| 1. |
- Rubertsson, Sten, et al.
(författare)
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Mechanical chest compressions and simultanous defibrillationvs conventional cardiopulmonary resuscitationin out-of hospital cardiac arrest:the LINC randomized trial
- 2014
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Ingår i: Journal of the American Medical Association (JAMA). - : American Medical Association. - 0098-7484 .- 1538-3598. ; 311:1, s. 53-61
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Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE: A strategy using mechanical chest compressions might improve the poor outcome in out-of-hospital cardiac arrest, but such a strategy has not been tested in large clinical trials. OBJECTIVE: To determine whether administering mechanical chest compressions with defibrillation during ongoing compressions (mechanical CPR), compared with manual cardiopulmonary resuscitation (manual CPR), according to guidelines, would improve 4-hour survival. DESIGN, SETTING, AND PARTICIPANTS: Multicenter randomized clinical trial of 2589 patients with out-of-hospital cardiac arrest conducted between January 2008 and February 2013 in 4 Swedish, 1 British, and 1 Dutch ambulance services and their referring hospitals. Duration of follow-up was 6 months. INTERVENTIONS: Patients were randomized to receive either mechanical chest compressions (LUCAS Chest Compression System, Physio-Control/Jolife AB) combined with defibrillation during ongoing compressions (n = 1300) or to manual CPR according to guidelines (n = 1289). MAIN OUTCOMES AND MEASURES: Four-hour survival, with secondary end points of survival up to 6 months with good neurological outcome using the Cerebral Performance Category (CPC) score. A CPC score of 1 or 2 was classified as a good outcome. RESULTS: Four-hour survival was achieved in 307 patients (23.6%) with mechanical CPR and 305 (23.7%) with manual CPR (risk difference, -0.05%; 95% CI, -3.3% to 3.2%; P > .99). Survival with a CPC score of 1 or 2 occurred in 98 (7.5%) vs 82 (6.4%) (risk difference, 1.18%; 95% CI, -0.78% to 3.1%) at intensive care unit discharge, in 108 (8.3%) vs 100 (7.8%) (risk difference, 0.55%; 95% CI, -1.5% to 2.6%) at hospital discharge, in 105 (8.1%) vs 94 (7.3%) (risk difference, 0.78%; 95% CI, -1.3% to 2.8%) at 1 month, and in 110 (8.5%) vs 98 (7.6%) (risk difference, 0.86%; 95% CI, -1.2% to 3.0%) at 6 months with mechanical CPR and manual CPR, respectively. Among patients surviving at 6 months, 99% in the mechanical CPR group and 94% in the manual CPR group had CPC scores of 1 or 2. CONCLUSIONS AND RELEVANCE: Among adults with out-of-hospital cardiac arrest, there was no significant difference in 4-hour survival between patients treated with the mechanical CPR algorithm or those treated with guideline-adherent manual CPR. The vast majority of survivors in both groups had good neurological outcomes by 6 months. In clinical practice, mechanical CPR using the presented algorithm did not result in improved effectiveness compared with manual CPR. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00609778.
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| 2. |
- Rubertsson, Sten, et al.
(författare)
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Per-Protocol and Pre-Defined population analysis of the LINC study
- 2015
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Ingår i: Resuscitation. - : Elsevier BV. - 0300-9572 .- 1873-1570. ; 96, s. 92-99
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To perform two predefined sub-group analyses within the LINC study and evaluate if the results were supportive of the previous reported intention to treat (ITT) analysis.METHODS: Predefined subgroup analyses from the previously published LINC study were performed. The Per-Protocol population (PPP) included the randomized patients included in the ITT-population but excluding those with violated inclusion or exclusion criteria and those that did not get the actual treatment to which the patient was randomized. In the Pre-Defined population (PDP) analyses patients were also excluded if the dispatch time to ambulance arrival at the address exceeded 12min, there was a non-witnessed cardiac arrest, or if it was not possible to determine whether the arrest was witnessed or not, and those cases where LUCAS was not brought to the scene at the first instance.RESULTS: After exclusion from the 2589 patients within the ITT-population, the Per-Protocol analysis was performed in 2370 patients and the Pre-Defined analysis within 1133 patients. There was no significant difference in 4-h survival of patients between the mechanical-CPR group and the manual-CPR group in the Per-Protocol population; 279 of 1172 patients (23.8%) versus 281 of 1198 patients (23.5%) (risk difference -0.35%, 95% C.I. -3.1 to 3.8, p=0.85) or in the Pre-Defined population; 176 of 567 patients (31.0%) versus 192 of 566 patients (33.9%) (risk difference -2.88%, 95% C.I. -8.3 to 2.6, p=0.31). There was no difference in any of the second outcome variables analyzed in the Pre-Protocol or Pre-Defined populations.CONCLUSIONS: The results from these predefined sub-group analyses of the LINC study population did not show any difference in 4h survival or in secondary outcome variables between patients treated with mechanical-CPR or manual-CPR. This is consistent with the previously published ITT analysis.
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| 3. |
- Bergkvist, Sara, et al.
(författare)
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Transition from a two-dimensional superfluid to a one-dimensional mott insulator
- 2007
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Ingår i: Physical Review Letters. - 0031-9007 .- 1079-7114. ; 99:11, s. 110401-1-110401-5
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Tidskriftsartikel (refereegranskat)abstract
- A two-dimensional system of atoms in an anisotropic optical lattice is studied theoretically. If the system is finite in one direction, it is shown to exhibit a transition between a two-dimensional superfluid and a one-dimensional Mott insulating chain of superfluid tubes. Monte Carlo simulations are consistent with the expectation that the phase transition is of Kosterlitz-Thouless type. The effect of the transition on experimental time-of-flight images is discussed.
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| 4. |
- Magnusson, Peter, et al.
(författare)
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Balloon venoplasty opens the road for an implantable defibrillator patient with complex stenosis
- 2017
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Ingår i: Clinical Case Reports. - : Wiley. - 2050-0904. ; 5:7, s. 1067-1071
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Tidskriftsartikel (refereegranskat)abstract
- Key Clinical Message There is an increasing need for physicians to handle venous obstructions in pacemaker/implantable cardioverter-defibrillator implants. Venoplasty performed by an experienced operator is a simple, safe, and fast way to manage this situation and proceed to implant. Compared to other approaches, this strategy may offer particular advantages.
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| 5. |
- Magnusson, Peter, et al.
(författare)
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Placement Of Cardiac PacemaKEr Trial (POCKET) - rationale and design : a randomized controlled trial
- 2017
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Ingår i: Heart International. - : Touch Medical Media, Ltd.. - 1826-1868 .- 2036-2579. ; 12:1, s. E8-E11
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Tidskriftsartikel (refereegranskat)abstract
- Background: A pacemaker system consists of one or two leads connected to a device that is implanted into a pocket formed just below the collarbone. This pocket is typically subcutaneous, that is, located just above the pectoral fascia. Even though the size of pacemakers has decreased markedly, complications due to superficial implants do occur. An alternative technique would be intramuscular placement of the pacemaker device, but there are no randomized controlled trials (RCTs) to support this approach, which is the rationale for the Placement Of Cardiac PacemaKEr Trial (POCKET). The aim is to study if intramuscular is superior to subcutaneous placement of a pacemaker pocket. Methods: In October 2016, we started to enroll 200 consecutive patients with an indication for bradycardia pacemaker implantation. Patients are randomized to random block sizes, stratified by age group (cut-off: 65 years) and sex, and then randomized to either subcutaneous or intramuscular implant. A concealed allocation procedure is employed, using sequentially numbered, sealed envelopes. Pocket site is blinded to the patient and in all subsequent care. The primary endpoint is patient overall satisfaction with the pocket location at 24 months as measured using a visual analog scale (VAS) 0-10. Secondary endpoints are: complications, patient-reported satisfaction at 1, 12, and 24 months (overall satisfaction, pain, discomfort, degree of unsightly appearance, movement problems, and sleep problems due to device). Conclusions: POCKET is a prospective interventional RCT designed to evaluate if intramuscular is superior to subcutaneous placement of a bradycardia pacemaker during a two-year follow-up.
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| 6. |
- Omerovic, Elmir, 1968, et al.
(författare)
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Rationale and Design of Switch Swedeheart: A Registry-Based, Stepped-Wedge, Cluster-Randomized, Open-Label Multicenter Trial to Compare Prasugrel and Ticagrelor for Treatment of Patients with Acute Coronary Syndrome.
- 2022
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Ingår i: American heart journal. - : Elsevier BV. - 0002-8703 .- 1097-6744. ; 251, s. 70-77
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Tidskriftsartikel (refereegranskat)abstract
- European treatment guidelines recommend prasugrel over ticagrelor for treating patients with non-ST-elevation acute coronary syndrome (ACS), prompting several Swedish administrative regions to transition from ticagrelor to prasugrel as the preferred treatment for patients with ACS. We aim to systematically evaluate this transition to determine the relative efficacy of prasugrel versus ticagrelor in a real-world cohort of patients with ACS.The SWITCH SWEDEHEART trial is a prospective, multicenter, open-label, cross-sectional, stepped-wedge cluster-randomized clinical trial, in which administrative regions in Sweden will constitute the clusters. At the start of the study, all clusters will use ticagrelor as the P2Y12 inhibitor drug of choice for ACS. The order in which the clusters will implement the transition from ticagrelor to prasugrel will be randomly assigned. Every nine months, one cluster will switch from ticagrelor to prasugrel as the P2Y12 inhibitor of choice for patients with ACS. The primary endpoint is the composite one-year death rate, stroke, or myocardial infarction.The SWITCH SWEDEHEART study will provide an extensive randomized comparison between ticagrelor and prasugrel to date. Novel therapies are frequently costly and supported by evidence from few or small studies, and systematic evaluation after the introduction is rare. This study will establish an important standard for introducing and evaluating the effects of healthcare changes within our societies.
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| 7. |
- Rehn, Magnus, 1972-, et al.
(författare)
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One-dimensional phase transitions in a two-dimensional optical lattice
- 2008
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Ingår i: European Physical Journal D. - : Springer Science and Business Media LLC. - 1434-6060 .- 1434-6079. ; 49:2, s. 223-230
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Tidskriftsartikel (refereegranskat)abstract
- A phase transition for bosonic atoms in a two-dimensional anisotropic optical lattice is considered. If the tunnelling rates in two directions are different, the system can undergo a transition between a two-dimensional superfluid and a one-dimensional Mott insulating array of strongly coupled tubes. The connection to other lattice models is exploited in order to better understand the phase transition. Critical properties are obtained using quantum Monte Carlo calculations. These critical properties are related to correlation properties of the bosons and a criterion for commensurate filling is established.
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| 8. |
- Saers, Robert, 1977-, et al.
(författare)
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A set-up for flexible geometry optical lattices
- 2008
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Ingår i: European Physical Journal. - : EDP Sciences. - 1286-0042 .- 1286-0050. ; 42:3, s. 269-273
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Tidskriftsartikel (refereegranskat)abstract
- We have developed an alignment tool for optical lattices with arbitrary beam angles, allowing for optical potentials with a range of geometries and topographies. A calibration procedure has been introduced, giving a precision of 10 mrad in the chosen beam angle, and a high degree of flexibility. The tool has been tested in simplified experiments on the confinement and expansion of cold atoms in one-dimensional and two-dimensional optical lattices, and has proved to work well.
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| 9. |
- Saers, Robert, 1977-
(författare)
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Ultracold rubidium atoms in periodic potentials
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis includes both experimental and theoretical investigations, presented in a series of eight papers. The experimental part ranges from the construction procedures of an apparatus for Bose-Einstein condensates, to full scale experiments using three different set-ups for ultracold atoms in optical lattices. As one of the main themes of the thesis, an experimental apparatus for production of Bose-Einstein Condensates is under construction. A magneto-optically trapped sample, hosting more than 200 million 87Rb atoms, have successfully been loaded into a magnetic trap with high transfer rate. The lifetime of the sample in the magnetic trap is in the range of 9 s, and the atoms have been shown to respond to evaporative cooling. The experiment is ready for optimization of the magnetic trap loading, and evaporative cooling parameters, which are the final steps for reaching Bose-Einstein condensation. The set-up is designed to host experiments including variable geometry optical lattices, and includes the possibility to align laser beams with high angular precision for this purpose. The breakdown of Bloch waves in a Bose-Einstein condensate is studied, attributed to the effect of energetic and dynamical instability. This experimental study is performed using a Bose-Einstein condensate in a moving one-dimensional optical lattice at LENS, Florence Italy. The optical lattice parameters, and the thermal distribution of the atomic sample required to trigger the instabilities, are detected, and compared with a theoretical model developed in parallel with the experiments. In close connection with these one-dimensional lattice studies, an experimental survey to characterize regimes of superradiant Rayleigh scattering and Bragg scattering is presented. Tunneling properties of repulsively bound atom pairs in double well potentials are characterized in an experiment at Johannes Gutenberg University, Mainz Germany. A three-dimensional optical lattice, producing an array of double wells with tunable properties is let to interact with a Bose-Einstein condensate. Pairs of ultracold atoms are produced on one side in the double wells, and their tunneling behavior, dependent on potential barrier and repulsion properties, is studied. A theoretical study of the crossover between one- and two-dimensional systems has been performed. The simulations were made for a two-dimensional array of atoms, where the behavior for different tunneling probabilities and atom-atom repulsion strengths was studied. Scaling relations for systems of variable sizes have been examined in detail, and numerical values for the involved variables have been found.
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