Lizbet Todorova - Academia.edu (original) (raw)

Papers by Lizbet Todorova

Resuscitation, 2018

Introduction: In out-of-hospital cardiac arrest (OHCA), prolonged ambulance response time has led... more Introduction: In out-of-hospital cardiac arrest (OHCA), prolonged ambulance response time has led to increased involvement of first responders [1,2]. Skåne County (Sweden) uses fire-fighters as first responders since 2005. The fire-fighters are dispatched if the dispatcher at the emergency medical dispatch center (EMDC) estimates a time gain compared to the estimated ambulance response time. The aim was to evaluate this selective dispatch system. Methods: Merging of EMDC dispatch data (EMS response time) with intervention and outcome data from the Swedish Cardiac Arrest Registry during 2010-2016. Inclusion: non-EMS witnessed OHCA, ≥ 18 years, dispatched as suspected OHCA. Comparison of regular ambulance dispatch (two ambulances) vs. dual dispatch (two ambulances and first responders) for presence of shockable rhythm at arrival and 30-day survival was performed. Data was compared using Chi 2 , Mann-Whitney, Wilcoxon signed-ranks test and logistic regression. Results: Valid cases (n = 2457) were analysed after deletion of missing data (n = 1179). Median ambulance response time

Resuscitation, 2013

The Purpose of this study was to analyze the influence of the country image and brand image of pr... more The Purpose of this study was to analyze the influence of the country image and brand image of product on Chinese consumers' brand attitude and the purchasing behavior. The results of this research are wrapped up as follows : First, the original country image of product is positive related to the product brand image itself. Second, both the country image and brand image of product have positive influences on consumers' brand attitude. Third, Chinese consumers' brand attitude has positive influences on purchasing behavior. Forth, both the country image and brand image of product have positive influences on consumers' purchasing behavior.

BMJ Open, 2018

Aim Most of the Emergency medical communication centres (EMCC) in Sweden uses the criteria based ... more Aim Most of the Emergency medical communication centres (EMCC) in Sweden uses the criteria based dispatch protocol (CBD), Medical Index1 which has three levels of priority. In the ambulance service, RETTS (Rapid Emergency Triage and Treatment System)2 is used and consists of four levels. This study evaluates the accuracy of dispatching ambulances, by evaluating the feedback sent from the ambulance crew after the first evaluation of the patients’ severity and condition. Method This is a retrospective study from October 2014 to June 2015. Sensitivity and specificity were used to estimate the agreement of assessed priority levels between ambulance priority Red to EMCC priority 1. The priority level assessed by ambulance crew was considered the ‘gold standard.’ Over and under triage was described for the six most frequent conditions assessed. Results There were 66 983 missions during the study period. Sensitivity for detecting highest priority indicated 67.1% correctly identified (95% c...

International Emergency Nursing, 2022

Healthcare, 2020

Background: In order to facilitate more effective patient assessment and diagnostic support by im... more Background: In order to facilitate more effective patient assessment and diagnostic support by improving the flow of information between ambulance nurses (AN) and physicians in the role of regional medical support (RMS), an application was developed for transmitting real-time video images. Objective: The objective of this study was to elucidate the physicians’ experiences using a video application to support the assessment and triage procedure in ambulance care, when patients are deemed to not have an urgent need for emergency care. Design: The design for this research was a qualitative interview study. Ten physicians, working as RMS in ambulance care, were purposively selected to participate. The telemedicine concept studied consisted of a real-time video image application, in addition to the currently used mobile phone. When a patient was deemed eligible for inclusion in the study, the ambulance nurse (AN) contacted the RMS via telephone to initiate a video consultation. To elucid...

Echocardiography (Mount Kisco, N.Y.), Jan 29, 2017

Although oxygen (O2 ) is routinely used in patients with acute myocardial infarction (AMI), it ma... more Although oxygen (O2 ) is routinely used in patients with acute myocardial infarction (AMI), it may have negative effects. In this substudy of the SOCCER trial, we aimed to evaluate the effects of O2 -treatment on myocardial function in patients with ST elevation myocardial infarction (STEMI). Normoxic (≥94%) STEMI patients were randomized in the ambulance to either supplemental O2 or room air until the end of the percutaneous coronary intervention (PCI). The patients underwent echocardiography on day 2-3 after the PCI and once again after 6 months. The study endpoints were wall-motion score index (WMSI) and left ventricular ejection fraction (LVEF). Forty-six patients in the O2 group and 41 in the air group were included in the analysis. The index echocardiography showed no significant differences between the groups in WMSI (1.32±0.27 for O2 group vs 1.28±0.28 for air group) or LVEF (47.0±8.5% vs 49.2±8.1%). Nor were there differences at 6 months in WMSI (1.16±0.25 vs 1.14±0.24) or ...

$Research paper thumbnail of Novel biomarkers for prediction of outcome in hip fracture patients—An exploratory study$

Acta Anaesthesiologica Scandinavica, 2020

Copyright (C) 2005 by the American Thoracic Society. 1 Proteoglycans contribute to extracellular ... more Copyright (C) 2005 by the American Thoracic Society. 1 Proteoglycans contribute to extracellular matrix remodeling in asthmatic airways. We investigated the effects of budesonide, a glucocorticoid, and formoterol, a long-acting ß2adrenergic agonist, on serum-induced proteoglycan production by human lung fibroblasts. In 10 % serum, total proteoglycan production was increased 1.5-fold (p<0.01) compared to basal production in 0.4 % serum. Budesonide (10-8 M) reduced this increase by 44 % (p<0.01), and while formoterol (10-10 –10-8 M) had no inhibitory effects, the drug combination abolished the increase (p<0.01) without affecting fibroblast proliferation. This synergistic effect required functional glucocorticoid and-adrenergic receptors. The production of the proteoglycans decorin, biglycan, perlecan, and versican, was increased 2.5–5-fold (p<0.01) in 10 % serum. Combination treatment with budesonide (10-8 M) and formoterol (10-10 M) abolished this increase to a significan...

Healthcare

The prevalence of mental illness is steadily increasing, and ambulance teams frequently attend ca... more The prevalence of mental illness is steadily increasing, and ambulance teams frequently attend cases with suspected mental illness. A pilot project, Psychiatric Emergency Response Team (PAP), was carried out in which a prehospital emergency nurse (PEN) was accompanied by a psychiatric specialist nurse in the assessment of individuals with mental illness. The aim of the present study was to evaluate a prehospital emergency psychiatric unit from the perspective of PENs. A qualitative method using content analysis was applied. Seven senior PENs who had worked for 1 year in a prehospital psychiatric ambulance unit were interviewed individually. The analysis resulted in one main theme, “Transition from limited care and insufficient competence to improved and adequate care for psychiatric patients in ambulance care”. This emerged from six subcategories: inter-professional development, access to patient records, the ambulance vehicle, non-conveyed patients, cooperation with the police and ...

Trauma

Objective To analyze if pre-hospital rescue times were associated with mortality in a trauma coho... more Objective To analyze if pre-hospital rescue times were associated with mortality in a trauma cohort arriving by ambulance to hospital in a Scandinavian urban setting. Methods Between 2011 and 2013, individuals and pre-hospital rescue times were identified in Emergency Medical Dispatcher Centre, hospital, and forensic records in red alarm trauma. Major trauma was defined as a New Injury Severity Score (NISS)>15. Results Overall, 89% of 378 trauma patients received hospital care within 60 min; 51% had a response time of ≤8 min, and 95% had response time within ≤20 min. The on-scene time (p < 0.05) and total pre-hospital time (p < 0.05) were longer for patients ≥65 years, in comparison with patients <65 years. The patients with penetrating trauma had shorter on-scene time (p < 0.01), total pre-hospital time (p < 0.01), and shorter transport distance from trauma scene to hospital (p = 0.004), compared to those with blunt trauma. Patients with NISS > 15 were found to have the same pre-hospital rescue times as those with NISS ≤ 15. There was a trend that the occurrence of gunshots was associated with increased mortality (p = 0.074). When entering age, NISS, penetrating versus blunt injury, response time, and on-scene time in a multivariate regression analysis, age (p < 0.001), NISS (p < 0.001), and penetrating injury (p = 0.009) remained as independent factors associated with mortality and a trend for shorter on-scene time (p = 0.093). Conclusions Pre-hospital rescue times had less impact on mortality than injury severity, age, and penetrating trauma. Even though penetrating traumas were associated with shorter on-scene time and shorter transport distance to hospital, mortality was increased in this Scandinavian urban setting.

Fibroblasts, being one of the resident and structural cells of the lung, have the capacity to pro... more Fibroblasts, being one of the resident and structural cells of the lung, have the capacity to produce inflammatory mediators, cytokines and extracellular matrix (ECM) proteins perpetuating the inflammation in the airways of asthmatics. Airway remodeling is also a prominent feature of asthma that affects the lung function causing a thickening of the airways. An increased ECM production of proteoglycans, collagens and other ECM molecules, usually accompanied by dysfunction of the ECM degrading enzymes, the metalloproteinases, may not only contribute to a subepithelial fibrosis formation, but it may also be a compartment where accumulating ECM sequesters and stores inflammatory mediators. Lung fibroblasts are the major producers of ECM components within the lung and may initiate, regulate and contribute to the airway remodeling in asthma. Current asthma treatments based on anti-inflammatory glucocorticoids (GC) and bronchodilatory long acting β2-agonists (LABA) are known to improve lun...

BMC Emergency Medicine, 2021

Introduction When in need of emergency care and ambulance services, the ambulance nurse is often ... more Introduction When in need of emergency care and ambulance services, the ambulance nurse is often the first point of contact for the patient with healthcare. This role requires comprehensive knowledge of the ambulance nurse to be able to assign the right level of care and, if necessary, to provide self-care advice for patients with no further conveyance to hospital. Recently, an application was developed for transmitting real-time video to facilitate consultation between ambulance nurses and prehospital physicians in the role of regional medical support (RMS) for ambulance care. The use of video communication as a complement of medical support when referring to self-care is still an unexplored method in a prehospital setting. Our study aimed to elucidate ambulance nurses’ experience of video consultation with RMS physician during the assessment of patients considered to be triaged to self-care. Method We conducted a qualitative design study using semi-structured interviews with open ...

Ardavan Khoshnood. Department of Emergency and Internal medicine, Clinical Sciences Lund, Lund Un... more Ardavan Khoshnood. Department of Emergency and Internal medicine, Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden. ardavan.Khoshnood@med.lu.se Background: Oxygen (O2) therapy is central in the treatment of myocardial infarction. O2 may, however, have negative cardiovascular effects. In this study we evaluated the effects of O2 therapy on myocardial salvage index (MSI), myocardium at risk (MaR) and infarct size (IS) as measured by cardiac magnetic resonance (CMR).

Resuscitation, 2016

Survival after out-of-hospital cardiac arrest (OHCA) remains low. Early recognition by emergency ... more Survival after out-of-hospital cardiac arrest (OHCA) remains low. Early recognition by emergency medical dispatchers is essential for an effective chain of actions, leading to early cardiopulmonary resuscitation, use of an automated external defibrillator and rapid dispatching of the emergency medical services. To analyse and compare the accuracy of OHCA recognition by medical dispatchers in two countries. An observational register-based study collecting data from national cardiac arrest registers in Denmark and Sweden during a six-month period in 2013. Data were analysed in two steps; registry data were merged with electronically registered emergency call data from the emergency medical dispatch centres in the two regions. Cases with missing or non-OHCA dispatch codes were analysed further by auditing emergency call recordings using a uniform data collection template. The sensitivity for recognition of OHCA was 40.9% (95% CI: 37.1-44.7%) in the Capital Region of Denmark and 78.4% (95% CI: 73.2-83.0%) in the Skåne Region in Sweden (p<0.001). With additional data from the emergency call recordings, the sensitivity was 80.7% (95% CI: 77.7-84.3%) and 86.0% (95% CI: 81.3-89.8%) for the two regions (p=0.06). The majority of the non-recognised OHCA were dispatched with the highest priority. The accuracy of OHCA recognition was high and comparable. We identified large differences in data registration practices despite the use of similar dispatch tools. This raises a discussion of definitions and transparency in general in scientific reporting of OHCA recognition, which is essential if used as quality indicator in emergency medical services.

Lund University Faculty of Medicine Doctoral Dissertation Series, 2007

sulfate proteoglycans increase during phenotypic modulation of aortic smooth muscle cells.