| 1. |
- Andersson, Ulf, 1985-, et al.
(författare)
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Clinical reasoning in the emergency medical services: an integrative review
- 2019
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Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - : Springer Science and Business Media LLC. - 1757-7241.
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Tidskriftsartikel (refereegranskat)abstract
- Abstract: Clinical reasoning is the process of gathering and understanding information conducted by clinicians in the emergency medical services (EMS) so as to make informed decisions. Research on clinical reasoning spans several disciplines, but a comprehensive view of the process is lacking. To our knowledge, no review of clinical reasoning in the EMS has been conducted.Aim: The aim was to investigate the nature, deployment, and factors influencing EMS clinicians’ clinical reasoning by means of a review.Method: Data was collected through searches in electronic databases, networking among research teams ,colleagues and friends, “grey literature,” and through ancestry searches. A total of 38 articles were deemed eligible for inclusion and were analyzed using descriptive thematic analysis. The analysis resulted in an overarching finding -namely, the importance for EMS clinicians to adjust for perceived control in unpredictable situations. Within this finding, 3 themes emerged in terms of EMS clinicians’ clinical reasoning: (1) maintaining a holistic view of the patient; (2) keeping an open mind; and (3) improving through criticism. Seven subthemes subsequently emerged from these three themes.Results: This review showed that EMS clinicians’ clinical reasoning begins with the information that they are given about a patient. Based on this information, clinicians calculate the best route to the patient and which equipment to use, and they also assess potential risks. They need to be constantly aware of what is happening on the scene and with the patient and strive to control the situation. This striving also enables EMS clinicians to work safely and effectively in relation to the patient, their relatives, other clinicians, associated organizations, and the wider community. A lack of contextually appropriate guidelines results in the need for creativity and forces EMS clinicians to use “workarounds” to solve issues beyond the scope of the guidelines available. In addition, they often lack organizational support and fear repercussions such as litigation, unemployment, or blame by their EMS or healthcare organization or by patients and relatives.Conclusion: Clinical reasoning is influenced by several factors. Further research is needed to determine which influencing factors can be addressed through interventions to minimize their impact on patient outcomes.
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| 2. |
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| 3. |
- Andersson, Henrik, 1968-, et al.
(författare)
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Simulation in Virtual World to Promote Communication
- 2018
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Ingår i: Pre-hospital care- Education and training of ambulance professionals. - Noordwijkerhout, The Netherlands.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Introduction Communication between ambulance professionals and patients is essential for understanding the patient's lifeworld (Wireklint Sundström & Dahlberg 2010). Simultaneously, communication is challenging to teach and learn within the framework of specific courses. However, simulation in virtual worlds can support the development of new skills such as communication (Combs, Sokolowski & Banks 2016). AimThe aim of this work was to design a simulation-based platform for communication training among ambulance nurse students (ANS). MethodsA qualitative action research approach was used (Coghlan & Casey 2001). Second Life® (SL) was selected since it was an existing virtual world. SL is a web-based flexible three-dimensional platform that allows customization. Interaction and communication with other virtual people can be done through avatars in real time (Hodge, Collins & Giordano 2011). Three ANS and five teachers participated, none of the participants had prior experience of SL. Observations and interviews were used as data and analysed using thematic analysis. Results The participants’ experiences generated three themes: Understanding the virtual worldIt was easy to interact and communicate with other virtual people. However, it took time to feel comfortable to navigate in SL. Technological challengesOne challenge was related to audio-visual problems e.g. not compatible headset, interfering echoes and that the image was distorted at times, which made it difficult to act and move the avatar. Another challenge was associated with the 3D modelling e.g. the capability to use of coordinates, positioning, object dimensioning and the fact that accidental deletions could not be restored. A third challenges that influenced the communication was the difficulty of visualizing clinically relevant care measures such as diagnostic examinations or drug treatment. Finally, there was a challenge to customize the avatars to look like ambulance professionals or a severely ill patient. Learning through avatars Learning through avatars requires that the participants take responsibility for delivering a convincing performance. Immersion was limited since actions do not take place from a first-person viewpoint. There is a need that the scenario is based on realistic conditions e.g. interiors, equipment, clothing, avatar appearance and behaviour. Conclusion The present system is not suitable for training of medical assessment. Teachers who are considering using virtual worlds in the training for future ambulance professionals should note that an appropriate design is crucial for how the simulation is experienced.
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| 4. |
- Andersson, Tova, et al.
(författare)
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Dela prylar, yta, bil och tid - Delningsekonomi i kommunerna
- 2018
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- För att uppnå de Globala målen i agenda 2030 och Sveriges miljömål behöver vår konsumtion vara hållbar och använda cirkulära resurser så effektivt och länge som möjligt på ett sätt som ryms inom de planetära gränserna och bidrar till välmående. Det handlar om att kommuner, företag och individer gör medvetna val, tar väl hand om, lagar, delar, tillgängliggör och återanvänder det vi har så att vi inte konsumerar mer än vi behöver eller vad planeten kan återskapa. Det handlar också om att skapa förutsättningar för hållbar konsumtion genom hela värdecykeln. Att återanvända och återvinna material, att designa, producera, distribuera och affärsutveckla på ett sätt som gör hållbar konsumtion till norm. Delning är en del av att förändra konsumtionen i en mer hållbar riktning. I Sverige har vi en lång tradition av att dela tvättstugor, badhus, daghem, kollektivtrafik och naturvärden genom allemansrätten. Den vanan kan man bygga vidare på nu när nya former för delning växer fram. Kommunal verksamhet handlar i grunden om att ta hand om gemensamma resurser och kommuner har därför stora möjligheter att stödja att de delas och återanvänds inom kommunens verksamheter genom att till exempel återanvända byggmaterial och inredning eller dela på transportpooler, lokaler eller utrustning mellan verksamheter. Men också genom att erbjuda invånare tillgång till lokaler eller odlingsmark, plattformar för delning av ting, tid eller transporter, eller system för återanvändning av saker. Den digitala utvecklingen har gjort möjligheterna att dela på resurser så mycket större och tillgängligare för fler. Många kommuner har idag tagit initiativ för ökad delning, samtidigt så finns det oklarheter och hinder kring hur delningen ska kunna skalas upp och utvidgas till fler områden. Avfall Sverige och IVL Svenska Miljöinstitutet har i samband med denna rapport också tagit fram en vägledning för hur kommunen kan jobba för att öka delningsekonomin inom kommunens verksamheter och mellan kommunen och invånarna: Dela prylar, yta, bil och tid. En vägledning till delningsekonomi i kommunerna.
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| 5. |
- Andersson, Tova, et al.
(författare)
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Dela prylar, yta, bil och tid - En vägledning till delningsekonomi i kommunerna
- 2018
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Delning handlar om att ge varandra tillgång till underutnyttjade resurser, som saker, ytor, transporter, tid, data eller kompetens. Det kan ske med eller utan vinstsyfte, privat eller kommersiellt och i de flesta fall utan ägarbyte. I Sverige finns en lång tradition och vana av att dela, både i grannskapet med tvättstuga, föreningslokaler och klädbytardagar, och samhälleligt med offentliga rum, kollektivtrafik och allemansrätt. Tilliten mellan människor är en av de högsta i världen enligt SOM-Institutet. Det gör steget att börja dela via nya tjänster och plattformar kortare. Intresset för delningsformer ökar hos invånarna. Det har skett flera normförflyttningar som ger delningsekonomin en skjuts. Att göra saker själv har fått högre status liksom att ta vara på saker. Prylar med en historia har fått ett uppgraderat värde och för allt fler unga är tillgång viktigare än ägande. Det finns ett stort behov hos kommuner av erfarenhets- och kunskapsutbyte kring delningsekonomi. Att inspireras av varandra och få inblick i vilka framgångsfaktorer andra kommuner funnit, hur ekonomiska och juridiska problem lösts och hållbarhetseffekter följts upp. Avfall Sverige och IVL Svenska Miljöinstitutet har tagit fram denna vägledning utifrån en kartläggning av vad som görs på kommunnivå, en enkätundersökning med cirka 30 svarande kommuner och intervjuer med åtta av dem. Det finns också en mer detaljerad rapport och en förteckning över delningsinitiativ för den som vill fördjupa sig. Vi hoppas att den ska inspirera och ge handgripliga råd både för de kommuner som är i full gång och de kommuner som just ska börja jobba med delningsekonomi.
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| 6. |
- DAWODY, JAZAER, 1959, et al.
(författare)
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An integrated system for energy-efficient exhaust aftertreatment for heavy-duty vehicles
- 2015
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Ingår i: Renewable Energy in the Service of Mankind. - Cham : Springer International Publishing. - 9783319177779 - 9783319177762 ; , s. 133-143
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- © Springer International Publishing Switzerland 2015. This chapter presents a unique system approach applied in a joint academic- industrial research programme, E4 Mistra, to attain the goals of high energy efficiency and low emissions in an exhaust aftertreatment system for heavy-duty vehicles. The high energy efficiency is achieved by heat recuperation, onboard hydrogen production for NOx reduction, and by finding new solutions for making the aftertreatment system active at low exhaust temperatures. To reach low particulate emissions, a mechanical filter using a sintered metal powder is developed and coated with catalytic material to improve the soot oxidation efficiency. Low NOx emissions are achieved by an efficient NOx reduction catalyst. The integrated E4 Mistra system comprises four technological advances: thermoelectric (TE) materials for heat recuperation, catalytic reduction of NOx over innovative catalyst substrates using either the onboard diesel or biodiesel, H2 from a high-efficiency fuel reformer, and particulate filtration over a porous metal filter. The TE materials are used in a TE generator (TEG) which converts thermal energy into electricity. The TEG is used to recuperate heat from the exhaust-gas recirculation (EGR) circuit of heavy-duty trucks and is expected to generate ~1 kW electric power from 20 kW heat in the exhaust gas. The TEG is integrated in a plate heat exchanger (HEX) designed particularly for this application. Apart from the knowledge and experiences in TEG and heat exchange technologies, a thorough fluid dynamics and TE analysis are performed in this project to understand the governing processes and optimize the system accordingly. The components of the E4 Mistra system are explained in the chapter in addition to test results, which show the system's capacity for H2 production, NOx conversion, particulate matter filtration and soot oxidation, and finally electric power generation via heat recuperation from the exhaust gas using the developed TEG-HEX system.
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| 8. |
- Maurin Söderholm, Hanna, et al.
(författare)
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Research challenges in prehospital care : the need for a simulation-based prehospital research laboratory
- 2019
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Ingår i: Advances in Simulation. - : BioMed Central. - 2059-0628 .- 2059-0628. ; 4:3, s. 1-6
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Tidskriftsartikel (refereegranskat)abstract
- There is a need for improved research in the field of prehospital care. At the same time, there are many barriers in prehospital research due to the complex context, posing unique challenges for research, development, and evaluation. The present paper argues for the potential of simulation for prehospital research, e.g., through the development of an advanced simulation-based prehospital research laboratory. However, the prehospital context is different from other healthcare areas, which implies special requirements for the design of this type of laboratory, in terms of simulation width (including the entire prehospital work process) and depth (level of scenario detail). A set of features pertaining to simulation width, scenario depth, equipment, and personnel and competence are proposed. Close tailoring between these features and the prehospital research problems and context presents great potential to improve and further prehospital research.
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| 9. |
- Ademuyiwa, Adesoji O., et al.
(författare)
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Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries
- 2016
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Ingår i: BMJ Global Health. - : BMJ Publishing Group Ltd. - 2059-7908. ; 1:4
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Tidskriftsartikel (refereegranskat)abstract
- Background: Child health is a key priority on the global health agenda, yet the provision of essential and emergency surgery in children is patchy in resource-poor regions. This study was aimed to determine the mortality risk for emergency abdominal paediatric surgery in low-income countries globally.Methods: Multicentre, international, prospective, cohort study. Self-selected surgical units performing emergency abdominal surgery submitted prespecified data for consecutive children aged <16 years during a 2-week period between July and December 2014. The United Nation's Human Development Index (HDI) was used to stratify countries. The main outcome measure was 30-day postoperative mortality, analysed by multilevel logistic regression.Results: This study included 1409 patients from 253 centres in 43 countries; 282 children were under 2 years of age. Among them, 265 (18.8%) were from low-HDI, 450 (31.9%) from middle-HDI and 694 (49.3%) from high-HDI countries. The most common operations performed were appendectomy, small bowel resection, pyloromyotomy and correction of intussusception. After adjustment for patient and hospital risk factors, child mortality at 30 days was significantly higher in low-HDI (adjusted OR 7.14 (95% CI 2.52 to 20.23), p<0.001) and middle-HDI (4.42 (1.44 to 13.56), p=0.009) countries compared with high-HDI countries, translating to 40 excess deaths per 1000 procedures performed.Conclusions: Adjusted mortality in children following emergency abdominal surgery may be as high as 7 times greater in low-HDI and middle-HDI countries compared with high-HDI countries. Effective provision of emergency essential surgery should be a key priority for global child health agendas.
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| 10. |
- Alexander, John H, et al.
(författare)
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Apixaban 5 mg Twice Daily and Clinical Outcomes in Patients With Atrial Fibrillation and Advanced Age, Low Body Weight, or High Creatinine : A Secondary Analysis of a Randomized Clinical Trial
- 2016
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Ingår i: JAMA cardiology. - : American Medical Association (AMA). - 2380-6583 .- 2380-6591. ; 1:6, s. 673-681
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Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE: In the Apixaban for Reduction of Stroke and Other Thromboembolic Complications in Atrial Fibrillation (ARISTOTLE) trial, the standard dose of apixaban was 5 mg twice daily; patients with at least 2 dose-reduction criteria-80 years or older, weight 60 kg or less, and creatinine level 1.5 mg/dL or higher-received a reduced dose of apixaban of 2.5 mg twice daily. Little is known about patients with 1 dose-reduction criterion who received the 5 mg twice daily dose of apixaban.OBJECTIVE: To determine the frequency of 1 dose-reduction criterion and whether the effects of the 5 mg twice daily dose of apixaban on stroke or systemic embolism and bleeding varied among patients with 1 or no dose-reduction criteria.DESIGN, SETTING, AND PARTICIPANTS: Among 18 201 patients in the ARISTOTLE trial, 17 322 were included in this analysis. Annualized event rates of stroke or systemic embolism and major bleeding and hazard ratios (HRs) and 95% CIs were evaluated. Interactions between the effects of apixaban vs warfarin and the presence of 1 or no dose-reduction criteria were assessed. The first patient was enrolled in the ARISTOTLE trial on December 19, 2006, and follow-up was completed on January 30, 2011. Data were analyzed from January 2015 to May 30, 2016.MAIN OUTCOMES AND MEASURES: Analysis of major bleeding included events during study drug treatment. Analysis of stroke or systemic embolism was based on intention to treat.RESULTS: Of the patients with 1 or no dose-reduction criteria assigned to receive the 5 mg twice daily dose of apixaban or warfarin, 3966 had 1 dose-reduction criterion; these patients had higher rates of stroke or systemic embolism (HR, 1.47; 95% CI, 1.20-1.81) and major bleeding (HR, 1.89; 95% CI, 1.62-2.20) compared with those with no dose-reduction criteria (n = 13 356). The benefit of the 5 mg twice daily dose of apixaban (n = 8665) compared with warfarin (n = 8657) on stroke or systemic embolism in patients with 1 dose-reduction criterion (HR, 0.94; 95% CI, 0.66-1.32) and no dose-reduction criterion (HR, 0.77; 95% CI, 0.62-0.97) were similar (P for interaction = .36). Similarly, the benefit of 5 mg twice daily dose of apixaban compared with warfarin on major bleeding in patients with 1 dose-reduction criterion (HR, 0.68; 95% CI, 0.53-0.87) and no dose-reduction criterion (HR, 0.72; 95% CI, 0.60-0.86) were similar (P for interaction = .71). Similar patterns were seen for each dose-reduction criterion and across the spectrum of age, body weight, creatinine level, and creatinine clearance.CONCLUSIONS AND RELEVANCE: Patients with atrial fibrillation and isolated advanced age, low body weight, or renal dysfunction have a higher risk of stroke or systemic embolism and major bleeding but show consistent benefits with the 5 mg twice daily dose of apixaban vs warfarin compared with patients without these characteristics. The 5 mg twice daily dose of apixaban is safe, efficacious, and appropriate for patients with only 1 dose-reduction criterion.TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00412984.
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