Managing Innovation in Occupational Health Care System for the Future

Occupational Health Care System (OHS) will by law concern every citizen in working age. The role of OHS is work-related and proactive by nature. The co-operation with actors like basic health care and rehabilitation is in key role in keeping people at work. The aim of project TYÖKE is to develop functional integration between OHS and other services in order to manage the wellbeing of people in working age. The basic questions in this paper are as follows: What is the role of OHS in general social and health care ecosystem and how do they co-operate across the boundaries in this context; What kind of innovations will be needed to meet the challenges from citizens´ and professionals´ perspective in different futures scenarios? and finally, Who will play the main role in the ecosystem to fulfil the requirements for the new situation

Global Water Ecosystem : past, present, future?

Water resources at the globe are among the critical elements of life conditions not only for biological processes but for industry as well. It is not only the water consumption for different kind of purposes but also the destroying of water reserves by many ways. This paper is based on the research project Circle, financed by European Regional Development Fund. The project will focus on opportunities for energy recycling, nutrients re-use, water reserves recycling and reducing of water use as well as opportunities for technology development. The geographical focus is on the global issues although the web survey results are based on the Finnish perspectives. In this paper we will present trends affecting the future of water service business in the long run, actors forming the water ecosystem as well as preliminary scenarios and visionary concepts concerning the future in water business. The data for this paper has been collected by a web-survey sent to actors in water ecosystem, but also from student work in Laurea UAS in spring 2017. Circle is an ongoing project until end November 2018

Estimating the effectiveness of pulmonary rehabilitation for COPD exacerbations : reduction of hospital inpatient days during the following year

Aims: To study the short- and long-term results of pulmonary rehabilitation (PR) given in the Helsinki University Heart and Lung Center and to understand the hospital resources used to treat severe COPD exacerbations in the city of Helsinki. Materials and methods: Seventy-eight inactive patients with severe COPD were recruited for a PR course; three of them did not finish the course. The course took 6-8 weeks and included 11-16 supervised exercise sessions. Using electronic medical records, we studied all COPD patients with hospital admission in the city of Helsinki in 2014, including COPD diagnosis, criteria for exacerbation, and potential exclusion/inclusion criteria for PR. Results: Seventy-five of the patients finished the PR course and 92% of those patients showed clinically significant improvement. Their hospital days were reduced by 54% when compared to the year before. At 1 year after the course, 53% of the patients reported that they have continued with regular exercise training. In the city of Helsinki, 437 COPD patients were treated in a hospital due to exacerbation during 2014. On the basis of their electronic medical records, 57% of them would be suitable for PR. According to a rough estimate, 10%-20% hospital days could be saved annually if PR was available to all, assuming that the PR results would be as good as those shown here. Conclusions: The study showed that in a real-world setting, PR is efficient when measured by saved hospital days in severe COPD. Half of the patients could be motivated to continue exercising on their own.Peer reviewe

Future Innovations for Independent Living : Defining New Competences and Professions

Due to economic turbulence and ageing population, the Nordic welfare model is facing significant challenges. Especially in terms of ageing Finland is interesting market since the demographic shift takes place first and more rapidly in Finland than in the other countries. As a result, the existing Finnish healthcare system is not able to meet the future challenges without significant transition and innovations. Therefore, in this study we are focusing on the innovation needs of the Finnish education system relating to independent living. Grounded on the multi-client participatory action scenario process which was supported by mass collaboration data collection method, we define four scenarios while noting the specific features from five geographical regions. On the basis of these scenarios new competences and skills are identified and novel professions are presented

Estimating the effectiveness of pulmonary rehabilitation for COPD exacerbations: reduction of hospital inpatient days during the following year

Aims: To study the short- and long-term results of pulmonary rehabilitation (PR) given in the Helsinki University Heart and Lung Center and to understand the hospital resources used to treat severe COPD exacerbations in the city of Helsinki.Materials and methods: Seventy-eight inactive patients with severe COPD were recruited for a PR course; three of them did not finish the course. The course took 6-8 weeks and included 11-16 supervised exercise sessions. Using electronic medical records, we studied all COPD patients with hospital admission in the city of Helsinki in 2014, including COPD diagnosis, criteria for exacerbation, and potential exclusion/inclusion criteria for PR.Results: Seventy-five of the patients finished the PR course and 92% of those patients showed clinically significant improvement. Their hospital days were reduced by 54% when compared to the year before. At 1 year after the course, 53% of the patients reported that they have continued with regular exercise training. In the city of Helsinki, 437 COPD patients were treated in a hospital due to exacerbation during 2014. On the basis of their electronic medical records, 57% of them would be suitable for PR. According to a rough estimate, 10%-20% hospital days could be saved annually if PR was available to all, assuming that the PR results would be as good as those shown here.Conclusions: The study showed that in a real-world setting, PR is efficient when measured by saved hospital days in severe COPD. Half of the patients could be motivated to continue exercising on their own

Työterveyshuollon tulevaisuuden skenaariot TYÖKE-hankkeessa

The goal of Työke project is to ensure the integration of the occupational health care and the rest of the social and health care. European Social Fund together with the research partners will finance the project. Finnish Institute of Occupational Health coordinates the project and other partners are University of Helsinki, University of Eastern Finland, Central Finland Health Care District and Laurea UAS. FuturesLab CoFi Laurea will create alternative futures scenarios for occupational health care to support the renewal of Finnish social and health care system. Driving forces are new requirements in working life challenging occupational health care both in structures and in action. Digitalization, robotics and globalization will change the working life not only among the customers of occupational health care but among professionals in the field, too.TYÖKE -hankkeen tavoitteena on varmistaa työterveyshuollon toiminnallinen integraatio muuhun sosiaali- ja terveydenhuoltoon. Hanketta rahoittaa Euroopan sosiaalirahasto sekä toteuttajat. Työterveyslaitos toimii hankkeen päätoteuttajana ja kumppanit ovat Helsingin yliopisto, Itä-Suomen yliopisto ja Keski-Suomen Sairaanhoitopiiri. Laurean FuturesLab CoFi rakentaa hankkeessa vaihtoehtoisia skenaarioita 20 vuoden päähän tukemaan sote-uudistustyötä. Muutosvoimina ovat työelämän uudet vaatimukset, jotka asettavat muutosvaateita myös työterveyshuollolle sekä rakenteellisesti että toiminnallisesti. Digitalisaatio, robotiikka ja globalisaatio muuttavat työelämää työterveyshuollon toimijoiden ja sen asiakkaiden keskuudessa

Tulevaisuuden näkymiä työterveyshuoltoon

Yhteiskunta ja työelämä ovat muutoksessa. Megatrendit muuttavat maailmaa ja Suomea siinä samalla. Teknologian murros, digitalisaatio, tekoäly sekä robottien lisääntyvä hyödyntäminen eri aloilla muuttavat työelämää. Muutos tuo uusia haasteita työntekijöille ja työyhteisöjen johtamiseen, mutta myös työterveyshuollolle. Teknologian mahdollistama 24/7/365-yhteiskunta yli aikavyöhykkeiden hämärryttää työn ja vapaa-ajan rajoja samalla kun työsuhteiden luonne muuttuu

Potilastiedon louhinta mullistaa tutkimuksen ja hoidon

Tekoäly on osa modernia tilastotiedettä, ja sitä on sovellettu pitkään monilla teollisuudenaloilla. Koneet voidaan ohjelmoida tekemään tarkkoja päätöksiä nopeasti ja väsymättä, kunhan merkityksellistä opetusmateriaalia on tarpeeksi. Tekoälyyn perustuvien tutkimusmenetelmien soveltaminen lääketieteeseen hyödyttää sekä potilasta että yhteiskuntaa, sillä näin pystytään tuottamaan entistä vaikuttavampia hoitoja nykyistä tehokkaammin. Tieteellisen avoimuus on välttämätöntä modernien analyysimenetelmien kehittämisessä, mutta avoimuus pitäisi laajentaa koskemaan myös oheisohjelmistoja. Näin voidaan riippumattomasti varmistaa, että menetelmien tuottamat tulokset ovat lääketieteellisesti oikeita, tilastollisesti pitäviä ja tietoturvallisesti tuotettuja. Tiedon hyödyntäminen on vasta alussa, mutta tekniikkaakin tärkeämpää on ymmärtää korkealaatuisen tiedon välttämättömyys hyvän hoidon tuottamisessa.</p

Motor vehicle accidents in CPAP-compliant obstructive sleep apnea patients-a long-term observational study

Purpose Obstructive sleep apnea (OSA) has been associated with a 2- to 7-fold risk of motor vehicle accidents (MVAs). Continuous positive airway pressure (CPAP) treatment may reduce MVA risk. We further explored this issue in long-term CPAP users and untreated controls. Methods We used both before-after and case-control study designs. The observational cohort consisted of CPAP-treated and untreated patients matched for gender, age, and apnea-hypopnea index. All MVAs reported to the police were identified. Results A total of 2060 patients (75.8% male, mean age 56.0 +/- 10.5 years) were included. The CPAP-treated patients (N = 1030) were screened for MVAs for a median of 9.0 years before and after treatment. The median CPAP usage was 6.4 h/day. The control patients (N = 1030) were screened for MVAs for a median of 6.5 years after discontinuation of CPAP. No significant differences were observed between the incidences of MVAs per 1000 person years before treatment (3.2), after treatment (3.9), or in controls (2.6). Compared with controls, patients who had MVA after treatment had a higher body mass index (BMI), but did not differ in terms of other baseline characteristics, sleep study data, or accident conditions. In the majority of these patients, daytime sleepiness was reduced, whereas BMI tended to increase during treatment. Conclusions The MVA incidence did not change after CPAP treatment. Among the patients who had MVA, BMI was the only baseline characteristic that differed between the groups and tended to further increase after CPAP treatment. Differences in sleep study data or accident conditions were not observed

Documentation of the patient's smoking status in common chronic diseases - analysis of medical' narrative reports using the ULMFiT based text classification

Introduction: Smoking cessation is essential part of a successful treatment in many chronic diseases. Our aim was to analyse how actively clinicians discuss and document patients' smoking status into electronic health records (EHR) and deliver smoking cessation assistance.Methods: We analysed the results using a combination of rule and deep learning-based algorithms. Narrative reports of all adult patients, whose treatment started between years 2010 and 2016 for one of seven common chronic diseases, were followed for two years. Smoking related sentences were first extracted with a rule-based algorithm. Subsequently, pre-trained ULMFiT-based algorithm classified each patient's smoking status as a current smoker, ex-smoker, or never smoker. A rule-based algorithm was then again used to analyse the physician-patient discussions on smoking cessation among current smokers.Results: A total of 35,650 patients were studied. Of all patients, 60% were found to have a smoking status in EHR and the documentation improved over time. Smoking status was documented more actively among COPD (86%) and sleep apnoea (83%) patients compared to patients with asthma, type 1&2 diabetes, cerebral infarction and ischemic heart disease (range 44-61%). Of the current smokers (N=7,105), 49% had discussed smoking cessation with their physician. The performance of ULMFiT-based classifier was good with F-scores 79-92.Conclusion: Ee found that smoking status was documented in 60% of patients with chronic disease and that the clinician had discussed smoking cessation in 49% of patients who were current smokers. ULMFiT-based classifier showed good/excellent performance and allowed us to efficiently study a large number of patients' medical narratives.</p