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  • 1. Abdon, Nils Johan
    et al.
    Bergfeldt, Lennart
    Herlitz, Johan
    University of Borås, School of Health Science.
    Hjärtstopp utlöst av läkemedel kanske vanligare än vi tror2010In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 107, no 8, 521-525 p.Article in journal (Refereed)
  • 2. Abdon, NJ
    et al.
    Herlitz, J
    University of Borås, School of Health Science.
    Andrersson, B
    Peripartumcardiomyopathi an often mised diagnosis2013In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 110, no 23-24, 1152-1154 p.Article in journal (Refereed)
    Abstract [sv]

    Peripartumkardiomyopati är en sällsynt form av hjärtsvikt. Diagnostiska kriterier är nytillkommen hjärtsvikt från sen graviditet och upp till fem månader efter förlossning, avsaknad av annan förklaring till hjärtsvikt och nedsatt systolisk vänsterkammarfunktion Orsaken till tillståndet tros vara omvandling av prolaktin till en kardiotoxisk variant. Terapin är den etablerade, men ACE-hämmare och ARB får inte ges till ammande mödrar. Hjärttransplantation har tillgripits. Maligna hjärtarytmier har krävt behandling med implanterbar defibrillator och pacemaker. Hämning av produktionen av prolaktin med bromokriptin har gett goda resultat i en liten studie. Resultaten har inte bekräftats.

  • 3. Abtahi, Farhad
    et al.
    Aslamy, Benjamin
    Boujabir, I
    Seoane, Fernando
    University of Borås, School of Health Science.
    Lindecrantz, Kaj
    University of Borås, School of Engineering.
    An Affordable ECG and Respiration Monitoring System Based on Raspberry PI and ADAS1000: First Step towards Homecare Applications2014In: 16th Nordic-Baltic Conference on Biomedical Engineering / [ed] Mindedal H., Persson M., Springer International Publishing , 2014, 5-8 p.Conference paper (Refereed)
    Abstract [en]

    Homecare is a potential solution for problems associated with an aging population. This may involve several physiological measurements, and hence a flexible but affordable measurement device is needed. In this work, we have designed an ADAS1000-based four-lead electrocardiogram (ECG) and respiration monitoring system. It has been implemented using Raspberry PI as a platform for homecare applications. ADuM chips based on iCoupler technology have been used to achieve electrical isolation as required by IEC 60601 and IEC 60950 for patient safety. The result proved the potential of Raspberry PI for the design of a compact, affordable, and medically safe measurement device. Further work involves developing a more flexible software for collecting measurements from different devices (measuring, e.g., blood pressure, weight, impedance spectroscopy, blood glucose) through Bluetooth or user input and integrating them into a cloud-based homecare system.

  • 4.
    Abtahi, Farhad
    et al.
    University of Borås, School of Health Science.
    Berndtsson, A
    University of Borås, School of Health Science.
    Abtahi, Shirin
    University of Borås, School of Health Science.
    Seoane, Fernando
    University of Borås, School of Health Science.
    Lindecrantz, Kaj
    KTH.
    Development and preliminary evaluation of an Android based heart rate variability biofeedback system2014Conference paper (Refereed)
    Abstract [en]

    The reduced Heart Rate Variability (HRV) is believed to be associated with several diseases such as congestive heart failure, diabetes and chronic kidney diseases (CKD). In these cases, HRV biofeedback may be a potential intervention method to increase HRV which in turn is beneficial to these patients. In this work, a real-time Android biofeedback application based on a Bluetooth enabled ECG and thoracic electrical bioimpedance (respiration) measurement device has been developed. The system performance and usability have been evaluated in a brief study with eight healthy volunteers. The result demonstrates real-time performance of system and positive effects of biofeedback training session by increased HRV and reduced heart rate. Further development of the application and training protocol is ongoing to investigate duration of training session to find an optimum length and interval of biofeedback sessions to use in potential interventions.

  • 5. Abtahi, Farhad
    et al.
    Snäll, Jonathan
    Aslamy, Benjamin
    Abtahi, Shirin
    Seoane, Fernando
    University of Borås, School of Health Science.
    Lindecrantz, Kaj
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Biosignal PI, an Affordable Open-Source ECG and Respiration Measurement System2014In: Sensors, ISSN 1424-8220, E-ISSN 1424-8220, Vol. 15, no 1, 93-109 p.Article in journal (Refereed)
    Abstract [en]

    Bioimedical pilot projects e.g., telemedicine, homecare, animal and human trials usually involve several physiological measurements. Technical development of these projects is time consuming and in particular costly. A versatile but affordable biosignal measurement platform can help to reduce time and risk while keeping the focus on the important goal and making an efficient use of resources. In this work, an affordable and open source platform for development of physiological signals is proposed. As a first step an 8–12 leads electrocardiogram (ECG) and respiration monitoring system is developed. Chips based on iCoupler technology have been used to achieve electrical isolation as required by IEC 60601 for patient safety. The result shows the potential of this platform as a base for prototyping compact, affordable, and medically safe measurement systems. Further work involves both hardware and software development to develop modules. These modules may require development of front-ends for other biosignals or just collect data wirelessly from different devices e.g., blood pressure, weight, bioimpedance spectrum, blood glucose, e.g., through Bluetooth. All design and development documents, files and source codes will be available for non-commercial use through project website, BiosignalPI.org.

  • 6. Adielsson, A
    et al.
    Hollenberg, J
    Karlsson, T
    Lindqvist, J
    Lundin, S
    Silfverstolpe, J
    Svensson, L
    Herlitz, Johan
    University of Borås, School of Health Science.
    Increase in survival and bystander CPR in out-of-hospital shockable arrhythmia: bystander CPR and female gender are predictors of improved outcome. Experiences from Sweden in an 18-year perspective2011In: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 97, no 17, 1391-1396 p.Article in journal (Refereed)
    Abstract [en]

    Objectives In a national perspective, to describe survival among patients found in ventricular fibrillation or pulseless ventricular tachycardia witnessed by a bystander and with a presumed cardiac aetiology and answer two principal questions: (1) what are the changes over time? and (2) which are the factors of importance? Design Observational register study. Setting Sweden. Patients All patients included in the Swedish Out of Hospital Cardiac Arrest Register between 1 January 1990 and 31 December 2009 who were found in bystander-witnessed ventricular fibrillation with a presumed cardiac aetiology. Interventions Bystander cardiopulmonary resuscitation (CPR) and defibrillation. Main outcome measures Survival to 1 month. Results In all, 7187 patients fulfilled the set criteria. Age, place of out-of-hospital cardiac arrest (OHCA) and gender did not change. Bystander CPR increased from 46% to 73%; 95% CI for OR 1.060 to 1.081 per year. The median delay from collapse to defibrillation increased from 12 min to 14 min (p for trend 0.0004). Early survival increased from 28% to 45% (95% CI 1.044 to 1.065) and survival to 1 month increased from 12% to 23% (95% CI 1.058 to 1.086). Strong predictors of early and late survival were a short interval from collapse to defibrillation, bystander CPR, female gender and OHCA outside the home. Conclusion In a long-term perspective in Sweden, survival to 1 month after ventricular fibrillation almost doubled. This was associated with a marked increase in bystander CPR. Strong predictors of outcome were a short delay to defibrillation, bystander CPR, female gender and place of collapse.

  • 7. Adriansson, C
    et al.
    Suserud, Björn-Ove
    University of Borås, School of Health Science.
    Bergbom, I
    The use of topical anaesthesia at children's minor lacerations: an experimental study2004In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 12, no 2, 74-84 p.Article in journal (Refereed)
    Abstract [en]

    Background: In a great many situations within health care and treatment, children are subjected to unnecessary pain and suffering. When local anaesthetics is to be administered the child can experience this as incomprehensible especially when the nursing staff assures the child that no pain would be felt, only to discover soon after, that it actually did hurt at the moment of anaesthetic infiltration. The soothing of pain during the suturing of wounds in emergency wards can be reduced, ensuring that unnecessary pain in the cafe-and-treatment process is mot meted out to children. In order to prevent this (subjection to unnecessary pain), and by improving accepted practice, it was interesting to investigate whether children felt pain at the time of infiltration anaesthesia following the initial topical anaesthesia. Aim: The aim of the present study was to investigate the effects of introductory topical anaesthesia using Xylocain solution dropped in the wound prior to a definitive infiltration-anaesthesia. An experimental, prospective design was used where children were included in either an experimental group or a control group. The experimental group (n=10) were given a Xylocain solution while the control group (n=10) received physiological Sodium solution. Data collection for the study was made by making VAS estimates and by interviews. Result: The study shows that a certain alleviation of pain does occur when using Xylocain but no statistically significant difference exists between the two groups. Irrespective of whether the children received an introductory topical anaesthesia with Xylocain or Sodium solution at the time of infiltration anaesthesia, they expressed pain in connection with infiltration. The study also shows that many children express fear and anxiety. Conclusion: Current research highlights the difficulties involved in offering children a really satisfactory form of pain relief in connection with infiltration anaesthesia and suturing of wounds. It is urgent to throw more light on children’s pain, both from a nursing and from a medical point of view. No statistically significant difference was found in children’s reported pain, after treatment with Xylocain but the solution can have a positive effect at the time of the infiltration jab, but a larger study needs to be done in order to establish this firmly.

  • 8.
    Ahl, Caroline
    et al.
    University of Borås, School of Health Science.
    Hjälte, L
    Johansson, C
    Wireklint-Sundström, Birgitta
    University of Borås, School of Health Science.
    Jonsson, Anders
    University of Borås, School of Health Science.
    Suserud, Björn-Ove
    University of Borås, School of Health Science.
    Culture and care in the Swedish ambulance services2005In: Emergency Nurse, ISSN 1354-5752, E-ISSN 2047-8984, Vol. 13, no 8, 30-36 p.Article in journal (Refereed)
  • 9.
    Ahl, Caroline
    et al.
    University of Borås, School of Health Science.
    Nyström, Maria
    University of Borås, School of Health Science.
    To Handle the Unexpected: The meaning of caring in pre-hospital emergency care2012In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 20, no 1, 33-41 p.Article in journal (Refereed)
    Abstract [en]

    The patient’s voice has not been present to the same degree as the professional perspective in caring research in a pre-hospital context. In order to further develop and improve pre-hospital care, it is therefore important to explore patients’ situations not only in life threatening but also in non-traumatic situations. This is especially important as these patients might be defined as inappropriate attendees of ambulance services. The aim of this study was to interpret and explain experiences of caring in pre-hospital care situations that are not defined as traumatic or life threatening. Twenty informants aged between 34 and 82 years were interviewed. The design of the study was exploratory, and it used an interpretative approach in order to understand the meaning of pre-hospital caring. The findings show that pre-hospital caring can be understood and explained as a matter of interplay between carer(s) and patient with potentials for positive as well as negative outcomes. Our conclusion is that the initial meeting is of vital importance in how patients experience pre-hospital care. It is suggested that general public information on the development of Swedish pre-hospital care received in turn may facilitate the first encounter between patient and carer(s).

  • 10.
    Ahl, Caroline
    et al.
    University of Borås, School of Health Science.
    Nyström, Maria
    University of Borås, School of Health Science.
    Jansson, L
    Making up one’s mind: Patients Experiences of Calling an Ambulance2006In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 14, no 1, 11-19 p.Article in journal (Refereed)
    Abstract [en]

    The issue of the inappropriate use of ambulance transport and care has mainly been studied from the professionals’ and caregivers’ perspective, with few studies focusing on the patient and his/her experiences. To further understand whether patients use ambulance care in an inappropriate manner and, if so, why, it is important to obtain an overall picture of the patients’ existential situation at the time they call an ambulance. The aim of this study was to analyse and describe patients’ experiences related to the decision to call an ambulance and the wait for it to arrive. The design was explorative, and twenty informants aged between 34 and 82 years were interviewed. Qualitative content analyses were performed. The findings showed that calling for an ambulance is a major decision that is preceded by hesitation and attempts to handle the situation by oneself. Our conclusion is that the definition of inappropriate use of valuable health care resources should not be based solely on the professionals’ point of view but also take account of the patients’ reactions when they experience a threat to their life and health.

  • 11.
    Ahlstrom, Linda
    University of Borås, School of Health Science.
    Improving Work Ability and Return to Work among Women on Long-term Sick Leave2014Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overall aim of this thesis was to gain new knowledge of factors and interventions that improve work ability and return to work (RTW) among women on long-term sick leave from human service organizations (HSOs). The specific aims of the studies were: to evaluate the associations between the self-rated Work Ability Index (WAI) and Work Ability Score (WAS), and the relationship with prospective sick leave, symptoms, and health (Paper I); to investigate whether intervention with myofeedback training or intensive muscular strength training could decrease pain and increase work ability among women with neck pain (Paper II); to examine the associations between workplace rehabilitation and the combination of supportive conditions at work with work ability and RTW over time (Paper III); and to explore experiences, views, and strategies in the rehabilitation process for RTW (Paper IV). This thesis is based on a prospective cohort study (n=324) and a randomized controlled study (RCT) (n=60, participants with neck pain). Both quantitative and qualitative methods were used. The data collection consisted of questionnaires, laboratory-observed data, register-based data, and interviews. The results showed a very strong association between WAI and WAS, and results predicted future sick leave degree, health-related quality of life, vitality, neck pain, self-rated general health, self-rated mental health, behavioral stress, and current stress (Paper I). In the RCT (Paper II), individuals in the myofeedback intervention group increased their vitality and work ability over time and individuals in the intensive musculoskeletal strength training group increased their WAI, WAS, and mental health over time. WAI, WAS, and RTW increased over time among individuals provided with workplace rehabilitation and supportive conditions at work (Paper III) such as a sense of feeling welcome back at work, influence at work, possibilities for development, degree of freedom at work, meaning of work, quality of leadership, social support, sense of community, and work satisfaction. Women described (Paper IV) how they were striving to work and how they had different views, strategies, and approaches in the rehabilitation process for RTW. They expressed a desire to work, their goals for work, and their wishes for work. In the rehabilitation process for RTW they described their interaction with stakeholders as either controlling the interaction or struggling in the interaction. They described strategies to cope with RTW in terms of yo-yo (fluctuating) working: yo-yo working as a strategy or yo-yo working as a consequence. This thesis identifies factors of importance in improving work ability and RTW among women on long-term sick leave from HSOs. For women with neck pain, the intervention study showed feasibility of the intervention and demonstrated improved work ability and decreased pain (Paper II). The intensive muscular strength training program, which is easy for the individual to learn and perform at home, was associated with increased work ability. The results regarding rehabilitation highlight the importance of integrating workplace rehabilitation with supportive conditions at work to increase work ability and improve RTW (Paper III). Women expressed that they were striving to work and that they wanted to work (Paper IV). These women were “going in and out” of work participation (yo-yo working) as a way to handle the rehabilitation process. For assessing the status and progress of work ability among women on long-term sick leave, the single-question WAS may be used as a compliment to the full WAI as a simple indicator (Paper I).

  • 12.
    Ahlstrom, Linda
    et al.
    University of Borås, School of Health Science.
    Ahlberg, Karin
    Hagberg, Mats
    Dellve, Lotta
    University of Borås, School of Health Science.
    Processen att återgå i arbete efter långtidssjukskrivning: Kvinnor med nacksmärta, arbetandes inom kommunal verksamhet2013Conference paper (Other academic)
    Abstract [sv]

    En kvalitativ studie pågår med syfte att belysa rehabiliteringsprocessen för långtidssjukskrivna kvinnor, med nacksmärta, för att möjliggöra återgång i arbete. Resultaten kan användas för preventivt och promotivt arbete inom ex. primärvården, företagshälsovården, försäkringskassan och arbetsförmedlingen.

  • 13. Ahlstrom, Linda
    et al.
    Hagberg, Mats
    Dellve, Lotta
    University of Borås, School of Health Science.
    Workplace Rehabilitation and Supportive Conditions at Work: A Prospective Study2013In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 23, no 2, 248-260 p.Article in journal (Refereed)
    Abstract [en]

    Purpose To investigate the impact of rehabilitation measures on work ability and return to work (RTW), specifically the association between workplace rehabilitation/supportive conditions at work and work ability and RTW over time, among women on long-term sick leave. Methods Questionnaire data were collected (baseline, 6 and 12 months) from a cohort of women (n = 324). Linear mixed models were used for longitudinal analysis of the repeated measurements of work ability index (WAI), work ability score and working degree. These analyses were performed with different models; the explanatory variables for each model were workplace rehabilitation, supportive conditions at work and time. Results The individuals provided with workplace rehabilitation and supportive conditions (e.g. influence at work, possibilities for development, degree of freedom at work, meaning of work, quality of leadership, social support, sense of community and work satisfaction) had significantly increased WAI and work ability score over time. These individuals scored higher work ability compared to those individuals having workplace rehabilitation without supportive conditions, or neither. Additionally, among the individuals provided with workplace rehabilitation and supportive conditions, working degree increased significantly more over time compared to those individuals with no workplace rehabilitation and no supportive conditions. Conclusion The results highlight the importance of integrating workplace rehabilitation with supportive conditions at work in order to increase work ability and improve the RTW process for women on long-term sick leave.

  • 14. Alexandersson, Karin
    et al.
    Beijer, Elisabeth
    Bengtsson, Staffan
    Hyvönen, Ulf
    Karlsson, Per-Åke
    University of Borås, School of Health Science.
    Nyman, Marie
    Producing and consuming knowledge in social work practice: research and development activities in a Swedish context2009In: Evidence & Policy: A Journal of Research, Debate and Practice, ISSN 1744-2648, E-ISSN 1744-2656, Vol. 5, no 2, 127-139 p.Article in journal (Refereed)
    Abstract [en]

    The aim of this article is to describe how experince-based knowledge can be made visible by giving some examples of how this has been done in Swedish social welfare services, in collaborations between social services agencies and research and development (R&D) units. These examples will be linked to theories and discussed in relation to different research utilisation models. By using one of these models, it is argued that R&D activities can broaden the concept of evidence-based practice and help brigde the gap between research and pracice.

  • 15. Alexandersson, Karin
    et al.
    Beijer, Elisabeth
    Hyvönen, Ulf
    Karlsson, Per-Åke
    University of Borås, School of Health Science.
    Marklund, Kristin
    Let´s Come Together: A Macro-Oriented Model for Organizing the Support o EBP2012In: Implementing Evicence-Informed Practice. International Perspectives / [ed] Kathrine Dill, Wes Shera, Canadian Scholars' Press , 2012, 156-169 p.Chapter in book (Refereed)
    Abstract [en]

    In this chapter a macro oriented model for understanding what is needed to develope EBP in socialt welfare work is developed and illustrated.

  • 16. Alexandersson, Karin
    et al.
    Hyvönen, Ulf
    Karlsson, Per-Åke
    University of Borås, School of Health Science.
    Larsson, Ann-Marie
    Supporting user involvement in child welfare work: a way of implementing evidence-based practice2014In: Evidence & Policy: A Journal of Research, Debate and Practice, ISSN 1744-2648, E-ISSN 1744-2656, Vol. 10, no 4, 541-554 p.Article in journal (Refereed)
    Abstract [en]

    The articel describes and analyses some preliminary working methods for user involvement in child welfare. The models are based on the results of a national project in Sweden where children and young peple have been involved as informants. How experiences and viewpoints from children and young people can be a source of knowledge in child welfare organisatiions is one of the main questions. The performance and the results of the project are analysed in relaton to a theoretical macro-oriented model created to illustrate the need for different kinds of knowledge in supporting the implementation of an evidence-based practice.

  • 17. Alfvén, Gösta
    et al.
    Caverius, Ulla
    Nilsson, Stefan R
    University of Borås, School of Health Science.
    Smärta hos barn och ungdomar ett eftersatt område2012In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 109, no 19, 966-967 p.Article in journal (Refereed)
    Abstract [sv]

    En enkät om organisationen av omhändertagandet av akut och återkommande smärta hos barn har besvarats av 26 av landets 34 barnkliniker. Drygt en tredjedel av dessa har organiserad verksamhet för akut och/eller långvarig smärta. En femtedel av barnklinikerna har en verksamhet som är specifikt organiserad för barn. Flertalet av dessa mottagningar är bemannade med deltidsarbetande personal. Endast två läkare och fyra sjuksköterskor arbetar heltid med dessa frågor, och antalet psykologer och sjukgymnaster är begränsat.

  • 18. Almerud, S
    et al.
    Alapack, R.J.
    Fridlund, Bengt
    Växjö University.
    Ekebergh, Margaretha
    University of Borås, School of Health Science.
    Caught in an Artificial Split: A Phenomenological Study of Being a Caregiver in the Technologically Intense Environment2007In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 24, no 2, 130-136 p.Article in journal (Refereed)
    Abstract [en]

    A symbiotic relationship exists between technology and caring, however, technologically advanced environments challenge caregivers. The aim of this study is to uncover the meaning of being a caregiver in the technologically intense environment. Ten open-ended interviews with intensive care personnel comprise the data. A phenomenological analysis shows that ambiguity abounds in the setting. The act of responsibly reading and regulating instruments easily melds the patient and the machinery into one clinical picture. The fusion skews the balance between objective distance and interpersonal closeness. The exciting captivating lure of technological gadgets seduces the caregivers and lulls them into a fictive sense of security and safety. It is mind-boggling and heart-rending to juggle ‘moments’ of slavish mastery and security menaced by insecurity in the act of monitoring a machine while caring for a patient. Whenever the beleaguered caregiver splits technique from human touch, ambiguity decays into ambivalence. Caring and technology become polarized. Everyone loses. Caregiver competence wanes; patients suffer. The intensive care unit should be technologically sophisticated, but also build-in a disclosive space where solace, trust, and reassurance naturally happen. Caring professionals need to balance state-of-the-art technology with integrated and comprehensive care and harmonize the demands of subjectivity with objective signs.

  • 19. Anderberg, Patrice
    et al.
    Lepp, Margret
    University of Borås, School of Health Science.
    Berglund, AL
    Segesten, Kerstin
    University of Borås, School of Health Science.
    Preserving dignity in caring for older adults: a concept analysis2007In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 59, no 6, 635-643 p.Article in journal (Refereed)
    Abstract [en]

    AIM: This paper is a report of a concept analysis of the meaning of preserving dignity. BACKGROUND: Preserving dignity, especially when caring for older adults, is essential when giving nursing care. There is a lack of clarity about what kinds of caring activities lead to preserved dignity. METHOD: Data were collected using several databases (CINAHL, Age Info, Libris, Medline, Pub Med, Psyc INFO and Blackwell Synergy) covering the years 1990-2005. The keywords used were 'dignity', 'human dignity', 'preserving dignity', 'elderly', 'aged', combined with 'patients/persons', 'caring relation' and 'nursing'. The analysis covered 53 articles, dissertations, reports and textbooks. FINDINGS: Dignity may be defined as a concept that relates to basic humanity. Dignity consists of inherent and external dimensions, which are common for all humans and at the same time are unique for each person, relating to social and cultural aspects. The attributes of preserving dignity are individualized care, control restored, respect, advocacy and sensitive listening. Antecedents are professional knowledge, responsibility, reflection and non-hierarchical organization. The consequences are strengthening life spirit, an inner sense of freedom, self-respect and successful coping. CONCLUSION: Preserving an older adult's dignity is complex. By using the attributes in, for example, nursing documentation, the action and value of preserving dignity could be made visible as a professional nursing activity.

  • 20.
    Andersson, Eva-Lotta
    University of Borås, School of Health Science.
    Vad gör tidigare medarbetare vid Äldre Väst Sjuhärad (ÄVS) nu och vad betydde uppdraget vid ÄVS?2009Report (Other academic)
  • 21.
    Andersson, Eva-Lotta
    et al.
    University of Borås, School of Health Science.
    Alth, Camilla
    Uppföljning av Informationsarbetet vid Äldreväst Sjuhärad2009Report (Other academic)
  • 22.
    Andersson, Eva-Lotta
    et al.
    University of Borås, School of Health Science.
    Karlsson, Per-Åke
    University of Borås, School of Health Science.
    ÄldreVäst Sjuhärad: Sju år av FoU-arbete. Del 1. En beskrivning och några värderande självreflektioner. Mars 2007.2007Report (Other academic)
    Abstract [sv]

    ÄldreVäst Sjuhärad (ÄVS) startade 1 november 1999 som en FoU-enhet inom äldreområdet. ÄVS var en av flera enheter som fick statligt etableringsstöd via Socialstyrelsen. Denna statliga satsning, ett pågående projekt vid Institutionen vårdhögskolan1 – ACTION2-projektet samt lokala önskemål från kommunerna i Sjuhärad och Västra Götalandsregionen om FoU inom äldreområdet var förklaringar till centrats etablering. Syftet med följande dokument är att sammanfatta den nu sjuåriga verksamhetsperioden, ge underlag för självreflektion och självvärdering samt utgöra ett underlag för den externa utvärdering som nyligen påbörjats. Som ett underlag för en samlad utvärdering av ÄVS kommer dessutom inom någon månad att föreligga en uppföljning av ”Vart tar tidigare ÄVS-medarbetare vägen?” liksom en uppföljning av ÄVS kommunikationsansträngningar. Denna text är skriven ur ett ”inifrånperpektiv” av projektledningen och där Eva-Lotta Andersson och Per-Åke Karlsson svarat för det huvudsakliga arbetet med texten. Som underlagsmaterial har använts verksamhetsberättelser inklusive bokslut, ekonomiska rapporter samt aktivitetsförteckningar. Till det kommer givetvis erfarenheter och minnesbilder. Projektledningens manus har diskuterats, korrigerats och kompletterats av medarbetarna vid ÄVS vid ett internt FoU-seminarium. Som en del två av denna (själv)värdering kommer att redovisas en enkätundersökning där ÄVS medarbetare värderar kvalitet utifrån olika aspekter. ÄVS sjuåriga historia kan grovt indelas i tre faser: En första fas, från slutet av 1999 t o m 2002 innebar uppbyggnad och etablering inom äldreområdet i Sjuhärad, bl.a. via fem programområden. En andra fas pågick under åren 2003 och 2004, utan programområden men med fortsatt avgränsning till äldrefrågor. En tredje fas, som pågår från år 2005, innebär en utvidgning till funktionshinder men fortfarande med betoning på äldre människor. Föreliggande framställning kommer att följa dessa faser under de två följande avsnitten. Närmast följer ett avsnitt om ÄVS målsättning, organisation och resurser. Därnäst följer en beskrivning av verksamhetens projekt och andra aktiviteter. På det följer en redovisning av de resultat som uppnåtts – den produktion som kan redovisas i form av skrifter, seminarier, konferenser m.m.Avslutningsvis följer en kort självvärdering i ljuset av målsättning och den miljö som ÄVS haft och har att verka i.

  • 23.
    Andersson Hagiwara, Magnus
    et al.
    University of Borås, School of Health Science.
    Kängström, Anna
    University of Borås, School of Health Science.
    Jonsson, Anders
    University of Borås, School of Health Science.
    Lundberg, Lars
    University of Borås, School of Health Science.
    Effect of Simulation on the Clinical Competence of Swedish Ambulance Nurses2014In: Australasian Journal of Paramedicine, ISSN 2202-7270, Vol. 11, no 2, 1-7 p.Article in journal (Refereed)
    Abstract [en]

    ntroduction Simulation has become an established method for education and training of Emergency Medical Services personnel in different skills such as advanced airway techniques, also in evaluation and initial care of stroke patients and in pre - hospital trauma. Simula tion can be a useful method to improve learning. To our knowledge, there are only a few studies that relate simulation to the effect on clinical skills. The aim of the present study was to investigate the effect of simulation on the clinical competence in a pre - hospital trauma care course for ambulance nurses. Methods The study was performed using a before - after design. Seventeen ambulance nurse students who participated in a trauma care course were evaluated in two simulated trauma cases. All subjects had passed the initial theoretical part of the course. The pre - test was performed in the beginning of the following part of the course involving simulation and the post - test at the end of the course. The analysis was performed by assessment of performance, as seen on video - tapes from the pre - tests and the post - tests. A validated instrument was used to determine the level of student’ s clinical competence. Paired t - test was used to confirm differences between the pre - test and post - test results . Results There was a significant increase in the over - all results for the post - test, with a difference of 1.12 points (t=4.642, df=16, p= 0.001) Situation Awareness, Patient Assessment and Decision Making showed the most pronounced improvements. Conclusion The results imply t hat simulation in addition to traditional theoretical education improves the clinical competence of the students, in comparison to traditional education and training without any significant amount of simulation.

  • 24.
    Andersson Hagiwara, Magnus
    et al.
    University of Borås, School of Health Science.
    Suserud, Björn-Ove
    University of Borås, School of Health Science.
    Andersson-Gare, Boel
    Sjöqvist, Bengt-Arne
    Henricson, Maria
    Jonsson, Anders
    University of Borås, School of Health Science.
    The effect of a Computerised Decision Support System (CDSS) on compliance with the prehospital assessment process: results of an interrupted time-series study2014In: BMC Medical Informatics and Decision Making, ISSN 1472-6947, E-ISSN 1472-6947, Vol. 14, no 70Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:Errors in the decision-making process are probably the main threat to patient safety in the prehospital setting. The reason can be the change of focus in prehospital care from the traditional "scoop and run" practice to a more complex assessment and this new focus imposes real demands on clinical judgment. The use of Clinical Guidelines (CG) is a common strategy for cognitively supporting the prehospital providers. However, there are studies that suggest that the compliance with CG in some cases is low in the prehospital setting. One possible way to increase compliance with guidelines could be to introduce guidelines in a Computerized Decision Support System (CDSS). There is limited evidence relating to the effect of CDSS in a prehospital setting. The present study aimed to evaluate the effect of CDSS on compliance with the basic assessment process described in the prehospital CG and the effect of On Scene Time (OST).METHODS:In this time-series study, data from prehospital medical records were collected on a weekly basis during the study period. Medical records were rated with the guidance of a rating protocol and data on OST were collected. The difference between baseline and the intervention period was assessed by a segmented regression.RESULTS:In this study, 371 patients were included. Compliance with the assessment process described in the prehospital CG was stable during the baseline period. Following the introduction of the CDSS, compliance rose significantly. The post-intervention slope was stable. The CDSS had no significant effect on OST.CONCLUSIONS:The use of CDSS in prehospital care has the ability to increase compliance with the assessment process of patients with a medical emergency. This study was unable to demonstrate any effects of OST.

  • 25.
    Andersson, Henrik
    University of Borås, School of Health Science.
    Medikaliserat och resultatstyrt vårdarbete på akutmottagning: en studie med utgångspunkt i medarbetares och chefers perspektiv2014Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overall aim of this thesis is to obtain an understanding of Emergency Healthcare Work (EHW) at the Emergency Department (ED), including the competencies required by EHW, and based on practitioners' and managers' perspectives. Methods: In study I, a quantitative method was employed. A questionnaire was sent to all Swedish EDs and data was analysed using descriptive statistics and content analysis. In studies II- IV, qualitative methods were used. In study II, participant observations and individual and group interviews were conducted. In studies III-IV individual and group interviews were conducted. In studies II-IV, data was analysed using qualitative content analysis. Results: According to head nurses, basic nursing education does not lead to sufficient competence for working at an ED and thus supplementary formal education is needed. A minority of head nurses perceive that they are completely responsible for creating preconditions for competence development (study I). The EHW is characterized by rapid, brief and standardized encounters with limited scope for providing individualized care. Practitioners strive to be adaptable by structuring EHW and they cooperate to achieve a good workflow (study II). Management is characterized by a command and control approach. Managers experience EHW as lifesaving work and they experience difficulties in meeting the expectations of their staff (study III). There is also tension between professional groups in EDs as well as hierarchical boundaries that influence the possibilities to develop competencies in EHW. The focus on competence in EHW is on account of the emergency and lifesaving nature of its actions. Purely medical competencies are valued and caring competencies are subsequently downgraded. A medical competence approach consolidates the current view of competencies necessary in everyday work in EDs (study IV). Conclusions: EHW and the competencies required by EHW are defined from a purely medicalized and result-driven viewpoint. Patients' medical needs are given greater importance than their caring needs. Medicalized and result-driven EHW makes it difficult to provide individualized care. This difficulty is a hindrance to the implementation of a holistic view in EHW.

  • 26.
    Andersson, Henrik
    et al.
    University of Borås, School of Health Science.
    Jakobsson, E
    Furåker, C
    Nilsson, K
    The everyday work at a Swedish emergency department: The practitioners’ perspective2012In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 20, no 2, 58-68 p.Article in journal (Refereed)
    Abstract [en]

    In the everyday work at emergency departments (EDs), the patients being cared for have different needs and perceived symptoms. To meet their need for emergency care, knowledge of the work is important. The aim of this study is to explore the everyday work at a Swedish ED from a practitioner’s perspective. Method This study has a qualitative, exploratory design with observations and interviews at two EDs. Data were analysed by content analysis. Findings The everyday work is characterised by a rapid, short and standardised encounter with limited scope to provide individualised care, which leads to a mechanical approach. It is also characterised by an adaptive approach in which practitioners strive to be adaptable by structuring everyday work and cooperation to achieve a good workflow. Conclusions The study shows that the practitioners’ encounter with patients and relatives is rapid and of limited duration. The care activities that practitioners mainly perform comprise standard medical management and are performed more mechanically than in a caring way. The practitioners strive to balance the requirements and the realisation of the everyday work through structures and in cooperation with other practitioners, although they work more in parallel than in integrated teams.

  • 27.
    Andersson, Henrik
    et al.
    University of Borås, School of Health Science.
    Wireklint Sundström, Birgitta
    University of Borås, School of Health Science.
    Nilsson, Kerstin
    Jakobsson Ung, Eva
    Competencies in Swedish emergency departments: The practitioners’ and managers’ perspective2014In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 22, no 2, 81-87 p.Article in journal (Refereed)
    Abstract [en]

    The task of emergency departments (EDs) is to provide safe emergency healthcare while adopting a caring, cost-effective approach. Patients attending EDs have different medical and caring needs and it is assumed that practitioners have the requisite competencies to meet those needs. The aim of the present study is to explore what kind of competencies practitioners and managers describe as necessary for the practitioners to perform their everyday work in EDs. Methods: This study used a qualitative, exploratory design. Interviews were conducted in two EDs. Data were analysed using inductive content analysis. Results: The competence focus in everyday work in EDs is on emergency and life-saving actions. There is a polarisation between medical and caring competencies. There is also tension between professional groups in EDs as well as hierarchical boundaries that influence the ability to develop competencies in everyday work. Medical competencies are valued more and caring competencies are subsequently downgraded. A medical approach to competencies consolidates the view of necessary competencies in everyday work in EDs. Conclusions: The study shows that the competencies that are valued consolidate the prevailing medical paradigm. There is a traditional, one-sided approach to competencies, a hierarchical distinction between professional groups and unclear occupational functions.

  • 28.
    Andersson, Henrik
    et al.
    University of Borås, School of Health Science.
    Wireklint Sundström, Birgitta
    University of Borås, School of Health Science.
    Nilsson, Kerstin
    Jakobsson Ung, Eva
    Management of everyday work in Emergency Departments: An exploratory study with Swedish Managers2014In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 22, no 4, 81-87 p.Article in journal (Refereed)
    Abstract [en]

    Introduction: Through their formal mandate, position and authority, managers are responsible for managing everyday work in Emergency Departments (EDs) as well as striving for excellence and dealing with the individual needs of practitioners and patients. The aim of the present study is to explore managers’experiences of managing everyday work in Swedish EDs. Method: A qualitative and exploratory design has been used in this study. Seven managers were interviewed at two EDs. Data was analysed using qualitative content analysis with focus on latent content. Results: Managers experience everyday work in the ED as lifesaving work. One of the characteristics of their approach to everyday work is their capability for rapidly identifying patients with life-threatening conditions and for treating them accordingly. The practitioners are on stand-by in order to deal with unexpected situations. This implies having to spend time waiting for the physicians’ decisions. Management is characterised by a command and control approach. The managers experience difficulties in meeting the expectations of their staff. They strive to be proactive but instead they become reactive since the prevailing medical, bureaucratic and production-orientated systems constrain them. Conclusion: The managers demonstrate full compliance with the organisational systems. This threatens to reduce their freedom of action and influences the way they perform their managerial duties within and outside the EDs.

  • 29.
    Andersson, Kerstin
    University of Borås, School of Health Science.
    Omvårdnad och trygghet: en metateoretisk och en fenomenologisk studie1984Doctoral thesis, monograph (Other academic)
  • 30. Andersson, L
    et al.
    Petersen, G
    Johnson, P
    Ståhl, Fredrik
    University of Borås, School of Health Science.
    A web tool for finding gene candidates associated with experimentally induced arthritis in rat2005In: Arthritis Research & Therapy, ISSN 1478-6354, E-ISSN 1478-6362, Vol. 7, no 3, R485-R492 p.Article in journal (Refereed)
    Abstract [en]

    Rat models are frequently used for finding genes contributing to the arthritis phenotype. In most studies, however, limitations in the number of animals result in a low resolution. As a result, the linkage between the autoimmune experimental arthritis phenotype and the genomic region, that is, the quantitative trait locus, can cover several hundred genes. The purpose of this work was to facilitate the search for candidate genes in such regions by introducing a web tool called Candidate Gene Capture (CGC) that takes advantage of free text data on gene function. The CGC tool was developed by combining genomic regions in the rat, associated with the autoimmune experimental arthritis phenotype, with rat/human gene homology data, and with descriptions of phenotypic gene effects and selected keywords. Each keyword was assigned a value, which was used for ranking genes based on their description of phenotypic gene effects. The application was implemented as a web-based tool and made public at http://ratmap.org/cgc. The CGC application ranks gene candidates for 37 rat genomic regions associated with autoimmune experimental arthritis phenotypes. To evaluate the CGC tool, the gene ranking in four regions was compared with an independent manual evaluation. In these sample tests, there was a full agreement between the manual ranking and the CGC ranking for the four highest-ranked genes in each test, except for one single gene. This indicates that the CGC tool creates a ranking very similar to that made by human inspection. The exceptional gene, which was ranked as a gene candidate by the CGC tool but not in the manual evaluation, was found to be closely associated with rheumatoid arthritis in additional literature studies. Genes ranked by the CGC tools as less likely gene candidates, as well as genes ranked low, were generally rated in a similar manner to those done manually. Thus, to find genes contributing to experimentally induced arthritis, we consider the CGC application to be a helpful tool in facilitating the evaluation of large amounts of textual information.

  • 31. Andersson, L
    et al.
    Petersen, G
    Johnson, P
    Ståhl, Fredrik
    University of Borås, School of Health Science.
    Finding genes contributing to the arthirits phenotype by comparing rat and human genome data2004In: Health Informatics Journal, ISSN 1460-4582, E-ISSN 1741-2811, Vol. 10, no 1, 71-75 p.Article in journal (Refereed)
    Abstract [en]

    Published quantitative trait locus (QTL) data, as well as all known rat genes and DNA markers, have since 1993 been collected and made easily accessible at the rat genome database, RatMap. The objective of the present study is to fully integrate available data concerning rat models with human genome information. The final goal of this process is to make results from any rat model experiment directly applicable to humans. The overall goal of this work is to create an automatic system which, for any given rat chromosomal region associated with a QTL, will characterize both mapped rat genes and all putative homologous human genes in that region. This article reports the use of the web application to find human gene candidates contributing to an arthritis phenotype.

  • 32. Andersson, L
    et al.
    Ståhl, Fredrik
    University of Borås, School of Health Science.
    Candidate Gene Capture (CGC): a Tool for Selecting Potentially2007Conference paper (Other academic)
  • 33. Andersson, L
    et al.
    Ståhl, Fredrik
    University of Borås, School of Health Science.
    Distribution of candidate genes for experimentally induced arthritis in rats2010In: BMC Genomics, ISSN 1471-2164, E-ISSN 1471-2164, Vol. 11, no 146Article in journal (Refereed)
    Abstract [en]

    Background: Rat models are frequently used to link genomic regions to experimentally induced arthritis in quantitative trait locus (QTL) analyses. To facilitate the search for candidate genes within such regions, we have previously developed an application (CGC) that uses weighted keywords to rank genes based on their descriptive text. In this study, CGC is used for analyzing the localization of candidate genes from two viewpoints: distribution over the rat genome and functional connections between arthritis QTLs. Methods: To investigate if candidate genes identified by CGC are more likely to be found inside QTLs, we ranked 2403 genes genome wide in rat. The number of genes within different ranges of CGC scores localized inside and outside QTLs was then calculated. Furthermore, we investigated if candidate genes within certain QTLs share similar functions, and if these functions could be connected to genes within other QTLs. Based on references between genes in OMIM, we created connections between genes in QTLs identified in two distinct rat crosses. In this way, QTL pairs with one QTL from each cross that share an unexpectedly high number of gene connections were identified. The genes that were found to connect a pair of QTLs were then functionally analysed using a publicly available classification tool. Results: Out of the 2403 genes ranked by the CGC application, 1160 were localized within QTL regions. No difference was observed between highly and lowly rated genes. Hence, highly rated candidate genes for arthritis seem to be distributed randomly inside and outside QTLs. Furthermore, we found five pairs of QTLs that shared a significantly high number of interconnected genes. When functionally analyzed, most genes connecting two QTLs could be included in a single functional cluster. Thus, the functional connections between these genes could very well be involved in the development of an arthritis phenotype. Conclusions: From the genome wide CGC search, we conclude that candidate genes for arthritis in rat are randomly distributed between QTL and non-QTL regions. We do however find certain pairs of QTLs that share a large number of functionally connected candidate genes, suggesting that these QTLs contain a number of genes involved in similar functions contributing to the arthritis phenotype.

  • 34. Andersson, Lars
    et al.
    Petersen, Greta
    Ståhl, Fredrik
    University of Borås, School of Health Science.
    Ranking candidate genes in rat models of type 2 diabetes2009In: Theoretical Biology Medical Modelling, ISSN 1742-4682, E-ISSN 1742-4682, Vol. 6, no 12Article in journal (Refereed)
    Abstract [en]

    Background Rat models are frequently used to find genomic regions that contribute to complex diseases, so called quantitative trait loci (QTLs). In general, the genomic regions found to be associated with a quantitative trait are rather large, covering hundreds of genes. To help selecting appropriate candidate genes from QTLs associated with type 2 diabetes models in rat, we have developed a web tool called Candidate Gene Capture (CGC), specifically adopted for this disorder. Methods CGC combines diabetes-related genomic regions in rat with rat/human homology data, textual descriptions of gene effects and an array of 789 keywords. Each keyword is assigned values that reflect its co-occurrence with 24 different reference terms describing sub-phenotypes of type 2 diabetes (for example "insulin resistance"). The genes are then ranked based on the occurrences of keywords in the describing texts. Results CGC includes QTLs from type 2 diabetes models in rat. When comparing gene rankings from CGC based on one sub-phenotype, with manual gene ratings for four QTLs, very similar results were obtained. In total, 24 different sub-phenotypes are available as reference terms in the application and based on differences in gene ranking, they fall into separate clusters. Conclusion The very good agreement between the CGC gene ranking and the manual rating confirms that CGC is as a reliable tool for interpreting textual information. This, together with the possibility to select many different sub-phenotypes, makes CGC a versatile tool for finding candidate genes. CGC is publicly available at http://ratmap.org/CGC.

  • 35.
    Andersson, L-O
    et al.
    External.
    Lundberg, Lars
    University of Borås, School of Health Science.
    Education in Military Medicine: The Swedish Model2005In: AMEE 2005 Abstracts, AMEE , 2005, 235- p.Conference paper (Refereed)
    Abstract [en]

    The Swedish Armed Forces Medical Centre is nationally responsible for the qualified education in military medicine. Studies at university level for conscript medical personnel were introduced in 1997, with the course Battlefield emergency care for nurses (7,5 ECTS points). Two years later, a parallel course for physicians was started. Other courses have also been studied at university level. Starting in 2001, a total of fifteen units throughout the country have arranged the Basic course in battlefield emergency care for Medical Orderly (15 ECTS points). The units have received academic support from local colleges and universities, while curriculum, study literature, supervision and examination have been the responsibility of the Armed Forces Medical Centre. The present reorganisation of the Swedish Armed Forces will result in a situation where the entire military medical education will be located in Gothenburg. Physicians, nurses and medics will be educated at the same campus. A close connection to the University of Gothenburg has been established, in order to promote the educational process of military medicine. Teachers at the Medical Centre will have positions as lecturers at the university, which will be favourable for the students in their acquisition of knowledge.

  • 36. Andersson, Sten-Ove
    et al.
    Lundberg, Lars
    University of Borås, School of Health Science.
    Jonsson, Anders
    University of Borås, School of Health Science.
    Tingström, Pia
    Abrandt Dahlgren, Madeleine
    Interaction, Action, and Reflection: How Medics Learn Medical Care in the Swedish Armed Forces2013In: Military medicine, ISSN 0026-4075, E-ISSN 1930-613X, Vol. 178, no 8, 861-866 p.Article in journal (Refereed)
    Abstract [en]

    The objective of this study is to examine how medics within the Swedish Armed Forces perceive their learning outcome following military prehospital training. A qualitative study with a phenomenographic approach was used to investigate how learning is perceived among military medics. At meta level, the results can be viewed as an interaction, i.e., being able to collaborate in the medical platoon, including the ability to interact within the group and being able to lead; an action, i.e., being able to assess and treat casualties, including the ability to communicate with the casualty, to prioritize, and to be able to act; and a reflection, i.e., having confidence in one's own ability in first aid, including being prepared and feeling confident. interaction during the period of education is important for learning. action, being able to act in the field, is based on a drill in which the subject progresses from simple to complex procedures. reflection, learning to help others, is important for confidence, which in turn creates preparedness, thereby making the knowledge meaningful.

  • 37. Andreasson, J
    et al.
    Jonsson, A
    Suserud, Björn-Ove
    University of Borås, School of Health Science.
    Åström, S
    Ambulance personnel should take pictures at the sites of accidents!2001In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 26-27, no 98, 3162-3163 p.Article in journal (Other academic)
    Abstract [sv]

    Bror Gårdelöf och Thomas Blomberg ställer i Läkartidningen 8/01 (sidorna 856-8) frågan om vem som skall fotografera på olycksplats. Per Örtenwall ifrågasätter i Läkartidningen 15/01 (sidorna 1825-6) om olyckan överhuvudtaget skall fotograferas. Författarna är sedan ett år verksamma i ett av de forskningsprojekt i Västra Götalandsregionen som Per Örtenwall nämner. Syftet är att utröna om bilder tagna på olycksplats tillför patienten och vården något av värde.

  • 38.
    Andreasson, Jörgen
    et al.
    University of Borås, School of Health Science.
    Eriksson, Andrea
    Dellve, Lotta
    University of Borås, School of Health Science.
    Health care manager’s views on and approaches to implementing models for care processes.2014Conference paper (Refereed)
  • 39. Andrews, RA
    et al.
    Austin, C
    Brown, R
    Chen, YZ
    Engindeniz, Z
    Girouard, R
    Leaman, P
    Masellis, M
    Nakayama, S
    Polentsov, YO
    Suserud, Björn-Ove
    University of Borås, School of Health Science.
    Sharing international experiences in disasters: summary and action plan2001In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 16, no 1, 42-45 p.Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: The discussions in this theme provided an opportunity to share specific experiences with disasters that occurred outside of the Asia-Pacific Rim. METHODS: Details of the methods used are provided in the preceding paper. The chairs moderated all presentations and produced a summary that was presented to an assembly of all of the delegates. Since the findings from the Theme 7 and Theme 3 groups were similar, the chairs of both groups presided over one workshop that resulted in the generation of a set of action plans that then were reported to the collective group of all delegates. RESULTS: The main points developed during the presentations and discussion included: (1) disaster response planning, (2) predetermined command and organizational structure, (3) rapid response capability, (4) mitigation, and (5) communications and alternatives. DISCUSSION: The action plans presented are in common with those presented by Theme 3, and include: (1) plan disaster responses including the different types, identification of hazards, training based on experiences, and provision of public education; (2) improving coordination and control; (3) maintaining communications assuming infrastructure breakdown; (4) maximizing mitigation through standardized evaluations, creation of a legal framework, and recognition of advocacy and public participation; and (5) providing resources and knowledge through access to existing therapies, using the media, and increasing decentralization of hospital inventories. CONCLUSIONS: Most of the problems that occurred outside the Asia-Pacific rim relative to disaster management are similar to those experienced within it. They should be addressed in common with the rest of the world.

  • 40. Apell, Jeanette
    et al.
    Paradi, Rikard
    Kokinsky, Eva
    Nilsson, Stefan R
    University of Borås, School of Health Science.
    Mätning av barns oro vid undersökning eller behandling på sjukhus: en studie som utvärderar short STAI2011In: Vård i Norden, ISSN 0107-4083, E-ISSN 1890-4238, Vol. 31, no 1, 45-47 p.Article in journal (Refereed)
    Abstract [en]

    Purpose: The purpose was to investigate the validity and reliability of short STAI (State-Trait Anxiety Inventory) for measuring children's anxiety in connection with procedures in hospital. Background: The children´s level of anxiety during hospitalization can cause problems and it should be evaluated with a valid and reliable instrument. STAIC-S (STAI for children) has previously been validated in children for this purpose but may be too complex to use. Short STAI has only been evaluated in adults and should be tested in children before it can be used. Methods: Children aged five to 16 filled in both STAIC-S and short STAI before and after an examination or treatment at the hospital. Results: Twenty children were included. Satisfactory internal reliability was found for short STAI with Cronbachs’s alpha 0.82. Correlation coefficients between the instruments were 0.88 before and 0.75 after the procedure. Significantly lower values were found after compared to before demonstrating constructive validity. Short STAI was easy to fill in but seven of 16 participants received help from their parents. Conclusion: Short STAI was shown to be a reliable and valid instrument for measuring anxiety in children, but a larger study is needed to confirm the validity and reliability further

  • 41. Arman, Rebecka
    et al.
    Wikström, Ewa
    Dellve, Lotta
    University of Borås, School of Health Science.
    Structuration in Managerial Communication Processes2012In: Offentlig Förvaltning. Scandinavian Journal of Public Administration, ISSN 2000-8058, E-ISSN 2001-3310, Vol. 16, no 2, 143-163 p.Article in journal (Refereed)
    Abstract [en]

    The aim of this article is to describe and analyse observed managerial communication. The research questions concerned: What characterizes managerial communication practices and the organizational consequences? We make use of structuration theory and view communication as a social interaction process in which temporary structures are negotiated. Ten first- and second-line managers were shadowed. The managers used a combination of structuration of caring, interdependency and accountability typical of health care organizations. The communication practices were related to how new norms of reputation management were institutionalized through structuration. The types of structuration were sometimes contradictory and productive communication was rare or non-existent. The managerial communication practices had consequences for the power and domination and for which issues were signified as part of the agenda. The conclusions can be generalizable to other professional organizations.

  • 42. Aronsson, Kenneth
    et al.
    Björkdahl, Ida
    Wireklint Sundström, Birgitta
    University of Borås, School of Health Science.
    Prehospital emergency care for patients with suspected hip fractures after falling: older patients’ experiences2014In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 23, no 21-22, 3115-3123 p.Article in journal (Refereed)
    Abstract [en]

    Aims and objectives: The aim of this study was to describe and explain elderly patients’ lived experiences of prehospital emergency care in cases of suspected hip fractures after falling. Background: Hip fractures represent a major health problem for older people and are a common assignment for the Emergency Medical Services (EMS), but there is little information on how patients experience prehospital emergency care. Design: A reflective lifeworld approach based on phenomenological epistemology was used in an interview study within the context of healthcare science. Methods: Ten elderly patients were interviewed. These depth interviews were tape-recorded, transcribed verbatim and analysed for meanings. Results: The comprehensive understanding of the phenomenon is: ‘Happy to have been rescued, despite bad experiences as well as good’. The elderly patient is offered care in an open and friendly atmosphere concurrently with feeling anxiety about the treatment. Intervention with streamlined care and treatment can thus simultaneously be beneficial as well as doing harm. Patients experience confusion and the need to ask questions about what really happened in the ambulance. Bad experiences remain unexplained. This study is based on three themes with relevant sub-themes: efficiency, concerned encounters and suffering from care. Conclusions: Our study contribute to this field of discussion, showing that administering drugs which cause side effects in already fragile older people is compatible with neither evidence-based care nor evidenced-based medicine. The side effects of pain relief – however efficient that pain relief may be – are taken seriously. Relevance to clinical practice: Pain relief in the EMS should be individualised. Responsibility for patients’ safety regarding pain relief is emphasised. This development should focus on care that is already good and gradually eradicate compassionless care. Keywords: caring science, hip fracture, lived experiences, phenomenology, emergency medical services, ambulance, care pathway, prehospital emergency nurse

  • 43. Atefi, Seyed Reza
    et al.
    Seoane, Fernando
    University of Borås, School of Health Science.
    The Emergence of Electrical Bioimpedance Monitoring for Prompt Detection of Stroke Damage2014Conference paper (Refereed)
  • 44. Aune, S
    et al.
    Karlsson, T
    Herlitz, Johan
    University of Borås, School of Health Science.
    Evaluation of 2 different instruments for exposing the chest in conjunction with a cardiac arrest2010In: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 29, no 5, 549-553 p.Article in journal (Refereed)
    Abstract [en]

    Background Time between onset of previous termcardiac arrestnext term and start of treatment is of ultimate importance for outcome. The length of time it takes to expose the previous termchestnext term in out-of-hospital previous termcardiac arrestnext term (OHCA) is not known. We aimed to compare the time from onset of OHCA until the time at which the previous termchestnext term was exposed using previous termanext term new device (S-CUT; ES Equipment, Gothenburg, Sweden) and previous termanext term pair of scissors. Methods In previous termanext term manikin study, the previous term2next term devices were compared in previous termanext term simulated previous termcardiac arrestnext term where the initial step was exposure of the previous termchest.next term The tests were performed using ambulance staff from 3 previous termdifferentnext term ambulance organizations in Western Sweden. Six previous termdifferentnext term types of clothing combinations were used. The primary choices of clothing for analyses were previous termanext term knitted sweater and shirt (indoors) and previous termanext term jacket with buttons, previous termanext term shirt, and previous termanext term college sweater (outdoors). Results The mean difference from onset of OHCA until the previous termchestnext term was exposed when S-CUT was compared with previous termanext term pair of scissors varied between 6 seconds (P = .006) and 63 seconds (P = .004; shorter with the S-CUT), depending on the type of clothing that was used. The mean differences for the clothing that was chosen for primary analyses were 23 and 63 seconds, respectively. Conclusion We found that previous termanext term new device (S-CUT) used for previous termexposing the chestnext term in OHCA was associated with previous termanext term marked shortening of procedure time as compared with previous termanext term pair of scissors.

  • 45.
    Axelsson, C
    et al.
    University of Borås, School of Health Science.
    Borgström, J
    Karlsson, T
    Axelsson, Å
    Herlitz, Johan
    University of Borås, School of Health Science.
    Dispatch codes of out-of-hospital cardiac arrest should be diagnosis related rather than symptom related2010In: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 17, no 5, 265-269 p.Article in journal (Refereed)
    Abstract [en]

    Objective: To describe the characteristics and outcome in out-of-hospital cardiac arrest (OHCA) in relation to (i) whether OHCA was coded by the dispatcher as a diagnosis or as a symptom and (ii) the delay until the first unit was alerted at the dispatch centre. Methods: OHCA patients in Göteborg, during 17 months, excluding OHCA after calling the rescue team. Results: Among 250 cases, 20% were coded as a diagnosis (i.e. CA) with or without ongoing cardiopulmonary resuscitation (CPR). Dispatch codes for the remaining 200 patients (80%) were mostly symptom related (unconsciousness in 61%, codes related to breathing problems in 10%, other codes in 24% and missing in 5%). Patients in whom the dispatchers coded the call as CA had an earlier start to CPR after collapse (median 2 vs. 10 min; P<0.0001) and a higher rate of bystander CPR (86% vs. 42%; P<0.0001). Furthermore, they tended to have a higher rate of survival to hospital discharge (14.0% vs. 6.5%; P  = 0.09). The median delay until the first unit was alerted was 1.8 min. Survival to hospital discharge was 10.0% if the delay was below median and 6.7% if the delay was above median (P = 0.48). Conclusion: Patients with OHCA who were not coded by dispatchers as such had a long delay to the start of CPR and a low survival. Dispatching according to diagnosis, that is, CA seems to improve these parameters most likely reflecting a more optimal communication between the dispatcher and the caller as well as the rescue team.

  • 46.
    Axelsson, C
    et al.
    University of Borås, School of Health Science.
    Herrera, MJ
    Fredriksson, M
    Lindqvist, J
    Herlitz, J
    University of Borås, School of Health Science.
    Implementation of mechanical chest compression in out-of-hospital carfdiac arrest in an emergency medical service system2013In: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 31, no 8, 1196-1200 p.Article in journal (Refereed)
    Abstract [en]

    AIM: The aim of this study is to describe the outcome changes after out-of-hospital cardiac arrest (OHCA) in Gothenburg, Sweden, after introduction of mechanical chest compression (MCC). METHODS: Following introduction of MCC, 1183 OHCA patients were treated from November 1, 2007, to December 31, 2011 (period 2). They were compared with 1218 OHCA patients before MCC was introduced from January 1, 1998, to May 30, 2003 (period 1). Patients in period 2 were evaluated for survival in relation to MCC use. RESULTS: The percentage of patients admitted to hospital alive increased from 25.4% to 31.9% (P < .0001). Survival to 1 month increased from 7.1% to 10.7% (P = .002) from period 1 to period 2. The proportion of ventricular fibrillation/ventricular tachycardia decreased in period 2 (P = .002). However, bystander cardiopulmonary resuscitation (P < .0001), crew-witnessed cases (P = .04), percutaneous coronary intervention (P < .0001), therapeutic hypothermia (P < .0001), and implantable cardioverter-defibrillator use (P = .01) increased, as did time from call to emergency medicine service arrival (P < .0001) and to defibrillation (P = .006). In period 2, 60% of OHCA patients were treated with MCC. The percentages admitted alive to hospital (MCC vs no MCC) were 28.6% and 36.1% (P = .008). Corresponding figures for survival to 1 month were 5.6% and 17.6% (P < .0001). In the MCC group, we found increase in the delay from collapse to defibrillation (P < .0001), greater use of adrenaline (P < .0001), and fewer crew-witnessed cases (P < .0001). CONCLUSION: Survival to 1 month after implementation of MCC was higher than before introduction. However, patients receiving MCC had low survival. Although case selection might play a role, results do not support a widespread use of MCC after OHCA.

  • 47.
    Axelsson, C
    et al.
    University of Borås, School of Health Science.
    Holmberg, S
    Axelsson, ÅB
    Herlitz, Johan
    University of Borås, School of Health Science.
    Passive leg raising during cardiopulmonary resuscitation in out-of-hospital cardiac arrest: Does it improve circulation and outcome?2010In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 81, no 12, 1615-1620 p.Article in journal (Refereed)
    Abstract [en]

    Background Passive leg raising (PLR), to augment the artificial circulation, was deleted from cardiopulmonary resuscitation (CPR) guidelines in 1992. Increases in end-tidal carbon dioxide (PETCO2) during CPR have been associated with increased pulmonary blood flow reflecting cardiac output. Measurements of PETCO2 after PLR might therefore increase our understanding of its potential value in CPR. We also observed the alteration in PETCO2 in relation to the return of spontaneous circulation (ROSC) and no ROSC. Methods and results The PETCO2 was measured, subsequent to intubation, in 126 patients suffering an out-of-hospital cardiac arrest (OHCA), during 15min or until ROSC. Forty-four patients were selected by the study protocol to PLR 35cm; 21 patients received manual chest compressions and 23 mechanical compressions. The PLR was initiated during uninterrupted CPR, 5min from the start of PETCO2 measurements. During PLR, an increase in PETCO2 was found in all 44 patients within 15s (p=0.003), 45s (p=0.002) and 75s (p=0.0001). Survival to hospital discharge was 7% among patients with PLR and 1% among those without PLR (p=0.12). Among patients experiencing ROSC (60 of 126), we found a marked increase in PETCO2 1min before the detection of a palpable pulse. Conclusion Since PLR during CPR appears to increase PETCO2 after OHCA, larger studies are needed to evaluate its potential effects on survival. Further, the measurement of PETCO2 could help to minimise the hands-off periods and pulse checks.

  • 48.
    Axelsson, C
    et al.
    University of Borås, School of Health Science.
    Jimenez, M
    Herlitz, J
    University of Borås, School of Health Science.
    PCI de Lucs. A safety and feasibility study on a pathway to the cath lab for patients with OHCA2014Conference paper (Refereed)
  • 49.
    Axelsson, Christer
    University of Borås, School of Health Science.
    Evaluation of various strategies to improve outcome after out-of-hospital cardiac arrest with particular focus on mechanical chest compressions2010Doctoral thesis, monograph (Other academic)
    Abstract [en]

    Cardiopulmonary resuscitation (CPR) skills vary among health care professionals. A previous study revealed that chest compressions were only performed half the time in out-of-hospital cardiac arrest (OHCA). Field conditions and fatigue could be possible explanations. The aim of this thesis was to study the impact of the introduction of mechanical chest compression in OHCA according to survival and its usability and b) passive leg raising (PLR), to augment the artificial circulation, during CPR. ... mer Methods: This thesis is based on a pilot study conducted in the Gothenburg/Mölndal and Södertälje Emergency Medical Service systems in 2003-2005. Witnessed OHCA (adult >18 years) received either mechanical (n=159) or manual (n=169) chest compressions. The pressure of end-tidal carbon dioxide (PETCO2) has been shown to correlate with cardiac output (CO) during CPR. To compare the effect of the different strategies, the PETCO2 was measured, during CPR, with standardised ventilation. Result: PLR during CPR increased the PETCO2 value within 30 seconds. Mechanical active compression-decompression (ACD) CPR, compared with manual compressions, produced the highest mean of initial, minimum and average values of PETCO2. However, mechanical chest compressions did not appear to result in improved survival. Clinical circumstances such as unidentified cardiac arrests (CAs) resulted in a large drop-out in the intervention group or a late start to the intervention in relation to CA. The late start meant that the intervention targeted a high-risk population with a low chance of survival. The majority of identified CAs were coded by the Rescue Co-ordination Centre (RCC) according to symptoms (usually unconsciousness), while the minority were coded according to the diagnosis of CA. Patients coded according to the diagnosis of CA had an earlier start of CPR, a higher rate of bystander CPR and a tendency toward higher survival rates. Conclusion: Since PLR during CPR appears to improve circulation after OHCA, larger studies are needed to evaluate its potential effects on survival. Compared with manual compressions, mechanical ACD CPR produces probably the most effective CPR. However, different clinical circumstances make the device difficult to study outside hospital. Coding a CA according to diagnosis rather than symptoms appears to improve the out-of-hospital care.

  • 50.
    Axelsson, Christer
    et al.
    University of Borås, School of Health Science.
    Azeli, Youcef
    Jiminez, Maria
    Ordonez Campana, A
    Might the bainbridge reflex have a role in resuscitation when chest compression is combined with passive leg raising?2014In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 85, no 1, e21- p.Article in journal (Refereed)
    Abstract [en]

    The effect of passive leg raising (PLR) in cardiac arrest is not clearly established but PLR has been associated with increased coronary perfusion pressure and increase in End tidal carbon dioxide (EtCO2) during cardiopulmonary resuscitation (CPR).1 A case in which PLR was used successfully has recently been published.

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