Asiakaslähtöisen munasolunsaajien hoitoprosessin kehittäminen lapsettomuusklinikalla

Tämä opinnäytetyö oli työelämä lähtöinen kehittämistyö, joka toteutettiin Väestöliiton lapsettomuus klinikoiden Helsingin yksikössä. Tämän kehittämistyön tarkoituksena oli tuottaa uusi asiakaslähtöinen munansolunsaajien hoitoprosessi ja sen myötä parantaa asiakkaiden tyytyväisyyttä saamaansa hoitoon. Kehittämishankkeen tavoitteena oli kartoittaa haastattelemalla munasolunluovutushoidon läpi käyneiden asiakkaiden näkemyksiä nykyisestä hoitoprosessista ja sen asiakaslähtöisyydestä. Tavoitteena oli myös huomioida klinikan kokeneen henkilökunnan ajatuksia hoitoprosessin parantamiseksi. Uuden hoitoprosessin luominen aloitettiin määrittelemällä nykyinen munasolunsaajien hoitoprosessi. Tämän jälkeen kartoitettiin munasolunluovutushoidon läpi käyneiden asiakkaiden näkemyksiä nykyisestä hoitoprosessista, sen asiakaslähtöisyydestä ja heidän ehdotuksia hoitoprosessin parantamiseksi. Analysoitujen haastattelu aineistojen avulla tehtiin hahmotelma uudesta hoitoprosessista. Hahmotelma hoitoprosessista ja haastatteluiden tulokset esiteltiin klinikan henkilökunnalle, joka ideoi näiden pohjalta kehittämiskohteita uuteen hoitoprosessiin. Edellisten vaiheiden jälkeen kehitettiin lopullinen versio uudesta hoitoprosessista. Munasolunluovutushoito on otettu käyttöön Väestöliiton klinikoilla vuonna 1991 ja se on nykyisin yksi standardi lapsettomuudenhoito menetelmä. Munasolunluovutushoito on saajille iso panostus henkisesti ja taloudellisesti. Hoitoprosessin kehittämisellä pyritään siihen, että hoitoprosessin toimimattomuuden takia he eivät joutuisi uusien pettymysten eteen. Terveydenhuollossa on ymmärretty viime vuosina asiakaslähtöisyyden tärkeys niin Suomessa, kuin maailmallakin. Opinnäytetyön lähestymistapana oli toimintatutkimus. Aineistonkeruu menetelmänä oli munasolunluovutushoidossa olleiden asiakkaiden teemahaastattelu. Tämän lisäksi henkilökunnan ehdotuksia hoitoprosessin kehittämiseksi kartoitettiin aivoriihi ideoinnin avulla. Teemahaastatteluun osallistui kahdeksan asiakasta ja haastatteluaineisto analysoitiin induktiivisella sisällön analyysilla. Aivoriihi ideoinnin tuloksena syntyneet ideat pisteytettiin, ryhmiteltiin ja yhdisteltiin samaa tarkoittaviin ideoihin. Tämän jälkeen aineistosta muodostettiin uusi hoitoprosessi. Haastatteluaineiston tulosten mukaan asiakaslähtöisyys on empaattista vuorovaikutusta ja asiakkaan kokonaisuuden huomioimista. Asiakkaat kokivat nykyisen hoitoprosessin sujuvana, mutta toisaalta kokivat siihen sisältyvän hallitsemattomuutta. Hyvänä nykyisessä hoitoprosessissa he kokivat tulosten mukaan olevan empaattisen ja yksilöllisen kohtaamisen ja hoitoprosessin yksilöllisyyden. Monipuolisiin palveluihin, hoitoprosessin yksilölliseen suunnitteluun ja psyykkiseen taakkaan tulisi tulosten mukaan kiinnittää huomiota uutta hoitoprosessia laadittaessa. Suomessa ei ole tehty tutkimuksia asiakaslähtöisyydestä lapsettomuushoitoihin liittyen. Ulkomaisista tutkimuksista on saatu samansuuntaisia tuloksia asiakaslähtöisyydestä lapsettomuushoitoihin liittyen kuin tässä opinnäytetyössä. Se osoittaa samojen asioiden olevan tärkeitä lapsettomuuspotilaille maan rajoista huolimatta. Jatkossa Väestöliiton klinikoilla tulisi tehdä seurantaa, siitä miten uuden hoitoprosessin käyttöönotto on mennyt.This thesis is the result of a workplace based development project implemented at the Väestöliitto fertility clinic in Helsinki. The goal of the project was to develop a new patient centred ovum donation process which would increase patients’ satisfaction with their care. The aim of the project was to survey thoughts of patients who had gone through the ovum donation process with regard to the current treatment process and its patient centeredness. The expertise of the more experienced employees of the clinic was to be taken into consideration throughout the development project. The development of the new process began by defining the current care process for ovum donation recipients. Following this, the ovum donation recipients were interviewed for their thoughts of the current care process and its patient centeredness. The patients were asked for suggestions for the improvement of the care process. Following an analysis of the intelligence gathered from the interviews, an outline for a new patient care process was drafted. The analysis of the intelligence and the new patient care process were presented to the clinic employees at a staff event. The goal of the event was to encourage the employees to brainstorm ideas for improving patient centeredness and thus enabling them to take part in developing the improved patient care process. Following the event, with the new ideas gathered, the final care process was developed. The ovum donation treatments started in 1991 at Väestöliitto fertility clinic and it is today one of the standard treatment methods for infertility. The treatment method requires a significant financial and psychological input from the recipients. The patients treated by this method have usually suffered from infertility for several years already, and have experienced many disappointments whilst going through previous infertility treatments. The aim of developing the new, improved patient care process, is that a poor design of the care process would not add to the disappointments that the patient may experience. The value of patient centeredness has been realised in Finland and all over the world in the recent years. The approach for this thesis was an action research method. The data was collected by interviewing patients and by executing a brainstorming event with the personnel. Eight patients who had undergone ovum donation were interviewed by an individual theme interview method. The data was analysed by inductive content analysis. The new ideas collected during the brainstorming ses-sion were categorised into groups based on their similarities and differences. By using a points system, the ideas and categories were analysed and the most significant ideas were utilized in the design of the new care process. The results of the patient interviews show that patient centeredness is empathic interaction and entire consideration of the patient. The patients felt that the current care process was fluent, but uncontrollable. Positive things in the current treatment process were empathic and individual encounter with the caregivers and the individuality of the treatment process. According to analysed data, a diverse range of treatment methods, individual planning of the treatment process, and the psychological burden of the treatments are things which should be taken carefully into account when planning new treatment processes. Previous studies show similar results about patient centerednes

Analytical and diagnostic validation of a flow cytometric strategy to quantify blood and marrow infiltration in dogs with large b-cell lymphoma

Background Lymph node (LN), peripheral blood (PB) and bone marrow (BM) samples are commonly analyzed by flow cytometry (FC) for the immunophenotyping and staging of canine lymphomas. A prognostic value for flow cytometric BM infiltration in dogs with large B-cell lymphoma (LBCL) was demonstrated. Aim of the present study was to define the analytical performances of this technique, and to establish a cutoff suitable to safely discriminate between infiltrated and non-infiltrated PB and BM samples. Methods Large B-cells were added to control PB and BM samples, to achieve twelve different large B-cells concentrations, ranging from 0% to 50%. The percentage of large B-cells was recorded for each dilution, using a BD Accuri C6 flow cytometer. Accuracy was evaluated by Passing-Bablok regression analysis. Intra-assay precision was assessed at 0%, 1%, 3% and 10% dilutions evaluating the CVs of ten repeated acquisitions. ROC curves were drawn to identify the cutoffs most suitable to discriminate between 25 infiltrated (PARR-positive) and 25 non-infiltrated (PARR-negative) PB and BM samples, respectively. Results Optimal analytical accuracy and precision were achieved. Almost all CVs were <10%. Negative controls had up to 0.5% large B-cells, with 50% and 22% CV in PB and BM samples, respectively. 0.56% and 2.45% cutoffs were selected based on the ROC curves for PB and BM samples, respectively. Conclusions Quantification of large B-cells in PB and BM samples by FC is reliable and analytical performances met the acceptance criteria. Assessment of performances of different instruments and protocols is warranted. This article is protected by copyright. All rights reserved

Evaluation of tyrosine-kinase receptor c-kit mutations, mRNA and protein expression in canine lymphoma: Might c-kit represent a therapeutic target?

c-kit plays an important role in proliferation, survival and differentiation of hematopoietic progenitor cells. In human hematopoietic malignancies, c-kit is mostly expressed by progenitor cell neoplasms and seldom by mature cell neoplasms. Aim of this study was to evaluate c-kit expression in canine lymphoma. Twenty-five B-cell lymphomas and 21 T-cell lymphomas were enrolled in the study. c-kit mRNA and protein expression was measured in lymph node fine needle aspirates by quantitative real-time RT-PCR, flow cytometry and immunocytochemistry, while the occurrence of KIT mutations on exons 8\u201311 and 17 was investigated by direct cDNA sequencing. KIT mRNA was amplifiable but below the limit of quantification in 76% of B-cell lymphomas and 33% of T-cell lymphomas. Remaining samples showed a very low expression of KIT, except for some high grade (HG) T-cell lymphomas where a comparatively higher mRNA amount was observed. Transcriptional data were confirmed at the protein level. No gain-of-function mutations were observed. Among canine lymphomas, T-cell lymphoma typically shows an aggressive biological behavior, partly being attributable to the lack of efficacious treatment options, and the evidence of c-kit expression in HG T-cell lymphomas might represent the rationale for its routinely diagnostic evaluation and the use of tyrosine kinase inhibitors in future clinical trials

Array-based comparative genomic hybridization analysis reveals chromosomal copy number aberrations associated with clinical outcome in canine diffuse large B-cell lymphoma.

Canine Diffuse Large B-cell Lymphoma (cDLBCL) is an aggressive cancer with variable clinical response. Despite recent attempts by gene expression profiling to identify the dog as a potential animal model for human DLBCL, this tumor remains biologically heterogeneous with no prognostic biomarkers to predict prognosis. The aim of this work was to identify copy number aberrations (CNAs) by high-resolution array comparative genomic hybridization (aCGH) in 12 dogs with newly diagnosed DLBCL. In a subset of these dogs, the genetic profiles at the end of therapy and at relapse were also assessed. In primary DLBCLs, 90 different genomic imbalances were counted, consisting of 46 gains and 44 losses. Two gains in chr13 were significantly correlated with clinical stage. In addition, specific regions of gains and losses were significantly associated to duration of remission. In primary DLBCLs, individual variability was found, however 14 recurrent CNAs (>30%) were identified. Losses involving IGK, IGL and IGH were always found, and gains along the length of chr13 and chr31 were often observed (>41%). In these segments, MYC, LDHB, HSF1, KIT and PDGFRα are annotated. At the end of therapy, dogs in remission showed four new CNAs, whereas three new CNAs were observed in dogs at relapse compared with the previous profiles. One ex novo CNA, involving TCR, was present in dogs in remission after therapy, possibly induced by the autologous vaccine. Overall, aCGH identified small CNAs associated with outcome, which, along with future expression studies, may reveal target genes relevant to cDLBCL

Molecole di adesione e metalloproteasi: indagine sul ruolo di CD44 e MMP-9 nelle neoplasie ematopoietiche canine

Il recettore per l\u2019acido ialuronico CD44 media l\u2019interazione tra cellule e matrice extracellulare (ECM) e sia la forma standard (CD44s) sia le sue varianti sono coinvolte nella crescita e diffusione neoplastica, interagendo con fattori angiogenici e metalloproteasi, favorendo la capacit\ue0 metastatizzante delle cellule neoplastiche. Scopo del lavoro \ue8 stato valutare l\u2019espressione di CD44s e MMP-9 in cani con neoplasie linfoidi. Sono stati analizzati 61 campioni di sangue: 15 cani controllo, 7 leucemie acute (ALL/AUL), 8 leucemie linfocitiche croniche (CLL), 31 linfomi (20 B di cui 8 stadio V; 11 T di cui 4 stadio V). In 17 linfomi B e 10 T sono stati analizzati aspirati linfonodali. I valori di intensit\ue0 media di fluorescenza (MFI) di CD44 sono stati misurati con citometria a flusso e rapportati all\u2019MFI di CD45. L\u2019espressione di MMP-9 \ue8 stata valutata a livello proteico e genico in 12 casi di leucemie (ALL/AUL e CLL) e 15 linfomi con immunocitochimica e Real Time RT-PCR. Il CD44 MFI nei linfociti era maggiore in tutti i casi patologici rispetto ai controlli, in particolare nelle ALL/AUL, linfomi V stadio e CLL (P<0.01), con una particolare over-espressione nelle ALL/AUL rispetto alle altre forme leucemiche (P=0.001) e diminuzioni significative di CD45 solo nelle ALL/AUL e nei linfomi B V. Nei linfomi V stadio, il CD44 nei linfociti circolanti era maggiore rispetto ai linfomi non leucemici (p=0.018). In tutte le forme leucemiche, i valori mediani del CD44/CD45 ratio erano maggiore di 1. Rispetto ai linfomi, le leucemie hanno evidenziato un CD44 MFI, un\u2019intensit\ue0 di positivit\ue0 ed un\u2019espressione di MMP-9 significativamente maggiori (P=0.01, P=0.03, P<0.001). Questi dati sembrano indicare come CD44s e MMP-9 siano coinvolti nello sviluppo e progressione delle forme leucemiche