Rintakipuisen potilaan hoito-ohjeen toteutuminen Kajaanin ensihoidossa

Rintakipu on yksi yleisimmistä tehtävistä ensihoidossa. Monesti rintakipu on merkkinä vakavasta vammasta tai sairaudesta, joka vaatii nopeaa ja asiantuntevaa hoitoa. Hoito-ohjeita kehittämällä yhtenäistetään ensihoidon antamaa hoitoa ja kehitetään hoidon laatua ja tehokkuutta. Samalla parannetaan kriittisille potilaille annettua hoitoa ja saadaan kuolleisuutta pienennettyä. Opinnäytetyön tarkoituksena oli selvittää kuinka Kainuun maakunta -kuntayhtymän ensihoidon kevään 2010 hoito-ohjeet toteutuivat rintakipupotilaan hoidossa Kajaanin yksiköissä. Hoito-ohjeiden toteutuminen todettiin ensihoitajien kirjausohjelmalle tekemien kirjausten perusteella. Opinnäytetyön tavoitteena oli tuottaa Kainuun maakunta -kuntayhtymälle tietoa Kajaanin ensihoitoyksiköiden antamasta rintakipupotilaiden hoidosta. Tieto on tärkeää hoidon laadun parantamiseksi sekä kevään 2010 hoito-ohjeiden toimivuuden toteamiseksi. Tutkimusongelmana opinnäytetyössä oli: Miten kevään 2010 rintakipuisen potilaan hoito-ohjeet toteutuvat Kainuun maakunta -kuntayhtymän Kajaanin ensi-hoidossa? Tutkimusmenetelmänä käytettiin kvantitatiivista eli määrällistä tutkimusta. Aineisto kerättiin Kajaanin ensihoidon ensihoitajien SAKU- ohjelmaan tekemien kirjausten perusteella. Tiedonkeruulomakkeelta aineisto taulukoitiin SPSS PASW statistics 18 -ohjelmalla, josta se analysoitiin. Otosaika oli 1.6.-31.12.2010. Aineistona olivat rintakipupotilastehtävät tältä ajalta poislukien heinäkuun ja marraskuun tehtävät, jotka jouduttiin vähentämään otoksen rajaamiseksi. Otoksen määrä oli yhteensä 76 tehtävää. Tulosten perusteella rintakipuisen potilaan hoito-ohjeet toteutuivat Kajaanin ensihoidossa pääsääntöisesti. Puutteita havaittiin muun muassa lääkehoidon toteuttamisessa sekä potilaan tutkimisessa. Tuloksiin vaikuttavat ensihoitajien mahdollisesti puutteelliset kirjaamiset. Kirjaamiseen voi vaikuttaa ensihoitajien rajallinen aika. Lisäksi tuloksiin vaikuttaa kirjausten analysoinnin vaikeus erilaisten kirjaustapojen ja SAKU-ohjelman käytön vuoksi. Jatkotutkimusaiheina ovat hoito-ohjeiden toteutumisen mittaaminen koko Kainuun alueella sekä sähköisen kirjaamisen yhtenäistämisen tutkiminen.Treating chest pain is one of the most common tasks in emergency care. Chest pain might be a sign of a severe trauma that needs swift and competent treatment. The quality and efficiency of the treatment given by paramedics is improved by developing emergency care guidelines, thus ensuring better care for critically ill patients as well as reducing mortality rate. The purpose of this thesis was to find out whether the new emergency care guidelines of the Joint Authority of Kainuu Region were followed while treating chest pain patients by Kajaani emergency care units. The objective was to produce information for the Kajaani emergency care for developing patient safety and quality of treatment further, and verifying the functionality of the emergency care guidelines. The database used was a patient information database where paramedics enter their case notes. The research method used was quantitative. The data for the analysis was collected from the paramedics’ case notes written on the patient information database SAKU. After the data was tabulated with the SPSS PASW statistics 18 software, it was analyzed. The data contained all chest pain cases during the period of 1 June -31 December 2010, excluding the cases in July and November in order to reduce the quantity of the data. The number of cases was 76. Based on the results, the emergency care guidelines for treating chest pain patients were generally followed in the emergency care units. Improvements were needed mainly concerning medication and patient assessment. The results may have been influenced by insufficiently recorded notes which may have been partially due to the limited time paramedics had for note-taking during treating a patient. The difficulty analyzing many different note-taking styles may also have influenced the results. Possible follow up research themes could entail studying how the emergency care guidelines for chest pain patients are followed in all emergency care units in Kainuu region as well as studying the standardization of entries into the SAKU database

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Quantitative comparison of pyranose dehydrogenase action on diverse xylooligosaccharides

Peer reviewe

Maternal microbiota-derived metabolic profile in fetal murine intestine, brain and placenta

Background The maternal microbiota affects the development of the offspring by microbial metabolites translocating to the fetus. To reveal the spectrum of these molecular mediators of the earliest host-microbe interactions, we compared placenta, fetal intestine and brain from germ-free (GF) and specific pathogen free (SPF) mouse dams by non-targeted metabolic profiling. Results One hundred one annotated metabolites and altogether 3680 molecular features were present in significantly different amounts in the placenta and/or fetal organs of GF and SPF mice. More than half of these were more abundant in the SPF organs, suggesting their microbial origin or a metabolic response of the host to the presence of microbes. The clearest separation was observed in the placenta, but most of the molecular features showed significantly different levels also in the fetal intestine and/or brain. Metabolites that were detected in lower amounts in the GF fetal organs included 5-aminovaleric acid betaine, trimethylamine N-oxide, catechol-O-sulphate, hippuric and pipecolic acid. Derivatives of the amino acid tryptophan, such as kynurenine, 3-indolepropionic acid and hydroxyindoleacetic acid, were also less abundant in the absence of microbiota. Ninety-nine molecular features were detected only in the SPF mice. We also observed several molecular features which were more abundant in the GF mice, possibly representing precursors of microbial metabolites or indicators of a metabolic response to the absence of microbiota. Conclusions The maternal microbiota has a profound impact on the fetal metabolome. Our observations suggest the existence of a multitude of yet unidentified microbially modified metabolites which pass through the placenta into the fetus and potentially influence fetal development.Peer reviewe

Kaupallisten eturauhassyövän riskinarviointipaneelien transkriptioanalyysi vaikeasti ennustettavissa erilaistumisryhmien 2-4 eturauhassyövissä

Tausta: Eturauhassyövän erilaistumisryhmien (grade group, GG) 2-4 prognoosin arvioinnissa tarvitaan edistysaskeleita ylihoidon minimoimiseksi. Tavoitteemme oli selvittää lähetti-RNA-tasolla kaupallisten paneelien, Decipher, Oncotype DX, Prolaris, ja mutaatiopaneeli MSK-IMPACTin suorituskykyä ennustaa etäpesäkevapaata ja eturauhassyöpäspesifistä selviytymistä GG 2-4 eturauhassyövässä radikaalin eturauhasen poiston jälkeen. Materiaalit ja metodologia: Retrospektiivinen kohortti koostui radikaalilla eturauhasen poistolla hoidetuista GG 2-4 potilaista (10,4 vuoden mediaaniseuranta-aika). Analysoimme 76 tapausta, joilla oli leikkauksen jälkeinen etäpesäke tai eturauhassyöpäspesifinen kuolema, sekä 84 verrokkia, joilla oli samanveroinen etenemisriski lähtötilanteessa, mutta syöpä ei edennyt. Indeksileesioiden lähetti-RNAt analysoitiin käyttäen NanoString-alustaa. Koulutimme satunnaismetsämalleja (random forest) ennustamaan kliinisiä päätetapahtumia käyttäen paneelien geenikokoelmia. Mittasimme käyrän alla olevaa pinta-alaa (area under the curve, AUC), sensitiivisyyttä, spesifisyyttä, Youden indeksiä sekä NND-lukua (number needed to diagnose). Selviytymistodennäköisyyttä arvioitiin käyttämällä Kaplan-Meier estimaattoria. Tulokset: Geenikokoelmien suorituskyky oli parempi etäpesäkevapaan ja eturauhassyöpäspesifisen selviytymisen ennustamisessa verrattuna kliinisiin muuttujiin. Paneelien välillä oli kuitenkin merkitseviä eroja. Oncotype DX ennusti metastaaseja heikommin (AUC=0,65) kuin muut paneelit (AUC=0,73-0,74). Decipherin, MSK-IMPACTin ja Prolariksen NND-luvut eivät eronneet merkittävästi (2,83-3,12), kun taas Oncotype DXn NND-luku oli korkein (4,79). Prolaris ennusti eturauhassyöpäspesifistä kuolemaa heikommin (AUC=0,66) kuin MSK-IMPACT tai Decipher (AUC=0,72). Oncotype DXn suorituskyky ei eronnut muista paneeleista (AUC=0,69, p>0,05), mutta sen NND-luku (2,79) oli matalampi kuin muilla paneeleilla (4,22-5,66). Pohdinta: Kaupallisten riskiluokituspaneelien geenien transkriptianalyysi ennustaa GG 2-4 potilaiden selviytymistä radikaalin eturauhasen poiston jälkeen ja saattaa olla avuksi kliinisessä päätöksenteossa. Paneelien välillä oli merkitseviä eroja, mutta paremmin ennustaville geenikokoelmille on tarvetta. Prospektiivinen tutkimus biopsia-aineistossa on tarpeen.Background: Improved prognostication is needed to minimize overtreatment in Grade Group (GG) 2-4 prostate cancer. Our aim was to determine, at messenger RNA (mRNA) level, the performance of the genes in the commercial panels Decipher, Oncotype DX, Prolaris and mutational panel MSK-IMPACT to predict metastasis-free and prostate cancer-specific death (PCSD) in patients with GG2-4 prostate cancer at radical prostatectomy. Methods: The retrospective cohort consisted of GG2-4 patients treated with radical prostatectomy (median follow-up 10.4 years). Seventy-six cases with post-operative metastasis or PCSD and 84 controls with similar clinical baseline risk, but without progression, were analyzed. Index lesion mRNA transcripts were analyzed using NanoString technology. Random forest models were trained using panel gene sets to predict clinical endpoints and area under the curve (AUC), sensitivity, specificity, Youden index and number needed to diagnose (NND) was measured. Survival probability was assessed with Kaplan-Meier estimator. Results: All gene sets outperformed clinical parameters and predicted metastasis-free and prostate cancer-specific survival. However, there were significant differences between the panels. In metastasis prediction, the genes in Oncotype DX had inferior performance (area under the curve [AUC] = 0.65) compared to other panels (AUC = 0.73-0.74). Decipher, MSK-IMPACT and Prolaris showed similar NND (2.83-3.12) with Oncotype DX having highest NND (4.79). In PCSD prediction, the Prolaris gene set performed worse (AUC = 0.66) than MSK-IMPACT or Decipher (AUC = 0.72). Oncotype DX performed similarly to other panels (AUC=0.69, p > .05). Oncotype DX demonstrated lowest NND (2.79) compared to other panels (4.22-5.66). Conclusion: Transcript analysis of genes included in commercial panels is feasible in survival prediction of GG2-4 patients after radical prostatectomy and may aid in clinical decision making. There were significant differences between the panels, and overall stronger predictive gene sets are needed. Prospective investigation is warranted in biopsy materials

Increased B-Type Natriuretic Peptide Concentration Is Associated with Reduced Coronary Vasoreactivity in Patients with Dilated Cardiomyopathy but Not in Healthy Young Subjects

Background/Aims. Natriuretic peptides are associated with the cardiovascular disease risk under a range of different circumstances. However, less is known about whether this association is found also in young healthy subjects. Methods. 9 patients with dilated cardiomyopathy and 26 healthy young subjects were studied. The myocardial blood flow measurements were performed basally and during adenosine infusion using PET. Results. S-proBNP concentrations were significantly higher (2153 ± 1964 versus 28 ± 17 ng/L, P = .000002) and adenosine-stimulated flow lower (1.6 ± 0.8 versus 3.6 ± 1.1 mL·g−1·min−1, P = .00001) in patients with dilated cardiomyopathy when compared to healthy subjects. S-proBNP concentration was inversely associated with adenosine stimulated flow in patients with dilated cardiomyopathy (r = −0.75, P = .019) but not in healthy subjects (r = −0.06, P = .84). Conclusions. Natriuretic peptides are inversely associated with coronary vasoreactivity in patients with dilated cardiomyopathy but not in healthy young subjects. Since reduced coronary vasoreactivity seems to be one of the earliest abnormalities in the development of coronary artery disease, this might indicate that natriuretic peptides are not predictor of cardiovascular disease risk in healthy young subjects

Maternal microbiota-derived metabolic profile in fetal murine intestine, brain and placenta

Background The maternal microbiota affects the development of the offspring by microbial metabolites translocating to the fetus. To reveal the spectrum of these molecular mediators of the earliest host-microbe interactions, we compared placenta, fetal intestine and brain from germ-free (GF) and specific pathogen free (SPF) mouse dams by non-targeted metabolic profiling. Results One hundred one annotated metabolites and altogether 3680 molecular features were present in significantly different amounts in the placenta and/or fetal organs of GF and SPF mice. More than half of these were more abundant in the SPF organs, suggesting their microbial origin or a metabolic response of the host to the presence of microbes. The clearest separation was observed in the placenta, but most of the molecular features showed significantly different levels also in the fetal intestine and/or brain. Metabolites that were detected in lower amounts in the GF fetal organs included 5-aminovaleric acid betaine, trimethylamine N-oxide, catechol-O-sulphate, hippuric and pipecolic acid. Derivatives of the amino acid tryptophan, such as kynurenine, 3-indolepropionic acid and hydroxyindoleacetic acid, were also less abundant in the absence of microbiota. Ninety-nine molecular features were detected only in the SPF mice. We also observed several molecular features which were more abundant in the GF mice, possibly representing precursors of microbial metabolites or indicators of a metabolic response to the absence of microbiota. Conclusions The maternal microbiota has a profound impact on the fetal metabolome. Our observations suggest the existence of a multitude of yet unidentified microbially modified metabolites which pass through the placenta into the fetus and potentially influence fetal development.</p

Asystole episodes and bradycardia in patients with end-stage renal disease

Background Knowledge of arrhythmias in patients with end-stage renal disease (ESRD) is mainly based on ambulatory electrocardiography (ECG) studies and observations during haemodialysis (HD). We used insertable cardiac monitors (ICMs) to define the prevalence of arrhythmias, focusing on bradyarrhythmias, in ESRD patients treated with several dialysis modes including home therapies. Moreover, we assessed whether these arrhythmias were detected in baseline or ambulatory ECG recordings. Methods Seventy-one patients with a subcutaneous ICM were followed for up to 3 years. Asystole (>= 4.0 s) and bradycardia (heart rate = 4 beats) episodes, ventricular tachyarrhythmias and atrial fibrillation (AF) were collected and verified visually. A baseline ECG and a 24- to 48-h ambulatory ECG were recorded at recruitment and once a year thereafter. Results At recruitment, 44 patients were treated in in-centre HD, 12 in home HD and 15 in peritoneal dialysis. During a median follow-up of 34.4 months, 18 (25.4%) patients had either an asystolic or a bradycardic episode. The median length of each patient's longest asystole was 6.6 s and that of a bradycardia 13.5 s. Ventricular tachyarrhythmias were detected in 16 (23%) patients, and AF in 34 (51%) patients. In-centre HD and Type II diabetes were significantly more frequent among those with bradyarrhythmias, whereas no bradyarrhythmias were found in home HD. No bradyarrhythmias were evident in baseline or ambulatory ECG recordings. Conclusions Remarkably many patients with ESRD had bradycardia or asystolic episodes, but these arrhythmias were not detected by baseline or ambulatory ECG.Peer reviewe

Sorting microplastics from other materials in water samples by ultra-high-definition imaging

In this study a commercial particle analyzer was used to image and help sorting microplastic particles (MPs) dispersed in filtrated and de-aerated tap water. The device provides a relatively easy and fast procedure for obtaining ultra-high-definition imaging, allowing the determination of shape, size, and number of 2D-projections of solid particles. The image analysis revealed clear differences among the studied different MPs originating from the grinding of five common grades of plastic sheets as they affect the image rendering differently, principally due to the light scattering either at the surface or in the volume of the microplastics. The high-quality imaging of the device also allows the discrimination of the microplastics from air bubbles with well-defined spherical shapes as well as to obtain an estimate of the size of MPs in a snapshot. We associate the differences among the shapes of the identified MPs in this study depending on the plastic type with known physical properties, such as brittleness, crystallinity, or softness. Furthermore, as a novel method we exploit a parameter based on the light intensity map from moving particles in cuvette flow to sort MPs from other particles, such as, wood fiber, human hair, and air bubbles. Using the light intensity map, which is related to the plastic-water refractive index ratio, the presence of microplastics in water can be revealed among other particles, but not their specific plastic type