Impact of comorbidities on the duration of COPD patients' hospital episodes

AbstractThe duration of inpatient episodes due to COPD and the factors that affect it have recently been an object of increasing attention, as the aim has been to shorten inpatient periods and thereby to cut health-care costs. All hospital episodes of patients aged over 45 for a primary diagnosis of COPD equal or less than 150 days in duration were drawn from the treatment register maintained by the National Research and Development Centre for Welfare and Health. The lengths of these 152 569 inpatient periods were analysed for sex, age and secondary diagnoses by covariance analysis. The mean age of men at the beginning of the hospital episode was 70.6 years and that of women 70.1 years. Men accounted for 76.9% of all inpatient episodes. Covariance analysis of the data with age standardised as 70.5 years yielded a mean hospital episode length of 8.9 (95% confidence interval (CI) 8.8–9.0) days. The mean length of hospital episodes without a secondary diagnosis was 7.7 (95% CI 7.6–7.7) days and that with a secondary diagnosis was 10.5 (95% CI 10.5–10.6) days. The longest inpatient episodes were recorded for the patients with secondary diagnoses of pneumonia, 14.7 (95% CI 14.2–15.2) days, and cerebral ischaemia, 14.2 (95% CI 13.5–14.9) days. Concurrent diseases prolonged the hospital episodes of COPD patients. At the beginning of a hospital episode, it is possible to estimate its duration and the need for different treatments based on the patient's age and secondary diagnoses

Asiakkaiden pitkäaikainen sitouttaminen free-to-play- mobiilipeleissä

Tässä pro gradu- tutkielmassa pyritään selvittämään tekijöitä, jotka vaikuttavat asiakkaiden pitkäaikaiseen pelaamiseen ja pelaamisen lopettamiseen free-to-play-mobiilipeleissä. Tutkielmassa asetettuja osaongelmia lähestytään pelaajien näkökulmia painottaen. Pelaajien näkemyksiä tutkimalla pyritään havainnollistamaan, mitä ominaisuuksia mobiilipeleissä tulisi olla ja mitä niissä tulisi välttää, jotta peliyritykset pystyisivät sekä sitouttamaan asiakkaitaan mahdollisimman pitkäaikaisesti, että ehkäisemään asiakaspoistuvuutta peleissään. Tutkimus toteutettiin laadullisena tutkimuksena fenomenografista analyysimenetelmää hyödyntäen. Tutkimuksen aineisto kerättiin mobiilipelien pelaajille suunnatulla sähköisellä pelaajakyselyllä avoimia kysymyksiä hyödyntäen. Aineisto analysoitiin fenomenografisella tutkimusotteella, jonka mukaisesti aineistossa esille nousseet pelaajien käsitykset esitettiin erilaisten kuvauskategorioiden muodossa. Avointen kysymysten ja fenomenografisen tutkimusmenetelmän avulla pystyttiin tunnistamaan pelaajien näkemyksiä siitä, mitkä free-to- play- mobiilipelien ominaisuudet nousevat merkittäviksi tekijöiksi pitkäaikaisen pelaamisen jatkumisen takaamiseksi. Tutkimustulokset sekä tukivat osaltaan aiempaa empiiristä tutkimusta, että nostivat esiin myös alalle uusia löydöksiä. Pelaajat kokivat mobiilipelien koetun sopivan haasteellisuuden, viihteellisyyden, koettujen saavutusten ja sosiaalisten elementtien, kuten tiimissä pelaamisen merkittävimmiksi vaikuttaviksi tekijöiksi pitkäaikaiselle pelaamiselle. Lisäksi, suurimmiksi pelaamisen lopettamisen syiksi nousi tylsistyminen, huonot palkinnot ja vastaan tullut maksumuuri. Lisäksi pelaamisen lopettamiseen vaikutti liian vaikeat pelitasot, vastaan tulleet bugit ja ajan puute. Free-to-play- mobiilipelien pelaamisen lopettamiseen johtaneille syille ei löydy aiempaa tutkimusta, minkä vuoksi kaikki tuloksissa nousseet pelaamisen lopettamiseen vaikuttavat tekijät edustavat alalle täysin uusia löydöksiä. Tutkimustulokset osoittavat, että peliyritysten tulisi keskittyä tarjoamaan mahdollisimman monipuolista ja uusiutuvaa pelisisältöä asiakkaidensa pitkäaikaisen sitouttamisen takaamiseksi. Tutkimuksessa onnistuttiin nostamaan esille tärkeitä kehityskohteita ja käytännön esimerkkejä, joiden avulla free-to-play- mobiilipelialalla toimivat peliyritykset pystyvät parhaimmassa tapauksessa parantamaan peliensä sisältöä ja asiakkaidensa pitkäaikaista sitouttamista.This Master’s thesis aims to investigate the factors influencing both players’ long-term retention and churn in free-to-play mobile games. The research problems identified in this thesis are approached from the players’ perspectives. By examining the players’ views, it enables to illustrate what features mobile games should have and what should be avoided. By doing so, it could help gaming companies to both increase their long-term customer engagement and prevent customer churn. The study was conducted as a qualitative phenomenographic study. The research material was collected through an electronic player questionnaire for mobile game players, by using open- ended questions. The research material was analyzed using a phenomenographic research approach, according to which the emerged perceptions of the players were presented in different descriptive categories. The open-ended questions and phenomenographic research method allowed to identify the players’ views on features where free-to-play mobile games become the most important factors in ensuring that the players keep interested in playing as long as possible. The results of this study both supported the previous empirical research and brought new findings to the field of study. In free-to-play mobile games, players found the appropriate challenges, perceived entertainment, accomplished achievements, and social elements, such as team play, to be the most important factors for long-term engagement. However, boredom, bad prizes, and running into a paywall turned out to be the biggest reasons to stop playing. Player churn was also caused by difficult game levels, game bugs, and lack of time. As there is no previous research on factors causing player churn in free-to-play mobile games, the results of this study represent completely new findings for the industry. This research shows that gaming companies should focus on providing as versatile and innovative gaming content as possible, in order to ensure the long-term retention of their customers. The study succeeded in highlighting important development areas and provided practical examples that could enable companies in free-to-play gaming industry to both improve the content of their games and engage their customers for as long as possible

Vaaratapahtumien raportointimenettely

Julkaisussa puutteelliset ISBN-numero

Features of hospitalisations for acute exacerbation of COPD resulting in death

Background. Hospitalisation periods for the acute exacerbation phase of COPD are a strain on health facilities and entail high rates of hospital mortality. The aim of this study was to ascertain the characteristics of treatment periods resulting in death and the risk factors involved on the basis of treatment registers and death certificates. Methods. Data on all treatment periods for persons over 44 years of age with a principal diagnosis of COPD that began as emergency admissions applying to the period 1993-2001 was gathered from the hospital treatment register maintained by the Finnish National Research and Development Centre for Welfare and Health, yielding a total of 72 896 cases. Data on the deaths of the patients concerned was then obtained from Statistics Finland and those treatment periods which could be shown to have ended in death (N=2331) were taken to form the material for analysis. These were compared with a same number of control hospitalisation periods (not ending in death) in terms of specialisation, type and geographical location of the hospital, length of the treatment period and the occurrence of subsidiary diagnoses. Attention was also paid to the season of the year and the days of the week on which admission and death took place. Results. The proportion of emergency admissions that ended in death was 3.2%, The patients concerned having a mean age of 74.5 years for men and 75.0 years for women on admission. The mean duration of the treatment period was 11.5 days (SD 14.8), compared with 8.0 days (SD 7.9) for the controls. A subsidiary diagnosis existed in the case of 53.6% of the periods ending in death and 37.5% of the control periods. Deaths were most frequent on Fridays, 15.6%, and least so on Tuesdays, 13.0%. Where 24.2% of patients admitted on Saturdays or Sundays died during the first 24 hours, the figure for those admitted on weekdays was only 17.7%. Altogether 62.8% of the treatment periods ending in death took place between December and May. Conclusions.The COPD patients admitted at weekends showed the poorest survival, while concurrent diseases and protraction of the treatment period in winter and early spring increased the risk of death. Recognition of risk cases on admission could enable mortality to be reduced and allow savings in terms of costs through the intensification of treatment in these cases

Keskittämisen kipukohdista eteenpäin

Erikoissairaanhoidon keskittämisen kipukohtien taustalla on ¬henkilöstön saatavuuteen, koulutukseen ja päivystysvalmiuteen sekä aluepolitiikkaan liittyviä argumentteja, todetaan erikois¬sairaanhoidon keskittämisen ja päivystyksen tilaa käsittelevässä tuoreessa raportiss

Turvapaikanhakijoiden infektiotuliaiset - ei uhka vaan diagnostinen haaste

Non peer reviewe

Vastine edelliseen : turvapaikanhakijoiden terveyspalveluista

Vastine Juha Tuomisen et al. kommenttiin Duodecim 132(8):752, 2016Non peer reviewe

Erikoissairaanhoidon järjestäminen Uudellamaalla : HUS-työryhmän loppuraportti

Uudenmaan erillisratkaisun selvityksen HUS-työryhmä on päätynyt yksimielisesti esittämään ratkaisua, jossa erikoissairaanhoidon järjestämisvastuu olisi yleisesti ja ensisijaisesti itsehallinnollisilla alueilla eli maakunnilla. HUS vastaisi puolestaan Uudenmaan alueella kiireellisestä erikoissairaanhoidosta, vaativasta ja yliopistosairaalalle kuuluvasta erikoissairaanhoidosta ja tämän järjestämiseksi tarpeellisesta muusta erikoissairaanhoidosta. HUS vastaisi myös muista erikoissairaanhoidon palveluista niiltä osin kuin maakunnat eivät niitä järjestä. HUSin järjestämisvastuu olisi toissijaista ja lakiin perustuvaa. Itsehallintoalueiden ja HUSin työnjako linjattaisiin tarkemmin järjestämissopimuksessa, jonka perusvaatimukset määriteltäisiin lainsäädännössä. HUSille taattaisiin tätä kautta riittävä yleinen erikoissairaanhoidon järjestämisvastuu toiminnan hyvää toteuttamista varten. Mikäli maakuntien ja HUSin välinen sopimus ei täyttäisi lain vaatimia kriteereitä tai sopimusta ei muuten syntyisi, valtioneuvostolla olisi oikeus ottaa asia päätettäväkseen. Työryhmän esittämällä mallilla turvattaisiin itsehallintoalueiden ja HUSin välisen työnjaon joustavuus ja vahvistettaisiin erikoissairaanhoidon tarkoituksenmukaisen käytön ohjausta. Ratkaisu huomioisi saavutetut keskittämishyödyt, HUSin kansalliset vastuut, valmiuden ja varautumisen ylläpidon, yliopistollisen opetuksen ja tutkimuksen sekä näiden edellyttämän riittävän tuotantovolyymin turvaamisen

Inter-rater reliability of medication error classification in a voluntary patient safety incident reporting system HaiPro in Finland

Background Medication errors are common in healthcare. Medication error reporting systems can be established for learning from medication errors and risk prone processes, and their data can be analysed and used for improving medication processes in healthcare organisations. However, data reliability testing is crucial to avoid biases in data interpretation and misleading findings informing patient safety improvement. Objective To assess the inter-rater reliability of medication error classifications in a voluntary patient safety incident reporting system (HaiPro) widely used in Finland, and to explore reported medication errors and their contributing factors. Method The data consisted of medication errors (n = 32 592), including near misses, reported by 36 Finnish healthcare organisations in 2007–2009. The reliability of the original classifications was tested by an independent researcher reclassifying a random sample of errors (1%, n = 288) based on narratives. The inter-rater reliability of agreement (κ) of the classifications was calculated to describe the degree of conformity between the researcher and the original data classifiers. Descriptive statistics were used to describe the medication errors. Results The inter-rater reliability between the researcher and the original data classifiers was acceptable (κ ≥ 0.41) in 11 of 42 (26%) medication error classes. Thus, these errors could be pooled from different healthcare units for the exploration of medication errors at the level of all reporting organisations. Contributing factors were identified in 48% (n = 137) of the medication error narratives in the random sample (n = 288). The most commonly reported errors were dispensing errors (34%, n = 10 906), administration errors 25% (n = 7972), and documentation errors 17% (n = 5641). Conclusions The data classified by different classifiers can be pooled for some of the medication error classes. Consistency of the classification and the quality of narratives need improvement, as well as reporting and classification of contributing factors to provide high quality information on medication errors.Peer reviewe

Short and long term treatment of asthma with intravenous nutrients

BACKGROUND: Asthma is an increasing problem in this country and others. Although medications for the treatment of asthma abound and are improving, there are inherent risks and side effects with all of them. Intravenous magnesium has been employed in the treatment of acute asthma, but its use has not become universal, nor has it been studied for the treatment of chronic asthma. It is known to be a safe drug with minimal side effects. In this study, the author investigates the use of magnesium and other nutrients in the treatment of both acute and chronic asthma. METHODS: In this non-blinded outcome study, following informed consent, forty-three (43) randomly selected volunteer patients with both acute and chronic asthma were treated with IV infusions described herein. All patients were observed with spirometry 10 minutes post-infusion; two sub-groups of patients were also observed after multiple infusions over a short period of time (less than one month) and a longer period of time (average 5.8 months). Pulmonary function was analyzed by spirometric testing with pre- and post-infusion spirometric measurements with the pre/post group. For longer term (Trend) patients, baseline spirometry measurements were compared to spirometry measurements after patients had received multiple infusions over a period of time. Eight (8) patients were measured for both pre/post and Trend data. RESULTS: The 38 pre-infusion/post-infusion patients with acute and chronic asthma demonstrated an overall average improvement (percentage improvement in percent predicted) of 45%. The 13 patients measured for improvement over time (Trend data, average duration 5.82 months), demonstrated an overall average improvement (percentage improvement in percent predicted) of 57%. Of the 13 patients in the multiple infusion group, 9 patients who received longer-term therapy (average duration of 12.58 months) for chronic asthma demonstrated an overall average improvement of 95% (percentage improvement in percent predicted). CONCLUSION: The use of intravenous treatment with multiple nutrients, including magnesium, for acute and chronic asthma may be of considerable benefit. Pulmonary function improved progressively the longer patients received treatment