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      The dialogue as decision support; lived experiences of extended collaboration when an ambulance is called

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          ABSTRACT

          Purpose

          This study aimed to describe extended collaboration in situations when an ambulance was called, as experienced by older patients, a significant other, and ambulance- and primary healthcare (PHC) centre personnel.

          Methods

          The study used a phenomenological reflective lifeworld research (RLR) approach. Participants included in three specific situations with extended collaboration were interviewed: three older patients, one significant other, three ambulance personnel and four personnel at the PHC centre. The transcribed interviews were analysed for meanings of the phenomenon.

          Results

          The extended collaboration means that decisions were supported through dialogue by bridging knowledge spaces between person, within-team and across-team levels. Through dialogue experience and knowledge were shared and certainty in decisions was increased. The extended collaboration was built on trust, responsibility taken, shared and entrusted, and the common goal of adapted care for the unique patient. A need for further improvement and transparency was elucidated.

          Conclusions

          The difficulty of making care decisions stresses the importance of available extended collaboration based on the dialogue between patients, significant others, and ambulance- and PHC centre personnel to increase certainty in decisions. Collaboration further requires respectful encounters, trust, responsibility and a common goal of adapting the care for the unique patient.

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          Most cited references47

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          Association between continuity of care in general practice and hospital admissions for ambulatory care sensitive conditions: cross sectional study of routinely collected, person level data

           To assess whether continuity of care with a general practitioner is associated with hospital admissions for ambulatory care sensitive conditions for older patients.
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            A patient-safety and professional perspective on non-conveyance in ambulance care: a systematic review

            Background This systematic review aimed to describe non-conveyance in ambulance care from patient-safety and ambulance professional perspectives. The review specifically focussed at describing (1) ambulance non-conveyance rates, (2) characteristics of non-conveyed patients, (3) follow-up care after non-conveyance, (4) existing guidelines or protocols, and (5) influencing factors during the non-conveyance decision making process. Methods We systematically searched MEDLINE, PubMed, CINAHL, EMBASE, and reference lists of included articles, in June 2016. We included all types of peer-reviewed designs on the five topics. Couples of two independent reviewers performed the selection process, the quality assessment, and data extraction. Results We included 67 studies with low to moderate quality. Non-conveyance rates for general patient populations ranged from 3.7%–93.7%. Non-conveyed patients have a variety of initial complaints, common initial complaints are related to trauma and neurology. Furthermore, vulnerable patients groups as children and elderly are more represented in the non-conveyance population. Within 24 h–48 h after non-conveyance, 2.5%–6.1% of the patients have EMS representations, and 4.6–19.0% present themselves at the ED. Mortality rates vary from 0.2%–3.5% after 24 h, up to 0.3%–6.1% after 72 h. Criteria to guide non-conveyance decisions are vital signs, ingestion of drugs/alcohol, and level of consciousness. A limited amount of non-conveyance guidelines or protocols is available for general and specific patient populations. Factors influencing the non-conveyance decision are related to the professional (competencies, experience, intuition), the patient (health status, refusal, wishes and best interest), the healthcare system (access to general practitioner/other healthcare facilities/patient information), and supportive tools (online medical control, high risk card). Conclusions Non-conveyance rates for general and specific patient populations vary. Patients in the non-conveyance population present themselves with a variety of initial complaints and conditions, common initial complaints or conditions are related to trauma and neurology. After non-conveyance, a proportion of patients re-enters the emergency healthcare system within 2 days. For ambulance professionals the non-conveyance decision-making process is complex and multifactorial. Competencies needed to perform non-conveyance are marginally described, and there is a limited amount of supportive tools is available for general and specific non-conveyance populations. This may compromise patient-safety. Electronic supplementary material The online version of this article (doi:10.1186/s13049-017-0409-6) contains supplementary material, which is available to authorized users.
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              Dynamics of stability: the physiologic basis of functional health and frailty.

              L. Lipsitz (2002)
              Under basal resting conditions most healthy physiologic systems demonstrate highly irregular, complex dynamics that represent interacting regulatory processes operating over multiple time scales. These processes prime the organism for an adaptive response, making it ready and able to react to sudden physiologic stresses. When the organism is perturbed or deviates from a given set of boundary conditions, most physiologic systems evoke closed-loop responses that operate over relatively short periods of time to restore the organism to equilibrium. This transiently alters the dynamics to a less complex, dominant response mode, which is denoted "reactive tuning." Aging and disease are associated with a loss of complexity in resting dynamics and maladaptive responses to perturbations. These alterations in the dynamics of physiologic systems lead to functional decline and frailty. Nonlinear mathematical techniques that quantify physiologic dynamics may predict the onset of frailty, and interventions aimed toward restoring healthy dynamics may prevent functional decline.
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                Author and article information

                Journal
                Int J Qual Stud Health Well-being
                Int J Qual Stud Health Well-being
                International Journal of Qualitative Studies on Health and Well-being
                Taylor & Francis
                1748-2623
                1748-2631
                24 August 2021
                2021
                : 16
                : 1
                : 1970095
                Affiliations
                [a ]Department of Health and Caring Sciences, Linnaeus University; , Växjö, Sweden
                [b ]Centre of Interprofessional Collaboration within Emergency Care CICE, Linnaeus University; , Växjö, Sweden
                [c ]Ambulance Service, Region Kronoberg; , Växjö, Sweden
                [d ]Department for Research and Development, Region Kronoberg; , Växjö, Sweden
                [e ]Department of Clinical Sciences in Malmö, Family Medicine, Lund University; , Malmö, Sweden
                Author notes
                CONTACT Elin-Sofie Forsgärde elinsofie.forsgarde@ 123456lnu.se Department of Health and Caring Sciences, Linnaeus University; , Växjö 35195, Sweden
                Author information
                https://orcid.org/0000-0002-8358-3920
                https://orcid.org/0000-0001-7479-8092
                https://orcid.org/0000-0002-5412-9497
                Article
                1970095
                10.1080/17482631.2021.1970095
                8386744
                34427535
                6da1bc58-8b27-4632-aed3-50974fbae5eb
                © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Page count
                Figures: 1, Tables: 1, References: 49, Pages: 1
                Categories
                Research Article
                Empirical Studies

                Health & Social care
                aged,emergency medical services,experiences of care,intersectoral collaboration,patients,prehospital emergency care,primary health care,reflective lifeworld research

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