Infuusioautomaatin ja ruiskupumpun turvallinen käyttö lääkehoidossa : opetusvideo lääkinnällisten laitteiden käytöstä

Potilasturvallisuus käsitteenä sisältää hoidon turvallisuuden, lääkehoidon turvallisuuden sekä lääkinnällisten laitteiden laiteturvallisuuden ja sen tarkoituksena on suojata potilaita vahingoittumiselta. Infuusioautomaatit ja ruiskupumput kehitettiin tarkkuuden lisäämiseksi lääkkeiden annossa. Tästä huolimatta niiden on osoitettu olevan yhteydessä laskimonsisäiseen lääkehoitoon liittyviin haittatapahtumiin. Suurin osa näistä virheistä johtuu siitä, että hoitohenkilökunta on asettanut laitteen asetukset virheellisesti. Sairaanhoitajien tulisikin saada riittävä koulutus laitteen turvallisesta käytöstä. Myös laki terveydenhuollon laitteista ja tarvikkeista velvoittaa ylläpitämään ja edistämään terveydenhuollon laitteiden käytön turvallisuutta. Laskimonsisäisesti annosteltavien lääkkeiden vaikutukset alkavat paljon nopeammin kuin suun kautta otettavien lääkkeiden, jolloin myös lääkkeiden haittavaikutuksien riskit kasvavat. Laitteiden oikealla käytöllä voidaan minimoida lääkitysvirheiden syntymistä. Nykyteknologian ansiosta lääkintälaitteiden ohjelmistot ovat kehitetty seulomaan paremmin hoitohenkilökunnasta johtuvia virheitä. Näiden niin kutsuttujen älypumppujen ohjelmistojen hälytykset reagoivat ohjelmointivirheisiin ja vääriin lääkeannoksiin, jotka olisivat muuten saattaneet koitua haitaksi potilaalle. Laiteteknologian kehittyessä tärkeää on, että laitteiden käyttäjien saamaan koulutukseen tulisi panostaa entistä enemmän. Tämän toiminnallisen opinnäytetyön tarkoituksena on lisätä sairaanhoitajien ja – opiskelijoiden tietämystä lääkinnällisten laitteiden käytöstä tuottamalla ajantasaisen ja näyttöön perustuvan tiedon pohjalta opetusvideo. Tavoitteena on edistää sairaanhoitajien ja – opiskelijoiden lääkinnällisten laitteiden turvallista käyttöä. Opinnäytetyö on osana Turun ammattikorkeakoulun ja Varsinais-Suomen sairaanhoitopiirin (VSSHP) Hoitotyön kehittämisprojekti 2009–2015 –hankkeen kummiluokkatoimintaa.Patient safety as a concept in health care includes the application of safety methods toward the goal of achieving a trustworthy system of health care. It also includes application of safe treatment methods related to medical devices. Infusion pumps and perfusors have been introduced to improve the accuracy in intravenous medication. However these devices have been the cause of incidents involving mistreatment. The cause for majority of these incidents has been incorrect device settings set by the medical personnel. Therefore the medical personnel using the devices should receive adequate training. The healthcare act on medical devices also requires maintaining and improving methods for the safe use of these devices. The risk for adverse effects on intravenous medicine is greater than on orally consumed medicine. Risk for mistreatment can be minimized with proper use of infusion pumps and perfusors. These devices are designed to prevent human errors. These so called smartpumps will inform the user of incorrect configuration and incorrect dosage that may cause harm to the patient. The challenge in patient care is that the users may not have the needed training in how to use the devices. The purpose of this thesis is to increase the knowledge of nurses and nursing students in using of medical devices by producing an evidence-based educational video. Educational video has been made to improve the skills of nurses and nursing students in the use of medical devices. The thesis is part of a development project between Turku University of Applied Sciences and Varsinais-Suomen sairaanhoitopiiri (VSSHP).https://www.youtube.com/watch?v=f1xgshJdN5

CD3⁺, CD8⁺, CD4⁺ and FOXP3⁺ T cells in the immune microenvironment of small bowel neuroendocrine tumors

Abstract The role of inflammation in neuroendocrine tumors is poorly known. The purpose of this study was to characterize the densities of CD3⁺, CD8⁺, CD4⁺ and FOXP3⁺ T cells in small bowel neuroendocrine tumors (SB-NETs), SB-NET lymph node metastases and gastric neuroendocrine tumors (G-NETs) to assess the prognostic role of immune cell infiltrates in SB-NETs. The final cohort included 113 SB-NETs, 75 SB-NET lymph node metastases and 19 G-NETs from two Finnish hospitals. CD3⁺- and CD8⁺-based immune cell score (ICS), and other T cell densities were evaluated. Survival analyses of SB-NETs and SB-NET lymph node metastases were performed with the Kaplan-Meier method and Cox regression adjusted for confounders. The primary outcome was disease-specific survival (DSS). No significant difference in DSS was seen between low and high ICS groups in SB-NETs at 5 years (92.6% vs. 87.8%) or 10 years (53.8% vs. 79.4%), p = 0.507, or in SB-NET lymph node metastases at 5 years (88.9% vs. 90.4%) or 10 years (71.1% vs. 59.8%), p = 0.466. Individual densities of the examined T cell types showed no correlation with prognosis either. SB-NETs and lymph node metastases had similar inflammatory cell profiles, whereas in G-NETs CD3⁺ and CD8⁺ T cells were particularly more abundant. In SB-NETs, ICS or T cell densities showed no correlation with prognosis

Monocarboxylate Transporters 1 and 4 and Prognosis in Small Bowel Neuroendocrine Tumors

Monocarboxylate transporters (MCTs) are cell membrane proteins transporting lactate, pyruvate, and ketone bodies across the plasma membrane. The prognostic role of MCTs in neuroendocrine tumors is unknown. We aimed to analyze MCT1 and MCT4 expression in small bowel neuroendocrine tumors (SB-NETs). The cohort included 109 SB-NETs and 61 SB-NET lymph node metastases from two Finnish hospitals. Tumor samples were immunohistochemically stained with MCT1 and MCT4 monoclonal antibodies. The staining intensity, percentage of positive cells, and stromal staining were assessed. MCT1 and MCT4 scores (0, 1 or 2) were composed based on the staining intensity and the percentage of positive cells. Survival analyses were performed with the Kaplan–Meier method and Cox regression, adjusted for confounders. The primary outcome was disease-specific survival (DSS). A high MCT4 intensity in SB-NETs was associated with better DSS when compared to low intensity (85.7 vs. 56.6%, p = 0.020). A high MCT4 percentage of positive cells resulted in better DSS when compared to a low percentage (77.4 vs. 49.1%, p = 0.059). MCT4 scores 0, 1, and 2 showed DSS of 52.8 vs. 58.8 vs. 100% (p = 0.025), respectively. After adjusting for confounders, the mortality hazard was lowest in the patients with a high MCT4 score. MCT1 showed no association with survival. According to our study, a high MCT4 expression is associated with an improved prognosis in SB-NETs

Tumour budding and tumour–stroma ratio in hepatocellular carcinoma

Abstract Background: Tumour budding and low tumour–stroma ratio (TSR) are associated with poor prognosis in some cancers, but their value in Western hepatocellular carcinoma is unclear. The prognostic value of tumour budding and TSR in hepatocellular carcinoma was examined. Methods: Some 259 hepatocellular carcinoma patients treated in Oulu University Hospital 1983–2018 were included in this retrospective cohort study. Tumour budding and TSR were analysed from the haematoxylin- and eosin-stained original diagnostic slides, by dividing patients into bud-negative (0 bud) or bud-positive (≥1 bud) groups, and into high TSR (<50%) and low TSR (≥50%) groups. Surgically treated patients (n = 47) and other treatments (n = 212) were analysed separately. Primary outcomes were overall, and disease-specific 5-year mortality was adjusted for confounding factors. Results: Surgically treated patients with positive tumour budding had increased 5-year overall (adjusted HR 3.87, 95% CI 1.10–13.61) and disease-specific (adjusted HR 6.17, 95% CI 1.19–31.90) mortality compared with bud-negative patients. In surgically treated patients, TSR had no effect on 5-year overall (adjusted HR 2.03, 95% CI 0.57–7.21) or disease-specific (adjusted HR 3.23, 95% CI 0.78–13.37) mortality. No difference in survival related to tumour budding and TSR in non-surgically treated patients was observed. Conclusions: Tumour budding is a prognostic factor in surgically treated hepatocellular carcinoma

Toll-like receptors 3, 7, 8, and 9 in gastric cancer

Abstract Toll-like receptors (TLRs) have been shown to have anti-tumor, pro-tumor, or even dual effects in cancer, and are thus potential prognostic biomarkers and immunotherapeutic targets. The present study aimed to evaluate associations between endosomal TLRs, namely TLR3, TLR7, TLR8, and TLR9, expression and clinicopathological variables and survival in gastric cancer. A total of 564 gastric adenocarcinoma patients were included in this retrospective cohort study. Samples and clinicopathological data were retrieved and organized into tissue microarray blocks. Protein expressions were detected by immunohistochemical staining. The patients were divided into low expression and high expression groups by median values of expression. Cox regression provided hazard ratios (HR) with 95% confidence intervals (CI), adjusted for confounders. Patients with high nuclear TLR3 expression had significantly poorer 5-year survival than the low nuclear TLR3 expression group in the univariable analysis (crude HR 1.31, 95% CI 1.07–1.60). With radically resected patients, poor prognosis was also seen in the multivariable analysis (adjusted HR 1.38, 95% CI 1.08–1.77). Cytoplasmic TLR3, TLR7, TLR8, and TLR9 were not associated with 5-year survival. In conclusion, high nuclear TLR3 expression seems to have prognostic impact in gastric cancer, while TLR7, TLR8, and TLR9 do not

Theoretical underpinnings of computing education research - what is the evidence?

We analyze the Computing Education Research (CER) literature to discover what theories, conceptual models and frameworks recent CER builds on. This gives rise to a broad understanding of the theoretical basis of CER that is useful for researchers working in that area, and has the potential to help CER develop its own identity as an independent field of study. Our analysis takes in seven years of publications (2005-2011, 308 papers) in three venues that publish long research papers in computing education: the journals ACM Transactions of Computing Education (TOCE) and Computer Science Education (CSEd), and the conference International Computing Education Research Workshop (ICER). We looked at the theoretical background works that are used or extended in the papers, not just referred to when describing related work. These background works include theories, conceptual models and frameworks. For each background work we tried to identify the discipline from which it originates, to gain an understanding of how CER relates to its neighboring fields. We also identified theoretical works originating within CER itself, showing that the field is building on its own theoretical works. Our main findings are that there is a great richness of work on which recent CER papers build; there are no prevailing theoretical or technical works that are broadly applied across CER; about half the analyzed papers build on no previous theoretical work, but a considerable share of these are building their own theoretical constructions. We discuss the significance of these findings for the whole field and conclude with some recommendations

Immune Cell Infiltrate and Prognosis in Gastric Cancer

Purpose: To examine and compare the prognostic value of immune cell score (ICS) and Klintrup–Mäkinen (KM) grade in gastric cancer. Methods: Gastric adenocarcinoma tissues from samples of 741 patients surgically treated in two hospitals in Finland were assessed for ICS and KM grade. Cox regression with adjustment for confounders provided hazard ratios (HRs) and 95% CIs. Subgroup analyses were performed in intestinal and diffuse type subgroups. The primary outcome was 5-year overall survival. Results: High ICS was associated to longer 5-year survival (adjusted HR 0.70, 95% CI 0.52–0.94), compared to low ICS. The difference was significant in intestinal type subgroup (adjusted HR 0.54, 95% CI 0.36–0.81) but not in diffuse type subgroup (adjusted HR 0.92, 95% CI 0.58–1.46). High KM grade was an independent prognostic factor for longer 5-year overall survival (adjusted HR 0.59, 95% CI 0.45–0.77) in both intestinal (adjusted HR 0.61, 95% CI 0.44–0.85) and diffuse subgroups (adjusted HR 0.52, 95% CI 0.31–0.86). ICS and KM grade were moderately correlated (ρ = 0.425). When both immune cell score and KM grade were included in the regression analysis, only KM grade remained prognostic. Conclusions: Both ICS and KM grade are prognostic factors in gastric adenocarcinoma, but immunohistochemistry-based ICS might not have additional prognostic value over hematoxylin–eosin-based KM grade

Characterizing research in computing education: a preliminary analysis of the literature

This paper presents a preliminary analysis of research papers in computing education. While previous analysis has explored what research is being done in computing education, this project explores how that research is being done. We present our classification system, then the results of applying it to the papers from all five years of ICER. We find that this subset of computing education research has more in common with research in information systems than with that in computer science or software engineering; and that the papers published at ICER generally appear to conform to the specified ICER requirements

Monocarboxylate transporters 1 and 4 and prognosis in small bowel neuroendocrine tumors

Abstract Monocarboxylate transporters (MCTs) are cell membrane proteins transporting lactate, pyruvate, and ketone bodies across the plasma membrane. The prognostic role of MCTs in neuroendocrine tumors is unknown. We aimed to analyze MCT1 and MCT4 expression in small bowel neuroendocrine tumors (SB-NETs). The cohort included 109 SB-NETs and 61 SB-NET lymph node metastases from two Finnish hospitals. Tumor samples were immunohistochemically stained with MCT1 and MCT4 monoclonal antibodies. The staining intensity, percentage of positive cells, and stromal staining were assessed. MCT1 and MCT4 scores (0, 1 or 2) were composed based on the staining intensity and the percentage of positive cells. Survival analyses were performed with the Kaplan–Meier method and Cox regression, adjusted for confounders. The primary outcome was disease-specific survival (DSS). A high MCT4 intensity in SB-NETs was associated with better DSS when compared to low intensity (85.7 vs. 56.6%, p = 0.020). A high MCT4 percentage of positive cells resulted in better DSS when compared to a low percentage (77.4 vs. 49.1%, p = 0.059). MCT4 scores 0, 1, and 2 showed DSS of 52.8 vs. 58.8 vs. 100% (p = 0.025), respectively. After adjusting for confounders, the mortality hazard was lowest in the patients with a high MCT4 score. MCT1 showed no association with survival. According to our study, a high MCT4 expression is associated with an improved prognosis in SB-NETs