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When studying emergency department (ED) visits, electronic health record systems of hospitals provide a good basis for retrospective studies. However, many intoxication patients presenting to the ED, may not be identified retrospectively if only a single search method is applied. In this study, a new four-way combined patient search method was used to retrospectively identify intoxication patients presenting to the ED. The search included reason for admission to the ED, laboratory results related to intoxication diagnostics, ICD-10 codes, and a novel free word search (FWS) of patient records. After the automated search, the researcher read the medical records of potential substance abuse patients to form comprehensive profiles and remove irrelevant cases. The addition of a free word search identified 36% more substance abuse patients than the combination of the other three methods mentioned above. Patients identified by the FWS search alone were generally admitted to the ED for trauma or mental health problems and were often found to be heavily under the influence of alcohol and/or drugs. The main intoxicants were ethanol and benzodiazepines. The free word search was highly complementary to traditional patient search methods, highlighting the importance of the combined patient search method in retrospective data collection. [ABSTRACT FROM AUTHOR]

The current evidence suggests that higher levels of crowding in the Emergency Department (ED) have a negative impact on patient outcomes, including mortality. However, only limited data are available about the association between crowding and mortality, especially for patients discharged from the ED. The primary objective of this study was to establish the association between ED crowding and overall 10-day mortality for non-critical patients. The secondary objective was to perform a subgroup analysis of mortality risk separately for both admitted and discharged patients. An observational single-centre retrospective study was conducted in the Tampere University Hospital ED from January 2018 to February 2020. The ED Occupancy Ratio (EDOR) was used to describe the level of crowding and it was calculated both at patient's arrival and at the maximum point during the stay in the ED. Age, gender, Emergency Medical Service transport, triage acuity, and shift were considered as confounding factors in the analyses. A total of 103,196 ED visits were included. The overall 10-day mortality rate was 1.0% (n = 1022). After controlling for confounding factors, the highest quartile of crowding was identified as an independent risk factor for 10-day mortality. The results were essentially similar whether using the EDOR at arrival (OR 1.31, 95% CI 1.07–1.61, p = 0.009) or the maximum EDOR (OR 1.27, 95% CI 1.04–1.56, p = 0.020). A more precise, mortality-associated threshold of crowding was identified at EDOR 0.9. The subgroup analysis did not yield any statistically significant findings. The risk for 10-day mortality increased among non-critical ED patients treated during the highest EDOR quartile. [ABSTRACT FROM AUTHOR]

Background: Emergency Medicine (EM) is an independent specialty in all five Nordic countries. This study aims to evaluate the structure of post-graduate EM training in the area. Methods: A leading hospital or hospitals in EM training in each country were identified. An e-survey was sent to each hospital to gather data on patient volume and physician staffing, curriculum, trainee supervision, and monitoring of progression in training. Results: Data were collected from one center in Iceland and Norway, two in Finland and Sweden, and four centers in Denmark. The data from each country in Denmark, Finland, and Sweden, were pooled to represent that country. The percentage of consultants with EM specialist recognition ranged from 49–100% of all consultants working in the participating departments. The number of patients seen annually per each full time EM consultant was almost three times higher in Finland than in Sweden. In Iceland, Denmark, and Sweden a consultant was present 24/7 in the ED but not in all centers in the other countries. The level of trainee autonomy in clinical practice varied between countries. Requirements for completing standardized courses, completing final exams, scientific and quality improvement projects, and evaluation of trainee progression, varied between the countries. Conclusions: All Nordic countries have established EM training programs. Despite cultural similarities, there are significant differences in how the EM training is structured between the countries. Writing and implementing a standardized training curriculum and assessment system for EM training in the Nordic countries should be considered. [ABSTRACT FROM AUTHOR]

Emergency department (ED) crowding is a well-recognized threat to patient safety and it has been repeatedly associated with increased mortality. Accurate forecasts of future service demand could lead to better resource management and has the potential to improve treatment outcomes. This logic has motivated an increasing number of research articles but there has been little to no effort to move these findings from theory to practice. In this article, we present first results of a prospective crowding early warning software, that was integrated to hospital databases to create real-time predictions every hour over the course of 5 months in a Nordic combined ED using Holt-Winters' seasonal methods. We show that the software could predict next hour crowding with an AUC of 0.94 (95% CI: 0.91-0.97) and 24 hour crowding with an AUC of 0.79 (95% CI: 0.74-0.84) using simple statistical models. Moreover, we suggest that afternoon crowding can be predicted at 1 p.m. with an AUC of 0.84 (95% CI: 0.74-0.91). [ABSTRACT FROM AUTHOR]

To study whether systemic hemodynamics, especially systemic vascular resistance, predicts the development of hypertension and improves the risk prediction of incident hypertension beyond common risk factors in the risk models in young adults. Typical risk factors for hypertension in the risk prediction models (systolic and diastolic blood pressure, parental history of hypertension, age, sex, body-mass index, smoking), laboratory values (high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, glucose, insulin, C-reactive protein), heart rate (HR), stroke index (SI), and systemic vascular resistance index (SVRI) calculated by whole-body impedance cardiography were evaluated in 2007 and blood pressure in 2011 in 1293 Finnish adults (aged 30–45 years; females 56%; n = 1058 normotensive in 2007). Of hemodynamic variables, SVRI and HR evaluated in 2007 were independently associated with systolic blood pressure (p < 0.001 and p = 0.047, respectively) and SVRI with diastolic blood pressure measured in 2011 (p = 0.014), and SVRI and HR were independent predictors of incident hypertension (p < 0.001 and p = 0.024, respectively). SVRI was the most significant predictor of incident hypertension independently of other risk factors (odds ratio 2.73 per 1 standard deviation increase, 95% confidence interval 1.93–3.94, p < 0.001). The extended prediction model (including SVRI) improved the incident hypertension risk prediction beyond other risk factors, with an area under the receiver operating characteristic curve of 0.846 versus 0.817 (p = 0.042) and a continuous net reclassification improvement of 0.734 (p < 0.001). These findings suggest that systemic vascular resistance index predicts the incidence of hypertension in young adults and that the evaluation of systemic hemodynamics could provide an additional tool for hypertension risk prediction. [ABSTRACT FROM AUTHOR]

Purpose: High pulse wave velocity (PWV), a marker of increased arterial stiffness, and an exaggerated exercise blood pressure (EEBP) response during an exercise test have both been related to an increased risk of hypertension and cardiovascular events. Contradictory results have been published about the association between these two parameters, and their relation in healthy young adults is unknown. Materials and methods: This study consisted of 209 young adults (mean age 38 years) who participated in the ongoing Cardiovascular Risk in Young Finns Study between 2007 and 2009. We measured resting PWV with impedance cardiography in 2007, and participants performed a maximal cardiopulmonary exercise test with blood pressure (BP) measurements at rest, during exercise and during recovery in 2008–2009. Results: High PWV (≥age- and sex-specific median) at baseline was associated with EEBP (SBP >210 mmHg for men and >190 mmHg for women) an average of 14 months later and with systolic BP during different stages of exercise from rest to peak and recovery (during peak exercise, β ± SE was 4.1 ± 1.1, p < 0.001). The association between high PWV and systolic BP remained after adjustment for traditional cardiovascular risk factors and other exercise parameters (during peak exercise, β ± SE was 2.3 ± 1.1, p = 0.04). Conclusions: Increased arterial stiffness predicts EEBP during a maximal exercise test in young adults during all stages of exercise from rest to peak and recovery. PWV could provide an additional tool for EEBP risk evaluation. [ABSTRACT FROM AUTHOR]

Introduction:Although metabolic syndrome (MetS) is evidently associated with the risk of cardiovascular disease (CVD), recently its use has been questioned. We studied the utility of MetS diagnosis when estimating individual CVD risk. Methods:We compared 27 fertile women with MetS and 27 counterparts without the syndrome, matched pairwise according to well-known risk factors of CVD. Pulse wave velocity (PWV) and central blood pressure (cBP) were determined noninvasively via a SphygmoCor device. Arterial compliance was measured noninvasively with an HDI/PulseWaveTMCR-2000 arterial tonometer. Results:PWV (7.1 ± 2.5 versus 6.5 ± 1.1 m/s,p = .037), and both systolic (120.9 ± 12.2 versus 111.5 ± 16.0 mmHg,p = .031) and diastolic cBP (81.3 ± 8.5 versus 74.1 ± 11.2 mmHg,p = .035) were higher in the MetS group. Systemic arterial compliance values were lower in both large (15.1 ± 8.0 versus 16.1 ± 4.4 mL/mmHg × 10,p = .034) and small arteries (7.1 ± 2.5 versus 9.3 ± 3.2 mL/mmHg ×100,p = .010) in women with MetS. Conclusions:Fertile women with MetS had increased arterial stiffness, as measured by three different methods. Our results highlight the utility of MetS when revealing increased individual CVD risks in fertile-aged women.Key messagesWomen with MetS have increased arterial stiffness when measured by different methods.MetS is a useful clinical tool to assess increased cardiovascular risk, particularly among fertile-aged women. [ABSTRACT FROM PUBLISHER]

Objective. Limited data are available regarding the relationship of thyrotropin (TSH) and arterial pulse wave velocity (PWV) at population level. Therefore, we conducted the present study to determine whether TSH is related to PWV assessed in young adulthood. Methods. The study population consisted of 1598 Finnish white young adults (aged 30-45 years, 47.4% males) who had TSH, traditional cardiovascular risk factors, and PWV measured in 2007. PWV measurements were performed using a whole-body impedance cardiography device. Results. In bivariate association analyses, TSH level was significantly associated with body mass index (BMI), smoking, diastolic blood pressure, triglyceride and insulin levels ( p < 0.001). In multivariable regression model, TSH (β = 0.055, p = 0.015) was associated with PWV when adjusted with age (β = 0.295, p < 0.001) and sex (β = 0.345, p < 0.001). The association of TSH with PWV was however diluted to non-significant after further adjustment with traditional risk factors (β = 0.027, p = 0.218 for TSH). Conclusion. Serum TSH was associated with PWV on population level when adjusted with age and sex. This association was diluted when cardiovascular risk factors were added in the model, suggesting that the association of thyroid hormone on arterial stiffening is not independent of changes in the traditional risk factor levels. [ABSTRACT FROM AUTHOR]

Summary Objective: To introduce and evaluate a new haemodynamic parameter known as arterial tension time (ATT) and study whether ATT is associated with traditional cardiovascular risk factors as well as with indices of arterial stiffness, cardiac pump function and subclinical atherosclerosis. Methods: Arterial tension time was measured from the whole-body impedance cardiography (ICG) signal and defined as the time difference between the onset of arterial distension induced by stroke volume (SV) and maximal integrated arterial distension. As measures of subclinical atherosclerosis and arterial stiffness, carotid artery intima-media thickness (IMT), Young's elastic modulus (YEM), arterial stiffness index (ASI) and carotid artery compliance (CAC) were assessed with ultrasound in 336 Finnish adults (aged 46-76 years, 43·2% men) participating in the Health 2000 Survey. In addition, pulse wave velocity (PWV) and stroke volume index (SI), as indices of arterial stiffness and cardiac pump function, were assessed with ICG. Results: Arterial tension time was associated inversely with PWV, IMT, YEM and ASI ( P<0·002 for all) and directly with SI and CAC ( P<0·001 for both). Age, systolic blood pressure, diastolic blood pressure and fasting glucose were independent determinants of decreased ATT ( P<0·04 for all). Moreover, accumulation of cardiovascular risk factors was associated with the decrease in ATT ( P for trend <0·001). Conclusion: Decreased ATT was associated with increased arterial stiffness, increased subclinical atherosclerosis and decreased SV. Current results suggest that ATT provides simultaneous information on several aspects of cardiovascular structure and function and could possibly serve as a new integrated parameter for cardiovascular risk stratification. [ABSTRACT FROM AUTHOR]

Objective. We conducted the present study to examine the associations of two different paediatric metabolic syndrome (MetS) definitions and recovery from childhood MetS with arterial pulse wave velocity (PWV), an index of arterial stiffness, measured in adulthood. Methods. A total of 945 subjects participated in the base-line study in 1986 (then aged 9--18 years) and the adult follow-up in 2007 (then aged 30--39 years). Cardiovascular risk factor data were available at both base-line and follow-up. In the follow-up study, arterial PWV was measured using a whole-body impedance cardiography device. Results. Subjects suffering from MetS in childhood (prevalence 11.1%--14.1%) had higher arterial PWV after 21-year follow-up when compared with those not afflicted by the syndrome in childhood ( P < 0.007). An increasing number of the MetS components in childhood were associated with increased PWV in adulthood ( P for trend == 0.005). Subjects who recovered from the MetS during the 21-year follow-up period had lower PWV than those with persistent MetS ( P < 0.001). Conclusion. MetS in childhood predicted increased arterial stiffness in adulthood, and recovery from childhood MetS was associated with decreased arterial PWV in adulthood. The current results emphasize the importance of the prevention and controlling of MetS risk factors both in childhood and adulthood. [ABSTRACT FROM AUTHOR]

Objective. We conducted the present study to examine associations of three different metabolic syndrome (MetS) definitions and their components to arterial stiffness, systemic vascular resistance, and left ventricular function at population level. In addition, the objective of the study was to examine associations of spontaneous recovery from MetS over 6 years' follow-up to systemic hemodynamics. Methods. The study population consisted of 1,741 Finnish young adults (aged 30-45 years) who had complete MetS risk factor and hemodynamic data available at 2007. Associations of spontaneous recovery from MetS to systemic hemodynamics was studied on a subpopulation of 1,391 subjects who had also complete MetS risk factor data available at 2001. Hemodynamic measurements were performed using a whole-body impedance cardiography device. Results. MetS and increasing number of MetS components were associated with lower stroke index ( P < 0.001) and higher systemic vascular resistance index ( P < 0.005) and arterial pulse wave velocity ( P < 0.005). In MetS persistent group, stroke index was lower ( P = 0.024), and pulse wave velocity was higher ( P = 0.003) compared to MetS recovery group. Conclusion. All current MetS definitions identify young adults with altered systemic hemodynamics, and recovery from MetS is associated with a favorable hemodynamic profile. [ABSTRACT FROM AUTHOR]

The stiffening of arteries is associated with various cardiovascular diseases. Arterial stiffening can be studied utilizing arterial pulse wave velocity (PWV), but the absence of reliable reference values for PWV has limited its use in clinical practice. The aim of this study was to establish a range of reference values for PWV. PWV was examined by measuring the time difference of systolic pulse waves in arteries from the aortic arch to the popliteal artery using whole-body impedance cardiography (ICG). The study population consisted of 799 individuals (age range 25–76 years), 283 of whom had no evidence of cardiovascular disease, and a low burden of risk factors was selected to represent an apparently healthy population. In healthy study population, PWV was higher in males (8·9 ± 1·8 m s−1) than females (8·1 ± 2·0 m s−1, P<0·001). Young males had lower PWV values than old males. Correspondingly, young females also had lower PWV values than old females. PWV was clearly associated with age, and PWV was higher in young and middle-aged males than in females. There was no statistically significant difference between old males and females in PWV. In conclusion, whole-body ICG provides a practical method for PWV measurement. Reference values can be useful in the clinical management of patients, especially in detecting early vascular disease or an increased risk of cardiovascular complications. [ABSTRACT FROM AUTHOR]

This paper presents a comparative analysis of novel supervised fuzzy adaptive resonance theory (SF-ART), multilayer perceptron (MLP) and Multi Layer Perceptrons (MLP) neural networks over Ballistocardiogram (BCG) signal recognition. To extract essential features of the BCG signal, we applied Biorthogonal wavelets. SF-ART performs classification on two levels. At first level, pre-classifier which is self-organized fuzzy ART tuned for fast learning classifies the input data roughly to arbitrary (M) classes. At the second level, post-classification level, a special array called Affine Look-up Table (ALT) with M elements stores the labels of corresponding input samples in the address equal to the index of fuzzy ART winner. However, in running (testing) mode, the content of an ALT cell with address equal to the index of fuzzy ART winner output will be read. The read value declares the final class that input data belongs to. In this paper, we used two well-known patterns (IRIS and Vowel data) and a medical application (Ballistocardiogram data) to evaluate and check SF-ART stability, reliability, learning speed and computational load. Initial tests with BCG from six subjects (both healthy and unhealthy people) indicate that the SF-ART is capable to perform with a high classification performance, high learning speed (elapsed time for learning around half second), and very low computational load compared to the well-known neural networks such as MLP which needs minutes to learn the training material. Moreover, to extract essential features of the BCG signal, we applied Biorthogonal wavelets. The applied wavelet transform requires no prior knowledge of the statistical distribution of data samples. [ABSTRACT FROM AUTHOR]