Ensihoidon kenttäjohtojärjestelmää tarvitaan Pohjois-Suomessa

Oulun yliopistollisen sairaalan erityisvastuualueen kenttäjohtajien ja ensihoitajien mielipiteitä kenttäjohtotoiminnasta selvitettiin kahdella kyselytutkimuksella. Kyselyihin vastasi 270 ensihoitajaa ja 29 kenttäjohtajaa viiden sairaanhoitopiirin alueelta. Kenttäjohtajan tärkeimmiksi työtehtäviksi arvioitiin ensihoitoasetuksen mukaiset tehtävät: johtamisen moniviranomaistilanteissa, ja usean ensihoitoyksikön tehtävillä, toimimisen hoitotason ensihoitajana sekä hätäkeskuksen tukemisen. Kenttäjohtajilla oli myös muita kuin asetuksessa säädettyjä tehtäviä ja ne vaihtelivat sairaanhoitopiireittäin. Kenttäjohtojärjestelmää pidettiin hyödyllisenä ja ensihoitopalvelun laatua parantavana

Feasibility of video/audio monitoring in the analysis of motion and treatment effects on night-time seizures - Interventional study

The aim of the study: This pilot study assessed the ability of a video/audio-based seizure monitoring system to evaluate (I) baseline frequency and severity of nocturnal seizures with motor features in patients with drugresistant epilepsy (DRE) and (II) the individual effect of brivaracetam (BRV) treatment on number, duration and movement intensity of these seizure types. Algorithmic feature analysis was developed for assessment of qualitative changes in movement intensity measurements within seizure types before and after BRV intervention. Materials and methods: Night-time motor seizures of recruited patients were recorded in two separate four-week monitoring periods. The first period defined a prescreening phase (n = 13 patients) to establish a baseline, and the second period defined the intervention phase (n = 9 patients), with BRV initiated during the second week of the second monitoring period. All recorded nights were analyzed by an expert video reviewer, and all unequivocal seizures were classified by an epileptologist. Seizure frequencies using both seizure diaries and video monitoring were compared. The effect of BRV on both seizure duration and movement intensity was assessed by numerical comparison of visual features calculated from motion characteristics of the video, as well as spectral features from the recorded audio. The statistical significance of changes in seizure duration and intensity before and after the intervention were investigated by Wilcoxon rank-sum test and visual inspection of Kernel density estimation. Results: 8 patients marked seizures in their seizure diaries during the prescreening phase. During the three-week follow-up, three patients achieved > 50% seizure decrease, four patients did not respond to treatment, and two patients experienced worsening of seizures. Five patients were able to document 40-70% of their seizures compared to the video/audio monitoring system. According to the signal feature analysis the intervention decreased movement intensity with clear clinical significance in three patients, whereas statistically significant differences in features appeared in 8 out of 9 patients. Conclusions: The novel video/audio monitoring system improved the evaluation of treatment effect compared to the seizure diaries and succeeded in providing a comparative intra-patient assessment of the movement intensity and duration of the recorded seizures.Peer reviewe

Enterovirus strain and type-specific differences in growth kinetics and virus-induced cell destruction in human pancreatic duct epithelial HPDE cells

Enterovirus infections have been suspected to be involved in the development of type 1 diabetes. However, the pathogenetic mechanism of enterovirus-induced type 1 diabetes is not known. Pancreatic ductal cells are closely associated with pancreatic islets. Therefore, enterovirus infections in ductal cells may also affect beta-cells and be involved in the induction of type 1 diabetes. The aim of this study was to assess the ability of different enterovirus strains to infect, replicate and produce cytopathic effect in human pancreatic ductal cells. Furthermore, the viral factors that affect these capabilities were studied. The pancreatic ductal cells were highly susceptible to enterovirus infections. Both viral growth and cytolysis were detected for several enterovirus serotypes. However, the viral growth and capability to induce cytopathic effect (cpe) did not correlate completely. Some of the virus strains replicated in ductal cells without apparent cpe. Furthermore, there were strain-specific differences in the growth kinetics and the ability to cause cpe within some serotypes. Viral adaptation experiments were carried out to study the potential genetic determinants behind these phenotypic differences. The blind-passage of non-lytic CV-B6-Schmitt strain in HPDE-cells resulted in lytic phenotype and increased progeny production. This was associated with the substitution of a single amino acid (K257E) in the virus capsid protein VP1 and the viral ability to use decay accelerating factor (DAF) as a receptor. This study demonstrates considerable plasticity in the cell tropism, receptor usage and cytolytic properties of enteroviruses and underlines the strong effect of single or few amino acid substitutions in cell tropism and lytic capabilities of a given enterovirus. Since ductal cells are anatomically close to pancreatic islets, the capability of enteroviruses to infect and destroy pancreatic ductal cells may also implicate in respect to enterovirus induced type 1 diabetes. In addition, the capability for rapid adaptation to different cell types suggests that, on occasion, enterovirus strains with different pathogenetic properties may arise from less pathogenic ancestors. (C) 2015 Elsevier B.V. All rights reserved.Peer reviewe

Feasibility of video/audio monitoring in the analysis of motion and treatment effects on night-time seizures - Interventional study

The aim of the study: This pilot study assessed the ability of a video/audio-based seizure monitoring system to evaluate (I) baseline frequency and severity of nocturnal seizures with motor features in patients with drugresistant epilepsy (DRE) and (II) the individual effect of brivaracetam (BRV) treatment on number, duration and movement intensity of these seizure types. Algorithmic feature analysis was developed for assessment of qualitative changes in movement intensity measurements within seizure types before and after BRV intervention.Materials and methods: Night-time motor seizures of recruited patients were recorded in two separate four-week monitoring periods. The first period defined a prescreening phase (n = 13 patients) to establish a baseline, and the second period defined the intervention phase (n = 9 patients), with BRV initiated during the second week of the second monitoring period. All recorded nights were analyzed by an expert video reviewer, and all unequivocal seizures were classified by an epileptologist.Seizure frequencies using both seizure diaries and video monitoring were compared.The effect of BRV on both seizure duration and movement intensity was assessed by numerical comparison of visual features calculated from motion characteristics of the video, as well as spectral features from the recorded audio. The statistical significance of changes in seizure duration and intensity before and after the intervention were investigated by Wilcoxon rank-sum test and visual inspection of Kernel density estimation.Results: 8 patients marked seizures in their seizure diaries during the prescreening phase. During the three-week follow-up, three patients achieved > 50% seizure decrease, four patients did not respond to treatment, and two patients experienced worsening of seizures. Five patients were able to document 40-70% of their seizures compared to the video/audio monitoring system. According to the signal feature analysis the intervention decreased movement intensity with clear clinical significance in three patients, whereas statistically significant differences in features appeared in 8 out of 9 patients.Conclusions: The novel video/audio monitoring system improved the evaluation of treatment effect compared to the seizure diaries and succeeded in providing a comparative intra-patient assessment of the movement intensity and duration of the recorded seizures

Smittsamma sjukdomar i Finland 2012

Rapporten Smittsamma sjukdomar i Finland ger en beskrivning av årets viktigaste fenomen, epidemier och förekomsten av sjukdomar. I publikationen finns information om luftvägs- och tarminfektioner, hepatiter, könssjukdomar och antimikrobiell resistens. Följande fenomen var aktuella år 2012: opastöriserad mjölk och kontakt med djur ledde till en ehec-epidemi som resulterade i att flera barn behövde intensivvård; dengueinfektionerna har ökat bland resenärer under de senaste åren och ett nytt fenomen är infektioner som har sitt ursprung på Madeira; i en tredjedel av gonorréfallen härstammade smittan från utlandet; resistensen hos gramnegativa enterobakterier fortsatte att öka och en del av bakteriestammarna härstammar från utlandet. I rapporten jämförs de nyaste uppgifterna med uppgifterna från tidigare år, vilket lyfter fram de förändringar som skett i förekomsten av smittsamma sjukdomar under en längre tid. Rapporten är en sammanställning av de uppgifter som finns i registret över smittsamma sjukdomar vid Institutet för hälsa och välfärd

Comparison of: (2S,4R)-4-[F-18]Fluoroglutamine, [C-11]Methionine, and 2-Deoxy-2-[F-18]Fluoro-D-Glucose and Two Small-Animal PET/CT Systems Imaging Rat Gliomas

Purpose: The three positron emission tomography (PET) imaging compounds: (2S,4R)-4-[F-18]Fluoroglutamine ([F-18]FGln), L-[methyl-C-11]Methionine ([C-11]Met), and 2-deoxy-2-[F-18]fluoro-D-glucose ([F-18]FDG) were investigated to contrast their ability to image orthotopic BT4C gliomas in BDIX rats. Two separate small animal imaging systems were compared for their tumor detection potential. Dynamic acquisition of [F-18]FGln was evaluated with multiple pharmacokinetic models for future quantitative comparison.Procedures: Up to four imaging studies were performed on each orthotopically grafted BT4C glioma-bearing BDIX rat subject (n = 16) on four consecutive days. First, a DOTAREM(R) contrast enhanced MRI followed by attenuation correction CT and dynamic PET imaging with each radiopharmaceutical (20 min [C-11]Met, 60 min [F-18]FDG, and 60 min [F-18]FGln with either the Molecubes PET/CT (n = 5) or Inveon PET/CT cameras (n = 11). Ex vivo brain autoradiography was completed for each radiopharmaceutical and [F-18]FGln pharmacokinetics were studied by injecting 40 MBq into healthy BDIX rats (n = 10) and collecting blood samples between 5 and 60 min. Erythrocyte uptake, plasma protein binding and plasma parent-fraction were combined to estimate the total blood bioavailability of [F-18]FGln over time. The corrected PET-image blood data was then applied to multiple pharmacokinetic models.Results: Average BT4C tumor-to-healthy brain tissue uptake ratios (TBR) for PET images reached maxima of: [F-18]FGln TBR: 1.99 +/- 0.19 (n = 13), [F-18]FDG TBR: 1.41 +/- 0.11 (n = 6), and [C-11]Met TBR: 1.08 +/- 0.08, (n = 12) for the dynamic PET images. Pharmacokinetic modeling in dynamic [F-18]FGln studies suggested both reversible and irreversible uptake play a similar role. Imaging with Inveon and Molecubes yielded similar end-result ratios with insignificant differences (p > 0.25).Conclusions: In orthotopic BT4C gliomas, [F-18]FGln may offer improved imaging versus [C-11]Met and [F-18]FDG. No significant difference in normalized end-result data was found between the Inveon and Molecubes camera systems. Kinetic modelling of [F-18]FGln uptake suggests that both reversible and irreversible uptake play an important role in BDIX rat pharmacokinetics.</p

STOPFLU : is it possible to reduce the number of days off in office work by improved hand-hygiene?

Peer reviewe