Luokanopettajien näkemyksiä yhteisopettajuudesta

Tiivistelmä. Tässä pro gradu -tutkielmassa tarkastelemme yhteisopettajuutta, sen etuja ja haasteita sekä ammatillista kasvua. Yhteisopettajuus on keino toteuttaa opetusta sekä oppilaita että opettajia hyödyttävällä tavalla. Opetusmuotona yhteisopettajuutta ei vielä tunneta kovinkaan yleisesti ja tutkimusta siitä ei Suomessa ole juuri tehty. Aiemmissa tutkimuksissa yhteisopettajuudessa toinen opettaja on erityisopettaja. Tämän vuoksi perehdyimme yhteisopettajuuteen kahden luokanopettajan välillä. Tutkielmamme tutkimuskysymyksillä pyrimme perehtymään opettajien näkemyksiin siitä, mitä yhteisopettajuus on, millaisia etuja ja haasteita siinä ilmenee sekä miten yhteisopettajuus vaikuttaa opettajien ammatilliseen kasvuun. Tutkielmamme taustalla oleva teoria määrittää yhteisopettajuuden kahden opettajan väliseksi yhteistoiminnaksi heterogeenisessä ryhmässä. Yhteisopettajuudella on monia toimintamalleja sekä erilaisia etuja ja haasteita. Yhteisopettajuus on nähty yhtenä ammatillisen kasvun keinona. Ammatillinen kasvu koostuu opettajien ammatillisesta oppimisesta ja kehityksestä. Tutkielmamme on laadullinen tutkimus, joka toteutettiin fenomenografisella tutkimusotteella teemahaastattelun avulla. Haastateltavina oli neljä yhteisopettajuutta toteuttavaa opettajaa. Haastatteluissa oli tarkoitus saada opettajien näkemyksiä yhteisopettajuuteen. Tutkimustulokset muotoutuivat aineistolähtöisen sisällönanalyysin avulla. Tutkielmassamme saimme selville opettajien näkemyksiä yhteisopettajuudesta. Opettajat määrittivät yhteisopettajuuden tärkeimmäksi olemukseksi työn jakamisen. Yhteisopettajuuden etuina nähtiin kollegiaalinen yhteistyö sekä oppilaiden saama hyöty useamman aikuisen läsnäolosta. Haasteena pidettiin suuria oppilasmääriä, jotka saattavat hankaloittaa opetusta. Yhteisopettajuudessa ammatillista kasvua nähtiin tapahtuvan toista opettajaa seuraamalla sekä opettajuudesta keskustelemalla. Tutkimustuloksistamme voidaan päätellä yhteisopettajuuden olevan laajempaa yhteistyötä, kuin miten aiempi tutkimus on sen määritellyt. Yhteisopettajuuden ei välttämättä tarvitse tapahtua samassa luokkatilassa jatkuvasti. Haastateltavamme toteuttivat yhteisopettajuutta eri tavoilla. Osa opettajista toteutti yhteisopettajuutta kokonaisvaltaisesti yhdessä ja osalla toiminta oli keskittynyt tiettyihin oppiaineisiin. Yhteisopettajuus nähtiin helpottavan opettajan työtä laajasti, koska työtä voitiin jakaa ja asioista keskustella. Mielestämme yhteisopettajuutta voidaan hyödyntää keinona vastaamaan jatkuvasti muuttuvaan koulumaailmaan

Prospective experience of percutaneous endoscopic gastrostomy tubes placed by otorhinolaryngologist-head and neck surgeons : safe and efficacious

Percutaneous endoscopic gastrostomy (PEG) is often the treatment of choice in head and neck cancer (HNC) patients needing long-term nutritional support. Prospective studies on PEG tube placement in an otorhinolaryngologist service are lacking. At our hospital, otolaryngologist-head and neck (ORL-HN) surgeons-have performed PEG insertions for HNC patients since 2008. We prospectively analyzed 127 consecutive HNC patients who received their PEG tubes at the Department of Otorhinolaryngology-head and neck surgery, and evaluated the outcome of PEG tube insertions performed by ORL-HN surgeons. To compare time delays before and after, PEG placement service was transferred from gastrointestinal surgeons to ORL-HN surgeons, and we retrospectively analyzed a separate group of 110 HNC patients who had earlier received PEG tubes at the Department of Gastrointestinal Surgery. ORL-HN surgeons' success rate in PEG insertion was 97.6%, leading to a final prospective study group of 124 patients. Major complications occurred in four (3.2%): two buried bumper syndromes, one subcutaneous hemorrhage leading to an abscess in the abdominal wall, and one metastasis at the PEG site. The most common minor complication was peristomal granulomatous tissue affecting 23 (18.5%) patients. After the change in practice, median time delay before PEG insertion decreased from 13 to 10 days (P <0.005). The proportion of early PEG placements within 0-3 days increased from 3.6 to 14.6% (P <0.005). PEG tube insertion seems to be a safe procedure in the hands of an ORL-HN surgeon. Independence from gastrointestinal surgeons' services reduced the time delay and improved the availability of urgent PEG insertions.Peer reviewe

The severity of Puumala hantavirus induced nephropathia epidemica can be better evaluated using plasma interleukin-6 than C-reactive protein determinations

<p>Abstract</p> <p>Background</p> <p>Nephropathia epidemica (NE) is a Scandinavian type of hemorrhagic fever with renal syndrome caused by Puumala hantavirus. The clinical course of the disease varies greatly in severity. The aim of the present study was to evaluate whether plasma C-reactive protein (CRP) and interleukin (IL)-6 levels associate with the severity of NE.</p> <p>Methods</p> <p>A prospectively collected cohort of 118 consecutive hospital-treated patients with acute serologically confirmed NE was examined. Plasma IL-6, CRP, and creatinine, as well as blood cell count and daily urinary protein excretion were measured on three consecutive days after admission. Plasma IL-6 and CRP levels higher than the median were considered high.</p> <p>Results</p> <p>We found that high IL-6 associated with most variables reflecting the severity of the disease. When compared to patients with low IL-6, patients with high IL-6 had higher maximum blood leukocyte count (11.9 <it>vs </it>9.0 × 10⁹/l, <it>P </it>= 0.001) and urinary protein excretion (2.51 <it>vs </it>1.68 g/day, <it>P </it>= 0.017), as well as a lower minimum blood platelet count (55 <it>vs </it>80 × 10⁹/l, <it>P </it>< 0.001), hematocrit (0.34 <it>vs </it>0.38, <it>P </it>= 0.001), and urinary output (1040 <it>vs </it>2180 ml/day, <it>P </it>< 0.001). They also stayed longer in hospital than patients with low IL-6 (8 <it>vs </it>6 days, <it>P </it>< 0.001). In contrast, high CRP did not associate with severe disease.</p> <p>Conclusions</p> <p>High plasma IL-6 concentrations associate with a clinically severe acute Puumala hantavirus infection, whereas high plasma CRP as such does not reflect the severity of the disease.</p

The Pro12Ala polymorphism of the PPAR gamma 2 gene is associated with hepatic glucose uptake during hyperinsulinemia in subjects with type 2 diabetes mellitus

The Ala12 allele of the peroxisome proliferator-activated receptor gamma gene (PPARG2) has been associated with reduced risk of type 2 diabetes mellitus (T2DM) and increased whole-body and skeletal muscle insulin sensitivity in nondiabetic subjects. The effect of the Pro12Ala polymorphism on tissue specific insulin sensitivity in subjects with T2DM has not been previously investigated. We studied the effect of the Pro12Ala polymorphism on the rates of whole-body, skeletal muscle, and subcutaneous adipose tissue glucose uptake (GU) in T2DM subjects, and the rates of hepatic GU in nondiabetic and T2DM subjects during hyperinsulinemia. Our study included 105 T2DM subjects whose whole-body, skeletal muscle, subcutaneous adipose tissue, and hepatic GUs were measured using F-18-fluorodeoxyglucose and positron emission tomography during the hyperinsulinemic euglycemic clamp. Hepatic GU was also measured in 68 nondiabetic subjects. In obese (body mass index >= 27 kg/m(2)) subjects with T2DM, the rate of hepatic GU was 28% lower in subjects with the Pro12Pro genotype than in carriers of the Ala12 allele (P = .001); and a similar trend was observed in nondiabetic obese subjects (P = .137). No effect of the Pro12Ala polymorphism on the rates of whole-body, skeletal muscle, or subcutaneous adipose tissue GU was observed in T2DM subjects. We conclude that the Ala12 allele of PPARG2 is associated with higher hepatic GU in obese subjects with T2DM. (C) 2009 Elsevier Inc. All rights reserved

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit