Röntgenhoitaja potilaan röntgentutkimuksen oikeutuksen arvioijana : "...me halutaan tehdä oikein ja hyvin."

Tämän opinnäytetyön tarkoitus on kuvailla röntgentutkimuksen oikeutuksen arviointia osana kliinistä radiografiaa. Opinnäytetyössä selvitetään röntgenhoitajien käsityksiä oikeutuksen arvioinnista, sekä sen edellyttämästä osaamisesta. Röntgentutkimus on oikeutettu, kun siitä on enemmän hyötyä, kuin haittaa. Röntgentutkimuksen oikeutuksesta vastaa ensisijaisesti potilasta hoitava lääkäri ja toissijaisesti radiologi. Röntgenhoitajalla ei ole toistaiseksi juridista vastuuta oikeutuksesta. EU:n uusi säteilydirektiivi on uudistunut ja sitä vastaava lainsäädäntö toimeenpannaan Suomessa 6.2.2018 mennessä. Lausunnolla olevassa lakiesityksessä on esi-tetty, että röntgentutkimuksen oikeutusarviointi tulisi koskemaan myös röntgenhoitajia. Opinnäytetyön aineisto kerättiin haastattelemalla neljää kokenutta röntgenhoitajaa, jotka työsken-televät perusterveydenhuoltoa vastaavassa organisaatiossa. Kukin haastattelu kesti 30-40 minuuttia ja haastattelut nauhoitettiin ja litteroitiin. Aineisto analysoitiin sisällön analyysilla. Opinnäytetyön tulosten perusteella oikeutuksen arviointi on osa röntgenhoitajan päätöksenteko-prosessia ja röntgentutkimuksen oikeutusarvionti kuuluu jo nyt osana röntgenhoitajan työteh-täviin. Ilmenneitä ongelmia ovat puutteelliset esitiedot, väärin kohdennettu tutkimuspyyntö ja turhat tutkimukset. Röntgenhoitajat kokevat tarpeelliseksi oikeutusarvioinnin kehittämisen osana työtään, mutta vastuun laajentuminen edellyttää koulutusta. Oikeutuksen arviointi toteutuu itse-näisesti lähetteen, mahdollisesti potilaan haastattelun ja havainnoinnin perusteella. Rajattu rönt-gentutkimuksen oikeutusarviointi -velvollisuus on potilaan etu ja oikeus. Ongelmat röntgentutkimuksen oikeutuksessa kuormittavat röntgenhoitajia ja lisäävät heidän työ-määräänsä ja aiheuttavat ristiriitoja työyhteisössä. Lähetteisiin liittyvät ongelmat lisäävät rönt-genhoitajan työtä, jonka takia he joutuvat tekemään lisäselvityksiä, potilaille saatetaan tehdä tur-hia röntgentutkimuksia tai röntgenhoitaja joutuu kiireen takia tekemään röntgentutkimuksen, joka on kyseenalainen ja täten toimimaan ammattietiikkansa vastaisesti. Selkeyttämällä oikeutuksen vastuita, pystytään kehittämään potilaan hoitoa ja palvelua, sekä vaikuttamaan röntgenhoitajien työhyvinvointiin.The purpose of this thesis was to describe the justification process of plain x-ray examination as a part of daily radiography procedure. X-ray examination is justified, when it brings more benefit than harm for patient. The patient’s physician and radiologist are both responsible for the justification. Radiographers have no legal responsibility for justification. However, they recognize that all x-ray examinations are not justified. The situation have been contradictory for radiographers. The new European Directive 2013/59/Euratom has been given in December 2013. The new directive lay down basic safety standards for protection against the dangers arising from exposure to ionizing radiation. The directive emphasizes also the need for justification of medical exposure. The new law and legislation based on a new directive come into force in Finland 6.2.2018. it has been proposed, that process of justification of a x-ray examination will involve also the Finish radiographers. This thesis focused on radiographer’s idea of the justification process of x-ray examination. There were also questions concerning skills justification process will require. Data was collected by interviewing four experienced radiographers who work in a organization which is responsible for Finish basic healthcare. Each interview lasted approx. 30-40 minutes and interviews were recorded and transcribed. Data was analyzed using content analysis. According to the results of this thesis the justification of x-ray examination is already part of radiographer’s daily decision making process. The problems radiographer need to resolve before exposure are insufficient pre-information, wrongly pointed examination request and so called unnecessary examinations. Radiographers consider improving evaluation of justification as a necessary part of radiography, but expanding responsibilities requires training. The independent justification of x-ray examination is patient’s benefit and his/her right and the duty for radiographers

Validity and reliability of the Finnish version of the Functioning Assessment Short Test (FAST) in bipolar disorder

The Functioning Assessment Short Test (FAST) was developed for the clinical evaluation of functional impairment of patients suffering from bipolar disorder. The aim of this study was to validate the Finnish version of FAST.Peer reviewe

Phase 1 Lymfactin (R) Study : Short-term Safety of Combined Adenoviral VEGF-C and Lymph Node Transfer Treatment for Upper Extremity Lymphedema

Objective: To study the safety and tolerability of Lymfactin (R) treatment combined with microvascular lymph node transfer surgery in patients with upper limb lymphedema. Background: Upper limb lymphedema is a common clinical challenge after breast cancer surgery and/or radiotherapy. Lymfactin (R) is an adenovirus type 5-based gene therapy involving expression of human vascular endothelial growth factor C (VEGF-C) in the damaged tissue. It aims to correct deficient lymphatic flow by promoting the growth and repair of lymphatic vessels. Methods: In Phase I, Lymfactin (R) was combined with microvascular lymph node transfer surgery to study the safety and tolerability of Lymfactin (R) and the biodistribution of the viral vector in patients with upper limb lymphedema. Results: Fifteen patients with breast cancer-associated secondary lymphedema of the upper arm were recruited between December 2016 and February 2018. Three patients received a lower dose (1 x 10(10)) and 12 a higher dose (1 x 10(11)) of viral particles, respectively. No dose-limiting toxicities were observed, and the study was completed with the pre-determined maximum dose. Commonly reported adverse events during the 12-month follow-up were common cold, fever, gastroenteritis, pain in the operation area, headache, muscle ache and elevated liver enzymes. Serious adverse events consisted of two erysipelas infections in the lymphedema arm (requiring hospitalization) and one hematoma of the flap donor site. Conclusions: After 12 months' follow-up, results indicate that Lymfactin (R) is well tolerated. The study continues with a 36-months efficacy and 5 years safety follow-up of the patients. The oncological safety aspects of Lymfactin (R) will require a longer follow-up period. (c) 2020 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Pub-lished by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license. (http://creativecommons.org/licenses/by-nc-nd/4.0/)Peer reviewe

Delay in the initiation of adjuvant chemotherapy in patients with breast cancer with mastectomy with or without immediate breast reconstruction

Background Patients with breast cancer undergoing mastectomy should be offered the option of immediate breast reconstruction (IBR). The aim of this retrospective study was to assess whether there is a delay in the initiation of adjuvant chemotherapy in patients undergoing mastectomy with or without IBR. Method The study included patients aged 70 years or younger with clinically node-negative breast cancer who underwent unilateral mastectomy with IBR (IBR group) or mastectomy alone (no-IBR group) followed by adjuvant chemotherapy at the Helsinki University Hospital between January 2012 to July 2018. Results A total of 645 patients were included; 186 in the IBR group and 459 in the no-IBR group. Sixty-six (35.5 per cent) patients in the IBR group and 102 (22.2 per cent) patients in the no-IBR group received their first chemotherapy cycle later than 6 weeks after surgery (P < 0.001). The respective numbers for later than 8 weeks were 17 (9.1 per cent) and 14 (3.1 per cent) (P = 0.001). Among all 645 patients, postoperative complications were a significant risk factor for a delay in the initiation of chemotherapy. Sixty-seven (39.9 per cent) patients with and 101 (21.2 per cent) patients without complications had a delay in chemotherapy (P < 0.001). The delay in chemotherapy was due to complications in 39 (59.1 per cent) in the IBR group and in 28 (27.5 per cent) in the no-IBR group (P < 0.001). Conclusion Patients undergoing mastectomy alone were more likely to receive adjuvant chemotherapy within 6 weeks after surgery compared with the IBR patients. IBR significantly increased the risk of postoperative complications in comparison with mastectomy alone. The complications, in turn, were a significant risk factor for delay in adjuvant chemotherapy. The aim of this retrospective study was to see whether immediate breast reconstruction (IBR) is linked to a delay in initiation of adjuvant chemotherapy. The study shows that patients undergoing mastectomy alone were more likely to receive adjuvant chemotherapy within the recommended 6 weeks after surgery when compared with IBR patients. IBR significantly increased the risk of postoperative complications and the complications, in turn, were a significant risk factor for delay in adjuvant chemotherapy.Peer reviewe

Determinants of sickness absence rate among Finnish municipal employees

Objective: In addition to acute health problems, various aspects of health behavior, work-related and sociodemographic factors have been shown to influence the rate of sickness absence. The aim of this study was to concomitantly examine factors known to have an association with absenteeism. We hypothesized the prevalence of chronic diseases being the most important factor associated with sickness absence. Design: A cross-sectional study. Setting: Occupational health care in the region of Pori, Finland. Subjects: 671 municipal employees (89% females) with a mean age of 49 (SD 10) years. Information about the study subjects was gathered from medical records, by physical examination and questionnaires containing information about physical and mental health, health behavior, work-related and sociodemographic factors. The number of sickness absence days was obtained from the records of the city of Pori. Main outcome measures: The relationship of absenteeism rate with sociodemographic, health- and work-related risk factors. Results: In the multivariate analysis, the mean number of chronic diseases (IRR 1.24, 95% CI 1.13 to 1.36), work ability (IRR 0.83, 95% CI 0.76 to 0.91), and length of years in education (IRR 0.90, 95% CI 0.85 to 0.95) remained as independent factors associated with absenteeism. Conclusion: According to our results, chronic diseases, self-perceived work ability and length of years in education are the most important determinants of the rate of sickness absence. This implies that among working-aged people the treatment of chronic medical conditions is also worth prioritizing, not only to prevent complications, but also to avoid sickness absences.</div

The effect of sildenafil on pleural and peritoneal effusions after the TCPC operation

Background We evaluated whether the administration of sildenafil in children undergoing the TCPC operation shortened the interval from the operation to the removal of the pleural and peritoneal drains. Methods We retrospectively reviewed the data of 122 patients who had undergone the TCPC operation between 2004 and 2014. Patients were divided into two groups on the basis of their treatments. Sildenafil was orally administered pre-operatively in the morning of the procedure or within 24 hours after the TCPC operation to the sildenafil group (n = 48), which was compared to a control group (n = 60). Fourteen patients were excluded from the study. Results The primary outcome measure was the time from the operation to the removal of the drains. The study groups had similar demographics. The median [interquartile range] time for the removal of drains (sildenafil group 11 [8-19] vs control group 11 [7-16] d, P = .532) was comparable between the groups. The median [interquartile range] fluid balance on the first post-operative day was significantly higher (P = .001) in the sildenafil group compared with controls (47 [12-103] vs 7 [-6-67] mL kg(-1)). The first post-operative day fluid balance was a significant predictor for a prolonged need for drains in the multivariate analysis. Conclusions Sildenafil administration, pre-operatively or within 24 hours after the TCPC operation, did not reduce the required time for pleural and peritoneal drains but was associated with a significantly higher positive fluid balance.Peer reviewe