Ohjaus ja dialoginen vuorovaikutus hoitotyössä

Hoitotyötä toteutetaan vuorovaikutuksessa asiakkaiden kanssa tavoitteena selvittää heidän hoitonsa tarve ja suunnitella sekä toteuttaa hoitoa asetettujen tavoitteiden suuntaan. Vuorovaikutuksella on merkitystä asiakkaiden hoidosta saamiinsa kokemuksiin. Kun ihmisten terveydentila muuttuu, aiheuttaa se usein haavoittuvuutta ja kriisin kokemuksia riippuen terveydentilan muutoksen vakavuudesta ja ihmisten omista persoonallisista vahvuuksista. Hoitajan tehtävänä on kohdata ihminen kokonaisvaltaisesti ja hänen kokemuksiaan huomioiden. Kun asiakas on mukana hoidossa päättämässä omaa hoitoaan koskevissa asioissa, niin sillä on todettu olevan vaikuttavuutta hoitotuloksiin ja myös hoidon kustannukset ovat laskeneet

Delineation of tumor and CT perfusion data.

<p>(a) Tumor. (b) Tumor blood flow (BF). (c) Tumor blood volume (BV). (d) Tumor permeability-surface area (PS) product.</p

Examples of brain histology with pimonidazole.

<p>(a) 5 μm thick brain specimen stained for hypoxia (red arrows). (b) Zoomed area around the tumour (orange outline), pimonidazole-positive area (green outline), and necrotic area (red dashed line).</p

Correlation between CT perfusion parameters with hypoxia and necrosis.

<p>Percent hypoxic area vs. tumor blood flow (a), blood volume (b), percent necrotic area vs. tumor blood flow (c) and percent necrotic area vs. blood volume (d). Data for animals in control (●), SRS1(○) and SRS2(+) groups are all included. Solid lines show the best fit and dotted lines denote the 95% confidence intervals.</p

Tumor volume vs. tumor blood flow for test subjects from control (●), SRS1(○) and SRS2(+) groups.

<p>Tumor volume vs. tumor blood flow for test subjects from control (●), SRS1(○) and SRS2(+) groups.</p

Kaplan-Meier plots of survival categorized by (A) response (B) tumor volume, (C) relative blood flow (rBF), (D) relative blood volume (rBV), and (E) permeability-surface area product (PS).

<p>For each imaging parameter, two response groups were identified based on whether the measured value was ≤ lower 50% confidence interval of variations across all treated animals derived from the between-subject variation on day 7 post-SRS. Those that met this criteria were ranked as “low” by applying this threshold, and the others were ranked as “high”. Animals with low rBF, rBV, and PS on day 7 post-SRS showed significantly longer survival than the rest of the treated animals (i.e. high rBF, rBV, and PS) and control animals. *Significantly different from control group. †Significantly different from the other treated animals with a “high” value. Significant at <i>P</i>≤0.02 level (log-rank test).</p

Histological examples of stereotactic radiosurgery (SRS) effects.

<p>Representative Hematoxylin & Eosin images of (A) an untreated control, (B) acute histological change at 4 days post-SRS, and (C) late histological change at 59 days post-SRS. Hypercellularity (four point star) and pseudopalisading necrosis (five point star) are classic signs of grade IV glioma, and these were observed in the control animals. Hyalinized blood vessels (arrow) and hypocellularity can be observed shortly after SRS. Regression of tumor and hyalinization of tissue were observed at a later stage after SRS.</p

α-smooth muscle actin (α-SMA) positive vessels in the normal brain, peritumoral region, and tumor of a control and a treated animal after stereotactic radiosurgery (SRS).

<p>Intact α-SMA positive vessels were observed in control animals, but fragmented coverage of vessels by α-SMA is mostly seen in treated animals (red arrow).</p