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  • 151. 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.

  • 152.
    Norberg Boysen, Gabriella
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Christensson, Lennart
    Jönköping University, Department of Nursing, School of Health Sciences.
    Jutengren, Göran
    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.
    Wireklint Sundström, Birgitta
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Patient trust and patient safety for low-priority patients: A randomized controlled trial pilot study in the prehospital chain of care.2019In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 46, article id 100778Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Patients who call for an ambulance but only have primary care needs do not always get appropriate care. The starting point in this study is that such patients should be assigned to as basic of care as possible, while maintaining high levels of patient trust and patient safety.

    AIM: To evaluate patient trust and patient safety among low-priority ambulance patients referred to care at either the Community Health Centre (CHC) or the Emergency Department (ED).

    METHODS: This randomized controlled trial pilot study compared the level of patient trust and patient safety among low-priority ambulance patients who were randomized into two groups: CHC (n = 105) or ED (n = 83).

    RESULTS: There was a high level of trust in the care received, regardless of whether the patient received care at CHC or ED. Overall 31% fulfilled one or more of the given criteria for potentially jeopardizing patient safety.

    CONCLUSION: Patient selection for the trial indicated a potential limit in patient safety. There was a high level of trust in the care received regardless of whether the patient received care. The accuracy of patient selection for the new care model needs to be further improved with the intention to enhance patient safety even further.

  • 153.
    Nord, Anette
    et al.
    Linköping University.
    Hult, Håkan
    Karolinska Institutet.
    Kreitz-Sandberg, Susanne
    Linköping University.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Svensson, Leif
    Karolinska.
    Nilsson, Lennart
    Linköping University.
    Effect of two additional interventions, test and reflection, added to standard cardiopulmonary resuscitation training on seventh grade students' practical skills and willingness to act: a cluster randomised trial.2017In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 6, article id e014230Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The aim of this research is to investigate if two additional interventions, test and reflection, after standard cardiopulmonary resuscitation (CPR) training facilitate learning by comparing 13-year-old students' practical skills and willingness to act.

    SETTINGS: Seventh grade students in council schools of two municipalities in south-east Sweden.

    DESIGN: School classes were randomised to CPR training only (O), CPR training with a practical test including feedback (T) or CPR training with reflection and a practical test including feedback (RT). Measures of practical skills and willingness to act in a potential life-threatening situation were studied directly after training and at 6 months using a digital reporting system and a survey. A modified Cardiff test was used to register the practical skills, where scores in each of 12 items resulted in a total score of 12-48 points. The study was conducted in accordance with current European Resuscitation Council guidelines during December 2013 to October 2014.

    PARTICIPANTS: 29 classes for a total of 587 seventh grade students were included in the study.

    PRIMARY AND SECONDARY OUTCOME MEASURES: The total score of the modified Cardiff test at 6 months was the primary outcome. Secondary outcomes were the total score directly after training, the 12 individual items of the modified Cardiff test and willingness to act.

    RESULTS: At 6 months, the T and O groups scored 32 (3.9) and 30 (4.0) points, respectively (p<0.001), while the RT group scored 32 (4.2) points (not significant when compared with T). There were no significant differences in willingness to act between the groups after 6 months.

    CONCLUSIONS: A practical test including feedback directly after training improved the students' acquisition of practical CPR skills. Reflection did not increase further CPR skills. At 6-month follow-up, no intervention effect was found regarding willingness to make a life-saving effort.

  • 154.
    Nord, Anette
    et al.
    Linköping Univdersity.
    Svensson, Leif
    Karolinska Institutet.
    Claesson, Andreas
    Karolinska Institutet.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Hult, Håkan
    Karolinska Institutet.
    Kreitz-Sandberg, Susanne
    Linköping University.
    Nilsson, Lennart
    Linköping University.
    The effect of a national web course "Help-Brain-Heart" as a supplemental learning tool before CPR training:: a cluster randomised trial.2017In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 25, no 1, article id 93Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The effectiveness of cardiopulmonary resuscitation (CPR) learning methods is unclear. Our aim was to evaluate whether a web course before CPR training, teaching the importance of recognition of symptoms of stroke and acute myocardial infarction (AMI) and a healthy lifestyle, could influence not only theoretical knowledge but also practical CPR skills or willingness to act in a cardiac arrest situation.

    METHODS: Classes with 13-year-old students were randomised to CPR training only (control) or a web course plus CPR training (intervention). Data were collected (practical test and a questionnaire) directly after training and at 6 months. CPR skills were evaluated using a modified Cardiff test (12-48 points). Knowledge on stroke symptoms (0-7 points), AMI symptoms (0-9 points) and lifestyle factors (0-6 points), and willingness to act were assessed by the questionnaire. The primary endpoint was CPR skills at 6 months. CPR skills directly after training, willingness to act and theoretical knowledge were secondary endpoints. Training and measurements were performed from December 2013 to October 2014.

    RESULTS: Four hundred and thirty-two students were included in the analysis of practical skills and self-reported confidence. The mean score for CPR skills was 34 points after training (control, standard deviation [SD] 4.4; intervention, SD 4.0; not significant [NS]); and 32 points at 6 months for controls (SD 3.9) and 33 points for intervention (SD 4.2; NS). At 6 months, 73% (control) versus 80% (intervention; P = 0.05) stated they would do compressions and ventilation if a friend had a cardiac arrest, whereas 31% versus 34% (NS) would perform both if the victim was a stranger. One thousand, two hundred and thirty-two students were included in the analysis of theoretical knowledge; the mean scores at 6 months for the control and intervention groups were 2.8 (SD 1.6) and 3.2 (SD 1.4) points (P < 0.001) for stroke symptoms, 2.6 (SD 2.0) and 2.9 (SD 1.9) points (P = 0.008) for AMI symptoms and 3.2 (SD 1.2) and 3.4 (SD 1.0) points (P < 0.001) for lifestyle factors, respectively.

    DISCUSSION: Use of online learning platforms is a fast growing technology that increases the flexibility of learning in terms of location, time and is available before and after practical training.

    CONCLUSIONS: A web course before CPR training did not influence practical CPR skills or willingness to act, but improved the students' theoretical knowledge of AMI, stroke and lifestyle factors.

  • 155.
    Nord, Anette
    et al.
    Linköping University.
    Svensson, Leif
    Karolinska Institutet.
    Karlsson, Thomas
    University of Gothenburg.
    Claesson, Andreas
    Karolinska Institutet.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Nilsson, Lennart
    Linköping University.
    Increased survival from out-of-hospital cardiac arrest when off duty medically educated personnel perform CPR compared with laymen.2017In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 120, p. 88-94, article id S0300-9572(17)30586-5Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Bystander cardiopulmonary resuscitation (CPR) has been proved to save lives; however, whether survival is affected by the training level of the bystander is not fully described.

    AIM: To describe if the training level of laymen and medically educated bystanders affect 30-day survival in out-of-hospital cardiac arrests (OHCA).

    METHODS: This observational study included all witnessed and treated cases of bystander CPR reported to the Swedish Registry of Cardiopulmonary Resuscitation between 2010 and 2014. Bystander CPR was divided into two categories: (a) lay-byCPR (non-medically educated) and (b) med-byCPR (off duty medically educated personnel).

    RESULTS: During 2010-2014, 24,643 patients were reported to the OHCA registry, of which 6850 received lay-byCPR and 1444 med-byCPR; 16,349 crew-witnessed and non-witnessed cases and those with missing information were excluded from the analysis. The median interval from collapse to call for emergency medical services was 2min in both groups (p=0.97) and 2min from collapse to start of CPR for lay-byCPR versus 1min for med-byCPR (p<0.0001). There were no significant differences in CPR methods used; 64.3% (lay-byCPR) and 65.7% (med-byCPR) applied compressions and ventilation, respectively (p=0.33). The 30-day survival was 14.7% for lay-byCPR and 17.2% for the med-byCPR group (p=0.02). The odds ratio adjusted for potential confounders regarding survival (med-byCPR versus lay-byCPR) was 1.34 (95% confidence interval, 1.11-1.62; p=0.002).

    CONCLUSIONS: In cases of OHCA, medically educated bystanders initiated CPR earlier and an increased 30-day survival was found compared with laymen bystanders. These results support the need to improve the education programme for laypeople.

  • 156. Nordberg, P
    et al.
    Hollenberg, J
    Rosenqvist, M
    Herlitz, J
    University of Borås, School of Health Science.
    Jonsson, L
    Järnbert-Pettersson,
    Forsberg,
    Dahlqvist,
    Ringh, M
    Svensson, L
    More than double survival in OHCA after the implementation of a Dual Dispatch System is attributable to Prehospital rather than In-hospital Factors2013Conference paper (Refereed)
  • 157. Nordberg, P
    et al.
    Hollenberg, J
    Rosenqvist, M
    Herlitz, J
    University of Borås, School of Health Science.
    Jonsson, M
    Järnbert-Pettersson, H
    Forsberg, s
    Dahlqvist, T
    Ringh, M
    Svensson, L
    The implementation of a dual dispatch system in out-of--hospital cardiac arrest is associated withimproved short and long term survival2014In: European heart journal. Acute cardiovascular care., ISSN 2048-8726, E-ISSN 20488734, Vol. 3, no 4, p. 293-303Article in journal (Refereed)
    Abstract [en]

    AIMS: To determine the impact of a dual dispatch system, using fire fighters as first responders, in out-of-hospital cardiac arrest (OHCA) on short (30 days) and long term (three years) survival, and, to investigate the potential differences regarding in-hospital factors and interventions between the patient groups, such as the use of therapeutic hypothermia and cardiac catheterization. METHODS AND RESULTS: OHCAs from 2004 (historical controls) and 2006-2009 (intervention period) were included. During the intervention period, fire fighters equipped with automated external defibrillators (AEDs) were dispatched in suspected OHCA. Logistic regression analyses of outcome data included: the intervention with dual dispatch, sex, age, location, aetiology, witnessed status, bystander-cardiopulmonary resuscitation, first rhythm and therapeutic hypothermia. In total, 2581 OHCAs were included (historical controls n=620, intervention period n=1961). Fire fighters initiated cardiopulmonary resuscitation and connected an AED before emergency medical services' arrival in 41% of the cases. The median time from dispatch to arrival of first responder or emergency medical services shortened from 7.7 in the control period to 6.7 min in the intervention period (p<0.001). The 30-day survival improved from 3.9% to 7.6% (p=0.001), adjusted odds ratio 2.8 (confidence interval 1.6-4.9). Survival to three years increased from 2.4% to 6.5% (p<0.001), adjusted odds ratio 3.8 (confidence interval 1.9-7.6). In the logistic regression analysis including in-hospital factors we found no outcome benefit of therapeutic hypothermia. CONCLUSIONS: The implementation of a dual dispatch system using fire fighters in OHCA was associated with increased 30-day and three-year survival. No major differences in the in-hospital treatment were seen between the studied patient groups.

  • 158. Nunes, I
    et al.
    Ayres-de-Campos, D
    Kwee, A
    Rosén, KG
    University of Borås, School of Engineering.
    Prolonged saltatory fetal heart rate pattern leading to newborn metabolic acidosis2014In: Clinical and Experimental Obstetrics and Gynecology, ISSN 0390-6663, Vol. 41, no 5, p. 507-11Article in journal (Refereed)
    Abstract [en]

    Purpose: The saltatory pattern, characterized by wide and rapid oscillations of the fetal heart rate (FHR), remains a controversial entity. The authors sought to evaluate whether it could be associated with an adverse fetal outcome. Material and Methods: The authors report a case series of four saltatory patterns occurring in the last 30 minutes before birth in association with cord artery metabolic acidosis, obtained from three large databases of internally acquired FHR tracings. The distinctive characteristics of this pattern were evaluated with the aid of a computer system. Results: All cases were recorded in uneventful pregnancies, with normal birth weight singletons, born vaginally at term. The saltatory pattern lasted between 23 and 44 minutes, exhibited a mean oscillatory amplitude of 45.9 to 80.0 beats per minute (bpm) and a frequency between four and eight cycles per minute. Conclusions: A saltatory pattern exceeding 20 minutes can be associated with the occurrence of fetal metabolic acidosis.

  • 159.
    Nyström, Maria
    University of Borås, School of Health Science.
    A Bridge Between a Lonely Soul and the Surrounding World: A study on Existential Consequences of being Closely Related to a person with Aphasia.2011In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 6, no 4Article in journal (Refereed)
    Abstract [en]

    This study illuminates existential consequences of being closely related to a person suffering from aphasia. Seventeen close relatives were interviewed and their narratives were interpreted with inspiration from Ricoeur, Levinas, Husserl, Winnicot, and Maurice Merleau-Ponty. The emerging interpretations resulted in four themes that illuminate a life characterized by lost freedom, staying, a new form of relationship, and growing strong together with others. An overarching theme suggests that a life together with an aphasic person means being used as a bridge between the aphasic person and the surrounding world. Moreover, it illuminates that a close relative to a person with aphasia is a person who does not leave, despite a heavy burden of lonely responsibility. It is concluded that community services need to fulfill their responsibility of providing support to informal caregivers as suggested by the Swedish lawmakers.

  • 160.
    Nyström, Maria
    University of Borås, School of Health Science.
    Musikterapi med Potential2011In: Framtider - Tidskrift från institutet för framtidsstudier, ISSN 0281-0492, no 4, p. 13-15Article in journal (Other academic)
  • 161.
    Nyström, Maria
    et al.
    University of Borås, School of Health Science.
    Petersson, Gunnar
    Music: Artistic Performance or a Therapeutic Tool. A Study on Differences.2011In: International Journal of Music Education, ISSN 0255-7614, E-ISSN 1744-795X, Vol. 29, no 3, p. 229-240Article in journal (Refereed)
    Abstract [en]

    The aim of this study is to analyze and describe how musicians who are also music therapy students separate music as artistic performance from music as a therapeutic tool. The data consist of 18 written reflections from music therapy students that were analyzed according to a phenomenographic method. The findings are presented as four qualitatively-separated perceptions that describe differences in the purpose, symbolic value, professional competence and perceived reception of music. The underlying meaning is discussed as a difference between intuition and reflection.

  • 162.
    Nyström, Thomas
    et al.
    Division of Endocrinology, Department of Clinical Science and Education, Karolinska Institutet.
    James, Stefan K
    Uppsala Clinical Research Center, Uppsala University, Uppsala.
    Lindahl, Bertil
    Uppsala Clinical Research Center, Uppsala University, Uppsala.
    Erlinge, David
    Cardiology, Department of Clinical Sciences, Lund University.
    Östlund, Ollie
    Uppsala Clinical Research Center, Uppsala University.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Omerovic, Elmir
    Department of Molecular and Clinical Medicine and Sahlgrenska University Hospital Department of Cardiology, University of Gothenburg.
    Mellbin, Linda
    Division of Cardiology, Department of Medicine, Solna, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital.
    Alfredsson, Joakim
    Department of Medical and Health Sciences and Department of Cardiology.
    Fröbert, Ole
    Department of Cardiology, Faculty of Medicine and Health, Örebro University.
    Jernberg, Tomas
    ardiology, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet.
    Hofmann, Robin
    ardiology, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet.
    Oxygen Therapy in Myocardial Infarction Patients With or Without Diabetes: A Predefined Subgroup Analysis From the DETO2X-AMI Trial.2019In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 42, no 11, p. 2032-2041Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To determine the effects of oxygen therapy in myocardial infarction (MI) patients with and without diabetes.

    RESEARCH DESIGN AND METHODS: In the Determination of the Role of Oxygen in Suspected Acute Myocardial Infarction (DETO2X-AMI) trial, 6,629 normoxemic patients with suspected MI were randomized to oxygen at 6 L/min for 6-12 h or ambient air. In this prespecified analysis involving 5,010 patients with confirmed MI, 934 had known diabetes. Oxidative stress may be of particular importance in diabetes, and the primary objective was to study the effect of supplemental oxygen on the composite of all-cause death and rehospitalization with MI or heart failure (HF) at 1 year in patients with and without diabetes.

    RESULTS: = 0.81). There was no statistically significant difference for the individual components of the composite end point or the rate of cardiovascular death up to 1 year. Likewise, corresponding end points in patients without diabetes were similar between the treatment groups.

    CONCLUSIONS: Despite markedly higher event rates in patients with MI and diabetes, oxygen therapy did not significantly affect 1-year all-cause death, cardiovascular death, or rehospitalization with MI or HF, irrespective of underlying diabetes, in line with the results of the entire study.

  • 163.
    Olander, Agnes
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Andersson, Henrik
    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.
    Bremer, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden.
    Ljungström, Lars
    Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg.
    Andersson Hagiwara, Magnus
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Prehospital characteristics among patientswith sepsis: a comparison between patients with or without adverse outcome2019In: BMC Emergency Medicine, ISSN 1471-227X, E-ISSN 1471-227X, article id 19:43Article in journal (Refereed)
    Abstract [en]

    Background: The prehospital care of patients with sepsis are commonly performed by the emergency medical services. These patients may be critically ill and have high in-hospital mortality rates. Unfortunately, few patients with sepsis are identified by the emergency medical services, which can lead to delayed treatment and a worse prognosis. Therefore, early identification of patients with sepsis is important, and more information about the prehospital characteristics that can be used to identify these patients is needed. Based on this lack of information, the objectives of this study were to investigate the prehospital characteristics that are identified while patients withseps is are being transported to the hospital by the emergency medical services, and to compare these values to those of the patients with and without adverse outcomes during their hospital stays.

    Methods: This was a retrospective observational study. The patients’ electronic health records were reviewed and selected consecutively based on the following: retrospectively diagnosed with sepsis and transported to an emergency department by the emergency medical services. Data were collected on demographics, prehospital characteristics and adverse outcomes, defined as the in-hospital mortality or treatment in the intensive care unit, and analysed by independent sample t-test and chi-square. Sensitivity, specificity and likelihood ratio, of prehospital characteristics for predicting or development of adverse outcome were analysed.

    Results: In total, 327 patients were included. Of these, 50 patients had adverse outcomes. When comparing patients with or without an adverse outcome, decreased oxygen saturation and body temperature, increased serumglucose level and altered mental status during prehospital care were found to be associated with an adverse outcome.

    Conclusions: The findings suggests that patients having a decreased oxygen saturation and body temperature, increased serum glucose level and altered mental status during prehospital care are at risk of a poorer patient prognosis and adverse outcome. Recognizing these prehospital characteristics may help to identify patients with sepsis early and improve their long-term outcomes. However further research is required to predict limit values of saturation and serum glucose and to validate the use of prehospital characteristics for adverse outcome in patients with sepsis.

  • 164.
    Peilot, Birgitta
    et al.
    Department of Molecular and Clinical Medicine/Pain Centre, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital.
    Andréll, Paulin
    Department of Molecular and Clinical Medicine/Pain Centre, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital.
    Gottfries, Johan
    Department of Chemistry and Molecular Biology, Gothenburg University.
    Sundler, Annelie Johansson
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Mannheimer, Clas
    Department of Molecular and Clinical Medicine/Pain Centre, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital.
    Vulnerability and Resilience in Patients with Chronic Pain in Occupational Healthcare: A Pilot Study with a Patient-Centered Approach.2018In: Pain Research and Treatment, ISSN 2090-1542, E-ISSN 2090-1550, Vol. 2018, article id 9451313Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim of this pilot study was to describe vulnerability and resilience and possible subgroups in patients with chronic work related musculoskeletal pain in occupational healthcare. A second aim was to evaluate a patient-centered approach.

    Methods: This study was based on consecutive patients with chronic pain, seen by the same physician and sick-listed full or part time three months or longer. They were included during a period of three months. Patient reported outcome measures (PROM) were administered at baseline and at follow-up after 8 months. A patient-centered approach was applied where the patient's whole situation was taken into account.

    Results: A dominance of an insecure dismissing attachment pattern and a subnormal sense of coherence (SOC) was reported both at baseline and at follow-up. The patients (n=38) reported significant improvement of pain severity (p=0.01), pain interference (p=0.001), life control (p=0.01), affective distress (p=0.02), and dysfunction (p=0.001) on the multidimensional pain inventory (MPI) and fewer patients were sick-listed full time at follow-up (13 patients versus 21). By means of multivariate data analyses this change in MPI was confirmed and was also correlated with a significant increase in health related quality of life (HRQoL). Moreover subgroups with different outcome at follow-up were identified according to attachment pattern and subgroups on MPI.

    Conclusion: A patient-centered approach may be of value for patients with chronic pain in occupational healthcare, improving pain and dysfunction. Patients with chronic pain are a heterogeneous group where outcome of treatment might be influenced by individual resilience and/or vulnerability.

  • 165. Peilot, Birgitta
    et al.
    Andréll, Paulin
    Samuelsson, Anita
    Mannheimer, Clas
    Frodi, Ann
    Sundler J, Annelie
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Time to gain trust and change--experiences of attachment and mindfulness-based cognitive therapy among patients with chronic pain and psychiatric co-morbidity.2014In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 9, no 1Article in journal (Refereed)
    Abstract [en]

    The treatment of patients with chronic pain disorders is complex. In the rehabilitation of these patients, coping with chronic pain is seen as important. The aim of this study was to explore the meaning of attachment and mindfulness-based cognitive therapy (CT) among patients with chronic pain and psychiatric co-morbidity. A phenomenological approach within a lifeworld perspective was used. In total, 10 patients were interviewed after completion of 7- to 13-month therapy. The findings reveal that the therapy and the process of interaction with the therapist were meaningful for the patients' well-being and for a better management of pain. During the therapy, the patients were able to initiate a movement of change. Thus, CT with focus on attachment and mindfulness seems to be of value for these patients. The therapy used in this study was adjusted to the patients' special needs, and a trained psychotherapist with a special knowledge of patients with chronic pain might be required.

  • 166. Peker, Y
    et al.
    Glatz, H
    Thunström, E
    Kallryd, A
    Herlitz, Johan
    [external].
    Ejdebäck, J
    Rationale and design of the Randomized Intervention with CPAP in Coronary Artery Disease and Sleep Apnoea--RICCADSA trial.2009In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 43, no 1, p. 24-31Article in journal (Refereed)
    Abstract [en]

    RATIONALE: Obstructive sleep apnoea (OSA) is common in coronary artery disease (CAD) and a possible cause of increased mortality. To date, there is a lack of randomized controlled trials to draw the conclusion that all CAD patients should be investigated for OSA and subsequently be treated with continuous positive airway pressure (CPAP). OBJECTIVE: The Randomized Intervention with CPAP in CAD and OSA (RICCADSA) trial is designed to address if CPAP treatment reduces the combined rate of new revascularization, myocardial infarction, stroke and cardiovascular mortality over a 3-year period in CAD patients with OSA. Secondary outcomes include cardiovascular biomarkers, cardiac function and maximal exercise capacity at 3-month- and 1-year follow-ups. PATIENTS AND METHODS: A sample of 400 CAD patients (100 non-sleepy OSA patients randomized to CPAP, 100 to non-CPAP; 100 sleepy OSA patients on CPAP, and 100 CAD patients without OSA) will be included. So far, 240 patients have been enrolled in the trial since December 31, 2005. CONCLUSION: The RICCADSA trial will contribute to defining the impact of CPAP on prognosis of CAD patients with OSA.

  • 167. Peker, Yüksel
    et al.
    Glantz, Helena
    Eulenburg, Christine
    Wegscheider, Karl
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Thunström, Erik
    Effect of Positive Airway Pressure on Cardiovascular Outcomes in Coronary Artery Disease Patients with Nonsleepy Obstructive Sleep Apnea: The RICCADSA Randomized Controlled Trial2016In: American Journal of Respiratory and Critical Care Medicine, ISSN 1073-449X, E-ISSN 1535-4970, Vol. 194, no 5, p. 613-620Article in journal (Refereed)
    Abstract [en]

    RATIONALE: Obstructive sleep apnea (OSA) is common in patients with coronary artery disease (CAD), many of whom do not report daytime sleepiness. First-line treatment for symptomatic OSA is continuous positive airway pressure (CPAP), but its value in patients without daytime sleepiness is uncertain.

    OBJECTIVES: To determine the effects of CPAP on long-term adverse cardiovascular outcome risk in patients with CAD with nonsleepy OSA.

    METHODS: This single-center, prospective, randomized, controlled, open-label, blinded evaluation trial was conducted between December 2005 and November 2010. Consecutive patients with newly revascularized CAD and OSA (apnea-hypopnea index ≥15/h) without daytime sleepiness (Epworth Sleepiness Scale score <10) were randomized to auto-titrating CPAP (n = 122) or no positive airway pressure (n = 122).

    MEASUREMENTS AND MAIN RESULTS: The primary endpoint was the first event of repeat revascularization, myocardial infarction, stroke, or cardiovascular mortality. Median follow-up was 57 months. The incidence of the primary endpoint did not differ significantly in patients who did versus did not receive CPAP (18.1% vs. 22.1%; hazard ratio, 0.80; 95% confidence interval, 0.46-1.41; P = 0.449). Adjusted on-treatment analysis showed a significant cardiovascular risk reduction in those who used CPAP for ≥4 versus <4 hours per night or did not receive treatment (hazard ratio, 0.29; 95% confidence interval, 0.10-0.86; P = 0.026).

    CONCLUSIONS: Routine prescription of CPAP to patients with CAD with nonsleepy OSA did not significantly reduce long-term adverse cardiovascular outcomes in the intention-to-treat population. There was a significant reduction after adjustment for baseline comorbidities and compliance with the treatment. Clinical trial registered with www.clinicaltrials.gov (NCT 00519597).

  • 168. Petursson, P
    et al.
    Herlitz, J
    University of Borås, School of Health Science.
    Lindqvist, J
    Sjöland, H
    Gudbjörnsdottir, S
    Prevalence and severity of abnormal glucose regulation and its relation to long-term prognosis after coronary artery bypass grafting.2013In: Coronary Artery Disease, ISSN 0954-6928, E-ISSN 1473-5830, Vol. 24, no 7, p. 577-582Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Diabetes is a strong predictor of a poor outcome after coronary artery bypass grafting (CABG). The prevalence of prediabetes and its impact on the prognosis after CABG is not well described. In this study, we evaluated the prevalence and prognostic impact of the different states of abnormal glucose regulation (AGR) after CABG. PATIENTS AND METHODS: In this prospective study, we included 244 patients undergoing CABG. An oral glucose tolerance test was used to stratify patients into three groups: normoglycaemia, prediabetes and diabetes. The primary outcome was a composite of all-cause mortality and hospitalization for a nonfatal cardiovascular event. RESULTS: Among the patients, 86 (35%) were normoglycaemic and 58 (24%) had prediabetes; 100 (41%) patients had diabetes, of whom 28 (28%) had newly diagnosed diabetes on the basis of oral glucose tolerance test. During a mean follow-up period of 5.3 years, 25% of the study population suffered the primary outcome. There was a successive increase in the primary outcome rate from normoglycaemia through prediabetes to diabetes (adjusted hazard ratio 1.40; 95% confidence interval 1.01-1.96; P=0.045). CONCLUSION: With increasing severity of AGR, there is an increasing risk of new cardiovascular events after CABG. AGR is prevalent and predicts a poor outcome after CABG. Systematic screening for AGR seems reasonable to identify these high-risk patients.

  • 169.
    Piscator, Eva
    et al.
    Center for Resuscitation Science, Department of Medicine Solna, Karolinska Institutet and Function of Emergency Medicine Karolinska University Hospital.
    Göransson, Katarina
    Department of Medicine Solna, Karolinska Institutet and Function of Emergency Medicine Karolinska University Hospital.
    Bruchfeld, Samuel
    Function of Emergency Medicine Karolinska University Hospital.
    Hammar, Ulf
    Institute of Environmental Medicine (IMM), Biostatistics, Karolinska Institutet.
    El Gharbi, Sara
    Function of Emergency Medicine Karolinska University Hospital.
    Ebell, Mark
    Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Djärv, Therese
    Center for Resuscitation Science, Department of Medicine Solna, Karolinska Institutet and Function of Emergency Medicine Karolinska University Hospital.
    Predicting neurologically intact survival after in-hospital cardiac arrest-external validation of the Good Outcome Following Attempted Resuscitation score.2018In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 128, p. 63-69, article id S0300-9572(18)30207-7Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: A do-not-attempt-resuscitation order is issued when it is against the wishes of the patient that cardiopulmonary resuscitation is performed, or when the chance of good quality survival is minimal. Therefore it is essential for physicians to make an objective prearrest prediction of the outcome after an in-hospital cardiac arrest (IHCA). Our aim was external validation of the Good Outcome Following Attempted Resuscitation (GO-FAR) score in a population based setting.

    METHODS: The study was based on a retrospective cohort of adult IHCAs in Stockholm County 2013-2014 identified through the Swedish Cardiopulmonary Resuscitation Registry. This registry provided patient and event characteristics and neurological outcome at discharge. Neurologically intact survival is defined as Cerebral Performance Category score (CPC) 1 at discharge. Data for the GO-FAR variables was obtained from manual review of electronic patient records. Model performance was evaluated by measure of discrimination with the area under the receiver operating curve (AUROC) and calibration with assessment of the calibration plot.

    RESULTS: The cohort included 717 patients with neurologically intact survival at discharge of 22%. In complete case analysis (523 cases) AUROC was 0.82 (95% CI 0.78-0.86) indicating good discrimination. The calibration plot showed that the GO-FAR score systematically underestimates the probability of neurologically intact survival.

    CONCLUSION: The GO-FAR score has satisfactory discrimination, but assessment of the calibration shows that neurologically intact survival is systematically underestimated. Therefore, only with caution should it without model update be taken into clinical practice in settings similar to ours.

  • 170.
    Piscator, Eva
    et al.
    Center for Resuscitation Science, Department of Medicine Solna, Karolinska Institutet and Function of Emergency Medicine Solna, Karolinska University Hospital.
    Göransson, Katarina
    Department of Medicine Solna, Karolinska Institutet and Function of Emergency Medicine, Karolinska University Hospital.
    Forsberg, Sune
    Center for Resuscitation Science, Department of Medicine Solna, Karolinska Institutet and Department of Anaesthesiology and Intensive Care.
    Bottai, Matteo
    Unit of Biostatistics, Department of Environmental Medicine (IMM), Karolinska Institutet.
    Ebell, Mark
    Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Djärv, Therese
    Center for Resuscitation Science, Department of Medicine Solna, Karolinska Institutet and Function of Emergency Medicine Solna.
    Prearrest prediction of favourable neurological survival following in-hospital cardiac arrest: The Prediction of outcome for In-Hospital Cardiac Arrest (PIHCA) score.2019In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 143, p. 92-99, article id S0300-9572(19)30568-4Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: A prearrest prediction tool can aid clinicians in consolidating objective findings with clinical judgement and in balance with the values of the patient be a part of the decision process for do-not-attempt-resuscitation (DNAR) orders. A previous prearrest prediction tool for in-hospital cardiac arrest (IHCA) have not performed satisfactory in external validation in a Swedish cohort. Therefore our aim was to develop a prediction model for the Swedish setting.

    METHODS: Model development was based on previous external validation of The Good Outcome Following Attempted Resuscitation (GO-FAR) score, with 717 adult IHCAs. It included redefinition and reduction of predictors, and addition of chronic comorbidity, to create a full model of 9 predictors. Outcome was favourable neurological survival defined as Cerebral Performance Category score 1-2  at discharge. The likelihood of favourable neurological survival was categorised into very low (<1%), low (1-3%) and above low (>3%).

    RESULTS: We called the model the Prediction of outcome for In-Hospital Cardiac Arrest (PIHCA) score. The AUROC was 0.808 (95% CI 0.807-0.810) and calibration was satisfactory. With a cutoff of 3% likelihood of favourable neurological survival sensitivity was 99.4% and specificity 8.4%. Although specificity was limited, predictive value for classification into ≤3% likelihood of favorable neurological survival was high (97.4%) and false classification into ≤3% likelihood of favourable neurological survival was low (0.6%).

    CONCLUSION: The PIHCA score has the potential to be used as an objective tool in prearrest prediction of outcome after IHCA, as part of the decision process for a DNAR order.

  • 171. Ravn-Fischer, A
    et al.
    Karlsson, T
    Johansson, P
    Herlitz, J
    University of Borås, School of Health Science.
    Prehospital ECG signs of acute coronary occlusion are associated with reduced one-year motality2013In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 168, no 4, p. 3594-3598Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: We wanted to evaluate predictors of direct admittance to a coronary care unit (CCU) and predictors of death in patients with suspected acute coronary syndromes (ACS). METHODS: During 2004-2007, all consecutive prehospitally triaged patients with suspected ACS were prospectively included. Prehospital and emergency data were collected at point of care. Data from medical records, ECG-, echocardiography- and laboratory databases was collected retrospectively. RESULTS: In all, 2757 patients were included. Out of these 858 were directly admitted to the CCU or cath/lab. Predictors for direct admittance to the CCU were ST-segment elevation on the initial ECG; odds ratio (OR) 46.11, left bundle branch block; OR 3.30, ongoing symptoms; OR 2.90, current smoking; OR 2.18 and ST-segment depression; OR 2.05. Independent predictors for 1-year mortality were cardiogenic shock; OR 14.40, increasing age OR (per year) 1.08, diabetes; OR 2.09 and chronic heart failure; OR 1.67. ST-segment elevation was associated with a lower 1-year mortality rate; OR 0.52. CONCLUSIONS: Among patients with a suspected ACS, prehospital ECG-signs indicating an acute coronary occlusion were not only a predictor for direct admission to acute coronary care but also a predictor for increased survival. To improve future outcome in acute ischemic heart diseases we must find and treat not only the STEMI's but also the high-risk NSTEMIs that otherwise would have a poor prognosis.

  • 172. Ravn-Fischer, A
    et al.
    Karlsson, T
    Santos, M
    Bergman, B
    Johasson, P
    Herlitz, J
    University of Borås, School of Health Science.
    Chain of care in chest pain-differenes beteen three hospitals in an urban area.2013In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 166, no 2, p. 440-7Article in journal (Refereed)
    Abstract [en]

    AIM: To describe differences in treatment and delay times in acute chest pain at the three hospitals in Göteborg, Sweden. METHODS: All patients admitted to the three hospitals within Sahlgrenska University (SU) (Sahlgrenska: SU/S, Östra: SU/Ö and Mölndal: SU/M) with acute chest pain during 3 months in 2008 were evaluated for diagnosis, early treatment and outcome. RESULTS: In all, 2588 visits by 2393 patients were included (visits n=1253 SU/S; n=853 SU/Ö; n=482 SU/M) of which 50%, 63% and 51% were hospitalised (p<0.0001). Among hospitalised patients, a diagnosis of ACS was reported in 26%, 9% and 22% respectively (p<0.0001). Among ACS patients, 83%, 66% and 57% respectively underwent coronary angiography (p=0.004). The median delay to coronary angiography in ST-elevation myocardial infarction (STEMI) was 42 min at SU/S, 3h 47 min at SU/Ö and 2h 34 min at SU/M (p=0.008). The corresponding values for coronary angiography in unstable coronary artery disease were 42h 7min, 48h 35 min and 123h 42 min (p=0.007). Overall mortality at 30 days was 3.6%, 3.2% and 1.5% (NS) and, at 1 year, it was 9.9%, 9.6% and 7.3% respectively (NS). CONCLUSION: In acute chest pain in the Municipality of Göteborg, there was a marked difference between hospitals in: 1) the percentage of hospitalised patients, 2) the percentage of ACS among hospitalised patients and 3) the delay to and rate of coronary angiography. The clinical consequences of these deviations remain to be proven.

  • 173. Rawshani, A
    et al.
    Larsson, A
    Gelang, C
    Lindqvist, J
    Gellerstedt, M
    Bång, A
    University of Borås, School of Health Science.
    Herlitz, J
    University of Borås, School of Health Science.
    Characteristics and outcome among patients who dial for the EMS due to chest pain2014In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 176, no 3, p. 859-865Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: This study aims to describe patients who called for the emergency medical service (EMS) due to chest discomfort, in relation to gender and age. METHODS: All patients who called the emergency dispatch centre of western Sweden due to chest discomfort, between May 2009 and February 2010, were included. Initial evaluation, aetiology and outcome are described as recorded in the databases at the dispatch centre, the EMS systems and hospitals. Patients were divided into the following age groups: ≤50, 51-64 and ≥65 years. RESULTS: In all, 14,454 cases were enrolled. Equal proportions of men (64%) and women (63%) were given dispatch priority 1. The EMS clinicians gave priority 1 more frequently to men (16% versus 12%) and older individuals (10%, 15% and 14%, respective of age group). Men had a significantly higher frequency of central chest pain (83% versus 81%); circulatory compromise (34% versus 31%); ECG signs of ischaemia (17% versus 11%); a preliminary diagnosis of acute coronary syndrome (40% versus 34%); a final diagnosis of acute myocardial infarction (14% versus 9%) and any potentially life-threatening condition (18% versus 12%). Individuals aged ≥65 years were given a lower priority than individuals aged 51-64 years, despite poorer characteristics and outcome. In all, 78% of cases with a potentially life-threatening condition and 67% of cases that died within 30 days of enrolment received dispatch priority 1. Mortality at one year was 1%, 4% and 18% in each individual age group. CONCLUSION: Men and the elderly were given a disproportionately low priority by the EMS.

  • 174.
    Rawshani, Araz
    et al.
    Sahlgrenska University Hospital.
    Rawshani, Nina
    Sahlgrenska University Hospital.
    Gelang, Carita
    Sahlgrenska University Hospital.
    Andersson, Jan-Otto
    Sahlgrenska University Hospital.
    Larsson, Anna
    University of Gothenburg.
    Bång, Angela
    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.
    Gellerstedt, Martin
    University West.
    Emergency medical dispatch priority in chest pain patients due to life threatening conditions: A cohort study examining circadian variations and impact of the education.2017In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 236, p. 43-48, article id S0167-5273(16)32916-3Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND AIMS: We examined the accuracy in assessments of emergency dispatchers according to their education and time of the day. We examined this in chest pain patients who were diagnosed with a potentially life-threatening condition (LTC) or died within 30days.

    METHODS: Among 2205 persons, 482 died, 1631 experienced an acute coronary syndrome (ACS), 1914 had a LTC. Multivariable logistic regression was used to study how time of the call and the dispatcher's education were associated with the risk of missing to give priority 1 (the highest).

    RESULTS: Among patients who died, a 7-fold increase in odds of missing to give priority 1 was noted at 1.00pm, as compared with midnight. Compared with assistant nurses, odds ratio for dispatchers with no (medical) training was 0.34 (95% CI 0.14 to 0.77). Among patients with an ACS, odds ratio for calls arriving before lunch was 2.02 (95% CI 1.22 to 3.43), compared with midnight. Compared with assistant nurses, odds ratio for operators with no training was 0.23 (95% CI 0.13 to 0.40). Similar associations were noted for those with any LTC. Dispatcher's education was not associated with the patient's survival.

    CONCLUSIONS: In this group of patients, which experience substantial mortality and morbidity, the risk of not obtaining highest dispatch priority was increased up to 7-fold during lunchtime. Dispatch operators without medical education had the lowest risk, compared with nurses and assistant nurses, of missing to give priority 1, at the expense of lower positive predictive value.

    KEY MESSAGES: What is already known about this subject? Use of the emergency medical service (EMS) increases survival among patients with acute coronary syndromes. It is unknown whether the efficiency - as judged by the ability to identify life-threatening cases among patients with chest pain - varies according to the dispatcher's educational level and the time of day. What does this study add? We provide evidence that the dispatcher's education does not influence survival among patients calling the EMS due to chest discomfort. However, medically educated dispatchers are at greatest risk of missing to identify life-threatening cases, which is explained by more parsimonious use of the highest dispatch priority. We also show that the risk of missing life-threatening cases is at highest around lunch time. How might this impact on clinical practice? Dispatch centers are operated differently all over the world and chest discomfort is one of the most frequent symptoms encountered; we provide evidence that it is safe to operate a dispatch center without medically trained personnel, who actually miss fewer cases of acute coronary syndromes. However, non-medically trained dispatchers consume more pre-hospital resources.

  • 175.
    Rawshani, Nina
    et al.
    Sahlgrenska University Hospital.
    Rawshani, Araz
    Sahlgrenska University Hospital.
    Gelang, Carita
    Sahlgrenska University Hospital.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Bång, Angela
    Sahlgrenska University Hospital.
    Andersson, Jan-Otto
    Department of Ambulance and Prehospital Emergency Care.
    Gellerstedt, Martin
    University West.
    Association between use of pre-hospital ECG and 30-day mortality: A large cohort study of patients experiencing chest pain.2017In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 248, p. 77-81, article id S0167-5273(17)30115-8Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In the assessment of patients with chest pain, there is support for the use of pre-hospital ECG in the literature and in the care guidelines. Using propensity score methods, we aim to examine whether the mere acquisition of a pre-hospital ECG among patients with chest pain affects the outcome (30-day mortality).

    METHODS: The association between pre-hospital ECG and 30-day mortality was studied in the overall cohort (n=13151), as well as in the one-to-one matched cohort with 2524 patients not examined with pre-hospital ECG and 2524 patients examined with pre-hospital ECG.

    RESULTS: In the overall cohort, 21% (n=2809) did not undergo an ECG tracing in the pre-hospital setting. Among those who had pain during transport, 14% (n=1159) did not undergo a pre-hospital ECG while 32% (n=1135) of those who did not have pain underwent an ECG tracing. In the overall cohort, the OR for 30-day mortality in patients who had a pre-hospital ECG, as compared with those who did not, was 0.63 (95% CI 0.05-0.79; p<0.001). In the matched cohort, the OR was 0.65 (95% CI 0.49-0.85; p<0.001). Using the propensity score, in the overall cohort, the corresponding HR was 0.65 (95% CI 0.58-0.74).

    CONCLUSION: Using propensity score methods, we provide real-world data demonstrating that the adjusted risk of death was considerably lower among the cases in whoma pre-hospital ECG was used. The PH-ECG is underused among patients with chest discomfort and the mere acquisition of a pre-hospital ECG may reduce mortality.

  • 176. Rawshani, Nina
    et al.
    Rawshani, Araz
    Gelang, Carita
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Bång, Angela
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Andersson, Jan-Otto
    Gellerstedt, Martin
    Could ten questions asked by the dispatch center predict the outcome for patients with chest discomfort?2016In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 209, p. 223-225Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND AIMS: From 2009 to 2010, approximately 14,000 consecutive persons who called for the EMS due to chest discomfort were registered. From the seventh month, dispatchers ask 2285 patient ten pre-specified questions. We evaluate which of these questions was independently able to predict an acute coronary syndrome (ACS), life-threatening condition (LTC) and death.

    METHODS: The questions asked mainly dealt with previous history and type of symptoms, each with yes/no answers. The dispatcher took a decision on priority; 1) immediately with sirens/blue light; 2) EMS on the scene within 30min; 3) normal waiting time.We examined the relationship between the answers to these questions and subsequent dispatch priority, as well as outcome, in terms of ACS, LTC and all-cause mortality.

    RESULTS: 2285 patients (mean age 67years, 49% women) took part, of which 12% had a final diagnosis of ACS and 15% had a LTC. There was a significant relationship between all the ten questions and the priority given by dispatchers. Localisation of the discomfort to the center of the chest, more intensive pain, history of angina or myocardial infarction as well as experience of cold sweat were the most important predictors when evaluating the probability of ACS and LTC. Not breathing normally and having diabetes were related to 30-day mortality.

    CONCLUSIONS: Among individuals, who call for the EMS due to chest discomfort, the intensity and the localisation of the pain, as well as a history of ischemic heart disease, appeared to be the most strongly associated with outcome.

  • 177.
    Ringh, M
    et al.
    Department for Medicine, Center for Resuscitation Science, Karolinska Institutet.
    Hollenberg, J
    Department for Medicine, Center for Resuscitation Science, Karolinska Institutet.
    Palsgaard-Moeller, T
    Emergency Medical Services Copenhagen, University of Copenhagen.
    Svensson, L
    Department for Medicine, Center for Resuscitation Science, Karolinska Institutet.
    Rosenqvist, M
    Department for Medicine, Center for Resuscitation Science, Karolinska Institutet.
    Lippert, F K
    Emergency Medical Services Copenhagen, University of Copenhagen.
    Wissenberg, M
    Emergency Medical Services Copenhagen, University of Copenhagen.
    Malta Hansen, C
    Emergency Medical Services Copenhagen, University of Copenhagen.
    Claesson, A
    Department for Medicine, Center for Resuscitation Science, Karolinska Institutet.
    Viereck, S
    Emergency Medical Services Copenhagen, University of Copenhagen.
    Zijlstra, J A
    Department of Cardiology, Heart Center, Academic Medical Center.
    Koster, R W
    Department of Cardiology, Heart Center, Academic Medical Center.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Blom, M T
    Department of Cardiology, Heart Center, Academic Medical Center.
    Kramer-Johansen, J
    Department of Anaesthesiology Oslo University Hospital and University of Oslo.
    Tan, H L
    Department of Cardiology, Heart Center, Academic Medical Center.
    Beesems, S G
    Department of Cardiology, Heart Center, Academic Medical Center,.
    Hulleman, M
    Department of Cardiology, Heart Center, Academic Medical Center.
    Olasveengen, T M
    Department of Anaesthesiology Oslo University Hospital and University of Oslo.
    Folke, F
    Emergency Medical Services Copenhagen, University of Copenhagen.
    The challenges and possibilities of public access defibrillation.2018In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 283, no 3, p. 238-256Article in journal (Refereed)
    Abstract [en]

    Out-of-hospital cardiac arrest (OHCA) is a major health problem that affects approximately four hundred and thousand patients annually in the United States alone. It is a major challenge for the emergency medical system as decreased survival rates are directly proportional to the time delay from collapse to defibrillation. Historically, defibrillation has only been performed by physicians and in-hospital. With the development of automated external defibrillators (AEDs), rapid defibrillation by nonmedical professionals and subsequently by trained or untrained lay bystanders has become possible. Much hope has been put to the concept of Public Access Defibrillation with a massive dissemination of public available AEDs throughout most Western countries. Accordingly, current guidelines recommend that AEDs should be deployed in places with a high likelihood of OHCA. Despite these efforts, AED use is in most settings anecdotal with little effect on overall OHCA survival. The major reasons for low use of public AEDs are that most OHCAs take place outside high incidence sites of cardiac arrest and that most OHCAs take place in residential settings, currently defined as not suitable for Public Access Defibrillation. However, the use of new technology for identification and recruitment of lay bystanders and nearby AEDs to the scene of the cardiac arrest as well as new methods for strategic AED placement redefines and challenges the current concept and definitions of Public Access Defibrillation. Existing evidence of Public Access Defibrillation and knowledge gaps and future directions to improve outcomes for OHCA are discussed. In addition, a new definition of the different levels of Public Access Defibrillation is offered as well as new strategies for increasing AED use in the society.

  • 178.
    Riva, Gabriel
    et al.
    Center for Resuscitation Science, Department of Medicine Solna, Karolinska Institutet.
    Ringh, Mattias
    Center for Resuscitation Science, Department of Medicine Solna, Karolinska Institutet.
    Jonsson, Martin
    Center for Resuscitation Science, Department of Medicine Solna, Karolinska Institutet.
    Svensson, Leif
    Center for Resuscitation Science, Department of Medicine Solna, Karolinska Institutet.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Claesson, Andreas
    Center for Resuscitation Science, Department of Medicine Solna, Karolinska Institutet.
    Djärv, Therese
    Center for Resuscitation Science, Department of Medicine Solna, Karolinska Institutet.
    Nordberg, Per
    Center for Resuscitation Science, Department of Medicine Solna, Karolinska Institutet.
    Forsberg, Sune
    Center for Resuscitation Science, Department of Medicine Solna, Karolinska Institutet.
    Rubertsson, Sten
    Department of Surgical Sciences, Anesthesiology and Intensive Care Medicine, Uppsala University.
    Nord, Anette
    Center for Resuscitation Science, Department of Medicine Solna, Karolinska Institutet.
    Rosenqvist, Mårten
    Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Section of Cardiology.
    Hollenberg, Jacob
    Center for Resuscitation Science, Department of Medicine Solna, Karolinska Institutet.
    Survival in Out-of-Hospital Cardiac Arrest After Standard Cardiopulmonary Resuscitation or Chest Compressions Only Before Arrival of Emergency Medical Services: Nationwide Study During Three Guideline Periods.2019In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539Article in journal (Refereed)
  • 179. Rolander, Bo
    et al.
    Jonker, Dirk
    Winkel, Jörgen
    Sandsjö, Leif
    University of Borås, School of Engineering.
    Balogh, Istvan
    Svensson, E
    Ekberg, Kerstin
    Working conditions, health and productivity among dentists in Swedish public dental care: a prospective study during a 5-year period of rationalisation2013In: Ergonomics, ISSN 0014-0139, E-ISSN 1366-5847, Vol. 56, no 9, p. 1376-1386Article in journal (Refereed)
    Abstract [en]

    In recent decades, comprehensive rationalisations have been implemented in public dentistry in Sweden. How rationalisations affect working conditions, health and production from a long-term perspective has been poorly investigated. This study aims to analyse changes and associations in dentists' working conditions, health and productivity during a 5-year period. In 2003 and 2008, 65 dentists responded to questionnaires measuring work conditions and health. Treatment times for patients and productivity were tracked in electronic registers. Paired t-tests showed that the number of treated adult patients per dentist increased, and perceived physical working conditions improved while perceived work control and leadership deteriorated. Structural equation modelling showed that physical factors were important for health and productivity. When assessing risks in the work environment, there is a need to understand the interaction of effects on working conditions and health due to rationalisations so as to increase the sustainability of production systems. PRACTITIONER SUMMARY: Dentistry in Sweden has undergone considerable change. Questionnaire surveys with dentists, undertaken in 2003 and 2008, found that the present rationalisations resulted in improved perceived physical working conditions. Aspects of the psychosocial working environment had deteriorated, however. This is a concern as health and workability are important for workplace efficiency.

  • 180.
    Rosén, KG
    University of Borås, School of Engineering.
    ST analysis reviewed2013In: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 209, no 4, p. 394-Article in journal (Other (popular science, discussion, etc.))
    Abstract [en]

    Comment on Effectiveness of electronic fetal monitoring with additional ST analysis in vertex singleton pregnancies at >36 weeks of gestation: an individual participant data metaanalysis

  • 181. Rubertsson, S
    et al.
    Lindgren, E
    Smekal, E
    Östlund, O
    Silverstolpe, J
    Lichtveld, RA
    Boomars, R
    Ahlstedt, B
    Skoog, B
    Kastberg, R
    Halliwell, D
    Box, M
    Herlitz, J
    University of Borås, School of Health Science.
    Karlsten, R
    Mechanical Chest Compressions and Simultanous Defibrillation vs Conventional Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest:the LINC Randomized Trial2014In: Journal of the American Medical Association (JAMA), ISSN 0098-7484, E-ISSN 1538-3598, Vol. 311, no 1Article in journal (Refereed)
    Abstract [en]

    Importance A strategy using mechanical chest compressions might improve the poor outcome in out-of-hospital cardiac arrest, but such a strategy has not been tested in large clinical trials. Objective To determine whether administering mechanical chest compressions with defibrillation during ongoing compressions (mechanical CPR), compared with manual cardiopulmonary resuscitation (manual CPR), according to guidelines, would improve 4-hour survival. Design, Setting, and Participants Multicenter randomized clinical trial of 2589 patients with out-of-hospital cardiac arrest conducted between January 2008 and February 2013 in 4 Swedish, 1 British, and 1 Dutch ambulance services and their referring hospitals. Duration of follow-up was 6 months. Interventions Patients were randomized to receive either mechanical chest compressions (LUCAS Chest Compression System, Physio-Control/Jolife AB) combined with defibrillation during ongoing compressions (n = 1300) or to manual CPR according to guidelines (n = 1289). Main Outcomes and Measures Four-hour survival, with secondary end points of survival up to 6 months with good neurological outcome using the Cerebral Performance Category (CPC) score. A CPC score of 1 or 2 was classified as a good outcome. Results Four-hour survival was achieved in 307 patients (23.6%) with mechanical CPR and 305 (23.7%) with manual CPR (risk difference, –0.05%; 95% CI, –3.3% to 3.2%; P > .99). Survival with a CPC score of 1 or 2 occurred in 98 (7.5%) vs 82 (6.4%) (risk difference, 1.18%; 95% CI, –0.78% to 3.1%) at intensive care unit discharge, in 108 (8.3%) vs 100 (7.8%) (risk difference, 0.55%; 95% CI, –1.5% to 2.6%) at hospital discharge, in 105 (8.1%) vs 94 (7.3%) (risk difference, 0.78%; 95% CI, –1.3% to 2.8%) at 1 month, and in 110 (8.5%) vs 98 (7.6%) (risk difference, 0.86%; 95% CI, –1.2% to 3.0%) at 6 months with mechanical CPR and manual CPR, respectively. Among patients surviving at 6 months, 99% in the mechanical CPR group and 94% in the manual CPR group had CPC scores of 1 or 2. Conclusions and Relevance Among adults with out-of-hospital cardiac arrest, there was no significant difference in 4-hour survival between patients treated with the mechanical CPR algorithm or those treated with guideline-adherent manual CPR. The vast majority of survivors in both groups had good neurological outcomes by 6 months. In clinical practice, mechanical CPR using the presented algorithm did not result in improved effectiveness compared with manual CPR.

  • 182. Rubertsson, S
    et al.
    Silverstolpe, J
    Rehn, L
    Nyman, T
    Lichtveld, R
    Boomars, R
    Bruins, W
    Ahlstedt, B
    Pugiolli, H
    Lindgren, E
    Smekal, D
    Skoog, G
    Kastberg, R
    Lindblad, A
    Halliwell, D
    Box, M
    Arnwald, F
    Hardig, BM
    Chamberlain, D
    Herlitz, J
    University of Borås, School of Health Science.
    Karlsten, R
    The Study Protocol for the LINC (LUCAS in Cardiac Arrest) Study: a study comparing conventional adult out-of-hospital cardiopulmonary resuscitation with a concept with mechanical chest compressions and simultaneous defibrillation2013In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 21, no 5Article in journal (Refereed)
    Abstract [en]

    Background The LUCAS™ device delivers mechanical chest compressions that have been shown in experimental studies to improve perfusion pressures to the brain and heart as well as augmenting cerebral blood flow and end tidal CO2, compared with results from standard manual cardiopulmonary resuscitation (CPR). Two randomised pilot studies in out-of-hospital cardiac arrest patients have not shown improved outcome when compared with manual CPR. There remains evidence from small case series that the device can be potentially beneficial compared with manual chest compressions in specific situations. This multicentre study is designed to evaluate the efficacy and safety of mechanical chest compressions with the LUCAS™ device whilst allowing defibrillation during on-going CPR, and comparing the results with those of conventional resuscitation. Methods/design This article describes the design and protocol of the LINC-study which is a randomised controlled multicentre study of 2500 out-of-hospital cardiac arrest patients. The study has been registered at ClinicalTrials.gov (http://clinicaltrials.gov/ct2/show/NCT00609778?term=LINC&rank=1 webcite). Results Primary endpoint is four-hour survival after successful restoration of spontaneous circulation. The safety aspect is being evaluated by post mortem examinations in 300 patients that may reflect injuries from CPR. Conclusion This large multicentre study will contribute to the evaluation of mechanical chest compression in CPR and specifically to the efficacy and safety of the LUCAS™ device when used in association with defibrillation during on-going CPR.

  • 183. Rubertsson, Sten
    et al.
    Lindgren, Erik
    Smekal, David
    Östlund, Ollie
    Silverstolpe, Johan
    Lichtveld, Robert A
    Boomars, Rene
    Ahlstedt, Björn
    Skoog, Gunnar
    Kastberg, Robert
    Halliwell, David
    Box, Martyn
    Herlitz, Johan
    University of Borås, School of Health Science.
    Karlsten, Rolf
    Mechanical chest compressions and simultanous defibrillationvs conventional cardiopulmonary resuscitationin out-of hospital cardiac arrest:the LINC randomized trial2014In: Journal of the American Medical Association (JAMA), ISSN 0098-7484, E-ISSN 1538-3598, Vol. 311, no 1, p. 53-61Article in journal (Refereed)
    Abstract [en]

    IMPORTANCE: A strategy using mechanical chest compressions might improve the poor outcome in out-of-hospital cardiac arrest, but such a strategy has not been tested in large clinical trials. OBJECTIVE: To determine whether administering mechanical chest compressions with defibrillation during ongoing compressions (mechanical CPR), compared with manual cardiopulmonary resuscitation (manual CPR), according to guidelines, would improve 4-hour survival. DESIGN, SETTING, AND PARTICIPANTS: Multicenter randomized clinical trial of 2589 patients with out-of-hospital cardiac arrest conducted between January 2008 and February 2013 in 4 Swedish, 1 British, and 1 Dutch ambulance services and their referring hospitals. Duration of follow-up was 6 months. INTERVENTIONS: Patients were randomized to receive either mechanical chest compressions (LUCAS Chest Compression System, Physio-Control/Jolife AB) combined with defibrillation during ongoing compressions (n = 1300) or to manual CPR according to guidelines (n = 1289). MAIN OUTCOMES AND MEASURES: Four-hour survival, with secondary end points of survival up to 6 months with good neurological outcome using the Cerebral Performance Category (CPC) score. A CPC score of 1 or 2 was classified as a good outcome. RESULTS: Four-hour survival was achieved in 307 patients (23.6%) with mechanical CPR and 305 (23.7%) with manual CPR (risk difference, -0.05%; 95% CI, -3.3% to 3.2%; P > .99). Survival with a CPC score of 1 or 2 occurred in 98 (7.5%) vs 82 (6.4%) (risk difference, 1.18%; 95% CI, -0.78% to 3.1%) at intensive care unit discharge, in 108 (8.3%) vs 100 (7.8%) (risk difference, 0.55%; 95% CI, -1.5% to 2.6%) at hospital discharge, in 105 (8.1%) vs 94 (7.3%) (risk difference, 0.78%; 95% CI, -1.3% to 2.8%) at 1 month, and in 110 (8.5%) vs 98 (7.6%) (risk difference, 0.86%; 95% CI, -1.2% to 3.0%) at 6 months with mechanical CPR and manual CPR, respectively. Among patients surviving at 6 months, 99% in the mechanical CPR group and 94% in the manual CPR group had CPC scores of 1 or 2. CONCLUSIONS AND RELEVANCE: Among adults with out-of-hospital cardiac arrest, there was no significant difference in 4-hour survival between patients treated with the mechanical CPR algorithm or those treated with guideline-adherent manual CPR. The vast majority of survivors in both groups had good neurological outcomes by 6 months. In clinical practice, mechanical CPR using the presented algorithm did not result in improved effectiveness compared with manual CPR. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00609778.

  • 184.
    Rusner, Marie
    University of Borås, School of Health Science.
    Bipolär sjukdom: ur ett existentiellt perspektiv2012Doctoral thesis, monograph (Other academic)
    Abstract [en]

    Aim: The overall aim was to create knowledge about what it means to live with bipolar disorder from an existential perspective, both for individuals with the diagnosis and for their close relatives. Method: An existential perspective in this context entails that it is explored and described from a lifeworld perspective of individuals who in various ways experience that which is termed as bipolar disorder. The lifeworld phenomenological approach Reflective Lifeworld Research (RLR) was used in the four empirical studies. Meaning-oriented interviews and analysis were conducted following the leading methodological principles of the chosen scientific approach. A synthesis, based on lifeworld hermeneutic existential philosophy, then presents how it is possible to understand the perspective of individuals with bipolar disorder and their close relatives as a coherent whole. Findings and conclusions: A magnitude and complexity of experiencing, which means that life with bipolar disorder is characterized by extra dimensions, specific tension and contradictions, has been elucidated. Knowledge of the meaning of these aspects enables for the persons with the illness and for their close relatives to understand, to put words to, and to communicate how their life is and what they need, which in turn enhances their ability to influence their lives. It also increases the opportunities for professional caregivers to develop care, both in content and organization, so that it can meet the actual needs of those concerned in an adequate way. Living with bipolar disorder means so much more than the usual description with changes between episodes of depression and mania. The diagnosis “bipolar disorder” thus appears to be an inadequate label that only reflects the more obvious and visible dimensions of the illness, while those that characterize life in its entirety remain hidden. The thesis also shows that the importance of the common everyday life of persons with bipolar disorder and their close relatives should be highlighted as the most important factor in a liveable existence. A change in the view of mental health care is thus needed; a change that is characterized by consensus, collaboration and transparent communication between the person with the illness, their close relatives and mental health care. The common goal should be about meeting actual needs, and to strengthen a profound connectedness in order to make everyday life more liveable.

  • 185.
    Rusner, Marie
    et al.
    University of Borås, School of Health Science.
    Carlsson, Gunilla
    University of Borås, School of Health Science.
    Brunt, David
    Nyström, Maria
    University of Borås, School of Health Science.
    The Paradox of Being Both Needed and Rejected: The Existential Meaning of Being Closely Related to a Person with Bipolar Disorder2012In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, ISSN 0161-2840, Vol. 33, no 4, p. 200-208Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to elucidate the existential meaning of being closely related to a person with bipolar disorder. A qualitative, descriptive, and explorative design with a phenomenological meaning-oriented analysis was used. The findings reveal a paradoxical, existential exposure of close relatives to a person with bipolar disorder, being both needed and rejected whilst being overshadowed by the specific changeable nature of bipolar disorder. Psychiatric health care services are recommended to consider changes in attitudes and structures that may facilitate close relatives’ participation in the care and treatment of persons with bipolar disorder.

  • 186. Santos, M
    et al.
    Ravn-Fischer, A
    Karlsson, T
    Herlitz, J
    University of Borås, School of Health Science.
    Bergman, B
    Is early treatment of ac ute chest pain provided sooner to patients who speak the national language2013In: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 25, no 5, p. 582-589Article in journal (Refereed)
    Abstract [en]

    Objective Identify differences in the early treatment of acute chest pain patients with regard to the language proficiency of patients and thus identify opportunities for improving equity in cardiac care. Design Retrospective cross-sectional study comparing care delivered to Swedish-speaking (SS) and non-Swedish-speaking (NSS) patients. Setting A Swedish university hospital that provides highly specialized care to 1.6 million inhabitants. Participants All patients with acute chest pain or symptoms suggestive of acute coronary syndrome who sought care between mid-September and mid-December 2008 (2588 visits). Missing data on the patient group to which study subjects belonged were 2% (45 visits). NSS represented 8% of the 2543 visits (NSS = 2334; NNSS = 209). Main Outcome Measure(s) Delay times from arrival in hospital to admission to catheterization laboratory or ward (ΔTHOSP-PCI), first physical contact to first electrocardiogram (ΔTCONTACT-ECG), first physical contact to first aspirin (ΔTCONTACT-ASA) and arrival in hospital to coronary angiography (ΔTHOSP-ANGIO). Also included baseline characteristics of patients, diagnosis and findings in hospital and secondary preventive activities. Results The median ΔTHOSP-PCI was longer for NSS by 43 min [254 versus 211, 95% confidence interval (CI), odds ratio (OR) = (1.3; 2.8)]. The median ΔTCONTACT-ECG and ΔTHOSP-ANGIO were longer for NSS by 4 min [17 versus 13, 95% CI, OR = (0.8; 1.8)] and 14 h [44 versus 30, 95% CI, OR = (0.6; 3.6)], respectively. Conversely, the median ΔTCONTACT-ASA was longer for SS by 20 min [81 versus 61, 95% CI, OR = (0.3; 1.6)]. Conclusions Poorer language proficiency was associated with longer delay time from arrival in hospital to admission to catheterization laboratory or ward. No other delay times were found to be statistically significantly different with respect to the language proficiency of patients.

  • 187. Scheiman, JM
    et al.
    Herlitz, J
    University of Borås, School of Health Science.
    Veldhyuzen van Zanten, SJ
    Lanas, A
    Agewall, S
    Naucler, EC
    Svedberg, LE
    Nagy, P
    Esomeprazole for prevention and resolution of upper gastrointestinal symptoms in patients treated with low-dose acetylsalicylic acid for cardiovascular protection: the OBERON trial.2013In: Journal of Cardiovascular Pharmacology, ISSN 0160-2446, E-ISSN 1533-4023, Vol. 61, no 3, p. 250-257Article in journal (Refereed)
    Abstract [en]

    Although low-dose acetylsalicylic acid (ASA) is recommended for prevention of cardiovascular events in at-risk patients, its long-term use can be associated with the risk of peptic ulcer and upper gastrointestinal (GI) symptoms that may impact treatment compliance. This prespecified secondary analysis of the OBERON study (NCT00441727) determined the efficacy of esomeprazole for prevention/resolution of low-dose ASA-associated upper GI symptoms. A post hoc analysis of predictors of symptom prevention/resolution was also conducted. Helicobacter pylori-negative patients taking low-dose ASA (75-325 mg) for cardiovascular protection who had ≥1 upper GI risk factor were eligible. The patients were randomized to once-daily esomeprazole 40 mg, 20 mg, or placebo, for 26 weeks; 2303 patients (mean age 67.6 years; 36% aged >70 years) were evaluable for upper GI symptoms. The proportion of patients with dyspeptic or reflux symptoms (self-reported Reflux Disease Questionnaire) was significantly lower (P < 0.0001) in those treated with esomeprazole versus in those treated with placebo. Treatment with esomeprazole (P < 0.0001), age >70 years (P < 0.01), and the absence of upper GI symptoms at baseline (P < 0.0001) were all factors associated with prevention/resolution of upper GI symptoms. Together, these analyses demonstrate that esomeprazole is effective in preventing and resolving patient-reported upper GI symptoms in low-dose ASA users at increased GI risk.

  • 188.
    Seoane, Fernando
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. KTH-School of Technology and Health.
    Atefi, Seyed Reza
    Harvard Univsersity.
    Tomner, Jens
    Karolinska Hospital.
    Kostulas, Konstantinos
    Karolinska Hospital.
    Lindecrantz, Kaj
    KTH-School of Technology and Health.
    Electrical Bioimpedance Spectroscopy on Acute Unilateral Stroke Patients: Initial Observations regarding Differences between Sides2015In: BioMed research international, Vol. 2015Article in journal (Refereed)
  • 189. Siira, Saila M.
    et al.
    Ojala, Tiina H.
    Vahlberg, Tero J.
    Rosén, Karl G.
    University of Borås, School of Engineering.
    Ekholm, Eeva M.
    Do spectral bands of fetal heart rate variability associate with concomitant fetal scalp pH?2013In: Early Human Development, ISSN 0378-3782, E-ISSN 1872-6232, Vol. 89, no 9, p. 739-742Article in journal (Refereed)
    Abstract [en]

    Background: Objective information on speci fi c fetal heart rate (FHR) parameters would be advantageous when assessing fetal responses to hypoxia. Small, visually undetectable changes in FHR variability can be quanti fi ed by power spectral analysis of FHR variability. Aims: To investigate the effect of intrapartum hypoxia and acidemia on spectral powers of FHR variability. Study design: This is a retrospective observational clinical study with data from an EU multicenter project. Subjects: We had 462 fetuses with a normal pH-value (pH > 7.20; controls) in fetal scalp blood sample (FBS) and 81 fetuses with a low scalp pH-value ( ≤ 7.20; low-FBS pH-fetuses). The low-FBS pH-fetuses were further divided into two subgroups according to the degree of acidemia: fetuses with FBS pH 7.11 – 7.20 (n = 58) and fetuses with FBS pH ≤ 7.10 (n = 23). Outcome measures: Spectral powers of FHR variability in relation to the concomitant FBS pH-value. Results: Fetuses with FBS pH ≤ 7.20 had increased spectral powers of FHR variability compared with controls (2.49 AU vs. 2.23 AU; p = 0.038). However, the subgroup of most affected fetuses (those with FBS pH ≤ 7.10) had signi fi cantly lower FHR variability spectral powers when compared to fetuses with FBS pH 7.11 – 7.20. Conclusions: This study shows that spectral powers of FHR variability change as a fetus becomes hypoxic, and that spectral powers decrease with deepening fetal acidemia.

  • 190. Sjöland, H
    et al.
    Wiklund, I
    Caidahl, K
    Haglid, M
    Westberg, S
    Herlitz, Johan
    [external].
    Improvement in quality of life and exercise capacity after coronary bypass surgery1996In: Archives of Internal Medicine, ISSN 0003-9926, E-ISSN 1538-3679, Vol. 156, no 3, p. 265-271Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Outcome after coronary artery bypass grafting is usually evaluated by exercise stress testing. Increased exercise capacity and reduced angina pectoris have been equated with improved quality of life, but this represents a limited view. OBJECTIVE: To prospectively evaluate the effects of coronary artery bypass grafting on quality of life and exercise capacity and their interrelationship. METHODS: In a consecutive series of patients (N = 2365) who underwent coronary artery bypass grafting, we administered a questionnaire to assess quality of life before and 2 years after surgery. A standardized exercise test was performed during the year before surgery and 2 years after. A preoperative exercise test was performed by 726 patients. Among these patients, 462 completed a quality-of-life questionnaire preoperatively and 578 did so postoperatively. Preoperative and postoperative exercise tests were obtained from 362 patients. RESULTS: The improvement in quality of life was related to the severity of preoperative angina (P < .001) and female sex (P = .004) and was inversely related to preoperative exercise performance (P = .04). The improvement in exercise capacity was greater among men (P < .001) and was inversely related to preoperative exercise capacity (P < .001). CONCLUSIONS: The greatest improvement in quality of life after coronary artery bypass grafting appeared in those patients with the most impaired exercise capacity, those with the most severe angina pectoris, and women. Improvement in exercise capacity was greatest in patients with the poorest preoperative exercise capacity and in men. These findings indicate that exercise testing is of limited value as a measure of quality of life and that assessment by a questionnaire has a complementary place.

  • 191. Skrifvars, MB
    et al.
    Castrén, M
    Aune, S
    Thorén, A-B
    Nurmi, J
    Herlitz, Johan
    [external].
    Variability in survival after in-hospital cardiac arrest depending on the hospital level of care.2007In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 73, no 1, p. 73-81Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Survival after in-hospital cardiac arrest (IHCA) differs considerably between hospitals. This study tries to determine whether this difference is due to patient selection because of the hospital level of care or to effective resuscitation management. METHODS: Prospectively collected data on management of in-hospital cardiac arrests from Sahlgrenska Hospital, a tertiary hospital in Gothenburg, Sweden (cohort one) and from five Finnish secondary hospitals (cohort two). A multiple logistic regression model was created for predicting survival to hospital discharge. RESULTS: A total of 954 cases from Sahlgrenska Hospital and 624 patients from the hospitals in Finland were included. The delay to defibrillation was longer at Sahlgrenska than at the five Finnish secondary hospitals (p=0.045). Significant predictors of survival were: (1) age below median (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.5-2.8); (2) no diabetes (OR 1.9, CI 1.2-2.9); (3) arrests occurring during office hours (OR 1.5, CI 1.1-2.2); (4) witnessed cardiac arrest (OR 6.3, CI 2.6-15.3); (5) ventricular fibrillation or ventricular tachycardia as the initial rhythm (OR 4.9, CI 3.5-6.7); (6) location of the arrest (compared to arrests in general wards, GW): thoracic surgery and heart transplantation ward (OR 2.9, CI 1.5-5.9), interventional radiology (OR 4.8, CI 1.9-12.0) and other in-hospital locations (3.0, CI 1.6-5.7) and (7) hospital (compared to arrests at Sahlgrenska Hospital); arrests at Etelä-Karjala Central Hospital [CH] (OR 0.3, CI 0.1-0.7), Päijät-Hame CH (OR 0.3, CI 0.1-0.8) and Seinäjoki CH (OR 0.4, CI 0.3-0.7). CONCLUSION: The comparison of survival following IHCA between different hospitals is difficult, there seems to be undefined factors greatly associated with outcome. A great variability in survival within different hospital areas probably because of differences in patient selection, patient surveillance and resuscitation management was also noted. A locally implemented strong in-hospital chain of survival is probably the only way to improve outcome following IHCA.

  • 192.
    Smidfelt, K
    et al.
    Sahlgrenska University Hospital.
    Drott, C
    Department of Surgery Borås Hospital.
    Törngren, K
    Sahlgrenska University Hospital.
    Nordanstig, J
    Sahlgrenska University Hospital.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Langenskiöld, M
    Sahlgrenska University Hospital.
    The Impact of Initial Misdiagnosis of Ruptured Abdominal Aortic Aneurysms on Lead Times, Complication Rate, and Survival.2017In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 54, no 1, p. 21-27, article id S1078-5884(17)30214-9Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE/BACKGROUND: To investigate the frequency of initial misdiagnosis and the clinical consequences of an initial misdiagnosis of ruptured abdominal aortic aneurysms (rAAA).

    METHODS: This was a retrospective cohort study. Data from the Swedish National Registry for Vascular Surgery (Swedvasc) and medical charts were extracted for patients treated for rAAA in the West of Sweden in the period 2008-14. Initially misdiagnosed patients were compared with correctly diagnosed patients.

    RESULTS: In all, 261 patients were included in the study. Patients with rAAA were initially misdiagnosed in 33% (n = 86) of the cases and this caused a 4.8 hour (median time) additional delay to surgical intervention. There were no differences in 30 day mortality between initially misdiagnosed patients and correctly diagnosed patients (27.9% vs. 28.0%; p = 1.00). The adjusted odds ratio for mortality in initially misdiagnosed patients compared with correctly diagnosed patients was 0.78 (95% confidence interval 0.38-1.60). No difference was observed between the groups regarding 90 day mortality, length of intensive care, need for post-operative ventilator support, need of haemodialysis support, and length of hospital stay.

    CONCLUSION: Misdiagnosis is common in patients with rAAA, and treatment is significantly delayed in misdiagnosed patients. The study did not show any survival disadvantage or increased frequency of post-operative complications in misdiagnosed patients despite the delayed treatment. However, only patients who reached surgical intervention were included in the analysis.

  • 193. Smith, LG
    et al.
    Herlitz, J
    University of Borås, School of Health Science.
    Karlsson, T
    Berger, AK
    Luepker, RV
    International comparision of treatment and long-term outcomes for acute myocardial infarction in the elederly: Minneapolis/St Paul, MN, USA and Goteborg, Sweden2013In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 34, no 41, p. 3191-3197Article in journal (Refereed)
    Abstract [en]

    AIMS: International studies provide an opportunity to compare treatment approaches and outcomes. The present study compares elderly hospitalized acute myocardial infarction (AMI) patients in Minneapolis/St. Paul, USA (MSP) and Göteborg, Sweden (GB). METHODS AND RESULTS: A population-based sample of hospitalized AMI (ICD-9 410) patients aged ≥75 in MSP and GB in 2001-02 was abstracted by trained nurses. Mortality was ascertained from medical records and death certificates. Demographics, cardiovascular procedures, and prescription medications were compared using sex-specific generalized linear models. Adjusted hazard ratios (HR) were calculated with Cox regression. In MSP 839 (387 men, 452 women) and in GB 564 (275 men, 289 women) patients were identified. Age was similar (men: MSP 83 ± 7, GB 82 ± 5; women: MSP 84 ± 6, GB 84 ± 6) yet MSP patients had more previous cardiovascular comorbidities and procedures (PCI/CABG). Guideline-based medication use was high in both locations. MSP patients were significantly more likely to undergo PCI (men: MSP 33%, GB 7%; women: MSP 30%, GB 7%). Survival at 7.5 years was 27.8% among MSP patients (men: 26.6%, women: 28.8%) and 17.2% among GB patients (men: 17.5%, women: 17.0%). After adjustment for baseline characteristics and guideline-based therapies, survival was higher among MSP men [HR: 0.66, 95% confidence interval (CI): 0.50-0.88] and women (HR: 0.49, 95% CI: 0.36-0.67) compared with GB. CONCLUSION: In MSP and GB, guideline-based therapy use was high. However, PCI use was markedly higher in MSP. Long-term survival was better among elderly men and women in MSP compared with GB possibly related to greater utilization of PCI.

  • 194. Strandmark, Rasmus
    et al.
    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.
    Claesson, Andreas
    Bremer, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Karlsson, Thomas
    Jimenez-Herrera, Maria
    Ravn-Fischer, Annica
    Determinants of pre-hospital pharmacological intervention and its association with outcome in acute myocardial infarction2015In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 15, no 1Article in journal (Refereed)
  • 195. Strandmark, Rasmus
    et al.
    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.
    Claesson, Andreas
    Bremer, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Karlsson, Thomas
    Jimenez-Herrera, Maria
    Ravn-Fischer, Annica
    Determinants of pre-hospitalpharmacological intervention and its association with outcome in acutemyocardial infarction2015In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 23, no 105Article in journal (Refereed)
  • 196. Strömsöe, A
    et al.
    Afzelius, S
    Axelsson, C
    University of Borås, School of Health Science.
    Södersved Kallestedt, ML
    Enlund, M
    Svensson, L
    Herlitz, J
    University of Borås, School of Health Science.
    Improvements in logistics could increase survival after out-of-hospital cardiac arrest in Sweden.2013In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 273, no 6, p. 622-7Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: In a review based on estimations and assumptions, to report the estimated number of survivors after out-of-hospital cardiac arrest (OHCA) in whom cardiopulmonary resuscitation (CPR) was started and to speculate about possible future improvements in Sweden. DESIGN: An observational study. SETTING: All ambulance organisations in Sweden. SUBJECTS: Patients included in the Swedish Cardiac Arrest Registry who suffered an OHCA between January 1, 2008 and December 31, 2010. Approximately 80% of OHCA cases in Sweden in which CPR was started are included. INTERVENTIONS: None RESULTS: In 11 005 patients, the 1-month survival rate was 9.4%. There are approximately 5000 OHCA cases annually in which CPR is started and 30-day survival is achieved in up to 500 patients yearly (6 per 100 000 inhabitants). Based on findings on survival in relation to the time to calling for the Emergency Medical Service (EMS) and the start of CPR and defibrillation, it was estimated that, if the delay from collapse to (i) calling EMS, (ii) the start of CPR, and (iii) the time to defibrillation were reduced to <2 min, <2 min, and <8 min, respectively, 300-400 additional lives could be saved. CONCLUSION: Based on findings relating to the delay to calling for the EMS and the start of CPR and defibrillation, we speculate that 300-400 additional OHCA patients yearly (4 per 100 000 inhabitants) could be saved in Sweden.

  • 197. Strömsöe, A
    et al.
    Svensson, L
    Axelsson, AB
    Claesson, A
    University of Borås, School of Health Science.
    Göransson, KE
    Nordberg, P
    Herlitz, J
    University of Borås, School of Health Science.
    Improved outcome in Sweden after out-of-hospital cardiac arrest and possible association with improvements in every link in the chain of survival2014In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, ISSN 0195-668, Vol. 36, no 14Article in journal (Refereed)
    Abstract [en]

    Aims To describe out-of-hospital cardiac arrest (OHCA) in Sweden from a long-term perspective in terms of changes in outcome and circumstances at resuscitation. Methods and results All cases of OHCA (n = 59 926) reported to the Swedish Cardiac Arrest Register from 1992 to 2011 were included. The number of cases reported (n/100 000 person-years) increased from 27 (1992) to 52 (2011). Crew-witnessed cases, cardiopulmonary resuscitation prior to the arrival of the emergency medical service (EMS), and EMS response time increased (P < 0.0001). There was a decrease in the delay from collapse to calling for the EMS in all patients and from collapse to defibrillation among patients found in ventricular fibrillation (P < 0.0001). The proportion of patients found in ventricular fibrillation decreased from 35 to 25% (P < 0.0001). Thirty-day survival increased from 4.8 (1992) to 10.7% (2011) (P < 0.0001), particularly among patients found in a shockable rhythm and patients with return of spontaneous circulation (ROSC) at hospital admission. Among patients hospitalized with ROSC in 2008–2011, 41% underwent therapeutic hypothermia and 28% underwent percutaneous coronary intervention. Among 30-day survivors in 2008–2011, 94% had a cerebral performance category score of 1 or 2 at discharge from hospital and the results were even better if patients were found in a shockable rhythm. Conclusion From a long-term perspective, 30-day survival after OHCA in Sweden more than doubled. The increase in survival was most marked among patients found in a shockable rhythm and those hospitalized with ROSC. There were improvements in all four links in the chain of survival, which might explain the improved outcome.

  • 198. Strömsöe, A
    et al.
    Svensson, L
    Axelsson, ÅB
    Göransson, K
    Todorova, L
    Herlitz, J
    University of Borås, School of Health Science.
    Validity of reported data in the Swedish Cardiac Arrest Register in selected parts in Sweden.2013In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 84, no 7, p. 952-956Article in journal (Refereed)
    Abstract [en]

    AIM: To describe differences and similarities between reported and non-reported data in the Swedish Cardiac Arrest Register in selected parts in Sweden. METHODS: Prospective and retrospective data for treated OHCA patients in Sweden, 2008-2010, were compared in the Swedish Cardiac Arrest Register. Data were investigated in three Swedish counties, which represented one third of the population. The recording models varied. Prospective data are those reported by the emergency medical service (EMS) crews, while retrospective data are those missed by the EMS crews but discovered afterwards by cross-checking with the local ambulance register. RESULT: In 2008-2010, the number of prospectively (n=2398) and retrospectively (n=800) reported OHCA cases was n=3198, which indicates a 25% missing rate. When comparing the two groups, the mean age was higher in patients who were reported retrospectively (69 years vs. 67 years; p=0.003). There was no difference between groups with regard to gender, time of day and year of OHCA, witnessed status or initial rhythm. Bystander cardiopulmonary resuscitation (CPR) was more frequent among patients who were reported prospectively (65% vs. 60%; p=0.023), whereas survival to one month was higher among patients who were reported retrospectively (9.2% vs. 11.9%; p=0.035). CONCLUSION: Among 3198 cases of OHCA in three counties in Sweden, 800 (25%) were not reported prospectively by the EMS crews but were discovered retrospectively as missing cases. Patients who were reported retrospectively differed from prospectively reported cases by being older, having less frequently received bystander CPR but having a higher survival rate. Our data suggest that reports on OHCA from national quality registers which are based on prospectively recorded data may be influenced by selection bias.

  • 199. Svensson, L
    et al.
    Isaksson, L
    Axelsson, Christer
    [external].
    Nordlander, R
    Herlitz, Johan
    [external].
    Predictors of myocardial damage prior to hospital admission among patients with acute chest pain or other symptoms raising a suspicion of acute coronary syndrome.2003In: Coronary Artery Disease, ISSN 0954-6928, E-ISSN 1473-5830, Vol. 14, no 3, p. 225-231Article in journal (Refereed)
    Abstract [en]

    AIM: To evaluate factors which, prior to hospital admission, predict the development of acute coronary syndrome or acute myocardial infarction among patients who call for an ambulance due to suspected acute coronary syndrome. DESIGN: Prospective observational study. METHODS: All the patients who called for an ambulance due to suspected acute coronary syndrome in South Hospital's catchment area in Stockholm and in the Municipality of Göteborg between January and November 2000, were included. On arrival of the ambulance crew, a blood sample was drawn for bedside analysis of serum myoglobin, creatine kinase (CK)MB and troponin-I. A 12-lead electrocardiogram (ECG) was simultaneously recorded. RESULTS: In all, 538 patients took part in the survey. Their mean age was 69 years and 58% were men. In all, 307 patients (57.3%) had acute coronary syndrome and 158 (29.5%) had acute myocardial infarction. Independent predictors of the development of acute coronary syndrome were a history of myocardial infarction (P=0.006), angina pectoris (P=0.005) or hypertension (P=0.017), ECG changes with ST elevation (P<0.0001), ST depression (P<0.0001) or T-wave inversion (P=0.012) and the elevation of CKMB (P=0.005). Predictors of acute myocardial infarction were being a man (P=0.011), ECG changes with ST elevation (P<0.0001) or ST depression (P<0.0001), the elevation of CKMB (P<0.0001) and a short interval between the onset of symptoms and blood sampling (P=0.010). CONCLUSION: Among patients transported by ambulance due to suspected acute coronary syndrome, predictors of myocardial damage can be defined prior to hospital admission on the basis of previous history, sex, ECG changes, the elevation of biochemical markers and the interval from the onset of symptoms until the ambulance reaches the patient.

  • 200. Thang, ND
    et al.
    Karlsson, BW
    Bergman, B
    Santos, M
    Karlsson, T
    Benttson, A
    Johanson, P
    Rawshani, A
    Herlitz, J
    University of Borås, School of Health Science.
    Patients admitted to hospital with chest pain-changes in a 20 year perspective.2013In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 166, no 1, p. 141-146Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To describe the differences in characteristics and outcome between two consecutive series of patients admitted to hospital with chest pain in a 20-year perspective. Particular emphasis is placed on changes in outcome in relation to the initial electrocardiogram (ECG). SUBJECTS: In the two periods, 1986-1987 and 2008, all patients with chest pain admitted to the study hospitals in Gothenburg, Sweden, were included. RESULTS: Five thousand and sixteen patients were registered in a period of 21 months in 1986-1987 and 2287 patients were registered during 3 months in 2008. In a comparison of the two time periods, the age of chest pain patients was not significantly different (mean age 60.1 ± 17.8 years in 1986-1987 and 59.8 ± 19.1 years in 2008, p=0.50). There was a lower prevalence of previous angina pectoris, congestive heart failure and current smoking in the second period, whereas a history of acute myocardial infarction, hypertension and diabetes mellitus had become more prevalent. The use of cardio-protective drugs increased and ECG changes indicating acute myocardial ischemia on admission to hospital decreased. Length of hospitalisation was reduced from a median of 5 days to 3 days (p<0.0001). A significant decrease in 30-day and 1-year mortality was found (3.8% in 1986-1987 vs 2.0% in 2008 and 9.9% vs 6.3% respectively, p<0.0001 for both comparisons). CONCLUSIONS: During a period of 20 years, the characteristics and outcome of patients admitted to hospital with chest pain changed. The most important changes were a lower prevalence of ECG signs indicating acute myocardial ischemia on admission, shorter hospitalisation time and a lower 30-day and 1-year mortality.

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