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Accuracy of GFR estimating equations combining standardized cystatin C and creatinine assays: a cross-sectional study in Sweden.

https://arctichealth.org/en/permalink/ahliterature270880
Source
Clin Chem Lab Med. 2015 Feb;53(3):403-14
Publication Type
Article
Date
Feb-2015
Author
Jonas Björk
Anders Grubb
Anders Larsson
Lars-Olof Hansson
Mats Flodin
Gunnar Sterner
Veronica Lindström
Ulf Nyman
Source
Clin Chem Lab Med. 2015 Feb;53(3):403-14
Date
Feb-2015
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Biomarkers - blood
Cohort Studies
Creatinine - blood
Cross-Sectional Studies
Cystatin C - blood
Female
Glomerular Filtration Rate
Humans
Male
Middle Aged
Renal Insufficiency, Chronic - blood - epidemiology
Sweden - epidemiology
Young Adult
Abstract
The recently established international cystatin C calibrator makes it possible to develop non-laboratory specific glomerular filtration rate (GFR) estimating (eGFR) equations. This study compares the performance of the arithmetic mean of the revised Lund-Malmö creatinine and CAPA cystatin C equations (MEANLM-REV+CAPA), the arithmetic mean of the Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI) creatinine and cystatin C equations (MEANCKD-EPI), and the composite CKD-EPI equation (CKD-EPICREA+CYSC) with the corresponding single marker equations using internationally standardized calibrators for both cystatin C and creatinine.
The study included 1200 examinations in 1112 adult Swedish patients referred for measurement of GFR (mGFR) 2008-2010 by plasma clearance of iohexol (median 51 mL/min/1.73 m2). Bias, precision (interquartile range, IQR) and accuracy (percentage of estimates ±30% of mGFR; P30) were compared.
Combined marker equations were unbiased and had higher precision and accuracy than single marker equations. Overall results of MEANLM-REV+CAPA/MEANCKD-EPI/CKD-EPICREA+CYSC were: median bias -2.2%/-0.5%/-1.6%, IQR 9.2/9.2/8.8 mL/min/1.73 m2, and P30 91.3%/91.0%/91.1%. The P30 figures were about 7-14 percentage points higher than the single marker equations. The combined equations also had a more stable performance across mGFR, age and BMI intervals, generally with P30 =90% and never
PubMed ID
25274955 View in PubMed
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Accuracy of GFR estimating equations in a large Swedish cohort: implications for radiologists in daily routine and research.

https://arctichealth.org/en/permalink/ahliterature280255
Source
Acta Radiol. 2017 Mar;58(3):367-375
Publication Type
Article
Date
Mar-2017
Author
Ulf Nyman
Anders Grubb
Veronica Lindström
Jonas Björk
Source
Acta Radiol. 2017 Mar;58(3):367-375
Date
Mar-2017
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Cohort Studies
Contrast Media - pharmacokinetics
Female
Glomerular Filtration Rate - physiology
Humans
Iohexol - pharmacokinetics
Kidney Function Tests - methods - statistics & numerical data
Male
Middle Aged
Radiologists
Radiology
Reproducibility of Results
Research
Sweden
Young Adult
Abstract
Background Guidelines recommend estimation of glomerular filtration rate (eGFR) prior to iodine contrast media (CM) examinations. It is also recommended that absolute eGFR in mL/min, not commonly used relative GFR (adjusted to body surface area; mL/min/1.73?m(2)), should be preferred when dosing and evaluating toxicity of renally excreted drugs. Purpose To validate the absolute Lund-Malmö equation (LM-ABS) in comparison with the absolute Cockcroft-Gault (CG) equation and the relative equations, revised Lund-Malmö (LM-REV), MDRD, and CKD-EPI, after converting relative estimates to absolute values, and to analyze change in eGFR classification when absolute instead of relative eGFR was used. Material and Methods A total of 3495 plasma clearance of iohexol to measure GFR (mGFR) served as reference test. Bias, precision, and accuracy (percentage of estimates ±30% of mGFR; P30) were compared overall and after stratification for various mGFR, eGFR, age, and BMI subgroups. Results The overall P30 results of CG/LM-ABS/LM-REV/MDRD/CKD-EPI were 62.8%/84.9%/83.7%/75.3%/75.6%, respectively. LM-ABS was the most stable equations across subgroups and the only equation that did not exhibit marked overestimation in underweight patients. For patients with relative eGFR 30-44 and 45-59?mL/min/1.73?m(2), 36% and 58% of men, respectively, and 24% and 32% of women, respectively, will have absolute eGFR values outside these relative eGFR intervals. Conclusion Choosing one equation to estimate GFR prior to contrast medium examinations, LM-ABS may be preferable. Unless absolute instead of relative eGFR are used, systematic inaccuracies in assessment of renal function may occur in daily routine and research on CM nephrotoxicity may be flawed.
PubMed ID
27166345 View in PubMed
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Clinical decision-making described by Swedish prehospital emergency care nurse students - An exploratory study.

https://arctichealth.org/en/permalink/ahliterature284665
Source
Int Emerg Nurs. 2016 Jul;27:46-50
Publication Type
Article
Date
Jul-2016
Author
Tomas Nilsson
Veronica Lindström
Source
Int Emerg Nurs. 2016 Jul;27:46-50
Date
Jul-2016
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Ambulances - manpower
Clinical Competence - standards
Decision Making
Emergency Medical Services - methods - standards
Female
Humans
Male
Middle Aged
Qualitative Research
Students, Nursing - psychology
Sweden
Abstract
The purpose of this study was to explore the PECN students' clinical decision-making during a seven-week clinical rotation in the ambulance services.
Developing expertise in prehospital emergency care practices requires both theoretical and empirical learning. A prehospital emergency care nurse (PECN) is a Registered Nurse (RN) with one year of additional training in emergency care. There has been little investigation of how PECN students describe their decision-making during a clinical rotation.
A qualitative study design was used, and 12 logbooks written by the Swedish PECN students were analysed using content analysis.
The students wrote about 997 patient encounters - ambulance assignments during their clinical rotation. Four themes emerged as crucial for the students' decision-making: knowing the patient, the context-situation awareness in the ambulance service, collaboration, and evaluation. Based on the themes, students made decisions on how to respond to patients' illnesses.
The PECN students used several variables in their decision-making. The decision- making was an on-going process during the whole ambulance assignment. The university has the responsibility to guide the students during their transition from an RN to a PECN. The findings of the study can support the educators and clinical supervisors in developing the programme of study for becoming a PECN.
PubMed ID
26615949 View in PubMed
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End-tidal carbon dioxide monitoring during bag valve ventilation: the use of a new portable device.

https://arctichealth.org/en/permalink/ahliterature140825
Source
Scand J Trauma Resusc Emerg Med. 2010;18:49
Publication Type
Article
Date
2010
Author
Veronica Lindström
Christer H Svensen
Patrik Meissl
Birgitta Tureson
Maaret Castrén
Author Affiliation
Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden. veronica.lindstrom@ki.se
Source
Scand J Trauma Resusc Emerg Med. 2010;18:49
Date
2010
Language
English
Publication Type
Article
Keywords
Carbon Dioxide - analysis
Female
Humans
Monitoring, Physiologic - instrumentation
Prospective Studies
Respiration, Artificial - instrumentation
Sweden
Tidal Volume - physiology
Abstract
For healthcare providers in the prehospital setting, bag-valve mask (BVM) ventilation could be as efficacious and safe as endotracheal intubation. To facilitate the evaluation of efficacious ventilation, capnographs have been further developed into small and convenient devices able to provide end- tidal carbon dioxide (ETCO2). The aim of this study was to investigate whether a new portable device (EMMA™) attached to a ventilation mask would provide ETCO2 values accurate enough to confirm proper BVM ventilation.
A prospective observational trial was conducted in a single level-2 centre. Twenty-two patients under general anaesthesia were manually ventilated. ETCO2 was measured every five minutes with the study device and venous PCO2 (PvCO2) was simultaneously measured for comparison. Bland- Altman plots were used to compare ETCO2, and PvCO2.
The patients were all hemodynamically and respiratory stable during anaesthesia. End-tidal carbon dioxide values were corresponding to venous gases during BVM ventilation under optimal conditions. The bias, the mean of the differences between the two methods (device versus venous blood gases), for time points 1-4 ranges from -1.37 to -1.62.
The portable device, EMMA™ is suitable for determining carbon dioxide in expired air (kPa) as compared to simultaneous samples of PvCO2. It could therefore, be a supportive tool to asses the BVM ventilation in the demanding prehospital and emergency setting.
Notes
Cites: Crit Care Med. 2003 Mar;31(3):800-412626987
Cites: Resuscitation. 2001 Mar;48(3):211-2111278085
Cites: J Trauma. 2004 Mar;56(3):531-615128123
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Cites: Crit Care. 2009;13(6):R19619995420
Cites: Am J Emerg Med. 2005 Nov;23(7):852-916291440
PubMed ID
20840740 View in PubMed
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Feasibility of a computer-assisted feedback system between dispatch centre and ambulances.

https://arctichealth.org/en/permalink/ahliterature136758
Source
Eur J Emerg Med. 2011 Jun;18(3):143-7
Publication Type
Article
Date
Jun-2011
Author
Veronica Lindström
Rolf Karlsten
Ann-Charlotte Falk
Maaret Castrèn
Author Affiliation
Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden. veronica.lindstrom@ki.se
Source
Eur J Emerg Med. 2011 Jun;18(3):143-7
Date
Jun-2011
Language
English
Publication Type
Article
Keywords
Ambulances - statistics & numerical data
Diagnosis, Computer-Assisted - instrumentation - methods
Emergency Medical Service Communication Systems - organization & administration
Feasibility Studies
Feedback
Humans
Quality of Health Care
Sweden
Abstract
The aim of the study was to evaluate the feasibility of a newly developed computer-assisted feedback system between dispatch centre and ambulances in Stockholm, Sweden.
A computer-assisted feedback system based on a Finnish model was designed to fit the Swedish emergency medical system. Feedback codes were identified and divided into three categories; assessment of patients' primary condition when ambulance arrives at scene, no transport by the ambulance and level of priority. Two ambulances and one emergency medical communication centre (EMCC) in Stockholm participated in the study. A sample of 530 feedback codes sent through the computer-assisted feedback system was reviewed. The information on the ambulance medical records was compared with the feedback codes used and 240 assignments were further analyzed.
The used feedback codes sent from ambulance to EMCC were correct in 92% of the assignments. The most commonly used feedback code sent to the emergency medical dispatchers was 'agree with the dispatchers' assessment'. In addition, in 160 assignments there was a mismatch between emergency medical dispatchers and ambulance nurse assessments.
Our results have shown a high agreement between medical dispatchers and ambulance nurse assessment. The feasibility of the feedback codes seems to be acceptable based on the small margin of error. The computer-assisted feedback system may, when used on a daily basis, make it possible for the medical dispatchers to receive feedback in a structural way. The EMCC organization can directly evaluate any changes in the assessment protocol by structured feedback sent from the ambulance.
PubMed ID
21346582 View in PubMed
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[Guidelines for prehospital care in severe head injuries are not followed. Big difference between the Scandinavian guidelines and the regional Swedish guidelines].

https://arctichealth.org/en/permalink/ahliterature123979
Source
Lakartidningen. 2012 Apr 25-May 8;109(17-18):882-3
Publication Type
Article
Author
Ann-Charlotte Falk
Veronica Lindström
Torbjörn Bergvall
Maaret Castrén
Author Affiliation
Instutionen för neurobiologi, vårdvetenskap och samhälle, Stockholm. ann-charlotte.falk@ki.se
Source
Lakartidningen. 2012 Apr 25-May 8;109(17-18):882-3
Language
Swedish
Publication Type
Article
Keywords
Craniocerebral Trauma - therapy
Emergency Medical Services - standards
Evidence-Based Medicine
Humans
Practice Guidelines as Topic
Quality Assurance, Health Care
Sweden
PubMed ID
22642056 View in PubMed
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Has increased nursing competence in the ambulance services impacted on pre-hospital assessment and interventions in severe traumatic brain-injured patients?

https://arctichealth.org/en/permalink/ahliterature257955
Source
Scand J Trauma Resusc Emerg Med. 2014;22:20
Publication Type
Article
Date
2014
Author
Ann-Charlotte Falk
Annika Alm
Veronica Lindström
Author Affiliation
Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, III, 141 83 Huddinge, Stockholm, Sweden. ann-charlotte.falk@ki.se.
Source
Scand J Trauma Resusc Emerg Med. 2014;22:20
Date
2014
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Ambulances
Brain Injuries - diagnosis - epidemiology - nursing
Female
Glasgow Coma Scale
Hospital Mortality - trends
Humans
Incidence
Length of Stay - trends
Male
Middle Aged
Nurse's Practice Patterns - trends
Outcome Assessment (Health Care)
Prognosis
Retrospective Studies
Sweden - epidemiology
Trauma Centers - statistics & numerical data
Young Adult
Abstract
Trauma is one of the most common causes of morbidity and mortality in modern society, and traumatic brain injuries (TBI) are the single leading cause of mortality among young adults. Pre-hospital acute care management has developed during recent years and guidelines have shown positive effects on the pre-hospital treatment and outcome for patients with severe traumatic brain injury. However, reports of impacts on improved nursing competence in the ambulance services are scarce. Therefore, the aim of this study was to investigate if increased nursing competence level has had an impact on pre-hospital assessment and interventions in severe traumatic brain-injured patients in the ambulance services.
A retrospective study was conducted. It included all severe TBI patients (>15 years of age) with a Glasgow Coma Score (GCS) of less than eight measured on admission to a level one trauma centre hospital, and requiring intensive care (ICU) during the years 2000-2009.
651 patients were included, and between the years 2000-2005, 395 (60.7%) severe TBI patients were injured, while during 2006-2009, there were 256 (39.3%) patients. The performed assessment and interventions made at the scene of the injury and the mortality in hospital showed no significant difference between the two groups. However, the assessment of saturation was measured more frequently and length of stay in the ICU was significantly less in the group of TBI patients treated between 2006-2009.
Greater competence of the ambulance personnel may result in better assessment of patient needs, but showed no impact on performed pre-hospital interventions or hospital mortality.
Notes
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Cites: Emerg Med J. 2004 Jul;21(4):404-715208218
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Cites: Resuscitation. 2005 Jan;64(1):21-915629551
Cites: Nurs Crit Care. 2005 Nov-Dec;10(6):269-7116255333
Cites: Med Care. 2013 Apr;51(4 Suppl 2):S6-1423502918
Cites: Prog Neurol Surg. 2006;19:171-9617033154
Cites: J Trauma. 2006 Jun;60(6):1250-6; discussion 125616766968
Cites: J Neurotrauma. 2007 Feb;24(2):287-9317375993
Cites: J Neurotrauma. 2007;24 Suppl 1:S1-10617511534
Cites: J Trauma. 2007 Aug;63(2):258-6217693821
Cites: BMJ. 2008 Feb 23;336(7641):425-918270239
Cites: BMJ. 2008 Feb 23;336(7641):397-818270240
Cites: Lakartidningen. 2008 Jun 11-24;105(24-25):1834-818619006
Cites: Eur J Emerg Med. 2009 Dec;16(6):312-719491690
Cites: J Am Coll Surg. 2010 Feb;210(2):220-720113943
Cites: J Trauma. 2010 Sep;69(3):589-94; discussion 59420838130
Cites: J Neurotrauma. 2002 Jan;19(1):111-7411852974
Cites: Am J Public Health. 2000 Apr;90(4):523-610754963
Cites: Resuscitation. 2004 Mar;60(3):239-4415050754
Cites: J Neurotrauma. 2002 Jul;19(7):855-6812184855
Cites: J Neurotrauma. 2007 Jan;24(1):147-5317263678
PubMed ID
24641814 View in PubMed
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Patients' experience of being badly treated in the ambulance service: A qualitative study of deviation reports in Sweden.

https://arctichealth.org/en/permalink/ahliterature285870
Source
Int Emerg Nurs. 2017 Jan;30:25-30
Publication Type
Article
Date
Jan-2017
Author
Marie Ahlenius
Veronica Lindström
Veronica Vicente
Source
Int Emerg Nurs. 2017 Jan;30:25-30
Date
Jan-2017
Language
English
Publication Type
Article
Keywords
Ambulances - standards
Emergency Medical Services - manpower - standards
Emergency Medical Technicians - standards
Female
Humans
Male
Patient satisfaction
Perception
Qualitative Research
Quality of Health Care - standards
Surveys and Questionnaires
Sweden
Abstract
The Swedish healthcare system aims to provide the best care possible, thus fulfilling legal and program requirements despite the need for reducing costs. This study's aim has been to acquire deeper understanding of the factors underlying patients' experience of inappropriate treatment and care or personnel's problematical attitudes during their contact with the Emergency Medical Services (EMS) (Ambulance Services).
This study used a care science perspective. It applied qualitative content analysis, analyzing data for meaning. Data comprised 32 deviation reports or complaints from patients in Stockholm, Sweden in 2014.
Patients at the limits of their self-help experienced acute need for speedy transfer to hospital. Lack of recognition for their suffering caused them to feel badly treated by ambulance personnel.
Patients in this study felt objectified and not treated as individual human beings, i.e. they "suffered from care". Ambulance personnel should avoid patient objectification by establishing an engaged relationship with attentiveness and committal, thus supporting patients' health processes. The aim of this study has been to draw attention to patients' experiences of the healthcare they received, in order to be able to improve and maintain healthcare standards, thus guaranteeing continued quality of care. This may be achieved by increasing the awareness of personnel concerning how their attitudes and treatment can influence patient well-being. Information, education and follow-up lead to increased awareness in personnel. The intended result of personnel's increased awareness is greater well-being and feelings of security for patients.
PubMed ID
27567212 View in PubMed
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Prehospital emergency care nurses' strategies while caring for patients with limited Swedish-English proficiency.

https://arctichealth.org/en/permalink/ahliterature296086
Source
J Clin Nurs. 2018 Oct; 27(19-20):3699-3705
Publication Type
Journal Article
Date
Oct-2018
Author
Annika B Alm-Pfrunder
Ann-Charlotte Falk
Veronica Vicente
Veronica Lindström
Author Affiliation
Department of Clinical Science and Education, Södersjukhuset Karolinska Institutet, Stockholm, Sweden.
Source
J Clin Nurs. 2018 Oct; 27(19-20):3699-3705
Date
Oct-2018
Language
English
Publication Type
Journal Article
Keywords
Adult
Communication Barriers
Critical Care Nursing - methods
Culturally Competent Care - methods
Emergency Medical Services - methods
Emergency Service, Hospital
Female
Humans
Male
Nurse-Patient Relations
Nursing Staff, Hospital - psychology
Qualitative Research
Sweden
Abstract
To explore the strategies of nurses working in the ambulance service while caring for patients with limited Swedish-English proficiency.
Communication difficulties due to lack of mutual language is a challenge in healthcare systems around the world. Little is known about nurses' strategies while caring for patients with whom they do not share a mutual language in an unstructured, unplanned prehospital emergency environment, the ambulance service.
A qualitative study design based on interviews was used, and a purposeful sample and snowball technique were used to identify nurses with prehospital emergency experience of caring for patients with limited Swedish-English proficiency.
Eleven nurses were interviewed, and the main strategy they used was adapting to the patients' need and the caring situation. The nurses used their own body, and tone of voice for creating a sense of trust and security. The nurses also used structured assessment in accordance with medical guidelines. Translation devices and relatives/bystanders were used as interpreters when possible. Another strategy was to transport the patient directly to the emergency department as they had not found a secure way of assessing and caring for the patients in the ambulance.
The nurses used a palette of strategies while assessing and caring for patients when there was no mutual language between the caregiver and care seeker.
The nurses need to be prepared for how to assess and care for patients when there is a lack of mutual language; otherwise, there is a risk of increased unequal care in the ambulance service. To further explore and learn about this field of research, studies exploring the patients' perspective are needed.
PubMed ID
29679408 View in PubMed
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Prehospital management of traumatic brain injury patients--a gender perspective.

https://arctichealth.org/en/permalink/ahliterature278757
Source
Int Emerg Nurs. 2015 Jul;23(3):250-3
Publication Type
Article
Date
Jul-2015
Author
Ann-Charlotte Falk
Annika Alm
Veronica Lindström
Source
Int Emerg Nurs. 2015 Jul;23(3):250-3
Date
Jul-2015
Language
English
Publication Type
Article
Keywords
Brain Injuries, Traumatic - mortality - therapy
Emergency Medical Services - manpower
Female
Glasgow Coma Scale
Hospital Mortality
Hospitals, University
Humans
Length of Stay - statistics & numerical data
Male
Middle Aged
Retrospective Studies
Sex Factors
Survival Rate
Sweden - epidemiology
Abstract
Studies show that there are differences between men and women when it comes to several aspects of health care. But the research on equal care in a prehospital setting for patients with severe traumatic brain injury (TBI) has been sparsely investigated. The aim of this study is to describe prehospital care from a gender perspective.
This is a retrospective study of (n = 651) patients (>15 years) with severe TBI requiring intensive care at a University Hospital in Sweden during the years 2000-2010. Outcome was measured by survival and Glasgow Outcome Scale (GOS) scores at discharge.
Our results show differences, though not significant, in the initial assessments and performed interventions between male and female TBI patients. Female patients received more assessments and performed interventions compared to men during prehospital care. Men received more interventions with I.V. fluid but significantly less airway interventions (endotracheal intubation) compared to female patients. More men were transported directly to neurosurgical specialist care as compared to females. No difference in outcome was found.
Our results show differences, however not significant in the assessments and performed interventions between gender, with female patients receiving more assessments and interventions compared to male patients during prehospital care. Future research should focus on gender differences in initial early signs of TBI to improve early identification.
PubMed ID
25676258 View in PubMed
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14 records – page 1 of 2.