The Quality of Paediatric Nursing Care - Children’s Perspective

Hoitotyön laatu - lasten näkökulma Tämän kolmivaiheisen tutkimuksen tarkoituksena oli kuvailla lasten odotuksia ja arviointeja lasten hoitotyön laadusta sekä kehittää mittari kouluikäisille sairaalassa oleville lapsille laadun arviointiin. Perimmäisenä tavoitteena oli lasten hoitotyön laadun kehittäminen sairaalassa. Ensimmäisessä vaiheessa 20 alle kouluikäistä (4-6v) sekä 20 kouluikäistä (7-11v) lasta kuvailivat odotuksiaan lasten hoitotyön laadusta. Aineisto kerättiin haastattelulla ja lasten piirustusten avulla, sekä analysoitiin sisällön analyysilla. Lasten odotukset lasten hoitotyön laadusta kohdistuivat hoitajaan, hoitotyön toimintoihin ja ympäristöön, fyysinen ympäristö korostui piirustuksissa. Ensimmäisen vaiheen tulosten, aikaisemman kirjallisuuden sekä Leino-Kilven “HYVÄ HOITO” mittarin pohjalta kehitettiin “Lasten Hoidon Laatu Sairaalassa” (LHLS) mittari ja testattiin sen psykometrisiä ominaisuuksia tutkimuksen toisessa vaiheessa. Mittaria kehitettiin ja testattiin kolmen vaiheen kautta. Aluksi asiantuntijapaneeli (n=7) arvioi mittarin sisältöä. Seuraavaksi mittari esitestattiin kahdesti kouluikäisillä sairaalassa olevilla lapsilla (n=41 ja n=16), samassa vaiheessa myös viiden lastenosaston hoitajat (n=19) yhdessä arvioivat mittarin sisältöä sekä 8 lasta. Lopuksi mittaria testattiin kouluikäisillä lapsilla (n=388) sairaalassa sekä hoitajat (n=198) arvioivat mittarin sisällön validiteettia. Mittarin kehittämisen aikana päälaatuluokkien: hoitajan ominaisuudet, hoitotyön toiminnot ja hoitotyön ympäristö Cronbachin alfa kertoimet paranivat. Pääkomponentti analyysi tuki mittarin hoitotyön toimintojen ja ympäristön alaluokkien teoreettista rakennetta. Kolmannessa vaiheessa “Lasten Hoidon Laatu Sairaalassa” (LHLS III, versio neljä) mittarilla kerättiin aineisto Suomen yliopistosairaaloiden lastenosastoilta kouluikäisiltä 7-11 -vuotiailta lapsilta (n=388). Mittarin lopussa lapsia pyydettiin lisäksi kuvailemaan kivointa ja ikävintä kokemustaan sairaalahoidon aikana lauseen täydennystehtävänä. Aineisto analysoitiin tilastollisesti sekä sisällön analyysilla. Lapset arvioivat fyysisen hoitoympäristön, hoitajien inhimillisyyden ja luotettavuuden sekä huolenpidon ja vuorovaikutustoiminnot kiitettäviksi. Lapset arvioivat hoitajien viihdyttämistoiminnot kaikkein alhaisimmiksi. Lapsen ikä ja sairaalantulotapa olivat yhteydessä lasten saamaan tiedon määrään. Lasten kivoimmat kokemukset liittyivät ihmisiin ja heidän ominaisuuksiinsa, toimintoihin, ympäristöön sekä lopputuloksiin. Ikävimmät kokemukset liittyivät potilaana oloon, tuntemuksiin sairauden oireista sekä erossaoloon, hoitotyön fyysisiin toimintoihin sekä ympäristöön. Tutkimuksen tulokset osoittavat lasten olevan kykeneviä arvioimaan omaa hoitoaan ja heidän näkökulmansa tulisi nähdä osana koko laadun kehittämisprosessia parannettaessa laatua käytännössä todella lapsilähtöisemmällä lähestymistavalla. “Lasten Hoidon Laatu Sairaalassa” (LHLS) mittari on mahdollinen väline saada tietoa lasten arvioinneista lasten hoitotyön laadusta, mutta mittarin testaamista tulisi jatkaa tulevaisuudessaThe purpose of this three-phase study was to describe children’s expectations and evaluations concerning the quality of paediatric nursing care and to develop a quality instrument for hospitalized school-age children. The aim of the study was to improve the quality of paediatric nursing in hospital. In the first phase, data were collected through theme interviews and children’s drawings from 20 preschool-age children (4 to 6 years) and 20 school-age children (7 to 11 years). The data were analysed by using content analysis. The children’s expectations concerning the quality of nursing care were related to the nurse, nursing activities and environment; the physical environment was emphasized in drawings. On the basis of the results of the first phase, as well as earlier literature and Leino-Kilpi’s “Good Nursing Care” Scale, the instrument “Child Care Quality at Hospital” (CCQH) was developed and its psychometrics tested in the second phase. First, an expert panel (n=7) assessed the content of the instrument. Second, the instrument was pilot-tested twice by collecting data from hospitalized school-age children (n=41 and n=16); in the same step the content validity of the instrument was assessed by nurses (n=19) from five wards together and by children (n=8). Finally, the instrument was tested with hospitalized school-age children (n=388), and nurses (n=198) assessed the content validity of the instrument. During the development process of the instrument, the main quality categories - nurse characteristics, nursing activities, and nursing environment Cronbach’s alpha values - improved. The principal component analysis supported the theoretical construct of the subcategories in nursing activities and environment. In the third phase, data were collected with the CCQH III (version four) from the paediatric clinics of the five university hospitals in Finland from school-age children (n=388) aged 7 to 11. At the end of the instrument there were two sentence completions in which children were asked to describe their best and worst experiences during hospitalization. The data were analysed using statistical methods and content analysis. The children rated the physical nursing environment, nurses’ humanity and trustworthiness, and caring and communication as excellent. They gave the lowest ratings to nurses’ entertainment activities. The age of the child and type of admission were both related to the amount of information they received. Children’s best experiences were related to people, their characteristics, activities, environment and outcomes. The worst experiences were related to being a patient, feelings related to symptoms of illness and separation, the physical care and treatment activities of nursing and to environment. The study showed that children are capable of evaluating their care, and their perspectives should be seen as part of the entire quality development process to improve quality in practice with a more genuinely child-centred approach. The instrument CCQH is a potential tool for obtaining knowledge about children’s evaluations of the quality of paediatric nursing care, but more testing should be done in the future. Keywords: paediatric nursing, quality of nursing care, quality of health care, child, instrumentSiirretty Doriast

Verkkohakemiston hyödyntäminen ja rooli yrityksen markkinoinnissa : case: Salonseudunpalvelut.fi

Tämän opinnäytetyön tarkoituksena on selvittää, minkälainen rooli sähköisellä hakemistossa on yritysten markkinoinnissa ja miten hakemistoa hyödynnetään. Tutkimuksen kohteena on Salonseudunpalvelut.fi -hakemisto, jota ylläpitää Salon Seudun Sanomat. Hakemisto tarjoaa yrityksille mahdollisuuden tuoda esille tuote- ja palvelutarjontansa, tehdä nettitarjouksia ja kertoa ajankohtaisia uutisia. Kyse on uudentyyppisestä palvelusta, joka tarjoaa enemmän kuin pelkät yhteystiedot. Tutkimuksen teoriaosuus kertoo markkinointiviestinnän murroksesta Suomessa. Monissa Euroopan maissa digitaalinen markkinointi on jo tätä päivää, Suomessa vauhti on ollut hitaampaa. On kuitenkin ennustettu, että massamarkkinoinnin aika on loppumassa ja yritykset siirtyvät yhä enemmän kohti henkilökohtaisempaa markkinointia, jolloin asiakassuhde nousee keskeiseksi. Digitaalisen markkinointiviestinnän avulla viesti voidaan suunnata potentiaalisille asiakasryhmille kustannustehokkaasti ja asiakkaat tarpeet huomioon ottaen. Kvalitatiivinen tutkimus toteutettiin puhelinhaastatteluina maaliskuussa 2012 ja siihen osallistui kuusi Salonseudunpalvelut.fi -hakemistossa mukana olevaa yrittäjää. Tutkimuksen mukaan pk-yrittäjät käyttävät digitaalista mainontaa vielä harkiten ja vähäisesti, mutta kiinnostus sitä kohtaan on kasvamassa. Salonseudunpalvelut.fi -hakemisto tukee yritysten muuta mainontaa, joka pääsääntöisesti on edelleen sanomalehtimainontaa. Osa yrittäjistä hyödyntää hakemistoa aktiivisesti, kun taas toisilla hakemiston hyödyntäminen on vähäistä, eikä sen tuomia etuja välttämättä nähdä.The purpose of this thesis is to find out what role digital directory has in company’s marketing and how companies are using it. The object of research is Salonseudunpalvelut.fi -directory which is maintained by Salon Seudun Sanomat (a local newspaper). The directory offers possibility to bring out company’s products and services. There is also a possibility to make product offers and tell latest news of company. Directory is a new service which is much more than contacts. Theoretical part deals with the transform of marketing communications in Finland. In many European countries digital marketing is in use all the time. In Finland the speed of digitalization has been slower. It is estimated that a time of mass marketing is running out and companies will use more and more personal marketing. Moreover, customer relationship will become the most important channel. With digital marketing communications it is possible to direct the message to any potential group cost-effectively and take account the customers’ needs. The used metod is qualitative. Research was carried out in March 2012 by interviewing six entrepreneurs who are involved in the directory. Interviews were made by telephone. According to the research it seems that small companies still use digital marketing with caution and only a little. However, interest is growing. Salonseudunpalvelut.fi -directory supports also companies’ other marketing functions. The most using marketing tool is still newspaper. It seems that some entrepreneurs are very active using the directory, whereas some others do not know how the directory can boost their marketing

Toxic lifespan of the synthetic opioid U-47,700 in Finland verified by re-analysis of UPLC-TOF-MS data

U-47,700 is a synthetic opioid that emerged on the novel psychoactive substance market a few years ago. After incorporating the substance into the urine UPLC-TOF-MS screening used in post-mortem toxicology, the drug was detected in 10 autopsy cases within routine case work. In all cases, the cause of death was accidental poisoning by U-47,700 alone or in combination with other psychoactive substances. The concentration of U-47,700 in the blood samples ranged between 0.15-2.0 mg/L with a median of 0.30 mg/L. In one of the cases with a U-47,700 concentration of 0.27 mg/L, no other psychoactive substances were detected. The stored TOF-MS analytical data from the year preceding the incorporation of U-47,700 into the screening was reprocessed in order to search for more positive cases. The data-independent acquisition of the original screening allowed for retrospective re-analysis of the full-scan data without additional experiments on the actual sample. The retrospective data-analysis revealed two additional cases positive for U-47,700. The first mention of U-47,700 on a Finnish internet discussion forum was in March 2015. After having been detected in several death cases, the drug was put under national control in November 2016 and the last fatality occurred in 2017. The toxic lifespan of U-47,700 thus lasted for approximately 2 years in Finland. Forensic and clinical laboratories need to rapidly adjust their screening procedures in order to adapt to the continuously expanding field of novel psychoactive substances. Retrospective data-analysis is a practical tool for monitoring the emergence of new substances onto the market. (C) 2019 Elsevier B.V. All rights reserved.Peer reviewe

Quantitative Estimation of 38 Illicit Psychostimulants in Blood by GC-APCI-QTOFMS with Nitrogen Chemiluminescence Detection Based on Three External Calibrators

A method was developed for quantitative estimation of illicit psychostimulants in blood, with an emphasis on new psychoactive substances, based on gas chromatography nitrogen chemiluminescence detection coupled with atmospheric pressure chemical ionization quadrupole time-of-flight mass spectrometry (GC-NCD-APCI-QTOFMS). Quantitative estimation relied on the NCD's N-equimolar response to nitrogen, using amphetamine, 3,4-methylenedioxymethamphetamine (MDMA) and methylenedioxypyrovalerone as external calibrators for prim-, sec- and tert- amines, respectively. After spiking with 38 stimulants at 3 concentration levels, the donor blood samples were submitted to liquid-liquid extraction at a basic pH followed by acylation with trifluoroacetic anhydride. All but 3 psychostimulants could be analyzed with a limit of quantification (LOQ) of 0.05 mg/L. At LOQ, the coefficient of variation (CV) values for between-day accuracy was 62.3-143.3% (mean, 93.5%; median, 88.5%) and precision 6.6-22.4% (mean, 15.8%; median, 16.1%). In addition, 11 post-mortem blood samples, containing 0.08-2.4 mg/L of amphetamine (n = 5), methamphetamine (n = 4) or MDMA (n = 4), were analyzed by the GC-NCD-APCI-QTOFMS method, and the results were compared with an established electron ionization GC-MS method with appropriate calibration. The agreement between the 2 methods was 62.5-117.3%. Regarding identification, the APCI source permitted detection of the intact precursor ion, or the respective acylation product, for all of the measured compounds. The GC-NCD-APCI-QTOFMS method developed here enables instant quantitative estimation of illicit psychostimulants in blood at reasonable accuracy, without the necessity of possessing the true reference standards for each analyte.Peer reviewe

Leptospira seroprevalence and associated risk factors in healthy Swedish dogs

Background Leptospirosis is an emerging zoonotic infection worldwide and a cause of life-threatening disease in dogs. Seroprevalence in Swedish dogs is unknown. The aims of the present study were to estimate seroprevalence of pathogenic Leptospira in healthy dogs in Sweden using the microagglutination test (MAT) and a rapid point-of-care enzyme-linked immunosorbent assay (ELISA), and to evaluate risk factors of Leptospira exposure in Swedish dogs. Results Positive MAT titres (>= 1:50) were detected in 27/369 (7.3%) of included dogs. Five different serovars were represented of which the Saxkoebing serovar was the most common (64.3%), followed by Copenhagi (14.3%), Bratislava (10.7%), Icterohaemorrhagiae (7.1%), and Canicola (3.6%). The ELISA test (SNAP (R) Lepto) was positive in 3/316 (0.9%) dogs. Living in urban areas and contact with stagnant water were found to be risk factors for Leptospira seropositivity (p < 0.05) in a multivariable logistic regression model. Conclusion In this first seroprevalence study of Leptospira in Swedish dogs, it was shown that healthy dogs without recent (24 months) travel history and antileptospira vaccination had been exposed to pathogenic Leptospira interrogans serovars. Contact with stagnant water and living in urban areas were independent risk factors for seropositivity

Nitrofurantoin plasma- and urine exposure in eight healthy beagle dogs following standard nitrofurantoin dosing regimen

Bacterial cystitis is common in dogs and is usually treated with antibiotics. Nitrofurantoin is used for treatment of bacterial cystitis in humans and might provide a feasible treatment option in dogs. The aim of this study was to investigate the nitrofurantoin plasma concentration-time course and potential adverse effects in dogs. Nitro-furantoin (4.4-5.0 mg/kg) was administered orally to eight healthy beagles every 8 h for five days before repeated plasma and urine samples were collected. An additional four beagles served as untreated controls. The nitrofurantoin plasma and urine concentrations were measured using ultra high precision liquid chromatography coupled to tandem mass-spectrometry and further analysed using a non-compartmental pharmacokinetic model. In plasma, the median C-max was 2.1 mu g/mL, t(max) was 2 h, the terminal rate constant was 0.9 per h and the terminal half-life was 0.8 h. In urine, median C-max was 56 mu g/mL, t(max) was 1 h and the terminal half-life was 4.3 h. No adverse effects were observed clinically or in haematology or biochemistry. The data presented in this study combined with in vitro sensitivity data from common urine pathogens and the lack of observed adverse effects suggest that nitrofurantoin in a standard dosing regimen could be effective in sporadic bacterial cystitis treatment in dogs. Further clinical studies are highly warranted to verify the effectiveness in clinical cases

Impact of equipment and handling on systolic blood pressure measurements in conscious dogs in an animal hospital environment

Background Situational hypertension and differences between devices complicate interpretations of systolic blood pressure (SBP) measurements in dogs.Hypothesis/Objectives To evaluate if time point of in-clinic SBP measurement, type of oscillometric device, and operator affect SBP measurements in conscious dogs.Animals Sixty-seven privately owned dogs with or without chronic kidney disease, divided into 2 study samples (A and B).Methods Cross-sectional diagnostic study. In part A, SBP measurements in dogs were performed using 2 different devices (HDO and petMap) after acclimatization at 3 standardized time points during a clinical visit. In part B, SBP measurements (HDO) were performed in dogs by a trained final year veterinary student and by the owner alone, at the same occasion.Results For all dogs, there was no difference in mean SBP (mSBP) among the 3 time points for HDO (P = .12) or petMAP (P = .67). However, intraindividual mSBP differences of up to 60 mm Hg between time points were documented. Mean SBP obtained with petMAP was on average 14 (95% CI: 8-20) mm Hg higher than mSBP obtained with HDO, and this difference increased with increasing SBP. Mean SBP measurements obtained by the trained student were 7 (95% CI: 2-11) mm Hg higher than mSBP measurements obtained by the owner.Conclusions and Clinical Importance According to the results of this study, time point of in-clinic SBP measurement in dogs is of minor importance, and instructing owners to perform measurements might reduce suspected situational hypertension. Differences in mSBP measured with HDO and petMAP underscore the need for validation of BP devices used clinically

Chronic Enteropathy in Dogs—Epidemiologic Aspects and Clinical Characteristics of Dogs Presenting at Two Swedish Animal Hospitals

Information about prevalence and breed predisposition of canine chronic enteropathy (CE) is limited. The aim of this retrospective study was to investigate period prevalence, breed disposition, clinical features, diagnostic results, and treatment response of CE in dogs presenting at two Swedish animal hospitals during 2013–2018. A medical record search was performed to identify CE dogs including those with ≥3 visits because of gastrointestinal disease and/or that had undergone gastroduodenoscopy/colonoscopy during 2013–2018. Dog characteristics, case history, physical examination, laboratory variables, therapeutic protocol, and treatment response were recorded. Inclusion criteria for CE were met by 814 dogs. Period prevalence of CE was 1.1% of total number of dogs. Breeds with the highest relative risk included Norwegian Lundehund, West Highland White Terrier, and Miniature Poodle. Median age at presentation was 3.8 (IQR 1.8–6.8) years. French Bulldogs and Miniature Schnauzers presented at a younger age

Development of a GC-APCI-QTOFMS library for new psychoactive substances and comparison to a commercial ESI library

Gas chromatography coupled to atmospheric pressure chemical ionization quadrupole time-of-flight mass spectrometry (GC-APCI-QTOFMS) was evaluated for the identification of new psychoactive substances (NPS). An in-house high mass resolution GC-APCI-QTOFMS test library was developed for 29 nitrogen-containing drugs belonging mostly to synthetic stimulants. The library was based on 12 intra-day measurements of each compound at three different collision energies, 10, 20 and 40 eV. The in-house library mass spectra were compared to mass spectra from a commercial library constructed by liquid chromatography-electrospray ionization (LC-ESI) QTOFMS. The reversed library search scores between the in-house GC-APCI library and the commercial LC-ESI library were compared once a week during a 5-week period by using data measured by GC-APCI-QTOFMS. The protonated molecule was found for all drugs in the full scan mode, and the drugs were successfully identified by both libraries in the targeted MS/MS mode. The GC-APCI library score averaged over all collision energies was as high as 94.4/100 with a high repeatability, while the LC-ESI library score was also high (89.7/100) with a repeatability only slightly worse. These results highlight the merits of GC-APCI-QTOFMS in the analysis of NPS even in situations where the reference standards are not immediately available, taking advantage of the accurate mass measurement of the protonated molecule and product ions, and comparison to existing soft-ionization mass spectral libraries.Peer reviewe