Vanhemmuuden tuki lastensuojelun avohuollon asiakasprosessin eri vaiheissa vanhempien kertomana

Vanhemmuuden tuki lastensuojelun avohuollon asiakasprosessin eri vaiheissa vanhempien kertomana Lastensuojeluprosessi käynnistyy sosiaalityöntekijän saatua tietää lastensuojelun tarpeessa olevasta lapsesta ja perheestä. Sosiaalityöntekijä laatii yhdessä perheen kanssa asiakassuunnitelman, joka on tärkeä väline suunnitella ja arvioida, mitä juuri tämä lapsi tai perhe tarvitsee. Perhetyössä pitäisi pyrkiä löytämään perheiden omat voimavarat ja näin perheet saisivat voimaantumisen kokemuksia. HyvinvointiTV:n lastensuojelun pilottihanke toteutettiin kevään ja kesän 2008 aikana. Hanke perustui lastensuojelun avohuollon palvelujen kehittämiseen tavoitteenaan lastensuojelun palvelujen kehittäminen hyvinvointiteknologiaa hyödyntäen. Tämän opinnäytetyön tarkoituksena oli selvittää kahden perheen omia kokemuksia vanhemmuuden tuesta lastensuojelun avohuollon asiakasprosessin eri vaiheissa. Lisäksi selvitimme vanhempien kokemuksia HyvinvointiTV:n lähetyksistä, joiden tavoitteena oli vanhemmuuden tukeminen. Aineisto on hankittu puolistrukturoidun teemahaastattelun menetelmää käyttäen. Haastattelimme kahden perheen äitejä syksyllä 2008. Haastatteluaineiston analysoimme teoriasidonnaisella sisällönanalyysilla. Tuloksista ilmeni, että neuvolalla on tärkeä rooli vanhemmuuden tukemisessa. Huolen puheeksi ottaminen on ensimmäinen askel kohti tuen saamista. Neuvolan tärkeä tehtävä on osata kuunnella perheitä ja lähteä etsimään oikeanlaista tukea. Tämän lisäksi on tärkeää motivoida perhettä ottamaan tukea vastaan. Haastattelemamme äidit kokivat, että perhetukikeskuksen kuntoutusjakson konkreettinen tuki oli erittäin tärkeä. Perheet saivat kuntoutusjaksollaan tukea arjessa selviytymiseen ja ohjausta arjen rutiinien opettelussa. Kuntoutusjaksollaan saamansa tuen avulla he kokivat vahvistuneensa vanhempina. Kuntoutusjakson jälkeen perheohjaajat kävivät kotikäynneillä jonkin aikaa, mutta tuen tarpeeseen ei enää ollut tarvetta muutaman kerran jälkeen. HyvinvointiTV:n tarjoama tuki tuli näille perheille liian myöhään. HyvinvointiTV:stä olisi perheille hyötyä, jos se olisi prosessissa mukana aikaisemmassa vaiheessa tukemassa avohuollon perhetyötä. Lastensuojelun avohuollon asiakasprosessissa on mukana monia eri toimijoita, joten oikeanlaisen tuen saaminen oikeaan aikaan on tärkeää. Neuvolan antama lyhytkestoinenkin tuki voi jo auttaa perheitä paljon. On kuitenkin tärkeää saada perheiden omat voimavarat näkyviksi ja käyttöön.Parenthood support in non-institutional child protection at the different stages of client process The child protection process starts when a social worker is informed of the child and its fam-ily and their need of child protection. The social worker prepares together with the family an assessment, which is an important tool to plan and estimate what exactly the child and the family needs. In family work the family’s own resources should be found. This way the family will get empowering experiences. Our thesis relates to CaringTV child protection pilot project, which was implemented during the spring and summer 2008. The project was based on developing non-institutional care ser-vices in child protection and the objectives were to develop services for child protection us-ing welfare technology. The purpose of our thesis was to find out two families’ experiences of parenthood support in non-institutional child protection at the different stages of client proc-ess. In addition we investigated parents’ experiences of those CaringTV’s broadcasts, which were targeted to support parenthood. We collected the research material trough semi-structured theme interviews. We interviewed the mothers of two families in fall 2008. We analyzed the interview material with theory-based content analysis. It emerged from the findings that a child welfare clinic has an important role in supporting parenthood. Taking the concern under discussion is the first step towards receiving support. An important task for child welfare clinics is to be able to listen to the families and to start to look for appropriate support. In addition to this it is important to motivate the family to ac-cept the support. The mothers that we interviewed felt that the concrete support received from the family support centre during the rehabilitation period was very important. The families received support to cope with the everyday life during their rehabilitation period and guidance to learn the routines in everyday life. Trough the support they received during their rehabilitation period the mothers felt they had become stronger parents. After the rehabilita-tion period family supervisors made home visit for a while but after a few visits there was not any need for the support anymore. CaringTV would be more beneficial for the families if it were involved in the process at an earlier stage to support family work. Many different agents are involved in non-institutional child protection in the client process, thus the right kind of support at the right time is very important. Even the short-term support that the child welfare clinic can give helps the families a lot. However, it is important to recognise and utilize the families’ own resources

Aikuisen aivovammapotilaan neurotehohoito

Teema : neuroanestesiologi

Aivovammapotilaan tehohoito

Teema : tehohoitolääketiede. English summaryPeer reviewe

Active Cerebrospinal Fluid Exchange System for Treatment of Pyogenic Ventriculitis

Peer reviewe

Perioperative Treatment of Brain Arteriovenous Malformations Between 2006 and 2014: The Helsinki Protocol

We reviewed retrospectively the perioperative treatment of microsurgically resected brain arteriovenous malformations (bAVMs) at the neurosurgical department of Helsinki University Hospital between the years 2006 and 2014. We examined the performance of the treatment protocol and the incidence of delayed postoperative hemorrhage (DPH).Peer reviewe

Ketamiini ja kallonsisäinen paine : todellinen ongelma vai paljon melua tyhjästä

Ketamiinin käyttö ensihoidossa on lisääntynyt, sillä se ei lamaa hengitystä eikä verenkiertoa. Ketamiini saattaa kuitenkin nostaa kallonsisäistä painetta. Onko ketamiini turvallinen lääke ensihoidossa aivotapahtumapotilaita hoidettaessa? Kannattaako teho-osastolla aivotapahtumapotilaita lääkitä ketamiinilla?</p

Variation in neurosurgical management of traumatic brain injury : a survey in 68 centers participating in the CENTER-TBI study

Correction: Volume: 161 Issue: 3 Pages: 451-455 DOI: 10.1007/s00701-019-03815-6 Accession Number: WOS:000460607500003BackgroundNeurosurgical management of traumatic brain injury (TBI) is challenging, with only low-quality evidence. We aimed to explore differences in neurosurgical strategies for TBI across Europe.MethodsA survey was sent to 68 centers participating in the Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. The questionnaire contained 21 questions, including the decision when to operate (or not) on traumatic acute subdural hematoma (ASDH) and intracerebral hematoma (ICH), and when to perform a decompressive craniectomy (DC) in raised intracranial pressure (ICP).ResultsThe survey was completed by 68 centers (100%). On average, 10 neurosurgeons work in each trauma center. In all centers, a neurosurgeon was available within 30min. Forty percent of responders reported a thickness or volume threshold for evacuation of an ASDH. Most responders (78%) decide on a primary DC in evacuating an ASDH during the operation, when swelling is present. For ICH, 3% would perform an evacuation directly to prevent secondary deterioration and 66% only in case of clinical deterioration. Most respondents (91%) reported to consider a DC for refractory high ICP. The reported cut-off ICP for DC in refractory high ICP, however, differed: 60% uses 25mmHg, 18% 30mmHg, and 17% 20mmHg. Treatment strategies varied substantially between regions, specifically for the threshold for ASDH surgery and DC for refractory raised ICP. Also within center variation was present: 31% reported variation within the hospital for inserting an ICP monitor and 43% for evacuating mass lesions.ConclusionDespite a homogeneous organization, considerable practice variation exists of neurosurgical strategies for TBI in Europe. These results provide an incentive for comparative effectiveness research to determine elements of effective neurosurgical care.Peer reviewe

Genetic and Epigenetic Characteristics of Inflammatory Bowel Disease–Associated Colorectal Cancer

doi: 10.1053/j.gastro.2021.04.042Background & Aims Inflammatory bowel disease (IBD) is a chronic, relapsing inflammatory disorder associated with an elevated risk of colorectal cancer (CRC). IBD-associated CRC (IBD-CRC) may represent a distinct pathway of tumorigenesis compared to sporadic CRC (sCRC). Our aim was to comprehensively characterize IBD-associated tumorigenesis integrating multiple high-throughput approaches, and to compare the results with in-house data sets from sCRCs. Methods Whole-genome sequencing, single nucleotide polymorphism arrays, RNA sequencing, genome-wide methylation analysis, and immunohistochemistry were performed using fresh-frozen and formalin-fixed tissue samples of tumor and corresponding normal tissues from 31 patients with IBD-CRC. Results Transcriptome-based tumor subtyping revealed the complete absence of canonical epithelial tumor subtype associated with WNT signaling in IBD-CRCs, dominated instead by mesenchymal stroma-rich subtype. Negative WNT regulators AXIN2 and RNF43 were strongly down-regulated in IBD-CRCs and chromosomal gains at HNF4A, a negative regulator of WNT-induced epithelial–mesenchymal transition (EMT), were less frequent compared to sCRCs. Enrichment of hypomethylation at HNF4α binding sites was detected solely in sCRC genomes. PIGR and OSMR involved in mucosal immunity were dysregulated via epigenetic modifications in IBD-CRCs. Genome-wide analysis showed significant enrichment of noncoding mutations to 5′untranslated region of TP53 in IBD-CRCs. As reported previously, somatic mutations in APC and KRAS were less frequent in IBD-CRCs compared to sCRCs. Conclusions Distinct mechanisms of WNT pathway dysregulation skew IBD-CRCs toward mesenchymal tumor subtype, which may affect prognosis and treatment options. Increased OSMR signaling may favor the establishment of mesenchymal tumors in patients with IBD.BACKGROUND & AIMS: Inflammatory bowel disease (IBD) is a chronic, relapsing inflammatory disorder associated with an elevated risk of colorectal cancer (CRC). IBD-associated CRC (IBD-CRC) may represent a distinct pathway of tumorigenesis compared to sporadic CRC (sCRC). Our aim was to comprehensively characterize IBD-associated tumorigenesis integrating multiple high-throughput approaches, and to compare the results with in-house data sets from sCRCs. METHODS: Whole-genome sequencing, single nucleotide polymorphism arrays, RNA sequencing, genome-wide methylation analysis, and immunohistochemistry were performed using fresh-frozen and formalin-fixed tissue samples of tumor and corresponding normal tissues from 31 patients with IBD-CRC. RESULTS: Transcriptome-based tumor subtyping revealed the complete absence of canonical epithelial tumor subtype associated with WNT signaling in IBD-CRCs, dominated instead by mesenchymal stroma-rich subtype. Negative WNT regulators AXIN2 and RNF43 were strongly down-regulated in IBD-CRCs and chromosomal gains at HNF4A, a negative regulator of WNTinduced epithelial-mesenchymal transition (EMT), were less frequent compared to sCRCs. Enrichment of hypomethylation at HNF4 alpha binding sites was detected solely in sCRC genomes. PIGR and OSMR involved in mucosal immunity were dysregulated via epigenetic modifications in IBD-CRCs. Genome-wide analysis showed significant enrichment of noncoding mutations to 50 untranslated region of TP53 in IBD-CRCs. As reported previously, somatic mutations in APC and KRAS were less frequent in IBD-CRCs compared to sCRCs. CONCLUSIONS: Distinct mechanisms of WNT pathway dysregulation skew IBD-CRCs toward mesenchymal tumor subtype, which may affect prognosis and treatment options. Increased OSMR signaling may favor the establishment of mesenchymal tumors in patients with IBD.Peer reviewe

Comparison of high versus low frequency cerebral physiology for cerebrovascular reactivity assessment in traumatic brain injury: a multi-center pilot study

Current accepted cerebrovascular reactivity indices suffer from the need of high frequency data capture and export for post-acquisition processing. The role for minute-by-minute data in cerebrovascular reactivity monitoring remains uncertain. The goal was to explore the statistical time-series relationships between intra-cranial pressure (ICP), mean arterial pressure (MAP) and pressure reactivity index (PRx) using both 10-s and minute data update frequency in TBI. Prospective data from 31 patients from 3 centers with moderate/severe TBI and high-frequency archived physiology were reviewed. Both 10-s by 10-s and minute-by-minute mean values were derived for ICP and MAP for each patient. Similarly, PRx was derived using 30 consecutive 10-s data points, updated every minute. While long-PRx (L-PRx) was derived via similar methodology using minute-by-minute data, with L-PRx derived using various window lengths (5, 10, 20, 30, 40, and 60 min; denoted L-PRx_5, etc.). Time-series autoregressive integrative moving average (ARIMA) and vector autoregressive integrative moving average (VARIMA) models were created to analyze the relationship of these parameters over time. ARIMA modelling, Granger causality testing and VARIMA impulse response function (IRF) plotting demonstrated that similar information is carried in minute mean ICP and MAP data, compared to 10-s mean slow-wave ICP and MAP data. Shorter window L-PRx variants, such as L-PRx_5, appear to have a similar ARIMA structure, have a linear association with PRx and display moderate-to-strong correlations (r ~ 0.700, p Peer reviewe

Variation in Structure and Process of Care in Traumatic Brain Injury: Provider Profiles of European Neurotrauma Centers Participating in the CENTER-TBI Study.

INTRODUCTION: The strength of evidence underpinning care and treatment recommendations in traumatic brain injury (TBI) is low. Comparative effectiveness research (CER) has been proposed as a framework to provide evidence for optimal care for TBI patients. The first step in CER is to map the existing variation. The aim of current study is to quantify variation in general structural and process characteristics among centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. METHODS: We designed a set of 11 provider profiling questionnaires with 321 questions about various aspects of TBI care, chosen based on literature and expert opinion. After pilot testing, questionnaires were disseminated to 71 centers from 20 countries participating in the CENTER-TBI study. Reliability of questionnaires was estimated by calculating a concordance rate among 5% duplicate questions. RESULTS: All 71 centers completed the questionnaires. Median concordance rate among duplicate questions was 0.85. The majority of centers were academic hospitals (n = 65, 92%), designated as a level I trauma center (n = 48, 68%) and situated in an urban location (n = 70, 99%). The availability of facilities for neuro-trauma care varied across centers; e.g. 40 (57%) had a dedicated neuro-intensive care unit (ICU), 36 (51%) had an in-hospital rehabilitation unit and the organization of the ICU was closed in 64% (n = 45) of the centers. In addition, we found wide variation in processes of care, such as the ICU admission policy and intracranial pressure monitoring policy among centers. CONCLUSION: Even among high-volume, specialized neurotrauma centers there is substantial variation in structures and processes of TBI care. This variation provides an opportunity to study effectiveness of specific aspects of TBI care and to identify best practices with CER approaches