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  • 1.
    Alsholm, Linda
    et al.
    Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg.
    Axelsson, Christer
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Andersson Hagiwara, Magnus
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Niva, My
    Department of Ambulance Care, Jönköping County Hospital.
    Claesson, Lisa
    Department of Ambulance Care, Halland County Hospital.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Magnusson, Carl
    Department of Molecular and Clinical Medicine, University of Gothenburg and Sahlgrenska University Hospital.
    Rosengren, Lars
    Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg.
    Jood, Katarina
    Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg.
    Interrupted transport by the emergency medical service in stroke/transitory ischemic attack: A consequence of changed treatment routines in prehospital emergency care.2019Ingår i: Brain and Behavior, ISSN 2162-3279, E-ISSN 2162-3279, artikel-id e01266Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

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

  • 2.
    Andersson, Elin
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Bohlin, Linda
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Sundler, Annelie Johansson
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Fekete, Zoltán
    Andersson Hagiwara, Magnus
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Prehospital Identification of Patients with a Final Hospital Diagnosis of Stroke.2018Ingår i: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, s. 1-8Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction the early phase of stroke, minutes are critical. Since the majority of patients with stroke are transported by the Emergency Medical Service (EMS), the early handling and decision making by the EMS clinician is important. Problem The study aim was to evaluate the frequency of a documented suspicion of stroke by the EMS nurse, and to investigate differences in the clinical signs of stroke and clinical assessment in the prehospital setting among patients with regard to if there was a documented suspicion of stroke on EMS arrival or not, in patients with a final hospital diagnosis of stroke.

    METHODS: The study had a retrospective observational design. Data were collected from reports on patients who were transported by the EMS and had a final diagnosis of stroke at a single hospital in western Sweden (630 beds) in 2015. The data sources were hospital and prehospital medical journals.

    RESULTS: In total, 454 patients were included. Among them, the EMS clinician suspected stroke in 52%. The findings and documentation on patients with a suspected stroke differed from the remaining patients as follows: a) More frequently documented symptoms from the face, legs/arms, and speech; b) More frequently assessments of neurology, face, arms/legs, speech, and eyes; c) More frequently addressed the major complaint with regard to time and place of onset, duration, localization, and radiation; d) Less frequently documented symptoms of headache, vertigo, and nausea; and e) More frequently had an electrocardiogram (ECG) recorded and plasma glucose sampled. In addition to the 52% of patients who had a documented initial suspicion of stroke, seven percent of the patients had an initial suspicion of transitory ischemic attack (TIA) by the EMS clinician, and a neurologist was approached in another 10%.

    CONCLUSION: Among 454 patients with a final diagnosis of stroke who were transported by the EMS, an initial suspicion of stroke was not documented in one-half of the cases. These patients differed from those in whom a suspicion of stroke was documented in terms of limited clinical signs of stroke, a less extensive clinical assessment, and fewer clinical investigations. Andersson E , Bohlin L , Herlitz J , Sundler AJ , Fekete Z , Andersson Hagiwara M . Prehospital identification of patients with a final hospital diagnosis of stroke.

  • 3.
    Andersson Hagiwara, Magnus
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Interrupted Time Series Versus Statistical Process Control in Quality Improvement Projects2016Ingår i: Journal of Nursing Care Quality, ISSN 1057-3631, Vol. 31, nr 1, s. E1-E8Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    To measure the effect of quality improvement interventions, it is appropriate to use analysis methods that measure data over time. Examples of such methods include statistical process control analysis and interrupted time series with segmented regression analysis. This article compares the use of statistical process control analysis and interrupted time series with segmented regression analysis for evaluating the longitudinal effects of quality improvement interventions, using an example study on an evaluation of a computerized decision support system.

  • 4.
    Andersson Hagiwara, Magnus
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Backlund, Per
    Söderholm, Hanna Maurin
    Lundberg, Lars
    Lebram, Mikael
    Engström, Henrik
    Measuring participants’ immersion in healthcare simulation: the development of an instrument2016Ingår i: Advances in Simulation, ISSN 2059-0628, Vol. 1, nr 1, s. 1-9Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Immersion is important for simulation-based education; however, questionnaire-based instruments to measure immersion have some limitations. The aim of the present work is to develop a new instrument to measure immersion among participants in healthcare simulation scenarios.

    Methods: The instrument was developed in four phases: trigger identification, content validity scores, inter-rater reliability analysis and comparison with an existing immersion measure instrument. A modified Delphi process was used to develop the instrument and to establish validity and reliability. The expert panel consisted of 10 researchers. All the researchers in the team had previous experience of simulation in the health and/or fire and rescue services as researchers and/or educators and simulation designers. To identify triggers, the panel members independently screened video recordings from simulation scenarios. Here, a trigger is an event in a simulation that is considered a sign of reduced or enhanced immersion among simulation participants.

    Results: The result consists of the Immersion Score Rating Instrument (ISRI). It contains 10 triggers, of which seven indicate reduced and three enhanced immersion. When using ISRI, a rater identifies trigger occurrences and assigns them strength between 1 and 3. The content validity analysis shows that all the 10 triggers meet an acceptable content validity index for items (I-CVI) standard. The inter-rater reliability (IRR) among raters was assessed using a two-way mixed, consistency, average-measures intra-class correlation (ICC). The ICC for the difference between weighted positive and negative triggers was 0.92, which indicates that the raters are in agreement. Comparison with results from an immersion questionnaire mirrors the ISRI results.

    Conclusions: In conclusion, we present a novel and non-intrusive instrument for identifying and rating the level of immersion among participants in healthcare simulation scenarios.

  • 5.
    Andersson Hagiwara, Magnus
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Kängström, Anna
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Jonsson, Anders
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Lundberg, Lars
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Effect of Simulation on the Clinical Competence of Swedish Ambulance Nurses2014Ingår i: Australasian Journal of Paramedicine, ISSN 2202-7270, Vol. 11, nr 2, s. 1-7Artikel i tidskrift (Refereegranskat)
    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.

  • 6.
    Andersson Hagiwara, Magnus
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Lundberg, Lars
    Sjöqvist, Bengt Arne
    Chalmers.
    Maurin Söderholm, Hanna
    Högskolan i Borås, Akademin för bibliotek, information, pedagogik och IT.
    The Effects of Integrated IT Support on the Prehospital Stroke Process: Results from a Realistic Experiment2019Ingår i: Journal of Healthcare Informatics Research, ISSN 2509-4971Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

  • 7.
    Andersson Hagiwara, Magnus
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Magnusson, Carl
    University of Gothenburg and Sahlgrenska University Hospital,.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Seffel, Elin
    Department of Ambulance Care, Södra Älvsborg Hospital.
    Axelsson, Christer
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Munters, Monica
    Department of Ambulance Care, Region of Dalarna.
    Strömsöe, Anneli
    School of Health, Care and Social Welfare, Mälardalens högskola.
    Nilsson, Lena
    Department of Anaesthesiology and Intensive Care and Department of Medical and Health Sciences, Linköping University.
    Adverse events in prehospital emergency care: a trigger tool study2019Ingår i: BMC Emergency Medicine, Vol. 19, nr 1Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

  • 8.
    Andersson Hagiwara, Magnus
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Nilsson, Lena
    Linköping University.
    Strömsöe, Anneli
    Mälardalens högskola.
    Axelsson, Christer
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Kängström, Anna
    Högskolan i Borås, Akademin för bibliotek, information, pedagogik och IT.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Patient safety and patient assessment in pre-hospital care: a study protocol2016Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, Vol. 24, nr 1, s. 1-7Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Patient safety issues in pre-hospital care are poorly investigated. The aim of the planned study is to

    survey patient safety problems in pre-hospital care in Sweden.

    Methods/Design: The study is a retro-perspective structured medical record review based on the use of 11 screening

    criteria. Two instruments for structured medical record review are used: a trigger tool instrument designed for

    pre-hospital care and a newly development instrument designed to compare the pre-hospital assessment with

    the final hospital assessment. Three different ambulance organisations are participating in the study. Every month,

    one rater in each organisation randomly collects 30 medical records for review. With guidance from the review

    instrument, he/she independently reviews the record. Every month, the review team meet for a discussion of

    problematic reviews. The results will be analysed with descriptive statistics and logistic regression.

    Discussion: The findings will make an important contribution to knowledge about patient safety issues in prehospital

    care.

  • 9.
    Andersson Hagiwara, Magnus
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Suserud, Björn-Ove
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Andersson-Gare, Boel
    Sjöqvist, Bengt-Arne
    Henricson, Maria
    Jonsson, Anders
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    The effect of a Computerised Decision Support System (CDSS) on compliance with the prehospital assessment process: results of an interrupted time-series study2014Ingår i: BMC Medical Informatics and Decision Making, ISSN 1472-6947, E-ISSN 1472-6947, Vol. 14, nr 70Artikel i tidskrift (Refereegranskat)
    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.

  • 10.
    Andersson Hagiwara, Magnus
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Vårdande och systematisk bedömning2016Ingår i: Prehospital akutsjukvård / [ed] B-O. Suserud & L. Lundberg, Stockholm: Liber, 2016, 2, s. 178-210Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 11.
    Andersson Hagiwara, Magnus
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Brink, P
    Högskolan väst.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Hansson, P-O
    University of Gothenburg.
    A shorter system delay for haemorrhagic stroke than ischaemic stroke among patients who use emergency medical service.2018Ingår i: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

  • 12.
    Andersson, Henrik
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Gabre, Marita
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Dehre, Andreas
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Andersson Hagiwara, Magnus
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Maurin Söderholm, Hanna
    Högskolan i Borås, Akademin för bibliotek, information, pedagogik och IT.
    Simulation in Virtual World to Promote Communication2018Ingår i: Pre-hospital care- Education and training of ambulance professionals, Noordwijkerhout, The Netherlands, 2018Konferensbidrag (Övrigt vetenskapligt)
    Abstract [en]

    Introduction

    Communication between ambulance professionals and patients is essential for understanding the patient's lifeworld (Wireklint Sundström & Dahlberg 2010). Simultaneously, communication is challenging to teach and learn within the framework of specific courses. However, simulation in virtual worlds can support the development of new skills such as communication (Combs, Sokolowski & Banks 2016).

     

    Aim

    The aim of this work was to design a simulation-based platform for communication training among ambulance nurse students (ANS).

     

    Methods

    A qualitative action research approach was used (Coghlan & Casey 2001). Second Life® (SL) was selected since it was an existing virtual world. SL is a web-based flexible three-dimensional platform that allows customization. Interaction and communication with other virtual people can be done through avatars in real time (Hodge, Collins & Giordano 2011). Three ANS and five teachers participated, none of the participants had prior experience of SL. Observations and interviews were used as data and analysed using thematic analysis.

     

    Results

    The participants’ experiences generated three themes:

     

    Understanding the virtual world

    It was easy to interact and communicate with other virtual people. However, it took time to feel comfortable to navigate in SL.

     

    Technological challenges

    One challenge was related to audio-visual problems e.g. not compatible headset, interfering echoes and that the image was distorted at times, which made it difficult to act and move the avatar. Another challenge was associated with the 3D modelling e.g. the capability to use of coordinates, positioning, object dimensioning and the fact that accidental deletions could not be restored. A third challenges that influenced the communication was the difficulty of visualizing clinically relevant care measures such as diagnostic examinations or drug treatment. Finally, there was a challenge to customize the avatars to look like ambulance professionals or a severely ill patient.

     

    Learning through avatars

    Learning through avatars requires that the participants take responsibility for delivering a convincing performance.  Immersion was limited since actions do not take place from a first-person viewpoint. There is a need that the scenario is based on realistic conditions e.g. interiors, equipment, clothing, avatar appearance and behaviour.

     

    Conclusion

    The present system is not suitable for training of medical assessment. Teachers who are considering using virtual worlds in the training for future ambulance professionals should note that an appropriate design is crucial for how the simulation is experienced.  

  • 13.
    Andersson, Henrik
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Gabre, Marita
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Dehre, Andreas
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Andersson Hagiwara, Magnus
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Maurin Söderholm, Hanna
    Högskolan i Borås, Akademin för bibliotek, information, pedagogik och IT.
    Simulation in Virtual World to Promote Communication2018Ingår i: Pre-hospital care- Education and training of ambulance professionals, Noordwijkerhout, The Netherlands, 2018Konferensbidrag (Refereegranskat)
    Abstract [en]

    Introduction

    Communication between ambulance professionals and patients is essential for understanding the patient's lifeworld (Wireklint Sundström & Dahlberg 2010). Simultaneously, communication is challenging to teach and learn within the framework of specific courses. However, simulation in virtual worlds can support the development of new skills such as communication (Combs, Sokolowski & Banks 2016).

     

    Aim

    The aim of this work was to design a simulation-based platform for communication training among ambulance nurse students (ANS).

     

    Methods

    A qualitative action research approach was used (Coghlan & Casey 2001). Second Life® (SL) was selected since it was an existing virtual world. SL is a web-based flexible three-dimensional platform that allows customization. Interaction and communication with other virtual people can be done through avatars in real time (Hodge, Collins & Giordano 2011). Three ANS and five teachers participated, none of the participants had prior experience of SL. Observations and interviews were used as data and analysed using thematic analysis.

     

    Results

    The participants’ experiences generated three themes:

     

    Understanding the virtual world

    It was easy to interact and communicate with other virtual people. However, it took time to feel comfortable to navigate in SL.

     

    Technological challenges

    One challenge was related to audio-visual problems e.g. not compatible headset, interfering echoes and that the image was distorted at times, which made it difficult to act and move the avatar. Another challenge was associated with the 3D modelling e.g. the capability to use of coordinates, positioning, object dimensioning and the fact that accidental deletions could not be restored. A third challenges that influenced the communication was the difficulty of visualizing clinically relevant care measures such as diagnostic examinations or drug treatment. Finally, there was a challenge to customize the avatars to look like ambulance professionals or a severely ill patient.

     

    Learning through avatars

    Learning through avatars requires that the participants take responsibility for delivering a convincing performance.  Immersion was limited since actions do not take place from a first-person viewpoint. There is a need that the scenario is based on realistic conditions e.g. interiors, equipment, clothing, avatar appearance and behaviour.

     

    Conclusion

    The present system is not suitable for training of medical assessment. Teachers who are considering using virtual worlds in the training for future ambulance professionals should note that an appropriate design is crucial for how the simulation is experienced.  

  • 14.
    Andersson, Ulf
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Maurin Söderholm, Hanna
    Högskolan i Borås, Akademin för bibliotek, information, pedagogik och IT.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Andersson Hagiwara, Magnus
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Clinical reasoning in the emergency medical services: an integrative review2019Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Abstract: Clinical reasoning is the process of gathering and understanding information conducted by clinicians in the emergency medical services (EMS) so as to make informed decisions. Research on clinical reasoning spans several disciplines, but a comprehensive view of the process is lacking. To our knowledge, no review of clinical reasoning in the EMS has been conducted.

    Aim: The aim was to investigate the nature, deployment, and factors influencing EMS clinicians’ clinical reasoning by means of a review.

    Method: Data was collected through searches in electronic databases, networking among research teams ,colleagues and friends, “grey literature,” and through ancestry searches. A total of 38 articles were deemed eligible for inclusion and were analyzed using descriptive thematic analysis. The analysis resulted in an overarching finding -namely, the importance for EMS clinicians to adjust for perceived control in unpredictable situations. Within this finding, 3 themes emerged in terms of EMS clinicians’ clinical reasoning: (1) maintaining a holistic view of the patient; (2) keeping an open mind; and (3) improving through criticism. Seven subthemes subsequently emerged from these three themes.

    Results: This review showed that EMS clinicians’ clinical reasoning begins with the information that they are given about a patient. Based on this information, clinicians calculate the best route to the patient and which equipment to use, and they also assess potential risks. They need to be constantly aware of what is happening on the scene and with the patient and strive to control the situation. This striving also enables EMS clinicians to work safely and effectively in relation to the patient, their relatives, other clinicians, associated organizations, and the wider community. A lack of contextually appropriate guidelines results in the need for creativity and forces EMS clinicians to use “workarounds” to solve issues beyond the scope of the guidelines available. In addition, they often lack organizational support and fear repercussions such as litigation, unemployment, or blame by their EMS or healthcare organization or by patients and relatives.

    Conclusion: Clinical reasoning is influenced by several factors. Further research is needed to determine which influencing factors can be addressed through interventions to minimize their impact on patient outcomes.

  • 15.
    Axelsson, Christer
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Bremer, Anders
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Hagiwara, Magnus
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Nationella regler krävs för ambulanssjukvård2011Ingår i: Svenska Dagbladet, ISSN 1101-2412Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
    Abstract [sv]

    Ambulanssjukvården i Sverige saknar nationella riktlinjer. En konsekvens av detta är brister i tillgängligheten vilket fått allvarliga konsekvenser för flera personer under den senaste tiden. En av dem är Maximilian och hans mamma som blev påkörda på trottoaren av en 23-årig förare som hade tappat kontrollen över sin bil. Det tog nästan en timme innan pojken flögs till sjukhus med helikopter från olycksplatsen på Tjörn utanför Stenungsund. Maximilian blev bara tio veckor.

  • 16.
    Axelsson, Christer
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Bremer, Anders
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Hagiwara, Magnus
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Englund, Lotta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Så skapas världens bästa ambulanssjukvård2011Ingår i: Göteborgsposten, ISSN 1103-9345Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
    Abstract [sv]

    Tiden från larm till dess att ambulans kommer har ökat dramatiskt de senaste tio åren i Västra Götaland. Samtidigt bedöms allt fler i behov av snabb utryckning. Kompetens finns att råda bot på detta – om den tillåts styra utvecklingen, skriver bland andra professor Johan Herlitz.

  • 17. Backlund, Per
    et al.
    Engström, Henrik
    Andersson Hagiwara, Magnus
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Johannesson, Mikael
    Maurin Söderholm, Hanna
    Högskolan i Borås, Akademin för bibliotek, information, pedagogik och IT.
    Enhancing Immersion with Contextualized Scenarios: Role-Playing in Prehospital Care Training2015Ingår i: 2015 7th International Conference on Games and Virtual Worlds for Serious Applications (VS-Games), Skövde, 2015Konferensbidrag (Refereegranskat)
    Abstract [en]

    This paper reports on a field experiment with 12 paramedic teams (n=24) exploring how they perceive a novel training approach. The feeling of being engaged in training (i.e. being immersed) is often held forward as a major benefit of roleplaying exercises. Engagement is expected to raise the quality of training as well as improving learning and retention. However, much simulation-based training in prehospital care is decontextualized, meaning that medical care is trained without taking other characteristics of prehospital care into account. In this paper we investigate how a richer setting (contextualization), which includes more of the complicating aspects of prehospital care, affects the perceived immersion of the participants. The results show that contextualization has a significant positive impact on perceived immersion. These results are important for further studies on how to organize and design role-playing exercises.

  • 18.
    Backlund, Per
    et al.
    Högskolan i Skövde, Forskningscentrum för Informationsteknologi..
    Engström, Henrik
    Högskolan i Skövde, Forskningscentrum för Informationsteknologi..
    Johannesson, Mikael
    Högskolan i Skövde, Forskningscentrum för Informationsteknologi..
    Lebram, Mikael
    Högskolan i Skövde, Forskningscentrum för Informationsteknologi..
    Danielsson, Magnus
    Västra Götalandsregionen.
    Andersson Hagiwara, Magnus
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Lundberg, Lars
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Maurin Söderholm, Hanna
    Högskolan i Borås, Akademin för bibliotek, information, pedagogik och IT.
    The S.A.R.E.K Simulation Environment: Technical description of a flexible training environment for prehospital care.2017Rapport (Övrigt vetenskapligt)
    Abstract [en]

    This report contains a technical description of the result of the S.A.R.E.K (Simulation – Ambulance – Research – Education - Kinship) collaboration project and the Sim2020 project. The projects are collaborations between researchers in healthcare and IT, and prehospital care practitioners, with the aim to design, develop and test a contextualized simulation environment for prehospital care. We built a simulation environment representing the full depth and width of a prehospital care process. Breadth refers to including all phases of a prehospital mission, from dispatch to handover; while depth refers to detailed representations and recreation of artefacts, information and context for each of these phases. This report outlines the details of the overall design, all equipment and practical solutions used to create this. Apart from the installation which is described in this report we have also developed methods and carried out a variety of tests and experiments which are reported elsewhere. The focus of this report is the system and its components.

  • 19. Backlund, Per
    et al.
    Maurin Söderholm, Hanna
    Högskolan i Borås, Akademin för bibliotek, information, pedagogik och IT.
    Engström, Henrik
    Andersson Hagiwara, Magnus
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Lebram, Mikael
    Breaking Out of the Bubble Putting Simulation Into Context to Increase Immersion and Performance2018Ingår i: Simulation & Gaming, artikel-id 1046878118772612Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: Simulation based training with full-size mannequins is a prominent means of training within the healthcare sector. Prehospital missions include all parts of the healthcare process which take place before a patient is handed over to the receiving hospital. This implies that the context for prehospital care is varied and potentially challenging or dangerous in several ways. In this article we present a study which explores immersion and performance by emergency medical services (EMS) professionals in in a training situation which takes the specifics of prehospital interventions into account.

    Methods: The study was carried out as a field experiment at an ambulance unit. The experiment was designed to compare the differences between two types of medical scenarios: basic and contextualized. We analyzed the levels of immersion throughout the scenarios and then team performance was evaluated by independent experts. Both analyses were made by observing video recordings from multiple camera angles with a custom made analysis tool.

    Results: Our results show that the contextualization of a medical scenario increases both immersion as measured by the Immersion Score Rating Instrument (ISRI) and team performance as measured by the Global Rating Scale (GRS). The overall ISRI score was higher in the contextualized condition as compared to the basic condition, with an average team wise difference of 2.94 (sd = 1.45). This difference is significant using a paired, two-tailed t-test (p<.001). The GRS score was higher for overall clinical performance in the contextualized scenario with an average team wise difference of 0.83 (sd = 0.83, p=.005).Conclusions. Full-size mannequin simulation based training for EMS professionals may be enhanced by contextualizing the medical scenarios. The main benefits are that the contextualized scenarios better take prehospital medical challenges into account and allow participants to perform better.

  • 20. Engström, Henrik
    et al.
    Andersson Hagiwara, Magnus
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Backlund, Per
    Lebram, Mikael
    Lundberg, Lars
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Johannesson, Mikael
    Sterner, Anders
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Maurin Söderholm, Hanna
    Högskolan i Borås, Akademin för bibliotek, information, pedagogik och IT.
    The impact of contextualization on immersion in healthcare simulation2016Ingår i: Advances in Simulation, ISSN 2059-0628, Vol. 1, nr 1, s. 1-11Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this paper is to explore how contextualization of a healthcare simulation scenarios impacts immersion, by using a novel objective instrument, the Immersion Score Rating Instrument. This instrument consists of 10 triggers that indicate reduced or enhanced immersion among participants in a simulation scenario. Triggers refer to events such as jumps in time or space (sign of reduced immersion) and natural interaction with the manikin (sign of enhanced immersion) and can be used to calculate an immersion score.

  • 21.
    Hagiwara Andersson, Magnus
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Lundberg, Lars
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Suserud, Björn-Ove
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Henricson, Maria
    Sjökvist, Bengt-Arne
    Jonsson, Anders
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Decision support system in prehospital care: a randomized controlled simulation study2013Ingår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 31, nr 1, s. 143-153Artikel i tidskrift (Refereegranskat)
    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.

  • 22.
    Hagiwara, M
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Bremer, A
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Claesson, A
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Axelsson, C
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Norberg, Gabriella
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    The impact of direct admission to a catheterisation lab/CCU in patients with ST-elevation myocardial infarction on the delay to reperfusion and early risk of death: results of a systematic review including meta-analysis2014Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 22, nr 67Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background For each hour of delay from fist medical contact until reperfusion in ST-elevation myocardial infarction (STEMI) there is a 10% increase in risk of death and heart failure. The aim of this review is to describe the impact of the direct admission of patients with STEMI to a Catheterisation laboratory (cath lab) as compared with transport to the emergency department (ED) with regard to delays and outcome. Methods Databases were searched for from April-June 2012 and updated January 2014: 1) Pubmed; 2) Embase; 3) Cochrane Library; 4) ProQuest Nursing and 5) Allied Health Sources. The search was restricted to studies in English, Swedish, Danish and Norwegian languages. The intervention was a protocol-based clinical pre-hospital pathway and main outcome measurements were the delay to balloon inflation and hospital mortality. Results Median delay from door to balloon was significantly shorter in the intervention group in all 5 studies reported. Difference in median delay varied between 16 minutes and 47 minutes. In all 7 included studies the time from symptom onset or first medical contact to balloon time was significantly shorter in the intervention group. The difference in median delay varied between 15 minutes and 1 hour and 35 minutes. Only two studies described hospital mortality. When combined the risk of death was reduced by 37%. Conclusion An overview of available studies of the impact of a protocol-based pre-hospital clinical pathway with direct admission to a cath lab as compared with the standard transport to the ED in ST-elevation AMI suggests the following. The delay to the start of revascularisation will be reduced. The clinical benefit is not clearly evidence based. However, the documented association between system delay and outcome defends the use of the pathway.

  • 23.
    Hagiwara, Magnus
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Development and evaluation of a computerised decision support system for use in pre-hospital care2014Doktorsavhandling, monografi (Övrigt vetenskapligt)
    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.

  • 24.
    Hagiwara, Magnus
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Henricson, M
    Jonsson, Anders
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Suserud, Björn-Ove
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Decision-Support Tool in Prehospital Care:A Systematic Review of Randomized Trials2011Ingår i: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 26, nr 4, s. 1-11Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: The objective of this study was to evaluate the effects of the decision support tool (DST) on the assessment of the acutely ill or injured out-of-hospital patient. Methods: This study included systematic reviews of randomized controlled trials (RCT) where the DST was compared to usual care in and out of the hospital setting. The databases scanned include: (1) Cochrane Reviews (up to January 2010); (2) Cochrane Controlled Clinical Trials (1979 to January 2010); (3) Cinahl (1986 to January 2010); and (4) Pubmed/ Medline (1926 to January 2010). In addition, information was gathered from related magazines, prehospital home pages, databases for theses, conferences, grey literature and ongoing trials. Results: Use of the DST in prehospital care may have the possibility to decrease “time to definitive care” and improve diagnostic accuracy among prehospital personnel, but more studies are needed. Conclusions: The amount of data in this review is too small to be able to draw any reliable conclusions about the impact of the use of the DST on prehospital care. The research in this review indicates that there are very few RCTs that evaluate the use of the DST in prehospital care.

  • 25.
    Hagiwara, Magnus
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Suserud, Björn-Ove
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Jonsson, Anders
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Henricson, Mia
    Exclusion of context knowledge in the development of prehospital guidelines: results produced by realistic evaluation.2013Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 21, nr 46Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Prehospital work is accomplished using guidelines and protocols, but there is evidence suggesting that compliance with guidelines is sometimes low in the prehospital setting. The reason for the poor compliance is not known. The objective of this study was to describe how guidelines and protocols are used in the prehospital context. Methods This was a single-case study with realistic evaluation as a methodological framework. The study took place in an ambulance organization in Sweden. The data collection was divided into four phases, where phase one consisted of a literature screening and selection of a theoretical framework. In phase two, semi-structured interviews with the ambulance organization's stakeholders, responsible for the development and implementation of guidelines, were performed. The third phase, observations, comprised 30 participants from both a rural and an urban ambulance station. In the last phase, two focus group interviews were performed. A template analysis style of documents, interviews and observation protocols was used. Results The development of guidelines took place using an informal consensus approach, where no party from the end users was represented. The development process resulted in guidelines with an insufficiently adapted format for the prehospital context. At local level, there was a conscious implementation strategy with lectures and manikin simulation. The physical format of the guidelines was the main obstacle to explicit use. Due to the format, the ambulance personnel feel they have to learn the content of the guidelines by heart. Explicit use of the guidelines in the assessment of patients was uncommon. Many ambulance personnel developed homemade guidelines in both electronic and paper format. The ambulance personnel in the study generally took a positive view of working with guidelines and protocols and they regarded them as indispensable in prehospital care, but an improved format was requested by both representatives of the organization and the ambulance personnel. Conclusions The personnel take a positive view of the use of guidelines and protocols in prehospital work. The main obstacle to the use of guidelines and protocols in this organization is the format, due to the exclusion of context knowledge in the development process.

  • 26.
    Hagiwara, Magnus
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Suserud, Björn-Ove (Redaktör)
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Vård och bedömning2009Ingår i: Prehospital akutsjukvård / [ed] Björn-Ove Suserud, Leif Svensson, Stockholm: Liber , 2009, s. 117-145Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 27.
    Hansson, Per-Olof
    et al.
    Sahlgrenska Academy, University of Gothenburg.
    Andersson Hagiwara, Magnus
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Brink, Peter
    University West.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Prehospital identification of factors associated with death during one-year follow-up after acute stroke.2018Ingår i: Brain and Behavior, ISSN 2162-3279, E-ISSN 2162-3279, artikel-id e00987Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: In acute stroke, the risk of death and neurological sequelae are obvious threats. The aim of the study was to evaluate the association between various clinical factors identified by the emergency medical service (EMS) system before arriving at hospital and the risk of death during the subsequent year among patients with a confirmed stroke.

    MATERIAL AND METHODS: All patients with a diagnosis of stroke as the primary diagnosis admitted to a hospital in western Sweden (1.6 million inhabitants) during a four-month period were included. There were no exclusion criteria.

    RESULTS: In all, 1,028 patients with a confirmed diagnosis of stroke who used the EMS were included in the analyses. Among these patients, 360 (35%) died during the following year. Factors that were independently associated with an increased risk of death were as follows: (1) high age, per year OR 1.07; 95% CI 1.05-1.09; (2) a history of heart failure, OR 2.08; 95% CI 1.26-3.42; (3) an oxygen saturation of <90%, OR 8.05; 95% CI 3.33-22.64; and (4) a decreased level of consciousness, OR 2.19; 95% CI 1.61-3.03.

    CONCLUSIONS: Among patients with a stroke, four factors identified before arrival at hospital were associated with a risk of death during the following year. They were reflected in the patients' age, previous clinical history, respiratory function, and the function of the central nervous system.

  • 28.
    Hansson, P-O
    et al.
    Sahlgrenska University Hospital and Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg.
    Andersson Hagiwara, Magnus
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Brink, P
    Intensive Care Unit, NU-hospital.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Prehospital assessment of suspected stroke and TIA: an observational study.2019Ingår i: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

  • 29. Heldal, Ilona
    et al.
    Lundberg, Lars
    Andersson Hagiwara, Magnus
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Technologies Supporting Longitudinal Collaboration Along Patients’ Pathway: Planning Training for Prehospital Care2015Konferensbidrag (Refereegranskat)
  • 30. Heldal, Ilona
    et al.
    Lundberg, Lars
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Andersson Hagiwara, Magnus
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Technologies supporting longitudinal collaboration along patients’ pathway: Planning training for prehospital care.2015Konferensbidrag (Refereegranskat)
  • 31.
    Herlitz, Johan
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Bång, Angela
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Wireklint-Sundström, Birgitta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Axelsson, Christer
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Bremer, Anders
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Hagiwara, Magnus
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Jonsson, Anders
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Lundberg, Lars
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Suserud, Björn-Ove
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Ljungström, Lars
    Suspicion and treatment of severe sepsis. An overview of the prehospital chain of care.2012Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 20, nr 42Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Sepsis is a life-threatening condition where the risk of death has been reported to be even higher than that associated with the major complications of atherosclerosis, i.e. myocardial infarction and stroke. In all three conditions, early treatment could limit organ dysfunction and thereby improve the prognosis. Aim To describe what has been published in the literature a/ with regard to the association between delay until start of treatment and outcome in sepsis with the emphasis on the pre-hospital phase and b/ to present published data and the opportunity to improve various links in the pre-hospital chain of care in sepsis. Methods A literature search was performed on the PubMed, Embase (Ovid SP) and Cochrane Library databases. Results In overall terms, we found a small number of articles (n=12 of 1,162 unique hits) which addressed the prehospital phase. For each hour of delay until the start of antibiotics, the prognosis appeared to become worse. However, there was no evidence that prehospital treatment improved the prognosis. Studies indicated that about half of the patients with severe sepsis used the emergency medical service (EMS) for transport to hospital. Patients who used the EMS experienced a shorter delay to treatment with antibiotics and the start of early goal-directed therapy (EGDT). Among EMS-transported patients, those in whom the EMS staff already suspected sepsis at the scene had a shorter delay to treatment with antibiotics and the start of EGDT. There are insufficient data on other links in the prehospital chain of care, i.e. patients, bystanders and dispatchers. Conclusion Severe sepsis is a life-threatening condition. Previous studies suggest that, with every hour of delay until the start of antibiotics, the prognosis deteriorates. About half of the patients use the EMS. We need to know more about the present situation with regard to the different links in the prehospital chain of care in sepsis.

  • 32.
    Hulldin, Martin
    et al.
    Southern Älvsborg Emergency Medical Services.
    Kängström, Jonas
    Southern Älvsborg Emergency Medical Services.
    Andersson Hagiwara, Magnus
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Claesson, Andreas
    Karolinska Institute.
    Perceived exertion using two different EMS stretcher systems, report from a Swedish study.2018Ingår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, artikel-id S0735-6757(18)30157-8Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Emergency medical services (EMS) facilitate out of hospital care in a wide variety of settings on a daily basis. Stretcher-related adverse events and long term musculoskeletal injuries are commonly reported. Novel stretcher mechanisms may facilitate enhanced movement of patients and reduce workload for EMS personnel.

    AIM: To describe EMS personnel's perceived exertion using two different stretcher systems.

    METHODS: The methodology of this explorative simulation study included enrolling twenty (n=20) registered nurses and paramedics who worked in ten pairs (n=10) to transport a conscious, 165lb. (75kg) patient using two different EMS stretcher systems: the Pensi stretcher labeled A and the ALLFA stretcher labeled B. The ten pairs (n=10) were randomized to use either an A stretcher or a B stretcher with subsequent crossover. The pairs performed six identical tasks with each stretcher, including conveying stretchers from an ambulance up to the first floor of a building via a staircase, loading a patient on to the stretcher, and using the stretcher to transport the patient back to the ambulance. The subjective Rating of Perceived Exertion (RPE) survey (Borg scale) was used to measure perceived exertion at predefined intervals during transport.

    RESULTS: No significant differences in workload were seen between stretcher groups A and B regarding unloading the stretcher (7.4 vs 8.2 p=0.3), transporting up a stairway (13.7 vs 12.5 p=0.06), lateral lift (12.1 vs 11.2 p=0.5), or flat ground transportation (10.4 vs 11.1 p=0.13). Pairs using stretcher A showed significantly less workload with regards to transporting down a stairway (11.0 vs 14.5 p<0.001) and loading into ambulance (11.1 vs 13.0 p<0.001).

    CONCLUSION: A structured methodology may be used for testing the exertion levels experienced while using different stretcher systems. The use of supporting stretcher system mechanisms may reduce perceived exertion in EMS personnel mainly during transports down stairs and during loading into ambulance vehicles.

  • 33.
    Höglund, Erik
    et al.
    Örebro University.
    Schröder, Agneta
    Örebro University.
    Möller, Margareta
    Örebro University.
    Andersson Hagiwara, Magnus
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Ohlsson-Nevo, Emma
    Örebro University.
    The ambulance nurse experiences of non-conveying patients.2018Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 1, nr 10Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIMS AND OBJECTIVES: To explore ambulance nurses' (ANs) experiences of non-conveying patients to alternate levels of care.

    BACKGROUND: Increases in ambulance utilisation and in the number of patients seeking ambulance care who do not require medical supervision or treatment during transport have led to increased nonconveyance (NC) and referral to other levels of care.

    DESIGN: A qualitative interview study was conducted using an inductive research approach.

    METHODS: The study was conducted in a region in the middle of Sweden during 2016-2017. Twenty nurses were recruited from the ambulance departments in the region. A conventional content analysis was used to analyse the interviews. The study followed the COREQ checklist.

    RESULTS: The ANs experienced NC as a complex and difficult task that carried a large amount of responsibility. They wanted to be professional, spend time with the patient and find the best solution for him or her. These needs conflicted with the ANs' desire to be available for assignments with a higher priority. The ANs could feel frustrated when they perceived that ambulance resources were being misused and when it was difficult to follow the NC guidelines.

    CONCLUSION: If ANs are expected to nonconvey patients seeking ambulance care, they need a formal mandate, knowledge and access to primary health care.

    RELEVANCE TO CLINICAL PRACTICE: This study provides new knowledge regarding the work situation of ANs in relation to NC. These findings can guide future research and can be used by policymakers and ambulance organisations to highlight areas that need to evolve to improve patient care.

  • 34. Knudsen, Kai
    et al.
    Björk Brämberg, Elisabeth
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Hagiwara, Magnus
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Svensson, Leif (Redaktör)
    Intoxikation2009Ingår i: Prehospital akutsjukvård / [ed] Björn-Ove Suserud, Leif Svensson, Stockholm: Liber , 2009, s. 309-316Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 35.
    Lundberg, Lars
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Andersson Hagiwara, Magnus
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Jonsson, Anders
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Simulation in pre-hospital care2013Konferensbidrag (Övrigt vetenskapligt)
  • 36.
    Lundberg, Lars
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Andersson Hagiwara, Magnus
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Jonsson, Anders
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Simulation in pre-hospital care2013Ingår i: Emergency MedicineArtikel, forskningsöversikt (Refereegranskat)
  • 37.
    Magnusson, Carl
    et al.
    Department of Molecular and Clinical Medicine, University of Gothenburg .
    Axelsson, Christer
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Nilsson, Lena
    Department of Anaesthesiology and Intensive Care and Department of Medical and Health Sciences, Linköping University.
    Strömsöe, Anneli
    School of Education, Health and Social Studies, Dalarna University .
    Munters, Monica
    Department of Ambulance Care, Region of Dalarna.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Andersson Hagiwara, Magnus
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    The final assessment and its association with field assessment in patients who were transported by the emergency medical service.2018Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 26, nr 1, artikel-id 111Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: In patients who call for the emergency medical service (EMS), there is a knowledge gap with regard to the final assessment after arriving at hospital and its association with field assessment.

    AIM: In a representative population of patients who call for the EMS, to describe a) the final assessment at hospital discharge and b) the association between the assessment in the field and the assessment at hospital discharge.

    METHODS: Thirty randomly selected patients reached by a dispatched ambulance each month between 1 Jan and 31 Dec 2016 in one urban, one rural and one mixed ambulance organisation in Sweden took part in the study. The exclusion criteria were age < 18 years, dead on arrival, transport between health-care facilities and secondary missions. Each patient received a unique code based on the ICD code at hospital discharge and field assessment.

    RESULTS: In all, 1080 patients took part in the study, of which 1076 (99.6%) had a field assessment code. A total of 894 patients (83%) were brought to a hospital and an ICD code (ICD-10-SE) was available in 814 patients (91% of these cases and 76% of all cases included in the study). According to these ICD codes, the most frequent conditions were infection (15%), trauma (15%) and vascular disease (9%). The most frequent body localisation of the condition was the thorax (24%), head (16%) and abdomen (13%). In 118 patients (14% of all ICD codes), the condition according to the ICD code was judged as time critical. Among these cases, field assessment was assessed as potentially appropriate in 75% and potentially inappropriate in 12%.

    CONCLUSION: Among patients reached by ambulance in Sweden, 83% were transported to hospital and, among them, 14% had a time-critical condition. In these cases, the majority were assessed in the field as potentially appropriate, but 12% had a potentially inappropriate field assessment. The consequences of these findings need to be further explored.

  • 38.
    Maurin Söderholm, Hanna
    et al.
    Högskolan i Borås, Akademin för bibliotek, information, pedagogik och IT.
    Andersson, Henrik
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Andersson Hagiwara, Magnus
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Backlund, Per
    School of Informatics, University of Skövde.
    Bergman, Johanna
    PICTA - Prehospital ICT Arena, Lindholmen Science Park AB.
    Lundberg, Lars
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Sjöqvist, Bengt Arne
    Biomedical Signals and Systems, Department of Electrical Engineering, Chalmers University of Technology.
    Research challenges in prehospital care: the need for a simulation-based prehospital research laboratory.2019Ingår i: Advances in Simulation, ISSN 2059-0628, Vol. 4, artikel-id 3Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

  • 39. Melby, V
    et al.
    Deeny, P
    Andersson Hagiwara, Magnus
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Jonsson, Anders
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Kängström, Anna
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Kernohan, WG
    Suserud, Björn-Ove
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Patient comfort in pre-hospital emergency care: A challenge to clinicians.2012Ingår i: Journal of Paramedic Practice, ISSN 1759-1376, Vol. 4, nr 7, s. 389-399Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: The aim of this paper is to report on a study that compared ambulance clinicians' views of two different types of patient coverings, focusing on core caring concepts such as comfort, dignity, and safety. Design: Ambulance clinicians' views were gathered in respect of two types of patient coverings, and 128 ambulance patients were randomly distributed into a control or experimental group receiving respectively either the traditional cotton blanket or a multi-layered TelesPro rescue covering. Views were gathered using a short questionnaire developed by the authors. Findings: Ambulance clinicians, in their own view, maintained the core caring concepts no matter which type of covering was used. Findings suggest strongly that the rescue covering provided for a superior patient experience in respect of all core concepts and one functional aspect. Conclusions: Ambulance clinicians undertake caring that encompasses the core caring concepts of comfort, safety, and dignity, while remaining vigilant to threats to these constituents of caring.

  • 40.
    Olander, Agnes
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Andersson, Henrik
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Sundler, Annelie Johansson
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Bremer, Anders
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden.
    Ljungström, Lars
    Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg.
    Andersson Hagiwara, Magnus
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Prehospital characteristics among patientswith sepsis: a comparison between patients with or without adverse outcome2019Ingår i: BMC Emergency Medicine, ISSN 1471-227X, E-ISSN 1471-227X, artikel-id 19:43Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

  • 41.
    Palmér, Lina
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Sterner, Anders
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Andersson Hagiwara, Magnus
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Kan komplex simuleringsträning öka patientsäkerheten? Vilken är högskolans och universitetens roll i patientsäkerhetsarbetet?2017Konferensbidrag (Övrig (populärvetenskap, debatt, mm))
  • 42.
    Sanfridsson, J
    et al.
    Department of Medicine, Centre for Resuscitation Science, Karolinska Institute.
    Sparrevik, J
    Västerbotten Emergency Medical Services.
    Hollenberg, J
    Department of Medicine, Centre for Resuscitation Science, Karolinska Institute.
    Nordberg, P
    Department of Medicine, Centre for Resuscitation Science, Karolinska Institute.
    Djärv, T
    Department of Medicine, Centre for Resuscitation Science, Karolinska Institute.
    Ringh, M
    Department of Medicine, Centre for Resuscitation Science, Karolinska Institute.
    Svensson, L
    Department of Medicine, Centre for Resuscitation Science, Karolinska Institute.
    Forsberg, S
    Department of Medicine, Centre for Resuscitation Science, Karolinska Institute.
    Nord, A
    Department of Medicine, Centre for Resuscitation Science, Karolinska Institute.
    Andersson Hagiwara, Magnus
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Claesson, A
    Department of Medicine, Centre for Resuscitation Science, Karolinska Institute.
    Drone delivery of an automated external defibrillator - a mixed method simulation study of bystander experience.2019Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 27, nr 1, artikel-id 40Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

  • 43.
    Sjösten, Oscar
    et al.
    SÄS.
    Nilsson, Johanna
    SÄS.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Axelsson, Christer
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Jiménez-Herrera, Maria
    Universitat Rovira i Virgili.
    Andersson Hagiwara, Magnus
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    The prehospital assessment of patients with a final hospital diagnosis of sepsis: Results of an observational study2019Ingår i: Australasian Emergency Care, ISSN 2588-994XArtikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

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

    Methods

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

    Results

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

    Conclusion

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

  • 44.
    Sterner, Anders
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Ramstrand, Nerrolyn (Medarbetare/bidragsgivare)
    Jönköping University.
    Palmér, Lina
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Factors developing nursing students and novice nurses’ ability to provide care in acute situations2019Ingår i: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 35, s. 135-140Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

  • 45.
    Sterner, Anders
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Nyström, Maria
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Ramstrand, Nerrolyn
    Andersson Hagiwara, Magnus
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Palmér, Lina
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Novice Nurses Perceptions Of Their Ability To Care In Acute Situations2018Konferensbidrag (Refereegranskat)
    Abstract [en]

    Introduction

    Nurses have an essential role in acute care situations for preventing adverse events and improve patient outcomes as they typically have most patient contact and are often first to detect acute sickness (Della Ratta, 2016). Education and experience is highlighted as important for developing nurses ability in acute situations (Massey et al., 2017). The aim of this study was to describe what affects novice nurses’ ability to care in acute situations.

    Method: Qualitative descriptive design with a phenomenographic approach. Data consisted of 17 interviews of novice nurses working in acute care hospitals in Sweden. Novice are defined as less than 1 year of working experience. The context acute situations following Sterner et al. (2017) findings that acute situations is more than physical deterioration of patients.

    Results: Experience of acute situations is perceived as significant for developing the pivotal knowledge and ability to care in acute situations. Clinical practice is not a guarantee for this experience during nurse education. Reasons for this could be that nothing acute happened during allocated shifts. If an acute situation occurred the student could be allocated additional assignments or sent home. The skills obtained in acute situations are perceived as a lottery dependent upon where you get your clinical practice assigned.

    Discussion: Experience is perceived as significant for developing ability to care in acute situations. If nurse education can’t facilitate learning of and in acute situations during clinical practice, simulation can be a method for developing the ability. When nursing students train, it is important to include different factors such as time pressure, surprises, contact with different occupational groups and next of kin to facilitate the ability to care in acute situations.

    References

    DELLA RATTA, C. 2016. Challenging graduate nurses' transition: Care of the deteriorating

    patient. Journal of Clinical Nursing, 25, 3036-3048.

    MASSEY, D., CHABOYER, W. & ANDERSON, V. 2017. What factors influence ward nurses’ recognition of and response to patient deterioration? An integrative review of the literature.Nursing open, 4, 6-23.

    STERNER, A., RAMSTRAND, N., NYSTRÖM, M., HAGIWARA, M. A. & PALMÉR, L. 2017. Novice nurses’ perceptions of acute situations–a phenomenographic study. International emergency nursing.

  • 46.
    Sterner, Anders
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Ramstrand, Nerrolyn
    Jönköping University.
    Nyström, Maria
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Andersson Hagiwara, Magnus
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Palmér, Lina
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Novice nurses' perceptions of acute situations - A phenomenographic study.2017Ingår i: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, artikel-id S1755-599X(17)30169-6Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Today's nurses face complex patient challenges and increased patient acuity. Novice nurses may feel unprepared for some of the tasks facing them. In order to prevent adverse events and improve patient outcomes, the management of acute situations has been identified as an area needing attention. Despite this, it is not yet clear what novice nurses themselves perceive as an acute situation. Therefore, the aim of this study is to describe novice nurses' perceptions of acute situations.

    METHOD: The study has a qualitative, descriptive design with a phenomenographic approach. Semi-structured interviews were conducted with twelve novice nurses, with less than a year of working experience, about their perceptions of acute situations.

    RESULTS: Acute situations are perceived as situations that occur suddenly, that involve shortage of time, or that generate a sense of insufficient personal competence. When acute situations arise, nurses experience a feeling of overwhelming responsibility. Acute situations involve not only deteriorating patient health but can also include challenging interpersonal relations or deficiencies in organisational procedures.

    CONCLUSION: An acute situation, as perceived by novice nurses, contains significantly more than medical manifestations related to the patient, a prominent perception being that interpersonal relations are crucial for appropriate management.

  • 47.
    Suserud, Björn-Ove
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Jonsson, Anders
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Backlund, Anna
    Andersson Hagiwara, Magnus
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Patients comfort in prehospital emergency care2009Ingår i: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 24, nr 2, s. 10-10Artikel, forskningsöversikt (Refereegranskat)
  • 48.
    Tärnqvist, Julia
    et al.
    The Ambulance Service in Skaraborg, Lidköping, Sweden.
    Dahlén, Erik
    The Ambulance Service in Skaraborg, Lidköping, Sweden.
    Magnusson, Carl
    Sahlgrenska Univ Hospital.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Strömsöe, Anneli
    University of Dalarna.
    Norberg, Gabriella
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Axelsson, Christer
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. Sahlgrenska University Hospital.
    Andersson Hagiwara, Magnus
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    On-Scene and Final Assessments and Their Interrelationship Among Patients Who Use the EMS on Multiple Occasions2017Ingår i: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 32, nr 5, s. 528-535Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction The use of Emergency Medical Services (EMS) is increasing. A number of patients call repeatedly for EMS. Early studies of frequent callers show that they form a heterogenous group. Problem There is a lack of research on frequent EMS callers. There is furthermore a lack of knowledge about characteristics and the prehospital assessment of the patients who call for EMS on several occasions. Finally, there is a general lack of knowledge with regard to the association between the prehospital assessment by health care providers and the final diagnosis. Method Patients in Skaraborg in Western Sweden, who used the EMS at least four times in 2014, were included, excluding transport between hospitals. Information on the prehospital assessment on-scene and the final diagnosis was collected from the EMS and hospital case records. Results In all, 339 individual patients who used the EMS on 1,855 occasions were included, accounting for five percent of all missions. Fifty percent were women. The age range was 10-98 years, but more than 50.0% were in the age range of 70-89 years. The most common emergency signs and symptoms (ESS) codes on the scene were dyspnea, chest pain, and abdominal pain. The most common final diagnosis was chronic obstructive pulmonary disease (eight percent). Thirteen percent of all cases had a final diagnosis defined as a potentially life-threatening condition. Among these, 22.0% of prehospital assessments were retrospectively judged as potentially inappropriate. Forty-nine percent had a defined final diagnosis not fulfilling the criteria for a potentially life-threatening condition. Among these cases, 30.0% of prehospital assessments were retrospectively judged as potentially inappropriate. Conclusion: Among patients who used EMS on multiple occasions, the most common symptoms on-scene were dyspnea, chest pain, and abdominal pain. The most common final diagnosis was chronic obstructive pulmonary disease. In 13.0%, the final diagnosis of a potentially life-threatening condition was indicated. In a minority of these cases, the assessment on-scene was judged as potentially inappropriate. Tärnqvist J , Dahlén E , Norberg G , Magnusson C , Herlitz J , Strömsöe A , Axelsson C , Andersson Hagiwara M . On-Scene and Final Assessments and Their Interrelationship Among Patients Who Use the EMS on Multiple Occasions. Prehosp Disaster Med. 2017;32(5):1–8.

  • 49.
    Wireklint Sundström, Birgitta
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Andersson Hagiwara, Magnus
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Brink, Peter
    NU-Hospital Organisation.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Hansson, Per-Olof
    University of Gothenburg.
    The early chain of care and risk of death in acute stroke in relation to the priority given at the dispatch centre: A multicentre observational study2017Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, Vol. 16, nr 7, s. 623-631Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background:The early chain of care is critical for stroke patients. The most important part is the so-called 'system delay' i.e. the delay time from call to the emergency medical services until a diagnosis is established (computer tomography).Aim:The purpose of this study was to relate the initial priority level given by the dispatch centre to the early chain of care in acute stroke and to short-term and long-term mortality.Methods:All patients hospitalised with the first and the final diagnosis of acute stroke, 15 December 2010?15 April 2011, were recruited across nine hospitals, each hospital with a stroke care unit.Results:In all, 897 stroke patients were included. Priority at the dispatch centre: 54% received highest priority 1, 41% priority 2 and 5% priority 3. Median system delay from call to emergency medical services until diagnosis by computer tomography was 2 h and 52 min, 4 h and 49 min and 6 h and 33 min respectively in the three priority groups (p<0.0001). There was a similarly strong association between priority level at the dispatch centre and system delay to arrival in a hospital ward, suspicion of stroke by the emergency medical services nurse as well as the physician on hospital admission and the proportion of patients given thrombolysis. Mortality during the subsequent 30 days was 22% among patients with priority 1 and 14% among patients with priority 2.Conclusion:Patients given a lower priority level at the dispatch centre had the longest system delay. Although many of these patients died, the risk of death was highest among those given the highest priority.

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