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Mustakallio M, Iisakkala V, Impola M, Nurmi C, Puustinen J, Kunvik S. Effect of nutritional guidance on employee work ability, work well-being and quality of life (RAVI trial): Study protocol for a randomized controlled trial. Contemp Clin Trials 2024; 140:107517. [PMID: 38552869 DOI: 10.1016/j.cct.2024.107517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 02/24/2024] [Accepted: 03/25/2024] [Indexed: 04/01/2024]
Abstract
BACKGROUND The minority of working-age Finns eat according to the national and Nordic nutritional guidelines and increasing numbers of health problems affect the Finnish workforce. Coincidently recruiting new workers in the more rural areas of Finland, such as Satakunta, has been problematic. To optimize the use of the existing workforce, health promotion interventions focusing on nutrition have been suggested to improve the health and well-being of the current working age Finns. METHODS AND ANALYSIS The aim of this RCT study is to assess the effectiveness of a 12-month multifactorial nutritional guidance intervention to improve work ability (performance), work well-being, health-related quality of life, work productivity, sickness absence, dietary intake and eating habits. In total, six small or medium-sized companies and their employees (n = 170) from the Satakunta region will be recruited. Companies will be randomized 1:1 to a 12-month multifactorial nutritional guidance intervention group (INT) or a control group (CG). Comprehensive measurements are taken before randomization (baseline) and at the end of the 12-month study period. Primary outcomes (work ability, work well-being and health-related quality of life) are measured with Work Ability Index, Utrecht Work Engagement Scale short questionnaire and EQ-5D. Dietary intake and eating habits are measured with 3-day food records and Food Frequency Questionnaire (FFQ). DISCUSSION This study will provide nationally important data on how workplace nutrition guidance affects work-related outcomes, quality of life, and nutritional and overall health status among working age Finns.
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Affiliation(s)
- Meri Mustakallio
- Satakunta University of Applied Sciences, Satakunnankatu 23, Pori 28130, Finland.
| | - Veera Iisakkala
- Satakunta University of Applied Sciences, Satakunnankatu 23, Pori 28130, Finland.
| | - Mika Impola
- Satakunta University of Applied Sciences, Satakunnankatu 23, Pori 28130, Finland.
| | - Cimmo Nurmi
- Satakunta University of Applied Sciences, Satakunnankatu 23, Pori 28130, Finland.
| | - Juha Puustinen
- Satakunta University of Applied Sciences, Satakunnankatu 23, Pori 28130, Finland; Satakunta Welfare Region, Satasairaala, Unit of Neurology, Pori, Finland.
| | - Susanna Kunvik
- Satakunta University of Applied Sciences, Satakunnankatu 23, Pori 28130, Finland.
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Dimitrow M, Saarenmaa R, Airaksinen M, Hassan G, Puumalainen E, Pitrová M, Kivelä SL, Fialová D, Puustinen J, Toivo T. Medication risk checklist for older adults (LOTTA) - development and validation of a self-assessment tool. Ann Med 2023; 55:2287707. [PMID: 38035545 PMCID: PMC10732188 DOI: 10.1080/07853890.2023.2287707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/20/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Patient safety strategies highlight patients' own active involvement in ensuring medication safety. A prerequisite for involving patients in their medication therapy is having tools that can assist them in ensuring safe medicine use. Older home-dwelling adults with multiple medications are at high risk for medication-related problems, yet only a few age-specific patient self-administered medication risk screening tools exist. This study aimed to develop, validate, and assess the feasibility of a self-administered medication risk checklist for home-dwelling older adults ≥65 years. MATERIALS AND METHODS The draft checklist was formed based on a validated practical nurse-administered Drug Related Problem Risk Assessment Tool supplemented with findings from two systematic literature reviews. The content validity of the draft checklist was determined by a three-round Delphi survey with a panel of 19 experts in geriatric care and pharmacotherapy. An agreement of ≥80% was required. A feasibility assessment (i.e. understandability of the items, fill-out time of the checklist) of the content-validated checklist was conducted among older adults ≥65 years (n = 87) visiting community pharmacies (n = 4). Data were analysed using qualitative content analysis. RESULTS The final validated and feasibility-tested Medication Risk Checklist (LOTTA) for home-dwelling older adults consists of eight items screening the highest priority systemic risks (three items), potentially drug-induced symptoms (one item), adherence, and self-management problems (four items). The checklist proved feasible for self-administration, the mean fill-out time being 6.1 min. CONCLUSIONS A wide range of potential medication risks related to the medication use process can be identified by patient self-assessment. Screening tools such as LOTTA can enhance early detection of potential medication risks and risk communication between older adults and their healthcare providers. A wider and more integrated use of the checklist could be facilitated by making it electronically available as part of the patient information systems.
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Affiliation(s)
- Maarit Dimitrow
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Roosa Saarenmaa
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Marja Airaksinen
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Ghada Hassan
- Division of Pharmaceutical Chemistry and Technology, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Emmi Puumalainen
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Markéta Pitrová
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Prague, Czech Republic
- Clinical Pharmacy Department, University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Sirkka-Liisa Kivelä
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
- Faculty of Medicine, Department of Clinical Medicine, Unit of Family Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Daniela Fialová
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Prague, Czech Republic
- Department of Geriatrics and Gerontology, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Juha Puustinen
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
- Service Unit of Neurology, Satasairaala Central Hospital, Wellbeing County of Satakunta, Pori, Finland
| | - Terhi Toivo
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
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Kanninen JC, Holm A, Koivisto AL, Hietasalo P, Heikkilä AM, Kunvik S, Bergman J, Airaksinen M, Puustinen J. Development of a Preventive Health Screening Procedure Enabling Supportive Service Planning for Home-Dwelling Older Adults (PORI75): Protocol for an Action Research Study. JMIR Res Protoc 2023; 12:e48753. [PMID: 37788079 PMCID: PMC10582811 DOI: 10.2196/48753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/11/2023] [Accepted: 08/17/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND In Finland, at least 1 in 4 residents will be >75 years of age in 2030. The national aging policy has emphasized the need to improve supportive services to enable older people to live in their own homes for as long as possible. OBJECTIVE This study aimed to develop a preventive health screening procedure for home-dwelling older adults aged 75 years to enable the use of clinical patient data for purposes of strategic planning of supportive services in primary care. METHODS The action research method was applied to develop the health screening procedure with selected validated health measures in cooperation with the local practicing interprofessional health care teams from 10 primary care centers in the Social Security Center of Pori, Western Finland (99,485 residents, n=11,938, 12% of them >75 years). The selection of evidence-based validated health measures was based on the national guide to screen factors increasing fall risk and the national functioning measures database. The cut-off points of the selected health measures and laboratory tests were determined in consecutive consensus meetings with the local primary care physicians, with decisions based on internationally validated measures, national current care guidelines, and local policies in clinical practice. RESULTS The health screening procedure for 75-year-old residents comprised 30 measures divided into three categories: (1) validated self-assessments (9 measures), (2) nurse-conducted screenings (14 measures), and (3) laboratory tests (7 measures). The procedure development process comprised the following steps: (1) inventory and selection of the validated health measures and laboratory tests, (2) training of practical nurses to perform screenings for the segment of 75-year-old residents and to guide them to possible further medical actions, (3) creation of research data from clinical patient data for secondary use purposes, (4) secondary data analysis, and (5) consensus meeting after the pilot test of the health screening procedure for 75-year-old residents procedure in 2019 based on the experiences of health care professionals and collected research data. CONCLUSIONS The developed preventive health screening procedure for 75-year-old residents enables the use of clinical patient data for purposes of strategic planning of supportive services in primary care if the potential bias by a low participation rate is controlled. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/48753.
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Affiliation(s)
- Jonna Carita Kanninen
- Faculty of Technology, Satakunta University of Applied Sciences, Pori, Finland
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
- Satasairaala Central Hospital, Pori, Finland
| | - Anu Holm
- Faculty of Technology, Satakunta University of Applied Sciences, Pori, Finland
| | | | | | | | - Susanna Kunvik
- Faculty of Health and Welfare, Satakunta University of Applied Sciences, Pori, Finland
| | - Jussi Bergman
- Faculty of Technology, Satakunta University of Applied Sciences, Pori, Finland
| | - Marja Airaksinen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Juha Puustinen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
- Unit of Neurology, Satasairaala Central Hospital, Satakunta Wellbeing County, Pori, Finland
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Kanninen J, Puustinen J, Airaksinen M, Kautiainen H, Koivisto A, Hietasalo P, Heikkilä A, Kunvik S, Toivo T, Dimitrow M, Bergman J, Holm A. Self-assessed medication risk factors as part of comprehensive health screening in home-dwelling older adults. Health Sci Rep 2023; 6:e1196. [PMID: 37064318 PMCID: PMC10101948 DOI: 10.1002/hsr2.1196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/30/2023] [Indexed: 04/18/2023] Open
Abstract
Background Poor medication management may negatively impact the health and functional capacity of older adults. This cross-sectional study aimed to identify medication-related risk factors in home-dwelling residents using a validated self-assessment as part of comprehensive health screening. Methods The data were derived from comprehensive health screening (PORI75) for older adults of 75 years living in Western Finland in 2020 and 2021. One of 30 validated measures in health screening focused on identifying medication-related risk factors (LOTTA Checklist). The Checklist items were divided into (1) systemic risk factors (10 items) and (2) potentially drug-induced symptoms (10 items). Polypharmacy was categorized according to the number of used drugs: (1) no polypharmacy (<5 drugs), (2) polypharmacy (≥5 and <10), and (3) excessive polypharmacy (≥10). The linearity across these three polypharmacy groups was evaluated using the Cochran-Armitage test. Results Altogether, 1024 out of 1094 residents who participated in the health screening consented to this study (n = 569 in 2020 and n = 459 in 2021). The mean number of all drugs in use was 7.0 (range 0-26; SD 4.1), with 71% of the residents using >5 drugs, that is, having polypharmacy. Of the systemic risk factors most common was that the resident had more than one physician responsible for the treatment (48% of the residents), followed by missing drug list (43%), missing regular monitoring (35%), and unclear durations of the medication (35%). The most experienced potentially drug-induced symptoms were self-reported constipation (21%), urinating problems (20%), and unusual tiredness (17%). An increasing number of drugs in use, particularly excessive polypharmacy, was associated with various medication-related risk factors. Conclusion As a part of comprehensive health screening the LOTTA Checklist provides useful information to prevent medication-related risk factors in home-dwelling older adults. The Checklist could be used to guide planning and implementing health services in the future.
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Affiliation(s)
- Jonna‐Carita Kanninen
- Faculty of TechnologySatakunta University of Applied SciencesPoriFinland
- Clinical Pharmacy Group, Division of Pharmacology and PharmacotherapyUniversity of HelsinkiHelsinkiFinland
| | - Juha Puustinen
- Clinical Pharmacy Group, Division of Pharmacology and PharmacotherapyUniversity of HelsinkiHelsinkiFinland
- Service Unit of Neurology, Satasairaala Central HospitalSatakunta Wellbeing CountyPoriFinland
| | - Marja Airaksinen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of PharmacyUniversity of HelsinkiHelsinkiFinland
| | - Hannu Kautiainen
- Department of General Practice, Unit of Primary Health Care, Helsinki University Central HospitalUniversity of HelsinkiHelsinkiFinland
| | | | | | | | - Susanna Kunvik
- Social Security Center of Pori, Faculty of Health and WelfareSatakunta University of Applied SciencesPoriFinland
| | - Terhi Toivo
- Tampere University Hospital, Hospital PharmacyWellbeing Services County of Pirkanmaa TampereTampereFinland
- Clinical Pharmacy GroupUniversity of HelsinkiHelsinkiFinland
| | - Maarit Dimitrow
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of PharmacyUniversity of HelsinkiHelsinkiFinland
| | | | - Anu Holm
- Faculty of MedicineUniversity of TurkuTurkuFinland
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Roaldsen MB, Eltoft A, Wilsgaard T, Christensen H, Engelter ST, Indredavik B, Jatužis D, Karelis G, Kõrv J, Lundström E, Petersson J, Putaala J, Søyland MH, Tveiten A, Bivard A, Johnsen SH, Mazya MV, Werring DJ, Wu TY, De Marchis GM, Robinson TG, Mathiesen EB, Valente M, Chen A, Sharobeam A, Edwards L, Blair C, Christensen L, Ægidius K, Pihl T, Fassel-Larsen C, Wassvik L, Folke M, Rosenbaum S, Gharehbagh SS, Hansen A, Preisler N, Antsov K, Mallene S, Lill M, Herodes M, Vibo R, Rakitin A, Saarinen J, Tiainen M, Tumpula O, Noppari T, Raty S, Sibolt G, Nieminen J, Niederhauser J, Haritoncenko I, Puustinen J, Haula TM, Sipilä J, Viesulaite B, Taroza S, Rastenyte D, Matijosaitis V, Vilionskis A, Masiliunas R, Ekkert A, Chmeliauskas P, Lukosaitis V, Reichenbach A, Moss TT, Nilsen HY, Hammer-Berntzen R, Nordby LM, Weiby TA, Nordengen K, Ihle-Hansen H, Stankiewiecz M, Grotle O, Nes M, Thiemann K, Særvold IM, Fraas M, Størdahl S, Horn JW, Hildrum H, Myrstad C, Tobro H, Tunvold JA, Jacobsen O, Aamodt N, Baisa H, Malmberg VN, Rohweder G, Ellekjær H, Ildstad F, Egstad E, Helleberg BH, Berg HH, Jørgensen J, Tronvik E, Shirzadi M, Solhoff R, Van Lessen R, Vatne A, Forselv K, Frøyshov H, Fjeldstad MS, Tangen L, Matapour S, Kindberg K, Johannessen C, Rist M, Mathisen I, Nyrnes T, Haavik A, Toverud G, Aakvik K, Larsson M, Ytrehus K, Ingebrigtsen S, Stokmo T, Helander C, Larsen IC, Solberg TO, Seljeseth YM, Maini S, Bersås I, Mathé J, Rooth E, Laska AC, Rudberg AS, Esbjörnsson M, Andler F, Ericsson A, Wickberg O, Karlsson JE, Redfors P, Jood K, Buchwald F, Mansson K, Gråhamn O, Sjölin K, Lindvall E, Cidh Å, Tolf A, Fasth O, Hedström B, Fladt J, Dittrich TD, Kriemler L, Hannon N, Amis E, Finlay S, Mitchell-Douglas J, McGee J, Davies R, Johnson V, Nair A, Robinson M, Greig J, Halse O, Wilding P, Mashate S, Chatterjee K, Martin M, Leason S, Roberts J, Dutta D, Ward D, Rayessa R, Clarkson E, Teo J, Ho C, Conway S, Aissa M, Papavasileiou V, Fry S, Waugh D, Britton J, Hassan A, Manning L, Khan S, Asaipillai A, Fornolles C, Tate ML, Chenna S, Anjum T, Karunatilake D, Foot J, VanPelt L, Shetty A, Wilkes G, Buck A, Jackson B, Fleming L, Carpenter M, Jackson L, Needle A, Zahoor T, Duraisami T, Northcott K, Kubie J, Bowring A, Keenan S, Mackle D, England T, Rushton B, Hedstrom A, Amlani S, Evans R, Muddegowda G, Remegoso A, Ferdinand P, Varquez R, Davis M, Elkin E, Seal R, Fawcett M, Gradwell C, Travers C, Atkinson B, Woodward S, Giraldo L, Byers J, Cheripelli B, Lee S, Marigold R, Smith S, Zhang L, Ghatala R, Sim CH, Ghani U, Yates K, Obarey S, Willmot M, Ahlquist K, Bates M, Rashed K, Board S, Andsberg G, Sundayi S, Garside M, Macleod MJ, Manoj A, Hopper O, Cederin B, Toomsoo T, Gross-Paju K, Tapiola T, Kestutis J, Amthor KF, Heermann B, Ottesen V, Melum TA, Kurz M, Parsons M, Valente M, Chen A, Sharobeam A, Edwards L, Blair C. Safety and efficacy of tenecteplase in patients with wake-up stroke assessed by non-contrast CT (TWIST): a multicentre, open-label, randomised controlled trial. Lancet Neurol 2023; 22:117-126. [PMID: 36549308 DOI: 10.1016/s1474-4422(22)00484-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Current evidence supports the use of intravenous thrombolysis with alteplase in patients with wake-up stroke selected with MRI or perfusion imaging and is recommended in clinical guidelines. However, access to advanced imaging techniques is often scarce. We aimed to determine whether thrombolytic treatment with intravenous tenecteplase given within 4·5 h of awakening improves functional outcome in patients with ischaemic wake-up stroke selected using non-contrast CT. METHODS TWIST was an investigator-initiated, multicentre, open-label, randomised controlled trial with blinded endpoint assessment, conducted at 77 hospitals in ten countries. We included patients aged 18 years or older with acute ischaemic stroke symptoms upon awakening, limb weakness, a National Institutes of Health Stroke Scale (NIHSS) score of 3 or higher or aphasia, a non-contrast CT examination of the head, and the ability to receive tenecteplase within 4·5 h of awakening. Patients were randomly assigned (1:1) to either a single intravenous bolus of tenecteplase 0·25 mg per kg of bodyweight (maximum 25 mg) or control (no thrombolysis) using a central, web-based, computer-generated randomisation schedule. Trained research personnel, who conducted telephone interviews at 90 days (follow-up), were masked to treatment allocation. Clinical assessments were performed on day 1 (at baseline) and day 7 of hospital admission (or at discharge, whichever occurred first). The primary outcome was functional outcome assessed by the modified Rankin Scale (mRS) at 90 days and analysed using ordinal logistic regression in the intention-to-treat population. This trial is registered with EudraCT (2014-000096-80), ClinicalTrials.gov (NCT03181360), and ISRCTN (10601890). FINDINGS From June 12, 2017, to Sept 30, 2021, 578 of the required 600 patients were enrolled (288 randomly assigned to the tenecteplase group and 290 to the control group [intention-to-treat population]). The median age of participants was 73·7 years (IQR 65·9-81·1). 332 (57%) of 578 participants were male and 246 (43%) were female. Treatment with tenecteplase was not associated with better functional outcome, according to mRS score at 90 days (adjusted OR 1·18, 95% CI 0·88-1·58; p=0·27). Mortality at 90 days did not significantly differ between treatment groups (28 [10%] patients in the tenecteplase group and 23 [8%] in the control group; adjusted HR 1·29, 95% CI 0·74-2·26; p=0·37). Symptomatic intracranial haemorrhage occurred in six (2%) patients in the tenecteplase group versus three (1%) in the control group (adjusted OR 2·17, 95% CI 0·53-8·87; p=0·28), whereas any intracranial haemorrhage occurred in 33 (11%) versus 30 (10%) patients (adjusted OR 1·14, 0·67-1·94; p=0·64). INTERPRETATION In patients with wake-up stroke selected with non-contrast CT, treatment with tenecteplase was not associated with better functional outcome at 90 days. The number of symptomatic haemorrhages and any intracranial haemorrhages in both treatment groups was similar to findings from previous trials of wake-up stroke patients selected using advanced imaging. Current evidence does not support treatment with tenecteplase in patients selected with non-contrast CT. FUNDING Norwegian Clinical Research Therapy in the Specialist Health Services Programme, the Swiss Heart Foundation, the British Heart Foundation, and the Norwegian National Association for Public Health.
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Affiliation(s)
- Melinda B Roaldsen
- Department of Clinical Research, University Hospital of North Norway, Tromsø, Norway
| | - Agnethe Eltoft
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Hanne Christensen
- Department of Neurology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Stefan T Engelter
- Department of Neurology, University Hospital Basel, Basel, Switzerland; Department of Neurology and Neurorehabilitation, University of Basel, Basel, Switzerland; University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland
| | - Bent Indredavik
- Department of Medicine, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway; Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Dalius Jatužis
- Faculty of Medicine, Vilnius University, Center of Neurology, Vilnius, Lithuania
| | - Guntis Karelis
- Department of Neurology and Neurosurgery, Riga East University Hospital, Riga, Latvia; Rīga Stradiņš University, Riga, Latvia
| | - Janika Kõrv
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia
| | - Erik Lundström
- Department of Medicine and Neurology, Uppsala University, Uppsala, Sweden
| | - Jesper Petersson
- Department of Neurology, Lund University, Institute for Clinical Sciences Lund, Lund, Sweden
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Mary-Helen Søyland
- Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway; Department of Neurology, Hospital of Southern Norway, Kristiansand, Norway
| | - Arnstein Tveiten
- Department of Neurology, Hospital of Southern Norway, Kristiansand, Norway
| | - Andrew Bivard
- Department of Medicine, Royal Melbourne Hospital, Melbourne Brain Centre, Melbourne, VIC, Australia
| | - Stein Harald Johnsen
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Michael V Mazya
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - David J Werring
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
| | - Teddy Y Wu
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Gian Marco De Marchis
- Department of Neurology, University Hospital Basel, Basel, Switzerland; Department of Neurology, University of Basel, Basel, Switzerland
| | - Thompson G Robinson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Ellisiv B Mathiesen
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway.
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Ruokolainen J, Haladijan J, Juutinen M, Puustinen J, Holm A, Vehkaoja A, Nieminen H. Mobilemicroservices Architecture for Remote Monitoring of Patients: A Feasibility Study. Stud Health Technol Inform 2022; 290:200-204. [PMID: 35673000 DOI: 10.3233/shti220061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Recent developments in smart mobile devices (SMDs), wearable sensors, the Internet, mobile networks, and computing power provide new healthcare opportunities that are not restricted geographically. This paper aims to introduce Mobilemicroservices Architecture (MMA) based on a study on architectures. In MMA, an HTTP-based Mobilemicroservivce (MM) is allocated to each SMD's sensor. The key benefits are extendibility, scalability, ease of use for the patient, security, and the possibility to collect raw data without the necessity to involve cloud services. Feasibility was investigated in a two-year project, where MMA-based solutions were used to collect motor function data from patients with Parkinson's disease. First, we collected motor function data from 98 patients and healthy controls during their visit to a clinic. Second, we monitored the same subjects in real-time for three days in their everyday living environment. These MMA applications represent HTTP-based business-logic computing in which the SMDs' resources are accessible globally.
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Affiliation(s)
- Jari Ruokolainen
- Satakunta Hospital District, Unit of Neurology, Sairaalantie 3, 28500 Pori, Finland.,Faculty of Medicine and Health Technology, Tampere University, Korkeakoulunkatu 10, 33720 Tampere, Finland.,Faculty of Industrial Engineering, Tampere University of Applied Sciences, Kuntokatu 3, 33520 Tampere, Finland
| | - Juan Haladijan
- Technical University of Munich, Boltzmanstr 3, D-85748 Munich, Germany
| | - Milla Juutinen
- Faculty of Medicine and Health Technology, Tampere University, Korkeakoulunkatu 10, 33720 Tampere, Finland
| | - Juha Puustinen
- Satakunta Hospital District, Unit of Neurology, Sairaalantie 3, 28500 Pori, Finland
| | - Anu Holm
- Faculty of Health and Welfare, Satakunta University of Applied Sciences, Satakunnankatu 23, Pori, Finland
| | - Antti Vehkaoja
- Faculty of Medicine and Health Technology, Tampere University, Korkeakoulunkatu 10, 33720 Tampere, Finland
| | - Hannu Nieminen
- Faculty of Medicine and Health Technology, Tampere University, Korkeakoulunkatu 10, 33720 Tampere, Finland
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7
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Skullbacka S, Airaksinen M, Puustinen J, Toivo T. Risk assessment tools for QT prolonging pharmacotherapy in older adults: a systematic review. Eur J Clin Pharmacol 2022; 78:765-779. [PMID: 35156131 PMCID: PMC9005415 DOI: 10.1007/s00228-022-03285-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 01/25/2022] [Indexed: 11/26/2022]
Abstract
Purpose Many drugs are associated with the risk of QT prolongation and torsades de pointes (TdP), and different risk assessment tools (RATs) are developed to help clinicians to manage related risk. The aim of this systematic review was to summarize the evidence of different RATs for QT prolonging pharmacotherapy. Methods A systematic review was conducted using PubMed and Scopus databases. Studies concerning risk assessment tools for QT prolonging pharmacotherapy, including older adults, were included. Screening and selection of the studies, data extraction, and risk of bias assessment were undertaken. Results A total of 21 studies were included, involving different risk assessment tools. Most commonly used tools were risk scores (n = 9), computerized physician order entry systems (n = 3), and clinical decision support systems (n = 6). The tools were developed mainly for physicians and pharmacists. Risk scores included a high number of risk factors, both pharmacological and non-pharmacological, for QT prolongation and TdP. The inclusion of patients’ risk factors in computerized physician order entry and clinical decision support systems varied. Conclusion Most of the risk assessment tools for QT prolonging pharmacotherapy give a comprehensive overview of patient-specific risks of QT prolongation and TdP and reduce modifiable risk factors and actual events. The risk assessment tools could be better adapted to different health information systems to help in clinical decision-making. Further studies on clinical validation of risk assessment tools with randomized controlled trials are needed. Supplementary Information The online version contains supplementary material available at 10.1007/s00228-022-03285-3.
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Affiliation(s)
- Simone Skullbacka
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E, P.O. Box 56, 00014 Helsinki Helsinki, Finland
| | - Marja Airaksinen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E, P.O. Box 56, 00014 Helsinki Helsinki, Finland
| | - Juha Puustinen
- Unit of Neurology, Satasairaala Central Hospital, Satakunta Hospital District, Pori, Finland
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E, P.O. Box 56, 00014 Helsinki, Finland
| | - Terhi Toivo
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E, P.O. Box 56, 00014 Helsinki, Finland
- Hospital Pharmacy, Tampere University Hospital, Pirkanmaa Hospital District, Tampere, Finland
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8
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Haula TM, Puustinen J, Takala M, Holm A. Wake-up strokes are linked to obstructive sleep apnea and worse early functional outcome. Brain Behav 2021; 11:e2284. [PMID: 34291603 PMCID: PMC8413798 DOI: 10.1002/brb3.2284] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND AIMS Presence of sleep-disordered breathing (SDB) and especially obstructive sleep apnea (OSA) is a known risk factor for ischemic stroke. Additionally, SDB effects negatively on recovery after stroke. Up to one fourth of strokes are present on awakening. The link between OSA and wake-up stroke (WUS) has been suggested. We aim to determine the association between OSA and WUS in a Finnish stroke unit cohort. MATERIAL AND METHODS An observational prospective longitudinal study consisted of 95 TIA (transient ischemic attack) and mild to moderate stroke patients referred to a Stroke Unit in Finland. Respiratory polygraphy was performed within 72 h of hospital admission. Patients were classified into WUS and non-WUS, and functional outcome measures (mRS, rehabilitation, hospitalization time) were collected. Functional outcomes and prevalence of OSA were compared between non-WUS and WUS. RESULTS OSA (AHI > 15/h) was more frequent among WUS than non-WUS (71% and 36%, respectively, p = 0.009). Functional outcome measured with mRS was worse in patients with WUS than non-WUS on registration day and at hospital discharge (p = 0.001). Need for rehabilitation in WUS was 43% of cases compared to 23% of non-WUS (p = 0.067). Hospitalization time was longer (5-15days) in 55% of WUS and 41% of non-WUS patients (p = 0.261). CONCLUSION Moderate-to-severe OSA is related to WUS compared to non-WUS. In addition, WUS have worse short-term outcomes measured in mRS. Further studies are needed to determine if OSA is causally linked to WUS.
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Affiliation(s)
- Tuuli-Maria Haula
- Unit of Neurology, Satakunta Hospital District, Clinical Neurosciences, University of Turku, Pori, Finland
| | - Juha Puustinen
- Unit of Neurology, Satakunta Hospital District, Social Security Centre of Pori, City of Pori, Clinical Pharmacy Group, University of Helsinki, Pori, Finland
| | - Mari Takala
- Unit of Clinical Neurophysiology, Satakunta Hospital District, Pori, Finland
| | - Anu Holm
- Unit of Clinical Neurophysiology, Satakunta Hospital District, Faculty of Health and Welfare, Satakunta University of Applied Sciences, Pori, Finland
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9
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Kortela E, Kanerva MJ, Puustinen J, Hurme S, Airas L, Lauhio A, Hohenthal U, Jalava-Karvinen P, Nieminen T, Finnilä T, Häggblom T, Pietikäinen A, Koivisto M, Vilhonen J, Marttila-Vaara M, Hytönen J, Oksi J. Oral Doxycycline Compared to Intravenous Ceftriaxone in the Treatment of Lyme Neuroborreliosis: A Multicenter, Equivalence, Randomized, Open-label Trial. Clin Infect Dis 2021; 72:1323-1331. [PMID: 32133487 DOI: 10.1093/cid/ciaa217] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/01/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Lyme neuroborreliosis (LNB) is often treated with intravenous ceftriaxone even if doxycycline is suggested to be noninferior to ceftriaxone. We evaluated the efficacy of oral doxycycline in comparison to ceftriaxone in the treatment of LNB. METHODS Patients with neurological symptoms suggestive of LNB without other obvious reasons were recruited. The inclusion criteria were (1) production of Borrelia burgdorferi-specific antibodies in cerebrospinal fluid (CSF) or serum; (2) B. burgdorferi DNA in the CSF; or (3) an erythema migrans during the past 3 months. Participants were randomized in a 1:1 ratio to receive either oral doxycycline 100 mg twice daily for 4 weeks, or intravenous ceftriaxone 2 g daily for 3 weeks. The participants described their subjective condition with a visual analogue scale (VAS) from 0 to 10 (0 = normal; 10 = worst) before the treatment, and 4 and 12 months after the treatment. The primary outcome was the change in the VAS score at 12 months. RESULTS Between 14 September 2012 and 28 December 2017, 210 adults with suspected LNB were assigned to receive doxycycline (n = 104) or ceftriaxone (n = 106). The per-protocol analysis comprised 82 patients with doxycycline and 84 patients with ceftriaxone. The mean change in the VAS score was -3.9 in the doxycycline group and -3.8 in the ceftriaxone group (mean difference, 0.17 [95% confidence interval, -.59 to .92], which is within the prespecified equivalence margins of -1 to 1 units). Participants in both groups improved equally. CONCLUSIONS Oral doxycycline is equally effective as intravenous ceftriaxone in the treatment of LNB. CLINICAL TRIALS REGISTRATION NCT01635530 and EudraCT 2012-000313-37.
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Affiliation(s)
- Elisa Kortela
- Department of Clinical Medicine, University of Turku, Turku, Finland.,Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mari J Kanerva
- Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Juha Puustinen
- Unit of Neurology, Satakunta Central Hospital, Pori, Finland.,Department of Neurology, University of Turku, Turku, Finland.,Division of Pharmacology and Pharmacotherapy, University of Helsinki, Helsinki, Finland
| | - Saija Hurme
- Department of Biostatistics, University of Turku, Turku, Finland
| | - Laura Airas
- Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland
| | | | - Ulla Hohenthal
- Department of Infectious Diseases, Turku University Hospital and University of Turku, Turku, Finland
| | - Päivi Jalava-Karvinen
- Department of Infectious Diseases, Turku University Hospital and University of Turku, Turku, Finland
| | - Tuomas Nieminen
- Infectious Diseases Unit, Satakunta Central Hospital, Pori, Finland
| | - Taru Finnilä
- Department of Infectious Diseases, Turku University Hospital and University of Turku, Turku, Finland
| | - Tony Häggblom
- Department of Infectious Diseases, Turku University Hospital and University of Turku, Turku, Finland
| | | | - Mari Koivisto
- Department of Biostatistics, University of Turku, Turku, Finland
| | - Johanna Vilhonen
- Department of Infectious Diseases, Turku University Hospital and University of Turku, Turku, Finland
| | - Minna Marttila-Vaara
- Department of Infectious Diseases, Turku University Hospital and University of Turku, Turku, Finland
| | - Jukka Hytönen
- Institute of Biomedicine, University of Turku, Turku, Finland.,Clinical Microbiology, Turku University Hospital, Turku, Finland
| | - Jarmo Oksi
- Department of Infectious Diseases, Turku University Hospital and University of Turku, Turku, Finland
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10
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Celikkayalar E, Puustinen J, Palmgren J, Airaksinen M. Collaborative Medication Reviews to Identify Inappropriate Prescribing in Pre-Admission Medications at Emergency Department Short-Term Ward. Integr Pharm Res Pract 2021; 10:23-32. [PMID: 33912437 PMCID: PMC8075306 DOI: 10.2147/iprp.s280523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 02/19/2021] [Indexed: 01/10/2023] Open
Abstract
PURPOSE Collaborative medication reviews (CMR) have been shown to reduce inappropriate prescribing (IP) in various settings. This study aimed at describing a CMR practice in an emergency department (ED) short-term ward in Finland to investigate IP in pre-admission medications. PATIENTS AND METHODS Pre-admission medications were collaboratively reviewed for all the adult ED admissions within a 5-month study period in 2016. Types of IP were inductively categorized, and descriptive statistics were used to show the incidence and type of IP events. RESULTS The pre-admission medications of 855 adult ED patients were reviewed by the pharmacist, with 113 IP events identified in 83 (9.7%) of the patients. The majority (81%, n=67) of these patients were older adults (≥65 years). Of these 94 IP events identified in 67 older patients, 58 (62%) were confirmed by the ED physicians. The following 3 main categories were inductively developed for the types of identified and confirmed IP events: 1) Misprescribing (prescription of medications that significantly increase the risk of adverse drug events); 2) Overprescribing (prescription of medications for which no clear clinical indications exist); and 3) Underprescribing (omission of potentially beneficial medications that are clinically indicated for treatment or prevention of a disease). Misprescribing was the most common type of IP identified (79% of the identified and 72% confirmed IP events). Benzodiazepines (29%) and antidepressants (28%) were involved in 33 out of 58 (57%) confirmed IP events. Medications with strong anticholinergic effects were involved in 19% of the confirmed IP events. CONCLUSION The CMR practice was able to identify IP in pre-admission medications of about one-tenth of ED patients. Older patients using benzodiazepines and drugs with strong anticholinergic effects should be paid special attention to ED admissions.
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Affiliation(s)
- Ercan Celikkayalar
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
- Hospital Pharmacy Department, Satasairaala Central Hospital, Pori, Finland
| | - Juha Puustinen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
- Social Security Center of Pori, Pori, Finland
- Unit of Neurology, Satasairaala Central Hospital, Pori, Finland
| | - Joni Palmgren
- Hospital Pharmacy Department, Satasairaala Central Hospital, Pori, Finland
| | - Marja Airaksinen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
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11
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Celikkayalar E, Airaksinen M, Kivelä SL, Nieminen J, Kleme J, Puustinen J. Are Older People Aware of Potential Risks Related to Benzodiazepines They are Taking and Has Anything Changed in Risk Awareness Over Ten Years? Patient Prefer Adherence 2021; 15:141-147. [PMID: 33536750 PMCID: PMC7850572 DOI: 10.2147/ppa.s280503] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/09/2020] [Indexed: 01/10/2023] Open
Abstract
PURPOSE The use of benzodiazepines and related drugs (BZD) is common among older adults although there is growing evidence of their harmful effects. This study investigated how well older people are aware of the potential risks related to the BZD they are taking and whether the risk awareness has changed in the years between 2004 and 2015. PATIENTS AND METHODS The data were collected by interviewing BZD using home-dwelling patients aged ≥65 years with normal cognitive function (MMSE ≥20) who were admitted to the hospital within a 1 month study period in the years 2004 and 2015. Patients were asked whether they were aware of the ten main potential risks related to BZD use. A risk awareness score (range 0-10) was assessed for each patient, each known potential risk yielding one point. RESULTS The study included 37 patients in 2004 and 31 patients in 2015. In 2004, 6/37 patients (16%), while 16/31 patients (52%) in 2015 had risk awareness scores between 6 and 10. Awareness of dependence (p=0.047), interaction with alcohol (p=0.001), dizziness (p=0.002) and developing tolerance (p=0.002) had improved, while awareness of the other potential risks remained unchanged, muscle weakness being the least known (3/37 in 2004 and 4/31 in 2015 were aware of it as a potential risk). Regular BZD use had declined (p=0.043) but pro re nata (PRN; when required) BZD use had increased (p=0.003) between the years 2004 and 2015. CONCLUSION Older BZD users' awareness of some potential risks related to BZD use (dependence, interaction with alcohol, dizziness and developing tolerance) had improved between 2004 and 2015, while awareness of other potential risks remained unchanged.
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Affiliation(s)
- Ercan Celikkayalar
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
- Correspondence: Ercan Celikkayalar Email
| | - Marja Airaksinen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Sirkka-Liisa Kivelä
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
- Unit of Family Medicine, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
| | - Jenni Nieminen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Jenni Kleme
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Juha Puustinen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
- Social Security Center of Pori, Pori, Finland
- Unit of Neurology, Satasairaala Central Hospital, Pori, Finland
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12
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Haula TM, Puustinen J, Takala M, Holm A. Relationship between SDB and short-term outcome in Finnish ischemic stroke patients. Brain Behav 2020; 10:e01762. [PMID: 32881402 PMCID: PMC7559619 DOI: 10.1002/brb3.1762] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/10/2020] [Accepted: 06/28/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Presence of sleep-disordered breathing (SDB) affects negatively recovery from stroke. The aim of this study is to evaluate the relationships between sleep-disordered breathing (SDB) and outcome measures in Finnish stroke unit cohort: mRS, need of rehabilitation and hospitalization time. MATERIAL AND METHODS An observational longitudinal study consisted of 95 patients referred to the Stroke Unit of Satakunta Hospital District over a period of November 2013 to March 2016. Patients were tested for SDB within 72 hr from the hospital admission because of ischemic stroke or TIA. The patients underwent polysomnography with NOX T3 wireless recorder. RESULTS There are 37% (n = 35) non-OSA patients, 20% (n = 19) of patients have mild obstructive sleep apnea (OSA) and 39% (n = 37) have moderate/severe OSA and 4% (n = 4) have CSA. Patients with OSA have higher proportion of disability scores of mRS 3-5 (38%) compared to non-OSA (11%) and mild OSA (5%) patients on registration day (mRS0), and the same trend is seen at hospital discharge 35% versus 9% and 5%. (p = .009). Proportion of patients with OSA who needed rehabilitation is 65% (n = 19) versus non-OSA patients 17.5% (n = 4) and mild OSA patients 17.5% (n = 4; p = .039). We observed longer duration of hospitalization (5-15 days) in 29% of OSA patients compared to mild OSA patients 47% and OSA patients 54%. (p = .045). CONCLUSION Ischemic stroke patients with OSA have higher disability, higher need of rehabilitation, and longer hospitalization length. Prescreening tools for recognizing these stroke patients in acute phase could be valuable. That could result in earlier initiation of treatment and might prevent worse recovery from stroke.
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Affiliation(s)
| | - Juha Puustinen
- Unit of Neurology, Satakunta Hospital District, Pori, Finland.,Division of Pharmacology and Pharmacotherapy, University of Helsinki, Helsinki, Finland.,Department of Clinical Neurosciences, University of Turku, Turku, Finland
| | - Mari Takala
- Unit of Clinical Neurophysiology, Satakunta Hospital District, Pori, Finland
| | - Anu Holm
- Unit of Clinical Neurophysiology, Satakunta Hospital District, Pori, Finland.,Faculty of Health and Welfare, Satakunta University of Applied Sciences, Pori, Finland
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13
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Toivo T, Airaksinen M, Dimitrow M, Savela E, Pelkonen K, Kiuru V, Suominen T, Uunimäki M, Kivelä SL, Leikola S, Puustinen J. Enhanced coordination of care to reduce medication risks in older home care clients in primary care: a randomized controlled trial. BMC Geriatr 2019; 19:332. [PMID: 31775650 PMCID: PMC6882364 DOI: 10.1186/s12877-019-1353-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 11/11/2019] [Indexed: 01/12/2023] Open
Abstract
Background As populations are aging, a growing number of home care clients are frail and use multiple, complex medications. Combined with the lack of coordination of care this may pose uncontrolled polypharmacy and potential patient safety risks. The aim of this study was to assess the impact of a care coordination intervention on medication risks identified in drug regimens of older home care clients over a one-year period. Methods Two-arm, parallel, cluster randomized controlled trial with baseline and follow-up assessment at 12 months. The study was conducted in Primary Care in Lohja, Finland: all 5 home care units, the public healthcare center, and a private community pharmacy. Participants: All consented home care clients aged > 65 years, using at least one prescription medicine who were assessed at baseline and at 12 months. Intervention: Practical nurses were trained to make the preliminary medication risk assessment during home visits and report findings to the coordinating pharmacist. The coordinating pharmacist prepared the cases for the triage meeting with the physician and home care nurse to decide on further actions. Each patient’s physician made the final decisions on medication changes needed. Outcomes were measured as changes in medication risks: use of potentially inappropriate medications and psychotropics; anticholinergic and serotonergic load; drug-drug interactions. Results Participants (n = 129) characteristics: mean age 82.8 years, female 69.8%, mean number of prescription medicines in use 13.1. The intervention did not show an impact on the medication risks between the original intervention group and the control group in the intention to treat analysis, but the per protocol analysis indicated tendency for effectiveness, particularly in optimizing central nervous system medication use. Half (50.0%) of the participants with a potential need for medication changes, agreed on in the triage meeting, had none of the medication changes actually implemented. Conclusion The care coordination intervention used in this study indicated tendency for effectiveness when implemented as planned. Even though the outcome of the intervention was not optimal, the value of this paper is in discussing the real world experiences and challenges of implementing new practices in home care. Trial registration ClinicalTrials.gov (NCT02545257). Registered September 9 2015.
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Affiliation(s)
- Terhi Toivo
- Faculty of Pharmacy, Division of Pharmacology and Pharmacotherapy, Clinical Pharmacy Group, University of Helsinki, Viikinkaari 5 E, P.O. BOX 56, 00014, Helsinki, Finland.
| | - Marja Airaksinen
- Faculty of Pharmacy, Division of Pharmacology and Pharmacotherapy, Clinical Pharmacy Group, University of Helsinki, Viikinkaari 5 E, P.O. BOX 56, 00014, Helsinki, Finland
| | - Maarit Dimitrow
- Faculty of Pharmacy, Division of Pharmacology and Pharmacotherapy, Clinical Pharmacy Group, University of Helsinki, Viikinkaari 5 E, P.O. BOX 56, 00014, Helsinki, Finland
| | - Eeva Savela
- 1st Pharmacy of Lohja, Laurinkatu 37-41 A, 08100, Turku, Finland
| | - Katariina Pelkonen
- City of Lohja, Services for Aged Residents, PL 71, 08101, Lohja, Finland
| | - Valtteri Kiuru
- City of Lohja, Services for Aged Residents, PL 71, 08101, Lohja, Finland
| | - Tuula Suominen
- City of Lohja, Services for Aged Residents, PL 71, 08101, Lohja, Finland
| | - Mira Uunimäki
- City of Lohja, Services for Aged Residents, PL 71, 08101, Lohja, Finland
| | - Sirkka-Liisa Kivelä
- Faculty of Pharmacy, Division of Pharmacology and Pharmacotherapy, Clinical Pharmacy Group, University of Helsinki, Viikinkaari 5 E, P.O. BOX 56, 00014, Helsinki, Finland.,Institute of Clinical Medicine, Department of Family Medicine, University of Turku, 20014, University of Turku, Finland
| | - Saija Leikola
- 1st Pharmacy of Lohja, Laurinkatu 37-41 A, 08100, Turku, Finland
| | - Juha Puustinen
- Faculty of Pharmacy, Division of Pharmacology and Pharmacotherapy, Clinical Pharmacy Group, University of Helsinki, Viikinkaari 5 E, P.O. BOX 56, 00014, Helsinki, Finland.,Satakunta Hospital District, Satakunta Central Hospital, Unit of Neurology, Sairaalantie 3, 28500, Pori, Finland
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14
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Kuusisto A, Joensuu A, Nevalainen M, Pakkanen T, Ranne P, Puustinen J. Standardizing Key Issues from Hospital Through an Electronic Multi-Professional Discharge Checklist to Ensure Continuity of Care. Stud Health Technol Inform 2019; 264:664-668. [PMID: 31438007 DOI: 10.3233/shti190306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This article describes development of the multi-professional discharge checklist and its implementation into the nursing documentation system (NDS) as part of the patient's overall care plan. The aim was to harmonize patient's admission and care period documentation and to improve the quality of electronic nursing discharge summaries. The ultimate goal was to ensure continuity of care. The multidisciplinary discharge checklist was developed in two phases to support the discharge of elderly patients (over 65 years). First, the information content of the checklist was defined, and second, it was integrated into the NDS. Focus groups of social and healthcare professionals (n = 82) in specialist health care, primary health care and social services defined the information content and participated in the feedback and checking rounds. The development work should continue. Particular attention should be given to the technical performance of discharge checklists in the NDS.
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Affiliation(s)
- Anne Kuusisto
- Administration Centre, Satakunta Hospital District, Pori, Finland
| | - Anne Joensuu
- Medical Care Area, Satakunta Hospital District, Pori, Finland
| | | | - Terhi Pakkanen
- Medical Care Area, Satakunta Hospital District, Pori, Finland
| | - Paula Ranne
- Medical Care Area, Satakunta Hospital District, Pori, Finland
| | - Juha Puustinen
- Medical Care Area, Satakunta Hospital District, Pori, Finland
- Pori Social Security Center, Pori, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
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15
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Jauhiainen M, Puustinen J, Mehrang S, Ruokolainen J, Holm A, Vehkaoja A, Nieminen H. Identification of Motor Symptoms Related to Parkinson Disease Using Motion-Tracking Sensors at Home (KÄVELI): Protocol for an Observational Case-Control Study. JMIR Res Protoc 2019; 8:e12808. [PMID: 30916665 PMCID: PMC6456828 DOI: 10.2196/12808] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/20/2019] [Accepted: 02/23/2019] [Indexed: 11/15/2022] Open
Abstract
Background Clinical characterization of motion in patients with Parkinson disease (PD) is challenging: symptom progression, suitability of medication, and level of independence in the home environment can vary across time and patients. Appointments at the neurological outpatient clinic provide a limited understanding of the overall situation. In order to follow up these variations, longer-term measurements performed outside of the clinic setting could help optimize and personalize therapies. Several wearable sensors have been used to estimate the severity of symptoms in PD; however, longitudinal recordings, even for a short duration of a few days, are rare. Home recordings have the potential benefit of providing a more thorough and objective follow-up of the disease while providing more information about the possible need to change medications or consider invasive treatments. Objective The primary objective of this study is to collect a dataset for developing methods to detect PD-related symptoms that are visible in walking patterns at home. The movement data are collected continuously and remotely at home during the normal lives of patients with PD as well as controls. The secondary objective is to use the dataset to study whether the registered medication intakes can be identified from the collected movement data by looking for and analyzing short-term changes in walking patterns. Methods This paper described the protocol for an observational case-control study that measures activity using three different devices: (1) a smartphone with a built-in accelerometer, gyroscope, and phone orientation sensor, (2) a Movesense smart sensor to measure movement data from the wrist, and (3) a Forciot smart insole to measure the forces applied on the feet. The measurements are first collected during the appointment at the clinic conducted by a trained clinical physiotherapist. Subsequently, the subjects wear the smartphone at home for 3 consecutive days. Wrist and insole sensors are not used in the home recordings. Results Data collection began in March 2018. Subject recruitment and data collection will continue in spring 2019. The intended sample size was 150 subjects. In 2018, we collected a sample of 103 subjects, 66 of whom were diagnosed with PD. Conclusions This study aims to produce an extensive movement-sensor dataset recorded from patients with PD in various phases of the disease as well as from a group of control subjects for effective and impactful comparison studies. The study also aims to develop data analysis methods to monitor PD symptoms and the effects of medication intake during normal life and outside of the clinic setting. Further applications of these methods may include using them as tools for health care professionals to monitor PD remotely and applying them to other movement disorders. Trial Registration ClinicalTrials.gov NCT03366558; https://clinicaltrials.gov/ct2/show/NCT03366558 International Registered Report Identifier (IRRID) DERR1-10.2196/12808
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Affiliation(s)
- Milla Jauhiainen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Juha Puustinen
- Unit of Neurology, Satakunta Central Hospital, Satakunta Hospital District, Pori, Finland.,Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, University of Helsinki, Helsinki, Finland.,Hospital Services, Social Security Center of Pori, Pori, Finland
| | - Saeed Mehrang
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Jari Ruokolainen
- Faculty of Management and Business, Tampere University, Tampere, Finland
| | - Anu Holm
- Faculty of Medicine, University of Turku, Turku, Finland.,Department of Clinical Neurophysiology, Satakunta Central Hospital, Satakunta Hospital District, Pori, Finland.,Faculty of Health and Welfare, Satakunta University of Applied Sciences, Pori, Finland
| | - Antti Vehkaoja
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Hannu Nieminen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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16
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Kuusisto AM, Joensuu A, Nevalainen M, Pakkanen T, Ranne P, Puustinen J. Sähköisen moniammatillisen kotiutuslistan kehittäminen sairaalasta kotiutuksen tueksi. FinJeHeW 2019. [DOI: 10.23996/fjhw.70465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Potilaan sujuvan ja turvallisen kotiutumisen edistämiseksi tarvitaan kotiutuskäytäntöjen yhtenäistämistä ja sähköisen hoitotyön yhteenvedon tietosisällön parantamista. Kotiutuslistan käytöllä voidaan parantaa potilaan hoidon jatkuvuutta ja laatua. Se auttaa muistuttamaan hoidon jatkuvuuden kannalta oleellisista asioista hoitojakson aikana, ja sitä voidaan hyödyntää esimerkiksi sähköisen hoitotyön yhteenvedon laatimisessa.
Kuvaamme tässä artikkelissa moniammatillisen kotiutuslistan tietosisällön kehittämistä hoitokertomukseen potilaan tulotilanteen ja hoitojakson aikaisen kirjaamisen yhtenäistämiseksi kirjallisuuden sekä erikoissairaanhoidossa, perusterveydenhuollossa ja sosiaalipalveluissa työskentelevien ammattilaisten (n = 82) yhteistyön tuloksena.
Kotiutuslistaan sisällytettiin aikaisemman kirjallisuuden, käytössä olleiden paperisten kotiutuslistaesimerkkien ja moniammatillisten työryhmien tuotoksena syntyneitä potilaan turvallisen kotiutuksen kannalta keskeisiä tarkasteltavia asioita. Kotiutuslista pilotoitiin Satakunnan sairaanhoitopiirissä. Pilotointi toteutettiin kolmella keskussairaalan vuodeosastolla, keuhkosairauksilla, sisätaudeilla ja neurologialla, sekä vanhuspsykiatrian ja kuntoutuksen vuodeosastoilla paperimuodossa. Pilotoitu tietosisältö siirrettiin sähköiseen muotoon Effican hoitokertomukseen (hokeen) osaksi potilaan kliinistä hoitosuunnitelmaa.
Moniammatillinen kotiutuslista otettiin pilotin jälkeen käyttöön Satakunnan erikoissairaanhoidon palveluissa. Kotiutuslistan keskeisimmät jatkokehittämistarpeet kohdistuvat asiakas- ja potilasnäkökulman esille saamiseen sekä sen tekniseen toimivuuteen potilastietojärjestelmässä.
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Lähteenmäki R, Neuvonen PJ, Puustinen J, Vahlberg T, Partinen M, Räihä I, Kivelä S. Withdrawal from long‐term use of zopiclone, zolpidem and temazepam may improve perceived sleep and quality of life in older adults with primary insomnia. Basic Clin Pharmacol Toxicol 2018; 124:330-340. [DOI: 10.1111/bcpt.13144] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 09/24/2018] [Indexed: 12/01/2022]
Affiliation(s)
| | - Pertti J. Neuvonen
- Department of Clinical Pharmacology University of Helsinki, and HUSLAB Helsinki University Hospital Helsinki Finland
| | - Juha Puustinen
- Unit of Neurology Satakunta Hospital District Pori Finland
- Division of Pharmacology and Pharmacotherapy Clinical Pharmacy Group University of Helsinki Helsinki Finland
| | - Tero Vahlberg
- Department of Biostatistics University of Turku Turku Finland
| | - Markku Partinen
- Helsinki Sleep Clinic Vitalmed Research Center Helsinki Finland
- Department of Neurology University of Helsinki Helsinki Finland
| | - Ismo Räihä
- Department of Family Medicine University of Turku Turku Finland
| | - Sirkka‐Liisa Kivelä
- Department of Family Medicine University of Turku Turku Finland
- Division of Pharmacology and Pharmacotherapy Clinical Pharmacy Group University of Helsinki Helsinki Finland
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18
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Takala M, Puustinen J, Rauhala E, Holm A. Pre-screening of sleep-disordered breathing after stroke: A systematic review. Brain Behav 2018; 8:e01146. [PMID: 30371010 PMCID: PMC6305929 DOI: 10.1002/brb3.1146] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 09/13/2018] [Accepted: 09/14/2018] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES Sleep-Disordered Breathing (SDB) is frequent in stroke patients. Polysomnography (PSG) and cardiorespiratory polygraphy are used to confirm SDB, but the need for PSG exceeds the available resources for systematic testing. Therefore, a simple and robust pre-screening instrument is necessary to identify the patients with an urgent need for a targeted PSG. The aim of this systematic review was to identify and evaluate the available methods to pre-screen stroke patients possibly suffering from SDB. MATERIALS AND METHODS Eleven studies out of 3,561 studies met the inclusion criteria. The selected studies assessed the efficiency of seven instruments based on the data acquired clinically or by inquiries (Berlin Questionnaire, Epworth Sleepiness Scale, SOS, Modified Sleep Apnea Scale of the Sleep Disorders Questionnaire, STOP-BANG, Four-variable Screening Tool and Multivariate Apnea Index) and three physiological measures (capnography, nocturia, nocturnal oximetry). The instruments were used to predict SDB in patients after acute or subacute stroke. Either PSG or cardiorespiratory polygraphy was used as a standard to measure SDB. RESULTS No independent studies using the same questionnaires, methods or criteria were published reducing generalizability. Overall, the questionnaires were quite sensitive in finding SDB but not highly specific in identifying the non-affected. The physiological measures (capnography) indicated promising results in predicting SDB, but capnography is not an ideal pre-screening instrument as it requires a specialist to interpret the results. CONCLUSIONS The results of pre-screening of SDB in acute and subacute stroke patients are promising but inconsistent. The current pre-screening methods cannot readily be referred to clinicians in neurologic departments. Thus, it is necessary to conduct more research on developing novel pre-screening methods for detecting SDB after stroke.
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Affiliation(s)
- Mari Takala
- Unit of Clinical Neurophysiology, Satakunta Central Hospital, Pori, Finland
| | - Juha Puustinen
- Unit of Neurology, Satakunta Central Hospital, Pori, Finland.,Division of Pharmacology and Pharmacotherapy, University of Helsinki, Helsinki, Finland.,Social Security Centre of Pori, Pori, Finland
| | - Esa Rauhala
- Unit of Clinical Neurophysiology, Satakunta Central Hospital, Pori, Finland
| | - Anu Holm
- Unit of Clinical Neurophysiology, Satakunta Central Hospital, Pori, Finland.,Faculty of Health and Welfare, Satakunta University of Applied Sciences, Pori, Finland
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Mehrang S, Jauhiainen M, Pietil J, Puustinen J, Ruokolainen J, Nieminen H. Identification of Parkinson's Disease Utilizing a Single Self-recorded 20-step Walking Test Acquired by Smartphone's Inertial Measurement Unit. Annu Int Conf IEEE Eng Med Biol Soc 2018; 2018:2913-2916. [PMID: 30441010 DOI: 10.1109/embc.2018.8512921] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Parkinson's disease (PD) is a degenerative and long-term disorder of the central nervous system, which often causes motor symptoms, e.g., tremor, rigidity, and slowness. Currently, the diagnosis of PD is based on patient history and clinical examination. Technology-derived decision support systems utilizing, for example, sensor-rich smartphones can facilitate more accurate PD diagnosis. These technologies could provide less obtrusive and more comfortable remote symptom monitoring. The recent studies showed that motor symptoms of PD can reliably be detected from data gathered via smartphones. The current study utilized an open-access dataset named "mPower" to assess the feasibility of discriminating PD from non-PD by analyzing a single self-administered 20-step walking test. From this dataset, 1237 subjects (616 had PD) who were age and gender matched were selected and classified into PD and non-PD categories. Linear acceleration (ACC) and gyroscope (GYRO) were recorded by built-in sensors of smartphones. Walking bouts were extracted by thresholding signal magnitude area of the ACC signals. Features were computed from both ACC and GYRO signals and fed into a random forest classifier of size 128 trees. The classifier was evaluated deploying 100-fold cross-validation and provided an accumulated accuracy rate of 0.7 after 10k validations. The results show that PD and non-PD patients can be separated based on a single short-lasting self-administered walking test gathered by smartphones' built-in inertial measurement units.
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20
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Puustinen J. Benzodiazepines and Z-drugs may cause prolonged cognitive issues in young adults - are hypnotics not only a geriatric dilemma? Sleep Med 2018; 52:219-220. [PMID: 30293847 DOI: 10.1016/j.sleep.2018.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Juha Puustinen
- University of Helsinki, Division of Pharmacology and Pharmacotherapy, Satakunta Hospital District, Unit of Neurology, Social Security Center of Pori, Hospital Services, Finland.
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21
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Puustinen J, Lähteenmäki R, Nurminen J, Vahlberg T, Aarnio P, Partinen M, Räihä I, Neuvonen PJ, Kivelä SL. Long-term persistence of withdrawal of temazepam, zopiclone, and zolpidem in older adults: a 3-year follow-up study. BMC Geriatr 2018; 18:142. [PMID: 29907085 PMCID: PMC6003076 DOI: 10.1186/s12877-018-0829-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 05/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies on persistence of benzodiazepine agonist (BZDA) withdrawal in older outpatients are few, and few studies on long-term persistence over years have yet been published. To describe the persistence of temazepam, zolpidem, and zopiclone (BZDA) withdrawal among older outpatients at 3 years from the beginning of withdrawal, as well as any changes in use of other medications. METHODS 92 outpatients (≥55 years) with primary insomnia, long-term BZDA use as hypnotics (mean duration of BZDA use 9.9 ± 6.2 years), and willingness to withdraw from BZDAs each received either melatonin or a placebo nightly for one month. During this period, BZDAs were meant to be gradually withdrawn. Sleep hygiene counselling and psychosocial support were provided. Three years later, use of BZDAs and other medications was determined by interview and confirmed from medical records. RESULTS Of the original 92 outpatients, 83 (90%) participated in the 3-year survey (mean follow-up 3.3 ± 0.2 years). The number of BZDA-free participants decreased from 34 (37%) at 6 months to 26 (28%; intention-to-treat) at 3 years, that of irregular BZDA users decreased from 44 (48%) at 6 months to 27 (29%) at 3 years, while that of regular users increased from 11 (12%) at 6 months to 30 (33%) at 3 years (P = 0.001). Those who were regular BZDA users at 3 years had at baseline (before withdrawal) higher BMI (P = 0.001) than did other participants. At 3 years, the total number of medications remained unchanged for non-users (P = 0.432), but increased for the irregular (P = 0.011) and regular users (P = 0.026) compared to baseline. At 3 years, compared to baseline, use of antidepressants, dopamine agonists, melatonin, and NSAIDs/paracetamol was significantly more common in the whole cohort, but their use did not differ between the BZDA-user subgroups. Randomization to melatonin or placebo during BZDA withdrawal was unrelated to BZDA-withdrawal result. CONCLUSIONS At 3 years after withdrawal, the number of BZDA-free participants had decreased, but still one-third of the subjects remained BZDA-free, and one-third had reduced their use. Successful BZDA withdrawal did not lead to any increase in total number of medications; use of symptomatic medications in the whole cohort, however, did increase.
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Affiliation(s)
- Juha Puustinen
- Satakunta Hospital District, Satakunta Central Hospital, Unit of Neurology, Sairaalantie 3, 28500, Pori, Finland. .,Division of Pharmacology and Pharmacotherapy, Clinical Pharmacy Group, University of Helsinki, Helsinki, Finland.
| | | | - Janne Nurminen
- The Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Tero Vahlberg
- Department of Biostatistics, University of Turku, Turku, Finland
| | - Pertti Aarnio
- Satakunta Hospital District, Satakunta Central Hospital, Unit of Surgery, Pori, Finland
| | - Markku Partinen
- Helsinki Sleep Clinic, Vitalmed Research Center, Helsinki, Finland.,Department of Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - Ismo Räihä
- Unit of Family Medicine, University of Turku, Turku, Finland
| | - Pertti J Neuvonen
- Department of Clinical Pharmacology, University of Helsinki, Helsinki, Finland
| | - Sirkka-Liisa Kivelä
- Division of Pharmacology and Pharmacotherapy, Clinical Pharmacy Group, University of Helsinki, Helsinki, Finland.,Unit of Family Medicine, University of Turku, Turku, Finland
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22
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Dimitrow M, Puustinen J, Viikari P, Puumalainen E, Vahlberg T, Airaksinen MSA, Kivelä SL. Can Practical Nurses Identify Older Home Care Clients at Risk of Drug-Related Problems-Geriatricians' Appraisal of Their Risk Screenings: A Pilot Study. J Pharm Technol 2018; 34:99-108. [PMID: 34861022 PMCID: PMC6580731 DOI: 10.1177/8755122518756332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Abstract
Background: Home care (HC) clients are increasingly older, have many chronic diseases, and use multiple medicines and thus are at high risk for drug-related problems (DRPs). Objective: Establish the sensitivity of practical nurse (PN) administered DRP risk assessment tool (DRP-RAT) compared with geriatrician's assessment of the medical record. Identify the clinically most significant DRPs needing action. Methods: Twenty-six PNs working in HC of Härkätie Health Center in Lieto, Finland, 46 HC clients (≥65 years), and a geriatrician participated in this pilot study. The geriatrician reviewed HC clients' medications using 3 different methods. The reviews were based on the following: (1) the PN's risk screening (ie, PN-completed DRP-RAT) and medication list, (2) health center's medical records, and (3) methods 1 and 2 together. The main outcome was the number of "at-risk patients" (ie, the patient is at risk of clinically significant DRPs) by using each review method. Secondary outcomes were clinically most significant DRP-risk predicting factors identified by the geriatrician. Results: The geriatrician reviewed 45 clients' medications using all 3 methods. Based on PN-completed DRP-RAT and medication list, 93% (42/45) of the clients were classified as "at-risk patients." Two other review methods resulted in 45/45 (100%) "at-risk patients." Symptoms suggestive of adverse drug reactions were the most significant risk predicting factors. Small sample size limits the generalizability of the results. Conclusions: The PN-completed DRP-RAT was able to provide clinically important timely patient information for clinical decision making. DRP-RAT could make it possible to more effectively involve PNs in medication risk management among older HC clients.
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Affiliation(s)
| | - Juha Puustinen
- University of Helsinki, Helsinki,
Finland
- Satakunta Central Hospital, Pori,
Finland
| | | | | | | | | | - Sirkka-Liisa Kivelä
- University of Helsinki, Helsinki,
Finland
- University of Turku, Turku,
Finland
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23
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Toivo T, Dimitrow M, Puustinen J, Savela E, Pelkonen K, Kiuru V, Suominen T, Kinnunen S, Uunimäki M, Kivelä SL, Leikola S, Airaksinen M. Coordinating resources for prospective medication risk management of older home care clients in primary care: procedure development and RCT study design for demonstrating its effectiveness. BMC Geriatr 2018; 18:74. [PMID: 29548304 PMCID: PMC5857129 DOI: 10.1186/s12877-018-0737-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 01/29/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The magnitude of safety risks related to medications of the older adults has been evidenced by numerous studies, but less is known of how to manage and prevent these risks in different health care settings. The aim of this study was to coordinate resources for prospective medication risk management of home care clients ≥ 65 years in primary care and to develop a study design for demonstrating effectiveness of the procedure. METHODS Health care units involved in the study are from primary care in Lohja, Southern Finland: home care (191 consented clients), the public healthcare center, and a private community pharmacy. System based risk management theory and action research method was applied to construct the collaborative procedure utilizing each profession's existing resources in medication risk management of older home care clients. An inventory of clinical measures in usual clinical practice and systematic review of rigorous study designs was utilized in effectiveness study design. DISCUSSION The new coordinated medication management model (CoMM) has the following 5 stages: 1) practical nurses are trained to identify clinically significant drug-related problems (DRPs) during home visits and report those to the clinical pharmacist. Clinical pharmacist prepares the cases for 2) an interprofessional triage meeting (50-70 cases/meeting of 2 h) where decisions are made on further action, e.g., more detailed medication reviews, 3) community pharmacists conduct necessary medication reviews and each patients' physician makes final decisions on medication changes needed. The final stages concern 4) implementation and 5) follow-up of medication changes. Randomized controlled trial (RCT) was developed to demonstrate the effectiveness of the procedure. The developed procedure is feasible for screening and reviewing medications of a high number of older home care clients to identify clients with severe DRPs and provide interventions to solve them utilizing existing primary care resources. TRIAL REGISTRATION The study is registered in the Clinical Trials.gov ( NCT02545257 ). Registration date September 9 2015.
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Affiliation(s)
- Terhi Toivo
- Faculty of Pharmacy, Division of Pharmacology and Pharmacotherapy, Clinical Pharmacy Group, University of Helsinki, Viikinkaari 5 E, P.O. BOX 56, 00014 Helsinki, Finland
| | - Maarit Dimitrow
- Faculty of Pharmacy, Division of Pharmacology and Pharmacotherapy, Clinical Pharmacy Group, University of Helsinki, Viikinkaari 5 E, P.O. BOX 56, 00014 Helsinki, Finland
| | - Juha Puustinen
- Faculty of Pharmacy, Division of Pharmacology and Pharmacotherapy, Clinical Pharmacy Group, University of Helsinki, Viikinkaari 5 E, P.O. BOX 56, 00014 Helsinki, Finland
- Satakunta Hospital District, Satakunta Central Hospital, Unit of Neurology, Sairaalantie 3, 28500 Pori, Finland
| | - Eeva Savela
- 1st Pharmacy of Lohja, Laurinkatu 37-41 A, 08100 Lohja, Finland
| | | | - Valtteri Kiuru
- City of Lohja, Services for Aged Residents, PL 71, 08101 Lohja, Finland
| | - Tuula Suominen
- City of Lohja, Services for Aged Residents, PL 71, 08101 Lohja, Finland
| | - Sirkka Kinnunen
- City of Lohja, Services for Aged Residents, PL 71, 08101 Lohja, Finland
| | - Mira Uunimäki
- City of Lohja, Services for Aged Residents, PL 71, 08101 Lohja, Finland
| | - Sirkka-Liisa Kivelä
- Faculty of Pharmacy, Division of Pharmacology and Pharmacotherapy, Clinical Pharmacy Group, University of Helsinki, Viikinkaari 5 E, P.O. BOX 56, 00014 Helsinki, Finland
- Institute of Clinical Medicine, Department of Family Medicine, University of Turku, 20014 Turku, Finland
| | - Saija Leikola
- 1st Pharmacy of Lohja, Laurinkatu 37-41 A, 08100 Lohja, Finland
| | - Marja Airaksinen
- Faculty of Pharmacy, Division of Pharmacology and Pharmacotherapy, Clinical Pharmacy Group, University of Helsinki, Viikinkaari 5 E, P.O. BOX 56, 00014 Helsinki, Finland
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24
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Luna E, Wu M, Hanke M, Puustinen J, Guina M, Trampert A. Spontaneous formation of three-dimensionally ordered Bi-rich nanostructures within GaAs1-x Bi x /GaAs quantum wells. Nanotechnology 2016; 27:325603. [PMID: 27364086 DOI: 10.1088/0957-4484/27/32/325603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In this work, we report on the spontaneous formation of ordered arrays of nanometer-sized Bi-rich structures due to lateral composition modulations in Ga(As,Bi)/GaAs quantum wells grown by molecular beam epitaxy. The overall microstructure and chemical distribution is investigated using transmission electron microscopy. The information is complemented by synchrotron x-ray grazing incidence diffraction, which provides insight into the in-plane arrangement. Due to the vertical inheritance of the lateral modulation, the Bi-rich nanostructures eventually shape into a three-dimensional assembly. Whereas the Bi-rich nanostructures are created via two-dimensional phase separation at the growing surface, our results suggest that the process is assisted by Bi segregation which is demonstrated to be strong and more complex than expected, implying both lateral and vertical (surface segregation) mass transport. As demonstrated here, the inherent thermodynamic miscibility gap of Ga(As,Bi) alloys can be exploited to create highly uniform Bi-rich units embedded in a quantum confinement structure.
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Affiliation(s)
- E Luna
- Paul-Drude-Institut für Festkörperelektronik, Hausvogteiplatz 5-7, D-10117, Berlin, Germany
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25
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Välimäki M, Apilo P, Po R, Jansson E, Bernardi A, Ylikunnari M, Vilkman M, Corso G, Puustinen J, Tuominen J, Hast J. R2R-printed inverted OPV modules--towards arbitrary patterned designs. Nanoscale 2015; 7:9570-80. [PMID: 25951787 DOI: 10.1039/c5nr00204d] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
We describe the fabrication of roll-to-roll (R2R) printed organic photovoltaic (OPV) modules using gravure printing and rotary screen-printing processes. These two-dimensional printing techniques are differentiating factors from coated OPVs enabling the direct patterning of arbitrarily shaped and sized features into visual shapes and, increasing the freedom to connect the cells in modules. The inverted OPV structures comprise five layers that are either printed or patterned in an R2R printing process. We examined the rheological properties of the inks used and their relationship with the printability, the compatibility between the processed inks, and the morphology of the R2R-printed layers. We also evaluate the dimensional accuracy of the printed pattern, which is an important consideration in designing arbitrarily-shaped OPV structures. The photoactive layer and top electrode exhibited excellent cross-dimensional accuracy corresponding to the designed width. The transparent electron transport layer extended 300 µm beyond the designed values, whereas the hole transport layer shrank 100 µm. We also examined the repeatability of the R2R fabrication process when the active area of the module varied from 32.2 cm(2) to 96.5 cm(2). A thorough layer-by-layer optimization of the R2R printing processes resulted in realization of R2R-printed 96.5 cm(2) sized modules with a maximum power conversion efficiency of 2.1% (mean 1.8%) processed with high functionality.
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Affiliation(s)
- M Välimäki
- VTT Technical Research Centre of Finland Kaitoväylä 1, FIN-90571 Oulu, Finland.
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26
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Lähteenmäki R, Puustinen J, Vahlberg T, Lyles A, Neuvonen PJ, Partinen M, Räihä I, Kivelä SL. Melatonin for sedative withdrawal in older patients with primary insomnia: a randomized double-blind placebo-controlled trial. Br J Clin Pharmacol 2015; 77:975-85. [PMID: 24286360 DOI: 10.1111/bcp.12294] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 11/21/2013] [Indexed: 11/29/2022] Open
Abstract
AIM We compared the efficacy of melatonin and placebo as adjuvants in the withdrawal of patients from long term temazepam, zopiclone or zolpidem (here 'BZD') use. METHODS A double-blind, placebo-controlled, randomized trial was conducted in a primary health care outpatient clinic. Ninety-two men or women (≥55 years) with primary insomnia and chronic BZD use received controlled release melatonin 2 mg (CRM) (n = 46) or placebo (n = 46) during the 1 month withdrawal from BZDs. Psychosocial support was provided. Follow-up continued for up to 6 months. Successful BZD withdrawal by the end of 1 month was confirmed by BZD plasma determinations, while reduction in BZD use and abstinence continuing for 6 months were noted. RESULTS There were two drop-outs on CRM and one on placebo. After a 1 month withdrawal, 31 participants (67%; 95% CI 54, 81) on CRM and 39 (85%; 74, 95) on placebo had withdrawn completely (intention-to-treat analysis between groups, P = 0.051; per protocol P = 0.043). Reduction in BZD use was similar or even more rare in the CRM than in the placebo group (P = 0.052 per protocol). After 6 months, 14 participants in the CRM group and 20 in the placebo group remained non-users of BZD (NS between groups). BZD doses were higher in the CRM than in the placebo group at the end of the 6 month follow-up (P = 0.025). Withdrawal symptoms did not differ between the groups. CONCLUSIONS Gradual dose reduction of BZDs combined with CRM or placebo, and psychosocial support produced high short term and moderate long term BZD abstinence. CRM showed no withdrawal benefit compared with placebo.
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27
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Nurminen J, Puustinen J, Lähteenmäki R, Vahlberg T, Lyles A, Partinen M, Räihä I, Neuvonen PJ, Kivelä SL. Handgrip strength and balance in older adults following withdrawal from long-term use of temazepam, zopiclone or zolpidem as hypnotics. BMC Geriatr 2014; 14:121. [PMID: 25416480 PMCID: PMC4246488 DOI: 10.1186/1471-2318-14-121] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 10/29/2014] [Indexed: 11/22/2022] Open
Abstract
Background Benzodiazepines and related drugs affect physical functioning negatively and increase fall and fracture risk. As impaired muscle strength and balance are risk factors for falls, we examined the effects of hypnotic withdrawal on handgrip strength and balance in older adult outpatients during and after long-term use of temazepam, zopiclone and zolpidem (here collectively referred to as “benzodiazepines”). Methods Eighty-nine chronic users (59 women, 30 men) of temazepam, zopiclone or zolpidem aged ≥55 years participated in a benzodiazepine withdrawal study. Individual physician-directed withdrawal was performed gradually over a one-month period and participants were followed up to six months. Handgrip strength was assessed using a handheld dynamometer, and balance using the Short Berg’s Balance Scale during the period of benzodiazepine use (baseline), and at 1, 2, 3 weeks, and 1, 2 and 6 months after initiating withdrawal. Withdrawal outcome and persistence were determined by plasma benzodiazepine-determinations at baseline and at four weeks (“short-term withdrawers”, n = 69; “short-term non-withdrawers”, n = 20), and by interviews at six months (“long-term withdrawers”, n = 34; “long-term non-withdrawers”, n = 55). Also most of the non-withdrawers markedly reduced their benzodiazepine use. Results Within three weeks after initiating withdrawal, handgrip strength improved significantly (P ≤ 0.005) compared to baseline values. Among women, long-term withdrawers improved their handgrip strength both when compared to their baseline values (P = 0.001) or to non-withdrawers (P =0.004). In men, improvement of handgrip strength from baseline was not significantly better in withdrawers than in non-withdrawers. However, men did improve their handgrip strength values compared to baseline (P = 0.002). Compared to balance test results at baseline, withdrawers improved starting from the first week after withdrawal initiation. There was, however, only a borderline difference (P = 0.054) in balance improvement between the long-term withdrawers and long-term non-withdrawers. Of note, the non-withdrawers tended to improve their handgrip strength and balance compared to baseline values, in parallel with their reduced benzodiazepine use. Conclusions Withdrawal from long-term use of benzodiazepines can rapidly improve muscle strength and balance. Our results encourage discontinuing benzodiazepine hypnotics, particularly in older women who are at a high risk of falling and sustaining fractures. Trial registration EU Clinical Trials Register: EudraCT2008000679530. Registered 31 October 2008
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Affiliation(s)
- Janne Nurminen
- Department of Family Medicine, University of Turku, Lemminkäisenkatu 1, FI-20014 Turku, Finland.
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Hytönen J, Kortela E, Waris M, Puustinen J, Salo J, Oksi J. CXCL13 and neopterin concentrations in cerebrospinal fluid of patients with Lyme neuroborreliosis and other diseases that cause neuroinflammation. J Neuroinflammation 2014; 11:103. [PMID: 24920219 PMCID: PMC4070086 DOI: 10.1186/1742-2094-11-103] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 05/21/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Laboratory diagnosis of Lyme neuroborreliosis (LNB) is partly based on the detection of intrathecal Borrelia burgdorferi-specific antibody production (increased antibody index (AI)). However, AI can be negative in patients with early LNB and, conversely, can remain elevated for months after antibiotic treatment. Recent studies suggested that the chemokine CXCL13 in the cerebrospinal fluid (CSF) is a biomarker for active LNB. Also, CSF neopterin-level determination has been used to assess the degree of neuroinflammation in a wide variety of diseases. METHODS CXCL13 concentrations were analyzed in CSF samples of 366 retrospectively identified individuals. The samples represented pretreatment LNB (38 patients), non-LNB comparison patients, tick-borne encephalitis, central nervous system (CNS) varicella zoster virus infection, CNS herpes simplex virus infection, CNS HHV6 infection, CNS enterovirus infection, and untreated neurosyphilis. The panel included also samples from patients with multiple sclerosis and other neuroinflammatory conditions. Of the LNB patients, 24 posttreatment CSF samples were available for CXCL13 analysis. Neopterin concentrations were determined in a subset of these samples. RESULTS The CXCL13 concentrations in CSF samples of untreated LNB patients were significantly higher (median, 6,480 pg/ml) than the concentrations in the non-LNB group (median, <7.8 pg/ml), viral CNS infection samples (median, <7.8 pg/ml), or samples from patients with noninfectious neuroinflammatory conditions (median, <7.8 pg/ml). The use of cut-off 415 pg/ml led to a sensitivity of 100% and specificity of 99.7% for the diagnosis of LNB in these samples. CSF CXCL13 median concentrations declined significantly from 16,770 pg/ml before to 109 pg/ml after the treatment.CSF neopterin concentration was significantly higher among the untreated LNB patients than in the non-LNB group. The use of neopterin concentration 10.6 nM as the cut-off led to a sensitivity of 88.6% and a specificity of 65.0% for the diagnosis of LNB. The CSF neopterin concentrations decreased statistically significantly with the treatment. CONCLUSIONS These results clearly indicate that highly elevated CSF CXCL13 levels are strongly associated with untreated LNB. CXCL13 outperformed neopterin and appears to be an excellent biomarker in differentiating LNB from viral CNS infections and from other neuroinflammatory conditions.
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Affiliation(s)
- Jukka Hytönen
- Department of Medical Microbiology and Immunology, University of Turku, Turku, Finland.
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Hurri L, Posti J, Seppä JM, Rauhala E, Puustinen J. [Cerebral oedema caused by sodium valproate]. Duodecim 2014; 130:1874-1877. [PMID: 25558630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Sodium valproate is widely used as an antiepileptic drug. It has potential side effects and its overdosage is toxic. We present a case where a sodium valproate intoxication with severe cerebral oedema was managed in the intensive care unit with hemodialysis, levocarnitine and supportive care.
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Puustinen J, Lähteenmäki R, Polo-Kantola P, Salo P, Vahlberg T, Lyles A, Neuvonen PJ, Partinen M, Räihä I, Kivelä SL. Effect of withdrawal from long-term use of temazepam, zopiclone or zolpidem as hypnotic agents on cognition in older adults. Eur J Clin Pharmacol 2013; 70:319-29. [PMID: 24337417 DOI: 10.1007/s00228-013-1613-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 11/06/2013] [Indexed: 12/22/2022]
Abstract
PURPOSE The aim of this study was to assess the effect of withdrawal from the long-term use of temazepam, zopiclone or zolpidem as hypnotics drugs (here referred to as BZD) on cognitive performance. METHODS Ninety-two adults (age ≥55 years) with primary insomnia and who were long-term daily users of BZD volunteered to participate in a 1-month medically supported withdrawal attempt from BZD use, with a subsequent 5-month follow-up. Withdrawal was based on plasma BZD measurements at baseline, at 1 month and during subsequent regular clinical appointments. Attention and psychomotor performance were measured using the CogniSpeed® at baseline and at 1, 2 and 6 months. Reaction times were determined in the Simple Reaction Time (SRT), Two-Choice Reaction Time (2-CRT) and Vigilance tests, and errors were measured by the 2-CRT and Vigilance tests. The cognition data of the withdrawal group were also compared with a cohort of BZD non-users. RESULTS Eighty-nine (97 %) participants (59 women, 30 men) were followed-up for a maximum of 6 months. During the follow-up period, changes in reaction times and errors did not differ between short-term withdrawers (no residual BZD at 1 month; N = 69), non-withdrawers (residual BZD at 1 month; N = 20) or long-term withdrawers (N = 34). Compared to the reaction times of the BZD-free cohort, those of BZD users were slower at baseline. The reaction times of BZD withdrawers based on the results of the SRT or 2-CRT tests during follow-up did not reach those of the BZD-free cohort, but there was no difference between these groups in the Vigilance test. CONCLUSIONS Long-term use of BDZ as hypnotic drugs by older adults is related to prolonged impairment of attentional and psychomotor cognitive functioning that persists for at least 6 months after withdrawal.
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Affiliation(s)
- Juha Puustinen
- Department of Family Medicine, University of Turku, Lemminkäisenkatu 1, 20014, Turku, Finland,
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Nurminen J, Puustinen J, Piirtola M, Vahlberg T, Lyles A, Kivelä SL. Opioids, antiepileptic and anticholinergic drugs and the risk of fractures in patients 65 years of age and older: a prospective population-based study. Age Ageing 2013. [PMID: 23204431 DOI: 10.1093/ageing/afs178] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND in men, the concomitant use of two or more benzodiazepines or two or more antipsychotics is associated with an increased risk of fracture(s). Potential associations between the concomitant use of drugs with central nervous system effects and fracture risk have not been studied. OBJECTIVE the purpose was to describe the gender-specific risk of fractures in a population aged 65 years or over associated with the use of an opioid, antiepileptic or anticholinergic drug individually; or, their concomitant use with each other; or the concomitant use of one of these with a psychotropic drug. METHODS this study was part of a prospective, population-based study performed in Lieto, Finland. Information about fractures in 1,177 subjects (482 men and 695 women) was confirmed with radiology reports. RESULTS at 3 years of follow-up, the concomitant use of an opioid with an antipsychotic was associated with an increased risk of fractures in men. During the 6-year follow-up, the concomitant use of an opioid with a benzodiazepine was also related to the risk of fractures for males. No significant associations were found for females. CONCLUSION the concomitant use of an opioid with an antipsychotic, or with a benzodiazepine may increase the risk of fractures in men aged 65 years and older.
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Affiliation(s)
- Janne Nurminen
- Department of Family Medicine, University of Turku, Lemminkäisenkatu 1 20014, Turku, Finland.
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Dimitrow M, Leikola S, Kivelä SL, Airaksinen M, Mykkänen S, Puustinen J. [Inappropriate medication use among the aged. Review of the criteria]. Duodecim 2013; 129:1159-1166. [PMID: 23819202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Inappropriate medication use among the aged review of the criteria Several criteria have been developed to assess inappropriate prescribing among individuals aged > or = 65 years. The criteria are classified as explicit (criterion-based) or implicit (judgment-based) and most of them have been validated using consensus methods. The criteria are based on risk-benefit definition of appropriateness; benzodiazepines and anticholinergics being the most often listed inappropriate medications. Many criteria also list inappropriate medication use due to drug-disease or drug-syndrome interactions. Avoiding unnecessary duplication is mentioned in the newest criteria. Fimea's database of medication for the elderly has been developed to support rational geriatric pharmacotherapy in Finnish healthcare. In addition to Fimea's database national evidence-based Current Care Guidelines on geriatric pharmacotherapy are needed.
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Affiliation(s)
- Maarit Dimitrow
- Vantaa V apteekki, ja Helsingin yliopisto, farmasian tiedekunta, sosiaalifarmasian osasto
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Puustinen J, Nurminen J, Vahlberg T, Lyles A, Isoaho R, Räihä I, Kivelä SL. CNS medications as predictors of precipitous cognitive decline in the cognitively disabled aged: a longitudinal population-based study. Dement Geriatr Cogn Dis Extra 2012; 2:57-68. [PMID: 22619661 PMCID: PMC3350354 DOI: 10.1159/000336710] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND/AIMS Psychotropics and antiepileptics (AE) are medications commonly used among the aged with cognitive decline or dementia, although they may precipitate further cognitive decline. Our aim was to analyze the relationships between the use of (i) psychotropics (i.e. benzodiazepines or related drugs, BZD, antipsychotics, AP, or antidepressants, AD), opioids (Op), anticholinergics (ACh) or AEs or the concomitant use of two of these drugs, and (ii) the risk of precipitous cognitive decline in an older (≥65 years) cognitively disabled population. METHODS A longitudinal population-based study of general aged community-dwelling patients was executed in two phases (1990-1991 and 1998-1999) in Lieto, Finland. Fifty-two individuals cognitively disabled (MMSE score 0-23) at the 1990-1991 baseline form this study's sample. Cognitive abilities were assessed in each phase with the Mini-Mental State Examination (MMSE) and medication utilization data were collected in both phases. The mean follow-up time was 7.6 years. Multivariate models were used to analyze the change in MMSE total score between medication users and non-users. RESULTS BZD or any psychotropic use was associated with greater cognitive decline in elders aged ≥75 years compared to non-users (change in MMSE sum score: -8.6 ± 7.0 vs. -3.3 ± 5.6 and -5.9 ± 7.0 vs. -2.7 ± 6.4, respectively). A greater decline was also associated specifically with the concomitant use of BZD and AP (-16 vs. -1.4 ± 7.8); as were BZD and any drug with CNS effects (-9.6 ± 9.9 vs. -1.3 ± 7.2) compared to non-users. The concomitant use of BZD and AD (-10.7 ± 4.7 vs. -3.2 ± 5.6) or ACh (-15.0 ± 8.5 vs. -3.3 ± 5.6) or any drug with CNS effects (-13.3 ± 6.5 vs. -3.3 ± 5.6) was associated with cognitive decline in patients ≥75 years compared to non-users of any drug with CNS effects. CONCLUSION The use of a BZD or any psychotropic medication may be an independent risk factor for cognitive decline in the cognitively disabled aged, and patients co-prescribed psychotropic medications had greater cognitive decline. Studies with larger sample sizes and studies on possible pathophysiologic mechanisms are needed.
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Affiliation(s)
- Juha Puustinen
- Department of Family Medicine, University of Turku, Turku and Pori, Pori
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Puustinen J, Nurminen J, Löppönen M, Vahlberg T, Isoaho R, Räihä I, Kivelä SL. Use of CNS medications and cognitive decline in the aged: a longitudinal population-based study. BMC Geriatr 2011; 11:70. [PMID: 22044595 PMCID: PMC3226547 DOI: 10.1186/1471-2318-11-70] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Accepted: 11/01/2011] [Indexed: 12/21/2022] Open
Abstract
Background Previous studies have found associations between the use of central nervous system medication and the risk of cognitive decline in the aged. Our aim was to assess whether the use of a single central nervous system (CNS) medication and, on the other hand, the combined use of multiple CNS medications over time are related to the risk of cognitive decline in an older (≥ 65 yrs) population that is cognitively intact at baseline. Methods We conducted a longitudinal population-based study of cognitively intact older adults. The participants were 65 years old or older and had Mini-Mental State Examination (MMSE) sum scores of 24 points or higher. The study included a 7.6-year follow-up. The use of benzodiazepines and related drugs (BZDs), antipsychotics (APs), antidepressants (ADs), opioids (Ops), anticholinergics (AChs) and antiepileptics (AEs) was determined at baseline and after a 7.6-years of the follow-up period. Cognitive functioning was used as an outcome variable measured with MMSE at baseline and at the mean follow-up of 7.6 years. Control variables were adjusted with analyses of covariance. Results After adjusting for control variables, the use of Ops and the concomitant use of Ops and BZDs as well as the use of Ops and any CNS medication were associated with cognitive decline. The use of AChs was associated with decline in cognitive functioning only in men. Conclusions Of all the CNS medications analyzed in this study, the use of Ops may have the greatest effect on cognitive functioning in the ageing population. Due to small sample sizes these findings cannot be generalized to the unselected ageing population. More studies are needed concerning the long-term use of CNS medications, especially their concomitant use, and their potential cognitive effects.
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Affiliation(s)
- Juha Puustinen
- Department of Family Medicine, University of Turku, Turku, Finland.
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Panula J, Puustinen J, Jaatinen P, Vahlberg T, Aarnio P, Kivela SL. Effects of Potent Anticholinergics, Sedatives and Antipsychotics on Postoperative Mortality in Elderly Patients with Hip Fracture. Drugs Aging 2009; 26:963-71. [DOI: 10.2165/11317660-000000000-00000] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Nurminen J, Puustinen J, Kukola M, Kivelä SL. The use of chemical restraints for older long-term hospital patients: a case report from Finland. J Elder Abuse Negl 2009; 21:89-104. [PMID: 19347712 DOI: 10.1080/08946560902779860] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to describe the use and concomitant use of psychotropics and other drugs as chemical restraints in the aged in long-term hospital care. The study consisted of 154 patients (42 men, 112 women) hospitalized in five long-term care wards in Pori City Hospital, Finland. Three or more psychotropics were regularly given to 33% of the patients and regularly or irregularly to 53% of the patients. Two or more benzodiazepine derivatives or related drugs were regularly given to 24% of the patients and regularly or irregularly to 46% of the patients. The very poor cognitive and functional abilities of the patients, the common concomitant use of psychotropic drugs, the use of psychotropics to control the behavior of the patients, and the lack of documentation of the effects and side effects of the drugs give rise to the conclusion that psychotropics were used as chemical restraints in these long-term care wards.
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Affiliation(s)
- Janne Nurminen
- Institute of Clinical Medicine, University of Turku and Turku Health Centre, Turku University Hospital, Turku, Finland.
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Vind AB, Andersen HE, Schwarz P, Skalska A, Salakowski A, Dubiel M, Fedak D, Grodzicki T, Annweiler C, Schott AM, Fantino B, Berrut G, Herrmann F, Beauchet O, Engels S, Schroll M, Popescu C, Onose G, Bojan A, van Zutphen M, Bemelmans W, de Groot L, Rea IM, Henry M, Young IS, Evans AE, Kee F, Ambien CF, Whitehead AS, Ryzhak G, Khavinson V, Kozlov L, Povoroznyuk V, Kivela SL, Nielsen DS, Nielsen W, Knold B, Ryg J, Nissen N, Brixen K, Bjorkman M, Sorva A, Tilvis R, Kannegaard PN, Jung A, Simonsen F, Sanders S, Puustinen J, Nurminen J, Lopponen M, Vahlberg T, Isoaho R, Kivela SL, Hayashi T, Ina K, Nomura H, Iguchi A, Rea IM, Henry M, Evans AE, Tiret L, Poire O, Cambien F, Pautex S, Notaridis G, Derame L, Zulian G, Ungar A, Fedeli A, Zanieri S, Pecchioni S, Belladonna M, Lambertucci L, Lotti E, Pepe G, Bambi A, Morrione A, Masotti G, Marchionni M, Mazzella F, Napoli C, Vitale DF, Viati L, Longobardi G, Lucchetti G, Abete P, Rengo F, Pautex S, Herrmann F, le Lous P, Gold G, Lihavainen K, Sipila S, Rantanenv T, Hartikainen S, Biswas S, Willicombe S, Myint P, Rashidi F, Gillain D, Van Den Noortgate N, Van Der Mark S, Petersen H, Sejtved B, Melton R, Mur AZ, Catevilla AZ, Boix LA, Jordá P, Ranhoff AH, González E, Florian J, Bueso P, Nuotio M, Luukkaala T, Tammela TLJ, Jylhä M, De Antonio García MP, De Abia PG, Bergua AA, Mowinckel P, Orozco MC, Ruiz MC, Verdejo-Bravo C, De Saint-Hubert M, Divoy C, Schoevaerdts D, Swine C, Heppner HJ, Sieber C, Bertsch T, Volpato S, Heppner HJ, Sieber C, Heppner HJ, Sieber C, Heppner HJ, Sieber C, Michael A, Scoyni R, Trani I, Schiaffini C, Sioulis F, Felli B, Aiello L, Belli P, Pacitti MT, Morelli A, D’imperio M, Falanga A, Carratelli D, Morocutti M, Kitisomprayoonkul W, Guerra G, Promsopa K, Chaiwanichsiri D, Ochiana V, Ghorghe S, Popescu G, Tekeira A, Khayat M, Povoroznyuk V, Grygoryeva N, Dzerovych N, Cavalieri M, Karasevskaya T, Mowe M, Skalska A, Fedak D, Grodzicki T, Soda K, Kano Y, Shingo T, Konishi F, Kawakami M, Maraldi C, Ulger Z, Cankurtaran M, Halil M, Yavuz BB, Orhan B, Dede D, Kavas GO, Kocaturk PA, Akyol O, Ariogul S, Guralnik JM, Pircalabu R, Hnidei R, Morosanu B, Rada C, Ionescu C, Yamada M, Kasagi F, Tatsukawa Y, Sasaki H, Alcalde P, Fellin R, Luque M, García M, Ariño S, Carmona G, Rizzoli R, Ammann P, Pressel E, Eddy C, Lilja A, Rønholt F, Pilotto A, Danbaek L, Van der Mark S, Ammann P, Kream B, Rosen C, Rizzoli R, Dubois-Ferrière V, Rizzoli R, Ammann P, Ditloto G, Addante F, Hussain W, Farrelly E, Marsden P, Brewer L, Fallon C, Murphy S, Jørgensen NR, Husted LB, Tofteng CL, Jensen JEB, Franceschi M, Eiken P, Nissen N, Langdahl BL, Schwarz P, Mcintosh S, Lacey E, Carvell C, Povoroznyuk V, Grygoryeva N, Kreslov Y, Leandro G, Dzerovych N, Ozerov I, Vayda V, Povoroznyuk V, Dzerovych N, Karasevskaya T, Povoroznyuk V, Vayda V, Böhmdorfer B, Frühwald T, D’onofrio G, Sommeregger U, Muster U, Böhmdorfer B, Frühwald T, Oeser B, Sommeregger U, Muster U, Cho C, Yoo B, Oh J, Corritore M, Cho K, Lee H, Clemmensen A, Lauridsen M, Nielsen NB, Crome P, Sinclair-Cohen J, Cherubini A, Oristrell J, Hertogh C, Niro V, Szczerbinska K, Lesauskaite V, Prada GI, Clarfield M, Topikova E, Dieppe P, Gallagher P, O’mahony D, Harbig P, Barat I, Scarcelli C, Nielsen PL, Damsgaard EM, Maanen ACDV, Van Marum RJ, Knol W, Van Der Linden CMJ, Jansen PAF, Karlsson M, Berggren AC, Lampela P, Seripa D, Hartikainen S, Lavikainen P, Sulkava R, Huupponen R, Lonergan MT, Coughlan T, ’Neill DO, Lonergan MT, Coughlan T, ’Neill DO, Piccola BD, Krajèík S, Mikus P, Errasquin BM, Cuervo MS, Castellano CS, Silveira ED, Vicedo TB, Cruz-Jentoft AJ, Petrovic M, Cobbaert K, Ferrucci L, Van Der Stichele R, Rajska-Neumann A, Wieczorowska-Tobis K, Ryan C, Kennedy J, O’mahony D, Byrne S, Castellano CS, Fernández CG, Errasquín BM, Bhuachalla BN, Del Rey JM, Peña MIA, Cruz-Jentoft AJ, Trellu LT, Villaneau D, Parel Y, Vogt-Ferrier N, Vanakoski J, Jokinen T, Skippari L, Cotter PE, Iso-Aho M, Guillemard E, Lacoin F, Marcus EL, Caine Y, Kasem H, Gross M, Mukherjee S, Goupal K, Juszczak A, Mhaille BN, Mukherjee S, Romero E, Fernandez C, Ramos M, Gonzalez E, Fuentes M, Mora J, Martin J, Ribera JM, Berg N, Egan A, Vanmeerbeek M, Moreau A, Massart V, Giet D, Bojan A, Onose G, Popescu C, Jönsdóttir AB, Damkjær K, Elkholy K, Kavanagh A, Schroll M, Lindhardt T, Ozdemir L, Gozukara F, Yucel C, Turk R, Akdemir N, Park SMI, Kim DH, Quinlan N, O’connor M, O’neill D, Caffrey N, Lonergan MT, Trainor S, Gowran L, Falconer M, Carroll N, Dwyer C, Coughlan T, O’neill D, O’keeffe ST, Collins DR, Given K, O’neill D, Collins DR, Lund A, Michelet M, Kjeken I, Wyller TB, Sveen U, Meade R, Kristjansson SR, Anniss S, Kachhia A, Hickey A, O’hanlon A, Mcgee H, Shelley E, Horgan F, O’neill D, Osawa A, Maeshima S, Nesbakken A, Sawayama Y, Maeda S, Ohnishi H, Hamada M, Otaguro S, Furusyo N, Hayashi J, Bonet AT, Martorell LV, Truyols AG, Wyller TB, Homar FA, Malberti JC, Huertas P, Wagle J, Farner L, Flekkøy K, Wyller TB, Sandvik L, Eiklid K, Fure B, Bautmans I, Stensrød B, Engedal K, Rnould A, Baron R, Gallais JL, Giniès P, Benmedjahed K, Bartley M, O’neill D, Hürny C, Njemini R, Brack B, Mukherjee S, Chroinin DNI, Farooq SFS, Burke M, Duggan J, Power D, Kyne L, Qvist A, Jørgensen NR, Jansen B, Schwarz P, Sleiman I, Rozzini R, Barbisoni P, Ranhoff A, Trabucchi M, Rønholt F, Jacobsen HN, Rytter L, Seidahamd M, Vierendeels J, Al-Dhahi L, Vigder C, Ben-Israel Y, Kaykov E, Granot E, Raz R, Wulff T, Hendriksen C, Ziccardi P, Cacciatore F, de Backer J, Mazzella F, Viati L, Abete P, Ferrara N, Rengo F, Raschilas F, Adane D, Oziol E, Millot O, Boubakri C, de Waele E, Hemmi P, Tigoulet F, Faucher N, Blain H, Jeandel C, Blain H, Carriere I, Berard C, Favier F, Colvez A, Mets T, Sørensen KI, Brynningsen P, Damsgaard EM, Mehrabian S, Seux ML, Miralles I, Cohen M, Esculier MC, Rigaud AS, Ducasse V, Pilotto A, Lidy C, Samandel S, Geny C, Comte F, Gabelle A, Touchon J, Jeandel C, Morel N, Verny M, Riou B, Addante F, Boddaert J, Marquis C, Greffard S, Dieudonne B, Barrou Z, Boddaert J, Verny M, Bonnet D, Forest A, Verny M, Franceschi M, Boulanger C, Riou B, Malla Z, Boddaert J, Leandro G, D’onofrio G, D’ambrosio LP, Longo MG, Cascavilla L, Paris F, Pazienza AM, Piccola BD, Ferrucci L, Ungar A, Morrione A, Landi A, Caldi F, Maraviglia A, Rafanelli M, Ruffolo E, Chisciotti VM, Masotti G, Marchionni N, van der Velde N, Ziere G, van der Cammen TJM, Hofman B, Stricker BHC, Rodriguez-Pascual C, Moraga AV, Galan EP, Sanchez MJL, Manso AL, Carballido MT, Chiva MTO, Andion JMV, Sierra AL, Pillay I, Saunders J, Cunniffe J, Cooke J, Blot S, Cankurtaran M, Vandijck D, Danneels C, Vandewoude K, Peleman R, Piette AA, Verschraegen G, van den Noortgate N, Vogelaers D, Petrovic M, Skerris A, Kjear P, Cristoffersen J, Shou C, Seest LS, Oestergaard A, Rønholt F, Overgaard K, Donnellan C, Hickey A, Hevey D, O’neill D, van Munster B, Korevaar J, Zwinderman A, Levi M, Wiersinga J, Rooij S, White S, Mahony SO, Bayer A, Juliebo V, Bjøro K, Krogseth M, Ranhoff AH, Wyller TB, Duque AS, Silvestre J, Freitas P, Palma-Reis I, Lopes JP, Martins A, Batalha V, Campos L, Ekstrom H, Elmstahl S, Ivanoff SD, Hayashi T, Ina K, Hirai H, Iguchi A, Lee T, Gallagher P, Hegarty E, Connor MO, Mahony DO, Mkhailova O, Khavinson V, Kozlov L, Chopra NR, Jones DA, Huwez F, Frimann J, Koefoed M, Meyling R, Holm E, Gryglewska B, Sulicka J, Fornal M, Wizner B, Grodzicki T, O’connor L, Lonergan MT, Cogan N, Coughlan T, O’neill D, Collins DR, Prada GI, Fita IG, Prada S, Herghelegiu AM, Datu C, Lonergan MT, Kelleher F, Mcdermott R, Collins DR, Retornaz F, Monette J, Batist G, Monette M, Sourial N, Small D, Caplan S, Wan-Chow-Wah D, Puts MTE, Bergman H, Retornaz F, Sourial N, Seux V, Monette J, Soubeyrand J, Bergman H, Andrei V, Pircalabu R, Lupeanu E, Pena C, Turcu E, Raducanu I, Hnidei A, Morosanu B, Gherasim P, Gradinaru D, Rachita M, Ionescu I, Arino S, Coindreau F, Alcalde P, Serra J, Baldasseroni S, Romboli B, di Serio C, Orso F, Pellerito S, Mannucci E, Colombi C, Bartoli N, Masotti G, Marchionni N, Tarantini F, Barry P, Kinsella S, Twomey C, O’mahony D, Bezerra AW, Popescu G, Azevedo E, Nobrega J, Ghiorghe S, Coindreau F, Serra J, Duems O, Saez I, Clapera G, Arino S, Coindreau F, Serra J, Saez I, Duems O, Clpaera G, Arino S, Jones DA, Chopra NR, Guha K, Clarkson P, Koga T, Furusyo N, Ogawa E, Sawayama Y, Ai M, Otokozawa S, Schaefer EJ, Hayashi J, Lupeanu E, Andrei V, Turcu E, Pircalabu R, Raducanu I, Hnidei R, Morosanu B, Opris S, Ionescu C, Gherasim P, Mellingsaeter M, Wyller TB, Ranhoff AH, Popescu G, Teixeira J, Ghiorghe S, Azevedo E, Teixeira A, Rodriguez-Pascual C, Moraga AV, Carballido MT, Galan EP, Quintela S, Leiros A, Sanchez MJL, Chiva MTO, Sierra AL, Andion JMV, Rios CF, Seabra Pereira MF, Jorge E, Dias R, Verissimo MT, Santos L, Saldanha MH, Sinha S, Dave P, Hussain S, Ayub A, Vilches-Moraga A, Rodriguez-Pascual C, Paredes-Galan E, Leiro-Manso A, Gonzalez-Rios C, Torrente-Carballido M, Vega-Andion JM, Olcoz-Chiva MT, Lopez-Sierra A, Lopez-Sanchez MJ, Narro-Vidal M, Garcia Q, Bozoglu E, Isk AT, Comert B, Doruk H, Sohrt C, Brynningsen P, Damsgaard EM, Kat M, Vreeswijk R, de Jonghe J, van der Ploeg T, van Gool W, Eikelenboom P, Kalisvaart K, Kat M, de Jonghe J, Vreeswijk R, van der Ploeg T, van Gool W, Eikelenboom P, Kalisvaart K, Krogseth M, Juliebø V, Engedal K, Wyller TB, Sharma V, Soiza RL, Ferguson K, Shenkin SD, Seymour DG, Maclullich AMJ, van Munster B, van Breemen M, Moerland P, Speijer D, Rooij S, Hollmann M, Zwinderman A, Korevaar J, Vreeswijk R, Toornvliet A, Honing M, Bakker K, de Man T, de Jonghe JFM, Kalisvaart KJ, Bisschop MM, Sival R, Driesen J, Cappuccio M, Cilesi I, Cirinei E, Ruggiero C, Dell’aquila G, Gasperini B, Patacchini F, Mancioli G, Lauretani F, Bandinelli S, Maggio M, Ferrucci L, Cherubini A, Cruz-Jentoft AJ, de Tena Fontaneda A, Cano LR, Custureri R, Curiale V, Prete C, Cella A, Bonomini C, Barban G, Trasciatti S, Palummeri E, Gasperini B, Ruggiero C, Dell’aquila G, Cirinei E, Patacchini F, Mancioli G, Lauretani F, Bandinelli S, Maggio M, Ferrucci L, Cherubini A, Gold G, Giannakopoulos P, Hermmann F, Bouras C, Kovari E, Halil M, Deniz A, Yavuz B, Yavuz BB, Ülger Z, Cankurtaran M, Isik M, Cankurtaran ES, Aytemir K, Ariogul S, Kanaya K, Abe S, Sakai M, Iwamoto T, Korfitsen T, Moe C, Mecocci P, Mangiaasche F, Costanzi E, Cecchetti R, Rinaldi P, Serafini V, Amici S, Baglioni M, Bastiani P, Lovestone S, Prada GI, Ftta IG, Prada S, Herghelegiu AM, Datu C, Rozzini R, Sleiman I, Barbisoni P, Ranhoff A, Maggi S, Trabucchi M, Shafiei R, Johansen AH, Moe C, Lyngholm-Kxærby P, Kristiansen K, Lestrup C, Lund C, Jones E, Such P, van Puyvelde K, Mets T, Yavuz BB, Yavuz B, Cankurtaran M, Halil M, Ulger Z, Aytemir K, Oto A, Ariogul S, Yavuz BB, Cankurtaran M, Halil M, Ulger Z, Ariogul S, di Bari M, Lattanzio F, Sgadari A, Baccini M, Ercolani S, Rengo F, Senin U, Bernabei R, Marchionni N, Cherubini A, del Bianco L, Lamanna C, Gori F, Monami M, Marchionni N, Masotti G, Mannucci E, Foss CH, Vestbo E, Frøland A, Mogensen CE, Damsgaard EM, Mossello E, Simoni D, Boncinelli M, Gullo M, Mello AM, Lopilato E, Lamanna C, Gori F, Cavallini MC, Marchionni N, Mannucci E, Masotti M, Pena CM, Olaru OG, Pircalabu RM, Raducanu I, Rodriguez-Justo S, Narro-Vidal M, Garcia-Villar E, Rodriguez-Pascual C, Vilches-Moraga A, Olcoz-Chiva MT, Lopez-Sierra A, Vega-Andion JM, Lopez-Sanchez MJ, Torrente-Carballido M, Paredes-Galan E, Vilches-Moraga A, Abbas A, Grue R, Adie K, Fox J, Wileman L, Pattison T, Briggs S, Bhat S, Baker P, Akdemir N, Kapucu SS, Özdemir L, Akkus Y, Balci G, Akyar Y, Cankuran M, Halil M, Kayihan H, Uyanik M, Hazer O, Ariogul S, Cella A, Curiale V, Cuneo G, Fraguglia C, Trasciatti S, Palummeri E, Blundell A, Gordon A, Masud T, Gladman J, Sclater A, Curran V, Kirby B, Forristall J, Sharpe D, Anstey SA, Dawe D, Edwards S, White M, Celik SS, Kapucu SS, Akkuþ Y, Tuna Z, Szczerbinska K, Kijowska V, Mirewska E, Topor-Madry R, Czabanowska K, Maggi S, Franceschi M, Pilotto A, Noale M, Parisi GC, Crepaldi G, Van Gara R, Mcgee H, Winder R, O’neill D, Piers R, Vanden Noortgate N, Schrauwen W, Maertens S, Velghe A, Petrovic M, Benoit D, Cronin H, O’regan C, Kearney P, Moreira A, Kamiya Y, Whelan B, Kenny RA, Carpena-Ruiz M, Anton JM, de Antonio P, Verdejo C, Cruz-Jentoft AJ, Anton JM, Verdejo C, de Antonio P, Carpena M, Cruz-Jentoft AJ, Sanchez FJM, Alonso CF, del Castillo JG, Ferrer MF, Armengol JG, Villarroel P, Gregorio PG, Casado JMR, Leiros BG, Garcia FJG, Clemente MRP, Acha AA, Ramiez LFM, Ballesteros CM, Ibanez JMF, Andres SA, Maya RP, Soria JF, Checa M, Melich AE, Lang PO, Herrmann F, Michel JP, Cebrian A, Duiez-Domingo J, San-Martin M, Vantieghem KM, Terumalai K, Kaiser L, Trellu LT, Brandt MS, Jørgensen B, Nyhuus C, Lyager A, Hagedorn D, Holm E, Lauritsen J, Leners JC, Sibret MP, Mas MA, Renom A, Vazquez O, Miralles R, Cervera AM, Mathur A, Lord S, Mikes Z, Mikes P, Holckova J, Dukat A, Lietava J, Petrovicova J, Strelkova V, Kolesar J, Rokkedal L, Granberg P, Mortensen RS, Shipman K, Vincent B, Patel T, Yau C, Rehman R, Salam A, Ballentyne S, Aw D, Weerasuriya N, Lee S, Masud T, Barry P, O’connor M, O’sullivan F, Moriarty E, O’connor K, O’connor M, Bogen B, Bjordal JM, Kristensen MT, Moe-Nilssen R, Crome I, Lally F, Crome P, Curiale V, Custureri R, Prete C, Trasciatti S, Galliera EOO, Herrmann F, Petitpierre N, Michel JP, Kitisomprayoonkul W, Chaiwanichsiri D, Kristensen MT, Bandholm T, Bencke J, Ekdahl C, Kehlet H, Lauritsen J, Sørensen GV, Gonzalez A, Lazaro M, Gonzalez E, Ribera JM, Casado JMR, Gillett S, MacMahon M, Pedersen SJ, Borgbjerg FM, Schousboe B, Pedersen BD, Jørgensen HL, Duus BR, Lauritzen JB, Cooke J, Pillay I, Binkley N, Boonen S, Roux C, He W, Rosenberg R, Yang Z, Salonoja M, Aarnio P, Vahlberg T, Ktvelä SL, Salpakoski A, Portegijs E, Kallinen M, Sihvonen S, Kiviranta I, Alen M, Rantanen T, Sipilä S, Szczerbinska K, Sørensen GV, Lauritsen J, Vincent B, Way B, Vergis N, Battacharya B, Chatterjee A, Bryden E, Vind AB, Andersen HE, Pedersen KD, Jørgensen T, Schwarz P, Zintchouk D, Mørch M, Damsgaard EM, De Saint-Hubert M, Divoy C, Godart P, Schoevaerdts D, Swine C, Alonso CF, Sanchez FJM, del Castillo JG, Ferrer MF, Armengol JG, Villarroel P, Bravo CV, Casado JMR, Hovmand B, Larsen AE, Pedersen S, Vinkler S, Christensen K, Øresund CVU, Matera MG, Goffredo V, Franceschi M, D’onofrio G, Addante F, Gravina C, Urbano M, Seripa D, Dallapiccola B, Pilotto A, Chroinin DNI, O’brien H, Power D, Santillo E, Ventura G, Migale M, Cassano S, Cariello FP, Crane S, Takahashi P, Tung E, Chandra A, Yu-Ballard A, Hanson G, Vandewoude M, Hoeck S, Geerts J, Van Hal G, Van der Heyden J, Breda J, Weber P, Meluzínová H, Hrubanová J, Kubšová H, Polcarová V, Campbell P, Henderson E, Macmahon M, Pedersen ABL, Mørch MM, Foss CH, Franceschi M, Maggi S, Pilotto A, Noale M, Parisi G, Crepaldi G, Furusyo N, Koga T, Ohnishi H, Maeda S, Takeoka H, Toyoda K, Ogawa E, Sawayama Y, Hayashi J, Kamigaki M, Nakagawa I, Kumei Y, Hayashi N, Takasugi Y, Maggi S, Pilotto A, Noale M, Franceschi L, Parisi GC, Crepaldi G, Maggi S, Pilotto A, Franceschi M, Noale M, Parisi GC, Crepaldi G, Michael A, Bhangu A, Fisher G, Rees E, Labib M, Ogawa E, Furusyo N, Koga T, Sawayama Y, Hayashi J, Ohishi M, Takagi T, Fujisawa T, Katsuya T, Rakugi H, Pilotto A, Franceschi M, Ferrucci L, Rengo F, Bernabei R, Leandro G, Pilotto A, Franceschi M, Maggi S, Noale M, Parisi G, Crepaldi G, Cotter PE, Simon M, Quinn C, O’keeffe ST, Moy I, Crome P, Crome I, Frisher M, Daly K, Huber P, Hilleret H, Lang PO, Le Saint L, Chamot C, Giannakopoulos P, Gold G, Leckie K, Bayes H, Birschel P, Lundgren B, Eniry BM, Pillay I, Matzen LE, O’neill D, Garavan R, O’hanlon A, Mcgee H, Akdemir N, Kapucu S, Ozdemir L, Akkus Y, Balci G, Akyar I, Patacchini F, Ruggiero C, Dell’aquila G, Ferretti R, Mariani T, Gugliotta R, Cirinei E, Gasperini B, Lattanzio F, Bernabei R, Senin U, Cherubini C, Pedersen TS, Raun KN, Jespersen E, Sixt E, Takahashi P, Crane S, Tung E, Chandra A, Yu-Ballard A, Hanson G, Velghe A, Petermans J. Oral and Poster Papers Submitted for Presentation at the 5th Congress of the EUGMS “Geriatric Medicine in a Time of Generational Shift September 3–6, 2008 Copenhagen, Denmark. J Nutr Health Aging 2008. [DOI: 10.1007/bf02983206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Puustinen J, Nurminen J, Kukola M, Vahlberg T, Laine K, Kivelä SL. Associations between use of benzodiazepines or related drugs and health, physical abilities and cognitive function: a non-randomised clinical study in the elderly. Drugs Aging 2008; 24:1045-59. [PMID: 18020536 DOI: 10.2165/00002512-200724120-00007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To describe associations between the use of benzodiazepines or related drugs (BZDs/RDs) and health, functional abilities and cognitive function in the elderly. METHODS A non-randomised clinical study of patients aged > or =65 years admitted to acute hospital wards during 1 month. 164 patients (mean age +/- standard deviation [SD] 81.6 +/- 6.8 years) were admitted. Of these, nearly half (n = 78) had used BZDs/RDs before admission, and the remainder (n = 86) were non-users. Cognitive ability was assessed by the Mini-Mental State Examination (MMSE). Patients scoring > or =20 MMSE sum points were interviewed (n = 79) and questioned regarding symptoms and functional abilities during the week prior to admission. Data on use of BZDs/RDs before admission, current medications and discharge diagnoses were collected from medical records. Health, physical abilities and cognitive function were compared between BZD/RD users and non-users, and adjustments were made for confounding variables. The residual serum concentrations of oxazepam, temazepam and zopiclone were analysed. RESULTS The mean +/- SD duration of BZD/RD use was 7 +/- 7 years (range 1-31). Two or three BZDs/RDs were concomitantly taken by 26% of users (n = 20). Long-term use of these drugs was associated with female sex and use of a higher number of drugs with effects on the CNS, which tended to be related to diagnosed dementia. After adjustment for these variables as confounders, use of BZDs/RDs was not associated with cognitive function as measured by the MMSE. However, use of BZDs/RDs was associated with dizziness, inability to sleep after awaking at night and tiredness in the mornings during the week prior to admission and with stronger depressive symptoms measured at the beginning of the hospital stay. Use of BZDs/RDs tended to be associated with a reduced ability to walk and shorter night-time sleep during the week prior to admission. A higher residual serum concentration of temazepam correlated with a lower MMSE sum score after adjustment for confounding variables. CONCLUSIONS Long-term use and concomitant use of more than one BZD/RD were common in elderly patients hospitalised because of acute illnesses. Long-term use was associated with daytime and night-time symptoms indicative of poorer health and potentially caused by the adverse effects of these drugs.
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Affiliation(s)
- Juha Puustinen
- Department of Family Medicine, University of Turku, Turku, Finland
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Hiltunen J, Lappalainen J, Puustinen J, Lantto V, Tuller HL. Size-dependent optical properties of BaTiO3-SrTiO3 superlattices. Opt Express 2008; 16:8219-8228. [PMID: 18545533 DOI: 10.1364/oe.16.008219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Artificial BaTiO(3)-SrTiO(3) superlattices with stacking periodicity varying between 27 and 1670 A in separate films were grown on MgO substrates by pulsed laser deposition. Both the static and active optical properties were found to be sensitive on the stacking periodicity. Birefringence decreased with increasing individual layer thickness due to relaxation of the interface originated stress. The electro-optic response also showed a layer thickness dependence, reaching a maximum at an individual layer thickness of 13 unit cells.
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Affiliation(s)
- J Hiltunen
- VTT Technical Research Centre of Finland, Kaitovayla 1, Fin-90571 Oulu, Finland.
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Nousiainen T, Vanninen E, Jantunen E, Puustinen J, Remes J, Rantala A, Vuolteenaho O, Hartikainen J. Natriuretic peptides during the development of doxorubicin-induced left ventricular diastolic dysfunction. J Intern Med 2002; 251:228-34. [PMID: 11886482 DOI: 10.1046/j.1365-2796.2002.00951.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To investigate changes in plasma atrial natriuretic peptide (ANP), N-terminal pro-atrial natriuretic peptide (NT-pro-ANP) and brain natriuretic peptide (BNP) during the development of doxorubicin-induced left ventricular systolic and diastolic dysfunction as measured by echocardiography (ECHO). DESIGN Prospective study. SETTING University hospital. SUBJECTS Twenty-eight adult patients with non-Hodgkin's lymphoma, who received doxorubicin to the cumulative dose of 400-500 mg m(-2). MAIN OUTCOME MEASURES The relationship between plasma natriuretic peptides and systolic and diastolic ECHO indices after the cumulative doxorubicin doses of 200, 400 and 500 mg m(-2). RESULTS Left ventricular ejection fraction (LVEF, by 2D ECHO) decreased from 58 +/- 1.7 to 52.5 +/- 1.3% (P=0.036) and fractional shortening (FS) from 34.6 +/- 1.4 to 27.8 +/- 0.9% (P=0.002). Peak E wave velocity decreased from 63.3 +/- 3.2 to 51.3 +/- 2.6 cm s(-1) (P=0.008) resulting in a statistically nonsignificant decrease in E/A ratio from 1.08 +/- 0.01 to 0.85 +/- 0.07. A significant decrease was observed in the percentage of left ventricular filling during the 1/3 of diastole (1/3FF) from 42.2 +/- 1.7 to 36.5 +/- 2.0% (P < 0.001). LV end systolic diameter increased from 32 +/- 1 to 38 +/- 1 mm (P=0.011), whereas left atrial (LA) diameter remained unchanged. Peak filling rate decreased from 4.4 +/- 0.2 to 4.0 +/- 0.2 stroke volume s(-1) (SV s(-1)) (ns). Plasma levels of ANP increased from 16.4 +/- 1.3 to 22.7 +/- 2.4 pmol L(-1) (P=0.002), NT-pro-ANP from 288 +/- 22 to 380 +/- 42 pmol L(-1) (P=0.019) and BNP from 3.3 +/- 0.4 to 8.5 +/- 2.0 pmol L(-1) (P=0.020). There was a significant inverse correlation between the decrease in FS and the increases in plasma NT-pro-ANP (r= -0.524, P=0.018) and plasma BNP (r=0.462, P=0.04) and between the decrease in PFR and the increases in plasma ANP (r= -0.457, P=0.043) and plasma NT-pro-ANP (r= -0.478, P=0.033). Furthermore, after doxorubicin therapy, significant inverse correlations were observed between E/A ratio and plasma ANP (r= -0.535, P=0.008), between E/A ratio and plasma NT-pro-ANP (r= -0.432, P=0.04) and between E/A ratio and plasma BNP (r= -0.557, P=0.006) as well as between 1/3FF and plasma BNP (r= -0.493, P=0.017). There was also a trend for correlation between LA diameter and plasma BNP (r=0.395, P=0.062) and peak E wave velocity and plasma BNP (r= -0.414, P=0.05), respectively. However, no significant correlations were observed between any of the systolic parameters and natriuretic peptide levels. CONCLUSIONS The results of this prospective study show that during the evolution of doxorubicin-induced LV dysfunction the secretion of natriuretic peptides is more closely associated with the impairment of left ventricular diastolic filling than with the deterioration of LV systolic function.
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Affiliation(s)
- T Nousiainen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland.
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Nousiainen T, Vanninen E, Jantunen E, Puustinen J, Remes J, Rantala A, Hartikainen J. Comparison of echocardiography and radionuclide ventriculography in the follow-up of left ventricular systolic function in adult lymphoma patients during doxorubicin therapy. J Intern Med 2001; 249:297-303. [PMID: 11298849 DOI: 10.1046/j.1365-2796.2001.00820.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To compare echocardiography (ECHO) and radionuclide ventriculography (RVG) in the monitoring of left ventricular systolic function during doxorubicin therapy in adult lymphoma patients. DESIGN Prospective study. SETTINGS University hospital. SUBJECTS A total of 28 adult patients who received doxorubicin to a cumulative dose of 400-500 mg m(-2). MAIN OUTCOME MEASURES ECHO and RVG were performed at baseline and after cumulative doxorubicin doses of 200, 400 and 500 mg m(-2). RESULTS At baseline, the mean (+/-SE) left ventricular ejection fractions (LVEF) were 58 +/- 1.3, 71 +/- 1.8 and 58 +/- 1.7% as determined by RVG, M-mode ECHO and two-dimensional (2D) ECHO, respectively. After the cumulative doxorubicin dose of 500 mg m(-2) LVEF decreased to 49.6 +/- 1.7% (RVG) (P < 0.001), 62 +/- 1.6% (M-mode) (P=0.006) and 52.5 +/- 1.3% (2D ECHO) (P=0.036). Although a significant correlation between LVEF determined by RVG and M-mode ECHO (r=0.615, P=0.002) and a trend between RVG and 2D ECHO (r=0.364, P=0.096) were observed, there were substantial differences in the results of individual patients. In the agreement analysis using the method of Bland and Altman there was a mean difference of 12% units with the upper limit of agreement +26% units and the lower limit of agreement -2.1% units for LVEF determinations with M-mode ECHO and RVG, and a mean difference of 3.3% units with upper and lower limits of agreement +19.6 and -13.1% units for LVEF determinations with 2D ECHO and RVG, respectively. CONCLUSION We found only a moderate agreement between left ventricular systolic function determined by ECHO and RVG methods. Thus, in the follow-up of left ventricular function in adult patients during doxorubicin therapy, the guidelines based on LVEF measurement by RVG cannot be applied to ECHO. Consequently, RVG remains the method of choice in this context.
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Affiliation(s)
- T Nousiainen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland.
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Jørgensen KS, Puustinen J, Suortti AM. Bioremediation of petroleum hydrocarbon-contaminated soil by composting in biopiles. Environ Pollut 2000; 107:245-54. [PMID: 15093002 DOI: 10.1016/s0269-7491(99)00144-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/1998] [Accepted: 05/22/1999] [Indexed: 05/13/2023]
Abstract
Composting of contaminated soil in biopiles is an ex situ technology, where organic matter such as bark chips are added to contaminated soil as a bulking agent. Composting of lubricating oil-contaminated soil was performed in field scale ( [Formula: see text] m(3)) using bark chips as the bulking agent, and two commercially available mixed microbial inocula as well as the effect of the level of added nutrients (N,P,K) were tested. Composting of diesel oil-contaminated soil was also performed at one level of nutrient addition and with no inoculum. The mineral oil degradation rate was most rapid during the first months, and it followed a typical first order degradation curve. During 5 months, composting of the mineral oil decreased in all piles with lubrication oil from approximately 2400 to 700 mg (kg dry w)(-1), which was about 70% of the mineral oil content. Correspondingly, the mineral oil content in the pile with diesel oil-contaminated soil decreased with 71% from 700 to 200 mg (kg dry w)(-1). In this type of treatment with addition of a large amount of organic matter, the general microbial activity as measured by soil respiration was enhanced and no particular effect of added inocula was observed.
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Affiliation(s)
- K S Jørgensen
- Finnish Environment Institute, Research Laboratory, Hakuninmaantie 4-6, FIN-00430 Helsinki, Finland.
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Nousiainen T, Jantunen E, Vanninen E, Remes J, Puustinen J, Rantala A, Vuolteenaho O, Hartikainen J. Acute neurohumoral and cardiovascular effects of idarubicin in leukemia patients. Eur J Haematol Suppl 1998; 61:347-53. [PMID: 9855251 DOI: 10.1111/j.1600-0609.1998.tb01099.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Idarubicin has been shown to have similar or superior antileukemic activity to daunorubicin with less cumulative cardiotoxicity. However, data of acute cardiovascular effects of idarubicin are scanty but may have clinical significance in predicting late cardiovascular complications. In the present study we evaluated prospectively acute neurohumoral and cardiovascular effects of idarubicin containing induction chemotherapy in 10 patients with newly diagnosed AML or MDS. Idarubicin was administered intravenously 12 mg/m2 on d 1, 3 and 5 as a part of the induction chemotherapy. Serial measurements of plasma atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) were performed at baseline and the day following each idarubicin infusion. Echocardiography was performed to assess cardiac systolic and diastolic function. Signal averaged electrocardiography (ECG) was recorded to observe myocardial late potentials associated with possible myocardial injury. In addition, ambulatory ECG recording was performed to assess arrhythmias. Plasma concentrations of ANP increased from 18.2 +/- 1.5 pmol/l to 27.8 +/- 3.5 pmol/l (p = 0.011), to 30.2 +/- 3.0 pmol/l (p = 0.002) and to 40.8 +/- 6.0 pmol/l (p = 0.006) after the first, second and third doses of idarubicin, respectively. Similarly, plasma concentration of BNP increased from 6.2 +/- 1.9 to 9.0 +/- 1.8 pmol/l (p = 0.049) and 17.5 +/- 8.1 pmol/l (p = 0.203) after the first and third idarubicin infusion. Concomitantly, there was a trend towards an increase in left ventricular end diastolic diameter (LVEDD) (50.2 +/- 1.8 to 54.4 +/- 2.2 mm, p = 0.070). The increase in plasma BNP concentrations correlated significantly with the increase in LVEDD (r = 0.624; p = 0.002). No significant ECG changes or arrhythmias were associated with idarubicin infusions except in 1 patient who developed abnormal myocardial late potentials. Our results show that idarubicin causes acute neurohumoral activation associated with increased LVEDD indicating subclinical myocardial dysfunction. Whether these acute changes predict late clinical cardiomyopathy should be evaluated in prospective studies with larger number of patients and with higher cumulative anthracycline doses.
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Affiliation(s)
- T Nousiainen
- Department of Medicine, Kuopio University Hospital and University of Kuopio, Finland.
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