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Changes in attitudes towards hastened death among Finnish physicians over the past sixteen years.

https://arctichealth.org/en/permalink/ahliterature298467
Source
BMC Med Ethics. 2018 05 30; 19(1):40
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
05-30-2018
Author
Reetta P Piili
Riina Metsänoja
Heikki Hinkka
Pirkko-Liisa I Kellokumpu-Lehtinen
Juho T Lehto
Author Affiliation
Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland. piili.reetta.p@student.uta.fi.
Source
BMC Med Ethics. 2018 05 30; 19(1):40
Date
05-30-2018
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adult
Age Factors
Aged
Attitude of Health Personnel
Attitude to Death
Death
Euthanasia
Female
Finland
Humans
Male
Medical Oncology
Middle Aged
Morphine - administration & dosage
Physicians - trends
Religion and Medicine
Resuscitation Orders
Sex Factors
Specialization
Suicide, Assisted
Surveys and Questionnaires
Abstract
The ethics of hastened death are complex. Studies on physicians' opinions about assisted dying (euthanasia or assisted suicide) exist, but changes in physicians' attitudes towards hastened death in clinical decision-making and the background factors explaining this remain unclear. The aim of this study was to explore the changes in these attitudes among Finnish physicians.
A questionnaire including hypothetical patient scenarios was sent to 1182 and 1258 Finnish physicians in 1999 and 2015, respectively. Two scenarios of patients with advanced cancer were presented: one requesting an increase in his morphine dose to a potentially lethal level and another suffering a cardiac arrest. Physicians' attitudes towards assisted death, life values and other background factors were queried as well. The response rate was 56%.
The morphine dose was increased by 25% and 34% of the physicians in 1999 and 2015, respectively (p?
PubMed ID
29843682 View in PubMed
Less detail

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

https://arctichealth.org/en/permalink/ahliterature269327
Source
Basic Clin Pharmacol Toxicol. 2015 Apr;116(4):291-307
Publication Type
Article
Date
Apr-2015
Author
Hannu Kankaanranta
Terttu Harju
Maritta Kilpeläinen
Witold Mazur
Juho T Lehto
Milla Katajisto
Timo Peisa
Tuula Meinander
Lauri Lehtimäki
Source
Basic Clin Pharmacol Toxicol. 2015 Apr;116(4):291-307
Date
Apr-2015
Language
English
Publication Type
Article
Keywords
Animals
Finland
Guidelines as Topic
Humans
Pulmonary Disease, Chronic Obstructive - diagnosis - drug therapy
Vaccination
Abstract
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  
Notes
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PubMed ID
25515181 View in PubMed
Less detail

Does special education in palliative medicine make a difference in end-of-life decision-making?

https://arctichealth.org/en/permalink/ahliterature296852
Source
BMC Palliat Care. 2018 Jul 18; 17(1):94
Publication Type
Journal Article
Date
Jul-18-2018
Author
Reetta P Piili
Juho T Lehto
Tiina Luukkaala
Heikki Hinkka
Pirkko-Liisa I Kellokumpu-Lehtinen
Author Affiliation
Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland. piili.reetta.p@student.uta.fi.
Source
BMC Palliat Care. 2018 Jul 18; 17(1):94
Date
Jul-18-2018
Language
English
Publication Type
Journal Article
Keywords
Adult
Attitude of Health Personnel
Decision Making
Education, Continuing - methods - standards
Female
Finland
Humans
Lung Neoplasms - therapy
Male
Middle Aged
Palliative Care - methods
Physician-Patient Relations
Physicians - psychology
Surveys and Questionnaires
Withholding Treatment
Abstract
Characteristics of the physician influence the essential decision-making in end-of-life care. However, the effect of special education in palliative medicine on different aspects of decision-making in end-of-life care remains unknown. The aim of this study was to explore the decision-making in end-of-life care among physicians with or without special competency in palliative medicine (cPM).
A questionnaire including an advanced lung cancer patient-scenario with multiple decision options in end-of-life care situation was sent to 1327 Finnish physicians. Decisions to withdraw or withhold ten life-prolonging interventions were asked on a scale from 1 (definitely would not) to 5 (definitely would) - first, without additional information and then after the family's request for aggressive treatment and the availability of an advance directive. Values from chronological original scenario, family's appeal and advance directive were clustered by trajectory analysis.
We received 699 (53%) responses. The mean values of the ten answers in the original scenario were 4.1 in physicians with cPM, 3.4 in general practitioners, 3.4 in surgeons, 3.5 in internists and 3.8 in oncologists (p?
PubMed ID
30021586 View in PubMed
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End-of-life care of patients with idiopathic pulmonary fibrosis.

https://arctichealth.org/en/permalink/ahliterature280174
Source
BMC Palliat Care. 2016 Oct 12;15(1):85
Publication Type
Article
Date
Oct-12-2016
Author
Kaisa Rajala
Juho T Lehto
M. Saarinen
E. Sutinen
T. Saarto
M. Myllärniemi
Source
BMC Palliat Care. 2016 Oct 12;15(1):85
Date
Oct-12-2016
Language
English
Publication Type
Article
Keywords
Advance Care Planning - utilization
Aged
Aged, 80 and over
Analgesics, Opioid - therapeutic use
Anti-Anxiety Agents - therapeutic use
Anti-Bacterial Agents - therapeutic use
Anxiety - drug therapy
Cohort Studies
Decision Making
Dyspnea - drug therapy
Female
Finland
Hospices
Hospitalization - statistics & numerical data
Hospitals, Community
Humans
Idiopathic Pulmonary Fibrosis - therapy
Intensive Care Units
Length of Stay
Male
Middle Aged
Noninvasive Ventilation - utilization
Nursing Homes
Pain - drug therapy
Resuscitation Orders
Retrospective Studies
Terminal Care
Tertiary Care Centers
Abstract
Idiopathic pulmonary fibrosis (IPF) is a progressive disease with median survival from 2 to 7 years. Palliative care is an important part of patients´ care as lung transplantation is not an option for the majority of patients. The aim of this study was to describe treatment practices, decision-making and symptoms during end-of-life care of IPF patients.
We identified 59 deceased patients from a national prospective IPF cohort study (FinnishIPF) and analyzed retrospectively their health care documentation during the 6 months that preceded death.
Hospital was the place of death for 47 patients (80 %). A majority of the patients (93 %) were hospitalized for a mean of 30 days (range 1-96 days) during the last 6 months of their life. Altogether, patients spent 15 % of their last 6 months of life in a hospital. End-of-life decisions and do not resuscitate (DNR) orders were made for 19 (32 %) and 34 (57 %) of the patients, respectively, and 22 (42 %) of these decisions were made?=?3 days prior to death. During the final hospital stay, antibiotics were given to 79 % and non-invasive ventilation to 36 % of patients. During the last 24 h of life, radiologic imaging or laboratory tests were taken in 19 % and 53 % of the hospitalized patients, respectively. These tests and life prolonging therapies were more common in tertiary hospitals compared to other places of death. Dyspnea (66 %) and pain (31 %) were the most common symptoms recorded. Opioids were prescribed to 71 % of the patients during the last week before death.
The majority of IPF patients died in a hospital with ongoing life-prolonging procedures until death. The frequent use of opioids is an indicator of an intention to relieve symptoms, but end-of-life decisions were still made very late. Early integrated palliative care with advance care plan could improve the end-of-life care of dying IPF patients.
PubMed ID
27729035 View in PubMed
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The impact of the duration of the palliative care period on cancer patients with regard to the use of hospital services and the place of death: a retrospective cohort study.

https://arctichealth.org/en/permalink/ahliterature306440
Source
BMC Palliat Care. 2020 Mar 24; 19(1):37
Publication Type
Journal Article
Date
Mar-24-2020
Author
Outi M Hirvonen
Riikka-Leena Leskelä
Lotta Grönholm
Olli Haltia
Samuli Voltti
Kristiina Tyynelä-Korhonen
Eeva K Rahko
Juho T Lehto
Tiina Saarto
Author Affiliation
Department of Oncology and Radiotherapy, Turku University Hospital and Department of Clinical Oncology, University of Turku, PO Box 52, FI-20521, Turku, Finland. outi.hirvonen@tyks.fi.
Source
BMC Palliat Care. 2020 Mar 24; 19(1):37
Date
Mar-24-2020
Language
English
Publication Type
Journal Article
Keywords
Aged
Cohort Studies
Female
Finland
Humans
Male
Middle Aged
Neoplasms - complications - psychology
Palliative Care - methods - standards - statistics & numerical data
Patient Acceptance of Health Care - psychology - statistics & numerical data
Retrospective Studies
Time Factors
Abstract
In order to avoid unnecessary use of hospital services at the end-of-life, palliative care should be initiated early enough in order to have sufficient time to initiate and carry out good quality advance care planning (ACP). This single center study assesses the impact of the PC decision and its timing on the use of hospital services at EOL and the place of death.
A randomly chosen cohort of 992 cancer patients treated in a tertiary hospital between Jan 2013 -Dec 2014, who were deceased by the end of 2014, were selected from the total number of 2737 identified from the hospital database. The PC decision (the decision to terminate life-prolonging anticancer treatments and focus on symptom centered palliative care) and use of PC unit services were studied in relation to emergency department (ED) visits, hospital inpatient days and place of death.
A PC decision was defined for 82% of the patients and 37% visited a PC unit. The earlier the PC decision was made, the more often patients had an appointment at the PC unit (>?180?days prior to death 72% and?
PubMed ID
32209075 View in PubMed
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Preplanned participation of paramedics in end-of-life care at home: A retrospective cohort study.

https://arctichealth.org/en/permalink/ahliterature303873
Source
Palliat Med. 2020 Dec 18; :269216320981713
Publication Type
Journal Article
Date
Dec-18-2020
Author
Leena K Surakka
Minna M Peake
Minna M Kiljunen
Pekka Mäntyselkä
Juho T Lehto
Author Affiliation
Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
Source
Palliat Med. 2020 Dec 18; :269216320981713
Date
Dec-18-2020
Language
English
Publication Type
Journal Article
Abstract
Paramedics commonly face acute crises of patients in palliative care, but their involvement in end-of-life care is not planned systematically.
To evaluate a protocol for end-of-life care at home including pre-planned integration of paramedics and end-of-life care wards.
Paramedic visits to patients in end-of-life care protocol were retrospectively studied.
All of the patients who had registered for the protocol between 1 March 2015 and 28 February 2017 in North Karelia, Finland, were included in this study.
A total of 256 patients were registered for the protocol and 306 visits by paramedic were needed. A need for symptom control (38%) and transportation (29%) were the most common reasons for a visit. Paramedics visited 43% and 70% of the patients in areas with and without 24/7 palliative home care services, respectively (p?
PubMed ID
33339483 View in PubMed
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The required competencies of physicians within palliative care from the perspectives of multi-professional expert groups: a qualitative study.

https://arctichealth.org/en/permalink/ahliterature305971
Source
BMC Palliat Care. 2020 May 09; 19(1):65
Publication Type
Journal Article
Date
May-09-2020
Author
Hanna-Leena Melender
Minna Hökkä
Tiina Saarto
Juho T Lehto
Author Affiliation
Department of Social and Health Care, VAMK University of Applied Sciences, Wolffintie 27-31, 65200, Vaasa, Finland. hanna-leena.melender@vamk.fi.
Source
BMC Palliat Care. 2020 May 09; 19(1):65
Date
May-09-2020
Language
English
Publication Type
Journal Article
Keywords
Clinical Competence - standards
Consensus
Delphi Technique
Expert Testimony
Finland
Humans
Palliative Care - methods - trends
Physicians - standards
Qualitative Research
Abstract
Although statements on the competencies required from physicians working within palliative care exist, these requirements have not been described within different levels of palliative care provision by multi-professional workshops, comprising representatives from working life. Therefore, the aim of this study was to describe the competencies required from physicians working within palliative care from the perspectives of multi-professional groups of representatives from working life.
A qualitative approach, using a workshop method, was conducted, wherein the participating professionals and representatives of patient organizations discussed the competencies that are required in palliative care, before reaching and documenting a consensus. The data (n?=?222) was collected at workshops held in different parts of Finland and it was analyzed using a qualitative content analysis method.
The description of the competencies required of every physician working within palliative care at the general level included 13 main categories and 50 subcategories in total. 'Competence in advanced care planning and decision-making' was the main category which was obtained from the highest number of reduced expressions from the original data (f?=?125). Competence in social interactions was another strong main category (f?=?107). In specialist level data, six main categories with 22 subcategories in total were found. 'Competence in complex symptom management' was the main category which was obtained from the biggest number of reduced expressions (f?=?46). A notable association between general level and specialist level data was related to networking, since one of the general level categories was 'Competence in consultations and networking' (f?=?34) and one of the specialist level categories was 'Competence to offer consultative and educational support to other professionals' (f?=?30). Moreover, part of the specialist level results were subcategories which belonged to the main categories produced from the general level data.
The competencies described in this study emphasize decision-making, social interactions and networking. It is important to listen to the voices of the working-life representatives when planning curricula. Moreover, the views of the working-life representatives inform how the competencies gained during their education meet the challenges of the ordinary work.
PubMed ID
32386513 View in PubMed
Less detail

Undergraduate curriculum in palliative medicine at Tampere University increases students' knowledge.

https://arctichealth.org/en/permalink/ahliterature280345
Source
BMC Palliat Care. 2017 Jan 25;16(1):13
Publication Type
Article
Date
Jan-25-2017
Author
Juho T Lehto
Kati Hakkarainen
Pirkko-Liisa Kellokumpu-Lehtinen
Tiina Saarto
Source
BMC Palliat Care. 2017 Jan 25;16(1):13
Date
Jan-25-2017
Language
English
Publication Type
Article
Keywords
Clinical Competence - standards
Curriculum
Education, Medical, Undergraduate
Feedback
Finland
Health Knowledge, Attitudes, Practice
Humans
Palliative Medicine - economics
Students, Medical - psychology
Teaching - standards
Abstract
Education in palliative medicine (PM) at medical schools reveals wide variation despite the increasing importance of palliative care. Many universities present poor description of the benefits and detailed content of the total curriculum in PM. Using the recommendations of European Association for Palliative Care (EAPC) as a reference, we evaluated the content and outcomes of the curriculum in PM at the University of Tampere, Finland.
We searched for a PM curriculum by examining the teaching offered by every specialty and compared it to EAPC recommendations. Students' knowledge was evaluated using a progress test over three consecutive years.
We found 53.5 teaching hours addressing PM issues, which exceeds the recommendation of the EAPC. Basics, symptom management, ethics, and communication skills were well established, while education in psychosocial/spiritual aspects, teamwork and self-reflection failed to reach the recommendations. Out of the maximum of 4.0, the progress test mean scores in PM among the third, fourth, fifth and sixth year students were 0.1 (SD 0.71), 0.69 (SD 1.28), 1.38 (SD 1.46) and 2.53 (SD 1.26), respectively (p?
Notes
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PubMed ID
28122553 View in PubMed
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Upper airway symptoms in primary snoring and in sleep apnea.

https://arctichealth.org/en/permalink/ahliterature128225
Source
Acta Otolaryngol. 2012 May;132(5):510-8
Publication Type
Article
Date
May-2012
Author
Hanna-Riikka Kreivi
Paula Virkkula
Juho T Lehto
Pirkko E Brander
Author Affiliation
Division of Pulmonary Diseases, Department of Medicine, Helsinki University Central Hospital, Finland. hanna-riikka.kreivi@hus.fi
Source
Acta Otolaryngol. 2012 May;132(5):510-8
Date
May-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Body mass index
Female
Finland - epidemiology
Follow-Up Studies
Humans
Male
Middle Aged
Nasal Obstruction - complications - diagnosis - epidemiology
Polysomnography
Prevalence
Prognosis
Questionnaires
Retrospective Studies
Rhinitis - complications - diagnosis - epidemiology
Severity of Illness Index
Sleep Apnea Syndromes - epidemiology - etiology - physiopathology
Snoring - diagnosis - epidemiology - etiology
Young Adult
Abstract
Upper airway symptoms were common in subjects referred for sleep study. In particular, nasal stuffiness and airway dryness already seemed to bother snorers before development of obstructive sleep apnea syndrome (OSAS). Mouth dryness increased with severity of obstructive sleep apnea (OSA).
Upper airway symptoms are common in patients with OSAS. However, prevalence of these symptoms is unknown in primary snoring and mild OSA. We evaluated frequency of upper airway symptoms in a large group of patients referred for diagnostic sleep studies.
We examined 524 consecutive subjects (69% men, mean ± SD age 51 ± 12 years, apnea-hypopnea index (AHI) 15 ± 21, body mass index 31 ± 6) by a questionnaire-based survey. The subjects filled in a questionnaire enquiring about current upper airway symptoms and history of nasal and pharyngeal disorders before the sleep study.
Frequent upper airway symptoms among study subjects were common: 56% of the patients reported throat dryness, 55% mouth dryness, 54% nasal stuffiness, 52% nose dryness, 33% sneezing, 33% postnasal drip, and 24% rhinorrhea. The patients with moderate or severe OSAS (AHI =15 and Epworth sleepiness score =10) suffered from mouth dryness more often (71% vs 40%, p
PubMed ID
22217396 View in PubMed
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