Lahti

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.

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.

This research focuses on patients undergoing laparoscopic colorectal resection for any pathology. It evaluates heart rate variability (HRV) parameters, such as RMSSD, before and after surgery to understand how surgery and related complications affect these measurements and their connection to specific adverse effects. Participants will have their HRV monitored postoperatively using a device called PulseOn. The study measures changes in HRV over a three-day period following surgery to assess the physiological impact and potential complications. During the study, patients will be monitored for HRV changes, with data collected through the PulseOn device. Researchers aim to track these changes and correlate them with any complications experienced after surgery. The primary outcome measure is the change in heart rate variability within three days post-surgery.

Implantation of a drug-eluting stent (DES) has become a standard of percutaneous coronary intervention (PCI) during the last two decades. However there are still significant drawbacks in using DES as a permanent coronary implant. Most importantly, bleeding remains a significant complication of PCI, especially in elderly patients. The number of PCI patients having OAC:s is already significant, and will grow in the future, as the volume of PCIs in octogenarians increases, and so does the incidence of atrial fibrillation by age. After stenting at least one month lasting dual antiplatlet treatment (DAPT) is mandatory, and it cannot be safely terminated in case of a bleed. The optimal duration of DAPT on patients at bleeding risk is not known. Balloon coated with paclitaxel and iopromide (drug-coated balloon, DCB) was originally developed for the treatment of in-stent restenosis, but later its potential for the treatment of de-novo coronary artery leasons has become clear in large registry trials. So far, the randomized controlled studies have shown the non-inferiority of PCI using DCB in comparison to DES in de novo leasons in small vessels. Also the non-inferiority of PCI using DCB in comparison to BMS was shown in the DEBUT trial in large vessels on patients at high bleeding risk. These results need to be confirmed in comparison of DCB to DES as the use of BMS is diminishing. The hypothesis of the DEBATE trial is that the strategy using DCB and a shorter DAPT regimen is non-inferior to the treatment using DES and longer DAPT duration in the treatment of stable CAD or in ACS (UAP or NSTEMI) in patients on anticoagulation medication or otherwise on high bleeding risk. If non-inferiority is shown, the superiority of the DCB strategy over DES strategy will be tested.

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.

Endometriosis is a chronic condition where tissue similar to the lining inside the uterus grows outside it, causing pain and fertility problems in many women of reproductive age. This research aims to find new diagnostic tools and treatments by studying specific RNA and protein expressions in endometriosis and healthy tissues. The study will also record different pain symptoms yearly and follow participants for 10 years to understand infertility, disease progression, and recurrence better. Participants will undergo surgical procedures such as laparoscopy or laparotomy to treat endometriosis or for sterilization purposes, during which tissue samples will be collected for detailed analysis. The study compares patients with verified endometriosis to a control group without the condition based on laparoscopic examination. These samples will help identify new targets for therapies and biomarkers. Throughout the study, researchers will analyze tissue hormone metabolism, serum markers, and gene expression during surgery. They will collect data via questionnaires over ten years, tracking fertility, treatments received, and pain symptoms using numeric rating scales. This long-term follow-up aims to find markers predicting infertility and disease course while monitoring safety and treatment outcomes.

Researchers are assessing the use of a new type of blood product called cold stored, 0 RhD positive, male donor, leucoreduced, platelet sparing, low blood group ABO antibody titer whole blood (LTOWB) for emergency blood transfusions in Finland. The study focuses on patients experiencing hemorrhagic shock and compares LTOWB to the currently used packed red blood cells (PRBC), which are typically type O RhD negative. The goal is to see if LTOWB is feasible and safe for use in prehospital emergency medical services and to study its effects on blood clotting, endothelial injury, and inflammation. Participants receive either LTOWB or PRBC transfusions during prehospital emergency care based on clinical need. The study is open and non-randomized, with LTOWB used in three emergency medical areas in Finland while other areas continue with PRBC transfusions for comparison. Along with transfusions, patients may receive medications that help blood clotting and fluids. The study began in early 2022 and will recruit patients over three years. During the study, researchers collect clinical data, blood samples for detailed analysis, and surveys from emergency care teams about transfusion experiences. They measure outcomes such as severe coagulopathy upon hospital arrival and various clinical endpoints including mortality and adverse effects within 30 days. The study also compares time spent at the scene between groups. Participation involves consent obtained after emergency treatment when possible, with follow-up to monitor safety and effectiveness.

Researchers are evaluating a health psychological group rehabilitation program designed for adults diagnosed with chronic fatigue syndrome (ME/CFS), a serious condition marked by long-lasting fatigue, cognitive difficulties, and orthostatic intolerance that restrict daily activities. The study aims to improve patients' overall functioning and illness management through psychological adaptation and behavioral changes. This doctoral research also examines patients' experiences and the effect of the healthcare system on their sense of agency. The study involves a randomized controlled design with about 70 adults aged 18 to 65 diagnosed with ME/CFS (ICD-10 code G93.3). Participants are divided into a treatment group receiving health psychological group rehabilitation focused on supporting their own agency and improving functional capacity, and a control group receiving six health counseling sessions. The research includes qualitative analyses of patient experiences and quantitative comparisons between groups, including patients with cognitive impairment or orthostatic intolerance. Participants undergo testing and assessments before the rehabilitation, immediately after, and at a three-month follow-up. These include psychological and psychiatric evaluations, laboratory and autonomic nervous system antibody tests, and measurements of disability and autonomic symptoms using WHO Disability Assessment Schedule 2.0 and COMPASS31. The study tracks changes in these outcomes to assess the impact of the rehabilitation program and health counseling on patient functioning and symptoms.

This study focuses on patients undergoing rehabilitation after a stroke. It evaluates the effects of adding nature-based therapies to the usual rehabilitation care during the hospital ward period. The research includes collecting biological samples and using questionnaires to understand changes in mood, quality of life, and functional abilities over time. Participants are randomly assigned to either an intervention group or a control group in a 1-2:1 ratio. The intervention group receives nature-based therapy sessions outdoors three times a week, including individual visits with a research worker, group sessions, and sessions involving a family member or volunteer. The control group performs simpler, conventional rehabilitation tasks indoors. Biological samples and assessments are repeated 4 weeks after starting and again 3 months after discharge from the ward. Throughout the study, participants provide blood, saliva, skin, and feces samples to monitor physiological changes, including autonomic nerve status. Questionnaires on mood, life quality, and functional deficits are completed at baseline, after 4 weeks, and 3 months post-discharge. Family members involved in therapy sessions also have their mood and quality of life tracked. The primary outcome measured is functional ability within 30 days, and safety and progress are monitored during and after the rehabilitation period.

Researchers are comparing two treatments for intra-articular proximal tibia fractures in people over 65 years old. The study focuses on how well patients regain knee function and manage pain one year after treatment. These fractures are common in the elderly and usually treated with open reduction and internal fixation (ORIF), though this method has a high failure rate and often leads to complications like infection, poor healing, and loss of walking ability. Total knee replacement (TKR) is another option that may allow quicker recovery, but it has not been directly compared to ORIF in a randomized trial for this condition. Participants will receive either osteosynthesis using a locking plate (ORIF) or primary total knee replacement (TKR). Both treatments are surgical procedures aimed at fixing the fracture and restoring knee function. The study includes 98 patients randomized to one of these two treatment groups to evaluate their outcomes. The goal is to determine which approach leads to better knee function, less pain, and improved ability to walk and quality of life one year after treatment. During the study, patients will be assessed for knee function and pain over a 12-month period following treatment. Researchers will use measures like the Oxford knee score and other evaluations of walking ability and life quality. The study also monitors complications and recovery progress. Participants are involved in follow-up visits and assessments to track their knee health and overall recovery throughout the year after their surgery.