Sairaanhoitajien näkemyksiä älyteknologian käytöstä tehohoitopotilaiden kivunarvioinnissa

Tutkimuksen tarkoituksena oli kuvata tehohoidossa työskentelevien sairaanhoitajien kokemiahaasteita kommunikoimaan kykenemättömien potilaiden kivunarvioinnissa sekä heidän näkemyksiään älyteknologian mahdollisuuksista kivunarvioinnin tukena. Aineisto kerättiin fokusryhmähaastatteluilla keväällä 2019. Fokusryhmähaastatteluihin (n=5) osallistui 20 yliopistosairaalan teho-osastolla työskentelevää sairaanhoitajaa. Teemahaastatteluissa käsiteltiin kivunarvioinnin haasteita, tulevaisuuden visioita ja älyteknologian käytettävyyttä. Haastattelut nauhoitettiin ja litteroitiin, ja aineisto analysoitiin induktiivisella sisällönanalyysillä. Analyysin tuloksena muodostui neljä pääluokkaa, joista ensimmäinen, kipu on jatkuvasti läsnä hoitotyössä, vastasi ensimmäiseen tutkimustehtävään hoitajien kokemista haasteista kivunarvioinnissa, ja kolme seuraavaa, päätöksenteon tukeminen, yksilöllisen kivunarvioinnin mahdollistaminen ja teknologiakriittisyys, vastasivat toiseen tutkimustehtävään älyteknologian soveltuvuudestakivunarviointiin. Suurimpina haasteina hoitajat kokivat kommunikoimaan kykenemättömien potilaiden kivunarvioinnissa potilaiden moninaisuuden, kivun sekoittumisen muihin oireisiin sekä kivunarvioinnin käytänteiden vaihtelun. Näkemykset älyteknologian soveltuvuudestakivunarvioinnin tukemiseen olivat osin ristiriitaisia. Positiivisena nähtiin mahdollisuusautomaattiseen tiedon prosessointiin, systemaattisempaan kivunarviointiin, kipulääkityksen optimointiin sekä esitietojen hyödyntämiseen. Toisaalta hoitajat suhtautuivat uusien laitteiden tuomiseen tekniseen hoitoympäristöön kriittisesti. Tutkimuksen tuottamaa tietoa voidaan hyödyntää laitteiden kehittämistutkimuksessa varmistamaan, että teknologia kohtaa käyttäjien tarpeet

Early postnatal nutrition after preterm birth and cardiometabolic risk factors in young adulthood

Objectives Adults born preterm at very low birthweight (VLBW; Study design The Helsinki Study of VLBW Adults includes 166 VLBW and preterm infants born between 1978 and 1985. We collected postnatal nutrition data among 125 unimpaired subjects, who attended two study visits at the mean ages of 22.5 and 25.1 years. We evaluated the effects of energy and macronutrient intakes during the first three 3-week periods of life on key cardiometabolic risk factors with multiple linear regression models. We also report results adjusted for prenatal, postnatal and adult characteristics. Results Macronutrient and energy intakes were not associated with blood pressure, heart rate, or lipid levels in adulthood. Intakes were neither associated with fasting glucose or most other markers of glucose metabolism. An exception was that the first-three-weeks-of-life intakes predicted higher fasting insulin levels: 1 g/kg/day higher protein intake by 37.6% (95% CI: 8.0%, 75.2%), and 10 kcal/kg/day higher energy intake by 8.6% (2.6%, 14.9%), when adjusted for sex and age. These early intakes similarly predicted the adult homeostasis model assessment index. Further adjustments strengthened these findings. Conclusions Among VLBW infants with relatively low early energy intake, early macronutrient and energy intakes were unrelated to blood pressure, lipid levels and intravenous glucose tolerance test results. Contrary to our hypothesis, a higher macronutrient intake during the first three weeks of life predicted higher fasting insulin concentration in young adulthood.Peer reviewe

Leisure Time Physical Activity in Young Adults Born Preterm

Objective To evaluate the amount of self-reported physical activity in young adults born prematurely compared with those born at term. Study design Unimpaired participants of the Preterm Birth Study (Preterm Birth and Early Life Programming of Adult Health and Disease) birth cohort study were studied at age 23.3 +/- 1.2 (SD) years: 118 born early preterm (= 37 weeks, controls). The participants completed a validated 30-item, 12-month physical activity questionnaire. The annual frequency and total volume of conditioning and nonconditioning leisure time physical activity and commuting physical activity were calculated and the data analyzed by means of linear regression. Results Adults born early preterm reported a 31.5% (95% CI, 17.4-43.2) lower volume of leisure time physical activity (in metabolic equivalents [MET] h/year) and had a 2.0-fold increased OR (1.2-3.3) of being in the least active quintile than controls. Lower amounts of conditioning, nonconditioning, and commuting physical activity all contributed to the difference. In addition, early preterm participants undertook less vigorous physical activity (>= 6 MET). No differences in physical activity were found between the late preterm and control groups. Adjustments for potential early life confounders and current mediating health characteristics did not change the results. Conclusions Young adults born early preterm engage less in leisure time physical activities than peers born at term. This finding may in part underlie the increased risk factors of cardiometabolic and other noncommunicable diseases in adults born preterm. Low physical activity is a risk factor for several noncommunicable diseases and amenable to prevention.Peer reviewe

Clinical and biochemical signs of polycystic ovary syndrome in young women born preterm

Objective: It has been suggested that adverse early life exposures increase the risk of developing polycystic ovary syndrome (PCOS) in later life. We hypothesized that women born preterm would have more biochemical and clinical signs of PCOS than women born at term. Design: The ESTER Preterm Birth Study participants were born in Northern Finland and identified from the Northern Finland Birth Cohort and the Finnish Medical Birth Register. Altogether, 74 women born very or moderately preterm (= 37 weeks, controls) were included in the analysis (mean age: 23.2 years). Methods: We measured serum total testosterone and sex hormone-binding globulin (SHBG) and calculated the free androgen index (FAI). PCOS according to the clinical and biochemical signs was defined either as hirsutism and oligoamenorrhea (via questionnaire) or as oligoamenorrhea and elevated testosterone levels (>2.4 nmol/L). Results: Women born VMPT/LPT exhibited 33.0% (8.7, 62.8)/16.4% (-2.0, 38.1) higher testosterone, 28.5% (5.3, 45.9)/24.1% (5.6, 38.9) lower SHBG levels, and 64.6% (19.4, 127.1)/42.5% (11.1, 82.9) higher FAI than controls after adjusting for age and recruitment cohort, maternal BMI, smoking, and pregnancy disorders, parental education, history of hypertension, diabetes, myocardial infarction or stroke, and subject's birth weight s.D. Odds ratios for having PCOS were 1.67 (0.44, 6.23)/3.11 (1.26, 7.70). Conclusions: Women born preterm have a more hyperandrogenic hormonal profile, and those born LPT are approximately three times more likely at risk to have PCOS compared to women born at term.Peer reviewe

Lung function in adults born preterm

Very preterm birth, before the gestational age (GA) of 32 weeks, increases the risk of obstructed airflow in adulthood. We examined whether all preterm births (GA= 37 weeks). Preterm birth was associated with poorer lung function. Mean differences between individuals born early preterm versus full-term were -0.23 standard deviation (SD) (95% confidence interval (CI): -0.40, -0.05)) for forced vital capacity z-score (zFVC), -0.44 SD (95% CI -0.64, -0.25) for forced expiratory volume z-score (zFEV1), and -0.29 SD (95% CI -0.47, -0.10) for zFEV1/FVC. For late preterm, mean differences with full-term controls were -0.02 SD (95% CI -0.17, 0.13), -0.12 SD (95% CI -0.29, 0.04) and -0.13 SD (95% CI -0.29, 0.02) for zFVC, zFEV1, and zFEV1/FVC, respectively. Examination of finer GA subgroups suggested an inverse non-linear association between lung function and GA, with the greatest impact on zFEV1 for those born extremely preterm. The subgroup means were GA= 37weeks): 0.02 SD. Corresponding means for zFEV1/FVC were -1.79, -0.44, -0.47, -0.48, -0.29, and -0.02. Adjustment for maternal pregnancy conditions and socioeconomic and lifestyle factors had no major impact on the relationship. Preterm birth is associated with airflow limitation in adult life. The association appears to be attributable predominantly to those born most immature, with only a modest decrease among those born preterm at later gestational ages.Peer reviewe

Preterm birth and subsequent timing of pubertal growth, menarche, and voice break

Background We evaluated pubertal growth and pubertal timing of participants born preterm compared to those born at term. Methods In the ESTER Preterm Birth Study, we collected growth data and measured final height of men/women born very or moderately preterm (= 37 weeks, 131/151), resulting in median 9 measurements at >= 6 years. Timing of menarche or voice break was self-reported. Peak height velocity (PHV, cm/year) and age at PHV (years) were compared with SuperImposition by Translation And Rotation (SITAR) model (sexes separately). Results Age at PHV (years) and PHV (cm/year) were similar in all gestational age groups. Compared to term controls, insignificant differences in age at PHV were 0.1 (95% CI: -0.2 to 0.4) years/0.2 (-0.1 to 0.4) for very or moderately/late preterm born men and -0.0 (-0.3 to 0.3)/-0.0 (-0.3 to 0.2) for women, respectively. Being born small for gestational age was not associated with pubertal growth. Age at menarche or voice break was similar in all the gestational age groups. Conclusions Timing of pubertal growth and age at menarche or voice break were similar in participants born preterm and at term. Impact Pubertal growth and pubertal timing were similar in preterm and term participants in a relatively large cohort with a wide range of gestational ages. Previous literature indicates that small for gestational age is a risk for early puberty in term born children. This was not shown in preterm children. While our study had limited power for children born very preterm, all children born preterm were not at increased risk for early puberty.Peer reviewe

Early postnatal nutrition after preterm birth and cardiometabolic risk factors in young adulthood

Adults born preterm at very low birthweight (VLBW; <1500 g) have a non-optimal cardiometabolic risk factor profile. Since higher protein intake during the first weeks of life predicted a healthier body composition in adulthood in our previous studies, we hypothesized that it would also predict a favorable cardiometabolic profile.STUDY DESIGN: The Helsinki Study of VLBW Adults includes 166 VLBW and preterm infants born between 1978 and 1985. We collected postnatal nutrition data among 125 unimpaired subjects, who attended two study visits at the mean ages of 22.5 and 25.1 years. We evaluated the effects of energy and macronutrient intakes during the first three 3-week periods of life on key cardiometabolic risk factors with multiple linear regression models. We also report results adjusted for prenatal, postnatal and adult characteristics.RESULTS: Macronutrient and energy intakes were not associated with blood pressure, heart rate, or lipid levels in adulthood. Intakes were neither associated with fasting glucose or most other markers of glucose metabolism. An exception was that the first-three-weeks-of-life intakes predicted higher fasting insulin levels: 1 g/kg/day higher protein intake by 37.6% (95% CI: 8.0%, 75.2%), and 10 kcal/kg/day higher energy intake by 8.6% (2.6%, 14.9%), when adjusted for sex and age. These early intakes similarly predicted the adult homeostasis model assessment index. Further adjustments strengthened these findings.CONCLUSIONS: Among VLBW infants with relatively low early energy intake, early macronutrient and energy intakes were unrelated to blood pressure, lipid levels and intravenous glucose tolerance test results. Contrary to our hypothesis, a higher macronutrient intake during the first three weeks of life predicted higher fasting insulin concentration in young adulthood.</p

Neonatal Nutrition Predicts Energy Balance in Young Adults Born Preterm at Very Low Birth Weight

Epidemiological studies and animal models suggest that early postnatal nutrition and growth can influence adult health. However, few human studies have objective recordings of early nutrient intake. We studied whether nutrient intake and growth during the first 9 weeks after preterm birth with very low birth weight (VLBW,Peer reviewe

Nutrition after preterm birth and adult neurocognitive outcomes

Background Preterm birth ( Methods In 86 participants of the Helsinki Study of Very Low Birth Weight Adults (birthweight <1500g), we examined if higher intakes of energy, macronutrients, and human milk during the first nine weeks after preterm birth predict performance in tests of cognitive ability at 25.1 years of age (SD = 2.1). Results 10 kcal/kg/day higher total energy intake at 3 to 6 weeks of age was associated with 0.21 SD higher adult IQ (95% Confidence Interval [CI] 0.07-0.35). Higher carbohydrate and fat intake at 3-6 weeks, and higher energy intake from human milk at 3-6 and at 6-9 weeks were also associated with higher adult IQ: these effect sizes ranged from 0.09 SD (95% CI 0.01-0.18) to 0.34 SD (0.14-0.54) higher IQ, per one gram/kg/day more carbohydrate and fat, and per 10 kcal/kg/day more energy from human milk. Adjustment for neonatal complications attenuated the associations: intraventricular hemorrhage, in particular, was associated with both poorer nutrition and poorer IQ. Conclusion In preterm neonates with very low birth weight, higher energy and human milk intake predict better neurocognitive abilities in adulthood. To understand the determinants of these infants' neurocognitive outcome, it seems important to take into account the role of postnatal nutrition, not just as an isolated exposure, but as a potential mediator between neonatal illness and long-term neurodevelopment.Peer reviewe

Assisting nurses in care documentation: from automated sentence classification to coherent document structures with subject headings

Background: Up to 35% of nurses' working time is spent on care documentation. We describe the evaluation of a system aimed at assisting nurses in documenting patient care and potentially reducing the documentation workload. Our goal is to enable nurses to write or dictate nursing notes in a narrative manner without having to manually structure their text under subject headings. In the current care classification standard used in the targeted hospital, there are more than 500 subject headings to choose from, making it challenging and time consuming for nurses to use. Methods: The task of the presented system is to automatically group sentences into paragraphs and assign subject headings. For classification the system relies on a neural network-based text classification model. The nursing notes are initially classified on sentence level. Subsequently coherent paragraphs are constructed from related sentences. Results: Based on a manual evaluation conducted by a group of three domain experts, we find that in about 69% of the paragraphs formed by the system the topics of the sentences are coherent and the assigned paragraph headings correctly describe the topics. We also show that the use of a paragraph merging step reduces the number of paragraphs produced by 23% without affecting the performance of the system. Conclusions: The study shows that the presented system produces a coherent and logical structure for freely written nursing narratives and has the potential to reduce the time and effort nurses are currently spending on documenting care in hospitals. </div