Perehdyttäminen ikääntyneiden pitkäaikaishoidossa : Sähköisen materiaalin tuottaminen

Tämän tuotokseen painottuvan opinnäytetyön tarkoituksena oli tuottaa perehdytysmalli tukemaan ikääntyneiden pitkäaikaishoidossa työskentelevää hoitohenkilökuntaa. Opinnäytetyön tavoitteena oli kehittää työhön perehdyttämisen prosessia ja tällä tavoin tukea henkilökunnan osaamista sekä ammattitaidon ylläpitämistä. Työ oli työelämälähtöinen, joten tavoitteet lähtivät työelämän tarpeesta. Opinnäytetyöhön vaikutti palvelurakenteen muutosprosessi, jota toteutetaan ikääntyneiden hoidossa. Työelämäyhteytenä toimi pirkanmaalaisen kunnan vanhainkoti. Opinnäytetyön teoriaosuuteen koottiin perustietoa perehdyttämisestä ja ikääntyneiden hoitotyöstä. Teoriatietoa käytettiin hyödyksi mallin suunnittelussa. Opinnäytetyöhön ja tuotokseen koottu tieto rajattiin käsittelemään aihealueita, jotka kirjallisuuden perusteella olivat osoittautuneet tärkeiksi. Kokonaisuuteen yhdistettiin myös työelämätahon tärkeinä pitämiä asioita. Tuotoksesta tehtiin sähköinen, muokattava ja päivitettävä malli. Sähköinen tuotos koostuu neljän kuukauden pituisesta perehdytysprosessista. Tuotoksessa on huomioitu, että prosessi on suunniteltu ikääntyneiden hoitotyöhön. Prosessiin sisältyy myös tulostettava muistilista perehdytettävälle. Opinnäytetyön kehittämisehdotukset koskevat perehdytysmateriaalin kehittämistä sekä perehdytyksen ja sen arvioinnin käytännön toteutumista. Olemme kiinnostuneita tietämään, miten perehdytys onnistuu vanhainkodissa niukoilla resursseilla toimittaessa. Sähköisen materiaalin kehittäminen päivityksien avulla on yksinkertaista lisäämällä uusia tekstejä ja linkkejä.The objective of this functional thesis was to produce an orientation model to support nursing staff working with elderly patients in long-term care. The goals of the thesis were to develop a job orientation process and to support the staff’s expertise. Practical needs dictated the goals of the thesis. The working life connection was a nursing home in Pirkanmaa area. The theory part of this study covered basic information on job orientation and elderly care. The theory part was utilized in planning the model. The theory was collected from literature. The orientation model is stored in electronic form and is therefore easily updated and modified. The electronic project is a four-month-long orientation process. It has been noted that the process is planned for care of the elderly. The process also includes a printable check list for the new employee. The development suggestions deal with improving the orientation material and issues relating to the orientation and staff evaluation in practise. We are interested in knowing how job orientation is done in a nursing home while coping with limited resources

Optimal administration of bronchodilators with valved holding chambers in preschool children: a review of literature

Our aim was to synthesize the published literature on factors that potentially affect the delivery of bronchodilators using valved holding chambers (VHC) in preschool children. We also aimed to identify those attributes that are not yet incorporated or clearly stated in the guidelines and those topics that are still lacking sufficient data. There is strong evidence supporting several recommendations in current guidelines. Based on present knowledge, bronchodilators should be delivered by VHC administering each puff separately. Face mask should be omitted as soon as the child can hold the mouthpiece of the VHC tightly between the lips and teeth. Based on the review, we suggest adding a specific note to current guidelines about the effect of chamber volume and the impact of co-operation during drug administration. Calming the child and securing a tight face-to-mask seal is critical for successful drug delivery. There is not enough evidence to make specific recommendations on the most reliable VHC and face mask for children. There is an urgent need for studies that evaluate and compare the effectiveness of VHCs in various clinical settings in wide age-groups and respiratory patterns. In addition, there is insufficient data on ideal chamber volume, material, and effective antistatic treatment. What is Known: Valved holding chambers (VHC) should not be considered interchangeable when used with pressurized metered dose inhalers (pMDI). Drug delivery is influenced by VHC volume, aerodynamic and electrostatic properties; mask fit; respiratory pattern and co-operation during inhalation; and the number of puffs actuated. What is New: The impact of co-operation, VHC volume, and good mask-to-face fit during drug inhalation is not stressed enough in the guidelines. Studies are urgently needed to evaluate the effectiveness of different VHCs in various clinical settings focusing on VHC electrostatic properties, respiratory patters, face masks, and ideal pMDI+VHC combinations.Peer reviewe

Associations Between Maternal Antenatal Corticosteroid Treatment and Psychological Developmental and Neurosensory Disorders in Children

Peer reviewe

Lasten kurkunpäätulehdus

Kurkunpäätulehdus (laryngiitti) on virustauti, jonka tavallisimpia aiheuttajia ovat parainfluenssavirukset. Lasten kurkunpäätulehduksen diagnoosi on kliininen, ja tyypillisiä oireita ovat kuiva, usein haukkuva yskä sekä sisäänhengityksen vinkuna ja vaikeutuminen. Kurkunpäätulehduksen tyypillinen esiintymisikä on 0,5-3 vuotta. Alle vuoden ikäisillä tulee muistaa kurkunpään rakenteelliset ja toiminnalliset poikkeavuudet, jotka aiheuttavat kurkunpäätulehdusta muistuttavia oireita infektion yhteydessä. Suurin osa lasten kurkunpäätulehduksista voidaan hoitaa kotona. Suun kautta annettava glukokortikoidi ja inhaloituna annettava raseeminen adrenaliini ovat tehokkaita lääkkeitä päivystyksessä

Lämmönsiirron kokeellinen määrittäminen radiaalisissa suljetuissa systeemeissä

The objective of this study was to design and conduct an easily reproducible test method to find out the thermal conductivities of different refractory materials. Another objective was to investigate the interfacial thermal resistances between the steel pipe and the refractory layer to receive better information of the total heat transfer coefficient from the outside surface of the refractory to the insides of the steel pipe. The test system consisted of an insulated cylindrical oven and a water distribution system with adjustable levels for the temperature, pressure and volume flow of the water circulating inside the test tube. Three different refractory masses were examined as they were casted on top of steel tubes and one of the masses was also used in a test tube with studs installed onto it to examine their effect onto the heat transfer. In addition to the thermal conductivity of the refractory mass the interfacial conductance between the steel pipe and the refractory was examined. After some adjustments and modifications of the equipment, the test procedures turned out to be well working and easily repeatable. The test results showed that the received thermal conductivity values were close to the estimates given by the material providers and the steel studs inside the refractory had a notable effect onto the overall heat transfer coefficient of the test tube system. Minor gap formation happened at the interface without studs, which was seen as the increase in the thermal resistance at the interface during the test runs. The obtained values for interfacial conductance cannot be used as such because they vary due to multiple things that cannot be controlled during the installation such as the contact pressure between the layers. Nevertheless, the phenomena of gap formation itself is an important thing to take into account. In conclusion, a test procedure for the testing of the thermal conductivity of a refractory in a cylindrical system was planned and executed and the procedure worked as it was planned as trustworthy and repeatable test results were obtained. Thus, the equipment can be used also in the future to examine the heat transfer of different masses or other type of cylindrical multi-layer systems

Lasten vaikeat A-streptokokki-infektiot

Vaikeat A-ryhmän streptokokki-infektiot lisääntyvät kaikkialla maailmassa.Vesirokko on lapsilla tärkein yksittäinen altistava tekijä. Myös pienet ihorikkoumat, leikkaus, tylppä vamma tai A-streptokokin aiheuttama tauti perheenjäsenellä lisäävät riskiä.Infektiofokus voi olla missä kohdassa elimistöä tahansa. Pehmytosan vaikea kipu voi olla diagnostinen vihje invasiivisesta streptokokki-infektiosta.Nopea hoidon aloitus beetalaktaamin ja klindamysiinin yhdistelmällä ja tarvittaessa kirurginen fokuksen avaus nopeuttavat paranemista ja vähentävät kuolleisuutta

Severe hospital-acquired hyponatremia in acutely ill children receiving moderately hypotonic fluids

Background Hypotonic fluids have been associated with hospital-acquired hyponatremia. The incidence of life-threatening severe hyponatremia associated with hypotonic fluids has not been evaluated. Methods This was a population-based cohort study of 46,518 acutely ill children 15 years of age or under who visited the pediatric emergency department (ED) at Oulu University Hospital, Finland, between 2007 and 2017. We retrieved all electrolyte measurements from the comprehensive electronic laboratory system and reviewed medical records for all patients with severe hyponatremia. Results The overall occurrence of severe hyponatremia (serum sodium < 125 mmol/L) was found in 27 out of 46,518 acutely ill children (0.06%, 95% confidence interval 0.04-0.08%). After admission, severe hyponatremia developed in seven of 6,984 children receiving moderately hypotonic fluid therapy (0.1%, 95% confidence interval 0.04-0.2%), usually within 8 h of admission. All children who developed severe hyponatremia during hospitalization were severely ill. Conclusion In this register-based cohort study of children presenting to the ED, severe hyponatremia developed in one of 998 acutely ill children receiving moderately hypotonic fluid therapy.Peer reviewe

Severe hospital-acquired hyponatremia in acutely ill children receiving moderately hypotonic fluids

Background Hypotonic fluids have been associated with hospital-acquired hyponatremia. The incidence of life-threatening severe hyponatremia associated with hypotonic fluids has not been evaluated. Methods This was a population-based cohort study of 46,518 acutely ill children 15 years of age or under who visited the pediatric emergency department (ED) at Oulu University Hospital, Finland, between 2007 and 2017. We retrieved all electrolyte measurements from the comprehensive electronic laboratory system and reviewed medical records for all patients with severe hyponatremia. Results The overall occurrence of severe hyponatremia (serum sodium < 125 mmol/L) was found in 27 out of 46,518 acutely ill children (0.06%, 95% confidence interval 0.04-0.08%). After admission, severe hyponatremia developed in seven of 6,984 children receiving moderately hypotonic fluid therapy (0.1%, 95% confidence interval 0.04-0.2%), usually within 8 h of admission. All children who developed severe hyponatremia during hospitalization were severely ill. Conclusion In this register-based cohort study of children presenting to the ED, severe hyponatremia developed in one of 998 acutely ill children receiving moderately hypotonic fluid therapy.Peer reviewe