Terveyskeskuksessa työskentelevien vastaanottotoiminnan hoitajien valmiudet, odotukset ja tiedon tarve psykiatristen asiakkaiden hoitotyössä

Ammatillinen kehittyminen hoitotyössä vaatii jatkuvaa kehittymistä ja kasvua. Asiantuntijuus muodostuu jatkuvan opiskelun ja kokemuksen karttuessa asteittain ja siihen vaikuttavat hoitajan yksilölliset tavoitteet ja motivaatio. Asiantuntijasairaanhoitajan konsultoinnista ja toiminnasta on tukea kollegan ammatilliselle kehittymiselle ja vuorovaikutus työryhmän ulkopuolisen kanssa voi tuottaa laadullisesti uusia oivalluksia, auttaa näkemään uusia mahdollisuuksia omassa toiminnassaan ja laajentaa näkemystä organisaatiosta. Tämä opinnäytetyö on selvitys Vantaan terveyskeskuksien vastaanottotoiminnassa työskentelevien hoitajien valmiuksista, tiedon tarpeesta ja nykyisistä käytänteistä psykiatristen asiakkaiden hoitotyössä. Opinnäytetyö myös kartoittaa hoitajien odotuksia ja toiveita psykiatrisen sairaanhoitajan konsultoinnista, konsultaatiokäytänteiden kehittämiseksi. Opinnäytetyössä tuotettua tietoa hyödynnetään kahden VALO -hankkeen osaprojektin kehittämistyössä, jotka ovat ”Pitkäaikaisen masennuksen hoidon kehittäminen yhteistyössä perusterveydenhuollon kanssa” ja ”Pitkäaikaisesti oireilevien psykoosipotilaiden hoidon ja kuntoutuksen rajapintatyöskentelyn kehittäminen”, POP-VALO. Kartoitus toteutettiin kyselylomakkeen avulla, joka lähetettiin kohderyhmälle sähköisessä muodossa. Vastauksia kyselyyn tuli viisitoista kappaletta. Vastanneista hoitajista yli 71 % oli sitä mieltä, että erikoissairaanhoidon psykiatrisen sairaanhoitajan konsultoiminen kehittää heidän osaamistaan. Vastaanottotoiminnan hoitajille sopivimmasta konsultaatiomuodosta ei kuitenkaan kyselyn avulla saatu mielipiteiden jakautumisen takia selkeää vastausta, mutta henkilökohtaista tapaamista vastaajat eivät kokeneet välttämättömäksi. Hoitajien mielestä yhteistyö psykiatrisen erikoissairaanhoidon välillä ei toiminut niin hyvin kuin sen kuuluisi. Viidestätoista vastanneesta hoitajasta kolmetoista (n.86%) oli sitä mieltä, että olisi hyvä, jos työpaikalla järjestettäisiin koulutusta liittyen hoidolliseen vuorovaikutukseen mielenterveysasiakkaiden kanssa ja heidän potilasohjaukseensa, kuten esimerkiksi jatkohoitoon. Yli 86 % toivoi myös lisäkoulutusta aggressiivisen asiakkaan kohtaamiseen. Suurin osa kuitenkin koki, ettei mielenterveys asiakkaiden kohtaaminen pelota. Kyselyn tuloksista nousi selvästi esiin koulutuksen tarpeen lisäksi ajan puute, joka hankaloitti monen mielestä heidän työtään asiakkaiden kanssa. Opinnäytetyön tutkimuskysymyksinä toimivat olettamukset, että hoitajien ikä vaikuttaa kokemukseen erikoissairaanhoidon konsultoinnin hyödystä ja työuran pituus vastaanottotoiminnassa vaikuttaa sekä mielenterveyshäiriöiden tunnistamiseen, että kokemukseen omasta asiantuntijuudesta mielenterveysasiakkaan hoidontarpeen arvioinnissa. Vastausten analysoinnissa todettiin, että mitä iäkkäämpi vastaaja oli, sitä suuremmaksi hän koki hyödyn. Työuran pituuden vertaus hoidontarpeen arviointiin ja häiriöiden tunnistukseen osoittautui sen sijaan virheelliseksi oletukseksi. Taulukoinnissa kävi kuitenkin ilmi, että ne henkilöt jotka kokivat oman asiantuntijuutensa riittäväksi, pystyivät myös tunnistamaan masentuneet ja psykoottiset asiakkaat

Hybrid renewable energy systems for remote locations

Many locations in Indonesia such as small islands and remote villages on the main islands are not connected to the main electricity grid, and may never be as they are too remote for grid extensions to be economically justifiable. Therefore, many either do not have electricity or are dependent on expensive diesel transports to fuel their stand alone, diesel powered mini-grids. Using a hybrid renewable energy system combining solar power and a diesel engine run on vegetable oil could provide this type of location with cheaper, more reliable energy. In order to investigate whether this type of system would be feasible, field studies were completed to gain an understanding of how well implemented systems are working and what challenges are connected to them. The field studies were conducted at the Karimunjawa archipelago, where the energy systems of the main island and three smaller islands were studied. The field studies were complemented by running experiments at the university laboratories to analyze the effect of using vegetable oil as fuel in a diesel engine. The installed solar power was working well on the two islands where it had been implemented recently, whereas another island with an older system had issues with corroding PV-panels. The main island was running on large diesel engines at a newly installed diesel power plant which were not used optimally. Two of the smaller sites also had wind turbines which were all broken. The experiments showed that it was possible to run the diesel engine with palm and coconut oil. The emissions were slightly lower for the vegetable oils, with palm oil have lower emissions that coconut oil. However, the fuel consumption for the vegetable oils was higher than for diesel, with coconut oil giving the highest result.Many locations in Indonesia such as small islands and remote villages on the main islands are not connected to the main electricity grid, and may never be as they are too remote for grid extensions to be economically justifiable. Therefore, many either do not have electricity or are dependent on expensive diesel transports to fuel their stand alone, diesel powered mini-grids. Using a hybrid renewable energy system combining solar power and a diesel engine run on vegetable oil could provide this type of location with cheaper, more reliable energy. In order to investigate whether this type of system would be feasible, field studies were completed to gain an understanding of how well implemented systems are working and what challenges are connected to them. The field studies were conducted at the Karimunjawa archipelago, where the energy systems of the main island and three smaller islands were studied. The field studies were complemented by running experiments at the university laboratories to analyze the effect of using vegetable oil as fuel in a diesel engine. The installed solar power was working well on the two islands where it had been implemented recently, whereas another island with an older system had issues with corroding PV-panels. The main island was running on large diesel engines at a newly installed diesel power plant which were not used optimally. Two of the smaller sites also had wind turbines which were all broken. The experiments showed that it was possible to run the diesel engine with palm and coconut oil. The emissions were slightly lower for the vegetable oils, with palm oil have lower emissions that coconut oil. However, the fuel consumption for the vegetable oils was higher than for diesel, with coconut oil giving the highest result

Selkeneekö fibromyalgian diagnostiikka?

Kommentti Markku Malin kirjoitukseen SLL 71(19):1371-1374, 210

Glucose tolerance in fibromyalgia

Objectives: Fibromyalgia (FM) patients have an increased risk for glucose metabolism disturbances, and impaired glucose tolerance may be associated with symptom severity. Elevated levels of plasma lactate have been detected in FM patients. Both pyruvate and lactate are produced in glucose metabolism and reflect oxidative metabolism. The objective of our study was to analyse disturbances in glucose, pyruvate, or lactate metabolism in FM patients. Methods: We measured plasma levels of glucose, pyruvate, and lactate during an oral glucose tolerance test in 40 non-diabetic, female FM patients and 30 age- and gender-matched healthy controls. Results: FM patients showed a higher glycaemic response to the glucose load at 1 hour (F [1,68] = 10.4, P = .006) and 2 hours (F [1,68] = 7.80, P = .02), and higher glucose area under the curve (13.8 [SD 2.92] vs 11.6 [SD 2.31], P < .01), than healthy controls. Group differences were explained by higher body mass index and percentage of smokers among the FM patients. Pyruvate and lactate levels were similar in both groups. Discussion: Impaired glucose regulation in FM patients is likely not due to FM itself, but to associated lifestyle factors. Our results highlight the importance of assessing the glucose regulation status and the lifestyle factors affecting glucose regulation in FM patients for prevention or early treatment of diabetes and associated complications.Peer reviewe

Video Stabilization Algorithm from Low Frame Rate Video for Hyperlapse Applications

There are several methods that one can use to visualize image sequences. One such method, called timelapse, is based on synthesizing a video from the image sequence. One sub category of timelapses is the so-called hyperlapse, which is defined as a timelapse with a camera movement over great space. A problem with combining camera movement with speeding up the frame rate per second is that camera shakes appear magnified. One way to minimize this problem is to stabilize the video, using estimated relative camera movement. Such estimates can be obtained using computer vision methods based on epipolar geometry. Choosing how to compensate for camera shakes and calculate a new, more smooth camera path is essential to the video stabilization algorithm. One aim of this thesis is to create such a video stabilization algorithm. Another aim is to examine how performance degrades with decreased frame rate for the input sequence. Along with this thesis we have collected a set of benchmark image sequences. Several different video stabilization algorithms have been developed in the project. These have all been tested on the benchmark data sets and evaluated with promising results.I dagens samhälle är vi alltmer ivriga att dokumentera och dela våra upplevelser och vår vardag med andra genom sociala medier. Ett nytt sätt att göra detta har utvecklats av Narrative som med sin smidiga kamera, vilken kan fästas på dina kläder, erbjuder dig ett verktyg att dokumentera händelser utan att du behöver anstränga dig. Men om man vill presentera bilderna som en video, går det? Det är frågan som har legat bakom vårt examensarbete

Selkeneekö fibromyalgian diagnostiikka?

Kommentti Markku Malin kirjoitukseen SLL 71(19):1371-1374, 210

Elevated highly sensitive C-reactive protein in fibromyalgia associates with symptom severity

Objectives. Fibromyalgia (FM), a common pain syndrome, is thought to be a non-inflammatory, nociplastic condition, but evidence implicating neuroinflammation has been increasing. Systemic inflammation may be associated with more severe symptoms in some FM patients. We studied healthy controls and FM patients with and without systemic inflammation detectable using high-sensitivity CRP (hsCRP) measurement. Methods. We measured hsCRP levels and gathered clinical and questionnaire data [including the Fibromyalgia Impact Questionnaire (FIQ)] from 40 female FM patients and 30 age-matched healthy women. An hsCRP level >3 mg/l was considered elevated. Results. FM patients had significantly higher mean hsCRP levels than controls, explained by overweight and lower leisure-time physical activity. Eight FM patients had elevated hsCRP levels and 29 had normal hsCRP levels. Levels of hsCRP were significantly correlated with FIQ scores. Patients with elevated hsCRP had higher FIQ scores, with worse physical functioning and greater pain and were less likely to be employed than patients with normal hsCRP. These patient groups did not differ by blood count, liver function or lipid profiles, nor by education, psychological measures, sleep disturbance, smoking or comorbidities. Conclusion. Some FM patients have elevated hsCRP, mostly due to overweight and physical inactivity. They have worse symptoms and their ability to work is impaired. Measurement of hsCRP may help to identify FM patients in greatest need of interventions supporting working ability.Peer reviewe

Claims by Anglo American feminists and Chicanas/os for alternative space: The LA art scene in the political 1970s

Abstract: Originating in the context of the Civil Rights Movements and political activities addressing issues of race, gender and sexuality, the Women’s Liberation movement and the Chicano Movement became departures for two significant counter art movements in Los Angeles in the 1970s. This article explores some of the various reasons why Anglo American feminist artists and Chicana artists were not able to fully collaborate in the 1970s, provides some possible explanations for their separation, and argues that the Eurocentric imperative in visual fine art was challenged already in the 1970s by Chicana/o artists in Los Angeles. In so doing, the art activism by Anglo American feminists and Chicanas/os is comparatively investigated with Los Angeles as the spatial framework and the 1970s as the time frame. Four main components are discussed: their respective political aims, alternative art spaces, pedagogical frameworks and aesthetic strategies. The study found that the art activisms by Anglo American feminists and Chicanas/os differed. These findings suggest that a task ahead is to open up a dialogue with Chicana/o activist art, making space for more diverse representations of activities and political issues, both on the mainstream art scene and in the history of art