Solitary caecal diverticulitis as an unusual cause of a right iliac fossa mass: a case report

Inflammation of a solitary caecal diverticulum is an uncommon pathological condition. Preoperatively the condition is almost indistinguishable from appendicitis, and is often confused with carcinoma of the caecum during operation. The typical patient with this condition is male, Asian, and in the fourth decade of life. This case is unusual in that the patient was a 26-year-old Caucasian man

Effects of alirocumab on types of myocardial infarction: insights from the ODYSSEY OUTCOMES trial

Aims  The third Universal Definition of Myocardial Infarction (MI) Task Force classified MIs into five types: Type 1, spontaneous; Type 2, related to oxygen supply/demand imbalance; Type 3, fatal without ascertainment of cardiac biomarkers; Type 4, related to percutaneous coronary intervention; and Type 5, related to coronary artery bypass surgery. Low-density lipoprotein cholesterol (LDL-C) reduction with statins and proprotein convertase subtilisin–kexin Type 9 (PCSK9) inhibitors reduces risk of MI, but less is known about effects on types of MI. ODYSSEY OUTCOMES compared the PCSK9 inhibitor alirocumab with placebo in 18 924 patients with recent acute coronary syndrome (ACS) and elevated LDL-C (≥1.8 mmol/L) despite intensive statin therapy. In a pre-specified analysis, we assessed the effects of alirocumab on types of MI. Methods and results  Median follow-up was 2.8 years. Myocardial infarction types were prospectively adjudicated and classified. Of 1860 total MIs, 1223 (65.8%) were adjudicated as Type 1, 386 (20.8%) as Type 2, and 244 (13.1%) as Type 4. Few events were Type 3 (n = 2) or Type 5 (n = 5). Alirocumab reduced first MIs [hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.77–0.95; P = 0.003], with reductions in both Type 1 (HR 0.87, 95% CI 0.77–0.99; P = 0.032) and Type 2 (0.77, 0.61–0.97; P = 0.025), but not Type 4 MI. Conclusion  After ACS, alirocumab added to intensive statin therapy favourably impacted on Type 1 and 2 MIs. The data indicate for the first time that a lipid-lowering therapy can attenuate the risk of Type 2 MI. Low-density lipoprotein cholesterol reduction below levels achievable with statins is an effective preventive strategy for both MI types.For complete list of authors see http://dx.doi.org/10.1093/eurheartj/ehz299</p

Effect of alirocumab on mortality after acute coronary syndromes. An analysis of the ODYSSEY OUTCOMES randomized clinical trial

Background: Previous trials of PCSK9 (proprotein convertase subtilisin-kexin type 9) inhibitors demonstrated reductions in major adverse cardiovascular events, but not death. We assessed the effects of alirocumab on death after index acute coronary syndrome. Methods: ODYSSEY OUTCOMES (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) was a double-blind, randomized comparison of alirocumab or placebo in 18 924 patients who had an ACS 1 to 12 months previously and elevated atherogenic lipoproteins despite intensive statin therapy. Alirocumab dose was blindly titrated to target achieved low-density lipoprotein cholesterol (LDL-C) between 25 and 50 mg/dL. We examined the effects of treatment on all-cause death and its components, cardiovascular and noncardiovascular death, with log-rank testing. Joint semiparametric models tested associations between nonfatal cardiovascular events and cardiovascular or noncardiovascular death. Results: Median follow-up was 2.8 years. Death occurred in 334 (3.5%) and 392 (4.1%) patients, respectively, in the alirocumab and placebo groups (hazard ratio [HR], 0.85; 95% CI, 0.73 to 0.98; P=0.03, nominal P value). This resulted from nonsignificantly fewer cardiovascular (240 [2.5%] vs 271 [2.9%]; HR, 0.88; 95% CI, 0.74 to 1.05; P=0.15) and noncardiovascular (94 [1.0%] vs 121 [1.3%]; HR, 0.77; 95% CI, 0.59 to 1.01; P=0.06) deaths with alirocumab. In a prespecified analysis of 8242 patients eligible for ≥3 years follow-up, alirocumab reduced death (HR, 0.78; 95% CI, 0.65 to 0.94; P=0.01). Patients with nonfatal cardiovascular events were at increased risk for cardiovascular and noncardiovascular deaths (P<0.0001 for the associations). Alirocumab reduced total nonfatal cardiovascular events (P<0.001) and thereby may have attenuated the number of cardiovascular and noncardiovascular deaths. A post hoc analysis found that, compared to patients with lower LDL-C, patients with baseline LDL-C ≥100 mg/dL (2.59 mmol/L) had a greater absolute risk of death and a larger mortality benefit from alirocumab (HR, 0.71; 95% CI, 0.56 to 0.90; Pinteraction=0.007). In the alirocumab group, all-cause death declined wit h achieved LDL-C at 4 months of treatment, to a level of approximately 30 mg/dL (adjusted P=0.017 for linear trend). Conclusions: Alirocumab added to intensive statin therapy has the potential to reduce death after acute coronary syndrome, particularly if treatment is maintained for ≥3 years, if baseline LDL-C is ≥100 mg/dL, or if achieved LDL-C is low. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01663402

Toimenkuvat organisaation kehittämisen välineenä

Tässä opinnäytetyössä käytettiin toimenkuvia organisaation kehittämisen välineenä. Ensisijaisena tavoitteena oli kehittää toimeksiantajayritystä määrittelemällä ja selkiyttämällä sen henkilöstölle toimenkuvat. Toimenkuvien määrittelyyn liittyi tarve saada vastuuta jaettua yrityksen sisällä tasaisemmin. Kehittämisen avuksi käytiin läpi teoriaa organisaation kehittämiseen ja muutoksen johtamiseen liittyen, jonka jälkeen syvennyttiin tarkemmin toimenkuviin. Tässä opinnäytetyössä tutustuttiin myös toimenkuvien tavoitteisiin eli niihin asioihin, joihin määritellyillä toimenkuvilla pyritään. Lisäksi työssä selvitettiin kirjoitettujen toimenkuvien tuomia hyötyjä, joista tärkeimmiksi todettiin positiiviset vaikutukset motivaatioon, osaamiseen, sitoutumiseen sekä työilmapiiriin ja hyvinvointiin. Työn myötä perehdyttiin myös toimenkuvien kirjoittamisen tärkeimpiin näkökulmiin, joiden pohjalta luotiin kirjoittamista ohjaava prosessikaavio. Tässä opinnäytetyössä toimeksiantajana oli pieni maarakennusalan yritys, jossa oli havaittu puutteellisesta tehtävien määrittelystä johtuvia ongelmia. Työ rajattiin koskemaan vain yrityksen varsinaisen työn eli kiviaineksen murskauksen parissa työskentelevää henkilöstöä sekä toimitusjohtajan roolia. Aluksi määriteltiin tehtävänimikkeet, jonka jälkeen kartoitettiin kunkin nimikkeen ja siihen liittyvän tehtävän tavoitteet. Tavoitteiden määrittelyn jälkeen kirjoitettiin toimenkuvat teoriaosassa luodun prosessikaavion avulla. Tuloksena saatiin aikaan selkeät toimenkuvat yrityksen kehittämisen tueksi. Tämän työn perusteella voidaan todeta toimenkuvat hyväksi yrityksen kehittämisen välineeksi. Tärkeä havainto oli huomata, että kaikkia tehtäviä ei tule kirjoittaa kuvaukseen vaan vain tärkeimmät ja yleisimmät. Kirjoitettu toimenkuva luo työntekijän toiminnalle kehykset, jotka ohjaavat häntä organisaation tavoitteiden mukaiseen suuntaan.Job descriptions were used as a tool in developing organization in this thesis. The aim of the present thesis was to develop the client organization by defining job descriptions. There was a need to share the responsibilities more equally in the client organization. Theories of developing an organization and management of change were processed as a support for the development. Important themes concerning job descriptions such as its purposes and benefits were studied. Also the writing process was examined which led to the flowchart about writing. The client of present thesis was a small organization which operates in the branch of earthworks. The client had met problems which were a result of lacking task definitions. The thesis was defined to deal with the personnel who are working with crushing including the managing director. The development began by defining titles and then the main goals. Defined goals were the base of the job descriptions which were written by using the flowchart created in the theory part. The study indicated that job descriptions are a good tool to develop an organization. It was important to notice that only the most common duties should be written in a description. A written job description provides a frame for an employee’s work and guides to the same direction as the whole organization