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Wilhelmson, K., Hammar, I. A., Ehrenberg, A., Niklasson, J., Eckerblad, J., Ekerstad, N., . . . Ivanoff, S. D. (2020). Comprehensive Geriatric Assessment for Frail Older People in Swedish Acute Care Settings (CGA-Swed): A Randomised Controlled Study. Geriatrics (Basel, Switzerland), 5(1), Article ID E5.
Open this publication in new window or tab >>Comprehensive Geriatric Assessment for Frail Older People in Swedish Acute Care Settings (CGA-Swed): A Randomised Controlled Study
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2020 (English)In: Geriatrics (Basel, Switzerland), ISSN 2308-3417, Vol. 5, no 1, article id E5Article in journal (Refereed) Published
Abstract [en]

The aim of the study is to evaluate the effects of the Comprehensive Geriatric Assessment (CGA) for frail older people in Swedish acute hospital settings - the CGA-Swed study. In this study protocol, we present the study design, the intervention and the outcome measures as well as the baseline characteristics of the study participants. The study is a randomised controlled trial with an intervention group receiving the CGA and a control group receiving medical assessment without the CGA. Follow-ups were conducted after 1, 6 and 12 months, with dependence in activities of daily living (ADL) as the primary outcome measure. The study group consisted of frail older people (75 years and older) in need of acute medical hospital care. The study design, randomisation and process evaluation carried out were intended to ensure the quality of the study. Baseline data show that the randomisation was successful and that the sample included frail older people with high dependence in ADL and with a high comorbidity. The CGA contributed to early recognition of frail older people's needs and ensured a care plan and follow-up. This study is expected to show positive effects on frail older people's dependence in ADL, life satisfaction and satisfaction with health and social care.

Keywords
activities of daily living, comprehensive geriatric assessment, frail older people, geriatric, hospital care
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-31882 (URN)10.3390/geriatrics5010005 (DOI)31991598 (PubMedID)2-s2.0-85081745401 (Scopus ID)
Available from: 2020-02-14 Created: 2020-02-14 Last updated: 2020-03-30
Naseer, M., Agerholm, J., Fastbom, J., Schön, P., Ehrenberg, A. & Dahlberg, L. (2020). Factors associated with emergency department revisits among older adults in two Swedish regions: A prospective cohort study. Archives of gerontology and geriatrics (Print), 86, Article ID 103960.
Open this publication in new window or tab >>Factors associated with emergency department revisits among older adults in two Swedish regions: A prospective cohort study
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2020 (English)In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 86, article id 103960Article in journal (Refereed) Published
Abstract [en]

Objectives

To assess the association between baseline characteristics at an index ED visit and ED revisit within 30 days among adults aged ≥ 65 years in two Swedish regions.

Methods

This was a register-based prospective cohort study. The sample included (N=16 688; N=101 017) older adults who have had an index ED visit in 2014 at hospital based EDs in the regions of Dalarna and Stockholm, Sweden. Several registers were linked to obtain information on sociodemographic factors, living conditions, social care, polypharmacy and health care use. Multivariate logistic regression was used to analyse the data.

Results

Seventeen percent of the study sample in Dalarna and 20.1% in Stockholm revisited ED within 30 days after an index ED visit. In both regions, male gender, being in the last year of life, excessive polypharmacy (≥ 10 drugs), ≥11 primary care visits and ED care utilization were positively associated with ED revisits. In Stockholm, but not in Dalarna, low level of education, polypharmacy, and institutional care was also associated with ED revisits. In contrast, home help was associated with ED revisits in Dalarna but not in Stockholm.

Conclusion

These findings call for further in-depth examinations of variations within single countries. ED revisits among older adults are driven by need of care but also by the social and care situation.

Keywords
Emergency department, Care utilisation, Older adults, Health and social care, Primary care
National Category
Nursing
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-31108 (URN)10.1016/j.archger.2019.103960 (DOI)000496954500020 ()31704624 (PubMedID)2-s2.0-85074431752 (Scopus ID)
Available from: 2019-11-18 Created: 2019-11-18 Last updated: 2019-12-09
Naseer, M., Agerholm, J., Fastbom, J., Schön, P., Ehrenberg, A. & Dahlberg, L. (2020). Factors associated with emergency department revisits among older adults in two Swedish regions: A prospective cohort study. Archives of gerontology and geriatrics (Print), 86, Article ID 103960.
Open this publication in new window or tab >>Factors associated with emergency department revisits among older adults in two Swedish regions: A prospective cohort study
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2020 (English)In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 86, article id 103960Article in journal (Refereed) Epub ahead of print
National Category
Health Sciences
Research subject
Health and Welfare, Varför söker äldre personer akutsjukvård? Orsaker, omständigheter och förklaringar
Identifiers
urn:nbn:se:du-31431 (URN)10.1016/j.archger.2019.103960 (DOI)
Available from: 2019-12-20 Created: 2019-12-20 Last updated: 2020-01-23Bibliographically approved
Ekdahl, A., Ehrenberg, A., Ekerstad, N., Dahlin-Ivanoff, S. & Wilhelmsson, K. (2019). Akutvården har blivit allt sämre för äldre. Svenska Dagbladet, Article ID 2019-01-28.
Open this publication in new window or tab >>Akutvården har blivit allt sämre för äldre
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2019 (Swedish)In: Svenska Dagbladet, ISSN 1101-2412, article id 2019-01-28Article in journal, News item (Other (popular science, discussion, etc.)) Published
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-31435 (URN)
Available from: 2019-12-20 Created: 2019-12-20 Last updated: 2019-12-20Bibliographically approved
Berg, L. M., Ehrenberg, A., Florin, J., Östergren, J., Discacciati, A. & Göransson, K. E. (2019). Associations between crowding and ten-day mortality among patients allocated lower triage acuity levels without need of acute hospital care on departure from the emergency department. Annals of Emergency Medicine, 74(3), 345-356
Open this publication in new window or tab >>Associations between crowding and ten-day mortality among patients allocated lower triage acuity levels without need of acute hospital care on departure from the emergency department
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2019 (English)In: Annals of Emergency Medicine, ISSN 0196-0644, E-ISSN 1097-6760, Vol. 74, no 3, p. 345-356Article in journal (Refereed) Published
Abstract [en]

STUDY OBJECTIVE: We describe the association between emergency department (ED) crowding and 10-day mortality for patients triaged to lower acuity levels at ED arrival and without need of acute hospital care on ED departure.

METHODS: This was a registry study based on ED visits with all patients aged 18 years or older, with triage acuity levels 3 to 5, and without need of acute hospital care on ED departure during 2009 to 2016 (n=705,699). The sample was divided into patients surviving (n=705,076) or dying (n=623) within 10 days. Variables concerning patient characteristics and measures of ED crowding (mean length of stay and ED occupancy ratio) were extracted from the hospital's electronic health records. ED length of stay per ED visit was estimated by the average length of stay for all patients who presented to the ED during the same day and shift and with the same acuity level. The 10-day mortality after ED discharge was used as the outcome measure. Multivariable logistic regression analyses were conducted.

RESULTS: The 10-day mortality rate was 0.09% (n=623). The event group had larger proportions of patients aged 80 years or older (51.4% versus 7.7%) and triaged with acuity level 3 (63.3% versus 35.6%), and greater comorbidity (age-combined Charlson comorbidity index median interquartile range 6 versus 0). We observed an increased 10-day mortality for patients with a mean ED length of stay greater than or equal to 8 hours versus less than 2 hours (adjusted odds ratio 5.86; 95% confidence interval [CI] 2.15 to 15.94) and for elevated ED occupancy ratio. Adjusted odds ratios for ED occupancy ratio quartiles 2, 3, and 4 versus quartile 1 were 1.48 (95% CI 1.14 to 1.92), 1.63 (95% CI 1.24 to 2.14), and 1.53 (95% CI 1.15 to 2.03), respectively.

CONCLUSION: Patients assigned to lower triage acuity levels when arriving to the ED and without need of acute hospital care on departure from the ED had higher 10-day mortality when the mean ED length of stay exceeded 8 hours and when ED occupancy ratio increased.

National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-30483 (URN)10.1016/j.annemergmed.2019.04.012 (DOI)000482210700011 ()31229391 (PubMedID)2-s2.0-85067334196 (Scopus ID)
Available from: 2019-06-27 Created: 2019-06-27 Last updated: 2019-09-20Bibliographically approved
Naseer, M., Agerholm, J., Fastbom, J., Schön, P., Ehrenberg, A. & Dahlberg, L. (2019). Emergency department revisits among older adults: A prospective cohort study. In: : . Paper presented at International Association of Gerontology and Geriatrics European Region Congress 2019, 23rd – 25th May 2019, Gothenburg, Sweden.
Open this publication in new window or tab >>Emergency department revisits among older adults: A prospective cohort study
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2019 (English)Conference paper, Poster (with or without abstract) (Refereed)
National Category
Social Work
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-31161 (URN)
Conference
International Association of Gerontology and Geriatrics European Region Congress 2019, 23rd – 25th May 2019, Gothenburg, Sweden
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare
Available from: 2019-12-05 Created: 2019-12-05 Last updated: 2019-12-06Bibliographically approved
Kislov, R., Cummings, G., Ehrenberg, A., Gifford, W., Harvey, G., Kitson, A., . . . Wilson, P. (2019). From research evidence to "Evidence by proxy".: Organisational enactment of evidence-based healthcare. In: : . Paper presented at 79th Annual Meeting of the Academy of Management, August 9-13, 2019, in Boston, Massachusetts, United States.
Open this publication in new window or tab >>From research evidence to "Evidence by proxy".: Organisational enactment of evidence-based healthcare
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2019 (English)Conference paper, Oral presentation with published abstract (Refereed)
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-31434 (URN)
Conference
79th Annual Meeting of the Academy of Management, August 9-13, 2019, in Boston, Massachusetts, United States
Available from: 2019-12-20 Created: 2019-12-20 Last updated: 2019-12-20Bibliographically approved
Kislov, R., Wilson, P., Cummings, G., Ehrenberg, A., Gifford, W., Kelly, J., . . . Harvey, G. (2019). From Research Evidence to “Evidence by Proxy”?: Organizational Enactment of Evidence-Based Health Care in Four High-Income Countries. PAR. Public Administration Review, 79(5), 684-698
Open this publication in new window or tab >>From Research Evidence to “Evidence by Proxy”?: Organizational Enactment of Evidence-Based Health Care in Four High-Income Countries
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2019 (English)In: PAR. Public Administration Review, ISSN 0033-3352, E-ISSN 1540-6210, Vol. 79, no 5, p. 684-698Article in journal (Refereed) Published
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-30082 (URN)10.1111/puar.13056 (DOI)000483717900007 ()2-s2.0-85065200893 (Scopus ID)
Available from: 2019-05-21 Created: 2019-05-21 Last updated: 2019-09-20Bibliographically approved
Harvey, G., Gifford, W., Cummings, G., Kelly, J., Kislov, R., Kitson, A., . . . Ehrenberg, A. (2019). Mobilising evidence to improve nursing practice: A qualitative study of leadership roles and processes in four countries. International Journal of Nursing Studies, 90, 21-30
Open this publication in new window or tab >>Mobilising evidence to improve nursing practice: A qualitative study of leadership roles and processes in four countries
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2019 (English)In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 90, p. 21-30Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The approach and style of leaders is known to be an important factor influencing the translation of research evidence into nursing practice. However, questions remain as to what types of roles are most effective and the specific mechanisms through which influence is achieved.

OBJECTIVES: The aim of the study was to enhance understanding of the mechanisms by which key nursing roles lead the implementation of evidence-based practice across different care settings and countries and the contextual factors that influence them.

DESIGN: The study employed a qualitative descriptive approach.

SETTINGS: Data collection was undertaken in acute care and primary/community health care settings in Australia, Canada, England and Sweden.

PARTICIPANTS: 55 individuals representing different levels of the nursing leadership structure (executive to frontline), roles (managers and facilitators), sectors (acute and primary/community) and countries.

METHODS: Individual semi-structured interviews were conducted with all participants exploring their roles and experiences of leading evidence-based practice. Data were analysed through a process of qualitative content analysis.

RESULTS: Different countries had varying structural arrangements and roles to support evidence-based nursing practice. At a cross-country level, three main themes were identified relating to different mechanisms for enacting evidence-based practice, contextual influences at a policy, organisational and service delivery level and challenges of leading evidence-based practice.

CONCLUSIONS: National policies around quality and performance shape priorities for evidence-based practice, which in turn influences the roles and mechanisms for implementation that are given prominence. There is a need to maintain a balance between the mechanisms of managing and monitoring performance and facilitating critical questioning and reflection in and on practice. This requires a careful blending of managerial and facilitative leadership. The findings have implications for theory, practice, education and research relating to implementation and evidence-based practice.

Keywords
Evidence-based practice, Facilitation, Facilitators, Implementation, Knowledge translation, Leadership, Managers
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-29100 (URN)10.1016/j.ijnurstu.2018.09.017 (DOI)000461265700005 ()30551080 (PubMedID)2-s2.0-85058064165 (Scopus ID)
Available from: 2018-12-17 Created: 2018-12-17 Last updated: 2019-03-28Bibliographically approved
Harvey, G., Gifford, W., Cummings, G., Kelly, J., Kislov, R., Kitson, A., . . . Ehrenberg, A. (2019). Mobilising evidence to improve nursing practice: A qualitative study of leadership roles and processes in four countries. In: : . Paper presented at Knowledge Utilization Colloquium 2019, 25-28 June 2019, Montebello, Quebec, Canada.
Open this publication in new window or tab >>Mobilising evidence to improve nursing practice: A qualitative study of leadership roles and processes in four countries
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2019 (English)Conference paper, Oral presentation with published abstract (Refereed)
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-31433 (URN)
Conference
Knowledge Utilization Colloquium 2019, 25-28 June 2019, Montebello, Quebec, Canada
Available from: 2019-12-20 Created: 2019-12-20 Last updated: 2019-12-20Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-3964-196X

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