Severe accidental hypothermia mainly affects victims of outdoor accidents. However, hypothermia can also occur in non-traumatized indoor patients. The aim of this study was to examine the occurrence of hypothermia obtained at the scene of the rescue in patients classified as priority 1 cases during two three-month periods in southern Sweden. This prospective, clinical cohort study was performed in a prehospital setting, southern Sweden. Ninety-four patients were included during two three-month periods. According to where the patients were found they were split into two groups, outdoor or indoor and then separated into three categories; general medicine-, trauma- and intoxicated patients. The environment temperature was measured on arrival according to the location where the rescue occurred and core temperatures (tympanic membrane) of patients were measured in connection with the monitoring in the ambulance before departure and at the time of arrival to the emergency room at the hospital. This study demonstrated that the only group that shows body core temperature below 36 degrees C, was the outdoor intoxication-group during the winter-period (35.7+/-1.3 degrees C). We conclude that intoxicated patients are at higher risk for hypothermia than minor trauma patients.
Unplanned perioperative hypothermia is a well-known complication to anesthesia. This study compares esophageal and nasopharyngeal temperature measured in the same patient for a period of 210 minutes of anesthesia. Forty-three patients undergoing colorectal surgery were randomly assigned in 2 groups, with or without a prewarming period (group A = prewarming [n = 21] or group B = no prewarming [n = 22]). Demographics were similar in both groups. Mean temperatures at 210 minutes were statistically different between the groups at both sites of measurement. Esophageal temperature in group A was 36.5 ? 0.6 vs 35.8 ? 0.7 in group B (P = .001), and nasopharyngeal temperature was 36.7 ? 0.6 and 36.0 ? 0.6 in group A and group B, respectively (P = .002). A negative correlation was found between esophageal temperature and age (r2 = -.381, P
A winning concept of crisis management can be summarized in 2 words: knowledge communication. If decision makers, communicators, experts, and the public understand what the crisis is about and share their knowledge, the process of handling it will be optimized. Effective crisis communication implies the necessity of an unhindered but purposeful exchange of information within and between authorities, organizations, media, involved individuals, and groups before, during, and after a crisis. This article focuses on the importance of the before, or prevention, part of a crisis since it holds a rich possibility to enhance the chances for successful crisis management of a bioterrorism incident. An extended perspective on crisis communication efficiently links to a more thorough understanding of risk perception with various stakeholders and the public, which also will be helpful for situational awareness. Furthermore, the grounded baseline for the dialogue type of crisis communication suitable in modern society and to modern social media is achieved by linking to those risk communication efforts that are made. The link between risk and crisis should be afforded more attention since, especially in biosecurity, there would be no crisis without risk negligence and poor or malfunctioning preventive efforts.
Studies have shown that adherence to prehospital treatment guidelines, for patients with non-traumatic chest pain is incomplete and that there is a gender difference in treatment provided.
The aim of this study was to examine adherence to guidelines in a nurse-led ambulance system in southern Sweden.
Retrospective cohort study, including 862 medical records was reviewed. Data relevant to treatment guidelines was obtained e.g. the provision of oxygen, acetylsalicylic acid, glycerin trinitrate, electrocardiogram recorded, pain assessment, patient gender and time of day. Results were presented using descriptive statistics and adherence to present guidelines was described as poor (= 20%), fair (21-40%), moderate (41-60%), good (61-80%) and very good (81-100%).
The medical records included 401 women and 461 men. Twenty-three percent of the patients received = 10L/min of oxygen (men vs. women, P
One of several quality indicators that are relevant to study is patient's satisfaction with health care in the ambulance services. Regular measurements of patient satisfaction in this field have not been carried out previously and a validated method of measurement is lacking.
This study aimed to measure patient satisfaction with health care in the ambulance services in Region Skane, southern Sweden.
Of the included patients 67% were women (n=27) and 33% men (n=13) with an average age of 65.6years (r=22-87). Informants average time of care in the ambulance was 31 min (r=12-75). A majority of the responses (93.1%) showed the most positive response option on each question position.
The present study shows that patients within ambulance care in the region of southern Sweden were pleased with the care received and the competence of the ambulance staff, and the patients experienced a high level of psychological and physical sense of security.
The prehospital emergency care has had a rapid progress in Sweden in terms of technology, treatments and personnel education demands. In the County of Skane there is at least one specialized nurse in every ambulance. Possible misuses of the resources by the public have been acknowledged.
To investigate the public's use, knowledge and expectations of the prehospital emergency care in Skane, southern Sweden.
A cross sectional descriptive survey, using a stratified sampling. Inclusion criteria were: 18 year or older and currently living in Skane.
Of 735 people who were asked 54.4% (n=400) chose to participate in the study. 44.0% of the respondents had been transported with ambulance. 34.5% of the respondents believed that the lowest educated personnel responsible for the patient was the paramedic. The results show that the respondents trust the personnel's knowledge and work skills. Older informants expected faster treatment by a physician when arriving by ambulance to the hospital, regardless of medical condition.
The public had confidence in the ambulance personnel's knowledge, ability to make assessment and give treatment despite not being updated on the current competence of the personnel. A positive experience of contact with the ambulance service was distinct.
Pain is a common condition among prehospital patients. The present study is designed to determine whether adding low-dose ketamine as additional analgesia improves the pain/nausea scores and hemodynamic parameters compared to morphine sulphate alone among patients with bone fractures.
Prospective, prehospital clinical cohort study. Twenty-seven patients were included with acute pain. Eleven patients received morphine sulphate 0.2 mg/kg (M-group) and 16 patients received morphine sulphate 0.1 mg/kg combined with 0.2 mg/kg ketamine (MK-group). Scores for pain, nausea, sedation (AVPU) and the haemodynamic parameters (systolic blood pressures (BP), heart rate (HR) and peripheral oxygen saturation (SpO2) were recorded at rescue scene before the start of analgesia and subsequently to admission at hospital.
Mean treatment time 46 +/- 17 minutes in the M-group and 56 +/- 11 minutes in the MK-group, respectively (ns). Mean doses of morphine sulphate in the M-group were 13.5 +/- 3.2 mg versus 7.0 +/- 1.5 mg in the MK-group. The mean additional doses of ketamine in the MK-group were 27.9 +/- 11.4 mg. There were significantly differences between the M- and the MK-group according to NRS scores for pain (5.4 +/- 1.9 versus 3.1 +/- 1.4) and BP (134 +/- 21 mmHg versus 167 +/- 32 mmHg) at admission at hospital, respectively (P
Rapid development of molecular techniques for the diagnosis of infections and typing of microbes has been seen during the last 10 years. The present review exemplifies this development by presenting the work of the authors and others regarding techniques for the diagnosis of tularemia and typing of Francisella tularensis. The lack of rapid and safe methods for the laboratory diagnosis of tularemia was the rationale behind the development of methods for the direct detection of F. tularensis in clinical specimens. Today, detection by polymerase chain reaction has become an important adjunct to clinical decisions for the early diagnosis of tularemia. The elucidation of the epidemiology and epizootology of the disease has been hampered by the lack of suitable methods. During recent years several DNA-based methods that allow rapid identification of the four F. tularensis subspecies, including differentiation of strains of the two clinically important subspecies, the highly virulent type A strains and less virulent type B strains, have been developed. Since F. tularensis strains of any origin exhibit highly conserved genomic sequences, the availability of extensive genome sequence data was a prerequisite for the development of a typing system that allows discrimination of individual isolates. The most discriminatory method is based on multiple-locus variable-number tandem repeat analysis (MLVA) and uses highly variable parts of the F. tularensis genome. The method will be an important tool in future studies of the molecular epidemiology of tularemia.
To evaluate the progression of dental erosion in 13-14 year-olds after 4 years, and its association with lifestyle and oral health.
227 randomly selected 13-14 year-olds from a Public Dental Clinic, Örebro, Sweden, were investigated. A clinical examination was performed which included dental caries/gingival/plaque status, as well as grading of dental erosion at the tooth surface and participant levels in "marker teeth", including buccal/palatal surfaces of 6 maxillary anterior teeth (13-23), and occlusal surfaces of first molars. An interview and a questionnaire regarding drinking habits and other lifestyle factors were completed. All investigations were repeated at follow-up. The participants were divided into high and low progression erosion groups and logistic regression statistics were applied.
175 individuals participated at follow-up. Progression occurred in 35% of the 2566 tooth surfaces. 32% of the surfaces had deteriorated by one severity grade (n=51 individuals) and 3% by two grades (n=2 individuals). Boys showed more severe erosion than girls at the follow-up. Among the variables predicting greater progression, a lower severity of erosive wear at baseline had the highest OR (13.3), followed in descending order by a "retaining" drinking technique, more frequent intake of drinks between meals, low GBI and lesser sour milk intake, with reference to the baseline recording. Using these five variables, sensitivity and specificity were 87% and 67% respectively, for predicting progression of erosion.
Progression of erosive lesions in Swedish adolescents aged 13-14 years followed up to age 17-18 years was common and related to certain lifestyle factors.
In permanent teeth, dental erosion may develop early in life and its progression is common. Dental health workers should be made aware of this fact and regular screenings for erosion and recording of associated lifestyle factors should be performed.
The aims of this study were to investigate the prevalence of dental erosion among Swedish children and adolescents and to examine its relation to soft drink consumption. It was hypothesized that the prevalence of dental erosion would be higher in boys than girls,that it would show a correlation with soft drink consumption and that a further simplification ofa previously-used partial recording screening system for dental erosion would have an acceptable sensitivity and specificity. 801 individuals were invited to participate, of whom 609 (75%) accepted. 135 were 5-6 years, 227 were 13-14 years, and 247 were18-19 years old. A questionnaire survey of each individual's soft drink consumption habits, in addition to a clinical examination, were performed. Severe erosion extending into dentine on one or more maxillary anterior teeth/ molars was found to be 13.3% in the 5-6 group, 11.9% in 13-14 group and 22.3% in 18-19 group. The total prevalence for all age groups was 16.4%. The severity of erosion was highest among 18-19 year-old boys, 34.4 % of whom exhibited one or more teeth with severe erosive damage while none of the girls did so. Soft drink consumption was significantly correlated with severity of dental erosion in the 18-19 and 13-14 groups but not in the 5-6 years old group. A simplified erosion partial recording system (SEPRS) using 4 (permanent) or 6 (primary) surfaces as markers showed excellent sensitivity (100%/100%, respectively) and specificity (98%/100%, respectively) in relation to scoring of all maxillary canines/incisors and first permanent/all primary molars. In view of the high prevalence of dental erosion and soft drink consumption among Swedish children and adolescents reported here,there is clearly a need for a national epidemiological registration system as well as for community-based preventive programs to be implemented. The hypothesis that dental erosion would be higher in boys than girls and that it would show a correlation with soft drink intake was confirmed.