Nukahtamiseen vaikuttavat tekijät uni-EEG -tutkimuksessa

Elektroenkefalografiatutkimuksessa (EEG-tutkimuksessa) mitataan aivojen sähköistä toimintaa päänahkaan asetettavien elektrodien avulla. Rekisteröinnin aikana suoritetaan erilaisia aktivaatioita, jotka voivat tuoda esiin mahdollisia poikkeavia aivotoiminnan ilmiöitä. Uni-EEG –tutkimuksessa käytetään myös uniaktivaatiota, jossa rekisteröidään unenaikaista aivosähkökäyrää. Tässä tutkimuksessa olisikin toivottavaa nukahtaa, mutta tämä ei ole ennakkovalmisteluista huolimatta aina helppoa. Tämän opinnäytetyön aihe saatiin Päijät-Hämeen Sosiaali- ja Terveysyhtymän (PHSOTEY) kliinisen neurofysiologian laboratorion ylilääkäriltä. Työn menetelmäsuuntaukseksi muodostui laadullinen tutkimus ja sen tarkoituksena oli laatia kartoittava ja kuvaileva kirjallisuuskatsaus nukahtamisen onnistumiseen vaikuttavista tekijöistä uni-EEG –tutkimuksessa. Tavoitteena oli, että PHSOTEY:n kliinisen neurofysiologian laboratorion henkilökunta voisi hyödyntää kirjallisuuskatsausta tutkimuksen laadun parantamisessa. Opinnäytetyössä pyrittiin vastaamaan kysymyksiin ”Mikä on kirjallisuuskatsaus ja kuinka se tehdään?” ja ”Mitkä tekijät vaikuttavat nukahtamisen onnistumiseen?”. Aineisto kirjallisuuskatsaukseen kerättiin tieteellisistä tietokannoista ja katsaukseen valittiin 11 tutkimusta niiden otsikoiden tai abstraktien perusteella. Kirjallisuuskatsauksen ja omien kokemusten pohjalta havaittiin, että uni-EEG –tutkimuksessa nukahtamiseen voidaan vaikuttaa niin ennakkovalmisteluin kuin tutkimuksen suorituksen aikana tehtävin toimenpitein. Nukahtamiseen vaikuttavia tekijöitä ovat mm. valvomisohjeistuksen antaminen sekä ennen nukkumaanmenoa tapahtuva raajojen lämmitys, kahvin juominen tai fyysinen aktiivisuus. Ihmisten yksilöllisyydestä johtuen kaikki nukahtamista helpottavat toimet eivät kuitenkaan välttämättä auta, mikä onkin otettava huomioon jokaisen potilaan kohdalla erikseen. Opinnäytetyömme pohjalta nousi esiin muutamia kehittämisehdotuksia. Katsauksesta saisi yhtenäisemmän keskittymällä vain yhteen potilasryhmään, esimerkiksi lapsiin. Tutkimuksen voisi myös toteuttaa kyselylomakkeen avulla, jolloin hoitaja haastattelisi rutiini uni-EEG –tutkimukseen tulevia potilaita. Tällöin tulokset koskisivat vain kyseessä olevaa laboratoriota.The purpose of this study was to determine the factors that affect the success of falling asleep in sleep EEG examination by collecting information in the form of research articles. The objective of this study was to compile a descriptive literature review so good that the personnel of the PHSOTEY Clinical Neurophysiology Laboratory could develop the quality of the sleep EEG examination by using our findings. The data for the literature review were collected from different scientific databases. Eleven studies were selected based on their titles and abstracts. This study also includes our own experiences that we gained in December 2013 by participating in the role of a patient in sleep EEG examination. The studies that we used in literature review show that one can influence the chances of falling asleep in many ways, for example by preparations before the examination and actions during the examination. Further studies on the subject, for example a questionnaire, could offer interesting information and provide us with a better understanding of this theme in the laboratory in question

Hypoglycaemia without diabetes encountered by emergency medical services : a retrospective cohort study

Background: The current study investigates the incidence, aetiology, and outcome of hypoglycaemia of patients without diabetes in the EMS. Methods: The study was a retrospective cohort study that utilized electronic EMS patient record system (population of one million). All patients encountered by EMS with plasma glucose Results: From EMS cases with a plasma glucose measurement a total of 5467 hypoglycaemic patients without diabetes were encountered by EMS during the study period with an incidence of 1082 (CI95% 1019-1148) per 100,000 inhabitants per year, corresponding 41.6%, (CI95% 40.8-42.3) of all hypoglycaemic patients. Of those patients, 3856 [71.6%, (CI95% 70.4-72.8)] were transported to hospital and 910 [23.2%, (CI95% 22.0-24.6)] had serious hypoglycaemia. The three main diagnosis groups that appeared in the subsequent hospital treatment associated with hypoglycaemia in all transported cases without diabetes as well with serious hypoglycaemia cases were: alcohol abuse [41.2%, (CI95% 39.7-42.8) and 42.2%, (CI95% 39.0-45.4)], hypothermia [17.2%, (CI95% 16.0-18.4) and 27.4%, (CI95% 24.6-30.4)], and malnutrition [16.9%, (CI95% 15.8-18.1) and 25.1%, (CI95% 22.4-28.0)]. Mortality ranged from 0.6-65.4% depending of admission reason and increased significantly at long-term. Non-Diabetics survival was less than with diabetics, when serious hypoglycaemia was present. Discussion: The most common possible hypoglycaemia related aetiological causes encountered in the EMS, alcohol abuse, hypothermia, and malnutrition, although frequent are often relatively benign conditions. These possible causes of hypoglycaemia can often be treated at scene or need only short hospital admissions. Hence they are not so prevalent in hospital studies. Conclusions: Hypoglycaemia without diabetes is commonly observed among the hypoglycaemic EMS cases. Main causes for it are alcohol abuse, hypothermia, and malnutrition. Mortality correlated with age, higher priority dispatch codes, and plasma glucose rate in multivariate logistic regression analysis. Some of the etiological subgroups carry a markedly high mortality rate.Peer reviewe

Alaistaitojen merkitys henkilöstön kehittämiselle

Tutkimuksen tavoite on kartoittaa henkilöstön kehittämisen ja henkilöstöjohtamisen ammattilaisten näkemyksiä organisaation jäsenten alaistaitojen merkityksestä henkilöstön kehittämistyölle. Tarkastelun kohteena on sekä alaistaitojen merkitys kehittämistyön onnistumiselle että kehittämistoimenpiteiden mahdollinen vaikutus organisaation jäsenten alaistaitojen käyttämiseen. Tässä tutkielmassa käytetään alaistaitojen rinnalla käsitettä alaistaitokäyttäytyminen, joka on johdettu englanninkielisestä organizational citizenship behaviorista, millä nimellä ilmiötä kansainvälisessä tutkimuksessa usein kutsutaan. Alaistaidoilla tarkoitetaan työntekijän käyttäytymistä, joka edistää organisaation tehokasta ja sopuisaa toimintaa. Alaistaidoille on ominaista, että käyttäytyminen on työntekijälle harkinnanvaraista eli sitä ei edellytetä virallisesti tehtävänkuvauksessa. Henkilöstön kehittäminen on osa laajempaa henkilöstöjohtamisen kenttää. Henkilöstön kehittämisen tehtävä on parantaa organisaation suoriutumista henkilöstön osaamisessa tapahtuvan muutoksen kautta. Kyseessä on haastattelututkimus, jossa on haastateltu yhdeksää henkilöstöjohtamisen ja henkilöstön kehittämisen ammattilaista. Tiedonkeruumenetelmänä on käytetty puolistrukturoitua haastattelua, ja haastatteluaineisto on analysoitu teoriasidonnaisella sisällönanalyysillä. Alaistaitokäyttäytymiseksi aineistossa mielletään etenkin työntekijän aloitteellisuus, vastuun kantaminen ja itseohjautuvuus sekä taito olla toimivassa vuorovaikutuksessa, antaa ja vastaanottaa palautetta ja huolehtia hyvästä työilmapiiristä. Näillä työntekijän ominaisuuksilla on aineistossa myönteinen vaikutus henkilöstön kehittämisen onnistumiseen. Haastateltavat tunnistavat henkilöstökäytänteillä voivan olla vaikutusta organisaation jäsenten alaistaitokäyttäytymiseen. Näitä henkilöstökäytänteitä ovat rekrytointi, osallisuuden lisääminen, palaute, johtamisen kehittäminen ja suorituksen johtaminen. Yhteenvetona voidaan todeta, että alaistaidoilla on merkitystä henkilöstön kehittämiselle. Erityisesti alaistaitokäyttäytymistä ja onnistunutta henkilöstön kehittämistä yhdistää työntekijän kokemus työnsä merkityksellisyydestä. Tutkimus on luonut uutta tietoa alueelle, jota on Suomessa tutkittu vain vähän. Yhtenä jatkotutkimusmahdollisuutena nostetaan esiin alaistaitokäyttäytymisen seurauksien tutkiminen

Spectrum, Volume 13, Number 3

Highlights include: WWPT will soon be transmitting a low power, on campus only, radio wave which can run continuously for 24 hours. WWPT currently broadcasts on 90.3. The new frequency is likely to be 91.5 pending further testing --Opening soon in former room SI 10, next to the radio station, is The Marche, which will offer a variety of grill and fast food items --The GE Scholar Program consists of students from a wide variety of ethnic backgrounds, many of whom are commuter students. Each scholar is awarded $2,000 per year and each participant in turn, contributes to the community --After seeing limited time in the Pioneer back field last season behind four-year starter Ron Stopkoski, Brian Ihlefeld has arrived as a strong and elusive runner this season as well as a big play maker for the SHU gridders --The varsity crews have their first competition this Sunday in Mystic, CT, where they will compete in the Great Pawcktuck Paddle or Row Race --The men’s soccer team is on a tear after winning 4 in a row --Women’s field hockey team has increased the win column to 4-1 with their recent victories over Manhattenville, Albany and Keene State

Wintertime pharmacokinetics of intravenously and orally administered meloxicam in semi-domesticated reindeer (Rangifer tarandus tarandus)

Objective To investigate the pharmacokinetics of orally and intravenously (IV) administered meloxicam in semi domesticated reindeer (Rangifer tarandus tarandus). Study design A crossover design with an 11 day washout period. Animals A total of eight young male reindeer, aged 1.5-2.5 years and weighing 74.3 +/- 6.3 kg, mean +/- standard deviation. Methods The reindeer were administered meloxicam (0.5 mg kg(-1) IV or orally). Blood samples were repeatedly collected from the jugular vein for up to 72 hours post administration. Plasma samples were analysed for meloxicam concentrations with ultraperformance liquid chromatography combined with triple quadrupole mass spectrometry. Noncompartmental analysis for determination of pharmacokinetic variables was performed. Results The pharmacokinetic values, median (range), were determined. Elimination half-life (t(1/2)) with the IV route (n = 4) was 15.2 (13.2-16.8) hours, the volume of distribution at steady state was 133 (113-151) mL kg(-1) and clearance was 3.98 (2.63-5.29) mL hour(-1) kg(-1). After oral administration (n = 7), the peak plasma concentration (C-max) was detected at 6 hours, t(1/2) was 19.3 (16.7-20.5) hours, C(max )1.82 (1.17-2.78) mu g mL(-1) and bioavailability (n = 3) 49 (46-73)%. No evident adverse effects were detected after either administration route. Conclusions and clinical relevance A single dose of meloxicam (0.5 mg kg(-1) IV or orally) has the potential to maintain the therapeutic concentration determined in other species for up to 3 days in reindeer plasma.Peer reviewe

Changes in CRP and CA19-9 during Preoperative Oncological Therapy Predict Postoperative Survival in Pancreatic Ductal Adenocarcinoma

Introduction: Tumor and systemic inflammatory markers predict survival. This retrospective study aimed to explore the changes in CRP, CA19-9, and other routine laboratory tests during preoperative oncological therapy as prognostic factors in pancreatic ductal adenocarcinoma (PDAC). Methods: Between 2000 and 2016, 68 borderline resectable PDAC patients received preoperative oncological therapy and underwent subsequent surgery at Helsinki University Hospital, Finland. We investigated changes in CRP, CA19-9, CEA, albumin, leukocytes, bilirubin, and platelets and examined the impact on survival. Results: In the multivariate analysis, CRP remaining at >= 3 mg/L after preoperative oncological therapy predicted a poorer postoperative outcome when compared to CRP decreasing to or remaining at 90% during preoperative treatment predicted a favorable postoperative outcome (HR 0.297, 95% CI: 0.124-0.708, p = 0.006). In the Kaplan-Meier analysis, the median survival for patients with CRP remaining at = 3 mg/L (42 months vs. 24 months, p = 0.001). Patients with a CA19-9 decrease >90% or level normalization (toPeer reviewe

The expression and prognostic value of toll-like receptors (TLRs) in pancreatic cancer patients treated with neoadjuvant therapy

Publisher Copyright: Copyright: © 2022 Nurmi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Objectives Toll-like receptors (TLRs) play a pivotal role in the immune system and carcinogenesis. There is no research on TLR expression and association with survival among preoperatively treated pancreatic cancer patients. We studied the expression intensity and prognostic value of TLRs in pancreatic cancer patients treated with neoadjuvant therapy (NAT) and compared the results to patients undergoing upfront surgery (US). Method Between 2000 and 2015, 71 borderline resectable patients were treated with NAT and surgery and 145 resectable patients underwent upfront surgery at Helsinki University Hospital, Finland. We immunostained TLRs 1–5, 7, and 9 on sections of tissue-microarray. We classified TLR expression as 0 (negative), 1 (mild), 2 (moderate), or 3 (strong) and divided into high (2–3) and low (0–1) expression for statistical purposes. Results Among TLRs 1, 3, and 9 (TLR1 81% vs 70%, p = 0.008; TLR3 92% vs 68%, p = 0.001; TLR9 cytoplasmic 83% vs 42%, p<0.001; TLR9 membranous 53% vs 25%, p = 0.002) NAT patients exhibited a higher immunopositivity score more frequently than patients undergoing upfront surgery. Among NAT patients, a high expression of TLR1 [Hazards ratio (HR) 0.48, p<0.05] associated with a longer postoperative survival, whereas among US patients, high expression of TLR5 (HR 0.64, p<0.05), TLR7 (HR 0.59, p<0.01, and both TLR7 and TLR9 (HR 0.5, p<0.01) predicted a favorable postoperative outcome in separate analysis adjusted for background variables. Conclusions We found higher immunopositive intensities among TLRs 1, 3, and 9 in NAT patients. A high TLR1 expression associated with a longer survival among NAT patients, however, among US patients, high expression intensity of TLR5 and TLR7 predicted a favorable postoperative outcome in the adjusted analysis.Peer reviewe

Mechanisms of early glucose regulation disturbance after out-of-hospital cardiopulmonary resuscitation : An explorative prospective study

Background Hyperglycemia is common and associated with increased mortality after out-of-hospital cardiac arrest (OHCA) and return of spontaneous circulation (ROSC). Mechanisms behind ultra-acute hyperglycemia are not well known. We performed an explorative study to describe the changes in glucose metabolism mediators during the prehospital postresuscitation phase. Methods We included patients who were successfully resuscitated from out-of-hospital cardiac arrest in two physician-staffed units. Insulin, glucagon, and glucagon-like peptide 1 (GLP-1) were measured in prehospital and hospital admission samples. Additionally, interleukin-6 (IL-6), cortisol, and HbA1c were measured at hospital admission. Results Thirty patients participated in the study. Of those, 28 cases (71% without diabetes) had sufficient data for analysis. The median time interval between prehospital samples and hospital admission samples was 96 minutes (IQR 85-119). At the time of ROSC, the patients were hyperglycemic (11.2 mmol/l, IQR 8.8-15.7), with insulin and glucagon concentrations varying considerably, although mostly corresponding to fasting levels (10.1 mU/l, IQR 4.2-25.2 and 141 ng/l, IQR 105-240, respectively). GLP-1 increased 2- to 8-fold with elevation of IL-6. The median glucose change from prehospital to hospital admission was -2.2 mmol/l (IQR -3.6 to -0.2). No significant correlations between the change in plasma glucose levels and the changes in insulin (r = 0.30, p = 0.13), glucagon (r = 0.29, p = 0.17), or GLP-1 levels (r = 0.32, p = 0.15) or with IL-6 (r = (-0.07), p = 0.75), cortisol (r = 0.13, p = 0.52) or HbA1c levels (r = 0.34, p = 0.08) were observed. However, in patients who did not receive exogenous epinephrine during resuscitation, changes in blood glucose correlated with changes in insulin (r = 0.59, p = 0.04) and glucagon (r = 0.65, p = 0.05) levels, demonstrating that lowering glucose values was associated with a simultaneous lowering of insulin and glucagon levels. Conclusions Hyperglycemia is common immediately after OHCA and cardiopulmonary resuscitation. No clear hormonal mechanisms were observed to be linked to changes in glucose levels during the postresuscitation phase in the whole cohort. However, in patients without exogenous epinephrine treatment, the correlations between glycemic and hormonal changes were more obvious. These results call for future studies examining the mechanisms of postresuscitation hyperglycemia and the metabolic effects of the global ischemic insult and medical treatment.Peer reviewe

Neoadjuvant therapy offers longer survival than upfront surgery for poorly differentiated and higher stage pancreatic cancer

Background: Neoadjuvant therapy for pancreatic cancer remains controversial. Our aim was to assess differences in survival, disease recurrence and histopathological tumor characteristics between patients treated with neoadjuvant therapy followed by subsequent surgery and patients undergoing upfront surgery.Material and methods: Out of 399 consecutive pancreatic ductal adenocarcinoma (PDAC) patients operated at Helsinki University Hospital in 2000-2015, 75 borderline resectable patients were treated with neoadjuvant therapy. Resectable propensity scored patients (n=150) underwent upfront surgery. Neoadjuvant therapy consisted of folfirinox, single gemcitabine or combined with cisplatin, nab-paclitaxel or capecitabine with or without radiation. Survival was calculated with Kaplan-Meier and compared with the Breslow test. Survival was determined from the start of treatment, being the first day of treatment for patients treated with neoadjuvant therapy and the date of surgery for others.Results: Between 2000 and 2015 median disease-specific survival (DSS) [34 vs. 26 months, p=.016] and disease-free survival (DFS) [22 vs. 13 months, p=.001] were longer in patients treated with neoadjuvant therapy than in those undergoing upfront surgery. Survival differences were not significant in the 2000s but were, in turn, among patients treated in the 2010s with better survival for patients treated with neoadjuvant therapy [DSS 35 vs. 26 months, p=.008 and DFS 25 vs. 13 months, p=.001]. Especially patients with poorly differentiated G3 tumors [DSS 30 vs. 11 months, p=.004 and DFS 21 vs. 7 months, p=.001] and higher stage IIB-III [DSS 34 vs. 20 months, p=.006 and DFS 21 vs. 10 months, p=.001] had longer survival when treated with neoadjuvant therapy.Conclusions: PDAC patients treated with neoadjuvant therapy had longer DSS and DFS than those undergoing upfront surgery. Neoadjuvant therapy benefits especially borderline resectable patients with higher stage and poorly differentiated tumors.Peer reviewe