Tartuntataudit Suomessa - raportoidut mikrobilöydökset

Valtakunnallinen tartuntatautirekisteri/Riksomfattande register över smittsamma sjukdomar

Bridging the gap between technical and human elements in digital service innovation

Creating and establishing a successful innovation is challenging and many attempts fail. Despite of the complex nature of the phenomenon, previous literature often tends to limit its focus on either to the technical elements or human elements related to an innovation. Current research-in-progress paper aims to avoid this ‘either-or’ thinking and rather examine the roles, impact and mutual interaction of both, technical and human elements, in order to further understand the successful emergence of a digital service innovation, i.e. a novel value co-creation practice enabled by a digital infrastructure. To achieve this we draw from three separate fields: service ecosystem perspective, information technology (IT) perspective and actor-network theory. The paper presents a plan for future empirical study and provides initial description of a case study about establishing a digital shopping solution in a small brick and mortar convenience store in Northern Finland

User Participation in Software Design via Social Media: Experiences from a Case Study with Consumers

User participation has proved to have many benefits in software development. The traditional methods for participation rely mainly on face-to-face meetings and are therefore not easily applicable to designing online services targeted at distributed consumers. Social media have become widely used among consumers and could thus offer many opportunities for involving users in software design. We present a case study in which a group of users participated for over six months in the process of designing a new online service via social media tools. The users played an active role in the development of the system, tailoring it to their own needs. Our results show that social media provide real possibilities for user involvement in software design and also shape some elements of the participation process. In social media, user contributions are mainly small and dispersed over time, but users can be involved almost continuously in the design process, thus enabling them to have a more active role in decision-making. Software development practices need to be modified so that small user contributions fit into the process

Leikkausalueen infektioiden seuranta lonkan ja polven tekonivelleikkausten sekä reisiluun murtumaleikkausten jälkeen Suomessa

Background and aims. Since 1999, hospitals in the Finnish Hospital Infection Program (SIRO) have reported data on surgical site infections (SSI) following major hip and knee surgery. The purpose of this study was to obtain detailed information to support prevention efforts by analyzing SIRO data on SSIs, to evaluate possible factors affecting the surveillance results, and to assess the disease burden of postoperative prosthetic joint infections in Finland. Methods. Procedures under surveillance included total hip (THA) and total knee arthroplasties (TKA), and the open reduction and internal fixation (ORIF) of femur fractures. Hospitals prospectively collected data using common definitions and written protocol, and also performed postdischarge surveillance. In the validation study, a blinded retrospective chart review was performed and infection control nurses were interviewed. Patient charts of deep incisional and organ/space SSIs were reviewed, and data from three sources (SIRO, the Finnish Arthroplasty Register, and the Finnish Patient Insurance Centre) were linked for capture-recapture analyses. Results. During 1999-2002, the overall SSI rate was 3.3% after 11,812 orthopedic procedures (median length of stay, eight days). Of all SSIs, 56% were detected after discharge. The majority of deep incisional and organ/space SSIs (65/108, 60%) were detected on readmission. Positive and negative predictive values, sensitivity, and specificity for SIRO surveillance were 94% (95% CI, 89-99%), 99% (99-100%), 75% (56-93%), and 100% (97-100%), respectively. Of the 9,831 total joint replacements performed during 2001-2004, 7.2% (THA 5.2% and TKA 9.9%) of the implants were inserted in a simultaneous bilateral operation. Patients who underwent bilateral operations were younger, healthier, and more often males than those who underwent unilateral procedures. The rates of deep SSIs or mortality did not differ between bi- and uni-lateral THAs or TKAs. Four deep SSIs were reported following bilateral operations (antimicrobial prophylaxis administered 48-218 minutes before incision). In the three registers, altogether 129 prosthetic joint infections were identified after 13,482 THA and TKA during 1999-2004. After correction with the positive predictive value of SIRO (91%), a log-linear model provided an estimated overall prosthetic joint infection rate of 1.6% after THA and 1.3% after TKA. The sensitivity of the SIRO surveillance ranged from 36% to 57%. According to the estimation, nearly 200 prosthetic joint infections could occur in Finland each year (the average from 1999 to 2004) after THA and TKA. Conclusions. Postdischarge surveillance had a major impact on SSI rates after major hip and knee surgery. A minority of deep incisional and organ/space SSIs would be missed, however, if postdischarge surveillance by questionnaire was not performed. According to the validation study, most SSIs reported to SIRO were true infections. Some SSIs were missed, revealing some weakness in case finding. Variation in diagnostic practices may also affect SSI rates. No differences were found in deep SSI rates or mortality between bi- and unilateral THA and TKA. However, patient materials between these two groups differed. Bilateral operations require specific attention paid to their antimicrobial prophylaxis as well as to data management in the surveillance database. The true disease burden of prosthetic joint infections may be heavier than the rates from national nosocomial surveillance systems usually suggest.Suomessa tehdään vuosittain yli 15 000 lonkan tai polven tekonivelleikkausta. Nykyaikainen tekonivelkirurgia parantaa potilaiden toimintakykyä ja helpottaa kipua. Vaikka leikkauksen jälkeisten infektioiden ilmaantuminen on selvästi vähentynyt tekonivelkirurgian alkuaikoihin verrattuna, edelleen osa tekonivelleikkauksista voi johtaa infektioon. Hoitoon liittyvien infektioiden seuranta on keskeinen osa niiden ehkäisyä. Suomessa sairaalat ovat voineet osallistua vapaaehtoiseen Kansanterveyslaitoksen valtakunnalliseen sairaalainfektio-ohjelmaan (SIRO) vuodesta 1999 lähtien. Tässä väitöskirjatutkimuksessa analysoitiin SIRO-seurannassa todettuja leikkausalueen infektioita ja niiden riskitekijöitä lonkan ja polven tekonivelleikkauksien ja reisiluun murtumien leikkauksien jälkeen. Lisäksi arvioitiin seurantatietojen laatua ja leikkauksen jälkeisten tekonivelinfektioiden kokonaismäärää Suomessa. SIRO-seurannassa sairaalat keräävät tietoja leikkausalueen infektioista käyttäen yhteisiä määritelmiä ja menetelmiä. Infektiotapauksia etsitään myös potilaiden kotiuduttua sairaalasta. Validaatiotutkimuksessa arvioitiin seurantatietojen laatua läpikäymällä sairauskertomuksia ja haastattelemalla sairaaloiden hygieniahoitajia. Kaikki vuosina 1999―2004 ilmoitetut vakavat leikkausalueen infektiotapaukset käytiin läpi. Lisäksi seurantatietoihin yhdistettiin tietoja kahdesta muusta lähteestä: Lääkelaitoksen implanttirekisteri ja Potilasvakuutuskeskus. Vuosina 1999―2002 leikkausalueen infektioiden esiintyvyys oli 3,3 prosenttia seurantaan kuuluneen 11 812 leikkauksen jälkeen. Vakavien infektioiden, joita ovat syvät haavainfektiot ja nivelen/luun infektiot, esiintyvyys oli 0,9 prosenttia. Infektioista yli puolet todettiin potilaan sairaalasta kotiutumisen jälkeen. Pääosa vakavista infektioista todettiin potilaan tullessa uudelleen sairaalahoitoon. SIRO-seurantatietojen laatu oli validaatiotutkimuksessa samaa tasoa kuin muiden maiden kansallisissa seurantajärjestelmissä: SIRO-seurannan herkkyys oli 75 prosenttia ja tarkkuus lähes 100 prosenttia. Infektioiden toteamiskäytännöt vaihtelevat jonkin verran sairaaloittain, mikä saattaa vaikuttaa seurantatuloksiin. Tulevaisuudessa sairaaloiden tietojärjestelmien kehittyminen voi helpottaa sairaalainfektioiden seurantaa ja parantaa sen laatua. Vuosina 2001―2004 asetetuista lonkan tai polven tekonivelistä 7 prosenttia oli asetettu kaksipuolisessa toimenpiteessä, jolloin molempiin lonkkiin tai polviin oli asetettu tekonivel samassa leikkauksessa. Kaksipuolisissa leikkauksissa potilaat olivat nuorempia ja terveempiä kuin yksipuolisissa. Tässä aineistossa vakavien infektioiden esiintyvyydessä ja kuolleisuudessa ei havaittu eroa yksi- ja kaksipuolisten leikkausten välillä. Rekisterien yhdistämistutkimuksen perusteella arvioitiin, että Suomessa esiintyy noin 200 leikkauksen jälkeistä tekonivelinfektiota vuosittain. Leikkauksen jälkeisten tekonivelinfektioiden tautitaakka saattaa olla jonkin verran suurempi kuin yleensä kansallisten seurantaohjelmien tulosten perusteella on arvioitu

High Cure Rate for Acute Streptococcal Prosthetic Joint Infections Treated With Debridement, Antimicrobials, and Implant Retention in a Specialized Tertiary Care Center

Streptococcal prosthetic joint infections (PJIs) treated with debridement, exchange of removable parts, antibiotics, and implant retention within 3 weeks from symptom onset had an implant survival rate of 97.9% and an implant survival rate without suppressive antimicrobials of 80.9%. Treatment centralization for acute streptococcal PJIs to specialized centers makes excellent cure rates possible.Non peer reviewe

The incidence of late prosthetic joint infections A registry-based study of 112,708 primary hip and knee replacements

Background and purpose - Late prosthetic joint infections (PJIs) are a growing medical challenge as more and more joint replacements are being performed and the expected lifespan of patients is increasing. We analyzed the incidence rate of late PJI and its temporal trends in a nationwide population. Patients and methods - 112,708 primary hip and knee replacements performed due to primary osteoarthritis (OA) between 1998 and 2009 were followed for a median time of 5 (1-13) years, using data from nationwide Finnish health registries. Late PJI was detected > 2 years postoperatively, and very late PJI was detected > 5 years postoperatively. Results - During the follow-up, involving 619,299 prosthesis-years, 1,345 PJIs were registered: cumulative incidence 1.20% (95% CI: 1.13-1.26) (for knees, 1.41%; for hips, 0.92%). The incidence rate of late PJI was 0.069% per prosthesis-year (CI: 0.061-0.078), and it was greater after knee replacement than after hip replacement (0.080% vs. 0.057%, p = 0.006). The incidence rate of very late PJI was 0.051% per prosthesis-year (CI: 0.042-0.063), 0.058% for knees and 0.044% for hips (p = 0.2). The incidence rate of late PJI varied between 0.041% and 0.107% during the years of observation without any temporal trend (incidence rate ratio (IRR) = 0.98, 95% CI: 0.93-1.03). Very late PJI increased from 0.026% in 2004 to 0.056% in 2010 (IRR = 1.11, 95% CI: 1.02-1.20). Interpretation - In our nationwide study, the incidence rate of late PJI after hip or knee arthroplasty was approximately 0.07% per prosthesis-year. The incidence of very late PJI appeared to increase.Peer reviewe

Infections after intramedullary fixation of trochanteric fractures are uncommon and implant removal is not usually needed

Background and purpose. Infections after intramedullary fixation of trochanteric femoral fractures are rare, but potentially life-threatening complications. There are limited data available to support decision making in these cases. Patients and methods. A retrospective study of 995 consecutive operatively treated trochanteric fractures was made to find out different risk factors for infection and to describe the results of treatment. Results. 28 patients developed a surgical site infection (2.8%) after intramedullary fixation of trochanteric fracture. 15 patients (1.5%) had a deep and 13 patients (1.3%) a superficial surgical site infection. Cigarette smoking ( p < 0.05) and prolonged operative time ( p < 0.05) were significant risk factors for an infection. 15 of 28 patients needed revision surgeries. Implant removal or exchange was needed only for 4 of 28 patients: 1 exchange of the blade, 1 removal of additional cable used to assist reduction and 2 removals of distal locking screws. None of the patients needed additional surgeries for problems with fracture healing. Mortality was not increased among patients with an infection. Interpretation. Infection after intramedullary fixation of trochanteric fractures can be successfully treated without removal or exchange of the fixation material. (c) 2020 Elsevier Ltd. All rights reserved.Peer reviewe

Eturauhasen näytepalojen ottamisen jälkeiset tulehdukset

English summaryPeer reviewe

Infectious complications after transrectal MRI-targeted and systematic prostate biopsy

Purpose To compare infectious complications after transrectal systematic prostate biopsy (SB) and magnetic resonance imaging (MRI)-targeted biopsy (TB) in a large retrospective cohort to assess whether one technique is superior to the other regarding infectious complications. Methods A total of 4497 patients underwent 5288 biopsies, 2875 (54%) SB and 2413 (46%) MRI-TB only. On average, 12 SB cores and 3.7 MRI-TB cores were taken per biopsy session during the study period. Infection-related complications within 30 days were compared. The primary endpoint was a positive urine culture. Secondary endpoints were positive blood cultures, urine tests with elevated leukocytes >= 100 E6/L and elevated C-reactive protein (CRP) >= 100 mg/L. Chi-square test was used to compare the cohorts. Results Positive urine cultures were found in 77 (2.7%) after SB and in 42 (1.7%) after MRI-TB (p = 0.022). In total, 46 (0.9%) blood culture positive infections were found, 23 (0.9%) occurred after SB and 23 (1.0%) after MRI-TB, (p = 0.848). Urine tests with elevated leukocytes >= 100 E6/L were found in 111 (3.9%) after SB and in 61 (2.5%) after MRI-TB (p = 0.006). Elevated CRP >= 100 mg/L was found in 122 (4.2%) after SB and in 72 (3.0%) after MRI-TB (p = 0.015). Blood cultures were drawn more often after SB than after MRI-TB, but the difference was not statistically significant. However, urine cultures and CRP were taken more often after SB than MRI-TB. Conclusion Blood culture positive infections were equally rare after SB and MRI-TB. However, all other infectious complications were more common after SB than MRI-TB.Peer reviewe