Miten turvataan myelooman yhdenvertainen hoito tulevaisuudessa?

Myelooman vuosittainen ilmaantuvuus on pysynyt vakaana, mutta ­kehittyneiden hoitojen ansiosta potilaiden elinikä pitenee. Siksi hoidossa olevien potilaiden määrä kasvaa.Kliinisen hematologian erikoislääkärien määrän huomattava vaje voi vaarantaa hoidon yhdenvertaisen toteutumisen.Hoidon kustannukset kasvavat pääasiassa lääkekustannusten nousun vuoksi. Lääkekustannuksia pyritään hallitsemaan erilaisilla riskinjako-­sopimuksilla.Kliiniset lääketutkimukset tarjoavat arvokasta varhaisvaiheen käyttö­kokemusta ja konkreettista säästöä sairaaloiden lääkebudjetteihin. Niiden toteuttaminen sujuvasti rinnakkain rutiinihoidon kanssa tulisi mahdollistaa.</p

Miten turvataan myelooman yhdenvertainen hoito tulevaisuudessa?

Vertaisarvioitu.• Myelooman vuosittainen ilmaantuvuus on pysynyt vakaana, mutta kehittyneiden hoitojen ansiosta potilaiden elinikä pitenee. Siksi hoidossa olevien potilaiden määrä kasvaa. • Kliinisen hematologian erikoislääkärien määrän huomattava vaje voi vaarantaa hoidon yhdenvertaisen toteutumisen. • Hoidon kustannukset kasvavat pääasiassa lääkekustannusten nousun vuoksi. Lääkekustannuksia pyritään hallitsemaan erilaisilla riskinjako- sopimuksilla. • Kliiniset lääketutkimukset tarjoavat arvokasta varhaisvaiheen käyttö- kokemusta ja konkreettista säästöä sairaaloiden lääkebudjetteihin. Niiden toteuttaminen sujuvasti rinnakkain rutiinihoidon kanssa tulisi mahdollistaa.Peer reviewe

Miten turvataan myelooman yhdenvertainen hoito tulevaisuudessa?

Vertaisarvioitu.• Myelooman vuosittainen ilmaantuvuus on pysynyt vakaana, mutta kehittyneiden hoitojen ansiosta potilaiden elinikä pitenee. Siksi hoidossa olevien potilaiden määrä kasvaa. • Kliinisen hematologian erikoislääkärien määrän huomattava vaje voi vaarantaa hoidon yhdenvertaisen toteutumisen. • Hoidon kustannukset kasvavat pääasiassa lääkekustannusten nousun vuoksi. Lääkekustannuksia pyritään hallitsemaan erilaisilla riskinjako- sopimuksilla. • Kliiniset lääketutkimukset tarjoavat arvokasta varhaisvaiheen käyttö- kokemusta ja konkreettista säästöä sairaaloiden lääkebudjetteihin. Niiden toteuttaminen sujuvasti rinnakkain rutiinihoidon kanssa tulisi mahdollistaa.Peer reviewe

Vestiges of an Ancient Border in the Contemporary Genetic Diversity of North-Eastern Europe

It has previously been demonstrated that the advance of the Neolithic Revolution from the Near East through Europe was decelerated in the northernmost confines of the continent, possibly as a result of space and resource competition with lingering Mesolithic populations. Finland was among the last domains to adopt a farming lifestyle, and is characterized by substructuring in the form of a distinct genetic border dividing the northeastern and southwestern regions of the country. To explore the origins of this divergence, the geographical patterns of mitochondrial and Y-chromosomal haplogroups of Neolithic and Mesolithic ancestry were assessed in Finnish populations. The distribution of these uniparental markers revealed a northeastern bias for hunter-gatherer haplogroups, while haplogroups associated with the farming lifestyle clustered in the southwest. In addition, a correlation could be observed between more ancient mitochondrial haplogroup age and eastern concentration. These results coupled with prior archeological evidence suggest the genetic northeast/southwest division observed in contemporary Finland represents an ancient vestigial border between Mesolithic and Neolithic populations undetectable in most other regions of Europe.Peer reviewe

Multinational Experiences in Reducing and Preventing the Use of Restraint and Seclusion

Restraint and seclusion (R/S) have been used in many countries and across service sectors for centuries. With the recent and increasing recognition of the harm associated with these procedures, efforts have been made to reduce and prevent R/S. Following a scathing media exposé in 1998 and congressional scrutiny, the United States began a national effort to reduce and prevent R/S use. With federal impetus and funding, an evidence-based practice, the Six Core Strategies1 to Prevent Conflict, Violence and the Use of Seclusion and Restraint, was developed. This model was widely and successfully implemented in a number of U.S. states and is being adopted by other countries, including Finland, Australia, and the United Kingdom. Recently, the first cluster randomized controlled study of the Six Core Strategies in Finland provided the first evidence-based data of the safety and effectiveness of a coercion prevention methodology. Preliminary findings of some of the international efforts are discussed. Reduction in R/S use and other positive outcomes are also reported

CD34+ cell mobilization, blood graft composition, and posttransplant recovery in myeloma patients compared to non-Hodgkinʼs lymphoma patients: results of the prospective multicenter Goa study

BACKGROUND Autologous stem cell transplantation is an established treatment option for patients with multiple myeloma (MM) or non-Hodgkin?s lymphoma (NHL). STUDY DESIGN AND METHODS In this prospective multicenter study, 147 patients with MM were compared with 136 patients with NHL regarding the mobilization and apheresis of blood CD34+ cells, cellular composition of infused blood grafts, posttransplant recovery, and outcome. RESULTS Multiple myeloma patients mobilized CD34+ cells more effectively (6.3???106/kg vs. 3.9???106/kg, p?=?0.001). The proportion of poor mobilizers (peak blood CD34+ cell count 100?days) nonrelapse mortality (NRM; 6% vs. 0%, p?=?0.003). CONCLUSIONS Non-Hodgkin?s lymphoma and MM patients differ in terms of mobilization of CD34+ cells, graft cellular composition, and posttransplant recovery. Thus, the optimal graft characteristics may also be different.Peer reviewe

Autograft cellular composition and outcome in myeloma patients: Results of the prospective multicenter GOA study

Background Autologous stem cell transplantation (auto-SCT) is a widely used treatment option in multiple myeloma (MM) patients. The optimal graft cellular composition is not known.Study design and methods Autograft cellular composition was analyzed after freezing by flow cytometry in 127 MM patients participating in a prospective multicenter study. The impact of graft cellular composition on hematologic recovery and outcome after auto-SCT was evaluated.Results A higher graft CD34(+) cell content predicted faster platelet recovery after auto-SCT in both the short and long term. In patients with standard-risk cytogenetics, a higher graft CD34(+) count (>2.5 x 10/kg) was linked with shorter progression-free survival (PFS; 28 vs. 46 months, p = 0.04), but there was no difference in overall survival (OS) (p = 0.53). In a multivariate model, a higher graft CD34(+)CD133(+)CD38(-) (>0.065 x 10/kg, p = 0.009) and NK cell count (>2.5 x 10/kg, p = 0.026), lenalidomide maintenance and standard-risk cytogenetics predicted better PFS. In contrast, a higher CD34(+) count (>2.5 x 10/kg, p = 0.015) predicted worse PFS. A very low CD3(+) cell count (Conclusions Autograft cellular composition may impact outcome in MM patients after auto-SCT. More studies are needed to define optimal graft composition.</div