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).

A systematic review of triage-related interventions to improve patient flow in emergency departments

Background Overcrowding in emergency departments is a worldwide problem. A systematic literature review was undertaken to scientifically explore which interventions improve patient flow in emergency departments. Methods A systematic literature search for flow processes in emergency departments was followed by assessment of relevance and methodological quality of each individual study fulfilling the inclusion criteria. Studies were excluded if they did not present data on waiting time, length of stay, patients leaving the emergency department without being seen or other flow parameters based on a nonselected material of patients. Only studies with a control group, either in a randomized controlled trial or in an observational study with historical controls, were included. For each intervention, the level of scientific evidence was rated according to the GRADE system, launched by a WHO-supported working group. Results The interventions were grouped into streaming, fast track, team triage, point-of-care testing (performing laboratory analysis in the emergency department), and nurse-requested x-ray. Thirty-three studies, including over 800,000 patients in total, were included. Scientific evidence on the effect of fast track on waiting time, length of stay, and left without being seen was moderately strong. The effect of team triage on left without being seen was relatively strong, but the evidence for all other interventions was limited or insufficient. Conclusions Introducing fast track for patients with less severe symptoms results in shorter waiting time, shorter length of stay, and fewer patients leaving without being seen. Team triage, with a physician in the team, will probably result in shorter waiting time and shorter length of stay and most likely in fewer patients leaving without being seen. There is only limited scientific evidence that streaming of patients into different tracks, performing laboratory analysis in the emergency department or having nurses to request certain x-rays results in shorter waiting time and length of stay.

The Development of Swedish Tourism Public Policy 1930-2010

In this article, the development and changes in Swedish public policy relating to tourism from the 1930s to 2010 is described and interpreted from a political economy perspective. A case study, compiled from mainly secondary sources, is analyzed from a theoretical framework based on regulation theory. The purpose with this study is to increase the understanding of how the macro political economy context has influenced the policy-making in tourism in Sweden, but also to make a contribution to an area which seems to be quite neglected when it comes to research. The changes are analyzed according to the three periods denoted as pre-Fordism (mid-19th century-1930s), Fordism (1930s-1970s) and post-Fordism (1970s to present). It is observed how the general changes between these periods regarding aspects such as regulation and deregulation, and the degree of state involvement, have affected tourism policy making. The tourism policy making has changed from being insignificant, to a high degree of state involvement including planning, control and supervision, to a situation where the market rather than government regulation is considered as state of the art. 

The impact of price changes on volume sales of alcoholic beverages in Sweden, 2006-2013

We evaluate whether price elasticities on registered alcohol have changed in the last ten years in Sweden, in particular with regard to the investigation by Asplund et al (2007). We also investigate the fiscal effects of such changes. According to our estimates, price elasticities have increased, and these increases may have substantial effects on estimated changes in tax revenues when commodity tax rates are changed. In particular, commodity tax rates on spirits may have reached “Laffer territory” where tax increases may actually lower tax revenues.

Gymnasisters skrivande : En studie av genre, textstruktur och sammanhang

Students in upper secondary school write in a number of different genres, and do this in school contexts as well as in their spare time. The study presented here is an overview of this activity and the genres concerned. The theoretical framework of the study is that of genre theory whereby genre is understood as a socially situated concept. The study is based on 2 000 texts gathered from students on different study programmes all over Sweden in the school year of 1996-97. The texts were written in different situations. The most important distinction made here is between test texts (i.e. texts from national tests) and self-chosen texts, which may come from schoolwriting or spare-time writing. The texts are categorized according to genre. This text inventory shows a repertoire of 33 different genres in the text material. A small number of genres, such as story, book-review and expository essay dominate the school writing. The test genres differ from this pattern in that they clearly imitate texts with a genuine communicative intent. The most frequent genres are studied further and each of them is demonstrated by an interpretative reading. This reading shows that the genres differ considerably with respect to genre character and stability of text structure. A quantitative study of text length and variation in vocabulary further shows that texts written by two categories of students, those on vocationally oriented programmes and those on programmes preparing for higher education, differ significantly. Reference cohesion is studied in a smaller sample of the texts. This lexico-semantic mechanism of cohesion proves to exhibit an interrelation with variation in vocabulary as well as with text type. One particular cohesive tie, inference, shows different patterns in texts written by the two categories of students mentioned above.

The Music Salon in Falun During the 19th Century

The aim of the project is to examine the music salon in Falun as a part of the mining community and in the historical context of European salon culture. A specifc goal is to develop a deeper understanding about the salon when it comes to education and pedagogic ideas. Of a certain interest is Johan Henrik Munktell’s (1804-1861) education travelling (bildningsresor). Inspired by Mendelssohn’s music salon in Berlin and the early salons in Upp-sala he created his own salon in Grycksbo. A letter collection from J.H. Munktell to his father J.J. Munktell in 1828-30 can be considered a unique historical material, which places the salon in Falun in a continental context of culture, education and industrial pretensions. The results have potential to extend the knowledge of Nordic salon culture and how it has infuenced general pedagogy and music education.

Sustainability in nursing : a concept analysis

Aim. The aim of this study was to describe, explore and explain the concept of sustainability in nursing. Background. Although researchers in nursing and medicine have emphasised the issue of sustainability and health, the concept of sustainability in nursing is undefined and poorly researched. A need exists for theoretical and empirical studies of sustainability in nursing. Design. Concept analysis as developed by Walker and Avant. Method. Data were derived from dictionaries, international healthcare organisations and literature searches in the CINAHL and MEDLINE databases. Inclusive years for the search ranged from 1990 to 2012. A total of fourteen articles were found that referred to sustainability in nursing. Results. Sustainability in nursing involves six defining attributes: ecology, environment, future, globalism, holism and maintenance. Antecedents of sustainability require climate change, environmental impact and awareness, confidence in the future, responsibility and a willingness to change. Consequences of sustainability in nursing include education in the areas of ecology, environment and sustainable development as well as sustainability as a part of nursing academic programs and in the description of the academic subject of nursing. Sustainability should also be part of national and international healthcare organisations. The concept was clarified herein by giving it a definition. Conclusion. Sustainability in nursing was explored and found to contribute to sustainable development, with the ultimate goal of maintaining an environment that does not harm current and future generations' opportunities for good health. This concept analysis provides recommendations for the healthcare sector to incorporate sustainability and provides recommendations for future research.

Older people's experience of utilisation and administration of medicines in a health- and social care context

BACKGROUND: People living at home who lack ability to manage their medicine are entitled to assistance to improve adherence provided by a home care assistant employed by social care. AIM: The aim was to describe how older people with chronic diseases, living at home, experience the use and assistance of administration of medicines in the context of social care. DESIGN: A qualitative descriptive study. METHODS: Ten participants (age 65+) living at home were interviewed in the participants' own homes. Latent content analysis was used. FINDINGS: The assistance eases daily life with regard to practical matters and increases adherence to a medicine regimen. There were mixed feelings about being dependent on assistance; it interferes with self-sufficiency at a time of health transition. Participants were balancing empowerment and a dubious perception of the home care assistants' knowledge of medicine and safety. Physicians' and district nurses' professional knowledge was a safety guarantee for the medicine process. CONCLUSIONS: Assistance eases daily life and medicine regimen adherence. Dependence on assistance may affect self-sufficiency. Perceived safety varied relating to home care assistants' knowledge of medicine. RELEVANCE TO CLINICAL PRACTICE: A well-functioning medicine assistance is crucial to enable older people to remain at home. A person-centred approach to health- and social care delivery is efficient and improve outcome for the recipient of care.

Quão romance é minha vida amorosa! : namoro virtual e narrativas

This research aims to acknowledge the virtual dating phenomenon. The research deals with this phenomenon in Orkut, a social networking website. Thus, it considers debates and forums that were present in a Brazilian Orkut online community called Conheci meu amor pela internet (I met my love through the Internet). As a staring point the research dealt with issues such as: what are the debates about? How can we deal with practices that question their own dating process? According to the initial hypothesis, these debates reveal different contemporary social aspects: 1) they emerge as a response to demands on behalf of a society that is rather reflexive. This reflexive element is fundamental for the constitution of the self 2) these debates work as support elements in social relations that are built upon this sphere. In this context, individuals write about themselves and constitute themselves as real individuals that acquire a sense as subjects; and 3) people discuss online dating as form reconstructing former experiences. Empirical analysis demonstrates that these forums and polls present themselves as a social phenomenon that allows a particular form of self presentation on the internet. In order for these subjects to present themselves they built their own self narratives. What is possible to acknowledge considering these narratives is that there is a predominance of the element of intrigue that is further solved and demonstrate a satisfactory result. These narrators then choose online dating situation that present happy endings and happiness that are associated to romantic ideals that are worthwhile being shown. The contents present in these narratives are dealt with by the research. Thus, this work defends the thesis that the online dating narratives are a mixture of facts and fiction once all experiences deal with romantic imaginary as well as personal dating experience. Thus, the research is an attempt to understand what goes on the forums and debates that deal with the fictionalized and dramatized daily experiences in the performances that are similar to games. This is possible due to the fact that there is use of romantic fables and concrete experiences realized by online dating

A leitura de literatura na escola: por uma educação emocional de crianças na educação infantil

This dissertation examines the contributions of juvenile literature reading for the problematization of the emotional experiences and conflicts of children at infant education. Its importance consists in providing useful information for the pedagogic work orientated to literature reading at the initial series of basic education, in order to increase the teacher s ability to explore the literary text from its instigating and enriching nature in view of the child s emotional experiences and conflicts. It is methodologically based on the principles of the qualitative research, what characterizes it as a case study. The research focused a level V-infant education class with 28 students in 5-6 age group, at a public school of Natal, State of Rio Grande do Norte (Brazil). The used resources were: audio recording, field diary, and interviews. Seventeen classes were carried out and they consisted in reading sessions of classic and contemporaneous tales, fables, and legends which used different didactic strategies. These sessions were developed in accordance with the reading experience through scaffolding instructions as it was described by Graves & Graves. The theoretical references were the studies of Amarilha (1997/ 2006), Bettelheim (2004), Coelho (1987/2000), Damásio (2005), Del Nero (2003), Eco (1994/2006), Held (1980), Iser (1996), Jauss (2002), Stierle (2002), Wallon (2007), Telles (2006), Yunes (2003), and Zilberman (1987). The analyses showed that literary reading in class is a special environment for inclusion of the reader s subjectivity; as well as the inclusion of their emotional experiences and their conflicts within the story by way of helping children think and become suitable for dealing with their inner feelings. The literary reading is presented as an experiential and formative activity which helps children understand their emotions through a process of identification, exteriorization, and catharsis; what implies that the esthetic experience from the text makes possible the reader s self-knowledge and increases the perception of his inner feelings and objective reality so that this reader has emotional capital to deal with life difficulties. It is important to highlight that the discussions carried out in the class represented a field of sharing experiences through which each reader had the chance to present their experience of life to the others, including their sorrows and sufferings, in order to help them to develop best strategies to deal with the social environment

Susceptibility to Yersinia pseudotuberculosis Infection is Linked to the Pattern of Macrophage Activation

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Sporothrix schenckii lipid inhibits macrophage phagocytosis: Involvement of nitric oxide and tumour necrosis factor-alpha

The role of cell-wall compounds in the immune response to sporotrichosis is unknown. The effect of cell-wall compounds and exoantigen obtained from Sporothrix schenckii in macrophage/fungus interaction was analysed with respect to nitric oxide (NO) and tumour necrosis factor-alpha (TNF-alpha). The lipid compound of the cell wall plays an important role in the pathogenesis of this mycosis and was found to inhibit the phagocytic process and to induce high liberation of NO and TNF-alpha in macrophage cultures in the present study. This is a very interesting result because it is the first report about one compound of the fungus S. schenckii that presents this activity.