Vereseerumi troponiini määramine erakorralises meditsiinis

Troponiinide (Tn) määramine on erakorralise meditsiini osakonnas (EMO) laialdaselt kasutusel, seda ennekõike ägedate koronaarsündroomide (ÄKS) diagnoosimiseks ja välistamiseks. Nüüdseks on kasutusel testid, mis on tuntud kui kardiaalse troponiini (cTN) määramise kõrgtundlikud testid (ingl high-sensitive cardiac troponin, hs-cTn). Nende testidega on võimalik sedastada vereseerumis juba minimaalne troponiinisisaldus. Paraku on suurem tundlikkus toonud kaasa testi vähenenud spetsiifilisuse. On tekkinud olukord, kus haigetel leitakse üha sagedamini cTn referentväärtust ületavaid tulemusi, kuid samal ajal puudub otsene südamekahjustusele viitav seisund või haigus. On kirjeldatud mitmeid erinevaid haigusseisundeid, millega seostatakse troponiinide sisalduse suurenemist, kuid selle kliiniline tähtsus pole alati üheselt selge.Eesti Arst 2016; 95(8):515–52

Fulminantne müokardiit. Haigusjuht ja kirjanduse ülevaade

Müokardiit on heterogeenne haigus nii etioloogia kui ka kliinilise kulu poolest. Haiguse aluseks on põletikuline südamelihase kahjustus, mis kulgeb ägeda, enamasti taaspöörduva sündroomina. Ebasoodsa kulu korral võib tekkida krooniline dilateeriv kardiomüopaatia, mis võib viia progresseeruva südamepuudulikkuseni. Äge müokardiit võib kulgeda ka eluohtliku seisundina ning sel puhul on tegu fulminantse müokardiidiga. Selle harva, kuid raske kuluga haiguse puhul võib olla vaja rakendada kehavälist vereringetoetust. Fulminantse müokardiidi kahtluse korral tuleb patsient suunata keskusesse, kus on võimalik müokardiidi spetsiifiline diagnostika ning ravi, sealhulgas MRTuuringute ning EMB tegemine. Müokardiidi diagnoosimisel on oluline järgida rahvusvahelisi diagnostilisi kriteeriume ning vältida ühelt poolt valediagnoose ning teiselt poolt diagnoosimise ja ravi hilinemisest tingitud püsivat elukvaliteedi halvenemist. Raviprotsessis tuleb lähtuda juhtivast kliinilisest sündroomist – südamepuudulikkust tuleb ravida tõenduspõhiste meetodite ja ravimiannustega, rindkerevalu valuvaigistitega. MSPVAde kasutamine on näidustatud valusündroomi või perikardi haaratuse korral. Dilateeriva kardiomüopaatia põhjuseks võib olla krooniline müokardiit ning võimaluse korral tuleks nendel patsientidel teha EMB ning otsida seerumist patogeenseid autoantikehi. Ägeda müokardiidi põdemise järel on soovitatav patsiendile teha kordusuuringuna ehhokardiograafia ning müokardi düsfunktsiooni korral on soovitatav jälgimine kardioloogi poolt. Müokardiidi diagnostika ning ravi põhineb senini vähesel tõenduspõhisusel ning vajalikud on täpsustavad uuringud.Eesti Arst 2018; 97(1):29–3

Mitteelustamise otsus Eestis

Ravitahe, sealhulgas mitteelustamise otsus (ingl do not resuscitate, do not attempt resuscitation order), on inimese juhis oma ravieelistuste kohta hetkeks, kui ta ise ei ole enam otsustusvõimeline. Mitteelustamise otsuse tegemise võib algatada ka arst, kui peab seda patsiendi terviseseisundist lähtuvalt sobilikuks. Mitteelustamise tava sai alguse Ameerika Ühendriikides, kui mõisteti, et kõigi kliinilises surmas patsientide elustamine ei saa olla ega ole tulemuslik ja patsientide käsitlus elu lõpus jätab tõsiselt soovida. Eestis on ravitahe ja mitteelustamise tava õiguslikult reguleerimata ning ka arstkonnal puuduvad ühtsed arusaamad ja tegevusjuhised. Artiklis on toodud põgus ülevaade mitteelustamise tekkeloost, praktikast Eestis ja näiteid teistest riikidest ning arutletud mitteelustamise eetilise tagamaa, sotsiaalse tähenduse ja Eesti õigusloome puudujääkide üle ravipiirangute kontekstis.Eesti Arst 2017; 96(9):523–53

An AI-powered data curation and publishing virtual assistant: usability and explainability/causability of, and patient interest in the first-generation prototype

IntroductionEnsuring high quality and reusability of personal health data is costly and time-consuming. An AI-powered virtual assistant for health data curation and publishing could support patients to ensure harmonization and data quality enhancement, which improves interoperability and reusability. This formative evaluation study aimed to assess the usability of the first-generation (G1) prototype developed during the AI-powered data curation and publishing virtual assistant (AIDAVA) Horizon Europe project.MethodsIn this formative evaluation study, we planned to recruit 45 patients with breast cancer and 45 patients with cardiovascular disease from three European countries. An intuitive front-end, supported by AI and non-AI data curation tools, is being developed across two generations. G1 was based on existing curation tools and early prototypes of tools being developed. Patients were tasked with ingesting and curating their personal health data, creating a personal health knowledge graph that represented their integrated, high-quality medical records. Usability of G1 was assessed using the system usability scale. The subjective importance of the explainability/causability of G1, the perceived fulfillment of these needs by G1, and interest in AIDAVA-like technology were explored using study-specific questionnaires.ResultsA total of 83 patients were recruited; 70 patients completed the study, of whom 19 were unable to successfully curate their health data due to configuration issues when deploying the curation tools. Patients rated G1 as marginally acceptable on the system usability scale (59.1 ± 19.7/100) and moderately positive for explainability/causability (3.3–3.8/5), and were moderately positive to positive regarding their interest in AIDAVA-like technology (3.4–4.4/5).DiscussionDespite its marginal acceptability, G1 shows potential in automating data curation into a personal health knowledge graph, but it has not reached full maturity yet. G1 deployed very early prototypes of tools planned for the second-generation (G2) prototype, which may have contributed to the lower usability and explainability/causability scores. Conversely, patient interest in AIDAVA-like technology seems quite high at this stage of development, likely due to the promising potential of data curation and data publication technology. Improvements in the library of data curation and publishing tools are planned for G2 and are necessary to fully realize the value of the AIDAVA solution

Digital Health in Cardiology: The Estonian Perspective

&lt;b&gt;&lt;i&gt;Background:&lt;/i&gt;&lt;/b&gt; Digital health is rapidly entering clinical practice in cardiology. Estonia is one of the leading nations in implementing digital nationwide solutions. Recently, the European Society of Cardiology organized the 1st Summit on Digital Health in Tallinn, which provided the opportunity to discuss various aspects concerning the digitalization of cardiology. &lt;b&gt;&lt;i&gt;Summary:&lt;/i&gt;&lt;/b&gt; The current review focuses on the advancements of Estonian digital health and digital cardiology as well as possible barriers and solutions for implementing digital innovations in cardiology. &lt;b&gt;&lt;i&gt;Key Messages:&lt;/i&gt;&lt;/b&gt; The authors have included aspects from the recent summit, personal communications, and literature reviews to express the current state and future possibilities of digital health in ­cardiology from the Estonian perspective.</jats:p

Late adult presentation of ALCAPA syndrome: need for a new clinical classification? A case report and literature overview

Abstract Background Anomalous origin of the left main coronary artery from the pulmonary artery (ALCAPA) is a very uncommon congenital coronary artery anomaly, most commonly presenting in early infancy. Late adult presentation of ALCAPA syndrome is extremely rare. Case summary We present a case of a 76-year-old patient with first presentation of ALCAPA. The coronary anomaly was first diagnosed during elective coronary angiography. The case was discussed at the Heart Team meeting and as the patient was asymptomatic, had good coronary collateral circulation, a medical treatment strategy was chosen and the patient was discharged in a good physical condition. During 3 years of follow-up, the patient has experienced no cardiovascular complications. Discussion We hereby also discuss briefly the clinical presentation, epidemiology, diagnostics and treatment options for adults with newly diagnosed ALCAPA and discuss the need for a new clinical classification. Only a few cases have been published of septuagenarians or octogenarians with first presentation of ALCAPA. To our knowledge, the patient presented in our case was one of the least symptomatic patients during her eight decades of life. </jats:sec

Promoting the systematic use of real-world data and real-world evidence for digital health technologies across Europe: a consensus framework

Despite the acceleration in the use of digital health technologies across different aspects of the healthcare system, the full potential of real-world data (RWD) and real-world evidence (RWE) arising from the technologies is not being utilised in decision-making. We examine current national efforts and future opportunities to systematically use RWD and RWE in decision-making in five countries (Estonia, Finland, Germany, Italy and the United Kingdom), and then develop a framework for promotion of the systematic use of RWD and RWE. A review assesses current national efforts, complemented with a three-round consensus-building exercise among an international group of experts (n1 = 44, n2 = 24, n3 = 24) to derive key principles. We find that Estonia and Finland have invested and developed digital health-related policies for several years; Germany and Italy are the more recent arrivals, while the United Kingdom falls somewhere in the middle. Opportunities to promote the systematic use of RWD and RWE were identified for each country. Eight building blocks principles were agreed through consensus, relating to policy scope, institutional role and data collection. Promoting post-market surveillance and digital health technology vigilance ought to rely on clarity in scope and data collection with consensus reached on eight principles to leverage RWD and RWE

Delphi consensus building technique to propose guiding principles to embed real-world data and real-world evidence into decision-making for digital health technologies

The purpose of this Delphi consensus building exercise is to articulate guiding principles as the first step to embed real-world data (RWD) and real-world-evidence (RWE) in a systematic way into decision-making. The intended outcome of this exercise is that these guiding principles could inform a digital capability policy framework and support best practices in policy, regulation and harmonisation in the use of RWD and RWE to make health services targeted, efficient and responsive