[Update on Current Care Guideline. Diabetes]. / Diabetes.

About 500,000 people suffer from diabetes in Finland, a number which is predicted to increase within the next decades. At the moment, diabetes can neither be prevented nor cured. Diabetes is associated with microvascular (kidney, eye and peripheral nerves) and macrovascular complications (coronary heart disease, stroke). These complications affect the quality of life of patients and account for a substantial proportion of healthcare costs in Finland. The.current guidelines offer recommendations for the diagnosis, screening, prevention and treatment of diabetes and its complications.

Finnish guidelines for the treatment of community-acquired pneumonia and pertussis in children.

UNLABELLED: Evidence-based guidelines are needed to harmonise and improve the diagnostics and treatment of children's lower respiratory tract infections. Following a professional literature search, an interdisciplinary working group evaluated and graded the available evidence and constructed guidelines for the treatment of community-acquired pneumonia and pertussis. CONCLUSION: The clinical guidelines state that chest radiography is not needed if the child is diagnosed with pneumonia and treated at home. Complications should be considered if there is no improvement after antimicrobial therapy and a paroxysmal cough can indicate pertussis, which is life-threatening in unvaccinated infants and can lead to respiratory failure.

Finnish guidelines for the treatment of laryngitis, wheezing bronchitis and bronchiolitis in children.

UNLABELLED: Evidence-based guidelines are needed to harmonise and improve the diagnostics and treatment of children's lower respiratory tract infections. Following a professional literature search, an interdisciplinary working group evaluated and graded the available evidence and constructed guidelines for treating laryngitis, bronchitis, wheezing bronchitis and bronchiolitis. CONCLUSION: Currently available drugs were not effective in relieving cough symptoms. Salbutamol inhalations could relieve the symptoms of wheezing bronchitis and should be administered via a holding chamber. Nebulised adrenaline or inhaled or oral glucocorticoids did not reduce hospitalisation rates or relieve symptoms in infants with bronchiolitis and should not be routinely used.

[Practices for hospital discharge of patients with pulmonary embolism in university and central hospital emergency call services]. / Muuttaisiko riskiluokituksen käyttö kotiutuskäytäntöä? Keuhkoemboliapotilaan kotiutuskäytännöt yliopisto- ja keskussairaalapäivystyksessä.

INTRODUCTION: 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. METHODS: We explored the practices for examination and treatment of patients with pulmonary embolism in a university hospital and a central hospital. An assessment was made on how these practices followed the risk classifications. RESULTS: A very small proportion (3.9%) of the patients were discharged directly from the emergency department. According to the risk classifications, the proportion of patients suited for home care would have been between 30 and 60%. CONCLUSIONS: A significant proportion of patients with pulmonary embolism can be treated on the outpatient basis.

[Update on Current Care Guidelines. Current Care Guideline: Stable Coronary Artery Disease]. / Kaypa Hoite-Suosituksen Paivitystiivistelma. Stabiili sepelvaltimotauti.

This guideline covers coronary heart disease symptoms, diagnosis and treatment. Stable coronary heart disease refers to a disease in, which patients have stable symptoms and evidence of ischemia or significant stenosis of coronary artery. Diagnosis is based on medical history and exercise test, which is the primary diagnostic test. Coronary angiography is in selected cases necessary to confirm the diagnosis and assess invasive treatment. Pharmacotherapy aims to improve the survival of the patient, relieve symptoms and improve quality of life. The guideline also deals with invasive treatment either with PCI or CABG.

[Update on current care guidelines. Current care guideline: Acute lower respiratory tract infection in adults]. / Kaypa hoite-suosituksen paivitystiivistelma. Alahengitystieinfektiot (aikuiset).

Pneumonia is recognised in patients suffering from acute cough or deteriorated general condition. Patients with acute cough without pneumonia-related symptoms or clinical findings do not benefit from antimicrobial treatment. Those with suspected or confirmed pneumonia are treated with antibiotics, amoxicillin being the first choice. Most patients with pneumonia can be treated at home. Those with severe symptoms are referred to hospital. Patients are always encouraged to contact his/her physician if the symptoms worsen or do not ameliorate within 2-3 days. Patients aged 50 years or older and smokers are controlled by thoracic radiography in 6-8 weeks.

Diagnosis and pharmacotherapy of stable chronic obstructive pulmonary disease: the finnish guidelines.

The Finnish Medical Society Duodecim initiated and managed the update of the Finnish national guideline for chronic obstructive pulmonary disease (COPD). The Finnish COPD guideline was revised to acknowledge the progress in diagnosis and management of COPD. This Finnish COPD guideline in English language is a part of the original guideline and focuses on the diagnosis, assessment and pharmacotherapy of stable COPD. It is intended to be used mainly in primary health care but not forgetting respiratory specialists and other healthcare workers. The new recommendations and statements are based on the best evidence available from the medical literature, other published national guidelines and the GOLD (Global Initiative for Chronic Obstructive Lung Disease) report. This guideline introduces the diagnostic approach, differential diagnostics towards asthma, assessment and treatment strategy to control symptoms and to prevent exacerbations. The pharmacotherapy is based on the symptoms and a clinical phenotype of the individual patient. The guideline defines three clinically relevant phenotypes including the low and high exacerbation risk phenotypes and the neglected asthma-COPD overlap syndrome (ACOS). These clinical phenotypes can help clinicians to identify patients that respond to specific pharmacological interventions. For the low exacerbation risk phenotype, pharmacotherapy with short-acting ß2 -agonists (salbutamol, terbutaline) or anticholinergics (ipratropium) or their combination (fenoterol-ipratropium) is recommended in patients with less symptoms. If short-acting bronchodilators are not enough to control symptoms, a long-acting ß2 -agonist (formoterol, indacaterol, olodaterol or salmeterol) or a long-acting anticholinergic (muscarinic receptor antagonists; aclidinium, glycopyrronium, tiotropium, umeclidinium) or their combination is recommended. For the high exacerbation risk phenotype, pharmacotherapy with a long-acting anticholinergic or a fixed combination of an inhaled glucocorticoid and a long-acting ß2 -agonist (budesonide-formoterol, beclomethasone dipropionate-formoterol, fluticasone propionate-salmeterol or fluticasone furoate-vilanterol) is recommended as a first choice. Other treatment options for this phenotype include combination of long-acting bronchodilators given from separate inhalers or as a fixed combination (glycopyrronium-indacaterol or umeclidinium-vilanterol) or a triple combination of an inhaled glucocorticoid, a long-acting ß2 -agonist and a long-acting anticholinergic. If the patient has severe-to-very severe COPD (FEV1  < 50% predicted), chronic bronchitis and frequent exacerbations despite long-acting bronchodilators, the pharmacotherapy may include also roflumilast. ACOS is a phenotype of COPD in which there are features that comply with both asthma and COPD. Patients belonging to this phenotype have usually been excluded from studies evaluating the effects of drugs both in asthma and in COPD. Thus, evidence-based recommendation of treatment cannot be given. The treatment should cover both diseases. Generally, the therapy should include at least inhaled glucocorticoids (beclomethasone dipropionate, budesonide, ciclesonide, fluticasone furoate, fluticasone propionate or mometasone) combined with a long-acting bronchodilator (ß2 -agonist or anticholinergic or both).

[Update on current care guideline: chronic obstructive pulmonary disease (COPD)]. / Keuhkoahtaumatauti.

Clinical serverity of COPD is based not only on the grade of obstruction in spirometry, but also on symptoms and risk of exacerbations. Symptoms can be defined by questionnaires, such as CAT-test (COPD assessment -test) or mMRC (modified Medical Research Council -test). Smoking cessation and physical activity are important treatment options. Pharmacological treatment is selected by symptoms, risk of exacerbations and co-occurrence of asthma and COPD. Non-invasive ventilation (NIV) is recommended in the treatment of severe hypercapnic exacerbations. Palliative treatment of end stage COPD is included in the guidelines.