Providing effective trauma care: the potential for service provider views to enhance the quality of care (qualitative study nested within a multicentre longitudinal quantitative study)

Objective: To explore views of service providers caring for injured people on: the extent to which services meet patients’ needs and their perspectives on factors contributing to any identified gaps in service provision

Reduced time to surgery improves patient-reported outcome after achilles tendon rupture.

Background: Patient outcome after an acute Achilles tendon rupture (ATR) continues to be suboptimal and heterogeneous. Thus, prognostic factors are called for to optimize evidence-based ATR treatment protocols, however, the influence of delayed time from injury to surgery (TTS) on patient outcome after ATR remains largely unknown. Purpose: To determine whether patient outcomes and adverse events after surgical repair of acute ATR are related to delayed TTS. Study Design: Cohort study; Level of evidence, 3. Methods: Two hundred and twenty-eight ATR patients treated with uniform anesthetic and surgical techniques, within 10 days after injury, were retrospectively assessed. TTS depended on a free slot in the operating theatre and neither surgeon nor patient could affect TTS. Patients were assigned into three groups according to trichotomized TTS; short- (72hours). Patient-reported outcome at one-year was assessed using the validated Achilles tendon Total Rupture Score, with scores>80 on a 0- to 100-point scale indicating an overall good outcome. The incidences of adverse events (peri- and postoperative) and deep venous thrombosis were assessed. Results: Shorter TTS was significantly associated with increased rate of good outcome and reduced risk of adverse events. Seventy-one percent (95% CI, 60%-83%) of the patients with short TTS attained a good outcome compared to 44% (95% CI, 33%-56%) of the patients 3 with long TTS (p=.002), and with the intermediate TTS group in between (63%, 95% CI, 47%-78%). The incidence of adverse events was significantly reduced among patients with short TTS 1.4% (95% CI, 1%-4%) as compared to those with intermediate TTS 11% (95% CI, 2%-21%) (p=.035) and to patients with long TTS 14.8% (95% CI, 7%-23%) (p=.003). The risk of sustaining a deep venous thrombosis was not statistically significant different among the three groups (p=.15). Conclusion: Patients with acute ATR operated on within 48 hours after injury yielded better outcomes and a lower number of adverse events compared to patients operated on after 72 hours. These results conform to evidence-based recommendations from other surgical disciplines and should be used as guidelines for optimizing ATR treatment protocols.Swedish Research Council (project nr. 2012-3510)Accepte

Using by‐catch data from wildlife surveys to quantify climatic parameters and the timing of phenology for plants and animals using camera traps

Gaining a better understanding of global environmental change is an important challenge for conserving biodiversity. Shifts in phenology are an important consequence of environmental change. Measuring phenology of different taxa simultaneously at the same spatial and temporal scale is necessary to study the effects of changes in phenology on ecosystems. Camera traps that take both time‐lapse as well as motion‐triggered images are increasingly used to study wildlife populations. The by‐catch data of these networks of camera traps provide a potential alternative for measuring several climatic and phenological variables. Here, we tested this ability of camera traps, and quantified climatic variables as well as the timing of changes in plant and animal phenology. We obtained data from 193 camera‐unit deployments during a year of camera trapping on a peninsula in northern Sweden aimed at studying wildlife. We estimated daily temperature at noon and snow cover using recordings provided by cameras. Estimates of snow cover were accurate, but temperature estimates were higher compared with a local weather station. Furthermore, we were able to identify the timing of leaf emergence and senescence for birches (Betula sp.) and the presence of bilberry berries (Vaccinium myrtillus ), as important food sources for herbivores. These were linked to the timing of the growth of antlers and the presence of new‐born young for three ungulate species as well as the presence of migratory Eurasian cranes (Grus grus ). We also identified the timing of spring and autumn moulting of mountain hares (Lepus timidus ) in relation to snow cover. In this novel study, we show the potential of (by‐catch) data from camera traps to study phenology across a broad range of taxa, suggesting that a global network of camera traps has great potential to simultaneously track wildlife populations and the phenology of interactions between animals and plants

Dealing with daily emotions—supportive activities for the elderly in a municipal care setting

There are diverse descriptions of supportive activities in nursing to be found in the literature. What they have in common is their association with good care outcomes, but they may differ depending on the context in which the care is given. In a Swedish municipal elderly care setting, registered nurses (RN) work in a consultative way and they describe a part of their tasks as comprising supportive activities without specifying what kind of supportive activities they mean. The aim of the study was to explore the main concern of the support given by RN to a group of patients in an elderly home care setting. The study was conducted using Grounded Theory. Data were collected using nonparticipant observations regarding the supportive activities of 12 RN at the home of 36 patients between the ages of 80 and 102. Most of the home visit lasted about 40 min but some lasted for 90 min. The central category was about dealing with daily emotions. This was done by encouraging the situation and reducing the patient's limitations, but situations also occurred in which there was a gap of support. Support was about capturing the emotions that the patient expressed for a particular moment, but there were also situations in which RN chose not to give support. To develop a holistic eldercare, more knowledge is needed about the factors causing the RN to choose not to provide support on some occasions

Advancing neuromuscular electrical stimulation optimizing comfort and hemodynamic efficiency [Elektronisk resurs]

Physical inactivity and immobilization are significant contributors to global health challenges, including venous thromboembolism (VTE), muscle atrophy, and chronic diseases. Neuromuscular electrical stimulation (NMES) has emerged as a promising intervention to counteract these effects by mimicking muscle contractions and enhancing venous circulation. However, traditional NMES systems face barriers such as discomfort, complex setups, and poor compliance. This thesis explores innovative approaches to improve NMES comfort and efficiency by integrating textile electrodes into wearable garments, such as socks, and optimizing stimulation parameters. The research comprised five interrelated studies investigating the design, efficacy, and usability of textile- based NMES systems. Study I examined the construction of textile electrodes, focusing on how hydration and pressure affected stimulation performance. Results demonstrated that hydrated electrodes under moderate compression (~20 mmHg) significantly improved comfort and reduced both current intensity requirements and performance variability for effective muscle activation. Study II mapped motor points on the calf muscles to identify areas optimal for electrode placement. A probability heatmap was developed to guide electrode positioning, thereby enhancing stimulation precision without requiring professional assistance. Study III compared newly developed transverse textile electrodes integrated into socks (TTE-socks) with standard gel electrodes placed on motor points (MPE) at different intensity levels. Both configurations effectively increased venous hemodynamics in key veins, such as the popliteal and femoral veins, compared to baseline. However, in most of the comparisons, NMES via TTE- socks produced significantly greater hemodynamic responses, though it required slightly higher current and caused marginally more discomfort. Study IV optimized NMES parameter settings for the TTE-sock by testing combinations of frequency (1 or 36 Hz) and phase duration ranging from 75-400 microseconds (us). Findings revealed that low-frequency stimulation at 1 Hz, combined with a phase duration between 150 us and 400 us, was the most energy-efficient while maintaining comfort, making it suitable for long-term use in wearable devices. Study V explored the hemodynamic effects of frequency (1 Hz vs. 36 Hz) and plateau time using TTE-socks. Low-frequency 1 Hz NMES produced distinct single twitches that enhanced venous flow with minimal discomfort. In contrast, high-frequency 36 Hz NMES induced sustained tetanic contractions associated with greater discomfort but also higher hemodynamic efficacy. These findings underscore the importance of tailoring NMES parameters to individual needs for optimal compliance and therapeutic outcomes. The thesis highlights the transformative potential of wearable NMES systems integrated into everyday garments to address physical inactivity-related health issues. By combining textile-based electrodes with optimized stimulation protocols, this research presents a user-friendly solution that may enhance comfort, mobility, and compliance. The integration of NMES into clothing has the potential to revolutionize preventive healthcare for populations at risk of VTE or unable to engage in regular physical activity due to aging or chronic conditions. Future research should focus on large-scale clinical trials to validate these findings and explore broader applications of wearable NMES technology across diverse medical contexts. List of scientific papers I. Euler L, Juthberg R, Flodin J, Guo L, Ackermann PW, Persson NK. Textile electrodes: influence of electrode construction and pressure on stimulation performance in neuromuscular electrical stimulation (NMES). Annu Int Conf IEEE Eng Med Biol Soc. 2021;2021:1305-1308. https://doi.org/10.1109/EMBC46164.2021.9630649 II. Schriwer E, Juthberg R, Flodin J, Ackermann PW. Motor point heatmap of the calf. J Neuroeng Rehabil. 2023 Mar;20(1):28. https://doi.org/10.1186/s12984-023-01152-5 III. Sundstrom C, Juthberg R, Flodin J, Guo L, Persson NK, Ackermann PW. Effects on hemodynamic enhancement and discomfort of a new textile electrode integrated in a sock during calf neuromuscular electrical stimulation. Eur J Appl Physiol. 2023 May;123(9):2013- 2022. https://doi.org/10.1007/s00421-023-05212-5 IV. Juthberg R, Flodin J, Guo L, Rodriguez S, Persson NK, Ackermann PW. Neuromuscular electrical stimulation in garments optimized for compliance. Eur J Appl Physiol. 2023 Apr;123(8):1739-1748. https://doi.org/10.1007/s00421-023-05181-9 (+ Correction Eur J Appl Physiol. 2023 Aug;123(8):1749 https://doi.org/10.1007/s00421-023-05211-6). V. Juthberg R, Flodin J, Aliaga N, Guo L, Rodriguez S, Persson NK, Ackermann PW. Electrically Induced Hemodynamic Enhancement via Sock-Integrated Electrodes is More Comfortable and Efficient at 1 Hz as compared to 36 Hz. [Accepted

An Honest Journalism : – An Interview Study About Constructive Journalism and the Journalistic Role

Constructive journalism aims to cover stories about progress and collaboration as well as stories about devastation and conflict. This qualitative interviewstudy explores how local journalists working at Sveriges Television and Sveriges Radio experience the impact of constructive journalism on their journalistic role. What has the constructive perspective, which is now quite implemented in the two media organizations, meant for the conceptions of the journalistic role considering norms, ideals and journalistic mission? By interviewing five journalists about their experiences, we received results that provide an understanding of constructive journalism as it pertains to journalist role conceptions. The results show that the constructive perspective has come with a great sense of change for these journalists, considering how they experience their journalistic role

An Honest Journalism : – An Interview Study About Constructive Journalism and the Journalistic Role

Constructive journalism aims to cover stories about progress and collaboration as well as stories about devastation and conflict. This qualitative interviewstudy explores how local journalists working at Sveriges Television and Sveriges Radio experience the impact of constructive journalism on their journalistic role. What has the constructive perspective, which is now quite implemented in the two media organizations, meant for the conceptions of the journalistic role considering norms, ideals and journalistic mission? By interviewing five journalists about their experiences, we received results that provide an understanding of constructive journalism as it pertains to journalist role conceptions. The results show that the constructive perspective has come with a great sense of change for these journalists, considering how they experience their journalistic role