Browsing by Subject "IMPROVE"

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  • Kiiski, A.; Airaksinen, M.; Mäntylä, A.; Desselle, S.; Kumpusalo-Vauhkonen, A.; Järvensivu, T.; Pohjanoksa-Mäntylä, M. (2019)
    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.
  • Lehto, Mika T; Pitkälä, Kaisu; Rahkonen, Ossi; Laine, Merja; Raina, Marko; Kauppila, Timo Ilmari (2021)
    Objectives: One purpose of electronic reminders is improvement of the quality of documentation in office-hours primary care. The aim of this study was to evaluate how implementation of electronic reminders alters the rate and/or content of diagnostic data recorded by primary care physicians in office-hours practices in primary care health centers. Methods: The present work is a register-based longitudinal follow-up study with a before-and-after design. An electronic reminder was installed in the electronic health record system of the primary health care of a Finnish city to remind physicians to include the diagnosis code of the visit in the health record. The report generator of the electronic health record system provided monthly figures for the number of various recorded diagnoses by using the International Classification of Diseases, 10th edition, and the total number of visits to primary care physicians, thus allowing the calculation of the recording rate of diagnoses on a monthly basis. The distribution of diagnoses before and after implementing ERs was also compared. Results: After the introduction of the electronic reminder, the rate of diagnosis recording by primary care physicians increased clearly from 39.7% to 87.2% (p < 0.001). The intervention enhanced the recording rate of symptomatic diagnoses (group R) and some chronic diseases such as hypertension, type 2 diabetes and other soft tissue disorders. Recording rate of diagnoses related to diseases of the respiratory system (group J), injuries, poisoning and certain other consequences of external causes (group S), and diseases of single body region of the musculoskeletal system and connective tissue (group M) decreased after the implementation of electronic reminders. Conclusion: Electronic reminders may alter the contents and extent of recorded diagnosis data in office-hours practices of the primary care health centers. They were found to have an influence on the recording rates of diagnoses related to chronic diseases. Electronic reminders may be a useful tool in primary health care when attempting to change the behavior of primary care physicians.
  • Forsell, Sabrina; Kalliala, Ilkka; Halttunen, Mervi; Redman, Charles W. E.; Leeson, Simon; Tropé, Ameli; Moss, Esther; Kyrgiou, Maria; Pyörälä, Eeva; Nieminen, Pekka (2020)
    Simple Summary Cervical cancer prevention is presently undergoing a thorough reformation due to introduction of human papillomavirus (HPV)-testing and vaccines in primary prevention. The screening program, however, is more than a single test or preventive intervention-the possible lesion has to be found, located and treated. Colposcopy plays a major role in this management. Literature dealing with training and learning, especially with colposcopy, is extremely scarce. The aim of the European Federation of Colposcopy, EFC, is to improve the education and training in colposcopy, e.g., by organizing colposcopy courses. The aim of our prospective interventional study was to pilot this intensive participant activating EFC Basic Colposcopy Course on the short- and long-term learning of colposcopy-related knowledge, image recognition and the diagnostic confidence. High-quality colposcopy is essential in cervical cancer prevention. We performed a multicentre prospective interventional pilot-study, evaluating the effect of a six-hour case-based colposcopy course on short- and long-term learning of colposcopy-related knowledge, diagnostic accuracy levels and confidence. We recruited 213 colposcopists participating in three European Federation of Colposcopy (EFC) basic colposcopy courses (Finland, Norway, UK). The study consisted of three tests with identical content performed before, after and 2 months after the course, including ten colposcopic images, ten patient cases and scales for marking confidence in the answers. Outcome measures where mean scores in correct case-management, diagnosis (including high-grade lesion recognition), transformation-zone recognition and confidence in answers. Results were compared between the three tests and stratified according to experience. Mean test scores improved after the course for all participants. The increase was highest for beginners. Confidence in answers improved and the number of colposcopists showing high confidence with low scores decreased. A structured case-based course improves skills and confidence especially for inexperienced colposcopists; however, trainers should be aware of the risk of overconfidence. To complement theoretical training, further hands-on training including high-quality feedback is recommended. Conclusions drawn from long-term learning are limited due to the low participation in the follow-up test.
  • Hosseinzadeh, Mahboubeh Sadat; Farhadi Qomi, Masood; Naimi, Babak; Roedder, Dennis; Kazemi, Seyed Mandi (2018)
    Species distribution models estimate the relationship between species occurrences and environmental and spatial characteristics. Herein, we used maximum entropy distribution modelling (MaxEnt) for predicting the potential distribution of the Plateau Snake Skink Ophiomorus nuchalis on the Iranian Plateau, using a small number of occurrence records (i.e. 10) and environmental variables derived from remote sensing. The MaxEnt model had a high success rate according to test AUC scores (0.912). A remotely sensed enhanced vegetation index (39.1%), and precipitation of the driest month (15.4%) were the most important environmental variables that explained the geographical distribution of O. nuchalis. Our results are congruent with previous studies suggesting that suitable habitat of O. nuchalis is limited to the central Iranian Plateau, although mountain ranges in western and eastern Iran might be environmentally suitable but not accessible.
  • Kerminen, H.; Jamsen, E.; Jantti, P.; Huhtala, H.; Strandberg, T.; Valvanne, J. (2016)
    Introduction: Comprehensive geriatric assessment (CGA) is one of the most important evaluation tools in geriatrics, but there is variability in its use in different clinical settings. In this study we aimed to clarify how Finnish geriatricians apply CGA in their clinical practice. Methods: We organized a web-based survey among the members of Finnish Geriatricians (n = 248). The questionnaire included items about use and content of CGA. The evaluated domains were assessment of cognition, nutrition and functional ability, evaluation of depression, and measurement of orthostatic blood pressure. Results: Altogether 121 physicians (49%) responded, and the present analysis included 95 geriatricians performing clinical work. Majority of the respondents (94%) used CGA. Of them, 38% performed CGA to all new patients and 62% to selected patients only. Ten respondents (11%) incorporated all five domains into CGA whereas others selected domains according to their clinical judgment. Greater proportion of female than male physicians included evaluation of depression (39% vs. 16%, P = 0.045) and assessment of functional ability (48% vs. 24%, P = 0.01) always in CGA. Respondents, who applied CGA to all new patients, incorporated nutritional assessment (68% vs. 34%, P = 0.002) and measurement of orthostatic blood pressure (76% vs. 54%, P = 0.04) always into CGA more often than those who performed CGA to selected patients only. Respondents' working conditions were not associated with the application of CGA. Conclusions: Majority of the respondents performed CGA to their patients. The content of CGA varied between geriatricians. Incomplete evaluation may lead to inadequate detection of geriatric syndromes and other problems. (C) 2016 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.
  • Ojala, Krista; Salmia, Jukka; Shevchenko, Anna; Ylikotila, Johanna; Korjamo, Timo; van Veen, Bert; Koistinen, Piritta; Malmstrom, Chira; Laakso, Sirpa; Bansal, Indu; Samiulla, D. S.; Juppo, Anne (2021)
    Our objectives were to stabilize a non-clinical suspension for use in toxicological studies and to develop methods to investigate the stability of the formulation in terms of salt disproportionation. The compound under research was a hydrochloride salt of a practically insoluble discovery compound ODM-203. The first of the three formulation approaches was a suspension prepared and stored at room temperature. The second formulation was stabilized by pH adjustment. In the third approach cooling was used to prevent salt disproportionation. 5 mg/mL aqueous suspension consisting of 20 mg/mL PVP/VA and 5 mg/mL Tween 80 was prepared for each of the approaches. The polymer was used as precipitation inhibitor to provide prolonged supersaturation while Tween 80 was used to enhance dissolution and homogeneity of the suspension. The consequences of salt disproportionation were studied by a small-scale in vitro dissolution method and by an in vivo pharmacokinetic study in rats. Our results show that disproportionation was successfully suppressed by applying cooling of the suspension in an ice bath at 2-8 degrees C. This procedure enabled us to proceed to the toxicological studies in rats. The in vivo study results obtained for the practically insoluble compound showed adequate exposures with acceptable variation at each dose level.
  • TTH48 Investigators; De Fazio, Chiara; Skrifvars, Markus B.; Soreide, Eldar; Taccone, Fabio Silvio (2021)
    Background: No data are available on the quality of targeted temperature management (TTM) provided to out-of-hospital cardiac arrest (OHCA) patients and its association with outcome. Methods: Post hoc analysis of the TTH48 study (NCT01689077), which compared the effects of prolonged TTM at 33 degrees C for 48 h to standard 24-h TTM on neurologic outcome. Admission temperature, speed of cooling, rewarming rates, precision (i.e. temperature variability), overcooling and overshooting as post-cooling fever (i.e. >38.0 degrees C) were collected. A specific score, ranging from 1 to 9, was computed to define the "quality of TTM". Results: On a total of 352 patients, most had a moderate quality of TTM (n = 217; 62% - score 4-6), while 80 (23%) patients had a low quality of TTM (score 1-3) and only 52 (16%) a high quality of TTM (score 7-9). The proportion of patients with unfavorable neurological outcome (UO; Cerebral Performance Category of 3-5 at 6 months) was similar between the different quality of TTM groups (p = 0.90). Although a shorter time from arrest to target temperature and a lower proportion of time outside the target ranges in the TTM 48-h than in the TTM 24-h group, quality of TTM was similar between groups. Also, the proportion of patients with UO was similar between the different quality of TTM groups when TTM 48-h and TTM 24-h were compared. Conclusions: In this study, high quality of TTM was provided to a small proportion of patients. However, quality of TTM was not associated with patients' outcome.