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- Höglund, Erik, 1983-
(author)
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Non-conveyance within the Swedish ambulance service : A prehospital patient safety study
- 2022
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Doctoral thesis (other academic/artistic)abstract
- BackgroundThere is an increasing demand for ambulance services and more patients than before are requesting ambulance assistance for low acuity conditions. Ambulance services non-convey patients because they lack acute care needs. Non-conveying patients can be a person-centred, resource- and cost-efficient measure and can allow the ambulance to become available sooner for patients with more acute illnesses or injuries. However, validated non-conveyance guidelines are lacking and non-conveying patients raises patient safety issues.AimThe overarching aim of the research project was to describe the patients that were non-conveyed, to explore if there were any potential patient safety issues with the regional non-conveyance guidelines, and to describe how patients and nurses experience non-conveyance.MethodsAll non-conveyance assignments during one year in a region in Sweden (n=2691) were consecutively and prospectively included. The quantitative data was described, compared, and analysed (Studies I and II). Two interview studies were carried out. Phenomenography and conventional content analysis were used to analyse the qualitative data. In total 14 patients were interviewed in Study III and 20 nurses were interviewed in Study IV.Conclusions Patients of all ages with varying characteristics and complaints were non-conveyed. No patient received intensive care, and few were admitted to in-hospital care or died within seven days after being non-conveyed. Older age increases the risk of hospitalisation and death. Patients could feel ashamed for being non-conveyed, and the ambulance nurse could feel frustration when believing that the ambulance resource was misused
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| 2. |
- Philipson, Anna, 1978-
(author)
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Health economic aspects of emotional problems and pain symptoms in childhood and adolescence : Long-term outcomes, efficacy and cost-effectiveness of interventions
- 2022
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Doctoral thesis (other academic/artistic)abstract
- Emotional problems and pain symptoms among children and adolescents are a global public health challenge that imposes a great burden on the individuals affected and on society. Because resources are limited, allocation and prioritization are needed. Health economic analysis can constitute a foundation for such decisions.The overall aim of this thesis is to estimate long-term outcomes associated with adolescent depression and to evaluate interventions for emotional problems and pain symptoms in childhood and adolescence from a health economic perspective. The thesis is based on four papers: paper I is a longitudinal cohort study of 539 participants, showing that adolescent depression is associated with reduced earnings in adulthood, papers II, III, and IV are based on two randomized controlled trials of interventions. In paper II, a dance intervention for 112 adolescent females with internalizing symptoms were evaluated. A cost–utility analysis was performed, indicating that the intervention was costeffective given a willingness-to-pay threshold of USD 50,000 with an incremental cost-effectiveness ratio of USD 3830/quality-adjusted life year. Papers III and IV evaluated a dance and yoga intervention for 121 girls, 9–13 years old, with functional abdominal pain disorders. Paper III showed that the intervention group decreased their abdominal pain more than did the control group. In paper IV, the cost–utility analysis of the trial indicated a negative incremental cost-effectiveness ratio, investigated from a societal perspective, over both one and ten years.In conclusion, this thesis identifies a need for preventive as well as treatment interventions for emotional problems in adolescence, to decrease the prevalence of emotional problems and mitigate negative outcomes. Dance or dance and yoga combined can be effective and cost-effective early treatment interventions for emotional problems and pain symptoms among females in childhood and adolescence. These findings may assist decision-makers in resource allocation within this area
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| 3. |
- Wennberg, Pär, 1972-
(author)
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Pain management in older persons with hip fractures
- 2019
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Doctoral thesis (other academic/artistic)abstract
- The overall aim of this thesis was to evaluate the preoperative management of pain from the perspectives of a literature overview, emergency medical service pain management, an intervention with a fascia iliaca compartment block and the association between cognitive status and the treatment of pain. Paper 1 is an integrative review of the literature on emergency care in patients with hip fractures or suspected hip fractures. Pain is a major problem for patients suffering a hip fracture when waiting for surgery and it is challenging for health care to provide sufficient pain relief. Listening to the patient’s narrative and the mandatory use of pain scales and pain documentation are necessary to deepen our understanding of individual patients’ needs. Paper 2 is a prospective observational study that explored the prehospital pain levels in 1,426 patients with suspected hip fractures. Furthermore, this study evaluated prehospital pain management. At the site of the injury, patients with hip fractures are often in substantial pain. Seventy-five per cent of the patients received pain relief from the emergency medical service (EMS) care providers and the pain relief was often effective. Several of the patients that did not receive prehospital pain relief had moderate to severe pain. Paper 3 is a randomised placebo-controlled double-blind trial (RCT) of 127 patients waiting for surgery. This RCT evaluated the effect of fascia iliaca compartment blocks (FICB) in relation to pain and medical pain relief, when added to regular preoperative analgesia. FICB improved pain relief when compared with regular analgesia alone (p=0.002). Paper 4 examined whether preoperative pain management with FICB could have an effect on cognitive status in the same 127 patients that were included in Paper 3. No impact on cognitive impairment was proven in this study. Patients with severe cognitive impairment received significantly lower doses of prehospital morphine than patients with higher cognitive status. Prehospital and hospital pain management need to improve. Pain management is especially challenging in persons with cognitive impairment.
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