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Mikkeli, Finland

Koski J.M.,Mikkeli Central Hospital | Hammer H.B.,Diakonhjemmet Hospital
Rheumatology (United Kingdom) | Year: 2012

US allows us to detect joint alterations and to perform procedures such as aspiration of fluid as well as therapeutic injections; it helps in placing the needle correctly, greatly improving the outcome. Tissue biopsies (of, for example, synovium, muscle or salivary glands) can be performed with US guidance, and this method may be of significant importance in diagnostic examinations. Other imaging methods may be fused with US, and thus detailed maps are available to navigate in soft tissues. The new era in rheumatology will include US as an important part of its armament. © The Author 2012. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. Source

Pakarinen M.,Kuopio University Hospital | Vanhanen S.,Mikkeli Central Hospital | Sinikallio S.,University of Eastern Finland | Aalto T.,Kyyhkyla Rehabilitation Center | And 3 more authors.
Spine Journal | Year: 2014

Background context In lumbar spinal stenosis (LSS), conservative treatment is usually the first choice of treatment. If conservative treatment fails, surgery is indicated. Psychological factors such as depression and anxiety are known to affect the outcome of surgery. Previous studies on depression and surgery outcome using long follow-up times are scarce.Purpose The purpose of this study was to investigate the effect of depressive symptoms on the surgical outcome during a 5-year follow-up among patients with LSS.Study design A prospective observational study.Patient sample Patient sample included 102 LSS patients who needed surgical treatment.Outcome measures The outcome of surgery was evaluated with the Oswestry Disability Index (ODI), visual analog scale pain assessment, and self-reported walking capacity.Methods The patients completed a set of questionnaires preoperatively and 3 and 6 months, as well as 1, 2, and 5 years after the surgery. Depressive symptoms were assessed with the Beck Depression Inventory. The depressive burden was estimated by summing all individual Beck Depression Inventory scores. Statistical analyses included cross-sectional group comparisons and linear regression analyses. No conflicts of interest.Results On 5-year follow-up, a high depressive burden associated with a poorer outcome of surgery when assessed with the ODI. In linear regression analysis, a high depressive burden associated with higher ODI score.Conclusions Even slightly elevated long-term depressive symptoms in LSS patients are associated with an increased risk of a poorer functional ability after decompressive surgery. © 2014 Elsevier Ltd. All rights reserved. Source

Rummukainen M.-L.,Central Finland Healthcare District | Jakobsson A.,Central Finland Healthcare District | Matsinen M.,Central Finland Healthcare District | Jarvenpaa S.,Medcare LTD | And 3 more authors.
American Journal of Infection Control | Year: 2012

Background: Urinary tract infection (UTI) is the most common diagnosis made in prescribing antimicrobials in long-term care facilities (LTCF). The diagnostic criteria for UTI vary among institutions and prescribers. Our aim was to reduce the inappropriate use of antimicrobials in LTCFs. Methods: A team comprising infectious disease consultant, infection control nurse, and geriatrician visited all LTCFs for older persons (2,321 patients in 25 primary care hospitals and 39 nursing homes and dementia units) in the Central Finland Healthcare District (population 267,000) during 2004-2005. The site visits consisted of a structured interview concerning patients, ongoing systematic antimicrobials, and diagnostic practices for UTI. Following the visits, regional guidelines for prudent use of antimicrobials in LTCFs were published, and the use of antimicrobials was followed up by an annual questionnaire. Results: The proportions of patients receiving antimicrobials in 2005, 2006, 2007, and 2008 were 19.9%, 16.9%, 16.2%, and 15.4%, respectively. Most of the antibiotics were used for UTI (range by year, 66.6%-81.1%). From 2005 through 2008, the proportion of patients on antibiotic prophylaxis for UTI decreased from 13% to 6%. The decrease was statistically significant in both types of settings. Conclusion: The visits and guidelines were associated with a reduction in the usage of antimicrobials. To sustain this, UTI surveillance and close collaboration between infection control experts and LTCFs are crucial. © 2012 by the Association for Professionals in Infection Control and Epidemiology, Inc.Published by Elsevier Inc. All rights reserved. Source

Kuikka L.,Kuopio University Hospital | Hermunen H.,Mikkeli Central Hospital | Paajanen H.,Kuopio University Hospital
Scandinavian Journal of Medicine and Science in Sports | Year: 2015

Athletic pubalgia (sportsman's hernia) is often repaired by surgery. The presence of pubic bone marrow edema (BME) in magnetic resonance imaging (MRI) may effect on the outcome of surgery. Surgical treatment of 30 patients with athletic pubalgia was performed by placement of totally extraperitoneal endoscopic mesh behind the painful groin area. The presence of pre-operative BME was graded from 0 to 3 using MRI and correlated to post-operative pain scores and recovery to sports activity 2 years after operation. The operated athletes participated in our previous prospective randomized study. The athletes with (n=21) or without (n=9) pubic BME had similar patients' characteristics and pain scores before surgery. Periostic and intraosseous edema at symphysis pubis was related to increase of post-operative pain scores only at 3 months after surgery (P=0.03) but not to long-term recovery. Two years after surgery, three athletes in the BME group and three in the normal MRI group needed occasionally pain medication for chronic groin pain, and 87% were playing at the same level as before surgery. This study indicates that the presence of pubic BME had no remarkable long-term effect on recovery from endoscopic surgical treatment of athletic pubalgia. © 2013 John Wiley & Sons A/S. Source

Juhakoski R.,Mikkeli Central Hospital | Tenhonen S.,Mikkeli Central Hospital | Malmivaara A.,Institute for Health and Wellbeing | Kiviniemi V.,University of Eastern Finland | And 3 more authors.
Clinical Rehabilitation | Year: 2011

Objective: To evaluate the short- and long-term effectiveness of exercise training in relation to pain, function and direct costs to health care systems attributable to hip osteoarthritis. Design: Prospective, two-year randomized controlled trial. Setting: An outpatient primary health care setting. Subjects: One hundred and twenty men and women aged from 55 to 80, with radiologically diagnosed hip osteoarthritis with associated clinical symptoms. Interventions: The combined exercise and general practitioner (GP) care group received 12 supervised (once per week) exercise sessions at the baseline and four additional booster sessions one year later. Both groups received standard GP care. Main measures: The WOMAC Osteoarthritis Index, physical functioning score of RAND-36 (SF-36), the use and health care system costs of doctor visits and physiotherapy associated with hip osteoarthritis, number of total hip replacements, the use of analgesic and non-steroidal anti-inflammatory drugs (NSAIDs), performancebased outcome scores and body mass index (BMI). Results: There were no differences between the groups with respect to WOMAC hip pain, physical functioning score of RAND-36, performance-based outcome scores or BMI. The effect of the exercise intervention on WOMAC function was statistically significant at 6 months (mean=-7.5; 95% confidence interval (CI) -13.9 to -1.0; P=0.02) and 18 months (mean=-7.9; 95% CI -15.3 to -0.4; P=0.04). There were no statistically significant differences in the total health care system costs between the groups. Conclusion: The mostly home-based exercise training programme provided in this study did not result in reduced hip pain over the two-year follow-up period. © The Author(s), 2010. Source

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