Fertility, gonadal and sexual function in survivors of testicular cancer

Modern treatments cure most testicular cancer patients, so an important goal is to minimise toxicity. Fertility and sexual functioning are key issues for patients. We have evaluated these outcomes in a cross-sectional study of long-term survivors of testicular cancer. In total, 680 patients treated between 1982 and 1992 completed the EORTC Qly-C-30(qc30) questionnaire, the associated testicular cancer specific module and a general health and fertility questionnaire. Patients have been subdivided according to treatment received: orchidectomy either alone (surveillance, S n=169), with chemotherapy (C, n=272), radiotherapy (R, n=158), or both chemotherapy and radiotherapy (C/RT n=81). In the surveillance group, 6% of patients had an elevated LH, 41% an elevated FSH and 11% a low (<10 nmol l−1) testosterone. Hormonal function deteriorated with additional treatment, but the effect in general was small. Low testosterone was more common in the C/RT group (37% P=0.006), FSH abnormalities were more common after chemotherapy (C 49%, C/RT 71% both P<0.005) and LH abnormalities after radiotherapy (11% P<0.01) and chemotherapy (10%, P<0.001). Baseline hormone data were available for 367 patients. After treatment, compared to baseline, patients receiving chemotherapy had significantly greater elevations of FSH (median rise of 6 (IQR 3–9.25) iu l−1 compared to 3 (IQR 1–5) iu l−1 for S; P<0.001) and a fall (compared to a rise in the surveillance group) in median testosterone levels (−2 (IQR −8.0 to −1.5) vs 1.0. (IQR −4.0–4.0) P<0.001). Patients with low testosterone (but not elevated FSH) had lower quality of life scores related to sexual functioning on the testicular cancer specific module and lower physical, social and role functioning on the EORTC Qly C-30. Patients with a low testosterone also had higher body mass index and blood pressure. Treatment was associated with reduction in sexual activity and patients receiving chemotherapy had more concerns about fathering children. In total, 207 (30%) patients reported attempting conception of whom 159 (77%) were successful and a further 10 patients were successful after infertility treatment with an overall success rate of 82%. There was a lower overall success rate after chemotherapy (C 71%; CRT 67% compared to S 85% (P=0.028)). Elevated FSH levels were associated with reduced fertility (normal FSH 91% vs elevated 68% P<0.001). In summary, gonadal dysfunction is common in patients with a history of testicular cancer even when managed by orchidectomy alone. Treatment with chemotherapy in particular can result in additional impairment. Gonadal dysfunction reduces quality of life and has an adverse effect on patient health. Most patients retain their fertility, but the risk of infertility is likely to be increased by chemotherapy. Screening for gonadal dysfunction should be considered in the follow-up of testicular cancer survivors

Perioperatiivisten sairaanhoitajien keräämät esitiedot potilaan hoitotyön suunnittelun perustana

Kirurgia ja perioperatiivinen hoitotyö ovat iso osa terveydenhuoltoa. Onnistuneen ja yksilöllisesti toteutetun leikkaushoidon takaamiseksi potilaasta tarvitaan esitietoja hoidon suunnittelua varten. Opinnäytetyömme tarkoituksena on kuvata, mitä tietoja perioperatiiviset sairaanhoitajat tarvitsevat ja keräävät potilaista, sekä miten näitä tietoja hyödynnetään leikkauksen aikaisen laadukkaan ja potilasturvallisen hoidon toteuttamisen suunnittelua varten. Työmme tavoitteena on tuottaa tietoa perioperatiivisen hoitotyön suunnittelun kehittämiseksi sairaanhoitajien näkökulmasta. Opinnäytetyömme toteutettiin yhteistyössä Helsingin ja Uudenmaan sairaanhoitopiirin (HUS) kanssa. Opinnäytetyömme toteutettiin laadullisin tutkimusmenetelmin ja aineistonkeruumenetelmänä käytettiin teemahaastattelua. Haastattelimme yhteensä kahdeksaa perioperatiivista sairaanhoitajaa ja toteutimme haastattelut yksilöhaastatteluina. Haastattelut nauhoitettiin, litteroitiin ja analysoitiin induktiivisella sisällönanalyysilla. Tulosten mukaan perioperatiiviset sairaanhoitajat tarvitsevat ja keräävät esitietoja potilaan terveydentilasta ja suunnitellusta toimenpiteestä perioperatiivista hoitotyötä varten. Potilaasta on tärkeää tietää ikä, pituus, paino, vitaalielintoiminnot, allergiat, perussairaudet, lääkitys, aiemmat toimenpiteet ja kehon vierasesineet. Oleellista on myös saada tieto suunnitellusta toimenpiteestä, tarvittavista välineistä ja leikkausasennosta. Tulosten mukaan osaston nopean työtahti ja suullisten raporttien niukkuus vaikeuttavat potilaan taustojen selvittämistä. Haastateltavien kokemusten mukaan toimenpideilmoitukset ovat usein puutteellisia, jolloin heidän on soitettava kirurgille saadakseen tarvittavat tiedot. Opinnäytetyömme tutkimuksen ja tulosten perusteella ehdotamme, että leikkaus- ja anestesiaosastoilla kiinnitetään tulevaisuudessa enemmän huomiota toimenpideilmoituksen täyttämiseen. Ehdotamme myös kiinnittämään huomiota raportointiin potilasturvallisuutta edistävänä tekijänä. Jatkotutkimusehdotuksemme on leikkaus- ja anestesiahoitajien näkemysten vertailu esitietojen keräämisestä perioperatiivisen hoitotyön suunnittelua varten. Olisi mielenkiintoista myös vertailla elektiivisen ja päivystyspotilaan perioperatiivisen hoidon suunnittelua ja toteutusta.Surgery and perioperative nursing care is a major part of health care. Ensuring tailored and succeeded surgery outcome the patient´s health status and medical history is needed. The purpose of the final project was to describe what information the perioperative nurses collect and require when planning nursing care and for providing quality care and patient safety during the procedure. Also, we described how the nurses utilize the information in intraoperative nursing care. The aim of the final project was to bring new information about perioperative nursing care planning from nurses’ point of view. The final project was carried out in cooperation with The Hospital District of Helsinki and Uusimaa (HUS). As for methods, we used qualitative research and unstructured interview as a data collection method. We interviewed individually eight perioperative nurses. The interviews were tape-recorded and transcripted. We analyzed the collected data using inductive content analysis. According to the results the perioperative nurses collect and requires information about the patient´s health status and the prospective operation when planning the nursing care. It´s essential to know the patient´s age, height, weight, vital signs, allergies, medication, medical history and presence of a foreign body. It´s also important to get the information about the operation plan, instruments needed and the surgical position. According to the results the rapid working speed and insufficient reports complicate the nursing care planning. Also, according to the nurses´ experiences they are usually not able to prepare the operating room nor the patient before consulting the surgeon for the information required. Based on the results of our final project, we propose the Operating and Anesthesia Units to pay attention on operative notes and documentation. We also propose to pay attention to the reporting for promoting the patient safety. As further research we suggest studies comparing the experiences of the perioperative nurses working in different roles, such as circulating nurse, instrumental nurse and anesthesia nurse. Also, we suggest studies comparing patient´s nursing care planning of elective surgery to emergency surgery

Magnetic and OpticalFluorescence Position Sensing for Planar Linear Motors

Planar linear motors, e.g. Sawyer motors, operate in an open-loop stepping manner. This mode of operation makes them i) susceptible to loss of steps, ii) unable to reject external disturbances, iii) unable to provide controlled forces, and iv) unable to provide high sti ness. These limitations, in turn, restrict their usefulness in a wide range of robotic applications. Suitable position sensing and control technology, when added to such motors, can to a large degree eliminate these problems. In this paper we present two new sensor technologies for planar motor systems: one uses an ac magnetic technique, the other uses an optical uorescence technique. The magnetic sensor has achieved 1 mposition resolution and is compact and easy to fabricate. The optical uorescence sensor has the advantage of complete insensitivity to nearby motor elds. Either technology has the potential to greatly improve future robotic systems that are based on planar linear motors.