Esa-Matti Tolppanen

Finnish Institute for Health and Welfare | THL · OPER

Chronic conditions are the major cause of illness, disability and death. A disease register is effective in supporting new models for delivering chronic care. To improve the care of diabetes two stand‐alone diabetes registers have been recently constructed in Finland – a national diabetes register (FinDM II) and a regional diabetes register (T2DR)...

This article describes a data warehouse approach when designing an information system to meet nursing management needs in acute hospital setting. The rapidly changing health care environment has created new challenges for nursing leaders and requires appropriate, accurate and timely data for decision-making. Key aspects of current information needs...

Objective: To study the efficacy of continuous quality improvement (CQI) compared to ordinary management in an on-duty radiology department.Material and Methods: Because of complaints regarding delivery of on-duty radiological services, an improvement was initiated simultaneously at two hospitals, at the HUCH (Helsinki University Central Hospital)...

To study the efficacy of continuous quality improvement (CQI) compared to ordinary management in an on-duty radiology department. Because of complaints regarding delivery of on-duty radiological services, an improvement was initiated simultaneously at two hospitals, at the HUCH (Helsinki University Central Hospital) utilising the CQI-method, and at...

To get an informative and detailed picture of the resource utilization in a radiology department in order to support its pricing and management. A system based mainly on the theoretical foundations of activity-based costing (ABC) was designed, tested and compared with conventional costing. The study was performed at the Pediatric Unit of the Depart...

As part of our work aiming at facilitation of growth screening, we analyzed the growth of 741 healthy infants from birth to 2 years of age. We 1) show that weight depends on length rather than age, 2) present new growth standards in a format which allows direct reading of relative length and relative weight, and 3) define the normal variation of ch...

To provide for early detection of abnormal changes in growth, we propose the monitoring of all children for changes in relative height and relative weight as indirect indicators of growth velocity. To this end we analyzed the growth of 2,156 children, as recorded by the child health surveillance services at ages 2 to 19 years. From their data we co...

Data on the growth of 1063 children and their parents were analysed. Of the variation in height at prepuberty about 20%, and of the final height 30-46%, were explained by the variation in parental heights; the children's own height at the age of 1.0 year increased the proportion explained to half. Two equations were developed for increasing the acc...

The results of 305 femorotibial bypass grafts performed in 246 patients are presented. Of these operations 246 were primary and 58 secondary or tertiary. A total of 66 diabetic patients were in the series. An autogenous saphenous vein graft was employed in 196 primary operations, the other grafts used being PTFE, human umbilical cord vein graft, ve...

From 1967 to 1982, 305 femoral tibial bypasses were performed. Of these 180 (59%) were performed on limb salvage indication. A reversed autogenous saphenous vein was used in 134 instances, among 46 vein substitutes there were 15 vein allografts, 13 human umbilical cord vein grafts, 12 PTFE grafts and six dacron grafts. Hospital mortality was six pa...

The peroperative exploration of axillary content gave wrong result from the stage of axillary nodes in every fourth case compared with the final result of axillary evacuation. There were no locoregional recurrences in stage I-patients irradiated after mastectomy. In postoperatively irradiated stage II-patients there were locoregional recurrences in...

An 153 Patienten wurde der zeitliche Verlauf von Körpertemperatur, Leukozytenzahl und C-reaktivem Protein im Serum (CRP) nach unkomplizierten offenen herzchirurgischen Eingriffen untersucht (85 koronar-chirurgische Operationen, 61 Klappenersatzoperationen und 7 andere). Es sollte ergründet werden, welchen Wert diese Parameter in der Diagnostik post...

To define risk factors and markers associated with proliferative retinopathy (PR), we compared 44 insulindependent diabetic patients with PR with 45 matched patients without advanced retinopathy (NR). Glycemic control assessed by HbA1 measurements from 5 yr preceding diagnosis of PR was significantly worse than in NR patients. The NR patients had m...

Determination of glycohemoglobin in blood (HbA1) represents an established measure of glycemic control in diabetic patients. In patients with uremia, however, the determination can be subject to pitfalls which may limit its reliability. In order to evaluate the clinical usefulness of HbA1 determinations in diabetic patients with nephropathy, concen...

One hundred consecutive patients treated for gastric cancer by total gastrectomy from 1977 to 1982 at the second department of surgery of the Helsinki University Central Hospital were analyzed. The mean age of the patients was 61.5 years. Gastroscopy proved to be diagnostically superior to roentgenographic examination, particularly in cases of prox...

The data of 331 women with breast cancer treated in the Second Department of Surgery, Helsinki University, during the period 1976-1980 (patient material, treatment, prognostic factors) is evaluated and compared with an equally large patient material treated during the period 1951-1961 in the same hospital. A breast lump was the main symptom in 94%...

A total of 24 normal children's hearts with their great vessels were examined at autopsy and the diameters of the pulmonary veins measured. The values so obtained were plotted against patient height, body-surface area, weight, and age and were subjected to multi-variate regression analysis. Height gave the best correlation with pulmonary venous dia...

One hundred consecutive patients were analysed who had been treated with total gastrectomy in the Second Department of Surgery, Helsinki University Central Hospital, for malignancies of the stomach from 1977 to 1982. Hospital mortality was 8%. The 5-year survival rate in this selected group of patients was 43% and 34% for patients with gastric canc...

One hundred consecutive patients treated for gastric cancer by total gastrectomy from 1977 to 1982 at the second department of surgery of the Helsinki University Central Hospital were analyzed. The mean age of the patients was 61.5 years. Gastroscopy proved to be diagnostically superior to roentgenographic examination, particularly in cases of prox...

Anatomic and visual results of retinal detachment surgery were analyzed in 352 consecutive eyes operated on for rhegmatogenous type of retinal detachment in 1978-1981 at the University Eye Hospital in Helsinki. From 1978-79 to 1980-81, both the re-attachment rate and the visual results improved significantly (P less than 0.05). In the latter period...

Patients who use phenytoin and some other anticonvulsive drugs have been shown to have raised concentrations of plasma high density lipoprotein. As this lipoprotein is known to be inversely associated with the incidence of ischaemic heart disease the causes of death of all patients with epilepsy known to be taking anticonvulsive drugs who died duri...

Estrogen and progesterone receptors (ER/PR) were measured in primary tumors and metastases of 397 breast cancer patients. Survival following mastectomy was significantly longer in patients with ER and PR positive tumors, as was survival after first recurrence. The prognostic value of ER and PR was compared with such clinical factors as disease-free...

The BJC is owned by Cancer Research UK, a charity dedicated to understanding the causes, prevention and treatment of cancer and to making sure that the best new treatments reach patients in the clinic as quickly as possible. The journal reflects these aims. It was founded more than fifty years ago and, from the start, its far-sighted mission was to...

Characteristics of rhegmatogenous retinal detachment and its predisposing factors were studied in a consecutive series of 342 patients operated on for retinal detachment (RD) at the University Eye Hospital in Helsinki in 1978-1981. On these, 234 were pre-operatively examined and operated on by the senior author. The mean age of the patients was 52....

During a -4 year period, 1978-1981, 310 eyes of 301 patients living in the district of the Helsinki University Central Hospital were examined for rhegmatogenous detachment of the retina. This corresponds to an annual incidence of 6.9 per 100 000 mean population. The mean age of the patients was 54.2 years, and the sex distribution corresponded with...

Fifteen Type 2 diabetics were treated for 4-week periods with once daily (10 mg) glibenclamide, glipizide and placebo according to a double-blind cross-over protocol. Post-dose glipizide concentrations were three times higher than those of glibenclamide, due to the incomplete bioavailability of the latter. On the other hand, pre-dose drug levels we...

In a double-blind cross-over study we compared the effects of insulin plus glibenclamide, 5 mg twice daily, with insulin plus placebo during 8-week periods on metabolic parameters in 13 non-insulin dependent diabetic (NIDDM) patients poorly controlled with insulin alone. The combination therapy improved diabetic control as assessed by fasting blood...

The purpose of this study is to determine the prognosis of attempted suicide in a long-term follow-up and to study whether a clinical interview can yield practical variables clinical significance to predict suicide.

Oestrogen and progesterone receptor assays were performed in 286 women with primary breast cancer, and the patient group was followed up for a minimum of 24 months. Of the 263 patients belonging to clinical stages I-III and serving as the population used for calculation of disease-free interval only 1.9% received postoperative endocrine treatment a...

The relationships between the presence of female sex steroid receptors and their concentrations, and the histological grade were investigated in primary breast carcinoma specimens from 151 patients. The concentrations of estrogen receptor were significantly lower in grade III tumours than in the more differentiated ones from pre- and post-menopausa...

This study was designed to evaluate the influence of age, duration of diabetes, relative body weight and glycaemic control on beta-cell function and insulin sensitivity in 250 patients with onset of nonketotic diabetes between the age of 35 and 70 years (Type 2 diabetes). Beta-cell function was assessed by measuring serum C-peptide concentrations a...

A novel format for a growth chart is proposed to facilitate early detection of aberrant growth. Normal growth is shown as a horizontal line and any deviation from this indicates abnormal change in growth. The vertical scales show relative height (height SDS) and relative weight (% deviation of weight from the mean weight for height) directly. Weigh...

Thirteen patients (6 females and 7 males) who were secondary failures on oral drug therapy were randomly allocated to either 2 months of treatment with insulin + glibenclamide or insulin + placebo. Thereafter the treatment schedules of the two groups were switched over for another two months. The combination of insulin and glibenclamide was more ef...

One hundred and sixty patients with onset of non-ketotic diabetes at the ages of 35-70 were investigated for chlorpropamide-alcohol flush (CPAF), beta-cell function, insulin sensitivity, human leucocyte antigens (HLA), organ specific antibodies and diabetic complications. A positive flush reaction was defined as an increase in facial skin temperatu...

The effects of two beta-blocking drugs on endogenous insulin secretion and insulin sensitivity were investigated in a double-blind cross-over study in 13 hypertensive patients. The patients were randomly allocated to each of three 2-week treatment periods with propranolol 80 mg b.i.d., atenolol 50 mg b.i.d. and placebo b.i.d. Endogenous insulin sec...

ABSTRACT One hundred and sixty patients with onset of non-ketotic diabetes at the ages of 35–70 were investigated for chlorpropamide-alcohol flush (CPAF), β-cell function, insulin sensitivity, human leucocyte antigens (HLA), organ specific antibodies and diabetic complications. A positive flush reaction was defined as an increase in facial skin tem...

Unlabelled: In order to investigate whether there is an association between the HLA system and type 2 diabetes, we have determined HLA-A, B- and C-antigens in 227 patients with onset of diabetes between the ages of 35 and 70 years and compared them with the HLA-antigen frequencies in Finnish blood donors. One hundred and sixty-eight patients (74%)...

Twenty-three healthy males, aged 23 to 62 years, were examined by M-mode echocardiography and systolic time intervals for 3 h after (1) ethanol 1 g/kg by mouth taken over 60 minutes; (2) atenolol 100 mg by mouth; (3) ethanol (1 g/kg) + atenolol (100 mg). The peak mean blood ethanol (+/- s.e.) was 112 +/- 4 mg/100 ml in test 1 and 104 +/- 7 mg/100 m...

In Finland COSTAR V based patient information systems are becoming a national de facto standard for both ambulatory care and hospital patient information systems. Helsinki University Central Hospital is developing a large distributed patient information system using MUMPS and several software packages including File Manager and a Finnish version of...

This electrophysiological study deals with the occurrence and with the mode of release of unusually large miniature end-plate potentials at the rat neuromuscular junction during physiological conditions. A specific limit for the normal miniature end-plate potential amplitude at each cell studied was determined after fitting the observed frequency-a...

The effect of prostaglandin E 1 on neuromuscular transmission in the phrenic nerve‐diaphragm muscle preparation of the rat was studied with intra‐ and extracellular recording techniques. Prostaglandin E 1 , in concentrations from 10 n m , induced intermittent failures in the generation of the end‐plate potential in response to repeated indirect sti...

In the rat phrenic nerve-diaphragm muscle preparation, X-537A at 6×10−6 to 3×10−5 M (1) depolarized muscle fibre membranes, (2) caused an occasional transient increase in and ultimate block of spontaneous transmitter release, (3) did not increase the amplitude of the end-plate potential (epp) but abruptly blocked stimulus-evoked transmitter release...