Varnamo

Researchers are evaluating the impact of two different guidelines for monitoring labor progress on neonatal and maternal outcomes. The study compares the World Health Organizations Labour Care Guide LCG with standard delivery care in Sweden. The goal is to see if using the LCG can reduce adverse neonatal outcomes and lower the rate of intrapartum Cesarean sections. This study uses a multicenter, stepped-wedge cluster randomized design to explore these effects along with economic considerations and experiences related to childbirth. Participants will receive labor monitoring either according to the WHOs LCG guidelines or standard care. The study will involve multiple delivery units in Sweden, and women in active labor will be randomly assigned to either group as the new guidelines are gradually introduced. Alongside the main study periods, researchers will examine perinatal interventions, labor complications, and collect qualitative data through questionnaires, focus groups, and interviews with women, their partners, and healthcare providers. During participation, women and their partners will be asked about their childbirth experiences, while providers compliance and views on using the LCG will also be assessed. The study will track outcomes such as perinatal mortality, neonatal morbidity, cesarean section rates, and obstetric events like postpartum hemorrhage and labor duration. Data collection and follow-up will occur from 12 weeks up to 18 months after delivery, including economic evaluations and provider experiences to fully understand the effects of the labor monitoring methods.

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.

Small bowel obstruction SBO is a surgical emergency where normal bowel movements are blocked, leading many patients to visit emergency departments annually. Most patients with SBO are initially managed without surgery, often using a nasogastric tube NGT to relieve gastric pressure and reduce complications. However, the true benefit of NGT placement for preventing respiratory complications is unclear, with some observational data suggesting it may increase pneumonia risk. This study is a randomized, controlled, open-label trial comparing two groups of patients with SBO who are planned for non-operative management. One group will receive a nasogastric tube placement, while the other will have the tube deferred. Both groups will receive other care according to local guidelines and will be monitored until their SBO resolves either spontaneously or through surgery. A total of 1000 patients will be enrolled across multiple centers. Participants will be regularly monitored for lung-related complications and whether they require care in a high dependency or intensive care unit during the hospital stay or up to 30 days. Other outcomes include surgery rates, death within one year, time to functional recovery, bowel complications, hospital stay length, and readmission rates. The study includes long-term follow-up for one year and qualitative interviews to assess health-economic impacts. This trial aims to provide high-quality evidence on the role of nasogastric tubes in managing SBO.

Researchers are investigating how different levels of physical activity, measured objectively, relate to health outcomes in patients who have had a type 1 myocardial infarction. The study aims to explore links between activities of varying intensity, sedentary time, and the risk of major cardiovascular events after a heart attack, as well as how changes in physical activity over time affect these outcomes. Participants in this observational study will be asked to wear an accelerometer device on their right hip during waking hours for seven consecutive days at two follow-up visits2 months and 1 year after hospital discharge. They will also keep a diary recording their wear time and working hours if applicable. About 4000 patients aged 18 to 79 diagnosed with myocardial infarction are expected to be included, and the study will analyze the dose-response relationship between accelerometer data and clinical outcomes. Throughout the study, participants will attend cardiac rehabilitation follow-up visits and provide accelerometer and diary data. Researchers will assess outcomes such as major adverse cardiovascular events, including heart failure, stroke, death, and coronary revascularization, at 1 and 3 years after the initial cardiac event. The study will monitor these outcomes while participants continue their usual care, with a total follow-up period extending to 3 years after the heart attack.

Researchers are evaluating the potential antitumor effects of tinzaparin, a commonly used anticoagulant, in women with advanced epithelial ovarian cancer EOC who are receiving neoadjuvant chemotherapy NACT. This pilot Phase II clinical trial aims primarily to assess how tinzaparin affects the levels of the tumor marker CA-125 during treatment. The study also explores how tinzaparin influences various immune and coagulation factors, and monitors compliance and side effects related to its use. Participants are randomly assigned to either receive daily subcutaneous injections of tinzaparin dose based on weight alongside standard chemotherapy with carboplatin and paclitaxel or to receive chemotherapy alone without tinzaparin. The treatment period spans 21 to 28 weeks, starting with chemotherapy and continuing through delayed primary debulking surgery DPDS and postoperative care. Blood samples for biomarker analysis are collected at multiple time points, including before each chemotherapy cycle, pre- and post-surgery, and after the last chemotherapy session. Patients in the tinzaparin group may choose to continue the anticoagulant following surgery and initial chemotherapy cycles. Throughout the study, women undergo clinical evaluations and imaging to guide surgery decisions. Researchers collect blood to measure markers such as hemoglobin, platelets, leucocytes, C-reactive protein, albumin, CA-125, and several coagulation and inflammation-related proteins. Compliance with tinzaparin injections and any treatment-related adverse events are closely monitored. The total participation time ranges from 22 to 29 weeks, covering chemotherapy, surgery, and follow-up periods.