National survey on availability, use and clinical impact of point-of-care blood analysis systems in Swedish emergency departments.

Background: Expedited diagnostic results are important in time sensitive operations like the Emergency Department (ED). Point-of-care testing (POCT) is used for a broad range of blood tests reducing wait times and providing faster decisions on patient management compared to central laboratory analysis. If POCT is to substitute central laboratory analysis as part of the decision making process in the ED, cognizance on the distribution and availability of the required instruments, staff training and workflow integration is essential.

Can we trust naked eye assessments of the capillary refill test in children? An experimental study.

Background: The capillary refill test is widely used in pediatric emergency medicine and critical care although its validity and reliability are debated. Naked eye estimation is the recommended method for capillary refill time (CR time) assessment. The goal of this study was to compare naked eye estimations of the CR time in pediatric patients to quantified capillary refill time (qCR time) using polarized reflectance imaging as an objective reference, and to investigate interobserver and intra-observer consistency of naked eye assessments of CR time.

Prehospital lactate analysis in suspected sepsis improves detection of patients with increased mortality risk: an observational study.

Background: Rapid, adequate treatment is crucial to reduce mortality in sepsis. Risk stratification scores used at emergency departments (ED) are limited in detecting all septic patients with increased mortality risk. We assessed whether the addition of prehospital lactate analysis to clinical risk stratification tools improves detection of patients with increased risk for rapid deterioration and death in sepsis.

Addition of the clinical frailty scale to triage tools and early warning scores improves mortality prognostication at 30 days: A prospective observational multicenter study.

Objectives: Frailty, assessed with clinical frailty scale (CFS), alone or in combination with aggregated vital signs, has been proposed as a measure to better predict mortality of older patients in the emergency department (ED), but the added predictive value to conventional triage is unclear.

Methods: This was a secondary analysis of a prospective observational study in three EDs in Sweden that evaluated the prognostic performance of the CFS alone or in combination with the national early warning score (NEWS), triage early warning score (TEWS) or the rapid emergency triage and treatment system (RETTS) triage tool using logistic regression. The primary outcome was 30-day mortality with 7- and 90-day mortality and admission as secondary outcomes reported as area under the receiver operating curve (AuROC) scores with 95% confidence intervals (CIs).

The Effect of Repeated Capillary Refill Tests on the Cutaneous Microcirculation.

Objective: The capillary refill test (CR test) is often used in emergency care, and the capillary refill time (CR time) is used to assess a patient's circulatory condition. The objective of this study was to investigate if repeated CR tests affect CR time.

Methods: Thirteen healthy volunteers had repeated CR tests performed on the sternum, forehead, and fingers.

Agreement of pCO in venous to arterial blood gas conversion models in undifferentiated emergency patients.

Background: Venous blood gas sampling has replaced arterial sampling in many critically ill patients, though interpretation of venous pCO still remains a challenge. Lemoël et al., Farkas and Zeserson et al.

Emergency department crowding and mortality: an observational multicenter study in Sweden.

Background: Emergency department (ED) crowding is a serious problem worldwide causing decreased quality of care. It is reasonable to assume that the negative effects of crowding are at least partially due to high staff workload, but previous crowding metrics based on high workload have not been generalisable to Swedish EDs and have not been associated with increased mortality, in contrast to, e.g.

Risk of venous thromboembolism in patients with COVID-19 during 2020; a retrospective cross-sectional study in a Swedish health care system.

To establish the impact of COVID-19 on the pre-test probability for VTE in patients with suspected VTE. This was a retrospective, observational, cross-sectional study of patients 18 years and older undergoing diagnostic tests for VTE in an integrated healthcare system covering a population of 465,000 during the calendar year of 2020. We adjusted for risk factors such as age, sex, previous VTE, ongoing anticoagulant treatment, malignancy, Charlson score, ward care, ICU care and wave of COVID-19.

Airway management procedures in Swedish emergency department patients - a national retrospective study.

Background: With the on-going debate about which specialty should be responsible for intubations in the emergency department in mind, the aim of this study was to describe the prevalence of endotracheal intubation and other airway management procedures in emergency department patients in Sweden.

Methods: All patients registered in the Swedish Intensive Care Registry with admission date from January 1 2013 until June 7 2018 and reported admission type "from the emergency department" or "emergency department" reported in the SAPS3 scoring were included. All patients missing codes for procedures were excluded.

Differentiating properties of occupancy rate and workload to estimate crowding: A Swedish national cross-sectional study.

Background: Emergency department (ED) crowding causes increased patient morbidity and mortality. ED occupancy rate (OR; patients by treatment beds) is a common measure of crowding, but the comparability of ORs between EDs is unknown. The objective of this investigation was to investigate differences in ORs between EDs using staff-perceived workload as reference.

Emergency department admissions to the intensive care unit - a national retrospective study.

Background: Emergency departments (EDs) see a rising number of patients, but only a small fraction of ED patients need immediate intensive care. The characteristics of these patients are mostly unknown and there is reason to believe that there are large inter-hospital differences in thresholds for intensive care admissions from the ED. The purpose of this study was to give a nationwide overview of ED admissions directly to intensive care units.

Risk of venous thromboembolism in a Swedish healthcare system during the COVID-19 pandemic: A retrospective cross-sectional study.

Objective: The objective of this study was to investigate the risk and prevalence of venous thromboembolism (VTE) for patients undergoing a diagnostic test for VTE with confirmed COVID-19 infection compared with patients with no COVID-19 infection.

Methods: This was a retrospective cross-sectional study of patients in an integrated healthcare system in Sweden, covering a population of 465,000, with a diagnostic test for VTE between March 1 and May 31 in the years 2015 to 2020. Risk for VTE with COVID-19 was assessed by logistic regression, adjusting for baseline risk factors.

Validation of the modified Skåne emergency department assessment of patient load (mSEAL) model for emergency department crowding and comparison with international models; an observational study.

Background: Emergency Department crowding is associated with increased morbidity and mortality but no measure of crowding has been validated in Sweden. We have previously derived and internally validated the Skåne Emergency Department Assessment of Patient Load (SEAL) score as a measure of crowding in Emergency Departments (ED) in a large regional healthcare system in Sweden. Due to differences in electronic health records (EHRs) between health care systems in Sweden, all variables in the original SEAL-score could not be measured reliably nationally.

Prevalence of crowding, boarding and staffing levels in Swedish emergency departments - a National Cross Sectional Study.

Background: Emergency Department (ED) crowding occurs when demand for care exceeds the available resources. Crowding has been associated with decreased quality of care and increased mortality, but the prevalence on a national level is unknown in most countries.

Method: We performed a national, cross-sectional study on staffing levels, staff workload, occupancy rate and patients waiting for an in-hospital bed (boarding) at five time points during 24 h in Swedish EDs.

Immune-mediated febrile response in female rats: Role of central hypothalamic mediators.

Lipopolysaccharide (LPS) induces fever through cytokines like receptor-activator of nuclear factor κB ligand (RANKL), triggering mediators like prostaglandins (PG), endothelin-1 (ET-1), corticotrophin-releasing factor (CRF), substance P (SP) and endogenous opioids. LPS-induced fever is reduced in females compared with males except in ovariectomized (OVX) females which show increased fever mediated by PG. The present study aimed to identify the mediators involved in fever in intact and OVX female rats.

Key occupational stressors in the ED: an international comparison.

Background: The ED Stressor Scale outlines 15 stressors that are of importance for ED staff. Limited research has identified how commonly such stressors occur, or whether such factors are perceived with similar importance across different hospitals. This study sought to examine the frequency or perceived severity of these 15 stressors using a multicentre cohort of emergency clinicians (nurses and physicians) in EDs in two countries (Australia and Sweden).

CGRP Is Critical for Hot Flushes in Ovariectomized Mice.

Hot flushes are common and troublesome symptoms of menopause. The neuropeptide calcitonin gene-related peptide (CGRP) is increased in plasma during hot flushes but it has not been clear if CGRP is causally involved in the mechanism underpinning the flushes. Here, we examined the effect of interventions with CGRP in a mouse model of hot flushes based on flush-like temperature increases triggered by forced physical activity in ovariectomized mice.

Muscarinic M4 Receptors on Cholinergic and Dopamine D1 Receptor-Expressing Neurons Have Opposing Functionality for Positive Reinforcement and Influence Impulsivity.

The neurotransmitter acetylcholine has been implicated in reward learning and drug addiction. However, the roles of the various cholinergic receptor subtypes on different neuron populations remain elusive. Here we study the function of muscarinic M4 receptors (M4Rs) in dopamine D1 receptor (D1R) expressing neurons and cholinergic neurons (expressing choline acetyltransferase; ChAT), during various reward-enforced behaviors and in a "waiting"-impulsivity test.

Inflammation-induced anorexia and fever are elicited by distinct prostaglandin dependent mechanisms, whereas conditioned taste aversion is prostaglandin independent.

Systemic inflammation evokes an array of brain-mediated responses including fever, anorexia and taste aversion. Both fever and anorexia are prostaglandin dependent but it has been unclear if the cell-type that synthesizes the critical prostaglandins is the same. Here we show that pharmacological inhibition or genetic deletion of cyclooxygenase (COX)-2, but not of COX-1, attenuates inflammation-induced anorexia.

Prostaglandin-dependent modulation of dopaminergic neurotransmission elicits inflammation-induced aversion in mice.

Systemic inflammation causes malaise and general feelings of discomfort. This fundamental aspect of the sickness response reduces the quality of life for people suffering from chronic inflammatory diseases and is a nuisance during mild infections like common colds or the flu. To investigate how inflammation is perceived as unpleasant and causes negative affect, we used a behavioral test in which mice avoid an environment that they have learned to associate with inflammation-induced discomfort.

Deletion of prostaglandin E2 synthesizing enzymes in brain endothelial cells attenuates inflammatory fever.

Fever is a hallmark of inflammatory and infectious diseases. The febrile response is triggered by prostaglandin E2 synthesis mediated by induced expression of the enzymes cyclooxygenase-2 (COX-2) and microsomal prostaglandin E synthase 1 (mPGES-1). The cellular source for pyrogenic PGE2 remains a subject of debate; several hypotheses have been forwarded, including immune cells in the periphery and in the brain, as well as the brain endothelium.

Acetaminophen reduces lipopolysaccharide-induced fever by inhibiting cyclooxygenase-2.

Acetaminophen is one of the world's most commonly used drugs to treat fever and pain, yet its mechanism of action has remained unclear. Here we tested the hypothesis that acetaminophen blocks fever through inhibition of cyclooxygenase-2 (Cox-2), by monitoring lipopolysaccharide induced fever in mice with genetic manipulations of enzymes in the prostaglandin cascade. We exploited the fact that lowered levels of a specific enzyme make the system more sensitive to any further inhibition of the same enzyme.