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Bamberg K, Mehtälä L, Arola O, Laitinen S, Nordling P, Strandberg M, Strandberg N, Paltta J, Mali M, Espinosa-Ortega F, Pirilä L, Lundberg IE, Savukoski T, Pettersson K. Evaluation of a New Skeletal Troponin I Assay in Patients with Idiopathic Inflammatory Myopathies. J Appl Lab Med 2021; 5:320-331. [PMID: 32445386 DOI: 10.1093/jalm/jfz016] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 07/01/2019] [Indexed: 11/13/2022]
Abstract
BACKGROUND The current biomarkers for diagnosis and monitoring of injured and diseased skeletal muscles, such as creatine kinase (CK), have limited tissue specificity and incapability to differentiate between pathological and physiological changes. Thus, new biomarkers with improved diagnostic accuracy are needed. Our aim was to develop and validate a novel assay for skeletal troponin I (skTnI), and to assess its clinical performance in patients with idiopathic inflammatory myopathies (IIM). METHODS A two-step fluoroimmunoassay was used to analyze samples from healthy reference individuals (n = 140), patients with trauma (n = 151), and patients with IIM (n = 61). RESULTS The limit of detection was 1.2 ng/mL, and the upper reference limit (90th percentile) was 5.2 ng/mL. The median skTnI concentrations were <limit of detection (LoD), 2.7 ng/mL, and 8.6 ng/mL in reference, trauma, and IIM cohorts, respectively. Differences in measured skTnI levels were statistically significant between all three study cohorts (Kruskal-Wallis P < 0.001; Mann-Whitney P < 0.001 for all). skTnI and CK had a strong positive correlation (Spearman's r = 0.771, P < 0.001), and the longitudinal changes in skTnI mirrored those observed with CK. CONCLUSIONS With the skTnI assay, patients with IIM were identified from healthy individuals and from patients with traumatic muscular injuries. When compared to CK, skTnI appeared to be more accurate in managing patients with low-grade IIM disease activities. The developed assay serves as a reliable analytical tool for the assessment of diagnostic accuracy of skTnI in the diagnosis and monitoring of myopathies.
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Affiliation(s)
- Katriina Bamberg
- Department of Biochemistry/Biotechnology, University of Turku, Turku, Finland
| | - Laura Mehtälä
- Department of Biochemistry/Biotechnology, University of Turku, Turku, Finland
| | - Olli Arola
- Intensive Care Medicine and Pain Management, Turku University Hospital, Turku, Finland
| | | | | | | | - Niko Strandberg
- Department of Orthopaedic Surgery, Turku University Hospital, Turku, Finland
| | - Johanna Paltta
- Department of Rheumatology, Turku University Hospital, Turku, Finland
| | - Markku Mali
- Department of Rheumatology, Turku University Hospital, Turku, Finland
| | - Fabricio Espinosa-Ortega
- Division of Rheumatology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Laura Pirilä
- Department of Rheumatology, Turku University Hospital, Turku, Finland
| | - Ingrid E Lundberg
- Division of Rheumatology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Tanja Savukoski
- Department of Biochemistry/Biotechnology, University of Turku, Turku, Finland
| | - Kim Pettersson
- Department of Biochemistry/Biotechnology, University of Turku, Turku, Finland
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Nordling P, Nordeman L, Skoglund IM, Björkelund C, Hensing G. Early systematic communication between physician, patient and employer to promote return to work. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In the sickness absence and return-to-work process communication between stakeholders is beneficial but difficult to achieve. Addressing work-related issues early in the process could support decision making. The aim of this study was to test if early systematic communication about work and health between physician, patient/employee and employer facilitated by a communication tool, the Capacity Note, was feasible for patients with common mental disorders (CMD) in primary care.
Methods
In a pragmatic trial, physicians at primary health care centers (PHCCs) were randomized to control/intervention physician and were responsible for identifying eligible patients. In addition to usual care, intervention patients used the Capacity Note with their physician and were then instructed to use it with their employer and return it to the physician. Control patients received usual care. A study log book and sick leave data for each PHCC were used for process evaluation purposes.
Results
Eighteen of 24 PHCCs in the region were contacted; eight participated. At study start, 434 patients filled the basic inclusion criteria. Of these, 93 were identified as eligible by the physicians and were asked to participate. Around 40% declined participation, most commonly due to lack of energy or hesitation to talk to the employer. The final sample included 56 patients. Of the 28 intervention patients nine (32%) completed the intervention.
Conclusions
The study was negatively affected by suboptimal research conditions in primary care (e.g. severe time constraints). Also, the patients' hesitation to participate highlights the sensitivity of the topic and the difficulties in doing research in this vulnerable patient group. Thus, the feasibility was hampered by both organizational and patient related factors. It is of utmost importance to improve possibilities for social psychiatric research in primary care given the high prevalence of CMD and associated reduced capacity to work.
Key messages
Discussing health-related issues with the employer was seen as a sensitive matter among patients with common mental disorders. Research on best practices for sickness certification and return-to-work was difficult to achieve due to both personal and organizational factors.
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Affiliation(s)
- P Nordling
- Insurance Medicine, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - L Nordeman
- Research and Development Primary Care, Region Västra Götaland, Borås, Sweden
| | - I M Skoglund
- Primary Care, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - C Björkelund
- Primary Care, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - G Hensing
- Insurance Medicine, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
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Nordling P, Priebe G, Björkelund C, Hensing G. Assessing work capacity - reviewing the what and how of physicians' clinical practice. BMC Fam Pract 2020; 21:72. [PMID: 32340611 PMCID: PMC7187489 DOI: 10.1186/s12875-020-01134-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 03/29/2020] [Indexed: 11/10/2022]
Abstract
Background Although a main task in the sickness certification process, physicians’ clinical practice when assessing work capacity has not been thoroughly described. Increased knowledge on the matter is needed to better understand and support the certification process. In this review, we aimed to synthesise existing qualitative evidence to provide a clearer description of the assessment of work capacity as practiced by physicians. Method Seven electronic databases were searched systematically for qualitative studies examining what and how physicians do when they assess work capacity. Data was analysed and integrated using thematic synthesis. Results Twelve articles were included. Results show that physicians seek to form a knowledge base including understanding the condition, the patient and the patient’s workplace. They consider both medical and non-medical aspects to affect work capacity. To acquire and process the information they use various skills, methods and resources. Medical competence is an important basis, but not enough. Time, trust, intuition and reasoning are also used to assess the patient’s claims and to translate the findings into a final assessment. The depth and focus of the information seeking and processing vary depending on several factors. Conclusion The assessment of work capacity is a complex task where physicians rely on their non-medical skills to a higher degree than in ordinary clinical work. These skills are highly relevant but need to be complemented with access to appropriate resources such as understanding of the associations between health, work and social security, enough time in daily work for the assessment and ways to better understand the patient’s work place. Also, the notion of an “objective” evaluation is questioned, calling for a greater appreciation of the complexity of the assessment and the role of professional judgement.
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Affiliation(s)
- P Nordling
- School of Public Health and Community Medicine, The Sahlgrenska Academy at University of Gothenburg, Box 453, SE-405 30, Gothenburg, Sweden. .,Region Västra Götaland, Närhälsan Research and Development Primary Health Care, Gothenburg, Sweden.
| | - G Priebe
- School of Public Health and Community Medicine, The Sahlgrenska Academy at University of Gothenburg, Box 453, SE-405 30, Gothenburg, Sweden
| | - C Björkelund
- School of Public Health and Community Medicine, The Sahlgrenska Academy at University of Gothenburg, Box 453, SE-405 30, Gothenburg, Sweden.,Region Västra Götaland, Närhälsan Research and Development Primary Health Care, Gothenburg, Sweden
| | - G Hensing
- School of Public Health and Community Medicine, The Sahlgrenska Academy at University of Gothenburg, Box 453, SE-405 30, Gothenburg, Sweden
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Nordling P. Work capacity assessments – reviewing the what and how of physicians’ clinical practice. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Although a main task in the sickness certification process, physicians’ clinical practice when assessing work capacity has not been thoroughly described. Increased knowledge on the matter is needed to support a better and more reliable certification process. In this review, we aimed to synthesise existing evidence to provide a clearer description of the work capacity assessment as practiced by physicians.
Methods
Seven electronic databases were searched systematically for qualitative studies examining what and how physicians do when they assess work capacity. Data was analysed and synthesised using qualitative manifest content analysis.
Results
Twelve articles were included in the review. Results show that physicians seek to form a knowledge base including understanding the condition, the patient and the patient’s workplace. They consider both medical and non-medical aspects to affect work capacity. Accordingly, to acquire and process the information they use both medical and non-medical skills, methods and resources. Medical competence is an important basis, but not enough. Time, trust, intuition and reasoning are also used to assess the patient’s claims and to translate the findings into a final decision. The depth and focus of the information seeking and processing vary depending on several factors.
Conclusions
The work capacity assessment is a complex task where physicians rely on their non-medical skills to a higher degree than in ordinary clinical work. These skills are highly relevant but need to be complemented with methods to better understand the patient’s work place, as well as theoretical knowledge regarding the intricate associations between health, work and social security. This would further enhance physicians’ competence and confidence, and promote better experiences and practices of the work capacity assessment.
Key messages
In the complex task of assessing work capacity physicians rely on their non-medical skills to a higher degree than in ordinary clinical work. A better understanding of the patient’s work situation and the intricate associations between health, work and social security would enhance physicians’ competence and promote better assessments.
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Affiliation(s)
- P Nordling
- Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
- Primary Health Care, Region Västra Götaland, Gothenburg, Sweden
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Nordling P, Strandberg M, Strandberg NNG, Kiviniemi TO, Mäkelä KT, Airaksinen KEJ. Preoperative myocardial troponin T elevation is associated with the fracture type in patients with proximal femoral fracture. Scand J Surg 2018; 108:305-312. [PMID: 30520365 DOI: 10.1177/1457496918816928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS Cardiovascular complications are common in hip fracture patients but the role of fracture type and operative method in these is unclear. This prospective cohort study aimed to evaluate the impact of fracture- and operative characteristics on perioperative cardiovascular complications and prognosis in unselected hip fracture patients. MATERIAL AND METHODS During a 7-month trial registration period, a population of 197 consecutive hip fracture patients (median age 84 years) diagnosed with femoral neck or pertrochanteric fracture was formed. The exclusion criteria were patient refusal, subtrochanteric fracture, or death preoperatively. Pre- and postoperative troponin T (TnT) elevation, perioperative N-terminal fragment of pro-B-type natriuretic peptide (NT-proBNP) level, perioperative cardiovascular adverse events, and all-cause 30-day and 2- and 5-year mortalities were studied. RESULTS Femoral neck fracture was independently associated with preoperative myocardial injury witnessed by TnT elevation (HR 2.95, 95% confidence interval 1.21-7.19, p = 0.018). The fracture type, surgery delay, or operative method were not significantly associated with NT-proBNP levels, cardiovascular adverse event diagnoses, or prognosis. Cardiovascular adverse events were clinically diagnosed in 28 (14%) participants, and these had a higher mortality compared to participants without such diagnosis (at 30 days, 32% vs 5%; 2 years, 71% vs 31%; and 5 years, 86% vs 59%; p < 0.001). CONCLUSION While the femoral neck fracture independently predicts preoperative cardiovascular morbidity, the operative method does not affect perioperative cardiovascular complications or the prognosis, and it may be selected by the treating clinician based on other criteria.
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Affiliation(s)
- P Nordling
- Heart Center, Turku University Hospital, Turku, Finland.,Department of Clinical Medicine, University of Turku, Turku, Finland
| | - M Strandberg
- Heart Center, Turku University Hospital, Turku, Finland.,Department of Clinical Medicine, University of Turku, Turku, Finland
| | - N N G Strandberg
- Department of Orthopaedic Surgery and Traumatology, Turku University Hospital, Turku, Finland
| | - T O Kiviniemi
- Heart Center, Turku University Hospital, Turku, Finland.,Department of Clinical Medicine, University of Turku, Turku, Finland
| | - K T Mäkelä
- Department of Orthopaedic Surgery and Traumatology, Turku University Hospital, Turku, Finland
| | - K E J Airaksinen
- Heart Center, Turku University Hospital, Turku, Finland.,Department of Clinical Medicine, University of Turku, Turku, Finland
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Nordling P, Hensing G. Physicians’ work with assessment of work capacity in sickness certification – a review. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw174.108] [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: 11/14/2022] Open
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Abstract
OBJECTIVE To examine the prognostic value of perioperative N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) in hip fracture patients. DESIGN Blinded prospective cohort study. SETTING Single centre trial at Turku University Hospital in Finland. PARTICIPANTS Inclusion criterion was admittance to the study hospital due to hip fracture during the trial period of October 2009--May 2010. Exclusion criteria were the patient's refusal and inadequate laboratory tests. The final study population consisted of 182 patients. PRIMARY AND SECONDARY OUTCOME MEASURES NT-proBNP was assessed once during the perioperative period and later if clinically indicated, and troponin T (TnT) and ECG recordings were evaluated repeatedly. The short-term (30-day) and long-term (1000 days) mortalities were studied. RESULTS Median (IQR) follow-up time was 3.1 (0.3) years. The median (IQR) NT-proBNP level was 1260 (2298) ng/L in preoperative and 1600 (3971) ng/L in postoperative samples (p=0.001). TnT was elevated in 66 (36%) patients, and was significantly more common in patients with higher NT-proBNP. Patients with high (>2370 ng/L) and intermediate (806-2370 ng/L) NT-proBNP level had significantly higher short-term mortality compared with patients having a low (<806 ng/L) NT-proBNP level (15 vs 11 vs 2%, p=0.04), and the long-term mortality remained higher in these patients (69% vs 49% vs 27%, p<0.001). Intermediate or high NT-proBNP level (HR 7.8, 95% CI 1.03 to 59.14, p<0.05) was the only independent predictor of short-term mortality, while intermediate or high NT-proBNP level (HR 2.27, 95% CI 1.30 to 3.96, p=0.004), the presence of dementia (HR 1.74, 95% CI 1.13 to 2.66, p=0.01) and higher preoperative American Society of Anesthesiologists' (ASA) classification (HR 1.59, 95% CI 1.06 to 2.38, p=0.02) were independent predictors of long-term mortality. CONCLUSION An elevated perioperative NT-proBNP level is common in hip fracture patients, and it is an independent predictor of short-term and long-term mortality superior to the commonly used clinical risk scores. TRIAL REGISTRATION NUMBER NCT01015105; Results.
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Affiliation(s)
- Pauliina Nordling
- Heart Center, Turku University Hospital and Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Tuomas Kiviniemi
- Heart Center, Turku University Hospital and Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Marjatta Strandberg
- Heart Center, Turku University Hospital and Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Niko Strandberg
- Department of Orthopedic Surgery, Turku University Hospital, Turku, Finland
| | - Juhani Airaksinen
- Heart Center, Turku University Hospital and Department of Clinical Medicine, University of Turku, Turku, Finland
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