| 1. |
- Herlitz, Johan, 1949-, et al.
(author)
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Prehospital akutsjukvård: ett potentiellt forskarutbildningsämne : populärvetenskaplig rapport från de första 82 doktorsavhandlingarna i Sverige
- 2022
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Reports (pop. science, debate, etc.)abstract
- Syfte: Att beskriva prehospital akutsjukvård som ett potentiellt forskarutbildningsämne utifrån avhandlingar som skrivits och försvarats i Sverige inom detta kunskapsområde.Metod: Systematisk och manuell sökning har gjorts via MEDLINE (PubMed) och kontakt med lärosäten.Resultat: Totalt har 80 doktorsavhandlingar och två licentiatavhandlingar identifierats inom kunskapsområdet prehospital akutsjukvård. Avhandlingarna har försvarats under tidsperioden 1982–2021. Produktiviteten har succesivt ökat med 31 avhandlingar som försvarats under den senaste femårsperioden. Flest avhandlingar har skrivits vid Göteborgs Universitet (n=27) Karolinska Institutet (n=22) och Umeå Universitet (n=9). Avhandlingarna har skrivits av 51 sjuksköterskor, 28 läkare, en statistiker, en socionom, en präst och en folkhälsovetare (en avhandling redovisade två professioner; sjuksköterska och läkare). Kvinnor har varit författare i 48%. Avhandlingarna har delats in i följande övergripande kunskapsområden med i några fall även tillhörande undergrupper: A. Akut sjukdom, A1) Prognostiska faktorer (n=25) samt A2) Patient och anhörigperspektiv (n=8); B. Katastrof (n=6); C. Etik och värderingar (n=3); D. Vård- och arbetsmiljö (n=2); E. Kompetens, lärande och utbildning, E1) Ambulanssjuksköterska (n=5) samt E2) Hjärt-lungräddning (n=2 ); F. Trauma och smärta, F1) Skador och räddning (n=4 ), F2) Smärta (n=1) samt F3) Hypotermi (n=4); G. Akuta vårdprocesser och prioritering, G1) Resursutnyttjande (n=1) samt G2) Larmcentral och samverkan (n=8); H. Vårdande bedömning och beslut, H1) Vårdande förhållningssätt (n=3), H2) Diagnostisk bedömning och beslutsstöd (n=6) samt H3) Identifikation av sjukdom och vårdnivå (n=4).Konklusion: Antalet doktorsavhandlingar inom prehospital akutsjukvård är i ökande. Majoriteten av författarna är sjuksköterskor. Avhandlingarna täcker ett brett spektrum av kunskapsområden, men prognostiska faktorer vid Akut sjukdom är dominerande. Könsfördelningen är acceptabel. Patient- och anhörigperspektivet är sparsamt belyst liksom vissa patientgrupper, t.ex. infektioner och trauma. Forskningen inom kunskapsområdet inleddes med fokus på överlevnad vid hjärtstopp utanför sjukhus. Under åren har forskningsområdet vidgats till allt bredare problemområden; vård på rätt vårdnivå är ett sådant exempel.
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| 2. |
- Andersson, Henrik, 1968-, et al.
(author)
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Acute coronary syndrome in relation to the occurrence of associated symptoms : A quantitative study in prehospital emergency care.
- 2017
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In: International Emergency Nursing. - : Elsevier BV. - 1755-599X .- 1878-013X. ; 33, s. 43-47
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Journal article (peer-reviewed)abstract
- INTRODUCTION: Acute chest pain is a common symptom among prehospital emergency care patients. Therefore, it is crucial that ambulance nurses (ANs) have the ability to identify symptoms and assess patients suffering from acute coronary syndrome (ACS). The aim of this study is to explore the occurrence of dyspnoea and nausea and/or vomiting in the prehospital phase of a suspected ACS and the associations with patients' outcome.METHODS: This study has a quantitative design based on data from hospital records and from a previous interventional study (randomised controlled trial) including five Emergency Medical Service (EMS) systems in western Sweden in the years 2008-2010.RESULTS: In all, 1836 patients were included in the interventional study. Dyspnoea was reported in 38% and nausea and/or vomiting in 26% of patients. The risk of death within one year increased with the presence of dyspnoea. The presence of nausea and/or vomiting increased the likelihood of a final diagnosis of acute myocardial infarction (AMI).CONCLUSION: This study shows that dyspnoea, nausea and/or vomiting increase the risk of death and serious diagnosis among ACS patients. This means that dyspnoea, nausea and/or vomiting should influence the ANs' assessment and that special education in cardiovascular nursing is required.
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| 3. |
- Andersson Hagiwara, Magnus, et al.
(author)
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A shorter system delay for haemorrhagic stroke than ischaemic stroke among patients who use emergency medical service
- 2018
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In: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 137:5, s. 523-530
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Journal article (peer-reviewed)abstract
- ObjectivesWe compare various aspects in the early chain of care among patients with haemorrhagic stroke and ischaemic stroke. Materials & methodsThe Emergency Medical Services (EMS) and nine emergency hospitals, each with a stroke unit, were included. All patients hospitalised with a first and a final diagnosis of stroke between 15 December 2010 and 15 April 2011 were included. The primary endpoint was the system delay (from call to the EMS until diagnosis). Secondary endpoints were: (i) use of the EMS, (ii) delay from symptom onset until call to the EMS; (iii) priority at the dispatch centre; (iv) priority by the EMS; and (v) suspicion of stroke by the EMS nurse and physician on admission to hospital. ResultsOf 1336 patients, 172 (13%) had a haemorrhagic stroke. The delay from call to the EMS until diagnosis was significantly shorter in haemorrhagic stroke. The patient's decision time was significantly shorter in haemorrhagic stroke. The priority level at the dispatch centre did not differ between the two groups, whereas the EMS nurse gave a significantly higher priority to patients with haemorrhage. There was no significant difference between groups with regard to the suspicion of stroke either by the EMS nurse or by the physician on admission to hospital. ConclusionsPatients with a haemorrhagic stroke differed from other stroke patients with a more frequent and rapid activation of EMS.
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| 4. |
- Herlitz, Johan, 1949-, et al.
(author)
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Över 100 doktorsavhandlingar inom den prehospitala akutsjukvården i Sverige
- 2023
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In: Läkartidningen. - : Läkartidningen Förlag AB. - 1652-7518. ; 120
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Research review (peer-reviewed)abstract
- HUVUDBUDSKAPÖver 100 avhandlingar har i dagsläget skrivits om den prehospitala akutsjukvården i Sverige.Dessa täcker ett omfattande kunskapsfält, allt ifrån prognostiska faktorer vid akut sjukdom till ambulans personalens psykiska och fysiska hälsa.Endast ett kunskapsområde har belysts mera om fattande, och det är hjärt–lungräddning vid plötsligt hjärtstopp.Vården av patienter med psykisk ohälsa har inte belysts i någon avhandling.Det finns stora kunskapsluckor, och vidare forskning inom området behövs.
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| 5. |
- Norberg Boysen, Gabriella, 1966-, et al.
(author)
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Patient trust and patient safety for low-priority patients : A randomized controlled trial pilot study in the prehospital chain of care
- 2019
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In: International Emergency Nursing. - : Elsevier. - 1755-599X .- 1878-013X. ; 46
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Journal article (peer-reviewed)abstract
- Background: Patients who call for an ambulance but only have primary care needs do not always get appropriate care. The starting point in this study is that such patients should be assigned to as basic of care as possible, while maintaining high levels of patient trust and patient safety.Aim: To evaluate patient trust and patient safety among low-priority ambulance patients referred to care at either the Community Health Centre (CHC) or the Emergency Department (ED).Methods: This randomized controlled trial pilot study compared the level of patient trust and patient safety among low-priority ambulance patients who were randomized into two groups: CHC (n = 105) or ED (n = 83).Results: There was a high level of trust in the care received, regardless of whether the patient received care at CHC or ED. Overall 31% fulfilled one or more of the given criteria for potentially jeopardizing patient safety.Conclusion: Patient selection for the trial indicated a potential limit in patient safety. There was a high level of trust in the care received regardless of whether the patient received care. The accuracy of patient selection for the new care model needs to be further improved with the intention to enhance patient safety even further.
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| 6. |
- Norberg Boysen, Gabriella, 1966-, et al.
(author)
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Trust in the early chain of healthcare: lifeworld hermeneutics from the patient's perspective
- 2017
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In: International Journal of Qualitative Studies on Health and Well-being. - : Informa UK Limited. - 1748-2623 .- 1748-2631. ; 12:1
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Journal article (peer-reviewed)abstract
- Purpose: Patients must be able to feel as much trust for caregivers and the healthcare system at the healthcare centre as at the emergency department. The aim of this study is to explain and understand the phenomenon of trust in the early chain of healthcare, when a patient has called an ambulance for non-urgent condition and been referred to the healthcare centre.Method: A lifeworld hermeneutic approach from the perspective of caring science was used. Ten patient participated: seven female and three male. The setting is the early chain of healthcare in south-wetern Sweden.Results: The findings show that the phenomenon of trust does not automatically involve medical care. However, attention to the patient's lifeworld in a professional caring relationship enables the patient to trust the caregiver and the healthcare environment. It is clear that the "voice of lifeworld" enables the patient to feel trust.Conclusion: Trust in the early chain of healthcare entails caregivers' ability to play attention to both medical and existentioal issues in compliance with the patient's information and questions. Thus, the patient must be invited to participate in assessment and decisions concerning his or her own healthcare, in a credible manner and using everyday language.
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| 7. |
- Norberg, Gabriella, et al.
(author)
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Swedish emergency medical services' identification of potential candidates for primary healthcare : Retrospective patient record study.
- 2015
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In: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 33:4, s. 311-317
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To investigate patients who called the emergency medical services (EMS) for primary healthcare (PHC) problems.DESIGN: A retrospective and exploratory patient record study from an EMS perspective, comparing two groups: those who were potential candidates for PHC and those who were not. All data were gathered from EMS and hospital records.SETTINGS: The study was completed at the EMS and five hospital areas in the western region of Sweden.SUBJECTS: The patients (n = 3001) who called the EMS in 2011. Data were missing for 10%.MAIN OUTCOME MEASURES: The frequency and the clinical characteristics of the patients who called the EMS and were actually potential candidates for PHC.RESULTS: Of a total of 2703 patients, a group of 426 (16%) were assessed as potential candidates for PHC and could thus be treated at a level of care other than the emergency department. Patients who were classified as suitable for PHC were found at all priority levels and within all symptom groups, but were younger and healthier than the other group.CONCLUSION: Numerous patients seeking help from the EMS do not end up at the most appropriate level in the healthcare system.IMPLICATIONS: In the EMS, guidelines are needed to enable pre-hospital emergency nurses to assess and triage patients to the most appropriate level of healthcare. Key points Patients calling the emergency medical services do not always end up at an appropriate level of healthcare. In total, 16% of patients were identified by the Swedish emergency medical services as potential candidates for primary healthcare. These patients were younger and healthier than those needing care at the emergency department. They were found at all priority levels and within all symptom groups.
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| 8. |
- Wireklint Sundström, Birgitta, 1951-, et al.
(author)
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Comparison of the university hospital and county hospitals in western Sweden to identify potential weak links in the early chain of care for acute stroke : Results of an observational study
- 2015
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In: BMJ Open. - : BMJ. - 2044-6055 .- 2044-6055.
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Other publication (other academic/artistic)abstract
- Objective: To identify weak links in the early chain of care for acute stroke.Setting: Nine emergency hospitals in western Sweden, each with a stroke unit, and the emergency medical services (EMS).Participants: All patients hospitalised with a first and a final diagnosis of stroke − between December 15, 2010 and April 15, 2011. The university hospital in the city of Gothenburg was compared with six county hospitals.Primary and secondary measures: (1) The system delay, i.e. median delay time from call to the EMS until diagnosis was designated as the primary endpoint. Secondary endpoints were: (2) the system delay time from call to the EMS until arrival in a hospital ward, (3) the use of the EMS, (4) priority at the dispatch centre and (5) suspicion of stroke by the EMS nurse.Results: In all, 1,376 acute patients with stroke (median age 79 years; 49% women) were included. The median system delay from call to the EMS until (1) diagnosis (CT scan) and (2) arrival in a hospital ward was 3 hours and 52 minutes and 4 hours and 22 minutes respectively. The system delay (1) was significantly shorter in the county hospitals. (3) The study showed that 76% used the EMS (Gothenburg 71%; the county 79%) (p <0.0001). (4) Priority 1 was given at the dispatch centre in 54% of cases. (5) Stroke was suspected in 65%. A prenotification was sent in 32% (Gothenburg 52%; the county 20%) (p <0.0001).Conclusion: System delay is still long and only a small fraction of patients received thrombolysis. Three of four used the EMS (more frequent in the county). They were given highest priority at the dispatch centre in half of the cases. Stroke was suspected in two thirds of the cases, but a prenotification was seldom sent to the hospital.
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| 9. |
- Wireklint Sundström, Birgitta, et al.
(author)
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Possible effects of a course in cardiovascular nursing on prehospital care of patients experiencing suspected acute coronary syndrome : a cluster randomised controlled trial
- 2016
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In: BMC Nursing. - : Springer. - 1472-6955 .- 1472-6955. ; 15:1
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Journal article (peer-reviewed)abstract
- Background:Current research suggests that nurses can influence the outcome for patients with acute coronary syndrome (ACS). The aim of this study has been to evaluate whether a course in cardiovascular nursing (CVN) can improve ambulance nurses' (ANs') prehospital care of patients experiencing suspected ACS, related to pain intensity.METHODS: This is a cluster randomised controlled trial that was conducted in the ambulance services. Patients were allocated to one of two groups: in the first group, patients were treated by ANs who had attended the CVN course and in the second group patients were treated by ANs without this qualification. Inclusion criteria were: 1/pain raising suspicion of ACS, and 2/pain score ≥4 on a visual analogue scale (VAS). The primary outcome was the estimated intensity of pain or discomfort according to VAS 15 min after randomisation. Secondary outcomes were estimated intensity of pain or discomfort on admission to hospital and further requirement of pain treatment, as well as symptoms such as paleness and/or cold sweat; nausea and/or vomiting; anxiety, dyspnea, degree of alertness, respiratory depression and aggressiveness. A further secondary outcome measured was survival to 30 days. Lastly, a final diagnosis was made. A total of 38 ANs attended the CVN course. There were 1,747 patients who fulfilled the inclusion criteria.RESULTS: The pain score did not differ significantly between the two groups fifteen minutes after randomisation (median value of VAS was 4.0 in both groups). On admission to hospital the pain score was significantly lower for patients treated by an AN who had attended the CVN course (n = 332) compared with those treated by an AN who had not attended the course (n = 1,415) (median 2.5 and 3.0 respectively, p = 0.001). The ANs who had attended the course used higher doses of morphine.CONCLUSIONS: An educational intervention with a CVN course did not relate significantly to more efficient pain relief in suspected ACS during the first 15 min. However, this intervention was associated with more effective pain relief later on in the prehospital setting. Thus, a CVN course for ANs appears to be associated with reduced pain intensity among patients experiencing suspected ACS. This result needs however to be confirmed in further trials.
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| 10. |
- Wireklint Sundström, Birgitta, et al.
(author)
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Pre-hospital care for patients suffering from suspected acute coronary syndrome - educational intervention for pain and anxiety relief
- 2016
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Conference paper (peer-reviewed)abstract
- Background: Pre-hospital care for patients from suffering acute coronary syndrome (ACS) has been shown to be a challenge. Associated symptoms appear together with typical ones. The symptoms have been reported to be more intense in the pre-hospital setting than after hospital admission. Special education could benefit for ambulance nurses (AN). Purpose: A. To describe the prevalence of dyspnea and nausea or vomiting and their associa tion with outcome. B.To explore the possible connection between the patients' estimated inten sity of pain before arrival to the hospital and clinical findings. C. To evaluate the possible effect of education in cardiovascular nursing on pain intensity in patients suffering from suspected ACS. Methods: A randomised controlled trail: an educational and a medical intervention. There is also a retrospective design. In the trial: The inclusion criteria were symptoms of pain 4 on the coloured analogue scale raising suspicion of ACS. In total 1,603 patients participated. The edu cational intervention was a course including care assessment and treatment as well as clinical cardiology. The medical intervention was Midazolam. Results: A. One in three patients has symptoms of dyspnea and the same number of patients has symptoms of nausea or vomiting, which increases the suspicion of ACS. B. More intensive pain was associated with: 1) lower age and a higher prevalence of previous smoking; 2) more complications before hospital admission in terms of hypotension and AV-block- bradycardia which required treatment and 3) a higher incidence of heart failure, anxiety, and pain after hos pital admission that required treatment. C. On admission to hospital, the pain score was signifi cantly lower for patients treated by an AN with special education compared with those treated by an AN without such education. The AN with special education used higher doses of mor phine to treat patients. Conclusion: An assessment and treatment strategy that combines all symptoms, both the typical symptoms and the associated ones, is needed. The estimated in tensity of pain can predict outcomes. The possible effect of special education for ANs is shown but needs to be confirmed in further trials.
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