Agreement between ambulance nurses and physicians in assessing stroke patients.

OBJECTIVES: If an ambulance nurse could bypass the emergency department (ED) and bring suspected stroke patients directly to a CT scanner, time to thrombolysis could be shortened. This study evaluates the level of agreement between ambulance nurses and emergency physicians in assessing the need for a CT scan, and interventions and monitoring beforehand, in patients with suspected stroke and/or a lowered level of consciousness. METHODS: From October 2008 to June 2009, we compared the ambulance nurses' and ED physicians' judgement of 200 patients with stroke symptoms. Both groups answered identical questions on patients' need for a CT scan, and interventions and monitoring beforehand. RESULTS: There was poor agreement between ambulance nurses and ED physicians in judging the need for a CT scan: κ = 0.22 (95% confidence interval (CI), 0.06-0.37). The nurses' ability to select the same patients as the physician for a CT scan had a sensitivity of 84% (95% CI, 77-89) and a specificity of 37% (95% CI, 23-53). Agreement concerning the need for interventions and monitoring was also low: κ = 0.32 (95% CI, 0.18-0.47). In 18% of cases, the nurses considered interventions before a CT scan unnecessary when the physicians' deemed them necessary. CONCLUSIONS: Additional tools to support ambulance nurses decisions appear to be required before suspected stroke patients can be taken directly to a CT scanner.

Distribution of intrathecal catheter positions in rat.

BACKGROUND: Although drug administration through an intrathecal catheter is widely used in the study of spinal pharmacology, the catheter positions in transverse plane that may cause a limited spread of a solution remain unclear. In the first step to clarify this issue, the distribution of the intrathecal catheter position was investigated in rats. METHODS: A polyethylene catheter (PE-10) was inserted intrathecally 8.5 cm through the atlanto-occipital membrane, aiming the tip of the catheter to the dorsal surface of the spinal cord. Three or four weeks after the implantation of the catheter, 83 rats were transcardiacally perfused with fixative solution. The catheter positions were investigated longitudinally and transversely by cutting the spinal cord segmentally through the intervertebral disk at different spinal levels. RESULTS: Seventeen rats were excluded from further data analysis. Transversely, catheters were located in the left lateral subarachnoid space in 23 rats (35%), in the right lateral in 15 (23%), in the dorsal in 22 (33%), and in the ventral in 6 (9%). Longitudinally, catheter position was significantly higher in the ventral group (median, T9) than that in the dorsal group (T11/12) (P<0.01). CONCLUSION: Chronic intrathecal catheters were variously located in the rat spinal subarachnoid space in the transverse plane, and lateral subarachnoid placement of the catheter (58%) was frequently observed, whereas dorsal subarachnoid placement occurred in 33%.

Sense of coherence as a predictor of subjective state of health: results of 4 years of follow-up of adults.

UNLABELLED: A number of cross-sectional population studies have shown that a strong sense of coherence (SOC) is associated with various aspects of good perceived health. The association does not seem to be entirely attributable to underlying associations of SOC with other variables, such as age or level of education. OBJECTIVE: The aim of the study reported here was to determine whether SOC predicted subjective state of health. METHODS: The study was carried out as a two-way panel mail survey of 1976 individuals with 4 years interval for two collections of data. The statistical method used was multivariate cumulative logistic modeling. Age, initial subjective state of health, initial occupational training level, and initial degree of social integration were included as potential explanatory variables. RESULTS: A strong SOC predicted good health in women and men. CONCLUSIONS: SOC can be interpreted as an autonomous internal resource contributing to a favorable development of subjective state of health. SOC data should, however, be regarded as complementary to and not a substitute for information already known to be associated with increased risk of future ill health.

Variation in rat sciatic nerve anatomy: implications for a rat model of neuropathic pain.

We discovered a variation of rat sciatic nerve anatomy as an incidental finding during the anatomical exploration of the nerve lesion site in a rat neuropathic pain model. To confirm the composition and distribution of rat sciatic nerve, macroscopic anatomical investigation was performed in both left and right sides in 24 adult Sprague-Dawley rats. In all rats, the L4 and L5 spinal nerves were fused tightly to form the sciatic nerve. However, the L6 spinal nerve did not fuse with this nerve completely as a part of the sciatic nerve, but rather sent a thin branch to it in 13 rats (54%), whereas in the remaining 11 rats (46%), L6 ran separately along with the sciatic nerve. Also, the L3 spinal nerve sent a thin branch to the L4 spinal nerve or sciatic nerve in 6 rats (25%). We conclude that the components of sciatic nerve in Sprague-Dawley rats vary from L3 to L6; however, the major components are L4 and L5 macroscopically. This finding is in contrast to the standard textbooks of rat anatomy which describe the sciatic nerve as having major contributions from L4, L5, and L6.

Orienteering competition injuries: injuries incurred in the Finnish Jukola and Venla relay competitions.

OBJECTIVES: The aim of this study was to find out the amount, type, and localisation of acute orienteering injuries in the 1995 Finnish Jukola (men's) and Venla (women's) relay competitions with 9724 participants. METHODS: Patient data were collected on a preplanned form at the first aid station. RESULTS: There were 244 acute competition injuries. The overall injury incidence was 2.5% (95% confidence interval (CI) 2.2 to 2.8), 2.3% in the men's relay and 3.2% in the women's relay, and the difference between incidences among men and women was statistically significant (odds ratio (OR) 1.4; 95% CI 1.1 to 1.9). The injury rates were also calculated per 1000 competition hours and per 1000 km and were 15.4 and 2.6 respectively. Most of the injuries could be treated at the first aid station. Female orienteers had more blisters (OR 4.4; 95% CI 2.5 to 7.9) and fewer wounds (OR 0.5; 95% CI 0.2 to 1.0) than male orienteers. Injuries occurred mostly in the lower extremities (70%), and ankle sprains accounted for 25% of all injuries. Injuries were more common during the first leg of both relays. CONCLUSIONS: This study shows the heavy workload in a first aid station of a big orienteering relay competition. It indicates a difference in injuries between the sexes and in the different stages of the relay, which should be further investigated in order to prevent orienteering competition injuries.

Finnish recommendation for methods used in urinalysis: results for five-year period.

A recommendation concerning basic urine examinations and bacteriological cultures was published in 1983 in Finland including three clinical indication groups with different screening strategies. Close cooperation between laboratory experts and clinicians as well as much training in urine sediment cytology were essential before the new principle became widely accepted. Decreased workload in laboratories in clinically less significant cases was shown with the use of the full capacity and qualities of complete urinalysis when needed. Standardized test procedures combined with sediment staining improved the clinical efficiency of urine microscopy.