Bakgrund: Intensivvård är den högsta vårdinstansen på ett sjukhus, en av sjukvårdens mest resurskrävande behandlingsformer. När en patient blir kritiskt sjuk eller påvisar försämrade vitalparametrar kontaktar vårdpersonalen mobil intensivvårdsgrupp (MIG) som utgår ifrån intensivvårdsavdelningen (IVA). Problemformulering: De kritiskt sjuka patienterna vårdas inte längre bara på IVA men också på vårdavdelningar. I ett omvårdnads- och professionsperspektiv som intensivvårdssjuksköterska är det av betydelse och centralt att förstå orsakerna till kontakt med MIG. Syfte: Att kartlägga kontakter, orsaker och skillnader med mobil intensivvårdsgrupp på ett sjukhus i Västra Götalandsregionen. Metod: En icke-experimentell studie med ett konsekutivt urval och retrospektiv journalgranskning av 386 patientkontakter med MIG under åren 2017–2019. Resultat: Studiens resultat påvisar en hög medelålder. Ingen skillnad återfanns i patientgruppen ur ett könsperspektiv. Den framträdande gruppen är den geriatriska patienten ≥65år som är utsatt och en högriskgrupp vid kontakt med MIG. De utgör majoriteten av alla kontakter med MIG åren 2017–2019. Diskussion: Studiens kartläggning och resultat påvisar behov av kompetenshöjande utbildning och optimeringsteam. Geriatriska patientgruppen behöver vårdinsatser i rätt tid och med rätt kompetens för att minska antalet MIG kontakter och initiera insatser i förtid och motverka svikt av vitala parametrar.

The Institute for Healthcare Improvement (IHI) has promoted implementing a RRS to provide safer care for hospitalized patients. Additionally, the Joint Commission made implementing a RRS a 2008 National Patient Safety Goal. Although mandated, the evidence to support the effectiveness of a RRS to reduce cardiac arrests on hospital medical or surgical floors and un-anticipated ICU transfers remains inconclusive, partly because of weak study designs and partly due to a failure of published studies to report all critical aspects of their intervention. This study attempted to evaluate the effectiveness and the implementation of a RRS on the two campuses of the UMass Memorial Medical Center (UMMMC). The first study presented was an attempt to identify the preventability and timeliness of floor to ICU transfers. This was done using 3 chief residents who reviewed 100 randomly selected medical records. Using Cohen’s kappa to assess the inter-rater reliability it was determined that 13% of the cases could have possibly been preventable with earlier intervention. The second study was an evaluation of the effectiveness of the Rapid Response System. Outcomes were cardiac arrests, code calls and floor to ICU admissions. There were two study periods 24 months before the intervention and 24 months after. A Spline regression model was used to compare the two time periods. Though there was a consistent downward trend over all 4 years there were no statistically significant changes in the cardiac arrests and ICU transfers when comparing the before and after periods. There was a significant reduction in code calls to the floors on the University campus. The third study was a modified process evaluation of the Rapid Response intervention that will assess fidelity of RRS implementation, the proportion of the intended patient population that is reached by the RRS, the overall number of RRS calls implemented (dose delivered) and the perceptions of the hospital staff affected by the RRS with respect to acceptability and satisfaction with the RRS and barriers to utilization. The process evaluation showed that that the Rapid Response System was for the most part being used as it was designed, though the nurses were not using the specific triggers as a deciding factor in making the call. Staff satisfaction with the intervention was very high. Overall these studies demonstrated the difficulty in clearly defining outcomes and data collection in a large hospital system. Additionally the importance of different study designs and analysis methods are discussed.

Bakgrund: Specialistsjuksköterskan i en prehospital miljö ställs inför utmaningar när en svår luftväg inte längre kan hanteras genom basal luftvägshantering. Denna situation kräver spetskompetens inom avancerad luftvägshantering och anestesi, samt särskilda hjälpmedel. Inom vissa regioner finns en prehospital förstärkningsenhet som har som uppgift att komplettera ordinarie verksamhet med spetskompetens när det finns behov av avancerad luftvägshantering. Syfte: Syftet med studien var att studera anestesisjuksköterskors strategier vid hantering av svår luftväg i en prehospital förstärkningsenhet. Metod: En kvalitativ studie med datainsamling via enkät tillämpades och analyserades med kritisk incident teknik (CIT). Sexton anestesisjuksköterskor i en prehospital förstärkningsenhet i Sverige besvarade enkäten. Resultat: Analysen ledde fram till fyra betydelsefulla strategier för att hantera en svår luftvägprehospitalt. Förberedelse i att ställas inför en svår luftväg, mental förberedelse på väg ut på larm, möjligheten att lägga upp en primär samt en sekundär plan tillsammans med kollegan och att våga agera direkt var strategier som identifierades för att hantera en svår luftvägprehospitalt. Detsamma gällde att ta beslut i tid, att flytta patienten så att omhändertagandet inte behövde anpassas i onödan av omständigheter som kanske gick att undvika, att skapa åtkomst och insyn till patientens luftväg och ha närhet till egen utrustning vid hantering av en svår luftväg. Kollegan, teamkänsla, kommunikation, igenkännande, förståelse för varandras uppdrag och kännedom om varandras arbetssätt och utrustning var framgångsfaktorer för att få ett bra och effektivt teamarbete runt den svårt sjuka patienten. Utrustning som normalt inte fanns i en akutambulans som videolaryngoskop, endotrakealtub förberedd med ledare, kapnograf och en bra sug var framgångsfaktorer för att hantera en svår luftväg prehospitalt. Slutsats: Resultatet kan komplettera specialistutbildningar och introduktionsutbildningar för att göra specialistsjuksköterskan bättre förberedd på luftvägshantering i en prehospital miljö. Kunskapen kan bidra till en större förståelse för hur den svåra luftvägen på olika sätt kan undvikas eller hanteras. Basal luftvägshantering skall ambulanssjuksköterskan behärska i sin akutambulans men för hantering av den svåra luftvägen behövs särskild spetskompetens, hjälpmedel och förmåga.

A rapidly growing topic of great interest is the adaptation of benchtop analytical instrumentation for use in outdoor harsh environments. Some of the areas that stand to benefit from field instrumentation development include government agencies involved with the preservation of the environment and institutions responsible for the safety of the general public. Detection systems are at the forefront of the miniaturization movement as the interest in analyte identification and quantitation appears to only be accessible through the use of analytical instrumentation. Mass spectrometry is a distinguished analytical technique known for its ability to detect the mass-to-charge (m/z) ratios of gas-phase ions of interest. Although these systems have been routinely limited to research lab-based analysis, there has been considerable development of miniaturized and portable mass spectrometry systems. Membrane Inlet Mass Spectrometry (MIMS) is becoming a common method of sample introduction that is subject to significant development. MIMS allows for minimal sample preparation, continuous sampling, and excludes complicated analyte introduction techniques. Sampling is accomplished using a semipermeable membrane that allows selective analyte passage into the vacuum of the mass spectrometer. MIMS is becoming the preeminent choice of homeland security and environmental monitoring applications with increasing opportunities for the future development of specialized systems. The steadfast development of miniaturized mass spectrometry systems with efficient operation capabilities for a variety of applications gives promise to the further development of MIMS technology as well as other analytical instrumentation.

Objective: Analysis of short- and long-term effects of rapid response across three different treatments for binge-eating disorder (BED). Method: In a randomized clinical study comparing interpersonal psychotherapy (IPT), cognitive-behavioral guided self-help (CBTgsh), and behavioral weight loss (BWL) treatment in 205 adults meeting DSM-IV criteria for BED, the predictive value of rapid response, defined as ≥ 70% reduction in binge-eating by week four, was determined for remission from binge-eating and global eating disorder psychopathology at posttreatment, 6-, 12-, 18-, and 24-month follow-up. Results: Rapid responders in CBTgsh, but not in IPT or BWL, showed significantly greater rates of remission from binge-eating than non-rapid responders, which was sustained over the long term. Rapid and non-rapid responders in IPT and rapid responders in CBTgsh showed a greater remission from binge-eating than non-rapid responders in CBTgsh and BWL. Rapid responders in CBTgsh showed greater remission from binge-eating than rapid responders in BWL. Although rapid responders in all treatments had lower global eating disorder psychopathology than non-rapid responders in the short term, rapid responders in CBTgsh and IPT were more improved than those in BWL and non-rapid responders in each treatment. Rapid responders in BWL did not differ from non-rapid responders in CBTgsh and IPT. Conclusions: Rapid response is a treatment-specific positive prognostic indicator of sustained remission from binge-eating in CBTgsh. Regarding an evidence-based stepped care model, IPT, equally efficacious for rapid and non-rapid responders, could be investigated as a second-line treatment in case of non-rapid response to first-line CBTgsh.

Thesis's Topic: The Activity Analysis of Rescue of Královehradecký kraj, station Trutnov 2006-2009 Aim of the thesis: To analyze the operation of the Emergeny Medical Service in Trutnov. Method: Research of available sources, data collection and the cooperation of the members of the Emergency Medical Service coming to the patient. Results: All here listed statistics data are base on intervetion documentation of Trutnov center. Therefore the presented results can't be taken, generalled to other centers and assumed that will be comparable. Keywords: Integrated Emergency Services, Emergency Medical Service, rapid response vehicle, advanced life support vehicle, calls for the crew of the Emergency Medical Service.

Submitted by Silvana Teresinha Dornelles Studzinski (sstudzinski) on 2017-04-19T15:55:11Z No. of bitstreams: 1 Fábio de Oliveira Dias_.pdf: 3212992 bytes, checksum: 687279fc82a1e707a3ba09c241b5e09b (MD5) / Made available in DSpace on 2017-04-19T15:55:11Z (GMT). No. of bitstreams: 1 Fábio de Oliveira Dias_.pdf: 3212992 bytes, checksum: 687279fc82a1e707a3ba09c241b5e09b (MD5) Previous issue date: 2017-02-17 / Nenhuma / A computação móvel e ubíqua tem propiciado o advento de soluções que permitem o monitoramento em tempo real de sinais provenientes de sensores e o seu processamento por aplicações que podem executar ações de acordo com as condições encontradas. Esta característica possibilita o uso da tecnologia para o monitoramento de condições de saúde de pacientes, denominado de cuidados ubíquos. Em diversas situações, a fim de salvar vidas de pacientes, é necessária a análise de seus sinais vitais de forma a prevenir eventuais colapsos. Este trabalho se insere nestas condições, estando voltado para a antecipação de ações de times de resposta rápida baseado em análise preditiva, propondo o modelo Predictvs. Um Time de Resposta Rápida busca prevenir mortes de pacientes que tenham piora clínica fora de ambientes de Unidades de Tratamento Intensivo em hospitais. De forma diversa dos trabalhos relacionados, que se preocupam apenas com ambientes de tratamento intensivo, o modelo Predictvs busca antecipar ações dos times de resposta rápida, através da análise dos sinais vitais dos pacientes com o uso de escores de alerta precoce e regressão linear. A contribuição científica do modelo é dada em virtude da possibilidade de efetuar a predição em tempo real de possíveis situações de colapso dos pacientes através do monitoramento e análise dos sinais vitais. A avaliação do Predictvs foi efetuada com a utilização de cenários, com a implementação de um protótipo e através de diversas simulações. Análises efetuadas com cerca de 228000 medições provenientes de um dataset público apresentaram bons resultados, onde a precisão da predição para a medição seguinte se mostrou bastante alta, atingindo mais de 99% no caso da frequência cardíaca e 100% na saturação de oxigênio arterial, ultrapassando 95% nos demais sinais vitais. Além disso, o índice de falsos negativos foi consideravelmente baixo, atingindo menos de 1% na frequência cardíaca e na saturação de oxigênio arterial. O índice de falsos positivos também foi baixo, embora não tanto quanto o de falsos negativos. No entanto, predições para três ou mais medições futuras mostram queda na precisão (mesmo demonstrando valores de acerto relativamente expressivos, com diversos sinais fisiológicos acima de 98%) e aumento do número de falsos negativos e, principalmente, de falsos positivos. / The mobile and ubiquitous computing has allowed the emergence of solutions that enable real-time monitoring of signals coming from sensors and processing for applications that can perform actions according to the conditions found. This feature enables the use of this technology for monitoring health conditions of patients, called ubiquitous healthcare. In several situations, in order to save his lives, it is necessary to analyze the vital signs of patients to prevent any collapses. This work is part of these conditions and is aimed at anticipating the actions of rapid response teams based on predictive analysis, proposing the Predictvs model. A Rapid Response Team intends to prevent deaths in patients who have clinical deterioration outside of intensive care units in hospitals environments. Differently of related works, which are concerned only with intensive care environments, the Predictvs model seeks to anticipate the actions of teams of rapid response through the analysis of vital signs of patients with the use of early warning scores and linear regression. The scientific contribution of the presented model is that we could better predict possible collapse situations of patients, through the monitoring and analysis of vital signs. The Predictvs evaluation was performed with the use of scenarios, implementation of a prototype and several simulations. Analyzes performed with about 228,000 measurements from a public dataset showed good results, where the accuracy of the prediction for the next measurement was very high, reaching more than 99% in the case of heart rate and 100% in arterial oxygen saturation, surpassing 95% in other vital signs. In addition, the false negative index was considerably lower, reaching less than 1% in heart rate and arterial oxygen saturation. The rate of false positives was also low, although not so much as that of false negatives. However, predictions for three or more future measurements show a drop in accuracy (even showing relatively expressive set values with several physiological signals above 98%) and an increase in the number of false negatives and, mainly, false positives.

Qualitative and quantitative research methods were used to study instances of sudden gains within the case load of a private practice practitioner. Five clients whose progress was marked by such changes were contrasted with the views of five clients whose progress was marked by significant setbacks. Results from the quantitative analyses indicated that clients who experienced sudden gains during therapy tended to retain their therapeutic gains over a 2-year time period. In contrast, individuals who experienced setbacks in therapy generally continued to be distressed at the 2-year reassessment. Clients who experienced sudden gains were more distressed prior to treatment and were more satisfied with their experience looking back. A stronger working alliance was found amongst those who experienced sudden gains, although there was no difference between the groups' ratings regarding the strength of the therapeutic bond. Qualitative results suggested that therapy was helpful in bringing about many changes in clients' lives, but clients who experienced sudden gains generally recalled more positive aspects of therapy, demonstrated greater utilization of therapeutic techniques, endorsed more long-term changes, accepted more responsibility for their treatment outcomes, and were less likely to react negatively to therapeutic techniques. Clients who experienced setbacks in therapy were generally less optimistic about the future, felt that they had regressed since termination, and demonstrated more resistance to therapeutic techniques.