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  • 801. Svensson, L
    et al.
    Karlsson, T
    Nordlander, R
    Wahlin, M
    Zedigh, C
    Herlitz, Johan
    [external].
    Implementation of prehospital thrombolysis in Sweden. Components of delay until delivery of treatment and examination of treatment feasibility2003Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 88, nr 2-3, s. 247-256Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To evaluate the feasibility of prehospital thrombolysis in Sweden in terms of safety and to examine the various components of the delay between onset of symptoms and start of treatment. SETTING: A total of 16 hospitals in Sweden in both urban and less populated areas and the associated ambulance organisations. DESIGN: Prospective evaluation of patients with an ST-elevation infarction treated with reteplase. An ECG was recorded and transmitted to hospital. The ambulances were staffed by a physician in 1% of cases, a nurse in 67% and a staff nurse in 32%. RESULTS: Of the 148 patients who received treatment prior to hospital admission, six (4%) had a cardiac arrest prior to hospital admission and two (1%) died prior to arrival at hospital. One patient was given treatment despite an exclusion criterion (previous stroke) and died on the 1st day in hospital due to a cerebral haemorrhage. The overall 30-day mortality was 7.1% and 1-year mortality 9.8%. Treatment was initiated within 2 h after the onset of symptoms in 53% of patients and within 1 h in 17% of patients. The median interval between the arrival of the ambulance and sending an ECG was 13 min and the median interval between sending an ECG and the start of thrombolysis was 18 min. The delay was similar regardless of ambulance staff. CONCLUSION: Implementation of prehospital thrombolysis on a national basis in Sweden appears to be safe. More than half the patients can be given treatment less than 2 h after the onset of symptoms. There is potential for reducing this time still further.

  • 802. Svensson, L
    et al.
    Nilsson, J
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Svensson, Leif ()
    Allmän rytmdiagnostik utifrån prehospital EKG2009Inngår i: Prehospital akutsjukvård, Liber AB , 2009, s. 279-294Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 803. Svensson, L
    et al.
    Nordlander, E
    Axelsson, C
    [external].
    Herlitz, Johan
    [external].
    Are predictors for myocardial infarction the same for women and men when evaluated prior to hospital admission?2006Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 109, nr 2, s. 241-247Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM: To describe predictors of myocardial infarction prior to hospital admission in women and men among patients with a suspected acute coronary syndrome without ST-elevation. DESIGN: Prospective observational study in Stockholm and Göteborg, Sweden. RESULTS: Of 433 patients who did fulfill the inclusion criteria 45% were women. Fewer women (17%) than men (26%) developed acute myocardial infarction (AMI) (p=0.054), particularly among patients with initial ST-depression, in whom AMI was developed in 22% of women and 54% of men (p = 0.001). Predictors for infarct development in women were: a history of AMI and advanced age. Among men they were: initial ST-depression or a Q-wave on ECG and elevation of biochemical markers (both recorded on admission of the ambulance crew). There was a significant interaction between gender and the influence of ST-depression on the risk for development of myocardial infarction (p < 0.05). CONCLUSION: Among patients transported with ambulance due to a suspected acute coronary syndrome and no ST-elevation fewer women than men seem to develop AMI particularly among patients with ST-depression. These results suggest that early prediction of myocardial infarction might differ between women and men with acute chest pain.

  • 804. Svensson, L
    et al.
    Wahlin, R
    Castrén, M
    Rosenqvist, M
    Hollenberg, J
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Fler kan räddas efter hjärtstopp utanför sjukhus. 10.000 drabbs varje år: bara drygt 300 överlever2010Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 107, nr 8, s. 502-505Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [sv]

    Hjärtstopp utanför sjukhus är vanligt, och få överlever. Alltför få patienter nås i tid av den reguljära ambulanssjukvården. Tidig hjärt–lungräddning (före ambulansens ankomst) kan dubblera, till och med tredubbla, överlevnaden. Överlevnadsvinster har internationellt kunnat påvisas med i stort sett alla ambulanssamverkande system som polis, väktare och brandmän. God långtidsprognos hos överlevare av hjärtstopp utan­för sjukhus kan påvisas. Vinsten med att placera ut hjärtstartare på allmänna platser är ännu inte väldokumenterad.

  • 805. Svensson, Leif
    et al.
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Bång, Angela
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Bremer, Anders
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Suserud, Björn-Ove
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Cirkulation, Bröstsmärtor2009Inngår i: Prehospital akutsjukvård, Stockholm: Liber , 2009, s. 264-278Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 806. Svensson, Leif
    et al.
    Nilsson, Jens
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Svensson, Leif ()
    Allmän rytmdiagnostik utifrån prehospitalt EKG2009Inngår i: Prehospital akutsjukvård, Stockholm: Liber , 2009, s. 279-295Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 807. Södersved Källestedt, M-L
    et al.
    Rosenblad, A
    Leppert, J
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Enlund, M
    Hospital employees' theoretical knowledge on what to do in an in-hospital cardiac arrest2010Inngår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 18, nr 43Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background Guidelines recommend that all health care professionals should be able to perform cardiopulmonary resuscitation (CPR), including the use of an automated external defibrillator. Theoretical knowledge of CPR is then necessary. The aim of this study was to investigate how much theoretical knowledge in CPR would increase among all categories of health care professionals lacking training in CPR, in an intervention hospital, after a systematic standardised training. Their results were compared with the staff at a control hospital with an ongoing annual CPR training programme. Methods Health care professionals at two hospitals, with a total of 3144 employees, answered a multiple-choice questionnaire before and after training in CPR. Bootstrapped chi-square tests and Fisher's exact test were used for the statistical analyses. Results In the intervention hospital, physicians had the highest knowledge pre-test, but other health care professionals including nurses and assistant nurses reached a relatively high level post-test. Improvement was inversely related to the level of previous knowledge and was thus most marked among other health care professionals and least marked among physicians. The staff at the control hospital had a significantly higher level of knowledge pre-test than the intervention hospital, whereas the opposite was found post-test. Conclusions Overall theoretical knowledge increased after systematic standardised training in CPR. The increase was more pronounced for those without previous training and for those staff categories with the least medical education.

  • 808. Thang, ND
    et al.
    Karlson, BW
    Santos, M
    Bengtson, A
    Johanson, P
    Rawshani, A
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Characteristics of and outcome for patients with chest pain in relation to transport by the emergency medical services in a 20-year perspective.2012Inngår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 30, nr 9, s. 1788-1795Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim The aims of this study were to describe the characteristics of and outcome of patients with chest pain in relation to transport by the emergency medical services (EMS) and to describe possible changes in this relationship in a 20-year perspective. Methods In the 2 periods, 1986 to 1987 and 2008, all patients with chest pain admitted to hospitals in Gothenburg, Sweden, were retrospectively evaluated in terms of previous history, final diagnosis, and mortality. P values were age adjusted. Results In 1986 to 1987 and 2008, 34% of 4270 patients with chest pain and 39% of 2286 patients, respectively, were transported to the hospital by the EMS (P = .0001). In both periods, patients who used EMS were older and had a higher prevalence of previous cardiovascular diseases and more often had a final diagnosis of acute myocardial infarction (AMI) than those who did not use EMS. The EMS users were more frequently hospitalized in 1986 to 1987 than in 2008 (P < .0001). Emergency medical service use was related to a significantly higher age-adjusted 1-year mortality in both periods for all patients with chest pain as well as for those hospitalized. Among hospitalized patients with myocardial ischemia and among patients with a final diagnosis of AMI, EMS use was associated with a higher 30-day mortality in 1986 to 1987. Regardless of the use of EMS, there was a decrease in the proportion of patients developing AMI as well as the rate of death at 30 days and 1 year in 2008 as compared with 1986 to 1987. Conclusions For 20 years, the proportion of patients with chest pain using the EMS increased. EMS users were more frequently hospitalized in 1986 to 1987 than in 2008. In overall terms, mortality was higher among EMS users than among nonusers in both periods. Among hospitalized patients with myocardial ischemia and among patients with a final diagnosis of AMI, EMS use was associated with a higher 30-day mortality only in 1986 to 1987.

  • 809. Thang, ND
    et al.
    Karlsson, BW
    Bergman, B
    Santos, M
    Karlsson, T
    Benttson, A
    Johanson, P
    Rawshani, A
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Patients admitted to hospital with chest pain-changes in a 20 year perspective.2013Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 166, nr 1, s. 141-146Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: To describe the differences in characteristics and outcome between two consecutive series of patients admitted to hospital with chest pain in a 20-year perspective. Particular emphasis is placed on changes in outcome in relation to the initial electrocardiogram (ECG). SUBJECTS: In the two periods, 1986-1987 and 2008, all patients with chest pain admitted to the study hospitals in Gothenburg, Sweden, were included. RESULTS: Five thousand and sixteen patients were registered in a period of 21 months in 1986-1987 and 2287 patients were registered during 3 months in 2008. In a comparison of the two time periods, the age of chest pain patients was not significantly different (mean age 60.1 ± 17.8 years in 1986-1987 and 59.8 ± 19.1 years in 2008, p=0.50). There was a lower prevalence of previous angina pectoris, congestive heart failure and current smoking in the second period, whereas a history of acute myocardial infarction, hypertension and diabetes mellitus had become more prevalent. The use of cardio-protective drugs increased and ECG changes indicating acute myocardial ischemia on admission to hospital decreased. Length of hospitalisation was reduced from a median of 5 days to 3 days (p<0.0001). A significant decrease in 30-day and 1-year mortality was found (3.8% in 1986-1987 vs 2.0% in 2008 and 9.9% vs 6.3% respectively, p<0.0001 for both comparisons). CONCLUSIONS: During a period of 20 years, the characteristics and outcome of patients admitted to hospital with chest pain changed. The most important changes were a lower prevalence of ECG signs indicating acute myocardial ischemia on admission, shorter hospitalisation time and a lower 30-day and 1-year mortality.

  • 810.
    Thang, ND
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Karlsson, T
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Karlsson, BW
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    ECG signs of acute myocardial ischemiain the prehospital setting of a suspected acute coronary syndrome and its association with outcomes2014Inngår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 32, nr 6, s. 601-605Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIMS: The aims of this study were (a) to determine the prehospital prevalence of electrocardiographic (ECG) signs of acute myocardial ischemia in patients with suspected acute coronary syndrome and (b) to describe the relationships between the various ECG patterns and the diagnosis of acute myocardial infarction (AMI) and outcomes. METHODS: Prospective cohort study using data from an interventional trial in acute chest pain patients transported by the emergency medical services. These patients were classified into 3 groups: patients with ECG showing signs of acute myocardial ischemia, patients with ECG showing other abnormal changes (bundle-branch block, pacemaker rhythm, Q-wave or T-wave inversion) and patients without significant pathologic findings. All P values are age-adjusted. RESULTS: Among 1546 patients, 312 (20%) had ECG signs of acute myocardial ischemia. Of them, 57% had a final diagnosis of AMI versus 26% of those with other abnormal ECGs and 12% of those with ECG without significant pathologic findings (P<.0001). In all, 53% of all AMI cases involved patients without ECG signs of acute myocardial ischemia. Although ECG signs of acute myocardial ischemia predicted heart failure and ventricular tachyarrhythmias both prior to and after hospital admission, there was no significant difference in 30-day mortality between the 3 patient groups (4.3%, 3.7%, and 1.2%, respectively, P=.11). CONCLUSION: Among patients with a clinical suspicion of AMI in the prehospital setting, the prevalence of ECG signs suggesting AMI was low, as was the ability to identify AMI patients using ECG findings only. We therefore need better instruments in the prehospital triage of patients with acute chest pain.

  • 811. Thang, Nguyen Dang
    et al.
    Karlson, Björn Wilgot
    Karlsson, Thomas
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Characteristics of and outcomes for elderly patients with acute myocardial infarction: differences between females and males2016Inngår i: Clinical Interventions in Aging, ISSN 1176-9092, E-ISSN 1178-1998, Vol. 11, s. 1309-1316Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: This study analyzed age-adjusted sex differences among acute myocardial infarction (AMI) patients aged 75 years and above with regard to 7-year mortality (primary end point) and the frequency of angiograms and admission to the coronary care unit (CCU) as well as 1-year mortality (secondary end points).

    METHODS: A retrospective cohort study comprised 1,414 AMI patients (748 females and 666 males) aged at least 75 years, who were admitted to Sahlgrenska University Hospital in Gothenburg, Sweden, during two periods (2001/2002 and 2007). All comparisons between female and male patients were age adjusted.

    RESULTS: Females were older and their previous history included fewer AMIs, coronary artery bypass grafting procedures, and renal diseases, but more frequent incidence of hypertension. On the contrary, males had higher age-adjusted 7-year mortality in relation to females (hazard ratio [HR] 1.16 with corresponding 95% confidence interval [95% CI 1.03, 1.31], P=0.02). Admission to the CCU was more frequent among males than females (odds ratio [OR] 1.38 [95% CI 1.11, 1.72], P=0.004). There was a nonsignificant trend toward more coronary angiographies performed among males (OR 1.34 [95% CI 1.00, 1.79], P=0.05), as well as a nonsignificant trend toward higher 1-year mortality (HR 1.18 [95% CI 0.99, 1.39], P=0.06).

    CONCLUSION: In an AMI population aged 75 years and above, males had higher age-adjusted 7-year mortality and higher rate of admission to the CCU than females. One-year mortality did not differ significantly between the sexes, nor did the frequency of performed coronary angiograms.

  • 812.
    Thang, Nguyen Dang
    et al.
    Göteborgs Universitet.
    Karlson, Björn Wilgot
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Karlsson, Thomas
    Herlitz, Johan
    Pre-hospital prediction of death or cardiovascular complications during hospitalisation and death within one year in suspected acute coronary syndrome patients.2015Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 185, s. 308-312Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: To identify pre-hospital predictors of a) death or the development of cardiovascular complications during hospitalisation (primary objective) and b) all-cause death during one year of follow-up (secondary objective), in chest pain patients with suspected acute coronary syndrome (ACS).

    METHODS: A prospective study that comprised patients in western Sweden, who were transported to hospital by the emergency medical service (EMS) due to chest pain and suspected ACS. Multiple logistic regression was used to identify independent predictors of adverse outcomes.

    RESULTS: Among all 1600 eligible patients, 21% died or had a cardiovascular complication during hospitalisation and 10% died during one year of follow-up. Nine factors were identified pre-hospitalisation as independent predictors of death or cardiovascular complications during hospitalisation. They were increasing age, a history of congestive heart failure, nausea and/or vomiting, rapid breathing rate, low oxygen saturation, high heart rate, together with ST-segment elevation, ST-segment depression and right bundle branch block on the pre-hospital electrocardiogram (ECG). For the secondary objective of death during one year of follow-up, the following five factors were identified as independent predictors: increasing age, a history of congestive heart failure, dyspnea, low oxygen saturation and left bundle branch block on the pre-hospital ECG.

    CONCLUSIONS: In the pre-hospital setting of chest pain and suspected ACS, we identified nine predictors of the primary adverse outcome. They were factors representing previous history, symptoms and ECG findings. This information may contribute to the development of a decision support system for the EMS, which then needs to be clinically tested.

  • 813. Thoren, Anna
    et al.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Engdahl, Johan
    Rawshani, Araz
    Djärv, Therese
    ECG monitoring in inhospital cardiac arrest2019Konferansepaper (Fagfellevurdert)
  • 814. Thorén, A-B
    et al.
    Axelsson, Å
    Herlitz, Johan
    [external].
    DVD-based or instructor-led CPR education: a comparison.2007Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 72, nr 2, s. 333-334Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The ERC advocates home-based learning with the use of video or interactive CD as a method for enhancing CPR training.

  • 815. Thorén, A-B
    et al.
    Axelsson, Å
    Herlitz, Johan
    [external].
    Possibilities for, and obstacles to, CPR training among cardiac care patients and their co-habitants.2005Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 65, nr 3, s. 337-343Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM: To investigate the level of cardiopulmonary resuscitation (CPR) training among cardiac patients and their co-habitants and to describe the possibilities for, and obstacles to, CPR training among this group. METHODS: All patients admitted to a coronary care unit during a four-month period were considered for participation in an interview study. Out of 401 patients, 268 were co-habiting. This study deals with these subjects. RESULTS: According to the answers given by the patients, 46% of the patients and 33% of the co-habitants had attended a CPR course at some time. Among those who had not previously attended a course, 58% were willing to attend, and 60% of the patients whose co-habitant had not received CPR education, wanted him or her to attend a course. The major obstacle to CPR training was the patient's own medical status. The major obstacle to the co-habitant's participation was the patient's doubts concerning their partner's physical ability or willingness to participate. Younger persons were more often willing to undergo training than older persons (p < 0.0001). Of those patients who had previously attended a course or who were willing to undergo training, 72% were prepared to do so together with their co-habitant. A course specially designed for cardiac patients and their relatives was a possible alternative for 75% of those willing to participate together with their co-habitant. CONCLUSIONS: Two-thirds of the patients did not believe that their co-habitant had taken part in CPR training. More than half of these would like their co-habitant to attend such a course. Seventy-two percent were willing to participate in CPR instruction together with their co-habitant. Major obstacles to CPR training were doubts concerning the co-habitant's willingness or physical ability and their own medical status.

  • 816. Thorén, A-B
    et al.
    Axelsson, Å
    Herlitz, Johan
    [external].
    The attitude of cardiac care patients towards CPR and CPR education.2004Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 61, nr 2, s. 163-171Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The recommended targeting of the elderly, those with heart conditions and their family members for CPR education remains unaccomplished. Little is known about cardiac patients' knowledge of and attitude towards CPR and CPR education. This study aimed to investigate cardiac care patients' attitude towards CPR and interest in CPR education. An interview, based on a questionnaire, was conducted with 401 consecutive patients admitted to a coronary care unit. Most participants had heard about the concept of CPR and 64% were aware of its content. In the event of an emergency, 96% were willing to undergo CPR. Age, previous myocardial infarction and heart failure were significantly associated with the willingness or lack of willingness to undergo CPR. Forty percent of the participants had attended one or more courses but only a few within the last two years. The major reasons for not being educated in CPR were a lack of awareness of the availability of CPR training for the public, lack of interest or lack of enterprise. Among those not educated in CPR, 46% would like to attend a course. A hospital was the preferred location for the course, often due to the perceived higher competence of the instructors, but sometimes, because it offered a safe environment. The primary health care centre was preferred because of its location near the participants' homes. In order to increase the proportion of people trained in CPR in target groups such as cardiac care patients and their family members, healthcare professionals should provide patients with information and opportunities to attend locally situated, professionally led courses.

  • 817. Thorén, A-B
    et al.
    Axelsson, Å
    Holmberg, S
    Herlitz, Johan
    [external].
    Measurement of skills in cardiopulmonary resuscitation: do professionals follow given guidelines?2001Inngår i: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 8, nr 3, s. 169-176Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Since it is suggested that only effective cardiopulmonary resuscitation (CPR) improves survival rates, quality control of training outcomes is important and comparisons between different training methods are desirable. The aim of this study was to test a model of quality assurance, consisting of a computer program combined with the Brennan et al. checklist, for evaluation of CPR performance. A small group of trained medical professionals (cardiac care unit nurses) (n = 10) was used in this pilot study. The result points out several points of concern: half of the participants did not open the airway prior to breathing control. Over 90% of all inflations were 'too fast' and 71% were 'too much'. Only 6.5% of the inflations were correct. On average, the participants made 5.4 inflations per minute. Concerning chest compressions, 40% were 'too deep' while only 4% were 'too shallow'. In spite of the fact that the participants had an average rate at 95 compressions per minute the number of compressions varied between 32 and 51 during 1 minute. When new guidelines are discussed, it would be beneficial if they were tested by a number of people to investigate if following the guidelines is at all possible.

  • 818. Thorén, A-B
    et al.
    Danielsson, E
    Herlitz, Johan
    [external].
    Axelsson, ÅB
    Spouses' experiences of a cardiac arrest at home: an interview study.2010Inngår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 9, nr 3, s. 161-167Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    INTRODUCTION: In case of out-of-hospital cardiac arrest (OHCA) influence of a bystander spouse is decisive for the chance of survival. AIM: To describe spouses' experiences of witnessing their partners' cardiac arrest at home, focusing on the time before the event and when it happened. METHODS: Interviews with fifteen spouses were recorded and transcribed verbatim. Qualitative content analysis was conducted. RESULTS: In the domain entitled "Time before cardiac arrest", four themes emerged in the analysis process: "Lack of early warning signs", "Difficulty interpreting early warning signs", "Interpreting signs in the light of previous illness" and "Denial of serious illness". In the domain entitled "The cardiac arrest event", three themes emerged: "Perceiving the seriousness", "Being unable to influence" and "Doing what is in one's power". The emergency call services' (ECS) ability to instruct and help the spouses to do what they can becomes evident in these themes. CONCLUSION: Spouses who experienced OHCA demonstrated a lack of confidence in or ability to interpret early warning signs and symptoms. This lack of confidence also extended to the process of cardiopulmonary resuscitation (CPR). The support from the ECS and CPR training was acknowledged as helpful and important. Further research is required to determine which interventions can improve people's ability to intervene as early as possible.

  • 819. Thuresson, M
    et al.
    Berglin Jarlöv, M
    Lindahl, B
    Svensson, L
    Zedigh, C
    Herlitz, Johan
    [external].
    Factors that influence the use of ambulance in acute coronary syndrome.2008Inngår i: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 156, nr 1, s. 170-176Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: National guidelines recommend activation of the emergency medical service by patients who have symptoms of acute coronary syndrome (ACS). In spite of this, only 50% to 60% of persons with myocardial infarction initiate care by using the emergency medical service. The aim of this study was to define factors influencing the use of ambulance in ACS. METHODS: The method used in this study was a national survey comprising intensive cardiac care units at 11 hospitals in Sweden; 1,939 patients with diagnosed ACS and symptom onset outside the hospital completed a questionnaire a few days after admission. RESULTS: Half of the patients went to the hospital by ambulance. Factors associated with ambulance use were knowledge of the importance of quickly seeking medical care and calling for an ambulance when having chest pain (odds ratio [OR] 3.61, 95% CI 2.43-5.45), abrupt onset of pain reaching maximum intensity within minutes (OR 2.08, 1.62-2.69), nausea or cold sweat (OR 2.02, 1.54-2.65), vertigo or near syncope (OR 1.63, 1.21-2.20), ST-elevation ACS (OR 1.58, 1.21-2.06), increasing age (per year) (OR 1.03, 1.02-1.04), previous history of heart failure (OR 2.48, 1.47-4.26), and distance to the hospital of >5 km (OR 2.0, 1.55-2.59). Those who did not call for an ambulance thought self-transport would be faster or did not believe they were sick enough. CONCLUSIONS: Symptoms, patient characteristics, ACS characteristics, and perceptions and knowledge were all associated with ambulance use in ACS. The fact that knowledge increases ambulance use and the need for behavioral change pose a challenge for health-care professionals.

  • 820. Thuresson, M
    et al.
    Berglin Jarlöv, M
    Lindahl, B
    Svensson, L
    Zedigh, C
    Herlitz, Johan
    [external].
    Thoughts, actions, and factors associated with prehospital delay in patients with acute coronary syndrome.2007Inngår i: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 36, nr 6, s. 398-409Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: The objective was to study patients' interpretations, thoughts, and actions after symptom onset in acute coronary syndrome (ACS) in total and in relation to gender, age, history of coronary artery disease, type of syndrome, and residential area and its influence on prehospital delay. SETTING: We performed a national survey comprising intensive cardiac care units at 11 hospitals in Sweden. METHOD: A total of 1,939 patients with diagnosed ACS and symptom onset outside hospital completed a questionnaire containing standardized questions within 3 days after admission. RESULTS: Three-quarters of the patients interpreted their symptoms as cardiac in origin, and the most common reason was that they knew someone who had had an acute myocardial infarction. The majority contacted a family member, whereas only 3% directly called for an ambulance. Interpreting the symptoms as cardiac in origin and severe pain were major reasons for deciding to seek medical care. Approaching someone after symptom onset and the belief that the symptoms were cardiac in origin were factors associated with a shorter prehospital delay, whereas taking medication to relieve pain resulted in the opposite. The reaction pattern was influenced by gender, age, a history of coronary artery disease, and the type of ACS, but to a lesser extent by residential area. CONCLUSIONS: Interpreting symptoms as cardiac in origin and approaching someone after symptom onset were major reasons for a shorter prehospital delay in ACS.

  • 821. Thuresson, M
    et al.
    Haglund, P
    Ryttberg, B
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Nilsson, U
    Impact of an information campaign on delays and ambulance use in acute coronary syndrome2014Inngår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 33, nr 2, s. 297-298Artikkel i tidsskrift (Fagfellevurdert)
  • 822. Thuresson, M
    et al.
    Jarlöv, MB
    Lindahl, B
    Svensson, L
    Zedigh, C
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Factors that influence the use of ambulance in acute coronary syndrome2008Inngår i: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 156, nr 1, s. 170-176Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: National guidelines recommend activation of the emergency medical service by patients who have symptoms of acute coronary syndrome (ACS). In spite of this, only 50% to 60% of persons with myocardial infarction initiate care by using the emergency medical service. The aim of this study was to define factors influencing the use of ambulance in ACS. METHODS: The method used in this study was a national survey comprising intensive cardiac care units at 11 hospitals in Sweden; 1,939 patients with diagnosed ACS and symptom onset outside the hospital completed a questionnaire a few days after admission. RESULTS: Half of the patients went to the hospital by ambulance. Factors associated with ambulance use were knowledge of the importance of quickly seeking medical care and calling for an ambulance when having chest pain (odds ratio [OR] 3.61, 95% CI 2.43-5.45), abrupt onset of pain reaching maximum intensity within minutes (OR 2.08, 1.62-2.69), nausea or cold sweat (OR 2.02, 1.54-2.65), vertigo or near syncope (OR 1.63, 1.21-2.20), ST-elevation ACS (OR 1.58, 1.21-2.06), increasing age (per year) (OR 1.03, 1.02-1.04), previous history of heart failure (OR 2.48, 1.47-4.26), and distance to the hospital of >5 km (OR 2.0, 1.55-2.59). Those who did not call for an ambulance thought self-transport would be faster or did not believe they were sick enough. CONCLUSIONS: Symptoms, patient characteristics, ACS characteristics, and perceptions and knowledge were all associated with ambulance use in ACS. The fact that knowledge increases ambulance use and the need for behavioral change pose a challenge for health-care professionals.

  • 823. Thuresson, M
    et al.
    Jarlöv, MB
    Lindahl, B
    Svensson, L
    Zedigh, C
    Herlitz, Johan
    [external].
    Symptoms and type of symptom onset in acute coronary syndrome in relation to ST elevation, sex, age, and a history of diabetes.2005Inngår i: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 150, nr 2, s. 234-242Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Various efforts to reduce patient delay in acute coronary syndrome (ACS) have had limited success. One reason might be a misinterpretation of the symptoms of ACS. The aim of this study was therefore to explore the characteristics and severity of symptoms among patients with an ACS in overall terms and in relation to the type of ACS, sex, age, and diabetes. METHODS: A total of 1939 patients at 11 hospitals in Sweden answered a questionnaire containing questions relating to the localization and intensity of symptoms, the presence of associated symptoms, the characteristics and experience of pain/symptoms, and the type of symptom onset. RESULTS: Patients with ST elevation differed from those without by more frequently having associated symptoms. They had higher pain/discomfort intensity and more frequently had pain with abrupt onset reaching maximum intensity within minutes. However, this type of symptom onset was only seen in less than half the patients with ST elevation and only 1 in 5 fulfilled all the criteria usually associated with a severe heart attack. Women differed from men in a few respects. They more frequently reported pain/discomfort in the neck or jaw and back, vomiting, and scored their pain/discomfort slightly higher than men. Differences between age groups were minor and there was no difference between patients with and without diabetes. CONCLUSIONS: The most striking finding was the low proportion of patients with the type of symptoms that are commonly associated with ACS. This is important for the planning of educational campaigns/programs to reduce patient delay.

  • 824.
    Torell, Matilda F
    et al.
    Sahlgrenska University Hospital.
    Strömsöe, Anneli
    Dalarna University.
    Zagerholm, Ellen
    Sahlgrenska University Hospital.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Claesson, Andreas
    Karolinska Institutet.
    Svensson, Leif
    Karolinska Institutet.
    Börjesson, Mats
    Sahlgrenska University Hospital.
    Higher survival rates in exercise-related out-of-hospital cardiac arrests, compared to non-exercise-related - a study from the Swedish Register of Cardiopulmonary Resuscitation.2017Inngår i: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 24, nr 15, s. 1673-1679Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background Despite the positive effects of physical activity, the risk of sudden cardiac arrest is transiently increased during and immediately after exercise. The purpose of this study was to assess the incidence of exercise-related out-of-hospital cardiac arrest in the general population and to compare characteristics and prognosis of these cardiac arrests with non-exercise-related out-of-hospital cardiac arrests. Methods Data from all cases of treated out-of-hospital cardiac arrest outside of home reported to the Swedish Register of Cardiopulmonary Resuscitation from 2011-2015 in three counties of Sweden were investigated (population 2.1 m). This registry captures almost 100% of all out-of-hospital cardiac arrests in Sweden. Results Of 1825 out-of hospital cardiac arrests, 137 (7.5%) were exercise-related, resulting in an incidence of 1.2 per 100,000 person-years. The 30-day survival rate was significantly higher among exercise-related out-of hospital cardiac arrests compared to non-exercise-related out-of-hospital cardiac arrests (54.3 % vs 19.4%, p < 0.0001). Patients suffering an exercise-related out-of-hospital cardiac arrest were on average 10 years younger than those who had a non-exercise-related out-of-hospital cardiac arrest, 56.4 years compared to 67.2 years. Exercise-related out-of-hospital cardiac arrests were more often witnessed (89.4% vs 78.6%, p = 0.002), had higher rates of bystander cardiopulmonary resuscitation (80.3% vs 61.0%, p < 0.0001) and were more frequently connected to an automated external defibrillator (20.4% vs 4.6%, p < 0.0001). Conclusions Cardiac arrests that occur in relation to exercise have a significantly better prognosis and outcome than non-exercise-related cardiac arrests. This may be explained by favourable circumstances but may also reflect that these persons experience a sudden cardiac arrest at a lower degree of coronary artery disease, due to their younger age and to exercise being a trigger.

  • 825.
    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 Occasions2017Inngår i: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 32, nr 5, s. 528-535Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 826. Vargas, A
    et al.
    Doliszny, K
    Herlitz, Johan
    [external].
    Karlsson, T
    McGovern, P
    Brandrup-Wognsen, G
    Luepker, RV
    Characteristics and outcomes among patients undergoing coronary artery bypass grafting in western Sweden and Minneapolis-St Paul USA, Minnesota2001Inngår i: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 142, nr 6, s. 1080-1087Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background The purpose of this study was to compare patient selection, operative factors, and survival for coronary artery bypass grafting (CABG) for coronary heart disease in Minneapolis–St Paul (MSP), Minnesota, and Western Sweden (WS). Methods and Results All patients from WS between 1988 and 1991 (n = 2365) and a 17% random sample of MSP patients between 1985 and 1990 (n = 1659) who underwent CABG surgery were studied. CABG was 3 times greater in MSP. MSP patients had significantly more obesity, cigarette smoking, prior CABG, and prior coronary angioplasty. WS patients had more and longer angina pectoris, better left ventricular function, and waited longer from previous acute MI until CABG. WS patients had more internal mammary artery graphs and a shorter aortic cross-clamp time. At discharge, WS patients received more β-blockers and antiplatelet agents, whereas MSP patients received more calcium channel blockers and digitalis. Age-adjusted mortality rate at 28 days was significantly higher in MSP but not at 3 years. Adjustment for patient characteristics and treatment factors reduced or eliminated these differences. Conclusions Although coronary heart disease rates were higher in WS, age-adjusted CABG rates were 3-fold higher in MSP. Better survival among WS patients was associated with differences in patient selection and clinical and treatment characteristics because MSP patients were more severely ill and at increased risk. Health system characteristics and practice may account for these differences.

  • 827.
    Viktorisson, Adam
    et al.
    Rehabilitation Medicine, Institute of Neuroscience and Physiology at Sahlgrenska Academy.
    Sunnerhagen, Katharina S
    Rehabilitation Medicine, Institute of Neuroscience and Physiology at Sahlgrenska Academy.
    Johansson, Dongni
    Rehabilitation Medicine, Institute of Neuroscience and Physiology at Sahlgrenska Academy.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. Department of Metabolism and Cardiovascular Research, Institute of Internal Medicine at Sahlgrenska University Hospital.
    Axelsson, Åsa
    Institute of Health and Care Sciences at Sahlgrenska Academy, University of Gothenburg.
    One-year longitudinal study of psychological distress and self-assessed health in survivors of out-of-hospital cardiac arrest.2019Inngår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, nr 7, artikkel-id e029756Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: Few studies have investigated the psychological and health-related outcome after out-of-hospital cardiac arrest (OHCA) over time. This longitudinal study aims to evaluate psychological distress in terms of anxiety and depression, self-assessed health and predictors of these outcomes in survivors of OHCA, 3 and 12 months after resuscitation.

    METHODS: Recruitment took place from 2008 to 2011 and survivors of OHCA were identified through the national Swedish Cardiopulmonary Resuscitation Registry. Inclusion criteria were age ≥18 years, survival ≥12 months and a Cerebral Performance Category score ≤2. Questionnaires containing the Hospital Anxiety and Depression Scale and European Quality of Life 5 Dimensions 3 Level (EQ-5D-3L) were administered at 3 and 12 months after the OHCA. Participants were also asked to report treatment-requiring comorbidities.

    RESULTS: Of 298 survivors, 85 (29%) were eligible for this study and 74 (25%) responded. Clinically relevant anxiety was reported by 22 survivors at 3 months and by 17 at 12 months, while clinical depression was reported by 10 at 3 months and 4 at 12 months. The mean EQ-5D-3L index value increased from 0.82 (±0.26) to 0.88 (±0.15) over time. There were significantly less symptoms of psychological distress (p=0.01) and better self-assessed health (p=0.003) at 12 months. Treatment-requiring comorbidity predicted anxiety (OR 4.07, p=0.04), while being female and young age predicted poor health (OR 6.33, p=0.04; OR 0.91, p=0.002) at 3 months. At 12 months, being female was linked to anxiety (OR 9.23, p=0.01) and depression (OR 14.78, p=0.002), while young age predicted poor health (OR 0.93, p=0.003).

    CONCLUSION: The level of psychological distress and self-assessed health improves among survivors of OHCA between 3 and 12 months after resuscitation. Higher levels of psychological distress can be expected among female survivors and those with comorbidity, while survivors of young age and who are female are at greater risk of poor health.

  • 828.
    Viktorisson, Adam
    et al.
    1 Institute of Neuroscience and Physiology, Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg.
    Sunnerhagen, Katharina S
    Institute of Neuroscience and Physiology, Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg.
    Pöder, Ulrika
    Department of Public Health and Caring Sciences, Uppsala University.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Axelsson, Åsa B
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg.
    Well-being among survivors of out-of-hospital cardiac arrest: a cross-sectional retrospective study in Sweden.2018Inngår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, nr 6, artikkel-id e021729Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: The psychological outcome of out-of-hospital cardiac arrest (OHCA) has been studied more extensively in recent years. Still, not much is known about the well-being among OHCA survivors. In this retrospective cross-sectional study, we aim to investigate post-OHCA well-being among patients with a good neurological outcome, 3 months after the cardiac event. To assess well-being, we analyse the frequency of anxiety, depression, post-traumatic stress disorder (PTSD) and health within this group. Further, we aim to evaluate the importance of five prognostic factors for post-OHCA well-being.

    METHODS: Data collection took place between 2008 and 2012, and every OHCA survivor within one region of Sweden, with a cerebral performance category (CPC) score of ≤2 at discharge, was asked to participate. Survivors were identified through the Swedish Cardiopulmonary Resuscitation Registry, and postal questionnaires were sent out 3 months after the OHCA. The survey included Hospital Anxiety and Depression scale (HADS), PTSD Checklist Civilian version (PCL-C) and European Quality of Life 5 Dimensions 3 level (EQ-5D-3L).

    RESULTS: Of 298 survivors, 150 were eligible for this study and 94 responded. The mean time from OHCA to follow-up was 88 days. There was no significant difference between respondents and non-respondents in terms of sex, age, cardiac arrest circumstances or in-hospital interventions. 48 participants reported reduced well-being, and young age was the only factor significantly correlated to this outcome (p=0.02). Women reported significantly higher scores in HADS (p=0.001) and PCL-C (p<0.001). Women also reported significantly lower EQ-5D index values (p=0.002) and EQ-visual analogue scale scores (p=0.002) compared with men.

    CONCLUSION: Reduced well-being is experienced by half of OHCA survivors with a CPC score ≤2, and young age is negatively correlated to this outcome. The frequency of anxiety and PTSD is higher among women, who also report worse health.

  • 829. Waagstein, F
    et al.
    Herlitz, Johan
    [external].
    Hjalmarson, Å
    Metoder för effektregistrering vid hjärtinfarkt1983Inngår i: Proceedings of Nordiskt Symposium "Klinisk Läkemedelsprövning", Göteborg 1982, A Lindrgren och söner AB , 1983, s. 97-110Konferansepaper (Fagfellevurdert)
  • 830.
    Wennberg, Pär
    et al.
    Research and Development Centre, Skaraborg Hospital, Skövde.
    Möller, Margareta
    University Health Care Research Center, Region Örebro and School of Health and Medical Sciences, Örebro University.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Kenne Sarenmalm, Elisabeth
    Research and Development Centre, Skaraborg Hospital, Skövde.
    Fascia iliaca compartment block as a preoperative analgesic in elderly patients with hip fractures - effects on cognition.2019Inngår i: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 19, nr 1, artikkel-id 252Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Impaired cognition is a major risk factor for perioperative delirium. It is essential to provide good pain control in patients with hip fractures and especially important in patients with severely impaired cognitive status, as they receive less pain medication, have poorer mobility, poorer quality of life and higher mortality than patients with intact cognition. The purpose of this study was to examine the association between preoperative pain management with nerve blocks and cognitive status in patients with hip fractures during the perioperative period.

    METHODS: One hundred and twenty-seven patients with hip fractures participating in a double-blind, randomised, controlled trial were included in this study. At hospital admission, a low-dose fascia iliaca compartment block (FICB) was administered as a supplement to regular analgesia. Cognitive status was registered on arrival at hospital before FICB and on the first postoperative day using the Short Portable Mental Status Questionnaire.

    RESULTS: Changes in cognitive status from arrival at hospital to the first postoperative day showed a positive, albeit not significant, trend in favour of the intervention group. The results also showed that patients with no or a moderate cognitive impairment received 50% more prehospital pain medication than patients with a severe cognitive impairment. FICB was well tolerated in patients with hip fractures.

    CONCLUSION: Fascia iliaca compartment block given to patients with hip fractures did not affect cognitive status in this study. Patients with a cognitive impairment may receive inadequate pain relief after hip fracture and this discrimination needs to be addressed in further studies.

    TRIAL REGISTRATION: EudraCT number 2008-004303-59 date of registration: 2008-10-24.

  • 831.
    Wennberg, Pär
    et al.
    Research and Development Centre, Skaraborg Hospital, Skövde.
    Norlin, Rolf
    Capio Movement, Halmstad, Sweden; Department of Orthopedics, Örebro University Hospital, and Örebro University.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Sarenmalm, Elisabeth Kenne
    Research and Development Centre, Skaraborg Hospital, Skövde.
    Möller, Margareta
    University Health Care Research Centre, Region Örebro, and School of Health Sciences, Örebro University.
    Pre-operative pain management with nerve block in patients with hip fractures: a randomized, controlled trial.2019Inngår i: International Journal of Orthopaedic and Trauma Nursing, ISSN 1878-1241, E-ISSN 1878-1292, Vol. 33, s. 35-43, artikkel-id S1878-1241(18)30001-7Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    INTRODUCTION: Pain management in patients with hip fractures is a major challenge for emergency care. The objective of this study was to evaluate whether the supplementation of pre-operative analgesia with low-dose fascia iliaca compartment block (FICB) compared with placebo would improve pain relief in patients with hip fractures.

    METHODS: A double-blind, randomized, controlled trial was conducted on 127 patients. At hospital admission, a low-dose FICB was administered to patients with hip fractures as a supplement to regular pre-operative analgesia. Patients with and without cognitive impairment were included. The instruments used were a visual analogue scale (VAS), a numerical rating scale and a tool for behavior related pain assessment. The primary endpoint was the change in reported pain on movement from hospital admission to two hours after FICB.

    RESULTS: The intervention group showed improved pain management by mean VAS score for pain on movement compared with the control group (p = 0.002).

    CONCLUSIONS: Our results support the use of low-dose FICB as a pain-relieving adjuvant to other analgesics when administered to patients with a hip fracture.

  • 832. Wennman, I
    et al.
    Klittermark, P
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Lernfelt, B
    Kihlgren, M
    Gustafsson, C
    Hansson, PO
    The clinical consequences of a pre-hospital diagnosis of stroke by the emergency medical service system. A pilot study.2012Inngår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 20, nr 48Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background There is still a considerable delay between the onset of symptoms and arrival at a stroke unit for most patients with acute stroke. The aim of the study was to describe the feasibility of a pre-hospital diagnosis of stroke by an emergency medical service (EMS) nurse in terms of diagnostic accuracy and delay from dialing 112 until arrival at a stroke unit. Methods Between September 2008 and November 2009, a subset of patients with presumed acute stroke in the pre-hospital setting were admitted by EMS staff directly to a stroke unit, bypassing the emergency department. A control group, matched for a number of background variables, was created. Results In all, there were 53 patients in the direct admission group, and 49 patients in the control group. The median delay from calling for an ambulance until arrival at a stroke unit was 54 minutes in the direct admission group and 289 minutes in the control group (p < 0.0001). In a comparison between the direct admission group and the control group, a final diagnosis of stroke, transient ischemic attack (TIA) or the sequelae of prior stroke was found in 85% versus 90% (NS). Among stroke patients who lived at home prior to the event, the percentage of patients that were living at home after 3 months was 71% and 62% respectively (NS). Conclusions In a pilot study, the concept of a pre-hospital diagnosis of stroke by an EMS nurse was associated with relatively high diagnostic accuracy in terms of stroke-related diagnoses and a short delay to arrival at a stroke unit. These data need to be confirmed in larger studies, with a concomitant evaluation of the clinical consequences and, if possible, the level of patient satisfaction as well.

  • 833. Werling, M
    et al.
    Thorén, A-B
    Axelsson, C
    [external].
    Herlitz, Johan
    [external].
    Treatment and outcome in post-resuscitation care after out-of-hospital cardiac arrest when a modern therapeutic approach was introduced.2007Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 73, nr 1, s. 40-45Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: The outcome among patients who are hospitalised alive after out-of-hospital cardiac arrest is still relatively poor. At present, there are no clear guidelines specifying how they should be treated. The aim of this survey was to describe the outcome for initial survivors of out-of-hospital cardiac arrest when a more aggressive approach was applied. PATIENTS: All patients hospitalised alive after out-of-hospital cardiac arrest in the Municipality of Göteborg, Sweden, during a period of 20 months. RESULTS: Of all the patients in the municipality suffering an out-of-hospital cardiac arrest in whom cardiopulmonary resuscitation (CPR) was attempted (n=375), 85 patients (23%) were hospitalised alive and admitted to a hospital ward. Of them, 65% had a cardiac aetiology and 50% were found in ventricular fibrillation. In 32% of the patients, hypothermia was attempted, 28% underwent a coronary angiography and 21% had a mechanical revascularisation. In overall terms, 27 of the 85 patients who were brought alive to a hospital ward (32%) survived to 30 days after cardiac arrest. Survival was only moderately higher among patients treated with hypothermia versus not (37% versus 29%; NS), and it was markedly higher among those who had early coronary angiography versus not (67% versus 18%; p<0.0001). CONCLUSION: In an era in which a more aggressive attitude was applied in post-resuscitation care, we found that the survival (32%) was similar to that in previous surveys. However, early coronary angiography was associated with a marked increase in survival and might be of benefit to many of these patients. Larger registries are important to further confirm the value of hypothermia in representative patient populations

  • 834. Wibring, Kristoffer
    et al.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Christensson, Lennart
    Lingman, Markus
    Bång, Angela
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Prehospital factors associated with an acute life-threatening condition in non-traumatic chest pain patients - A systematic review.2016Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 219, s. 373-379Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Chest pain is a common symptom among patients contacting the emergency medical services (EMS). Risk stratification of these patients is warranted before arrival in hospital, regarding likelihood of an acute life-threatening condition (LTC).

    AIM: To identify factors associated with an increased risk of acute LTC among patients who call the EMS due to non-traumatic chest pain.

    METHODS: Several databases were searched for relevant articles. Identified articles were quality-assessed using the Scottish Intercollegiate Guidelines Network checklists. Extracted data was analysed using a semi-quantitative synthesis evaluating the level of evidence of each identified factor.

    RESULTS: In total, 10 of 1245 identified studies were included. These studies provided strong evidence for an increased risk of an acute LTC with increasing age, male gender, elevated heart rate, low systolic blood pressure and ST elevation or ST depression on a 12-lead ECG. The level of evidence regarding the history of myocardial infarction, angina pectoris or presence of a Q wave or a Left Bundle Branch Block on the ECG was moderate. The evidence was inconclusive regarding dyspnoea, cold sweat/paleness, nausea/vomiting, history of chronic heart failure, smoking, Right Bundle Branch Block or T-inversions on the ECG.

    CONCLUSIONS: Factors reflecting age, gender, myocardial ischemia and a compromised cardiovascular system predicted an increased risk of an acute life-threatening condition in the prehospital setting in cases of acute chest pain. These factors may form the basis for prehospital risk stratification in acute chest pain.

  • 835. Wibring, Kristoffer
    et al.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Lingman, Markus
    Bång, Angela
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Symptom description in patients with chest pain-A qualitative analysis of emergency medical calls involving high-risk conditions.2019Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 28, nr 15-16, s. 2844-2857Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIMS AND OBJECTIVES: To explore the symptoms descriptions and situational information provided by patients during ongoing chest pain events caused by a high-risk condition.

    BACKGROUND: Chest pain is a common symptom in patients contacting emergency dispatch centres. Only 15% of these patients are later classified as suffering from a high-risk condition. Prehospital personnel are largely dependent on symptom characteristics when trying to identify these patients.

    DESIGN: Qualitative descriptive.

    METHODS: Manifest content analysis of 56 emergency medical calls involving patients with chest pain was carried out. A stratified purposive sampling was used to obtain calls concerning patients with high-risk conditions. These calls were then listened to and transcribed. Thereafter, meaning units were identified and coded and finally categorised. Consolidated criteria for reporting qualitative studies guidelines have been applied.

    RESULTS: A wide range of situational information and symptoms descriptions was found. Pain and affected breathing were dominating aspects, but other situational information and several other symptoms were also reported. The situational information and these symptoms were classified into seven categories: Pain narrative, Affected breathing, Bodily reactions, Time, Bodily whereabouts, Fear and concern and Situation management. The seven categories consisted of 17 subcategories.

    CONCLUSIONS: Patients with chest pain caused by a high-risk condition present a wide range of symptoms which are described in a variety of ways. They describe different kinds of chest pain accompanied by pain from other parts of the body. Breathing difficulties and bodily reactions such as muscle weakness are also reported. The variety of symptoms and the absence of a typical symptomatology make risk stratification on the basis of symptoms alone difficult.

    RELEVANCE TO CLINICAL PRACTICE: This study highlights the importance of an open mind when assessing patients with chest pain and the requirement of a decision support tool in order to improve risk stratification in these patients.

  • 836. Wiklund, I
    et al.
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap. [external].
    Bengtsson, A
    Hjalmarson, Å
    Long-term follow-up of health related quality of life in patients with suspected acute myocardial infarction when the diagnosis was not confirmed1991Inngår i: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 9, nr 1, s. 47-52Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This study describes the outcome in terms of health-related quality of life (QL) five years after onset of symptoms in 397 patients with an initial suspicion of acute myocardial infarction (MI) but in whom the diagnosis was not confirmed. The patients were approached by means of a postal inquiry that comprised two questionnaires. The most pronounced impairment in health-related QL was expressed as decreased energy, whereas social life was the least affected area. The overall QL was very similar to that in patients who had a confirmed MI. Subsets of patients with impaired QL were those given the diagnosis of angina pectoris or possible infarction.

  • 837. Wiklund, I
    et al.
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap. [external].
    Hjalmarson, Å
    Quality of life five years after myocardial infarction1989Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 10, nr 5, s. 464-472Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In 539 patients 5 years after myocardial infarction (MI), quality of life and factors influencing life quality were studied. All patients originally participated in an early intervention trial with metoprolol. A cardiac follow-up questionnaire and the Nottingham Health Profile were answered by 82%. In the former, information about subjective symptoms, smoking, work and current medication was obtained; the latter described health-related quality of life in terms of energy, sleep, emotions, mobility, pain and social isolation. The rate of and the reasons for rehospitalization were registered in the patients' records. The MI patients reported a comparatively high quality of life. Compared with ‘normal’ population, a decrease was noted in energy, sleep and mobility, and in sex life, hobby-activity and holiday activity. A non-parametric multivariate analysis disclosed that dyspnoea, angina pectoris and anxiety were closely associated with decreased quality of life. In conclusion, 5 years after MI most patients seemed well-adjusted. Impaired quality of life was reported by patients suffering from angina pectoris, dyspnoea and emotional distress. No relationship was found between health-related quality of life and the beta blocker, metoprolol, which was the most frequently used drug.

  • 838. Wiklund, I
    et al.
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap. [external].
    Hjalmarson, Å
    Quality of life in postmyocardial infarction patients in relation to drug therapy1989Inngår i: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 7, nr 1, s. 13-18Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Quality of life (QL) was assessed in relation to drug therapy in 539 patients who were still alive five years after myocardial infarction (MI), and the interaction between drug therapy and QL was investigated. The patients originally participated in a double-blind trial that evaluated the effect of early administration of the beta blocker metoprolol. A cardiac follow-up questionnaire (CFQ) and the Nottingham Health Profile (NHP) were answered by 82%. In the CFQ, sel-fassessed cardiac symptoms, medication (diuretics, digitalis, antiarrhythmics, long-acting nitrates, beta blockers, psychoactive drugs), smoking habits, and work status were described. NHP described QL within the sections of mobility, energy, pain, sleep, emotional reactions, and social isolation. The independent relation between morbidity, drugs, and QL was analyzed multi variately. Apart from symptoms of angina pectoris and dyspnoea, anxiety resulted in impaired QL. A relation between diuretics and decreased QL was found, but no indications of adverse effects of the beta blocker metoprolol.

  • 839. Wiklund, I
    et al.
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap. [external].
    Johansson, S
    Bengtsson, A
    Karlson, BW
    Persson, NG
    Subjective symptoms and wellbeing differ in women and men after myocardial infarction1993Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 14, nr 10, s. 1315-1319Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The frequency of subjective cardiac and psychological complaints among men and women a year after a confirmed diagnosis of myocardial infarction (MI) were compared. Among 660 survivors, 595 patients completed mailed questionnaires at home one year after the MI. There were 421 men, mean age 67.1±10.7 years, and 174 women, mean age 72.1±10.6 years. Controlling for the significantly higher mean age among the women, the latter more often had a previous history of angina pectoris, 54.6% (P≤0.05) versus 42.9%, and heart failure, 24.7% versus 13.5% (P≤0.01). Despite these facts, the women were significantly less often referred to CCU, 82.2% versus 91.7% (P≤0.05). One year after the MI, controlling for differences in age and co-morbidity, women reported significantly higher frequencies of psychological and psychosomatic complaints, including sleep disturbances. These differences may have clinical implications for diagnosis and treatment of women with coronary heart disease.

  • 840. Wiklund, I
    et al.
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Risenfors, M
    Hjalmarson, Å
    Koronar bypass-kirurgi: Effekt på livskvalitet och återgång i arbete1987Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 84, nr 43, s. 3509-3511Artikkel i tidsskrift (Fagfellevurdert)
  • 841. Wiklund, I
    et al.
    Karlson, BW
    Bengtsson, A
    Herlitz, Johan
    [external].
    Subjective symptoms and wellbeing one year after acute myocardial infarction in relation to age1993Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 14, nr 10, s. 1315-1319Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The frequency of subjective cardiac and psychological complaints among men and women a year after a confirmed diagnosis of myocardial infarction (MI) were compared. Among 660 survivors, 595 patients completed mailed questionnaires at home one year after the MI. There were 421 men, mean age 67.1±10.7 years, and 174 women, mean age 72.1±10.6 years. Controlling for the significantly higher mean age among the women, the latter more often had a previous history of angina pectoris, 54.6% (P≤0.05) versus 42.9%, and heart failure, 24.7% versus 13.5% (P≤0.01). Despite these facts, the women were significantly less often referred to CCU, 82.2% versus 91.7% (P≤0.05). One year after the MI, controlling for differences in age and co-morbidity, women reported significantly higher frequencies of psychological and psychosomatic complaints, including sleep disturbances. These differences may have clinical implications for diagnosis and treatment of women with coronary heart disease.

  • 842.
    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 study2017Inngår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, Vol. 16, nr 7, s. 623-631Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 843.
    Wireklint Sundström, Birgitta
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Bång, Angela
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Karlsson, Thomas
    Winge, Karin
    Lundberg, Camilla
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Anxiolytics in patients suffering a suspected acute coronary syndrome: Multi-centre randomised controlled trial in Emergency Medical Service2013Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 168, nr 4, s. 3580-3587Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The prehospital treatment of pain and discomfort among patients who suffer from acute coronary syndrome (ACS) needs a treatment strategy which combines relief of pain with relief of anxiety. Aim: The aim of the present study was to evaluate the impact on pain and anxiety of the combination of an anxiolytic and an analgesic as compared with an analgesic alone in the prehospital setting of suspected ACS. Methods: A multi-centre randomised controlled trial compared the combination of Midazolam (Mi) + Morphine (Mo) and Mo alone. All measures took part: Prior to randomisation, 15 min thereafter and on admission to a hospital. Inclusion criteria were: 1) pain raising suspicion of ACS and 2) pain score ≥4. Primary endpoint: Pain score after 15 min. Results: In all, 890 patients were randomised to Mi + Mo and 873 to Mo alone. Pain was reduced from a median of 6 to 4 and finally to 3 in both groups. The mean dose of Mo was 5.3 mg in Mi + Mo and 6.0 mg in Mo alone (p b 0.0001). Anxiety was reported in 66% in Mi + Mo and in 64% in Mo alone at randomisation (NS); 15 min thereafter in 31% and 39% (p = 0.002) and finally in 12% and 26% respectively (p b 0.0001). On admission to a hospital nausea or vomiting was reported in 9% in Mi + Mo and in 13% in Mo alone (p = 0.003). Drowsiness differed; 15% and 14% were drowsy in Mi + Mo versus 2% and 3% in Mo alone respectively (p b 0.001). Conclusion: Despite the fact that the combination of anxiolytics and analgesics as compared with analgesics alone reduced anxiety and the requirement of Morphine in the prehospital setting of acute coronary syndrome, this strategy did not reduce patients' estimation of pain (primary endpoint). More effective pain relief among these patients is warranted.

  • 844.
    Wireklint Sundström, Birgitta
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Holmberg, Mats
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Andersson, Henrik
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Pre-hospital care for patients suffering from suspected acute coronary syndrome - educational intervention for pain and anxiety relief2016Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Background: Pre-hospital care for patients from suffering acute coronary syndrome (ACS) has been shown to be a challenge. Associated symptoms appear together with typical ones. The symptoms have been reported to be more intense in the pre-hospital setting than after hospital admission. Special education could benefit for ambulance nurses (AN).

     

    Purpose: A. To describe the prevalence of dyspnea and nausea or vomiting and their associa­ tion with outcome. B.To explore the possible connection between the patients' estimated inten­ sity of pain before arrival to the hospital and clinical findings. C. To evaluate the possible effect of education in cardiovascular nursing on pain intensity in patients suffering from suspected ACS.

     

    Methods:  A randomised controlled trail: an educational and a medical intervention. There is also a retrospective design. In the trial: The inclusion criteria were symptoms of pain 4 on the coloured analogue scale raising suspicion of ACS. In total 1,603 patients participated. The edu­ cational intervention was a course including care assessment and treatment as well as clinical cardiology. The medical intervention was Midazolam.

     

    Results: A. One in three patients has symptoms of dyspnea and the same number of patients has symptoms of nausea or vomiting, which increases the suspicion of ACS. B. More intensive pain was associated with: 1) lower age and a higher prevalence of previous smoking; 2) more complications before hospital admission in terms of hypotension and  AV-block-  bradycardia which required treatment and 3) a higher incidence of heart failure, anxiety, and pain after hos­ pital admission that required treatment. C. On admission to hospital, the pain score was signifi­ cantly lower for patients treated by an AN with special education compared with those treated by an AN without such education. The AN with special education used higher doses of mor­ phine to treat patients.

     

    Conclusion: An assessment and treatment strategy that combines all symptoms, both the typical symptoms and the associated ones, is needed. The estimated in­ tensity of pain can predict outcomes. The possible effect of special education for ANs is shown but needs to be confirmed in further trials.

  • 845.
    Wireklint Sundström, Birgitta
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Holmberg, Mats
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Andersson, Henrik
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Karlsson, Thomas
    Sahlgrenska Universitetssjukhuset.
    Possible effects of a course in cardiovascular nursing on prehospital care of patients experiencing suspected acute coronary syndrome: a cluster randomised controlled trial2016Inngår i: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 15, nr 52Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    Current research suggests that nurses can influence the outcome for patients with acute coronary syndrome (ACS). The aim of this study has been to evaluate whether a course in cardiovascular nursing (CVN) can improve ambulance nurses’ (ANs’) prehospital care of patients experiencing suspected ACS, related to pain intensity.

    Methods

    This is a cluster randomised controlled trial that was conducted in the ambulance services. Patients were allocated to one of two groups: in the first group, patients were treated by ANs who had attended the CVN course and in the second group patients were treated by ANs without this qualification. Inclusion criteria were: 1/pain raising suspicion of ACS, and 2/pain score ≥4 on a visual analogue scale (VAS). The primary outcome was the estimated intensity of pain or discomfort according to VAS 15 min after randomisation. Secondary outcomes were estimated intensity of pain or discomfort on admission to hospital and further requirement of pain treatment, as well as symptoms such as paleness and/or cold sweat; nausea and/or vomiting; anxiety, dyspnea, degree of alertness, respiratory depression and aggressiveness. A further secondary outcome measured was survival to 30 days. Lastly, a final diagnosis was made. A total of 38 ANs attended the CVN course. There were 1,747 patients who fulfilled the inclusion criteria.

    Results

    The pain score did not differ significantly between the two groups fifteen minutes after randomisation (median value of VAS was 4.0 in both groups). On admission to hospital the pain score was significantly lower for patients treated by an AN who had attended the CVN course (n = 332) compared with those treated by an AN who had not attended the course (n = 1,415) (median 2.5 and 3.0 respectively, p = 0.001). The ANs who had attended the course used higher doses of morphine.

    Conclusions

    An educational intervention with a CVN course did not relate significantly to more efficient pain relief in suspected ACS during the first 15 min. However, this intervention was associated with more effective pain relief later on in the prehospital setting. Thus, a CVN course for ANs appears to be associated with reduced pain intensity among patients experiencing suspected ACS. This result needs however to be confirmed in further trials.

    Trial registration

    The ClinicalTrials.gov Protocol Registration System (registration number NCT00792181).

  • 846.
    Wireklint-Sundström, B
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Petersson, E
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Sjöholm, M
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Gelang, C
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Axelsson, C
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    A pathway care model allowing low-risk patients to gain direct admissionto a hospital medical ward a pilot study on ambulance nurses and Emergency Department phycisians2014Inngår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 22, nr 1, s. 72-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    A pathway care model allowing low-risk patients to gain rapid admission to a hospital medical ward¿¿¿a pilot study on ambulance nurses and Emergency Department physicians.BackgroundPatients with non-urgent medical symptoms who nonetheless require inpatient hospital treatment often have to wait for an unacceptably long time at the Emergency Department (ED). The purpose of this study is to evaluate the feasibility and effect on length of delay of a pathway care model for low-risk patients who have undergone prehospital assessment by an ambulance nurse and ED assessment by a physician within 10 minutes of arrival at the ED.MethodsThe pilot study comparing two low-risk groups took place in western Sweden from October 2011 until January 2012. The pathway model for low-risk patients was used prospectively in the rapid admission group (N¿=¿51), who were admitted rapidly after being assessed by the nurse on scene and then assessed by the ED physician on ED admission. A retrospectively assembled control group (N¿=¿51) received traditional care at the ED. All p-values are age-adjusted.ResultsPatients in the rapid admission group were older (mean age 80 years old) than patients in the control group (mean age 73 years old) (p¿=¿0.02). The median delay from arrival at the patient¿s side until arrival in a hospital medical ward was 57 minutes for the rapid admission group versus 4 hours 13 minutes for the control group (p¿<¿0.0001). However, the median delay time from the ambulance¿s arrival at the patient¿s side until the nurse was free for a new assignment was 77 minutes for the rapid admission group versus 49 minutes for the control group (p¿<¿0.0001). The 30-day mortality rate was 20% for the rapid admission group and only 4% for the control group (p¿=¿0.16).ConclusionThe pathway care model for low-risk patients gaining rapid admission to a hospital medical ward shortened length of delay from the first assessment until arrival at the ward. However, the result was achieved at the cost of an increased workload for the ambulance nurse. Furthermore patients who were rapidly admitted to a hospital ward had a high age level and a high early mortality rate. Patient safety in this new model of fast-track assessment needs to be further evaluated.

  • 847. Wnent, Jan
    et al.
    Masterson, Siobhán
    Gräsner, Jan-Thorsten
    Böttiger, Bernd W
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Koster, Ruud W
    Rosell Ortiz, Fernando
    Tjelmeland, Ingvild
    Maurer, Holger
    Bossaert, Leo
    EuReCa ONE - 27 Nations, ONE Europe, ONE Registry: a prospective observational analysis over one month in 27 resuscitation registries in Europe - the EuReCa ONE study protocol.2015Inngår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 23, nr 7Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: There is substantial variation in the incidence, likelihood of attempted resuscitation and outcomes from out-of-hospital cardiac arrest (OHCA) across Europe. A European, multi-centre study provides the opportunity to uncover differences throughout Europe and may help find explanations for these differences. Results may also have potential to support the development of quality benchmarking between European Emergency Medical Services (EMS).

    METHODS/DESIGN: This prospective European study involves 27 different countries. It provides a common Utstein-based dataset, data collection tool and a common data collection period for all participants. Study research questions will address the following: OHCA incidence in different European regions; incidence of cardiopulmonary resuscitation (CPR); initial presenting rhythm in patients where bystanders or EMS start CPR or any other resuscitation intervention; proportion of patients with any return of spontaneous circulation (ROSC); patient status at the end of pre-hospital treatment i.e. ROSC at handover to hospital, ongoing CPR, dead; proportion of patients still alive 30 days after OHCA; proportion of patients discharged alive from hospital. All patients who suffered an OHCA during October 2014 and were attended and/or treated by an EMS and documented in one of the participating registries will be included in the study. Each National Coordinator is responsible for data collection and quality control in his/her country and will transfer unprocessed anonymised data via secure electronic transfer. Descriptive analysis will be performed at European, national and registry level. For endpoints like ROSC, admission or survival, multivariate logistic regression analysis will be performed.

    DISCUSSION: Documenting differences in epidemiology, treatment and outcome in out-of-hospital cardiac arrest throughout Europe is a first step in finding explanations for these differences. Study results might also support the development of quality benchmarking between Emergency Medical Services (EMS) which in turn will facilitate initiatives to improve OHCA outcome in Europe.

    TRIAL REGISTRATION: The EuReCa ONE Study is registered by ClinicalTrials.gov National Coordinator T02236819 ).

  • 848. Yusuf, S
    et al.
    Estrada-Yamamoto, M
    Reyes, CP
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Hjalmarson, Å
    Factors of Importance for QRS Complex Recovery after Acute Myocardial Infarction1982Inngår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 211, nr 3, s. 157-162Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The regression of the ECG signs of myocardial infarction has been studied in 101 patients. A significant increase in R wave amplitude and decrease in Q wave depth on the standard ECG was observed over three months. In 21% of the patients, Q waves disappeared completely. In inferior infarction, these changes were more apparent in the lateral V leads than in the inferior limb leads. Patients with intraventricular conduction defects were excluded. Two factors associated with the Q and R wave changes have been identified. Lower heart rates appeared to facilitate the recovery of R waves, and smaller infarcts, as assessed by peak LDH, showed greater ECG recovery. This study raises the interesting possibility that modification of the heart rate may affect favourably the healing process after an acute myocardial infarction.

  • 849. Zedigh, C
    et al.
    Alho, A
    Hammar, E
    Karlsson, Thomas
    Kellerth, T
    Svensson, L
    Grimbrandt, E
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Aspects on the intensity and the relief of pain in the prehospital phase of acute coronary syndrome: experiences from a randomized clinical trial2010Inngår i: Coronary Artery Disease, ISSN 0954-6928, E-ISSN 1473-5830, Vol. 21, nr 2, s. 113-120Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The primary aim of this study was to evaluate the pain relief and tolerability of two pain-relieving strategies in the prehospital phase of presumed acute coronary syndrome (ACS), and the secondary aim was to assess the relationship between the intensity and relief of pain and heart rate, blood pressure, and ST deviation. Patients with chest pain judged as caused by ACS were randomized (open) to either metoprolol 5 mg intravenously (i.v.) three times at 2-min intervals (n = 84; metoprolol group) or morphine 5 mg i.v. followed by metoprolol 5 mg three times i.v (n = 80; morphine group). Pain was assessed on a 10-grade scale before randomization and 10, 20, and 30 min thereafter. The mean pain score decreased from 6.5 at randomization to 2.8 30 min later, with no significant difference between groups. The percentages with complete pain relief (pain score <=1) after 10, 20, and 30 min were 11, 16, and 21%, respectively, with no difference between groups. Hypotension was less frequent in the metoprolol group compared with the morphine group (0 vs. 6.3%; P=0.03), as was nausea/vomiting (7.2 vs. 24.0%; P=0.004). At randomization intensity of pain was associated with degree of ST elevation (P=0.009). The degree of pain relief over 30 min was associated with decrease in heart rate (P=0.03) and decrease in ST elevation (P=0.01). In conclusion, in the prehospital phase of presumed ACS, neither a pain-relieving strategy including an anti-ischemic agent alone nor an analgesic plus anti-ischemic strategy in combination resulted in complete pain relief. Fewer side effects were found with the former strategy. Other pain-relieving strategies need to be evaluated.

  • 850.
    Zijlstra, Jolande A
    et al.
    Department of Cardiology, Academic Medical Center.
    Koster, Rudolph W
    Department of Cardiology, Academic Medical Center.
    Blom, Marieke T
    Department of Cardiology, Academic Medical Center.
    Lippert, Freddy K
    Emergency Medical Services Copenhagen, University of Copenhagen.
    Svensson, Leif
    Department of Medicine, Centre for Resuscitation Science, Karolinska Institutet.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Kramer-Johansen, Jo
    Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS) and Department of Anaesthesiology, Oslo University Hospital.
    Ringh, Mattias
    Department of Medicine, Centre for Resuscitation Science, Karolinska Institutet.
    Rosenqvist, Mårten
    Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet.
    Palsgaard Møller, Thea
    Emergency Medical Services Copenhagen, University of Copenhagen.
    Tan, Hanno L
    Department of Cardiology, Academic Medical Center.
    Beesems, Stefanie G
    Department of Cardiology, Academic Medical Center.
    Hulleman, Michiel
    Department of Cardiology, Academic Medical Center.
    Claesson, Andreas
    Department of Medicine, Centre for Resuscitation Science, Karolinska Institutet.
    Folke, Fredrik
    Emergency Medical Services Copenhagen, University of Copenhagen.
    Olasveengen, Theresa Mariero
    Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS) and Department of Anaesthesiology.
    Wissenberg, Mads
    Department of Cardiology, Copenhagen University Hospital Gentofte.
    Hansen, Carolina Malta
    Department of Cardiology, Copenhagen University Hospital Gentofte.
    Viereck, Soren
    Emergency Medical Services Copenhagen, University of Copenhagen.
    Hollenberg, Jacob
    Department of Medicine, Centre for Resuscitation Science, Karolinska Institutet.
    Different defibrillation strategies in survivors after out-of-hospital cardiac arrest.2018Inngår i: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 104, nr 23, s. 1929-1936Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: In the last decade, there has been a rapid increase in the dissemination of automated external defibrillators (AEDs) for prehospital defibrillation of out-of-hospital cardiac arrest patients. The aim of this study was to study the association between different defibrillation strategies on survival rates over time in Copenhagen, Stockholm, Western Sweden and Amsterdam, and the hypothesis was that non-EMS defibrillation increased over time and was associated with increased survival.

    METHODS: We performed a retrospective analysis of four prospectively collected cohorts of out-of-hospital cardiac arrest patients between 2008 and 2013. Emergency medical service (EMS)-witnessed arrests were excluded.

    RESULTS: A total of 22 453 out-of-hospital cardiac arrest patients with known survival status were identified, of whom 2957 (13%) survived at least 30 days postresuscitation. Of all survivors with a known defibrillation status, 2289 (81%) were defibrillated, 1349 (59%) were defibrillated by EMS, 454 (20%) were defibrillated by a first responder AED and 429 (19%) were defibrillated by an onsite AED and 57 (2%) were unknown. The percentage of survivors defibrillated by first responder AEDs (from 13% in 2008 to 26% in 2013, p<0.001 for trend) and onsite AEDs (from 14% in 2008 to 30% in 2013, p<0.001 for trend) increased. The increased use of these non-EMS AEDs was associated with the increase in survival rate of patients with a shockable initial rhythm.

    CONCLUSION: Survivors of out-of-hospital cardiac arrest are increasingly defibrillated by non-EMS AEDs. This increase is primarily due to a large increase in the use of onsite AEDs as well as an increase in first-responder defibrillation over time. Non-EMS defibrillation accounted for at least part of the increase in survival rate of patients with a shockable initial rhythm.

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