Asiakastyytyväisyys Pielaveden terveyskeskuksen INR-poliklinikalla

Varfariini on tällä hetkellä yleisin Suomessa käytössä oleva antikoagulantti, ja sen kauppanimi on Marevan®. Antikoagulanttihoidon tavoitteena on ehkäistä verihyytymien paikallinen kehittyminen tai estää jo syntyneen hyytymän kasvua ja kulkeutumista muualle elimistöön. Sydämen eteisvärinä eli flimmeri on yleisin syy säännölliseen antikoagulanttihoitoon. Varfariinihoidossa olevia asiakkaita on Suomessa koko väestöstä 2 % ja väestön ikääntyessä asiakkaiden määrä kasvaa 5 – 10 % vuosittain. Suomeen on perustettu INR-poliklinikoita, joiden tarkoituksena on Marevan® -asiakkaiden hoidon keskittäminen lääkäriltä sairaanhoitajalle. Poliklinikalla työskentelevä INR-hoitaja suorittaa yleensä INR-vieritutkimuksen eli ottaa näytteen sormenpäästä. INR-hoitaja seuraa asiakkaiden INR-arvoja ja hoitotasapainoa. Kun INR-tutkimuksen tulokset saadaan asiakkaan läsnäollessa, asiakas saa välittömästi asianmukaisen ohjauksen ja Marevan® -annostuksen mukaansa. Tällä hetkellä Suomessa on yhteensä 110 INR-poliklinikkaa ja kotihoidon yksikköä, joissa käytetään INR-pikamittausta. Arvioidaan, että INR-pikamittausta käyttäviä poliklinikoita ja kotihoidon yksikköjä tulee vuodessa noin 10 – 15 uutta. Toimeksiantaja opinnäytetyössä oli Pielaveden terveyskeskus, jossa on aloitettu syksyllä 2014 INR-poliklinikka. Koska poliklinikka on uusi, opinnäytetyön tarkoituksena oli selvittää asiakkaiden kokemuksia INR-poliklinikan toiminnasta. Tavoitteena oli tuottaa tietoa, jonka avulla poliklinikan toimintaa voidaan kehittää. Opinnäytetyössä tutkimusmenetelmä oli kvalitatiivinen. Poliklinikan asiakkaille laadittiin kyselylomake, jossa selvitettiin asiakkaiden tyytyväisyyttä poliklinikan toimintaa kohtaan. Vastauksia kerättiin 33 INR-poliklinikan asiakkaalta, ja aineisto analysoitiin induktiviisellä sisällönanalyysillä. Tutkimustulosten mukaan INR-poliklinikan asiakkaat ovat tyytyväisiä saamaansa hoitoon ja uuteen toimintamalliin Marevan® -hoidon seurannassa. Suurin osa vastaajista kertoi INR-arvojen hoitotasapainon parantuneen. Jatkossa olisi hyvä selvittää myös kehitettäviä asioita INR-poliklinikan toiminnassa, koska niitä ei tullut esille. Muita jatkotutkimusaiheita voisivat olla antikoagulanttihoidon komplikaatioiden ja hoidon kustannusten vertailu entisen lääkärivetoisen toimintamallin ja nykyisen INR-poliklinikan toiminnan aikana.Currently warfarin is the most common anticoagulant in Finland and its trade name is Marevan®. The aim of the anticoagulant treatment is to prevent the local progress of thrombosis or to block the growth transmission of an existing thrombosis to the rest of the body. Atrial fibrillation is the most common reason for regular anticoagulant medication. Two percent of the Finnish population are using the warfarin treatment, and because the population ages, the number is expected to grow 5 – 10 % annually. Anticoagulation clinics have been set up in Finland. The purpose of these clinics is to center the treatment of Mare-van® -clients from doctors to nurses. The anticoagulation nurse working at the clinic will usually conduct the INR-bloodsample examinations, which means that she/he will take a sample from the tip of the finger of the client. The anticoagulation nurse monitors the INR-values and the balance of the treatment. When the result of the INR-examination is received in the presence of the client, the client will immediately receive appropriate consultation and Marevan® dosage with her/him. At the moment there are 110 anticoagulation clinics and home care units in Finland that use INR express measurement. It is estimated that annually there will be approximately 10 to 15 new clinics and home care units that use INR express measurement. The employer of this thesis was the Pielavesi Health Center, which launched their anticoagulation clinic in the autumn of 2014. Because the outpatient clinic is new, the purpose of this thesis was to examine the clients’ experiences of the clinic. The aim was to provide knowledge that could help further improve the policies of the clinic. A qualitative research method was used in the present thesis. A questionnaire that investigated the clients’ satisfaction towards the policies of the clinic was composed. The completed questionnaires were collected from 33 clients from the anticoagulation clinic, and the data was analysed by using the inductive content analysis approach. According to the results, the clients of the anticoagulation clinic were satisfied with the received treatment and the new operating model used to monitor their Marevan® -treatment. The majority of the respondents reported that the balance of the treatment regarding their INR-values had improved. In the future, it would be beneficial to investigate whether there are any policies that need to improvement, although no issues emerged during this re-search. Other topics of the future research could include the comparison of the anticoagulation treatment complications and treatment costs between the previous, doctor-oriented policy and the current, INR outpatient clinic policy

Brain stem audiometry may supply markers for diagnostic and therapeutic control in psychiatry

The purpose of the present study is to try an alternative way of analyzing the ABR (Auditory Brainstem Response). The stimuli were complex sounds (c-ABR) as used in earlier studies. It was further aimed at corroborating earlier findings that this method can discriminate several neuropsychiatric states. Forty healthy control subjects, 26 subjects with the diagnosis schizophrenia (Sz) and 33 with ADHD (Attention deficit hyperactivity disorder) were recruited for the study. The ABRs were recorded. The analysis was based on calculation of areas of significantly group different time spans in the waves. Both latency and amplitude were thereby influential. The spans of differences were quantified for each subject in relation to the total area of the curve which made comparisons balanced. The results showed highly significant differences between the study groups. The results are important for future work on identifying markers for neuropsychiatric clinical use. To reach that goal calls for more extensive studies than this preliminary one

Hypertrophic cardiomyopathy in young Maine Coon cats caused by the p.A31P cMyBP-C mutation - the clinical significance of having the mutation

<p>Abstract</p> <p>Background</p> <p>In Maine Coon (MC) cats the c.91G > C mutation in the gene <it>MYBPC3</it>, coding for cardiac myosin binding protein C (cMyBP-C), is associated with feline hypertrophic cardiomyopathy (fHCM). The mutation causes a substitution of an alanine for a proline at residue 31 (p.A31P) of cMyBP-C. The pattern of inheritance has been considered autosomal dominant based on a single pedigree. However, larger studies are needed to establish the significance of cats being heterozygous or homozygous for the mutation with respect to echocardiographic indices and the probability of developing fHCM. The objective of the present study was to establish the clinical significance of being homozygous or heterozygous for the p.A31P cMyBP-C mutation in young to middle-aged cats.</p> <p>Methods</p> <p>The cohort consisted of 332 MC cats, 282 cats < 4 years (85%). All cats were examined by 2-D and M-mode echocardiography. DNA was extracted from blood samples or buccal swabs and screened for the p.A31P cMyBP-C mutation in exon 3 of the gene, using polymerase chain reaction followed by DNA sequencing.</p> <p>Results</p> <p>The fHCM prevalence was 6.3% in the cohort. Eighteen cats were homozygous and 89 cats were heterozygous for the mutation. The odds ratio for having fHCM for homozygous cats was 21.6 (95% confidence interval 7.01-66.2) - when the group of equivocal cats was categorized as non-affected. Overall, 50% of the cats that were homozygous for the mutation had fHCM. p.A31P heterozygosity was not associated with a significant odds ratio for fHCM. In cats in the 4 to 6 years of age range a similar, non significant, odds ratio was seen in heterozygous cats. Only two cats over four years were homozygous and both were diagnosed with fHCM.</p> <p>Conclusion</p> <p>As there is no significant odds ratio associated with being heterozygous for the pA31P cMyBP-C mutation at this age, the mutation must have a very low penetrance in this group. From our data it would appear that most MC cats that develop fHCM due to the p.A31P mutation prior to the age of approximately 6 years do so because they are homozygous for this mutation.</p

En studie om anknytningsstil hos par som kommer till familjerådgivningen

I denna kvantitativa tvärsnittsstudie undersöktes om det fanns några skillnader av tendenser i anknytningsstil mellan par på familjerådgivning och en icke-klinisk grupp. Det undersöktes även om det fanns några skillnader av tendenser i anknytningsstil mellan olika familjerådgivningsmottagningar. 60 par från två familjerådgivningsmottagningar deltog i studien. Ytterligare en liknande grupp från en tidigare studie användes. Vid sitt första besök på familjerådgivningen fyllde paren i vars ett självskattningsformulär, Attachment Style Questionnaire, som mäter anknytningsstil. Paren fyllde också i vars en blankett med sociodemografiska uppgifter som hade utformats av författarna till studien. De sociodemografiska uppgifterna visade att paren befanns sig i olika livscykelfaser och att många barn var berörda. Resultatet visade att det fanns större tendens av otrygg anknytningsstil, speciellt undvikande anknytningsstil, i de kliniska grupperna. Det framkom även att de kliniska grupperna var mer lika än olika varandra vad gäller anknytningsstil. En slutsats var att paren som kom till familjerådgivning var en grupp som, ur ett anknytningsperspektiv, verkligen var i behov av denna insats. Detta indikerade att det krävs kunskap om anknytningsbaserade behandlingar i familjerådgivning. En annan slutsats var att familjerådgivare behöver kunskap om familjers fungerande i alla livscykelns faser.This quantitative cross-sectional study examined if there were any differences in attachment styles tendencies between couples from family counseling and a non-clinical group. It also examined if there were any differences regarding attachment styles tendencies between family counseling receptions. 60 couples from two family counseling receptions participated in the study. A similar group from a former study were also used. During the couple’s first visit they completed the self-report measure Attachment Style Questionnaire, concerning their attachment style. They also completed a form with sociodemographic data designed by the authors of the study. The sociodemographic data showed a variety of life-cycle phases among the couples and many affected children. The result suggested that there were more tendencies of insecure attachment style, especially avoidant attachment style, in the clinical groups. It also suggested that the clinical groups were more alike than different from each other, regarding attachment styles. One of the conclusions were that family counseling, from an attachment perspective, addressed couples in need of counseling. This indicates that it requires knowledge of attachment-based treatments in family counseling. Another conclusion was that family counselors need knowledge about family’s function in all stages in the life-cycle

The association of parent-reported executive functioning, reading, and math is explained by nature, not nurture

According to the hybrid model (van Bergen, van der Leij, & de Jong, 2014), the significant association among executive functioning (EF), reading, and math may be partially explained by parent-reported EF's role as a common risk and/or protective factor in reading and math (dis)abilities. The current study used a sample of 434 twin pairs (Mage = 12.12) from Florida to conduct genetically sensitive modeling on children's parent-reported EF, reading, and math skills to determine the common and unique etiological influences among the three domains. EF was measured through parent report and reading and math were measured with standardized test scores drawn from Florida's Progress Monitoring and Reporting Network as well as standardized parent-administered assessments collected by mail. Our trivariate Cholesky modeling showed that no matter which parent-reported EF component was modeled, the overlap of parent-reported EF with reading and math was explained by common genetic influences. Supplemental analysis suggested that this might in part be due to general parent report of problem behaviors. Additionally, significant environmental influences, with higher shared environmental overlap than previous work, were also found for reading and math. Findings indicate that poor parent-reported EF is a common cognitive risk factor for reading and math disabilities, which is driven by a shared genetic basis among all three domains. (PsycInfo Database Record (c) 2020 APA, all rights reserved)

Abnormal auditory forward masking pattern in the brainstem response of individuals with Asperger syndrome.

Abnormal auditory information processing has been reported in individuals with autism spectrum disorders (ASD). In the present study auditory processing was investigated by recording auditory brainstem responses (ABRs) elicited by forward masking in adults diagnosed with Asperger syndrome (AS). Sixteen AS subjects were included in the forward masking experiment and compared to three control groups consisting of healthy individuals (n = 16), schizophrenic patients (n = 16) and attention deficit hyperactivity disorder patients (n = 16), respectively, of matching age and gender. The results showed that the AS subjects exhibited abnormally low activity in the early part of their ABRs that distinctly separated them from the three control groups. Specifically, wave III amplitudes were significantly lower in the AS group than for all the control groups in the forward masking condition (P < 0.005), which was not the case in the baseline condition. Thus, electrophysiological measurements of ABRs to complex sound stimuli (eg, forward masking) may lead to a better understanding of the underlying neurophysiology of AS. Future studies may further point to specific ABR characteristics in AS individuals that separate them from individuals diagnosed with other neurodevelopmental diseases

Considering Parents of Malignant ill Children in COVID-19 Health Crisis

Aim: Parents of children suffering from malignant diseases indubitably represent a very dainty population, underrepresented in psychosocial research. It is common for these parents to move to the hospital wards in order to support their children, which causes an unnatural cut in their lifeline, in addition to coping with terrifying diagnosis. Coping with a child’s malignant disease includes a continuous feeling of fear and concern, and change in the overall family dynamics, but also the cessation of daily life activities, even outside the context of a global pandemic, some pre-COVID research had shown. COVID-19 brought some additional challenges. In order to protect children’s fragile physical state, parents were obliged to adapt to new rules and distance from the others even more. At the same time, their fears and worries grew only bigger and coping mechanisms were seriously limited. Subjects and Methods: In this paper we investigate parental experiences and needs during COVID-19 crisis. Semi-structured in-depth interviews were conducted with ten mothers with experience of children’s in-patient treatment before and during pandemics. Results: According to main findings, theoretical model of parental adjustment and wellbeing in health crisis is proposed. Conclusion: Results imply the necessity to consider parental psychological wellbeing in order to support them and their children, especially when additional stressful and/or traumatic experiences emerge, and treat them as especially vulnerable group in research and practice

Abnormal auditory forward masking pattern in the brainstem response of individuals with Asperger syndrome

Abnormal auditory information processing has been reported in individuals with autism spectrum disorders (ASD). In the present study auditory processing was investigated by recording auditory brainstem responses (ABRs) elicited by forward masking in adults diagnosed with Asperger syndrome (AS). Sixteen AS subjects were included in the forward masking experiment and compared to three control groups consisting of healthy individuals (n = 16), schizophrenic patients (n = 16) and attention deficit hyperactivity disorder patients (n = 16), respectively, of matching age and gender. The results showed that the AS subjects exhibited abnormally low activity in the early part of their ABRs that distinctly separated them from the three control groups. Specifically, wave III amplitudes were significantly lower in the AS group than for all the control groups in the forward masking condition (P < 0.005), which was not the case in the baseline condition. Thus, electrophysiological measurements of ABRs to complex sound stimuli (eg, forward masking) may lead to a better understanding of the underlying neurophysiology of AS. Future studies may further point to specific ABR characteristics in AS individuals that separate them from individuals diagnosed with other neurodevelopmental diseases