Cerebral autoregulation after aneurysmal subarachnoid haemorrhage. A preliminary study comparing dexmedetomidine to propofol and/or midazolam

Abstract Background Cerebral autoregulation is often impaired after aneurysmal subarachnoid haemorrhage (aSAH). Dexmedetomidine is being increasingly used, but its effects on cerebral autoregulation in patients with aSAH have not been studied before. Dexmedetomidine could be a useful sedative in patients with aSAH as it enables neurological assessment during the infusion. The aim of this preliminary study was to compare the effects of dexmedetomidine on dynamic and static cerebral autoregulation with propofol and/or midazolam in patients with aSAH. Methods Ten patients were recruited. Dynamic and static cerebral autoregulation were assessed using transcranial Doppler ultrasound during propofol and/or midazolam infusion and then during three increasing doses of dexmedetomidine infusion (0.7, 1.0 and 1.4 µg/kg/h). Transient hyperaemic response ratio (THRR) and strength of autoregulation (SA) were calculated to assess dynamic cerebral autoregulation. Static rate of autoregulation (sRoR)% was calculated by using noradrenaline infusion to increase the mean arterial pressure 20 mmHg above the baseline. Results Data from 9 patients were analysed. Compared to baseline, we found no statistically significant changes in THRR or sROR%. THRR was (mean±SD) 1.20 ±0.14, 1.17±0.13(p=0.93), 1.14±0.09 (p=0.72) and 1.19±0.18 (p=1.0) and sROR% was 150.89±84.37, 75.22±27.75 (p=0.08), 128.25±58.35 (p=0.84) and 104.82±36.92 (p=0.42) at baseline and during 0.7, 1.0 and 1.4 µg/kg/h dexmedetomidine infusion, respectively. Dynamic SA was significantly reduced after 1.0 µg/kg/h dexmedetomidine (p=0.02). Conclusions Compared to propofol and/or midazolam, dexmedetomidine did not alter static cerebral autoregulation in aSAH patients, whereas a significant change was observed in dynamic SA. Further and larger studies with dexmedetomidine in aSAH patients are warranted.Peer reviewe

Finnish flow diverter study : 8 years of experience in the treatment of acutely ruptured intracranial aneurysms

Background Flow diversion of acutely ruptured intracranial aneurysms (IAs) is controversial due to high treatment-related complication rates and a lack of supporting evidence. We present clinical and radiological results of the largest series to date. Methods This is a nationwide retrospective study of acutely ruptured IAs treated with flow diverters (FDs). The primary outcome was the modified Rankin Scale (mRS) score at the last available follow-up time. Secondary outcomes were treatment-related complications and the aneurysm occlusion rate. Results 110 patients (64 females; mean age 55.7 years; range 12-82 years) with acutely ruptured IAs were treated with FDs between 2012 and 2020 in five centers. 70 acutely ruptured IAs (64%) were located in anterior circulation, and 47 acutely ruptured IAs (43%) were blister-like. A favorable functional outcome (mRS 0-2) was seen in 73% of patients (74/102). Treatment-related complications were seen in 45% of patients (n=49). Rebleeding was observed in 3 patients (3%). The data from radiological follow-ups were available for 80% of patients (n=88), and complete occlusion was seen in 90% of aneurysms (79/88). The data from clinical follow-ups were available for 93% of patients (n=102). The overall mortality rate was 18% (18/102). Conclusions FD treatment yields high occlusion for acutely ruptured IAs but is associated with a high risk of complications. Considering the high mortality rate of aneurysmal subarachnoid hemorrhage, the prevention of rebleeding is crucial. Thus, FD treatment may be justified as a last resort option.Peer reviewe

Finnish flow diverter study : 8 years of experience in the treatment of acutely ruptured intracranial aneurysms

Background Flow diversion of acutely ruptured intracranial aneurysms (IAs) is controversial due to high treatment-related complication rates and a lack of supporting evidence. We present clinical and radiological results of the largest series to date. Methods This is a nationwide retrospective study of acutely ruptured IAs treated with flow diverters (FDs). The primary outcome was the modified Rankin Scale (mRS) score at the last available follow-up time. Secondary outcomes were treatment-related complications and the aneurysm occlusion rate. Results 110 patients (64 females; mean age 55.7 years; range 12-82 years) with acutely ruptured IAs were treated with FDs between 2012 and 2020 in five centers. 70 acutely ruptured IAs (64%) were located in anterior circulation, and 47 acutely ruptured IAs (43%) were blister-like. A favorable functional outcome (mRS 0-2) was seen in 73% of patients (74/102). Treatment-related complications were seen in 45% of patients (n=49). Rebleeding was observed in 3 patients (3%). The data from radiological follow-ups were available for 80% of patients (n=88), and complete occlusion was seen in 90% of aneurysms (79/88). The data from clinical follow-ups were available for 93% of patients (n=102). The overall mortality rate was 18% (18/102). Conclusions FD treatment yields high occlusion for acutely ruptured IAs but is associated with a high risk of complications. Considering the high mortality rate of aneurysmal subarachnoid hemorrhage, the prevention of rebleeding is crucial. Thus, FD treatment may be justified as a last resort option.Peer reviewe

Varhaiskasvatuksen, esi- ja perusopetuksen digitalisaation tavoitetila

Varhaiskasvatuksen, esi- ja perusopetuksen digitalisaation tavoitetilan kuvaus valmistuu syksyllä 2023 osana Varhaiskasvatuksen, esi- ja perusopetuksen sekä vapaan sivistystyön digitalisaation viitekehys -hanketta. Hankkeessa kehitetään digitalisaation ohjausta ja vaikuttavuutta sekä hallinnonalan ennakointikykyä. Tavoitetilan kuvauksella konkretisoidaan Suomen digitaalisen kompassin, Kasvatuksen ja koulutuksen digitalisaation linjausten 2027 sekä muiden merkittävien toimialan digitalisaatiota määrittelevien asiakirjojen asettamia tavoitteita varhaiskasvatuksen, esi- ja perusopetuksen näkökulmasta. Digitalisaatiota tarkastellaan seitsemän osa-alueen kautta: digitalisaation kehittämisen edellytykset, digitaalinen osaaminen, digitaalisen infrastruktuurin, palveluiden ja yhteentoimivuuden kehittämisen tuki, tiedonhallinta ja laatu, tietosuoja ja -turva, digitalisaation lainsäädäntö ja -tulkinta sekä digitalisaation tutkimus. Digitalisaation tavoitteet kuvataan varhaiskasvatuksen, esi- ja perusopetuksen kontekstissa.Tällöin kaikki kasvatus- ja koulutustoimijat voivat tehdä pitkäjänteistä, ennakoivaa ja strategisesti ohjattua työtä tavoitetilan toteutumiseksi. Kansallisesti määritellyn ja yhteisesti jaetun tavoitetilan kuvaaminen mahdollistaa konkreettisten toimenpiteiden muodostamisen, mikä edistää toimialan digitalisaation kehitystä kohti yhteisesti jaettua tavoitetilaa

Target state of digitalisation in early childhood education and care, pre-primary, primary and lower secondary education

Aiemmin ilmestyneissä suomen- ja ruotsinkielisessä versioiden tiivistelmissä englanninkielisen nimi on Desired outcomes for digitalisation of early childhood education and care, pre-primary, primary and lower secondary education.A description of the target state of digital transformation in early childhood education and care, pre-primary, primary and lower secondary education is completed in autumn 2023. The description is drawn up as part of the ‘Framework for Digitalisation in Early Childhood Education and Care, Comprehensive School Education and Liberal Adult Education’ project, which develops the guidance, direction and effectiveness of digitalisation and the anticipation capacity of the Ministry's administrative branch. The description makes concrete the objectives set out in Finland's Digital Compass, Policies for the digitalisation of education and training until 2027, and other significant documents defining how digitalisation should be carried out in the sector from the perspective of early childhood education and care and pre-primary, primary and lower secondary education. Digitalisation is examined through seven areas: preconditions for digitalisation development, digital competence, support for developing digital infrastructure, services and interoperability, data management and quality, data protection and information security, digitalisation-related legislation and legal interpretation, and digitalisation research. The objectives of digitalisation are described in the context of early childhood education and care, pre-primary, primary and lower secondary education. This should enable all those involved in the education and training sector to carry out long-term, proactive and strategically guided work to achieve the desired outcomes. A description of the nationally defined and shared outcomes will help the parties to come up with concrete measures, advancing digital transformation towards the sector's shared target state

Målbild för digitaliseringen av småbarnspedagogiken, förskoleundervisningen och den grundläggande utbildningen

Beskrivningen av målbilden för digitaliseringen av småbarnspedagogiken, förskoleundervisningen och den grundläggande utbildningen blir klar hösten 2023 som en del av projektet för en referensram för digitaliseringen av småbarnspedagogiken, förskoleundervisningen och den grundläggande utbildningen. I projektet utvecklas styrningen och effekterna av digitalisering samt förvaltningsområdets förmåga till förutseende. Genom beskrivningen av målbilden konkretiseras de mål som ställs upp av Finlands digitala kompass, riktlinjerna för digitaliseringen av fostran och utbildning 2027 samt andra betydande dokument som definierar digitalisering inom sektorn för småbarnspedagogikens, förskoleundervisningens och den grundläggande utbildningens del. Digitaliseringen granskas genom sju delområden: förutsättningar för utveckling av digitaliseringen, digital kompetens, stöd för utveckling av digital infrastruktur, tjänster och interoperabilitet, informationshantering och kvalitet, dataskydd och datasäkerhet, lagstiftning och -tolkning gällande digitalisering samt forskning om digitalisering. Målen för digitaliseringen beskrivs i småbarnspedagogikens, förskoleundervisningens och den grundläggande utbildningens kontext. Då kan alla aktörer inom fostran och utbildning arbeta långsiktigt, förutseende och strategiskt för att förverkliga målbilden. Beskrivning av en nationellt definierad och gemensam målbild gör det möjligt att utforma konkreta åtgärder, vilket främjar utvecklingen av digitaliseringen inom sektorn mot den gemensamma målbilden

Relationship of Edoxaban Plasma Concentration and Blood Coagulation in Healthy Volunteers Using Standard Laboratory Tests and Viscoelastic Analysis

The capability of viscoelastic measurement parameters to screen anticoagulation activity of edoxaban in relation to its plasma concentrations was evaluated in 15 healthy male volunteers. Blood samples were drawn before the oral administration of edoxaban 60 mg and 2, 4, 6, 8, and 24 hours after administration. At each time, standard coagulation tests were performed, blood viscoelastic properties were measured with a thromboelastometry device ROTEM delta analyzer (Instrumentation Laboratory, Werfen, Barcelona, Spain), and edoxaban plasma concentrations were measured. Our primary interest was the possible correlation between edoxaban plasma concentrations and values for ROTEM ExTEM, and FibTEM. We also studied the correlation of edoxaban plasma concentrations with the results of standard coagulation tests. We saw the effect of a single dose of edoxaban most clearly in clotting time (CT) of ROTEM ExTEM and FibTEM. Changes in these parameters correlated significantly with edoxaban plasma concentrations up to 6 hours from the ingestion of the drug. Activated partial thromboplastin time, prothrombin time, and anti-factor Xa were also affected. Peak changes were observed 2 and 4 hours after administration of edoxaban. The changes were mostly reversed after 8 hours. In conclusion, ROTEM CT correlates significantly with edoxaban plasma concentrations and can be used to estimate the effect of edoxaban. ROTEM should be considered as part of the assessment of coagulation, with the big advantage of being readily available on site