| 1. |
- Aslam, Tayyba N., et al.
(författare)
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A survey of preferences for respiratory support in the intensive care unit for patients with acute hypoxaemic respiratory failure
- 2023
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Ingår i: Acta Anaesthesiologica Scandinavica. - : WILEY. - 0001-5172 .- 1399-6576. ; 67:10, s. 1383-1394
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundWhen caring for mechanically ventilated adults with acute hypoxaemic respiratory failure (AHRF), clinicians are faced with an uncertain choice between ventilator modes allowing for spontaneous breaths or ventilation fully controlled by the ventilator. The preferences of clinicians managing such patients, and what motivates their choice of ventilator mode, are largely unknown. To better understand how clinicians preferences may impact the choice of ventilatory support for patients with AHRF, we issued a survey to an international network of intensive care unit (ICU) researchers.MethodsWe distributed an online survey with 32 broadly similar and interlinked questions on how clinicians prioritise spontaneous or controlled ventilation in invasively ventilated patients with AHRF of different severity, and which factors determine their choice.ResultsThe survey was distributed to 1337 recipients in 12 countries. Of these, 415 (31%) completed the survey either fully (52%) or partially (48%). Most respondents were identified as medical specialists (87%) or physicians in training (11%). Modes allowing for spontaneous ventilation were considered preferable in mild AHRF, with controlled ventilation considered as progressively more important in moderate and severe AHRF. Among respondents there was strong support (90%) for a randomised clinical trial comparing spontaneous with controlled ventilation in patients with moderate AHRF.ConclusionsThe responses from this international survey suggest that there is clinical equipoise for the preferred ventilator mode in patients with AHRF of moderate severity. We found strong support for a randomised trial comparing modes of ventilation in patients with moderate AHRF.
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| 2. |
- Barbateskovic, Marija, et al.
(författare)
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A new tool to assess Clinical Diversity In Meta-analyses (CDIM) of interventions
- 2021
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Ingår i: Journal of Clinical Epidemiology. - : Elsevier BV. - 0895-4356 .- 1878-5921. ; 135, s. 29-41
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To develop and validate Clinical Diversity In Meta-analyses (CDIM), a new tool for assessing clinical diversity between trials in meta-analyses of interventions. Study design and setting: The development of CDIM was based on consensus work informed by empirical literature and expertise. We drafted the CDIM tool, refined it, and validated CDIM for interrater scale reliability and agreement in three groups. Results: CDIM measures clinical diversity on a scale that includes four domains with 11 items overall: setting (time of conduct/country development status/units type); population (age, sex, patient inclusion criteria/baseline disease severity, comorbidities); interventions (intervention intensity/strength/duration of intervention, timing, control intervention, cointerventions); and outcome (definition of outcome, timing of outcome assessment). The CDIM is completed in two steps: first two authors independently assess clinical diversity in the four domains. Second, after agreeing upon scores of individual items a consensus score is achieved. Interrater scale reliability and agreement ranged from moderate to almost perfect depending on the type of raters. Conclusion: CDIM is the first tool developed for assessing clinical diversity in meta-analyses of interventions. We found CDIM to be a reliable tool for assessing clinical diversity among trials in meta-analysis.
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| 3. |
- Jonmarker, Sandra, et al.
(författare)
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A retrospective multicenter cohort study of the association between anti-Factor Xa values and death, thromboembolism, and bleeding in patients with critical COVID-19
- 2023
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Ingår i: Thrombosis Journal. - 1477-9560. ; 21, s. 1-11
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Patients with critical COVID-19 have a high risk of thromboembolism, but intensified thromboprophylaxis has not been proven beneficial. The activity of low-molecular-weight heparins can be monitored by measuring anti-Factor Xa. We aimed to study the association between anti-Factor Xa values and death, thromboembolism, and bleeding in patients with critical COVID-19.METHOD: This retrospective cohort study included adult patients with critical COVID-19 admitted to an intensive care unit at three Swedish hospitals between March 2020 and May 2021 with at least one valid peak and/or trough anti-Factor Xa value. Within the peak and trough categories, patients' minimum, median, and maximum values were determined. Logistic regressions with splines were used to assess associations.RESULTS: In total, 408 patients had at least one valid peak and/or trough anti-Factor Xa measurement, resulting in 153 patients with peak values and 300 patients with trough values. Lower peak values were associated with thromboembolism for patients' minimum (p = 0.01), median (p = 0.005) and maximum (p = 0.001) values. No association was seen between peak values and death or bleeding. Higher trough values were associated with death for median (p = 0.03) and maximum (p = 0.002) values and with both bleeding (p = 0.01) and major bleeding (p = 0.02) for maximum values, but there were no associations with thromboembolism.CONCLUSIONS: Measuring anti-Factor Xa activity may be relevant for administrating low-molecular-weight heparin to patients with critical COVID-19. Lower peak values were associated with an increased risk of thromboembolism, and higher trough values were associated with an increased risk of death and bleeding. Prospective studies are needed to confirm the results.TRIAL REGISTRATION: The study was retrospectively registered at Clinicaltrials.gov, NCT05256524, February 24, 2022.
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| 4. |
- Cronhjort, Mikael, PhD, 1965-, et al.
(författare)
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Avstånd med olika metriker
- 2021
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Ingår i: Nämnaren. - Göteborg : Nationellt Centrum för Matematikutbildning. - 0348-2723. ; :1, s. 44-50
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Författarna beskriver en lektion om avståndsberäkningar med olika metrikersom de tror att kan vara inspirerande både för elever och matematiklärare pågymnasiet. Lektionen utvecklades i ett samarbete mellan fem lärare underKleindagarna i januari 2020.
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| 5. |
- Cronhjort, Mikael, et al.
(författare)
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Can Peer Instruction in calculus improve student learning?
- 2013
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Ingår i: Proceedings of the 9th International CDIO Conference<em></em>. - Cambridge, Massachusetts, USA : CDIO.
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Konferensbidrag (refereegranskat)abstract
- We report on an experiment in which we used Peer Instruction instead of traditional lectures in a Calculus course for beginning engineering students at KTH Royal Institute of Technology. In order to enable evaluation in a controlled experiment setting, we kept the rest of the course – text book, tutorials and examination – unchanged. The student’s pre-knowledge was measured by a diagnostic test, and their post-knowledge was measured by the written exam of the course. Our data indicate that the Peer Instruction group learned more than the control group, who had traditional lectures. In questionnaires at the beginning of the course and at the end, we asked for the students’ perceptions of Peer Instruction as teaching method and if they had found it useful as a tool for learning calculus. The answers show that the students appreciated being more active and motivated with Peer Instruction, but also that they found the method challenging and somewhat frustrating. A major problem was that the textbook was difficult to read in advance.
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| 6. |
- Cronhjort, Mikael, et al.
(författare)
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Improved engagement and learning in flipped-classroom calculus
- 2018
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Ingår i: Teaching Mathematics and its Applications. - : Oxford University Press. - 0268-3679 .- 1471-6976. ; 37:3, s. 113-121
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Tidskriftsartikel (refereegranskat)abstract
- We report on an effort tomeasure the effect of replacing traditional lecture-based teachingin calculus with a flipped-classroom approach.We base the comparison between the twoteaching models on data fromthree sources: (a) a Calculus BaselineTest, designed specificallyfor this purpose and given as pre-test and post-test; (b) a survey measuring studentengagement; and (c) student achievement on the final exam. On the Calculus BaselineTest, we found that the normalized gain was 13% higher in the flipped-classroom group.Similarly, the flipped-classroom group scored significantly higher on the engagementsurvey. Also, the students of the flipped-classroom group performedmuch better than expectedon the final exam of the course, with a substantial decrease in failure rate.
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| 7. |
- Cronhjort, Mikael, 1965-, et al.
(författare)
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STUDENT PERSPECTIVES ON FLIPPED CLASSROOMS INENGINEERING EDUCATION
- 2016
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Ingår i: Proceedings of the 12th International CDIO Conference. - : CDIO. ; , s. 1041-1050
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Konferensbidrag (refereegranskat)abstract
- We used focus group interviews and the student perspective in order to investigate student perceptions of flipped classroom in engineering education. The learning environment included web-based interactive video films, where students had to answer quizzes in order to continue seeing the films, and interactive in-class sessions with clickers. In general the students had experience of flipped classroom in many courses and subjects, and could compare different implementations in physics, mechanics and calculus. We studied perceived advantages, strengths, drawbacks, or difficulties, and students’ views on learning with flipped classroom. Overall, the students were positive, or in one case indifferent to flipped classroom. They saw many advantages, but they also pointed out difficulties and had many opinions about how a flipped learning environment was best implemented. In the interviews, they also expressed their views on learning and described how they studied. Many used rote learning and surface approaches to learning, but many also had a focus on understanding. Some declared an intention to focus on understanding but still used rote learning. Some students expressed a strategic approach to learning with focus on the examination. Heavy workload and a threatening examination system seem to favor surface approaches to learning also in a flipped classroom learning environment. One of our interviewees had dyslexia and described her experience and special conditions. We conclude by suggesting a list of five key elements for flipped classroom. We think that the interplay between these elements is important, and that they are considerably weaker without the support of the others.
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| 8. |
- Cronhjort, Maria
(författare)
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Treatment of septic patients : fluids, blood and timing of antibiotics
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Fluid therapy is an important component of the treatment of septic shock. The Surviving Sepsis Campaign recommends early fluid resuscitation with at least 30 ml/kg and there is no recommendation on when to stop giving fluids. Many studies have shown an association between fluid overload and morbidity and mortality. Clinicians base fluid prescription on variables that do not reflect fluid responsiveness. Aim: The overall intention was to explore what scientific support there is for the treatment of septic patients in terms of their fluid management and the timing of antibiotics and to investigate new tools that could help the clinician decide on the amount and timing of blood and other fluids in septic shock. Overview of methods: See image in thesis pdf Summary of research results: The scientific support for how fluid management in patients with septic shock should be performed is poor. • It is safe to adopt a Hb threshold of 7 g/dl in septic ICU patients except in patients with preexisting cardiovascular disease for whom a transfusion threshold of 8 g/dl is suggested. • It is uncertain whether fluid overload is associated with mortality at a median fluid balance of 2.5 l on day three. • It has not been proven that protocolised haemodynamic management improves outcome. • It was possible to use the protocol based on a passive leg raising (PLR) test, but the recruitment rate was low. The weight gain was low in both the PLR and the control groups. • Female patients and patients with surgical sepsis were overrepresented in the group that received antibiotics after more than one hour in the emergency department. We could neither confirm nor exclude a survival benefit from early administration of antibiotics.
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| 9. |
- Granholm, Anders, et al.
(författare)
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Dexamethasone 12 mg versus 6 mg for patients with COVID-19 and severe hypoxaemia: a pre-planned, secondary Bayesian analysis of the COVID STEROID 2 trial
- 2022
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Ingår i: Intensive Care Medicine. - : SPRINGER. - 0342-4642 .- 1432-1238. ; 48:1, s. 45-55
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Tidskriftsartikel (refereegranskat)abstract
- Purpose We compared dexamethasone 12 versus 6 mg daily for up to 10 days in patients with coronavirus disease 2019 (COVID-19) and severe hypoxaemia in the international, randomised, blinded COVID STEROID 2 trial. In the primary, conventional analyses, the predefined statistical significance thresholds were not reached. We conducted a pre-planned Bayesian analysis to facilitate probabilistic interpretation. Methods We analysed outcome data within 90 days in the intention-to-treat population (data available in 967 to 982 patients) using Bayesian models with various sensitivity analyses. Results are presented as median posterior probabilities with 95% credible intervals (CrIs) and probabilities of different effect sizes with 12 mg dexamethasone. Results The adjusted mean difference on days alive without life support at day 28 (primary outcome) was 1.3 days (95% CrI -0.3 to 2.9; 94.2% probability of benefit). Adjusted relative risks and probabilities of benefit on serious adverse reactions was 0.85 (0.63 to 1.16; 84.1%) and on mortality 0.87 (0.73 to 1.03; 94.8%) at day 28 and 0.88 (0.75 to 1.02; 95.1%) at day 90. Probabilities of benefit on days alive without life support and days alive out of hospital at day 90 were 85 and 95.7%, respectively. Results were largely consistent across sensitivity analyses, with relatively low probabilities of clinically important harm with 12 mg on all outcomes in all analyses. Conclusion We found high probabilities of benefit and low probabilities of clinically important harm with dexamethasone 12 mg versus 6 mg daily in patients with COVID-19 and severe hypoxaemia on all outcomes up to 90 days.
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| 10. |
- Granholm, Anders, et al.
(författare)
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Higher vs Lower Doses of Dexamethasone in Patients with COVID-19 and Severe Hypoxia (COVID STEROID 2) trial: Protocol for a secondary Bayesian analysis
- 2021
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Ingår i: Acta Anaesthesiologica Scandinavica. - : WILEY. - 0001-5172 .- 1399-6576. ; 65:5, s. 702-710
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Tidskriftsartikel (refereegranskat)abstract
- Background Coronavirus disease 2019 (COVID-19) can lead to severe hypoxic respiratory failure and death. Corticosteroids decrease mortality in severely or critically ill patients with COVID-19. However, the optimal dose remains unresolved. The ongoing randomised COVID STEROID 2 trial investigates the effects of higher vs lower doses of dexamethasone (12 vs 6 mg intravenously daily for up to 10 days) in 1,000 adult patients with COVID-19 and severe hypoxia. Methods This protocol outlines the rationale and statistical methods for a secondary, pre-planned Bayesian analysis of the primary outcome (days alive without life support at day 28) and all secondary outcomes registered up to day 90. We will use hurdle-negative binomial models to estimate the mean number of days alive without life support in each group and present results as mean differences and incidence rate ratios with 95% credibility intervals (CrIs). Additional count outcomes will be analysed similarly and binary outcomes will be analysed using logistic regression models with results presented as probabilities, relative risks and risk differences with 95% CrIs. We will present probabilities of any benefit/harm, clinically important benefit/harm and probabilities of effects smaller than pre-defined clinically minimally important differences for all outcomes analysed. Analyses will be adjusted for stratification variables and conducted using weakly informative priors supplemented by sensitivity analyses using sceptic priors. Discussion This secondary, pre-planned Bayesian analysis will supplement the primary, conventional analysis and may help clinicians, researchers and policymakers interpret the results of the COVID STEROID 2 trial while avoiding arbitrarily dichotomised interpretations of the results. Trial registration ClinicalTrials.gov: NCT04509973; EudraCT: 2020-003363-25.
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