Mielenterveyspotilaan osallisuuden ilmeneminen ja kokemukset - kirjallisuuskatsaus

Opinnäytetyön tarkoituksena oli selvittää osallisuuden ilmenemistä mielenterveyshoitotyössä ja potilaiden osallisuuden kokemuksia. Opinnäytetyön tavoitteena oli tuoda lisää tietoa osallisuuden merkityksestä potilaan hoidossa. Osallisuus näkyy konkreettisesti hoitotyössä potilaiden hoitotoiveiden kartoittamisena ja huomioimisena hoidon suunnitteluvaiheessa ja koko hoitoprosessin aikana. Potilaan huomioiminen hoidossa vaikuttaa myönteisesti potilaan koherenssin tunteeseen ja hoitoon ylipäänsä sekä voimaannuttaa potilasta. On merkittävää, että ihminen saa olla osallisena ja mukana asioiden käsittelyssä itselle merkittävissä asioissa ja yhteisöissä. Opinnäytetyö on osa Laurea-ammattikorkeakoulun, Helsingin ja Uudenmaan sairaanhoitopiirin (HUS) Psykiatrian toimialan ja Mielen avain –hankkeen hoitotyön kehittämisen yhteistyöhanketta. Viisivuotisen (2011–2015) hankkeen tavoitteena on kehittää mielenterveyshoitotyön laatua näyttöön perustuvan, kehittämishankkeissa tapahtuvan oppimisen avulla yhteistoiminnallisesti edellä mainittujen tahojen kesken. Opinnäytetyö on osa Kellokosken sairaalan tulevaa kehityshanketta. Opinnäytetyön tutkimuskysymykset olivat, miten mielenterveyspotilaan osallisuus ilmenee ja miten mielenterveyspotilaat kokevat osallisuutensa. Kohderyhmänä olivat aikuiset mielenterveyspotilaat. Tutkimus toteutettiin kirjallisuuskatsauksena. Tutkimusaineisto koostui 13 tieteellisestä julkaisusta sisältäen pro gradu -tutkielmia, väitöskirjoja ja tieteellisiä artikkeleita. Aineisto haettiin kahdesta eri tietokannasta, Medic ja Cinahl (Ebsco), ja se analysoitiin käyttäen induktiivista sisällönanalyysia. Tulosten perusteella voidaan todeta, että potilaan osallisuus on monitahoista toimintaa. Potilaan osallisuuden ja itsemääräämisen toteutuminen ovat merkittäviä tekijöitä onnistuneen hoitoprosessin saavuttamisessa. Potilaan osallisuuden kokemukseen vaikuttavat tiedon saanti, potilaan ja työntekijän yhteistyösuhde sekä eri ympäristötekijät. Työtoiminta, jäsentynyt mielekäs arki ja läheiset sosiaaliset suhteet tukevat potilaan hyvinvointia. Potilaat kohtaavat edelleen leimaamista, mikä vaikeuttaa yhteiskuntaan integroitumista ja vähentää osallisuuden kokemusta. Opinnäytetyö herättää ajatuksia hyvistä käytänteistä, joilla voi edistää potilaan osallisuuden kokemusta. Tulokset vastaavat siihen, kuinka Kellokoski voisi omalla toiminnallaan edistää potilaidensa osallisuuden kokemusta. Vaikka kyseessä on Kellokosken hanke, asia on puhututtanut myös muissa vastaavissa hoitoympäristöissä, joten mahdollisesti myös muut yksiköt voisivat hyödyntää tuloksia ja saada pohtimisen aihetta omille käytännöilleen soveltaen tuloksia oman yksikkönsä toimintaan.The manifestation and experiences of the mental patient’s participation – a literature re-view The purpose of the thesis was to find out how the participation appears in mental health care and what kind of experiences the patients have of the participation. The goal of the thesis was to provide more information about the meaning of the participation in patient care. Usually the participation appears in the nursing as mapping and paying attention to the patient’s wishes through the care planning phase and the whole care process. Paying attention to the patient during the care affects the sense of coherence in patients. It has also positive effects on the care in general and it empowers the patient. It is significant that the patient can be involved in the processes of the care that are meaningful for him/her. This thesis is based on the co-operation project between Laurea University of Applied Sciences, the psychiatry division of the Hospital District of Helsinki and Uusimaa (HUS) and the Key to the Mind project. The purpose of the five-year (2011-2015) project is to develop the quality of mental health care through evidence-based learning in developing projects cooperatively with the parties mentioned above. The thesis is part of the forthcoming developing project of Kellokoski Hospital. The target group of the thesis was the adult psychiatric patients. The study was a literature review. The data consisted on thirteen scientific publications including pro gradu theses, doctoral theses and scientific articles. The material was found by using two different databases, Medic and Cinahl (Ebsco), and it was analysed by using inductive content analysis. According to the results it can be stated that the participation of the patient is a multifaceted action. The fulfilment of the patient’s participation and self-determination are significant factors in the successful nursing process. For example the access to the information, the cooperation relationship between the patient and the nurse and different environmental factors affect the experiences of the patient’s participation. Work activities, structured and meaningful everyday activities and close social relationships support the wellbeing of the patient. The patients are still being labelled which complicates their integration to the society and reduces the feeling of being a part of the society. The results indicate that good practices could be used to promote the experience of the patient's participation. The results show also how Kellokoski Hospital could promote the experience participation among its patients through its own activities. Even though the project concerns only Kellokoski Hospital, the matter is discussed in other similar nursing environments. Thus the results of the thesis could benefit also other nursing environments

Utilization of BIM-based cost estimation in construction company

Kohdeyrityksen kustannuslaskentaprosessi pohjautuu pääosin perinteiseen dokumentti-pohjaiseen määrälaskentaan, eikä käytössä oleva prosessi tue juurikaan suunnitteluaikaista kustannuslaskentaa. Diplomityössä tullaan tutkimaan tietomallien tuomia mahdollisuuksia rakennusliikkeen määrä- ja kustannuslaskennalle sekä suunnittelu- ja rakentamisaikaiselle kustannusohjaukselle. Tutkimuksen päätavoite on määrittää tieto-mallipohjainen kustannuslaskentaprosessi, joka tukisi suunnitteluaikaista kustannuslaskentaa sekä hyödyntäisi tietomalliteknologian luomia etuja. Diplomityö rajautuu aikaan, jossa investointipäätös on jo tehty, ulottuen aikaan ennen vastaanottopäätöstä eli tutkimuksen viitekehys kattaa rakennushankkeen vaiheet rakennussuunnittelu ja rakentaminen. Tutkimustyön tilaajana ja kohdeyrityksenä oli NCC Suomen asuntorakentamisen yksikkö. Tutkimustyö tehtiin kvalitatiivisena tutkimuksena ja se jakautui kolmeen vaiheeseen sekä tulosten testaukseen. Diplomityön tutkimustuloksista muodostui uudistettu tietomallipohjainen kustannus-laskentaprosessi, joka on määritelty kohdeyrityksen käyttöön. Tutkimuksessa määritetyllä tietomallipohjaisella prosessilla kustannusarviointia voidaan suorittaa jatkuvana prosessina, suunnitteluaikaisesta kustannusarvioinnista aina lopulliseen kustannusarvion määrittämiseen asti. Määritetty prosessi mahdollistaa kustannusarvioinnin toteuttamisen vajavaisilla suunnitelmilla, eikä sido tietyn ohjelmistotoimittajan tuotteisiin

A Complete Expression Profile of Matrix-Degrading Metalloproteinases in Dupuytren’s Disease

Dupuytren’s disease (DD) is a common fibrotic condition of the palmar fascia, leading to deposition of collagen-rich cords and finger contractions. The metzincin superfamily contains key enzymes in the turnover of collagen and other extracellular matrix macromolecules. A number of broad-spectrum matrix metalloproteinase inhibitors, used in cancer clinical trials, caused side effects of DD-like contractures. We tested the hypothesis that changes in the expression of specific metalloproteinases underlie or contribute to the fibrosis and contracture seen in DD. We collected tissue from patients with DD and used normal palmar fascia as a control. We profiled the expression of the entire matrix metalloproteinase (MMP), tissue inhibitor of metalloproteinases (TIMP), and a disintegrin and metalloproteinase domain with thrombospondin motif (ADAMTS) gene families in these tissues using real-time reverse-transcription polymerase chain reaction. A number of metalloproteinases and inhibitors are regulated in DD. The expression of 3 key collagenases, MMP1, MMP13, and MMP14 is increased significantly in the DD nodule, as is the expression of the collagen biosynthetic enzyme ADAMTS14. The expression of MMP7, an enzyme with broad substrate specificity, is increased in the DD nodule and remains equally expressed in the DD cord. TIMP1 expression is increased significantly in DD nodule compared with normal palmar fascia. This study measured the expression of all MMP, ADAMTS, and TIMP genes in DD. Contraction and fibrosis may result from: (1) increased collagen biosynthesis mediated by increased ADAMTS-14; (2) an increased level of TIMP-1 blocking MMP-1– and MMP-13–mediated collagenolysis; and (3) contraction enabled by MMP-14–mediated pericellular collagenolysis (and potentially MMP-7), which may escape inhibition by TIMP-1. The complete expression profile will provide a knowledge-based approach to novel therapeutics targeting these genes

Budesonide foam versus budesonide enema in active ulcerative proctitis and proctosigmoiditis

Background: Rectal budesonide is an effective treatment of active ulcerative proctitis or proctosigmoiditis. Aim: To compare the therapeutic efficacy, tolerability and safety, and patient's preference of budesonide foam vs. budesonide enema. Methods: Patients with active ulcerative proctitis or proctosigmoiditis (clinical activity index >4 and endoscopic index ≥4) were eligible for this double-blind, double-dummy, randomized, multicentre study. They received 2 mg/25 mL budesonide foam and placebo enema (n = 265), or 2 mg/100 mL budesonide enema and placebo foam (n = 268) for 4 weeks. Primary endpoint was clinical remission (clinical activity index ≤4) at the final/withdrawal visit (per protocol). Results: A total of 541 patients were randomized - 533 were evaluable for intention-to-treat analysis and 449 for per protocol analysis. Clinical remission rates (per protocol) were 60% for budesonide foam and 66% for budesonide enema (P = 0.02362 for non-inferiority of foam vs. enema within a predefined non-inferiority margin of 15%). Both formulations were safe and no drug-related serious adverse events were observed. Because of better tolerability and easier application most patients preferred foam (84%). Conclusion: Budesonide foam is as effective as budesonide enema in the treatment of active ulcerative proctitis or proctosigmoiditis. Both budesonide formulations are safe, and most patients prefer foam.publishersversionPeer reviewe

Laxative effects of partially defatted flaxseed meal on normal and experimental constipated mice

<p>Abstract</p> <p>Background</p> <p>Constipation is a very common health problem in the world. Intake of sufficient amount of dietary fibers is a cornerstone in the prevention and treatment of constipation. As a traditional medicine, flaxseed has been used to treat constipation for centuries, but the controlled trials are rare. The purpose of the present study was to assess that whether partially defatted flaxseed meal (PDFM) has the potential role to facilitate fecal output in normal and experimental constipated mice.</p> <p>Methods</p> <p>After supplemented with 2.5%, 5% and 10% (w/w) PDFM (L-, M- and H -PDFM) for 14 days, the constipation models of mice were induced by atropine-diphenoxylate. The small intestinal transit rates, start time of defecation, amount of defecation and wet weight of feces were researched in normal and constipation model mice.</p> <p>Results</p> <p>M- and H-PDFM significantly increase small intestinal transit rates in constipation model mice. All dose of PDFM markedly shortened the start time of defecation and M- and H-PDFM significantly increase stool frequency and weight in both normal and constipation model mice.</p> <p>Conclusions</p> <p>PDFM may be a useful laxative to facilitate fecal output in normal and constipation conditions.</p

Irritable bowel syndrome symptom severity improves equally with probiotic and placebo

AIM To determine the effects of Lactobacillus acidophilus NCFM on irritable bowel syndrome (IBS) symptoms and quality of life (QoL). METHODS In this randomized triple-blind trial, adult IBS volunteers who were recruited according to Rome. criteria received 109 or 1010 colony-forming units of NCFM or placebo daily for 12 wk. IBS Symptom Severity Score (IBS-SSS), which constituted the primary outcome, and secondary outcomes, including individual IBS symptoms, IBS-related QoL questionnaire, anxiety and depression, defecation frequency, and stool consistency, were assessed at baseline at the end of the 8-wk runin period, after 4 and 12 wk of intervention, and after a 4-wk washout. RESULTS A total of 340 of 391 randomized volunteers completed the trial. IBS-SSS improved over 12 wk of treatment in all treatment groups, decreasing by a mean +/- SD of 44.0 +/- 80.2, 50.8 +/- 82.4, and 48.3 +/- 72.2 in the placebo, active low-dose, and active high-dose groups, respectively. Similarly, secondary outcomes did not differ between treatment groups. However, in a post hoc analysis of volunteers with moderate to severe abdominal pain at baseline (VAS > 35/100), the treatment significantly reduced the sensation of abdominal pain. Pain scores fell by 20.8 +/- 22.8, 29.4 +/- 17.9, and 31.2 +/- 21.9 in the placebo, active low-dose, and active high-dose groups, respectively (P value for placebo vs combined active doses = 0.0460). CONCLUSION NCFM alleviates moderate to severe abdominal pain, consistent with earlier observations of this strain mitigating visceral pain through increased analgesic receptor expression.Peer reviewe

Effects of a safflower tea supplement on antioxidative status and bone markers in postmenopausal women

We conducted this study to examine the effects of safflower seed granular tea containing physiologically active polyphenols on antioxidative activities and bone metabolism. Forty postmenopausal women ages 49 to 64-years were recruited from Daegu and Gyeongbuk and were randomly assigned to either a safflower tea supplement (Saf-tea) group (n = 27) or a placebo group (n = 13). The Saf-tea group received 20 g of safflower seed granule tea per day containing a 13% ethanol extract of defatted safflower seeds, whereas the placebo group received a similar type of tea that lacked the ethanol extract. No significant changes in nutrient intake for either the placebo or Saf-tea groups were observed before or after the study period, except vitamin A intake increased after 6 months in the Saf-tea group. Dietary phytoestrogen intakes were similar in the Saf-tea group (60.3 mg) and placebo group (52.5 mg). Significant increases in plasma genistein and enterolactone were observed in the Saf-tea group. After 6 months of supplementation, serum levels of antioxidant vitamins such as α-tocopherol and ascorbic acid increased significantly, and TBARS levels decreased in the Saf-tea group compared to the placebo group. Serum osteocalcin levels were reduced (P < 0.05) in the Saf-tea group after 6 months, whereas serum osteocalcin did not change in the placebo group. Urinary deoxypyridinoline/creatinine excretion was not different between the two groups at baseline, and did not change in either group after 6 months. Bone mineral density decreased significantly in the placebo group (P < 0.01) but not in the supplemented group. It was concluded that polyphenols (72 mg/day), including serotonin derivatives, in the Saf-tea had both antioxidant and potential bone protecting effects in postmenopausal women without liver toxicity

Cholesterol-Lowering Effects of Probiotics and Prebiotics: A Review of in Vivo and in Vitro Findings

Probiotics are live microorganisms that promote health benefits upon consumption, while prebiotics are nondigestible food ingredients that selectively stimulate the growth of beneficial microorganisms in the gastrointestinal tract. Probiotics and/or prebiotics could be used as alternative supplements to exert health benefits, including cholesterol-lowering effects on humans. Past in vivo studies showed that the administration of probiotics and/or prebiotics are effective in improving lipid profiles, including the reduction of serum/plasma total cholesterol, LDL-cholesterol and triglycerides or increment of HDL-cholesterol. However, other past studies have also shown that probiotics and prebiotics had insignificant effects on lipid profiles, disputing the hypocholesterolemic claim. Additionally, little information is available on the effective dosage of probiotics and prebiotics needed to exert hypocholesterolemic effects. Probiotics and prebiotics have been suggested to reduce cholesterol via various mechanisms. However, more clinical evidence is needed to strengthen these proposals. Safety issues regarding probiotics and/or prebiotics have also been raised despite their long history of safe use. Although probiotic-mediated infections are rare, several cases of systemic infections caused by probiotics have been reported and the issue of antibiotic resistance has sparked much debate. Prebiotics, classified as food ingredients, are generally considered safe, but overconsumption could cause intestinal discomfort. Conscientious prescription of probiotics and/or prebiotics is crucial, especially when administering to specific high risk groups such as infants, the elderly and the immuno-compromised