| 1. |
- Abul-Kasim, Kasim, et al.
(författare)
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Combined Clinical and Radiological Prognostic Model in Acute Ischemic Stroke
- 2010
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Ingår i: Acta Neurologica Belgica. - 2240-2993. ; 110:3, s. 239-245
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Tidskriftsartikel (refereegranskat)abstract
- We sought to propose and test the validity of a comprehensive prognostic model in middle cerebral artery-stroke treated with Intravenous thrombolysis. A total of 127 consecutive patients (aged 70 +/- 12 years; 54% males) were included in this retrospective study. Variables included in our prognostic model were: NIHSS on admission (1-3 points), occurrence of hyperdense middle cerebral artery sign and early ischemic signs on baseline CT (1 point each). NIHSS at 24 hours (0-3 points), posttreatment hemorrhage (1 point), and infarct volume (0-4 points). The score range teas 1-13, with higher values suggest unfavorable prognosis. Our prognostic score was correlated with the modified Rankin scale (mRS) at 3 months after stroke [correlation coefficient of 0.62, P < 0.001] and can thus help early prediction of the functional outcome. Logistic regression showed that NIHSS at 24 hours and EICs on baseline CT were independent predictor of our prognostic score (adjusted odds ratio of 4.1 and 5). Adopting a cut-off value of prognostic score <= 3 for favorable prognosis and >= 7 for unfavorable prognosis helped to predict the need for institutionalization and the functional outcome with higher accuracy and predictive values compared with using scores only based on NIHSS.
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| 2. |
- Abul-Kasim, Kasim, et al.
(författare)
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Hyperdense middle cerebral artery sign is an ominous prognostic marker despite optimal workflow.
- 2010
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Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 1600-0404 .- 0001-6314. ; 122, s. 132-139
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Tidskriftsartikel (refereegranskat)abstract
- Abul-Kasim K, Brizzi M, Petersson J. Hyperdense middle cerebral artery sign is an ominous prognostic marker despite optimal workflow. Acta Neurol Scand: DOI: 10.1111/j.1600-0404.2009.01277.x. (c) 2009 The Authors Journal compilation (c) 2009 Blackwell Munksgaard.Objectives - To evaluate the association between the hyperdense middle cerebral artery sign (HMCAS) and the functional outcome on one hand, and different predictors such as the National Institutes of Health Stroke Scale (NIHSS), infarct size, ASPECTS Score, intracerebral hemorrhage, and mortality on the other hand. Material and methods - Retrospective analysis of 120 patients with MCA-stroke treated with intravenous thrombolysis. We tested the association between HMCAS and NIHSS, infarct volume, ASPECTS, outcome, level of consciousness, different recorded time intervals, and the day/time of admission. Results - Seventy-four percentage of patients treated with thrombolysis developed cerebral infarction. All patients with HMCAS (n = 39) sustained infarction and only 31% showed favorable outcome compared with 62% and 60%, respectively among patients without HMCAS (P < 0.001 and P = 0.002). There was statistically significant association between functional outcome and HMCAS (P = 0.002), infarct volume, NIHSS, and ASPECTS (P < 0.001). The time to treatment was 12 min shorter in patients who developed infarction (P = 0.037). Independent predictors for outcome were NIHSS and the occurrence of cerebral infarction on computed tomography for the whole study population, and infarct volume for patients who sustained cerebral infarction. Conclusions - Despite optimal workflow, patients with HMCAS showed poor outcome after intravenous thrombolysis. The results emphasize the urgent need for more effective revascularization therapies and neuroprotective treatment in this subgroup of stroke patients.
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| 3. |
- Borg, Markus, et al.
(författare)
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Conflict management in student groups - a teacher’s perspective in higher education
- 2011
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Ingår i: Högre utbildning. - 2000-7558. ; 1:2, s. 111-124
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Tidskriftsartikel (refereegranskat)abstract
- Students working in groups is a commonly used method of instruction in higher education, popularized by the introduction of problem based learning. As a result, management of small groups of people has become an important skill for teachers. The objective of our study is to investigate why conflicts arise in student groups at the Faculty of Engineering at Lund University and how teachers manage them. We have conducted an exploratory interdepartmental interview study on teachers' views on this matter, interviewing ten university teachers with different levels of seniority. Our results show that conflicts frequently arise in group work, most commonly caused by different levels of ambition among students. We also found that teachers prefer to work proactively against conflicts and stress the student’s responsibility. Finally, we show that teachers at our faculty tend to avoid the more drastic conflict resolution strategies suggested by previous research. The outcome of our study could be used as input to future guidelines on conflict management in student groups.
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| 4. |
- Eriksson, Tommy, et al.
(författare)
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ApoLänk decreases patient medication discrepancies at discharge: initial experience from a Swedish bedside pharmacy service
- 2013
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Ingår i: European Journal of Hospital Pharmacy: Science and Practice. - : BMJ. - 2047-9964 .- 2047-9956. ; 20:1, s. 54-56
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To develop a working model so that dispensing pharmacists, patients and medical staff can work together to identify, solve and prevent problems associated with discharge prescriptions. Method: A routine was developed for communication between pharmacists, patients and medical staff and for dispensing drugs at the bedside. Hospital medication lists and prescriptions from the pharmacy and healthcare databases were simultaneously assessed. The study was carried out in two neurological wards in a Swedish university hospital. Results: Major shortcomings were identified in the coordination of pharmacy and healthcare records and in patients’ ability to take responsibility for their medication at discharge. Discussion between patients and staff allowed discrepancies in communication and documentation to be corrected. Cooperation between pharmacists and nurses was perceived as being very positive and important. Conclusions: The Apolänk service was appreciated by nurses, is almost cost neutral and reduces discrepancies that have the potential to cause patient harm.
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| 5. |
- Gallo, Valentina, et al.
(författare)
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Prediagnostic body fat and risk of death from amyotrophic lateral sclerosis: The EPIC cohort.
- 2013
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Ingår i: Neurology. - : Lippincott Williams & Wilkins. - 1526-632X .- 0028-3878. ; 80:9, s. 829-838
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The aim of this study was to investigate for the first time the association between body fat and risk of amyotrophic lateral sclerosis (ALS) with an appropriate prospective study design. METHODS: The EPIC (European Prospective Investigation into Cancer and Nutrition) study included 518,108 individuals recruited from the general population across 10 Western European countries. At recruitment, information on lifestyle was collected and anthropometric characteristics were measured. Cox hazard models were fitted to investigate the associations between anthropometric measures and ALS mortality. RESULTS: Two hundred twenty-two ALS deaths (79 men and 143 women) occurred during the follow-up period (mean follow-up = 13 years). There was a statistically significant interaction between categories of body mass index and sex regarding ALS risk (p = 0.009): in men, a significant linear decrease of risk per unit of body mass index was observed (hazard ratio = 0.93, 95% confidence interval 0.86-0.99 per kg/m(2)); among women, the risk was more than 3-fold increased for underweight compared with normal-weight women. Among women, a significant risk reduction increasing the waist/hip ratio was also evident: women in the top quartile had less than half the risk of ALS compared with those in the bottom quartile (hazard ratio = 0.48, 95% confidence interval 0.25-0.93) with a borderline significant p value for trend across quartiles (p = 0.056). CONCLUSION: Increased prediagnostic body fat is associated with a decreased risk of ALS mortality.
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| 6. |
- Macleod, Malcolm R., et al.
(författare)
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Hypothermia for Stroke: call to action 2010
- 2010
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Ingår i: International Journal of Stroke. - : SAGE Publications. - 1747-4949 .- 1747-4930. ; 5:6, s. 489-492
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Tidskriftsartikel (refereegranskat)abstract
- The European Hypothermia Stroke Research Workshop was held in January 2010, in response to the alarming prospects of a significant increase of stroke expected in the coming years globally. Considering that a minority of patients (around 10%) are currently eligible for thrombolytic treatment, there is a need for an efficacious, cost-effective novel therapy that can be implemented broadly within European health care systems. Accordingly, the primary objective of the workshop was the definition of a research agenda aiming to assess the therapeutic benefits of hypothermia in patients with acute ischaemic stroke. The meeting was organised by the European Stroke Research Network for Hypothermia(EuroHyp) and attended by the representatives of World Stroke Organisation, European Stroke Organisation, Stroke Alliance for Europe, Society for Cryobiology and other organisations - specifically the European Space Agency, and small-and medium-sized enterprises based in EU member states. The participants adopted the 'Hypothermia for Stroke - Call to Action 2010', a declaration specifying the priorities for hypothermia research in acute ischaemic stroke. The research programme outlined - a clinical study programme designed to identify and validate therapeutic cooling as a novel treatment providing benefit to a large number of stroke patients-contains a well-integrated series of Phase II studies aiming to refine the intervention (depth, duration, and mode of cooling; antishivering strategy; patient selection) and a pivotal Phase III clinical trial. The proposed integrated Phase II and III clinical study programme would test the effectiveness of this optimised intervention, and would allow the development of evidence-based Clinical Practice Guidelines describing the optimal use of therapeutic hypothermia as a treatment strategy for stroke.
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| 7. |
- Ovesen, C., et al.
(författare)
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Feasibility of endovascular and surface cooling strategies in acute stroke
- 2013
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Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 1600-0404 .- 0001-6314. ; 127:6, s. 399-405
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Tidskriftsartikel (refereegranskat)abstract
- Background Therapeutic hypothermia (TH) is a promising treatment of stroke, but limited data are available regarding the safety and effectiveness of cooling methodology. We investigated the safety of TH and compared the cooling capacity of two widely used cooling strategies endovascular and surface cooling. Methods COOLAID Oresund is a bicentre randomized trial in Copenhagen (Denmark) and Malmo (Sweden). Patients were randomized to either TH (33 degrees C for 24h) in a general intensive care unit (ICU) or standardized stroke unit care (control). Cooling was induced by a surface or endovascular-based strategy. Results Thirty-one patients were randomized. Seven were cooled using endovascular and 10 using surface-based cooling methods and 14 patients received standard care (controls). 14 (45%) patients received thrombolysis. Pneumonia was recorded in 6 (35%) TH patients and in 1 (7%) control. 4 TH patients and 1 control developed massive infarction. 1 TH patient and 2 control suffered asymptomatic haemorrhagic transformation. Mortality was comparable with 2 (12%) in the TH group and 1 (7%) among controls. Mean (SD) duration of hospital stay was 25.0days (24, 9) in TH and 22.5days (20.6) in control patients (P=0.767). Mean (SD) induction period (cooling onset to target temperature) was 126.3min (80.6) with endovascular cooling and 196.3min (76.3) with surface cooling (P=0.025). Conclusions Therapeutic hypothermia with general anaesthesia is feasible in stroke patients. We noticed increased rates of pneumonia, while the length of hospital stay remained comparable. The endovascular cooling strategy provides a faster induction period than surface cooling.
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| 8. |
- Petersson, Jesper, et al.
(författare)
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Albitization and quartz dissolution in Paleoproterozoic metagranite, central Sweden - Implications for the disposal of spent nuclear fuel in a deep geological repository
- 2012
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Ingår i: Lithos. - : Elsevier BV. - 0024-4937 .- 1872-6143. ; 148, s. 10-26
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Tidskriftsartikel (refereegranskat)abstract
- Hydrothermal alteration resulting in albitization and quartz dissolution has been identified in Paleoproterozoic metagranites down to - 1000 m elevation at Forsmark, Sweden. The alteration features were discovered during investigations to locate a site for the disposal of spent nuclear fuel in a deep geological repository. In general, albitization occurs extensively, but it is also observed locally adjacent to minor intrusive bodies of amphibolite. The altered rocks show a marked decrease in K-feldspar and an increase in quartz relative to the unaltered equivalents, resulting in an epitonalitic composition. Plagioclase is metamorphic in character and generally richer in albite than in the unaltered rocks. It is inferred that albitization was triggered by the input of basic or intermediate melts into the crust during igneous activity close to the peak of regional metamorphism at 1.87-1.86 Ga. The mineralogy of the epitonalites gives rise to an increased thermal conductivity and, thereby, a positive influence for the design and safety of a deep geological repository for spent nuclear fuel. However, the increased frequency of low conductive amphibolite in the albitized volumes, consistent with the proposed mechanism for alteration, gives a negative influence. In sharp contrast to the albitization, a majority of the occurrences of quartz dissolution, which resulted in the formation of episyenite, are located along fracture zones. Quartz dissolution took place between or after 1.8-1.7 Ga, when the bedrock was able to respond to deformation in a brittle manner. Most of the vugs left after the removal of quartz are, to a variable extent, refilled by hydrothermal assemblages, including quartz, albite, K-feldspar, hematite, chlorite and calcite. The geometry and spatial distribution of episyenite argue against an extreme fluid/rock ratio and it is inferred that the fluids had at least a moderate salinity with a temperature in excess of 300 degrees C. The dissolution process was promoted by the generation of secondary permeability localized in columnar or pipe-like volumes. The close spatial connection to fracture zones provides a basis to avoid bedrock affected by this type of alteration and, thereby, reduce the negative mechanical and hydrogeological aspects for a deep geological repository. (C) 2012 Elsevier B.V. All rights reserved.
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| 9. |
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| 10. |
- Petersson, Jesper, 1974
(författare)
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Geographies of eHealth: Studies of Healthcare at a Distance
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis examines the proliferation of healthcare services using information and communication technology to overcome spatial and temporal obstacles. These services are given such names as telemedicine and telecare, which are sometimes grouped together as telehealthcare under the umbrella term eHealth. My main argument is that a prevalent and overoptimistic rhetoric of how the possibilities of digitalization are expected to produce a homogenous and ubiquitous healthcare space conceals many of the spatiotemporal complexities involved in introducing telehealthcare and in the overall organizing of healthcare. To counteract such simplifications, I contend that we need a relational understanding of the technical and the geographical as always nested in the social and vice versa. With such an approach, it is arguably possible to begin to tease apart the many spatiotemporal entanglements of these innovations and to trace their political ramifications. This position is developed by integrating perspectives from science and technology studies with insights from human geography. The four constituent papers of this thesis pursue this argument in qualitatively grounded case studies of telehealthcare and its geographies. Paper I looks at various initiatives for fetal tele-ultrasonography, demonstrating that this practice cannot be reduced to a mere transparent relay for the speedy transmission of digital information across space and time. The paper investigates how its introduction could affect medical knowledge production, power hierarchies, and subject positions, for example, the status attributed to the fetal figure. Paper II traces Swedish transformations of telehealthcare. The use of telemedicine to reach those outside medicine’s range has arguably been accompanied by efforts to achieve intra-organizational streamlining via telemedicine. This process has continued with the emergence of telecare for personal use directed toward the overlapping groups of the elderly people and patients with chronic conditions. I contend that this shift can be understood through a geographical lens as attempts to save space and time by keeping as many patients as possible out of costly hospitalization and preventing them from engaging scarce specialist resources. Paper III compares four telemedicine projects in Sweden. In detailing how the purpose of practicing telemedicine differed between these projects in relation to, for example, the specifics of distance, care availability, and treated medical conditions, the paper demonstrates the existence of many versions of telemedicine. Whereas this fluidity could further the spread of telemedicine, it could also cause problems. To various actors wanting to use telemedicine in a homogenous and fixed way for national streamlining purposes, this diversity has generated confusion when they wished to align telemedicine in a preferred direction. The paper concludes that technology travels best when it can contain both fluid and fixed relationships. Paper IV argues that, whatever is claimed about creating a space- and time-independent healthcare by means of telehealthcare, the use of telecare to connect the standardized spaces of healthcare with the fluid everyday lives of elderly people and patients with chronic conditions actually works by unfolding new spaces of visibilities and establishing new temporalities as well. By investigating these spatiotemporalities, I demonstrate how these applications draw together discourses on individual freedom with medically derived algorithms and concerns about how to make best use of scarce healthcare resources.
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