Vaikeahoitoinen epilepsia ja masennus

Epilepsian haitat ja rajoitukset ulottuvat toimintakykyyn kokonaisvaltaisesti. Vaikeahoitoista epilepsiaa sairastavien keskuudessa kielteiset vaikutukset ovat entisestään korostuneet ja sairauteen liittyy huomattavasti kohonnut tapaturma- ja äkkikuolemariski. Asianmukaisella, ajoissa aloitetulla lääkehoidolla voidaan ehkäistä lääkeresistenttiä epilepsiaa. Masennustila on merkittävä kansanterveydellinen ongelma ja sen 12 kuukauden esiintyvyydeksi on raportoitu 6,8 %. Perusterveydenhuollon potilaista noin yhdellä kymmenestä arvioidaan olevan kliinisesti merkittävä masennus. Epilepsian ja masennuksen taustalla on yhteisiä patogeenimekanismeja. Epilepsian ja neuropsykiatristen oireiden suhde on kaksisuuntainen. Psykiatristen oireiden ja häiriöiden esiintyvyys on yliedustettuna epileptikoiden keskuudessa. Ohimo- ja otsalohkoepilepsiassa on havaittu muita epilepsioita korkeampi riski psyykkisiin oireisiin. Toisaalta psykiatrisesti oireilevien riski sairastua epilepsiaan on moninkertainen. Psykiatrisista häiriöistä yleisin on masennus. Epilepsia myötävaikuttaa kliinisesti merkittävän masennuksen puhkeamisessa. Se heikentää merkittävästi epileptikoiden elämänlaatua, kohottaa kohtausaktiivisuutta ja lisää terveyspalvelujen käyttöä. Ongelmaan kytkeytyy myös masennuksen alidiagnosointi ja puutteellinen hoito. Vaikeahoitoista epilepsiaa sairastavilla potilailla on mahdollisesti yli 50% elinikäinen prevalenssi depressiolle. Tämän kirjallisuuskatsauksen tarkoituksena on kuvata ja tutkia assosiaatioyhteyden voimakkuutta epilepsian ja masennustilan välillä. Asiaa arvioidaan aiheesta julkaistujen tutkimusten ja kirjallisuuden avulla

Can a long-term continuing education course in patient counselling promote a change in the practice of Finnish community pharmacists?

Access restricted by publisherObjective To assess community pharmacists' perceptions of the impact of a long-term continuing education (CE) course on their patient counselling skills. Methods Three focus groups were conducted with the course participants (n = 17) during the last module of the CE course. Data were analysed using computer software for qualitative analysis. Key findings The focus groups revealed eight preliminary categories that were further categorised into four themes related to the learning process in patient counselling skills. The first theme related to achieving the learning objectives. The second related to personal development, understanding principles of two-way communication, and problems in their implementation in practice. The third theme related to actions taken by the participants in their work place, and the fourth involved the potential conflict between the new skills gained and the traditional communication culture in the participant's pharmacy. Conclusion The CE course provided the community pharmacists with new skills and knowledge in patient counselling and collective in-house training. The findings show that the greatest challenge is to change the communication culture of the pharmacy. To achieve this, it may be necessary for more than one pharmacist from the same pharmacy to participate in the training process at the same time

Ravinnon proteiinin aiheuttama enterokoliitti - pienten lasten harvinainen ongelma

Ravinnon proteiinin aiheuttama enterokoliitti (FPIES) on ei-IgE-välitteinen ruoka-ainereaktio, jonka tarkka mekanismi on vielä tuntematon. Kyseessä on tavallisesti yhden ruoka-aineen laukaisema runsasta oksentelua, ripulointia ja kalpeutta aiheuttava reaktio, joka alkaa muutaman tunnin kuluessa altistumisesta. Oireet alkavat tyypillisesti alle vuoden iässä. Vakavissa tapauksissa reaktio voi johtaa vaikeaan nestetasapainon häiriöön tai tajuttomuuteen. Oireet voidaan estää tarkalla välttämisruokavaliolla. Oksentelun aiheuttamaa kuivumista voidaan hillitä nesteytyksellä ja pahoinvointia lievittää pahoinvointilääke ondansetronilla. Oireet ohittuvat itsestään alle vuorokaudessa. Diagnoosi varmistetaan avoimella valvotulla ruoka-ainealtistuksella. FPIES-enterokoliitin ennuste on hyvä, oireet tyypillisesti ohittuvat ja välttämisruokavalio päästään purkamaan kolmen vuoden ikään mennessä.publishedVersionPeer reviewe

Progress in patient couselling practices in Finnish community pharmacies

Access restricted by publisherObjective The aim of this study was to assess progress in patient counselling practices in Finnish community pharmacies during a national four-year program (TIPPA) from 2000–2003 promoting enhanced pharmacist–customer communication about medicines. Method A pseudo customer method was applied. Four visits with four different scenarios were conducted in a convenience sample of 60 Finnish community pharmacies of different size and geographic location. In total there were 240 visits during each time point measured (baseline in 2000 and three annual follow-ups, n = 960). The pseudo customers presented three scenarios related to self-medication and one related to a prescription medicine with a new prescription (baseline and the second follow-up) or a repeat prescription of the same medication (the first and the third follow-up). A structured data form customised to each scenario was used to record the interaction. Key findings Baseline scores were generally low. In two of the four scenarios (one self-medication and one prescription) a statistically significant improvement (P < 0.05) was found in total scores between the baseline and the third follow-up. Aggregation of the scores of the three self-medication scenarios did not show any change in counselling practices between the baseline and the third follow-up, measured as mean total scores (P = 0.439). Conclusions Some improvements were found in pharmacists' counselling performance in relation to customers' requests for advice about nasal products and also when prescription scenarios were presented. However, pharmacists' counselling rates were low in relation to a repeat prescription or when a request was made to buy a specific medicine. Further attention needs to be paid to the latter two types of consultation

The Relationship of the Anthropometric Variables to the Infusion Rate of Rocuronium in the Elderly

We have determined the infusion rates of rocuronium in the elderly and young adult patients during sevoflurane and nitrous oxide anesthesia. The correlation of some anthropometric predictors with infusion rate of rocuronium was also investigated for both elderly and young adult. Participating patients were assigned to one of two groups: 1) young adult patients aged 20 to 50 years (n = 30); 2) elderly patients aged over 65 years (n = 30). The anthropometric variables such as height, weight, ratio of weight to body surface area, subscapularis and suprailiac skin folds, body surface area, body mass index and % ideal body weight were evaluated as predictors for infusion rate. The infusion rate in elderly patients was significantly less compared with that in young adult patients (p < 0.05). In elderly patients, no anthropometric predictor was related to the infusion rate of rocuronium. This suggests that the infusion rate of rocuronium for an elderly patient needs to be individualized by monitoring neuromuscular transmission to avoid excessive dose