Publications by authors named "Miretta Tommila"

8 Publications

  • Page 1 of 1

The accuracy of preliminary diagnoses made by paramedics - a cross-sectional comparative study.

Scand J Trauma Resusc Emerg Med 2020 Jul 23;28(1):70. Epub 2020 Jul 23.

Department of Nursing Science, University of Turku, Department of Nursing Science 20014 University of Turku, Turku Finland and Satakunta Central Hospital, Sairaalantie 3, 28500, Pori, Finland.

Background: Clinical decision-making skills of paramedics have been emphasized because of the growing complexity of emergency medicine nursing. A preliminary diagnosis made by a paramedic has an essential role in directing the subsequent care. An accurate preliminary diagnosis improves the patient's outcome. The research in this area is relatively scarce and there are no previous studies in Finland describing the accuracy of preliminary diagnoses made by paramedics. The aim of this study was to evaluate whether paramedics are making accurate preliminary diagnoses for the patients they are transporting to hospital. In addition, the aim was to describe the variables related to an accurate preliminary diagnosis.

Methods: A cross-sectional comparative approach was used and conducted through a questionnaire to gather data from the paramedics. A total of 71 paramedics participated in the study and 378 patient cases were included. The paramedics were asked to describe the basic information of a case, to state their preliminary diagnosis, and give their own educational background. The accuracy of the paramedic's preliminary diagnosis was compared with the discharge diagnosis of the ED physicians retrieved from hospital's patient records. Logistic regression analysis and a binomial test were used to test the statistical significance.

Results: The agreement between the paramedics' preliminary diagnosis vs. hospital diagnosis was 70% (n = 261). Diagnostic accuracy varied according to the medical condition from mental diseases and intoxication (86%, p = 0,000), cerebral strokes (81%, p = 0,007) to infections (31% p = 0,029). The educational background of a bachelor-degree-level paramedic (p = 0,016, 95% Cl 1,7-139,6) and a good self-assessment value (p = 0,003, 95% Cl 1,2-2,7) were related to making a correct diagnosis.

Conclusions: Paramedics are able to determine preliminary diagnoses at satisfactory level. The relationship between educational background and diagnostic accuracy suggests that there is a definitive need for a specific pre-hospital nursing education.
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http://dx.doi.org/10.1186/s13049-020-00761-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7376915PMC
July 2020

Exploring Unsupervised Query Paraphrasing to Identify Relevant Search Phrases for a Literature Review.

Stud Health Technol Inform 2020 Jun;272:429-432

Department of Future Technologies, University of Turku, Turku, Finland.

Literature databases have multifaceted search options, but emerging research areas do not have an established terminology and therefore it is difficult to find relevant literature when conducting a review. This study aimed to explore if an unsupervised paraphrasing approach is useful in identifying relevant search phrases for a literature review on an emerging research topic - situational leadership in critical care. Using an initial set of 12 search phrases, the system was used to propose additional phrases, which were manually classified and further used in an expanded PubMed database search. Finally, we assessed the papers found with the expanded search and compared this to the initial search results. As a result, the expanded search more than tripled the search results, from 182 to 673 papers. The expanded search also more than tripled the number of relevant papers, from 12 in the original search to 39 in the expanded search.
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http://dx.doi.org/10.3233/SHTI200587DOI Listing
June 2020

An observational study of technical and non-technical skills in advanced life support in the clinical setting.

Resuscitation 2020 08 16;153:162-168. Epub 2020 Jun 16.

Department of Anaesthesiology and Intensive Care, University of Turku, P.O. Box 51, Kiinamyllynkatu 4-8, FI-20521, Turku, Finland; Division of Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital, P.O. Box 52, FI-20521 Turku, Finland.

Objective: Technical skills (TS) and non-technical skills (NTS) are the primary elements ensuring patient safety during advanced life support (ALS) and effective crisis resource management (CRM). Both skills are needed to perform high-quality ALS, though they are traditionally practiced separately. The evidence of the association between NTS and TS in high-quality ALS performance is insufficient. Hence, we aimed to evaluate the association between the skills in real-life in-hospital ALS situations.

Methods: We video recorded real-life in-hospital ALS situations, analyzed TS and NTS demonstrated in them with an instrument measuring TS and NTS, and tested the linear association between NTS and TS using a linear mixed model.

Results: Among 50 real-life in-hospital ALS situations that we recorded, 20 had adequate data for analysis. NTS and TS total scores were associated with one another (slope 0.48, P < 0.001). All NTS subcategories were associated with the TS total score (slopes ranging from 0.29 to 0.39, P < 0.001). The NTS total score and TS subcategories (chest compression quality, ventilation quality, rhythm control and defibrillation quality) were associated with one another (slopes ranging from 0.37 to 0.56, P < 0.01).

Conclusions: The resuscitation teams who demonstrated good NTS also performed the technical aspects of ALS better. The results suggest that NTS and TS have an association with one another in real-life in-hospital ALS situations. NTS performance had the most evident association with chest compression quality and rhythm control and defibrillation quality; these are considered the most crucial elements affecting outcomes of ALS. The findings of the study present novel information of what and why to emphasize in ALS training.

Clinical Trial Registration: ClinicalTrials.gov, NCT03017144.
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http://dx.doi.org/10.1016/j.resuscitation.2020.06.010DOI Listing
August 2020

Two cases of low birth weight infant survival by prehospital emergency hysterotomy.

Scand J Trauma Resusc Emerg Med 2017 Jul 3;25(1):62. Epub 2017 Jul 3.

Division of Perioperative Services, Intensive Care Medicine and Pain Management and Department of Anaesthesiology and Intensive Care, University of Turku and Turku University Hospital, Turku, Finland.

Background: During maternal cardiac arrest, emergency hysterotomy (EH) is recommended after four minutes of resuscitation, if no signs of spontaneous circulation are detected. This extreme procedure is believed to be potentially beneficial for both the mother and the infant. Both maternal and neonatal survivals seem to be associated to the time delay between the cardiac arrest and the delivery and in-hospital resuscitation location. In addition to this, gestational age is an important determinant to neonatal outcome.

Case Presentation: We report two emergency hysterotomies executed in an out-of-hospital location. The infants delivered by EH were low birth weight infants and born 20-23 min after maternal cardiac arrest. Both infants survived and had normal physical and neurological growth at the age of two years. Unfortunately, mothers in these both cases died in the field.

Conclusion: Contrary to earlier beliefs, it is possible to perform a successful EH also in out-of-hospital setting, even with incomplete surgical skills. However, training and preparation are extremely important for achieving the highest possible readiness to treat maternal cardiac arrest situations also prehospitally.
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http://dx.doi.org/10.1186/s13049-017-0407-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5496320PMC
July 2017

Hemoglobin expression in rat experimental granulation tissue.

J Mol Cell Biol 2011 Jun 8;3(3):190-6. Epub 2010 Nov 8.

Department of Medical Biochemistry and Genetics, University of Turku, Turku, Finland.

The general opinion that hemoglobin is only a carrier protein for oxygen and carbon dioxide has been challenged by several recent studies showing hemoglobin expression in other cells than those of the erythroid series, for example, in macrophages. We discovered β-globin expression in rat experimental granulation tissue induced by subcutaneously implanted cellulose sponges. Closer investigation revealed also α-globin expression. The first peak of the biphasic globin expression noticed during granulation tissue formation correlated with the invasion of monocytes/macrophages, whereas the second one seemed to be connected to the appearance of hematopoietic progenitors. Data presented in this study indicate globin expression both in macrophages and in immature erythroid cells as validated by erythroid-specific markers.
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http://dx.doi.org/10.1093/jmcb/mjq036DOI Listing
June 2011

Hydroxyapatite coating of cellulose sponges attracts bone-marrow-derived stem cells in rat subcutaneous tissue.

J R Soc Interface 2009 Oct 11;6(39):873-80. Epub 2009 Mar 11.

Department of Medical Biochemistry and Genetics, University of Turku, Kiinamyllynkatu 10, Turku, Finland.

The presence of bone-marrow-derived stem cells was investigated in a wound-healing model where subcutaneously implanted cellulose sponges were used to induce granulation tissue formation. When cellulose was coated with hydroxyapatite (HA), the sponges attracted circulating haemopoietic and mesenchymal progenitor cells more efficiently than uncoated cellulose. We hypothesized that the giant cells/macrophages of HA-coated sponges recognize HA as foreign material, phagocyte or hydrolyse it and release calcium ions, which are recognized by the calcium-sensing receptors (CaRs) expressed on many cells including haemopoietic progenitors. Our results showed, indeed, that the HA-coated sponges contained more CaR-positive cells than untreated sponges. The stem cells are, most probably, responsible for the richly vascularized granulation tissue formed in HA-coated sponges. This cell-guiding property of HA-coated cellulose might be useful in clinical situations involving impaired wound repair.
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http://dx.doi.org/10.1098/rsif.2009.0020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2838357PMC
October 2009

Bioactive glass-derived hydroxyapatite-coating promotes granulation tissue growth in subcutaneous cellulose implants in rats.

Acta Biomater 2008 Mar 28;4(2):354-61. Epub 2007 Jul 28.

Departments of Medical Biochemistry and Molecular Biology, University of Turku, Kiinamyllynkatu 10, FIN-20520 Turku, Finland.

Granulation tissue was induced in hydroxyapatite-coated cellulose sponges with subcutaneous implantation in rats. A massive inflammatory reaction with an intense foreign body reaction and an increased invasion of fibrovascular tissue was observed by days 1-3 post-operation, whereas tissue growth into the uncoated control implants was much slower and took place mainly on their surfaces. The foreign body reaction in apatite-coated sponges declined after post-operative day 14, and no obvious differences were seen between the two cellulose sponges from 1 month up to 1 year after implantation. The apatite-coated implants attracted macrophages and fibroblasts, and favored angiogenesis. The excessive connective tissue formation was histologically normal, synthesized the major extracellular matrix molecules in a normal ratio and did not seem to disturb the animals in any way. These results warrant further investigations on clinical applicability of hydroxyapatite-coated cellulose sponges, when fast proliferation of connective tissue is desirable.
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http://dx.doi.org/10.1016/j.actbio.2007.07.005DOI Listing
March 2008

Hydroxyapatite coating of cellulose sponge does not improve its osteogenic potency in rat bone.

Acta Biomater 2005 Sep 15;1(5):535-44. Epub 2005 Jul 15.

Department of Medical Biochemistry and Molecular Biology, University of Turku, Kiinamyllynkatu 10, FIN-20520 Turku, Finland.

Regenerated cellulose sponges were coated biomimetically with hydroxyapatite to increase their osteogenic properties. Induction of apatite precipitation was carried out with bioactive glass in simulated body fluid (SBF) for 24 h and the final coating was carried out in 1.5 x concentrated SBF for 14 days. Biomimetically mineralized and non-mineralized sponges were then implanted into standard size femoral cortical defects of rats, and the invasion of bone into the implant was followed up to one year. The apatite coating did not improve the osteoconductive property of cellulose in this rat cortical defect model. In fact, it generated a strong and highly cellular inflammatory reaction and less osteoid tissue. The biomimetic implants contained more immunodetectable TGFbeta1 (a strong stimulator of fibroblast activity) than untreated implants, and also bound more TGFbeta1 in vitro, which could, at least in part, explain the fibrotic invasion of biomimetically mineralized sponges.
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http://dx.doi.org/10.1016/j.actbio.2005.05.003DOI Listing
September 2005