Duodecim; lääketieteellinen aikakauskirja
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The recommendation to discharge low-risk pulmonary embolism patients from or after a brief monitoring in the emergency department has not been widely adopted in Finland. ⋯ A significant proportion of patients with pulmonary embolism can be treated on the outpatient basis.
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Practice Guideline
[Update on current care guidelines. The tendon disorders of the shoulder].
Degenerative rotator cuff tendon disease (tendinopathy) is the most common disorder of the shoulder. A full-thickness tear of the rotator cuff may be caused by degeneration, or it may develop due to an acute trauma. The typical symptoms include pain and functional deficiencies. ⋯ The primary radiologic imaging is x-ray. Degenerative tendon diseases are primarily treated conservatively in primary health care, the most important treatment modality is physiotherapy-guided therapeutic rehabilitation. Surgical treatment is considered in full-thickness rotator cuff tears, especially after traumatic onset.
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Key findings and recommendations from a study comparing clinical research regulation in Finland with those in England, Canada (Ontario) and USA are presented. Data were collected with various methods, including interviewing key experts. ⋯ Research ethics committees (REC) were crucial, as well as drug authorities in research with drugs. Recommendations include reforming the medical research law, widening the dimensions of ethics judgment, restricting the REC tasks, including a central committee, and introducing quality assurance and restricting the drug control authority tasks.
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Modern methods of brain imaging have enabled objective measurements of functional and structural brain changes associated with chronic pain conditions. According to recent investigations, chronic pain is not only associated with abnormally strong or prolonged activity of regions processing acute pain, but also with activation of brain networks that are characteristic for each pain state, changes in cortical remodeling, as well as local reduction of grey matter in several regions of the brain. Brain changes associated with chronic pain facilitate the understanding of mechanisms of various chronic pain conditions.
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Acute respiratory failure is the most common organ failure leading to need of intensive care. The incidence of acute respiratory failure in adult population is 78-89/100000/year and mortality is 35-40 %. ⋯ However, the evidence of NIV's effect on mortality in more heterogenous group of hypoxemic patients is scarce. Key recommendations conserning invasive ventilation is to avoid tidal volumes over 7 ml/bodyweight and to use at least 5 cm H2O of PEEP.