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Search Results: 1 - 10 of 81 matches for " Reijo Sund "
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Modeling the volume-effectiveness relationship in the case of hip fracture treatment in Finland
Reijo Sund
BMC Health Services Research , 2010, DOI: 10.1186/1472-6963-10-238
Abstract: Data consisting of 22,857 hip fracture patients from 52 hospitals in Finland in 1998-2001 were extracted from the administrative registers. The relationship between hospital and rehabilitation unit volumes and effectiveness was examined using a statistical model that allowed risk adjustments and hierarchical modeling of volume trends, developed for the purposes of this study. Four-month mortality and the alternative register-based measure of maintainability were used as effectiveness indicators.No clear relationship was found between hospital volume and the effectiveness of hip fracture treatment, but a novel result showing an association between the rehabilitation unit volume and effectiveness was detected. The face validity of the maintainability indicator seemed to be acceptable.The methodological ideas presented allow for improved examination of the volume-effectiveness relationship. There are no indications that patients with hip fractures should only be treated in high-volume hospitals, though it may be beneficial to centralize the rehabilitation of hip fracture patients to specialized units.A common argument in the recent health policy debate is that treatment is more effective among care providers with large volumes. A wealth of empirical evidence also demonstrates improved effectiveness with selected procedures at high-volume hospitals and by high-volume surgeons [1-4]. It has been suggested that experience or routine (individual and organizational learning), patient selection (better outcomes lead to higher volumes), and the availability of supplementary services (more structure-related resources) may play a part in the relationship between volume and effectiveness, and many of these aspects probably hold true across several health system implementations [5-8]. It has been claimed, however, that the health care provider volume is a nonspecific, indirect, and unreliable measure of provider performance, and a causal relationship between volume and effectiven
Utilization of routinely collected administrative data in monitoring the incidence of aging dependent hip fracture
Sund Reijo
Epidemiologic Perspectives and Innovations , 2007, DOI: 10.1186/1742-5573-4-2
Abstract: Societies are facing challenges as the public health burden increases in tandem with population aging. Local information systems are needed that would allow a continuous monitoring of the incidence and effectiveness of treatments. This study investigates the possibilities of routinely collected administrative data as a data source for hip fracture incidence monitoring in Finland. The study demonstrates that a straightforward use of register data results in biased estimates for the numbers of hip fractures. An interpretation of hip fractures from the population aging point of view offers an alternative perspective for hip fracture incidence calculation. This enables development of a generalizable method for probabilistic detection of starting points of hip fracture care episodes. Several risk factor and risk population extraction techniques required in register-based data analyses are also demonstrated. Finally, it is shown that empirical evidence suggests that hip fracture incidence is proportional to population level disability prevalence. In conclusion, Finnish administrative data makes it possible to derive data for rather detailed population level risk factor stratification. Certain limitations of register-based data can be partly avoided by synthesizing data-sensitive methodological solutions during the analysis process.
Pathways leading to coronary revascularisation among patients with diabetes in Finland: a longitudinal register-based study
Tuulikki Vehko, Reijo Sund, Kristiina Manderbacka, Unto H?kkinen, Ilmo Keskim?ki
BMC Health Services Research , 2011, DOI: 10.1186/1472-6963-11-180
Abstract: This retrospective, nationwide register-based study in Finland in 1998-2007 describes temporal trends in the proportions of 1) revascularisations performed at the first treatment period, and 2) suboptimal treatment pathways to revascularisations, i.e. pathways containing several cardiac emergency hospitalisations. Differences between patient groups were examined using a logistic regression model adjusting for age, comorbidity, and region.Among patients who underwent revascularisation, upward trends were found in the proportions of revascularisations performed during first hospital admission: among men with CHD alone, the percentages were 28% in 1998 and 77% in 2007; among men with insulin-dependent diabetes (IDD) they were 16% vs. 58% for the respective years; and among men with non-insulin dependent diabetes (NIDD) they were 25% vs. 69%, respectively. Among women the percentages were for non-diabetic group 32% vs. 77%; for IDD group 36% vs. 64%; and for NIDD group 33% vs. 73% for the respective years. Patients with diabetes were less likely to undergo revascularisation during the first hospital admission, in 2005-2007, the odds ratio (OR) for IDD among men was 0.52 (95% confidence interval 0.42-0.64) and for NIDD among men it was 0.79 (95% CI 0.73-0.86) compared to patients with CHD alone. The respective ORs among women were 0.59 (95% CI 0.44-0.78), and 0.83 (95% CI 0.74-0.93).Treatment practices changed substantially during the study period to favour performing revascularisation during the first hospital admission. The large increase in coronary angioplasty operations is likely to be an important factor behind these changes. However, fewer operations are performed during the first CHD hospitalisation of diabetic patients who undergo coronary revascularisation and they experience more often emergency hospital admissions before the operation than patients without diabetes. To avoid adverse cardiac events, more attention is needed in managing diabetic CHD patients' r
Simplified Approximate Expressions for the Boundary Layer Flow in Cylindrical Sections in Plankton Nets and Trawls  [PDF]
Svein Helge Gj?sund
Open Journal of Marine Science (OJMS) , 2012, DOI: 10.4236/ojms.2012.22009
Abstract: Trawls and plankton nets are basically made up of conical and cylindrical net sections. In conical sections the flow will pass through the inclined net wall with a noticeable angle of attack, and then the flow, filtration and drag can be suitably modelled e.g. by a pressure drop approach [1]. In cylindrical and other non-tapered net sections, such as foreparts and extension pieces in trawls and plankton nets, the flow is directed along the net wall and is best considered in terms of a boundary layer. Boundary layer theory and turbulence models can be used to describe such flow, but this requires extensive numerical modelling and computational effort. Simplified approximate formulas providing a qualitative description of the flow with some quantitative accuracy are therefore also useful. This work presents simplified parametric expressions for boundary layer flow in cylindrical net sections, including the boundary layer thickness and growth rate along the net, the filtration velocity out of the net wall, the decrease in mass flux through the net due to the growing boundary layer, and the effect of twine thickness, flow (towing) velocity and the dimensions of the net. These expressions may be useful for assessing the existence and extension of a boundary layer, for appropriate scaling of boundary layer effects in model tests, for proper placement of velocity measurement probes, for assessing the influence on filtration and clogging of plankton net sections, and more.
Pragmatism and activity theory: Is Dewey's philosophy a philosophy of cultural retooling?
Reijo Miettinen
Outlines : Critical Practice Studies , 2006,
Abstract: A philosopher of education, Jim Garrison, has suggested that John Dewey's philosophy is a philosophy of cultural retooling and that Dewey adopted both his conception of work and the idea of tool as "a middle term between subject and object” from Hegel. This interpretation raises the question of what the relationship of the idea of cultural retooling in Dewey’s work is to his naturalism and to his allegiance to Darwinian biological functionalism. To deal with this problem, this paper analyzes how the idea of cultural retooling is elaborated in Dewey’s logic and in his theory of reflective thinking and compares it to the concept of retooling in Vygotsky and activity theory. Dewey does recognize the significance of tools in human practice and the role of language in the formation of meaning. However, in his theory of thinking and problem solving, he primarily resorts to the biological or ecological language of the organism–environment, in which the concepts of habit and situation play a central role. It is argued that this language does not deal with the functions and relationships of different kinds of tools and artifacts in changes of activity nor supply satisfactory means of analyzing the historical, institutionalized and cultural dimensions of human activity.
Enthusiastic, realistic and critical: discourses of Internet use in the context of everyday life information seeking Internet, Everyday life, Information seeking, Discourse analysis, Interpretative repertoires, Information sources, Value, Use
Reijo Savolainen
Information Research: an international electronic journal , 2004,
Abstract: Based on the interviews of 18 participants, the ways in which people talk about their source preferences with regard to the Internet in everyday life information seeking were investigated by using discourse analysis. Three major interpretative repertoires were identified: Enthusiastic, Realistic and Critical. The Enthusiastic repertoire emphasizes the strengths of the Internet, conceiving it as a 'great enabler' or as a 'technology of freedom'. In this repertoire, positive expressions such as fast, easy and interactive are favoured. In the Realistic repertoire, the source preferences are constructed as situation-bound choices. The Internet is given no absolute priority but its value is seen to depend on the relative advantages in specific situations. No sources or channels are superior by themselves but their value is contingent on the use situation and its specific requirements. Finally, the Critical repertoire is characterized by a reserved standpoint to the advantages brought by the Internet. Central to this repertoire is the critical view on the low amount of relevant informationavailable in the Internet and the poor organization of networked information, rendering effective information seeking difficult. Due to their ideal-typical nature, the above repertoires are rather independent. However, in the everyday discursive practices, the repertoires are used alternately, and the same speaker may shift from one repertoire to another within the same account.
Media credibility and cognitive authority. The case of seeking orienting information
Reijo Savolainen
Information Research: an international electronic journal , 2007,
Abstract: Introduction. This article results from a qualitative case study focusing on the information seeking practices of environmental activists. The main attention was devoted to their perceptions of media credibility and cognitive authority in the context of seeking orienting information about environmental issues in particular. Method. The empirical data were gathered in 2005 by semi-structured interviews with twenty environmental activists in Finland. Analysis. The interview data were examined by means of qualitative content analysis by constantly comparing the articulations of media credibility and cognitive authority. Results. The perceptions of media credibility and cognitive authority tend to be dependent on the topic at hand. No specific cognitive authorities were recognized. Sources providing focused information issued by environmental asssociations were perceived as most credible. Newspapers were perceived as less credible due to their political bias and the general level of news reporting. The significance of one's own critical reflection was emphasized in the judgement of the credibility of information sources of various types. Conclusion. Perceived media credibility and cognitive authority significantly, though often implicitly, orient the selection of information sources. There is a need also to explore their role in the context of seeking problem-specific information, both job-related and non-work.
Photogrammetric methods applied to Svalbard glaciers: accuracies and challenges
Trond Eiken,Monica Sund
Polar Research , 2012, DOI: 10.3402/polar.v31i0.18671
Abstract: Use of digital images is expanding as a tool for glacier monitoring, and small-format time-lapse cameras are increasingly being used for glacier monitoring of fast-flowing glaciers. Stereoscopic imagery is preferable since it yields direct displacement results but stereo photogrammetry has more requirements regarding geometry in set-up and control points, as well as the additional cost of another complete camera system. We investigate a combination of methods to achieve satisfactory control of accuracy with resulting significant day-to-day velocity variations ranging from 1.5–4 m day 1 made at a distance of 2 km. Validation of results was made by comparing different methods, partly using the same image material, but also in combination with aerial and satellite images. Monoscopic results can also be used to gain continuity in a stereo data set when geometry or visibility is poor. We also explore the use of ordinary photographs taken from airliners for compilation of orthoimages as a potential low cost method for detection of sudden changes. The method, showing some tens of metres accuracy, was verified for monitoring velocities and front positions during a glacier surge and was also used to validate monoscopic time-lapse images.
Cosmopolitan perspectives on education and sustainable development
Louise Sund,Johan ?hman
Utbildning & Demokrati : Tidsskrift f?r Didaktik och Utbildningspolitik , 2011,
Abstract: In this paper we draw attention to the possibilities of the philosophical perspectives of cosmopolitanism in the development of ESD. We argue that one challenge facing the development and implementation of ESD is the finding of balanced ways to deal with the normativity dilemma that take both the search for consensus and universal claims and particular contexts and dissensionseriously. The paper begins with a brief sketch of environmental andsustainability education in transition and a problematisation of the universal characteristics of ESD. Drawing on the recent works of Martha C. Nussbaum, Peter Kemp, Kwame Anthony Appiah and Sharon Todd, we then explore how scholars with different cosmopolitanism approaches balance between the cultivation of universal values and individuals’ autonomous thinking and relate these approaches to ESD. Our overall claim is that ESD is in need of a critical discussion and exploration of ESD as a political project with dissonant voices that takes the particular human encounter into consideration.
Developing an analytical tool for evaluating EMS system design changes and their impact on cardiac arrest outcomes: combining geographic information systems with register data on survival rates
Sund Bj?rn
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2013, DOI: 10.1186/1757-7241-21-8
Abstract: Background Out-of-hospital cardiac arrest (OHCA) is a frequent and acute medical condition that requires immediate care. We estimate survival rates from OHCA in the area of Stockholm, through developing an analytical tool for evaluating Emergency Medical Services (EMS) system design changes. The study also is an attempt to validate the proposed model used to generate the outcome measures for the study. Methods and results This was done by combining a geographic information systems (GIS) simulation of driving times with register data on survival rates. The emergency resources comprised ambulance alone and ambulance plus fire services. The simulation model predicted a baseline survival rate of 3.9 per cent, and reducing the ambulance response time by one minute increased survival to 4.6 per cent. Adding the fire services as first responders (dual dispatch) increased survival to 6.2 per cent from the baseline level. The model predictions were validated using empirical data. Conclusion We have presented an analytical tool that easily can be generalized to other regions or countries. The model can be used to predict outcomes of cardiac arrest prior to investment in EMS design changes that affect the alarm process, e.g. (1) static changes such as trimming the emergency call handling time or (2) dynamic changes such as location of emergency resources or which resources should carry a defibrillator.
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