Soluble Urokinase Plasminogen Activator Receptor (suPAR) in the Emergency Department (Ed): A Tool for the Assessment of Elderly Patients

Emergency department (ED) overcrowding is a global issue setting challenges to all care providers. Elderly patients are frequent visitors of the ED and their risk stratification is demanding due to insufficient assessment methods. A prospective cohort study was conducted to determine the risk-predicting value of a prognostic biomarker, soluble urokinase plasminogen activator receptor (suPAR), in the ED, concentrating on elderly patients. SuPAR levels were determined as part of standard blood sampling of 1858 ED patients. The outcomes were assessed in the group o

Cost-minimization modeling of venous thromboembolism diagnostics: performing limited compression ultrasound in primary health care reduces costs compared to referring patients to a hospital

Background: The aim of this retrospective study was to determine whether diagnosing a deep venous thrombosis (DVT) in primary health care using limited compression ultrasound (LCUS) can save resources compared to referring these patients to hospital. According to the current literature, LCUS is as safe as a standard protocol based on a whole-leg ultrasound (US).Methods: We created a standardized patient for this cost-analysis model based on 76 patients that were referred to hospital for a suspected DVT. Travel distance to the health care centre and hospital was calculated based on the home address. Hospital costs were acquired from the hospital price list and Finnish legislation. Time spent in the hospital was retrieved from hospital statistics. Time spent in the health care centre and travelling were estimated and monetized based on average salary. The cost of participating physicians attending a US training course was estimated based on the national average salary of a general practitioner as well as the course participation fee. A cost-minimization modeling was performed for this standardized patient comparing the total costs, including private and public costs, of standard and LCUS strategies.Results: The total costs per patient of standard and LCUS pathways were 1151.52€ and 301.94€ [difference 849.59€ (95% CI 800.21€-898.97€, p Conclusion: Using LCUS in diagnosing DVT in primary health care instead of referring these patients to the hospital is shown to save a significant amount of public and private resources.</p

Teaching limited compression ultrasound to general practitioners reduces referrals of suspected DVT to a hospital: a retrospective cross-sectional study

Background The aim of this study was to retrospectively determine whether teaching limited compression ultrasound (LCUS) to general practitioners (GP) would reduce the number of patients with a suspected lower extremity DVT referred to a hospital for ultrasound (US) examination. According to the current literature, an LCUS protocol is a safe way to diagnose or exclude lower extremity deep venous thrombosis (DVT) and a good option to radiologist-performed whole-leg ultrasound (US), especially in remote health care units where there may be a limited availability of radiological services. MethodsBetween 2015 and 2016, altogether 13 GPs working in the same primary care unit were trained in LCUS for DVT diagnostics. The number of annual referrals due to a suspected DVT from Saarikka primary care unit to the closest hospital was evaluated before and after training. The incidence of DVT was considered to be constant. Thus, the reduction of referrals was attributed to the fact that these patients were diagnosed and treated in primary health care. Incidence rate ratio of hospital referrals was calculated. As a measure of safety, all patients diagnosed with a pulmonary embolism in the nearest hospital were evaluated to determine if they had undergone LCUS by a GP in primary care. Results Before training in 2014, there were 60 annual referrals due to a suspected DVT; in 2017, after training, the number was reduced to 16, i.e., a 73.3% decrease. The incidence of referrals decreased from 3.21 to 0.89 per 1000 person-years. (IRR 3.58, 95% CI 2.04-6.66, p Conclusions Teaching LCUS to GPs can safely reduce the number of patients with a suspected DVT referred to a hospital substantially.</p

Postitse vai sähköisesti? Näkemyksiä tiedonkeruumenetelmän valintaan Lääkäri 2008 –tutkimuksen pohjalta

Tässä artikkelissa pohditaan yhtäältä sähköisen tiedonkeruun, toisaalta paperisen ja sähköisen yhdistelmänä toteutetun tiedonkeruun mahdollisuuksia, haasteita ja ongelmia Lääkäri 2008 -tutkimuksen kokemusten valossa. Lääkäri 2008 -tutkimuksen tiedonkeruuta arvioidaan suhteessa yleisesti kyselytutkimuksessa havaittuihin virhelähteisiin, joita ovat kattavuusongelma, otosharha, vastauskato ja mittausvirhe. Artikkelin tavoitteena on auttaa muita tutkijoita ja tutkimusryhmiä tutkimusasetelman suunnittelussa ja oikean tiedonkeruumenetelmän valinnassa

Self-reported skills and self-confidence in point-of-care ultrasound : a cross-sectional nationwide survey amongst Finnish emergency physicians

Background: The use of point-of-care ultrasound (POCUS) is increasing. Numerous investigators have evaluated the learning curves in POCUS, but there are no published studies on how emergency physicians perceive their own competence level with this skill. Methods: A nationwide survey amongst Finnish emergency physicians was conducted. The respondents reported their use of POCUS and how it has affected their clinical decision-making. The number of POCUS examinations performed was compared to the self-assessed skill level with different applications. Cut-off values were determined for the number of examinations required to acquire a good self-assessed skill level in each POCUS application. The correlation between self-confidence and the self-estimated skill level was analyzed. Several different statistical methods were used, such as Student’s t-test, Pearson’s correlation test, Loess method and ROC curve analysis. Results: A total of 134 out of 253 Finnish emergency medicine specialists and residents (52%) responded to the survey. The most commonly used POCUS applications were POCUS-assisted procedures, pleural effusion and pneumothorax, inferior vena cava and lower extremity deep venous thrombosis. The initial rate of perceived skill acquisition was very steep with the curve flattening with greater skill and more experience. The number of examinations performed to reach a self-assessed good competence varied from seven to 75 with different applications. The lowest cut-off point for self-assessed good competence was obtained for rapid ultrasound for the shock and hypotension-protocol and the highest for focused cardiac examinations. There was an excellent correlation between self-confidence and the self-assessed skill level. Conclusions: The Finnish emergency practitioners’ self-assessed development of POCUS skills parallels the previously published learning curves of POCUS. The correlation of self-confidence and the self-assessed skill level was found to be excellent. These findings add information on the development of perceived POCUS skills amongst emergency physicians and could complement a formal performance assessment.publishedVersionPeer reviewe

Potilaat ovat muuttuneet Vuosina 1977–1991 valmistuneiden lääkärien arvio muutoksesta

Yhteiskunnassa tapahtuneiden muutosten keskellä potilaiden ja lääkärien kanssakäyminen on saanut uusia muotoja. Miten lääkärit ovat muutoksen kokeneet? Lääkäri 2003 -tutkimuksessa olivat perusjoukkona vuosina 1977–1991 valmistuneet eli 12–26 vuotta työelämässä olleet lääkärit. Satunnaisotokseen valituilta (n = 4 137) kysyttiin, mitä myönteisiä ja kielteisiä muutoksia oli lääkärin työssä tapahtunut heidän työssäoloaikanaan. Kysymykseen vastasi 2 060 lääkäriä. Vastaukset luokiteltiin aihepiireittäin 12 pääluokkaan, joista kaksi liittyi potilaisiin. Potilaiden tietotason nousuun liittyy lääkärien mielestä myönteisiä ja kielteisiä piirteitä. Potilaiden vaatimusten lisääntymisen lääkärit kokevat kielteisenä muutoksena. Ei-lääketieteelliset vastaanotolle tulon syyt lisäävät lääkärien työtaakkaa. Hyvän potilas-lääkärisuhteen edellytykset ovat lääkärien mielestä kuitenkin parantuneet

What predicts doctors’ satisfaction with their chosen medical specialty? A Finnish national study

Background In Finland the number of medical specialists varies between specialties and regions. More regulation of the post-graduate medical training is planned. Therefore, it is important to clarify what predicts doctors’ satisfaction with their chosen specialty. Methods A random sample contained 50 % of all Finnish doctors under 70 years of age. The respose rate was 50.5 %. Working-age specialists were asked to value their motives when choosing a specialty. They were also asked if they would choose the same specialty again. The odds ratios for not choosing the same specialty again were tested. Results Diversity of work was the most important motive (74 % of respondents). Seventeen percent of GPs would not choose the same specialty again, compared to 2 % of ophthalmologists and 4 % of pediatricians. A major role of Diversity of work and Prestigious field correlated with satisfaction whereas Chance with dissatisfaction with the specialty. Discussion Motives and issues related to the work and training best correlate with satisfaction with the specialty. Conclusions When the numbers of Finnish postgraduate medical training posts become regulated, a renewed focus should be given to finding the most suitable speciality for each doctor. Information about employment and career advice should play an important role in this.BioMed Central open acces

Lääkäri 2018 : Kyselytutkimus vuosina 2007–2016 valmistuneille lääkäreille

Lääkäri 2018 -tutkimus on osa viiden vuoden välein toistettavaa poikkileikkaustutkimusten sarjaa, joka aloitettiin kolme vuosikymmentä sitten. Tutkimuksen perusjoukkona olivat vuosina 2007–2016 laillistetut lääkärit (N=6 472), joista otokseen valittiin parittomana päivänä syntyneet (n=3 148). Vastausosuus oli 39 %. Vastaajista 85 % oli melko tai erittäin tyytyväisiä ammatinvalintaansa. Lääkärit tunsivat itsensä entistä enemmän työryhmän jäseniksi, ja lähes joka kolmas oli kiinnostunut johtamisesta. Neljäsosa vastanneista oli väitellyt tai teki väitöskirjaa. Peruskoulutuksen osalta tyytyväisyys sairaalatyön opetukseen oli suurempaa kuin tyytyväisyys terveyskeskusopetukseen. Sairaalaopetukseensa tyytyväisimmät olivat valmistuneet Itä-Suomen ja Turun yliopistoista, ja terveyskeskusopetukseen Itä-Suomen ja Tampereen yliopistoista. Lääkärit toivoivat peruskoulutuksen sisältävän enemmän etenkin toiminnanohjauksen taitoja. Erikoistumiskoulutuksessa toteutui parhaiten alan diagnostisten taitojen ja hoitotoimenpiteiden oppiminen. Kehitettävää löytyi erityisesti osaamisen arvioinnin ja oppimistavoitteiden täyttymisen seurannassa. Johtamistaitojen, tutkimus- ja opetustyön sekä terveystalouden opetusta toivottiin lisää. Saman erikoisalan valitsisi vielä 90 % vastanneista. Lääkäri 2018 -tutkimus toteutettiin kaikkien lääketieteellisten tiedekuntien sekä Lääkäriliiton yhteistyönä