PAINAD -mittarin hyödynnettävyys dementiapotilaiden kivun arvioinnissa

Dementiapotilaiden kivunarviointi voi olla haasteellista, koska potilaan omaa arviota hänen kivustaan pidetään kaikkein luotettavimpana keinona kivunarvioinnissa ja dementianpotilaat eivät välttämättä pysty kommunikoimaan. Siksi dementiapotilaiden kipu on usein alidiagnosoitua ja -hoidettua. Tutkimuksen tarkoituksena on testata PAINAD -mittarin hyödynnettävyyttä hoitotyössä kivun arvioinnissa dementiaa sairastavilla potilailla. Tutkimus on osa Turun ammattikorkeakoulun Kivun hoidon potilasohjaus -hanketta. Hanke toteutetaan Turun ammattikorkeakoulun terveysala-tulosalueen ja Turun sosiaali- ja terveystoimen yhteistyönä. Opinnäytetyö on kvalitatiivinen tutkimus. PAINAD- mittari esiteltiin kolmen geriatrisen sairaalahoidon osaston ja neljän ympärivuorokautisenhoidon osaston hoitohenkilökunnalle. He käyttivät PAINAD -mittaria neljän viikon ajan dementiapotilaiden kivun arvioinnissa. Neljän viikon jälkeen hoitohenkilökuntaa haastateltiin heidän kokemuksistaan PAINAD -mittarin käytöstä. Tutkimusta ohjasi kolme tutkimuskysymystä, jotka olivat; Miten hoitohenkilökunta voisi hyödyntää PAINAD -mittaria dementiapotilaan kivun arvioinnissa? Miten hoitajien mielipiteet PAINAD -mittarista eroavat toisistaan eri osastoilla? Mitä kritiikkiä ilmeni PAINAD -mittarin käytössä? Tulokset osoittivat hoitohenkilökunnan kokevan PAINAD- mittarin helpottavan todentamaan kipua. Kipulääkkeen käyttö koettiin perustellummaksi ja mittarista koettiin olevan apua myös kivun ja ahdistuksen erottamisessa. Mielipide eroja oli myös lähihoitajien ja sairaanhoitajien mielipiteissä. Kritiikkiä ilmeni PAINAD- mittarin raja-arvojen epäselvyydestä ja arviointi koettiin vaikeaksi niiden potilaiden kohdalla, jotka olivat jatkuvasti levottomia tai jäykkiä. PAINAD- mittarista näytti kuitenkin ollevan hyötyä dementiapotilaiden kivun arvioinnissa. Tutkimuksen tuloksia voidaan käyttää, kun etsitään hyvää kivunarviointia ja -hoitoa dementiapotilaille. PAINAD- mittari osoittautui hyväksi apuvälineeksi kivunarviointiin dementiapotilailla vaikka kritiikkiä ja eroavaisuuksia hoitohenkilökunnan mielipiteissä ilmeni. PAINAD- mittarin hyödynnettävyyttä, luotettavuutta ja soveltuvuutta dementiapotilaiden kivunarviointiin tulee kuitenkin vielä tutkia.Normally, persons’ self-report is kept as the most reliable measurement of pain. Pain assessment in people with dementia can be challenging because demented patients are often unable to communicate, and therefore their pain can often go under-recognized and/or under-treated. The purpose of the study was to test the usefulness of the observational tool PAINAD in pain assessment in patients with dementia. This Bachelor’s thesis is part of the Patient education in pain management project. This project was ran by the Turku University of Applied sciences the Faculty of Health Care and the Department of Health Care and Social Services of the city of Turku. This thesis is a qualitative research. The PAINAD was presented to nursing staff in three geriatric hospital wards and four long term care wards. These wards used the PAINAD- scale for four weeks in assessment of the pain in demented patients. After four weeks, a group interview was held and the nurses' opinions of the PAINAD and its use were clarified. Three questions were used as to help in the research, and they were: How could the nursing staff utilize the PAINAD- scale in evaluating the pain of dementia patient? How do the nurses' opinions of the PAINAD- scale differ from each other in different wards? What criticism did become apparent in the use of the PAINAD- scale? The results of this study showed that nursing staff felt that the PAINAD-scale helped them in their work as it made it easier to register the pain which in turn helped to justify when to use medication for that pain. It also helped them to separate pain from anxiety which isn’t always easy with demented patents. The opinions of the PAINAD varied in different wards quite a lot. The opinions between the nurses and practical nurses were also distinctly different. Criticism was shown in the unclarity of the values of the PAINAD. The assessment of pain was also regarded to be difficult if the patient was constantly restless or stiff. PAINAD- scale, however, seemed to be beneficial in pain assessment in patients with dementia. The results of this study can be utilized when seeking a good pain assessment and care of pain in demented patients. PAINAD proved to be a good tool for the assessment of demented patients' pain even though criticism and differences in opinions appeared. The benefit, reliability and suitability of the PAINAD should still be further examined in demented patients

Anti-inflammatory effects of flap and lymph node transfer

Background: Transfer of healthy tissue is commonly used in the treatment of complicated wounds and in reconstruction of tissue defects. Recently, microvascular lymph node transfer (LN) has been used to improve the lymphatic function in lymphedema patients. To elucidate the biological effects of flap transfer (with and without lymph nodes), we have studied the postoperative production of proinflammatory, anti-inflammatory, prolymphangiogenic and antilymphangiogenic cytokines, and growth factors (interleukin 1 alpha [IL-1 alpha], IL-1 beta, tumor necrosis factor alpha [TNF-alpha], IL-10, transforming growth factor beta 1 [TGF-beta 1], IL-4 and IL-13, and vascular endothelial growth factor C [VEGF-C] and VEGF-D) in postoperative wound exudate samples. Methods: Axillary wound exudate samples were analyzed from four patient groups: axillary lymph node dissection (ALND), microvascular breast reconstruction (BR), LN, and combined LN and BR (LN-BR). Results: The concentration of proinflammatory cytokines was low in all the flap transfer groups as opposed to the ALND group, which showed an extensive proinflammatory response. The level of anti-inflammatory and antifibrotic cytokine IL-10 was increased in the LN-BR group samples compared with the ALND and BR groups. In the LN and LN-BR groups, the cytokine profile showed an anti-inflammatory response. Conclusions: Transfer of healthy tissue hinders the proinflammatory response after surgery, which may explain the beneficial effects of flap transfer in various patient groups. In addition, flap transfer with lymph nodes seems to also promote an antifibrotic effect. The clinical effects of LN in lymphedema patients may be mediated by the increased production of prolymphangiogenic growth factor (VEGF-C) and antifibrotic cytokine (IL-10). (C) 2015 Elsevier Inc. All rights reserved.Peer reviewe