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  • 51.
    Jiang, Wei
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Gu, Weigang
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Neurology.
    Hossmann, Konstantin-Alexander
    Mies, Günter
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Establishing a photothrombotic 'ring' stroke model in adult mice with late spontaneous reperfusion: quantitative measurements of cerebral blood flow and cerebral protein synthesis.2006In: Journal of Cerebral Blood Flow and Metabolism, ISSN 0271-678X, E-ISSN 1559-7016, Vol. 26, no 7, p. 927-936Article in journal (Refereed)
  • 52.
    Johansson, E.
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Cuadrado-Godia, E.
    Hayden, D.
    Ois, A.
    Roquerl, J.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Kelly, P. J.
    Risk and predictors of recurrent stroke in symptomatic carotid stenosis awaiting revascularization-Pooled analysis of individual patient data2015In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 10, p. 19-19Article in journal (Other academic)
  • 53.
    Johansson, Elias
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Ahlqvist, Jan
    Umeå University, Faculty of Medicine, Department of Odontology.
    Garoff, Maria
    Umeå University, Faculty of Medicine, Department of Odontology.
    Levring Jäghagen, Eva
    Umeå University, Faculty of Medicine, Department of Odontology.
    Meimermondt, Amanda
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Carotid calcifications on panoramic radiographs: a 5-year follow-up study2015In: Oral surgery, oral medicine, oral pathology and oral radiology, ISSN 2212-4403, E-ISSN 2212-4411, Vol. 120, no 4, p. 513-520Article in journal (Refereed)
    Abstract [en]

    Objective. The aim of this study was to determine whether people with calcifications in the area of the carotid arteries on panoramic radiographs (CALPANs) have an increased prevalence of vascular risk factors or an increased risk of future vascular events. Materials and Methods. We included 113 consecutive patients with CALPANs and 116 gender- and age-matched controls without CALPANs. Vascular risk factors were generally known in the study population, since it was recorded in a population-based community-screening program. Results. Patients with CALPANs had a higher prevalence of vascular risk factors than controls independent of previous vascular events. During the 5.4-year follow-up, patients with CALPANs had a higher risk of a combined endpoint of vascular events (5.6%/yr) compared with the controls (2.4%/yr) (P = .004 by log rank test; unadjusted hazard ratio (HR) 2.4; 95% CI 1.3-4.3). This difference was not significant when previous vascular events and risk factors were taken into account (adjusted HR; 1.2; 95% CI 0.6-2.3; P = .62; Cox regression). Conclusions. People with CALPANs are very likely to have vascular risk factors, but these factors might be unknown when CALPANs are detected. Accordingly, patients with CALPANs should be advised to have their vascular risk factors regularly checked in order to receive advice on preventive lifestyle modifications and medical treatment when indicated. However, it remains unknown whether CALPANs add information about the independent risk of future vascular events. Therefore, further studies are warranted to investigate whether the detection of CALPANs indicates a need for additional or more intense vascular treatment.

  • 54.
    Johansson, Elias
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Arnerlöv, Conny
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Risk of recurrent stroke before carotid endarterectomy: the ANSYSCAP study2013In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 8, no 4, p. 220-227Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Carotid endarterectomy yields greater risk reduction for ipsilateral ischemic stroke when performed within two-weeks of the last cerebrovascular symptom than when performed two-weeks or more after the last symptom. However, additional benefit might be gained if carotid endarterectomy is performed earlier than within two-weeks. AIMS: To investigate the 90-day risk of ipsilateral ischemic stroke recurrence after amaurosis fugax, retinal artery occlusion, transient ischemic attack, or minor ischemic stroke in patients with 50-99% carotid stenosis before carotid endarterectomy, with emphasis on the first 14 days. METHODS: Prospective cohort study. 230 consecutive patients with symptomatic 50-99% carotid stenosis (North American Symptomatic Carotid Endarterectomy Trial grading method) who underwent evaluation before carotid endarterectomy. Of these, 183 underwent carotid endarterectomy; the median delay to carotid endarterectomy was 29 days. Blood pressure lowering medication was used by 93% and lipid-lowering medication by 90%. RESULTS: The risk of ipsilateral ischemic stroke recurrence before carotid endarterectomy was 5·2% (n = 12) within two-days, 7·9% (n = 18) within seven-days, 11·2% (n = 25) within 14 days, and 18·6% (n = 33) within 90 days of the presenting event. The risk of ipsilateral ischemic stroke recurrence was higher if the presenting event was a stroke (adjusted hazard ratio 12·4, P = 0·015) or transient ischemic attack (adjusted hazard ratio 10·2, P = 0·026) compared with an amaurosis fugax. DISCUSSION: The risk of recurrent ipsilateral ischemic stroke was high within the first days of the presenting event. Many recurrences would likely have been avoided if carotid endarterectomy had been performed within the first days of the presenting event.

  • 55.
    Johansson, Elias
    et al.
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Bjellerup, Jakob
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Prediction of recurrent stroke with ABCD2 and ABCD3 scores in patients with symptomatic 50-99% carotid stenosis2014In: BMC Neurology, ISSN 1471-2377, E-ISSN 1471-2377, Vol. 14, article id 223Article in journal (Refereed)
    Abstract [en]

    Background: Although it is preferable that all patients with a recent Transient Ischemic Attack (TIA) undergo acute carotid imaging, there are centers with limited access to such acute examinations. It is controversial whether ABCD2 or ABCD3 scores can be used to triage patients to acute or delayed carotid imaging. It would be acceptable that some patients with a symptomatic carotid stenosis are detected with a slight delay as long as those who will suffer an early recurrent stroke are detected within 24 hours. The aim of this study is to analyze the ability of ABCD2 and ABCD3 scores to predict ipsilateral ischemic stroke among patients with symptomatic 50-99% carotid stenosis. Methods: In this secondary analysis of the ANSYSCAP-study, we included 230 consecutive patients with symptomatic 50-99% carotid stenosis. We analyzed the risk of recurrent ipsilateral ischemic stroke before carotid endarterectomy based on each parameter of the ABCD2 and ABCD3 scores separately, and for total ABCD2 and ABCD3 scores. We used Kaplan-Meier analysis. Results: None of the parameters in the ABCD2 or ABCD3 scores could alone predict all 12 of the ipsilateral ischemic strokes that occurred within 2 days of the presenting event, but clinical presentation tended to be a statistically significant risk factor for recurrent ipsilateral ischemic stroke (p = 0.06, log rank test). An ABCD2 score >= 2 and an ABCD3 score >= 4 could predict all 12 of these strokes as well as all 25 ipsilateral ischemic strokes that occurred within 14 days. To use ABCD3 score seems preferable over the ABCD2 score because a higher proportion of low risk patients were identified (17% of the patients had an ABCD3 score <4 while only 6% had an ABCD2 < 2). Conclusions: Although it is preferable that carotid imaging be performed within 24 hours, our data support that an ABCD3 score >= 4 might be used for triaging patients to acute carotid imaging in clinical settings with limited access to carotid imaging. However, our findings should be validated in a larger cohort study.

  • 56.
    Johansson, Elias
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Cuadrado-Godia, Elisa
    Hayden, Derek
    Bjellerup, Jakob
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Ois, Angel
    Roquer, Jaume
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Kelly, Peter J.
    Recurrent stroke in symptomatic carotid stenosis awaiting revascularization: A pooled analysis2016In: Neurology, ISSN 0028-3878, E-ISSN 1526-632X, Vol. 86, no 6, p. 498-504Article in journal (Refereed)
    Abstract [en]

    Objective: We aimed to quantify the risk and predictors of ipsilateral ischemic stroke in patients with symptomatic carotid stenosis awaiting revascularization (carotid endarterectomy [CEA] or carotid artery stenting) by pooling individual patient data from recent prospective studies with high rates of treatment with modern stroke prevention medications.

    Methods: Data were included from 2 prospective hospital-based registries (Umea, Barcelona) and one prospective population-based study (Dublin). Patients with symptomatic 50%-99% carotid stenosis eligible for carotid revascularization were included and followed for early recurrent ipsilateral stroke or retinal artery occlusion (RAO).

    Results: Of 607 patients with symptomatic 50%-99% carotid stenosis, 377 met prespecified inclusion criteria. Ipsilateral recurrent ischemic stroke/RAO risk pre-revascularization was 2.7% (1 day), 5.3% (3 days), 11.5% (14 days), and 18.8% (90 days). On bivariate analysis, presentation with a cerebral vs ocular event was associated with higher recurrent stroke risk (log-rank p = 0.04). On multivariable Cox regression, recurrence was associated with older age (adjusted hazard ratio [HR] per 10-year increase 1.5, p = 0.02) with a strong trend for association with cerebral (stroke/TIA) vs ocular symptoms (adjusted HR 2.7, p = 0.06), but not degree of stenosis, smoking, vascular risk factors, or medications.

    Conclusions: We found high risk of recurrent ipsilateral ischemic events within the 14-day time period currently recommended for CEA. Randomized trials are needed to determine the benefits and safety of urgent vs subacute carotid revascularization within 14 days after symptom onset.

  • 57.
    Johansson, Elias
    et al.
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Gu, Thomas
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Normal findings on pretreatment transcranial ultrasound in patients treated with sonthrombolysis2014In: Interventional Neurology, ISSN 1664-9737, Vol. 3, no 1, p. 1-8Article in journal (Refereed)
    Abstract [en]

    In populations with a high (≥14) median National Institute of Health Stroke Score (NIHSS), a normal finding of Thrombolysis in Brain Ischemia grade 5 (TIBI 5) in the artery of interest has been reported to be an unusual finding when transcranial ultrasound is performed during thrombolysis. In such instances, a stroke mimic can be suspected, but there are alternative pathophysiological explanations. In this case series, the median NIHSS was relatively low (5), and 33% (6/18) of the patients treated with thrombolysis had TIBI 5 in the artery of interest at the time of treatment initiation. These 6 patients had normal findings on the computerized tomography angiography. Only 33% (2/6) of these patients were stroke mimics, the remaining had either lacunar (n = 2) or cortical strokes (n = 2). These cortical stroke patients probably had a pretreatment recanalization marked by partial symptom regression before treatment onset. Compared to patients with TIBI <5 at baseline, the patients with TIBI 5 at baseline tended to be younger (p = 0.19, Mann-Whitney test) and more often have lacunar syndrome (p = 0.18, chi(2) test). Thus, among patients treated with thrombolysis and with a low median NIHSS, a finding of TIBI 5 is not unusual. This does not mean that the patient has a stroke mimic per se, and it tends to be more common among patients with lacunar syndrome than among patients with cortical syndromes.

  • 58.
    Johansson, Elias P
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Ahlqvist, Jan
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    Garoff, Maria
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    Karp, Kjell
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
    Levring Jäghagen, Eva
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Ultrasound screening for asymptomatic carotid stenosis in subjects with calcifications in the area of the carotid arteries on panoramic radiographs: a cross-sectional study2011In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 11, no 44, p. 1-9Article in journal (Refereed)
    Abstract [en]

    Background: Directed ultrasonic screening for carotid stenosis is cost-effective in populations with > 5% prevalence of the diagnosis. Occasionally, calcifications in the area of the carotid arteries are incidentally detected on odontological panoramic radiographs. We aimed to determine if directed screening for carotid stenosis with ultrasound is indicated in individuals with such calcifications. Methods: This was a cross-sectional study. Carotid ultrasound examinations were performed on consecutive persons, with findings of calcifications in the area of the carotid arteries on panoramic radiography that were otherwise eligible for asymptomatic carotid endarterectomy. Results: Calcification in the area of the carotid arteries was seen in 176 of 1182 persons undergoing panoramic radiography. Of these, 117 fulfilled the inclusion criterion and were examined with carotid ultrasound. Eight persons (6.8%; 95% CI 2.2-11.5%) had a carotid stenosis - not significant over the 5% pre-specified threshold (p = 0.232, Binomial test). However, there was a significant sex difference (p = 0.008), as all stenoses were found in men. Among men, 12.5% (95% CI 4.2-20.8%) had carotid stenosis - significantly over the 5% pre-specified threshold (p = 0.014, Binomial test). Conclusions: The incidental finding of calcification in the area of the carotid arteries on panoramic radiographs should be followed up with carotid screening in men that are otherwise eligible for asymptomatic carotid endarterectomy.

  • 59.
    Johansson, Elias
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Carotid bruits as predictor for carotid stenoses detected by ultrasonography: an observational study2008In: BMC Neurology, ISSN 1471-2377, E-ISSN 1471-2377, Vol. 8, article id 23Article in journal (Refereed)
    Abstract [en]

    Background: Carotid surgery in asymptomatic subjects with carotid stenosis is effective to prevent ischemic stroke. There is, however, uncertainty how to find such persons at risk, because mass screening with carotid artery ultrasonography (US) is not cost-effective. Signs of carotid bruits corresponding to the carotid arteries may serve as a tool to select subjects for further investigation. This study is thus aimed at determining the usefulness of carotid bruits in the screening of carotid stenoses. Methods: 1555 consecutive carotid ultrasonography investigations from 1486 cases done between January 2004 and March 2006 at Norrlands University Hospital, Sweden, were examined. 356 subjects, medium age 69 (27–88) years, had a significant (≥ 50%) US-verified carotid stenosis uni- or bilaterally, 291 had been examined for signs of carotid bruits. The likelihood ratios for carotid bruits to predict US-verified carotid stenoses were calculated and expressed as likelihood percentages. Results: Thirty-one out of 100 persons (31%) with carotid bruit as an indication to perform carotid US had a significant (≥ 50%) carotid stenosis. 281 of the 356 (79%) cases with significant carotid stenoses were found among patients with cerebrovascular disease (CVD). 145 of 226 (64%) CVD patients with a significant carotid stenosis had a carotid bruit. In patients with 50–99% carotid stenoses carotid bruits had an accuracy of 75% (436/582), a sensitivity of 71% (236/334), a specificity of 81% (200/248), a positive likelihood ratio at 3.65 and a negative likelihood at 0.36. Patients with 70–99% stenoses had the highest sensitivity at 77% (183/238). In patients with 100% carotid stenoses, carotid bruits had a sensitivity of 26% (15/57) and a specificity of 49% (256/525). Conclusion: Although carotid bruits are not accurate to confirm or to exclude significant carotid stenoses, these signs are appropriate for directed screening for further investigation with carotid US if the patient lacks contraindications for surgery. Lack of carotid bruits in CVD patients does not exclude a carotid stenosis

  • 60.
    Johansson, Elias
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Delay from symptoms to carotid endarterectomy2008In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 263, no 4, p. 404-411Article in journal (Refereed)
    Abstract [en]

    Objectives.  To investigate the time between cerebrovascular symptom and carotid endarterectomy (CEA), what prolongs this time and if and when the patients suffer additional cerebrovascular events.

    Design.  Observational.

    Setting.  Single Centre study at a specialized Stroke Centre.

    Subjects.  A total of 275 patients with ≥50% symptomatic carotid stenosis (according to the NASCET-criteria) between 1 January 2004 and 31 March 2006.

    Main outcome measures.  Time between cerebrovascular symptom and CEA, time between different parts of the investigation, additional cerebrovascular symptoms before CEA and as perioperative complication.

    Results.  A total of 128 patients underwent CEA. The median time between symptom and CEA was 11.7 weeks in the beginning and 6.9 weeks at the end of the study. Seven per cent were operated within 2 weeks and 11% between 2 and 4 weeks after their cerebrovascular symptom. The time delays were most pronounced between symptom onset and arrival at the Umeå Stroke Centre from the secondary hospitals and between the decision to recommend CEA and the CEA. Twenty-eight per cent of the patients who were intended for surgery suffered additional cerebrovascular events, 1.4% suffered a major stroke which excluded the indication of CEA and 3.0% of the CEA patients suffered a stroke with functional dependence within 30 days of the operation.

    Conclusions.  The delay between symptom and CEA was substantially longer than the desired 2 weeks. Many patients suffered additional cerebrovascular events before CEA. The risk of a severe additional stroke before CEA was about the same as the risk of a severe complication from the CEA.

  • 61.
    Johansson, Elias
    et al.
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Recurrent stroke risk is high after a single cerebrovascular event in patients with symptomatic 50-99% carotid stenosis: a cohort study2014In: BMC Neurology, ISSN 1471-2377, E-ISSN 1471-2377, Vol. 14, p. 23-Article in journal (Refereed)
    Abstract [en]

    Background:

    Recurrent TIAs are thought to signal a high stroke risk. The aim of this study is to examine if repeated ischemic events increase the risk of recurrent ipsilateral stroke among patients with symptomatic 50-99% carotid stenosis.

    Methods: This is a secondary analysis of the ANSYSCAP study, where we analyzed recurrent ipsilateral ischemic stroke before carotid endarterectomy in 230 consecutive patients with symptomatic 50-99% carotid stenosis. Here, we further analyzed the patients according to if they were clinically stable, unstable or highly unstable - respectively defined as having 0, 1 or >= 2 additional ipsilateral events within 7 days before and/or after the ischemic cerebrovascular event for which the patient sought health care (the presenting event).

    Results:

    Of the 230 included patients, 155 (67%) were clinically stable, 47 (20%) were clinically unstable and 28 (12%) were clinically highly unstable. Eighteen patients suffered a stroke within 7 days; of these patients, 12 (67%) were clinically stable. The risk of recurrent ipsilateral ischemic stroke within 7 days was equally high for clinically stable (8%), unstable (9%) and highly unstable (7%) patients. Fourteen patients had 3-11 additional ipsilateral events; of these patients, only one suffered a recurrent ipsilateral ischemic stroke.

    Conclusions:

    The seemingly clinical stable symptomatic 50-99% carotid stenosis patients without additional ipsilateral events have a high risk of recurrent stroke. Patients without additional events should undergo preoperative evaluation and carotid endarterectomy in the same expedient manner as patients with additional events.

  • 62.
    Johansson, Elias
    et al.
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Öhman, K.
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Symptomatic carotid near-occlusion with full collapse might cause a very high risk of stroke2015In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 277, no 5, p. 615-623Article in journal (Refereed)
    Abstract [en]

    BackgroundThe risk of early stroke recurrence amongst patients with symptomatic carotid near-occlusion with and without full collapse is unknown. Therefore, the aim of this study was to analyse the 90-day risk of recurrent ipsilateral ischaemic stroke in patients with symptomatic carotid near-occlusion both with and without full collapse. MethodsThis study was a secondary analysis of the Additional Neurological SYmptoms before Surgery of the Carotid Arteries: a Prospective study (ANSYSCAP). We prospectively analysed 230 consecutive patients with symptomatic 50-99% carotid stenosis or near-occlusion. Based on the combination of several imaging modalities, 205 (89%) patients were classified as having 50-99% carotid stenosis, and 10 (4%) and 15 (7%) as having near-occlusion with and without full collapse, respectively. The 90-day risk of recurrent ipsilateral ischaemic stroke was compared between these three groups. Only events that occurred before carotid endarterectomy were analysed. ResultsThe 90-day risk of recurrent stroke was 18% [95% confidence interval (CI) 12-25%; n=29] for patients with 50-99% carotid stenosis, 0% for patients with near-occlusion without full collapse and 43% (95% CI 25-89%; n=4) for patients with near-occlusion with full collapse (P=0.035, log-rank test). The increased risk of recurrent ipsilateral ischaemic stroke for patients with symptomatic near-occlusion with full collapse remained significant after multivariable adjustment for age, sex and type of presenting event. ConclusionsPatients with symptomatic carotid near-occlusion with full collapse might have a very high risk of stroke recurrence. Carotid endarterectomy could be considered for these patients.

  • 63.
    Johansson, Elias
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Öhman, Kjell
    Dept Radiology, University Hospital of Northern Sweden.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Risk of recurrent ipsilateral ischemic stroke in patients with symptomatic near-occlusionManuscript (preprint) (Other academic)
  • 64. Jood, Katarina
    et al.
    Karlsson, Nadine
    Medin, Jennie
    Pessah-Rasmussen, Helene
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital.
    Ekberg, Kerstin
    The psychosocial work environment is associated with risk of stroke at working age2017In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 43, no 4, p. 367-374Article in journal (Refereed)
    Abstract [en]

    Objective The aim of this study was to explore the relation between the risk of first-ever stroke at working age and psychological work environmental factors. Methods A consecutive multicenter matched 1:2 case control study of acute stroke cases (N=198, age 30-65 years) who had been working full-time at the time of their stroke and 396 sex- and age-matched controls. Stroke cases and controls answered questionnaires on their psychosocial situation during the previous 12 months. The psychosocial work environment was assessed using three different measures: the job control demand model, the effort reward imbalance (ERI) score, and exposures to conflict at work. Results Among 198 stroke cases and 396 controls, job strain [odds ratio (OR) 1.30, 95% confidence interval (95% CI) 1.05-1.62], ERI (OR 1.28, 95% CI 1.01-1.62), and conflict at work (OR 1.75, 95% CI 1.07-2.88) were independent risk factors of stroke in multivariable regression models. Conclusions Adverse psychosocial working conditions during the past 12 months were more frequently observed among stroke cases. Since these factors are presumably modifiable, interventional studies targeting job strain and emotional work environment are warranted.

  • 65. Khangure, Simon R.
    et al.
    Benhabib, Hadas
    Machnowska, Matylda
    Fox, Allan J.
    Grönlund, Christer
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Herod, Wendy
    Maggisano, Robert
    Sjöberg, Anders
    Umeå University, Faculty of Medicine, Department of Radiation Sciences. Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine. Department of Clinical Sciences, Karolinska Institutet Danderyds Hospital, Stockholm, Sweden.
    Hojjat, Seyed-Parsa
    Hopyan, Julia
    Aviv, Richard I.
    Johansson, Elias
    Carotid near-occlusion frequently has high peak systolic velocity on Doppler ultrasound2018In: Neuroradiology, ISSN 0028-3940, E-ISSN 1432-1920, Vol. 60, no 1, p. 17-25Article in journal (Refereed)
    Abstract [en]

    Purpose: Carotid near-occlusion is a tight atherosclerotic stenosis of the internal carotid artery (ICA) resulting in decrease in diameter of the vessel lumen distal to the stenosis. Near-occlusions can be classified as with or without full collapse, and may have high peak systolic velocity (PSV) across the stenosis, mimicking conventional > 50% carotid artery stenosis. We aimed to determine how frequently near-occlusions have high PSV in the stenosis and determine how accurately carotid Doppler ultrasound can distinguish high-velocity near-occlusion from conventional stenosis.

    Methods: Included patients had near-occlusion or conventional stenosis with carotid ultrasound and CT angiogram (CTA) performed within 30 days of each other. CTA examinations were analyzed by two blinded expert readers. Velocities in the internal and common carotid arteries were recorded. Mean velocity, pulsatility index, and ratios were calculated, giving 12 Doppler parameters for analysis.

    Results: Of 136 patients, 82 had conventional stenosis and 54 had near-occlusion on CTA. Of near-occlusions, 40 (74%) had high PSV (≥ 125 cm/s) across the stenosis. Ten Doppler parameters significantly differed between conventional stenosis and high-velocity near-occlusion groups. However, no parameter was highly sensitive and specific to separate the groups.

    Conclusion: Near-occlusions frequently have high PSV across the stenosis, particularly those without full collapse. Carotid Doppler ultrasound does not seem able to distinguish conventional stenosis from high-velocity near-occlusion. These findings question the use of ultrasound alone for preoperative imaging evaluation.

  • 66. Lindskog Jonsson, Annika
    et al.
    Fåk Hållenius, Frida
    Akrami, Rozita
    Johansson, Elias
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Karolinska Institute Danderyds Hospital, Department of Clinical Sciences, Stockholm, Sweden.
    Arnerlöv, Conny
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Bäckhed, Fredrik
    Bergström, Göran
    Bacterial profile in human atherosclerotic plaques2017In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 263, p. 177-183Article in journal (Refereed)
    Abstract [en]

    Background and aims: Several studies have confirmed the presence of bacterial DNA in atherosclerotic plaques, but its contribution to plaque stability and vulnerability is unclear. In this study, we investigated whether the bacterial plaque-profile differed between patients that were asymptomatic or symptomatic and whether there were local differences in the microbial composition within the plaque. Methods: Plaques were removed by endarterectomy from asymptomatic and symptomatic patients and divided into three different regions known to show different histological vulnerability: A, upstream of the maximum stenosis; B, site for maximum stenosis; C, downstream of the maximum stenosis. Bacterial DNA composition in the plaques was determined by performing 454 pyrosequencing of the 16S rRNA genes, and total bacterial load was determined by qPCR. Results: We confirmed the presence of bacterial DNA in the atherosclerotic plaque by qPCR analysis of the 16S rRNA gene but observed no difference (n.s.) in the amount between either asymptomatic and symptomatic patients or different plaque regions A, B and C. Unweighted UniFrac distance metric analysis revealed no distinct clustering of samples by patient group or plaque region. Operational taxonomic units (OTUs) from 5 different phyla were identified, with the majority of the OTUs belonging to Proteobacteria (48.3%) and Actinobacteria (40.2%). There was no difference between asymptomatic and symptomatic patients, or plaque regions, when analyzing the origin of DNA at phylum, family or OTU level (n.s.). Conclusions: There were no major differences in bacterial DNA amount or microbial composition between plaques from asymptomatic and symptomatic patients or between different plaque regions, suggesting that other factors are more important in determining plaque vulnerability.

  • 67. Lundström, Erik
    et al.
    Isaksson, Eva
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine. Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Laska, Ann-Charlotte
    Näsman, Per
    Enhancing Recruitment Using Teleconference and Commitment Contract (ERUTECC): study protocol for a randomised, stepped-wedge cluster trial within the EFFECTS trial2018In: Trials, ISSN 1745-6215, E-ISSN 1745-6215, Vol. 19, article id 14Article in journal (Refereed)
    Abstract [en]

    Background: Many randomised controlled trials (RCTs) fail to meet their recruitment goals in time. Trialists are advised to include study recruitment strategies within their trials. EFFECTS is a Swedish, academic-led RCT of fluoxetine for stroke recovery. The trial's primary objective is to investigate whether 20 mg fluoxetine daily compared with placebo for 6 months after an acute stroke improves the patient's functional outcome. The first patient was included on 20 October 2014 and, as of 31 August 2017, EFFECTS has included 810 of planned 1500 individuals. EFFECTS currently has 32 active centres. The primary objective of the ERUTECC (Enhancing Recruitment Using Teleconference and Commitment Contract) study is to investigate whether a structured teleconference re-visit with the study personnel at the centres, accompanied by a commitment contract, can enhance recruitment by 20% at 60 days post intervention, compared with 60 days pre-intervention, in an ongoing RCT.

    Methods: ERUTECC is a randomised, stepped-wedge cluster trial embedded in EFFECTS. The plan is to start ERUTECC with a running-in period of September 2017. The first intervention is due in October 2017, and the study will continue for 12 months. We are planning to intervene at all active centres in EFFECTS, except the five top recruiting centres (n=27). The rationale for not intervening at the top recruiting centres is that we believe they have reached their full potential and the intervention would be too weak for them. The hypothesis of this study is that a structured teleconference re-visit with the study personnel at the centres, accompanied by a commitment contract, can enhance recruitment by 20% 60 days post intervention, compared to 60 days pre-intervention, in an ongoing RCT.

    Discussion: EFFECTS is a large, pragmatic RCT of stroke in Sweden. Results from the embedded ERUTECC study could probably be generalised to high-income Western countries, and is relevant to trial management and could improve trial management in the future. It might also be useful in clinical settings outside the field of stroke.

  • 68.
    Lämås, Kristina
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Lindgren, Lenita
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB).
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Does touch massage facilitate recovery after stroke?: A study protocol of a randomized controlled trial2016In: BMC Complementary and Alternative Medicine, ISSN 1472-6882, E-ISSN 1472-6882, Vol. 16, article id 50Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Despite high quality stroke care, decreased sensorimotor function, anxiety and pain often remain one year after stroke which can lead to impaired health and dependence, as well as higher healthcare costs. Touch massage (TM) has been proven to decrease anxiety and pain, and improve quality of health in other conditions of reduced health, where reduced anxiety seems to be the most pronounced benefit. Thus there are reasons to believe that TM may also reduce anxiety and pain, and improve quality of life after stroke. Further, several studies indicate that somatosensory stimulation can increase sensorimotor function, and it seems feasible to believe that TM could increase independence after stroke. In this study we will evaluate effects of TM after stroke compared to sham treatment.

    METHODS: This is a prospective randomized open-labelled control trial with blinded evaluation (PROBE-design). Fifty patients with stroke admitted to stroke units will be randomized (1:1) to either a TM intervention or a non-active transcutaneous electrical nerve stimulation (non-TENS) control group. Ten sessions of 30 min treatments (TM or control) will be administered during two weeks. Assessment of status according to the International Classification of Functioning, Disability and Health (ICF), including body function, activity, and participation. Assessment of body function will include anxiety, pain, and stress response (heart rate variability and salivary cortisol), where anxiety is the primary outcome. Activity will be assessed by means of sensorimotor function and disability, and participation by means of health-related quality of life. Assessments will be made at baseline, after one week of treatment, after two weeks of treatment, and finally a follow-up after two months. The trial has been approved by the Regional Ethical Review Board.

    DISCUSSION: TM seems to decrease anxiety and pain, increase health-related quality of life, and improve sensorimotor functions after stroke, but the field is largely unexplored. Considering the documented pleasant effects of massage in general, absence of reported adverse effects, and potential effects in relation to stroke, it is essential to evaluate effects of TM during the sub-acute phase after stroke. The results of this project will hopefully provide important knowledge for evidence-based care.

    TRIAL REGISTRATION: ClinicalTrials.gov: NTC01883947.

  • 69.
    Magaard, Gustaf
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine. Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Levi, Richard
    Lindvall, Peter
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Gustafsson, Emma
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Nazemroaya Sedeh, Arzhang
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Lönnqvist, Malin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Berggren, Stina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Nyman, Kristin
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Hu, Xiao-Lei
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Neurocentrum, NUS.
    Identifying unmet rehabilitation needs in patients after stroke with a graphic rehab-compassTM2018In: Journal of Stroke & Cerebrovascular Diseases, ISSN 1052-3057, E-ISSN 1532-8511, Vol. 27, no 11, p. 3224-3235Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Unmet rehabilitation needs are common among stroke survivors. We aimed to evaluate whether a comprehensive graphic "Rehab-Compass," a novel combination of structured patient-reported outcome measures, was feasible and useful in facilitating a capture of patients' rehabilitation needs in clinical practice.

    METHODS: A new graphic overview of broad unmet rehabilitation needs covers deficits in functioning, daily activity, participation, and quality of life. It was constructed by using 5 patient-oriented, well-validated, and reliable existing instruments with converted data into a 0 (worst outcome) to 100 (best outcome) scale but unchanged in terms of variable properties. Satisfaction of the Rehab-CompassTM was studied by a qualitative interview of 9 patients with stroke and 3 clinicians. Practical feasibility and capacity of the instrument were evaluated in a cross-sectionalstudy with 48 patients at 5-month follow-ups after subarachnoid hemorrhage.

    RESULTS: The Rehab-CompassTM identified and graphically visualized a panoramic view of the multidimensional needs over time which was completed before clinical consultation. The Rehab-CompassTM appeared to be feasible and time-efficientin clinical use. The interviews of both patients and clinicians showed high satisfaction when using the Rehab-CompassTM graph. In the studied stroke patients, the Rehab-CompassTM identified memory and processing information, fatigue, mood, and pain after subarachnoid hemorrhage as the most common problems.

    CONCLUSIONS: The graphic Rehab-CompassTM seems to be a feasible, useful, and time-saving tool for identification of unmet rehabilitation needs among stroke survivors in clinical practice. Further research is needed to make the Rehab-CompassTM more concise and evaluate the instrument among different stroke subgroups.

  • 70.
    Murray, V
    et al.
    Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden.
    Norrving, B
    Department of Neurology, University Hospital, Lund, Sweden.
    Sandercock, P A G
    Division of Clinical Neurosciences, Western General Hospital, University of Edinburgh, Edinburgh, UK.
    Terént, A
    Department of Medical Sciences, Acute and Internal Medicine, Academic Hospital, Uppsala, Sweden.
    Wardlaw, J M
    Division of Clinical Neurosciences, Western General Hospital, University of Edinburgh, Edinburgh, UK.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    The molecular basis of thrombolysis and its clinical application in stroke2010In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 267, no 2, p. 191-208Article in journal (Refereed)
    Abstract [en]

    The rationale for thrombolysis, the most promising pharmacological approach in acute ischaemic stroke, is centred on the principal cause of most ischaemic strokes: the thrombus that occludes the cerebral artery, and renders part of the brain ischaemic. The occluding thrombus is bound together within fibrin. Fibrinolysis acts by activation of plasminogen to plasmin; plasmin splits fibrinogen and fibrin and lyses the clot, which then allows reperfusion of the ischaemic brain. Thrombolytic agents include streptokinase (SK) and recombinant tissue-type plasminogen activator (rt-PA) amongst others under test or development. SK is nonfibrin-specific, has a longer half-life than tissue-type plasminogen activator (t-PA), prevents re-occlusion and is degraded enzymatically in the circulation. rt-PA is more fibrin-specific and clot-dissolving, and is metabolized during the first passage in the liver. In animal models of ischaemic stroke, the effects of rt-PA are remarkably consistent with the effects seen in human clinical trials. For clinical application, some outcome data from the Cochrane Database of Systematic Reviews which includes all randomized evidence available on thrombolysis in man were used. Trials included tested urokinase, SK, rt-PA, pro-urokinase, or desmoteplase. The chief immediate hazard of thrombolytic therapy is fatal intracranial bleeding. However, despite the risk, the human trial data suggest the immediate hazards and the apparent substantial scope for net benefit of thrombolytic therapy given up to 6 h of acute ischaemic stroke. So far the fibrin-specific rt-PA is the only agent to be approved for use in stroke. This may be due to its short half-life and its absence of any specific amount of circulating fibrinogen degradation products, thereby leaving platelet function intact. The short half-life does not leave rt-PA without danger for haemorrhage after the infusion. Due to its fibrin-specificity, it can persist within a fibrin-rich clot for one or more days. The molecular mechanisms with regards to fibrin-specificity in thrombolytic agents should, if further studied, be addressed in within-trial comparisons. rt-PA has antigenic properties and although their long-term clinical relevance is unclear there should be surveillance for allergic reactions in relation to treatment. Although rt-PA is approved for use in selected patients, there is scope for benefit in a much wider variety of patients. A number of trials are underway to assess which additional patients - beyond the age and time limits of the current approval - might benefit, and how best to identify them.

  • 71. Murray, Veronica
    et al.
    Berge, Eivind
    Sandercock, Peter
    Norrving, Bo
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Terént, Andreas
    The need to recognize the difference between a quality register and a randomized controlled trial.2004In: Stroke, ISSN 1524-4628, Vol. 35, no 11, p. 2431-2Article in journal (Refereed)
  • 72. Nielsen-Kudsk, Jens Erik
    et al.
    Johnsen, Soren Paaske
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Karolinska Inst, Danderyd, Sweden.
    Damgaard, Dorte
    Airaksinen, Juhani
    Lund, Juha
    De Backer, Ole
    Pakarinen, Sami
    Odenstedt, Jacob
    Vikman, Saila
    Settergren, Magnus
    Kongstad, Ole
    Rosenqvist, Marten
    Krieger, Derk W.
    Left atrial appendage occlusion versus standard medical care in patients with atrial fibrillation and intracerebral haemorrhage: a propensity score-matched follow-up study2017In: EuroIntervention, ISSN 1774-024X, E-ISSN 1969-6213, Vol. 13, no 3, p. 371-378Article in journal (Refereed)
    Abstract [en]

    Aims: The aim of this study was to investigate the prognosis in patients with atrial fibrillation (AF) and intracerebral haemorrhage (ICH) having a left atrial appendage occlusion (LAAO) versus patients receiving standard medical therapy. Methods and results: A total of 151 patients from the Nordic countries with AF and previous ICH who underwent LAAO using the AMPLATZER Cardiac Plug or the AMPLATZER AMULET were compared to a propensity score-matched group of 151 patients receiving standard medical therapy. The two groups were matched so that their risks for stroke and bleeding were similar (CHA2DS2-VASc and HAS-BLED scores). The standard care patients were identified from the Danish Stroke Registry among 787 patients with AF and ICH. The primary endpoint was a composite of all-cause mortality, ischaemic stroke and major bleeding. Patients with AF and a prior ICH treated with LAAO had a lower risk of the composite outcome as compared to patients treated with standard medical care (events/1,000 years [95% confidence interval]: 53.3 [44.3-64.1] vs. 366.7 [298.2-450.9]; hazard ratio 0.16 [0.07-0.37]). Conclusions: LAAO is suggested to be of major clinical benefit in AF patients having sustained an ICH. These results have to be confirmed in a randomised clinical trial.

  • 73. Norrving, B
    et al.
    Stibrant Sunnerhagen, KS
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Strokesjukvård: Vetenskapligt underlag för Nationella riktlinjer 20092009Other (Other academic)
  • 74. Norrving, Bo
    et al.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Sunnerhagen, Katharina Stibrant
    Terént, Andreas
    Sohlberg, Anna
    Berggren, Fredrik
    Wester, Per-Olov
    Asplund, Kjell
    Beyond conventional stroke guidelines: setting priorities.2007In: Stroke, ISSN 1524-4628, Vol. 38, no 7, p. 2185-90Article in journal (Refereed)
  • 75.
    Näslund, Ulf
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Lundgren, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Fhärm, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Grönlund, Christer
    Umeå University, Faculty of Medicine, Department of Radiation Sciences. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Johansson, Helene
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Lindahl, Bernt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Lindahl, Bertil
    Lindvall, Kristina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Nilsson, Stefan K.
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Physiological chemistry.
    Nordin, Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Nordin, Steven
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Nyman, Emma
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Vanoli, Davide
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Wennberg, Patrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Norberg, Margareta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA): a pragmatic, open-label, randomised controlled trial2019In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 393, no 10167, p. 133-142Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Primary prevention of cardiovascular disease often fails because of poor adherence among practitioners and individuals to prevention guidelines. We aimed to investigate whether ultrasound-based pictorial information about subclinical carotid atherosclerosis, targeting both primary care physicians and individuals, improves prevention.

    METHODS: Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA) is a pragmatic, open-label, randomised controlled trial that was integrated within the Västerbotten Intervention Programme, an ongoing population-based cardiovascular disease prevention programme in northern Sweden. Individuals aged 40, 50, or 60 years with one or more conventional risk factors were eligible to participate. Participants underwent clinical examination, blood sampling, and ultrasound assessment of carotid intima media wall thickness and plaque formation. Participants were randomly assigned 1:1 with a computer-generated randomisation list to an intervention group (pictorial representation of carotid ultrasound plus a nurse phone call to confirm understanding) or a control group (not informed). The primary outcomes, Framingham risk score (FRS) and European systematic coronary risk evaluation (SCORE), were assessed after 1 year among participants who were followed up. This study is registered with ClinicalTrials.gov, number NCT01849575.

    FINDINGS: 3532 individuals were enrolled between April 29, 2013, and June 7, 2016, of which 1783 were randomly assigned to the control group and 1749 were assigned to the intervention group. 3175 participants completed the 1-year follow-up. At the 1-year follow-up, FRS and SCORE differed significantly between groups (FRS 1·07 [95% CI 0·11 to 2·03, p=0·0017] and SCORE 0·16 [0·02 to 0·30, p=0·0010]). FRS decreased from baseline to the 1-year follow-up in the intervention group and increased in the control group (-0·58 [95% CI -0·86 to -0·30] vs 0·35 [0·08 to 0·63]). SCORE increased in both groups (0·13 [95% CI 0·09 to 0·18] vs 0·27 [0·23 to 0·30]).

    INTERPRETATION: This study provides evidence of the contributory role of pictorial presentation of silent atherosclerosis for prevention of cardiovascular disease. It supports further development of methods to reduce the major problem of low adherence to medication and lifestyle modification.

  • 76. Rejnö, Åsa
    et al.
    Andersson, Per
    Wester, Per
    "StrokeSverige" lär i webbaserad kompetensutbildning2018In: VILÄR Abstraktbok, Trollhättan: Högskolan Väst , 2018Conference paper (Other academic)
    Abstract [sv]

    Bakgrund: Verksamhetsintegrerat lärande omfattar lärande som sker integrerat mellan akademi och arbetsliv. Ofta är integrationen sådan att arbetslivet integreras i akademin. Det omvända är inte lika vanligt. Strokeenhetsvård är sedan 1980-talet ett internationellt evidensbaserat vårdkoncept som minskar mortalitet, institutionsboende och beroende i ADL efter stroke. För att en verksamhet ska få kalla sig strokeenhet ingår att vården ska bedrivas av ett multidisciplinärt team med expertkunnande inom stroke och rehabilitering. Strokekompetensutbildning med både teoretiska och praktiska moment som ger detta expertkunnande ges sedan av STROKE Riksförbundet och drivs lokalt. Antalet som genomgår utbildningen minskar på grund av vårdens pressadef örhållanden vilket gett svårigheter att organisera och driva utbildningen lokalt. Från centralt håll har oro uttryckts då strokekompetensen genom detta minskar vilket potentiellt leder till sämre vård. Syftet med presentationen är att visa hur lokalt drivna utbildningar i arbetslivet kan webbaseras i samarbete med akademin för att möjliggöra personalgruppers möjlighet till kompetenshöjning

    Metod: Utbildningen har digitaliserats för att ge förutsättningar för jämlik vård. Alla teoretiska moment har gjorts som filmade föreläsningar av personer med spetskompetens inom sitt område och en tredelad examination har tagits fram som säkerställer att utbildningen ger jämn och hög kvalitet.

    Resultat: Utbildningen som använder det flippade klassrummet som teoretisk modell är nu en poänggivande högskoleutbildning som ges av Umeå universitet där teambased learning och constructive alignment varit ledord för uppbyggnaden. Utbildningen omfattar filmade föreläsningar, quiz och webbaserad examination som genomförs via lärplattformen, samt material för träffar där praktiska moment ingår som ordnas lokalt av respektive verksamhet, liksom material för såväl individuell examination som gruppexamination. Utöver detta finns länkar till referensmaterial samt fördjupningsmaterial.

    Diskussion: Med noggrann planering, förankring och tydliga pedagogiska utgångspunkter kan utbildning utvecklas i samarbete mellan offentlig sektor och universitet/högskolor. Utbildningen är exempel på ett initiativ från arbetslivet där akademin är tydligt integrerad för att möjliggöra lärande för personer i arbetslivet. Genom digitaliseringen ges möjlighet för verksamheter att erbjuda personal utbildning inommer flexibla ramar och på tider som passar dem jämfört med traditionella kurser inom högre utbildning. Konceptet kan potentiellt användas för många verksamheter och visar på möjligheterna med digitalisering av högre utbildning för att nå ut till arbetslivet

  • 77. Terént, A
    et al.
    Asplund, Kjell
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Farahmand, B
    Henriksson, K M
    Norrving, B
    Stegmayr, Birgitta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Wester, P-O
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Asberg, K H
    Asberg, S
    Stroke unit care revisited: who benefits the most? A cohort study of 105,043 patients in Riks-Stroke, the Swedish Stroke Register.2009In: Journal of Neurology, Neurosurgery and Psychiatry, ISSN 0022-3050, E-ISSN 1468-330X, Vol. 80, no 8, p. 881-887Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Treatment at stroke units is superior to treatment at other types of wards. The objective of the present study is to determine the effect size of stroke unit care in subgroups of patients with stroke. This information might be useful in a formal priority setting. METHODS: All acute strokes reported to the Swedish Stroke Register from 2001 through 2005 were followed until January 2007. The subgroups were age (18-64, 65-74, 75-84, 85+ years and above), sex (male, female), stroke subtype (intracerebral haemorrhage, cerebral infarction and unspecified stroke) and level of consciousness (conscious, reduced, unconscious). Cox proportional hazards and logistic regression analyses were used to estimate the risk for death, institutional living or dependency. RESULTS: 105,043 patients were registered at 86 hospitals. 79,689 patients (76%) were treated in stroke units and 25,354 patients (24%) in other types of wards. Stroke unit care was associated with better long-term survival in all subgroups. The best relative effect was seen among the following subgroups: age 18-64 years (hazard ratio (HR) for death 0.53; 0.49 to 0.58), intracerebral haemorrhage (HR 0.61; 0.58 to 0.65) and unconsciousness (HR 0.70; 0.66 to 0.75). Stroke unit care was also associated with reduced risk for death or institutional living after 3 months. CONCLUSIONS: Stroke unit care was associated with better long-term survival in all subgroups, but younger patients, patients with intracerebral haemorrhage and patients who were unconscious had the best relative effect and may be given the highest priority to this form of care.

  • 78. Westander, Fredrik
    et al.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Strokesjukvården i Sverige: kvalitetsjämförelser mellan olika sjukhus och landsting/regioner2007Report (Other academic)
  • 79.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Cerebrovaskulära sjukdomar2010In: Kardiovaskulär medicin / [ed] Ulf Dahlström, Lena Jonasson, Fredrik Nyström, Stockholm: Liber , 2010, p. 145-171Chapter in book (Other academic)
  • 80.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Introduction: Stockholm stroke symposium - from genes to acute care.2010In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 267, no 2, p. 136-138Article in journal (Refereed)
    Abstract [en]

    The acute stroke research field is dynamic and exciting with several clinical breakthroughs, which give reason for optimism. There is gradually a broader understanding of the genetic linkage with different aspects of stroke. As a majority of stroke cases are caused by thrombo-embolism with blocking of one or more of the cerebral arteries, the obvious acute treatment strategy is to remove the occluded vessel and thereby restore the aerobic metabolism provided that neuroimaging analyses reveal the presence of rescuable ischaemic tissue. On January 28-29, 2009, the Journal of Internal Medicine arranged a 2-day symposium entitled Stockholm stroke symposium - from genes to acute care. In this issue of JIM, five comprehensive reviews from this symposium are presented. These include the genetic factors in the aetiology and treatment of ischaemic stroke, the interplay between microvessels, neurons and glia (i.e., the microvascular unit) in the setting of acute stroke, a critical review of various neuroimaging techniques to visualize ischaemic tissue that is still viable (the ischaemic penumbra), recanalization strategies by means of intravenous thrombolysis as well as future recanalization techniques by, for example, intra-arterial or mechanical thrombolysis and sonothrombolysis by a transcranial approach.

  • 81.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Socialstyrelsens riktlinjer för strokesjukvård 2009: stöd för styrning och ledning. Nationella riktlinjer2009Other (Other academic)
  • 82.
    Wester, Per
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Staaf, Ann
    Johansson, Åsa B
    Eriksson, Marie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Wester, PO
    Westander, Fredrik
    Strokeenheter i Sverige: kartläggning av dimensionering, praxis och vårdinnehåll2007Report (Other academic)
  • 83.
    Wester, Per
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    van Mansfelt, Erik
    Vidarklinikens husläkarmottagning, Järna.
    Cerebrovaskulära sjukdomar2009In: Läkemedelsboken, Apoteket AB , 2009, p. 317-333Chapter in book (Other academic)
12 51 - 83 of 83
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