| 1. |
- Albert, Malin, et al.
(författare)
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Cardiac arrest after pulmonary aspiration in hospitalised patients : a national observational study.
- 2020
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 10:3
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To study characteristics and outcomes among patients with in-hospital cardiac arrest (IHCA) due to pulmonary aspiration.DESIGN: A retrospective observational study based on data from the Swedish Registry of Cardiopulmonary Resuscitation (SRCR).SETTING: The SRCR is a nationwide quality registry that covers 96% of all Swedish hospitals. Participating hospitals vary in size from secondary hospitals to university hospitals.PARTICIPANTS: The study included patients registered in the SRCR in the period 2008 to 2017. We compared patients with IHCA caused by pulmonary aspiration (n=127), to those with IHCA caused by respiratory failure of other causes (n=2197).PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome was 30-day survival. Secondary outcome was sustained return of spontaneous circulation (ROSC) defined as ROSC at the scene and admitted alive to the intensive care unit.RESULTS: In the aspiration group 80% of IHCA occurred on general wards, as compared with 63.6% in the respiratory failure group (p<0.001). Patients in the aspiration group were less likely to be monitored at the time of the arrest (18.5% vs 38%, p<0.001) and had a significantly lower rate of sustained ROSC (36.5% vs 51.6%, p=0.001). The unadjusted 30-day survival rate compared with the respiratory failure group was 7.9% versus 18.0%, p=0.024. In a propensity score analysis (including variables; year, age, gender, location of arrest, initial heart rhythm, ECG monitoring, witnessed collapse and a previous medical history of; cancer, myocardial infarction or heart failure) the OR for 30-day survival was 0.46 (95% CI 0.19 to 0.94).CONCLUSIONS: In-hospital cardiac arrest preceded by pulmonary aspiration occurred more often on general wards among unmonitored patients. These patients had a lower 30-day survival rate compared with IHCA caused by respiratory failure of other causes.
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| 2. |
- Backemar, Lovisa, et al.
(författare)
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Comorbidities and Risk of Complications After Surgery for Esophageal Cancer : A Nationwide Cohort Study in Sweden.
- 2015
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Ingår i: World Journal of Surgery. - : Springer Science and Business Media LLC. - 0364-2313 .- 1432-2323. ; 39:9, s. 2282-8
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The selection for surgery is multifaceted for patients diagnosed with esophageal cancer. Since it is uncertain how comorbidity should influence the selection, this study addressed comorbidities in relation to risk of severe complications following esophageal cancer surgery.METHODS: This population-based cohort study was based on prospectively included patients who underwent surgical resection for an esophageal or gastro-esophageal junctional cancer in Sweden during 2001-2005. The participation rate was 90%. Associations between pre-defined comorbidities and pre-defined post-operative complications occurring within 30 days of surgery were analyzed using multivariable logistic regression. The resulting odds ratios (ORs) and 95% confidence intervals (CIs) were adjusted for age, sex, tumor stage, tumor histology, neoadjuvant therapy, type of surgery, annual hospital volume, other comorbidities, and other complications.RESULTS: Among 609 included patients, those with cardiac disease (n = 92) experienced an increased risk of pre-defined complications in general (adjusted OR 1.81, 95% CI 1.13-2.90), while patients with hypertension (n = 137), pulmonary disorders (n = 79), diabetes (n = 67), and obesity (n = 66) did not. Patients with a Charlson comorbidity index score ≥2 had substantially increased risks of pre-defined complications (adjusted OR 2.44, 95% CI 1.60-3.72).CONCLUSION: Cardiac disease and a Charlson comorbidity index score ≥2 seem to increase the risk of severe and early post-operative complications in patients with esophageal cancer, while hypertension, pulmonary disorders, diabetes, and obesity do not. These findings should be considered in the clinical decision-making for improved selection of patients for surgery.
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| 3. |
- Berg, Lena M, et al.
(författare)
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Factors influencing clinicians' perceptions of interruptions as disturbing or non-disturbing : a qualitative study
- 2016
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Ingår i: International Emergency Nursing. - : Elsevier. - 1755-599X .- 1878-013X. ; 27, s. 11-16
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Emergency departments consist of multiple systems requiring interaction with one another while still being able to operate independently, creating frequent interruptions in the clinical workflow. Most research on interruptions in health care settings has focused on the relationship between interruptions and negative outcomes. However, there are indications that not all interruptions are negatively perceived by those being interrupted. Therefore, this study aimed to explore factors that influence when a clinician perceives interruptions as non-disturbing or disturbing in an emergency department context.METHOD: Explorative design based on interviews with 10 physicians and 10 registered nurses at two Swedish emergency departments. Data were analyzed using qualitative content analysis.RESULT: Factors influencing whether emergency department clinicians perceived interruptions as non-disturbing or disturbing were identified: clinician's constitution, external factors of influence and the nature of the interrupted task. The clinicians' perceptions were related to a complex of attributes inherent in these three factors at the time of the interruption. Thus, the same type of interruption could be perceived as either non-disturbing or disturbing contingent on the surrounding circumstances in which the event occurred.CONCLUSION: Emergency department clinicians' perceptions of interruptions as non-disturbing or disturbing were related to the character of identified influencing factors.
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| 4. |
- Berg, Lena M, et al.
(författare)
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Reasons for interrupting colleagues during emergency department work : A qualitative study
- 2016
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Ingår i: International Emergency Nursing. - : Elsevier. - 1755-599X .- 1878-013X. ; 29, s. 21-26
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Emergency department team members frequently need to interact with each other, a circumstance causing multiple interruptions. However, information is lacking about the motives underlying these interruptions and this study aimed to explore clinicians' reasons to interrupt colleagues during emergency department work.Method: Semi-structured interviews with 10 physicians and 10 registered nurses at two Swedish emergency departments. The interviews were analyzed inductively using content analysis.Results: The working conditions to some extent sustained the clinicians' need to interrupt, for example different routines. Another reason to interrupt was to improve the initiator's work process, such as when the initiators perceived that the interruption had high clinical relevance. The third reason concerns the desire to influence the work process of colleagues in order to prevent mistakes and provide information for the person being interrupted to improve patient care.Conclusion: The three identified categories for why emergency department clinicians interrupt their colleagues were related to working conditions and a wish to improve/influence the work processes for both initiators and recipients. Several of the reasons given for interrupting colleagues were done in order to improve patient care. Interruptions perceived as negative to the recipient were mostly related to the working conditions.
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| 5. |
- Berglund, Ellinor, et al.
(författare)
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A smartphone application for dispatch of lay responders to out-of-hospital cardiac arrests.
- 2018
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Ingår i: Resuscitation. - : Elsevier BV. - 1873-1570 .- 0300-9572. ; 126, s. 160-165
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Tidskriftsartikel (refereegranskat)abstract
- Dispatch of lay volunteers trained in cardiopulmonary resuscitation (CPR) and equipped with automated external defibrillators (AEDs) may improve survival in cases of out-of-hospital cardiac arrest (OHCA). The aim of this study was to investigate the functionality and performance of a smartphone application for locating and alerting nearby trained laymen/women in cases of OHCA.A system using a smartphone application activated by Emergency Dispatch Centres was used to locate and alert laymen/women to nearby suspected OHCAs. Lay responders were instructed either to perform CPR or collect a nearby AED. An online survey was carried out among the responders.From February to August 2016, the system was activated in 685 cases of suspected OHCA. Among these, 224 cases were Emergency Medical Services (EMSs)-treated OHCAs (33%). EMS-witnessed cases (n = 11) and cases with missing survey data (n = 15) were excluded. In the remaining 198 OHCAs, lay responders arrived at the scene in 116 cases (58%), and prior to EMSs in 51 cases (26%). An AED was attached in 17 cases (9%) and 4 (2%) were defibrillated. Lay responders performed CPR in 54 cases (27%). Median distance to the OHCA was 560 m (IQR 332-860 m), and 1280 m (IQR 748-1776 m) via AED pick-up. The survey-answering rate was 82%.A smartphone application can be used to alert CPR-trained lay volunteers to OHCAs for CPR. Further improvements are needed to shorten the time to defibrillation before EMS arrival.
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| 6. |
- Castrén, Maaret, et al.
(författare)
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Non-specific complaints in the ambulance; predisposing structural factors
- 2015
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Ingår i: BMC Emergency Medicine. - : BioMed Central. - 1471-227X .- 1471-227X. ; 15
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The pre-hospital assessment non-specific complaint (NSC) often applies to patients whose diagnosis does not match any other specific assessment correlating to particular symptoms or diseases, though some previous studies have found them to be related to serious underlying conditions. The aim was to identify whether the structural factors such as urgency according to the dispatch priority of the Emergency Medical Communication Centre (EMCC) or work load in the Emergency Medical Services (EMS) are predisposing factors for the assessment of NSC instead of a specific assessment.METHODS: All patients with assessed condition NSCs by the EMS to Södersjukhuset during 2011 (n = 493) were compared with gender- and age-matched controls (n = 493), which were randomly drawn from all patients with specific conditions in the EMS, regarding day of week, time of day and priority set by EMCC with chi-squared tests and multivariate logistic regression models.RESULTS: Among patients with NSCs, more were females (58 %) and the median age was 82. Almost all patients were categorized with NSCs during the daytime (8 a.m. to 9 p.m.), i.e. 450 (91 %) as compared to 373 (75 %) of those with specific conditions (p < 0.01). The risk of having an EMS dispatched as low priority by the EMCC was almost doubled among patients with NSCs compared to controls (OR 1.97, 95 % CI 1.38-2.79).CONCLUSIONS: Since patients with NSCs appear most frequently during the hours with most transportations for the EMS, i.e. 10 a.m. to 2 p.m., and the risk of having the assessment NSC was doubled if the EMCC dispatched EMS as low priority, structural factors might be predisposing factors for the assessment.
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| 7. |
- Claesson, Andreas, et al.
(författare)
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Medical versus non medical etiology in out-of-hospital cardiac arrest-Changes in outcome in relation to the revised Utstein template.
- 2016
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Ingår i: Resuscitation. - : Elsevier. - 0300-9572 .- 1873-1570. ; 110, s. 48-55
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION:The Utstein-style recommendations for reporting etiology and outcome in out-of-hospital cardiac arrest (OHCA) from 2004 have recently been revised. Among other etiologies a medical category is now introduced, replacing the cardiac category from Utstein template 2004.AIM:The aim of this study is to describe characteristics and temporal trends from reporting OHCA etiology according to the revised Utstein template 2014 in regards to patient characteristics and 30-day survival rates.METHODS:This registry study is based on consecutive OHCA cases reported from the Emergency medical services (EMS) to the Swedish Registry of Cardiopulmonary Resuscitation (SRCR) 1992-2014. Characteristics, including a presumed cardiac etiology in Utstein template 2004, were transcribed to a medical etiology in Utstein template 2014.RESULTS:Of a total of n=70,846 cases, 92% were categorized as having a medical etiology and 8% as having a non-medical cause. Using the new classifications, the 30-day survival rate has significantly increased over a 20-year period from 4.7% to 11.0% in the medical group and from 3% to 9.9% in the non-medical group (p≤0.001). Trauma was the most common cause in OHCA of a non-medical etiology (26%) with a 30-day survival rate of 3.4% whilst drowning and drug overdose had the highest survival rates (14% and 10% respectively).CONCLUSION:Based on Utstein 2014 categories of etiology, overall survival after OHCA with a medical etiology has more than doubled in a 20-year period and tripled for non-medical cases. Patients with a medical etiology found in a shockable rhythm have the highest chance of survival. There is great variability in characteristics among non-medical cases.
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| 8. |
- Crilly, Julia, et al.
(författare)
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Factors predictive of hospital admission for children via emergency departments in Australia and Sweden: an observational cross-sectional study
- 2024
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Ingår i: BMC Health Services Research. - : Springer Nature. - 1472-6963. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Identifying factors predictive of hospital admission can be useful to prospectively inform bed management and patient flow strategies and decrease emergency department (ED) crowding. It is largely unknown if admission rate or factors predictive of admission vary based on the population to which the ED served (i.e., children only, or both adults and children). This study aimed to describe the profile and identify factors predictive of hospital admission for children who presented to four EDs in Australia and one ED in Sweden.Methods: A multi-site observational cross-sectional study using routinely collected data pertaining to ED presentations made by children < 18 years of age between July 1, 2011 and October 31, 2012. Univariate and multivariate analysis were undertaken to determine factors predictive of hospital admission.Results: Of the 151,647 ED presentations made during the study period, 22% resulted in hospital admission. Admission rate varied by site; the children's EDs in Australia had higher admission rates (South Australia: 26%, Queensland: 23%) than the mixed (adult and children's) EDs (South Australia: 13%, Queensland: 17%, Sweden: 18%). Factors most predictive of hospital admission for children, after controlling for triage category, included hospital type (children's only) adjusted odds ratio (aOR):2.3 (95%CI: 2.2-2.4), arrival by ambulance aOR:2.8 (95%CI: 2.7-2.9), referral from primary health aOR:1.5 (95%CI: 1.4-1.6) and presentation with a respiratory or gastrointestinal condition (aOR:2.6, 95%CI: 2.5-2.8 and aOR:1.5, 95%CI: 1.4-1.6, respectively). Predictors were similar when each site was considered separately.Conclusions: Although the characteristics of children varied by site, factors predictive of hospital admission were mostly similar. The awareness of these factors predicting the need for hospital admission can support the development of clinical pathways.
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| 9. |
- Djärv, Therese, et al.
(författare)
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Decreased general condition in the emergency department : high in-hospital mortality and a broad range of discharge diagnoses
- 2015
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Ingår i: European journal of emergency medicine. - : Lippincott Williams & Wilkins. - 0969-9546 .- 1473-5695. ; 22:4, s. 241-246
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Decreased general condition (DGC) is a frequent presenting complaint within the Adaptive Triage Process. DGC describes a nonspecific decline in health and well-being, and it is common among elderly patients in the emergency department (ED).AIM: The aim of this study was to compare the in-hospital mortality among patients presenting with DGC with that among patients in the corresponding triage category presenting with other complaints to an ED. The secondary aim was to describe the discharge diagnoses of patients presenting with DGC.METHODS: All patients admitted to Södersjukhuset from the ED in 2008 were included. The difference in the in-hospital mortality rate was stratified for triage category at the ED, between patients with DGC (n=1182) and those with all other presenting complaints (n=20 775), and assessed with sex-adjusted and age-adjusted logistic regression models. Discharge diagnoses were assessed as the primary discharge diagnosis according to International Statistical Classification of Diseases and Related Health Problems 10th revision (ICD-10) in the medical discharge notes.RESULTS: A total of 1182 patients with DGC at the ED were admitted for in-hospital care, and they had a four-fold risk of suffering an in-hospital death [odds ratio 4.74 (95% confidence interval 3.88-5.78)] compared with patients presenting with other presenting complaints. The most common discharge diagnoses were diseases of the circulatory system (14%), respiratory system (14%), and genitourinary system (10%).INTERPRETATION: Patients presenting with DGC to an ED often receive low triage priority, frequently require admission for in-hospital care, and, because of the three-fold increased risk of in-hospital death compared with others, belong to a high-risk group.
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| 10. |
- Djärv, Therese
(författare)
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Health-related quality of life after oesophageal cancer surgery for prediction of morbidity and mortality
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis investigates the health-related quality of life (HRQL) among surgically treated oesophageal cancer patients. The established curative treatment for oesophageal cancer is extensive surgery with a high risk of morbidity and a limited chance of long-term survival. Only every third patient is suitable for surgery. Subjective outcomes such as HRQL are therefore of particular importance among this group of patients. In three of the four studies (I, II, IV) included in this thesis, a nationwide Swedish cohort of oesophageal cancer patients, operated in 2001-2005, was used, while in study III a British cohort of operated patients was used. In all studies, HRQL was assessed with an international validated core questionnaire on the symptoms and functions of cancer (EORTC QLQ-C30). Studies I, II and IV also included an oesophageal cancer specific module (EORTC QLQ-OES18). In Studies I and III a difference in transformed mean scores of at least 10 points on a scale of 0-100 was used as a cut-off for clinical relevance. In Studies II and IV raw scores were categorised into good or poor HRQL. In Study I, the long term HRQL after oesophageal cancer surgery was investigated. HRQL was shown to be similar both six months and three years postoperatively, which suggests that the long-standing HRQL level is already established at six months. The HRQL was poorer than that of the general population. Study II assessed if patient and tumour characteristics affect HRQL six months postoperatively. Sex, age and BMI showed no associations while co-morbidity and tumour characteristics such as histology and tumour stage affected HRQL. The findings may be useful for clinical decision making. Study III explored if both baseline HRQL and changes in HRQL from baseline to six months followup was associated with survival. Dyspnoea at baseline was associated with an increased risk of mortality. Not recovering physical function and worsening of pain and fatigue were linked with a higher risk of mortality. Therefore, changes in HRQL might be prognostic and of importance when planning follow-up and supportive care. Study IV analysed whether postoperative HRQL was associated with survival. Poor HRQL measures were associated with increased risk of mortality. This knowledge could be used for prognostic discussions and intensity of the clinical follow-up. In conclusion, this thesis shows that measures of HRQL could aid decision-making prior to treatment and in planning the follow-up of osesophageal cancer patients.
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