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- Andsberg, Gunnar, et al.
(author)
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PreHospital Ambulance Stroke Test : pilot study of a novel stroke test
- 2017
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In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - London, UK : BioMed Central. - 1757-7241. ; 25:1
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Journal article (peer-reviewed)abstract
- BACKGROUND: There is a need for a prehospital stroke test that in addition to high sensitivity for stroke, also is able to communicate stroke severity similar to the National Institute of Health Stroke Scale (NIHSS).METHODS: The PreHospital Ambulance Stroke Test (PreHAST), an eight item test based on NIHSS, which scores stroke severity from 0-19 points, was designed and adapted for the ambulance services. In the pilot study the ambulance nurses used PreHAST to assess patients with suspected stroke in the prehospital setting. Regardless of the results after PreHAST testing the patients were triaged with a provisional stroke diagnosis. The PreHAST scores were compared with the final diagnosis and the ability to differentiate stroke and transient ischemic attacks (TIA) with ongoing symptoms at evaluation from non-stroke patients was analysed.RESULTS: 69 patients were included in the study, 26 had stroke/TIA and 43 other diagnoses. All stroke/TIA patients were identified by PreHAST (sensitivity 100% (95% CI; 87-100%)). The specificity increased with higher PreHAST scores and the discriminative capacity for PreHAST for different cut off values showed an area under the curve of 0.77 (95%CI; 0.66-0.88) in the receiver operating characteristic (ROC) analysis.DISCUSSION: PreHAST is designed for high sensitivity, screening for a broad range of stroke symptoms including most key components of NIHSS. The promising sensitivity between 87 and 100% in our study has to be confirmed in a larger study also including multiple centres. Higher PreHAST scores implied more typical patterns of stroke and accordingly the proportion of stroke mimics decrease with higher scores. However, also stroke mimics with epilepsy/seizure and patients with deficit after prior stroke could show higher PreHAST scores. Other prehospital stroke tests that evaluate stroke severity have been designed with the main purpose to screen for large vessel occlusion. The advantage of PreHAST is the dual purpose not only to evaluate stroke severity but also to screen for stroke in general.CONCLUSIONS: PreHAST is a new screening test of stroke adapted for ambulance services that in addition to high sensitivity for stroke, provides a grading system with increasing specificity with higher scores.
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| 2. |
- Lindgren, Magnus, 1967-
(author)
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Brottsoffer i rättsprocessen : Om ideala brottsoffer och goda myndigheter
- 2004
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Doctoral thesis (other academic/artistic)abstract
- During the past few decades interest in, and concern for, crime victims have grown considerably in Sweden. New acts have been introduced and existing ones have been revised and amended, research into crime victim issues has developed and the situation of crime victims has increasingly been brought to the fore in the criminal justice system. The question is whether this new focus has had any significant impact on the way crime victims are treated by the criminal justice system.The thesis shows that a number of measures and reforms have been implemented with a view to improving the support, protection and assistance afforded to crime victims, e.g. with regard to criminal injuries compensation, the provision of legal counsel, the obligation of the police and public prosecutors to provide victims with information about the criminal justice process and about developments in their cases, providing crime victims with a new identity etc. However, the results of the empirical studies show that the government’s intentions have not yet been fully translated into action. Despite the extensive obligations of the police when it comes to the provision of information, approximately 25 per cent of crime victims stated that they had not received any such information. The studies also show that the police only rarely pay attention to the fact that some victims are subjected to repeat victimisation. In addition, the manner in which victims are treated by the police appears to vary depending on the type of crime involved. For example, compared to victims of burglary and mugging, a considerably larger number of assault victims described the police officers they met as brusque, surly and uninterested. Regarding the experience victims have of the public prosecutors assigned to their cases, the negative views expressed concern mainly the timing of the first contact with the prosecutor. Many victims do not meet the prosecutor until the day of the trial, either shortly before the trial itself or in the actual courtroom. Crime victims are also relatively often dissatisfied with the waiting arrangements in court buildings; a recurring complaint is that they had to share a waiting room with the accused.
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