Om nyttan och nödwändigheten för en präst, at äga insikt i medicine

Painovuosi nimekkeestä.

Informationsbeteende och inlärningsmiljöer : en kvalitativ studie av medicine studerandes informationsbeteende i två olika utbildningsprogram

Avhandlingens övergripande syfte är att granska relationerna mellan olika undervisningsmetoder och studenters informationsbeteende, vilket i denna undersökning inbegriper även deras informationskompetens. Vikten av att undersöka dessa förhållanden kan motiveras med att både kunskap om de faktorer som påverkar utvecklandet av informationskompetens och forskning som tar fram olika mönster i studenternas informationsbeteende behövs för att sådana inlärningsmiljöer, informationssystem och -tjänster som stöder studenternas inlärning skall kunna utvecklas. I avhandlingen söks svar på följande frågor: 1. Vilka faktorer i inlärningsmiljöerna, dvs. problembaserad inlärningsmiljö (pbl) och traditionell inlärningsmiljö, påverkar informationsbeteendet och hur påverkar dessa faktorer? 2. Hurdan information behövs i inlärningsprocessen? Hur anskaffas informationen? Vilka informationskanaler och -källor används och hur används de? 3. Hur används information i samband med inlärningen? I undersökningen används en kvalitativ forskningsansats och det huvudsakliga undersökningsmaterialet består av intervjuer med 16 medicine studerande som studerar enligt en problembaserad inlärningsmetod och 15 studerande som studerar i ett traditionellt ämnesbaserat utbildningsprogram. Den empiriska delen av undersökningen utfördes i slutet av 1990-talet. Resultaten indikerar att en problembaserad inlärningsmiljö utvecklar förståelsen av kunskap, aktiverar informationsanskaffningen och informationsanvändningen, samt främjar utvecklingen av studenternas informationskompetens såsom den definierades i denna undersökning. Högre nivå av informationskompetens och aktiv informationsanvändning förekom emellertid i båda utbildningsprogrammen även bland studenter som hade påbörjat de fördjupade studiernas slutarbete, vilket framhäver motivationens och de verkliga informationsbehovens roll i informationsbeteendet och i utvecklandet av informationskompetensen.

Effects of cytochrome P450 enzyme inhibitors and inducers on the metabolism of S-ketamine

The human body eliminates foreign compounds primarily by metabolizing them to hydrophilic forms to facilitate effective excretion through the kidneys. Cytochrome P450 (CYP) enzymes in the liver and intestine contribute to the metabolism of many drugs. Pharmacokinetic drugdrug interactions occur if the activity of CYPs are inhibited or induced by another drug. Prescribing multiple drugs to the improve effectiveness of therapy or to treat coexisting diseases is a common practice in clinical medicine. Polypharmacy predisposes patients to adverse effects because of the profound unpredictability in CYP enzymatic-mediated drug metabolism. S-ketamine is a phencyclidine derivative which functions as an antagonist of the N-methyl-Daspartate (NMDA) receptor in the central nervous system. It is a unique anaesthetic producing “dissociative anaesthesia” in high doses and analgesia in low doses. Studies with human liver microsomes suggest that ketamine is metabolized primarily via CYP3A4 and CYP2B6 enzymes. In this thesis, in healthy volunteers, randomized and controlled cross-over studies were conducted to investigate the effects of different CYP inducers and inhibitors on the pharmacokinetics and pharmacodynamics of oral and intravenous S-ketamine. The plasma concentrations of ketamine and its metabolite, norketamine, were determined at different timepoints over a 24 hour period. Other pharmacodynamic variables were examined for 12 hours. Results of these studies showed that the inhibition of the CYP3A4 pathway by clarithromycin or grapefruit juice increased the exposure to oral S-ketamine by 2.6- and 3.0-fold. Unexpectedly, CYP3A4 inhibition by itraconazole caused no significant alterations in the plasma concentrations of oral S-ketamine. CYP3A4 induction by St. John´s wort or rifampicin decreased profoundly the concentrations of oral S-ketamine. However, after rifampicin, there were no significant differences in the plasma concentrations of S-ketamine when it was administered intravenously. This demonstrated that rifampicin inhibited the metabolism of Sketamine at the intestinal level. When CYP2B6 was inhibited by ticlopidine, there was a 2.4- fold increase in the exposure of S-ketamine. These studies demonstrated that low dose oral Sketamine is metabolized both via CYP3A4 and CYP2B6 pathways. The concomitant use of drugs that affect CYP3A4 or CYP2B6, during oral S-ketamine treatment, may cause clinically significant drug-drug interactions.

Sick leave prescribing practices in Finland

Background: Sick leave prescribing is a common task of doctors and being on sick leave results in notable economic consequences to society. However, there appears to be limited research into this field and the factors affecting sick leave prescribing practices of doctors. Aims: To examine the prescribing of sick leave by doctors and dentists, the extent of variation in practices, whether clinician-related factors and local structural factors affect variation, and the economic consequences of varying practices. Materials and methods: Questionnaire studies with 19 or 16 hypothetical patient cases were conducted among 165 primary health care (PHC) physicians, 356 occupational health care (OHC) physicians, 338 surgeons and 1132 dentists. Results: The difference between the lowest and the highest number of sick leave days prescribed for the 19 patient cases was almost four-fold in PHC physicians and surgeons and eight-fold in OHC physicians, which represents a societal cost of tens of thousands of euros. Some dentists did not prescribe sick leave to any of the 16 patient cases, and some prescribed nearly a hundred days altogether. The overall number of sick leave days OHC physicians prescribed was smaller than in PHC physicians. More days of sick leave were prescribed by those working in smaller municipalities than larger population centres. Conclusion: There was considerable variation in the sick leave prescribing practices of Finnish health care professionals. This means that patients may not receive equal social benefits. Sick leave carries considerable economic consequences, and unifying prescribing practices could bring significant cost savings to society.

Improving oral healthcare in Scotland with special reference to sustainability and caries prevention

Brett Duane Improving oral healthcare in Scotland with special reference to sustainability and caries prevention University of Turku, Faculty of Medicine, Institute of Dentistry, Community Dentistry, Finnish Doctoral Program in Oral Sciences (FINDOS-Turku), Turku, Finland Annales Universitatis Turkuensis, Sarja- Ser. D, Medica-Odontologica. Painosalama Oy, Turku, Finland, 2015. Dentistry must provide sustainable, evidence-based, and prevention-focused care. In Scotland oral health prevention is delivered through the Childsmile programme, with an increasing use of high concentration fluoride toothpaste (HCFT). Compared with other countries there is little knowledge of xylitol prevention. The UK government has set strict carbon emission limits with which all national health services (NHS) must comply. The purpose of these studies was firstly to describe the Scottish national oral health prevention programme Childsmile (CS), to determine if the additional maternal use of xylitol (CS+X) was more effective at affecting the early colonisation of mutans streptococci (MS) than this programme alone; secondly to analyse trends in the prescribing and management of HCFT by dentists; and thirdly to analyse data from a dental service in order to improve its sustainability. In all, 182 mother/child pairs were selected on the basis of high maternal MS levels. Motherswere randomly allocated to a CS or CS+X group, with both groups receiving Childsmile. Theintervention group consumed xylitol three times a day, from when the child was 3 months until 24 months. Children were examined at age two to assess MS levels. In order to understand patterns of HCFT prescribing, a retrospective secondary data analysis of routine prescribing data for the years 2006-2012 was performed. To understand the sustainability of dental services, carbon accounting combined a top-down approach and a process analysis approach, followed by the use of Pollard’s decision model (used in other healthcare areas) to analyse and support sustainable service reconfiguration. Of the CS children, 17% were colonised with MS, compared with 5% of the CS+X group. This difference was not statistically significant (P=0.1744). The cost of HCFT prescribing increased fourteen-fold over five years, with 4% of dentists prescribing 70% of the total product. Travel (45%), procurement (36%) and building energy (18%) all contributed to the 1800 tonnes of carbon emissions produced by the service, around 4% of total NHS emissions. Using the analytical model, clinic utilisation rates improved by 56% and patient travel halved significantly reducing carbon emissions. It can be concluded that the Childsmile programme was effective in reducing the risk for MS transmission. HCFT is increasing in Scotland and needs to be managed. Dentistry has similar carbon emissions proportionally as the overall NHS, and the use of an analytic tool can be useful in helping identify these emissions. Key words: Sustainability, carbon emissions, xylitol, mutans streptococci, fluoride toothpaste, caries prevention.