Tehokkaan pahoinvoinnin estolääkityksen yhteys pahoinvoinnin vähenemiseen rintasyöpäpotilailla

Rintasyöpäpotilaille toteutetaan leikkaushoidon liitännäishoitona usein solunsalpaajahoitoja estämään taudin uusiutumista. Solunsalpaajahoidoista voi ilmaantua potilaalle useita erilaisia haittavaikutuksia, muun muassa pahoinvointia ja oksentelua, joita potilaat etukäteen jo monesti pelkäävät. Usein rintasyövän liitännäishoidot sisältävät antrasykliinin ja syklofosfamidin yhdistelmää, kuten CEF- tai CEX-syöpälääkehoidot, jotka luokitellaan korkean pahoinvoinnin riskin lääkityksiin ja joihin suositellaan tehokasta pahoinvoinnin estolääkehoitoa. Tutkimusasetelmana oli retrospektiivinen kohorttitutkimus. Yhteensä tutkittavia oli 229 ja he kaikki olivat saaneet yhteensä kolme sykliä CEF-solunsalpaajahoitoa (syklofosfamidi, epirubisiini, fluorourasiili). Perustiedot potilaista, pahoinvoinnin estolääkitykset sekä mahdolliset riskitekijät pahoinvoinnille merkittiin ylös sairaskertomusmerkinnöistä, sytostaattihoitokorteista sekä erillisistä potilaskansioista. Keräämiemme tietojen pohjalta vertasimme aprepitanttia saaneiden potilaiden kohtalaisen ja vaikea-asteisen pahoinvoinnin määrän vähentymistä aprepitanttia saamattomiin. Aprepitantti yhdistettiin tutkimuksessamme vähäisempään pahoinvoinnin haitta-asteeseen (p-arvo=0,024) sekä vähäisempään oksenteluun (p-arvo=0,004). Verrattaessa aiempaa pahoinvoinnin estolääkityksen protokollaa (deksametasoni ja 5-HT3-salpaaja) uuteen ohjeistukseen (deksametasoni, 5-HT3-salpaaja ja aprepitantti) havaittiin uusi protokolla hyödyllisemmäksi pahoinvoinnin suhteen (p-arvo=0,002). Tämän opinnäytteen alkuperäisyys on tarkastettu Turnitin OriginalityCheck-ohjelmalla Tampereen yliopiston laatujärjestelmän mukaisesti

Randomized, Double-Blind Trial of the Effect of Fluid Composition on Electrolyte, Acid-Base, and Fluid Homeostasis in Patients Early After Subarachnoid Hemorrhage

Background: Hyper- and hyponatremia are frequently observed in patients after subarachnoidal hemorrhage, and are potentially related to worse outcome. We hypothesized that the fluid regimen in these patients is associated with distinct changes in serum electrolytes, acid-base disturbances, and fluid balance. Methods: Thirty-six consecutive patients with SAH were randomized double-blinded to either normal saline and hydroxyethyl starch dissolved in normal saline (Voluven®; saline) or balanced crystalloid and colloid solutions (Ringerfundin® and Tetraspan®; balanced, n=18, each) for 48h. Laboratory samples and fluid balance were evaluated at baseline and at 24 and 48h. Results: Age [57±13years (mean±SD; saline) vs. 56±12years (balanced)], SAPS II (38±16 vs. 34±17), Hunt and Hess [3 (1-4) (median, range) vs. 2 (1-4)], and Fischer scores [3.5 (1-4) vs. 3.5 (1-4)] were similar. Serum sodium, chloride, and osmolality increased in saline only (p≤0.010, time-group interaction). More patients in saline had Cl >108mmol/L [16 (89%) vs. 8 (44%); p=0.006], serum osmolality >300mosmol/L [10 (56%) vs. 2 (11%); p=0.012], a base excess 1,500mL during the first 24h [11 (61%) vs. 5 (28%); p=0.046]. Hyponatremia and hypo-osmolality were not more frequent in the balanced group. Conclusions: Treatment with saline-based fluids resulted in a greater number of patients with hyperchloremia, hyperosmolality, and positive fluid balance >1,500mL early after SAH, while administration of balanced solutions did not cause more frequent hyponatremia or hypo-osmolality. These results should be confirmed in larger studie

Targeted temperature control following traumatic brain injury:ESICM/NACCS best practice consensus recommendations

Aims and scope: The aim of this panel was to develop consensus recommendations on targeted temperature control (TTC) in patients with severe traumatic brain injury (TBI) and in patients with moderate TBI who deteriorate and require admission to the intensive care unit for intracranial pressure (ICP) management. Methods: A group of 18 international neuro-intensive care experts in the acute management of TBI participated in a modified Delphi process. An online anonymised survey based on a systematic literature review was completed ahead of the meeting, before the group convened to explore the level of consensus on TTC following TBI. Outputs from the meeting were combined into a further anonymous online survey round to finalise recommendations. Thresholds of ≥ 16 out of 18 panel members in agreement (≥ 88%) for strong consensus and ≥ 14 out of 18 (≥ 78%) for moderate consensus were prospectively set for all statements. Results: Strong consensus was reached on TTC being essential for high-quality TBI care. It was recommended that temperature should be monitored continuously, and that fever should be promptly identified and managed in patients perceived to be at risk of secondary brain injury. Controlled normothermia (36.0–37.5 °C) was strongly recommended as a therapeutic option to be considered in tier 1 and 2 of the Seattle International Severe Traumatic Brain Injury Consensus Conference ICP management protocol. Temperature control targets should be individualised based on the perceived risk of secondary brain injury and fever aetiology. Conclusions: Based on a modified Delphi expert consensus process, this report aims to inform on best practices for TTC delivery for patients following TBI, and to highlight areas of need for further research to improve clinical guidelines in this setting.</p

Tranilast increases vasodilator response to acetylcholine in rat mesenteric resistance arteries through increased EDHF participation

Background and Purpose: Tranilast, in addition to its capacity to inhibit mast cell degranulation, has other biological effects, including inhibition of reactive oxygen species, cytokines, leukotrienes and prostaglandin release. In the current study, we analyzed whether tranilast could alter endothelial function in rat mesenteric resistance arteries (MRA). Experimental Approach: Acetylcholine-induced relaxation was analyzed in MRA (untreated and 1-hour tranilast treatment) from 6 month-old Wistar rats. To assess the possible participation of endothelial nitric oxide or prostanoids, acetylcholineinduced relaxation was analyzed in the presence of L-NAME or indomethacin. The participation of endothelium-derived hyperpolarizing factor (EDHF) in acetylcholine-induced response was analyzed by preincubation with TRAM-34 plus apamin or by precontraction with a high K+ solution. Nitric oxide (NO) and superoxide anion levels were measured, as well as vasomotor responses to NO donor DEA-NO and to large conductance calcium-activated potassium channel opener NS1619. Key Results: Acetylcholine-induced relaxation was greater in tranilast-incubated MRA. Acetylcholine-induced vasodilation was decreased by L-NAME in a similar manner in both experimental groups. Indomethacin did not modify vasodilation. Preincubation with a high K+ solution or TRAM-34 plus apamin reduced the vasodilation to ACh more markedly in tranilastincubated segments. NO and superoxide anion production, and vasodilator responses to DEA-NO or NS1619 remained unmodified in the presence of tranilast. Conclusions and Implications: Tranilast increased the endothelium-dependent relaxation to acetylcholine in rat MRA. This effect is independent of the nitric oxide and cyclooxygenase pathways but involves EDHF, and is mediated by an increased role of small conductance calcium-activated K+ channelsThis study was supported by Ministerio de Ciencia e Innovación (SAF 2009-10374), Ministerio de Economía y Competitividad (SAF 2012-38530), and Fundación Mapfre. F.E. Xavier is recipient of research fellowship from Conselho Nacional de Desenvolvimento Científico e Tecnológico (Brazil

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

BACKGROUND: Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI). METHODS: We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2016. We calculated DALYs by summing years of life lost and years of life lived with disability for each location, age group, sex, and year. We estimated HALE using age-specific death rates and years of life lived with disability per capita. We explored how DALYs and HALE differed from expected trends when compared with the SDI: the geometric mean of income per person, educational attainment in the population older than age 15 years, and total fertility rate. FINDINGS: The highest globally observed HALE at birth for both women and men was in Singapore, at 75·2 years (95% uncertainty interval 71·9-78·6) for females and 72·0 years (68·8-75·1) for males. The lowest for females was in the Central African Republic (45·6 years [42·0-49·5]) and for males was in Lesotho (41·5 years [39·0-44·0]). From 1990 to 2016, global HALE increased by an average of 6·24 years (5·97-6·48) for both sexes combined. Global HALE increased by 6·04 years (5·74-6·27) for males and 6·49 years (6·08-6·77) for females, whereas HALE at age 65 years increased by 1·78 years (1·61-1·93) for males and 1·96 years (1·69-2·13) for females. Total global DALYs remained largely unchanged from 1990 to 2016 (-2·3% [-5·9 to 0·9]), with decreases in communicable, maternal, neonatal, and nutritional (CMNN) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). The exemplars, calculated as the five lowest ratios of observed to expected age-standardised DALY rates in 2016, were Nicaragua, Costa Rica, the Maldives, Peru, and Israel. The leading three causes of DALYs globally were ischaemic heart disease, cerebrovascular disease, and lower respiratory infections, comprising 16·1% of all DALYs. Total DALYs and age-standardised DALY rates due to most CMNN causes decreased from 1990 to 2016. Conversely, the total DALY burden rose for most NCDs; however, age-standardised DALY rates due to NCDs declined globally. INTERPRETATION: At a global level, DALYs and HALE continue to show improvements. At the same time, we observe that many populations are facing growing functional health loss. Rising SDI was associated with increases in cumulative years of life lived with disability and decreases in CMNN DALYs offset by increased NCD DALYs. Relative compression of morbidity highlights the importance of continued health interventions, which has changed in most locations in pace with the gross domestic product per person, education, and family planning. The analysis of DALYs and HALE and their relationship to SDI represents a robust framework with which to benchmark location-specific health performance. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform health policies, health system improvement initiatives, targeted prevention efforts, and development assistance for health, including financial and research investments for all countries, regardless of their level of sociodemographic development. The presence of countries that substantially outperform others suggests the need for increased scrutiny for proven examples of best practices, which can help to extend gains, whereas the presence of underperforming countries suggests the need for devotion of extra attention to health systems that need more robust support. FUNDING: Bill & Melinda Gates Foundation

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015 : a systematic analysis for the Global Burden of Disease Study 2015

Background Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures. Methods We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography-year datapoints. For GBD 2015, eight causes, including Ebola virus disease, were added to the previous GBD cause list for mortality. We used six modelling approaches to assess cause-specific mortality, with the Cause of Death Ensemble Model (CODEm) generating estimates for most causes. We used a series of novel analyses to systematically quantify the drivers of trends in mortality across geographies. First, we assessed observed and expected levels and trends of cause-specific mortality as they relate to the Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Second, we examined factors affecting total mortality patterns through a series of counterfactual scenarios, testing the magnitude by which population growth, population age structures, and epidemiological changes contributed to shifts in mortality. Finally, we attributed changes in life expectancy to changes in cause of death. We documented each step of the GBD 2015 estimation processes, as well as data sources, in accordance with Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Findings Globally, life expectancy from birth increased from 61.7 years (95% uncertainty interval 61.4-61.9) in 1980 to 71.8 years (71.5-72.2) in 2015. Several countries in sub-Saharan Africa had very large gains in life expectancy from 2005 to 2015, rebounding from an era of exceedingly high loss of life due to HIV/AIDS. At the same time, many geographies saw life expectancy stagnate or decline, particularly for men and in countries with rising mortality from war or interpersonal violence. From 2005 to 2015, male life expectancy in Syria dropped by 11.3 years (3.7-17.4), to 62.6 years (56.5-70.2). Total deaths increased by 4.1% (2.6-5.6) from 2005 to 2015, rising to 55.8 million (54.9 million to 56.6 million) in 2015, but age-standardised death rates fell by 17.0% (15.8-18.1) during this time, underscoring changes in population growth and shifts in global age structures. The result was similar for non-communicable diseases (NCDs), with total deaths from these causes increasing by 14.1% (12.6-16.0) to 39.8 million (39.2 million to 40.5 million) in 2015, whereas age-standardised rates decreased by 13.1% (11.9-14.3). Globally, this mortality pattern emerged for several NCDs, including several types of cancer, ischaemic heart disease, cirrhosis, and Alzheimer's disease and other dementias. By contrast, both total deaths and age-standardised death rates due to communicable, maternal, neonatal, and nutritional conditions significantly declined from 2005 to 2015, gains largely attributable to decreases in mortality rates due to HIV/AIDS (42.1%, 39.1-44.6), malaria (43.1%, 34.7-51.8), neonatal preterm birth complications (29.8%, 24.8-34.9), and maternal disorders (29.1%, 19.3-37.1). Progress was slower for several causes, such as lower respiratory infections and nutritional deficiencies, whereas deaths increased for others, including dengue and drug use disorders. Age-standardised death rates due to injuries significantly declined from 2005 to 2015, yet interpersonal violence and war claimed increasingly more lives in some regions, particularly in the Middle East. In 2015, rotaviral enteritis (rotavirus) was the leading cause of under-5 deaths due to diarrhoea (146 000 deaths, 118 000-183 000) and pneumococcal pneumonia was the leading cause of under-5 deaths due to lower respiratory infections (393 000 deaths, 228 000-532 000), although pathogen-specific mortality varied by region. Globally, the effects of population growth, ageing, and changes in age-standardised death rates substantially differed by cause. Our analyses on the expected associations between cause-specific mortality and SDI show the regular shifts in cause of death composition and population age structure with rising SDI. Country patterns of premature mortality (measured as years of life lost [YLLs]) and how they differ from the level expected on the basis of SDI alone revealed distinct but highly heterogeneous patterns by region and country or territory. Ischaemic heart disease, stroke, and diabetes were among the leading causes of YLLs in most regions, but in many cases, intraregional results sharply diverged for ratios of observed and expected YLLs based on SDI. Communicable, maternal, neonatal, and nutritional diseases caused the most YLLs throughout sub-Saharan Africa, with observed YLLs far exceeding expected YLLs for countries in which malaria or HIV/AIDS remained the leading causes of early death. Interpretation At the global scale, age-specific mortality has steadily improved over the past 35 years; this pattern of general progress continued in the past decade. Progress has been faster in most countries than expected on the basis of development measured by the SDI. Against this background of progress, some countries have seen falls in life expectancy, and age-standardised death rates for some causes are increasing. Despite progress in reducing age-standardised death rates, population growth and ageing mean that the number of deaths from most non-communicable causes are increasing in most countries, putting increased demands on health systems. Copyright (C) The Author(s). Published by Elsevier Ltd.Peer reviewe

Ensihoidon immobilisaatiovälineiden vaikutukset vammapotilaille

Suomessa selkäydinvamman saa vuosittain noin 100 potilasta. Selkäydinvamma vaikuttaa merkittävällä tavalla potilaan elämänlaatuun, joten näiden vammojen pahenemisen ehkäisy on yksi ensi- ja päivystyshoidon tehtävistä. Selkärangan immobilisaatio erilaisten välineiden avulla on yleinen käytäntö selkärangan ja –ytimen lisävaurioiden ehkäisemiseksi. Tämä opinnäytetyö on osa Helsingin ja Uudenmaan sairaanhoitopiirin Siltasairaala- hanketta, jonka osana kehitetään selkäpotilaiden hoitopolkuja. Työn tarkoituksena on kartoittaa olemassa olevan kirjallisuuden perusteella ensihoidon immobilisaatiovälineiden vaikutuksia vammapotilaille. Tässä opinnäytetyössä toteutimme kuvailevan kirjallisuuskatsauksen, jonka aineisto haettiin Medic-, Cinahl- ja PubMed- tietokannoista viimeisen kymmenen vuoden ajalta. Lopullisen aineiston laajuus oli 16 kansainvälisissä tieteellisissä julkaisuissa julkaistua alkuperäistutkimusta. Aineiston analyysi toteutettiin induktiivisen sisällön analyysin menetelmällä. Tulostemme mukaan immobilisaatiovälineiden hyöty on tilannekohtaista. Vaikka välineiden on osoitettu toimivan tarkoituksenmukaisesti, on niillä myös epätoivottuja vaikutuksia. Lisäksi välineiden käytön seurauksena potilaiden hoitoisuus kasvaa, sillä ne vaikeuttavat hoitotoimenpiteitä ja aiheuttavat muutoksia potilaiden tilaan. Tuloksemme osoittavat välineiden aiheuttavan potilaille muun muassa painehaavoja, kipua ja epämukavuutta. Työmme aikana kävi ilmi, että näihin välineisiin liittyvä tutkimusnäyttö on osin ristiriitaista ja tulosten laajennettavuus usein heikkoa erilaisten tutkimusmenetelmiin liittyvien haasteiden vuoksi. Vammapotilaiden tutkiminen satunnaistetulla ja kontrolloiduilla koeasetelmilla on haasteellista, joten tutkimusta tehdään muun muassa terveillä vapaaehtoisilla ja vainajilla. Eri traumarekistereistä kerättyjä aineistoja on myös käytetty tutkimuksissa. Tulostemme perusteella jatkotutkimusta immobilisaatiovälineiden kyvystä tukea selkärankaa tarvitaan lisää ja haittojen kuten painehaavojen ehkäisyä tulee kehittää. Lisäksi välineiden oikea-aikaiseen käyttöön ja käytöstä luopumiseen tulee kiinnittää huomiota sekä ensi- että päivystyshoidon aikana. Uskomme että tuloksemme ovat siirrettävissä suomalaiseen terveydenhuoltoon ja käyttökelpoisia hoitotyön kehittämisessä kaikkialla Suomessa.In Finland, approximately 100 patients per year suffer a spinal cord injury. Spinal cord injuries impact severely on patient’s quality of life, therefore treatment and prevention of their further deterioration is important aspect of emergency care. Immobilizing the spine with various devices is a common procedure to prevent further damage to the spine and the spinal cord. This study was part of Helsinki and Uusimaa hospital district’s Siltasairaala- project, part of which involves reviewing clinical pathways for patients with spinal injuries. Purpose of this study was to review the effects of immobilization devices used in prehospital care of trauma patients based on existing scientific literature. In this study we conducted a descriptive literature review. Data was collected from following databases: Medic, Cinahl and PubMed. Studies published during the last ten years were included. 16 studies were analysed using the method of inductive content analysis. Our results showed that condition of patient determines does the patient benefit of immobilization. Although these devices function as they are supposed to, they do not function as well as expected. In addition these devices may hamper medical procedures and cause changes in the condition of the patient. Our results also showed that among other problems these devices may cause pressure ulceration, pain and discomfort to the patient. It appeared to us that research concerning immobilization devices is partially contradictory. The methodologies used often asserted limitations to extrapolation of the results to trauma patients. Randomized and controlled studies are challenging to conduct on trauma patients and in emergency care setting. Therefore studies are being made using other methods, such as healthy volunteers and cadavers. Information collected from various trauma registries have also been used in studies. Our results indicate that more research is needed regarding immobilization devices and their ability to protect the spinal cord. Further development of methods to avoid complications, such as pressure ulcers is also needed. Practice on weather of not to immobilize patients and when to remove these devices should be paid attention to during prehospital and emergency medical care. We believe that our results can be used to further develop practices of care in Finland

Nuoret elinympäristönsä suunnittelijoina

Tämä opinnäytetyö on toimeksianto Lappeenrannan kaupungin teknisen toimen palvelutuotannolta. Opinnäytetyön tavoitteena oli tutkia nuoren ympäristösuhdetta ja esittää keinoja, joiden avulla nuori voisi osallistua oman elinympäristönsä kehittämiseen. Tutkimuksen tavoitteena on ollut selvittää, kuinka nuori kokee oman lähiympäristönsä. Tutkimus kertoo myös millaisia vaikutuksia nuoren kehitykseen ja käyttäytymiseen on heidän osallistumisellaan oman elinympäristönsä suunnitteluun. Lisäksi työssä esiteltiin nuorten ympäristötietoisuutta tukeva koulupiha. Opinnäytetyössä etsittiin syitä nuorten passiiviseen suhtautumiseen lähiympäristöään kohtaan ja tarkasteltiin keinoja, joiden avulla heidän mielenkiintonsa paikallisiin ympäristöasioihin saataisiin herätettyä. Tarkastelun kohteina olivat muun muassa ympäristökasvatus ja vuorovaikutteinen suunnittelu. Työssä esiteltiin nuorille suunnattuja osallistumiskanavia, joita ovat koulun oppilashallitus, yhdistykset ja nuorisovaltuusto. Opinnäytetyön suunnitelmaan liittyvässä osuudessa on perehdytty Sammonlahden ydinalueen historiaan, Sulo Savolaisen luomaan arkkitehtuuriin, katuverkostoon ja viheralueisiin. Työssä esiteltiin myös Lappeenrannan teknisen toimen laatimia Sammonlahden ydinalueen liikenne- ja ympäristösuunnitelmaluonnoksia. Opinnäytetyössä esitetään tarkka selvitys suunnittelualueena olevan Sammonlahden koulun nykytilasta. Selvityksessä käydään läpi muun muassa alueen kasvillisuus, toiminnot, tilat sekä kehitystä vaativat ongelma-alueet. Sammonlahden koulun yleissuunnitelmaa laadittaessa on koulun käyttäjille annettu mahdollisuus osallistua työn ideointiin. Yleissuunnitelman pohjana on käytetty oppilaille ja opettajille laaditun kirjallisen kyselyn vastauksia ja argumentteja, ja oppilaat ovat suunnitelleet pihalle sijoitettavan ympäristötaideteoksen. Suunnitelman tavoitteena on luoda kouluympäristö, jonka toteuttamiseen myös opettajat ja oppilaat voivat osallistua. Pihan tulee tarjota elämyksiä ja kokemuksia koulun käyttäjien lisäksi myös lähialueen asukkaille.The commissioner of this thesis was the city of Lappeenranta. This thesis examined the interaction between the young and the environment, and how a good environment affects young people. The thesis deals with methods that help the young to approach nature in polite and respectful ways. The interaction between the young and the environment was examined by orientating to the ways the young experience their environment. This thesis examined what kind of effects participating in environmental planning has on the development and behaviour of the young. Some ways of how to make the young more interested in nature and the environment are also presented in this study. In the inventory the focus was on the history and the present state of the school of Sammonlahti in Lappeenranta. A detailed investigation of the schoolyard and its elements was also carried out. For example, the school building has unique architecture and it affected a lot to the character on the principal plan of the schoolyard that was made. The plan for the Sammonlahti school in Lappeenranta serves as an example of a cosy and practical schoolyard. The plan was drawn according to the wishes of the students and the teachers as a basis. The basic idea of the plan was to have more green areas, activities and outside lounges in the yard. The conclusion can be drawn that this schoolyard should serve the pupils of the school and also meet the needs of the local inhabitants