BioFACTS : biomarkers of rhabdomyolysis in the diagnosis of acute compartment syndrome - protocol for a prospective multinational, multicentre study involving patients with tibial fractures

Introduction The ischaemic pain of acute compartment syndrome (ACS) can be difficult to discriminate from the pain linked to an associated fracture. Lacking objective measures, the decision to perform fasciotomy is based on clinical findings and performed at a low level of suspicion. Biomarkers of muscle cell damage may help to identify and monitor patients at risk, similar to current routines for patients with acute myocardial infarction. This study will test the hypothesis that biomarkers of muscle cell damage can predict ACS in patients with tibial fractures. Methods and analysis Patients aged 15-65 years who have suffered a tibial fracture will be included. Plasma (P)-myoglobin and P-creatine phosphokinase will be analysed at 6-hourly intervals after admission to the hospital (for 48 hours) and-if applicable-after surgical fixation or fasciotomy (for 24 hours). In addition, if ACS is suspected at any other point in time, blood samples will be collected at 6-hourly intervals. An independent expert panel will assess the study data and will classify those patients who had undergone fasciotomy into those with ACS and those without ACS. All primary comparisons will be perforated between fracture patients with and without ACS. The area under the receiver operator characteristics curves will be used to identify the success of the biomarkers in discriminating between fracture patients who develop ACS and those who do not. Logistic regression analyses will be used to assess the discriminative abilities of the biomarkers to predict ACS corrected for prespecified covariates. Ethics and dissemination The study has been approved by the Regional Ethical Review Boards in Linkoping (2017/514-31) and Helsinki/Uusimaa (HUS/2500/2000). The BioFACTS study will be reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology recommendations.Peer reviewe

Расширенная оценка технологической сложности отливок на основе применения методов нейросетей

Материалы XIII Междунар. науч.-техн. конф. (науч. чтения, посвящ. 125-летию со дня рождения П. О. Сухого), Гомель, 22 окт. 2020 г

Clinical-epidemiological studies on cutaneous malignant melanoma : A register approach

The incidence of cutaneous malignant melanoma (CMM) is steadily increasing. Most of the patients have thin CMM with a good prognosis and a 5-year survival of about 90%. The prognosis is highly related to tumour thickness and clinical stage at diagnosis. Effective systemic treatment for patients with metastatic disease has only recently been available. This thesis aims to increase knowledge of trends in tumour thickness, prognostic factors, socioeconomic differences and medical costs in patients with CMM. The population-based Swedish melanoma register is the main source of data in all papers in the thesis. Papers I-III include patients from all of Sweden while paper IV is delimited to the County of Östergötland. Cox regression and logistic regression are the main multivariable methods used. Paper IV is focused on stage-specific costs of CMM by comparing direct healthcare costs to a general population. For men, there has been a shift over time towards thinner tumours at diagnosis accompanied by an improved survival. Women are still diagnosed with considerably thinner tumours and they experience a better survival than men. Tumour ulceration, tumour thickness and Clark’s level of invasion all showed significant independent long-term prognostic information in T1 CMMs. By combining these factors, three distinct prognostic subgroups were identified. Lower level of education was associated with reduced CMM-specific survival, which may at least partially be attributed to a more advanced stage at diagnosis. The direct healthcare costs for CMM patients were significantly higher than for the general population, independent of clinical stage. CMM patients diagnosed in clinical stage III-IV were associated with particularly high costs. Even though the survival among Swedish patients with CMM is among the highest in the world and still seems to improve, the results of this thesis emphasise the need of improved early detection strategies. This may be of particular concern in men, older women, and groups with a low level of education. The results also imply that the costs for the management of CMM patients may be reduced if early detection efforts are successful and lead to a more favourable stage distribution. The finding of a better risk stratification of thin CMMs may help to improve the management of this large patient group

En jämförelse mellan individers självuppskattade livskvalitet och samhällets hälsopreferenser : En paneldatastudie av hjärtpatienter

Objective: In recent years there has been an increasing interest within the clinical (medical) science in measuring people’s health. When estimating quality of life, present practise is to use the EQ-5D questionnaire and an index which weighs the different questions. The question is what happens if the individuals estimate there own health, would it differ from the public preferences? The aim is to make a new prediction model based on the opinion of patients and compare it to the present model based on public preferences. Method: A sample of 362 patients with unstable coronary artery disease from the Frisc II trial, valued their quality of life in the acute phase and after 3, 6 and 12 months. The EQ-5D question form and also the Time Trade-off method (TTO), a direct method of valuing health was used. A regression technique managing panel data had to be used in estimating TTO by the EQ-5D and other variables like gender and age. Result: Different regression techniques vary in estimating parameters and standard errors. A Generalized Estimating Equation approach with empirical correlation structure is the most suitable regression technique for the data material. A model based on the EQ-5D question form and a continuous age variable proves to be the best model for an index derived by individuals. The difference between heart patients own opinion of health and the public preferences differs a great amount in the severe health conditions, but are rather small for healthy patients. Of the total 243 health conditions, only eight of the conditions were estimated higher by the public index. Conclusions: As the differences between the approaches are significantly large the choice of index could affect the decision making in a health economic study

Motivation, Leadership and Teambuilding : A Study about Mediamakarna i Sverige AB

Motiverade och engagerade medarbetare anses idag vara en av de viktigaste faktorerna för att skapa goda resultat inom företag och organisationer. Genom hela historien så har en ledares uppgift varit att inrikta människornas självbevarelsedrift på gemensamma mål, att uttrycka och att försvara en vision som fyller de ledda med hopp. Mediamakarna i Sverige AB, beläget i centrala Stockholm, startades av tre personer vid namn Richard Ehlesjö, Fredrik Sandblad och Sammy Jeridi. Som delägare i företaget arbetar de efter egen modell där öppen kommunikation anses vara extremt betydelsefullt. Med tanke på att de är relativt oerfarna som ledare ställer jag mig frågande till huruvida ledarna har en tillräcklig kompetens och personliga egenskaper för att leda sig själva samt att motivera ett säljteam till framgång. Hur motiverar Mediamakarna säljarna till att prestera det yttersta och hur gör man för att få självmotiverade säljare? Anser cheferna att de har de egenskaper som gör dem till bra ledare som nyttjar varje ledares positiva egenskaper på rätt sätt? Dessutom ska jag granska företagets rollfördelning. Syftet med uppsatsen är att förstå vilka metoder cheferna använder för att skapa och framförallt bibehålla hög motivation hos säljpersonalen. För att förstå relationen mellan ledning och säljare är min avsikt också att studera ledarstruktur och roller. Jag har intervjuat tre personer. För att intervjuerna skulle bli så bra som möjligt intervjuades den person med mest kunskap och ansvar inom det ämne jag skriver om. Det hermeneutiska förhållningssättet kommer att användas därför att de lämpar sig mer gentemot min forskning. Jag tolkar respondenternas åsikter med hjälp av min förståelse. Jag skall använda mig av en mer kvalitativ metod gentemot kvantitativ eftersom jag kommer att söka förståelse samt meningen med företeelsen av rapportens syfte. Efter avslutande studier där jag främst granskat olika motivationsfaktorer hos Mediamakarna anser jag att de har en god struktur men att de bör fokusera på vissa specifika områden som kan skapa eventuella framtida problem. Jag tycker att de har en god syn på motivation där de främst vill bevara inre motivationsintressen kontra yttre sådana. Vad man däremot kan göra är att belöna de säljare som verkligen presterar bra med sådana ”belöningar som främjar den inre företagskulturen” i högre utsträckning så att de i sin tur är trogna gentemot företaget och på sikt kan bli viktiga aktörer när företaget expanderar. När det gäller huvuduppgifterna som en ledare bör ha så tycker jag att Mediamakarna uppfyller kraven. Visionerna och målen som är uppsatta tillsammans med säljarna betyder att den största pressen inte kommer från ledarna utan från säljarna själva. En säljare känner då att han kan utgå från sin egen förmåga och inte hela tiden bli jämförd med andra vilket bidrar till en ökad positiv energi istället för ett ökande tryck på axlarna. Synsättet ökar, enligt mig, förståelsen gentemot varandra och underlättar för ledarna att förmedla en gemensam vision som ska finnas hos respektive säljare. Jag tycker att Fredrik och Rickard klarar av att vara ett föredöme utåt. De har, med tanke på sin ringa erfarenhet som ledare, lyckats etablera sig i en hård bransch där det gäller att synas och att skapa kontakter. Det Fredrik dock bör tänka på är att fortsätta med att sätta upp klara riktlinjer vad som är ledare kontra kamrat, vara rättvis och undvika favoriseringar. När det gäller rollfördelningen inom organisation ser jag i nuläget att det inte är några större problem. För att tillsätta en analytiker samt en riktig verkställare så måste Mediamakarna börja att fokusera mer på grupptänkandet. Ledningen har en viktig fråga framför sig, hur man ska bli ”bredare” i sitt urvalsmönster av säljare. De får inte vara rädda för att anställa ”udda” säljare som skiljer sig från den nuvarande säljgruppen. Ju större karaktärsbredd desto lättare är det att hitta den saknade ”pusselbiten” och göra gruppen mer dynamisk.Motivated and absorbed co-workers is today considered as one of the most important factors in creating good results within companies and organisations. A leaders aim has always been, throughout the whole history, to concentrate human instinct of self-preservation towards common interests, to express and defend a vision which enhance co-workers with believe. Mediamakarna i Sverige AB, founded by Richard Ehlesjö, Fredrik Sandblad and Sammy Jeridi wants to emphasise open communication as something significant within their organisation. Considered their relative inexperienced qualities of leadership, I’m making inquiries about their qualifications and characteristics managing themselves and motivating a sales team to success. How is Mediamakarna motivating salesmen to perform their outmost and how to receive self- motivated members? Considering the management, are they of that opinion having sufficient quality of being good leaders and do they use each others skills in a right, positive manner? Furthermore, I will revise the company’s role of structure. The purpose with this article is to understand what kind of methods the management are using to create and above all preserve a high level of motivation among the salesmen. To understand the relationship between management and salesman my purpose is also to study management structure and roles. I have had interviews with three persons. To receive maximum extent, I interviewed the person with the greatest knowledge and responsibility within each field. The hermeneutic approach will be used because it suits my study field. I interpret the respondents opinions with my comprehension. I’m using a more qualitative approach compare to a quantitative one seeing that I will be in search of comprehension and intention of the purpose of the report. After completed studies at Mediamakarna, I consider the company having a good structure but also that the management must focus on certain specific fields that may lead to future complex of problems. My opinion is that they have an agreeable view regarding motivation where they foremost want to preserve internal motivation versus external ones. What the company can do is to reward those salesmen that perform on a constant high basis with ”such rewards that encourage the inner culture of company” in a higher extent that they in return are faithful towards the company and in the future can be major assets when the company expands. Regarding the main tasks a manager must have, I think that Mediamakarna fulfils the requirements. The vision and goals that are constructed together means that the great amount of pressure are not from the management but from the salesmen themselves. One salesman might then feel that he can emanate from his own capacity and not be judged on a constant basis which create a positive energy instead of a increasing pressure on the shoulders. In my point of view it increases the understanding towards each other and make it easier for the management to supply a common vision that must be found in each salesperson. I’m finding Fredrik and Rickard being good examples of external acting. They have, in regard to their slight experience, manage to establish themselves in a tough line of business where you have to be visible and create contacts. Fredrik must however continue to follow his guiding principles – manager versus friend, to be impartial and avoid favouritism. Concerning the role division within the organisation I can’t in this moment see any major problems. To appoint an analysts and a performer, Mediamakarna must focused and intensify more on how to create dynamic groups. The management has an important task how to become more wider in the recruiting of salesperson. They can’t be afraid of appointing ”odd” salesmen that are separate from the current sales group. The more traits of character in a group the easier it might be to find the missing piece of a puzzle and accordingly make the group more dynamic

Clinical-epidemiological studies on cutaneous malignant melanoma : A register approach

The incidence of cutaneous malignant melanoma (CMM) is steadily increasing. Most of the patients have thin CMM with a good prognosis and a 5-year survival of about 90%. The prognosis is highly related to tumour thickness and clinical stage at diagnosis. Effective systemic treatment for patients with metastatic disease has only recently been available. This thesis aims to increase knowledge of trends in tumour thickness, prognostic factors, socioeconomic differences and medical costs in patients with CMM. The population-based Swedish melanoma register is the main source of data in all papers in the thesis. Papers I-III include patients from all of Sweden while paper IV is delimited to the County of Östergötland. Cox regression and logistic regression are the main multivariable methods used. Paper IV is focused on stage-specific costs of CMM by comparing direct healthcare costs to a general population. For men, there has been a shift over time towards thinner tumours at diagnosis accompanied by an improved survival. Women are still diagnosed with considerably thinner tumours and they experience a better survival than men. Tumour ulceration, tumour thickness and Clark’s level of invasion all showed significant independent long-term prognostic information in T1 CMMs. By combining these factors, three distinct prognostic subgroups were identified. Lower level of education was associated with reduced CMM-specific survival, which may at least partially be attributed to a more advanced stage at diagnosis. The direct healthcare costs for CMM patients were significantly higher than for the general population, independent of clinical stage. CMM patients diagnosed in clinical stage III-IV were associated with particularly high costs. Even though the survival among Swedish patients with CMM is among the highest in the world and still seems to improve, the results of this thesis emphasise the need of improved early detection strategies. This may be of particular concern in men, older women, and groups with a low level of education. The results also imply that the costs for the management of CMM patients may be reduced if early detection efforts are successful and lead to a more favourable stage distribution. The finding of a better risk stratification of thin CMMs may help to improve the management of this large patient group

Motivation, Leadership and Teambuilding : A Study about Mediamakarna i Sverige AB

Motiverade och engagerade medarbetare anses idag vara en av de viktigaste faktorerna för att skapa goda resultat inom företag och organisationer. Genom hela historien så har en ledares uppgift varit att inrikta människornas självbevarelsedrift på gemensamma mål, att uttrycka och att försvara en vision som fyller de ledda med hopp. Mediamakarna i Sverige AB, beläget i centrala Stockholm, startades av tre personer vid namn Richard Ehlesjö, Fredrik Sandblad och Sammy Jeridi. Som delägare i företaget arbetar de efter egen modell där öppen kommunikation anses vara extremt betydelsefullt. Med tanke på att de är relativt oerfarna som ledare ställer jag mig frågande till huruvida ledarna har en tillräcklig kompetens och personliga egenskaper för att leda sig själva samt att motivera ett säljteam till framgång. Hur motiverar Mediamakarna säljarna till att prestera det yttersta och hur gör man för att få självmotiverade säljare? Anser cheferna att de har de egenskaper som gör dem till bra ledare som nyttjar varje ledares positiva egenskaper på rätt sätt? Dessutom ska jag granska företagets rollfördelning. Syftet med uppsatsen är att förstå vilka metoder cheferna använder för att skapa och framförallt bibehålla hög motivation hos säljpersonalen. För att förstå relationen mellan ledning och säljare är min avsikt också att studera ledarstruktur och roller. Jag har intervjuat tre personer. För att intervjuerna skulle bli så bra som möjligt intervjuades den person med mest kunskap och ansvar inom det ämne jag skriver om. Det hermeneutiska förhållningssättet kommer att användas därför att de lämpar sig mer gentemot min forskning. Jag tolkar respondenternas åsikter med hjälp av min förståelse. Jag skall använda mig av en mer kvalitativ metod gentemot kvantitativ eftersom jag kommer att söka förståelse samt meningen med företeelsen av rapportens syfte. Efter avslutande studier där jag främst granskat olika motivationsfaktorer hos Mediamakarna anser jag att de har en god struktur men att de bör fokusera på vissa specifika områden som kan skapa eventuella framtida problem. Jag tycker att de har en god syn på motivation där de främst vill bevara inre motivationsintressen kontra yttre sådana. Vad man däremot kan göra är att belöna de säljare som verkligen presterar bra med sådana ”belöningar som främjar den inre företagskulturen” i högre utsträckning så att de i sin tur är trogna gentemot företaget och på sikt kan bli viktiga aktörer när företaget expanderar. När det gäller huvuduppgifterna som en ledare bör ha så tycker jag att Mediamakarna uppfyller kraven. Visionerna och målen som är uppsatta tillsammans med säljarna betyder att den största pressen inte kommer från ledarna utan från säljarna själva. En säljare känner då att han kan utgå från sin egen förmåga och inte hela tiden bli jämförd med andra vilket bidrar till en ökad positiv energi istället för ett ökande tryck på axlarna. Synsättet ökar, enligt mig, förståelsen gentemot varandra och underlättar för ledarna att förmedla en gemensam vision som ska finnas hos respektive säljare. Jag tycker att Fredrik och Rickard klarar av att vara ett föredöme utåt. De har, med tanke på sin ringa erfarenhet som ledare, lyckats etablera sig i en hård bransch där det gäller att synas och att skapa kontakter. Det Fredrik dock bör tänka på är att fortsätta med att sätta upp klara riktlinjer vad som är ledare kontra kamrat, vara rättvis och undvika favoriseringar. När det gäller rollfördelningen inom organisation ser jag i nuläget att det inte är några större problem. För att tillsätta en analytiker samt en riktig verkställare så måste Mediamakarna börja att fokusera mer på grupptänkandet. Ledningen har en viktig fråga framför sig, hur man ska bli ”bredare” i sitt urvalsmönster av säljare. De får inte vara rädda för att anställa ”udda” säljare som skiljer sig från den nuvarande säljgruppen. Ju större karaktärsbredd desto lättare är det att hitta den saknade ”pusselbiten” och göra gruppen mer dynamisk.Motivated and absorbed co-workers is today considered as one of the most important factors in creating good results within companies and organisations. A leaders aim has always been, throughout the whole history, to concentrate human instinct of self-preservation towards common interests, to express and defend a vision which enhance co-workers with believe. Mediamakarna i Sverige AB, founded by Richard Ehlesjö, Fredrik Sandblad and Sammy Jeridi wants to emphasise open communication as something significant within their organisation. Considered their relative inexperienced qualities of leadership, I’m making inquiries about their qualifications and characteristics managing themselves and motivating a sales team to success. How is Mediamakarna motivating salesmen to perform their outmost and how to receive self- motivated members? Considering the management, are they of that opinion having sufficient quality of being good leaders and do they use each others skills in a right, positive manner? Furthermore, I will revise the company’s role of structure. The purpose with this article is to understand what kind of methods the management are using to create and above all preserve a high level of motivation among the salesmen. To understand the relationship between management and salesman my purpose is also to study management structure and roles. I have had interviews with three persons. To receive maximum extent, I interviewed the person with the greatest knowledge and responsibility within each field. The hermeneutic approach will be used because it suits my study field. I interpret the respondents opinions with my comprehension. I’m using a more qualitative approach compare to a quantitative one seeing that I will be in search of comprehension and intention of the purpose of the report. After completed studies at Mediamakarna, I consider the company having a good structure but also that the management must focus on certain specific fields that may lead to future complex of problems. My opinion is that they have an agreeable view regarding motivation where they foremost want to preserve internal motivation versus external ones. What the company can do is to reward those salesmen that perform on a constant high basis with ”such rewards that encourage the inner culture of company” in a higher extent that they in return are faithful towards the company and in the future can be major assets when the company expands. Regarding the main tasks a manager must have, I think that Mediamakarna fulfils the requirements. The vision and goals that are constructed together means that the great amount of pressure are not from the management but from the salesmen themselves. One salesman might then feel that he can emanate from his own capacity and not be judged on a constant basis which create a positive energy instead of a increasing pressure on the shoulders. In my point of view it increases the understanding towards each other and make it easier for the management to supply a common vision that must be found in each salesperson. I’m finding Fredrik and Rickard being good examples of external acting. They have, in regard to their slight experience, manage to establish themselves in a tough line of business where you have to be visible and create contacts. Fredrik must however continue to follow his guiding principles – manager versus friend, to be impartial and avoid favouritism. Concerning the role division within the organisation I can’t in this moment see any major problems. To appoint an analysts and a performer, Mediamakarna must focused and intensify more on how to create dynamic groups. The management has an important task how to become more wider in the recruiting of salesperson. They can’t be afraid of appointing ”odd” salesmen that are separate from the current sales group. The more traits of character in a group the easier it might be to find the missing piece of a puzzle and accordingly make the group more dynamic

The Health Diary Telemonitoring and Hospital-Based Home Care Improve Quality of Life Among Elderly Multimorbid COPD and Chronic Heart Failure Subjects

Background: Elderly, multimorbid patients with advanced chronic obstructive pulmonary disease (COPD) and/or chronic heart failure (CHF) exhibit poor health-related quality of life (HRQoL). Telemonitoring, based on digital pen technology, supported by hospital-based home care (HBHC) significantly reduces the number of hospitalizations. We hypothesized that the same intervention would prevent the deterioration of HRQoL that follows upon disease progression. Methods: Elderly computer-illiterate subjects with amp;gt;= 2 hospitalizations the previous year were included. HRQoL was assessed at inclusion (baseline) and at 1, 6 and 12 months employing EuroQol-5 Dimensions (EQ-5D) and RAND-36 for general HRQoL, and Minnesota Living with Heart Failure Questionnaire (MLHFQ) and St. Georges Respiratory Questionnaire (SGRQ) for disease-specific HRQoL. Healthcare contacts, hospitalizations, as-needed medications, prescription changes and healthcare costs were registered. Results: Ninety-four patients were enrolled of which 53 subjects completed the 12-month study period. Compared to baseline, most domains of RAND-36 were improved significantly at 1 time-point or more. Only among COPD subjects, the disease-specific HRQoL was worsened at the 12 month evaluation. Measures of healthcare dependency were associated with poor HRQoL. Conclusion: The Health Diary system and HBHC together improve general HRQoL, and measures of healthcare dependency are associated with HRQoL variables.Funding Agencies|county council of Ostergotland (Region Ostergotland); E-care@home: a "SIDUS -Strong Distributed Research Environment" project - Swedish Knowledge Foundation; European Regional Development Fund through the NovaMedTech venture; RISE Research Institutes of Sweden AB</p

Cost-Effectiveness of Comprehensive Geriatric Assessment Adapted to Primary Care

Objectives To estimate the cost-effectiveness of a pragmatic trial of comprehensive geriatric assessment adapted to primary care, compared with care as usual. Design Within-trial cost-effectiveness study of a prospective controlled multicenter trial. Setting and Participants Nineteen primary care practices in Sweden. The original trial included 1304 individuals aged ≥75 years at high risk of hospitalization selected using a prediction model. From the original trial, 369 individuals participated in the cost-effectiveness analysis, 185 in the intervention group and 184 in the control group. Mean age was 83.9 years and 57% of the participants were men. Methods We obtained health care costs from administrative registries. Community costs and health-related quality of life data were obtained from a questionnaire sent to participants. Health-related quality of life was measured using EQ-5D-3L and quality-adjusted life years were calculated. We analyzed all outcomes according to intention to treat, and adjusted them to age, gender, and risk score (risk of hospitalization in the next 12 months). The primary outcome was the incremental cost-effectiveness ratio associated with the intervention at follow-up after 24 months. Results The difference in total cost (incremental cost) between intervention and control groups was USD −11,275 (95% CI −407 to −22,142). The incremental effect in quality-adjusted life years was −0.05 (95% CI −0.17 to 0.08). In the cost-effectiveness plane that illustrates the uncertainty of the analysis, 77.9 of the observations were within the south-east quadrant, implying lower cost and greater effect in the intervention group. Conclusions and Implications The results suggests that a primary care comprehensive geriatric assessment intervention delivered to older adults at high risk of hospitalization is cost-effective at follow-up after 24 months. The use of a prediction model to select participants and an intervention with a low cost is promising but requires further study