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  • 1.
    Bertilsson, Emelie
    et al.
    Kalmar County Hospital.
    Semark, Birgitta
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Schildmeijer, Kristina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Bremer, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Carlsson, Jörg
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Usage of Do-not-attempt-to resuscitate-orders in a Swedish community hospital: patient involvement, documentation and compliance2018In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 130, no s1, p. e93-e94Article in journal (Refereed)
  • 2.
    Israelsson, Johan
    et al.
    Linnaeus University, Faculty of Technology, Kalmar Maritime Academy. Kalmar County Hospital ; Linköping University.
    von Wangenheim, Burkard
    Kalmar County Hospital.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linköping University.
    Semark, Birgitta
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Schildmeijer, Kristina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Carlsson, Jörg
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Kalmar County Hospital.
    Sensitivity and specificity of two different automated external defibrillators2017In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 120, p. 108-112Article in journal (Refereed)
    Abstract [en]

    Aim: The aim was to investigate the clinical performance of two different types of automated external defibrillators (AEDs). Methods: Three investigators reviewed 2938 rhythm analyses performed by AEDs in 240 consecutive patients (median age 72, q1-q3 = 62-83) who had suffered cardiac arrest between January 2011 and March 2015. Two different AEDs were used (AED A n = 105, AED B n = 135) in-hospital (n = 91) and out-of-hospital (n = 149). Results: Among 194 shockable rhythms, 17 (8.8%) were not recognized by AED A, while AED B recognized 100% (n = 135) of shockable episodes (sensitivity 91.2 vs 100%, p < 0.01). In AED A, 8 (47.1%) of these episodes were judged to be algorithm errors while 9 (52.9%) were caused by external artifacts. Among 1039 non-shockable rhythms, AED A recommended shock in 11 (1.0%), while AED B recommended shock in 63 (4.1%) of 1523 episodes (specificity 98.9 vs 95.9, p < 0.001). In AED A, 2 (18.2%) of these episodes were judged to be algorithm errors (AED B, n = 40, 63.5%), while 9 (81.8%) were caused by external artifacts (AED B, n = 23, 36.5%). Conclusions: There were significant differences in sensitivity and specificity between the two different AEDs. A higher sensitivity of AED B was associated with a lower specificity while a higher specificity of AED A was associated with a lower sensitivity. AED manufacturers should work to improve the algorithms. In addition, AED use should always be reviewed with a routine for giving feedback, and medical personnel should be aware of the specific strengths and shortcomings of the device they are using. (C) 2017 Elsevier B.V. All rights reserved.

  • 3.
    Israelsson, Johan
    et al.
    Kalmar County Hospital, Sweden.
    von Wangenheim, Burkard
    Kalmar County Hospital, Sweden.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Semark, Birgitta
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Schildmeijer, Kristina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Carlsson, Jörg
    Kalmar County Hospital, Sweden.
    Sensitivity and specificity of two different automated external defibrillators used in-hospital and out-of-hospital2015In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 96, no Supplement 1, p. 23-23, article id AS041Article in journal (Other academic)
    Abstract [en]

    Purpose: To investigate the performance of two different types of automated external defibrillators (AED) in out-of-hospital and in-hospital cardiac pulmonary resuscitation (CPR). Performance criteria in terms of sensitivity and specificity have been established but real life data are sparse.

    Materials and methods: Three investigators reviewed 2938 rhythm analyses performed by AED in 240 consecutive patients (38.3% women) suffering cardiac arrest between January 2011 and March 2015. The mean age was 70.1 ± 17.0 (3 months–104 years). Two different AED were used (AED A n = 105, AED B n = 135) in-hospital (n = 91) and out-of-hospital (n = 149).

    Results: Among 194 shockable rhythms, 17 (8.8%) were not recognized by AED A, while AED B recognized 100% (n = 135) of shockable episodes (p < 0.001). In AED A, 8 (47.1%) of these episodes were judged to be algorithm errors while 9 (52.9%) were caused by external artifacts. Among 1039 non-shockable rhythms, AED A recommended shock in 11 (1.0%), while AED B recommended shock in 63 (4.1%) of 1523 episodes (p < 0.001). In AED A, 2 (18.2%) of these episodes were judged to be algorithm errors (AED B, n = 40, 63.5%) while 9 (81.8%) were caused by external artifacts (AED B, n = 23, 36.5%). Fine ventricular fibrillation was analyzed as a separate category since guidelines do not recommend shock in these cases. AED A advised shock in 24 (80%) of 30 episodes, while AED B advised shock in 8 (47%) of 17 episodes (p < 0.027).

    Conclusions: Significant differences in performance could be detected between two different AED. A higher sensitivity of AED B was associated with a lower specificity while a higher specificity of AED A was associated with a lower sensitivity. Caregivers should be aware of the specific shortcomings of the device they are using. AED manufacturers should try to improve the algorithms in order to minimize the gap between sensitivity and specificity.

  • 4.
    Schildmeijer, Kristina
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Israelsson, Johan
    Kalmar County Hospital, Sweden.
    von Wangenheim, Burkard
    Kalmar County Hospital, Sweden.
    Semark, Birgitta
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Carlsson, Jörg
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Sensitivitet och specificitet hos två olika hjärtstartare2016In: Presented at HLR2016: "Ett hjärtsäkert Sverige”, Gothenburg, Sweden, October 11-12, 2016, 2016Conference paper (Other academic)
  • 5.
    Schildmeijer, Kristina
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Semark, Birgitta
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Israelsson, Johan
    Kalmar County Hospital.
    Carlsson, Jörg
    Kalmar County Hospital.
    von Wangenheim, Burkard
    Kalmar County Hospital.
    Quality of chest compressions by healthcare professionals using real-time audiovisual feedback during in-hospital cardiopulmonary resusscitation2017In: Paper presented at the 2nd International Nursing Conference (Nursing-2017), Barcelona, Spain, November 1-3, 2017, Madridge , 2017Conference paper (Other academic)
  • 6.
    Schildmeijer, Kristina
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Semark, Birgitta
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Israelsson, Johan
    Linnaeus University, Faculty of Technology, Kalmar Maritime Academy.
    von Wangenheim, Burkard
    Carlsson, Jörg
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Quality of chest compressions and complaince by healthcare professionals with real-time audiovisual feedback during in-hospital cardiopulmonary resuscitation2017In: 2nd International Nursing Conference, November 1-3, 2017, Barcelona, Spain, 2017Conference paper (Other academic)
  • 7.
    Semark, Birgitta
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Patient characteristic, perceived health and drug prescription in primary care2013Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Patients have increased demands for information and involvement in decision-making including drug selection.  At the same time, society needs to limit costs, e.g. for subsidized drugs, thus entailing a challenge to in particular primary care. The overall aim of this thesis was to describe different factors influencing drug prescription in primary care and perceived health.

    In a register study, the actual costs of prescribed subsidized drugs at five health care centers (HCCs) in areas of varying socioeconomic status (SES) were compared to the assigned drug budget. It revealed that HCCs with many citizens in the catchment area with low SES showed a deficit at year’s end. HCCs in areas with citizens with a higher SES showed a surplus.

    In another register study, the prescription of drugs at lower or higher price levels for the diagnoses of chronic obstructive bronchitis, depression, diabetes and osteoporosis was studied. Drug prescription was then compared with individual factors for age, sex, education, income and country of birth, and whether the care provider was private or public. It was found that certain individual and provider factors appear to influence the prescribing of drugs of different price levels.

    To investigate patient involvement in the decision to start long-term drug treatment, respondents who had recently begun taking medication were interviewed. The study showed that patient participation was important, but that participation implied different things to different patients. One view was that participation could be achieved without sharing the decision-making process, whereas another view was that participation was more or less willingness to become involved in decision-making. Prerequisites for patient participation were knowledge in the relevant area and trust in the physician.

    A fourth study examined how individuals aged 65-80 years rated their health. The study showed that health was assessed much lower in respondents with depressive symptoms compared to those without corresponding symptoms. Health was also assessed as worse for people with hypertension and in those treated with drugs for depression and hypertension. Health was perceived as better in the younger age groups, in individuals with higher educational levels, and for men. 

    Drug prescription in primary care is controlled, in addition to medical necessity, by economic constraints, and that patients need an opportunity to influence decisions about their care and treatment. However, economic constraints make it difficult for physicians to support patients in their choice of medication. This may influence patient adherence to medication.

  • 8.
    Semark, Birgitta
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Brudin, Lars
    Linköpings universitet.
    Tågerud, Sven
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Petersson, Göran
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Peterson, Ulla
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Self-rated health and educational level among elderly with depressive and physical disordersManuscript (preprint) (Other academic)
    Abstract [en]

    Aim: Poor self-rated health (SRH) among elderly has been suggested to be more closely related to mental than to physical disorders. The aim was to investigate the association between SRH in elderly and depressive and physical disorders in relation to age, sex and educational level.

    Methods: A cross-sectional study was conducted using a questionnaire sent to a randomised Swedish sample of individuals aged 65-80 years with a response rate of 67% (n= 6659). SRH in relation to age, sex, education, depressive symptoms, hypertension, diabetes and asthma was calculated by univariate and multivariate logistic regressions analyses.

    Results: There was an association between good SRH and not feeling depressed (OR 9.4), to not having hypertension (OR 1.6), diabetes (OR 2.8), or asthma (OR 2.1). SRH was rated as less good with higher age. SRH was rated as better with higher educational levels and men rated their health as better than women did. The association to depressive symptoms, hypertension, diabetes and asthma were lower with higher educational level and varied with sex.

    Conclusion: Poor SRH in elderly was associated with depressive symptoms, hypertension, diabetes and asthma with the strongest association to depressive symptoms. Thus, SRH might serve as a valuable complement to other diagnostic methods in the health care of the elderly, as it also can provide health information beyond classical risk factors or medical history.

  • 9.
    Semark, Birgitta
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Engström, Sven
    Brudin, Lars
    Linköpings universitet.
    Tågerud, Sven
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Fredlund, Kerstin
    Borgquist, Lars
    Linköpings universitet.
    Petersson, Göran
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Factors influencing the prescription of drugs of different price levels2013In: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, Vol. 22, no 3, p. 286-293Article in journal (Refereed)
    Abstract [en]

    Purpose Socioeconomic factors have been suggested to influence the prescribing of newer and more expensive drugs. In the present study, individual and health care provider factors were studied in relation to the prevalence of differently priced drugs. Methods Register data for dispensed drugs were retrieved for 18486 individuals in a county council in Sweden. The prevalence of dispensed drugs was combined with data for the individual's gender, age, education, income, foreign background, and type of caregiver. For each of the diagnostic groups (chronic obstructive pulmonary disease [COPD], depression, diabetes, and osteoporosis), selected drugs were dichotomized into cost categories, lower and higher price levels. Univariate and multivariate logistic regressions were performed using cost category as the dependent variable and the individual and provider factors as independent variables. Results In all four diagnostic groups, differences were observed in the prescription of drugs of lower and higher price levels with regard to the different factors studied. Age and gender affected the prescription of drugs of lower and higher price levels more generally, except for gender in the osteoporosis group. Income, education, foreign background, and type of caregiver affected prescribing patterns but in different ways for the different diagnostic groups. Conclusions Certain individual and provider factors appear to influence the prescribing of drugs of different price levels. Because the average price for the cheaper drugs versus more costly drugs in each diagnostic group was between 19% and 69%, there is a risk that factors other than medical needs are influencing the choice of drug. Copyright (c) 2013 John Wiley & Sons, Ltd.

  • 10.
    Semark, Birgitta
    et al.
    University of Kalmar, School of Human Sciences.
    Fredlund, K
    Åstrand, Bengt
    University of Kalmar, School of Pure and Applied Natural Sciences.
    Brudin, L
    Linköpings universitet.
    Reimbursement for drugs: a register study comparing economic outcome for five healthcare centres in areas with different socioeconomic conditions2009In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 37, no 6, p. 647-653Article in journal (Refereed)
    Abstract [en]

    AIMS

    Previous studies have indicated the negative effects of socioeconomic deprivation on health status and morbidity. Nevertheless, the economic assignment systems for pharmaceutical benefits in Sweden do not take socioeconomic status (SES) into account. The aim of the study was, therefore, to compare reimbursement for subsidized drugs at primary healthcare centres (HCCs) with differing socioeconomic conditions in relation to real costs. The word reimbursement is used to denote economic compensation to the HCCs from the county council for drug benefit costs.

    METHODS

    The numbers of individuals dispensed drugs, total costs and reimbursement at five HCCs with different socioeconomic conditions were compared. A socioeconomic index was calculated for each HCC on the basis of information from the municipality registries on income (with negative sign), assistance allowance, education, foreign background, and unemployment. Register data on drug benefit costs were retrieved from the National Corporation of Pharmacies (Apoteket AB) and the Swedish Prescribed Drug Register at the National Board of Health and Welfare. Data on listed and unlisted citizens at the Kalmar County Council and on public statistics from registers at the HCC municipalities where the HCCs were situated were retrieved.

    RESULTS

    There was an almost inverse linear relationship between total cost compensation and the socioeconomic index (n = 5; r =-0.99; p = 0.001). The HCCs with the lowest SES received lower cost compensation.

    CONCLUSIONS

    HCCs responsible for citizens with lower SES appeared to be disadvantaged by the prevalent reimbursement system in Sweden, thereby increasing differences in the state of health of the citizens. This, in turn, hampers health preventing programmes and lifestyle interventions. An HCC-specific standardized summary of socioeconomic burden is presented.

  • 11.
    Semark, Birgitta
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Petersson, Göran
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Engström, Sven
    Arvidsson, Eva
    Nilsson, Gunilla
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Participation in decision making when starting long-term medication: patients´ experiences2014In: European Journal for Person Centered Healthcare, ISSN 2052-5648, E-ISSN 2052-5656, Vol. 2, no 3, p. 282-289Article in journal (Refereed)
    Abstract [en]

    Rationale, aim and objective

    To achieve the beneficial effect of drug treatment and reduce unnecessary health care costs, patients must be involved in shared decision making. The aim of this study was to describe patient experiences of participation in decision making when starting long-term medication.

    Method

    Nine patients at two health care centers were semi-structured interviewed about their experiences, beliefs and feelings about their participation in the decision to start long-term medication. Data was analyzed by a qualitative content method.

    Results

    Respondents stated that participating in decision making in drug treatment requires knowledge of the relevant area and requiring trusting the physician. The respondent’s responsibility and motivation facilitate adherence to drug treatment. 

    Conclusion

    Patients sought participation in the decision making of long-term medication and wished for adequate time needed for this dialogue. If they lacked sufficient knowledge, they wanted relevant and useful information from the physician. To experience trust in the physician through a good encounter increases the possibility for participation and enhancement of medication adherence. In order to participate in decision making, the patient needs the physician’s encouragement.

     

  • 12.
    Semark, Birgitta
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Israelsson, Johan
    Kalmar County Hospital, Sweden.
    Carlsson, Jörg
    Kalmar County Hospital, Sweden.
    von Wangenheim, Burkard
    Kalmar County Hospital, Sweden.
    Schildmeijer, Kristina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Quality of chest compressions during CPR: comparison between manual and automatic review2015Conference paper (Other academic)
  • 13.
    Semark, Birgitta
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Israelsson, Johan
    Kalmar County Hospital.
    Carlsson, Jörg
    Kalmar County Hospital.
    von Wangenheim, Burkard
    Kalmar County Hospital.
    Schildmeijer, Kristina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Quality of chest compressions during CPR-comparison between manual and automatic review2015In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 96, no Supplement 1, p. 66-66, article id AP058Article in journal (Refereed)
  • 14.
    Semark, Birgitta
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linköping University.
    Israelsson, Johan
    Linnaeus University, Faculty of Technology, Kalmar Maritime Academy. Linköping University ; Kalmar County Hospital.
    von Wangenheim, Burkard
    Kalmar County Hospital.
    Carlsson, Jörg
    Kalmar County Hospital.
    Schildmeijer, Kristina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Quality of chest compressions by healthcare professionals using real-time audiovisual feedback during in-hospital cardiopulmonary resuscitation2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no 5, p. 453-457Article in journal (Refereed)
    Abstract [en]

    Introduction: A high quality of chest compressions, e.g. sufficient depth (5-6 cm) and rate (100-120 per min), has been associated with survival. The patient's underlay affects chest compression depth. Depth and rate can be assessed by feedback systems to guide rescuers during cardiopulmonary resuscitation. Aim: The purpose of this study was to describe the quality of chest compressions by healthcare professionals using real-time audiovisual feedback during in-hospital cardiopulmonary resuscitation. Method: An observational descriptive study was performed including 63 cardiac arrest events with a resuscitation attempt. Data files were recorded by Zoll AED Pro, and reviewed by RescueNet Code Review software. The events were analysed according to depth, rate, quality of chest compressions and underlay. Results: Across events, 12.7% (median) of the compressions had a depth of 5-6 cm. Compression depth of >6 cm was measured in 70.1% (median). The underlay could be identified from the electronic patient records in 54 events. The median compression depth was 4.5 cm (floor) and 6.7 cm (mattress). Across events, 57.5% (median) of the compressions were performed with a median frequency of 100-120 compressions/min and the most common problem was a compression rate of <100 (median=22.3%). Conclusions: Chest compression quality was poor according to the feedback system. However, the distribution of compression depth with regard to underlay points towards overestimation of depth when treating patients on a mattress. Audiovisual feedback devices ought to be further developed. Healthcare professionals need to be aware of the strengths and weaknesses of their devices.

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