An instrument for measuring health-related quality of life in patients with Deep Venous Thrombosis (DVT): development and validation of Deep Venous Thrombosis Quality of Life (DVTQOL) questionnaire

BACKGROUND: Few studies have evaluated patient-reported outcomes in connection with a primary event of deep venous thrombosis, partly due to a lack of disease-specific measures. The aim here was to develop a disease-specific health-related quality of life (HRQL) measure, the deep venous thrombosis quality of life questionnaire (DVTQOL), for patients with recent exposition and treatment of proximal deep venous thrombosis. METHODS: A total of 121 consecutive outpatients (50 % males; mean age 61.2 ± 14 years) treated with warfarin (Waran(®)) for symptomatic proximal deep venous thrombosis were included in the study. Patients completed the SF-36, EQ-5D and the pilot version of the DVTQOL. RESULTS: Items having: high ceiling and floor effect, items with lower factor loadings than 0.50 and items loading in several factors were removed from the pilot version of DVTQOL. In addition, overlapping and redundant items identified by the Rasch analysis were excluded. The final DVTQOL questionnaire consists of 29 items composing six dimensions depicting problems with: emotional distress; symptoms (e.g. pain, swollen ankles, cramp, bruising); limitation in physical activity; hassle with coagulation monitoring; sleep disturbance; and dietary problems. The internal consistency reliability was high (alpha value ranged from 0.79 to 0.93). The relevant domains of the SF-36 and EQ-5D significantly correlated with DVTQOL, thereby confirming its construct validity. CONCLUSIONS: The DVTQOL is a short and user-friendly instrument with good reliability and validity. Its test-retest reliability and responsiveness to change in clinical trials, however, must be explored

Blödarsjuka med HIV. Långsammare infektionsförlopp hos yngre och vid större förbrukning av faktorkoncentrat

HIV disease progression and the effect of replacement therapy with clotting factor concentrates (CFCs) were studied in 100 Swedish haemophiliacs, mean age at seroconversion 29 years (range, 4-72). On average 16 years after seroconversion, 67 per cent of the patients had CD4+ cell counts of < 200 x 10(6)/l, 50 per cent had developed AIDS, and 58 per cent had died. HIV disease progression was significantly slower in those aged less than 28 (median age) at seroconversion (P = 0.004). Moreover, mortality was inversely correlated to total annual CFC consumption after adjustment for age and HIV-related therapy, i.e., Pneumocystis carinii prophylaxis and antiretroviral drugs (P = 0.014), but unrelated to the purity of the CFCs used. After adjustment for age, annual CFC consumption and HIV-therapy, prophylactic replacement therapy was not associated with significantly better survival than on-demand treatment. It is concluded that in HIV-positive haemophiliacs replacement therapy may have a beneficial effect on the immune system, and that CFC purity and the regimen (prophylaxis vs on-demand) would seem to be factors of minor importance

Menorrhagia and minor bleeding symptoms in women on oral anticoagulation.

Background Oral anticoagulation (OA) is a common treatment with a known risk of fatal or major bleeding, but also minor bleeding symptoms and menorrhagia can cause substantial discomfort and necessitate medical or surgical interventions. The extent of these side effects is however not previously reported. The objective of this study is to assess the frequency of minor bleeding symptoms and menorrhagia attributed to OA treatment. Methods Ninety fertile women between 15 and 49 years-of-age on OA treatment completed an inquiry at the anticoagulation clinics of Malmö, Lund and Gothenburg, Sweden. Results The frequency of minor bleeding symptoms was significantly increased during OA treatment (P 3 h) increased from 3.0 to 45.2%, easy bruising 17.8–75.6%, epistaxis 11.1–23.6%, gingival bleeding 22.2–48.3% and hematuria 10.0–15.6% (Table 1). Hematemesis was reported in 5.6% prior to as compared to 14.4% during OA treatment, blood in the feces in 8.9 and 18.9%, respectively. Mean duration of menses increased from 5.6 to 6.1 days (P < 0.01) and reported menorrhagia from 44.2 to 70.8% (P < 0.001). Eighteen percent were treated for menorrhagia before and 29.9% during OA treatment (P < 0.01). Conclusions OA treatment is known to confer increased risk of fatal or major bleeding. This study shows that fertile women on OA also experience significantly increased minor bleeding symptoms including menorrhagia that may considerably impair quality of life

Mer samstämmiga laboratorieresultat efter övergången till INR. Skillnaderna mellan sjukhus- och primärvårdslaboratorier utjämnade

In 1999 a new and simplified procedure for calibration of the Owren prothrombin time (Owren PT) assay was introduced in Sweden by the national external quality assessment scheme (Equalis). The new protocol allowed local calibration by means of lyophilised national plasma calibrators and expression of results as an international normalised ratio (INR). A two-year follow-up involving analysis of data from all laboratories that have returned results to Equalis is reported. There was a significant reduction in both between-laboratory and within-laboratory variation after the introduction of the new calibration procedure. For the larger hospital laboratories analysing external controls with INR>2, the mean coefficient of variation (CV) was reduced from 9.1% to 5.6% (P<0.0001). The corresponding results from smaller laboratories in the primary health care units showed a similar decrease in CV from 8.8% to 6.3% (P<0.0001). This study shows that the Owren PT assay is well suited for INR calibration employing calibrant plasmas

"Amoralle" Brand Development Strategy in the International Market

Maģistra darba „Amoralle zīmola attīstības stratēģija starptautiskajā tirgū” mērķis ir pētot starptautiskā mārketinga un preču virzīšanas tirgū metodes, kā arī luksusa zīmola nozīmes uzņēmumā teorētisko pamatojumu, izanalizēt „Amoralle” darbību Latvijā un izstrādāt uzņēmuma attīstības plānu starptautiskajā tirgū. Darbā tika apskatīts zīmola jēdziens, patērētāju uzvedība luksusa zīmola izvēlē, luksusa zīmols, starptautiskais zīmols un sadarbības zīmols. Autore apkopoja Latvijas uzņēmēju interviju rezultātus un darba beigās izstrādāja uzņēmuma attīstības plānu starptautiskajā tirgū. Maģistra darba beigās veikti secinājumi un izstrādāti priekšlikumi uzņēmuma darbības uzlabošanai un attīstībai. Darbs sastāv no 90 lapaspusēm, 10 tabulām, 18 attēliem un 12 pielikumiem. Atslēgvārdi: starptautiskais mārketings, interneta mārketings, luksusa zīmols.Master's Thesis "Amoralle brand development strategy for the international market" is studying international marketing and trade promotion in the market methods, as well as the luxury brand company meanings theoretical basis, to analyze "Amoralle" Latvian functioning and development of the company's development plan for the international market. The study looked brand concept, consumer behavior luxury brand of choice, luxury brand, international brand and brand cooperation. The author summarized the results of the interviews of Latvian businesses and the end of work developed by the company's development plan for the international market. Master's Thesis at the end made conclusions and proposals to improve the company's operations and development. The work consists of 90 pages, 10 tables, 18 images and 12 annexes. Keywords: international marketing, internet marketing, luxury brand

Effects of the oral, direct thrombin inhibitor dabigatran on five common coagulation assays

Dabigatran is an oral, reversible thrombin inhibitor that has shown promising results in large clinical trials. Laboratory monitoring is not needed but the effects on common coagulation assays are incompletely known. Dabigatran was added to plasma from healthy subjects in the concentration range 0-1,000 mu g/l and analysed using several reagents for activated thromboplastin time (APTT), prothrombin time (PT), fibrinogen, antithrombin, and activated protein C resistance. Typical trough concentrations are about 50 mu g/l, peak concentrations 100-300 mu g/l. At 100 mu g/l all APTT-results were prolonged. The concentration required to double APTT ranged between 227 and 286 mu g/l, the responses for all five reagents were similar. PT-reagents were much less affected with almost no samples above INR 1.2 at 100 mu g/l. The effect was sample dilution dependent with PT Quick type more sensitive than PT Owren type methods. If a patient on dabigatran has prolonged APTT, andgt; 90 seconds, and Quick PT INR andgt; 2 or Owren PT INR andgt; 1.5 over-dosing or accumulation of dabigatran should be considered. Two of four fibrinogen reagents underestimated the fibrinogen concentration considerably at expected peak concentration. Methods based on inhibition of thrombin over-estimated the antithrombin concentration, but not Xa-based. The APC-resistance methods over-estimated the APC-ratio, which may lead to miss-classification of factory Leiden patients as being normal. Different coagulation assays, and even different reagents within an assay group, display variable effects at therapeutic concentrations of dabigatran. Some of these assay variations are of clinical importance, thus knowledge is needed for a correct interpretation of results.This article is not an exact copy of the original published article in THROMBOSIS AND HAEMOSTASIS. The definitive publisher-authenticated version is available:: Tomas Lindahl, Fariba Baghaei, Inger Fagerberg Blixter, Kerstin Gustafsson, Lennart Stigendal, Margareta Sten-Linder, Karin Strandberg and Andreas Hillarp, Effects of the oral, direct thrombin inhibitor dabigatran on five common coagulation assays, 2011, THROMBOSIS AND HAEMOSTASIS, (105), 2, 371-378. http://dx.doi.org/10.1160/TH10-06-034