Käytösoireisen muistisairaan lääkkeettömät hoitotyön keinot : Opas sairaanhoitajille

Aiheena opinnäytetyölle oli Käytösoireisen muistisairaan lääkkeettömät hoitotyön keinot – opas sairaanhoitajille. Opinnäytetyön tavoitteena oli tuottaa tietoa muistisairaan käytöshäiriöiden syistä ja lisäksi lisätä ymmärrystä sairaanhoitajille muistisairaan haasteellisen käytöksen lisääntymisestä. Opinnäytetyön tarkoituksena oli tuottaa yhteistyökumppanille opas, joka sisältää yleisimmät muistisairaudet ja niihin liittyvien käytöshäiriöiden ilmenemismuodot aiheuttajineen ja vaikuttavine tekijöineen. Tämän lisäksi opas sisältää hoitotyön keinoja, joiden avulla sairaanhoitaja pystyy havainnoimaan ja lieventämään muistisairaan käytösoireita. Opinnäytetyö on tehty yhteistyössä Suupohjan peruspalveluliikelaitoskuntayhtymän hoidon ja hoivan alueen kanssa. Etenevien muistisairauksien diagnostiikkaan kuuluu käytösoireiden lisääntyminen. Käytösoireita on muistisairauksien kaikissa vaiheissa ja niiden ilmaantuminen voi johtaa liialliseen ja turhaan rauhoittavien lääkkeiden määräämiseen ja käyttöön, on kuitenkin hyvä huomioida kokonaisvaltainen hoito, joka on potilaan yksilöllisen tilanteen huomioon ottava. Muistisairaiden määrä kasvaa nopeasti, varhaisen diagnosoinnin avulla pystytään ylläpitämään sairastuneen toimintakykyä ja huomioimaan sairastuneen oman elämänlaadun pysyminen hyvänä, unohtamatta hänen läheisiään. Käytösoireisen potilaan hoitolinja tulisi valita arvioimalla oireita ja selvittämällä niiden syy. Lääkkeettömän hoidon tarkoitus on, että muistisairaasta huolehditaan kokonaisvaltaisesti ja mahdollisimman hyvin hänen tarpeensa huomioon ottaen. Sairastuneen toimintakyvyn tukeminen on tärkeää, silloin hän tuntee olonsa turvatuksi ja arvostetuksi. Hyvien elämäntapojen huomioiminen, riittävän unen ja aktiviteetin turvaaminen tukevat sairastuneen tasapainon tunnetta. Käytöshäiriöiden syntyyn vaikuttaa myös ympäristössä tapahtuvat muutokset. Sairaanhoitajan on tärkeä luoda sairastuneelle tässä tilanteessa rauhallinen ja turvattu ympäristö.The subject for the thesis is non-drug nursing methods of a patient with memory disease and behavioural disorder. The aim of the thesis was to provide information on the causes of behavioural disorders of a patient with memory disease, and in addition, to increase nurses’ understanding about the negative behaviour of memory patients. The purpose of the thesis was to produce a guide containing the most common memory disorders and related manifestations of behavioural disorders, with their causes and contributing factors. In addition, the guide includes nursing tools that help the nurse to observe and mitigate the behavioural disorders of a patient with a memory disease. The thesis has been carried out in cooperation with the treatment and care area of The Suupohja Area Health and Social Services Joint Municipal Board. The diagnostics for progressive memory diseases include an increase in behavioural disorders. There are behavioural disorders at all stages of memory disorders, and their appearance may lead to the prescription and use of excessive and unnecessary medication. However, it is good to take into account the holistic treatment that is appropriate to the patient's individual condition. The number of patients with memory disease is increasing rapidly. With early diagnosis, it is pos-sible to maintain patients’ functional ability and take account of their quality of life, not forgetting their close relatives. The treatment line for the patient with behavioural disorder should be selected by evaluating the symptoms and finding out their cause. The purpose of non-drug nursing is that the patient with memory disorder is taken care of comprehensively, and his or her needs are taken into account as well as possible. Supporting the functional ability of the patient is important, and he or she feels secure and appreciated. Paying attention to a good lifestyle, ensuring adequate sleep and activity support the balance feeling of the patient. Changes in the environment also affect the appearance of behavioural disorders. It is important for the nurse to create a calm and secure environment for the patient in this situation

Analysis of distinct tartrate-resistant acid phosphatase promoter regions in transgenic mice

The tartrate-resistant acid phosphatase (TRAP) is present in multiple tissues, including kidney, liver, lung, spleen, and bone. Recent study of (TRAP) gene expression has provided evidence for distinct promoters within the (TRAP) gene, suggesting that the gene has alternative, tissue-preferred mRNA transcripts. Examination of endogenous (TRAP) exon 1B and 1C mRNA transcripts revealed tissue-preferred transcript abundance with increased exon 1B transcripts detected in liver and kidney and increased exon 1C transcripts detected in bone and spleen. In this investigation, we have made transgenic mice that express a marker gene driven by two candidate promoters, designated BC and C, within the (TRAP) gene. The BC and C promoters are 2.2 and 1.6 kb, respectively, measured from the translation initiation site. Evaluation of BC transgenic lines demonstrated robust expression in multiple tissues. In contrast, significant transgene expression was not detected in C transgenic lines. Evaluation of transgene mRNAs in BC transgenic lines revealed that virtually all expression was in the form of B transcripts, suggesting that the tissue-preferred pattern of endogenous (TRAP) was not replicated in the BC transgenic line. Likewise, osteoclastogenic cultures from BC, but not C, transgenic bone marrow cells expressed the transgene following receptor activator of NFkappaB ligand/macrophage colony-stimulating factor stimulation. In conclusion, when compared with the 2.2-kb BC portion of the (TRAP) promoter region, the 1.6-kb C portion does not account for significant gene expression in vivo or in vitro; production of the bone- and spleen-preferred (TRAP) C transcript must depend on regulatory elements outside of the 2.2-kb promoter. As the majority of currently investigated transcription factors that influence transcriptional regulation of osteoclast gene expression bind within the 1.6-kb C portion of the (TRAP) promoter, it is likely that transcription binding sites outside of the 2.2-kb region will have profound effects on regulation of the gene in vivo and in vitro

Effect of anorganic bovine bone to autogenous cortical bone ratio upon bone remodeling patterns following maxillary sinus augmentation

Introduction: Maxillary sinus augmentation is a predictable implant site development technique, although several local and systemic factors may influence outcomes. The aim of this study was to evaluate healing patterns and bone remodeling activity following the use of two different graft mixtures for maxillary sinus augmentation. Materials and methods: Patients in need of maxillary sinus augmentation were randomly assigned to two different groups. A graft mixture using a 50% autologous bone (AB) to 50% anorganic bovine bone (ABB) ratio was used in group 1, while a 20% AB to 80% ABB ratio was utilized for group 2. After a 6‐month healing period, bone core biopsies were harvested for histological, histomorphometrical, and immunohistochemical analyses. Results: Twenty‐eight subjects participated in this study. No statistically significant differences were found between groups in regards to vital bone and non‐mineralized tissue proportions. Higher number of osteoid lines (18.05 ± 10.06 in group 1 vs. 9.01 ± 7.53 in group 2; P =0.023) and higher cellularity, particularly regarding the number of osteocytes (631.85 ± 607.98 in group 1 vs. 219.08 ± 103.26 in group 2; P =0.002), were observed in specimens from group 1. Differences in expression patterns of osteopontin and tartrate‐resistant acid phosphatase were also detected between groups. Conclusion: AB to ABB ratio appears to influence bone remodeling patterns and cell content following maxillary sinus augmentation procedures. Similar proportion of vital bone was found in specimens obtained from both groups. More cellular presence was observed in samples containing higher proportions of AB. To cite this article: Galindo‐Moreno P, Moreno‐Riestra I, Avila G, Padial‐Molina M, Paya JA, Wang H‐L, O'Valle F. Effect of anorganic bovine bone to autogenous cortical bone ratio upon bone remodeling patterns following maxillary sinus augmentation. Clin. Oral Impl. Res . 22 , 2011; 857–864. doi: 10.1111/j.1600‐0501.2010.02073.xPeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/86802/1/j.1600-0501.2010.02073.x.pd

Kindlin-3–mediated signaling from multiple integrin classes is required for osteoclast-mediated bone resorption

Loss of kindlin-3 impairs activation of β1, β2, and β3 integrin classes, resulting in osteopetrotic defects in osteoclast adhesion and spreading

R-Ras Regulates Migration through an Interaction with Filamin A in Melanoma Cells

Changes in cell adhesion and migration in the tumor microenvironment are key in the initiation and progression of metastasis. R-Ras is one of several small GTPases that regulate cell adhesion and migration on the extracellular matrix, however the mechanism has not been completely elucidated. Using a yeast two-hybrid approach we sought to identify novel R-Ras binding proteins that might mediate its effects on integrins.We identified Filamin A (FLNa) as a candidate interacting protein. FLNa is an actin-binding scaffold protein that also binds to integrin β1, β2 and β7 tails and is associated with diverse cell processes including cell migration. Indeed, M2 melanoma cells require FLNa for motility. We further show that R-Ras and FLNa interact in co-immunoprecipitations and pull-down assays. Deletion of FLNa repeat 3 (FLNaΔ3) abrogated this interaction. In M2 melanoma cells active R-Ras co-localized with FLNa but did not co-localize with FLNa lacking repeat 3. Thus, activated R-Ras binds repeat 3 of FLNa. The functional consequence of this interaction was that active R-Ras and FLNa coordinately increased cell migration. In contrast, co-expression of R-Ras and FLNaΔ3 had a significantly reduced effect on migration. While there was enhancement of integrin activation and fibronectin matrix assembly, cell adhesion was not altered. Finally, siRNA knockdown of endogenous R-Ras impaired FLNa-dependent fibronectin matrix assembly.These data support a model in which R-Ras functionally associates with FLNa and thereby regulates integrin-dependent migration. Thus in melanoma cells R-Ras and FLNa may cooperatively promote metastasis by enhancing cell migration

Monomeric Tartrate Resistant Acid Phosphatase Induces Insulin Sensitive Obesity

Obesity is associated with macrophage infiltration of adipose tissue, which may link adipose inflammation to insulin resistance. However, the impact of inflammatory cells in the pathophysiology of obesity remains unclear

Spontaneous Breathing in Early Acute Respiratory Distress Syndrome: Insights From the Large Observational Study to UNderstand the Global Impact of Severe Acute Respiratory FailurE Study

OBJECTIVES: To describe the characteristics and outcomes of patients with acute respiratory distress syndrome with or without spontaneous breathing and to investigate whether the effects of spontaneous breathing on outcome depend on acute respiratory distress syndrome severity. DESIGN: Planned secondary analysis of a prospective, observational, multicentre cohort study. SETTING: International sample of 459 ICUs from 50 countries. PATIENTS: Patients with acute respiratory distress syndrome and at least 2 days of invasive mechanical ventilation and available data for the mode of mechanical ventilation and respiratory rate for the 2 first days. INTERVENTIONS: Analysis of patients with and without spontaneous breathing, defined by the mode of mechanical ventilation and by actual respiratory rate compared with set respiratory rate during the first 48 hours of mechanical ventilation. MEASUREMENTS AND MAIN RESULTS: Spontaneous breathing was present in 67% of patients with mild acute respiratory distress syndrome, 58% of patients with moderate acute respiratory distress syndrome, and 46% of patients with severe acute respiratory distress syndrome. Patients with spontaneous breathing were older and had lower acute respiratory distress syndrome severity, Sequential Organ Failure Assessment scores, ICU and hospital mortality, and were less likely to be diagnosed with acute respiratory distress syndrome by clinicians. In adjusted analysis, spontaneous breathing during the first 2 days was not associated with an effect on ICU or hospital mortality (33% vs 37%; odds ratio, 1.18 [0.92-1.51]; p = 0.19 and 37% vs 41%; odds ratio, 1.18 [0.93-1.50]; p = 0.196, respectively ). Spontaneous breathing was associated with increased ventilator-free days (13 [0-22] vs 8 [0-20]; p = 0.014) and shorter duration of ICU stay (11 [6-20] vs 12 [7-22]; p = 0.04). CONCLUSIONS: Spontaneous breathing is common in patients with acute respiratory distress syndrome during the first 48 hours of mechanical ventilation. Spontaneous breathing is not associated with worse outcomes and may hasten liberation from the ventilator and from ICU. Although these results support the use of spontaneous breathing in patients with acute respiratory distress syndrome independent of acute respiratory distress syndrome severity, the use of controlled ventilation indicates a bias toward use in patients with higher disease severity. In addition, because the lack of reliable data on inspiratory effort in our study, prospective studies incorporating the magnitude of inspiratory effort and adjusting for all potential severity confounders are required

Identifying associations between diabetes and acute respiratory distress syndrome in patients with acute hypoxemic respiratory failure: an analysis of the LUNG SAFE database

Background: Diabetes mellitus is a common co-existing disease in the critically ill. Diabetes mellitus may reduce the risk of acute respiratory distress syndrome (ARDS), but data from previous studies are conflicting. The objective of this study was to evaluate associations between pre-existing diabetes mellitus and ARDS in critically ill patients with acute hypoxemic respiratory failure (AHRF). Methods: An ancillary analysis of a global, multi-centre prospective observational study (LUNG SAFE) was undertaken. LUNG SAFE evaluated all patients admitted to an intensive care unit (ICU) over a 4-week period, that required mechanical ventilation and met AHRF criteria. Patients who had their AHRF fully explained by cardiac failure were excluded. Important clinical characteristics were included in a stepwise selection approach (forward and backward selection combined with a significance level of 0.05) to identify a set of independent variables associated with having ARDS at any time, developing ARDS (defined as ARDS occurring after day 2 from meeting AHRF criteria) and with hospital mortality. Furthermore, propensity score analysis was undertaken to account for the differences in baseline characteristics between patients with and without diabetes mellitus, and the association between diabetes mellitus and outcomes of interest was assessed on matched samples. Results: Of the 4107 patients with AHRF included in this study, 3022 (73.6%) patients fulfilled ARDS criteria at admission or developed ARDS during their ICU stay. Diabetes mellitus was a pre-existing co-morbidity in 913 patients (22.2% of patients with AHRF). In multivariable analysis, there was no association between diabetes mellitus and having ARDS (OR 0.93 (0.78-1.11); p = 0.39), developing ARDS late (OR 0.79 (0.54-1.15); p = 0.22), or hospital mortality in patients with ARDS (1.15 (0.93-1.42); p = 0.19). In a matched sample of patients, there was no association between diabetes mellitus and outcomes of interest. Conclusions: In a large, global observational study of patients with AHRF, no association was found between diabetes mellitus and having ARDS, developing ARDS, or outcomes from ARDS. Trial registration: NCT02010073. Registered on 12 December 2013

Epidemiology and patterns of tracheostomy practice in patients with acute respiratory distress syndrome in ICUs across 50 countries

Background: To better understand the epidemiology and patterns of tracheostomy practice for patients with acute respiratory distress syndrome (ARDS), we investigated the current usage of tracheostomy in patients with ARDS recruited into the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG-SAFE) study. Methods: This is a secondary analysis of LUNG-SAFE, an international, multicenter, prospective cohort study of patients receiving invasive or noninvasive ventilation in 50 countries spanning 5 continents. The study was carried out over 4 weeks consecutively in the winter of 2014, and 459 ICUs participated. We evaluated the clinical characteristics, management and outcomes of patients that received tracheostomy, in the cohort of patients that developed ARDS on day 1-2 of acute hypoxemic respiratory failure, and in a subsequent propensity-matched cohort. Results: Of the 2377 patients with ARDS that fulfilled the inclusion criteria, 309 (13.0%) underwent tracheostomy during their ICU stay. Patients from high-income European countries (n = 198/1263) more frequently underwent tracheostomy compared to patients from non-European high-income countries (n = 63/649) or patients from middle-income countries (n = 48/465). Only 86/309 (27.8%) underwent tracheostomy on or before day 7, while the median timing of tracheostomy was 14 (Q1-Q3, 7-21) days after onset of ARDS. In the subsample matched by propensity score, ICU and hospital stay were longer in patients with tracheostomy. While patients with tracheostomy had the highest survival probability, there was no difference in 60-day or 90-day mortality in either the patient subgroup that survived for at least 5 days in ICU, or in the propensity-matched subsample. Conclusions: Most patients that receive tracheostomy do so after the first week of critical illness. Tracheostomy may prolong patient survival but does not reduce 60-day or 90-day mortality. Trial registration: ClinicalTrials.gov, NCT02010073. Registered on 12 December 2013