113 research outputs found
Kardioloogia. Teade Eesti Kardioloogide Seltsilt: Uuenenud müokardiinfarkti kolmas universaalne definitsioon
No full textEesti Arst 2017; 96(2):113–11
Toomas Pauli keerulised küsimused
No full textThe difficult questions of Toomas PaulToomas Paul, born in Tartu in 1939, is a prominent theologian,church historian, New Testament scholar and translator, as wellas an essayist, and a member of Academia Scientiarum et ArtiumEuropaea. He took part in the preparation of the Porvoo CommonStatement (1992) and attended the Lutheran-Orthodox Joint Commissionfor 12 years. Paul has published 19 books and countless articles,and still often gets press coverage concerning current problemsin different fields. He is deeply interested in science and culture andhas held a constant dialogue with physicists, neurologists, historiansand other professionals. His sermons, articles, conversations on theradio and TV have always interested different communities due tohis intellectual spirit, wittiness, honesty and broad mental horizon.At the same time, his chosen topics can be uneasy (data leaks, migration,prostitution, etc.), he is equally critical towards totalitarian andconsumer societies, while he even censures some church activities.Paul studied in Tallinn and worked at eight parish churches inthe countryside from 1960 to 1986. From then on he served at StJohn’s Church in the centre of Tallinn, and, since 1989, at SutlepaChapel on the premises of the Estonian Open Air Museum.Among other things, Paul’s connection to Tartu is that his teacherand collaborator Uku Masing (1909–1985), whose legacy he interpretsand publishes to this day in cooperation with Tartu scholars,resided there. Paul received his doctoral degree (1994, on the historyof Bible translation in Estonia) at the University of Tartu and hastaught at and been a member of the Religious Anthropology ProgramCommittee. Rector Volli Kalm, who presented Paul with the NationalThought Award on behalf of the University of Tartu, called Paul acustodian of basic values and stressed his importance in shaping socialmentality. Paul has been awarded many other prizes.In the article, I present biographical data and briefly characterizePaul as a reader and interpreter of theologians and philosophers likeMeister Eckhart or Spinoza, scientists and others, as well as an author. I am also publishing an unique questionnaire that he presentedto his audience already in the 1960s as a young cleric, and outline thedifficult questions about religion he has raised in his publications.I quote other authors and archival sources of the Consistory of theEstonian Evangelical Lutheran Church, adding passages from Paul’spersonal archives and our correspondence to show why he is highlyrecognised in both the religious and secular societies of Estonia
Use of evidence-based pharmacotherapy after myocardial infarction in Estonia
No full textAbstract Background Mortality from cardiovascular disease in Estonia is among the highest in Europe. The reasons for this have not been clearly explained. Also, there are no studies available examining outpatient drug utilization patterns in patients who suffered from acute myocardial infarction (AMI) in Estonia. The objective of the present study was to examine drug utilization in different age and gender groups following AMI in Estonia. Methods Patients admitted to hospital with AMI (ICD code I21-I22) during the period of 01.01.2004-31.12.2005 and who survived more than 30 days were followed 365 days from the index episode. Data about reimbursed prescriptions of beta-blockers (BBs), angiotensin converting enzyme inhibitors/angiotensin II receptor blockers (ACE/ARBs) and statins for these patients was obtained from the database of the Estonian Health Insurance Fund. Data were mainly analysed using frequency tables and, where appropriate, the Pearson's χ2 test, the Mann-Whitney U-test and the t-test were used. A logistic regression method was used to investigate the relationship between drug allocation and age and gender. We presented drug utilization data as defined daily dosages (DDD) per life day in four age groups and described proportions of different combinations used in men and women. Results Four thousand nine hundred patients were hospitalized due to AMI and 3854 of them (78.7%) were treated by BBs, ACE/ARBs and/or statins. Of the 4025 inpatients who survived more than 30 days, 3799 (94.4%) were treated at least by the one of drug groups studied. Median daily dosages differed significantly between men and women in the age group 60-79 years for BBs and ACE/ARBs, respectively. Various combinations of the drugs studied were not allocated in equal proportions for men and women, although the same combinations were the most frequently used for both genders. The logistic regression analysis adjusted to gender and age revealed that some combinations of drugs were not allocated similarly in different age and gender groups. Conclusions Most of the patients were prescribed at least one of commonly recommended drugs. Only 40% of them were treated by combinations of beta-blockers, ACE inhibitors/angiotensin II receptor blockers and statins, which is inconsistent with guideline recommendations in Estonia. Standards of training and quality programs in Estonia should be reviewed and updated aiming to improve an adherence to guidelines of management of acute myocardial infarction in all age and gender groups.</p
Müokardiinfarkti neljas universaalne definitsioon
No full textEuroopa Kardioloogide Seltsi juhendmaterjal, tunnustanud ja kohandanud Eesti Kardioloogide Selts, Eesti Laborimeditsiini Ühing ja Eesti Radioloogia Ühing
Äge müokardiinfarkt Eestis 2001–2014: suund riskipõhisele ennetusele ja ravile
No full textVäitekirja elektrooniline versioon ei sisalda publikatsiooneSüdame-veresoonkonna haiguste, eelkõige südame isheemiatõvest ja südamelihase infarktist põhjustatud suremus Eestis on viimastel aastakümnetel langenud, kuid on jätkuvalt Euroopa keskmisest kõrgem. Suremuse edasine langetamine eeldab tõhusamat infarkti ennetamist ja paremat ravi.
Ennetuse nurgakiviks on kõrgeima haigestumisriskiga inimeste kindlaks tegemine ja neile ennetava ravi pakkumine, et vähendada infarkti haigestumise tõenäosust. Ravijuhised soovitavad selleks kasutada riski hindamise skoore, mis ennustavad riskifaktorite esinemise põhjal haigestumise tõenäosust. Riskihinnangu alusel otsustatakse ennetava ravi vajadus – kõrgem risk eeldab varasemat ja tõhusamat sekkumist. Riskiskoorid on välja töötatud madalama südame-veresoonkonna haiguste levimusega arenenud riikides ning seni ei ole nende sobivust Eesti rahvastikul hinnatud. Doktoritöö tulemusel selgus, et kolmest riskiskoorist kaks – Euroopas kasutatav SCORE ja Ameerika PCE sobivad südame-veresoonkonna haiguste riski hindamiseks Eestis. Suurbritannia QRISK2 alahindas oluliselt haigestumise tõenäosust ja seega vajaks enne kasutamist kohandamist Eesti oludele.
Doktoritöös hinnati ka südamelihase infarktiga patsientide ravi kvaliteeti Eestis 2001–2014. Kuigi patsientide keskmine vanus ja kaasuvate haiguste esinemise sagedus kasvasid, paranes oluliselt infarktijärgne elulemus, mida võib seostada ravijuhistes soovitatud kaasaegse ravi paranenud kättesaadavusega. Uuringuperioodi jooksul ühtlustusid infarkti ravikvaliteet ja -tulemused Eestis – 2011. aastaks ei sõltunud ellujäämise tõenäosus enam sellest, kas patsient pöördus esmaselt piirkondlikku või kohalikku haiglasse. Probleemina tõi töö välja nn. ”riski-ravi paradoksi”, mille kohaselt kõrgeima riskiga patsiente ravitakse vähem tõhusalt võrreldes madalama riskiga haigetega. Seega, infarktijärgse elulemuse edasiseks parandamiseks tuleb enam tähelepanu pöörata kõrgeima riskiga, sealhulgas eakate, suhkrutõve ja neerupuudulikkusega patsientide ravile.Mortality from cardiovascular disease, more specifically ischaemic heart disease and myocardial infarction, has shown substiantial decrease over the last decades in Estonia, but remains higher than an European average. More effective prevention and improved treatment after MI should be a priority to achieve better outcomes.
The cornerstone of prevention is identifying the highest risk individuals and treating them to reduce the risk of developing myocardial infarction. The intensity of preventive therapy should match the individual’s risk level – higher risk warrants more intensive treatment and guidelines recommend using risk scores for risk estimation. However, the predictive ability of risk scores has not been previously evaluated in Estonia. The current study found that the US PCE (Pooled Cohort Equations) and European SCORE performed at acceptable level in their original form and should be used for guiding management decisions in the prevention of cardiovascular disease. The UK QRISK2 markedly underestimated the risk and requires modification prior to use.
There has been an increase in the use of guideline-recommended therapies in myocardial infarction treatment over the period of 2001–2014 in Estonia. The current study showed an improved survival after myocardial infarction over the same time course, which was seen despite the increased mean age of the patients and rising burden of other diseases. Paradoxically, the improvement in treatment quality was more pronounced in patients with lower baseline mortality risk, while patients with higher mortality risk received less guideline-recommended treatments. The study also demonstrated the equalization of treatment quality between Estonian secondary and tertiary care hospitals – by the year 2011 the prognosis did not depend on the hospital type where a patient with myocardial infarction was initially hospitalized.
https://www.ester.ee/record=b523171
Registriandmetest kliinilisse praktikasse: müokardiinfarkti käsitlus ja ennetus Eestis ja Euroopas
No full textDoktoritöö elektrooniline versioon ei sisalda publikatsiooneEestis on südamelihaseinfarkti (müokardiinfarkti, MI) järgne suremus viimastel kümnenditel langenud, kuid langus on olnud aeglasem kui Põhjamaades ning viimasel ajal veelgi pidurdunud. Üks põhjus peitub patsientides: erakorraliselt jõuab haiglasse üha rohkem nooremaid kõrge metaboolse riskiga inimesi (ülekaalulised, II tüüpi diabeediga, kõrge vererõhuga patsiendid) ning samal ajal lisandub väga eakaid ja mitmete kaasuvate haigustega patsiente. „Tüüpilist“ MI-patsienti kohtab üha harvem; erinevad riskiprofiilid vajavad erinevaid lahendusi. Eesti suurim kasutamata võimalus on süstemaatiline järelravi ja sekundaarne preventsioon - st uue MI ja surma ennetamine järjekindla medikamentoosse ravi, taastusravi ja selgete ravieesmärkide abil.
Oma doktoritöös uuris kardioloog Piret Asser Eesti Müokardiinfarktiregistri (EMIR) andmeid ja võrdles neid Rootsi, Norra ja Ungari registritega. Eestis on ägeda seisundi ravi haigla etapil selgelt paranenud, paraku aga tekivad lüngad edasises käsitluses. Võrreldes Põhjamaadega püsib MI järgne pikaajaline suremus kõrgem — selle põhjuseks on liiga hiline abi otsimine, kõrge riskiga MI-patsientide alaravi ja ebaühtlane järelravi.
Uurimustöö toob esile ka südame ja neerude vahelise seose. Isegi kerge neerufunktsiooni langus noorematel MI-patsientidel seostub kõrgema suremusega. Vanemaealistel hoiavad absoluutset riski kõrgel muud haigused. Kuna neerud aitavad reguleerida vererõhku, vedelikutasakaalu ja põletikku, võimendab halvenev neerutalitlus vaikselt südame-veresoonkonna riski.
Põhjamaade kogemusest on palju õppida: haiglast väljakirjutamine on alles stardipauk, mitte finiš. Taastusravi on standard, mitte erand; sellele järgneb selge jälgimisplaan koos isiklike eesmärkidega vererõhu, LDL kolesterooli ja veresuhkur väärtuste jaoks ning süsteemne, registriandmetel põhinev tagasiside. Eesti liigub samas suunas ja patsientide ravijärgimine on paranenud, kuid ühtne üleriigiline MI patsienditeekond on veel väljakujunemisel. Suurima võidu MI järgse suremuse langetamisel saame pärast haiglaravi: süsteemsest järelkontrollist, taastusravist ja jõulisest sekundaarse preventsiooni rakendamisest.Post–heart attack (myocardial infarction, MI) mortality in Estonia has fallen over recent decades, but the decline is slower than in the Nordic countries and has lately lost pace. One reason is a changing patient mix: emergency rooms see more younger people with high metabolic risk (patients who are overweight, with type 2 diabetes and high blood pressure) alongside very elderly patients with multiple conditions. The “typical” MI patient is rare; different risk profiles need different solutions. Estonia’s biggest unused lever is systematic post-MI follow-up and secondary prevention.
In her PhD thesis, cardiologist Piret Asser investigated data from the Estonian Myocardial Infarction Registry (EMIR) and compared it with registries from Sweden, Norway and Hungary. Estonia’s acute hospital care has improved markedly: the path from ambulance to catheterisation is shorter, blocked arteries are opened faster, and evidence-based medicines reach patients more reliably. The gap appears after discharge. Compared with the Nordics, long-term mortality remains higher, driven by delays in seeking help, undertreatment of high-risk patients, and uneven follow-up.
The thesis also underscores the heart–kidney link. Even mild kidney impairment in younger MI patients is associated with higher mortality. In older adults, other illnesses keep absolute risk high. Because the kidneys regulate blood pressure, fluid balance and inflammation, declining renal function quietly amplifies cardiovascular risk.
Nordic experience shows what works: after MI, discharge is only the starting line, rehabilitation as standard, follow-up plans with personal targets, and registry-based feedback. Estonia is moving this way and medication adherence has improved, yet a consistent, nationwide aftercare pathway is still taking shape. The next big gains will come after the hospital—from organised follow-up, rehabilitation and steadfast secondary prevention.https://www.ester.ee/record=b597348
Optimization of parcel machine routes on the example of AS Eesti Post Tallinn courierpoint
No full textAntud lõputöös uuris autor tänast pakiautomaadi veoringide ülesehitust, saadetiste mahte ja veovahendite mahutavust Omniva Tallinna kullerpunkti näitel. Lõputöö eesmärk oli leida uue hanketsükli jaoks efektiivsed ja optimaalsed veoringid pakiautomaatide teenindamiseks.
Lõputöö teoreetilises osas anti ülevaade pakiautomaatide viimase miili logistika teoreetilisest poolest. Lisaks uuris autor veebipõhiste optimeerimistarkvarade näitel, kas ja millised tarkvarad on saadaval ilma takistava maksumüürita. Võimalikuks sobivaks tarkvaraks osutus autori valikul OptimoRoute rakendus, mille kohta tegi autor ka lühiülevaate.
Teises peatükis andis autor üldise ülevaate Omnivast ning tutvustas olemasolevat Omniva Tallinna kullerpunkti teenindatavat pakiautomaatide võrgustikku ja veoringide ülesehitust.
Lõputöö empiirilises osas leidis autor lahendused järgmistele uurimisküsimustele:
• milline on tänase pakimahu olukorras veoringide efektiivsus;
• millised on tuleviku hanketsükli jaoks optimaalsed pakiautomaadi veoringid;
• milline on potentsiaalne kokkuhoid või täiendav kulu koostööpartnerite kasutamisel võrreldes Omniva omatööjõu kasutamisega.
Lisaks proovis autor kasutada valitud OptimoRoute tarkvara püstitatud ülesande lahendamisel, kas ja kui hästi sobib antud tarkvara Omniva Tallinna kullerpunkti veoringide analüüsiks ja optimeerimiseks. Käesoleva ülesande lahendamisel leidis autor, et antud tarkvara kasutamine ei ole ilma täispaketti ostmata võimalik. Autori arvates ei ole selle ülesande lahendamiseks mõistlik antud tarkvara litsentsi soetada, kuna pakiautomaadi veoringide planeerimisel on tegemist kohtkindlate aadresspunktidega, mis on päevast päeva samad ning piisab ainult ühekordsest optimeerimisest.
Töö tulemusena leidis autor, et tänased olemasolevad pakiautomaatide veoringid vajavad muutmist, kuna veoringide pakimahud on liiga kõrged ja tööajad liiga pikad. Pärast uute veoringide moodustamist teostas autor kuluarvutused koostööpartnerite ja Omniva omatööjõu kasutamise kohta. Arvutuse tulemusel leidis autor, et koostööpartnerite kasutamine on soodsam kui omatööjõu kasutamine.In the thesis, the author studied the structure of parcel machine transport routes and the volume and quality of shipments on the example of Eesti Post AS, i.e. Omniva, Tallinn courier point. The aim of the thesis was to find efficient and optimal transport routes for servicing the parcel machines for the new procurement cycle.
In the theoretical part of the thesis, an overview was given on the theoretical background of the last mile logistics of parcel machines. In addition, on the example of web-based optimization software, the author investigated whether and which, if any, software is available to use without an impeding tax wall. The author chose the OptimoRoute application as a software most likely suitable for the analysis, of which a brief overview was given by the author.
In the second chapter, the author gave a general overview of Omniva and introduced the existing network of parcel machines serviced by Omniva Tallinn courier point as well as the structure of the existing transport routes.
In the empirical part of the thesis, the author found solutions to the following research questions:
• what is the efficiency of transport routes in the case of current package volumes;
• what are the optimal parcel machine routes for the upcoming procurement cycle;
• what are the potential savings or additional costs of using cooperation partners compared to using Omniva's own workforce.
In addition, the author attempted to use the previously selected OptimoRoute software for solving the set task of whether and how suitable the software is for the analysis and optimization of the routes of Omniva Tallinn courier point.
In the process of attempting to solve the task, the author discovered that using the software is not possible without purchasing the full package. Per author's opinion, it is not reasonable to acquire a license for the software in order to solve the task, as planning parcel machine routes is based on location-specific address points which remain unchanged on a day-to-day basis, due to which a one-time optimization is sufficient.
As a result of the thesis, the author found that the current routes for parcel machines should be changed, as the delivery volumes of the routes are too high and the working hours are too long. After the formation of new routes, the author performed cost calculations on the use of cooperation partners and Omniva's own workforce. As a result of the calculation, the author found that the use of cooperation partners is less expensive than the use of own workforce
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