Tuberoosiskleroosi - suomalainen diagnoosi- ja seurantasuositus

•Tuberoosiskleroosia sairastavat potilaat tarvitsevat systemaattista, monen erikoisalan seurantaa läpi elämän. •Tavoitteena on haitallisten tai jopa hengenvaarallisten elinmuutosten varhainen toteaminen ja hoito. •Epilepsian tehokkaalla hoidolla ja kehityksen oikea-aikaisella tuella pyritään vaikuttamaan potilaiden kehitys¬ennusteeseen ja neuropsykiatristen häiriöiden esiintymiseen. •Tässä suosituksessa esitetään diagnosointi- ja seurantavaiheessa tarvittavat tutkimukset ja niiden toteutus, jossa hyödynnetään sekä erikoissairaanhoidon että perusterveydenhuollon palveluja.Peer reviewe

Real-world treatment outcomes in multiple myeloma: Multicenter registry results from Finland 2009-2013

Outcomes for patients with multiple myeloma (MM) have improved with the advent of novel therapies, however, real-world evidence of outcomes in clinical practice is scarce. We conducted a multi-center registry study to build a reliable picture of treatment and patient outcomes in Finland. The aim of this study was also to understand any methodological challenges in assessing treatment outcomes using disease registry data. Methods: We carried out a retrospective, observational study using data from the national Finnish Hematology Registry (FHR) to provide real-world evidence of outcomes for all adult patients diagnosed with and treated for MM between 2009–2013 at one of the six regional hospitals, with at least six months of recorded follow-up. Patients were identified within the FHR by applying eligibility criteria of a diagnosis of MM and verifiable records of medical treatment and lines of treatment during the study period. Patients receiving allogenic stem cell transplantation were excluded from the cohort, as were individuals who only had monoclonal gammopathy of undetermined significance diagnosis and patients who had not initiated treatment during this period. Kaplan Meier curves were used to calculate overall survival and time to next treatment. Stratification was carried out by drug status (conventional/novel) and by autologous stem cell transplant (ASCT) status. Results: A total of 321 patients met the inclusion criteria and were included in this study. Overall survival (OS) was longest in patients who received first-line novel therapy and ASCT (median not reached during 60-month follow-up) versus 46.2 months for novel first-line therapy without ASCT and 25.6 months for first-line conventional therapy without ASCT. Similarly, median time to next treatment were 33.9 months, 12.6 months and 7.8 months, respectively. Conclusions: The adoption of novel treatments in MM in Finland has had substantial impact on patient outcomes. Given the reality of complex treatment combinations for MM and relatively low patient numbers, assessing individual treatment effectiveness will require substantial cohort sizes and advanced, collaborative analytics on an international scale</p

RVD induction and autologous stem cell transplantation followed by lenalidomide maintenance in newly diagnosed multiple myeloma: a phase 2 study of the Finnish Myeloma Group

Autologous stem cell transplantation (ASCT) combined with novel agents is the standard treatment for transplant-eligible, newly diagnosed myeloma (NDMM) patients. Lenalidomide is approved for maintenance after ASCT until progression, although the optimal duration of maintenance is unknown. In this trial, 80 patients with NDMM received three cycles of lenalidomide, bortezomib, and dexamethasone followed by ASCT and lenalidomide maintenance until progression or toxicity. The primary endpoint was the proportion of flow-negative patients. Molecular response was assessed if patients were flow-negative or in stringent complete response (sCR). By intention to treat, the overall response rate was 89%. Neither median progression-free survival nor overall survival (OS) has been reached. The OS at 3 years was 83%. Flow-negativity was reached in 53% and PCR-negativity in 28% of the patients. With a median follow-up of 27 months, 29 (36%) patients are still on lenalidomide and 66% of them have sustained flow-negativity. Lenalidomide maintenance phase was reached in 8/16 high-risk patients but seven of them have progressed after a median of only 6 months. In low- or standard-risk patients, the outcome was promising, but high-risk patients need more effective treatment approach. Flow-negativity with the conventional flow was an independent predictor for longer PFS

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Perehdyttämisen malli vanhainkoti Kuuselaan

Tämän opinnäytetyön tarkoituksena oli luoda Laukaan kunnan vanhainkoti Kuuselaan malli hyvästä perehdyttämisestä. Perehdyttämisen mallin tekemiseen saimme vanhainkoti Kuuselan osastonhoitajalta toimeksiannon keväällä 2009. Perehdyttämisen mallin tarkoituksena on omalta osaltaan selkiyttää työnte-kijöiden toimenkuvia. Työn teoriaosuudessa tarkastelemme oppimista, ohjaamista, hiljaista tietoa, mentorointia, perehdytystä ja perehdyttämisen keinoja. Opinnäytetyön aineistokeruu vanhainkoti Kuuselan työntekijöiltä tapahtui kyselyllä, jonka teimme kalanruotokaaviota apuna käyttäen. Teimme tutkimuksemme laadullisen tutkimuksen keinoin kehittämis-hankkeena. Käytimme työssämme Demingin työnkehitysmallia, joka rakentuu pohjimmiltaan oppimisen ja jatkuvan parantamisen filosofialle. Analysoimme aineistomme aineistolähtöisen sisällönanalyysin avul-la. Perehdyttäminen on työyhteisön yksi tärkeimmistä ja suurimmista haasteista. Hyvä perehdyttäminen sisältää ne toimet, jotka auttavat työssä aloittamista sekä uuden työntekijän ammattitaidon kehittämisen ja opastuksen työtehtävään, organisaatioon ja työympäristöön. Hyvässä perehdyttämisessä otetaan huo-mioon uuden työntekijän ammattitaito hyödyntäen sitä mahdollisimman paljon jo perehdyttämisen aika-na. Perehdyttäminen edesauttaa uutta työntekijää onnistumaan työssään. Luomamme perehdytyksen malli sisältää osatekijöitä hyvästä perehdyttämisestä. Se on koottu perehdyt-tämiseen liittyvien teorioiden ja työntekijöiden toivomusten avulla.In this bachelor’s thesis our goal is to create a good work orientation model for Kuusela Residential Care Unit in Laukaa. The work was assigned by the residential care unit manager in spring 2009. The goal of the model is also to provide clarification to employee roles. In theoretical framework we review learning, guiding, silent knowledge, mentoring, orientation and ori-entation techniques. We collected the research data from the employees of Kuusela Residential Care Unit through a question-naire. The questionnaire was modified from the Ishikawa fishbone. This thesis is a qualitative research and development project. We used Deming's work development model which is based on a philosophy of learning and constant improvement. We analysed the data with content analysis which is a three stage process. Orientation is one of the most important and extensive challenges in a work community. Good orientation includes actions that will help to start work, improve new workers’ professional skills as well as guide to the work assignment, organisation and work environment. In good work orientation you appreciate and utilise new workers’ professional skills already during the orientation. Orientation helps a new worker to succeed in the work better. The orientation model that we created includes some parts of good orientation. It was composed based on different orientation theories and the wishes of the employees

Real-world treatment outcomes in multiple myeloma : Multicenter registry results from Finland 2009-2013

Outcomes for patients with multiple myeloma (MM) have improved with the advent of novel therapies, however, real-world evidence of outcomes in clinical practice is scarce. We conducted a multi-center registry study to build a reliable picture of treatment and patient outcomes in Finland. The aim of this study was also to understand any methodological challenges in assessing treatment outcomes using disease registry data. Methods: We carried out a retrospective, observational study using data from the national Finnish Hematology Registry (FHR) to provide real-world evidence of outcomes for all adult patients diagnosed with and treated for MM between 2009-2013 at one of the six regional hospitals, with at least six months of recorded follow-up. Patients were identified within the FHR by applying eligibility criteria of a diagnosis of MM and verifiable records of medical treatment and lines of treatment during the study period. Patients receiving allogenic stem cell transplantation were excluded from the cohort, as were individuals who only had monoclonal gammopathy of undetermined significance diagnosis and patients who had not initiated treatment during this period. Kaplan Meier curves were used to calculate overall survival and time to next treatment. Stratification was carried out by drug status (conventional/novel) and by autologous stem cell transplant (ASCT) status. Results: A total of 321 patients met the inclusion criteria and were included in this study. Overall survival (OS) was longest in patients who received first-line novel therapy and ASCT (median not reached during 60-month follow-up) versus 46.2 months for novel first-line therapy without ASCT and 25.6 months for first-line conventional therapy without ASCT. Similarly, median time to next treatment were 33.9 months, 12.6 months and 7.8 months, respectively. Conclusions: The adoption of novel treatments in MM in Finland has had substantial impact on patient outcomes. Given the reality of complex treatment combinations for MM and relatively low patient numbers, assessing individual treatment effectiveness will require substantial cohort sizes and advanced, collaborative analytics on an international scale.Peer reviewe

RVD induction and autologous stem cell transplantation followed by lenalidomide maintenance in newly diagnosed multiple myeloma:a phase 2 study of the Finnish Myeloma Group

Abstract Autologous stem cell transplantation (ASCT) combined with novel agents is the standard treatment for transplant-eligible, newly diagnosed myeloma (NDMM) patients. Lenalidomide is approved for maintenance after ASCT until progression, although the optimal duration of maintenance is unknown. In this trial, 80 patients with NDMM received three cycles of lenalidomide, bortezomib, and dexamethasone followed by ASCT and lenalidomide maintenance until progression or toxicity. The primary endpoint was the proportion of flow-negative patients. Molecular response was assessed if patients were flow-negative or in stringent complete response (sCR). By intention to treat, the overall response rate was 89%. Neither median progression-free survival nor overall survival (OS) has been reached. The OS at 3 years was 83%. Flow-negativity was reached in 53% and PCR-negativity in 28% of the patients. With a median follow-up of 27 months, 29 (36%) patients are still on lenalidomide and 66% of them have sustained flow-negativity. Lenalidomide maintenance phase was reached in 8/16 high-risk patients but seven of them have progressed after a median of only 6 months. In low- or standard-risk patients, the outcome was promising, but high-risk patients need more effective treatment approach. Flow-negativity with the conventional flow was an independent predictor for longer PFS

Lasten ja nuorten liikuntakäyttäytyminen Suomessa : LIITU-tutkimuksen tuloksia 2022

Lasten ja nuorten liikuntakäyttäytyminen Suomessa (LIITU) -tutkimus on kansallinen 7-15-vuotiaiden liikkumista, liikuntakäyttäytymistä ja -kulttuuria laajasti kartoittava seurantatutkimus. Tämä raportti käsittelee kyseisen ikäryhmän lapsilta ja nuorilta maalis-kesäkuussa 2022 sähköisillä kyselyillä (n = 10 098) ja liikemittareilla (n = 1 525) kerättyä aineistoa. Aineiston keruun ajalle ajoittui kolmas korona-aalto (koulujen sulku-uhka), Ukrainan sodan alku sekä opetusalan lakkoja sekä lakonuhkia. Nämä tekijät ovat voineet vaikuttaa tutkimuksen osallistumishalukkuuteen sekä osallistujien liikunta- ja terveyskäyttäytymiseen. Vaikka lähes kaksi kolmesta (61 %) kaikista 7–15-vuotiaista arvioi liikkumisensa lisääntyneen viimeisen 12 kuukauden aikana, vain noin kolmasosa (36 %) raportoi saavuttavansa liikkumissuosituksen, joka on pienempi osuus kuin vuonna 2018 (38 %). Liikemittarilla mitatut tulokset ovat samansuuntaiset; liikkumissuosituksen saavutti mitatusti vuonna 2022 kolmasosa (33 %) lapsista ja nuorista. Mittariaineiston mukaan lasten ja nuorten liikkumisesta suurin osa kertyi 5–10 minuuttia kerrallaan kestäneistä jaksoista. Liikkumisessa on edelleen nähtävillä selvä sukupuoliero; pojat saavuttivat suosituksen kaikissa ikäryhmissä tyttöjä yleisemmin. Iänmukainen liikkumisen väheneminen alkoi tytöillä aikaisempiin LIITU-aineistoihin verrattuna poikia aikaisemmin (9-vuotiaasta alkaen). Samalla sukupuolierot liikkumissuosituksen saavuttaneiden osuuksissa kasvoivat kaikissa ikäryhmissä. Valtaosa lapsista ja nuorista liikkui omatoimisesti ja noin puolet urheiluseuroissa, tosin näin tekevien osuudet olivat pienentyneet kaikissa ikäluokissa. Vuonna 2022 yleisimmin käytettyjä liikuntapaikkoja olivat kevyen liikenteen väylät, oma tai kaverin piha sekä aito luonto. Oma tai kaverin piha lisättiin uutena elementtinä kyselyyn ja se osoittautui yhdeksi eniten käytetyistä liikuntapaikoista. Samalla, luonnossa viikoittain liikkuneiden osuus oli kasvanut merkittävästi vuodesta 2016. Yleisimmät lasten ja nuorten raportoimat vapaa-ajan liikkumismuodot olivat talvella hiihto, jalkapallo, luistelu, jääkiekko ja laskettelu, kesällä jalkapallo, uinti, pyöräily ja frisbeegolf. Vuonna 2018 todettu liikunnan vetovoimaisuuden väheneminen näyttää jatkuneen (2018–2022), muttei yhtä jyrkkänä kuin aiemmin (2014–2018). Merkitysten arvostuksen väheneminen oli tapahtunut erityisesti tyttöjen keskuudessa. Myös liikkumisen esteitä tytöt raportoivat vuonna 2022 useammin kuin vuonna 2018. Urheiluseuratoimintaan osallistuvien lasten ja nuorten osuus oli pienempi vuonna 2022 (58 %) kuin vuonna 2018 (62 %). Vuoteen 2016 verrattuna urheiluseuratoimintaan osallistuminen vähentyi erityisesti 13- ja 15-vuotiaiden ikäryhmissä. Myös kilpailutoimintaan osallistuminen oli pandemian jälkeen vähäisempää. Tässä raportissa esitellään lisäksi tuloksia seuraavilta aihealueilta: liikkumisen seurantalaitteet ja -sovellukset, liikemittareilla mitatun paikallaanolon ja unen määrä, vanhempien ja kavereiden liikunnallinen tuki, liikunnanopetuksen tuntimäärät ja oppilaiden arvosanat, nuorten käsityksiä liikunnanopetuksesta, koulun liikunnallinen toimintakulttuuri, aktiivisesti kuljetut koulumatkat, epäasiallinen kohtelu urheilussa, liikuntavammat, digipelaaminen ja liikkuminen, sekä liikunta, terveys ja terveydenlukutaito. Lisäksi eroja liikuntakäyttäytymisessä tarkastellaan sekä suomen- ja ruotsinkielisten että toimintarajoitteisten lasten ja nuorten ja niiden, joilla ei ole toimintarajoitteita, välillä. Kaikkinensa tämän LIITU-raportin tulosten perusteella voidaan sanoa, että vaikka korona-aikana keskimäärin vähentynyt liikkuminen on alkanut elpymään, ei se ole kaikilla palannut korona-aikaa edeltäneelle tasolle. Liikkumissuositusten mukaan liikkuvien osuudet ovat aiempaa matalammalla tasolla. Vähentymistä oli tapahtunut erityisesti omaehtoisessa liikkumisessa ja seuraharrastamisessa. Erityisen huolestuttavaa on tyttöjen ja poikien välisen eron lisääntyminen useilla eri osa-alueilla. Esimerkiksi, tyttöjen liikkumisaktiivisuus lähtee poikia aiemmin iän myötä laskuun, heillä liikunnan merkitysten arvostus on vähentynyt poikia enemmän, ja tytöt raportoivat enemmän liikkumisen esteitä kuin pojat. Suomessa on edelleen kasvava tarve edistää liikkumista suurimmalla osalla lapsista ja nuorista, erityisesti vanhemmissa ikäryhmissä sekä tytöillä.The Finnish School-aged Physical Activity (F-SPA, LIITU in Finnish) monitoring study provides a comprehensive insight into the physical activity of children and young people aged 7 to 15 in Finland, including the behavioural and cultural aspects. This report presents data collected from children and adolescents between March and June 2022 using online surveys (n = 10,098) and accelerometers (n = 1,525). The data was collected during the third wave of the COVID-19 pandemic (threat of school closures), the start of Russia’s war of aggression in Ukraine, strikes and strike threats in the education sector. These factors may have influenced the willingness of potential participants to take part in the study and the physical activity and health behaviour of those who participated. Although almost two thirds (61%) of all respondents aged 7 to 15 estimated that their physical activity had increased over the past 12 months, only around one in three (36%) reported that they would meet a physical activity (PA) recommendation, showing a reduction from 2018 (38%). The results measured using accelerometers are similar: in 2022, one in three (33%) children and adolescents met the recommendation on physical activity measured. According to the measured data, most physical activity among children and young people took place in periods of 5 to 10 minutes at a time. There is still a clear gender difference in physical activity: boys met the PA recommendation in all age groups more often than girls. The drop-off in physical activity as children get older started earlier among girls than in previous LIITU data (from the age of 9). At the same time, gender differences among those who reached the recommendation on physical activity increased in all age groups. The majority of children and adolescents engaged in independent physical activity and about half of them participated in sports club activities, although the share of both independent PA and club participation had decreased in all age groups. In 2022, the most commonly used sports facilities were pedestrian and bicycle routes, one’s own garden or a friend’s garden, and the natural environment. The respondent’s yard or a friend’s yard was added as a new element to the survey and proved to be one of the most common sports facilities. At the same time, the share of people who moved in a natural environment on a weekly basis had increased significantly since 2016. The most common forms of physical activity reported by children and adolescents were cross-country skiing, football, skating, ice hockey and downhill skiing in winter, and football, swimming, cycling and disc golf in summer. The decrease in the attractiveness of physical activity identified in 2018 seems to have continued (2018–2022), but not as steeply as before (2014–2018). The appreciation of meanings had decreased especially among girls. Girls also reported obstacles to physical activity more often in 2022 than in 2018. The share of children and adolescents participating in sports club activities was smaller in 2022 (58%) than in 2018 (62%). Compared to 2016, participation in sports club activities decreased especially among those aged 13 and 15. Participation in competitions was also less common after the pandemic. In addition to the above, this report presents results in the following areas: use of physical activity monitoring devices and applications, amount of sedentary time and sleep measured using accelerometers, support for physical activity from parents and friends, number of lessons in physical education and students’ school grades, adolescents perceptions concerning physical education, school cultural support related to physical activity, active school travel, inappropriate treatment in sports, sports injuries, digital gaming and physical activity, and physical activity, health and health literacy. In addition, differences in behaviour related to physical activity are examined between both Finnish and Swedish speakers and adolescents with and without disabilities. Based on the results of this F-SPA study, even though the take-up of physical activity, which on average declined during the COVID-19 pandemic, has begun to increase again, it has not returned to its pre-COVID level in all cases. The proportion of those who accumulate the recommended amount of physical activity is lower than before. There had been a particularly steep decline in independent physical activity and club activities. It is particularly alarming that the gap between girls and boys has increased in many areas. For example, girls’ physical activity rates begin to drop off earlier than boys’, their appreciation of meanings of physical activity has decreased more than that of boys, and girls reported more obstacles to physical activity than boys. In Finland, there is still a growing need to promote physical activity among the majority of children and adolescents, especially in older age groups and among girls.nonPeerReviewe