30 research outputs found
PotilaslÀhtöisyys hoitotyössÀ - estÀvÀt ja edistÀvÀt tekijÀt
OpinnÀytetyön tarkoituksena oli selvittÀÀ erÀÀn kantahÀmÀlÀisen sairaalaan kolmen eri vuodeosaston potilaslÀhtöisyyttÀ estÀviÀ ja edistÀviÀ tekijöitÀ. Tavoitteena oli, ettÀ tutkittavat osastot saavat tutkittua tietoa kuinka heidÀn osastoillaan toteutuu potilaslÀhtöisyys. OpinnÀytetyön aihe oli työ-elÀmÀlÀhtöinen, sillÀ ehdotus aiheesta tuli sairaalalta, jossa tutkimus toteu-tettiin.
Työ toteutettiin kvantitatiivisena tutkimuksena. Osastojen hoitohenkilö-kunta vastasi kyselylomakkeeseen. Kyselylomake oli paperinen ja sen ky-symykset ja vastausvaihtoehdot muokattiin Elonen, Laine, Ylönen 2002 âKysely hoitohenkilökunnalle asiakaslĂ€htöisyydestĂ€â-tutkimuksen mitta-rista. Osastoille vietiin 75 kyselykaavaketta. Vastauksia saatiin 36 (n=36). Vastausprosentti tĂ€hĂ€n tutkimukseen oli 48 %.
Aiempaa tutkittu tietoa aiheesta kerÀttiin sÀhköisistÀ tietokannoista Medi-cistÀ, Melindasta ja Cinahlista. Tutkimuksia etsittiin >2003 <2015 aikavÀ-liltÀ. Manuaalisesti tietoa haettiin hoitotyön kirjallisuudesta ja artikkeleista sekÀ tutkimuksista.
OpinnÀytetyön tuloksia tarkasteltaessa potilaslÀhtöisyyttÀ estÀviksi teki-jöiksi yksiköissÀ nousivat hoitohenkilökunnan riittÀmÀttömyys, kiire, or-ganisaation tuottavuusvaatimukset ja yksilöllisten ohjausmenetelmien puute. PotilaslÀhtöisyyttÀ edistÀviksi tekijöiksi yksiköissÀ nousivat potilaan fyysisen, psyykkisen ja sosiaalisen tilan selvittÀminen, potilaan kuun-teleminen, potilaan tiedon saanti omasta hoidosta sekÀ potilaan oma moti-voituneisuus hoitoonsa.
Aiheesta voisi tehdÀ jatkotutkimuksen, missÀ selvitettÀisiin kuinka potilas-lÀhtöisyyttÀ estÀviÀ tekijöitÀ voitaisiin konkreettisesti vÀhentÀÀ ja edistÀviÀ tekijöitÀ lisÀtÀ. Jatkotutkimuksen voisi toteuttaa suuremmalla otoksella, jolloin tutkimuksen johtopÀÀtökset olisivat paremmin yleistettÀvissÀ.The purpose of this thesis was to find out the prohibitive and promoting factors on patient-friendliness in three different hospital wards in a Tavas-tia Proper hospital. The aim was that the wards included in this study will get examined information on how patient-friendliness comes true on their wards. The theme of the thesis is work life based, for the idea for this study came directly from the hospital the study was conducted in.
The study was conducted as a quantitative study. The staff of the wards answered to a questionnaire. The questionnaire was on paper, and the questions and the alternative answers were all based on a barometer found in a study âKysely hoitohenkilökunnalle asiakaslĂ€htöisyydestĂ€â by Elonen, Laine and Ylönen (2002). The wards were given 75 questionnaire forms in total, and the number of replies received was 36 (n=36). The percentage of participation for this study was 48%.
Previously published information on the subject was gathered from elec-tronic databases Medic, Melinda and Cinahl. Published studies were searched from the years 2003-2015. Information was also searched manu-ally from nursing literature, as well as articles and studies on nursing.
While examining the results the most significant prohibitive factors on pa-tient-friendliness were insufficiency of staff, hurry, the organization's calls for productivity, and the lack of individual guidance.
The most significant promoting factors were detection of oneâs physical, mental and social space, listening to the patient, informing the patient of their own care, and the patientâs own motivation towards his or her care.
A further study on this subject could be made in order to find out how the prohibitive factors could be diminished, and how the promoting factors could be increased in practice. The further study could be made with a larger sample in order to get conclusions which could be more generalized
Fyysisen toimintakyvyn mittaaminen ja arviointi vÀestötutkimuksissa
TOIMIA-suositus ID S029/29.09.202
EnemmÀn irti kuulemisprosessista: kohti yhteistoiminnallisia menettelyjÀ lainvalmistelussa
TÀssÀ julkaisussa arvioidaan, minkÀlaisia hyötyjÀ uudenlaiset osallistumisen ja yhteistoiminnan (collaboration) menetelmÀt ovat tuoneet lainvalmisteluprosesseihin ja mitÀ nÀistÀ kokemuksista voidaan oppia lainvalmistelun kehittÀmisessÀ.
Julkaisussa esitellÀÀn neljÀssÀ eri lainvalmisteluhankkeessa toteutetut kuulemisprosessit ja niissÀ hyödynnettyjÀ osallistumisen ja yhteistoiminnan menetelmiÀ. Yhteistoiminnallisilla menetelmillÀ tarkoitetaan osallistumisen prosesseja, jotka tÀhtÀÀvÀt erilaisten nÀkökulmien yhteensovittamiseen ja yhteiseen ongelmanratkaisuun.
Esimerkkihankkeissa on hyödynnetty erilaisia kuulemisen menetelmiÀ. TÀllaisia ovat tavanomaisten lausuntopyyntöjen ohella muun muassa sÀhköiset kyselyt, verkkokeskustelut, työryhmÀt, työpajat, esittelytilaisuudet ja dialogitilaisuudet. Olennaiseksi osoittautuu se, miten valmisteluprosessin kokonaisuus jÀsentyy ja mihin tarkoitukseen osallistumisen menetelmiÀ hyödynnetÀÀn. Selvimmin yhteistoiminnallisia elementtejÀ sisÀltÀvissÀ menettelyissÀ osalliset ovat yhdessÀ ratkaisemassa lainsÀÀdÀntöhankkeiden keskeisiÀ pulma- ja kiistakysymyksiÀ. Tarkastelu osoittaa, ettÀ yhteistoiminnallisuus ei kuitenkaan sovellu yhtÀ hyvin kaikkiin lainvalmisteluhankkeisiin
Modifiable risk factors for RA: prevention, better than cure?
Objective. To perform a meta-synthesis of the evidence for modifiable lifestyle risk factors for inflammatory polyarthritis (IP) and RA
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Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.
Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (nâ=â143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (nâ=â152), or no hydrocortisone (nâ=â108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (nâ=â137), shock-dependent (nâ=â146), and no (nâ=â101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707
Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19
IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19.
Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19.
DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 nonâcritically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022).
INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (nâ=â257), ARB (nâ=â248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; nâ=â10), or no RAS inhibitor (control; nâ=â264) for up to 10 days.
MAIN OUTCOMES AND MEASURES The primary outcome was organ supportâfree days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes.
RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ supportâfree days among critically ill patients was 10 (â1 to 16) in the ACE inhibitor group (nâ=â231), 8 (â1 to 17) in the ARB group (nâ=â217), and 12 (0 to 17) in the control group (nâ=â231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ supportâfree days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively).
CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes.
TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570
Developing Northern Ostrobothniaâs Entrepreneurship Education Model â A Diary Based Thesis
In this work the development process of the Northern Ostrobothniaâs entrepreneurship education model was documented as a diary-based thesis. The theoretical background of this thesis and the development process of the entrepreneurship education model takes tools and includes concepts from service design and entrepreneurship education. The aim of this diary-based thesis was to learn how a developing process of an entrepreneurship education model could be planned and carried out and if service design tools could be used in the process. This thesis also documented the development process.
The diary-entries covered the whole development process of the Northern Ostrobothniaâs entrepreneurship education model, which was about eight months from October 2021 to May 2022. The diary-entries were made based on different meaningful events for the development work, the work process, and the authorâs learning. The diary entries were made based on events, meetings and important work related to the development process. The diary-entries were reported in this thesis under monthly headlines. The Northern Ostrobothniaâs entrepreneurship education model will be published at www.minunpolkuni.fi during academic year 2022â2023.
The Northern Ostrobothniaâs entrepreneurship education model is being developed in a European Social Fund (ESF) project called âSustainable development, digitalisation, and internationalization as a part of the entrepreneurship education â VĂKEVĂâ. The author worked as a project manager for the project âSustainable development, digitalisation, and internationalization as a part of the entrepreneurship education â VĂKEVĂâ at the University of Ouluâs Kerttu Saalasti Institute
Pohjois-Pohjanmaan yrittĂ€jyyskasvatuksen mallin kehittĂ€minen VĂKEVĂ-hankkeessa
EsiteltÀvÀn kehittÀmistyön tavoitteena oli luoda Pohjois-Pohjanmaalle yhteinen kestÀvÀn kehityksen, digitalisaation ja
kansainvÀlisyyden osaamistavoitteet sisÀltÀvÀ uusi yrittÀjyyskasvatuksen malli. KehittÀmisen taustana oli aiemmin maa-
kunnassa laadittu yrittÀjyyskasvatuksen strategia ja toimintaohjelma sekÀ muut koulutusta ohjaavat dokumentit. Mallin
laadinta on toteutettu ESR-rahoitteisessa KestĂ€vĂ€ kehitys, digitalisaatio ja kansainvĂ€lisyys osana yrittĂ€jyyskasvatusta â
VĂKEVĂ-hankkeessa. Hankkeen toteuttajina ovat Oulun yliopiston Kerttu Saalasti Instituutti, Oulun ammattikorkeakoulu,
KoulutuskuntayhtymÀ OSAO, KoulutuskuntayhtymÀ Brahe, Jokilaaksojen koulutuskuntayhtymÀ JEDU, Centria-ammat-
tikorkeakoulu ja Oulun kaupunki. TÀmÀ laaja toteuttajajoukko edustaa laajasti eri kouluasteita.
KehittÀmistyön kautta on kiinnitetty kestÀvÀ kehitys, digitalisaatio ja kansainvÀlisyys uusina elementteinÀ mukaan yrit-
tÀjyyskasvatuksen ehjÀlle polulle varhaiskasvatuksesta korkeakouluihin asti. NÀmÀ ovat nÀkyvissÀ myös kouluastekoh-
taisina osaamistavoitteina.
Suunnitteluvaiheessa on huomioitu alueen aikaisemmin luotu yrittĂ€jyyskasvatuksen strategia, VĂKEVĂ-hankkeen seutu-
tiimien työskentelyn tulokset, partneriorganisaatioiden omien kehittÀmistiimien työ, EntreComp (Eurooppalainen yrittÀ-
jyyskasvatuksen viitekehys) sekÀ erilaisia eri kouluasteita ohjaavia dokumentteja, kuten opetussuunnitelman perusteet,
OKM:n ammatillisen koulutuksen linjaukset, Arenen yrittÀjyyssuositukset korkeakouluille.
KehittÀmistyö on toteutettu laajasti alueen toimijoita osallistavana prosessina, johon on kuulunut mm. seututiimien
tapaamiset kolmella kierroksella. Mallin juurruttaminen koulutusorganisaatioiden kÀytÀntöön aloitettiin toukokuussa
2022 kolmansissa seututiimitapaamisissa ja sitĂ€ jatketaan koko lukuvuoden 2022â23 ajan erilaisten kĂ€ytĂ€nnöllisten
toimenpiteiden avulla. Alueelle onnistuttiin luomaan yhteinen yrittÀjyyskasvatuksen malli, jonka arviointi ja kehittÀminen
edelleen jatkuvat.
MerkittÀvimpÀnÀ tuloksena voidaan pitÀÀ työn jatkuvuutta. Pohjois-Pohjanmaan alueella pÀÀstÀÀn edelleen jatkamaan
pitkÀjÀnteistÀ työtÀ yrittÀjyyskasvatuksessa ehjÀllÀ polulla. Uusi malli tullaan viemÀÀn kÀytÀntöön ja sen toteutumista
on tarkoitus seurata jatkossa