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1.
  • Norrving, Bo, et al. (författare)
  • Beyond conventional stroke guidelines - Setting priorities
  • 2007
  • Ingår i: Stroke: a journal of cerebral circulation. - American Heart Association. - 1524-4628. ; 38:7, s. 2185-2190
  • Tidskriftsartikel (refereegranskat)abstract
    • Background and Purpose - Priorities in the care of stroke patients are often intuitive. An open and translucent priority-setting procedure would benefit patients, professionals, and decision-makers. Prioritization is an innovative part of the new Swedish national stroke guidelines. Methods - Working groups identified diagnostic procedures, interventions and therapies in stroke care, assessed each one according to severity (needs), effect of action, level of scientific evidence and cost-effectiveness. The items were then ranked into priority groups from 1 (highest) to 10 (lowest). Procedures lacking evidence for routine clinical use were also identified (and entered a do-not-do list), as well as procedures in research and development. Resource allocations resulting from the priority-setting process were identified. Results - Of 102 core procedures identified, 50 were assigned to high-priority groups (1-3), 29 to moderate priority groups (4-7) and 23 to low priority groups (8-10). Almost a quarter were graded 8 to 10, indicating that they may not necessarily be applied if resources are scarce. Twenty-eight procedures were assigned to the do-not-do list and 16 to the research and development list. Conclusions - In stroke services, it is possible to identify not only diagnostic procedures and interventions with high priority, but also a considerable number of items used today that have low priority or should not be used at all. Strict adherence to the guidelines would result in a substantial reallocation of resources from low-priority to high-priority areas.
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4.
  • Aronsson, Mattias, et al. (författare)
  • Cost-effectiveness of endovascular thrombectomy in patients with acute ischemic stroke.
  • 2016
  • Ingår i: Neurology. - 0028-3878. ; 86:11, s. 1053-9
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective:To evaluate the cost-effectiveness of adding endovascular thrombectomy to standard care in patients with acute ischemic stroke.Methods:The cost-effectiveness analysis of endovascular thrombectomy in patients with acute ischemic stroke was based on a decision-analytic Markov model. Primary outcomes from ESCAPE, Extending the Time for Thrombolysis in Emergency Neurological Deficits-Intra-Arterial (EXTEND-IA), Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN), Endovascular Revascularization With Solitaire Device Versus Best Medical Therapy in Anterior Circulation Stroke Within 8 Hours (REVASCAT), and Solitaire with the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke (SWIFT PRIME) along with data from published studies and registries were used in this analysis. We used a health care payer perspective and a lifelong time horizon to estimate costs and effects.Results:The model showed that adding thrombectomy with stent retrievers to guideline-based care (including IV thrombolysis) resulted in a gain of 0.40 life-years and 0.99 quality-adjusted life-years along with a cost savings of approximately $221 per patient. The sensitivity analysis showed that the results were not sensitive to changes in uncertain parameters or assumptions.Conclusions:Adding endovascular treatment to standard care resulted in substantial clinical benefits at low costs. The results were consistent throughout irrespective of whether data from ESCAPE, EXTEND-IA, MR CLEAN, REVASCAT, or SWIFT PRIME were used in this model.
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5.
  • Blom Johansson, Monica, 1965- (författare)
  • Aphasia and Communication in Everyday Life Experiences of persons with aphasia, significant others, and speech-language pathologists
  • 2012
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • <p>The aims of this thesis were to describe the experiences of persons with aphasia and their significant others of their conversations and use of communication strategies, examine current practice of family-oriented speech-language pathology (SLP) services, and test a family-oriented intervention in the early phase of rehabilitation.</p><p>The persons with aphasia valued having conversations despite perceiving their aphasia as a serious social disability. They acknowledged the importance of the communication partners’ knowledge and understanding of aphasia and their use of supporting conversation strategies. Their own use of communication strategies varied considerably. The persons with aphasia longed to regain language ability and to be active participants in society.</p><p>A majority of the significant others perceived their conversations with the person with aphasia as being less stimulating and enjoyable than conversations before stroke onset. Aphasia was considered a serious problem. The significant others took on increased communicative responsibility, where two thirds had changed their communicative behaviour to facilitate conversations. Type and severity of aphasia were especially related to the communicative experiences of the significant others and their motivation to be involved in SLP services.</p><p>Thirty percent of the speech-language pathologists worked with people with aphasia and typically met with their families. They considered the involvement of significant others in SLP services as very important, especially in providing information about aphasia and communication partner training (CPT). However, involvement of significant others was restricted because of a time shortage and perceived limited skills and knowledge. In addition, there were national differences regarding aphasia rehabilitation services.</p><p>The intervention consisted of three sessions directed to significant others (primarily emotional support and information) and three directed to the dyads (a person with aphasia and a significant other) (primarily CPT). All six participants (three dyads) felt that their knowledge and understanding of aphasia had increased and that their conversations had improved. These improvements were also evident to some extent with formal assessments.</p><p>These results suggest the following: CPT should be an integral part of SLP services, national clinical guidelines are needed, and further education of speech-language pathologists and implementation of new knowledge into clinical practice requires consideration.</p>
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7.
  • Hägglund, Patricia, 1989- (författare)
  • Swallowing dysfunction among older people in short-term care prevalence, effect of intervention, and risk of mortality
  • 2019
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • <p>Sväljningsdysfunktion (ibland benämnt dysfagi) är ett vanligt, men ofta förbisett tillstånd bland äldre individer. Dysfunktion vid sväljning kan orsaka svåra komplikationer såsom näringsbrist, viktförlust, lunginflammation och för tidig död. Enkla behandlingsmetoder vid sväljsvårigheter saknas och är efterfrågade. Neuromuskulär behandling med munskärm innebär stimulering av muskler och nerver i ansiktet, munnen och svalget, och har nyligen visats vara effektivt vid behandling av sväljsvårigheter. Det saknas dock kunskap om metoden fungerar bland äldre personer.</p><p>Syftet med avhandlingen är att i) beskriva metoderna och designen i det multidisciplinära, multicenter projektet SOFIA (Swallowing function, Oral health, and Food Intake in old Age), ii) beskriva förekomsten av och analysera samband mellan sväljningsdysfunktion och risk för undernäring bland äldre som vistas på korttidsboende, iii) undersöka utfallet av en ny träningsmetod med munskärm för äldre individer med sväljsvårigheter samt iv) analysera dödlighet relaterat till dålig munhälsa och sväljningsdysfunktion.</p><p>Delstudie 1 är en metodstudie där det övergripande SOFIA-projektet beskrivs. Totalt inkluderades 391 äldre individer från 36 korttidsboende från fem regioner (län) i Sverige som uppfyllde inklusionskriterierna: 65 år eller äldre, vistats på korttidsboende minst tre dagar, förstår svenska och kan delta i de kliniska undersökningarna. Individer i livets slutskede eller med måttlig till svår kognitiv svikt exkluderades. Efter inklusion i SOFIA-projektet bedömdes samtliga deltagares status avseende sväljfunktion, risk för undernäring, munhälsa och delaktighet i sin allmänna dagliga livsföring (ADL). Kliniska och socioekonomiska data samlades också in för varje deltagare. Delstudie 2 var en deskriptiv tvärsnittsstudie, där förekomsten av sväljningsdysfunktion och risk för undernäring undersöktes bland de äldre. Vidare undersöktes om sväljningsdysfunktion ökade risken för undernäring. I Delstudie 3 erbjöds de äldre som uppvisade sväljningsdysfunktion vid basbedömningen deltagande i en behandlingsstudie. De som tackad ja till deltagande randomiserades till fem veckors munskärmsträning eller till rutinvård utan munskärm. Varje deltagares sväljfunktion och sväljrelaterad livskvalitet bedömdes före och efter munskärmsträningen samt sex månader efter avslutad intervention. Delstudie 4 var en longitudinell kohortstudie. Ett år efter första bedömningen av deltagarna gjordes ett utdrag från dödsregistret och relationen mellan dålig munhälsa och sväljningsdysfunktion analyserades med överlevnad som utfall.</p><p>Resultaten visade att nästan två tredjedelar (64%) av de äldre i korttidsboende har en sväljningsdysfunktion och var fjärde (23%) löper risk för undernäring (delstudie 2). Sväljningsdysfunktion är en riskfaktor för undernäring (delstudie 2). De äldre som tränade med munskärm i fem veckor visade sig förbättra sväljfunktionen signifikant jämfört med kontrollerna (delstudie 3). Både sväljningsdysfunktion och dålig munhälsa, oberoende av varandra, visade sig ge högre risk för dödlighet inom ett år bland äldre på korttidsboende (delstudie 4). Även att ha lågt kroppsmasseindex (BMI) visades vara en riskfaktor för tidig död.</p><p>Resultaten i denna avhandling visar att både sväljningsdysfunktion och dålig munhälsa medför en högre risk för dödlighet bland äldre som vistas på korttidsboende. Detta ger starkt stöd för att diagnostik av och omvårdnad vid sväljsvårigheter och dålig munhälsa behöver förbättras bland äldre i korttidsboende. Vidare visar resultaten att sväljningsdysfunktion och risk för undernäring är vanligt förekommande och att munsskärmsträning är en ny potentiell behandlingsmetod vid nedsatt sväljfunktion bland äldre. Implementering av munskärmsträning vid sväljningsdysfunktion kan minska riskerna för näringsbrist, uttorkning och lungkomplikationer samt för tidig död.</p>
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8.
  • Isaksson, Eva, et al. (författare)
  • Identifying important barriers to recruitment of patients in randomised clinical studies using a questionnaire for study personnel
  • 2019
  • Ingår i: Trials. - 1745-6215 .- 1745-6215. ; 20:1
  • Tidskriftsartikel (refereegranskat)abstract
    • <p><strong>Background:</strong></p><p>Many randomised controlled trials (RCT) fail to meet their recruitment goals. Study personnel play a key role in recruitment. The aim of this study was to identify successful strategies that study personnel consider to be important in patient recruitment to RCT.</p><p><strong>Methods: </strong></p><p>We constructed a questionnaire based on the literature, discussions with colleagues and our own experience as trialists. The survey was named "What is Important for Making a Study Successful questionnaire" (WIMSS-q). Our target group was the study personnel in the ongoing EFFECTS study. The questionnaire was sent out electronically to all physicians and nurses (n = 148). Success factors and barriers were divided according to patient, centre and study level, respectively.</p><p><strong>Results:</strong></p><p>Responses were received from 94% of the study personnel (139/148). The five most important factors at centre level for enhancing recruitment were that the research question was important (97%), a simple procedure for providing information and gaining consent (92%), a highly engaged local principal investigator and research nurse (both 87%), and that study-related follow-ups are practically feasible and possible to coordinate with the clinical follow-up (87%). The most significant barrier at the local centre was lack of time and resources devoted to research (72%). Important patient-related barriers were fear of side effects (35%) and language problems (30%).</p><p><strong>Conclusions: </strong></p><p>For recruitment in an RCT to be successful, the research question must be relevant, and the protocol must be simple and easy to implement in the daily routine.</p>
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9.
  • Isaksson, Eva, et al. (författare)
  • Identifying important barriers to recruitment of patients in randomised clinical studies using a questionnaire for study personnel
  • 2019
  • Ingår i: Trials. - BioMed Central. - 1745-6215 .- 1745-6215. ; 20:1
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Background: Many randomised controlled trials (RCT) fail to meet their recruitment goals. Study personnel play a key role in recruitment. The aim of this study was to identify successful strategies that study personnel consider to be important in patient recruitment to RCT.</p><p>Methods: We constructed a questionnaire based on the literature, discussions with colleagues and our own experience as trialists. The survey was named “What is Important for Making a Study Successful questionnaire” (WIMSS-q). Our target group was the study personnel in the ongoing EFFECTS study. The questionnaire was sent out electronically to all physicians and nurses (<em>n</em> = 148). Success factors and barriers were divided according to patient, centre and study level, respectively.</p><p>Results: Responses were received from 94% of the study personnel (139/148). The five most important factors at centre level for enhancing recruitment were that the research question was important (97%), a simple procedure for providing information and gaining consent (92%), a highly engaged local principal investigator and research nurse (both 87%), and that study-related follow-ups are practically feasible and possible to coordinate with the clinical follow-up (87%). The most significant barrier at the local centre was lack of time and resources devoted to research (72%). Important patient-related barriers were fear of side effects (35%) and language problems (30%).</p><p>Conclusions: For recruitment in an RCT to be successful, the research question must be relevant, and the protocol must be simple and easy to implement in the daily routine.</p>
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10.
  • Isaksson, Eva, et al. (författare)
  • Identifying important barriers to recruitment of patients in randomised clinical studies using a questionnaire for study personnel
  • 2019
  • Ingår i: Trials. - BMC. - 1745-6215 .- 1745-6215. ; 20:1
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Background: Many randomised controlled trials (RCT) fail to meet their recruitment goals. Study personnel play a key role in recruitment. The aim of this study was to identify successful strategies that study personnel consider to be important in patient recruitment to RCT. Methods: We constructed a questionnaire based on the literature, discussions with colleagues and our own experience as trialists. The survey was named "What is Important for Making a Study Successful questionnaire" (WIMSS-q). Our target group was the study personnel in the ongoing EFFECTS study. The questionnaire was sent out electronically to all physicians and nurses (n = 148). Success factors and barriers were divided according to patient, centre and study level, respectively. Results: Responses were received from 94% of the study personnel (139/148). The five most important factors at centre level for enhancing recruitment were that the research question was important (97%), a simple procedure for providing information and gaining consent (92%), a highly engaged local principal investigator and research nurse (both 87%), and that study-related follow-ups are practically feasible and possible to coordinate with the clinical follow-up (87%). The most significant barrier at the local centre was lack of time and resources devoted to research (72%). Important patient-related barriers were fear of side effects (35%) and language problems (30%). Conclusions: For recruitment in an RCT to be successful, the research question must be relevant, and the protocol must be simple and easy to implement in the daily routine.</p>
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