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1.
  • Abid, Muhammad Adil, et al. (författare)
  • A Genetic Algorithm for Optimizing Mobile Stroke Unit Deployment
  • 2023
  • Ingår i: Procedia Computer Science. - : Elsevier. - 1877-0509. ; 225, s. 3536-3545
  • Tidskriftsartikel (refereegranskat)abstract
    • A mobile stroke unit (MSU) is an advanced ambulance equipped with specialized technology and trained healthcare personnel to provide on-site diagnosis and treatment for stroke patients. Providing efficient access to healthcare (in a viable way) requires optimizing the placement of MSUs. In this study, we propose a time-efficient method based on a genetic algorithm (GA) to find the most suitable ambulance sites for the placement of MSUs (given the number of MSUs and a set of potential sites). We designed an efficient encoding scheme for the input data (the number of MSUs and potential sites) and developed custom selection, crossover, and mutation operators that are tailored according to the characteristics of the MSU allocation problem. We present a case study on the Southern Healthcare Region in Sweden to demonstrate the generality and robustness of our proposed GA method. Particularly, we demonstrate our method's flexibility and adaptability through a series of experiments across multiple settings. For the considered scenario, our proposed method outperforms the exhaustive search method by finding the best locations within 0.16, 1.44, and 10.09 minutes in the deployment of three MSUs, four MSUs, and five MSUs, resulting in 8.75x, 16.36x, and 24.77x faster performance, respectively. Furthermore, we validate the method's robustness by iterating GA multiple times and reporting its average fitness score (performance convergence). In addition, we show the effectiveness of our method by evaluating key hyperparameters, that is, population size, mutation rate, and the number of generations.
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2.
  • Abul-Kasim, Kasim, et al. (författare)
  • Added diagnostic utility of CT perfusion and CT angiography in acute ischemic stroke. Evaluation of three different patient categories
  • 2009
  • Ingår i: Functional Neurology. - 0393-5264. ; 24:2, s. 93-98
  • Tidskriftsartikel (refereegranskat)abstract
    • Patients with a clinical picture of acute ischemic stroke are a heterogeneous group. The aim of this study was to evaluate the added utility of CT perfusion (CTP) and CT angiography (CTA) in the workup of three different categories of acute ischemic stroke patients. Fifty patients (61 +/- 05 years old) were included in this retrospective analysis. Twenty-nine patients had transient ischemic attacks (TIAs) (Group I), 15 were not eligible for treatment with thrombolysis (Group II) and six showed no improvement after thrombolysis (Group III). CTP and CTA provided additional information, not revealed by plain CT, in all the Group II patients and in one third of the patients belonging to the other groups. The final diagnoses were TIA (n=23), thromboembolic cerebral infarctions (n=22), carotid artery dissection (n=4) and metastases (n=1). Of the 29 patients admitted with TIA, only 22 patients still had this diagnosis on discharge from the stroke unit. Given the risk of impending stroke, it would be important to include these modalities in the initial workup of TIA.
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3.
  • Abul-Kasim, Kasim, et al. (författare)
  • Combined Clinical and Radiological Prognostic Model in Acute Ischemic Stroke
  • 2010
  • Ingår i: Acta Neurologica Belgica. - 2240-2993. ; 110:3, s. 239-245
  • Tidskriftsartikel (refereegranskat)abstract
    • We sought to propose and test the validity of a comprehensive prognostic model in middle cerebral artery-stroke treated with Intravenous thrombolysis. A total of 127 consecutive patients (aged 70 +/- 12 years; 54% males) were included in this retrospective study. Variables included in our prognostic model were: NIHSS on admission (1-3 points), occurrence of hyperdense middle cerebral artery sign and early ischemic signs on baseline CT (1 point each). NIHSS at 24 hours (0-3 points), posttreatment hemorrhage (1 point), and infarct volume (0-4 points). The score range teas 1-13, with higher values suggest unfavorable prognosis. Our prognostic score was correlated with the modified Rankin scale (mRS) at 3 months after stroke [correlation coefficient of 0.62, P < 0.001] and can thus help early prediction of the functional outcome. Logistic regression showed that NIHSS at 24 hours and EICs on baseline CT were independent predictor of our prognostic score (adjusted odds ratio of 4.1 and 5). Adopting a cut-off value of prognostic score <= 3 for favorable prognosis and >= 7 for unfavorable prognosis helped to predict the need for institutionalization and the functional outcome with higher accuracy and predictive values compared with using scores only based on NIHSS.
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4.
  • Abul-Kasim, Kasim, et al. (författare)
  • Hyperdense middle cerebral artery sign in multidetector computed tomography: Definition, occurrence, and reliability analysis.
  • 2009
  • Ingår i: Neurology India. - : Medknow. - 0028-3886. ; 57:2, s. 143-150
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The hyperdense middle cerebral artery sign (HMCAS) is one of the early changes seen on the computed tomography in acute ischemic stroke of MCA territory. Aims: To evaluate the reliability of subjective evaluation of HMCAS on CT performed at multidetector CT (MDCT) and evaluated in the Picture Archiving Communication Systems, to define objective criteria for HMCAS and to find out if there are any predictors for the occurrence of HMCAS. Materials and Methods: CTs of 121 consecutive patients (mean age of 70 years) treated with thrombolytic therapy were retrospectively evaluated by two neuroradiologists both subjectively and objectively with respect to HMCAS. Results: HMCAS was subjectively found in 32% of study population. The interobserver and intraobserver agreement were substantial (K value of 0.69 and 0.80, respectively) and increased to almost perfect (Kvalue of 0.86) when the reader provided with clinical information. The HMCAS was found twice as often in male patients. Patients with HMCAS were three years younger than those whose baseline CT did not show HMCAS. A 100% sensitivity achieved when objective criteria were defined as combination of MCA attenuation >/= 46HU and MCA ratio > 1.2 (using oval ROIs) and MCA attenuation >/= 50 HU and MCA ratio of > 1.4 (using pixel sized ROIs). Conclusion: Performing CT examinations on MDCT and assessment of the images in PACS might have contributed to improvement of the reliability of evaluating HMCAS on CT by enabling an objective evaluation of this sign with measurements of attenuation value in the course of MCA using oval or pixel sized ROIs as well as estimation of MCA ratio .
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5.
  • Abul-Kasim, Kasim, et al. (författare)
  • Hyperdense middle cerebral artery sign is an ominous prognostic marker despite optimal workflow.
  • 2010
  • Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 1600-0404 .- 0001-6314. ; 122, s. 132-139
  • Tidskriftsartikel (refereegranskat)abstract
    • Abul-Kasim K, Brizzi M, Petersson J. Hyperdense middle cerebral artery sign is an ominous prognostic marker despite optimal workflow. Acta Neurol Scand: DOI: 10.1111/j.1600-0404.2009.01277.x. (c) 2009 The Authors Journal compilation (c) 2009 Blackwell Munksgaard.Objectives - To evaluate the association between the hyperdense middle cerebral artery sign (HMCAS) and the functional outcome on one hand, and different predictors such as the National Institutes of Health Stroke Scale (NIHSS), infarct size, ASPECTS Score, intracerebral hemorrhage, and mortality on the other hand. Material and methods - Retrospective analysis of 120 patients with MCA-stroke treated with intravenous thrombolysis. We tested the association between HMCAS and NIHSS, infarct volume, ASPECTS, outcome, level of consciousness, different recorded time intervals, and the day/time of admission. Results - Seventy-four percentage of patients treated with thrombolysis developed cerebral infarction. All patients with HMCAS (n = 39) sustained infarction and only 31% showed favorable outcome compared with 62% and 60%, respectively among patients without HMCAS (P < 0.001 and P = 0.002). There was statistically significant association between functional outcome and HMCAS (P = 0.002), infarct volume, NIHSS, and ASPECTS (P < 0.001). The time to treatment was 12 min shorter in patients who developed infarction (P = 0.037). Independent predictors for outcome were NIHSS and the occurrence of cerebral infarction on computed tomography for the whole study population, and infarct volume for patients who sustained cerebral infarction. Conclusions - Despite optimal workflow, patients with HMCAS showed poor outcome after intravenous thrombolysis. The results emphasize the urgent need for more effective revascularization therapies and neuroprotective treatment in this subgroup of stroke patients.
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6.
  • Al Fatah, Jabir, et al. (författare)
  • An agent-based simulation model for assessment of prehospital triage policies concerning destination of stroke patients
  • 2018
  • Ingår i: Procedia Computer Science. - : Elsevier. - 1877-0509. ; 141, s. 405-412
  • Tidskriftsartikel (refereegranskat)abstract
    • Stroke is a life threatening medical condition that is caused either by a blood clot or a bleeding inside the brain. It is generally agreed that immediate treatment of stroke patients is crucial for their ability to recover; however, before treatment can be initiated, the stroke patient has to be diagnosed using, for example, a computed tomography scan of the brain. This, in turn, requires that the patient is transported to a hospital for diagnosis, which is a procedure that consumes valuable time and resources. In the current paper, we present an agent-based simulation model for assessment of logistical stroke patient triage policies. Using a population of stroke patients as input, the model enables to simulate the activities and the main decisions involved in the logistical operations of stroke patients. In an experimental study covering the southernmost part of Sweden, we used the simulation model in order to assess two different policies regarding where to send patients for diagnosis; the nearest hospital policy and the nearest hospital towards the stroke center policy. Our simulation results show that the patients in need of special treatment favor from being transported in direction towards the stroke center, whereas the patients who are not in need of specialist treatment favor from being sent to the closest hospital.
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7.
  • Amouzad Mahdiraji, Saeid, et al. (författare)
  • A Framework for Constructing Discrete Event Simulation Models for Emergency Medical Service Policy Analysis
  • 2022
  • Ingår i: Procedia Computer Science. - : Elsevier BV. - 1877-0509. ; 210, s. 133-140
  • Konferensbidrag (refereegranskat)abstract
    • Constructing simulation models can be a complex and time-consuming task, in particular if the models are constructed from scratch or if a general-purpose simulation modeling tool is used. In this paper, we propose a model construction framework, which aims to simplify the process of constructing discrete event simulation models for emergency medical service (EMS) policy analysis. The main building blocks used in the framework are a set of general activities that can be used to represent different EMS care chains modeled as flowcharts. The framework allows to build models only by specifying input data, including demographic and statistical data, and providing a care chain of activities and decisions. In a case study, we evaluated the framework by using it to construct a model for the simulation of the EMS activities related to acute stroke. Our evaluation shows that the predefined activities included in the framework are sufficient to build a simulation model for the rather complex case of acute stroke.
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8.
  • Amouzad Mahdiraji, Saeid, et al. (författare)
  • A Micro-Level Simulation Model for Analyzing the Use of MSUs in Southern Sweden
  • 2021
  • Ingår i: Procedia Computer Science : 12th International Conference on Emerging Ubiquitous Systems and Pervasive Networks, EUSPN 2021 / 11th International Conference on Current and Future Trends of Information and Communication Technologies in Healthcare, ICTH 2021 - 12th International Conference on Emerging Ubiquitous Systems and Pervasive Networks, EUSPN 2021 / 11th International Conference on Current and Future Trends of Information and Communication Technologies in Healthcare, ICTH 2021. - : Elsevier BV. ; 198, s. 132-139
  • Konferensbidrag (refereegranskat)abstract
    • A mobile stroke unit (MSU) is a special type of ambulance, where stroke patients can be diagnosed and provided intravenous treatment, hence allowing to cut down the time to treatment for stroke patients. We present a discrete event simulation (DES) model to study the potential benefits of using MSUs in the southern health care region of Sweden (SHR). We included the activities and actions used in the SHR for stroke patient transportation as events in the DES model, and we generated a synthetic set of stroke patients as input for the simulation model. In a scenario study, we compared two scenarios, including three MSUs each, with the current situation, having only regular ambulances. We also performed a sensitivity analysis to further evaluate the presented DES model. For both MSU scenarios, our simulation results indicate that the average time to treatment is expected to decrease for the whole region and for each municipality of SHR. For example, the average time to treatment in the SHR is reduced from 1.31h in the baseline scenario to 1.20h and 1.23h for the two MSU scenarios. In addition, the share of stroke patients who are expected to receive treatment within one hour is increased by a factor of about 3 for both MSU scenarios.
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9.
  • Amouzad Mahdiraji, Saeid, et al. (författare)
  • An Optimization Model for the Placement of Mobile Stroke Units
  • 2024
  • Ingår i: Advanced Research in Technologies, Information, Innovation and Sustainability - 3rd International Conference, ARTIIS 2023, Proceedings. - : Springer. - 1865-0929 .- 1865-0937. - 9783031488573 - 9783031488580 ; 1935 CCIS, s. 297-310
  • Konferensbidrag (refereegranskat)abstract
    • Mobile Stroke Units (MSUs) are specialized ambulances that can diagnose and treat stroke patients; hence, reducing the time to treatment for stroke patients. Optimal placement of MSUs in a geographic region enables to maximize access to treatment for stroke patients. We contribute a mathematical model to optimally place MSUs in a geographic region. The objective function of the model takes the tradeoff perspective, balancing between the efficiency and equity perspectives for the MSU placement. Solving the optimization problem enables to optimize the placement of MSUs for the chosen tradeoff between the efficiency and equity perspectives. We applied the model to the Blekinge and Kronoberg counties of Sweden to illustrate the applicability of our model. The experimental findings show both the correctness of the suggested model and the benefits of placing MSUs in the considered regions.
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10.
  • Amouzad Mahdiraji, Saeid (författare)
  • On the Use of Simulation and Optimization for the Analysis and Planning of Prehospital Stroke Care
  • 2022
  • Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Immediate treatment is of extreme importance for stroke patients. However, providing fast enough treatment for stroke patients is far from trivial, mainly due to logistical challenges and difficulties in diagnosing the correct stroke type. One way to reduce the time to treatment is to use so-called Mobile Stroke Units (MSUs), which allows to diagnose and provide treatment for stroke patients already at the patient scene. A well-designed stroke transport policy is vital to improve the access to treatment for stroke patients. Simulation and mathematical optimization are useful approaches for assessing and optimizing stroke transport policies, without endangering the health of the patients.The main purpose of this thesis is to contribute to improving the situation for stroke patients and to reducing the social impacts of stroke. The aim is to study how to use simulation and optimization to achieve improved analysis and planning of prehospital stroke care. In particular, we focus on assessing the potential use of MSUs in a geographic area. In this thesis, optimization is used to identify the optimal locations of MSUs, and simulation is used to assess different stroke transport policies, including MSU locations. The results of this thesis aim to support public health authorities when making decisions in the prehospital stroke care domain.In order to fulfill the aim of this thesis, we develop and analyze a number of different simulation and optimization models. First, we propose a macro-level simulation model, an average time to treatment estimation model, used to estimate the expected time to treatment for different parts of a geographic region. Using the proposed model, we generate two different MSU scenarios to explore the potential benefits of employing MSUs in Sweden’s southern healthcare region (SHR).  Second, we present an optimization model to identify the best placement of MSUs while making a trade-off between the efficiency and equity perspectives, providing maximum population coverage and equal service for all patients, respectively. The trade-off function used in the model makes use of the concepts of weighted average time to treatment to model efficiency and the time difference between the expected time to treatment for different geographical areas to model equity. In a scenario study applied in the SHR, we evaluate our optimization model by comparing the current situation with three MSU scenarios, including 1, 2, and 3 MSUs.Third, we present a micro-level discrete event simulation model to assess stroke transport policies, including MSUs, allowing us to model the behaviors of individual entities, such as patients and emergency vehicles, over time. We generate a synthetic set of stroke patients using a Poisson distribution, used as input in a scenario study.Finally, we present a modeling framework with reusable components, which aims to facilitate the construction of discrete event simulation models in the emergency medical services domain. The framework consists of a number of generic activities, which can be used to represent healthcare chains modeled in the form of flowcharts. As the framework includes activities and policies modeled on the general level, the framework can be used to create models only by providing input data and a care chain specification. We evaluate the framework by using it to build a model for simulating EMS activities related to the complex case of acute stroke.
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11.
  • Andreasson, Torbjörn, et al. (författare)
  • Kriskommunikation 2032. Fyra samhällsscenarier för strategisk planering – SOMCRISC rapport 2
  • 2017
  • Rapport (övrigt vetenskapligt/konstnärligt)abstract
    • Forskningsprojektet Digitala och sociala mediers betydelse för kommunikation i samband med samhälleliga kriser (SOMCRISC) tar avstamp i den genomgripande digitalisering som skett i samhället under senare decennier. Fokus i projektet ligger på hur digital teknik öppnat för nya möjligheter och utmanat de förhållningssätt och praktiker som präglat kriskommunikation i samband med samhälleliga kriser. I de två rapporter som producerats tar projektet sikte på år 2032, de behov som framtida krishantering kan komma att ställas inför och de möjligheter och förutsättningar som den digitala tekniken kan tänkas tillhandahålla. Rapport 1, Kriskommunikation 2032 – Tolv trender i ett digitalt samhälle, redogör för ett antal trender kring digital teknik och tillämpning av digitala tjänster, som kan förväntas få stor betydelse för det svenska krishanteringssystemet. Utgångspunkten har varit att identifiera, analysera och redogöra för viktiga trender i gränssnittet mellan digitalisering å ena sidan, och medier, myndigheter och teknisk infrastruktur å andra sidan. Rapport 2, Kriskommunikation 2032 – Fyra samhällsscenarier för strategisk planering, är tänkt att fungera som ett metodstöd för proaktiv reflektion kring och analys av kriser i ett framtida digitalt samhälle. Baserat på tidigare forskning och domänexpertis presenterar rapporten fyra digitala framtidsscenarier, konstruerade kring dimensionerna medborgardeltagande och offentlig styrning.
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12.
  • Andreasson, Torbjörn, et al. (författare)
  • Kriskommunikation 2032. Tolv trender i ett digitalt samhälle – SOMCRISC rapport 1
  • 2017
  • Rapport (övrigt vetenskapligt/konstnärligt)abstract
    • Forskningsprojektet Digitala och sociala mediers betydelse för kommunikation i samband med samhälleliga kriser (SOMCRISC) tar avstamp i den genomgripande digitalisering som skett i samhället under senare decennier. Fokus i projektet ligger på hur digital teknik öppnat för nya möjligheter och utmanat de förhållningssätt och praktiker som präglat kriskommunikation i samband med samhälleliga kriser. I de två rapporter som producerats tar projektet sikte på år 2032, de behov som framtida krishantering kan komma att ställas inför och de möjligheter och förutsättningar som den digitala tekniken kan tänkas tillhandahålla. Rapport 1, Kriskommunikation 2032 – Tolv trender i ett digitalt samhälle, redogör för ett antal trender kring digital teknik och tillämpning av digitala tjänster, som kan förväntas få stor betydelse för det svenska krishanteringssystemet. Utgångspunkten har varit att identifiera, analysera och redogöra för viktiga trender i gränssnittet mellan digitalisering å ena sidan, och medier, myndigheter och teknisk infrastruktur å andra sidan. Rapport 2, Kriskommunikation 2032 – Fyra samhällsscenarier för strategisk planering, är tänkt att fungera som ett metodstöd för proaktiv reflektion kring och analys av kriser i ett framtida digitalt samhälle. Baserat på tidigare forskning och domänexpertis presenterar rapporten fyra digitala framtidsscenarier, konstruerade kring dimensionerna medborgardeltagande och offentlig styrning.
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13.
  • Apostolaki-Hansson, Trine, et al. (författare)
  • Patient factors associated with receiving reversal therapy in oral anticoagulant-related intracerebral hemorrhage
  • 2022
  • Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 146:5, s. 590-597
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: We aimed to describe baseline characteristics of patients with oral anticoagulant-related intracerebral hemorrhage (OAC-ICH) in Sweden and to identify predictive variables associated with receiving hemostatic treatment in the event of OAC-ICH. Methods: We performed an observational study based on data from Riksstroke and the Swedish Causes of Death Register to define baseline characteristics of patients with OAC-ICH who received reversal treatment compared with patients who did not receive reversal treatment during 2017–2019. Predictive analysis was performed using multivariable logistic regression to identify odds ratios for factors associated with receiving OAC reversal treatment. Results: We included 1902 patients ((n = 1146; OAC reversal treatment) (n = 756; no OAC reversal treatment)). The proportion of non-Vitamin K oral anticoagulant associated ICH (NOAC-ICH) patients who received reversal treatment was 48.4% and the proportion of Vitamin K antagonist-associated ICH (VKA-ICH) patients was 72.9%. Factors associated with a lower odds of receiving reversal treatment were increased age (OR = 0.98; 95% CI: 0.96–0.99), previous stroke (OR = 0.78; 95% CI: 0.62–0.98), comatose LOC (OR = 0.36;95%CI: 0.27–0.48; ref. = alert), pre-stroke dependency (OR = 0.72; 95% CI: 0.58–0.91), and NOAC treatment (OR = 0.34; 95% CI: 0.28–0.42). Care at a university hospital was not associated with higher odds of receiving reversal treatment compared to treatment at a county hospital. Conclusion: Treatment with a reversal agent following OAC-ICH was related to several patient factors including type of OAC drug. We identified that only 48% of patients with NOAC-ICH received hemostatic treatment despite an increase in these cases. Further studies are required to guide the use of reversal therapies more precisely, particularly in NOAC-ICH.
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14.
  • Apostolaki-Hansson, Trine, et al. (författare)
  • Prognosis for intracerebral hemorrhage during ongoing oral anticoagulant treatment
  • 2019
  • Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 139:5, s. 415-421
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Intracerebral hemorrhage (ICH) is the most serious adverse effect of treatment with oral anticoagulants. Prognostic data after ICH associated with non-vitamin K antagonist oral anticoagulants (NOAC) compared to vitamin K antagonists (VKA) are sparse. We compared 90-day survival and functional outcome following NOAC-ICH versus VKA-ICH using data from the Swedish Stroke Register (Riksstroke). Methods: Using data from Riksstroke and the Swedish Causes of Death Register between 2012 and 2016, we compared all-cause 90-day mortality for patients with NOAC-ICH versus VKA-ICH using Kaplan-Meier survival analysis and Log-rank test. Cox regression, with adjustment for age, sex, previous stroke, and level of consciousness (LOC) on admission, was used to estimate hazard ratios (HR) for 90-day mortality. Estimated functional outcome at 90 days, based on the modified Rankin Scale (mRS), was compared between VKA- and NOAC-associated ICH using chi-squared test. Results: We included 2483 patients; 300 with NOAC-ICH and 2183 with VKA-ICH. In both groups, mean age was 79 years, and 58% were male. No significant difference between NOAC-ICH and VKA-ICH was found for all-cause 90-day mortality (44.3% NOAC-ICH versus 42.6% VKA-ICH; P = 0.54, HR = 0.93; 95% confidence interval (CI): 0.78-1.12) or 90-day estimated functional outcome (mRS 0-2:13.7% and 15.3%; mRS 3-5:27.3% and 28.9%, respectively (P = 0.52)). Factors predicting death were increased age (HR = 1.03; 95%CI: 1.02-1.04) and reduced LOC (drowsy: HR = 3.48; 95%CI: 2.86-4.23; comatose: HR = 12.27; 95%CI: 10.13-14.87). Conclusion: In this large study on anticoagulant-associated ICH, we found no significant difference in mortality and functional outcome at 90 days between NOAC-ICH versus VKA-ICH.
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15.
  • Apostolaki-Hansson, Trine, et al. (författare)
  • Prognosis of Intracerebral Hemorrhage Related to Antithrombotic Use : An Observational Study From the Swedish Stroke Register (Riksstroke)
  • 2021
  • Ingår i: Stroke. - 1524-4628. ; 52:3, s. 966-974
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND AND PURPOSE: To date, large studies comparing mortality and functional outcome of intracerebral hemorrhage (ICH) during oral anticoagulant (OAC), antiplatelet, and nonantithrombotic use are few and show discrepant results. METHODS: We used data on 13 291 patients with ICH registered in Riksstroke between 2012 and 2016 to compare 90-day mortality and functional outcome following OAC-related ICH (n=2300), antiplatelet-related ICH (n=3637), and nonantithrombotic ICH (n=7354). Univariable and multivariable Cox regression analyses, with adjustment for relevant confounders, were used to compare 90-day mortality. Early (≤24 hours and 1-7 days) and late (8-90 days) mortality was also studied in subgroup analyses. Univariable and multivariable 90-day functional outcome, based on self-reported modified Rankin Scale, was determined using logistic regression. RESULTS: Patients with antithrombotic treatment were more often prestroke dependent, older, and had a larger comorbidity burden compared with patients without antithrombotic treatment. At 90 days, antiplatelet and OAC were associated with an increased death rate in multivariable analysis (antiplatelet ICH: hazard ratio, 1.23 [95% CI, 1.14-1.33]; OAC ICH: hazard ratio, 1.40 [95% CI, 1.26-1.57]) compared with nonantithrombotic ICH (reference). OAC ICH and antiplatelet ICH were associated with higher risk of early mortality (≤24 hours: OAC ICH: hazard ratio, 1.93 [95% CI, 1.57-2.38]; antiplatelet ICH: hazard ratio, 1.32 [95% CI, 1.13-1.54]). In multivariable analysis, the odds ratios for the association of antiplatelet and OAC treatment on functional dependency (modified Rankin Scale score, 3-5) at 90 days were nonsignificant (antiplatelet: odds ratio, 1.07 [95% CI, 0.92-1.24]; OAC: odds ratio, 0.96 [95% CI, 0.76-1.22]). CONCLUSIONS: In this large observational study, we found that 90-day mortality outcome was worse not only in OAC ICH but also in antiplatelet ICH, compared with patients with nonantithrombotic ICH. Antiplatelet ICH is common and is a serious condition with poor clinical outcome. Further studies are, therefore, warranted in determining the appropriate clinical management of these patients.
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16.
  • Apostolaki-Hansson, Trine, et al. (författare)
  • Reversal Treatment in Oral Anticoagulant-Related Intracerebral Hemorrhage—An Observational Study Based on the Swedish Stroke Register
  • 2020
  • Ingår i: Frontiers in Neurology. - : Frontiers Media SA. - 1664-2295. ; 11
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Intracerebral hemorrhage (ICH) is the most serious adverse effect of oral anticoagulant (OAC) treatment. The effect of OAC reversal therapy on outcome is uncertain. We compared 90-day survival and functional outcome in patients with OAC-ICH who received OAC reversal therapy with those who did not. Methods: Data from The Swedish Stroke Register (Riksstroke) for all registered cases of OAC-ICH during 2017 (572 patients) were used to obtain information on reversal (n = 369) and non-reversal (n = 203) treatment receiving patients. Univariate and multivariate Cox regression analysis stratified for level of consciousness (LOC) on admission, and adjustment for relevant baseline variables, was used to compare 90-day Hazard Ratios (HR) for mortality. Results: Sixty-five percent of patients received reversal treatment. These patients were younger, more often pre-stroke independent and alert at presentation. Withholding reversal treatment was associated with an increased death rate (HR = 1.47; 95% CI: 1.08–2.01) in a Cox regression model stratified for LOC and adjusted for baseline imbalances. Additional factors associated with an increased 90-day death rate were male sex (HR = 1.42; 95% CI: 1.06–1.92), age (HR = 1.05; 95% CI: 1.02–1.07), and intraventricular hemorrhage (HR = 2.41; CI: 1.77–3.29). Conclusion: In this large observational study 35% of patients with OAC-ICH did not receive reversal treatment. Patients receiving OAC-reversal treatment had an improved 90-day mortality outcome compared to those not receiving treatment. Mortality was strongly related to LOC. Further, and larger, studies are required to determine which patient groups may benefit from reversal therapy and in whom non-reversal is adequate.
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17.
  • Arlien-Soborg, Mai C., et al. (författare)
  • Acromegaly management in the Nordic countries: A Delphi consensus survey
  • 2024
  • Ingår i: Clinical Endocrinology. - : WILEY. - 0300-0664 .- 1365-2265.
  • Tidskriftsartikel (refereegranskat)abstract
    • ObjectiveAcromegaly is associated with increased morbidity and mortality if left untreated. The therapeutic options include surgery, medical treatment, and radiotherapy. Several guidelines and recommendations on treatment algorithms and follow-up exist. However, not all recommendations are strictly evidence-based. To evaluate consensus on the treatment and follow-up of patients with acromegaly in the Nordic countries.MethodsA Delphi process was used to map the landscape of acromegaly management in Denmark, Sweden, Norway, Finland, and Iceland. An expert panel developed 37 statements on the treatment and follow-up of patients with acromegaly. Dedicated endocrinologists (n = 47) from the Nordic countries were invited to rate their extent of agreement with the statements, using a Likert-type scale (1-7). Consensus was defined as >= 80% of panelists rating their agreement as >= 5 or <= 3 on the Likert-type scale.ResultsConsensus was reached in 41% (15/37) of the statements. Panelists agreed that pituitary surgery remains first line treatment. There was general agreement to recommend first-generation somatostatin analog (SSA) treatment after failed surgery and to consider repeat surgery. In addition, there was agreement to recommend combination therapy with first-generation SSA and pegvisomant as second- or third-line treatment. In more than 50% of the statements, consensus was not achieved. Considerable disagreement existed regarding pegvisomant monotherapy, and treatment with pasireotide and dopamine agonists.ConclusionThis consensus exploration study on the management of patients with acromegaly in the Nordic countries revealed a relatively large degree of disagreement among experts, which mirrors the complexity of the disease and the shortage of evidence-based data.
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18.
  • Arlien-Søborg, Mai C., et al. (författare)
  • Acromegaly management in the nordic countries : a Delphi consensus survey
  • 2024
  • Ingår i: Clinical Endocrinology. - : John Wiley & Sons. - 0300-0664 .- 1365-2265.
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: Acromegaly is associated with increased morbidity and mortality if left untreated. The therapeutic options include surgery, medical treatment, and radiotherapy. Several guidelines and recommendations on treatment algorithms and follow-up exist. However, not all recommendations are strictly evidence-based. To evaluate consensus on the treatment and follow-up of patients with acromegaly in the Nordic countries.Methods: A Delphi process was used to map the landscape of acromegaly management in Denmark, Sweden, Norway, Finland, and Iceland. An expert panel developed 37 statements on the treatment and follow-up of patients with acromegaly. Dedicated endocrinologists (n = 47) from the Nordic countries were invited to rate their extent of agreement with the statements, using a Likert-type scale (1−7). Consensus was defined as ≥80% of panelists rating their agreement as ≥5 or ≤3 on the Likert-type scale.Results: Consensus was reached in 41% (15/37) of the statements. Panelists agreed that pituitary surgery remains first line treatment. There was general agreement to recommend first-generation somatostatin analog (SSA) treatment after failed surgery and to consider repeat surgery. In addition, there was agreement to recommend combination therapy with first-generation SSA and pegvisomant as second- or third-line treatment. In more than 50% of the statements, consensus was not achieved. Considerable disagreement existed regarding pegvisomant monotherapy, and treatment with pasireotide and dopamine agonists.Conclusion: This consensus exploration study on the management of patients with acromegaly in the Nordic countries revealed a relatively large degree of disagreement among experts, which mirrors the complexity of the disease and the shortage of evidence-based data.
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19.
  • Berge, Eivind, et al. (författare)
  • Methods to improve patient recruitment and retention in stroke trials
  • 2016
  • Ingår i: International Journal of Stroke. - : SAGE Publications. - 1747-4930 .- 1747-4949. ; 11:6, s. 663-676
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The success of randomized-controlled stroke trials is dependent on the recruitment and retention of a sufficient number of patients, but fewer than half of all trials meet their target number of patients. Methods: We performed a search and review of the literature, and conducted a survey and workshop among 56 European stroke trialists, to identify barriers, suggest methods to improve recruitment and retention, and make a priority list of interventions that merit further evaluation. Results: The survey and workshop identified a number of barriers to patient recruitment and retention, from patients’ incapacity to consent, to handicaps that prevent patients from participation in trial-specific follow-up. Methods to improve recruitment and retention may include simple interventions with individual participants, funding of research networks, and reimbursement of new treatments by health services only when delivered within clinical trials. The literature review revealed that few methods have been formally evaluated. The top five priorities for evaluation identified in the workshop were as follows: short and illustrated patient information leaflets, nonwritten consent, reimbursement for new interventions only within a study, and monetary incentives to institutions taking part in research (for recruitment); and involvement of patient groups, remote and central follow-up, use of mobile devices, and reminders to patients about their consent to participate (for retention). Conclusions: Many interventions have been used with the aim of improving recruitment and retention of patients in stroke studies, but only a minority has been evaluated. We have identified methods that could be tested, and propose that such evaluations may be nested within on-going clinical trials.
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20.
  • Blauenfeldt, Rolf Ankerlund, et al. (författare)
  • Remote Ischemic Conditioning for Acute Stroke : The RESIST Randomized Clinical Trial
  • 2023
  • Ingår i: JAMA. - 0098-7484. ; 330:13, s. 1236-1246
  • Tidskriftsartikel (refereegranskat)abstract
    • Importance: Despite some promising preclinical and clinical data, it remains uncertain whether remote ischemic conditioning (RIC) with transient cycles of limb ischemia and reperfusion is an effective treatment for acute stroke. Objective: To evaluate the effect of RIC when initiated in the prehospital setting and continued in the hospital on functional outcome in patients with acute stroke. Design, Setting, and Participants: This was a randomized clinical trial conducted at 4 stroke centers in Denmark that included 1500 patients with prehospital stroke symptoms for less than 4 hours (enrolled March 16, 2018, to November 11, 2022; final follow-up, February 3, 2023). Intervention: The intervention was delivered using an inflatable cuff on 1 upper extremity (RIC cuff pressure, ≤200 mm Hg [n = 749] and sham cuff pressure, 20 mm Hg [n = 751]). Each treatment application consisted of 5 cycles of 5 minutes of cuff inflation followed by 5 minutes of cuff deflation. Treatment was started in the ambulance and repeated at least once in the hospital and then twice daily for 7 days among a subset of participants. Main Outcomes and Measures: The primary end point was improvement in functional outcome measured as a shift across the modified Rankin Scale (mRS) score (range, 0 [no symptoms] to 6 [death]) at 90 days in the target population with a final diagnosis of ischemic or hemorrhagic stroke. Results: Among 1500 patients who were randomized (median age, 71 years; 591 women [41%]), 1433 (96%) completed the trial. Of these, 149 patients (10%) were diagnosed with transient ischemic attack and 382 (27%) with a stroke mimic. In the remaining 902 patients with a target diagnosis of stroke (737 [82%] with ischemic stroke and 165 [18%] with intracerebral hemorrhage), 436 underwent RIC and 466 sham treatment. The median mRS score at 90 days was 2 (IQR, 1-3) in the RIC group and 1 (IQR, 1-3) in the sham group. RIC treatment was not significantly associated with improved functional outcome at 90 days (odds ratio [OR], 0.95; 95% CI, 0.75 to 1.20, P =.67; absolute difference in median mRS score, -1; -1.7 to -0.25). In all randomized patients, there were no significant differences in the number of serious adverse events: 169 patients (23.7%) in the RIC group with 1 or more serious adverse events vs 175 patients (24.3%) in the sham group (OR, 0.97; 95% CI, 0.85 to 1.11; P =.68). Upper extremity pain during treatment and/or skin petechia occurred in 54 (7.2%) in the RIC group and 11 (1.5%) in the sham group. Conclusions and Relevance: RIC initiated in the prehospital setting and continued in the hospital did not significantly improve functional outcome at 90 days in patients with acute stroke. Trial Registration: ClinicalTrials.gov Identifier: NCT03481777.
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21.
  • Borg, Markus, et al. (författare)
  • Conflict management in student groups - a teacher’s perspective in higher education
  • 2011
  • Ingår i: Högre utbildning. - 2000-7558. ; 1:2, s. 111-124
  • Tidskriftsartikel (refereegranskat)abstract
    • Students working in groups is a commonly used method of instruction in higher education, popularized by the introduction of problem based learning. As a result, management of small groups of people has become an important skill for teachers. The objective of our study is to investigate why conflicts arise in student groups at the Faculty of Engineering at Lund University and how teachers manage them. We have conducted an exploratory interdepartmental interview study on teachers' views on this matter, interviewing ten university teachers with different levels of seniority. Our results show that conflicts frequently arise in group work, most commonly caused by different levels of ambition among students. We also found that teachers prefer to work proactively against conflicts and stress the student’s responsibility. Finally, we show that teachers at our faculty tend to avoid the more drastic conflict resolution strategies suggested by previous research. The outcome of our study could be used as input to future guidelines on conflict management in student groups.
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22.
  • Buchwald, Fredrik, et al. (författare)
  • Atrial Fibrillation in Transient Ischemic Attack Versus Ischemic Stroke : A Swedish Stroke Register (Riksstroke) Study
  • 2016
  • Ingår i: Stroke: a journal of cerebral circulation. - 0039-2499. ; 47:10, s. 2456-2461
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND AND PURPOSE—: Compared with ischemic stroke (IS), the association of atrial fibrillation (AF) with transient ischemic attack (TIA) is less well established. We aimed to assess the proportion of AF in patients with TIA, and these patients’ characteristics and secondary preventive treatment in comparison to patients with IS. METHODS—: Hospital-based data on TIA and IS events, registered from July 2011 to June 2013, were obtained from the Swedish Stroke Register (Riksstroke). A time-based TIA definition (duration of symptoms <24 hours) was applied. AF was registered as present when previously known or diagnosed at the time of assessment. RESULTS—: AF was present in 2779 of 14 980 (18.6%) patients with TIA and 13 258 of 44 173 (30.0%) patients with IS. The proportion of AF increased with age, reaching 32.9% in TIA and 46.6% in IS patients ≥85 years. Both in TIA and IS, age, hypertension, a history of stroke, and TIA, and being a nonsmoker were associated with the presence of AF. In contrast to IS, AF was less common in female than in male patients with TIA. At discharge, 64.2% of TIA and 50.0% of IS patients with AF were treated with oral anticoagulants. Proportions of AF patients treated with oral anticoagulants decreased substantially with increasing age. CONCLUSIONS—: AF is highly prevalent not only in IS but also in TIA patients, with proportions steeply increasing with age. In both TIA and IS, a substantial proportion of patients with AF were discharged without anticoagulant therapy.
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23.
  • Buchwald, Fredrik, et al. (författare)
  • Validation of Diagnoses of Transient Ischemic Attack in the Swedish Stroke Register (Riksstroke) TIA-Module
  • 2015
  • Ingår i: Neuroepidemiology. - : S. Karger. - 0251-5350 .- 1423-0208. ; 45:1, s. 40-43
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: In 2010, the Swedish Stroke Register (Riksstroke; RS) established a module for transient ischemic attacks (RS-TIA). We report a diagnostic validation study of patients included in RS-TIA.Methods: During the first year, 7,825 patients were registered at 59 out of 74 Swedish hospitals. A time-based TIA definition was applied. A sample of 180 patients (30 patients each from 6 hospitals), with a similar distribution of age and sex as in RS-TIA, was prepared. Two independent observers assessed medical records for quality of documentation and assigned a diagnosis of likely, possible, unlikely TIA or ischennic stroke, according to pre-specified criteria.Results:The 2 observers agreed in 77% of cases that the event was a likely or possible TIA, in 3% that the event was an ischemic stroke, and in 2% that the event was an unlikely TIA. The observers disagreed in 8% of patients on TIA vs. ischennic stroke, and in 11% on a vascular vs. non-vascular cause. Quality of documentation was fair.Conclusions: There was interobserver agreement on diagnosis of TIA in the majority of patients included in RS-TIA. Diagnostic accuracy may be further improved by more systematic documentation of symptoms and signs.
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24.
  • Caporuscio, Mauro, 1975-, et al. (författare)
  • IoT-enabled Physical Telerehabilitation Platform
  • 2017
  • Ingår i: Proccedings of the International Workshop on Engineering IoT Systems. - : IEEE. - 9781509047932 ; , s. 112-119
  • Konferensbidrag (refereegranskat)abstract
    • Physical telerehabilitation services over the Internet allow physiotherapists to engage in remote consultation with patients at their homes, improving the quality of care and reducing costs. Traditional visual approaches, such as webcams and videophones, are limited in terms of precision of assessment and support for assistance with exercises. In this paper, we present a Physical Telerehabilitation System (PTS) that enhances video interaction with IoT technology to monitor the position of the body of patients in space and provide smart data to physiotherapists and users. We give an overview of the architecture of the PTS and evaluate (i) its usability based on a number of interviews and focus groups with stakeholders, and (ii) its technical efficiency based on a series of measurements. From this evaluation, we derive a number of challenges for further improvement of the PTS and outline a possible solution based on a microservices architecture.
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25.
  • Dahllöf, Oliver, et al. (författare)
  • Optimal placement of mobile stroke units considering the perspectives of equality and efficiency
  • 2018
  • Ingår i: 9th International Conference on Emerging Ubiquitous Systems and Pervasive Networks, EUSPN 2018. - : Elsevier BV. - 1877-0509. ; 141, s. 311-318
  • Konferensbidrag (refereegranskat)abstract
    • It is widely known that the time to treatment is vital for patients who suffer from a stroke. Therefore, in different places in the world, the value of acquiring mobile stroke units has been identified. A mobile stroke unit is a specially developed ambulance for stroke treatment, which has special equipment and trained personnel who can perform intravenous stroke treatment (thrombolysis). It is clear that the involvement of mobile stroke units will aid at least a certain proportion of the stroke patients; however, mobile stroke units are often purchased and placed without any developed method or analysis of where and how it should be placed. In the current paper, we use expected value optimization in order to identify, depending on what perspective is of interest, efficiency or equality, the optimal placement of a mobile stroke unit. In an experimental study, considering the Skane County in Sweden, we show that the placement of a mobile stroke unit may vary considerably depending on which of the two perspectives is adopted.
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26.
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27.
  • Drescher, Conrad, et al. (författare)
  • Diverging Trends in the Incidence of Spontaneous Intracerebral Hemorrhage in Sweden 2010-2019 : An Observational Study from the Swedish Stroke Register (Riksstroke)
  • 2023
  • Ingår i: Neuroepidemiology. - 0251-5350. ; 57:6, s. 367-376
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Although ischemic stroke incidence has decreased in Sweden over the past decade, trends in spontaneous intracerebral hemorrhage (ICH) incidence are less well delineated. In this time period, there has been a dramatic increase in use of oral anticoagulants (OAC). The aim of our study was to investigate incidence trends in spontaneous first-ever ICH in Sweden between 2010 and 2019, with a focus on non-OAC-associated and OAC-associated ICH. Methods: We included patients (≥18 years) with first-ever ICH registered in the hospital-based Swedish Stroke Register (Riksstroke) 2010-2019. Data were stratified by non-OAC and OAC ICH and analyzed for 2010-2012, 2013-2016, and 2017-2019. Incidence rates are shown as crude and age-specific per 100,000 person-years. Results: Between 2010 and 2019, 22,289 patients with first-ever ICH were registered; 18,325 (82.2%) patients with non-OAC ICH and 3,964 (17.8%) patients with OAC ICH. Annual crude incidence (per 100,000) of all first-ever ICH decreased by 10% from 29.5 (95% CI 28.8-30.3) to 26.7 (95% CI 26.0-27.3) between 2010-2012 and 2017-2019. The crude incidence rate of non-OAC ICH decreased by 20% from 25.7 (95% CI 25.0-26.3) to 20.7 (95% CI 20.1-21.2), whereas OAC ICH increased by 56% from 3.86 (95% CI 3.61-4.12) to 6.01 (95% CI 5.70-6.32). The proportion of OAC ICH of all first-ever ICH increased between 2010-2012 and 2017-2019 from 13.1% to 22.5% (p < 0.001). Proportional changes were largest in the age group ≥85 years with a decrease in non-OAC ICH by 32% from 155 (95% CI 146-164) to 106 (95% CI 98.6-113) and an increase in OAC ICH by 155% from 25.7 (95% CI 22.1-29.4) to 65.5 (95% CI 59.9-71.2). Conclusion: Incidence of first-ever ICH in Sweden decreased by 10% between 2010 and 2019. We found diverging trends with a 20% decrease in non-OAC-associated ICH and a 56% increase in OAC-associated ICH. Further research on ICH epidemiology, analyzing non-OAC and OAC-associated ICH separately, is needed to follow up these diverging trends including underlying risk factors.
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28.
  • Drescher, Conrad, et al. (författare)
  • Epidemiology of First and Recurrent Ischemic Stroke in Sweden 2010-2019 : A Riksstroke Study
  • 2023
  • Ingår i: Neuroepidemiology. - : S. Karger AG. - 0251-5350 .- 1423-0208. ; 56:6, s. 433-442
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Ischemic stroke incidence appears to have decreased during the last decades, but most studies focus on the first-ever events and epidemiological data on recurrent stroke are scarce. The aim of our study was to investigate trends in incidence, risk factors, and medication in patients with first-ever and recurrent ischemic stroke between 2010 and 2019 in Sweden. Methods: We included patients (≥18 years old) with ischemic stroke registered in the hospital-based Swedish Stroke Register (Riksstroke) 2010-2019. The coverage of Riksstroke was consistently high (about 90%) during this period. Data were stratified by first-ever and recurrent ischemic stroke in three different time periods (2010-2012, 2013-2016, and 2017-2019) and shown as crude and age-specific incidence rates per 100,000 person-years. Statistics Sweden provided census data on the Swedish population in different age groups. Results: During the study period, 201,316 cases of ischemic stroke were registered in Riksstroke, including 153,865 (76.4%) cases of first-ever ischemic stroke and 46,248 (23.0%) cases of recurrent ischemic stroke (0.6% of cases unclassified). The crude incidence of first-ever ischemic stroke decreased by 17% from 216 (95% CI 214-218) to 179 (95% CI 177-181) between 2010-2012 and 2017-2019, whereas recurrent ischemic stroke decreased by 33% from 72 (95% CI 71-73) to 48 (95% CI 47-49). Between these time periods, diminishing ischemic stroke incidence was seen in all age groups with highest decline noted in those aged 75-84 years (928 [95% CI 914-943] to 698 [95% CI 686-709];-25% in first-ever ischemic stroke and 361 [95% CI 351-370] to 219 [95% CI 213-226];-39% in recurrent ischemic stroke) and ≥85 years (1,674 [95% CI 1,645-1,703] to 1,295 [95% CI 1,270-1,320];-23% in first-ever ischemic stroke and 683 [95% CI 664-702] to 423 [95% CI 409-437];-38% in recurrent ischemic stroke). Treatment with anticoagulants in patients with atrial fibrillation and lipid-lowering drugs increased considerably in patients with first-ever and recurrent ischemic stroke both at admission and discharge during the study period. Conclusion: Whereas both first-ever and recurrent ischemic stroke rates declined in Sweden between 2010 and 2019, the proportional decline was almost double for recurrent ischemic stroke than for first-ever ischemic stroke and most pronounced in the elderly. Increased use of secondary preventive drugs, in particular anticoagulants in atrial fibrillation, appears to have contributed, but further studies on precise causes for the decline in recurrent ischemic stroke are needed.
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29.
  • Ek, Martin, et al. (författare)
  • Compositional analysis of oxide-embedded III-V nanostructures
  • 2022
  • Ingår i: Nanotechnology. - : IOP Publishing. - 0957-4484 .- 1361-6528. ; 33:37
  • Tidskriftsartikel (refereegranskat)abstract
    • Nanowire growth enables creation of embedded heterostructures, where one material is completely surrounded by another. Through materials-selective post-growth oxidation it is also possible to combine amorphous oxides and crystalline, e.g. III-V materials. Such oxide-embedded structures pose a challenge for compositional characterization through transmission electron microscopy since the materials will overlap in projection. Furthermore, materials electrically isolated by an embedding oxide are more sensitive to electron beam-induced alterations. Methods that can directly isolate the embedded material, preferably at reduced electron doses, will be required in this situation. Here, we analyse the performance of two such techniques-local lattice parameter measurements from high resolution micrographs and bulk plasmon energy measurements from electron energy loss spectra-by applying them to analyse InP-AlInP segments embedded in amorphous aluminium oxide. We demonstrate the complementarity of the two methods, which show an overall excellent agreement. However, in regions with residual strain, which we analyse through molecular dynamics simulations, the two techniques diverge from the true value in opposite directions.
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30.
  • Ekman, Linnéa, et al. (författare)
  • Evaluation of small nerve fiber dysfunction in type 2 diabetes
  • 2020
  • Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 141:1, s. 38-46
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: To assess potential correlations between intraepidermal nerve fiber densities (IENFD), graded with light microscopy, and clinical measures of peripheral neuropathy in elderly male subjects with normal glucose tolerance (NGT), impaired glucose tolerance (IGT), and type 2 diabetes (T2DM), respectively. Materials and methods: IENFD was assessed in thin sections of skin biopsies from distal leg in 86 men (71-77 years); 24 NGT, 15 IGT, and 47 T2DM. Biopsies were immunohistochemically stained for protein gene product (PGP) 9.5, and intraepidermal nerve fibers (IENF) were quantified manually by light microscopy. IENFD was compared between groups with different glucose tolerance and related to neurophysiological tests, including nerve conduction study (NCS; sural and peroneal nerve), quantitative sensory testing (QST), and clinical examination (Total Neuropathy Score; Neuropathy Symptom Score and Neuropathy Disability Score). Results: Absent IENF was seen in subjects with T2DM (n = 10; 21%) and IGT (n = 1; 7%) but not in NGT. IENFD correlated weakly negatively with HbA1c (r = −.268, P =.013) and Total Neuropathy Score (r = −.219, P =.042). Positive correlations were found between IENFD and sural nerve amplitude (r =.371, P =.001) as well as conduction velocity of both the sural (r =.241, P =.029) and peroneal nerve (r =.258, P =.018). Proportions of abnormal sural nerve amplitude became significantly higher with decreasing IENFD. No correlation was found with QST. Inter-rater reliability of IENFD assessment was good (ICC = 0.887). Conclusions: Signs of neuropathy are becoming more prevalent with decreasing IENFD. IENFD can be meaningfully evaluated in thin histopathological sections using the presented technique to detect neuropathy.
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31.
  • Eltoft, Agnethe, et al. (författare)
  • Statistical analysis plan for the randomized controlled trial Tenecteplase in Wake-up Ischaemic Stroke Trial (TWIST)
  • 2022
  • Ingår i: Trials. - : Springer Nature. - 1745-6215. ; 23:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Patients with wake-up ischemic stroke are frequently excluded from thrombolytic treatment due to unknown symptom onset time and limited availability of advanced imaging modalities. The Tenecteplase in Wake-up lschaemic Stroke Trial (TWIST) is a randomized controlled trial of intravenous tenecteplase 0.25 mg/kg and standard care versus standard care alone (no thrombolysis) in patients who wake up with acute ischemic stroke and can be treated within 4.5 h of wakening based on non-contrast CT findings. Objective: To publish the detailed statistical analysis plan for TWIST prior to unblinding. Methods: The TWIST statistical analysis plan is consistent with the Consolidating Standard of Reporting Trials (CON-SORT) statement and provides clear and open reporting. Discussion: Publication of the statistical analysis plan serves to reduce potential trial reporting bias and clearly outlines the pre-specified analyses.
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32.
  • Eriksson, Tommy, et al. (författare)
  • ApoLänk decreases patient medication discrepancies at discharge: initial experience from a Swedish bedside pharmacy service
  • 2013
  • Ingår i: European Journal of Hospital Pharmacy: Science and Practice. - : BMJ. - 2047-9964 .- 2047-9956. ; 20:1, s. 54-56
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To develop a working model so that dispensing pharmacists, patients and medical staff can work together to identify, solve and prevent problems associated with discharge prescriptions. Method: A routine was developed for communication between pharmacists, patients and medical staff and for dispensing drugs at the bedside. Hospital medication lists and prescriptions from the pharmacy and healthcare databases were simultaneously assessed. The study was carried out in two neurological wards in a Swedish university hospital. Results: Major shortcomings were identified in the coordination of pharmacy and healthcare records and in patients’ ability to take responsibility for their medication at discharge. Discussion between patients and staff allowed discrepancies in communication and documentation to be corrected. Cooperation between pharmacists and nurses was perceived as being very positive and important. Conclusions: The Apolänk service was appreciated by nurses, is almost cost neutral and reduces discrepancies that have the potential to cause patient harm.
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33.
  • Fagerström, Martin, 1979, et al. (författare)
  • MODELLING AND TESTING THE CRASH BEHAVIOUR OF COMPOSITE VEHICLES COMPONENTS
  • 2019
  • Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
    • In the current contribution we will present the latest developments in the project “Modelling crash behaviour in future lightweight composite vehicles – Step 2”, involving 11 Swedish partners. On the material modelling side, a fully three-dimensional model to describe fibre kinking has recently been developed. The model is physically based and considers the fibre rotation during kink-band formation under large deformations. The FE implementation of the model is straightforward which allows for easy implementation. The validation of the model for stiffness and strength shows good correlation with the experiments. The influence of initial misalignments on the stiffness is well captured, the strength defined at the onset of unstable fibre rotation, is well predicted, and, in addition, the crushing response shows very good agreement with experimental results in terms of morphology in the crushing zone, as well as in the load response. To allow for computational efficiency, we have also developed and implemented (as a user element in LS-DYNA) an adaptive modelling strategy which allows for laminates to be initially modelled with only one element over the thickness.The user element kinematics can be adaptively enriched by introducing new degrees of freedom during the simulation to allow for more accurate stress predictions in critical regions by introducing discrete material interfaces, and for the modelling of delamination crack growth by introducing discrete crack surfaces interconnected with a cohesive zone law. In this work, special care has been taken to develop a robust method for explicit crash analysis. In the element, we also able to consider the correct intralaminar fracture toughness regularisation for various spatial discretisations. To assess and validate the models developed in the project, we have also conducted a series of bending and crushing experiments on component level. Three-point bending tests (in total 45 beams) have been conducted for three different carbon-epoxy material systems (pre-preg and vacuum infused), two different span lengths and two different lay-ups at several impact speeds. Similarly, crushing tests have been conducted for the same material systems by crushing tubes (in total 35 tubes) at various angles, with two different lay-ups and at two different loading speeds (quasi-static and dynamic). We believe that these tests serve as a very strong basis for any crash model validation.
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34.
  • Fransson, Åsa, 1971, et al. (författare)
  • Geological and hydrogeological reference conditions for rock engineering: An example for grouting design at äspö hard rock laboratory, Sweden
  • 2017
  • Ingår i: ISRM AfriRock - Rock Mechanics for Africa. ; 2017-October, s. 983-994
  • Konferensbidrag (refereegranskat)abstract
    • © 2017 International Society for Rock Mechanics. All Rights Reserved. The observational method includes the idea that rock engineering design can be modified as construction progresses, and that identification (confirmation or rejection and updating) of e.g. rock classes can be used in order to choose from predefined design classes. To facilitate rock engineering design, we suggest that geological and hydrogeological reference conditions are used as a basis. Fundamental to a reference condition approach is the identification and sampling of reference sites. Attributes, in this case geological and hydrogeological attributes, are selected and used to define the reference conditions. The reference conditions should be defined and described early on in a project, using relevant engineering parameters, and grouped together into rock classes with similar engineering characteristics. The reference conditions are subsequently used to define e.g. grouting design classes, to adapt to project-specific flow requirements. In this paper we suggest and give examples of geological and hydrogeological reference conditions for grouting, and present an example where reference conditions were used to define the grouting design for a site in crystalline rock, located at a depth of 400 m at the Äspö Hard Rock Laboratory, Sweden.
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35.
  • Frid, Petrea, et al. (författare)
  • Fetal posterior cerebral artery configurations in an ischemic stroke versus an unselected hospital population
  • 2022
  • Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 145:3, s. 297-304
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Few MRA-based studies have systematically evaluated the prevalence and laterality of a fetal configuration of the posterior cerebral artery (FTP) in ischemic stroke populations versus other populations. This common variant is important in the setting of acute stroke and secondary prevention decisions. Objective: To determine the prevalence and laterality of FTP configurations in MRI-DWI verified acute ischemic stroke patients investigated with MRA, and compare the findings with an unselected hospital population investigated with computed tomography angiography (CTA). We also evaluated the association of FTP with posterior cerebral artery (PCA) territory infarctions. Methods: We reviewed the MRAs of 1407 ischemic stroke patients with acute lesions on MRI-DWI sequences and 546 consecutive CTAs of patients investigated on any indication in a tertiary hospital. The MRA and CTA assessments were made by neuroradiologists blinded to original reports on stroke location and vessel anatomy. Results: The prevalence of any FTP was similar in ischemic stroke patients (31%) and unselected patients (32%). Unilateral FTP was significantly more frequent on the right than on the left side in both groups (15% right vs. 8% left). The presence of FTP ipsilateral to stroke side was not associated with involvement of the PCA territory versus no FTP on the stroke side. Conclusions: FTP is present in approximately 30% of ischemic stroke patients and unselected hospital populations and was detected significantly more frequently on the right versus left side in both groups. PCA territory infarction was not associated with the presence of ipsilateral FTP.
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36.
  • Gallo, Valentina, et al. (författare)
  • Parkinson's Disease Case Ascertainment in the EPIC Cohort : The NeuroEPIC4PD Study
  • 2015
  • Ingår i: Neurodegenerative Diseases. - : S. Karger. - 1660-2854 .- 1660-2862. ; 15:6, s. 331-338
  • Tidskriftsartikel (refereegranskat)abstract
    • Background/Aims: Large epidemiological prospective studies represent an important opportunity for investigating risk factors for rare diseases such as Parkinson's disease (PD). Here we describe the procedures we used for ascertaining PD cases in the EPIC (European Prospective Investigation into Cancer and Nutrition) study. Methods: The following three-phase procedure was used: (1) elaboration of a NeuroEPIC4PD template for clinical data collection, (2) identification of all potential PD cases via record linkage and (3) validation of the diagnosis through clinical record revision, in a population of 220,494 subjects recruited in 7 European countries. All cases were labelled with the NeuroEPIC4PD diagnoses of 'definite', 'very likely', 'probable', or 'possible' PD. Results: A total of 881 PD cases were identified, with over 2,741,780 person-years of follow-up (199 definite, 275 very likely, 146 probable, and 261 possible). Of these, 734 were incident cases. The mean age at diagnosis was 67.9 years (SD 9.2) and 458 patients (52.0%) were men. Bradykinesia was the most frequent presenting motor sign (76.5%). Tremor-dominant and akinetic rigid forms of PD were the most common types of PD. A total of 289 patients (32.8%) were dead at the time of the last follow-up. Conclusions: This exercise proved that it is feasible to ascertain PD in large population-based cohort studies and offers a potential framework to be replicated in similar studies.
  •  
37.
  • Gallo, Valentina, et al. (författare)
  • Physical activity and risk of Amyotrophic Lateral Sclerosis in a prospective cohort study
  • 2016
  • Ingår i: European Journal of Epidemiology. - : Springer Science and Business Media LLC. - 0393-2990 .- 1573-7284. ; 31:3, s. 255-266
  • Tidskriftsartikel (refereegranskat)abstract
    • Previous case-control studies have suggested a possible increased risk of Amyotrophic Lateral Sclerosis (ALS) with physical activity (PA), but this association has never been studied in prospective cohort studies. We therefore assessed the association between PA and risk of death from ALS in the European Prospective Investigation into Cancer and Nutrition. A total of 472,100 individuals were included in the analysis, yielding 219 ALS deaths. At recruitment, information on PA was collected through standardised questionnaires. Total PA was expressed by the Cambridge Physical Activity Index (CPAI) and analysed in relation to ALS mortality, using Cox hazard models. Interactions with age, sex, and anthropometric measures were assessed. Total PA was weakly inversely associated with ALS mortality with a borderline statistically significant trend across categories (p = 0.042), with those physically active being 33 % less likely to die from ALS compared to those inactive: HR = 0.67 (95 % CI 0.42-1.06). Anthropometric measures, sex, and age did not modify the association with CPAI. The present study shows a slightly decreased-not increased like in case-control studies-risk of dying from ALS in those with high levels of total PA at enrolment. This association does not appear confounded by age, gender, anthropometry, smoking, and education. Ours was the first prospective cohort study on ALS and physical activity.
  •  
38.
  • Gallo, Valentina, et al. (författare)
  • Prediagnostic body fat and risk of death from amyotrophic lateral sclerosis: The EPIC cohort.
  • 2013
  • Ingår i: Neurology. - : Lippincott Williams & Wilkins. - 1526-632X .- 0028-3878. ; 80:9, s. 829-838
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVES: The aim of this study was to investigate for the first time the association between body fat and risk of amyotrophic lateral sclerosis (ALS) with an appropriate prospective study design. METHODS: The EPIC (European Prospective Investigation into Cancer and Nutrition) study included 518,108 individuals recruited from the general population across 10 Western European countries. At recruitment, information on lifestyle was collected and anthropometric characteristics were measured. Cox hazard models were fitted to investigate the associations between anthropometric measures and ALS mortality. RESULTS: Two hundred twenty-two ALS deaths (79 men and 143 women) occurred during the follow-up period (mean follow-up = 13 years). There was a statistically significant interaction between categories of body mass index and sex regarding ALS risk (p = 0.009): in men, a significant linear decrease of risk per unit of body mass index was observed (hazard ratio = 0.93, 95% confidence interval 0.86-0.99 per kg/m(2)); among women, the risk was more than 3-fold increased for underweight compared with normal-weight women. Among women, a significant risk reduction increasing the waist/hip ratio was also evident: women in the top quartile had less than half the risk of ALS compared with those in the bottom quartile (hazard ratio = 0.48, 95% confidence interval 0.25-0.93) with a borderline significant p value for trend across quartiles (p = 0.056). CONCLUSION: Increased prediagnostic body fat is associated with a decreased risk of ALS mortality.
  •  
39.
  • Górecki, Kamil, et al. (författare)
  • Microfluidic-Derived Detection of Protein-Facilitated Copper Flux Across Lipid Membranes
  • 2022
  • Ingår i: Analytical Chemistry. - : American Chemical Society (ACS). - 0003-2700 .- 1520-6882. ; 94:34, s. 11831-11837
  • Tidskriftsartikel (refereegranskat)abstract
    • Measurement of protein-facilitated copper flux across biological membranes is a considerable challenge. Here, we demonstrate a straightforward microfluidic-derived approach for visualization and measurement of membranous Cu flux. Giant unilamellar vesicles, reconstituted with the membrane protein of interest, are prepared, surface-immobilized, and assessed using a novel quencher-sensor reporter system for detection of copper. With the aid of a syringe pump, the external buffer is exchanged, enabling consistent and precise exchange of solutes, without causing vesicle rupture or uneven local metal concentrations brought about by rapid mixing. This approach bypasses common issues encountered when studying heavy metal-ion flux, thereby providing a new platform for in vitro studies of metal homeostasis aspects that are critical for all cells, health, and disease.
  •  
40.
  • Hansen, Jesper S., et al. (författare)
  • Glucose transport activity measured in giant vesicles
  • 2018
  • Ingår i: Methods in Molecular Biology. - New York, NY : Springer New York. - 1064-3745. ; 1713, s. 77-91
  • Bokkapitel (refereegranskat)abstract
    • Incorporation of membrane proteins and internal reporter systems directly into giant vesicles, during their formation from a hydrogel surface, has emerged as a promising new concept in membrane protein characterization. Here, we provide the detailed protocol for a glucose transporter activity assay based on giant vesicles containing a fluorescent enzyme-linked reporter system internally. This assay is applicable for the functional analysis of a variety of hexose-transporting proteins. We furthermore believe that it can aid in the development of drugs targeting hexose transporters.
  •  
41.
  • Hansen, Jesper S., et al. (författare)
  • Peptide-Oleate Complexes Create Novel Membrane-Bound Compartments
  • 2020
  • Ingår i: Molecular biology and evolution. - : Oxford University Press (OUP). - 0737-4038 .- 1537-1719. ; 37:11, s. 3083-3093
  • Tidskriftsartikel (refereegranskat)abstract
    • A challenging question in evolutionary theory is the origin of cell division and plausible molecular mechanisms involved. Here, we made the surprising observation that complexes formed by short alpha-helical peptides and oleic acid can create multiple membrane-enclosed spaces from a single lipid vesicle. The findings suggest that such complexes may contain the molecular information necessary to initiate and sustain this process. Based on these observations, we propose a new molecular model to understand protocell division.
  •  
42.
  • Hansen, Jesper S., et al. (författare)
  • Visualization of lipid directed dynamics of perilipin 1 in human primary adipocytes
  • 2017
  • Ingår i: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 7:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Perilipin 1 is a lipid droplet coating protein known to regulate lipid metabolism in adipocytes by serving as a physical barrier as well as a recruitment site for lipases to the lipid droplet. Phosphorylation of perilipin 1 by protein kinase A rapidly initiates lipolysis, but the detailed mechanism on how perilipin 1 controls lipolysis is unknown. Here, we identify specific lipid binding properties of perilipin 1 that regulate the dynamics of lipolysis in human primary adipocytes. Cellular imaging combined with biochemical and biophysical analyses demonstrate that perilipin 1 specifically binds to cholesteryl esters, and that their dynamic properties direct segregation of perilipin 1 into topologically distinct micro domains on the lipid droplet. Together, our data points to a simple unifying mechanism that lipid assembly and segregation control lipolysis in human primary adipocytes.
  •  
43.
  • Huang, Peng, et al. (författare)
  • Aquaglyceroporins and orthodox aquaporins in human adipocytes
  • 2022
  • Ingår i: Biochimica et Biophysica Acta - Biomembranes. - : Elsevier BV. - 0005-2736. ; 1864:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Aquaporins play a crucial role in water homeostasis in the human body, and recently the physiological importance of aquaporins as glycerol channels have been demonstrated. The aquaglyceroporins (AQP3, AQP7, AQP9 and AQP10) represent key glycerol channels, enabling glycerol flux across the membranes of cells. Adipocytes are the major source of glycerol and during lipolysis, glycerol is released to be metabolized by other tissues through a well-orchestrated process. Here we show that both AQP3 and AQP7 bind to the lipid droplet protein perilipin 1 (PLIN1), suggesting that PLIN1 is involved in the coordination of the subcellular translocation of aquaglyceroporins in human adipocytes. Moreover, in addition to aquaglyceroporins, we discovered by transcriptome sequencing that AQP1 is expressed in human primary adipocytes. AQP1 is mainly a water channel and thus is thought to be involved in the response to hyper-osmotic stress by efflux of water during hyperglycemia. Thus, this data suggests a contribution of both orthodox aquaporin and aquaglyceroporin in human adipocytes to maintain the homeostasis of glycerol and water during fasting and feeding.
  •  
44.
  • Kanerva Rice, Sophie, et al. (författare)
  • Rationale and Design of a Novel Method to Assess the Usability of Body-Worn Absorbent Incontinence Care Products by Caregivers
  • 2018
  • Ingår i: Journal of Wound, Ostomy and Continence Nursing (WOCN). - 1071-5754 .- 1528-3976. ; 45:5, s. 456-464
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE: The purpose of this study was to develop and test a new method to measure the usability of absorbent incontinence care products from the caregivers' perspective and to investigate if the method can be used to differentiate between product types in a product change.DESIGN: Process evaluation and validation study.SUBJECTS AND SETTING: Product developers and end users participated in designing the new method. Thereafter, professional caregivers acted as testers of the new method, ranking usability when performing absorbent product changes on patients in a simulated nursing home care environment, assisted by third-party research institute moderators.METHODS: Design and evaluation of a new method designed to assess the usability of body-worn absorbent incontinence care products for lay caregivers were completed. The evaluation included formative and summative evaluations of effectiveness (product fit), efficiency (time and physical workload), and satisfaction. A person-centered approach aimed at including all subjects and settings to generate a single usability score for decision making and product benchmarking. Experienced caregivers changed 4 types of products: (1) disposable body-worn pads with mesh briefs (2-piece system); (2) disposable all-in-one briefs; (3) disposable, T-shaped, and belted brief; and (4) disposable pull-up pants on simulated patients in standing or lying position. Each product change was performed by 1 unassisted experienced caregiver. The probability of success as a score for each product type was calculated across the 4 metrics and reported with 95% confidence intervals (CIs). Descriptive and inferential statistics were developed assuming a binary statistical model, using the weighted scores from each of the factors. An overall usability score was calculated.RESULTS: The method we developed discriminated between usability of different product types. The overall score for the disposable pull-up product (90%; CI: 83%-97%) was better (P < .05) than for the disposable T-shaped brief (83%; CI: 77%-89%), the disposable brief (53%; CI: 45%-61%), and the disposable body-worn pad with mesh pant (61%; CI: 56%-66%) in standing patients. For lying patients, the overall score for the disposable T-shaped brief product (81%; CI: 73%-89% was better (P < .05) than the disposable brief (65%; CI: 45%-61%) and the disposable body-worn pads with mesh brief (62%; CI: 55%-69%). Reliability was evaluated quantitatively in terms of measurement uncertainties in the results.CONCLUSION: The method we described demonstrated differentiation of usability based on product type indicating concurrent validity. Further testing in diverse real-world care environments is needed to evaluate and confirm the validity and to assess reliability of this method in the research setting.
  •  
45.
  • Leoo, T, et al. (författare)
  • Risk factors and treatment at recurrent stroke onset: Results from the recurrent stroke quality and epidemiology (RESQUE) study
  • 2008
  • Ingår i: Cerebrovascular Diseases. - : S. Karger AG. - 1015-9770 .- 1421-9786. ; 25:3, s. 254-260
  • Tidskriftsartikel (refereegranskat)abstract
    • <i>Background:</i> Much effort has been made to study first-ever stroke patients. However, recurrent stroke has not been investigated as extensively. It is unclear which risk factors dominate, and whether adequate secondary prevention has been provided to patients who suffer from recurrent stroke. Also, the different types of recurrent stroke need further evaluation. <i>Methods:</i> The study included patients with recurrent stroke admitted to twenty-three Swedish stroke centers. The type of previous and recurrent stroke was determined, as well as evaluation (when applicable) of recurrent ischemic stroke according to the TOAST classification. Presence of vascular risk factors was registered and compared to the type of stroke. Also assessed was ongoing secondary prevention treatment at recurrent stroke onset. <i>Results:</i> A total of 889 patients with recurrent stroke (mean age 77) were included in the study. Of these, 805 (91%) had ischemic stroke, 78 (9%) had intracerebral hemorrhage and 6 (<1%) stroke of unknown origin. The most frequent vascular risk factors were hypertension (75%) and hyperlipidemia (56%). Among the 889 patients, 29% had atrial fibrillation. Of the patients in the ischemic group with cardiac embolism, only 21% were on anticoagulation treatment. The majority of the patients (75%) had their most recent previous stroke >12 months before admission. <i>Conclusions:</i> Few patients had a recurrent stroke shortly after the previous stroke in this study. This indicates that it is meaningful to prevent a second event with an adequate long-term treatment strategy for secondary prevention after first-ever stroke. There also seems to be a clear potential for improving secondary prevention after stroke.
  •  
46.
  •  
47.
  • Macleod, Malcolm R., et al. (författare)
  • Hypothermia for Stroke: call to action 2010
  • 2010
  • Ingår i: International Journal of Stroke. - : SAGE Publications. - 1747-4949 .- 1747-4930. ; 5:6, s. 489-492
  • Tidskriftsartikel (refereegranskat)abstract
    • The European Hypothermia Stroke Research Workshop was held in January 2010, in response to the alarming prospects of a significant increase of stroke expected in the coming years globally. Considering that a minority of patients (around 10%) are currently eligible for thrombolytic treatment, there is a need for an efficacious, cost-effective novel therapy that can be implemented broadly within European health care systems. Accordingly, the primary objective of the workshop was the definition of a research agenda aiming to assess the therapeutic benefits of hypothermia in patients with acute ischaemic stroke. The meeting was organised by the European Stroke Research Network for Hypothermia(EuroHyp) and attended by the representatives of World Stroke Organisation, European Stroke Organisation, Stroke Alliance for Europe, Society for Cryobiology and other organisations - specifically the European Space Agency, and small-and medium-sized enterprises based in EU member states. The participants adopted the 'Hypothermia for Stroke - Call to Action 2010', a declaration specifying the priorities for hypothermia research in acute ischaemic stroke. The research programme outlined - a clinical study programme designed to identify and validate therapeutic cooling as a novel treatment providing benefit to a large number of stroke patients-contains a well-integrated series of Phase II studies aiming to refine the intervention (depth, duration, and mode of cooling; antishivering strategy; patient selection) and a pivotal Phase III clinical trial. The proposed integrated Phase II and III clinical study programme would test the effectiveness of this optimised intervention, and would allow the development of evidence-based Clinical Practice Guidelines describing the optimal use of therapeutic hypothermia as a treatment strategy for stroke.
  •  
48.
  • Mahdiraji, Saeid Amouzad, et al. (författare)
  • An Optimization Model for the Tradeoff Between Efficiency and Equity for Mobile Stroke Unit Placement
  • 2021
  • Ingår i: Innovation in Medicine and Healthcare. - Singapore : Springer. - 2190-3026 .- 2190-3018. - 9789811630125 - 9789811630132 ; , s. 183-193
  • Konferensbidrag (refereegranskat)abstract
    • A mobile stroke unit (MSU) is an ambulance, where stroke patients can be diagnosed and treated. Recently, placement of MSUs has been studied focusing on either maximum population coverage or equal service for all patients, termed efficiency and equity, respectively. In this study, we propose an unconstrained optimization model for the placement of MSUs, designed to introduce a tradeoff between efficiency and equity. The tradeoff is based on the concepts of weighted average time to treatment and the time difference between the expected time to treatment for different geographical areas. We conduct a case-study for Sweden’s Southern Health care Region (SHR), generating three scenarios (MSU1, MSU2, and MSU3) including 1, 2, and 3 MSUs, respectively. We show that our proposed optimization model can tune the tradeoff between the efficiency and equity perspectives for the MSU(s) allocation. This enables a high level of equal service for most inhabitants, as well as reducing the time to treatment for most inhabitants of a geographic region. In particular, placing three MSUs in the SHR with the proposed tradeoff, the share of inhabitants who are expected to receive treatment within an hour potentially improved by about a factor of 14 in our model.
  •  
49.
  • Mahdiraji, Saeid Amouzad, et al. (författare)
  • Mobile stroke units for acute stroke care in the south of sweden
  • 2021
  • Ingår i: Cogent Engineering. - : Informa UK Limited. - 2331-1916. ; 8:1
  • Tidskriftsartikel (refereegranskat)abstract
    • A Mobile stroke unit (MSU) is a type of ambulance deployed to promote the rapid delivery of stroke care. We present a computational study using a time to treatment estimation model to analyze the potential benefits of using MSUs in Sweden’s Southern Health Care Region (SHR). In particular, we developed two scenarios (MSU1 and MSU2) each including three MSUs, which we compared with a baseline scenario containing only regular ambulances. For each MSU scenario, we assessed how much the expected time to treatment is estimated to decrease for the whole region and each subregion of SHR, and how the population is expected to benefit from the deployment of MSUs. For example, the average time to treatment in SHR was decreased with 20,4 and 15,6 minutes, respectively, in the two MSU scenarios. Moreover, our computational results show that the locations of the MSUs significantly influence what benefits can be expected. While MSU1 is expected to improve the situation for a higher share of the population, MSU2 is expected to have a higher impact on the patients who currently have the longest time to treatment.
  •  
50.
  • Midlöv, Patrik, et al. (författare)
  • Descriptive study and pharmacotherapeutic intervention in patients with epilepsy or Parkinson's disease at nursing homes in southern Sweden.
  • 2002
  • Ingår i: European Journal of Clinical Pharmacology. - : Springer Science and Business Media LLC. - 1432-1041 .- 0031-6970. ; 57:12, s. 903-910
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVES: To describe the drug use in epilepsy and Parkinson's patients living in nursing homes and to evaluate the impact of multi-speciality team intervention on health-related quality of life, activities of daily living (ADL) and confusion state. METHODS: Nursing home residents with epilepsy or Parkinson's disease in the county of Skåne in Sweden were identified. From 119 nursing homes, 262 patients were identified. After obtaining informed consent, 157 patients from 48 nursing homes were included. Of these patients 74 were diagnosed with epilepsy and 84 with Parkinson's disease (one patient had both diagnoses). The average age of the epilepsy patients was 79 years and of the Parkinson's patients 81 years. Pharmacists documented the patients' drug use and any drug-related problems after communication with nursing-home residents, their contact persons at the nursing home and the residents' physicians. A multi-speciality group consisting of pharmacists, a primary care physician, a neurologist, a neuro-psychiatrist and a clinical pharmacologist evaluated the patients' medication and, when appropriate, suggested changes. Lists of each resident's medications were collected together with information about drug-related problems. The use of drugs deemed inappropriate for geriatric nursing-home residents according to Beer's criteria was documented. Health-related quality of life was evaluated using a generic health-related quality of life instrument, SF-36. Confusion state was measured using the Behaviour Pathology in Alzheimer's Disease Rating Scale (Behave-AD), and ability to perform ADL was assessed using the Schwab and England capacity for daily living scale. All measurements were repeated after approximately 6 months. During that period, for the group randomised to active intervention, the physicians involved in the care of the patients had received the recommendations for changes in drug treatment from the multi-speciality group. RESULTS: Epilepsy patients at nursing homes used on average 8.0 drugs for continuous use whereas Parkinson's patients used 8.6 drugs. According to Beer's criteria about 40% of both patient groups used drugs that are classified as inappropriate to geriatric nursing-home patients. Dopamine receptor-blocking psychotropic drugs were used by 29% of the Parkinson's patients. Indication for a patient's total drug treatment was not documented for 50% of epilepsy and 40% of Parkinson's patients. There were no significant differences between the active and control groups in changes in SF-36, Behave-AD or ADL for epilepsy patients. For Parkinson's patients there was a significant decrease in ADL for the active group, whereas there were no differences in SF-36 or Behave-AD. CONCLUSION: Nursing-home residents with epilepsy or Parkinson's disease use many drugs and often drugs that are classified as inappropriate. A simple problem-oriented questionnaire may be helpful in identifying specific drug-related problems in geriatric patients with common neurological diseases. Methods on how to improve the pharmacotherapy of these patients still have to be developed.
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