Kotihoidon työntekijöiden näkemyksiä mielenterveys- ja päihdeasiakkaiden kohtaamisesta

Opinnäytetyömme tarkoituksena oli selvittää Itä-Savon sairaanhoitopiirin kuntayhtymän (SOSTERI) kotihoidon työntekijöiden näkemyksiä mielenterveys- ja päihdeasiakkaiden kohtaamisesta. Tavoitteena oli selvittää, onko mielenterveys- ja päihdehoitotyön koulutus riittävää mielenterveys- ja päihdeasiakkaiden kohtaamiseksi. Tavoitteenamme oli tuottaa työnantajalle ja esimiehelle tietoa mielenterveys- ja päihdeasiakkaita koskevan koulutuksen ja työnohjauksen tarpeesta. Tutkimusmenetelminä käytimme sekä kvantitatiivista että kvalitatiivista lähestymistapaa. Aineiston keräsimme Webropol-ohjelman avulla tehdyllä kyselyllä heinäkuussa 2013. Kyselylomakkeemme sisälsi 26 strukturoitua kysymystä ja 2 avointa kysymystä. Kyselyyn vastasi 99 työntekijää, jolloin vastausprosentiksi muodostui 55. Aineiston analysoimme hyödyntäen Webropol-ohjelmaa sekä sisällönanalyysia. Tulosten mukaan lisä- ja täydennyskoulutuksen tarve mielenterveysasiakkaan, päihdeasiakkaan ja kaksoisdiagnoosiasiakkaan kohtaamiseen on ilmeinen. Eniten koettiin tarvetta mielenterveyshoitotyön lisä- ja/tai täydennyskoulutukselle. Kaksoisdiagnoosiasiakkaan kohtaaminen koettiin kolmesta asiakasryhmästä kaikkein haasteellisimmaksi. Kaksoisdiagnoosiasiakasta koskeviin kysymyksiin vastattiin myös kaiken kaikkiaan hyvin vaihtelevasti ja epävarmasti. Päihdeasiakkaiden kohdalla taas vastaajien henkilökohtaiset ominaisuudet koettiin kaikkein heikoimmiksi. Työn tueksi kaivataan selkeää toimintamallia, joka auttaisi työntekijöitä mielenterveys- ja päihdeasiakkaiden kohtaamisessa. Tulokset voimme yleistää koskettavaksi Itä-Savon sairaanhoitopiirin kuntayhtymän (SOSTERI) kotihoitoa.The goal of our Bachelor's thesis was to find out the understanding and views among the home health care employees in Eastern health care district in Savonlinna. Our goal was to examine how conclusive is the education of mental health care and the education of substance abuse nursing is when confronting patients having these issues. And the final goal of our Bachelor's thesis was to provide information for the employer and managers about education of mental health care and substance abuse nursing and information about the need for supervision of work. As our research method we used quantitative and qualitative approach. We gathered the material by a questionnaire made with Webropol program in July 2013. The questionnaire included 26 structured ques-tions and 2 open questions. The questionnaire was returned by 99 employees which formed the answer rate of 55 %. In analyzing the results we used the Webropol program and content analyzing method. The conclusion of the Bachelors's thesis was that there is a distinct need for in-service training in con-fronting the patients with mental health problems or patients abusing substances and confronting the patients with double diagnosed mental status. The need of in-service training was obvious. Confronting the patients with double diagnosis patients was shown to be challenging. On the whole the questions concerning double diagnosed patients were also given very uncertain and versatile answers. The answerers thought that their personal abilities concerning substance abuse patients were insufficient. There is a need for a clear operation model which would help the employees to confront the patients with mental health problems or with substance abuse. The results can be generalized concerning the home healtch care in Eastern health care district

Long-term cognitive functioning is impaired in ICU-treated COVID-19 patients : a comprehensive controlled neuropsychological study

Publisher Copyright: © 2022, The Author(s).Background: Cognitive impairment has emerged as a common post-acute sequela of coronavirus disease 2019 (COVID-19). We hypothesised that cognitive impairment exists in patients after COVID-19 and that it is most severe in patients admitted to the intensive care unit (ICU). Methods: This prospective controlled cohort study of 213 participants performed at the Helsinki University Hospital and the University of Helsinki, Finland, comprised three groups of patients—ICU-treated (n = 72), ward-treated (n = 49), and home-isolated (n = 44)—with confirmed COVID-19 between March 13 and December 31, 2020, participating in a comprehensive neuropsychological evaluation six months after the acute phase. Our study included a control group with no history of COVID-19 (n = 48). Medical and demographic data were collected from electronic patient records and interviews carried out four months after the acute phase. Questionnaires filled six months after the acute phase provided information about change in cognitive functioning observed by a close informant, as well as the presence of self-reported depressive and post-traumatic symptoms. Results: The groups differed (effect size η2p = 0.065, p = 0.004) in the total cognitive score, calculated from neuropsychological measures in three domains (attention, executive functions, and memory). Both ICU-treated (p = 0.011) and ward-treated patients (p = 0.005) performed worse than home-isolated patients. Among those with more than 12 years of education, ICU-treated patients performed worse in the attention domain than ward-treated patients (p = 0.021) or non-COVID controls (p = 0.045); ICU-treated male patients, in particular, were impaired in executive functions (p = 0.037). Conclusions: ICU-treated COVID-19 patients, compared to patients with less severe acute COVID-19 or non-COVID controls, showed more severe long-term cognitive impairment. Among those with more than 12 years of education, impairment existed particularly in the domains of attention and for men, of executive functions. Trial registration number: ClinicalTrials.gov NCT04864938, retrospectively registered February 9, 2021.Peer reviewe

Elevated CRP levels indicate poor progression-free and overall survival on cancer patients treated with PD-1 inhibitors

Background Anti-PD-(L)1 agents are standard of care treatments in various cancers but predictive factors for therapy selection are limited. We hypothesised that markers of systemic inflammation would predict adverse outcomes in multiple cancers treated with anti-PD-(L)1 agents. Material and methods Discovery cohort consisted of patients who were treated with anti-programmed cell death protein-1 (PD-1) agents for advanced melanoma (MEL), non-small cell lung cancer (NSCLC) or renal and bladder cancers (GU) at Oulu University Hospital and had pretreatment C reactive protein (CRP), or neutrophil/lymphocyte values available. As a validation cohort, we collected patients treated with anti-PD-1 agents from three other hospitals in Finland. Results In the discovery cohort (n=56, MEL n=23, GU n=17, NSCLC n=16), elevated CRP over the upper limit of normal (ULN) (>10mg/mL) indicated poor progression-free (PFS; p=0.005) and overall survival (OS; p=0.000004) in the whole population and in MEL subgroup. Elevated neutrophil-to-lymphocyte ratio (>2.65) also indicated inferior PFS (p=0.02) and OS (p=0.009). In the validation cohort (n=107,MEL n=44, NSCLC n=42, GU n=17, other n=4), CRP over ULN also was a strong indicator for poor PFS (p=0.0000008), and OS (p=0.000006) in the whole population, and in MEL and NSCLC also. Conclusions Systemic inflammation suggested by elevated CRP is a very strong indicator for adverse prognosis on patients treated with anti-PD-(L)1 agents and has a potential negative predictive value for treatment with anti-PD-(L)1 agents. Prospective trials should investigate whether patients with elevated CRP gain any significant benefit from anti-PD-1 therapy.Peer reviewe

Associations of subjective and objective cognitive functioning after COVID-19 : A six-month follow-up of ICU, ward, and home-isolated patients

Publisher Copyright: © 2023 The AuthorsBackground: Subjective and objective cognitive dysfunction are reported after COVID-19 but with limited data on their congruence and associations with the severity of the acute disease. The aim of this cohort study is to describe the prevalence of subjective and objective cognitive dysfunction at three and six months after COVID-19 and the associations of subjective cognitive symptoms and psychological and disease-related factors. Methods: We assessed a cohort of 184 patients at three and six months after COVID-19: 82 patients admitted to the Intensive Care Unit (ICU), 53 admitted to regular hospital wards, and 49 isolated at home. A non-COVID control group of 53 individuals was included. Demographic and clinical data were collected. Subjective cognitive symptoms, objective cognitive impairment, and depressive and post-traumatic stress disorder (PTSD) symptoms were assessed. Results: At six months, subjective cognitive impairment was reported by 32.3% of ICU-treated, 37.3% of ward-treated, and 33.3% of home-isolated patients and objective cognitive impairment was observed in 36.1% of ICU-treated, 34.7% of ward-treated, and 8.9% of home-isolated patients. Subjective cognitive symptoms were associated with depressive and PTSD symptoms and female sex, but not with objective cognitive assessment or hospital metrics. Conclusions: One-third of COVID-19 patients, regardless of the acute disease severity, reported high levels of subjective cognitive dysfunction which was not associated with results from objective cognitive screening but with psychological and demographic factors. Our study stresses the importance of thorough assessment of patients reporting long-term subjective symptoms, screening for underlying mental health related factors such as PTSD or depression.Peer reviewe

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

Psyykkinen oireilu puoli vuotta COVID-19-taudin jälkeen suomalaisessa Recovid-20-aineistossa

TAUSTA : COVID-19-tautiin liittyy mielenterveyden ongelmia, erityisesti ahdistuneisuutta ja masennusta, joita voi ilmetä vielä akuuttivaiheen väistyttyä. Selvitimme suomalaisten COVID-19-potilaiden psyykkistä vointia kuuden kuukauden kuluttua sairauden akuuttivaiheesta. AINEISTO JA MENETELMÄT : Tutkimuksen kliininen aineisto koostui teho- ja muussa osastohoidossa hoidetuista ja kotona sairastaneista COVID-19-potilaista sekä verrokeista, jotka täyttivät kyselyitä kolmen ja kuuden kuukauden kuluttua sairauden akuuttivaiheesta. TULOKSET : Potilailla havaittiin puolen vuoden seurannassa verrokkeja enemmän ahdistuneisuutta, masennusta, traumaperäistä stressioireilua ja väsymystä. Oireet olivat pääosin lieviä, ja niitä selitti kolmen kuukauden kuluttua akuuttivaiheesta koettu psyykkinen oireilu. Akuuttivaiheessa koettu suurempi psyykkisen tuen tarve oli yhteydessä ahdistuneisuuteen ja traumaperäiseen stressioireiluun puolen vuoden seurannassa. PÄÄTELMÄT : Psyykkinen oireilu tulee ottaa huomioon COVID-19-potilaiden hoidossa. Akuuttivaiheen psyykkisen tuen riittämättömyys voi olla yhteydessä myöhempään ahdistuneisuusoireiluun ja traumaperäisen stressioireilun kokemiseen.Peer reviewe

The prognostic and predictive roles of plasma C-reactive protein and PD-L1 in non-small cell lung cancer

Background: Anti-PD-(L)1 agents have revolutionized the treatment paradigms of non-small cell lung cancer (NSCLC), while predictive biomarkers are limited. It has been previously shown that systemic inflammation, indicated by elevated C-reactive protein (CRP) level, is associated with a poor prognosis in anti-PD-(L)1 treated. The aim of the study was to analyze the prognostic and predictive value of CRP in addition to traditional prognostic and predictive markers and tumor PD-L1 score. Methods: We identified all NSCLC patients (n = 329) who had undergone PD-L1 tumor proportion score (TPS) analysis at Oulu University Hospital 2015–22. CRP levels, treatment history, immune checkpoint inhibitor (ICI) therapy details, and survival were collected. The patients were categorized based on CRP levels (≤10 vs. >10) and PD-L1 TPS scores (10) carried a high negative predictive value with a median PFS of 4.11 months (CI 95% 0.00–9.63), which was similar to patients with low PD-L1 (4.11 months, CI 95% 2.61–5.60). Conclusions: Adding plasma CRP levels to PD-L1 TPS significantly increased the predictive value of sole PD-L1. Furthermore, patients with high CRP beard little benefit from anti-PD-(L)1 therapies independent of PD-L1 score. The study highlights the combined evaluation of plasma CRP and PD-L1 TPS as a negative predictive marker for ICI therapies.Peer reviewe

Direct Estimation of HDL-Mediated Cholesterol Efflux Capacity from Serum

BACKGROUND: HDL-mediated cholesterol efflux capacity (HDL-CEC) is a functional attribute that may have a protective role in atherogenesis. However, the estimation of HDL-CEC is based on in vitro cell assays that are laborious and hamper large-scale phenotyping. METHODS: Here, we present a cost-effective high-throughput nuclear magnetic resonance (NMR) spectroscopy method to estimate HDL-CEC directly from serum. We applied the new method in a population-based study of 7603 individuals including 574 who developed incident coronary heart disease (CHD) during 15 years of follow-up, making this the largest quantitative study for HDL-CEC. RESULTS: As estimated by NMR-spectroscopy, a 1-SD higher HDL-CEC was associated with a lower risk of incident CHD (hazards ratio, 0.86; 95% CI, 0.79-0.93, adjusted for traditional risk factors and HDL-C). These findings are consistent with published associations based on in vitro cell assays. CONCLUSIONS: These corroborative large-scale findings provide further support for a potential protective role of HDL-CEC in CHD and substantiate this new method and its future applications. (C) 2019 American Association for Clinical ChemistryPeer reviewe

Ihomelanooman onkologinen hoito päivittyi

Suomen Melanoomaryhmä ry päivitti suosituksensa ihomelanooman onkologisesta hoidosta. Vuoden kestävää liitännäislääkehoitoa PD-1-vasta-aineella eli immuuniaktivaation vapauttajalla (nivolumabi tai pembrolitsumabi) tai dabrafenibilla ja trametinibilla harkitaan leikatuille, levinneisyysasteen IIIB-IV melanoomapotilaille melanooman uusiutumisriskin pienentämiseksi. Päätös liitännäishoidosta tehdään yhdessä potilaan kanssa hyödyt ja haitat huomioiden. Levinneen melanooman ensilinjan hoitovaihtoehtona ovat PD-1-vasta-aineet, joiden lisäksi BRAFV600-mutaatiopositiivisille potilaille soveltuvat hoidot BRAF:n ja MEK:n estäjillä. Immunologista yhdistelmähoitoa CTLA-4- ja PD-1-vasta-aineilla (ipilimumabi ja nivolumabi) harkitaan huonoennusteisille hyväkuntoisille potilaille. Muita edenneen melanooman lääkehoitovaihtoehtoja ovat onkolyyttinen virushoito (TVEC) pinnallisen metastasoinnin ja isoloitu raajaperfuusio- eli ILP-hoito raajaan rajoittuvan metastasoinnin yhteydessä sekä solunsalpaajahoidot. Nopeasti kehittyvän hoidon vuoksi melanoomapotilaat pyritään rekrytoimaan kliinisiin hoitotutkimuksiin aina kun se on mahdollista

Elevated plasma heparin-binding protein is associated with early death after resuscitation from cardiac arrest

Background: An intense systemic inflammatory response is observed following reperfusion after cardiac arrest. Heparin-binding protein (HBP) is a granule protein released by neutrophils that intervenes in endothelial permeability regulation. In the present study, we investigated plasma levels of HBP in a large population of patients resuscitated from out-of-hospital cardiac arrest. We hypothesized that high circulating levels of HBP are associated with severity of post-cardiac arrest syndrome and poor outcome. Methods: Plasma was obtained from 278 patients enrolled in a prospective multicenter observational study in 21 intensive care units (ICU) in Finland. HBP was assayed at ICU admission and 48 h later. Multiple organ dysfunction syndrome (MODS) was defined as the 24 h Sequential Organ Failure Assessment (SOFA) score >= 12. ICU death and 12-month Cerebral Performance Category (CPC) were evaluated. Multiple linear and logistic regression tests and receiver operating characteristic curves with area under the curve (AUC) were performed. Results: Eighty-two percent of patients (229 of 278) survived to ICU discharge and 48 % (133 of 276) to 1 year with a favorable neurological outcome (CPC 1 or 2). At ICU admission, median plasma levels of HBP were markedly elevated, 15.4 [9.6-31.3] ng/mL, and persisted high 48 h later, 14.8 [9.8-31.1] ng/mL. Admission levels of HBP were higher in patients who had higher 24 h SOFA and cardiovascular SOFA score (p <0.0001) and in those who developed MODS compared to those who did not (29.3 [13.7-60.1] ng/mL vs. 13.6 [9.1-26.2] ng/mL, p <0.0001; AUC = 0.70 +/- 0.04, p = 0.0001). Admission levels of HBP were also higher in patients who died in ICU (31.0 [17.7-78.2] ng/mL) compared to those who survived (13.5 [9.1-25.5] ng/mL, p <0.0001) and in those with an unfavorable 12-month neurological outcome compared to those with a favorable one (18.9 [11.3-44.3] ng/mL vs. 12.8 [8.6-30.4] ng/mL, p <0.0001). Admission levels of HBP predicted early ICU death with an AUC of 0.74 +/- 0. 04 (p <0.0001) and were independently associated with ICU death (OR [95 %CI] 1.607 [1.076-2.399], p = 0.020), but not with unfavorable 12-month neurological outcome (OR [95 %CI] 1.154 [0.834-1.596], p = 0.387). Conclusions: Elevated plasma levels of HBP at ICU admission were independently associated with early death in ICU.Peer reviewe