Emergency department triage scales and their components : a systematic review of the scientific evidence

Emergency department (ED) triage is used to identify patients' level of urgency and treat them based on their triage level. The global advancement of triage scales in the past two decades has generated considerable research on the validity and reliability of these scales. This systematic review aims to investigate the scientific evidence for published ED triage scales. The following questions are addressed: 1. Does assessment of individual vital signs or chief complaints affect mortality during the hospital stay or within 30 days after arrival at the ED? 2. What is the level of agreement between clinicians' triage decisions compared to each other or to a gold standard for each scale (reliability)? 3. How valid is each triage scale in predicting hospitalization and hospital mortality? A systematic search of the international literature published from 1966 through March 31, 2009 explored the British Nursing Index, Business Source Premier, CINAHL, Cochrane Library, EMBASE, and PubMed. Inclusion was limited to controlled studies of adult patients (≥15 years) visiting EDs for somatic reasons. Outcome variables were death in ED or hospital and need for hospitalization (validity). Methodological quality and clinical relevance of each study were rated as high, medium, or low. The results from the studies that met the inclusion criteria and quality standards were synthesized applying the internationally developed GRADE system. Each conclusion was then assessed as having strong, moderately strong, limited, or insufficient scientific evidence. If studies were not available, this was also noted. We found ED triage scales to be supported, at best, by limited and often insufficient evidence. The ability of the individual vital signs included in the different scales to predict outcome is seldom, if at all, studied in the ED setting. The scientific evidence to assess interrater agreement (reliability) was limited for one triage scale and insufficient or lacking for all other scales. Two of the scales yielded limited scientific evidence, and one scale yielded insufficient evidence, on which to assess the risk of early death or hospitalization in patients assigned to the two lowest triage levels on a 5-level scale (validity).

Om lärarskapets moraliska dimension : ett perspektiv och en studie av lärarstuderandes nätbaserade seminariesamtal

In this dissertation, an educational perspective called the moral dimension of teaching is developed. The work includes a theoretically informed discussion from a pragmatist point of view in which the concept of pedagogical rhythm is introduced. The concept captures the need for teachers to regularly shift their intentions and occasionally act in contradictory ways as a consequence of the moral which emerges from interaction in pedagogical situations. Using this perspective, criteria are developed for the characteristics of discussions of the work of teachers, which are desirable in order for students in pre-service teacher education to have opportunities to develop their teachership. Secondly, the educational perspective as it is conceptualised serves as a theoretical framework for a study of discussions taking place in net-based seminars among students in teacher education. The study consists of 14 recorded seminars in which discussions of the work of teachers are analysed in terms of content and direction for reflection. The result of the analysis is a construction of four different focal points for processes of making judgements: existential, performative, critical and professional. Mainly the performative, and to some extent the critical, focal points appear to be supported by the net-based environment, although potential for the professional focal point is found when available tools in net-based settings are used in deliberate ways. Finally, based on these four focal points, possible future predispositions among student teachers are deliberated. Student teachers’ future opportunities to develop a moral and epistemological authority are discussed, as well as teachers’ general opportunities to exercise professional responsibility. The conclusion emphasises that a perspective such as the one developed in the dissertation is important, as it creates an understanding for the need to educate student teachers to exercise a form of responsibility that goes beyond being accountable to society.

Degree projects improving co-operation between the teacher education program and schools : - Swedish experiences

In 1977, when teacher education inSwedenwas incorporated into the university system, the main reason was to transform it into an academic tradition. Now, nearly 30 years later, there is still tension between the academic and the vocational tradition; they show up as different and separated elements in a program that is meant to prepare students for a career as a teacher and for a possible future career as a researcher in this field. This tension gives rise to a risk of allowing parallel “tracks” to develop and of isolating the degree thesis work from other courses. On the teacher-training program in which we are involved, close co-operation with partner-schools, where the practical part of the program takes place, has been established. Here, the students´ degree theses are an important factor in making this co-operation work on a concrete level. Accordingly, the purpose of the degree thesis is both to reflect problems in schools and contribute to better teaching in the individual school, but also to offer relevant educational subject matter to the students, which may be adapted as an element in the university’s research environments. From these points of view, the degree thesis is an important part of teacher education and rather more than just a single course. The degree thesis should be an element that gives the students an opportunity to show that they have reached central goals in the teacher education program. It should also be an integral part in the development of critical and scholarly thinking, deepening pedagogical and didactic knowledge and giving the students an opportunity to apply research methods. We will here use two minor case studies: one that compares teacher education programs in five Swedish universities and one minor study at one of those universities, in order to elaborate on the questions: - What purpose has a degree thesis and what role does it play in teacher education? - What criteria are relevant to assessing a degree thesis and what qualities do the degree theses have? - Is it possible to assess a degree thesis fairly and what happens to students who do not pass? - How could the degree thesis be used to improve the contact between the teacher education program and its partner schools in order to contribute to the development of the individual school?

Assessing the physical environment of older people’s residential care facilities: development of the Swedish version of the Sheffield Care Environment Assessment Matrix (S-SCEAM)

Background There is emerging evidence that the physical environment is important for health, quality of life and care, but there is a lack of valid instruments to assess health care environments. The Sheffield Care Environment Assessment Matrix (SCEAM), developed in the United Kingdom, provides a comprehensive assessment of the physical environment of residential care facilities for older people. This paper reports on the translation and adaptation of SCEAM for use in Swedish residential care facilities for older people, including information on its validity and reliability. Methods SCEAM was translated into Swedish and back-translated into English, and assessed for its relevance by experts using content validity index (CVI) together with qualitative data. After modification, the validity assessments were repeated and followed by test-retest and inter-rater reliability tests in six units within a Swedish residential care facility that varied in terms of their environmental characteristics. Results Translation and back translation identified linguistic and semantic related issues. The results of the first content validity analysis showed that more than one third of the items had item-CVI (I-CVI) values less than the critical value of 0.78.  After modifying the instrument, the second content validation analysis resulted in I-CVI scores above 0.78, the suggested criteria for excellent content validity. Test-retest reliability showed high stability (96% and 95% for two independent raters respectively), and inter-rater reliability demonstrated high levels of agreement (95% and 94% on two separate rating occasions). Kappa values were very good for test-retest (κ= 0.903 and 0.869) and inter-rater reliability (κ= 0.851 and 0.832). Conclusions Adapting an instrument to a domestic context is a complex and time-consuming process, requiring an understanding of the culture where the instrument was developed and where it is to be used. A team, including the instrument’s developers, translators, and researchers is necessary to ensure a valid translation and adaption. This study showed preliminary validity and reliability evidence for the Swedish version (S-SCEAM) when used in a Swedish context. Further, we believe that the S-SCEAM has improved compared to the original instrument and suggest that it can be used as a foundation for future developments of the SCEAM model.