| 1. |
- Berg, Lena M
(författare)
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Patient safety at emergency departments : challenges with crowding, multitasking and interruptions
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Several challenges with patient safety in the emergency department (ED) context have beenpreviously identified, and some commonly mentioned are crowding, multitasking, andinterruptions. The ED is a complex, high-risk work environment where multiple clinicians(physicians, registered nurses [RNs], and licensed practical nurses [LPNs]) are constantlyworking in parallel work processes, in an often crowded ED, while conducting tasksinvolving cognitively demanding decision-making processes. ED crowding has for the past20 years been identified as a problem internationally, resulting in extended ED length of stay(LOS) and increased morbidity and mortality for patients. ED crowding is also considered tohave negative effects on the clinicians' workload and work satisfaction.Both multitasking and interruptions have been identified as risk factors for patient safety byhaving negative effects on a clinician's decision-making processes and thus increasing therisk of forgetting important details and events because of memory overload. However,information has been lacking about what specific work assignments ED clinicians conduct,and thus there is little information about the types of assignments they perform whilemultitasking and being exposed to interruptions. Further, because not all interruptions lead toerrors and because they are not all preventable, a more refined account of interruptions iscalled for. Moreover, it seems that previous studies have not identified which specific factorsinfluence the ED clinicians' perceptions of interruptions. The work environment has beenreferred to as a possible influencing factor, but specific details on the relationship between thework environment and negative effects from interruptions are pending.The overall aim of the thesis was to describe ED crowding, and its influence on EDclinicians' work processes (activities, multitasking, and interruptions) and patient outcomes,from a patient safety perspective. The thesis addressed six research questions: 1) How has EDcharacteristics, patient case mix and occurrence of ED crowding changed over time? 2) Whatwork activities are performed by ED clinicians? 3) What kind of multitasking situations areclinicians exposed to during ED work? 4) What kind of interruptions are clinicians exposedto during ED work? 5) How do ED clinicians perceive interruptions? 6) Is there anassociation between ED crowding and mortality for stable patients without the need for acutehospital care upon departure from the ED?The data in the thesis were generated from two data collections: 1) registry data containingpatient characteristics and measures of ED crowding (ED occupancy ratio [EDOR], ED LOS,and patient/clinician ratios) extracted from the patients' electronic health records (paper I andIV) and 2) observations and interviews with ED clinicians (physicians, RNs, and LPNs)(paper II and III). Nonparametric statistics were used in paper I and III, quantitative and qualitative content analysis were used in paper II and III, and multivariate logistic regressionanalysis was used in paper IV.The main results in the thesis are presented based on Asplin's conceptual model of EDcrowding, from the aspect of input-throughput-output, and how parts of a sub-optimalthroughput influence patient safety through ED clinicians' work processes and patientoutcomes. During 2009 – 2016 there has been a change in patient case mix at the EDs at thestudy hospital, primarily with an increase in unstable patients (input) and a decrease in thenumber of patients admitted to in-hospital care (output). The median for ED LOS over thestudy period increased, and the largest increases occurred among the subgroups of unstablepatients, patients ≥80 years of age, and those admitted to in-hospital care (throughput).Further, an increase in crowding, in terms of median EDOR and median patients per RNratios, was identified, with an increase in EDOR from 0.8 in 2009 to 1.1 in 2016 and anaverage increase of 0.164 patients/RN/year (throughput). The ED clinicians' workassignments consisted of 15 categories of activities, and information exchange was found tobe the most common activity (42.1%). In contrast, the clinicians only spent 9.4% of theiractivities on direct interaction with patients and their families (ED clinicians' workprocesses). The clinicians multitasked during 23% of their total number of performedactivities, and there was an overall interruption rate of 5.1 interruptions per hour. Themajority of the observed multitasking situations and interruptions in the ED clinicians' workoccurred during demanding activities that required focus or concentration (ED clinicians'work processes). Finally, an association was identified between an increase in ED LOS andEDOR and 10-day mortality for stable patients without the need for acute hospital care upondeparture from the ED (patient outcomes).This thesis illustrates how a sub-optimal throughput, affected by conditions in both the inputand output components, negatively influence the ED clinicians' work processes as well aspatient outcomes.
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| 2. |
- Berglund, Anna, 1949-, et al.
(författare)
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Våldsutsatta kvinnor- samhällets ansvar
- 2014. - 3
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Ingår i: Lärobok, tredje upplagan, framtagen av Nationellt centrum för kvinnofrid, Uppsala universitet. - Uppsala : Studentlitteratur AB. - 9789144094441
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 3. |
- Göransson, Anna-Lena, et al.
(författare)
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NORDYRK 2013
- 2013
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Ingår i: Kapet (elektronisk). - : Karlstads universitet. - 2002-3979. ; 9:1, s. 125-130
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 4. |
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| 5. |
- Halldórsdóttir, Anna M., et al.
(författare)
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High-resolution genomic screening in mantle cell lymphoma : specific changes correlate with genomic complexity, the proliferation signature and survival
- 2011
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Ingår i: Genes, Chromosomes and Cancer. - : Wiley. - 1045-2257 .- 1098-2264. ; 50:2, s. 113-121
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Tidskriftsartikel (refereegranskat)abstract
- Mantle cell lymphoma (MCL) is characterized by the t(11;14)(q13;q32) and numerous copy number aberrations (CNAs). Recently, gene expression profiling defined a proliferation gene expression signature in MCL where high scores predict shorter survival. We investigated 31 MCL cases using high-density single nucleotide polymorphism arrays and correlated CNA patterns with the proliferation signature and with clinical data. Many recurrent CNAs typical of MCL were detected, including losses at 1p (55%), 8p (29%), 9q (29%), 11q (55%), 13q (42%) and 17p (32%), and gains at 3q (39%), 8q (26%), 15q (23%) and 18q (23%). A novel deleted region at 20q (16%) contained only one candidate gene, ZFP64, a putative tumor suppressor. Unsupervised clustering identified subgroups with different patterns of CNAs, including a subset (19%) characterized by the presence of 11q loss in all cases and by the absence of 13q loss, and 3q and 7p gains. Losses at 1p, 8p, 13q and 17p were associated with increased genomic complexity. High proliferation signature scores correlated with increased number of large (>15 Mbp) CNAs (P = 0.03) as well as copy number gains at 7p (P = 0.02) and losses at 9q (P = 0.04). Furthermore, large/complex 13q losses were associated with improved survival (P < 0.05) as were losses/copy number neutral LOH at 19p13 (P = 0.01). In summary, this high-resolution genomic analysis identified novel aberrations and revealed that several CNAs correlated with genomic complexity, the proliferation status and survival.
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| 6. |
- Halldorsdottir, Anna Margret, et al.
(författare)
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Mantle cell lymphoma displays a homogenous methylation profile : A comparative analysis with chronic lymphocytic leukemia
- 2012
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Ingår i: American Journal of Hematology. - : John Wiley & Sons. - 0361-8609 .- 1096-8652. ; 87:4, s. 361-367
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Tidskriftsartikel (refereegranskat)abstract
- Mantle cell lymphoma (MCL) and chronic lymphocytic leukemia (CLL) are mature CD5(+) B-cell malignancies with different biological/clinical characteristics. We recently reported an association between different prognostic subgroups of CLL (i.e., IGHV mutated and unmutated) and genomic methylation pattern. However, the relationship between DNA methylation and prognostic markers, such as the proliferation gene expression signature, has not been investigated in MCL. We applied high-resolution methylation microarrays (27,578 CpG sites) to assess the global DNA methylation profiles in 20 MCL (10 each with high/low proliferation signature) and 30 CLL (15 poor-prognostic IGHV unmutated subset #1 and 15 good-prognostic IGHV mutated subset #4) samples. Notably, MCL and each CLL subset displayed distinct genomic methylation profiles. After unsupervised hierarchical clustering, 17/20 MCL cases formed a cluster separate from CLL, while CLL subsets #1 and #4 formed subclusters. Surprisingly, few differentially methylated genes (n = 6) were identified between high vs. low proliferation MCL. In contrast, distinct methylation profiles were demonstrated for MCL and CLL. Importantly, certain functional classes of genes were preferentially methylated in either disease. For instance, developmental genes, in particular homeobox transcription factor genes (e.g., HLXB9, HOXA13), were more highly methylated in MCL, whereas apoptosis-related genes were enriched among targets methylated in CLL (e.g., CYFIP2, NR4A1). Results were validated using pyrosequencing, RQ-PCR and reexpression of specific genes. In summary, the methylation profile of MCL was homogeneous and no correlation with the proliferation signature was observed. Compared to CLL, however, marked differences were discovered such as the preferential methylation of homeobox genes in MCL.
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| 7. |
- Halldorsdottir, Anna Margret, et al.
(författare)
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Mantle cell lymphoma displays a homogenous methylation profile: A comparative analysis with chronic lymphocytic leukemia
- 2012
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Ingår i: American Journal of Hematology. - : Wiley. - 0361-8609 .- 1096-8652. ; 87:4, s. 361-367
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Tidskriftsartikel (refereegranskat)abstract
- Mantle cell lymphoma (MCL) and chronic lymphocytic leukemia (CLL) are mature CD5(+) B-cell malignancies with different biological/clinical characteristics. We recently reported an association between different prognostic subgroups of CLL (i.e., IGHV mutated and unmutated) and genomic methylation pattern. However, the relationship between DNA methylation and prognostic markers, such as the proliferation gene expression signature, has not been investigated in MCL. We applied high-resolution methylation microarrays (27,578 CpG sites) to assess the global DNA methylation profiles in 20 MCL (10 each with high/low proliferation signature) and 30 CLL (15 poor-prognostic IGHV unmutated subset #1 and 15 good-prognostic IGHV mutated subset #4) samples. Notably, MCL and each CLL subset displayed distinct genomic methylation profiles. After unsupervised hierarchical clustering, 17/20 MCL cases formed a cluster separate from CLL, while CLL subsets #1 and #4 formed subclusters. Surprisingly, few differentially methylated genes (n = 6) were identified between high vs. low proliferation MCL. In contrast, distinct methylation profiles were demonstrated for MCL and CLL. Importantly, certain functional classes of genes were preferentially methylated in either disease. For instance, developmental genes, in particular homeobox transcription factor genes (e.g., HLXB9, HOXA13), were more highly methylated in MCL, whereas apoptosis-related genes were enriched among targets methylated in CLL (e.g., CYFIP2, NR4A1). Results were validated using pyrosequencing, RQ-PCR and reexpression of specific genes. In summary, the methylation profile of MCL was homogeneous and no correlation with the proliferation signature was observed. Compared to CLL, however, marked differences were discovered such as the preferential methylation of homeobox genes in MCL. Am. J. Hematol., 2012. (C) 2012 Wiley Periodicals, Inc.
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| 9. |
- Strömsöe, Anneli, 1969, et al.
(författare)
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Education in cardiopulmonary resuscitation in Sweden and its clinical consequences
- 2009
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Ingår i: Cardiology. - 0008-6312. - 9783805591430 ; 113:S1
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Aim: To describe the use of cardiopulmonary resuscitation (CPR) training programmes in Sweden in a 25 years perspective and relate it to out of hospital cardiac arrest (OHCA) who receives bystander CPR. Methods: In this retrospective study based on register data, 1983–2007, the number of rescuers and instructors educated in different CPR training programmes in Sweden are described as well as the increase in bystander CPR in OHCA over time in a national perspective. Information was gathered from the Swedish CPR training and the Swedish Cardiac Arrest Register (SCAR). Results: The CPR education in Sweden functions according to a cascade principle (instructor trainers who train instructors who then train rescuers in CPR). Since 1989, 5000 instructors trainers have taught more than 50.000 instructors who have taught nearly 2 millions of Sweden’s 9 millions inhabitants adult CPR. In addition since 1989, 51.000 new rescuers in advanced life support (ALS) and since 1996, 41.000 new rescuers in AED defibrillation. As a consequence of this CPR training there has been an increase in bystander CPR attempts in OHCA in Sweden from 31% in 1992 to 55% in 2007. The proportion of bystander resuscitation attempts performed by non health care providers has increased from 66% to 77% during the same period. Conclusion: By using a cascade principle for CPR education nearly 2 million rescuers have been educated in Sweden between 1989 and 2007. This has resulted in a marked increase in bystander CPR attempts.
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