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Bremer, Anders, DocentORCID iD iconorcid.org/0000-0001-7865-3480
Publications (10 of 69) Show all publications
Andersson, H., Axelsson, C., Larsson, A., Bremer, A., Gellerstedt, M., Bång, A., . . . Ljungström, L. (2018). The early chain of care in bacteraemia patients: early suspicion, treatment and survival in prehospital emergency care. American Journal of Emergency Medicine
Open this publication in new window or tab >>The early chain of care in bacteraemia patients: early suspicion, treatment and survival in prehospital emergency care
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2018 (English)In: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171Article in journal (Refereed) Epub ahead of print
Abstract [en]

Introduction

Bacteraemia is a first stage for patients risking conditions such as septic shock. The primary aim of this study is to describe factors in the early chain of care in bacteraemia, factors associated with increased chance of survival during the subsequent 28 days after admission to hospital. Furthermore, the long-term outcome was assessed.

Methods

This study has a quantitative design based on data from Emergency Medical Services (EMS) and hospital records.

Results

In all, 961 patients were included in the study. Of these patients, 13.5% died during the first 28 days. The EMS was more frequently used by non-survivors. Among patients who used the EMS, the suspicion of sepsis already on scene was more frequent in survivors. Similarly, EMS personnel noted the ESS code “fever, infection” more frequently for survivors upon arriving on scene. The delay time from call to the EMS and admission to hospital until start of antibiotics was similar in survivors and non-survivors. The five-year mortality rate was 50.8%. Five-year mortality was 62.6% among those who used the EMS and 29.5% among those who did not (p < 0.0001).

Conclusion

This study shows that among patients with bacteraemia who used the EMS, an early suspicion of sepsis or fever/infection was associated with improved early survival whereas the delay time from call to the EMS and admission to hospital until start of treatment with antibiotics was not. 50.8% of all patients were dead after five years.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Bacteraemia, Infection, Emergency Medical Services, Emergency care, Prehospital emergency care, Sepsis
National Category
Infectious Medicine
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-74688 (URN)10.1016/j.ajem.2018.04.004 (DOI)
Available from: 2018-05-29 Created: 2018-05-29 Last updated: 2018-09-06
Claesson, A., Herlitz, J., Svensson, L., Ottosson, L., Bergfeldt, L., Engdahl, J., . . . Bremer, A. (2017). Defibrillation before EMS arrival in western Sweden. American Journal of Emergency Medicine, 35(8), 1043-1048, Article ID S0735-6757(17)30117-1.
Open this publication in new window or tab >>Defibrillation before EMS arrival in western Sweden
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2017 (English)In: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 35, no 8, p. 1043-1048, article id S0735-6757(17)30117-1Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Bystanders play a vital role in public access defibrillation (PAD) in out-of-hospital cardiac arrest (OHCA). Dual dispatch of first responders (FR) alongside emergency medical services (EMS) can reduce time to first defibrillation. The aim of this study was to describe the use of automated external defibrillators (AEDs) in OHCAs before EMS arrival.

METHODS: All OHCA cases with a shockable rhythm in which an AED was used prior to the arrival of EMS between 2008 and 2015 in western Sweden were eligible for inclusion. Data from the Swedish Register for Cardiopulmonary Resuscitation (SRCR) were used for analysis, on-site bystander and FR defibrillation were compared with EMS defibrillation in the final analysis.

RESULTS: Of the reported 6675 cases, 24% suffered ventricular fibrillation (VF), 162 patients (15%) of all VF cases were defibrillated before EMS arrival, 46% with a public AED on site. The proportion of cases defibrillated before EMS arrival increased from 5% in 2008 to 20% in 2015 (p<0.001). During this period, 30-day survival increased in patients with VF from 22% to 28% (p=0.04) and was highest when an AED was used on site (68%), with a median delay of 6.5min from collapse to defibrillation. Adjusted odds ratio for on-site defibrillation versus dispatched defibrillation for 30-day survival was 2.45 (95% CI: 1.02-5.95).

CONCLUSIONS: The use of AEDs before the arrival of EMS increased over time. This was associated with an increased 30-day survival among patients with VF. Thirty-day survival was highest when an AED was used on site before EMS arrival.

Place, publisher, year, edition, pages
Elsevier, 2017
Keywords
Automated external defibrillator, Emergency medical services, First responder, Out-of-hospital cardiac arrest
National Category
Cardiac and Cardiovascular Systems
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-62832 (URN)10.1016/j.ajem.2017.02.030 (DOI)28238537 (PubMedID)
Available from: 2017-05-04 Created: 2017-05-04 Last updated: 2018-06-01Bibliographically approved
Ågård, A., Bremer, A., Sallin, K. & Engström, I. (2017). Ethical controversies in the process of formulating new national guidelines on cardiopulmonary resuscitation in Sweden. Clinical Ethics, 12(4), 174-179
Open this publication in new window or tab >>Ethical controversies in the process of formulating new national guidelines on cardiopulmonary resuscitation in Sweden
2017 (English)In: Clinical Ethics, ISSN 1477-7509, E-ISSN 1758-101X, Vol. 12, no 4, p. 174-179Article in journal (Refereed) Published
Abstract [en]

The Delegation for Medical Ethics within the Swedish Society of Medicine has taken the initiative to create national ethical guidelines on cardiopulmonary resuscitation. The reasons behind this initiative were indications of differences in the way decisions about cardiopulmonary resuscitation were made and documented and requests expressed by health- care professionals for new national ethical guidelines. During the process of creating the guidelines, a number of work- shops were held with representatives from the delegation and clinical experts from various branches of medicine. Several versions of the working document were sent to consultation bodies with requests for comments. We therefore believe that the final guidelines are well supported by the medical profession in Sweden. The purpose of this article is to present ethical issues on which it was difficult to reach consensus due to divergent opinions expressed by the people and organisations involved. The arguments for and against a particular point of view or wording in the text are presented. The main controversies were related to the following six issues; Determining whether or not cardiopulmonary resus- citation is beneficial for the patient – The presence of close loved ones during cardiopulmonary resuscitation – Performing cardiopulmonary resuscitation for the benefit of people other than the patient – Ambulance personnel’s mandate to decide not to initiate and to terminate cardiopulmonary resuscitation outside hospital – Limiting the length and content of cardiopulmonary resuscitation – Whether or not to specify a week of gestation before which cardio- pulmonary resuscitation should not be started. 

Place, publisher, year, edition, pages
Sage Publications, 2017
Keywords
Clinical ethics, Advance directives, Informed consent, Professional ethics in medicine
National Category
Medical Ethics
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-67305 (URN)10.1177/1477750917724331 (DOI)
Available from: 2017-08-20 Created: 2017-08-20 Last updated: 2018-01-18Bibliographically approved
Israelsson, J., Thylén, I., Strömberg, A., Bremer, A. & Årestedt, K. (2017). Factors associated with health status and psychological distress among cardiac arrest (CA) survivors living with an implantable cardioverter-defibrillator (ICD). In: : . Paper presented at 3rd International Symposium on Post Cardiac Arrest Care, Lund, Sweden, September 4-5, 2017.
Open this publication in new window or tab >>Factors associated with health status and psychological distress among cardiac arrest (CA) survivors living with an implantable cardioverter-defibrillator (ICD)
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2017 (English)Conference paper, Oral presentation only (Refereed)
Abstract [en]

Background: The aim was to explore factors associated with health status and psychological distress among ICD-implanted CA survivors.  

Materials and methods: This cross-sectional study included all eligible adult ICD-implanted CA survivors in the Swedish ICD and Pacemaker Registry, 2011-2012. Health status and psychological distress were measured with the EQ-5D-5L (EQ index & EQ VAS) and the Hospital Anxiety and Depression Scale (HADS) respectively. Linear regression analyses were used to explore associations between explanatory- and outcome variables.

Results: In total, 990 patients (22% women) with a median age of 68 (q1-q3=60-74) were included. Time since the CA varied between 6 months to 23 years. The median values for EQ index and EQ VAS were 0.85 (q1-q3=0.73-1.00) and 80 (q1-q3=69-90) respectively. Gender, comorbidity, receiving ICD-shock/-s, perceived control and personality were independently associated with health status. The final models explained 25% (EQ index) and 30% (EQ VAS) of the total variance (according to the R2 values). The median values for HADS Anxiety and HADS Depression were 3 (q1-q3=1-6) and 2 (q1-q3=1-4) respectively. Age, gender, comorbidity, living alone, ICD-related concerns, perceived control and personality were independently associated with psychological distress. The final models explained 51% (HADS Anxiety) and 44% (HADS Depression) of the total variance.

Conclusion: Age, gender, living alone, comorbidity, receiving ICD-shock/-s, ICD-related concerns, perceived control and personality were associated with health status and/or psychological distress. These results contribute to a better understanding of the life situation among CA survivors, and may be important to develop individualized post CA care. 

Keywords
Health status, Psychological distress, Cardiac arrest, survivors, Implantable cardioverter-defibrillator
National Category
Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-68014 (URN)
Conference
3rd International Symposium on Post Cardiac Arrest Care, Lund, Sweden, September 4-5, 2017
Available from: 2017-09-18 Created: 2017-09-18 Last updated: 2018-05-17Bibliographically approved
Wireklint Sundström, B., Abelsson, A., Jakopovic, D., Wallin, K., Bremer, A., Rantala, A., . . . Adolfsson, A. (2017). "Förödande att sänka kraven på ambulanspersonal". Svenska Dagbladet (2017-06-08)
Open this publication in new window or tab >>"Förödande att sänka kraven på ambulanspersonal"
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2017 (Swedish)In: Svenska Dagbladet, ISSN 1101-2412, no 2017-06-08Article in journal, News item (Other (popular science, discussion, etc.)) Published
Abstract [sv]

Tidig och avancerad bedömning krävs när patienter möter personal inom ambulanssjukvården. Hur är det möjligt att frågan om sänkta kompetenskrav inom svensk ambulanssjukvård överhuvudtaget har väckts? undrar Nät­verket för ut­bildning av ambulanssjuksköterskor.

Keywords
Ambulanssjukvård, kompetens, ambulanssjuksköterskor, patientsäkerhet, katastrofberedskap
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:lnu:diva-65049 (URN)
Available from: 2017-06-09 Created: 2017-06-09 Last updated: 2018-08-30Bibliographically approved
Israelsson, J., Bremer, A., Herlitz, J., Axelsson, Å. B., Cronberg, T., Djärv, T., . . . Årestedt, K. (2017). Health status and psychological distress among in-hospital cardiac arrest survivors in relation to gender. Resuscitation, 114, 27-33
Open this publication in new window or tab >>Health status and psychological distress among in-hospital cardiac arrest survivors in relation to gender
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2017 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 114, p. 27-33Article in journal (Refereed) Published
Abstract [en]

AIM: To describe health status and psychological distress among in-hospital cardiac arrest (IHCA) survivors in relation to gender.

METHODS: This national register study consists of data from follow-up registration of IHCA survivors 3-6 months post cardiac arrest (CA) in Sweden. A questionnaire was sent to the survivors, including measurements of health status (EQ-5D-5L) and psychological distress (HADS).

RESULTS: Between 2013 and 2015, 594 IHCA survivors were included in the study. The median values for EQ-5D-5L index and EQ VAS among survivors were 0.78 (q1-q3=0.67-0.86) and 70 (q1-q3=50-80) respectively. The values were significantly lower (p&lt;0.001) in women compared to men. In addition, women reported more problems than men in all dimensions of EQ-5D-5L, except self-care. A majority of the respondents reported no problems with anxiety (85.4%) and/or symptoms of depression (87.0%). Women reported significantly more problems with anxiety (p&lt;0.001) and symptoms of depression (p&lt;0.001) compared to men. Gender was significantly associated with poorer health status and more psychological distress. No interaction effects for gender and age were found.

CONCLUSIONS: Although the majority of survivors reported acceptable health status and no psychological distress, a substantial proportion reported severe problems. Women reported worse health status and more psychological distress compared to men. Therefore, a higher proportion of women may be in need of support. Health care professionals should make efforts to identify health problems among survivors and offer individualised support when needed.

Place, publisher, year, edition, pages
Elsevier, 2017
Keywords
medication adherence, reasons, attitudes, gender, anxiety symptoms, depression symptoms, Cardiac and Cardiovascular Systems, Kardiologi, Health Sciences, Hälsovetenskaper
National Category
Cardiac and Cardiovascular Systems
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-62745 (URN)10.1016/j.resuscitation.2017.02.006 (DOI)000402487800021 ()28216089 (PubMedID)
Available from: 2017-05-03 Created: 2017-05-03 Last updated: 2018-06-01Bibliographically approved
Olander, A., Bremer, A., Andersson, H., Ljungström, L., Gellerstedt, M., Fridlund, B. & Bång, A. (2017). Identify the septic patient in the prehospital care. In: Abstractbook: Advances in Health Care Sciences Conference 2017, Doctoral School in Health Care Sciences, Stockholm, November 15 & 16. Paper presented at Advances in Health Care Sciences Conference 2017, Stockholm, Sweden, November 15-16, 2017 (pp. 63-63).
Open this publication in new window or tab >>Identify the septic patient in the prehospital care
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2017 (English)In: Abstractbook: Advances in Health Care Sciences Conference 2017, Doctoral School in Health Care Sciences, Stockholm, November 15 & 16, 2017, p. 63-63Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

AIM

The aim was to determine the sensitivity of the new symptom based index test Altered Signs and Symptoms Emerge Sudden in Sepsis (ASSESS) in order to identify sepsis and compare it with four established index tests in the prehospital care.

METHOD

This is a quantitative study were the researchers collected data from medical records, and tested whether a new symptom based index test ASSESS was significantly better to identify sepsis compared to Rapid Emergency Triage and Treatment System (RETTS-ESS 47), BAS 90-30-90, Quick Sequential [Sepsis-related] (qSOFA) and The prehospital severe sepsis screening tool (PSSST). According to the Standards for Reporting of Diagnostic Accuracy (STARD-concept), a retrospective diagnostic accuracy and cohort study was conducted. The participants were 380 consecutive adult patients (age >18 years) who activated the Prehospital care-system and were transported to Skaraborgs County Hospital in west of Sweden , and subsequently discharged with an ICD-10-code consistent with sepsis, during a three-month period between January through April, 2012.

RESULTS

Of 380 patients 180 (47%) were female and 200 (53%) were male and with a mean age of 74±15 years. The ASSESS had a higher sensitivity to all four established index tests. Of the included symptoms in ASSESS the most common were sudden fever (63,9%), sudden breathing difficulties (60%), sudden muscle weakness (23,9%) and sudden gastrointestinal symptoms (20,2%).

CONCLUSION

ASSESS showed a higher sensitivity compared to the other four index test, which could in turn enable an earlier identification of sepsis patients in the prehospital care. Symptom presentation is included in the ASSESS index test as compared to the other four index tests which focus in major on vital signs alone. An inclusion of symptom presentation in a prehospital screening tool may thus increase the identification of sepsis. However, evidence on clinical benefit of the ASSESS index test need to be prospectively validated. 

Keywords
Sepsis, Symptom, Index test, Prehospital care, Medical records review
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-69409 (URN)
Conference
Advances in Health Care Sciences Conference 2017, Stockholm, Sweden, November 15-16, 2017
Available from: 2017-12-20 Created: 2017-12-20 Last updated: 2018-01-16Bibliographically approved
Sandlund, M., Bremer, A., Ågård, A., Engström, I. & Sallin, K. (2017). Kontinuitet främjar personligt och professionellt ansvarstagade. Läkartidningen, 114(42), 1-2, Article ID ETHI.
Open this publication in new window or tab >>Kontinuitet främjar personligt och professionellt ansvarstagade
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2017 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 114, no 42, p. 1-2, article id ETHIArticle in journal (Other (popular science, discussion, etc.)) Published
Abstract [sv]

Att utröna medicinska behov, fatta beslut och se dem genomförda är läkarens ansvar.

För att få veta den enskilde patientens värderingar och önskemål krävs en förtroendefull relation med vårdgivaren. Kontinuitet förenklar skapandet av en sådan relation.  

Trots att kontinuitet är centralt är det inte ett mål i sig, utan bör betraktas som ett medel för att uppnå andra mål som följer av läkarens yrkesetik och lagstiftning.

Place, publisher, year, edition, pages
Läkartidningen Förlag, 2017
Keywords
Kontinuitet, Professionellt ansvar, Personligt ansvar, Läkare, Etik
National Category
Medical Ethics
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-68393 (URN)
Available from: 2017-10-18 Created: 2017-10-18 Last updated: 2017-10-20Bibliographically approved
Wireklint Sundström, B., Hagiwara, M., Andersson, H., Abelsson, A., Jakopovic, D., Wallin, K., . . . Ribeiro, S. (2017). ”Nationella riktlinjer behövs för ambulanspersonal”. Svenska Dagbladet (2017-06-29)
Open this publication in new window or tab >>”Nationella riktlinjer behövs för ambulanspersonal”
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2017 (Swedish)In: Svenska Dagbladet, ISSN 1101-2412, no 2017-06-29Article in journal, News item (Other (popular science, discussion, etc.)) Published
Abstract [sv]

Det är förödande att sänka kraven på ambulanspersonal. Därför efterlyser vi nationella riktlinjer och beslut som tydligt anger en lägsta utbildningsnivå för anställning inom ambulanssjukvården, skriver Nät­verket för ut­bildning av ambulanssjuksköterskor i en slutreplik.

Keywords
Ambulanssjuksköterska, Kompetens, Utbildning, Riktlinjer
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-66005 (URN)
Available from: 2017-06-30 Created: 2017-06-30 Last updated: 2018-08-30Bibliographically approved
Årestedt, K., Sawatsky, R., Israelsson, J., Herlitz, J., Lilja, G., Cronberg, T. & Bremer, A. (2017). Psychometric properties of the Hospital Anxiety and Depression scale in cardiac arrest survivors. In: : . Paper presented at EuroHeartCare 2017, Jönköping, Sweden, May 18-20, 2017.
Open this publication in new window or tab >>Psychometric properties of the Hospital Anxiety and Depression scale in cardiac arrest survivors
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2017 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Background: The Hospital Anxiety and Depression scale (HAD) is commonly used to assess emotional distress in different group of patients. Despite emotional distress is common in sudden cardiac arrest survivors (SCA), HAD have not to our best knowledge been psychometrically evaluated in this patient group.

Purpose: The aim was to evaluate the psychometric properties of the HAD, with focus on factor structure, internal consistency and differential item functioning (DIF) for sex and age, in SCA survivors.

Methods: Data from the national Swedish Register of Cardiopulmonary Resuscitation were used, including HAD ratings from in-hospital cardiac arrest survivors, collected 3-12 months after resuscitation. Confirmatory factor analysis (CFA) was used to evaluate the hypothesized two factor structure for Anxiety and Depression, respectively. Ordinal version of Cronbach’s alpha was calculated to evaluate internal consistency reliability of the two factors. Multiple indicator multiple causes CFA models (MIMIC) were used to detect presence of DIF.

Results: The sample consisted of 604 in-hospital cardiac arrest survivors (mean age 69.4±12.6), 384 men and 220 women. The suggested two-factor model was confirmed after item 7 was allowed to cross-load on Depression. The internal consistency was satisfactory for both Anxiety (.92) and Depression (.91). No DIF for sex and age was demonstrated.

Conclusion: This study shows that the HAD Anxiety and Depression subscales are unidimensional. Both scales can also be used to make invariant comparisons between groups of different sex and age. Therefore, HAD can be used to assess psychological distress (anxiety and depression) in SCA survivors.

Keywords
Cardiac arrest, Patients, Psychometric evaluation, Hospital Anxiety and Depression scale
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-64383 (URN)
Conference
EuroHeartCare 2017, Jönköping, Sweden, May 18-20, 2017
Available from: 2017-05-25 Created: 2017-05-25 Last updated: 2018-05-17Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-7865-3480

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