Turku City Hospital Research Articles

Rapid implementation of home oxygen treatment and remote monitoring for COVID-19 patients at the verge of the Omicron wave in Turku, Finland

BackgroundIn Turku, Finland, we introduced a home oxygen treatment and app-based monitoring program for hospitalized COVID-19 patients to facilitate an early discharge during the Omicron wave. In this case series we explore the clinical parameters of patients enrolled in the program and evaluate the cost–benefit and safety issues of the program.MethodsHospitalized COVID-19 patients with marked hypoxemia but otherwise in stable condition were screened from Turku City Hospital and Turku University Hospital by treating doctors for eligibility in the program. Peripheral oxygen saturation of > 92% and breathing frequency < 30/min in rest with oxygen supplementation were among the criteria. All patients actively participating in the program between 10th of January 2022 and 30th of September 2022 were included in this case series. Clinical data of hospitalization and monitoring were analysed, and cost–benefit evaluation was based on the number of saved hospitalization days.ResultsNineteen COVID-19 patients were included in this case series and recruited from three different hospital departments in the Turku city region, South-West Finland. All patients were male, the median age was 59 years and the median duration of hospitalization before enrolment in the program was 6 days (range 3—20 days). The median duration of home oxygen treatment was 13 days (range 3—72 days) and the median duration of home monitoring was 18 days (range 7—41 days). A total of 210,5 hospital days were prevented, resulting in savings of €144,490 of healthcare expenditure (on average 9 days and €7,605 per patient). No major safety issues were reported during the program.ConclusionsIn our case series, home oxygen treatment combined with home monitoring was safe and economically beneficial. Application based monitoring could be considered in other post-acute pulmonary conditions to reduce hospitalization and healthcare costs.

Elective laparoscopic cholecystectomy for symptomatic uncomplicated gallstone disease: do the symptoms disappear?

Symptomatic gallstone disease is considered an indication for cholecystectomy. A considerable proportion of patients may experience persistent symptoms after surgery. The purpose of the present study was to find out the rate of symptom persistence after elective laparoscopic cholecystectomy (LC) performed for symptomatic uncomplicated gallstone disease and, in particular, to clarify whether the recurrence rate differs according to the severity of preoperative symptoms. During a 10-year period (1992-2001), 1,101 patients underwent elective LC at Turku City Hospital for Surgery. A questionnaire concerning the intensity of preoperative symptoms, persistence of symptoms postoperatively, and overall satisfaction with the outcome of the procedure was sent to patients. A total of 677 patients [mean age (range) 59 (21-94) years; 554 (83.1%) females] with uncomplicated gallstone disease returned the completed form. Overall, 380 (57%) patients reported attacks of intense upper abdominal pain, and 287 (43%) reported episodic mild abdominal symptoms as the prevailing preoperative symptom. Two hundred and forty-eight (37%) patients continued to have abdominal symptoms after the operation. Among those with predominantly mild abdominal symptoms preoperatively, 119 (41%) reported the persistence of symptoms after the operation, while in the group with mainly severe upper abdominal pain attacks, 129 (33%) patients had recurrences (p = 0.052). According to our data, more than one-third of patients with symptomatic uncomplicated gallstone disease experienced persistent symptoms after elective LC. Patients with mild preoperative symptoms seemed to have more recurrences than those with severe symptoms, although the difference was not statistically significant.

Elective Laparoscopic Cholecystectomy without Routine Intraoperative Cholangiography: A Retrospective Analysis of 1101 Consecutive Cases

Laparoscopic cholecystectomy (LC) is today the operation of choice for symptomatic gallstone disease. Before the laparoscopic era intraoperative cholangiography (IOC) was generally considered as a fundamental step in cholecystectomy while nowadays the role of IOC is controversial: is there a need for IOC to specify anatomy of biliary tree in order to avoid bile duct injuries (BDI) and to detect possible common bile duct (CBD) stones or not? We studied retrospectively all the elective LCs done in Turku City Hospital for Surgery during the ten years (1992-2001). Cholecystectomy was performed to 1101 patients, 874 (79%) female and 227 (21%) male patients, mean age 53y (range 15-89). LC was possible in 1022 (93%) cases while 79 (7%) had to be converted to open procedure. The number and severity of bile duct injuries were recorded. The cases with endoscopic retrograde cholangiopancreatography (ERCP) and/or magnetic resonance cholangiopancreatography (MRCP) during the follow-up and the findings in ERCP and MRCP were recorded from patient records and radiological database. IOC was performed in 32 operations (20 in LC and 12 after conversion) and CBD stones were found in seven patients. There were four primary BDIs: two CBD injuries and two minor bile leaks. During a mean follow-up of 72 months (range 36-144) ERCP was performed in 16 and MRCP in three patients. Three patients underwent both MRCP and ERCP. CBD stones were detected in ten patients and a postoperative late CBD stricture was found in one case. According to our data, both the incidence of BDIs (0.5%) and symptomatic postoperative CBD stones (0.9%) remain low without the routine use of IOC.

The knowledge management on the elderly care

Purpose: The elderly care pathway from the public health emergency unit to the university hospital and back home needs rationalising. Another purpose is to utilise the information of the electronic patient record system in care coordination. Theory: The processed knowledge from the electronic patient record system enables the geriatric professionals to deal with the information of the elderly care pathway effectively and to develop the care in a patient-centred way. Methods: All the 75-year-old or older patients who had visited the emergency unit of Turku health care centre were analysed. The data were collected from the Pegasos electronic patient record system. The method used was time-series analysis. Statistical analyses were run on SAS System for Windows, release 9.1. Results: Twenty-three thousand-three hundred and seventy-two older patients visited the emergency unit and 25% of them were referred to hospital, less to the Turku city hospital, more to the university hospital. The information of transitions into the local organisations could be followed, but there were many information gaps in transitions to the university hospital. Conclusion: Older people are cared for in the university hospital too often. The expensive care begins at the emergency unit and leads to the long-term institutional care. The care pathway of older patients has to be based on professional capability, co-operation and knowledge management.

P031: Nuchal translucency measurement screening for aneuploidy at 11-14 weeks?first experiences from Turku, Finland Feto-maternal ultrasound unit of Turku Health Center and prenatal outpatient department of Turku City Hospital

To study the value of the nuchal translucency (NT) measurement in screening for chromosomal abnormalities by ultrasound at 11–14 weeks of gestation and to compare 95% reference ranges with the ranges of 99% (Braith-waite et al. 1996). A total of 1540 fetuses were consecutively studied with NT measurement in an unselected population from March 2001 up to June 2002. Reference range of 99% was used in 705 fetuses and 95% range in 835 fetuses. When using 99% range the second trimester DS screening (s-AFP and hCG) was also offered, if NT was between 95 and 99% ranges. Crown rump measure (crl) was measured and pregnancy was dated. Amniocentesis was offered when NT was over reference ranges. All newborns were physically examined for major chromosomal anomalies up to April, 2003. There were no statistical differences between the 99 and 95% groups regarding pregnant women's mean age (28 vs. 28 yrs), crl (59 vs. 62 mm), pregnancy length (12 + 2 vs. 12 + 5 weeks) or NT (1.2 vs. 1.3 mm). NT was above 99% range in 2.3% of fetuses (16/705) and above 95% range in 5.6% (48/835) (P < 0.05). Four DSs and one trisomy 18 were found. Two DSs were found in 95% group (the mothers 32 and 34 yrs, NT 2.4 and 3.1 mm). One trisomy 18 was found in 99% group (the mother 32 yrs, NT 4.0 mm). In 99% group one 38 years old woman with 2.6 mm NT a positive trisomy test was recognised and amniocentesis confirmed DS. Only one DS newborn (NT 1.6 mm) was delivered by a 38-year old woman. For age of 38 yrs an amniocentesis was offered, but she refused. No pregnancy losses were associated with 61 amniocentesis procedures. NT screening with only 99% reference range doesn't seem to be sufficient to find out chromosomal abnormalities; two chromosomal abnormalities should have been detected from the whole studied population. Reference range of 95% served clearly better; that range should have detected four out of five chromosomal abnormalities.

Factors predicting readmissions in personality disorders and other nonpsychotic illnesses. A retrospective study on 64 first-ever admissions to the Psychiatric Clinic of Turku, Finland.

A retrospective study of factors predicting readmissions and follow-up treatment was undertaken of all first-ever episodes of inpatient care (age under 65), excluding psychotic and organic mental disorders, during 1987 and 1988 in University Psychiatric Clinic in Turku City Hospital, Finland. The cohort consisted of 64 subjects, 24 men and 40 women. The study was carried out in the end of 1993, thus allowing about 5 years of follow-up. The diagnosis of personality disorder did not predict readmission. The only factor predicting readmission nearly significantly was not having a relationship. The incidence of the revolving door syndrome, defined as 4 or more admissions within 5 years, was 12.5%. Women had a greater risk of readmission, but not that of the revolving door. Patients who had psychotherapy as follow-up treatment showed a frequency of 8% for 4 or more admissions, whereas patients who had no follow-up treatment had a frequency of 21% for 4 or more readmissions. The only factor significantly predicting follow-up treatment arrangement was previous treatment contact.

The role of potassium in postural hypotension: electrolytes and neurohumoral factors in elderly hypertensive patients using diuretics

To study the association between postural hypotension and (i) electrolyte levels and (ii) neurohumoral factors in elderly hypertensive patients using diuretics. Cross-sectional study of patients and controls. The subjects were gathered from senior citizen clubs or they were referred to the study by general practitioners. The subjects were examined on a geriatric ward in Turku City Hospital. Seven subjects with postural hypotension and 13 controls. Plasma electrolyte levels and neurohumoral response to head-up tilt. There were significantly more hypokalaemic subjects in the postural hypotension group (5/7) than in the control group (1/13) (P < 0.01). The plasma potassium level was negatively correlated to plasma aldosterone (r = -0.57; P < 0.01) and renin activity (r = -0.69; P < 0.001). Subjects with postural hypotension had higher levels of noradrenaline, both supine (P < 0.05) and during tilt (P < 0.05). There were no significant differences in supine or tilt levels of plasma adrenaline, vasopressin, atrial natriuretic peptide, aldosterone and renin activity between the groups. The results suggest that potassium depletion is associated with postural hypotension in elderly hypertensive patients using diuretics. However, it is unclear whether there is a causative link between potassium depletion and postural hypotension or whether they are both caused by some other factor, e.g. volume contraction.

A novel dihydrofolate reductase cassette inserted in an integron borne on a Tn21-like element

In this study, a 498-bp dhfrXII gene coding for trimethoprim resistance was found inserted in a cassette-like manner in the recombinationally active locus, the integron, borne on a transposon Tn21-like element. The dhfrXII cassette is distinct from those cassettes earlier observed in integrons and was found here upstream of two similarly inserted cassettes. The second one carried the new unidentified orfF, which is 85% identical to the orfD cassette in R46. The third cassette contained the aadA2 gene mediating spectinomycin resistance. The plasmid carrying this Tn21-like element was originally isolated from a trimethoprim-resistant urinary tract pathogen, Escherichia coli, from Turku City Hospital, Turku, Finland. By colony hybridization and polymerase chain reaction, this group of three cassettes, including dhfrXII, was detected in four additional E. coli strains of similar origin and in four Shigella strains isolated in Finland but originating from Asia. The dihydrofolate reductase produced from dhfrXII showed an unusual drug resistance in that 50% of the enzymatic activity remained at a trimethoprim concentration of 1 mM.

Trimethoprim resistance in Escherichia coli isolates from a geriatric unit

The frequency of trimethoprim resistance among Escherichia coli isolates from urine samples collected at Turku City Hospital, Turku, Finland, remained at 40% during 1984 to 1988. The proportion of highly resistant (MIC, greater than or equal to 1,024 micrograms/ml) isolates increased, however, and most of these harbored the type I dihydrofolate reductase gene. Only a few isolates possessed type II or VII genes.

Evaluation of plasmid-encoded beta-lactamase resistance in Escherichia coli blood culture isolates.

The frequency of beta-lactam resistance was determined among 313 strains of Escherichia coli, 119 of Enterobacter/Klebsiella/Proteus spp., and 48 of Pseudomonas spp. isolated from blood cultures (at Turku University Central Hospital and Turku City Hospital) in 1983-1987. During this period the MIC50 of ampicillin for Escherichia coli increased from 8 to 32 micrograms/ml, the MIC90 of piperacillin from 16 to greater than 32 micrograms/ml and the MIC90 of cefuroxime from 4-8 to 16 micrograms/ml. Among 172 ampicillin-resistant isolates beta-lactamase-mediated resistance was characterized by DNA hybridization with TEM-1, SHV-1, OXA-1, OXA-2, PSE-1, PSE-2 and PSE-4 beta-lactamase probes and by isoelectric focusing. Beta-lactamase types found were TEM-1, TEM-2, SHV-1 and OXA-1. Isoelectric focusing did not show any other plasmid-mediated beta-lactamase varieties. Piperacillin-resistant strains showed mostly TEM-1 activity, but also produced OXA-1 and chromosomal beta-lactamase. Interestingly, a decrease in cefuroxime susceptibility in Escherichia coli occurred in a few OXA-1 producing strains as well as in strains that produced only chromosomal beta-lactamase. Two Escherichia coli strains that overproduced chromosomal beta-lactamase had increased ceftazidime MIC values (8-16 micrograms/ml).

Unilateral myogenic cramps and muscle hypertrophy in a child. A new disease?: [formula omitted], A. Sahlman and H. Savolainen (Turku City Hospital, Turku, Finland)

Unilateral myogenic cramps and muscle hypertrophy in a child. A new disease?: [formula omitted], A. Sahlman and H. Savolainen (Turku City Hospital, Turku, Finland)

Emergence of trimethoprim resistance in relation to drug consumption in a Finnish hospital from 1971 through 1984.

Emergence of trimethoprim resistance among urinary tract Escherichia coli strains, isolated mostly from long-term patients in the Turku City Hospital, Turku, Finland, was studied from 1971 through 1984. Emergence of resistance to trimethoprim was associated with changes in the consumption of both trimethoprim-sulfamethoxazole and trimethoprim, with occurrence of high-level trimethoprim resistance and sequences homologous to trimethoprim resistance transposon Tn7. Since 1971, resistance of E. coli to trimethoprim-sulfamethoxazole increased from 8 to between 32 and 35% in 1983 and 1984; resistance to sulfamethoxazole varied from 39 to between 40 and 44%. The frequency of DNA sequence homology with our Tn7 probe among trimethoprim-resistant E. coli strains was 42% from 1980 to 1981 and 64% in 1983 (P less than 0.005). Fourteen years after the introduction of trimethoprim therapy in this hospital, resistance has reached the level of resistance to sulfonamide.

Characterization of trimethoprim resistance by use of probes specific for transposon Tn7.

Transposon Tn7 codes for resistance to trimethoprim and streptomycin. For detection of Tn7 by DNA-DNA hybridization, two recombinant plasmids were constructed. The former contained a 1-kilobase BamHI fragment and the latter contained a 4.3-kilobase EcoRI-BamHI fragment of Tn7. These DNA fragments, which did not include the drug resistance genes, were used as probes for detecting Tn7-like sequences in bacterial strains by colony hybridization. They hybridized strongly to bacterial DNA known to carry Tn7 but not to DNA known to carry transposons other than Tn7. These probes were used to study the occurrence of Tn7 in bacterial strains isolated in the Turku City Hospital in Finland. Transposon Tn7 was present in 47.2% of 199 trimethoprim-resistant enterobacteria (MIC greater than or equal to 8 micrograms/ml). Among the 69 Proteus mirabilis strains studied, 75% contained Tn7, although none of these strains transferred trimethoprim resistance in conjugation tests. The reliability of colony hybridization was further confirmed by Southern hybridization to detect the Tn7-specific 2.6-kilobase HindIII restriction fragment. Colony hybridization proved to be a sensitive and rapid method for detecting Tn7-determined sequences.

Trimethoprim-resistant Escherichia coli in a geriatric hospital

A total of 1751 strains of Escherichia coli was collected from the Turku City Hospital in 1981-1982. Of these, 81 per cent were from patients aged 65 years or more. Total trimethoprim resistance was about 22 per cent of strains studied. There was a significant difference between the trimethoprim resistance of strains from those patients with a urinary tract catheter (38 per cent) and those without such a catheter (13.4 per cent) (P less than 0.001).

Transferable trimethoprim resistance in three Finnish hospitals.

Resistance to trimethoprim in urinary tract isolates was studied in the Turku City Hospital in 1979 and 1980-81 and in the Turku and Kuopio University Central Hospitals in 1980-81. In the Turku City Hospital no changes occurred during this time in the frequency of strains highly-resistant to trimethoprim (MIC greater than 1000 mg/l) or of those in which transferable resistance was demonstrated. However, the nature of resistance has changed since 1979, when the only transferable pattern was trimethoprim-ampicillin resistance. In 1980-81 over half of the transfer-positive stains transferred only trimethoprim resistance. In the university hospitals the strains highly-resistant to trimethoprim occurred in 36.8% of strains resistant to greater than or equal to 8 mg/l. This is significantly less than 68.7% observed at the same time in the Turku City Hospital. Among the highly-resistant strains the frequency of those transferring resistance was the same in the university hospitals as in the Turku City Hospital.

Trimethoprim resistance in hospitals.

During November 1980 to April 1981, 1561 urinary tract pathogens were collected from Turku City Hospital, Turku University Central Hospital, and Kuopio University Central Hospital. Resistance of the strains was tested by agar-plate dilution against trimethoprim, sulphamethoxazole-trimethoprim, sulphamethoxazole, ampicillin, and nitrofurantoin. Resistance to trimethoprim (greater than 8 mg/l) occurred in 8.6-12.2% of strains from the university hospitals (Pseudomonas excluded) and 38.3% of strains from Turku City Hospital. Resistance of Escherichia coli occurred in 4.1-6.2% of strains from the university hospitals and 21% of strains from Turku City Hospital. Proteus mirabilis was the most resistant of the clinically important bacterial species with resistance to trimethoprim in 29-78%. Attention is called for in defining the type of hospital used for a particular study: bacterial resistance in different hospitals cannot be compared direct and one hospital is not necessarily representative for a whole country. After seven years' use of plain trimethoprim the prevalence of resistance in the two university hospitals in Finland was similar to that in a London hospital just before plain trimethoprim was registered for use in Britain.