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Asplund, Kjell
Publications (10 of 102) Show all publications
Asplund, K., Lundström, S. & Stegmayr, B. (2018). End of life after stroke: a nationwide study of 42,502 deaths occurring within a year after stroke. European Stroke Journal, 3(1), 74-81
Open this publication in new window or tab >>End of life after stroke: a nationwide study of 42,502 deaths occurring within a year after stroke
2018 (English)In: European Stroke Journal, ISSN 2396-9873, E-ISSN 2396-9881, Vol. 3, no 1, p. 74-81Article in journal (Refereed) Published
Abstract [en]

Introduction: In the scientific literature, there is very limited empirical information on end-of-life issues after stroke in the scientific literature. The present nationwide study describes the circumstances surrounding deaths that occur within a year after a stroke. Patients and methods: Datasets from three nationwide Swedish registers (on stroke, palliative care and cause of death) were linked. Basic information was available for 42,502 unselected cases of death that occurred within a year after a stroke and more detailed information was available for 16,408 deaths. Odds ratios for characteristics of end-of-life care were calculated by logistic regression. Results: In the late phase after stroke (three months to one year), 46% of patients died in a nursing home, whereas 37% of patients died in a hospital after readmission and 10% of patients died at home. Eleven per cent of deaths were reported as being unexpected. A next of kin was present at 49% of deaths. The frequency of unattended deaths (neither next of kin nor staff were present at the time of death) ranged from 5% at home with specialised home care to 25% in hospitals. Discussion: This is, by far, the largest study published on end-of-life issues after stroke. Major differences between countries in healthcare, community services, family structure and culture may limit direct transfer of the present results to other settings. Conclusion: There is considerable discordance between presumed good death' late after stroke (dying at home surrounded by family members) and the actual circumstances at the end of life.

Place, publisher, year, edition, pages
Sage Publications, 2018
Keywords
Stroke, end of life, terminal care, death, next of kin, nursing homes
National Category
Neurology Neurosciences
Identifiers
urn:nbn:se:umu:diva-147349 (URN)10.1177/2396987317736202 (DOI)000429801100009 ()
Available from: 2018-05-11 Created: 2018-05-11 Last updated: 2018-06-09Bibliographically approved
Eriksson, M., Glader, E.-L., Norrving, B., Stegmayr, B. & Asplund, K. (2017). Acute stroke alert activation, emergency service use, and reperfusion therapy in Sweden. Brain and Behavior, 7(4), Article ID e00654.
Open this publication in new window or tab >>Acute stroke alert activation, emergency service use, and reperfusion therapy in Sweden
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2017 (English)In: Brain and Behavior, ISSN 2162-3279, E-ISSN 2162-3279, Vol. 7, no 4, article id e00654Article in journal (Refereed) Published
Abstract [en]

Objectives: Ambulance services and stroke alerts reduce the time from stroke onset to acute stroke diagnosis. We describe the use of stroke alerts and ambulance services in different hospitals and patient groups and their relationship with reperfusion therapy. Methods: This nationwide study included 49,907 patients admitted with acute stroke who were registered in The Swedish Stroke Register (Riksstroke) in 2011-2012. Results: The proportions of patients admitted as stroke alerts out of all acute stroke admissions varied from 12.2% to 45.7% in university hospitals (n=9), 0.5% to 38.7% in specialized nonuniversity hospitals (n=22), and 4.2% to 40.3% in community hospitals (n=41). Younger age, atrial fibrillation (AF), living in an institution, reduced consciousness upon admission, and hemorrhagic stroke were factors associated with a higher probability of stroke alerts. Living alone, primary school education, non-European origin, previous stroke, diabetes, smoking, and dependency in activities of daily living (ADL) were associated with a lower probability of stroke alert. The proportion of patients arriving at the hospital by ambulance varied from 60.3% to 94.5%. Older age, living alone, primary school education, being born in a European country, previous stroke, AF, dependency in ADL, living in an institution, reduced consciousness upon admission, and hemorrhagic stroke were associated with ambulance services. Hospital stroke alert frequencies correlated strongly with reperfusion rates (r=.75). Conclusion: Acute stroke alerts have a significant potential to improve stroke reperfusion rates. Prehospital stroke management varies conspicuously between hospitals and patient groups, and the elderly and patients living alone have a markedly reduced likelihood of stroke alerts.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-132774 (URN)10.1002/brb3.654 (DOI)000399452500010 ()28413705 (PubMedID)
Available from: 2017-03-23 Created: 2017-03-23 Last updated: 2018-06-09Bibliographically approved
Lövtrup, M., Engström, I., Wennlund, E. & Asplund, K. (2017). Dödshjälp: En kunskapssammanställning. Stockholm: Statens medicinsk-etiska råd
Open this publication in new window or tab >>Dödshjälp: En kunskapssammanställning
2017 (Swedish)Report (Other academic)
Abstract [sv]

Smer ger i denna rapport en bred översyn av kunskapsläget kring dödshjälp, med fokus på forskning och statistik från länder och delstater som legaliserat dödshjälp i någon form. Utifrån de uppgifter som framkommer i kunskapsgenomgången analyseras stödet för några av de vanligast förekommande argumenten i den svenska debatten för och mot dödshjälp. Syftet med rapporten är att bidra till en mer faktabaserad debatt kring dödshjälp.

Place, publisher, year, edition, pages
Stockholm: Statens medicinsk-etiska råd, 2017. p. 213
Series
Smer rapport, ISSN 1101-0398 ; 2017:2
National Category
Medical Ethics
Identifiers
urn:nbn:se:umu:diva-143920 (URN)978-91-38-24708-2 (ISBN)
Available from: 2018-01-15 Created: 2018-01-15 Last updated: 2018-06-09Bibliographically approved
Asplund, K. (2017). Hur kan tandhälsans stora gap bestå?. Tandläkartidningen (2), 37-37
Open this publication in new window or tab >>Hur kan tandhälsans stora gap bestå?
2017 (Swedish)In: Tandläkartidningen, ISSN 0039-6982, no 2, p. 37-37Article in journal (Other academic) Published
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-144029 (URN)
Available from: 2018-01-18 Created: 2018-01-18 Last updated: 2018-06-09Bibliographically approved
Asplund, K. (2017). Hur tungt får kollegialiteten väga?. Tandläkartidningen (7), 43-43
Open this publication in new window or tab >>Hur tungt får kollegialiteten väga?
2017 (Swedish)In: Tandläkartidningen, ISSN 0039-6982, no 7, p. 43-43Article in journal (Other academic) Published
National Category
Clinical Medicine
Identifiers
urn:nbn:se:umu:diva-143998 (URN)
Available from: 2018-01-17 Created: 2018-01-17 Last updated: 2018-06-09Bibliographically approved
Nordanstig, A., Asplund, K., Norrving, B., Wahlgren, N., Wester, P. & Rosengren, L. (2017). Impact of the Swedish National Stroke Campaign on stroke awareness. Acta Neurologica Scandinavica, 136(4), 345-351
Open this publication in new window or tab >>Impact of the Swedish National Stroke Campaign on stroke awareness
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2017 (English)In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 136, no 4, p. 345-351Article in journal (Refereed) Published
Abstract [en]

Background: Time delay from stroke onset to arrival in hospital is an important obstacle to widespread reperfusion therapy. To increase knowledge about stroke, and potentially decrease this delay, a 27-month national public information campaign was carried out in Sweden.

Aims: To assess the effects of a national stroke campaign in Sweden.

Methods: The variables used to measure campaign effects were knowledge of the AKUT test [a Swedish equivalent of the FAST (Face-Arm-Speech-Time)] test and intent to call 112 (emergency telephone number) . Telephone interviews were carried out with 1500 randomly selected people in Sweden at eight points in time: before, three times during, immediately after, and nine, 13 and 21 months after the campaign.

Results: Before the campaign, 4% could recall the meaning of some or all keywords in the AKUT test, compared with 23% during and directly after the campaign, and 14% 21 months later. Corresponding figures were 15%, 51%, and 50% for those remembering the term AKUT and 65%, 76%, and 73% for intent to call 112 when observing or experiencing stroke symptoms. During the course of the campaign, improvement of stroke knowledge was similar among men and women, but the absolute level of knowledge for both items was higher for women at all time points.

Conclusion: The nationwide campaign substantially increased knowledge about the AKUT test and intention to call 112 when experiencing or observing stroke symptoms, but knowledge declined post-intervention. Repeated public information therefore appears essential to sustain knowledge gains.

Keywords
ambulance call, emergency medical services, knowledge, public education, stroke, stroke campaign
National Category
Other Medical Sciences not elsewhere specified
Identifiers
urn:nbn:se:umu:diva-140943 (URN)10.1111/ane.12777 (DOI)000409134100009 ()
Available from: 2017-11-13 Created: 2017-11-13 Last updated: 2018-06-09Bibliographically approved
Asplund, K. (2017). Kunskap, etik och tandkräm. Tandläkartidningen (12), 37-37
Open this publication in new window or tab >>Kunskap, etik och tandkräm
2017 (Swedish)In: Tandläkartidningen, ISSN 0039-6982, no 12, p. 37-37Article in journal (Other academic) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-143997 (URN)
Available from: 2018-01-17 Created: 2018-01-17 Last updated: 2018-06-09Bibliographically approved
Pennlert, J., Overholser, R., Asplund, K., Carlberg, B., Van Rompaye, B., Wiklund, P.-G. & Eriksson, M. (2017). Optimal Timing of Anticoagulant Treatment After Intracerebral Hemorrhage in Patients With Atrial Fibrillation. Stroke, 48(2), 314-320
Open this publication in new window or tab >>Optimal Timing of Anticoagulant Treatment After Intracerebral Hemorrhage in Patients With Atrial Fibrillation
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2017 (English)In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 48, no 2, p. 314-320Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND PURPOSE: This study aims to provide observational data on the relationship between the timing of antithrombotic treatment and the competing risks of severe thrombotic and hemorrhagic events in a cohort of Swedish patients with atrial fibrillation and intracerebral hemorrhage (ICH).

METHODS: Patients with atrial fibrillation and a first-ever ICH were identified in the Swedish Stroke Register, Riksstroke, 2005 to 2012. Riksstroke was linked with other national registers to find information on treatment, comorbidity, and outcome. The optimal timing of treatment in patients with low and high thromboembolic risk was described through cumulative incidence functions separately for thrombotic and hemorrhagic events and for the combined end point vascular death or nonfatal stroke.

RESULTS: The study included 2619 ICH survivors with atrial fibrillation with 5759 person-years of follow-up. Anticoagulant treatment was associated with a reduced risk of vascular death and nonfatal stroke in high-risk patients with no significantly increased risk of severe hemorrhage. The benefit seemed to be greatest when treatment was started 7 to 8 weeks after ICH. For high-risk women, the total risk of vascular death or stroke recurrence within 3 years was 17.0% when anticoagulant treatment was initiated 8 weeks after ICH and 28.6% without any antithrombotic treatment (95% confidence interval for difference, 1.4%-21.8%). For high-risk men, the corresponding risks were 14.3% versus 23.6% (95% confidence interval for difference, 0.4%-18.2%).

CONCLUSIONS: This nationwide observational study suggests that anticoagulant treatment may be initiated 7 to 8 weeks after ICH in patients with atrial fibrillation to optimize the benefit from treatment and minimize risk.

Place, publisher, year, edition, pages
American Heart Association, 2017
Keywords
anticoagulants, atrial fibrillation, cerebral hemorrhage, ischemia, stroke
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-129335 (URN)10.1161/STROKEAHA.116.014643 (DOI)000394510300024 ()27999135 (PubMedID)
Note

Presented in part at the 2nd European Stroke Organisation Conference (ESOC 2016), Barcelona, Spain, May 10–12, 2016

Available from: 2016-12-22 Created: 2016-12-22 Last updated: 2018-06-09Bibliographically approved
Pennlert, J., Asplund, K. & Eriksson, M. (2017). Response by Pennlert et al to Letter Regarding Article, "Optimal Timing of Anticoagulant Treatment After Intracerebral Hemorrhage in Patients With Atrial Fibrillation". [Letter to the editor]. Stroke, 48(4), Article ID e116.
Open this publication in new window or tab >>Response by Pennlert et al to Letter Regarding Article, "Optimal Timing of Anticoagulant Treatment After Intracerebral Hemorrhage in Patients With Atrial Fibrillation".
2017 (English)In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 48, no 4, article id e116Article in journal, Letter (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-132525 (URN)10.1161/STROKEAHA.117.016838 (DOI)000398207000011 ()28283602 (PubMedID)
Available from: 2017-03-16 Created: 2017-03-16 Last updated: 2018-06-09Bibliographically approved
Asplund, K. (2017). Ska obeprövade metoder få användas i svensk sjukvård?. PIObladet (2), 10-11
Open this publication in new window or tab >>Ska obeprövade metoder få användas i svensk sjukvård?
2017 (Swedish)In: PIObladet, ISSN 1103-6249, no 2, p. 10-11Article in journal (Other academic) Published
Place, publisher, year, edition, pages
Primär immunbristorganisationen, 2017
National Category
Immunology in the medical area
Identifiers
urn:nbn:se:umu:diva-144033 (URN)
Available from: 2018-01-18 Created: 2018-01-18 Last updated: 2018-06-09Bibliographically approved
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