The reliability of the ICD-AIS map in identifying serious road traffic injuries from the Helsinki Trauma Registry

Objective: The EU has recommended that its member countries compile statistics on the number of serious road traffic injuries. In Finland, the number of seriously injured road traffic patients is assessed using the International Classification of Diseases, 10th Revision (ICD-10) and the automatic conversion tool (ICD-AIS map) developed by The Association for the Advancement of Automotive Medicine (AAAM). The aim of this study was to assess how reliably the ICD-AIS map identifies both serious injuries and seriously injured patients due to road traffic accidents. Methods: Data was derived from the Helsinki Trauma Registry (HTR) and included 215 severe (New Injury Severity Score >15) trauma patients injured in road traffic accidents from the years 2016 and 2017. The severity ratings of injuries (Abbreviated Injury Scale, AIS 3+) and patients (Maximum Abbreviated Injury Scale, MAIS 3+) were determined by direct AIS coding of the HTR and were also generated by the ICD-AIS map based on ICD-10 injury codes. These two ratings were compared by injury mechanism and Injury Severity Score (155) body regions. The strength of agreement was described using Cohen's kappa. The most common injury codes with errors in severity rating by the ICD-AIS map were presented. Results: The number of seriously injured patients by the ICD-AIS map was 21% lower, and the number of serious injuries was 36% lower than the corresponding numbers by direct coding. The exact agreement of the injury ratings was 72% (kappa = 0.44, 95% CI 0.42-0.46). Most of the conversion errors were due to the simplicity of the ICD-10 codes used in Finland compared to those used in the ICD-AIS map (ICD-10-CM) and the missing codes from the ICD-AIS map. The most frequent misclassifications were due to multiple rib fractures, visceral organ injuries, some open fractures of extremities, and specific head injuries. Missing codes were most common in face, chest, and limb injuries. Conclusions: The ICD-10 injury codes presently used in Finland should be more specific to permit reliable conversion results by the ICD-AIS map. The problem with missing codes should be considered more closely. When implementing the ICD-11, all detailed injury codes should be introduced. (C) 2019 Elsevier Ltd. All rights reserved.Peer reviewe

Minor troponin T elevation and mortality in patients with atrial fibrillation presenting to the emergency department

Background There are limited data on the association of minor troponin elevation in unselected patients with atrial fibrillation (AF) presenting to the emergency department (ED) with adverse events. In this study, we sought to assess the early and mid-term mortality of these patients. Methods In this observational study, 2911 patients with AF were admitted to the ED. They were divided into 3 groups based on peak high-sensitivity troponin (TnT) levels: normal ( Results All-cause mortality was 6.7% (n = 196) at 30 days and 22.2% (n = 646) at 1 year. Mortality rate increased along with increasing levels of TnT irrespective of baseline covariates, primary discharge diagnosis and type of AF. A significant association between TnT levels and all-cause mortality was observed. The adjusted hazard ratio (HR) at 30 days was 6.02 (95% CI 2.62-13.83) for TnT 15-50 ng/L and 11.28 (95% CI 4.87-26.12) for TnT 51-100 ng/L (P Conclusions Among patients with AF admitted to the ED, increased TnT levels were associated with increased early and mid-term all-cause mortality irrespective of baseline covariates and type of AF.Peer reviewe

Positiivinen pedagogiikka luokanopettajan työssä:voimavaroja vahvuuksista

Tiivistelmä. Tämän kandidaatintyön tavoitteena on määritellä positiivisen pedagogiikan pääpiirteitä ja tutkia, miten luokanopettaja voi toteuttaa positiivista pedagogiikkaa opetuksessaan. Tutkimuksella pyritään löytämään positiivisen pedagogiikan menetelmiä. Positiivinen pedagogiikka on oppilaan luonteenvahvuuksiin sekä voimavaroihin keskittyvä kasvatuksellinen suuntaus, joka pyrkii ennaltaehkäisemään ongelmia sekä keskittymään yksilön hyvinvointia edistäviin tekijöihin. Valitsimme aiheen tutkimusalan tuoreuden, oman kiinnostuksen sekä opettajan näkökulman tutkimisen tarpeellisuuden vuoksi. Tutkimuksessa perehdytään integratiivista kirjallisuuskatsausta käyttäen positiivisen pedagogiikan kansainväliseen sekä suomalaiseen tieteelliseen kirjallisuuteen sekä tutkimuksiin. Positiivista pedagogiikkaa voidaan toteuttaa pedagogisena ja kasvatuksellisena lähtökohtana, jolloin se ilmenee arjen vuorovaikutustilanteissa. Luonteenvahvuuksia ja keskeisiä kehitettäviä taitoja kuten resilienssiä ja positiivista kasvun asennetta voidaan opettaa myös projekteina tai lyhempinä tuokioina. Opettajan roolimallin ja esimerkin kautta oppilaat oppivat tiedostamaan sekä kehittämään omia vahvuuksia, toiminta- ja ajattelumallejaan. Positiivisen pedagogiikan tavoitteena on tarjota oppilaalle voimavaroja sekä uusia keinoja selvitä arjen haastavistakin tilanteista. Positiivinen pedagogiikka tarjoaa luokanopettajille pedagogisia toimintatapoja, joiden avulla lapsen itsetuntoa, minäkäsitystä, itsesäätelyä, tunnetaitoja sekä sosiaalisia taitoja voidaan parantaa, saavuttaa parempia oppimistuloksia ja luoda hyvinvoivia yksilöitä. Tämän tutkimuksen tuloksia ei voida yleistää, sillä aihe on tuore ja tutkimukset ovat suurimmalta osin ulkomaalaisia. Tulokset ovat kuitenkin sovellettavissa opetuksen lähtökohdiksi suomalaiseen koulukontekstiin. Jatkotutkimuksena olisi tarpeellista perehtyä oppilaan kokemuksiin positiivisesta pedagogiikasta

The effect of a probiotic blend on gastrointestinal symptoms in constipated patients: A double blind, randomised, placebo controlled 2-week trial

Selected strains of lactobacilli and bifidobacteria are known to ameliorate constipation-related symptoms and have previously shown efficacy on digestive health. In this clinical trial, the safety and effectiveness of a probiotic blend containing lactobacilli and bifidobacteria were evaluated in adults with self-reported bloating and functional constipation. Constipation was diagnosed by the Rome III criteria. A total of 156 adults were randomised into this double-blind and placebo-controlled trial. Participants consumed the combination of Lactobacillus acidophilus NCFM (1010 cfu), Lactobacillus paracasei Lpc-37 (2.5×109 cfu), Bifidobacterium animalis subsp. lactis strains Bl-04 (2.5×109 cfu), Bi-07 (2.5×109 cfu) and HN019 (1010 cfu) (n=78), or placebo (microcrystalline cellulose) (n=78) for two weeks. After treatment the following were measured: primary outcome of bloating and secondary outcomes of colonic transit time, bowel movement frequency, stool consistency, other gastrointestinal symptoms (flatulence, abdominal pain, and burbling), constipation-related questionnaires (PAC-SYM and PAC-QoL) and product satisfaction. Faecal recovery of consumed strains was determined. The enrolled population was defined as constipated, however, the initial bloating severity was lower than in previous similar studies. No clinically significant observations related to the safety of the product were reported. Product efficacy was not shown in the primary analysis for bloating nor for the secondary efficacy analyses. The placebo functioned similarly as the probiotic product. In post-hoc analysis, a statistically significant decrease in flatulence in favour of the probiotic group was observed; day 7 (intention-to-treat (ITT): P=0.0313; per-protocol (PP): 0.0253) and on day 14 (ITT: P=0.0116; PP: P=0.0102) as measured by area under the curve (AUC) analysis. The mean AUC of all symptoms decreased in favour of the probiotic group, indicating less digestive discomfort. The study was registered at the ISRCTN registry (ISRCTN41607808)

An inventory of collaborative medication reviews for older adults-evolution of practices

Background Collaborative medication review (CMR) practices for older adults are evolving in many countries. Development has been under way in Finland for over a decade, but no inventory of evolved practices has been conducted. The aim of this study was to identify and describe CMR practices in Finland after 10 years of developement. Methods An inventory of CMR practices was conducted using a snowballing approach and an open call in the Finnish Medicines Agency's website in 2015. Data were quantitatively analysed using descriptive statistics and qualitatively by inductive thematic content analysis. Clyne et al's medication review typology was applied for evaluating comprehensiveness of the practices. Results In total, 43 practices were identified, of which 22 (51%) were designed for older adults in primary care. The majority (n = 30, 70%) of the practices were clinical CMRs, with 18 (42%) of them being in routine use. A checklist with criteria was used in 19 (44%) of the practices to identify patients with polypharmacy (n = 6), falls (n = 5), and renal dysfunction (n = 5) as the most common criteria for CMR. Patients were involved in 32 (74%) of the practices, mostly as a source of information via interview (n = 27, 63%). A medication care plan was discussed with the patient in 17 practices (40%), and it was established systematically as usual care to all or selected patient groups in 11 (26%) of the practices. All or selected patients' medication lists were reconciled in 15 practices (35%). Nearly half of the practices (n = 19, 44%) lacked explicit methods for following up effects of medication changes. When reported, the effects were followed up as a routine control (n = 9, 21%) or in a follow-up appointment (n = 6, 14%). Conclusions Different MRs in varying settings were available and in routine use, the majority being comprehensive CMRs designed for primary outpatient care and for older adults. Even though practices might benefit from national standardization, flexibility in their customization according to context, medical and patient needs, and available resources is important.Peer reviewe

Time-course of left ventricle function during mild therapeutic hypothermia in out-of-hospital cardiac arrest patients

Peer reviewe

Reliability of pulse palpation in the detection of atrial fibrillation in an elderly population

Purpose: Atrial fibrillation (AF) may first present as an ischemic stroke. Pulse palpation is a potential screening method for asymptomatic AF. We aimed to assess the reliability of pulse palpation by the elderly in detecting AF.Materials and methods: After brief information and training session conducted by a nurse, 173 subjects aged 75 years were instructed to palpate their pulse regularly for a month. After this, their ability to distinguish sinus rhythm (SR), SR with premature ventricular contractions (PVC) and AF by pulse palpation was assessed using an anatomic human arm model programmable with various rhythms. A control group of 57 healthcare professionals received the same information but not the training. Subjects unable to find the pulse were excluded (25 (14.5%) of the elderly and none in the healthcare group).Results: The median age of the elderly subjects was 78.4 [3.9] years and 98 (56.6%) were women. There were no differences between the elderly and healthcare groups in detecting SR (97.3% vs. 96.5%) or SR with PVCs (74.3% vs. 71.4%), but the elderly subjects identified slow (81.8% vs. 56.1%) and fast AF (91.9% vs. 80.7%) significantly better than the healthcare group. The ability to recognize SR with PVCs by the elderly was independently predicted by previous pulse palpation experience, secondary or higher level of education and one-point increase in MMSE score, while identifying the other rhythms had no predictors.Conclusions: The elderly can learn to reliably distinguish a normal rhythm after education. Pulse self-palpation may be a useful low-cost method to screen for asymptomatic AF

Keuhkovaltimoiden pallolaajennus - uusi hoito krooniseen tromboemboliseen pulmonaalihypertensioon

• Krooninen tromboembolinen pulmonaalihypertensio huonontaa merkittävästi elämänlaatua. Hoitamattomana se voi johtaa ennenaikaiseen kuolemaan.• Taudin vakiintunut hoitomuoto on kirurginen keuhkovaltimoiden endarterektomia. Lähes puolelle potilaista seei sovi tai tulos jää huonoksi.• Keuhkovaltimoiden pallolaajennus on uusi tehokas hoito osalle potilaista.• TYKS:n Sydänkeskuksessa on tehty keuhkovaltimoiden pallolaajennuksia vuodesta 2016 ja tulokset ovat olleet rohkaisevia.</p