Monivammapotilaan kivunhoito

Tämän opinnäytetyön tarkoituksena oli kartoittaa monivammapotilaan kivunhoitoa ennen sairaalaan tuloa, sairaalassa ja kotona systemaattista kirjallisuuskatsausta soveltaen. Tavoitteena on edistää monivammapotilaan kivunhoitoa. Opinnäytetyöhön valikoitui analysoitavaksi 38 (=n) julkaisua. Monivammapotilaan kivunhoito vaatii moniammatillista osaamista ja yhteistyötä. Kivunhoidon oleellisena osana on kivun arviointi. Kipua voidaan arvioida erilaisin mittarein, kuten sanallinen asteikko (VRS), numeroasteikko (NRS) ja visuaalianalogiasteikko (VAS). Potilaan ollessa tajuton, kivunarviointi muuttuu haasteellisemmaksi, sillä silloin mittareita ei voida käyttää. Monivammapotilaan kipua hoidetaan pääsääntöisesti lääkkeillä. Keskeisimpiä lääkkeitä ovat tulehduskipulääkkeet, parasetamoli ja opioidit. Lääkkeettömiä kivunhoitomuotoja kuten asentohoito, fysikaaliset hoitomuodot, hengitysharjoitukset, musiikin kuuntelu, rentoutumis- ja mielikuvaharjoitukset, käytetään myös, mutta ne ovat tehokkaampia yhdistettynä lääkkeelliseen kivunhoitoon. Lääkehoito koostuu monen lääkeryhmän yhdistelmistä eli multimodaalisesta kivunhoidosta. Puudutteet ovat keskeinen osa monivammapotilaan kivunhoitoa, sillä ne vähentävät huomattavasti opioidien käyttöä. Kivunhoito on tasapainoilua potilaan kivuttomuuden ja kivunhoidon haittavaikutuksien välillä. Potilaan kivunhoito jatkuu koko hoidon ajan, myös kotiutumisen jälkeen. Kivunhoito on potilaan oikeus eikä ole olemassa mitään pätevää syytä jättää kipua hoitamatta. Monivammapotilaat ovat todella kivuliaita, joten kivun hoidon tutkiminen ja kehittäminen on tärkeää. Tehokkaalla kivunhoidolla voidaan ehkäistä kivun kroonistumista.The purpose of this thesis is to improve multi-trauma patients pain management before coming to a hospital, in hospital and at home by using a systematic literature review. The aim is to improve multi-trauma patient’s pain management. There was 38(=n) publications chosen for this thesis. The pain management of a multi-trauma patient requires multi-professional expertise and cooperation. An essential part of pain management is assessment of pain. The pain can be assessed with different kind of rating scales for example verbal rating scale (VRS), numeric rating scale (NRS) and visual analog scale (VAS). When patient is being unconscious assessment of pain becomes challenging so the rating scales cannot be used. The pain of a multi-trauma patient is mainly managed with medicine. The most common medicines are inflammatory drugs, paracetamol and opioids. Drug-free pain management formats such as position management, physical therapies, breathing exercises, listening to music, relaxing and imagination exercises are used but they are more effective combined with medicinal pain management. Medication consist of the combination of different drug groups called multimodal pain management. Regional anesthetics are a key part of the pain management of a multi-trauma patient because regional anesthetics reduce remarkably the use of opioids. Pain management is balancing between painless and side effects pain management. The pain management of the patient goes through the whole care also after discharging from hospital. Pain management is the patients right and there is no competent reason to not treat the pain. Multi-trauma patients are in a high amount of pain so the study and development of pain management is really important. With efficient pain management you can anticipate chronical pain

Registration and Summation of Respiratory-Gated or Breath-Hold PET Images Based on Deformation Estimation of Lung from CT Image

Lung motion due to respiration causes image degradation in medical imaging, especially in nuclear medicine which requires long acquisition times. We have developed a method for image correction between the respiratory-gated (RG) PET images in different respiration phases or breath-hold (BH) PET images in an inconsistent respiration phase. In the method, the RG or BH-PET images in different respiration phases are deformed under two criteria: similarity of the image intensity distribution and smoothness of the estimated motion vector field (MVF). However, only these criteria may cause unnatural motion estimation of lung. In this paper, assuming the use of a PET-CT scanner, we add another criterion that is the similarity for the motion direction estimated from inhalation and exhalation CT images. The proposed method was first applied to a numerical phantom XCAT with tumors and then applied to BH-PET image data for seven patients. The resultant tumor contrasts and the estimated motion vector fields were compared with those obtained by our previous method. Through those experiments we confirmed that the proposed method can provide an improved and more stable image quality for both RG and BH-PET images

Sclerite formation in the hydrothermal-vent “scaly-foot” gastropod — possible control of iron sulfide biomineralization by the animal

A gastropod from a deep-sea hydrothermal field at the Rodriguez triple junction, Indian Ocean, has scale-shaped structures, called sclerites, mineralized with iron sulfides on its foot. No other organisms are known to produce a skeleton consisting of iron sulfides. To investigate whether iron sulfide mineralization is mediated by the gastropod for the function of the sclerites, we performed a detailed physical and chemical characterization. Nanostructural characterization of the iron sulfide sclerites reveals that the iron sulfide minerals pyrite (FeS2) and greigite (Fe3S4) form with unique crystal habits inside and outside of the organic matrix, respectively. The magnetic properties of the sclerites, which are mostly consistent with those predicted from their nanostructual features, are not optimized for magnetoreception and instead support use of the magnetic minerals as structural elements. The mechanical performance of the sclerites is superior to that of other biominerals used in the vent environment for predation as well as protection from predation. These characteristics, as well as the co-occurrence of brachyuran crabs, support the inference that the mineralization of iron sulfides might be controlled by the gastropod to harden the sclerites for protection from predators. Sulfur and iron isotopic analyses indicate that sulfur and iron in the sclerites originate from hydrothermal fluids rather than from bacterial metabolites, and that iron supply is unlikely to be regulated by the gastropod for iron sulfide mineralization. We propose that the gastropod may control iron sulfide mineralization by modulating the internal concentrations of reduced sulfur compounds