KETJULÄHETTITOIMINTA : Avain ammatillisen osaamisen kehittämiseen

Ketjulähettitoiminta on Vaasan sairaanhoitopiirin alueen perusterveydenhuollon ja erikoissairaanhoidon välinen yhteistyömuoto. Ketjulähettitoiminnan tarkoituksena on tiedonsiirto ja palvelujen laadun kehittäminen verkostotyöskentelyn avulla ja organisaatioiden välistä toimintaa tehostamalla sekä toisten asiantuntijuuteen ja organisaatioiden toimintaan tutustumalla. Ketjulähettitoiminnan tavoitteena on muun muassa hoitoketjujen kehittäminen. Tässä tutkimuksessa tarkasteltiin saatujen kyselyiden ja palautteiden perusteella ketjulähettijakson käytännön onnistumista, kehittämiskohteita ja merkitystä ammatillisen osaamisen ja kehittymisen näkökulmasta ketjulähettijaksolla olleiden hoitotyön asiantuntijoiden kokemana. Lisäksi tavoitteena oli selvittää erikoissairaanhoidon ja perusterveydenhuollon välisen yhteistyön ongelmia ja kehittämiskohteita. Tutkimusmenetelmä oli kvantitatiivinen. Tutkimusaineisto kerättiin kysely- ja palautelomakkeiden avulla. Ketjulähettitoimintaan osallistui kaikkiaan 28 asiantuntijaa syyskuun 2010–elokuun 2011 aikana. Tutkimusaineisto on analysoitu käyttämällä apuna Excel-taulukkolaskentaohjelmaa. Lomakkeiden avoimet kysymykset on käsitelty sisällönanalyysillä. Tutkimuksessa selvisi, että ketjulähettijakso tuki ja lisäsi hoitotyön asiantuntijoiden ammatillista tietämystä ja osaamista. Ketjulähettitoiminta koettiin hyvänä yhteistyön ja hoitoketjujen kehittämisen välineenä. Ketjulähettitoiminnan ansiosta tieto toisen organisaation toimintakulttuurista ja käytännön hoitotyöstä lisääntyi. Verkostoitumisen avulla saavutettiin yhteistyön kannalta tärkeitä asioita.Chain messenger model is a cooperation method between primary health care and specialized medical health care operating in Vaasa health care district. The fundamental idea behind the chain messenger model is to transfer information and to develop the quality. This is done by networking. Networking enhances the cooperation between the different organizations and shares specialized expertise information. The goal of the chain messenger model is to develop the care chain model. The success, development targets and meaning of the chain messenger model were looked at with the help of the research material and the focus was on the professional skills and development as experienced by the nursing professionals. A further purpose was to find out the problems and development targets in the cooperation between the primary health care and specialized medical care. The research method was quantitative. The research material was gathered by questionnaires and feedback forms. The chain messenger model was participated by 28 experts during September 2010- August 2011. The research material has been analyzed by using Excel-spreadsheet program. The answers to the openended questions were analyzed with content analysis method. The research results showed that the chain messenger model period supported and increased the health care experts’ knowledge and skills. Chain messenger model is considered to be a good tool for developing cooperation and the care chain model. It also increased the knowledge about other organizations, their organizational culture and practical work settings. Networking promoted many factors that are important for good cooperation

Changes in HbA_1cduring the first six years after the diagnosis of Type 2 diabetes mellitus predict long-term microvascular outcomes

To analyze the association between change in HbA1c during the first 6 years after diagnosis of Type 2 diabetes mellitus (Type 2 DM) and incident micro- and macrovascular morbidity and mortality during 13 years thereafter. This is an observational study of the participants in the intervention arm of the randomized controlled trial Diabetes Care in General Practice (DCGP) in Denmark. 494 newly diagnosed persons with Type 2 DM aged 40 years and over with three or more measurements of HbA1c during six years of intervention were included in the analyses. Based on a regression line, fitted through the HbA1c-measurements from 1 to 6 years after diabetes diagnosis, glycaemic control was characterized by the one-year level of HbA1c after diagnosis, and the slope of the regression line. Outcomes were incident diabetes-related morbidity and mortality from 6 to 19 years after diabetes diagnosis. The association between change in HbA1c (the slope of the regression line) and clinical outcomes were assessed in adjusted Cox regression models. The median HbA1c level at year one was 60 (IQR: 52-71) mmol/mol or (7.65 (IQR: 6.91-8.62) %). Higher HbA1c levels one year after diagnosis were associated with a higher risk of later diabetes-related morbidity and mortality. An increase in HbA1c during the first 6 years after diabetes diagnosis was associated with later microvascular complications (HR per 1.1 mmol/mol or 0.1% point increase in HbA1c per year; 95% CI) = 1.14; 1.05-1.24). Change in HbA1c did not predict the aggregate outcome 'any diabetes-related endpoint, all-cause mortality, diabetes-related mortality, myocardial infarction, stroke, or peripheral vascular diseases. We conclude that suboptimal development of glycaemic control during the first 6 years after diabetes diagnosis was an independent risk factor for microvascular complications during the succeeding 13-year follow-up, but not for mortality or macrovascular complications

Killer whales (Orcinus orca) produce ultrasonic whistles

This study reports that killer whales, the largest dolphin, produce whistles with the highest fundamental frequencies ever reported in a delphinid. Using wide-band acoustic sampling from both animal-attached (Dtag) and remotely deployed hydrophone arrays, ultrasonic whistles were detected in three Northeast Atlantic populations but not in two Northeast Pacific populations. These results are inconsistent with analyses suggesting a correlation of maximum frequency of whistles with body size in delphinids, indicate substantial intraspecific variation in whistle production in killer whales, and highlight the importance of appropriate acoustic sampling techniques when conducting comparative analyses of sound repertoires