Efficacy of topical resin lacquer, amorolfine and oral terbinafine for treating toenail onychomycosis: a prospective, randomized, controlled, investigator-blinded, parallel-group clinical trial.

BACKGROUND: Norway spruce (Picea abies) produces resin to protect against decomposition by microbial pathogens. In vitro tests have shown that spruce resin has antifungal properties against dermatophytes known to cause nearly 90% of onychomycosis in humans. OBJECTIVES: To confirm previous in vivo observations that a topical resin lacquer provides mycological and clinical efficacy, and to compare this lacquer with topical amorolfine hydrochloride lacquer and systemic terbinafine for treating dermatophyte toenail onychomycosis. METHODS: In this prospective, randomized, controlled, investigator-blinded study, 73 patients with onychomycosis were randomized to receive topical 30% resin lacquer once daily for 9 months, topical 5% amorolfine lacquer once weekly for 9 months, or 250 mg oral terbinafine once daily for 3 months. The primary outcome measure was complete mycological cure at 10 months. Secondary outcomes were clinical efficacy, cost-effectiveness and patient compliance. RESULTS: At 10 months, complete mycological cure rates with the resin, amorolfine and terbinafine treatments were 13% [95% confidence interval (CI) 0-28], 8% (95% CI 0-19) and 56% (95% CI 35-77), respectively (P ≤ 0·002). At 10 months, clinical responses were complete in four patients (16%) treated with terbinafine, and partial in seven (30%), seven (28%) and nine (36%) patients treated with resin, amorolfine and terbinafine, respectively (P < 0·05). Resin, amorolfine and terbinafine treatments cost €41·6, €56·3 and €52·1, respectively, per patient (P < 0·001). CONCLUSIONS: Topical 30% resin lacquer and topical 5% amorolfine lacquer provided similar efficacy for treating dermatophyte toenail onychomycosis. However, orally administered terbinafine was significantly more effective in terms of mycological cure and clinical outcome than either topical therapy at the 10-month follow-up.

Paramedic helicopter emergency service in rural Finland - do benefits justify the cost?

BACKGROUND: The benefit of the Helicopter Emergency Medical Service (HEMS) is not well documented. The aim of our study was to investigate the potential health benefits of HEMS, and their relation to cost of the service in a rural area in Finland. We also evaluated whether the patient benefit is due to early Advanced Life Support (ALS) procedures performed on-scene, or due to rapid transport of patients to definitive care. METHODS: We reviewed all helicopter missions during 1 year (1999). Based on given prehospital care, we divided these missions into various categories. At the time of discharge, in-hospital records were reviewed for patients who received prehospital ALS care in order to estimate the potential benefit of HEMS. RESULTS: There were 588 missions. In 40% (n = 233/588), the mission was aborted. ALS care was given on-scene to 206 patients. It was estimated that in this group lives of three patients (1.5%) were saved, and 42 (20%) patients, mostly with cardiovascular disease, otherwise benefited from the service. The majority (84%) of the patients benefited from on-scene ALS procedures only. The cost for beneficial mission was euro 28 444. CONCLUSION: A minority of all patients did benefit from HEMS. Benefit was related to early ALS care and the cost per beneficial mission was 28 444.

Information technology in medical education: a nationwide project on the opportunities of the new technology.

CONTEXT: The aim of the national "IT Culture in Medical Education" project in Finland is to enhance the opportunities new technology may provide for medical education. The project focuses on attitudes towards information technology (IT) and on its current use among teachers and students. METHOD: This survey was part of a Finnish nationwide project in medical education. Data were collected by means of a questionnaire designed to gather information about IT use in medical education, sent to teachers and students. The questions were 5-point Likert-type. The participants were medical teachers (n=196) and medical students (n=392) at two medical schools. RESULTS: In both universities, it appeared that medical teachers and students had a very positive attitude toward the advances in modern technology. In addition to the favourable attitudes, computer-related technology was also widely applied. Teachers, however, used information technology more in their research work than in teaching. CONCLUSIONS: The results pose challenges to medical education and underline the importance of educational and psychological knowledge in combination with new technical skills.

WWW--an effective way of teaching radiology.

The Internet and especially the World Wide Web (WWW) have given new opportunities and challenges in teaching radiology. In Kuopio University and Kuopio University Hospital, we started to develop a new WWW-based radiology teaching file in 1996. Our file was made as a result of weaknesses in other files and as an answer to our local needs. The file consists of 1245 separate radiographs in 14 different categories. The language is Finnish, because the target use primarily is basic medical education in Finland. A small part has been translated into English. The quality of images was improved using a separate viewer (Osiris, Digital Imaging Unit, University Hospital of Geneva, Switzerland), which also allowed image manipulation needed with radiological images. We have monitored the utilisation of pages (Analog 1.92 beta-3.0/UNIX) and found the results encouraging. The follow-up time was 814 days (10 February 1997-27 September 1999), the total number of requests was 762797 and that for HTML pages is 288664. Monthly means are 27243 and 10309, respectively. The total number for visited domains is 61. The URL for these pages is http://www.uku.fi/laitokset/klrad/opetuskuvasto/.

Randomized, placebo controlled trial of withdrawal of slow-acting antirheumatic drugs and of observer bias in rheumatoid arthritis.

Patients with rheumatoid arthritis, in stable treatment with methotrexate, penicillamine, or sulfasalazine, were randomized in a double-blind fashion either to continuation of their usual treatment or to placebo. 112 patients were included; 52 patients who refused participation had no more severe disease than the others. The patients felt worse on placebo than on active drug (p = 0.002). The mean differences in number of tender, painful and swollen joints after one month were 2.4 (p = 0.08), 3.0 (p = 0.12) and 2.2 (p = 0.03), respectively. Treatment failure occurred for 42 patients of whom 33 received placebo (p = 0.000,001). There was no difference in the severity of side effects (p = 0.91). The patients guessed their treatment correctly more often than expected (p = 0.02) because of the perceived effect. None of the two observers guessed better than chance, and there were no differences between the observers' evaluations of the joints. The effect of slow-acting antirheumatic drugs was unequivocal and no observer bias occurred.

AIDS and Danish adolescents--knowledge, attitudes, and behaviour relevant to the prevention of HIV-infection.

To evaluate the effect of previous AIDS education on AIDS knowledge and sex behaviour among Danish adolescents, a survey was carried out in April-May 1988 amongst 15-16 year-old school children of 9th grade elementary school. Through a cluster-sampling procedure, 45 school classes in nine geographical areas around the country were selected representing various degrees of urbanisation. A questionnaire was handed out and collected by the local school physician during a class session. The 728 pupils responding corresponded to a response rate of 89% of the pupils enlisted and 99% of the pupils present. The results demonstrate that AIDS education has been widely introduced in Danish schools and is well accepted. However, school health services have only rarely been involved. The educational activities seem to have a positive effect on knowledge about HIV-transmission and AIDS, attitudes towards the use of condoms and actual sexual behaviour, although risk-behaviour is still prevalent. The respondents express positive attitudes towards more AIDS education--especially among those with very little or no previous educational experiences.