Browsing by Subject "vaikuttavuus"
Now showing items 1-4 of 4
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(2021)Objective: The choice of patient outcomes in clinical quality registries is crucial for comparable and relevant data collection. Ideally, a uniform outcome framework would guide the assessment of outcomes. We set out to find a suitable published framework and validate it in clinical quality registries. Study design and Setting: A literature review was conducted to find an outcome framework that is patient-centric, easy-to-use, shared with clinical research, and allows registry evaluation. Chosen outcome framework was validated by extracting and classifying outcomes from 63 clinical quality registries at HUS Helsinki University Hospital, Finland. Results: COMET taxonomy was chosen from 23 published frameworks. HUS Clinical quality registries showed great variation in outcome domains and in number of measures. Physiological outcomes were present in 98%, resource use in all, and functioning domains in 62% of the registries. Patient-reported outcome measures were found in 48% of the registries. Conclusions: The COMET taxonomy was suitable for evaluating the choice of outcomes in clinical quality registries while some improvements are suggested. HUS Helsinki University Hospital clinical quality registries exist at different maturity levels showing room for improvement in life impact outcomes and in outcome prioritization. This article offers a comparison point for other registry evaluators.
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(2020)Objective. The FRIENDS programme is a group cognitive behavioural therapy (CBT) programme, developed for the prevention and treatment of child and adolescent anxiety and depression. In the context of prevention, FRIENDS has been extensively researched; however, little research has been conducted on FRIENDS in a treatment setting and with different populations. To help fill this gap, the aim of the present study was to evaluate the effectiveness of the Finnish version of FRIENDS in reducing internalising symptoms in children diagnosed with psychiatric and neuropsychiatric disorders. Methods. The present study was conducted at Helsinki University Hospital (HUS) Child Psychiatry outpatient clinics in the Helsinki metropolitan area, Finland. The participating children (n = 99, mean age = 9.45 years, range 6–13 years, 68.7 % boys) were randomly assigned to either FRIENDS (n = 52) or a waitlist control group (n = 47), which received treatment as usual for a period of 3 months before the intervention. The children’s internalising symptoms were assessed using parent- and teacher-report questionnaires (Child Behavior Checklist and Teacher’s Report Form) at referral to treatment, pre-treatment, post-treatment, and six-month follow-up. Results and conclusions. In both groups, there was a medium-sized statistically significant decrease in parent-reported internalising symptoms immediately after the intervention; however, these improvements were not retained at six-month follow-up. Teacher-reported internalising symptoms followed a similar pattern of decrease during the intervention and increase during follow-up; however, these changes were smaller in magnitude and did not reach statistical significance, possibly due to loss of statistical power caused by missing data. Neither parent- or teacher-reports showed an intervention effect, with children’s internalising symptoms exhibiting similar changes regardless of whether they belonged to the intervention group or the waitlist control group, which received treatment as usual during the wait period. These results raise questions on the durability of treatment effects and the superiority of FRIENDS over active waitlist control conditions or treatment as usual when treating children diagnosed with diverse psychiatric and neuropsychiatric disorders in a community setting where treatment adherence and integrity may not be ideal.
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(2017)Tutkimuksessa tarkasteltiin Töölön sairaalassa Helsingissä vuosina 1995-2015 suoritettuja kielekerekonstruktioleikkauksia munuaissiirtopotilailla. Tutkimuksen tarkoituksena oli kartoittaa kyseisen potilaskohortin leikkausten tuloksia ja vaikuttavuutta. Mielenkiinto kyseiseen potilaskohorttiin on kasvava johtuen elinsiirtopotilaiden kohoavasta elinajanodotteesta. Elinajanodote elinsiirtopotilailla on parantunut Suomessa sitten ensimmäisen operaation 1960-luvulla. Tähän trendiin ovat myötävaikuttaneet hyljintälääkityksen monipuolistuminen ja mahdollisuus yksilöllistämiseen, kirurgisten tekniikoiden kehittyminen sekä tarkempi potilasvalinta. Elinajanodotteen kasvaessa myöskin tarve myöhemmin suoritettaville kirurgisille operaatioille, esimerkiksi kielekerekonstruktioille, kasvaa. Kielekerekonstruktiot ovat merkittävässä osassa eri aloilla kudospuutosten rekonstruktiossa tai toiminnan palauttamisessa. Yleisimpiä syitä kielekerekonstruktioille ovat rintarekonstruktiot, avomurtumat ja ihosyövät. Kielekerekonstruktioleikkausta suunniteltaessa on otettava huomioon mahdolliset riskit ja komplikaatiot. Elinsiirtopotilailla tähän tulee kiinnittää erityistä huomioita heidän immunosuppressiivisen lääkityksen ja monisairastavuuden takia. Elinsiirtopotilaille riskit komplikaatioille, kuten tromboosille, infektiolle ja pidentyneelle haavan paranemiselle, ovat korkeammat kuin normaalilla väestöllä. Tutkimus tehtiin retrospektiivisenä potilasasiakirjatutkimuksena. Tunnistetuista potilaista kerättiin tiedot munuaissiirrosta ja kielekerekonstruktioleikkauksesta. Potilaista kerättyä aineistoa verrattiin kirjallisuudessa raportoituihin vastaavanlaisiin tutkimuksiin niin elinsiirtopotilailla kuin terveillä. Pre-operatiivisesti komplikaatioriski ja post-operatiivisesti toipuminen ja komplikaatiot arvioitiin hyödyntäen Charlson Comorbidity indeksiä, ASA-luokitusta ja Clavien-Dindolla-luokitusta. Aineistoksi muodostui 10 potilaan ryhmä, jolle suoritettiin yhteensä 11 kielekerekonstruktiota ja kaksi ihonsiirtoa. Potilaista 70% oli miehiä. Kielekerekonstruktioleikkaus suoritettiin keskimäärin 63,9 vuoden iässä ja munuaissiirteen saannista kielekerekonstruktioon oli kulunut keskimäärin 16,5 vuotta. Komplikaatioita esiintyi yhdeksässä leikkauksessa (69,2 %). Yleisimmät komplikaatiot olivat pidentynyt haavan paraneminen ja hematooman muodostuminen. Operoiduista kielekkeistä 10 tuli vitaaleiksi ja yksi menetettiin välittömästi leikkauksen jälkeen. Onnistumisprosentti kielekerekonstruktioleikkauksissa oli 90,9 %. Huolimatta immunosuppressiivisesta lääkityksestä ja monisairastavuudesta, kielekerekonstruktioleikkausta voidaan pitää varteen otettavana hoitotoimenpiteenä hoidettaessa elinsiirtopotilaiden kudospuutoksia, esimerkiksi radikaalimman tuumorinpoiston seurauksena. Korkeampi komplikaatioiden esiintyminen ja hieman alhaisempi onnistumisprosentti verrattuna terveeseen väestöön vaatii onnistuneeseen lopputulokseen pääsemiseksi huolellisen pre-operatiivisen suunnittelun ja potilasvalinnan.
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(2021)Aphasia is a linguistic-cognitive disorder that impedes the understanding and production of speech and is often accompanied by disorders in non-linguistic cognitive functioning, such as working memory (WM). WM has a key role in supporting on-going linguistic processing. Earlier research shows that the impairments caused by aphasia can be alleviated with speech therapy but it is still unclear which amount of therapy is most effective, at which stage of the illness and with which intensity. Some research suggests that greater amount of therapy within a shorter time span yields greater outcome. However, research findings on the matter are difficult to synthesize as the definition of ‘intensity’ varies across studies. Language Enrichment Therapy (LET) is a systemic and developmental therapy programme for aphasia rehabilitation. LET aims to restore linguistic-cognitive functioning. LET also enables rehabilitation of working memory with “brain-jogging”. As there is hardly any prior research on the LET system, the aim of this thesis is to investigate its effectiveness as an intensive aphasia therapy programme and the role of working memory in rehabilitation and, further, to identify possible background factors predicting rehabilitation outcome. The data for this thesis was collected for a research project between 1987 and 2010. The data consists of 24 persons with aphasia (PWA) who suffered a first-time stroke and whose time post-onset at baseline was 2 to 8 months. Linguistic functioning was assessed six times within the research frame with Tsvetkova’s Speech Dynamics Test, Western Aphasia Battery and the Token test. The data was analysed statistically using Friedman’s test to analyse the change in understanding and producing speech, linear regression to analyse possible factors predicting outcome and linear correlation to analyse the connection between working memory and rehabilitation outcome. The findings show that intensive rehabilitation with the LET system improves the understanding and production of speech with PWA. LET is the most effective in ameliorating speech understanding for those PWA with greater impairment and lesser time post-onset. No factors predicting the outcome of speech production were found which might be due to the developmental nature of the LET system in which rehabilitation of understanding always precedes that of production. WM had no predictive value for rehabilitation outcome. These findings must be interpreted with caution but can still be used for clinical decision making.
Now showing items 1-4 of 4