Hameenlinna

Researchers are evaluating two treatment approaches for patients with acute atrial fibrillation or atrial flutter when rhythm control is desired. The study compares conventional acute cardioversion performed within 48 hours in the emergency department to elective delayed cardioversion performed approximately one week later in an out-patient clinic. The goal is to see if these arrhythmias can be safely managed with an elective timing approach. Participants are randomly assigned to either immediate cardioversion in the emergency department or to an elective delayed cardioversion after discharge. All patients receive anticoagulation treatment according to guidelines, with extra precautions such as transesophageal cardiac ultrasound if needed before delayed cardioversion. Patients in the elective group can choose early cardioversion if symptoms become unmanageable before the scheduled out-patient visit. Participants undergo follow-up visits including a cardiologist assessment about one week after enrollment and further assessments one month later with an ECG to check heart rhythm. Quality of life and symptom monitoring occur during the first week and one month after the clinic visit. Patients are then followed up for up to five years to monitor any medical interventions related to atrial fibrillation or flutter. New antiarrhythmic drugs like flecainide are not used during the first month.

Researchers are conducting a prospective observational cohort study in Finland to evaluate adolescent depression treatment pathways in primary care. The study focuses on adolescents aged 13 to 16 years attending grades 7 to 9 in selected schools, aiming to understand access to treatment and identify those who may benefit from adolescent interpersonal counseling IPC-A. The study compares IPC-A, a brief behavioral intervention, to treatment as usual and no treatment, assessing effectiveness and cost-effectiveness. The study involves adolescents completing surveys over six months about depressive symptoms, treatment motivation, and benefits or harms from treatment every two weeks. Caretakers will also provide information on adolescent support needs and treatment outcomes through surveys at six-month intervals. When applicable, professionals providing support will report on their training and treatment content. Register data on social welfare and health care service use will be collected from one year before to up to ten years after the study to inform cost and service provision. Participants will be followed for 12 months to measure outcomes including the proportion referred to specialized psychiatric services and changes in depression symptom scores. Data on received support and treatment response will be gathered from adolescents, caretakers, professionals, and patient records. The study will monitor benefits and harms of treatment, aiming to improve detection, equal access, and inform prevention strategies 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 common bile duct stones successfully removed using endoscopy. The study focuses on patients 75 years and older, including those with additional health issues, to determine if avoiding surgery is as safe as performing cholecystectomy. The main measurement is a combined outcome of death, serious complications, or recurring biliary problems within one year after randomization. Participants are randomly assigned to one of two groups one will have laparoscopic cholecystectomy within two weeks following stone removal, and the other will be managed without surgery but can have cholecystectomy later if needed. The study includes an interim safety check after the first 100 participants, with a plan to stop early if significant differences arise. Both groups are monitored over time to assess health outcomes and complications. During the study, participants will be followed for at least one year to track outcomes such as survival, complications, biliary events, quality of life, pain, and healthcare costs. Assessments occur at various intervals, including 30, 180, and 365 days after randomization. Researchers will evaluate these factors carefully to understand the benefits and risks of each approach, ensuring participant safety throughout the trial.

Researchers are evaluating the use of mobile-device assisted management of hypertension combined with screening for hidden atrial fibrillation in patients who recently experienced an ischemic stroke or transient ischemic attack TIA. The trial aims to compare this approach to standard care in reducing cardiovascular risks. The study focuses on detecting atrial fibrillation, a key treatable risk factor, and improving blood pressure control, both important for preventing recurrent strokes. Participants are randomly assigned in a 21 ratio to either the standard diagnostic work-up and treatment group or an intervention group. The intervention involves 3 weeks of continuous ECG monitoring to detect hidden atrial fibrillation and monthly self-monitoring of blood pressure for one week with self-adjustment of blood pressure medications guided by a mobile device application. The control group receives usual follow-up and hypertension management without these additional technologies. During the 12-month study period, researchers will measure the incidence of new atrial fibrillation cases and changes in average blood pressure. Secondary outcomes include new cardiovascular events and healthcare costs up to 36 months. Participants will undergo regular assessments and follow-up to monitor these outcomes, with safety and adherence tracked throughout the study.

This research evaluates treatment methods for older adults aged 65 years or older who have displaced distal radius fractures caused by low-energy injuries. It compares casting without prior closed reduction to casting after closed reduction to see if they provide equivalent results in wrist pain and disability after 12 months. The study is a randomized controlled trial including 532 participants and led by Tampere University Hospital, focusing on the Patient-Rated Wrist Evaluation PRWE score as the primary measure. Participants are randomly assigned to one of two groups one receiving a dorsal cast without reduction right after the initial x-ray, and the other undergoing closed reduction under local anesthesia followed by casting. Both groups have their casts removed after 5 weeks and are encouraged to resume normal wrist use without restrictions. An observational group receiving standard care without randomization is also followed remotely. Follow-up visits occur at 3 and 12 months, with radiographs taken at 3 months only. Participants will attend follow-up appointments in person or remotely, completing questionnaires and wearing accelerometer wristbands if remote. Data is collected via the REDCap system. Outcomes measured include wrist function, pain, quality of life, and adverse events. Patients with ongoing symptoms may receive physiotherapy for up to one year and further evaluation if needed. A 5-year follow-up is planned as an exploratory endpoint to monitor long-term results.