Sydänpotilaan henkinen tukeminen hoitotyössä : Koulutusmateriaalia hoitohenkilökunnalle

Hyvä psyykkinen ja fyysinen terveys on ihmiselle luonnollinen elämän perusoletus, johon sisältyy odotuksia elämän ja toimintakyvyn säilymisestä lähes ongelmattomina. Kun ihminen sairastuu, oletus muuttuu merkittävällä tavalla ja ihminen joutuu tilanteeseen, jossa normaali elämänkulku pysähtyy ja tulevaisuuden mielikuvat muuttuvat hetkessä. Sairastuessaan ihminen käy läpi kriisin eri vaiheineen ja tarvitsee toipumisensa aikana paljon erilaista tukea. Yksi keskeisistä tuen muodoista on yksilöllinen henkinen tuki, joka auttaa potilasta jaksamaan sairastumis- ja sitä seuraavan sopeutumisprosessin aikana. Opinnäytetyö sai alkunsa tekijöiden kiinnostuksesta somaattisesti sairaan potilaan kokonaisvaltaiseen hoitotyöhön. Tuotokseen painottuva opinnäytetyön tarkoituksena oli tehdä koulutusmateriaalia TAYS Sydänsairaalan hoitohenkilökunnalle sydänpotilaan henkiseen tukemiseen vaikuttavista tekijöistä. Materiaalin oli tarkoitus tukea hoitohenkilökunnan valmiuksia potilaan henkiseen tukemiseen eri hoitotyön käytännön keinoin. Opinnäytetyön tavoitteena oli lisätä TAYS Sydänsairaalan hoitohenkilökunnan tietoa käytännön keinoista sydänpotilaan henkisessä tukemisessa ja siten kehittää hoitotyötä. Opinnäytetyön perusteella voidaan osoittaa, että käytännön hoitotyössä henkinen tukeminen on monilla osa-alueilla tapahtuvaa auttamista, kuuntelemista ja ohjaamista, joka tulee muotoilla kullekin yksilölle soveltuvimpaan muotoon. Jokainen potilas tulee kohdata yksilöllisesti ja jokaisen hoitohenkilökunnan jäsenen tulee ottaa kriisissä olevan potilaan tukeminen osaksi toteuttamaansa hoitotyötä. Opinnäytetyössä koottua koulutusmateriaalia voidaan hyödyntää monipuolisesti hoitotyössä lisäämässä hoitohenkilökunnan valmiuksia potilaan henkiseen tukemiseen. Sairastumisesta aiheutuvaa kriisiä läpikäyvän potilaan henkinen tukeminen kuluttaa hoitohenkilökunnan voimavaroja, joten jatkotutkimusaiheena voisi tarkastella ja koota yhteen käytännön keinoja hoitohenkilökunnan henkisen jaksamisen tukemiseksi hoitotyössä.Bachelor’s thesis began from the authors interests to the overall care of the patients with somatic disorders. The purpose of this study was to provide study material for the care workers of TAYS Sydänsairaala Heart Hospital about the factors that affect the mental support of cardiac patients. The focus of the study was on the produced product which is a PDF-material. The material provides nursing staff with ways to mentally support a patient with different ways of practical care work. This study had a functional approach. It contains the theoretical framework, the report and the product. The theoretical framework introduces the crisis of a person with a sudden onset of a disease, moral support for a patient , as well as characteristics of a good study material. The report contains a description of the production process, and information about crisis and ways to secure patient’s peace of mind and moral support. Every patient should be treated individually with different ways of practical care work. The nurse should be capable of recognizing the phases of crisis and to supporting every patient. Support given at the right time promotes recovery.Tuotos poistettu theseus-versiosta, saatavilla TAYS Sydänsairaalan intrassa

Globus and dysphagia : clinical features and diagnostics

Globus, a non-painful sensation of a lump in the throat, is a common symptom; however, little is known about the etiology, and the causes have remained controversial. Dysphagia is a multifaceted symptom. Identifying the stage of the swallowing process at which the problem occurs directs us to possible further investigations in dysphagia diagnostics. The aim of this thesis was to investigate the etiology of globus, to clarify globus and dysphagia diagnostics, and to describe the natural course of these symptoms. In the first study, we examined the esophageal background of globus with transnasal esophagoscopy, high-resolution manometry, and 24-hour multichannel intraluminal impedance and pH monitoring. We had 30 globus patients and, as controls, 24 patients who were referred to the Department of Abdominal Surgery for evaluation of operative treatment because of difficult reflux symptoms. The study indicated that globus patients without reflux symptoms did not have acid or non-acid gastroesophageal reflux disease, the upper esophageal sphincter pressure was not elevated, and esophageal motor disorders diagnosed were mainly minor, a finding evident in healthy subjects, as well. However, globus patients had supragastric belching more often than controls with reflux. In the second study, we observed that globus patients felt symptom relief in the Reflux Symptom Index and Deglutition Handicap Index after a four-month follow-up without any treatment. None of the videolaryngoscopies revealed a laryngopharyngeal reflux using the Reflux Finding Score. A speech and language pathologist examined globus patients after four months and found six patients with simultaneous functional voice problems, possibly associated with persistent globus. In the third and fourth study, we searched from the hospital database all globus (n=76) and dysphagia (n=303) patients, respectively, who were referred to our clinic in 2009. From the medical records, we surveyed patients symptoms, investigations, findings, and treatment. From the Finnish Cancer Registry (FCR) database, we recorded all of these patients cancer diagnoses at the end of 2012. In the third study, the questionnaire concerning the globus patients present symptoms indicated that three and six years after their initial visit half of the globus patients were asymptomatic or had fewer symptoms, whereas the rest suffered persistent symptoms. Videofluorography and neck ultrasound showed no benefit in globus diagnostics. The FCR data revealed no malignancies associated with globus during the follow-up to the end of 2012. In the fourth study, dysphagia patients received a questionnaire about their current symptoms three years after their visit to our clinic. It showed that almost half of the dysphagia patients were asymptomatic or had milder symptoms, implying that spontaneous recovery may occur. Based on the case records, most dysphagia diagnoses remained unspecific dysphagia (55%) despite performing many investigations. All patients with a malignant disease either already had a positive finding at the ear, nose, and throat examination or suffered from alarming signs leading to gastroscopy, which revealed the diagnosis. The FCR data indicated no additional malignant cases during the three-year follow-up. Our study clarifies the esophageal background of globus, but also offers some new insights into possible causes. The study updates globus and dysphagia diagnostics and presents the natural course of these symptoms. According to our study, many swallowing difficulties are mild and no specific cause can be identified. Our results emphasize the importance of a careful clinical evaluation to find possible malignancies and to determine whether further investigations in dysphagia diagnostics are necessary.Palantunne ja nielemisvaikeus ovat yleisiä, perusterveydenhuollossa vastaantulevia, potilaita huolestuttavia oireita, jotka johtavat usein erikoissairaanhoidon konsultointiin. Vaikka palantunne on yleinen vaiva, sen aiheuttajista tiedetään vain vähän. Nielemisvaikeus taas on useita erikoisaloja koskettava oire, ja siitä kärsivää potilasta tutkittaessa onkin tärkeää selvittää, mihin nielemisen vaiheeseen ongelma liittyy. Väitöskirjassa tutkittiin palantunteen ruokatorviperäisiä syitä nenän kautta tehtävällä ruokatorven tähystyksellä (transnasal esophagoscopy), tarkkuusmanometrialla (high-resolution manometry) sekä impedanssin ja pH:n pitkäaikaisrekisteröinnillä (24-hour multichannel intraluminal impedance and pH monitoring). Tutkimuksessa oli 30 HYKS:n korvaklinikkaan lähetettyä palantunnepotilasta, ja kontrolliryhmänä 24 hankalasta refluksista kärsivää, HYKS:n vatsaelinkirurgian klinikkaan lähetettyä potilasta. Niillä palantunnepotilailla, jotka eivät kärsineet närästyksestä, ei todettu hapanta tai ei-hapanta refluksitautia ja ruokatorven yläsulkijan paine oli normaali. Myös todetut ruokatorven liikehäiriöt olivat pääosin lieviä, joiden kaltaisia voidaan löytää myös terveillä henkilöillä. Kuitenkin palantunnepotilailla oli ruokatorviröyhtäilyä yleisemmin kuin refluksista kärsivillä kontrolleilla. Palantunnepotilaiden neljän kuukauden seuranta osoitti, että oireet voivat lievittyä jo lyhyessä ajassa ilman hoitoa. Puheterapeutti löysi kuudelta potilaalta ääneen liittyviä ongelmia, jotka voivat olla myötävaikuttava tekijä palantunteen jatkumiselle. Väitöskirjatyössä kerättiin lisäksi kaikkien vuonna 2009 HYKS:n korvaklinikkaan lähetettyjen palantunne- ja nielemisvaikeuspotilaiden tiedot (oireet, tutkimukset, löydökset, hoito). Videofluorografia ja kaulan ultraääni eivät olleet hyödyllisiä palantunnepotilaiden diagnostiikassa. Palantunnepotilaille lähetetyt kyselyt kolme ja kuusi vuotta ensikäynnistä osoittivat, että puolet potilaista oli oireettomia tai heidän oireensa olivat lievittyneet, kun taas loput kärsivät edelleen palantunteesta. Syöpärekisterin tiedot vahvistivat, ettei kenenkään palantunnepotilaan oire ollut kehittynyt syöväksi kolmen vuoden seurannassa. Yli puolessa tapauksista nielemisvaikeuspotilaan diagnoosi jäi epäselväksi, vaikka potilaita tutkittiin melko paljon. Potilaille lähetetty kysely kolme vuotta ensikäynnin jälkeen kuitenkin osoitti, että puolet vastanneista oli oireettomia tai heidän oireensa olivat lievittyneet. Kaikilla potilailla, joilla nielemisvaikeuden syy oli syöpä, löydös oli ollut nähtävissä jo korva-, nenä- ja kurkkualueen tutkimuksessa tai potilaan hälyttävien oireiden vuoksi tehdyssä gastroskopiassa. Syöpärekisterin mukaan kenellekään muulle nielemisvaikeuspotilaalle ei kehittynyt tähän oireeseen liittyvää syöpää kolmen vuoden seurannassa. Tutkimuksemme osoittaa, että usein palantunteen taustalla epäilty refluksitauti ei ole syy, ellei potilas kärsi närästyksestä. Vaikka palantunne saattaa lievittyä jo lyhyessä seurannassa, osalla potilaista vaiva on pitkäkestoinen. Monet nielemisvaikeudet taas ovat lieviä, eikä oireelle löydy erityistä syytä. Tuloksemme painottavat potilaan esitietojen ja huolellisen kliinisen tutkimuksen tärkeyttä sekä palantunteen että nielemisvaikeuden diagnostiikassa. Jatkotutkimusten tarve harkitaan erityisesti sen perusteella, onko potilaalla huolestuttavia oireita tai löydöksiä

Globus pharyngeus : a review of etiology, diagnostics, and treatment

Globus is a non-painful sensation of a lump or a foreign body in the throat, and it frequently improves with eating. Although globus is a common symptom, only little is known about the etiology, and the causes have remained controversial. Previously, globus was labelled as a hysterical symptom. However, nowadays, the research has been mainly focused on somatic causes and it is suspected that the etiology is complex. Because of the unclear etiology, the diagnostics and treatment are varying, predisposing patients to possible unnecessary investigations. This review presents the current literature of globus: its etiology, diagnostics, and treatment. In addition, a special aim is to discuss the rational investigation methods in globus diagnostics and present a diagnostic algorithm based on recent researches.Peer reviewe

Nielemisvaikeuden arviointi

VertaisarvioituNielemisvaikeuden selvittely aloitetaan yleensä perusterveydenhuollossa. Syy selviää usein potilaan huolellisella haastattelulla, jota kliininen tutkimus täydentää. Etiologialtaan epäselvän nielemisvaikeuden syy tulee selvittää viipymättä. Nielemisvaikeutta tutkitaan ja hoidetaan usealla erikoisalalla. Ongelman tason paikantaminen auttaa valitsemaan jatkoselvittelyt.Peer reviewe

Work-up of globus : assessing the benefits of neck ultrasound and videofluorography

Globus patients with normal ear, nose, and throat ( ENT) status are a diagnostic challenge. The symptom may be long lasting and cause concern about malignancy, leading to possibly unnecessary further investigation. The aim of the study was to assess whether radiological examinations are useful in globus diagnostics, how often patients suffer from persistent globus, and whether globus patients with normal ENT status develop a malignancy during a follow-up. We reviewed medical records of all 76 globus patients referred to Helsinki University Hospital, Department of Otorhinolaryngology-Head and Neck Surgery in 2009. Patient history and findings in physical and radiological examinations were registered. A questionnaire concerning patients' present pharyngeal symptoms was sent 3 and 6 years after their initial visit. Data from the Finnish Cancer Registry revealed whether patients developed malignancies within a 3-year follow-up. Based on medical records, neck ultrasound was performed for 37 (49 %) and videofluorography for 22 patients (29 %), with nonsignificant findings. After a 3- and 6-year follow-up, half patients indicated that they were asymptomatic or had fewer symptoms, whereas the rest had persistent symptoms. The Finnish Cancer Registry data confirmed that globus patients developed no head and neck malignancies during a 3-year follow-up. In the present study, neck ultrasound and videofluorography showed no additional benefit to evaluate the globus etiology in patients whose ENT status was normal. Half the globus patients suffered from persistent symptoms after a 3- and 6-year follow-up, indicating that globus may cause discomfort chronically. However, no patients developed malignancies during a 3-year follow-up.Peer reviewe

Sinonasal inverted papilloma - malignant transformation and non-sinonasal malignancies

Objectives To assess malignant transformation rate, non-sinonasal malignancies, and factors contributing to recurrence in patients treated for sinonasal inverted papilloma (SNIP). Study Design Retrospective study. Methods We retrospectively reviewed medical records of all patients treated for SNIP (n = 296) between the years 1984-2014 at Helsinki University Hospital. Data from the Finnish Cancer Registry confirmed the number of those patients with sinonasal and non-sinonasal malignancies. Results Only 2 of 296 (0.7%) patients primarily diagnosed with benign SNIP developed sinonasal cancer in a mean follow-up of 5.8 years. The most common non-sinonasal cancer sites were similar to those reported for the whole Finnish population. None of the patients presented with an HPV-associated non-sinonasal malignancy. The recurrence rate among patients who underwent attachment-oriented surgery was significantly lower compared to those operated on with other approaches (40.2% vs. 56.6%, p = 0.006). Dysplasia in SNIP was associated with a higher recurrence rate (p < 0.001). Conclusions Malignant transformation of SNIP was rare. Patients with SNIP were not prone to HPV-associated non-sinonasal malignancies. Endoscopic resection and attachment-oriented surgery have become predominant approaches in the treatment of SNIP; meanwhile, the total number of SNIP recurrences has decreased. Level of Evidence 3 Laryngoscope, 2022Peer reviewe

Finnish Version of the Eating Assessment Tool (F-EAT-10) : A Valid and Reliable Patient-reported Outcome Measure for Dysphagia Evaluation

Our aim was to validate a Finnish version of the Eating Assessment Tool (F-EAT-10) for clinical use and to test its reliability and validity in a multicenter nationwide study. Normative data were acquired from 180 non-dysphagic participants (median age 57.0 years, 62.2% female). Dysphagia patients (n = 117, median age 69.7 years, 53.0% female) referred to fiberoptic endoscopic evaluation of swallowing (FEES) completed F-EAT-10 before the examination and after 2 weeks. Patients underwent the 100-ml water swallow test (WST) and FEES was evaluated using the following three scales: the Yale Pharyngeal Residue Severity Rating Scale, Penetration-Aspiration Scale, and the Dysphagia Outcome Severity Scale. An operative cohort of 19 patients (median age 75.8 years, 57.9% female) underwent an endoscopic operation on Zenker's diverticulum, tight cricopharyngeal muscle diagnosed in videofluorography, or both. Patients completed the F-EAT-10 preoperatively and 3 months postoperatively. The cut-off score for controls was = 3 is abnormal. Re-questionnaires for test-retest reliability analysis were available from 92 FEES patients and 123 controls. The intraclass correlation coefficient was excellent for the total F-EAT-10 score (0.93, 95% confidence interval 0.91-0.95). Pearson correlation coefficients were strong (p < 0.001) for each of the questions and the total score. Internal consistency as assessed by Cronbach's alpha was excellent (0.95). Some correlations between findings in FEES and 100-ml WST with F-EAT-10 were observed. The change in subjective symptoms of operative patients paralleled the change in F-EAT-10. F-EAT-10 is a reliable, valid, and symptom-specific patient-reported outcome measure for assessing dysphagia among Finnish speakers.Peer reviewe

Finnish Version of the Eating Assessment Tool (F-EAT-10): A Valid and Reliable Patient-reported Outcome Measure for Dysphagia Evaluation

Our aim was to validate a Finnish version of the Eating Assessment Tool (F-EAT-10) for clinical use and to test its reliability and validity in a multicenter nationwide study. Normative data were acquired from 180 non-dysphagic participants (median age 57.0 years, 62.2% female). Dysphagia patients (n = 117, median age 69.7 years, 53.0% female) referred to fiberoptic endoscopic evaluation of swallowing (FEES) completed F-EAT-10 before the examination and after 2 weeks. Patients underwent the 100-ml water swallow test (WST) and FEES was evaluated using the following three scales: the Yale Pharyngeal Residue Severity Rating Scale, Penetration-Aspiration Scale, and the Dysphagia Outcome Severity Scale. An operative cohort of 19 patients (median age 75.8 years, 57.9% female) underwent an endoscopic operation on Zenker's diverticulum, tight cricopharyngeal muscle diagnosed in videofluorography, or both. Patients completed the F-EAT-10 preoperatively and 3 months postoperatively. The cut-off score for controls was = 3 is abnormal. Re-questionnaires for test-retest reliability analysis were available from 92 FEES patients and 123 controls. The intraclass correlation coefficient was excellent for the total F-EAT-10 score (0.93, 95% confidence interval 0.91-0.95). Pearson correlation coefficients were strong (p < 0.001) for each of the questions and the total score. Internal consistency as assessed by Cronbach's alpha was excellent (0.95). Some correlations between findings in FEES and 100-ml WST with F-EAT-10 were observed. The change in subjective symptoms of operative patients paralleled the change in F-EAT-10. F-EAT-10 is a reliable, valid, and symptom-specific patient-reported outcome measure for assessing dysphagia among Finnish speakers

Authors' response to Commentary on "Role of barium swallow pharyngoesophagography in the management of globus pharyngeus"

Non peer reviewe