Tutkimus kuuluu yliopistosairaaloiden hoitohenkilökunnankin työnkuvaan

Tutkimuksista on tiedotettu vain sen verran, kuin tutkija on katsonut välttämättömäksi

Morphology and histology of silent and symptom-causing atherosclerotic carotid plaques - Rationale and design of the Helsinki Carotid Endarterectomy Study 2 (the HeCES2)

Introduction: Every fifth ischemic stroke is caused by thromboembolism originating from an atherosclerotic carotid artery plaque. While prevention is the most cost-effective stroke therapy, antiplatelet and cholesterol-lowering drugs have a ceiling effect in their efficacy. Therefore, discovery of novel pathophysiologic targets are needed to improve the primary and secondary prevention of stroke. This article provides a detailed study design and protocol of HeCES2, an observational prospective cohort study with the objective to investigate the pathophysiology of carotid atherosclerosis.Materials and Methods: Recruitment and carotid endarterectomies of the study patients with carotid atherosclerosis were performed from October 2012 to September 2015. After brain and carotid artery imaging, endarterectomised carotid plaques (CPs) and blood samples were collected from 500 patients for detailed biochemical and molecular analyses.Findings to date: We developed a morphological grading for macroscopic characteristics within CPs. The dominant macroscopic CP characteristics were: smoothness 62%, ulceration 61%, intraplaque hemorrhage 60%, atheromatous gruel 59%, luminal coral-type calcification 34%, abundant (44%) and moderate (39%) intramural calcification, and symptom-causing hot spot area 53%.Future plans: By combining clinically oriented and basic biomedical research, this large-scale study attempts to untangle the pathophysiological perplexities of human carotid atherosclerosis.Key MessagesThis article is a rationale and design of the HeCES2 study that is an observational prospective cohort study with the objective to investigate the pathophysiology of carotid atherosclerosis.The HeCES2 study strives to develop diagnostic algorithms including radiologic imaging to identify carotid atherosclerosis patients who warrant surgical treatment.In addition, the study aims at finding out new tools for clinical risk stratification as well as novel molecular targets for drug development.Peer reviewe

Yliopistosairaalan tutkimustoiminta hoitohenkilökunnan kokemana

Lääketieteellinen ja hoitotieteellinen tutkimustoiminta on välttämätöntä sairaalan toiminnan tuotekehityksen ja hoidon laadun kannalta. Yliopistosairaalan hoitohenkilökunnalta odotetaan myönteistä suhtautumista tutkimustoimintaan ja tutkimustoiminnassa avustamisen katsotaan kuuluvan jokaisen työntekijän toimenkuvaan. Opinnäytetyön tarkoituksena on kuvata hoitohenkilökunnan kokemuksia sairaalassa toteutettavasta tutkimustoiminnasta. Opinnäytetyön tavoitteena on tuottaa tietoa, jonka avulla voidaan kehittää ja edistää yhteistyötä tutkijoiden ja hoitohenkilökunnan välillä sekä vahvistaa tutkimustoiminnan asemaa yhtenä sairaalan perustehtävistä. Opinnäytetyön aineisto koostuu yhdeksäntoista (19) vastaajan kokemuksista. Vastaajat työskentelevät Meilahden sairaalassa hoitotyössä kahdella eri erikoisalan osastolla. Aineisto kerättiin viiden (5) avoimen kysymyksen avulla ja analysoitiin aineistolähtöisellä sisällönanalyysillä. Tulosten mukaan sairaalan tutkimustoiminta vaikuttaa hoitohenkilökunnan työhön monella eri tavalla. Vastaajat kuvasivat vastauksissaan tiedon puutteen kokemuksia, ylimääräisen työn kokemuksia sekä potilaan hoitoa ja hoitohenkilökunnan työtä vaikeuttavia kokemuksia. Tutkimuksista tiedottamisen käytännöt vaihtelevat suuresti. Tutkimustoiminta nähdään tärkeänä ja kaikkia hyödyttävänä toimintana, mutta tietoa tutkimusten vaiheista tai työn tuloksista ei saada lainkaan. Tulokset vastaavat pääosin aiempia tutkimustuloksia. Tulosten perusteella kehittämisehdotuksiksi nousevat tiedottamisen käytäntöjen kehittäminen ja yhtenäistäminen sekä tutkijoiden ja hoitohenkilökunnan välisen yhteistyön ja vuorovaikutuksen lisääminen. Tutkijoiden ja hoitohenkilökunnan välinen toimiva yhteistyö hyödyttäisi hoitohenkilökuntaa, tutkijoita, tutkimusta sekä potilasta. Laajemman tutkimuksen avulla tulisi selvittää, kuinka yleisiä vastaajien kuvaavat kokemukset ovat. Työssä saatua aineistoa voi hyödyntää jatkotutkimusten suunnittelun pohjana. Aihetta täydentämään olisi syytä selvittää myös tutkijoiden kokemuksia tutkijoiden ja hoito-henkilökunnan välisestä yhteistyöstä.Medical and nursing science research is essential for continued development of university hospital operations and contributes to improved quality of care. University hospital medical staff is expected to have a positive attitude towards research, and assistance in these research endeavors is considered an integral part of each university hospital employee's job description. In this study the experiences of the nursing staff assisting in research projects at the Helsinki University Hospital were investigated. The aim here is to provide information that can be used to develop and promote co-operation between researchers and medical nursing staff, as well as to strengthen the role of research as one of the core interest areas of any university hospital. The material in this thesis consists of the experiences of nineteen (19) nursing profession-als. Respondents in this study worked in the Meilahti hospital in two different specialized departments. Data were collected using an online accessible questionnaire containing five (5) open questions, and analyzed using established content analysis methods. Results shows that research activities impacts the work of university hospital nursing staff in many ways. In their replies participants reported that they had experienced a lack of shared information about the research project, increases in work load, as well as inconvenience affecting both patient care and personal work performance. It appears that practices regarding information sharing and keeping the nursing staff informed during different research projects varies extensively. Medical research is perceived to be an important part of university hospital practice, a function that ultimately benefits a wide audience. However, information on the progress of these research projects or their results are not readily available to the nursing staff. Essentially, these results are in line with previous data in the field. These results identify the distribution of uniform information and better co-operation between researchers and medical nursing staff as two potential improvement areas. Improved bidirectional co-operation between researchers and medical nursing staff would significantly benefit other medical personnel, researchers, and ultimately also the patient. A larger study should be conducted to determine how common the views uncovered in this study truly are. Results obtained from this study may serve as the bases for future research in this area. However, for more comprehensive view of the interplay between researchers and hospital nursing staff the experiences of the researchers should also be investigated

Warfarin Treatment Is Associated to Increased Internal Carotid Artery Calcification

Background: Long-term treatment with the vitamin K antagonist warfarin is widely used for the prevention of venous thrombosis and thromboembolism. However, vitamin K antagonists may promote arterial calcification, a phenomenon that has been previously studied in coronary and peripheral arteries, but not in extracranial carotid arteries. In this observational cohort study, we investigated whether warfarin treatment is associated with calcification of atherosclerotic carotid arteries. Methods: Overall, 500 consecutive patients underwent carotid endarterectomy, 82 of whom had received long-term warfarin therapy. The extent of calcification was assessed with preoperative computed tomography angiography, and both macroscopic morphological grading and microscopic histological examination of each excised carotid plaque were performed after carotid endarterectomy. Results: Compared with non-users, warfarin users had significantly more computed tomography angiography-detectable vascular calcification in the common carotid arteries (odds ratio 2.64, 95% confidence interval 1.51-4.63, P < 0.001) and even more calcification in the internal carotid arteries near the bifurcation (odds ratio 18.27, 95% confidence interval 2.53-2323, P < 0.001). Histological analysis revealed that the intramural calcified area in plaques from warfarin users was significantly larger than in plaques from non-users (95% confidence interval 3.36-13.56, P = 0.0018). Conclusions: Long-lasting warfarin anticoagulation associated with increased calcification of carotid atherosclerotic plaques, particularly in locations known to be the predilection sites of stroke-causing plaques. The clinical significance of this novel finding warrants further investigations.Peer reviewe