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  • 1.
    Bremer, Anders
    University of Borås, School of Health Science.
    Hjärtstopp utanför sjukhus2012Conference paper (Other academic)
  • 2.
    Eriksson, Magnus
    et al.
    Minso Solutions AB, Sven Eriksonsplatsen 4, Boras, 503 38, Sweden.
    Billhult, Annika
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Billhult, Tommy
    Minso Solutions AB, Sven Eriksonsplatsen 4, Boras, 503 38, Sweden.
    Pallari, Elena
    Centre for Implementation Science, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Health Service and Population Research Department, King’s College London, London, SE5 8AF, UK; MRC Clinical Trials and Methodology, University College London, 90 High Holborn, London, WC1V 6LJ, UK.
    Lewison, Grant
    School of Cancer and Pharmaceutical Sciences, Division of Cancer Studies, King’s College London, Guy’s Hospital, London, SE1 9RT, UK.
    A new database of the references on international clinical practice guidelines: a facility for the evaluation of clinical research2020In: Scientometrics, ISSN 0138-9130, E-ISSN 1588-2861, Vol. 122, no 2, p. 1221-1235Article in journal (Refereed)
    Abstract [en]

    Although there are now several bibliographic databases of research publications, such as Google Scholar, Pubmed, Scopus, and the Web of Science (WoS), and some also include counts of citations, there is at present no similarly comprehensive database of the rapidly growing number of clinical practice guidelines (CPGs), with their references, which sometimes number in the hundreds. CPGs have been shown to be useful for the evaluation of clinical (as opposed to basic) biomedical research, which often suffers from relatively low counts of citations in the serial literature. The objectives were to introduce a new citation database, clinical impact (R), and demonstrate how it can be used to evaluate research impact of clinical research publications by exploring the characteristics of CPG citations of two sets of papers, as well as show temporal variation of clinical impactand the WoS. The paper includes the methodology used to retain the data and also the rationale adopted to achieve data quality. The analysis showed that although CPGs tend preferentially to cite papers from their own country, this is not always the case. It also showed that cited papers tend to have a more clinical research level than uncited papers. An analysis of diachronous citations in both clinical impactand the WoS showed that although the WoS citations showed a decreasing trend after a peak at 2-3 years after publication, this was less clear for CPG citations and a longer timescale would be needed to evaluate their impact on these documents.

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  • 3.
    Hagiwara Andersson, Magnus
    et al.
    University of Borås, School of Health Science.
    Lundberg, Lars
    University of Borås, School of Health Science.
    Suserud, Björn-Ove
    University of Borås, School of Health Science.
    Henricson, Maria
    Sjökvist, Bengt-Arne
    Jonsson, Anders
    University of Borås, School of Health Science.
    Decision support system in prehospital care: a randomized controlled simulation study2013In: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 31, no 1, p. 143-153Article in journal (Refereed)
    Abstract [en]

    Introduction Prehospital emergency medicine is a challenging discipline characterized by a high level of acuity, a lack of clinical information and a wide range of clinical conditions. These factors contribute to the fact that prehospital emergency medicine is a high-risk discipline in terms of medical errors. Prehospital use of Computerized Decision Support System (CDSS) may be a way to increase patient safety but very few studies evaluate the effect in prehospital care. The aim of the present study is to evaluate a CDSS. Methods In this non-blind block randomized, controlled trial, 60 ambulance nurses participated, randomized into 2 groups. To compensate for an expected learning effect the groups was further divided in two groups, one started with case A and the other group started with case B. The intervention group had access to and treated the two simulated patient cases with the aid of a CDSS. The control group treated the same cases with the aid of a regional guideline in paper format. The performance that was measured was compliance with regional prehospital guidelines and On Scene Time (OST). Results There was no significant difference in the two group's characteristics. The intervention group had a higher compliance in the both cases, 80% vs. 60% (p < 0.001) but the control group was complete the cases in the half of the time compare to the intervention group (p < 0.001). Conclusion The results indicate that this CDSS increases the ambulance nurses' compliance with regional prehospital guidelines but at the expense of an increase in OST.

  • 4.
    Hagiwara, Magnus
    University of Borås, School of Health Science.
    Development and evaluation of a computerised decision support system for use in pre-hospital care2014Doctoral thesis, monograph (Other academic)
    Abstract [en]

    The aim of the thesis was to develop and evaluate a Computerised Decision Support System (CDSS) for use in pre-hospital care. The thesis was guided by a theoretical framework for developing and evaluating a complex intervention. The four studies used different designs and methods. The first study was a systematic review of randomised controlled trials. The second and the last studies had experimental and quasi-experimental designs, where the CDSS was evaluated in a simulation setting and in a clinical setting. The third study included in the thesis had a qualitative case study design. The main findings from the studies in the thesis were that there is a weak evidence base for the use of CDSS in pre-hospital care. No studies have previously evaluated the effect of CDSS in pre-hospital care. Due to the context, pre-hospital care is dependent on protocol-based care to be able to deliver safe, high-quality care. The physical format of the current paper based guidelines and protocols are the main obstacle to their use. There is a request for guidelines and protocols in an electronic format among both clinicians and leaders of the ambulance organisations. The use of CDSS in the pre-hospital setting has a positive effect on compliance with pre-hospital guidelines. The largest effect is in the primary survey and in the anamnesis of the patient. The CDSS also increases the amount of information collected in the basic pre-hospital assessment process. The evaluated CDSS had a limited effect on on-the-scene time. The developed and evaluated CDSS has the ability to increase pre-hospital patient safety by reducing the risks of cognitive bias. Standardising the assessment process, enabling explicit decision support in the form of checklists, assessment rules, differential diagnosis lists and rule out worst-case scenario strategies, reduces the risk of premature closure in the assessment of the pre-hospital patient.

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  • 5.
    Kauppi, Wivica
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Characteristics and prediction of an adverse outcome among patients assessed with dyspnoea as the main symptoms by ambulance clinicians2023In: 4th Global conference on emergency nursing & trauma care, Gothenburg, Sweden,  November 9-11, 2023., 2023Conference paper (Refereed)
    Abstract [en]

    Background: Dyspnoea (breathing difficulty) is a common reason why patients are in need of pre-hospital care provided by ambulance clinicians. Within the pre-hospital field, knowledge among patients with dyspnoea is still limited even though it is caused by several serious underlying medical conditions. Aim: To describe characteristics and prediction of an adverse outcome among patients with dyspnoea, assessed by ambulance clinicians. Methods: A retrospective observational study including patients aged ≥ 16 years during 2017 in Sweden. In all, 6354 ambulance missions were included.  Data were manually collected through  ambulance- and hospital records.  Descriptive statistics and multiple logistic regression were used. Results:  Mean age was 73 years, 56% were women. There were more than 400 different final diagnostic codes where chronic obstructive pulmonary disease (20.4%), pulmonary infection (17%), and heart failure (15%) were most common. In all, 84% had previously experienced dyspnoea. The overall 30-day mortality was 11%. Among  patients with a time-sensitive final diagnosis (13%),  27% died within 30 days. The most frequent  time-sensitive diagnoses were cardiac diseases (4.1% of all diagnoses), infectious/inflammatory diseases (2.6%), and vascular diseases (2.4%).  Hypertension, renal disease, symptoms of pain, abnormal respiratory rate, impaired consciousness, a pathologic ECG and a short delay until calling the emergency number predicted an increased risk of a time-sensitive final diagnosis. Increasing age, renal disease, cancer, low systolic blood pressures, impaired consciousness and abnormal body temperature predicted an increased risk of death. Conclusions: Patients with dyspnoea often show a complexity of symptoms and signs. They have a coexistence of several chronic diseases and a high risk of death.  Underlying life-threatening conditions are common.Thus, a great burden are placed on ambulance clinicians who are responsible for the pre-hospital care.

  • 6.
    Kauppi, Wivica
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Prehospital dyspnoea2017Data set
    Abstract [sv]

    Observationsstudier vilka baserades på retrospektiv journalgranskning. Urvalet bestod av samtliga ambulansuppdrag (n=7260) som klassificerats som ESS 04 (andnöd som huvudsymtom) av vårdare i ambulans under år 2017 i två upptagningsområden i sydvästra Sverige, vilket inkluderade 16ambulansstationer.Efter en manuell granskning av ambulansjournaler och sjukhusjournaler exkluderades 908 patienter (orsak: ålder < 16 år, personnummer saknades, ambulanstransporter till sjukhus utanför inkluderade upptagningsområden, dubbla ambulansjournaler, bristfällig dokumentation, felaktig ESS kod samt sekundärtransporter). Detta medförde att 6354 patienter slutligen inkluderades.

    Etisk provning utförd nr: 989-17 (Gothenburg)

  • 7.
    Kauppi, Wivica
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Prehospital dyspnoea; How is the patient assessed and treated- preliminary data from the dyspnoea project2019Conference paper (Refereed)
    Abstract [en]

    Background:

    Patients with respiratory distress (dyspnoea) often seek emergency medical care and are cared for in ambulance. Although dyspnoea is subjective, it has a physiologic basis. Behind the symptom of dyspnoea, several serious medical diagnoses can be hidden and the presence of dyspnoea is also associated with increased mortality. Based on the patient's individual needs and complex illnesses or injuries, the ambulance staff will independently be responsible for advanced care. In caring for these patients, an intertwining between medical and caring assessment are needed. Through medical assessments the ambulance staff tries to identify the underlying cause of dyspnoea. Medical assessments are important in order to make a prioritisation of the patient's condition and need for treatment. But from a caring science perspective, another part in the assessment is to have a patient perspective in order to promote health and wellbeing for the vulnerable patient.  Through a caring conversation, by listening to the patients story, the medical and caring assessment can be safer by providing  information that is relevant but not measureable, for example, diagnosis and treatment goals. The ambulance staff´s ability to intertwine a medical and existential perspective promotes patient´s well-being and relieves suffering.

    Aim

    The overall aim of this project is to explore the healthcare meeting, the assessment and caring of patients with dyspnoea who has been received an ambulance.

    Methods: Quantitative- and qualitative methods

    Importance of the thesis

    This project will increase knowledge and understanding in patients with dyspnoea. Early diagnosis and treatment are crucial to the outcome of this group of patients.

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    Accepterat abstract RAS- kongress
  • 8.
    Magnusson, Carl
    et al.
    Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Karlsson, Thomas
    Health Metrics Unit, Sahlgrenska Academy, University of Gothenburg.
    Axelsson, Christer
    Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg.
    Initial assessment, level of care and outcome among children who were seen by emergency medical services: a prospective observational study.2018In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, E-ISSN 1757-7241, Vol. 26, no 1, article id 88Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The assessment of children in the Emergency Medical Service (EMS) is infrequent representing 5.4% of the patients in an urban area in the western part of Sweden. In Sweden, patients are assessed on scene by an EMS nurse whom independently decides on interventions and level of care. To aid the EMS nurse in the assessment a triage instrument, Rapid Emergency Triage and Treatment System-paediatrics (RETTS-p) developed for Emergency Department (ED) purpose has been in use the last 5 years. The aim of this study was to evaluate the EMS nurse assessment, management, the utilisation of RETTS-p and patient outcome.

    METHODS: A prospective, observational study was performed on 651 children aged < 16 years from January to December 2016. Statistical tests used in the study were Mann-Whitney U test, Fisher's exact test and Spearman's rank statistics.

    RESULTS: The dispatch centre indexed life-threatening priority in 69% of the missions but, of all children, only 6.1% were given a life threatening RETTS-p red colour by the EMS nurse. A total of 69.7% of the children were transported to the ED and, of these, 31.7% were discharged without any interventions. Among the non-conveyed patients, 16 of 197 (8.1%) visited the ED within 72 h but only two were hospitalised. Full triage, including five out of five vital signs measurements and an emergency severity index, was conducted in 37.6% of all children. A triage colour was not present in 146 children (22.4%), of which the majority were non-conveyed. The overall 30-day mortality rate was 0.8% (n = 5) in children 0-15 years.

    CONCLUSIONS: Despite the incomplete use of all vital signs according to the RETTS-p, the EMS nurse assessment of children appears to be adapted to the clinical situation in most cases and the patients appear to be assessed to the appropriate level of care but indicating an over triage. It seems that the RETTS-p with full triage is used selectively in the pre-hospital assessment of children with a risk of death during the first 30 days of less than 1%.

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  • 9.
    Olsson, H
    et al.
    Department of Cardiology, NU Hospital Group, Trollhättan, Sweden.
    Karlson, B W
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; AstraZeneca Gothenburg, Mölndal, Sweden.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Karlsson, T
    Biostatistics, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Hellberg, J
    Department of Cardiology, NU Hospital Group, Trollhättan, Sweden.
    Prytz, M
    Department of Surgery, NU-Hospital Group, Region Västra Götaland, Trollhättan, Sweden.
    Sernert, N
    Department of Orthopaedics Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.
    Ekerstad, N
    Department of Gothenburg Health, Medicine and Caring Sciences, Unit of Health Care Analysis, Linköping University, Linköping, Sweden.
    Predictors of short- and long-term mortality in critically ill, older adults admitted to the emergency department: an observational study2022In: BMC Emergency Medicine, E-ISSN 1471-227X, Vol. 22, no 1, article id 15Article in journal (Refereed)
    Abstract [en]

    Background In the future, we can expect an increase in older patients in emergency departments (ED) and acute wards. The main purpose of this study was to identify predictors of short- and long-term mortality in the ED and at hospital discharge. Methods This is a retrospective, observational, single-center, cohort study, involving critically ill older adults, recruited consecutively in an ED. The primary outcome was mortality. All patients were followed for 6.5-7.5 years. The Cox proportional hazards model was used. Results Regarding all critically ill patients aged >= 70 years and identified in the ED (n = 402), there was a significant association between mortality at 30 days after ED admission and unconsciousness on admission (HR 3.14, 95% CI 2.09-4.74), hypoxia on admission (HR 2.51, 95% CI 1.69-3.74) and age (HR 1.06 per year, 95% CI 1.03-1.09), (all p < 0.001). Of 402 critically ill patients aged >= 70 years and identified in the ED, 303 were discharged alive from hospital. There was a significant association between long-term mortality and the Charlson Comorbidity Index (CCI) > 2 (HR 1.90, 95% CI 1.46-2.48), length of stay (LOS) > 7 days (HR 1.72, 95% CI 1.32-2.23), discharge diagnosis of pneumonia (HR 1.65, 95% CI 1.24-2.21) and age (HR 1.08 per year, 95% CI 1.05-1.10), (all p < 0.001). The only symptom or vital sign associated with long-term mortality was hypoxia on admission (HR 1.70, 05% CI 1.30-2.22). Conclusions Among critically ill older adults admitted to an ED and discharged alive the following factors were predictive of long-term mortality: CCI > 2, LOS > 7 days, hypoxia on admission, discharge diagnosis of pneumonia and age. The following factors were predictive of mortality at 30 days after ED admission: unconsciousness on admission, hypoxia and age. These data might be clinically relevant when it comes to individualized care planning, which should take account of risk prediction and estimated prognosis.

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  • 10.
    Årestedt, Kristoffer
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Allert, Camilla
    Blekinge Institute of Technology.
    Djucanovic, Ingrid
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Israelsson, Johan
    Linnaeus University, Faculty of Technology, Kalmar Maritime Academy.
    Schildmeijer, Kristina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Agerström, Jens
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Årestedt, Liselott
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Bremer, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Health Related Quality of Life Among In-Hospital Cardiac Arrest Survivors in Working Age2018Conference paper (Refereed)
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