Iron Behaving Badly: Inappropriate Iron Chelation as a Major Contributor to the Aetiology of Vascular and Other Progressive Inflammatory and Degenerative Diseases

The production of peroxide and superoxide is an inevitable consequence of aerobic metabolism, and while these particular "reactive oxygen species" (ROSs) can exhibit a number of biological effects, they are not of themselves excessively reactive and thus they are not especially damaging at physiological concentrations. However, their reactions with poorly liganded iron species can lead to the catalytic production of the very reactive and dangerous hydroxyl radical, which is exceptionally damaging, and a major cause of chronic inflammation. We review the considerable and wide-ranging evidence for the involvement of this combination of (su)peroxide and poorly liganded iron in a large number of physiological and indeed pathological processes and inflammatory disorders, especially those involving the progressive degradation of cellular and organismal performance. These diseases share a great many similarities and thus might be considered to have a common cause (i.e. iron-catalysed free radical and especially hydroxyl radical generation). The studies reviewed include those focused on a series of cardiovascular, metabolic and neurological diseases, where iron can be found at the sites of plaques and lesions, as well as studies showing the significance of iron to aging and longevity. The effective chelation of iron by natural or synthetic ligands is thus of major physiological (and potentially therapeutic) importance. As systems properties, we need to recognise that physiological observables have multiple molecular causes, and studying them in isolation leads to inconsistent patterns of apparent causality when it is the simultaneous combination of multiple factors that is responsible. This explains, for instance, the decidedly mixed effects of antioxidants that have been observed, etc...Comment: 159 pages, including 9 Figs and 2184 reference

The quality of patient education in day surgery by adult patients

Abstract Purpose: The purpose of the study was to describe the quality of patient education in day surgery as evaluated by adult patients. Design: Descriptive design using survey methodology. Methods: The data were collected by questionnaire and measured the quality and implementation of education resources for day surgery patients (n = 600) in a university hospital. The data were analyzed statistically using basic and multivariate methods. Findings: The implementation of patient education has been done in a patient-centered and goal-oriented way by half of respondents. Most respondents (81%) were satisfied with the interaction in patient education. The education resources were reported as good by 77% of respondents. Conclusions: Health care staff should assess for the presence of anxiety as a barrier to the comprehension of information. In developing patient education, the professional expertise and skills of health care staff in educating patients should be used

Quality of pain counselling for orthopaedic patients in the hospital:a cross-sectional study

Abstract Background: Earlier studies demonstrate that pain counselling for orthopaedic patients benefits quality of life and adherence to care. Aim: The aim of this study was to describe the quality of pain counselling for orthopaedic patients in a Finnish central hospital. Methods: A cross-sectional design was used. Data were collected from orthopaedic patients (n = 71) using the Quality of Counselling Instrument (CQI) and analysed using descriptive statistics including frequencies and percentages. Findings: Most participants were women (67%), and the mean age was 52 years. Non-pharmacological pain relief was rated as inadequate (69%). Counselling of pain treatment was satisfactory for about 38% of orthopaedic patients, but 20% of participants had not received medication counselling. Pain counselling was not always patient-centered (50%), nor was interaction (48%) and goal-oriented counselling (49%). Staff skills and knowledge of orthopaedic patients’ pain counselling was satisfactory, although there were differences between patients with/without previous experience (p = 0.047) and different education (p = 0.008). Conclusion: Pain counselling is an important part of orthopaedic patients’ treatment and healing processes. This study identified that there is lack of use of non-pharmacological pain relief, and counselling of pain should be implemented in a more patient-centered way. Inpatient counselling should use more personalised approaches with diverse counselling methods

Translation and cultural adaptation of the Family Centered Care Assessment Scale (FCCAS) for Finnish pediatric nursing

Abstract Purpose: The purpose of this study was to translate and culturally adapt the Family Centered Care Assessment Scale (FCCAS) to evaluate family-centered care in the context of Finnish pediatric nursing. Design and methods: The translation and cultural adaptation were done according guidelines of International Society for Pharmacoeconomics and Outcomes (ISPOR), which constitute a systematic process including ten phases. The presented research included cognitive interviews conducted with the end user of the scale: parents of hospitalized children. Results: The FCCAS was successfully translated and culturally adapted to the Finnish context. Translational, clinical and parental expertise were used to develop the scale. Conceptual equivalence was achieved in the translation. In the cultural adaptation, some of the items were modified based on experts’ assessments to make them comprehensible and appropriate to the Finnish culture. The scale showed good evidence of content. Reporting of the study adheres to the COSMIN checklist. Conclusions: Combining ISPOR guidelines and cognitive interviews are recommended to use in the translation and cultural adaptation process. Nursing staff and parents’ involvement and awareness of family-centered care have been concretized. Systematic translation and cultural adaptation have prepared a Finnish version of the scale for psychometric testing. Practice implications: The study outlines how rigorous methodological approaches can be applied to the translation and cultural adaptation of a measurement tool. The developed scale includes items which comprehensively cover family-centered care characteristics. In following study, it will be possible to evaluate the extent to which family-centered care is implemented in Finnish pediatric nursing

A quasi-experimental study of group counselling effectiveness for patient functional ability and quality of counselling among patients with hip arthroplasty

Abstract Aim: The aim of this study was to investigate effectiveness of group counselling for the patients with hip arthroplasty, self-assessed functional ability, and quality of counselling. Design: A quasi-experimental study. Method: The questionnaire included the Counselling Quality Instrument (CQI), Harris hip score and Oldwellactive self-rated wellness profile. A Mann–Whitney U- and chi-squared and t-tests were used. A Wilcoxon singed rank test were used to evaluate changes in functional ability. No Patient or Public Contribution: Patients and the public were not involved in the design, recruitment and implementation of this study. Results: Fifty patients participated. Patients reported better results for limping (p = 0.000), walking distance (p = 0.000) and use of a walking aid (p = 0.001) in the follow-up time point and they pain decreased. Patients were satisfied with interactions during counselling; gender (p = 0.000) and use of a walking aid (p = 0.044) were found to significantly affect. A lack of goal-oriented counselling was in depressive symptoms (p = 0.016), worries (p = 0.010) and loneliness (p = 0.026)

Patient evaluations of asthma counselling quality in primary health care:a cross-sectional survey

Abstract Background: Healthcare staff have a key role in counselling patients. This study describes asthma patients’ evaluations of primary care counselling quality. Methods: The research applied a cross-sectional study design, with data collected from adult asthma patients (n = 73). Data were analysed by descriptive statistics. Results: Most of participating patients were women (73%) and over 60 years old (67%). The patients were generally satisfied with the counselling. Subjection to an asthma test (p = 0.009) and smoking (p = 0.019) were found to significantly positively affect patient perceptions of counselling quality. The patients also felt that support services should be covered more (74%). Patients with comprehensive education (p = 0.039) and smokers (p = 0.015) were more likely to be satisfied with the counselling than other patients. Counselling was client-oriented (53%) and most patients reported experiencing positive interactions (92%). Most patients agreed that counselling benefitted adherence to self-care (75%) and health promotion (67%). Moreover, almost all of the patients were satisfied with the staff members’ knowledge and skills (97%). Subjection to an asthma test (p = 0.043), age (p = 0.030), smoking (p = 0.014), and duration of illness (p = 0.002) influenced satisfaction with counselling resources. Conclusion: The results indicate that counselling benefits asthma patients. Performing an asthma test, as well as considering smoking habits and educational level, can improve patient perceptions of counselling

Äitien tyytyväisyys synnytyksenaikaiseen hoitoon:kysely kolmessa keskussairaalassa

Tiivistelmä Tutkimuksen tarkoituksena oli kuvata äitien tyytyväisyyttä synnytyksenaikaiseen hoitoon kolmessa suomalaisessa keskussairaalassa. Aineisto kerättiin Synnyttäjän tyytyväisyys synnytyksenaikaiseen hoitoon (SynTy) -mittarilla joulukuun 2019 ja helmikuun 2020 välisenä aikana. Kyselylomakkeen palautti täytettynä 231 äitiä ja vastausprosentti oli 51. Aineisto analysoitiin tilastollisin menetelmin. Äitien tyytyväisyys synnytyksenaikaiseen hoitoon oli korkea kaikilla mitatuilla sisäisen hallinnan ulottuvuuksilla, jotka olivat biologis-fysiologinen, toiminnallinen, tiedollinen, sosiaalis-yhteisöllinen, kokemuksellinen ja eettinen ulottuvuus. Kuitenkin verrattuna muihin eri ulottuvuuksien yksittäisiin kysymyksiin, äidit eivät olleet aivan niin tyytyväisiä omiin vaikutusmahdollisuuksiinsa ja tiedonsaantiinsa kivunhallinnassa sekä oman hallinnan tunteensa säilymiseen. Synnytyksen käynnistymisellä, synnytyssairaalan internetsivuihin tutustumisella ennen synnytystä ja raskaudenaikaisilla ongelmilla oli tilastollisesti merkitsevä yhteys tyytyväisyyteen. Tutkimustulokset osoittivat, että äitien asiakastyytyväisyyden näkökulmasta synnytyksen aikainen hoito oli pääosin laadukasta. Tuloksia voidaan hyödyntää esimiestyössä, kätilöiden ja lääkäreiden koulutuksissa sekä työhön perehdytyksessä.Abstract Maternal satisfaction with intrapartum care : a survey in three central hospitals The purpose of this study was to describe maternal satisfaction with intrapartum care in three central hospitals. The data was collected with the Maternal Satisfaction with Intrapartum Care (MatSatIC) instrument between December 2019 and February 2020. A questionnaire was completed and returned by 231 mothers, giving a response rate of 51%. The data was analysed by statistical methods. Maternal satisfaction with intrapartum care was high in all measured dimensions of empowerment, which were bio-physiological, functional, cognitive, social, experiential, and ethical. However, of the single items included in the different sum variables formed according to the dimensions, the mothers were not quite so satisfied with their opportunities to influence the choices regarding pain control, the amount of information given about pain management methods and maintaining their sense of control. The way the labour had started, becoming acquainted with the hospital websites and problems with the pregnancy itself were statistically significantly associated with satisfaction with intrapartum care. The results of this study showed that from the participating mothers’ client/patient satisfaction perspective, they received high quality intrapartum care. These findings can be utilized by leadership and management in maternity units, in the education of midwives and physicians, and orientation programs for new employees

Lähihoitajien kokemukset palliatiivisen hoidon ja saattohoidon osaamisesta

Tiivistelmä Tutkimuksen tarkoituksena oli kuvailla lähihoitajien kokemuksia palliatiivisen hoidon ja saattohoidon osaamisesta. Aineisto kerättiin lähihoitajilta (n=52) sähköisenä kyselynä Webropol-ohjelmalla syksyllä 2018. Tutkimusaineisto muodostui avoimesta kysymyksestä, jossa vastaajaa pyydettiin arvioimaan osaamista palliatiivisen hoidon eri osa-alueiden näkökulmasta. Aineisto analysoitiin aineistolähtöisellä sisällönanalyysillä. Lähihoitajat kokivat tarvitsevansa osaamista palliatiivisessa hoidossa ja saattohoidossa hienovaraisesta ja tukevasta vuorovaikutuksesta potilaan ja läheisten kanssa, moniammatillisesta yhteistyöstä sekä viestintä- ja suunnitteluosaamisesta. Lisäksi he arvioivat tarvitsevansa työssään perustietoa lääketieteestä, fysiologiasta, hoitotieteestä, tunteiden prosessoinnista, kulttuurista, uskonnosta, lääkehoidosta ja farmakologiasta. Myös osaaminen kivun sekä somaattisten ja psyykkisten oireiden hoidosta, yksilöllisestä palliatiivisesta perushoidosta, kuoleman arvokkaasta kohtaamisesta, eettisyydestä ja lainsäädännöstä sekä työhyvinvointitaidoista koettiin tärkeiksi. Lähihoitajat tarvitsevat monipuolista osaamista hyvän palliatiivisen hoidon ja saattohoidon toteuttamiseen. Tutkimuksen tuloksia voidaan hyödyntää lähihoitajien palliatiivisen hoidon ja saattohoidon osaamisen kartoittamisessa ja koulutuksen sekä opetuksen suunnittelussa ja kehittämisessä.Abstract Practical nurses’ experiences of the need for competence in hospice and palliative care The purpose of the study was to describe practical nurses’ experiences of competences in hospice and palliative care. The data collect were performed with an electronic questionnaire from practical nurses (n=52). The data consisted open questions with palliative care theme. The data were analyzed with inductive content analysis. Practical nurses needed competence in hospice and palliative care including interaction of patient and relatives, multi-professional, communication and care planning. In addition, they estimate that they will need competence in of medicine, physiology, nursing science, emotion processing, culture, religion, medication and pharmacology. Also, competence pain and somatic symptom management, individualized hospice and palliative care basic care, precious death, ethical and legislative and well-being at work were considered important. Practical nurses need versatile competence for the nursing out of hospice and palliative care. The result of this study can be used to develop hospice and palliative care training, teaching and competence assessment

Health care professionals’ experiences of counselling competence in digital care pathways:a descriptive qualitative study

Abstract Aim: Health care professionals are tasked with the role of supporting patients in using eHealth services in their personal care and counselling competence in digital environments to ensure appropriate patient care. Our aim was to describe health care professionals’ experiences of counselling competence in Digital Care Pathways. Design: A descriptive qualitative study. Methods: Interviews with semi-structured questions were conducted. Twelve healthcare professionals were interviewed. The data were analysed using inductive content analysis. The results were reported according to the Consolidated Criteria for Reporting Qualitative Research. Results: The analysis revealed eight distinct areas of competence related to counselling in Digital Care Pathways, namely, counselling competences related to the use of Digital Care Pathways, supporting patients’ self-care, information technology competence, competence in creating an interactive counselling relationship on the Digital Care Pathway, information management, ethical competence related to counselling in Digital Care Pathways, competence to developing Digital Care Pathways services, and change competence. No Public or Patient Contribution: Due to the complex and unpredictable circumstances of COVID, people’s strict confinement in the hospital prohibited free access to them and the study environment. Therefore, the professionals involved in the study were interviewed through online systems

Vanhempien ohjaustarpeet sairaalassa ennen keskosen syntymää:integratiivinen kirjallisuuskatsaus

Tiivistelmä Integratiivisen kirjallisuuskatsauksen tarkoituksena oli kuvailla vanhempien ohjaustarpeita sairaalassa ennen keskosen syntymää. Tiedonhaku tehtiin Cinahl-, Medic-, Medline-, Scopus- ja PsycArticles -tietokantoihin vuosilta 2005–2019. Lisäksi suoritettiin manuaalinen haku tietokantohakujen tuloksena valittujen artikkeleiden lähdeluetteloista. Laadunarvioinnin jälkeen haku tuotti 11 tutkimusta. Aineisto analysoitiin induktiivisella sisällönanalyysillä. Vanhempien ohjaustarpeet sairaalassa ennen keskosen syntymää muodostuivat ohjauksen sisällöstä, ohjauksen toteutuksesta, ohjauksen vuorovaikutuksesta ja ohjausmenetelmistä. Ohjauksen tulee sisältää tietoa keskosen eloonjäämisen ennusteesta, keskosuuden lyhyt -ja pitkäaikaisvaikutuksista ja hoidosta. Lisäksi vanhemmat haluavat etukäteen tietää oman roolinsa keskosen hoidossa, koska se helpottaa heidän muun elämän järjestämistä. Ohjauksen toteutuksessa molempien vanhempien läsnäolo on tärkeää ja ohjaus tulee toteuttaa mahdollisimman pian sen jälkeen, kun ennenaikaisen syntymän riski on todettu. Vanhemmat toivoivat useampaa kuin yhtä ohjauskertaa, sillä ensimmäinen ohjauskerta on heille stressaava kokemus. Ohjauksessa hyvä vuorovaikutus edisti luottamuksellisen vuorovaikutussuhteen syntymistä vanhempien ja henkilökunnan välille. Tutkimus tuo uutta tietoa vanhempien ohjaustarpeista ennen keskosen syntymää sairaalassa. Tutkimustietoa voidaan hyödyntää kehitettäessä sairaalan ohjauskäytänteitä ja -sisältöjä sekä henkilökunnan koulutusta.Abstract Parental counselling needs at the hospital before the birth of a preterm infant: integrative literature review The purpose of this integrative literature review was to describe parental counselling needs at the hospital before the birth of a preterm infant. The data were collected from Cinahl, Medic, Medline, Scopus and PsycArticles databases and manually for the years 2005–2019. The search resulted 11 references. Parental counselling needs at the hospital before the birth of a preterm infant consist the content of counselling, implementation of counselling, interaction of counselling and counselling procedure. Antenatal consultation should contain information about the chances of survival, short- and long-term medical problems and treatments. Parents want to know their role in the care of their baby, because it will help them to organize e.g. their family life. In antenatal counselling the presence of both parents is important, and the counselling should take place as soon as possible after the risk of preterm delivery has been diagnosed. Parents wanted more than one counselling session, because they thought that the first time was too stressful. In antenatal counselling good interaction with parents’ advances building a trustworthy relationship between parents and professionals. This research produces new information about parental counselling needs in the hospital before the birth of a preterm infant. Research information can be used in developing hospital practices and content in parent counselling and in staff education