| 1. |
- Björklund, Erik, et al.
(författare)
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Postoperative platelet function is associated with severe bleeding in ticagrelor-treated patients
- 2019
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Ingår i: Interactive Cardiovascular and Thoracic Surgery. - : Oxford University Press (OUP). - 1569-9293 .- 1569-9285. ; 28:5, s. 709-715
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Preoperative testing of platelet function predicts bleeding risk in cardiac surgery patients treated with dual antiplatelet therapy, but the value of postoperative platelet function testing, reflecting both preoperative antiplatelet therapy and perioperative changes in platelet function, has not been evaluated. Methods: Seventy-four patients with acute coronary syndrome treated with acetylsalicylic acid and ticagrelor within 5 days before cardiac surgery were included in a prospective observational study. Platelet aggregation induced by adenosine diphosphate, arachidonic acid and thrombin receptor-activating peptide was assessed with multiple electrode impedance aggregometry immediately before surgery and 2 h after weaning off cardiopulmonary bypass. Receiver operating characteristic curves were used to determine any association between platelet aggregation and severe bleeding according to the universal definition of perioperative bleeding in adult cardiac surgery. Results: Severe bleeding occurred in 25 of 74 patients (34%). Preoperative and postoperative adenosine diphosphate-induced platelet aggregations were associated with bleeding, with comparable areas under the receiver operating characteristic curve [0.77 (95% confidence interval 0.65-0.89) vs 0.75 (0.62-0.87)]. Postoperative arachidonic acid-and thrombin receptor-activating peptide-induced aggregation had markedly smaller areas under the curve. There were significant correlations between preoperative and postoperative platelet aggregation induced by adenosine diphosphate (r2 = 0.77, P < 0.001), arachidonic acid (r2 = 0.24, P < 0.001) and thrombin receptoractivating peptide (r2 = 0.21, P < 0.001) but with large interindividual variations. Conclusions: Poor postoperative platelet function was associated with severe bleeding, with accuracy comparable to that of preoperative platelet function. There was a correlation between preoperative and postoperative platelet function, but the predictability in an individual patient was limited. © 2018 The Author(s). Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
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| 2. |
- Björklund, Erik, et al.
(författare)
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Secondary prevention medications after coronary artery bypass grafting and long-term survival : a population-based longitudinal study from the SWEDEHEART registry.
- 2019
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Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 41:17, s. 1653-1661
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: To evaluate the long-term use of secondary prevention medications [statins, β-blockers, renin-angiotensin-aldosterone system (RAAS) inhibitors, and platelet inhibitors] after coronary artery bypass grafting (CABG) and the association between medication use and mortality.METHODS AND RESULTS: All patients who underwent isolated CABG in Sweden from 2006 to 2015 and survived at least 6 months after discharge were included (n = 28 812). Individual patient data from SWEDEHEART and other mandatory nationwide registries were merged. Multivariable Cox regression models using time-updated data on dispensed prescriptions were used to assess associations between medication use and long-term mortality. Statins were dispensed to 93.9% of the patients 6 months after discharge and to 77.3% 8 years later. Corresponding figures for β-blockers were 91.0% and 76.4%, for RAAS inhibitors 72.9% and 65.9%, and for platelet inhibitors 93.0% and 79.8%. All medications were dispensed less often to patients ≥75 years. Treatment with statins [hazard ratio (HR) 0.56, 95% confidence interval (95% CI) 0.52-0.60], RAAS inhibitors (HR 0.78, 95% CI 0.73-0.84), and platelet inhibitors (HR 0.74, 95% CI 0.69-0.81) were individually associated with lower mortality risk after adjustment for age, gender, comorbidities, and use of other secondary preventive drugs (all P < 0.001). There was no association between β-blockers and mortality risk (HR 0.97, 95% CI 0.90-1.06; P = 0.54).CONCLUSION: The use of secondary prevention medications after CABG was high early after surgery but decreased significantly over time. The results of this observational study, with inherent risk of selection bias, suggest that treatment with statins, RAAS inhibitors, and platelet inhibitors is essential after CABG whereas the routine use of β-blockers may be questioned.
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| 3. |
- Dacasa, Hugo, et al.
(författare)
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Single-shot extreme-ultraviolet wavefront measurements of high-order harmonics
- 2019
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Ingår i: Optics Express. - 1094-4087. ; 27:3, s. 2656-2670
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Tidskriftsartikel (refereegranskat)abstract
- We perform wavefront measurements of high-order harmonics using an extreme-ultraviolet (XUV) Hartmann sensor and study how their spatial properties vary with different generation parameters, such as pressure in the nonlinear medium, fundamental pulse energy and duration as well as beam size. In some conditions, excellent wavefront quality (up to 휆/11) was obtained. The high throughput of the intense XUV beamline at the Lund Laser Centre allows us to perform single-shot measurements of both the full harmonic beam generated in argon and individual harmonics selected by multilayer mirrors. We theoretically analyze the relationship between the spatial properties of the fundamental and those of the generated high-order harmonics, thus gaining insight into the fundamental mechanisms involved in high-order harmonic generation (HHG).
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| 4. |
- Enkirch, Theresa, et al.
(författare)
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Hepatitis A outbreak linked to imported frozen strawberries by sequencing, Sweden and Austria, June to September 2018
- 2018
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Ingår i: Eurosurveillance. - : European Centre for Disease Prevention and Control. - 1025-496X .- 1560-7917. ; 23:41
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Tidskriftsartikel (refereegranskat)abstract
- Between June-September 2018, 20 hepatitis A cases were notified in six counties in Sweden. Combined epidemiological and microbiological investigations identified imported frozen strawberries produced in Poland as the source of the outbreak. Sequence analysis confirmed the outbreak strain IB in the strawberries with 100 % identity and the respective batch was withdrawn. Sharing the sequence information internationally led to the identification of 14 additional cases in Austria, linked to strawberries from the same producer.
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| 5. |
- Hansson, Emma C., 1985, et al.
(författare)
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Platelet function recovery after ticagrelor withdrawal in patients awaiting urgent coronary surgery
- 2017
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Ingår i: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. - : Oxford University Press (OUP). - 1010-7940 .- 1873-734X. ; 51:4, s. 633-637
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Dual antiplatelet therapy with ticagrelor and aspirin is associated with an increased risk of perioperative bleeding complications. Current guidelines recommend therefore discontinuation of ticagrelor 5 days before surgery to allow sufficient recovery of platelet function. It is not known how the time to recovery varies between individual patients after discontinuation of ticagrelor. METHODS: Twenty-five patients accepted for urgent coronary artery bypass surgery and treated with ticagrelor and aspirin were included in a prospective observational study. Platelet aggregation was evaluated with impedance aggregometry at five timepoints 12-96 h after discontinuation of ticagrelor. In a subset of patients (n = 15), we also tested the ex vivo efficacy of platelet concentrate supplementation on platelet aggregation. RESULTS: There was a gradual increase in mean adenosine diphosphate-induced platelet aggregation after discontinuation of ticagrelor. After 72 h, mean aggregation was 38 +/-23 aggregation units (U), which is above a previously suggested cut-off of 22 U, when patients can be operated without increased bleeding risk. However, there was a large interindividual variability (range 488 U at 72 h) and 6/24 patients (25%) had <22 U after 72 h. Ex vivo administration of platelet concentrate did not improve adenosine diphosphate-induced aggregation at any timepoint after ticagrelor discontinuation. CONCLUSIONS: Adenosine diphosphate-induced aggregation was acceptable after 72 h in the majority of patients but with a large interindividual variability. Due to the large variability, platelet function testing may prove to be a valuable tool in timing of surgery in patients with ongoing or recently stopped ticagrelor treatment. Adenosine diphosphate-induced aggregation was not improved by addition of platelet concentrate.
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| 6. |
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IMPROVER D2.2 Report of criteria for evaluating resilience
- 2016
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- In the recent years, the focus has moved from critical infrastructure protection to that of resilience. But how do we know whether a critical infrastructure is resilient or not, how can it be evaluated, measured and enhanced? Drawing on, combining and developing the ideas of the existing literature and practices, the current report develops a holistic, easy-to-use and computable methodology to evaluate critical infrastructure resilience, called Critical Infrastructure Resilience Index (CIRI). The methodology is applicable to all types of critical infrastructure, including a possibility to tailor it to the specific needs of different sectors, facilities and hazard scenarios. The proposed methodology is especially suitable for organizational and technological resilience evaluation, but permits including also elements of societal resilience indicators to the evaluations. The methodology is based on four levels of hierarchically organized indicators. Level 1 consists of the phases well known from the so-called crisis management cycle. Under these phases, we find sets of Level 2 rather generic indicators. Thus under level 1 ‘Prevention’, for instance, we may find a Level 2 indicator such as ‘Resilient design’, further divided into Level 3 more detailed indicators such as ‘Physical robustness’, ‘Cyber robustness’, ‘Redundancy’, ‘Modularity’, and ‘Independency’. The task is to study these indicators on Level 4 in the context of concrete critical infrastructure facilities and hazard scenarios, that is, applying Level 3 indicators into concrete circumstances. The methodology then permits to transfer quantitative, semi-quantitative and qualitative evaluations of individual sector-specific resilience indicators into uniform metrics, based on process maturity levels. This in turn makes it possible to give a specific critical infrastructure, or its part, a resilience value on the scale 0-5. While the real resilience value becomes clear only when one engages in the analysis of several indicators, the methodology can be used also as a step-by-step measurement and development tool for resilience, without necessary immediately engaging in time-consuming total resilience analysis. The user of this methodology is supposed to be the operator of critical infrastructure, or part of it, in the spirit of self-auditing. In case it would be implemented in a wider scale, in cooperation between the operators and authorities, it would give the authorities a holistic picture about the respective society’s critical infrastructure resilience. In this report, we draw a concise picture of the methodology and illustrate how this methodology could be applied to a specific infrastructure and hazard scenario.
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| 7. |
- Malm, Annika, et al.
(författare)
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Privata servisledningar för dricksvatten, spillvatten och dagvatten : så långa är de
- 2017
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Längden av Sveriges privata servisledningar för dricksvatten, spillvatten och dagvatten har nu beräknats. Den del av VA-näten som ägs privat är betydande. Ansvaret för drift, underhåll och förnyelse av de privata serviserna ligger på respektive fastighetsägare. Även längden av de allmänna servisledningarna har beräknats.En servisledning binder samman en fastighet med huvudledningen i gatan. De privata servisledningarna omfattar alla VA-ledningar på privata fastigheter fram till den så kallade förbindelsepunkten ”i närheten” av tomtgränsen. Huvudledningarnas längd är väl kartlagd hos kommunerna, medan det för servisledningar i första hand är antalet serviser som har sammanställts och inte längden. För de privata serviserna fanns tidigare ingen sammanställning av vare sig antal eller längd. Nu är alltså samtliga servisledningars längd beräknad, utifrån dataunderlag fram till och med 2015. Projektet har genomförts av RISE Research Institutes of Sweden.Sveriges bebyggelse kan delas upp i olika hustyper: småhus, radhus (inklusive kedjehus), flerbostadshus och övrig bebyggelse för verksamheter och samhällstjänster. För varje bebyggelsetyp finns det nyckeltal för servisledningslängden. Projektet sammanställde nyckeltalslängder utifrån lämpliga ”typområden”. Typområdena extrapolerades till hela Sverige genom att ledningslängden per fastighet multiplicerades med antalet sådana fastigheter i Sverige. Längderna angavs dels för dricksvatten-, spillvatten- och dagvattenserviser, dels för allmänna respektive privata serviser.Totalt uppskattas de privata servisledningarna bestå av 25 500 km dricksvatten-, 24 000 km spillvatten- och 152 000 km dagvattenledningar. De allmänna serviserna uppskattas bestå av 6 200 km dricksvatten-, 6 600 km spillvatten- och 4 400 km dagvattenledningar.I tabellen anges också den andel (i procent) av vardera ledningstypen som huvudledningar, allmänna serviser och privata serviser utgör. De privata dricksvatten- och spillvattenserviserna utgör knappt en fjärdedel av det totala dricksvatten- respektive spillvattenförande ledningsnätet. De privata dagvattenserviserna utgör nästan 80 procent av det totala dagvattennätet. Den totala längden av de privata serviserna (dricksvatten, spillvatten och dagvatten) är sammantaget ungefär hälften av den totala VA-ledningslängden i Sverige.Nyckeltalen för olika bebyggelsetyper kan användas för att varje VA-verksamhet ska kunna göra egna beräkningar. När man känner till servisledningslängden för dricksvattennätet kan en bedömning göras av hur stor andel av vattenförlusterna som uppstår i de privata servisledningarna och därför är svår att påverka för VA-verksamheterna, det som brukar anges som de oundvikliga vattenförlusterna.Återanskaffningsvärdet för de privata serviserna i Sverige bedöms till drygt 200 miljarder kronor.
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| 8. |
- Malm, Carl Johan, et al.
(författare)
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Preoperative platelet function predicts perioperative bleeding complications in ticagrelor-treated cardiac surgery patients: a prospective observational study
- 2016
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Ingår i: British Journal of Anaesthesia. - : Elsevier BV. - 0007-0912. ; 117:3, s. 309-315
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Tidskriftsartikel (refereegranskat)abstract
- Background: Treatment with P2Y(12) receptor antagonists increases the risk for perioperative bleeding, but there is individual variation in the antiplatelet effect and time to offset of this effect. We investigated whether preoperative platelet function predicts the risk of bleeding complications in ticagrelor-treated cardiac surgery patients. Methods: Ninety patients with ticagrelor treatment within <5 days of surgery were included in a prospective observational study. Preoperative platelet aggregation was assessed with impedance aggregometry using adenosine diphosphate (ADP), arachidonic acid (AA), and thrombin receptor-activating peptide (TRAP) as initiators. Severe bleeding complications were registered using a new universal definition of perioperative bleeding. The accuracy of aggregability tests for predicting severe bleeding was assessed using receiver operating characteristic (ROC) curves, which also identified optimal cut-off values with respect to sensitivity and specificity, based on Youden's index. Results: The median time from the last ticagrelor dose to surgery was 35 (range 4-108)h. The accuracy of platelet function tests to predict severe bleeding was highest for ADP [area under the ROC curve 0.73 (95% confidence interval 0.63-0.84, P<0.001); TRAP 0.61 (0.49-0.74); AA 0.53 (0.40-0.66)]. The optimal cut-off for ADP-induced aggregation was 22 U. In subjects with ADP-induced aggregation below the cut-off value, 24/38 (61%) developed severe bleeding compared with 8/52 (14%) when aggregation was at or above the cut-off value (P<0.001). The positive and negative predictive values for this cut-off value were 63 and 85%, respectively. Conclusions: Preoperative ADP-induced platelet aggregability predicts the risk for severe bleeding complications in ticagrelor-treated cardiac surgery patients.
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| 9. |
- Malm, Dan, 1954-, et al.
(författare)
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Effects of brief mindfulness-based cognitive behavioural therapy on health-related quality of life and sense of coherence in atrial fibrillation patients
- 2018
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Ingår i: European Journal of Cardiovascular Nursing. - : Sage Publications. - 1474-5151 .- 1873-1953. ; 17:7, s. 589-597
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Tidskriftsartikel (refereegranskat)abstract
- Background: The aim of this study was to evaluate the effects of a brief dyadic cognitive behavioural therapy (CBT) programme on the health-related quality of life (HRQoL), as well as the sense of coherence in atrial fibrillation patients, up to 12 months post atrial fibrillation.Methods: A longitudinal randomised controlled trial with a pre and 12-month post-test recruitment of 163 persons and their spouses, at a county hospital in southern Sweden. In all, 104 persons were randomly assigned to either a CBT (n=56) or a treatment as usual (TAU) group (n=55). The primary outcome was changes in the HRQoL (Euroqol questionnaire; EQ-5D), and the secondary outcomes were changes in psychological distress (hospital anxiety and depression scale; HADS) and sense of coherence (sense of coherence scale; SOC-13).Results: At the 12-month follow-up, the CBT group experienced a higher HRQoL than the TAU group (mean changes in the CBT group 0.062 vs. mean changes in the TAU group −0.015; P=0.02). The sense of coherence improved in the CBT group after the 12-month follow-up, compared to the TAU group (mean changes in the CBT group 0.062 vs. mean changes in the TAU group −0.16; P=0.04). The association between the intervention effect and the HRQoL was totally mediated by the sense of coherence (z=2.07, P=0.04).Conclusions: A dyadic mindfulness-based CBT programme improved HRQoL and reduced psychological distress up to 12 months post atrial fibrillation. The sense of coherence strongly mediated the HRQoL; consequently, the sense of coherence is an important determinant to consider when designing programmes for atrial fibrillation patients.
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| 10. |
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