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Ihle-Hansen H, Pedersen R, Westbye SF, Sævareid TJL, Brøderud L, Larsen MH, Hermansen K, Rostoft S, Romøren M. Patient preferences in geriatric wards, a survey of health care professionals' practice, experience and attitudes. Eur Geriatr Med 2024; 15:153-158. [PMID: 38282088 PMCID: PMC10876711 DOI: 10.1007/s41999-023-00922-7] [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: 08/19/2023] [Accepted: 12/13/2023] [Indexed: 01/30/2024]
Abstract
PURPOSE We aimed to identify whether health care professionals (HCP) examine their patient and next-of-kin preferences, and to study whether medical decisions follow these preferences. METHOD A cross-sectional web-based survey was conducted with multidisciplinary HCP from 12 geriatric wards in the South-Eastern Norway Regional Health Authority. RESULTS Of the 289 HCPs responding (response rate 61%), mean age 37.8 years (SD 11.3), 235 (81.3%) women, 12.4 (SD 9.6) years of experience and 67 (23.2%) medical doctors, only half report clarifying patients' preferences. The majority reported that they did not inform, involve and treat in line with such preferences. However, 53% believe that HCP, patients and next-of-kin should make clinical decisions together. DISCUSSION Our findings indicate a lack of engagement in conversation and inclusion of patient preferences when providing health interventions in geriatric wards. Measures for change of culture are needed.
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Affiliation(s)
- Hege Ihle-Hansen
- Centre for Medical Ethics, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
- Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
- Department of Neurology, Oslo University Hospital, Oslo, Norway.
| | - R Pedersen
- Centre for Medical Ethics, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - S F Westbye
- Centre for Medical Ethics, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - T J L Sævareid
- Centre for Medical Ethics, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - L Brøderud
- Centre for Medical Ethics, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - M H Larsen
- Lovisenberg Diaconal University College, Oslo, Norway
| | - K Hermansen
- Centre for Medical Ethics, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Health Sciences, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Aalesund, Norway
| | - S Rostoft
- Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - M Romøren
- Centre for Medical Ethics, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Amundsen R, Thorarinsdottir S, Larmo A, Pedersen R, Andersen TE, Møller M, Bahr R. #ReadyToplay: hamstring injuries in women's football - a two-season prospective cohort study in the Norwegian women's premier league. SCI MED FOOTBALL 2024:1-9. [PMID: 38243669 DOI: 10.1080/24733938.2024.2305389] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/07/2024] [Indexed: 01/21/2024]
Abstract
In this two-season prospective cohort study (2020-2021), we aimed to describe the characteristics, clinical findings and magnetic resonance imaging (MRI) findings of hamstring injuries in the Norwegian women's premier league. Hamstring injuries were examined by team physiotherapists using a standardised clinical examination and injury form. Injury location and severity (modified Peetrons classification) were graded based on MRI by two independent radiologists. Fifty-three hamstring injuries were clinically examined, 31 of these with MRI. Hamstring injuries caused 8 days (median) lost from football (interquartile range: 3-15 days, range: 0-188 days), most were non-contact and occurred during sprinting. Gradual-onset (53%) and sudden-onset injuries (47%) were evenly distributed. The injuries examined with MRI were classified as grade 0 (52%), grade 1 (16%) or grade 2 (29%). One proximal tendinopathy case was not graded. Grade 2 injuries caused more time loss than grade 0 (19 ± 8 vs. 7 ± 7 days, p = 0.002). Of injuries with MRI changes, 60% were in the m. biceps femoris, mainly the muscle-tendon junction, and 40% in the m. semimembranosus, most in the proximal tendon. Compared to previous findings from men's football, a higher proportion of hamstring injuries in women's football had a gradual onset and involved the m. semimembranosus, particularly its proximal tendon.
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Affiliation(s)
- R Amundsen
- Oslo Sports Trauma Research Center, Institute of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - S Thorarinsdottir
- Oslo Sports Trauma Research Center, Institute of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - A Larmo
- Radiology Department, Evidia Norge AS, Oslo, Norway
| | - R Pedersen
- Radiology Department, Unilabs Norge AS, Oslo, Norway
| | - T E Andersen
- Oslo Sports Trauma Research Center, Institute of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
- The Norwegian Football Association Medical Centre (Idrettens helsesenter), The Norwegian Football Association, Oslo, Norway
| | - M Møller
- Oslo Sports Trauma Research Center, Institute of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - R Bahr
- Oslo Sports Trauma Research Center, Institute of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
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Pedersen R, Skagen KM, Aamaas B, Trulsen PU. Kirurgisk engangsutstyr fra Pakistan – en kasuistikk om bærekraft. Tidsskr Nor Laegeforen 2023; 143:23-0510. [PMID: 37874062 DOI: 10.4045/tidsskr.23.0510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023] Open
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Van Heukelom P, Vakkalanka JP, Pedersen R, Nugent AS. Inpatient boarding definitions and mitigation strategies: A cross-sectional survey of academic emergency departments in the United States. Am J Emerg Med 2023; 67:37-40. [PMID: 36796239 PMCID: PMC10121851 DOI: 10.1016/j.ajem.2023.01.056] [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: 12/13/2022] [Revised: 01/25/2023] [Accepted: 01/30/2023] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVE Conceptually, inpatient boarding is a result in the delay of admitting patients from the Emergency Department (ED) to inpatient units, but there is no consistent definition across academic EDs. The purpose of this study was to evaluate the definition of boarding across academic EDs, and to identify mitigation strategies used by EDs to alleviate crowd management. METHODS This was a cross-sectional survey of boarding-related questions (i.e., boarding definitions and practices) that were embedded into the annual benchmarking survey conducted by the Academy of Academic Administrators of Emergency Medicine and the Association of Academic Chairs of Emergency Medicine. Results were descriptively assessed and tabulated. RESULTS Of the 130 eligible institutions, 68 participated in the survey. Approximately 70% of institutions reported starting the boarding clock at the time of ED admission, while 19% reported that the clock started with the completion of inpatient orders. Approximately 35% of institutions considered patients boarded within 2 h, while 34% considered patients boarded >4 h after admission decision. In response to ED overcrowding brought on by inpatient boarding, 35% reported using hallway beds for patient care. Surge capacity measures reported included having a high census/surge capacity plan (81%), going on ambulance diversion (54%), and institutional use of a discharge lounge (49%). CONCLUSIONS We found that definitions for boarding varied widely. Inpatient boarding has serious consequences to patient care and well-being, suggesting the need for standardized definitions to describe inpatient boarding.
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Affiliation(s)
- Paul Van Heukelom
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Suite RCP1008, Iowa City, IA 52242, USA.
| | - J Priyanka Vakkalanka
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Suite RCP1008, Iowa City, IA 52242, USA; Department of Epidemiology, University of Iowa College of Public Health, 145 N. Riverside Drive, Iowa City, IA 52242, USA.
| | - Robert Pedersen
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Suite RCP1008, Iowa City, IA 52242, USA; Minneapolis VA Health Care System, 1 Veterans Dr, Minneapolis, MN 55417, USA
| | - Andrew S Nugent
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Suite RCP1008, Iowa City, IA 52242, USA.
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Valika A, Pedersen R, Sulemanjee N. Reduction in 90 Day Readmission Rates with Ambulatory Pulmonary Artery Pressure Monitoring. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1629] [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: 11/25/2022] Open
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Wetterslev M, Møller MH, Granholm A, Hassager C, Haase N, Aslam TN, Shen J, Young PJ, Aneman A, Hästbacka J, Siegemund M, Cronhjort M, Lindqvist E, Myatra SN, Kalvit K, Arabi YM, Szczeklik W, Sigurdsson MI, Balik M, Keus F, Perner A, Huang B, Yan M, Liu W, Deng Y, Zhang L, Suk P, Mørk Sørensen K, Andreasen AS, Bestle MH, Krag M, Poulsen LM, Hildebrandt T, Møller K, Møller‐Sørensen H, Bove J, Kilsgaard TA, Salam IA, Brøchner AC, Strøm T, Sølling C, Kolstrup L, Boczan M, Rasmussen BS, Darfelt IS, Jalkanen V, Lehto P, Reinikainen M, Kárason S, Sigvaldason K, Olafsson O, Vergis S, Mascarenhas J, Shah M, Haranath SP, Van Der Poll A, Gjerde S, Fossum OK, Strand K, Wangberg HL, Berta E, Balsliemke S, Robertson AC, Pedersen R, Dokka V, Brügger‐Synnes P, Czarnik T, Albshabshe AA, Almekhlafi G, Knight A, Tegnell E, Sjövall F, Jakob S, Filipovic M, Kleger G, Eck RJ. Management of acute atrial fibrillation in the intensive care unit: An international survey. Acta Anaesthesiol Scand 2022; 66:375-385. [PMID: 34870855 DOI: 10.1111/aas.14007] [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: 10/07/2021] [Revised: 11/11/2021] [Accepted: 11/30/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is common in intensive care unit (ICU) patients and is associated with poor outcomes. Different management strategies exist, but the evidence is limited and derived from non-ICU patients. This international survey of ICU doctors evaluated the preferred management of acute AF in ICU patients. METHOD We conducted an international online survey of ICU doctors with 27 questions about the preferred management of acute AF in the ICU, including antiarrhythmic therapy in hemodynamically stable and unstable patients and use of anticoagulant therapy. RESULTS A total of 910 respondents from 70 ICUs in 14 countries participated in the survey with 24%-100% of doctors from sites responding. Most ICUs (80%) did not have a local guideline for the management of acute AF. The preferred first-line strategy for the management of hemodynamically stable patients with acute AF was observation (95% of respondents), rhythm control (3%), or rate control (2%). For hemodynamically unstable patients, the preferred strategy was observation (48%), rhythm control (48%), or rate control (4%). Overall, preferred antiarrhythmic interventions included amiodarone, direct current cardioversion, beta-blockers other than sotalol, and magnesium in that order. A total of 67% preferred using anticoagulant therapy in ICU patients with AF, among whom 61% preferred therapeutic dose anticoagulants and 39% prophylactic dose anticoagulants. CONCLUSION This international survey indicated considerable practice variation among ICU doctors in the clinical management of acute AF, including the overall management strategies and the use of antiarrhythmic interventions and anticoagulants.
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Affiliation(s)
- Mik Wetterslev
- Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Morten Hylander Møller
- Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Anders Granholm
- Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Christian Hassager
- Department of Cardiology Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Nicolai Haase
- Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Tayyba Naz Aslam
- Department of Anaesthesiology Division of Emergencies and Critical Care Rikshospitalet Oslo University Hospital Oslo Norway
| | - Jiawei Shen
- Department of Critical Care Medicine Peking University People's Hospital Beijing China
| | - Paul J. Young
- Intensive Care Specialist and co‐Director, Intensive Care Unit Wellington Hospital Wellington New Zealand
- Intensive Care Programme Director Medical Research Institute of New Zealand Wellington New Zealand
- Australian and New Zealand Intensive Care Research Centre Department of Epidemiology and Preventive Medicine School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
| | - Anders Aneman
- Department of Intensive Care Medicine Liverpool Hospital South Western Sydney Local Health District and South Western Sydney Clinical School University of New South Wales Sydney Australia
| | - Johanna Hästbacka
- Department of Anaesthesiology, Intensive Care and Pain Medicine University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Martin Siegemund
- Department of Intensive Care Medicine Department of Clinical Research University Hospital Basel and University of Basel Basel Switzerland
| | - Maria Cronhjort
- Department of Clinical Science and Education Section of Anaesthesia and Intensive Care Södersjukhuset Karolinska Institutet Stockholm Sweden
| | - Elin Lindqvist
- Department of Clinical Science and Education Section of Anaesthesia and Intensive Care Södersjukhuset Karolinska Institutet Stockholm Sweden
| | - Sheila N. Myatra
- Department of Anaesthesiology Critical Care and Pain Tata Memorial Hospital Homi Bhabha National Institute Mumbai India
| | - Kushal Kalvit
- Department of Anaesthesiology Critical Care and Pain Tata Memorial Hospital Homi Bhabha National Institute Mumbai India
| | - Yaseen M. Arabi
- Department of Intensive Care Medicine Ministry of National Guard Health Affairs King Saud bin Abdulaziz University for Health Sciences King Abdullah International Medical Research Center Riyadh Saudi Arabia
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine Jagiellonian University Medical College Kraków Poland
| | - Martin I. Sigurdsson
- Division of Anaesthesia and Intensive Care Perioperative Services at Landspitali The National University Hospital of Iceland Reykjavik Iceland
- Faculty of Medicine University of Iceland Reykjavik Iceland
| | - Martin Balik
- Department of Anesthesiology and Intensive Care 1st Faculty of Medicine General University Hospital Charles University Prague Czech Republic
| | - Frederik Keus
- Department of Critical Care University of Groningen University Medical Center Groningen Groningen the Netherlands
| | - Anders Perner
- Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
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Bruun H, Huniche L, Stenager E, Mogensen CB, Pedersen R. Hospital ethics reflection groups: a learning and development resource for clinical practice. BMC Med Ethics 2019; 20:75. [PMID: 31651308 PMCID: PMC6813973 DOI: 10.1186/s12910-019-0415-5] [Citation(s) in RCA: 3] [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: 06/23/2019] [Accepted: 10/09/2019] [Indexed: 11/13/2022] Open
Abstract
Background An ethics reflection group (ERG) is one of a number of ethics support services developed to better handle ethical challenges in healthcare. The aim of this article is to evaluate the significance of ERGs in psychiatric and general hospital departments in Denmark. Methods This is a qualitative action research study, including systematic text condensation of 28 individual interviews and 4 focus groups with clinicians, ethics facilitators and ward managers. Short written descriptions of the ethical challenges presented in the ERGs also informed the analysis of significance. Results A recurring ethical challenge for clinicians, in a total of 63 cases described and assessed in 3 ethical reflection groups, is to strike a balance between respect for patient autonomy, paternalistic responsibility, professional responsibilities and institutional values. Both in psychiatric and general hospital departments, the study participants report a positive impact of ERG, which can be divided into three categories: 1) Significance for patients, 2) Significance for clinicians, and 3) Significance for ward managers. In wards characterized by short-time patient admissions, the cases assessed were retrospective and the beneficiaries of improved dialogue mainly future patients rather than the patients discussed in the specific ethical challenge presented. In wards with longer admissions, the patients concerned also benefitted from the dialogue in the ERG. Conclusion This study indicates a positive significance and impact of ERGs; constituting an interdisciplinary learning resource for clinicians, creating significance for themselves, the ward managers and the organization. By introducing specific examples, this study indicates that ERGs have significance for the patients discussed in the specific ethical challenge, but mostly indirectly through learning among clinicians and development of clinical practice. More research is needed to further investigate the impact of ERGs seen from the perspectives of patients and relatives.
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Affiliation(s)
- H Bruun
- Focused Research Unit in Psychiatry, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | - L Huniche
- Department of Psychology, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - E Stenager
- Focused Research Unit in Psychiatry, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - C B Mogensen
- Focused Research Unit in Emergency Medicine, Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - R Pedersen
- Center for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
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Bruun H, Lystbaek SG, Stenager E, Huniche L, Pedersen R. Ethical challenges assessed in the clinical ethics Committee of Psychiatry in the region of Southern Denmark in 2010-2015: a qualitative content analyses. BMC Med Ethics 2018; 19:62. [PMID: 29914461 PMCID: PMC6006832 DOI: 10.1186/s12910-018-0308-z] [Citation(s) in RCA: 6] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 06/04/2018] [Indexed: 11/16/2022] Open
Abstract
Background The aim of this article is to give more insight into what ethical challenges clinicians in mental healthcare experience and discuss with a Clinical Ethics Committee in psychiatry in the Region of Southern Denmark. Ethical considerations are an important part of the daily decision-making processes and thereby for the quality of care in mental healthcare. However, such ethical challenges have been given little systematic attention – both in research and in practices. Methods A qualitative content analysis of 55 written case-reports from the Clinical Ethics Committee. The Committee offers clinicians in mental healthcare structured ethical analyses of ethical challenges and makes a thorough written case-report. Results The ethical challenges are grouped into three overarching topics: 1. Clinicians and their relation to patients and relatives. 2. Clinicians and institutional aspects of mental healthcare 3. Clinicians and mental healthcare in a wider social context. Through presentation of illustrative examples the complexity of daily clinical life in mental healthcare becomes evident, as well as typical interests, values and arguments. Conclusions This qualitative study indicates that difficult ethical challenges are an inherent part of mental healthcare that requires time, space and competence to be dealt with adequately.
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Affiliation(s)
- H Bruun
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark. .,Psychiatric hospitals, the Region of Southern Denmark, Toldbodgade 45, 5000, Odense, Denmark.
| | - S G Lystbaek
- Psychiatric hospitals, the Region of Southern Denmark, Toldbodgade 45, 5000, Odense, Denmark
| | - E Stenager
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Psychiatric hospitals, the Region of Southern Denmark, Toldbodgade 45, 5000, Odense, Denmark
| | - L Huniche
- User Perspectives, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - R Pedersen
- Center for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
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Askar W, Rappelt M, Pedersen R, Sulemanjee N, Hastings T, Cheema O, Roberts E, Downey F, Crouch J, Thohan V. Implication of Pre-Operative Pulmonary Function Testing on Gastrointestinal Bleeding After Continuous Flow LVAD. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.946] [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: 11/24/2022] Open
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Omery B, Pedersen R, Sulemanjee N, Hastings T, Cheema O, Roberts E, Downey F, Crouch J, Thohan V. Implication of Appropriate ICD Shock on Mortality After Continuous Flow LVAD. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Sidelmann J, Brabrand M, Pedersen R, Pedersen J, Esbensen K, Standeven K, Ariëns R, Gram J, Sjøland J. Fibrin clot structure in patients with end-stage renal disease. Thromb Haemost 2017. [DOI: 10.1160/th06-12-0715] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
SummaryFibrin clots with reduced permeability, increased clot stiffness and reduced fibrinolysis susceptibility may predispose to cardiovascular disease (CVD). Little is known, however, about the structure of fibrin clots in patients with end-stage renal disease (ESRD).These patients suffer from a high risk of CVD in addition to their chronic low-grade inflammation. Using permeability, compaction and turbidity studies in 22 ESRD patients and 24 healthy controls, fibrin clots made from patient plasma were found to be less permeable (p<0.001), less compactable (p<0.001), and less susceptible to fibrinolysis (p<0.001) than clots from controls.The maximum rate of turbidity increase was also higher for the patients than controls (p<0.001), and scan-ning electron microscopy revealed higher clot density of fibrin fibers in clots from patients than clots from controls (p<0.001). Patients had higher plasma concentrations of fibrinogen, C-reative protein and interleukin 6 than controls.These plasma markers of inflammation correlated significantly with most of the fibrin structure characteristics observed in the patients. In contrast, plasma markers of azothemia showed no such correlations. The results suggest that in ESRD patients fibrin clots are significantly different from healthy controls, and that the fibrin structure characteristics in the patients are associated primarily with the inflammatory plasma milieu rather than with level of azothemia.
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Akkoc N, Zerbini C, Karateev D, Pedersen R, Vlahos B, Marshall L, Bao C, Al-Maini M, Shen Q. THU0065 Potential Predictors for Achieving and/or Maintaining Low Disease Activity or Remission in Patients with Rheumatoid Arthritis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1856] [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: 11/04/2022]
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Dougados M, Maksymowych W, van der Heijde D, Pedersen R, Bonin R, Logeart I, Bukowski J, Jones H. SAT0405 No Radiological Sacroiliac Joint Progression after 2 Years of Etanercept Treatment in Non-Radiographic Axial Spondyloarthritis: Data from The Embark Study. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1858] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Flo E, Husebo BS, Bruusgaard P, Gjerberg E, Thoresen L, Lillemoen L, Pedersen R. A review of the implementation and research strategies of advance care planning in nursing homes. BMC Geriatr 2016; 16:24. [PMID: 26797091 PMCID: PMC4722739 DOI: 10.1186/s12877-016-0179-4] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 01/04/2016] [Indexed: 11/29/2022] Open
Abstract
Background Nursing home (NH) patients have complex health problems, disabilities and needs for Advance Care Planning (ACP). The implementation of ACP in NHs is a neglected research topic, yet it may optimize the intervention efficacy, or provide explanations for low efficacy. This scoping review investigates methods, design and outcomes and the implementation of ACP (i.e., themes and guiding questions, setting, facilitators, implementers, and promoters/barriers). Methods A systematic search using ACP MESH terms and keywords was conducted in CINAHL, Medline, PsychINFO, Embase and Cochrane libraries. We excluded studies on home-dwelling and hospital patients, including only specific diagnoses and/or chart-based interventions without conversations. Results Sixteen papers were included. There were large variations in definitions and content of ACP, study design, implementation strategies and outcomes. Often, the ACP intervention or implementation processes were not described in detail. Few studies included patients lacking decision-making capacity, despite the fact that this group is significantly present in most NHs. The chief ACP implementation strategy was education of staff. Among others, ACP improved documentation of and adherence to preferences. Important implementation barriers were non-attending NH physicians, legal challenges and reluctance to participate among personnel and relatives. Conclusion ACP intervention studies in NHs are few and heterogeneous. Variation in ACP definitions may be related to cultural and legal differences. This variation, along with sparse information about procedures, makes it difficult to collate and compare research results. Essential implementation considerations relate to the involvement and education of nurses, physicians and leaders.
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Affiliation(s)
- E Flo
- Centre for Elderly-and Nursing Home Medicine, Department of Global Public Health and Primary Care, University of Bergen, P.O. Box: 7200, Bergen, Norway.
| | - B S Husebo
- Centre for Elderly-and Nursing Home Medicine, Department of Global Public Health and Primary Care, University of Bergen, P.O. Box: 7200, Bergen, Norway.
| | - P Bruusgaard
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - E Gjerberg
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - L Thoresen
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - L Lillemoen
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - R Pedersen
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway.
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Flo E, Bruusgaard P, Husebø BS, Gjerberg E, Thoresen L, Pedersen R. P-29 Implementation strategies and research of advance care planning in nursing homes. An integrative, systematic review of the literature. BMJ Support Palliat Care 2015. [DOI: 10.1136/bmjspcare-2015-000978.159] [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: 11/03/2022]
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Sævareid TJL, Lillemoen L, Thoresen L, Gjerberg E, Førde R, Pedersen R. O-32 Developing, implementing and evaluating advance care planning (ACP) in norwegian nursing homes (NHS) – a mixed methods study. BMJ Support Palliat Care 2015. [DOI: 10.1136/bmjspcare-2015-000978.31] [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: 11/03/2022]
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Pavelka K, Akkoç N, Al-Maini M, Zerbini C, Bao C, Karateev D, Nasonov E, Pedersen R, Dinh A, Shen Q, Vasilescu R, Mahgoub E, Vlahos B. AB0422 Impact of Combination Etanercept-Dmard Induction Therapy in Active Rheumatoid Arthritis: Interim Results of an International Treat-to-Target Study Conducted in Regions with Limited Biologic Access: Table 1. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1689] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Zhang W, Bansback N, Sun H, Pedersen R, Kotak S, Anis A. FRI0341 Influence of Tapering Etanercept on Work Productivity Outcomes in Patients with Early Rheumatoid Arthritis Tapered: 117 Week Results from the Prize Study. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1864] [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: 11/03/2022]
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Sieper J, Jones H, Bukowski J, Pedersen R, Mahgoub E, Marshall L. THU0209 Responder vs Non-Responder Baseline Characteristics and Early Response in Patients with Non-Radiographic Axial Spondyloarthritis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1846] [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: 11/04/2022]
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Downey F, Pedersen R, Sulemanjee N, Hastings T, Cheema O, Zwicke D, Crouch J, Downey C, Thohan V. Temporal Benefits of Continuous Flow Left Ventricular Assist Device Therapy Assessed With SF-36. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.196] [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: 10/23/2022] Open
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Mrowietz U, Chouela EN, Mallbris L, Stefanidis D, Marino V, Pedersen R, Boggs RL. Pruritus and quality of life in moderate-to-severe plaque psoriasis: post hoc explorative analysis from the PRISTINE study. J Eur Acad Dermatol Venereol 2014; 29:1114-20. [PMID: 25376448 DOI: 10.1111/jdv.12761] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 09/05/2014] [Indexed: 01/20/2023]
Abstract
BACKGROUND Pruritus is a clinically important symptom of psoriasis that has a major impact on quality of life (QoL). OBJECTIVE The objective of this study was to examine pruritus and QoL in patients with moderate-to-severe psoriasis treated with etanercept (ETN) in the PRISTINE clinical trial. METHODS Patients were randomized (1 : 1, double-blind) to ETN 50 mg QW or 50 mg BIW for 12 weeks, followed by 50 mg QW for 12 weeks. Pruritus was reported as 0 (no itching) to 5 (severe itching). Associations were examined between pruritus and Psoriasis Area and Severity Index, Dermatology Life Quality Index (DLQI), Hospital Anxiety and Depression Screening (HADS), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue), Euro-Qol 5D (EQ-5D) and Medical Outcomes Study (MOS) Sleep Index II. RESULTS At baseline, patients (n = 270) had a mean pruritus level of 3.6. Itching (level ≥1) was reported by 96% of patients, 62% of whom had severe itching (level ≥4) and 26% had the highest level of itching. DLQI, HADS-Anxiety, HADS-Depression, FACIT-Fatigue, EQ-5D visual analog scale, and MOS Sleep Index II were significantly associated with itch. At week 12, mean pruritus improvement in the ETN BIW/QW group was greater than in the QW/QW group (2.4 vs. 1.6, P < 0.001), but not at week 24 (2.2 vs. 2.0, P = 0.180). Patients with the most severe itching at baseline (score of 5) had a mean score of 1.7 at week 24. Overall, patients with clinically meaningful pruritus improvement at week 24 reported greater improvement in QoL measures than other patients. CONCLUSION Most patients with moderate-to-severe psoriasis in this study (96%) reported pruritus. Pruritus improved significantly with ETN therapy and was strongly associated with improvements in QoL. These data support the clinical relevance of pruritus as an important symptom of patients with moderate/severe psoriasis.
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Affiliation(s)
- U Mrowietz
- Psoriasis Center at the Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Germany
| | - E N Chouela
- Hospital General de Agudos, Buenos Aires, Argentina
| | | | - D Stefanidis
- Pfizer Specialty Care, Medical Affairs Europe, Inflammation, Rome, Italy
| | - V Marino
- Pfizer Italia S.r.l., Rome, Italy
| | | | - R L Boggs
- Formerly of Pfizer Inc, Collegeville, PA, USA
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Emery P, Pedersen R, Bukowski J, Marshall L. OP0039 Early Response to Etanercept-Methotrexate Induction Therapy Predicts Sustained Remission with Reduced-Dose Combination Regimen in the Prize Study: Table 1. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.1704] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Sieper J, Drescher E, Rosa J, Pedersen R, Bonin R, Vlahos B, Bukowski J, Kotak S. SAT0350 Quality of Life with Etanercept in Early Non-Radiographic Axial Spondyloarthritis: 24 and 48-Week Data from A Randomized, Double-Blind, Placebo-Controlled Trial. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2242] [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: 11/04/2022]
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Maksymowych W, van der Heijde D, Dougados M, Sieper J, Braun J, Citera G, Miceli-Richard C, Wei JCC, Pedersen R, Bonin R, Logeart I, Wajdula J, Rahman M, Vlahos B, Bukowski J. SAT0372 Clinical and Imaging Efficacy of Etanercept in Early Non-Radiographic Axial Spondyloarthritis: 48-Week Treatment Data: Table 1. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.1138] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Zhang W, Bansback N, Sun H, Pedersen R, Kotak S, Anis A. THU0423 The Impact of Etanercept and Methotrexate Treatment on Work Productivity in Patients with Rheumatoid Arthritis: Results from Phase 2 of the Prize Study. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.1198] [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: 11/04/2022]
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Dougados M, van der Heijde D, Sieper J, Braun J, Maksymowych WP, Citera G, Pedersen R, Bonin R, Bukowski J, Koenig AS, Vlahos B, Alvarez D. OP0108 Clinical and Imaging Efficacy of Etanercept in Early Non-Radiographic Axial Spondyloarthritis: A 12-Week, Randomized, Double-Blind, Placebo-Controlled Trial. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2013-eular.313] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Emery P, Hammoudeh M, FitzGerald O, Combe B, Martin Mola E, Bukowski J, Pedersen R, Williams T, Gaylord S, Vlahos B. FRI0089 Assessing maintenance of remission with reduced dose etanercept plus methotrexate, methotrexate alone, or placebo in patients with early rheumatoid arthritis who achieved remission with etanercept and methotrextate: the prize study. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2013-eular.1216] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Thaçi D, Galimberti R, Amaya-Guerra M, Rosenbach T, Robertson D, Pedersen R, Yang S, Kuligowski M, Boggs R. Improvement in aspects of sleep with etanercept and optional adjunctive topical therapy in patients with moderate-to-severe psoriasis: results from the PRISTINE trial. J Eur Acad Dermatol Venereol 2013; 28:900-6. [PMID: 23848989 DOI: 10.1111/jdv.12207] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 06/04/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Impaired sleep in patients with moderate-to-severe psoriasis and improvement on therapy has not been widely studied. OBJECTIVE Quantify baseline aspects of sleep and improvement in patients with psoriasis receiving etanercept (ETN) when allowed concomitant topical medications (PRISTINE study). METHODS Patients with moderate-to-severe psoriasis were randomized to 50 mg ETN once weekly (QW/QW) or 50 mg ETN twice weekly (BIW/QW) for weeks 1-12, followed by 50 mg QW for weeks 13-24; a broad range of topical therapies were permitted during weeks 13-24. Sleep impairment was measured by the Medical Outcomes Study (MOS) sleep questionnaire Index II (population norm = 25.8; minimum clinically important difference = 5.1); quality of life (QoL) measures included Dermatology Life Quality Index (DLQI), EuroQoL 5 Dimension (EQ-5D) Utility Index and Visual Analogue Scale (VAS) and Functional Activity in Chronic Therapy-Fatigue (FACIT-Fatigue). ancova and Fisher's exact test or chi-squared tests were used for between-group testing. RESULTS Mean baseline MOS-Sleep scores were 34.0 for both groups indicating impairment (N = 270; QW/QW n = 137; BIW/QW n = 133, approximately 64% had impaired sleep). At week 12 of treatment, MOS-Sleep scores improved to 30.8 and 30.1, and at week 24, to 28.4 and 28.2 respectively. Poor sleep was significantly associated with clinically important problems in EQ-5D utility, VAS and FACIT-Fatigue; sleep improvement was associated with improved EQ-5D utility and FACIT-Fatigue (P < 0.001). CONCLUSION This study confirms that most patients with moderate-to-severe psoriasis have impaired sleep which is associated with impaired QoL. Treatment with etanercept significantly improved sleep, with most improvement occurring before a broad range of topicals were allowed. Sleep improvement was associated with improved QoL.
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Affiliation(s)
- D Thaçi
- Excellence Center for Inflammation Medicine, University Hospital Schleswig-Holstein, University of Lübeck, Lübeck, Germany
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Helliwell P, FitzGerald O, Marshall L, Pedersen R, Bananis E. SAT0297 Comparison of Composite Disease Activity Scores in Psoriatic Arthritis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.2022] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Emery P, Wiland P, Dudler J, Ionescu RM, Vlahos B, Bukowski J, Pedersen R, Williams T, Gaylord S, Kotak S. SAT0543 Reduced/Withdrawn Dose of Etanercept-Methotrexate Therapy of Early Rheumatoid Arthritis has a Favorable Impact on Patient-Reported Outcomes Compared with MTX Alone or Placebo: the Prize Study. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.2267] [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: 11/04/2022]
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Lundereng K, Sund JK, Sporsem HM, Pedersen R, Molden E. CPC-114 Prevalence and Management of Drug-Related Problems in an Intensive Care Unit. Eur J Hosp Pharm 2013. [DOI: 10.1136/ejhpharm-2013-000276.571] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Gniadecki R, Robertson D, Molta C, Freundlich B, Pedersen R, Li W, Boggs R, Zbrozek A. Self-reported health outcomes in patients with psoriasis and psoriatic arthritis randomized to two etanercept regimens. J Eur Acad Dermatol Venereol 2011; 26:1436-43. [DOI: 10.1111/j.1468-3083.2011.04308.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Prust M, Wang J, Morizono H, Messing A, Brenner M, Gordon E, Hartka T, Sokohl A, Schiffmann R, Gordish-Dressman H, Albin R, Amartino H, Brockman K, Dinopoulos A, Dotti MT, Fain D, Fernandez R, Ferreira J, Fleming J, Gill D, Griebel M, Heilstedt H, Kaplan P, Lewis D, Nakagawa M, Pedersen R, Reddy A, Sawaishi Y, Schneider M, Sherr E, Takiyama Y, Wakabayashi K, Gorospe JR, Vanderver A. GFAP mutations, age at onset, and clinical subtypes in Alexander disease. Neurology 2011; 77:1287-94. [PMID: 21917775 PMCID: PMC3179649 DOI: 10.1212/wnl.0b013e3182309f72] [Citation(s) in RCA: 159] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 06/14/2011] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To characterize Alexander disease (AxD) phenotypes and determine correlations with age at onset (AAO) and genetic mutation. AxD is an astrogliopathy usually characterized on MRI by leukodystrophy and caused by glial fibrillary acidic protein (GFAP) mutations. METHODS We present 30 new cases of AxD and reviewed 185 previously reported cases. We conducted Wilcoxon rank sum tests to identify variables scaling with AAO, survival analysis to identify predictors of mortality, and χ(2) tests to assess the effects of common GFAP mutations. Finally, we performed latent class analysis (LCA) to statistically define AxD subtypes. RESULTS LCA identified 2 classes of AxD. Type I is characterized by early onset, seizures, macrocephaly, motor delay, encephalopathy, failure to thrive, paroxysmal deterioration, and typical MRI features. Type II is characterized by later onset, autonomic dysfunction, ocular movement abnormalities, bulbar symptoms, and atypical MRI features. Survival analysis predicted a nearly 2-fold increase in mortality among patients with type I AxD relative to those with type II. R79 and R239 GFAP mutations were most common (16.6% and 20.3% of all cases, respectively). These common mutations predicted distinct clinical outcomes, with R239 predicting the most aggressive course. CONCLUSIONS AAO and the GFAP mutation site are important clinical predictors in AxD, with clear correlations to defined patterns of phenotypic expression. We propose revised AxD subtypes, type I and type II, based on analysis of statistically defined patient groups.
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Affiliation(s)
- M Prust
- Children's National Medical Center, 111 Michigan Ave. NW, Washington, DC 20010, USA
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Conca W, Al-Salam S, Ding HJ, Mohd Thabit AA, Hussein H, Koc A, Karatepe AG, Gunaydin R, Kaya T, Lee YH, Park W, Jin Choi H, Jae Hong S, Hee Lee C, Suh CH, Hwang JY, Park SW, Lee J, Wong RH, Shiu LJ, Huang CH, Lee HS, Cheng-Chung Wei J, Surkan E, Fuat ES, Alpaslan A, Gary M, Vijitha DS, Ashraf EM, Robert M, Mbiantcha M, Nguelefack TB, Ndontsa BL, Tane P, Kamanyi A, Karadag O, Yilmaz S, Kisacik B, Kalyoncu U, Tezcan E, Yilmaz S, Ozgen M, Kaskari D, Direskeneli H, Kiraz S, Ertenli I, Dinc A, Capkin E, Karkucak M, Kose MM, Cakmak VA, Turkyilmaz AK, Tosun M, Baykal T, Senel K, Alp F, Erdal A, Ugur M, Ediz L, Tuluce Y, Ozkol H, Hiz O, Gulcu E, Toprak M, Kokkonen H, Mullazehi M, Ronnelid J, Rantapaa-Dahlqvist S, Bodur H, Rezvani A, Andersone D, Bulina I, Jaunalksne I, Batmaz I, Karakoc M, Yazici S, Cevik R, Nas K, Sarac AJ, Atilgan Z, Budak S, Arman MI, Ozcan E, Esmaeilzadeh S, Sen E, Baysak T, Kayikci O, Pamuk ON, Arican O, Donmez S, Pamuk GE, Cakir N, Koyuncu H, Gun K, Uludag M, Ornek NI, Suzen S, Battal H, Karamehmetoglu S, Senel K, Baykal T, Baygutalp F, Kiziltunc A, Ugur M, Yildirim S, Hatemi G, Yurdakul S, Fresko I, Ozdogan H, Ebru T, Murat B, Serdar K, Mert C, Ufuk U, Nurettin T, Smolen JS, Freundlich B, Pavelka K, Nash P, Miranda P, Hammond C, Vlahos B, Pedersen R, Koenig AS, Zinnuroglu M, Erden Z, Gogus F, Yalcin T, Bal A, Dulgeroglu D, Cakci A, Yalcin T, Bal A, Dulgeroglu D, Cakci A, Takeuchi T, Tanaka Y, Amano K, Hoshi D, Nawata M, Nagasawa H, Satoh E, Saito K, Kaneko Y, Fukuyo S, Kurasawa T, Hanami K, Kameda H, Yamanaka H. Thematic stream: inflammatory arthritis (PP01-PP31): PP01. Autoinflammatory Synovitis in Familial Mediterranean Fever is Characterized by Numerous Neutrophils Lacking Myeloperoxidase and Lysozyme, Macrophages, Mast Cells and B Cells, Up-Regulation of Galectin-1, P65 (REL A)/NF-KB and Inos, but not COX-2. Rheumatology (Oxford) 2011. [DOI: 10.1093/rheumatology/ker097] [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: 11/14/2022] Open
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Allegaert K, Stamer U, Anderson B, Holford S, Rochette A, Troconiz I, Pedersen R, Holford N. Tramadol and O-demethyltramadol disposition in humans: a pooled study. Crit Care 2011. [PMCID: PMC3067021 DOI: 10.1186/cc9767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Pedersen R, Hurst SA, Schildmann J, Schuster S, Molewijk B. The development of a descriptive evaluation tool for clinical ethics case consultations. ACTA ACUST UNITED AC 2010. [DOI: 10.1258/ce.2010.010025] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
There is growing interest in clinical ethics. However, we still have sparse knowledge about what is actually going on in the everyday practice of clinical ethics consultations. This paper introduces a descriptive evaluation tool to present, discuss and compare how clinical ethics case consultations are actually carried out. The tool does not aim to define ‘best practice’. Rather, it facilitates concrete comparisons and evaluative discussions of the role, function, procedures and ideals inherent in clinical ethics case consultation practices. The tool was developed during meetings of the European Clinical Ethics Network. Based on written reports and participation in the network meetings, the development and the content of the tool and the results of its application in presenting and discussing 10 case consultations are summarized. The tool facilitated understanding of the details of clinical ethics case consultations across individuals and institutions with various experiences and cultures, and comparison between various practices.
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Affiliation(s)
- R Pedersen
- Section for Medical Ethics, University of Oslo, Norway
| | - S A Hurst
- Institute for Biomedical Ethics, Geneva University Medical School, Switzerland
| | - J Schildmann
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Germany
| | - S Schuster
- Department for Medical and Health Ethics, Medical Faculty of Basel/University Hospital, Switzerland
| | - B Molewijk
- Department for Medical Humanities, Free University Medical Center (VUMC), Amsterdam, The Netherlands
- GGNet Institute for Mental Health, Zutphen, The Netherlands
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Prinz JC, FitzGerald O, Boggs RL, Foehl J, Robertson D, Pedersen R, Molta CT, Freundlich B. Combination of skin, joint and quality of life outcomes with etanercept in psoriasis and psoriatic arthritis in the PRESTA trial. J Eur Acad Dermatol Venereol 2010; 25:559-64. [DOI: 10.1111/j.1468-3083.2010.03838.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Mohimont L, Bottex B, Dorne J, Pedersen R, Reich H, Liem D. Trends and developments in the risk assessment of chemical mixtures in food. Toxicol Lett 2010. [DOI: 10.1016/j.toxlet.2010.03.158] [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: 10/19/2022]
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Martín-Mola E, Sieper J, Leirisalo-Repo M, Dijkmans BAC, Vlahos B, Pedersen R, Koenig AS, Freundlich B. Sustained efficacy and safety, including patient-reported outcomes, with etanercept treatment over 5 years in patients with ankylosing spondylitis. Clin Exp Rheumatol 2010; 28:238-245. [PMID: 20483046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Accepted: 02/16/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVES To assess long-term safety and clinical efficacy of etanercept 25 mg subcutaneously twice weekly up to 5 years in subjects with ankylosing spondylitis (AS). METHODS An open-label (OL), multicentre, phase 4, 156-week extension study of subjects with AS who had completed a 12-week randomised, placebo-controlled study (N=84; n=45 etanercept, n=39 placebo) followed by a 96-week OL study (n=81; n=42 etanercept/etanercept; n=39 placebo/etanercept); 59 subjects who completed the 96-week OL extension enrolled in the current OL trial and continued etanercept 25 mg BIW for an additional 156 weeks (total duration: 264 weeks, original etanercept group; 252 weeks, original placebo group). Safety was based on spontaneous reports of adverse events (AEs). Last observation carried forward was used for imputation of missing values. RESULTS Thirty-seven of 59 subjects (63%) completed 5 years of etanercept treatment. Serious non infectious AEs and serious infections occurred at a rate of 0.17 and 0.03 events per subject years, respectively; inflammatory bowel disease and uveitis (including iritis and iridiocyclitis) occurred at 0.01 and 0.14, respectively. No cases of tuberculosis or opportunistic infections were reported. Assessment in Ankylosing Spondylitis (ASAS) responses and improvements in Bath Ankylosing Spondylitis Functional Index and spinal mobility were sustained from week 108 through week 264. CONCLUSIONS Etanercept was well tolerated with no new safety signals detected in subjects with AS over 5 years. Clinical efficacy and improvements in function and mobility seen during the double-blind and first OL study were sustained. These results support etanercept therapy for the long-term management of this chronic disease.
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Kekow J, Moots RJ, Emery P, Durez P, Koenig A, Singh A, Pedersen R, Robertson D, Freundlich B, Sato R. Patient-reported outcomes improve with etanercept plus methotrexate in active early rheumatoid arthritis and the improvement is strongly associated with remission: the COMET trial. Ann Rheum Dis 2010; 69:222-5. [PMID: 19293160 DOI: 10.1136/ard.2008.102509] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To compare the effects of etanercept (ETN) 50 mg once weekly plus methotrexate (MTX) versus MTX alone on patient-reported outcomes (PROs) and the relationship between remission and PRO improvement. METHODS In this double-blind, randomised clinical trial (COMET), PROs included: the Health Assessment Questionnaire (HAQ), EuroQoL health status, fatigue and pain visual analogue scales, Hospital Anxiety and Depression Scale, and Medical Outcomes Short-Form-36. Mean changes from baseline were analysed by analysis of covariance using the last observation carried forward method. Results from week 52 are presented. RESULTS Most PROs demonstrated significantly greater improvements with ETN+MTX than MTX alone, including physical functioning, pain, fatigue and overall health status. A significantly greater improvement in HAQ score was observed in the ETN+MTX than the MTX group (-1.02 vs -0.72; p<0.001) and a greater proportion reached the minimal clinically important difference of 0.22 (88% vs 78%; p<0.006). The relationship between PRO score and clinical status indicated that improvement was greatest among patients achieving remission. CONCLUSIONS Early treatment with ETN+MTX leads to significantly greater improvements in multiple dimensions of PROs than MTX alone. The close relationship between disease activity and PRO improvement suggests that early treatment, with remission as a goal, should maximise the chance of restoring normal functioning and HRQoL.
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Affiliation(s)
- J Kekow
- Clinic of Rheumatology, Vogelsang-Gommern, and University of Magdeburg, Germany
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Messiaen L, Yao S, Brems H, Callens T, Sathienkijkanchai A, Denayer E, Spencer E, Arn P, Babovic-Vuksanovic D, Bay C, Bobele G, Cohen BH, Escobar L, Eunpu D, Grebe T, Greenstein R, Hachen R, Irons M, Kronn D, Lemire E, Leppig K, Lim C, McDonald M, Narayanan V, Pearn A, Pedersen R, Powell B, Shapiro LR, Skidmore D, Tegay D, Thiese H, Zackai EH, Vijzelaar R, Taniguchi K, Ayada T, Okamoto F, Yoshimura A, Parret A, Korf B, Legius E. Clinical and mutational spectrum of neurofibromatosis type 1-like syndrome. JAMA 2009; 302:2111-8. [PMID: 19920235 DOI: 10.1001/jama.2009.1663] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Autosomal dominant inactivating sprouty-related EVH1 domain-containing protein 1 (SPRED1) mutations have recently been described in individuals presenting mainly with café au lait macules (CALMs), axillary freckling, and macrocephaly. The extent of the clinical spectrum of this new disorder needs further delineation. OBJECTIVE To determine the frequency, mutational spectrum, and phenotype of neurofibromatosis type 1-like syndrome (NFLS) in a large cohort of patients. DESIGN, SETTING, AND PARTICIPANTS In a cross-sectional study, 23 unrelated probands carrying a SPRED1 mutation identified through clinical testing participated with their families in a genotype-phenotype study (2007-2008). In a second cross-sectional study, 1318 unrelated anonymous samples collected in 2003-2007 from patients with a broad range of signs typically found in neurofibromatosis type 1 (NF1) but no detectable NF1 germline mutation underwent SPRED1 mutation analysis. MAIN OUTCOME MEASURES Comparison of aggregated clinical features in patients with or without a SPRED1 or NF1 mutation. Functional assays were used to evaluate the pathogenicity of missense mutations. RESULTS Among 42 SPRED1-positive individuals from the clinical cohort, 20 (48%; 95% confidence interval [CI], 32%-64%) fulfilled National Institutes of Health (NIH) NF1 diagnostic criteria based on the presence of more than 5 CALMs with or without freckling or an NF1-compatible family history. None of the 42 SPRED1-positive individuals (0%; 95% CI, 0%-7%) had discrete cutaneous or plexiform neurofibromas, typical NF1 osseous lesions, or symptomatic optic pathway gliomas. In the anonymous cohort of 1318 individuals, 34 different SPRED1 mutations in 43 probands were identified: 27 pathogenic mutations in 34 probands and 7 probable nonpathogenic missense mutations in 9 probands. Of 94 probands with familial CALMs with or without freckling and no other NF1 features, 69 (73%; 95% CI, 63%-80%) had an NF1 mutation and 18 (19%; 95% CI, 12%-29%) had a pathogenic SPRED1 mutation. In the anonymous cohort, 1.9% (95% CI, 1.2%-2.9%) of individuals with the clinical diagnosis of NF1 according to the NIH criteria had NFLS. CONCLUSIONS A high SPRED1 mutation detection rate was found in NF1 mutation-negative families with an autosomal dominant phenotype of CALMs with or without freckling and no other NF1 features. Among individuals in this study, NFLS was not associated with the peripheral and central nervous system tumors seen in NF1.
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Affiliation(s)
- Ludwine Messiaen
- Medical Genomics Laboratory, Department of Genetics, University of Alabama at Birmingham, 720 20th St S, Birmingham, AL 35294, USA.
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Daudén E, Griffiths CEM, Ortonne JP, Kragballe K, Molta CT, Robertson D, Pedersen R, Estojak J, Boggs R. Improvements in patient-reported outcomes in moderate-to-severe psoriasis patients receiving continuous or paused etanercept treatment over 54 weeks: the CRYSTEL study. J Eur Acad Dermatol Venereol 2009; 23:1374-82. [PMID: 19563497 DOI: 10.1111/j.1468-3083.2009.03321.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess patient-reported outcomes (PRO) in patients with moderate-to-severe plaque psoriasis receiving continuous or paused etanercept treatment. METHODS In a multicentre European open-label study, one group (n = 352) received continuous therapy: 25 mg subcutaneously (SC) twice weekly (BIW) throughout 54-weeks. The other group (n = 359) received paused therapy: 50 mg SC BIW (<or= 12 weeks) until response was adequate by Physician Global Assessment; after psoriasis returned, retreatment (25 mg BIW) was begun. PRO included the Dermatology Life Quality Index (DLQI), EuroQoL-5D (EQ-5D), Hospital Anxiety and Depression Scale (HADS), and the SF-36 Vitality subscale. RESULTS At baseline, mean DLQI for patients in the continuous (12.8) and paused group (13.8), indicated significant quality-of-life impairment; mean EQ-5D utility scores were 0.65 and 0.66 for continuous and paused patients, respectively; 30.0% of continuous and 37.0% of paused patients had at least mild symptoms of depression; 40.2% and 48.6%, respectively, had at least mild symptoms of anxiety. At week 54, both groups showed statistically significant (P < 0.05) and meaningful improvement in DLQI and EQ-5D scores; improvements in HADS-D, HADS-A, and SF-36 vitality were also significant. Improvements in DLQI and EQ-5D were significantly greater in the continuous arm than the paused arm, but the differences were not meaningful. Differences between arms in HADS and SF-36 Vitality at week 54 were not significant. CONCLUSIONS At baseline, patients exhibited significant quality-of-life impairment. Both continuous and paused etanercept treatment provided improvements in PRO measures. Either regimen could be considered and care should be individualized.
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Affiliation(s)
- E Daudén
- Servicio de Dermatologia, Hospital Universitario de la Princesa, Madrid, Spain.
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Ortonne JP, Taïeb A, Ormerod AD, Robertson D, Foehl J, Pedersen R, Molta C, Freundlich B. Patients with moderate-to-severe psoriasis recapture clinical response during re-treatment with etanercept. Br J Dermatol 2009; 161:1190-5. [PMID: 19566665 DOI: 10.1111/j.1365-2133.2009.09238.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients with psoriasis experience remission and gradual reappearance of erythematous and scaly plaques and require individualized treatment over time. A goal of psoriasis treatment is to provide optimal efficacy with a flexible therapeutic regimen that may include treatment pauses. OBJECTIVES To determine whether patients receiving initial treatment with etanercept who then pause therapy would subsequently recapture response during re-treatment. PATIENTS AND METHODS A post-hoc analysis of 226 patients with moderate-to-severe psoriasis from a large multicentre trial was performed. Patients had received etanercept 50 mg twice weekly subcutaneously until a target clinical response had been achieved, then had paused treatment and eventually relapsed. They were then re-treated with etanercept 25 mg twice weekly. The number of patients recapturing a Physician Global Assessment (PGA) of psoriasis rating of < or = 2 (clear, almost clear or mild) on first re-treatment was assessed. Patient satisfaction during the initial treatment and first re-treatment period was also determined. RESULTS A total of 187 (83%) patients recaptured the target clinical response of a PGA of < or = 2 after re-treatment. The majority of patients [219 of 226 (97%)] reported satisfaction with etanercept re-treatment. No new safety concerns emerged during re-treatment. CONCLUSIONS In this post-hoc analysis, patients with psoriasis who were re-treated with etanercept 25 mg twice weekly effectively recaptured clinical responses that patients found satisfactory. A flexible treatment option is available to dermatologists and patients for individualized care.
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Affiliation(s)
- J-P Ortonne
- University of Nice-Sophia Antipolis, BP 3079, Nice Cedex 3, France.
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Hack KM, Pedersen R. Mental status changes and bradycardia: don't forget the eye! Traumatic hyphema can mimic increased intracranial pressure. Clin Pediatr (Phila) 2009; 48:331-3. [PMID: 18832533 DOI: 10.1177/0009922808324490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Kara-Marie Hack
- Department of Pediatrics, Tripler Army Medical Center, Honolulu, Hawaii 96859-5000, USA.
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Abstract
BACKGROUND Clinical ethics consultation services have been established in many countries during recent decades. An important task is to discuss concrete clinical cases. However, empirical research observing what is happening during such deliberations is scarce. OBJECTIVES To explore clinical ethics committees' deliberations and to identify areas for improvement. DESIGN A pilot study including observations of committees deliberating a paper case, semistructured group interviews, and qualitative analysis of the data. PARTICIPANTS Nine hospital ethics committees in Norway. RESULTS AND INTERPRETATIONS Key elements of the deliberations included identifying the ethical problems; exploring moral values and principles; clarifying key concepts and relevant legal regulation; exploring medical facts, the patient's situation, the therapists' perspective, analogous clinical situations, professional uncertainties, the patient's and relatives' perspective, and clinical communication; identifying the involved parties and how to involve them; identifying possible courses of action, and possible conclusion and follow-up. The various elements were closely interwoven. The content and conclusions varied and seemed to be contingent on the committee members' interpretations, experience and knowledge. Important aspects of a clinical ethics deliberation were sometimes neglected. When the committees used a deliberation procedure and a blackboard, the deliberations tended to become more systematic and transparent. Many of the committees were insecure about how to include the involved parties and how to document the deliberations. CONCLUSION Clinical ethics committees may provide an important arena for multidisciplinary discussions of complex clinical ethics challenges. However, this seems to require adequate composition, adoption of transparent deliberation procedures, and targeted training.
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Affiliation(s)
- R Pedersen
- Department of General Practice and Community Medicine, Section for Medical Ethics, University of Oslo, Oslo, Norway.
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van der Heijde D, Burmester G, Melo-Gomes J, Codreanu C, Mola EM, Pedersen R, Robertson D, Chang D, Koenig A, Freundlich B. Inhibition of radiographic progression with combination etanercept and methotrexate in patients with moderately active rheumatoid arthritis previously treated with monotherapy. Ann Rheum Dis 2008; 68:1113-8. [DOI: 10.1136/ard.2008.094375] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Halvorsen K, Slettebø A, Nortvedt P, Pedersen R, Kirkevold M, Nordhaug M, Brinchmann BS. Priority dilemmas in dialysis: the impact of old age. J Med Ethics 2008; 34:585-589. [PMID: 18667645 DOI: 10.1136/jme.2007.022061] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
AIM This study explores priority dilemmas in dialysis treatment and care offered elderly patients within the Norwegian public healthcare system. BACKGROUND Inadequate healthcare due to advanced age is frequently reported in Norway. The Norwegian guidelines for healthcare priorities state that age alone is not a relevant criterion. However, chronological age, if it affects the risk or effect of medical treatment, can be a legitimate criterion. METHOD A qualitative approach is used. Data were collected through semistructured interviews and analysed through hermeneutical content analysis. The informants were five physicians and four nurses from dialysis wards. FINDINGS Pressing priority dilemmas centre around decision-making concerning withholding and withdrawal of dialysis treatment. Advanced age is rarely an absolute or sole priority criterion. It seems, however, that advanced age appears to be a more subtle criterion in relation with, for example, comorbidity, functional status and cognitive impairment. Nurses primarily prioritise specialised dialysis care and not comprehensive nursing care. The complex needs of elderly patients are therefore often not always met. CONCLUSIONS Clinical priorities should be made more transparent in order to secure legitimate and fair resource allocation in dialysis treatment and care. Difficult decisions concerning withholding or withdrawal of dialysis ought to be openly discussed within the healthcare team as well as with patients and significant others. The biomedical focus and limitations on comprehensive care during dialysis should be debated.
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Affiliation(s)
- K Halvorsen
- Department of General Practice and Community Medicine, Section for Medical Ethics, University of Oslo, PB 1130 Blindern, NO-0318 Oslo, Norway.
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Bambha K, Kim WR, Pedersen R, Bida JP, Kremers WK, Kamath PS. Predictors of early re-bleeding and mortality after acute variceal haemorrhage in patients with cirrhosis. Gut 2008; 57:814-20. [PMID: 18250126 DOI: 10.1136/gut.2007.137489] [Citation(s) in RCA: 174] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Risk factors for mortality and re-bleeding following acute variceal haemorrhage (AVH) are incompletely understood. The aim of this study was to determine risk factors for 6-week mortality, and re-bleeding within 5 days in patients with cirrhosis and AVH. METHODS Kaplan-Meier and Cox proportional hazards regression analyses were used to determine risk factors among 256 patients with AVH entered into a randomised, prospective trial. RESULTS Thirty-five patients (14%) died within 6 weeks of AVH; 14 deaths (40%) occurred within 5 days. Only the Model for End-stage Liver Disease (MELD) score and units of packed red blood cells (PRBCs) transfused in the first 24 h were associated with 6-week mortality univariately (HR 1.11, p < 0.001; HR 1.22, p < 0.001) and bivariately (HR MELD = 1.10, p < 0.001; HR per unit of PRBCs transfused = 1.15, p = 0.005). Re-bleeding within 5 days occurred in 37 patients (15%); MELD score (p = 0.01) and a clot on a varix (p = 0.05) predicted re-bleeding. Patients with a MELD score > or = 18; both MELD score > or = 18 and > or = 4 units of PRBCs transfused; both MELD score > or = 18 and active bleeding at index endoscopy; and variceal re-bleeding had increased risk of death 6 weeks post-AVH (HR = 7.4, p < 0.001; 11.3, p < 0.001; 9.9, p < 0.001; 10.2, p < 0.001 respectively). CONCLUSIONS Patients with AVH and MELD score > or = 18, requiring > or = 4 units of PRBCs within the first 24 h or with active bleeding at endoscopy are at increased risk of dying within 6 weeks. MELD score > or = 18 is also a strong predictor of variceal re-bleeding within the first 5 days.
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Affiliation(s)
- K Bambha
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA
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Nortvedt P, Pedersen R, Grøthe KH, Nordhaug M, Kirkevold M, Slettebø A, Brinchmann BS, Andersen B. Clinical prioritisations of healthcare for the aged--professional roles. J Med Ethics 2008; 34:332-335. [PMID: 18448710 DOI: 10.1136/jme.2007.020693] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Although fair distribution of healthcare services for older patients is an important challenge, qualitative research exploring clinicians' considerations in clinical prioritisation within this field is scarce. OBJECTIVES To explore how clinicians understand their professional role in clinical prioritisations in healthcare services for old patients. DESIGN A semi-structured interview-guide was employed to interview 45 clinicians working with older patients. The interviews were analysed qualitatively using hermeneutical content analysis. PARTICIPANTS 20 physicians and 25 nurses working in public hospitals and nursing homes in different parts of Norway. RESULTS AND INTERPRETATIONS The clinicians struggle with not being able to attend to the comprehensive needs of older patients, and being unfaithful to professional ideals and expectations. There is a tendency towards lowering the standards and narrowing the role of the clinician. This is done in order to secure the vital needs of the patient, but is at the expense of good practice and holistic role modelling. Increased specialisation, advances and increase in medical interventions, economical incentives, organisational structures, and biomedical paradigms, may all contribute to a narrowing of the clinicians' role. CONCLUSION Distributing healthcare services in a fair way is generally not described as integral to the clinicians' role in clinical prioritisations. If considerations of justice are not included in clinicians' role, it is likely that others will shape major parts of their roles and responsibilities in clinical prioritisations. Fair distribution of healthcare services for older patients is possible only if clinicians accept responsibility in these questions.
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Affiliation(s)
- P Nortvedt
- Department of General Practice and Community Medicine, Section for Medical Ethics, University of Oslo, PO Box 1130 Blindern, NO-0318 Oslo, Norway.
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Pedersen R, Nortvedt P, Nordhaug M, Slettebø A, Grøthe KH, Kirkevold M, Brinchmann BS, Andersen B. In quest of justice? Clinical prioritisation in healthcare for the aged. J Med Ethics 2008; 34:230-235. [PMID: 18375671 DOI: 10.1136/jme.2006.018531] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND A fair distribution of healthcare services for older patients is an important challenge, but qualitative research exploring clinicians' consideration in daily clinical prioritisation in healthcare services for the aged is scarce. OBJECTIVES To explore what kind of criteria, values, and other relevant considerations are important in clinical prioritisations in healthcare services for older patients. DESIGN A semi-structured interview-guide was used to interview 45 clinicians working with older patients. The interviews were analysed qualitatively using hermeneutical content analysis and template organising style. PARTICIPANTS 20 physicians and 25 nurses working in public hospitals and nursing homes in different parts of Norway. RESULTS AND INTERPRETATIONS Important dilemmas relate to under-provision of community care and comprehensive approaches, and over-utilisation of certain specialised services. Overt ageism is generally not reported, but the healthcare services for the aged seem to be inadequate due to more subtle processes, for example, dominating considerations and ideals and operating conditions that do not pay sufficient attention to older patients' needs and considerations of justice. Clinical prioritisations are described as being dominated by adapting traditional biomedical approaches to the operating conditions. Many of the clinicians indicate that there is a potential for improving end of life decisions and for reducing exaggerated use of life-prolonging treatment and hospitalisations. CONCLUSION The interviews in this study indicate that considerations of justice and patients' perspectives should be given more attention to strike a balance between specialised medical approaches and more general and comprehensive approaches in healthcare services for older patients.
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Affiliation(s)
- R Pedersen
- Department of General Practice and Community Medicine, Section for Medical Ethics, University of Oslo, PO Box 1130 Blindern, NO-0318 Oslo, Norway.
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