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- Kristiansson, M., et al.
(författare)
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Drones can be used to provide dispatch centres with on-site photos before arrival of EMS in time critical incidents
- 2024
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Ingår i: Resuscitation. - 0300-9572 .- 1873-1570. ; , s. 110312-110312
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundDrones are able to deliver automated external defibrillators in cases of out-of-hospital cardiac arrest (OHCA) but can be deployed for other purposes. Our aim was to evaluate the feasibility of sending live photos to dispatch centres before arrival of other units during time-critical incidents.MethodsIn this retrospective observational study, the regional dispatch centre implemented a new service using five existing AED-drone systems covering an estimated 200 000 inhabitants in Sweden. Drones were deployed automatically over a 4-month study period (December 2022–April 2023) in emergency calls involving suspected OHCAs, traffic accidents and fires in buildings. Upon arrival at the scene, an overhead photo was taken and transmitted to the dispatch centre. Feasibility of providing photos in real time, and time delays intervals were examined.ResultsOverall, drones were deployed in 59/440 (13%) of all emergency calls: 26/59 (44%) of suspected OHCAs, 20/59 (34%) of traffic accidents, and 13/59 (22%) of fires in buildings.The main reasons for non-deployment were closed airspace and unfavourable weather conditions (68%). Drones arrived safely at the exact location in 58/59 cases (98%). Their overall median response time was 3:49 min, (IQR 3:18–4:26) vs. emergency medical services (EMS), 05:51 (IQR: 04:29–08:04) p-value for time difference between drone and EMS = 0,05. Drones arrived first on scene in 47/52 cases (90%) and the largest median time difference was found in suspected OHCAs 4:10 min, (IQR: 02:57–05:28). The time difference in the 5/52 (10%) cases when EMS arrived first the time difference was 5:18 min (IQR 2:19–7:38), p = NA. Photos were transmitted correctly in all 59 alerts. No adverse events occurred.ConclusionIn a newly implemented drone dispatch service, drones were dispatched to 13% of relevant EMS calls. When drones were dispatched, they arrived at scene earlier than EMS services in 90% of cases. Drones were able to relay photos to the dispatch centre in all cases.Although severely affected by closed airspace and weather conditions, this novel method may facilitate additional decision-making information during time-critical incidents.
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| 2. |
- Dunér, Anna, 1962, et al.
(författare)
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TalkingMats as a decision aid to promote involvement in choice and decision-making around home care services for older people with mild to moderate dementia - study protocol for a randomized controlled trial.
- 2023
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Ingår i: BMC geriatrics. - : BioMed Central (BMC). - 1471-2318. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- In Sweden, 72% of people with dementia live in ordinary housing. Of these, 50% receive home care services. Older people with dementia may benefit from developments in decision-making support which aim to facilitate their ability to communicate their personal needs and preferences with care managers and staff in home care services. In this study, we will test and evaluate the use of TalkingMats in Swedish municipal home care services for older people with mild to moderate dementia. TalkingMats is a low-technology communication tool, to help people with communication difficulties express their views. It uses a simple system of picture symbols which are placed on a textured mat. This study will provide insight into the extent to which TalkingMats benefits older people with dementia to feel more involved in decisions related to home care services. In addition, this study will assess the extent to which the use of TalkingMats promotes service providers' efforts to involve service recipients in decision making. The implementation of TalkingMats in home care services will also be studied.A parallel group, two-armed randomized controlled trial design in which TalkingMats and Usual Conversation Method will be compared. Two specific situations where older people with dementia must make decisions about home care services will be studied. First, a follow-up needs-assessment conversation between study participants and care managers will be studied. Second, a conversation between participants and home care staff regarding the delivery of the decided home care services will be studied. In addition, a qualitative approach will be used to gain an understanding of study participant and service provider experiences of the impact and implementation of TalkingMats.The combined exploratory, descriptive, and experimental study design is considered an important strength which will facilitate multi-facetted knowledge production concerning the involvement and communication needs of older people with dementia generally and within the context of home care services specifically. Combining qualitative and quantitative methods will maximize our ability to assess the effects of TalkingMats.ClinicalTrials.gov ID: NCT05561998 . Registered in September 28, 2022.
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| 3. |
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| 4. |
- Olsson, H, et al.
(författare)
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Predictors of short- and long-term mortality in critically ill, older adults admitted to the emergency department : an observational study
- 2022
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Ingår i: BMC Emergency Medicine. - : Springer Nature. - 1471-227X. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background In the future, we can expect an increase in older patients in emergency departments (ED) and acute wards. The main purpose of this study was to identify predictors of short- and long-term mortality in the ED and at hospital discharge. Methods This is a retrospective, observational, single-center, cohort study, involving critically ill older adults, recruited consecutively in an ED. The primary outcome was mortality. All patients were followed for 6.5-7.5 years. The Cox proportional hazards model was used. Results Regarding all critically ill patients aged >= 70 years and identified in the ED (n = 402), there was a significant association between mortality at 30 days after ED admission and unconsciousness on admission (HR 3.14, 95% CI 2.09-4.74), hypoxia on admission (HR 2.51, 95% CI 1.69-3.74) and age (HR 1.06 per year, 95% CI 1.03-1.09), (all p < 0.001). Of 402 critically ill patients aged >= 70 years and identified in the ED, 303 were discharged alive from hospital. There was a significant association between long-term mortality and the Charlson Comorbidity Index (CCI) > 2 (HR 1.90, 95% CI 1.46-2.48), length of stay (LOS) > 7 days (HR 1.72, 95% CI 1.32-2.23), discharge diagnosis of pneumonia (HR 1.65, 95% CI 1.24-2.21) and age (HR 1.08 per year, 95% CI 1.05-1.10), (all p < 0.001). The only symptom or vital sign associated with long-term mortality was hypoxia on admission (HR 1.70, 05% CI 1.30-2.22). Conclusions Among critically ill older adults admitted to an ED and discharged alive the following factors were predictive of long-term mortality: CCI > 2, LOS > 7 days, hypoxia on admission, discharge diagnosis of pneumonia and age. The following factors were predictive of mortality at 30 days after ED admission: unconsciousness on admission, hypoxia and age. These data might be clinically relevant when it comes to individualized care planning, which should take account of risk prediction and estimated prognosis.
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| 5. |
- Sárvári Horváth, Ilona, et al.
(författare)
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Biogas från lignocellulosa Tekno : ekonomisk utvärdering av förbehandling med NMMO
- 2013
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Biogas has been identified as one of the most cost - effective renewable fuels. In order to increase biogas production, yields from traditionally substrates either need to be improved or other alternative substrates must be made available for anaerobic digestion. Cellulose and lignocellulose rich wastes are available in large amounts and have great potential to be utilized for biogas production. This project focused on the opti mization of the pretreatment conditions when using the organic solvent N - methylmorpholine - N - oxide (NMMO) to enhance the methane yield from forest residues and straw. It also focused on a techno - economic evaluation of this pre - treatment technology. NMMO has previously been shown to be effective in dissolving cellulose and, as a consequence, in increasing the methane yield during the subsequent digestion. The goal of this project was to develop a technology that increases energy production from domestic subst rates in a cost - effective and environmentally friendly way. The treatment works well at lower temperatures (90°C), which means that water from the district heating system can advantageously be used in the treatment. The results showed that treatment with NMMO at 90°C doubles the methane yield from forest residues and increases the methane yield from straw by 50 %. For the techno - economic evaluation, the base case was assumed to be a facility with a capacity of 100 000 tones forest residues/year. After a w ashing and filtration step, the treated material will be utilized in a co - digestion process where 33% of the incoming material consists of forest residues and the rest is source - sorted household waste. The scale - up, process design, simulation and calculati ons were made using the software tool Intelligen SuperPro Design ® . The total investment costs were calculated to be about 145 million €, when forest residues or straw are to be used as raw material. Costs for operation (i.e. raw materials, energy, waste ma nagement, maintenance and personnel costs) were set against the incomes from the products (i.e. methane, carbon dioxide and the lignin - rich digested residue) to see if the process was profitable. The internal return rate (IRR), a parameter that indicates w hether a process is profitable or not, indicated that evaluated processes with capacities over 50 000 tons forest residues/year are profitable. However, co - digestion of forest residues with sewage sludge instead of household waste was not profitable. Both the laboratory results and the energy and economic calculations showed that the washing and filtration step is critical for the proposed process. The energy balance calculation resulted in an EROI value of 0.5, which means that the produced methane from fo rest residues counted up only the half of the energy needed for the treatment as well as NMMO separation and recycling. It is important to separate the NMMO well after the treatment, since remaining NMMO at concentrations higher than 0.002% were found to i nhibit the subsequent digestion step. Also it was showed out to be important that the washing step operates with small amounts of water to save energy within the NMMO recovery. A rotary vacuum filtration is therefore recommended for the washing and filtrat ion step, and a mechanical vapor design is recommended for the evaporation, saving up to 70 - 90% energy compared to a conventional design. Treatment of straw with recycled instead of fresh NMMO has also been tested and equal amounts of methane were obtain ed. After a well - functioning washing and filtration step, NMMO could not be detected in the digestate residue.
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