| 1. |
- Azouri, Kristian, et al.
(författare)
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Hotellrapport Stockholm
- 2011
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Rapport (populärvet., debatt m.m.)abstract
- Stockholm är Sveriges största stad och marknadsför sig som ”The Capital of Scandinavia”. De flesta resenärer som besöker Sverige åker till just Stockholm. År 2010 nådde Stockholms län 10 miljoner kommersiella övernattningar. Det är lätt att ta sig till Stockholm med både flyg, tåg, båt, bil och buss. Stockholm har ett brett utbud av kongress- och mässanläggningar. År 2009 var Stockholm den sjunde mest populära staden i världen att förlägga kongresser på. I dagsläget är Sverige på väg ur den lågkonjunktur som startade år 2008. Sveriges BNP och valuta är på väg att stabiliseras och stärkas. Regeringen har även lagt in ett förslag om att sänka tjänstemomsen inom hotell- och restaurangbranschen. I denna rapport har vi valt att avgränsa oss till ett eget utvalt område inom Stockholm. Detta område innefattar 143 hotell med 20 054 hotellrum.De prognoser vi gjort gällande staden Stockholm och segmenten affärsresenärer och fritidsresenärer pekar på en ökning av besökare till staden. Detta kommer resultera i att hotellens beläggning, snittpris och RevPAR kommer att öka framtill år 2013. Efter år 2013 tror vi att segmentet affärsresenärer kommer att minska något procentuellt och kurvan för belagda nätter kommer att stabiliseras. Dock tror vi att segmentet fritidsresenärer kommer att öka procentuellt efter år 2013 och antalet belagda hotellrum kommer att successivt öka mellan åren 2011 – 2015. Vi tror att snittpris och RevPAR kommer att sjunka på grund av att en fritidsresenär generellt sätt inte betalar lika mycket för ett hotellrum som en affärsresenär gör.
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| 2. |
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| 3. |
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| 4. |
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| 5. |
- Gardeström, Johanna, et al.
(författare)
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Demonstration Restoration Measures in Tributaries of the Vindel River Catchment
- 2013
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Ingår i: Ecology and Society. - : Resilience Alliance Publications. - 1708-3087. ; 18:3, s. Article Number: UNSP 8-
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Tidskriftsartikel (refereegranskat)abstract
- Some ecological restoration projects include elements of trial and error where new measures are repeatedly tried, evaluated, and modified until satisfactory results are achieved. Thereafter, the resulting methods may be applied on larger scales. A difficult step is judging whether developed "best-practice" methods have become reasonably ecologically functional or whether further experimentation "demonstration" methods can lead to yet better results. Here, we use a stream restoration project as a case study for evaluating methods and abiotic effects and outlining stakeholder support for demonstration restoration measures, rather than only using best-practice methods. Our work was located in the Vindel River system, a free-flowing river that is part of the Natura 2000 network. The river was exploited for timber floating from 1850-1976, and rapids in the main channel and tributaries below timberline were channelized to increase timber transport capacity. Several side channels in multi-channeled rapids were blocked and the flow was concentrated to a single channel from which boulders and large wood were removed. Hence, previously heterogeneous environments were replaced by more homogeneous systems with limited habitat for riverine species. The restoration project strives to alleviate the effects of fragmentation and channelization in affected rapids by returning coarse sediment from channel margins to the main channel. However, only smaller, angular sediment is available given blasting of large boulders, and large (old-growth) wood is largely absent; therefore, original levels of large boulders and large wood in channels cannot be achieved with standard restoration practices. In 10 demonstration sites, we compensated for this by adding large boulders and large wood (i.e., entire trees) from adjacent upland areas to previously best-practice restored reaches and compared their hydraulic characteristics with 10 other best-practice sites. The demonstration sites exhibited significantly reduced and more variable current velocities, and wider channels, but with less variation than pre-restoration. The ecological response to this restoration has not yet been studied, but potential outcomes are discussed.
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| 6. |
- Gustafsson, Linnea, et al.
(författare)
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Characteristics, survival and neurological outcome in out-of-hospital cardiac arrest in young adults in Sweden : A nationwide study.
- 2023
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Ingår i: Resuscitation Plus. - 2666-5204. ; 16
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The aim of this study was to present a comprehensive overview of out-of-hospital cardiac arrests (OHCA) in young adults.METHODS: The data set analyzed included all cases of OHCA from 1990 to 2020 in the age-range 16-49 years in the Swedish Registry of Cardiopulmonary Resuscitation (SRCR). OHCA between 2010 and 2020 were analyzed in more detail. Clinical characteristics, survival, neurological outcomes, and long-time trends in survival were studied. Logistic regression was used to study 30-days survival, neurological outcomes and Utstein determinants of survival.RESULTS: Trends were assessed in 11,180 cases. The annual increase in 30-days survival during 1990-2020 was 5.9% with no decline in neurological function among survivors. Odds ratio (OR) for heart disease as the cause was 0.55 (95% CI 0.44 to 0.67) in 2017-2020 compared to 1990-1993. Corresponding ORs for overdoses and suicide attempts were 1.61 (95% CI 1.23-2.13) and 2.06 (95% CI 1.48-2.94), respectively. Exercise related OHCA was noted in roughly 5%. OR for bystander CPR in 2017-2020 vs 1990-1993 was 3.11 (95% CI 2.57 to 3.78); in 2020 88 % received bystander CPR. EMS response time increased from 6 to 10 minutes.CONCLUSION: Survival has increased 6% annually, resulting in a three-fold increase over 30 years, with stable neurological outcome. EMS response time increased with 66% but the majority now receive bystander CPR. Cardiac arrest due to overdoses and suicide attempts are increasing.
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| 7. |
- Habbouche, S., et al.
(författare)
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Comparison of the novel WEst coast System for Triage (WEST) with Rapid Emergency Triage and Treatment System (RETTS (c)): an observational pilot study
- 2022
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Ingår i: International Journal of Emergency Medicine. - : Springer Science and Business Media LLC. - 1865-1372 .- 1865-1380. ; 15:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Most Swedish emergency departments (ED) use the triage system Rapid Emergency Triage and Treatment System (RETTS (c)), which over time has proven to prioritize patients to higher triage levels. When many patients are prioritized to high triage levels, challenges with identifying true high-risk patients and increased waiting time for these patients has emerged. In order to achieve a more balanced triage in relation to actual medical risk, the triage system WEst coast System for Triage (WEST) was developed, based on the South African Triage Scale (SATS). The aim of this study was to perform an initial evaluation of the novel emergency triage system WEST compared to the existing RETTS (c). Methods Both RETTS (c) and WEST are five level triage systems illustrated by colors. Nurses from each of the three adult EDs of Sahlgrenska University Hospital in Gothenburg and the ambulance service assessed and triaged 1510 patients according to RETTS (c) and immediately thereafter filled out the WEST triage form. Data from each triage report were analyzed and grouped according to the triage color, chief complaint, and outcome of each patient. Data on discharge categories and events within 72 h were also collected. Data were analyzed with descriptive statistical methods. Results In general, WEST displayed lower levels of prioritization compared to RETTS (c), with no observed impact on patients' medical outcomes. In RETTS (c) orange triage level, approximately 50% of the patients were down prioritized in WEST to yellow or green triage levels. Also, in the RETTS (c) yellow triage level, more than 55% were down prioritized to green triage level in WEST. The number of patients who experienced a serious event during the first 72 h was few. Three patients died, these were all prioritized to red triage level in RETTS (c). In WEST two of these patients were prioritized to red triage level and one to orange triage level. All these patients were admitted to hospital before deterioration. Conclusions WEST may reduce over prioritization at the ED, especially in the orange and yellow triage levels of RETTS (c), with no observed increase in medical risk. WEST can be recommended for a clinical comparative study.
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| 8. |
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| 9. |
- Heyman, Ellen Tolestam, et al.
(författare)
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Improving Machine Learning 30-Day Mortality Prediction by Discounting Surprising Deaths
- 2021
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Ingår i: Journal of Emergency Medicine. - Philadelphia, PA : Elsevier BV. - 0736-4679 .- 1090-1280. ; 61:6, s. 763-773
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Machine learning (ML) is an emerging tool for predicting need of end-of-life discussion and palliative care, by using mortality as a proxy. But deaths, unforeseen by emergency physicians at time of the emergency department (ED) visit, might have a weaker association with the ED visit.OBJECTIVES: To develop an ML algorithm that predicts unsurprising deaths within 30 days after ED discharge.METHODS: In this retrospective registry study, we included all ED attendances within the Swedish region of Halland in 2015 and 2016. All registered deaths within 30 days after ED discharge were classified as either "surprising" or "unsurprising" by an adjudicating committee with three senior specialists in emergency medicine. ML algorithms were developed for the death subclasses by using Logistic Regression (LR), Random Forest (RF), and Support Vector Machine (SVM).RESULTS: Of all 30-day deaths (n = 148), 76% (n = 113) were not surprising to the adjudicating committee. The most common diseases were advanced stage cancer, multidisease/frailty, and dementia. By using LR, RF, and SVM, mean area under the receiver operating characteristic curve (ROC-AUC) of unsurprising deaths in the test set were 0.950 (SD 0.008), 0.944 (SD 0.007), and 0.949 (SD 0.007), respectively. For all mortality, the ROC-AUCs for LR, RF, and SVM were 0.924 (SD 0.012), 0.922 (SD 0.009), and 0.931 (SD 0.008). The difference in prediction performance between all and unsurprising death was statistically significant (P < .001) for all three models.CONCLUSION: In patients discharged to home from the ED, three-quarters of all 30-day deaths did not surprise an adjudicating committee with emergency medicine specialists. When only unsurprising deaths were included, ML mortality prediction improved significantly.
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| 10. |
- Holmqvist Gattario, Kristina, 1981, et al.
(författare)
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Masculinity and muscularity across Western cultures
- 2014
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Ingår i: Appearance Matters 6, 1-2 July, Bristol, England.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Previous research has suggested that men’s conformity to masculine norms (CMN) is an important correlate of men’s drive for muscularity. The present study aims to further delineate the relationship between masculinity and men’s body image by examining various dimensions of CMN in relation to various dimensions of men’s body image (muscularity, leanness, and fitness) in a cross-cultural sample. Participants comprised young men from the United States (n = 192), the United Kingdom (n = 141), Australia (n = 160), and Sweden (n = 142) - men who may be similarly exposed to the muscular ideal but who may differ in their degree of CMN. Multi-group path analyses showed that CMN was related to body image in all four countries, but there were cross-cultural differences in which dimensions of CMN that predicted men’s body image. Whereas conformity to the dimension of ‘winning’ predicted men’s fitness orientation in all four countries, conformity to the dimension of ‘violent behavior’ particularly predicted UK men’s fitness orientation and drive for muscularity. Conformity to the dimension of ‘playboy attitude’ was related to US and Australian men’s drive for muscularity, but was not applicable to UK and Swedish men. Among Swedish men, conformity to the dimensions of ‘winning’ and ‘priority of work’ were most salient in predicting their body image. These findings suggest that masculinity norms play an important role in Western men’s body image; however, the relationship between masculinity and muscularity may function different cross-culturally.
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| 11. |
- Holmqvist, Lina, et al.
(författare)
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Cardiovascular outcome in treatment-resistant hypertension: results from the Swedish Primary Care Cardiovascular Database (SPCCD).
- 2018
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Ingår i: Journal of hypertension. - 1473-5598. ; 36:2, s. 402-409
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Tidskriftsartikel (refereegranskat)abstract
- To assess cardiovascular outcome in patients with treatment-resistant hypertension (TRH) compared with patients with nontreatment-resistant hypertension (HTN).Cohort study with data from 2006 to 2012 derived from the Swedish Primary Care Cardiovascular Database with hypertensive patients aged at least 30 years. TRH was defined as blood pressure at least 140/90mmHg despite medication adherence to three or more dispensed antihypertensive drug classes. Patients with cardiovascular comorbidity were excluded. The association between TRH and cardiovascular events with adjustment for important confounders was analyzed.We included 4317 TRH patients and 32282 HTN patients. TRH patients (61% women) were older (70 vs. 66 years), had higher SBP (152 vs. 141mmHg) and more diabetes (30 vs. 20%) (P<0.001 for all) compared with HTN patients. Mean follow-up time was 4.3 years. In the adjusted analysis, TRH patients had an increased risk for total mortality [hazard ratio 1.12; 95% confidence interval (CI), 1.03-1.23], cardiovascular mortality (hazard ratio 1.20; 95% CI, 1.03-1.40) and incident heart failure (hazard ratio 1.34; 95% CI, 1.17-1.54) but not for incident stroke (hazard ratio 1.03; 95% CI, 0.90-1.19) or transitoric ischemic attack (hazard ratio 1.12; 95% CI, 0.86-1.46) compared with HTN patients.Patients with TRH have a poor prognosis beyond blood pressure level, compared with hypertensive patients without TRH. In particular, the high risk for heart failure is of clinical importance and merits further investigation.
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| 12. |
- Holmqvist, Lina, et al.
(författare)
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Drug adherence in treatment resistant and in controlled hypertension - Results from the Swedish Primary Care Cardiovascular Database (SPCCD)
- 2018
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Ingår i: Pharmacoepidemiology and Drug Safety. - : Wiley. - 1053-8569 .- 1099-1557. ; 27:3, s. 315-321
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Tidskriftsartikel (refereegranskat)abstract
- Purpose To assess drug adherence in patients treated with 3 antihypertensive drug classes, with both controlled and uncontrolled blood pressure and describe associated factors for nonadherence. Methods Patients with hypertension, without cardiovascular comorbidity, aged >30years treated with 3 antihypertensive drug classes were followed for 2years. Both patients with treatment resistant hypertension (TRH) and patients with controlled hypertension were included. Clinical data were derived from a primary care database. Pharmacy refill data from the Swedish Prescribed drug registry was used to calculate proportion of days covered (PDC). Patients with a PDC level80% were included. Results We found 5846 patients treated 3 antihypertensive drug classes, 3508 with TRH (blood pressure140/90), and 2338 with controlled blood pressure (<140/90mmHg). TRH patients were older (69.1 vs 65.8years, P<.0001) but had less diabetes (28.5 vs 31.7%, P<.009) compared with patients with controlled blood pressure. The proportion of patients with PDC80% declined with 11% during the first year in both groups. Having diabetes was associated with staying adherent at 1year (RR 0.82; 95% CI, 0.68-0.98) whilst being born outside Europe was associated with nonadherence at one and (RR 2.05; 95% CI, 1.49-2.82). ConclusionsPatients with multiple antihypertensive drug therapy had similar decline in adherence over time regardless of initial blood pressure control. Diabetes was associated with better adherence, which may imply that the structured caregiving of these patients enhances antihypertensive drug treatment.
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| 13. |
- Holmqvist, Lina, et al.
(författare)
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Exercise blood pressure and the risk of future hypertension
- 2012
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Ingår i: Journal of human hypertension. - : Springer Science and Business Media LLC. - 1476-5527 .- 0950-9240. ; 26, s. 691-695
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this prospective cohort study was to identify which blood pressure measurement during exercise is the best predictor of future hypertension. Further we aimed to create a risk chart to facilitate the evaluation of blood pressure reaction during exercise testing. A number (n=1047) of exercise tests by bicycle ergometry, performed in 1996 and 1997 were analysed. In 2007-2008, 606 patients without hypertension at the time of the exercise test were sent a questionnaire aimed to identify current hypertension. The response rate was 58% (n=352). During the 10-12 years between exercise test and questionnaire, 23% developed hypertension. The strongest predictors of future hypertension were systolic blood pressure (SBP) before exercise (odds ratios (OR) 1.63 (1.31-2.01) for 10 mm Hg difference) in combination with the increase of SBP over time during exercise testing (OR 1.12 (1.01-1.24) steeper increase for every 1 mm Hg min(-1)). A high SBP before exercise and a steep rise in SBP over time represented a higher risk of developing hypertension. A risk chart based on SBP before exercise, increase of SBP over time and body mass index was created. SBP before exercise, maximal SBP during exercise and SBP at 100 W were significant single predictors of future hypertension and the prediction by maximal SBP was improved by adjusting for time/power at which SBP max was reached during exercise testing. Recovery ratio (maximal SBP/SBP 4 min after exercise) was not predictive of future hypertension.
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| 14. |
- Holmqvist, Lina, et al.
(författare)
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Prevalence of treatment-resistant hypertension and important associated factors—results from the Swedish Primary Care Cardiovascular Database
- 2016
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Ingår i: Journal of the American Society of Hypertension. - : Elsevier BV. - 1933-1711 .- 1878-7436. ; 10:11, s. 838-846
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Tidskriftsartikel (refereegranskat)abstract
- © 2016 American Society of HypertensionWe aimed to describe the prevalence, treatment, and associated comorbidity of treatment-resistant hypertension (TRH). This registry-based cohort study from The Swedish Primary Care Cardiovascular Database assessed 53,090 hypertensive patients attending primary care. Patients adherent to antihypertensive treatment measured by pharmacy fills and with proportion of days covered ≥80% were included. The prevalence of TRH was 17% when considering all current TRH definitions. Adherence to mineralocorticoid receptor antagonists differed between TRH- and non-TRH patients (8 vs. 4%). Higher frequencies (prevalence ratio and 95% confidence intervals) of diabetes mellitus (1.59, 1.53–1.66), heart failure (1.55, 1.48–1.64), atrial fibrillation (1.33, 1.27–1.40), ischemic heart disease (1.25, 1.20–1.30), and chronic kidney disease (1.38, 1.23–1.54) were seen in patients with TRH compared to patients without TRH. These findings, in a population with valid data on medication adherence, emphasize a broad preventive approach for these high-risk patients.
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| 15. |
- Khorram-Manesh, Amir, 1958, et al.
(författare)
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Reasons for longer LOS at the emergency departments: Practical, patient‐centred, medical, or cultural?
- 2020
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Ingår i: International Journal of Health Planning and Management. - : Wiley. - 0749-6753 .- 1099-1751. ; 34:4
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Tidskriftsartikel (refereegranskat)abstract
- Emergency department (ED) overcrowding is caused by external and/or internal factors. One critical internal factor, leading to longer length of stay (LOS) at ED (eg, frequent ED users), is the physician's uncertainty in management of patients with unclear diagnosis and or complex medical history. The aim of this study was to identify whether the causes of physicians' uncertainty was practical, patient‐centred, medical, or cultural. Using earlier published dimensions of uncertainty, 18 physicians were asked to reply to a template by choosing a relevant dimension that causes a delay in assessment of a known complex patient. This stage was completed by interviews through which participants had an opportunity to express their concerns and critical thoughts, if any. The data obtained from the template were collected and analysed. The interviews were recorded and transcribed verbatim. The results of the template indicated medical dimension as the main factor in delayed assessment of a complex patient. However, this finding was challenged by the results of the interviews, which indicated higher impact of personal/routines/cultural dimension (eg, being afraid of criticism, reprimand, and gossip or feelings of guilt). Although medical, patient‐centred, and practical issues are important causes of longer LOS at ED, physicians' working and professional environment may have a higher impact than previously perceived. The uncertainty caused by interpersonal, organisational, and cultural issues within a clinic/hospital seems to influence the physician's ability to make decisions and thus a patient's medical outcome.
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| 16. |
- Leclair, Valerie, et al.
(författare)
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Distinct HLA associations with autoantibody-defined subgroups in idiopathic inflammatory myopathies
- 2023
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Ingår i: EBioMedicine. - : Elsevier. - 2352-3964. ; 96
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Tidskriftsartikel (refereegranskat)abstract
- Background In patients with idiopathic inflammatory myopathies (IIM), autoantibodies are associated with specific clinical phenotypes suggesting a pathogenic role of adaptive immunity. We explored if autoantibody profiles are associated with specific HLA genetic variants and clinical manifestations in IIM. Methods We included 1348 IIM patients and determined the occurrence of 14 myositis-specific or-associated autoantibodies. We used unsupervised cluster analysis to identify autoantibody-defined subgroups and logistic regression to estimate associations with clinical manifestations, HLA-DRB1, HLA-DQA1, HLA-DQB1 alleles, and amino acids imputed from genetic information of HLA class II and I molecules. Findings We identified eight subgroups with the following dominant autoantibodies: anti-Ro52, -U1RNP, -PM/Scl,-Mi2,-Jo1,-Jo1/Ro52,-TIF1 gamma or negative for all analysed autoantibodies. Associations with HLA-DRB1*11, HLA-DRB1*15, HLA-DQA1*03, and HLA-DQB1*03 were present in the anti-U1RNP-dominated subgroup. HLA-DRB1*03, HLA-DQA1*05, and HLA-DQB1*02 alleles were overrepresented in the anti-PM/Scl and anti-Jo1/ Ro52-dominated subgroups. HLA-DRB1*16, HLA-DRB1*07 alleles were most frequent in anti-Mi2 and HLA- DRB1*01 and HLA-DRB1*07 alleles in the anti-TIF1 gamma subgroup. The HLA-DRB1*13, HLA-DQA1*01 and HLA-DQB1*06 alleles were overrepresented in the negative subgroup. Significant signals from variations in class I molecules were detected in the subgroups dominated by anti-Mi2, anti-Jo1/Ro52, anti-TIF1 gamma, and the negative subgroup. Interpretation Distinct HLA class II and I associations were observed for almost all autoantibody-defined subgroups. The associations support autoantibody profiles use for classifying IIM which would likely reflect underlying pathogenic mechanisms better than classifications based on clinical symptoms and/or histopathological features. Funding See a detailed list of funding bodies in the Acknowledgements section at the end of the manuscript. Copyright (c) 2023 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
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| 17. |
- Lönnbro, Johan, et al.
(författare)
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Inter-rater reliability of assessments regarding the quality of drug treatment, and drug-related hospital admissions
- 2021
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Ingår i: British Journal of Clinical Pharmacology. - : Wiley. - 0306-5251 .- 1365-2125. ; 87:10, s. 3825-3834
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Tidskriftsartikel (refereegranskat)abstract
- Aims To investigate inter-rater agreement on the quality of drug treatment, and the relationship between the drug treatment and hospital admission. Methods Three specialist physicians and two resident physicians determined, independently and in consensus, the quality of drug treatment from an overall medical perspective, and its association with admission, in 30 randomly selected patients (50% female, median age 72 years) admitted to Sahlgrenska University Hospital, Sweden, in April 2018. The inter-rater agreement was evaluated with Gwet's agreement coefficient (AC(1)). Results In all, 200 (95%) out of 210 drugs at admission and 238 (97%) out of 245 drugs at discharge were assessed as reasonable drug treatment by all assessors. Conversely, none of the drugs at admission, and two at discharge, were assessed as unreasonable drug treatment by all assessors (AC(1): 0.88 and 0.94 [all], 0.86 and 0.95 [specialists], 0.92 and 0.92 [residents], respectively). The assessments regarding the association between the drug treatment and the hospital admission (not related or main/contributory reason) were consistent between the assessors for 16 out of 30 patients (AC(1): 0.67 [all], 0.74 [specialists], 0.54 [residents]). In none of the three cases where the hospital admission was considered possibly attributable to a prescribing error did the assessors make consistent assessments. Conclusions As the inter-rater agreement ranged between weak and almost perfect, the reliability of assessments of drug treatment quality, as well as adverse consequences, appears to be a methodological concern. To yield acceptably reliable results regarding both drug treatment aspects at issue, specialist physicians should be involved.
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| 18. |
- Nilsson, Christer, et al.
(författare)
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How do biota respond to additional physical restoration of restored streams?
- 2017
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Ingår i: Ecosystems (New York. Print). - : Springer. - 1432-9840 .- 1435-0629. ; 20:1, s. 144-162
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Tidskriftsartikel (refereegranskat)abstract
- Restoration of channelized streams by returning coarse sediment from stream edges to the wetted channel has become a common practice in Sweden. Yet, restoration activities do not always result in the return of desired biota. This study evaluated a restoration project in the Vindel River in northern Sweden in which practitioners further increased channel complexity of previously restored stream reaches by placing very large boulders (> 1 m), trees (> 8 m), and salmonid spawning gravel from adjacent upland areas into the channels. One reach restored with basic methods and another with enhanced methods were selected in each of ten different tributaries to the main channel. Geomorphic and hydraulic complexity was enhanced but the chemical composition of riparian soils and the communities of riparian plants and fish did not exhibit any clear responses to the enhanced restoration measures during the first 5 years compared to reaches restored with basic restoration methods. The variation in the collected data was among streams instead of between types of restored reaches. We conclude that restoration is a disturbance in itself, that immigration potential varies across landscapes, and that biotic recovery processes in boreal river systems are slow. We suggest that enhanced restoration has to apply a catchment-scale approach accounting for connectivity and availability of source populations, and that low-intensity monitoring has to be performed over several decades to evaluate restoration outcomes.
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| 19. |
- Phattharapornjaroen, Phatthranit, et al.
(författare)
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Alternative Leadership in Flexible Surge Capacity—The Perceived Impact of Tabletop Simulation Exercises on Thai Emergency Physicians Capability to Manage a Major Incident
- 2020
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Ingår i: Sustainability. - : MDPI AG. - 2071-1050. ; 12:15
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Tidskriftsartikel (refereegranskat)abstract
- Flexible surge capacity aims to activate and utilize other resources than normally are surged in a community during the primary and secondary surge capacity. The presence of alternative leadership, skilled and knowledgeable in hospital and prehospital emergency management, is invaluable. Thai emergency physicians work at both levels, emphasizing their important role in emergency management of any source in a disaster-prone country. We aimed to investigate Thai emergency physicians’ ability in terms of knowledge and preparedness to manage potential emergencies using tabletop simulation exercises. Using an established method for training collaboration, two training courses were arranged for over 50 Thai emergency physicians, who were divided into three teams of prehospital, hospital, and incident command groups. Three scenarios of a terror attack along with a bomb explosion, riot, and shooting, and high building fire were presented, and the participants’ performance was evaluated regarding their preparedness, response and gained knowledge. Two senior observers followed the leadership characteristic in particular. Thai physicians’ perceived ability in command and control, communication, collaboration, coordination, and situation assessment improved in all groups systematically. New perspectives and innovative measures were presented by participants, which improved the overall management on the final day. Tabletop simulation exercise increased the perceived ability, knowledge, and attitude of Thai emergency physicians in managing major incidents and disasters. It also enabled them to lead emergency management in a situation when alternative leadership is a necessity as part of the concept of a flexible surge capacity response system.
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| 20. |
- Phattharapornjaroen, Phatthranit, et al.
(författare)
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Assessing Thai Hospitals’ Evacuation Preparedness Using the Flexible Surge Capacity Concept and Its Collaborative Tool
- 2023
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Ingår i: International Journal of Disaster Risk Science. - : Springer Science and Business Media LLC. - 2095-0055 .- 2192-6395. ; 14:1, s. 52-63
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Tidskriftsartikel (refereegranskat)abstract
- According to the concept of “flexible surge capacity,” hospitals may need to be evacuated on two occasions: (1) when they are exposed to danger, such as in war; and (2) when they are contaminated, such as during the Covid-19 pandemic. In the former, the entire hospital must be evacuated, while in the latter, the hospital becomes a pandemic center necessitating the transfer of its non-contaminated staff, patients, and routine activities to other facilities. Such occasions involve several degrees of evacuation—partial or total—yet all require deliberate surge planning and collaboration with diverse authorities. This study aimed to investigate the extent of hospital evacuation preparedness in Thailand, using the main elements of the flexible surge capacity concept. A mixed method cross-sectional study was conducted using a hospital evacuation questionnaire from a previously published multinational hospital evacuation study. The tool contained questions regarding evacuation preparedness encompassing surge capacity and collaborative elements and an open-ended inquiry to grasp potential perspectives. All 143 secondary care, tertiary care, and university hospitals received the questionnaire; 43 hospitals provided responses. The findings indicate glitches in evacuation protocols, particularly triage systems, the inadequacies of surge planning and multiagency collaboration, and knowledge limitations in community capabilities. In conclusion, the applications of the essential components of flexible surge capacity allow the assessment of hospital preparedness and facilitate the evaluation of guidelines and instructions through scenario-based training exercises.
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| 21. |
- Phattharapornjaroen, Phatthranit, et al.
(författare)
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The feasibility of implementing the flexible surge capacity concept in bangkok: Willing participants and educational gaps
- 2021
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 18:15
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Tidskriftsartikel (refereegranskat)abstract
- The management of emergencies consists of a chain of actions with the support of staff, stuff, structure, and system, i.e., surge capacity. However, whenever the needs exceed the present resources, there should be flexibility in the system to employ other resources within communities, i.e., flexible surge capacity (FSC). This study aimed to investigate the possibility of creating alternative care facilities (ACFs) to relieve hospitals in Bangkok, Thailand. Using a Swedish questionnaire, quantitative data were compiled from facilities of interest and were completed with qualitative data obtained from interviews with key informants. Increasing interest to take part in a FSC system was identified among those interviewed. All medical facilities indicated an interest in offering minor treatments, while a select few expressed interest in offering psychosocial support or patient stabilization before transport to major hospitals and minor operations. The non-medical facilities interviewed proposed to serve food and provide spaces for the housing of victims. The lack of knowledge and scarcity of medical instruments and materials were some of the barriers to implementing the FSC response system. Despite some shortcomings, FSC seems to be applicable in Thailand. There is a need for educational initiatives, as well as a financial contingency to grant the sustainability of FSC.
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| 22. |
- Phattharapornjaroen, Phatthranit, et al.
(författare)
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The impact of the three-level collaboration exercise on collaboration and leadership during scenario-based hospital evacuation exercises using flexible surge capacity concept: a mixed method cross-sectional study.
- 2023
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Ingår i: BMC health services research. - 1472-6963. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Hospitals play a crucial role in responding to disasters and public health emergencies. However, they are also vulnerable to threats such as fire or flooding and can fail to respond or evacuate adequately due to unpreparedness and lack of evacuation measures. The United Nations Office for Disaster Risk Reduction has emphasised the importance of partnerships and capacity building in disaster response. One effective way to improve and develop disaster response is through exercises that focus on collaboration and leadership. This study aimed to examine the effectiveness of using the 3-level collaboration (3LC) exercise in developing collaboration and leadership in districts in Thailand, using the concept of flexible surge capacity (FSC) and its collaborative tool during a hospital evacuation simulation.A mixed-method cross-sectional study was conducted with 40 participants recruited from disaster-response organisations and communities. The data from several scenario-based simulations were collected according to the collaborative elements (Command and control, Safety, Communication, Assessment, Triage, Treatment, Transport), in the disaster response education, "Major Incident Medical Management and Support" using self-evaluation survey pre- and post-exercises, and direct observation.The 3LC exercise effectively facilitated participants to gain a mutual understanding of collaboration, leadership, and individual and organisational flexibility. The exercise also identified gaps in communication and the utilisation of available resources. Additionally, the importance of early community engagement was highlighted to build up a flexible surge capacity during hospital evacuation preparedness.the 3LC exercise is valuable for improving leadership skills and multiagency collaboration by incorporating the collaborative factors of Flexible Surge Capacity concept in hospital evacuation preparedness.
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| 23. |
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| 24. |
- Sjöstedt, H., et al.
(författare)
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Fewer overtriaged children with PEPP compared to RETTS-p at a Swedish pediatric emergency department : Svenskanpassad triage gav färre överprioriteringar på barnakut
- 2022
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Ingår i: Lakartidningen. - 1652-7518. ; 119
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Tidskriftsartikel (refereegranskat)abstract
- Pediatric Priority Process (PEPP) is a triage system derived from the South African Triage Scale. It was developed by healthcare professionals at the Queen Silvia Children's hospital in Gothenburg. PEPP is a four-level triage system with two parts: vital parameters and warning symptoms. The aim of the study was to compare the amount of overtriage and the specificity for children in need of hospitalization in PEPP compared to RETTS-p. Our study shows that PEPP yields significantly fewer children with a high priority and has a higher specificity than RETTS-p. Senior triage nurses judged PEPP to have a higher accuracy, and the system triages children in need of supplemental oxygen higher than RETTS-p. We conclude that PEPP has high patient safety, and the next step is to implement it at our pediatric emergency department and to continue research for further validation.
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| 25. |
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| 26. |
- Tolestam Heyman, Ellen, 1969, et al.
(författare)
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Likelihood of admission to hospital from the emergency department is not universally associated with hospital bed occupancy at the time of admission
- 2021
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Ingår i: International Journal of Health Planning and Management. - : Wiley. - 0749-6753 .- 1099-1751. ; 36:2, s. 353-363
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Tidskriftsartikel (refereegranskat)abstract
- Background The decision to admit into the hospital from the emergency department (ED) is considered to be important and challenging. The aim was to assess whether previously published results suggesting an association between hospital bed occupancy and likelihood of hospital admission from the ED can be reproduced in a different study population. Methods A retrospective cohort study of attendances at two Swedish EDs in 2015 was performed. Admission to hospital was assessed in relation to hospital bed occupancy together with other clinically relevant variables. Hospital bed occupancy was categorized and univariate and multivariate logistic regression were performed. Results In total 89,503 patient attendances were included in the final analysis. Of those, 29.1% resulted in admission within 24 h. The mean hospital bed occupancy by the hour of the two hospitals was 87.1% (SD 7.6). In both the univariate and multivariate analysis, odds ratio for admission within 24 h from the ED did not decrease significantly with an increasing hospital bed occupancy. Conclusions A negative association between admission to hospital and occupancy level, as reported elsewhere, was not replicated. This suggests that the previously shown association might not be universal but may vary across sites due to setting specific circumstances.
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| 27. |
- Zeijlon, Rickard, et al.
(författare)
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Sports nutrition supplements and adverse events - a meta-epidemiological study of case reports specifically addressing causality assessment
- 2022
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Ingår i: European Journal of Clinical Pharmacology. - : Springer Science and Business Media LLC. - 0031-6970 .- 1432-1041. ; 78, s. 1-9
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Tidskriftsartikel (refereegranskat)abstract
- Purpose This meta-epidemiological study aimed to systematically review case reports regarding sports nutrition supplements and adverse events (AEs), specifically addressing the issue of causality assessments. Methods Through a systematic literature search we identified all published case reports of AEs associated with sports nutrition supplements between 1 January 2008 and 1 March 2019. Data regarding AEs, suspected supplements, relevant causality assessment factors and the reporting of clinical reasoning and/or systematic causality assessment methods were extracted. Results In all, 72 publications were included, reporting 134 supplements and 37 different AEs in 97 patients (85% males; median age: 30 years [range: 14-60]). Information regarding previous health and regular prescription drugs was not presented in 30% (29/97) and 46% (45/97) of cases, respectively. In 23% (22/97) of the cases, no alternative cause was mentioned. Clinical reasoning was identified in 63% (61/97), and in 13% (8/61) of these, a systematic causality assessment method was applied. In cases with clinical reasoning, a theoretic rationale (92% vs 78%, P = 0.05), a description of previous cases (90% vs 72%, P = 0.021) and body fluid analysis (18% vs 3%, P = 0.027) were reported to a greater extent. Among cases with clinical reasoning, the application of a systematic causality assessment method captured additional important aspects: use of medication (100% vs 55%, P = 0.015), alcohol use (88% vs 43%, P = 0.020) and illicit drug use (88% vs 40%, P = 0.011). Conclusions In published case reports where sports nutrition supplements were suspected to have caused AEs, essential factors for causality assessment were left out in a non-negligible proportion. Clinical reasoning was identified in most cases whereas a systematic causality assessment method was applied in a minority. Factors of importance for causality assessment were reported to a greater extent in cases including clinical reasoning, and the application of a systematic causality assessment method captured additional aspects of importance.
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