Modifiers of patients' emergency department care-seeking behavior

Background: Inflow of patients to the emergency departments (ED) is increasing in many parts of the world, including Sweden. At the same time the number of EDs are decreasing. In addition to this, ED inflow is volatile. To some degree this volatility is explicable with variations over the hour of the day, day of the week and season, but a considerable portion of the ED inflow is yet to be explained in order to be able to predict the coming load on EDs. Aim: The overall aim of this thesis is to explore different factors modifying ED inflow. Methods: In four studies, different possible modifiers of ED inflow and modifiers of the patients’ decision to seek ED care was explored. In Study I, laypersons ability to triage trauma cases was investigated in a prospective survey study. In Study II – IV, retrospective observational studies were conducted. Studies II and III explored the impact of online health information seeking and the effect of news media reporting on ED inflow, respectively. In study II, a forecasting model was constructed, including website visits as explanatory variable, Study IV assessed the impact of callers’ sociodemographic background on advice from a telephone advice service (TAS) and compliance to those advices. Results: For Study I, 69 persons participated in the study, who in total triaged 52 % of the cases correctly. There was an over-triage (i.e. case triaged as more serious than it was) in 12.5 % and under-triage in 6.3 % of the cases. In Study II, correlation between a population’s number of visits to a regional website for health information and physical ED inflow was found. The forecasting model in Study II exhibited Mean Absolute Percentage Error of 4.8 %. In Study III, it was shown that news media reporting negativity, expressed as a numeric index, significantly correlated to and partially explained ED inflow. In Study IV, findings were that both the advices given to a caller by the TAS and the caller’s odds of complying to the advice were affected by sociodemographic factors, but that the compliance was also affected by the advice issued. Conclusions: This thesis shows that ED care-seeking behavior is modified by online health information, news media reporting, advices from the TAS and by the individual’s own sociodemographic background. This knowledge can be used to better understand ED care-seeking behavior and to construct better forecasting models of ED inflow

Life cycle assessment of an all-organic battery: Hotspots and opportunities for improvement

Organic batteries are emerging as a potential sustainable power source for future flexible devices. Using life cycle assessment, this study analyzed the environmental impacts from the synthesis process for an all-organic battery with conducting redox polymers as active materials for electrodes. Synthesis steps were modeled and analyzed in detail, based on actual laboratory processes data for electrodes, and industrial data for other battery components. Complete and transparent inventory data are presented and can be used in future environmental assessments. The organic battery studied is still at an early development stage, so environmental hotspots and potential improvements in the synthesis processes were examined. For selected environmental impact categories, the life cycle assessment results showed that synthesis of cathode backbone was the major contributor (47-63%) to the environmental impacts of the all-organic battery cell among different synthesis stages, because of a long synthesis route associated with high solvent usage. Solvents (e.g., dichloromethane), catalysts (e.g., copper oxide, Pd (PPh3)4), zinc, and waste treatment processes were important single contributors to the total impacts. The results reveal significant potential for improvement by optimizing the amount of solvents needed to synthesize battery electrodes. Changing treatment methods for laboratory waste solvents can also strongly influence the results

Prospective life cycle assessment of a flexible all-organic battery

Strong interest from researchers and industry is accelerating development of flexible energy storage technologies for future flexible devices. It is critical to consider the environmental perspective in early development of new emerging technologies. In this study, cradle-to-factory gate prospective life cycle assessment (LCA) was performed on production of an all-organic battery with conductive redox polymers as electrode material. To gain a better understanding of the environmental performance of the all-organic battery, a flexible lithium-ion (Li-ion) battery with lithium titanate oxide and lithium cobalt oxide as electrode active materials was modeled as reference. Main environmental impacts of the all-organic battery were attributable to anode and cathode production, with electrode backbones being the main contributors. Solvents, catalysts, waste treatment, energy, and bromine were key individual contributors. Comparison with the flexible Li-ion battery indicated inferior environmental performance of the all-organic battery due to its relatively low specific energy (Wh/kg) and large amount of materials needed for production of its electrode backbones. Sensitivity analysis showed that changing scaling-up parameters and the production route of 3,4-ethylenedioxythiophene (a precursor of electrode backbones) strongly influenced the results. In order to lower the environmental impacts of the all-organic battery, future research should focus on designing a short production chain with lower material inputs of electrode backbones, increasing battery cycle life, and improving the specific energy of the battery. In addition, relevant recommendations were provided for prospective LCAs of upscaled systems

"Överbelastning på akutmottagningen" - svensk definition behövs.

An article discussing the problems of overcrowding at the emergency department

The association between vital signs and mortality in a retrospective cohort study of an unselected emergency department population

Background: Vital signs are widely used in emergency departments. Previous studies on the association between vital signs and mortality in emergency departments have been restricted to selected patient populations. We aimed to study the association of vital signs and age with 1-day mortality in patients visiting the emergency department. Methods: This retrospective cohort included patients visiting the emergency department for adults at Sodersjukhuset, Sweden from 4/1/2012 to 4/30/2013. Exclusion criteria were: age = 80 years to <50 years (OR 35.9, CI 10.7 to 120.2) and patients with respiratory rates <8/min to 8-25/min (OR 18.1, CI 2.1 to 155.5). Discussion: Most of the vital signs used in the ED are significantly associated with one-day mortality. The more the vital signs deviate from the normal range, the larger are the odds of mortality. We did not find a suitable way to adjust for the inherent influence the triage system and medical treatment has had on mortality. Conclusions: Most deviations of vital signs are associated with 1-day mortality. The same triage level is not associated with the same odds for death with respect to the individual vital sign. Patients that were unresponsive or had low respiratory rates or old age had the highest odds of 1-day mortality.Peer reviewe

Effect of Trans-Nasal Evaporative Intra-arrest Cooling on Functional Neurologic Outcome in Out-of-Hospital Cardiac Arrest : The PRINCESS Randomized Clinical Trial

© 2019 American Medical Association. All rights reserved.Importance: Therapeutic hypothermia may increase survival with good neurologic outcome after cardiac arrest. Trans-nasal evaporative cooling is a method used to induce cooling, primarily of the brain, during cardiopulmonary resuscitation (ie, intra-arrest). Objective: To determine whether prehospital trans-nasal evaporative intra-arrest cooling improves survival with good neurologic outcome compared with cooling initiated after hospital arrival. Design, Setting, and Participants: The PRINCESS trial was an investigator-initiated, randomized, clinical, international multicenter study with blinded assessment of the outcome, performed by emergency medical services in 7 European countries from July 2010 to January 2018, with final follow-up on April 29, 2018. In total, 677 patients with bystander-witnessed out-of-hospital cardiac arrest were enrolled. Interventions: Patients were randomly assigned to receive trans-nasal evaporative intra-arrest cooling (n = 343) or standard care (n = 334). Patients admitted to the hospital in both groups received systemic therapeutic hypothermia at 32°C to 34°C for 24 hours. Main Outcomes and Measures: The primary outcome was survival with good neurologic outcome, defined as Cerebral Performance Category (CPC) 1-2, at 90 days. Secondary outcomes were survival at 90 days and time to reach core body temperature less than 34°C. Results: Among the 677 randomized patients (median age, 65 years; 172 [25%] women), 671 completed the trial. Median time to core temperature less than 34°C was 105 minutes in the intervention group vs 182 minutes in the control group (P < .001). The number of patients with CPC 1-2 at 90 days was 56 of 337 (16.6%) in the intervention cooling group vs 45 of 334 (13.5%) in the control group (difference, 3.1% [95% CI, -2.3% to 8.5%]; relative risk [RR], 1.23 [95% CI, 0.86-1.72]; P = .25). In the intervention group, 60 of 337 patients (17.8%) were alive at 90 days vs 52 of 334 (15.6%) in the control group (difference, 2.2% [95% CI, -3.4% to 7.9%]; RR, 1.14 [95% CI, 0.81-1.57]; P = .44). Minor nosebleed was the most common device-related adverse event, reported in 45 of 337 patients (13%) in the intervention group. The adverse event rate within 7 days was similar between groups. Conclusions and Relevance: Among patients with out-of-hospital cardiac arrest, trans-nasal evaporative intra-arrest cooling compared with usual care did not result in a statistically significant improvement in survival with good neurologic outcome at 90 days. Trial Registration: ClinicalTrials.gov Identifier: NCT01400373.Peer reviewedFinal Accepted Versio

The Normal Red-Letter, volume 3, number 3, December (1901)

https://red.mnstate.edu/normalredletter/1013/thumbnail.jp

Time to intra-arrest therapeutic hypothermia in out-of-hospital cardiac arrest patients and its association with neurologic outcome: a propensity matched sub-analysis of the PRINCESS trial

© 2020, The Author(s). Purpose: To study the association between early initiation of intra-arrest therapeutic hypothermia and neurologic outcome in out-of-hospital cardiac arrest. Methods: A prespecified sub-analysis of the PRINCESS trial (NCT01400373) that randomized 677 bystander-witnessed cardiac arrests to transnasal evaporative intra-arrest cooling initiated by emergency medical services or cooling started after hospital arrival. Early cooling (intervention) was defined as intra-arrest cooling initiated \u3c 20 min from collapse (i.e., ≤ median time to cooling in PRINCESS). Propensity score matching established comparable control patients. Primary outcome was favorable neurologic outcome, Cerebral Performance Category (CPC) 1–2 at 90 days. Complete recovery (CPC 1) was among secondary outcomes. Results: In total, 300 patients were analyzed and the proportion with CPC 1–2 at 90 days was 35/150 (23.3%) in the intervention group versus 24/150 (16%) in the control group, odds ratio (OR) 1.92, 95% confidence interval (CI) 0.95–3.85, p =.07. In patients with shockable rhythm, CPC 1–2 was 29/57 (50.9%) versus 17/57 (29.8%), OR 3.25, 95%, CI 1.06–9.97, p =.04. The proportion with CPC 1 at 90 days was 31/150 (20.7%) in the intervention group and 17/150 (11.3%) in controls, OR 2.27, 95% CI 1.12–4.62, p =.02. In patients with shockable rhythms, the proportion with CPC 1 was 27/57 (47.4%) versus 12/57 (21.1%), OR 5.33, 95% CI 1.55–18.3, p =.008. Conclusions: In the whole study population, intra-arrest cooling initiated \u3c 20 min from collapse compared to cooling initiated at hospital was not associated with improved favorable neurologic outcome. In the subgroup with shockable rhythms, early cooling was associated with improved favorable outcome and complete recovery