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  • 1. Dieperink, W
    et al.
    Weelink, E E M
    van der Horst, I C C
    de Vos, R
    Jaarsma, T
    Aarts, L P H J
    Zijlstra, F
    Nijsten, M W N
    Treatment of presumed acute cardiogenic pulmonary oedema in an ambulance system by nurses using Boussignac continuous positive airway pressure.2009In: Emergency Medicine Journal, ISSN 1472-0205, E-ISSN 1472-0213, Vol. 26, no 2, p. 141-4Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Early initiation of continuous positive airway pressure (CPAP) applied by face mask benefits patients with acute cardiogenic pulmonary oedema (ACPE). The simple disposable Boussignac CPAP (BCPAP) has been used in ambulances by physicians. In the Netherlands, ambulances are manned by nurses and not physicians. It was hypothesised that ambulance nurses are able to identify patients with ACPE and can successfully apply BCPAP. A prospective case series of patients with presumed ACPE treated with BCPAP by ambulance nurses is described. METHODS: After training of ambulance nurses, all 33 ambulances in the region were equipped with BCPAP. ACPE was diagnosed on clinical signs and pulse oximetry saturation (Spo(2)) <95%. BCPAP (5 cm H(2)O, Fio(2)>80%) was generated with an oxygen flow of 15 l/min. The physiological responses, experiences and clinical outcomes of the patients were collected from ambulance and hospital records, and ambulance nurses and patients received a questionnaire. RESULTS: From March to December 2006, 32 patients (age range 61-94 years) received BCPAP during transport to six different regional hospitals. In 26 patients (81%) a diagnosis of ACPE was confirmed. With BCPAP, median (IQR) Spo(2) increased from 79% (69-94%) to 96% (89-98%) within 20 min. The median (IQR) duration of BCPAP treatment was 26 min (21-32). The patients had no negative recollections of the treatment. Ambulance personnel were satisfied with the BCPAP therapy. CONCLUSION: When applied by ambulance nurses, BCPAP was feasible and effective in improving oxygen saturation in patients with ACPE. Although survival benefit can only be demonstrated by further research, it is considered that BCPAP can be implemented in all ambulances in the Netherlands.

  • 2.
    Greenslade, Jaimi H.
    et al.
    Royal Brisbane and Womens Hosp, Australia; Queensland Univ Technol, Australia; Queensland Univ Technol, Australia.
    Wallis, Marianne
    Univ Sunshine Coast, Australia.
    Johnston, Amy N. B.
    Princess Alexandra Hosp, Australia; Univ Queensland, Australia.
    Carlstrom, Eric
    Univ Goteborgs, Sweden.
    Wilhelms, Daniel
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Emergency Medicine in Linköping.
    Crilly, Julia
    Griffith Univ, Australia; Gold Coast Hlth, Australia.
    Key occupational stressors in the ED: an international comparison2020In: Emergency Medicine Journal, ISSN 1472-0205, E-ISSN 1472-0213, Vol. 37, no 2, p. 106-+Article in journal (Refereed)
    Abstract [en]

    Background The ED Stressor Scale outlines 15 stressors that are of importance for ED staff. Limited research has identified how commonly such stressors occur, or whether such factors are perceived with similar importance across different hospitals. This study sought to examine the frequency or perceived severity of these 15 stressors using a multicentre cohort of emergency clinicians (nurses and physicians) in EDs in two countries (Australia and Sweden). Method This was a cross-sectional survey of staff working in eight hospitals in Australia and Sweden. Data were collected between July 2016 and June 2017 (depending on local site approvals) via a printed survey incorporating the 15-item ED stressor scale. The median stress score for each item and the frequency of experiencing each event was reported. Results Events causing most distress include heavy workload, death or sexual abuse of a child, inability to provide optimum care and workplace violence. Stressors reported most frequently include dealing with high acuity patients, heavy workload and crowding. Violence, workload, inability to provide optimal care, poor professional relations, poor professional development and dealing with high-acuity patients were reported more commonly by Australian staff. Swedish respondents reported more frequent exposure to mass casualty incidents, crisis management and administrative concerns. Conclusions Workload, inability to provide optimal care, workplace violence and death or sexual abuse of a child were consistently reported as the most distressing events across sites. The frequency with which these occurred differed in Australia and Sweden, likely due to differences in the healthcare systems.

  • 3.
    Rahmqvist Linnarsson, Josefin
    et al.
    Linnaeus University, Sweden .
    Benzein, Eva
    Linnaeus University, Sweden .
    Franzén Årestedt, Kristofer
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Erlingsson, Christen
    Linnaeus University, Sweden .
    Preparedness to care for victims of violence and their families in emergency departments2013In: Emergency Medicine Journal, ISSN 1472-0205, E-ISSN 1472-0213, Vol. 30, no 3, p. 198-201Article in journal (Refereed)
    Abstract [en]

    Objective To describe the preparedness to provide care for victims of violence and their families in emergency departments (EDs) in Sweden. less thanbrgreater than less thanbrgreater thanMethods A web-based questionnaire was sent to all hospital EDs in Sweden (N=66). less thanbrgreater than less thanbrgreater thanResults A total of 46 out of 66 (70%) heads of EDs completed the questionnaire. The results show that most of the EDs are prepared to care for women and children who are victims of violence. However, there seems to be a lack of preparedness to care for other groups of patients, such as victimised men. Very few EDs have routines to identify victims of violence among patients. Results also indicate that nurses play a key role in the care for victims of violence; however, family members are rarely included in care. less thanbrgreater than less thanbrgreater thanConclusions A lack of general preparedness in EDs to care for all victims of violence, regardless of gender and age, can lead to many patients not receiving appropriate care and treatment. To correct this there is a need to implement guidelines and routines about the care for victims of violence. Further research can shed more light on which measures are needed to improve quality of care for these patients and their families.

  • 4.
    Toll, Rani
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Emergency Medicine.
    Henricson, Joakim
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Emergency Medicine.
    Anderson, Chris
    Linköping University, Department of Clinical and Experimental Medicine, Division of Cell Biology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Dermatology and Venerology.
    Wilhelms, Daniel
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Emergency Medicine.
    Man versus machine: comparison of naked-eye estimation and quantified capillary refill2019In: Emergency Medicine Journal, ISSN 1472-0205, E-ISSN 1472-0213, Vol. 36, no 8, p. 465-471Article in journal (Refereed)
    Abstract [en]

    Background Capillary refill (CR) time is traditionally assessed by naked-eye inspection of the return to original colour of a tissue after blanching pressure. Few studies have addressed intra-observer reliability or used objective quantification techniques to assess time to original colour. This study compares naked-eye assessment with quantified CR (qCR) time using polarisation spectroscopy and examines intra-observer and interobserver agreements in using the naked eye. Method A film of 18 CR tests (shown in a random fixed order) performed in healthy adults was assessed by a convenience sample of 14 doctors, 15 nurses and 19 secretaries (Department of Emergency Medicine, Linkoping University, September to November 2017), who were asked to estimate the time to return to colour and characterise it as fast, normal or slow. The qCR times and corresponding naked-eye time assessments were compared using the Kruskal-Wallis test. Three videos were shown twice without observers knowledge to measure intra-observer repeatability. Intra-observer categorical assessments were compared using Cohens Kappa analysis. Interobserver repeatability was measured and depicted with multiple-observer Bland-Altman plotting. Differences in naked-eye estimation between professions were analysed using ANOVA. Results Naked-eye assessed CR time and qCR time differ substantially, and agreement for the categorical assessments (naked-eye assessment vs qCR classification) was poor (Cohens kappa 0.27). Bland-Altman intra-observer repeatability ranged from 6% to 60%. Interobserver agreement was low as shown by the Bland-Altman plotting with a 95% limit of agreement with the mean of +/- 1.98 s for doctors, +/- 1.6 s for nurses and +/- 1.75 s for secretaries. The difference in CR time estimation (in seconds) between professions was not significant. Conclusions Our study suggests that naked-eye-assessed CR time shows poor reproducibility, even by the same observers, and differs from an objective measure of CR time.

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