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1.	Blomberg, Hans, et al. (författare) Poor chest compression quality with mechanical compressions in simulated cardiopulmonary resuscitation : A randomized, cross-over manikin study 2011 Ingår i: Resuscitation. - : Elsevier BV. - 0300-9572 .- 1873-1570. ; 82:10, s. 1332-1337 Tidskriftsartikel (refereegranskat)abstract Introduction: Mechanical chest compression devices are being implemented as an aid in cardiopulmonary resuscitation (CPR), despite lack of evidence of improved outcome. This manikin study evaluates the CPR-performance of ambulance crews, who had a mechanical chest compression device implemented in their routine clinical practice 8 months previously. The objectives were to evaluate time to first defibrillation, no-flow time, and estimate the quality of compressions. Methods: The performance of 21 ambulance crews (ambulance nurse and emergency medical technician) with the authorization to perform advanced life support was studied in an experimental, randomized cross-over study in a manikin setup. Each crew performed two identical CPR scenarios, with and without the aid of the mechanical compression device LUCAS. A computerized manikin was used for data sampling. Results: There were no substantial differences in time to first defibrillation or no-flow time until first defibrillation. However, the fraction of adequate compressions in relation to total compressions was remarkably low in LUCAS-CPR (58%) compared to manual CPR (88%) (95% confidence interval for the difference: 13-50%). Only 12 out of the 21 ambulance crews (57%) applied the mandatory stabilization strap on the LUCAS device. Conclusions: The use of a mechanical compression aid was not associated with substantial differences in time to first defibrillation or no-flow time in the early phase of CPR. However, constant but poor chest compressions due to failure in recognizing and correcting a malposition of the device may counteract a potential benefit of mechanical chest compressions.
2.	Johansson, Jakob, et al. (författare) Prehospital Trauma Life Support (PHTLS) training of ambulance caregivers and impact on survival of trauma victims 2012 Ingår i: Resuscitation. - : Elsevier BV. - 0300-9572 .- 1873-1570. ; 83:10, s. 1259-1264 Tidskriftsartikel (refereegranskat)abstract BACKGROUND:The Prehospital Trauma Life Support (PHTLS) course has been widely implemented and approximately half a million prehospital caregivers in over 50 countries have taken this course. Still, the effect on injury outcome remains to be established. The objective of this study was to investigate the association between PHTLS training of ambulance crew members and the mortality in trauma patients.METHODS:A population-based observational study of 2830 injured patients, who either died or were hospitalized for more than 24h, was performed during gradual implementation of PHTLS in Uppsala County in Sweden between 1998 and 2004. Prehospital patient records were linked to hospital-discharge records, cause-of-death records, and information on PHTLS training and the educational level of ambulance crews. The main outcome measure was death, on scene or in hospital.RESULTS:Adjusting for multiple potential confounders, PHTLS training appeared to be associated with a reduction in mortality, but the precision of this estimate was poor (odds ratio, 0.71; 95% confidence interval, 0.42-1.19). The mortality risk was 4.7% (36/763) without PHTLS training and 4.5% (94/2067) with PHTLS training. The predicted absolute risk reduction is estimated to correspond to 0.5 lives saved annually per 100,000 population with PHTLS fully implemented.CONCLUSIONS:PHTLS training of ambulance crew members may be associated with reduced mortality in trauma patients, but the precision in this estimate was low due to the overall low mortality. While there may be a relative risk reduction, the predicted absolute risk reduction in this population was low.
3.	Ahlsson, Fredrik, et al. (författare) Treatment of extreme hyperglycemia monitored with intracerebral microdialysis. 2004 Ingår i: Pediatr Crit Care Med. - 1529-7535. ; 5:1, s. 89-92 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
4.	Aronsson Dannewitz, Anna, et al. (författare) Optimized diagnosis-based comorbidity measures for all-cause mortality prediction in a national population-based ICU population 2022 Ingår i: Critical Care. - : Springer Nature. - 1364-8535 .- 1466-609X. ; 26 Tidskriftsartikel (refereegranskat)abstract Background: We aimed to optimize prediction of long-term all-cause mortality of intensive care unit (ICU) patients, using quantitative register-based comorbidity information assessed from hospital discharge diagnoses prior to intensive care treatment.Material and methods: Adult ICU admissions during 2006 to 2012 in the Swedish intensive care register were followed for at least 4 years. The performance of quantitative comorbidity measures based on the 5-year history of number of hospital admissions, length of stay, and time since latest admission in 36 comorbidity categories was compared in time-to-event analyses with the Charlson comorbidity index (CCI) and the Simplified Acute Physiology Score (SAPS3).Results: During a 7-year period, there were 230,056 ICU admissions and 62,225 deaths among 188,965 unique individuals. The time interval from the most recent hospital stays and total length of stay within each comorbidity category optimized mortality prediction and provided clear separation of risk categories also within strata of age and CCI, with hazard ratios (HRs) comparing lowest to highest quartile ranging from 1.17 (95% CI: 0.52-2.64) to 6.41 (95% CI: 5.19-7.92). Risk separation was also observed within SAPS deciles with HR ranging from 1.07 (95% CI: 0.83-1.38) to 3.58 (95% CI: 2.12-6.03).Conclusion: Baseline comorbidity measures that included the time interval from the most recent hospital stay in 36 different comorbidity categories substantially improved long-term mortality prediction after ICU admission compared to the Charlson index and the SAPS score. Trial registration ClinicalTrials.gov ID NCT04109001, date of registration 2019-09-26 retrospectively.
5.	Arvidson, Johan, et al. (författare) Toxic epidermal necrolysis and hemolytic uremic syndrome after allogeneic stem-cell transplantation 2007 Ingår i: Pediatric Transplantation. - : Wiley. - 1397-3142 .- 1399-3046. ; 11:6, s. 689-693 Tidskriftsartikel (refereegranskat)abstract TEN and HUS are challenging complications with excessive mortality after HSCT. We report the development of these two conditions in combination in a nine-yr-old boy after HSCT from an unrelated donor. TEN with skin detachment of more than 90% of body surface area developed after initial treatment for GvHD. Within a few days of admission to the burns unit, the patient developed severe hemolysis, hypertension, thrombocytopenia, and acute renal failure consistent with HUS, apparently caused by CSA. The management included intensive care in a burns unit, accelerated drug removal using plasmapheresis, and a dedicated multi-disciplinary team approach to balance immunosuppression and infections management in a situation with extensive skin detachment. The patient survived and recovered renal function but requires continued treatment for severe GvHD. Suspecting and identifying causative drugs together with meticulous supportive care in the burns unit is essential in the management of these patients and long-term survival is possible.
6.	Bergström, Monica Frick, et al. (författare) Extent and consequences of misclassified injury diagnoses in a national hospital discharge registry 2011 Ingår i: Injury Prevention. - : BMJ. - 1353-8047 .- 1475-5785. ; 17:2, s. 108-113 Tidskriftsartikel (refereegranskat)abstract Background Classification of injuries and estimation of injury severity on the basis of ICD-10 injury coding are powerful epidemiological tools. Little is known about the characteristics and consequences of primary coding errors and their consequences for such applications. Materials and methods From the Swedish national hospital discharge register, 15 899 incident injury cases primarily admitted to the two hospitals in Uppsala County between 2000 and 2004 were identified. Of these, 967 randomly selected patient records were reviewed. Errors in injury diagnosis were corrected, and the consequences of these changes were analysed. Results Out of 1370 injury codes, 10% were corrected, but 95% of the injury codes were correct to the third position. In 21% (95% CI 19% to 24%) of 967 hospital admissions, at least one ICD-10 code for injury was changed or added, but only 13% (127) had some change made to their injury mortality diagnosis matrix classification. Among the cases with coding errors, the mean ICD-based injury severity score changed slightly (difference 0.016; 95% CI 0.007 to 0.032). The area under the receiver operating characteristics curve was 0.892 for predicting hospital mortality and remained essentially unchanged after the correction of codes (95% CI for difference -0.022 to 0.013). Conclusion Errors in ICD-10-coded injuries in hospital discharge data were common, but the consequences for injury categorisation were moderate and the consequences for injury severity estimates were in most cases minor. The error rate for detailed levels of cause-of-injury codes was high and may be detrimental for identifying specific targets for prevention.
7.	Bernhoff, Karin, et al. (författare) Popliteal artery injury in knee arthroplasty : a population based, nationwide study 2013 Ingår i: Journal of Bone and Joint Surgery. - 0301-620X .- 2044-5377. ; 95:12, s. 1645-1649 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract Popliteal artery injury (PAI) is a feared but rare complication during knee arthroplasty (KA). The aim was to study PAI during KA: Type of injury, treatment and outcome.Thirty-two cases were identified in the national Swedish vascular registry (Swedvasc) and the Swedish Patient Insurance databases. Prospective data from the registries was supplemented with case-records, including long-term follow-up.Twenty-five injuries (78%) were due to penetrating, seven to blunt trauma. Three different presentations of injury were identified: Bleeding (n=14), ischaemia (n=7) and false aneurysm formation (n=11). Five (16%) cases were during revision KA. Twelve injuries (38%) were detected intraoperatively, eight (25%) within 24 hours (range 3-24) and twelve (38%) >24 hours postoperatively (range 2-90), 28 (88%) were treated with open surgery. Patency at 30 days was 97% (one amputation). Twenty-five (78%) patients had residual symptoms at the end of follow-up (median 546 days, range: 24-1251). Six of the seven patients with complete recovery had an early diagnosis of the PAI during the procedure, and were treated by a vascular surgeon in the same hospital.Outcome after popliteal artery injury during KA is often negatively affected by diagnostic and therapeutic delay. Bleeding and pseudoaneurysm were the most common clinical presentations.
8.	Blomberg, Hans, 1963-, et al. (författare) Agreement between ambulance nurses and physicians in assessing stroke patients 2013 Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 129:1, s. 49-55 Tidskriftsartikel (refereegranskat)abstract Objectives: If an ambulance nurse could bypass the emergency department (ED) and bring suspected stroke patients directly to a CT scanner, time to thrombolysis could be shortened. This study evaluates the level of agreement between ambulance nurses and emergency physicians in assessing the need for a CT scan, and interventions and monitoring beforehand, in patients with suspected stroke and/or a lowered level of consciousness.Materials and Methods: From October 2008 to June 2009 we compared the ambulance nurses’ and ED physicians’ judgement of 200 patients with stroke symptoms . Both groups answered identical questions on patients’ need for a CT scan, and interventions and monitoring beforehand. Results: There was a poor agreement between ambulance nurses and ED physicians in judging the need for a CT scan: κ = 0.22 (95% confidence interval (CI): 0.06–0.37). The nurses’ ability to select the same patients as the physician for a CT scan had a sensitivity of 84% (95% CI: 77–89) and a specificity of 37% (95% CI: 23–53). Agreement concerning the need for interventions and monitoring was also low: κ = 0.32 (95% CI: 0.18–0.47). In 18% of cases, the nurses considered interventions before a CT scan unnecessary when the physicians’ deemed them necessary.Conclusions: Additional tools to support ambulance nurses decisions appear to be required before suspected stroke patients can be taken directly to a CT scanner.
9.	Blomberg, Hans, 1963-, et al. (författare) Impact of prehospital trauma life support (PHTLS) training of ambulance caregivers on the outcome of traffic injury victims – a nation-wide study. Annan publikation (övrigt vetenskapligt/konstnärligt)abstract Background: Prehospital trauma life support (PHTLS) is a widely implemented educational program for prehospital trauma care. Evidence for improved patient outcome is, however, limited. The primary aim of this nation-wide study was to investigate the association between regional implementation of PHTLS training and mortality after traffic injuries.Methods: We extracted from the Swedish National Patient Registry and the Cause of Death Registry information on victims of motor vehicle traffic injuries in Sweden from 2001 to 2004 (n=28 041). During this time period, PHTLS training was implemented at a varying pace in different regions. We used a Bayesian approach with Markov chain Monte Carlo to estimate odds ratios (OR) for prehospital and 30-day mortality. We entered region and hospital into hierarchical models and controlled for the calendar year for each injury. We analyzed the time to death and time to return to work using Cox’s proportional hazards frailty models.Results: A total of 1395 individuals died before being admitted to hospital. After multivariable adjustment, the OR for prehospital mortality with PHTLS-trained prehospital staff was 1.11 (95% credibility interval, 0.88 to 1.38). For 30-day mortality (365 deaths), the adjusted OR was 0.80 (95% credibility interval, 0.53 to 1.17). There was no association between PHTLS training and time to death (hazard ratio 0.99; 95% confidence interval, 0.85 to 1.14) or time to return to work (hazard ratio 0.98, 95% confidence interval, 0.92 to 1.05).Conclusion: The implementation of PHTLS training did not appear to reduce mortality or disability after motor vehicle traffic injuries. .
10.	Blomberg, Hans, 1963- (författare) Influence of The Education and Training of Prehospital Medical Crews on Measures of Performance and Patient Outcomes 2013 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract Prehospital care has developed dramatically the last decades with the implementation of new devices and educational concepts. Clinical decisions and treatments have moved out from the hospitals to the prehospital setting. In Sweden this has been accompanied by an increase in the level of competence, i.e. by introducing nurses in the ambulances. With some exceptions the scientific support for these changes is poor.This thesis deals with such changes in three different subsets of prehospital care: Cardiopulmonary resuscitation (CPR), the stroke chain of survival and trauma care.We assessed the performance of ambulance crews during CPR, using a mechanical compression device, as compared to CPR using manual compressions. There was a strikingly poor quality of compressions using the mechanical device compared to CPR with manual compressions. The result calls for caution when implementing a chest compression device in clinical practice and reinforce the importance of randomised controlled trials to evaluate new interventions. Careful attention should be given to the assurance of correct application of the device. Further implementation without evaluation of the quality of mechanical compressions in a clinical setting is discouraged.Among patients with a prehospital suspicion of stroke we analysed the ambulance nurses’ ability to select the correct patient subset eligible for a CT scan as a preparation for potential thrombolysis. The results do not support an implementation of a bypass of the emergency department, using ambulance nurse competence to select patients eligible and suitable for a CT scan without a preceding assessment by a physician.The association between the Prehospital Trauma Life Support (PHTLS) course and the outcome in victims of trauma was analysed in two observational studies. A study covering one county gave some support for a protective effect from PHTLS, but the estimate had a low precision. A nationwide study, covering all of Sweden, could not confirm those results. Although there was a reduction in mortality over time coinciding with the implementation of PHTLS, it did not appear to be associated with the implementation of PHTLS. Thus, we could not detect any clear beneficial impact of the PHTLS course on the outcome of trauma patients.
11.	Blomberg, Hans, et al. (författare) Prehospital Trauma Life Support Training of Ambulance Caregivers and the Outcomes of Traffic-Injury Victims in Sweden 2013 Ingår i: Journal of the American College of Surgeons. - : Ovid Technologies (Wolters Kluwer Health). - 1072-7515 .- 1879-1190. ; 217:6, s. 1010-1019 Tidskriftsartikel (refereegranskat)abstract BACKGROUND:There is limited evidence that the widely implemented Prehospital Trauma Life Support (PHTLS) educational program improves patient outcomes. The primary aim of this national study in Sweden was to investigate the association between regional implementation of PHTLS training and mortality after traffic injuries.STUDY DESIGN:We extracted information from the Swedish National Patient Registry and the Cause of Death Registry on victims of motor-vehicle traffic injuries in Sweden from 2001 to 2004 (N = 28,041). During this time period, PHTLS training was implemented at a varying pace in different regions. To control for other influences on patient outcomes related to regional and hospital-level effects, such as variations in performance of trauma care systems, we used Bayesian hierarchical regression models to estimate odds ratios for prehospital mortality and 30-day mortality after hospital admission. We also controlled for the calendar year for each injury to account for period effects. We analyzed the time to death after hospital admission and time to return to work using Cox's proportional hazards frailty models.RESULTS:After multivariable adjustment, the odds ratio for prehospital mortality with PHTLS-trained prehospital staff was 1.54 (95% credibility interval, 1.07-2.13). For 30-day mortality among those surviving to hospital admission, the odds ratio was 0.85 (95% credibility interval, 0.45-1.48). There was no association between PHTLS training and time to death (hazard ratio = 0.99; 95% CI, 0.85-1.14) or time to return to work (hazard ratio = 0.98; 95% CI, 0.92-1.05).CONCLUSIONS:In this observational study, the implementation of PHTLS training did not appear to be associated with reduced mortality or ability to return to work after motor-vehicle traffic injuries.
12.	Brink, Magnus, 1960, et al. (författare) Respiratory support during the influenza A (H1N1) pandemic flu in Sweden 2012 Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 56:8, s. 976-986 Tidskriftsartikel (refereegranskat)abstract Background Acute respiratory insufficiency characterised critically ill patients during the influenza A (H1N1) pandemic 20092010. Detailed understanding of disease progression and outcome in relation to different respiratory support strategies is important. Methods Data collected between August 2009 and February 2010 for a national intensive care unit influenza registry were combined with cases identified by the Swedish Institute for Infectious Disease Control. Results Clinical data was available for 95% (126/136) of the critically ill cases of influenza. Median age was 44 years, and major co-morbidities were present in 41%. Respiratory support strategies were studied among the 110 adult patients. Supplementary oxygen was sufficient in 15% (16), non-invasive ventilation (NIV) only was used in 20% (22), while transition from NIV to invasive ventilation (IV) was seen in 41% (45). IV was initiated directly in 24% (26). Patients initially treated with NIV had a higher arterial partial pressure of oxygen/fraction of oxygen in inspired gas ratio compared with those primarily treated with IV. Major baseline characteristics and 28-day mortality were similar, but 90-day mortality was higher in patients initially treated with NIV 17/67 (25%) as compared with patients primarily treated with IV 3/26 (12%), relative risk 1.2 (95% confidence interval 0.34.0). Conclusions Critical illness because of 2009 influenza A (H1N1) in Sweden was dominated by hypoxic respiratory failure. The majority of patients in need of respiratory support were initially treated with NIV. In spite of less severe initial hypoxemia, initiation of ventilatory support with NIV was not associated with improved outcome.
13.	Byberg, Liisa, et al. (författare) Prediction of fracture risk in men : A cohort study 2012 Ingår i: Journal of Bone and Mineral Research. - : Wiley. - 0884-0431 .- 1523-4681. ; 27:4, s. 797-807 Tidskriftsartikel (refereegranskat)abstract FRAX is a tool that identifies individuals with high fracture risk who will benefit from pharmacological treatment of osteoporosis. However, a majority of fractures among elderly occur in people without osteoporosis and most occur after a fall. Our aim was to accurately identify men with a high future risk of fracture, independent of cause. In the population-based Uppsala Longitudinal Study of Adult Men (ULSAM) and using survival analysis we studied different models' prognostic values (R(2) ) for any fracture and hip fracture within 10 years from age 50 (n = 2322), 60 (n = 1852), 71 (n = 1221), and 82 (n = 526). During the total follow-up period from age 50, 897 fractures occurred in 585 individuals. Of these, 281 were hip fractures occurring in 189 individuals. The rates of any fracture were 5.7/1000 person-years at risk from age 50 and 25.9/1000 person-years at risk from age 82. Corresponding hip fractures rates were 2.9 and 11.7/1000 person-years at risk. The FRAX model included all variables in FRAX except bone mineral density. The full model combining FRAX variables, comorbidity, medications, and behavioral factors explained 25-45% of all fractures and 80-92% of hip fractures, depending on age. The corresponding prognostic values of the FRAX model were 7-17% for all fractures and 41-60% for hip fractures. Net reclassification improvement (NRI) comparing the full model with the FRAX model ranged between 40 and 53% for any fracture and between 40 and 87% for hip fracture. Within the highest quintile of predicted fracture risk with the full model, 1/3 of the men will have a fracture within 10 years after age 71 years and 2/3 after age 82 years. We conclude that the addition of comorbidity, medication and behavioral factors to the clinical components of FRAX can substantially improve the ability to identify men at high risk of fracture, especially hip fracture.
14.	Byberg, Liisa, et al. (författare) Total mortality after changes in leisure time physical activity in 50 year old men : 35 year follow-up of population based cohort 2009 Ingår i: British Journal of Sports Medicine. - : BMJ Publishing Group Ltd. - 0306-3674 .- 1473-0480. ; 338, s. b688- Tidskriftsartikel (refereegranskat)abstract Objective: To examine how change in level of physical activity after middle age influences mortality and to compare it with the effect of smoking cessation.Design: Population based cohort study with follow-up over 35 years.Setting: Municipality of Uppsala, Sweden.Participants: 2205 men aged 50 in 1970-3 who were reexamined at ages 60, 70, 77, and 82 years.Main Outcome Measure: Total (all cause) mortality.Results: The absolute mortality rate was 27.1, 23.6, and 18.4 per 1000 person years in the groups with low, medium, and high physical activity, respectively. The relative rate reduction attributable to high physical activity was 32% for low and 22% for medium physical activity. Men who increased their physical activity level between the ages of 50 and 60 continued to have a higher mortality rate during the first five years of follow-up (adjusted hazard ratio 2.64, 95% confidence interval 1.32 to 5.27, compared with unchanged high physical activity). After 10 years of follow-up their increased physical activity was associated with reduced mortality to the level of men with unchanged high physical activity (1.10, 0.87 to 1.38). The reduction in mortality associated with increased physical activity (0.51, 0.26 to 0.97, compared with unchanged low physical activity) was similar to that associated with smoking cessation (0.64, 0.53 to 0.78, compared with continued smoking).Conclusions: Increased physical activity in middle age is eventually followed by a reduction in mortality to the same level as seen among men with constantly high physical activity. This reduction is comparable with that associated with smoking cessation
15.	Bäckström, Denise, 1976-, et al. (författare) Deaths caused by injury among people of working age (18-64) are decreasing, while those among older people (64+) are increasing. 2018 Ingår i: European Journal of Trauma and Emergency Surgery. - : Springer Science and Business Media LLC. - 1863-9933 .- 1863-9941. ; 44:4, s. 589-596 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Injury is an important cause of death in all age groups worldwide, and contributes to many losses of human and economic resources. Currently, we know a few data about mortality from injury, particularly among the working population. The aim of the present study was to examine death from injury over a period of 14 years (1999-2012) using the Swedish Cause of Death Registry (CDR) and the National Patient Registry, which have complete national coverage.METHOD: CDR was used to identify injury-related deaths among adults (18 years or over) during the years 1999-2012. ICD-10 diagnoses from V01 to X39 were included. The significance of changes over time was analyzed by linear regression.RESULTS: The incidence of prehospital death decreased significantly (coefficient -0.22, r (2) = 0.30; p = 0.041) during the study period, while that of deaths in hospital increased significantly (coefficient 0.20, r (2) = 0.75; p < 0.001). Mortality/100,000 person-years in the working age group (18-64 years) decreased significantly (coefficient -0.40, r (2) = 0.37; p = 0.020), mainly as a result of decrease in traffic-related deaths (coefficient -0.34, r (2) = 0.85; p < 0.001). The incidence of deaths from injury among elderly (65 years and older) patients increased because of the increase in falls (coefficient 1.71, r (2) = 0.84; p < 0.001) and poisoning (coefficient 0.13, r (2) = 0.69; p < 0.001).CONCLUSION: The epidemiology of injury in Sweden has changed during recent years in that mortality from injury has declined in the working age group and increased among those people 64 years old and over.
16.	Chung, Sheng-Chia, et al. (författare) Acute myocardial infarction : a comparison of short-term survival in national outcome registries in Sweden and the UK 2014 Ingår i: The Lancet. - 0140-6736 .- 1474-547X. ; 383:9925, s. 1305-1312 Tidskriftsartikel (refereegranskat)abstract Background International research for acute myocardial infarction lacks comparisons of whole health systems. We assessed time trends for care and outcomes in Sweden and the UK. Methods We used data from national registries on consecutive patients registered between 2004 and 2010 in all hospitals providing care for acute coronary syndrome in Sweden and the UK. The primary outcome was all-cause mortality 30 days after admission. We compared effectiveness of treatment by indirect casemix standardisation. This study is registered with ClinicalTrials.gov, number NCT01359033. Findings We assessed data for 119 786 patients in Sweden and 391 077 in the UK. 30-day mortality was 7.6% (95% CI 7.4-7.7) in Sweden and 10.5% (10.4-10.6) in the UK. Mortality was higher in the UK in clinically relevant subgroups defined by troponin concentration, ST-segment elevation, age, sex, heart rate, systolic blood pressure, diabetes mellitus status, and smoking status. In Sweden, compared with the UK, there was earlier and more extensive uptake of primary percutaneous coronary intervention (59% vs 22%) and more frequent use of beta blockers at discharge (89% vs 78%). After casemix standardisation the 30-day mortality ratio for UK versus Sweden was 1.37 (95% CI 1.30-1.45), which corresponds to 11 263 (95% CI 9620-12 827) excess deaths, but did decline over time (from 1.47, 95% CI 1.38-1.58 in 2004 to 1.20, 1.12-1.29 in 2010; p=0.01). Interpretation We found clinically important differences between countries in acute myocardial infarction care and outcomes. International comparisons research might help to improve health systems and prevent deaths.
17.	Corsini, Christian, et al. (författare) Survival Trend in Individuals With De Novo Metastatic Prostate Cancer After the Introduction of Doublet Therapy 2023 Ingår i: JAMA Network Open. - : American Medical Association (AMA). - 2574-3805. ; 6:10 Tidskriftsartikel (refereegranskat)abstract IMPORTANCE: Recently, life-prolonging treatments for patients with advanced prostate cancer have been introduced in clinical practice.OBJECTIVE: To investigate if the introduction of doublet therapy is associated with changes in survival on a population-basis.DESIGN, SETTING, AND PARTICIPANTS: This nationwide population-based cohort study used data from the Prostate Cancer data Base Sweden from 2008 to 2020. Men registered with de novo metastatic castration-sensitive prostate cancer (mCSPC) were included.EXPOSURE: The proportion of men with mCSPC who received doublet therapy, ie, androgen deprivation therapy plus androgen receptor pathway inhibitor drugs or chemotherapy was assessed.MAIN OUTCOMES AND MEASURES: Standardized overall survival, taking age, comorbidity, and cancer characteristics into consideration, was estimated by use of a parametric survival model.RESULTS: A total of 11 382 men were included in this study (median [IQR] age, 74.0 [68-81] years). There was a shift toward less advanced prostate cancer during the study period with a decrease in median (IQR) prostate-specific antigen at diagnosis in men with mCSPC from 145 (39-571) ng/mL to 107 (27-426) ng/mL. Upfront treatment with doublet therapy in these men simultaneously increased from 1% (7 of 991) in 2016 to 44% (402 of 922) in 2020. The adjusted 5-year overall survival increased from 26% (95% CI, 25%-28%) from 2008 to 2012 to 35% (95% CI, 31%-40%) from 2017 to 2020. During the first 5 years after diagnosis, there was an increase in mean survival of 6 months, from 2.7 (95% CI, 2.6-2.8) years from 2008 to 2012 to 3.2 (95% CI, 3.1-3.1) years from 2017 to 2020.CONCLUSIONS AND RELEVANCE: In parallel with improvements in treatment of advanced prostate cancer, a clinically meaningful increase in mean survival was observed in men with de novo mCSPC in Sweden between 2008 and 2020 in this study.
18.	Fallara, Giuseppe, et al. (författare) A drug comorbidity index to predict mortality in men with castration resistant prostate cancer 2021 Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 16:7 Tidskriftsartikel (refereegranskat)abstract Background The Charlson Comorbidity Index is a poor predictor of mortality in men with castration resistant prostate cancer (CRPC). To improve this prediction, we created a comorbidity index based on filled prescriptions intended to be used in registry-based studies. Materials and methods In a population-based cohort of men with CPRC a drug comorbidity index (DCI-CRPC) was calculated based on prescriptions filled during a 365-day period before the date of CRPC diagnosis to predict mortality. Five risk categories for men with CRPC were defined based on PSA kinetics. Mortality rates were described by Kaplan-Meier curves. The predictive ability of the DCI-CRPC was compared in univariable models to that of the original DCI, derived from men in the general population, and to that of the Charlson Comorbidity Index. Results In 1,885 men with CRPC the median overall survival ranged from 3.0 years (95% confidence interval [CI] 2.8 to 3.4) in the first tertile of the DCI-CRPC, to 1.0 year (95% CI 0.9 to 1.1) in the third tertile of the DCI-CRPC. The index had higher discriminative ability (C-index 0.667) than the Charlson Comorbidity Index (C-index 0.508). The discriminative ability of the DCI-CRPC was highest in the subgroup with least aggressive cancer (C-index 0.651) and lowest in men with most aggressive cancer (C-index 0.618). The performance of the DCI-CRPC was comparable to that of the original DCI. Conclusion Our newly created comorbidity index using filled prescriptions predicted death in men with CRPC better than the Charlson Comorbidity Index.
19.	Fallara, Giuseppe, et al. (författare) Rapid ascertainment of uptake of a new indication for abiraterone by use of three nationwide health care registries in Sweden. 2021 Ingår i: Acta Oncologica. - : Taylor & Francis. - 0284-186X .- 1651-226X. ; 60:1, s. 56-60 Tidskriftsartikel (refereegranskat)
20.	Feltelius, Nils, et al. (författare) Utility of registries for post-marketing evaluation of medicines. A survey of Swedish health care quality registries from a regulatory perspective. 2017 Ingår i: Upsala Journal of Medical Sciences. - : Uppsala Medical Society. - 0300-9734 .- 2000-1967. ; 122:2, s. 136-147 Tidskriftsartikel (refereegranskat)abstract AIM: The aim of this study was to describe content and procedures in some selected Swedish health care quality registries (QRs) of relevance to regulatory decision-making.METHODS: A workshop was organized with participation of seven Swedish QRs which subsequently answered a questionnaire regarding registry content on drug treatments and outcomes. Patient populations, coverage, data handling and quality control, as well as legal and ethical aspects are presented. Scientific publications from the QRs are used as a complementary measure of quality and scientific relevance.RESULTS: The registries under study collect clinical data of high relevance to regulatory and health technology agencies. Five out of seven registries provide information on the drug of interest. When applying external quality criteria, we found a high degree of fulfillment, although information on medication was not sufficient to answer all questions of regulatory interest. A notable strength is the option for linkage to the Prescribed Drug Registry and to information on education and socioeconomic status. Data on drugs used during hospitalization were also collected to some extent. Outcome measures collected resemble those used in relevant clinical trials. All registries collected patient-reported outcome measures. The number of publications from the registries was substantial, with studies of appropriate design, including randomized registry trials.CONCLUSIONS: Quality registries may provide a valuable source of post-marketing data on drug effectiveness, safety, and cost-effectiveness. Closer collaboration between registries and regulators to improve quality and usefulness of registry data could benefit both regulatory utility and value for health care providers.
21.	Gedeborg, Rolf, et al. (författare) Adverse effects of high-dose epinephrine on cerebral blood flow during experimental cardiopulmonary resuscitation 2000 Ingår i: Critical Care Medicine. - 0090-3493 .- 1530-0293. ; 28:5, s. 1423-1430 Tidskriftsartikel (refereegranskat)abstract OBJECTIVE:To study the effects of high-dose epinephrine, compared with standard-dose epinephrine, on the dynamics of superficial cortical cerebral blood flow as well as global cerebral oxygenation during experimental cardiopulmonary resuscitation. We hypothesized that high-dose epinephrine might be unable to improve cerebral blood flow during cardiopulmonary resuscitation as compared with standard-dose epinephrine.DESIGN:Randomized controlled study.SETTING:University hospital research laboratory.SUBJECTS:A total of 20 male anesthetized piglets.INTERVENTIONS:Ventricular fibrillation was induced. A nonintervention interval of 8 mins was followed by open-chest cardiopulmonary resuscitation. The animals were randomized to receive repeated bolus injections of either 20 microg/kg (standard-dose group, n = 10) or 200 microg/kg (high-dose group, n = 10) of epinephrine.MEASUREMENTS AND MAIN RESULTS:Focal cortical cerebral blood flow was measured continuously by using laser Doppler flowmetry. The duration of blood flow increase was significantly shorter in the high-dose group after the second dose of epinephrine. In the high-dose group there was also a consistent tendency for lower peak levels and shorter duration of flow increase in response to repeated bolus doses of epinephrine. Cerebral oxygen extraction ratio was significantly lower in the high-dose group after administration of epinephrine.CONCLUSIONS:Repeated bolus doses of epinephrine 200 microg/kg, as compared with 20 microg/kg, do not improve superficial cortical cerebral blood flow during experimental open-chest cardiopulmonary resuscitation. High-dose epinephrine appears to induce vasoconstriction of cortical cerebral blood vessels resulting in redistribution of blood flow from superficial cortex. This might be one explanation for the failure of high-dose epinephrine to improve overall outcome in clinical trials.
22.	Gedeborg, Rolf, et al. (författare) Adverse effects of high-dose epinephrine on cerebral blood flow duringexperimental cardiopulmonary resuscitation. 2000 Ingår i: Crit Care Med. ; 28, s. 1423- Tidskriftsartikel (refereegranskat)
23.	Gedeborg, Rolf (författare) Akut njursvikt och dialys 2005 Ingår i: Intensivvård. - : Liber AB, Stockholm. - 9147051353 ; , s. 347-378 Bokkapitel (populärvet., debatt m.m.)
24.	Gedeborg, Rolf, et al. (författare) An Aggregated Comorbidity Measure Based on History of Filled Drug Prescriptions : Development and Evaluation in Two Separate Cohorts 2021 Ingår i: Epidemiology. - : Lippincott Williams & Wilkins. - 1044-3983 .- 1531-5487. ; 32:4, s. 607-615 Tidskriftsartikel (refereegranskat)abstract Background: The ability to account for comorbidity when estimating survival in a population diagnosed with cancer could be improved by using a drug comorbidity index based on filled drug prescriptions.Methods: We created a drug comorbidity index from age-stratified univariable associations between filled drug prescriptions and time to death in 326,450 control males randomly selected from the general population to men with prostate cancer. We also evaluated the index in 272,214 control females randomly selected from the general population to women with breast cancer.Results: The new drug comorbidity index predicted survival better than the Charlson Comorbidity Index (CCI) and a previously published prescription index during 11 years of follow-up. The concordance (C)-index for the new index was 0.73 in male and 0.76 in the female population, as compared with a C-index of 0.67 in men and 0.69 in women for the CCI. In men of age 75-84 years with CCI = 0, the median survival time was 7.1 years (95% confidence interval [CI] = 7.0, 7.3) in the highest index quartile. Comparing the highest to the lowest drug comorbidity index quartile resulted in a hazard ratio (HR) of 2.2 among men (95% CI = 2.1, 2.3) and 2.4 among women (95% CI = 2.3, 2.6).Conclusions: A new drug comorbidity index based on filled drug prescriptions improved prediction of survival beyond age and the CCI alone. The index will allow a more accurate baseline estimation of expected survival for comparing treatment outcomes and evaluating treatment guidelines in populations of people with cancer.
25.	Gedeborg, Rolf, et al. (författare) Androgen deprivation therapy and excess mortality in men with prostate cancer during the initial phase of the COVID-19 pandemic. 2021 Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 16:10 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Men have a higher risk of death from COVID-19 than women and androgens facilitate entrance of the SARS-CoV-2 virus into respiratory epithelial cells. Thus, androgen deprivation therapy may reduce infection rates and improve outcomes for COVID-19. In the spring of 2020, Sweden was highly affected by COVID-19. The aim was to estimate the impact of androgen deprivation therapy on mortality from COVID-19 in men with prevalent prostate cancer by comparing all-cause mortality in the spring of 2020 to that in previous years.PATIENTS AND METHODS: Using the Prostate Cancer data Base Sweden all men with prostate cancer on March 1 each year in 2015-2020 were followed until June 30 the same year. Exposure to androgen deprivation therapy was ascertained from filled prescriptions for bicalutamide monotherapy, gonadotropin-releasing hormone agonists (GnRH), or bilateral orchidectomy.RESULTS: A total of 9,822 men died in March-June in the years 2015-2020, of whom 5,034 men were on androgen deprivation therapy. There was an excess mortality in 2020 vs previous years in all men. The crude relative mortality rate ratio for 2020 vs 2015-2019 was 0.93 (95% confidence interval (CI) 0.83 to 1.04) in men on GnRH, and 0.90 (95% CI 0.78 to 1.05) in men on bicalutamide monotherapy. After multivariable adjustment these ratios were attenuated to 1.00 (95% CI 0.89 to 1.12) and 0.97 (95% CI 0.84 to 1.12), respectively. When restricting the analysis to the regions with the highest incidence of COVID-19 or to the time period between 2 April to 10 June when mortality in 2020 was increased >30% compared to previous years, the results were similar to the main analysis.CONCLUSIONS: In this large national population-based cohort of men with prevalent prostate cancer, there was no clear evidence in support for an effect of androgen deprivation therapy on COVID-19 mortality.
26.	Gedeborg, Rolf, et al. (författare) Androgen deprivation therapy, comorbidity, cancer stage and mortality from COVID-19 in men with prostate cancer 2022 Ingår i: Scandinavian journal of urology. - : Taylor & Francis. - 2168-1805 .- 2168-1813. ; 56:2, s. 104-111 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Androgens facilitate entrance of the severe acute respiratory syndrome coronavirus 2 into respiratory epithelial cells, and male sex is associated with a higher risk of death from corona virus disease (COVID-19). Androgen deprivation therapy (ADT) could possibly improve COVID-19 outcomes.METHODS: In a case-control study nested in the Prostate Cancer data Base Sweden (PCBaSe) RAPID 2019, we evaluated the association between ADT and COVID-19 as registered cause of death in men with prostate cancer. Each case was matched to 50 controls by region. We used conditional logistic regression to adjust for confounders and also evaluated potential impact of residual confounding.RESULTS: We identified 474 men who died from COVID-19 in March-December 2020. In crude analyses, ADT exposure was associated with an increased risk of COVID-19 death (odds ratio [OR] 5.05, 95% CI: 4.18-6.10); however, the OR was substantially attenuated after adjustment for age, comorbidity, prostate cancer characteristics at diagnosis, recent healthcare use, and indicators of advanced cancer (adjusted OR 1.25, 95% CI: 0.95-1.65). If adjustment has accounted for at least 85% of confounding, then the true effect could be no more than a 5% reduction of the odds for COVID-19 death.CONCLUSIONS: The increased mortality from COVID-19 in men with prostate cancer treated with ADT was mainly related to high age, comorbidity, and more advanced prostate cancer. There was no evidence to support the hypothesis that ADT is associated with improved COVID-19 outcomes.
27.	Gedeborg, Rolf, et al. (författare) Att mäta det omätbara [Measuring the immeasurable] : Objektiv måttstock saknas för intensivvårdens dimensionering [There are no objective measures for the dimensioning of intensive care] 2004 Ingår i: Lakartidningen. - 0023-7205. ; 101:47, s. 3752-3 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
28.	Gedeborg, Rolf (författare) Augmentation of vital organ blood flow during experimental cardiopulmonary resuscitation 1999 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract Clinical outcome from cardiac arrest remains poor. If the time from arrest to restoration of spontaneous circulation can be shortened and resuscitation techniques improved so that higher blood flow and oxygen delivery to vital organs is achieved, it is possible that the outcome from cardiac arrest could improve. This thesis is based on experimental studies of different aspects of blood flow augmentation during cardiopulmonary resuscitation.Using a biological assay, it was found that the biological activity of epinephrine is reduced after injection through an intravenous cannula containing alkaline buffer, but the degree of inactivation is unlikely to be of clinical significance.In a porcine model of ventricular fibrillation, a cardiovascular post-resuscitation syndrome was described. The cardiovascular compromise seen after restoration of spontaneous circulation was characterised by a substantially reduced cardiac index and mixed venous oxygen saturation. Cortical cerebral blood flow and the cerebral oxygen extraction ratio were reduced, and there was a protracted acidosis in cerebral tissue in spite of buffering to normal arterial pH. The cardiovascular post-resuscitation syndrome was in no respect alleviated by Platelet Activating Factor antagonism.Repeated doses of high-dose epinephrine during cardiopulmonary resuscitation were unable to improve cortical cerebral blood flow compared to standard-dose epinephrine, and appeared to redistribute blood flow from the superficial cerebral cortex to other parts of the brain.The novel method of continuous balloon occlusion of the descending aorta during cardiopulmonary resuscitation increased coronary blood flow, cortical cerebral blood flow and the rate of restoration of spontaneous circulation. No detrimental effects were noted after restoration ofspontaneous circulation and deflation of the balloon.A prominent finding was the short duration of increased cortical cerebral blood flow seen after bolus administration of standard-dose epinephrine during cardiopulmonary resuscitation. No evidence of vasoconstriction in superficial cerebral cortex was found after administration of standard-dose epinephrine.
29.	Gedeborg, Rolf, et al. (författare) Cerebral ischaemia in experimental cardiopulmonary resuscitation--comparison of epinephrine and aortic occlusion. 2001 Ingår i: Resuscitation. - 0300-9572 .- 1873-1570. ; 50:3, s. 319-29 Tidskriftsartikel (refereegranskat)abstract The apparent inability of epinephrine to improve outcome after cardiopulmonary resuscitation (CPR) could be caused by direct negative effects on the cerebral circulation. Constant aortic occlusion with a balloon catheter could be an alternative way to improve coronary and cerebral perfusion during CPR. The objective of the present study was to compare the effects of standard-dose epinephrine with balloon occlusion of the descending aorta on cortical cerebral blood flow augmentation during CPR. Ventricular fibrillation was induced in 24 anaesthetised piglets. A non-intervention interval of 9 min was followed by open-chest CPR. The animals were randomised to receive repeated intravenous bolus doses of epinephrine 20 microg/kg or balloon occlusion of the descending aorta. Focal cortical cerebral blood flow was measured continuously using laser-Doppler flowmetry. Balloon occlusion of the aorta resulted in a significantly higher mean cortical cerebral blood flow and a lower cerebral oxygen extraction ratio than epinephrine during CPR. After restoration of spontaneous circulation the cerebral perfusion appeared compromised to the same extent in both groups, with lower blood flow compared to baseline, high cerebral oxygen extraction and cerebral tissue acidosis. No difference in cerebral cortical vascular resistance between the two groups could be detected. It is concluded that aortic balloon occlusion was superior to epinephrine in cerebral blood flow augmentation during resuscitation and did not generate adverse effects on cerebral blood flow, oxygenation or tissue pH after restoration of spontaneous circulation. No evidence of cerebral vasoconstriction induced by standard-dose epinephrine was found.
30.	Gedeborg, Rolf, et al. (författare) Cerebral ischaemia in experimental cardiopulmonaryresuscitation--comparison of epinephrine and aortic occlusion. 2001 Ingår i: Resuscitation. ; 50, s. 319- Tidskriftsartikel (refereegranskat)
31.	Gedeborg, Rolf, et al. (författare) Diagnosis-dependent misclassification of infections using administrative data variably affected incidence and mortality estimates in ICU patients 2007 Ingår i: Journal of Clinical Epidemiology. - : Elsevier BV. - 0895-4356 .- 1878-5921. ; 60:2, s. 155-162 Tidskriftsartikel (refereegranskat)abstract OBJECTIVE: To determine the accuracy of hospital discharge diagnoses in identifying severe infections among intensive care unit (ICU) patients, and estimate the impact of misclassification on incidence and 1-year mortality. STUDY DESIGN AND SETTING: Sepsis, pneumonia, and central nervous system (CNS) infections among 7,615 ICU admissions were identified using ICD-9 and ICD-10 diagnoses from the Swedish hospital discharge register (HDR). Sensitivity, specificity, and likelihood ratios were calculated using ICU database diagnoses as reference standard, with inclusion in sepsis trials (IST) as secondary reference for sepsis. RESULTS: CNS infections were accurately captured (sensitivity 95.4% [confidence interval (CI)=86.8-100] and specificity 99.6% [CI=99.4-99.8]). Community-acquired sepsis (sensitivity 51.1% [CI=41.0-61.2] and specificity 99.4% [CI=99.2-99.6]) and primary pneumonia (sensitivity 38.2% [CI=31.2-45.2] and specificity 98.6% [CI=98.2-99.0]) were more accurately detected than sepsis and pneumonia in general. One-year mortality was accurately estimated for primary pneumonia but underestimated for community-acquired sepsis. However, there were only small differences in sensitivity and specificity between HDR and ICU data in the ability to identify IST. ICD-9 appeared more accurate for sepsis, whereas ICD-10 was more accurate for pneumonia. CONCLUSION: Accuracy of hospital discharge diagnoses varied depending on diagnosis and case definition. The pattern of misclassification makes estimates of relative risk more accurate than estimates of absolute risk.
32.	Gedeborg, Rolf, et al. (författare) Effects of "high dose" epinephrine on cerebral blood flow during experimental open chest cardiopulmonary resuscitation. 1997 Ingår i: Crit Care Med. ; 25, s. 32- Tidskriftsartikel (refereegranskat)
33.	Gedeborg, Rolf, et al. (författare) Experimental model of cardiovascular post-resuscitation syndrome-no effect of platelet activating factor antagonism. 1998 Ingår i: Resuscitation. ; 39, s. 115- Tidskriftsartikel (refereegranskat)
34.	Gedeborg, Rolf, et al. (författare) Federated analyses of multiple data sources in drug safety studies 2023 Ingår i: Pharmacoepidemiology and Drug Safety. - : John Wiley & Sons. - 1053-8569 .- 1099-1557. ; 32:3, s. 279-286 Forskningsöversikt (refereegranskat)abstract PurposeStudies of rare side effects of new drugs with limited exposure may require pooling of multiple data sources. Federated Analyses (FA) allow real-time, interactive, centralized statistical processing of individual-level data from different data sets without transfer of sensitive personal data.MethodsWe review IT-architecture, legal considerations, and statistical methods in FA, based on a Swedish Medical Products Agency methodological development project.ResultsIn a review of all post-authorisation safety studies assessed by the EMA during 2019, 74% (20/27 studies) reported issues with lack of precision in spite of mean study periods of 9.3 years. FA could potentially improve precision in such studies. Depending on the statistical model, the federated approach can generate identical results to a standard analysis. FA may be particularly attractive for repeated collaborative projects where data is regularly updated. There are also important limitations. Detailed agreements between involved parties are strongly recommended to anticipate potential issues and conflicts, document a shared understanding of the project, and fully comply with legal obligations regarding ethics and data protection. FA do not remove the data harmonisation step, which remains essential and often cumbersome. Reliable support for technical integration with the local server architecture and security solutions is required. Common statistical methods are available, but adaptations may be required.ConclusionsFederated Analyses require competent and active involvement of all collaborating parties but have the potential to facilitate collaboration across institutional and national borders and improve the precision of postmarketing drug safety studies.
35.	Gedeborg, Rolf, 1962-, et al. (författare) Identification of Incident Injuries in Hospital Discharge Registers 2008 Ingår i: Epidemiology. - 1044-3983 .- 1531-5487. ; 19:6, s. 860-867 Tidskriftsartikel (refereegranskat)abstract Background: Hospital discharge data on injuries constitute a potentially powerful data source for epidemiologic studies. However, reliable identification of incident injury admissions is necessary. The objective of this study was to develop a prediction model for identifying incident hospital admissions, based on variables derived from a hospital discharge register.Methods: There were 743,022 hospital admissions for injury in Sweden 1998–2004. Of these, 23,920 were in the county of Uppsala and 24% of these people had previous injury admissions. To determine if these admissions were new injuries or readmissions for earlier injuries, we reviewed 817 randomly selected hospital records. A prediction model for incident injury admissions was developed on the basis of patient age, type of admission (urgent or elective), time interval from the previous injury admission, main diagnosis, and department type.Results: The final prediction model showed good discrimination (c-statistic = 0.969). This model was applied to the validation dataset using the optimal cut-off level, and the resulting sensitivity and specificity were adjusted according to the proportion with a previous injury admission in each injury category. The injury with the highest proportion of possible readmissions was hip contusion (35%). Nevertheless, using the prediction model, incident hip contusions were identified with a sensitivity of 94% (95% confidence interval = 93%–95%) and a specificity of 95% (94%–97%). The accuracy was higher for all other injury categories.Conclusions: Incident injury admissions can be accurately separated from readmissions using a prediction model based on information derived from hospital discharge data.
36.	Gedeborg, Rolf, et al. (författare) Improved haemodynamics and restoration of spontaneous circulation with constant aortic occlusion during experimental cardiopulmonary resuscitation. 1999 Ingår i: Resuscitation. ; 40, s. 171- Tidskriftsartikel (refereegranskat)
37.	Gedeborg, Rolf, et al. (författare) Improved haemodynamics and restoration of spontaneous circulation with constant aortic occlusion during experimental cardiopulmonary resuscitation. 1999 Ingår i: Resuscitation. - 0300-9572 .- 1873-1570. ; 40:3, s. 171-180 Tidskriftsartikel (refereegranskat)abstract Continuous balloon occlusion of the descending aorta is an experimental method that may improve blood flow to the myocardium and the brain during cardiopulmonary resuscitation (CPR). The aim of the present investigation was to evaluate the effects of this intervention on haemodynamics and the frequency of restoration of spontaneous circulation. Ventricular fibrillation was induced in 39 anaesthetised piglets, followed by an 8-min non-intervention interval. In a haemodynamic study (n = 10), closed chest CPR was performed for 7 min before the intra-aortic balloon was inflated. This intervention increased mean arterial blood pressure by 20%, reduced cardiac output by 33%, increased coronary artery blood flow by 86%, and increased common carotid artery blood flow by 62%. All these changes were statistically significant. Administration of epinephrine further increased mean arterial blood pressure and coronary artery blood flow, while cardiac output and common carotid artery blood flow decreased. In a study of short-term survival, nine out of 13 animals (69%) in the balloon group and in three out of 13 animals (23%) in the control group had spontaneous circulation restored. The difference between these two proportions was 0.46, which was statistically significant with a 95% confidence interval from 0.12 to 0.80. In conclusion, balloon occlusion of the descending aorta increased coronary and common carotid artery blood flow and the frequency of restoration of spontaneous circulation. It was also noted that epinephrine appears to augment the redistribution of blood flow caused by the aortic occlusion.
38.	Gedeborg, Rolf, et al. (författare) Increased availability of paracetamol in Sweden and incidence of paracetamol poisoning : using laboratory data to increase validity of a population-based registry study 2017 Ingår i: Pharmacoepidemiology and Drug Safety. - : WILEY. - 1053-8569 .- 1099-1557. ; 26:5, s. 518-527 Tidskriftsartikel (refereegranskat)abstract Purpose: To estimate the incidence trend and outcome of paracetamol poisoning, in relation to increased availability of paracetamol from non-pharmacy outlets in 2009.Method: Patients' serum paracetamol results over 14years (2000-2013) from 20 (out of 21) regions in Sweden were linked to national registers of hospital care, cause of death, and prescriptions. Paracetamol poisonings were defined by serum paracetamol levels, hospital diagnoses, or cause of death. The change in incidence of poisonings following increased availability of paracetamol was analysed by using segmental regression of time series.Results: Of the 12068 paracetamol poisonings, 85% were classified as intentional self-harm. Following increased availability from non-pharmacy outlets, there was a 40.5% increase in the incidence of paracetamol poisoning, from 11.5/100000 in 2009 to 16.2/100000 in 2013. Regression analyses indicated a change in the trend (p<0.0001) but not an immediate jump in the incidence (p=0.5991) following the increased availability. Adjusting for trends in hospital episodes for self-harm, suicides, and the sales volume of paracetamol did not influence the result. All-cause mortality at 30days (3.2%) did not change over time.Conclusions: The incidence of paracetamol poisoning in Sweden has increased since 2009, contrasting the decreased incidence in the period of 2007-2009. The change in trend was temporally associated with the introduction of availability of paracetamol from non-pharmacy outlets but did not appear to be related to sales volume of paracetamol or general trends in self-harm or suicides.
39.	Gedeborg, Rolf, et al. (författare) Internationally comparable diagnosis-specific survival probabilities for calculation of the ICD-10-based Injury Severity Score 2014 Ingår i: Journal of Trauma and Acute Care Surgery. - 2163-0755. ; 76:2, s. 358-365 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: The International Statistical Classification of Diseases, 10th Revision (ICD-10) -based Injury Severity Score (ICISS) performs well but requires diagnosis-specific survival probabilities (DSPs), which are empirically derived, for its calculation. The objective was to examine if DSPs based on data pooled from several countries could increase accuracy, precision, utility, and international comparability of DSPs and ICISS. METHODS: Australia, Argentina, Austria, Canada, Denmark, New Zealand, and Sweden provided ICD-10-coded injury hospital discharge data, including in-hospital mortality status. Data from the seven countries were pooled using four different methods to create an international collaborative effort ICISS (ICE-ICISS). The ability of the ICISS to predict mortality using the country-specific DSPs and the pooled DSPs was estimated and compared. RESULTS: The pooled DSPs were based on a total of 3,966,550 observations of injury diagnoses from the seven countries. The proportion of injury diagnoses having at least 100 discharges to calculate the DSP varied from 12% to 48% in the country-specific data set and was 66% in the pooled data set. When compared with using a country's own DSPs for ICISS calculation, the pooled DSPs resulted in somewhat reduced discrimination in predicting mortality (difference in c statistic varied from 0.006 to 0.04). Calibration was generally good when the predicted mortality risk was less than 20%. When Danish and Swedish data were used, ICISS was combined with age and sex in a logistic regression model to predict in-hospital mortality. Including age and sex improved both discrimination and calibration substantially, and the differences from using country-specific or pooled DSPs were minor. CONCLUSION: Pooling data from seven countries generated empirically derived DSPs. These pooled DSPs facilitate international comparisons and enables the use of ICISS in all settings where ICD-10 hospital discharge diagnoses are available. The modest reduction in performance of the ICE-ICISS compared with the country-specific scores is unlikely to outweigh the benefit of internationally comparable Injury Severity Scores possible with pooled data.
40.	Gedeborg, Rolf (författare) Minimizing trauma of feeding tube exchange in patients with bleeding diathesis. 2005 Ingår i: Paediatr Anaesth. - 1155-5645. ; 15:7, s. 621-2 Tidskriftsartikel (refereegranskat)
41.	Gedeborg, Rolf, et al. (författare) Population density and mortality among individuals in motor vehicle crashes 2010 Ingår i: Injury Prevention. - : BMJ. - 1353-8047 .- 1475-5785. ; 16:5, s. 302-308 Tidskriftsartikel (refereegranskat)abstract ObjectiveTo assess whether higher mortality rates among individuals in motor vehicle crashes in areas with low population density depend on injury type and severity or are related to the performance of emergency medical services (EMS).Methods Prehospital and hospital deaths were studied in a population-based cohort of 41 243 motor vehicle crashes that occurred in Sweden between 1998 and 2004. The final multivariable analysis was restricted to 6884 individuals in motor vehicle crashes, to minimise the effects of confounding factors.Results Crude mortality rates following motor vehicle crashes were inversely related to regional population density. In regions with low population density, the unadjusted rate ratio for prehospital death was 2.2 (95% CI 1.9 to 2.5) and for hospital death 1.5 (95% CI 1.1 to 1.9), compared with a high-density population. However, after controlling for regional differences in age, gender and the type/severity of injuries among 6884 individuals in motor vehicle crashes, low population density was no longer associated with increased mortality. At 25 years of age, predicted prehospital mortality was 9% lower (95% CI 5% to 12%) in regions with low population density compared with high population density. This difference decreased with increasing age, but was still 3% lower (95% CI 0.5% to 5%) at 65 years of age.ConclusionsThe inverse relationship between population density and mortality among individuals in motor vehicle crashes is related to pre-crash factors that influence the type and severity of injuries and not to differences in EMS.
42.	Gedeborg, Rolf, et al. (författare) Pragmatic clinical trials in the context of regulation of medicines 2018 Ingår i: Upsala Journal of Medical Sciences. - : Uppsala Medical Society. - 0300-9734 .- 2000-1967. ; 124:1, s. 37-41 Tidskriftsartikel (refereegranskat)abstract The pragmatic clinical trial addresses scientific questions in a setting close to routine clinical practice and sometimes using routinely collected data. From a regulatory perspective, when evaluating a new medicine before approving marketing authorization, there will never be enough patients studied in all subgroups that may potentially be at higher risk for adverse outcomes, or sufficient patients to detect rare adverse events, or sufficient follow-up time to detect late adverse events that require long exposure times to develop. It may therefore be relevant that post-marketing trials sometimes have more pragmatic characteristics, if there is a need for further efficacy and safety information. A pragmatic study design may reflect a situation close to clinical practice, but may also have greater potential methodological concerns, e.g. regarding the validity and completeness of data when using routinely collected information from registries and health records, the handling of intercurrent events, and misclassification of outcomes. In a regulatory evaluation it is important to be able to isolate the effect of a specific product or substance, and to have a defined population that the results can be referred to. A study feature such as having a wide and permissive inclusion of patients might therefore actually hamper the utility of the results for regulatory purposes. Randomization in a registry-based setting addresses confounding that could otherwise complicate a corresponding non-interventional design, but not any other methodological issues. Attention to methodological basics can help generate reliable study results, and is more important than labelling studies as 'pragmatic'.
43.	Gedeborg, Rolf, et al. (författare) Prediction of mortality risk in victims of violent crimes 2017 Ingår i: Forensic Science International. - : Elsevier BV. - 0379-0738 .- 1872-6283. ; 281, s. 92-97 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: To predict mortality risk in victims of violent crimes based on individual injury diagnoses and other information available in health care registries.METHODS: Data from the Swedish hospital discharge registry and the cause of death registry were combined to identify 15,000 hospitalisations or prehospital deaths related to violent crimes. The ability of patient characteristics, injury type and severity, and cause of injury to predict death was modelled using conventional, Lasso, or Bayesian logistic regression in a development dataset and evaluated in a validation dataset.RESULTS: Of 14,470 injury events severe enough to cause death or hospitalization 3.7% (556) died before hospital admission and 0.5% (71) during the hospital stay. The majority (76%) of hospital survivors had minor injury severity and most (67%) were discharged from hospital within 1day. A multivariable model with age, sex, the ICD-10 based injury severity score (ICISS), cause of injury, and major injury region provided predictions with very good discrimination (C-index=0.99) and calibration. Adding information on major injury interactions further improved model performance. Modeling individual injury diagnoses did not improve predictions over the combined ICISS score.CONCLUSIONS: Mortality risk after violent crimes can be accurately estimated using administrative data. The use of Bayesian regression models provides meaningful risk assessment with more straightforward interpretation of uncertainty of the prediction, potentially also on the individual level. This can aid estimation of incidence trends over time and comparisons of outcome of violent crimes for injury surveillance and in forensic medicine.
44.	Gedeborg, Rolf, et al. (författare) Prehospital injury deaths-Strengthening the case for prevention : Nationwide cohort study 2012 Ingår i: Journal of Trauma and Acute Care Surgery. - 2163-0755 .- 2163-0763. ; 72:3, s. 765-772 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: To determine the frequency and characteristics of prehospital deaths compared with hospital deaths in different subpopulations with severe injuries.METHODS: Population-based cohort study using person-based linkage of the Swedish nationwide hospital discharge register with death certificate data. In all, 28,715 injury deaths were identified among 419,137 cases of severe injury during 1998 to 2004. Prehospital deaths were defined as autopsied out-of-hospital deaths with injury as the underlying cause. Their impact on mortality prediction was assessed using the International Classification of Disease Injury Severity Score with the C statistic as a measure of discrimination.RESULTS: The majority of all injury deaths occurred either at the scene or before hospitalization. Among persons younger than 65 years, for each hospital death there were nine prehospital deaths. A high proportion of deaths from drowning, suffocation, and firearm injuries were prehospital (85, 82, and 67% of all cases, respectively). More than 90% of hospital deaths resulted from unintentional injuries, while only 43% of prehospital deaths were unintentional. The largest increase in a cause-specific case fatality risk estimate was seen for poisoning, where inclusion of prehospital deaths increased the risk estimate from 1.6% to 22.8%. Injury mortality prediction based on International Classification of Disease Injury Severity Score improved when prehospital deaths were added to hospital data (C statistic increased from 0.86 to 0.93).CONCLUSIONS: Prehospital deaths constitute the majority of trauma deaths and differ in major characteristics from hospital deaths. The high proportion of prehospital deaths among young and middle aged people highlights the potential impact of preventive efforts.
45.	Gedeborg, Rolf, et al. (författare) Prescription-based prediction of baseline mortality risk among older men 2020 Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 15:10 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Understanding the association between patients' history of prescribed medications and mortality rate could optimize characterization of baseline risk when the Charlson Comorbidity Index is insufficient.METHODS: Using a Swedish cohort of men selected randomly as controls to men with prostate cancer diagnosed 2007-2013, we estimated the association between medications prescribed during the previous year and mortality rates, using Cox regression stratified for age.RESULTS: Among the 326,450 older men with median age of 69 years included in this study, 73% were categorized as free of comorbidity according to the Charlson Comorbidity Index; however, 84% had received at least one prescription during the year preceding the follow-up. This was associated with a 60% overall increase in mortality rate (hazard ratio [HR] = 1.60, 95% confidence interval [CI] 1.56 to 1.64). Some drugs that were unexpectedly associated with mortality included locally acting antacids (HR = 4.7, 95% CI 4.4 to 5.1), propulsives (HR = 4.7, 95% CI 4.4 to 5.0), vitamin A and D (HR = 4.6, 95% CI 4.3 to 4.9), and loop diuretics, for example furosemide (HR = 3.7; 95% CI 3.6 to 3.8). Thiazide diuretics, however, were only weakly associated with a mortality risk (HR = 1.5; 95% CI 1.4 to 1.5). Surprisingly, only weak associations with mortality were seen for major cardiovascular drug classes.CONCLUSIONS: A majority of older men had a history of prescribed medications and many drug classes were associated with mortality rate, including drug classes not directly indicated for a specific comorbidity represented in commonly used comorbidity measures. Prescription history can improve baseline risk assessment but some associations might be context-sensitive.
46.	Gedeborg, Rolf, et al. (författare) Susceptibility to SARS-Cov-2 infection and risk for severe COVID-19 in patients with prostate cancer on androgen deprivation therapy 2022 Ingår i: International Journal of Cancer. - : John Wiley & Sons. - 0020-7136 .- 1097-0215. ; 151:11, s. 1925-1934 Tidskriftsartikel (refereegranskat)abstract Androgen deprivation therapy (ADT) has been hypothesized to protect against COVID-19, but previous observational studies of men with prostate cancer on ADT have been inconsistent regarding mortality risk from coronavirus disease 2019 (COVID-19). Using data from the Prostate Cancer data Base Sweden (PCBaSe), we identified a cohort of 114 547 men with prevalent prostate cancer on the start of follow-up in February 2020, and followed them until 16 December 2020 to evaluate the association between ADT and time to test positive for COVID-19. Among men testing positive for COVID-19, we used regression analyses to estimate the association between ADT and risk of COVID-19-related hospital admission/death from any cause within 30 days of the positive test. In total, 1695 men with prostate cancer tested positive for COVID-19. In crude analyses, exposure to ADT was associated with a 3-fold increased risk of both testing positive for COVID-19 infection and subsequent hospital admission/death. Adjustment for age, comorbidity and prostate cancer risk category substantially attenuated the associations: HR 1.3 (95% CI: 1.1-1.5) for testing positive for COVID-19, and OR 1.4 (95% CI: 1.0-1.9) for risk of subsequent hospital admission/death. In conclusion, although these results suggest increased risks of a positive COVID-19 test, and COVID-19-related hospital admission/death in men on ADT, these findings are likely explained by confounding by old age, cancer-associated morbidity and other comorbidities being more prevalent in men on ADT, rather than a direct effect of the therapy.
47.	Gedeborg, Rolf, 1962-, et al. (författare) The impact of clinically undiagnosed injuries on survival estimates 2009 Ingår i: Critical Care Medicine. - 0090-3493 .- 1530-0293. ; 37:2, s. 449-55 Tidskriftsartikel (refereegranskat)abstract OBJECTIVES:: Missed injury diagnoses may cause potentially preventable deaths. To estimate the effect of clinically undiagnosed injuries on injury-specific survival estimates and the accuracy of an injury severity score. To also estimate the potentially preventable mortality attributable to these injuries. DESIGN, SETTING, AND PATIENTS:: In a nation-wide, population-based study, data were collected from all hospital admissions for injuries in Sweden between 1998 and 2004. We studied 8627 deaths in hospital among 598,137 incident hospital admissions. MEASUREMENTS AND MAIN RESULTS:: New specific-injury categories were added in 7.4% (95% confidence interval [CI] 6.8-8.0) of all deaths with an autopsy rate of 24.2%. It was estimated that this proportion would have increased to 25.1% (95% CI 23.0-27.2), if all deaths had been autopsied. The most pronounced effect of clinically undiagnosed injuries was found for internal organ injury in the abdomen or pelvis, where they reduced the estimated survival from 0.83 to 0.69 (95% CI for the difference: 0.09-0.20). Autopsy diagnoses also revealed substantial bias of survival estimates for vascular injuries in the thorax and crush injuries to the head. The performance of the International Classification of Diseases Injury Severity Score improved when autopsy diagnoses were added to hospital discharge diagnoses. The maximum proportion of injury deaths attributable to missed injuries was estimated to be 6.5%. CONCLUSIONS:: Maintaining a high autopsy rate and merging accurate hospital discharge data and autopsy data are effective ways to improve the accuracy of survival estimates and mortality prediction models, and to estimate mortality attributable to diagnostic failures.
48.	Gedeborg, Rolf, et al. (författare) Time on treatment with abiraterone in men with de novo metastatic castration sensitive prostate cancer: a drug utilization study. 2022 Ingår i: Acta oncologica (Stockholm, Sweden). - : Taylor & Francis. - 1651-226X .- 0284-186X. ; 61:3, s. 328-332 Tidskriftsartikel (refereegranskat)
49.	Gedeborg, Rolf, et al. (författare) Uptake of doublet therapy for de novo metastatic castration sensitive prostate cancer : a population-based drug utilisation study in Sweden 2023 Ingår i: Scandinavian journal of urology. - : Medical Journals Sweden. - 2168-1805 .- 2168-1813. ; 58, s. 93-100 Tidskriftsartikel (refereegranskat)abstract Background: Randomised controlled trials have demonstrated prolonged survival with new upfront treatments in addition to standard androgen deprivation therapy (ADT) in men with de novo metastatic castration-sensitive prostate cancer. We describe patient characteristics, time trends and regional differences in uptake of these new treatment strategies in clinical practice.Material and methods: This descriptive study consisted of men registered in the National Prostate Cancer Register of Sweden from 1 January 2018 to 31 March 2022 with de novo metastatic castration-sensitive prostate cancer defined by the presence of metastases on imaging at the time of diagnosis. Life expectancy was calculated based on age, Charlson Comorbidity Index and a Drug Comorbidity Index.Results: Within 6 months from diagnosis, 57% (1,677/2,959) of men with de novo metastatic castration-sensitive prostate cancer and more than 3 years of life expectancy had received docetaxel, abiraterone, enzalutamide, apalutamide and/or radiotherapy. Over time, there was a 2-fold increase in uptake of any added treatment, mainly driven by a 6-fold increase in use of abiraterone, enzalutamide or apalutamide, with little change in use of other treatments.Conclusions: Slightly more than half of men diagnosed with de novo metastatic castration-sensitive prostate cancer and a life expectancy of at least 3 years received additions to standard ADT as recommended by national guidelines in 2019-2022 in Sweden. There was a 2-fold increase in use of these treatments during the study period; however, efforts to further increase adherence to guidelines are warranted.
50.	Gedeborg, Rolf, et al. (författare) Validation of myocarditis diagnoses in the Swedish patient register for analyses of potential adverse reactions to COVID-19 vaccines 2023 Ingår i: Upsala Journal of Medical Sciences. - : Upsala Medical Society. - 0300-9734 .- 2000-1967. ; 128:1 Tidskriftsartikel (refereegranskat)abstract Background: Coronavirus disease 2019 (COVID-19) mRNA vaccines are associated with an increased risk of myocarditis using hospital discharge diagnoses as an outcome. The validity of these register-based diagnoses is uncertain.Methods: Patient records for subjects < 40 years of age and a diagnosis of myocarditis in the Swedish National Patient Register were manually reviewed. Brighton Collaboration diagnosis criteria for myocarditis were applied based on patient history, clinical examination, laboratory data, electrocardiograms, echocardiography, magnetic resonance imaging and myocardial biopsy. Poisson regression was used to estimate incidence rate ratios, comparing the register-based outcome variable to validated outcomes. Interrater reliability was assessed by a blinded re-evaluation.Results: Overall, 95.6% (327/342) of cases registered as myocarditis were confirmed (definite, probable or possible myocarditis according to Brighton Collaboration diagnosis criteria, positive predictive value 0.96 [95% CI 0.93–0.98]). Of the 4.4% (15/342) cases reclassified as no myocarditis or as insufficient information, two cases had been exposed to the COVID-19 vaccine no more than 28 days before the myocarditis diagnosis, two cases were exposed >28 days before admission and 11 cases were unexposed to the vaccine. The reclassification had only minor impact on incidence rate ratios for myocarditis following COVID-19 vaccination. In total, 51 cases were sampled for a blinded re-evaluation. Of the 30 randomly sampled cases initially classified as either definite or probably myocarditis, none were re-classified after re-evaluation. Of the in all 15 cases initially classified as no myocarditis or insufficient information, 7 were after re-evaluation re-classified as probable or possible myocarditis. This re-classification was mostly due to substantial variability in electrocardiogram interpretation.Conclusion: This validation of register-based diagnoses of myocarditis by manual patient record review confirmed the register diagnosis in 96% of cases and had high interrater reliability. Reclassification had only a minor impact on the incidence rate ratios for myocarditis following COVID-19 vaccination.

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