Endoscopic biliary procedures: studies on cannulation and stenting

Deep cannulation is a prerequisite for successful endoscopic retrograde cholangiopancreatography (ERCP) procedures. Of the biliary procedures, stenting is one of the most common. This study was carried out to investigate current and controversial issues regarding biliary cannulation and stenting. The double guidewire (DGW) technique was studied to analyze its safety and feasibility in biliary cannulation as a single procedure and as a part of the novel three-step cannulation protocol. Female gender was evaluated in regard to difficult cannulation. The use of an angled and a straight tipped guidewire in biliary cannulation was studied in a prospective, randomized trial. Additionally, the patency of the novel antireflux plastic biliary stent was compared to the patency of the conventional plastic biliary stent in a prospective, randomized setting. The DGW method seems safe and feasible as an alternative cannulation technique in biliary cannulation. Female gender was not associated significantly with difficult biliary cannulation in our study, although the cannulation times seemed to be longer and the alternative cannulation techniques seemed to be needed more often in females than males. According to the results of this thesis, an angled tipped guidewire may facilitate biliary cannulation. In controversy to the previous result presented in the literature, the antireflux plastic biliary stent tested herein should not be used, as the patency of the stent was significantly shorter compared to the conventional plastic stent.Siirretty Doriast

One-year functional outcomes of patients aged 80 years or more undergoing colonic cancer surgery : prospective, multicentre observational study

Background Older patients are at high risk of experiencing delayed functional recovery after surgical treatment. This study aimed to identify factors that predict changes in the level of support for activities of daily living and mobility 1 year after colonic cancer surgery. Methods This was a multicentre, observational study conforming to STROBE guidelines. The prospective data included pre-and postoperative mobility and need for support in daily activities, co-morbidities, onco-geriatric screening tool (G8), clinical frailty scale (CFS), operative data, and postoperative surgical outcomes. Results A total of 167 patients aged 80 years or more with colonic cancer were recruited. After surgery, 30 per cent and 22 per cent of all patients had increased need for support and decreased motility. Multivariableanalysis with all patients demonstrated that preoperative support in daily activities outside the home (OR 3.23, 95 per cent c.i. 1.06 to 9.80, P = 0.039) was associated with an increased support at follow-up. A history of cognitive impairment (3.15, 1.06 to 9.34, P = 0.038) haemoglobin less than 120 g/l (7.48, 1.97 to 28.4, P = 0.003) and discharge to other medical facilities (4.72, 1.39 to 16.0, P = 0.013) were independently associated with declined mobility. With functionally independent patients, haemoglobin less than 120 g/l (8.31, 1.76 to 39.2, P = 0.008) and discharge to other medical facilities (4.38, 1.20 to 16.0, P = 0.026) were associated with declined mobility. Conclusion Increased need for support before surgery, cognitive impairment, preoperative anaemia, and discharge to other medical facilities predicts an increased need for support or declined mobility 1 year after colonic cancer surgery. Preoperative assessment and optimization should focus on anaemia correction, nutritional status, and mobility with detailed rehabilitation plan. Greater increased need for support before surgery, cognitive impairment, preoperative anaemia, and discharge to other medical facilities predicted an increased need for support or declined mobility 1 year after colonic cancer surgery. Preoperative assessment and optimization should especially focus on anaemia correction, nutritional status, and mobility with a detailed rehabilitation plan.Peer reviewe

Lapsen surun kohtaaminen päiväkodissa

Opinnäytetyöni tavoitteena oli selvittää, kohtaako päiväkodin henkilökunta lapsen surua työssään, miten lapsi mahdollista surua käsittelee ja minkälaisia ajatuksia ja tunteita tämä kasvattajassa herättää. Opinnäytetyössäni oli sekä tutkimus-, että kehit-tämistehtävä, sillä saatujen tuloksien pohjalta tein oppaan, josta päiväkodin henkilö-kunta pystyy nopeasti etsimään tietoa. Opas on liitteenä opinnäytetyössäni ja painettu versio on toimitettu päiväkodille. Ryhmähaastattelut toteutin toukokuussa 2013 ja haastatteluja tuli yhteensä neljä, joi-hin kaikkiin osallistui 4-6-kasvatusalan ammattilaista. Haastateltavat olivat koulutuk-seltaan lastentarhaopettajia, sosionomeja (AMK), lastenhoitajia, lähihoitajia sekä so-siaalikasvattajia. Ryhmähaastattelut toteutettiin teemahaastattelulla, joka on yksi puolistrukturoidun haastattelumetodin muoto. Teoreettinen viitekehykseni muodostui lapsen surusta, surureaktioista sekä surutilan-teessa tukemisesta. Teoreettinen tietoperusta ja haastatteluista saamani tiedot muo-dostivat selkeän käsityksen siitä, että kuolema ei ole ainut asia, jota lapsi suree. Tun-nistamalla surureaktioita, päiväkodin henkilökunnan on helpompi auttaa ja tukea las-ta. Lapsen surun kunnioittaminen, aito läsnäolo sekä lapsen yksilöllisyyden huomi-oiminen, auttavat jokaista lasta selviytymään surusta paremmin.The purpose of this thesis was to find out if day care employees encounter children’s sorrow, how the children deal with the possible feelings caused by sorrow and what kind of thoughts and feelings the child’s sorrow causes in the day care employees. This bachelor’s thesis contained both research and development tasks. Based on the collected results I created a guidebook from which the staff of the day care centre can effectively find information. This bachelor’s thesis also works as an information source for the staff. The guidebook is attached to this thesis. A printed version of the guidebook has also been delivered to the day care centre. Group interviews were conducted in May 2013. There were four interview sessions to all of which 4 to 6 social service professionals took part. Participants were nursery teachers, bachelors of social services (UAS), nannies, practical nurses and social ed-ucators. The interview style was theme interviews, which is one of the semi-structured interview forms. The theoretical frame of reference comprised of a child’s sorrow, reactions to sorrow and support in an event of sorrow. The theoretical frame of reference and infor-mation from the interviews formed a clear picture of the fact that children do not face sorrow only when it comes to dealing with death. By recognizing reactions to sorrow it is easier for nursery staff to support and help the child. Respecting the child’s sor-row, offering genuine presence for the child and recognizing the child’s individuality helps every child to better survive from the feelings of sorrow

Perheiden ja päiväkodin henkilökunnan yhteistyö : vanhempien mielipiteet päivähoidosta ja toiveet päivähoidon aloitusvaiheelle

TIIVISTELMÄ Hannila, Hanna & Vihervaara, Sarianne. Perheiden ja päiväkodin henkilökunnan yhteistyö : vanhempien mielipiteet päivähoidosta ja toiveet päivähoidon aloitusvaiheelle. Diak Etelä, Helsinki, syksy 2011, 63 s., 2 liitettä. Diakonia-ammattikorkeakoulu, Sosiaalialan koulutusohjelma, Sosionomi (AMK) + lastentarhanopettajan kelpoisuus. Opinnäytetyössämme käsittelemme päivähoitoa. Opinnäytetyömme tarkoituksena oli tutkia mitä mieltä vanhemmat ovat lapsensa päivähoidosta tänä päivänä. Lisäksi halusimme tietää, minkälaista tietoa vanhempien olisi ollut hyvä tietää ennen päivähoidon aloitusta. Pyrimme selvittämään vanhempien mielipiteitä seuraavista aihealueista: lapsiryhmä, työntekijät, kasvatuskumppanuus, ryhmätoiminta, ruokailu, uni/lepo ja ulkoilu. Teoriaosuudessa käsittelemme varhaiskasvatusta, päivähoidon aloitusta, arkea, vanhempien ja työntekijöiden yhteistyön syntymistä ja vuorovaikutusta. Työmme on sekä kvantitatiivinen eli määrällinen että kvalitatiivinen eli laadullinen. Kvantitatiivisena menetelmänä käytimme kyselylomaketta, jonka ensimmäinen osio sisälsi 30 suljettua kysymystä. Näitä tuloksia analysoimme Excel-taulukon avulla. Kyselylomakkeen toinen osio sisälsi avoimia kysymyksiä, joiden analysoimiseen käytimme kvalitatiivisena tutkimusmenetelmänä sisällönanalyysia. Keväällä 2011 veimme 60 kyselylomaketta espoolaisen päiväkodin vanhemmille. Kohderyhmänä olivat 3–5-vuotiaiden lasten vanhemmat. Palautuneita vastauksia saimme yhteensä 12. Opinnäytetyömme tuloksista selvisi, että vanhemmat ovat tänä päivänä pääosin tyytyväisiä päivähoitoon. Päivähoidon aloitusvaiheessa vanhemmat olisivat halunneet enemmän informaatiota päiväkodin päivätoiminnasta ja työntekijöistä. Opinnäytetyömme on tärkeä, koska mielestämme vanhempien mielipiteitä on tuotava esiin heidän lapsensa päivähoidosta. Vanhempien mielipiteet on tärkeää huomioida, jotta päivähoidon laatua voidaan kehittää sekä työntekijöiden ja perheiden välistä vuorovaikutusta parantaa. Aiemmin tehdyt tutkimukset myös osoittavat sen, että vanhempien näkemykset ovat merkittäviä. Jokainen päiväkoti voisi hyödyntää opinnäytetyömme ideaa ja kartoittaa vanhempien ajatuksia päivähoidosta; mihin vanhemmat ovat tyytyväisiä ja mitä on jäänyt epäselväksi päivähoidosta. Näin voitaisiin kehittää päivähoidon aloitusvaiheen informointia tarkemmaksi uusille perheille. Asiasanat: varhaiskasvatus, päiväkodit, kasvatuskumppanuus, vuorovaikutus, päivähoito, vanhemmatABSTRACT Hannila, Hanna and Vihervaara, Sarianne Families’ and staff’s cooperation in kindergarten: Parents’ opinions in children’s day care and their wishes concerning the beginning at day care. 63p., 2 appendices. Language: Finnish. Helsinki, Autumn 2011. Diaconia University of Applied Sciences. Degree Programme in Social Services, Degree: Bachelor of Social Services. The thesis focused on children’s day care. The aim of the study was to investigate parents’ opinions on their children’s day care of today. Another aspect was to find out what facts parents did not have but would have needed before their child started the day care. The theory part included early upbringing, beginning at day care and the everyday life in kindergartens. It also contains theories on parents’ and staff’s cooperation, interaction and shared educational task. In this study we used quantitative and qualitative methods. In spring 2011 we submitted 60 questionnaires with both open-ended and closed questions to the parents of one kindergarten in Espoo. 12 parents responded. We analysed the quantitative results with Microsoft Office Excel and the qualitative results with content analysis. The research revealed that parents were satisfied with present day care, but they would have needed more information in the beginning about the employees and what children did in the kindergarten during the day. With the help of this thesis’ results it is possible to develop the quality of day care and also improve parents’ and employees’ interaction. Other studies also reveal that parents’ opinions are significant. In future every kindergarten could use the idea of our study and clarify what parents would like to know and what they already think about day care. That would help employees to plan what kind of information they will give to parents whose children start at kindergarten. Keywords: early upbringing, kindergarten, cooperation between parents and employees, interactio

Susceptibility of low-density lipoprotein particles to aggregate depends on particle lipidome, is modifiable, and associates with future cardiovascular deaths

Abstract Aims: Low-density lipoprotein (LDL) particles cause atherosclerotic cardiovascular disease (ASCVD) through their retention, modification, and accumulation within the arterial intima. High plasma concentrations of LDL drive this disease, but LDL quality may also contribute. Here, we focused on the intrinsic propensity of LDL to aggregate upon modification. We examined whether inter-individual differences in this quality are linked with LDL lipid composition and coronary artery disease (CAD) death, and basic mechanisms for plaque growth and destabilization. Methods and results: We developed a novel, reproducible method to assess the susceptibility of LDL particles to aggregate during lipolysis induced ex vivo by human recombinant secretory sphingomyelinase. Among patients with an established CAD, we found that the presence of aggregation-prone LDL was predictive of future cardiovascular deaths, independently of conventional risk factors. Aggregation-prone LDL contained more sphingolipids and less phosphatidylcholines than did aggregation-resistant LDL. Three interventions in animal models to rationally alter LDL composition lowered its susceptibility to aggregate and slowed atherosclerosis. Similar compositional changes induced in humans by PCSK9 inhibition or healthy diet also lowered LDL aggregation susceptibility. Aggregated LDL in vitro activated macrophages and T cells, two key cell types involved in plaque progression and rupture. Conclusion: Our results identify the susceptibility of LDL to aggregate as a novel measurable and modifiable factor in the progression of human ASCVD