Browsing by Subject "systematic review"

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  • Jaskari, Johanna (Helsingfors universitet, 2015)
    Aims. The purpose of this qualitative study was to systematically analyze how university teaching and learning vary in one Finnish university. My research questions were "How do students' approaches to learning vary?" and "How do teachers' approaches to teaching vary?" In this systematic review, I used the relational model of learning and teaching in universities as a theoretical framework. This model provides a tool to analyze the variation in students' approaches to learning and teachers' approaches to teaching in different teaching-learning environments. The quality of what students learn is linked to the variation in how students learn and how university teachers teach in teaching-learning environments in universities. The quality of learning and teaching is also connected with the allocation of resources and funding in universities and global university rankings. Methods. By using the method of systematic review, I analyzed the variation in teaching and learning in a data sample of 23 high-quality peer-reviewed academic articles. The research context of the studies, which concerned teaching and learning in universities, was the University of Helsinki. Results and conclusions. In this review, students' learning varies mainly in how the students approach their learning (i.e. as surface or deep approaches to learning). Students' learning is modified by the students' learning strategies (e.g. as systematic or critical studies), study orientations (i.e. reproduction- or meaning-oriented learning), and study orchestrations (i.e. different profiles of approaches to learning). Teaching varies mainly in how the teachers approach their teaching (i.e. as teacher- or student-focused approaches to teaching). Teaching is modified by the teachers' conceptions of teaching, teaching strategies (i.e. content- or learning-focused approaches to teaching), and amounts of pedagogical training (that affect the approaches to teaching). Both learning and teaching vary in different teaching-learning environments (both within courses and between disciplines). Both students' and teachers' conceptions of knowledge (e.g. as integrated or fragmented knowledge; declarative or procedural knowledge) affect their approaches to learning and teaching. This systematic review synthesizes what we know about learning and teaching in one university in Finland. This knowledge provides guidelines on how the quality of learning and teaching can be improved both in policy and practice largely in universities in Finland. Essentially, learning is based on good teaching that is focused on the students' learning.
  • Tornivuori, Anna; Tuominen, Outi; Salantera, Sanna; Kosola, Silja (2020)
    Aims To define digital health services that have been studied among chronically ill adolescents and to describe e-health coaching elements that may have an impact on transition outcomes. Design Systematic review without meta-analysis. Data sources MEDLINE (Ovid), Pub Med, Scopus and CINAHL on 28 May 2018. Review methods Peer-reviewed articles published between January 2008-May 2018 were reviewed following the Cochrane Handbook for Systematic Reviews of Interventions and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. Results Twelve randomized controlled trials were included. The interventions varied significantly in duration and content. E-coaching that included human and social support showed positive impact on transition outcomes. Digital health services incorporated into usual care provide efficient and accessible care. Conclusion E-coaching elements enable tailoring and personalization and present a tool for supporting and motivating chronically ill adolescents during transition of care. Future research should evaluate the effectiveness of e-coaching elements. Impact Digital services are considered a means for increasing adolescents' motivation for self-care and for increasing their accessibility to health care. The coaching elements in digital services consist of a theoretical basis, human support, interactive means and social support. Included interventions varied in terms of duration, dose, content and design. Our results may serve the development of digital health services for adolescents in transition. E-coaching can be used to engage and motivate chronically ill adolescents to improve health behaviour and self-management during transition of care.
  • Heliste, Maria; Pettilä, Ville; Berger, David; Jakob, Stephan M.; Wilkman, Erika (2022)
    Background Critical illness may lead to activation of the sympathetic system. The sympathetic stimulation may be further increased by exogenous catecholamines, such as vasopressors and inotropes. Excessive adrenergic stress has been associated with organ dysfunction and higher mortality. beta-Blockers may reduce the adrenergic burden, but they may also compromise perfusion to vital organs thus worsening organ dysfunction. To assess the effect of treatment with beta-blockers in critically ill adults, we conducted a systematic review and meta-analysis of randomized controlled trials. Materials and methods We conducted a search from three major databases: Ovid Medline, the Cochrane Central Register for Controlled Trials and Scopus database. Two independent reviewers screened, selected, and assessed the included articles according to prespecified eligibility criteria. We assessed risk of bias of eligible articles according to the Cochrane guidelines. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results Sixteen randomized controlled trials comprising 2410 critically ill patients were included in the final review. A meta-analysis of 11 trials including 2103 patients showed a significant reduction in mortality in patients treated with beta-blockers compared to control (risk ratio 0.65, 95%CI 0.53-0.79; p < .0001). There was no significant difference in mean arterial pressure or vasopressor load. Quality of life, biventricular ejection fraction, blood lactate levels, cardiac biomarkers and mitochondrial function could not be included in meta-analysis due to heterogenous reporting of outcomes. Conclusions In this systematic review we found that beta-blocker treatment reduced mortality in critical illness. Use of beta-blockers in critical illness thus appears safe after initial hemodynamic stabilization. High-quality RCT's are needed to answer the questions concerning optimal target group of patients, timing of beta-blocker treatment, choice of beta-blocker, and choice of physiological and hemodynamic parameters to target during beta-blocker treatment in critical illness. KEY MESSAGES A potential outcome benefit of beta-blocker treatment in critical illness exists according to the current review and meta-analysis. Administration of beta-blockers to resuscitated patients in the ICU seems safe in terms of hemodynamic stability and outcome, even during concomitant vasopressor administration. However, further studies, preferably large RCTs on beta-blocker treatment in the critically ill are needed to answer the questions concerning timing and choice of beta-blocker, patient selection, and optimal hemodynamic targets.
  • Mäkinen, Arttu (Helsingfors universitet, 2018)
    This is a systematic review aiming to investigate the efficacy, effectiveness, and safety of biosimilars in the treatment of inflammatory bowel diseases. Biosimilar drugs used to treat inflammatory bowel diseases include biosimilar infliximab and biosimilar adalimumab. Biosimilar infliximab has been authorized by the European Medicines Agency (EMA) in 2013 and by the US Food and Drug Administration (FDA) in 2016. Biosimilar adalimumab has been authorized by EMA and FDA in 2017 and, at the time the literary search for this systematic review was conducted no studies were found regarding the treatment of adalimumab biosimilar for inflammatory bowel diseases. To acquire marketing authorization for biosimilars, it must be proven that the biosimilar is biologically similar to the original medicinal product. Bioequivalence is demonstrated through physicochemical trials and clinical trials. However, clinical trials do not have to be performed with all of the indications for which the original medical product is registered. After proving bioequivalence with one or more indication it is possible to extrapolate the biosimilar to be used in all of the original medical products indications. This has raised the question of whether biosimilars are really comparable to the originator in indications for which no clinical trials have been conducted. This systematic review was implemented using the Cochrane Handbook for Systematic Reviews and Interventions. Systematic literature searches were made in Cochrane, Medline (Ovid®), PubMed and Scopus databases on 12.05.2017. 14 observational studies, one systematic review and a randomized clinical trial that met the inclusion criteria were included in the systematic review. The quality of the publications was evaluated using the STROBE-, NOS- and CONSORT-checklists and information regarding the efficacy, effectiveness and safety of biosimilars was extracted. CD-patients receiving tumor necrosis factor alpha inhibitors for the first time, the clinical response was achieved in 50.0 % to 97.2 % of patients depending on patient population and the duration of treatment. Similarly, for UC-patients, the clinical response was achieved in 62.2 % to 100.0 %. The clinical remission was achieved among 28.9 % to 84.4 % of CD-patients and among 28.9 % to 84.4 % of UC-patients, depending on patient population and treatment follow-up. After the switch from original infliximab to biosimilar, the proportion of patients in clinical remission during follow-up ranged from 62.3 % to 100.0 % in CD-patients and from 45.5 % to 100.0 % in UC-patients. Clinical remission was sustained throughout the whole follow-up in 70 % to 100 % of CD-patients and 66.7 % to 92.0 % of UC-patients. The incidence of adverse events leading to the discontinuation of drug treatment was between 0.0 % and 25.0 %, and the incidence of all adverse events ranged from 0.0 % to 93.6 % in CD- and UC-patients. Biosimilar infliximab seems to be comparable to the original product regarding the efficacy, effectiveness and safety. This result is supported by the systematic literature review published earlier. Conducting a meta-analysis of the information contained in this systematic literature review could have led to a more final decision considering efficacy, effectiveness and safety of biosimilar-infliximab in the treatment of inflammatory bowel diseases.
  • von Weissenberg, Rebecka (Helsingin yliopisto, 2021)
    Klimatkompensation har blivit ett populärt sätt för konsumenter och företag att bidra till bekämpning av klimatförändring. Klimatkompensation, dvs. köpandet av en verifierad kompensationsenhet som produceras av miljövänliga projekt runtom i världen, regleras inte på en statlig eller mellanstatlig nivå, utan regelverket runt klimatkompensation består främst av självreglerande certifieringsprogram som upprätthåller regler och processer som kompensationsprojekt måste uppfylla för att få certifikatets tillkännagivande om kompensationsenhetens trovärdighet. Kontroversen kring till förhållandet mellan klimatkompensation och lagen om penningsamlingar (863/2019) som uppstod år 2019 har resulterat i att Inrikesministeriet inlett diverse utredningar om hur frivillig klimatkompensation kunde regleras och övervakas för att säkerställa att verksamheten sker på ett tillförlitligt sett. Under utredningsprocessen har möjligheten för Konsumentskyddsmannen att funktionera som övervakande och verkställande myndighet diskuterats. Detta utgör forskningsintresset i denna studie, som försöker besvara följande fråga; vilket/vilka reglerings- och övervakningsinstrument borde myndigheterna tillämpa på den inhemska klimatkompensationsmarknaden för att säkerställa att verksamheten fyller kraven på tillförlitlig klimatkompensation? Avhandlingen granskar ämnet från perspektivet av Konsumentskyddsmannens breda övervaknings- och verkställighetsmandat under konsumentskyddslagen (38/1978) genom rättsdogmatisk metod, men analysen grundar sig främst på rättsteoretisk granskning av regleringsstrategier presenterade i den internationella rättslitteraturen. De övervaknings- och verkställighetsstrategier som identifierades i den internationella rättsliteraturen genom en systematisk litteraturöversikt är 1) vägledning och instruktioner 2) offentlig tillkänna givning av privata certifieringsprogram genom separat lagstiftning samt 3) upprättande av en registreringsskyldighet för säljare av kompensationsenheter. Dessa strategier analyseras utifrån kriterierna av effektivitet och kostnads effektivitet, samt hur de förhåller sig till den finska Konsumentskyddsmannens övervaknings- och verkställighetsmandat. Dessutom framställs minimikrav som borde uppfyllas för att effektiv övervakning och verkställighet av klimatkompenseringens legitimitet kan säkerställas. Avhandlingen finner att även om sampeln är begränsad, borde Konsumentskyddsmannen inom sin så kallade compliance-verksamhet i första hand utveckla vägledning och instruktioner till både säljare och köpare (konsumenter) av klimatkompensationsenheter för att åtgärda informationsbristen som existerar inom denna marknad. Denna vägledning bör innefatta minimikraven på tillförlitlig klimatkompensation, samt redogöra för säljarens informationsskyldighet under 6 § och 7 § av konsumentskyddslagen. Tilläggsåtgärder med att antingen offentligt implementera ett privat certifieringsprogram, eller genom upprättande av en registreringsskyldighet, borde även implementeras för att säkerställa effektiv övervakning av denna verksamhet. Dock är de två senaste åtgärderna beroende av den framtida utvecklingen av EU-rätten eftersom konsumentskydd är ett område som berörs av principen för harmonisering inom den inre marknaden. Slutsatserna är även att implementering av regleringsåtgärder för klimatkompensation kräver mer forskning av diverse juridiska faktorer som kompensationsenheter berör, samt internationellt avgörande av hur klimatkompensation borde hanteras inom de mellanstatliga utsläppsminskningsmålen.
  • Jylänki, Pinja; Mbay, Theo Chidiebere Ismael; Byman, Anni Elina; Hakkarainen, Airi; Sääkslahti, Arja; Aunio, Pirjo (2022)
    This systematic review aimed to investigate the methodological quality and the effects of fundamental motor skills and physical activity interventions on cognitive and academic skills in 3- to 7-year-old children with special educational needs. The review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) statement. A literature search was carried out in April 2020 (updated in January 2022) using seven electronic databases, including ERIC, Scopus, Web of Science, PsycINFO, CINAHL, PubMed, and SPORTDiscus. The methodological quality of the studies was assessed with Effective Public Health Practice Project (EPHPP) Quality Assessment Tool. Cohen's d effect sizes and post-hoc power analyses were conducted for the included studies. Altogether 22 studies (1883 children) met the inclusion criteria, representing children at-risk for learning difficulties, due to family background (n(studies) = 8), children with learning difficulties (n(studies) = 7), learning disabilities (n(studies) = 5), and physical disabilities (n(studies) = 2). Two of the included 22 studies displayed strong, one moderate, and 19 studies weak methodological quality. The intervention effects appeared to be somewhat dependent on the severity of the learning difficulty; in cognitive and language skills, the effects were largest in children at-risk due to family background, whereas in executive functions the effects were largest in children with learning disabilities. However, due to the vast heterogeneity of the included studies, and a rather low methodological quality, it is challenging to summarize the findings in a generalizable manner. Thus, additional high-quality research is required to determine the effectiveness of the interventions.
  • Kallio, Eeva-Liisa; Öhman, Hanna; Kautiainen, Hannu; Hietanen, Marja; Pitkala, Kaisu (2017)
    Background: Cognitive training (CT) refers to guided cognitive exercises designed to improve specific cognitive functions, as well as enhance performance in untrained cognitive tasks. Positive effects of CT on cognitive functions in healthy elderly people and persons with mild cognitive impairment have been reported, but data regarding the effects of CT in patients with dementia is unclear. Objective: We systematically reviewed the current evidence from randomized controlled trials (RCTs) to find out if CT improves or stabilizes cognition and/or everyday functioning in patients with mild and moderate Alzheimer's disease. Results: Altogether, 31 RCTs with CT as either the primary intervention or part of a broader cognitive or multi-component intervention were found. A positive effect was reported in 24 trials, mainly on global cognition and training-specific tasks, particularly when more intensive or more specific CT programs were used. Little evidence of improved everyday functioning was found. Conclusions: Despite some positive findings, the inaccurate definitions of CT, inadequate sample sizes, unclear randomization methods, incomplete datasets at follow-up and multiple testing may have inflated the results in many trials. Future high quality RCTs with appropriate classification and specification of cognitive interventions are necessary to confirm CT as an effective treatment option in Alzheimer's disease.
  • Tuuliainen, Suvi Tuuli Eufrosyne (Helsingin yliopisto, 2022)
    Ympäristökriisi on yksi aikamme suurimmista globaaleista ongelmista. Voimakkaana tekijänä kriisissä ovat ihmisten valinnat niin arjen kuluttamisessa kuin yleisessä käyttäytymisessä luontoa kohtaan. Ympäristömyönteinen käyttäytyminen kumpuaa luontoyhteydestä, jonka nähdään rappeutuneen nyky-yhteiskunnassamme. Tästä johtuen lisäämällä ihmisten luontoyhteyttä voisimme edistää heidän ympäristömyönteistä käyttäytymistään. Tämä tutkielma käsittelee luontoyhteyden ja ympäristömyönteisen käyttäytymisen välistä yhteyttä. Tavoitteena on hahmottaa, millä tavoin tämä yhteys muodostuu, jotta voimme lisätä ihmisten ympäristömyönteistä käyttäytymistä syvällä ja perusteellisella tasolla. Tutkielmassa pyritään vastaamaan tähän systemaattisen kirjallisuuskatsauksen keinoin perehtymällä aiempien tutkimusten aihepiireihin ja niiden teoreettiseen pohjaan koskien luontoyhteyden ja ympäristömyönteisen käyttäytymisen suhdetta. Katsauksessa löydettiin 38 kappaletta soveltuvia artikkeleita, joita analysoitiin luokittelemalla niitä seuraavin perustein: 1) millaisia yhteyksiä aiempi tutkimus on luonut luontoyhteyden ja ympäristömyönteisen käyttäytymisen välille, ja 2) mitä välittäviä muuttujia luontoyhteyden ja ympäristömyönteisen käyttäytymisen välillä on havaittu aiemmissa tutkimuksissa. Tutkimuksen mukaan aineistosta voidaan muodostaa kolme kategoriaa, jotka ovat: 1) CTN-PEB, 2) x-CTN-PEB, and 3) CTN-x-PEB. Tutkimuksessa syvennyttiin eniten kategoriaan numero kolme, jossa luontoyhteyden ja ympäristömyönteisen käyttäytymisen suhdetta selvitettiin erilaisten välittävien muuttujien avulla. Jatkotutkimusta kausaalisen yhteyden selvittämiseksi tarvitaan.
  • Bazelier, Marloes T.; Eriksson, Irene; de Vries, Frank; Schmidt, Marjanka K.; Raitanen, Jani; Haukka, Jari; Starup-Linde, Jakob; De Bruin, Marie L.; Andersen, Morten (2015)
    PurposeTo identify pharmacoepidemiological multi-database studies and to describe data management and data analysis techniques used for combining data. MethodsSystematic literature searches were conducted in PubMed and Embase complemented by a manual literature search. We included pharmacoepidemiological multi-database studies published from 2007 onwards that combined data for a pre-planned common analysis or quantitative synthesis. Information was retrieved about study characteristics, methods used for individual-level analyses and meta-analyses, data management and motivations for performing the study. ResultsWe found 3083 articles by the systematic searches and an additional 176 by the manual search. After full-text screening of 75 articles, 22 were selected for final inclusion. The number of databases used per study ranged from 2 to 17 (median=4.0). Most studies used a cohort design (82%) instead of a case-control design (18%). Logistic regression was most often used for individual-level analyses (41%), followed by Cox regression (23%) and Poisson regression (14%). As meta-analysis method, a majority of the studies combined individual patient data (73%). Six studies performed an aggregate meta-analysis (27%), while a semi-aggregate approach was applied in three studies (14%). Information on central programming or heterogeneity assessment was missing in approximately half of the publications. Most studies were motivated by improving power (86%). ConclusionsPharmacoepidemiological multi-database studies are a well-powered strategy to address safety issues and have increased in popularity. To be able to correctly interpret the results of these studies, it is important to systematically report on database management and analysis techniques, including central programming and heterogeneity testing. (c) 2015 The Authors. Pharmacoepidemiology and Drug Safety published by John Wiley & Sons, Ltd.
  • Karikoski, Essi; Sarkola, Taisto; Blomqvist, My (2021)
    Aim Poor oral health is related with bacteraemia that may lead to endocarditis in children with congenital heart disease (CHD). The aim of this study was to conduct a systematic literature review to compare caries prevalence in children ( Material and methods A literature search of studies from two online databases (Pubmed (MEDLINE) and Scopus) published from January 2000 to October 2019 using Medical subject heading terms Congenital Heart Disease, Congenital Heart Defect, and Caries was done, and manual search from the reference lists of selected publications. PICO (Patient/Population, Intervention, Comparison group, and Outcome) criteria was applied. Quality of the publications was assessed with the modified Newcastle-Ottawa scale. Results The search resulted in 151 articles of which nine fulfilled the inclusion criteria. Caries prevalence was significantly higher in children with CHD compared to healthy children in three out of nine studies. Information on predisposing background factors was limited but difference in caries prevalence was not attributed to SES. The quality of the studies varied. Conclusions Although evidence is limited, the current literature indicates that children with CHD experience a higher caries prevalence compared to healthy children.
  • Marionneau, Virve; Nikkinen, Janne (2020)
    The economic benefits of gambling may be offset by economic harm to other industries. This economic phenomenon, also known as substitution or cannibalization, refers to a new product that diverts consumption and profits from other products or industries. Gambling may displace revenue from other businesses, but economic impact studies on gambling do not consider such shifts between expenditures. This paper presents a systematic review of the available evidence (N = 118) on whether the introduction or expansion of gambling harms or benefits other business activity. Although the issue has been considered in previous review studies, no industry-level analysis is currently available. The results show that such an approach is necessary, as the impacts of gambling on other industries appear to depend strongly on the type of industry, as well as on the location and type of gambling. Industries that are negatively affected by gambling include other recreation, retail and merchandise, manufacturing, and agriculture and mining. Alcohol consumption, construction, and the finance, insurance, and real estate industries, as well as other services, appear to be positively affected by the presence of gambling. In other cases, the evidence is either mixed or inconclusive. These results nevertheless depend strongly on the type of gambling. Destination gambling appears to be more beneficial to other industries than recreational gambling. Overall, the results show that even in cases when gambling does substitute for other industries, the displacement is not complete. The reasons for this and the gaps in the existing evidence and literature are discussed.
  • Baumgartner, Ana; Drame, Katarina; Geutjens, Stijn; Airaksinen, Marja (2020)
    Many patients, especially those with a high pill burden and multiple chronic illnesses, are less adherent to medication. In medication treatments utilizing polypills, this problem might be diminished since multiple drugs are fused into one formulation and, therefore, the therapy regimen is simplified. This systematic review summarized evidence to assess the effect of polypills on medication adherence. The following databases were searched for articles published between 1 January 2000, and 14 May 2019: PubMed, Web of Science, Cochrane Library, and Scopus. Medication adherence was the only outcome assessed, regardless of the method of measuring it. Sixty-seven original peer-reviewed articles were selected. Adherence to polypill regimens was significantly higher in 56 articles (84%) compared to multiple pill regimens. This finding was also supported by the results of 13 out of 17 selected previously published systematic reviews and meta-analyses dealing with this topic. Adherence can be improved through the formulation of polypills, which is probably why the interest in researching them is growing. There are many polypills on the market, but the adherence studies so far focused mainly on a small range of medical conditions.
  • Vainio, Sanna (Helsingfors universitet, 2019)
    Despite the long history of skin grafting, there is no standardized treatment for split-thickness skin graft donor sites. These sites cause a notable amount of pain and discomfort to the patients and open wounds also introduce a risk for infection. There is an extensive need for treatment options promoting the fastest and least painful healing possible while also being infection-free. The treatment of split-thickness skin graft donor sites is constantly studied and there is plenty of scientific literature available about this topic. In the theory section of this Master’s thesis, the structure of skin, the process of wound healing, skin grafting surgery and wound care products for split-thickness skin graft donor sites are briefly introduced. Additionally, the method of systematic review is described. In the empirical section, a systematic review is performed to compare animal- and non-animal-based wound care products in the treatment of split skin graft donor sites. The methodological quality of the included studies is reviewed. In the literature search, 3552 references were found. In this systematic review a total of 23 articles were included comprising of 21 comparative clinical studies and two previous literature reviews. Of the original studies, 20 reviewed healing, 14 infection and 17 pain of the split-thickness skin graft donor sites. Based on the results of the systematic review, animal-based wound care products might promote healing and reduce pain experienced by patients in the treatment of split-thickness skin graft donor sites when compared with non-animal-based wound care products. The results concerning infection were inconsistent. Generally, the reporting of the clinical original studies was not comprehensive enough for proper evaluation of methodological quality. Some defects, mostly in the blinding of the patients, study personnel and the assessors of outcomes, were also found. Moreover, the studies were heterogeneous in their definitions and measuring of the reported outcomes. Therefore, there is substantial uncertainty in the results of this systematic review. The systematic and transparent way of conducting the literature search, the review of the methodological quality and the reporting of the outcomes can be considered as a strength of this thesis. The main weakness is, that only one person performed the critical steps of this study, which might increase the risk of bias and reduce the repeatability of the study.
  • Viljemaa, Kati (Helsingfors universitet, 2017)
    The economic burden of adverse events (AEs) is substantial and in direct relation to current increasing drug utilisation. According to previous research, the annual cost of AEs in the U.S. may be as high as 22.9 billion euros. In Europe AEs are considered to contribute to 3.6 percent of hospital admissions, have an impact on 10 percent of inpatients during their hospital admission and are responsible for less than 0.5 percent of inpatient deaths. AEs thus clearly constitute a major clinical issue. Fluoroquinolones have been in clinical use since the 1980s and are globally among the most consumed antimicrobials. Fluoroquinolones are generally well tolerated antimicrobials. The most common AEs are mild and reversible, such as diarrhea, nausea and headaches. Nevertheless, fluoroquinolones are also associated with more serious AEs, including Clostridium difficile associated diarrhea (CDAD), rate-corrected electrocardiographic prolonged QT interval, tendinitis and tendon rupture, dysglycemia, hepatic toxicity, phototoxicity, acute renal failure and serious AEs involving the central nervous system, such as seizures. Health service use and costs specifically associated with fluoroquinolone-related AEs have not been evaluated previously. The theory section of this Marter's thesis considers adverse events and fluoroquinolones. The main principles of conducting a systematic review are also discussed. The empirical section is a systematic review. The aim of this study is to identify health care use and costs associated with ciprofloxacin, levofloxacin, moxifloxacin, norfloxacin and ofloxacin -related AEs. A literature search covering Medline, SCOPUS, Cinahl, Web of Science and Cochrane Library was performed in April 2017. Two independent reviewers systematically extracted the data and assessed the quality of the included studies. All costs were converted to 2016 euro in order to improve comparability. Of the 5,687 references found in the literature search, 19 observational studies, of which 5 were case-controlled, fulfilled the inclusion criteria. Hospitalization was an AE-related health care use outcome in 17 studies. Length of stay associated with AEs varied between <5 - 45 days. The estimated cost of an AE episode ranged between 140 and 18,252 €. CDAD was associated with the longest stays in hospital. However, a mere 10 studies reported AE-related length of stays and only 5 evaluated costs associated with AEs. Although rare, in particular serious fluoroquinolone-related AEs can have substantial economic implications, in addition to imposing potentially devastating health complications for patients. Further measures are required to prevent and reduce health service use and costs associated with fluoroquinolone-related AEs. Equally, better-quality reporting and additional published data on health service use and costs associated with AEs are essential. The strengths of this study are a comprehensive and systematic literature search and transparency of methodologies and reporting. The main weakness is the generalizability of the results.
  • 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.
  • Sanabria, Alvaro; Shah, Jatin P.; Medina, Jesus E.; Olsen, Kerry D.; Robbins, K. Thomas; Silver, Carl E.; Rodrigo, Juan P.; Suarez, Carlos; Coca-Pelaz, Andres; Shaha, Ashok R.; Mäkitie, Antti A.; Rinaldo, Alessandra; de Bree, Remco; Strojan, Primoz; Hamoir, Marc; Takes, Robert P.; Sjogren, Elisabeth V.; Cannon, Trinitia; Kowalski, Luiz P.; Ferlito, Alfio (2020)
    Background: Larynx cancer is a common site for tumors of the upper aerodigestive tract. In cases with a clinically negative neck, the indications for an elective neck treatment are still debated. The objective is to define the prevalence of occult metastasis based on the subsite of the primary tumor, T classification and neck node levels involved. Methods: All studies included provided the rate of occult metastases in cN0 larynx squamous cell carcinoma patients. The main outcome was the incidence of occult metastasis. The pooled incidence was calculated with random effects analysis. Results: 36 studies with 3803 patients fulfilled the criteria. The incidence of lymph node metastases for supraglottic and glottic tumors was 19.9% (95% CI 16.4-23.4) and 8.0% (95% CI 2.7-13.3), respectively. The incidence of occult metastasis for level I, level IV and level V was 2.4% (95% CI 0-6.1%), 2.0% (95% CI 0.9-3.1) and 0.4% (95% CI 0-1.0%), respectively. For all tumors, the incidence for sublevel IIB was 0.5% (95% CI 0-1.3). Conclusions: The incidence of occult lymph node metastasis is higher in supraglottic and T3-4 tumors. Level I and V and sublevel IIB should not be routinely included in the elective neck treatment of cN0 laryngeal cancer and, in addition, level IV should not be routinely included in cases of supraglottic tumors.
  • Boertien, Jeffrey M.; Pereira, Pedro A. B.; Aho, Velma T. E.; Scheperjans, Filip (2019)
    Gut microbiota have been studied in relation to the pathophysiology of Parkinson's disease (PD) due to the early gastrointestinal symptomatology and presence of alpha-synuclein pathology in the enteric nervous system, hypothesized to ascend via the vagal nerve to the central nervous system. Accordingly, sixteen human case-control studies have published gut microbiome composition changes in PD and reported over 100 differentially abundant taxa covering all taxonomic levels from phylum to genus or species, depending on methodology. While certain findings were replicated across several studies, various contradictory findings were reported. Here, differences in methodologies and the presence of possible confounders in the study populations are assessed for their potential to confound the results of gut microbiome studies in PD. Gut microbiome studies in PD exhibited considerable variability with respect to the study population, sample transport conditions, laboratory protocols and sequencing, bioinformatics pipelines, and biostatistical methods. To move from the current heterogeneous dataset towards clinically relevant biomarkers and the identification of putative therapeutic targets, recommendations are derived from the limitations of the available studies to increase the future comparability of microbiome studies in PD. In addition, integration of currently available data on the gut microbiome in PD is proposed to identify robust gut microbiome profiles in PD. Furthermore, expansion of the current dataset with atypical parkinsonism cohorts, prodromal and treatment naive de novo PD subjects, measurements of fecal microbial concentrations and multi-omics assessments are required to provide clinically relevant biomarkers and reveal therapeutic targets within the gut microbiome of PD.
  • Niittynen, Ilona (Helsingfors universitet, 2018)
    Medication-related events are a significant cause of in-hospital adverse events. Intravenous medication errors occur more frequently and are more likely to result in serious harm than other medication therapies. Closed loop medication management which seamlessly integrates automated and intelligent systems barriers, is used for reducing medication errors. The aim of this systematic review was to identify what kind of scientific studies exist regarding closed loop medication in intravenous medication therapy and barriers related to it. This study is part of a larger systematic review. The literature search indentified 2292 scientific papers. Of these, only 57 were included in the larger review since most of the references were excluded based on titles, abstracts or full-texts. Of these, 21 studies regarding closed loop medication management in intravenous medication therapy were included in this thesis. The studies conserned intelligent infusion devices, computerized physician order entries, clinical decision support systems, automated workflow management systems reducing compounding errors and bar-code confirmation of drugs and patients. According to this review, closed loop medication management potentially reduces medication errors related to intravenous medication therapy. It seems to be more effective to seamlessly integrate the closed loop medication management barriers to each other and to the medication management process than to implement the barriers separately. It’s important to plan the implementation carefully by a multidisciplinary team. In addition, the latest care guidelines need to be taken in to account. Significant resources must be allocated to training and engaging employees and to systematically maintaining and developing the process to manage the successful implementation of the process. This review provides valuable information for Finnish hospitals implementing the closed loop medication management since the concept is not yet well-known in Finland.
  • Järvinen, Nina (Helsingfors universitet, 2016)
    Breast cancer is the most common cancer among women, about 25 % of all cancers in women. 15 - 20 % of them are HER2 positive. HER2 is a transmembrane protein receptor with tyrosine kinase activity. When the overexpressed receptor is activated it turns on a cascade which results to activation of genes coding for for the growth of the cancer cells. Drugs against HER2 protein have significantly improved the survival of patients with HER2 positive breast cancer. In this systematic review the epidemiology, diagnostics and the principles of treatment is reviewed with focus on the treatment of HER2 positive breast cancer and anti-HER2 medications. Endpoints of clinical trials and handling the data are also reviewed. The aim of this study is to collect data of lapatinib, pertuzumab and trastuzumab emtansine in randomized clinical trials studying progression free survival, overall survival and adverse effects of patients with metastatic HER2 positive breast cancer. As a result of the literature search 22 whole text articles were found. There were 14 of randomized clinical trials, 2 of previous systematic reviews and 6 of meta-analysis. The facts and results of the selected studies were collected in tables. The quality of the studies was evaluated with CONSORT and PRISMA guidance. Lapaninib is used mainly for treatment of patients with resistanse to trastuzumab. Lapatinib improves the progression free survival and overall survival but the effect has not been as goog as expected. Lapatinib is better than chemotherapy but worse than trastuzumab in the treatment of metastatic HER2 positive breast cancer. Combinaition therapy is better than none of these alone. Lapatinib is a small molecule tyrosine kinase inhibitor. Pertuzumab and trastuzumab emtansine are monoclonal antibodies targeting HER2 receptor. In trastuzumab emtansine there is also a cytotoxic drug which is delivered into the cancer cell. Pertuzumab is effective in the treatment of metastatic HER2 positive breast cancer and it improves the survival also after treatment with trastuzumab. Pertuzumab is now approved also as neoadjuvant. Promising results has been published with trastuzmab emtansine in the treatment of heavily medicated patients with progressive disease. Adverse effects were abundant but usually manageable and reversible. The quality of the studies was mainly good. Some limitations were noticed, especially in reporting methods. Cancer therapy with targeted medication improves the effect of the treatment and decrease systemic adverse effects. It seems that the use of lapatinib is going to be mostly complementary when more promising pertuzumab and trastuzumab emtansine turned up to be more effective in the treatment of metastatic HER2 positive breast cancer. In the future there should be more clinical experience with the use of lapatinib, pertuzumab and trastuzumab emtansine. That would guarantee a cancer patient the most effective treatment, hopefully at the early stage of cancer.
  • Santos-Cortez, R.L.P.; Bhutta, M.F.; Earl, J.P.; Hafrén, Lena; Jennings, M.; Mell, J.C.; Pichichero, M.E.; Ryan, A.F.; Tateossian, Hilda; Ehrlich, G.D. (2020)
    Objective: To review the most recent advances in human and bacterial genomics as applied to pathogenesis and clinical management of otitis media. Data sources: PubMed articles published since the last meeting in June 2015 up to June 2019. Review methods: A panel of experts in human and bacterial genomics of otitis media was formed. Each panel member reviewed the literature in their respective fields and wrote draft reviews. The reviews were shared with all panel members, and a merged draft was created. The panel met at the 20th International Symposium on Recent Advances in Otitis Media in June 2019, discussed the review and refined the content. A final draft was made, circulated, and approved by the panel members. Conclusion: Trans-disciplinary approaches applying pan-omic technologies to identify human susceptibility to otitis media and to understand microbial population dynamics, patho-adaptation and virulence mechanisms are crucial to the development of novel, personalized therapeutics and prevention strategies for otitis media. Implications for practice: In the future otitis media prevention strategies may be augmented by mucosal immunization, combination vaccines targeting multiple pathogens, and modulation of the middle ear microbiome. Both treatment and vaccination may be tailored to an individual's otitis media phenotype as defined by molecular profiles obtained by using rapidly developing techniques in microbial and host genomics. © 2020 Elsevier B.V.