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- 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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| 2. |
- Claesson, Andreas, et al.
(författare)
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Simulation and education Outline and validation of a new dispatcher-assisted cardiopulmonary resuscitation educational bundle using the Delphi method
- 2024
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Ingår i: Resuscitation Plus. - : ELSEVIER. - 2666-5204. ; 17
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Tidskriftsartikel (refereegranskat)abstract
- Aim: Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) is time-dependent. To date, evidence-based training programmes for dispatchers are lacking. This study aimed to reach expert consensus on an educational bundle content for dispatchers to provide DA-CPR using the Delphi Method: An educational bundle was created by the Swedish Resuscitation Council consisting of three parts: e-learning on DA-CPR, basic life support training and audit of emergency out-of-hospital cardiac arrest calls. Thereafter, a two-round modified Delphi study was conducted between November 2022 and March 2023; 37 experts with broad clinical and/or scientific knowledge of DA-CPR were invited. In the first round, the experts participated in the e-learning module and answered a questionnaire with 13 closed and open questions, whereafter the e-learning part of the bundle was revised. In the second round, the revised e-learning part was evaluated using Likert scores (20 items). The predefined consensus level was set Results: Delphi rounds one and two were assessed by 20 and 18 of the invited experts, respectively. In round one, 18 experts (18 of 20, 90%) stated that they did not miss any content in the programme. In round two, the scale-level content validity index based on the average method (S-CVI/AVE, 0.99) and scale-level content validity index based on universal agreement (S-CVI/UA, 0.85) exceeded the threshold level of 80%. Conclusion: Expert consensus on the educational bundle content was reached using the Delphi method. Further work is required to evaluate its effect in real-world out-of-hospital cardiac arrest calls.
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| 3. |
- Hordoir, Robinson, et al.
(författare)
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Nemo-Nordic 1.0 : a NEMO-based ocean model for the Baltic and North seas - research and operational applications
- 2019
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Ingår i: Geoscientific Model Development. - : Copernicus GmbH. - 1991-959X .- 1991-9603. ; 12:1, s. 363-386
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Tidskriftsartikel (refereegranskat)abstract
- We present Nemo-Nordic, a Baltic and North Sea model based on the NEMO ocean engine. Surrounded by highly industrialized countries, the Baltic and North seas and their assets associated with shipping, fishing and tourism are vulnerable to anthropogenic pressure and climate change. Ocean models providing reliable forecasts and enabling climatic studies are important tools for the shipping infrastructure and to get a better understanding of the effects of climate change on the marine ecosystems. Nemo-Nordic is intended to be a tool for both short-term and long-term simulations and to be used for ocean forecasting as well as process and climatic studies. Here, the scientific and technical choices within Nemo-Nordic are introduced, and the reasons behind the design of the model and its domain and the inclusion of the two seas are explained. The model's ability to represent barotropic and baroclinic dynamics, as well as the vertical structure of the water column, is presented. Biases are shown and discussed. The short-term capabilities of the model are presented, especially its capabilities to represent sea level on an hourly timescale with a high degree of accuracy. We also show that the model can represent longer timescales, with a focus on the major Baltic inflows and the variability in deep-water salinity in the Baltic Sea.
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| 4. |
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| 5. |
- Kåhlin, Ida, et al.
(författare)
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Ageing in people with intellectual disability as it is understood by group home staff
- 2016
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Ingår i: Journal of Intellectual & Developmental Disability. - : Routledge. - 1366-8250 .- 1469-9532. ; 41:1
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Tidskriftsartikel (refereegranskat)abstract
- The number of older residents in group homes for people with intellectual disability (ID) is increasing. This interview study was focused on how group home staff addresses issues of ageing and being old among people with ID. Twelve members of staff at four different group homes in Sweden were interviewed. Findings revealed old age as something unarticulated in the group home. Group home staff felt unprepared to meet age-related changes in residents. The study also revealed that group home staff had a one-tracked way of describing the process of ageing among people with ID, seemingly rooted in a medical paradigm of disability. This study suggests that there is a need to raise issues and give guidance related to ageing and ID in disability policy documents in order to support the development of a formal culture that addresses old age and ID in disability services.
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| 6. |
- Kåhlin, Ida, et al.
(författare)
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Lived experience of ageing and later life in older people with intellectual disability
- 2013
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Ingår i: NNDR 2013.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Older people with intellectual disability (ID) are a growing population in Sweden as in the rest of the western world. The challenges to understand what it means to be old for an individual who have lived her whole life with ID need to be addressed. The aim of this study is to explore how older people ID who live in group accommodations describe their lived experience in relation to ageing and later life. The study has a phenomenological approach, based on the concept of life-world. Individual qualitative interviews were conducted with twelve people (five men, seven women) with ID, between 48 to 71 years (m=64), who lived in four different group accommodations in southern Sweden. A semi-structured interview guide was used. The descriptive phenomenological analysis method used discloses a structure consisting of themes and subthemes. The findings of the study reveal the informants’ lived experience of ageing and later life as a multifaceted phenomenon expressed through the two themes “Age as a process of change” and “Existential aspects of ageing” and six substantializing subthemes. The own body is essential for both how ageing and becoming old is experienced and for how this experience are expressed. The study also finds social, cultural and historical dimensions of the life-world to be important in the informants’ experience of ageing and later life and manifest the existence of a collective life-world for older people with ID, being the unique experiences that the informants share because of their disability and its life course consequences.
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| 7. |
- Kåhlin, Ida, et al.
(författare)
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Lived experiences of ageing and later life in older people with intellectual disabilities
- 2015
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Ingår i: Ageing & Society. - : Cambridge University Press. - 0144-686X .- 1469-1779. ; 35:3, s. 602-628
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this article is to explore how older people with intellectual disability (ID), who live in group accommodation, describe their lived experience in relation to ageing and later life. The study adopted a phenomenological approach, based on the concept of life-world. Individual, qualitative interviews were conducted with twelve people with ID (five men, seven women), between the ages of 48 and 71 (m=64), who lived in four different group accommodation units in southern Sweden. A descriptive phenomenological analysis method was used, which disclosed a structure consisting of themes and subthemes. The findings of the study reveal the informants’ lived experience of ageing and later life as a multifaceted phenomenon, expressed through the two themes, “age as a process of change” and “existential aspects of ageing”, each with three sub themes. along with six substantialising[SK1] subthemes. The body is an essential element in their experience of ageing and growing old, and in how this experience is expressed. The study also finds social, cultural and historical dimensions of the life-world to be important in the informants’ experience of ageing and later life. This supports understanding of the existence of a collective life-world for older people with ID, the unique experiences the informants share because of their disability and its consequences for their life course.
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| 8. |
- Miedel, Charlotte, et al.
(författare)
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Underlying reasons for sex difference in survival following out-of-hospital cardiac arrest: a mediation analysis
- 2024
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Ingår i: Europace. - 1099-5129 .- 1532-2092. ; 26:5
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Tidskriftsartikel (refereegranskat)abstract
- AimsPrevious studies have indicated a poorer survival among women following out-of-hospital cardiac arrest (OHCA), but the mechanisms explaining this difference remain largely uncertain.This study aimed to assess the survival after OHCA among women and men and explore the role of potential mediators, such as resuscitation characteristics, prior comorbidity, and socioeconomic factors.Methods and resultsThis was a population-based cohort study including emergency medical service-treated OHCA reported to the Swedish Registry for Cardiopulmonary Resuscitation in 2010–2020, linked to nationwide Swedish healthcare registries. The relative risks (RR) of 30-day survival were compared among women and men, and a mediation analysis was performed to investigate the importance of potential mediators. Total of 43 226 OHCAs were included, of which 14 249 (33.0%) were women. Women were older and had a lower proportion of shockable initial rhythm. The crude 30-day survival among women was 6.2% compared to 10.7% for men [RR 0.58, 95% confidence interval (CI) = 0.54–0.62]. Stepwise adjustment for shockable initial rhythm attenuated the association to RR 0.85 (95% CI = 0.79–0.91). Further adjustments for age and resuscitation factors attenuated the survival difference to null (RR 0.98; 95% CI = 0.92–1.05). Mediation analysis showed that shockable initial rhythm explained ∼50% of the negative association of female sex on survival. Older age and lower disposable income were the second and third most important variables, respectively.ConclusionWomen have a lower crude 30-day survival following OHCA compared to men. The poor prognosis is largely explained by a lower proportion of shockable initial rhythm, older age at presentation, and lower income.
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| 9. |
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| 10. |
- Nord, Anette, 1972-
(författare)
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Bystander CPR : New aspects of CPR training among students and the importance of bystander education level on survival
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: It has been proved that bystander cardiopulmonary resuscitation (CPR) saves lives; however, which training method in CPR is most instructive and whether survival is affected by the training level of the bystander have not yet been fully described. Aim: To identify the factors that may affect 7th grade students’ acquisition of CPR skills during CPR training and their willingness to act, and to describe 30-day survival from outof- hospital cardiac arrest (OHCA) after bystander CPR and the actions performed by laymen versus off-duty medically educated personnel. Methods: Studies I–III investigate a CPR training intervention given to students in 7th grade during 2013–2014. The classes were randomized to the main intervention: the mobile phone application (app) or DVD-based training. Some of the classes were randomized to one or several additional interventions: a practical test with feedback, reflection, a web course, a visit from elite athletes and automated external defibrillator (AED) training. The students’ practical skills, willingness to act and knowledge of stroke symptoms, symptoms of acute myocardial infarction (AMI) and lifestyle factors were assessed directly after training and at 6 months using the Laerdal PC SkillReporting system (and entered into a modified version of the Cardiff test scoring sheet) and a questionnaire. The Cardiff test resulted in a total score of 12–48 points, and the questionnaire resulted in a total score of 0–7 points for stroke symptoms, 0–9 points for symptoms of AMI and 0– 6 points on lifestyle factors. Study IV is based on retrospective data from the national quality register, the Swedish registry of cardiopulmonary resuscitation, 2010-2014. Results: A total of 1339 students were included in the CPR training intervention. The DVD-based group was superior to the app-based group in CPR skills, with a total score of 35 (SD 4.o) vs 33 (SD 4.2) points directly after training (p<0.001) and 33 (SD 4.0) vs 31 (SD 4.2) points at six months (p<0.001). Of the additional interventions, the practical test with feedback had the greatest influence regarding practical skills: at six months the intervention group scored 32 (SD 3.9) points and the control group (CPR only) scored 30 (SD 4.0) points (p<0.001). Reflection, the web course, visits from elite athletes and AED training did not further increase the students’ acquisition of practical CPR skills.The students who completed the web course Help-Brain-Heart received a higher total score for theoretical knowledge in comparison with the control group, directly after training: stroke 3.8 (SD 1.8) vs 2.7 (SD 2.0) points (p<0.001); AMI 4.0 (SD 2.0) vs 2.5 (SD 2.0) points (p<0.001); lifestyle factors 5.4 (SD 1.2) vs 4.5 (SD 2.0) points p<0.001.Most of the students (77% at 6 months), regardless of the intervention applied, expressed that they would perform both chest compressions and ventilations in a cardiac arrest (CA) situation involving a relative. If a stranger had CA, a significantly lower proportion of students (32%; p<0.001) would perform both compressions and ventilations. In this case, however, many would perform compressions only.In most cases of bystander-witnessed OHCA, CPR was performed by laymen. Off-duty health care personnel bystanders initiated CPR within 1 minute vs 2 minutes for laymen (p<0.0001). Thirty-day survival was 14.7% among patients who received CPR from laymen and 17.2% (p=0.02) among patients who received bystander CPR from off-duty health care personnel. Conclusions: The DVD-based method was superior to the app-based method in terms of teaching practical CPR skills to 7th grade students. Of the additional interventions, a practical test with feedback was the most efficient intervention to increase learning outcome. The additional interventions, reflection, web course, visit from elite athletes and AED did not increase CPR skills further. However, the web course Help-Brain-Heart improved the students’ acquisition of theoretical knowledge regarding stroke, AMI and lifestyle factors. For OHCA, off-duty health care personnel bystanders initiated CPR earlier and 30-day survival was higher compared with laymen bystanders.
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