Biomedical subjects

A Ohinmaa

Publications and source records attributed to A Ohinmaa.

11 recordsLinked to original sources

PubMed2001

Cost effectiveness of periradicular infiltration for sciatica: subgroup analysis of a randomized controlled trial.

STUDY DESIGN: A subgroup analysis of a prospective, randomized controlled trial was performed. OBJECTIVE: To describe the cost effectiveness of periradicular infiltration with steroid in subgroups of patients with sciatica. SUMMARY OF BACKGROUND DATA: A recent trial on periradicular infiltration indicated that a methylprednisolone-bupivacaine combination had a short-term effect, as compared with that of saline. This report describes the efficacy and cost effectiveness of steroid in subgroups of patients with sciatic. METHODS: This study involved 160 patients with unilateral sciatica. Outcome assessments were leg pain (100-mm visual analog scale), disability on the Oswestry Low Back Disability Questionnaire, and the Nottingham Health Profile. Data on medical costs and sick leaves also were gathered. Patients were randomized for periradicular infiltration with either methylprednisolone-bupivacaine or saline. The adjusted between-group treatment differences at each follow-up assessment, the number of patients free of leg pain (responders, cutoff 75%), and efficacy by the area-under-the-curve method were calculated. For the cost-effectiveness estimate, the total costs were divided by the number of responders. The rate of operations in different subgroups was evaluated by Kaplan-Meier analysis. RESULTS: In the case of contained herniations, the steroid injection produced significant treatment effects and short-term efficacy in leg pain and in Nottingham Health Profile emotional reactions. For symptomatic lesions at L3-L4-L5, steroid was superior to saline for leg pain, disability, and straight leg raising in the short term. By 1 year, steroid seemed to have prevented operations for contained herniations, costing $12,666 less per responder in the steroid group (P < 0.01). For extrusions, steroid seemed to increase the operation rate, and the steroid infiltration was more expensive, costing $4445 per responder (P < 0.01). CONCLUSIONS: In addition to short-term effectiveness for contained herniations and lesions at L3-L4-L5, steroid treatment also prevented surgery for contained herniations. However, steroid was countereffective for extrusions. The results of the subgroup analyses call for a verification study.

Adult↗

PubMed2001

Assessing telemedicine: a systematic review of the literature.

BACKGROUND: To clarify the current status of telemedicine, we carried out a systematic review of the literature. We identified controlled assessment studies of telemedicine that reported patient outcomes, administrative changes or economic assessments and assessed the quality of that literature. METHODS: We carried out a systematic electronic search for articles published from 1966 to early 2000 using the MEDLINE (1966-April 2000), HEALTHSTAR (1975-January 2000), EMBASE (1988-February 2000) and CINALH (1982-January 2000) databases. In addition, the HSTAT database (Health Services/Technology Assessment Text, US National Library of Medicine), the Database of Abstracts of Reviews of Effectiveness (DARE, NHS Centre for Reviews and Dissemination, United Kingdom), the NHS Economic Evaluation Database and the Cochrane Controlled Trials Register were searched. We consulted experts in the field and did a manual search of the reference lists of review articles. RESULTS: A total of 1124 studies were identified. Based on a review of the abstracts, 133 full-text articles were obtained for closer inspection. Of these, 50 were deemed to represent assessment studies fulfilling the inclusion criteria of the review. Thirty-four of the articles assessed at least some clinical outcomes; the remaining 16 were mainly economic analyses. Most of the available literature referred only to pilot projects and short-term outcomes, and most of the studies were of low quality. Relatively convincing evidence of effectiveness was found only for teleradiology, teleneurosurgery, telepsychiatry, transmission of echocardiographic images, and the use of electronic referrals enabling e-mail consultations and video conferencing between primary and secondary health care providers. Economic analyses suggested that teleradiology, especially transmission of CT images, can be cost-saving. INTERPRETATION: Evidence regarding the effectiveness or cost-effectiveness of telemedicine is still limited. Based on current scientific evidence, only a few telemedicine applications can be recommended for broader use.

Cost-Benefit Analysis↗

PubMed2001

Periradicular infiltration for sciatica: a randomized controlled trial.

STUDY DESIGN: A randomized, double-blind trial was conducted. OBJECTIVES: To test the efficacy of periradicular corticosteroid injection for sciatica. SUMMARY OF BACKGROUND DATA: The efficacy of epidural corticosteroids for sciatica is controversial. Periradicular infiltration is a targeted technique, but there are no randomized controlled trials of its efficacy. METHODS: In this study 160 consecutive, eligible patients with sciatica who had unilateral symptoms of 1 to 6 months duration, and who never underwent surgery were randomized for double-blind injection with methylprednisolone bupivacaine combination or saline. Objective and self-reported outcome parameters and costs were recorded at baseline, at 2 and 4 weeks, at 3 and 6 months, and at 1 year. RESULTS: Recovery was better in the steroid group at 2 weeks for leg pain (P = 0.02), straight leg raising (P = 0.03), lumbar flexion (P = 0.05), and patient satisfaction (P = 0.03). Back pain was significantly lower in the saline group at 3 and 6 months (P = 0.03 and 0.002, respectively), and leg pain at 6 months (13.5, P = 0.02). Sick leaves and medical costs were similar for both treatments, except for cost of therapy visits and drugs at 4 weeks, which were in favor of the steroid injection (P = 0.05 and 0.005, respectively). By 1 year, 18 patients in the steroid group and 15 in the saline group underwent surgery. CONCLUSIONS: Improvement during the follow-up period was found in both the methylprednisolone and saline groups. The combination of methylprednisolone and bupivacaine seems to have a short-term effect, but at 3 and 6 months, the steroid group seems to experience a "rebound" phenomenon.

Adult↗

PubMed2001

Elements for assessment of telemedicine applications.

OBJECTIVES: As an initiative of the International Network of Agencies for Health Technology Assessment, an approach to assessment of telemedicine applications was prepared to assist decision makers who are considering introduction and use of this technology. METHODS: Review and commentary drawing on published assessment frameworks and reports of primary evaluations of telemedicine, with particular reference to experience in Finland and Canada. RESULTS: Elements of the approach included development of a business case (considering population and services, personnel and consumers, delivery arrangements, specifications and costs); subsequent evaluation of the telemedicine application; and follow-up (covering the domains of technical assessment, effectiveness, user assessment of the technology, costs of telemedicine, trials, economic evaluation methods, and sensitivity analysis). CONCLUSIONS: Decision makers should link introduction of new and often costly technology to appraisal of its feasibility, followed by evaluation of the application, including longer term consideration of its sustainability and impact on the healthcare system. As the effectiveness and efficiency of telemedicine applications will often be strongly influenced by local issues, results of assessments may not be generalizable.

Canada↗

PubMed2000

Psychiatric inpatient care planning via telemedicine.

We assessed the costs of psychiatric inpatient care-planning consultations to remote areas using videoconferencing, instead of the conventional face-to-face consultations at a hospital. The data were collected from all wards at the department of psychiatry of Oulu University Hospital over 11 months. A total of 14 videoconferences were conducted with two primary-care centres located 220 km and 160 km from Oulu. During the same period, 20 conventional consultations at the Oulu University Hospital were also assessed. A questionnaire was completed by a total of 124 patients, relatives and health-care personnel; the response rate was about 90%. Of the respondents, 90% were satisfied with the quality of communication afforded by videoconferencing. At a workload of 20 patients per year, the cost of the videoconferences was FM2510 per patient; the cost of the conventional alternative was FM4750 per patient. At 50 care consultations per year, a remote municipality would save about FM117,000.

Attitude of Health Personnel↗

PubMed2000

The feasibility of telemedicine for orthopaedic outpatient clinics--a randomized controlled trial.

We investigated the use of videoconferencing in the examination of orthopaedic outpatients. A consecutive sample of orthopaedic outpatients was randomized to examination either via videoconferencing (n = 76) while attending a primary-care unit or at a conventional hospital outpatient clinic 160 km away (n = 69). Videoconferencing was found to be feasible and the equipment functioned well technically. There were somewhat more problems in examining the telemedicine patients than the clinic patients. The two patient groups were equally satisfied with the specialist service. The telemedicine patients were more willing to have their next visit by videoconferencing than the conventional patients. Videoconferencing between primary and secondary care can be used in the examination of orthopaedic patients whenever no demanding imaging technology is needed.

Ambulatory Care↗

PubMed1999

Cost-effectiveness analysis of nimodipine treatment after aneurysmal subarachnoid hemorrhage and surgery.

OBJECTIVE: To assess the cost-effectiveness ratio of nimodipine administration after aneurysmal subarachnoid hemorrhage (SAH) and surgery. METHODS: One hundred twenty-seven patients of both sexes who had a ruptured aneurysm (verified using angiography), who presented with Hunt and Hess Grades I to III on admission, who underwent an operation within the first week after SAH, and who had participated in a randomized prospective clinical trial of nimodipine medication were enrolled in the study. The efficiency (cost-effectiveness) of nimodipine treatment was evaluated by incremental cost-effectiveness analysis. The cost-effectiveness ratio was evaluated for two groups: patients treated with nimodipine and patients given placebo. The cost was estimated as direct hospitalization costs, and the patient outcome was measured as life years gained. RESULTS: The incremental cost-effectiveness ratio for nimodipine treatment was $223 per life year gained on the basis of 1996 monetary values and contemporary management of SAH. Patients in the nimodipine group had an average of 3.46 years longer life expectancy (incremental effectiveness) than those in the placebo group. There was a significant difference in 3-month follow-up mortality and a slight difference in sickness pensions during the 10 years after SAH. Nimodipine treatment was associated with a significant decrease in mortality. There were no statistically significant differences between the treatment groups in the length of hospital stay. There were no statistically significant differences between the treatment groups in sickness pensions. CONCLUSION: Nimodipine is cost-effective. Therefore, its use in the management of patients with SAH seems economically justified because it increases patient life years at very low incremental cost.

Adolescent↗

PubMed1998

The use of videoconferencing for telepsychiatry in Finland.

Some of the first telepsychiatry experiments in Finland were carried out at the Department of Psychiatry of the University of Oulu, where videoconferencing has been used for family therapy, occupational counselling, consultation and teaching. In 1996 videoconferencing was used for a total of 249 hours, which increased to 434 hours in 1997. During 1997, 45% of the time was used for teaching, 26% for occupational counselling, consultations and therapies, 23% for training and 6% for administration (mainly testing the connections). In a survey, 37 participants rated aspects of the quality of the videoconferences on a scale from 4 (poor) to 10 (excellent). The audio quality had a mean value of 8.0 (SD 0.9), the picture quality 7.5 (SD 1.5), and the general value of the videoconference was rated 7.5 (SD 1.0). Preliminary results with telepsychiatry in Finland have been promising. Interactive videoconferencing provides an easy, fast and relatively inexpensive method of providing psychiatric services over long distances.

Finland↗

PubMed1996

Health related quality of life in diabetic patients measured by the Nottingham Health Profile.

The aim of the present study was to assess the health related quality of life of adult diabetic patients using the Nottingham Health Profile (NHP) as a measure. A further aim was to describe different Quality of Life (QOL) outcomes in different treatment groups of diabetes. The target population consisted of all registered adult (18 years or older) diabetic patients (n = 2519) in the district of Oulu, a city of 100 000 inhabitants in Northern Finland. All these persons were invited to participate in a screening examination for diabetic retinopathy, and the NHP questionnaire was mailed along with this invitation. A total of 1804 patients (72%) returned the NHP questionnaire when they came to the fundus photography session. The data were analysed by using mean values of NHP dimensions with the 95% confidence intervals (CI) and the logistic regression analysis to predict the risk (OR) for having at least one health problem in a particular dimension. The results indicated that patients with tablet treatment had significantly lower QOL levels than the 'general population' in all NHP dimensions. The diet treatment group patients had lower QOL levels than the 'general population' only in the 'Sleep' and 'Social isolation' dimensions. The diet group had a significantly better QOL level in all six dimensions of QOL of NHP than the tablet treatment or combined treatment (patients treated with tablets and insulin) groups. The tablet treatment and combined treatment groups did not differ significantly in any of the NHP dimensions. The logistic models testing the presence of at least one problem in the NHP dimensions showed that the number of other diseases increased the risk of having QOL problems in all dimensions and duration of the diabetes and the age of the patient had risk increasing effects in four NHP dimensions while the gender had only a small effect on the QOL in diabetic patients. The study shows that the NHP questionnaire as a general measure of the QOL reveals differences in the QOL between the different treatment groups and between diabetic patients and general population.

Adult↗

PubMed1996

Young diabetics' compliance in the framework of the MIMIC model.

The compliance of 346 young diabetics aged 13-17 years with health regimens is analysed in the framework of a MIMIC (multiple indicators, multiple causes) model. The data were compiled by means of a questionnaire on compliance, conditions for compliance, the meaning attached to treatment and the impact of the disease, and the model constructed using the LISREL VII programme, treating compliance as an unobserved variable formulated in terms of observed causes (x-variables) and observed indicators (y-variables). The resulting solutions are entirely satisfactory. The goodness-of-fit index is 0.983, the root mean square residual 0.058 and the chi-squared statistic 43.35 (P < 0.001). The values for the individual parameters in the model are also shown to be reliable and valid. The model shows compliance to be indicated by self-care behaviour, responsibility for treatment, intention to pursue the treatment and collaboration with the physician, and to be greatly determined by motivation, experience of the results of treatment and having the energy and will-power to pursue the treatment and, to a lesser extent, by a sense of normality and fear.

Adolescent↗

PubMedDate not supplied

Comparison of Finnish and U.S.-based visual analog scale valuations of the EQ-5D measure.

The EQ-5D is a multiattribute health status measure that can be used to derive preference-based index scores for health-related quality-of-life (HRQOL) assessment. Valuations for EQ-5D health states using different techniques have been obtained in a number of countries. It is not clear how valuations from different countries compare. Using an ordinary least-squares regression, visual analog scale valuations for EQ-5D health states obtained in postal surveys in Finland and the United States were compared. The regression model estimates indicated that Finnish and U.S. respondents did provide different preference valuations for different levels of health. However, the country-specific differences were not large and depended on the dimension and the level of problem on that dimension. Differences in health-state valuations are unlikely to have important implications when using the EQ-5D in international studies.

Adolescent↗