Browsing by Subject "Neoplasms"

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  • Jokelainen, Kalle (2017)
    Pitkittynyt eli yli neljä viikkoa kestänyt ripuli on yleinen vaiva ja yksi tavallisimmista syistä hakeutua lääkärin vastaanotolle. Merkittävä osa potilaista voidaan tutkia ja hoitaa perusterveydenhuollossa. Koska pitkäaikaisen ripulin syynä voi olla joko orgaaninen sairaus tai toiminnallinen vaiva, selvittelyssä on välttämätöntä edetä järjestelmällisesti ja potilaan ikä sekä yksilöllinen oirekuva huomioon ottaen. Mikäli potilaalla esiintyy hälytysoireita, kuten verenvuotoa peräaukosta, painonlaskua tai poikkeava vatsan palpaatiolöydös, tai laboratoriokokeissa ilmenee poikkeavaa, hänet on syytä lähettää gastroenterologin arvioon.
  • Hui, David; Mori, Masanori; Meng, Yee-Choon; Watanabe, Sharon M.; Caraceni, Augusto; Strasser, Florian; Saarto, Tiina; Cherny, Nathan; Glare, Paul; Kaasa, Stein; Bruera, Eduardo (2018)
    Palliative care referral is primarily based on clinician judgment, contributing to highly variable access. Standardized criteria to trigger automatic referral have been proposed, but it remains unclear how best to apply them in practice. We conducted a Delphi study of international experts to identify a consensus for the use of standardized criteria to trigger automatic referral. Sixty international experts stated their level of agreement for 14 statements regarding the use of clinician-based referral and automatic referral over two Delphi rounds. A consensus was defined as an agreement of ae70% a priori. The response rate was 59/60 (98%) for the first round and 56/60 (93%) for the second round. Twenty-six (43%), 19 (32%), and 11 (18%) respondents were from North America, Asia/Australia, and Europe, respectively. The panel reached consensus that outpatient palliative care referral should be based on both automatic referral and clinician-based referral (agreement = 86%). Only 18% felt that referral should be clinician-based alone, and only 7% agreed that referral should be based on automatic referral only. There was consensus that automatic referral criteria may increase the number of referrals (agreement = 98%), facilitate earlier palliative care access, and help administrators to set benchmarks for quality improvement (agreement = 86%). Our panelists favored the combination of automatic referral to augment clinician-based referral. This integrated referral framework may inform policy and program development.
  • Kansikas, Minttu; Nyström, Minna; Peltomäki, Päivi (2017)
  • Saavalainen, Liisu; Lassus, Heini; Härkki, Päivi; Tiitinen, Aila; Pukkala, Eero; Heikinheimo, Oskari (2021)
    Aiempien tutkimusten mukaan endometrioosia sairastavien naisten kokonaissyöpäriski ei poikkea muista samanikäisistä naisista. Munasarjasyöpää, kilpirauhassyöpää ja ihomelanoomaa on todettu hieman useammin ja kohdunkaulasyöpää esiastemuutoksineen hieman harvemmin kuin muilla naisilla. Uuden suomalaistutkimuksen perusteella näyttää siltä, että suurentunut munasarjasyöpäriski liittyy vain munasarjan endometrioosiin.
  • Isoherranen, Kirsi; Salmi, Teea; Tasanen, Kaisa (2020)
    Epätyypilliset haavat ovat merkittävä haavatyyppi, johon haavaklinikoiden aineistoissa jopa 10-20 % kroonisista haavoista lukeutuu. Epätyypilliseen haavaan viittaavia tunnusmerkkejä ovat haavan epätyypillinen ulkonäkö tai sijainti, huomattava kipu haavan kokoon nähden, poikkeava hypergranulaatio tai pigmentaatio ja huono hoitovaste. Kliinisen kuvan ja histologisen löydöksen lisäksi diagnosoinnissa tulee huomioida epätyypillisten haavojen liitännäissairaudet. Hoito määräytyy diagnoosin mukaan. Monen epätyypillisen haavaan diagnoosi viivästyy, mikä heikentää potilaan ja haavan paranemisennustetta.
  • Kononen, Juha; Sundvall, Maria; Kontro, Mika; Rantala, Juha (2021)
    Syövän tutkimus- ja hoitomenetelmät kehittyvät jatkuvasti yksilöllistetympään suuntaan. Syynä ovat molekyyliprofiloinnin menetelmien kehitys, siitä saatava tieto ja geenidiagnostiikkaan perustuvat lääkkeet. Hoidon valitsemiseksi tarvitaan ja käytetään yhä useammin vastetta ennakoivia biomarkkereita. Potilaskohtaiset ex vivo -syöpämallit mahdollistavat tulevaisuudessa yksilöllistetyn, systeemibiologian periaatteita hyödyntävän syövänhoidon tutkimuksen, biomarkkereiden identifioinnin ja uusien hoitostrategioiden testaamisen. Ex vivo -mallien avulla voitaneen ohjata myös suoraan hoidon valintaa, luultavasti ensin hematologisissa syöpätaudeissa. Nestebiopsiasta tehtävä molekyyliprofilointi mahdollistaa ajantasaisen geenidiagnostiikan, jolloin hoitojen aiheuttamassa evoluutiopaineessa alati tapahtuva syövän muuntuminen voidaan huomata. Jotta syövän systeemibiologisen perustutkimuksen havaintoja päästään hyödyntämään potilastyössä, tarvitaan kliiniseen työhön niveltyvää yksilöllistä syövänhoidon tutkimusta, koulutusta ja osaamista.
  • Koskenvuo, Laura; Pöyhönen, Minna; Lepistö, Anna (2020)
  • Kask, Gilber; Uimonen, Mikko M.; Barner-Rasmussen, Ian; Tukiainen, Erkki J.; Blomqvist, Carl; Repo, Jussi P. (2021)
    The most widely used patient-reported outcome (PRO) measure for soft tissue sarcoma (STS) patients is the Toronto Extremity Salvage Score (TESS). The aim of the study was to validate and test the reliability of the TESS for patients with lower extremity STS based on Finnish population data. Patients were assessed using the TESS, the QLQ-C30 Function and Quality of life (QoL) modules, the 15D and the Musculoskeletal tumour Society (MSTS) score. The TESS was completed twice with a 2- to 4-week interval. The intraclass correlation coefficient (ICC) was used for test-retest reliability. Construct validity was tested for structural validity and convergent validity. Altogether 136 patients completed the TESS. A ceiling effect was noted as 21% of the patients scored maximum points. The ICC between first and second administration of the TESS was 0.96. The results of exploratory factor analysis together with high Cronbach's alpha (0.98) supported a unidimensional structure. The TESS correlated moderately with the MSTS score (rho = 0.59, p < 0.001) and strongly with the mobility dimension in the 15D HRQL instrument (rho = 0.76, p < 0.001) and the physical function in QLQ-C30 (rho = 0.83, p < 0.001). The TESS instrument is a comprehensive and reliable PRO measure. The TESS may be used as a validated single index score, for lower extremity STS patients for the measurement of a functional outcome. The TESS seems to reflect patients' HRQoL well after the treatment of lower extremity soft tissue sarcomas. (C) 2020 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
  • Alanne, Erika; Joensuu, Heikki; Elenius, Klaus (2021)
    Geenidiagnostiikka on viime vuosina herättänyt odotuksia syövän tehokkaammasta hoidosta. Syövän kohdennetut lääkehoidot ovat lisääntyneet ja kehittyneet, ja syövän hoidon valinta on nykyään mahdollista pienellä osalla potilaista pelkästään syövän geneettisen profiilin perusteella. Kliiniset tutkimukset, joissa on käytetty geeniprofilointia hoidon ohjaamisessa, ovat olleet keskeisessä asemassa geenitiedon perusteella valittavien syöpähoitojen yleistymisessä. Geenitestauksesta onkin tullut osa syövän diagnostiikkaa. Geenidiagnostiikkaan perustuvan syövän hoidon mukanaan tuomiin haasteisiin liittyen geenitestaukseen, tulosten tulkintaan ja hoidon saatavuuteen joudutaan etsimään uusia ratkaisuja.
  • Seppälä, Toni; Meretoja, Tuomo (2019)
  • Juteau, Susanna; Koljonen, Virve; Kytölä, Soili (2019)
  • Vesanen, Kari (Helsingfors universitet, 2016)
    Studies have shown that there is a familial risk in developing lymphomas. This thesis aimed to find candidate predisposing mutations for inherited non-Hodgkin lymphoma susceptibility in a Finnish pedigree. Exome sequences were available from two individuals in the pedigree, and common mutations were sought from exomes using bioinformatical tools. The validity and uniqueness of these common mutations were verified, and variation segregation was assessed by sequencing variation areas from all lymphoma patients in the pedigree. After filtering, 13 common variations were found, but due to variation's presence also in healthy control samples or the lack of segregation in the kindred, no candidate variation explaining non-Hodgkin lymphoma clustering in the pedigree was found. However, this study proved a group of mutations that probably do not need further studies as candidate variations for inheritable non-Hodgkin lymphoma. This study also provided rough comparison data for two different DNA sequence analysis programs.
  • Global Burden of Disease Cancer Collaboration; Fitzmaurice, C.; Doku, D.T.; Hadkhale, K.; Meretoja, T.J.; Neupane, S. (2019)
    Importance: Cancer and other noncommunicable diseases (NCDs) are now widely recognized as a threat to global development. The latest United Nations high-level meeting on NCDs reaffirmed this observation and also highlighted the slow progress in meeting the 2011 Political Declaration on the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting, and budgeting have been identified as major obstacles in achieving these goals. All of these have in common that they require information on the local cancer epidemiology. The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data. Objective: To describe cancer burden for 29 cancer groups in 195 countries from 1990 through 2017 to provide data needed for cancer control planning. Evidence Review: We used the GBD study estimation methods to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-Adjusted life-years (DALYs). Results are presented at the national level as well as by Socio-demographic Index (SDI), a composite indicator of income, educational attainment, and total fertility rate. We also analyzed the influence of the epidemiological vs the demographic transition on cancer incidence. Findings: In 2017, there were 24.5 million incident cancer cases worldwide (16.8 million without nonmelanoma skin cancer [NMSC]) and 9.6 million cancer deaths. The majority of cancer DALYs came from years of life lost (97%), and only 3% came from years lived with disability. The odds of developing cancer were the lowest in the low SDI quintile (1 in 7) and the highest in the high SDI quintile (1 in 2) for both sexes. In 2017, the most common incident cancers in men were NMSC (4.3 million incident cases); tracheal, bronchus, and lung (TBL) cancer (1.5 million incident cases); and prostate cancer (1.3 million incident cases). The most common causes of cancer deaths and DALYs for men were TBL cancer (1.3 million deaths and 28.4 million DALYs), liver cancer (572000 deaths and 15.2 million DALYs), and stomach cancer (542000 deaths and 12.2 million DALYs). For women in 2017, the most common incident cancers were NMSC (3.3 million incident cases), breast cancer (1.9 million incident cases), and colorectal cancer (819000 incident cases). The leading causes of cancer deaths and DALYs for women were breast cancer (601000 deaths and 17.4 million DALYs), TBL cancer (596000 deaths and 12.6 million DALYs), and colorectal cancer (414000 deaths and 8.3 million DALYs). Conclusions and Relevance: The national epidemiological profiles of cancer burden in the GBD study show large heterogeneities, which are a reflection of different exposures to risk factors, economic settings, lifestyles, and access to care and screening. The GBD study can be used by policy makers and other stakeholders to develop and improve national and local cancer control in order to achieve the global targets and improve equity in cancer care. © 2019 American Medical Association. All rights reserved.
  • Sutinen, Jussi; Leppä, Sirpa; Tarkkanen, Maija (2016)
  • Heikinheimo, Oskari; Apter, Dan (2018)
  • Utriainen, Meri; Rämet, Mika (2016)