Duodecim; Laaketieteellinen Aikakauskirja[JOURNAL]
Sun
200 papers
[Changes in consumption of blood products in Finland from 2007 to 2014].
Ihalainen J, Lauronen J, Syrjälä M
Duodecim · 2016 · PMID 27400587
The Finnish Red Cross Blood Service (FRCBS) collects and distributes all cellular blood products in Finland. The use of red cells in Finland follows neither the aging of the Finnish population nor morbidity. The use of r...
The Finnish Red Cross Blood Service (FRCBS) collects and distributes all cellular blood products in Finland. The use of red cells in Finland follows neither the aging of the Finnish population nor morbidity. The use of red blood cells has diminished 34% during the last 20 years and half of this decrease has taken place during the last three years. Use of platelet preparations per inhabitant in Finland clearly exceeds European median. An enhanced IT support for the blood supply chain is needed to maximize the effectiveness of use of blood products.
[Diagnosis and treatment of prosthetic hip and knee joint infections].
Huotari K, Leskinen J
Duodecim · 2016 · PMID 27400586
Successful replacement arthroplasty enhances the patient's functional capacity, alleviates pain and improves the quality of life. Prosthetic joint infection is one of the most dangerous complications following replacemen...
Successful replacement arthroplasty enhances the patient's functional capacity, alleviates pain and improves the quality of life. Prosthetic joint infection is one of the most dangerous complications following replacement arthroplasty. In cases of suspected prosthetic joint infection it is essential to consult with the prosthetic joint unit and abstain from starting antibiotics before the appropriate microbiological samples. The diagnosis is made on the basis of history, clinical picture, levels of inflammatory markers, synovial fluid cells and microbiological findings. The most common options of surgical treatment are early debridement and replacement of loose parts, and replacement of the prosthesis. Antimicrobial drug therapy will be planned according to the surgical mode of treatment and the causative bacterium.
[Twenty years' psychiatric treatment path].
Korhonen L, Tani P
Duodecim · 2016 · PMID 27382835
Treatment paths in psychiatry may extend from infancy to old age, particularly in neuropsychiatric patients. In the diagnostics and treatment it is important to consider the variations in the symptoms and focuses of reha...
Treatment paths in psychiatry may extend from infancy to old age, particularly in neuropsychiatric patients. In the diagnostics and treatment it is important to consider the variations in the symptoms and focuses of rehabilitation during the different periods of the life cycle. Good care and its provision require a perspective extending through the lifespan and assurance of continuity. In our case report we describe a treatment path of 20 years' duration of our neuropsychiatric patient
[Psychological well-being during pregnancy - early roots of the child's mental health?].
Luoma I
Duodecim · 2016 · PMID 27382834
The conditions during pregnancy may influence the child's subsequent well-being via developmental programming. On the other hand, recurrence or continuation of the harmful exposure at a later stage during development may...
The conditions during pregnancy may influence the child's subsequent well-being via developmental programming. On the other hand, recurrence or continuation of the harmful exposure at a later stage during development may be more essential. The parent's mental disorder is one of the best known risk factors potentially affecting the mental health of the child. The mother's depressive and anxiety symptoms during pregnancy have been found to be predictive of symptoms in the young person and in the adult. Regarding the risk of disorder, the recurrence of the exposure to psychological symptoms and accumulation of other risk factors at a later stage of development seem, however, to be more important.
[Are programs supporting parenthood skills effective in the prevention and reduction of conduct disorders and problems of childhood?].
Karjalainen P, Santalahti P, Sihvo S
Duodecim · 2016 · PMID 27382833
In this systematic review it will be evaluated whether parent-targeted programs teaching positive methods of upbringing and interaction are effective in the reduction and prevention of conduct disorders and behavioral pr...
In this systematic review it will be evaluated whether parent-targeted programs teaching positive methods of upbringing and interaction are effective in the reduction and prevention of conduct disorders and behavioral problems in children belonging to a risk group. Altogether 29 European studies on parent-targeted programs were selected for the review. Most of the examined methods were based on the social learning theory and the cognitive behavior theory. The majority of the studies proved that long-term programs of 8 to 20 weeks'duration are effective in the reduction of behavioral problems and conduct disorders of childhood.
[Children's disruptive behavior].
Aronen E
Duodecim · 2016 · PMID 27382832
During normal development, a child learns to regulate her/his aggressions and follow the social norms of her/his community.This learning takes place in interaction with the environment. Risk factors associated with the c...
During normal development, a child learns to regulate her/his aggressions and follow the social norms of her/his community.This learning takes place in interaction with the environment. Risk factors associated with the child, parenthood and environment underlie the disruptive behavior. If a child of preschool/school age exhibits age group deviant difficulties in the management of aggression, defiant, rule-breaking behavior or difficulties in social relationships, there is every reason to get worried and to evaluate the child's symptoms and situation. The earlier the support and therapy is provided, the better are the possibilities to influence the prognosis of conduct disorders.
[Infant psychiatry - more reality than tale].
Puura K, Tamminen T
Duodecim · 2016 · PMID 27382831
In early childhood, the ability of the parent and the child to adapt to each other's needs during early interaction is essential for a healthy mental development.The parent's ability to carry out adequate early interacti...
In early childhood, the ability of the parent and the child to adapt to each other's needs during early interaction is essential for a healthy mental development.The parent's ability to carry out adequate early interaction may be compromised because of various problems. Positive, shared emotional experiences with the parent can protect the child's mental health. Severe or prolonged problems in baby care, interaction or behavior of the infant may result in the development of a psychic disorder in the infant. Infant psychiatric diagnosis and treatment plan are based on clinical examination of the child and the family and evaluation of the need for support.
[Drug therapy and the most common drugs for childhood psychiatric disorders].
Puustjärvi A, Raunio H, Lecklin A … +1 more , Kumpulainen K
Duodecim · 2016 · PMID 27382830
Psychotropic drugs are more commonly prescribed for children, although scientific evidence about psychotrophic medication and long-term effects thereof in children is scarce. The drugs are often used off-label. ADHD drug...
Psychotropic drugs are more commonly prescribed for children, although scientific evidence about psychotrophic medication and long-term effects thereof in children is scarce. The drugs are often used off-label. ADHD drugs, antipsychotics and antidepressants and melatonin are the most commonly used drugs. ADHD medication possesses the most established status. Antipsychotic drugs are utilized for the treatment of psychoses, bipolar disorder, and conduct disorder symptoms in particular. Antidepressants are utilized for the treatment of childhood depression and anxiety disorders, melatonin for the treatment of children's sleep problems. Drug therapy should always be carried out as part of other psychiatric therapy.
[Pregnancy contraception (Current Care Guideline)].
Halttunen-Nieminen M, Piltonen T, Alenius H … +7 more , Apukka L, Kosunen E, Pietilä K, Sihvo S, Vuorela P, Väänänen E, Yli-Kivistö T
Duodecim · 2016 · PMID 27382829
There are no age limits for the start or use of contraception. Prior gynecological examination or cervical smear is not needed. Condom is the only method that protects from sexually transmitted diseases. An increase in t...
There are no age limits for the start or use of contraception. Prior gynecological examination or cervical smear is not needed. Condom is the only method that protects from sexually transmitted diseases. An increase in the risk of venous thromboembolism (VTE) is associated only with combined contraceptives. However, the risk is remarkably higher with pregnancy, puerperium or with smoking. The most effective reversible methods are intrauterine devices (IUD) and implants, as these do not depend on daily memory. Natural family planning methods are not reliable, and effective contraception should be easily available for all at all times.
[Novel approved form of treatment for colonic cancer with peritoneal metastases - radicality-aimed surgery combined with hyperthermic intraperitoneal chemotherapy].
Lepistö A
Duodecim · 2016 · PMID 27382828
Carcinomatosis occurs in almost 10% of colonic cancer patients, whereby the five-year survival rate on cytostatic chemotherapy is approx. 13% at best. For patients having carcinomatosis restricted to a fairly small area,...
Carcinomatosis occurs in almost 10% of colonic cancer patients, whereby the five-year survival rate on cytostatic chemotherapy is approx. 13% at best. For patients having carcinomatosis restricted to a fairly small area, surgical removal of peritoneal metastases combined with hyperthermic intraperitoneal chemotherapy (HIPEC) may be a curative procedure. The treatment has resulted in a five-year life expectancy of 30 to 35% for selected patients. The treatment is, however, associated with significant morbidity and even mortality. Colorectal cancer patients diagnosed with restricted peritoneal carcinomatosis should be referred to an assessment for HPEC treatment.
[Malignized dermoid cyst of the ovary].
Koivisto-Korander R, Bützow R
Duodecim · 2016 · PMID 27382827
Mature germ cell derived cystic teratoma of the ovary, i.e. dermoid cyst, is a common ovarian neoplasm, seldom progressing to malignancy. Malignized dermoid cyst is most commonly diagnosed in a woman of approx. 50 years...
Mature germ cell derived cystic teratoma of the ovary, i.e. dermoid cyst, is a common ovarian neoplasm, seldom progressing to malignancy. Malignized dermoid cyst is most commonly diagnosed in a woman of approx. 50 years of age, either during or after an operation. Owing to the rarity of the disease, the lines of treatment are based on retrospective series of cases.
[Update on Current Care Guideline. Diabetes].
Laakso M, Groop L, Isomaa B … +8 more , Honkasalo M, Juselius P, Lindström J, Meinander T, Nuutinen H, Saltevo J, Syvänne M, Tuomi T
Duodecim · 2016 · PMID 27319085
About 500,000 people suffer from diabetes in Finland, a number which is predicted to increase within the next decades. At the moment, diabetes can neither be prevented nor cured. Diabetes is associated with microvascular...
About 500,000 people suffer from diabetes in Finland, a number which is predicted to increase within the next decades. At the moment, diabetes can neither be prevented nor cured. Diabetes is associated with microvascular (kidney, eye and peripheral nerves) and macrovascular complications (coronary heart disease, stroke). These complications affect the quality of life of patients and account for a substantial proportion of healthcare costs in Finland. The.current guidelines offer recommendations for the diagnosis, screening, prevention and treatment of diabetes and its complications.
[Emergency craniotomies at the North Karelia Central Hospital in 2006 to 2014].
Aro E, Jääskeläinen JE, Reinikainen M … +2 more , Leinonen V, Hakala T
Duodecim · 2016 · PMID 27319084
Traditionally, acute evacuations of traumatic intracranial hematomas are performed by neurosurgeons in university hospitals. However, most patients with traumatic brain injury are initially transported to regional hospit...
Traditionally, acute evacuations of traumatic intracranial hematomas are performed by neurosurgeons in university hospitals. However, most patients with traumatic brain injury are initially transported to regional hospitals that lack neurosurgical expertise. Thus, a trauma surgeon in a regional hospital may encounter a patient with an expanding hematoma that must be operated without delays. During 2006 to 2014, 14 craniotomies were performed at the North Karelia Central Hospital. Twelve patients were operated for acute traumatic subdural hematoma (ASDH): three patients made good recovery, two were left with severe disability, and seven died. Two patients operated with acute epidural hematoma (EDH) recovered well.
[Implementation in Finnish].
Sipilä R, Mäntyranta T, Mäkelä M … +2 more , Komulainen J, Kaila M
Duodecim · 2016 · PMID 27319083
Implementation research examines and promotes the uptake of research findings in various operational environments. The concepts of implementation research in Finnish are not yet established. In support of the research fi...
Implementation research examines and promotes the uptake of research findings in various operational environments. The concepts of implementation research in Finnish are not yet established. In support of the research field we describe the Finnish equivalents of the central terms related to knowledge translation in healthcare and the frame of reference of Implementation research, with the national Current Care Guidelines as the starting point. The frame of reference is based on literature, experiences of the authors, iterative modification of the frame of reference on the basis of discussions, and results of expert inquiry. The frame of reference describes seven objects of evaluation, examples of research set-ups and methods as well as tools.
[Decision about DNR for a palliative patient - do I dare to bring up the subject?].
Hirvonen O, Pöyhiä R
Duodecim · 2016 · PMID 27319082
The do not resuscitate decision (DNR) is an important choice of line of action, which should not be made on light grounds, but if neglected, may harm a patient receiving palliative care. Before making the decision, one s...
The do not resuscitate decision (DNR) is an important choice of line of action, which should not be made on light grounds, but if neglected, may harm a patient receiving palliative care. Before making the decision, one should evaluate an unsuccessful result of possible resuscitation regarding the restoration of vital functions and quality of life. Evaluation of factors suggesting a poor prognosis should be possible already before arriving at the resuscitation situation. The decision should be discussed with the patient, trying to reach a consensus on the matter. DNRs should be made more actively for patients benefiting from the decision.
[Adenomyosis - diagnostic and therapeutic challenge].
Seikkula J, Niinimäki M, Suvitie P
Duodecim · 2016 · PMID 27319081
In adenomyosis, endometrial glandular and stromal cells grow inside the myometrium, and form localized or diffusely expanding islets. Smooth muscle cells of the uterus surrounding the adenomyosis colonies become hypertro...
In adenomyosis, endometrial glandular and stromal cells grow inside the myometrium, and form localized or diffusely expanding islets. Smooth muscle cells of the uterus surrounding the adenomyosis colonies become hypertrophic, which may lead to abnormal contractions of the uterine wall. Adenomyosis is an estrogen-dependent disease with abnormal uterine bleeding and dysmenorrhea as typical symptoms. The disease may even be asymptomate. The diagnosis is made by histologically or ultrasonic or MRI imaging. Adenomyosis can be treated with hormonal medications. Fertility-sparing radiologic and surgical techniques are also available.
[Timing of surgical treatment of fractures of multiply iniured patients - from science to tactics].
Simons T, Brinck T, Handolin L
Duodecim · 2016 · PMID 27319080
Timing of the treatment of orthopaedic injuries in multiply injured patients has undergone changes. The timing of definitive fracture management has varied from several weeks to within hours of injury. In many studies a...
Timing of the treatment of orthopaedic injuries in multiply injured patients has undergone changes. The timing of definitive fracture management has varied from several weeks to within hours of injury. In many studies a clear benefit has been identified from early definitive care of long bone fractures: early total care (ETC). The most seriously injured patients benefit from damage control orthopaedics, an approach employing primary external fixator stabilization followed by secondary intramedullary nailing. Debate over these approaches with enhanced understanding of biological response to injury has led to recent emphasis on the need for aggressive patient monitoring and continued multidisciplinary evaluation of the patient's physiological response to treatment.
[Innate lymphoid cells - a new group of immune cells].
Grönholm A, Junttila I, Pesu M
Duodecim · 2016 · PMID 27319079
A new group of immune cells, innate lymphoid cells, i.e. ILC cells has recently been identified in the territory between the cells of innate and acquired immunity. While the understanding of their functioning and groupin...
A new group of immune cells, innate lymphoid cells, i.e. ILC cells has recently been identified in the territory between the cells of innate and acquired immunity. While the understanding of their functioning and grouping still remains incomplete, their importance in defending the interfaces of the body seems clear. The central role of ILC cells is to sense danger signals in the body and modify immune responses on the basis of this information. In addition to understanding of the defense response, future research. on ILC cells is expected to provide information about the mechanisms of autoimmunity and allergic inflammation as well as disorders of immunity associated with cancer and obesity.
[FAST ultrasonography].
Rinta-Kiikka I
Duodecim · 2016 · PMID 27244939
FAST ultrasonography has established its status as part of the initial evaluation of a trauma patient. FAST allows for the rapid identification of the presence of free fluid (blood) in the pericardium or in the abdominal...
FAST ultrasonography has established its status as part of the initial evaluation of a trauma patient. FAST allows for the rapid identification of the presence of free fluid (blood) in the pericardium or in the abdominal cavity. In practical work, examination of the pleurae is usually included in the approach and examination. In addition to free fluid, findings indicating pneumothorax can be searched from them.
[FATE echocardiography at the emergency outpatient unit].
Rossinen J
Duodecim · 2016 · PMID 27244938
FATE (Focus Assessed Transthoracic Echocardiography) echocardiography can be learned more quickly than extensive cardiologic examination. It is intended to be used in emergency situations as a qualitative examination to...
FATE (Focus Assessed Transthoracic Echocardiography) echocardiography can be learned more quickly than extensive cardiologic examination. It is intended to be used in emergency situations as a qualitative examination to resolve the cardiogenic mechanism of circulatory insufficiency and possible hypovolemia. The procedure is worth utilizing as a dynamic method in the assessment of the response to fluid therapy and vasoactive medications. In many cases, however, a more profound ultrasound imaging will provide essential further information.
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