| 1. |
- Al Fatah, Jabir, et al.
(author)
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An agent-based simulation model for assessment of prehospital triage policies concerning destination of stroke patients
- 2018
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In: Procedia Computer Science. - : Elsevier. - 1877-0509. ; 141, s. 405-412
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Journal article (peer-reviewed)abstract
- Stroke is a life threatening medical condition that is caused either by a blood clot or a bleeding inside the brain. It is generally agreed that immediate treatment of stroke patients is crucial for their ability to recover; however, before treatment can be initiated, the stroke patient has to be diagnosed using, for example, a computed tomography scan of the brain. This, in turn, requires that the patient is transported to a hospital for diagnosis, which is a procedure that consumes valuable time and resources. In the current paper, we present an agent-based simulation model for assessment of logistical stroke patient triage policies. Using a population of stroke patients as input, the model enables to simulate the activities and the main decisions involved in the logistical operations of stroke patients. In an experimental study covering the southernmost part of Sweden, we used the simulation model in order to assess two different policies regarding where to send patients for diagnosis; the nearest hospital policy and the nearest hospital towards the stroke center policy. Our simulation results show that the patients in need of special treatment favor from being transported in direction towards the stroke center, whereas the patients who are not in need of specialist treatment favor from being sent to the closest hospital.
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| 2. |
- Andreasson, Torbjörn, et al.
(author)
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Kriskommunikation 2032. Fyra samhällsscenarier för strategisk planering – SOMCRISC rapport 2
- 2017
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Reports (other academic/artistic)abstract
- Forskningsprojektet Digitala och sociala mediers betydelse för kommunikation i samband med samhälleliga kriser (SOMCRISC) tar avstamp i den genomgripande digitalisering som skett i samhället under senare decennier. Fokus i projektet ligger på hur digital teknik öppnat för nya möjligheter och utmanat de förhållningssätt och praktiker som präglat kriskommunikation i samband med samhälleliga kriser. I de två rapporter som producerats tar projektet sikte på år 2032, de behov som framtida krishantering kan komma att ställas inför och de möjligheter och förutsättningar som den digitala tekniken kan tänkas tillhandahålla. Rapport 1, Kriskommunikation 2032 – Tolv trender i ett digitalt samhälle, redogör för ett antal trender kring digital teknik och tillämpning av digitala tjänster, som kan förväntas få stor betydelse för det svenska krishanteringssystemet. Utgångspunkten har varit att identifiera, analysera och redogöra för viktiga trender i gränssnittet mellan digitalisering å ena sidan, och medier, myndigheter och teknisk infrastruktur å andra sidan. Rapport 2, Kriskommunikation 2032 – Fyra samhällsscenarier för strategisk planering, är tänkt att fungera som ett metodstöd för proaktiv reflektion kring och analys av kriser i ett framtida digitalt samhälle. Baserat på tidigare forskning och domänexpertis presenterar rapporten fyra digitala framtidsscenarier, konstruerade kring dimensionerna medborgardeltagande och offentlig styrning.
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| 3. |
- Andreasson, Torbjörn, et al.
(author)
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Kriskommunikation 2032. Tolv trender i ett digitalt samhälle – SOMCRISC rapport 1
- 2017
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Reports (other academic/artistic)abstract
- Forskningsprojektet Digitala och sociala mediers betydelse för kommunikation i samband med samhälleliga kriser (SOMCRISC) tar avstamp i den genomgripande digitalisering som skett i samhället under senare decennier. Fokus i projektet ligger på hur digital teknik öppnat för nya möjligheter och utmanat de förhållningssätt och praktiker som präglat kriskommunikation i samband med samhälleliga kriser. I de två rapporter som producerats tar projektet sikte på år 2032, de behov som framtida krishantering kan komma att ställas inför och de möjligheter och förutsättningar som den digitala tekniken kan tänkas tillhandahålla. Rapport 1, Kriskommunikation 2032 – Tolv trender i ett digitalt samhälle, redogör för ett antal trender kring digital teknik och tillämpning av digitala tjänster, som kan förväntas få stor betydelse för det svenska krishanteringssystemet. Utgångspunkten har varit att identifiera, analysera och redogöra för viktiga trender i gränssnittet mellan digitalisering å ena sidan, och medier, myndigheter och teknisk infrastruktur å andra sidan. Rapport 2, Kriskommunikation 2032 – Fyra samhällsscenarier för strategisk planering, är tänkt att fungera som ett metodstöd för proaktiv reflektion kring och analys av kriser i ett framtida digitalt samhälle. Baserat på tidigare forskning och domänexpertis presenterar rapporten fyra digitala framtidsscenarier, konstruerade kring dimensionerna medborgardeltagande och offentlig styrning.
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| 4. |
- Apostolaki-Hansson, Trine, et al.
(author)
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Prognosis for intracerebral hemorrhage during ongoing oral anticoagulant treatment
- 2019
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In: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 139:5, s. 415-421
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Journal article (peer-reviewed)abstract
- Background: Intracerebral hemorrhage (ICH) is the most serious adverse effect of treatment with oral anticoagulants. Prognostic data after ICH associated with non-vitamin K antagonist oral anticoagulants (NOAC) compared to vitamin K antagonists (VKA) are sparse. We compared 90-day survival and functional outcome following NOAC-ICH versus VKA-ICH using data from the Swedish Stroke Register (Riksstroke). Methods: Using data from Riksstroke and the Swedish Causes of Death Register between 2012 and 2016, we compared all-cause 90-day mortality for patients with NOAC-ICH versus VKA-ICH using Kaplan-Meier survival analysis and Log-rank test. Cox regression, with adjustment for age, sex, previous stroke, and level of consciousness (LOC) on admission, was used to estimate hazard ratios (HR) for 90-day mortality. Estimated functional outcome at 90 days, based on the modified Rankin Scale (mRS), was compared between VKA- and NOAC-associated ICH using chi-squared test. Results: We included 2483 patients; 300 with NOAC-ICH and 2183 with VKA-ICH. In both groups, mean age was 79 years, and 58% were male. No significant difference between NOAC-ICH and VKA-ICH was found for all-cause 90-day mortality (44.3% NOAC-ICH versus 42.6% VKA-ICH; P = 0.54, HR = 0.93; 95% confidence interval (CI): 0.78-1.12) or 90-day estimated functional outcome (mRS 0-2:13.7% and 15.3%; mRS 3-5:27.3% and 28.9%, respectively (P = 0.52)). Factors predicting death were increased age (HR = 1.03; 95%CI: 1.02-1.04) and reduced LOC (drowsy: HR = 3.48; 95%CI: 2.86-4.23; comatose: HR = 12.27; 95%CI: 10.13-14.87). Conclusion: In this large study on anticoagulant-associated ICH, we found no significant difference in mortality and functional outcome at 90 days between NOAC-ICH versus VKA-ICH.
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| 5. |
- Berge, Eivind, et al.
(author)
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Methods to improve patient recruitment and retention in stroke trials
- 2016
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In: International Journal of Stroke. - : SAGE Publications. - 1747-4930 .- 1747-4949. ; 11:6, s. 663-676
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Journal article (peer-reviewed)abstract
- Background: The success of randomized-controlled stroke trials is dependent on the recruitment and retention of a sufficient number of patients, but fewer than half of all trials meet their target number of patients. Methods: We performed a search and review of the literature, and conducted a survey and workshop among 56 European stroke trialists, to identify barriers, suggest methods to improve recruitment and retention, and make a priority list of interventions that merit further evaluation. Results: The survey and workshop identified a number of barriers to patient recruitment and retention, from patients’ incapacity to consent, to handicaps that prevent patients from participation in trial-specific follow-up. Methods to improve recruitment and retention may include simple interventions with individual participants, funding of research networks, and reimbursement of new treatments by health services only when delivered within clinical trials. The literature review revealed that few methods have been formally evaluated. The top five priorities for evaluation identified in the workshop were as follows: short and illustrated patient information leaflets, nonwritten consent, reimbursement for new interventions only within a study, and monetary incentives to institutions taking part in research (for recruitment); and involvement of patient groups, remote and central follow-up, use of mobile devices, and reminders to patients about their consent to participate (for retention). Conclusions: Many interventions have been used with the aim of improving recruitment and retention of patients in stroke studies, but only a minority has been evaluated. We have identified methods that could be tested, and propose that such evaluations may be nested within on-going clinical trials.
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| 6. |
- Buchwald, Fredrik, et al.
(author)
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Atrial Fibrillation in Transient Ischemic Attack Versus Ischemic Stroke : A Swedish Stroke Register (Riksstroke) Study
- 2016
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In: Stroke: a journal of cerebral circulation. - 0039-2499. ; 47:10, s. 2456-2461
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Journal article (peer-reviewed)abstract
- BACKGROUND AND PURPOSE—: Compared with ischemic stroke (IS), the association of atrial fibrillation (AF) with transient ischemic attack (TIA) is less well established. We aimed to assess the proportion of AF in patients with TIA, and these patients’ characteristics and secondary preventive treatment in comparison to patients with IS. METHODS—: Hospital-based data on TIA and IS events, registered from July 2011 to June 2013, were obtained from the Swedish Stroke Register (Riksstroke). A time-based TIA definition (duration of symptoms <24 hours) was applied. AF was registered as present when previously known or diagnosed at the time of assessment. RESULTS—: AF was present in 2779 of 14 980 (18.6%) patients with TIA and 13 258 of 44 173 (30.0%) patients with IS. The proportion of AF increased with age, reaching 32.9% in TIA and 46.6% in IS patients ≥85 years. Both in TIA and IS, age, hypertension, a history of stroke, and TIA, and being a nonsmoker were associated with the presence of AF. In contrast to IS, AF was less common in female than in male patients with TIA. At discharge, 64.2% of TIA and 50.0% of IS patients with AF were treated with oral anticoagulants. Proportions of AF patients treated with oral anticoagulants decreased substantially with increasing age. CONCLUSIONS—: AF is highly prevalent not only in IS but also in TIA patients, with proportions steeply increasing with age. In both TIA and IS, a substantial proportion of patients with AF were discharged without anticoagulant therapy.
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| 7. |
- Buchwald, Fredrik, et al.
(author)
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Validation of Diagnoses of Transient Ischemic Attack in the Swedish Stroke Register (Riksstroke) TIA-Module
- 2015
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In: Neuroepidemiology. - : S. Karger. - 0251-5350 .- 1423-0208. ; 45:1, s. 40-43
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Journal article (peer-reviewed)abstract
- Background: In 2010, the Swedish Stroke Register (Riksstroke; RS) established a module for transient ischemic attacks (RS-TIA). We report a diagnostic validation study of patients included in RS-TIA.Methods: During the first year, 7,825 patients were registered at 59 out of 74 Swedish hospitals. A time-based TIA definition was applied. A sample of 180 patients (30 patients each from 6 hospitals), with a similar distribution of age and sex as in RS-TIA, was prepared. Two independent observers assessed medical records for quality of documentation and assigned a diagnosis of likely, possible, unlikely TIA or ischennic stroke, according to pre-specified criteria.Results:The 2 observers agreed in 77% of cases that the event was a likely or possible TIA, in 3% that the event was an ischemic stroke, and in 2% that the event was an unlikely TIA. The observers disagreed in 8% of patients on TIA vs. ischennic stroke, and in 11% on a vascular vs. non-vascular cause. Quality of documentation was fair.Conclusions: There was interobserver agreement on diagnosis of TIA in the majority of patients included in RS-TIA. Diagnostic accuracy may be further improved by more systematic documentation of symptoms and signs.
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| 8. |
- Caporuscio, Mauro, 1975-, et al.
(author)
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IoT-enabled Physical Telerehabilitation Platform
- 2017
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In: Proccedings of the International Workshop on Engineering IoT Systems. - : IEEE. - 9781509047932 ; , s. 112-119
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Conference paper (peer-reviewed)abstract
- Physical telerehabilitation services over the Internet allow physiotherapists to engage in remote consultation with patients at their homes, improving the quality of care and reducing costs. Traditional visual approaches, such as webcams and videophones, are limited in terms of precision of assessment and support for assistance with exercises. In this paper, we present a Physical Telerehabilitation System (PTS) that enhances video interaction with IoT technology to monitor the position of the body of patients in space and provide smart data to physiotherapists and users. We give an overview of the architecture of the PTS and evaluate (i) its usability based on a number of interviews and focus groups with stakeholders, and (ii) its technical efficiency based on a series of measurements. From this evaluation, we derive a number of challenges for further improvement of the PTS and outline a possible solution based on a microservices architecture.
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| 9. |
- Dahllöf, Oliver, et al.
(author)
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Optimal placement of mobile stroke units considering the perspectives of equality and efficiency
- 2018
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In: 9th International Conference on Emerging Ubiquitous Systems and Pervasive Networks, EUSPN 2018. - : Elsevier BV. - 1877-0509. ; 141, s. 311-318
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Conference paper (peer-reviewed)abstract
- It is widely known that the time to treatment is vital for patients who suffer from a stroke. Therefore, in different places in the world, the value of acquiring mobile stroke units has been identified. A mobile stroke unit is a specially developed ambulance for stroke treatment, which has special equipment and trained personnel who can perform intravenous stroke treatment (thrombolysis). It is clear that the involvement of mobile stroke units will aid at least a certain proportion of the stroke patients; however, mobile stroke units are often purchased and placed without any developed method or analysis of where and how it should be placed. In the current paper, we use expected value optimization in order to identify, depending on what perspective is of interest, efficiency or equality, the optimal placement of a mobile stroke unit. In an experimental study, considering the Skane County in Sweden, we show that the placement of a mobile stroke unit may vary considerably depending on which of the two perspectives is adopted.
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| 10. |
- Fagerström, Martin, 1979, et al.
(author)
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MODELLING AND TESTING THE CRASH BEHAVIOUR OF COMPOSITE VEHICLES COMPONENTS
- 2019
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Conference paper (other academic/artistic)abstract
- In the current contribution we will present the latest developments in the project “Modelling crash behaviour in future lightweight composite vehicles – Step 2”, involving 11 Swedish partners. On the material modelling side, a fully three-dimensional model to describe fibre kinking has recently been developed. The model is physically based and considers the fibre rotation during kink-band formation under large deformations. The FE implementation of the model is straightforward which allows for easy implementation. The validation of the model for stiffness and strength shows good correlation with the experiments. The influence of initial misalignments on the stiffness is well captured, the strength defined at the onset of unstable fibre rotation, is well predicted, and, in addition, the crushing response shows very good agreement with experimental results in terms of morphology in the crushing zone, as well as in the load response. To allow for computational efficiency, we have also developed and implemented (as a user element in LS-DYNA) an adaptive modelling strategy which allows for laminates to be initially modelled with only one element over the thickness.The user element kinematics can be adaptively enriched by introducing new degrees of freedom during the simulation to allow for more accurate stress predictions in critical regions by introducing discrete material interfaces, and for the modelling of delamination crack growth by introducing discrete crack surfaces interconnected with a cohesive zone law. In this work, special care has been taken to develop a robust method for explicit crash analysis. In the element, we also able to consider the correct intralaminar fracture toughness regularisation for various spatial discretisations. To assess and validate the models developed in the project, we have also conducted a series of bending and crushing experiments on component level. Three-point bending tests (in total 45 beams) have been conducted for three different carbon-epoxy material systems (pre-preg and vacuum infused), two different span lengths and two different lay-ups at several impact speeds. Similarly, crushing tests have been conducted for the same material systems by crushing tubes (in total 35 tubes) at various angles, with two different lay-ups and at two different loading speeds (quasi-static and dynamic). We believe that these tests serve as a very strong basis for any crash model validation.
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