Magister Scientiae (Physiotherapy) - MSc(Physio) / Stroke is a leading cause of death and disability worldwide. Individuals with stroke often face functional limitations. There are several factors that are associated with functional outcome post stroke. Treatment in a stroke unit with a multidisciplinary approach reduces the likelihood of dependency after stroke. The aim of the present study is to identify factors influencing functional outcome of stroke patients admitted to a South African tertiary hospital. A descriptive, observational, longitudinal quantitative study design was used to obtain the data. Convenience non-probability sampling method was used. The research instruments used to collect the data were National Institute of Health Stroke Scale (NIHSS), Hospital Anxiety and Depression Scale (HADS), Barthel Index and a socio-demographic and medical profile data form. All the instruments were used at admission and discharge while at two months only Barthel Index was used for data collection. The data analysis was done using SPSS v 18 and SAS v 9. Mean, standard deviation, range and percentages were used for descriptive purposes and Tobit analysis was used to determine the association between independent and dependent variables. The descriptive results showed that the mean age was 59.83 years with number of females slightly more than males and hypertension being the most common risk factor. The results of the quantitative analysis revealed four factors that influence functional outcome at either discharge or at two months: age, severity of stroke, functional level at admission. Age and severity of stroke influenced the functional outcome at both the stages. The necessary ethical clearance was obtained in prior to commencement of the study. The outcomes of the study could contribute to enhance rehabilitation of stroke patients at an inpatient settings and awareness among population.

Acute ischemic stroke (AIS) is a major cause of death and disability in the United States. With advancements in therapeutic reperfusion, it has become clear that improving time-to-treatment is among the most important factors in yielding better outcomes for patients. When AIS occurs in the community, away from readily available interventions, timely recognition and transport are paramount to decreasing the time-to-treatment and ultimately increasing rates of reperfusion and reducing morbidity and mortality. Over the past several years, investigations have launched studying the efficacy of mobile stroke units (MSU) in reducing the morbidity and mortality burden of AIS. MSUs are specially designed transport vehicles, run by trained expert stroke management personnel, and stocked with diagnostic imaging equipment in the form of computed tomography scanners and fibrinolytic therapy. In a number of prospective study designs comparing MSUs to standard management by emergency medical services, researchers have utilized several endpoints including time-to-treatment, rates of symptom resolution, and long-term recovery from AIS. These studies have generally demonstrated better outcomes with MSUs and provided evidence for the efficacy of the MSU model in treating AIS. However, most studies have been limited to metropolitan regions of the country, and no randomized-controlled trials have been completed, although one is currently underway. There is little evidence, however, evaluating the cost-effectiveness of MSUs in the management of AIS. The expense of constructing and operating these specialized vehicles over ten years has been estimated to be millions of dollars, while the cost of a single case of AIS can range anywhere from the cost of the emergency department visit to the inclusion of long-term care from resultant sequelae depending on the patient outcome. It remains unclear to what degree the upfront investment in quicker management for AIS is capable of producing downstream cost savings for the healthcare system in the setting of demonstrated improved outcomes. In this study, I propose a method of cost-effectiveness analysis to compare the MSU model to standard management of AIS occurring in metropolitan communities to determine whether MSUs are cost-effective, or possibly cost-saving.

Die vorliegende Arbeit überprüft an einem nach Alter, Geschlecht, Barthel-Index und Mini-Mental-State-Test gematchten geriatrischen Patientenkollektiv mit erstmaligem Schlaganfall die Wirksamkeit einer vorausgegangenen Akutbehandlung an einer Stroke Unit (n=59) gegenüber einer allgemeinen (internistischen oder neurologischen) stationären Akutbehandlung (n=59) für die Prognose im Laufe einer nachfolgenden geriatrischen Rehabilitationsbehandlung. Hintergrund dieser Frage ist der erhöhte ökonomische Druck im Gesundheitswesen, der eine Effizienzprüfung einer personell, technisch und logistisch aufwändigeren und damit teureren Behandlung auf einer Spezialstation verlangt. Bei Anwendung zahlreicher funktioneller Skalen und Erhebung einiger sozioökonomischer Faktoren zeigte sich auf Signifikanzniveau, dass die auf Stroke Unit Vorbehandelten bei Aufnahme in die Rehabilitation motorisch schwerer beeinträchtigt waren (timed up and go-Test p=0,044, Lachs-Test p=0,34) und sich dann ausgeprägter (Transferleistung p=0,024) auf ein bei Rehabilitationsende schließlich vergleichbares Leistungsniveau verbesserten. Die ursprünglich geplante Langzeiteffizienzbetrachtung im Gruppenvergleich scheiterte an Datenschutzbedenken. Gesundheitsökonomisch relevant ist, dass die Vorverweildauer im Akutkrankenhaus bei Stroke Unit-Patienten sechs Tage kürzer war, die Rehabilitationsdauer allerdings vier Tage länger. Weitergehende Kostenbetrachtungen scheiterten am Unwillen zur Leistungsoffenlegung verschiedener Beteiligter im Gesundheitssystem. Eine plausible Erklärung für diese positive motorische Leistungsweiterentwicklung nach Stroke Unit-Vorbehandlung kann in einer frühzeitigeren und effektiveren Anstrengung durch Krankengymnastik, Ergotherapie, Logopädie, aktivierende Pflege, „enriched environment“ gesucht werden, die sich positiv auf die Plastizität im Gehirn als wesentliche Bedingung zur Funktionswiedergewinnung auswirken könnte, was aber noch umstritten ist und Ziel weiterer Untersuchungen sein muss. / This dissertation compares 2 groups of geriatric patients during their stay in a rehabilitation clinic after they suffered a first apoplexy. The first group is a group a 59 patients who have been admitted in the hospital on a general ward after their stroke. In the second group (n=59), the patients have been admitted in a special stroke unit after the apoplexy. In order to study the profit of the stroke unit pre-treatment, the 2 groups have been compared under the following criteria: age, sex, barthel-index and mini-mental-state examination. A long term comparison of efficiency was impossible because of data protection. The stroke unit patients stayed 6 day shorter in the acute hospital but they had to stay 4 days longer during the rehabilitation treatment before leaving the clinic of rehabilitation. Le travail suivant examine l’efficacité d’un traitement d’urgence dans un service de stroke unit par rapport à un traitement d’urgence dans un service général stationnaire (médecine interne ou neurologie) sur le pronostique lors du traitement de rééducation gériatrique à venir. Afin de pouvoir établir une comparaison, un groupe de patients gériatriques ayant subi un premier AVC a été choisi et couplé selon les critères de l’âge, du sexe, de l’index de Barthel et du test « mini-metal-state ». L’intérêt de cette question est la forte pression économique dans le secteur de la santé qui exige l’examen de l’efficacité d’un traitement dans un service spécialisé dont les moyens personnels, techniques et logistiques sont plus élévés et plus chers. L’utilisation de nombreuses échelles fonctionnelles et le relevé de quelques facteurs socio-économiques ont permis de mettre en évidence de facon significative que les patients traités dans un service stroke unit étaient plus gênés sur le plan motorique lors de l’admission mais qu’à la fin de la rééducation, ils s’étaient améliorés de facon nette, atteignant finalement un niveau de performance comparable. L’observation de l’efficacité à long terme dans le groupe de comparaison initialement prévue, a finalement échoué en raison de doutes quant à la protection des données. En ce qui concerne l’aspect éco-sanitaire, il est flagrant que le séjour à l’hôpital avant la rééducation a duré 6 jours de moins chez les patients du groupe stroke unit, mais la durée de rééducation 4 jours de plus. Il a été impossible d’examiner les coûts plus en détail en raison du refus de différents acteurs du système sanitaire à mettre leurs données à disposition. Cette évolution positive de la performance motorique suite au pré-traitement stroke unit peut s’expliquer par les efforts très précoces fournis en matière de physiothérapie, d’ergothérapie, de logopédie et de soins de rééducation active (enriched environment) qui ont une influence positive sur la plasticité du cerveau, laquelle est une condition indispensable au regain de fonctions. Ceci est encore controversé et devra faire l’objet d’autres études.

Stroke är den näst vanligaste dödsorsaken i världen och den tredje vanligaste orsaken till funktionshinder. I Sverige drabbas cirka 25 000 personer årligen. Patienter med stroke är den enskilda sjukdomsgrupp som står för flest vårddagar på svenska sjukhus. I akut behandling av stroke används termen ”Time is Brain”, då det dör cirka två miljoner hjärnceller vid varje minuts fördröjning. Det har utförts stora ansträngningar i två decennier för att effektivisera akuta vårdkedjan vid stroke. Endast två till 13 procent av patienterna får möjlighet till behandling på sjukhus med trombolys och antalet trombektomi är mycket lägre. Av de patienter som får trombolys är det cirka en till tio procent som får trombolys inom en timme efter symtomdebut. Främsta orsaken till underbehandling är att patienter inte når sjukhuset tillräckligt snabbt för att undersökas och behandlas inom det smala terapeutiska fönstret. I Sverige år 2016 anlände 33 procent av patienterna med stroke inom tre timmar till sjukhus och antalet har inte ökat sedan 2011. Det var angeläget att beskriva befintlig kunskap om hur ambulanspersonal kan påskynda behandlingen för patienter med stroke. Syftet var att belysa ambulansteamets betydelse för att minska tiden från symtomdebut till behandling av stroke Metoden för studien var en litteraturöversikt med 16 vetenskapliga artiklar publicerade mellan åren 2012 och 2017. Artiklarna söktes i databaserna PubMed och Cinahl. Resultatet som framkom av de valda artiklarna kunde sammanställas genom två huvudkategorier och fem underkategorier. Den ena huvudkategorin handlade om ambulanspersonalens omhändertagande av patienter med stroke. Den andra huvudkategorin handlade om ambulanspersonalens kunskap. Resultatet visade att ambulanspersonal kunde genom teamarbete i ett ambulansfordon med en inbyggd röntgenapparat, kallad Mobile Stroke Unit (MSU), förkorta tiden från symtomdebut till behandling. MSU var mellan 25 till 81 minuter snabbare, jämfört med konventionell ambulans. Dörr-till-nål tiderna (tiden från det att patient ankommer till sjukhus till start av trombolys) förbättrades med fem minuter när ambulanspersonal förvarnade sjukhusen med strokelarm. Ambulanspersonal förbättrade inte akuta vårdkedjan med hjälp av telemedicin. Patienter med stroke i bakre cirkulationen hade en timmes prehospitala fördröjningar jämfört med patienter med stroke i främre cirkulationen. Akuta vårdkedjan förbättrades inte när ambulanspersonal fick en timmes föreläsning om stroke. Slutsatsen var att ambulansteamet förkortade tiden från symtomdebut till behandling genom teamarbete i Mobile Stroke Unit. Ambulansteamet förbättrade inte akuta vårdkedjan med hjälp av telemedicin. Det skedde prehospitala fördröjningar för patienter med stroke i bakre cirkulationen. Ytterligare forskning av MSU behövs. Framtida randomiserade studier bör undersöka kliniskt utfall och kostnadseffektivitet. Det bör även forskas i området om hur ambulansteamet kan minska tiden från symtomdebut till behandling av stroke i en konventionell ambulans. Nyckelord: stroke, ambulanspersonal, tid, prehospital trombolys, Mobile Stroke Unit. / Stroke is the second most common cause of death in the world and the third most common reason cause for disability. In Sweden approximately 25000 people are affected annually. Patients whit stroke are the group that accounts for most care days in Swedish hospitals. In acute stroke treatment, the term "Time is Brain" is used, as about two million brain cells die at every minute delay. Despite two decades of substantial efforts to streamline systems of care in stroke, only two to 13 percent of patients receive the treatment thtombolysis in a hospital and the rates of delivery of thrombectomy are far lower. Of the patients who are treated with thrombolysis, approximately one to ten percent receives thrombolysis within one hour after symptom on set. The main reason for such undertreatment is that patients do not reach the hospital quickly enough to be assesed and treated within the narrow therapeutic window. In Sweden 2016, only 33 percent of patients with stroke arrived to the hospital within three-hours after symptom on set and the rates has not increased since 2011. It was important to describe existing knowledge about how the ambulance staff can shorten the time from symptom on set to treatment for stroke patients. The aim was to highlight the importance of the ambulance staff to reduce the time from symptom on set to stroke treatment. The method of the study was a literature review of 16 scientific articles published between the years 2012 and 2017. The articles were searched in the PubMed and Cinahl databases. The results obtained from the selected articles were compiled by two main categories and five subcategories. One main category was about the care of ambulance staff in patients with stroke. The second main category was about the ambulance staff's knowledge. The result showed that ambulance staff can shorten the time from symptom on set to treatment though teamwork in an ambulance with an inbuilt CT-scan, called Mobile Stroke Unit (MSU). MSU was between 25 minutes and 81 minutes faster, compared to conventional ambulance. Door-to-Needle time (time from patient arriving to hospital until start of thrombolysis) improved with five minutes when ambulance staff warned the hospital with a strokealarm. Ambulance staff did not improve the system of care using telemedicine. Patients with stroke in the posterior circulation had one hour of prehospital delays compared with patients with stroke in the anterior circulation. The system of care did not improve when ambulance staff received an hour's lecture on stroke. The conclusion was that ambulance staff shortened the time from symptom on set to treatment through teamwork in the Mobile Stroke Unit. Ambulance staff did not improve the system of care using telemedicine. There where prehospital delays for patients with stroke in the posterior circulation. Further research of MSU is required. Further randomized studies should investigate clinical outcome and cost-effectiveness. It should also be researched in the area of how the ambulance staff can shorten the time from symptom on set to treatment in a conventional ambulance Keywords: stroke, emergency medical service, time, prehospital thrombolysis, Mobile Stroke Unit.

ABSTRACT Speech-language pathology practice in the acute hospital setting has changed dramatically over the last 25 years. A significant increase in the number of referrals and a broadening of the speech-language pathologist’s caseload to include patients with dysphagia has meant there has been less time to see hospital inpatients with communication disabilities. This change in practice has caused speech-language pathologists working in the acute hospital setting to question their role in relation to patients with communication disabilities in the acute hospital setting. The thesis applies the World Health Organization’s International Classification of Functioning, Disability and Health (ICF) framework to explore the role of speech-language pathologists in the acute hospital setting, specifically the acute hospital stroke unit, in relation to patients with communication disabilities. The ICF proposes that a health condition can be understood in terms of four separate components. These components are Body Structures and Functions, Activities and Participation, Environmental Factors and Personal Factors. Whilst the distinction between body structures and body functions within the ICF Body Functions and Structures component is clear, there is less clarity about the relationship between the ICF concepts of activity and participation in the ICF Activities and Participation component. Therefore, the first part of the thesis explores the conceptual similarities and differences between the concepts of activity and participation generally and communication activity and communication participation in particular. This discussion concludes that the ICF concepts of activity and participation are distinct concepts that are considered separately in this thesis. Following this conceptual clarification, the thesis applies the ICF framework to patients with communication disabilities in the acute hospital stroke unit. Specifically, patients with communication disabilities are described from the perspective of communication-related body functions within the ICF Body Structures and Functions component, communication activities within the ICF Activities and Participation component and communication-related environmental factors in the ICF Environmental Factors component. It is important to understand how many patients experience a communication disability in the acute hospital stroke unit so that adequate supports can be developed. Therefore an efficient way of identifying patients in acute hospital stroke units with a communication-related body function impairment such as hearing, vision, speech, language and/or cognitive communicative impairment was required. Hence, the first study describes the development of ICF compatible scales, called the OHW scales, to rate a patient’s degree of speech, language and cognitive communicative impairment. These three rating scales were called the OHW scales because they reflect the WHO framework and also represent the authors’ initials. The concurrent validity and interrater reliability of the OHW scales were then investigated. Results indicated that the OHW had acceptable levels of concurrent validity against standardised measures of speech, language and cognitive communicative impairment. The speech and cognitive communicative OHW scales also demonstrated moderately high interrater reliability, but exact agreement on the OHW language impairment scale was low. At a minimum, the OHW scales were valid measures of speech, language and cognitive communicative impairment and therefore they were used by the researcher to determine the number of patients with communication-related impairments in the acute hospital stroke unit. Patients in acute hospital stroke units may have communication-related impairments, such as speech, language or cognitive communicative impairments as a consequence of stroke. Patients may also have communication-related impairments (e.g., in hearing, vision and cognitive communicative) due to ageing and age related illnesses. Therefore, the second study of the thesis describes the number of patients with communication-related impairments in acute stroke units, regardless of the cause. Of the 69 patients screened, 88% had a mild or more severe communication-related impairment. In addition, 69% of inpatients, screened on two or more measures, had multiple communication-related impairments. Although many patients in acute stroke units have communication-related impairments, what may be particularly important is how many patients experience difficulty communicating their healthcare needs with healthcare providers in acute hospital stroke units. The ICF describes a person’s ability to carry out an activity, such as communicate healthcare needs, as an activity limitation. The ICF describes activity limitations in four different ways. Two ways are capacity with assistance and performance. Capacity with assistance indicates the person’s highest probable level of function in an activity given assistance and performance indicates a person’s level of function in the context of everyday life. Therefore, the third study of the thesis details how many patients experienced capacity with assistance limitation, that is, difficulty communicating their healthcare needs given assistance, and performance limitation, that is, difficulty communicating their healthcare needs during everyday healthcare routines. Results indicated that 51% of 65 patients had a capacity with assistance limitation and 57% had a performance limitation. Strong and significant relationships were found between patients’ degree of communication-related impairments and their degree of communication activity limitation, in both capacity with assistance and performance. Furthermore, the presence of a communication-related impairment accounted for up to 77% of the variance in a patient’s capacity with assistance limitation. Such impairments only accounted for up to 32% of the variance in a patient’s performance limitation. This finding suggests that other factors, such as environmental factors also affect a patient’s ability to communicate, particularly during everyday health care routines. In light of this, a review of the literature on the range of environmental factors that influence communication between patients with communication-related impairments and healthcare providers in the acute hospital setting was conducted. The review of the literature indicated the need for research on the environmental factors that influence communication between patients and healthcare providers in the acute hospital stroke unit. Therefore, the final study of the thesis investigates this further. This study employed a focused ethnographic methodology to identify the range of environmental factors that appeared to influence communication between patients and their healthcare providers. Seven themes were identified including the healthcare providers’ knowledge of communication-related impairments, skills, attitudes, and individual characteristics. Other themes included the presence of family, the physical environment and hospital systems and services. In summary, this series of studies indicates that the majority of patients admitted into acute hospital stroke units have a communication-related impairment and approximately half to two thirds of patients experience difficulty communicating their healthcare needs with healthcare providers. Whilst having a communication-related impairment increases the likelihood that a patient will experience difficulty communicating with healthcare providers, other factors, such as the communicative environment also appear to play an important role. Speech-language pathologists working in the acute hospital stroke unit may have an important role in identifying patients who are experiencing difficulty communicating their healthcare needs and supporting these patients and their healthcare providers to communicate in optimal ways. Further research is required to demonstrate that improving a patient’s ability to communicate with his or her healthcare providers improves a patient’s health outcomes. With this evidence, speech-language pathologists may be more able to support patients with communication disabilities to get the healthcare they deserve.

Stroke is a major health problem in all developed countries. These studies, performed in a stroke unit at a medical department, were designed to characterize essential clinical features of the different cerebrovascular disorders on admission to hospital, to evaluate the efficacy of admitting unselected stroke patients to a stroke unit and, to evaluate hemodilution as a therapeutical regime in patients with cerebral infarction. A prospective registry included 409 patients admitted to the stroke unit over a five-year period. Modern diagnostic equipment (CT scan and CSF analyses) and strict diagnostic criteria revealed a diagnostic distribution of 11% hemorrhagic, 76% ischemic cerebrovascular lesions and 13% TIAs. Mean age varied between 65.8 and 77.5 years in the various diagnostic groups with the highest in patients with embolic cerebral infarctions. Concomitant disorders affecting the cardiovascular system were highly prevalent and only 14% was free of such diseases prior to the stroke. In a comparative prospective study, over 16 months, no differences were found between patients treated in the stroke unit (n = 110) and the general medical wards (n = 183) regarding prognostic indicators on admission such as age, concomitant disorders and neurological symptoms. The stroke patients treated in the stroke unit had a statistically significant better prognosis regarding functional outcome and the need for long-term hospitalization was reduced up to one year after the stroke when compared to patients treated in general medical wards. All stroke patients seemed to benefit with the possible exception of patients in coma on admission. These results were achieved within the same or shorter length of initial hospital stay for patients in the stroke unit. Neither overall mortality, nor mortality in subgroups of prognostic importance was significantly affected by the stroke unit regime. Rapid hemodilution in the early phase of cerebral infarction by the combination of venesection and administration of dextran 40 was evaluated in a prospective controlled trial. After randomization 52 hemodi- luted and 50 control patients were comparable in prognostic variables. Signs of blood-brain-barrier breakdown and hemorrhagic admixture to the cerebrospinal fluid in the acute phase were less frequent in hemodiluted subjects. The hemodi luted patients showed a significantly higher degree of early improvement and fewer progressions. Neurological and functional disability in survivors and need for long-term hospitalization was significantly reduced at 3 months and at one year after the stroke compared to controls. Mortality was not affected. / digitalisering@umu

No description available.

Immediate treatment is of extreme importance for stroke patients. However, providing fast enough treatment for stroke patients is far from trivial, mainly due to logistical challenges and difficulties in diagnosing the correct stroke type. One way to reduce the time to treatment is to use so-called Mobile Stroke Units (MSUs), which allows to diagnose and provide treatment for stroke patients already at the patient scene. A well-designed stroke transport policy is vital to improve the access to treatment for stroke patients. Simulation and mathematical optimization are useful approaches for assessing and optimizing stroke transport policies, without endangering the health of the patients. The main purpose of this thesis is to contribute to improving the situation for stroke patients and to reducing the social impacts of stroke. The aim is to study how to use simulation and optimization to achieve improved analysis and planning of prehospital stroke care. In particular, we focus on assessing the potential use of MSUs in a geographic area. In this thesis, optimization is used to identify the optimal locations of MSUs, and simulation is used to assess different stroke transport policies, including MSU locations. The results of this thesis aim to support public health authorities when making decisions in the prehospital stroke care domain. In order to fulfill the aim of this thesis, we develop and analyze a number of different simulation and optimization models. First, we propose a macro-level simulation model, an average time to treatment estimation model, used to estimate the expected time to treatment for different parts of a geographic region. Using the proposed model, we generate two different MSU scenarios to explore the potential benefits of employing MSUs in Sweden’s southern healthcare region (SHR).   Second, we present an optimization model to identify the best placement of MSUs while making a trade-off between the efficiency and equity perspectives, providing maximum population coverage and equal service for all patients, respectively. The trade-off function used in the model makes use of the concepts of weighted average time to treatment to model efficiency and the time difference between the expected time to treatment for different geographical areas to model equity. In a scenario study applied in the SHR, we evaluate our optimization model by comparing the current situation with three MSU scenarios, including 1, 2, and 3 MSUs. Third, we present a micro-level discrete event simulation model to assess stroke transport policies, including MSUs, allowing us to model the behaviors of individual entities, such as patients and emergency vehicles, over time. We generate a synthetic set of stroke patients using a Poisson distribution, used as input in a scenario study. Finally, we present a modeling framework with reusable components, which aims to facilitate the construction of discrete event simulation models in the emergency medical services domain. The framework consists of a number of generic activities, which can be used to represent healthcare chains modeled in the form of flowcharts. As the framework includes activities and policies modeled on the general level, the framework can be used to create models only by providing input data and a care chain specification. We evaluate the framework by using it to build a model for simulating EMS activities related to the complex case of acute stroke. / <p>Note: The papers are not included in the fulltext online.</p>

Tid till behandling är livsviktigt för människor som får en stroke. På olika platser i världen har man därför sett värdet i att införskaffa en specialambulans för stroke (stroke-ambulans) som har specialutrustning och specialpersonal som kan utföra intravenös behandling (trombolys). Då det är uppenbart att dess involvering i vården skulle hjälpa åtminstone en viss andel patienter används ofta ingen utvecklad metod eller analys av var och hur denna stroke-ambulans ska placeras. Genom att noggrant undersöka läget i Skåne län om hur denna placeringen kan gå till, är vårt mål att genom vår metod, som bygger på optimering av förväntade transporttider, upplysa beslutstagare om olika perspektiv man bör ta hänsyn till. Vår metod kan användas över olika geografiska områden.Vi föreslår en optimeringsmetod som utgår från två olika perspektiv: effektivitet och jämlikhet. Metoden visar att beroende på vilket perspektiv man väljer, kan den optimala placeringen för ett givet område variera kraftigt. Det är därför viktigt att beslutstagare av placering för stroke-ambulanser har tydliga och väl genomtänkta mål. Dessa mål bör även innefatta de lokala sjukhusens mål när det kommer till förbättring av behandlingstiden för strokepatienter, s.k. door-to-needle-time (DTN) då dessa i vissa fall kan göra större förbättringar än vad en införskaffning av en stroke-ambulans skulle göra. / Tid till behandling är livsviktigt för människor som får en stroke. På olika platser i världen har man därför sett värdet i att införskaffa en specialambulans för stroke (stroke-ambulans) som har specialutrustning och specialpersonal som kan utföra intravenös behandling (trombolys). Då det är uppenbart att dess involvering i vården skulle hjälpa åtminstone en viss andel patienter används ofta ingen utvecklad metod eller analys av var och hur denna stroke-ambulans ska placeras. Genom att noggrant undersöka läget i Skåne län om hur denna placeringen kan gå till, är vårt mål att genom vår metod, som bygger på optimering av förväntade transporttider, upplysa beslutstagare om olika perspektiv man bör ta hänsyn till. Vår metod kan användas över olika geografiska områden.Vi föreslår en optimeringsmetod som utgår från två olika perspektiv: effektivitet och jämlikhet. Metoden visar att beroende på vilket perspektiv man väljer, kan den optimala placeringen för ett givet område variera kraftigt. Det är därför viktigt att beslutstagare av placering för stroke-ambulanser har tydliga och väl genomtänkta mål. Dessa mål bör även innefatta de lokala sjukhusens mål när det kommer till förbättring av behandlingstiden för strokepatienter, s.k. door-to-needle-time (DTN) då dessa i vissa fall kan göra större förbättringar än vad en införskaffning av en stroke-ambulans skulle göra. / The time to treatment is vital for people who suffer from a stroke. Therefore, in different places in the world, the value of acquiring a specially developed ambulance for a stroke (i.e., a Mobile Stroke Unit, MSU) with special equipment and specialists who can perform intravenous treatment (thrombolysis) has been identified. Since it is clear that an MSU’s involvement in health care would aid at least a certain proportion of the patients, the MSU is often purchased and placed without any developed method or analysis of where and how this MSU is to be placed. By carefully examining the situation in Skåne Municipality of how this placement could be performed, we will inform decision makers about different perspectives that should be taken into consideration, including other areas than Skåne.Our optimization method showed that depending on what perspective you are investing, efficiency or equality, the optimal placement for any given area can vary greatly. It is therefore importantthat decision-makersofMSUpurchaseshaveclearandwell-thought-outgoals.These goals should also include the goals of the local hospitals when it comes to improving the treatment time for stroke patients, door-to-needle (DTN), as the DTN may in some cases make greater improvements than a purchase of an MSU would. / The time to treatment is vital for people who suffer from a stroke. Therefore, in different places in the world, the value of acquiring a specially developed ambulance for a stroke (i.e., a Mobile Stroke Unit, MSU) with special equipment and specialists who can perform intravenous treatment (thrombolysis) has been identified. Since it is clear that an MSU’s involvement in health care would aid at least a certain proportion of the patients, the MSU is often purchased and placed without any developed method or analysis of where and how this MSU is to be placed. By carefully examining the situation in Skåne Municipality of how this placement could be performed, we will inform decision makers about different perspectives that should be taken into consideration, including other areas than Skåne.Our optimization method showed that depending on what perspective you are investing, efficiency or equality, the optimal placement for any given area can vary greatly. It is therefore importantthat decision-makersofMSUpurchaseshaveclearandwell-thought-outgoals.These goals should also include the goals of the local hospitals when it comes to improving the treatment time for stroke patients, door-to-needle (DTN), as the DTN may in some cases make greater improvements than a purchase of an MSU would.

No description available.