Essential Emergency and Critical Care: a consensus among global clinical experts.

BACKGROUND: Globally, critical illness results in millions of deaths every year. Although many of these deaths are potentially preventable, the basic, life-saving care of critically ill patients are often overlooked in health systems. Essential Emergency and Critical Care (EECC) has been devised as the care that should be provided to all critically ill patients in all hospitals in the world. EECC includes the effective care of low cost and low complexity for the identification and treatment of critically ill patients across all medical specialties. This study aimed to specify the content of EECC and additionally, given the surge of critical illness in the ongoing pandemic, the essential diagnosis-specific care for critically ill patients with COVID-19. METHODS: In a Delphi process, consensus (>90% agreement) was sought from a diverse panel of global clinical experts. The panel iteratively rated proposed treatments and actions based on previous guidelines and the WHO/ICRC's Basic Emergency Care. The output from the Delphi was adapted iteratively with specialist reviewers into a coherent and feasible package of clinical processes plus a list of hospital readiness requirements. RESULTS: The 269 experts in the Delphi panel had clinical experience in different acute medical specialties from 59 countries and from all resource settings. The agreed EECC package contains 40 clinical processes and 67 requirements, plus additions specific for COVID-19. CONCLUSION: The study has specified the content of care that should be provided to all critically ill patients. Implementing EECC could be an effective strategy for policy makers to reduce preventable deaths worldwide

Identification of nursing assessment models/tools validated in clinical practice for use with diverse ethno-cultural groups: an integrative review of the literature

<p>Abstract</p> <p>Background</p> <p>High income nations are currently exhibiting increasing ethno-cultural diversity which may present challenges for nursing practice. We performed an integrative review of literature published in North America and Europe between 1990 and 2007, to map the state of knowledge and to identify nursing assessment tools/models which are have an associated research or empirical perspective in relation to ethno-cultural dimensions of nursing care.</p> <p>Methods</p> <p>Data was retrieved from a wide variety of sources, including key electronic bibliographic databases covering research in biomedical fields, nursing and allied health, and culture, e.g. CINAHL, MEDline, PUBmed, Cochrane library, PsycINFO, Web of Science, and HAPI. We used the Critical Appraisal Skills Programme tools for quality assessment. We applied Torraco's definition and method of an integrative review that aims to create new knowledge and perspectives on a given phenomena. To add methodological rigor with respect to the search strategy and other key review components we also used the principles established by the Centre for Reviews and Dissemination.</p> <p>Results</p> <p>Thirteen thousand and thirteen articles were retrieved, from which 53 full papers were assessed for inclusion. Eight papers met the inclusion criteria, describing research on a total of eight ethno-cultural assessment tools/models. The tools/models are described and synthesized.</p> <p>Conclusions</p> <p>While many ethno-cultural assessment tools exist to guide nursing practice, few are informed by research perspectives. An increased focus on the efficiency and effectiveness of health services, patient safety, and risk management, means that provision of culturally responsive and competent health services will inevitably become paramount.</p

Sekventiell anomalidetektering i nätverkskanten

The society of today relies a lot on the industry and the automation of factory tasks is more prevalent than ever before. However, the machines taking on these tasks require maintenance to continue operating. This maintenance is typically given periodically and can be expensive while sometimes requiring expert knowledge. Thus it would be very beneficial if one could predict when a machine needs maintenance and only employ maintenance as necessary. One method to predict when maintenance is necessary is to collect sensor data from a machine and analyse it for anomalies. Anomalies are usually an indicator of unexpected behaviour and can therefore show when a machine needs maintenance. Due to concerns like privacy and security, it is often not allowed for the data to leave the local system. Hence it is necessary to perform this kind of anomaly detection in an online manner and in an edge environment. This environment imposes limitations on hardware and computational ability. In this thesis we consider four machine learning anomaly detection methods that can learn and detect anomalies in this kind of environment. These methods are LoOP, iForestASD, KitNet and xStream. We first evaluate the four anomaly detectors on the Skoltech Anomaly Benchmark using their suggested metrics as well as the Receiver Operating Characteristic curves. We also perform further evaluation on two data sets provided by the company Gebhardt. The experimental results are promising and indicate that the considered methods perform well at the task of anomaly detection. We finally propose some avenues for future work, such as implementing a dynamically changing anomaly threshold. Dagens samhälle är väldigt beroende av industrin och automatiseringen av fabriksuppgifter är mer förekommande än någonsin. Dock kräver maskinerna som tar sig an dessa uppgifter underhåll för att forsätta arbeta. Detta underhåll ges typiskt periodvis och kan vara dyrt och samtidigt kräva expertkunskap. Därför skulle det vara väldigt fördelaktigt om det kunde förutsägas när en maskin behövde underhåll och endast göra detta när det är nödvändigt. En metod för att förutse när underhåll krävs är att samla in sensordata från en maskin och analysera det för att hitta anomalier. Anomalier fungerar ofta som en indikator av oväntat beteende, och kan därför visa att en maskin behöver underhåll. På grund av frågor som integritet och säkerhet är det ofta inte tillåtet att datan lämnar det lokala systemet. Därför är det nödvändigt att denna typ av anomalidetektering genomförs sekventiellt allt eftersom datan samlas in, och att detta sker på nätverkskanten. Miljön som detta sker i påtvingar begränsningar på både hårdvara och beräkningsförmåga. I denna avhandling så överväger vi fyra anomalidetektorer som med användning av maskininlärning lär sig och upptäcker anomalier i denna sorts miljö. Dessa metoder är LoOP, iForestASD, KitNet och xStream. Vi analyserar först de fyra anomalidetektorerna genom Skoltech Anomaly Benchmark där vi använder deras föreslagna mått samt ”Receiver Operating Characteristic”-kurvor. Vi genomför även vidare analys på två dataset som vi har tillhandhållit av företaget Gebhardt. De experimentella resultaten är lovande och indikerar att de övervägda metoderna presterar väl när det kommer till detektering av anomalier. Slutligen föreslår vi några idéer som kan utforskas för framtida arbete, som att implementera en tröskel för anomalidetektering som anpassar sig dynamiskt

Cultural competence in nursing

The overall aim of this thesis is to explore, analyze and clarify how cultural competence is understood. This is explored from the perspective of nurses, nursing students, nurse educators, and nurse researchers in relation to the Swedish care context. The field of transcultural nursing and cultural competence was founded in the United States in the 1950s in response to an increased awareness of cultural diversity arising from immigration. In Sweden an interest in transcultural nursing and cultural competence has emerged only recently and therefore knowledge in this area is quite sparse. In Study I, an instrument for measuring cultural competence was translated, adapted and evaluated for use in Sweden. By following guidelines in the literature, this process was carefully laid out and the content and internal structure of the instrument was evaluated. The findings indicated that the instrument did not meet appropriate validity and reliability levels, and the evaluation of the content indicated a weak relation between the instrument and the constructs. Therefore, it was concluded that the instrument could not be used in Sweden. In Study II, the aim was to analyze the core components found in the descriptions of the most frequently cited theoretical frameworks of cultural competence. Nine theoretical frameworks of cultural competence were analyzed using a documentary analysis method. The data were analyzed using qualitative content analysis. The findings revealed four themes that characterized cultural competence: an awareness of diversity among human beings; an ability to care for individuals; nonjudgmental openness for all individuals and; enhancing cultural competence as a longterm continuous process. In Study III, the aim was to identify the core components of cultural competence from a Swedish perspective. The Delphi technique was used and 24 experts took part in the study. The first round was conducted with qualitative interviews and was followed by three rounds with questionnaires. In total, consensus was reached on 118 core components that were grouped into five categories, with 17 associated subcategories. These categories are: cultural sensitivity; cultural understanding; cultural encounter; understanding of health, ill-health and healthcare; and social and cultural context. In the final study, Study IV, qualitative interviews were conducted with 10 nursing students, five with an immigrant background and five with a Swedish background, to explore their experiences of communication in cross-cultural care encounters. The interviews were analyzed using the framework approach. Four themes were identified: conceptualizing cross-cultural care encounters; difficulties in communication; strategies employed; and factors influencing communication. The synthesis of the findings from the four studies is illustrated in Figure 1 as the common patterns in the constituent elements of cultural competence in the Swedish context, which are identified as: the nurse s cultural awareness, personal beliefs and values; cultural assessment; and cross-cultural communication. The thesis concludes that transcultural nursing and cultural competence is about nurses being able to take the patient s cultural background, beliefs, values and traditions into consideration in nursing care. Cultural competence should not only be employed when caring for immigrants or ethnic minority groups, but also in encounters with all patients

Sekventiell anomalidetektering i nätverkskanten

The society of today relies a lot on the industry and the automation of factory tasks is more prevalent than ever before. However, the machines taking on these tasks require maintenance to continue operating. This maintenance is typically given periodically and can be expensive while sometimes requiring expert knowledge. Thus it would be very beneficial if one could predict when a machine needs maintenance and only employ maintenance as necessary. One method to predict when maintenance is necessary is to collect sensor data from a machine and analyse it for anomalies. Anomalies are usually an indicator of unexpected behaviour and can therefore show when a machine needs maintenance. Due to concerns like privacy and security, it is often not allowed for the data to leave the local system. Hence it is necessary to perform this kind of anomaly detection in an online manner and in an edge environment. This environment imposes limitations on hardware and computational ability. In this thesis we consider four machine learning anomaly detection methods that can learn and detect anomalies in this kind of environment. These methods are LoOP, iForestASD, KitNet and xStream. We first evaluate the four anomaly detectors on the Skoltech Anomaly Benchmark using their suggested metrics as well as the Receiver Operating Characteristic curves. We also perform further evaluation on two data sets provided by the company Gebhardt. The experimental results are promising and indicate that the considered methods perform well at the task of anomaly detection. We finally propose some avenues for future work, such as implementing a dynamically changing anomaly threshold. Dagens samhälle är väldigt beroende av industrin och automatiseringen av fabriksuppgifter är mer förekommande än någonsin. Dock kräver maskinerna som tar sig an dessa uppgifter underhåll för att forsätta arbeta. Detta underhåll ges typiskt periodvis och kan vara dyrt och samtidigt kräva expertkunskap. Därför skulle det vara väldigt fördelaktigt om det kunde förutsägas när en maskin behövde underhåll och endast göra detta när det är nödvändigt. En metod för att förutse när underhåll krävs är att samla in sensordata från en maskin och analysera det för att hitta anomalier. Anomalier fungerar ofta som en indikator av oväntat beteende, och kan därför visa att en maskin behöver underhåll. På grund av frågor som integritet och säkerhet är det ofta inte tillåtet att datan lämnar det lokala systemet. Därför är det nödvändigt att denna typ av anomalidetektering genomförs sekventiellt allt eftersom datan samlas in, och att detta sker på nätverkskanten. Miljön som detta sker i påtvingar begränsningar på både hårdvara och beräkningsförmåga. I denna avhandling så överväger vi fyra anomalidetektorer som med användning av maskininlärning lär sig och upptäcker anomalier i denna sorts miljö. Dessa metoder är LoOP, iForestASD, KitNet och xStream. Vi analyserar först de fyra anomalidetektorerna genom Skoltech Anomaly Benchmark där vi använder deras föreslagna mått samt ”Receiver Operating Characteristic”-kurvor. Vi genomför även vidare analys på två dataset som vi har tillhandhållit av företaget Gebhardt. De experimentella resultaten är lovande och indikerar att de övervägda metoderna presterar väl när det kommer till detektering av anomalier. Slutligen föreslår vi några idéer som kan utforskas för framtida arbete, som att implementera en tröskel för anomalidetektering som anpassar sig dynamiskt

Congenital cataract in newborns : A qualitative study on parents' experiences of the surgery and subsequent care

PURPOSE: Having a child with congenital cataract that requires surgery, contact lens treatment, and frequent medication is a life-altering experience. The aim of this study was to provide more in-depth knowledge of parents' experiences of diagnosis, surgery, and subsequent care, in order to find the areas for improvement. METHODS: Data were collected via semi-structured interviews with parents recruited from St. Erik Eye Hospital, Sweden. The children were operated for congenital cataract before 3 months of age and were aged 12-24 months at the time of the interviews. The interviews were analysed using qualitative content analysis with an inductive approach. RESULTS: Three themes emerged from the data: living in a turbulent time before the diagnosis, coping during the time of initial treatment, and managing the responsibility of their child's visual development. All parents expressed confidence in the operating unit. However, there was a clear need for reliable information on the condition, the surgery, and likely the long-term outcome in the time between receiving the preliminary diagnosis at the maternity ward and getting it confirmed by a paediatric ophthalmologist. CONCLUSION: Much of the parents' concern in this turbulent time is linked to poor information before the visit to the eye hospital. We, therefore, recommend earlier contact with the eye hospital, preferably at the time of writing the referral. Moreover, the possibility of providing up-to-date information via alternative information channels such as smartphone apps should be investigated

Experiences of parents whose school‐aged children were treated with therapeutic hypothermia as newborns: A focus group study

Abstract Aim To describe parents' past and present experiences of their newborn infant's therapeutic hypothermia (TH) treatment after perinatal asphyxia 10–13 years after the event. Background Newborn infants are treated with TH following perinatal asphyxia to improve neurodevelopmental outcomes. Design A qualitative descriptive design using focus groups (FGs). Methods Twenty one parents to 15 newborn infants treated with TH between 2007 and 2009 participated in five FGs. The FGs were transcribed verbatim and analysed using framework approach. The SRQR checklist was followed for study reporting. Results Two main categories were identified: hardships and reliefs during TH treatment and struggles of everyday life. Both categories include three subcategories, the first: (1) concern and gratitude for the unrecognized treatment, (2) insufficiency of information and proposed participation and (3) NICU nurses instilled security and hope. The second with subcategories: (1) unprocessed experiences of the TH treatment, (2) later challenges at school and (3) existential and psychological challenges in everyday life. Conclusion TH of their newborns affected the parents psychologically not only during the treatment, but lasted months and years later. Information and communication with health care professionals and school management were inefficient and inadequate. The parents' concerns could be prevented by an improved identification and understanding of the problems and the needs of the infants and their families before discharge. Relevance for Clinical Practice Through more personalized and efficient preparation and communication by the nursing staff before discharge, many of the parents' worries and problems could be reduced. Check‐up of parents' needs of psychosocial support before and after discharge and offering counselling should become routine. Also, nurses at Well‐Baby Clinics and in school health care should receive knowledge about TH treatment and the challenges the children and the parents experience. Patient or Public Contribution Participation of parents was limited to the data provided through interviews