| 1. |
- Hörberg, Anna, et al.
(author)
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Striving for balance - A qualitative study to explore the experiences of nurses new to the ambulance service in Sweden
- 2017
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In: Nurse Education in Practice. - : Elsevier BV. - 1471-5953 .- 1873-5223. ; 27, s. 63-70
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Journal article (peer-reviewed)abstract
- New nurses and nurses new to a professional practice go through a transition where they adopt a new professional identity. This has been described as a challenging time where peer support and limited responsibility are considered necessary. Little is known about the experience of nurses being new to the ambulance service where support is limited and the nurse holds full responsibility of patient care. The aim of this study has therefore been to explore nurses' experiences during their first year of employment in the Swedish ambulance service. Data was generated from semi-structured interviews with 13 nurses having less than 12 months of experience of work in the ambulance service. The nurses represented nine different districts in Sweden. Analysis was a latent inductive qualitative content analysis. The analysis resulted in the main category, Striving for balance during the transition process in the ambulance context. Transition in the ambulance service was experienced as a balance act between emotions, expectations and a strive for professional development. The balance was negatively affected by harsh, condescending attitudes among colleagues and the lack of structured support and feedback. In striving for balance in their new professional practice, the nurses described personal, unsupervised strategies for professional development.
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| 2. |
- Hörberg, Anna, et al.
(author)
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We need support! A Delphi study about desirable support during the first year in the emergency medical service.
- 2017
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In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - : Springer Science and Business Media LLC. - 1757-7241. ; 25:1
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Journal article (peer-reviewed)abstract
- BACKGROUND: New and inexperienced emergency medical service (EMS) professionals lack important experience. To prevent medical errors and improve retention there is an urgent need to identify ways to support new professionals during their first year in the EMS.METHODS: A purposeful sample and snowball technique was used and generated a panel of 32 registered nurses with 12-48 months of EMS experience. A Delphi technique in four rounds was used. Telephone interviews were undertaken in round one to identify what desirable support professionals new to the EMS desire during their first year. Content analysis of the transcribed interviews yielded items which were developed into a questionnaire. The experts graded each item in terms of perceived importance on a 5-graded likert scale. Consensus level was set at 75%. Items which reached consensus were removed from questionnaires used in subsequent rounds.RESULTS: Desirable support was categorized into eight areas: Support from practical skills exercises, support from theoretical knowledge, support from experiences based knowledge, theoretical support, support from an introduction period, support from colleagues and work environment, support from management and organization and other support. The experts agree on the level of importance on 64 of a total of 70 items regarding desirable support. One item was considered not important, graded 1 or 2, 63 items were considered important, graded 4 or 5.CONCLUSION: Even with extensive formal competence the EMS context poses challenges where a wide variety of desirable forms of support is needed. Support structures should address both personal and professional levels and be EMS context oriented.
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| 3. |
- Ivic, Robert, et al.
(author)
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Soluble urokinase plasminogen activator receptor and lactate as prognostic biomarkers in patients presenting with non-specific chief complaints in the pre-hospital setting - the PRIUS-study
- 2021
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In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - : BioMed Central. - 1757-7241. ; 29:1
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Journal article (peer-reviewed)abstract
- BACKGROUND: Emergency Medical Services (EMS) are faced daily with patients presenting with non-specific chief complaints (NSC). Patients presenting with NSCs often have normal vital signs. It has previously been established that NSCs may have a serious underlying condition that has yet to be identified. The aim of the current study was to determine if soluble urokinase plasminogen activator receptor (suPAR) and lactate could be used to identify serious conditions among patients presenting with NSCs to the EMS. The secondary aim was to describe the prognostic value for mortality in the group.METHOD: A blinded prospective observational cohort study was conducted of patients brought to the ED by ambulance after calling the national emergency number 112 and who were assessed as having NSC by the EMS. Biomarkers were measured during index EMS assessment before transportation to the ED. Patients were followed via EMS and hospital electronic health records. Descriptive and logistic regression analyses were used.RESULTS: A total of 414 patients were included, with a median age of 82 years. A serious condition was present in 15.2% of the patients. Elevated suPAR above 3 ng/ml had a positive likelihood ratio (LR+) of 1.17 and a positive predictive value (PPV) of 17.3% as being predictive of a prevalent serious condition. Elevated suPAR above 9 ng/ml had LR+ 4.67 and a PPV of 16.7% as being predictive of 30-day mortality. Lactate was not significantly predictive.CONCLUSION: Pre-hospital suPAR and lactate cannot differentiate serious conditions in need of urgent treatment and assessment in the ED among patients presenting with non-specific chief complaints. suPAR has shown to be predictive of 30-day mortality, which could add some value to the clinical assessment.TRIAL REGISTRATION: NCT03089359. Registered 20 March 2017, retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03089359 .
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| 4. |
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| 5. |
- Sjölin, Helena, 1951-, et al.
(author)
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Prehospital emergency nurses' experiences of care in critical incidents
- 2020
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In: International Emergency Nursing. - : Elsevier. - 1755-599X .- 1878-013X. ; 51
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Journal article (peer-reviewed)abstract
- INTRODUCTION: The ambulance care setting is complex and unpredictable and the personnel must prepare for upcoming assignments. Prehospital emergency care nurses (PENs), are frequently exposed to critical incidents (CIs). There are, to our knowledge, no prior studies describing experiences of requirements for management of caring for a patient during a CI in the ambulance care context. Therefore, the aim of the study was to explore PENs' experiences of care in CIs.METHOD: A qualitative research design with content analysis has been used, based on semi-structured interviews with eleven PENs in Sweden.RESULTS: PENs' experiences can be described as: "In a critical incident, personal ability based on experiential knowledge is central to patient care". Three generic categories underpinned the main category: "Clinical expertise", "Professional approach" and "Broad knowledge base".CONCLUSIONS: The care given during a CI in the ambulance care setting depends on PENs' personal ability based on experiential knowledge. Employers need to build an organization providing prerequisites and support during an CI. Suggested activities are to create forums for PENs to share experiences with each other, possibility to get feedback on completed assignments and continued training to develop new knowledge and be prepared for the unpredictable environment that characterizes CI.
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| 6. |
- Wireklint Sundström, Birgitta, Ass professor, 1951-, et al.
(author)
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Caring science research in the ambulance services : an integrative systematic review
- 2019
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In: Scandinavian Journal of Caring Sciences. - : John Wiley & Sons. - 0283-9318 .- 1471-6712. ; 33:1, s. 3-33
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Research review (peer-reviewed)abstract
- BackgroundThe ambulance services are associated with emergency medicine, traumatology and disaster medicine, which is also reflected in previous research. Caring science research is limited and, since no systematic reviews have yet been produced, its focus is unclear. This makes it difficult for researchers to identify current knowledge gaps and clinicians to implement research findings.AimThis integrative systematic review aims to describe caring science research content and scope in the ambulance services.Data sourcesDatabases included were MEDLINE (PubMed), CINAHL, Web of Science, ProQDiss, LibrisDiss and The Cochrane Library. The electronic search strategy was carried out between March and April 2015. The review was conducted in line with the standards of the PRISMA statement, registration number: PROSPERO 2016:CRD42016034156.Review methodsThe review process involved problem identification, literature search, data evaluation, data analysis and reporting. Thematic data analysis was undertaken using a five‐stage method. Studies included were evaluated with methodological and/or theoretical rigour on a 3‐level scale, and data relevance was evaluated on a 2‐level scale.ResultsAfter the screening process, a total of 78 studies were included. The majority of these were conducted in Sweden (n = 42), fourteen in the United States and eleven in the United Kingdom. The number of study participants varied, from a case study with one participant to a survey with 2420 participants, and 28 (36%) of the studies were directly related to patients. The findings were identified under the themes: Caregiving in unpredictable situations; Independent and shared decision‐making; Public environment and patient safety; Life‐changing situations; and Ethics and values.ConclusionCaring science research with an explicit patient perspective is limited. Areas of particular interest for future research are the impact of unpredictable encounters on openness and sensitivity in the professional–patient relation, with special focus on value conflicts in emergency situations.
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| 7. |
- Anney, Richard, et al.
(author)
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A genome-wide scan for common alleles affecting risk for autism.
- 2010
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In: Human Molecular Genetics. - : Oxford University Press (OUP). - 0964-6906 .- 1460-2083. ; 19:20, s. 4072-4082
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Journal article (peer-reviewed)abstract
- Although autism spectrum disorders (ASDs) have a substantial genetic basis, most of the known genetic risk has been traced to rare variants, principally copy number variants (CNVs). To identify common risk variation, the Autism Genome Project (AGP) Consortium genotyped 1558 rigorously defined ASD families for 1 million single-nucleotide polymorphisms (SNPs) and analyzed these SNP genotypes for association with ASD. In one of four primary association analyses, the association signal for marker rs4141463, located within MACROD2, crossed the genome-wide association significance threshold of P < 5 × 10(-8). When a smaller replication sample was analyzed, the risk allele at rs4141463 was again over-transmitted; yet, consistent with the winner's curse, its effect size in the replication sample was much smaller; and, for the combined samples, the association signal barely fell below the P < 5 × 10(-8) threshold. Exploratory analyses of phenotypic subtypes yielded no significant associations after correction for multiple testing. They did, however, yield strong signals within several genes, KIAA0564, PLD5, POU6F2, ST8SIA2 and TAF1C.
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| 8. |
- Anney, Richard, et al.
(author)
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Individual common variants exert weak effects on the risk for autism spectrum disorders.
- 2012
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In: Human Molecular Genetics. - : Oxford University Press (OUP). - 0964-6906 .- 1460-2083. ; 21:21, s. 4781-92
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Journal article (peer-reviewed)abstract
- While it is apparent that rare variation can play an important role in the genetic architecture of autism spectrum disorders (ASD), the contribution of common variation to ASD risk is less clear. To produce a more comprehensive picture, we report Stage 2 of the Autism Genome Project genome-wide association study, adding 1301 ASD families and bringing the total to 2705 families analysed (Stages 1 and 2). In addition to evaluating association of individual SNPs, we also sought evidence that common variants, en masse, might affect risk. Despite genotyping over a million SNPs covering the genome, no single SNP shows significant association with ASD or selected phenotypes at a genome-wide level. The SNP that achieves the smallest p-value from secondary analyses is rs1718101. It falls in CNTNAP2, a gene previously implicated in susceptibility for ASD. This SNP also shows modest association with age of word/phrase acquisition in ASD subjects, of interest because features of language development are also associated with other variation in CNTNAP2. By contrast, allele-scores derived from the transmission of common alleles to Stage 1 cases significantly predict case-status in the independent Stage 2 sample. Despite being significant, the variance explained by these allele scores was small (Vm< 1%). Based on results from individual SNPs and their en masse effect on risk, as inferred from the allele-score results, it is reasonable to conclude that common variants affect ASD risk but their individual effects are modest.
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| 9. |
- Börjesson, Annica, et al.
(author)
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Lived experiences of closeness to a person using Anabolic androgenic steroids a next of kin perspective
- 2023
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In: International Journal of Qualitative Studies on Health and Well-being. - 1748-2623 .- 1748-2631. ; 19:1
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Journal article (peer-reviewed)abstract
- Purpose: Anabolic androgenic steroids (AAS) are used for their aesthetic and performance-enhancing effects and are associated with physical and psychological side effects. Behavioural changes/side effects as mood swings, aggressiveness, depression, potency problems, anxiety, and emotional coldness have been reported by next of kin to people using AAS.Methods: This phenomenological study is based on the reflective lifeworld research approach. Interviews were conducted with twelve next of kin about their experiences of living close to persons using AAS.Results: Next of kin to persons using AAS are particularly vulnerable because they experience little opportunity to influence their situation. Their given and safe context is lost, and their lives are circumscribed by feelings of insecurity, fear, powerlessness, and grief. Feelings of loneliness develop when their problems are not noticed by others and support is lacking from family and society.Conclusions: Our research adds important knowledge on how the use of AAS affects next of kin. Understanding is required to approach the lifeworld of next of kin with flexibility and empathy in their difficulties and vulnerability. Healthcare professionals and other concerned professions need to be aware of next of kin existential needs to be able to meet and support them in their life situation.
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| 10. |
- Börjesson, Annica, et al.
(author)
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Women's Experiences of Using Anabolic Androgenic Steroids
- 2021
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In: Frontiers in Sports and Active Living. - : Frontiers Media SA. - 2624-9367. ; 3
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Journal article (peer-reviewed)abstract
- Anabolic androgenic steroids are used by women to increase their muscle mass and because of their performance-enhancing effects. Despite permanent/high risk of side effects, knowledge is inadequate. Our aim has been to deepen understanding about women's use of anabolic androgenic steroids. This phenomenological study is based on the reflective lifeworld research (RLR) approach. Lifeworld interviews were conducted with 12 women, aged 21-56 years, about their experiences of using anabolic steroids. The results show that women experience a sense of pride when they successfully achieve their goals. This is the driving force, triggering tension between suffering and success. Our research adds important knowledge from a reflective lifeworld perspective and shows that women's use of anabolic androgenic steroids is a complex phenomenon. Understanding and knowledge are important in order to be able to meet and support women in their fears and difficulties.
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| 11. |
- Casey, Jillian P, et al.
(author)
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A novel approach of homozygous haplotype sharing identifies candidate genes in autism spectrum disorder.
- 2012
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In: Human Genetics. - : Springer Science and Business Media LLC. - 0340-6717 .- 1432-1203. ; 131:4, s. 565-579
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Journal article (peer-reviewed)abstract
- Autism spectrum disorder (ASD) is a highly heritable disorder of complex and heterogeneous aetiology. It is primarily characterized by altered cognitive ability including impaired language and communication skills and fundamental deficits in social reciprocity. Despite some notable successes in neuropsychiatric genetics, overall, the high heritability of ASD (~90%) remains poorly explained by common genetic risk variants. However, recent studies suggest that rare genomic variation, in particular copy number variation, may account for a significant proportion of the genetic basis of ASD. We present a large scale analysis to identify candidate genes which may contain low-frequency recessive variation contributing to ASD while taking into account the potential contribution of population differences to the genetic heterogeneity of ASD. Our strategy, homozygous haplotype (HH) mapping, aims to detect homozygous segments of identical haplotype structure that are shared at a higher frequency amongst ASD patients compared to parental controls. The analysis was performed on 1,402 Autism Genome Project trios genotyped for 1 million single nucleotide polymorphisms (SNPs). We identified 25 known and 1,218 novel ASD candidate genes in the discovery analysis including CADM2, ABHD14A, CHRFAM7A, GRIK2, GRM3, EPHA3, FGF10, KCND2, PDZK1, IMMP2L and FOXP2. Furthermore, 10 of the previously reported ASD genes and 300 of the novel candidates identified in the discovery analysis were replicated in an independent sample of 1,182 trios. Our results demonstrate that regions of HH are significantly enriched for previously reported ASD candidate genes and the observed association is independent of gene size (odds ratio 2.10). Our findings highlight the applicability of HH mapping in complex disorders such as ASD and offer an alternative approach to the analysis of genome-wide association data.
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| 12. |
- Frank, Jens, et al.
(author)
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Human behaviour can trigger large carnivore attacks in developed countries
- 2016
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In: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 6
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Journal article (peer-reviewed)abstract
- The media and scientific literature are increasingly reporting an escalation of large carnivore attacks on humans in North America and Europe. Although rare compared to human fatalities by other wildlife, the media often overplay large carnivore attacks on humans, causing increased fear and negative attitudes towards coexisting with and conserving these species. Although large carnivore populations are generally increasing in developed countries, increased numbers are not solely responsible for the observed rise in the number of attacks by large carnivores. Here we show that an increasing number of people are involved in outdoor activities and, when doing so, some people engage in risk-enhancing behaviour that can increase the probability of a risky encounter and a potential attack. About half of the well-documented reported attacks have involved risk-enhancing human behaviours, the most common of which is leaving children unattended. Our study provides unique insight into the causes, and as a result the prevention, of large carnivore attacks on people. Prevention and information that can encourage appropriate human behaviour when sharing the landscape with large carnivores are of paramount importance to reduce both potentially fatal human-carnivore encounters and their consequences to large carnivores.
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| 13. |
- Ivic, Robert, et al.
(author)
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Serious conditions among patients with non-specific chief complaints in the pre-hospital setting : a retrospective cohort study
- 2020
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In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - : BMC. - 1757-7241. ; 28:1
-
Journal article (peer-reviewed)abstract
- Background: Emergency Medical Services (EMS) are faced daily with patients presenting with a non-specific chief complaints (NSC); i.e. decreased general condition, general malaise, sense of illness, or just being unable to cope with usual daily activities. Patients presenting with NSCs often have normal vital signs. It has previously been established that however, NSCs may have a serious underlying condition that has yet to be identified. The primary outcome of this study was to determine the prevalence of serious conditions in patients presenting with NSCs to the EMS.Method: A retrospective cohort study of patients >= 18 years of age who were reported as presenting with chief complaints compatible with NSCs to the EMS in Stockholm Region and transported to an emergency department between January 1st, 2013 and December 31st, 2013. Patients were identified via the EMS electronic health care record and followed via records from the National Patient Registry and Causes of Death Registry at Sweden's National Board for Health and Welfare. The definition of serious condition was defined by expert consensus. Descriptive statistics as well as regression analyses were used.Results: A total of 3780 patients were included, with a median age of 77 years. A serious condition was present in 35.3% of the patients. The in-hospital mortality rate for the group with serious conditions was 10.1% (OR 6.8, CI 95%, 4.1-11.3), and the 30-day mortality rate was 20.2% (OR 3.1, CI 95%, 2.3-4.0). In the group with no serious conditions the rates were 1.0 and 4.2%, respectively. The total hospitalization rate was 67.6%. The presence of serious conditions as well as increased mortality rates were associated with Rapid Emergency Triage and Treatment system (RETTS) as well as National Early Warning Score (NEWS) irrespective of triage score.Conclusion: More than one-third of the patients presenting with NSCs to EMS had a serious underlying condition which was associated with increased mortality and hospitalization rates.
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| 14. |
- Karmelić, Ema, et al.
(author)
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Decision-making on the fly : a qualitative study of physicians in out-of-hospital emergency medical services
- 2023
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In: BMC Emergency Medicine. - London : BioMed Central (BMC). - 1471-227X. ; 23
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Journal article (peer-reviewed)abstract
- Background: Out-of-hospital Emergency Medical Services (OHEMS) require fast and accurate assessment of patients and efficient clinical judgment in the face of uncertainty and ambiguity. Guidelines and protocols can support staff in these situations, but there is significant variability in their use. Therefore, the aim of this study was to increase our understanding of physician decision-making in OHEMS, in particular, to characterize the types of decisions made and to explore potential facilitating and hindering factors. Methods: Qualitative interview study of 21 physicians in a large, publicly-owned and operated OHEMS in Croatia. Data was subjected to an inductive content analysis. Results: Physicians (mostly young, female, and early in their career), made three decisions (transport, treat, and if yes on either, how) after an initial patient assessment. Decisions were influenced by patient needs, but to a greater extent by factors related to themselves and patients (microsystem), their organization (mesosystem), and the larger health system (macrosystem). This generated a high variability in quality and outcomes. Participants desired support through further training, improved guidelines, formalized feedback, supportive management, and health system process redesign to better coordinate and align care across organizational boundaries. Conclusions: The three decisions were made complex by contextual factors that largely lay outside physician control at the mesosystem level. However, physicians still took personal responsibility for concerns more suitably addressed at the organizational level. This negatively impacted care quality and staff well-being. If managers instead adopt a learning orientation, the path from novice to expert physician could be more ably supported through organizational demands and practices aligned with real-world practice. Questions remain on how managers can better support the learning needed to improve quality, safety, and physicians’ journey from novice to expert. © 2023, The Author(s).
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| 15. |
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| 16. |
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| 17. |
- Perez-Recio, Sandra, et al.
(author)
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Identification of Recent Tuberculosis Exposure Using QuantiFERON-TB Gold Plus, a Multicenter Study
- 2021
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In: Microbiology Spectrum. - : American Society for Microbiology. - 2165-0497. ; 9:3
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Journal article (peer-reviewed)abstract
- We investigated whether the difference of antigen tube 2 (TB2) minus antigen tube 1 (TB1) (TB22TB1) of the QuantiFERON-TB gold plus test, which has been postulated as a surrogate for the CD81 T-cell response, could be useful in identifying recent tuberculosis (TB) exposure. We looked at the interferon gamma (IFN-g) responses and differences in TB2 and TB1 tubes for 686 adults with QFT-plus positive test results. These results were compared among groups with high (368 TB contacts), low (229 patients with immune-mediated inflammatory diseases [IMID]), and indeterminate (89 asylum seekers or people from abroad [ASPFA]) risks of recent TB exposure. A TB2-TB1 value.0.6 IU.ml(-1) was deemed to indicate a true difference between tubes. In the whole cohort, 13.6%, 10.9%, and 11.2% of cases had a TB2>TB1 result in the contact, IMID, and ASPFA groups, respectively (P = 0.591). The adjusted odds ratios (aORs) for an association between a TB2-TB1 result of >0.6 IU.ml(-1) and risk of recent exposure versus contacts were 0.71 (95% confidence interval [CI], 0.31 to 1.61) for the IMID group and 0.86 (95% CI, 0.49 to 1.52) for the ASPFA group. In TB contact subgroups, 11.4%, 15.4%, and 17.7% with close, frequent, and sporadic contact had a TB2>TB1 result (P = 0.362). The aORs versus the close subgroup were 1.29 (95% CI, 0.63 to 2.62) for the frequent subgroup and 1.55 (95% CI, 0.67 to 3.60) for the sporadic subgroup. A TB2-TB1 difference of.0.6 IU.ml(-1) was not associated with increased risk of recent TB exposure, which puts into question the clinical potential as a proxy marker for recently acquired TB infection. IMPORTANCE Contact tuberculosis tracing is essential to identify recently infected people, who therefore merit preventive treatment. However, there are no diagnostic tests that can determine whether the infection is a result of a recent exposure or not. It has been suggested that by using the QuantiFERON-TB gold plus, an interferon gamma (IFN-gamma) release assay, a difference in IFN-gamma production between the two antigen tubes (TB2 minus TB1) of.0.6 IU.ml(-1) could serve as a proxy marker for recent infection. In this large multinational study, infected individuals could not be classified according to the risk of recent exposure based on differences in IFN- g in TB1 and TB2 tubes that were higher than 0.6 IU.ml(-1). QuantiFERON-TB gold plus is not able to distinguish between recent and remotely acquired tuberculosis infection, and it should not be used for that purpose in contact tuberculosis tracing.
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| 18. |
- Pinto, Dalila, et al.
(author)
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Convergence of Genes and Cellular Pathways Dysregulated in Autism Spectrum Disorders.
- 2014
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In: American journal of human genetics. - : Elsevier BV. - 1537-6605 .- 0002-9297. ; 94:5, s. 677-694
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Journal article (peer-reviewed)abstract
- Rare copy-number variation (CNV) is an important source of risk for autism spectrum disorders (ASDs). We analyzed 2,446 ASD-affected families and confirmed an excess of genic deletions and duplications in affected versus control groups (1.41-fold, p = 1.0× 10(-5)) and an increase in affected subjects carrying exonic pathogenic CNVs overlapping known loci associated with dominant or X-linked ASD and intellectual disability (odds ratio = 12.62, p = 2.7× 10(-15), ∼3% of ASD subjects). Pathogenic CNVs, often showing variable expressivity, included rare de novo and inherited events at 36 loci, implicating ASD-associated genes (CHD2, HDAC4, and GDI1) previously linked to other neurodevelopmental disorders, as well as other genes such as SETD5, MIR137, and HDAC9. Consistent with hypothesized gender-specific modulators, females with ASD were more likely to have highly penetrant CNVs (p = 0.017) and were also overrepresented among subjects with fragile X syndrome protein targets (p = 0.02). Genes affected by de novo CNVs and/or loss-of-function single-nucleotide variants converged on networks related to neuronal signaling and development, synapse function, and chromatin regulation.
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| 19. |
- Pinto, Dalila, et al.
(author)
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Functional impact of global rare copy number variation in autism spectrum disorders.
- 2010
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In: Nature. - : Springer Science and Business Media LLC. - 0028-0836 .- 1476-4687. ; 466:7304, s. 368-372
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Journal article (peer-reviewed)abstract
- The autism spectrum disorders (ASDs) are a group of conditions characterized by impairments in reciprocal social interaction and communication, and the presence of restricted and repetitive behaviours. Individuals with an ASD vary greatly in cognitive development, which can range from above average to intellectual disability. Although ASDs are known to be highly heritable ( approximately 90%), the underlying genetic determinants are still largely unknown. Here we analysed the genome-wide characteristics of rare (<1% frequency) copy number variation in ASD using dense genotyping arrays. When comparing 996 ASD individuals of European ancestry to 1,287 matched controls, cases were found to carry a higher global burden of rare, genic copy number variants (CNVs) (1.19 fold, P = 0.012), especially so for loci previously implicated in either ASD and/or intellectual disability (1.69 fold, P = 3.4 x 10(-4)). Among the CNVs there were numerous de novo and inherited events, sometimes in combination in a given family, implicating many novel ASD genes such as SHANK2, SYNGAP1, DLGAP2 and the X-linked DDX53-PTCHD1 locus. We also discovered an enrichment of CNVs disrupting functional gene sets involved in cellular proliferation, projection and motility, and GTPase/Ras signalling. Our results reveal many new genetic and functional targets in ASD that may lead to final connected pathways.
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| 20. |
- Strålin, Kristoffer, et al.
(author)
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Design of a national patient-centred clinical pathway for sepsis in Sweden
- 2023
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In: Infectious Diseases. - : Taylor & Francis. - 2374-4235 .- 2374-4243. ; 55:10, s. 716-724
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Journal article (peer-reviewed)abstract
- BACKGROUND: The World Health Organization has adopted a resolution on sepsis and urged member states to develop national processes to improve sepsis care. In Sweden, sepsis was selected as one of the ten first diagnoses to be addressed, when the Swedish government in 2019 allocated funds for patient-centred clinical pathways in healthcare. A national multidisciplinary working group, including a patient representative, was appointed to develop the patient-centred clinical pathway for sepsis.METHODS: The working group mapped challenges and needs surrounding sepsis care and included a survey sent to all emergency departments (ED) in Sweden, and then designed a patient-centred clinical pathway for sepsis.RESULTS: The working group decided to focus on the following four areas: (1) sepsis alert for early detection and management optimisation for the most severely ill sepsis patients in the ED; (2) accurate sepsis diagnosis coding; (3) structured information to patients at discharge after sepsis care and (4) structured telephone follow-up after sepsis care. A health-economic analysis indicated that the implementation of the clinical pathway for sepsis will most likely not drive costs. An important aspect of the clinical pathway is implementing continuous monitoring of performance and process indicators. A national working group is currently building up such a system for monitoring, focusing on extraction of this information from the electronic health records systems.CONCLUSION: A national patient-centred clinical pathway for sepsis has been developed and is currently being implemented in Swedish healthcare. We believe that the clinical pathway and the accompanying monitoring will provide a more efficient and equal sepsis care and improved possibilities to monitor and further develop sepsis care in Sweden.
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| 21. |
- Valdés, Alberto, et al.
(author)
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Shotgun proteomic analysis to study the decrease of xenograft tumor growth after rosemary extract treatment
- 2017
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In: Journal of Chromatography A. - : Elsevier BV. - 0021-9673 .- 1873-3778. ; 1499, s. 90-100
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Journal article (peer-reviewed)abstract
- The antiproliferative activity of Rosemary (Rosmarinus officinalis) has been widely studied in different in vitro and in vivo models, which demonstrate that rosemary extracts inhibit the cellular proliferation due to its ability to interact with a wide spectrum of molecular targets. However, a comprehensive proteomics study in vivo has not been carried out yet. In the present work, the effects of rosemary extract on xenograft tumor growth has been studied and, for the first time, a shotgun proteomic analysis based on nano-LC-MS/MS together with stable isotope dimethyl labeling (DML) has been applied to investigate the global protein changes in vivo. Our results show that the daily administration of a polyphenol-enriched rosemary extract reduces the progression of colorectal cancer in vivo with the subsequent deregulation of 74 proteins. The bioinformatic analysis of these proteins indicates that the rosemary extract mainly alters the RNA Post-Transcriptional Modification, the Protein Synthesis and the Amino Acid Metabolism functions and suggests the inactivation of the oncogene MYC. These results demonstrate the high utility of the proposed analytical methodology to determine, simultaneously, the expression levels of a large number of protein biomarkers and to generate new hypothesis about the molecular mechanisms of this extract in vivo.
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| 22. |
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| 23. |
- Vicente, Veronica, et al.
(author)
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Developing a decision support system for geriatric patients in prehospital care.
- 2013
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In: European journal of emergency medicine. - : Lippincott Williams & Wilkins, Ltd.. - 0969-9546 .- 1473-5695. ; 20:4, s. 240-247
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Journal article (peer-reviewed)abstract
- Objectives To develop a feasible and safe prehospital decision support system (DSS) for the emergency medical services (EMS), facilitating safe steering of geriatric patients to an optimal level of healthcare. Methods The development process involves four consecutive steps. The first step was gathering data from patients transported by EMS, with the electronic patient care record, to retrospectively identify appropriate patient categories for steering. The second step was to allow a group of medical experts to give advice and suggestions for further development of the DSS. The third step was validation of the decision support tool and the fourth step was validation of the entire prehospital DSS in a pilot study. Results The patient categories relevant to steering were those medical conditions that the geriatric clinicians felt confident in receiving from the EMS. A prehospital DSS was then developed for these 11 medical conditions. The evaluation and validation of the DSS showed a high degree of compliance with the patients’ final level of healthcare. The pilot study included 110 randomized patients; 33.9% were triaged to an alternative level of healthcare, that is geriatric care or primary care. No medical inaccuracies or secondary transports from alternative care to the hospital emergency department were identified. Conclusion Using this prehospital DSS – developed for 11 medical conditions – the Swedish prehospital nurse can safely decide on the level of healthcare to which an elderly patient can be steered. Keywords: ambulance, assessment, emergency medical service, geriatrics, prehospital nurse, triage
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| 24. |
- Vicente, Veronica, et al.
(author)
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Differentiating frailty in older people using the Swedish ambulance service : A retrospective audit
- 2012
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In: International Emergency Nursing. - : Elsevier Ltd. - 1755-599X .- 1878-013X. ; 20:4, s. 228-235
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Journal article (peer-reviewed)abstract
- The elderly population in Sweden is increasing. This will lead to an increased need for healthcare resources and put extra demands on healthcare professionals. Consequently, ambulance personnel will be faced with the challenge of meeting extra demands from increasing numbers of older people with complex and atypical clinical presentations. Therefore we highlight that great problems exist for ambulance personnel to understand and meet these patients’ care needs. Using a caring science approach, we apply the patient’s perspective, and the aim of this study is to identify and illuminate the conditions that affect elderly people assessed with the assessment category “general affected health condition”. Thus, we have analyzed the characteristics belonging to this specific condition. The method is a retrospective audit, involving a qualitative content analysis of a total of 88 emergency service records. The conclusion is that by using caring science, the concept of frailty which is based on a comprehensive understanding of human life can clarify the state of “general affected health condition”, as either illness or ill-health. This offers a new assessment category and outlines care and treatment that strengthen and support the health and wellbeing of the individual elderly person. Furthermore, the concept of frailty ought to be included in “The International Statistical Classification of Diseases and Related Health Problems” (ICD-10).
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| 25. |
- Vicente, Veronica, et al.
(author)
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Experience of using video support by prehospital emergency care physician in ambulance care - an interview study with prehospital emergency nurses in Sweden
- 2021
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In: BMC Emergency Medicine. - : Springer Science and Business Media LLC. - 1471-227X. ; 21:1
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Journal article (peer-reviewed)abstract
- Introduction: When in need of emergency care and ambulance services, the ambulance nurse is often the first point of contact for the patient with healthcare. This role requires comprehensive knowledge of the ambulance nurse to be able to assign the right level of care and, if necessary, to provide self-care advice for patients with no further conveyance to hospital. Recently, an application was developed for transmitting real-time video to facilitate consultation between ambulance nurses and prehospital physicians in the role of regional medical support (RMS) for ambulance care. The use of video communication as a complement of medical support when referring to self-care is still an unexplored method in a prehospital setting. Our study aimed to elucidate ambulance nurses’ experience of video consultation with RMS physician during the assessment of patients considered to be triaged to self-care. Method: We conducted a qualitative design study using semi-structured interviews with open questions. Twelve ambulance nurses were included in the study. To explore the ambulance nurses’ experience of performing video consultation with RMS physician, in cases when a patient was assessed and triaged to self-care, a content analysis was performed. Results: A main category emerged from the results: “ Video consultation as decision support in the ambulance care promotes increased patient participation and for the ambulance nurses, it creates a feeling of increased patient safety “. The main category was based and formed on the following categories: “ Simultaneous presence of ambulance nurse and a physician increases patient participation during the assessment resulting in a confident care decision “. “Interprofessional collaboration strengthens the medical assessment”. “Video technology promotes accessibility for patients needs in the ambulance care regardless of emergency level”. Conclusions: Ambulance nurses experienced that the use of video consultation increases patient involvement and confidence in healthcare when both the ambulance nurse and the physician were present when deciding on self-care advice. The live imaging allowed the ambulance nurse and prehospital physician to reach a consensus on the patient’s current medical care needs, which in turn led to a feeling of increased patient safety for the ambulance nurses.
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| 26. |
- Vicente, Veronica, et al.
(author)
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Nurse’s experiences of the caring encounter as single responder in prehospital emergency care
- 2021
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In: International Emergency Nursing. - : Elsevier. - 1755-599X .- 1878-013X. ; 58
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Journal article (peer-reviewed)abstract
- Background: In the Swedish emergency medical services, single responder and assessment units have beenimplemented to meet the increasing need for ambulance assessment and care.Aim: To describe registered nurseś experiences of care encounters as single responders in the emergency medicalservices.Method: The study design was descriptive with a qualitative approach. Semi-structured interviews with eightsingle responders were used together with inductive content analysis.Results: From the theme which showed the experiences of being a single responder in the caring encounter in theambulance care “meeting unique human care needs with conscious caution”, three categories emerged: Increasedrisk-awareness, Lack of resource support creates vulnerability and Professional experiences and personal qual-ities contribute to patient safety.Conclusion: The single responders was aware of their vulnerability and a consistent theme was “caution”. Riskassessments had evolved and were constantly present to maintain their own and the patient’s safety. In criticalpatients, the experience of frustration and insufficiency dominated but at the same time there was a sense ofmeaningfulness. The main experience among all single responders was the feeling of getting close to the patientand responding to them in their own way.
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| 27. |
- Vicente, Veronica, et al.
(author)
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Prehospital Emergency Nurses' coping strategies associated to traumatic experiences
- 2021
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In: International Emergency Nursing. - : Elsevier. - 1755-599X .- 1878-013X. ; 59:November
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Journal article (peer-reviewed)abstract
- BackgroundPrehospital care constitutes a work environment in which Prehospital Emergency Nurses (PENs) are exposed to traumatic situations that can lead to stress and increase their vulnerability to stress reactions. PENs' coping strategies after traumatic experiences have been little explored, which suggests that an investigation leading to a deeper understanding of their coping strategies is needed.AimTo investigate and describe PENs' coping strategies after traumatic experiences.MethodA descriptive, inductive design with a qualitative research approach was used. Semi-structured interviews were analysed using Graneheim and Lundman's method of content analysis. Twelve PENs were interviewed.ResultsThe main theme that emerged was: "a professional approach supports coping strategies for traumatic experiences". Being unprepared increases the feeling of vulnerability when facing a traumatic event, even though PENs acknowledge that traumatic events are unavoidable in their profession. Previous experiences and mental preparation help PENs to keep focused. To be able to act professionally, PENs distance themselves, thus acquiring a sense of control. Inter-professional teamwork can reduce the sense of aloneness.ConclusionPENs' coping involves several strategies. Their own processing and understanding of an experience are crucial for the management of their own feelings, also affecting the care that PENs can offer the next patient. This study emphasises that a professional approach is the strongest coping strategy after traumatic events.
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| 28. |
- Vicente, Veronica, et al.
(author)
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Randomized Controlled Trial of a Prehospital Decision System by Emergency Medical Services to Ensure Optimal Treatment for Older Adults in Sweden
- 2014
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In: Journal of The American Geriatrics Society. - : Wiley. - 0002-8614 .- 1532-5415. ; 62:7, s. 1281-1287
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Journal article (peer-reviewed)abstract
- OBJECTIVES: Evaluate the safety and feasibility of a prehospital system (“system”) and a support tool (“tool”) that allow the ambulance nurse to transport geriatric patients, depending on their medical needs, directly to a geriatric ward (GW), to a community emergency care centre (CECC) at a community-based hospital (CH) or to an emergency department (ED). DESIGN: Randomised controlled trial. SETTING: The Emergency Medical Services in Stockholm, Sweden. PARTICIPANTS: 806 geriatric patients who had rung the emergency telephone number 112 were randomised into an intervention group [n=410] and a control group [n=396]. INTERVENTION: The patients were randomised by the dispatcher either to an ambulance that could steer geriatric patients to alternative destinations instead of the ED, depending on the patient’s medical needs (intervention), or to an ambulance that transported all patients to the ED (control). MEASUREMENTS: The primary endpoint; number of patients steered directly to the community-based hospital [effect] i.e. the GW or CECC. The secondary endpoint; number of subsequent transfers [safety] from the CH to the ED within 24 hours after initial admittance. RESULTS: Twenty percent, 90 patients out of 449, [Confidence interval (Cl) 16.6-24.0] could be steered directly to the CH with the help of the prehospital “system” and 6.7%, 6 patients out of 90, [Cl 3.1-13.8] requested subsequent transfer from the GW or CECC to the ED. CONCLUSION: Ambulance nurses could safely and effectively steer geriatric patients to an alternative healthcare facility with the help of a prehospital decision support system and an associated decision support tool. This new system in Stockholm is a better and more effective way of using the under-dimensioned emergency care resources. It is also better for the geriatric patients. Key words: Emergency medical service; Triage; Geriatric patients.
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| 29. |
- Vicente, Veronica, et al.
(author)
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The Experience of Using Video Support in Ambulance Care : An Interview Study with Physicians in the Role of Regional Medical Support
- 2020
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In: Healthcare. - : MDPI AG. - 2227-9032. ; 8:2, s. 1-9
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Journal article (peer-reviewed)abstract
- Background: In order to facilitate more effective patient assessment and diagnostic support by improving the flow of information between ambulance nurses (AN) and physicians in the role of regional medical support (RMS), an application was developed for transmitting real-time video images. Objective: The objective of this study was to elucidate the physicians' experiences using a video application to support the assessment and triage procedure in ambulance care, when patients are deemed to not have an urgent need for emergency care. Design: The design for this research was a qualitative interview study. Ten physicians, working as RMS in ambulance care, were purposively selected to participate. The telemedicine concept studied consisted of a real-time video image application, in addition to the currently used mobile phone. When a patient was deemed eligible for inclusion in the study, the ambulance nurse (AN) contacted the RMS via telephone to initiate a video consultation. To elucidate the RMS experience of using the application, a conventional content analysis was performed. Results: The main theme "a feeling of being satisfied through a sense of increased patient safety" emerged from the following two categories: adds value in diagnosing situations (three subcategories, i.e., support in diagnosing, usability, and technical weakness) and increase communication opportunities (four subcategories, i.e., assessing the level of care, patient dialogue, professional communication, and team learning). Conclusions: Physicians in the role of RMS experienced a positive impact using video image transmission in addition to the currently used mobile phone. This evaluation was derived from a sense of increased patient safety in the assessment situation when patients were considered to be triaged to self-care.
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| 30. |
- Vicente, Veronica
(author)
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The use of a prehospital decision system in the emergency medical service : the acute chain for geriatric patients
- 2013
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Doctoral thesis (other academic/artistic)abstract
- Background: The objective of this organisational study was to create and evaluate, for use by the prehospital emergency nurse (PEN), a Prehospital Decision System (PDS) and a decision support tool (DST), to safely steer geriatric patients to optimal healthcare in Stockholm, Sweden. Aim: The overall aim was to optimise the acute emergency chain to ensure that elderly persons ended up at the optimal healthcare based on their medical needs. Methods: Study I was built on mixt methods approach with descriptive analysis (step one-three) and an interim analyse of a clinical trial (step four) to create a PDS and DST. In study II qualitative content analysis with the perspective of caring science were used on data from the emergency medical services’ (EMS) medical records to identify and illuminate the assessment category “general affected health condition”. In study III, a randomised control trial was used to evaluate the safety and feasibility of transport the geriatric patients to an optimal healthcare. Study IV, was a qualitative interview study with elderly patients. The study was carried with the perspective of caring science and a phenomenological approach was applied to describe patients’ lived experiences of participating in the choice of healthcare when being offered an alternative care pathway by the EMS. Findings: In study I, a PDS and DST were created. The developing process identified organisational and logistical factors that were prerequisites to safely steering elderly patients directly from their homes to an optimal healthcare. The most important factors that were found were the receiving units’ capacity, personnel competence, organisational resource ability, and the patient categories (medical conditions) of which eleven conditions were identified. In study II, a total of 1006 EMS medical records were analysed and after exclusion there remained 88 records. The findings showed that “general affected health condition” in elderly people in the EMS setting could be understood as referring to a patient with frailty. These patients had a growing weakness that had become unmanaged and prevented them having a controlled and functioning life, which forced them to seek help. In study III, of a total of 806 randomised geriatric patients, 666 remained after exclusion, 449 (67.4%) were assigned to the intervention group and 217 (32.6%) to the control group. The primary outcome result showed that 20% (Cl. 95%, 16.6-24.0) of the intervention group could be steered to a geriatric ward (GW) or to a community acute centre (CCAC) at a community based-hospital (CH). The secondary outcome showed that 6.7% (Cl. 95%, 3.1-13.8) of the intervention group required a secondary transport within 24 hours from the CH to the tertiary hospital ED. The evaluation of the PDS and DST showed that the Swedish PEN had good compliance with the system. Study IV show that, elderly patients choose a healthcare alternative involving a caring encounter in which they are treated like unique human beings. Five meaning constituents emerged in the descriptions: endurable waiting, speedy transference, a concerned encounter, trust in competence and choice based on suffering from care. Conclusion: The findings from the four studies demonstrate that with the help of the created PDS and DST – developed for eleven medical conditions – the Swedish PEN could safely decide upon which optimal healthcare elderly patient should be steered and treated at. The PDS offer a reduced risk for being exposed for suffering from care for elderly patients.
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| 31. |
- Wireklint Sundström, Birgitta, et al.
(author)
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Den äldre personens delaktighet i vårdval vid akut behov av vård : Ett exempel från ambulanssjukvård. Webbdelen.
- 2013
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In: Omvårdnad på avancerad nivå. Kärnkompetenser inom sjuksköterskans specialistområden. Webbdelen.. - : Studentlitteratur. - 9789144071459
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Book chapter (other academic/artistic)abstract
- Ambulanssjuksköterskor ansvarar för avancerad omvårdnad av äldre personer. Centralt i omvårdnaden är att bedöma vårdbehov och på plats besluta om optimal vårdnivå. Betydelsen understryks av att det ibland kan krävas snabba beslut som avgör vad som är det optimala vårdvalet för den unika patienten. Bedömning utgår från att lyssna på patientens berättelse ibland även på anhörigas, och ta ställning till olika tecken på sjukdom och ohälsa hos patienten. Äldre personer uppskattar att bli delaktiga i sin vård och få möjligheten till att göra vårdval. Att bli erbjuden ett direktspår till närakutmottagning eller geriatrisk vårdavdelning har visat sig vara en positiv invit till delaktighet. Tidigare vårderfarenheter från akutsjukvård har varit av traditionell vård på akutmottagning utan att kunna välja andra alternativ. Minnen av’icke vård’ på en akutmottagning lever kvar, vilket bör betraktas som ett vårdlidande. Således är det betydelsefullt att patienten bjuds in till ett vårdande möte och får känna tilliten till ambulanssjusköterskans kompetens, vilket kan bli avgörande för hur patienten kommer att känna fortsatt förtroende för vården. Då förutsätts det en mellanmänsklig relation med en ambulanssjuksköterska som upplevs vara närvarande och engagerad. En sådan mellanmänsklig relation kan ge den äldre personen djupa intryck.
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| 32. |
- Wireklint Sundström, Birgitta, et al.
(author)
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Optimal vårdnivå vid icke-akuta tillstånd
- 2009
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In: Prehospital akutsjukvård. - : Stockholm: Liber. - 9789147084487 ; , s. 199-212
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Book chapter (other academic/artistic)
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