Biomedical subjects

J Nurmi

Publications and source records attributed to J Nurmi.

12 recordsLinked to original sources

PubMed2006

Assessment of CPR-D skills of nurses in Göteborg, Sweden and Espoo, Finland: teaching leadership makes a difference.

INTRODUCTION: Construction of an effective in-hospital resuscitation programme is challenging. To document and analyse resuscitation skills assessment must provide reliable data. Benchmarking with a hospital having documented excellent results of in-hospital resuscitation is beneficial. The purpose of this study was to assess the resuscitation skills to facilitate construction of an educational programme. MATERIALS AND METHODS: Nurses working in a university hospital Jorvi, Espoo (n=110), Finland and Sahlgrenska University Hospital, Göteborg (n=40), Sweden were compared. The nurses were trained in the same way in both hospitals except for the defining and teaching of leadership applied in Sahlgrenska. Jorvi nurses are not trained to be, nor do they act as, leaders in a resuscitation situation. Their cardiopulmonary resuscitation (CPR) skills using an automated external defibrillator (AED) were assessed using Objective Structured Clinical Examination (OSCE) which was build up as a case of cardiac arrest with ventricular fibrillation (VF) as the initial rhythm. The subjects were tested in pairs, each pair alone. Group-working skills were registered. RESULTS: All Sahlgrenska nurses, but only 49% of Jorvi nurses, were able to defibrillate. Seventy percent of the nurses working in the Sahlgrenska hospital (mean score 35/49) and 27% of the nurses in Jorvi (mean score 26/49) would have passed the OSCE test. Statistically significant differences were found in activating the alarm (P<0.001), activating the AED without delay (P<0.01), setting the lower defibrillation electrode correctly (P<0.001) and using the correct resuscitation technique (P<0.05). The group-working skills of Sahlgrenska nurses were also significantly better than those of Jorvi nurses. CONCLUSIONS: Assessment of CPR-D skills gave valuable information for further education in both hospitals. Defining and teaching leadership seems to improve resuscitation performance.

Cardiopulmonary Resuscitation↗

PubMed2006

Teaching basic life support to nurses.

BACKGROUND AND OBJECTIVE: Every member of healthcare personnel should be able to perform basic life support including defibrillation (CPR-D). The biggest cost of implementation is training and these costs need to be reduced. The purpose of this randomized study was to evaluate the applicability of distance learning as a method to teach CPR-D. METHODS: Nurses (n = 56) working in a geriatric hospital were randomized into three groups. The first group was given the Internet-based CPR-D course and the second was given a traditional, small-group CPR-D course. A third group without specific training in CPR-D served as a control group. An objective structured clinical examination (OSCE) was performed 2 weeks after the courses with a manikin patient having a cardiac arrest. RESULTS: The median score of all participants was 31/49 (range 21-38). The reliability of the checklist was adequate (Cronbach alpha 0.77). Nurses receiving traditional CPR-D performed better than those receiving the Internet-based course (median score 34 vs. 28, P < 0.05) and the control group (median score 34 vs. 26, P < 0.0001). Nurses receiving Internet-based course performed similarly as the control group (median score 28 vs. 26, ns). CONCLUSIONS: Distance learning cannot substitute for traditional small-group learning.

Education, Distance↗

PubMed2005

Observations and warning signs prior to cardiac arrest. Should a medical emergency team intervene earlier?

BACKGROUND: The Medical Emergency Team (MET) has evolved in some hospitals as a means of delivering effective treatment early enough to prevent cardiac arrests. Our aim was to analyze the effectiveness of observation practice to detect abnormalities in vital signs prior to cardiac arrest and to determine the need for a MET system in Finnish hospitals. METHODS: The charts of patients who suffered cardiac arrest during 18 months in four hospitals were reviewed. The vital signs, symptoms and interventions during 8 h prior to arrest were recorded and analyzed against trigger criteria of the MET. RESULTS: During the study period, 110 patients suffered cardiac arrest in hospitals, and 56 (51%) of the arrests occurred on the wards. Of those patients, 30 (54%) had an abnormal vital sign fulfilling the MET criteria, documented on average 3.8 h prior to the arrest. During this period, 13 patients did not receive any intervention (e.g. supplemental oxygen or medication), eight received intervention within 1 h and nine received intervention after more than 1 h. Response to the first intervention was not attained in any patient; nevertheless re-interventions took place in one patient only. CONCLUSION: Significant physiological deterioration seems to be common in the hours before a cardiac arrest on the wards of Finnish hospitals, suggesting that implementation of a MET-system may be worthwhile. However, the practice of vital sign observation by the nursing staff should be improved before maximal benefit of a MET can be achieved.

Adolescent↗

PubMed2004

Teaching public access defibrillation to lay volunteers--a professional health care provider is not a more effective instructor than a trained lay person.

BACKGROUND: Survival improves in witnessed out-of-hospital cardiac arrest if the victim receives bystander-initiated cardiopulmonary resuscitation and rapid defibrillation (BLS/AED). The European Resuscitation Council has a simple programme to teach these life-saving skills that require no previous experience of automated external defibrillators (AEDs). To be able to implement the use of AEDs widely, many instructors are needed, and therefore, lay persons may also be used as trainers. The purpose of this randomized study was to compare lay volunteers trained by a lay person with those trained by a health care professional using the Objective Structured Clinical Examination (OSCE). METHODS: Eight instructors, including four lay persons and four health care professionals, were given a basic course and an instructor course in CPR-D by the same instructor. All newly trained instructors trained 38 lay volunteers (19 pairs) who had no previous training in the use of a defibrillator. The lay volunteers performed the OSCE 2-3 weeks after the course. The OSCE comprised two scenarios with a manikin: the first, a patient in cardiac arrest with ventricular fibrillation, and the second, an imminent cardiac arrest with asystole as the initial rhythm. The same OSCE was performed by a group of lay first aiders practicing every 2 weeks who served as the control group. RESULTS: No statistical difference was present between the two groups of lay volunteers in the OSCE. All were able to use the AED and follow instructions. They identified patients with ventricular fibrillation and cardiac arrest, but had difficulties identifying cases with imminent cardiac arrest. The control group of trained first aiders performed significantly more effectively than the newly trained lay persons. CONCLUSIONS: No significant benefit exists in the trainer being a health care professional, but thorough training and subsequent rehearsing of the skills learned are crucial.

Cardiopulmonary Resuscitation↗

PubMed2004

Measurement of the abdominal circumference for the detection of intra-abdominal hemorrhage has no diagnostic value.

BACKGROUND: Measuring the circumference of the abdomen is still commonly used when treating a patient with suspicion of intra-abdominal bleeding. In the present study the usefulness of this method for a diagnostic purpose is questioned because of the assumed method-related interindividual variation. METHODS: The study group consisted of 34 end-stage renal failure (ERSF) patients treated with peritoneal dialysis. Each patient was measured by the same nurse at the level of the umbilicus and the level of the iliac crest both before and after an infusion of 2000 ml of peritoneal dialysis fluid into the peritoneal cavity. One healthy female served as a control. Her abdominal circumference was measured at the level of the umbilicus by 10 different emergency medical technicians (EMTs), each of whom performed the measurement three times. The measuring tape was blank and the place of the first measurement was marked as performed in clinical practice. RESULTS: The mean abdominal circumference at the level of the umbilicus before an infusion of peritoneal fluid was 93.2 +/- 9.5 cm (SD), and after filling the peritoneal cavity 96.3 +/- 9.5 cm (difference 3.1 +/- 1.7 cm). These figures at the level of the iliac crest were 96 +/- 8.3 and 97.2 +/- 8.4 cm (difference 1.2 +/- 1.4 cm) (P < 0.0001), respectively. The mean value between the smallest and largest values when measuring the circumference of a healthy control person was 1.85 +/- 1.11 (P < 0.0005). The mean difference in circumference in the peritoneal dialysis patients was smaller than the largest difference among the three measurements taken by the same EMT. CONCLUSION: Measuring the abdominal circumference should not be used as a diagnostic tool when intra-abdominal bleeding is suspected.

Abdomen↗

PubMed2001

High-throughput genetic analysis using time-resolved fluorometry and closed-tube detection.

Robust methods for genetic analysis are required for efficient exploitation of the constantly accumulating genetic information. We describe a closed-tube genotyping method suitable for high-throughput screening of genetic markers. The method is based on allele-specific probes labeled with an environment-sensitive lanthanide chelate, the fluorescence intensity of which is significantly increased upon PCR amplification of a complementary target. Genomic DNA samples were analyzed in an insulin gene single nucleotide polymorphism (SNP) assay using universal amplification primers and probes that recognized the two different alleles. The feasibility of dry reagent based all-in-one PCR assays was tested using another diabetes-related genetic marker, human leukocyte antigen DQB1 allele *0302 as a model analyte in a dual-color, closed-tube end-point assay. There was a 100% correlation between the novel SNP assay and a conventional PCR restriction fragment length polymorphism assay. It was also demonstrated that using real-time monitoring, accurate genotyping results can be obtained despite strongly cross-reacting probes, minimizing the time and effort needed for optimization of probe sequence. Throughput can be maximized by using predried PCR mixtures that are stable for at least 6 months. This homogenous, all-in-one dry reagent assay chemistry permits cost-effective genetic screening on a large scale.

Alleles↗

PubMed2001

Automated color correction method for Vibrio fischeri toxicity test. Comparison of standard and kinetic assays.

We demonstrate in this study that the toxicity of solid and highly colorful samples can be measured with kinetic bioassay using luminescent bacterium Vibrio fischeri. The Flash assay, named after the test protocol, is performed with a tube luminometer. In this method, each sample acts as a reference for itself, and therefore, the color correction is possible with minimal hands-on-time. The bacteria are dispensed into the sample and the signal is recorded continuously. The maximum signal received after immediately dispensing is compared to the signal after an incubation period. With many chemicals, the toxic effects are obtained after a very short contact time. However, different chemicals have different modes of toxicity. Thus, kinetic data from sample analyses after 15 or 30 min for this bacterium gives an additional dimension for obtaining reliable results. The performance of the test was compared to the standardized photobacteria test protocol with reference chemicals. The repeatability of the test was excellent. The coefficient of variation was normally below 1% with 10 replicates.

Automation↗

PubMed2000

A new label technology for the detection of specific polymerase chain reaction products in a closed tube.

A novel signal generation principle suitable for real time and end-point detection of specific PCR products in a closed tube is described. Linear DNA probes were labeled at their 5'-ends with a stable, fluorescent terbium chelate. The fluorescence intensity of this chelate is lower when it is coupled to single-stranded DNA than when the chelate is free in solution. The synthesized probes were used in the real time monitoring of PCR using a prototype instrument that consisted of a fluorometer coupled to a thermal cycler. When the probe anneals to a complementary target amplicon, the 5'-->3' exonucleolytic activity of DNA polymerase detaches the label from the probe. This results in an enhanced terbium fluorescence signal. Since terbium has a long excited state lifetime, its fluorescence can be measured in a time-resolved manner, which results in a low background fluorescence and a 1000-fold signal amplification. The detection method is quantitative over an extremely wide linear range (at least 10-10(7)initial template molecules). The label strategy can easily be combined with existing label technologies, such as TaqMan 5'-exonuclease assays, in order to carry out multiplex assays that do not suffer from overlapping emission peaks of the fluorophores.

Chelating Agents↗

PubMed2000

Effects of season and processing on oil content and fatty acids of baltic herring (Clupea harengus membras).

Fatty acid composition, oil content, free fatty acid content, and peroxide value of Baltic herring (Clupea harengus membras) and two processed products (fried fillets and fish burgers) were investigated. The highest oil content of the fillets was found in autumn (10%), at the time when the free fatty acids had their minimum (1.4%). The main fatty acids were oleic (18-23%), palmitic (17%), palmitoleic (8-12%), and docosahexaeneoic (8-10%) acids. The proportion of saturated fatty acids was a constant 23% all year around, whereas mono- and polyunsaturated acids varied from 34 to 39% and 33 to 37%, respectively. During processing the oil content doubled and the fatty acid composition changed to the pattern of the rapeseed oil used for frying. Oleic acid was a major fatty acid in the products comprising over 40% of the total fatty acids. The proportion of n-3 acids decreased during processing but the total amount of polyunsaturated acids remained fairly constant.

Animals↗

PubMed1992

Crystal structure of lactitol (4-O-beta-D-galactopyranosyl-D-glucitol) trihydrate.

Lactitol trihydrate, C12H24O11.3H2O, crystallises in the orthorhombic space group, P2(1)2(1)2(1) with cell dimensions a = 8.306(2), b = 10.163(1), c = 21.321(1) A, and V = 1799.8(5) A3; Z = 4, Dx = 1.47 Mg m-3, lambda(Cu-K alpha) = 1.54178 A, mu = 1.14 mm-1, F(000) = 856, and T = 23 degrees. There are one intra- and thirteen inter-molecular hydrogen bonds in the structure. The bond lengths and angles agree well with the mean values of related structures. The galactopyranosyl ring has a chair conformation.

Carbohydrate Conformation↗

PubMed1992

Crystal structure of lactitol (4-O-beta-D-galactopyranosyl-D-glucitol) dihydrate.

Lactitol dihydrate, C12H24O11.2H2O, is tetragonal, space group P4(3)2(1)2 with cell dimensions a and b = 8.7612(1), c = 45.500(3) A, and V = 3493.2(3) A3, Z = 8, Dx = 1.45 Mg.m-3, lambda (Cu-K alpha) = 1.54056 A, mu = 1.108 mm-1, F(000) = 1632, and T = 23 degrees. The structure was solved by direct methods and refined by least-squares calculations to R = 0.054 for 2037 unique observed reflections. There are three intra- and twelve inter-molecular hydrogen bonds in the structure. Bond lengths and angles accord quite well with the mean values of related structures. The galactopyranosyl ring has a chair conformation.

Carbohydrate Conformation↗

PubMedDate not supplied

Time-resolved fluorometry in end-point and real-time PCR quantification of nucleic acids.

Two time-resolved fluorescence-based methods for nucleic acid quantification are described and their results are compared. Both methods use an exogenous internal standard to eliminate errors arising from different steps of the assay. The first method is a competitive end-point assay, where the standard competes for the same primers with the actual target sequence, prostate-specific antigen (PSA) cDNA. The standard and target are quantified in a dual-label plate hybridization with lanthanide-labelled probes after a fixed number of PCR cycles. The second method is based on real-time monitoring of PCR and on the use of a novel homogeneous signal generation principle that relies on the use of a 5'-->3' exonucleolytic DNA polymerase and a probe labelled with an environment sensitive, stable and fluorescent lanthanide chelate. In this assay, a non-competitive, exogenous internal standard is used. Both assays have a wide linear range (50-5 x 10(6) and 10-5 x 10(7) input PSA cDNA molecules for the end-point and real-time assays, respectively) and there is a strong correlation between the results obtained with the two assays (r = 1.0). Being somewhat faster to perform, the real-time format is better suited for assays that require high throughput.

Base Sequence↗