Hameenlinna

Researchers are comparing two treatment approaches for patients with acute atrial fibrillation or flutter who need rhythm control. The study focuses on whether these irregular heart rhythms can be safely managed with elective treatment within 5 to 9 days. Patients are recruited from the emergency department and must be healthy enough to be discharged regardless of their assigned treatment. One group receives conventional care with immediate rhythm control using medical or electrical cardioversion in the emergency department within 48 hours of arrhythmia onset. The other group is treated electively, discharged after temporary rhythm control, and if still in arrhythmia one week later, undergo cardioversion at an outpatient cardiology clinic. All patients receive anticoagulation according to guidelines, including pre-treatment before delayed cardioversion if applicable, with additional heart ultrasound screening when needed. Patients in the elective group can opt for immediate cardioversion if symptoms worsen. Participants complete quality-of-life questionnaires and are monitored for symptoms and any urgent medical needs during the first week and one month after the outpatient visit. At one month, an ECG is performed to check for normal heart rhythm maintenance. After this, patients are followed up for up to five years to track any further treatments required for atrial fibrillation or flutter. New antiarrhythmic drugs are not used during the first month.

Researchers are studying adolescent depression by examining how young people with depressive symptoms access mental health services and respond to different treatments. This observational cohort study focuses on Finnish adolescents in grades 7 to 9 (ages 13 to 16) without prior depression treatment. The study aims to understand if adolescents have equal access to care and how to best identify those who could benefit from adolescent interpersonal counseling (IPC-A), a newer, shorter form of therapy adapted from interpersonal psychotherapy. Participants will be grouped based on treatment received: IPC-A, treatment as usual (other behavioral or medical support), or no treatment. IPC-A involves 3 to 8 brief individual sessions focusing on interpersonal relationships to prevent or treat mild to moderate depression. Researchers will follow participants over 6 months through surveys completed by adolescents and caretakers, collecting data on depressive symptoms, treatment needs, received care, motivation, and treatment effects. Information from therapists and health records will describe treatment content and frequency, and register data will be used to analyze service use and costs from one year before baseline up to 10 years after. Throughout the study, adolescents will complete surveys on risk and protective factors for depression three times in 6 months and report depressive symptoms every two weeks. Caretakers will provide their perspectives through two surveys during the same period. The main outcome is the proportion of adolescents referred to specialized psychiatric services within 12 months. Secondary measures include the proportion receiving any support, changes in depression scores, and cost-effectiveness. The study's findings aim to improve access to care, treatment detection, and inform best practices for adolescent depression.

This research aims to compare the safety and effectiveness of laparoscopic cholecystectomy versus a wait-and-see approach in elderly patients who have had successful endoscopic removal of common bile duct stones. The study focuses on a combined outcome of death, major postoperative complications, or recurrent biliary disease within one year after randomization. The trial is designed as a randomized study involving elderly patients with specific age and health criteria. Participants are randomly assigned to either the laparoscopic cholecystectomy group or the wait-and-see group in equal numbers. The cholecystectomy procedure is performed during the same hospital stay or within two weeks after randomization. The study includes one planned interim safety analysis after 100 patients have been randomized, with the trial possibly ending early if significant differences in outcomes are detected between the two groups. During the study, researchers will monitor participants for death, major complications, or recurrent biliary events from the time of randomization up to one year. Safety and efficacy are carefully assessed to determine if the wait-and-see strategy is not worse than surgery. Participants' health status and outcomes will be tracked throughout the year following their enrollment in the trial.

Researchers are evaluating a new approach to managing cardiovascular risk factors in patients who have recently experienced an ischemic stroke or transient ischemic attack (TIA). This trial focuses on detecting hidden atrial fibrillation (AF), a common cause of stroke, and improving blood pressure control. AF detection is important because anticoagulation treatment can reduce the risk of additional strokes, while hypertension remains a major challenge despite available treatments. The study aims to compare standard care with a mobile-device assisted intervention in this patient group. Participants will be randomly assigned to one of two groups: the control group receiving standard diagnostic work-up, follow-up, and treatment; and the intervention group receiving continuous ECG monitoring for 3 weeks to detect hidden AF, along with monthly one-week periods of self-monitoring blood pressure and adjusting antihypertensive medication using a mobile app. The randomization ratio is 2:1 favoring the control group. This design will help evaluate the benefits of mobile technology and self-management in controlling these cardiovascular risks. During the study, participants will be monitored for the development of new atrial fibrillation and changes in blood pressure over 12 months. Researchers will collect data on the number of patients diagnosed with new AF and measure the difference in average blood pressure between groups at one year. The study includes regular assessments and follow-ups to ensure safety and adherence to the intervention, providing insights into the effectiveness of mobile technology in stroke risk management.

Researchers are evaluating treatments for older adults with displaced distal radius fractures caused by low-energy injuries, such as falls from less than 1 meter. This randomized controlled trial, called the DISCLOSE trial, involves 532 participants aged 65 years or older living independently. The study aims to determine if casting without prior closed reduction is as effective as casting after closed reduction in reducing wrist pain and disability, measured by the Patient-Rated Wrist Evaluation (PRWE) score at 12 months. Participants are randomly assigned to one of two groups. In the "no reduction" group, a dorsal cast is applied immediately after the initial X-ray without attempting to realign the fracture first. In the "closed reduction" group, the fracture is realigned under local anesthesia before casting. Both groups have their cast removed after 5 weeks and are encouraged to resume normal wrist use without restrictions. Patients who decline randomization may join an observational group receiving standard care with closed reduction and casting. Participants attend follow-up visits at 3 and 12 months, with wrist X-rays at 3 months. Follow-up can be in person or remotely via phone or email, with wrist activity monitored by accelerometer wristbands sent by mail. Questionnaires assessing wrist function and pain are completed before follow-up appointments. A 5-year phone follow-up is planned. Participants with ongoing symptoms may receive physiotherapy for up to one year and, if needed, further evaluation including CT scans or surgery. The primary outcome is the PRWE score at 12 months post-injury.