61. |
- Nordberg, P, et al.
(författare)
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The implementation of a dual dispatch system in out-of--hospital cardiac arrest is associated withimproved short and long term survival
- 2014
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Ingår i: European Heart Journal. - : SAGE Publications. - 2048-8726 .- 2048-8734. ; 3:4, s. 293-303
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: To determine the impact of a dual dispatch system, using fire fighters as first responders, in out-of-hospital cardiac arrest (OHCA) on short (30 days) and long term (three years) survival, and, to investigate the potential differences regarding in-hospital factors and interventions between the patient groups, such as the use of therapeutic hypothermia and cardiac catheterization. METHODS AND RESULTS: OHCAs from 2004 (historical controls) and 2006-2009 (intervention period) were included. During the intervention period, fire fighters equipped with automated external defibrillators (AEDs) were dispatched in suspected OHCA. Logistic regression analyses of outcome data included: the intervention with dual dispatch, sex, age, location, aetiology, witnessed status, bystander-cardiopulmonary resuscitation, first rhythm and therapeutic hypothermia. In total, 2581 OHCAs were included (historical controls n=620, intervention period n=1961). Fire fighters initiated cardiopulmonary resuscitation and connected an AED before emergency medical services' arrival in 41% of the cases. The median time from dispatch to arrival of first responder or emergency medical services shortened from 7.7 in the control period to 6.7 min in the intervention period (p<0.001). The 30-day survival improved from 3.9% to 7.6% (p=0.001), adjusted odds ratio 2.8 (confidence interval 1.6-4.9). Survival to three years increased from 2.4% to 6.5% (p<0.001), adjusted odds ratio 3.8 (confidence interval 1.9-7.6). In the logistic regression analysis including in-hospital factors we found no outcome benefit of therapeutic hypothermia. CONCLUSIONS: The implementation of a dual dispatch system using fire fighters in OHCA was associated with increased 30-day and three-year survival. No major differences in the in-hospital treatment were seen between the studied patient groups.
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62. |
- Perers, E, et al.
(författare)
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Outcomes of patients hospitalized after out-of-hospital cardiac arrest in relation to sex
- 1999
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Ingår i: Coronary Artery Disease. - : Lippincott Williams & Wilkins. - 0954-6928 .- 1473-5830. ; 10:7, s. 509-514
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To describe characteristics and outcomes of patients hospitalized after out-of-hospital cardiac arrest in relation to sex. PATIENTS: All patients in the community of Göteborg who between 1980 and 1996 suffered out-of-hospital cardiac arrest and were hospitalized alive. METHODS: We calculated age-adjusted P values. RESULTS: In all 1038 patients were hospitalized alive of whom 29% were women. Women differed from men by being older and there being lower prevalences of previous acute myocardial infarction (AMI) and smoking and a higher prevalence of bronchial asthma among them. They had less commonly received cardio-pulmonary resuscitation (CPR) from bystanders (16 versus 25% of cases; P = 0.002) and were less commonly found to be in ventricular fibrillation when the ambulance crew arrived (55 versus 73% of cases; P < 0.0001). They were less commonly judged to have a cardiac etiology behind the arrest (87 versus 92% of cases; P = 0.016). Of women 31.3% could be discharged alive from hospital, compared with 41.8% of men (P = 0.001). While they were in hospital, women were less commonly subjected to exercise tests, coronary angiography, and coronary artery bypass grafting. CONCLUSION: Among patients who suffered out-of-hospital cardiac arrest and were hospitalized alive, women had less commonly received CPR from bystanders, were less commonly found in ventricular fibrillation, less commonly underwent coronary angiography and coronary artery bypass grafting and had a lower survival rate than did men.
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63. |
- Petursson, P, et al.
(författare)
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Prevalence and severity of abnormal glucose regulation and its relation to long-term prognosis after coronary artery bypass grafting.
- 2013
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Ingår i: Coronary Artery Disease. - : Lippincott Williams & Wilkins. - 0954-6928 .- 1473-5830. ; 24:7, s. 577-582
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Diabetes is a strong predictor of a poor outcome after coronary artery bypass grafting (CABG). The prevalence of prediabetes and its impact on the prognosis after CABG is not well described. In this study, we evaluated the prevalence and prognostic impact of the different states of abnormal glucose regulation (AGR) after CABG. PATIENTS AND METHODS: In this prospective study, we included 244 patients undergoing CABG. An oral glucose tolerance test was used to stratify patients into three groups: normoglycaemia, prediabetes and diabetes. The primary outcome was a composite of all-cause mortality and hospitalization for a nonfatal cardiovascular event. RESULTS: Among the patients, 86 (35%) were normoglycaemic and 58 (24%) had prediabetes; 100 (41%) patients had diabetes, of whom 28 (28%) had newly diagnosed diabetes on the basis of oral glucose tolerance test. During a mean follow-up period of 5.3 years, 25% of the study population suffered the primary outcome. There was a successive increase in the primary outcome rate from normoglycaemia through prediabetes to diabetes (adjusted hazard ratio 1.40; 95% confidence interval 1.01-1.96; P=0.045). CONCLUSION: With increasing severity of AGR, there is an increasing risk of new cardiovascular events after CABG. AGR is prevalent and predicts a poor outcome after CABG. Systematic screening for AGR seems reasonable to identify these high-risk patients.
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64. |
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65. |
- Rubertsson, Sten, et al.
(författare)
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The Study Protocol for the LINC (LUCAS in Cardiac Arrest) Study : a study comparing conventional adult out-of-hospital cardiopulmonary resuscitation with a concept with mechanical chest compressions and simultaneous defibrillation
- 2013
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Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - : BioMed Central Ltd.. - 1757-7241. ; 21:5
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Tidskriftsartikel (refereegranskat)abstract
- Background The LUCAS™ device delivers mechanical chest compressions that have been shown in experimental studies to improve perfusion pressures to the brain and heart as well as augmenting cerebral blood flow and end tidal CO2, compared with results from standard manual cardiopulmonary resuscitation (CPR). Two randomised pilot studies in out-of-hospital cardiac arrest patients have not shown improved outcome when compared with manual CPR. There remains evidence from small case series that the device can be potentially beneficial compared with manual chest compressions in specific situations. This multicentre study is designed to evaluate the efficacy and safety of mechanical chest compressions with the LUCAS™ device whilst allowing defibrillation during on-going CPR, and comparing the results with those of conventional resuscitation. Methods/design This article describes the design and protocol of the LINC-study which is a randomised controlled multicentre study of 2500 out-of-hospital cardiac arrest patients. The study has been registered at ClinicalTrials.gov (http://clinicaltrials.gov/ct2/show/NCT00609778?term=LINC&rank=1 webcite). Results Primary endpoint is four-hour survival after successful restoration of spontaneous circulation. The safety aspect is being evaluated by post mortem examinations in 300 patients that may reflect injuries from CPR. Conclusion This large multicentre study will contribute to the evaluation of mechanical chest compression in CPR and specifically to the efficacy and safety of the LUCAS™ device when used in association with defibrillation during on-going CPR.
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66. |
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67. |
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68. |
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69. |
- Steel, J, et al.
(författare)
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Pre-migration trauma and HIV-risk behavior
- 2003
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Ingår i: Transcultural psychiatry. - : SAGE Publications. - 1363-4615 .- 1461-7471. ; 40:1, s. 91-108
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Tidskriftsartikel (refereegranskat)abstract
- This study examined the relationship between pre-migration trauma and HIV-risk behavior in refugees from sub-Saharan Africa. The sample comprised 122 persons who had emigrated from sub-Saharan Africa and were currently residing in Sweden. Qualitative methods including individual interviews, focus groups, and interviews with key informants addressed questions regarding trauma experience and HIV-risk behavior. A history of pre-migration trauma was found to be associated with HIV-risk behavior. According to the participants, symptoms associated with post-traumatic stress disorder, depression, adjustment disorder, and substance use mediated the relationship between pre-migration trauma and sexual risk behavior. In contrast, a minority of the participants who reported pre-migration trauma but not psychological sequelae, or experienced post-traumatic growth, reported safer sexual practices. It appears that for some individuals, pre-migration trauma resulted in psychiatric sequelae, which may increase an individual's risk to be infected with HIV. Interventions targeted at individuals at increased risk (i.e. pre-migration trauma with unresolved psychiatric symptomatology) may facilitate the prevention of HIV and other sexually transmitted diseases in this population. Integration of multiple psychosocial and health issues is recommended for comprehensive treatment and prevention programs.
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70. |
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