Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe: A prospective European multicentre observational study

BACKGROUND: Little is known about current clinical practice concerning peri-operative red blood cell transfusion in neonates and small infants. Guidelines suggest transfusions based on haemoglobin thresholds ranging from 8.5 to 12 g dl-1, distinguishing between children from birth to day 7 (week 1), from day 8 to day 14 (week 2) or from day 15 (≥week 3) onwards. OBJECTIVE: To observe peri-operative red blood cell transfusion practice according to guidelines in relation to patient outcome. DESIGN: A multicentre observational study. SETTING: The NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) trial recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. PATIENTS: The data included 5609 patients undergoing 6542 procedures. Inclusion criteria was a peri-operative red blood cell transfusion. MAIN OUTCOME MEASURES: The primary endpoint was the haemoglobin level triggering a transfusion for neonates in week 1, week 2 and week 3. Secondary endpoints were transfusion volumes, 'delta haemoglobin' (preprocedure - transfusion-triggering) and 30-day and 90-day morbidity and mortality. RESULTS: Peri-operative red blood cell transfusions were recorded during 447 procedures (6.9%). The median haemoglobin levels triggering a transfusion were 9.6 [IQR 8.7 to 10.9] g dl-1 for neonates in week 1, 9.6 [7.7 to 10.4] g dl-1 in week 2 and 8.0 [7.3 to 9.0] g dl-1 in week 3. The median transfusion volume was 17.1 [11.1 to 26.4] ml kg-1 with a median delta haemoglobin of 1.8 [0.0 to 3.6] g dl-1. Thirty-day morbidity was 47.8% with an overall mortality of 11.3%. CONCLUSIONS: Results indicate lower transfusion-triggering haemoglobin thresholds in clinical practice than suggested by current guidelines. The high morbidity and mortality of this NECTARINE sub-cohort calls for investigative action and evidence-based guidelines addressing peri-operative red blood cell transfusions strategies. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02350348

Eläimet apuna mielenterveyden hoitotyössä, sairaanhoitajan näkökulma

Opinnäytetyön tavoitteena oli haastattelujen kautta saadun tiedon avulla kehittää hoitotyötä eläinavusteisen toiminnan kautta mielenterveyden hoitotyössä. Opin-näytetyön tarkoituksena on sairaanhoitajille tehtävien teemahaastattelujen kautta selvittää, miten eläimiä käytetään mielenterveyden hoitotyössä apuna. Opinnäyte-työssä selvitettiin eläinten käyttöä mielenterveyden hoidossa haastattelemalla sairaanhoitajia sekä tekemällä tutustumiskäyntejä Kennelliiton Kaverikoirien mukana. Yhteistyökumppaniksi saatiin Kauhajoen palvelukoti. Opinnäytetyö toteutettiin kvalitatiivista tutkimusmenetelmää käyttäen. Aineistonkeruumenetelmänä olivat teemahaastattelut ja havainnointi. Opinnäytetyössä haastateltiin neljää sairaanhoitajaa. Vastaukset käsiteltiin sisällönanalyysillä. Eläinten käyttö mielenterveyden hoitotyössä vaikuttaa positiivisesti asiakkaiden elämään. Säännöllisillä vierailuilla asiakas ja eläin saavat luotua läheisen suhteen toisiinsa. Eläin luo luottamuksellisen suhteen myös sellaisiin henkilöihin, joiden on vaikea luottaa toisiin ihmisiin. Eläimen pehmeän karvan silittäminen luo mielihyvää ja rentouttaa. Eläimestä välitetään ja sille ei kiukutella, vaikka ihmisille oltaisiin ”pahalla päällä”. Opinnäytetyön tulosten mukaan eläinten käyttö on suositeltavaa mielenterveyden hoitotyössä laajemmin, mitä tällä hetkellä niitä käytetään.The aim of the thesis was to develop mental health nursing with the help of the material obtained from the interviews, using animal-assisted activities. The purpose of the thesis is to find out how animals are used for mental health nursing through theme interviews with nurses. The thesis investigated the use of animals in the treatment of mental illnesses by interviewing nurses and making visits with the Kennel Club Dog Mates. Kauhajoki service home was the partner in this study. The thesis was carried out using a qualitative research method. The material collection method was theme interviews and observation. Four (n=4) nurses were interviewed for this thesis. The responses were processed by content analysis. The use of animals in mental health nursing has a positive impact on customers' lives. During regular visits, the client and the animal can create an attachment to each other. The animal also creates a trusted relationship with people who find it difficult to trust other people. Caressing the animal's soft coat brings pleasure and relaxes. The animal is cared for and it is not fired, even if it is “in a bad mood”. According to the results of this thesis, the use of animals is recommended in mental health nursing more widely than is currently being used

Rintamamiestalon ullakon laajennus

Tässä opinnäytetyössä tutustuttiin rintamamiestalojen historiaan ja suunniteltiin esimerkkikohteeseen ullakon laajennus voimassa olevien lakien ja säädösten mukaan. Suunnitelmat tehtiin yksityishenkilölle, joka hakee rakennuslupaa kantavien rakenteiden ja ullakkotilojen muutosta varten. Esimerkkikohde on rakennettu 1940-luvulla, ja se laajennettiin paritaloksi vuonna 1957. Vuosikymmenien aikana kohteessa on tehty paljon muutoksia, ja entinen puolitoista kerroksinen paritalo on nykyisin yhden perheen asunto. Myös kellaritilat on otettu käyttöön. Työn tilaaja ja kohde ovat opinnäytetyössä salaisia. Opinnäytetyön tarkoitus oli toteuttaa tilaajalle rakennuslupakuvat sekä rakennesuunnitelmat. Kohteesta löytyi vain peruskorjaukseen haetut rakennuslupakuvat vuodelta 1977. Uusia rakennuslupakuvia varten kohteessa tehtiin tarkemittaus, jotta pohjakuvat saatiin päivitettyä ajantasaisiksi, ja lisäksi ulkoseinän rakenne tarkastettiin videoendoskoopilla. Työssä mitoitettiin ullakkotilan kantavat rakenteet Finnwood 2.3 SR1 -mitoitusohjelmalla. Korjaussuunnitelmat toteutettiin pilari-palkkiratkaisulla. Palkiksi saatiin yksiaukkoinen 115x405 liimapuupalkki ja pilariksi 115x115 liimapuinen mastopilari. Kuormat siirrettiin välipohjan kautta kantavalle ulkoseinälle. Rakennuksen energiatehokkuutta parannettiin asentamalla lisälämmöneristys ulkoseinän sisäpuolelle ja yläpohjaan. Korjauskohteen suunnittelussa olisi tärkeää saada mahdollisimman paljon tietoa rakennuksen historiasta ja tehdyistä korjauksista. Näitä varten entisten asukkaiden haastattelu olisi hyvä lisä. Rintamamiestalot ovat lähtökohtaisesti melko samankaltaisia, ja ne on rakennettu monesti samojen tyyppipiirustusten pohjalta. Suunnittelijan tulee kuitenkin huomioida, että jokainen kohde on erilainen ja yllättäviä ongelmia voi ilmetä. Museovirasto ja kaavamääräykset voivat vaikuttaa vanhan rintamamiestalon korjaukseen.The purpose of this study was to plan a renovation to a type house in the post-war reconstruction period in Finland. The house was built in 1940’s and it was enlarged in 1957. The planning permission was applied for the enlargement of the attic. The change had impact on the primary structures. The history of the type house in general and the old plans of the previous planning permission were explored in the beginning of the planning process. The law and enactment of the day were perceived which had an effect on the insulation. As a result of this study the new planning permission and structural plans of the enlargement were produced. The old primary structures were replaced with the laminated beam and columns. The energy efficiency was improved with the supplementary insulation in the exterior wall and the roof. There is a lot of this kind of type houses in Finland which were built after the Second World War. Even though they are based on the same plans there can be large amount of variations of changes. While making a renovation in the type house an engineer must be prepared for the structural surprises

Morbidity and mortality after anaesthesia in early life: results of the European prospective multicentre observational study, neonate and children audit of anaesthesia practice in Europe (NECTARINE)

Background: Neonates and infants requiring anaesthesia are at risk of physiological instability and complications, but triggers for peri-anaesthetic interventions and associations with subsequent outcome are unknown. Methods: This prospective, observational study recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. The primary aim was to identify thresholds of pre-determined physiological variables that triggered a medical intervention. The secondary aims were to evaluate morbidities, mortality at 30 and 90 days, or both, and associations with critical events. Results: Infants (n=5609) born at mean (standard deviation [sd]) 36.2 (4.4) weeks postmenstrual age (35.7% preterm) underwent 6542 procedures within 63 (48) days of birth. Critical event(s) requiring intervention occurred in 35.2% of cases, mainly hypotension (>30% decrease in blood pressure) or reduced oxygenation (SpO2 <85%). Postmenstrual age influenced the incidence and thresholds for intervention. Risk of critical events was increased by prior neonatal medical conditions, congenital anomalies, or both (relative risk [RR]=1.16; 95% confidence interval [CI], 1.04-1.28) and in those requiring preoperative intensive support (RR=1.27; 95% CI, 1.15-1.41). Additional complications occurred in 16.3% of patients by 30 days, and overall 90-day mortality was 3.2% (95% CI, 2.7-3.7%). Co-occurrence of intraoperative hypotension, hypoxaemia, and anaemia was associated with increased risk of morbidity (RR=3.56; 95% CI, 1.64-7.71) and mortality (RR=19.80; 95% CI, 5.87-66.7). Conclusions: Variability in physiological thresholds that triggered an intervention, and the impact of poor tissue oxygenation on patient's outcome, highlight the need for more standardised perioperative management guidelines for neonates and infants

Difficult tracheal intubation in neonates and infants. NEonate and Children audiT of Anaesthesia pRactice IN Europe (NECTARINE): a prospective European multicentre observational study

International audienceBackground: Neonates and infants are susceptible to hypoxaemia in the perioperative period. The aim of this study was to analyse interventions related to anaesthesia tracheal intubations in this European cohort and identify their clinical consequences.Methods: We performed a secondary analysis of tracheal intubations of the European multicentre observational trial (NEonate and Children audiT of Anaesthesia pRactice IN Europe [NECTARINE]) in neonates and small infants with difficult tracheal intubation. The primary endpoint was the incidence of difficult intubation and the related complications. The secondary endpoints were the risk factors for severe hypoxaemia attributed to difficult airway management, and 30 and 90 day outcomes.Results: Tracheal intubation was planned in 4683 procedures. Difficult tracheal intubation, defined as two failed attempts of direct laryngoscopy, occurred in 266 children (271 procedures) with an incidence (95% confidence interval [CI]) of 5.8% (95% CI, 5.1-6.5). Bradycardia occurred in 8% of the cases with difficult intubation, whereas a significant decrease in oxygen saturation (SpO2<90% for 60 s) was reported in 40%. No associated risk factors could be identified among co-morbidities, surgical, or anaesthesia management. Using propensity scoring to adjust for confounders, difficult anaesthesia tracheal intubation did not lead to an increase in 30 and 90 day morbidity or mortality.Conclusions: The results of the present study demonstrate a high incidence of difficult tracheal intubation in children less than 60 weeks post-conceptual age commonly resulting in severe hypoxaemia. Reassuringly, the morbidity and mortality at 30 and 90 days was not increased by the occurrence of a difficult intubation event