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Stress ulcer prophylaxis with a proton pump inhibitor versus placebo in critically ill patients (SUP-ICU trial): study protocol for a randomised controlled trial
Full text linkBackground: Critically ill patients in the intensive care unit (ICU) are at risk of clinically important gastrointestinal bleeding, and acid suppressants are frequently used prophylactically. However, stress ulcer prophylaxis may increase the risk of serious adverse events and, additionally, the quantity and quality of evidence supporting the use of stress ulcer prophylaxis is low. The aim of the SUP-ICU trial is to assess the benefits and harms of stress ulcer prophylaxis with a proton pump inhibitor in adult patients in the ICU. We hypothesise that stress ulcer prophylaxis reduces the rate of gastrointestinal bleeding, but increases rates of nosocomial infections and myocardial ischaemia. The overall effect on mortality is unpredictable. Methods/design: The SUP-ICU trial is an investigator-initiated, pragmatic, international, multicentre, randomised, blinded, parallel-group trial of stress ulcer prophylaxis with a proton pump inhibitor versus placebo (saline) in 3350 acutely ill ICU patients at risk of gastrointestinal bleeding. The primary outcome measure is 90-day mortality. Secondary outcomes include the proportion of patients with clinically important gastrointestinal bleeding, pneumonia, Clostridium difficile infection or myocardial ischaemia, days alive without life support in the 90-day period, serious adverse reactions, 1-year mortality, and health economic analyses. The sample size will enable us to detect a 20 % relative risk difference (5 % absolute risk difference) in 90-day mortality assuming a 25 % event rate with a risk of type I error of 5 % and power of 90 %. The trial will be externally monitored according to Good Clinical Practice standards. Interim analyses will be performed after 1650 and 2500 patients. Conclusion: The SUP-ICU trial will provide high-quality data on the benefits and harms of stress ulcer prophylaxis with a proton pump inhibitor in critically ill adult patients admitted in the ICU
Alkoholin väärinkäyttö kriittisesti sairailla potilailla
No full textAbstractAlcohol consumption is a major health problem worldwide, causing approximately 5% of all deaths per year. High-risk alcohol consumption causes acute and chronic disorders that are often treated in intensive care units (ICUs). The magnitude of alcohol-related health problems amongst critically ill patients has not yet been well studied.The aim of this thesis was to examine the role of high-risk alcohol consumption in critical illness. It includes four retrospective studies conducted in the Oulu University Hospital district. The study populations comprised the following: I) 899 non-trauma patients admitted to the ICU in 2014; II) 8379 subjects born in 1966 participating in the Northern Finland Birth Cohort study; III) 250 patients with liver cirrhosis or other liver disease admitted to the ICU in 2017; and IV) 290 sudden cardiac death (SCD) victims with alcoholic cardiomyopathy (ACM).One-third of the ICU-admitted patients had alcohol-related health problems. Alcohol consumption did not affect the ICU treatment profile, but one-year mortality was lower in patients with alcohol-related health problems due to less severe admission causes and comorbidities. This difference subsided when patients with intoxication as the ICU admission cause were excluded. Alcohol consumption ≥ 11 g/day at the age of 31 years was associated with a later need for ICU admission. The ICU-admitted patients with high alcohol consumption more often had alcohol-related admission causes (25.0%) compared with those without high alcohol consumption. Nearly 40% of the ICU-admitted patients with liver disease died during the one-year follow-up period. Alcohol consumption did not affect long-term mortality, but the patients with alcoholic liver cirrhosis died more often due to liver disease (56.8%), whereas the patients without high-risk alcohol consumption died more often due to malignancies (55.9%). Amongst the SCD victims with ACM, only 22.1% of the victims were diagnosed with cardiac disease prior to death, despite documented high-risk alcohol consumption (98.6%). The rate of clinical diagnosis among SCD victims was higher in high-income areas compared with low- and middle-income areas, and most victims were in the working population (57.0%).In conclusion, high-risk alcohol consumption increases the need for intensive care, and the prevalence of patients with alcohol-related health problems amongst the ICU population is substantial. The long-term mortality of patients with alcoholic liver cirrhosis after intensive care is high, and most patients die due to liver disease. Most ACM remains undiagnosed, demonstrating the lack of screening for alcohol-related diseases. The health care system’s focus should be aimed at preventing alcohol-related disorders to decrease alcohol-related morbidity, ICU resource utilization and mortality in the working-age population.Original papersOriginal papers are not included in the electronic version of the dissertation.Hietanen, S., Ala-Kokko, T., Ohtonen, P., Käkelä, R., Niemelä, S., & Liisanantti, J. H. (2017). Treatment Profile and 1-Year Mortality Among Nontraumatic Intensive Care Unit Patients With Alcohol-Related Health Problems. Journal of Intensive Care Medicine, 35(3), 244–250. https://doi.org/10.1177/0885066617740071Self-archived versionHietanen, S., Kaakinen, T., Ala-Kokko, T., Herajärvi, J., Auvinen, J., Niittyvuopio, M., & Liisanantti, J. (2020). Alcohol consumption is associated with a later need for ICU admission: a Northern Finland Birth Cohort 1966—study. Journal of Public Health. https://doi.org/10.1093/pubmed/fdaa085Hietanen, S., Herajärvi, J., Lehtonen, A., Lahtinen, S., & Liisanantti, J. (2020). Treatment profile and long-term outcome of intensive care unit-admitted patients with liver cirrhosis or other liver disease in relation to alcohol consumption. Scandinavian Journal of Gastroenterology, 56(2), 180–187. https://doi.org/10.1080/00365521.2020.1861646Hietanen, S., Herajärvi, J., Junttila, J., Pakanen, L., Huikuri, H. V., & Liisanantti, J. (2019). Characteristics of subjects with alcoholic cardiomyopathy and sudden cardiac death. Heart, 106(9), 686–690. https://doi.org/10.1136/heartjnl-2019-315534TiivistelmäAlkoholin käyttö on merkittävä maailmanlaajuinen terveysongelma aiheuttaen noin 5 % kaikista kuolemantapauksista vuosittain. Alkoholin käyttö aiheuttaa akuutteja ja kroonisia sairauksia, joita usein hoidetaan teho-osastoilla. Alkoholiperäisten terveysongelmien laajuutta kriittisesti sairailla potilailla ei ole tutkittu kattavasti.Väitöskirjan tarkoitus oli tutkia alkoholin käytön merkitystä kriittisissä sairauksissa. Väitöskirja koostuu neljästä osatyöstä, jotka on toteutettu Oulun yliopistollisen sairaalaan alueella. Tutkimusjoukkoon kuuluvat; I) 899 teho-osastolla muun syyn kuin vamman vuoksi vuonna 2014 hoidettua potilasta, II) 8379 vuonna 1963 syntynyttä Pohjois-Suomen syntymäkohorttiin osallistunutta tutkittavaa, III) 250 teho-osastolla vuonna 2017 hoidettua potilasta, joilla on todettu maksakirroosi tai muu maksasairaus, IV) 290 alkoholiperäisen sydänsairauden vuoksi äkkikuollutta potilasta.Kolmasosalla tehohoitopotilaista todettiin alkoholin riskikulutusta. Alkoholilla ei ollut vaikutusta tehohoidon erityispiirteisiin, mutta vuoden seurannassa alkoholia käyttävien potilaiden kuolleisuus oli matalampi johtuen lievemmistä tehohoidon syistä ja perussairauksista. Kuolleisuusero väistyi, kun myrkytyksien vuoksi tehohoitoon joutuneet potilaat poistettiin analyysistä. 31-vuotiaiden alkoholin kulutus ≥ 11 g/vrk oli yhteydessä myöhempään tehohoidon tarpeeseen. Korkean alkoholinkulutuksen potilaat joutuivat tehohoitoon useammin alkoholiperäisistä syistä (25,0 %) verrattuna vähemmän alkoholia käyttäviin. Lähes 40 % tehohoidetuista maksasairauspotilaista menehtyi vuoden seurannassa. Alkoholin kulutus ei vaikuttanut kuolleisuuteen, mutta alkoholikirroosipotilaat menehtyivät useammin maksasairauteen (56,8 %) ja potilaat ilman alkoholin riskikulutusta menehtyivät useammin pahanlaatuisiin kasvaimiin (55,9 %). Alkoholiperäisen sydänsairauden vuoksi äkkikuolleista potilaista vain 22,1 %:lla sydänsairaus oli diagnosoitu elinaikana, huolimatta kirjatusta alkoholin riskikulutuksesta (98, 6%). Tiedossa olleen sydänsairauden osuus äkkikuoleman uhreilla oli suurempi korkeatuloisilla alueilla verrattuna keski- ja matalatuloisiin, ja näistä potilaista useimmat kuuluivat työssäkäyvään väestöön (57,0 %).Alkoholin riskikulutus altistaa tehohoidon tarpeelle ja alkoholin riskikuluttajien osuus tehohoitoväestössä on merkittävä. Alkoholikirroosipotilailla on korkea kuolleisuus tehohoidon jälkeen ja useimmat menehtyvät maksasairauteen. Valtaosa alkoholiperäisestä sydänsairaudesta jää diagnosoimatta osoittaen puutteet alkoholiperäisten sairauksien seulonnassa. Terveydenhuollon tulisi panostaa alkoholisairauksien ehkäisyyn, jotta alkoholiperäistä sairastavuutta, tehohoitoresurssien kulutusta ja työikäisen väestön kuolleisuutta voitaisiin vähentää.OsajulkaisutOsajulkaisut eivät sisälly väitöskirjan elektroniseen versioon.Hietanen, S., Ala-Kokko, T., Ohtonen, P., Käkelä, R., Niemelä, S., & Liisanantti, J. H. (2017). Treatment Profile and 1-Year Mortality Among Nontraumatic Intensive Care Unit Patients With Alcohol-Related Health Problems. Journal of Intensive Care Medicine, 35(3), 244–250. https://doi.org/10.1177/0885066617740071Rinnakkaistallennettu versioHietanen, S., Kaakinen, T., Ala-Kokko, T., Herajärvi, J., Auvinen, J., Niittyvuopio, M., & Liisanantti, J. (2020). Alcohol consumption is associated with a later need for ICU admission: a Northern Finland Birth Cohort 1966—study. Journal of Public Health. https://doi.org/10.1093/pubmed/fdaa085Hietanen, S., Herajärvi, J., Lehtonen, A., Lahtinen, S., & Liisanantti, J. (2020). Treatment profile and long-term outcome of intensive care unit-admitted patients with liver cirrhosis or other liver disease in relation to alcohol consumption. Scandinavian Journal of Gastroenterology, 56(2), 180–187. https://doi.org/10.1080/00365521.2020.1861646Hietanen, S., Herajärvi, J., Junttila, J., Pakanen, L., Huikuri, H. V., & Liisanantti, J. (2019). Characteristics of subjects with alcoholic cardiomyopathy and sudden cardiac death. Heart, 106(9), 686–690. https://doi.org/10.1136/heartjnl-2019-315534Academic dissertation to be presented with the assent of the Doctoral Training Committee of Health and Biosciences of the University of Oulu for public defence in Auditorium 2 of Oulu University Hospital, on 27 August 2021, at 12 noonAbstract
Alcohol consumption is a major health problem worldwide, causing approximately 5% of all deaths per year. High-risk alcohol consumption causes acute and chronic disorders that are often treated in intensive care units (ICUs). The magnitude of alcohol-related health problems amongst critically ill patients has not yet been well studied.
The aim of this thesis was to examine the role of high-risk alcohol consumption in critical illness. It includes four retrospective studies conducted in the Oulu University Hospital district. The study populations comprised the following: I) 899 non-trauma patients admitted to the ICU in 2014; II) 8379 subjects born in 1966 participating in the Northern Finland Birth Cohort study; III) 250 patients with liver cirrhosis or other liver disease admitted to the ICU in 2017; and IV) 290 sudden cardiac death (SCD) victims with alcoholic cardiomyopathy (ACM).
One-third of the ICU-admitted patients had alcohol-related health problems. Alcohol consumption did not affect the ICU treatment profile, but one-year mortality was lower in patients with alcohol-related health problems due to less severe admission causes and comorbidities. This difference subsided when patients with intoxication as the ICU admission cause were excluded. Alcohol consumption ≥ 11 g/day at the age of 31 years was associated with a later need for ICU admission. The ICU-admitted patients with high alcohol consumption more often had alcohol-related admission causes (25.0%) compared with those without high alcohol consumption. Nearly 40% of the ICU-admitted patients with liver disease died during the one-year follow-up period. Alcohol consumption did not affect long-term mortality, but the patients with alcoholic liver cirrhosis died more often due to liver disease (56.8%), whereas the patients without high-risk alcohol consumption died more often due to malignancies (55.9%). Amongst the SCD victims with ACM, only 22.1% of the victims were diagnosed with cardiac disease prior to death, despite documented high-risk alcohol consumption (98.6%). The rate of clinical diagnosis among SCD victims was higher in high-income areas compared with low- and middle-income areas, and most victims were in the working population (57.0%).
In conclusion, high-risk alcohol consumption increases the need for intensive care, and the prevalence of patients with alcohol-related health problems amongst the ICU population is substantial. The long-term mortality of patients with alcoholic liver cirrhosis after intensive care is high, and most patients die due to liver disease. Most ACM remains undiagnosed, demonstrating the lack of screening for alcohol-related diseases. The health care system’s focus should be aimed at preventing alcohol-related disorders to decrease alcohol-related morbidity, ICU resource utilization and mortality in the working-age population.Tiivistelmä
Alkoholin käyttö on merkittävä maailmanlaajuinen terveysongelma aiheuttaen noin 5 % kaikista kuolemantapauksista vuosittain. Alkoholin käyttö aiheuttaa akuutteja ja kroonisia sairauksia, joita usein hoidetaan teho-osastoilla. Alkoholiperäisten terveysongelmien laajuutta kriittisesti sairailla potilailla ei ole tutkittu kattavasti.
Väitöskirjan tarkoitus oli tutkia alkoholin käytön merkitystä kriittisissä sairauksissa. Väitöskirja koostuu neljästä osatyöstä, jotka on toteutettu Oulun yliopistollisen sairaalaan alueella. Tutkimusjoukkoon kuuluvat; I) 899 teho-osastolla muun syyn kuin vamman vuoksi vuonna 2014 hoidettua potilasta, II) 8379 vuonna 1963 syntynyttä Pohjois-Suomen syntymäkohorttiin osallistunutta tutkittavaa, III) 250 teho-osastolla vuonna 2017 hoidettua potilasta, joilla on todettu maksakirroosi tai muu maksasairaus, IV) 290 alkoholiperäisen sydänsairauden vuoksi äkkikuollutta potilasta.
Kolmasosalla tehohoitopotilaista todettiin alkoholin riskikulutusta. Alkoholilla ei ollut vaikutusta tehohoidon erityispiirteisiin, mutta vuoden seurannassa alkoholia käyttävien potilaiden kuolleisuus oli matalampi johtuen lievemmistä tehohoidon syistä ja perussairauksista. Kuolleisuusero väistyi, kun myrkytyksien vuoksi tehohoitoon joutuneet potilaat poistettiin analyysistä. 31-vuotiaiden alkoholin kulutus ≥ 11 g/vrk oli yhteydessä myöhempään tehohoidon tarpeeseen. Korkean alkoholinkulutuksen potilaat joutuivat tehohoitoon useammin alkoholiperäisistä syistä (25,0 %) verrattuna vähemmän alkoholia käyttäviin. Lähes 40 % tehohoidetuista maksasairauspotilaista menehtyi vuoden seurannassa. Alkoholin kulutus ei vaikuttanut kuolleisuuteen, mutta alkoholikirroosipotilaat menehtyivät useammin maksasairauteen (56,8 %) ja potilaat ilman alkoholin riskikulutusta menehtyivät useammin pahanlaatuisiin kasvaimiin (55,9 %). Alkoholiperäisen sydänsairauden vuoksi äkkikuolleista potilaista vain 22,1 %:lla sydänsairaus oli diagnosoitu elinaikana, huolimatta kirjatusta alkoholin riskikulutuksesta (98, 6%). Tiedossa olleen sydänsairauden osuus äkkikuoleman uhreilla oli suurempi korkeatuloisilla alueilla verrattuna keski- ja matalatuloisiin, ja näistä potilaista useimmat kuuluivat työssäkäyvään väestöön (57,0 %).
Alkoholin riskikulutus altistaa tehohoidon tarpeelle ja alkoholin riskikuluttajien osuus tehohoitoväestössä on merkittävä. Alkoholikirroosipotilailla on korkea kuolleisuus tehohoidon jälkeen ja useimmat menehtyvät maksasairauteen. Valtaosa alkoholiperäisestä sydänsairaudesta jää diagnosoimatta osoittaen puutteet alkoholiperäisten sairauksien seulonnassa. Terveydenhuollon tulisi panostaa alkoholisairauksien ehkäisyyn, jotta alkoholiperäistä sairastavuutta, tehohoitoresurssien kulutusta ja työikäisen väestön kuolleisuutta voitaisiin vähentää
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Randomized, Double-Blind Trial of the Effect of Fluid Composition on Electrolyte, Acid-Base, and Fluid Homeostasis in Patients Early After Subarachnoid Hemorrhage.
Full text linkHyper- and hyponatremia are frequently observed in patients after subarachnoidal hemorrhage, and are potentially related to worse outcome. We hypothesized that the fluid regimen in these patients is associated with distinct changes in serum electrolytes, acid-base disturbances, and fluid balance
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