Potilaan postoperatiivinen kivunhoidon ohjaus polven tekonivelleikkauksessa:kirjallisuuskatsaus

Tiivistelmä. Tämän kirjallisuuskatsauksen tarkoituksena on kuvailla potilaiden postoperatiivista kivunhoidon ohjausta polventekonivelleikkauksessa. Tiedonhaku toteutettiin CINAHL sekä Scopus tietokantoihin syksyllä 2019. Haku tuotti yhteensä 728 viitettä. Artikkelit valittiin sisäänottokriteerien ja tutkimustehtävän perusteella. Varsinaiseen tulososioon sisällytettiin viisi vertaisarvioitua tieteellistä artikkelia. Artikkelit analysoitiin narratiivisen kirjallisuuskatsauksen mukaan. Kirjallisuuskatsauksen aineiston tuloksista nousi esille kaksi yläluokkaa: Potilaan riittämätön kivunhoidon ohjaus postoperatiivisesti sekä ohjauksen hyödyt potilaan kivunkokemukseen. Kahdessa tutkimuksessa potilaat kokivat saamansa kivunhoidon ohjauksen puutteelliseksi. Tulosten mukaan potilaiden kivunhoidon ohjaus ei ollut toteutunut ja ne potilaat, joiden ohjaus toteutui kokivat sen riittämättömäksi. Potilaat hyötyivät ohjauksesta. Potilaat, joiden ohjaus sisälsi tietoa tulevasta polven tekonivelleikkauksesta arvioivat postoperatiivisen kivun lievemmäksi, kuin potilaat, joiden ohjaus oli riittämätöntä. Ohjausta saaneet potilaat olivat myös valmistautuneet tulevaan leikkaukseen, postoperatiiviseen vaiheeseen sekä myös tulevaan postoperatiiviseen kipuun

Climate change in the Baltic Sea region : a summary

Based on the Baltic Earth Assessment Reports of this thematic issue in Earth System Dynamics and recent peer-reviewed literature, current knowledge of the effects of global warming on past and future changes in climate of the Baltic Sea region is summarised and assessed. The study is an update of the Second Assessment of Climate Change (BACC II) published in 2015 and focuses on the atmosphere, land, cryosphere, ocean, sediments, and the terrestrial and marine biosphere. Based on the summaries of the recent knowledge gained in palaeo-, historical, and future regional climate research, we find that the main conclusions from earlier assessments still remain valid. However, new long-term, homogenous observational records, for example, for Scandinavian glacier inventories, sea-level-driven saltwater inflows, so-called Major Baltic Inflows, and phytoplankton species distribution, and new scenario simulations with improved models, for example, for glaciers, lake ice, and marine food web, have become available. In many cases, uncertainties can now be better estimated than before because more models were included in the ensembles, especially for the Baltic Sea. With the help of coupled models, feedbacks between several components of the Earth system have been studied, and multiple driver studies were performed, e.g. projections of the food web that include fisheries, eutrophication, and climate change. New datasets and projections have led to a revised understanding of changes in some variables such as salinity. Furthermore, it has become evident that natural variability, in particular for the ocean on multidecadal timescales, is greater than previously estimated, challenging our ability to detect observed and projected changes in climate. In this context, the first palaeoclimate simulations regionalised for the Baltic Sea region are instructive. Hence, estimated uncertainties for the projections of many variables increased. In addition to the well-known influence of the North Atlantic Oscillation, it was found that also other low-frequency modes of internal variability, such as the Atlantic Multidecadal Variability, have profound effects on the climate of the Baltic Sea region. Challenges were also identified, such as the systematic discrepancy between future cloudiness trends in global and regional models and the difficulty of confidently attributing large observed changes in marine ecosystems to climate change. Finally, we compare our results with other coastal sea assessments, such as the North Sea Region Climate Change Assessment (NOSCCA), and find that the effects of climate change on the Baltic Sea differ from those on the North Sea, since Baltic Sea oceanography and ecosystems are very different from other coastal seas such as the North Sea. While the North Sea dynamics are dominated by tides, the Baltic Sea is characterised by brackish water, a perennial vertical stratification in the southern subbasins, and a seasonal sea ice cover in the northern subbasins.Peer reviewe

Quality of counselling assessed by patients after total knee arthroplasty:a cross-sectional study

Abstract Patient counselling is a key function in nursing. High-quality counselling promotes adherence to treatment and reduces complications. The purpose of the study was to describe the quality of counselling experienced by total knee arthroplasty patients following surgery. The study was a descriptive cross-sectional study. The data were collected from patients following total knee arthroplasty (N = 60) in 2016 with a modified Quality of Counselling Instrument, and analysed using statistical methods. Over half of the patients (58%) were women and the mean age was 68 years (range 49–84). Over a quarter of patients (28.9%) lived alone, and about two-thirds were overweight (42.1%), or obese (31.6%). After surgery, many patients (88%) experienced moderate pain. Half of patients (52.6%) received a good quality of counselling for the disease and its treatment, and counselling for recovery from treatment (81.6%) was good. Most patients (92.1%) received satisfactory counselling about physical activity. There was a correlation between the disease and its treatment counselling and quality of life (r = −0.553, p = 0.003) and pain (r = −0657, p = 0.000). Interaction during counselling was good (97.4%) and it was implemented in a patient-centred way (89.5%). High-quality counselling implemented in a patient-centred manner can play a part in reducing pain and increasing patients’ quality of life