Duodecim; laaketieteellinen aikakauskirja最新文献

Introduction of genomic data into health care requires willingness from physicians to adopt decision support systems as well as genomic information as part of their work. In the interview study, doctors' expectations about data systems and genomic data, as well as challenges for their utilization, are brought into light. Besides technical functionality, linking of data systems and the new knowledge mediated by them for clinicians also requires that doctors understand them as part of their professional expertise and thus useful.

The importance of communication in medical practice is widely recognized, but what is good communication in patient encounter? Feedback and surveys based on patient experience or "smileys" provide a narrow and often too insignificant view of communication. In addition to patient experience, communication benefits the information gathering by the physician and the patient, the patient's ability to promote his/her recovery, the physician's coping with workload, and the effectiveness of health care. In order to evaluate communication and improve it, one has to recognize the criteria and objectives of good communication. Medical communication that supports the rehabilitation of patients is reasonably good and responsible communication.

An informed consent is a prerequisite for participating in medical trials, whereby the person asked to take part in the trial shall understand what he is committing himself to, and that the consent is given voluntarily. Voluntariness can be undermined by so-called therapeutic optimism, i.e. belief in personal benefit brought about by the trial, as well as the difficulty of understanding how conventional treatment and the trial differ from each other, i.e. the so-called therapeutic misconception. The investigator, especially if he is also the attending physician, may influence the development of therapeutic misconception, because the participant may assume that the physician works as an investigator for the best benefit of the patients. It is important to recognize unrealistic optimism and therapeutic misconception of the trial, because for the participant they may result in disappointment and loss of confidence during the trial.

Introduction: Improving primary care services for mental health and substance abuse problems was one of the major goals of the Finnish national plan for mental health and substance abuse work.

Methods: The study data are drawn from the Regional Health and Well-being Study samples. Participants reported their health service use.

Results: Women and young adults used more mental health services than did men and older citizens. However, a significant proportion of those with mental health problems had not used any health services.

Conclusions: More attention should be paid on reducing the stigma associated to mental health and substance abuse problems both within the health care system and the society.

Periodontitis is common in the adult Finnish population. Also the prevalence of peri-implant diseases increases. As symptoms are rare, affected patients seldom seek dental care but require attention through the health care system. A careful periodontal screening, including risk assessment, is essential. Individual brushing and interdental cleaning instructions, as well as tobacco counseling, are important in preventing and treating these diseases, Early signs of periodontitis are indication for treatment, including necessary maintenance visits, preventing the severe periodontitis and its harmful consequences for the patient's dentition and general health.

This case report comprises three cases of antipsychotic drug-induced hypoglycemia and hypothermia. The mechanisms behind these side-effects are not known, but in hypoglycemia we describe signs of inappropriate insulin secretion. We assume that antipsychotic drug-induced hypoglycemia and hypothermia are underdiagnosed. Antipsychotic drugs are, however, widely used and these rare adverse-effects may occur in the clinical practice. It is of utmost importance to measure blood glucose and body temperature of patients taking these drugs who have unspecific symptoms.

Graft-versus-host disease (GvHD) remains a major treatment-related risk in patients undergoing stem cell transplantation. Although advances in HLA-typing and graft types have reduced the risk of GvHD, a breakthrough in the treatment of severe GvHD is still lacking. Allogenic stem cell transplant has potentially beneficial immunological effects on the malignant disease necessitating transplantation, and the importance of these effects must be considered when treating GvHD.

Pericardial fluid is a common finding on echocardiography. Less than 10 mm of fluid on ultrasound scan is not necessarily associated with any significant illness. Clinical examination, blood count, renal and liver enzymes and thyroid function tests as well as inflammatory marker tests are often adequate for a patient who is in good health. A significant amount of fluid requires further investigations, especially in a symptomatic patient. Cancers, infections and various systemic diseases are the most common causes of prominent effusion.

The savings in treatment costs generated by disease cases prevented by the national vaccination program exceed the costs of the vaccination program by at least 60 million euros. In addition, other costs due to contracting the illness are avoided. Vaccinations serve the purpose of both increasing well-being and releasing resources for other uses. Financial support of vaccinations through the health insurance system would be costly and targetted to those with the ability to pay. Public funds should be directed to the development of a vaccination program. New vaccines coming on the market are expensive. Adding a new vaccine to the vaccination program is based on scientific evidence-based expert assessments and cost-effectiveness. In addition to preliminary assessments carried out in support of decision-making, the National Institute of Health and Welfare monitors by using population-based health registers the effectiveness and cost-effectiveness of the vaccination program. From the standpoint of transparency of decision-making it would be preferred that the decision-makers define a willingness to pay threshold below which an intervention would be accepted and lead to funding.

Any complaint about memory should be examined. Diagnosis is based on international criteria. Basic evaluation consists of medical history, clinical evaluation, cognitive tests and brain imaging. When a diagnosis of Alzheimer's disease (AD), AD with cerebrovascular disease or with Lewy Body disease (LBD), or Dementia associated with Parkinson's disease or LBD is made, evidence-based medical therapy (acetylcholine esterase inhibitor or memantine) is indicated as a part of comprehensive care. In frontotemporal degenerations, these drugs are ineffective. For severe behavioural disorders, other psychoactive medications can be applied if non-pharmacological treatments are not sufficient.