| 1. |
- Albert, Malin, et al.
(författare)
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Aetiology and outcome in hospitalized cardiac arrest patients.
- 2023
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Ingår i: European Heart Journal Open. - 2752-4191. ; 3:4
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: To study aetiologies of in-hospital cardiac arrests (IHCAs) and their association with 30-day survival.METHODS AND RESULTS: Observational study with data from national registries. Specific aetiologies (n = 22) of IHCA patients between April 2018 and December 2020 were categorized into cardiac vs. non-cardiac and six main aetiology categories: myocardial ischemia, other cardiac causes, pulmonary causes, infection, haemorrhage, and other non-cardiac causes. Main endpoints were proportions in each aetiology, 30-day survival, and favourable neurological outcome (Cerebral Performance Category scale 1-2) at discharge. Among, 4320 included IHCA patients (median age 74 years, 63.1% were men), approximate 50% had cardiac causes with a 30-day survival of 48.4% compared to 18.7% among non-cardiac causes (P < 0.001). The proportion in each category were: myocardial ischemia 29.9%, pulmonary 21.4%, other cardiac causes 19.6%, other non-cardiac causes 11.6%, infection 9%, and haemorrhage 8.5%. The odds ratio (OR) for 30-day survival compared to myocardial ischemia for each category were: other cardiac causes OR 1.48 (CI 1.24-1.76); pulmonary causes OR 0.36 (CI 0.3-0.44); infection OR 0.25 (CI 0.18-0.33); haemorrhage OR 0.22 (CI 0.16-0.3); and other non-cardiac causes OR 0.56 (CI 0.45-0.69). IHCA caused by myocardial ischemia had the best favourable neurological outcome while those caused by infection had the lowest OR 0.06 (CI 0.03-0.13).CONCLUSION: In this nationwide observational study, aetiologies with cardiac and non-cardiac causes of IHCA were evenly distributed. IHCA caused by myocardial ischemia and other cardiac causes had the strongest associations with 30-day survival and neurological outcome.
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| 2. |
- 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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| 3. |
- Awad, Akil, et al.
(författare)
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Transnasal Evaporative Cooling in Out-of-Hospital Cardiac Arrest Patients to Initiate Hypothermia—A Substudy of the Target Temperature Management 2 (TTM2) Randomized Trial
- 2023
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Ingår i: Journal of Clinical Medicine. - 2077-0383. ; 12:23
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Tidskriftsartikel (refereegranskat)abstract
- Background: In animal models, early initiation of therapeutic cooling, intra-arrest, or restored circulation has been shown to be neuroprotective shortly after cardiac arrest. We aimed to assess the feasibility and cooling efficacy of transnasal evaporative cooling, initiated as early as possible after hospital arrival in patients randomized to cooling in the TTM2 trial. Methods: This study took the form of a single-center (Södersjukhuset, Stockholm) substudy of the TTM2 trial (NCT02908308) comparing target temperature management (TTM) to 33 °C versus normothermia in OHCA. In patients randomized to TTM33 °C, transnasal evaporative cooling was applied as fast as possible. The primary objectives were the feasibility aspects of initiating cooling in different hospital locations (i.e., in the emergency department, coronary cathlab, intensive care unit (ICU), and during intrahospital transport) and its effectiveness (i.e., time to reach target temperature). Transnasal cooling was continued for two hours or until patients reached a core temperature of <34 °C. Cooling intervals were compared to participants at the same site who were randomized to hypothermia and treated at 33 °C but who for different reasons did not receive transnasal evaporative cooling. Results: From October 2018 to January 2020, 32 patients were recruited, of which 17 were randomized to the TTM33. Among them, 10 patients (8 men, median age 69 years) received transnasal evaporative cooling prior to surface systemic cooling in the ICU. In three patients, cooling was started in the emergency department; in two patients, it was started in the coronary cathlab, and in five patients, it was started in the ICU, of which three patients were subsequently transported to the coronary cathlab or to perform a CT scan. The median time to initiate transnasal cooling from randomization was 9 min (range: 5 to 39 min). The median time from randomization to a core body temperature of 34 °C was 120 min (range 60 to 334) compared to 178 min among those in the TTM33 group that did not receive TNEC and to 33 °C 230 min (range: 152 to 351) vs. 276 min (range: 150 to 546). No feasibility or technical issues were reported. No adverse events occurred besides minor nosebleeds. Conclusions: The early induction of transnasal cooling in out-of-hospital cardiac arrest patients was feasible to initiate in the emergency department, coronary cathlab, ICU, and during intrahospital transport. Time to target temperature was shortened compared to standard cooling.
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| 4. |
- 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 560m (IQR 332-860m), and 1280m (IQR 748-1776m) 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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| 5. |
- Berglund, Ellinor, et al.
(författare)
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Effect of Smartphone Dispatch of Volunteer Responders on Automated External Defibrillators and Out-of-Hospital Cardiac Arrests : The SAMBA Randomized Clinical Trial
- 2023
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Ingår i: JAMA cardiology. - : American Medical Association (AMA). - 2380-6583 .- 2380-6591. ; 8:1, s. 81-88
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Tidskriftsartikel (refereegranskat)abstract
- Importance Smartphone dispatch of volunteer responders to nearby out-of-hospital cardiac arrests (OHCAs) has emerged in several emergency medical services, but no randomized clinical trials have evaluated the effect on bystander use of automated external defibrillators (AEDs).Objective To evaluate if bystander AED use could be increased by smartphone-aided dispatch of lay volunteer responders with instructions to collect nearby AEDs compared with instructions to go directly to patients with OHCAs to start cardiopulmonary resuscitation (CPR).Design, Setting, and Participants This randomized clinical trial assessed a system for smartphone dispatch of volunteer responders to individuals experiencing OHCAs that was triggered at emergency dispatch centers in response to suspected OHCAs and randomized 1:1. The study was conducted in 2 main Swedish regions: Stockholm and Västra Götaland between December 2018 and January 2020. At study start, there were 3123 AEDs in Stockholm and 3195 in Västra Götaland and 24 493 volunteer responders in Stockholm and 19 117 in Västra Götaland. All OHCAs in which the volunteer responder system was activated by dispatchers were included. Excluded were patients with no OHCAs, those with OHCAs not treated by the emergency medical services, and those with OHCAs witnessed by the emergency medical services.Interventions Volunteer responders were alerted through the volunteer responder system smartphone application and received map-aided instructions to retrieve nearest available public AEDs on their way to the OHCAs. The control arm included volunteer responders who were instructed to go directly to the OHCAs to perform CPR.Main Outcomes and Measures Overall bystander AED attachment, including those attached by volunteer responders and lay volunteers who did not use the smartphone application.Results Volunteer responders were activated for 947 patients with OHCAs. Of those, 461 were randomized to the intervention group (median [IQR] age of patients, 73 [61-81] years; 295 male patients [65.3%]) and 486 were randomized to the control group (median [IQR] age of patients, 73 [63-82] years; 312 male patients [65.3%]). Primary outcome of AED attachment occurred in 61 patients (13.2%) in the intervention arm vs 46 patients (9.5%) in the control arm (difference, 3.8% [95% CI, −0.3% to 7.9%]; P = .08). The majority of AEDs were attached by lay volunteers who were not using the smartphone application (37 in intervention arm, 28 in control). There were no significant differences in secondary outcomes. Among the volunteer responders using the application, crossover was 11% and compliance to instructions was 31%. Volunteer responders attached 38% (41 of 107) of all AEDs and provided 45% (16 of 36) of all defibrillations and 43% (293 of 666) of all CPR.Conclusions and Relevance In this study, smartphone dispatch of volunteer responders to OHCAs to retrieve nearby AEDs vs instructions to directly perform CPR did not significantly increase volunteer AED use. High baseline AED attachement rate and crossover may explain why the difference was not significant.Trial Registration ClinicalTrials.gov Identifier: NCT02992873
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| 6. |
- Berglund, Ellinor, et al.
(författare)
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Wellbeing, emotional response and stress among lay responders dispatched to suspected out-of-hospital cardiac arrests
- 2022
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Ingår i: Resuscitation. - : Elsevier Ireland Ltd. - 0300-9572 .- 1873-1570. ; 170, s. 352-360
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Tidskriftsartikel (refereegranskat)abstract
- Background: Systems for smartphone dispatch of lay responders to perform cardio-pulmonary resuscitation (CPR) and bring automated external defibrillators to out-of-hospital cardiac arrests (OHCAs) are advocated by recent international guidelines and emerging worldwide. Objectives: This study aimed to investigate the emotional responses, posttraumatic stress reactions and levels of wellbeing among smartphone-alerted lay responders dispatched to suspected OHCAs. Methods: Lay responders were stratified by level of exposure: unexposed (Exp-0), tried to reach (Exp-1), and reached the suspected OHCA (Exp-2). Participants rated their emotional responses online, at 90 minutes and at 4–6 weeks after an incident. Level of emotional response was measured in two dimensions of core affect: “alertness” – from deactivation to activation, and “pleasantness” – from unpleasant to pleasant. At 4–6 weeks, WHO wellbeing index and level of posttraumatic stress (PTSD) were also rated. Results: Altogether, 915 (28%) unexposed and 1471 (64%) exposed responders completed the survey. Alertness was elevated in the exposed groups: Exp-0: 6.7 vs. Exp-1: 7.3 and Exp-2: 7.5, (p < 0.001) and pleasantness was highest in the unexposed group: 6.5, vs. Exp-1: 6.3, and Exp-2: 6.1, (p < 0.001). Mean scores for PTSD at follow-up was below clinical cut-off, Exp-0: 9.9, Exp-1: 8.9 and Exp-2: 8.8 (p = 0.065). Wellbeing index showed no differences, Exp-0: 78.0, Exp-1: 78.5 and Exp-2: 79.9 (p = 0.596). Conclusion: Smartphone dispatched lay responders rated the experience as high-energy and mainly positive. No harm to the lay responders was seen. The exposed groups had low posttraumatic stress scores and high-level general wellbeing at follow-up. © 2021
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| 7. |
- Bergman Ärlebäck, Jonas, 1972-, et al.
(författare)
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IPAs - ihopparningsaktiviteter : aktiviteter med låg tröskel som tränar elevers begrepps-, procedur-/ metod- och resonemangsförmåga
- 2017
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Syftet med denna rapport är att på ett beskrivande sätt delge hur arbetet i projektet om IPAs som genomförts HT2014 – VT2015 gått till och vilka erfarenheter och slutsatser som arbetet resulterat i. Den tänkte läsaren är framför allt kommunernas matematiklärare, men vi tror även att andra lärare och skolpersonal kan finna innehållet intressant och användbart. Det är vår förhoppning att rapporten med tillhörande aktiviteter kan inspirera till reflektion och en mer varierad undervisning. När pronomen som vi och oss används i rapporten åsyftats alla som aktivt ingått i IPAprojektets forskande grupp, vilken har bestått av såväl deltagande lärare som forskare:Marcus Claesson (Kungsgårdsgymnasiet, Norrköping), Malin Hällgren (Birgittaskolans vuxenutbildning, Linköping), Sofia Lindh (Hagagymnasiet, Norrköping), Mia Lundell (Djäkneparksskolan, Norrköping), Mattias Nordling (Anders Ljungstedska gymnasiet, Linköping) och Jonas Bergman Ärlebäck (LiU). Huvudansvaret för författandet av rapporten har Jonas haft som medverkande forskare i projektet. De medforskande lärarna har bidragit med analyser, erfarenheter och exempel från sina klassrum, utvecklat, testat och formulerat aktiviteterna som utgjort navet i projektet, samt läst och kommenterat rapporten under dess framställning.Rapporten följer samma logik och uppbyggnad som de rapporter skrivna inom det övergripande samarbetsprojektet Matematikdidaktik för bättre matematikkunskaper av det arbete och den forskning som bedrivits av Lisa Björklund Boistrup (Björklund Boistrup et al. 2013a; 2013b; 2013c; 2014a; 2014b). Vissa delar av texten använder därför, eller bygger till viss del på, Lisas texter, och när så är fallet tydliggörs detta med fotnoter. Andra delar av texten, så som exempelvis beskrivningen av de teoretiska utgångspunkterna, är i stort identiskt i samtliga delprojektsrapporter för de projekt som Jonas medverkat i som forskare (Ärlebäck et. al. 2017a, 2017b, 2017c, 2017d). Rapporten är dock skriven för att kunna läsas helt fristående från de andra rapporterna författade i projektet och förutsätter med andra ord ingen tidigare kunskap eller kännedom om projektet och de perspektiv som används. De läsare som redan tagit del av arbetet inom samarbetsprojektet Matematikdidaktik för bättre matematikkunskaper på olika sätt kommer här och var att känna igen sig, men vi hoppas att de delar som är unikt specifika för just detta delprojekt ska vara intressant och inspirerande.
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| 8. |
- Bhattacharya, Prosun, et al.
(författare)
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Distribution and mobility of arsenic in the Rio Dulce alluvial aquifers in Santiago del Estero Province, Argentina
- 2006
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Ingår i: Science of the Total Environment. - : Elsevier BV. - 0048-9697 .- 1879-1026. ; 358:1-3, s. 97-120
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Tidskriftsartikel (refereegranskat)abstract
- Factors controlling arsenic (As) mobilization in the aquifers of the Rio Dulce alluvial cone were investigated. Groundwater analyses show severe As contamination (average concentration of 743 mu g/L) from geogenic sources, but spatial variability of As concentration is considerable. Sequential leaching of sediment samples from unsaturated zone using de-ionised water, bicarbonate, acetate, and oxalate extracted As to different extents. Sediment oxalate extraction showed that Al and Mn oxide and hydroxides are more abundant than Fe oxides and hydroxides, in spite of similar total Fe, Mn, and Al concentrations in the sediment. Speciation calculations performed for saturated zone samples indicated that Fe and Al oxides and hydroxides are stable in groundwater, suggesting that As adsorption processes may be to some extent controlled by the presence of Fe and Al mineral phases. Principal Component Analysis (PCA) showed that As is related to F, V, Mo, B, Si, most likely due to their common origin in volcanic ash. This suggests the volcanic ash as the probable source of groundwater As. Locally, elevated pH values linked to carbonate dissolution, cation exchange, and dissolution of silicates promote release of adsorbed As. Another factor contributing to the release of As locally may be the input of organic matter from excessive irrigation. The conceptual model of As release includes: i) As influx from dissolution of volcanic glass in volcanic ash, ii) adsorption of As on the surface of Fe and Al mineral phases in relatively low pH zones, and iii) high mobility of As in high pH zones. Future work should be focused on the determination of mineralogical forms of As in volcanic ash and on detailed investigation on factors controlling As mobility.
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| 9. |
- Bhattacharya, Prosun, et al.
(författare)
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Natural arsenic in the groundwater of the alluvial aquifers of Santiago del Estero Province, Argentina
- 2005
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Ingår i: Natural Arsenic in Groundwater. - London : Balkema. - 041536700X ; , s. 57-65
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Konferensbidrag (refereegranskat)abstract
- Natural occurrences of arsenic has been documented in groundwater of the shallow aquifers of the Chaco-Pampean Plain, Argentina. The distribution of arsenic and mechanisms of its mobilization in the shallow alluvial aquifers was investigated around the city of Santiago del Estero in Northwestern Argentina in order to provide an insight into the complex hydrological and geochemical conditions that yields high As concentrations in groundwater. Significant spatial variations of total arsenic (As-tot) concentrations were observed with an average value of 743 mu g/L. Arsenate was a dominant species in most samples. Average concentrations of Al, Mn, and Fe were 360 mu g/L, 574 mu g/L, and 459 mu g/L, respectively. The 7M HNO3 extraction of sediments and volcanic ash-layer indicated AS(N03) concentrations ranging between 2.5-7.1 mg/kg. AS(N03) indicated a significant positive correlation with Mn-N03, Al-N03, and Fe-N03. Oxalate extractions revealed significant fractions of As (Aso(ox)) in the sediments (0.4-1.4mg/kg) and a dominance of oxalate extractable Al- and Mn. Speciation calculations indicate that Al oxide and hydroxides have the potential to precipitate in the groundwater, suggesting that As adsorption processes may be to some extent controlled by Al oxides and hydroxides. Mobility of As at local scale seems to depend on high pH values, related to the dissolution of carbonates driven by cation exchange, and dissolution of silicates. There is a clear relationship of As with F, V, B and Si, suggesting their common origin in volcanic ash layer. Preliminary conceptual model of arsenic input includes release of As and Al from dissolution of volcanic ash layer, precipitation of Al oxides and hydroxides followed by adsorption of As on Al and Fe phases in sediments, and release of As under high pH conditions.
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| 10. |
- Börjesson, Mattias, 1978, et al.
(författare)
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Förord
- 2021
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Ingår i: Nordisk Tidskrift för Allmän didaktik. - 2002-2832. ; 7:1
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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