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- Ekelund, Ulf, et al.
(author)
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Effektiviserad utredning möjlig vid misstänkt akut koronart syndrom. Nya undersökningsmetoder kan ge bättre vårdkvalitet och spara resurser
- 2005
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In: Läkartidningen. - 0023-7205. ; 102:7, s. 464-466
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Journal article (peer-reviewed)abstract
- The immediate evaluation of patients with suspected acute coronary syndrome (ACS) in the emergency department (ED) has remained almost unchanged for decades. At the same time, therapy for established ACS has undergone a remarkable and successful change towards early active intervention. Studies show that 7 out of 10 patients admitted with a suspicion of ACS do not have it, and that 2-5% of the patients with ACS are incorrectly sent home from the ED. With new diagnostic strategies, including e.g. risk prediction algorithms, new blood samples for plaque instability, special investigations like echocardiography, myocardial perfusion imaging and magnetic resonance imaging, as well as the Chest Pain Unit concept, improvements should definitely be possible. With the structured and evidence-based use of such strategies, it is our belief that more patients can be managed as outpatients, that length of stay can be shortened for those admitted, and that some patients with ACS can get an earlier adequate intervention.
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- Ekelund, Ulf, et al.
(author)
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Patients with suspected acute coronary syndrome in a university hospital emergency department: an observational study.
- 2002
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In: BMC Emergency Medicine. - 1471-227X. ; 2:1
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Journal article (peer-reviewed)abstract
- Background: Improved diagnostics in suspected acute coronary syndrome (ACS) are considered to be needed. To help clarify the current situation and the improvement potential, judged risk in the emergency department (ED) and outcome were analyzed among patients with suspected ACS at a university hospital. Methods: 157 consecutive patients with symptoms of ACS were included at the ED during 10 days. Risk of ACS was estimated in the ED for each patient based on history, physical examination and ECG by assigning them to one of four risk categories; I (obvious myocardial infarction, MI), II (strong suspicion of ACS), III (vague suspicion of ACS), and IV (no suspicion of ACS). Results: 4, 17, 29 and 50% of the patients were allocated to risk categories I-IV respectively. 74 patients (47%) were hospitalized but only 19 (26%) had ACS as the discharge diagnose. In risk categories I-IV, ACS rates were 100, 37, 12 and 0%, respectively. Of those admitted without ACS, at least 37% could probably, given perfect ED diagnostics, have been immediately discharged. 83 patients were discharged from the ED, and among them there were no hospitalizations for ACS or cardiac mortality at 6 months. Only about three patients per 24 h were considered eligible for a potential ED chest pain unit. Conclusions: Almost 75% of the patients hospitalized with suspected ACS did not have it, and some 40% of these patients could probably, given perfect immediate diagnostics, have been managed as outpatients. The potential for diagnostic improvement in the ED seems large.
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- Feldmann, M., et al.
(author)
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Economic and durable design of composite bridges with integral abutments
- 2010
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Reports (peer-reviewed)abstract
- In the design and construction of bridges, questions of sustainability, maintenance and durability are becoming more and more important for European road administrations, in addition to safety and serviceability issues. Therefore integral abutment bridges are becoming highly attractive to designers, constructors and road administrations, as they tend to be less expensive to build, easier to maintain and more economical to own over their life time. Bearings and joints are main sources of maintenance costs during a lifetime. These costs vanish because the bridges are joint- and bearing-free. However, this very advantage complicates the design compared to conventional bridges in some crucial respects. Combined with the fact that most European countries have only limited experience with integral bridges to date, this leads to a reluctance of road administrations to use this bridge type. Thus the main objective of the project is to experimentally and theoretically investigate the behaviour of critical points of integral abutment bridges. Regarding the soil-structure interaction, recommendations are elaborated based on monitoring results as well as previous research and monitoring campaigns. Conventional HP piles and sheet piles are investigated as a foundation. Furthermore a hinged HP connection is developed to decrease the stresses in the pile system. An investigation of the design and construction of the slab to pavement approach is also carried out to avoid major damages to the structure. Finally the most important information is condensed into the essential features in form of a 'Design guide for composite bridges with integral abutments'
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- Hadad, Ronza, 1984-, et al.
(author)
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Macrolide and fluoroquinolone resistance in Mycoplasma genitalium in two Swedish counties, 2011-2015
- 2018
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In: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS). - Hoboken, NJ, USA : Wiley-Blackwell Publishing Inc.. - 0903-4641 .- 1600-0463. ; 126:2, s. 123-127
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Journal article (peer-reviewed)abstract
- Mycoplasma genitalium, causing non-gonococcal non-chlamydial urethritis and associated with cervicitis, has developed antimicrobial resistance (AMR) to both the macrolide azithromycin (first-line treatment) and the fluoroquinolone moxifloxacin (second-line treatment). Our aim was to estimate the prevalence of resistance, based on genetic AMR determinants, to these antimicrobials in the M. genitalium population in two Swedish counties, Örebro and Halland, 2011-2015. In total, 672 M. genitalium positive urogenital samples were sequenced for 23S rRNA and parC gene mutations associated with macrolide and fluoroquinolone resistance, respectively. Of the samples, 18.6% and 3.2% in Örebro and 15.2% and 2.7% in Halland contained mutations associated with macrolide and fluoroquinolone resistance, respectively. The predominating resistance-associated mutations in the 23S rRNA gene was A2059G (n = 39) in Örebro and A2058G (n = 13) and A2059G (n = 13) in Halland. The most prevalent possible resistance-associated ParC amino acid alterations were S83I (n = 4) in Örebro and S83N (n = 2) in Halland. Resistance-associated mutations to both macrolides and fluoroquinolones were found in 0.7% of samples. Our findings emphasize the need for routine AMR testing, at a minimum for macrolide resistance, of all M. genitalium-positive samples and regular national and international surveillance of AMR in M. genitalium, to ensure effective patient management and rational antimicrobial use.
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