Rakenteinen kirjaaminen aikuispsykiatrisessa hoitotyössä : käyttöönoton loppumittaus

Tämä tutkimus on osa Turun Sosiaali- ja terveystoimen HoiDok-hanketta, jonka tarkoituksena on kehittää hoitotyön rakenteista kirjaamista. Hankkeen tavoitteena on käyttöönottaa valtakunnallisesti luotu kirjaamisen perusmalli, jonka avulla voidaan parantaa kirjaamisen ja hoitotyön laatua, sekä parantaa tiedonkulkua hoitoprosessin aikana. Lisäksi mallin avulla saadaan laadukasta tietoa hoitotyön johtamisen perustiedostoon. Rakenteisen kirjaamisen kehittymistä on arvioitu vuosittain opinnäytetöillä. Hankkeen ensimmäinen opinnäytetyö on tehty vuonna 2008. Tämän tutkimuksen tarkoituksena oli tehdä psykiatrisessa hoitotyössä toteutuvan rakenteisen kirjaamisen tilan loppumittaus aiempien hankkeen tutkimustuloksia vertaillen. Tutkimusaineistona olivat 40 potilaan hoitokertomukset, jotka analysoitiin deduktiivista sisällönanalyysiä käyttäen, minkä jälkeen saadut arvot syötettiin SPSS 19.0-tilastointiohjelmaan. Hoitokertomukset olivat Turun Sosiaali- ja Terveystoimen psykiatrian tulosalueen vuodeosastoilta. Potilasaineiston ikäjakauma oli 19–60 vuotta. Hankkeen aikana rakenteisessa kirjaamisessa on havaittu tapahtuneen kehitystä parempaan suuntaan. Hankkeen aikana huomattiin esimerkiksi hoitosuunnitelman käytön yleistyminen, potilaan hoidon tavoitteiden kirjaamisen lisääntyminen sekä potilaan näkemysten huomioiminen kirjaamisessa oli osittain parantunut. Tämän viimeisimmän tutkimuksen osalta on hahmottunut selkeitä kehittämiskohteita, joista tärkeimpiä olivat hoitosuunnitelman ajan tasalla pitäminen, potilaan hoidon loppuarvioinnin tekeminen sekä täsmällisempi ja potilaslähtöisempi kirjaaminen. Lisäksi havaittiin opetuksen/ohjauksen kirjaamisessa olevan vielä kehitettävää. Näitä kehittämällä kirjaamisesta saataisiin tarkoituksenmukaisempaa ja siten laadukkaampaa. Rakenteisen kirjaamismallin toteutumisesta on syytä tehdä jatkotutkimuksia vasta sitten, kun hoitajat ovat saaneet riittävästi tietoa ja kokemusta sen käytöstä. Tämä hanke on ajoittunut juuri sellaiseen ajankohtaan, kun hoitajat eivät välttämättä ole vielä ehtineet sisäistää täysin uuden kirjaamismallin toteuttamista.This research is part of Turku Municipal Social and Health Department of HoiDok-project, which purpose is to develop the structured documentation of nursing. The aim of the project is to introduce a nationally created basic model of the recording, which can be used to improve the quality of documentation and nursing as well as the communication during the nursing process. In addition, this model gives high-quality information for administrative nursing. The development of the structured documentation has been evaluated annually by bachelor’s thesis. The first research part has been done in 2008.The purpose of this study was to make the final measurement in psychiatric nursing based on previous years’ studies. The research material consisted of 40 patient records, which were analyzed using a deductive content method. After this the results were entered into statistics program SPSS 19.0. The patient records were from the psychiatric ward of Turku’s Municipal Health Care and Social Services Department. During the project a good development of the structured recording has been noticed. There was noticed for example that the care plan’s use became widely used, patient’s goals of care were more recorded and recording of patient’s views improved. This last study has led to highlighting clear development targets, like for example updating the care plan, carrying out patient`s final evaluation and generally recording more specifically and patient-focused. In addition was noticed that there were need to develop recording of the teaching/guidance. By developing these details the structured documentation would be more appropriate and thus it would also have a higher quality. Further researches about the structured documentation should take place only after the nurses have got sufficient information about it. This project happened in a phase when the nurses have not maybe yet totally internalized the new recording model

Molecular definition of multiple sites of antibody inhibition of malaria transmission-blocking vaccine antigen Pfs25.

The Plasmodium falciparum Pfs25 protein (Pfs25) is a leading malaria transmission-blocking vaccine antigen. Pfs25 vaccination is intended to elicit antibodies that inhibit parasite development when ingested by Anopheles mosquitoes during blood meals. The Pfs25 three-dimensional structure has remained elusive, hampering a molecular understanding of its function and limiting immunogen design. We report six crystal structures of Pfs25 in complex with antibodies elicited by immunization via Pfs25 virus-like particles in human immunoglobulin loci transgenic mice. Our structural findings reveal the fine specificities associated with two distinct immunogenic sites on Pfs25. Importantly, one of these sites broadly overlaps with the epitope of the well-known 4B7 mouse antibody, which can be targeted simultaneously by antibodies that target a non-overlapping site to additively increase parasite inhibition. Our molecular characterization of inhibitory antibodies informs on the natural disposition of Pfs25 on the surface of ookinetes and provides the structural blueprints to design next-generation immunogens

Structure and mechanism of monoclonal antibody binding to the junctional epitope of Plasmodium falciparum circumsporozoite protein.

Lasting protection has long been a goal for malaria vaccines. The major surface antigen on Plasmodium falciparum sporozoites, the circumsporozoite protein (PfCSP), has been an attractive target for vaccine development and most protective antibodies studied to date interact with the central NANP repeat region of PfCSP. However, it remains unclear what structural and functional characteristics correlate with better protection by one antibody over another. Binding to the junctional region between the N-terminal domain and central NANP repeats has been proposed to result in superior protection: this region initiates with the only NPDP sequence followed immediately by NANP. Here, we isolated antibodies in Kymab mice immunized with full-length recombinant PfCSP and two protective antibodies were selected for further study with reactivity against the junctional region. X-ray and EM structures of two monoclonal antibodies, mAb667 and mAb668, shed light on their differential affinity and specificity for the junctional region. Importantly, these antibodies also bind to the NANP repeat region with equal or better affinity. A comparison with an NANP-only binding antibody (mAb317) revealed roughly similar but statistically distinct levels of protection against sporozoite challenge in mouse liver burden models, suggesting that junctional antibody protection might relate to the ability to also cross-react with the NANP repeat region. Our findings indicate that additional efforts are necessary to isolate a true junctional antibody with no or much reduced affinity to the NANP region to elucidate the role of the junctional epitope in protection

Molecular definition of multiple sites of antibody inhibition of malaria transmission-blocking vaccine antigen Pfs25.

The Plasmodium falciparum Pfs25 protein (Pfs25) is a leading malaria transmission-blocking vaccine antigen. Pfs25 vaccination is intended to elicit antibodies that inhibit parasite development when ingested by Anopheles mosquitoes during blood meals. The Pfs25 three-dimensional structure has remained elusive, hampering a molecular understanding of its function and limiting immunogen design. We report six crystal structures of Pfs25 in complex with antibodies elicited by immunization via Pfs25 virus-like particles in human immunoglobulin loci transgenic mice. Our structural findings reveal the fine specificities associated with two distinct immunogenic sites on Pfs25. Importantly, one of these sites broadly overlaps with the epitope of the well-known 4B7 mouse antibody, which can be targeted simultaneously by antibodies that target a non-overlapping site to additively increase parasite inhibition. Our molecular characterization of inhibitory antibodies informs on the natural disposition of Pfs25 on the surface of ookinetes and provides the structural blueprints to design next-generation immunogens

Salaojituksen tavoiteohjelma 2002

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