Duodecim; lääketieteellinen aikakauskirja
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According to the update of the Finnish guidelines for management of patients with atrial fibrillation (AF) dronedarone should be used only in patients with non-permanent AF as a second line medication. It is recommended to monitor the patients regularly and stop dronedarone if permanent AF, heart failure or other adverse events are detected. Dabigatran and rivaroxaban can be used as an alternative to warfarin in patients requiring oral anticoagulation therapy. The selection between warfarin and the new anticoagulants should be based on careful evaluation of the benefits and disadvantages of the drugs in a given patient.
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Both mechanical and pharmacological methods are used for induction of labour. ⋯ Labour induction with Foley catheter is as safe and effective as induction with misoprostol.
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The updated Current Care guideline for children and adolescents with ADHD covers both diagnosis and treatment. Psychosocial support is provided when hyperactivity problems arise, even before specific diagnosis. While psychosocial interventions are effective in the treatment of ADHD, the core symptoms are best treated with medication, such as methylphenidate, dexamphetamine, lisdexamphetamine or atomoxetine. Collaboration between families, primary health care services, specialist consultation services and day-care and school professionals is essential within the chain of care.
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The pathophysiology of delirium is poorly known and scientific evidence of effective forms of treatment is scarce. Detection of triggering factors and their appropriate treatment still constitute the cornerstone of the treatment. ⋯ The use of restraint systems should be avoided. The delirium experience is often gravely traumatizing for the patient, and the psychological aftercare of delirium must therefore not be ignored.
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Bronchiolitis is the most common disease leading to hospitalization of infants of less than one year of age in Finland. Among each age group, the disease needs hospitalization in approx. 3% of the cases. ⋯ When required, inhalations of racemic epinephrine are given for severe symptoms. The authors' treatment practice for bronchiolitis is presented in this article.