Browsing by Subject "retrospective study"

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  • Övermark, Meri; Koskenmies, Sari; Pitkanen, Sari (2016)
    Squamous cell carcinoma in situ is an intra-epidermal malignancy of the skin with potential to progress to invasive carcinoma. Commonly used treatments are surgical excision, cryotherapy, photodynamic therapy, laser ablation, curettage with cautery, radiotherapy, topical 5-fluorouracil, and topical imiquimod. The efficacies of these different treatment modalities are compared in this retrospective study of 239 patients with squamous cell carcinoma in situ diagnosed and treated at our hospital during a period of 1 year. A total of 263 histologically confirmed in situ lesions were followed up for approximately 8 years. The overall recurrence rate was 6.5%. Surgical excision had the lowest recurrence rate, at 0.8%. Recurrence rates with the less-invasive treatment modalities were markedly higher; cryotherapy 4.7% and photodynamic therapy 18%. Of all recurrences, 65% were carcinoma in situ and 35% squamous cell carcinomas. Twenty-three patients had actinic keratosis in the area treated, but these were not counted as recurrences. In conclusion, excisional surgery is the gold standard treatment for squamous cell carcinoma in situ, although it has limitations. Less invasive methods may sometimes be preferred.
  • Tiškina, Valentina; Lindqvist, E.-L.; Blomqvist, A.-C.; Orav, Merle; Stensvold, C.R.; Jokelainen, P. (2019)
    Angiostrongylus vasorum has spread farther north in Europe. In this study, two autochthonous findings from dogs from Finland are described: In February 2014, the infection was diagnosed in a 10-month-old labrador retriever, and in February 2017, in a three-year-old French bulldog. These diagnoses were based on direct detection of the larvae from faeces of the dogs. The dogs had no history of travel to or import from abroad; the first lived in Southern Finland and the other in Western Finland, about 150 km apart. The dogs had no clinical signs attributable to angiostrongylosis. An online questionnaire was used to survey the extent to which veterinarians in Finland have self-reportedly observed canine A vasorum infections. A total of 38 veterinarians authorised to work in Finland answered the questionnaire in December 2017, and 9 (24%) of them reported having seen one or more dogs with A vasorum infection in Finland. The results suggest that at least five individual dogs with A vasorum infection would have been seen in Finland, three of which had an apparently autochthonous infection. While the geographical distribution of A vasorum in Finland remains largely unknown, findings have started to appear from domestic dogs. It remains possible that some veterinarians could have misdiagnosed, for example, Crenosoma vulpis larvae as those of A vasorum, and the findings without confirmation using antigen test could be due to coprophagy and passage of ingested larvae; however, this does not change the main conclusion that can be made: A vasorum is already multifocally present in Finland. Increasing awareness about A vasorum is important in areas where it is emerging and spreading. © 2019 British Veterinary Association.
  • Kaipio, Johanna; Karisalmi, N.; Hiekkanen, K.; Stenhammar, H.; Lahdenne, P. (IOS PRESS, 2019)
    Studies in Health Technology and Informatics
    Patient experience (PX) is an important evaluation criterion for quality in healthcare. Compared to patient satisfaction, however less research has focused on the development of instruments to measure experiences of patients and their families. In the article, we describe the process of developing a PX questionnaire for the parents of pediatric patients in the context of children's hospital and illustrate the questionnaire items for measuring PX. The phases of the development process included retrospective interviews, description of the themes influencing PX and the metrics for measuring PX, as well as iterative development of three versions of questionnaires including data gathering and factor analysis. The final versions of the surveys suggested for implementation at the hospitals include eight PX statements for the outpatient clinic and five statements for the ward. Compared to satisfaction surveys, the developed surveys emphasize the aspects of parent's attitude towards the illness, support for families, and daily arrangements with a child patient. © 2019 American Psychological Association Inc. All rights reserved.
  • Pajunen, T.; Vuori, E.; Lunetta, P. (2018)
    Background: Post-mortem (PM) ethanol production may hamper the interpretation of blood alcohol concentration (BAC) in victims of drowning. Different exclusion criteria (e.g. cases with low BAC or with protracted interval between death and toxicological analysis) have been proposed with no factual figures to reduce the potential bias due to PM ethanol production when examining the prevalence rates for alcohol-related drowning. The aim of this study is to verify the extent to which PM alcohol production may affect the accuracy of studies on drowning and alcohol. Findings: Unintentional fatal drowning cases (n = 967) for which a full medico-legal autopsy and toxicological analysis was performed, in Finland, from 2000 to 2013, and relevant variables (demographic data of the victims, month of incident, PM submersion time, blood alcohol concentration, urine alcohol concentration (UAC), vitreous humour alcohol concentration (VAC) were available. Overall, out of 967 unintentional drownings, 623 (64.4%) were positive for alcohol (BAC > 0 mg/dL), 595 (61.5%) had a BAC ≥ 50 mg/dL, and 567 (58.6%) a BAC ≥ 100 mg/dL. Simultaneous measurements, in each victim, of BAC, UAC, and VAC revealed PM ethanol production in only 4 victims (BAC: 25 mg/dL – 48 mg/dL). These false positive cases represented 0.4% of drownings with BAC > 0 mg/dL and 14.3% of drownings with BAC > 0 mg/dL and <50 mg/dL. Conclusions: The present study suggests that PM ethanol production has a limited impact on research addressing the prevalence rate for alcohol-related drowning and that the use of too rigorous exclusion criteria, such as those previously recommended, may led to a significant underestimation of actual alcohol-positive drowning cases. © 2018, The Author(s).
  • Niinikoski, Iida-Maria (Helsingin yliopisto, 2019)
    This licentiate thesis consists of a literature review and a retrospective study. Diabetes mellitus is a common endocrinopathy in cats. It mainly resembles type II diabetes mellitus of humans, where the dysfunction of pancreatic beta cells together with peripheral insulin resistance causes increased blood glucose concentrations. Along with other risk factors such as breed and neuter status, obesity is closely related to the development of feline diabetes mellitus. The aim of the retrospective study was to assess risk factors and treatment protocols of diabetes mellitus. Factors influencing treatment outcome were also investigated. The results were compared with current scientific evidence. The hypotheses were that diabetic cats with an optimal body condition score (BCS) are more likely to achieve stable disease requiring administration of exogenous insulin and are more likely to achieve remission, where administration of exogenous insulin is no longer needed. The veterinary patient database ProvetNet was used to search for cats with diabetes mellitus presented to the University of Helsinki, Small Animal Teaching Hospital and the Saari Small Animal Clinic between March 2006 and March 2016. Data such as breed, gender, BCS and concurrent diseases were recorded for 123 cats. Statistical analyses were performed using GraphPad Prism. Neutered male cats had 2.8 times the risk of developing diabetes mellitus when compared to intact cats and neutered females. Domestic shorthair cats had 1.7 times the risk of developing diabetes mellitus when compared to other breeds. Remission rates were substantially lower than what has been reported in literature. The results did not support the hypotheses. Cats with an optimal BCS were not more likely to achieve stable disease or remission. However, the small sample size should be taken into consideration when interpreting the results. Investigating the relationship between BCS and diabetes mellitus was difficult due to incomplete documentation of BCS values and limitations of the veterinary patient database. Measures should be taken to develop the database so the evaluation and recording of BCS is a convenient routine. Further research into risk factors for both diabetes mellitus and obesity as well as treatment protocols resulting in remission is needed, so evidence-based data can be used for prevention and remission of the disease.
  • Yli-Kankahila, Anssi (Helsingin yliopisto, 2019)
    Tutkimuksen tarkoitus: Tutkimuksen tarkoituksena oli selvittää hammaslääketieteen opiskelijoiden kliinisen hoitoharjoittelun aikana tekemien hammaspaikkojen kestävyyttä vertaamalla niitä Helsingin kaupungin terveyskeskushammaslääkärien tekemiin paikkoihin. Hammaspaikkojen kestävyyttä ja pitkäikäisyyttä on tutkittu runsaasti, mutta opiskelijoiden tekemien paikkojen kestävyydestä ei ole julkaistu aikaisempaa kirjallisuutta. Materiaalit ja menetelmät: Tutkimuksen aineistona käytettiin Effica-potilastietojärjestelmästä saatua dataa, johon sisältyi kaikki Helsingissä tehdyt hammaslääketieteelliset toimenpiteet vuosilta 2002-2016. Tuolloin hammaslääketieteen opiskelijoiden kliininen hoitoharjoittelu oli osa Helsingin kaupungin järjestämää hammashoidon peruspalvelua. Aineiston käyttöön saatiin tutkimuslupa Helsingin kaupungin Sosiaali- ja terveystoimialan taholta. Aineistosta eroteltiin Yliopistohammasklinikalla tehdyt paikat, jotka jouduttiin uusimaan vastaavan kokoisella paikalla seurannan aikana. Paikat jaoteltiin paikkojen laajuuden ja paikattujen pintojen mukaan. Kestävyyttä arvioitiin laskemalla keskiarvot kuukausina ensimmäisen ja toisen paikkaustoimenpiteen välillä. Tuloksia verrattiin sijainniltaan ja laajuudeltaan vastaavanlaisien terveyskeskushammaslääkärien tekemien paikkojen kestävyyteen. Tulosten tilastollinen merkitsevyys laskettiin Studentin T-kokeen avulla. Tulokset: Tutkimuksen aineistossa oli mukana 2167 Yliopistohammasklinikalla hoidettua potilasta. Potilaat olivat iältään 18-91- vuotiaita. Ikäjakauman keskiarvo oli 43,97 vuotta ja mediaani 42 vuotta. Approksimaaliset kahden pinnan paikat kestivät terveyskeskushammaslääkärien tekeminä 45-47 kuukautta ja kandidaattien tekeminä 39-41 kuukautta. Vähintään kolmelle pinnalle ulottuvat paikat kestivät terveyskeskushammaslääkärien tekeminä 42 kuukautta ja kandidaattien tekeminä 44 kuukautta. Vapaiden pintojen paikat kestivät terveyskeskushammaslääkärien tekeminä 35-44 kuukautta ja kandidaattien tekeminä 22-42 kuukautta. Terveyskeskushammaslääkärien tekemät yhdistelmämuovipaikat kestivät 35-43 kuukautta ja amalgaamipaikat 28-45 kuukautta. Kandidaattien tekemät yhdistelmämuovipaikat kestivät 24-41 kuukautta ja amalgaamipaikat 31-47 kuukautta. Johtopäätökset: Opiskelijoiden tekemät yhdistelmämuovipaikat kestivät lähes poikkeuksetta heikommin, kuin terveyskeskushammaslääkärien tekemät yhdistelmämuovipaikat. Opiskelijoiden tekemät amalgaamipaikat kestivät kuitenkin usein jopa terveyskeskushammaslääkärien paikkoja paremmin. Laajoilla paikoilla vaikuttaisi olevan samankaltainen kestävyys opiskelijoiden ja terveyskeskushammaslääkärien tekemänä. Tulosten perusteella amalgaamia voitaisiin pitää kestävänä paikkausmateriaalina opetusklinikalla.
  • Hänninen-Khoda, L.; Koljonen, V.; Ylä-Kotola, T. (2018)
    Late cancellations of scheduled operations cause direct and indirect costs for a hospital and economic and emotional stress for the patient. Previously, late cancellation rates for scheduled operations in plastic surgery have been shown to be attributable to patient-related causes in the majority of cases. In this retrospective study, we sought to examine specifically the patient-related reasons for the late cancellations in a plastic surgery operating theatre at Helsinki University Hospital in Finland from 2013 to 2014. We calculated latency between the date of decision for surgery and the scheduled operation day. In cases where the surgery was rescheduled and performed before 31 December 2015, the rescheduled waiting time latency was calculated. We aimed to improve our knowledge of the causes of late cancellations to further optimise the operating theatre efficiency and propose a strategic algorithm to avoid late cancellations During the study period, 327 (5.5%) of all the scheduled operations were recorded as late cancellations. Of these, 45.3% were because of patient-related issues. Acute infection, change in medical condition not noticed before and operation no longer necessary were by far the most common causes of cancellation, comprising 63.5%. Sixty-six per cent of patient-related cancelled operations were performed later, especially when the specific reason was patient's acute illness. Root-cause analysis shows that most of the underlying reasons for the cancellations can be attributed to a failure in communication. The majority of these cancellations were considered to be preventable, thus emphasising the importance of communication and skilful multi-professional planning of the operating theatre list. © 2018 The Author(s)
  • Niini, Tarmo; Laakso, Aki; Tanskanen, Päivi; Niemelä, Mika; Luostarinen, Teemu (Helsingin yliopisto, 2018)
    Tutkimuksen tarkoitus Tutkimuksessa arvioimme kuinka Helsingin yliopistollisen sairaalan neurokirurgian klinikassa vuosina 2006-2014 mikrokirurgisesti hoidettujen aivojen arteriovenoosi malformaatio (AVM) potilaiden perioperatiivinen hoitoprotokolla on toteutunut. Lisäksi selvitimme viivästyneiden postoperatiivisten vuotojen (VPV) ilmaantuvuuden protokollaa käytettäessä. Aineisto ja menetelmät HYKSin neurokirurgian klinikan aivojen arteriovenoosien malformaatioiden perioperatiivisen hoidon protokollaa käytettiin koko tutkimuksen 121 operatiivisen hoidon saaneen potilaan kohortille. Neurokirurgian klinikan AVM- tietokantaa sekä potilastietojärjestelmää käyttäen kerättiin perioperatiiviseen hoitoon liittyvät tiedot (mm. päivittäiset systoliset verenpainetavoitteet sekä näiden toteutuminen, laskimonsisäinen nestehoito, nestetasapaino ja hengityskonehoidon sekä tehohoitojakson pituus). Potilaat, joille ilmaantui VPV, käytiin läpi tutkimuksessa yksityiskohtaisesti. Tulokset Viidelle potilaalle 121:stä (4.1%) ilmaantui VPV. Näiden potilaiden arteriovenoosi malformaatio oli keskimäärin korkeampaa Spetzler-Martin luokkaa (p=0.043) kuin niiden potilaiden, joille ei ilmaantunut viivästynyttä postoperatiivista vuodoa. Näiden potilaiden AV- malformaatioiden vievät suonet olivat monimutkaisempaa tyyppiä (p=0.003) ja heille annettiin enemmän laskimonsisäistä nestehoitoa neurokirurgisella teho-osastolla (keskimäärin 3726 ml/vrk vs keskimäärin 2980 ml/vrk ei vuotaneilla) (p=0.040). Kaikki VPV:n saaneet potilaat olivat miehiä (p=0.040). Johtopäätökset HYKSin Neurokirurgian klinikan aivojen AV-malformaatioiden perioperatiivinen hoitoprotokolla on yhtä hyvä, ellei hieman parempi (4.1% vs 5.0% VPV:n ilmaantuvuus), kuin aiemmin julkaistu, monimutkaisempi hoitoprotokolla. Tutkimustuloksemme tukevat Spetzler-Martin luokituksen käyttöä potilaiden postoperatiivista hoitoa suunnitellessa. Tutkimuksemme kaikki viivästyneet postoperatiiviset vuodot tapahtuivat potilaille, jotka olivat Spetzler-Martin luokkia 2-5. Avainsanat: intracranial arteriovenous malformations, neurosurgical intensive care unit, postoperative hemorrhage, retrospective study, blood pressure, clinical protocols
  • Pihlajamäki, Minna; Uitti, J.; Arola, H.; Ollikainen, J.; Korhonen, M.; Nummi, T.; Taimela, S. (2019)
    Objectives To study whether self-reported health problems predict sickness absence (SA) from work in employees from different industries. Methods The results of a health risk appraisal (HRA) were combined with archival data of SA of 21 608 employees (59% female, 56% clerical). Exposure variables were self-reported health problems, labelled as ' work disability (WD) risk factors' in the HRA, presence of problems with occupational well-being and obesity. Age, socioeconomic grading and the number of SA days 12 months before the survey were treated as confounders. The outcome measure was accumulated SA days during 12-month follow-up. Data were analysed separately for males and females. A Hurdle model with negative binomial response was used to analyse zero-inflated count data of SA. Results The HRA results predicted the number of accumulated SA days during the 12-month follow-up, regardless of occupational group and gender. The ratio of means of SA days varied between 2.7 and 4.0 among those with ' WD risk factors' and the reference category with no findings, depending on gender and occupational group. The lower limit of the 95% CI was at the lowest 2.0. In the Hurdle model, ' WD risk factors', SA days prior to the HRA and obesity were additive predictors for SA and/or the accumulated SA days in all occupational groups. Conclusion Self-reported health problems and obesity predict a higher total count of SA days in an additive fashion. These findings have implications for both management and the healthcare system in the prevention of WD. © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
  • Laitinen, A.; Hagström, J.; Mustonen, H.; Kokkola, A.; Tervahartiala, T.; Sorsa, T.; Böckelman, C.; Haglund, C. (2018)
    Despite gastric cancer being rare nowadays in Western countries, it remains one of the leading causes of cancer death worldwide. The course of the disease varies, so the individual gastric cancer patient’s prognosis is difficult to determine. The need for new biomarkers is crucial. The aim of this study was to evaluate the prognostic value of serum matrix metalloproteinase-8, serum tissue inhibitor of metalloproteinase-1, and tissue matrix metalloproteinase-8 in patients with gastric cancer. Preoperative serum samples from 233 patients with gastric cancer were retrospectively analyzed. Serum levels of matrix metalloproteinase-8 were analyzed with immunofluorometric assay, and tissue inhibitor of metalloproteinase-1 levels were determined by enzyme-linked immunosorbent assay. We also determined the tissue expression of matrix metalloproteinase-8 in 276 gastric cancer samples by immunohistochemistry. Survival data and death causes came from patient records, the Population Register Center of Finland, and Statistics Finland. Patients with a low (131 ng/mL) serum matrix metalloproteinase-8 level had a considerably unfavorable prognosis (p = 0.002). Those patients with a high (≥170 ng/mL) serum tissue inhibitor of metalloproteinase-1 level also had a poor prognosis (p <0.001), and the latter remained significant in multivariable analysis (hazard ratio = 1.85; 95% confidence interval: 1.26–2.72; p = 0.002). The molar ratio of serum matrix metalloproteinase-8 and tissue inhibitor of metalloproteinase-1 levels with low (0.30) molar ratios predicted a worse prognosis (p = 0.020). Tissue matrix metalloproteinase-8 did not influence prognosis. These results suggest that serum matrix metalloproteinase-8, tissue inhibitor of metalloproteinase-1, and the ratio of matrix metalloproteinase-8/ tissue inhibitor of metalloproteinase-1 may prove useful biomarkers for prediction of prognosis in patients with gastric cancer. © The Author(s) 2018.
  • Mattila, Elina; Lappalainen, Raimo; Valkkynen, Pasi; Sairanen, Essi; Lappalainen, Paivi; Karhunen, Leila; Peuhkuri, Katri; Korpela, Riitta; Kolehmainen, Marjukka; Ermes, Miikka (2016)
    Background: Mobile phone apps offer a promising medium to deliver psychological interventions. A mobile app based on Acceptance and Commitment Therapy (ACT) was developed and studied in a randomized controlled trial (RCT). Objective: To study usage metrics of a mobile ACT intervention and dose-response relationship between usage and improvement in psychological flexibility. Methods: An RCT was conducted to investigate the effectiveness of different lifestyle interventions for overweight people with psychological stress. This paper presents a secondary analysis of the group that received an 8-week mobile ACT intervention. Most of the analyzed 74 participants were female (n=64, 86%). Their median age was 49.6 (interquartile range, IQR 45.4-55.3) years and their mean level of psychological flexibility, measured with the Acceptance and Action Questionnaire II, was 20.4 (95% confidence interval 18.3-22.5). Several usage metrics describing the intensity of use, usage of content, and ways of use were calculated. Linear regression analyses were performed to study the dose-response relationship between usage and the change in psychological flexibility and to identify the usage metrics with strongest association with improvement. Binary logistic regression analyses were further used to assess the role of usage metrics between those who showed improvement in psychological flexibility and those who did not. In addition, associations between usage and baseline participant characteristics were studied. Results: The median number of usage sessions was 21 (IQR 11.8-35), the number of usage days was 15 (IQR 9.0-24), and the number of usage weeks was 7.0 (IQR 4.0-8.0). The participants used the mobile app for a median duration of 4.7 (IQR 3.2-7.2) hours and performed a median of 63 (IQR 46-98) exercises. There was a dose-response relationship between usage and the change in psychological flexibility. The strongest associations with psychological flexibility (results adjusted with gender, age, and baseline psychological variables) were found for lower usage of Self as context related exercises (B=0.22, P=.001) and higher intensity of use, described by the number of usage sessions (B=-0.10, P=.01), usage days (B=-0.17, P=.008), and usage weeks (B=-0.73, P=.02), the number of exercises performed (B=-0.02, P=.03), and the total duration of use (B=-0.30, P=.04). Also, higher usage of Acceptance related exercises (B=-0.18, P=.04) was associated with improvement. Active usage was associated with female gender, older age, and not owning a smart mobile phone before the study. Conclusions: The results indicated that active usage of a mobile ACT intervention was associated with improved psychological flexibility. Usage metrics describing intensity of use as well as two metrics related to the usage of content were found to be most strongly associated with improvement.