Ensihoidon koulutusohjelman nykytila : Kyselytutkimus valmistuville Ensihoitaja (AMK) -opiskelijoille

Kyselytutkimuksen tarkoituksena oli kartoittaa syksyllä 2008 opintonsa aloittaneiden Ensihoitaja (AMK) -opiskelijoiden mielipiteitä ensihoidon koulutusohjelman sisällöstä sekä sen antamista ammatillisista valmiuksista. Tutkimukseen osallistui 56 syksyllä 2008 opintonsa aloittanutta ensihoitajaopiskelijaa viidestä eri suomalaisesta ammattikorkeakoulusta. Kvantitatiivisena kyselytutkimuksena toteutetun tutkimuksen sisältö perustui Opetusministeriön laatimaan selvitykseen ammattikorkeakouluista valmistuvien ensihoitajien ammatillisesta osaamisesta sekä keskeisistä opinnoista. Kyseinen selvitys toimii myös ohjeistuksena ammattikorkeakoulutasoisen ensihoitajakoulutuksen järjestämisestä. Tämän lisäksi työssä kartoitettiin opiskelijoiden kokemuksia opetuksen laadusta. Tutkimuksesta kävi ilmi että ammattikorkeakoulujen kliinisten taitojen opetus on opiskelijoiden mielestä hyvällä tasolla, sekä ensihoidon välineistön ja laitteiden että eri potilasryhmien ensihoidon opetus koettiin riittäväksi. Opiskelijat toivoivat kuitenkin opintojen painottumista sekä pienryhmä- että simulaatioharjoitteluun sekä käytännön työelämässä tapahtuvien harjoitteluiden painottumista akuuttihoitotyöhön. Tämän lisäksi opiskelijat kokivat erityisesti viestiliikenteen hallinnan sekä turvallisen hälytysajon opetuksen ja harjoittelun riittämättöminä. Ensihoidon ammattiopintojen opetus koettiin laadukkaana. Muiden kuin ensihoidon ammattiopintojen koettiin tukevan heikosti ensihoidon osaamista. Opiskelijoiden kokemusten perusteella ensihoitajakoulutuksen valintakokeet mittaavat heikosti alalla työskentelyssä vaadittavia fyysisiä sekä psyykkisiä ominaisuuksia, lisäksi opiskelijat kokivat, ettei koulutusohjelma tue lainkaan fyysisen kunnon ylläpitämistä opiskeluaikana. Tutkimuksella pystyttiin tuomaan ilmi nykyisen ensihoitajakoulutuksen ongelmakohtia opiskelijoiden kokemana, näiden pohjalta ensihoidon koulutusohjelman sisältöä tulisi kehittää vastaamaan paremmin opiskelijoiden sekä työelämän vaatimuksia. Suurimpana kehitysideana tulisi pohtia hyvinkin teoriapainotteisen koulutuksen muuntamista käytännönläheisemmäksi sekä ensihoitajan tutkintoon sisältyvien sairaanhoitajan opintojen kohdentamista paremmin ensihoidon ammattiosaamista tukeviksi.The aim of this study was to map the opinions of emergency nurses about the contents of the Degree Programmes in Emergency Care and about the quality of the teaching. The sample consisted of 56 graduating emergency nurses from five universities of applied sciences. The quantitative survey carried out as part of the study was based on the main contents of a report by the Ministry of Education that dictates the minimum professional skills of graduating emergency nurses. The main topics in the questionnaire were about the professional skills and key studies of emergency nurses. According to this study, the quality of teaching was on a good level as regards clinical skills. The students also experienced that the teaching of equipment and devices used in emergency care as well as the treatment of different patient groups was also adequate. However, the students required more teaching of practical skills in smaller groups and more simulation training. The students also emphasised that most of the clinical training should take place in acute nursing. The majority of participants wanted more training in the use of the Public Authority Network (VIRVE) device and in emergency vehicle operation. The non-emergency nursing studies included in the Degree Programme in Emergency Care supported emergency care skills poorly. The students also emphasised that the entrance exams do not properly measure the physical and psychological properties required in the everyday work of emergency nurses. The findings indicated that the contents of the Degree Programmes in Emergency Care should be more emphasised on the practical studies. The non-emergency nursing studies included in the Degree Programme in Emergency Care should be modified so that they would support emergency care proficiency

Effect of exhalation flow rates and level of nitric oxide output on accuracy of linear approximation of pulmonary nitric oxide dynamics

The method of Tsoukias and George (T and G) is a commonly used linear approximation of pulmonary nitric oxide (NO) dynamics that can be used to calculate bronchial NO output (JawNO) and alveolar NO concentration (CANO). We aimed to investigate how flow rate range in exhaled NO measurements and levels of pulmonary NO parameters affect the accuracy of the T and G method. This study has three parts. (a) A theoretical part demonstrating how different exhalation flow rates and NO parameter levels affect the accuracy of the T and G method, (b) testing how exhalation flow rate range affects the method in a sample of asthmatic and healthy subjects, and (c) a meta-analysis of published literature to test whether minimum flow rate has an association with the NO parameter values. We found that both the chosen exhalation flow rates and magnitude of the pulmonary NO parameters affect the accuracy of the T and G method. Underestimation of JawNO increased with lower flow rates and higher bronchial diffusion factor of NO (DawNO), while overestimation of CANO increased with higher DawNO and bronchial wall NO concentration (CawNO) and lower CANO. Of the NO parameters, CANO was the most prone to bias and high DawNO was the most significant factor causing the bias. Furthermore, we found that using 40 ml s-1 as the lowest flow rate in our sample and 50 ml s-1 in the meta-analysis compared to 100 ml s-1 resulted in higher CANO, but JawNO was not statistically significantly affected. We have provided objective evidence that not only the flow rates used but also the magnitude of NO output in the test subjects affect the accuracy of the T and G method. We suggest that flow rates below 100 ml s-1 should not be used with the T and G method to maintain accuracy.acceptedVersionPeer reviewe

Employment status and changes in working career in relation to asthma : a cross-sectional survey

Background: Asthmatics confront inconveniences in working life that make it more difficult to pursue a sustainable career, such as unemployment and work disability. Ways of dealing with these inconveniences may be career changes. More needs to be known about the backgrounds and consequences of career changes among asthmatics, especially their relation to asthma or a change in asthma symptoms. The aim of this study was to compare earlier career changes of adults with asthma who are working full time to those who have drifted away from active working life because of work disability, unemployment or early retirement. The frequency of having changed tasks, work place or occupation, whether the changes had been driven by asthma and furthermore, whether the changes had affected their asthma symptoms were investigated. Methods: In this population-based survey study, all patients with reimbursement rights for asthma aged 20-65 years in the city of Tampere (total population 190,000), Finland (n = 2613) were recruited. The questionnaire was sent in October 2000 and the response rate was 79%. The questionnaire included questions e.g. on changing tasks, work place and occupation, whether these changes were driven by asthma or associated with change of asthma symptoms. The respondents were divided into four groups: working full-time, work disability, unemployed and retired due to age. We applied ANOVA with Dunnet's post-test (variances were not equal between the groups) for a continued variable age and Chi-squared tests for categorical variables. Logistic regression models were built using unemployed vs. full-time work or work disability vs. full-time work as an outcome variable. A p-value of Results: Adults with asthma working full time had more often made changes in their career, but not as often driven by asthma as those with current work disability. The reason for changing work place compared to full-time workers (24.9%) was more often mainly or partly due to asthma among those with work disability (47.9%, p <0.001) and the unemployed (43.3%, p = 0.006). Of those who made career changes because of asthma, a major proportion (over 67%) reported relief in asthma symptoms. Changing tasks (OR 5.8, 95% CI 1.9-18.0, for unemployment vs. full-time work), work place (OR 2.8, 95% CI 1.1-7.0, for work disability vs. full-time work and OR 2.6, 95% CI 1.3-5.4, for unemployment vs. full-time work) or occupation (OR 2.7, 95% CI 1.2-6.0, for unemployment vs. full-time work) mainly because of asthma was associated with an elevated risk for undesirable employment status even after adjusting for age, gender, smoking and professional status. Conclusions: Career changes that were made mainly because of asthma were associated with undesirable employment status in this study. However, asthma symptoms were relieved after career changes especially among those who reported asthma to be the reason for the change. In addition to proper treatment and counselling of asthma patients towards applicable area of work or study, it may be beneficial to support early career changes in maintaining sustainable working careers among adults with asthma.Peer reviewe

Asthma trigger perceptions are associated with work disability

Objective: To study the association between perceptions of various triggers of asthma and employment status. Methods: A questionnaire was administered to all those adults living in the city of Tampere, Finland, who were entitled to special reimbursement for asthma medication by the Social Insurance Institution (n = 2613). The response rate was 79%. The study population (n = 1657) consisted of individuals who worked full-time (n = 967), were unemployed (n = 197), had all-cause work disability (n = 334), or were retired due to old age (n = 159). Given a list of potential asthma triggers, the respondents were asked how often (never/sometimes/often) the trigger caused or worsened their asthma symptoms during leisure time. Results: After adjusting for background variables (age, sex, smoking, and professional status), frequency of asthma symptoms, and the use of asthma medication during the last year, any individual trigger identified as asthma-relevant was associated with having work disability (vs. working full-time). The highest odds ratio (OR) was found for vehicle exhaust (OR 5.0, CI 2.2-11.4). We found similar but less consistent associations between asthma trigger perceptions and unemployment. No elevated ORs were found regarding asthma trigger perceptions for old-age retirement. Conclusions: Perceptions of asthma triggers are associated with all-cause work disability. Our findings suggest that asthmatics have excess trigger perceptions that are not explained by asthma alone. Asthmatics need to be informed that inaccurate trigger perceptions may develop, and how they are induced, because unnecessary trigger avoidance may interfere with work life.Peer reviewe

Symptom control among asthmatics with a clinically significant smoking history : a cross-sectional study in Finland

Background Surprisingly little is known about asthma control among asthmatics who smoke. The aim of this cross-sectional study was to investigate asthma symptom control according to the GINA guidelines among asthmatics with a clinically significant smoking history. Methods One hundred ninety asthmatics from primary care in Finland were investigated. The patients were current or previous cigarette smokers with a history of 10 or more pack-years. They completed a questionnaire including questions on asthma symptoms and reliever use so that their level of asthma symptom control (well controlled, partly controlled, or uncontrolled) according to GINA could be determined. Results Sixty-six (34.7%) patients had their asthma well controlled, 81 (42.6%) had their asthma partly controlled, and 43 (22.6%) had uncontrolled asthma. Current smokers had uncontrolled asthma more often than ex-smokers, OR 2.54 (95% CI 1.25-5.14, p = 0.01). Patients with moderate to severe asthma exacerbation during the previous year had uncontrolled asthma more often than patients without an exacerbation, OR 2.17 (95% CI 1.06-4.47, p = 0.04), and patients with FEV1 80% of predicted, OR 2.04 (95% CI 1.02-4.08, p = 0.04). Conclusions Asthmatic patients with a clinically significant smoking history often do not have well controlled asthma. Poor asthma symptom control was associated with current smoking status, history of exacerbations and impaired lung function. Therefore, every attempt should be made to help asthmatics who smoke to quit smoking.Peer reviewe

Astman ja keuhkoahtaumataudin sekamuoto ACO - diagnostiikka ja hoito

Vertaisarvioitu. English summary.Astman ja keuhkoahtaumataudin sekamuoto on ahtauttavia keuhkosairauksia sairastavilla potilailla melko tavallinen. Huolellinen anamneesi, status ja tupakointihistorian kartoitus sekä keuhkojen toimintakokeet ovat diagnostiikassa olennaisia. Hoidossa sovelletaan astman ja keuhkoahtaumataudin hoitosuosituksia yksilöllisen harkinnan mukaan. Hengitettävän glukokortikoidin (ICS) ja pitkävaikutteisen β2-agonistin (LABA) yhdistelmään pohjautuvan lääkehoidon ohella elämäntapamuutokset sekä liitännäissairauksien hoitaminen ovat tärkeitä kokonaisvaltaisen hoidon elementtejä.Peer reviewe

The burden of chronic rhinosinusitis with nasal polyps and its relation to asthma in Finland

Background Chronic rhinosinusitis with nasal polyps (CRSwNP) is commonly associated with asthma. Treatment of CRSwNP includes intranasal and systemic corticosteroids, with non-responsive patients commonly considered for endoscopic sinus surgery (ESS). This nationwide register-based study evaluated the incidence, prevalence, and treatment burden of CRSwNP in Finland, and their association with the presence and severity of comorbid asthma. Methods Electronic health records of patients diagnosed with CRSwNP between 1.1.2012 and 31.12.2018 in Finnish specialty and primary care were included in the study. The patients were divided into subgroups based on presence, severity, and control of asthma: no asthma, mild to moderate asthma, severe controlled asthma, and severe uncontrolled asthma. A mean cumulative count of ESS was calculated over time per subgroup. Results The prevalence of CRSwNP increased from 602.2 to 856.7 patients per 100,000 population between years 2012 and 2019 (p < 0.001). A total of 18,563 patients (59.9% male) had incident CRSwNP between 2012 and 2019, with 27% having asthma, 6% having severe asthma, and 1.5% having severe uncontrolled asthma. In the no asthma, severe controlled asthma, and severe uncontrolled asthma subgroups, systemic corticosteroids were used by 54.1%, 94.9% and 99.3% (p < 0.001), respectively, while the ESS count 3 years post diagnosis was 0.49, 0.68 and 0.80, respectively. Conclusions The prevalence of CRSwNP showed a significant increase in the recent decade in Finland. Comorbid asthma, and in particular severe asthma, increased the probability of receiving systemic corticosteroids and undergoing ESS. Thus, improved management of CRSwNP in patients with comorbid asthma is urgently needed.Peer reviewe

Adipokine resistin predicts anti-inflammatory effect of glucocorticoids in asthma

<p>Abstract</p> <p>Background</p> <p>Adipokines are protein mediators secreted by adipose tissue. Recently, adipokines have also been involved in the regulation of inflammation and allergic responses, and suggested to affect the risk of asthma especially in obese female patients. We assessed if adipokines predict responsiveness to glucocorticoids and if plasma adipokine levels are associated with lung function or inflammatory activity also in non-obese (body mass index (BMI) ≤ 30 kg/m²) women with newly-diagnosed steroid-naïve asthma.</p> <p>Methods</p> <p>Lung function, exhaled NO, plasma levels of adipokines leptin, resistin, adiponectin and adipsin, and inflammatory markers were measured in 35 steroid-naïve female asthmatics and in healthy controls. The measurements were repeated in a subgroup of asthmatics after 8 weeks of treatment with inhaled fluticasone. Adipokine concentrations in plasma were adjusted for BMI.</p> <p>Results</p> <p>High baseline resistin concentrations were associated with a more pronounced decrease in serum levels of eosinophil cationic protein (ECP) (r = -0.745, p = 0.013), eosinophil protein X (EPX) (r = -0.733, p = 0.016) and myeloperoxidase (MPO) (r = -0.721, p = 0.019) during fluticasone treatment. In asthmatics, leptin correlated positively with asthma symptom score and negatively with lung function. However, no significant differences in plasma adipokine levels between non-obese asthmatics and healthy controls were found. The effects of resistin were also investigated in human macrophages in cell culture. Interestingly, resistin increased the production of proinflammatory factors IL-6 and TNF-α and that was inhibited by fluticasone.</p> <p>Conclusions</p> <p>High resistin levels predicted favourable anti-inflammatory effect of inhaled glucocorticoids suggesting that resistin may be a marker of steroid-sensitive phenotype in asthma. High leptin levels were associated with a more severe disease suggesting that the link between leptin and asthma is not restricted to obesity.</p

Hengitysäänten kuuntelu ja suomenkieliset termit

Vertaisarvioitu. Näin tutkin.Hengitysäänten kuuntelulla saadaan helposti ja nopeasti tietoa keuhkojen tilasta. Hengitysäänten sanalliseen kuvaamiseen on kansainväliset suositukset, mutta suomenkieliset termit vaihtelevat. Teimme lääkäreille kyselyn hengitysäänten suomenkielisistä termeistä ja pyysimme niistä kannanoton Lääketieteen sanastolautakunnalta. Esitämme myös hengitysäänten kuunteluun ja tulkintaan liittyvät perusasiat. Kyselyyn vastasi kaikkiaan 154 lääkäriä. Vastaajat eivät olleet aivan yksimielisiä suomenkielisistä termeistä. Kyselyn ja sanastolautakunnan arvion perusteella ehdotamme käyttöön suomenkielisiä termejä kurkkuvinkuna (stridor), vinkuna (wheezing), rohina (rhonchus), ritinä (fine cracles), rahina (coarse cracles), vingahdus (squawk) ja keuhkopussin hankausääni (pleural friction rub). Samojen termien käyttäminen löydöksen kirjaamisessa parantaa hengitysäänten kuuntelun arvoa potilastyössä. Hengitysäänten kuuntelua voidaan jatkossa tarkentaa elektronisilla apuvälineillä ja tietokoneanalyysillä

Adherence to treatment guidelines and good asthma control in Finland

Background: Asthma program in Finland decreased asthma-related mortality and expenses of care on national level, but there is lack of data on adherence to treatment guidelines and disease control on individual level. We aimed to assess adherence to guidelines and disease control among Finnish adult asthmatics. Methods: Questionnaires were sent in Finland to 2000 randomly selected recipients aged 18–80 years, who had bought medication for obstructive airways disease during the previous 12 months. The questionnaire included questions on asthma medication, exacerbations, self-management and follow-up. Asthma symptom control was assessed by the Asthma Control Test (ACT). Results: A high proportion (82.4%) of the 541 responders with physician-diagnosed asthma reported regular use of asthma medication and 97.1% of them used inhaled corticosteroids. Almost all (97.0%) of the asthmatics were taught how to use their inhaler and 78.4% had an asthma self-management plan, but only 35.7% reported regular annual follow-up visits. According to symptoms, 60.0% had their asthma well-controlled (ACT score ≥20). On the other hand, 29.2% had a course of oral corticosteroid and 21.8% had an asthma-related unscheduled health care visit during the previous year, but only 2.6% reported a hospitalization. Asthma control was better in those not using regular asthma medication. Conclusions: The guidelines are well adopted in Finnish adult asthma care except for regular follow-up visits. Majority of patients had good symptom control and hospitalizations were rare. Better asthma control among those not using regular asthma medication implies they are not undertreated but have a mild disease.publishedVersionPeer reviewe