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- Falchenberg, Åsa, et al.
(författare)
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Clinical practice guidelines for comprehensive patient assessment in emergency care : A quality evaluation study
- 2021
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Ingår i: Nordic journal of nursing research. - : Sage Publications. - 2057-1585 .- 2057-1593. ; 41:4, s. 207-215
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Tidskriftsartikel (refereegranskat)abstract
- Emergency care nurses (ECNs) face several challenges when they assess patients with different symptoms, signs, and conditions to determine patients’ care needs. Patients’ care needs do not always originate from physical or biomedical dysfunctions. To provide effective patient-centred care, ECNs must be sensitive to patients’ unique medical, physical, psychological, social, and existential needs. Clinical practice guidelines (CPGs) provide guidance for ECNs in such assessments. The aim of this study was to evaluate the quality of CPGs for comprehensive patient assessments in emergency care. A quality evaluation study was conducted in Sweden in 2017. Managers from 97 organizations (25 emergency medical services and 72 emergency depart- ments) were contacted, covering all 20 Swedish county councils. Fifteen guidelines were appraised using the validated Appraisal of Guidelines for Research & Evaluation II (AGREE II) tool. The results revealed that various CPGs are used in emergency care, but none of the CPGs support ECNs in performing a comprehensive patient assessment; rather, the CPGs address parts of the assessment primarily related to biomedical needs. The results also demonstrate that the foundation for evidence-based CPGs is weak and cannot confirm that an ECN has the prerequisites to assess patients and refer them to treatment, such as home- based self-care. This may indicate that Swedish emergency care services utilize non-evidence-based guidelines. This implies that ECN managers and educators should actively seek more effective ways of highlighting and safeguarding patients’ various care needs using more comprehensive guidelines.
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| 2. |
- Kainulainen, Kent, 1978-
(författare)
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Evolution and biodiversity of the Ixoroideae (Rubiaceae)
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The phylogenetic relationships within subfamily Ixoroideae of the coffee family are investigated by phylogenetic reconstruction of molecular data, including regions of the chloroplast DNA (matK, ndhF, rbcL, rps16, trnH-psbA, trnS-G, and trnT-F), and the nuclear ribosomal DNA (ITS). The evolution of morphological characters within the group are inferred, with focus on characters used in classification. Ixoroideae have primarily been characterized by secondary pollen presentation, contorted corolla aestivation, and fleshy fruits. Secondary pollen presentation appears synapomorhic of a clade comprising the Ixoroideae crown group together with Retiniphyllum, whereas contorted corolla aestivation has evolved earlier and is synapomorphic for the crown group, Retiniphyllum, and Steenisia. Capsules likely represent a plesiomorphy from which various dry or fleshy indehiscent fruits have evolved independently in different clades. Reductions in seed number have also occured in many clades, none of which shows a secondary increase in the number of seeds. Within Ixoroideae, the phylogeny and tribal delimitations of Alberteae and Condamineeae are studied in more detail. The former appears restricted to Alberta, Nematostylis, and Razafimandimbisonia, a new genus described here. The Condamineeae are a diverse tribe largely unresolved in previous molecular phylogenetic studies. Our results support a synonymization of both Calycophylleae and Hippotideae, because these are nested within the Condamineeae. Ancestral state reconstructions indicate that intrapetiolar stipules, poricidal anthers, and protogyny, otherwise uncommon characters in Rubiaceae, all have evolved more than once in the Condamineeae. The rare genera Jackiopsis, Glionnetia, and Trailliaedoxa previously not included in molecular phylogenetic analyses, are all found nested within the Ixoroideae, and their systematic positions are discussed. The genera Bathysa, Calycophyllum, Elaeagia, and Rustia do not appear monophyletic. Consequently, resurrections of the names Holtonia, Schizocalyx, and Semaphyllanthe, and synonymizations of Phitopis (as Schizocalyx) and Tresanthera (as Rustia) are proposed. Also proposed are five new tribal names for clades that are not associated with any previously described tribes in the phylogenetic hypotheses presented.
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| 3. |
- Korall, Petra, 1968-
(författare)
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Phylogeny of Selaginellaceae
- 2003
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The phylogeny of Selaginellaceae, a small, but historically important family of heterosporous lycopods, has been the focus of this thesis. The approximately 700 extant species are herbaceous and distributed all over the world, with most species in the tropics and subtropics. Lycopods constituted a dominant element of the Upper Carboniferous flora, but Selaginellaceae were probably established already in the Lower Carboniferous some 345 million years ago, as revealed by macrofossil data. Major patterns of relationships were investigated based on a representative sample of global diversity and molecular (plastid gene rbcL, nuclear region 26S rDNA) and morphological data. Analyses were performed using parsimony and Bayesian inference. A survey of megaspore surface and wall structures was carried out for living species and included in the phylogenetic analyses. The resulting phylogenetic trees were used to evaluate various hypotheses on the evolution of the group, including the origins of tropical and temperate species diversity, as well as the evolution of xerophytism. Results showed that Selaginellaceae are monophyletic, and many subclades were identified. In a basal dichotomy two species, Selaginella selaginoides (L.) Link and S. deflexa Brackenridge, appear in a strongly supported clade as sister group to a clade comprising all other species (rhizophoric clade). The rhizophoric clade is recognised by the presence of rhizophores, which are highly characteristic root-like organs, and on the presence of decussately arranged sporophylls. Within the rhizophoric clade a basal dichotomy is most often found resulting in two more or less equally sized sister groups. These and many other groupings within these clades are new and have not previously been recognized in any other systematic study. Some of the new groups seem to have corresponding morphological synapomorphies, such as aspects of rhizophore development and megaspore characteristics. Others share distinctive ecological traits (e.g., xerophytism). For many groups, however, no morphological, ecological, or physiological markers are yet known.The inclusion of megaspore fossils allowed for tentative ages to be assigned to certain clades within the family. The phylogenetic tree is inconclusive with regard to a tropical or temperate origin of modern species diversity, but there is clear evidence for multiple independent origins of xerophytic strategies. Besides the phylogenetic results, this study reveals exceptionally high levels of substitution rates and rate heterogeneity in Selaginellaceae.
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| 5. |
- Smedmark, Jenny E. E., 1972-
(författare)
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The evolutionary history of Geum (Rosaceae, Colurieae) : a study of ancient allopolyploid speciation
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Allopolyploid speciation plays an important role in flowering plant evolution. Its contribution to diversity has been suggested to be significant in Geum. In this thesis the evolutionary history of Geum and its closest relatives was investigated by phylogenetic analysis of sequence data from the trnL-trnF region of the chloroplast, the ITS region of nuclear ribosomal DNA, and the nuclear low-copy gene GBSSI. The data were analysed using parsimony, Bayesian inference, and maximum likelihood. The phylogenies were used to test hypotheses about allopolyploid speciation, to investigate the evolution of some fruit characters and the implications for the taxonomy of the group. The GBSSI phylogenies indicated that allopolyploid speciation has occurred in the history of Geum. However, earlier hypotheses based on cytogenetic data about the allopolyploid ancestry of certain species were rejected. One tetraploid species and a morphologically diverse group of hexaploids, likely also including species with higher ploidy levels, were suggested to be of allopolyploid origin. A hypothesis of reticulate organismal relationships, including two instances where new lineages have been formed by allopolyploidy, was proposed based on the gene trees. A molecular dating analysis indicated that these reticulations occurred several million years ago. None of the previously suggested circumscriptions of Geum, Acomastylis, or Sieversia sensu lato were found to be monophyletic. Nested within Geum sensu lato were Waldsteinia, Coluria, and Taihangia and therefore Geum was recircumscribed to include these taxa. Colurieae, the former Dryadeae (in part), was recircumscribed and given a phylogenetic definition. According to this classification, Colurieae includes Fallugia, Sieversia sensu stricto, and Geum. Morphological evolution within the putative allopolyploid group appears to be homoplasious. Initial optimisation of the presence of a "joint", an abscission layer where the style, or part of it, is shed at maturity, on the gene trees indicated that it evolved four times from persistent, elongating styles. However, scanning electron microscopy showed that the development of the various types of fruits with jointed styles is similar, indicating that the joint and the deciduous segment of the style, of different lineages are homologous. The joint was thus hypothesised to have originated in the ancestral lineage of Waldsteinia and Coluria and to have been passed on via hybridisation to the polyploids. It is, however, only expressed in some lineages among the polyploids.
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| 6. |
- Wireklint Sundström, Birgitta, Ass professor, 1951-, et al.
(författare)
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Caring science research in the ambulance services : an integrative systematic review
- 2019
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Ingår i: Scandinavian Journal of Caring Sciences. - : John Wiley & Sons. - 0283-9318 .- 1471-6712. ; 33:1, s. 3-33
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Forskningsöversikt (refereegranskat)abstract
- BackgroundThe ambulance services are associated with emergency medicine, traumatology and disaster medicine, which is also reflected in previous research. Caring science research is limited and, since no systematic reviews have yet been produced, its focus is unclear. This makes it difficult for researchers to identify current knowledge gaps and clinicians to implement research findings.AimThis integrative systematic review aims to describe caring science research content and scope in the ambulance services.Data sourcesDatabases included were MEDLINE (PubMed), CINAHL, Web of Science, ProQDiss, LibrisDiss and The Cochrane Library. The electronic search strategy was carried out between March and April 2015. The review was conducted in line with the standards of the PRISMA statement, registration number: PROSPERO 2016:CRD42016034156.Review methodsThe review process involved problem identification, literature search, data evaluation, data analysis and reporting. Thematic data analysis was undertaken using a five‐stage method. Studies included were evaluated with methodological and/or theoretical rigour on a 3‐level scale, and data relevance was evaluated on a 2‐level scale.ResultsAfter the screening process, a total of 78 studies were included. The majority of these were conducted in Sweden (n = 42), fourteen in the United States and eleven in the United Kingdom. The number of study participants varied, from a case study with one participant to a survey with 2420 participants, and 28 (36%) of the studies were directly related to patients. The findings were identified under the themes: Caregiving in unpredictable situations; Independent and shared decision‐making; Public environment and patient safety; Life‐changing situations; and Ethics and values.ConclusionCaring science research with an explicit patient perspective is limited. Areas of particular interest for future research are the impact of unpredictable encounters on openness and sensitivity in the professional–patient relation, with special focus on value conflicts in emergency situations.
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