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  • 1. Aasa, M
    et al.
    Dellborg, M
    Herlitz, Johan
    [external].
    Svensson, L
    Grip, L
    Risk Reduction for Cardiac Events After Primary Coronary Intervention Compared With Thrombolysis for Acute ST-Elevation Myocardial Infarction (Five-Year Results of the Swedish Early Decision Reperfusion Strategy [SWEDES] Trial)2010Ingår i: American Journal of Cardiology, ISSN 0002-9149, E-ISSN 1879-1913, Vol. 106, nr 12, s. 1685-1691Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction compares favorably to thrombolysis. In previous studies the benefit has been restricted to the early postinfarction period with no additional risk decrease beyond this period. Long-term outcome after use of third-generation thrombolytics and modern adjunctive pharmaceutics in the 2 treatment arms has not been investigated. This study was conducted to compare 5-year outcome after updated regimens of PPCI or thrombolysis. Patients with ST-elevation myocardial infarction were randomized to enoxaparin and abciximab followed by PPCI (n = 101) or enoxaparin followed by reteplase (n = 104), with prehospital initiation of therapy in 42% of patients. Data on survival and major cardiac events were obtained from Swedish national registries after 5.3 years. PPCI resulted in a better outcome with respect to the composite of death or recurrent myocardial infarction (hazard ratio 0.54, confidence interval 0.31 to 0.95) compared to thrombolysis. This was attributed to a significant decrease in cardiac deaths (hazard ratio 0.16, confidence interval 0.04 to 0.74). The difference evolved continuously over the 5-year follow-up. After adjustment for covariates, a significant benefit remained with respect to cardiac death or recurrent infarction but not for the composite of total survival or recurrent myocardial infarction (p = 0.07). The observed differences were not seen in patients in whom therapy was initiated in the prehospital phase. In conclusion, PPCI in combination with enoxaparin and abciximab compares favorably to thrombolysis in combination with enoxaparin with a risk decrease that stretches beyond the early postinfarction period. Prehospital thrombolysis may, however, match PPCI in long-term outcome.

  • 2. Abdon, NJ
    et al.
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Andrersson, B
    Peripartumcardiomyopathi an often mised diagnosis2013Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 110, nr 23-24, s. 1152-1154Artikel i tidskrift (Refereegranskat)
    Abstract [sv]

    Peripartumkardiomyopati är en sällsynt form av hjärtsvikt. Diagnostiska kriterier är nytillkommen hjärtsvikt från sen graviditet och upp till fem månader efter förlossning, avsaknad av annan förklaring till hjärtsvikt och nedsatt systolisk vänsterkammarfunktion Orsaken till tillståndet tros vara omvandling av prolaktin till en kardiotoxisk variant. Terapin är den etablerade, men ACE-hämmare och ARB får inte ges till ammande mödrar. Hjärttransplantation har tillgripits. Maligna hjärtarytmier har krävt behandling med implanterbar defibrillator och pacemaker. Hämning av produktionen av prolaktin med bromokriptin har gett goda resultat i en liten studie. Resultaten har inte bekräftats.

  • 3.
    Adekunle, Kayode
    et al.
    Högskolan i Borås, Institutionen Ingenjörshögskolan.
    Åkesson, Dan
    Högskolan i Borås, Institutionen Ingenjörshögskolan.
    Skrifvars, Mikael
    Högskolan i Borås, Institutionen Ingenjörshögskolan.
    Biobased Composites Prepared by Compression Moulding using a Novel Thermoset Resin from Soybean oil and a Natural Fibre Reinforcement2009Konferensbidrag (Övrigt vetenskapligt)
    Abstract [en]

    Biobased composites were manufactured by using a compression moulding technique. Novel thermoset resins from soybean oil were used as matrix while flax fibres were used as reinforcement. The airlaid fibres were stacked randomly while woven fabrics were stacked crosswisely (90°) and impregnation was done manually. The fibre/ resin ratio was 60% to 40%.

  • 4.
    Adielsson, Anna
    et al.
    Sahlgrenska University Hospital.
    Aune, Solveig
    Sahlgrenska University Hospital.
    Ravn-Fischer, Annica
    Sahlgrenska University Hospital.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Measurements of time intervals after in-hospital cardiac arrest give important information but can be further improved.2016Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754Artikel i tidskrift (Refereegranskat)
  • 5.
    Adielsson, Anna
    et al.
    Sahlgrenska University Hospital.
    Karlsson, Thomas
    University of Gothenburg.
    Aune, Solveig
    Sahlgrenska University Hospital.
    Lundin, Stefan
    Sahlgrenska University Hospital.
    Hirlekar, Geir
    Sahlgrenska University Hospital.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Ravn-Fischer, Annica
    Sahlgrenska University Hospital.
    A 20-year perspective of in hospital cardiac arrest: Experiences from a university hospital with focus on wards with and without monitoring facilities.2016Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 216, s. 194-199Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Knowledge about change in the characteristics and outcome of in hospital cardiac arrests (IHCAs) is insufficient.

    AIM: To describe a 20year perspective of in hospital cardiac arrest (IHCA) in wards with and without monitoring capabilities.

    SETTINGS: Sahlgrenska University Hospital (800 beds). The number of beds varied during the time of survey from 850-746 TIME: 1994-2013.

    METHODS: Retrospective registry study. Patients were assessed in four fiveyear intervals.

    INCLUSION CRITERIA: Witnessed and nonwitnessed IHCAs when cardiopulmonary resuscitation (CPR) was attempted.

    EXCLUSION CRITERIA: Age below 18years.

    RESULTS: In all, there were 2340 patients with IHCA during the time of the survey. 30-Day survival increased significantly in wards with monitoring facilities from 43.5% to 55.6% (p=0.002) for trend but not in wards without such facilities (p=0.003 for interaction between wards with/without monitoring facilities and time period). The CPC-score among survivors did not change significantly in any of the two types of wards. In wards with monitoring facilities there was a significant reduction of the delay time from collapse to start of CPR and an increase in the proportion of patients who were defibrillated before the arrival of the rescue team. In wards without such facilities there was a significant reduction of the delay from collapse to defibrillation. However, the latter observation corresponds to a marked decrease in the proportion of patients found in ventricular fibrillation.

    CONCLUSION: In a 20year perspective the treatment of in hospital cardiac arrest was characterised by a more rapid start of treatment. This was reflected in a significant increase in 30-day survival in wards with monitoring facilities. In wards without such facilities there was a decrease in patients found in ventricular fibrillation.

  • 6.
    Al-Dury, Nooraldeen
    et al.
    Sahlgrenska Academy, University of Gothenburg.
    Rawshani, Araz
    Sahlgrenska Academy, University of Gothenburg.
    Israelsson, Johan
    Linnaeus University.
    Strömsöe, Anneli
    School of Health, Care and Social Welfare, Västerås.
    Aune, Solveig
    Sahlgrenska University Hospital.
    Agerström, Jens
    Linnaeus University.
    Karlsson, Thomas
    Sahlgrenska Academy.
    Ravn-Fischer, Annica
    Sahlgrenska University Hospital, University of Gothenburg.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Characteristics and outcome among 14,933 adult cases of in-hospital cardiac arrest: A nationwide study with the emphasis on gender and age.2017Ingår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 35, nr 12, s. 1839-1844, artikel-id S0735-6757(17)30451-5Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To investigate characteristics and outcome among patients suffering in-hospital cardiac arrest (IHCA) with the emphasis on gender and age.

    METHODS: Using the Swedish Register of Cardiopulmonary Resuscitation, we analyzed associations between gender, age and co-morbidities, etiology, management, 30-day survival and cerebral function among survivors in 14,933 cases of IHCA. Age was divided into three ordered categories: young (18-49years), middle-aged (50-64years) and older (65years and above). Comparisons between men and women were age adjusted.

    RESULTS: The mean age was 72.7years and women were significantly older than men. Renal dysfunction was the most prevalent co-morbidity. Myocardial infarction/ischemia was the most common condition preceding IHCA, with men having 27% higher odds of having MI as the underlying etiology. A shockable rhythm was found in 31.8% of patients, with men having 52% higher odds of being found in VT/VF. After adjusting for various confounders, it was found that men had a 10% lower chance than women of surviving to 30days. Older individuals were managed less aggressively than younger patients. Increasing age was associated with lower 30-day survival but not with poorer cerebral function among survivors.

    CONCLUSION: When adjusting for various confounders, it was found that men had a 10% lower chance than women of surviving to 30days after in-hospital cardiac arrest. Older individuals were managed less aggressively than younger patients, despite a lower chance of survival. Higher age was, however, not associated with poorer cerebral function among survivors.

  • 7. Almerud, S
    et al.
    Alapack, R.J.
    Fridlund, Bengt
    Växjö University.
    Ekebergh, Margaretha
    Växjö University.
    Beleuguered by technology: Care in technologically intense environments2008Ingår i: Nursing Philosophy, ISSN 1466-7681, E-ISSN 1466-769X, Vol. 9, nr 1, s. 55-61Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Modern technology has enabled the use of new forms of information in the care of critically ill patients. In intensive care units (ICUs), technology can simultaneously reduce the lived experience of illness and magnify the objective dimensions of patient care. The aim of this study, based upon two empirical studies, is to find from a philosophical point of view a more comprehensive understanding for the dominance of technology within intensive care. Along with caring for critically ill patients, technology is part of the ICU staff's everyday life. Both technology and caring relationships are of indispensable value. Tools are useful, but technology can never replace the closeness and empathy of the human touch. It is a question of harmonizing the demands of subjectivity with objective signs. The challenge for caregivers in ICU is to know when to heighten the importance of the objective and measurable dimensions provided by technology and when to magnify the patients’ lived experiences, and to live and deal with the ambiguity of the technical dimension of care and the human side of nursing.

  • 8. Almerud, S
    et al.
    Alapack, R.J.
    Fridlund, Bengt
    Växjö University.
    Ekebergh, Margaretha
    Växjö University.
    Of vigilance and invisibility: being a patient in technologically intense environments2007Ingår i: Nursing in Critical Care, ISSN 1362-1017, E-ISSN 1478-5153, Vol. 12, nr 3, s. 151-158Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Equipment and procedures developed during the past several decades have made the modern intensive care unit (ICU) the hospital’s most technologically advanced environment. In terms of patient care, are these advances unmitigated gains? This study aimed to develop a knowledge base of what it means to be critically ill or injured and cared for in technologically intense environments. A lifeworld perspective guided the investigation. Nine unstructured interviews with intensive care patients comprise its data. The qualitative picture uncovered by a phenomenological analysis shows that contradiction and ambivalence characterized the entire care episode. The threat of death overshadows everything and perforates the patient’s existence. Four inter-related constituents further elucidated the patients’ experiences: the confrontation with death, the encounter with forced dependency, an incomprehensible environment and the ambiguity of being an object of clinical vigilance but invisible at the personal level. Neglect of these issues lead to alienating ‘moments’ that compromised care. Fixed at the end of a one-eyed clinical gaze, patients described feeling marginalized, subjected to rituals of power, a stranger cared for by a stranger. The roar of technology silences the shifting needs of ill people, muffles the whispers of death and compromises the competence of the caregivers. This study challenges today’s caregiving system to develop double vision that would balance clinical competence with a holistic, integrated and comprehensive approach to care. Under such vision, subjectivity and objectivity would be equally honoured, and the broken bonds re-forged between techne, ‘the act of nursing’, and poesis, ‘the art of nursing’.

  • 9. Ambjörnsson, Joakim
    et al.
    Jonsson, Anders
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Strömsöe, Annelie
    Andersson, Henrik
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Bång, Angela
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Bremer, Anders
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Prehospital suspicion and identification of adult septic patients: Experiences of a screening tool2016Konferensbidrag (Refereegranskat)
    Abstract [en]

    Introduction: Sepsis is life threatening and requires urgent healthcare to reduce suffering and death. Therefore it is important that septic patients are identified early to enable treatment.

    Aim: To investigate to what extent EMS personnel identified patients with sepsis using the “BAS 90-30-90” model, and to describe assessments and medical procedures that were undertaken by the personnel.

    Methods: This was a retrospective study where 185 EMS medical records were reviewed. The inclusion was based on patients who were later diagnosed with sepsis in the hospital.

    Results: A physician assessed the patients in 74 of the EMS cases, which lead to exclusion of these records in regard to the EMS personnel’s ability to identify sepsis. The personnel documented suspicion of severe sepsis in eight (n=8) of the remaining 111 records (7.2%). The proportion of patients ˃65 years of age was 73% (n=135) of which 37% (n=50) were over 80 years old. Thirty-nine percent (39%, n=72) were females. The personnel documented blood pressure in 91% (n=168), respiratory rate in 76% (n=140), saturation in 100% (n=185), temperature in 76% (n=141), and heart rate in 94% (n=174) of the records. Systolic blood pressure <90 mmHg was documented in 14,2% (n=24), respiratory rate ˃30 in 36% (n=50), saturation <90 in 49%  (n=91), temperature >38°C in 37.6% (n=53), and heart rate ˃90 in 70% (n=121) of the records. Documented medical procedures and treatments were intravenous lines (70%, n=130), intravenous fluids (10%, n=19) and administration of oxygen (72%, n=133).

    Conclusion: The EMS personnel identified only a few septic patients with the help of the BAS 90-30-90 model when all three criteria would be met for severe sepsis. Either advanced age (>65 years), fever (>38°C) or tachypnea (˃20 breaths/min) appeared to increase the personnel’s suspicion of sepsis. Oxygen, but not intravenous fluids, was given in an adequate way.

  • 10. Amer-Wåhlin, Isis
    et al.
    Rosén, KG
    Högskolan i Borås, Institutionen Ingenjörshögskolan.
    ST-Analysis of the Fetal ECG2013Ingår i: Antenatal and Intrapartum fetal surveillance, Universities Press , 2013, s. 220-236Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 11.
    Andersson Hagiwara, Magnus
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Brink, P
    Högskolan väst.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Hansson, P-O
    University of Gothenburg.
    A shorter system delay for haemorrhagic stroke than ischaemic stroke among patients who use emergency medical service.2018Ingår i: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: We compare various aspects in the early chain of care among patients with haemorrhagic stroke and ischaemic stroke.

    MATERIALS & METHODS: The Emergency Medical Services (EMS) and nine emergency hospitals, each with a stroke unit, were included. All patients hospitalised with a first and a final diagnosis of stroke between 15 December 2010 and 15 April 2011 were included. The primary endpoint was the system delay (from call to the EMS until diagnosis). Secondary endpoints were: (i) use of the EMS, (ii) delay from symptom onset until call to the EMS; (iii) priority at the dispatch centre; (iv) priority by the EMS; and (v) suspicion of stroke by the EMS nurse and physician on admission to hospital.

    RESULTS: Of 1336 patients, 172 (13%) had a haemorrhagic stroke. The delay from call to the EMS until diagnosis was significantly shorter in haemorrhagic stroke. The patient's decision time was significantly shorter in haemorrhagic stroke. The priority level at the dispatch centre did not differ between the two groups, whereas the EMS nurse gave a significantly higher priority to patients with haemorrhage. There was no significant difference between groups with regard to the suspicion of stroke either by the EMS nurse or by the physician on admission to hospital.

    CONCLUSIONS: Patients with a haemorrhagic stroke differed from other stroke patients with a more frequent and rapid activation of EMS.

  • 12.
    Andersson, Henrik
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Axelsson, Christer
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Larsson, Anna
    Bremer, Anders
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Gellerstedt, Martin
    Bång, Angela
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Ljungström, Lars
    The early chain of care in bacteraemia patients: Early suspicion, treatment and survivalin prehospital emergency care2018Ingår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Bacteraemia is a first stage for patients risking conditions such as septic shock. The primary aim ofthis study is to describe factors in the early chain of care in bacteraemia, factors associated with increased chanceof survival during the subsequent 28 days after admission to hospital. Furthermore, the long-term outcome wasassessed.

    Methods: This study has a quantitative design based on data fromEmergencyMedical Services (EMS) and hospitalrecords.

    Results: In all, 961 patients were included in the study. Of these patients, 13.5% died during the first 28 days. TheEMS was more frequently used by non-survivors. Among patients who used the EMS, the suspicion of sepsis alreadyon scene was more frequent in survivors. Similarly, EMS personnel noted the ESS code “fever, infection”more frequently for survivors upon arriving on scene. The delay time fromcall to the EMS and admission to hospitaluntil start of antibiotics was similar in survivors and non-survivors. The five-year mortality rate was 50.8%.Five-year mortalitywas 62.6% among those who used the EMS and 29.5% among those who did not (p b 0.0001).

    Conclusion: This study shows that among patientswith bacteraemiawho used the EMS, an early suspicion of sepsisor fever/infection was associated with improved early survival whereas the delay time from call to the EMSand admission to hospital until start of treatment with antibiotics was not. 50.8% of all patients were deadafter five years.

  • 13. Atefi, Seyed Reza
    et al.
    Seoane, Fernando
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    The Emergence of Electrical Bioimpedance Monitoring for Prompt Detection of Stroke Damage2014Konferensbidrag (Refereegranskat)
  • 14. Aune, S
    et al.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Bång, Angela
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Characteristics of patients who die in hospital with no attempt at resuscitation2005Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 65, nr 3, s. 291-299Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To describe the characteristics, cause of hospitalisation and symptoms prior to death in patients dying in hospital without resuscitation being started and the extent to which these decisions were documented. Materials and methods: All patients who died at Sahlgrenska University Hospital in Göteborg, Sweden, in whom cardiopulmonary resuscitation (CPR) was not attempted during a period of one year. Results: Among 674 patients, 71% suffered respiratory insufficiency, 43% were unconscious and 32% had congestive heart failure during the 24 h before death. In the vast majority of patients, the diagnosis on admission to hospital was the same as the primary cause of death. The cause of death was life-threatening organ failure, including malignancy (44%), cerebral lesion (10%) and acute coronary syndrome (10%). The prior decision of ‘do not attempt resuscitation’ (DNAR) was documented in the medical notes in 82%. In the remaining 119 patients (18%), only 16 died unexpectedly. In all these 16 cases, it was regarded retrospectively as ethically justifiable not to start CPR. Conclusion: In patients who died at a Swedish University Hospital, we did not find a single case in which it was regarded as unethical not to start CPR. The patient group studied here had a poor prognosis due to a severe deterioration in their condition. To support this, we also found a high degree of documentation of DNAR. The low rate of CPR attempts after in-hospital cardiac arrest appears to be justified.

  • 15.
    Axelsson, C
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Herrera, MJ
    Fredriksson, M
    Lindqvist, J
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Implementation of mechanical chest compression in out-of-hospital carfdiac arrest in an emergency medical service system2013Ingår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 31, nr 8, s. 1196-1200Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: The aim of this study is to describe the outcome changes after out-of-hospital cardiac arrest (OHCA) in Gothenburg, Sweden, after introduction of mechanical chest compression (MCC). METHODS: Following introduction of MCC, 1183 OHCA patients were treated from November 1, 2007, to December 31, 2011 (period 2). They were compared with 1218 OHCA patients before MCC was introduced from January 1, 1998, to May 30, 2003 (period 1). Patients in period 2 were evaluated for survival in relation to MCC use. RESULTS: The percentage of patients admitted to hospital alive increased from 25.4% to 31.9% (P < .0001). Survival to 1 month increased from 7.1% to 10.7% (P = .002) from period 1 to period 2. The proportion of ventricular fibrillation/ventricular tachycardia decreased in period 2 (P = .002). However, bystander cardiopulmonary resuscitation (P < .0001), crew-witnessed cases (P = .04), percutaneous coronary intervention (P < .0001), therapeutic hypothermia (P < .0001), and implantable cardioverter-defibrillator use (P = .01) increased, as did time from call to emergency medicine service arrival (P < .0001) and to defibrillation (P = .006). In period 2, 60% of OHCA patients were treated with MCC. The percentages admitted alive to hospital (MCC vs no MCC) were 28.6% and 36.1% (P = .008). Corresponding figures for survival to 1 month were 5.6% and 17.6% (P < .0001). In the MCC group, we found increase in the delay from collapse to defibrillation (P < .0001), greater use of adrenaline (P < .0001), and fewer crew-witnessed cases (P < .0001). CONCLUSION: Survival to 1 month after implementation of MCC was higher than before introduction. However, patients receiving MCC had low survival. Although case selection might play a role, results do not support a widespread use of MCC after OHCA.

  • 16. Axelsson, Å
    et al.
    Stibrant Sunnerhagen, K
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Comparision of respondents and non-respondents in a follow-upsurvey after cardiac arrest2013Konferensbidrag (Refereegranskat)
  • 17. Axelsson, Åsa B
    et al.
    Sunnerhagen, Katharina S
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Representativity and co-morbidity: Two factors of importance when reporting health status among survivors of cardiac arrest.2016Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 101, s. 44-49Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: Reports on differences between respondents and non-respondents of out-of-hospital cardiac arrest (OHCA) survivors are sparse. This study compares respondents with non-respondents in a follow-up study of a consecutive sample of OHCA survivors and describes the relation between respondents' self-reported morbidity and health.

    METHODS/DESIGN: Questionnaires were administered within 12 months after the OHCA. The study population was adult patients who had survived an OHCA during 2008 to 2011, with a cerebral performance score of ≤2 at discharge. The patients were identified through the Swedish registry of OHCA. The Self-administered comorbidity questionnaire and EQ VAS (Euroqol questionnaire visual analogue scale) was used to measure morbidity and health status.

    RESULTS: Of 298 survivors, 224 were eligible for the study and 127 responded. Mean time from cardiac arrest (CA) to follow up was 178 days. Comparing the 127 respondents with the 97 lost to follow-up and non-respondents, no significant differences were found in terms of age, sex, factors at resuscitation and in-hospital interventions. The EQ VAS median was 75 (25th,75th percentile 60,80)). Self-rated health differed between respondents reporting 0-2 conditions (n=68) and respondents reporting more than two (n=43), median EQ VAS 78 (68,90) and 65 (50,80)), respectively; p-value 0.0001.

    CONCLUSIONS: Despite a limited response rate, representativeness in terms of patient characteristics among survivors of OHCA with an acceptable cerebral function is achievable. A considerable proportion of the survivors lived with the burden of multi-morbidity which worsened health.

  • 18.
    Axelsson, Åsa B
    et al.
    University of Gothenburg.
    Sunnerhagen, Katharina S
    University of Gothenburg.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Representativity and co-morbidity: Two factors of importance when reporting health status among survivors of cardiac arrest.2016Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 101Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: Reports on differences between respondents and non-respondents of out-of-hospital cardiac arrest (OHCA) survivors are sparse. This study compares respondents with non-respondents in a follow-up study of a consecutive sample of OHCA survivors and describes the relation between respondents' self-reported morbidity and health.

    METHODS/DESIGN: Questionnaires were administered within 12 months after the OHCA. The study population was adult patients who had survived an OHCA during 2008 to 2011, with a cerebral performance score of ≤2 at discharge. The patients were identified through the Swedish registry of OHCA. The Self-administered comorbidity questionnaire and EQ VAS (Euroqol questionnaire visual analogue scale) was used to measure morbidity and health status.

    RESULTS: Of 298 survivors, 224 were eligible for the study and 127 responded. Mean time from cardiac arrest (CA) to follow up was 178 days. Comparing the 127 respondents with the 97 lost to follow-up and non-respondents, no significant differences were found in terms of age, sex, factors at resuscitation and in-hospital interventions. The EQ VAS median was 75 (25th,75th percentile 60,80)). Self-rated health differed between respondents reporting 0-2 conditions (n=68) and respondents reporting more than two (n=43), median EQ VAS 78 (68,90) and 65 (50,80)), respectively; p-value 0.0001.

    CONCLUSIONS: Despite a limited response rate, representativeness in terms of patient characteristics among survivors of OHCA with an acceptable cerebral function is achievable. A considerable proportion of the survivors lived with the burden of multi-morbidity which worsened health.

  • 19. Berglind, L
    et al.
    Karlsson, T
    Hirlekar, G
    Albertsson, P
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Ravn-Fischer, A
    Delay and inequality in treatment of the elderly with suspected acute coronary syndrome2014Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 176, nr 3, s. 946-950Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND/OBJECTIVES: The aim of this study is to determine differences between elderly patients (≥80 years) and younger patients with suspected acute coronary syndrome (ACS) regarding delay times before diagnostic tests and treatments. METHODS: All patients with chest pain who were admitted to a hospital in the Gothenburg area were included consecutively over a 3-month period. They were divided into an elderly group (≥80 years) and a reference group (<80 years). Previous medical history, ECG findings, treatments, diagnostic tests, and delay times were registered. RESULTS: Altogether, 2588 patients were included (478 elderly and 2110 reference). There were no significant differences in delay time to hospital ward admission, to first medical therapy with aspirin, or to investigation with coronary angiography (CA) between the two groups. The elderly patients had a significantly shorter median time from first medical contact to first ECG (12 vs. 14 min, p=0.002) but after adjustment for confounding factors, especially mode of transport, the opposite was found to be the case (p=0.002). Elderly hospitalized patients with ACS were less often investigated with CA (44% vs. 89%, p<0.0001) and received less medical treatment with P2Y12 antagonists and lipid lowering drugs. CONCLUSIONS: Elderly individuals with chest pain could not be shown to have a delay to hospital admission compared to their younger counterparts. Nevertheless, higher age was associated with a longer time to first ECG. The elderly patients received less active therapy, and fear of age-related side effects might explain this difference.

  • 20.
    Bergström, Mattias
    et al.
    Lund University.
    Schmidbauer, Simon
    Lund University.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Rawshani, Araz
    University of Gothenburg.
    Friberg, Hans
    Lund University.
    Pulseless electrical activity is associated with improved survival in out-of-hospital cardiac arrest with initial non-shockable rhythm.2018Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 133, s. 147-152, artikel-id S0300-9572(18)31010-4Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To describe the prevalence, baseline characteristics and factors associated with survival in out-of-hospital cardiac arrest (OHCA) with initial non-shockable rhythm sub-grouped into pulseless electrical activity (PEA) and asystole as presenting rhythm.

    METHODS: The Swedish Registry of Cardiopulmonary Resuscitation is a prospectively recorded nationwide registry of modified Utstein parameters, including all patients with attempted resuscitation after OHCA. Data between 1990-2016 were analyzed.

    RESULTS: After exclusions, the study population consisted of 48,707 patients presenting with either PEA or asystole. The proportion of PEA increased from 12% to 22% during the study period with a fivefold increase in 30-day survival reaching 4.9%. Survival in asystole showed a modest increase from 0.6% to 1.3%. In the multivariable analysis, PEA was independently associated with survival at 30 days (OR 1.54, 95% CI 1.26-1.88).

    CONCLUSION: Between 1990 and 2016, the proportion of PEA as the first recorded rhythm doubled with a five-fold increase in 30-day survival, while survival among patients with asystole remained at low levels. PEA and asystole should be considered separate entities in clinical decision-making and be reported separately in observational studies and clinical trials.

  • 21. Blad, Sofia
    et al.
    Larsson, David
    Outram, Nicolas
    Rosén, Karl G
    Högskolan i Borås, Institutionen Ingenjörshögskolan.
    Assessment of fetal reactivity biopatterns during labour by fetal ECG analysis2009Konferensbidrag (Refereegranskat)
    Abstract [en]

    Reactivity is the pattern of reactions associated with response to changes in the environment such as stress. Labour with uterine contractions hampering fetal and uterine blood flow provides significant stress and we need to improve our ability to assess fetal reactivity biopatterns during delivery. The study illustrates progress made with regard to detailed analysis of the fetal heart rate (FHR) and beat-to-beat variations (RR-intervals) as a clinical measure of fetal reactivity. A method, named residuals, is presented of using a small set of index cases to identify parameter settings which are then further evaluated in extensive database tests of 8100 cases.

  • 22. Blimark, M
    et al.
    Örtenwall, P
    Lundberg, Lars
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    DSTC as war surgery course2011Konferensbidrag (Övrigt vetenskapligt)
  • 23. Blohm, M
    et al.
    Herlitz, Johan
    [external].
    Hartford, M
    Karlson, BW
    Risenfors, M
    Luepker, RV
    Sjölin, M
    Holmberg, S
    Consequences of a media campaign focusing on delay in acute myocardial infarction1992Ingår i: American Journal of Cardiology, ISSN 0002-9149, E-ISSN 1879-1913, ISSN 0002-914, Vol. 69, nr 4, s. 411-413Artikel i tidskrift (Övrigt vetenskapligt)
  • 24. Blohm, M
    et al.
    Herlitz, Johan
    [external].
    Schröder, U
    Hartford, M
    Karlsson, BW
    Risenfors, M
    Larsson, E
    Luepker, R
    Wennerblom, B
    Holmberg, S
    Reaction to a media campaign focusing on delay in acute myocardial infarction1991Ingår i: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 20, nr 6, s. 661-666Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    A media campaign conducted to reduce delay time and to increase the use of ambulance transport in acute myocardial infarction was performed in an urban area with about half a million inhabitants during 1 year. The main message was that chest pain lasting more than 15 minutes might indicate acute myocardial infarction; dial 90,000 immediately for ambulance transport to the hospital. The target population was the general public. After 6 and 12 months 400 and 610 randomly chosen persons, respectively, were contacted by telephone to evaluate the reaction of the general public to the campaign. Of these, 60% and 71%, respectively, had heard of the campaign, and all parts of the message were spontaneously remembered by 15% and 19%, respectively. The reaction to the campaign was generally positive. Among all patients admitted to the coronary care unit of one of the two city hospitals, 65% were aware of the campaign and 31% of them were of the opinion that they came to the hospital faster because of the campaign. In conclusion, a media campaign aimed at reducing patient delay time in acute myocardial infarction was shown to reach a majority of people in the community and patients with ischemic heart disease. The reaction was positive and about one fifth of interviewed people spontaneously remembered the total message.

  • 25.
    Bremer, Anders
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Att överleva hjärtstopp2007Konferensbidrag (Övrigt vetenskapligt)
  • 26.
    Bremer, Anders
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Hjärtstopp utanför sjukhus2012Konferensbidrag (Övrigt vetenskapligt)
  • 27. Bäck, M
    et al.
    Cider, Å
    Gillström, J
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Physical activity in relation to cardiac risk markers in secondary prevention of coronary artery disease2013Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 168, nr 1, s. 478-483Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The relationship between physical activity and cardiac risk markers in secondary prevention for patients with coronary artery disease (CAD) is uncertain. The aims of the study were therefore to examine the level of physical activity in patients with CAD, and to investigate the association between physical activity and cardiac risk markers. METHODS: In total, 332 patients, mean age, 65 ± 9.1 years, diagnosed with CAD at a university hospital were included in the study 6 months after their cardiac event. Physical activity was measured with a pedometer (steps/day) and two questionnaires. Investigation of cardiac risk markers included serum lipids, oral glucose-tolerance test, twenty-four hour blood pressure and heart rate monitoring, smoking, body-mass index (BMI), waist-hip ratio, and muscle endurance. The study had a cross-sectional design. RESULTS: The patients performed a median of 7,027 steps/day. After adjustment for confounders, statistically significant correlations between steps/day and risk markers were found with regard to; high-density lipoprotein cholesterol (HDL-C) (r=0.19, p<0.001), muscle endurance measures (r ranging from 0.19 to 0.25, p=0.001 or less) triglycerides (r=-0.19, p<0.001), glucose-tolerance (r=-0.23, p<0.001), BMI (r=-0.21, p<0.001), 24-h heart rate recording during night (r=-0.17, p=0.004), and average 24-h heart rate (r=-0.13, p=0.02). CONCLUSIONS: A relatively high level of physical activity was found among patients with CAD. There was a weak, but significant, association between pedometer steps/day and HDL-C, muscle endurance, triglycerides, glucose-tolerance, BMI and 24-h heart rate, indicating potential positive effects of physical activity on these parameters. However, before clinical implications can be formed, more confirmatory data are needed.

  • 28. Bäck, M
    et al.
    Cider, Å
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Lundberg, M
    Jansson, B
    What variables predict participation in exercise-based cardiac rehabilitation in patients with coronary artery disease?2014Konferensbidrag (Refereegranskat)
    Abstract [en]

    Background Despite the well-established positive effects of exercise-based cardiac rehabilitation (CR) participation has been shown to be sub-optimal. A significant association between kinesiophobia (fear of movement) and participation in CR has previously been found. Therefore, the aim of this study was to identify predictors of participation in CR in patients with coronary artery disease (CAD), with a special reference to kinesiophobia. Material and methods In all, 332 patients (75 women; mean age 65±9.1 years) with a diagnosis of CAD were recruited between 2007 and 2009 at Sahlgrenska University Hospital/Sahlgrenska. The patients were tested regarding muscle endurance, level of physical activity, health related quality of life, anxiety, depression and kinesiophobia. A path model with direct and indirect effects via kinesiophobia was used to predict participation in CR. An explorative selection of significant predictors was performed. Results Kinesiophobia (p=.012), waist circumference (p=.023), and a previous history of PCI (p=.037) had direct negative effects on participation in CR, while current incidence of CABG (p<.001), PCI (p=.005) and BMI (p=.008) had positive effects. Compared to patients diagnosed with unstable angina, a diagnosis of myocardial infarction (p=.004) had a positive effect on participation in CR. The following indirect effects on participation in CR were found. Anxiety (p=.001) and previous PCI (p=.025) increased kinesiophobia, while muscle endurance (p=.003), perceptions of general health (p<.001) and physical functioning (p=.009) decreased kinesiophobia. Moreover, men had higher kinesiophobia compared to women (p=.031) and smoking was found to reduce kinesiophobia (p=.004). Conclusion Several important variables with an influence on participation in CR were identified and should be further analysed in relation to clinical practice. A reduction of kinesiophobia can be an efficient way to increase participation in CR and should therefore be given priority in future research.

  • 29. Bäck, M
    et al.
    Jansson, B
    Cider, A
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Lundberg, M
    Validation of a questionnaire to detect kinesiophobia (fear of movement) in patients with coronary artery disease.2012Ingår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 44, nr 4, s. 363-369Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To investigate the validity and reliability of the Tampa Scale for Kinesiophobia Heart (TSK-SV Heart), a brief questionnaire to detect kinesiophobia (fear of movement) in patients with coronary artery disease. Design: Methodological research (cross-sectional study). Subjects: A total of 332 patients, mean age 65 years (standard deviation 9.1) diagnosed with coronary artery disease at a university hospital were included in the study. Methods: The psychometric properties of the TSK-SV Heart were tested. The tests of validity comprised face, content, and construct validity. The reliability tests included composite reliability, internal consistency and stability over time. Results: In terms of reliability, the TSK-SV Heart was found to be stable over time (intra-class correlation coefficient 0.83) and internally consistent (Cronbach's alpha 0.78). Confirmatory factor analysis provided acceptable fit for a hypothesized 4-factor model with inclusion of a method factor. Conclusion: These results provide support for the reliability of the TSK-SV Heart. The questionnaire appears to be valid for use in patients with coronary artery disease. However, some items require further investigation due to low influence on some sub-dimensions of the test. The sub-dimensions of kinesiophobia require future research concerning their implications for the target group.

  • 30. Bäck, Maria
    et al.
    Cider, Åsa
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Lundberg, Mari
    Jansson, Bengt
    Kinesiophobia mediates the influences on attendance at exercise-based cardiac rehabilitation in patients with coronary artery disease.2016Ingår i: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 32, nr 8, s. 571-580Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: To identify predictors of attendance at exercise-based cardiac rehabilitation (CR) and to test the hypothesis that kinesiophobia mediates the influence on attendance at CR in patients with coronary artery disease (CAD).

    PATIENTS: In total, 332 patients (75 women; mean age 65 ± 9.1 years) with a diagnosis of CAD were recruited at Sahlgrenska University Hospital, Sweden.

    METHODS: The patients were tested in terms of objective measurements, self-rated psychological measurements, and level of physical activity. A path model with direct and indirect effects via kinesiophobia was used to predict participation in CR. An exploratory selection of significant predictors was made.

    RESULTS: A current incidence of coronary bypass grafting (p < 0.001) and a diagnosis of ST-elevation myocardial infarction (p = 0.004) increased the probability of attendance at CR, while kinesiophobia (p = 0.001) reduced attendance. As a mediator, kinesiophobia was influenced by four predictors and the following indirect effects were found. General health and muscle endurance increased the probability of attendance at CR, while self-rated anxiety and current incidence of heart failure had the opposite effect.

    CONCLUSIONS: This study suggests that kinesiophobia has an influence on and a mediating role in attendance at CR. The results need to be further investigated in relation to clinical practice.

  • 31.
    Bäck, Maria
    et al.
    Sahlgrenska University Hospital.
    Lundberg, Mari
    Sahlgrenska University Hospital.
    Cider, Åsa
    Sahlgrenska University Hospital.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Jansson, Bengt
    University of Gothenburg.
    Relevance of Kinesiophobia in Relation to Changes Over Time Among Patients After an Acute Coronary Artery Disease Event.2017Ingår i: Journal of cardiopulmonary rehabilitation and prevention, ISSN 1932-751XArtikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: To identify levels of kinesiophobia during the first 4 months after an acute episode of coronary artery disease (CAD), while controlling for gender, anxiety, depression, and personality traits.

    METHODS: In all, 106 patients with CAD (25 women), mean age 63.1 ± 11.5 years, were included in the study at the cardiac intensive care unit, Sahlgrenska University Hospital, Sweden. The patients completed questionnaires at 3 time points: in the cardiac intensive care unit (baseline), 2 weeks, and 4 months after baseline. The primary outcome measure was kinesiophobia. Secondary outcome measures were gender, anxiety, depression, harm avoidance, and positive and negative affect. A linear mixed model procedure was used to compare kinesiophobia across time points and gender. Secondary outcome measures were used as covariates.

    RESULTS: Kinesiophobia decreased over time (P = .005) and there was a significant effect of gender (P = .045; higher values for women). The presence of a high level of kinesiophobia was 25.4% at baseline, 19% after 2 weeks, and 21.1% after 4 months. Inclusion of the covariates showed that positive and negative affect and harm avoidance increased model fit. The effects of time and gender remained significant.

    CONCLUSIONS: This study highlights that kinesiophobia decreased over time after an acute CAD episode. Nonetheless, a substantial part of the patients were identified with a high level of kinesiophobia across time, which emphasizes the need for screening and the design of a treatment intervention.

  • 32.
    Bång, A
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Grip, L
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Kihlgren, S
    Karlsson, T
    Caidahl, K
    Hartford, M
    Lower mortality after prehospital recognition and treatment followed by fast tracking to coronary care compared with admittance via emergency department in patients with ST-elevation myocardial infarction.2008Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 129, nr 3, s. 325-332Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To describe the short-and long-term outcome among patients with an ST-elevation myocardial infarction (STEMI), assessed and treated by the emergency medical services (EMS) in relation to whether they were fast tracked to a coronary care unit (CCU) or admitted via the emergency department (ED). METHODS: Consecutive patients admitted to the CCU at Sahlgrenska University Hospital with ST elevations on admission ECG were analysed with respect to whether they by the EMS were fast tracked to the CCU or the adjacent coronary angiography laboratory (direct CCU group; n=261) or admitted via the ED (ED group; n=235). RESULTS: Whereas the two groups were similar with regard to age and previous history, those who were fast tracked to CCU were more frequently than the ED patients diagnosed and treated as STEMI already prior to hospital admission. Reperfusion therapy was more commonly applied in the CCU group compared with the ED group (90% vs 67%; <0.0001). The delay times (median) were shorter in the direct CCU group than in the ED group, with a difference of 10 min from the onset of symptoms to arrival in hospital and 25 min from hospital arrival to the start of reperfusion treatment (primary PCI or in-hospital fibrinolysis). Patients in the direct CCU group had lower 30-day mortality (7.3% vs. 15.3%; p=0.004), as well as late mortality (>30 days to five years) (11.6% vs. 20.6%; p=0.008). CONCLUSION: Among patients transported with ambulance due to STEMI there was a significant association between early recognition and treatment followed by fast tracking to the CCU and long term survival. A higher rate of and a more rapid revascularisation were probably of significant importance for the outcome.

  • 33. Caidahl, K
    et al.
    Hartford, M
    Karlsson, T
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Pettersson, K
    de Faire, U
    Frostegård, J
    IGM-phosphorylcholine autoantibodies and outcome in acute coronary syndromes.2013Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 167, nr 2, s. 464-469Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Antibodies against proinflammatory phosphorylcholine (anti-PC) seem to be protective and reduce morbidity. We sought to determine whether low levels of immunoglobulin-M (IgM) autoantibodies against PC add prognostic information in acute coronary syndromes (ACS). METHODS: IgM anti-PC titers were measured in serum obtained within 24h of admission from 1185 ACS patients (median age 66 years, 30% women). We evaluated major acute cardiovascular events (MACE) and all-cause mortality short--(6 months), intermediate--(18 months) and long--(72 months) terms. RESULTS: Low anti-PC titers were associated with MACE and all-cause mortality at all follow-up times. After adjusting for clinical variables, plasma troponin-I, proBNP and CRP levels, associations remained at all times with MACE, short and intermediate terms also with all-cause mortality. With anti-PC titers below median, adjusted hazard ratios at 18months were for MACE 1.79 (95% confidence interval [CI]: 1.31 to 2.44; p=0.0002) and for all-cause mortality 2.28 (95% CI: 1.32 to 3.92; p=0.003). Anti-PC and plasma CRP were unrelated and added to risk prediction. CONCLUSIONS: Serum IgM anti-PC titers provide prognostic information above traditional risk factors in ACS. The ease of measurement and potential therapeutic perspective indicate that it may be a valuable novel biomarker in ACS.

  • 34.
    Carlsson, Gunilla
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Hot och våld: patienters och vårdares upplevelser av våldsamma möten2009Konferensbidrag (Övrigt vetenskapligt)
  • 35. Claesson, A
    et al.
    Druid, H
    Lindqvist, J
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Cardiac disease and probable intent after drowning2013Ingår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 31, nr 7, s. 1073-7Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: The aim of this study is to determine the prevalence of cardiac disease and its relationship to the victim's probable intent among patients with cardiac arrest due to drowning. METHOD: Retrospective autopsied drowning cases reported to the Swedish National Board of Forensic Medicine between 1990 and 2010 were included, alongside reported and treated out-of-hospital cardiac arrests due to drowning from the Swedish Out of Hospital Cardiac Arrest Registry that matched events in the National Board of Forensic Medicine registry (n = 272). RESULTS: Of 2166 drowned victims, most (72%) were males; the median age was 58 years (interquartile range, 42-71 years). Drowning was determined to be accidental in 55%, suicidal in 28%, and murder in 0.5%, whereas the intent was unclear in 16%. A contributory cause of death was found in 21%, and cardiac disease as a possible contributor was found in 9% of all autopsy cases. Coronary artery sclerosis (5%) and myocardial infarction (2%) were most frequent. Overall, cardiac disease was found in 14% of all accidental drownings, as compared with no cases (0%) in the suicide group; P = .05. Ventricular fibrillation was found to be similar in both cardiac and noncardiac cases (7%). This arrhythmia was found in 6% of accidents and 11% of suicides (P = .23). CONCLUSION: Among 2166 autopsied cases of drowning, more than half were considered to be accidental, and less than one-third, suicidal. Among accidents, 14% were found to have a cardiac disease as a possible contributory factor; among suicides, the proportion was 0%. The low proportion of cases showing ventricular fibrillation was similar, regardless of the presence of a cardiac disease.

  • 36.
    Claesson, A
    et al.
    Karolinska Institutet.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Svensson, L
    Karolinska Institute.
    Ottosson, L
    Sahlgrenska University Hospital.
    Bergfeldt, L
    Sahlgrenska University Hospital.
    Engdahl, J
    Karolinska Institutet.
    Ericson, C
    Sahlgrenska University Hospital.
    Sandén, P
    Sahlgrenska University Hospital.
    Axelsson, Christer
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Bremer, Anders
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Defibrillation before EMS arrival in western Sweden.2017Ingår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 35, nr 8, s. 1043-1048, artikel-id S0735-6757(17)30117-1Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Bystanders play a vital role in public access defibrillation (PAD) in out-of-hospital cardiac arrest (OHCA). Dual dispatch of first responders (FR) alongside emergency medical services (EMS) can reduce time to first defibrillation. The aim of this study was to describe the use of automated external defibrillators (AEDs) in OHCAs before EMS arrival.

    METHODS: All OHCA cases with a shockable rhythm in which an AED was used prior to the arrival of EMS between 2008 and 2015 in western Sweden were eligible for inclusion. Data from the Swedish Register for Cardiopulmonary Resuscitation (SRCR) were used for analysis, on-site bystander and FR defibrillation were compared with EMS defibrillation in the final analysis.

    RESULTS: Of the reported 6675 cases, 24% suffered ventricular fibrillation (VF), 162 patients (15%) of all VF cases were defibrillated before EMS arrival, 46% with a public AED on site. The proportion of cases defibrillated before EMS arrival increased from 5% in 2008 to 20% in 2015 (p<0.001). During this period, 30-day survival increased in patients with VF from 22% to 28% (p=0.04) and was highest when an AED was used on site (68%), with a median delay of 6.5min from collapse to defibrillation. Adjusted odds ratio for on-site defibrillation versus dispatched defibrillation for 30-day survival was 2.45 (95% CI: 1.02-5.95).

    CONCLUSIONS: The use of AEDs before the arrival of EMS increased over time. This was associated with an increased 30-day survival among patients with VF. Thirty-day survival was highest when an AED was used on site before EMS arrival.

  • 37. Claesson, A
    et al.
    Lindqvist, J
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Cardiac arrest due to drowning-changes over time and factors of importance for survival2014Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 85, nr 5, s. 644-648Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To evaluate changes in characteristics and survival over time in out-of-hospital cardiac arrest (OHCA) due to drowning and describe factors of importance for survival. METHOD: Retrospectively reported and treated drowning cases reported to the Swedish OHCA registry between 1990 and 2012, n=529. The data were clustered into three seven-year intervals for comparisons of changes over time. RESULTS: There were no changes in age, gender, witnessed status, shockable rhythm or place of OHCA during the time periods. Bystander CPR increased over time, 59% in interval 1992-1998, versus 74% in interval 2006-2012 (p=0.005). There was a decrease in delay between OHCA and calling for the Emergency Medical Service (EMS) over the years, while calling for the EMS to arrival increased in terms of time. Survival to hospital admission appears to have increased over the years (p=0.009), whereas survival to one month did not change significantly over time. In a multivariate analysis, witnessed status, female gender, bystander CPR, place-home and EMS response time were associated with survival to hospital admission. For survival to one month, place, age, shockable rhythm and logarithmised delay from calling for an ambulance to arrival were of significance for survival. CONCLUSION: In OHCA due to drowning, over a period of 20 years, bystanders have called for help at an earlier stage and administered CPR more frequently in the past few years. Survival to hospital admission has increased, while shockable rhythm and early arrival of the EMS appear to be the most important factors for survival to one month.

  • 38.
    Darcy, Laura
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap. Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Björk, M
    Enkär, K
    Knutsson, Susanne
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    The process of striving for an ordinary, everyday life, in young children living with cancer, at six months and one year post diagnosis2014Ingår i: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 18, nr 6, s. 605-612Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose Health care focus is shifting from solely looking at surviving cancer to elements of attention relating to living with it on a daily basis.The young child's experiences are crucial to providing evidence based care. The aim of this study was to explore the everyday life of young children as expressed by the child and parents at six months and one year post diagnosis. Methods Interviews were conducted with children and their parents connected to a paediatric oncology unit in Southern Sweden. A qualitative content analysis of interview data from two time points, six months and one year post diagnosis, was carried out. Results The process of living with cancer at six months and at one year post diagnosis revealed the child's striving for an ordinary, everyday life. Experiences over time of gaining control, making a normality of the illness and treatment and feeling lonely were described. Conclusion Nurses have a major role to play in the process of striving for a new normal in the world post-diagnosis, and provide essential roles by giving the young child information, making them participatory in their care and encouraging access to both parents and peers. Understanding this role and addressing these issues regularly can assist the young child in the transition to living with cancer. Longitudinal studies with young children are vital in capturing their experiences through the cancer trajectory and necessary to ensure quality care.

  • 39.
    Darcy, Laura
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Enkär, K
    Granlund, M
    Someonsson, R J
    Peterson, C
    Björk, M
    Health and functioning in the everyday lives of young children with cancer: documenting with the International Classification of Functioning, Disability & Health – Children & Youth (ICF-CY)2014Ingår i: Child Care Health and Development, ISSN 0305-1862, E-ISSN 1365-2214, Vol. 41, nr 3, s. 475-482Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Health care focus is shifting for children from surviving childhood cancer to living with it on a daily basis. There is a need to document health and function in the everyday lives of young children with cancer using the multidimensional framework and language of the International Classification of Functioning, Disability and Health – Children and Youth (ICF-CY). Aims The aims of this study were (1) to document health and functioning in the everyday lives of young children with cancer using ICF-CY codes and (2) to identify a comprehensive code set that can aid clinical assessment. Method Interviews with children diagnosed with cancer and their parents, were transcribed, reviewed for content and coded to the ICF-CY using linking procedures. Results A comprehensive code set (n = 70) for childhood cancer was identified. The majority of content identified to codes was related to activity and participation describing social relations with family, peers and professionals, preschool attendance and play, as well as issues related to support and independence.

  • 40.
    Darcy, Laura
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.
    Enskär, Karin
    Högskolan i Jönköping, HHJ, Avd. för omvårdnad.
    Björk, Maria
    Högskolan i Jönköping, HHJ, Avd. för omvårdnad.
    Young children's experiences of living an everyday life with cancer – A three year interview study2018Ingår i: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose

    The young child's experiences of living with cancer are crucial to providing evidence based care. This study explores and describes experiences of everyday life of young children with cancer, over a three year period from diagnosis.

    Method

    This is a longitudinal, inductive interview study with young children with cancer, and their parents. Interviews from shortly after diagnosis, six and 12 months after diagnosis have been reanalysed. Interviews with the same children and their parents from 18 to 36 months after diagnosis have been analysed for the first time in the present paper. A longitudinal temporal analysis at category level for five synchronic data sets forms the basis for the results.

    Results

    The child living with cancer over a three year period is described as a child apart, striving to live an everyday life. This description is built on three categories: I want to be a child like any other, I need security and control and I feel lonely and left out. Young children with cancer actively strive to understand their illness, participate in care and live an ordinary everyday life- but with ongoing feelings of social isolation and loneliness.

    Conclusions

    Young children with cancer need access to and ongoing contact with peers and preschool. A structured follow-up throughout the cancer trajectory and not just during active treatment, is necessary. A child-centred philosophy of care would guide the child towards attainment of health and wellbeing.

  • 41.
    Darcy, Laura
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Enskär, Karin
    Granlind, Mats
    Simeonsson, Rune J
    Peterson, Christina
    Björk, Maria
    Health and functioning in the everyday lives of young children with cancer: documenting with the International Classification of Functioning, Disability and Health – Children and Youth (ICF-CY)2014Ingår i: Child Care Health and Development, ISSN 0305-1862, E-ISSN 1365-2214Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Health care focus is shifting for children from surviving childhood cancer to living with it on a daily basis. There is a need to document health and function in the everyday lives of young children with cancer using the multidimensional framework and language of the International Classification of Functioning, Disability and Health – Children and Youth (ICF-CY). Aims The aims of this study were (1) to document health and functioning in the everyday lives of young children with cancer using ICF-CY codes and (2) to identify a comprehensive code set that can aid clinical assessment. Method Interviews with children diagnosed with cancer and their parents, were transcribed, reviewed for content and coded to the ICF-CY using linking procedures. Results A comprehensive code set (n = 70) for childhood cancer was identified. The majority of content identified to codes was related to activity and participation describing social relations with family, peers and professionals, preschool attendance and play, as well as issues related to support and independence. Conclusions The ICF-CY can be used to document the nature and range of characteristics and consequences of cancer experienced by children. The identified comprehensive code set could be helpful to health care professionals, parents and teachers in assessing and supporting young children’s health and everyday life through the cancer trajectory. The comprehensive code set could be developed as a clinical assessment tool for those caring for young children with cancer. The universal language of the ICF-CY means that the utility of a clinical assessment tool based on identified codes can have wide reaching effects for the care of young children with cancer.

  • 42. Deedwania, PC
    et al.
    Giles, TD
    Klibaner, M
    Ghali, JK
    Herlitz, Johan
    [external].
    Hildebrandt, P
    Kjekshus, J
    Spinar, J
    Vitovec, J
    Stanbrook, H
    Wikstrand, J
    Efficacy, Safety and Tolerability of Metoprolol CR/XL in Patients With Diabetes and Chronic Heart Failure: Experiences From MERIT-HF2005Ingår i: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 149, nr 1, s. 159-167Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The objective of the current study was to examine the efficacy and tolerability of the β-blocker metoprolol succinate controlled release/extended release (CR/XL) in patients with diabetes in the Metoprolol CR/XL Randomized Intervention Trial in Chronic Heart Failure (MERIT-HF). Methods: The Cox proportional hazards model was used to calculate hazard ratios (HR) for convenience expressed as relative risks (risk reduction = 1-HR), and 95% confidence intervals (CI). Results: The risk of hospitalization for heart failure was 76% higher in diabetics compared to non-diabetics (95% CI 38% to 123%). Metoprolol CR/XL was well tolerated and reduced the risk of hospitalization for heart failure by 37% in the diabetic group (95% CI 53% to 15%), and by 35% in the non-diabetic group (95% CI 48% to 19%). Pooling of mortality data from the Cardiac Insufficiency Bisoprolol Study II (CIBIS II), MERIT-HF, and the Carvedilol Prospective Randomized Cumulative Survival Study (COPERNICUS) showed similar survival benefits in patients with diabetes (25%; 95% CI 40% to 4%) and without diabetes (36%; 95% CI 44% to 27%); test of diabetes by treatment interaction was non-significant. Adverse events were reported more often on placebo than on metoprolol CR/XL. Conclusions: Patients with heart failure and diabetes have a much higher risk of hospitalization than patients without diabetes. Regardless of diabetic status, a highly significant reduction in hospitalizations for heart failure was observed with metoprolol CR/XL therapy, which was very well tolerated also by patients with diabetes. Furthermore, the pooled data showed a statistically significant survival benefit in patients with diabetes.

  • 43.
    Djarv, T
    et al.
    Karolinska University Hospital.
    Axelsson, Christer
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Stromsoe, A
    Mälardalen University.
    Israelsson, J
    Linnaeus University.
    Claesson, A
    Linköping University.
    Traumatic cardiac arrest in Sweden 1990-2016 - a population-based national cohort study.2018Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 26, nr 1, artikel-id 30Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Trauma is a main cause of death among young adults worldwide. Patients experiencing a traumatic cardiac arrest (TCA) certainly have a poor prognosis but population-based studies are sparse. Primarily to describe characteristics and 30-day survival following a TCA as compared with a medical out-of-hospital cardiac arrest (medical CA).

    METHODS: A cohort study based on data from the nationwide, prospective population-based Swedish Registry for Cardiopulmonary Resuscitation (SRCR), a medical cardiac arrest registry, between 1990 and 2016. The definition of a TCA in the SRCR is a patient who is unresponsive with apnoea where cardiopulmonary resuscitation and/or defibrillation have been initiated and in whom the Emergency Medical Services (EMS, mainly a nurse-based system) reported trauma as the aetiology. Outcome was overall 30-day survival. Descriptive statistics as well as multivariable logistic regression models were used.

    RESULTS: In all, between 1990 and 2016, 1774 (2.4%) cases had a TCA and 72,547 had a medical CA. Overall 30-day survival gradually increased over the years, and was 3.7% for TCAs compared to 8.2% following a medical CA (p < 0.01). Among TCAs, factors associated with a higher 30-day survival were bystander witnessed and having a shockable initial rhythm (adjusted OR 2.67, 95% C.I. 1.15-6.22 and OR 8.94 95% C.I. 4.27-18.69, respectively).

    DISCUSSION: Association in registry-based studies do not imply causality but TCA had short time intervals in the chain of survival as well as high rates of bystander-CPR.

    CONCLUSION: In a medical CA registry like ours, prevalence of TCAs is low and survival is poor. Registries like ours might not capture the true incidence. However, many individuals do survive and resuscitation in TCAs should not be seen futile.

  • 44. dos Santos, MA
    et al.
    Tygessen, H
    Eriksson, H
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Clinical decision support system (CDSS)-effects on care quality.2014Ingår i: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 27, nr 8, s. 707-718Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: Despite their efficacy, some recommended therapies are underused. The purpose of this paper is to describe clinical decision support system (CDSS) development and its impact on clinical guideline adherence. DESIGN/METHODOLOGY/APPROACH: A new CDSS was developed and introduced in a cardiac intensive care unit (CICU) in 2003, which provided physicians with patient-tailored reminders and permitted data export from electronic patient records into a national quality registry. To evaluate CDSS effects in the CICU, process indicators were compared to a control group using registry data. All CICUs were in the same region and only patients with acute coronary syndrome were included. FINDINGS: CDSS introduction was associated with increases in guideline adherence, which ranged from 16 to 35 per cent, depending on the therapy. Statistically significant associations between guideline adherence and CDSS use remained over the five-year period after its introduction. During the same period, no relapses occurred in the intervention CICU. PRACTICAL IMPLICATIONS: Guideline adherence and healthcare quality can be enhanced using CDSS. This study suggests that practitioners should turn to CDSS to improve healthcare quality. ORIGINALITY/VALUE: This paper describes and evaluates an intervention that successfully increased guideline adherence, which improved healthcare quality when the intervention CICU was compared to the control group.

  • 45. E., Hedberg-Borenstein
    et al.
    Peter, Borenstein
    Göteborgs universitet.
    A., Lundgren
    I., Vidal
    The importance of disconnection and diaschisis in aphasia - A case study1992Ingår i: Scandinavian Journal of Rehabilitation Medicine, Supplement, ISSN 0346-8720, nr 26, s. 81-82Artikel i tidskrift (Refereegranskat)
  • 46.
    Efraimsson, Eva
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Vårdplaneringsmötet som institutionellt samtal2007Konferensbidrag (Övrigt vetenskapligt)
  • 47. Efraimsson, Eva
    Äldreomsorgens grindvakter2007Konferensbidrag (Övrigt vetenskapligt)
  • 48.
    Elfwén, Ludvig
    et al.
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute.
    Lagedal, Rickard
    Department of Surgical Sciences/Anesthesiology and Intensive Care Medicine, Uppsala University.
    James, Stefan
    Uppsala Clinical Research Center and Department of Medical Sciences, Cardiology.
    Jonsson, Martin
    Department of Medicine, Center for Resuscitation Science, Karolinska Institute, Solna.
    Jensen, Ulf
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute.
    Ringh, Mattias
    Department of Medicine, Center for Resuscitation Science, Karolinska Institute, Solna.
    Claesson, Andreas
    Department of Medicine, Center for Resuscitation Science, Karolinska Institute, Solna.
    Oldgren, Jonas
    Uppsala Clinical Research Center and Department of Medical Sciences, Cardiology.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Rubertsson, Sten
    Department of Surgical Sciences/Anesthesiology and Intensive Care Medicine, Uppsala University.
    Nordberg, Per
    Department of Medicine, Center for Resuscitation Science, Karolinska Institute, Solna.
    Coronary angiography in out-of-hospital cardiac arrest without ST elevation on ECG-Short- and long-term survival.2018Ingår i: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 200, s. 90-95, artikel-id S0002-8703(18)30081-4Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The potential benefit of early coronary angiography in out-of-hospital cardiac arrest (OHCA) patients without ST elevation on ECG is unclear. The aim of this study was to evaluate the association between early coronary angiography and survival in these patients.

    METHODS: Nationwide observational study between 2008 and 2013. Included were patients admitted to hospital after witnessed OHCA, with shockable rhythm, age 18 to 80 years and unconscious. Patients with ST-elevation on ECG were excluded. Patients that underwent early CAG (within 24 hours) were compared with no early CAG (later during the hospital stay or not at all). Outcomes were survival at 30 days, 1 year, and 3 years. Multivariate analysis included pre-hospital factors, comorbidity and ECG-findings.

    RESULTS: In total, 799 OHCA patients fulfilled the inclusion criteria, of which 275 (34%) received early CAG versus 524 (66%) with no early CAG. In the early CAG group, the proportion of patients with an occluded coronary artery was 27% and 70% had at least one significant coronary stenosis (defined as narrowing of coronary lumen diameter of ≥50%). The 30-day survival rate was 65% in early CAG group versus 52% with no early CAG (P < .001). The adjusted OR was 1.42 (95% CI 1.00-2.02). The one-year survival rate was 62% in the early CAG group versus 48% in the no early CAG group with the adjusted hazard ratio of 1.35 (95% CI 1.04-1.77).

    CONCLUSION: In this population of bystander-witnessed cases of out-of-hospital cardiac arrest with shockable rhythm and ECG without ST elevation, early coronary angiography may be associated with improved short and long term survival.

  • 49. Engdahl, J
    et al.
    Abrahamsson, P
    Bång, A
    [external].
    Lindqvist, J
    Karlsson, T
    Herlitz, Johan
    [external].
    Is hospital care of major importance for outcome after out-of-hospital cardiac arrest? Experience acquired from patients with out-of-hospital cardiac arrest resuscitated by the same Emergency Medical Service and admitted to one of two hospitals over a 16-year period in the municipality of Göteborg2000Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 43, nr 3, s. 201-211Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To describe patient characteristics, hospital investigations and interventions and early mortality among patients being hospitalized after out-of-hospital cardiac arrest in two hospitals. SETTING: Municipality of Göteborg, Sweden. PATIENTS: All patients suffering an out-of-hospital cardiac arrest who were successfully resuscitated and admitted to hospital between 1 October 1980 and 31 December 1996. All patients were resuscitated by the same Emergency Medical Service and admitted alive to one of the two city hospitals in Göteborg. RESULTS: Of 579 patients admitted to Sahlgrenska Hospital, 253 (44%) were discharged alive and of 459 patients admitted to Ostra Hospital, 152 (33%) were discharged alive (P < 0.001). More patients in Sahlgrenska Hospital were still receiving cardiopulmonary resuscitation (CPR) treatment (P = 0.03), but patients in Ostra had a lower systolic blood pressure and higher heart rate on admission. A larger percentage of patients admitted to Sahlgrenska Hospital underwent coronary angiography (P < 0.001), electrophysiological testing (P < 0.001), Holter recording (P < 0.001), echocardiography (P = 0.004), percutaneous transluminal coronary angioplasty (PTCA, P = 0.009), implantation of automatic implantable cardioverter defibrillator (AICD, P = 0.03) and exercise stress tests (P = 0.003). Inhabitants in the catchment area of Ostra Hospital had a less favourable socio-economic profile. CONCLUSION: Survival after out-of-hospital cardiac arrest may be affected by the course of hospital management. Other variables that might influence survival are socio-economic factors and cardiorespiratory status on admission to hospital. Further investigation is called for as more patients are being hospitalised alive after out-of-hospital cardiac arrest.

  • 50. Erhardt, L
    et al.
    Herlitz, Johan
    [external].
    Näslund, U
    Persson, S
    Allt mer komplicerad kombinationsterapi för att angripa ischemisk hjärtsjukdom1989Ingår i: Drugs, ISSN 0012-6667, E-ISSN 1179-1950, Vol. 86, nr 52, s. 495-497Artikel i tidskrift (Refereegranskat)
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