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- Berglin Blohm, Marianne, et al.
(författare)
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A media campaign aiming at reducing delay times and increasing the use of ambulance in AMI.
- 1994
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Ingår i: The American journal of emergency medicine. - : W.B. Saunders Co.. - 0735-6757 .- 1532-8171. ; 12:3, s. 315-8
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Tidskriftsartikel (refereegranskat)abstract
- To improve the prognosis in patients with acute myocardial infarction (AMI) if treatment by early instituting treatment, we initiated a media campaign during 1 year with the intention to reduce delay times and increase ambulance use in patients with acute chest pain. This article describes the outcome during 3 years after the campaign was finished. The median delay time in patients with AMI was reduced from 3 hours 0 min before the campaign to 2 hours 20 minutes during the year of the campaign (P < .001). The median delay time remained at a similar level (2 hours 20 min) during the 3 years after the campaign. Ambulance use was not affected during or after the campaign. It can be concluded that a media campaign resulted in a reduction of delay times not only during the campaign, but also during 3 years after its performance, whereas ambulance use was not affected.
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| 2. |
- Herlitz, Johan, 1949, et al.
(författare)
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Delay time between onset of myocardial infarction and start of thrombolysis in relation to prognosis.
- 1993
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Ingår i: Cardiology. - : S. Karger AG. - 0008-6312 .- 1421-9751. ; 82:5, s. 347-53
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Tidskriftsartikel (refereegranskat)abstract
- In 292 patients with suspected acute myocardial infarction given thrombolytic agents, we describe the delay time between the onset of pain and the start of thrombolysis and relate the observations to the prognosis. In 3%, treatment was started 1 h or less and in 22% 2 h or less after onset of symptoms. The median delay time between onset of symptoms and arrival in hospital was 1 h 38 min, and the median delay time between the arrival in hospital and start of thrombolysis was 1 h 25 min. A very strong association between delay time to thrombolysis and mortality during 2 weeks and 1 year of follow-up was observed.
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| 3. |
- Herlitz, Johan, 1949, et al.
(författare)
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Impact of early thrombolysis on chest pain score reflecting myocardial ischemia in relation to various markers of ischemic damage. TEAHAT Study Group.
- 1993
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Ingår i: International journal of cardiology. - : Elsevier Ireland Ltd. - 0167-5273 .- 1874-1754. ; 41:2, s. 123-31
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Tidskriftsartikel (refereegranskat)abstract
- We randomized 352 patients with pain suggestive of acute myocardial infarction who were seen less than 3 h after onset of symptoms to either tissue plasminogen activator or placebo. The impact of treatment on chest pain score was assessed during the first 24 h and related to limitation of final myocardial damage as assessed by various indirect markers. The most marked effect of tissue plasminogen activator was observed in the chest pain score being reduced by 43% in the tissue plasminogen activator group as compared with placebo. Limitation of infarct size with tissue plasminogen activator reached the following percentage values when various methods were used: maximum serum lactate dehydrogenase I activity, 32%; vectorcardiography (QRS vector difference), 20%; electrocardiography (Palmeri score), 20%; ejection fraction, 9%. We conclude that early thrombolysis in acute myocardial infarction reduces the severity of chest pain by nearly 50%. The effect on chest pain is much more marked as compared with the effect on various markers of the final ischemic damage.
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| 4. |
- Herlitz, Johan, 1949, et al.
(författare)
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Mortality and morbidity 1 year after early thrombolysis in suspected AMI: results from the TEAHAT Study.
- 1991
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Ingår i: Journal of internal medicine. Supplement. - : Journal of Internal Medicine. - 0955-7873. ; 734:suppl 1, s. 43-51
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Tidskriftsartikel (refereegranskat)abstract
- We randomized 352 patients with suspected acute myocardial infarction (AMI) to treatment with rt-PA (n = 177) or placebo (n = 175). Patients were eligible if evaluated within 2 h and 45 min from onset of chest pain, and if aged less than 75 years. There were no ECG criteria for inclusion. A mobile coronary-care unit with a cardiologist present was used to initiate treatment at home in 29% of cases. During 1 year of follow-up the mortality in patients treated with rt-PA was 10.2%, as compared with 14.3% in patients the initial ECG, the mortality during the first year was 8% in the rt-PA group vs. 18% in the placebo group (P less than 0.05). Among patients without ST-elevation the mortality was 9% for the rt-PA group vs. 12% for the placebo group (NS). Requirement for rehospitalization, symptoms of angina pectoris and congestive heart failure, time of return to work and requirement for various medications did not differ significantly between the two groups, regardless of the initial ECG pattern.
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| 5. |
- Herlitz, Johan, 1949, et al.
(författare)
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Occurrence of hypotension during streptokinase infusion in suspected acute myocardial infarction, and its relation to prognosis and metoprolol therapy.
- 1993
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Ingår i: The American journal of cardiology. - : Elsevier, Excerpta Medica, Inc.. - 0002-9149 .- 1879-1913. ; 71:12, s. 1021-4
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Tidskriftsartikel (refereegranskat)abstract
- In all patients who received streptokinase infusion for strongly suspected acute myocardial infarction in 1 hospital during 1989 to 1990, the occurrence of hypotension during infusion is described and related to prognosis. In 54% of patients, the beta blocker metoprolol was simultaneously administered intravenously. The median systolic blood pressure (BP) before infusion was 135 mm Hg, and the median value for the lowest systolic BP recorded during infusion was 100 mm Hg (p < 0.001). A positive correlation between systolic BP before streptokinase and the lowest systolic BP during infusion was found (r = 0.53; p < 0.001). Among patients administered streptokinase and metoprolol, 23% had systolic BP < 90 mm Hg, and 12% had < 80 mm Hg at any time during infusion; corresponding values for patients administered streptokinase only were 47 and 30%, respectively. Patients with the lowest systolic BP < 80 mm Hg during infusion had a mortality during the first 2 weeks of 22 vs 11% for those with between 80 and 100 mm Hg, and 8% for those with > 100 mm Hg (p < 0.001). However, in a multivariate analysis the systolic BP before infusion rather than the lowest systolic BP during infusion was independently associated with death. It is concluded that although patients with low systolic BP during streptokinase infusion have a high mortality, the level of systolic BP before infusion is more strongly associated with the outcome. Simultaneous use of intravenous beta blockade does not increase the occurrence of hypotension during streptokinase infusion.
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| 6. |
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| 7. |
- Sjöström, Lars, et al.
(författare)
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Swedish obese subjects (SOS). Recruitment for an intervention study and a selected description of the obese state
- 1992
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Ingår i: International Journal of Obesity. ; 19, s. 465-479
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Tidskriftsartikel (refereegranskat)abstract
- Department of Medicine, Sahlgren's Hospital, University of Göteborg, Sweden. SOS (Swedish obese subjects) is an on-going intervention trial designed to determine whether the mortality and morbidity rates among obese individuals who lose weight by surgical means (gastric banding, vertical banded gastroplasty and gastric by-pass) differ from the rates associated with conventional treatment. For this purpose, the study is recruiting a sample of obese men and women who constitute a registry of potential subjects from which the participants are drawn. Eligibility criteria for participation in the registry were: age at application 37-57 years and BMI greater than or equal to 34 kg/m2 for men and greater than or equal to 38 kg/m2 for women. Before receiving a health examination, all patients complete extensive questionnaires on current and past health status, utilization of medical care and medications, socio-economic status, psychological profiles, dietary habits, physical activity, weight history, and familial disposition to obesity. Each surgical case is matched to its optimal control in the registry, to ensure that the two groups do not differ systematically with respect to any of 18 matching variables that may affect prognosis. The first 1006 subjects included in the registry have been studied with respect to morbidity and compared with on-going population studies of men and women in Göteborg, Sweden. The relative risks of prevalent disease and symptoms associated with obesity in 50-year-old males and females respectively were 4.3 and 4.7 (dyspnoea), 14.7 and 11.8 (angina), 6.3 (myocardial infarction, males only), 2.1 and 4.5 (hypertension), 5.2 and 6.6 (diabetes), 4.6 and 26.1 (claudication) and 1.7 and 1.8 (gall bladder disease). Correspondingly, obese males and females display elevations of systolic and diastolic blood pressure, fasting glucose, insulin, triglyceride, and uric acid levels. However, total cholesterol was not increased in obese males and was in fact significantly lower in obese compared with reference women. HDL-cholesterol was lower in obese than reference men (data were not available in reference women). The rate of taking sick pensions was over twice as high in SOS obese patients than in population controls. Finally, comparison of measurements with self-reported prevalence estimates revealed a considerable amount of previously undiagnosed hypertension and diabetes in the obese subjects. These data suggest that the excess health risks associated with obesity may not be fully appreciated. PMID: 1322873 [PubMed - indexed for MEDLINE]
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| 8. |
- Sullivan, Marianne, 1943, et al.
(författare)
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"The Göteborg Quality of Life Instrument"--a psychometric evaluation of assessments of symptoms and well-being among women in a general population
- 1993
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Ingår i: Scandinavian Journal of Primary Health Care. ; 11, s. 267-275
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Tidskriftsartikel (refereegranskat)abstract
- Health Care Research Unit, Sahlgrenska University Hospital, Goteborg, Sweden. OBJECTIVE--To examine with psychometric analysis techniques the potential for constructing valid composite variables of "The Göteborg Quality of Life Instruments". DESIGN--Prospective population study of women in 1974-75 and in 1980-81. SETTING--City of Göteborg, Sweden. PARTICIPANTS--Representative samples of the general population of women in five age strata between 44 and 66 years of age in 1974-75, followed 1980-81 including new cohorts of women aged 26 and 38. 1302 women were examined in 1974-75 and 1408 in 1980-81. MAIN OUTCOME MEASURE--"The Göteborg Quality of Life instrument", constructed in the early 1970s to measure symptoms and well-being in a population study of men. RESULTS--Four multi-item scales were identified with satisfactory reliability and validity, i.e., they met defined criteria of multi-item scales and benefit from higher reliability than single questions. The psychological symptom scale comprised all ten questions intended to reflect depression and tension, while the physical symptom scale included all six pain questions, the general symptoms dizziness, breathlessness, and nausea, and general fatigue that belonged to both symptom scales. The social well-being scale comprises all well-being questions believed to reflect the broad concept of life satisfaction. The physical-mental wellbeing scale reflected satisfaction with both general and mental health. Several symptom and well-being questions were clearly outside the main clusters and should be treated as single items. CONCLUSIONS--Use of a few, distinct scales instead of a number of single questions should increase statistical power because the number of comparisons is greatly reduced and problems of chance findings are thus minimized. PMID: 8146511 [PubMed - indexed for MEDLINE]
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