Team players and helpers - describing professional identity among finnish physicians in a cross-sectional study.

BACKGROUND: Every physician has a unique professional identity. However, little is known about the diversity of identities among physicians. This study aimed to quantitatively assess the professional identity of physicians in Finland using descriptions of professional identity. METHODS: This study was part of a larger cross-sectional Finnish Physician 2018 Study. The target population consisted of all Finnish physicians under the age of 70 (N = 24,827) in 2018. The sample was drawn from physicians born on even numbered days (N = 11,336) using the Finnish Medical Association register. A total of 5,187 (46%) physicians responded. Professional identity was examined by 27 given characterisations using a five-point Likert scale. Multivariate logistic regression was used in assessing how place of work, graduation year and gender were associated with identity descriptions. RESULTS: The descriptions which most physicians identified with were "member of a working group/team" (82%), "helper" (82%), and "health expert" (79%); the majority reported these as describing them very or quite well. Identity descriptions such as "prescriber of medications" (68% vs. 45%), "prioritiser" (57% vs. 35%) and "someone issuing certificates" (52% vs. 32%) were more popular among junior than senior physicians. The biggest differences between the genders were found in the descriptions "provider of comfort" (62% vs. 40%) and "someone engaged in social work" (45% vs. 25%), with which women identified more frequently than men. CONCLUSIONS: Strong identification as a member of a team is an important finding in the increasingly multiprofessional world of health care. Importantly, most physicians shared several core professional identity descriptions (i.e., helper, health expert) that reflect the traditional image of an exemplary doctor.

Self-reported skills and self-confidence in point-of-care ultrasound: a cross-sectional nationwide survey amongst Finnish emergency physicians.

BACKGROUND: The use of point-of-care ultrasound (POCUS) is increasing. Numerous investigators have evaluated the learning curves in POCUS, but there are no published studies on how emergency physicians perceive their own competence level with this skill. METHODS: A nationwide survey amongst Finnish emergency physicians was conducted. The respondents reported their use of POCUS and how it has affected their clinical decision-making. The number of POCUS examinations performed was compared to the self-assessed skill level with different applications. Cut-off values were determined for the number of examinations required to acquire a good self-assessed skill level in each POCUS application. The correlation between self-confidence and the self-estimated skill level was analyzed. Several different statistical methods were used, such as Student's t-test, Pearson's correlation test, Loess method and ROC curve analysis. RESULTS: A total of 134 out of 253 Finnish emergency medicine specialists and residents (52%) responded to the survey. The most commonly used POCUS applications were POCUS-assisted procedures, pleural effusion and pneumothorax, inferior vena cava and lower extremity deep venous thrombosis. The initial rate of perceived skill acquisition was very steep with the curve flattening with greater skill and more experience. The number of examinations performed to reach a self-assessed good competence varied from seven to 75 with different applications. The lowest cut-off point for self-assessed good competence was obtained for rapid ultrasound for the shock and hypotension-protocol and the highest for focused cardiac examinations. There was an excellent correlation between self-confidence and the self-assessed skill level. CONCLUSIONS: The Finnish emergency practitioners' self-assessed development of POCUS skills parallels the previously published learning curves of POCUS. The correlation of self-confidence and the self-assessed skill level was found to be excellent. These findings add information on the development of perceived POCUS skills amongst emergency physicians and could complement a formal performance assessment.

What predicts doctors' satisfaction with their chosen medical specialty? A Finnish national study.

BACKGROUND: In Finland the number of medical specialists varies between specialties and regions. More regulation of the post-graduate medical training is planned. Therefore, it is important to clarify what predicts doctors' satisfaction with their chosen specialty. METHODS: A random sample contained 50% of all Finnish doctors under 70 years of age. The respose rate was 50.5%. Working-age specialists were asked to value their motives when choosing a specialty. They were also asked if they would choose the same specialty again. The odds ratios for not choosing the same specialty again were tested. RESULTS: Diversity of work was the most important motive (74% of respondents). Seventeen percent of GPs would not choose the same specialty again, compared to 2% of ophthalmologists and 4% of pediatricians. A major role of Diversity of work and Prestigious field correlated with satisfaction whereas Chance with dissatisfaction with the specialty. DISCUSSION: Motives and issues related to the work and training best correlate with satisfaction with the specialty. CONCLUSIONS: When the numbers of Finnish postgraduate medical training posts become regulated, a renewed focus should be given to finding the most suitable speciality for each doctor. Information about employment and career advice should play an important role in this.

Modern emergency care is aimed at a safe and quick discharge of the patient.

In Finland, there has been a need to develop emergency care in the past years because of the government's statutes and the need to meet the international standards. Emergency medicine as a newcomer specialty has encouraged the process. Emergency physicians are expected to take more responsibility of patient flow and treatment in the emergency departments (ED). The observation unit is an important part of the ED. It allows patients to be treated on a short-term basis, and patient care is efficient due to the close communication between specialties. Patient selection is in the essence of a well-functioning observation ward.

Factors important in the choice of a medical career: a Finnish national study.

BACKGROUND: Applying for medical school is the first and also one of the most important career choices a physician makes. It is important to understand the reasons behind this decision if we are to choose the best applicants for medical schools and enable them to pursue satisfying careers. METHODS: Respondents to the Finnish Junior Physician 88, Physician 1998 and Physician 2008 studies were asked: "To what extent did the following factors influence your decision to apply for medical school?" In 1998 and 2008 the respondents were also asked: "If you were starting your studies now, would you start studying medicine?" and had to answer "Yes" or "No". The odds ratios for the answer "No" were tested using logistic regression models. RESULTS: "Interest in people" was the main motive for starting to study medicine. "Good salary" and "Prestigious profession" were more important motives for males and "Vocation" and "Interest in people" for females. There were some significant changes in the motives for entering medicine in the 20-year period between studies. "Vocation" and "Wide range of professional opportunities" as important motives for entering medicine predicted satisfaction with the medical profession. DISCUSSION: Strong inner motivation may indicate the ability to adapt to the demands of work as a physician. CONCLUSIONS: Medical schools should try to select those applicants with the greatest vocational inclination towards a medical career.

Where have all the GPs gone--where will they go? Study of Finnish GPs.

BACKGROUND: In this paper a specialist in general practice is referred to as a general practitioner (GP). In Finland only half of all GPs work as a health centre physician. The present aim was to establish what the working places of specializing and specialized physicians in general practice are, and where they assume they will work in the future. METHODS: The study population comprised 5,357 physicians licensed in Finland during the years 1977-1996. Altogether 2,956 questionnaires were returned, a response rate of 55.2%. Those either specializing (GP trainees, n=133) or already having specialized (GPs, n=426) in general practice were included in the study. Respondents were asked what kind of physician's work they would most preferably do. They were further asked what work they assumed they would be doing in the year 2020. RESULTS: Altogether 72% were working in public primary health centres and 14% in the private sector. Of GPs 53% and of GP trainees 70% would most preferably work in health centres. Of GPs 14% would most preferably work as private practitioners and 9% as occupational health physicians. Sixteen per cent assumed they would be working as private practitioners and 35% assumed they would be retired in the year 2020. Of GP trainees 57% assumed they would be working as health centre physicians in 2020. CONCLUSIONS: According to the present findings many experienced GPs will leave their work as a health centre physician. Moreover, several GP trainees do not consider health centre physician's work as a long-term career option. These trends may in the future reflect a recruiting problem in many primary health centres.

Soluble Urokinase Plasminogen Activator Receptor (suPAR) in the Emergency Department (Ed): A Tool for the Assessment of Elderly Patients.

Emergency department (ED) overcrowding is a global issue setting challenges to all care providers. Elderly patients are frequent visitors of the ED and their risk stratification is demanding due to insufficient assessment methods. A prospective cohort study was conducted to determine the risk-predicting value of a prognostic biomarker, soluble urokinase plasminogen activator receptor (suPAR), in the ED, concentrating on elderly patients. SuPAR levels were determined as part of standard blood sampling of 1858 ED patients. The outcomes were assessed in the group of <75 years (=younger) and ≥75 years (=elderly). The elderly had higher median suPAR levels than the younger (5.4 ng/mL vs. 3.7 ng/mL, p < 0.001). Increasing suPAR levels were associated with higher probability for 30-day mortality and hospital admission in all age groups. SuPAR also predicted 30-day mortality when adjusted to other clinical factors. SuPAR acts successfully as a nonspecific risk predictor for 30-day mortality, independently and with other risk-assessment tools. Low suPAR levels predict positive outcomes and could be used in the discharging process. A cut-off value of 4 ng/mL could be used for all ED patients, 5 ng/mL being a potential alternative in elderly patients.

Choosing a medical specialty--study of Finnish doctors graduating in 1977-2006.

BACKGROUND: Choosing a medical specialty is an important element predefining a physician's career and life. Although there has been some research in this area of interest, there has not been much research where the profession has been researched as a whole, or where trend data over different generations has been presented. AIM: The aim of our study was to ascertain the motives affecting physicians' choice of a medical specialty. METHODS: The study cohort comprised random sample of 7758 doctors who were registered in Finland during the years 1977-2006. Altogether 4167 questionnaires were returned, giving a response rate of 54%. An electronic questionnaire was used in data collection, supported by a traditional postal questionnaire. RESULTS: Of the respondents, 76% thought the diversity of the field had affected their choices of specialty considerably or very much. For physicians under 35 years old, especially the good example set by colleagues (48%), and opportunities for career development (39%) were more important motives compared to those of older physicians. CONCLUSIONS: According to this study, diversity of the work is the main motivating factor affecting physicians' choices of specialty. Especially, younger physicians follow the example set by more experienced colleagues.

Cost-minimization modeling of venous thromboembolism diagnostics: performing limited compression ultrasound in primary health care reduces costs compared to referring patients to a hospital.

BACKGROUND: The aim of this retrospective study was to determine whether diagnosing a deep venous thrombosis (DVT) in primary health care using limited compression ultrasound (LCUS) can save resources compared to referring these patients to hospital. According to the current literature, LCUS is as safe as a standard protocol based on a whole-leg ultrasound (US). METHODS: We created a standardized patient for this cost-analysis model based on 76 patients that were referred to hospital for a suspected DVT. Travel distance to the health care centre and hospital was calculated based on the home address. Hospital costs were acquired from the hospital price list and Finnish legislation. Time spent in the hospital was retrieved from hospital statistics. Time spent in the health care centre and travelling were estimated and monetized based on average salary. The cost of participating physicians attending a US training course was estimated based on the national average salary of a general practitioner as well as the course participation fee. A cost-minimization modeling was performed for this standardized patient comparing the total costs, including private and public costs, of standard and LCUS strategies. RESULTS: The total costs per patient of standard and LCUS pathways were 1151.52€ and 301.94€ [difference 849.59€ (95% CI 800.21€-898.97€, p < 0.001)], respectively. The real-life costs of these strategies, considering that some patients are probably referred to hospital every year and including training costs, are 1151.53€ and 508.69€ [difference 642.84€ (95% CI 541.85€-743.82€)], respectively. CONCLUSION: Using LCUS in diagnosing DVT in primary health care instead of referring these patients to the hospital is shown to save a significant amount of public and private resources.

Teaching limited compression ultrasound to general practitioners reduces referrals of suspected DVT to a hospital: a retrospective cross-sectional study.

BACKGROUND: The aim of this study was to retrospectively determine whether teaching limited compression ultrasound (LCUS) to general practitioners (GP) would reduce the number of patients with a suspected lower extremity DVT referred to a hospital for ultrasound (US) examination. According to the current literature, an LCUS protocol is a safe way to diagnose or exclude lower extremity deep venous thrombosis (DVT) and a good option to radiologist-performed whole-leg ultrasound (US), especially in remote health care units where there may be a limited availability of radiological services. METHODS: Between 2015 and 2016, altogether 13 GPs working in the same primary care unit were trained in LCUS for DVT diagnostics. The number of annual referrals due to a suspected DVT from Saarikka primary care unit to the closest hospital was evaluated before and after training. The incidence of DVT was considered to be constant. Thus, the reduction of referrals was attributed to the fact that these patients were diagnosed and treated in primary health care. Incidence rate ratio of hospital referrals was calculated. As a measure of safety, all patients diagnosed with a pulmonary embolism in the nearest hospital were evaluated to determine if they had undergone LCUS by a GP in primary care. RESULTS: Before training in 2014, there were 60 annual referrals due to a suspected DVT; in 2017, after training, the number was reduced to 16, i.e., a 73.3% decrease. The incidence of referrals decreased from 3.21 to 0.89 per 1000 person-years. (IRR 3.58, 95% CI 2.04-6.66, p < 0.001). No patient with a pulmonary embolism diagnosis had LCUS performed previously, indicating that there were no false negatives, resulting in pulmonary embolism. CONCLUSIONS: Teaching LCUS to GPs can safely reduce the number of patients with a suspected DVT referred to a hospital substantially.

Status epilepticus: Practice variation and adherence to treatment guideline in a large community hospital.

PURPOSE: To evaluate the treatment of status epilepticus (SE) and adherence to treatment guideline in a large Finnish community hospital. MATERIALS AND METHODS: A consecutive series of 137 patients treated in the emergency department of Kuopio University Hospital. Enrollment took place between March 23 and December 31, 2015. Pediatric patients and postanoxic seizures were excluded. The Finnish Status Epilepticus Current Care Guideline was used as the evaluation benchmark. RESULTS: Seventeen patients recovered spontaneously. First-line treatment was given to 108 patients with 35.2% efficacy. Second-line treatment was given to 81 patients with 87.7% efficacy. Six patients with refractory SE received successful third-line treatment and four were excluded from intensive care because of futility. The starting dose of a first-line drug was lower than the lowest therapeutic dose in 37.0% of the patients. The escalation from first- to second-line treatment took longer than 60 min in 55.1% of the 70 patients who received both treatments. The first loading dose of a second-line drug was markedly low (<80% of the recommended dose) in 26.2% of the 81 patients treated with second-line drugs. CONCLUSIONS: Prompt and effective pharmacotherapy is the cornerstone of good SE treatment. Subtherapeutic doses of first-line benzodiazepines should be avoided. Benzodiazepine-resistant SE must be recognized early to facilitate rapid treatment escalation. The quality of second-line treatment suffers from excessive delays and inadequate weight-based dosing of antiseizure medications.

suPAR Cut-Offs for Risk Stratification in Patients With Symptoms of COVID-19.

OBJECTIVES: Elevated soluble urokinase Plasminogen Activator Receptor (suPAR) is a biomarker associated with adverse outcomes. We aimed to investigate the associations between plasma suPAR levels (testing the cut-offs ⩽4, 4-6, and ⩾6 ng/mL) with risk of 14-day mortality, and with the risk of mechanical ventilation in patients that tested positive for SARS-CoV-2. METHODS: Observational cohort study of patients presenting with symptoms of COVID-19 at Department of Emergency Medicine, Amager and Hvidovre Hospital, Denmark from March 19th, 2020 to April 3rd, 2020. Plasma suPAR was measured using suPARnostic technologies. Patients were followed for development of mechanical ventilation and mortality for 14 days. Validation of our findings were carried out in a similar sized COVID-19 patient cohort from Mikkeli Central Hospital, Finland. RESULTS: Among 386 patients with symptoms of COVID-19, the median (interquartile range) age was 64 years (46-77), 57% were women, median suPAR was 4.0 ng/mL (2.7-5.9). In total, 35 patients (9.1%) died during the 14 days follow-up. Patients with suPAR ⩽4 ng/mL (N = 196; 50.8%) had a low risk of mortality (N = 2; 1.0%; negative predictive value of 99.0%, specificity 55.3%, sensitivity 95.2%, positive predictive value 17.4%). Among patients with suPAR ⩾6 ng/mL (N = 92; 23.8%), 16 died (17.4%). About 99 patients (25.6%) tested positive for SARS CoV-2 and of those 12 (12.1%) developed need for mechanical ventilation. None of the SARS-CoV-2 positive patients with suPAR ⩽4 ng/mL (N = 28; 38.8%) needed mechanical ventilation or died. The Mikkeli Central Hospital validation cohort confirmed our findings concerning suPAR cut-offs for risk of development of mechanical ventilation and mortality. CONCLUSIONS: Patients with symptoms of COVID-19 and suPAR ⩽4 or ⩾6 ng/mL had low or high risk, respectively, concerning the need for mechanical ventilation or mortality. We suggest cut-offs for identification of risk groups in patients presenting to the ED with symptoms of or confirmed COVID-19.

Outcome of status epilepticus and the predictive value of the EMSE and STESS scores: A prospective study.

PURPOSE: To assess the short-term outcome of status epilepticus (SE) and test the Epidemiology-based Mortality score in Status Epilepticus (EMSE) and the Status Epilepticus Severity Score (STESS) performance in outcome prediction. METHODS: Consecutive adults with SE in the Kuopio University Hospital emergency department were recruited between March 23 and December 31, 2015. The one-month outcome was assessed by a combined phone interview and medical record review using the Glasgow Outcome Scale-Extended. The prognostic performance of the EMSE-EAC (EMSE using the combination of etiology, age and comorbidity) and STESS were statistically evaluated. RESULTS: We recorded 151 SE episodes in 137 patients, of whom 47 had a first-time epileptic event (seizure or SE). Of the SE episodes, 9.0% resulted in death, 31.6% in functional decline. For mortality prediction, the AUCs of the EMSE-EAC and STESS were 0.790 (95% CI: 0.633-0.947) and 0.736 (95% CI: 0.559-0.914), respectively. The optimal cutoff points were ≥ 34 for the EMSE-EAC and ≥ 4 for STESS. Negative predictive values for mortality using the EMSE-EAC-34 and STESS-4 were 97.5% and 96.7%, respectively. For functional decline prediction, the EMSE-EAC yielded statistically insignificant results, the STESS performance was poor (AUC = 0.621, 95% CI: 0.519-0.724). CONCLUSIONS: Over 40% of SE patients suffer adverse outcomes. The EMSE-EAC and STESS are useful in short-term mortality prediction, with a high negative predictive value. The optimized cutoff points for the EMSE-EAC and STESS were ≥ 34 and ≥ 4 for cohort, respectively.

Intravenous vernakalant in comparison with intravenous flecainide in the cardioversion of recent-onset atrial fibrillation.

BACKGROUND:: Pharmacological cardioversion of atrial fibrillation is a reasonable alternative for electrical cardioversion in acute atrial fibrillation. We compared the efficacy and safety of intravenous vernakalant and intravenous flecainide in patients with recent-onset (< 48 h) atrial fibrillation. METHODS:: A total of 200 consecutive patients, 100 patients undergoing cardioversion with intravenous vernakalant and 100 patients undergoing cardioversion with intravenous flecainide, were included in this single centre non-randomized retrospective study. The primary endpoint was conversion to sinus rhythm within 120 minutes from the drug administration. RESULTS:: Cardioversion was successful in 67% of patients treated with vernakalant and in 46% of patients treated with flecainide ( p=0.003). Vernakalant (odds ratio 1.99, 95% confidence interval 1.08-3.69, p=0.029) and female gender (odds ratio 2.48, 95% confidence interval 1.22-15.05, p=0.012) were significant predictors of successful cardioversion. The success rate of cardioversion was lowest among men treated with flecainide (36.9%). Patients treated with vernakalant were discharged earlier from the emergency department compared with those treated with flecainide (8.2 ± 4.7 h vs. 12.0 ± 6.0 h, p < 0.001). There was no difference in the complication rate between the groups. Vernakalant treated patients were older (59.3 ± 12.5 vs. 55.4 ± 13.0 years, p=0.03), had higher CHA2DS2-VASc score (1.4 ± 1.3 vs. 0.9 ± 1.2, p = 0.002) and were more often on beta-blocker medication (59% vs. 42%, p= 0.016) than flecainide treated patients. CONCLUSION:: Vernakalant was safe, more effective and faster than flecainide in the cardioversion of recent-onset atrial fibrillation. The difference in efficacy was especially apparent among men.

Treatment delay in status epilepticus - more effective prehospital symptom recognition warranted.

BACKGROUND: The outcome of status epilepticus (SE) can be improved by facilitating early recognition and treatment with antiepileptic drugs. The purpose of this study was to analyze the treatment delay of SE in a prospectively recruited patient cohort. Improvements to the treatment process are suggested. METHODS: Consecutive adult patients with SE were recruited in the emergency department of Kuopio University Hospital (KUH) between March 23 and December 31, 2015. SE was defined as a prolonged (> 5 min) epileptic seizure or recurrent tonic-clonic seizures (≥ 3 seizures within any 24 h). Diagnostic and treatment delays and the features of SE were subject to statistical analysis. RESULTS: We recorded 151 cases of SE during the study period. First-line treatment was initiated outside of hospital in 79 cases (52.3%), with a significantly shorter median delay compared to intrahospital initiation (28 min vs. 2 h 5 min, p < 0.001). Forty-six episodes of SE (30.5%) were not recognized during the prehospital phase. The median delay in recognition of tonic-clonic SE (23 min) was significantly shorter than in focal aware (2 h 0 min, p = 0.045) or focal impaired awareness SE (2 h 25 min, p < 0.001). Second-line treatment was used in 91 cases (60.3%), with a median delay of 2 h 42 min. Anesthesia was used in seven cases (4.6%) with refractory SE, with a median delay of 6 h 40 min. CONCLUSIONS: SE is often not recognized during the prehospital phase of treatment, which delays the initiation of first-line treatment. Intrahospital delay could be reduced by streamlining patient transition between the three lines of treatment.

Use of quality improvement methods in Finnish health centres in 1998 and 2003.

OBJECTIVE: To evaluate how widely quality improvement methods are used in Finnish primary health centres and how the use has changed over five years. DESIGN: Two national cross-sectional postal enquiries. SETTING AND SUBJECTS: The questionnaire in 1998 was sent to every other physician graduated during the years 1977-1986, and the questionnaire in 2003 to every other physician graduated during the years 1982-1991. The response rates were 73.9% and 62.2%. The answers of primary healthcare physicians (n = 503 vs. 344) were analysed. MAIN OUTCOME MEASURES: The availability of 13 quality improvement methods was solicited. The change over five years was analysed. RESULTS: Opportunity to obtain continuing medical education (CME), in-service training, meetings, opportunity to consult a colleague in own speciality, and agreed guidelines on how a certain problem should be solved were highly reported both in 1998 and 2003. The biggest improvement (16.8%) concerned clinical guidelines. There was also progress with regard to quality improvement manuals at the place of work, opportunity to consult a colleague in another speciality, and computer-assisted monitoring of own work. CONCLUSION: Many quality improvement methods were highly reported in both 1998 and 2003 in Finnish health centres. The biggest positive change concerns clinical guidelines.

The role of job satisfaction, job dissatisfaction and demographic factors on physicians' intentions to switch work sector from public to private.

This study is based on a unique data set for the years 1988-2003 and uses structural equation models to examine the impact of job satisfaction and job dissatisfaction on physicians' intention to switch from public- to private-sector work. In Finland, physicians who work primarily in a public-hospital or health-centre setting can also run a private practice. Therefore, we also analysed the impact of having a private practice on a physician's intention to change sector. We found that private practice had a positive, statistically significant effect on the intention to switch sector in 1998 and 2003. Results also suggest that job satisfaction decreases a physician's intention to switch sector, although for 1998 it had no effect. Surprisingly, job dissatisfaction significantly increased the physicians' intentions to leave the public sector only in the 1988 data.

Antiarrhythmic drug therapy among patients presenting to emergency department with symptomatic atrial fibrillation - a prospective nationwide cohort.

BACKGROUND: Atrial fibrillation (AF) is a common arrhythmia that causes numerous visits to emergency departments (ED). The aim of the FinFib2 study was to evaluate whether treatment of patients with AF in ED is consistent with the contemporary European Society of Cardiology (ESC) management guidelines. Here we report the results of antiarrhythmic drug therapy (AAD) in ED. METHODS: All patients within the two-week study period whose primary reason for the ED visit was symptomatic AF were included into this prospective multicentre study. Comprehensive data on factors contributing to the treatment of AF were collected, including a data of previous use of ADDs, and changes made for them during a visit in ED. RESULTS: The study population consisted of 1013 consecutive patients (mean age 70 ± 13 years, 47.6% female). The mean European Heart Rhythm Association (EHRA) symptom score was 2.2 ± 0.8. Rhythm control strategy was opt for 498 (63.8%) and 140 (64.5%) patients with previously and newly diagnosed AF, respectively. In patients with previously diagnosed AF the most frequently used AAD was a beta blocker (80.9%). Prior use of class I (11.4%) and III (9.1%) AADs as well as start or adjustment of their dosage (7.4%) were uncommon. Most of the patients with newly diagnosed AF were prescribed a beta blocker (71.0%) or a calcium channel antagonist (24.0%), and only two of them received class I or class III AADs. CONCLUSIONS: Our data demonstrated that in patients presenting to the ED with recurrent symptomatic AF and aimed for rhythm control strategy, the use of class I and class III AADs was rare despite ESC guideline recommendations. It is possible that early adaptation of a more aggressive rhythm control strategy might improve a quality of life for symptomatic patients and alleviate the ED burden associated with AF. Beta blockers were used by majority of patients as rate control therapy both in rate and rhythm control groups. TRIAL REGISTRATION: NCT01990105 . Registered 15 November 2013.

Factors associated with physicians' choice of working sector: a national longitudinal survey in Finland.

OBJECTIVE: To analyse factors affecting physicians' choice to work in either the public or the private sector. METHOD: We undertook a longitudinal data analysis in the years 1988, 1993, 1998 and 2003 (n = 12 909) using a multilevel modelling technique. Factors related to economic factors, physician identity, appreciation as well as demographic factors were hypothesised to influence sector choice. RESULTS: Physicians seem to make their career choices prior to graduation, at least to some extent. Wage levels, the physician's personal characteristics and whether or not the physician knew his or her place of work before graduation were the key factors affecting the decision-making process in the years 1988, 1993, 1998 and 2003. Physicians for whom wages were important were less likely to choose the public sector. Also, physicians who regarded themselves as entrepreneurial preferred to work in the private sector. If a physician had worked in the public sector during his or her medical training before graduation, the probability of applying for a vacancy in the public sector was higher. CONCLUSION: It is not only economic factors, such as salary, that are involved in the physician's decision to choose the working sector.

The non-clinical contents of GP training need more attention. Results from the Finnish Physician Study.

BACKGROUND: The competencies required of a GP are complex and ever-expanding. GP training should adequately cover all the content areas. OBJECTIVES: The aim was to assess GPs' and GP trainees' satisfaction with their specialist training and with the contents of training. Trends in assessments over a ten-year period were investigated. METHODS: Data from Finnish national surveys of physicians conducted in 1998, 2003 and 2008 were analysed with 606, 457 and 324 GPs and GP trainees respectively being sampled in the present study. Respondents were asked how satisfied they were with their own specialist training in general, and how much instruction they had received in 12 specific areas during their specialist training. RESULTS: Satisfaction with GP training slowly increased during the study years. In 2008, 59% of respondents were satisfied with their training, compared to 46% in 1998. The best covered content area was clinical work. Major shortcomings were reported in many of the content areas analysed, e.g. management and leadership. CONCLUSION: Although the trend in satisfaction with GP training in Finland is for the better, there are shortcomings, especially in many of the non-clinical content areas of training. More attention needs to be paid to these areas in the future.