Kulkutautisairaalan pystyttäminen 2020

HUS:n koronapotilaat päätettiin keskittää Kirurgisen sairaalan tiloihin. Kiinteistö soveltui erinomaisesti erilliseksi infektiopotilaiden hoitoyksiköksi – jollaiseksi se pitkälti oli suunniteltukin sairaalan aloittamisvuonna 1882. Näin toiminta rakennettiin

Mean arterial pressure and vasopressor load after out-of-hospital cardiac arrest : Associations with one-year neurologic outcome

The aim of the study: There are limited data on blood pressure targets and vasopressor use following cardiac arrest. We hypothesized that hypotension and high vasopressor load are associated with poor neurological outcome following out-of-hospital cardiac arrest (OHCA). Methods: We included 412 patients with OHCA included in FINNRESUSCI study conducted between 2010 and 2011. Hemodynamic data and vasopressor doses were collected electronically in one, two or five minute intervals. We evaluated thresholds for time-weighted (TW) mean arterial pressure (MAP) and outcome by receiver operating characteristic (ROC) curve analysis, and used multivariable analysis adjusting for co-morbidities, factors at resuscitation, an illness severity score, TW MAP and total vasopressor load (VL) to test associations with one-year neurologic outcome, dichotomized into either good (1-2) or poor (3-5) according to the cerebral performance category scale. Results: Of 412 patients, 169 patients had good and 243 patients had poor one-year outcomes. The lowest MAP during the first six hours was 58 (inter-quartile range [IQR] 56-61) mmHg in those with a poor outcome and 61 (59-63) mmHg in those with a good outcome (p <0.01), and lowest MAP was independently associated with poor outcome (OR 1.02 per mmHg, 95% CI 1.00-1.04, p = 0.03). During the first 48h the median (IQR) of the 1W mean MAP was 80 (78-82) mmHg in patients with poor, and 82 (81-83) mmHg in those with good outcomes (p=0.03) but in multivariable analysis TWA MAP was not associated with outcome. Vasopressor load did not predict one-year neurologic outcome. Conclusions: Hypotension occurring during the first six hours after cardiac arrest is an independent predictor of poor one-year neurologic outcome. High vasopressor load was not associated with poor outcome and further randomized trials are needed to define optimal MAP targets in OHCA patients. (C) 2016 Elsevier Ireland Ltd. All rights reserved.Peer reviewe

APCAP - activated protein C in acute pancreatitis: a double-blind randomized human pilot trial

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Työhyvinvointi etätyössä

Tämä opinnäytetyö on tutkimustyyppinen työ, jonka tavoitteena oli saada kokemukseen perustuvaa tietoa yrityksen X työntekijöiden etätyöhyvinvoinnista. Opinnäytetyön toimeksiantaja on yritys X. Työntekijät ovat asiantuntijoita ja tekevät työtään asiakkailleen konsultinomaisesti. Opinnäytetyön lähtökohtana oli koronaviruspandemian leviämistä hillitsevänä keinona asetettu etätyösuositus, jota yrityksessä X noudatettiin maaliskuusta 2020 alkaen. Lisäksi kevät ja kesä 2020 olivat yrityksessä X kiireisempiä kuin koskaan aikaisemmin ja yrityksen hallitus alkoi olla huolissaan työntekijöidensä jaksamisesta. Niinpä yritys toivoikin kokemukseen perustuvaa tietoa työntekijöidensä etätyöhyvinvoinnista. Aineistonhankintamenetelmänä tässä työssä käytettiin puolistrukturoitua kyselytutkimusta. Kysely lähetettiin yrityksen X kaikille työntekijöille syksyllä 2020. Kyselyssä pyrittiin selvittämään työntekijöiden työhyvinvoinnin kokemusta etätyöaikana. Tämä toteutettiin itseohjautuvan organisaation näkökulmasta. Opinnäytetyön kyselyn tulokset kertoivat, miten työntekijät ovat etätyön arjen kokeneet. Kyselyn avulla pyrittiin myös selvittämään hieman työntekijöiden itsensä johtamisen taitojen tasoa. Itsensä johtamisen taidot ovat keskeisessä osassa vaativassa asiantuntijatyössä ja itseohjautuvassa organisaatiossa

Stratification of aggressive prostate cancer from indolent disease - Prospective controlled trial utilizing expression of 11 genes in apparently benign tissue

Background: The aim of the study was to evaluate the diagnostic power of molecular markers in men with a clinical suspicion of prostate cancer (PCa) using apparently benign areas as targeted by magnetic resonance imaging (MRI). Methods: In the study, 99 consecutive men with clinical suspicion of PCa in a prospective controlled trial (IMPROD, NCT01864135) were included. In addition to 12-core systematic and MRI-targeted biopsies, cores from normal-appearing prostate areas, based on clinical examination, ultrasound, and biparametric prostate MRI, were obtained. The RNA transcript levels of ACSM1, AMACR, CACNA1D, DLX1, KLK3, PCA3, PLA2G7, RHOU, SPINK1, SPON2, TMPRSS2-ERG, and TDRD1 were measured with quantitative reverse-transcription polymerase chain reaction. Results: Of the 99 men, 69 were diagnosed with PCa, 31 with primary Gleason pattern 3 and 38 with primary Gleason 4 or 5. TDRD1 messenger RNA (mRNA) levels were 1.3 times higher (P = 0.029) and the presence of TMPRSS2-ERG mRNAs more frequent in biopsies from men diagnosed with PCa (27/69, 39%) than in men without (5/30, 16%) (P = 0.035). The 2 markers identified aggressive PCa defined as Gleason sum≥7 at biopsy: median TDRD1 mRNA level was 1.4 higher (P = 0.005) and TMPRSS2-ERG expression more frequent (P<0.001) in high-grade cancer. A multivariate analysis of mRNA expression of 11 candidate genes combined with KLK3, serum prostate-specific antigen (PSA), percentage-free PSA, and prostate volume improved the discrimination between aggressive and nonaggressive PCa (area under the curve = 0.77) compared with the use of the candidate genes or clinical parameters alone. However, serum PSA, percentage-free PSA, and prostate volume resulted in the best discrimination between non-organ-confined PCa (T3) from organ-confined PCa (T2) and healthy prostate (area under the curve = 0.86). Conclusions: Of the 11 studied genes, TDRD1 and TMPRSS2-ERG were able to statistically significantly differentiate men with PCa from men without it as single markers. However, a multivariate analysis using 15 features outperformed each individual marker in identifying aggressive PCa. © 2016 Elsevier Inc