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  • 101. Hofmann, R
    et al.
    James, SK
    Svensson, L
    Witt, N
    Frick, M
    Lindahl, B
    Östlund, O
    Ekelund, U
    Erlinge, D
    Herlitz, J
    University of Borås, School of Health Science.
    Jernberg, T
    DETermination of the role of OXygen in suspected Acute Myocardial Infarction trial2014In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 167, no 3, p. 322-328Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The use of supplemental oxygen in the setting of suspected acute myocardial infarction (AMI) is recommended in international treatment guidelines and established in prehospital and hospital clinical routine throughout the world. However, to date there is no conclusive evidence from adequately designed and powered trials supporting this practice. Existing data are conflicting and fail to clarify the role of supplemental oxygen in AMI. METHODS: A total of 6,600 normoxemic (oxygen saturation [SpO2] ≥90%) patients with suspected AMI will be randomly assigned to either supplemental oxygen 6 L/min delivered by Oxymask (MedCore Sweden AB, Kista, Sweden) for 6 to 12 hours in the treatment group or room air in the control group. Patient inclusion and randomization will take place at first medical contact, either before hospital admission or at the emergency department. The Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies registry will be used for online randomization, allowing inclusion of a broad population of all-comers. Follow-up will be carried out in nationwide health registries and Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies. The primary objective is to evaluate whether oxygen reduces 1-year all-cause mortality. Secondary end points include 30-day mortality, major adverse cardiac events, and health economy. Prespecified subgroups include patients with confirmed AMI and certain risk groups. In a 3-month pilot study, the study concept was found to be safe and feasible. CONCLUSION: The need to clarify the uncertainty of the role of supplemental oxygen therapy in the setting of suspected AMI is urgent. The DETO2X-AMI trial is designed and powered to address this important issue and may have a direct impact on future recommendations.

  • 102.
    Hofmann, Robin
    et al.
    Karolinska Institutet.
    James, Stefan K
    Uppsala University.
    Jernberg, Tomas
    Danderyd Hospital.
    Lindahl, Bertil
    Uppsala University.
    Erlinge, David
    Uppsala University.
    Witt, Nils
    Karolinska Institutet.
    Arefalk, Gabriel
    Karolinska Institutet.
    Frick, Mats
    Karolinska Institutet.
    Alfredsson, Joakim
    Linköping University.
    Nilsson, Lennart
    Linköping University.
    Ravn-Fischer, Annica
    Sahlgrenska University Hospital.
    Omerovic, Elmir
    Sahlgrenska University Hospital.
    Kellerth, Thomas
    Örebro University Hospital.
    Sparv, David
    Uppsala University.
    Ekelund, Ulf
    Lund University.
    Linder, Rickard
    Karolinska Institutet.
    Ekström, Mattias
    Danderyd Hospital.
    Lauermann, Jörg
    Ryhov Hospital, Jönköping.
    Haaga, Urban
    Karlstad Central Hospital.
    Pernow, John
    Karolinska Institutet.
    Östlund, Ollie
    Uppsala University.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Svensson, Leif
    Karolinska Institutet.
    Oxygen Therapy in Suspected Acute Myocardial Infarction.2017In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 377, no 13, p. 1240-1249Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The clinical effect of routine oxygen therapy in patients with suspected acute myocardial infarction who do not have hypoxemia at baseline is uncertain.

    METHODS: In this registry-based randomized clinical trial, we used nationwide Swedish registries for patient enrollment and data collection. Patients with suspected myocardial infarction and an oxygen saturation of 90% or higher were randomly assigned to receive either supplemental oxygen (6 liters per minute for 6 to 12 hours, delivered through an open face mask) or ambient air.

    RESULTS: A total of 6629 patients were enrolled. The median duration of oxygen therapy was 11.6 hours, and the median oxygen saturation at the end of the treatment period was 99% among patients assigned to oxygen and 97% among patients assigned to ambient air. Hypoxemia developed in 62 patients (1.9%) in the oxygen group, as compared with 254 patients (7.7%) in the ambient-air group. The median of the highest troponin level during hospitalization was 946.5 ng per liter in the oxygen group and 983.0 ng per liter in the ambient-air group. The primary end point of death from any cause within 1 year after randomization occurred in 5.0% of patients (166 of 3311) assigned to oxygen and in 5.1% of patients (168 of 3318) assigned to ambient air (hazard ratio, 0.97; 95% confidence interval [CI], 0.79 to 1.21; P=0.80). Rehospitalization with myocardial infarction within 1 year occurred in 126 patients (3.8%) assigned to oxygen and in 111 patients (3.3%) assigned to ambient air (hazard ratio, 1.13; 95% CI, 0.88 to 1.46; P=0.33). The results were consistent across all predefined subgroups.

    CONCLUSIONS: Routine use of supplemental oxygen in patients with suspected myocardial infarction who did not have hypoxemia was not found to reduce 1-year all-cause mortality. (Funded by the Swedish Heart-Lung Foundation and others; DETO2X-AMI ClinicalTrials.gov number, NCT01787110 .).

  • 103.
    Hofmann, Robin
    et al.
    Division of Cardiology, Department of Clinical Science and Education, Karolinska Institutet.
    Witt, Nils
    Division of Cardiology, Department of Clinical Science and Education, Karolinska Institutet.
    Lagerqvist, Bo
    Cardiology, Department of Medical Sciences, Uppsala University, Akademiska Sjukhuset.
    Jernberg, Tomas
    Cardiology, Department of Clinical Sciences, Karolinska Institutet.
    Lindahl, Bertil
    Cardiology, Department of Medical Sciences, Uppsala University, Akademiska Sjukhuset.
    Erlinge, David
    Department of Cardiology, Clinical Sciences, Lund University.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Department of Cardiology, Sahlgrenska University Hospital.
    Alfredsson, Joakim
    Department of Medical and Health Sciences, Linköping University.
    Linder, Rikard
    Cardiology, Department of Clinical Sciences, Karolinska Institutet.
    Omerovic, Elmir
    Department of Cardiology, Sahlgrenska University Hospital.
    Angerås, Oskar
    Department of Cardiology, Sahlgrenska University Hospital.
    Venetsanos, Dimitrios
    Department of Medical and Health Sciences, Linköping University.
    Kellerth, Thomas
    Department of Cardiology, Örebro University Hospital.
    Sparv, David
    Department of Cardiology, Clinical Sciences, Lund University.
    Lauermann, Jörg
    Division of Cardiology, Department of Internal Medicine, Ryhov Hospital.
    Barmano, Neshro
    Division of Cardiology, Department of Internal Medicine, Ryhov Hospital.
    Verouhis, Dinos
    Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital.
    Östlund, Ollie
    Uppsala Clinical Research Center, Uppsala University.
    Svensson, Leif
    Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital.
    James, Stefan K
    Cardiology, Department of Medical Sciences, Uppsala University, Akademiska Sjukhuset.
    Oxygen therapy in ST-elevation myocardial infarction.2018In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 39, no 29, p. 2730-2739Article in journal (Refereed)
    Abstract [en]

    Aims: To determine whether supplemental oxygen in patients with ST-elevation myocardial infarction (STEMI) impacts on procedure-related and clinical outcomes.

    Methods and results: The DETermination of the role of Oxygen in suspected Acute Myocardial Infarction (DETO2X-AMI) trial randomized patients with suspected myocardial infarction (MI) to receive oxygen at 6 L/min for 6-12 h or ambient air. In this pre-specified analysis, we included only STEMI patients who underwent percutaneous coronary intervention (PCI). In total, 2807 patients were included, 1361 assigned to receive oxygen, and 1446 assigned to ambient air. The pre-specified primary composite endpoint of all-cause death, rehospitalization with MI, cardiogenic shock, or stent thrombosis at 1 year occurred in 6.3% (86 of 1361) of patients allocated to oxygen compared to 7.5% (108 of 1446) allocated to ambient air [hazard ratio (HR) 0.85, 95% confidence interval (95% CI) 0.64-1.13; P = 0.27]. There was no difference in the rate of death from any cause (HR 0.86, 95% CI 0.61-1.22; P = 0.41), rate of rehospitalization for MI (HR 0.92, 95% CI 0.57-1.48; P = 0.73), rehospitalization for cardiogenic shock (HR 1.05, 95% CI 0.21-5.22; P = 0.95), or stent thrombosis (HR 1.27, 95% CI 0.46-3.51; P = 0.64). The primary composite endpoint was consistent across all subgroups, as well as at different time points, such as during hospital stay, at 30 days and the total duration of follow-up up to 1356 days.

    Conclusions: Routine use of supplemental oxygen in normoxemic patients with STEMI undergoing primary PCI did not significantly affect 1-year all-cause death, rehospitalization with MI, cardiogenic shock, or stent thrombosis.

  • 104. Hollenberg, J
    et al.
    Bång, Angela
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Lindqvist, J
    Herlitz, Johan
    [external].
    Nordlander, R
    Svensson, L
    Rosenqvist, M
    Difference in survival after out-of-hospital cardiac arrest between the two largest cities in Sweden: a matter of time?2005In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 257, no 3, p. 247-254Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Dramatic differences in survival after out-of-hospital cardiac arrests (OHCA) reported from different geographical locations require analysis. We therefore compared patients with OHCA in the two largest cities in Sweden with regard to various factors at resuscitation and outcome. SETTING: All patients suffering an OHCA in Stockholm and Goteborg between 1 January 2000 and 30 June 2001, in whom cardiopulmonary resuscitation (CPR) was attempted were included in this retrospective analysis. RESULTS: All together, 969 OHCA in Stockholm and 398 in Goteborg were registered during the 18-month study period. There were no differences in terms of age, gender, and percentage of witnessed cases or percentage of patients who had received bystander CPR. However, the percentage of patients with ventricular fibrillation (VF) at arrival of the ambulance crew was 18% in Stockholm versus 31% in Goteborg (P <0.0001). The percentage of patients who were alive 1 month after cardiac arrest was 2.5% in Stockholm versus 6.8% in Goteborg (P=0.0008). Various time intervals such as cardiac arrest to calling for an ambulance, cardiac arrest to the start of CPR and calling for an ambulance to its arrival were all significantly longer in Stockholm than in Goteborg. CONCLUSION: Survival was almost three times higher in Goteborg than in Stockholm amongst patients suffering an OHCA. This is primarily explained by a higher occurrence of VF at the time of arrival of the ambulance crew, which in turn probably is explained by shorter delays in Goteborg. The reason for the difference in time intervals is most likely multifactorial, with a significantly higher ambulance density in Goteborg as one possible explanation.

  • 105. Hollenberg, J
    et al.
    Ringh, M
    Fredman, D
    Nordberg, P
    Herlitz, J
    University of Borås, School of Health Science.
    Rosenqvist, M
    Svensson, L
    replik till Bengt Fagrell: Fler hjärtstartare behövs i samhället2013In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 110, no 19-20, p. 959-Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Fler hjärtstartare behövs, men konceptet behöver utvecklas. Vi måste dessutom finna nya sätt att mobilisera hjärtstartare till platsen för hjärtstoppet.

  • 106. Holmberg, M
    et al.
    Holmberg, S
    Herlitz, Johan
    [external].
    Effect of bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest patients in Sweden.2000In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 47, no 1, p. 59-70Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Information from the Swedish Cardiac Arrest Registry was used to investigate: (a) The proportion of patients suffering an out-of-hospital cardiac arrest who were given bystander cardiopulmonary resuscitation (B-CPR). (b) Where and by whom B-CPR was given. (c) The effect of B-CPR on survival. METHOD: a prospective, observational study of cardiac arrests reported to the Swedish Cardiac Arrest Registry. Analyses were based on standardised reports of out-of-hospital cardiac arrests from ambulance organisations in Sweden, serving 60% of the Swedish population. From 1983 to 1995 approximately 15-20% of the population had been trained in CPR. RESULTS: Of 9877 patients, collected between January 1990 and May 1995, B-CPR was attempted in 36%. In 56% of these cases, the bystanders were lay persons and in 25% they were medical personnel. Most of the arrests took place at home (69%) and only 23% of these patients were given B-CPR in contrast to cardiac arrest in other places where 53% were given CPR. Survival to 1 month was significantly higher in all cases that received B-CPR (8.2 vs. 2.5%). The odds ratio for survival to 1 month with B-CPR was in a logistic regression analysis 2.5 (95% CI 1.9-3.1). CONCLUSIONS: In Sweden, the willingness and ability to perform B-CPR appears to be relatively widespread. More than half of B-CPR was performed by laypersons. B-CPR resulted in a two to threefold increase in survival.

  • 107. Holmgren, CM
    et al.
    Abdon, NJ
    Bergfeldt, LB
    Edvardsson, NG
    Herlitz, J
    University of Borås, School of Health Science.
    Karlsson, T
    Svensson, LG
    Åstrand, BH
    Changes in medication preceededing out-of hopital cardiac arrest where resuscitation was attempted2014In: Journal of Cardiovascular Pharmacology, ISSN 0160-2446, E-ISSN 1533-4023, Vol. 63, no 6, p. 497-503Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To describe recent changes in medication preceding out-of-hospital cardiac arrest (OHCA) where resuscitation was attempted. METHODS: OHCA victims were identified by the Swedish Cardiac Arrest Register and linked by means of their unique 10-digit personal identification numbers to the Prescribed Drug Register. We identified new claimed prescriptions during a 6-month period before the OHCA compared with those claimed in the period 12 to 18 months before. The 7-digit Anatomical Therapeutical Chemical codes of individual drugs were used. The study period was November 2007-January 2011. RESULTS: OHCA victims with drugs were (1) older than those who did not claim any drugs in any period (70 ± 16 years vs. 54 ± 22 years, P < 0.001), (2) more often women (34% vs. 20%, P < 0.001), and (3) had more often a presumed cardiac etiology (67% vs. 54%, P < 0.001). The OHCA victims were less likely to have ventricular tachycardia/ventricular fibrillation as the first recorded rhythm (26% vs. 33%, P < 0.001) or to survive 1 month (9% vs. 17%, P < 0.0001). New prescriptions were claimed by 5122 (71%) of 7243 OHCA victims. The most frequently claimed new drugs were paracetamol (acetaminophen) 10.3%, furosemide 7.8%, and omeprazole 7.6%. Of drugs known or supposed to cause QT prolongation, ciprofloxacin was the most frequent (3.4%) altogether; 16% had a new claimed prescription of a drug included in the "qtdrugs.org" lists. CONCLUSIONS: Most OHCA victims had new drugs prescribed within 6 months before the event but most often intended for diseases other than cardiac. No claims can be made as to the causality.

  • 108. Holmgren, CM
    et al.
    Abdon, NJ
    Bergfeldt, LB
    Edvardsson, NG
    Herlitz, Johan
    University of Borås, School of Health Science.
    Karlsson, T
    Svensson, LG
    Astrand, BH
    Changes in medication preceding out-of-hospital cardiac arrest where resuscitation was attempted2014In: Journal of Cardiovascular Pharmacology, ISSN 0160-2446, E-ISSN 1533-4023, Vol. 63, no 6, p. 497-503Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:: To describe recent changes in medication preceding Out-of-Hospital Cardiac Arrest (OHCA) where resuscitation was attempted. METHODS:: OHCA victims were identified by the Swedish Cardiac Arrest Register and linked by means of their unique 10-digit personal identification numbers to the Prescribed Drug Register. We identified new claimed prescriptions during a six month period prior to the OHCA compared with those claimed 12-18 months before. The 7-digit ATC codes of individual drugs were used. The study period was November 2007 to January 2011 RESULTS:: OHCA victims with drugs were older than those who did not claim any drugs in any period (70±16years vs. 54±22 years p<0.001), were more often women (34% vs. 20%, p<0.001) and had more often a presumed cardiac etiology (67% vs. 54% (p<0.001), were less likely to have VT/VF as the first recorded rhythm (26% vs. 33%, p<0.001) or to survive one month (9% vs. 17%, p<0.0001). New prescriptions were claimed by 5122 (71%) of 7243 OHCA victims. The most frequently claimed new drugs were paracetamol (acetaminophen) 10.3%, furosemide 7.8% and omeprazole 7.6%. Of drugs known or supposed to cause QT prolongation, ciprofloxacin was the most frequent (3.4%) altogether; 16% had a new claimed prescription of a drug included in the ¨qtdrugs.org¨ lists. CONCLUSION:: A majority of OHCA victims had new drugs prescribed within six months prior to the event, but most often intended for diseases other than cardiac. No claims can be made as to the causality.

  • 109.
    Holmén, Johan
    et al.
    Department of Anesthesiology and Intensive Care, Queen Silvia’s Children’s Hospital.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Sahlgrenska Academy, University of Gothenburg.
    Axelsson, Christer
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Immediate coronary intervention in prehospital cardiac arrest-Aiming to save lives.2018In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 202, p. 144-147, article id S0002-8703(18)30158-3Article in journal (Refereed)
  • 110.
    Holmén, Johan
    et al.
    Department of Prehospital and Emergency Care, Department of Anaesthesiology and Intensive Care, Queen Silvia's Children's Hospital Sahlgrenska University Hospital.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Jimenez-Herrera, Maria
    Department of Nursing, Universitat Rovira i Virgili Spain.
    Karlsson, Thomas
    Health Metrics Unit, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg.
    Axelsson, Christer
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Passive leg raising in out-of-hospital cardiac arrest.2019In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 137, p. 94-101, article id S0300-9572(18)30888-8Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The use of passive leg raising (PLR) in cardiopulmonary resuscitation (CPR) is sometimes discussed and even recommended. The effect of this intervention has never been properly addressed. We planned to determine whether PLR in out-of-hospital cardiac arrest (OHCA) is associated with an improved survival to 30 days.

    METHODS: In eight districts in western Sweden, we introduced PLR within five minutes after the start of CPR, among patients with OHCA. Patients in whom PLR was not performed, within the same district, served as a control group. Thirty-day survival was the primary endpoint. A propensity score analysis, as well as a standard multivariate analysis, was used to assess possible differences between the two groups.

    RESULTS: We identified 3554 patients with OHCA from the eight districts. Forty-four percent were treated with PLR during CPR. Patients who received PLR differed from those who did not, by having more risk factors for an adverse outcome (fewer crew-witnessed cases, more OHCA at home, a greater need for medication and prolonged delays to treatment). The overall survival to 30 days was 7.9% among patients who received PLR versus 13.5% among those who did not. A comparison of the groups, using propensity score matching, revealed a 30 -day survival of 8.6% in the PLR group versus 8.2% in the control group (odds ratio 1.07; 95% confidence interval 0.80-1.44).

    CONCLUSION: In an observational study, we introduced PLR as an addition to standard treatment in patients with OHCA. We did not find any evidence that this treatment improves survival to 30 days.

  • 111.
    Holmén, Johan
    et al.
    Sahlgrenska University Hospital.
    Hollenberg, Jacob
    Karolinska Institutet.
    Claesson, Andreas
    Karolinska Institutet.
    Herrera, Maria Jiménez
    Sistema Emergències Mèdiques de Catalunya.
    Azeli, Youcef
    Sistema Emergències Mèdiques de Catalunya.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Axelsson, Christer
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Survival in ventricular fibrillation with emphasis on the number of defibrillations in relation to other factors at resuscitation.2017In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 113, p. 33-38, article id S0300-9572(17)30017-5Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Mortality after out of hospital cardiac arrest (OHCA) is high and a shockable rhythm is a key predictor of survival. A concomitant need for repeated shocks appears to be associated with less favorable outcome.

    AIM: To, among patients found in ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT) describe: (a) factors associated with 30-day survival with emphasis on the number of defibrillatory shocks delivered; (b) the distribution of and the characteristics of patients in relation to the number of defibrillatory shocks that were delivered.

    METHODS: Patients who were reported to The Swedish Register for Cardiopulmonary Resuscitation (SRCR) between January 1 1990 and December 31 2015 and who were found in VF/pVT took part in the survey.

    RESULTS: In all there were 19,519 patients found in VF/pVT. The 30-day survival decreased with an increasing number of shocks among all patients regardless of witnessed status and regardless of time period in the survey. In a multivariate analysis there were 12 factors that were associated with the chance of 30-day survival one of which was the number of shocks that was delivered. For each shock that was added the chance of survival decreased. Factors associated with an increased 30-day survival included CPR before arrival of EMS, female sex, cardiac etiology and year of OHCA (increasing survival over years). Factors associated with a decreased chance of 30-day survival included: increasing age, OHCA at home, the use of adrenaline and intubation and an increased delay to CPR, defibrillation and EMS arrival.

    CONCLUSION: Among patients found in VF/pVT, 7.5% required more than 10 shocks. For each shock that was added the chance of 30-day survival decreased. There was an increase in 30-day survival over time regardless of the number of shocks. On top of the number of defibrillations, eleven further factors were associated with 30-day survival.

  • 112. Iglebekk, Wenche
    et al.
    Tjell, Carsten
    Borenstein, Peter
    University of Borås, School of Health Science.
    Pain and other symptoms in patients with chronic benign paroxysmal positional vertigo (BPPV)2013In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 4, no 4, p. 233-240Article in journal (Refereed)
    Abstract [en]

    Background and aim A diagnosis of chronic benign paroxysmal positional vertigo (BPPV) is based on brief attacks of rotatory vertigo and concomitant nystagmus elicited by rapid changes in head position relative to gravity. However, the clinical course of BPPV may vary considerably from a self-limiting to a persisting and/or recurrent disabling problem. The authors’ experience is that the most common complaints of patients with chronic BPPV are nautical vertigo or dizziness with other symptoms including neck pain, headache, widespread musculoskeletal pain, fatigue, and visual disturbances. Trauma is believed to be the major cause of BPPV in individuals younger than fifty years. Chronic BPPV is associated with high morbidity. Since these patients often suffer from pain and do not have rotatory vertigo, their symptoms are often attributed to other conditions. The aim of this study was to investigate possible associations between these symptoms and chronic BPPV. Methods During 2010 a consecutive prospective cohort observational study was performed. Diagnostic criteria: (A) BPPV diagnosis confirmed by the following: (1) a specific history of vertigo/dizziness evoked by acceleration/deceleration, (2) nystagmus in the first position of otolith repositioning maneuvers, and (3) appearing and disappearing nystagmus during the repositioning maneuvers; (B) the disorder has persisted for at least six months. (C) Normal MRI of the cerebrum. Exclusion criteria: (A) Any disorder of the central nervous system (CNS), (B) migraine, (C) active Ménière's disease, and (D) severe eye disorders. Symptom questionnaire (‘yes or no’ answers during a personal interview) and Dizziness Handicap Inventory (DHI) were used. Results We included 69 patients (20 males and 49 females) with a median age of 45 years (range 21–68 years). The median duration of the disease was five years and three months. The video-oculography confirmed BPPV in more than one semicircular canal in all patients. In 15% there was a latency of more than 1 min before nystagmus occurred. The Dizziness Handicap Inventory (DHI) median score was 55.5 (score >60 indicates a risk of fall). Seventy-five percent were on 50–100% sick leave. Eighty-one percent had a history of head or neck trauma. Nineteen percent could not recall any history of trauma. In our cohort, nautical vertigo and dizziness (81%) was far more common than rotatory vertigo (20%). The majority of patients (87%) reported pain as a major symptom: neck pain (87%), headache (75%) and widespread pain (40%). Fatigue (85%), visual disturbances (84%), and decreased concentration ability (81%) were the most frequently reported symptoms. In addition, unexpected findings such as involuntary movements of the extremities, face, neck or torso were found during otolith repositioning maneuvers (12%). We describe one case, as an example, how treatment of his BPPV also resolved his chronic, severe pain condition. Conclusion This observational study demonstrates a likely connection between chronic BPPV and the following symptoms: nautical vertigo/dizziness, neck pain, headache, widespread pain, fatigue, visual disturbances, cognitive dysfunctions, nausea, and tinnitus. Implications Patients with complex pain conditions associated with nautical vertigo and dizziness should be evaluated with the Dizziness Handicap Inventory (DHI)-questionnaire which can identify treatable balance disorders in patients with chronic musculoskeletal pain.

  • 113.
    Israelsson, Johan
    et al.
    Kalmar Maritime Academy.
    Bremer, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Axelsson, Åsa B
    The Sahlgrenska Academy, Gothenburg.
    Cronberg, Tobias
    Lund University.
    Djärv, Therese
    Karolinska Institutet.
    Kristofferzon, Marja-Leena
    Uppsala University.
    Larsson, Ing-Marie
    Uppsala University.
    Lilja, Gisela
    Lund University.
    Sunnerhagen, Katharina S
    University of Gothenburg.
    Wallin, Ewa
    Uppsala University.
    Ågren, Susanna
    Linköping University.
    Åkerman, Eva
    Karolinska Institutet.
    Årestedt, Kristofer
    Kalmar County Hospital.
    Health status and psychological distress among in-hospital cardiac arrest survivors in relation to gender.2017In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 114, p. 27-33, article id S0300-9572(17)30059-XArticle in journal (Refereed)
    Abstract [en]

    AIM: To describe health status and psychological distress among in-hospital cardiac arrest (IHCA) survivors in relation to gender.

    METHODS: This national register study consists of data from follow-up registration of IHCA survivors 3-6 months post cardiac arrest (CA) in Sweden. A questionnaire was sent to the survivors, including measurements of health status (EQ-5D-5L) and psychological distress (HADS).

    RESULTS: Between 2013 and 2015, 594 IHCA survivors were included in the study. The median values for EQ-5D-5L index and EQ VAS among survivors were 0.78 (q1-q3=0.67-0.86) and 70 (q1-q3=50-80) respectively. The values were significantly lower (p<0.001) in women compared to men. In addition, women reported more problems than men in all dimensions of EQ-5D-5L, except self-care. A majority of the respondents reported no problems with anxiety (85.4%) and/or symptoms of depression (87.0%). Women reported significantly more problems with anxiety (p<0.001) and symptoms of depression (p<0.001) compared to men. Gender was significantly associated with poorer health status and more psychological distress. No interaction effects for gender and age were found.

    CONCLUSIONS: Although the majority of survivors reported acceptable health status and no psychological distress, a substantial proportion reported severe problems. Women reported worse health status and more psychological distress compared to men. Therefore, a higher proportion of women may be in need of support. Health care professionals should make efforts to identify health problems among survivors and offer individualised support when needed.

  • 114. Israelsson, Johan
    et al.
    Bremer, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Årestedt, Kristofer
    Health-related quality of life among in-hospital cardiacarrest survivors2015Conference paper (Other academic)
    Abstract [en]

    Purpose: A cardiac arrest can cause brain injury with cognitive dysfunctions, emotional reactions and negative effects on activities in daily life. However, most research has focused on survival and the knowledge about health-related quality of life (HRQoL) among survivors is limited. In addition, almost all studies are performed in an out-of-hospital context. The aim of the current study was therefore to describe HRQoL among in-hospital cardiac arrest (IHCA) survivors.

    Methods: This study has a cross-sectional design. In collaboration with the Swedish national register for cardiopulmonary resuscitation, data was collected 3-6 months after resuscitation by using a questionnaire including EuroQol-5 dimension (EQ-5D), the Hospital Anxiety and Depression Scale (HADS) and single questions on activities in daily life and mental/intellectual recovery. In addition, the Cerebral Performance Category (CPC) was scored.

    Results: In total, 286 IHCA survivors with a mean age of 67±12 were included. A majority of the survivors were men (65%), had a cerebral function of CPC 1 (88%) and had no need of assistance from other people in daily life (70%). A large proportion of the survivors had not made a complete mental and/or intellectual recovery (34%), causing problems in daily life for 65% of them. Pain was the dimension in EQ-5D where most survivors reported problems of some degree (64%). Problems within the dimensions anxiety/depression and mobility were reported by more than half of the survivors (53% vs. 51%). In the dimensions personal care and activities in daily life problems were reported by less than half of the survivors (24% vs. 49%). The individual variations of present health measured by the EQ-VAS were substantial (range 0-100), with a mean value of 67±22. Symptoms of anxiety and depression (measured by HADS) were reported by 15% and 16% respectively.

    Conclusions: Although the majority of the IHCA survivors reported satisfactory HRQoL, the results indicate major individual differences, with a substantial group reporting serious problems. Our findings stress the importance of assessing HRQoL among IHCA survivors and the need of follow-up and structured post cardiac arrest care.

  • 115.
    James, Stefan K
    et al.
    Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University.
    Erlinge, David
    Department of Clinical Sciences, Cardiology, Lund University.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Alfredsson, Joakim
    Department of Medical and Health Sciences and Department of Cardiology, Linköping University.
    Koul, Sasha
    Department of Clinical Sciences, Cardiology, Lund University.
    Fröbert, Ole
    Department of Cardiology, Faculty of Medicine and Health, Örebro University.
    Kellerth, Thomas
    Department of Cardiology, Faculty of Medicine and Health, Örebro University.
    Ravn-Fischer, Annica
    Department of Molecular and Clinical Medicine and Sahlgrenska University Hospital, Department of Cardiology, University of Gothenburg.
    Alström, Patrik
    Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet.
    Östlund, Ollie
    Uppsala Clinical Research Center, Uppsala University.
    Jernberg, Tomas
    Department of Clinical Sciences, Cardiology, Karolinska Institutet, Danderyd Hospital.
    Lindahl, Bertil
    Department of Medical Sciences, Cardiology, Uppsala University.
    Hofmann, Robin
    Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet.
    Effect of Oxygen Therapy on Cardiovascular Outcomes in Relation to Baseline Oxygen Saturation.2019In: JACC: Cardiovascular Interventions, ISSN 1936-8798, E-ISSN 1876-7605, article id S1936-8798(19)31940-5Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The aim of this study was to determine the effect of supplemental oxygen in patients with myocardial infarction (MI) on the composite of all-cause death, rehospitalization with MI, or heart failure related to baseline oxygen saturation. A secondary objective was to investigate outcomes in patients developing hypoxemia.

    BACKGROUND: In the DETO2X-AMI (Determination of the Role of Oxygen in Suspected Acute Myocardial Infarction) trial, 6,629 normoxemic patients with suspected MI were randomized to oxygen at 6 l/min for 6 to 12 hours or ambient air.

    METHODS: The study population of 5,010 patients with confirmed MI was divided by baseline oxygen saturation into a low-normal (90% to 94%) and a high-normal (95% to 100%) cohort. Outcomes are reported within 1 year. To increase power, all follow-up time (between 1 and 4 years) was included post hoc, and interaction analyses were performed with oxygen saturation as a continuous covariate.

    RESULTS: The composite endpoint of all-cause death, rehospitalization with MI, or heart failure occurred significantly more often in patients in the low-normal cohort (17.3%) compared with those in the high-normal cohort (9.5%) (p < 0.001), and most often in patients developing hypoxemia (23.6%). Oxygen therapy compared with ambient air was not associated with improved outcomes regardless of baseline oxygen saturation (interaction p values: composite endpoint, p = 0.79; all-cause death, p = 0.33; rehospitalization with MI, p = 0.86; hospitalization for heart failure, p = 0.35).

    CONCLUSIONS: Irrespective of oxygen saturation at baseline, we found no clinically relevant beneficial effect of routine oxygen therapy in normoxemic patients with MI regarding cardiovascular outcomes. Low-normal baseline oxygen saturation or development of hypoxemia was identified as an independent marker of poor prognosis. (An Efficacy and Outcome Study of Supplemental Oxygen Treatment in Patients With Suspected Myocardial Infarction; NCT01787110).

  • 116. Jonker, Dirk
    et al.
    Rolander, Bo
    Balogh, Istvan
    Sandsjö, Leif
    University of Borås, School of Engineering.
    Ekberg, Kerstin
    Winkel, Jörgen
    Rationalisation in public dental care: Impact on clinical work tasks and mechanical exposure for dentists - a prospective study2013In: Ergonomics, ISSN 0014-0139, E-ISSN 1366-5847, Vol. 56, no 2, p. 303-313Article in journal (Refereed)
    Abstract [en]

    Swedish dentistry has been exposed to frequent rationalisation initiatives during the last half century. Previous research has shown that rationalisation often results in increased risk of developing work-related musculoskeletal disorders, thus reducing sustainability in the production system. In this prospective study, we assessed mechanical exposures among Swedish dentists in relation to specific rationalisations of clinical dental work during a six-year period. Body postures and movements of 12 dentists were assessed by inclinometry synchronised to video recordings of their work. No rationalisation effects could be shown in terms of a reduction in non-value-adding work ('waste'), and at job level, no major differences in mechanical exposure could be shown between baseline and follow-up. CONCLUSION: The present rationalisation measures in dentistry do not seem to result in rationalisation at job level, but may potentially be more successful at the overall dental system level. PRACTITIONER SUMMARY: In contrast to many previous investigations of the mechanical exposure implications of rationalisation, the present rationalisation measures did not increase the level of risk for dentists. It is highlighted that all occupations involved in the production system should be investigated to assess production system sustainability.

  • 117.
    Jonsson, Martin
    et al.
    Center for Resuscitation Science, Department for Medicine, Karolinska Institutet.
    Härkönen, Juho
    Department of Political and Social Sciences, European University Institute.
    Ljungman, Petter
    Institute of Environmental Medicine, Karolinska Institutet.
    Rawshani, Araz
    Department of Molecular and Clinical Medicine, Gothenburg University.
    Nordberg, Per
    Center for Resuscitation Science, Department for Medicine, Karolinska Institutet.
    Svensson, Leif
    Center for Resuscitation Science, Department for Medicine, Karolinska Institutet.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Hollenberg, Jacob
    Center for Resuscitation Science, Department for Medicine, Karolinska Institutet.
    Survival after out-of-hospital cardiac arrest is associated with area-level socioeconomic status.2018In: Heart, ISSN 1355-6037, E-ISSN 1468-201X, article id heartjnl-2018-313838Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Out-of-hospital cardiac arrest (OHCA) is a major cause of death in the Western world. In this study we aimed to investigate the relationship between area-level socioeconomic status (SES) and 30-day survival after OHCA. We hypothesised that high SES at an area level is associated with an improved chance of 30-day survival.

    METHODS: Patients with OHCA in Stockholm County between 1 January 2006 and 31 December 2015 were analysed retrospectively. To quantify area-level SES, we linked the patient's home address to 250 × 250/1000 × 1000 meter grids with aggregated information about income and education. We constructed multivariable logistic regression models in which area-level SES measures were adjusted for age, sex, emergency medical services response time, witnessed status, initial rhythm, aetiology, location and year of cardiac arrest.

    RESULTS: We included 7431 OHCAs. There was significantly greater 30-day survival (p=0.003) in areas with a high proportion of university-educated people. No statistically significant association was seen between median disposable income and 30-day survival. The adjusted OR for 30-day survival among patients in the highest educational quintile was 1.70 (95% CI 1.15 to 2.51) compared with patients in the lowest educational quintile. We found no significant interaction for sex. Positive trend with increasing area-level education was seen in both men and women but the trend was only statistically significant among men (p=0.012) CONCLUSIONS: Survival to 30 days after OHCA is positively associated with the average educational level of the residential area. Area-level income does not independently predict 30-day survival after OHCA.

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  • 118. Jorum, E
    et al.
    Lundberg, Lars
    Torebjörk, E
    Peripheral projections of nociceptive unmyelinated axons in the human peroneal nerve1989In: Journal of Physiology, ISSN 0022-3751, E-ISSN 1469-7793, Vol. 416, no 1, p. 291-301Article in journal (Refereed)
    Abstract [en]

    1. Previous knowledge of the anatomical course of unmyelinated (C) axons along a peripheral nerve has been scarce and has led to the concept of the axons in a constantly interchanging position. 2. Results obtained by microneurography in the peroneal nerve at knee or ankle levels in awake humans demonstrated that the receptive fields of neighbouring C units in the nerve cluster in close vicinity on the skin of the foot or the ankle. These findings indicate that C afferents run closely together throughout large portions of the peripheral nerve. 3. Intraneural microstimulation performed at neural sites where nociceptive C units were recorded induced painful sensations projected to the skin. When the stimulus intensity was increased, there was typically a concentric increase in the area of projected pain, rather than recruitment of several scattered pain projections. This finding further supports the hypothesis of a neighbouring relation of nociceptive C axons within nerve fascicles, implying spatial recruitment of adjacent axons in the nerve with adjacent peripheral projections. 4. A pain locognosia test performed during ischaemic block of impulse conduction in myelinated fibres demonstrated a fairly precise cerebral localization of noxious events on the foot from the input of C afferent fibres alone.

  • 119. Karlson, BW
    et al.
    Hartford, M
    Herlitz, Johan
    [external].
    Prognosis in acute myocardial infarction in relation to gender1994In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 128, no 3, p. 477-483Article in journal (Refereed)
    Abstract [en]

    We studied 921 consecutive patients admitted to a single hospital for acute myocardial infarction during a period of 21 months and related their prognosis to gender. Women (n = 300, 33%) were on average 7 years older (p < 0.001) and more frequently had a previous history of hypertension (p < 0.001) and congestive heart failure (p < 0.001) than did men. They also tended to delay longer in seeking medical treatment and more often presented with only vague symptoms (p < 0.05). The in-hospital mortality for women was 19% versus 12% for men (p < 0.01). Women more often showed signs of congestive heart failure (p < 0.05) despite smaller infarcts as estimated from enzyme levels (p < 0.05). Total mortality during 1 year was 36% in women and 25% in men (p < 0.01). In a multivariate analysis, female gender did not appear as an independent risk factor for death. During 1 year of follow-up no differences in morbidity were observed between the sexes. We conclude that if women fare worse than men after suffering an acute myocardial infarction, the increased mortality is accounted for by older age.

  • 120. Karlson, BW
    et al.
    Herlitz, Johan
    [external].
    Pettersson, P
    Hallgren, P
    Strömbom, U
    Hjalmarson, Å
    One year prognosis in patients hospitalized with a history of unstable angina1993In: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 16, no 5, p. 397-401Article in journal (Refereed)
    Abstract [en]

    The prognosis during 1 year of follow-up in 715 patients admitted to one single hospital due to suspected acute myocardial infarction (AMI) with a history of unstable angina pectoris immediately preceding hospitalization is described. AMI developed in 192 patients (27%) during the first three days and in 255 patients (38%) during the first year. The mortality during hospitalization was 7% (50 patients) and during 1 year 19% (130 patients). Of the nonsurvivors, 54% died of AMI, 28% of congestive heart failure, and 20% of cardiogenic shock. Based on simple clinical parameters on admission to the emergency room, risk indicators for death during the following year could be identified as follows, in the order of significance: high age (p < 0.001), ST-segment depression on admission (p < 0.001), and a history of diabetes mellitus (p < 0.05). At admission to the emergency room, risk indicators for development of AMI during the following year were as follows: initial degree of suspicion of AMI (p < 0.001), electrocardiographic signs of acute ischemia on admission (p < 0.001), ST-segment elevation on admission (p < 0.01), age (p < 0.05), and lack of a previous history of chronic stable angina pectoris (p < 0.05). We conclude that, among patients admitted to hospital due to suspected AMI with a history of unstable angina pectoris immediately preceding hospitalization, 38% developed a confirmed infarction and 19% died during the following year.

  • 121. Karlsson, B W
    et al.
    Dellborg, M
    Gullestad, L
    Åberg, L
    Sugg, J
    Herlitz, J
    University of Borås, School of Health Science.
    A pharmacokinetic and pharmacodynamic comparison of immediate-release metoprolol and extended-release metoprolol CR/XL in patients with suspected acute myocardial infarction: a randomized, open-label study2014In: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 127, no 2, p. 73-82Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Previous metoprolol studies in myocardial infarction patients were performed with immediate-release (IR) metoprolol. This study aims to evaluate if extended-release metoprolol CR/XL once daily gives a similar β-blockade over 24 h compared to multiple dosing of metoprolol IR. METHODS: After 2 days of routine metoprolol treatment, 27 patients with suspected acute myocardial infarction were randomized to open-label treatment with metoprolol IR (50 mg four times daily or 100 mg twice daily) or metoprolol CR/XL 200 mg once daily for 3 days. RESULTS: Metoprolol CR/XL 200 mg once daily gave more pronounced suppression of peak heart rate, with lower peak and less variation in peak to trough plasma levels. There were no differences in AUC between the CR/XL and IR formulations, although the trough plasma metoprolol levels were comparable for metoprolol CR/XL 200 mg once daily and metoprolol IR 50 mg four times daily, but lower for metoprolol IR 100 mg twice daily. Both treatments were well tolerated. CONCLUSIONS: Metoprolol CR/XL 200 mg once daily showed lower peak and less variation in peak to trough plasma levels compared to multiple dosing of metoprolol IR with the same AUC. This was accompanied by a more uniform β-blockade over time, which was reflected by heart rate, and a more pronounced suppression of peak heart rate with similar tolerability. This suggests metoprolol CR/XL may be used as an alternative to metoprolol IR in patients with myocardial infarction.

  • 122. Karlsson, BW
    et al.
    Emanuelsson, H
    Herlitz, Johan
    [external].
    Nilsson, J-E
    Olsson, G
    Evaluation of the antianginal effect of nifedipine: influence of formulation dependent pharmacokinetics1991In: European Journal of Clinical Pharmacology, ISSN 0031-6970, E-ISSN 1432-1041, Vol. 40, no 5, p. 501-506Article in journal (Refereed)
    Abstract [en]

    Nifedipine capsules t.d.s. and an extended release formulation of nifedipine, nifedipine-ER tablets, given once daily in corresponding daily doses, have been compared with placebo in a double-blind, three-way cross-over study in 24 patients with stable angina pectoris. The objective was to study the influence on the antianginal effect of the different pharmacokinetics of several preparations of nifedipine. All patients received concomitant treatment with beta-adrenoceptor blockers. Antianginal efficacy was assessed by a dynamic exercise test at the end of the dosage intervals, i.e. 8 and 24 h after nifedipine capsules and nifedipine-ER, respectively, as well as 6 h after dosing. Six h after dosing the time of onset of chest pain and total exercise time were longer and total work was significantly higher during both nifedipine-ER (plasma concentration 260 nmol/l) and placebo treatment than after nifedipine capsules (plasma concentration 78 nmol/l). Time to 1 mm ST depression was longer during nifedipine-ER than during nifedipine capsule treatment. No significant difference was seen between nifedipine-ER and placebo. At the end of the dosage interval (24 and 8 h after nifedipine-ER and nifedipine capsules, respectively), no significant difference was found between nifedipine-ER (plasma concentration 75 nmol/l) and the other two treatments. However, placebo was superior to nifedipine capsules (plasma concentration 58 nmol/l) both in the time to onset of chest pain and total exercise time. The lack of effect at the end of the dosage interval was probably due to the subtherapeutic plasma nifedipine level.

  • 123. Karlsson, Katarina
    The Children's Action-Reaction Assessment Tool (CARAT) as an observational tool for assessing pain management: An initial validation study with children undergoing needle procedures.2019In: 51 st congress of the international society of paediatrics oncolgy (SIOP), Wiley, 2019, Vol. 66Conference paper (Refereed)
  • 124. Karlsson, Sandra
    et al.
    Ståhl, Fredrik
    University of Borås, School of Health Science.
    Larsson, Dennis
    Molecular diagnostic markers in endometrial carcinoma: an overview2013In: Journal of Oncopathology, ISSN 2052-5931, Vol. 1, no 2, p. 145-150Article in journal (Refereed)
    Abstract [en]

    Endometrial, ovarian, and cervical cancers are three of the most common malignancies of the female reproductive organs and the most common cause of gynecological cancer deaths in the Western world. Approximately 80% or more of endometrial cancers are low-grade, estrogen-dependent, endometrioid adenocarcinoma (type I), whereas 20% are high-grade endometrial carcinomas (type II) associated with poor prognosis. Although endometrial cancer is usually diagnosed at an early stage, still almost 20% of the patients present with advanced disease. Thus, there is a need for highly sensitive markers that can distinguish between high- and low-risk endometrial carcinoma. To date, however, there are no validated molecular markers for endometrial cancer. Recent genomic and proteomic-based anaes show great promise for the discovery of new and more useful biomarkers. In this review, we will discuss the currently reported biomarkers that hold potential as diagnostic tools for endometrial cancer.

  • 125.
    Kauppi, Wivica
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Prehospital dyspnoea; How is the patient assessed and treated- preliminary data from the dyspnoea project2019Conference paper (Refereed)
    Abstract [en]

    Background:

    Patients with respiratory distress (dyspnoea) often seek emergency medical care and are cared for in ambulance. Although dyspnoea is subjective, it has a physiologic basis. Behind the symptom of dyspnoea, several serious medical diagnoses can be hidden and the presence of dyspnoea is also associated with increased mortality. Based on the patient's individual needs and complex illnesses or injuries, the ambulance staff will independently be responsible for advanced care. In caring for these patients, an intertwining between medical and caring assessment are needed. Through medical assessments the ambulance staff tries to identify the underlying cause of dyspnoea. Medical assessments are important in order to make a prioritisation of the patient's condition and need for treatment. But from a caring science perspective, another part in the assessment is to have a patient perspective in order to promote health and wellbeing for the vulnerable patient.  Through a caring conversation, by listening to the patients story, the medical and caring assessment can be safer by providing  information that is relevant but not measureable, for example, diagnosis and treatment goals. The ambulance staff´s ability to intertwine a medical and existential perspective promotes patient´s well-being and relieves suffering.

    Aim

    The overall aim of this project is to explore the healthcare meeting, the assessment and caring of patients with dyspnoea who has been received an ambulance.

    Methods: Quantitative- and qualitative methods

    Importance of the thesis

    This project will increase knowledge and understanding in patients with dyspnoea. Early diagnosis and treatment are crucial to the outcome of this group of patients.

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  • 126.
    Kiraly, Laszlo
    et al.
    Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi.
    Kiraly, Balint
    Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary.
    Szigeti, Krisztian
    Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary.
    Tamas, Csaba Zsolt
    Gottsegen Hungarian Institute of Cardiology, Budapest, Hungary.
    Darányi, Sándor
    University of Borås, Faculty of Librarianship, Information, Education and IT.
    Virtual museum of congenital heart defects: digitization and establishment of a database for cardiac specimens.2019In: Quantitative imaging in medicine and surgery, ISSN 2223-4292, Vol. 9, no 1, p. 115-126Article in journal (Refereed)
    Abstract [en]

    Education and training of morphology for medical students, and professionals specializing in pediatric cardiology and surgery has traditionally been based on hands-on encounter with congenitally malformed cardiac specimens. Large international archives are no longer widely available due to stricter data protection rules, a reduced number of autopsies, attrition rate of existing specimens, and most importantly due to a higher survival rate of patients. Our Cardiac Archive houses about 400 cardiac specimens with congenital heart disease. The collection spans almost 60 years and thus goes back to pre-surgical era. Unfortunately, attrition rate due to desiccation has led to an increased natural decay in recent years. The present multi-institutional project focuses on saving the collection by digitization. Specimens are scanned by high-resolution micro-CT/MRI. Virtual 3D-models are segmented and a comprehensive database is built. We now report an initial feasibility study with six test specimens that provided promising results, however, adequate presentation of the intracardiac anatomy, including septa and cardiac valves requires further refinements. Computer assisted design methods are necessary to overcome consequences of pathological examination, shrinkage and/or distortion of the specimens. For a next step, we anticipate an expandable web-based virtual museum with interactive reference and training tools. Web access for professional third parties will be provided by registration/subscription. In a future phase, segmental wall motion data could be added to virtual models. 3D-printed models may replace actual specimens and serve as hands-on surgical training to elucidate complex morphologies, promote surgical emulation, and extract more accurate procedural knowledge based on such a collection.

  • 127.
    Kleye, Ida
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Darcy, Laura
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Karlsson, Katarina
    Hedén, Lena E
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Sundler, Annelie Johansson
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    "This is the way i want it": Children's strategies for dealing with fear and pain during hospital care2019In: / [ed] Ida Kleye, 2019Conference paper (Refereed)
    Abstract [en]

    Introduction

    The aim of this study was to describe children's self-identified strategies for dealing with fear and pain during hospital care and treatment

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  • 128. Kro, GA
    et al.
    Yli B, M
    Rasmussen, S
    Norèn, H
    Amer-Wåhlin, I
    Rosén, KG
    University of Borås, School of Engineering.
    Stray-Pedersen, B
    Saugstad, OD
    Association between umbilical cord artery pCO₂ and the Apgar score; elevated levels of pCO₂ may be beneficial for neonatal vitality after moderate acidemia.2013In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 92, no 6, p. 662-70Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To determine the association between 5-min Apgar score and umbilical cord artery carbon dioxide tension (pCO₂). DESIGN: Observational study. SETTING: European hospital labor wards. POPULATION: Data from 36,432 newborns ≥36 gestational weeks were obtained from three sources: two trials of monitoring with fetal electrocardiogram (the Swedish randomized controlled trial and the European Union Fetal ECG trial) and Mölndal Hospital data. After validation of the acid-base values, 25,806 5-min Apgar scores were available for analysis. METHODS: Validation of the umbilical cord acid-base values was performed to obtain reliable data. 5-min Apgar score was regressed against cord artery pCO₂ in a polynomial multilevel model. MAIN OUTCOME MEASURES: Five-min Apgar score, umbilical cord pCO₂, pH, and base deficit. RESULTS: Overall, a higher cord artery pCO₂ was found to be associated with lower 5-min Apgar scores. However, among newborns with moderate acidemia, lower umbilical cord artery pCO₂ (≤median pCO₂ for the specific cord artery pH) was associated with lower 5-min Apgar scores, with a relative risk of 2.0 (95% confidence interval: 1.4-2.8) for 5-min Apgar scores 0-6. CONCLUSIONS: Metabolic acidosis affects the newborn's vitality more than respiratory acidosis. In addition, elevated levels of pCO₂ may be beneficial for fetuses with moderate acidemia, and thus cord artery pCO₂ is a factor that should be considered when assessing the compromised newborn.

  • 129.
    Langenskiöld, M
    et al.
    The Sahlgrenska Academy, Gothenburg University.
    Smidfelt, K
    The Sahlgrenska Academy, Gothenburg University.
    Karlsson, A
    The Sahlgrenska Academy, Gothenburg University.
    Bohm, C
    The Sahlgrenska Academy, Gothenburg University.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Nordanstig, J
    The Sahlgrenska Academy, Gothenburg University.
    Weak Links in the Early Chain of Care of Acute Lower Limb Ischaemia in Terms of Recognition and Emergency Management.2017In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 54, no 2, p. 235-240, article id S1078-5884(17)30268-XArticle in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Acute lower limb ischaemia (ALLI) is a potentially fatal, limb threatening medical emergency. Early treatment is essential for a good outcome. The aim was to describe the early chain of care in ALLI focusing on lead times and emergency management in order to identify weak links for improvement.

    METHODS: This was a retrospective, descriptive case study. This study analysed the medical records of all patients with a main discharge diagnosis of ALLI between January 2009 and December 2014. Predetermined emergency care data on lead times, diagnosis recognition, presenting symptoms, emergency care treatment and outcome were collected for patients who were transported by the Emergency Medical Service (EMS) and those who were not.

    RESULTS: In total, 552 medical records were audited of which 195 patients fulfilled the inclusion criteria and were analysed. Among them were 117 (60%) transported by the EMS. The median time from symptom onset to revascularisation was 23 (interquartile range [IQR] 10-55; EMS transported) and 93 (IQR 42-152, not EMS transported) hours (p < .01). The time from symptom onset to arrival in hospital was 5 (IQR 2-26; EMS transported) and 48 (IQR 6-108; not EMS transported) hours. After arrival in hospital, the median time to first doctor evaluation was 51 (IQR 28-90; EMS transported) and 80 (IQR 44-169; not EMS transported) minutes, p = .01. Low molecular weight heparin (LMWH) was given to 72% of patients in the emergency department (ED) and a multivariate analysis showed that the use of LMWH was associated with a more favourable outcome.

    CONCLUSIONS: Both the time spent in the ED and the time from the onset of symptoms to revascularisation were considerably longer than optimal. Time delays in the early treatment chain can mainly be attributed to "patient delay" and a considerable time spent in hospital before revascularisation. The use of LMWH as an integral part of ED management was associated with a better outcome.

  • 130. Libungan, B
    et al.
    Karlsson, T
    Hirleikar, G
    Albertsson, P
    Herlitz, Johan
    University of Borås, School of Health Science.
    Ravn-Fischer, A
    Delay and inequality in Treatment of the very elderly with Suspected Acute Coronary Syndrome2014Conference paper (Refereed)
  • 131.
    Libungan, Berglind
    et al.
    Sahlgrenska University Hospital.
    Karlsson, Thomas
    Sahlgrenska Academy at University of Gothenburg.
    Albertsson, Per
    Sahlgrenska University Hospital.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Elderly patients with myocardial infarction selected for conservative or invasive treatment strategy.2015In: Clinical Interventions in Aging, ISSN 1176-9092, E-ISSN 1178-1998, Vol. 10Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: There are limited data on patients aged >75 years with myocardial infarction (MI), especially those who are treated conservatively.

    HYPOTHESIS: There are important differences in the clinical characteristics and outcome between elderly MI patients selected for invasive or conservative treatment strategy.

    METHODS: A total of 1,413 elderly patients (>75 years old) admitted to Sahlgrenska University Hospital, Gothenburg, Sweden with a final diagnosis of acute MI in 2001 or 2007, were divided into two groups, those who underwent a conservative treatment strategy (conservative group [CG], n=1,169) and those who underwent coronary angiography and were revascularized if indicated (invasive group [IG], n=244).

    RESULTS: Other than higher age in the CG, there were no significant differences in traditional risk factors such as hypertension, diabetes, and smoking in the two groups. A higher proportion of patients in the CG had a history of heart failure and cerebrovascular disease. The hazard ratio (with 95% confidence interval), adjusted for potential confounders, for 5 year mortality in the IG in relation to the CG was 0.49 (0.39, 0.62), P<0.0001. Overall, in the elderly with MI, the proportion who underwent an invasive treatment strategy doubled from 12% in 2001 to 24% in 2007, despite a slightly higher mean age.

    CONCLUSION: Elderly patients with MI in the CG (no coronary angiography), were generally older and a higher proportion had chronic diseases such as congestive heart failure and cerebrovascular disease than those in the IG. Our data suggest that the invasive treatment strategy is associated with better outcome. However, randomized trials will be needed to determine whether revascularization procedures are beneficial in elderly patients with MI, in terms of less symptoms, better outcome, and improved quality of life.

  • 132.
    Libungan, Berglind
    et al.
    Sahlgrenska University Hospital.
    Lindqvist, Jonny
    Sahlgrenska University Hospital.
    Strömsöe, Anneli
    University of Dalarna.
    Nordberg, Per
    Karolinska Institutet.
    Hollenberg, Jacob
    Karolinska Institutet.
    Albertsson, Per
    Sahlgrenska University Hospital.
    Karlsson, Thomas
    Sahlgrenska Academy at University of Gothenburg.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Out-of-hospital cardiac arrest in the elderly: A large-scale population-based study.2015In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 94Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: There is little information on elderly people who suffer from out-of-hospital cardiac arrest (OHCA).

    AIM: To determine 30-day mortality and neurological outcome in elderly patients with OHCA.

    METHODS: OHCA patients ≥ 70 years of age who were registered in the Swedish Cardiopulmonary Resuscitation Register between 1990 and 2013 were included and divided into three age categories (70-79, 80-89, and ≥ 90 years). Multiple logistic regression analyses were performed to identify independent predictors of 30-day survival.

    RESULTS: Altogether, 36,605 cases were included in the study. Thirty-day survival was 6.7% in patients aged 70-79 years, 4.4% in patients aged 80-89 years, and 2.4% in those over 90 years. For patients with witnessed OHCA of cardiac aetiology found in a shockable rhythm, survival was higher: 20%, 15%, and 11%, respectively. In 30-day survivors, the distribution according to the cerebral performance categories (CPC) score at discharge from hospital was similar in the three age groups. In multivariate analysis, in patients over 70 years of age, the following factors were associated with increased chance of 30-day survival: younger age, OHCA outside the home, witnessed OHCA, CPR before arrival of EMS, shockable first-recorded rhythm, and short emergency response time.

    CONCLUSIONS: Advanced age is an independent predictor of mortality in OHCA patients over 70 years of age. However, even in patients above 90 years of age, defined subsets with a survival rate of more than 10% exist. In survivors, the neurological outcome remains similar regardless of age.

  • 133. Lingman, M
    et al.
    Hartford, M
    Karlsson, T
    Herlitz, J
    University of Borås, School of Health Science.
    Rubulis, A
    Caidahl, K
    Bergfeldt, L
    Transient repolarization alterations dominate the initial phase of an acute anterior infarction-a vectorcardiography study2014In: Journal of Electrocardiology, ISSN 0022-0736, E-ISSN 1532-8430, Vol. 47, no 4, p. 478-485Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To study effects of ischemia-reperfusion on ventricular electrophysiology in humans by three-dimensional electrocardiography. METHODS: Fifty-seven patients with first-time acute anterior ST elevation myocardial infarction were monitored from admission and >24h after symptom onset with continuous vectorcardiography (VCG; modified Frank orthogonal leads). Global ventricular depolarization and repolarization (VR) measures were compared at maximum vs. minimum ST vector magnitude (STVM) (median 208; 111-303 vs. 362; 165-1359min after symptom onset). RESULTS: At maximum vs. minimum STVM the Tarea (overall VR dispersion) almost tripled (118 vs. 41μVs; p<0.0001), the T-loop bulginess was 90% greater (Tavplan 0.91 vs 0.48μV; p<0.0001), and Tpeak-end/QT was 39% larger (0.32 vs 0.23; p<0.0001). QRSarea (overall dispersion of depolarization) was 12% larger at maximum STVM, while QRS duration was 10% longer at minimum STVM. CONCLUSIONS: Ischemia-reperfusion was accompanied by profound and transient alterations of VR dispersion, while changes in depolarization were modest and delayed.

  • 134. Lingman, Markus
    et al.
    Hartford, Marianne
    Karlsson, Thomas
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Rubulis, Aigars
    Caidahl, Kenneth
    Bergfeldt, Lennart
    Value of the QRS-T area angle in improving the prediction of sudden cardiac death after acute coronary syndromes.2016In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 218, p. 1-11Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Prediction of sudden cardiac death (SCD) after acute coronary syndromes (ACS) remains a challenge. Although electrophysiology measures obtained by 3-D vectorcardiography (VCG) shortly after ACS may be useful predictors of SCD, they have not been adopted into clinical practice. The main objective of our study was to assess whether the VCG-derived QRS-T area angle (between area vectors) and the QRS-T angle (between maximum vectors) have additional value beyond standard risk factors in predicting SCD after ACS.

    METHODS AND RESULTS: We studied 643 consecutive ACS patients for whom data on VCG and echocardiography during the index hospitalization were available. Seventy-seven patients (12%) died, 37 (6%) from SCD and 21 (3%) from other cardiac causes during the 30-month follow-up. After adjusting for 9 standard risk factors (age, sex, diabetes, previous stroke, left ventricular ejection fraction; and estimated glomerular filtration rate, heart rate, systolic blood pressure<100mmHg, and Killip class>1 on admission), QRS-T area angle and QRS-T angle were shown to have independent predictive value for both SCD and all cardiac deaths. Reclassification analysis showed that both measures had additional predictive value beyond the 9 standard risk factors. For SCD, net reclassification improvements for QRS-T area angle and QRS-T angle were 46% and 45% and relative integrated discriminative improvements were 16% and 13% (vs the average~11% of the 9 standard risk factors).

    CONCLUSIONS: The VCG-derived QRS-T area angle and QRS-T angle improved prediction of SCD after ACS beyond standard risk factors. Further evaluation of their clinical utility and cost-effectiveness is therefore warranted.

  • 135. Lundberg, Lars
    Cold Injury2004In: The British Military Surgery Pocket Book / [ed] P Roberts, British Army , 2004, p. 582-590Chapter in book (Other academic)
  • 136. Lundberg, Lars
    Pain and hyperalgesia in the human skin1992Doctoral thesis, monograph (Other academic)
  • 137. Lundin, Andreas
    et al.
    Djärv, Therese
    Engdahl, Johan
    Hollenberg, Jacob
    Nordberg, Per
    Ravn-Fischer, Annika
    Ringh, Mattias
    Rysz, Susanne
    Svensson, Leif
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Lundgren, Peter
    Drug therapy in cardiac arrest: a review of the literature2016In: European heart journal. Cardiovascular pharmacotherapy, ISSN 2055-6845, Vol. 2, no 1, p. 54-75Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to review the literature on human studies of drug therapy in cardiac arrest during the last 25 years. In May 2015, a systematic literature search was performed in PubMed, Embase, the Cochrane Library, and CRD databases. Prospective interventional and observational studies evaluating a specified drug therapy in human cardiac arrest reporting a clinical endpoint [i.e. return of spontaneous circulation (ROSC) or survival] and published in English 1990 or later were included, whereas animal studies, case series and reports, studies of drug administration, drug pharmacology, non-specified drug therapies, preventive drug therapy, drug administration after ROSC, studies with primarily physiological endpoints, and studies of traumatic cardiac arrest were excluded. The literature search identified a total of 8936 articles. Eighty-eight articles met our inclusion criteria and were included in the review. We identified no human study in which drug therapy, compared with placebo, improved long-term survival. Regarding adrenaline and amiodarone, the drugs currently recommended in cardiac arrest, two prospective randomized placebo-controlled trials, were identified for adrenaline, and one for amiodarone, but they were all underpowered to detect differences in survival to hospital discharge. Of all reviewed studies, only one recent prospective study demonstrated improved neurological outcome with one therapy over another using a combination of vasopressin, steroids, and adrenaline as the intervention compared with standard adrenaline administration. The evidence base for drug therapy in cardiac arrest is scarce. However, many human studies on drug therapy in cardiac arrest have not been powered to identify differences in important clinical outcomes such as survival to hospital discharge and favourable neurological outcome. Efforts are needed to initiate large multicentre prospective randomized clinical trials to evaluate both currently recommended and future drug therapies.

  • 138.
    Lundin, Andreas
    et al.
    Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg.
    Rylander, Christian
    Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg.
    Karlsson, Thomas
    Health Metrics at Sahlgrenska Academy, University of Gothenburg.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Lundgren, Peter
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. peter.lundgren@hb.se.
    Adrenaline, ROSC and survival in patients resuscitated from in-hospital cardiac arrest.2019In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 140, p. 64-71, article id S0300-9572(18)30800-1Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To describe how administration of adrenaline is associated with return of spontaneous circulation (ROSC) and 30-day survival in patients with in-hospital cardiac arrest (IHCA).

    DESIGN: Retrospective observational study.

    SETTING: Analysis of data extracted from a national cardiac arrest registry.

    STUDY POPULATION: Patients >18 years old with IHCA from January 2015 up to June 2017.

    OUTCOME MEASURES: Primary outcomes were ROSC and 30-day survival. Secondary outcome was survival to hospital discharge with a good neurologic outcome defined as cerebral performance category (CPC) score 1-2.

    RESULTS: Of 6033 patients eligible for inclusion, 4055 (67%) received at least one dose of adrenaline. The rate of ROSC was lower in the adrenaline group (72 vs. 98% for shockable rhythm and 50% versus 65% for non-shockable rhythm; p < 0.0001 for both). Patients who had been treated with adrenaline showed a lower rate of 30-day survival (30 vs. 85% for shockable rhythm and 12 vs. 48% for non-shockable rhythm; p < 0.0001 for both). Survival to hospital discharge with a good neurological outcome was lower in the adrenaline group (22 vs. 80% for shockable rhythm and 8 vs. 41% for non-shockable rhythm; p < 0.0001 for both). There was a marked imbalance between the two groups in median duration of cardiopulmonary resuscitation. Stratification by duration of cardiopulmonary resuscitation attenuated the differences in outcomes between treatment groups and in patients with an initial non-shockable rhythm the association between adrenaline and ROSC was reversed to the benefit for adrenaline.

    CONCLUSIONS: In our cohort of 6033 patients retrieved from a national cardiopulmonary resuscitation registry, administration of adrenaline during resuscitation from IHCA was associated with a lower rate of ROSC and 30-day survival.

  • 139. Lundstam, U
    et al.
    Herlitz, Johan
    [external].
    Karlsson, T
    Linden, T
    Wiklund, O
    Serum lipids, lipoprotein(a) level, and apolipoprotein(a) isoforms as prognostic markers in patients with coronary heart disease.2002In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 251, no 2, p. 111-118Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Our objective was to study prognostic factors for death in patients with coronary heart disease (CHD), focusing on serum lipids and lipoproteins. DESIGN AND SUBJECTS: The study subjects were 964 patients with angina pectoris who underwent coronary angiography between 1985 and 1987. Follow-up, including survival and cause of death, was carried out in April 1998. RESULTS: A total of 363 patients died. Increasing age, diabetes and low levels of HDL cholesterol and of apolipoprotein (apo) AI were associated with increased risk of total mortality and cardiac mortality. In men, low levels of LDL cholesterol and of apoB were associated with increased risk of death, but not of cardiac death only; high levels of lipoprotein(a) [Lp(a)] were not associated with increased risk. In women, however, there was a trend towards increased risk with increasing Lp(a) levels (P = 0.054); the smallest isoform of apo(a) was associated with a twofold increase in risk. In women, but not in men, risk decreased with increasing molecular weight of the apo(a) isoforms. CONCLUSIONS: Amongst lipoprotein variables, low levels of HDL cholesterol and of apoAI and the presence of low-molecular weight isoforms of apo(a) are associated with increased risk of death in patients with CHD. Apo(a) isoforms and Lp(a) levels seem to be more important as risk factors amongst women. Low LDL cholesterol and apoB levels were associated with increased risk, but only in men. These findings demonstrate the importance of a gender-specific analysis of risk factors for CHD.

  • 140.
    Magnusson, Carl
    et al.
    Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Karlsson, Thomas
    Health Metrics Unit, Sahlgrenska Academy, University of Gothenburg.
    Axelsson, Christer
    Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg.
    Initial assessment, level of care and outcome among children who were seen by emergency medical services: a prospective observational study.2018In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 26, no 1, article id 88Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The assessment of children in the Emergency Medical Service (EMS) is infrequent representing 5.4% of the patients in an urban area in the western part of Sweden. In Sweden, patients are assessed on scene by an EMS nurse whom independently decides on interventions and level of care. To aid the EMS nurse in the assessment a triage instrument, Rapid Emergency Triage and Treatment System-paediatrics (RETTS-p) developed for Emergency Department (ED) purpose has been in use the last 5 years. The aim of this study was to evaluate the EMS nurse assessment, management, the utilisation of RETTS-p and patient outcome.

    METHODS: A prospective, observational study was performed on 651 children aged < 16 years from January to December 2016. Statistical tests used in the study were Mann-Whitney U test, Fisher's exact test and Spearman's rank statistics.

    RESULTS: The dispatch centre indexed life-threatening priority in 69% of the missions but, of all children, only 6.1% were given a life threatening RETTS-p red colour by the EMS nurse. A total of 69.7% of the children were transported to the ED and, of these, 31.7% were discharged without any interventions. Among the non-conveyed patients, 16 of 197 (8.1%) visited the ED within 72 h but only two were hospitalised. Full triage, including five out of five vital signs measurements and an emergency severity index, was conducted in 37.6% of all children. A triage colour was not present in 146 children (22.4%), of which the majority were non-conveyed. The overall 30-day mortality rate was 0.8% (n = 5) in children 0-15 years.

    CONCLUSIONS: Despite the incomplete use of all vital signs according to the RETTS-p, the EMS nurse assessment of children appears to be adapted to the clinical situation in most cases and the patients appear to be assessed to the appropriate level of care but indicating an over triage. It seems that the RETTS-p with full triage is used selectively in the pre-hospital assessment of children with a risk of death during the first 30 days of less than 1%.

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  • 141. Magnusson, Lennart
    et al.
    Sandman, Lars
    University of Borås, School of Health Science.
    Rosén, Karl Gustaf
    University of Borås, School of Engineering.
    Hanson, Elizabeth
    Extended safety and support systems for people with dementia living at home2014In: Journal of Assistive Technologies, ISSN 1754-9450, E-ISSN 2042-8723, Vol. 8, no 4, p. 188-206Article in journal (Refereed)
    Abstract [en]

    Abstract Purpose – The purpose of this paper is to highlight the complexity surrounding the implementation of advanced electronic tracking, communication and emergency response technologies, namely, an extended safety and support (ESS) system for people with dementia (pwd) living at home. Results are presented from a Swedish demonstration study (2011-2012) conducted in 24 municipalities. Design/methodology/approach – It is a descriptive intervention study with a pre-post test design. Questionnaires were administered to pwd, carers and professionals at the outset and eight months later. ESS logging data were analyzed. Findings – ESS usage rates varied widely. A total of 650 alerts were triggered, mainly when the pwd was outdoors. Activities were reduced amongst pwd, most likely due to a progression of their disease. Carers noted that pwd were more independent than previously on those occasions when they engaged in outdoor activities. Staff considered that nearly half of pwd could remain living at home due to the ESS, compared with a third amongst carers. In total, 50 per cent of carers felt it was justified to equip their relative with an ESS without their explicit consent, compared to one in eight staff. Research limitations/implications – A limitation is the amount of missing data and high drop- out rates. Researchers should recruit pwd earlier in their illness trajectory. A mixed-methods approach to data collection is advisable. Practical implications – Carers played a crucial role in the adoption of ESS. Staff training/supervision about assistive devices and services is recommended. Social implications – Overall, use of ESS for pwd living at home was not an ethical problem. Originality/value – The study included key stakeholder groups and a detailed ethical analysis was conducted.

  • 142. Martinell, L
    et al.
    Herlitz, J
    University of Borås, School of Health Science.
    Lindqvist, J
    Gottfridsson, C
    Factors influencing the decision to ICD implantation in survivors of OHCA and its influence on long term survival.2013In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 84, no 2, p. 213-217Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Knowledge is insufficient of the long-term benefit of an implantable cardioverter defibrillator (ICD) after out of hospital cardiac arrest (OHCA). AIM: To describe the use and factors of importance for outcome in relation to ICD use among survivors of ventricular fibrillation (VF). METHODS: In consecutive patients discharged alive after OHCA in Gothenburg between 1988 and 2008 the long-term prognosis was followed. RESULTS: In all, there were 5443 OHCAs of which 1489 (27%) were hospitalized alive. Of those, 495 (33%) were discharged alive, of which 390 (79%) had shockable rhythm. The use of ICDs increased, but only 58 of 390 (15%) had an ICD. Among patients who received an ICD, the 2-year mortality was 2%, versus 25% of those who did not (p<0.0001). In follow-up (mean 5.5 years; maximum 10 years), the use of an ICD showed a borderline association with mortality (adjusted hazard ratio 0.49; 95% confidence interval, 024-1.01; p=0.052). Patients who had ICD were younger and had better cerebral function compared with patients without. Predictors for mortality were cerebral function at discharge, age, history of heart failure and myocardial infarction and no coronary angiography during hospitalization. CONCLUSION: Among survivors of OHCA caused by VT/VF who had ICD during hospitalization only 2% died during the subsequent 2 years. The use of ICDs was low but increasing. Factors of importance for mortality were cerebral function at the time of discharge, age, history of heart failure and myocardial infarction and no coronary angiography during hospitalization.

  • 143.
    Martinell, Louise
    et al.
    Sahlgrenska Academy, University of Gothenburg.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Karlsson, Thomas
    Sahlgrenska Academy, University of Gothenburg.
    Nielsen, Niklas
    Lund University.
    Rylander, Christian
    Sahlgrenska Academy, University of Gothenburg.
    Mild induced hypothermia and survival after out-of-hospital cardiac arrest.2017In: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 35, no 11, p. 1595-1600, article id S0735-6757(17)30335-2Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Mild induced hypothermia (MIH) was introduced for post cardiac arrest care in Sweden in 2003, based on two clinical trials. This retrospective study evaluated its association with 30-day survival after out-of-hospital cardiac arrest (OHCA) in a Swedish community from 2003 to 2015.

    METHODS: Out of 3680 patients with OHCA, 1100 were hospitalized after return of spontaneous circulation and 871 patients who remained unconscious were included in the analysis. Prehospital data were extracted from the Swedish Registry of Cardiopulmonary Resuscitation and in-hospital data were extracted from clinical records. Propensity score analysis on complete data sets and multivariable logistic regression with multiple imputations to compensate for missing data were performed.

    RESULTS: Unadjusted 30-day survival was 23.5%; 37% in 386/871 (44%) MIH treated and 13% in 485/871 (56%) non-MIH treated patients. Unadjusted odds ratio (OR) for 30-day survival in patients treated with MIH compared to non-MIH treated patients was 3.79 (95% CI 2.71-5.29; p<0.0001). Using stratified propensity score analysis and in addition adjusting for in-hospital factors, 30-day survival was not significantly different in patients treated with MIH compared to non-MIH treated patients; OR 1.33 (95% CI 0.83-2.15; p=0.24). Using multiple imputations to handle missing data yielded a similar adjusted OR of 1.40 (95% CI 0.88-2.22; p=0.15). Good neurologic outcome at hospital discharge was seen in 82% of patients discharged alive.

    CONCLUSION: Treatment with MIH was not significantly associated with increased 30-day survival in patients remaining unconscious after OHCA when adjusting for potential confounders.

  • 144.
    Martinell, Louise
    et al.
    University of Gothenburg.
    Nielsen, Niklas
    Lund University.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Karlsson, Thomas
    University of Gothenburg.
    Horn, Janneke
    University of Amsterdam.
    Wise, Matt P
    University Hospital of Wales.
    Undén, Johan
    Lund University.
    Rylander, Christian
    University of Gothenburg.
    Early predictors of poor outcome after out-of-hospital cardiac arrest.2017In: Critical Care, ISSN 1364-8535, E-ISSN 1466-609X, Vol. 21, no 1, article id 96Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Early identification of predictors for a poor long-term outcome in patients who survive the initial phase of out-of-hospital cardiac arrest (OHCA) may facilitate future clinical research, the process of care and information provided to relatives. The aim of this study was to determine the association between variables available from the patient's history and status at intensive care admission with outcome in unconscious survivors of OHCA.

    METHODS: Using the cohort of the Target Temperature Management trial, we performed a post hoc analysis of 933 unconscious patients with OHCA of presumed cardiac cause who had a complete 6-month follow-up. Outcomes were survival and neurological function as defined by the Cerebral Performance Category (CPC) scale at 6 months after OHCA. After multiple imputations to compensate for missing data, backward stepwise multivariable logistic regression was applied to identify factors independently predictive of a poor outcome (CPC 3-5). On the basis of these factors, a risk score for poor outcome was constructed.

    RESULTS: We identified ten independent predictors of a poor outcome: older age, cardiac arrest occurring at home, initial rhythm other than ventricular fibrillation/tachycardia, longer duration of no flow, longer duration of low flow, administration of adrenaline, bilateral absence of corneal and pupillary reflexes, Glasgow Coma Scale motor response 1, lower pH and a partial pressure of carbon dioxide in arterial blood value lower than 4.5 kPa at hospital admission. A risk score based on the impact of each of these variables in the model yielded a median (range) AUC of 0.842 (0.840-0.845) and good calibration. Internal validation of the score using bootstrapping yielded a median (range) AUC corrected for optimism of 0.818 (0.816-0.821).

    CONCLUSIONS: Among variables available at admission to intensive care, we identified ten independent predictors of a poor outcome at 6 months for initial survivors of OHCA. They reflected pre-hospital circumstances (six variables) and patient status on hospital admission (four variables). By using a simple and easy-to-use risk scoring system based on these variables, patients at high risk for a poor outcome after OHCA may be identified early.

  • 145.
    Maurer, H
    et al.
    University Hospital Schleswig-Holstein.
    Masterson, S
    National University of Ireland Galway.
    Tjelmeland, I B
    Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS).
    Gräsner, J T
    University Hospital Schleswig-Holstein.
    Lefering, R
    Institute for Research in Operative Medicine, Faculty of Medicine, University Witten/Herdecke.
    Böttiger, B W
    University Hospital of Cologne.
    Bossaert, L
    University of Antwerp.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Koster, R
    Academic Medical Center.
    Rosell-Ortiz, F
    Empresa Pública de Emergencias Sanitarias.
    Perkins, G D
    University of Warwick and Heartlands Hospital.
    Wnent, J
    When is a bystander not a bystander any more? A European Survey.2018In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, article id S0300-9572(18)30979-1Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: There is international variation in the rates of bystander cardiopulmonary resuscitation (CPR). 'Bystander CPR' is defined in the Utstein definitions, however, differences in interpretation may contribute to the variation reported. The aim of this cross-sectional survey was to understand how the term 'bystander CPR' is interpreted in Emergency Medical Service (EMS) across Europe, and to contribute to a better definition of 'bystander' for future reference.

    METHODS: During analysis of the EuReCa ONE study, uncertainty about the definition of a 'bystander' emerged. Sixty scenarios were developed, addressing the interpretation of 'bystander CPR'. An electronic version of the survey was sent to 27 EuReCa National Coordinators, who distributed it to EMS representatives in their countries. Results were descriptively analysed.

    RESULTS: 362 questionnaires were received from 23 countries. In scenarios where a layperson arrived on scene by chance and provided CPR, up to 95% of the participants agreed that 'bystander CPR' had been performed. In scenarios that included community response systems, firefighters and/or police personnel, the percentage of agreement that 'bystander CPR' had been performed ranged widely from 16% to 91%. Even in scenarios that explicitly matched examples provided in the Utstein template there was disagreement on the definition.

    CONCLUSION: In this survey, the interpretation of 'bystander CPR' varied, particularly when community response systems including laypersons, firefighters, and/or police personnel were involved. It is suggested that the definition of 'bystander CPR' should be revised to reflect changes in treatment of OHCA, and that CPR before arrival of EMS is more accurately described.

  • 146.
    Mollberg, Margareta
    University of Borås, School of Health Science.
    Comparison of infants with transient and persistent obstetric brachial plexus palsy: differences in obstetric management2007Conference paper (Refereed)
  • 147.
    Mollberg, Margareta
    University of Borås, School of Health Science.
    Obstetric Brachial Plexus Palsy2007Doctoral thesis, monograph (Other academic)
  • 148.
    Mollberg, Margareta
    University of Borås, School of Health Science.
    Obstetriska plexus brachialisskador i relation till den kliniska handläggningen2007Conference paper (Refereed)
  • 149.
    Niklasson, Amanda
    et al.
    Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, The Sahlgrenska Academy, University of Gothenburg.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Jood, Katarina
    Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, The Sahlgrenska Academy, University of Gothenburg.
    Socioeconomic disparities in prehospital stroke care.2019In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 27, no 1, article id 53Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND PURPOSE: Recent studies have revealed socioeconomic disparities in stroke outcomes. Here, we investigated whether prehospital stroke care differs with respect to socioeconomic status (SES).

    METHODS: Consecutive stroke and TIA patients (n = 3006) admitted to stroke units at Sahlgrenska University Hospital, Gothenburg, Sweden, from 1 November 2014 to 31 July 2016, were included. Data on prehospital care were obtained from a local stroke register. Socioeconomic status was classified according to the average level of income and education within each patient's neighbourhood (postcode area).

    RESULTS: The median system delay from calling the emergency medical communication centre (EMCC) to start of brain computed tomography on hospital arrival was 3 h 47 min (95% confidence interval (CI) 3 h 30 min to 4 h 05 min) for patients within the lowest SES tertile and 3 h 17 min (95% CI 3 h 00 min to 3 h 37 min) for the highest tertile (p < 0.05). Patients with a lower SES were less likely to receive the highest priority in the ambulance (p < 0.05) and had lower rates of prehospital recognition of stroke/TIA (p < 0.05) than those with a high SES. No inequities were found concerning EMCC prioritisation or the probability of ambulance transport.

    CONCLUSIONS: We found socioeconomic inequities in prehospital stroke care which could affect the efficacy of acute stroke treatment. The ambulance nurses' ability to recognise stroke/TIA may partly explain the observed inequities.

  • 150. Nishiyama, C
    et al.
    Brown, SP
    May, S
    Iwami, T
    Koster, RW
    Beesems, SG
    Kuisma, M
    Salo, A
    Jacobs, I
    Finn, J
    Sterz, F
    Nurnberger, A
    Smith, K
    Morrison, L
    Olasveengen, TM
    Callaway, CV
    Shin, SD
    Gräsner, JT
    Daya, M
    Ma, MH
    Herlitz, J
    University of Borås, School of Health Science.
    Strömsöe, A
    Aufderheide, TP
    Masterson, S
    Wang, H
    Christenson, J
    Stiell, I
    Davis, D
    Huszti, E
    Nichol, G
    Apples to apples or apples to oranges? International variation in reporting of process and outcome of care for out-of-hospital cardiac arrest2014In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 85, no 11, p. 1599-1609Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Survival after out-of-hospital cardiac arrest (OHCA) varies between communities, due in part to variation in the methods of measurement. The Utstein template was disseminated to standardize comparisons of risk factors, quality of care, and outcomes in patients with OHCA. We sought to assess whether OHCA registries are able to collate common data using the Utstein template. A subsequent study will assess whether the Utstein factors explain differences in survival between emergency medical services (EMS) systems. STUDY DESIGN: Retrospective study. SETTING: This retrospective analysis of prospective cohorts included adults treated for OHCA, regardless of the etiology of arrest. Data describing the baseline characteristics of patients, and the process and outcome of their care were grouped by EMS system, de-identified, and then collated. Included were core Utstein variables and timed event data from each participating registry. This study was classified as exempt from human subjects' research by a research ethics committee. MEASUREMENTS AND MAIN RESULTS: Thirteen registries with 265 first-responding EMS agencies in 13 countries contributed data describing 125,840 cases of OHCA. Variation in inclusion criteria, definition, coding, and process of care variables were observed. Contributing registries collected 61.9% of recommended core variables and 42.9% of timed event variables. Among core variables, the proportion of missingness was mean 1.9±2.2%. The proportion of unknown was mean 4.8±6.4%. Among time variables, missingness was mean 9.0±6.3%. CONCLUSIONS: International differences in measurement of care after OHCA persist. Greater consistency would facilitate improved resuscitation care and comparison within and between communities.

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