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1.	Blom Johansson, Monica, 1965- (författare) Aphasia and Communication in Everyday Life : Experiences of persons with aphasia, significant others, and speech-language pathologists 2012 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract The aims of this thesis were to describe the experiences of persons with aphasia and their significant others of their conversations and use of communication strategies, examine current practice of family-oriented speech-language pathology (SLP) services, and test a family-oriented intervention in the early phase of rehabilitation.The persons with aphasia valued having conversations despite perceiving their aphasia as a serious social disability. They acknowledged the importance of the communication partners’ knowledge and understanding of aphasia and their use of supporting conversation strategies. Their own use of communication strategies varied considerably. The persons with aphasia longed to regain language ability and to be active participants in society.A majority of the significant others perceived their conversations with the person with aphasia as being less stimulating and enjoyable than conversations before stroke onset. Aphasia was considered a serious problem. The significant others took on increased communicative responsibility, where two thirds had changed their communicative behaviour to facilitate conversations. Type and severity of aphasia were especially related to the communicative experiences of the significant others and their motivation to be involved in SLP services.Thirty percent of the speech-language pathologists worked with people with aphasia and typically met with their families. They considered the involvement of significant others in SLP services as very important, especially in providing information about aphasia and communication partner training (CPT). However, involvement of significant others was restricted because of a time shortage and perceived limited skills and knowledge. In addition, there were national differences regarding aphasia rehabilitation services.The intervention consisted of three sessions directed to significant others (primarily emotional support and information) and three directed to the dyads (a person with aphasia and a significant other) (primarily CPT). All six participants (three dyads) felt that their knowledge and understanding of aphasia had increased and that their conversations had improved. These improvements were also evident to some extent with formal assessments.These results suggest the following: CPT should be an integral part of SLP services, national clinical guidelines are needed, and further education of speech-language pathologists and implementation of new knowledge into clinical practice requires consideration.
2.	Eklov, Solveig, et al. (författare) Estramustine-binding protein content in four different cell lines and its correlation to estramustine induced metaphase arrest. 1996 Ingår i: Anticancer Res. ; 16, s. 1819- Tidskriftsartikel (refereegranskat)
3.	Hägglund, Patricia, 1989- (författare) Swallowing dysfunction among older people in short-term care : prevalence, effect of intervention, and risk of mortality 2019 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract Objectives: Swallowing dysfunction (dysphagia) is a common, but often neglected condition among geriatric patients that can cause severe complications such as malnutrition, aspiration pneumonia and death. The aims of this thesis were to (i) describe the study design and method of the multidisciplinary and multicenter project SOFIA (Swallowing function, Oral health, and Food Intake in old Age), (ii) study the prevalence of and the relationship between swallowing dysfunction and risk of undernutrition among older individuals in short-term care, (iii) study the effect of oral neuromuscular training on swallowing dysfunction among older individuals, and (iv) to investigate the association between poor oral health, swallowing dysfunction and mortality.Methods: This thesis includes four original papers that are all part of the SOFIA project. Paper Iis the study protocol. In total, 391 individuals aged 65 or older, from 36 short-term care units were included in the project. At baseline the participants’ status regarding swallowing function (assessed with the Timed Water Swallow Test, TWST), oral health (using the Revised Oral Assessment Guide, ROAG) and nutrition (assessed with the Minimal Eating Observation and Nutrition Form-version II, MEONF-II) were assessed and collected by calibrated professionals. Clinical data were also collected. Paper IIwas a cross-sectional study where the baseline assessments of the participants’ swallowing function and nutritional status were obtained and the relationship analyzed. Paper IIIwas a cluster randomized, controlled trial (cRCT) that included 116 participants identified with swallowing dysfunction in paper II. These participants were randomly assigned to either usual care (control group) or oral neuromuscular training (intervention group). All participants were assessed at baseline, after five weeks’ training and six months after end-of-treatment, regarding swallowing function and swallowing-related quality of life (QOL). Paper IVwas a prospective cohort study where all participants were followed-up 1-year after inclusion to investigate risk factors for mortality by analysis of the associations between swallowing dysfunction, poor oral health, and 1-year survival. Results: Paper II:The median age of the 391 participants was 84 years (Interquartile range [IQR] 11) and 209 (53%) were females. In total, 248 of the 385 (64%) participants showed swallowing dysfunction, and risk of undernutrition was observed in 91 of 390 (23%) participants. The adjusted logistics regression model revealed that participants with swallowing dysfunction had significantly higher odds of undernutrition than those with normal swallowing (Odds ratio [OR]: 1.74, 95% Confidence interval [CI] 1.04 to 2.92, P=0.034).Paper III: At end-of-treatment, a linear mixed model showed significant between-group differences of changes in swallowing efficacy between baseline and after completed treatment period (Ratio 1.60, 95% CI 1.15 to 2.29, P=0.007); indicating a 60% higher swallowing efficacy in the intervention group compared with the control group. Paper IV: A mixed effects Cox model showed that swallowing dysfunction and poor oral health were both independently associated with 1-year mortality (adjusted Hazard Ratio [aHR]: 1.67, 95% CI 1.02 to 2.75,P=0.041 and aHR: 1.98, 95% CI 1.07 to 3.65, P=0.029, respectively). In addition, swallowing dysfunction and poor oral health in combination predicted the highest mortality rate (35%, P<0.001).Conclusion: Swallowing dysfunction is highly prevalent and a risk factor for undernutrition among older people in short-term care. Oral neuromuscular training improves swallowing dysfunction and is thus a promising method of swallowing rehabilitation for older people with impaired swallowing. Swallowing dysfunction and poor oral health are independent risk factors for 1-year morality among older people in short-term care. Therefore, systematic screening and intervention to improve swallowing dysfunction and poor oral health are important to achieve healthy aging and to prevent undernutrition and early death.
4.	Isaksson, Eva, et al. (författare) Identifying important barriers to recruitment of patients in randomised clinical studies using a questionnaire for study personnel 2019 Ingår i: Trials. - : BMC. - 1745-6215. ; 20:1 Tidskriftsartikel (refereegranskat)abstract Background: Many randomised controlled trials (RCT) fail to meet their recruitment goals. Study personnel play a key role in recruitment. The aim of this study was to identify successful strategies that study personnel consider to be important in patient recruitment to RCT. Methods: We constructed a questionnaire based on the literature, discussions with colleagues and our own experience as trialists. The survey was named "What is Important for Making a Study Successful questionnaire" (WIMSS-q). Our target group was the study personnel in the ongoing EFFECTS study. The questionnaire was sent out electronically to all physicians and nurses (n = 148). Success factors and barriers were divided according to patient, centre and study level, respectively. Results: Responses were received from 94% of the study personnel (139/148). The five most important factors at centre level for enhancing recruitment were that the research question was important (97%), a simple procedure for providing information and gaining consent (92%), a highly engaged local principal investigator and research nurse (both 87%), and that study-related follow-ups are practically feasible and possible to coordinate with the clinical follow-up (87%). The most significant barrier at the local centre was lack of time and resources devoted to research (72%). Important patient-related barriers were fear of side effects (35%) and language problems (30%). Conclusions: For recruitment in an RCT to be successful, the research question must be relevant, and the protocol must be simple and easy to implement in the daily routine.
5.	Isaksson, Eva, et al. (författare) Validation of the Simplified Modified Rankin Scale Questionnaire 2020 Ingår i: European Neurology. - : S. Karger. - 0014-3022 .- 1421-9913. ; 83:5, s. 493-499 Tidskriftsartikel (refereegranskat)abstract Introduction: The modified Rankin scale (mRS) is the most common assessment tool for measuring overall functional outcome in stroke studies. The traditional way of using mRS face-to-face is time- and cost-consuming. The aim of this study was to test the validity of the Swedish translation of the simplified modified Rankin scale questionnaire (smRSq) as compared with the mRS assessed face-to-face 6 months after a stroke.Methods: Within the ongoing EFFECTS trial, smRSq was sent out to 108 consecutive stroke patients 6 months after a stroke. The majority, 90% (97/108), of the patients answered the questionnaire; for the remaining 10%, it was answered by the next of kin. The patients were assessed by face-to-face mRS by 7 certified healthcare professionals at 4 Swedish stroke centres. The primary outcome was assessed by Cohen's kappa and weighted kappa.Results: There was good agreement between postal smRSq, answered by the patients, and the mRS face-to-face; Cohen's kappa was 0.43 (CI 95% 0.31-0.55), weighted kappa was 0.64 (CI 95% 0.55-0.73), and Spearman rank correlation was 0.82 (p < 0.0001). In 55% (59/108), there was full agreement, and of the 49 patients not showing exact agreement, 44 patients differed by 1 grade and 5 patients had a difference of 2 grades.Discussion/Conclusion: Our results show good validity of the postal smRSq, answered by the patients, compared with the mRS carried out face-to-face at 6 months after a stroke. This result could help trialists in the future simplify study design and make multicentre trials and quality registers with a large number of patients more feasible and time-saving.
6.	Lundstrom, Erik, et al. (författare) Correction: Update on the EFFECTS study of fluoxetine for stroke recovery : a randomised controlled trial in Sweden (vol 21, 233, 2020) 2020 Ingår i: Trials. - : BioMed Central. - 1745-6215. ; 21:1 Tidskriftsartikel (refereegranskat)abstract Following publication of the original article [1], we were notified that one of the corresponding author's affiliations was omitted.
7.	Lundström, Erik, 1964-, et al. (författare) Effects of Fluoxetine on Outcomes at 12 Months After Acute Stroke Results From EFFECTS, a Randomized Controlled Trial 2021 Ingår i: Stroke. - : Ovid Technologies (Wolters Kluwer Health). - 0039-2499 .- 1524-4628. ; 52:10, s. 3082-3087 Tidskriftsartikel (refereegranskat)abstract BACKGROUND AND PURPOSE: The EFFECTS (Efficacy of Fluoxetine-a Randomised Controlled Trial in Stroke) recently reported that 20 mg fluoxetine once daily for 6 months after acute stroke did not improve functional outcome but reduced depression and increased fractures and hyponatremia at 6 months. The purpose of this predefined secondary analysis was to identify if any effects of fluoxetine were maintained or delayed over 12 months. METHODS: EFFECTS was an investigator-led, randomized, placebo-controlled, double-blind, parallel group trial in Sweden that enrolled adult patients with stroke. Patients were randomized to 20 mg oral fluoxetine or matching placebo for 6 months and followed for another 6 months. The primary outcome was functional outcome (modified Rankin Scale), at 6 months. Predefined secondary outcomes for these analyses included the modified Rankin Scale, health status, quality of life, fatigue, mood, and depression at 12 months. RESULTS: One thousand five hundred patients were recruited from 35 centers in Sweden between 2014 and 2019; 750 were allocated fluoxetine and 750 placebo. At 12 months, modified Rankin Scale data were available in 715 (95%) patients allocated fluoxetine and 712 (95%) placebo. The distribution of modified Rankin Scale categories was similar in the 2 groups (adjusted common odds ratio, 0.92 [95% CI, 0.76-1.10]). Patients allocated fluoxetine scored worse on memory with a median value of 89 (interquartile range, 75-100) versus 93 (interquartile range, 82-100); P=0.0021 and communication 93 (interquartile range, 82-100) versus 96 (interquartile range, 86-100); P=0.024 domains of the Stroke Impact Scale compared with placebo. There were no other differences in secondary outcomes. CONCLUSIONS: Fluoxetine after acute stroke had no effect on functional outcome at 12 months. Patients allocated fluoxetine scored worse on memory and communication on the Stroke Impact Scale compared with placebo, but this is likely to be due to chance.
8.	Lundström, E, 1964-, et al. (författare) Enhancing Recruitment Using Teleconference and Commitment Contract (ERUTECC) : study protocol for a randomised, stepped-wedge cluster trial within the EFFECTS trial 2018 Ingår i: Trials. - : BIOMED CENTRAL LTD. - 1745-6215. ; 19 Tidskriftsartikel (refereegranskat)abstract Background: Many randomised controlled trials (RCTs) fail to meet their recruitment goals in time. Trialists are advised to include study recruitment strategies within their trials. EFFECTS is a Swedish, academic-led RCT of fluoxetine for stroke recovery. The trial's primary objective is to investigate whether 20 mg fluoxetine daily compared with placebo for 6 months after an acute stroke improves the patient's functional outcome. The first patient was included on 20 October 2014 and, as of 31 August 2017, EFFECTS has included 810 of planned 1500 individuals. EFFECTS currently has 32 active centres. The primary objective of the ERUTECC (Enhancing Recruitment Using Teleconference and Commitment Contract) study is to investigate whether a structured teleconference re-visit with the study personnel at the centres, accompanied by a commitment contract, can enhance recruitment by 20% at 60 days post intervention, compared with 60 days pre-intervention, in an ongoing RCT. Methods: ERUTECC is a randomised, stepped-wedge cluster trial embedded in EFFECTS. The plan is to start ERUTECC with a running-in period of September 2017. The first intervention is due in October 2017, and the study will continue for 12 months. We are planning to intervene at all active centres in EFFECTS, except the five top recruiting centres (n=27). The rationale for not intervening at the top recruiting centres is that we believe they have reached their full potential and the intervention would be too weak for them. The hypothesis of this study is that a structured teleconference re-visit with the study personnel at the centres, accompanied by a commitment contract, can enhance recruitment by 20% 60 days post intervention, compared to 60 days pre-intervention, in an ongoing RCT. Discussion: EFFECTS is a large, pragmatic RCT of stroke in Sweden. Results from the embedded ERUTECC study could probably be generalised to high-income Western countries, and is relevant to trial management and could improve trial management in the future. It might also be useful in clinical settings outside the field of stroke.
9.	Lundström, Erik, 1964-, et al. (författare) Safety and efficacy of fluoxetine on functional recovery after acute stroke (EFFECTS): a randomised, double-blind, placebo-controlled trial. 2020 Ingår i: The Lancet. Neurology. - 1474-4465 .- 1474-4422. ; 19:8, s. 661-669 Tidskriftsartikel (refereegranskat)abstract Studies have suggested that fluoxetine could improve neurological recovery after stroke. The Efficacy oF Fluoxetine-a randomisEd Controlled Trial in Stroke (EFFECTS) trial aimed to assess whether administration of oral fluoxetine for 6 months after acute stroke improves functional outcome.EFFECTS was an investigator-led, multicentre, randomised, placebo-controlled, double-blind, parallel group trial that enrolled patients aged 18 years or older between 2 and 15 days after stroke onset in 35 stroke and rehabilitation centres in Sweden. Eligible patients had a clinical diagnosis of ischaemic or intracerebral haemorrhage, brain imaging that was consistent with intracerebral haemorrhage or ischaemic stroke, and had at least one persisting focal neurological deficit. A web-based randomisation system that incorporated a minimisation algorithm was used to randomly assign (1:1) participants to receive oral fluoxetine 20 mg once daily or matching placebo capsules for 6 months. Patients, care providers, investigators, and outcomes assessors were masked to the allocation. The primary outcome was functional status, measured with the modified Rankin Scale (mRS) at 6 months, analysed in all patients with available mRS data at the 6-month follow-up; we did an ordinal analysis adjusted for the minimisation variables used in the randomisation. This trial is registered with EudraCT, 2011-006130-16; ISRCTN, 13020412; and ClinicalTrials.gov, NCT02683213.Between Oct 20, 2014, and June 28, 2019, 1500 patients were enrolled, of whom 750 were randomly assigned to fluoxetine and 750 were randomly assigned to placebo. At 6 months, mRS data were available for 737 (98%) patients in the fluoxetine group and 742 (99%) patients in the placebo group. There was no effect of fluoxetine on the primary outcome-distribution across mRS score categories-compared with placebo (adjusted common odds ratio 0·94 [95% CI 0·78 to 1·13]; p=0·42). The proportion of patients with a new diagnosis of depression was lower with fluoxetine than with placebo (54 [7%] patients vs 81 [11%] patients; difference -3·60% [-6·49 to -0·71]; p=0·015), but fluoxetine was associated with more bone fractures (28 [4%] vs 11 [2%]; difference 2·27% [0·66 to 3·87]; p=0·0058) and hyponatraemia (11 [1%] vs one [<1%]; difference 1·33% [0·43 to 2·23]; p=0·0038) at 6 months.Functional outcome after acute stroke did not improve with oral fluoxetine 20 mg once daily for 6 months. Fluoxetine reduced the occurrence of depression but increased the risk of bone fractures and hyponatraemia. Our results do not support the use of fluoxetine after acute stroke.The Swedish Research Council, the Swedish Heart-Lung Foundation, the Swedish Brain Foundation, the Swedish Society of Medicine, King Gustav V and Queen Victoria's Foundation of Freemasons, and the Swedish Stroke Association (STROKE-Riksförbundet).
10.	Lundström, Erik, Docent, 1964-, et al. (författare) Update on the EFFECTS study of fluoxetine for stroke recovery: a randomised controlled trial in Sweden 2020 Ingår i: Trials. - Uppsala : Springer Science and Business Media LLC. - 1745-6215. ; 21:1 Tidskriftsartikel (refereegranskat)abstract Studies have suggested that fluoxetine might improve neurological recovery after stroke, but the results remain inconclusive. The EFFECTS (Efficacy oF Fluoxetine - a randomisEd Controlled Trial in Stroke) reached its recruitment target of 1500 patients in June 2019. The purpose of this article is to present all amendments to the protocol and describe how we formed the EFFECTS trial collaboration in Sweden. Methods In this investigator-led, multicentre, parallel-group, randomised, placebo-controlled trial, we enrolled non-depressed stroke patients aged 18 years or older between 2 and 15 days after stroke onset. The patients had a clinical diagnosis of stroke (ischaemic or intracerebral haemorrhage) with persisting focal neurological deficits. Patients were randomised to fluoxetine 20 mg or matching placebo capsules once daily for 6 months. Results Seven amendments were made and included clarification of drug interaction between fluoxetine and metoprolol and the use of metoprolol for severe heart failure as an exclusion criterion, inclusion of data from central Swedish registries and the Swedish Stroke Register, changes in informed consent from patients, and clarification of design of some sub-studies. EFFECTS recruited 1500 patients at 35 centres in Sweden between 20 October 2014 and 28 June 2019. We plan to unblind the data in January 2020 and report the primary outcome in May 2020. Conclusion EFFECTS will provide data on the safety and efficacy of 6 months of treatment with fluoxetine after stroke in a Swedish health system setting. The data from EFFECTS will also contribute to an individual patient data meta-analysis.
11.	Norrving, Bo, et al. (författare) Beyond conventional stroke guidelines: setting priorities 2007 Ingår i: Stroke. - 1524-4628 .- 0039-2499. ; 38:7, s. 2185-2190 Tidskriftsartikel (refereegranskat)abstract BACKGROUND AND PURPOSE: Priorities in the care of stroke patients are often intuitive. An open and translucent priority-setting procedure would benefit patients, professionals, and decision-makers. Prioritization is an innovative part of the new Swedish national stroke guidelines. METHODS: Working groups identified diagnostic procedures, interventions and therapies in stroke care, assessed each one according to severity (needs), effect of action, level of scientific evidence and cost-effectiveness. The items were then ranked into priority groups from 1 (highest) to 10 (lowest). Procedures lacking evidence for routine clinical use were also identified (and entered a do-not-do list), as well as procedures in research and development. Resource allocations resulting from the priority-setting process were identified. RESULTS: Of 102 core procedures identified, 50 were assigned to high-priority groups (1-3), 29 to moderate priority groups (4-7) and 23 to low priority groups (8-10). Almost a quarter were graded 8 to 10, indicating that they may not necessarily be applied if resources are scarce. Twenty-eight procedures were assigned to the do-not-do list and 16 to the research and development list. CONCLUSIONS: In stroke services, it is possible to identify not only diagnostic procedures and interventions with high priority, but also a considerable number of items used today that have low priority or should not be used at all. Strict adherence to the guidelines would result in a substantial reallocation of resources from low-priority to high-priority areas.
12.	Nyman, Emma, et al. (författare) Baseline carotid intima media echogenicity is associated with the 3-year progression of intima media thickness Annan publikation (övrigt vetenskapligt/konstnärligt)
13.	Nyman, Emma, et al. (författare) Carotid wall echogenicity at baseline associates with accelerated vascular aging in a middle-aged population 2023 Ingår i: The International Journal of Cardiovascular Imaging. - : Springer Science+Business Media B.V.. - 1569-5794 .- 1875-8312. ; 39:3, s. 575-583 Tidskriftsartikel (refereegranskat)abstract Ultrasonic echolucent carotid intima-media (IM) complex and accelerated progression of carotid intima mediathickness (cIMT) have both separately been shown to predict future cardiovascular events. The aim of this studywas to evaluate if the echogenicity of the IM-complex is associated with the 3-year progression of cIMT. B-modeultrasound images captured at baseline and 3-year follow-up in the ‘Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention’ (VIPVIZA) trial were included (n: 3154). The bilateral mean cIMT and IM-echogenicity by greyscale median (GSM) were measured in the common carotid artery. Associations between IM-GSM at baseline and the 3-year cIMT progression were investigated using linear regression models for the whole population and stratified by sex, age and VIPVIZA study group (intervention versus control). In addition, adjusted analyses for confounding factors were performed. Unadjusted analysis showed that decreased IM-GSM at baseline was associated with increased progression of cIMT (p < 0.001). Stratified by age, the association was significant among 40 (p < 0.001) and 60 years old (p < 0.001). The association was statistically significant in both sexes and on comparison of VIPVIZA study subgroups. Adjustments for confounding factors did not alter the estimated relationship between IM-GSM and cIMT progression. Echolucent carotid intima media at baseline associates with increased 3-year cIMT progression among an asymptomatic, middle-aged population. Echogenicity of the intima media may identify individuals at risk for accelerated vascular aging.
14.	Nyman, Emma, et al. (författare) Reduced progression of carotid intima media thickness by personalised pictorial presentation of subclinical atherosclerosis in VIPVIZA : A randomised controlled trial 2023 Ingår i: Clinical Physiology and Functional Imaging. - : John Wiley & Sons. - 1475-0961 .- 1475-097X. ; 43:4, s. 232-241 Tidskriftsartikel (refereegranskat)abstract Objectives: Reduced progression of atherosclerosis can decrease the risk of cardiovascular disease (CVD). This study aimed at evaluating the effect of a pictorial intervention showing atherosclerotic severity on the progression of carotid atherosclerosis.Methods: A prospective randomised open-label blinded end-point trial with participants aged 40–60 years enroled from a routine CVD prevention programme. The intervention group (n: 1575) and their treating physicians received an image based presentation of subclinical atherosclerotic severity measured by carotid ultrasound. The control group (n: 1579) did not receive any information about ultrasound results. Carotid ultrasound at baseline and at 3-year follow-up contained plaque detection and measurements of carotid intima media thickness (cIMT). The left, right and bilateral-mean-cIMT, plaque prevalence and total plaque area (TPA) at 3-year follow-up were compared between groups. Significance level was set to p = 0.01 to adjust for multiple comparisons.Results: The intervention group revealed reduced cIMT progression in the left-mean-cIMT of −0.011 mm (p = 0.001) compared with the control group. The intervention effect on cIMT progression was most prominent in individuals with increased cIMT and plaque prevalence at baseline (−0.021 mm, p = 0.005). There were no differences in progression between groups for the right-and bilateral-mean-cIMT (−0.005 mm, p = 0.223 and −0.005 mm, p = 0.036, respectively), nor any differences between groups for plaque prevalence or TPA (odds ratio 0.88, p = 0.09 and 0.89, p = 0.21, respectively).Conclusion: Pictorial presentation of subclinical atherosclerotic severity sent to both the individual and their treating physician resulted in significantly reduced left cIMT progression. Pictorial presentation has the potential to increase adherence in CVD prevention.
15.	Nyman, Emma, et al. (författare) Reduced progression of carotid intima media thickness by pictorial presentation of subclinical atherosclerosis in VIPVIZA – a randomized controlled trial Annan publikation (övrigt vetenskapligt/konstnärligt)
16.	Näsman, Per, Docent, 1954-, et al. (författare) Is there a role for SSRIs after FOCUS, AFFINITY and EFFECT? 2019 Konferensbidrag (övrigt vetenskapligt/konstnärligt)
17.	Rejnö, Åsa, 1970-, et al. (författare) "StrokeSverige" lär i webbaserad kompetensutbildning 2018 Ingår i: VILÄR Abstraktbok. - Trollhättan : Högskolan Väst. - 9789187531460 - 9789187531477 ; , s. 4-5 Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract BakgrundVerksamhetsintegrerat lärande omfattar lärande som sker integrerat mellan akademi och arbetsliv. Ofta är integrationen sådan att arbetslivet integreras i akademin. Det omvända är inte lika vanligt. Strokeenhetsvård är sedan 1980-talet ett internationellt evidensbaserat vårdkoncept som minskar mortalitet, institutionsboende och beroende i ADL efter stroke. För att en verksamhet ska få kalla sig strokeenhet ingår att vården ska bedrivas av ett multidisciplinärt team med expertkunnande inom stroke och rehabilitering. Strokekompetensutbildning med både teoretiska och praktiska moment som ger detta expertkunnande ges sedan av STROKE Riksförbundet och drivs lokalt. Antalet som genomgår utbildningen minskar på grund av vårdens pressadef örhållanden vilket gett svårigheter att organisera och driva utbildningen lokalt. Från centralt håll har oro uttryckts då strokekompetensen genom detta minskar vilket potentiellt leder till sämre vård. Syftet med presentationen är att visa hur lokalt drivna utbildningar i arbetslivet kan webbaseras i samarbete med akademin för att möjliggöra personalgruppers möjlighet till kompetenshöjning.MetodUtbildningen har digitaliserats för att ge förutsättningar för jämlik vård. Alla teoretiska moment har gjorts som filmade föreläsningar av personer med spetskompetens inom sitt område och en tredelad examination har tagits fram som säkerställer att utbildningen ger jämn och hög kvalitet.ResultatUtbildningen som använder det flippade klassrummet som teoretisk modell är nu en poänggivande högskoleutbildning som ges av Umeå universitet där teambased learning och constructive alignment varit ledord för uppbyggnaden. Utbildningen omfattar filmade föreläsningar, quiz och webbaserad examination som genomförs via lärplattformen, samt material för träffar där praktiska moment ingår som ordnas lokalt av respektive verksamhet, liksom material för såväl individuell examination som gruppexamination. Utöver detta finns länkar till referensmaterial samt fördjupningsmaterial.DiskussionMed noggrann planering, förankring och tydliga pedagogiska utgångspunkter kan utbildning utvecklas i samarbete mellan offentlig sektor och universitet/högskolor. Utbildningen är exempel på ett initiativ från arbetslivet där akademin är tydligt integrerad för att möjliggöra lärande för personer i arbetslivet. Genom digitaliseringen ges möjlighet för verksamheter att erbjuda personal utbildning inommer flexibla ramar och på tider som passar dem jämfört med traditionella kurser inom högre utbildning. Konceptet kan potentiellt användas för många verksamheter och visar på möjligheterna med digitalisering av högre utbildning för att nå ut till arbetslivet
18.	Rejnö, Åsa, et al. (författare) "StrokeSverige" lär i webbaserad kompetensutbildning 2018 Ingår i: VILÄR Abstraktbok. - Trollhättan : Högskolan Väst. - 9789187531460 - 9789187531477 Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract Bakgrund: Verksamhetsintegrerat lärande omfattar lärande som sker integrerat mellan akademi och arbetsliv. Ofta är integrationen sådan att arbetslivet integreras i akademin. Det omvända är inte lika vanligt. Strokeenhetsvård är sedan 1980-talet ett internationellt evidensbaserat vårdkoncept som minskar mortalitet, institutionsboende och beroende i ADL efter stroke. För att en verksamhet ska få kalla sig strokeenhet ingår att vården ska bedrivas av ett multidisciplinärt team med expertkunnande inom stroke och rehabilitering. Strokekompetensutbildning med både teoretiska och praktiska moment som ger detta expertkunnande ges sedan av STROKE Riksförbundet och drivs lokalt. Antalet som genomgår utbildningen minskar på grund av vårdens pressadef örhållanden vilket gett svårigheter att organisera och driva utbildningen lokalt. Från centralt håll har oro uttryckts då strokekompetensen genom detta minskar vilket potentiellt leder till sämre vård. Syftet med presentationen är att visa hur lokalt drivna utbildningar i arbetslivet kan webbaseras i samarbete med akademin för att möjliggöra personalgruppers möjlighet till kompetenshöjningMetod: Utbildningen har digitaliserats för att ge förutsättningar för jämlik vård. Alla teoretiska moment har gjorts som filmade föreläsningar av personer med spetskompetens inom sitt område och en tredelad examination har tagits fram som säkerställer att utbildningen ger jämn och hög kvalitet.Resultat: Utbildningen som använder det flippade klassrummet som teoretisk modell är nu en poänggivande högskoleutbildning som ges av Umeå universitet där teambased learning och constructive alignment varit ledord för uppbyggnaden. Utbildningen omfattar filmade föreläsningar, quiz och webbaserad examination som genomförs via lärplattformen, samt material för träffar där praktiska moment ingår som ordnas lokalt av respektive verksamhet, liksom material för såväl individuell examination som gruppexamination. Utöver detta finns länkar till referensmaterial samt fördjupningsmaterial.Diskussion: Med noggrann planering, förankring och tydliga pedagogiska utgångspunkter kan utbildning utvecklas i samarbete mellan offentlig sektor och universitet/högskolor. Utbildningen är exempel på ett initiativ från arbetslivet där akademin är tydligt integrerad för att möjliggöra lärande för personer i arbetslivet. Genom digitaliseringen ges möjlighet för verksamheter att erbjuda personal utbildning inommer flexibla ramar och på tider som passar dem jämfört med traditionella kurser inom högre utbildning. Konceptet kan potentiellt användas för många verksamheter och visar på möjligheterna med digitalisering av högre utbildning för att nå ut till arbetslivet
19.	Rejnö, Åsa, 1970-, et al. (författare) WebbSKU – Nätbaserad nationell stroketeamutbildning 2020 Konferensbidrag (refereegranskat)abstract Stroke är en folksjukdom som drabbar 25000 svenskar årligen. Vårdkedjan innefattar omhändertagande före ankomst till sjukhus, under sjukhusvistelse samt efter utskrivning och sköts av interdisciplinära team. En utmaning är det stora behovet av kunskap hos all personal, speciellt i senare skede. Hösten 2018 sjösattes därför en ny nationell utbildning utvecklad för alla strokevårdsteam i Sverige. Den tidigare utbildningen som genomfördes lokalt på många enheter var mycket resurskrävande, hade en trend av minskat deltagande och spretigt innehåll samt skilde sig avseende examinationen (Rejnö, 2016) Målbilden för utbildningen, benämnd WebbSKU (WebbStrokeKompetensUtbildning, 2020) som ges som uppdragsutbildning (3,0 hp) inom Umeå universitet, var att öka antalet deltagare, säkra kvaliteten samt göra utbildningen nationellt enhetlig. Utbildningen skulle även vara lättillgänglig och flexibel samt stärka teamkänslan. En nationell grupp bildades som enades om kursinnehåll och en mindre grupp som arbetade med genomförandet. Tydliga pedagogiska utgångspunkter var centralt. Med utgångspunkt i konstruktiv länkning har det flippade klassrummet använts genomgående. Utbildningen ska pågå under minst ett år och ske parallellt med arbete i den egna strokeverksamheten. De teoretiska delarna sker via nätet som förberedelse för kursens fyra obligatoriska teamträffar där teambaserat lärande är den pedagogiska utgångspunkten. Deltagarna ska komma förberedda och bearbeta olika problem gemensamt i teamet (Michaelsen & Sweet, 2008). För produktion av kursmaterial inbjöds expertis från hela strokekedjan. Totalt producerades 66 filmer omfattande totalt ca 700 minuter film med tillhörande flervalsfrågor som instuderings- och examinationsfrågor. För teamträffarna skapades case, diskussionsfrågor samt praktiska övningar. Examinationen består av tre delar. En del sker i form av ett individuellt test i kursens webbplattform. De två andra delarna sker under sista fysiska sammankomsten; individuell skriftlig examination samt teamexamination. Aktivt deltagande vid de fysiska teamträffarna krävs. Kursen har nu drygt 1000 deltagare från sjukhusens strokeenheter, primärvård och kommun spridda över landet och 300 har slutfört utbildningen. Utbildningens pedagogiska upplägg har utvärderats med gott resultat. Framgångsfaktorer har varit att innehåll, genomförande och pedagogiska utgångspunkter varit tydliga. Kanske mest centralt har varit att det funnits nyckelpersoner som drivit processen framåt och lyckats förankra arbetet i alla led. Svårigheterna var att enas om gemensamt innehåll passande för samtliga yrkeskategorier samt att skapa en struktur för hur materialet ska produceras på enhetligt sätt. Lärdomarna är att med bra förankring och planering samt tydliga pedagogiska utgångspunkter är det fullt möjligt att ta fram en helt ny flexibel nationell utbildning som bygger på en tydlig idé om arbetsintegrerat lärande både i framtagande och genomförande.
20.	Wester, Per, et al. (författare) Strokeenheter i Sverige : kartläggning av dimensionering, praxis och vårdinnehåll 2007 Rapport (övrigt vetenskapligt/konstnärligt)
21.	Andersson, Per, 1961-, et al. (författare) "One day, one problem" : endags PBL-undervisning 2015 Ingår i: Universitetspedagogiska konferensen 2015. - Umeå : Universitetspedagogik och lärandestöd (UPL), Umeå universitet. ; , s. 10-11 Konferensbidrag (övrigt vetenskapligt/konstnärligt)
22.	Andersson, Per, et al. (författare) “One day, one problem” : applying SOTL on a course about teaching in higher education 2015 Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract At the Centre for Teaching and Learning at Umeå University, we are responsible for the development of university teachers’ pedagogical competence. One of the main purposes of our courses is to help teachers develop an array of teaching methods – including a sound basis for their decisions about which method to use. We work with teaching methods for student active learning that develop sustainable knowledge (Hattie, 2009), for example Problem Based Learning, PBL. Our problem is that this usually takes a lot of time on our short courses. So we asked ourselves: How can we use SoTL to describe, develop and evaluate a method that gives key transitions in the university teachers’ journey towards pedagogical competence, both theoretically and practically (Dietz-Uhler and Bishop-Clark, 2012)? We wanted a group of teachers on one of our courses to learn more about PBL and to be active while doing this. We also wanted a meta-didactic discussion about it afterwards. We found a method called “One day, one problem” (O’Grady, 2012) that we wanted to try. We had to redesign the method slightly to fit our context, by writing a relevant scenario in line with our expected learning outcomes. Apart from this we followed the suggested process in the article. We carried out formative and summative evaluations, and we as teachers documented the activity. Our preliminary analysis shows that this method gave us what we wanted since the learners were positive towards working this way, and the self- evaluated learning process and product was given high grades. Our preliminary results and conclusion is that this method is a useful way to both teach about the PBL process and to work with course content. We also saw that SoTL, systematically searching, finding, developing and evaluating a new teaching method is a good way to develop both our own and our students’ pedagogical competence.
23.	Andersson, Per, et al. (författare) Pedagogical development in higher education with a focus on teaching methods 2017 Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract Pedagogical development in higher education with a focus on teaching methodsP. Andersson and M. Wester, Umeå University, SwedenABSTRACT The theme of the presentation is teaching methods and how the educational developer’s choice of teaching methods can affect the development of teaching and learning in higher education. The starting point is a study and survey of the teaching methods used at one university teaching development unit, and how and why these methods were chosen. The survey consisted of a systematic review of teaching methods used on fourteen courses, in various fields and levels in teacher professional development in higher education. Both a description of how the survey was conducted and the results will be presented.The survey also included information on the background and reasons why these methods were chosen. Another aim of the study was to find ways for systematic method development and two concrete examples will be presented. We will also discuss the role and importance the choice of teaching methods has for university teaching development, both at the individual and unit level.[1] Another aspect addresses the role of the educational developer as a role model with a wide range of teaching methods and an ambition for constant development.[2]In the study we also address responses to the development initiative. We proposed to our colleagues that the whole unit should work systematically with the development of teaching methods. In general, the responses were positive, but we do not yet know what the result of this will be for the unit as a whole.[3]ReferencesArnold-Garza, Sara (2014), The Flipped Classroom Teaching Model and Its Use for Information Literacy Instruction, in Communications in Information LiteracyBaume, David & Popovic, Celia (red) (2016), Advancing Practice in Academic Development. Routledge, New YorkEntwistle, Noel (2009), Teaching for understanding at university, Houndmills, Basingstoke: Palgrave MacmillanTimmermans, Julie A. (2014), Identifying threshold concepts in the careers of educational Developers, International Journal for Academic Development, Vol 19, No 4, pp 305-317[1] Arnold-Garza, 2014; Entwistle, 2009[2] Timmermans, 2014[3] Baume et al (red), 2016
24.	Arnell, Kai, 1945- (författare) Cerebrospinal Fluid Shunts in Children : Technical Considerations and Treatment of Certain Complications 2007 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract Ventriculo-peritoneal shunting is the most commonly used method for the treatment of paediatric hydrocephalus. Despite improved shunts and surgical techniques there are still complications. This retrospective study focuses on diagnoses and treatment of shunt malfunction and infections. Cost/benefit of using an adjustable shunt was assessed. Two adjustable cerebrospinal fluid shunts and their compatible antisiphon devices were compared in-vitro. In 21 of 46 children the standard shunt was changed to an adjustable one due to over-drainage. Adjustment of the shunt was performed in 73% of the children thereby avoiding surgery in several cases. This was a financial advantage. Ascites or an abdominal pseudocyst without infection was detected in eight children due to resorption difficulties. A ventriculo-atrial shunt was inserted for a period of time. In three children it could successfully be reverted to a ventriculo-peritoneal. In six children papilloedema was the only sign of shunt dysfunction. At revision the intracranial pressure ranged from 25 to 52 cm H2O. Fundoscopic examination in children older than 8 years may detect symptomless shunt malfunction. During a 13-year period 39 shunt infections were diagnosed. Skin bacteria were found in 80%. Prolonged and anaerobic cultures increased the detection rate by more than one third. The intraventricular infections were treated with intraventricular and systemic antibiotics resulting in quick sterilisation. No relapses were encountered. In five older children with distal catheter infection Propionibacterium acne was found. These were treated with intravenous antibiotics and exchanging of the shunt system. Strata NSCTM and Codman HakimTM worked according to the manufacturers except at the lowest setting. The resistance was below and in the lower range of the physiological one respectively. The antisiphon device of Strata shunt had to be placed in line with shunt to function properly.
25.	Arnell, Kai, et al. (författare) Treatment of cerebrospinal fluid shunt infections in children using systemic and intraventricular antibiotic therapy in combination with externalization of the ventricular catheter : efficacy in 34 consecutively treated infections 2007 Ingår i: Journal of Neurosurgery. - 0022-3085 .- 1933-0693. ; 107:3, s. 213-219 Tidskriftsartikel (refereegranskat)abstract OBJECT: There are no randomized studies comparing the efficacy of different antibiotic regimens for the treatment of cerebrospinal fluid (CSF) shunt infections, and in the studies that have been reported, efficacy data are limited. The aim of this study was therefore to report the authors' experience using a specific protocol for the management of shunt infections in children. Standard treatment included a two-stage procedure involving externalization of the ventricular catheter in combination with intraventricular and systemic administration of antibiotic medication followed by shunt replacement. Intraventricular treatment consisted of daily instillations of vancomycin or gentamicin with trough concentrations held at high levels of 7 to 17 mg/L for both antibiotic agents. METHODS: During a 13-year study period, the authors treated 34 consecutive intraventricular shunt infections in 30 children. Infections with coagulase-negative staphylococci predominated, and Gram-negative bacterial infection occurred in five children. Ten of the children were initially treated with intravenous antibiotic therapy for at least 3 days, but this treatment did not sterilize the CSF. After externalization of the ventricular catheter, high-dose intraventricular treatment was given for a median of 8 days (range 3-17 days) before shunt replacement. RESULTS: The CSF was found to be sterile (cultures were negative for bacteria) in one of three, seven of eight, 20 of 20, and six of six cases after 1, 2, 3, and more than 3 days' treatment, respectively. In no case was any subsequent culture positive after a negative result had been obtained. Clinical symptoms resolved in parallel with the sterilization of the CSF. There were no relapses or deaths during the 6-month follow-up period, and there have been none as of April 2007. CONCLUSIONS: Despite the ventricular catheter being left in place and the short duration of therapy, the treatment regimen described by the authors resulted in quick sterilization of the CSF, a low relapse rate, and survival of all patients in this series.
26.	Aronsson, Mattias, et al. (författare) Cost-effectiveness of endovascular thrombectomy in patients with acute ischemic stroke. 2016 Ingår i: Neurology. - : American Academy of neurology. - 0028-3878 .- 1526-632X. ; 86:11, s. 1053-9 Tidskriftsartikel (refereegranskat)abstract Objective:To evaluate the cost-effectiveness of adding endovascular thrombectomy to standard care in patients with acute ischemic stroke.Methods:The cost-effectiveness analysis of endovascular thrombectomy in patients with acute ischemic stroke was based on a decision-analytic Markov model. Primary outcomes from ESCAPE, Extending the Time for Thrombolysis in Emergency Neurological Deficits-Intra-Arterial (EXTEND-IA), Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN), Endovascular Revascularization With Solitaire Device Versus Best Medical Therapy in Anterior Circulation Stroke Within 8 Hours (REVASCAT), and Solitaire with the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke (SWIFT PRIME) along with data from published studies and registries were used in this analysis. We used a health care payer perspective and a lifelong time horizon to estimate costs and effects.Results:The model showed that adding thrombectomy with stent retrievers to guideline-based care (including IV thrombolysis) resulted in a gain of 0.40 life-years and 0.99 quality-adjusted life-years along with a cost savings of approximately $221 per patient. The sensitivity analysis showed that the results were not sensitive to changes in uncertain parameters or assumptions.Conclusions:Adding endovascular treatment to standard care resulted in substantial clinical benefits at low costs. The results were consistent throughout irrespective of whether data from ESCAPE, EXTEND-IA, MR CLEAN, REVASCAT, or SWIFT PRIME were used in this model.
27.	Aronsson, Mattias, et al. (författare) Kostnadseffektiviteten av trombektomibehandling vid akut ischemisk stroke 2016 Ingår i: Neurologi i Sverige. - 2000-8538. ; 3 Tidskriftsartikel (refereegranskat)abstract Flera randomiserade studier har visat på mycket goda kortsiktiga medicinska effekter av trombektomibehandling som tillägg till standardbehandling. Frågan återstår dock om den långsiktiga nyttan kan rättfärdiga de höga kostnaderna för denna behandling. Mattias Aronsson, Josefine Persson, Christian Blomstrand, Per Wester och Lars-Åke Levin beskriver här resultaten från sin hälsoekonomiska studie, som publicerades i tidskriften Neurology tidigare i år.
28.	Asplund, Kjell, et al. (författare) Diagnostic procedures, treatments, and outcomes in stroke patients admitted to different types of hospitals 2015 Ingår i: Stroke. - : Lippincott Williams & Wilkins. - 0039-2499 .- 1524-4628. ; 46:3, s. 806-812 Tidskriftsartikel (refereegranskat)abstract Background and Purpose: In many countries, including Sweden, initiatives have been taken to reduce between-hospital differences in the quality of stroke services. We have explored to what extent hospital type (university, specialized nonuniversity, or community hospital) influences hospital performance. Methods: Riksstroke collects clinical data during hospital stay (national coverage 94%). Follow-up data at 3 months were collected using administrative registers and a questionnaire completed by surviving patients (response rate 88%). Structural data were collected from a questionnaire completed by hospital staff (response rate 100%). Multivariate analyses with adjustment for clustering were used to test differences between types of hospitals. Results: The proportion of patients admitted directly to a stroke unit was highest in community hospitals and lowest in university hospitals. Magnetic resonance, carotid imaging, and thrombectomy were more frequently performed in university hospitals, and the door-to-needle time for thrombolysis was shorter. Secondary prevention with antihypertensive drugs was used less often, and outpatient follow-up was less frequent in university hospitals. Fewer patients in community hospitals were dissatisfied with their rehabilitation. After adjusting for possible confounders, poor outcome (dead or activities of daily living dependency 3 months after stroke) was not significantly different between the 3 types of hospital. Conclusions: In a setting with national stroke guidelines, stroke units in all hospitals, and measurement of hospital performance and benchmarking, outcome (after case-mix adjustment) is similar in university, specialized nonuniversity, and community hospitals. There seems to be fewer barriers to organizing well-functioning stroke services in community hospitals compared with university hospitals.
29.	Asplund, Kjell, et al. (författare) Riks-stroke - a Swedish national quality register for stroke care. 2003 Ingår i: Cerebrovasc Dis. - 1015-9770. ; 15 Suppl 1, s. 5-7 Tidskriftsartikel (refereegranskat)
30.	Asplund, Kjell, et al. (författare) The Riks-Stroke story : building a sustainable national register for quality assessment of stroke care 2011 Ingår i: International Journal of Stroke. - : SAGE Publications. - 1747-4930 .- 1747-4949. ; 6:2, s. 99-108 Tidskriftsartikel (refereegranskat)abstract Background Riks-Stroke, the Swedish Stroke Register, is the world's longest-running national stroke quality register (established in 1994) and includes all 76 hospitals in Sweden admitting acute stroke patients. The development and maintenance of this sustainable national register is described. Methods Riks-Stroke includes information on the quality of care during the acute phase, rehabilitation and secondary prevention of stroke, as well as data on community support. Riks-Stroke is unique among stroke quality registers in that patients are followed during the first year after stroke. The data collected describe processes, and medical and patient-reported outcome measurements. The register embraces most of the dimensions of health-care quality (evidence-based, safe, provided in time, distributed fairly and patient oriented). Result Annually, approximately 25 000 patients are included. In 2009, approximately 320 000 patients had been accumulated (mean age 76-years). The register is estimated to cover 82% of all stroke patients treated in Swedish hospitals. Among critical issues when building a national stroke quality register, the delicate balance between simplicity and comprehensiveness is emphasised. Future developments include direct transfer of data from digital medical records to Riks-Stroke and comprehensive strategies to use the information collected to rapidly implement new evidence-based techniques and to eliminate outdated methods in stroke care. Conclusions It is possible to establish a sustainable quality register for stroke at the national level covering all hospitals admitting acute stroke patients. Riks-Stroke is fulfilling its main goals to support continuous quality improvement of Swedish stroke services and serve as an instrument for following up national stroke guidelines.
31.	Barut, Oya, et al. (författare) Calcifications in the neck region of patients with carotid artery stenosis : a computed tomography angiography study of topographic anatomy 2020 Ingår i: Oral surgery, oral medicine, oral pathology and oral radiology. - : Elsevier. - 2212-4403 .- 2212-4411. ; 129:5, s. 523-530 Tidskriftsartikel (refereegranskat)abstract Objectives: The aim of this study was to map the vertical locations of calcified carotid plaques (CCPs), osseous anatomic structures, and calcified soft tissues in the area of the carotid artery, determine to what extent CCPs are superimposed on the cervical spine in coronal images, and analyze the differences between men and women.Study Design: Computed tomography angiography (CTA) scans of 79 patients were studied. CCPs were discovered in 152 of the total 158 neck sides. Evaluations were performed by using sagittal and coronal reformatted CTA images with maximum intensity projection.Results: Most of the calcified anatomic structures studied, including the carotid bifurcation, were found in close relationship to the level of the third and fourth cervical vertebrae. In the coronal view, all or most of the areas of the CCPs were superimposed on the cervical spine in 22 of 44 (50%) neck sides with CCP in women and in 37 of 108 (34.2%) in men (P = .070).Conclusions: The carotid bifurcation is in close proximity to various calcified anatomic structures. This should be taken into account when diagnosing CCPs in panoramic radiographs. In the coronal view, CCPs and the cervical spine are often superimposed; thus, coronal images are not recommended for confirmation of putative carotid calcifications diagnosed on the basis of panoramic radiographs.
32.	Becker, Per, et al. (författare) Efterklokhet underminerar förmågan att avvärja terror 2018 Ingår i: Dagens nyheter (DN debatt). - 1101-2447. Tidskriftsartikel (populärvet., debatt m.m.)abstract Analyzes of the terrorist attack on Drottninggatan have begun to be published. The risk is now that the debate will be governed by the logic of hindsight, that politicians and the media will be on the stands, pointing out mistakes and demand responsibility. Such a climate jeopardizes in the long run the development of our ability to prevent terrorist attacks, write four security researchers.
33.	Bengtsson, Anna, 1973-, et al. (författare) Association of cardiovascular disease risk factors with combined carotid ultrasound measurements in subclinical atherosclerosis Annan publikation (övrigt vetenskapligt/konstnärligt)
34.	Bengtsson, Anna, 1973-, et al. (författare) Multi-view carotid ultrasound is stronger associated with cardiovascular risk factors than presence of plaque or single carotid intima media thickness measurements in subclinical atherosclerosis 2023 Ingår i: The International Journal of Cardiovascular Imaging. - : Springer Nature. - 1569-5794 .- 1875-8312. ; 39:8, s. 1461-1471 Tidskriftsartikel (refereegranskat)abstract We aimed to explore the prevalence of atherosclerosis by using multi-view ultrasound examination of the carotid arteries and its association with clinical risk factors in a middle-aged population at low to intermediate risk of cardiovascular disease (CVD). Carotid vascular ultrasound was performed in 3532 participants in the VIPVIZA trial. Mean and maximal carotid intima media thickness (cIMT) at prespecified angles and plaque presence were examined on the left and right side. Associations between CVD risk factors and ultrasound variables were quantified by partial least squares (PLS) regression. A combined ultrasound variable was computed using weights of the first PLS component. Associations between CVD risk factors and the combined multi-view ultrasound variable, single cIMT and plaque measurements, respectively, were determined using linear regression modelling. The participants’ mean age was 55.7 years and 52.9% were women. Plaque prevalence was 51.1% in men and 39.0% in women. cIMT was higher in men than in women and in the left compared with the right carotid artery. The strongest association of CVD risk factors was observed with the combined multi-view ultrasound variable (R2 = 24%), compared with single cIMT variables (R2 = 14–18%) and plaque presence (R2 = 15%). The pattern was similar in both sexes. The association with CVD risk factors and the combined ultrasound variable was stronger in 40-year olds (R2 = 22%) compared with 50- or 60-year olds (R = 12%). CVD risk factors are stronger associated with a combined ultrasound variable than plaque presence or single cIMT measures suggesting that carotid multi-view ultrasonography better captures the focality of early atherosclerosis. Clinical Trial Registration: ClinicalTrials.gov, number NCT01849575. May 8, 2013.
35.	Bengtsson, Anna, 1973- (författare) Pictorial presentation of subclinical atherosclerosis : a measure to reduce the risk for cardiovascular disease 2021 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract The overall aim was improved cardiovascular disease (CVD) prevention through the VIPVIZA intervention. This includes the provision of pictorial information of subclinical atherosclerosis to participants and their general practitioners (GPs), follow-up phone call, and written information to the participant. VIPVIZA is a Prospective Randomized Open Blinded End-point (PROBE) trial nested within VIP, a CVD prevention program in primary health care in Västerbotten county, Sweden. Middle-aged individuals at low/intermediate CVD risk were enrolled to VIPVIZA and randomized 1:1 to an intervention (n=1749) or control group (n=1783 who received no pictorial or other information). Preventive measures were managed within primary health care.At baseline, clinical risk factors were measured and carotid ultrasound examination was performed. The prevalence of subclinical atherosclerotic disease was assessed as intima media thickness and presence of plaque. The association between clinical risk factors and measures of subclinical atherosclerosis was investigated. In addition to conventional risk factor-based risk evaluation, the impact of the VIPVIZA intervention on CVD risk, traditional risk factors and pharmacological treatment was evaluated after 1 and 3 years. Individual interviews were conducted with 15 GPs to explore how a pictorial representation of subclinical atherosclerosis affects physicians in their perception and communication of CVD risk. The interviews were analyzed by qualitative content analysis.The plaque prevalence was 44.7% in this population. Clinical risk factors explained more of the variation in a combined ultrasound measurement than single measurements. The results up to three years showed a VIPVIZA intervention effect, with lower and sustained CVD risk in the intervention as compared to the control group. The effect was partly mediated by differences in intake of lipid-lowering medication and partly by lifestyle behaviour. The GPs described their risk assessment and patients’ risk perception as more accurate with the VIPVIZA intervention. Informing patients about examination results prior to a consultation can facilitate shared decision-making and enhance adherence to preventive measures.The results show that the VIPVIZA intervention reduces CVD risk over three years. In the long run this has the potential to reduce the incidence of CVD events.
36.	Bengtsson, Anna, 1973-, et al. (författare) The beneficial effect over 3 years by pictorial information to patients and their physician about subclinical atherosclerosis and cardiovascular risk : results from the VIPVIZA randomized clinical trial 2021 Ingår i: American Journal of Preventive Cardiology. - : Elsevier. - 2666-6677. ; 7 Tidskriftsartikel (refereegranskat)abstract Objective: Non-adherence to guidelines and preventive measures is a major challenge, particularly so to ob- tain long-term adherence to lifestyle changes and recommended medication. The objective was to investigate if pictorial information regarding subclinical carotid atherosclerosis provided to individuals and physicians gave sustained effects on cardiovascular risk beyond the previously reported effect after 1 year and up to 3 years. Methods: A Prospective Randomized Open Blinded End-point (PROBE) trial. Within a CVD prevention program in Västerbotten County, Sweden, 3532 healthy individuals aged 40, 50 or 60 years were enrolled and 1:1 ran- domized to intervention ( n = 1749; pictorial information with additional prevention materials to participants and physicians) or control group ( n = 1783; no pictorial information to participants and physicians). Preventive measures were managed within primary care. Participants were investigated at baseline during 2013–2016 and at follow-up after 1 and 3 years. Results: A beneficial effect on cardiovascular risk was observed at 3-year follow-up; Framingham Risk Score (FRS) was 13.38 for the intervention group and 14.08 for the control group ( p = 0.047) and SCORE was 1.69 vs. 1.82 ( p = 0.022). The effect observed at 1-year was sustained over 3 years after adjustment for sex and education and more pronounced among participants with a severe atherosclerotic picture at baseline.Conclusions: This study provides evidence of sustained beneficial effects on the adherence to prevention guidelines over 3 years of pictorial information about subclinical carotid atherosclerosis, resulting in lower cardiovascular risk regardless of sex and educational level. Direct visualization of the underlying still subclinical atherosclerotic disease, rather than just indirect information about risk factors and statistical risk of future myocardial infarction, stroke and death, is one way to tackle the problem of non-adherence to prevention of cardiovascular diseases.
37.	Berglund, Lisa, et al. (författare) A genecentric Human Protein Atlas for expression profiles based on antibodies 2008 Ingår i: Molecular & Cellular Proteomics. - 1535-9476 .- 1535-9484. ; 7:10, s. 2019-2027 Forskningsöversikt (refereegranskat)abstract An attractive path forward in proteomics is to experimentally annotate the human protein complement of the genome in a genecentric manner. Using antibodies, it might be possible to design protein-specific probes for a representative protein from every protein-coding gene and to subsequently use the antibodies for systematical analysis of cellular distribution and subcellular localization of proteins in normal and disease tissues. A new version (4.0) of the Human Protein Atlas has been developed in a genecentric manner with the inclusion of all human genes and splice variants predicted from genome efforts together with a visualization of each protein with characteristics such as predicted membrane regions, signal peptide, and protein domains and new plots showing the uniqueness (sequence similarity) of every fraction of each protein toward all other human proteins. The new version is based on tissue profiles generated from 6120 antibodies with more than five million immunohistochemistry-based images covering 5067 human genes, corresponding to approximately 25% of the human genome. Version 4.0 includes a putative list of members in various protein classes, both functional classes, such as kinases, transcription factors, G-protein-coupled receptors, etc., and project-related classes, such as candidate genes for cancer or cardiovascular diseases. The exact antigen sequence for the internally generated antibodies has also been released together with a visualization of the application-specific validation performed for each antibody, including a protein array assay, Western blot analysis, immunohistochemistry, and, for a large fraction, immunofluorescence-based confocal microscopy. New search functionalities have been added to allow complex queries regarding protein expression profiles, protein classes, and chromosome location. The new version of the protein atlas thus is a resource for many areas of biomedical research, including protein science and biomarker discovery.
38.	Björck, Fredrik, et al. (författare) Outcomes in a Warfarin-Treated Population With Atrial Fibrillation 2016 Ingår i: JAMA cardiology. - : American Medical Association (AMA). - 2380-6583 .- 2380-6591. ; 1:2, s. 172-180 Tidskriftsartikel (refereegranskat)abstract IMPORTANCE Vitamin K antagonist (eg, warfarin) use is nowadays challenged by the non-vitamin K antagonist oral anticoagulants (NOACs) for stroke prevention in atrial fibrillation (AF). NOAC studies were based on comparisons with warfarin arms with times in therapeutic range (TTRs) of 55.2% to 64.9%, making the results less credible in health care systems with higher TTRs. OBJECTIVES To evaluate the efficacy and safety of well-managed warfarin therapy in patients with nonvalvular AF, the risk of complications, especially intracranial bleeding, in patients with concomitant use of aspirin, and the impact of international normalized ratio (INR) control. DESIGN, SETTING, AND PARTICIPANTS A retrospective, multicenter cohort study based on Swedish registries, especially AuriculA, a quality register for AF and oral anticoagulation, was conducted. The register contains nationwide data, including that from specialized anticoagulation clinics and primary health care centers. A total of 40 449 patients starting warfarin therapy owing to nonvalvular AF during the study period were monitored until treatment cessation, death, or the end of the study. The study was conducted from January 1, 2006, to December 31, 2011, and data were analyzed between February 1 and November 15, 2015. Associating complications with risk factors and individual INR control, we evaluated the efficacy and safety of warfarin treatment in patients with concomitant aspirin therapy and those with no additional antiplatelet medications. EXPOSURES Use of warfarin with and without concomitant therapy with aspirin. MAIN OUTCOMES AND MEASURES Annual incidence of complications in association with individual TTR (iTTR), INR variability, and aspirin use and identification of factors indicating the probability of intracranial bleeding. RESULTS Of the 40 449 patients included in the study, 16 201 (40.0%) were women; mean (SD) age of the cohort was 72.5 (10.1) years, and the mean CHA(2)DS(2)-VASc (cardiac failure or dysfunction, hypertension, age >= 75 years [doubled], diabetes mellitus, stroke [doubled]-vascular disease, age 65-74 years, and sex category [female]) score was 3.3 at baseline. The annual incidence, reported as percentage (95% CI) of all-cause mortality was 2.19% (2.07-2.31) and, for intracranial bleeding, 0.44%(0.39-0.49). Patients receiving concomitant aspirin had annual rates of any major bleeding of 3.07%(2.70-3.44) and thromboembolism of 4.90% (4.43-5.37), and those with renal failure were at higher risk of intracranial bleeding (hazard ratio, 2.25; 95% CI, 1.32-3.82). Annual rates of any major bleeding and any thromboembolism in iTTR less than 70% were 3.81% (3.51-4.11) and 4.41% (4.09-4.73), respectively, and, in high INR variability, were 3.04%(2.85-3.24) and 3.48% (3.27-3.69), respectively. For patients with iTTR 70% or greater, the level of INR variability did not alter event rates. CONCLUSIONS AND RELEVANCE Well-managed warfarin therapy is associated with a low risk of complications and is still a valid alternative for prophylaxis of AF-associated stroke. Therapy should be closely monitored for patients with renal failure, concomitant aspirin use, and poor INR control.
39.	Björck, Fredrik, 1974- (författare) Warfarin treatment quality in stroke prevention 2016 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract BackgroundIschemic stroke is a serious condition often associated to presence of atrial fibrillation (AF). Use of anticoagulants for AF patients greatly reduces the risk of stroke. Warfarin is the most commonly used anticoagulant in Sweden. The aim of this thesis was to study the impact of warfarin treatment quality in Swedish stroke prevention.MethodsStudy I, II and IV were relatively large multicentre, retrospective, cohort studies based on Swedish registries, especially AuriculA, a quality register for AF and anticoagulation. Background data as well as bleeding and thromboembolic complications were retrieved from the National Patient Register. The Cause of Death Register was used in study II and IV. The Swedish Prescribed Drug Register was used in study IV, for data on concomitant acetylsalicylic acid (ASA) use. Study period was January 1, 2006, to December 31, 2011. Study III enrolled all warfarin treated AF patients in Sundsvall, registered in AuriculA on January 1, 2010. This smaller cohort was followed until discontinuation or study-stop December 31, 2013. All used data were collected from each patient’s medical record.ResultsThe annual risk of major bleedings and thromboembolic events for warfarin treated patients, including all different indications for warfarin, was relatively low (2.24% and 2.66%), with incidence of intracranial bleeding of 0.37% per treatment year. The overall mean time in therapeutic range (TTR) was 76.5%. Patients started on warfarin due to AF had a mean TTR of 68.6%, with an annual risk of major bleeding and thromboembolic events of 2.23% and 2.95%, and with 0.44% annual risk of intracranial bleeding. No significant differences in overall complications were found when comparing treatment monitored in anticoagulation clinics (ACC) with treatment monitored in primary health care centers (PHCC). There were significantly increased risk of both overall major bleedings and thromboembolic events for those warfarin treated AF patients receiving additional ASA treatment, having individual TTR (iTTR) below 70%, or having high international normalized ratio (INR) variability. AF patients with low INR variability had generally lower complication rates, compared with patients with high INR variability. There were however no alteration on cumulative incidence of complications due to INR variability, for AF patients with iTTR ≥70%. The overall proportion of persistence to warfarin treatment for stroke patients with AF was found to be 0.69 after 2 years treatment and 0.47 after 5 years. Stroke patients with diagnosed dementia at baseline were more than two-times likely of discontinuing warfarin than others. Excessive alcohol use, chronic obstructive pulmonary disease, cancer and chronic heart failure were baseline diagnoses each associated with over 20% increased risk of treatment discontinuation. Lower persistence to treatment was linked to increasing start-age and CHA2DS2-VASc scores. As documented reasons for warfarin treatment discontinuation in AF patients, we found regained sinus rhythm as the most common addressed cause (31.2%), followed by problematic monitoring and bleedings. We estimated that only half (49.5%) of the treatment discontinuations were clinically well motivated.ConclusionsQuality of Swedish warfarin treatment in initiated stroke prevention is high, with generally low rates of complications and high TTRs, no matter treatment in ACC or PHCC, including high long time persistence to warfarin in secondary stroke prevention. For better outcome in future warfarin stroke prophylactic treatment clinicians should aim for iTTRs above 70%, avoid additional ASA therapy, support fragile patients like those with excessive alcohol use and dementia, and base decisions on treatment discontinuations on solid medical arguments.
40.	Brattström, Daniel, et al. (författare) HER-2, EGFR, COX-2 expression status correlated to microvessel density and survival in resected non-small cell lung cancer. 2004 Ingår i: Acta Oncol. - : Informa UK Limited. - 0284-186X .- 1651-226X. ; 43:1, s. 80-6 Tidskriftsartikel (refereegranskat)
41.	Bråndal, Anna, 1966-, et al. (författare) Does a cardiorespiratory interval training program at home improve post-stroke fatigue? Study protocol of a randomized controlled trial Annan publikation (övrigt vetenskapligt/konstnärligt)
42.	Bråndal, Anna, 1966-, et al. (författare) Effect of early supported discharge after stroke on patient reported outcome based on the Swedish Riksstroke registry 2019 Ingår i: BMC Neurology. - : BioMed Central. - 1471-2377. ; 19 Tidskriftsartikel (refereegranskat)abstract Background: The efficacy of early supported discharge (ESD) has not been tested in current stroke care setting, which provide relatively short hospital stays, access to hyper-acute therapies and early carotid stenosis interventions. This study aimed to compare patient-reported outcome measures (PROM) among patients with stroke that received modern stroke unit care with or without ESD.Methods: Observational study of 30,232 patients with first-ever stroke registered in the Riksstroke registry in Sweden, between 1 January 2010 and 31 December 2013. Patient characteristics were collected from the Riksstroke and Statistics Sweden databases. The primary outcome was satisfaction with the rehabilitation at 3 months after discharge. Secondary outcome were information about stroke provided, tiredness/fatigue, pain, dysthymia/ depression, general health status and dependence in activities of daily living (mobility, toileting and dressing) at 3 months after the stroke. We used separate multivariable logistic regression models for each PROM variable to analyze associations between PROMs and ESD/no ESD.Results: The ESD group comprised 1495 participants: the control group comprised 28,737 participants. Multivariable logistic regression models of PROMs showed that, compared to controls, the ESD group was more satisfied with rehabilitation after discharge (OR: 1.78, 95% CI: 1.17–2.49), experienced less dysthymia/depression (OR: 0.68, 95% 0.55–0.84) and showed more independence in mobility (OR: 1.50, 95% CI: 1.17–1.92), toileting (OR: 1.30, 95%CI: 1.05–1.61), and dressing (OR: 1.23, 95%CI: 1.02–1.48).Conclusion: In the setting of modern stroke unit care, ESD appeared to have positive effects on stroke rehabilitation, in the subacute phase.
43.	Bråndal, Anna, 1966- (författare) Rehabilitation after stroke with focus on early supported discharge and post-stroke fatigue 2016 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract Background Stroke is a major cause of disability worldwide. After treatment in a specialized stroke unit, early supported discharge (ESD) followed by home rehabilitation has shown to be an effective way to improve patient outcome and quality of care for persons with mild to moderate stroke. ESD service is recommended in the national and international guidelines for stroke care, but has only partially been implemented in Sweden. Following stroke, fatigue is a common consequence that often becomes more evident when the patient comes home. Currently, there is insufficient evidence about how to measure, treat and handle post-stroke fatigue. The overall aim of this thesis was to evaluate and implement early supported discharge (ESD) based on stroke patients experience after discharge from the stroke unit and local conditions. The aim was also to evaluate post-stroke fatigue with a potentially valid and reliable scale and finally to prepare for a study to evaluate cardiorespiratory training as a part of ESD service for patients with post-stroke fatigue.Methods In paper I, nine strategically chosen patients were interviewed of their experience of falling ill, the hospital stay, discharge, contact with health care after discharge and their request of support. Papers II-III describe and evaluate the development, content, implementation and effects of a locally adopted method for early supported discharge (Umeå Stroke Center ESD) in modern stroke care. Paper II included 153 consecutive patients and paper III, 30 232 patients with first-ever stroke registered in the Riksstroke registry in Sweden. Paper II evaluated number of patients/year, clinical and functional health status, satisfaction in relation to needs, accidental falls/other injuries and resources with the result summarized in a value compass. The implementation process was evaluated retrospectively by means of Consolidated Framework for Implementation (CFIR). Paper III evaluated patient reported outcome measurements (PROMs) at 3 months. The primary outcome in paper III was satisfaction with the rehabilitation after discharge. Secondary outcomes were information about stroke provided, tiredness/fatigue, pain, dysthymia/depression, general health status and dependence in activities of daily living (mobility, toilet hygiene and dressing). Multivariable logistic regression models for each PROM was used to analyze associations between PROMs and ESD/no ESD. In Paper IV, the Fatigue Assessment scale (FAS) was translated into Swedish and evaluated regarding psychometric properties when self-administered by persons with mild to moderate stroke. 72 consecutively patients selected from the stroke unit admission register received a letter including three questionnaires: the FAS, the Short Form Health Survey (SF-36) subscale for vitality and the Geriatric Depression Scale GDS-15. A second letter with FAS was sent within 2 weeks, for re-test evaluation. Paper V is a study protocol for a planned randomized controlled trial (RCT) of 50 consecutive stroke patients will who receive stroke unit care followed by ESD-service at Umeå Stroke Center, University Hospital, Umeå, Sweden. Paper V will investigate if a structured cardiorespiratory interval training program (CITP) added to the ESD-service may result in relieved post-stroke fatigue and increased oxygen uptake.Results The interviews in Paper I revealed three main categories with subcategories: “Responsible and implicated”, “Depersonalized object for caring measures” and “The striving for repersonalization and autonomy”. The findings indicate that coming home gave the informants’ important insights and understanding of the stroke, its consequences and was also an important factor for the recovery. Paper II-III showed that it is possible to develop and implement an adapted ESD service for stroke patients based on the patients’ experiences and requests, evidence-based recommendations and local conditions. The ESD service reduced dependence of activity, increased mobility with seemingly no increased risk of accidental falls or other injuries. The patient satisfaction in relation to needs regarding the ESD was high. Paper III showed that patients that received ESD were more satisfied with rehabilitation after discharge, had less need for assistance with ADL and less dysthymia/depression compared to patients that did not receive ESD. Study IV showed that the Swedish FAS used at home as a selfadministered questionnaire is a reliable and valid questionnaire for measuring fatigue in persons with mild to moderate stroke. The internal consistency was good, the agreement between the test and retest reliability for individual items (weighted kappa) was for the majority of items good or moderate. The relative reliability for total scores was good and the absolute reliability was 9 points. The Swedish FAS had no floor nor ceiling effects and correlated both with the SF-36, subscale for vitality and the GDS-15 indicating convergent construct validity, but not divergent construct validity.Conclusion It is possible to develop and implement ESD care for stroke patients based on patients’ experience and needs, evidence-based principles and local conditions. Early supported discharge (ESD) in the setting of modern stroke unit care appears to have positive effects on rehabilitation in the subacute phase. The Swedish FAS used at home as a self-administered questionnaire is reliable and valid for measuring fatigue in persons with mild to moderate stroke.
44.	Bråndal, Anna, 1966-, et al. (författare) Reliability and validity of the Swedish Fatigue Assessment Scale when self-administrered by persons with mild to moderate stroke 2016 Ingår i: Topics in Stroke Rehabilitation. - : Informa UK Limited. - 1074-9357 .- 1945-5119. ; 23:2, s. 90-97 Tidskriftsartikel (refereegranskat)abstract Objective: To examine internal consistency, test-retest reliability, floor/ceiling effects and construct validity of the Fatigue Assessment Scale (FAS), when self-administrated by persons with mild to moderate stroke.Method: The FAS was translated into Swedish and tested for psychometric properties when self-administrated by persons with mild to moderate stroke. Participants, consequently selected from the stroke unit admission register received a letter with three questionnaires: the FAS, Short Form Health Survey (SF-36) subscale for vitality and Geriatric Depression Scale, GDS-15. Within two weeks, a second letter with FAS was sent for re-test.Result: Seventy-tree persons with mild to moderate stroke participated in the study. Internal consistency was good (Cronbach’s alpha 0.82). The test and retest reliability of individual items showed that five items out of 10 items were good (weighted kappa > 0.60), four were moderate (0.40-0.60), and one was fair (0.22). The relative reliability between total scores was good (ICC 3.1 = 0.73) and the absolute reliability was nine points, meaning that a change of at least nine points in total score implies a real change of fatigue level. Correlation analysis showed that the Swedish FAS correlated with the SF-36 subscale for vitality (rs = - 0.73) and GDS-15 (rs = 0.62), suggesting convergent construct validity. There were no floor or ceiling effects.Conclusion: The Swedish translation of the FAS used as a self-administrated questionnaire is reliable and valid for measuring fatigue in persons with mild to moderate stroke.
45.	Bråndal, Anna, 1966-, et al. (författare) Stroke unit at home : A prospective observational implementation study for early supported discharge from the hospital 2013 Ingår i: International Journal of Physical Medicine Rehabilitation. - : OMICS Publishing Group. - 2329-9096. ; 1:170 Tidskriftsartikel (refereegranskat)abstract Background: Randomized controlled trials on early supported discharge (ESD) service in stroke have demonstrated favorable results. However, there are difficulties in transferring research results regarding ESD to the clinic. The aim of this study is to describe the method, content, implementation and outcome of ESD in its natural habit for stroke patients.Methods: A prospective observational implementation study of 153 consecutive stroke patients with mild to moderate severity with ESD and rehabilitation by a specially trained interdisciplinary team in the patient’s home, directly after discharge from the stroke unit. The interdisciplinary team in the ESD team is similar to the work at the stroke unit. Number of patients/year, clinical and functional health status, patient satisfaction, accidental falls/other injuries and resources were evaluated.Results: The number of patients/year in the ESD service has gradually increased from 2005 to 2009.The stroke patients subjected to Umea ESD service in January 2008 until May 2009 had a mean of 8.6 days of in-hospital care. The ESD service included 11 visits and 18 h per patient during 23 days (mean values). Compared with time of enrollment, patients exhibited reduced functional dependency (ADL- stairs 3 (1 - 5) vs. 1 (0–3), median, Q1–Q3, p <0.001, two-sided Wilcoxon Signed Ranks test) and increased mobility (Rivermead Mobility Index, (RMI) 11 (9–13) vs. 13 (12–15), p <0.001) at the time of discharge from the ESD service. Patient satisfaction regarding ESD was high. The long-term risk of accidental falls and other injuries appeared not to be increased.Conclusions: It is possible to locally develop and implement ESD care for stroke patients based on evidencebased principles. Our locally adapted ESD care, a stroke unit in the patients’ home, appears to be an appropriate alternative to conventional rehabilitation for patients with mild to moderate stroke.
46.	Bytyçi, Ibadete, et al. (författare) Carotid Atherosclerosis in Predicting Coronary Artery Disease : A Systematic Review and Meta-Analysis 2021 Ingår i: Arteriosclerosis, Thrombosis and Vascular Biology. - : Lippincott Williams & Wilkins. - 1079-5642 .- 1524-4636. ; 41:4, s. e224-e237 Forskningsöversikt (refereegranskat)abstract Objective: This meta-Analysis aims to compare the relationship between phenotypic manifestation of coronary and carotid atherosclerosis using available imaging techniques. Approach and Results: We searched all electronic databases until October 2020 for studies which reported relationship between carotid and coronary atherosclerosis. The primary end point was correlation between carotid intima-media thickness (CIMT) and carotid plaque features (calcification and lipid-rich necrotic core) with coronary artery disease (CAD). Secondary end points included carotid pathology that predicts CAD. Eighty-nine papers with 22 683 patients comparing carotid and coronary atherosclerosis were included in the analysis. CIMT was increased linearly with severity of CAD irrespective of its significance (P<0.001), mono versus 2 vessel disease (P=0.003), and 2 versus multivessel disease (P<0.001). Carotid plaque presence and calcification were less, and lipid-rich necrotic core was highly prevalent in nonsignificant versus significant CAD (P<0.001, P=0.03, P<0.001, respectively). Moderate correlation was found between CIMT and severity of CAD (r=0.60, P<0.001) and the number of diseased vessels (r=0.49, P<0.001). There was a moderate correlation between carotid and coronary stenosis (r=0.53, P<0.001) and between carotid and coronary calcification (r=0.61, P<0.001). CIMT ≥1.0 mm with a summary sensitivity of 77% and summary specificity of 72% and respective values of 80% and 67% for carotid plaque were the best predictors of CAD, irrespective of the technique used for its diagnosis. Conclusions: These results support the concept that atherosclerosis affects both carotid and coronary systems, although not always in identical phenotypic manner. These findings highlight the beneficial examination of carotid arteries whenever CAD is suspected.
47.	Carlberg, Bo, et al. (författare) Cererovaskulära sjukdomar 2009 Ingår i: Diabetes. - : Liber. - 9789147093311 ; , s. 401-410, s. 317-333 Bokkapitel (övrigt vetenskapligt/konstnärligt)
48.	Carlsson, Jörgen, et al. (författare) EGFR-expression in primary urinary bladder cancer and corresponding metastases and the relation to HER2-expression. On the possibility to target these receptors with radionuclides 2015 Ingår i: Radiology and Oncology. - : Walter de Gruyter GmbH. - 1318-2099 .- 1581-3207. ; 49:1, s. 50-58 Tidskriftsartikel (refereegranskat)abstract Background. There is limited effect of tyrosine kinase inhibitors or "naked" antibodies binding EGFR or HER2 for therapy of metastasized urinary bladder canter and these methods are therefore not routinely used. Targeting radionuclides to the extracellular domain of the receptors is potentially a better possibility. Methods. EGFR- and HER2-expression was analyzed for primary tumors and corresponding metastases from 72 patients using immunohistochemistry and the internationally recommended HercepTest. Intracellular mutations were not analyzed since only the receptors were considered as targets and intracellular abnormalities should have minor effect on radiation dose. Results. EGFR was positive in 71% of the primary tumors and 69% of corresponding metastases. Local and distant metastases were EGFR-positive in 75% and 66% of the cases, respectively. The expression frequency of HER2 in related lesions was slightly higher (data from previous study). The EGFR-positive tumors expressed EGFR in metastases in 86% of the cases. The co-expression of EGFR and HER2 was 57% for tumors and 53% for metastases. Only 3% and 10% of the lesions were negative for both receptors in tumors and metastases, respectively. Thus, targeting these receptors with radionuclides might be applied for most patients. Conclusions. At least one of the EGFR- or HER2-receptors was present in most cases and co-expressed in more than half the cases. It is therefore interesting to deliver radionuclides for whole-body receptor-analysis, dosimetry and therapy. This can hopefully compensate for resistance to other therapies and more patients can hopefully be treated with curative instead of palliative intention.
49.	Choi, Heung-Kook, et al. (författare) Image analysis based grading of bladder carcinoma. Comparison of object, texture and graph based methods and their reproducibility 1997 Ingår i: Analytical Cellular Pathology. - : IOS PRESS. - 0921-8912 .- 1878-3651. ; 15:1, s. 1-18 Tidskriftsartikel (refereegranskat)abstract The possibility that computerized image analysis could increase the reproducibility of grading of bladder carcinoma as compared to conventional subjective grading made by pathologists was investigated. Object, texture and graph based analysis were carried
50.	Choi, Heung-Kook, et al. (författare) Minimum Spanning Trees (MST) as a Tool for Describing Tissue Architecture when Grading Bladder Carcinoma 1995 Ingår i: 8th International Conference on Image Analysis and Processing. - : Springer Verlag. ; , s. 615-620 Konferensbidrag (refereegranskat)

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