Teollisten mineraalikuitujen esiintyminen sisäilmassa P1-puhtaustason mukaisessa rakentamisessa

P1-puhtaustaso on ainut rakentamisessa käytössä oleva puhtaustaso. Puhtaustason pääperiaatteet ja ohjeet rakennushankkeen toteuttamiseksi puhtaustason mukaisesti, on esitetty Sisäilmastoluokitus 2018-julkaisussa. Puhtaustason vaatimusten mukaisesti rakennuksen ilmanvaihtojärjestelmän ja loppusiivouksen onnistuminen todennetaan ennen toimintakokeita ja vastaanottoa sekä visuaalisesti, että tarvittaessa myös mittauksin. Työssä tutkittiin P1-puhtaustason toteutumista eri hankkeissa. Tutkimuksen tarkoituksena oli selvittää, onko P1-puhtaustason mukainen pölynpeittomittaus riittävä tapa varmistamaan, että kohteissa ei esiinny teollisia mineraalikuituja loppusiivousten jälkeen. Tutkimukseen valittiin mukaan viisi eri kohdetta. Kaksi kohdetta oli uudisrakennuksia, ja kolme oli perusparannuskohteita. Kohteissa mitattiin pölynpeittoprosentteja eri pinnoilta, ja verrattiin tuloksia P1-puhtaustason mukaisiin pölynpeittoprosentin raja-arvoihin. Mittausten jälkeen pinnoilla olevien kuitujen määrä laskettiin laboratoriotutkimuksissa. Kuitulaskennan tuloksia verrattiin Asumisterveysasetuksen toimenpiderajana käytettävään raja-arvoon. Tutkimustulosten perusteella voitiin todeta, että teolliset mineraalikuidut eivät vaikuta pölynpeittoprosentin mittaustuloksiin niitä heikentävästi. Vaikka kohde olisi toteutettu P1-puhtaustasolle asetettujen vaatimusten mukaisesti, ja tulokset alittaisivat puhtaustason määrittämät raja-arvot, voi rakennuksen pinnoilla silti esiintyä merkittäviä määriä teollisia mineraalikuituja. Tutkimuksen tuloksia hyödynnetään tulevien rakennushankkeiden suunnittelussa ja toteutuksessa. Tutkimusten yhteydessä tehtyjen havaintojen ja tulosten perusteella voidaan tarkentaa tulevien hankkeiden suunnitteluprosessia ja rakentamisen aikaista pölynhallintaa siten, että kuitujen määrää voidaan vähentää

DentView-palvelujärjestelmän datan hyödyntäminen suuhygienistin työssä : näkemyksiä DentViewPro-raportointityökalun käytöstä, hyödyntämismahdollisuuksista ja kehittämistarpeista

Digitalisaation ja teknologian kehitys uudistaa terveydenhoitojärjestelmää ja tuo uusia digitaalisia ratkaisuja myös ennaltaehkäisevään suun terveydenhoitoon. Digitaaliset ratkaisut voivat tehostaa ennaltaehkäisevää hoitoa, ja niiden tuottamaa terveysdataa voidaan hyödyntää esimerkiksi potilaan kliinisen hoidon tukena. Tässä opinnäytetyössä käsitellään suomalaista digitaalista ehkäisevän hammashoidon tuotekokonaisuutta, DentView-palvelujärjestelmää, jota on tutkittu vielä toistaiseksi hyvin vähän. Opinnäytetyö toteutettiin laadullisena kehittämistyönä. Tarkoituksena oli kuvailla DentView-palvelujärjestelmään kuuluvan uuden DentViewPro-omahoitoraportointityökalun käyttäjäkokemuksia sekä arvioida hyödyntämismahdollisuuksia ja kehittämistarpeita suuhygienistin työssä. Tavoitteena oli tuottaa tietoa omahoitoraportointityökalun käyttökokemuksista ja tavoista hyödyntää ominaisuuden tuottamaa dataa suuhygienistin työssä. Aineistonkeruumenetelmänä käytettiin puolistrukturoitua teemahaastattelua. Yksilöhaastatteluihin osallistui kuusi (n=6) DentViewPro-ominaisuutta työssään käyttävää suuhygienistiä. Aineisto analysoitiin laadullisen tutkimuksen sisällönanalyysillä. Tulosten mukaan DentViewPro-ominaisuus toimi suuhygienistin työn tukena erityisesti potilaiden omahoidon ohjauksessa. Suuhygienistien tapa ohjata potilaat DentView-virtuaalikioskille vaihteli, mikä vaikuttaa merkittävästi DentViewPro:n hyödynnettävyyteen. Hyöty jää vähäisemmäksi, jos ohjaus laitteelle tapahtuu vastaanoton jälkeen. Muita DentView-palvelujärjestelmän hyödyntämisen haasteita olivat muun muassa suuhygienistin kiireinen aikataulu, ominaisuuden sovittaminen osaksi työskentelytapoja ja potilaslähtöiset tekijät. Tutkimuksessa kartoitettiin myös DentView:n kehittämistarpeita ja tapaa saada DentView-palvelujärjestelmän käyttö osaksi potilaiden hoitoprosessia. Kehittämistyöpajassa DentView:n edustajille esitettiin haastateltavien esiin tuomat kehittämisehdotukset sekä opinnäytetyöntekijöiden aineiston pohjalta nousseet kehittämisehdotukset. Kehitysehdotukset liittyivät muun muassa DentView-palvelujärjestelmän kehittämiseen ja päivittämiseen, DentViewPro-raportin integroimiseen potilastietojärjestelmän yhteyteen ja raporttien toiminnallisuuksiin

Nursing students’ experiences of nurse teacher mentoring and beneficial digital technologies in a clinical practice setting

AbstractDue to educational reforms in Finland, the nurse teacher’s role is being reduced in mentoring of nursing students in the clinical practice. Students reported experiencing a lack of instruction and feeling abandoned in the clinical practice. The aim of this study was to describe nursing student experiences of mentoring by nurse teachers in clinical practice, as well as the benefits of digital technology in this context. Qualitative study design was used with semi-structured focus group interviews. Nursing students (n = 15) who had completed at least one clinical placement during their nursing education. Data were collected in autumn 2017 from two universities of applied sciences in northern Finland. The data were analyzed using inductive content analysis. Mentoring by nurse teacher was perceived as a key part of learning evaluation, integrating theoretical and practical knowledge, understanding the student’s role and emotional support. The results also revealed that mentoring can be improved by using digital technology. However, technology cannot completely replace face-to-face mentoring. The mentoring provided by nurse teachers plays an important role in the success of a nursing student’s clinical practice. Digital technology can be leveraged to enhance the learning experience when easy-to-use and ubiquitous applications are integrated into the clinical learning setting.Abstract Due to educational reforms in Finland, the nurse teacher’s role is being reduced in mentoring of nursing students in the clinical practice. Students reported experiencing a lack of instruction and feeling abandoned in the clinical practice. The aim of this study was to describe nursing student experiences of mentoring by nurse teachers in clinical practice, as well as the benefits of digital technology in this context. Qualitative study design was used with semi-structured focus group interviews. Nursing students (n = 15) who had completed at least one clinical placement during their nursing education. Data were collected in autumn 2017 from two universities of applied sciences in northern Finland. The data were analyzed using inductive content analysis. Mentoring by nurse teacher was perceived as a key part of learning evaluation, integrating theoretical and practical knowledge, understanding the student’s role and emotional support. The results also revealed that mentoring can be improved by using digital technology. However, technology cannot completely replace face-to-face mentoring. The mentoring provided by nurse teachers plays an important role in the success of a nursing student’s clinical practice. Digital technology can be leveraged to enhance the learning experience when easy-to-use and ubiquitous applications are integrated into the clinical learning setting

Serum angiopoietin-2 and soluble VEGFR-2 levels predict malignancy of ovarian neoplasm and poor prognosis in epithelial ovarian cancer

BACKGROUND: The aim of the study was to explore the serum levels of eight angiogenesis biomarkers in patients with benign, borderline or malignant epithelial ovarian neoplasms and to compare them to those of healthy controls. In addition, we aimed to study how those biomarkers predict the clinical course and survival of patients with epithelial ovarian cancer. METHODS: We enrolled 132 patients with ovarian neoplasms and 32 unaffected women in this study. Serum samples were collected preoperatively at the time of diagnosis and the levels of angiogenesis biomarkers were measured with an ELISA. RESULTS: Levels of Ang-1, Ang-2, VEGF, VEGF-D, VEGF/sVEGFR-2 and Ang-2/ sVEGFR-2 ratios were elevated whereas sVEGFR-2 was lower in patients with ovarian carcinoma than in women with normal ovaries, benign and/or borderline ovarian neoplasms. In ROC analysis, the area under the curve for serum Ang-2/sVEGFR-2 ratio (0.76) was greater than Ang-2 (0.75) and VEGF (0.65) but lower than for CA 125 (0.90) to differentiate ovarian cancer from benign or borderline ovarian tumors. In ovarian cancer high Ang-2/sVEGFR-2 ratio was associated with the presence of ascites, high stage and grade of ovarian cancer, with the size of primary residual tumor >1 cm and with recurrence of disease. Elevated Ang-2, VEGF, VEGF/sVEGFR-2, Ang-2/VEGF and Ang-2/sVEGFR-2 ratios and low level of sVEGFR-2 were significant predictors of poor overall survival (OS) and recurrence free survival (RFS) in univariate survival analyses. CONCLUSIONS: Ovarian cancer patients had elevated levels of angiogenesis related growth factors in circulation reflecting increased angiogenesis and poor prognosis. The serum level of Ang-2 predicted most accurately poor OS and Ang-2/sVEGFR-2 ratio malignancy of ovarian neoplasms and short RFS. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/1471-2407-14-696) contains supplementary material, which is available to authorized users

HETU projekti 2001-2003

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Thrombocytopenia and platelet transfusions in ICU patients: an international inception cohort study (PLOT-ICU)

Purpose Thrombocytopenia (platelet count < 150 × 109/L) is common in intensive care unit (ICU) patients and is likely associated with worse outcomes. In this study we present international contemporary data on thrombocytopenia in ICU patients. Methods We conducted a prospective cohort study in adult ICU patients in 52 ICUs across 10 countries. We assessed frequencies of thrombocytopenia, use of platelet transfusions and clinical outcomes including mortality. We evaluated pre-selected potential risk factors for the development of thrombocytopenia during ICU stay and associations between thrombocytopenia at ICU admission and 90-day mortality using pre-specified logistic regression analyses. Results We analysed 1166 ICU patients; the median age was 63 years and 39.5% were female. Overall, 43.2% (95% confidence interval (CI) 40.4–46.1) had thrombocytopenia; 23.4% (20–26) had thrombocytopenia at ICU admission, and 19.8% (17.6–22.2) developed thrombocytopenia during their ICU stay. Non-AIDS-, non-cancer-related immune deficiency, liver failure, male sex, septic shock, and bleeding at ICU admission were associated with the development of thrombocytopenia during ICU stay. Among patients with thrombocytopenia, 22.6% received platelet transfusion(s), and 64.3% of in-ICU transfusions were prophylactic. Patients with thrombocytopenia had higher occurrences of bleeding and death, fewer days alive without the use of life-support, and fewer days alive and out of hospital. Thrombocytopenia at ICU admission was associated with 90-day mortality (adjusted odds ratio 1.7; 95% CI 1.19–2.42). Conclusion Thrombocytopenia occurred in 43% of critically ill patients and was associated with worse outcomes including increased mortality. Platelet transfusions were given to 23% of patients with thrombocytopenia and most were prophylactic.publishedVersio

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570