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Facility design related to rapidly changing healthcare (HC) processes is in dire need of new innovations. Due to an ongoing nationwide HC reform in Finland, five University Hospitals among other central hospitals are forced to find ways to carry out competitive HC design practices in order to maintain efficient work environments and processes. This article illustrates a brief overview of Kuopio University Hospital's (KUH's) design development concept. The researchers reviewed and evaluated all the major facility design projects being carried out at KUH during the past five years. KUH aspires to continuously learn in order to stay effective and improve as a major player in Finnish HC. Creative thinking and openness to new, state-of-the-art solutions have enabled gradual development in the facility design process. Emphasis on participatory design approach, change management and evidence-based design has proven to be beneficial as well. Furthermore, integrating operational design as a main part of the facility design process should pay dividends in the near future. This article brings forth a HC design concept from one of the leading hospitals among Finnish HC. The article sheds light on the methods crucial to KUH for continuous improvement. [ABSTRACT FROM PUBLISHER]

Background: To evaluate the association between maternal and paternal smoking during pregnancy, and asthma among offspring.Methods: We conducted a hospital-based birth retrospective observational birth cohort study in a University-based Obstetrics and Gynecology Department, Kuopio University Hospital, Finland. 39 306 women, delivering between 1989 and 2006, were linked to the national register for asthma reimbursement for their offspring (2641 asthmatics). Pregnancy factors were recorded during pregnancy.Results: The risk of asthma was significantly elevated if both parents smoked (aOR 3.7; 95 % Cl 3.2-4.4) and it remained high in only paternal smoking families (aOR 2.9; 95 % Cl 2.5-3.3) as well as only maternal smoking families (aOR 1.7; 95 % Cl 1.2-2.2). Paternal cessation of smoking during pregnancy seemed to reduce the risk of asthma regardless of maternal smoking (aOR 0.3-0.4).Conclusions: Parental smoking, and especially paternal smoking, was significantly associated with the risk of asthma in offspring and paternal cessation of smoking during pregnancy was associated with a decreased risk of childhood asthma regardless of maternal smoking. The results indicate that both parents should be encouraged to quit smoking during pregnancy, since it is a relatively easy and cheap way to reduce the risk of asthma in offspring.Trial Registration: The study is registered in Kuopio University Hospital register (TUTKI): ID5302448. [ABSTRACT FROM AUTHOR]

Purpose: The three major techniques for a gastrostomy in children are open gastrostomy (OG), percutaneous endoscopic gastrostomy (PEG) and laparoscopic-assisted gastrostomy. Here, we have evaluated the outcome after OG and PEG in 69 children operated in Kuopio University Hospital. Methods: The medical records of 69 consecutive children who had either PEG ( n = 56) or OG ( n = 13) over an 18-year period (1990-2008) were reviewed. Results: There was no difference between the PEG- and OG-groups in the patients' characteristics, indications for tube placement and hospital stay. The mean procedure time was 43 min shorter in the PEG-group (28 ± 38 min) than in the OG-group (71 ± 58 min) ( P = 0.003). Four children (8%) in the PEG-group and one (8%) in the OG-group required later surgical interventions related to gastrostomy. Severe gastro-oesophageal reflux (GER) necessitating fundoplication was detected in 15 children (27%) in the PEG-group and in 7 children (54%) in the OG-group ( P = 0.06). Conclusion: The results of this study indicated a higher incidence for severe GER leading to fundoplication in children with OG, while no difference with complications and clinical outcome between the two techniques, OG and PEG, were observed. [ABSTRACT FROM AUTHOR]

Background Postdural puncture headache ( PDPH) is a relatively common complication after lumbar punctures ( LP). If conservative treatment is not sufficient within a few days and the symptoms are severe, an epidural blood patch ( EBP) may be performed. Aim A chart review to evaluate the need and effectiveness of EBPs in children and adolescents over a 10-year period at Kuopio University Hospital ( KUH) and Satakunta Central Hospital ( SCH). Methods The information system patient measures databases were reviewed to identify patients who had received an EBP. Then, the pediatric patients' medical records were compared to the characteristics of the PDPH and associated symptoms and were evaluated for the effectiveness of EBPs. Results Forty-two EBPs were performed in 41 patients (24 girls, 17 boys), 26 at KUH and 15 at SCH. Five patients, all at KUH, were children aged 3-12 years, and 36 patients were adolescents, aged 13-18 years. The indications for LPs were diagnostic ( n = 26), spinal anesthesia/analgesia ( n = 11), or introduction of chemotherapy ( n = 2), and four patients developed PDPH after an inadvertent dural puncture with an epidural needle. The first EBP provided a complete relief of symptoms in 37 children, an initial success rate of 90%, and permanent relief in 85%. At KUH, the need for EBPs after spinal anesthesia/analgesia was <1/1000 in children and 2-3/1000 in adolescents, and that after chemotherapy 1-2/1000. No serious adverse effects related to EBPs were recorded. Conclusion If PDPH symptoms are severe and are not relieved with conservative treatment, EBP is a highly effective procedure in pediatric patients. [ABSTRACT FROM AUTHOR]

There are no data on serum cortisol of hematological patients at the onset of neutropenic fever and its possible association with the severity of infection. The purpose of this study was to evaluate the association of serum cortisol with the level of C-reactive protein (CRP) and procalcitonin (PCT), widely used markers of infection and inflammation, and with the development of severe sepsis in this patient group. All clinical data were collected prospectively at the hematology ward of Kuopio University Hospital. Altogether, 69 hematological patients with 93 periods of neutropenic fever were included. Nineteen patients received therapy for acute myeloid leukemia, and 50 patients were autologous stem cell transplantation recipients. Each period of neutropenic fever was classified as severe sepsis or not. Serum cortisol, CRP, and PCT were determined at the onset of fever on day 0 and then at 8-9 a.m. on days 1-4. Level of serum cortisol correlated positively with maximal CRP level during days 0 to 4 in neutropenic fever periods without severe sepsis, but no correlation was observed in fever periods with severe sepsis. To conclude, the level of cortisol correlated with the severity of infection measured as maximal CRP or elevated PCT in fever periods without severe sepsis, but in fever periods with severe sepsis, the cortisol response was attenuated. [ABSTRACT FROM AUTHOR]

Objectives: Hepcidin is the key regulator of iron homeostasis. The aims of this study were to determine serum hepcidin concentrations and reference ranges in pregnant women and cord blood of newborns at term and to evaluate the associations between hepcidin concentrations and iron status parameters. Methods: A total of 191 pregnant women-newborn pairs were studied in Kuopio University Hospital, Finland. The measured parameters were serum hepcidin, ferritin, transferrin receptor, transferrin saturation, red cell indices, and erythropoietin. Results: The hepcidin concentration in pregnant women was significantly lower than in cord blood at term [geometric mean concentration (GMC) (95% confidence intervals) in pregnant women 10.7 ng/mL (8.5-13.4 ng/mL) vs. GMC of cord blood hepcidin 69.3 ng/mL (55.3-86.8 ng/mL), P < 0.001, adjusted analysis of variance]. Hepcidin was undetectable in 12% of mothers. Hepcidin concentration in pregnant women was the lowest in those who had the lowest iron status. However, maternal hepcidin concentration was not associated with cord blood hepcidin or iron status markers. Hepcidin concentration in cord blood was associated with cord blood iron status, but not with maternal iron status. Conclusions: At term pregnancy, hepcidin concentrations are very low, allowing maximal availability of iron for the fetus. Maternal and cord blood hepcidin levels were independently associated with either maternal or cord blood iron status. [ABSTRACT FROM AUTHOR]

In this paper we study the connection between coronary artery bypass graft (CABG) operation time and quality. Our quality metric was the improvement in health related quality of life (HRQoL) survey score in a sample of 432 patients admitted to Kuopio University Hospital. Patients were interviewed with a structured questionnaire a day before the procedure and the follow-up questionnaires were mailed 6 and 12 months after the surgery. However, the HRQoL metric used did not have high retest reliability. Subsequently, we did not find any connection between CAGB operation times and HRQoL. Likewise, we did not find the speed of the surgeon to have any connection to HRQoL improvement. [ABSTRACT FROM AUTHOR]

Kuopio University Hospital, situated within middle-east Finland, adopted the ISO 9002 standard as its quality system and gained formal certification in March 1999. The rationale behind the decision to adopt ISO 9002 is given, along with the main elements of the journey. The experiences of the hospital, including the advantages and disadvantages, are explained. In particular, issues regarding the documentation process, control and calibration of 4,000 pieces of medical equipment and the impact on staffing levels for in-house trained personnel to undertake the audits are described. The impact on the service to date, including benefits and drawbacks, is covered, along with aspirations for the future. Kuopio Hospitals adopted some techniques during the implementation process which did not work as successfully as others. The article therefore includes these in an effort to pass on the learning acquired from implementing ISO 9002 within such a large hospital as Kuopio University Hospital. [ABSTRACT FROM AUTHOR]

Background: At present, measurements of troponins play a key role in the diagnosis of myocardial infarction. There is a consensus that a turnaround time (TAT) of 1 h or less should be achieved for cardiac marker assays. However, little is known about the real delays between the patient's arrival at the emergency department (ED) and the reporting of the test. Methods: In the present study, the TATs of a cardiac marker, troponin T (TnT), were analyzed at a central laboratory at Kuopio University Hospital in a population consisting of 215 patients who were admitted to the hospital ED. Four specific time points were recorded: 1) the time of the patient's arrival to the ED, 2) the time of the ordering of the test, 3) the time when blood samples arrived at the laboratory, and 4) the time of completion and reporting of the test. Results: The median diagnostic TAT from patient's arrival to the reporting of the TnT result was 122 min. The clinical median TAT was 46 min and the laboratory median TAT was 69 min. Laboratory TAT consisted of the preanalytical TAT at the ED (median 14 min), pre- and postanalytical TAT in the laboratory (median 40 min), and the analytical TAT (on average 10 min). The laboratory TAT was approximately half of the complete diagnostic TAT. Conclusions: On the basis of this analysis, we propose new concepts for the TATs in the diagnostic process: diagnostic TAT which consists of clinical and laboratory TAT. The focus should be shifted from the analytical TAT to the diagnostic process as a whole. Clin Chem Lab Med 2008;46:1030–2. [ABSTRACT FROM AUTHOR]

The article reports on the findings of a study in Finland about the risk factors for genital human papillomavirus (HPV) infection. The study, conducted by researchers at Kuopio University Hospital in Kuopio, Finland, found that having multiple sexual partners is strongly associated with HPV infection. Participants in the study, which included women who had had Pap smear at communal health centers, completed a questionnaire about their gynecologic and obstetric history, medical history, history of sexually transmitted diseases, and smoking habits. The results of the study, which varied with age, are discussed.