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  • 1.
    Andersson, Jessika
    et al.
    Department of Medicine, Uppsala University Hospital, Uppsala, Sweden.
    Sundström, Johan
    Department of Medicine, Uppsala University Hospital, Uppsala, Sweden.
    Kurland, Lisa
    Department of Medicine, Uppsala University Hospital, Uppsala, Sweden.
    Gustavsson, Thomas
    Department of Signals and Systems, Chalmers University of Technology, Gothenburg, Sweden.
    Hulthe, Johannes
    Wallenberg Laboratory, Sahlgrenska University Hospital, Gothenburg, Sweden; AstraZeneca R&D, Mölndal, Sweden.
    Elmgren, Anders
    AstraZeneca R&D, Mölndal, Sweden.
    Zilmer, Kersti
    Department of Biochemistry, University of Tartu, Tartu, Estonia.
    Zilmer, Mihkel
    Department of Biochemistry, University of Tartu, Tartu, Estonia.
    Lind, Lars
    Department of Medicine, Uppsala University Hospital, Uppsala, Sweden.
    The carotid artery plaque size and echogenicity are related to different cardiovascular risk factors in the elderly: the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study2009In: Lipids, ISSN 0024-4201, E-ISSN 1558-9307, Vol. 44, no 5, p. 397-403Article in journal (Refereed)
    Abstract [en]

    Carotid plaques can be characterised by ultrasound by size and echogenicity. Both size and echogenicity are predictors of cardiovascular events. The aim of this study was to examine whether traditional risk factors and markers of inflammation and oxidation were associated with plaque size and echogenicity. Computerised analysis of carotid plaque size and echogenicity (grey scale median, GSM) were performed by ultrasound in a population-based health survey in 1,016 subjects aged 70 years (PIVUS study). Information on cardiovascular risk factors was collected, together with markers of inflammation and oxidation. Increased Framingham risk score, systolic blood pressure, higher BMI and decreased HDL, lower glutathione levels were related to echolucent plaques. Previous or present smoking was common with significantly more pack-years related to the echorich plaques. Plaque size was associated with increased Framingham risk score, systolic blood pressure, blood glucose levels, smoking, ApoB/A1 ratio, OxLDL, TNF alpha, HOMA insulin resistance, leucocyte count, decreased BCD-LDL and low levels of l-selectin. Low HDL, increased BMI and decreased glutathione levels were associated with the echolucency of carotid plaques, implying metabolic factors to play a role for plaque composition. Markers of inflammation were related to plaque size alone, implying inflammation to be predominantly associated with the amount of atherosclerosis. These results suggest that plaque size and echogenicity are influenced by different risk factors.

  • 2. Bohm, K.
    et al.
    Kurland, Lisa
    Örebro University, School of Medical Sciences.
    The accuracy of medical dispatch: a systematic review2017In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241Article in journal (Refereed)
  • 3.
    Bohm, Katarina
    et al.
    Karolinska Institutet, Institution of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden.
    Kurland, Lisa
    Karolinska Institutet, Institution of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden; Section of Emergency Medicine, Södersjukhuset, Stockholm, Sweden.
    Bartholdson, Sofia
    Karolinska Institutet, Institution of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden.
    Castrèn, Maaret
    Karolinska Institutet, Institution of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden; Section of Emergency Medicine, Södersjukhuset, Stockholm, Sweden.
    Descriptions and presentations of sepsis: A qualitative content analysis of emergency calls2015In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 23, no 4, p. 294-298Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Sepsis is a serious condition which requires early treatment. We often fail to recognize sepsis patients in the chain of prehospital care. Knowledge of how sepsis is expressed in calls to the emergency medical communication centre (EMCC) is limited. An increased understanding could lead to earlier identification of patients with sepsis.

    OBJECTIVE: The aim of this study was to describe the descriptions of sepsis used during communication between the caller and the emergency medical dispatcher (EMD).

    METHODS: To achieve the aim of the study, an inductive approach of qualitative content analysis was used. In total, 29 consecutive patients, who arrived at the emergency department by ambulance and received a diagnosis of sepsis according to the International Classification of Diseases (ICD)-10, were included in the study. For each case, the corresponding emergency call recording from the EMCC was transcribed verbatim. Main categories and subcategories from the text were abstracted.

    RESULTS: From fifteen subcategories, three main categories were abstracted: "Deterioration", "Physical signs and symptoms" and "Difficulties establishing satisfactory contact with the patient." The way laymen and professionals expressed themselves seemed to differ.

    CONCLUSIONS: Sepsis was described in terms of the physical symptoms, changes of condition and communication abilities of the patient. This knowledge could lead to the identification of keywords which could be incorporated in the decision tool used by the EMD to increase sepsis identification, but further research is required.

  • 4.
    Brink, Magnus
    et al.
    Infektionskliniken, Sahlgrenska universitetssjukhuset, Göteborg, Sverige.
    Cronqvist, Jonas
    Infektionskliniken, Skånes universitetssjukhus, Malmö, Sverige.
    Fagerberg, Anneli
    Anestesi och intensivvård, Sahlgrenska universitetssjukhuset, Göteborg, Sverige.
    Kurland, Lisa
    Akutkliniken, Universitetssjukhuset Örebro, Örebro, Sverige.
    Lindgren, Pär
    Anestesi och intensivvård, Växjö ­centrallasarett, Växjö, Sverige.
    Lipcsey, Miklos
    Anestesi och intensivvård, Akademiska sjukhuset, Uppsala, Sverige.
    Okas, Mantas
    Akutmedicinkliniken, ­Capio S:t Görans sjukhus AB, Stockholm, Sverige.
    Petersson, Johan
    Funktion perioperativ medicin och intensiv­vård, Karolinska universitetssjukhuset Solna, Stockholm, Sverige.
    Nu gäller Sepsis-3 för definitioner och diagnostiska kriterier [New definition of and diagnostic criteria for sepsis: Swedish use of Sepsis-3]2018In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115, no 15, p. 660-667, article id E3W9Article in journal (Refereed)
  • 5.
    Castrén, Maaret
    et al.
    Department of Clinical Science and Education at Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Section of Emergency Medicine, Södersjukhuset, Stockholm, Sweden.
    Kurland, Lisa
    Department of Clinical Science and Education at Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Section of Emergency Medicine, Södersjukhuset, Stockholm, Sweden.
    Liljegard, Sofia
    Department of Clinical Science and Education at Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Djärv, Therese
    Department of Clinical Science and Education at Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Emergency Department, Karolinska University Hospital, Solna, Sweden.
    Non-specific complaints in the ambulance; predisposing structural factors2015In: BMC Emergency Medicine, ISSN 1471-227X, E-ISSN 1471-227X, Vol. 15, article id 8Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The pre-hospital assessment non-specific complaint (NSC) often applies to patients whose diagnosis does not match any other specific assessment correlating to particular symptoms or diseases, though some previous studies have found them to be related to serious underlying conditions. The aim was to identify whether the structural factors such as urgency according to the dispatch priority of the Emergency Medical Communication Centre (EMCC) or work load in the Emergency Medical Services (EMS) are predisposing factors for the assessment of NSC instead of a specific assessment.

    METHODS: All patients with assessed condition NSCs by the EMS to Södersjukhuset during 2011 (n = 493) were compared with gender- and age-matched controls (n = 493), which were randomly drawn from all patients with specific conditions in the EMS, regarding day of week, time of day and priority set by EMCC with chi-squared tests and multivariate logistic regression models.

    RESULTS: Among patients with NSCs, more were females (58 %) and the median age was 82. Almost all patients were categorized with NSCs during the daytime (8 a.m. to 9 p.m.), i.e. 450 (91 %) as compared to 373 (75 %) of those with specific conditions (p < 0.01). The risk of having an EMS dispatched as low priority by the EMCC was almost doubled among patients with NSCs compared to controls (OR 1.97, 95 % CI 1.38-2.79).

    CONCLUSIONS: Since patients with NSCs appear most frequently during the hours with most transportations for the EMS, i.e. 10 a.m. to 2 p.m., and the risk of having the assessment NSC was doubled if the EMCC dispatched EMS as low priority, structural factors might be predisposing factors for the assessment.

  • 6.
    Cone, David C
    et al.
    Department of Emergency Medicine, Yale University School of Medicine, New Haven CT, USA.
    Serra, John
    Department of Emergency Medicine, University of California, San Diego CA, USA.
    Kurland, Lisa
    Department of Clinical Research and Education, Karolinska Institutet, Stockholm, Sweden.
    Comparison of the SALT and Smart triage systems using a virtual reality simulator with paramedic students2011In: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 18, no 6, p. 314-321Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Virtual reality systems may allow for organized study of mass casualty triage systems by allowing investigators to replicate the same mass casualty incident, with the same victims, for a large number of rescuers. The study objectives were to develop such a virtual reality system, and use it to assess the ability of trained paramedic students to triage simulated victims using two triage systems.

    METHODS: Investigators created 25 patient scenarios for a highway bus crash in a virtual reality simulation system. Paramedic students were trained to proficiency on the new 'Sort, Assess, Life saving interventions, Treat and Transport (SALT)' triage system, and 22 students ran the simulation, applying the SALT algorithm to each victim. After a 3-month washout period, the students were retrained on the 'Smart' triage system, and each student ran the same crash simulation using the Smart system. Data inputs were recorded by the simulation software and analyzed with the paired t-tests.

    RESULTS: The students had a mean triage accuracy of 70.0% with SALT versus 93.0% with Smart (P=0.0001). Mean overtriage was 6.8% with SALT versus 1.8% with Smart (P=0.0015), and mean undertriage was 23.2% with SALT versus 5.1% with Smart (P=0.0001). The average time for a student to triage the scene was 21 min 3 s for SALT versus 11 min 59 s for Smart (P=0.0001).

    CONCLUSION: The virtual reality platform seems to be a viable research tool for examining mass casualty triage. A small sample of trained paramedic students using the virtual reality system was able to triage simulated patients faster and with greater accuracy with 'Smart' triage than with 'SALT' triage.

  • 7.
    Djalali, Ahmadreza
    et al.
    Center for Research and Education in Emergency and Disaster Medicine, Università Del Piemonte Orientale, Novara, Italy; Department of Clinical Sciences and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Ardalan, Ali
    Department of Disaster and Emergency Health, National Institute of Health Research, Tehran, iran; University of Medical Sciences, Tehran, Iran; Harvard Humanitarian Initiative, Department of Global Health and Population, Harvard School of Public Health, Cambridge MA, United States.
    Ohlen, Gunnar
    Intervention and Technology, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Ingrassia, Pier Luigi
    Center for Research and Education in Emergency and Disaster Medicine, Università Del Piemonte Orientale, Novara, Italy.
    Corte, Francesco Della
    Center for Research and Education in Emergency and Disaster Medicine, Università Del Piemonte Orientale, Novara, Italy.
    Castren, Maaret
    Department of Clinical Sciences and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Section of Emergency Medicine, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Kurland, Lisa
    Department of Clinical Sciences and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Section of Emergency Medicine, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Nonstructural Safety of Hospitals for Disasters: A Comparison Between Two Capital Cities2014In: Disaster Medicine and Public Health Preparedness, ISSN 1935-7893, E-ISSN 1938-744X, Vol. 8, no 2, p. 179-184Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Hospitals are expected to function as a safe environment during disasters, but many become unusable because of nonstructural damage. This study compares the nonstructural safety of hospitals to disasters in Tehran and Stockholm.

    METHODS: Hospital safety in Tehran and Stockholm was assessed between September 24, 2012, and April 5, 2013, with use of the nonstructural module of the hospital safety index from the World Health Organization. Hospital safety was categorized as safe, at risk, or inadequate.

    RESULTS: All 4 hospitals in Stockholm were classified as safe, while 2 hospitals in Tehran were at risk and 3 were safe. The mean nonstructural safety index was 90% ± 2.4 SD for the hospitals in Stockholm and 64% ± 17.4 SD for those in Tehran (P = .014).

    CONCLUSIONS: The level of hospital safety, with respect to disasters, was not related to local vulnerability. Future studies on hospital safety should assess other factors such as legal and financial issues. (Disaster Med Public Health Preparedness. 2014;0:1-6).

  • 8.
    Djalali, Ahmadreza
    et al.
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Castren, Maaret
    Department of Clinical Sciences and Education and Department of Emergency Medicine, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Hosseinijenab, Vahid
    Department of emergency management, Natural Disaster Research Institute, Tehran, Iran.
    Khatib, Mahmoud
    Tehran social security organization, Tehran, Iran.
    Ohlen, Gunnar
    Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    Kurland, Lisa
    Department of Clinical Sciences and Education and Department of Emergency Medicine, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Hospital Incident Command System (HICS) performance in Iran; decision making during disasters2012In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 20, article id 14Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Hospitals are cornerstones for health care in a community and must continue to function in the face of a disaster. The Hospital Incident Command System (HICS) is a method by which the hospital operates when an emergency is declared. Hospitals are often ill equipped to evaluate the strengths and vulnerabilities of their own management systems before the occurrence of an actual disaster. The main objective of this study was to measure the decision making performance according to HICS job actions sheets using tabletop exercises.

    METHODS: This observational study was conducted between May 1st 2008 and August 31st 2009. Twenty three Iranian hospitals were included. A tabletop exercise was developed for each hospital which in turn was based on the highest probable risk. The job action sheets of the HICS were used as measurements of performance. Each indicator was considered as 1, 2 or 3 in accordance with the HICS. Fair performance was determined as < 40%; intermediate as 41-70%; high as 71-100% of the maximum score of 192. Descriptive statistics, T-test, and Univariate Analysis of Variance were used.

    RESULTS: None of the participating hospitals had a hospital disaster management plan. The performance according to HICS was intermediate for 83% (n = 19) of the participating hospitals. No hospital had a high level of performance. The performance level for the individual sections was intermediate or fair, except for the logistic and finance sections which demonstrated a higher level of performance. The public hospitals had overall higher performances than university hospitals (P = 0.04).

    CONCLUSIONS: The decision making performance in the Iranian hospitals, as measured during table top exercises and using the indicators proposed by HICS was intermediate to poor. In addition, this study demonstrates that the HICS job action sheets can be used as a template for measuring the hospital response. Simulations can be used to assess preparedness, but the correlation with outcome remains to be studied.

  • 9.
    Djalali, Ahmadreza
    et al.
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; RIMEDIM - Center for Research and Education in Emergency and Disaster Medicine, Università del Piemonte Orientale, Novara, Italy.
    Castren, Maaret
    Department of Clinical Sciences and Education and Section of Emergency Medicine, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Khankeh, Hamidreza
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Nursing Department, University of Social Welfare and Rehabilitation, Tehran, Iran.
    Gryth, Dan
    Department of Physiology and Pharmacology and Section of Anaesthesiology and Intensive care, Karolinska Institutet, Stockholm, Sweden.
    Radestad, Monica
    Department of Clinical Sciences and Education and Section of Emergency Medicine, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Öhlen, Gunnar
    Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    Kurland, Lisa
    Department of Clinical Sciences and Education and Section of Emergency Medicine, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Hospital disaster preparedness as measured by functional capacity: a comparison between Iran and Sweden2013In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 28, no 5, p. 454-461Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Hospitals are expected to continue to provide medical care during disasters. However, they often fail to function under these circumstances. Vulnerability to disasters has been shown to be related to the socioeconomic level of a country. This study compares hospital preparedness, as measured by functional capacity, between Iran and Sweden.

    METHODS: Hospital affiliation and size, and type of hazards, were compared between Iran and Sweden. The functional capacity was evaluated and calculated using the Hospital Safety Index (HSI) from the World Health Organization. The level and value of each element was determined, in consensus, by a group of evaluators. The sum of the elements for each sub-module led to a total sum, in turn, categorizing the functional capacity into one of three categories: A) functional; B) at risk; or C) inadequate.

    RESULTS: The Swedish hospitals (n = 4) were all level A, while the Iranian hospitals (n = 5) were all categorized as level B, with respect to functional capacity. A lack of contingency plans and the availability of resources were weaknesses of hospital preparedness. There was no association between the level of hospital preparedness and hospital affiliation or size for either country.

    CONCLUSION: The results suggest that the level of hospital preparedness, as measured by functional capacity, is related to the socioeconomic level of the country. The challenge is therefore to enhance hospital preparedness in countries with a weaker economy, since all hospitals need to be prepared for a disaster. There is also room for improvement in more affluent countries.

  • 10.
    Djalali, Ahmadreza
    et al.
    Department of Clinical Science and Education, Södersjukhuset (KI SÖS), Karolinska Institute, Stockholm, Sweden.
    Khankeh, Hamidreza
    Department of Clinical Science and Education, Södersjukhuset (KI SÖS), Karolinska Institute, Stockholm, Sweden; Nursing Department, University of Social Welfare and Rehabilitation, Tehran, Iran.
    Öhlén, Gunnar
    Department of Clinical Science and Education, Södersjukhuset (KI SÖS), Karolinska Institute, Stockholm, Sweden.
    Castrén, Maaret
    Department of Clinical Science and Education, Södersjukhuset (KI SÖS), Karolinska Institute, Stockholm, Sweden.
    Kurland, Lisa
    Department of Clinical Science and Education, Södersjukhuset (KI SÖS), Karolinska Institute, Stockholm, Sweden.
    Facilitators and obstacles in pre-hospital medical response to earthquakes: a qualitative study2011In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 19, article id 30Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Earthquakes are renowned as being amongst the most dangerous and destructive types of natural disasters. Iran, a developing country in Asia, is prone to earthquakes and is ranked as one of the most vulnerable countries in the world in this respect. The medical response in disasters is accompanied by managerial, logistic, technical, and medical challenges being also the case in the Bam earthquake in Iran. Our objective was to explore the medical response to the Bam earthquake with specific emphasis on pre-hospital medical management during the first days.

    METHODS: The study was performed in 2008; an interview based qualitative study using content analysis. We conducted nineteen interviews with experts and managers responsible for responding to the Bam earthquake, including pre-hospital emergency medical services, the Red Crescent, and Universities of Medical Sciences. The selection of participants was determined by using a purposeful sampling method. Sample size was given by data saturation.

    RESULTS: The pre-hospital medical service was divided into three categories; triage, emergency medical care and transportation, each category in turn was identified into facilitators and obstacles. The obstacles identified were absence of a structured disaster plan, absence of standardized medical teams, and shortage of resources. The army and skilled medical volunteers were identified as facilitators.

    CONCLUSIONS: The most compelling, and at the same time amenable obstacle, was the lack of a disaster management plan. It was evident that implementing a comprehensive plan would not only save lives but decrease suffering and enable an effective praxis of the available resources at pre-hospital and hospital levels.

  • 11.
    Djärv, Therese
    et al.
    Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.
    Castrén, Maaret
    Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden; Section of Emergency Medicine, Karolinska Institute, Stockholm, Sweden.
    Mårtenson, Linda
    Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.
    Kurland, Lisa
    Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden; Section of Emergency Medicine, Karolinska Institute, Stockholm, Sweden.
    Decreased general condition in the emergency department: high in-hospital mortality and a broad range of discharge diagnoses2015In: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 22, no 4, p. 241-246Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Decreased general condition (DGC) is a frequent presenting complaint within the Adaptive Triage Process. DGC describes a nonspecific decline in health and well-being, and it is common among elderly patients in the emergency department (ED).

    AIM: The aim of this study was to compare the in-hospital mortality among patients presenting with DGC with that among patients in the corresponding triage category presenting with other complaints to an ED. The secondary aim was to describe the discharge diagnoses of patients presenting with DGC.

    METHODS: All patients admitted to Södersjukhuset from the ED in 2008 were included. The difference in the in-hospital mortality rate was stratified for triage category at the ED, between patients with DGC (n=1182) and those with all other presenting complaints (n=20 775), and assessed with sex-adjusted and age-adjusted logistic regression models. Discharge diagnoses were assessed as the primary discharge diagnosis according to International Statistical Classification of Diseases and Related Health Problems 10th revision (ICD-10) in the medical discharge notes.

    RESULTS: A total of 1182 patients with DGC at the ED were admitted for in-hospital care, and they had a four-fold risk of suffering an in-hospital death [odds ratio 4.74 (95% confidence interval 3.88-5.78)] compared with patients presenting with other presenting complaints. The most common discharge diagnoses were diseases of the circulatory system (14%), respiratory system (14%), and genitourinary system (10%).

    INTERPRETATION: Patients presenting with DGC to an ED often receive low triage priority, frequently require admission for in-hospital care, and, because of the three-fold increased risk of in-hospital death compared with others, belong to a high-risk group.

  • 12.
    Dryver, Eric T
    et al.
    Emergency Department, Skane's University Hospital, Akutkliniken, Lund, Sweden; Practicum Clinical Skills Centre, Region Skåne, Lund/Malmö, Sweden.
    Eriksson, Anders
    Anesthesiology Department, Ersta Hospital, Stockholm, Sweden.
    Söderberg, Patrik
    Södersjukhus Hospital, Stockholm's County Council, Stockholm, Sweden.
    Kurland, Lisa
    Södersjukhus Hospital, Karolinska Institution, Stockholm, Sweden.
    The Swedish specialist examination in emergency medicine: form and function2017In: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 24, no 1, p. 19-24Article in journal (Refereed)
    Abstract [en]

    AIM/BACKGROUND: The purpose of the Swedish specialist examination in Emergency Medicine is not only to determine whether residents have attained the level of competence of specialists, but also to guide and facilitate residency training.

    METHODS: The Swedish Society for Emergency Medicine has developed checklists that delineate criteria of consideration and action items for particular processes. These checklists are freely available and used to assess competence during the examination. They are also intended for use during teaching and clinical care, thus promoting alignment between clinical practice, teaching and assessment. The examination is carried out locally by residency program educators, thereby obviating travel expenses. It consists of a total of 24 stations and over 100 potential scenarios, thereby minimizing case specificity. Each station consists of a scenario based on a real case. The checklists allow for direct feedback to the examinee after each station.

    RESULTS AND CONCLUSION: This model may be of interest to other European countries.

  • 13.
    Ekelund, Ulf
    et al.
    Emergency Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden.
    Kurland, Lisa
    Department of Clinical Sciences and Education and Section of Emergency Medicine, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Eklund, Fredrik
    Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    Torkki, Paulus
    HEMA-Institute, BIT Research Centre, Aalto University, Espoo, Finland.
    Letterstål, Anna
    Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden.
    Lindmarker, Per
    Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden.
    Castrén, Maaret
    Department of Clinical Sciences and Education and Section of Emergency Medicine, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Patient throughput times and inflow patterns in Swedish emergency departments: A basis for ANSWER, A National SWedish Emergency Registry2011In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 19, article id 37Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Quality improvement initiatives in emergency medicine (EM) often suffer from a lack of benchmarking data on the quality of care. The objectives of this study were twofold: 1. To assess the feasibility of collecting benchmarking data from different Swedish emergency departments (EDs) and 2. To evaluate patient throughput times and inflow patterns.

    METHOD: We compared patient inflow patterns, total lengths of patient stay (LOS) and times to first physician at six Swedish university hospital EDs in 2009. Study data were retrieved from the hospitals' computerized information systems during single on-site visits to each participating hospital.

    RESULTS: All EDs provided throughput times and patient presentation data without significant problems. In all EDs, Monday was the busiest day and the fewest patients presented on Saturday. All EDs had a large increase in patient inflow before noon with a slow decline over the rest of the 24 h, and this peak and decline was especially pronounced in elderly patients. The average LOS was 4 h of which 2 h was spent waiting for the first physician. These throughput times showed a considerable diurnal variation in all EDs, with the longest times occurring 6-7 am and in the late afternoon.

    CONCLUSION: These results demonstrate the feasibility of collecting benchmarking data on quality of care targets within Swedish EM, and form the basis for ANSWER, A National SWedish Emergency Registry.

  • 14. Ekström, A.
    et al.
    Eng Larsson, Fredrik
    Isaksson, Olov Hans Daniel
    Kurland, Lisa
    Örebro University, School of Medical Sciences.
    Nordberg, Martin
    The effect of a terrorist attack on emergency department inflow2017In: Annals of Emergency Medicine, ISSN 0196-0644, E-ISSN 1097-6760Article in journal (Refereed)
  • 15.
    Ekström, Andreas
    et al.
    Department of Clinical Science and Education, Section of Emergency Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Emergency Medicine, Södersjukhuset, Stockholm, Sweden.
    Kurland, Lisa
    Department of Clinical Science and Education, Section of Emergency Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Emergency Medicine, Södersjukhuset, Stockholm, Sweden.
    Farrokhnia, Nasim
    Department of Clinical Science and Education, Section of Emergency Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Emergency Medicine, Södersjukhuset, Stockholm, Sweden.
    Castrén, Maaret
    Department of Clinical Science and Education, Section of Emergency Medicine, Karolinska Institutet, Stockholm, Sweden.
    Nordberg, Martin
    Department of Clinical Science and Education, Section of Emergency Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Emergency Medicine, Södersjukhuset, Stockholm, Sweden.
    Forecasting emergency department visits using internet data2015In: Annals of Emergency Medicine, ISSN 0196-0644, E-ISSN 1097-6760, Vol. 65, no 4, p. 436-442.e1Article in journal (Refereed)
    Abstract [en]

    STUDY OBJECTIVE: Using Internet data to forecast emergency department (ED) visits might enable a model that reflects behavioral trends and thereby be a valid tool for health care providers with which to allocate resources and prevent crowding. The aim of this study is to investigate whether Web site visits to a regional medical Web site, the Stockholm Health Care Guide, a proxy for the general public's concern of their health, could be used to predict the ED attendance for the coming day.

    METHODS: In a retrospective, observational, cross-sectional study, a model for forecasting the daily number of ED visits was derived and validated. The model was derived through regression analysis, using visits to the Stockholm Health Care Guide Web site between 6 pm and midnight and day of the week as independent variables. Web site visits were measured with Google Analytics. The number of visits to the ED within the region was retrieved from the Stockholm County Council administrative database. All types of ED visits (including adult, pediatric, and gynecologic) were included. The period of August 13, 2011, to August 12, 2012, was used as a training set for the model. The hourly variation of visits was analyzed for both Web site and the ED visits to determine the interval of hours to be used for the prediction. The model was validated with mean absolute percentage error for August 13, 2012, to October 31, 2012.

    RESULTS: The correlation between the number of Web site visits between 6 pm and midnight and ED visits the coming day was significant (r=0.77; P<.001). The best forecasting results for ED visits were achieved for the entire county, with a mean absolute percentage error of 4.8%. The result for the individual hospitals ranged between mean absolute percentage error 5.2% and 13.1%.

    CONCLUSION: Web site visits may be used in this fashion to predict attendance to the ED. The model works both for the entire region and for individual hospitals. The possibility of using Internet data to predict ED visits is promising.

  • 16.
    Eriksson, Jan W.
    et al.
    Department of Medicine, Umeå University Hospital, Umeå, Sweden; Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden; AstraZeneca R&D, Mölndal, Sweden.
    Jansson, Per-Anders
    Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Carlberg, Bo
    Department of Medicine, Umeå University Hospital, Umeå, Sweden.
    Hägg, Anders
    Department of Medicine, Uppsala University Hospital, Uppsala, Sweden.
    Kurland, Lisa
    Department of Medicine, Uppsala University Hospital, Uppsala, Sweden.
    Svensson, Maria K.
    Department of Medicine, Umeå University Hospital, Umeå, Sweden; Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Ahlström, Håkan
    Department of Radiology, Uppsala University Hospital, Uppsala, Sweden.
    Ström, Conny
    Department of Radiology, Umeå University Hospital, Umeå, Sweden.
    Lönn, Lars
    Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Faculty of Health Sciences, Rigshospitalet, Copenhagen, Denmark.
    Öjbrandt, Kristina
    Department of Medicine, Umeå University Hospital, Umeå, Sweden.
    Johansson, Lars
    Department of Radiology, Uppsala University Hospital, Uppsala, Sweden; AstraZeneca R&D, Mölndal, Sweden.
    Lind, Lars
    Department of Medicine, Uppsala University Hospital, Uppsala, Sweden.
    Hydrochlorothiazide, but not Candesartan, aggravates insulin resistance and causes visceral and hepatic fat accumulation: the mechanisms for the diabetes preventing effect of Candesartan (MEDICA) Study2008In: Hypertension, ISSN 0194-911X, E-ISSN 1524-4563, Vol. 52, no 6, p. 1030-1037Article in journal (Refereed)
    Abstract [en]

    Treatment with angiotensin II receptor blockers is associated with lower risk for the development of type 2 diabetes mellitus compared with thiazide diuretics. The Mechanisms for the Diabetes Preventing Effect of Candesartan Study addressed insulin action and secretion and body fat distribution after treatment with candesartan, hydrochlorothiazide, and placebo. Twenty-six nondiabetic, abdominally obese, hypertensive patients were included in a multicenter 3-way crossover trial, and 22 completers (by predefined criteria; 10 men and 12 women) were included in the analyses. They underwent 12-week treatment periods with candesartan (C; 16 to 32 mg), hydrochlorothiazide (H; 25 to 50 mg), and placebo (P), respectively, and the treatment order was randomly assigned and double blinded. Intravenous glucose tolerance tests and euglycemic hyperinsulinemic (56 mU/m(2) per minute) clamps were performed. Intrahepatic and intramyocellular and extramyocellular lipid content and subcutaneous and visceral abdominal adipose tissue were measured using proton magnetic resonance spectroscopy and MRI. Insulin sensitivity (M-value) was reduced following H versus C and P (6.07+/-2.05, 6.63+/-2.04, and 6.90+/-2.10 mg/kg of body weight per minute, mean+/-SD; P<or=0.01). Liver fat content was higher (P<0.05) following H than both P and C. The subcutaneous to visceral abdominal adipose tissue ratio was reduced following H versus C and P (P<0.01). Glycosylated hemoglobin, alanine aminotransferase, aspartate aminotransferase, and high-sensitivity C-reactive protein levels were higher (P<0.05) after H, but not C, versus P. There were no changes in body fat, intramyocellular lipid, extramyocellular lipid, or first-phase insulin secretion. Blood pressure was reduced similarly by C and H versus P. In conclusion, visceral fat redistribution, liver fat accumulation, low-grade inflammation, and aggravated insulin resistance were demonstrated after hydrochlorothiazide but not candesartan treatment. These findings can partly explain the diabetogenic potential of thiazides.

  • 17.
    Hallberg, P.
    et al.
    Department of Medical Sciences, Uppsala University, Uppsala.
    Karlsson, J.
    Department of Medical Sciences, Uppsala University, Uppsala.
    Lind, L.
    Department of Medical Sciences, Uppsala University, Uppsala.
    Michaëlsson, K.
    Department of Surgical Sciences, Uppsala University, Uppsala.
    Kurland, Lisa
    Department of Medical Sciences, Uppsala University, Uppsala.
    Kahan, T.
    Division of Internal Medicine, Karolinska Institute, Danderyd Hospital, Stockholm.
    Malmqvist, K.
    Division of Internal Medicine, Karolinska Institute, Danderyd Hospital, Stockholm.
    Öhman, K. P.
    Division of Internal Medicine, Karolinska Institute, Danderyd Hospital, Stockholm; Department of Medicine and Care, Faculty of Health Sciences, Linköping.
    Nyström, F.
    Department of Medicine and Care, Faculty of Health Sciences, Linköping; Department of Biomedicine and Surgery, Faculty of Health Sciences, Linköping, Sweden.
    Liljedahl, U.
    Department of Medical Sciences, Uppsala University, Uppsala.
    Syvänen, A. C.
    Department of Medical Sciences, Uppsala University, Uppsala.
    Melhus, H.
    Department of Medical Sciences, Uppsala University, Uppsala.
    Gender-specific association between preproendothelin-1 genotype and reduction of systolic blood pressure during antihypertensive treatment–results from the Swedish Irbesartan Left Ventricular Hypertrophy Investigation versus Atenolol (SILVHIA)2004In: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 27, no 5, p. 287-90Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Studies suggest that endothelin-1 contributes to the pathogenesis of hypertension. A G5665T gene polymorphism of preproendothelin-1 has been shown to be associated with higher blood pressure in overweight patients. No study has yet determined the effect of this polymorphism on the change in blood pressure during antihypertensive treatment.

    HYPOTHESIS: This study aimed to determine this effect in hypertensive patients with left ventricular (LV) hypertrophy during antihypertensive treatment with either irbesartan or atenolol.

    METHODS: We determined the preproendothelin-1 genotype using minisequencing in 102 patients with essential hypertension and LV hypertrophy verified by echocardiography, randomized in a double-blind fashion to treatment with either the AT1-receptor antagonist irbesartan or the beta1-adrenoceptor antagonist atenolol.

    RESULTS: The change in systolic blood pressure (SBP) after 12 weeks of treatment was related to the preproendothelin-1 genotype in men; after adjustment for potential covariates (age, blood pressure, and LV mass index at study entry, dose of irbesartan/atenolol, and type of treatment), those carrying the T-allele responded on average with a more than two-fold greater reduction than those with the G/G genotype (-21.9 mmHg 13.9] vs. -8.9 [2.3], p = 0.007). No significant differences in blood pressure change between G/G and carriers of the T-allele were seen among women.

    CONCLUSIONS: Our finding suggests a gender-specific relationship between the G5665T preproendothelin-1 polymorphism and change in SBP in response to antihypertensive treatment with irbesartan or atenolol, suggesting the endothelin pathway to be a common mechanism included in the hypertensive action of the drugs.

  • 18.
    Hallberg, Pär
    et al.
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Karlsson, Julia
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Kurland, Lisa
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Lind, Lars
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden; AstraZeneca Research & Development, Mölndal, Sweden.
    Kahan, Thomas
    Division of Internal Medicine, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
    Malmqvist, Karin
    Division of Internal Medicine, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
    Öhman, K. Peter
    AstraZeneca Research & Development, Mölndal, Sweden; Department of Medicine and Care, Faculty of Health Sciences, Linköping, Sweden.
    Nyström, Fredrik
    Department of Medicine and Care, Faculty of Health Sciences, Linköping, Sweden; Department of Biomedicine and Surgery, Faculty of Health Sciences, Linköping, Sweden.
    Melhus, Håkan
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    The CYP2C9 genotype predicts the blood pressure response to irbesartan: results from the Swedish Irbesartan Left Ventricular Hypertrophy Investigation vs Atenolol (SILVHIA) trial2002In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 20, no 10, p. 2089-2093Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The cytochrome P450 CYP2C9 enzyme (CYP2C9) metabolizes many clinically important drugs, for example, phenytoin, warfarin and the angiotensin II type 1 (AT(1)) receptor antagonists, losartan and irbesartan. Single nucleotide polymorphisms in the CYP2C9 gene result in the expression of three important variants, CYP2C9*1(wild-type), CYP2C9*2 and CYP2C9*3, the last two exhibiting reduced catalytic activity compared with the wild-type. The CYP2C9 genotype is known to determine sensitivity to and dose requirements for both warfarin and phenytoin, and also the rate of metabolism of losartan. However, its influence on clinical response to treatment with the AT(1) receptor antagonist, irbesartan, has not been investigated.

    OBJECTIVE: To determine whether the CYP2C9genotype influences the blood pressure-decreasing response to antihypertensive treatment with irbesartan.

    DESIGN AND METHODS: One hundred and two patients with essential hypertension and left ventricular hypertrophy were allocated randomly to groups to receive double-blind treatment with either irbesartan (n = 49) or the beta(1)-adrenergic receptor blocker, atenolol ( n= 53). Blood pressure was measured before and after 12 weeks of treatment. genotyping was performed using solid-phase minisequencing.

    RESULTS: The diastolic blood pressure (DBP) response differed in relation to the CYP2C9 genotype in patients given irbesartan: the reduction in patients with genotype CYP2C9*1/CYP2C9*1 (n = 33) was 7.5% and that with CYP2C9*1/CYP2C9*2 (n = 12) was 14.4% ( P= 0.036). A similar trend was seen for systolic blood pressure. In contrast, no relation was seen between the CYP2C9 genotype and blood pressure response to atenolol, a drug not metabolized via CYP2C9.

    CONCLUSIONS: The CYP2C9 genotype seems to predict the DBP response to irbesartan, but not to atenolol, in patients with essential hypertension.

  • 19.
    Hallberg, Pär
    et al.
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Lind, Lars
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden; AstraZeneca Research & Development, Mölndal, Sweden.
    Billberger, Katarina
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Michaelsson, Karl
    Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
    Karlsson, Julia
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Kurland, Lisa
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Kahan, Thomas
    Division of Internal Medicine, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden.
    Malmqvist, Karin
    Division of Internal Medicine, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
    Öhman, K. Peter
    AstraZeneca Research & Development, Mölndal, Sweden; Department of Medicine and Care, Faculty of Health Sciences, Linköping, Sweden.
    Nyström, Fredrik
    Department of Medicine and Care, Faculty of Health Sciences, Linköping, Sweden; Department of Biomedicine and Surgery, Faculty of Health Sciences, Linköping, Sweden.
    Liljedahl, Ulrika
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Syvänen, Ann-Christine
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Melhus, Håkan
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Transforming growth factor beta1 genotype and change in left ventricular mass during antihypertensive treatment–results from the Swedish Irbesartan Left Ventricular Hypertrophy Investigation versus Atenolol (SILVHIA)2004In: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 27, no 3, p. 169-173Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Angiotensin II, via the angiotensin II type 1 (AT1) receptor, may mediate myocardial fibrosis and myocyte hypertrophy seen in hypertensive left ventricular (LV) hypertrophy through production of transforming growth factor beta1 (TGF-beta1); AT1-receptor antagonists reverse these changes. The TGF-beta1 G + 915C polymorphism is associated with interindividual variation in TGF-beta1 production. No study has yet determined the impact of this polymorphism on the response to antihypertensive treatment.

    HYPOTHESIS: We aimed to determine whether the TGF-beta1 G + 915C polymorphism was related to change in LV mass during antihypertensive treatment with either an AT1-receptor antagonists or a beta1-adrenoceptor blocker. The polymorphism was hypothesized to have an impact mainly on the irbesartan group.

    METHODS: We determined the association between the TGF-beta1 genotype and regression of LV mass in 90 patients with essential hypertension and echocardiographically diagnosed LV hypertrophy, randomized in a double-blind study to receive treatment for 48 weeks with either the AT1-receptor antagonist irbesartan or the beta1-adrenoceptor blocker atenolol.

    RESULTS: Irbesartan-treated patients who were carriers of the C-allele, which is associated with low expression of TGF-beta1, responded with a markedly greater decrease in LV mass index (LVMI) than subjects with the G/G genotype (adjusted mean change in LVMI -44.7 g/m2 vs. -22.2 g/m2, p = 0.007), independent of blood pressure reduction. No association between genotype and change in LVMI was observed in the atenolol group.

    CONCLUSIONS: The TGF-beta1 G + 915C polymorphism is related to the change in LVMI in response to antihypertensive treatment with the AT1-receptor antagonist irbesartan.

  • 20. Hallberg, Pär
    et al.
    Lind, Lars
    Michaëlsson, Karl
    Karlsson, Julia
    Kurland, Lisa
    Kahan, Thomas
    Malmqvist, Karin
    Öhman, K. Peter
    Nyström, Fredrik
    Melhus, Håkan
    B2 bradykinin receptor (B2BKR) polymorphism and change in left ventricular mass in response to antihypertensive treatment: results from the Swedish Irbesartan Left Ventricular Hypertrophy Investigation versus Atenolol (SILVHIA) trial2003In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 21, no 3, p. 621-624Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Hypertension is associated with a number of adverse morphologic and functional changes in the cardiovascular system, including left ventricular (LV) hypertrophy. Studies have demonstrated that bradykinin, through the B2 bradykinin receptor (B2BKR), mediates important cardiovascular effects that may protect against LV hypertrophy. Recently, a +9/-9 exon 1 polymorphism of the B2BKR was shown to be strongly associated with LV growth response among normotensive males undergoing physical training. We aimed to clarify whether the processes found in exercise-induced LV growth in normotensive people also occur in pathological LV hypertrophy.

    DESIGN AND METHODS: We determined the B2BKR genotype of 90 patients with essential hypertension and echocardiographically diagnosed LV hypertrophy, included in a double-blind study to receive treatment for 48 weeks with either the angiotensin II type 1 (AT1) receptor antagonist irbesartan or the beta1-adrenoceptor antagonist atenolol.

    RESULTS: B2BKR +9/+9 genotypes responded poorly in LV mass regression, independent of blood pressure reduction or treatment, as compared to the other genotypes (adjusted mean change in LV mass index = -10.0 +/- 4.6 versus -21.6 +/- 2.2 g/m2, P = 0.03).

    CONCLUSIONS: Our results suggest an impact of the B2BKR polymorphism on LV mass regression during antihypertensive treatment.

  • 21.
    Hallberg, Pär
    et al.
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Lind, Lars
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden; AstraZeneca Research & Development, Mölndal, Sweden.
    Michaëlsson, Karl
    Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
    Kurland, Lisa
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Kahan, Thomas
    Division of Internal Medicine, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden.
    Malmqvist, Karin
    Division of Internal Medicine, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden.
    Öhman, Karl Peter
    AstraZeneca Research & Development, Mölndal, Sweden; Department of Medicine and Care, Faculty of Health Sciences, Linköping, Sweden.
    Nyström, Fredrik
    Department of Medicine and Care, Faculty of Health Sciences, Linköping, Sweden; Department of Biomedicine and Surgery, Faculty of Health Sciences, Linköping, Sweden.
    Liljedahl, Ulrika
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Syvänen, Ann-Christine
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Melhus, Håkan
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Adipocyte-derived leucine aminopeptidase genotype and response to antihypertensive therapy2003In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 3, article id 11Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Adipocyte-derived leucine aminopeptidase (ALAP) is a recently identified member of the M1 family of zinc-metallopeptidases and is thought to play a role in blood pressure control through inactivation of angiotensin II and/or generation of bradykinin. The enzyme seems to be particularly abundant in the heart. Recently, the Arg528-encoding allele of the ALAP gene was shown to be associated with essential hypertension.

    METHODS: We evaluated the influence of this polymorphism on the change in left ventricular mass index in 90 patients with essential hypertension and echocardiographically diagnosed left ventricular hypertrophy, randomised in a double-blind study to receive treatment with either the angiotensin II type I receptor antagonist irbesartan or the beta1-adrenoceptor blocker atenolol for 48 weeks. Genyotyping was performed using minisequencing.

    RESULTS: After adjustment for potential covariates (blood pressure and left ventricular mass index at baseline, blood pressure change, age, sex, dose and added antihypertensive treatment), there was a marked difference between the Arg/Arg and Lys/Arg genotypes in patients treated with irbesartan; those with the Arg/Arg genotype responded on average with an almost two-fold greater regression of left ventricular mass index than patients with the Lys/Arg genotype (-30.1 g/m2 [3.6] vs -16.7 [4.5], p = 0.03).

    CONCLUSIONS: The ALAP genotype seems to determine the degree of regression of left ventricular hypertrophy during antihypertensive treatment with the angiotensin II type I receptor antagonist irbesartan in patients with essential hypertension and left ventricular hypertrophy. This is the first report of a role for ALAP/aminopeptidases in left ventricular mass regulation, and suggests a new potential target for antihypertensive drugs.

  • 22.
    Karlsson, J.
    et al.
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Lind, L.
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden; AstraZeneca Research and Development, Mölndal, Sweden.
    Hallberg, P.
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Michaëlsson, K.
    Department of Surgical Sciences, Uppsala University, Uppsala.
    Kurland, Lisa
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Kahan, T.
    Division of Internal Medicine, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden.
    Malmqvist, K.
    Division of Internal Medicine, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
    Öhman, K. P.
    AstraZeneca Research and Development, Mölndal, Sweden; Department of Medicine and Care, Faculty of Health Sciences, Linköping, Sweden.
    Nyström, F.
    Department of Medicine and Care, Faculty of Health Sciences, Linköping, Sweden; Department of Biomedicine and Surgery, Faculty of Health Sciences, Linköping, Sweden.
    Melhus, H.
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Beta1-adrenergic receptor gene polymorphisms and response to beta1-adrenergic receptor blockade in patients with essential hypertension2004In: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 27, no 6, p. 347-350Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Studies suggest that the Ser49Gly and Arg389Gly polymorphisms in the beta1-adrenergic receptor might be of functional importance for the cardiovascular system. Both have been associated with altered receptor activity in vitro, and with hypertension and cardiac failure in vivo.

    HYPOTHESIS: The aim of this study was to test whether these polymorphisms were associated with the change in heart rate or blood pressure in patients with essential hypertension and left ventricular (LV) hypertrophy treated with the beta1-adrenergic receptor blocker atenolol.

    METHODS: Blood pressure and heart rate were measured in 101 hypertensive patients with echocardiographically verified LV hypertrophy, randomized in a double-blind study to treatment with either the beta1-adrenergic receptor blocker atenolol or the angiotensin II type I receptor antagonist irbesartan. Changes in blood pressure and heart rate were evaluated after 12 weeks. Beta1-adrenergic receptor genotyping was performed using polymerase chain reaction and restriction fragment length polymorphism.

    RESULTS: We found no significant associations between the changes in the measured variables and either of the two polymorphisms. However, carriers of the 49Gly allele showed a tendency toward a greater reduction in heart rate compared with patients with the Ser/Ser49 genotype (p = 0.06).

    CONCLUSIONS: The Ser49Gly and Arg389Gly beta1-adrenergic receptor polymorphisms do not seem to exert a major effect on the changes in heart rate and blood pressure during 12 weeks of treatment with atenolol in patients with essential hypertension and LV hypertrophy.

  • 23.
    Khankeh, Hamidreza
    et al.
    University of Social Welfare & Rehabilitation Sciences, Tehran, Iran; Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden.
    Nakhaei, Maryam
    University of Social Welfare & Rehabilitation Sciences, Tehran, Iran.
    Masoumi, Gholamreza
    Iran University of Medical Sciences, Teheran, Iran.
    Hosseini, Mohammadali
    University of Social Welfare & Rehabilitation Sciences, Tehran, Iran.
    Parsa-Yekta, Zohreh
    Tehran University of Medical Sciences, Teheran, Iran.
    Kurland, Lisa
    Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden.
    Castren, Maaret
    Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden.
    Life recovery after disasters: a qualitative study in the Iranian context2013In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 28, no 6, p. 573-9Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Planned and organized long-term rehabilitation services should be provided to victims of a disaster for social integration, economic self-sufficiency, and psychological health. There are few studies on recovery and rehabilitation issues in disaster situations. This study explores the disaster-related rehabilitation process.

    METHOD: This study was based on qualitative analysis. Participants included 18 individuals (eight male and ten female) with experience providing or receiving disaster health care or services. Participants were selected using purposeful sampling. Data were collected through in-depth and semi-structured interviews. All interviews were transcribed and content analysis was performed based on qualitative content analysis.

    RESULTS: The study explored three main concepts of recovery and rehabilitation after a disaster: 1) needs for health recovery; 2) intent to delegate responsibility; and 3) desire for a wide scope of social support. The participants of this study indicated that to provide comprehensive recovery services, important basic needs should be considered, including the need for physical rehabilitation, social rehabilitation, and livelihood health; the need for continuity of mental health care; and the need for family re-unification services. Providing social activation can help reintegrate affected people into the community.

    CONCLUSION: Effective rehabilitation care for disaster victims requires a clear definition of the rehabilitation process at different levels of the community. Involving a wide set of those most likely to be affected by the process provides a comprehensive, continuous, culturally sensitive, and family-centered plan.

  • 24.
    Kurland, Lisa
    Örebro University, School of Medical Sciences.
    Sverige: akutsjukvård i nästan 20 år2017In: Finska Läkaresällskapets Handlingar, ISSN 0015-2501, no 2, p. 10-14Article in journal (Refereed)
  • 25.
    Kurland, Lisa
    et al.
    Swedish Society for Emergency Medicine, Stockholm, Sweden; Department of Clinical Research and Education, Karolinska Institutet, Stockholm, Sweden; Department of Emergency Medicine, Södersjukhuset, Stockholm, Sweden.
    Graham, Colin A
    Department of Emergency Medicine, Chinese University, Hong Kong, China.
    Emergency medicine development in the Nordic countries2014In: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 21, no 3, p. 163-163Article in journal (Refereed)
  • 26.
    Kurland, Lisa
    et al.
    Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
    Hallberg, Pär
    Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
    Melhus, Håkan
    Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
    Liljedahl, Ulrika
    Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
    Hashemi, Nashmil
    Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden.
    Syvänen, Ann-Christine
    Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
    Lind, Lars
    Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
    Kahan, Thomas
    Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden.
    The relationship between the plasma concentration of irbesartan and the antihypertensive response is disclosed by an angiotensin II type 1 receptor polymorphism: results from the Swedish Irbesartan Left Ventricular Hypertrophy Investigation vs. Atenolol (SILVHIA) Trial.2008In: American Journal of Hypertension, ISSN 0895-7061, E-ISSN 1941-7225, Vol. 21, no 7, p. 836-839Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The aim of this study was to investigate the effect of the plasma concentration of irbesartan, a specific angiotensin II type 1 receptor (AT1R) antagonist, and the blood pressure response in relation to AT1R gene polymorphisms.

    METHODS: Plasma irbesartan was analyzed in 42 patients with mild-to-moderate hypertension and left ventricular hypertrophy from the Swedish Irbesartan Left Ventricular Hypertrophy Investigation vs. Atenolol (SILVHIA) trial, who were treated with irbesartan as monotherapy for 12 weeks. Blood pressure and irbesartan concentration were measured at trough, i.e., 24 +/- 3 h after the last dose. Five AT1R gene polymorphisms were analyzed by minisequencing.

    RESULTS: Neither the plasma concentration of irbesartan, nor any of the AT1R polymorphisms were associated with the blood pressure response to irbesartan treatment. However, the interaction term between the plasma concentration of irbesartan and the AT1R C5245T polymorphism was related to the reduction in systolic blood pressure after 12 weeks of treatment (P = 0.025). Furthermore, the plasma concentration of irbesartan was related to the change in systolic blood pressure in individuals homozygous for the AT1R 5245 T allele (r = -0.56, P = 0.030), but not for other genotypes.

    CONCLUSIONS: There was an association between plasma concentrations of irbesartan and the blood pressure response for hypertensive patients with AT1R 5245 TT. Because of the small sample size, this study needs to be viewed as hypothesis generating. This is the first study, to our knowledge, indicating that the concentration-response relationship of an antihypertensive drug may be genotype dependent.

  • 27.
    Kurland, Lisa
    et al.
    Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
    Liljedahl, Ulrika
    Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
    Karlsson, Julia
    Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
    Kahan, Thomas
    Division of Medicine, Karolinska Institute Danderyd Hospital, Stockholm, Sweden.
    Malmqvist, Karin
    Division of Medicine, Karolinska Institute Danderyd Hospital, Stockholm, Sweden.
    Melhus, Håkan
    Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
    Syvänen, Ann Christine
    Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
    Lind, Lars
    AstraZeneca R&D, Mölndal, Sweden.
    Angiotensinogen gene polymorphisms: relationship to blood pressure response to antihypertensive treatment. Results from the Swedish Irbesartan Left Ventricular Hypertrophy Investigation vs Atenolol (SILVHIA) trial.2004In: American Journal of Hypertension, ISSN 0895-7061, E-ISSN 1941-7225, Vol. 17, no 1, p. 8-13Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The renin-angiotensin-aldosterone system (RAAS) is important for the development of hypertension, and several antihypertensive drugs target this system. Our aim was to determine whether specific single nucleotide polymorphisms (SNPs) in RAAS genes were related to the blood pressure (BP) lowering effect of antihypertensive treatment.

    METHODS: Patients with mild to moderate primary hypertension and left ventricular hypertrophy were randomized in a double-blind fashion to treatment with either the angiotensin II type 1 receptor antagonist irbesartan (n = 48) or the beta(1)-adrenergic receptor blocker atenolol (n = 49) as monotherapy. A microarray-based minisequencing system was used to genotype 30 SNPs in seven genes in the RAAS. These polymorphisms were related to the antihypertensive response after 12 weeks treatment.

    RESULTS: The BP reductions were similar in the atenolol and the irbesartan groups. Presence of the angiotensinogen (AGT) -6A allele or the AGT 235T allele were both associated with the most pronounced systolic BP response to atenolol treatment (P =.001 when -6 AA+AG was compared with GG and P =.008 for presence of the 235T variant compared with 235 MM).

    CONCLUSIONS: We found that SNPs in the angiotensinogen gene were associated with the BP lowering response to atenolol. This study is limited by a relatively small sample size, and the results should therefore be viewed as preliminary. Despite this limitation, these results illustrate the potential of using SNP genotyping as a pharmacogenetic tool in antihypertensive treatment.

  • 28.
    Kurland, Lisa
    et al.
    Department of Medical Sciences, Uppsala University Hospital, Sweden; Department of Medicine, University Hospital, Uppsala, Sweden.
    Melhus, H
    Department of Medical Sciences, Uppsala University Hospital, Sweden.
    Sarabi, M
    Department of Medical Sciences, Uppsala University Hospital, Sweden.
    Millgård, J
    Department of Medical Sciences, Uppsala University Hospital, Sweden.
    Ljunghall, S
    Department of Medical Sciences, Uppsala University Hospital, Sweden.
    Lind, L
    Department of Medical Sciences, Uppsala University Hospital, Sweden.
    Polymorphisms in the renin-angiotensin system and endothelium-dependent vasodilation in normotensive subjects2001In: Clinical Physiology, ISSN 0144-5979, E-ISSN 1365-2281, Vol. 21, no 3, p. 343-349Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Our aim was to test the hypothesis that genes encoding components in the renin-angiotensin system influence endothelial vasodilatory function.

    METHODS: In 59 apparently healthy, normotensive individuals, endothelium-dependent vasodilation (EDV) and endothelial-independent vasodilation (EIDV) was evaluated by infusing metacholine and sodium nitroprusside into the brachial artery. Forearm blood flow was measured by venous occlusion plethysmography. The ACE insertion (I)/deletion (D) polymorphism, the T174M and M235T angiotensinogen restriction fragments length polymorphisms, the angiotensin II receptor type 1 (AT1R) A1166C, and the aldosterone synthase gene (CYP11B2) C-344T polymorphisms were analysed.

    RESULTS: When analysing the ACE, the two angiotensinogen and the aldosterone synthase CYP11B2 genotypes independently, no significant association with endothelial vasodilatory function was found. However, a significant reduction in endothelium-dependent vasodilation was observed in the subjects (n=9) with the ACE D allele and the angiotensinogen T174M genotype (P<0.05). Subjects with the AT1R genotype AC showed a reduction in both EDV (P=0.05) and EIDV (P=0.04) when compared with those with the AA genotype.

    CONCLUSIONS: The subjects with the ACE D allele in combination with the angiotensinogen T174M genotype are associated with a reduced EDV. This together with the observation that the AC AT1R genotype is associated with a reduction in both EDV and EIDV, supports the hypothesis that endothelial vasodilatory function is influenced by genes in the renin-angiotensinogen system.

  • 29.
    Kurland, Lisa
    et al.
    Department of Internal Medicine, Uppsala University Hospital, Uppsala, Sweden.
    Melhus, Håkan
    Department of Internal Medicine, Uppsala University Hospital, Uppsala, Sweden.
    Karlsson, Julia
    Department of Internal Medicine, Uppsala University Hospital, Uppsala, Sweden.
    Kahan, Thomas
    Division of Internal Medicine, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden.
    Malmqvist, Karin
    Division of Internal Medicine, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden.
    Öhman, K. Peter
    Department of Medicine and Care, Faculty of Health Sciences, Linköping, Sweden.
    Nyström, Fredrik
    Department of Medicine and Care, Faculty of Health Sciences, Linköping, Sweden.
    Hägg, Anders
    Department of Internal Medicine, Uppsala University Hospital, Uppsala, Sweden.
    Lind, Lars
    Department of Internal Medicine, Uppsala University Hospital, Uppsala, Sweden.
    Angiotensin converting enzyme gene polymorphism predicts blood pressure response to angiotensin II receptor type 1 antagonist treatment in hypertensive patients2001In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 19, no 10, p. 1783-1787Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To determine whether polymorphisms in the renin-angiotensin system can predict blood pressure-lowering response to antihypertensive treatment; more specifically, in response to treatment with irbesartan or atenolol.

    DESIGN AND METHODS: Eighty-six patients with hypertension were randomized to double-blind treatment with either the angiotensin II type 1 receptor antagonist irbesartan or the beta1 adrenergic receptor blocker atenolol and followed for 3 months. We analysed angiotensinogen T174M and M235T, angiotensin converting enzyme (ACE) I/D and angiotensin II type 1 receptor A1166C polymorphisms and related them to blood pressure reduction.

    RESULTS: The mean reductions in blood pressure were similar for both treatments. In the irbesartan group, individuals homozygous for the ACE gene I allele showed a greater reduction in diastolic blood pressure, exceeding those with the D allele (-18 +/- 11 SD versus -7 +/- 10 mmHg, P = 0.0096). This was not the case during treatment with atenolol, and the interaction term between type of treatment and ACE II genotype was significant (P = 0.0176). The angiotensinogen and angiotensin II type 1 receptor polymorhisms were not related to the response to treatment.

    CONCLUSIONS: ACE genotyping predicted the blood pressure-lowering response to antihypertensive treatment with irbesartan but not atenolol. Thus, specific genotypes might predict the response to specific antihypertensive treatment.

  • 30.
    Kurland, Lisa
    et al.
    Department of Internal Medicine, Uppsala University Hospital, Uppsala, Sweden.
    Melhus, Håkan
    Department of Internal Medicine, Uppsala University Hospital, Uppsala, Sweden.
    Karlsson, Julia
    Department of Internal Medicine, Uppsala University Hospital, Uppsala, Sweden.
    Kahan, Thomas
    Division of Internal Medicine, Karolinska Institute, Danderyd Hospital, Danderyd, Sweden.
    Malmqvist, Karin
    Division of Internal Medicine, Karolinska Institute, Danderyd Hospital, Danderyd, Sweden.
    Öhman, Peter
    Department of Medicine and Care, Faculty of Health Sciences, Linköping, Sweden.
    Nyström, Fredrik
    Department of Medicine and Care, Faculty of Health Sciences, Linköping, Sweden.
    Hägg, Anders
    Department of Internal Medicine, Uppsala University Hospital, Uppsala, Sweden.
    Lind, Lars
    Department of Internal Medicine, Uppsala University Hospital, Uppsala, Sweden.
    Aldosterone synthase (CYP11B2) -344 C/T polymorphism is related to antihypertensive response: result from the Swedish Irbesartan Left Ventricular Hypertrophy Investigation versus Atenolol (SILVHIA) trial2002In: American Journal of Hypertension, ISSN 0895-7061, E-ISSN 1941-7225, Vol. 15, no 5, p. 389-393Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Our aim was to determine whether the aldosterone synthase (CYP11B2) -344 C/T polymorphism was associated with the blood pressure (BP)-lowering response to antihypertensive treatment.

    METHODS: Patients with mild-to-moderate primary hypertension and left ventricular hypertrophy were randomized in a double-blind study to receive treatment with either the angiotensin II type 1 (AT1) receptor antagonist irbesartan (n = 43), or the beta1-adrenergic receptor blocker atenolol (n = 43). The aldosterone synthase (CYP11B2) -344 C/T polymorphism was analyzed using solid-phase minisequencing and related to BP reduction after 3 months treatment. Serum aldosterone levels were measured.

    RESULTS: After 3 months treatment the mean reductions in BP were similar for both treatment groups. When assessing the systolic BP reduction in the irbesartan group, patients with the TT variant had a more pronounced reduction (-21 +/- 19 SD mm Hg, n = 17) than both the TC (-14 +/- 18 mm Hg, n= 18) and CC (0 +/- 17 mm Hg, n = 8) genotypes (P = .04). There was no association between this polymorphism and the diastolic BP response. The -344 C/T polymorphism was not associated with the BP response to atenolol. Nor was it related to the baseline serum aldosterone level.

    CONCLUSIONS: The aldosterone synthase -344 C/T polymorphism was related to the BP-lowering response in hypertensive patients treated with the AT1-receptor antagonist irbesartan.

  • 31.
    Kurland, Lisa
    et al.
    Department of Internal Medicine, Uppsala University Hospital, Uppsala, Sweden.
    Melhus, Håkan
    Department of Internal Medicine, Uppsala University Hospital, Uppsala, Sweden.
    Karlsson, Julia
    Department of Internal Medicine, Uppsala University Hospital, Uppsala, Sweden.
    Kahan, Thomas
    Division of Internal Medicine, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden.
    Malmqvist, Karin
    Division of Internal Medicine, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden.
    Öhman, Peter
    Department of Medicine and Care, Faculty of Health Sciences, Linköping, Sweden.
    Nyström, Fredrik
    Department of Medicine and Care, Faculty of Health Sciences, Linköping, Sweden.
    Hägg, Anders
    Department of Internal Medicine, Uppsala University Hospital, Uppsala, Sweden.
    Lind, Lars
    Department of Internal Medicine, Uppsala University Hospital, Uppsala, Sweden.
    Polymorphisms in the angiotensinogen and angiotensin II type 1 receptor gene are related to change in left ventricular mass during antihypertensive treatment: results from the Swedish Irbesartan Left Ventricular Hypertrophy Investigation versus Atenolol (SILVHIA) trial2002In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 20, no 4, p. 657-663Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Our aim was to determine if gene polymorphisms in the renin-angiotensin-aldosterone system (RAAS) were related to the degree of change in left ventricular hypertrophy (LVH) during antihypertensive treatment.

    METHODS AND RESULTS: Patients with essential hypertension and echocardiographically diagnosed LVH were included in a double-blind study to receive treatment with either the angiotensin II type 1 receptor (AT1-receptor) antagonist irbesartan (n = 41), or the beta-1 adrenergic receptor blocker atenolol (n = 43) as monotherapy for 3 months. The angiotensinogen T174M and M235T, the angiotensin-converting enzyme I/D, the AT1-receptor A1166C and the aldosterone synthase (CYP11B2) -344 C/T polymorphisms were analysed and related to the change in left ventricular mass (LVM). Patients with the angiotensinogen 174 TM genotype treated with irbesartan responded with the greatest reduction in LVM (-23 +/- 31SD g/m2 for TM and +0.5 +/- 18 g/m2 for TT, P = 0.005), independent of blood pressure reduction. Both the angiotensinogen 235 T-allele (P = 0.02) and the AT1-receptor 1166 AC genotype responded with the greatest reduction in LVM when treated with irbesartan (-0.1 +/- 19 g/m2 for AA and -18 +/- 30 g/m2 for AC, P = 0.02), independent of blood pressure reduction. These polymorphisms were not associated with the change in LVM during treatment with atenolol.

    DISCUSSION: The angiotensinogen T174M and M235T and the AT1-receptor A1166C polymorphisms were related to the change in LVH during antihypertensive treatment with an AT1-receptor antagonist; of these angiotensinogen T174M was the most powerful. This highlights the role of the RAAS for left ventricular hypertrophy and the potential of pharmacogenetics as a tool for guidance of antihypertensive therapy.

  • 32.
    Kurland, Lisa
    et al.
    Örebro University, School of Medical Sciences.
    Meyer, Frida
    Akutsjukvård på grundutbildningen: en nationell målbeskrivningIn: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518Article in journal (Refereed)
  • 33.
    Liljedahl, Ulrika
    et al.
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Kahan, Thomas
    Division of Internal Medicine, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden.
    Malmqvist, Karin
    Division of Internal Medicine, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden.
    Melhus, Håkan
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Syvänen, Ann-Christine
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Lind, Lars
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden; Astra Zeneca R&D, Mölndal, Sweden.
    Kurland, Lisa
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Single nucleotide polymorphisms predict the change in left ventricular mass in response to antihypertensive treatment2004In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 22, no 12, p. 2321-2328Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Our aim was to determine whether the change in left ventricular (LV) mass in response to antihypertensive treatment could be predicted by multivariate analysis of single nucleotide polymorphisms (SNPs) in candidate genes reflecting pathways likely to be involved in blood pressure control.

    METHODS: Patients with mild to moderate primary hypertension and LV hypertrophy were randomized in a double-blind fashion to treatment with either the angiotensin II type 1 receptor antagonist irbesartan (n = 48) or the beta1 adrenoreceptor blocker atenolol (n = 49). A microarray-based minisequencing system was used for genotyping 74 SNPs in 25 genes. These genotypes were related to the change in LV mass index by echocardiography, after 12 weeks treatment as monotherapy, using stepwise multiple regression analysis.

    RESULTS: The blood pressure reductions were similar and significant in both treatment groups. Two SNPs in two separate genes (the angiotensinogen T1198C polymorphism, corresponding to the M235T variant and the apolipoprotein B G10108A polymorphism) for those treated with irbesartan, and the adrenoreceptor alpha2A A1817G for those treated with atenolol, significantly predicted the change in LV mass. The predictive power of these SNPs was independent of the degree of blood pressure reduction.

    CONCLUSION: SNPs in the angiotensinogen, apolipoprotein B, and the alpha2 adrenoreceptor gene predicted the change in LV mass during antihypertensive therapy. These results illustrate the potential of using microarray-based technology for SNP genotyping in predicting individual drug responses.

  • 34.
    Liljedahl, Ulrika
    et al.
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Karlsson, Julia
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Melhus, Håkan
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Kurland, Lisa
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Lindersson, Marie
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Kahan, Thomas
    Division of Internal Medicine, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden.
    Nyström, Fredrik
    Department of Medicosurgical Gastroenterology, Endocrinology and Metabolism, University Hospital of Linköping, Linköping, Sweden.
    Lind, Lars
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden; Astra Zeneca R&D, Mölndal, Sweden.
    Syvänen, Ann-Christine
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    A microarray minisequencing system for pharmacogenetic profiling of antihypertensive drug response2003In: Pharmacogenetics, ISSN 0960-314X, E-ISSN 1473-561X, Vol. 13, no 1, p. 7-17Article in journal (Refereed)
    Abstract [en]

    We aimed to develop a microarray genotyping system for multiplex analysis of a panel of single nucleotide polymorphisms (SNPs) in genes encoding proteins involved in blood pressure regulation, and to apply this system in a pilot study demonstrating its feasibility in the pharmacogenetics of hypertension. A panel of 74 SNPs in 25 genes involved in blood pressure regulation was selected from the SNP databases, and genotyped in DNA samples of 97 hypertensive patients. The patients had been randomized to double-blind treatment with either the angiotensin II type 1 receptor blocker irbesartan or the beta 1-adrenergic receptor blocker atenolol. Genotyping was performed using a microarray based DNA polymerase assisted 'minisequencing' single nucleotide primer extension assay with fluorescence detection. The observed genotypes were related to the blood pressure reduction using stepwise multiple regression analysis. The allele frequencies of the selected SNPs were determined in the Swedish population. The established microarray-based genotyping system was validated and allowed unequivocal multiplex genotyping of the panel of 74 SNPs in every patient. Almost 7200 SNP genotypes were generated in the study. Profiles of four or five SNP-genotypes that may be useful as predictors of blood pressure reduction after antihypertensive treatment were identified. Our results highlight the potential of microarray-based technology for SNP genotyping in pharmacogenetics.

  • 35.
    Liljedahl, Ulrika
    et al.
    Department of Medical Sciences, Uppsala University, Uppsala University Hospital, Uppsala, Sweden.
    Lind, Lars
    Department of Medical Sciences, Uppsala University, Uppsala University Hospital, Uppsala, Sweden; Astra Zeneca Research & Development Mölndal, Mölndal, Sweden.
    Kurland, Lisa
    Department of Medical Sciences, Uppsala University, Uppsala University Hospital, Uppsala, Sweden.
    Berglund, Lars
    Uppsala Clinical Research Center (UCR), Uppsala University, Uppsala, Sweden.
    Kahan, Thomas
    Division of Internal Medicine, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden.
    Syvänen, Ann-Christine
    Department of Medical Sciences, Uppsala University, Uppsala University Hospital, Uppsala, Sweden.
    Single nucleotide polymorphisms in the apolipoprotein B and low density lipoprotein receptor genes affect response to antihypertensive treatment2004In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 4, no 1, article id 16Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Dyslipidemia has been associated with hypertension. The present study explored if polymorphisms in genes encoding proteins in lipid metabolism could be used as predictors for the individual response to antihypertensive treatment.

    METHODS: Ten single nucleotide polymorphisms (SNP) in genes related to lipid metabolism were analysed by a microarray based minisequencing system in DNA samples from ninety-seven hypertensive subjects randomised to treatment with either 150 mg of the angiotensin II type 1 receptor blocker irbesartan or 50 mg of the beta1-adrenergic receptor blocker atenolol for twelve weeks.

    RESULTS: The reduction in blood pressure was similar in both treatment groups. The SNP C711T in the apolipoprotein B gene was associated with the blood pressure response to irbesartan with an average reduction of 19 mmHg in the individuals carrying the C-allele, but not to atenolol. The C16730T polymorphism in the low density lipoprotein receptor gene predicted the change in systolic blood pressure in the atenolol group with an average reduction of 14 mmHg in the individuals carrying the C-allele.

    CONCLUSIONS: Polymorphisms in genes encoding proteins in the lipid metabolism are associated with the response to antihypertensive treatment in a drug specific pattern. These results highlight the potential use of pharmacogenetics as a guide for individualised antihypertensive treatment, and also the role of lipids in blood pressure control.

  • 36.
    Lindström, V.
    et al.
    Department of Clinical Science and Education, Karolinska Institute, Stockolm, Sweden; Academic EMS, Stockholm, Sweden.
    Bohm, K.
    Department of Clinical Science and Education, Karolinska Institute, Stockolm, Sweden; SOS Alarm AB, Stockholm, Sweden.
    Kurland, Lisa
    Department of Clinical Science and Education, Karolinska Institute, Stockolm, Sweden; Department of Emergency Medicine, Södersjukhuset, Stockholm, Sweden.
    Prehospital care in Sweden: From a transport organization to advanced healthcare2015In: Notfall & Rettungsmedizin, ISSN 1434-6222, E-ISSN 1436-0578, Vol. 18, no 2, p. 107-109Article in journal (Refereed)
    Abstract [en]

    Background: Prehospital care, starting from the patient’s first contact with the emergency medical call centre and including medical care provided in the ambulance, is part of the continuum of care defined as emergency medicine (EM). Sweden has a network of emergency medical call centres that are all reached by one telephone number and staffed by nurses, among other personnel.

    Objective: This review presents a summary of the prehospital care systems currently in place in Sweden, the role of the physician and the future challenges in this evolving and important field.

    Results and conclusions: Since 2005, the presence of registered nurses in ambulance teams has become a requirement. This proved to be a turning point in the development of advanced care in the prehospital setting in Sweden. Due to overcrowding in emergency departments, the ambulance services work to steer patients from the ambulance directly to definitive care. Although there are limited numbers of physicians in the prehospital setting today, this should change as the specialty of EM grows stronger.

  • 37.
    Ljunggren, Malin
    et al.
    Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden; Section of Emergency Medicine, Karolinska Institutet, Stockholm, Sweden.
    Castrén, Maaret
    Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden; Section of Emergency Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki University, Helsinki, Finland.
    Nordberg, Martin
    Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden; Section of Emergency Medicine, Karolinska Institutet, Stockholm, Sweden.
    Kurland, Lisa
    Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden; Section of Emergency Medicine, Karolinska Institutet, Stockholm, Sweden.
    The association between vital signs and mortality in a retrospective cohort study of an unselected emergency department population2016In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 24, article id 21Article in journal (Refereed)
    Abstract [en]

    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 Södersjukhuset, Sweden from 4/1/2012 to 4/30/2013. Exclusion criteria were: age < 18 years, deceased upon arrival, chief complaint circulatory or respiratory arrest, key data missing and patients who were directed to a certain fast track for conditions demanding little resources. Vital sign data was collected through the Rapid Emergency Triage and Treatment System - Adult (RETTS-A). Descriptive analyses and logistic regression models were used. The main outcome measure was 1-day mortality.

    RESULTS: The 1-day mortality rate was 0.3%. 96,512 patients met the study criteria. After adjustments of differences in the other vital signs, comorbidities, gender and age the following vital signs were independently associated with 1-day mortality: oxygen saturation, systolic blood pressure, temperature, level of consciousness, respiratory rate, pulse rate and age. The highest odds ratios was observed when comparing unresponsive to alert patients (OR 31.0, CI 16.9 to 56.8), patients ≥ 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.

  • 38.
    Lo, Ronson S L
    et al.
    Department of Emergency Medicine, Chinese University of Hong Kong, Hong Kong, China.
    Brabrand, Mikkel
    Department of Emergency Medicine, Odense University Hospital, Odense, Denmark; Hospital of South West Jutland, Odense University, Odense, Denmark; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.
    Kurland, Lisa
    Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.
    Graham, Colin A
    Department of Emergency Medicine, Chinese University of Hong Kong, Hong Kong, China.
    Sepsis - where are the emergency physicians?2016In: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 23, no 3, p. 159-159Article in journal (Refereed)
  • 39.
    Madsen, Michael
    et al.
    Silkeborg Hospital and University, Copenhagen, Denmark.
    Kiuru, Sampsa
    Ashburton Hospital, Canterbury DHB, New Zealand; University of Turku, Turku, Finland.
    Castrèn, Maaret
    Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland; Department of Emergency Medicine and Services, Helsinki University, Helsinki, Finland.
    Kurland, Lisa
    Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden; Department of Emergency Medicine, Södersjukhuset, Stockholm, Sweden.
    The level of evidence for emergency department performance indicators: systematic review2015In: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 22, no 5, p. 298-305Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to perform a comprehensive systematic review of emergency department performance indicators in relation to evidence. A systematic search was performed through PUBMED, EMBASE, CINAHL and COCHRANE databases with (and including synonyms of) the search words: [emergency medicine OR emergency department] AND [quality indicator(s) OR performance indicator(s) OR performance measure(s)]. Articles were included according to the inclusion/exclusion criteria using the PRISMA protocol. The level of evidence was rated according to the evidence levels by the Oxford Centre for Evidence-Based Medicine. Performance indicators were extracted and organized into five categories; outcome, process, satisfaction, equity and structural/organizational measures. Six thousand four hundred and forty articles were initially identified; 127 provided evidence for/against a minimum of one performance indicator: these were included for further study. Of the 127 articles included, 113 (92%) were primary research studies and only nine (8%) were systematic reviews. Within the 127 articles, we found evidence for 202 individual indicators. Approximately half (n=104) of all this evidence (n=202) studied process-type indicators. Only seven articles (6%) qualified for high quality (level 1b). Sixty-six articles (51%) were good retrospective quality (level 2b or better), whereas the remaining articles were either intermediate quality (25% level 3a or 3b) or poor quality (17% level 4 or 5). We found limited evidence for most emergency department performance indicators, with the majority presenting a low level of evidence. Thus, a core group of evidence-based performance indicators cannot currently be recommended on the basis of this broad review of the literature.

  • 40.
    Madsen, Michael M.
    et al.
    Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
    Kiuru, Sampsa
    Ashburton Hospital, Canterbury DHB, New Zealand; University of Turku, Turku, Finland.
    Castrèn, Maaret
    Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki University, Helsinki, Finland.
    Kurland, Lisa
    Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden; Department of Emergency Medicine, Södersjukhuset, Stockholm, Sweden.
    Research into the evidence basis for widely used emergency department performance indicators should be prioritized2016In: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 23, no 5, p. 396-7Article in journal (Refereed)
  • 41.
    Madsen, Michael Moesmann
    et al.
    Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
    Eiset, Andreas Halgreen
    Research Center for Emergency Medicine, University of Aarhus, Aarhus, Denmark.
    Mackenhauer, Julie
    Research Center for Emergency Medicine, University of Aarhus, Aarhus, Denmark.
    Odby, Annette
    The Danish Clinical Registers, Aarhus, Denmark.
    Christiansen, Christian Fynbo
    Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
    Kurland, Lisa
    Department of Clinical Research and Education, Karolinska Institutet, Stockholm, Sweden; Department of EM, Södersjukhuset, Stockholm, Sweden.
    Kirkegaard, Hans
    Research Center for Emergency Medicine, University of Aarhus, Aarhus, Denmark.
    Selection of quality indicators for hospital-based emergency care in Denmark, informed by a modified-Delphi process2016In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 24, article id 11Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In 2013, Danish policy-makers on a nationwide level decided to set up a national quality of care database for hospital-based emergency care in Denmark including the selection of quality indicators. The aim of the study was to describe the Delphi process that contributed to the selection of quality indicators for a new national database of hospital-based emergency care in Denmark.

    METHODS: The process comprised a literature review followed by a modified-Delphi survey process, involving a panel of 54 experts (senior clinicians, researchers and administrators from the emergency area and collaborating specialties). Based on the literature review, we identified 43 potential indicators, of which eight were time-critical conditions. We then consulted the Expert panel in two consecutive rounds. The Expert panel was asked to what extent each indicator would be a good measure of hospital-based emergency care in Denmark. In each round, the Expert panel participants scored each indicator on a Likert scale ranging from one (=disagree completely) through to six (=agree completely). Consensus for a quality indicator was reached if the median was greater than or equal to five (=agree). The Delphi process was followed by final selection by the steering group for the new database.

    RESULTS: Following round two of the Expert panel, consensus was reached on 32 quality indicators, including three time-critical conditions. Subsequently, the database steering group chose a set of nine quality indicators for the initial version of the national database for hospital-based emergency care.

    CONCLUSIONS: The two-round modified Delphi process contributed to the selection of an initial set of nine quality indicators for a new a national database for hospital-based emergency care in Denmark. Final selection was made by the database steering group informed by the Delphi process.

  • 42.
    Meyer, Frida
    et al.
    Akutsjukvård, akutkliniken, Universitetssjukhuset i Linköping, Linköping, Sverige.
    Kurland, Lisa
    Örebro University, School of Medical Sciences. Akutkliniken, Universitetssjukhuset Örebro, Örebro, Sweden.
    Hög tid att planera undervisning i akutsjukvård på läkarutbildningarna2018In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115, article id E34CArticle in journal (Refereed)
  • 43. Miyan, Mamud
    et al.
    Uggla, Alexander
    Kurland, Lisa
    Örebro University, School of Medical Sciences.
    Nordberg, Martin
    Societal apprehension as a predictor of emergency department attendance2017In: Article in journal (Refereed)
  • 44. Murphy, Jason P.
    et al.
    Rådestad, Monica
    Kurland, Lisa
    Örebro University, School of Medical Sciences.
    Jirwe, Maria
    Djalali, Ahmadreza
    Rüter, Anders
    Emergency department registered nurses’ competencies in disaster medicine: A Delphi studyIn: Article in journal (Refereed)
  • 45.
    Mäkinen, M.
    et al.
    Department of Anaesthesia and Intensive Care Medicine, Helsinki University Hospital, Helsinki, Finland; Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Niemi-Murola, L.
    Department of Anaesthesia and Intensive Care Medicine, Helsinki University Hospital, Helsinki, Finland; Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Ponzer, S.
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Kurola, J.
    Centre for Prehospital Emergency Care, Kuopio University Hospital, Kuopio, Finland.
    Aune, S.
    Division of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Kurland, Lisa
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Castrén, M.
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Helsinki University Hospital, Helsinki, Finland.
    Healthcare professionals hesitate to perform CPR for fear of harming the patient2014In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 85, no 11, p. e181-e182Article in journal (Refereed)
  • 46.
    Möller, Anders
    et al.
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Hunter, Luke
    Khayelitsha Hospital, Private Bag X6, Khayelitsha, Cape Town, South Africa.
    Kurland, Lisa
    Örebro University, School of Medical Sciences. Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Department of Emergency Medicine, Örebro University Hospital, School of Medical Sciences, Campus USÖ, Örebro, Sweden.
    Lahri, Sa'ad
    Khayelitsha Hospital, Private Bag X6, Khayelitsha, Cape Town, South Africa.
    van Hoving, Daniel J.
    Division of Emergency Medicine, Stellenbosch University, Private Bag X1, Matieland, Cape Town, South Africa.
    The association between hospital arrival time, transport method, prehospital time intervals, and in-hospital mortality in trauma patients presenting to Khayelitsha Hospital, Cape Town2018In: African Journal of Emergency Medicine, ISSN 2211-419X, Vol. 8, no 3, p. 89-94Article in journal (Refereed)
    Abstract [en]

    Introduction: Trauma is a leading cause of unnatural death and disability in South Africa. The aim of the study was to determine whether method of transport, hospital arrival time or prehospital transport time intervals were associated with in-hospital mortality among trauma patients presenting to Khayelitsha Hospital, a district-level hospital on the outskirts of Cape Town, South Africa.

    Methods: The Khayelitsha Hospital Emergency Centre database was retrospectively analysed for trauma-related patients presenting to the resuscitation area between 1 November 2014 and 30 April 2015. Missing data and additional variables were collected by means of a chart review. Eligible patients' folders were scrutinised for hospital arrival time, transport time intervals, transport method and in-hospital mortality. Descriptive statistics were presented for all variables. Categorical data were analysed using the Fisher's Exact test and Chi-square, continuous data by logistic regression and the Mann Whitney test. A confidence interval of 95% was used to describe variance and a p-value of < 0.05 was deemed significant.

    Results: The majority of patients were 19-44 year old males (n=427, 80.3%) and penetrating trauma the most frequent mechanism of injury (n=343, 64.5%). In total, 258 (48.5%) patients arrived with their own transport, 254 (47.7%) by ambulance and 20 (3.8%) by the police service. The arrival of trauma patients peaked during the weekend, and was especially noticeable between midnight and six a. m. In-hospital mortality (n=18, 3.4%) was not significantly affected by transport method (p=0.26), hospital arrival time (p=0.22) or prehospital transport time intervals (all p-values > 0.09).

    Discussion: Method of transport, hospital arrival time and prehospital transport time intervals did not have a substantially measurable effect on in-hospital mortality. More studies with larger samples are suggested due to the small event rate.

  • 47.
    Nakhaei, Maryam
    et al.
    Birjand Health Qualitative Research Center, Birjand University of Medical Sciences, Birjand, Iran.
    Khankeh, Hamid Reza
    University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden.
    Masoumi, Gholam Reza
    Iran University of Medical Sciences, Tehran, Iran.
    Hosseini, Mohammad Ali
    University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
    Parsa-Yekta, Zohreh
    Tehran University of Medical Sciences, Tehran, Iran.
    Kurland, Lisa
    Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden.
    Castren, Maaret
    Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden.
    Impact of disaster on women in Iran and implication for emergency nurses volunteering to provide urgent humanitarian aid relief: A qualitative study2015In: Australasian emergency nursing journal : AENJ, ISSN 1574-6267, Vol. 18, no 3, p. 165-172Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Men and women are equally affected by disasters, but they experience disaster in different ways. To provide new knowledge and promote women's involvement in all phases of the disaster management, we decided to capture the perspectives and experiences of the women themselves; and to explore the conditions affecting Iranian women after recent earthquake disasters.

    METHODS: The study was designed as a qualitative content analysis. Twenty individuals were selected by purposeful sampling and data collected by in-depth, semi-structured interviews analysed qualitatively.

    RESULTS: Three main themes were evident reflecting women's status after disaster: individual impacts of disaster, women and family, and women in the community. Participants experienced the emotional impact of loss, disorganisation of livelihood and challenges due to physical injuries. Women experienced changes in family function due to separation and conflicts which created challenges and needed to be managed after the disaster. Their most urgent request was to be settled in their own permanent home. This motivated the women to help reconstruction efforts.

    CONCLUSIONS: Clarification of women's need after a disaster can help to mainstream gender-sensitive approaches in planning response and recovery efforts.

  • 48.
    Nekoie-Moghadam, Mahmood
    et al.
    Research Center for Health Services Management, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
    Kurland, Lisa
    Department of Clinical Sciences and Education, Karolinska Institutet, Stockholm, Sweden; Department of Emergency Medicine, Södersjukhuset, Stockholm, Sweden.
    Moosazadeh, Mahmood
    Health Sciences Research Center, School of Health, Mazandaran University of Medical Sciences, Sari, Iran.
    Ingrassia, Pier Luigi
    Center for Research and Education in Emergency and Disaster Medicine - CRIMEDIM, University degli Studi del Piemonte Orientale "A. Avogadro", Novara, Italy.
    Della Corte, Francesco
    Center for Research and Education in Emergency and Disaster Medicine - CRIMEDIM, University degli Studi del Piemonte Orientale "A. Avogadro", Novara, Italy.
    Djalali, Ahmadreza
    Center for Research and Education in Emergency and Disaster Medicine - CRIMEDIM, University degli Studi del Piemonte Orientale "A. Avogadro", Novara, Italy.
    Tools and Checklists Used for the Evaluation of Hospital Disaster Preparedness: A Systematic Review2016In: Disaster Medicine and Public Health Preparedness, ISSN 1935-7893, E-ISSN 1938-744X, Vol. 10, no 5, p. 781-788Article, review/survey (Refereed)
    Abstract [en]

    Hospitals need to be fully operative during disasters. It is therefore essential to be able to evaluate hospital preparedness. However, there is no consensus of a standardized, comprehensive and reliable tool with which to measure hospital preparedness. The aim of the current study was to perform a systematic review of evaluation tools for hospital disaster preparedness. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The key words "crisis," "disaster," "disaster medicine," "emergency," "mass casualty," "hospital preparedness," "hospital readiness," "hospital assessment," "hospital evaluation," "hospital appraisal," "planning," "checklist," and "medical facility" were used in combination with the Boolean operators "OR" and "AND." PubMed (National Library of Medicine, Bethesda, MD), ISI Web of Science (Thomson Reuters, New York, NY), and Scopus (Elsevier, New York, NY) were searched. A total of 51,809 publications were screened. The following themes were required for relevance: logistics, planning, human resources, triage, communication, command and control, structural and nonstructural preparedness, training, evacuation, recovery after disaster, coordination, transportation, surge capacity, and safety. The results from 15 publications are presented. Fifteen articles fulfilled the criteria of relevance and considered at least 1 of the 14 predetermined themes. None of the evaluated checklists and tools included all dimensions required for an appropriate hospital preparedness evaluation. The results of the current systematic review could be used as a basis for designing an evaluation tool for hospital disaster preparedness.

  • 49.
    Rüter, Andres
    et al.
    Sophiahemmet University, Stockholm, Sweden; Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Kurland, Lisa
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Gryth, Dan
    Department of Physiology and Pharmacology, Section of Anaesthesiology and Intensive Care, Karolinska Institutet, Stockholm, Sweden.
    Murphy, Jason
    Sophiahemmet University, Stockholm, Sweden; Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Rådestad, Monica
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Djalali, Ahmadreza
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Center for Research and Education in Emergency and Disaster Medicine, Novara, Italy.
    Evaluation of Disaster Preparedness Based on Simulation Exercises: A Comparison of Two Models2016In: Disaster Medicine and Public Health Preparedness, ISSN 1935-7893, E-ISSN 1938-744X, Vol. 10, no 4, p. 544-548Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The objective of this study was to highlight 2 models, the Hospital Incident Command System (HICS) and the Disaster Management Indicator model (DiMI), for evaluating the in-hospital management of a disaster situation through simulation exercises.

    METHODS: Two disaster exercises, A and B, with similar scenarios were performed. Both exercises were evaluated with regard to actions, processes, and structures. After the exercises, the results were calculated and compared.

    RESULTS: In exercise A the HICS model indicated that 32% of the required positions for the immediate phase were taken under consideration with an average performance of 70%. For exercise B, the corresponding scores were 42% and 68%, respectively. According to the DiMI model, the results for exercise A were a score of 68% for management processes and 63% for management structure (staff skills). In B the results were 77% and 86%, respectively.

    CONCLUSIONS: Both models demonstrated acceptable results in relation to previous studies. More research in this area is needed to validate which of these methods best evaluates disaster preparedness based on simulation exercises or whether the methods are complementary and should therefore be used together. (Disaster Med Public Health Preparedness. 2016;10:544-548).

  • 50. Sjölin, Helena
    et al.
    Lindström, Veronica
    Hult, Håkan
    Ringsted, Charlotte
    Kurland, Lisa
    Örebro University, School of Medical Sciences.
    Common core content in education for nurses in the ambulance care in Sweden, Finland and Belgium2017In: Article in journal (Refereed)
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