Ambulance crew-initiated non-conveyance in the Helsinki EMS system-A retrospective cohort study

Background Ambulance patients are usually transported to the hospital in the emergency medical service (EMS) system. The aim of this study was to describe the non-conveyance practice in the Helsinki EMS system and to report mortality following non-conveyance decisions. Methods All prehospital patients >= 16 years attended by the EMS but not transported to a hospital during 2013-2017 were included in the study. EMS mission- and patient-related factors were collected and examined in relation to patient death within 30 days of the EMS non-conveyance decision. Results The EMS performed 324,207 missions with a patient during the study period. The patient was not transported in 95,909 (29.6%) missions; 72,233 missions met the study criteria. The patient mean age (standard deviation) was 59.5 (22.5) years; 55.5% of patients were female. The most common dispatch codes were malaise (15.0%), suspected decline in vital signs (14.0%), and falling over (12.9%). A total of 960 (1.3%) patients died within 30 days after the non-conveyance decision. Multivariate logistic regression analysis revealed that mortality was associated with the patient's inability to walk (odds ratio 3.19, 95% confidence interval 2.67-3.80), ambulance dispatch due to shortness of breath (2.73, 2.27-3.27), decreased level of consciousness (2.72, 1.75-4.10), decreased blood oxygen saturation (2.64, 2.27-3.06), and abnormal systolic blood pressure (2.48, 1.79-3.37). Conclusion One-third of EMS missions did not result in patient transport to the hospital. Thirty-day mortality was 1.3%. Abnormalities in multiple respiratory-related vital signs were associated with an increased likelihood of death within 30 days.Peer reviewe

Kotihoidon asiakkaiden avuntarve lisää ensihoitohälytyksiä

Tutkimuksen tavoitteena oli tutkia, mitkä tekijät ovat yhteydessä kotihoidon asiakkaiden ensihoitohälytyksiin ja päivystyskäynteihin ja kuinka yleisesti ensihoitoyksikkö tekee kuljettamatta jättämispäätöksiä kotihoidon ja palvelutalojen asiakkaille. Tutkimuksen rekisteriaineiston muodostivat Helsingin kotihoidon käyntiaineisto, ensihoidon tehtäväaineisto ja päivystyskäyntiaineisto vuosilta 2017 ja 2018. Tulosten mukaan alle viidesosassa kotihoidon asiakkaiden ensihoitotehtävistä hoidon tarve oli kiireellinen tai potilas oli hengenvaarassa. Ensihoitoyksikkö teki kuljettamatta jättämispäätöksen kolmasosassa kotihoidon asiakkaiden ensihoitotehtävistä. Ensihoitohälytykseen ja päivystyskäyntiin kotihoidon asiakkailla vuonna 2018 olivat yhteydessä asiakkaan korkea ikä, miessukupuoli, suuri avuntarve, kotihoidon suoritteiden suuri määrä, kotihoitoyksikkö sekä asiakkaalle edellisenä vuonna tehty ensihoitohälytys. Tässä tutkimuksessa kotihoidon asiakkaat tekivät suhteellisesti enemmän päivystyskäyntejä kuin aiemmissa tutkimuksissa kaikki kotona asuvat vastaavan ikäiset. Tulokset osoittavat, että kotihoidon asiakkaan avuntarpeen lisääntyessä myös ensihoitohälytykset ja päivystyskäynnit ovat todennäköisempiä ja ensihoitohälytysten lukumäärä lisääntyy. Merkittävä osa ensihoitohälytyksistä on ei-kiireellisiä, ja lähes kolmasosaa ensihoitohälytyksistä ei seuraa kuljetus jatkohoitoon. Näitä ensihoitohälytyksiä tulee voida vähentää kotihoidon toimintaa kehittämällä, hoitolinjoja selkeyttämällä, henkilöstöä kouluttamalla ja asiakkaita sekä omaisia informoimalla.&nbsp

Genetic association study of QT interval highlights role for calcium signaling pathways in myocardial repolarization.

The QT interval, an electrocardiographic measure reflecting myocardial repolarization, is a heritable trait. QT prolongation is a risk factor for ventricular arrhythmias and sudden cardiac death (SCD) and could indicate the presence of the potentially lethal mendelian long-QT syndrome (LQTS). Using a genome-wide association and replication study in up to 100,000 individuals, we identified 35 common variant loci associated with QT interval that collectively explain ∼8-10% of QT-interval variation and highlight the importance of calcium regulation in myocardial repolarization. Rare variant analysis of 6 new QT interval-associated loci in 298 unrelated probands with LQTS identified coding variants not found in controls but of uncertain causality and therefore requiring validation. Several newly identified loci encode proteins that physically interact with other recognized repolarization proteins. Our integration of common variant association, expression and orthogonal protein-protein interaction screens provides new insights into cardiac electrophysiology and identifies new candidate genes for ventricular arrhythmias, LQTS and SCD

Pharmacogenomics Study of Thiazide Diuretics and QT Interval in Multi-Ethnic Populations: The Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE)

Thiazide diuretics, commonly used antihypertensives, may cause QT interval (QT) prolongation, a risk factor for highly fatal and difficult to predict ventricular arrhythmias. We examined whether common SNPs modified the association between thiazide use and QT or its component parts (QRS interval, JT interval) by performing ancestry-specific, trans-ethnic, and cross-phenotype genome-wide analyses of European (66%), African American (15%), and Hispanic (19%) populations (N=78,199), leveraging longitudinal data, incorporating corrected standard errors to account for underestimation of interaction estimate variances and evaluating evidence for pathway enrichment. Although no loci achieved genome-wide significance (P<5×10−8), we found suggestive evidence (P<5×10−6) for SNPs modifying the thiazide-QT association at 22 loci, including ion transport loci (e.g. NELL1, KCNQ3). The biologic plausibility of our suggestive results and simulations demonstrating modest power to detect interaction effects at genome-wide significant levels indicate that larger studies and innovative statistical methods are warranted in future efforts evaluating thiazide-SNP interactions

Alirocumab and cardiovascular outcomes after acute coronary syndrome

BACKGROUN

Alirocumab and Cardiovascular Outcomes after Acute Coronary Syndrome

BACKGROUN