile A, Iliceto S, Kang MK, Yu S, Park J, Kim S, Park T, Mun HS, C S, Cho SR, Han S, Lee N, Khalifa EA, Hamodraka E, Kallistratos M, Zacharopoulou I, Kouremenos N, Mavropoulos D, Tsoukas A, Kontogiannis N, Papanikolaou N, Tsoukanas K, Manolis A, Villagraz Tecedor L, Jimenez Lopez Guarch C, Alonso Chaterina S, Blazquez Arrollo L, Lopez Melgar B, Veitia Sarmiento A, Mayordomo Gomez S, Escribano Subias M, Lichodziejewska B, Kurnicka K, Goliszek S, Dzikowska Diduch O, Kostrubiec M, Krupa M, Grudzka K, Ciurzynski M, Palczewski P, Pruszczyk P, Sakata K, Ishiguro M, Kimura G, Uesugo Y, Takemoto K, Minamishima T, Futuya M, Matsue S, Satoh T, Yoshino H, Signorello M, Gianturco L, Colombo C, Stella D, Atzeni F, Boccassini L, Sarzi-Puttini P, Turiel M, Kinova E, Deliiska B, Krivoshiev S, Goudev A, De Stefano F, Santoro C, Buonauro A, Schiano-Lomoriello V, Muscariello R, De Palma D, Galderisi M, Ranganadha Babu B, Chidambaram S, Sangareddi V, Dhandapani V, Ravi M, Meenakshi K, Muthukumar D, Swaminathan N, Ravishankar G, Bruno RM, Giardini G, Catizzo B, Brustia R, Malacrida S, Armenia S, Cauchy E, Pratali L, Cesana F, Alloni M, Vallerio P, De Chiara B, Musca F, Belli O, Ricotta R, Siena S, Moreo A, Giannattasio C, Magnino C, Omede' P, Avenatti E, Presutti D, Sabia L, Moretti C, Bucca C, Gaita F, Veglio F, Milan A, Eichhorn J, Springer W, Helling A, Alarajab A, Loukanov T, Ikeda M, Kijima Y, Akagi T, Toh N, Oe H, Nakagawa K, Tanabe Y, Watanabe N, Ito H, Hascoet S, Hadeed K, Marchal P, Bennadji A, Peyre M, Dulac Y, Heitz F, Alacoque X, Chausseray G, Acar P, Kong W, Ling L, Yip J, Poh K, Vassiliou V, Rekhraj S, Hoole S, Watkinson O, Kydd A, Boyd J, Mcnab D, Densem C, Shapiro L, Rana B, Potpara T, Djikic D, Polovina M, Marcetic Z, Peric V, Lip G, Gaudron P, Niemann M, Herrmann S, Hu K, Strotmann J, Beer M, Bijnens B, Liu D, Ertl G, Weidemann F, Peric V, Jovanovic A, Djikic D, Otasevic P, Kochanowski J, Piatkowski R, Scislo P, Grabowski M, Marchel M, Opolski G, Bandera F, Guazzi M, Arena R, Corra U, Ghio S, Forfia P, Rossi A, Dini F, Cahalin L, Temporelli L, Rallidis L, Tsangaris I, Makavos G, Anthi A, Pappas A, Orfanos S, Lekakis J, Anastasiou-Nana M, Kuznetsov VA, Krinochkin DV, Yaroslavskaya EI, Zaharova EH, Pushkarev GS, Mizia-Stec K, Wita K, Mizia M, Loboz-Grudzien K, Szwed H, Kowalik I, Kukulski T, Gosciniak P, Kasprzak J, Plonska-Gosciniak E, Cimino S, Pedrizzetti G, Tonti G, Cicogna F, Petronilli V, De Luca L, Iacoboni C, Agati L, Hoffmann R, Barletta G, Von Bardeleben S, Kasprzak J, Greis C, Vanoverschelde J, Becher H, Galrinho A, Moura Branco L, Fiarresga A, Cacela D, Ramos R, Cruz Ferreira R, Van Den Oord S, Akkus Z, Bosch J, Renaud G, Sijbrands E, Verhagen H, Van Der Lugt A, Van Der Steen A, Schinkel A, Mordi I, Tzemos N, Stanton T, Delgado D, Yu E, Drakopoulou M, Gonzalez-Gonzalez A, Karonis T, Roussin I, Babu-Narayan S, Swan L, Senior R, Li W, Parisi V, Pagano G, Pellegrino T, Femminella G, De Lucia C, Formisano R, Cuocolo A, Perrone Filardi P, Leosco D, Rengo G, Unlu S, Farsalinos K, Amelot K, Daraban A, Ciarka A, Delcroix M, Voigt J, Miskovic A, Poerner T, Goebel B, Stiller C, Moritz A, Sakata K, Uesugo Y, Kimura G, Ishiguro M, Takemoto K, Minamishima T, Futuya M, Satoh T, Yoshino H, Miyoshi T, Tanaka H, Kaneko A, Matsumoto K, Imanishi J, Motoji Y, Mochizuki Y, Minami H, Kawai H, Hirata K, Wutthimanop A, See O, Vathesathokit P, Yamwong S, Sritara P, Rosner A, Kildal A, Stenberg T, Myrmel T, How O, Capriolo M, Frea S, Giustetto C, Scrocco C, Benedetto S, Grosso Marra W, Morello M, Gaita F, Garcia-Gonzalez P, Cozar-Santiago P, Chacon-Hernandez N, Ferrando-Beltran M, Fabregat-Andres O, De La Espriella-Juan R, Fontane-Martinez C, Jurado-Sanchez R, Morell-Cabedo S, Ridocci-Soriano F, Mihaila S, Piasentini E, Muraru D, Peluso D, Casablanca S, Puma L, Naso P, Iliceto S, Vinereanu D, Badano L, Tarzia P, Villano A, Figliozzi S, Russo G, Parrinello R, Lamendola P, Sestito A, Lanza G, Crea F, Sulemane S, Panoulas V, Bratsas A, Frankel A, Nihoyannopoulos P, Dores H, Andrade M, Almeida M, Goncalves P, Branco P, Gaspar A, Gomes A, Horta E, Carvalho M, Mendes M, Yue W, Li X, Chen Y, Luo Y, Gu P, Yiu K, Siu C, Tse H, Cho E, Lee S, Hwang B, Kim D, Jang S, Jeon H, Youn H, Kim J. Poster session Thursday 12 December - PM: 12/12/2013, 14:00-18:00 * Location: Poster area. Eur Heart J Cardiovasc Imaging 2013. [DOI: 10.1093/ehjci/jet204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gustafsson M, Bohman DM, Borglin G. Challenges of conducting experimental studies within a clinical nursing context. Appl Nurs Res 2013; 27:133-6. [PMID: 24355415 DOI: 10.1016/j.apnr.2013.11.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 11/14/2013] [Accepted: 11/17/2013] [Indexed: 11/16/2022]
Abstract
In recent years, several distinguished scholars have advocated for nursing research that may carry strong evidence for practice. Their advocacy have highlighted that nursing science has reached a point where as nurse researchers we need to develop the questions we ask and design studies that have the power to produce solid, translational, evidence-based knowledge. To do so, we need to carry out experimental tests on complex, everyday nursing interventions and activities. We also need to create public space to present accounts of our endeavours pursuing this type of design in clinical practice. This paper will discuss some of the most important insights gained from conducting a quasi-experimental study in which the aim was to investigate the effect of a theory-based intervention, targeting knowledge and attitudes among registered nurses regarding cancer pain management. The importance of careful practical and methodological planning is emphasised, and the need for participation-friendly interventions is discussed.
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Affiliation(s)
- M Gustafsson
- Department of Health Science, Blekinge Institute of Technology, SE-379 71 Blekinge, Sweden.
| | - D M Bohman
- Department of Health Science, Blekinge Institute of Technology, SE-379 71 Blekinge, Sweden
| | - G Borglin
- Department of Health Science, Blekinge Institute of Technology, SE-379 71 Blekinge, Sweden
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