Laadukkaalla saattohoidolla kohti hyvää kuolemaa

Saattohoito ei riipu ihmisen iästä eikä diagnoosista, se kuuluu kaikille, joilla on parantumaton sairaus ja jäljellä olevan eliniän odotetaan olevan lyhyt. Saattohoidolla pyritään lievittämään ihmisen oireita ja kärsimystä elämän viime vaiheessa, tukemaan häntä ja hänen omaisiaan ennen kuolemaan ja sen jälkeen. Nyt ja tulevaisuudessa hoidot monipuolistuvat, väestörakenne muuttuu, elinikä pitenee ja kroonisten sairauksien todennäköisyys kasvaa. Samanaikaisesti tiukka taloustilanne asettaa kustannustehokkuusvaatimuksillaan omat haasteensa saattohoidon kehittämiseksi. Tämän laadullisen opinnäytetyön tarkoituksena oli kuvata yksilöä huomioivia laadukkaan saattohoidon menetelmiä. Tavoitteena oli selvittää, mistä osatekijöistä hyvä suomalainen saattohoito muodostuu, ja miten sairaanhoitaja voi niitä hyödyntäen turvata kuolevalle ihmiselle oikeudenmukaisen ja ihmisarvoa kunnioittavan hoidon ja kuoleman. Opinnäytetyö toteutettiin kuvailevana kirjallisuuskatsauksena. Tutkimusaineistoon valittiin kaksi teosta, yksi opas, yksi väitöskirja, kaksi pro gradu tutkielmaa ja 17 aiheeseen liittyvää tutkimusta ja artikkelia. Saadusta aineistosta pyrittiin luomaan ydinkohdat sisältävä yhtenäinen kokonaisuus aineistolähtöistä sisällönanalyysiä käyttäen. Tuloksista ilmeni, että tärkeintä on kuolevan ihmisen kokonaisvaltainen hoito, jossa hänen fyysiset, psyykkiset, sosiaaliset ja hengelliset tarpeensa huomioidaan omaisia unohtamatta. Aito läsnäolo, potilaan ja omaisten kohtaaminen ja kunnioittaminen sekä hyvä oireiden hoito takaavat inhimillisen, elämänarvojen mukaisen saattohoidon. Jatkotutkimusaiheita voisivat olla saattohoidon toteutuminen omaisten näkökulmasta sekä hoitoneuvottelukäytännöt ja niiden toteuttaminen.Everyone having an incurable disease with a short prognosis has the right to hospice care. The aim of hospice care is to relieve the symptoms and suffering and to offer support to the patient, and the family members. The selection of available treatments is constantly improving, structure of the population keeps changing, people live longer than ever and chronic diseases will become even more common. The purpose of the study was to describe methods of quality hospice care from the individual perspective. The aim was to examine what elements high-quality hospice care in Finland consists of and how nurses could use the different methods to secure decent and dignified care and death for a dying person. The study was carried out by using descriptive literature review as the research method. Two books, one guide book, one doctoral thesis, two master’s theses and 17 articles were included in the research material. The data was analysed with content review. The aim was to create a coherent conception of the topic containing the key points. The results of the study indicate that the most important aspect is to nurse the dying patient holistically. All physical, psychological, social and emotional needs should be taken into account and family members should not be disregarded. Care with genuine presence as well as respectful treatment will ensure humane and individual hospice care. Further studies could be carried out on hospice care that consider the perspective of the family as well as consultation meetings and their practices

Diagnostic Value of Cerebrospinal Fluid Neurofilament Light Protein in Neurology: A Systematic Review and Meta-analysis

Importance: Neurofilament light protein (NfL) is elevated in cerebrospinal fluid (CSF) of a number of neurological conditions compared with healthy controls (HC) and is a candidate biomarker for neuroaxonal damage. The influence of age and sex is largely unknown, and levels across neurological disorders have not been compared systematically to date. Objectives: To assess the associations of age, sex, and diagnosis with NfL in CSF (cNfL) and to evaluate its potential in discriminating clinically similar conditions. Data Sources: PubMed was searched for studies published between January 1, 2006, and January 1, 2016, reporting cNfL levels (using the search terms neurofilament light and cerebrospinal fluid) in neurological or psychiatric conditions and/or in HC. Study Selection: Studies reporting NfL levels measured in lumbar CSF using a commercially available immunoassay, as well as age and sex. Data Extraction and Synthesis: Individual-level data were requested from study authors. Generalized linear mixed-effects models were used to estimate the fixed effects of age, sex, and diagnosis on log-transformed NfL levels, with cohort of origin modeled as a random intercept. Main Outcome and Measure: The cNfL levels adjusted for age and sex across diagnoses. Results: Data were collected for 10059 individuals (mean [SD] age, 59.7 [18.8] years; 54.1% female). Thirty-five diagnoses were identified, including inflammatory diseases of the central nervous system (n = 2795), dementias and predementia stages (n = 4284), parkinsonian disorders (n = 984), and HC (n = 1332). The cNfL was elevated compared with HC in a majority of neurological conditions studied. Highest levels were observed in cognitively impaired HIV-positive individuals (iHIV), amyotrophic lateral sclerosis, frontotemporal dementia (FTD), and Huntington disease. In 33.3% of diagnoses, including HC, multiple sclerosis, Alzheimer disease (AD), and Parkinson disease (PD), cNfL was higher in men than women. The cNfL increased with age in HC and a majority of neurological conditions, although the association was strongest in HC. The cNfL overlapped in most clinically similar diagnoses except for FTD and iHIV, which segregated from other dementias, and PD, which segregated from atypical parkinsonian syndromes. Conclusions and Relevance: These data support the use of cNfL as a biomarker of neuroaxonal damage and indicate that age-specific and sex-specific (and in some cases disease-specific) reference values may be needed. The cNfL has potential to assist the differentiation of FTD from AD and PD from atypical parkinsonian syndromes

Diagnostic Value of Cerebrospinal Fluid Neurofilament Light Protein in Neurology: A Systematic Review and Meta-analysis

Importance: Neurofilament light protein (NfL) is elevated in cerebrospinal fluid (CSF) of a number of neurological conditions compared with healthy controls (HC) and is a candidate biomarker for neuroaxonal damage. The influence of age and sex is largely unknown, and levels across neurological disorders have not been compared systematically to date. Objectives: To assess the associations of age, sex, and diagnosis with NfL in CSF (cNfL) and to evaluate its potential in discriminating clinically similar conditions. Data Sources: PubMed was searched for studies published between January 1, 2006, and January 1, 2016, reporting cNfL levels (using the search terms neurofilament light and cerebrospinal fluid) in neurological or psychiatric conditions and/or in HC. Study Selection: Studies reporting NfL levels measured in lumbar CSF using a commercially available immunoassay, as well as age and sex. Data Extraction and Synthesis: Individual-level data were requested from study authors. Generalized linear mixed-effects models were used to estimate the fixed effects of age, sex, and diagnosis on log-transformed NfL levels, with cohort of origin modeled as a random intercept. Main Outcome and Measure: The cNfL levels adjusted for age and sex across diagnoses. Results: Data were collected for 10059 individuals (mean [SD] age, 59.7 [18.8] years; 54.1% female). Thirty-five diagnoses were identified, including inflammatory diseases of the central nervous system (n = 2795), dementias and predementia stages (n = 4284), parkinsonian disorders (n = 984), and HC (n = 1332). The cNfL was elevated compared with HC in a majority of neurological conditions studied. Highest levels were observed in cognitively impaired HIV-positive individuals (iHIV), amyotrophic lateral sclerosis, frontotemporal dementia (FTD), and Huntington disease. In 33.3% of diagnoses, including HC, multiple sclerosis, Alzheimer disease (AD), and Parkinson disease (PD), cNfL was higher in men than women. The cNfL increased with age in HC and a majority of neurological conditions, although the association was strongest in HC. The cNfL overlapped in most clinically similar diagnoses except for FTD and iHIV, which segregated from other dementias, and PD, which segregated from atypical parkinsonian syndromes. Conclusions and Relevance: These data support the use of cNfL as a bioma