Perustason sairaankuljettajien elvytysosaaminen : elvytysosaamista arvioivan mittarin luotettavuuden ja käyttökelpoisuuden arviointi, osa I ja II

Opinnäytetyömme on osa Keski-Uudenmaan pelastuslaitoksen KUOSCE -hanketta, jonka tarkoitukse-na on selvittää perustason sairaankuljettajien taitoja hoitamisen ja tutkimisen eri osa-alueilla, sekä luoda perustason osaamisen kehittymisen malli ensihoidon koulutukseen ja Keski-Uudenmaan pelastuslaitok-sen käyttöön. Opinnäytetyön tarkoituksena on kuvata tutkittuun tietoon perustuen, minkälaista elvytysosaamista perustason sairaankuljettajat tarvitsevat. Toisena tarkoituksena on arvioida elvytysosaamista arvioivan mittarin luotettavuutta ja käyttökelpoisuutta. Olemme kuvanneet kirjallisuuskatsauksessamme tutkimuksiin perustuen elvytyksessä tarvittavaa osaamista sekä osaamisessa todettuja puutteita niin sairaalassa kuin sen ulkopuolisessa ensihoidossa. Tutkimuksissa todettiin, että sairaankuljettajien elvytystaidoissa on paljon parannettavaa. Lähes jokaisella osa-alueella on osaamispuutteita. Elottomuuden tunnistamiseen kuluu liian pitkä aika, painelupaikka määritellään väärin, oikean painelusyvyyden hallitsemisessa on vaikeuksia, ventilaation oikean suhteen toteuttaminen on käytännössä vaikeaa. Tutkimusten mukaan sairaankuljettajien tiedolliset taidot elvytystilanteissa ovat hyvät, mutta käytännön taidoissa on parannettavaa. Mittarin luotettavuuden ja käyttökelpoisuuden arvioimiseksi järjestimme Helsingin ammattikorkeakoulu Stadian valmistuville ensihoitajaopiskelijoille (n=16) simuloidun elvytystilanteen Antti- elvytysnukella. Totesimme mittarin olevan pääosin luotettava, mutta havaitsimme mittarissa olevan myös sen luotettavuutta heikentäviä tekijöitä, kuten arvioijien eriävä mielipide testaustilanteessa johtuen mittarin vaikeasta seurattavuudesta.

Julnatten. Piano I och II

Soitinnus: urut, pianot (2).

Psalmus I ja II

Digitoitu 26. 5. 2008.

Ethnographisk kart over Finmarken n:o 1 : præstegjældene : I Vardö, II Vadsö, og en deel af III Næsseby og IV Lebesby

Kartta kuuluu A. E. Nordenskiöldin kokoelmaan

Ethnographisk kart over Finmarken n:o 3 : præstegjældene : I Alten, II Koutokæino, III Hammerfest og en deel af IV Skjærvö, V Loppen og VI Maasö

Kartta kuuluu A. E. Nordenskiöldin kokoelmaan

De cognitione Dei et Christi usum rationis supponente, locos Joh. XVII:3. & I Cor. II:14. illustratura

Invokaatio: D.D.

De unctione omnia docente, I Joh. II: 27

Invokaatio: Q.B.V.J.D.T.O.M.

De lapidibus viventibus, I. Pet. II:5

Invokaatio: I.N.J.

Cardiac Troponin Specific Autoantibodies: Analytical Tools for Exploring Their Impact on Cardiac Troponin I Testing

Cardiac troponin (cTn) I and T are the recommended biomarkers for the diagnosis and risk stratification of patients with suspected acute coronary syndrome (ACS), a major cause of cardiovascular death and disability worldwide. It has recently been demonstrated that cTn-specific autoantibodies (cTnAAb) can negatively interfere with cTnI detection by immunoassays to the extent that cTnAAb-positive patients may be falsely designated as cTnI-negative. The aim of this thesis was to develop and optimize immunoassays for the detection of both cTnI and cTnAAb, which would eventually enable exploring the clinical impact of these autoantibodies on cTnI testing and subsequent patient management. The extent of cTnAAb interference in different cTnI assay configurations and the molecular characteristics of cTnAAbs were investigated in publications I and II, respectively. The findings showed that cTnI midfragment targeting immunoassays used predominantly in clinical practice are affected by cTnAAb interference which can be circumvented by using a novel 3+1-type assay design with three capture antibodies against the N-terminus, midfragment and C-terminus and one tracer antibody against the C-terminus. The use of this assay configuration was further supported by the epitope specificity study, which showed that although the midfragment is most commonly targeted by cTnAAbs, the interference basically encompasses the whole molecule, and there may be remarkable individual variation at the affected sites. In publications III and IV, all the data obtained in previous studies were utilized to develop an improved version of an existing cTnAAb assay and a sensitive cTnI assay free of this specific analytical interference. The results of the thesis showed that approximately one in 10 patients with suspected ACS have detectable amounts of cTnAAbs in their circulation and that cTnAAbs can inhibit cTnI determination when targeted against the binding sites of assay antibodies used in its immunological detection. In the light of these observations, the risk of clinical misclassification caused by the presence of cTnAAbs remains a valid and reasonable concern. Because the titers, affinities and epitope specificities of cTnAAbs and the concentration of endogenous cTnI determine the final effect of circulating cTnAAbs, appropriately sized studies on their clinical significance are warranted. The new cTnI and cTnAAb assays could serve as analytical tools for establishing the impact of cTnAAbs on cTnI testing and also for unraveling the etiology of cTn-related autoimmune responses.

Kjærlighet i forbundethet : en kraft i gamle menneskers åndelighet og verdighet

The thesis is rooted in caring science and the notion that the human being is an indivisible unity of body, soul and spirit. The purpose is to search for new, or expanded knowledge and understanding of the substance of the human’s spiritual space, as well as aspects that may constitute a foundation for the safeguard of human dignity. The clinical research study concerns the importance of spirituality and dignity in the care for older people. The thesis consists of three substudies with four articles, and the methodology is based on Gadamer’s philosophical hermeneutics. Through a metasynthesis of 17 research articles, sub-study I searched for understanding of the concept of spirituality as it may appear in reality (deduction). 17 older people were interviewed in sub-study II. This sub-study sought understanding for spirituality and dignity in the specific reality (induction). Sub-study III searched for theory development regarding spirituality, through a literature review of 20 research articles and a text by Tillich (abduction). The findings imply that spirituality entails human beings’ connectedness with one’s inner space and connectedness beyond oneself. Love in connectedness appears as a force in both spirituality and dignity. Themes portrayed include understanding of the spiritual space, religiousness, dignity, and spiritual care. The relationship between dignity and spirituality can be seen in the confirmation of human worth and care for the whole human being, including the spiritual dimension, and this is understood as a prerequisite for perceived dignity. It seems to be important that older people feel valued, loved, not abandoned, and alive. The theoretical model portrays love as a reunifying and connecting force that may foster confirmation, serving, longing and holiness. The movement towards connectedness may create room for the human being’s perception of dignity and holiness, and as such, it may be a force in the search for wholeness and becoming in health.

Graduale (MS A.ö.II.41, "Graduale Uskelense")

Complete critical and codicological description of the book and its contents available in the Codices Fennici -database.