Aju tiheliiduste valkude ekspressioon sepsise korral lahangumaterjalis

Eesti Arst 2021; 100(8):45

The development of emergency medical services benefit score : a European Delphi study

Publisher Copyright: © 2021. The Author(s).BACKGROUND: The helicopter emergency services (HEMS) Benefit Score (HBS) is a nine-level scoring system developed to evaluate the benefits of HEMS missions. The HBS has been in clinical use for two decades in its original form. Advances in prehospital care, however, have produced demand for a revision of the HBS. Therefore, we developed the emergency medical services (EMS) Benefit Score (EBS) based on the former HBS. As reflected by its name, the aim of the EBS is to measure the benefits produced by the whole EMS systems to patients. METHODS: This is a four-round, web-based, international Delphi consensus study with a consensus definition made by experts from seven countries. Participants reviewed items of the revised HBS on a 5-point Likert scale. A content validity index (CVI) was calculated, and agreement was defined as a 70% CVI. Study included experts from seven European countries. Of these, 18 were prehospital expert panellists and 11 were in-hospital commentary board members. RESULTS: The first Delphi round resulted in 1248 intervention examples divided into ten diagnostic categories. After removing overlapping examples, 413 interventions were included in the second Delphi round, which resulted in 38 examples divided into HBS categories 3-8. In the third Delphi round, these resulted in 37 prehospital interventions, examples of which were given revised version of the score. In the fourth and final Delphi round, the expert panel was given an opportunity to accept or comment on the revised scoring system. CONCLUSIONS: The former HBS was revised by a Delphi methodology and EBS developed to represent its structural purpose better. The EBS includes 37 exemplar prehospital interventions to guide its clinical use. Trial registration The study permission was requested and granted by Turku University Hospital (decision number TP2/010/18).Peer reviewe

Bioreactance and fourth-generation pulse contour methods in monitoring cardiac index during off-pump coronary artery bypass surgery

cited By 0The pulmonary artery catheter (PAC) is considered the gold standard for cardiac index monitoring. Recently new and less invasive methods to assess cardiac performance have been developed. The aim of our study was to assess the reliability of a non-invasive monitor utilizing bioreactance (Starling SV) and a non-calibrated mini-invasive pulse contour device (FloTrac/EV1000, fourth-generation software) compared to bolus thermodilution technique with PAC (TDCO) during off-pump coronary artery bypass surgery (OPCAB). In this prospective study, 579 simultaneous intra- and postoperative cardiac index measurements obtained with Starling SV, FloTrac/EV1000 and TDCO were compared in 20 patients undergoing OPCAB. The agreement of data was investigated by Bland-Altman plots, while trending ability was assessed by four-quadrant plots with error grids. In comparison with TDCO, Starling SV was associated with a bias of 0.13 L min(-1) m(-2) (95% confidence interval, 95% CI, 0.07 to 0.18), wide limits of agreement (LOA, - 1.23 to 1.51 L min(-1) m(-2)), a percentage error (PE) of 60.7%, and poor trending ability. In comparison with TDCO, FloTrac was associated with a bias of 0.01 L min(-1) m(-2) (95% CI - 0.05 to 0.06), wide LOA (- 1.27 to 1.29 L min(-1) m(-2)), a PE of 56.8% and poor trending ability. Both Starling SV and fourth-generation FloTrac showed acceptable mean bias but imprecision due to wide LOA and high PE, and poor trending ability. These findings indicate limited reliability in monitoring cardiac index in patients undergoing OPCAB.Peer reviewe

Bioreactance and fourth-generation pulse contour methods in monitoring cardiac index during off-pump coronary artery bypass surgery

cited By 0The pulmonary artery catheter (PAC) is considered the gold standard for cardiac index monitoring. Recently new and less invasive methods to assess cardiac performance have been developed. The aim of our study was to assess the reliability of a non-invasive monitor utilizing bioreactance (Starling SV) and a non-calibrated mini-invasive pulse contour device (FloTrac/EV1000, fourth-generation software) compared to bolus thermodilution technique with PAC (TDCO) during off-pump coronary artery bypass surgery (OPCAB). In this prospective study, 579 simultaneous intra- and postoperative cardiac index measurements obtained with Starling SV, FloTrac/EV1000 and TDCO were compared in 20 patients undergoing OPCAB. The agreement of data was investigated by Bland-Altman plots, while trending ability was assessed by four-quadrant plots with error grids. In comparison with TDCO, Starling SV was associated with a bias of 0.13 L min(-1) m(-2) (95% confidence interval, 95% CI, 0.07 to 0.18), wide limits of agreement (LOA, - 1.23 to 1.51 L min(-1) m(-2)), a percentage error (PE) of 60.7%, and poor trending ability. In comparison with TDCO, FloTrac was associated with a bias of 0.01 L min(-1) m(-2) (95% CI - 0.05 to 0.06), wide LOA (- 1.27 to 1.29 L min(-1) m(-2)), a PE of 56.8% and poor trending ability. Both Starling SV and fourth-generation FloTrac showed acceptable mean bias but imprecision due to wide LOA and high PE, and poor trending ability. These findings indicate limited reliability in monitoring cardiac index in patients undergoing OPCAB.Peer reviewe

The development of emergency medical services benefit score: a European Delphi study

BackgroundThe helicopter emergency services (HEMS) Benefit Score (HBS) is a nine-level scoring system developed to evaluate the benefits of HEMS missions. The HBS has been in clinical use for two decades in its original form. Advances in prehospital care, however, have produced demand for a revision of the HBS. Therefore, we developed the emergency medical services (EMS) Benefit Score (EBS) based on the former HBS. As reflected by its name, the aim of the EBS is to measure the benefits produced by the whole EMS systems to patients.MethodsThis is a four-round, web-based, international Delphi consensus study with a consensus definition made by experts from seven countries. Participants reviewed items of the revised HBS on a 5-point Likert scale. A content validity index (CVI) was calculated, and agreement was defined as a 70% CVI. Study included experts from seven European countries. Of these, 18 were prehospital expert panellists and 11 were in-hospital commentary board members.ResultsThe first Delphi round resulted in 1248 intervention examples divided into ten diagnostic categories. After removing overlapping examples, 413 interventions were included in the second Delphi round, which resulted in 38 examples divided into HBS categories 3–8. In the third Delphi round, these resulted in 37 prehospital interventions, examples of which were given revised version of the score. In the fourth and final Delphi round, the expert panel was given an opportunity to accept or comment on the revised scoring system.ConclusionsThe former HBS was revised by a Delphi methodology and EBS developed to represent its structural purpose better. The EBS includes 37 exemplar prehospital interventions to guide its clinical use.Trial registration The study permission was requested and granted by Turku University Hospital (decision number TP2/010/18).</p

Viemäröinnin vaikutukset Tornion Keropudas-Karunki-alueella

Tornioon rakennetaan viemäriä haja-asutusalueelle Keropudas–Karunki-alueella. Viemäröinnin pituus on noin 25 km. Viemäröinnillä saadaan johdettua jätevedet Karungin jätevedenpuhdistamolta Haaparanta-Tornion jätevedenpuhdistamolle Bottenvikens Reningsverketille. Karungin jätevedenpuhdistamo on saneeraustarpeessa. Samalla saadaan viemäröityä haja-asutuksen jätevedet siirtoviemärin alueelta. Viemäröimällä saadaan vähennettyä Tornionjokilaakson asukkaiden jätevesien fosfori-, typpi- ja kiintoaineskuormituksen vaikutusta Tornionjokeen. Euroopan unionin vesipolitiikan puitedirektiivin(2000) mukaan vesien tilan tulisi olla vuoteen 2015 mennessä hyvässä tilassa, ja viemäröinti alueella tulee parantamaan veden laatua. Tällä hetkellä veden laatu on osittain luokiteltu tyydyttäväksi. Vuonna 2016 tulee voimaan hajajätevesiasetus, jonka mukaan kiinteistökohtaisten jätevesijärjestelmien tulisi olla ajan mukaiset. Viemäröinnillä asukkaat välttyvät kiinteistökohtaisten järjestelmien uusimiselta. Työssä tehdyissä kuormituslaskuista havaittiin, että luonnonhuuhtoumasta syntyvät ravinteet ovat Tornionjokea suurin kuormittava tekijä, mutta luonnonhuuhtoumasta syntyvät ravinteet eivät ole biomassoille käyttökelpoisessa muodossa. Ihmisperäinen jätevesi sisältää ravinteita, jotka ovat biomassoille käyttökelpoisessa muodossa. Tämän vuoksi ihmisperäisiä jätevesien vaikutusta ympäristöön tulisi vähentää. Ihmisperäisiä jätevedenlähteitä Tornionjoella ovat maatalous, haja-asutus, jätevedenpuhdistamot, teollisuus, kalankasvatus, turvetuotanto ja metsätalous. Kuormituslaskujen lisäksi työssä tehtiin vertailua kiinteistökohtaisten jätevesijärjestelmien puhdistuksesta. Työssä on myös kustannusvertailua kiinteistökohtaisista jätevedenpuhdistusjärjestelmistä ja viemäröinnistä alueella. Tornionjokilaakson eteläisimmässä osassa Tornionjokisuulla asuu iso osa Tornionjokilaakson asukkaista, joten viemäröinti Keropudas-Karunki- alueella tulee vähentämään jäteveden ympäristövaikutuksia. Viemäröinnin myötä Tornionjoen kuormitus ja biomassojen ravinteet vähenevät, joka minimoi myös rehevöitymisen.A sewer is being built in a sparsely populated area in the Tornio area. The length of the Keropudas-Karunki sewer is around 25 km. The main idea of this sewer is to lead the sewage away from Karunki’s wastewater treatment plant because the plant needs renovation. The cleaned water from the plant is led to the Tornio river. The plant does not meet today´s purification demands. Another purpose of this sewer is to decrease the load of phosphor, nitrogen and solids originating from inhabitants´ sewage in the southern area of the Tornio valley to the Tornio river. The load of nutrients of natural wash to the Tornio river is the biggest nutrient loader of the river but the nutrients of natural wash are in a form which biomasses cannot use as nutrition. The sewage of anthropogenic sources contains nutrients which are in a suitable form to biomasses. That is the reason why the focus should be on decreasing the anthropogenic part of the load. The anthropogenic waste water comes from agriculture, sparsely populated areas, water treatment plants, industry, fish farming, peat production and forestry. The majority of the inhabitants of the Tornio valley live in the southern area so the sewer should decrease the environmental impact of sewage. The whole harmful impact on the environment and especially on the Tornio river will decrease with the sewer

Etä- ja verkko-opetus onnistumaan : Vinkkejä välineisiin, katsauksia käytäntöihin

Kemi-Tornion ammattikorkeakoulussa on tehty aikuisten tutkintoon johtavan verkkokoulutuksen sekä etä- ja verkko-opintojen tukipalveluiden systemaattista kehittämistyötä. Etä- ja verkko-opetusta on kaikilla koulutusaloilla ja verkossa opettaminen koskettaa lähes jokaista opettajaa. Tämä haastaa suuren joukon opettajia kehittämään tieto- ja viestintätekniikan (tvt) opetuskäyttötaitojaan, opiskelijoita ottamaan haltuun verkkovälineet ja verkko-opiskelutaidot sekä tukipalveluita kehittämään monimuotoisia tukipalveluiden toteuttamistapoja. Laajeneva etä- ja verkko-opetus vaatii yhä monipuolisempia pedagogisen ja teknisen tuen muotoja. Koulutuksien, räätälöidyn vierihoidon, erilaisten oppaiden ja ohjeiden sekä verkkopalveluiden rinnalle syntyi kolme vuotta sitten Viikon eVinkki. eVinkkien tavoitteena on viestittää opettajille ja opiskelijoille ajankohtaisista etä- ja verkko-opintojen asioista sekä kuvata erilaisia tapoja hyödyntää verkkovälineitä. Vinkit käsittelevät Kemi-Tornion ammattikorkeakoulussa ja Ammattiopisto Lappiassa käytössä olevia verkkovälineitä ja menetelmiä sekä esittelevät muita verkossa vapaasti saatavilla olevia sosiaalisen median välineitä että niiden käyttötapoja. Tässä julkaisussa on valikoiden koottu kokonaisuudeksi vuosien varrella julkaistuja eVinkkejä. Vinkkien kirjoittajina ovat toimineet eOppimiskeskuksen henkilökunnan jäsenet. eOppimiskeskus on osa Lapin korkeakoulukonsernin tukipalvelukeskusta ja vastaa Kemi-Tornion ammattikorkeakoulun ja Ammattiopisto Lappian verkko-opetuksen ja opiskelun tukipalveluista