Finnish Medical Foundation

There is currently limited data to guide treatment selection, dosing, combination strategies and sequencing in the management of myasthenia gravis (MG). Additionally, MG symptoms are heterogenous between people and with time, requiring an individualized treatment approach. As such, successful patient-physician communication is key. This Delphi project was undertaken by MG specialists and patient representatives to explore their opinion on improving MG management via effective physician-patient communication and collaboration approach. This mixed-methods study was conducted in two phases. In Phase I, seven MG specialists and two patient representatives contributed to idea generation. Relevant insights informed the development of the Phase II Delphi survey. A panel of 16 MG specialists and seven patient representatives participated in a two-round Delphi survey. Consensus was defined as ≥ 70% agreement or disagreement on a 6-point Likert scale. Participants responded to the survey from what they considered an ideal scenario, regardless of their real-world experience. Consensus was achieved on 89% of all statements. Key areas of alignment were – importance of incorporating patient preferences on quality of life (QoL), sustained symptom control, route of administration, and side effects profile. Both groups agreed that current clinical practices insufficiently integrate mental health considerations and patient engagement remains suboptimal. Two key areas of misalignment were – patient representative and physicians had different perspective on how well physicians understood patient preferences and both groups showed different interpretations of side effects (adverse reaction versus issues of tolerability). This Delphi consensus found that while physician and patient representatives shared similar perspectives these were not always reflected in current clinical practice due to differences in understanding of patient preferences. Prioritizing structured conversations on QoL, treatment expectations, and side effect were found important for physicians while improving access to information, openly communicating and actively participating in treatment decisions were key outcomes for patients. This study lays a valuable foundation for deepening conversations and alignment on key topics in MG management among the medical, patient and caregiving communities.

Review Stage at time of this submission -Formal screening of search results.

BackgroundDebates around euthanasia and physician-assisted suicide (PAS) are ongoing around the globe. Public support has been mounting in Western countries, while some decline has been observed in the USA and Eastern Europe. Physicians’ support for euthanasia and PAS has been lower than that of the general public, but a trend toward higher acceptance among physicians has been seen in recent years. The aim of this study was to examine the current attitudes of Finnish physicians toward euthanasia and PAS and whether there have been changes in these attitudes over three decades.MethodsA questionnaire survey was conducted with all Finnish physicians of working age in 2020 and the results were compared to previous studies conducted in 1993, 2003 and 2013.ResultsThe proportions of physicians fully agreeing and fully disagreeing with the legalization of euthanasia increased from 1993 to 2020 (from 5 to 25%, p < 0.001, and from 30 to 34%, p < 0.001, respectively). The number of physicians, who expressed no opinion for or against euthanasia (cannot say) decreased from 19 to 5% (p < 0.001) during the same period. The proportion of physicians having no opinion (cannot say) of whether a physician should be punished for assisting in a suicide decreased from 20 to 10% (p < 0.001).ConclusionsThis study shows that Finnish physicians’ ambivalence toward euthanasia and PAS has decreased. The ongoing debate has probably forced physicians to form more solid opinions on these matters. Our study highlights that attitudes toward euthanasia and PAS are still divided within the medical profession.

This analysis of the Finnish health system reviews developments in its organization and governance, financing, provision of services, health reforms and health system performance. Finland is a welfare state witha high standard of social and living conditions and a low poverty rate. Its health system has a highly decentralized administration, multiple funding sources, and three provision channels for statutory services in first-contact care: the municipal system, the national health insurance system, and occupational health care. The core health system is organized by the municipalities (i.e. local authorities) which are responsible for financing primary and specialized care. Health financing arrangements are fragmented, with municipalities, the health insurance system, employers and households all contributing substantial shares. The health system performs relatively well, as health services are fairly effective, but accessibility may be an issue due to long waiting times and relatively high levels of cost sharing. For over a decade, there has been broad agreement on the need to reform the Finnish health system, but reaching a feasible policy consensus has been challenging.

Menopausal hot flushes are associated with elevated activity of the sympathetic nervous system and may be related to increased risk for cardiovascular events. Sympathetic activation may trigger severe arrhythmias by modulating cardiac repolarization. The aim of this study was to evaluate the impact of hot flushes on cardiac repolarization in postmenopausal women with and without hot flushes. We assessed 150 recently postmenopausal healthy women-72 with hot flushes and 78 without hot flushes. They underwent 24-hour electrocardiographic recording, comprising a total of over 10,000,000 QT-interval measurements. The cardiac repolarization was assessed by measuring QT-intervals, heat rate dependence of QT-end intervals, and T-waves. The maximal QT-end interval was shorter in women with hot flushes compared with those without hot flushes (481 ± 64 ms vs 493 ± 50 ms; P = 0.046). There were no differences between the rate dependence of QT-end intervals and T-wave measures between the groups. During the night-time hot flush period, we detected a steeper rate-dependence of QT-end intervals and a longer maximal T-peak-T-end interval (117 ± 54 ms vs 111 ± 56 ms; P < 0.001) compared with the control period. Women with hot flushes did not have clinically significant differences in ambulatory cardiac repolarization measurements compared with asymptomatic women. However, a sudden sympathetic surge occurring during the night-time hot flush may have direct effects on cardiac repolarization.

Implementation of the Directive on the Application on Patient's Rights in Cross-border Healthcare (2011/24/EU) has proved to be quite challenging in Finland.

Doctors are important collaborators with journalists specializing in health issues. A survey was conducted among Finnish health journalists about their views on doctor-journalist relationships, their opinions of source reliability and what sort of prejudices doctors and journalists might have of one another. In general the respondents had positive experiences of such collaboration. Most respondents identified more strongly with medical science than alternate therapies. Respondents considered scientific publications and research centers to be the most reliable information sources and considered online discussion forums and alternative therapy providers to be unreliable. Most common experiences of collaboration were positive or varying between individual doctors, although doctors’ busy schedules sometimes make collaboration challenging. According to the respondents, not all doctors recognize the need for clarification of difficult topics for laypeople instead of favoring accurate scientific language. Potential prejudices that respondents felt doctors might have towards their profession was a sensationalist approach and inaccurate reporting of facts. Our findings could benefit both doctors and journalists in terms of fruitful collaboration.Keywordshealth journalismmedical journalismmedia ethicsmedical professionsource reliability

Abstract The Council for Mass Media in Finland is a self-regulatory board of journalism that evaluates complaints concerning the execution of the Finnish Journalism Guidelines. Between 1995 and early 2002 26 verdicts given by the Council dealt with matters related to the private lives or work of medical professionals. These cases were analyzed in order to determine the limits for acceptability in treatment of physicians in the media. Four key themes were identified: the rights of an interviewee, the right for a subject of negative publicity to defend a physician’s right to privacy and media impact on patients’ health choices. Results: patient-doctor confidentiality may pose a challenge to a doctor’s right to defend him/herself publicly; a doctor’s profession should not be mentioned if it has no relevance to the event that is being reported; the media may well challenge existing medical paradigms.Keywordsmedical journalismmedia ethicsmedical profession