Impedanssipneumografian validointi sydän- ja keuhkoleikkauspotilaiden hengitysfunktion arviointia varten

Impedance pneumography (IP) is an indirect method of assessing respiration by measuring bioimpedance of the thorax. Conventionally respiration is evaluated by measuring the volume of air inhaled and exhaled during forced spirometry manoeuvres: these patterns require skills and cooperation from the patient, and strong guidance from the physician. IP provides a comfortable alternative for the patient, since the results do not depend on the performance of the patient. Purpose of the work was to assess the agreement of IP measurement and pneumotachography (PNT), which was used as a reference method. Open-chest surgery intrudes chest anatomy and physiology and decreases the functions for several days after the surgery. Pain and medication also complicate respiration, and postoperative complications, such as air leak or pneumothorax are common. Thus, an effective method for measuring respiration with minimal effort from the patient is needed to evaluate the physiotherapy needs and recovery. IP is a promising method for this purpose. The study population was 136 patients with elective cardiac operations, pulmonary resections and minor pleuropulmonary surgeries. The study was conducted during the normal episode of care in the hospital one day before the operation and for 1–3 days after the operation. Simultaneous IP and PNT measurements were conducted for one minute. The linearity of IP and PNT was evaluated by calculating the sample-by-sample difference and average deviation from the linearity in different phases of the respiratory cycle. The results showed that there was no difference in linearity in the three surgery groups before and immediately after the operation. Also, difference between the groups in the same measurement day was not detected. The study indicates that thoracic surgery does not change the linearity properties of IP, thus it can be used to evaluate the recovery of the surgery patients by assessing the lung functions. It should be considered in further studies, whether some changes in the linearity were due to fluid accumulation in cardiac patients, or for some other reasons

Lääkintätekniikan prosessien järjestäminen sairaanhoitopiirin tietohallinnossa

Pirkanmaan sairaanhoitopiirin lääkintätekniikka on osa tietohallinnon ja teknologian vastuualuetta TAYS palvelukeskuksessa. Tietohallinto vastaa perustietotekniikan palveluiden lisäksi tietohallinnon palveluista, potilastietopalveluista ja tietohallinnon muutostöiden suunnittelusta. Lääkintätekniikka vastaa strategisista palveluista, kun taas operatiivisista palveluista vastaa Istekki Oy. Lääkintälaitteiden lainsäädäntö vaatii laitteiden laadun, turvallisuuden ja toiminnan mittaamista kvantitatiivisesti, minkä prosessinäkökulma mahdollistaa. Yhteiset toimintatavat kaikille tietoteknisille laitteille sairaanhoitopiirissä mahdollistavat tehokkaan ja turvallisen hoitoympäristön.Lääkintätekniikan ja tietohallinnon prosesseissa on paljon yhteisiä rajapintoja, sillä useat lääkintälaitteet ovat verkotettuja ja yhteydessä muihin laitteisiin. Verkotettujen lääkintälaitteiden elinkaaren aikainen ylläpito vaatii erikoisosaamista sekä tietotekniikasta että laitteen toiminnasta ja lainsäädännöstä. Lääkintätekniikan yhä enemmän digitalisoituessa tulisi huolehtia siitä, että prosesseja uudistetaan ja toimintatavoista pidetään kiinni yhteistyössä prosesseissa toimivien asiantuntijoiden kanssa. Lääkintälaitteiden elinkaaren hallinnalle on eduksi, jos palvelujen tuottaminen keskittyy sairaanhoitopiirissä samalle toimijalle.The Medical Technical Department of Pirkanmaa Hospital District is part of the Information Management Unit of the Hospital Service Center. Medical Technology is responsible of the strategic services, whereas Istekki Oy is responsible of the operative services of medical devices. Information Management Unit is responsible of the computer services, information management, patient information services and changes of information management. Medical devices are strictly regulated and the legislation requires quantitative measurements of quality, safety and functionality. This is possible by using a process approach of medical device management. Common policies for all interactive devices in the hospital district enables efficient and safe environment for healthcare.Medical technology and information management processes have common interfaces, since most of the current medical devices are in a network and connected to other devices. Medical devices connected to a network require maintenance with special competences from both computer sciences and medical devices functionalities, as well as legislation of medical devices. As digitalization makes progress also in medical technology, the organization should ensure that processes are being renewed and the policies are kept in cooperation with the medical technology professionals. Medical technology life cycle control benefits if the services are focused on one actor.<br/

Identification of Motor Symptoms Related to Parkinson Disease Using Motion-Tracking Sensors at Home (KAVELI) : Protocol for an Observational Case-Control Study

Background: Clinical characterization of motion in patients with Parkinson disease (PD) is challenging: symptom progression, suitability of medication, and level of independence in the home environment can vary across time and patients. Appointments at the neurological outpatient clinic provide a limited understanding of the overall situation. In order to follow up these variations, longer-term measurements performed outside of the clinic setting could help optimize and personalize therapies. Several wearable sensors have been used to estimate the severity of symptoms in PD; however, longitudinal recordings, even for a short duration of a few days, are rare. Home recordings have the potential benefit of providing a more thorough and objective follow-up of the disease while providing more information about the possible need to change medications or consider invasive treatments. Objective: The primary objective of this study is to collect a dataset for developing methods to detect PD-related symptoms that are visible in walking patterns at home. The movement data are collected continuously and remotely at home during the normal lives of patients with PD as well as controls. The secondary objective is to use the dataset to study whether the registered medication intakes can be identified from the collected movement data by looking for and analyzing short-term changes in walking patterns. Methods: This paper described the protocol for an observational case-control study that measures activity using three different devices: (1) a smartphone with a built-in accelerometer, gyroscope, and phone orientation sensor, (2) a Movesense smart sensor to measure movement data from the wrist, and (3) a Forciot smart insole to measure the forces applied on the feet. The measurements are first collected during the appointment at the clinic conducted by a trained clinical physiotherapist. Subsequently, the subjects wear the smartphone at home for 3 consecutive days. Wrist and insole sensors are not used in the home recordings. Results: Data collection began in March 2018. Subject recruitment and data collection will continue in spring 2019. The intended sample size was 150 subjects. In 2018, we collected a sample of 103 subjects, 66 of whom were diagnosed with PD. Conclusions: This study aims to produce an extensive movement-sensor dataset recorded from patients with PD in various phases of the disease as well as from a group of control subjects for effective and impactful comparison studies. The study also aims to develop data analysis methods to monitor PD symptoms and the effects of medication intake during normal life and outside of the clinic setting. Further applications of these methods may include using them as tools for health care professionals to monitor PD remotely and applying them to other movement disorders.Peer reviewe

Identification of Motor Symptoms Related to Parkinson Disease Using Motion-Tracking Sensors at Home (KAVELI): Protocol for an Observational Case-Control Study

Background: Clinical characterization of motion in patients with Parkinson disease (PD) is challenging: symptom progression, suitability of medication, and level of independence in the home environment can vary across time and patients. Appointments at the neurological outpatient clinic provide a limited understanding of the overall situation. In order to follow up these variations, longer-term measurements performed outside of the clinic setting could help optimize and personalize therapies. Several wearable sensors have been used to estimate the severity of symptoms in PD; however, longitudinal recordings, even for a short duration of a few days, are rare. Home recordings have the potential benefit of providing a more thorough and objective follow-up of the disease while providing more information about the possible need to change medications or consider invasive treatments.Objective: The primary objective of this study is to collect a dataset for developing methods to detect PD-related symptoms that are visible in walking patterns at home. The movement data are collected continuously and remotely at home during the normal lives of patients with PD as well as controls. The secondary objective is to use the dataset to study whether the registered medication intakes can be identified from the collected movement data by looking for and analyzing short-term changes in walking patterns.Methods: This paper described the protocol for an observational case-control study that measures activity using three different devices: (1) a smartphone with a built-in accelerometer, gyroscope, and phone orientation sensor, (2) a Movesense smart sensor to measure movement data from the wrist, and (3) a Forciot smart insole to measure the forces applied on the feet. The measurements are first collected during the appointment at the clinic conducted by a trained clinical physiotherapist. Subsequently, the subjects wear the smartphone at home for 3 consecutive days. Wrist and insole sensors are not used in the home recordings.Results: Data collection began in March 2018. Subject recruitment and data collection will continue in spring 2019. The intended sample size was 150 subjects. In 2018, we collected a sample of 103 subjects, 66 of whom were diagnosed with PD.Conclusions: This study aims to produce an extensive movement-sensor dataset recorded from patients with PD in various phases of the disease as well as from a group of control subjects for effective and impactful comparison studies. The study also aims to develop data analysis methods to monitor PD symptoms and the effects of medication intake during normal life and outside of the clinic setting. Further applications of these methods may include using them as tools for health care professionals to monitor PD remotely and applying them to other movement disorders

Faskialle suositeltava venyttelytekniikka : Kuvaileva kirjallisuuskatsaus

Opinnäytetyön tavoitteena oli vastata kuvailevan kirjallisuuskatsauksen avulla kysymykseen, mikä on faskialle suositeltava venyttelytekniikka. Faskia on verkostoitunutta sidekudosta, joka ympäröi ja yhdistää kaikki lihakset ja jokaisen elimen kehossa. Opinnäytetyön tarkoitus oli tarjota toimeksiantajalle aiheeseen liittyvää luotettavaa tietoa ja dokumentoida se yhdeksi tiedostoksi. Opinnäytetyön toimeksiantajana on toiminut ProFTraining Finland Oy. Aineisto rajattiin vuosiin 2012-2017. Aineistoa kerättiin seuraavista tietokannoista: ScienceDirect (Elsevier), EBSCO Academic search elite, ResearchGate ja PubMed. Kirjallisuuskatsauksen analysoitava aineisto koostui neljästä alkuperäistutkimuksesta. Yksi oli kirjallisuuskatsaus, kaksi oli satunnaistettua kontrolloitua tutkimusta ja yksi satunnaistamaton kontrolloitu tutkimus. Kerätty aineisto analysoitiin aineistolähtöisen sisällönanalyysin menetelmää hyödyntäen. Kirjallisuuskatsaus osoitti, että faskian ja eri venyttelytekniikoiden suhteesta on tehty vain vähän tutkimuksia. Perustuen tutkittuun tietoon, hitaat passiiviset ja dynaamiset venytykset eri kulmissa ovat suositeltavia faskian kannalta.The goal of this thesis, using a descriptive literature review, was to answer what is the recommended stretching technique form for fascia. Fascia, also known as connective tissue, is a tensional network which surrounds and connects all the muscles and every organ in the body. The target was to offer reliable research data about the subject to commissioner and document the data into a single file. Comissioner of this thesis was ProFTraining Finland Oy. During the data collection process, the data search was limited with a timeline ranging from 2012 to 2017 and collected only from the following databases: ScienceDirect (Elsevier), EBSCO Academic Search Elite, ResearchGate and PubMed. The data to be analyzed consisted of four original research articles: one literature review, two randomized controlled studies and one un-randomized controlled trial. Collected data was analyzed by the material based content analysis. According to this literature review, there is only a few studies done regarding the relationship between fascia and different stretching techniques. Based on scientific studies, slow passive and dynamic stretching at different angles and are recommendable from fascia point of view

Impedanssipneumografian validointi sydän- ja keuhkoleikkauspotilaiden hengitysfunktion arviointia varten

Impedance pneumography (IP) is an indirect method of assessing respiration by measuring bioimpedance of the thorax. Conventionally respiration is evaluated by measuring the volume of air inhaled and exhaled during forced spirometry manoeuvres: these patterns require skills and cooperation from the patient, and strong guidance from the physician. IP provides a comfortable alternative for the patient, since the results do not depend on the performance of the patient. Purpose of the work was to assess the agreement of IP measurement and pneumotachography (PNT), which was used as a reference method. Open-chest surgery intrudes chest anatomy and physiology and decreases the functions for several days after the surgery. Pain and medication also complicate respiration, and postoperative complications, such as air leak or pneumothorax are common. Thus, an effective method for measuring respiration with minimal effort from the patient is needed to evaluate the physiotherapy needs and recovery. IP is a promising method for this purpose. The study population was 136 patients with elective cardiac operations, pulmonary resections and minor pleuropulmonary surgeries. The study was conducted during the normal episode of care in the hospital one day before the operation and for 1–3 days after the operation. Simultaneous IP and PNT measurements were conducted for one minute. The linearity of IP and PNT was evaluated by calculating the sample-by-sample difference and average deviation from the linearity in different phases of the respiratory cycle. The results showed that there was no difference in linearity in the three surgery groups before and immediately after the operation. Also, difference between the groups in the same measurement day was not detected. The study indicates that thoracic surgery does not change the linearity properties of IP, thus it can be used to evaluate the recovery of the surgery patients by assessing the lung functions. It should be considered in further studies, whether some changes in the linearity were due to fluid accumulation in cardiac patients, or for some other reasons

Kuiv keratokonjunktiviit koertel: Eesti Maaülikooli Väikeloomakliiniku oftalmoloogiaüksuses esinenud juhtumite ülevaade

Final Thesis Curriculum in Veterinary MedicineKeratoconjunctivitis sicca (KCS) is a common ocular disease seen in dogs, and the management of the disease may prove to be challenging. The aim of this study was to analyse clinical cases of KCS in the Small Animal Clinic of Estonian University of Life Sciences regarding the breed, age, and sex of the affected dogs, the analysis of the diagnostic methods and treatment options utilised, and finally making recommendations for the management of dogs with KCS. The study data was collected from the Small Animal Clinic of Estonian University of Life Sciences patient database. The patient population consisted of 45 canines which were treated for KCS at the clinic from 2017-2022. There were 23 different breeds of dogs included, with Yorkshire terrier being most frequent (17.8%). There was no relationship found between the age groups (young, middle, and senior age; p = 0.989), sex (p = 0.837) and the summed Schirmer tear test (STT) results from both eyes. 60% of the study population was affected by KCS bilaterally and in these patients the summed STT result from both eyes was significantly lower than in unilaterally affected patients (p = 0.011 and p = 0.002 in left and right affected eye respectively). The STT results increased significantly from the initial visit to the second control in both eyes (left eye p = 0.013, right eye p = 0.002), with STT increasing more in the left than in the right eye. According to the findings, the most commonly applied treatment of eye cleansing, artificial tear replacers and topical cyclosporine A (CsA) seem to be effective in the management of KCS in the majority of the dogs in this study population.Kuiv keratokonjunktiviit (KCS) on koertel sageli esinev silmahaigus ja selle haiguse ravi võib osutuda väljakutseks. Käesoleva töö eesmärgiks oli analüüsida KCS kliinilisi juhtumeid Eesti Maaülikooli Väikeloomakliinikus haigestunud koerte tõu, vanuse ja soo osas, analüüsida kasutatud diagnostika meetodeid ja ravivõimalusi ning koostada soovitused KCS-ga koerte raviks. Uuringu andmed koguti Eesti Maaülikooli Väikeloomakliiniku patsientide andmebaasist. Patsientide populatsioon koosnes 45 koerast, keda raviti kliinikus KCS-a tõttu aastatel 2017–2022. Uuringus oli 23 erinevat tõugu koera, kusjuures Yorkshire'i terjer oli sagedamini esindatud (17.8%). Koerte vanuse kategooria (noor, keskmine vanus ja vanem; p = 0.989), soo (p = 0.837) ning summaarse Schirmeri pisaratesti (STT) tulemuste vahel seost ei leitud. KCS esines kahepoolselt 60% uuringupopulatsioonist ja nendel patsientidel oli mõlema silma summaarne STT tulemus oluliselt madalam kui ühepoolselt tabandunud patsientidel (p = 0.011 ja p = 0.002 vasakus ja paremas silmas). STT tulemused suurenesid oluliselt järgmisel kontrollil (vasak silm p = 0.013, parem silm p = 0.002), võrreldes esialgse visiidiga mõlemas silmas, kusjuures STT suurenes vasakus silmas rohkem kui paremas silmas. Tulemuste kohaselt, KCS-i ravis enamikul selle uuringupopulatsiooni koertel osutus tõhusamaks kõige sagedamini kasutatav ravi silmapuhastusega, pisaraasendajatega ja paikse tsüklosporiiniga (CsA)

Organization of the Medical Technical Department Processes in the Information Management of the Health Care District

Pirkanmaan sairaanhoitopiirin lääkintätekniikka on osa tietohallinnon ja teknologian vastuualuetta TAYS palvelukeskuksessa. Tietohallinto vastaa perustietotekniikan palveluiden lisäksi tietohallinnon palveluista, potilastietopalveluista ja tietohallinnon muutostöiden suunnittelusta. Lääkintätekniikka vastaa strategisista palveluista, kun taas operatiivisista palveluista vastaa Istekki Oy. Lääkintälaitteiden lainsäädäntö vaatii laitteiden laadun, turvallisuuden ja toiminnan mittaamista kvantitatiivisesti, minkä prosessinäkökulma mahdollistaa. Yhteiset toimintatavat kaikille tietoteknisille laitteille sairaanhoitopiirissä mahdollistavat tehokkaan ja turvallisen hoitoympäristön. Lääkintätekniikan ja tietohallinnon prosesseissa on paljon yhteisiä rajapintoja, sillä useat lääkintälaitteet ovat verkotettuja ja yhteydessä muihin laitteisiin. Verkotettujen lääkintälaitteiden elinkaaren aikainen ylläpito vaatii erikoisosaamista sekä tietotekniikasta että laitteen toiminnasta ja lainsäädännöstä. Lääkintätekniikan yhä enemmän digitalisoituessa tulisi huolehtia siitä, että prosesseja uudistetaan ja toimintatavoista pidetään kiinni yhteistyössä prosesseissa toimivien asiantuntijoiden kanssa. Lääkintälaitteiden elinkaaren hallinnalle on eduksi, jos palvelujen tuottaminen keskittyy sairaanhoitopiirissä samalle toimijalle.The Medical Technical Department of Pirkanmaa Hospital District is part of the Information Management Unit of the Hospital Service Center. Medical Technology is responsible of the strategic services, whereas Istekki Oy is responsible of the operative services of medical devices. Information Management Unit is responsible of the computer services, information management, patient information services and changes of information management. Medical devices are strictly regulated and the legislation requires quantitative measurements of quality, safety and functionality. This is possible by using a process approach of medical device management. Common policies for all interactive devices in the hospital district enables efficient and safe environment for healthcare. Medical technology and information management processes have common interfaces, since most of the current medical devices are in a network and connected to other devices. Medical devices connected to a network require maintenance with special competences from both computer sciences and medical devices functionalities, as well as legislation of medical devices. As digitalization makes progress also in medical technology, the organization should ensure that processes are being renewed and the policies are kept in cooperation with the medical technology professionals. Medical technology life cycle control benefits if the services are focused on one actor.publishedVersio