| 1. |
- Holmström, Inger, 1960-, et al.
(author)
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Better safe than sorry : Registered nurses' strategies for handling difficult calls to emergency medical dispatch centres - An interview study
- 2022
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In: Journal of Clinical Nursing. - : WILEY. - 0962-1067 .- 1365-2702. ; 31:17-18, s. 2486-2494
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Journal article (peer-reviewed)abstract
- Aims and objectives To describe strategies employed by registered nurses for handling difficult calls to emergency medical dispatch centres. Background At emergency medical dispatch centres, registered nurses encounter a range of difficult calls in their clinical practice. They often use clinical decision support systems, but these may be of limited help if the caller is for instance abusive or has limited language proficiency. Much can be learnt from strategies developed by registered nurses for handling difficult calls. Design A descriptive qualitative study was conducted. Methods A purposeful sample of 24 registered nurses from three different emergency medical dispatch centres were interviewed. The transcribed interviews were analysed using qualitative content analysis. The COREQ checklist was applied. Results An overarching theme was established: "Using one's nursing competence and available resources for a safe outcome", based on three sub-themes: Use one's own professional and personal resources, Use resources within the organisation and Use external resources. The themes in turn consist of ten categories. Conclusions Registered nurses employed a range of strategies to deal with difficult calls, often in combination. They used their personal resources, resources within their own organisation, and collaboration partners to make safe triage decisions and use resources wisely. The effectiveness of these strategies, however, remains unknown. When registered nurses were unable to rule out a high-acuity condition, they used safety-netting and sent an ambulance. Evaluating current strategies and making strategies explicit could further improve the ability of nurses to handle difficult calls. Relevance to clinical practice The strategies described by registered nurses for handling difficult calls to EMDCs included using a consecutive set of strategies. Some of the strategies seemed to be used deliberately, while others seemed tacit and applied in a routinised way. These strategies could potentially be useful for RNs working with telephone triage in different contexts.
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| 2. |
- Holmström, Inger, 1960-, et al.
(author)
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Registered Nurses' experiences of using a clinical decision support system for triage of emergency calls : A qualitative interview study
- 2020
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In: Journal of Advanced Nursing. - : WILEY. - 0309-2402 .- 1365-2648. ; 76:11, s. 3104-3112
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Journal article (peer-reviewed)abstract
- Objectives To describe how Registered Nurses make use of a Clinical Decision Support System to triage calls to emergency medical dispatch centres, from the perspective of professional autonomy. Design The study had a descriptive design with a qualitative inductive approach. Methods Interviews were done with 24 Registered Nurses during 2018-2019. Thematic analysis was conducted. Results Five themes and 16 subthemes were established: (a) Using the CDSS as a general support to professional competence in emergency calls, including subthemes:Support for professional competence,an aid to reflection,a compulsory support; (b) A specific support useful in difficult situations and calls, with subthemes:RN being tired or stressed out;vague and unclear symptoms,rare situations,aggressive and agitated callers; (c) Using the CDSS but changing triage recommendations/priority, including subthemes:Recommending a higher priority than the CDSSandrecommending a lower priority than the CDSS; (d) Development areas for better use of the CDSS in collaboration with other services, with subthemes:Request for common documentation system with ambulancesandcloser collaboration with the national telephone nursing helpline; and (e) Possible technical development areas in the CDSS for optimal use, including subthemes:image transfer,medical records,development of certain areas in the CDSS,update of maps,a need for more knowledge. Conclusion The CDSS was not perceived as a restriction on professional autonomy. It was particularly useful in rare situations. Technical improvements as well as education and training should be done in close collaboration with registered nurses. Impact The study contributes with knowledge about how registered nurses triaging emergency calls use a decision support system. The system was a support for professional competence and did not seem to restrict them. The findings could be useful for clinicians and researchers in development of telephone triage and decision support systems.
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| 3. |
- Holmström, Inger, 1960-, et al.
(author)
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The perspectives of Swedish registered nurses about managing difficult calls to emergency medical dispatch centres : a qualitative descriptive study
- 2021
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In: BMC Nursing. - : BMC. - 1472-6955. ; 20:1
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Journal article (peer-reviewed)abstract
- Background Telephone triage at emergency medical dispatch centres is often challenging for registered nurses due to lack of visual cues, lack of knowledge about the patient, and time pressure - and making the right decision can be a matter of life and death. Some calls may be more difficult to handle, and more knowledge is needed about these calls to develop education and coping strategies. Therefore, the aim of this study was to describe the perspectives of registered nurses' views about managing difficult calls to emergency medical dispatch centres. Methods A descriptive design with a qualitative inductive approach was used. Three dispatch centers in mid-Sweden were investigated, covering about 950,000 inhabitants and handling around 114,000 calls per year. Individual interviews were carried out with a purposeful sample of 24 registered nurses. Systematic text condensation was conducted. Results Seven themes were generated: calls with communication barriers, calls from agitated or rude callers, calls about psychiatric illness, calls from third parties, calls about rare or unclear situations, calls with unknown addresses and calls regarding immediate life-threatening conditions. There was a strong consensus among the registered nurses about which calls were experienced as difficult, with the exception of calls about immediate life-threatening conditions. Some registered nurses thought calls about immediate life-threatening conditions were easy to handle as they simply adhered to protocol, while others described these calls as difficult and were emotionally affected. Conclusion The registered nurses' descriptions of difficult calls focused on the callers, while their own role, the organisational framework, and leadership were not mentioned. Many types of calls included difficulties, which could be related to the caller, their symptoms, or different circumstances. The registered nurses pointed to language barriers and rude, agitated callers as increasing problems. An investigation of actual emergency calls is warranted to examine the extent and nature of such calls.
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| 4. |
- Höglund, Erik, 1983-, et al.
(author)
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Ambulance quality and outcome measures for general non-conveyed populations (AQUA) : A scoping review
- 2024
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In: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 19:8
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Research review (peer-reviewed)abstract
- BACKGROUND: An increasing number of patients receive ambulance care without being conveyed to a definitive care provider. This process has been described as complex, challenging, and lacking in guideline support by EMS clinicians. The use of quality- and outcome measures among non-conveyed patients is an understudied phenomenon.AIM: To identify current quality- and outcome measures for the general population of non-conveyed patients in order to describe major trends and knowledge gaps. METHODS: A scoping review of peer-reviewed original articles was conducted to identify quality- and outcome measures for non-conveyance within emergency medical services. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews statement (PRISMA-ScR) was followed. The PROSPERO and OSF database were checked for pending reviews or protocols. PubMed, CINAHL, Scopus, Web of Science and the Cochrane Library database were searched for relevant articles. Searches were performed in November 2023. RESULTS: Thirty-six studies fulfilled the inclusion criteria and were included in the review. Mortality was the most used outcome measure, reported in 24 (67%) of the articles. Emergency department attendance and hospital admission were the following most used outcome measures. Follow-up durations varied substantially between both measures and studies. Mortality rates were found to have the longest follow-up times, with a median follow-up duration a little bit over one week. CONCLUSIONS: This scoping review shows that studies report a wide range of quality and outcome measures in the ambulance setting to measure non-conveyance. Reported quality and outcome measures were also heterogeneous with regard to their follow-up timeframe. The variety of approaches to evaluate non-conveyance poses challenges for future research and quality improvement. A more uniform approach to reporting and measuring non-conveyance is needed to enable comparisons between contexts and formal meta-analysis.
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| 5. |
- Kaminsky, Elenor, et al.
(author)
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Registered nurses' understandings of emergency medical dispatch center work : A qualitative phenomenographic interview study
- 2021
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In: Nursing and Health Sciences. - : John Wiley & Sons. - 1441-0745 .- 1442-2018. ; 23:2, s. 430-438
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Journal article (peer-reviewed)abstract
- Non-urgent and urgent telephone nursing services are increasing globally, and phenomenographic research has shown that how work is understood may influence work performance. This descriptive study makes a qualitative inductive investigation of understandings of emergency medical dispatch center work among registered nurses. Twenty-four registered nurses at three mid Swedish emergency medical dispatch centers were interviewed. Analysis based on phenomenographic principles identified five categories in the interviews: (i) Assess, prioritize, direct, or refer; (ii) Facilitate ambulance nursing work; (iii) Perform nursing care; (iv) Always be available for the public; and (v) Have the person behind the patient in mind. The first constitutes the basis of the work. The second emphasizes cooperation with and support for the ambulance staff. The third entails remotely providing nursing care, whilst the fourth stresses serving the entire population. The fifth and most comprehensive way of understanding work involves having a holistic view of the person in need, including person-centered care. Provision of high-quality emergency medical dispatch center work involves all categories. Combined, they constitute a "work map," valuable for reflection, competence development, and introduction of new staff.
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| 6. |
- Mohajershojai, Tabassom, et al.
(author)
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Enhanced Therapeutic Effects of 177Lu-DOTA-M5A in Combination with Heat Shock Protein 90 Inhibitor Onalespib in Colorectal Cancer Xenografts
- 2023
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In: Cancers. - : MDPI. - 2072-6694. ; 15:17
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Journal article (peer-reviewed)abstract
- Carcinoembryonic antigen (CEA) has emerged as an attractive target for theranostic applications in colorectal cancers (CRCs). In the present study, the humanized anti-CEA antibody hT84.66-M5A (M5A) was labeled with 177Lu for potential CRC therapy. Moreover, the novel combination of 177Lu-DOTA-M5A with the heat shock protein 90 inhibitor onalespib, suggested to mediate radiosensitizing properties, was assessed in vivo for the first time. M5A antibody uptake and therapeutic effects, alone or in combination with onalespib, were assessed in human CRC xenografts and visualized using SPECT/CT imaging. Although both 177Lu-DOTA-M5A and onalespib monotherapies effectively reduced tumor growth rates, the combination therapy demonstrated the most substantial impact, achieving a fourfold reduction in tumor growth compared to the control group. Median survival increased by 33% compared to 177Lu-DOTA-M5A alone, and tripled compared to control and onalespib groups. Importantly, combination therapy yielded comparable or superior effects to the double dose of 177Lu-DOTA-M5A monotherapy. 177Lu-DOTA-M5A increased apoptotic cell levels, indicating its potential to induce tumor cell death. These findings show promise for 177Lu-DOTA-M5A as a CRC therapeutic agent, and its combination with onalespib could significantly enhance treatment efficacy. Further in vivo studies are warranted to validate these findings fully and explore the treatment’s potential for clinical use.Simple summaryCancer treatment is hampered by the limitations of individual therapy modalities and the intricate nature of the disease. The administration of maximal monotherapy doses often leads to undesirable side effects and/or therapy resistance. As a result, there is a growing recognition of the importance of investigating combination therapy to effectively address these obstacles. In the present in vivo study, the therapeutic effects of combination therapy with the heat shock protein 90 inhibitor onalespib, a potential radiosensitizer, and 177Lu-DOTA-M5A for colorectal cancer (CRC) treatment were explored for the first time. The results demonstrated that the combination treatment was so effective that retained or even superior therapeutic effects could be achieved with only half the dose of administered 177Lu-DOTA-M5A, showing enhanced tumor growth suppression and increased apoptosis. Consequently, the combination therapy involving 177Lu-DOTA-M5A and onalespib constitutes a promising approach for treating metastatic CRCs. By enhancing therapeutic effects, minimizing therapy resistance, and reducing side effects, this approach has the potential to expand the patient population that can benefit from targeted treatment.
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| 7. |
- Mohajershojai, Tabassom, et al.
(author)
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PD-1 blockade enhances therapeutic effects of 177Lu-DOTA-M5A in colorectal cancer CEA-transgenic mice
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Other publication (other academic/artistic)abstract
- Radioimmunotherapy (RIT) is emerging as an effective treatment for metastatic solid tumors by coupling radionuclides with tumor-targeting molecules, precisely directing radiation to cancer cells while sparing healthy tissue. Carcinoembryonic antigen (CEA) is a promising target for RIT in CEA-expressing cancers, including colorectal cancers (CRCs). Recent studies highlight radiotherapy's role in enhancing the immune response against cancer. Combining RIT with immune checkpoint inhibitors, such as anti-PD-1 antibodies, may further enhance anti-tumor immunity and improve outcomes. This study aimed to investigate, for the first time, the in vivo effects of CEA-targeted RIT using the novel humanized anti-CEA antibody hT84.66-M5A labeled with 177Lu (177Lu-DOTA-M5A), combined with PD-1 blockade. Radioconjugate uptake and therapeutic effects were first assessed in vitro using the CRC spheroid model MC38-CEA1. The therapeutic effects of 177Lu-DOTA-M5A and PD-1 blockade were then evaluated alone or in combination in CEA-transgenic mice bearing CEA-transduced CRC xenografts, with radioconjugate uptake validated in biodistribution studies and visualized via SPECT/CT imaging. Dose-dependent therapeutic effects of 177Lu-DOTA-M5A were demonstrated in the 3D spheroid model. In vivo studies showed that both 177Lu-DOTA-M5A and PD-1 antibody monotherapies effectively reduced tumor growth rates compared to the control group, but the combination therapy had the most significant impact. Combination therapy resulted in a dramatic tumor growth inhibition rate of -6% average daily, compared to +7%, +7.9%, and +13.5% in the PD-1 blockade, 177Lu-DOTA-M5A (2.5 MBq), and control groups, respectively. Median survival increased by 31% in the PD-1 blockade group and by 52% in the 177Lu-DOTA-M5A (2.5 MBq) group compared to the control group, while median survival was not reached in the corresponding combination group. Radioconjugate monotherapies and combination therapies did not introduce any bone marrow toxicity. 177Lu-DOTA-M5A slightly altered the immune cell profile in the tumor microenvironment, increasing cytotoxic and helper T cells. Notably, pro-inflammatory macrophages became dominant over tumor-promoting ones in the tumor microenvironment of combination-treated mice. These findings highlight the promise of 177Lu-DOTA-M5A as a CRC therapeutic agent and its enhanced efficacy when combined with an immune checkpoint inhibitor. Further in vivo studies are needed to fully validate these findings and explore the treatment’s potential for clinical use.
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| 8. |
- Mälberg, Johan, et al.
(author)
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Continuous chest compressions are associated with higher peak inspiratory pressures when compared to 30:2 in an experimental cardiac arrest model
- 2023
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In: Intensive Care Medicine Experimental. - : Springer. - 2197-425X. ; 11:1
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Journal article (peer-reviewed)abstract
- BACKGROUND: Ventilation during cardiopulmonary resuscitation (CPR) has long been a part of the standard treatment during cardiac arrests. Ventilation is usually given either during continuous chest compressions (CCC) or during a short pause after every 30 chest compressions (30:2). There is limited knowledge of how ventilation is delivered if it effects the hemodynamics and if it plays a role in the occurrence of lung injuries. The aim of this study was to compare ventilation parameters, hemodynamics, blood gases and lung injuries during experimental CPR given with CCC and 30:2 in a porcine model.METHODS: Sixteen pigs weighing approximately 33 kg were randomized to either receive CPR with CCC or 30:2. Ventricular fibrillation was induced by passing an electrical current through the heart. CPR was started after 3 min and given for 20 min. Chest compressions were provided mechanically with a chest compression device and ventilations were delivered manually with a self-inflating bag and 12 l/min of oxygen. During the experiment, ventilation parameters and hemodynamics were sampled continuously, and arterial blood gases were taken every five minutes. After euthanasia and cessation of CPR, the lungs and heart were removed in block and visually examined followed by sampling of lung tissue which were examined using microscopy.RESULTS: In the CCC group and the 30:2 group, peak inspiratory pressure (PIP) was 58.6 and 35.1 cmH2O (p < 0.001), minute volume (MV) 2189.6 and 1267.1 ml (p < 0.001), peak expired carbon dioxide (PECO2) 28.6 and 39.4 mmHg (p = 0.020), partial pressure of carbon dioxide (PaCO2) 50.2 and 61.1 mmHg (p = 0.013) and pH 7.3 and 7.2 (p = 0.029), respectively. Central venous pressure (CVP) decreased more over time in the 30:2 group (p = 0.023). All lungs were injured, but there were no differences between the groups.CONCLUSIONS: Ventilation during CCC resulted in a higher PIP, MV and pH and lower PECO2 and PaCO2, showing that ventilation mode during CPR can affect ventilation parameters and blood gases.
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| 9. |
- Spangler, Douglas, et al.
(author)
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A validation of machine learning-based risk scores in the prehospital setting
- 2019
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In: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 14:12
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Journal article (peer-reviewed)abstract
- BACKGROUND: The triage of patients in prehospital care is a difficult task, and improved risk assessment tools are needed both at the dispatch center and on the ambulance to differentiate between low- and high-risk patients. This study validates a machine learning-based approach to generating risk scores based on hospital outcomes using routinely collected prehospital data.METHODS: Dispatch, ambulance, and hospital data were collected in one Swedish region from 2016-2017. Dispatch center and ambulance records were used to develop gradient boosting models predicting hospital admission, critical care (defined as admission to an intensive care unit or in-hospital mortality), and two-day mortality. Composite risk scores were generated based on the models and compared to National Early Warning Scores (NEWS) and actual dispatched priorities in a prospectively gathered dataset from 2018.RESULTS: A total of 38203 patients were included from 2016-2018. Concordance indexes (or areas under the receiver operating characteristics curve) for dispatched priorities ranged from 0.51-0.66, while those for NEWS ranged from 0.66-0.85. Concordance ranged from 0.70-0.79 for risk scores based only on dispatch data, and 0.79-0.89 for risk scores including ambulance data. Dispatch data-based risk scores consistently outperformed dispatched priorities in predicting hospital outcomes, while models including ambulance data also consistently outperformed NEWS. Model performance in the prospective test dataset was similar to that found using cross-validation, and calibration was comparable to that of NEWS.CONCLUSIONS: Machine learning-based risk scores outperformed a widely-used rule-based triage algorithm and human prioritization decisions in predicting hospital outcomes. Performance was robust in a prospectively gathered dataset, and scores demonstrated adequate calibration. Future research should explore the robustness of these methods when applied to other settings, establish appropriate outcome measures for use in determining the need for prehospital care, and investigate the clinical impact of interventions based on these methods.
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| 10. |
- Spangler, Douglas, et al.
(author)
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Prehospital identification of Covid-19 : an observational study
- 2021
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In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - : Springer Nature. - 1757-7241. ; 29:1
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Journal article (peer-reviewed)abstract
- BACKGROUND: The novel coronavirus disease 2019 (Covid-19) pandemic has affected prehospital care systems across the world, but the prehospital presentation of affected patients and the extent to which prehospital care providers are able to identify them is not well characterized. In this study, we describe the presentation of Covid-19 patients in a Swedish prehospital care system, and asses the predictive value of Covid-19 suspicion as documented by dispatch and ambulance nurses.METHODS: Data for all patients with dispatch, ambulance, and hospital records between January 1-August 31, 2020 were extracted. A descriptive statistical analysis of patients with and without hospital-confirmed Covid-19 was performed. In a subset of records beginning from April 14, we assessed the sensitivity and specificity of documented Covid-19 suspicion in dispatch and ambulance patient care records.RESULTS: A total of 11,894 prehospital records were included, of which 481 had a primary hospital diagnosis code related to-, or positive test results for Covid-19. Covid-19-positive patients had considerably worse outcomes than patients with negative test results, with 30-day mortality rates of 24% vs 11%, but lower levels of prehospital acuity (e.g. emergent transport rates of 14% vs 22%). About half (46%) of Covid-19-positive patients presented to dispatchers with primary complaints typically associated with Covid-19. Six thousand seven hundred seventy-six records were included in the assessment of predictive value. Sensitivity was 76% (95% CI 71-80) and 82% (78-86) for dispatch and ambulance suspicion respectively, while specificities were 86% (85-87) and 78% (77-79).CONCLUSIONS: While prehospital suspicion was strongly indicative of hospital-confirmed Covid-19, based on the sensitivity identified in this study, prehospital suspicion should not be relied upon as a single factor to rule out the need for isolation precautions. The data provided may be used to develop improved guidelines for identifying Covid-19 patients in the prehospital setting.
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