Lindesberg

This trial investigates opioid-free and opioid-sparing care pathways compared to conventional opioid-based treatment for pain relief and recovery in patients undergoing obesity surgery. The study aims to assess the short-, medium-, and long-term effects on cognitive and physical recovery, opioid use, quality of life, and economic impact. It is a prospective, randomized, non-blinded, multi-center study conducted from November 2018 to December 2022 and approved by relevant Swedish authorities. The study compares three groups: a control group receiving standard opioid-based anesthesia and pain management, an intervention group receiving non-opioid medications including dexmedetomidine, esketamine, lidocaine, and Transcutaneous Electrical Nerve Stimulation (TENS) during the hospital stay, and a second intervention phase that adds person-centred care to the opioid-free treatment. The control group uses opioids such as remifentanil during anesthesia and oxycodone postoperatively. Patient-controlled TENS is used postoperatively if pain exceeds a certain level. Participants will be monitored for pain levels from post-anesthesia care unit arrival to discharge, cognitive and physical recovery using validated scales, opioid consumption during and after hospitalization, and quality of life up to two years after surgery. Assessments include questionnaires on self-efficacy, quality of recovery, and economic evaluations. The study also tracks intraoperative nociception and long-term analgesic use. Safety and recovery will be followed throughout hospitalization and up to 24 months post-surgery.

Researchers are evaluating whether remote video exercise-based cardiac rehabilitation (exCR) can increase participation in rehabilitation sessions after a myocardial infarction (heart attack), compared to traditional center-based exCR. The study is designed as a national multicenter registry-based cluster randomized crossover clinical trial, preceded by a feasibility and safety study conducted during the COVID-19 pandemic. Patients diagnosed with type 1 myocardial infarction and aged 18 to 79 years are included, with long-term follow-up planned at 1 and 3 years after the cardiac event. The study involves two phases: first, a feasibility study offering remote exCR at participating sites until the pandemic peak subsides, ending in August 2022; second, a randomized trial where cardiac rehabilitation centers are assigned to provide either remote exCR, usual center-based exCR, or a combination based on patient preference at intervention sites, while control sites offer only center-based exCR. The exercise program is standardized, requiring at least 24 supervised sessions over 3 to 4 months, each session including aerobic exercise and strength training at specified intensity levels. Success is defined as attending at least 75% of sessions within four months. Participants will be monitored through their attendance and adherence to the exercise sessions. Researchers will assess the average number of exCR sessions completed over 3 to 4 months. Additional evaluations include safety monitoring and long-term follow-up at 1 and 3 years to observe outcomes after the initial cardiac event. The study also considers patient access to internet for remote participation and evaluates exercise test results to ensure safety during rehabilitation.