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- Farrokhnia, Nasim, et al.
(författare)
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Emergency Department Triage Scales and Their Components : A Systematic Review of the Scientific Evidence
- 2011
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Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - : Springer Science and Business Media LLC. - 1757-7241. ; 19, s. 42-
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Forskningsöversikt (refereegranskat)abstract
- Emergency department (ED) triage is used to identify patients' level of urgency and treat them based on their triage level. The global advancement of triage scales in the past two decades has generated considerable research on the validity and reliability of these scales. This systematic review aims to investigate the scientific evidence for published ED triage scales. The following questions are addressed: 1. Does assessment of individual vital signs or chief complaints affect mortality during the hospital stay or within 30 days after arrival at the ED? 2. What is the level of agreement between clinicians' triage decisions compared to each other or to a gold standard for each scale (reliability)? 3. How valid is each triage scale in predicting hospitalization and hospital mortality? A systematic search of the international literature published from 1966 through March 31, 2009 explored the British Nursing Index, Business Source Premier, CINAHL, Cochrane Library, EMBASE, and PubMed. Inclusion was limited to controlled studies of adult patients (>= 15 years) visiting EDs for somatic reasons. Outcome variables were death in ED or hospital and need for hospitalization (validity). Methodological quality and clinical relevance of each study were rated as high, medium, or low. The results from the studies that met the inclusion criteria and quality standards were synthesized applying the internationally developed GRADE system. Each conclusion was then assessed as having strong, moderately strong, limited, or insufficient scientific evidence. If studies were not available, this was also noted. We found ED triage scales to be supported, at best, by limited and often insufficient evidence. The ability of the individual vital signs included in the different scales to predict outcome is seldom, if at all, studied in the ED setting. The scientific evidence to assess interrater agreement (reliability) was limited for one triage scale and insufficient or lacking for all other scales. Two of the scales yielded limited scientific evidence, and one scale yielded insufficient evidence, on which to assess the risk of early death or hospitalization in patients assigned to the two lowest triage levels on a 5-level scale (validity).
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- Jonsson, Anna, et al.
(författare)
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A qualitative study of recorded telephone support calls with mothers of preterm infants : Expressing both positive and negative feelings.
- 2021
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Ingår i: Nursing Open. - : Wiley. - 2054-1058. ; 8:6, s. 3065-3072
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To describe the structure and content of telephone support calls between mothers of preterm infants and support team members after hospital discharge.DESIGN: This is a qualitative study.METHODS: Data consisted of 19 recordings of telephone calls that occurred between March 2013 and December 2015. The calls were made by support team members to mothers within two weeks of discharge from the neonatal unit. Analyses were performed using content analysis.RESULTS: One category referred to what the support team members said that facilitated or did not facilitate the conversation. It was found that the support team members managed to have conversations that were tailored to the mother's current needs and conversations where the focus was on what the support team members thought was important. A second category referred to the topics the mothers talked about and that the mothers expressed both negative and positive feelings.
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- Jonsson, Anna, 1967-, et al.
(författare)
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Defining goals in participatory water management: merging local visions and expert judgements
- 2011
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Ingår i: Journal of Environmental Planning and Management. - Oxfordshire, UK : Informa UK Limited. - 1360-0559 .- 0964-0568. ; 54:7, s. 909-935
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Tidskriftsartikel (refereegranskat)abstract
- Management by objectives is intrinsic to the EU Water Framework Directive (WFD) and Swedish environmental policy. We describe three approaches to formulating objectives via model-assisted dialogue with local stakeholders concerning eutrophication in a coastal drainage area in south-eastern Sweden: a WFD eco-centred approach based on 'natural state'; Swedish environmental policy reformulated into quantified reduction goals; and a participatory approach based on local stakeholder definitions of desirable environmental status. Despite problems with representation, we conclude that local stakeholder participation in formulating local goals could increase goal functionality and robustness when adapting and implementing national and EU WFD goals at the local level.
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- Oredsson, Sven, et al.
(författare)
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A systematic review of triage-related interventions to improve patient flow in emergency departments
- 2011
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Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - London : Springer Science and Business Media LLC. - 1757-7241. ; 19, s. 43-
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Forskningsöversikt (refereegranskat)abstract
- Background: Overcrowding in emergency departments is a worldwide problem. A systematic literature review was undertaken to scientifically explore which interventions improve patient flow in emergency departments. Methods: A systematic literature search for flow processes in emergency departments was followed by assessment of relevance and methodological quality of each individual study fulfilling the inclusion criteria. Studies were excluded if they did not present data on waiting time, length of stay, patients leaving the emergency department without being seen or other flow parameters based on a nonselected material of patients. Only studies with a control group, either in a randomized controlled trial or in an observational study with historical controls, were included. For each intervention, the level of scientific evidence was rated according to the GRADE system, launched by a WHO-supported working group. Results: The interventions were grouped into streaming, fast track, team triage, point-of-care testing (performing laboratory analysis in the emergency department), and nurse-requested x-ray. Thirty-three studies, including over 800,000 patients in total, were included. Scientific evidence on the effect of fast track on waiting time, length of stay, and left without being seen was moderately strong. The effect of team triage on left without being seen was relatively strong, but the evidence for all other interventions was limited or insufficient. Conclusions: Introducing fast track for patients with less severe symptoms results in shorter waiting time, shorter length of stay, and fewer patients leaving without being seen. Team triage, with a physician in the team, will probably result in shorter waiting time and shorter length of stay and most likely in fewer patients leaving without being seen. There is only limited scientific evidence that streaming of patients into different tracks, performing laboratory analysis in the emergency department or having nurses to request certain x-rays results in shorter waiting time and length of stay.
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- Ruge, Toralph, et al.
(författare)
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Circulating plasma levels of cathepsin S and L are not associated with disease severity in patients with rheumatoid arthritis
- 2014
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Ingår i: Scandinavian Journal of Rheumatology. - : Informa UK Limited. - 0300-9742 .- 1502-7732. ; 43:2, s. 371-373
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Tidskriftsartikel (refereegranskat)abstract
- Background: Rheumatoid arthritis (RA) is characterized by chronic synovitis and articular cartilage destruction. Increased activities of cathepsin S and cathepsin L, two potent cysteine proteases, are thought to play a role in the pathogenesis of the irreversible articular cartilage destruction. Nevertheless, data regarding the potential importance of the cathepsins as circulating biomarkers in RA patients are limited.Method: Subjects enrolled in this study are part of a larger study where patients from the three northern counties of Sweden diagnosed with early RA are followed in an ongoing prospective study. In total, 71 patients were included, along with 44 age- and sex-matched control subjects. Plasma levels of cathepsin S and L were analysed. Disease severity was assessed using the 28-joint count Disease Activity Score (DAS28).Results: Plasma levels of cathepsin S and L were significantly increased in patients with RA compared to healthy controls (p < 0.05 for both). However, in the patients with RA, no association between the cathepsins and the severity of the disease, as characterized by DAS28, was observed (p > 0.51).Conclusions: Although circulating levels of cathepsin S and L were significantly increased in patients with recently diagnosed RA, our data do not support the notion that circulating levels of cathepsins are relevant biomarkers for disease severity.
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