Browsing by Subject "elämänlaatu"

Objective: To discover the health-related quality of life (HRQOL) of patients with treated arteriovenous malformation (AVM), we used the self-applicable HRQOL instrument, the 15D, and analyzed the scores in both in the whole study population and specified cohorts. Methods: The 15D questionnaires were mailed to adult patients with AVM alive in 2016 (n = 432) in our database. Patients with completely eradicated AVM (n = 262) were included in a subsequent analysis. The results were compared with those of the general population standardized for age and sex. Subgroup analyses were conducted for epilepsy, number of bleeding episodes, location of the lesion, modified Rankin Scale score, and Spetzler-Ponce classification (SPC) using independent-samples t test or analysis of covariance. Tobit regression was used to explain the variance in the 15D score. Results: Patients had impaired HRQOL compared to the reference population (p < 0.0001). Deep location, multiple bleeding episodes, and refractory epilepsy were associated with impaired HRQOL. Patients in SPC A and B had similar posttreatment 15D scores, whereas those in class C had an impaired HRQOL. Significant explanatory variables in the regression model were age, sex, number of bleeding episodes, refractory epilepsy, and SPC. Conclusions: With careful patient selection, patients in SPC B can reach as favorable HRQOL as those in SPC A provided the operation is successful. Multiple bleeding episodes should be prevented with effective treatment aiming at complete AVM obliteration. The postoperative treatment of patients with AVM should focus on preventing depressive symptoms, anxiety, and epileptic seizures. We encourage other research groups to use HRQOL instruments to fully understand the consequences of neurologic and neurosurgical diseases on patients’ HRQOL.

Lymfooma eli imukudossyöpä on koirien kolmanneksi yleisin kasvainsairaus. Se saa alkunsa lymfosyyteistä. Suurimmalla osalla koirista lymfooma on fenotyypiltään B-soluista lähtöisin. Koirilla yleisin lymfooman muoto on multisentrinen lymfooma, jonka tyypillisin oire on suurentuneet imusolmukkeet. Lymfoomaa voidaan tavata primaarikasvaimena kuitenkin myös muissa elimissä kuten ruuansulatuskanavassa tai ihossa. Diagnosointiin voidaan käyttää apuna ohutneulanäytettä, jossa keskikokoiset tai suuret lymfosyytit hallitsevat solukuvaa. Lymfooman hoitoon käytetään solunsalpaajia ja se on yksi parhaiten solunsalpajahoitoon vastaavista kasvainsairauksista. Ilman hoitoa koirien keskimääräinen elinikä vaihtelee 4 viikosta 3 kuukauteen. Solunsalpaajahoidoilla noin 60 – 90 % koirista saavuttaa täydellisen remission ja keskimääräinen elinikä vaihtelee 6 – 12 kk välillä ja jopa 20 – 25 % hoidetuista koirista elää vielä kaksi vuotta hoitojen aloittamisen jälkeen. Merkittävimmät ennusteeseen vaikututtavat tekijät ovat lymfooman fenotyyppi sekä kliinisen leviinneisyysluokan alaluokka. Lymfooman hoitoon on kehitetty useita erilaisia hoitoprotokollia, mutta yleisimmin käytettäviä lääkeaineita ovat doksorubisiini, syklofosfamidi, vinkristiini, prednisoloni ja lomustiini. Koska solunsalpaajat vaikuttavat kaikkiin elimistön nopeasti jakautuviin soluihin, myös elimistön normaalit solut kärsivät hoidoista. Hoitojen aiheuttamat haittavaikutukset kohdistuvat useinmiten luuytimeen ja ruuansulatuskanavaan. Solunsalpaajien käyttö eläinten kasvainsairauksien hoidossa on Suomessa vielä melko harvinaista, ja pelko hoitojen aiheuttamista haittavaikutuksista saattaa vaikuttaa sekä eläinlääkäreiden että lemmikkien omistajien päätöksiin hoitojen aloittamisesta. Tutkimuksen tarkoituksena oli selvittää solunsalpaajahoitojen aiheuttamia haittavaikutuksia ja koirien elämänlaatua hoitojen aikana sekä omistajien tyytyväisyyttä hoitoihin. Tutkimus toteutettiin retrospektiivisenä kyselytutkimuksena. Mukaan tutkimukseen valittiin omistajat, joiden koirien lymfoomaa oli vuosien 2004 – 2008 aikana hoidettu eläinlääkäriasema HauMaussa. Kaikkiaan kyselylomakkeita jaettiin 42 kappaletta, joista täytettynä palautettiin 35 kappaletta (vastausprosentti 83,30 %). Haittavaikutuksia ilmeni lähes kaikilla koirilla (97 %), mutta ne olivat aineiston mukaan suurimmaksi osaksi melko lieviä ja lyhytkestoisia. Yleisimpiin haittavaikutuksiin lukeutuivat väsymys ja apatia (54,30 %) sekä ruuansulatuskanavan oireet kuten oksentelu (51,40 %), ruokahaluttomuus (48,60 %) tai ripuli (45,70 %). Koirien elämänlaatu ei tilastollisesti parantunut hoitojen aikana verrattuna sairasaikaan ennen hoitoja. Omistajista 74,30 % oli täysin tyytyväisiä ja 22,90 % melko tyytyväisiä koiriensa saamaan hoitoon. Omistajista 85,70 % olisi edelleen valinnut solunsalpaajahoidot kyseiselle lemmikilleen, mikäli olisi jälkikäteen saanut valita. Lisäksi tulevaisuudessa 91,40 % omistajista voisi hoidattaa muita lemmikkejään solunsalpaajilla, mikäli ne sairastuisivat johonkin kasvainsairauteen. Ennen hoitoja omistajia mietityttivät eniten haittavaikutukset ja ennuste. Näistä asioista omistajat olisivat myös toivoneet saavansa vielä enemmän tietoa hoitokäyntien yhteydessä.

Background Gallstones are common in the Western adult population: their incidence is 10-20 %. Half of the patients are asymptomatic when the gallstones are diagnosed. Uncomplicated, symptomatic cholecystolithiasis means that the gallstones generate pain, but the disease has not developed any complications. The treatment for symptomatic patients is cholecystectomy which is normally made in laparoscopy. Despite the operation, pain continues in 28 % of the electively operated patients. The purpose of this systematic review is to find out based on literature whether there is a patient group that does not benefit from the operation or what the characteristics of such patients are. Methods The source of the literature is Ovid Medline database. The research question has been divided into PICO keywords and 790 results have been found. The results have been reviewed by title, abstract, and by the whole text, and the articles that do not fulfil the inclusion criteria have been ruled out. The articles have to concern people minimum of 18 years old that have had their gallbladder removed because of symptomatic, uncomplicated cholecystolithiasis. In addition, some symptom and quality of life parameters must have been asked before and after operation. Eventually, there are 22 articles left that the systematic review is based on. These articles have been reviewed with the Newcastle-Ottawa scale. Results There is no research on the patient group that does not benefit from the cholecystectomy, but there are parameters found that have an impact on the benefit. High-level anxiety increases the risk of continuous pain up to three times higher. Alexithymia and psychologic distress are more common in patients that have continuous abdominal symptoms after the operation. High pain frequency is linked to worse postoperative pain relief. To get the best benefit from the operation, pain symptoms need to be typical and intense, but pain frequency low. Female gender and functional gastrointestinal disorder are connected to worse outcome. Pain duration more than a year, high score in preoperative quality of life questionnaire, and episodic pain predict pain relief after the operation. Discussion According to the systematic review, there is no research on who should not be operated because of symptomatic, uncomplicated cholecystolithiasis. However, some parameters that predict worse operation outcome have been found. Further research on the topic is needed to find out the parameters that determine whether the patients get benefit from the operation.

End stage renal disease (ESRD) burdens both society and patient trough lower quality of life and the cost of treatment, as well as through lost productivity. In 2012, the incidence of ESRD was 81 patients per one million inhabitants in Finland. Annual number of kidney transplantations range from 150 to 210. The costs of specialized medical care, adherence to medication and health related quality of life (HRQoL) of kidney transplant patients were analyzed in this study. The aim of the study was to provide research to support the improvement of the kidney transplant patients' health care process and future research on the cost-effectiveness of kidney transplantation. In addition, the aim was to produce information to support health care decision making and resource allocation. The study population included 320 patients who had received a kidney transplant in HYKS. Of the included patients, 198 answered the questionnaire and 122 formed a control population of which only cost data was available. The cost data was collected from the HUS Ecomed-database. Medication adherence was measured with the BAASIS- and VAS-instruments and the HRQoL with the generic 15D-instrument. Forty-three per cent of the patients were non-adherent. There was no statistical difference in the adherence of patients with different dialysis modalities. The correct timing of taking the immunosuppressive medication proved to be its biggest challenge. The average quality of life for kidney transplant patients was measured at 0.87. There were no statistically significant differences in the 15D scores between adherent and non-adherent patients or different dialysis modalities. Instead, there were statistically significant differences between dialysis modalities in some of the 15 dimensions. The 15D score was on average lower among patients with a higher MRCI-score or a longer dialysis period prior to transplantation. The average cost for the specialized medical care of the kidney transplant patients was 34 331 euros on the year prior to the transplant, 52 834 euros one year after the transplant and 8 537 and 7 791 euros on the second and third year after the transplant, respectively. Average costs for all three years after the transplantation combined were 68 932 euros. Based on the results of this study, non-adherence to medication proved to be a considerable issue for kidney transplant patients. The HRQoL after a kidney transplantation was moderately high, although lower than in the age standardized general population. Adherence to medication, HRQoL or the dialysis modality were not associated with cost of the specialized medical care after the kidney transplantation and there was no single factor associated with these post transplant costs. The strength of the study is a comprehensive longitudinal analysis of special care costs and the factors associated with them. On the other hand, health related quality of life is only measured once, which is a limitation. The cost analysis would have been more comprehensive if all the health care cost and other direct costs such as travel and time cost as well as indirect costs such the loss of productivity had been included.

Objectives: Stroke is one of the most common causes of long-term adult disability. The fastest recovery occurs during the first months of post-stroke. Still, patients in rehabilitation wards spend most of the time in nontherapeutic activities. There are promising findings on using music listening as part of the rehabilitation of stroke patients in the rehabilitation ward environment. Nevertheless, the implementation of music listening therapy still requires more research. This pilot study was designed to determine usability of music listening devices (MP3 player compared to a tablet computer with Spotify), to evaluate whether music listening can facilitate recovery after stroke and to study the subjective benefits that occur as a result of music listening on stroke patients. Methods: In total 24 subacute phase stroke patients (age 51–82 years) in a rehabilitation ward took part in the study. Patients listened to music using either MP3 device (n = 8) or Spotify on a tablet computer (n = 16). Patients listened to their favourite music for approximately one hour a day, during 2–3 weeks period. Neurological examination and brief cognitive testing were performed at the beginning and the end of the study. Patients filled questionnaires on functioning, quality of life, mood, and motor and cognitive deficits as well as role of music in life and experiences on music listening before and after the music listening intervention. At the end of the study, patients also evaluated the usability of the music listening technology. Rehabilitation ward nurses observed patients during the usage of music listening devices at the beginning, middle and end of the study. Results and conclusions: There were no changes in functioning, quality of life and mood measures, apart from the improvement in the neurological examination compared to pre-examination. There were no differences in the impacts of music listening between groups. The usability of the MP3 player and the tablet computer and Spotify were evaluated as quite good on average by patients and there were no differences between groups in this evaluation. In qualitative analysis, there seemed to occur more problems in the tablet group, but usage became easier over time. Stroke patients felt that music listening was rewarding and beneficial to their recovery and they were eager to recommend music listening as a part of stroke rehabilitation. Stroke patients felt that music listening was useful to them with both devices and beneficial to their rehabilitation. Stroke patients were eager to recommend music listening as a part of the stroke rehabilitation. Based on the results of this study, music listening therapy can be recommended as a part of the rehabilitation of subacute phase stroke patients.

Tutkimuksen tavoite oli selvittää terveyteen liittyvää elämänlaatua potilailla, joille on tehty rinta-aortan toimenpide hypotermiassa ja verenkierron pysäytyksessä. Alue on oleellinen arvioitaessa alati paranevien kirurgisten hoitomuotojen vaikutusta potilaiden henkilökohtaiseen käsitykseen terveydestään. Aineisto kerättiin prospektiivisesti. Tutkimusryhmässä oli 30 potilasta, jotka leikattiin verenkierron pysäytyksessä syvässä hypotermiasuojassa. Tutkimuspotilaita verrattiin 31 kontrollipotilaaseen, joille tehtiin ohitusleikkaus joko perfuusiossa lievässä hypotermiassa tai käyvällä sydämellä ilman perfuusiota. 4,6–8,0 vuotta toimenpiteen jälkeen tutkimukseen tavoitetut potilaat haastateltiin käyttäen RAND 36-Item Health Survey -kyselylomaketta. Tutkimus- ja kontrolliryhmän välillä elossaolo-osuudet vastasivat toisiaan ollen 90 %, 90 % ja 87 % tutkimusryhmässä ja 100 %, 94 % ja 94 % kontrolliryhmässä 1., 4. ja 8. vuoden kohdalla (p = 0,62, log-rank-testi). RAND-36-kyselyn tulokset yhtenivät kaikissa elämäänlaatuun liittyvissä osa-alueissa. Verrattaessa ryhmiä ikä- ja sukupuolivakioidun kansallisen otannan kroonisesti sairaisiin henkilöihin ainoaksi eroksi muodostui kontrolliryhmän parempi tulos psyykkisen hyvinvoinnin ulottuvuudessa. Terveeseen suomalaiseen ikä- ja sukupuolivakioituun väestöön verrattuna tutkimuspotilaat saavuttivat huonomman tuloksen kolmella ja verrokkiryhmä neljällä kahdeksasta terveyteen liittyvän elämänlaadun osa-alueesta.

Breast cancer is the most common cancer among women world wide and it´s incidence is constantly growing. The prognosis of local breast cancer is good and patients with metastatic breast cancer are living longer with their disease. The growing survivorship and population of chronically ill breast cancer patients has made quality of life one of the most important aspects in the treatment of breast cancer. Cytotoxic chemotherapy is a widely used treatment for breast cancer. Chemotherapy can cause difficult adverse events, which can affect the patients’ quality of life. Chemotherapy can also relieve the symptoms caused by cancer when used to treat metastatic breast cancer. The aim of this systematic review was to collect the currently available literature about breast cancer patients´ health related quality of life as comprehensively as possible, review the quality of the literature and the effects of chemotherapy on breast cancer patients ‘quality of life. The literature search produced 1666 references. According to the inclusion and exclusion criteria, 107 full text articles were accepted to the final systematic review, 53 of which reported the health related quality of life during adjuvant treatment of breast cancer, and 51 of which reported it during the treatment of advanced or metastatic breast cancer. In addition 3 previous systematic reviews were found. The basic information about the articles was extracted into a table. Articles were heterogeneous regarding their study settings, used quality of life instruments and reporting. Most studies used a disease specific quality of life instrument. The collected literature gave a strong indication of quality of life worsening during adjuvant chemotherapy of breast cancer. This observation was further supported by the previous systematic reviews. Most of the studies reporting the quality of life during chemotherapy for metastatic breast cancer, reported less than clinically important changes during the treatment. A few studies reported clinically important worsening or improvement in quality of life. 11 studies, which were made during or after 21: st century, which reported numerical data from quality of life, which reported predominantly quality of life and which had sample size of at least 100 patients in baseline, were accepted to further assessment of quality of the studies and closer observation. The quality of the studies was assessed with STROBE and CONSORT checklists. The quality of studies was heterogeneous as the studies fulfilled 44.8 % to 86.1 % of the scoring items. Only one randomized controlled trial reported quality of life as their primary end point. The data from these studies supported the previous observation of quality of life worsening during adjuvant chemotherapy of breast cancer. The effect of chemotherapy during metastatic breast cancer on quality of life was not unambiguous. Both clinically meaningful worsening and improvement of quality of life was reported. Breast cancer patients´ health related quality of life has been assessed in multiple publications, but the existing literature is heterogeneous and it´s use in decision making and economic evaluation is not easily feasible. Breast cancer patients´ health related quality of life worsened during adjuvant chemotherapy. Significant improvement in breast cancer patients´ health related quality of life was not observed during chemotherapy for metastatic breast cancer.

Tavoitteet. Muistisairaudet ovat kasvava kansanterveydellinen ongelma. Keskeinen oire muistisairauksissa on kielen ja kommunikaation heikkeneminen, mikä johtaa elämänlaadun heikkenemiseen. Tämän integroivan kirjallisuuskatsauksen tavoitteena on selvittää millaisia ryhmämuotoisia menetelmiä käytetään muistisairaiden kielellisten- ja kommunikatiivisten kykyjen kohentamiseen, ja mitä niiden vaikuttavuudesta voidaan todeta. Lisäksi katsauksessa tarkastellaan menetelmien vaikutusta elämänlaatuun. Menetelmät. Tutkimuskysymyksiin pyrittiin vastaamaan integroivan kirjallisuuskatsauksen keinoin. Hakusanat hahmottuivat taustateoriaan perehtyessä ja hakulausekkeet neljään eri tietokantaan pyrittiin muotoilemaan mahdollisimman samankaltaisiksi. Aineistoon pyrittiin poimimaan kattavasti eri interventiomenetelmiä käsitteleviä alkuperäistutkimuksia inkluusiokriteerien puitteissa. Aineistoon päätyi seitsemän artikkelia, jotka analysoitiin tutkimuskysymysten valossa. Lisäksi pyrittiin koostamaan tietoa aineiston metodologisesta laadusta. Aineistosta pyrittiin luomaan synteesi, josta voitiin johtaa johtopäätöksiä sekä havaituista tiedollisista aukoista herääviä jatkokysymyksiä Tulokset ja johtopäätökset. Kielellisten kykyjen arviot olivat pääasiassa kognitiivisten testien osia, eikä kaikissa tutkimuksissa raportoitu osatestien tuloksia. Kognitiiviset kyvyt kohenivat viidessä niitä mittaavassa tutkimuksessa. Raportit kielellisten taitojen kohenemisesta koskivat vain joitain kielen osa-alueita, vaihdellen käytettyjen arviointimenetelmien mukaan. Kommunikointikyky parani merkitsevästi kahdessa kolmesta tutkimuksesta ja yhdessä tutkimuksessa nonverbaalisen kommunikaation todettiin kohentuneen. Kahdessa tutkimuksesta todettiin elämänlaadun parantumista, minkä lisäksi yhdessä tutkimuksessa elämänlaatu koheni vasta intervention ja seuranta-arvioinnin välillä. Kolmessa tutkimuksessa muutosta elämänlaadussa ei havaittu. Ryhmäinterventioilla voidaan kohentaa muistisairaiden kognitiivisia taitoja, mutta tarkemmin kielellisten kykyjen osalta ei voida sanoa mitään varmaa. Interventioiden vaikutuksesta kommunikaatiokykyyn saatiin aineistosta positiivisia viitteitä. Aineisto antaa viitteitä siitä, että ryhmämuotoiset menetelmät saattavat kohentaa muistisairaiden ihmisten elämänlaatua.

Bröstcancer är den vanligaste cancertypen hos finländska kvinnor. Syftet med denna undersökning var att kartlägga levnadsvanor, psykiskt välmående och livskvalitet hos finländska bröstcancerpatienter under de sex första månaderna av onkologisk behandling. Målet var att utreda, ifall kända riskfaktorer för bröstcancer framhävdes inom cancerpatienterna och att känna igen möjliga interventionsmål för att förbättra patienternas livskvalitet. Undersökningens material är samlat under åren 2019 och 2020 som del av den större BOUNCE-undersökningen, från vilken det till denna undersökning inkluderades 236 kvinnor som vårdats för bröstcancer på HUS Cancercentrum. Deltagarna fyllde under sin vårdtid i enkäter gällande sosiodemografiska faktorer, levnadsvanor, psykiska symtom och livskvalitet. Enkäterna fylldes i vid början av den onkologiska behandlingen, samt vid tre och sex månaders tid från påbörjad behandling. Baserat på enkätsvaren har vi jämfört patientmaterialet med det finska medeltalet gällande sosiodemografiska faktorer och levnadsvanor. Forskningspopulationen skiljde sig inte avsevärt från normalpopulationen, och vi fann inte att olika redan kända riskfaktorer för bröstcancer, som till exempel rökning eller barnlöshet, skulle ha framhävts hos bröstcancerpatienterna. Gällande livskvaliteten såg vi att den i startläget var på liknande nivå som normalpopulationens, sjönk vid tre månader från påbörjad behandling, men började redan återhämta sig vid sex månader från påbörjad behandling. Interventionsmål för att förbättra bröstcancerpatienters livskvalitet kunde till exempel vara näringsrådgivning och/eller en intervention för psykiskt stöd.

Aim: Social interaction is the basis for experiencing life and knowing the fact that one even exists. For people with speech impairments the opportunities to be heard and to participate in social interaction depends greatly their communication partner's skills to act as a competent and a guiding partner. In this study, the term communication partner refers to staff working with people with speech impairments. Staff interaction skills will largely depend on the knowledge, skills and attitudes that they have embraced during their education, work and life experience. The purpose of this study was to gather and describe staff observations of interaction when the OIVA-interaction model applied in community. The aim of this study was to provide information about the elements of a successful interaction, as well as to illustrate the factors which are key in developing interaction skills in communities that provide services for people with severe speech impairments. Methods: The research data for this study were collected by the Communication and Technology Center of the Finnish Association on Intellectual and Developmental Disabilities (Tikoteekki). The data consisted of 38 OIVA-interaction model summary forms, which were gathered during the period of 2010-2013 from the communities that provide services for people with severe speech impairments and whom participated in the OIVA-interaction models. Summary forms were filled in by the actual OIVA-counselors. The data were analyzed applying the Grounded Theory method. Results and conclusions: The core category of collaborative interaction learning became the combining theme for the entire data set. The core category consisted of three main categories: community and learning, competent partner and customer's quality of life. The core category describes the collaborative way of working, as well as socioconstructive and experiential learning to improve staff communication skills. Collaborative working practices helped staff to identify the key elements of interaction and strengthen the competent partnership by utilizing these elements. Well-functioning community and reflecting on learning among the members of the community played a key role when adopting new interaction skills. Staff as a competent partner made it possible for their customers to have the best possible quality of life regarding interaction.