Sairaalasta kotiutuminen - Ikääntyneen kotona selviytyminen sairaalajakson jälkeen

Sairaalasta kotiutuminen – Ikääntyneen kotona selviytyminen sairaalajakson jälkeen Sairaalasta kotiutuminen on ikääntyneen elämässä stressaava, kriittinen ja pelottavakin tilanne. Ikääntynyt tarvitsee tukea eri tahoilta selviytyäkseen kotiutusvaiheen yli. Onnistunut kotiutuminen sairaalahoidon jälkeen on riippuvainen sekä saadusta avusta että ohjauksesta, mutta myös ikääntyneen omista voimavaroista. Tämän kirjallisuuskatsauksen tavoitteena oli selvittää mitkä asiat tukevat ikääntyneen kotona selviytymistä sairaalajakson jälkeen. Tutkimuksen tekemisessä käytettiin kotimaisia ja kansainvälisiä julkaisuja aiheesta ja näistä etsittiin vastauksia tutkimuskysymyksiin. Tiedonhaku suoritettiin suomen- ja englanninkielisillä hakusanoilla helmikuussa 2016 Medic-, Melinda- ja EBSCOhost-tietokannoista. Lisäksi tutkimuksia etsittiin manuaalisella haulla sopivan aineiston lähdeluetteloista. Katsaukseen valittiin kuusi suomenkielistä ja neljä englanninkielistä sisäänottokriteerit täyttävää julkaisua. Aineisto analysoitiin sisällönerittelyllä. Katsauksen tulosten mukaan onnistunutta kotiutumista edistävät eri tahoilta saatu konkreettinen apu ja tuki, laadukas ohjaus ja hoito, ikääntyneen psyykkiset ja fyysiset voimavarat sekä ympäristötekijät. Kotona selviytymistä vaikeuttivat ikääntyneen heikko toimintakyky, epävarmuus ja passiivisuus sekä puutteelliset asuinolosuhteet ja riittämätön apu. Hoitajien antamalla ohjauksella, tiedottamisella ja ikääntyneen ottamisella mukaan kotiutuksen suunnitteluun, voidaan merkittävästi vaikuttaa kotiutumisen onnistumiseen. Aiheesta kaivataan tuoretta ikääntyneiden, heidän omaistensa ja kotihoidon työntekijöiden haastatteluihin pohjautuvaa tutkimustietoa. Asiasanat: kotiutuminen, kotona selviytyminen, vanhus, ikääntynyt, sairaalaHow to help the elderly cope with the return home after discharge from a hospital The returning home from the hospital can be stressful, critical and even a frightening situation in an elderly person's life. They need support from various sources to manage over the discharging period. Successful returning home is dependent on both the received help and instruction as well as the elderly person's own resources. The purpose of this literature review was to examine the issues that support coping at home after discharge from hospital. Both domestic and international publications were used in the study to answer the research questions. The information retrieval was performed with Finnish and English terms in February 2016. The used databases were Medic, Melinda and EBSCOhost. In addition, suitable material was also manually searched for. Six Finnish and four English publications that fulfilled the intake criterion were chosen to the study. The material was analyzed on a contents specification. According to the results, successful returning home is promoted by concrete help and support that has been received from different sources, by high-quality instruction and care, an elderly person’s mental and physical resources and environmental factors. The difficulties in coping at home were a weak ability to function, uncertainty and passiveness of the elderly person and an inadequate home environment and insufficient help. The success of returning home can increase significantly with instructions given by the nurses, informing and guiding an elderly person through the discharge planning. Suggested further research would be to do an interview study with the elderly, their close relatives or the home care. Keywords: discharging, coping, old person, elderly, hospita

Common Inflammation-Related Candidate Gene Variants and Acute Kidney Injury in 2647 Critically Ill Finnish Patients

Acute kidney injury (AKI) is a syndrome with high incidence among the critically ill. Because the clinical variables and currently used biomarkers have failed to predict the individual susceptibility to AKI, candidate gene variants for the trait have been studied. Studies about genetic predisposition to AKI have been mainly underpowered and of moderate quality. We report the association study of 27 genetic variants in a cohort of Finnish critically ill patients, focusing on the replication of associations detected with variants in genes related to inflammation, cell survival, or circulation. In this prospective, observational Finnish Acute Kidney Injury (FINNAKI) study, 2647 patients without chronic kidney disease were genotyped. We defined AKI according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria. We compared severe AKI (Stages 2 and 3, n = 625) to controls (Stage 0, n = 1582). For genotyping we used iPLEX(TM) Assay (Agena Bioscience). We performed the association analyses with PLINK software, using an additive genetic model in logistic regression. Despite the numerous, although contradictory, studies about association between polymorphisms rs1800629 in TNFA and rs1800896 in IL10 and AKI, we found no association (odds ratios 1.06 (95% CI 0.89-1.28, p = 0.51) and 0.92 (95% CI 0.80-1.05, p = 0.20), respectively). Adjusting for confounders did not change the results. To conclude, we could not confirm the associations reported in previous studies in a cohort of critically ill patients.Peer reviewe

Heme oxygenase-1 repeat polymorphism in septic acute kidney injury

Acute kidney injury (AKI) is a syndrome that frequently affects the critically ill. Recently, an increased number of dinucleotide repeats in the HMOX1 gene were reported to associate with development of AKI in cardiac surgery. We aimed to test the replicability of this finding in a Finnish cohort of critically ill septic patients. This multicenter study was part of the national FINNAKI study. We genotyped 300 patients with severe AKI (KDIGO 2 or 3) and 353 controls without AKI (KDIGO 0) for the guanine-thymine (GTn) repeat in the promoter region of the HMOX1 gene. The allele calling was based on the number of repeats, the cut off being 27 repeats in the S-L (short to long) classification, and 27 and 34 repeats for the S-M-L2 (short to medium to very long) classification. The plasma concentrations of heme oxygenase-1 (HO-1) enzyme were measured on admission. The allele distribution in our patients was similar to that published previously, with peaks at 23 and 30 repeats. The S-allele increases AKI risk. An adjusted OR was 1.30 for each S-allele in an additive genetic model (95% CI 1.01-1.66; p = 0.041). Alleles with a repeat number greater than 34 were significantly associated with lower HO-1 concentration (p<0.001). In septic patients, we report an association between a short repeat in HMOX1 and AKI risk

Nestemäinen kuluttajavirkiste leikkoruusuilla

Opinnäytetyön tarkoituksena on kartoittaa leikkoruusujen sadonkorjuun jälkeiseen laatuun vaikuttavia tekijöitä, sekä selvittää Chrysalin nestemäisen kuluttajavirkisteen vaikutus lajikkeiden Akito ja Golden Sonrise maljakkokestävyyteen. Nestemäiset kuluttajavirkisteet ovat Suomessa vielä uusia, mutta niiden odotetaan korvaavan perinteiset jauhepussit. Työn teoriaosuudessa tarkastellaan ruusua leikkokukkana, sekä tutustutaan leikkoruusun markkinatilanteeseen ja viljelyyn. Tutkimuksen taustaksi selvitettiin leikkoruusun käsittelyä sadonkorjuun jälkeen, sen tavanomaisia kuljetus- ja varastointiolosuhteita, sekä maljakkokestävyyteen vaikuttavia tekijöitä. Teoriaosuuden tavoitteena on selvittää, mitkä ovat tärkeimmät leikkoruusun maljakkokestävyyttä lyhentävät tekijät, sekä miksi ne ovat tärkeitä. Kirjallisuuden avulla tutustutaan myös leikkokukkavirkisteisiin ja niiden käytön perusteisiin. Nestemäisen virkisteen toimintaa tutkittiin maljakkokestävyyskokeella Puutarhakeskus Kauppilassa syksyllä 2009. Kokeen muuttujina oli virkiste ja imupinta, ja kerranteita oli kaksi. Koe toteutettiin kahtena erillisenä maljakkokestävyyskokeena, joissa kumpikin leikkoruusulajike tutkittiin erikseen. Nestemäisen virkisteen ominaisuuksia selvitettiin vielä laboratoriokokein keväällä 2010. Kokeen tulosten perusteella nestemäisen virkisteen vaikutus on riippuvainen paitsi lajikkeesta, myös ruusun saamasta käsittelystä. ’Akitolla’ virkisteen positiivinen vaikutus maljakkokestävyyteen oli selkeämmin nähtävissä kuin ’Golden Sonrisella’. Imupinnan leikkaaminen joissain tapauksissa lyhensi nestemäistä virkistettä saaneen ruusun maljakkoikää, mikä vaatisi lisäselvitystä. Jos pakkauksen käyttömukavuutta saadaan parannettua, nestemäinen virkiste voi hyvin korvata jauhemaiset virkisteet kuluttajakäytössäkin.The aim of this thesis is to give an account of the factors influencing the post-harvest life of cut roses, and to test the effect of the Chrysal Clear Liquid cut flower food on cut rose cultivars Akito and Golden Sonrise. Consumer stick packs of liquid flower food have only recently been introduced in Finland, but are expected to replace the traditional consumer packs. The theory section gives an introduction to roses as cut flowers. Cultivatio¬n, varieties and marketing, and post harvest conditions of cut roses are discussed. The factors affecting the vase life of flowers are listed, and their importance in the decrease of the ornamental value is explained. The theory section also gives an introduction to cut flower foods in general. The effects of the liquid flower food on the two cut rose cultivars were studied in August of 2009 in the premises of Kauppila. The vase life tests were set up separately for both varieties. The variables were cut stems and flower foods. Laboratory tests were also included in the study in Spring 2010 in order to find out the characteristics of the liquid cut flower food. According to the results, the vase life of rose is dependent on the cultivar, but also on the treatments given. The positive effects of flower food use were clearer on ‘Akito’ than on ‘Golden Sonrise’. In some cases cutting the stem of the roses nourished with the liquid flower food resulted as shortened vase life. This is a matter that needs further studying. If the packaging of the liquid flower food can be made more user-friendly, the liquid flower food could replace the traditional flower foods also in consumer use

Heme oxygenase-1 repeat polymorphism in septic acute kidney injury

Abstract Acute kidney injury (AKI) is a syndrome that frequently affects the critically ill. Recently, an increased number of dinucleotide repeats in the HMOX1 gene were reported to associate with development of AKI in cardiac surgery. We aimed to test the replicability of this finding in a Finnish cohort of critically ill septic patients. This multicenter study was part of the national FINNAKI study. We genotyped 300 patients with severe AKI (KDIGO 2 or 3) and 353 controls without AKI (KDIGO 0) for the guanine–thymine (GTn) repeat in the promoter region of the HMOX1 gene. The allele calling was based on the number of repeats, the cut off being 27 repeats in the S–L (short to long) classification, and 27 and 34 repeats for the S–M–L₂ (short to medium to very long) classification. The plasma concentrations of heme oxygenase-1 (HO-1) enzyme were measured on admission. The allele distribution in our patients was similar to that published previously, with peaks at 23 and 30 repeats. The S-allele increases AKI risk. An adjusted OR was 1.30 for each S-allele in an additive genetic model (95% CI 1.01–1.66; p = 0.041). Alleles with a repeat number greater than 34 were significantly associated with lower HO-1 concentration (p&lt;0.001). In septic patients, we report an association between a short repeat in HMOX1 and AKI risk