Vaasa Central Hospital Research Articles

Area-based disparities in non-small-cell lung cancer survival.

In the Nordic countries, universal healthcare access has been effective in reducing socioeconomic disparities in non-small-cell lung cancer (NSCLC) management. However, other factors, such as proximity to healthcare facilities, may still affect access to care. This study aimed at investigating the influence of residential area on NSCLC survival. This population-based study utilized hospital records to identify NSCLC patients who underwent their initial treatment at Vaasa Central Hospital between January 1, 2016, and December 31, 2020. Patients were categorized based on their postal codes into urban areas (≤50 km from the hospital) and rural areas (>50 km from the hospital). Survival rates between these two groups were compared using Cox regression analysis. A total of 321 patients were included in the study. Patients residing in rural areas (n = 104) exhibited poorer 12-month survival rates compared to their urban counterparts (n = 217) (unadjusted Hazard Ratio [HR]: 1.38; 95% Confidence Interval [CI]: 1.01-1.89; p = 0.042). After adjusting for factors such as performance status, frailty, and stage at diagnosis in a multivariate Cox regression model, the adjusted HR increased to 1.47 (95% CI: 1.07-2.01; p = 0.017) for patients living in rural areas compared to those in urban areas. The study findings indicate that the distance to the hospital is associated with increased lung cancer mortality. This suggests that geographical proximity may play a crucial role in the disparities observed in NSCLC survival rates. Addressing these disparities should involve strategies aimed at improving healthcare accessibility, particularly for patients residing in rural areas, to enhance NSCLC outcomes and reduce mortality.

End-of-Life Care and Use of Hospital Resources in Radiotherapy-Treated Cancer Patients with Brain Metastases: A Single-Institution Retrospective Study.

The aim of this single-institution retrospective study of patients treated with radiotherapy for brain metastases (BM) was to evaluate the timing of the palliative care (PC) decision, the use of health care services, i.e., emergency department (ED) visits and hospitalizations, and the implementation of radiotherapy at the end of life (EOL). Data on all cancer patients with BM treated in Finland at the Vaasa Central Hospital Radiotherapy Department between March 2011 and November 2020 were retrospectively reviewed. The follow-up period lasted until November 2021. Altogether, 91 patients (54 men, mean age 67 years [range 23-91 years]) were analyzed. Data on timing of PC decision, visits to the PC outpatient unit, and ED and hospitalization periods were collected retrospectively from patients' records. The median overall survival from diagnosis of BM was 3.7 months (range 1-62 months) and, after radiotherapy, 2 months (0-61 months). Thirty-two percent of the patients received radiotherapy in the last month of life. During the last 30 days of life, 44 patients (48%) visited the ED and 38 (42%) were hospitalized. Patients with an early PC decision (>30 days before death) had fewer hospitalizations (22% vs. 53%; p = 0.005) and died less often during the hospitalization period (9% vs. 27%; p = 0.047) at EOL. No significant difference was found in ED visits (41% vs. 53%; p = 0.28). For a large proportion of patients with BM, the prognosis is very poor. It is important to identify these patients and abstain from radiotherapy at EOL to reducing inappropriate health care utilization.

Making meaning of an artwork: promoting expression of thoughts through artwork for patients with eating disorders

ABSTRACT The purpose of the study was to demonstrate how art could be connected to therapeutic treatment processes. The intervention took place between 2020 and 2021 at an eating disorder (ED) unit in Vaasa Central Hospital, Finland. Eating disorder patients and reference group saw an art video by artist Johanna Ketola depicting nature and mystical features. Participants then discussed thoughts stimulated by the artwork. Participants’ depictions were coded, and content analysis of the written texts was carried out by applying cognitive semiotics blending theory (CSBT). Findings show that the artwork stimulated flexibility of thought, which allowed further possibilities to develop thinking and ways of expression. Art-viewing interventions can help patients find new ways to express themselves. The study shows how CSBT, and art viewing interventions, can be used in the clinical context to analyse meaning-making processes. With such interventions, the patient can develop skills to express one's own personal condition.

Impact of sex and age on adherence to guidelines in non-small cell lung cancer management

IntroductionAge-related disparities in non-small cell lung cancer (NSCLC) treatment are well known, but few studies have assessed the impact of sex on treatment disparities. Disparities in guideline-adherence may explain the superior survival in women with NSCLC. Therefore, we aimed to define patient- and tumor-related factors associated with non-adherence to guidelines in NSCLC management with a special focus on sex and age. Patients and MethodsPatients with NSCLC who received first-line treatment at the Vaasa Central Hospital between 2016 and 2020 were included in the study. The primary outcome was guideline adherence, defined as adherent, undertreatment, or overtreatment considering performance status. A binary logistic regression model was used to calculate the adjusted odds ratio (aOR) for non-adherence to treatment guidelines depending on patient- and tumor-related factors. Results321 patients were included in the study. Non-adherence was highest in ≥75-year-old women (41.3%), followed by ≥75-year-old men (32.6%), <75-year-old men (27.6%) and lowest in women <75-year-old (19.7%) (p = 0.035). Non-adherent care consisted more often of undertreatment in <75-year-old men than women (26.0% versus 12.1%) and overtreatment in <75-year-old women than men (7.6% versus 1.6%). Non-adherence was associated with stage III disease (aOR 2.21; 95% CI 1.07–4.59), poor pulmonary function (aOR 3.69, 95% CI 1.56–8.71), and Charlson Comorbidity Index 1–2 (aOR 2.09; 95% CI 1.09–4.01). ConclusionSex- and age-related disparities in guideline adherence were observed in <75-year-old men and in ≥75-year-olds. Stage III NSCLC was associated with non-adherence.

Nonoperatively treated forearm shaft fractures in children show good long-term recovery

Background and purpose — The incidence of forearm shaft fractures in children has increased and operative treatment has increased compared with nonoperative treatment in recent years. We analyzed the long-term results of nonoperative treatment.Patients and methods — We performed a population-based age- and sex-matched case-control study in Vaasa Central Hospital, concerning fractures treated in the period 1995–1999. There were 47 nonoperatively treated both-bone forearm shaft fractures, and the patients all participated in the study. 1 healthy control per case was randomly selected and evaluated for comparison. We analyzed clinical and radiographic outcomes of all fractures at a mean of 11 (9–14) years after the trauma.Results — The main outcome, pronosupination of the forearm, was not decreased in the long term. Grip strength was also equally as good as in the controls. Wrist mobility was similar in flexion (85°) and extension (83°) compared to the contralateral side. The patients were satisfied with the outcome, and pain-free. Radiographally, 4 cases had radio-carpal joint degeneration and 4 had a local bone deformity.Interpretation — The long-term outcome of nonoperatively treated both-bone forearm shaft fractures in children was excellent.

Isolated semitendinosus involvement in the initial stages of limb-girdle muscular dystrophy 2L

Unit of Neuromuscular Disorders, Laboratory of Molecular Medicine, Bambino Gesu’ Children’s Research Hospital, Rome, Italy Folkhalsan Institute of Genetics and Department of Medical Genetics, Haartman Institute, University of Helsinki, Helsinki, Finland Pediatric Neurology Unit, Catholic University School of Medicine, Rome, Italy d Institute of Neurology, Catholic University School of Medicine, Rome, Italy Neuromuscular Research Center, University of Tampere and Tampere University Hospital, Tampere, Finland Neurology Department, Vaasa Central Hospital, Vaasa, Finland

Is Routine Preoperative Upper GI Endoscopy Needed Prior to Gastric Bypass?

In Finland, upper GI endoscopy (UGI) prior to bariatric surgery is routine in all but one hospital performing bariatric surgery. However, UGI is an unpleasant investigation for the patient and requires resources. Helicobacter pylori (HP) can be tested from blood and cannot be considered as an indication for UGI. We wanted to identify the most common findings in UGI and see if the findings influenced the decision to operate or if they even canceled the operation. We evaluated retrospectively the data of 412 patients undergoing preoperative UGI in Vaasa Central Hospital in the years 2006-2010. UGI was considered normal in 191 (55.8%) patients. The most common findings were hiatal hernia in 25.4% (n = 87); gastritis, 13.7% (n = 47); and esophagitis, 13.2% (n = 45). Also benign polyps, 6.7% (n = 23), and ulcers, 2.9% (n = 10), were detected. One 0.5-cm esophageal leiomyoma was found, but no malignant lesions. Histology was found normal in 185 (54.1%) patients. HP was found in 12.0% (n = 41) of patients. In this study, all the findings were benign and mild. The findings did not influence the operative plan. The most common findings were hiatal hernia and esophagitis which may be considered contraindications for sleeve gastrectomy, but not for gastric bypass. Our results do not support the performance of routine preoperative UGI prior to gastric bypass.

How to measure a process in the cardiac invasive procedures?: The frame of reference for a hospital unit

The aim of this research is to consider how to measure the process of the invasive procedures in the heart unit of Vaasa Central Hospital. This research question could be divided into the following sub questions: what is the aim or the aims of the measurement and what should we measure and in what way? The main result of the study was a new frame of reference for process measurement for the heart unit. There were five groups of measures which were developed: quality, time, efficiency, utilisation rate and effectiveness. It is strongly suggested that in the future the research should aim at finding out how to measure processes which cross the borders of hospital units and also the borders of other service providers in a process. This research was a single case study which means that the results of the study can be generalised only partially.

Is it possible to improve the accuracy of EuroSCORE?

We derived a new risk-scoring method by modifying some of the risk factors included in the EuroSCORE algorithm. This study includes 3613 patients who underwent cardiac surgery at the Vaasa Central Hospital, Finland. The EuroSCORE variables, along with modified age classes (< 60 years, 60-69.9 years, 70-79.9 years and > or = 80 years), eGFR-based chronic kidney disease classes (classes 1-2, class 3 and classes 4-5) and the number of cardiac procedures, were entered into the regression analysis. An additive risk score was calculated according to the results of logistic regression by adding the risk of the following variables: patients' age classes (0, 2, 4 and 6 points), female (2 points), pulmonary disease (3 points), extracardiac arteriopathy (2 points), neurological dysfunction (4 points), redo surgery (3 points), critical preoperative status (8 points), left ventricular ejection fraction (> 50%: 0; 30-50%: 2 and < 30%: 3 points), thoracic aortic surgery (8 points), postinfarct septal rupture (9 points), chronic kidney disease classes (0, 3 and 6 points), number of procedures (1: 0; 2: 2 and 3 or more: 7 points). The modified score had a better area under the receiver operating characteristic curve (additive: 0.867; logistic: 0.873) than the EuroSCORE (additive: 0.835; logistic: 0.840) in predicting 30-day postoperative mortality. The modified score, but not EuroSCORE, correctly estimated the 30-day postoperative mortality. EuroSCORE still performs well in identifying high-risk patients, but significantly overestimates the immediate postoperative mortality. This study shows that the score's accuracy and clinical relevance can be significantly improved by modifying a few of its variables. This institutionally derived risk-scoring method represents a modification and simplification of the EuroSCORE and, likely, it would provide a more realistic estimation of the mortality risk after adult cardiac surgery.

Testicular seminoma: ESMO Clinical Recommendations for diagnosis, treatment and follow-up

Testicular non-seminoma: ESMO Clinical Recommendations for diagnosis, treatment and follow-up H.-J. Schmoll, K. Jordan, R. Huddart, M. P. Laguna, A. Horwich, K. Fizazi & V. Kataja On behalf of the ESMO Guidelines Working Group* Department of Oncology/Haematology/Haemostaseology, University Hospital Halle, Halle, Germany; Department of Academic Radiotherapy, Institute of Cancer Research, Royal Marsden Hospital, Sutton Hospital, UK; Department of Urology, AMC University Hospital, Amsterdam, The Netherlands; Department of Medicine, Institute Gustave Roussy, Villejuif, France; Department of Oncology, Kuopio University Hospital, Kuopio and Vaasa Central Hospital, Vaasa, Finland

Invasive bladder cancer: ESMO Clinical Recommendations for diagnosis, treatment and follow-up

Invasive bladder cancer: ESMO Clinical Recommendations for diagnosis, treatment and follow-up J. Bellmunt, S. Albiol & V. Kataja On behalf of the ESMO Guidelines Working Group* Department of Medical Oncology, University Hospital del Mar; Department of Medical Oncology, Instituto Oncologico Teknon, Barcelona, Spain; Department of Oncology, Vaasa Central Hospital, Vaasa and Kuopio University Hospital, Kuopio, Finland

Invasive bladder cancer: ESMO Clinical Recommendations for diagnosis, treatment and follow-up

Invasive bladder cancer: ESMO Clinical Recommendations for diagnosis, treatment and follow-up J. Bellmunt, S. Albiol & V. Kataja On behalf of the ESMO Guidelines Working Group* Department of Medical Oncology, University Hospital del Mar; Department of Medical Oncology, Instituto Oncologico Teknon, Barcelona, Spain; Department of Oncology, Vaasa Central Hospital, Vaasa and Kuopio University Hospital, Kuopio, Finland

Testicular seminoma: ESMO Clinical Recommendations for diagnosis, treatment and follow-up

Testicular non-seminoma: ESMO Clinical Recommendations for diagnosis, treatment and follow-up H.-J. Schmoll, K. Jordan, R. Huddart, M. P. Laguna, A. Horwich, K. Fizazi & V. Kataja On behalf of the ESMO Guidelines Working Group* Department of Oncology/Haematology/Haemostaseology, University Hospital Halle, Halle, Germany; Department of Academic Radiotherapy, Institute of Cancer Research, Royal Marsden Hospital, Sutton Hospital, UK; Department of Urology, AMC University Hospital, Amsterdam, The Netherlands; Department of Medicine, Institute Gustave Roussy, Villejuif, France; Department of Oncology, Kuopio University Hospital, Kuopio and Vaasa Central Hospital, Vaasa, Finland

Reductions in Postdischarge Suicide After Deinstitutionalization and Decentralization: A Nationwide Register Study in Finland

Reductions in Postdischarge Suicide After Deinstitutionalization and Decentralization: A Nationwide Register Study in Finland

Merkel cell carcinoma: a clinicopathological study of 34 patients

Background: Merkel cell carcinoma (MCC) is a rare cutaneous malignant tumour. Its natural course is fast progression of the primary tumour and rapid regional metastasis. Methods: The pathological archives of Helsinki University Hospital and Vaasa Central Hospital were reviewed from 1987 to 2001. Specimens were re-evaluated by two pathologists and size was measured from primary tumours. Multivariate analysis was performed for age, sex, primary tumour size, and method of initial surgery, development of metastatic disease and development of local recurrence. Overall survival (OS) was calculated by the Kaplan–Meier method. Results: Of 34 patients, 12 male and 22 female patients, are reported. Their median age was 76.4 years. Half of the primaries were located in the head and neck region. All patients were treated surgically. The mean OS was 2.7 years by the Kaplan–Meier method. The 2-year survival rate was 65% and 5-year rate was 50%. The mean OS for tumour size >2 cm was 1.7 years and for tumour size ≤2 cm 4.48. Poor prognostic factors for OS were: male sex, size of the primary tumour (>2 cm) and metastatic dissemination. A favourable prognosis seemed to correlate to more aggressive surgical management as use of primary excision with split skin graft or reconstruction with a local flap. Conclusion: MCC affects the elderly patients. In this study, female patients predominated. Primary tumour size >2 cm predicts poorer outcome of the disease. A wide surgical excision is recommended for the primary treatment of MCC.

Incidence of complications and problems related to orthognathic surgery: A review of 655 patients

Purpose: This retrospective report evaluates the incidence of pre-, intra-, and postoperative complications of orthognathic surgery and their significance to the patient. Patients and Methods: The clinical records and radiographs of 655 patients operated on in Vaasa Central Hospital, Finland during a 13-year period between 1983 and 1996 were examined. The total number of operations was 689. All notes referring to problems or complications from the orthodontic phase to the varying postoperative follow-up times were gathered and analyzed. Results: The most common complication was a neurosensory deficit in the region innervated by the inferior alveolar nerve; mild in 32% of patients (183 of 574 patients with an osteotomy in the mandible) and disturbing in 3% of patients (18/574). The most serious complication was severe intraoperative bleeding in 1 patient necessitating major blood transfusions and later embolization of the internal maxillary artery. There were no fatal complications. The incidence of other problems was low, and there were very few patient complaints. Conclusions: Despite the great variety of severe complications reported in the literature, their frequency seems to be extremely low, and orthognathic surgery treatment can be considered to be a safe procedure. © 2001 American Association of Oral and Maxillofacial Surgeons

Use of obstetric forceps in Finland today, ‐ experience at Vaasa Central Hospital 1984‐1998

Forceps delivery has become rare in Finland since the introduction of the vacuum extractor. Our aim was to survey the number of forceps deliveries in Finland and analyze our own material of 130 forceps deliveries during a 15-year period between 1984 and 1998. During this period there were 17,887 deliveries at Vaasa Central Hospital. A retrospective study of 130 forceps deliveries and 11 trial forceps cases, which subsequently resulted in a cesarean section. There was no maternal or neonatal mortality. In 39 cases a cesarean section could be avoided by use of forceps after a failed vacuum extraction. Only in one case was maternal morbidity regarded as serious. There was no serious neonatal morbidity. Anal sphincter ruptures occurred in three cases (2.3%). All the women in the trial forceps group were nulliparous, in 73% of these the fetus was in a persistent occipito-posterior position. Failed vacuum extraction and trial forceps did not significantly influence neonatal outcome. Forceps delivery appears to be a safe alternative in our setting.

Use of obstetric forceps in Finland today, - experience at Vaasa Central Hospital 1984-1998

Use of obstetric forceps in Finland today, - experience at Vaasa Central Hospital 1984-1998

Evaluation of a 3-piece silicone intraocular lens with poly(methyl methacrylate) haptics

Purpose: To evaluate the safety and performance of a foldable silicone intraocular lens (IOL) in small incision phacoemulsification surgery.Setting: Vaasa Central Hospital, Vaasa, Finland.Methods: Phacoemulsification with primary implantation of a posterior chamber IOL was performed in 50 patients. All eyes were implanted with a CeeOn™ IOL (model 920, Pharmacia & Upjohn) with a silicone optic and poly(methyl methacrylate) haptics. The ease of folding, implanting, and unfolding the IOL in the bag were recorded. Visual acuity, postoperative complications, optic;decentration, and optic tilt were measured at 5 postoperative visits. The IOLs were evaluated for haze and discoloration and the IOL surface, for inflammatory or pigment deposits. Follow-up was 12 months.Results: In 44 of 50 cases, folding the IOL was easy, and in 46 of 50, unfolding the IOL was controlled. The mean follow-up was 11.45 months ± 0.52 (SD), No postoperative complications occurred, and 96% of patients achieved a best corrected visual acuity (BCVA) of 0.5 or better and 56%, a BCVA of 1.0 or better. The IOL decentration was less than 0.25 mm in 89% of cases, and there was no optic tilt. The neodymium:YAG laser capsulotomy rate was 11%.Conclusion: Good visual outcome and excellent centration were achieved with the CeeCin model 920 IOL. It is therefore suitable for small incision cataract surgery. Because of the IOLs smooth, polished surface, the choice of instruments for folding and implantation is important.

PARVOVIRUS B19 AND TRANSIENT ERYTHROBLASTOPENIA OF CHILDHOOD

British Journal of HaematologyVolume 83, Issue 4 p. 679-679 Free Access PARVOVIRUS B19 AND TRANSIENT ERYTHROBLASTOPENIA OF CHILDHOOD S. Nikkari, S. Nikkari Departments of Medical Microbiology and Virology, Turku UniversitySearch for more papers by this authorO. Meurman, O. Meurman Departments of Medical Microbiology and Virology, Turku UniversitySearch for more papers by this authorO. Wanne, O. Wanne Department of Pediatrics, Vaasa Central Hospital, Vaasa, FinlandSearch for more papers by this authorJ. S. Lilleyman, J. S. Lilleyman Section of Paediatric Haematology, University of Sheffield Department of Paediatrics, The Children's Hospital, Sheffield S10 2THSearch for more papers by this author S. Nikkari, S. Nikkari Departments of Medical Microbiology and Virology, Turku UniversitySearch for more papers by this authorO. Meurman, O. Meurman Departments of Medical Microbiology and Virology, Turku UniversitySearch for more papers by this authorO. Wanne, O. Wanne Department of Pediatrics, Vaasa Central Hospital, Vaasa, FinlandSearch for more papers by this authorJ. S. Lilleyman, J. S. Lilleyman Section of Paediatric Haematology, University of Sheffield Department of Paediatrics, The Children's Hospital, Sheffield S10 2THSearch for more papers by this author First published: April 1993 https://doi.org/10.1111/j.1365-2141.1993.tb04716.xCitations: 8AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume83, Issue4April 1993Pages 679-679 ReferencesRelatedInformation