13 research outputs found
Denial of long-term issues with agriculture on tropical peatlands will have devastating consequences
Tajunnaltaan alentuneen potilaan työdiagnoosin määrittäminen ensihoitovaiheessa
Opinnäytetyön tarkoituksena on luoda kirjallisuuskatsauksen pohjalta systemaattinen tapa haastatella ja tutkia tajunnaltaan alentunutta potilasta ensihoitovaiheessa. Potilaasta saatujen löydösten, oireiden sekä anamneesin kautta luodaan käsitys työdiagnoosista, jota voidaan vahvistaa kirjallisuuskatsauksen pohjalta tehtyjen taulukoiden avulla.
Tajuttomuudelle on useita syitä ja käsiteltäväksi on valittu syyt, joiden toteaminen on ensihoidossa mahdollista. Tajuttomuuden syyt on jaettu kolmeen eri ryhmään, systeemisiin syihin, kallonsisäisiin syihin sekä muihin keskushermostollisiin syihin ja infektioihin. Systeemisiä syitä ovat alkoholiepilepsia, hapenpuute, hiilidioksidiretentio, intoksikaatio, maksan vajaatoiminta ja maksakooma, metaboliset syyt, nestetasapainon häiriöt ja riittämätön verenkierto. Kallonsisäisiä syitä ovat aivoinfarkti, aivoverenvuodot, aivovammat, kohonnut kallonsisäinen paine ja hydrokefalus. Muihin syihin lukeutuvat epileptiset kohtaukset, alkoholiepilepsia, bakteerimeningiitti, enkefaliitti ja sepsis. Potilaiden oireet ovat moninaisia ja kaikkien potilaiden tutkimisessa tulee noudattaa ABCDE-protokollaa, jottei mikään asia jää huomioimatta.
Tämä opinnäytetyö tuottaa kaksi erilaista taulukkoa tajunnaltaan alentuneen potilaan työdiagnoosin määrittämiseen. Taulukoista ensimmäinen toimii yhteenvetona kirjallisuuskatsauksesta, eli siitä löytyy tiivistettynä jokaiseen työdiagnoosin liittyvät tiedot. Tätä voidaan käyttää työdiagnoosin varmistamisen tukena. Jälkimmäisen taulukon merkitys korostuu kun mahdollisia työdiagnooseja on useita. Taulukko antaa mahdollisuuden tarkastella työdiagnooseja uudelleen, mikäli jokin yksittäinen tekijä ei sovi jo epäiltyyn syyhyn, jolloin herää epäily työdiagnoosin riittämättömyydestä. Taulukoiden käyttö vaatii tietoa sairauksista sekä patofysiologiasta.
Opinnäytetyö on osa InnoHealth-hanketta. Tätä opinnäytetyötä tullaan sen julkaisemisen jälkeen säilyttämään Turun ammattikorkeakoulun Ruiskadun-toimipisteen kirjastossa sekä se tulee löytymään Theseus-tietokannasta.The goal of this thesis is to create a systematic method for assessing a patient with decreased level of consciousness during acute care phase based on the literature review. A working diagnosis is made based on a patient's signs, symptoms and medical history. The working diagnosis can be backed up with charts based on the literature review.
There are many causes for unconsciousness and the causes covered in this thesis are ones which can be determined in acute care phase. The causes of unconsciousness are divided into three different groups: systemic, intracranial and central nervous system and infectious causes. Systemic causes are alcohol related epilepsy, hypoxia, carbon dioxide retention, intoxication, liver failure and hepatic coma. Intracranial causes are stroke, intracranial haemorrhage, brain injuries, elevated intracranial pressure and hydrocephalus. Other causes include epileptic seizures, bacterial meningitis, encephalitis and sepsis. Patients' symptoms are diverse and when performing the assessment one should follow the ABCDE -protocol in order to avoid missing anything.
This thesis will produce two different charts used to come up with a working diagnosis in patients with decreased level of consciousness. The first chat works as a summary of the literature review. The chart summarizes all the information from the working diagnosis. This can be used as a confirming the right working diagnosis. The second chart on the other hand is meat to provide opportunity to view the working diagnosis anew when there are several possible working diagnoses. To use this charts the user needs to have knowledge about the illnesses and pathophysiology.
This thesis is part of the InnoHealth -project. This thesis will be available after publication in the Ruiskatu - facility library of Turku University of Applied Sciences. It can also be found in the Theseus database
Uniapneapotilaiden maskin valintasovelluksen pilotti TYKS keuhkoklinikalla
Uniapneapotilaiden maskin valintasovelluksen pilotti TYKS keuhkoklinikalla
Terveysteknologian rooli nähdään kustannustehokkaana menetelmänä vapauttaa hoitohenkilökunnan resursseja itse hoitotyöhön, kun uniapneapotilaiden määrät ovat kasvaneet ja on löydettävä uusia lähestymistapoja tasa-arvoisten terveyspalveluiden takaamiseksi. Tyks keuhkoklinikka on lähtenyt yhdessä valmistajien kanssa kehittämään ja muuttamaan toimintamallejaan ja tämän yhteistyön tuloksena on syntynyt uusia tapoja tarjota potilaille laadukasta ja yksilöllistä hoitoa.
Opinnäytetyössä seurattiin uniapnean hoitoon tarkoitetun maskin valintasovelluksen pilottia keuhkoklinikalla keväällä 2023 hoitohenkilökunnan näkökulmasta. Tutkimuksen tavoitteena oli selvittää henkilökunnan käyttökokemuksia, miten sovelluksen käyttö vaikutti heidän työnkulkuunsa sekä voisiko sovellus vaikuttaa organisaation kustannuksiin.
Tutkimusmateriaali kerättiin yhteistyössä keuhkopoliklinikan henkilöstön kanssa ja aineistonkeruumenetelminä tässä työssä käytettiin teemahaastattelua sekä kyselytutkimusta. Saatu aineisto arvioitiin aineistolähtöisellä sisällönanalyysilla.
Tutkimuksen perusteella sovellus koettiin lupaavaksi, mutta se vaatii vielä kehittämistä pilotista kerätyn palautteen avulla. Kun ongelmakohdat on saatu korjattua, uskotaan tämän soveltuvan hyvin yhdeksi työvälineeksi, jota voitaisiin hyödyntää niin hoidon aloituksissa kuin maski vaihdoissakin
Lääkehoidon turvallisuuden kartoittaminen yhteispäivystys Acutassa
Turvallinen lääkehoito on osa nykyaikaista potilashoitoa. Lääkehoitoon liittyvät haittatapahtumat muodostavat merkittävän osan terveydenhuollon haitta-ja vaaratapahtumista. Ongelma on globaali ja maailman terveysjärjestö WHO:n tilastojen mukaan vuodelta 2019 lääkitysvirheet aiheuttavat vuosittain yli 42 miljardin menot. Jokainen lääkehoitoa toteuttava on avainasemassa lääkitysvirheiden vähentämisessä.
Tays Ensiapu Acuta tarjoaa ympärivuorokautista päivystyshoitoa ja vuosittaisia päivystyskäyntejä on yli 100 000. Päivittäin kävijöitä on kahdesta kolmeen sataan. Opinnäytetyössä kartoitettiin vuosien 2017 ja 2018 ajalta työyksikössä tehtyjä HaiPro-ilmoituksia liittyen lääkehoitoon. Ilmoituksia kartoittamalla etsittiin vastauksia siihen, millaisissa tilanteissa potilaiden lääkehoidon toteutuksessa tapahtui haitta- ja vaaratapahtumia. Tutkimus aineisto analysoitiin laadullisen sisällön analyysin mukaan ja kyseessä oli laadullinen tutkimus
Kartoituksen perusteella haittatapahtumia lääkehoidossa tapahtui potilaille lääkityksiä määrätessä ja kotilääkitysten tarkastamisessa. Potilaat saivat lääkkeitä väärin tai eivät saaneet kaikkia tarvitsemiaan lääkkeitä. Nestehoidon ja verensiirtojen toteuttamisessa havaittiin puutteita. Lääkehoidon kirjaamisessa oli myös puutteita. Lääkehoidon määräyksiin liittyvien haittatapahtumien näkökulmasta suurin ongelma oli se, että potilaat siirtyivät Acutasta jatkohoitoon puutteellisin lääkitysohjein ja tiedot potilaiden kotona käyttämistä lääkkeistä eivät siirtyneet oikein. Lääkkeenantoon liittyvillä haittatapahtumilla tarkoitetaan tilanteita, joissa potilas on saanut väärää lääkettä tai lääkkeen väärin. Aineiston mukaan saatiin selville, että potilailta jäi toistuvasti saamatta esimerkiksi riittävää kipulääkitystä tai hoitonsa kannalta olennaisia kotilääkkeitä.
Kiire, stressi ja suuri henkilöstön määrä ja vaihtuvuus ovat omiaan altistamaan lääkitysvirheille. Selvityksen perusteella työyksikköön tarvittaisiin enemmän yhtenäisiä käytäntöjä ja ohjeistuksia, joiden avulla voitaisiin välttää haittatapahtumia. Henkilöstön perehdyttäminen ja koulutus ovat myös avainasemassa.Medication safety is part of modern patient care. Medication errors are most common adverse effects. It causes costs over 42 billions worldwide each year. Everyone giving medical care, especially nurses, has crucial part of taking responsibility of it.
Tays ensiapu Acuta is an emergency department in Tampere Finland. There are over 100 000 visits every year, 200-300 patients per day. The aim of this study was to explore adverse effect notices from years 2017 and 2018 about medication errors. The study method was qualitative. There were problems recording medication.
The study showed that medical errors occurred mostly when medication was prescribed. There were also notices about patients receiving wrong medications or patients receiving no medications at all. There were also problems with fluid therapy and blood transfusions.
The results indicated that stress, rush, enormous number of staff and turnover off staff are risks for medical errors. Organization needs more common guidelines and compatible working methods to reduce errors. Education of staff is also an important method of decreasing medical errors
Key Questions and Recent Research Advances on Harmful Algal Blooms in Stratified Systems
22 pages, 5 figuresThe GEOHAB Core Research Project (CRP) on HABs in Stratified Systems was a crosscutting project focused on the relevance of physical structure to fundamental life processes of harmful microorganisms such as growth (together with nutrient and light availability), reproduction, life cycle, and ecological interactions. Advances in this area have heavily depended on the development of innovative instruments to observe and adequately sample these environments, as well as on improvements in numerical modelling techniques (GEOHAB 2011, 2013; Berdalet et al. 2014). [...]Peer reviewe
Stathmin Protein Level, a Potential Predictive Marker for Taxane Treatment Response in Endometrial Cancer
Denial of long-term issues with agriculture on tropical peatlands will have devastating consequences
The first International Peat Congress (IPC) held in the tropics - in Kuching (Malaysia) - brought together over 1000 international peatland scientists and industrial partners from across the world (“International Peat Congress with over 1000 participants!,” 2016). The congress covered all aspects of peatland ecosystems and their management, with a strong focus on the environmental, societal and economic challenges associated with contemporary large-scale agricultural conversion of tropical peat.
However, recent encouraging developments towards better management of tropical peatlands have been undermined by misleading newspaper headlines and statements first published during the conference. Articles in leading regional newspapers (“Oil palm planting on peat soil handled well, says Uggah,” 2016; Cheng & Sibon, 2016; Nurbianto, 2016a, 2016b; Wong, 2016) widely read across the region, portrayed a general consensus, in summary of the conference, that current agricultural practices in peatland areas, such as oil palm plantations, do not have a negative impact on the environment. This view is not shared by many scientists, or supported by the weight of evidence that business-as-usual management is not sustainable for tropical peatland agriculture.
Peer-reviewed scientific studies published over the last 19 years, as reflected in the Intergovernmental Panel on Climate Change (IPCC) Wetland Supplement on greenhouse gas inventories, affirms that drained tropical peatlands lose considerable amounts of carbon at high rates (Drösler et al., 2014). Tropical peat swamp forests have sequestered carbon for millennia, storing a globally significant reservoir below ground in the peat (Page et al., 2011; Dommain et al., 2014). However, contemporary agriculture techniques on peatlands heavily impact this system through land clearance, drainage and fertilization, a process that too often involves fire. Along with biodiversity losses driven by deforestation (Koh et al., 2011; Posa et al., 2011; Giam et al., 2012), the carbon stored in drained peatlands is rapidly lost through oxidation, dissolution and fire (Couwenberg et al., 2009; Hirano et al., 2012; Ramdani & Hino, 2013; Schrier-Uijl et al., 2013; Carlson et al., 2015; Warren et al., 2016). Tropical peat fires are a major contributor to global greenhouse gas emissions and produce transboundary haze causing significant impacts on human health, regional economies and ecosystems (Page et al., 2002; Marlier et al., 2012; Jaafar & Loh, 2014; Chisholm et al., 2016; Huijnen et al., 2016; Stockwell et al., 2016). With future El-Niño events predicted to increase in frequency and severity (Cai et al., 2014) and with fire prevalence now decoupled from drought years (Gaveau et al., 2014), future large scale fire and haze events are imminent given the extensive areas of now drained fire prone drained peatlands (Kettridge et al., 2015; Turetsky et al., 2015; Page & Hooijer, 2016).
In reality, just how much of the estimated 69 gigatonnes of carbon (Page et al., 2011) stored in Southeast Asian tropical peatlands is being lost due to agricultural operations under the current management regime is still uncertain. Of great concern is that none of the agricultural management methods applied to date have been shown to prevent the loss of peat and the associated subsidence of the peatland surface following drainage (Wösten et al., 1997; Melling et al., 2008; Hooijer et al., 2012; Evers et al., 2016). Recent projections suggest that large areas of currently drained coastal peatlands will become un-drainable, and progressively be subjected to longer periods of inundation by river and ultimately sea water (Hooijer et al., 2015a, 2015b; Sumarga et al., 2016). With growing risk of saltwater intrusion, agriculture in these coastal lands will become increasingly untenable, calling into question the very notion of “long-term sustainability of tropical peatland agriculture”.
A more accurate view of drained peatland agriculture is that of an extractive industry, in which a finite resource (the peat) is ‘mined’ to produce food, fibre and fuel, driven by global demand. In developing countries with growing populations, there are strong socio-economic arguments for exploiting this resource to support local livelihoods and broader economic development (Mizuno et al., 2016). However, an acceptance that on-going peat loss is inevitable under this scenario. Science-based measures towards improved management, including limitations on the extent of plantation development, can be used to minimise the rate of this peat loss (President of Indonesia, 2011). Such an evidence-based position, supported with data and necessary legal instruments are needed for sustainable futures. The scientifically unfounded belief that drained peatland agriculture can be made ‘sustainable’, and peat loss can be halted, via unproven methods such as peat compaction debilitates the effort to find sustainable possibilities. To a large extent, the issues surrounding unsustainable peatland management have now been recognized by sections of industry (Wilmar, 2013; APP, 2014; Cargill Inc., 2014; Mondelēz International, 2014; Sime Darby Plantation, 2014; APRIL, 2015; Olam International, 2015), government (President of Indonesia, 2014, 2016; Mongabay, 2015; Mongabay Haze Beat, 2015; Hermansyah, 2016) and consumers (Wijedasa et al., 2015). In recognition of the constraints and risks of peatland development, many large and experienced oil palm and pulpwood companies have halted further development on peat and introduced rigorous management requirements for existing peatland plantations(Lim et al., 2012). However, the denial of the empirical basis calling for improved peatland management remains persistent in influential policy spaces, as illustrated by the articles reporting on the conference (“Oil palm planting on peat soil handled well, says Uggah,” 2016; Cheng & Sibon, 2016; Nurbianto, 2016a, 2016b).
The search for more responsible tropical peatland agriculture techniques includes promising recent initiatives to develop methods to cultivate crops on peat under wet conditions (Giesen, 2015; Dommain et al., 2016; Mizuno et al., 2016). While a truly sustainable peatland agriculture method does not yet exist, the scientific community and industry are collaborating in the search for solutions(International Peat Society, 2016), and for interim measures to mitigate ongoing rates of peat loss under existing plantations. Failing to recognize the devastating consequences of the current land use practices on peat soils and failing to work together to address them could mean that the next generation will have to deal with an irreversibly altered, dysfunctional landscape where neither environment nor society, globally or locally, will be winners.JRC.D.1-Bio-econom
Sleep apnoea is a risk factor for severe COVID-19
Background Obstructive sleep apnoea (OSA) is associated with higher body mass index (BMI), diabetes, older age and male gender, which are all risk factors for severe COVID-19.We aimed to study if OSA is an independent risk factor for COVID-19 infection or for severe COVID-19.Methods OSA diagnosis and COVID-19 infection were extracted from the hospital discharge, causes of death and infectious diseases registries in individuals who participated in the FinnGen study (n=260 405). Severe COVID-19 was defined as COVID-19 requiring hospitalisation. Multivariate logistic regression model was used to examine association. Comorbidities for either COVID-19 or OSA were selected as covariates. We performed a meta-analysis with previous studies.Results We identified 445 individuals with COVID-19, and 38 (8.5%) of them with OSA of whom 19 out of 91 (20.9%) were hospitalised. OSA associated with COVID-19 hospitalisation independent from age, sex, BMI and comorbidities (p-unadjusted=5.13×10−5, OR-adjusted=2.93 (95% CI 1.02 to 8.39), p-adjusted=0.045). OSA was not associated with the risk of contracting COVID-19 (p=0.25). A meta-analysis of OSA and severe COVID-19 showed association across 15 835 COVID-19 positive controls, and n=1294 patients with OSA with severe COVID-19 (OR=2.37 (95% 1.14 to 4.95), p=0.021).Conclusion Risk for contracting COVID-19 was the same for patients with OSA and those without OSA. In contrast, among COVID-19 positive patients, OSA was associated with higher risk for hospitalisation. Our findings are in line with earlier works and suggest OSA as an independent risk factor for severe COVID-19
Genetic architecture of human plasma lipidome and its link to cardiovascular disease
Abstract
Understanding genetic architecture of plasma lipidome could provide better insights into lipid metabolism and its link to cardiovascular diseases (CVDs). Here, we perform genome-wide association analyses of 141 lipid species (n = 2,181 individuals), followed by phenome-wide scans with 25 CVD related phenotypes (n = 511,700 individuals). We identify 35 lipid-species-associated loci (P <5 ×10−8), 10 of which associate with CVD risk including five new loci-COL5A1, GLTPD2, SPTLC3, MBOAT7 and GALNT16 (false discovery rate<0.05). We identify loci for lipid species that are shown to predict CVD e.g., SPTLC3 for CER(d18:1/24:1). We show that lipoprotein lipase (LPL) may more efficiently hydrolyze medium length triacylglycerides (TAGs) than others. Polyunsaturated lipids have highest heritability and genetic correlations, suggesting considerable genetic regulation at fatty acids levels. We find low genetic correlations between traditional lipids and lipid species. Our results show that lipidomic profiles capture information beyond traditional lipids and identify genetic variants modifying lipid levels and risk of CVD