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Biomedical subjects

J Laurila

Publications and source records attributed to J Laurila.

At least 19 recordsLinked to original sources
PubMed2006

Epidemiology of intensive care unit (ICU)-acquired infections in a 14-month prospective cohort study in a single mixed Scandinavian university hospital ICU.

BACKGROUND: Our aim was to evaluate the epidemiology of intensive care unit (ICU)-acquired infections in a prospective cohort study. METHODS: Patients with longer than a 48-h stay in an adult mixed medical-surgical ICU in a tertiary level teaching hospital were included. The incidence (per cent) and incidence density (per 1000 patient days) of ICU-acquired infections and the device-associated infection rates per 1000 device days were analysed prospectively in a 14-month study. RESULTS: Eighty (23.9%) of 335 patients, whose ICU stay was longer than 48 h, acquired a total of 107 infections (1.3 per patient) during their ICU stay, with an infection rate of 48 per 1000 patient days. The most common infections were ventilator-associated pneumonia (VAP) [33.8% (18.8 per 1000 respiratory days)], other lower respiratory tract infections (LRTIs) (20%) and sinusitis (13.8%). The rate of central catheter-related (CRI) or primary bloodstream infections was 6.3% (2.2 per 1000 central venous catheter days), and the rate of urinary tract infections was 1.3% (0.5 per 1000 urinary catheter days). The first ICU infection was observed in 58.8% (47/80) of cases within 6 days after admission. The median time from admission to the diagnosis of an ICU-acquired infection was 4 days (25th-75th percentiles, 4.0-6.0) for VAP, 6.0 days (4.5-7.0) for LRTIs and 9.5 days (6.5-13.0) for CRIs. CONCLUSIONS: The rates of urinary tract infections and bloodstream infections were lower than reported previously, differentiating our results from the classic pattern of ICU-acquired infections, with the exception of the predominance of VAP.

Adult↗
PubMed2006

Organ system dysfunction following open cholecystectomy for acute acalculous cholecystitis in critically ill patients.

BACKGROUND: Acute acalculous cholecystitis (AAC) refers to cholecystitis without gallstones and is a serious complication of critical illness. We describe the time course of organ system dysfunction associated with cholecystectomy in critically ill patients with AAC. METHODS: The data of all intensive care unit (ICU) patients who had operatively confirmed AAC during their ICU stay between 2003 and 2004 were analyzed. Patients who also had other intra-abdominal pathologies were excluded. The Sequential Organ Failure Assessment (SOFA) scores were recorded 3 days before, on the day of operation and on the first, second, third and seventh post-operative day after cholecystectomy. The impact of open cholecystectomy on organ dysfunction was evaluated on the basis of the change in the total and individual organ SOFA scores. RESULTS: Twenty-four patients underwent open cholecystectomy for AAC with no other intra-abdominal pathology. Sepsis was the most common admission diagnosis, followed by cardiovascular surgery. The mean (standard deviation, SD) Acute Physiology and Chronic Health Evaluation (APACHE II), Simplified Acute Physiology Score (SAPS) II and SOFA scores on admission were 24.7 (5.8), 44.3 (12.3) and 9.4 (3.2), respectively. The median (25th, 75th percentiles) total SOFA score 3 days before cholecystectomy was 7.5 (1.3, 8.0), which increased to 10.5 (8.3, 13.0) (P < 0.0001) by the day of cholecystectomy, indicating developing multiorgan dysfunction. After the operation, the score decreased to 5.5 (3.3, 10.8) (P = 0.004) by the seventh post-operative day. The change was most obvious in cardiovascular and respiratory SOFA scores. CONCLUSIONS: AAC is associated with multiorgan dysfunction in critically ill patients. Open cholecystectomy seems to alter the course of multiorgan dysfunction in these patients.

APACHE↗
PubMed2006

Development of renal failure during the initial 24 h of intensive care unit stay correlates with hospital mortality in trauma patients.

BACKGROUND: Although multiple organ failure is the leading late cause of death, there is controversy about the impact of acute organ dysfunction and failure on trauma survival. METHODS: Consecutive adult trauma admissions between January 2000 and June 2003, excluding isolated head traumas and burns, were analysed for parameters of organ function during the first 24 h following intensive care unit (ICU) admission using the Sequential Organ Failure Assessment (SOFA) scoring system. A national prospectively collected ICU data registry was used for analysis, including data from 22 ICUs in university and central hospitals in Finland. RESULTS: The study population consisted of 1044 eligible trauma admissions; 32% of the cases were treated at university hospital level, the rest being secondary referral central hospital admissions. The mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 15 (SD8), ICU mortality was 5.6% and a further 1.6% of patients died during their post-ICU hospital stay. Forty-five per cent of the patients were categorized as having multiple traumas. In univariate analysis, APACHE II > or = 25 [odds ratio (OR), 35; 95% confidence interval (CI), 18-66] and renal failure (OR, 29.5; 95% CI, 14-63) produced the highest ORs for ICU mortality. In the APACHE II-, sex- and age-adjusted logistic regression model, renal failure was a significant risk factor for both ICU and hospital mortality (OR, 11.8; 95% CI, 3.9-35.4; OR, 8.2; 95% CI, 2.9-23.2, respectively). CONCLUSION: The development of renal failure during the initial 24 h of ICU stay remained an independent risk factor for mortality in trauma patients requiring intensive care treatment even after adjusting for the APACHE II score, age and sex.

APACHE↗
PubMed2004

Glycoalkaloid aglycone accumulations associated with infection by Clavibacter michiganensis ssp. sepedonicus in potato species Solanum acaule and Solanum tuberosum and their interspecific somatic hybrids.

Solanum acaule Bitt., a wild potato species, is closely related to cultivated potato (Solanum. tuberosum L.). Incorporation of desirable traits from allotetraploid [2n=4x=48, 2 endosperm balance number (EBN)] S. acaule (acl) into autotetraploid (2n=4x=48, 4EBN) S. tuberosum (tbr) is difficult due to incongruity boundaries. In this study, three hybrid combinations, each with a specific genome constitution, were produced through protoplast fusion: (1) hexaploid 2x acl (+) 4x tbr, (2) tetraploid 2x acl (+) 2x tbr, and (3) hexaploid 4x acl (+) 2x tbr hybrids. In terms of glycoalkaloid aglycones, the hybrids produced demissidine, tomatidine and solanidine, similarly to the S. acaule parental species, but S. tuberosum synthesised only solanidine. Inoculations with Clavibacter michiganensis ssp. sepedonicus (Cms), which is the causal agent of bacterial ring rot in potato, yielded significantly lower total glycoalkaloid aglycone accumulation both in S. acaule plants and in interspecific hybrids in comparison with the corresponding mock-inoculated plants. However, in S. tuberosum the aglycone levels were either higher or unchanged as a result of infection by Cms. To incorporate the desirable traits of the interspecific somatic hybrids into 4EBN S. tuberosum, sexual backcrosses were carried out. The hexaploid 4x acl (+) 2x tbr hybrids with the hypothetical 4EBN showed the greatest capacity to undergo backcrosses with S. tuberosum.

Actinomycetales↗
PubMed2004

Acute acalculous cholecystitis in critically ill patients.

BACKGROUND: Acute acalculous cholecystitis (AAC) is a serious complication of critical illness. We evaluated the underlying diseases, clinical and diagnostic features, severity of associated organ failures, and outcome of operatively treated AAC in a mixed ICU patient population. METHODS: The data of all ICU patients who had operatively confirmed AAC during their ICU stay between 1 January 2000 and 31 December 2001 were collected from the hospital records and the intensive care unit's data management system for predetermined variables. RESULTS: Thirty-nine (1%) out of 3984 patients underwent open cholecystectomy for AAC during the two-year period. Infection was the most common admission diagnosis, followed by cardiovascular surgery. The mean APACHE II score on admission was 25, and 64% of the patients had three or more failing organs on the day of cholecystectomy. The mean length of ICU stay before cholecystectomy was 8 days, and the mean total length of ICU stay was 19 days. Most patients (85%) received norepinephrine infusion, and 90% suffered respiratory failure before cholecystectomy. Hospital mortality was 44%. The non-survivors had higher Sequential Organ Failure Assessment (SOFA) scores on the day of cholecystectomy compared to the survivors (12.9 vs. 9.5, P = 0.007). CONCLUSION: Acute acalculous cholecystitis was associated with severe illness, infection, long ICU stay, and multiple organ failure. Mortality was related to the degree of organ failure. Prompt diagnosis and active treatment of AAC can be life-saving in these patients.

APACHE↗
PubMed2002

On what are our end-of-life decisions based?

BACKGROUND: The incidence of withholding and withdrawing life support from the critically ill has increased in recent years. The aim of this study was to assess the degree of consistency between the weight assigned by intensivists to different determinants and their relation to end-of-life decisions, and to evaluate the current concepts in withholding or withdrawing intensive care in Nordic countries. METHODS: Forty-one intensivists from Nordic countries completed a questionnaire sent by e-mail: consistency between contributing factors and the decisions regarding 10 actual cases was evaluated by logistic regression analysis and by the classification (leave-one-out) method. Concepts in management after the withdrawal decision were also analyzed. RESULTS: The median (range) number of withdrawals per physician was four (range 0-10) out of 10 cases. No single factor was an independent covariant of all decisions made. The classification method revealed that approximately 70% only of decisions could be predicted correctly. Different actions taken after a decision to withdraw intensive care varied from 9.8% (discontinuing ventilator therapy) to 97.6% (informing relatives). CONCLUSIONS: No generally accepted grounds for end-of-life decisions could be detected among Nordic intensivists. In addition, the current concept of management after decision to withdraw therapy varies markedly. This study has implications in further assessment of the individual decision-making process and the uniformity of actions after withdrawal decisions.

Critical Care↗
PubMed2001

Determinants of ICU mortality in necrotizing pancreatitis: the influence of Staphylococcus epidermidis.

BACKGROUND: The severity of acute necrotizing pancreatitis ranges from self-limited to rapidly progressive illness leading to multiple organ failure. Several scoring systems and clinical parameters have been used to predict the course of the disease. The aim of this study was to evaluate the clinical and microbiological determinants of poor outcome in necrotizing acute pancreatitis. METHODS: Medical records of 67 consecutive patients admitted to the intensive care unit (ICU) of Oulu University Hospital due to acute necrotizing pancreatitis were retrospectively analyzed. All patients received standard surgical intensive care. RESULTS: Patients who died (n=14) had significantly higher APACHE II, SAPS II and Ranson scores at admission to the ICU and maximum SOFA score achieved during ICU stay than did the survivors. The non-survivors were hospitalized later from the time the symptoms were first manifest (5.3 vs. 2.4 days, P=0.051). Mechanical ventilation (P=0.002), surgical management (P=0.028), open packing surgical management (P=0.03), renal replacement therapy (P<0.001), use of inotropic drugs (P=0.012) and Staphylococcus epidermidis growth (P=0.029) in infected pancreatic tissue were all associated with mortality. CONCLUSIONS: In this study the time to hospitalization, severity of illness, intensity of care, and surgical management were associated with poor outcome. In addition, Staphylococcus epidermidis in pancreatic necrosis was associated with increased mortality.

APACHE↗
PubMed2001

Intensive Care Nursing Scoring System Part 2: nursing interventions and nursing outcomes.

Different medical classifications and scoring systems have been developed to measure and compare intensive care outcomes in international contexts. Many of them, however, do not include outcome variables to describe autonomous nursing and its effects on the patient's experiences and restrictions as a result of the onset and process of illness, or relatives' or significant others' distress in the intensive care environment. The Intensive Care Nursing Scoring System (ICNSS) is a new instrument to describe and highlight nurses' work and its effects on the patients and their relatives in a way not allowed by medical classifications and scoring systems. ICNSS can be used to evaluate a single intensive care nursing process from admission to discharge or to compare patients in different intensive care units for certain variables. ICNSS can also be used to measure nurses' workload. The classification of nursing diagnoses was described in a previous article. This paper describes nursing outcomes and nursing interventions as well as the use of ICNSS in a computer-based information management system in three adult intensive care units in the Oulu University Hospital.

Finland↗
PubMed2001

The efficacy of a continuous quality improvement (CQI) method in a radiological department. Comparison with non-CQI control material.

OBJECTIVE: To study the efficacy of continuous quality improvement (CQI) compared to ordinary management in an on-duty radiology department. MATERIAL AND METHODS: Because of complaints regarding delivery of on-duty radiological services, an improvement was initiated simultaneously at two hospitals, at the HUCH (Helsinki University Central Hospital) utilising the CQI-method, and at the OUH (Oulu University Hospital) with a traditional management process. For the CQI project, a team was formed to evaluate the process with flow-charts, cause and effect diagrams, Pareto analysis and control charts. Interventions to improve the process were based on the results of these analyses. RESULTS: The team at the HUCH implemented the following changes: A radiologist was added to the evening shift between 15:00-22:00 and a radiographer was moved from the morning shift to 15:00-22:00. A clear improvement was achieved in the turn-around time, but in the follow-up some of the gains were lost. Only minimal changes were achieved at the OUH, where the intervention was based on traditional management processes. CONCLUSION: CQI was an effective method for improving the quality of performance of a radiology department compared with ordinary management methods, but some of this improvement may be subsequently lost without a continuous measurement system.

Finland↗
PubMed2000

Cost-effectiveness of Percutaneous Transluminal Angioplasty (PTA) Versus Vascular Surgery in Limb-threatening Ischaemia.

The purpose of this study was to analyze the cost and cost-effectiveness of femoropopliteal PTA compared to femoropopliteal bypass surgery in chronic critical ischaemia of the lower limb. A total of 772 patients were treated either by femoropopliteal PTA or vascular reconstruction in two of the three largest vascular centers in Finland 1991-1992. A subset of 124 cases with chronic critical leg ischaemia, which according to a retrospective independent analysis by a vascular surgeon and a radiologist could have been treated with either modality, were included in the study. Eighty-six of those were treated with PTA and 38 with surgery. The patients were followed up for to three years after treatment. Clinical outcomes were measured as change in the ABI (ankle-brachial pressure index) and avoidance of reoperation and amputation. The hospital costs covering all events from preoperative examinations to the three-year follow-up visit were identified by using hospital discharge register and accounting data. Cost-effectiveness was calculated as cost per reoperation-free year and year of leg saved. Surgery cases were found to have a more severe disease as indicated by lower distal pressures and longer occlusions and they also showed a slightly better clinical outcome, although the differences were not statistically significant. PTA costs were half of those of vascular surgery. The cost-effectiveness rates were significantly better for the PTA patients. PTA is a feasible and cost-effective procedure in chronic critical ischaemia of the lower limb and should be the treatment of choice in the subset of patients where both procedures are possible.

Journal Article↗
PubMed2000

Intensive care nursing scoring system. Part 1: Classification of nursing diagnoses.

The introduction of computer-based information management systems to intensive care units offers new possibilities to describe and document the content of nursing. In different countries and health care organizations, the hospital culture and the approach taken by nurses and medical colleagues determine what, how and to what extent nursing is documented. There are nursing diagnosis classifications that are used in North America, such as NANDA (North American Nursing Diagnosis Association), and the European Union Telenurse project will promote the use of the ICNP (International Classifications of Nursing Practice) throughout Europe. The above classifications are used to describe individual, family or community responses to potential or actual health problems or life processes. But there is no nursing diagnosis classification that would take into account both the aims and the unique context of intensive care nursing. This first article describes part of our research: the action research process and the result of the development of a nursing diagnosis classification compatible with the goals of intensive care in three adult intensive care units in the Oulu University Hospital. The classification of nursing diagnoses is part of the Intensive Care Nursing Scoring System (ICNSS) which was developed in the course of this study. The other parts deal with nursing outcomes and nursing interventions. ICNSS is used to facilitate information exchange in the process of intensive care nursing and to describe the nursing workload.

Adult↗
PubMed2000

Activity-based costing in radiology. Application in a pediatric radiological unit.

PURPOSE: To get an informative and detailed picture of the resource utilization in a radiology department in order to support its pricing and management. MATERIAL AND METHODS: A system based mainly on the theoretical foundations of activity-based costing (ABC) was designed, tested and compared with conventional costing. The study was performed at the Pediatric Unit of the Department of Radiology, Oulu University Hospital. The material consisted of all the 7,452 radiological procedures done in the unit during the first half of 1994, when both methods of costing where in use. Detailed cost data were obtained from the hospital financial and personnel systems and then related to activity data captured in the radiology information system. RESULTS: The allocation of overhead costs was greatly reduced by the introduction of ABC compared to conventional costing. The overhead cost as a percentage of total costs dropped to one-fourth of total costs, from 57% to 16%. The change of unit costs of radiological procedures varied from -42% to +82%. CONCLUSION: Costing is much more detailed and precise, and the percentage of unspecified allocated overhead costs diminishes drastically when ABC is used. The new information enhances effective departmental management, as the whole process of radiological procedures is identifiable by single activities, amenable to corrective actions and process improvement.

Child↗
PubMed2000

Diagnosis of meningeoma. A comparison of costs before CT, during CT and after introduction of MR imaging.

OBJECTIVE: To assess whether the capital investment required by advances in radiological technology is offset by savings in the direct costs of diagnostic services. MATERIAL AND METHODS: Meningeoma was used as an indicator case. All meningeoma patients from three study periods were included: Twenty patients in 1976-77 before the introduction of CT, 22 patients in 1984-85 when CT was used and 16 patients in 1992 when MR imaging had replaced CT as the most informative imaging modality. Radiological and other diagnostic investigations, and the hospital stay were identified and cost analyzed. RESULTS: The costs of radiological examinations increased from 293 Euros in 1976-77 to 513 Euros in 1992. The average number of diagnostic examinations per patient decreased from 5.1 in 1976 77 to 2.4 in 1992. The length of hospital stay decreased from 11.5 to 2.7 days and the total costs of the diagnostic work-up decreased to one-third of the original, i.e. from 3423 Euros in 1976-77 to 1282 Euros in 1992. CONCLUSION: The costs of the radiological examinations rose, but the development of radiological technology simplified the diagnostic practice. The hospital stay drastically decreased. The total costs of diagnostic work-up per patient dropped to one-third of the baseline costs.

Costs and Cost Analysis↗
PubMed1999

Determination of solanidine- and tomatidine-type glycoalkaloid aglycons by gas Chromatography/Mass spectrometry.

A combined derivatization method for gas chromatographic/mass spectrometric (GC/MS) analysis of steroidal glycoalkaloid (SGA) aglycons was developed using both trimethylsilylation and pentafluoropropionylation. In comparison with underivatized or only silylated aglycons, the new technique produces more specific and abundant fragmentation for compounds with a tomatidine-type structure. For example, the difference between solasodine and tomatidine, the former containing a double bond at position 5,6 in the steroidal skeleton, can be observed by their base peak fragments at m/z 417 (C(24)H(41)O(2)Si(2)) and m/z 419 (C(24)H(43)O(2)Si(2)). The method is well suited for the simultaneous determination of both solanidane- and spirosolane-type SGA aglycons from Solanum species and hybrids. The reproducibility of the method, including SGA extraction, hydrolysis, derivatization, and quantitative GC/MS analysis, was <6% (CV) for the principal aglycons determined from a hybrid between a wild potato species, Solanum brevidens Phil., and a cultivated potato, S. tuberosum L. A single ion monitoring technique using specific fragments m/z 419 and 417 could be applied for the determination of minor stereoisomers, which are often overlapped by large amounts of tomatidine.

Diosgenin↗
PubMed1998

Costs of plain-film radiography in a partially digitized radiology department. An activity-based cost analysis.

PURPOSE: The aim of the study was to analyse the costs of computed radiography (CR) as part of a small picture archiving and communication system (mini-PACS), and to compare these costs with those of conventional analogue radiography using activity-based accounting (ABC). MATERIAL AND METHODS: The study was conducted at the Central Hospital of Vaasa where in 1993 the Radiology Department acquired a mini-PACS with a CR reader, a chest CR unit, and a CT unit as digital image processing modalities. Of altogether 34140 plain-film examinations, 3/4 were made with CR and stored mostly on film, and 1/4 were made with conventional analogue radiography. The costs and activities of these two modes were analysed by means of the ABC method which identifies and allocates indirect costs in radiological procedures. RESULTS: The costs of CR imaging were 9% higher than those of conventional radiography. The costs of the chest CR unit were equal to those of conventional radiography. The difference was due to higher investment costs in digital image processing. The time gained from a reduction in the number of retakes did not shorten the time spent by patients in the examination room, and its effect on film costs was minimal. CONCLUSION: In planning the step-by-step transition of conventional film-based analogue radiography to fully digitized radiography, it should be noted that films are still used in the transition period and that this is associated with higher costs than in the previous system of conventional analogue plain-film imaging.

Costs and Cost Analysis↗