| 1. |
- Herlitz, Johan, et al.
(författare)
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Suspicion and treatment of severe sepsis : An overview of the prehospital chain of care
- 2012
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Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - : BioMed Central. - 1757-7241. ; 20:42
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundSepsis is a life-threatening condition where the risk of death has been reported to be even higher than that associated with the major complications of atherosclerosis, i.e. myocardial infarction and stroke. In all three conditions, early treatment could limit organ dysfunction and thereby improve the prognosis.AimTo describe what has been published in the literature a/ with regard to the association between delay until start of treatment and outcome in sepsis with the emphasis on the pre-hospital phase and b/ to present published data and the opportunity to improve various links in the pre-hospital chain of care in sepsis.MethodsA literature search was performed on the PubMed, Embase (Ovid SP) and Cochrane Library databases.ResultsIn overall terms, we found a small number of articles (n=12 of 1,162 unique hits) which addressed the prehospital phase. For each hour of delay until the start of antibiotics, the prognosis appeared to become worse. However, there was no evidence that prehospital treatment improved the prognosis.Studies indicated that about half of the patients with severe sepsis used the emergency medical service (EMS) for transport to hospital. Patients who used the EMS experienced a shorter delay to treatment with antibiotics and the start of early goal-directed therapy (EGDT). Among EMS-transported patients, those in whom the EMS staff already suspected sepsis at the scene had a shorter delay to treatment with antibiotics and the start of EGDT.There are insufficient data on other links in the prehospital chain of care, i.e. patients, bystanders and dispatchers.ConclusionSevere sepsis is a life-threatening condition. Previous studies suggest that, with every hour of delay until the start of antibiotics, the prognosis deteriorates. About half of the patients use the EMS. We need to know more about the present situation with regard to the different links in the prehospital chain of care in sepsis.
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| 2. |
- Ljungström, Lars, 1956-
(författare)
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Magnus Gabriel De la Gardies Venngarn : Herresätet som byggnadsverk och spegelbild
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Starting in about 1640, Sweden experienced a building boom among the nobility lasting up to 1680, when Charles XI initiated a massive withdrawal of Crown fiefs. Based on contemporary Swedish sources, the strategies and ideology behind these large new houses are discussed in connection with questions concerning visual identity – corporate as well as individual. Opinions held in the Swedish debate are compared with the characteristics described by Volker Bauer in his analysis of competing German court ideal types, and are found strikingly reminiscent. This approach constitutes the framework for a close examination of Venngarn, one of Count Magnus Gabriel De la Gardie´s country houses, rebuilt and considerably enlarged from 1661 and onwards. De la Gardie was Rikskansler, Chancellor of the Realm, a dominating magnate and one of Sweden´s most eager building patrons. The remodelling of Venngarn was begun at a time when major works were in progress at five other estates, at the palace in Stockholm and his father´s burial chapel. Other projects were to follow suite. At Venngarn the idea of an ideal correspondence between the level of Magnificentia and the individual´s station is expressed by a systematic gradation of the apartments. Another court ideal, that of the prince (or aristocrat) as a disciple of the Muses, was just as befitting an attribute. The most telling example is the 'learned' décor of the chapel. More than fifty emblems, parables and devotional subjects are found to be organized according to a comprehensive programme, combining important tendencies in contemporary Lutheran spirituality, on the one hand themes from Johann Arndt, on the other the dogma of Ordo salutis. A more mundane aspect of aristocratic behaviour was villeggiatura, or the preference for temporary retreats from urban life and public affairs. De la Gardie has left several drafts defining the weekly round of a country life and aiming at an otium, as recommended by Seneca, Cicero and the neo-Stoics. Several circumstances indicate that De la Gardie considered this a component of a true statesman´s life and that Venngarn and his other country houses were to serve such a purpose.In these and other ways, De la Gardie could be said to have arranged the house at Venngarn as an ideal mirror image of his persona, an image that would testify to his greatness and further his reputation.
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| 3. |
- Pepic, I., et al.
(författare)
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Early detection of sepsis using artificial intelligence : a scoping review protocol
- 2021
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Ingår i: Systematic Reviews. - : Springer Nature. - 2046-4053. ; 10:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. To decrease the high case fatality rates and morbidity for sepsis and septic shock, there is a need to increase the accuracy of early detection of suspected sepsis in prehospital and emergency department settings. This may be achieved by developing risk prediction decision support systems based on artificial intelligence.Methods: The overall aim of this scoping review is to summarize the literature on existing methods for early detection of sepsis using artificial intelligence. The review will be performed using the framework formulated by Arksey and O’Malley and further developed by Levac and colleagues. To identify primary studies and reviews that are suitable to answer our research questions, a comprehensive literature collection will be compiled by searching several sources. Constrictions regarding time and language will have to be implemented. Therefore, only studies published between 1 January 1990 and 31 December 2020 will be taken into consideration, and foreign language publications will not be considered, i.e., only papers with full text in English will be included. Databases/web search engines that will be used are PubMed, Web of Science Platform, Scopus, IEEE Xplore, Google Scholar, Cochrane Library, and ACM Digital Library. Furthermore, clinical studies that have completed patient recruitment and reported results found in the database ClinicalTrials.gov will be considered. The term artificial intelligence is viewed broadly, and a wide range of machine learning and mathematical models suitable as base for decision support will be evaluated. Two members of the team will test the framework on a sample of included studies to ensure that the coding framework is suitable and can be consistently applied. Analysis of collected data will provide a descriptive summary and thematic analysis. The reported results will convey knowledge about the state of current research and innovation for using artificial intelligence to detect sepsis in early phases of the medical care chain.Ethics and dissemination: The methodology used here is based on the use of publicly available information and does not need ethical approval. It aims at aiding further research towards digital solutions for disease detection and health innovation. Results will be extracted into a review report for submission to a peer-reviewed scientific journal. Results will be shared with relevant local and national authorities and disseminated in additional appropriate formats such as conferences, lectures, and press releases.
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| 4. |
- Alsiö, Åsa, 1965, et al.
(författare)
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Impact of obesity on outcome of severe bacterial infections
- 2021
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Ingår i: Plos One. - : Public Library of Science (PLoS). - 1932-6203. ; 16:5
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Obesity is a rapidly growing global health concern with considerable negative impact on life-time expectancy. It has yet not been clarified if and how obesity impacts outcomes of severe bacterial infections. The aim of this study was to determine how body mass index impacts outcome of severe bacterial infections in a well-defined population-based cohort. Methods This study is based on a cohort of 2196 patients included in a Swedish prospective, population-based, consecutive observational study of the incidence of community-onset severe sepsis and septic shock in adults. All patients with weight and height documented in the medical records on admission were included. Results The case fatality rate (CFR) was negatively correlating with increasing BMI. Outcomes included 28-day CFR (p-value = 0.002), hospital CFR (p-value = 0.039) and 1-year CFR (p-value<0.001). When BMI was applied as continuous variable in a multiple logistic regression together with other possible covariates, we still could discern that BMI was associated with decreasing 28-day CFR (OR = 0.93, 95% CI 0.88-0.98, p-value = 0.009) and 1-year CFR (OR = 0.94, 95% CI 0.91-0.97, p-value<0.001). Conclusion The hypothesis and paradox of obesity being associated with higher survival rates in severe bacterial infections was confirmed in this prospective, population-based observational study.
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| 5. |
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| 6. |
- Axelsson, Christer, et al.
(författare)
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The Early Chain of Care in Patients with Bacteraemia with the Emphasis on the Prehospital Setting
- 2016
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Ingår i: Prehospital and Disaster Medicine. - : Cambridge University Press. - 1049-023X .- 1945-1938. ; 31:3, s. 272-277
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Tidskriftsartikel (refereegranskat)abstract
- There is a lack of knowledge about the early phase of severe infection. This report describes the early chain of care in bacteraemia as follows: (a) compare patients who were and were not transported by the Emergency Medical Services (EMS); (b) describe various aspects of the EMS chain; and (c) describe factors of importance for the delay to the start of intravenous antibiotics. It was hypothesized that, for patients with suspected sepsis judged by the EMS clinician, the delay until the onset of antibiotic treatment would be shorter.All patients in the Municipality of Gothenburg (Sweden) with a positive blood culture, when assessed at the Laboratory of Bacteriology in the Municipality of Gothenburg, from February 1 through April 30, 2012 took part in the survey.In all, 696 patients fulfilled the inclusion criteria. Their mean age was 76 years and 52% were men. Of all patients, 308 (44%) had been in contact with the EMS and/or the emergency department (ED). Of these 308 patients, 232 (75%) were transported by the EMS and 188 (61%) had “true pathogens” in blood cultures. Patients who were transported by the EMS were older, included more men, and suffered from more severe symptoms and signs.The EMS nurse suspected sepsis in only six percent of the cases. These patients had a delay from arrival at hospital until the start of antibiotics of one hour and 19 minutes versus three hours and 21 minutes among the remaining patients (P =.0006). The corresponding figures for cases with “true pathogens” were one hour and 19 minutes versus three hours and 15 minutes (P =.009).Among patients with bacteraemia, 75% used the EMS, and these patients were older, included more men, and suffered from more severe symptoms and signs. The EMS nurse suspected sepsis in six percent of cases. Regardless of whether or not patients with true pathogens were isolated, a suspicion of sepsis by the EMS clinician at the scene was associated with a shorter delay to the start of antibiotic treatment.
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| 7. |
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| 8. |
- Bengtsson, Lars, 1958-, et al.
(författare)
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Framtida produktionskoncept : Verkstadsorienterad produktion och decentraliserat datorstöd
- 1993
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- This report elaborate a vision of decentralized work organisation and especially the use of shop floor oriented computer system to support this. The focus is on industrial production. The report is divided into three parts.The first part discuss the characteristics of future production concepts in industrial companies. The point of departure is that Swedish companies abandon Taylorist principles of organization. Alternative paths of rationalization are examined, e.g. Anthropocentric Productions System, Computer Integrated Manufacturing, Lean Production, Total Quality Management and Time Based Management. A conclusion drawn is that future production concepts should be shop floor oriented.The second part present a vision of this shop floor oriented concept. The vision is elaborated in terms of work organization, goal oriented group work and decentralized computer support. Primarily the principles and the concrete functions of new types of shop floor oriented computer systems are presented. This concern systems for production planning and control (Leitstand) and NC programming (WOP). Examples of graphics produced by these systems are given. An alternative CIM strategy based on these systems is also examined.The third part discuss the process of change toward this new production concept. This is enlightened through two case studies.
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| 9. |
- Bengtsson, Lars, 1958-, et al.
(författare)
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Kvalitet och arbetsutveckling- hur går det ihop? : En förstudie
- 1994
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- During the 20th century taylorism has been dominating as a production. concept. But lately the companies has started to look for new concepts. Examples of these are presented in the report: Flexible taylorism, Computer Integrated Manufacturing, Socio-technic, Anthropocentric Production Systems, Lean Production, Time Based Management, Total Quality Management (TQM) and Reengineering. Quality as a strategy is getting stronger and stronger and the prior focus on work organization. and better jobs have now turned towards TQM. TQM consists of, except of different techniques and methods, development of organization, work and personnel.The main question in our study concern the connection between the development of quallity and work. The efficiency in changes is in many parts depending on the organization of work and the motivation and knowledge of the employees. In accordance to this we have used a model in six case-studies that distinguish the technical system and different quality methods used, but mainly the changes concerning personnel and organization. The results are:* The companies follow three quality strategies that affect the employees situation: Control, Motivation and Work development.* The choice of strategy depends on experiences from Work development and the production philosophy in the company.* The Control strategy can give better quality but poor productivity. There are no belief in workers and the work is controlled in detail.* The Motivation strategy upgrade the workers but only optimize the existing system. It can give contradictory work demands if the responsibility for quality inspection is not based on authorities.* The Working development strategy gives possibilities to a flexible manufacturing system and a good work. In ideal the development of work and quality is one process with the same persons involved.* Quality systems based on ISO 9000 have limited effects on the inner efficiency and bring a risk for a new hierarchy.* TQM-work can change the quality organization and create two different organizations. One that is working with product quality and one that is working across the traditional organization.* Kaizen-work has in the study only been seen on the shop floor and as a tool for optimizing the direct work/working place.* TQM is to make all processes in a company better. That makesmeasuring and feedback important. It can affect in total managementcontrol or give the opportunity to management by objectives.* The unions has no strategy for have to deal with quality strategies.
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| 10. |
- Bengtsson, Lars, et al.
(författare)
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Total Quality Management and Work Organization : Relationsship between TQM and Work Organization in Swedish Industrial Companies
- 1998
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Ingår i: Human Factors and Ergonomics in Manufacturing. - 1090-8471 .- 1520-6564. ; 8:4, s. 351-366
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Tidskriftsartikel (refereegranskat)abstract
- This article examines the relationship between quality management strategies and changes of work and work organization in industrial companies. Nine case studies in Sweden show that companies whose aim is total quality practice three different quality strategies characterized by detailed control, motivation of employees, and reorganization. It is argued that total quality management should include redesign of the work processes, combining decentralization, group work, goal-oriented control, and skill development. This reorganization strategy not only offers a greater potential for improvement of work, but it also seems essential for improving quality and productivity in the long run. (C) 1998 John Wiley & Sons, Inc.
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