Perehdytysmateriaalia uusille dialyysihoitajille ja opiskelijoille

Opinnäytetyön tarkoitus oli tuottaa perehdytysvideo uusille dialyysihoitajille ja hoi-toalan opiskelijoille hemodialyysin toteutuksesta ja potilasohjauksesta. Opinnäytetyön tehtävinä oli selvittää mitä on hemodialyysi munuaisten vajaatoimintaa sairastavan hoidossa, mitä on laadukas ohjaus potilaan omatoimisuuden tukemisessa ja millainen on laadukas perehdytysmateriaali. Työn tavoitteena oli kehittää dialyysiin tulevien hoitajien ja opiskelijoiden tietoa dialyysissä toimimisesta ja laadukkaasta potilasohjauksesta, jolloin perehdytys paranee. Opinnäytetyö oli työelämälähtöinen ja se toteutettiin Hämeenkyrön dialyysiyksikön toimeksiannosta. Opinnäytetyö tehtiin toiminnallisena opinnäytetyönä, joka painottuu tuotokseen. Hemodialyysihoidolla hoidetaan munuaisten kroonista vajaatoimintaa sairastavia potilaita. Hoito on elintärkeä, sillä ilman dialyysihoitoa potilaan elimistöön kertyy kuona-aineita, koska munuaiset eivät kykene puhdistamaan ja erittämään niitä pois elimistöstä. Hemodialyysissä potilaan verestä puhdistetaan hemodialyysikoneen, dialysaattorin ja veriteiden avulla kuona-aineet ja elimistöön kertynyt ylimääräinen neste. Hemodialyysi tehdään keskimäärin kolme kertaa viikossa ja se kestää noin neljä tuntia kerrallaan. (Ala-huhta 2008.) Hoitajan antamalla hyvällä ja laadukkaalla ohjauksella potilas sitoutuu paremmin hoitoonsa ja mahdollistaa toteuttamaan hemodialyysihoitoaan mahdollisimman itsenäisesti. Potilaan ohjaus ja omatoimisuuden tukeminen sisältävät monia eri vaiheita, jotka ovat tärkeitä ohjatessa potilasta omatoimiseen hemodialyysihoitoon. Jokainen oppimisprosessi on erilainen ja jotkut potilaat eivät välttämättä koskaan halua itsenäisesti suorittaa hemodialyysihoitoaan. Hoitotyön kehityssuuntana on, että potilas olisi mahdollisimman omatoiminen ja oman hoitonsa asiantuntija. Potilaan ohjaaminen alkaa heti predialyysivaiheessa, jolloin potilaalle valitaan sopiva dialyysimuoto. Erilaiset oppimisprosessit edellyttävät dialyysiyksikössä työskentelevältä sairaanhoitajalta vahvaa ymmärrystä ja osaamista ohjauksesta sekä oppimisesta prosessina. Tuotosta voidaan hyödyntää dialyysiyksikössä uuden työntekijän tai hoitoalan opiskelijoiden perehdytykseen dialyysin eri vaiheiden opettelemisessa. Jatkotutkimusaiheena esitetään, onko perehdytysvideoilla vaikuttavuutta työntekijöiden tai opiskelijoiden perehdytyksessä. Suomenkielistä perehdytysmateriaalia omatoimiseen hemodialyysin suo-rittamiseen on niukasti, tätä aihetta voisi jatkossa tutkia enemmän.The purpose of this study was to provide newly graduated dialysis nurses and students with an introductory video on how hemodialysis is performed. Another purpose was to educate patients to carry out hemodialysis independently. Other goals were to examine what sort of role hemodialysis plays in the treatment of a patient suffering from kidney failure, what are the requirements for satisfactory guidance when patient performs hemodialysis independently and what sort of introduction material is required for a patient to be able to perform hemodialysis independently. This study was requested by the dialysis unit in Hämeenkyrö (Hämeenkyrön dialyysiyksikkö). The approach of the study was functional, with its focus on the end product, which in this case is the introductory video. The guidance and the support for self-treating hemodialysis patients include many different phases, all of which are equally important. Each learning process is unique and some patients may not ever be willing to perform their hemodialysis treatment independently. The trend in nursing is, however, that the patient is encouraged to be as independent as possible and to be the expert of one´s own treatment. A potential future study could examine the effects of this study and especially the introductonary video on new workers and students. Introductonary material on independent hemodialysis in Finnish is somewhat limited at the moment, so this topic and especially the experiences of the patients should/could be further researched

Evaluation of myosin VI, E-cadherin and beta-catenin immunostaining in renal cell carcinoma

<p>Abstract</p> <p>Background</p> <p>Renal cell carcinoma (RCC) is a cancer of increasing incidence and mortality. Currently, there are no immunohistochemical prognostic markers for RCCs in routine use. The aim of this study was to examine for the first time the immunostaining of myosin VI in RCCs as well as its association with E-cadherin and beta-catenin immunostaining and the prognostic significance of these markers in RCCs.</p> <p>Methods</p> <p>Our study population consisted of 152 patients who underwent surgery for RCCs between 1990 and 1999. The tumours were examined with three immunohistochemical markers: myosin VI, E-cadherin and beta-catenin.</p> <p>Results</p> <p>The immunostaining for cytoplasmic myosin VI was common (72%). One-third of the tumours were immunopositive for nuclear myosin VI. Cytoplasmic myosin VI immunopositivity and nuclear beta-catenin immunostaining were associated with lower Fuhrman grades (<it>p </it>= 0.04 and <it>p </it>= 0.005, respectively), but not stages. There was no significant association between myosin VI immunostaining and the histological subtype of RCC. Nuclear myosin VI was associated with the nuclear expression of beta-catenin. A direct association could also be proven between membranous E-cadherin and cytoplasmic beta-catenin. Cytoplasmic myosin VI immunostaining was a marker of poorer prognosis in multivariate Cox regression model adjusted with stage and Fuhrman grade with hazard ratio 2.4 (95% confidence interval 1.1 to 5.0 with <it>p </it>= 0.024).</p> <p>Conclusions</p> <p>Cytoplasmic myosin VI immunopositivity and nuclear beta-catenin immunostaining were associated with lower Fuhrman grades, and there was a strong positive relationship between E-cadherin immunostaining and beta-catenin immunostaining in RCCs. Cytoplasmic myosin VI immunostaining was associated with poorer prognosis in RCCs.</p

Effectiveness and cost-effectiveness of a people-centred care model for community-living older people versus usual care ─ A randomised controlled trial

Background There is a need for effective and cost-effective interprofessional care models that support older people to maintain their quality of life (QoL) and physical performance to live longer independently in their own homes. Objectives The objectives were to evaluate effectiveness, QoL and physical performance, and cost-utility of a people-centred care model (PCCM), including the contribution of clinically trained pharmacists, compared with that of usual care in primary care. Methods A randomised controlled trial (RCT) with a two-year follow-up was conducted. The participants were multimorbid community-living older people, aged ≥75 years. The intervention comprised an at-home patient interview, health review, pharmacist-led clinical medication review, an interprofessional team meeting, and nurse-led care coordination and health support. At the baseline and at the 1-year and 2-year follow-ups, QoL (SF-36, 36-Item Short-Form Health Survey) and physical performance (SPPB, Short Performance Physical Battery) were measured. Additionally, a physical dimension component summary in the SF-36 was calculated. The SF-36 data were transformed into SF-6D scores to calculate quality-adjusted life-years (QALYs). Healthcare resource use were collected and transformed into costs. A healthcare payer perspective was adopted. Incremental cost-effectiveness ratio (ICER) was calculated, and one-way sensitivity analysis was performed. Results No statistically or clinically significant differences were observed between the usual care (n = 126) and intervention group (n = 151) patients in their QoL; at the 2-year follow-up the mean difference was −0.02, (95 % CI -0.07; 0.04,p = 0.56). While the mean difference between the groups in physical performance at the 2-year follow-up was −1.02, (−1.94;-0.10,p = 0.03), between the physical component summary scores it was −7.3, (−15.2; 0.6,p = 0.07). The ICER was −73 638€/QALY, hence, the developed PCCM dominated usual care, since it was more effective and less costly. Conclusions The cost-utility analysis showed that the PCCM including pharmacist-led medication review dominated usual care. However, it had no effect on QoL and the effect towards physical performance remained unclear.Peer reviewe

Nuorten vaihtoehtoliikunta yhteisöllisen kasvun ja oppimisen mahdollistajana

This article focuses on alternative youth sports as environments of late modern education, learning and teaching. The analysis presented is based on an online survey (n=754), theme interviews and a contextualising ethnographic fieldwork conducted in Finland. Alternative sports are analysed through a historical frame of physical and youth education. Young people practising alternative sports adopt sporty lifestyles and ideas of personal responsibility, as well as learn communication skills and cooperation. The analysis shows that even though education disengages from traditional contexts and authoritative relations, the aims set to sports education are fulfilled for the most part in alternative sports. Learning and teaching sports skills is based on a strong sense of collaborative learning, which is at the same time spontaneous and goal oriented. This article is a part of an ongoing research project Diverse Spaces and Practises of Youth Sports (2012–2015).Artikkelissa tarkastellaan nuorten vaihtoehtoliikuntaa kasvatus- ja oppimisympäristönä liikunta- ja nuorisokasvatuksen määritelmien ja niille asetettujen tavoitteiden historiallisessa kehyksessä. Analyysi osoittaa, että vaikka vaihtoehtoliikunnassa liikuntakasvatus irtoaa perinteisistä konteksteistaan ja auktoriteettisuhteistaan, liikuntakasvatukselle asetetut tavoitteet ja ideaalit toteutuvat myös vaihtoehtolajeissa

Absent Toll-like receptor-9 expression predicts poor prognosis in renal cell carcinoma

<p>Abstract</p> <p>Background</p> <p>Toll-like receptor 9 (TLR9) is a cellular DNA-receptor whose activation with cognate ligands triggers an immune reaction, with increased production of inflammatory cytokines. The aim of this study was to examine the expression of TLR9 in renal cell carcinoma (RCC), which is generally renowned of its immunogenic nature. We also evaluated the prognostic value of TLR9 in RCC.</p> <p>Methods</p> <p>TLR9 expression in RCC was characterized with immunohistochemistry in a retrospective study population of 152 RCC patients who underwent renal surgery. The TLR9 staining intensity was compared with clinical parameters.</p> <p>Results</p> <p>Of the studied tumours, 112 (81%) exhibited cytoplasmic TLR9 immunostaining. No association was detected between cytoplasmic TLR9 immunoexpression intensity and stage, nuclear grade, histological subtype or tumour necrosis. Cytoplasmic TLR9 immunoexpression was, however, a marker of favourable RCC specific survival both in univariate analysis and in multivariate regression model.</p> <p>Conclusions</p> <p>We conclude that TLR9 expression is an independent prognostic marker of RCC and the absence of TLR9 expression is related to poorer prognosis in RCC.</p

Intraoperative complications in kidney tumor surgery : critical grading for the European Association of Urology intraoperative adverse incident classification

Introduction The European Association of Urology committee in 2020 suggested a new classification, intraoperative adverse incident classification (EAUiaiC), to grade intraoperative adverse events (IAE) in urology. Aims We applied and validated EAUiaiC, for kidney tumor surgery. Patients and methods A retrospective multicenter study was conducted based on chart review. The study group comprised 749 radical nephrectomies (RN) and 531 partial nephrectomies (PN) performed in 12 hospitals in Finland during 2016-2017. All IAEs were centrally graded for EAUiaiC. The classification was adapted to kidney tumor surgery by the inclusion of global bleeding as a transfusion of >= 3 units of blood (Grade 2) or as >= 5 units (Grade 3), and also by the exclusion of preemptive conversions. Results A total of 110 IAEs were recorded in 13.8% of patients undergoing RN, and 40 IAEs in 6.4% of patients with PN. Overall, bleeding injuries in major vessels, unspecified origin and parenchymal organs accounted for 29.3, 24.0, and 16.0% of all IEAs, respectively. Bowel (n = 10) and ureter (n = 3) injuries were rare. There was no intraoperative mortality. IAEs were associated with increased tumor size, tumor extent, age, comorbidity scores, surgical approach and indication, postoperative Clavien-Dindo (CD) complications and longer stay in hospital. 48% of conversions were reactive with more CD-complications after reactive than preemptive conversion (43 vs. 25%). Conclusions The associations between IAEs and preoperative variables and postoperative outcome indicate good construct validity for EAUiaiC. Bleeding is the most important IAE in kidney tumor surgery and the inclusion of transfusions could provide increased objectivity.Peer reviewe

Genomic and epidemiological report of the recombinant XJ lineage SARS-CoV-2 variant, detected in northern Finland, January 2022

Recombinant sequences of the SARS-CoV-2 Omicron variant were detected in surveillance samples collected in north-western Finland in January 2022. We detected 191 samples with an identical genome arrangement in weeks 3 to 11, indicating sustained community transmission. The recombinant lineage has a 5'-end of BA.1, a recombination breakpoint between orf1a and orf1b (nucleotide position 13,296-15,240) and a 3'-end of BA.2 including the S gene. We describe the available genomic and epidemiological data about this currently circulating recombinant XJ lineage.Peer reviewe

Genomic and epidemiological report of the recombinant XJ lineage SARS-CoV-2 variant, detected in northern Finland, January 2022

Recombinant sequences of the SARS-CoV-2 Omicron variant were detected in surveillance samples collected in north-western Finland in January 2022. We detected 191 samples with an identical genome arrangement in weeks 3 to 11, indicating sustained community transmission. The recombinant lineage has a 5'-end of BA.1, a recombination breakpoint between orf1a and orf1b (nucleotide position 13,296-15,240) and a 3'-end of BA.2 including the S gene. We describe the available genomic and epidemiological data about this currently circulating recombinant XJ lineage.Peer reviewe

Distributed Asymmetric Virtual Reality in Industrial Context : Enhancing the Collaboration of Geographically Dispersed Teams in the Pipeline of Maintenance Method Development and Technical Documentation Creation

Virtual Reality (VR) is a critical emerging technology in industrial contexts, as it facilitates collaboration and supports the product development lifecycle. However, its broad adoption is con-strained by complex and high-cost integration. The use of VR among devices with various immersion and control levels may solve this obstacle, and increase the scalability of VR technologies. This article presents a case study on applying asymmetry between the COVE-VR platform and Microsoft Teams to enable distributed collaboration of multinational departments and enhance the maintenance method and documentation creation processes. Overall, five remote collaborative sessions were held with 20 experts from four countries. Our findings suggest that asymmetry between head-mounted display and Teams users enhances the quality of communication among geographically dispersed teams and their spatial understanding, which positively influences knowledge transfer and efficiency of industrial processes. Based on qualitative evaluation of the asymmetric VR setup, we further suggest a list of guidelines on how to enhance the collaboration efficiency for low-cost distributed asymmetric VR from three perspectives: organization, collaboration and technology.Peer reviewe

Toward Efficient Academia-Industry Collaboration: A Case Study of Joint VR System Development

Collaborative academia-industry development and evaluation of virtual reality (VR) systems is a mutually beneficial opportunity to investigate VR technology in a real context and conduct user studies with target users. However, such collaboration is rarely performed due to variations in project pace and work methods. In this article, we introduce the process of action research on joint design, development, and evaluation of a collaborative VR system to address industrial needs. The paper further presents employees’ subjective opinions and perceived value of industrial VR applica- tions and reflects on their involvement throughout the process. The article concludes with a process-oriented framework for remote academia-industry collaboration, supported with practical sugges- tions on how to support this collaboration. Our experiences reveal the methods and advantages of remote collaboration in all phases of the process and signify the efficiency of the remote framework for academia-industry collaboration, especially relevant in the light of the COVID-19 pandemiaacceptedVersionPeer reviewe