Päänsärkypotilaan kivunhoito : esimerkkinä migreenipotilaan hoito

Opinnäytetyö on toteutettu yhteistyössä Helsingin ja Uudenmaan sairaanhoitopiiriin kuuluvan Hyvinkään sairaalan päivystyspoliklinikan kanssa. Työhön saimme idean HUS:n opinnäytetöiden aihepankista. Opinnäytetyö on toteutettu systemaattista kirjallisuuskatsausta tutkimusmenetelmänä käyttäen. Kirjallisuuskatsauksessa käsittelimme migreenipotilaan ohjausta sekä lääkkeetöntä että lääkkeellistä hoitoa tutkimuskysymysten avulla. Työmme tavoitteena oli oman ammatillisen kasvun kehittäminen sairaanhoitajina sekä terveydenhoitajana ja lisäksi vastaaminen Hyvinkään sairaalan päivystyspoliklinikan tarpeeseen, joka koskee päänsärkypotilaan kivunhoitoa. Aineistohaun perusteella mukaan kirjallisuuskatsaukseen valikoitui 17 tieteellistä tutkimusta sekä tutkimusartikkelia. Tutkimusten valintakriteereinä oli, että tutkimukset vastasivat sisällöltään tutkimuskysymyksiin ja että tutkittu tieto oli riittävän ajantasaista. Tuotimme Hyvinkään sairaalan päivystyspoliklinikalle ohjelehtisen kirjallisuuskatsauksen perusteella. Tutkimusten mukaan ohjaus migreenipotilaan hoidossa koetaan tärkeäksi. Ohjauksen onnistuminen vaatii hoitohenkilökunnalta paljon osaamista sekä resursseja. Yhdessä tutkimuksessa potilaiden kokemukset olivat negatiivisia ja ohjaus oli koettu liian vähäiseksi. Potilaan ohjaaminen perustuu myös lakiin potilaan asemasta ja oikeuksista. Laissa kerrotaan, että potilaan on saatava selvitys terveydestään, hoitovaihtoehdoista, hoidon merkityksestä ja myös hoidon vaikutuksesta. Tutkimusten perusteella tärkeintä migreenin lääkkeettömässä estohoidossa on migreenikohtauksia ärsyttävien tekijöiden välttäminen. Yleisimpiä laukaisevia tekijöitä ovat stressi tai stressin laukeaminen, kuukautisten alkaminen tai nälkä. Monet migreeniä sairastavat ihmiset tarvitsevat myös lääkehoitoa lääkkeettömän hoidon rinnalle. Akuutin migreenin hoidossa tehokkaimpia ensilinjan lääkkeitä ovat ibuprofeeni sekä triptaaneista tsolmitriptaani sekä sumatriptaani. Aspiriini erityisesti pahoinvointilääkkeeseen yhdistettynä vaikuttaisi olevan myös tehokas lääke migreenipäänsäryn hoidossa. Migreenin aiheuttaman päänsäryn lääkehoidossa tulee huomioida yksilöllisyys.This thesis was made in cooperation with Hyvinkää Hospital which is a part of the nursing care district of Helsinki and Uusimaa. The idea for this thesis came from the thesis topic bank of HUS. The thesis was made using a systematic review of the literature as an examination method. In the review of the literature we dealt with the control of a migraine patient as well as medical and non-medical treatment with the help of the research questions. Our goal was to develop our skills as nurses and to answer Hyvinkää Hospital’s need for management of a headache patient’s pain. According to the research we made we found 17 scientific research related articles. The criteria used was that our research answered the questions by their content and that the examined information was updated enough. We produced an indication sheet of the most essential results to the Hyvinkää Hospital. According to the research the control in nursing of a migraine patient is important. Success in control requires the staff to have a great deal of knowledge and resources. In the used research the patients´ experiences were negative and the control was experienced as too minor. Controlling the patient is also based on the law and the rights of the patient.The law states that a patient has the right to get a clear picture of the state he/her is in, treatment options, meaning of the treatment and the effect of the treatment. Based on the studies the most important thing in non-medical treatment of migraine is avoiding stimulus. The most common reasons that cause a migraine to burst are stress, periods and hunger. Many of the people suffering from migraine also need medical treatment together with non-medical treatment. The most efficient medicine in treating acute migraine are Ibuprofen, Tsolmtriptane and Sumatriptane. Aspirin combined especially with antiemetic seems to be an effective medicine in treating a migraine headache. In the medical treatment of migraine it is important to take notice of the different individual circumstances

Is preoperative gastroscopy necessary before sleeve gastrectomy and Roux-en-Y gastric bypass?

Background: Consensus on the necessity of esophagogastroduodenoscopy (EGD) before bariatric surgery is lacking. Recommendations and practices vary by country and unit. Several reports have expressed concerns on gastroesophageal reflux disease (GERD) and its consequences after sleeve gastrectomy (SG) and the risk of leaving a premalignant lesion in the excluded stomach after Roux en -Y gastric bypass (RYGB). Objectives: We explored the number and types of clinically significant findings in preoperative EGDs and how they associate with preexisting GERD-symptoms (SG) and premalignant lesions (RYGB). We also studied how many reoperations were performed due to postoperative GERD in SG-patients. Setting: University hospital. Methods: We investigated preoperative EGD-findings and gastrointestinal symptoms before bariatric surgery in all patients with a primary bariatric operation in our unit between December 2007 and May 2016. Results: We performed 1474 operations: 1047 (71.0%) RYGB, 407 (27.6%) SG, and 20 (1.4%) others. One thousand two hundred seventy-five (86.5%) preoperative EGD reports were analyzed: 647 (50.7%) EGDs were completely normal. Altogether, 294 patients (23.0% of total) had a clinically significant finding that was relevant for SG (hiatal hernia, esophagitis, Barrett's esophagus, esophageal dysplasia), 144 (49.0%) of whom reported gastrointestinal symptoms. Twenty patients (1.6%) had a significant finding relevant for RYGB (peptic ulcer, atrophic gastritis, gastrointestinal stromal tumor), and 6 (30%) reported gastrointestinal symptoms. Thirteen (3.2%) SGs were converted into RYGB due to GERD. Conclusions: Preoperative EGD is indicated before SG but not before RYGB for asymptomatic patients without a risk for gastric pathology. (C) American Society for Metabolic and Bariatric Surgery. All rights reserved.Peer reviewe

Catatonic features in adolescents with schizophrenia with and without a comorbid pervasive developmental disorder

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A novel partial de novo duplication of JARID2 gene causing a neurodevelopmental phenotype

Publisher Copyright: © 2022 The Authors. Molecular Genetics & Genomic Medicine published by Wiley Periodicals LLC.Background: Deletions covering the entire or partial JARID2 gene as well as pathogenic single nucleotide variants leading to haploinsufficiency of JARID2 have recently been shown to cause a clinically distinct neurodevelopmental syndrome. Here, we present a previously undescribed partial de novo duplication of the JARID2 gene in a patient displaying features similar to those of patients with JARID2 loss-of-function variants. Case report: The index patient presents with abnormalities in gross motor skills and speech development as well as neuropsychiatric disorders. The patient has markedly dark infraorbital circles and slightly prominent supraorbital ridges.Whole-genome sequencing and array comparative genomic hybridization revealed a novel disease-causing variant type, a partial tandem duplication of JARID2, covering the exons 1–7. Furthermore, RNA sequencing validated the increased expression of these exons. Expression alterations were also detected in target genes of the PRC2 complex, in which JARID2 acts as an essential member. Conclusion: Our data add to the variety of different pathogenic variants associated with JARID2 neurodevelopmental syndrome.Peer reviewe

Risk factors related to self-harming behavior in Finnish adolescent inpatients with a history of non-suicidal self-injury, suicidal behavior or both

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High Beck Depression Inventory 21 scores in adolescents without depression are associated with negative self-image and immature defense style

Beck Depression Inventory (BDI) is widely used in assessing adolescents' psychological wellbeing, but occasionally the result diverges from diagnostics. Our aim was to identify factors associated with discrepancies between BDI scores and diagnostic assessment in adolescent psychiatric patients and general population. The study comprised 206 inpatients (13-17 years old) and 203 age and gender matched non -referred adolescents. Study subjects filled self-reports on depression symptoms (BDI-21), alcohol use (AUDIT), defense styles (DSQ-40) and self-image (OSIQ-11), and on background information and adverse life events. Diagnostics was based on K-SADS-PL interview, and/or clinical interview and clinical records when available. We compared subjects who scored in BDI-21 either 0-15 points or 16-63 points firstly among subjects without current unipolar depression (n = 284), secondly among those with unipolar depression (n = 105). High BDI-21 scores in subjects without depression diagnosis (n = 48) were associated with female sex, adverse life events, parents' psychiatric problems, higher comorbidity, higher AUDIT scores, worse self-image and more immature defense styles. Low BDI-21 scores among subjects with depression diagnosis (n = 23) were associated with male sex, more positive self-image and less immature defense style. In conclusion, high BDI-21 scores in the absence of depression may reflect a broad range of challenges in an adolescent's psychological development.Peer reviewe

Health care resource utilization and characteristics of patients with eosinophilic asthma in secondary health care in Finland

Background: Eosinophilic airway inflammation is common in asthma patients and appears to be associated with severe exacerbations and loss of asthma control.Objective: To describe the resource utilization and clinical characteristics of patients with eosinophilic asthma.Design: Asthma patients >= 18 years with >= 1 blood eosinophil count in secondary care (South West Finland) during 2003. 2013 were included. Clinical characteristics (age, lung function, body mass index, and comorbidities) and asthma-related resource utilization (hospital admissions, outpatient visits, and emergency room [ER] visits) were retrieved. Resource utilization rates were compared for patients with blood eosinophil 300 cells/mu L, using adjusted negative binomial regression models.Results: Overall, 4,357 eligible patients were identified (mean age 60 years, females 68%), of which 1,927 (44%) had > 300 eosinophil cells/mu L blood. Patients with 300 eosinophil counts, exhibited similar clinical characteristics, including advanced age, poor lung function, and overweight. Comorbidities such as pneumonia, sinusitis, and nasal polyps, were more frequent among those with > 300 eosinophil cells/mu L blood compared with patients with lower counts. Eosinophil counts > 300 cells/mu L were associated with greater hospital admissions (rate ratio [RR] [95% confidence interval CI]: 1.13 [1.02; 1.24]) and outpatient visits (RR [95% CI]: 1.11 [1.03; 1.20]) compared with patients with lower eosinophil counts. Rates of ER visits were similar between the patient groups (RR [95% CI]: 0.99 [0.87; 1.12]).Conclusions: Hospital admissions and outpatient visits occurred more often for patients with eosinophil counts > 300 cells/mu L, than for patients with lower eosinophil counts. Routine blood eosinophil screening might be useful to identify patients with an eosinophilic phenotype eligible for more targeted treatments

Psychometric properties of the Symptom Checklist-90 in adolescent psychiatric inpatients and age- and gender-matched community youth

Background: The Symptom Checklist-90 (SCL-90) is a questionnaire that is widely used to measure subjective psychopathology. In this study we investigated the psychometric properties of the SCL-90 among adolescent inpatients and community youth matched on age and gender. Methods: The final SCL-90 respondents comprised three subsets: 201 inpatients at admission, of whom 152 also completed the instrument at discharge, and 197 controls. The mean age at baseline was 15.0 years (SD 1.2), and 73 % were female. Differential SCL-90 item functioning between the three subsets was assessed with an iterative algorithm, and the presence of multidimensionality was assessed with a number of methods. Confirmatory factor analyses for ordinal items compared three latent factor models: one dimension, nine correlated dimensions, and a one-plus-nine bifactor model. Sensitivity to change was assessed with the bifactor model's general factor scores at admission and discharge. The accuracy of this factor in detecting the need for treatment used, as a gold standard, psychiatric diagnoses based on clinical records and the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime (K-SADS-PL) interview. Results: Item measurement properties were largely invariant across subsets under the unidimensional model, with standardized factor scores at admission being 0.04 higher than at discharge and 0.06 higher than those of controls. Determination of the empirical number of factors was inconclusive, reflecting a strong main factor and some multidimensionality. The unidimensional factor model had very good fit, but the bifactor model offered an overall improvement, though subfactors accounted for little item variance. The SCL-90s ability to identify those with and without a psychiatric disorder was good (AUC = 83 %, Glass's. = 1.4, Cohen's d = 1.1, diagnostic odds ratio 12.5). Scores were also fairly sensitive to change between admission and discharge (AUC 72 %, Cohen's d = 0.8). Conclusions: The SCL-90 proved mostly unidimensional and showed sufficient item measurement invariance, and is thus a useful tool for screening overall psychopathology in adolescents. It is also applicable as an outcome measure for adolescent psychiatric patients. SCL-90 revealed significant gender differences in subjective psychopathology among both inpatients and community youth.Peer reviewe

Effects of hormonal contraception on systemic metabolism : cross-sectional and longitudinal evidence

Background: Hormonal contraception is commonly used worldwide, but its systemic effects across lipoprotein subclasses, fatty acids, circulating metabolites and cytokines remain poorly understood. Methods: A comprehensive molecular profile (75 metabolic measures and 37 cytokines) was measured for up to 5841 women (age range 24-49 years) from three population-based cohorts. Women using combined oral contraceptive pills (COCPs) or progestin-only contraceptives (POCs) were compared with those who did not use hormonal contraception. Metabolomics profiles were reassessed for 869 women after 6 years to uncover the metabolic effects of starting, stopping and persistently using hormonal contraception. Results: The comprehensive molecular profiling allowed multiple new findings on the metabolic associations with the use of COCPs. They were positively associated with lipoprotein subclasses, including all high-density lipoprotein (HDL) subclasses. The associations with fatty acids and amino acids were strong and variable in direction. COCP use was negatively associated with albumin and positively associated with creatinine and inflammatory markers, including glycoprotein acetyls and several growth factors and interleukins. Our findings also confirmed previous results e.g. for increased circulating triglycerides and HDL cholesterol. Starting COCPs caused similar metabolic changes to those observed cross-sectionally: the changes were maintained in consistent users and normalized in those who stopped using. In contrast, POCs were only weakly associated with metabolic and inflammatory markers. Results were consistent across all cohorts and for different COCP preparations and different types of POC delivery. Conclusions: Use of COCPs causes widespread metabolic and inflammatory effects. However, persistent use does not appear to accumulate the effects over time and the metabolic perturbations are reversed upon discontinuation. POCs have little effect on systemic metabolism and inflammation.Peer reviewe