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| 2. |
- James, Stefan, 1964-, et al.
(författare)
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Bivalirudin Versus Heparin Monotherapy in ST-Segment-Elevation Myocardial Infarction
- 2021
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Ingår i: Circulation. Cardiovascular Interventions. - : Lippincott Williams & Wilkins. - 1941-7640 .- 1941-7632. ; 14:12
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Bivalirudin was not superior to unfractionated heparin in patients with myocardial infarction (MI) treated with percutaneous coronary intervention and no planned use of GPI (glycoprotein IIb/IIIa inhibitors) in contemporary clinical practice of radial access and potent P2Y12-inhibitors in the VALIDATE-SWEDEHEART randomized clinical trial (Bivalirudin Versus Heparin in STEMI and NSTEMI Patients on Modern Antiplatelet Therapy-Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies Registry).METHODS: In this prespecified separately powered subgroup analysis, we included patients with ST-segment-elevation MI undergoing primary percutaneous coronary intervention with the primary composite end point of all-cause death, MI, or major bleeding event within 180 days.RESULTS: Among the 6006 patients enrolled in the trial, 3005 patients with ST-segment-elevation MI were randomized to receive bivalirudin or heparin. The mean age was 66.8 years. According to protocol recommendations, 87% were treated with potent oral P2Y12-inhibitors before start of angiography and radial access was used in 90%. GPI was used in 51 (3.4%) and 74 (4.9%) of patients randomized to receive bivalirudin and heparin, respectively. The primary end point occurred in 12.5% (187 of 1501) and 13.0% (196 of 1504; hazard ratio [HR], 0.95 [95% CI, 0.78-1.17], P=0.64) with consistent results in all major subgroups. All-cause death occurred in 3.9% versus 3.9% (HR, 1.00 [0.70-1.45], P=0.98), MI in 1.7% versus 2.2% (HR, 0.76 [0.45-1.28], P=0.30), major bleeding in 8.3% versus 8.0% (HR, 1.04 [0.81-1.33], P=0.78), and definite stent thrombosis in 0.5% versus 1.3% (HR, 0.42 [0.18-0.96], P=0.04).CONCLUSIONS: In patients with ST-segment-elevation MI undergoing primary percutaneous coronary intervention with radial access and receiving current recommended treatments with potent P2Y12-inhibitors rate of the composite of all-cause death, MI, or major bleeding was not lower in those randomized to receive bivalirudin as compared with heparin.REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02311231.
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| 3. |
- Andersson, Henrik C, et al.
(författare)
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Fiskevårdsplan 2007 - 2010 för Stockholms län
- 2007
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Fiskevårdsbehovet är stort i Stockholms län. Problemen med fiskbestånden täcker hela skalan från gäddans kraftiga beståndsnedgångar med kopplingar till storskaliga miljöproblem i Östersjön till utdikade sjöar och våtmarker iinlandet. Påverkan på länets vattendrag är omfattande. Det finns även stort behov att förbättra förvaltningen av de kommersiella fiskarterna i länet och därigenom skapa underlag för livskraftiga näringar baserade på fisk samtrekreation för länets invånare.Det statliga fiskevårdsbidraget kan omöjligt täcka dessa behov. Det är därför nödvändigt att samordna olika finansieringskällor och intressen. I fiskevårdsplanen finns en översiktlig beskrivning av målen för verksamheten samt strategier för att öka samordning och skapasynergieffekter mellan olika åtgärder. Länsstyrelsen har en ambition att Stockholms skärgård skall bli ett "särskilt fiskeområde" under den innevarande strukturmedelsperioden.För fiskevården inom ramen för det statliga fiskevårdsanslaget beräknas till ca 5,5 kronor miljoner per år. Statsbidraget utgör ca 2,3 miljoner per år. Kostnaderna för åtgärder i skärgården har inte specificerats för åren 2009 och 2010. Under 2007-2008 kommer det att genomföras en förstudie tillsammans med Fiskeriverket för att definiera detta behov på objektsnivå.Målgruppen för planen är centrala verk, kommuner, fiskets organisationer och enskilda. Förhoppningen är att det i det kommande fiskevårdsarbetet sker en ökad integrering av fiskevårdsarbetet med övriga mål för miljö- ochfiskeripolitiken samt den kommunala översiktsplaneringen.
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| 5. |
- Böhm, Felix, et al.
(författare)
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FFR-Guided Complete or Culprit-Only PCI in Patients with Myocardial Infarction
- 2024
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Ingår i: New England Journal of Medicine. - : Massachusetts Medical Society. - 0028-4793 .- 1533-4406. ; 390:16, s. 1481-1492
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The benefit of fractional flow reserve (FFR)-guided complete revascularization in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease remains unclear. METHODS: In this multinational, registry-based, randomized trial, we assigned patients with STEMI or very-high-risk non-STEMI (NSTEMI) and multivessel disease who were undergoing primary percutaneous coronary intervention (PCI) of the culprit lesion to receive either FFR-guided complete revascularization of nonculprit lesions or no further revascularization. The primary outcome was a composite of death from any cause, myocardial infarction, or unplanned revascularization. The two key secondary outcomes were a composite of death from any cause or myocardial infarction and unplanned revascularization. RESULTS: A total of 1542 patients underwent randomization, with 764 assigned to receive FFR-guided complete revascularization and 778 assigned to receive culprit-lesion-only PCI. At a median follow-up of 4.8 years (interquartile range, 4.3 to 5.2), a primary-outcome event had occurred in 145 patients (19.0%) in the complete-revascularization group and in 159 patients (20.4%) in the culprit-lesion-only group (hazard ratio, 0.93; 95% confidence interval [CI], 0.74 to 1.17; P = 0.53). With respect to the secondary outcomes, no apparent between-group differences were observed in the composite of death from any cause or myocardial infarction (hazard ratio, 1.12; 95% CI, 0.87 to 1.44) or unplanned revascularization (hazard ratio, 0.76; 95% CI, 0.56 to 1.04). There were no apparent between-group differences in safety outcomes. CONCLUSIONS: Among patients with STEMI or very-high-risk NSTEMI and multivessel coronary artery disease, FFR-guided complete revascularization was not shown to result in a lower risk of a composite of death from any cause, myocardial infarction, or unplanned revascularization than culprit-lesion-only PCI at 4.8 years. (Funded by the Swedish Research Council and others; FULL REVASC ClinicalTrials.gov number, NCT02862119.).
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| 6. |
- Eklund, Annika, 1981-, et al.
(författare)
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Exploring focus group discussions for building knowledge across emergency services organisations : a foundation for road tunnel incidents responses and future research?
- 2022
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Ingår i: International Conference on Work Integrated Learning. - Trollhättan : University West. - 9789189325302 ; , s. 65-67
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Introduction and aimRoad tunnels are important parts of today’s infrastructure and society, but also with potential for many injured in case of an incident and a challenging work environment for emergency services organisations. If a mass-casualty incident (MCI) occurs in a road tunnel, specific challenges in terms of safety, heat, smoke, long distances to the injured and lack of and contradictory information will impact the response and how collaboration is established (Holgersson et al., 2020; Lockey et al., 2005). In addition, sharing information during responses is, however, often limited due to the lack of knowledge and understanding of each other’s work processes at an individual and organisational level (Sederholm et al., 2021). A key for collaboration here is a good understanding of how their own, and collaborative organisations interpret and operate in a potentially shared task (Edwards, 2012; Wolbers et al., 2017). Thus, the road tunnel environment is one area where research has pointed to the need for a shared understanding of incidents across the organisations (Casse & Caroly, 2019) and for arenas facilitating exchange of experiences and reflections upon work procedures to develop collaboration (Njå & Svela, 2018; Hylander et al., 2022). This calls for activities that could stimulate work-integrated learning. While exercises and simulations are valuable in enhancing response preparedness, the perceived effects have been reported to vary in terms of learning and usefulness (see e.g., Roud et al., 2021). In addition, exercises and simulations are expensive and time consuming, calling for alternative but still effective learning activities for developing collaboration. This abstract aim to present and critically explore an innovative learning activity for development of joint knowledge to improve MCI response in road tunnel environments.Design and participants The learning activity analysed for this abstract was a series of four focus groups á 4 to 4,5 hours, conducted online in a region of Sweden. The overall aim of the series was to share experiences and develop joint knowledge across emergency organisations in tunnel environments. The participants in the focus groups represented the organisations that typically respond to tunnel incidents, i.e., ambulance service (EMS), police service, rescue service, Swedish Transport Administration (RTCC, Trafikverket) and emergency dispatch center (EDC, SOS Alarm) (Table 1). The study participants had extensive work experience within their organisations and are expected to have a tactical or operational management function in a major response.Table 1 not included in this abstractThe researchers designed the focus group series with the intention to alternate experiences, with procedural, conceptual and practical elements. The study used a partly participatory design. For this study, rather than being co-interpreters of the results, the participants were involved to shape the sessions content and questions to be discussed in ways they found valuable (Baum et al., 2005). The researchers built the following session from what the participants had asked for, discussed, or found challenging in the prior sessions. One week in advance, the overarching theme, goal, and suggestions for discussion questions for the session, and a summary of bullet points from the previous session, was sent out to the participants. Session I was set out to be an open discussion to familiarize themselves with each other’s ways of working, and to discern the participants’ understandings of specific challenges and needs for responses in tunnels, but also to illuminate the impact of internal decisions and actions for saving lives safely. The first approximate 20 minutes was discussed as crucial for establishing a tunnel response, which is why this phase was focused on during Session II: a best-practice discussion based on the initial 20 minutes of a full-scaled exercise where several of the participants had been involved. Information gathering and sharing was highlighted as both crucial and challenging, which lead to the research group introducing and participants discussing practical implications of concepts of “situational awareness” in Session III. Session IV was a ‘digital exercise’ based on a crash and vehicle fire in a tunnel, aiming to wrap up the identified challenges and practicing information sharing and management during the initial 20 minutes of the response.The analysis was conducted as critical discussions in the research group, in-between the sessions and when the full series was conducted, set out to identify potential strengths and weaknesses/challenges of the design and content for knowledge development. The results will present the preliminary findings and contributions.Results The analysis performed for this abstract found that the focus groups series ha s strengths and weaknesses/challenges to build knowledge across organisations regarding potential MCI road tunnel responses. First, the opportunity to discuss the same questions from four “basis”/perspectives, including presenting the organisations own perspectives and exercise experiences, a theoretical concept, and a practical moment was a strength. However, rather than a progression of learning (such as becoming more effective in information sharing), the design primarily allowed analysis of a deeper and more complex understanding of the overall question of joint and timely responses. Second, the iterative and participatory design was a strength in terms of that the sessions could to some extent focus on the issues the participants highlighted. By using this method, the participants also had the possibility to reflect upon prior and upcoming sessions (Baum et al., 2006). This could, however, be a limitation for comparing results across different groups if the issues of concern diverge too much.Third, the focus groups could contribute to the organisations’ knowledge development across practices, such as identifying specifically critical moments when establishing a response or sharing thoughts about safety. Using this design could be a complement to the typical focus on actions in exercises and training (Roud et al., 2021). In addition, the nature of focus group data provides opportunities to analyse interactions (Wilkinson, 2021). Still, how the knowledge developed could be further implemented in and across the organisations remains unknown and needs further consideration in research and practice.Fourth, the focus groups were effective for researchers to explore how knowledge is shared and possible contradictions in interpretations and actions. This approach is valuable for developing knowledge in cross-practice collaborations (Edwards, 2012). Including materials from a full-scale exercise and a practical digital exercise was valuable due to the obvious connection to their work tasks and potential challenges, and to contextualize their learning. Further, the amount and various types of data obtained from each session, such as discussing a theoretical concept and a practical exercise moment, could pose challenges for analysis. However, including both structured discussions and practical exercises as stimuli could strengthen the internal validity of the findings (e.g., reduce the discrepancies between what they say they do and what they actually do).Fifth, using online meetings was time-effective (and safe during the COVID-19 pandemic), allowing participants and researchers to work from where they choose. However, the online setting produced primarily a dialogue between moderator and participants, with less initiatives for dialogues between participants. It co uld be valuable to further evaluate the design in physical meetings. Moreover, it was easier to drop out or pop out, to simultaneously manage other work tasks, from online meetings compared to physical meetings.ConclusionIn conclusion, we would here argue that using inter-organisational focus groups, that acknowledge participants needs for learning and providing various stimuli to engage in a shared problem, can contribute to knowledge development for future tunnel responses. Research and practice should further explore how various interpretations and actions can be used to improve strategies, communication and organizational changes. Further research could 67 also explore how discussion-based learning activities can be used as a platform to develop and main tain collaborative learning networks, and as a complement to exercises and simulations.
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| 7. |
- Erlinge, David, et al.
(författare)
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Bivalirudin versus heparin monotherapy in non-ST-segment elevation myocardial infarction
- 2019
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Ingår i: European Heart Journal. - : Sage Publications. - 2048-8726 .- 2048-8734. ; 8:6, s. 492-501
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The optimal anti-coagulation strategy for patients with non-ST-elevation myocardial infarction treated with percutaneous coronary intervention is unclear in contemporary clinical practice of radial access and potent P2Y12-inhibitors. The aim of this study was to investigate whether bivalirudin was superior to heparin monotherapy in patients with non-ST-elevation myocardial infarction without routine glycoprotein IIb/IIIa inhibitor use.METHODS: In a large pre-specified subgroup of the multicentre, prospective, randomised, registry-based, open-label clinical VALIDATE-SWEDEHEART trial we randomised patients with non-ST-elevation myocardial infarction undergoing percutaneous coronary intervention, treated with ticagrelor or prasugrel, to bivalirudin or heparin monotherapy with no planned use of glycoprotein IIb/IIIa inhibitors during percutaneous coronary intervention. The primary endpoint was the rate of a composite of all-cause death, myocardial infarction or major bleeding within 180 days.RESULTS: A total of 3001 patients with non-ST-elevation myocardial infarction, were enrolled. The primary endpoint occurred in 12.1% (182 of 1503) and 12.5% (187 of 1498) of patients in the bivalirudin and heparin groups, respectively (hazard ratio of bivalirudin compared to heparin treatment 0.96, 95% confidence interval 0.78-1.18, p=0.69). The results were consistent in all major subgroups. All-cause death occurred in 2.0% versus 1.7% (hazard ratio 1.15, 0.68-1.94, p=0.61), myocardial infarction in 2.3% versus 2.5% (hazard ratio 0.91, 0.58-1.45, p=0.70), major bleeding in 8.9% versus 9.1% (hazard ratio 0.97, 0.77-1.24, p=0.82) and definite stent thrombosis in 0.3% versus 0.2% (hazard ratio 1.33, 0.30-5.93, p=0.82).CONCLUSION: Bivalirudin as compared to heparin during percutaneous coronary intervention for non-ST-elevation myocardial infarction did not reduce the composite of all-cause death, myocardial infarction or major bleeding in non-ST-elevation myocardial infarction patients receiving current recommended treatments with modern P2Y12-inhibitors and predominantly radial access.
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| 8. |
- Erlinge, David, et al.
(författare)
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Rapid Endovascular Catheter Core Cooling Combined With Cold Saline as an Adjunct to Percutaneous Coronary Intervention for the Treatment of Acute Myocardial Infarction The CHILL-MI Trial : A Randomized Controlled Study of the Use of Central Venous Catheter Core Cooling Combined With Cold Saline as an Adjunct to Percutaneous Coronary Intervention for the Treatment of Acute Myocardial Infarction
- 2014
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Ingår i: Journal of the American College of Cardiology. - : Elsevier BV. - 0735-1097 .- 1558-3597. ; 63:18, s. 1857-1865
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Tidskriftsartikel (refereegranskat)abstract
- Objectives The aim of this study was to confirm the cardioprotective effects of hypothermia using a combination of cold saline and endovascular cooling. Background Hypothermia has been reported to reduce infarct size (IS) in patients with ST-segment elevation myocardial infarctions. Methods In a multicenter study, 120 patients with ST-segment elevation myocardial infarctions (<6 h) scheduled to undergo percutaneous coronary intervention were randomized to hypothermia induced by the rapid infusion of 600 to 2,000 ml cold saline and endovascular cooling or standard of care. Hypothermia was initiated before percutaneous coronary intervention and continued for 1 h after reperfusion. The primary end point was IS as a percent of myocardium at risk (MaR), assessed by cardiac magnetic resonance imaging at 4 +/- 2 days. Results Mean times from symptom onset to randomization were 129 +/- 56 min in patients receiving hypothermia and 132 +/- 64 min in controls. Patients randomized to hypothermia achieved a core body temperature of 34.7 degrees C before reperfusion, with a 9-min longer door-to-balloon time. Median IS/MaR was not significantly reduced (hypothermia: 40.5% [interquartile range: 29.3% to 57.8%; control: 46.6% [interquartile range: 37.8% to 63.4%]; relative reduction 13%; p = 0.15). The incidence of heart failure was lower with hypothermia at 45 +/- 15 days (3% vs. 14%, p < 0.05), with no mortality. Exploratory analysis of early anterior infarctions (0 to 4 h) found a reduction in IS/MaR of 33% (p < 0.05) and an absolute reduction of IS/left ventricular volume of 6.2% (p = 0.15). Conclusions Hypothermia induced by cold saline and endovascular cooling was feasible and safe, and it rapidly reduced core temperature with minor reperfusion delay. The primary end point of IS/MaR was not significantly reduced. Lower incidence of heart failure and a possible effect in patients with early anterior ST-segment elevation myocardial infarctions need confirmation. (Efficacy of Endovascular Catheter Cooling Combined With Cold Saline for the Treatment of Acute Myocardial Infarction [CHILL-MI]; NCT01379261)
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| 9. |
- Erlinge, David, et al.
(författare)
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Therapeutic Hypothermia for the Treatment of Acute Myocardial Infarction-Combined Analysis of the RAPID MI-ICE and the CHILL-MI Trials
- 2015
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Ingår i: Therapeutic Hypothermia and Temperature Management. - : Mary Ann Liebert Inc. - 2153-7658 .- 2153-7933. ; 5:2, s. 77-84
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Tidskriftsartikel (refereegranskat)abstract
- In the randomized rapid intravascular cooling in myocardial infarction as adjunctive to percutaneous coronary intervention (RAPID MI-ICE) and rapid endovascular catheter core cooling combined with cold saline as an adjunct to percutaneous coronary intervention for the treatment of acute myocardial infarction CHILL-MI studies, hypothermia was rapidly induced in conscious patients with ST-elevation myocardial infarction (STEMI) by a combination of cold saline and endovascular cooling. Twenty patients in RAPID MI-ICE and 120 in CHILL-MI with large STEMIs, scheduled for primary percutaneous coronary intervention (PCI) within <6 hours after symptom onset were randomized to hypothermia induced by rapid infusion of 600-2000mL cold saline combined with endovascular cooling or standard of care. Hypothermia was initiated before PCI and continued for 1-3 hours after reperfusion aiming at a target temperature of 33 degrees C. The primary endpoint was myocardial infarct size (IS) as a percentage of myocardium at risk (IS/MaR) assessed by cardiac magnetic resonance imaging at 4 +/- 2 days. Patients randomized to hypothermia treatment achieved a mean core body temperature of 34.7 degrees C before reperfusion. Although significance was not achieved in CHILL-MI, in the pooled analysis IS/MaR was reduced in the hypothermia group, relative reduction (RR) 15% (40.5, 28.0-57.6 vs. 46.6, 36.8-63.8, p=0.046, median, interquartile range [IQR]). IS/MaR was predominantly reduced in early anterior STEMI (0-4h) in the hypothermia group, RR=31% (40.5, 28.8-51.9 vs. 59.0, 45.0-67.8, p=0.01, median, IQR). There was no mortality in either group. The incidence of heart failure was reduced in the hypothermia group (2 vs. 11, p=0.009). Patients with large MaR (>30% of the left ventricle) exhibited significantly reduced IS/MaR in the hypothermia group (40.5, 27.0-57.6 vs. 55.1, 41.1-64.4, median, IQR; hypothermia n=42 vs. control n=37, p=0.03), while patients with MaR<30% did not show effect of hypothermia (35.8, 28.3-57.5 vs. 38.4, 27.4-59.7, median, IQR; hypothermia n=15 vs. control n=19, p=0.50). The prespecified pooled analysis of RAPID MI-ICE and CHILL-MI indicates a reduction of myocardial IS and reduction in heart failure by 1-3 hours with endovascular cooling in association with primary PCI of acute STEMI predominantly in patients with large area of myocardium at risk. (ClinicalTrials.gov id NCT00417638 and NCT01379261).
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| 10. |
- Hanpatchaiyakul, Kulnaree, 1961-
(författare)
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Barriers to alcohol addiction treatment in women and men experiencing alcohol addiction in a Thai context : Exploring lived experiences and healthcare providers’ perspectives
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Risky drinking behaviour can strongly influence the lives of individuals and families, including having negative effects on social welfare and health. The low rate of healthcare service use among people experiencing alcohol addiction is an important problem in Thai society.The overall aim of the study was to explore the barriers to alcohol treatments for people experiencing alcohol addiction. This thesis includes four qualitative studies that employed three different data collection methods. Individual interviews were used in studies I and II and were analysed with descriptive phenomenology. Focus group interviews were conducted in study III, and the Delphi method was applied in study IV. Both of the latter studies employed content analysis. Purposive sampling was applied to identify participants for the four studies, which included 13 men (study I) and 12 women (study II) experiencing alcohol addiction, 32 healthcare providers (study III) and 32 experts in the alcohol treatment field (study IV); the providers and experts were primarily nurses (study III and IV).The identified barriers at the individual level included the unawareness of alcohol addiction, gender differences in treatment and in society, the experienced stigma related to alcohol addiction and the lack of engagement in alcohol treatment. Barriers at the organizational level were related to healthcare providers’ agencies and engagement, vertical and horizontal collaborative practices within the hospital wards, and the collaboration with patients and their next of kin. Additionally, the struggle of handling the different sexes during treatment and the difficulties of using the required standard methods were described by the healthcare providers. At the structural level, the barriers were related to the patriarchal society, gender equity and the resources and funding from the Ministry of Public Health for improving the well-being and equal healthcare rights of people experiencing alcohol addiction in Thailand.In order to improve equal rights to health for people experiencing alcohol addiction in Thailand, knowledge of alcohol addiction, stigma and domestic violence related issues needs to be improved in the healthcare service system. Formal training and nurse educational programmes are needed to reach the theoretical and practical potential of nurses and of other healthcare providers working in alcohol addiction.Key words: alcohol addiction, gender perspective, lived experiences, alcohol dependency, focus- group interviews, Delphi study
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