The number of unaccompanied minors arriving in Sweden continues to rise. The majority are placed in residential care units. This qualitative study aims to increase the understanding given by the ...professionals to the concept of ‘home’ within the framework of residential care for unaccompanied young people. Data are based on participatory observations at two residential care units, followed up by individual interviews with staff. The findings confirm that the concept of home has a complex meaning involving both objective aspects such as physical buildings, and more subjective components that can be seen as state of mind. The staff's desire to offer an ‘ordinary home’ fails because of the surveillance, their dominant positions and especially due to the legal restrictions that were not initially meant for this target group. Unaccompanied young people have to be considered based on their own specific needs in order to make it possible for society to offer the most suitable care.
In Sweden, unaccompanied youths are placed within residential care units. However, to settle in a foreign country and feel emotional belonging is more complex than access to a physical building. The ...aim of this study is to critically discuss the concept of 'home' as experienced by the youths, narrated in nine focus group interviews. These interviews occurred in the aftermath of a turbulent migration time (2015), when over 35,000 unaccompanied youths arrived in Sweden. A transnational theoretical perspective stretches the meaning across national borders, when home links to people, processes and other geographical places. It is difficult to create an environment that mirrors the emotional attachment described in analysis. Earlier research has shown that residential care workers refer to the institutional setting as home, yet the results of this study show that the young people relate to the concept differently. Staff utilisation of the concept of home rather emphasises the lack of home-like aspects for the youths, creating a frustration in the current institutional conditions. Staff in residential care units must therefore be aware of the different interpretations and reactions that their actions and communications generate, in order to respond to various needs.
Objective
Perineural cysts, also known as Tarlov cysts, are cerebrospinal fluid-filled growths that develop at the intersection of a dorsal root ganglion and posterior nerve root. They are typically ...an asymptomatic and incidental finding during routine spine imaging. For symptomatic perineural cysts, there is little evidence on which treatment is most effective or when it is indicated. The aim of this study was to review our experience from a population-based cohort of patients with symptomatic perineural cysts and to propose an algorithm that could be used in the selection of surgical candidates.
Methods
A retrospective review was conducted of all adult (≥ 15 years) patients with symptomatic perineural cysts who were referred to Karolinska University Hospital between 2002 and 2018.
Results
Thirty-nine patients were included. The most common symptom was sciatica (
n
= 22). Cyst aspiration was performed in 28 patients, 24 of whom showed clinical improvement and were offered surgery. Microsurgical cyst fenestration was performed in 17 patients, 16 of whom showed clinical improvement at long-term follow-up. There were no surgical complications. Ten of the patients who were offered surgery chose to be treated conservatively instead, four of whom showed progression of symptoms at long-term follow-up.
Conclusions
Microsurgical cyst fenestration seems to be a safe and effective option for symptomatic relief in patients with perineural cysts. Based on the results from our series and those of others, we propose an algorithm for the selection of surgical candidates.
Most studies of the treatment for acute basilar occlusion focus on intravenous or intra-arterial thrombolysis whereas data on mechanical thrombectomy as the preferred treatment for acute basilar ...occlusion are scarce. In this study, data are presented on 28 patients treated with mechanical thrombectomy as the preferred treatment for basilar artery occlusion.
Retrospective study comprising all patients who were treated for acute basilar occlusion at the Karolinska University Hospital from September 2005 to November 2010. Favorable outcome was defined as a modified Rankin score of ≤2 at 3-8 months after thrombectomy.
Of 28 patients treated with mechanical thrombectomy, the proportion reaching a favorable outcome was 57% (95% CI 37% to 75%), and if there were no signs of acute infarction prior to treatment the proportion was 73% (95% CI 50% to 89%). Only 21% died (95% CI 8% to 41%).
The results for mechanical thrombectomy for basilar artery occlusion were superior to those presented previously for intravenous and intra-arterial thrombolysis. The study suggests that mechanical thrombectomy is a method distinct from therapies based on thrombolysis and that any randomized clinical trial on treatment for acute basilar occlusion must consider mechanical thrombectomy as a separate entity.
Introduction
We present our results from the first 6 years with mechanical thrombectomy in the treatment of ischemic stroke.
Methods
Every patient treated with mechanical thrombectomy for acute ...ischemic stroke from September 2005 to December 2011 was consecutively included in this retrospective analysis. Baseline and outcome data were retrieved from computerized records at the hospital. National Institute of Health Stroke Scale (NIHSS) score and the modified Rankin Scale (mRS) score were used as outcome parameters. Favorable outcome was defined as a mRS score of 0–2, corresponding to independence in activities of daily living. We also evaluated revascularization and severe adverse events, with focus on symptomatic intracranial hemorrhage.
Results
Good functional outcome (mRS 0–2) was achieved in 50 % (120/240) of all patients. For patients with no neurological deficit prior to stroke onset (i.e., mRS = 0 before stroke), the proportion with good functional outcome was 54 %. Symptomatic hemorrhages occurred in 4.6 % of the cases (5.7 % in the anterior circulation).
Conclusion
In summary, our results supports that mechanical thrombectomy is a safe and effective method to restore blood flow in selected patients suffering from an acute ischemic stroke.
This paper aims to provide an analysis of a project-based activation programme, called the Vista project, under the authority of the social services and run in a local community in Sweden. Research ...has shown that people with a migrant background, in all age groups and especially women, are overrepresented in unemployment rates. The argument presented in the paper is that an anti-racist framework is of great relevance for these provisions and would provide a strong theoretical foundation with clear implications for practice. The Vista project's main objective was to find new matching strategies to increase labour market integration and to increase the number of people engaged in a full-time activity, such as employment, education or field practices. The findings show that the flexibility that characterizes this kind of organization has a negative impact on clearly defining its identity and work processes, something that could undermine its legitimacy. This study exemplifies how the flexibility leads to ambiguity and struggles in mediating a clear picture of the purpose of the project. Some core values of anti-racist practice are included in the foundation of the Vista project, for example, the resources addressed to a so-called disadvantaged group. Projects such as the Vista contribute to racial oppression, just as other more traditional social work organizations do. However, the form of the post-bureaucracy may create possibilities to both make such structures visible and find ways to give the participants exposed to the program greater influence on its design and to define their own needs.
Background We have assessed to what extent age, sex, preintervention infarct size, time to groin puncture, and stroke severity are associated with outcome of mechanical thrombectomy in patients ...treated for acute ischemic stroke. Methods All 192 patients treated with mechanical thrombectomy for acute ischemic stroke from September 2005 to December 2011 were included in this observational study. Main outcomes were independence, defined as a modified Rankin Scale score of 0-2, an improvement in stroke severity score post-thrombectomy, and the occurrence of symptomatic hemorrhage. Exposure variables were sex, age, intravenous thrombolysis, prethrombectomy stroke severity grading, pretreatment infarct size, time from onset of symptoms to groin puncture, thrombectomy device used, and the angiographic result from the thrombectomy. Results For patients above 50 years with no neurological symptoms before stroke onset, the proportion gaining independence was unrelated to age group, ranging from 49% to 54%. For patients younger than 50 years of age, the proportion was significantly higher (81%). Patients with wake-up stroke did not differ from other patients with regard to outcome. Conclusions Our results emphasize that when patients are selected on the basis of angiographic and perfusion imaging, both older patients and patients with wake-up stroke may experience a favorable outcome after mechanical thrombectomy.
New recommendations for mechanical thrombectomy in acute ischemic stroke suggest that thrombectomy should be considered for eligible patients with a large artery occlusion in the anterior circulation ...within 6 hours of stroke onset. The resources are unevenly spread and, in order to be able to meet a potentially increased demand, we have estimated the future need for thrombectomy.
The new treatment recommendations are similar to those that have been in use at the Karolinska University Hospital since 2007. Using our local thrombectomy data (2009-2011), we calculated the proportion of thrombectomies performed at our hospital by level of stroke severity according to the National Institutes of Health Stroke Scale score (0-5, 6-11, 12-19, and 20-35). We then estimated the total number of potential thrombectomies expected in Sweden by extrapolating our treatment proportions to the rest of Sweden through the use of data from the Swedish National Stroke Registry.
The number of potential thrombectomies would have been more than five times higher (1268 estimated compared with 232 actually reported in the National Stroke Registry) if the new recommendations for thrombectomy in acute ischemic stroke had been implemented in 2013 (the year from which we had the most recent available data from the Swedish Stroke Registry).
When the new recommendations are implemented broadly, there may be a substantial increase in demand for thrombectomies. Our study highlights the need for policymakers and healthcare professionals to prepare for the increasing demands for advanced endovascular stroke treatment.
The transition from care is a critical phase for care leavers in general, and even more complex for those who have arrived in Sweden as unaccompanied minors and belong to an ethnic minority group. ...The aim of this article is to examine unaccompanied minors' experiences of leaving care, and to explore the experience in relation to perceptions about ethnicity and culture within a transnational space. Interviews were completed with 11 care leavers who had been received in Sweden as unaccompanied minors. The results show that these young people have to deal with multiple adjustments. Conquering obstacles as care leavers involves not only resolving general issues such as reintegration into society, but also adjustment to perceived and created views of how to become Swedish. From the young people's point of view, this seems to be necessary to make a successful transition from care into adulthood.
Intravenous thrombolysis with tissue plasminogen activator is standard treatment in acute stroke today. The benefit of endovascular treatment has been questioned. Recently, studies evaluating ...endovascular treatment and intravenous thrombolysis compared with intravenous thrombolysis alone, have reported improved outcome for the intervention group. The aim of this study was to perform a meta-analysis of randomized controlled trials comparing endovascular treatment in addition to intravenous thrombolysis with intravenous thrombolysis alone.
Databases were searched for eligible randomized controlled trials. The primary outcome was a functional neurological outcome after 90 days. A secondary outcome was severe disability and death. Data were pooled in the control and intervention groups, and OR was calculated on an intention to treat basis with 95% CIs. Outcome heterogeneity was evaluated with Cochrane's Q test (significance level cut-off value at <0.10) and I(2) (significance cut-off value >50%) with the Mantel-Haenszel method for dichotomous outcomes. A p value <0.05 was regarded as statistically significant.
Six studies met the eligibility criteria, and data from 1569 patients were analyzed. A higher probability of a functional neurological outcome after 90 days was found for the intervention group (OR 2, 95% CI 2 to 3). There was a significantly higher probability of death and severe disability in the control group compared with the intervention group.
Endovascular treatment in addition to intravenous thrombolysis for acute ischemic stroke leads to an improved clinical outcome after 3 months, compared with patients receiving intravenous thrombolysis alone.
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