Asiakaslähtöisen munasolunsaajien hoitoprosessin kehittäminen lapsettomuusklinikalla

Tämä opinnäytetyö oli työelämä lähtöinen kehittämistyö, joka toteutettiin Väestöliiton lapsettomuus klinikoiden Helsingin yksikössä. Tämän kehittämistyön tarkoituksena oli tuottaa uusi asiakaslähtöinen munansolunsaajien hoitoprosessi ja sen myötä parantaa asiakkaiden tyytyväisyyttä saamaansa hoitoon. Kehittämishankkeen tavoitteena oli kartoittaa haastattelemalla munasolunluovutushoidon läpi käyneiden asiakkaiden näkemyksiä nykyisestä hoitoprosessista ja sen asiakaslähtöisyydestä. Tavoitteena oli myös huomioida klinikan kokeneen henkilökunnan ajatuksia hoitoprosessin parantamiseksi. Uuden hoitoprosessin luominen aloitettiin määrittelemällä nykyinen munasolunsaajien hoitoprosessi. Tämän jälkeen kartoitettiin munasolunluovutushoidon läpi käyneiden asiakkaiden näkemyksiä nykyisestä hoitoprosessista, sen asiakaslähtöisyydestä ja heidän ehdotuksia hoitoprosessin parantamiseksi. Analysoitujen haastattelu aineistojen avulla tehtiin hahmotelma uudesta hoitoprosessista. Hahmotelma hoitoprosessista ja haastatteluiden tulokset esiteltiin klinikan henkilökunnalle, joka ideoi näiden pohjalta kehittämiskohteita uuteen hoitoprosessiin. Edellisten vaiheiden jälkeen kehitettiin lopullinen versio uudesta hoitoprosessista. Munasolunluovutushoito on otettu käyttöön Väestöliiton klinikoilla vuonna 1991 ja se on nykyisin yksi standardi lapsettomuudenhoito menetelmä. Munasolunluovutushoito on saajille iso panostus henkisesti ja taloudellisesti. Hoitoprosessin kehittämisellä pyritään siihen, että hoitoprosessin toimimattomuuden takia he eivät joutuisi uusien pettymysten eteen. Terveydenhuollossa on ymmärretty viime vuosina asiakaslähtöisyyden tärkeys niin Suomessa, kuin maailmallakin. Opinnäytetyön lähestymistapana oli toimintatutkimus. Aineistonkeruu menetelmänä oli munasolunluovutushoidossa olleiden asiakkaiden teemahaastattelu. Tämän lisäksi henkilökunnan ehdotuksia hoitoprosessin kehittämiseksi kartoitettiin aivoriihi ideoinnin avulla. Teemahaastatteluun osallistui kahdeksan asiakasta ja haastatteluaineisto analysoitiin induktiivisella sisällön analyysilla. Aivoriihi ideoinnin tuloksena syntyneet ideat pisteytettiin, ryhmiteltiin ja yhdisteltiin samaa tarkoittaviin ideoihin. Tämän jälkeen aineistosta muodostettiin uusi hoitoprosessi. Haastatteluaineiston tulosten mukaan asiakaslähtöisyys on empaattista vuorovaikutusta ja asiakkaan kokonaisuuden huomioimista. Asiakkaat kokivat nykyisen hoitoprosessin sujuvana, mutta toisaalta kokivat siihen sisältyvän hallitsemattomuutta. Hyvänä nykyisessä hoitoprosessissa he kokivat tulosten mukaan olevan empaattisen ja yksilöllisen kohtaamisen ja hoitoprosessin yksilöllisyyden. Monipuolisiin palveluihin, hoitoprosessin yksilölliseen suunnitteluun ja psyykkiseen taakkaan tulisi tulosten mukaan kiinnittää huomiota uutta hoitoprosessia laadittaessa. Suomessa ei ole tehty tutkimuksia asiakaslähtöisyydestä lapsettomuushoitoihin liittyen. Ulkomaisista tutkimuksista on saatu samansuuntaisia tuloksia asiakaslähtöisyydestä lapsettomuushoitoihin liittyen kuin tässä opinnäytetyössä. Se osoittaa samojen asioiden olevan tärkeitä lapsettomuuspotilaille maan rajoista huolimatta. Jatkossa Väestöliiton klinikoilla tulisi tehdä seurantaa, siitä miten uuden hoitoprosessin käyttöönotto on mennyt.This thesis is the result of a workplace based development project implemented at the Väestöliitto fertility clinic in Helsinki. The goal of the project was to develop a new patient centred ovum donation process which would increase patients’ satisfaction with their care. The aim of the project was to survey thoughts of patients who had gone through the ovum donation process with regard to the current treatment process and its patient centeredness. The expertise of the more experienced employees of the clinic was to be taken into consideration throughout the development project. The development of the new process began by defining the current care process for ovum donation recipients. Following this, the ovum donation recipients were interviewed for their thoughts of the current care process and its patient centeredness. The patients were asked for suggestions for the improvement of the care process. Following an analysis of the intelligence gathered from the interviews, an outline for a new patient care process was drafted. The analysis of the intelligence and the new patient care process were presented to the clinic employees at a staff event. The goal of the event was to encourage the employees to brainstorm ideas for improving patient centeredness and thus enabling them to take part in developing the improved patient care process. Following the event, with the new ideas gathered, the final care process was developed. The ovum donation treatments started in 1991 at Väestöliitto fertility clinic and it is today one of the standard treatment methods for infertility. The treatment method requires a significant financial and psychological input from the recipients. The patients treated by this method have usually suffered from infertility for several years already, and have experienced many disappointments whilst going through previous infertility treatments. The aim of developing the new, improved patient care process, is that a poor design of the care process would not add to the disappointments that the patient may experience. The value of patient centeredness has been realised in Finland and all over the world in the recent years. The approach for this thesis was an action research method. The data was collected by interviewing patients and by executing a brainstorming event with the personnel. Eight patients who had undergone ovum donation were interviewed by an individual theme interview method. The data was analysed by inductive content analysis. The new ideas collected during the brainstorming ses-sion were categorised into groups based on their similarities and differences. By using a points system, the ideas and categories were analysed and the most significant ideas were utilized in the design of the new care process. The results of the patient interviews show that patient centeredness is empathic interaction and entire consideration of the patient. The patients felt that the current care process was fluent, but uncontrollable. Positive things in the current treatment process were empathic and individual encounter with the caregivers and the individuality of the treatment process. According to analysed data, a diverse range of treatment methods, individual planning of the treatment process, and the psychological burden of the treatments are things which should be taken carefully into account when planning new treatment processes. Previous studies show similar results about patient centerednes

Long-term outcomes and predictive ability of non-invasive scoring systems in patients with non-alcoholic fatty liver disease

[Background & Aims] Non-invasive scoring systems (NSS) are used to identify patients with non-alcoholic fatty liver disease (NAFLD) who are at risk of advanced fibrosis, but their reliability in predicting long-term outcomes for hepatic/extrahepatic complications or death and their concordance in cross-sectional and longitudinal risk stratification remain uncertain.[Methods] The most common NSS (NFS, FIB-4, BARD, APRI) and the Hepamet fibrosis score (HFS) were assessed in 1,173 European patients with NAFLD from tertiary centres. Performance for fibrosis risk stratification and for the prediction of long-term hepatic/extrahepatic events, hepatocarcinoma (HCC) and overall mortality were evaluated in terms of AUC and Harrell’s c-index. For longitudinal data, NSS-based Cox proportional hazard models were trained on the whole cohort with repeated 5-fold cross-validation, sampling for testing from the 607 patients with all NSS available.[Results] Cross-sectional analysis revealed HFS as the best performer for the identification of significant (F0-1 vs. F2-4, AUC = 0.758) and advanced (F0-2 vs. F3-4, AUC = 0.805) fibrosis, while NFS and FIB-4 showed the best performance for detecting histological cirrhosis (range AUCs 0.85-0.88). Considering longitudinal data (follow-up between 62 and 110 months), NFS and FIB-4 were the best at predicting liver-related events (c-indices>0.7), NFS for HCC (c-index = 0.9 on average), and FIB-4 and HFS for overall mortality (c-indices >0.8). All NSS showed limited performance (c-indices <0.7) for extrahepatic events.[Conclusions] Overall, NFS, HFS and FIB-4 outperformed APRI and BARD for both cross-sectional identification of fibrosis and prediction of long-term outcomes, confirming that they are useful tools for the clinical management of patients with NAFLD at increased risk of fibrosis and liver-related complications or death.[Lay summary] Non-invasive scoring systems are increasingly being used in patients with non-alcoholic fatty liver disease to identify those at risk of advanced fibrosis and hence clinical complications. Herein, we compared various non-invasive scoring systems and identified those that were best at identifying risk, as well as those that were best for the prediction of long-term outcomes, such as liver-related events, liver cancer and death.This study has been supported by the EPoS (Elucidating Pathways of Steatohepatitis) consortium funded by the Horizon 2020 Framework Program of the European Union under Grant Agreement 634413 and the Newcastle NIHR Biomedical Research Centre. The authors are contributing members of The European NAFLD Registry. The study was also supported by the Italian Ministry of Health, grant RF-2016-02364358 (Ricerca Finalizzata, Ministero della Salute), and the Italian Ministry for Education, University and Research (Ministero dell’Istruzione, dell’Università e della Ricerca - MIUR) under the programme “Dipartimenti di Eccellenza 2018 – 2022” Project code D15D18000410001.Peer reviewe

Ceramiche fini di produzione pompeiana: i dati dal recupero e studio dei materiali dei saggi Impianto Elettrico 1980-81

International audienc

A semi-quantitative risk assessment of remote handling operations on the SPES Front-End based on HAZOP-LOPA

This paper presents the Probabilistic Risk Assessment (PRA) developed for crucial components of the SPES (Selective Production of Exotic Species) nuclear facility, a research plant currently under construction at INFN’s Legnaro National Laboratories. The study systematically analyzes the most serious failure scenarios of the SPES Front-End and the remote handling systems, with the aim of identifying critical issues and improving the systems in terms of operational safety, hardware design, robustness and reliability. The approach adopted in this study is a blended methodology based on semi-quantitative techniques. HAZOP (HAZard and OPerability analysis) and LOPA (Layer Of Protection Analysis) have been applied to evaluate the risk of failure scenarios during operation and to assess their consequences. This study identified some weaknesses in the system’s design, leading to possible undesirable behaviors. A number of safeguards and recommendations have been proposed, as well as a selection of design improvements related to the robustness and maintainability of pivotal components. The results of this assessment support the validity of the proposed Independent Protection Layers (IPLs) adopted to ensure operational safety and optimize maintenance interventions in such highly radioactive environment

Long-term outcomes and predictive ability of non-invasive scoring systems in patients with non-alcoholic fatty liver disease

Background &amp; Aims: Non-invasive scoring systems (NSS) are used to identify patients with non-alcoholic fatty liver disease (NAFLD) who are at risk of advanced fibrosis, but their reliability in predicting long-term outcomes for hepatic/extrahepatic complications or death and their concordance in cross-sectional and longitudinal risk stratification remain uncertain. Methods: The most common NSS (NFS, FIB-4, BARD, APRI) and the Hepamet fibrosis score (HFS) were assessed in 1,173 European patients with NAFLD from tertiary centres. Performance for fibrosis risk stratification and for the prediction of long-term hepatic/extrahepatic events, hepatocarcinoma (HCC) and overall mortality were evaluated in terms of AUC and Harrell's c-index. For longitudinal data, NSS-based Cox proportional hazard models were trained on the whole cohort with repeated 5-fold cross-validation, sampling for testing from the 607 patients with all NSS available. Results: Cross-sectional analysis revealed HFS as the best performer for the identification of significant (F0-1 vs. F2-4, AUC = 0.758) and advanced (F0-2 vs. F3-4, AUC = 0.805) fibrosis, while NFS and FIB-4 showed the best performance for detecting histological cirrhosis (range AUCs 0.85-0.88). Considering longitudinal data (follow-up between 62 and 110 months), NFS and FIB-4 were the best at predicting liver-related events (c-indices&gt;0.7), NFS for HCC (c-index = 0.9 on average), and FIB-4 and HFS for overall mortality (c-indices &gt;0.8). All NSS showed limited performance (c-indices &lt;0.7) for extrahepatic events. Conclusions: Overall, NFS, HFS and FIB-4 outperformed APRI and BARD for both cross-sectional identification of fibrosis and prediction of long-term outcomes, confirming that they are useful tools for the clinical management of patients with NAFLD at increased risk of fibrosis and liver-related complications or death. Lay summary: Non-invasive scoring systems are increasingly being used in patients with non-alcoholic fatty liver disease to identify those at risk of advanced fibrosis and hence clinical complications. Herein, we compared various non-invasive scoring systems and identified those that were best at identifying risk, as well as those that were best for the prediction of long-term outcomes, such as liver-related events, liver cancer and death