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Andersson Hagiwara, Magnus
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Publications (10 of 48) Show all publications
Andersson Hagiwara, M., Magnusson, C., Herlitz, J., Seffel, E., Axelsson, C., Munters, M., . . . Nilsson, L. (2019). Adverse events in prehospital emergency care: a trigger tool study. BMC Emergency Medicine, 19(1)
Open this publication in new window or tab >>Adverse events in prehospital emergency care: a trigger tool study
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2019 (English)In: BMC Emergency Medicine, Vol. 19, no 1Article in journal (Refereed) Published
Abstract [en]

Prehospital emergency care has developed rapidly during the past decades. The care is given in a complex context which makes prehospital care a potential high-risk activity when it comes to patient safety. Patient safety in the prehospital setting has been only sparsely investigated. The aims of the present study were 1) To investigate the incidence of adverse events (AEs) in prehospital care and 2) To investigate the factors contributing to AEs in prehospital care.

Keywords
Emergency medical service, Adverse events, Patient safety, Trigger tool, Prehospital
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hb:diva-15726 (URN)10.1186/s12873-019-0228-3 (DOI)
Available from: 2019-02-04 Created: 2019-02-04 Last updated: 2019-02-07Bibliographically approved
Sanfridsson, J., Sparrevik, J., Hollenberg, J., Nordberg, P., Djärv, T., Ringh, M., . . . Claesson, A. (2019). Drone delivery of an automated external defibrillator - a mixed method simulation study of bystander experience.. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 27(1), Article ID 40.
Open this publication in new window or tab >>Drone delivery of an automated external defibrillator - a mixed method simulation study of bystander experience.
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2019 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 27, no 1, article id 40Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Out-of-hospital cardiac arrest (OHCA) affects some 275,000 individuals in Europe each year. Time from collapse to defibrillation is essential for survival. As emergency medical services (EMS) response times in Sweden have increased, novel methods are needed to facilitate early treatment. Unmanned aerial vehicles (i.e. drones) have potential to deliver automated external defibrillators (AED). The aim of this simulation study was to explore bystanders' experience of a simulated OHCA-situation where a drone delivers an AED and how the situation is affected by having one or two bystanders onsite.

METHODS: This explorative simulation study used a mixed methodology describing bystanders' experiences of retrieving an AED delivered by a drone in simulated OHCA situations. Totally eight participants were divided in two groups of bystanders a) alone or b) in pairs and performed CPR on a manikin for 5 minutes after which an AED was delivered by a drone at 50 m from the location. Qualitative data from observations, interviews of participants and video recordings were analysed using content analysis alongside descriptive data on time delays during bystander interaction.

RESULTS: Three categories of bystander experiences emerged: 1) technique and preparedness, 2) support through conversation with the dispatcher, and 3) aid and decision-making. The main finding was that retrieval of an AED as delivered by a drone was experienced as safe and feasible for bystanders. None of the participants hesitated to retrieve the AED; instead they experienced it positive, helpful and felt relief upon AED-drone arrival and were able to retrieve and attach the AED to a manikin. Interacting with the AED-drone was perceived as less difficult than performing CPR or handling their own mobile phone during T-CPR. Single bystander simulation introduced a significant hands-off interval when retrieving the AED, a period lasting 94 s (range 75 s-110 s) with one participant compared to 0 s with two participants.

CONCLUSION: The study shows that it made good sense for bystanders to interact with a drone in this simulated suspected OHCA. Bystanders experienced delivery of AED as safe and feasible. This has potential implications, and further studies on bystanders' experiences in real cases of OHCA in which a drone delivers an AED are therefore necessary.

Keywords
AED, Bystander experience, CPR, Defibrillator, Drone, OHCA, UAV
National Category
Other Medical Sciences
Identifiers
urn:nbn:se:hb:diva-16023 (URN)10.1186/s13049-019-0622-6 (DOI)000464226700002 ()30961651 (PubMedID)2-s2.0-85064119066 (Scopus ID)
Available from: 2019-04-24 Created: 2019-04-24 Last updated: 2019-04-24Bibliographically approved
Sterner, A. (2019). Factors developing nursing students and novice nurses’ ability to provide care in acute situations. Nurse Education in Practice, 35, 135-140
Open this publication in new window or tab >>Factors developing nursing students and novice nurses’ ability to provide care in acute situations
2019 (English)In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 35, p. 135-140Article in journal (Refereed) Published
Abstract [en]

Nurses play an important role in detecting, interpreting and deciding appropriate actions to take in order to care for patients in acute situations. Nevertheless, novice nurses are reported as feeling unprepared to provide appropriate care in acute situations. In order to address this issue, it is important to describe factors in nursing education and first year of practice that enable nurses to provide appropriate care in acute situations. 17 novice nurses were interviewed in this qualitative study. A phenomenographic analysis was applied and four categories were discovered: Integrating theory into practice, access to adequate support, experience-based knowledge and personality traits. Results suggest that a variety of factors contribute to novice nurses’ ability to provide appropriate care in acute situations. Experience of acute situations and the integration of theory and practice are pivotal in acquiring skills to provide appropriate care. To accomplish this, reflection, practice and/or applied training with a patient perspective is recommended.

Place, publisher, year, edition, pages
Elsevier: , 2019
National Category
Nursing
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-15891 (URN)10.1016/j.nepr.2019.02.005 (DOI)30818117 (PubMedID)2-s2.0-85062686089 (Scopus ID)
Available from: 2019-03-21 Created: 2019-03-21 Last updated: 2019-04-12Bibliographically approved
Alsholm, L., Axelsson, C., Andersson Hagiwara, M., Niva, M., Claesson, L., Herlitz, J., . . . Jood, K. (2019). Interrupted transport by the emergency medical service in stroke/transitory ischemic attack: A consequence of changed treatment routines in prehospital emergency care.. Brain and Behavior, Article ID e01266.
Open this publication in new window or tab >>Interrupted transport by the emergency medical service in stroke/transitory ischemic attack: A consequence of changed treatment routines in prehospital emergency care.
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2019 (English)In: Brain and Behavior, ISSN 2162-3279, E-ISSN 2162-3279, article id e01266Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: The discovery that not all patients who call for the emergency medical service (EMS) require transport to hospital has changed the structure of prehospital emergency care. Today, the EMS clinician at the scene already distinguishes patients with a time-critical condition such as stroke/transitory ischemic attack (TIA) from patients without. This highlights the importance of the early identification of stroke/TIA.

AIM: To describe patients with a final diagnosis of stroke/TIA whose transport to hospital was interrupted either due to a lack of suspicion of the disease by the EMS crew or due to refusal by the patient or a relative/friend.

METHODS: Data were obtained from a register in Gothenburg, covering patients hospitalised due to a final diagnosis of stroke/TIA. The inclusion criterion was that patients were assessed by the EMS but were not directly transported to hospital by the EMS.

RESULTS: Among all the patients who were assessed by the EMS nurse and subsequently diagnosed with stroke or TIA in 2015, the transport of 34 of 1,310 patients (2.6%) was interrupted. Twenty-five of these patients, of whom 20 had a stroke and five had a TIA, are described in terms of initial symptoms and outcome. The majority had residual symptoms at discharge from hospital. Initial symptoms were vertigo/disturbed balance in 11 of 25 cases. Another three had symptoms perceived as a change in personality and three had a headache.

CONCLUSION: From this pilot study, we hypothesise that a fraction of patients with stroke/TIA who call for the EMS have their direct transport to hospital interrupted due to a lack of suspicion of the disease by the EMS nurse at the scene. These patients appear to have more vague symptoms including vertigo and disturbed balance. Instruments to identify these patients at the scene are warranted.

Keywords
EMS, stroke/TIA, transport
National Category
Other Medical Sciences
Identifiers
urn:nbn:se:hb:diva-16016 (URN)10.1002/brb3.1266 (DOI)30980519 (PubMedID)
Available from: 2019-04-24 Created: 2019-04-24 Last updated: 2019-04-29Bibliographically approved
Hansson, P.-O., Andersson Hagiwara, M., Herlitz, J., Brink, P. & Wireklint Sundström, B. (2019). Prehospital assessment of suspected stroke and TIA: an observational study.. Acta Neurologica Scandinavica
Open this publication in new window or tab >>Prehospital assessment of suspected stroke and TIA: an observational study.
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2019 (English)In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: Symptoms related to stroke diverge and may mimic many other conditions.

AIMS: To evaluate clinical findings among patients with a clinical suspicion of stroke in a prehospital setting and find independent predictors of a final diagnosis of stroke or transient ischemic attack (TIA) METHODS: An observational multi-centre study including nine emergency hospitals in western Sweden. All patients transported to hospital by ambulance and in whom a suspicion of stroke was raised by the EMS clinician before hospital admission during a four-month period were included.

RESULTS: Of 1,081 patients, a diagnosis of stroke was confirmed at hospital in 680 patients (63%), while 69 (6%) were diagnosed as TIA and 332 patients (31%) received other final diagnoses. In a multiple logistic regression analysis, factors independently associated with a final diagnosis of stroke or TIA were increasing age, odds ratio (OR) per year: 1.02, p=0.007, a history of myocardial infarction (OR: 1.77, p= 0.01), facial droop (OR: 2.81, p<0.0001), arm weakness (OR: 2.61, p<0.0001), speech disturbance (OR: 1.92, p<0.0001) and high systolic blood pressure (OR: 1.50, p=0.02), while low oxygen saturation was significantly associated with other diagnoses (OR: 0.41, p=0.007). More than half of all patients among patients with both stroke/TIA and other final diagnoses died during the five-year follow-up.

CONCLUSIONS: Seven factors including the three symptoms included in the Face Arm Speech Test (FAST) were significantly associated with a final diagnosis of stroke or TIA in a prehospital assessment of patients with a suspected stroke. This article is protected by copyright. All rights reserved.

Keywords
Emergency Medical Services, diagnosis, mortality, stroke
National Category
Other Medical Sciences
Identifiers
urn:nbn:se:hb:diva-16022 (URN)10.1111/ane.13107 (DOI)31009075 (PubMedID)
Available from: 2019-04-24 Created: 2019-04-24 Last updated: 2019-04-29Bibliographically approved
Olander, A., Andersson, H., Sundler, A. J., Bremer, A., Ljungström, L. & Andersson Hagiwara, M. (2019). Prehospital characteristics among patientswith sepsis: a comparison between patients with or without adverse outcome. BMC Emergency Medicine, Article ID 19:43.
Open this publication in new window or tab >>Prehospital characteristics among patientswith sepsis: a comparison between patients with or without adverse outcome
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2019 (English)In: BMC Emergency Medicine, ISSN 1471-227X, E-ISSN 1471-227X, article id 19:43Article in journal (Refereed) Published
Abstract [en]

Background: The prehospital care of patients with sepsis are commonly performed by the emergency medical services. These patients may be critically ill and have high in-hospital mortality rates. Unfortunately, few patients with sepsis are identified by the emergency medical services, which can lead to delayed treatment and a worse prognosis. Therefore, early identification of patients with sepsis is important, and more information about the prehospital characteristics that can be used to identify these patients is needed. Based on this lack of information, the objectives of this study were to investigate the prehospital characteristics that are identified while patients withseps is are being transported to the hospital by the emergency medical services, and to compare these values to those of the patients with and without adverse outcomes during their hospital stays.

Methods: This was a retrospective observational study. The patients’ electronic health records were reviewed and selected consecutively based on the following: retrospectively diagnosed with sepsis and transported to an emergency department by the emergency medical services. Data were collected on demographics, prehospital characteristics and adverse outcomes, defined as the in-hospital mortality or treatment in the intensive care unit, and analysed by independent sample t-test and chi-square. Sensitivity, specificity and likelihood ratio, of prehospital characteristics for predicting or development of adverse outcome were analysed.

Results: In total, 327 patients were included. Of these, 50 patients had adverse outcomes. When comparing patients with or without an adverse outcome, decreased oxygen saturation and body temperature, increased serumglucose level and altered mental status during prehospital care were found to be associated with an adverse outcome.

Conclusions: The findings suggests that patients having a decreased oxygen saturation and body temperature, increased serum glucose level and altered mental status during prehospital care are at risk of a poorer patient prognosis and adverse outcome. Recognizing these prehospital characteristics may help to identify patients with sepsis early and improve their long-term outcomes. However further research is required to predict limit values of saturation and serum glucose and to validate the use of prehospital characteristics for adverse outcome in patients with sepsis.

National Category
Infectious Medicine
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-21573 (URN)10.1186/s12873-019-0255-0 (DOI)
Available from: 2019-08-07 Created: 2019-08-07 Last updated: 2019-08-07Bibliographically approved
Maurin Söderholm, H., Andersson, H., Andersson Hagiwara, M., Backlund, P., Bergman, J., Lundberg, L. & Sjöqvist, B. A. (2019). Research challenges in prehospital care: the need for a simulation-based prehospital research laboratory.. Advances in Simulation, 4, Article ID 3.
Open this publication in new window or tab >>Research challenges in prehospital care: the need for a simulation-based prehospital research laboratory.
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2019 (English)In: Advances in Simulation, ISSN 2059-0628, Vol. 4, article id 3Article in journal (Refereed) Published
Abstract [en]

There is a need for improved research in the field of prehospital care. At the same time, there are many barriers in prehospital research due to the complex context, posing unique challenges for research, development, and evaluation. The present paper argues for the potential of simulation for prehospital research, e.g., through the development of an advanced simulation-based prehospital research laboratory. However, the prehospital context is different from other healthcare areas, which implies special requirements for the design of this type of laboratory, in terms of simulation width (including the entire prehospital work process) and depth (level of scenario detail). A set of features pertaining to simulation width, scenario depth, equipment, and personnel and competence are proposed. Close tailoring between these features and the prehospital research problems and context presents great potential to improve and further prehospital research.

Keywords
Laboratory, Prehospital, Simulation
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hb:diva-15823 (URN)10.1186/s41077-019-0090-0 (DOI)30783539 (PubMedID)
Available from: 2019-02-22 Created: 2019-02-22 Last updated: 2019-02-25Bibliographically approved
Andersson Hagiwara, M., Lundberg, L., Sjöqvist, B. A. & Maurin Söderholm, H. (2019). The Effects of Integrated IT Support on the Prehospital Stroke Process: Results from a Realistic Experiment. Journal of Healthcare Informatics Research
Open this publication in new window or tab >>The Effects of Integrated IT Support on the Prehospital Stroke Process: Results from a Realistic Experiment
2019 (English)In: Journal of Healthcare Informatics Research, ISSN 2509-4971Article in journal (Refereed) Epub ahead of print
Abstract [en]

Stroke is a serious condition and the stroke chain of care is a complex. The present study aims to explore the impact of a computerised decision support system (CDSS) for the prehospital stroke process, with focus on work processes and performance. The study used an exploratory approach with a randomised controlled crossover design in a realistic contextualised simulation experiment. The study compared clinical performance among 11 emergency medical services (EMS) teams of 22 EMS clinicians using (1) a computerised decision support system (CDSS) and (2) their usual paper-based process support. Data collection consisted of video recordings, postquestionnaires and post-interviews, and data were analysed using a combination of qualitative and quantitative approaches. In this experiment, using a CDSS improved patient assessment, decision making and compliance to process recommendations. Minimal impact of the CDSS was found on EMS clinicians’ self-efficacy, suggesting that even though the system was found to be cumbersome to use it did not have any negative effects on self-efficacy. Negative effects of the CDSS include increased on-scene time and a cognitive burden of using the system, affecting patient interaction and collaboration with team members. The CDSS’s overall process advantage to the prehospital stroke process is assumed to lead to a prehospital care that is both safer and of higher quality. The key to user acceptance of a system such as this CDSS is the relative advantages of improved documentation process and the resulting patient journal. This could improve the overall prehospital stroke process.

Keywords
Stroke, Decision support, EMS team, Prehospital process
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hb:diva-21183 (URN)10.1007/s41666-019-00053-4 (DOI)
Projects
PrehospIT
Funder
Vinnova
Available from: 2019-06-11 Created: 2019-06-11 Last updated: 2019-06-17Bibliographically approved
Sjösten, O., Nilsson, J., Herlitz, J., Axelsson, C., Jiménez-Herrera, M. & Andersson Hagiwara, M. (2019). The prehospital assessment of patients with a final hospital diagnosis of sepsis: Results of an observational study. Australasian Emergency Care
Open this publication in new window or tab >>The prehospital assessment of patients with a final hospital diagnosis of sepsis: Results of an observational study
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2019 (English)In: Australasian Emergency Care, ISSN 2588-994XArticle in journal (Refereed) Epub ahead of print
Abstract [en]

Background

Sepsis is a severe condition which affects 300–800/100,000 persons each year. There are indications that the prehospital identification of patients with sepsis is difficult. The aim of the study was, among patients with a final hospital diagnosis of sepsis, to compare emergency medical service (EMS) field assessments of patients in whom there was a prehospital suspicion of sepsis with those without this suspicion.

Methods

The study had a retrospective, observational design. The data used in the study were retrieved from the prehospital and hospital medical records of patients with a final hospital diagnosis of sepsis, transported to hospital by the EMS within a region in the south west of Sweden during a period of one year.

Results

Among patients with a final diagnosis of sepsis (n = 353), the EMS identified the condition in 36% of the cases. These patients were characterised by more abnormal vital signs (a higher respiratory rate and heart rate and more frequent temperature abnormalities) and were more ambitiously assessed (more lung auscultations and more assessments of the degree of consciousness).

Conclusion

The EMS was already able to identify 36% of patients with a final diagnosis of sepsis in the prehospital phase. There were minor differences in the prehospital assessment between patients who were identified by the EMS nurse and those who were not.

Keywords
EMS, Sepsis, Assessment, Prehospital
National Category
Other Medical Sciences
Identifiers
urn:nbn:se:hb:diva-16010 (URN)10.1016/j.auec.2019.02.002 (DOI)
Available from: 2019-04-23 Created: 2019-04-23 Last updated: 2019-04-24Bibliographically approved
Andersson Hagiwara, M., Wireklint Sundström, B., Brink, P., Herlitz, J. & Hansson, P.-O. (2018). A shorter system delay for haemorrhagic stroke than ischaemic stroke among patients who use emergency medical service.. Acta Neurologica Scandinavica
Open this publication in new window or tab >>A shorter system delay for haemorrhagic stroke than ischaemic stroke among patients who use emergency medical service.
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2018 (English)In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404Article in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVES: We compare various aspects in the early chain of care among patients with haemorrhagic stroke and ischaemic stroke.

MATERIALS & METHODS: The Emergency Medical Services (EMS) and nine emergency hospitals, each with a stroke unit, were included. All patients hospitalised with a first and a final diagnosis of stroke between 15 December 2010 and 15 April 2011 were included. The primary endpoint was the system delay (from call to the EMS until diagnosis). Secondary endpoints were: (i) use of the EMS, (ii) delay from symptom onset until call to the EMS; (iii) priority at the dispatch centre; (iv) priority by the EMS; and (v) suspicion of stroke by the EMS nurse and physician on admission to hospital.

RESULTS: Of 1336 patients, 172 (13%) had a haemorrhagic stroke. The delay from call to the EMS until diagnosis was significantly shorter in haemorrhagic stroke. The patient's decision time was significantly shorter in haemorrhagic stroke. The priority level at the dispatch centre did not differ between the two groups, whereas the EMS nurse gave a significantly higher priority to patients with haemorrhage. There was no significant difference between groups with regard to the suspicion of stroke either by the EMS nurse or by the physician on admission to hospital.

CONCLUSIONS: Patients with a haemorrhagic stroke differed from other stroke patients with a more frequent and rapid activation of EMS.

Keywords
EMS, prehospital, stroke, system delay
National Category
Clinical Medicine
Identifiers
urn:nbn:se:hb:diva-13521 (URN)10.1111/ane.12895 (DOI)000429693800010 ()29315463 (PubMedID)2-s2.0-85040200414 (Scopus ID)
Available from: 2018-01-17 Created: 2018-01-17 Last updated: 2018-12-07Bibliographically approved
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