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FINPOP 2012-2021
GKS 10.9.2021
Jyrki Jalkanen
Sidonnaisuudet Ei sidonnaisuuksia
2
FINPOP 2015 Tavoite: kerätä 1 vuoden ajalta kaikkien Suomessa
tehtävien gynekologisten laskeumaleikkausten tiedot
Arvioitu kokonaismäärä n. 4200 leikkausta
Pääasiallisesti seurattavat parametrit
Potilastyytyväisyys ja elämänlaatu leikkauksen jälkeen
Kirurgian tuloksellisuutta ennustavat tekijät
41/45 sairaalaa mukana
3
Tutkimusryhmä
Ohjaajat
Dos. Anna-Mari Heikkinen
Dos. Kari Nieminen
Dos. Jyrki Jalkanen
Prof. Anna-Maija Tolppanen
Tutkijat
LL Nina Mattsson
LL Päivi Karjalainen
LL Olga Wihersaari
Sairaala Nova4
Tutkimuskaavio
5
Sairaala Nova6
Sairaala Nova7
2012• Idea of a study of safety and effectiveness of POP surgey in Kanta-Häme Central Hospital
2013
• Decision of a multicenter national cohort study organized by Finnish Society for GynecologicalSurgery
• Translation process of the prolapse-specific HRQoL questionnaires in Finnish
• Ethical and other study approvals
2014
• Pilot study• Recruirement and information of the doctors in all 45 Finnish hospitals performing POP surgery
2015• FINPOP 2015 study• 41 hospitals
• 3515 patients, 3535 operations for POP
2016• 6 months follow-up (n=2528)
2017
• 24 months follow-up (n=2351)• 1st Publication: Mattsson NK: Study I
2018• Data analysis (NM), HILMO-kysely komplikatioista (OW)
2019
• 3 Publications: Mattsson NK: Study II, Study III, Karjalainen PK: Study I
2020•Doctoral Thesis: Mattsson NK: The Effect of Pelvic Organ Prolapse Surgery on Quality of Lfe
•3 Publications: Mattsson NK Sudy IV, Karjalainen PK Study II, Wihersaari O, Study I
2021 5-v -kyselyn loppuun saattaminen
2133/2824 vastausta (75,5%)
Karjalainen PK, Study III
Sairaala Nova9
FINPOP-julkaisut ad9/2021
Mattsson N, Nieminen K, Heikkinen AM, Jalkanen J, Koivurova S, Eloranta ML, Aaltonen R,
Tolppanen AM: Validation of short forms of the Pelvic Floor Distress Inventory (PFDI-20), Pelvic
Floor Impact Questionnaire (PFIQ-7) and Pelvic Organ Prolapse/Urinary Incontinence Sexual
Questionnaire (PISQ-12) in Finnish. Health and Quality of Life Outcomes 2017 15:88. Epub 2017
May 2.
Mattsson NK, Karjalainen P, Tolppanen AM, Heikkinen AM, Jalkanen J, Härkki P, Nieminen K:
Methods of surgery for pelvic organ prolapse in a nationwide cohort (FINPOP 2015). Acta Obstet
Gynecol Scand 2019;98:451-459.
Karjalainen PK, Mattsson NK, Nieminen K, Tolppanen A-M, Jalkanen JT: The relationship of
defecation symptoms and posterior vaginan wall prolapse in women undergoing pelvic organ
prolapse surgery. Am J Obstet Gynecol 2019;211:480.e1-10
Mattsson NK, Karjalainen P, Tolppanen A-M, Heikkinen A-M, Sintonen H, Härkki P, Nieminen K,
Jalkanen J: Pelvic organ prolapse surgery and quality of life – a nationwide cohort study. Am J
Obstet Gynecol 2020;222:588,e1-10.
Mattsson NK, Karjalainen P, Heikkinen A-M, Nieminen K, Jalkanen J, Tolppanen A-M: Agreement
between patient global impression scale of improvement, pelvic floor distress inventory and 15D in
measuring the outcome of pelvic organ prolapse surgery. Neurology and urodynamics 2020;1-8.
Karjalainen PK, Mattsson NK, Jalkanen JT, Nieminen K, Tolppanen A-M:Minimal Important
Difference and Patient Acceptable Symptom State for the Pelvic Floor Distress Inventory-20 among
patients undergoing pelvic organ prolapse surgery. I Urogynecol J. 2020, DOI: 10.1007/s00192-
020-04513-z
Wihersaari O, Karjalainen P, Tolppanen AM, Mattsson N, Jalkanen J, Nieminen K: Complications of
Pelvic Organ Prolapse Surgery in the 2015 Finnish Pelvic Organ Prolapse Surgery Survey Study.
Obstet Gynecol. 2020 Dec;136(6):1135-1144.
Karjalainen PK, Tolppanen AM, Mattsson NK, Wihersaari OAE, Jalkanen JT, Nieminen K: Pelvic
organ prolapse surgery and overactive bladder symptoms—a population-based cohort (FINPOP). I
Urogynecol J. 2021 https://doi.org/10.1007/s00192-021-04920-w
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TULOKSET
Pahin oire
20.10.2017 16.54Gynekologisen Kirurgian Seura
Sivu 1 / 4ht tp:/ /gks.f i/
GKS Koulutuspäivät 28.-29.9.2017
Ohjelma ja LUENNOT
Koulutuspäivien ESITE
PRESYMPOSIUM 27.9.17
Perineaalinen ultraääni lantionpohjan ja laskeuman arvioinnissa
Presymposiumin OHJELMA
Dietz handout Pelvic Floor Ultrasound 2017
MERKITSE KALENTERIIN:
! Navigation
% o
f p
ati
en
ts
Tyytyväisyys leikkaustulokseen,pahimman oireen mukaan
1 = hyvin tyytyväinen
7 = hyvin tyytymätön
20.10.2017 16.54Gynekologisen Kirurgian Seura
Sivu 1 / 4ht tp:/ /gks.f i/
GKS Koulutuspäivät 28.-29.9.2017
Ohjelma ja LUENNOT
Koulutuspäivien ESITE
PRESYMPOSIUM 27.9.17
Perineaalinen ultraääni lantionpohjan ja laskeuman arvioinnissa
Presymposiumin OHJELMA
Dietz handout Pelvic Floor Ultrasound 2017
MERKITSE KALENTERIIN:
! Navigation
PFDI-20 subscales
PFDI-
subscale
BASELINE SCORES,
Mean, median, SD,
(95%CI)
CHANGE of scores from
baseline to 6 Month
Mean, median, SD (95%CI)
Change of 6
Month mean
scores from
baseline , %
POPDI40.8, 37.5, 19.9, (40.0,
41.6)
- 29.6, 29.2, 20.7 (28.7,
30.4) - 73
UDI32.4, 29.2, 21.0 (31.5,
33.2)
- 15.4, 12.5, 19.7 (14.6,
16.1) - 45
CRADI26.3, 25.0, 19.6 (25.6,
27.1)
- 11.0, 9.4, 16.2 (10.3,
11.6) - 42
Best improvement of bulge symptoms
Least improvement in defecation problems
20.10.2017 16.54Gynekologisen Kirurgian Seura
Sivu 1 / 4ht tp:/ /gks.f i/
GKS Koulutuspäivät 28.-29.9.2017
Ohjelma ja LUENNOT
Koulutuspäivien ESITE
PRESYMPOSIUM 27.9.17
Perineaalinen ultraääni lantionpohjan ja laskeuman arvioinnissa
Presymposiumin OHJELMA
Dietz handout Pelvic Floor Ultrasound 2017
MERKITSE KALENTERIIN:
! Navigation
15
Mattsson N et al. AJOG 2020
20.10.2017 16.54Gynekologisen Kirurgian Seura
Sivu 1 / 4ht tp:/ /gks.f i/
GKS Koulutuspäivät 28.-29.9.2017
Ohjelma ja LUENNOT
Koulutuspäivien ESITE
PRESYMPOSIUM 27.9.17
Perineaalinen ultraääni lantionpohjan ja laskeuman arvioinnissa
Presymposiumin OHJELMA
Dietz handout Pelvic Floor Ultrasound 2017
MERKITSE KALENTERIIN:
! Navigation
15D-results, by question
Oireiden paraneminen,PGI-kysely
Mattsson N et al., AJOG 2020
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Outcomesatisfaction
Satisfied 87 %
Indifferent 5%
Dissatisfied 8%
REASONS FOR DISSATISFACTION:
Prolapse recurrenc
e33 %
No improvement of symptoms
12 %
De novosymptom…
Post op complication 8%
other 17%
20.10.2017 16.54Gynekologisen Kirurgian Seura
Sivu 1 / 4ht tp:/ /gks.f i/
GKS Koulutuspäivät 28.-29.9.2017
Ohjelma ja LUENNOT
Koulutuspäivien ESITE
PRESYMPOSIUM 27.9.17
Perineaalinen ultraääni lantionpohjan ja laskeuman arvioinnissa
Presymposiumin OHJELMA
Dietz handout Pelvic Floor Ultrasound 2017
MERKITSE KALENTERIIN:
! Navigation
Mattsson N et al.AJOG 2020 and
Unpublished data
Would you recommend this operationto your friend if she had a similarproblem?
95%
5%
kylläYes
No
Mikä on muna ja mikä kana?
Karjalainen PK, Mattsson NK, Nieminen K, Tolppanen
A-M, Jalkanen JT: The relationship of defecation
symptoms and posterior vaginan wall prolapse in
women undergoing pelvic organ prolapse
surgery. Am J Obstet Gynecol 2019;211:480.e1-10
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FIGURE 2
Prevalence of bothersome symptoms by prolapse stage at baseline21
Improvement of bothersome bowel symptoms bysurgery, FINPOP-study
0
10
20
30
Baseline 6 months 24 months
Splinting Straining
Incomplete emptying FI, normal stool
FI, loose stool Flatal incontinence
Pain when defecating Urgency
Rectal prolapse
Karjalainen P, et. Al, AJOG 2019
Pe
rce
nta
ge
of
pa
tie
nts
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24
PROM-analyysit uudelle tasolle
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Neurourology and Urodynamics. 2020;39:2171–2178. wileyonlinelibrary.com/journal/nau | 2171
Received: 20 April 2020 | Accepted: 12 July 2020
DOI: 10.1002/nau.24467
O R I G I N A L C L I N I C A L A R T I C L E
Agreement between pat ient global impression scale of
improvement, pelvic floor distress inventory and 15D in
measur ing the outcome of pelvic organ prolapse surgery
Nina K. M attsson M D1,2 | Päivi Kar jalainen M D2,3 |
Anna M ar i Heikk inen PhD2,4 | Kar i Nieminen PhD5,6 | Jyrk i Jalkanen PhD7 |
Anna M ai ja Tolppanen PhD8
1Department of Obstetrics and
Gynecology, Kanta Häme Central
Hospital, Hämeenlinna, Finland
2Institute of Clinical Medicine, University
of Eastern Finland, Kuopio, Finland
3Department of Obstetrics and
Gynecology, Central Finland Central
Hospital, Jyväskylä, Finland
4Terveystalo, Finland
5Department of Obstetrics and
Gynecology, Tampere University Hospital,
Tampere, Finland
6Faculty of Medicine and Health
Technology, Tampere University,
Tampere, Finland
7Central Finland Hospital District,
Jyväskylä, Finland
8School of Pharmacy, University of
Eastern Finland, Kuopio, Finland
Correspondence
Nina K. Mattsson, MD, Department of
Obstetrics and Gynecology, Kanta Häme
Central Hospital, Hämeenlinna, Finland,
Rautatienkatu 66, 13220 Hämeenlinna,
Finland.
Email: nina.mattsson@fimnet.fi
Funding information
Emil Aaltosen Säätiö; Sosiaali ja
Terveysministeriö; Hämeen Rahasto
Abstract
Aims: To evaluate the correlation between three commonly used patient
reported outcome measures, two generic and one condition specific instru-
ment, in assessing the change in health related quality of life following pelvic
organ prolapse surgery.
M ethods: The generic health related quality of life measure 15 dimensional
instrument (15D), Patient Global Impression of Improvement (PGI I), and
prolapse specific Pelvic Floor Distress Inventory (PDFI 20) were used to assess
the effectiveness of pelvic organ prolapse surgery in the national FINPOP study
of 3535 surgeries (83% of all pelvic organ prolapse operations) performed in
Finland in 2015. Spearman correlations between PGI I, change in 15D and its
dimensions and change in PFDI 20 and its subscales over a 2 year follow up
were investigated. The proportion of concordant ratings was also studied by
investigating the proportion of women rated similarly (worse/no change/bet-
ter/much better) by two instruments according to validated cutoffs.
Resul ts: Among 2248 women for whom the 2 year change in all instruments
could be measured, changes in PFDI 20 and 15D and its dimensions were
weak (ρ< 0.2 for all except excretion; ρ= 0.39 and sexual activity; ρ= 0.27).
PFDI 20 change (ρ= 0.39) and its subscales (ρ= 0.19 0.40, all P< .001) were
more strongly correlated with PGI I. The proportion of fully concordant ratings
were higher for PFDI 20 and PGI I (50.6%) than for PFDI 20 and 15D (33.0%).
Conclusion: The weak correlations between 15D, PGI I, and PDFI 20 ob-
served in this study show that the quantified health gains are strongly de-
pendent on the chosen patient reported outcome measures. This demonstrates
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -This is an open access article under the terms of the Creative Commons Attribution NonCommercial License, which permits use, distribution and reproduction in any
medium, provided the original work is properly cited and is not used for commercial purposes.
© 2020 The Authors. Neurourology and Urodynamics published by Wiley Periodicals LLC
MID ja arviointi-menetelmä
Karjalainen et al. IUJ 2020
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PASS ja PGI-I –vertailu
Karjalainen P et al. IUJ 2020
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PASS= patient acceptable symptom score
Karjalainen P et al. IUJ 2021
POP and OAB
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Komplikaatioista
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Original Research
Complications of Pelvic Organ ProlapseSurgery in the 2015 Finnish Pelvic OrganProlapse Surgery Survey Study
Olga Wihersaari, MD, Päivi Karjalainen, MD, Anna-Maija Tolppanen, PhD, Nina Mattsson, PhD,Jyrki Jalkanen, PhD, and Kari Nieminen, PhD
OBJECTIVE: To describe the major complicat ions of
pelvic organ prolapse (POP) surgery in Finland.
METHODS: The Finnish Pelvic Organ Prolapse Surgery
Survey 2015 study is a prospect ive cohort of POP
surgeries performed in Finland in 2015. Perioperat ive,
postoperat ive, and late complications during 1 year of
follow-up were compared among native tissue repair,
transvaginal mesh, and abdominal mesh surgery. Major
complications were assessed using the Clavien-Dindo
grading system. Predictive factors for major complica-
tions were studied with logistic regression analysis.
RESULTS: Within 1 year after POP surgery, 396 (11.2%)
of 3,515 women had at least one complication: 10.9%
after native tissue, 11.7% after transvaginal mesh, and
13.5% after abdominal mesh repair. The majority of
complications occurred within 2 months after surgery
and postoperat ive infection (4.3%) and bleeding or
hematoma (2.6%) were the most frequent. The incidence
of organ injuries was low. Mesh-augmented surgery was
associated with significantly higher rates of bladder and
bowel injuries than native tissue surgery. Complication-
related reoperat ions occurred significantly more often
after abdominal mesh repair than native tissue surgery
(5.2% vs1.8%, P5.001). Mesh-related complications were
diagnosed more often after transvaginal mesh repair. The
overall rate of major complications (Clavien-Dindo
grades III–V) was 3.3%. Abdominal mesh surgery was
associated with the highest rate of major adverse events
(8.8% vs native tissue repair 2.6% and transvaginal mesh
4.9%). The incidence of Clavien-Dindo grade IV or V
complications was rare (less than 0.6%). Mesh surgery
(transvaginal mesh adjusted odds ratio [aOR] 2.23, 95%
CI 1.31–3.80, and abdominal mesh aOR 3.02, 95% CI
1.67–5.46), longer operating time (aOR 2.84, 95% CI
1.78–4.53), prior POP surgery (aOR 1.68, 95% CI 1.00–
2.81) and difficult surgery (aOR 2.75, 95% CI 1.63–4.62)
were associated with an increased risk for occurrence of
major complications.
CONCLUSION: Serious adverse events were rare
regardless of the operative approach. However, mesh-
augmented surgery was associated with higher risk for
major complications.
(Obstet Gynecol 2020;136:1135–44)
DOI: 10.1097/AOG.0000000000004159
Pelvic organ prolapse(POP) isacommon and often
asymptomatic condition, affecting up to 50% of
parouswomen when based on examination.1 The esti-
mated lifetime risk for prolapse surgery in the general
female population is between 12% and 18%.2–4 A
variety of surgical procedures have been designed to
reducePOP symptoms. There is, however, no consen-
sus on the optimal approach, which is reflected by
high reoperation ratesdue to recurrent prolapse, espe-
cially after native tissue repair.1,5,6 Even though POP
surgery isconsidered to be a relatively safe procedure,
serious adverse events do occur and especially mor-
bidity related to mesh procedures has raised concerns
worldwide.7
From the Department of Obstetrics and Gynecology, Tampere University
Hospital, and the Faculty of Medicine and Health Technology, Tampere
University, Tampere, the Institute of Clinical Medicine and the School of
Pharmacy, University of Eastern Finland, Kuopio, theDepartment of Obstetrics
and Gynecology, Central Finland Central Hospital, Jyväskylä, theDepartment of
Obstetrics and Gynecology, Kanta-Häme Central Hospital, Hämeenlinna, and
theCentral Finland Hospital District, Jyväskylä, Finland.
Financial support for thisstudy wasprovided by Finnish Society for Gynecolog-
ical Surgery (a nonprofit organization).
Each author has confirmed compliance with the journal ’s requirements for
authorship.
Corresponding author: Olga Wihersaari, MD, Department of Obstetrics and
Gynecology, Tampere University Hospital, Tampere, Finland; email:
olga.wihersaari@fimnet.fi.
Financial Disclosure
Theauthorsdid not report any potential conflicts of interest.
© 2020 by theAmerican College of Obstetriciansand Gynecologists. Published
by WoltersKluwer Health, Inc. All rights reserved.
ISSN: 0029-7844/20
© 2020 by the American College of Obstetriciansand Gynecologists. Published by Wolters Kluwer Health, Inc.
Unauthorized reproduction of this article is prohibited.
VOL. 136, NO. 6, DECEMBER 2020 OBSTETRICS & GYNECOLOGY 1135
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Original Research
Complications of Pelvic Organ ProlapseSurgery in the 2015 Finnish Pelvic OrganProlapse Surgery Survey Study
Olga Wihersaari, MD, Päivi Karjalainen, MD, Anna-Maija Tolppanen, PhD, Nina Mattsson, PhD,Jyrki Jalkanen, PhD, and Kari Nieminen, PhD
OBJECTIVE: To describe the major complicat ions of
pelvic organ prolapse (POP) surgery in Finland.
METHODS: The Finnish Pelvic Organ Prolapse Surgery
Survey 2015 study is a prospect ive cohort of POP
surgeries performed in Finland in 2015. Perioperat ive,
postoperat ive, and late complications during 1 year of
follow-up were compared among native tissue repair,
transvaginal mesh, and abdominal mesh surgery. Major
complications were assessed using the Clavien-Dindo
grading system. Predict ive factors for major complica-
tions were studied with logistic regression analysis.
RESULTS: Within 1 year after POP surgery, 396 (11.2%)
of 3,515 women had at least one complication: 10.9%
after native tissue, 11.7% after transvaginal mesh, and
13.5% after abdominal mesh repair. The majority of
complications occurred within 2 months after surgery
and postoperat ive infection (4.3%) and bleeding or
hematoma (2.6%) were the most frequent. The incidence
of organ injuries was low. Mesh-augmented surgery was
associated with significantly higher rates of bladder and
bowel injuries than native tissue surgery. Complication-
related reoperat ions occurred significantly more often
after abdominal mesh repair than native tissue surgery
(5.2% vs 1.8%, P5 .001). Mesh-related complications were
diagnosed more often after transvaginal mesh repair. The
overall rate of major complications (Clavien-Dindo
grades III–V) was 3.3%. Abdominal mesh surgery was
associated with the highest rate of major adverse events
(8.8% vs native tissue repair 2.6% and transvaginal mesh
4.9%). The incidence of Clavien-Dindo grade IV or V
complications was rare (less than 0.6%). Mesh surgery
(transvaginal mesh adjusted odds ratio [aOR] 2.23, 95%
CI 1.31–3.80, and abdominal mesh aOR 3.02, 95% CI
1.67–5.46), longer operat ing time (aOR 2.84, 95% CI
1.78–4.53), prior POP surgery (aOR 1.68, 95% CI 1.00–
2.81) and difficult surgery (aOR 2.75, 95% CI 1.63–4.62)
were associated with an increased risk for occurrence of
major complications.
CONCLUSION: Serious adverse events were rare
regardless of the operat ive approach. However, mesh-
augmented surgery was associated with higher risk for
major complications.
(Obstet Gynecol 2020;136:1135–44)
DOI: 10.1097/AOG.0000000000004159
Pelvic organ prolapse (POP) isa common and often
asymptomatic condition, affecting up to 50% of
parouswomen when based on examination.1 The esti-
mated lifetime risk for prolapse surgery in the general
female population is between 12% and 18%.2–4 A
variety of surgical procedures have been designed to
reduce POP symptoms. There is, however, no consen-
sus on the optimal approach, which is reflected by
high reoperation rates due to recurrent prolapse, espe-
cially after native tissue repair.1,5,6 Even though POP
surgery isconsidered to be a relatively safe procedure,
serious adverse events do occur and especially mor-
bidity related to mesh procedures has raised concerns
worldwide.7
From the Department of Obstetrics and Gynecology, Tampere University
Hospital, and the Faculty of Medicine and Health Technology, Tampere
University, Tampere, the Institute of Clinical Medicine and the School of
Pharmacy, University of Eastern Finland, Kuopio, theDepartment of Obstetrics
and Gynecology, Central Finland Central Hospital, Jyväskylä, theDepartment of
Obstetrics and Gynecology, Kanta-Häme Central Hospital, Hämeenlinna, and
the Central Finland Hospital District, Jyväskylä, Finland.
Financial support for this study wasprovided by Finnish Society for Gynecolog-
ical Surgery (a nonprofit organization) .
Each author has confirmed compliance with the journal ’s requirements for
authorship.
Corresponding author: Olga Wihersaari, MD, Department of Obstetrics and
Gynecology, Tampere University Hospital, Tampere, Finland; email:
olga.wihersaari@fimnet.fi.
Financial Disclosure
Theauthors did not report any potential conflicts of interest.
© 2020 by the American College of Obstetricians and Gynecologists. Published
by Wolters Kluwer Health, Inc. All rights reserved.
ISSN: 0029-7844/20
© 2020 by the American College of Obstetriciansand Gynecologists. Published by Wolters Kluwer Health, Inc.
Unauthorized reproduction of this article is prohibited.
VOL. 136, NO. 6, DECEMBER 2020 OBSTETRICS & GYNECOLOGY 1135
Komplikaatiota (1 vuoden seuranta):
NT: 10,9%
TVM: 11,7%
AM: 13,5% Yhteensä 11,2%
Vakaville komplikaatioille (3,3%) (Clavien Dindo III-IV) tekijät altistavat:
TVM: OR 2,23
AM: OR 3,02
Pitkä leikkausaika: OR 2,84
Aiempi laskeumaleikkaus: OR 1,68
Vaikea leikkaus: OR 2,75
Mitä tämä lysti on maksanut?
GKS vv. 2013-2021
N. 43t€
luvat, lomakkeet, postitukset, rekisterikyselyt
Nina Mattsson
Henkilökohtaisia apurahoja n. xx t€
Päivi Karjalainen
Henkilökohtaisia apurahoja (ml. VTR) n. xxt€
Olga Wihersaari
Henkilökohtaisia apurahoja (ml. VTR ) n. xxt€
Tutkimusryhmällä kuluapurahaa (SKR) xx t€
30
Tulevaisuus 5-v –seurantadatan analyysi
Laskeumakirurgian vaikutus seksuaaliterveyteen
Uusintaleikkauksiin joutuvat potilaat
Sairaala Nova31
Tutkimuksen”low points”
32
Opetus: muista varmuuskopiointi!
ESGE,Belek 2017
Sairaala Nova33
…and ups!
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