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Fornander L, Laukkanen K, Molin I, Nilsson L, Berggren P. Team communication patterns during real and simulated trauma resuscitation-a social network analysis. Ergonomics 2024; 67:225-239. [PMID: 37273191 DOI: 10.1080/00140139.2023.2221000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 05/29/2023] [Indexed: 06/06/2023]
Abstract
In trauma teams, coordination can be established through a centralised leader. The team can also use a decentralised strategy. In this descriptive study of video-recorded trauma resuscitations, using quantification of qualitative data, Social Network analysis of all real-time communications of eight in-real-life (IRL) and simulated trauma teams explained team social structure. The communication network structures in the simulated scenarios were more centralised using individually directed speech and had a high proportion of communication to update all team members. Such a structure might be the result of work performed in a complexity-stripped simulation environment where simplified task-executions required less interactions, or from work revolving around a deteriorating patient, imposing high demands on rapid decision-making and taskwork. Communication IRL was mostly decentralised, with more variability between cases, possibly due to unpredictability of the IRL case. The flexibility to act in a decentralised manner potentiates adaptability and seems beneficial in rapidly changing situations.Practitioner summary: Efficient collaboration in trauma teams is essential. Communication in in-real-life and simulated trauma teams was analysed using social network analysis. The simulation teams were overall more centralised compared to the IRL teams. The flexibility to act decentralised seems beneficial for emergency teams as it enables adaptability in unpredictable situations.
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Affiliation(s)
- Liselott Fornander
- Department of Anaesthesiology and Intensive Care in Norrköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Kati Laukkanen
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Ida Molin
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Emergency Medicine, Norrköping and Centre for Disaster Medicine and Traumatology, Linköping University, Linköping, Sweden
| | - Lena Nilsson
- Department of Anaesthesiology and Intensive Care in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Peter Berggren
- Center for Disaster Medicine and Traumatology, Linköping University, Linköping, Sweden
- Department of Computer and Information Science, Linköping University, Linköping, Sweden
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Hamid S, Gadré A, Fornander L, Sjöwall J, Muhrbeck M. Clostridium septicum myonecrosis following gardening: A case report. Int J Surg Case Rep 2023; 105:108000. [PMID: 36940540 PMCID: PMC10036948 DOI: 10.1016/j.ijscr.2023.108000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 03/08/2023] [Accepted: 03/16/2023] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Clostridial myonecrosis (CM), or gas gangrene, is a rare necrotizing muscle infection caused most often by Clostridium perfringens or C. septicum. Inoculation can occur either traumatically or spontaneously. CM has a high mortality rate if not treated promptly. CASE PRESENTATION A 64-year-old male presented to the emergency department (ED) with sudden onset left flank pain and fever. Repeated CT scans demonstrated progressive edema around the left iliopsoas muscle with gas formation and bleeding. The patient received intravenous fluids, meropenem, and clindamycin. Emergency laparotomy was performed on suspicion of necrotizing fasciitis and revealed a necrotic left iliopsoas muscle which was partially excised. Blood cultures were positive at 12 h with growth of C. septicum. Prolonged stay in the intensive care unit, and six additional surgical interventions to the abdomen, left thigh, and flank were needed. The patient was discharged after four months to a nursing home. CLINICAL DISCUSSION C. septicum CM more often occurs spontaneously and is associated with colorectal malignancy. However, for our patient, CT colonography and proctoscopy did not reveal any pathology. Therefore, we believe the CM resulted from an injury the patient sustained while working in his backyard, either a cut from barbed wire on his arm or from soil contaminating his psoriatic lesions. Successful outcomes for patients with CM require a high index of suspicion, timely treatment with antibiotics, and repeated surgical debridements. CONCLUSION This case report describes the presentation and management of a presumably injury-related CM caused by C. septicum.
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Affiliation(s)
- Salik Hamid
- Department of Surgery, Vrinnevi Hospital, Norrköping, Sweden
| | - Ashok Gadré
- Department of Surgery, Vrinnevi Hospital, Norrköping, Sweden
| | - Liselott Fornander
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Anesthesiology and Intensive Care, Vrinnevi Hospital, Norrköping, Sweden
| | - Johanna Sjöwall
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Infectious Diseases, Vrinnevi Hospital, Norrköping, Sweden
| | - Måns Muhrbeck
- Department of Surgery, Vrinnevi Hospital, Norrköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
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Fornander L, Berterö C, Molin I, Laukkanen K, Nilsson L, Björnström K. Development of trauma team cognition can be explained by "split vision": A grounded theory study. J Interprof Care 2023:1-9. [PMID: 36739575 DOI: 10.1080/13561820.2023.2171970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The aim of this study was to explore interaction of interprofessional hospital trauma teams. A theory about how team cognition is developed through a dynamical process was established using grounded theory methodology. Video recordings of in-real-life resuscitations performed in the emergency ward of a Scandinavian mid-size urban hospital were collected and eligible for inclusion using theoretical sampling. By analyzing interactions during seven trauma resuscitations, the theory that trauma teams perform patient assessment and resuscitation by alternating between two process modes, the two main categories "team positioning" and "sensitivity to the patient," was generated. The core category "working with split vision" explicates how the teams interplay between the two modes to coordinate team focus with an emergent mental model of the specific situation. Split vision ensures that deeper aspects of the team, such as culture, knowledge, empathy, and patient needs are absorbed to continuously adapt team positioning and create precision in care for the specific patient.
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Affiliation(s)
- Liselott Fornander
- Department of Anaesthesiology and Intensive Care, Vrinnevi Hospital, Norrköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Carina Berterö
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Ida Molin
- Department of Emergency Medicine, Vrinnevi Hospital, Norrköping and Centre for Disaster Medicine and Traumatology, Linköping, Sweden
| | - Kati Laukkanen
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Lena Nilsson
- Department of Anaesthesiology and Intensive Care, University Hospital, Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Karin Björnström
- Department of Anaesthesiology and Intensive Care, University Hospital, Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Molin I, Fornander L, Berggren P. An analysis of trauma team communication using the verbal response mode taxonomy. Surgery 2021; 170:1849-1854. [PMID: 34217502 DOI: 10.1016/j.surg.2021.05.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 04/26/2021] [Accepted: 05/11/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although 40 years has passed since the Institute of Medicine released its report "To Err Is Human," error counts are still high in healthcare. The understanding and training of nontechnical skills and teamwork thus remains a pertinent area for improvement. Most evaluation of nontechnical skills of trauma teams takes place in simulation rooms. The aim of this study was to determine if real trauma resuscitation communication could be analyzed using the speech classification system of verbal response modes, otherwise known as the verbal response mode taxonomy and, if so, if there is a predominant approach of verbally delivering messages. METHODS Video and audio recordings of 5 trauma team resuscitations were transcribed. Communication was coded using the verbal response mode taxonomy for both form and intent. The rate of mixed-mode communication (unmatched form and intent) and pure-mode communication were calculated and compared between the participants roles. Comparisons were made with simulated material published in other research. RESULTS The most frequent mixed-mode communication was acknowledgment in service of confirmation. Question in service of a question was the most used pure-mode communication. Six predominant roles were seen, which matched well with the roles in the simulations. CONCLUSION The verbal response mode taxonomy can be used to study communication during real trauma resuscitation, and it was found that pure-mode communication was predominant, meaning that the grammatical form matches the intent. Verbal response mode methodology is time consuming and requires analysts with domain knowledge. Comparisons show some differences between simulations and our material indicating that verbal response modes can be used to evaluate differences in communication.
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Affiliation(s)
- Ida Molin
- Department of Emergency Medicine, Norrköping, Sweden; Centre for Disaster Medicine and Traumatology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
| | - Liselott Fornander
- Department of Anesthesiology and Intensive Care, Norrköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping, Sweden
| | - Peter Berggren
- Department of Computer and Information Science, Linköping University, Linköping, Sweden; Centre for Disaster Medicine and Traumatology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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Wåhlén K, Fornander L, Olausson P, Ydreborg K, Flodin U, Graff P, Lindahl M, Ghafouri B. Protein profiles of nasal lavage fluid from individuals with work-related upper airway symptoms associated with moldy and damp buildings. Indoor Air 2016; 26:743-754. [PMID: 26451694 DOI: 10.1111/ina.12257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 10/03/2015] [Indexed: 06/05/2023]
Abstract
Upper airway irritation is common among individuals working in moldy and damp buildings. The aim of this study was to investigate effects on the protein composition of the nasal lining fluid. The prevalence of symptoms in relation to work environment was examined in 37 individuals working in two damp buildings. Microbial growth was confirmed in one of the buildings. Nasal lavage fluid was collected from 29 of the exposed subjects and 13 controls, not working in a damp building. Protein profiles were investigated with a proteomic approach and evaluated by multivariate statistical models. Subjects from both workplaces reported upper airway and ocular symptoms. Based on protein profiles, symptomatic subjects in the two workplaces were discriminated from each other and separated from healthy controls. The groups differed in proteins involved in inflammation and host defense. Measurements of innate immunity proteins showed a significant increase in protein S100-A8 and decrease in SPLUNC1 in subjects from one workplace, while alpha-1-antitrypsin was elevated in subjects from the other workplace, compared with healthy controls. The results show that protein profiles in nasal lavage fluid can be used to monitor airway mucosal effects in personnel working in damp buildings and indicate that the profile may be separated when the dampness is associated with the presence of molds.
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Affiliation(s)
- K Wåhlén
- Division of Community Medicine, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, Pain and Rehabilitation Center, Anaesthetics, Operations and Speciality Surgery Center, Region Östergötland, Linkoping, Sweden
| | - L Fornander
- Occupational and Environmental Medicine, Div of Neuro and Inflammation Science, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - P Olausson
- Division of Community Medicine, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, Pain and Rehabilitation Center, Anaesthetics, Operations and Speciality Surgery Center, Region Östergötland, Linkoping, Sweden
| | - K Ydreborg
- Clinic of Otorhinolaryngology, County Hospital Ryhov, Jönköping, Sweden
| | - U Flodin
- Division of Neuro and Inflammation Science, Department of Clinical and Experimental Medicine, Linköping University, Occupational and Environmental Medicine Center, Heart and Medicine Center, Region Östergötland, Linkoping, Sweden
| | - P Graff
- Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - M Lindahl
- Occupational and Environmental Medicine, Div of Neuro and Inflammation Science, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - B Ghafouri
- Division of Community Medicine, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, Pain and Rehabilitation Center, Anaesthetics, Operations and Speciality Surgery Center, Region Östergötland, Linkoping, Sweden.
- Division of Neuro and Inflammation Science, Department of Clinical and Experimental Medicine, Linköping University, Occupational and Environmental Medicine Center, Heart and Medicine Center, Region Östergötland, Linkoping, Sweden.
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