| 1. |
- Robinson, Yohan, 1977, et al.
(författare)
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AI och framtidens försvarsmedicin
- 2020
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Medicinskt legitimerad personal är, och kommer med stor sannolikhet fortsattatt vara, en knapp resurs inom Försvarsmaktens sjukvårdsorganisation. I denna rapport ges en översikt över pågående och planerade ansatser baserade påartificiell intelligens (AI) inom akutsjukvård med särskild tonvikt på omhändertagandet av traumapatienter, där lösningarna skulle kunna bidra till att Försvarsmakten kan bibehålla sin sjukvårdskapacitet i kritiska lägen. Rapporten är ett resultat av samarbetet mellan FM, FOI, FMV, FHS och KI, och vänder sig i första hand till Försvarsmaktens strategiska ledning.Användningen av AI-teknik i framtida beslutsstöd kan skapa nya möjligheter till avlastning av personal och resurseffektivisering. Tekniken ger möjligheter att i realtid samla in, bearbeta och analysera stora mängder blandadinformation om förbands hälsoläge och fysiska stridsvärde. Bedömning av skadade kan t.ex. göras av triagedrönare och den efterföljande evakueringen kanunderlättas av intelligenta autonoma plattformar. Införandet av AI-system ställer dock vårdgivaren inför svåra etiska och medikolegala överväganden.Försvarsmedicin har en central roll i Försvarsmaktens krigföringsförmåga och för samhällets uthållighet. För att nyttja hela AI-teknikens framfart till Försvarsmaktens nytta måste dess innebörd och konsekvens för försvarsmedicinen förstås. Därför rekommenderar denna studie att Försvarsmaktens framtida satsningar inom AI och autonomi inkluderar den försvarsmedicinska teknikutveckling som är beskriven i denna rapport.
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| 2. |
- Henje Blom, Eva, 1962-, et al.
(författare)
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Heart rate variability (HRV) in adolescent females with anxiety disorders and major depressive disorder
- 2010
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 99:4, s. 604-611
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The aim of this study was to investigate heart rate variability (HRV) in a clinical sample of female adolescents with anxiety disorders (AD) and/or major depressive disorder (MDD) compared with healthy controls and to assess the effect of selective serotonin reuptake inhibitors (SSRI) on HRV. METHODS: Heart rate variability was measured in adolescent female psychiatric patients with AD and/or MDD (n = 69), mean age 16.8 years (range: 14.5-18.4), from 13 out-patient clinics and in healthy controls (n = 65), mean age 16.5 years (range: 15.9-17.7). HRV was registered in the sitting position during 4 min with no interventions. RESULTS: Logarithmically transformed high frequency HRV (HF), low frequency HRV (LF) and standard deviation of inter beat intervals (SDNN) were lower in the clinical sample compared with the controls (Cohen's d for HF = 0.57, LF = 0.55, SDNN = 0.60). This was not explained by body mass index, blood pressure or physical activity. Medication with SSRI explained 15.5% of the total variance of HF, 3.0% of LF and 6.5% of SDNN. CONCLUSIONS: Adolescent female psychiatric patients with AD and/or MDD show reduced HRV compared with healthy controls. Medication with SSRI explained a part of this difference.
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| 3. |
- Bäckström, Denise, 1976-, et al.
(författare)
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Physicians’ challenges when working in the prehospital environment : a qualitative study using grounded theory
- 2024
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Ingår i: International Journal of Emergency Medicine. - : BMC. - 1865-1372 .- 1865-1380. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundIn the rapid development in prehospital medicine the awareness of the many challenges in prehospital care is important as it highlights which areas need improvement and where special attention during education and training should be focused. The purpose of this study is to identify challenges that physicians face when working in the prehospital environment. The research question is thus; what challenges do physicians face when working in prehospital care?MethodThis is a qualitative study with an inductive approach and is based on individual interviews. The interviews were analyzed using the Classic Grounded Theory (GT) method as an approach. The interviews were conducted as semi-structured interviews via the digital platform Zoom during winter / early spring 2022.ResultsChallenges for prehospital physicians can be understood as a process that involves a balancing act between different factors linked to the extreme environment in which they operate. This environment creates unique challenges not usually encountered in routine hospital practice, which results in trade-offs that they would not otherwise be faced with. Their individual situation needs to be balanced against organizational conditions, which means, among other things, that their medical decisions must be made based on limited information as a result of the constraints that exist in the prehospital environment. They must, both as individuals and as part of a team, maneuver in time and space for decision-making and practical tasks. This theory of balancing different entities is based on four themes; thus the theory is the relation between the four themes: leadership, environment, emotion management and organization.ConclusionsWith the help of previous studies and what we have found, it is reasonable to review what training is needed before starting to work prehospital as a physician. This should include components of the themes we have described: organization, environment, leadership and emotional management.
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| 4. |
- Henje Blom, Eva, 1962-, et al.
(författare)
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Heart rate variability is related to self-reported physical activity in a healthy adolescent population
- 2009
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Ingår i: European Journal of Applied Physiology. - : Springer Science and Business Media LLC. - 1439-6319 .- 1439-6327. ; 106:6, s. 877-883
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Tidskriftsartikel (refereegranskat)abstract
- This study investigated whether there is a relationship between heart rate variability (HRV) versus lifestyle and risk factors for cardiovascular disease in a population of healthy adolescents. HRV is as an index of tonic autonomic activity and in adults HRV is related to lifestyle and risk factors for cardiovascular disease, but it is not known if this is the case in adolescents. HRV was registered for 4 min in sitting position in 99 healthy adolescents (age range 15 years 11 months-17 years 7 months) and repeated after 6 months. On both occasions there were significant correlations (P < 0.05) between physical activity and HRV, with respective r values: high frequency (HF) 0.26, 0.30; low frequency power (LF) 0.35, 0.29 and the standard deviation of inter-beat intervals (SDNN) 0.28, 0.37. There was no significant interaction between first and second measurements. In contrast, there were no correlations to sleeping patterns, eating habits and smoking. Risk factors for cardiovascular disease [body mass index (BMI = weight (kg)/length in m(2)), systolic blood pressure and p-glucose] did not show any repeatable significant correlations to HRV. Multiple regression models showed that physical activity was a predictor for HF, LF and SDNN in both measurements. In conclusion HF, LF and SDNN were reproducible after 6 months and were related to physical activity on both occasions.
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| 5. |
- Blimark, Magnus, 1963, et al.
(författare)
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Swedish emergency hospital surgical surge capacity to mass casualty incidents
- 2020
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Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - : Springer Science and Business Media LLC. - 1757-7241. ; 28:1
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Tidskriftsartikel (refereegranskat)abstract
- Background In Sweden the surgical surge capacity for mass casualty incidents (MCI) is managed by county councils within their dedicated budget. It is unclear whether healthcare budget constraints have affected the regional MCI preparedness. This study was designed to investigate the current surgical MCI preparedness at Swedish emergency hospitals. Methods Surveys were distributed in 2015 to department heads of intensive care units (ICU) and surgery at 54 Swedish emergency hospitals. The survey contained quantitative measures as the number of (1) surgical trauma teams in hospital and available after activating the disaster plan, (2) surgical theatres suitable for multi-trauma care, and (3) surgical ICU beds. The survey was also distributed to the Armed Forces Centre for Defence Medicine. Results 53 hospitals responded to the survey (98%). Included were 10 university hospitals (19%), 42 county hospitals (79%), and 1 private hospital (2%). Within 8 h the surgical capacity could be increased from 105 to 399 surgical teams, while 433 surgical theatres and 480 ICU beds were made available. The surgical surge capacity differed between university hospitals and county hospitals, and regional differences were identified regarding the availability of surgical theatres and ICU beds. Conclusions The MCI preparedness of Swedish emergency care hospitals needs further attention. To improve Swedish surgical MCI preparedness a national strategy for trauma care in disaster management is necessary.
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| 6. |
- Ellervall, Eva, et al.
(författare)
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How confident are general dental practitioners in their decision to administer antibiotic prophylaxis?
- 2008
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Ingår i: BMC Medical Informatics and Decision Making. - : BioMed Central. - 1472-6947. ; 8
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Tidskriftsartikel (refereegranskat)abstract
- Background: Common dental procedures induce bacteremia. To prevent infectious complications from bacteremia in patients with specific medical conditions, antibiotic prophylaxis is considered. Recommendations are often unclear and ambiguous. In a previous study we reported wide variations in general dental practitioners’ (GDPs’) administrations of antibiotic prophylaxis. We hypothesized that within such a conflicting clinical area, decisions are made with a high level of personal uncertainty. This study examined GDPs’ confidence in their decisions and analyzed the extent to which case-related factors might explain individual variations in confidence. Methods: Postal questionnaires in combination with telephone interviews were used. The response rate was 51% (101/200). There were no significant differences between respondents and non-respondents regarding sex, age, or place of work. The GDPs were presented to patient cases of different medical conditions, where some should receive antibiotic prophylaxis according to recommendations when performing dental procedures that could cause gingival bleeding. The GDPs assessed on visual analogue scales how confident they were in their decisions. The extent to which case-related factors, medical condition and dental procedure, could explain individual variation in confidence was analyzed. Results: Overall the GDPs exhibited high confidence in their decisions regardless of whether they administered antibiotic prophylaxis or not, or whether their decisions were in accordance with recommendations or not. The case-related factors could explain between 30–100% of the individual variation in GDPs’ confidence. For 46%, the medical condition significantly explained the individual variation in confidence. However, for most of these GDPs, lower confidence was not presented for conditions where recommendations are unclear and higher confidence was not presented for conditions where recommendations are more clear. For 8% the dental procedure significantly explained the variation, although all procedures could cause bacteremia. For 46% neither the medical condition nor the dental procedure could significantly explain the individual variation in confidence. Conclusions: The GDPs presented high confidence in their decisions, and the majority of GDPs did not present what could be considered a justified varied level of confidence according to the clarity of recommendations. Clinicians who are overconfident in their decisions may be less susceptible to modifications of their behavior to more evidence-based strategies.
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| 7. |
- Kennedy, Beatrice, 1982-, et al.
(författare)
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Sociodemographic characteristics and COVID-19 testing rates : spatiotemporal patterns and impact of test accessibility in Sweden
- 2024
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Ingår i: European Journal of Public Health. - : Oxford University Press. - 1101-1262 .- 1464-360X. ; 34:1, s. 14-21
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundDiagnostic testing is essential for disease surveillance and test–trace–isolate efforts. We aimed to investigate if residential area sociodemographic characteristics and test accessibility were associated with Coronavirus Disease 2019 (COVID-19) testing rates.MethodsWe included 426 224 patient-initiated COVID-19 polymerase chain reaction tests from Uppsala County in Sweden from 24 June 2020 to 9 February 2022. Using Poisson regression analyses, we investigated if postal code area Care Need Index (CNI; median 1.0, IQR 0.8–1.4), a composite measure of sociodemographic factors used in Sweden to allocate primary healthcare resources, was associated with COVID-19 daily testing rates after adjustments for community transmission. We assessed if the distance to testing station influenced testing, and performed a difference-in-difference-analysis of a new testing station targeting a disadvantaged neighbourhood.ResultsWe observed that CNI, i.e. primary healthcare need, was negatively associated with COVID-19 testing rates in inhabitants 5–69 years. More pronounced differences were noted across younger age groups and in Uppsala City, with test rate ratios in children (5–14 years) ranging from 0.56 (95% CI 0.47–0.67) to 0.87 (95% CI 0.80–0.93) across three pandemic waves. Longer distance to the nearest testing station was linked to lower testing rates, e.g. every additional 10 km was associated with a 10–18% decrease in inhabitants 15–29 years in Uppsala County. The opening of the targeted testing station was associated with increased testing, including twice as high testing rates in individuals aged 70–105, supporting an intervention effect.ConclusionsEnsuring accessible testing across all residential areas constitutes a promising tool to decrease inequalities in testing.
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| 8. |
- Lalouni, Maria, et al.
(författare)
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Parental responses and catastrophizing in online cognitive behavioral therapy for pediatric functional abdominal pain : A mediation analysis of a randomized controlled trial
- 2022
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Ingår i: Frontiers in Pain Research. - : Frontiers Media SA. - 2673-561X. ; 3
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To test if decreased parental protective behaviors, monitoring behaviors, and parental catastrophizing mediate relief of gastrointestinal symptoms in children 8–12 years with functional abdominal pain disorders(FAPDs). The study uses secondary data analyses of a randomized controlled trial in which exposure-based online cognitive behavioral therapy (ICBT) was found superior to treatment as usual in decreasing gastrointestinal symptoms.Methods: The ICBT included 10 weekly modules for children and 10 weekly modules for parents. Treatment as usual consisted of any medication, dietary adjustments, and healthcare visits that the participants engaged in during 10 weeks. All measures were self-assessed online by parents. Biweekly assessments of the Adult Responses to Children’s Symptoms (ARCS), Protectand Monitor subscales, and the Pain Catastrophizing Scale, parental version (PCS-P) were included in univariate and multivariate growth models to test their mediating effect on the child’s gastrointestinal symptoms assessed withthe Pediatric Quality of Life Gastrointestinal Symptoms Scale (PedsQL).Results: A total of 90 dyads of children with FAPDs and their parents were includedin the study, of which 46 were randomized to ICBT and 44 to treatment as usual. The PCS-P was found to mediate change in the PedsQL ab = 0.639 (95% CI0.020–2.331), while the ARCS Monitor ab = 0.472 (95% CI −1.002 to 2.547), and Protect ab= −0.151 (95% CI −1.455 to 0.674) were not mediators of change.Conclusions: To target parental catastrophizing in ICBT for pediatric FAPDs is potentially important to reduce abdominal symptoms in children.
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| 9. |
- Melin, Jeanette, et al.
(författare)
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Forward and Backward Recalling Sequences in Spatial and Verbal Memory Tasks : What Do We Measure?
- 2023
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Ingår i: Entropy. - : MDPI. - 1099-4300. ; 25:5
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Tidskriftsartikel (refereegranskat)abstract
- There are different views in the literature about the number and inter-relationships of cognitive domains (such as memory and executive function) and a lack of understanding of the cognitive processes underlying these domains. In previous publications, we demonstrated a methodology for formulating and testing cognitive constructs for visuo-spatial and verbal recall tasks, particularly for working memory task difficulty where entropy is found to play a major role. In the present paper, we applied those insights to a new set of such memory tasks, namely, backward recalling block tapping and digit sequences. Once again, we saw clear and strong entropy-based construct specification equations (CSEs) for task difficulty. In fact, the entropy contributions in the CSEs for the different tasks were of similar magnitudes (within the measurement uncertainties), which may indicate a shared factor in what is being measured with both forward and backward sequences, as well as visuo-spatial and verbal memory recalling tasks more generally. On the other hand, the analyses of dimensionality and the larger measurement uncertainties in the CSEs for the backward sequences suggest that caution is needed when attempting to unify a single unidimensional construct based on forward and backward sequences with visuo-spatial and verbal memory tasks.
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| 10. |
- Rawski, A. A., et al.
(författare)
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The major factors that influence endodontic retreatment decisions
- 2003
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Ingår i: Swedish Dental Journal. - : Swedish Dental Association. - 0347-9994. ; 27:1, s. 23-29
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Tidskriftsartikel (refereegranskat)abstract
- The presence of a new or persistent periapical radiolucency adjacent to a rootfilled tooth is often used as a criterion of endodontic treatment "failure". However, clinicians' suggested management of such cases is subject to substantial interindividual variation. Several components that might influence endodontic retreatment decision making have been explored, but data on which factors dentists actually think they consider, are missing. The aim was to interview 20 general dental practitioners (GDPs) and 20 endodontists about factors they thought would influence the prescription of endodontic retreatment. Six simulated cases were presented as cartoons accompanied with a clinical history. In two of the cases the teeth were planned to serve as an abutment tooth in a fixed prosthodontic construction. The status of the periapical bone tissue and the quality of rootfilling seal were varied. Between 1 and 6 factors per case were reported to influence decision making. In cases not planned to serve as abutment teeth most dentists considered that the periapical condition was the most important factor, whilst they considered the fixed prosthodontic construction to be the most important factor in cases planned as abutment teeth. Generally, endodontists seem to be more inclined to retreat and act on the mere presence of a periapical lesion regardless of size than GDPs. In a real clinical setting in direct contact with patients, additional factors like economy and patients' preferences might be expected to exert a major influence. The majority of the dentists stated that they thought that their colleagues would make similar decisions as they did themselves.
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