| 1. |
- Jung, Christian, et al.
(författare)
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A comparison of very old patients admitted to intensive care unit after acute versus elective surgery or intervention
- 2019
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Ingår i: Journal of critical care. - : W B SAUNDERS CO-ELSEVIER INC. - 0883-9441 .- 1557-8615. ; 52, s. 141-148
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Tidskriftsartikel (refereegranskat)abstract
- Background: We aimed to evaluate differences in outcome between patients admitted to intensive care unit (ICU) after elective versus acute surgery in a multinational cohort of very old patients (80 years; VIP). Predictors of mortality, with special emphasis on frailty, were assessed.Methods: In total, 5063 VIPs were induded in this analysis, 922 were admitted after elective surgery or intervention, 4141 acutely, with 402 after acute surgery. Differences were calculated using Mann-Whitney-U test and Wilcoxon test. Univariate and multivariable logistic regression were used to assess associations with mortality.Results: Compared patients admitted after acute surgery, patients admitted after elective surgery suffered less often from frailty as defined as CFS (28% vs 46%; p < 0.001), evidenced lower SOFA scores (4 +/- 5 vs 7 +/- 7; p < 0.001). Presence of frailty (CFS >4) was associated with significantly increased mortality both in elective surgery patients (7% vs 12%; p = 0.01), in acute surgery (7% vs 12%; p = 0.02).Conclusions: VIPs admitted to ICU after elective surgery evidenced favorable outcome over patients after acute surgery even after correction for relevant confounders. Frailty might be used to guide clinicians in risk stratification in both patients admitted after elective and acute surgery.
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| 2. |
- Berglund, Johan, et al.
(författare)
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Prospective motion correction for diffusion weighted EPI of the brain using an optical markerless tracker.
- 2021
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Ingår i: Magnetic Resonance in Medicine. - : Wiley. - 0740-3194 .- 1522-2594. ; 85:3, s. 1427-1440
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To enable motion-robust diffusion weighted imaging of the brain using well-established imaging techniques.METHODS: An optical markerless tracking system was used to estimate and correct for rigid body motion of the head in real time during scanning. The imaging coordinate system was updated before each excitation pulse in a single-shot EPI sequence accelerated by GRAPPA with motion-robust calibration. Full Fourier imaging was used to reduce effects of motion during diffusion encoding. Subjects were imaged while performing prescribed motion patterns, each repeated with prospective motion correction on and off.RESULTS: Prospective motion correction with dynamic ghost correction enabled high quality DWI in the presence of fast and continuous motion within a 10° range. Images acquired without motion were not degraded by the prospective correction. Calculated diffusion tensors tolerated the motion well, but ADC values were slightly increased.CONCLUSIONS: Prospective correction by markerless optical tracking minimizes patient interaction and appears to be well suited for EPI-based DWI of patient groups unable to remain still including those who are not compliant with markers.
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| 3. |
- Agewall, Stefan, et al.
(författare)
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Efterlyses : politik mot hjärtinfarkt
- 2013
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Ingår i: Läkartidningen. - Stockholm : Sveriges läkarförbund. - 0023-7205 .- 1652-7518. ; 110:13-14, s. 664-
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Tidskriftsartikel (refereegranskat)
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| 4. |
- Anand, Sonia S, et al.
(författare)
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Rivaroxaban with or without aspirin in patients with stable peripheral or carotid artery disease: an international, randomised, double-blind, placebo-controlled trial.
- 2018
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Ingår i: Lancet (London, England). - 1474-547X. ; 391:10117, s. 219-229
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Tidskriftsartikel (refereegranskat)abstract
- Patients with peripheral artery disease have an increased risk of cardiovascular morbidity and mortality. Antiplatelet agents are widely used to reduce these complications.This was a multicentre, double-blind, randomised placebo-controlled trial for which patients were recruited at 602 hospitals, clinics, or community practices from 33 countries across six continents. Eligible patients had a history of peripheral artery disease of the lower extremities (previous peripheral bypass surgery or angioplasty, limb or foot amputation, intermittent claudication with objective evidence of peripheral artery disease), of the carotid arteries (previous carotid artery revascularisation or asymptomatic carotid artery stenosis of at least 50%), or coronary artery disease with an ankle-brachial index of less than 0·90. After a 30-day run-in period, patients were randomly assigned (1:1:1) to receive oral rivaroxaban (2·5 mg twice a day) plus aspirin (100 mg once a day), rivaroxaban twice a day (5 mg with aspirin placebo once a day), or to aspirin once a day (100 mg and rivaroxaban placebo twice a day). Randomisation was computer generated. Each treatment group was double dummy, and the patient, investigators, and central study staff were masked to treatment allocation. The primary outcome was cardiovascular death, myocardial infarction or stroke; the primary peripheral artery disease outcome was major adverse limb events including major amputation. This trial is registered with ClinicalTrials.gov, number NCT01776424, and is closed to new participants.Between March 12, 2013, and May 10, 2016, we enrolled 7470 patients with peripheral artery disease from 558 centres. The combination of rivaroxaban plus aspirin compared with aspirin alone reduced the composite endpoint of cardiovascular death, myocardial infarction, or stroke (126 [5%] of 2492 vs 174 [7%] of 2504; hazard ratio [HR] 0·72, 95% CI 0·57-0·90, p=0·0047), and major adverse limb events including major amputation (32 [1%] vs 60 [2%]; HR 0·54 95% CI 0·35-0·82, p=0·0037). Rivaroxaban 5 mg twice a day compared with aspirin alone did not significantly reduce the composite endpoint (149 [6%] of 2474 vs 174 [7%] of 2504; HR 0·86, 95% CI 0·69-1·08, p=0·19), but reduced major adverse limb events including major amputation (40 [2%] vs 60 [2%]; HR 0·67, 95% CI 0·45-1·00, p=0·05). The median duration of treatment was 21 months. The use of the rivaroxaban plus aspirin combination increased major bleeding compared with the aspirin alone group (77 [3%] of 2492 vs 48 [2%] of 2504; HR 1·61, 95% CI 1·12-2·31, p=0·0089), which was mainly gastrointestinal. Similarly, major bleeding occurred in 79 (3%) of 2474 patients with rivaroxaban 5 mg, and in 48 (2%) of 2504 in the aspirin alone group (HR 1·68, 95% CI 1·17-2·40; p=0·0043).Low-dose rivaroxaban taken twice a day plus aspirin once a day reduced major adverse cardiovascular and limb events when compared with aspirin alone. Although major bleeding was increased, fatal or critical organ bleeding was not. This combination therapy represents an important advance in the management of patients with peripheral artery disease. Rivaroxaban alone did not significantly reduce major adverse cardiovascular events compared with asprin alone, but reduced major adverse limb events and increased major bleeding.Bayer AG.
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| 5. |
- Anell, Anders, et al.
(författare)
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A randomized comparison between league tables and funnel plots as an aid to health care decision-making
- 2017
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Ingår i: International Journal for Quality in Health Care. - : Oxford University Press (OUP). - 1464-3677 .- 1353-4505. ; 28:6, s. 816-823
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Tidskriftsartikel (refereegranskat)abstract
- Objective Comparison of provider performance is commonly used to inform health care decision-making. Little attention has been paid to how data presentations influence decisions. This study analyzes differences in suggested actions by decision-makers informed by league tables or funnel plots.Design Decision-makers were invited to a survey and randomized to compare hospital performance using either league tables or funnel plots for four different measures within the area of cancer care. For each measure, decision-makers were asked to suggest actions towards 12–16 hospitals (no action, ask for more information, intervene) and provide feedback related to whether the information provided had been useful.Setting Swedish health care.Participants Two hundred and twenty-one decision-makers at administrative and clinical levels.Intervention Data presentations in the form of league tables or funnel plots.Main outcome measures Number of actions suggested by participants. Proportion of appropriate actions.Results For all four measures, decision-makers tended to suggest more actions based on the information provided in league tables compared to funnel plots (44% vs. 21%, P < 0.001). Actions were on average more appropriate for funnel plots. However, when using funnel plots, decision-makers more often missed to react even when appropriate.Conclusions The form of data presentation had an influence on decision-making. With league tables, decision-makers tended to suggest more actions compared to funnel plots. A difference in sensitivity and specificity conditioned by the form of presentation could also be identified, with different implications depending on the purpose of comparisons. Explanations and visualization aids are needed to support appropriate actions.
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| 6. |
- Anselm, Jonas, et al.
(författare)
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Bannlys alla politiska beslut som ger mer klimatutsläpp
- 2014
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Ingår i: Dagens Nyheter.
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Torftig valdebatt. Dagspolitiken klarar inte att hantera ödesfrågan om klimatet, vilket oroar oss. Vi föreslår därför ett ”utsläppsmoratorium”: inga beslut får tas som ökar utsläppen av växthusgaser. Principen måste kopplas till mål om exempelvis förnybar energi och grön infrastruktur, skriver 23 forskare och debattörer.
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| 7. |
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| 8. |
- Avventi, Enrico, et al.
(författare)
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Projection-based 3D/2D registration for prospective motion correction.
- 2020
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Ingår i: Magnetic Resonance in Medicine. - : Wiley. - 0740-3194 .- 1522-2594. ; 84:3, s. 1534-1542
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To develop a registration method that is capable of estimating the full range of rigid body motion from three orthogonal collapsed images of the head. These images can be obtained using the collapsed FatNav, a previously introduced navigator for prospective motion correction. It combines a short duration with wide compatibility with different main sequences due to its robustness against spin history effects.THEORY AND METHODS: A projection-based 3D/2D registration method is presented and then modified to take into account the peculiarities of the collapsed FatNav. Water/fat separated volumes were used in simulations to assess the accuracy of the proposed method at different resolutions by comparison with high-resolution 3D registration. The sensitivity with respect to masking strategies and starting motion parameters was investigated. Finally, prospective experiments with a healthy volunteer were performed with different types of motion patterns. A PROPELLER main sequence was chosen to compare the prospective correction with PROPELLER's own retrospective correction.RESULTS: In the simulations the proposed method has shown comparable performance to 3D registration. Furthermore, evidence of its robustness with respect to masking strategies and starting motion parameters was presented. The combination with collapsed FatNav has performed well in correcting most of the motion artifacts prospectively with improved image quality compared to only using PROPELLER's retrospective motion correction.CONCLUSIONS: The proposed 3D/2D registration together with collapsed FatNav is characterized by a good balance between navigator duration and estimate accuracy. Further work is needed to validate the method across a wider variety of subject anatomies.
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| 9. |
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| 10. |
- Berglund, Johan, et al.
(författare)
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Fat/water separation in k-space with real-valued estimates and its combination with POCS.
- 2020
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Ingår i: Magnetic Resonance in Medicine. - : Wiley. - 0740-3194 .- 1522-2594. ; 83:2, s. 653-661
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To develop reconstruction methods for improved image quality of chemical shift displacement-corrected fat/water imaging combined with partial Fourier acquisition.THEORY: Fat/water separation in k-space enables correction of chemical shift displacement. Modeling fat and water as real-valued rather than complex improves the conditionality of the inverse problem. This advantage becomes essential for k-space separation. In this work, it was described how to perform regularized fat/water imaging with real estimates in k-space, and how fat/water imaging can be combined with partial Fourier reconstruction using Projection Onto Convex Sets (POCS).METHODS: The reconstruction methods were demonstrated on chemical shift encoded gradient echo and fast spin echo data from volunteers, acquired at 1.5 T and 3 T. Both fully sampled and partial Fourier acquisitions were made. Data was retrospectively rejected from the fully sampled dataset to evaluate POCS and homodyne reconstruction.RESULTS: Fat/water separation in k-space eliminated chemical shift displacement, while real-valued estimates considerably reduced the noise amplification compared to complex estimates. POCS reconstruction could recover high spatial frequency information in the fat and water images with lower reconstruction error than homodyne. Partial Fourier in the readout direction enabled more flexible choice of gradient echo imaging parameters, in particular image resolution.CONCLUSION: Chemical shift displacement-corrected fat/water imaging can be performed with regularization and real-valued estimates to improve image quality by reducing ill-conditioning of the inverse problem in k-space. Fat/water imaging can be combined with POCS, which offers improved image quality over homodyne reconstruction.
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