Reliability of prehospital patient classification in helicopter emergency medical service missions

Background Several scores and codes are used in prehospital clinical quality registries but little is known of their reliability. The aim of this study is to evaluate the inter-rater reliability of the American Society of Anesthesiologists physical status (ASA-PS) classification system, HEMS benefit score (HBS), International Classification of Primary Care, second edition (ICPC-2) and Eastern Cooperative Oncology Group (ECOG) performance status in a helicopter emergency medical service (HEMS) clinical quality registry (CQR). Methods All physicians and paramedics working in HEMS in Finland and responsible for patient registration were asked to participate in this study. The participants entered data of six written fictional missions in the national CQR. The inter-rater reliability of the ASA-PS, HBS, ICPC-2 and ECOG were evaluated using an overall agreement and free-marginal multi-rater kappa (Kappa(free)). Results All 59 Finnish HEMS physicians and paramedics were invited to participate in this study, of which 43 responded and 16 did not answer. One participant was excluded due to unfinished data entering. ASA-PS had an overall agreement of 40.2% and Kappa(free) of 0.28 in this study. HBS had an overall agreement of 44.7% and Kappa(free) of 0.39. ICPC-2 coding had an overall agreement of 51.5% and Kappa(free) of 0.47. ECOG had an overall agreement of 49.6% and Kappa(free) of 0.40. Conclusion This study suggests a marked inter-rater unreliability in prehospital patient scoring and coding even in a relatively uniform group of practitioners working in a highly focused environment. This indicates that the scores and codes should be specifically designed or adapted for prehospital use, and the users should be provided with clear and thorough instructions on how to use them.Peer reviewe

The reliability and accuracy of operational system data in a nationwide helicopter emergency medical services mission database

Aim The aim of this study was to evaluate the reliability and accuracy of documentation in FinnHEMS database, which is a nationwide helicopter emergency service (HEMS) clinical quality registry. Methods This is a nationwide study based on written fictional clinical scenarios. Study subjects were HEMS physicians and paramedics, who filled in the clinical quality registry based on the clinical scenarios. The inter-rater -reliability of the collected data was analyzed with percent agreement and free-marginal multi-rater kappa. Results Dispatch coding had a percent agreement of 91% and free-marginal multi-rater kappa value of 0.83. Coding for transportation or mission cancellation resulted in an agreement of 84% and free-marginal kappa value of 0.68. An agreement of 82% and a kappa value of 0.73 for dispatcher coding was found. Mission end, arrival at hospital and HEMS unit dispatch -times had agreements from 80 to 85% and kappa values from 0.61 to 0.73. The emergency call to dispatch centre time had an agreement of 71% and kappa value of 0.56. The documentation of pain had an agreement of 73% on both the first and second measurements. All other vital parameters had less than 70% agreement and 0.40 kappa value in the first measurement. The documentation of secondary vital parameter measurements resulted in agreements from 72 to 91% and kappa values from 0.43 to 0.64. Conclusion Data from HEMS operations can be gathered reliably in a national clinical quality registry. This study revealed some inaccuracies in data registration and data quality, which are important to detect to improve the overall reliability and validity of the HEMS clinical quality register.Peer reviewe

The reliability and accuracy of operational system data in a nationwide helicopter emergency medical services mission database

Aim The aim of this study was to evaluate the reliability and accuracy of documentation in FinnHEMS database, which is a nationwide helicopter emergency service (HEMS) clinical quality registry. Methods This is a nationwide study based on written fictional clinical scenarios. Study subjects were HEMS physicians and paramedics, who filled in the clinical quality registry based on the clinical scenarios. The inter-rater -reliability of the collected data was analyzed with percent agreement and free-marginal multi-rater kappa. Results Dispatch coding had a percent agreement of 91% and free-marginal multi-rater kappa value of 0.83. Coding for transportation or mission cancellation resulted in an agreement of 84% and free-marginal kappa value of 0.68. An agreement of 82% and a kappa value of 0.73 for dispatcher coding was found. Mission end, arrival at hospital and HEMS unit dispatch -times had agreements from 80 to 85% and kappa values from 0.61 to 0.73. The emergency call to dispatch centre time had an agreement of 71% and kappa value of 0.56. The documentation of pain had an agreement of 73% on both the first and second measurements. All other vital parameters had less than 70% agreement and 0.40 kappa value in the first measurement. The documentation of secondary vital parameter measurements resulted in agreements from 72 to 91% and kappa values from 0.43 to 0.64. Conclusion Data from HEMS operations can be gathered reliably in a national clinical quality registry. This study revealed some inaccuracies in data registration and data quality, which are important to detect to improve the overall reliability and validity of the HEMS clinical quality register

Stabilization of the number of Bose-Einstein condensed atoms in evaporative cooling via three-body recombination loss

The dynamics of evaporative cooling of magnetically trapped $^{87}$Rb atoms is studied on the basis of the quantum kinetic theory of a Bose gas. We carried out the quantitative calculations of the time evolution of conventional evaporative cooling where the frequency of the radio-frequency magnetic field is swept exponentially. This "exponential-sweep cooling" is known to become inefficient at the final stage of the cooling process due to a serious three-body recombination loss. We precisely examine how the growth of a Bose-Einstein condensate depends on the experimental parameters of evaporative cooling, such as the initial number of trapped atoms, the initial temperature, and the bias field of a magnetic trap. It is shown that three-body recombination drastically depletes the trapped $^{87}$Rb atoms as the system approaches the quantum degenerate region and the number of condensed atoms finally becomes insensitive to these experimental parameters. This result indicates that the final number of condensed atoms is well stabilized by a large nonlinear three-body loss against the fluctuations of experimental conditions in evaporative cooling.Comment: 7 pages, REVTeX4, 8 eps figures, Phys. Rev A in pres

Reliability of prehospital patient classification in helicopter emergency medical service missions

BackgroundSeveral scores and codes are used in prehospital clinical quality registries but little is known of their reliability. The aim of this study is to evaluate the inter-rater reliability of the American Society of Anesthesiologists physical status (ASA-PS) classification system, HEMS benefit score (HBS), International Classification of Primary Care, second edition (ICPC-2) and Eastern Cooperative Oncology Group (ECOG) performance status in a helicopter emergency medical service (HEMS) clinical quality registry (CQR).MethodsAll physicians and paramedics working in HEMS in Finland and responsible for patient registration were asked to participate in this study. The participants entered data of six written fictional missions in the national CQR. The inter-rater reliability of the ASA-PS, HBS, ICPC-2 and ECOG were evaluated using an overall agreement and free-marginal multi-rater kappa (Kappa(free)). ResultsAll 59 Finnish HEMS physicians and paramedics were invited to participate in this study, of which 43 responded and 16 did not answer. One participant was excluded due to unfinished data entering. ASA-PS had an overall agreement of 40.2% and Kappa(free) of 0.28 in this study. HBS had an overall agreement of 44.7% and Kappa(free) of 0.39. ICPC-2 coding had an overall agreement of 51.5% and Kappa(free) of 0.47. ECOG had an overall agreement of 49.6% and Kappa(free) of 0.40.ConclusionThis study suggests a marked inter-rater unreliability in prehospital patient scoring and coding even in a relatively uniform group of practitioners working in a highly focused environment. This indicates that the scores and codes should be specifically designed or adapted for prehospital use, and the users should be provided with clear and thorough instructions on how to use them.</div

Kansallinen allergiaohjelma 2008-2018 muutti asenteita ja vähensi sairastavuutta

Lähtökohdat : Allergiaohjelma 2008–2018 on kansallinen kansanterveysohjelma, jonka avulla välttö­strategia on käännetty sietostrategiaksi ja painotettu allergiaterveyttä. Raportoimme 10 vuoden tulokset.Menetelmät : Ohjelmalla oli kuusi tavoitetta, joiden toteuttamiseksi määriteltiin tehtävät, työkalut ja mittarit. Ohjelmaa toteutettiin kouluttamalla terveydenhuoltoa ja viestimällä väestölle.Tulokset : Astman ja allergisen nuhan esiintyvyys tasoittui asevelvollisissa ja Helsingin aikuisväestössä. Helsingin aikuisista astmaatikoista 41 % oli ollut vuoden 2016 kyselyä edeltäneen vuoden oireettomia (31 % 2006). Lasten allergiaruokavaliot vähenivät koko maassa noin puoleen. Työperäiset allergiset sairaudet vähenivät 45 %. Astman sairaalahoidon tarve puolittui, mutta päivystyskäynnit vähenivät oleellisesti vain lapsilla. Anafylaksia aiheutti aiempaa enemmän päivystyskäyntejä. Allergiasta ja astmasta aiheutuvat vuosittaiset suorat ja epäsuorat kustannukset vähenivät 200 miljoonaa euroa ­(30 %) verrattaessa vuosia 2007 ja 2018.Päätelmät : Allergian ja astman aiheuttama sairastavuus ja niistä koituvat kustannukset vähenivät merkittävästi. Haitat vähenivät aluksi nopeasti, myöhemmin hitaammin. Ammattilaiset ja suuri yleisö hyväksyivät uuden suunnan, jossa painottuivat sietokyky ja terveys allergiasta huolimatta. Tietoon perustuvat systemaattiset ohjelmat ovat vahva keino parantaa kansanterveyttä

Multifactor effects and evidence of potential interaction between complement factor H Y402H and LOC387715 A69S in age-related macular degeneration

Peer reviewe