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Juhlin, Claes
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Publikasjoner (10 av 16) Visa alla publikasjoner
Linder, F., Holmberg, L., Björck, M., Juhlin, C., Thorbjörnsen, K., Wisinger, J., . . . Mani, K. (2019). A prospective stepped wedge cohort evaluation of the new national trauma team activation criteria in Sweden - the TRAUMALERT study.. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 27(1), Article ID 52.
Åpne denne publikasjonen i ny fane eller vindu >>A prospective stepped wedge cohort evaluation of the new national trauma team activation criteria in Sweden - the TRAUMALERT study.
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2019 (engelsk)Inngår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 27, nr 1, artikkel-id 52Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

BACKGROUND: Trauma triage based on prehospital information facilitates correct allocation of in-hospital resources. The Swedish national two-tier trauma team activation (TTA) criteria were revised in 2016. The current study aimed to evaluate the safety and efficacy of the new criteria.

METHODS: Five centres covering trauma care for 1.2 million inhabitants registered all trauma patients prospectively in the Swedish trauma registry (SweTrau) prior to and after stepwise introduction of new TTA criteria within the cohort (a prospective stepped-wedge cohort study design; period August 2016-November 2017). Evaluation of full- and limited-TTA frequency, under- and overtriage were performed at equal duration before and after this change.

RESULTS: The centres registered 1948 patients, 1882 (96.6%) of which were included in the study. With new criteria, frequency of full-TTA was unchanged, while limited-TTA decreased with 46.3% (from 988 to 531). 30-day trauma mortality was unchanged. The overtriage was 107/150 (71.3%) with former criteria, and 104/144 (72.2%) with new criteria, p = 0.866. Undertriage was 50/1037 (4.8%) versus 39/551 (7.1%), p = 0.063. Undertriage was consistently > 20% in patients with fall injury. Among patients with Injury Severity Score (ISS) > 15, 50/93 (53.8%) did not initiate full-TTA with former, vs 39/79 (49.4%) with new criteria, p = 0.565. Age > 60-years was a risk factor for undertriage (OR 2.89, p < 0.001), while low fall injuries indicated a trend (OR 2.70, p = 0.051).

CONCLUSIONS: The newly implemented Swedish TTA criteria result in a reduction in limited TTA frequency, indicating an increased efficiency in use of resources. The over- and undertriage is unchanged compared to former criteria, thus upholding patient safety.

Emneord
Epidemiology, Patient safety, Prospective stepped wedge cohort design, Trauma, Triage, Wounds and injuries
HSV kategori
Identifikatorer
urn:nbn:se:uu:diva-383430 (URN)10.1186/s13049-019-0619-1 (DOI)000466508600002 ()31039800 (PubMedID)
Tilgjengelig fra: 2019-05-14 Laget: 2019-05-14 Sist oppdatert: 2019-11-21bibliografisk kontrollert
Linder, F., Holmberg, L., Eklöf, H., Björck, M., Juhlin, C. & Mani, K. (2019). Better compliance with triage criteria in trauma would reduced costs with maintained patient safety. European journal of emergency medicine, 26(4), 283-288
Åpne denne publikasjonen i ny fane eller vindu >>Better compliance with triage criteria in trauma would reduced costs with maintained patient safety
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2019 (engelsk)Inngår i: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 26, nr 4, s. 283-288Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

OBJECTIVE: To evaluate trauma triage criteria in terms of compliance, undertriage, and overtriage and identify risk factors for mistriage.

METHODS: In a retrospective cohort study, all consecutive trauma patients at a University Hospital in Sweden in 2012 were included. Patients were stratified into three groups on the basis of trauma team activation (full trauma team, limited trauma team, and no trauma team). Case records were reviewed for mechanism of injury, vital signs, and injuries. Compliance with alert criteria was evaluated and injury severity score combined with the Matrix method was used for assessment of overtriage and undertriage.

RESULTS: A total of 1424 trauma patients were included in the study. Seventy-three (5.1%) patients activated a full trauma team, 732 (51.4%) a limited trauma team, and 619 (43.5%) did not activate any trauma team. Undertriage was 2.7% [95% confidence interval (CI): 1.9-3.8%] and overtriage was 34.2% (95% CI: 23.5-46.3%) in the complete cohort. Compliance with 'trauma triage criteria' was assessed by comparing actual alerts with what was estimated to be the correct alert levels on the basis of prehospital case records. Compliance with full trauma team criteria was 80% (68-88%), limited trauma team was 54% (51-58%), and no trauma team was 79% (76-82%). Assuming full compliance with trauma criteria, the Matrix method resulted in an undertriage of 2.3% (95% CI: 1.6-3.3%) and an overtriage of 42.6% (95% CI: 32.4-53.2%).

CONCLUSION: The overtriage and undertriage in this study is in line with the recommendations of the American College of Surgeons Committee on Trauma. However, better compliance with trauma alert criteria would result in fewer trauma team activations without affecting patient safety.

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Identifikatorer
urn:nbn:se:uu:diva-383431 (URN)10.1097/MEJ.0000000000000544 (DOI)000480684900011 ()29438134 (PubMedID)
Tilgjengelig fra: 2019-05-14 Laget: 2019-05-14 Sist oppdatert: 2019-09-30bibliografisk kontrollert
Tegelberg, A., Jangland, E., Juhlin, C. & Muntlin Athlin, Å. (2019). Who is in charge of the care of patients with acute abdominal pain? An interview study with managers across the acute care chain. Journal of Clinical Nursing, 28(19-20), 3641-3650
Åpne denne publikasjonen i ny fane eller vindu >>Who is in charge of the care of patients with acute abdominal pain? An interview study with managers across the acute care chain
2019 (engelsk)Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 28, nr 19-20, s. 3641-3650Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Aim and objectives: To describe managers' perspectives on the care of patients with acute abdominal pain and explore how they influence the care.

Background: Patients with acute abdominal pain form a common group of patients who often report poor pain management. Managers are key actors in ensuring that patients receive high‐quality care. This stresses the need to deepen the understanding of their perspectives on these patients, in order to provide high‐quality fundamental care across the acute care chain.

Design: Qualitative descriptive semi‐structured interview study, with an inductive approach. The Consolidated Criteria for Reporting Qualitative Research (COREQ) was used.

Methods: Individual interviews were conducted with managers (n = 17) from ambulance services, emergency departments and surgical departments at four hospitals in Sweden, representing managers at the micro‐ and macrolevels across the acute care chain.

Results: The patient group was described as a challenging heterogeneous group, with a focus on medical care, shaped by clinical practice guidelines, for which others were responsible. Managers with a physician background expressed that nursing care was important for the outcome of the care, while managers with a nursing background focused solely on the medical care. Additionally, the managers described that they affected the care by providing resources and serving as role models.

Conclusions: The solely medical perspective is worrying. By being a stakeholder, the managers' responsibility should be to highlight the patient perspective in the care and promote and support all health professionals in redesigning the care, where achieving higher quality both in nursing and in medical care for patients with acute abdominal pain becomes a shared goal.

Relevance to clinical practice: Managers should use their leadership to bridge the gap between medicine and nursing care by highlighting patients' need for fundamental care, and to support health professionals in providing evidence‐based and high‐quality care.

Emneord
acute abdominal pain, ambulance care service, emergency department, interviews, managers, surgical department
HSV kategori
Identifikatorer
urn:nbn:se:uu:diva-393384 (URN)10.1111/jocn.14962 (DOI)000485989700028 ()31190406 (PubMedID)
Tilgjengelig fra: 2019-09-20 Laget: 2019-09-20 Sist oppdatert: 2019-10-22bibliografisk kontrollert
Athlin, Å. M., Juhlin, C. & Jangland, E. (2017). Lack of existing guidelines for a large group of patients in Sweden: a national survey across the acute surgical care delivery chain. Journal of Evaluation In Clinical Practice, 23(1), 89-95
Åpne denne publikasjonen i ny fane eller vindu >>Lack of existing guidelines for a large group of patients in Sweden: a national survey across the acute surgical care delivery chain
2017 (engelsk)Inngår i: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 23, nr 1, s. 89-95Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Rationale, aims and objectivesEvidence-informed healthcare is the fundament for prac-tice, whereby guidelines based on the best available evidence should assist health profes-sionals in managing patients. Patients seeking care for acute abdominal pain form acommon group in acute care settings worldwide, for whom decision-making and timelytreatment are of paramount importance. There is ambiguity about the existence, use andcontent of guidelines for patients with acute abdomen. The objective was to describe andcompare guidelines and management of patients with acute abdomen in different settingsacross the acute care delivery chain in Sweden.MethodA national cross-sectional design was used. Twenty-nine ambulance stations, 17emergency departments and 33 surgical wards covering all six Swedish health regions wereincluded, and 23 guidelines were quality appraised using the validated Appraisal of Guide-lines for Research & Evaluation II tool.ResultsThere is a lack of guidelines in use for the management of this large group of pa-tients between and within different healthcare areas across the acute care delivery chain.The quality appraisal identified that several guidelines were of poor quality, especiallythe in-hospital ones. Further, range orders for analgesics are common in the ambulance ser-vices and the surgical wards, but are seldom present in the emergency departments. Also,education in pain management is more common in the ambulance services. Thesefindingsare noteworthy as, hypothetically, the same patient could be treated in three different waysduring the same care episode.ConclusionsThere is an urgent need to develop high-quality evidence-based clinicalguidelines for this patient group, with the entire care process in focus

Emneord
abdominal pain, acute care delivery chain, ambulance, emergency care, guidelines, surgical care
HSV kategori
Identifikatorer
urn:nbn:se:uu:diva-304033 (URN)10.1111/jep.12607 (DOI)000395024900012 ()27491471 (PubMedID)
Tilgjengelig fra: 2016-09-29 Laget: 2016-09-29 Sist oppdatert: 2018-01-10bibliografisk kontrollert
Linder, F., Mani, K., Juhlin, C. & Eklöf, H. (2016). Routine whole body CT of high energy trauma patients leads to excessive radiation exposure. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 24(1)
Åpne denne publikasjonen i ny fane eller vindu >>Routine whole body CT of high energy trauma patients leads to excessive radiation exposure
2016 (engelsk)Inngår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 24, nr 1Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

BACKGROUND: Whole body computed tomography (WBCT) is an important adjunct in trauma care, which is often part of standard protocol in initial management of trauma patients. However, WBCT exposes patients to a significant dose of radiation. The use of WBCT was assessed in a modern trauma cohort in Sweden.

METHODS: A two-center retrospective cohort study was performed. All consecutive trauma alert patients at a university hospital (July-December 2008), and a rural county hospital (January 2009- December 2010) were included. Patients were stratified into three groups (high, intermediate and low risk) based on documented suspected injuries at primary survey at the site of accident or at the emergency department. Injury severity score (ISS) was calculated. Case records were reviewed for clinical and radiological findings at the time of trauma, and during a ≥36 months of follow-up period to identify possible missed injuries.

RESULTS: A total of 523 patients were included in the study (university hospital n = 273; rural county hospital n = 250), out of which 475 patients (91.0 %) underwent radiological examinations, 290 patients (55.4 %) underwent WBCT, which identified trauma related findings in 125 patients (43.1 % of those examined). The high-risk group (n = 62) had a mean age of 38.5 years (21.1 SD). Mean ISS was 16.48 (18.14 SD). In this group, WBCT resulted in a positive finding in 38 (74.5 %) patients. In the intermediate-risk group (n = 322; mean age 37.66, 20.24 SD) ISS was 4.42 (6.30 SD). A positive finding on WBCT was found in 87 of the intermediate group patients (44.8 %). The low-risk group (n = 139; mean age 32.5 years; 21.4 SD) had a mean ISS of 0.84 (1.57 SD) with no positive findings on WBCT and no missed injuries in medical records at ≥36 months.

DISCUSSION: The risk of developing radiation induced cancer is significant for young people if exposed to relatively high dose radiation as is the case in WBCT. WBCT in high-energy trauma is important for planning of treatment in severely injured patients while it can be questioned in the seemingly not injured where it is used mainly to permit early discharge from the ED.

CONCLUSIONS: Risk stratification criteria could in this retrospective study identify high energy trauma patients not in need of radiological imaging. WBCT in high-energy trauma does not affect patient care if the patient is mentally alert, not intoxicated nor shows signs of other than minor injuries when evaluated by a trauma-team. The risk of missing important traumatic findings in these patients is very low. Observation of the patient with reexamination instead of imaging may be considered in this group of often young patients where radiation dose is an issue.

HSV kategori
Identifikatorer
urn:nbn:se:uu:diva-278958 (URN)10.1186/s13049-016-0199-2 (DOI)000370592500001 ()26817669 (PubMedID)
Tilgjengelig fra: 2016-02-26 Laget: 2016-02-26 Sist oppdatert: 2018-02-14bibliografisk kontrollert
Jangland, E., Becker, D., Börjeson, S., Doherty, C., Gimm, O., Griffith, P., . . . Yngman-Uhlin, P. (2014). The development of a Swedish Nurse Practitioner Program: a request from clinicians and a process supported by US experience. Journal of Nursing Education and Practice, 4(2), 38-48
Åpne denne publikasjonen i ny fane eller vindu >>The development of a Swedish Nurse Practitioner Program: a request from clinicians and a process supported by US experience
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2014 (engelsk)Inngår i: Journal of Nursing Education and Practice, ISSN 1925-4040, E-ISSN 1925-4059, Vol. 4, nr 2, s. 38-48Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

High nursing turnover and a shortage of nurses in acute hospital settings in Sweden challenge health care systems to deliver and ensure safe care. Advanced nursing roles implemented in other countries have offered nurses new career opportunities and had positive effects on patient safety, effectiveness of care, and patient satisfaction. The advanced nursing position of Nurse Practitioner has existed for many years in the United States, while similar extended nursing roles and changes in the scope of nursing practice are being developed in many other countries. In line with this international trend, the role of Nurse Practitioner in surgical care has been proposed for Sweden, and a master’s programme for Acute Nurse Practitioners has been in development for many years. To optimize and facilitate the introduction of this new nursing role and its supporting programme, we elicited the experiences and support of the group who developed a Nurse Practitioner programme for a university in the US. This paper describes this collaboration and sharing of experiences during the process of developing a Swedish Nurse Practitioner programme. We also discuss the challenges of implement- ting any new nursing role in any national health care system. We would like to share our collaborative experiences and thoughts for the future and to open further national and international dialogue about how best to expand the scope of practice for nurses in acute hospital care, and thereby to improve patient care in Sweden and elsewhere.

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Identifikatorer
urn:nbn:se:uu:diva-210636 (URN)10.5430/jnep.v4n2p38 (DOI)
Tilgjengelig fra: 2013-11-12 Laget: 2013-11-12 Sist oppdatert: 2017-12-06bibliografisk kontrollert
Örlefors, H., Sundin, A., Garske, U., Juhlin, C., Öberg, K., Skogseid, B., . . . Eriksson, B. (2005). Whole-Body 11C-5-Hydroxytryptophan Positron Emission Tomography as a Universal Imaging Technique for Neuroendocrine Tumors: Comparison with Somatostatin Receptor Scintigraphy and Computed Tomography. Journal of Clinical Endocrinology and Metabolism, 90(6), 3392-3400
Åpne denne publikasjonen i ny fane eller vindu >>Whole-Body 11C-5-Hydroxytryptophan Positron Emission Tomography as a Universal Imaging Technique for Neuroendocrine Tumors: Comparison with Somatostatin Receptor Scintigraphy and Computed Tomography
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2005 (engelsk)Inngår i: Journal of Clinical Endocrinology and Metabolism, ISSN 0021-972X, E-ISSN 1945-7197, Vol. 90, nr 6, s. 3392-3400Artikkel i tidsskrift (Fagfellevurdert) Published
HSV kategori
Identifikatorer
urn:nbn:se:uu:diva-73096 (URN)10.1210/jc.2004-1938 (DOI)15755858 (PubMedID)
Tilgjengelig fra: 2006-01-19 Laget: 2006-01-19 Sist oppdatert: 2017-12-14bibliografisk kontrollert
Radecka, E., Brekkan, E., Juhlin, C., Nilsson, L., Sundin, A. & Magnusson, A. (2003). An unusual case of tumor thrombus in the inferior vena cava: A case report. Acta Radiologica, 44(2), 160-161
Åpne denne publikasjonen i ny fane eller vindu >>An unusual case of tumor thrombus in the inferior vena cava: A case report
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2003 (engelsk)Inngår i: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 44, nr 2, s. 160-161Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Adrenal cortical carcinoma (ACC) is a rare malignancy. Patients present either with a functional tumor or secondary to mass effect. In non-functioning tumors, the tumor size often exceeds 5 cm by the time of diagnosis, and tumor thrombus can occur. We report on a case of a small non-functioning ACC causing a large tumor thrombus in the inferior vena cava.

Emneord
Adrenal Cortex Neoplasms/*pathology, Adrenocortical Carcinoma/*secondary, Humans, Male, Middle Aged, Neoplasm Circulating Cells, Vena Cava; Inferior
HSV kategori
Identifikatorer
urn:nbn:se:uu:diva-73657 (URN)12694101 (PubMedID)
Tilgjengelig fra: 2007-03-13 Laget: 2007-03-13 Sist oppdatert: 2017-12-14bibliografisk kontrollert
Stenquist, M., Juhlin, C., Åström, G. & Friberg, U. (2003). Fallbeskrivning: Anomali i fjärde gälfickan med recidiverande halsabscesser. Etsning med triklorättiksyra tillslöt fistelmynning och botade patienten.. Läkartidningen, 100, 1536-9
Åpne denne publikasjonen i ny fane eller vindu >>Fallbeskrivning: Anomali i fjärde gälfickan med recidiverande halsabscesser. Etsning med triklorättiksyra tillslöt fistelmynning och botade patienten.
2003 (svensk)Inngår i: Läkartidningen, Vol. 100, s. 1536-9Artikkel i tidsskrift (Annet vitenskapelig) Published
Identifikatorer
urn:nbn:se:uu:diva-64939 (URN)
Tilgjengelig fra: 2007-05-04 Laget: 2007-05-04 Sist oppdatert: 2011-01-13
Correa, P., Juhlin, C., Rastad, J., Akerstrom, G., Westin, G. & Carling, T. (2002). Allelic loss in clinically and screening-detected primary hyperparathyroidism. Clin Endocrinol (Oxf), 56(1), 113-117
Åpne denne publikasjonen i ny fane eller vindu >>Allelic loss in clinically and screening-detected primary hyperparathyroidism
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2002 (engelsk)Inngår i: Clin Endocrinol (Oxf), Vol. 56, nr 1, s. 113-117Artikkel i tidsskrift (Fagfellevurdert) Published
Identifikatorer
urn:nbn:se:uu:diva-80861 (URN)
Tilgjengelig fra: 2006-06-08 Laget: 2006-06-08 Sist oppdatert: 2011-01-13
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