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

Saalistus ja tulvat uhkina Perämeren etelänsuosirrin (Calidris alpina schinzii) pesimämenestykselle

Tiivistelmä. Lajien uhanalaisuuden seurannalla ja suojelulla pyritään pysäyttämään kiihtyvää luonnon monimuotoisuuden köyhtymistä. Uhanalaisuuden jatkuva seuranta mahdollistaa nopean reagoinnin eliölajin tilan heikkenemiseen. Uhanalaistumisen syyt ovat useimmiten ihmisen välillisesti tai välittömästi aiheuttamia. Ilmastonmuutos vaikuttaa lajistoon aikaistamalla kevään kulkua sekä lisäämällä sään vaihtelua ja sään ääri-ilmiöiden esiintymistä. Osalla lajeista edellä mainitut ilmiöt vaikuttavat muun muassa populaatioiden kasvuun, mutta myös sen vaihtelua lisäävästi, mikä voi edistää niiden tilan heikkenemistä. Pitkäikäisillä lajeilla lisääntyminen on alttiimpaa ympäristön vaikutuksille kuten pedoille, ravinnolle ja säälle. Varsinkin maassa pesivät linnut ovat alttiita saalistukselle, ja rannoilla pesät voivat tuhoutua tulvien takia. Pitkäaikaismuutokset lisääntymisessä voivat johtaa lintupopulaatioiden häviämiseen, joten on tärkeää selvittää, onko uhanalaisten lajien pesinnän onnistuminen heikentynyt ja mitkä tekijät vaikuttavat pesien säilyvyyteen. Pro gradu -tutkielmassani tutkin saalistuksen ja tulvien vaikutuksia Perämeren etelänsuosirrin (Calidris alpina schinzii) pesimämenestykseen pitkäaikaisaineiston (2002–2020) avulla. Suomessa etelänsuosirri on luokiteltu erittäin uhanalaiseksi (EN). Sen elinympäristöjä ovat niittyrannat ja avoimet tulvarannat. Lajin pesimäympäristöt vähenevät ja niiden laatu heikkenee erityisesti rantaniittyjen laidunnuksen loppumisen myötä sulkeutuvan kasvillisuuden takia. Lisääntynyt ja ajoittain kova saalistuspaine uhkaa Perämeren alueella pesiviä lintulajeja ja etelänsuosirri on pienen populaatiokokonsa vuoksi erityisen altis myös satunnaistekijöille, kuten pesimäaikaisille tulville. Selvitän tutkielmassani, onko pesäsäilyvyystodennäköisyydessä ajallista pitkäaikaisvaihtelua ja testaan, onko populaation pesäsäilyvyys heikentynyt. Selvitän, onko pesäsäilyvyyden ajallinen vaihtelu yhteydessä pesinnän ajoitukseen. Testaan myös toimivatko etelänsuosirrien pesät vaihtoehtoisena saaliina myyriä saalistaville pedoille. Tutkin meriveden vaihtelevan korkeuden merkitystä pesien säilymiselle, sekä pohdin tulvatuhojen merkitystä tulevaisuudessa. Pesien säilyvyys ei heikentynyt tutkimusjakson aikana, mutta se vaihteli vuosien välillä. Yleisin pesän tuhoutumisen syy oli saalistus, mutta se ei lisääntynyt tutkimuksen aikana. Pienjyrsijöiden määrän vaihtelu keväällä ja syksyllä selitti pesäsäilyvyyden ajallista vaihtelua tukien vaihtoehtosaalishypoteesia. Pesinnän aloitusajankohta oli yhteydessä pesäsäilyvyyden vuosivaihteluun. Aikaisena keväänä oli parempi pesäsäilyvyys. Säilyvyys tulvilta heikkeni tutkimuksen aikana, sillä tuulitulvat ovat lisääntyneet viimeisen viiden vuosikymmenen aikana. Ilmastonmuutos voi siis vaikuttaa aikaistamalla keväitä, mutta myös lisäämällä tulvia. Tulvien lisääntyminen on suuri uhka etelänsuosirripopulaatiolle. Jatkotutkimuksissa tulisi selvittää eri ympäristötekijöiden vaikutuksia tulvien ja saalistuksen aiheuttamiin pesätuhoihin.Predation and floods threatening the nesting success of the Southern Dunlins (Calidris alpina schinzii) living in the Bothnian Bay. Abstract. Monitoring and controlling endangered species aim to halt the accelerating loss of biodiversity. Continuous monitoring of the endangered species allows a faster response to the weakening condition of the species. The causes of endangerment are most often directly or indirectly caused by humans. Climate change is affecting the species by advancing springs, increasing variation of weather and the occurrence of the extreme weather events. These factors affect, among other things, to increased variability in population growth rates, which contributes to population decline. Reproduction in long-lived species is more sensitive to environmental influences such as predators, nutrition, and weather. Especially ground-nesting birds are more exposed to predation and on the shores, nests can be destroyed by floods. Long-term changes in reproduction can lead to the extinction of bird populations, so it is important to determine whether the nesting success of endangered species is impaired and what factors affect nest survival. In my master’s thesis, I study the effect of predation and floods on the nesting success of the Southern Dunlin (Calidris alpina schinzii), living in Bothnian Bay, using long-term data (2002–2020). In Finland, the Southern Dunlin has been classified as endangered (EN). Its habitats are coastal meadows and open floodplains. Area of these is decreasing, due to the overgrowth caused by the end of traditional grazing and eutrophication of the weathers. Increased predation pressure threatens bird species nesting in the Bay of Bothnia, and due to its small population size, the Southern Dunlin is also exposed to random environmental factors such as flooding during nesting. In my research, I study whether there is a variation in the probability of survival over time and test whether the species survival is impaired. I study whether the temporal variation of these survival probabilities is related to the onset of egg laying. Also, I test whether the nests of the Southern Dunlin act as an alternative prey for species preferring voles and small rodents in the peak years. I study the significance of varying sea level for the survival, and I discuss the significance of flood damage in the future. Nest survival did not decrease during the study period, but it varied between years. The most common cause of nest loss was predation, but it did not increase during the study. The variation in the number of small rodents in spring and autumn explained the temporal variation and it gave support to the alternative prey hypothesis. The start date of nesting was related to the annual variation of nest survival. In early springs nesting success was better. Survival from floods decreased during the study as wind floods have increased over the last five decades. Climate change can therefore have an impact by advancing springs, but also increasing flooding. The increase of floods is a major threat to the Southern Dunlin population. Further research should investigate the effects of various environmental factors of damage caused by floods and predation

Sosiaalinen media soitonopiskelun tukena

Tiivistelmä. Tämä pro gradu -tutkielma käsittelee sitä, miten sosiaalinen media toimii oppimisympäristönä soitonopiskelussa. Uudet oppimisympäristöt ovat tänä päivänä suuressa suosiossa sekä lähiopetuksen että etäopetuksen piirissä. Tilastojen mukaan prosentuaalisesti suuri osa väestöstä on kirjautuneena sosiaalisen median palveluihin ja viettävät myös runsaasti aikaa sen parissa. Sosiaalinen media on ottanut paikkansa myös soitonopiskelussa. Tutkimusosuudessa tarkastelin oppimista sekä median aikaisempia tutkimuksia ja käsitteitä. Käytin tutkimusmuotona survey-tutkimusta ja haastattelut toteutettiin teemahaastattelulle tyypillisin keinoin. Haastateltaville esitin viisi pääkysymystä, johon tarpeen vaatiessa esitin lisäkysymyksiä. Haastattelut toteutettiin kasvotusten ja tallennettiin puhelimen ääninauhurille. Haastattelusta kerätyn aineiston purin litteroinnin ja värikoodauksen avulla. Tämän jälkeen analysoin huolellisesti aineistolähtöisen sisällönanalyysin avulla. Tutkimustulosten mukaan sosiaalinen media antaa monia eri kulmia soitonopiskelulle, jota perinteinen opetusmalli ei tarjoa. Merkittäviksi eduiksi median tarjoamassa sisällössä koettiin esimerkiksi sen helppo saatavuus, monipuolisuus sekä tavoitettavuus ajasta tai paikasta riippumatta. Eri alustoilla koettiin olevan myös motivoiva vaikutus oppimiseen. Sen koettiin myös nostattavan yhteisöllisyyttä muusikoiden, opettajien ja muiden musiikin ammattilaisten keskuudessa. Sosiaalisen median sisällöstä koettiin olevan myös haitallisia vaikutuksia oppimiselle. Yhtenä suurimpana haittana mainittiin opettajan ja opiskelijan välinen kommunikoinnin ja lähietäisyyden puuttuminen. Tämän myötä myös välittömän palautteen saaminen on mahdotonta. Palautteella on suuri merkitys ja sillä voidaan korjata nopeasti pieniä tai suuria asioita. Tutkittavat nostivat esille eri instrumenttien soittotekniikkaan liittyvät opit. Ilman opettajan läsnäoloa ja palautetta tekniikka saatetaan oppia väärin. Tällä saattaa olla pitkäaikaisia vaikutuksia ja ilmentyä fyysisinä ongelmina. Tutkimus osoitti, että sosiaalisella medialla on paikkansa myös soitonopetuksen tukena. Voidaan todeta, että se ei ole korvannut eikä tule korvaamaan perinteistä opetusmallia. Sen sisältö tarjoaa ja mahdollistaa monia asioita, mutta ei pysty vastaamaan kaikkiin soitonopiskeluun liittyviin kysymyksiin tai tarpeisiin. Sosiaalinen media toimii hyvänä tukena itsenäisen soitonopiskelun ohella.Learning to play music via social media. Abstract. This master’s thesis deals with how social media functions as a learning environment in instrumental learning. Nowadays new learning environments are very popular in contact teaching as well as in distance learning. According to statistics, a large percentage of the population uses social media services and also spend a lot of time using it. Social media has also taken its place in learning to play music. In the theoretical part of the work previous research projects and the concepts of media education are discussed. Based on the theory a survey research was used and the interviews were conducted by means typical of a thematic interview. I asked the interviewees five main questions, to which I asked additional questions if necessary. Interviews were conducted face-to-face and recorded on a telephone voice recorder. Through the spelling and color coding of the material collected from the interview. I then carefully analyzed using data-driven content analysis. According to the research results, social media gives many different angles to the study of playing, which the traditional teaching model does not offer. Significant advantages in the content provided by the media were felt to be that it is easily accessible, diverse and accessible regardless of time or place. Different platforms were also felt to have a motivating effect on learning. It was also felt to foster communality between musicians, teachers and other music professionals. Social media content was also perceived to have detrimental effects on learning. One of the biggest disadvantages mentioned was the communication between the teacher and the student and the lack of close distance. This also makes it impossible to get immediate feedback. Feedback is very important and can be used to quickly fix small or large things. The interviewees highlighted the teachings related to the playing technique of different instruments. Without the presence and feedback of a teacher, the technique may be learned incorrectly. This can have long-term effects and even physical problems. The study showed that social media also has a place in the playing field of playing music. It can be said that it has not replaced and will not replace the traditional teaching model. Its content offers and enables many things but is not able to answer all the questions or needs related to playing music. Social media serves as a good support alongside independent play learning

Comparison of drug-related problem risk assessment tools for older adults : a systematic review

Purpose This study aims to systematically review studies describing screening tools that assess the risk for drug-related problems (DRPs) in older adults (>= 60 years). The focus of the review is to compare DRP risks listed in different tools and describe their development methods and validation. Methods The systematic search was conducted using evidence-based medicine, Medline Ovid, Scopus, and Web of Science databases from January 1, 1985, to April 7, 2016. Publications describing general DRP risk assessment tools for older adults written in English were included. Disease, therapy, and drug-specific tools were excluded. Outcome measures included an assessment tool's content, development methods, and validation assessment. Results The search produced 15 publications describing 11 DRP risk assessment tools. Three major categories of risks for DRPs included (1) patient or caregiver related risks; (2) pharmacotherapy-related risks; and (3) medication use process-related risks. Of all the risks included in the tools only 8 criteria appeared in at least 4 of the tools, problems remembering to take the medication being the most common (n=7). Validation assessments varied and content validation was the most commonly conducted (n = 9). Reliability assessment was conducted for 6 tools, most commonly by calculating internal consistency (n = 3) and inter-rater reliability (n = 2). Conclusions The considerable variety between the contents of the tools indicates that there is no consensus on the risk factors for DRPs that should be screened in older adults taking multiple medicines. Further research is needed to improve the accuracy and timeliness of the DRP risk assessment tools.Peer reviewe

Usefulness of Post-coronary Dilation to Prevent Recurrent Myocardial Infarction in Patients Treated With Percutaneous Coronary Intervention for Acute Coronary Syndrome (from the BASE ACS Trial)

Stent underexpansion is associated with worse outcome after stent implantation. Whether post-dilation (PD) improves outcome in patients with acute coronary syndrome (ACS) remains unclear. We performed post hoc analysis of outcome in patients from the BASE ACS (A prospective randomized comparison of titanium-nitride-oxide-coated bioactive stents with everolimus-eluting stents in acute coronary syndrome) trial who underwent PD versus those who did not. The BASE ACS trial randomized 827 patients (1:1) with ACS to receive either titanium-nitride-oxide coated bioactive stents or everolimus-eluting stents. The primary end point was major adverse cardiac events (MACE): a composite of cardiac death, nonfatal myocardial infarction (MI), or ischemia-driven target lesion revascularization. Follow-up was planned at 12 months and yearly thereafter for up to 7 years. Of 827 patients enrolled in the BASE ACS trial, 357 (43.2%) underwent PD. Median follow-up duration was 5 years. Patients who, underwent PD had less frequent nonfatal MI events at long-term follow-up, compared with those who did not (4.5% vs 8.5%, respectively, p = 0.02). The rates of MACE (15.7% vs 15.1%, respectively, p = 0.81), and the other endpoints, were not significantly different (p >0.5 for all). The results were consistent in propensity score matched analysis (270 pairs). In patients treated with bioactive stents, those who underwent PD had a trend for a fewer nonfatal MI events (p = 0.076). Comparably, in patients treated with everofimus-eluting stents, MACE and all the individual end points were comparable (p >0.5 for all). In conclusion, patients treated with early percutaneous coronary intervention for ACS who underwent PD had less frequent nonfatal MI events at long-term follow-up, compared with those who did not; MACE rates were not significantly different. (C) 2016 Elsevier Inc. All rights reserved.Peer reviewe

Association of Heart Rate With Troponin Levels Among Patients With Symptomatic Atrial Fibrillation

This cohort study investigates heart rate and cardiac troponin levels in patients admitted to the emergency department with symptomatic atrial fibrillation.Non peer reviewe

Developing a procedure for medication reconciliation and review on admission to geriatric wards

Peer reviewe

Void conditions and potential for mould growth in insulated and uninsulated suspended timber ground floors

PURPOSE: Millions of properties have suspended timber ground floors globally, with around ten million in the UK alone. However, it is unknown what the floor void conditions are, nor the effect of insulating such floors. Upgrading floors changes the void conditions, which might increase or decrease moisture build-up and mould and fungal growth. The purpose of this paper is to provide a review of the current global evidence and present the results of in situ monitoring of 15 UK floor voids. DESIGN/METHODOLOGY/APPROACH: An extensive literature review on the moisture behaviour in both uninsulated and insulated suspended timber crawl spaces is supplemented with primary data of a monitoring campaign during different periods between 2012 and 2015. Air temperature and relative humidity sensors were placed in different floor void locations. Where possible, crawl spaces were visually inspected. FINDINGS: Comparison of void conditions to mould growth thresholds highlights that a large number of monitored floor voids might exceed the critical ranges for mould growth, leading to potential occupant health impacts if mould spores transfer into living spaces above. A direct comparison could not be made between insulated and uninsulated floors in the sample due to non-random sampling and because the insulated floors included historically damp floors. The study also highlighted that long-term monitoring over all seasons and high-resolution monitoring and inspection are required; conditions in one location are not representative of conditions in other locations. ORIGINALITY/VALUE: This study presents the largest UK sample of monitored floors, evaluated using a review of current evidence and comparison with literature thresholds