Common Inflammation-Related Candidate Gene Variants and Acute Kidney Injury in 2647 Critically Ill Finnish Patients

Acute kidney injury (AKI) is a syndrome with high incidence among the critically ill. Because the clinical variables and currently used biomarkers have failed to predict the individual susceptibility to AKI, candidate gene variants for the trait have been studied. Studies about genetic predisposition to AKI have been mainly underpowered and of moderate quality. We report the association study of 27 genetic variants in a cohort of Finnish critically ill patients, focusing on the replication of associations detected with variants in genes related to inflammation, cell survival, or circulation. In this prospective, observational Finnish Acute Kidney Injury (FINNAKI) study, 2647 patients without chronic kidney disease were genotyped. We defined AKI according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria. We compared severe AKI (Stages 2 and 3, n = 625) to controls (Stage 0, n = 1582). For genotyping we used iPLEX(TM) Assay (Agena Bioscience). We performed the association analyses with PLINK software, using an additive genetic model in logistic regression. Despite the numerous, although contradictory, studies about association between polymorphisms rs1800629 in TNFA and rs1800896 in IL10 and AKI, we found no association (odds ratios 1.06 (95% CI 0.89-1.28, p = 0.51) and 0.92 (95% CI 0.80-1.05, p = 0.20), respectively). Adjusting for confounders did not change the results. To conclude, we could not confirm the associations reported in previous studies in a cohort of critically ill patients.Peer reviewe

Heme oxygenase-1 repeat polymorphism in septic acute kidney injury

Acute kidney injury (AKI) is a syndrome that frequently affects the critically ill. Recently, an increased number of dinucleotide repeats in the HMOX1 gene were reported to associate with development of AKI in cardiac surgery. We aimed to test the replicability of this finding in a Finnish cohort of critically ill septic patients. This multicenter study was part of the national FINNAKI study. We genotyped 300 patients with severe AKI (KDIGO 2 or 3) and 353 controls without AKI (KDIGO 0) for the guanine-thymine (GTn) repeat in the promoter region of the HMOX1 gene. The allele calling was based on the number of repeats, the cut off being 27 repeats in the S-L (short to long) classification, and 27 and 34 repeats for the S-M-L2 (short to medium to very long) classification. The plasma concentrations of heme oxygenase-1 (HO-1) enzyme were measured on admission. The allele distribution in our patients was similar to that published previously, with peaks at 23 and 30 repeats. The S-allele increases AKI risk. An adjusted OR was 1.30 for each S-allele in an additive genetic model (95% CI 1.01-1.66; p = 0.041). Alleles with a repeat number greater than 34 were significantly associated with lower HO-1 concentration (p<0.001). In septic patients, we report an association between a short repeat in HMOX1 and AKI risk

Sairaanhoitajien perehdytys teho-osastolla

Tämän opinnäytetyön tarkoituksena on kartoittaa kirjallisuuskatsauksen avulla, mitä teho-osastolla sairaanhoitajien perehdytykseltä edellytetään ja mitä vaikutuksia perehdytyksellä on. Tutkimuksia haettiin kansainvälisistä terveysalan tietokannoista ja haut rajattiin koskemaan vuosia 2003–2014. Lopulliseksi aineistoksi valikoitui 10 tutkimusartikkelia ennalta päätettyjen kriteerien mukaan. Tämän kirjallisuuskatsauksen perusteella sairaanhoitajien perehdytykselle teho-osastolla tulisi varata riittävästi aikaa ja perehdytysohjelman tulisi olla yksilöllinen odotusten ja tarpeiden mukaan. Vuorovaikutussuhteilla on merkittävä rooli ja perehdyttäjän tulisi olla kliinisesti pätevä ja kiinnostunut tehtävästään. Edellytyksenä laadukkaalle perehdytykselle ovat myös esimiehen tuki ja vuorovaikutussuhteet osastolla. Perehdys vaikuttaa potilasturvallisuuteen, vahvistaa sairaanhoitajien sitoutumista työhönsä ja ennaltaehkäisee työuupumusta. Saatuja tuloksia perehdytyksen edellytyksistä ja vaikutuksista voidaan hyödyntää perehdytysohjelmia laadittaessa. Jatkotutkimusta tarvitaan eri oppimismenetelmien merkityksestä perehdytyksessä ja perehdyttäjän koulutustarpeista.The aim of this master’s thesis is study the necessary conditions and the effects of nurse orientation in the intensive care unit. The method used in this study is a literature review. The used ten articles, which met the pre-decided survey criteria were selected from international health care database covering years 2003-2014. According to this systematic literature review enough time should be reserved for the orientation of the nurses in the intensive care unit. The orientation program should also be personalized taking into a consideration the expectations and the needs of the individual. The human interaction between the nurse and her/his mentor play a significant role here. The mentor should be clinically competent and also interested in her/his task as a mentor. The support of the head nurse and the good interaction between the nurses at the ward form the preconditions for a high quality nurse orientation in the intensive care unit. The orientation has impact on patient safety. Orientation does also strengthen nurses’ commitment to their work and prevents work exhaustion. The achieved results of the preconditions and the effects of nurse orientation presented here can be used for designing orientation programs for nurses in the intensive care unit. Further research should be carried out focusing on the significance of different learning methods used in the orientation program. The other area of suggested further research consist of the training needs of the mentor

Heme oxygenase-1 repeat polymorphism in septic acute kidney injury

Abstract Acute kidney injury (AKI) is a syndrome that frequently affects the critically ill. Recently, an increased number of dinucleotide repeats in the HMOX1 gene were reported to associate with development of AKI in cardiac surgery. We aimed to test the replicability of this finding in a Finnish cohort of critically ill septic patients. This multicenter study was part of the national FINNAKI study. We genotyped 300 patients with severe AKI (KDIGO 2 or 3) and 353 controls without AKI (KDIGO 0) for the guanine–thymine (GTn) repeat in the promoter region of the HMOX1 gene. The allele calling was based on the number of repeats, the cut off being 27 repeats in the S–L (short to long) classification, and 27 and 34 repeats for the S–M–L₂ (short to medium to very long) classification. The plasma concentrations of heme oxygenase-1 (HO-1) enzyme were measured on admission. The allele distribution in our patients was similar to that published previously, with peaks at 23 and 30 repeats. The S-allele increases AKI risk. An adjusted OR was 1.30 for each S-allele in an additive genetic model (95% CI 1.01–1.66; p = 0.041). Alleles with a repeat number greater than 34 were significantly associated with lower HO-1 concentration (p&lt;0.001). In septic patients, we report an association between a short repeat in HMOX1 and AKI risk