Adherence to risk-assessment protocols to guide computed tomography pulmonary angiography in patients with suspected pulmonary embolism

AimsThe use of computed tomography pulmonary angiography (CTPA) in the detection of pulmonary embolism (PE) has considerably increased due developing technology and better availability of imaging. The underuse of pre-test probability scores and overuse of CTPA has been previously reported. We sought to investigate the indications for CTPA at a University Hospital emergency clinic and seek for factors eliciting the potential overuse of CTPA.Methods and resultsAltogether 1001 patients were retrospectively collected and analysed from the medical records using a structured case report form. PE was diagnosed in 222/1001 (22.2%) of patients. Patients with PE had more often prior PE/deep vein thrombosis, bleeding/thrombotic diathesis and less often asthma, chronic obstructive pulmonary disease, coronary artery disease, or decompensated heart failure. Patients were divided into three groups based on Wells PE risk-stratification score and two groups based on the revised Geneva score. A total of 9/382 (2.4%), 166/527 (31.5%), and 47/92 (52.2%) patients had PE in the CTPA in the low, intermediate, and high pre-test likelihood groups according to Wells score, and 200/955 (20.9%) and 22/46 (47.8%) patients had PE in the CTPA in the low-intermediate and the high pre-test likelihood groups according to the revised Geneva score, respectively. D-dimer was only measured from 568/909 (62.5%) and 597/955 (62.5%) patients who were either in the low or the intermediate-risk group according to Wells score and the revised Geneva score. Noteworthy, 105/1001 (10.5%) and 107/1001 (10.7%) of the CTPAs were inappropriately ordered according to the Wells score and the revised Geneva score. Altogether 168/1001 (16.8%) could theoretically be avoided.ConclusionsThis study highlights scant utilization of guideline-recommended risk-stratification tools in CTPA use at the emergency department.</p

Sosiaalipolitiikan kilpailevien ideologioiden vertailua : Hyvinvointivaltion eurooppalainen malli ja uusliberalismi vaihtoehtoisina esikuvina

Julkaisu esittelee ja vertailee eri näkökulmista ns. hyvinvointivaltion eurooppalaista mallia ja uusliberalismia sosiaalipolitiikan vaihtoehtoisina esikuvina. Raportti kuvaa näiden kahden mallin ideaalityyppisiä ominaispiirteitä ja eroja. Tarkastelu kohdistuu ajattelumallien pääpiirteisiin, sosiaalipolitiikan toimintaperiaatteisiin, toimeenpanijoihin, instituutioihin ja keinoihin kansallisvaltioiden tasolla sekä toimintaperiaatteisiin ja toiminnan seurauksiin yleismaailmallisella tasolla. Esitetty vertailu ei vastaa itse ideologian paremmuutta koskeviin kysymyksiin, mutta on hyödyllinen työkalu jokaiselle, joka haluaa tutkia tai suunnitella sosiaalipolitiikkaa tai ymmärtää sen kehittämistä.5,55 euro