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  • 1.
    Blom, Mathias Carl
    et al.
    Department of Clinical Sciences, Lund University, Lund, Sweden.
    Ashfaq, Awais
    Halmstad University, School of Information Technology, Halmstad Embedded and Intelligent Systems Research (EIS), CAISR - Center for Applied Intelligent Systems Research. Halland Hospital, Region Halland, Halmstad, Sweden.
    Pinheiro Sant'Anna, Anita
    Halmstad University, School of Information Technology, Halmstad Embedded and Intelligent Systems Research (EIS), CAISR - Center for Applied Intelligent Systems Research.
    Anderson, Philip D.
    Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA & Harvard Medical School, Boston, Massachusetts, USA.
    Lingman, Markus
    Halland Hospital, Region Halland, Sweden & Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Training machine learning models to predict 30-day mortality in patients discharged from the emergency department: a retrospective, population based registry study2019In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 8, article id e028015Article in journal (Refereed)
    Abstract [en]

    Background: Aggressive treatment at end-of-life (EOL) can be traumatic to patients and may not add clinical benefit. Absent an accurate prognosis of death, individual level biases may prevent timely discussions about the scope of EOL care and patients are at risk of being subject to care against their desire. The aim of this work is to develop predictive algorithms for identifying patients at EOL, with clinically meaningful discriminatory power.

    Methods: Retrospective, population-based study of patients utilizing emergency departments (EDs) in Sweden, Europe. Electronic health records (EHRs) were used to train supervised learning algorithms to predict all-cause mortality within 30 days following ED discharge. Algorithm performance was validated out of sample on EHRs from a separate hospital, to which the algorithms were previously unexposed.

    Results: Of 65,776 visits in the development set, 136 (0.21%) experienced the outcome. The algorithm with highest discrimination attained ROC-AUC 0.945 (95% CI 0.933 - 0.956), with sensitivity 0.869 (95% CI 0.802, 0.931) and specificity 0.858 (0.855, 0.860) on the validation set.

    Conclusions: Multiple algorithms displayed excellent discrimination and outperformed available indexes for short-term mortality prediction. The practical utility of the algorithms increases as the required data were captured electronically and did not require de novo data collection.

    Trial registration number: Not applicable.

  • 2.
    Gossec, L.
    et al.
    Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS), Paris, France & Department of rheumatology, AP-HP, Pitié Salpêtrière Hospital, Paris, France.
    Smolen, J. S.
    Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria & Second Department of Medicine, Hietzing Hospital, Vienna, Austria.
    Ramiro, S.
    Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands.
    de Wit, M.
    EULAR, representing People with Arthritis/Rheumatism in Europe (PARE), London, United Kingdom.
    Cutolo, M.
    Research Laboratory and Clinical Division of Rheumatology, Department of Internal Medicine, University of Genova, Viale Benedetto, Italy.
    Dougados, M.
    Medicine Faculty, Paris Descartes University, Paris, France & Rheumatology B Department, APHP, Cochin Hospital, Paris, France.
    Emery, P.
    Leeds NIHR Musculoskeletal Biomedical Research Unit, LTHT, Leeds, United Kingdom & Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom.
    Landewé, R.
    Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, Amsterdam, The Netherlands & Atrium Medical Center, Heerlen, The Netherlands.
    Oliver, S.
    North Devon, United Kingdom.
    Aletaha, D.
    Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria.
    Betteridge, N.
    EULAR, representing People with Arthritis/Rheumatism in Europe (PARE), London, United Kingdom.
    Braun, J.
    Rheumazentrum Ruhrgebiet, Herne and Ruhr-Universität Bochum, Herne, Germany.
    Burmester, G.
    Department of Rheumatology and Clinical Immunology, Charité—University Medicine Berlin, Germany.
    Cañete, J. D.
    Arthritis Unit, Department of Rheumatology, Hospital Clínic and IDIBAPS, Barcelona, Spain.
    Damjanov, N.
    Belgrade University School of Medicine, Belgrade, Serbia.
    FitzGerald, O.
    Department of Rheumatology, St. Vincent's University Hospital and Conway Institute, University College Dublin, Dublin, Ireland.
    Haglund, Emma
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS). Section of Rheumatology, Department of Clinical Sciences, Lund University, Lund, Sweden.
    Helliwell, P.
    Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, Leeds, United Kingdom.
    Kvien, T. K.
    Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
    Lories, R.
    Laboratory of Tissue Homeostasis and Disease, Skeletal Biology and Engineering Research Center, KU Leuven, Belgium & Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium.
    Luger, T.
    Department of Dermatology, University Hospital Münster, Münster, Germany.
    Maccarone, M.
    A.DI.PSO. (Associazione per la Difesa degli Psoriasici)—PE.Pso.POF (Pan European Psoriasis Patients’ Organization Forum), Rome, Italy.
    Marzo-Ortega, H.
    Leeds NIHR Musculoskeletal Biomedical Research Unit, LTHT, Leeds, United Kingdom & Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom.
    McGonagle, D.
    Leeds NIHR Musculoskeletal Biomedical Research Unit, LTHT, Leeds, United Kingdom & Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom.
    McInnes, I. B.
    Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom.
    Olivieri, I.
    Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza, Italy.
    Pavelka, K.
    Institute and Clinic of Rheumatology Charles University Prague, Czech Republic.
    Schett, G.
    Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany.
    Sieper, J.
    Department of Rheumatology, Campus Benjamin Franklin, Charité, Berlin, Germany.
    van den Bosch, F.
    Ghent University Hospital, Ghent, Belgium.
    Veale, D. J.
    Centre for Arthritis and Rheumatic Disease, Dublin Academic Medical Centre, St. Vincent's University Hospital, Dublin, Ireland.
    Wollenhaupt, J.
    Schoen Klinik Hamburg, Rheumatology and Clinical Immunology, Hamburg, Germany.
    Zink, A.
    Department of Rheumatology and Clinical Immunology, German Rheumatism Research Centre Berlin, Charité—University Medicine Berlin, Germany.
    van der Heijde, D.
    Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands.
    European League Against Rheumatism (EULAR) recommendations for the management of psoriatic arthritis with pharmacological therapies: 2015 update2016In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 75, no 3, p. 499-510Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Since the publication of the European League Against Rheumatism recommendations for the pharmacological treatment of psoriatic arthritis (PsA) in 2012, new evidence and new therapeutic agents have emerged. The objective was to update these recommendations.

    METHODS: A systematic literature review was performed regarding pharmacological treatment in PsA. Subsequently, recommendations were formulated based on the evidence and the expert opinion of the 34 Task Force members. Levels of evidence and strengths of recommendations were allocated.

    RESULTS: The updated recommendations comprise 5 overarching principles and 10 recommendations, covering pharmacological therapies for PsA from non-steroidal anti-inflammatory drugs (NSAIDs), to conventional synthetic (csDMARD) and biological (bDMARD) disease-modifying antirheumatic drugs, whatever their mode of action, taking articular and extra-articular manifestations of PsA into account, but focusing on musculoskeletal involvement. The overarching principles address the need for shared decision-making and treatment objectives. The recommendations address csDMARDs as an initial therapy after failure of NSAIDs and local therapy for active disease, followed, if necessary, by a bDMARD or a targeted synthetic DMARD (tsDMARD). The first bDMARD would usually be a tumour necrosis factor (TNF) inhibitor. bDMARDs targeting interleukin (IL)12/23 (ustekinumab) or IL-17 pathways (secukinumab) may be used in patients for whom TNF inhibitors are inappropriate and a tsDMARD such as a phosphodiesterase 4-inhibitor (apremilast) if bDMARDs are inappropriate. If the first bDMARD strategy fails, any other bDMARD or tsDMARD may be used.

    CONCLUSIONS: These recommendations provide stakeholders with an updated consensus on the pharmacological treatment of PsA and strategies to reach optimal outcomes in PsA, based on a combination of evidence and expert opinion. © 2015 BMJ Publishing Group Ltd & European League Against Rheumatism.

  • 3.
    Landgren, Ellen
    et al.
    Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden & Skåne University Hospital, Lund, Sweden & RandD Spenshult, Halmstad, Sweden.
    Bremander, Ann
    Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden & Skåne University Hospital, Lund, Sweden & RandD Spenshult, Halmstad, Sweden & Department of Regional Health Research, University of Southern Denmark, Odense, Denmark & Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sonderborg, Denmark.
    Lindqvist, Elisabeth
    Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden & Skåne University Hospital, Lund, Sweden.
    Van der Elst, Kristien
    Department of Rheumatology, University Hospitals Leuven, Leuven, Belgium & Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven–University of Leuven, Leuven, Belgium.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). RandD Spenshult, Halmstad, Sweden.
    “To regain one’s health” – patients’ preferencesof treatment outcomes in early rheumatoid arthritis – a qualitative study2019In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 78, no Suppl 2, p. 648-648Article in journal (Refereed)
    Abstract [en]

    Background: Rheumatology care strives to identify and meet the needs of the patients, and to understand disease and treatment impact from the patients’ perspective. A better understanding of patients’ expectations from the treatment is needed to enable a patient centered approach in clinical practice and a shared-decision making as recommended in the EULAR treatment recommendations for rheumatoid arthritis (RA). Understanding of patients’ expectations in the early stage of the RA disease may facilitate adherence to treatment, patient independence and prevent unmet needs in the future.

    Objectives: To explore patients’ preferred treatment outcomes in early rheumatoid arthritis (eRA).

    Methods: A qualitative, explorative study. Individual interviews were conducted with 31 patients with eRA, defined as disease duration of ≤ 1 year and disease-modifying antirheumatic drugs (DMARDs) treatment for 3-6 months 1 . Interviews were analyzed using a constant comparison method according to the Qualitative Analysis Guide of Leuven (QUAGOL) and lasted in a core category and four related concepts.

    Results: The patient-preferred treatment outcomes in eRA were described in the core category “to regain one’s health” and the four related concepts: to experience external control of the disease, to experience independence, to regain identity and to experience joy in everyday life. The patients expected to experience external control of the disease by the given treatment to regain one’s health. It was perceived as controlling the symptoms and as absence of disease. Independence was perceived as regaining former activity levels, experiencing autonomy and using active coping strategies. Patients wanted to regain identity through participation, empowerment and their self-image. Joy in everyday life was perceived as vitality and believing in the future.

    Conclusion: Patients’ preferred treatment outcomes in eRA were to regain one’s health including both external and internal control. External control as disease control and independence as well as internal control as identity and joy in everyday life. The results from this study can assist healthcare professionals to better understand patients’ preferred treatment outcomes early in the disease process and to tailor the interventions accordingly to improve long term treatment outcome. © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.

  • 4.
    Silwer, Louise
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Wahlström, Rolf
    Div of Global Health (IHCAR), Dep of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Stålsby Lundborg, Cecilia
    Nordic School of Public Health, Göteborg, Sweden.
    Views on primary prevention of cardiovascular disease: an interview study with Swedish GPs2010In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 11, no 44Article in journal (Refereed)
    Abstract [en]

    Background: General practitioners (GPs) have gradually become more involved in the prevention of cardiovascular disease (CVD), both through more frequent prescribing of pharmaceuticals and by giving advice regarding lifestyle factors. Most general practitioners are now faced with decisions about pharmaceutical or non-pharmaceutical treatment for primary prevention every day. The aim of this study was to explore, structure and describe the views on primary prevention of cardiovascular disease in clinical practice among Swedish GPs.

    Methods: Individual interviews were conducted with 21 GPs in southern Sweden. The interview transcripts were analysed using a qualitative approach, inspired by phenomenography.

    Results: Two main categories of description emerged during the analysis. One was the degree of reliance on research data regarding the predictability of real risk and the opportunities for primary prevention of CVD. The other was the allocation of responsibility between the patient and the doctor. The GPs showed different views, from being convinced of an actual and predictable risk for the individual to strongly doubting it; from relying firmly on protection from disease by pharmaceutical treatment to strongly questioning its effectiveness in individual cases; and from reliance on prevention of disease by non-pharmaceutical interventions to a total lack of reliance on such measures.

    Conclusions: The GPs' different views, regarding the rationale for and practical management of primary prevention of CVD, can be interpreted as a reflection of the complexity of patient counselling in primary prevention in clinical practice. The findings have implications for development and implementation of standard treatment guidelines, regarding long-time primary preventive treatment.

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