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5. Posters

Author

Török, T., Kardos, A., Rudas, L., Paprika, D., McLuckie, A., Beale, R. J., Bihari, D., Keller, H., Seltzer, N., Weimer, A., Menning, H., Ulrich, P., Staedt, U., Kirschstein, W., Kasai, T., Endo, S., Arakawa, N., Sato, N., Suzuki, T., Taniguchi, S., Inada, K., Hiramori, K., Schmidt, W., Meineke, I., Nottrott, M., Frerichs, I., Müller, S., Hellige, G., De Blasio E., De Sio A., Sibilio G., Papa A., Golia D., Grassia V., Bove G., Zehelgruber, M., Mundigler, G., Christ, G., Merhaut, C., Klaar, U., Kratochwill, C., Hofmann, S., Siostrzonek, P., Suarez, F., Corrales, M., Rábago, R., Gonzalez-Arenas, P., Morales, R., Sanchez J., Fraile, J., Rey, M., Martinell, J., Niederst, P. -N., Mellwig, K. -P., Schmidt, H. K., Gleichmann, U., Körfer, R., Di Bartolomeo, S., Bertolissi, M., Nardi, G., De Monte, A., Janssens, U., Ochs, J. -G., Klues, H. G., Hanrath, P., Sajjanhar, T., Tibby, S. M., Hatherill, M., Anderson, D., Murdoch, I. A., Krivec, B., Voga, G., Žuran, I., Skale, R., Parežnik, R., Podbregar, M., Bonnefoy, E., Chevalier, P., Kirkorian, G., Guidolet, J., Marchand, A., Bouchayer, D., Marcaz, P. Bert, Touboul, P., Welte, T., Molling, J., Jepsen, M. S., Claus, G., Klein, H., Cinnella, G., Dambrosio, M., Brienza, N., Conte, M., Maggiore, S. M., Leone, A. M., Brienza, A., DiVenere, N., Vandewoude, K., Poelaert, J., Vogelaers, D., Garcia, R. Blanca, Buylaert, W., Roosens, C., Colardyn, F., Annane, D., Béllissant, E., Pussard, E., Asmar, R., Lacombe, F., Lanata, E., Madonna, O., Safar, M., Giudicelli, J. F., Raphael, J. C., Gajdos, Ph., Mattys, M., Dumont, L., Annaert, J. F., Mardirosoff, C., Goldstein, J., Verbeet, T., Massaut, J., Haas, N. A., Uhlemann, F., Daehnert, I., Berger, F., Stiller, B., Dittrich, S., Schulze-Neick, I., Eweit, P., Lange, P. E., Langenherp, C. J. M., Pietersen, H., Geskes, G., Wagenmakers, A., Soeters, P., Maggiorini, M., Brimioulle, S., Lejeune, P., Delcroix, M., Vermeulen, F., Stephanazzi, J., Naeije, R., Kunert, M., Stolzenburg, H., Scheuble, L., Emmerich, K., Ulbricht, L. J., Krakau, I., Gülker, H., Broch, M. J., Valentín, V., Murcia, B., Bartual, E., Málaga, A., Miralles, L. L., Valls, F., Wallin, C. J., Sidenö, B., Vaage, J., Leksell, L. G., Stuchlinger, H. G., Seidler, D., Hollenstein, U., Janata, K., Muellner, M., Loeffler, W., Gamper, G., Bur, A., Malzer, R., Laggner, A. N., Hirschl, M. M., Binder, M., Herkner, H., Bur, A., Laggner, A. N., Turani, F., Ceraso, C., Lironcurti, A., Senesi, P., Leonardis, C., Sabato, A. F., Pietersen H. G., Langenberg C. J. M., Geskes G., Wagenmakers A. J. M., de Lange S., Soeters P. B., Royira, A., Oussedik, L., Cambray, C., Glmeno, C., Cerda, M., Sanchez, Ma. A., Lesmes, A., Guerrero, M., Vigil, E., Ortega, F., Lucena, F., Righini, E. R., Alvisi, R., Marangoni, E., Gritti, G., Ordóñez, A., Hernández, A., Pérez-Bernal, J., Hinojosa, R., Borrego, J. M., Franco, A., López-Barneo, J., Pérez-Bernal, J., Gutiérrez, E., Hinojosa, R., Hernández, A., Borrego, J. M., Cerro, J., Rincón, D., Ordóñez, A., Martin, R., Saussine, M., Sany, C. L., Calvet, B., Raison, D., Frapier, J. M., Wallin, C. -J., Olsson, Å., Nordländer, R., Leksell, L. G., Vasilkov, V., Safronov, A., Marinchev, V., Rodrigues, A. C., Moraes, A., Galas, F., Angelim, V., Medeiros, C., Auler, J. O., Bellotti, G., Pilleggi, F., Carmona, M. J., Messias, E. R. R., Joseph, D., Baigorri, F., Artigas, A., Blanch, L., Wagner, F., Dandel, M., Günther, G., Schulze-Neick, I., Weng, Y., Loebe, M., Hetzer, R., Colreavy, F., Balea, M., Cahalan, M., Carpintero, JL., de la Fuente, M. C., Estecha, M. A., Molina, J. M., del Fresno, L. R., Daga, D., Toro, R., Poullet, A., de la Torre, M. V., Garcia, A. J., Michalopoulos, A., Rellos, K., Skambas, D., Liakopoulos, O., and Geroulanos, S.

Published
1996
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14. Perkutane transluminale Koronarangioplastie (PTCA) als Primärtherapie beim akuten Myokardinfarkt

Author

Arens R, Krakau I, Willgeroth W, Heuer H, and Schulze-Waltrop N

Subjects
medicine.medical_specialty, Resuscitation, Ejection fraction, business.industry, Mortality rate, Cardiogenic shock, medicine.medical_treatment, General Medicine, medicine.disease, Restenosis, Internal medicine, Shock (circulatory), medicine, Cardiology, cardiovascular diseases, Myocardial infarction, Cardiopulmonary resuscitation, medicine.symptom, business
Abstract

BASIC PROBLEM AND OBJECTIVE Percutaneous transluminal coronary angioplasty (PTCA) is being increasingly considered as an alternative to thrombolytic treatment of acute myocardial infarction. Studies performed so far, some on selected groups of patients, have produced high initial results of success. This prospective study was undertaken to determined primary success, complications and recurrence after primary PTCA in acute myocardial infarction (AMI). PATIENTS AND METHODS Primary treatment in the form of immediate PTCA of the infarct vessel was undertaken in 111 patients (84 men, 27 women; mean age 58.6 +/- 10.3 years) with AMI. PTCA was judged successful if the infarct vessel had been reopened to perfusion grade 3 and restenosis was < 50%. No thrombolytic treatment was given, but heparin infusions were given during and for 24-48 hours after the procedure. 13 patients (11.7%) were in cardiogenic shock or required cardiopulmonary resuscitation for infarct-related arrhythmias. RESULTS The primary success rate of PTCA for the whole group was 91% (101 of 111 patients), but only 77% (ten of 13) among patients in cardiogenic shock and (or) after resuscitation. Acute re-occlusion (0-6 days after PTCA) occurred in seven patients. Eight patients (7.2%) died during the hospital phase (0-4 weeks), seven of whom had been in shock or required resuscitation (death rate 54%). The overall complication rate of the intervention was 6.3%. No emergency aortocoronary bypass was necessary. Repeat coronary angiography was performed in 71 of the 101 successfully treated patients 6 or 12 weeks after the PTCA. Re-occlusion was demonstrated in four (5.6%), a restenosis of more than 50% in 25% of patients. Mean left ventricular ejection fraction, obtained by planimetry from the levocardiogram was 58.6 +/- 9.3%. CONCLUSION PTCA, performed immediately after acute myocardial infarction is an effective therapeutic measure with a high primary success rate.

Published
2008

15. Differentialindikation der koronaren Stent-Implantation: Vergleichende Untersuchung kardialer und vaskulärer Akutkomplikationen in Abhängigkeit von der Indikation

Author

Hartmut Gülker, Müller A, Emmerich K, Sänger A, and Krakau I

Subjects
medicine.medical_specialty, business.industry, Unstable angina, medicine.medical_treatment, Infarction, Stent, General Medicine, medicine.disease, Surgery, Stenosis, Restenosis, Internal medicine, Coronary stent, Occlusion, medicine, Cardiology, cardiovascular diseases, Myocardial infarction, business
Abstract

BACKGROUND AND OBJECTIVE Coronary stents are used nowadays not only for the reduction of restenosis and for treating acute vessel occlusions after PTCA but also after acute myocardial infarction. This study was undertaken to determine whether widening the indications has affected the incidence of acute complications and to compare acute cardiac and vascular complications. PATIENTS AND METHODS The data on 197 consecutive patients (155 men, 42 women; mean age 62 +/- 9 [37-85] years) with coronary stents were analysed retrospectively, divided into 5 groups depending on the indications for the stent implantation: 1) acute or threatened vessel occlusion after elective PTCA ("bail-out"); 2) acute myocardial infarction (AMI); 3) unstable angina with threatened vessel occlusion; 4) suboptimal primary results (angiographically assessed) after PTCA; 5) elective stent implantation to prevent restenosis. Acute or subacute stent thrombosis, side-branch occlusion, intra- and transmural infarction, death and emergency aortocoronary bypass operation were classified as acute cardiac complications. Haemorrhage in the inguinal region requiring blood transfusion, false aneurysm and operative vascular reconstruction were classified as vascular complications. RESULTS An intended stent implantation was impossible in 18 patients (primary success rate 91%). Independent of indication an acute or chronic stent stenosis occurred in three (1.6%) and seven (3.9%) patients, respectively. Side-branch occlusion was observed in 12 patients (6.7%), transmural infarction in nine (5.6%). No emergency bypass operation had to be performed. Comparing the different indication groups there was a significantly increased rate of "non-Q" infarctions in patients with unstable angina pectoris (P < 0.014). Among acute vascular complications (10 [5%] inguinal haemorrhages requiring transfusion and 5 [2.5%] operative vascular reconstructions), false aneurysm was significantly more common in patients with AMI (P < 0.014). Comparing emergency and elective stent implantations, side-branch occlusions were significantly more common in the former (12% vs. 0%; P < 0.08), as were also "non-Q" infarcts (10% vs. 0%; P < 0.002). CONCLUSION Coronary stent implantation for these indications, including AMI, can be taken as firmly established. Stent thrombosis was not significantly increased after "bail out". Implantation in an acute ischaemic episode led to a significantly higher incidence of side-branch occlusion and "non-Q" infarction.

Published
2008

16. Bedeutung der intrakoronaren Stentimplantation für die kardialen Ereignisse im Akut- und Langzeitverlauf nach direkter Koronarangioplastie des akuten Myokardinfarktes

Author

Alexander Bufe, A. Matern, T. Ketteler, Hartmut Gülker, Harald Lapp, Marc Horlitz, and Krakau I

Subjects
Gynecology, medicine.medical_specialty, business.industry, Emergency Medicine, medicine, Emergency Nursing, Critical Care and Intensive Care Medicine, business
Abstract

Hintergrund Die primare PTCA entwickelt sich zum Goldstandard der Myokardinfarkttherapie. Ein Problem ist die Rezidivstenose, welche durch die Implantation von Stents bereits seit einigen Jahren zu umgehen versucht wird. Langzeiterfahrungen liegen jedoch bisher nur in wenigen Studien bis zu 12 Monaten vor. Methodik In einer prospektiven Studie wurden 717 Patienten von 1989–1999 mit akutem Myokardinfarkt konsekutiv in einer Datenbank erfasst, welche mittels primarer PTCA mit (n=130) oder ohne (n=587) Stent-Implantation behandelt wurden. Rezidivstenose und Re-Interventionsrate wurden nach 4 Monaten im Rahmen einer koronarangiographischen Kontrolle untersucht. Nach im Mittel 30 Monaten erfolgte eine telefonische bzw. schriftliche Nachbefragung. Ergebnisse Stichprobe: Alter 59,6 (SD 11,5) Jahre, 74,9% Manner/25,1% Frauen, 49,8% koronare Mehrgefaserkrankung, 14,6% Diabetiker, 10,9% kardiogener Schock, 83% Ischamiezeit

Published
2002

17. Threatening or manifest reocclusion of the infarct artery in acute myocardial infarction treated with primary PTCA: Outcome after prolonged autoperfusionballoon catheter treatment ≥ 30 minutes

Author

H. Gulker, Alexander Bufe, Ulbricht Lj, Emmerich K, Probst H, and Krakau I

Subjects
Catheter, medicine.medical_specialty, medicine.anatomical_structure, business.industry, Internal medicine, Cardiology, Medicine, Electrocardiography in myocardial infarction, Myocardial infarction, business, medicine.disease, Cardiology and Cardiovascular Medicine, Artery
Published
1996
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30. Group living, an alternative for dementia patients. A cost analysis

Author

Wimo, A, Wallin, J-O, Lundgren, K, Rönnbäck, E, Asplund, Kenneth, Mattsson, Bengt, Krakau, I, Wimo, A, Wallin, J-O, Lundgren, K, Rönnbäck, E, Asplund, Kenneth, Mattsson, Bengt, and Krakau, I

Abstract

The increasing number of patients with dementia requires new forms of care management. Group living (GL) is an alternative, and two units were established in Sundsvall, Sweden, in 1984. The patients in GL used institutional care to a significantly lower extent (nursing homes, emergency hospital care, psychiatric care) after admission to GL (p < 0.001). The costs for the Municipality and the County Council changed from £49 to £42/day (p=0.21) and patient during the first six-month period in GL compared to the six-month period prior to GL. If the costs for GL are compared to the costs for nursing home care (£68/day), GL is significantly cheaper (p < 0.05).

Published
1991
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32. Impact of Day Care on Dementia Patients–Costs, Well-being and Relatives' Views

Author

Wimo, A, Wallin, J-O, Lundgren, K, Rönnbäck, E, Asplund, Kenneth, Mattson, B, Krakau, I, Wimo, A, Wallin, J-O, Lundgren, K, Rönnbäck, E, Asplund, Kenneth, Mattson, B, and Krakau, I

Abstract

Forty-seven patients in psychogeriatric day centre were analysed regarding use of resources, costs and well-being. The level of well-being was based on interviews with staff and relatives and related to the economic outcome--a cost utility analysis. A 6 month period prior to day care was compared with the first 6 months in such care. The use of resources at home increased by 20% while the use of institutional care was reduced by 22%. Fifty-three percent of the patients improved in their well-being after participation in day care. When the cost of utility analysis was applied, the cost for a well-year was 4293 pounds.

Published
1990

33. Dobutamine stress echocardiography

Author

Krahwinkel, W., primary, Ketteler, T., additional, Godke, J., additional, Wolfertz, J., additional, Ulbricht, L. J., additional, Krakau, I., additional, and Gulker, H., additional

Published
1997
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39. The cost of monitoring warfarin in patients with chronic atrial fibrillation in primary care in Sweden.

Author

Björholt I, Andersson S, Nilsson GH, and Krakau I

Abstract

Background: Warfarin is used for the prevention of stroke in chronic atrial fibrillation. The product has a narrow therapeutic index and to obtain treatment success, patients must be maintained within a given therapeutic range (International Normalised Ratio;INR). To ensure a wise allocation of health care resources, scrutiny of costs associated with various treatments is justified. The objective of this study was to estimate the health care cost of INR controls in patients on warfarin treatment with chronic atrial fibrillation in primary care in Sweden.Methods: Data from various sources were applied in the analysis. Resource consumption was derived from two observational studies based on electronic patient records and two Delphi-panel studies performed in two and three rounds, respectively. Unit costs were taken from official databases and primary health care centres.Results: The mean cost of one INR control was SEK 550. The mean costs of INR controls during the first three months, the first year and during the second year of treatment were SEK 6,8111, SEK 16,244 and SEK 8,904 respectively.Conclusion: INR controls of patients on warfarin treatment in primary care in Sweden represent a substantial cost to the health care provider and they are particularly costly when undertaken in home care. The cost may however be off-set by the reduced incidence of stroke. [ABSTRACT FROM AUTHOR]

Published
2007

40. Self-rated health, symptoms of depression and general symptoms at 3 and 12 months after first-ever stroke: a municipality-based study in Sweden.

Author

Skånér Y, Nilsson GH, Sundquist K, Hassler E, and Krakau I

Abstract

BACKGROUND: Self-rated health is an important indicator of quality of life as well as a good predictor of future health. The purpose of the study was to follow up the self-rated health and the prevalence of symptoms of depression and general symptoms in a population of first-ever stroke patients 3 and 12 months after stroke. METHODS: All patients surviving their first-ever stroke and residing in Nacka municipality in Stockholm County Council were included using a multiple overlapping search strategy during an 18-month period (n = 187). Our study group comprised the 145 patients who survived the first 3 months after stroke. Three and 12 months after their stroke, the patients were assessed regarding self-rated health and general symptoms using parts of the Göteborg Quality of Life Instrument (GQLI), and regarding symptoms of depression using the Montgomery Asberg Depression Scale (MADRS-S). RESULTS: Self-rated health was rated as very good or rather good by 62% at 3 months after stroke and by 78% at 12 months after stroke. More than half of the patients suffered from symptoms of depression, with no significant improvement at 12 months. The most common general symptoms at 3 months after stroke were fatigue, sadness, pain in the legs, dizziness and irritability. Fatigue and sadness were still common at 12 months. Twelve months after stroke the prevalences of crying easily, irritability, impaired concentration, nausea and loss of weight were significantly lower. CONCLUSION: The majority of patients rated their health as rather good or very good at 3 and 12 months after stroke. However, the majority suffered from fatigue and from symptoms of depression after both 3 and 12 months. In continued care of stroke survivors, it is important to consider the fact that many patients who rate their health as good may nevertheless have symptoms of depression, and some of them may benefit from anti-depressive treatment. [ABSTRACT FROM AUTHOR]

Published
2007

41. Resource consumption and management associated with monitoring of warfarin treatment in primary health care in Sweden.

Author

Andersson S, Björholt I, Nilsson GH, and Krakau I

Abstract

BACKGROUND: Warfarin is used for the prevention and treatment of various thromboembolic complications. It is an efficacious anticoagulant, but it has a narrow therapeutic range, and regular monitoring is required to ensure therapeutic efficacy and at the same time avoid life-threatening adverse events. The objective was to assess management and resource consumption associated with patient monitoring episodes during warfarin treatment in primary health care in Sweden. METHODS: Delphi technique was used to systematically explore attitudes, demands and priorities, and to collect informed judgements related to monitoring of warfarin treatment. Two separate Delphi-panels were performed in three and two rounds, respectively, one concerning tests taken in primary health care centres, involving 34 GPs and 10 registered nurses, and one concerning tests taken in patients' homes, involving 49 district nurses. RESULTS: In the primary health care panel 10 of the 34 GPs regularly collaborated with a registered nurse. Average time for one monitoring episode was estimated to 10.1 minutes for a GP and 21.4 minutes for a nurse, when a nurse assisted a doctor. The average time for monitoring was 17.6 minutes for a GP when not assisted by a nurse. Considering all the monitoring episodes, 11.6% of patient blood samples were taken in the individual patient's home. Average time for such a monitoring episode was estimated to 88.2 minutes. Of all the visits, 8.2% were performed in vain and took on average 44.6 minutes. In both studies, approximately 20 different elements of work concerning management of patients during warfarin treatment were identified. CONCLUSION: Monitoring of patients during treatment with warfarin in primary health care in Sweden involves many elements of work, and demands large resources, especially when tests are taken in the patient's home. [ABSTRACT FROM AUTHOR]

Published
2006

42. A Population Study on Irritable Bowel Syndrome and Mental Health.

Author

Österberg, E., Blomquist, L., Krakau, I., Weinryb, R. M., Åsberg, M., and Hultcrantz, R.

Subjects
IRRITABLE colon, MENTAL health, PSYCHOLOGY
Abstract

Background: Irritable bowel syndrome (IBS) is commonly thought to be associated with psychologic distress. However, in some studies only persons who had sought medical care for IBS (IBS patients) showed an increased frequency of psychiatric symptoms, and nonpatients did not differ significantly from normal subjects. Our aims were 1) to estimate the prevalence of IBS in the population aged 18-45 years, 2) to find the proportion seeking medical care for IBS, and 3) to compare IBS subjects with normals, and IBS patients with IBS nonpatients with regard to mental health. Methods: Questionnaires on IBS symptoms and the General Health Questionnaire (GHQ) were mailed to 5000 randomly sampled persons aged 18-45 years. The response rate was 58%. Results: IBS was found in 7.4% of the men and 13.3% of the women. Those who had sought medical attention had more severe symptoms. The Likert mean score on the GHQ was 4.7 (95% confidence interval, 4.4-5.0) points higher for the IBS group than for normals (P < 0.001). There was no difference in GHQ scores between IBS patients and nonpatients. Conclusions: The results indicate that IBS per se is associated with more psychiatric distress, regardless of medical care-seeking. Seeking medical care is associated with more severe IBS symptoms. [ABSTRACT FROM AUTHOR]

Published
2000
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48. Self-rated health, symptoms of depression and general symptoms at 3 and 12 months after a first-ever stroke: a municipality-based study in Sweden

Author

Hassler Ejda, Sundquist Kristina, Nilsson Gunnar H, Skånér Ylva, and Krakau Ingvar

Subjects
Medicine (General), R5-920
Abstract

Abstract Background Self-rated health is an important indicator of quality of life as well as a good predictor of future health. The purpose of the study was to follow up the self-rated health and the prevalence of symptoms of depression and general symptoms in a population of first-ever stroke patients 3 and 12 months after stroke. Methods All patients surviving their first-ever stroke and residing in Nacka municipality in Stockholm County Council were included using a multiple overlapping search strategy during an 18-month period (n = 187). Our study group comprised the 145 patients who survived the first 3 months after stroke. Three and 12 months after their stroke, the patients were assessed regarding self-rated health and general symptoms using parts of the Göteborg Quality of Life Instrument (GQLI), and regarding symptoms of depression using the Montgomery Asberg Depression Scale (MADRS-S). Results Self-rated health was rated as very good or rather good by 62% at 3 months after stroke and by 78% at 12 months after stroke. More than half of the patients suffered from symptoms of depression, with no significant improvement at 12 months. The most common general symptoms at 3 months after stroke were fatigue, sadness, pain in the legs, dizziness and irritability. Fatigue and sadness were still common at 12 months. Twelve months after stroke the prevalences of crying easily, irritability, impaired concentration, nausea and loss of weight were significantly lower. Conclusion The majority of patients rated their health as rather good or very good at 3 and 12 months after stroke. However, the majority suffered from fatigue and from symptoms of depression after both 3 and 12 months. In continued care of stroke survivors, it is important to consider the fact that many patients who rate their health as good may nevertheless have symptoms of depression, and some of them may benefit from anti-depressive treatment.

Published
2007
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49. The cost of monitoring warfarin in patients with chronic atrial fibrillation in primary care in Sweden

Author

Nilsson Gunnar H, Andersson Stina, Björholt Ingela, and Krakau Ingvar

Subjects
Medicine (General), R5-920
Abstract

Abstract Background Warfarin is used for the prevention of stroke in chronic atrial fibrillation. The product has a narrow therapeutic index and to obtain treatment success, patients must be maintained within a given therapeutic range (International Normalised Ratio;INR). To ensure a wise allocation of health care resources, scrutiny of costs associated with various treatments is justified. The objective of this study was to estimate the health care cost of INR controls in patients on warfarin treatment with chronic atrial fibrillation in primary care in Sweden. Methods Data from various sources were applied in the analysis. Resource consumption was derived from two observational studies based on electronic patient records and two Delphi-panel studies performed in two and three rounds, respectively. Unit costs were taken from official databases and primary health care centres. Results The mean cost of one INR control was SEK 550. The mean costs of INR controls during the first three months, the first year and during the second year of treatment were SEK 6,811, SEK 16,244 and SEK 8,904 respectively. Conclusion INR controls of patients on warfarin treatment in primary care in Sweden represent a substantial cost to the health care provider and they are particularly costly when undertaken in home care. The cost may however be off-set by the reduced incidence of stroke.

Published
2007
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50. Resource consumption and management associated with monitoring of warfarin treatment in primary health care in Sweden

Author

Nilsson Gunnar H, Björholt Ingela, Andersson Stina, and Krakau Ingvar

Subjects
Medicine (General), R5-920
Abstract

Abstract Background Warfarin is used for the prevention and treatment of various thromboembolic complications. It is an efficacious anticoagulant, but it has a narrow therapeutic range, and regular monitoring is required to ensure therapeutic efficacy and at the same time avoid life-threatening adverse events. The objective was to assess management and resource consumption associated with patient monitoring episodes during warfarin treatment in primary health care in Sweden. Methods Delphi technique was used to systematically explore attitudes, demands and priorities, and to collect informed judgements related to monitoring of warfarin treatment. Two separate Delphi-panels were performed in three and two rounds, respectively, one concerning tests taken in primary health care centres, involving 34 GPs and 10 registered nurses, and one concerning tests taken in patients' homes, involving 49 district nurses. Results In the primary health care panel 10 of the 34 GPs regularly collaborated with a registered nurse. Average time for one monitoring episode was estimated to 10.1 minutes for a GP and 21.4 minutes for a nurse, when a nurse assisted a doctor. The average time for monitoring was 17.6 minutes for a GP when not assisted by a nurse. Considering all the monitoring episodes, 11.6% of patient blood samples were taken in the individual patient's home. Average time for such a monitoring episode was estimated to 88.2 minutes. Of all the visits, 8.2% were performed in vain and took on average 44.6 minutes. In both studies, approximately 20 different elements of work concerning management of patients during warfarin treatment were identified. Conclusion Monitoring of patients during treatment with warfarin in primary health care in Sweden involves many elements of work, and demands large resources, especially when tests are taken in the patient's home.

Published
2006
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