A protocol for the analysis of DTI data collected from young children

Analysis of scalar maps obtained by diffusion tensor imaging (DTI) produce valuable information about the microstructure of the brain white matter. The DTI scanning of child populations, compared with adult groups, requires specifically designed data acquisition protocols that take into consideration the trade-off between the scanning time, diffusion strength, number of diffusion directions, and the applied analysis techniques. Furthermore, inadequate normalization of DTI images and non-robust tensor reconstruction have profound effects on data analyses and may produce biased statistical results. Here, we present an acquisition sequence that was specifically designed for pediatric populations, and describe the analysis steps of the DTI data collected from extremely preterm-born young school-aged children and their age- and gender-matched controls. The protocol utilizes multiple software packages to address the effects of artifacts and to produce robust tensor estimation. The computation of a population-specific template and the nonlinear registration of tensorial images with this template were implemented to improve alignment of brain images from the children.Peer reviewe

OMAHOITAJAJÄRJESTELMÄN TOIMIVUUS HOITAJIEN JA POTILAIDEN KOKEMANA

Opinnäytetyö tehtiin yhteistyössä Keski-Suomen keskussairaalan operatiivisten osastojen kanssa. Tutkimus oli osa Keski-Suomen sairaanhoitopiirin kehittämisprojektia. Projektin tarkoituksena oli selvittää yksilövastuisen hoitotyön ja omahoitajuuden toteutumista erikoissairaanhoidon operatiivisilla osastoilla. Hoitohenkilökunta voi hyödyntää tutkimustuloksia omahoitajuuden kehittämisessä. Kehittämisprojektiin liittyen tehtiin kolme opinnäytetyötä. Yhdessä työssä tutkittiin hoitohenkilökunnan kokemuksia omahoitajuuden toimivuudesta, toinen työ keskittyi potilaiden kokemuksiin ja tässä työssä tehtiin näiden kahden näkökulman yhteenvetoa ja vertailua. Tutkimuksen lähestymistapa on kvantitatiivinen. Aineiston keruussa käytettiin strukturoituja kyselylomakkeita valmiine vastausvaihtoehtoineen sekä muutamia avoimia kysymyksiä. Tutkimustuloksista kävi ilmi, että suurin osa hoitajista koki potilaidensa olevan tietoisia omahoitajastaan. Potilaistakin yli puolet koki tietävänsä kuka on heidän omahoitajansa. Yli puolet potilaista ja hoitajista oli sitä mieltä, että potilas tietää, milloin hänen omahoitajansa on työvuorossa. Luottamus toisen hoitajakollegan osaamiseen oli korkeaa, mikä kuvastaa kollegan ammattitaidon arvostamista. Myös potilaat luottivat muiden kuin omahoitajien osaamiseen. Pääsääntöisesti potilaat kokivat neuvottelevansa hoitoaan koskevista päätöksistä omahoitajansa kanssa. Hoitajista näin koki kolmasosa. Hoitajien ja potilaiden käsitykset omahoitajan työvuoron aikana yhdelle potilaalle antamasta ajasta poikkesivat toisistaan. Hoitajat arvioivat, että heillä oli keskimäärin 35 minuuttia aikaa yhdelle omalle potilaalle työvuorossaan. Potilaat arvioivat, että omahoitajalla oli ollut keskimäärin 8 minuuttia aikaa heille työvuoron aikana. Tutkimuksen tulosten perusteella voidaan todeta, että yksilövastuinen hoitotyö toteutui tutkimusorganisaatiossa kohtalaisen hyvin.The dissertation was done in cooperation with the operative departments of the Central Finland Central Hospital. The study was a part from the development project of the Central Finland Central Hospital. The purpose of the project was to clarify primary nursing and the primary nurse’s implementation in the operative departments of the specialised health care. The nursing staff can utilise the results of the research for developing the primary nursing. In connection with the development project, there were done three dissertations. In one of the projects were studied the nurses’ experiences in primary nursing. The second thesis was concentrated on the patient's experiences. In this dissertation were made the summary and comparison of the previous two. The approach of the study is quantitative. In the collecting of information for the dissertation, have been used structured questionnaires with ready alternatives and there were handled some few open questions. From the results of the research it appeared, that the majority of the nurses have ex-perienced that their patients had the knowledge about their own personal nurse. More than half of the patients also experienced that they knew who their personal nurse is. More than half of the patients and also nurses had the opinion that the patient knows about the schedule of his personal nurse. The confidence in the expertise and abilities of the own nurse’s colleagues, was high, which reflects the appreciating of the nurses’ professional skills. The patients have confidence in the skills of other nurses also. In the majority, the patients experienced that they were discussing with their personal nurse, about the decisions concerning their care; but only one third of the nurses had the same opinion. The nurses and patients’ estimation about the time accorded to the patient during the nurse’s shift were different. The nurses estimated that they were according around 35 minutes to their own patient, during their shift. The patients estimated that the personal nurse had accorded to them, in average about 8 minutes, during their shift. Based on the results of the study, it can be stated, that the primary nursing was imple-mented moderately well in the research organisation

Altered working memory-related brain responses and white matter microstructure in extremely preterm-born children at school age

Preterm birth poses a risk for neurocognitive and behavioral development. Preterm children, who have not been diagnosed with neurological or cognitive deficits, enter normal schools and are expected to succeed as their term-born peers. Here we tested the hypotheses that despite an uneventful development after preterm birth, these children might exhibit subtle abnormalities in brain function and white-matter microstructure at school-age. We recruited 7.5-year-old children born extremely prematurely (<28 weeks’ gestation), and age- and gender-matched term-born controls (≥37 weeks’ gestation). We applied fMRI during working-memory (WM) tasks, and investigated white-matter microstructure with diffusion tensor imaging. Compared with controls, preterm-born children performed WM tasks less accurately, had reduced activation in several right prefrontal areas, and weaker deactivation of right temporal lobe areas. The weaker prefrontal activation correlated with poorer WM performance. Preterm-born children had higher fractional anisotropy (FA) and lower diffusivity than controls in several white-matter areas, and in the posterior cerebellum, the higher FA associated with poorer visuospatial test scores. In controls, higher FA and lower diffusivity correlated with faster WM performance. Together these findings demonstrate weaker WM-related brain activations and altered white matter microstructure in children born extremely preterm, who had normal global cognitive ability.Peer reviewe