Kungalv

Researchers are studying patients who experience out-of-hospital cardiac arrest OHCA with ventricular fibrillation VF or ventricular tachycardia VT that do not respond to initial defibrillation. The study aims to evaluate whether using double sequential defibrillation DSD earlier, after the first failed standard defibrillation, can improve 30-day survival compared to continuing with standard defibrillation. This trial addresses important gaps in knowledge about optimal defibrillation strategies to increase survival in this critical condition. The trial compares two treatment groups one using early double sequential defibrillation, where a second defibrillator with pads placed in the anterior-posterior position is applied as soon as possible, delivering rapid sequential shocks from two devices and the other continuing with standard single defibrillation using one defibrillator with anterior-lateral pad placement. Both groups receive resuscitation until return of spontaneous circulation, resuscitation is stopped, or the patient is transported to the hospital. The study is randomized and open-label, involving ambulance units equipped with two study-specific defibrillators. Participants are adult OHCA patients with an initial shockable rhythm and at least one failed standard defibrillation. During the study, ambulance teams perform screening, randomization, treatment according to assigned group, and initial follow-up. The main outcome measured is survival at 30 days. Secondary outcomes include return of spontaneous circulation, survival to hospital admission and discharge, and neurological function at discharge. The study will continue monitoring these outcomes to assess the effectiveness of early DSD compared to standard defibrillation strategies.

This research aims to determine if hip replacement surgery arthroplasty can reduce the need for additional operations compared to internal fixation in elderly patients with an undisplaced femoral neck fracture. Patients aged 75 years and older with this type of fracture will be included and randomly assigned to one of two treatments through the Swedish Fracture Register platform. The study focuses on combining reoperation rates and mortality into a single main outcome measure to evaluate which treatment offers better results. Participants will receive either arthroplasty, which may be hemi or total hip replacement depending on the patients condition and surgeons decision, or internal fixation using screws, pins, or a sliding hip screw device based on hospital routine. The study is a randomized controlled trial without blinding, comparing these two device-based treatments for hip fractures in elderly patients. During the study, researchers will monitor the combined rate of reoperations and mortality for 1 to 2 years after surgery. Additional outcomes include reoperation rates, short- and long-term mortality, and patient-reported physical function one year after surgery. Participants will be followed up to assess these outcomes, with care taken to track their progress and safety over the study period.

Spontaneous intracerebral hemorrhage ICH is a serious type of stroke with high death and disability rates. Researchers are investigating whether a structured treatment package called a Care Bundle can improve the 3-month outcomes for patients with acute ICH compared to standard care. The study is an international, multicenter, parallel, cluster-randomized clinical trial focusing on implementing this Care Bundle in high-income countries, building on results from previous trials mostly done in low- and middle-income countries. The Care Bundle includes early intensive blood pressure lowering, treatment of fever and high blood sugar, rapid reversal of oral anticoagulation, and timely referrals to intensive care or neurosurgery when needed. Hospitals are randomized in batches through three phases usual care, randomized evaluation of the Care Bundle versus usual care, and a post-implementation follow-up where all hospitals apply the Care Bundle. Each batch lasts 18 months, with 6 months per phase, and the overall study rollout spans 2.5 years. Participants are adults aged 18 or older diagnosed with spontaneous ICH confirmed by imaging within 24 hours of symptom onset. During the study, patient management details and outcomes will be closely monitored, including brain imaging, blood pressure, glucose levels, and functional status. The primary outcome is functional recovery measured by a utility-weighted modified Rankin Scale score at 180 days. Secondary outcomes include disability, death, and health-related quality of life. The study also collects data on treatments and care decisions to evaluate the Care Bundles effectiveness and sustainability.

This research aims to study the recovery process in men undergoing surgery for benign prostatic hyperplasia BPH. It specifically looks at patient-reported outcomes such as pain, burning sensation, urine leakage, hematuria, and the use of pain-relieving medications during the first three months after surgery. The study will compare these outcomes across three different surgical techniques transurethral resection, transurethral vaporization, and GreenLight laser enucleation of the prostate Green-LEP. Patients undergoing any of the three surgical methods for BPH will be included in this prospective observational study. They will complete a daily self-assessment form for three months to record pain levels, burning sensation, urine leakage, use of painkillers, and hematuria. After this period, patients will be sent questionnaires to assess their urinary symptoms using the IPSS form at six months and then annually for up to five years, allowing for long-term follow-up of their recovery and symptom changes. Participants will be closely monitored through daily reports for three months and periodic questionnaires afterward. The study will use numeric rating scales for pain and burning, daily yesno questions for urine leakage and hematuria, and detailed medication logs. Researchers aim to understand the timeline and intensity of recovery symptoms, evaluate differences between surgical methods, and provide insights to improve patient care and counseling. The total observation period can be up to five years including annual follow-ups.

Researchers are evaluating the effectiveness of an accelerated intermittent theta-burst stimulation 1W-AiTBS protocol in treating depression. This therapy is a type of repetitive transcranial magnetic stimulation rTMS applied to the brains dorsolateral prefrontal cortex. The study aims to observe how well this accelerated treatment works in everyday clinical practice, enrolling up to 150 patients over 1.5 years, with a target of at least 36 participants. The treatment involves magnetic pulses delivered with a specialized device targeting a specific brain area. Each session lasts about 3 minutes and 20 seconds, with 600 pulses per session. Patients may receive up to 8 sessions per day, spaced by more than 15 minutes, totaling 30 treatments over approximately 10 weekdays. The device coil is positioned carefully using a standardized method to ensure correct targeting. Participants will complete self-rating questionnaires at screening, before and after the treatment period, and at 6 weeks, 12 weeks, and 6 months after starting treatment. Researchers will monitor changes in depression scores and side effects over time. The main outcome measured is the difference in depression rating scale MADRS-S scores from baseline to six weeks after the first treatment session. Safety and tolerability data will also be collected throughout the study.

Researchers are evaluating two different protocols of intermittent theta burst stimulation iTBS, a type of repetitive transcranial magnetic stimulation, for treating depression. The study compares an accelerated iTBS protocol delivering 1200 pulses per session twice daily over 15 days with a routine protocol delivering 600 pulses once daily over 30 days. The goal is to assess which approach better affects depression symptoms over time in patients diagnosed with depression. Participants will receive iTBS treatment applied over the left dorsolateral prefrontal cortex using a MagPro R30 stimulator and a cool-B65 coil. The accelerated group will have two 6-minute 40-second sessions daily with a 50-minute break, while the routine group will have one 3-minute 20-second session daily. Both groups treatments follow precise protocols regarding pulse frequency, duration, and coil positioning. During the study, patients will be assessed by psychiatrists before treatment and again at 3 and 6 weeks after starting iTBS. They will also complete self-rated questionnaires weekly for 6 weeks and at 6 months post-treatment. Researchers will measure changes in depression rating scales such as MADRS-S, QIDS-SR, SDS, EQ-VAS, and CGI scores as primary and secondary outcomes. The total study duration for participants extends from the start of treatment through 6 months of follow-up for ongoing symptom monitoring.