| 11. |
- Asplund, Kjell, et al.
(författare)
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Effects of Extending the Time Window of Thrombolysis to 4.5 Hours : Observations in the Swedish Stroke Register (Riks-Stroke)
- 2011
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Ingår i: Stroke. - New York : American Heart Association. - 0039-2499 .- 1524-4628. ; 42:9, s. 2492-2497
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Tidskriftsartikel (refereegranskat)abstract
- Background and Purpose: The European Cooperative Acute Stroke Study (ECASS) III trial and Safe Implementation of Thrombolysis in Stroke–International Stroke Thrombolysis Register (SITS-ISTR) data were published in 2008. Riks-Stroke, the Swedish Stroke Register, was used to explore how thrombolysis in the 3- to 4.5-hour window has been spread in different hospitals and patient groups and what effects this has had on treatment within 3 hours.Methods: All 76 hospitals in Sweden admitting patients with acute stroke participate in Riks-Stroke. During the study period, January 2003 to June 2010, 92 150 18- to 80-year-old patients were hospitalized for acute ischemic stroke.Results: After the publication of the ECASS III results in the third quarter of 2008, thrombolysis in the 3- to 4.5-hour window increased from 0.5% before publication to 2.1% in 2010. Thrombolysis in the 3- to 4.5-hour window spread somewhat faster in men than women (P=0.04) but at a similar rate in different age groups. The use of thrombolysis within 3 hours after onset of symptoms increased successively from 0.9% in 2003 to 6.6% in late 2008 and then it stabilized at 6%. The median time from arrival to the hospital to start of treatment remained unchanged at 66 to 69 minutes before and after 2008 (P=0.06).Conclusions: Since the end of 2008, there has been a rapid nationwide dissemination of thrombolysis in the 3- to 4.5-hour window, whereas rates in the <3-hour window have leveled off. The extended time window has not affected door-to-needle time.
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| 12. |
- Asplund, Kjell, et al.
(författare)
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End of life after stroke : a nationwide study of 42,502 deaths occurring within a year after stroke
- 2018
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Ingår i: European Stroke Journal. - : Sage Publications. - 2396-9873 .- 2396-9881. ; 3:1, s. 74-81
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: In the scientific literature, there is very limited empirical information on end-of-life issues after stroke in the scientific literature. The present nationwide study describes the circumstances surrounding deaths that occur within a year after a stroke. Patients and methods: Datasets from three nationwide Swedish registers (on stroke, palliative care and cause of death) were linked. Basic information was available for 42,502 unselected cases of death that occurred within a year after a stroke and more detailed information was available for 16,408 deaths. Odds ratios for characteristics of end-of-life care were calculated by logistic regression. Results: In the late phase after stroke (three months to one year), 46% of patients died in a nursing home, whereas 37% of patients died in a hospital after readmission and 10% of patients died at home. Eleven per cent of deaths were reported as being unexpected. A next of kin was present at 49% of deaths. The frequency of unattended deaths (neither next of kin nor staff were present at the time of death) ranged from 5% at home with specialised home care to 25% in hospitals. Discussion: This is, by far, the largest study published on end-of-life issues after stroke. Major differences between countries in healthcare, community services, family structure and culture may limit direct transfer of the present results to other settings. Conclusion: There is considerable discordance between presumed good death' late after stroke (dying at home surrounded by family members) and the actual circumstances at the end of life.
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| 13. |
- Asplund, Kjell, et al.
(författare)
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Etiska dilemman i strokevården : [Frequent ethical issues encountered in stroke care]
- 2023
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Ingår i: Läkartidningen. - : Sveriges läkarförbund. - 0023-7205 .- 1652-7518. ; 120
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Forskningsöversikt (refereegranskat)abstract
- We review some of the most frequent ethical issues encountered in stroke care. Priorities in stroke care should be based on the principles of the Swedish prioritization platform: human dignity, needs/solidarity, and cost-effectiveness. The prognosis is often uncertain very early after stroke. We therefore advocate time for careful assessment before taking decisions on treatment restrictions such as do-not-resuscitate orders. Swedish law permits acute treatment for patients unable to consent because of severe stroke. For selected patients already living in home-based medical care or institutional care when afflicted by stroke, it may be appropriate not to transfer them to an acute care hospital, provided that sufficient skills in acute evaluation and stroke care are available. Likewise, if a stroke patient is discharged from hospital with a percutaneous endoscopic gastrostomy, adequate competence is needed in home-based or institutional care. It is not ethically appropriate to continue advanced medical treatment that is without benefit for the patient during the last days of life.
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| 14. |
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| 15. |
- Asplund, Kjell, et al.
(författare)
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Hemikraniektomi är livräddande, visar Riks-Stroke : erfarenheter av ingreppet vid malign hjärninfarkt och intracerebral blödning
- 2014
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Ingår i: Läkartidningen. - : Sveriges läkarförbund. - 0023-7205 .- 1652-7518. ; 111:3-4
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Tidskriftsartikel (refereegranskat)abstract
- From 2009 to mid-2013, 229 hemicraniectomies were reported in Riks-Stroke, of which 43 were performed in patients with intracerebral hemorrhage. In patients with brain infarction, it was performed in 0.19% (all ages) and 1.07% (below 60 years), higher than reported from the US. Of the hemicraniectomies, 45% were performed in patients above 60 years. Survival was 83% at 3 months and 81% at 12 months, similar to survival reported in the literature. Three months after hemicraniectomy, 69% of survivors responded to a follow-up questionnaire. Of these, 31% were independent in personal ADL and 46% were living at home. Case fatality was higher but functional outcome in survivors was similar in patients above 60 years compared to below 60. In conclusion, outcomes are similar in Sweden to those reported in randomized trials and international observational studies. With proper patient selection, it seems that hemicraniectomy may also benefit patients above 60 years.
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| 16. |
- Asplund, Kjell
(författare)
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Hur kan tandhälsans stora gap bestå?
- 2017
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Ingår i: Tandläkartidningen. - 0039-6982. ; :2, s. 37-37
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 17. |
- Asplund, Kjell
(författare)
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Hur tungt får kollegialiteten väga?
- 2017
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Ingår i: Tandläkartidningen. - 0039-6982. ; :7, s. 43-43
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 18. |
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