27 research outputs found
A comparative study of two various models of organising diabetes follow-up in public primary health care â the model influences the use of services, their quality and costs
Background In Finland diabetologists have long been concerned about the level of diabetes care as the incidence of type 1 diabetes and complicated type 2 diabetes is exceeding the capacity of specialist clinics. We compared the outcome of diabetes care in two middle-sized Finnish municipalities with different models of diabetes care organisation in public primary health care. In Kouvola the primary health care of all diabetic patients is based on general practitioners, whereas in NurmijĂ€rvi the follow-up of type 1 and most complicated type 2 diabetic patients is assigned to a general practitioner specialised in diabetes care. Methods Our study population consisted of all adult diabetic patients living in the municipalities under review. We compared the use and costs of public diabetes care, glycemic control, blood pressure, LDL-cholesterol level, the application of the national guidelines and patient satisfaction. The main outcome measures were the costs and use of health care services due to diabetes and its complications. Results In NurmijĂ€rvi, where diabetes care was centralised, more type 1 diabetic patients were followed up in primary health care than in Kouvola, where general practitioners need more specialist consultations. The centralisation resulted in cost savings in the diabetes care of type 1 diabetic patients. Although the quality of care was similar, type 1 diabetic patients were more satisfied with their follow-up in the centralised system. In the care of type 2 diabetic patients the centralised system required fewer specialist consultations, but the quality and costs were similar in both models. Conclusions The follow-up of most diabetic patients â including type 1 diabetes â can be organised in primary health care with the same quality as in secondary care units. The centralised primary care of type 1 diabetes is less costly and requires fewer specialist consultations.Peer reviewe
Response to letter on use of functional imaging by 11C-metomidate PET for primary aldosteronism subtyping
Non peer reviewe
A comparative study of two various models of organising diabetes follow-up in public primary health care â the model influences the use of services, their quality and costs
Reversible Congenital Hypogonadotropic Hypogonadism in Patients with CHD7, FGFR1 or GNRHR Mutations
Peer reviewe
Long-Term Effect of Gastric Bypass and Sleeve Gastrectomy on Severe Obesity : Do Preoperative Weight Loss and Binge Eating Behavior Predict the Outcome of Bariatric Surgery?
Few studies have examined weight loss sustainability after sleeve gastrectomy (SG). The purpose of this study was to determine long-term outcome after SG and gastric bypass (GBP) and learn whether preoperative weight loss and binge eating behavior can be used to predict outcome. Together, 257 patients (64 % women) were operated, 163 by GBP and 94 by SG. Binge eating was assessed by binge eating scale (BES) and preoperative weight loss was advised to all, including very low-calorie diet for 5 weeks. Postoperative visits took place at 1 and 2 years, and long-term outcome was at median 5 years (range 2.29-6.85). Multivariate linear regression analysis was used to predict outcome at 2-year and long-term control. Median age was 48 years, weight 141.1 kg, and BMI 48.2 kg/m(2). Preoperative weight loss was median 4.9 % before GBP and 3.8 % before SG, P = 0.04. Total weight loss at year one was 24.1 % in GBP and 23.7 % in SG (P = 0.40), at year two 24.4 and 23.4 % (P = 0.26), and at long-term control 23.0 and 20.2 % (P = 0.006), respectively. Weight was analyzed in 93, 88, and 89 % of those alive, respectively. BES did not predict weight outcome, but larger preoperative weight loss predicted less postoperative weight loss at 2 years. On long term, weight loss was better maintained after GBP compared with SG. Binge eating behavior was not a significant predictor, but larger preoperative weight loss predicted less postoperative weight loss for the next 2 years.Peer reviewe
A 5-Year Prospective Follow-Up Study of Lipid-Rich Adrenal Incidentalomas: No Tumor Growth or Development of Hormonal Hypersecretion
BackgroundCurrent guidelines for follow-up of adrenal incidentalomas are extensive and hampered by lack of follow-up studies. We tested the hypothesis that small lipid-rich adrenal incidentalomas, initially characterized by tumor size 20 mm for the patient with largest tumor growth and those with subclinical hypercortisolism. All patients had normal 24-hour urinary metanephrines and normetanephrines. Low attenuation (<10 HU) was demonstrated in 97% of 67 masses re-evaluated with unenhanced CT.ConclusionNone of the patients developed clinically relevant tumor growth or new subclinical hypercortisolism. Biochemical screening for pheochromocytoma in incidentalomas demonstrating <10 HU on unenhanced CT is not needed. For such incidentalomas <40 mm, it seems sufficient to perform control CT and screen for hypercortisolism after 5 years
Sairaalloisen lihavuuden ryhmÀhoito on tuloksellista
LÀhtökohdat: HYKS:n Meilahden sairaalassa on hoidettu sairaalloista lihavuutta vuodesta 1984 lÀhtien, mikÀ mahdollistaa potilasmateriaalin muutoksen, hoidon tulosten ja pysyvyyden tarkastelun lÀhes kolmen vuosikymmenen ajalta.
MenetelmÀt: Painonhallintaryhmiin osallistuneiden potilaiden painotiedot analysoitiin retro-spektiivisesti. Tietojen tallennus potilasasiakirjoihin oli tehty kÀsin.
Tulokset: Vuosina 1984-2013 ryhmÀhoitoihin osallistui yhteensÀ 1 031 henkilöÀ. Painonhallintaryhmien osallistujien keskimÀÀrÀinen lÀhtöpaino on vuosien mittaan noussut 121 ± 23 (SD) kg:sta 142 ± 26 kg:aan (95 %:n LV 115,8-126,6 kg ja 137,3-147,0). Nuorimpien potilaiden lÀhtöpaino nousi eniten. RyhmÀhoidossa kÀytettiin erittÀin niukkaenergiaista (ENE) ruo-kavaliota, joka paransi laihdutustuloksia. Paino laski 6-12 viikon ENE-ruokavalion avulla ensimmÀisen 16 viikon aikana keskimÀÀrin 12,1 ± 5,8 % (95 %:n LV 11,7-12,6 %), mutta pyrki nousemaan osalla potilaista pian hoidon pÀÀttymisen jÀlkeen. Vuoden kuluttua seurantapunnitukseen kutsutun ja tulleen 186 potilaan (21 % alkuperÀisestÀ joukosta) paino oli 11,5 ± 10,0 % (95 %:n LV 10,1-13,0 %) matalampi kuin ennen hoidon aloittamista ja 73 %:lla nÀistÀ poti-laista paino oli edelleen vÀhintÀÀn 5 % lÀhtöpainoa pienempi. EnsimmÀisen 16 viikon aikana 11 % ei laihtunut, ja 25 % oli keskeyttÀnyt viikkoon 12 mennessÀ.
PÀÀtelmÀt: Lihavuuden ryhmÀhoitoon osallistuneet potilaat ovat yhÀ lihavampia ja erityisesti vaikeasti lihavien nuorten painonnousu on huolestuttavaa. Vaikean lihavuuden konservatiivisen hoidon tulokset ovat kohtalaisen hyviÀ, mutta liian moni potilas keskeyttÀÀ hoidon. Onnistujien mÀÀrÀn lisÀÀminen, tulosten pysyvyys ja hoitoon sitoutuminen ovat suurimpia lihavuuden hoidon haasteita