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Reitala E, Lääperi M, Skrifvars MB, Silfvast T, Vihonen H, Toivonen P, Tommila M, Raatiniemi L, Nurmi J. Development and internal validation of an algorithm for estimating mortality in patients encountered by physician-staffed helicopter emergency medical services. Scand J Trauma Resusc Emerg Med 2024; 32:33. [PMID: 38654337 DOI: 10.1186/s13049-024-01208-y] [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: 12/27/2023] [Accepted: 04/15/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Severity of illness scoring systems are used in intensive care units to enable the calculation of adjusted outcomes for audit and benchmarking purposes. Similar tools are lacking for pre-hospital emergency medicine. Therefore, using a national helicopter emergency medical services database, we developed and internally validated a mortality prediction algorithm. METHODS We conducted a multicentre retrospective observational register-based cohort study based on the patients treated by five physician-staffed Finnish helicopter emergency medical service units between 2012 and 2019. Only patients aged 16 and over treated by physician-staffed units were included. We analysed the relationship between 30-day mortality and physiological, patient-related and circumstantial variables. The data were imputed using multiple imputations employing chained equations. We used multivariate logistic regression to estimate the variable effects and performed derivation of multiple multivariable models with different combinations of variables. The models were combined into an algorithm to allow a risk estimation tool that accounts for missing variables. Internal validation was assessed by calculating the optimism of each performance estimate using the von Hippel method with four imputed sets. RESULTS After exclusions, 30 186 patients were included in the analysis. 8611 (29%) patients died within the first 30 days after the incident. Eleven predictor variables (systolic blood pressure, heart rate, oxygen saturation, Glasgow Coma Scale, sex, age, emergency medical services vehicle type [helicopter vs ground unit], whether the mission was located in a medical facility or nursing home, cardiac rhythm [asystole, pulseless electrical activity, ventricular fibrillation, ventricular tachycardia vs others], time from emergency call to physician arrival and patient category) were included. Adjusted for optimism after internal validation, the algorithm had an area under the receiver operating characteristic curve of 0.921 (95% CI 0.918 to 0.924), Brier score of 0.097, calibration intercept of 0.000 (95% CI -0.040 to 0.040) and slope of 1.000 (95% CI 0.977 to 1.023). CONCLUSIONS Based on 11 demographic, mission-specific, and physiologic variables, we developed and internally validated a novel severity of illness algorithm for use with patients encountered by physician-staffed helicopter emergency medical services, which may help in future quality improvement.
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Affiliation(s)
- Emil Reitala
- Department of Anaesthesia, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, PO Box 340, FI-00029, Helsinki, HUS, Finland.
| | - Mitja Lääperi
- Department of Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, PO Box 340, FI-00029, Helsinki, HUS, Finland
| | - Markus B Skrifvars
- Department of Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, PO Box 340, FI-00029, Helsinki, HUS, Finland
| | - Tom Silfvast
- Department of Anaesthesia, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, PO Box 340, FI-00029, Helsinki, HUS, Finland
| | - Hanna Vihonen
- Emergency Medical Services, Centre for Prehospital Emergency Care, Department of Emergency, Anaesthesia and Pain Medicine, Tampere University Hospital, PO Box 2000, FI-33521, Tampere, Finland
- Department of Emergency Medicine and Services, Päijät-Häme Central Hospital, FI-15850, Lahti, Finland
| | - Pamela Toivonen
- Centre for Prehospital Care, Institute of Clinical Medicine, Kuopio University Hospital, PO Box 100, FI-70029, Kuopio, KYS, Finland
| | - Miretta Tommila
- Department of Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital and University of Turku, PO Box 52, FI-20521, Turku, Finland
| | - Lasse Raatiniemi
- HEMS unit, Division for prehospital emergency care, Oulu University Hospital, Lentokentäntie 670, FI-09460, Oulunsalo, Finland
- Research Group of Surgery, Anaesthesiology and Intensive Care, Division of Anaesthesiology, Oulu University Hospital, Medical Research Centre, University of Oulu, PO Box FI-90029, Oulu, Finland
| | - Jouni Nurmi
- Department of Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, PO Box 340, FI-00029, Helsinki, HUS, Finland
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Ngarmsak M, Delaquis P, Toivonen P, Ngarmsak T, Ooraikul B, Mazza G. Microbiology of Fresh-cut Mangoes Prepared from Fruit Sanitised in Hot Chlorinated Water. FOOD SCI TECHNOL INT 2016. [DOI: 10.1177/1082013206063735] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Whole mangoes ( Mangifera indica, cv. Chok Anun) were washed in water with or without chlorine (100 mg total chlorine/L) at 11.7 ºC and 50 ºC before slicing and packaging. Microbiological analysis of the whole fruit showed that the stem scar contained larger populations of microorganisms than the skin. Washing reduced populations at both sites and the effect was enhanced by the addition of chlorine and heating of the wash water. None of the treatments prevented transfer of contaminants to the flesh during slicing, and evidence of spoilage in the form of discrete fungal colonies was observed in samples stored for 1 week at 5 ºC. Several species of bacteria, yeast and mould were recovered from packaged slices, but yeast and moulds accounted for the bulk of the spoilage of microflora. Barriers to the growth of these microorganisms may be necessary to reduce the risk of microbial spoilage of mango slices manufactured under commercial conditions.
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Affiliation(s)
| | - P. Delaquis
- Agriculture and Agri-Food Canada, Pacific Agri-Food Research Center, 4200 Highway 97, Summerland, BC, Canada V0H 1Z0
| | - P. Toivonen
- Agriculture and Agri-Food Canada, Pacific Agri-Food Research Center, 4200 Highway 97, Summerland, BC, Canada V0H 1Z0
| | | | | | - G. Mazza
- Agriculture and Agri-Food Canada, Pacific Agri-Food Research Center, 4200 Highway 97, Summerland, BC, Canada V0H 1Z0
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Pouwels J, Salmela A, Varis A, Halonen P, Toivonen P, Sahlberg N, Perälä M, Gorbsky G, Kallio M. Dietary flavonoid fisetin induces a forced exit from mitosis by targeting the spindle assembly checkpoint. EJC Suppl 2008. [DOI: 10.1016/s1359-6349(08)71272-2] [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: 11/15/2022] Open
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Leistevuo T, Toivonen P, Osterblad M, Kuistila M, Kahra A, Lehtonen A, Huovinen P. Problem of antimicrobial resistance of fecal aerobic gram-negative bacilli in the elderly. Antimicrob Agents Chemother 1996; 40:2399-403. [PMID: 8891151 PMCID: PMC163541 DOI: 10.1128/aac.40.10.2399] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [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: 02/02/2023] Open
Abstract
In this study, we assessed the magnitude of risk (odds ratio [OR]) of patients being colonized with fecal aerobic gram-negative bacilli in two geriatric hospitals compared with the community, and we associated the use of antimicrobial agents with bacterial resistance. One fecal sample was collected from each of 341 patients, aged 60 years or older, during the hospital stay or when visiting the outpatient service. Samples were collected in 1988 and 1993 to 1994. The aerobic gram-negative bacilli from all samples were examined for resistance to seven antimicrobials by a replica plating method. The long-term-hospitalized patients had a significantly higher risk of being colonized with bacilli resistant to ampicillin (OR, 14.3; 95% confidence interval [95% CI], 6.0 to 34.1), cefuroxime (OR, 7.5; 95% CI, 2.7 to 20.8), trimethoprim (ORs, 22.3; 95% CI, 8.6 to 57.8), and tetracycline (OR, 5.2; 95% CI, 2.4 to 10.9) than the outpatients. The respective ORs among the short-term-hospitalized patients compared with the outpatients were 4.0 (95% CI, 1.9 to 8.4), 7.5 (95% CI, 2.7 to 20.8), 5.5 (95% CI, 2 to 14), and 2.0 (95% CI, 1 to 4). In 1993 to 1994 compared with 1988, in both hospitals there was a significantly increased risk of colonization by bacilli resistant to ampicillin (OR, 3.1; 95% CI, 1.9 to 5.1), cefuroxime (OR, 3.8; 95% CI, 2.1 to 6.7), and tetracycline (OR, 1.6; 95% CI, 1.0 to 2.5). However, the total use of antimicrobial agents increased only among the patients of the short-term-care hospital.
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Affiliation(s)
- T Leistevuo
- Antimicrobial Research Laboratory, National Public Health Institute, Turku, Finland.
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Leistevuo T, Leistevuo J, Osterblad M, Arvola T, Toivonen P, Klaukka T, Lehtonen A, Huovinen P. Antimicrobial resistance of fecal aerobic gram-negative bacilli in different age groups in a community. Antimicrob Agents Chemother 1996; 40:1931-4. [PMID: 8843307 PMCID: PMC163443 DOI: 10.1128/aac.40.8.1931] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [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: 02/02/2023] Open
Abstract
We measured the occurrence of antimicrobial resistance in fecal aerobic gram-negative bacilli by age in community subjects. For none of the eight antimicrobial agents studied were there any statistically significant differences in the carriage rates of resistance in different age groups. Bacterial resistance was common in all age groups, including the children, and occurred for all antimicrobial agents tested.
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Affiliation(s)
- T Leistevuo
- Antimicrobial Research Laboratory, National Public Health Institute, Turku, Finland.
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Leistevuo T, Osterblad M, Toivonen P, Kuistila M, Huovinen S, Heikkilä E, Kahra A, Lehtonen A, Huovinen P. Increase of antimicrobial resistance of faecal aerobic gram-negative bacteria in a geriatric hospital. Age Ageing 1996; 25:197-200. [PMID: 8670551 DOI: 10.1093/ageing/25.3.197] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Antimicrobial resistance of faecal aerobic Gram-negative bacteria to eight different antimicrobials was determined by a velvet replica-plating method in 1988 and 1933. Faecal samples were taken from 131 geriatric inpatients in the Turku City Hospital with a hospitalization of more than 7 days. From 1987 to 1992 the use of first and second generation cephalosporins and ciprofloxacin increased from 3.32 defined daily doses (DDD) per bed to 24.25 DDD/bed and from 0.63 DDD/Bed to 28.11 DDD/bed, respectively. A statistically significant increase was observed in the frequency of samples resistant (with >= 1% of resistant colonies) to cefuroxime (p = 0.0004) and ceftazidime (p = 0.037) in patients who received antimicrobial therapy and to ampicillin (p = 0.046) in patients who had not received antimicrobial therapy. In addition, despite the decreased use of sulphonamides and trimethoprim (from 17.11 DDD/bed to 5.54 DDD/bed) no significant changes in the frequency of resistant faecal samples were observed. Use of ciprofloxacin has been found to cure resistance plasmids from bacteria in vitro. However, despite the increased use of ciprofloxacin, no decrease in faecal bacteria resistant to any of the other antimicrobials (i.e. trimethoprim) studied was observed.
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Affiliation(s)
- T Leistevuo
- Antimicrobial Research Laboratory, National Public Health Institute, PO Box 57, FIN-20521 Turku, Finland
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Leistevuo T, Osterblad M, Toivonen P, Kahra A, Lehtonen A, Huovinen P. Colonization of resistant faecal aerobic gram-negative bacilli among geriatric patients in hospital and the community. J Antimicrob Chemother 1996; 37:169-73. [PMID: 8647760 DOI: 10.1093/jac/37.1.169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 02/01/2023] Open
Abstract
Among the elderly most infections are caused by organisms of faecal origin. The study of the resistance of such Gram-negative bacilli should therefore be a priority. In this study, we determine the occurrence of resistance to five antimicrobials commonly used in geriatric outpatient care, and compare it with long-term and short-term hospitalized geriatric patients treated and not treated with antimicrobials.
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Affiliation(s)
- T Leistevuo
- Antimicrobial Research Laboratory, National Public Health Institute, Turku, Finland
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Abstract
Regulation of photosynthetic activity can contribute to the prevention of photodamage in stress resistant plants during exposure to drought or low temperatures. Responses to increasing levels of water stress were examined in seedlings of the stress resistant forest conifer, white spruce (Picea glauca [Moench.] Voss). Some seedlings were grown under aseptic in vitro conditions and others in pots. In relatively resistant in vivo seedlings, photosynthetic activities changed slowly in response to increasing water stress. Highly sensitive in vitro seedlings responded to water deficits similarly to in vivo seedlings but over a much shorter time scale. Fluorescence, CO(2) exchange, and stomatal conductance data reported here suggest possible mechanisms for the regulation of photochemical activity in these plants.
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Affiliation(s)
- P Toivonen
- Department of Biological Sciences, Simon Fraser University, Burnaby, B.C. V5A 1S6
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