Nanoparticle-Assisted Immunoassays for Point-of-Care Testing - With Specific Interest in Minimally Interference-Prone Assays for Cardiac Troponin I

Cardiac troponins (cTn) I and T are the current golden standard biochemical markers in the diagnosis and risk stratification of patients with suspected acute coronary syndrome. During the past few years, novel assays capable of detecting cTn‐concentrations in >50% of apparently healthy individuals have become readily available. With the emerging of these high sensitivity cTn assays, reductions in the assay specificity have caused elevations in the measured cTn levels that do not correlate with the clinical picture of the patient. The increased assay sensitivity may reveal that various analytical interference mechanisms exist. This doctoral thesis focused on developing nanoparticle‐assisted immunometric assays that could possibly be applied to an automated point‐of‐care system. The main objective was to develop minimally interference‐prone assays for cTnI by employing recombinant antibody fragments. Fast 5‐ and 15‐minute assays for cTnI and D‐dimer, a degradation product of fibrin, based on intrinsically fluorescent nanoparticles were introduced, thus highlighting the versatility of nanoparticles as universally applicable labels. The utilization of antibody fragments in different versions of the developed cTnI‐assay enabled decreases in the used antibody amounts without sacrificing assay sensitivity. In addition, the utilization of recombinant antibody fragments was shown to significantly decrease the measured cTnI concentrations in an apparently healthy population, as well as in samples containing known amounts of potentially interfering factors: triglycerides, bilirubin, rheumatoid factors, or human anti‐mouse antibodies. When determining the specificity of four commercially available antibodies for cTnI, two out of the four cross‐reacted with skeletal troponin I, but caused crossreactivity issues in patient samples only when paired together. In conclusion, the results of this thesis emphasize the importance of careful antibody selection when developing cTnI assays. The results with different recombinant antibody fragments suggest that the utilization of antibody fragments should strongly be encouraged in the immunoassay field, especially with analytes such as cTnI that require highly sensitive assay approaches.

Spectrally Tuned Lanthanide Photoluminescence for Point-of-Care Testing

Point-of-care (POC) –diagnostics is a field with rapidly growing market share. As these applications become more widely used, there is an increasing pressure to improve their performance to match the one of a central laboratory tests. Lanthanide luminescence has been widely utilized in diagnostics because of the numerous advantages gained by the utilization of time-resolved or anti-Stokes detection. So far the use of lanthanide labels in POC has been scarce due to limitations set by the instrumentation required for their detection and the shortcomings, e.g. low brightness, of these labels. Along with the advances in the research of lanthanide luminescence, and in the field of semiconductors, these materials are becoming a feasible alternative for the signal generation also in the future POC assays. The aim of this thesis was to explore ways of utilizing time-resolved detection or anti-Stokes detection in POC applications. The long-lived fluorescence for the time-resolved measurement can be produced with lanthanide chelates. The ultraviolet (UV) excitation required by these chelates is cumbersome to produce with POC compatible fluorescence readers. In this thesis the use of a novel light-harvesting ligand was studied. This molecule can be used to excite Eu(III)-ions at wavelengths extending up to visible part of the spectrum. An enhancement solution based on this ligand showed a good performance in a proof-of-concept -bioaffinity assay and produced a bright signal upon 365 nm excitation thanks to the high molar absorptivity of the chelate. These features are crucial when developing miniaturized readers for the time-resolved detection of fluorescence. Upconverting phosphors (UCPs) were studied as an internal light source in glucose-sensing dry chemistry test strips and ways of utilizing their various emission wavelengths and near-infrared excitation were explored. The use of nanosized NaYF :Yb3+,Tm3+-particles enabled the replacement of an external UV-light source with a NIR-laser and gave an additional degree of freedom in the optical setup of the detector instrument. The new method enabled a blood glucose measurement with results comparable to a current standard method of measuring reflectance. Microsized visible emitting UCPs were used in a similar manner, but with a broad absorbing indicator compound filtering the excitation and emission wavelengths of the UCP. This approach resulted in a novel way of benefitting from the non-linear relationship between the excitation power and emission intensity of the UCPs, and enabled the amplification of the signal response from the indicator dye.

Biomarkkerit sepsiksen diagnostiikassa sekä Kvantitatiivisen prokalsitoniini-immunomäärityksen pystyttäminen ja optimointi point-of-care-ympäristöön

Termiä sepsis käytetään infektion aiheuttamasta yleisestä tulehdusreaktio-oireyhtymästä. Biokemiallinen merkkiaine eli biomarkkeri on aine, joka objektiivisesti mitattuna ja arvioituna toimii indikaattorina erottaen toisistaan normaalit biologiset prosessit ja patogeeniset prosessit. Lisäksi biomarkkeri saattaa osoittaa farmakologisen vasteen lääkehoidolle. Tutkielman kirjallisessa osassa on esitelty ja verrattu toisiinsa jo kliinisessä käytössä olevia sekä lupaavia, vielä tutkimusvaiheessa olevia, sepsiksen biomerkkiaineita. Lisäksi tutkielmassa on tarkasteltu sepsiksen todentamisen, tunnistamisen ja hoidon tulevaisuudennäkymiä. Prokalsitoniini (PCT) on eräs jo kliinisessä käytössä oleva sepsiksen biomerkkiaine. Tutkielman kokeellisessa osassa pystytettiin teho-osastoille suunnattu pikatesti PCT:n mittaamiseen aikaerotteista fluoresenssiteknologiaa hyödyntävälle AQT-järjestelmälle (DHR Finland Oy, Innotrac Diagnostics, Suomi). Järjestelmä mittaa 20–30 minuutissa biomerkkiainepitoisuuden. Tavoitteena oli löytää sopiva vasta-ainepari ja pystyttää kaksipuoleinen immunomääritys, jonka analyyttinen herkkyys on alle 0,02 ng/ml:ssa. Työssä tutkittiin biotinyloidun kokonaisen vasta-aineen ja paikkaspesifisesti biotinyloidun antigeenia sitovan fragmentin (engl. fragment antigen binding, Fab) toimivuutta sitojamolekyylinä. Lisäksi työssä verrattiin kahden eri leimamolekyylin, 9 hampaisen europiumkelaatin sekä Innotracissa kehitetyn tähtikelaatin, toimivuutta PCT-immunomäärityksessä. Vasta-aineiden mahdolliset ristireaktiot testattiin ja määritystä testattiin alustavasti eri näytematriiseissa. Työssä löydettiin 5 vasta-aineparia, joiden analyyttinen herkkyys oli alle 0,02 ng/ml:ssa. Aiemmin testattuja vasta-ainepareja parempi analyyttinen herkkyys johtui todennäköisesti yhden uuden leimavasta-aineen paremmasta affiniteetistä. Tähtikelaatilla leimatulla vasta-aineella analyyttinen herkkyys parani lähes viisinkertaisesti, kun sitä verrattiin 9-hampaisella euroopiumkelaatilla leimatun vasta-aineen määritykseen. Havaittiin myös, että Fab-fragmentilla mitattiin määrityksissä lähes kaksi kertaa suuremmat signaali-taustasuhteet, kun sitä verrattiin kokonaiseen vasta-aineeseen, tietyllä vasta-aineparilla. Tämä johtui luultavasti steeristen esteiden vähenemisestä. Näytematriisilla ei todettu olevan vaikutusta määritykseen, eikä ristireaktioita havaittu. Kehitetyn määrityksen suoriutumista verrattiin markkinoilla olevaan BRAHMS AG:n (Saksa) PCT-määritykseen käyttäen potilasnäytteitä. Korrelaatiokertoimet potilasnäytevertailuissa olivat 0,965–0,989 ja näytteiden mitatuissa pitoisuuksissa oli tasoero.

Muistipotilaan tarkoituksenmukaisen hoitopaikan määrittäminen Balance of Care -menetelmällä

Tutkimuksen tarkoituksena oli kuvata Balance of Care (BoC) -menetelmän käyttöä ikääntyneen muistipotilaan tarkoituksenmukaisen hoitopaikan määrittelyssä. Tutkimuksen avulla pyrittiin selvittämään miten yhtenäinen on asiantuntijoiden muodostama käsitys ikääntyneen muistipotilaan tarkoituksenmukaisesta hoitopaikasta, sekä mitkä tekijät vaikuttavat asiantuntijoiden päätöksentekoon muodostettaessa tarkoituksenmukaisia hoitopaikkoja. Tutkimus on osa kansainvälistä EU:n rahoittamaa RightTimePlaceCare -projektia (RTPC), jonka tavoitteena on kehittää muistisairaiden ikääntyneiden hoitokäytänteitä tilanteisiin, joissa pohditaan tarkoituksenmukaisinta hoitopaikkaa. Tutkimuksessa tarkasteltiin asiantuntijoiden (N = 27) päätöksentekoa käytettäessä BoC -menetelmää. Tutkimus toteutettiin viidessä kunnassa, jossa kussakin kokoontui yksi asiantuntijaryhmä pohtimaan BoC -menetelmän avulla tarkoituksenmukaista hoitopaikkaa 14 esimerkkitapaukselle. Esimerkkitapaukset kuvasivat tyypillisiä ikääntyneitä muistipotilaita. Kukin asiantuntijaryhmä tutustui seitsemään esimerkkitapaukseen. Jokaista esimerkkitapausta arvioi kaksi tai kolme asiantuntijaryhmää. Asiantuntijat valitsivat ja kirjasivat ensin itsenäisesti hoitopaikan esimerkkitapaukselle, tämän jälkeen asiantuntijat keskustelivat ryhmässä ja pyrkivät muodostamaan konsensuksen tarkoituksenmukaisesta hoitopaikasta sekä mahdollisesti tarvittavista palveluista. Myös nämä kirjattiin. Aineisto analysoitiin kvantifioimalla ja induktiivisesti teemoittelemalla. Asiantuntijoiden itsenäisesti muodostamissa hoitopaikkapäätöksissä oli paljon eroja. Ainoastaan yhden esimerkkitapauksen (7 %) kohdalla asiantuntijoiden päätös oli yksimielinen. Osalle asiantuntijoista tuotti vaikeuksia valita vaihtoehdoista vain yksi hoitopaikka ikääntyneelle muistipotilaalle. Asiantuntijaryhmien päätökset olivat yhtenäisempiä, kuin yksittäisten asiantuntijoiden. Ryhmät päätyivät täysin yhteneviin hoitopaikkasuosituksiin seitsemän esimerkkitapauksen (50 %) kohdalla. Tulosten mukaan ikääntyneen muistipotilaan hoitopaikkaa koskevat päätökset olisi järkevää toteuttaa moniammatillisissa asiantuntijaryhmissä, näin saavutetaan yhdenmukaisempia hoitopäätöksiä. Sekä asiantuntijoiden että asiantuntijaryhmien päätöksistä suurin osa painottui kotihoitoon, joten suurinta osaa tässä tutkimuksessa mukana olleista ikääntyneistä muistipotilasta voidaan hoitaa palveluiden turvin kotona. Asiantuntijoiden päätöksentekoon vaikuttavat tekijät muodostuivat muistipotilaan hoidon tukipalveluista, fyysisestä hoitoympäristöstä, muistipotilaan läheisistä ja ikääntyneestä muistipotilaasta. Tutkimuksen avulla saatua tietoa voidaan hyödyntää päätöksenteon tukena määritettäessä tarkoituksenmukaista hoitopaikkaa ikääntyneelle muistipotilaalle sekä suunniteltaessa menetelmää muistipotilaan hoidon koordinointiin.

Expectations of elderly people on the nurse-client relationship and interaction in home care : "When I see the nurse's smiling face it feels likes sunshine on a rainy and gloomy day"

The purpose of the thesis was to explore expectations of elderly people on the nurse-client relationship and interaction in home care. The aim is to improve the quality of care to better meet the needs of the clients. A qualitative approach was adopted. Semi-structured theme interviews were used for data collection. The interviews were conducted during spring 2006. Six elderly clients of a private home care company in Southern Finland acted as informants. Content analysis was used as the method of data analysis. The findings suggest that clients expect nurses to provide professional care with loving-kindness. Trust and mutual, active interaction were expected from the nurse-client relationship. Clients considered it important that the nurse recognizes each client's individual needs. The nurse was expected to perform duties efficiently, but in a calm and unrushed manner. A mechanic performance of tasks was considered negative. Humanity was viewed as a crucial element in the nurse-client relationship. Clients expressed their need to be seen as human beings. Seeing beyond the illness was considered important. A smiling nurse was described to be able to alleviate pain and anxiety. Clients hoped to have a close relationship with the nurse. The development of a close relationship was considered to be more likely if the nurse is familiar and genuine. Clients wish the nurses to have a more attending presence. Clients suggested that the work areas of the nurses could be limited so that they would have more time to transfer from one place to another. Clients felt that they would benefit from this as well. The nurses were expected to be more considerate. Clients wished for more information regarding changes that affect their care. They wished to be informed about changes in schedules and plans. Clients hoped for continuity from the nurse-client relationship. Considering the expectations of clients promotes client satisfaction. Home care providers have an opportunity to reflect their own care behaviour on the findings. To better meet the needs of the clients, nurses could apply the concept of loving-kindness in their work, and strive for a more attending presence.

Coercion, Perceived Care and Quality of Life Among Patients in Psychiatric Hospitals

The goals of the study were to describe patients’ perceptions of care after experiencing seclusion/restraint and their quality of life. The goal was moreover to identify methodological challenges related to studies from the perspective of coerced patients. The study was conducted in three phases between September 2008 and April 2012. In the first phase, the instrument Secluded/ Restrained Patients’ Perception of their Treatment (SR-PPT) was developed and validated in Japan in cooperation with a Finnish research group (n = 56). Additional data were collected over one year from secluded/restrained patients using the instrument (n = 90). In the second phase, data were collected during the discharge process (n = 264). In the third phase, data were collected from electronic databases. Methodological and ethical issues were reviewed (n = 32) using systematic review method. Patients perceived that co-operation with the staff was poor; patients’ opinions were not taken into account, treatment targets collated and treatment methods were seen in different ways. Patients also felt that their concerns were not well enough understood. However, patients received getting nurses’ time. In particular, seclusion/restraint was considered unnecessary. The patients felt that they benefited from the isolation in treating their problems more than they needed it, even if the benefit was seen to be minor. Patients treated on forensic wards rated their treatment and care significantly lower than in general units. During hospitalization secluded/restrained patients evaluated their quality of life, however, better than did non-secluded/restrained patients. However, no conclusion is drawn to the effect that the better quality of life assessment is attributable to the seclusion/restraint because patients’ treatment period after the isolation was long and because of many other factors, as rehabilitation, medication, diagnostic differences, and adaptation. According to the systematic mixed studies review variation between study designs was found to be a methodological challenge. This makes comparison of the results more difficult. A research ethical weakness is conceded as regards descriptions of the ethical review process (44 %) and informed consent (32 %). It can be concluded that patients in psychiatric hospital care and having a voice as an equal expert require special attention to clinical nursing, decision-making and service planning. Patients and their family members will be consulted in plans of preventive and alternative methods for seclusion and restraint. The study supports the theory that in ethical decision-making situations account should be taken of medical indications, in addition to the patients’ preferences, the effect of treatment on quality of life, and this depends on other factors. The connection between treatment decisions and a patient’s quality of life should be evaluated more structurally in practice. Changing treatment culture towards patients’ involvement will support daily life in nursing and service planning taking into account improvements in patients’ quality of life.

Quality of radiotherapy care by development of e-feedback knowledge

The aim of this three phase study was to develop quality of radiotherapy care by the e-Feedback knowledge of radiotherapy -intervention (e-Re-Know). In Phase I, the purpose was to describe the quality of radiotherapy care and its deficits experienced by cancer patients. Based on the deficits in patient education in Phase II, the purpose was to describe cancer patients’ e-knowledge expectations in radiotherapy. In Phase III, the purpose was to develop and evaluate the outcomes of the e-Re-Know among breast cancer patients. The ultimate aim was to develop radiotherapy care to support patients’ empowerment with patient e-education. In Phase I (2004-2005), the descriptive design was used, and 134 radiotherapy patients evaluated their experiences by Good Nursing Care Scale for Patients (GNCS-P) in the middle of RT period. In Phase II (2006-2008), the descriptive longitudinal design was used and 100 radiotherapy patients’ e-knowledge expectations of RT were evaluated using open-ended questionnaire developed for this study before commencing first RT, in the middle of the treatment, and concluding RT period. In Phase III, firstly (2009-2010), the e-Re-Know intervention, i.e. knowledge test and feedback, was developed in terms of empowering knowledge and implemented with e-feedback approach based on literature and expert reviews. Secondly (2011-2014), the randomized controlled study was used to evaluate the e-Re-Know. Breast cancer patients randomized to either the intervention group (n=65) receiving the e-Re-Know by e-mail before commencing first RT and standard education or the control group (n=63) receiving standard education. The data were collected before commencing first RT, concluding last RT and 3 months after last RT using RT Knowledge Test, Spielberger’s State Trait Inventory (STAI) and Functional Assessment of Cancer Therapy - Breast (FACT-B) –instruments. Data were analyzed using statistical methods and content analysis. The study showed radiotherapy patients experienced quality of care high. However, there were deficits in patient education. Furthermore, radiotherapy patients’ multidimensional e-knowledge expectations through Internet covered mainly bio-physiological and functional knowledge. Thus, the e-Re-Know was developed and evaluated. The study showed when breast cancer patients’ carried out the e-Re-Know their knowledge of side effects self-care was significantly increased and quality of life (QOL) significantly improved in line with decrease in anxiety from time before radiotherapy period to three months after. In addition, the e-Re-Know has potential to have positive effects on anxiety and QOL, regardless of patient characteristics or knowledge level. The results support the theory of empowering patient education suggesting that empowerment can be supported by confirming patients’ understanding of own knowledge level. In summary, the e-Feedback knowledge of radiotherapy (e-Re-Know) intervention can be recommended in development of quality of radiotherapy care experienced by breast cancer patients. Further research is needed to assess and develop patient-centred quality of care by patient education among cancer patients.

Continuity of patient care in day surgery

Continuity is a part of high-quality patient care. The purpose of this study was to analyse what factors are important in the continuity of patients’ care, and how well continuity is achieved in different stages of the care of day surgical patients. Day surgery has become significantly more prevalent in the past few decades, and in order for it to be carried out successfully, continuity in care is particularly essential. The study was carried out in two stages. In the first stage (2001–2005) of the study, continuity was examined through a review of literature from the perspective of critical pathways, naming the continuity categories of time flow, coordination flow, caring relationship flow, and information flow. The first stage also entailed an analysis of matters important to the patient and problems concerning the achievement of care continuity, carried out by interviewing 25 day surgical patients. In the second stage (2006–2015), the degree to which the continuity of day surgical patient care was achieved was analysed from the perspective of patients (n=203, 58%) and nurses working in day surgery units (n=83, 69%), and suggestions for developing the continuity of day surgery patient care were made. In this study continuity of care was examined through a review of literature from the perspective of critical pathways, naming the continuity categories of time flow, coordination flow, caring relationship flow, and information flow. Within these categories, several important factors for the patient were found. According to both patients and nurses, continuity of care is generally achieved to a high degree. Continuity of care is improved by patients being acquainted with and meeting the staff attending to them (nurse and surgeon) before and after the operation. From patients’ perspective, there is room for improvement especially in terms of being admitted to care and in the carer-patient relationship. From nurses’ perspective, there is room for improvement in terms of the smoothness of care. Nurses evaluated the continuity of care to be the least successful before and after the operation. An extensive social and health care reform is planned in Finland in the coming years, aiming to enhance social and health care services and to create smoothly functioning service and care. As a topic of further study supporting the development of the service system, it is important to follow the patient’s progress throughout the entire chain of care, e.g. as a case study. On the other hand, there is also a need to study the views of nurses and other health care professionals in health care, e.g. in primary health care.

The role of emotions in value creation for families in pediatric health care

The purpose of this study was to analyze emotions related to a child’s critical illness from the perspective of the family and discuss the link those emotions might form with value creation. High quality service is of paramount importance in hospital care, especially when a child is diagnosed with critical illness. Through the analysis of patient family emotions and their triggers, the study was aiming to deepen the understanding of value creation for customer. Therefore, the research sought to find answers to the following three sub-questions: 1. What are the emotions experienced? 2. What triggers them? 3. How are the emotions linked to amelioration or aggravation of value for patient and family? The theoretical background of this research is built on two core concepts: emotions and value creation. As both concepts are wide and multifaceted, the research concentrates on viewing emotions from the applicable cognitive angle, identifying and categorizing emotions in a general level. Value creation is studied from the service perspective, discussing the possible relations between emotions and value creation. Moreover, the suitability of views regarding customer value co-creation to health care encounters is analyzed. Qualitative approach was selected as the most appropriate methodology for conducting the empirical research. The empirical data was collected from public blogs, for which a total of 18 blogs were reviewed. Five blogs were selected for the analysis, which had the intent of identifying the emotions experienced by patient families and deepening the knowledge of their role in value creation during health care service encounters. The empirical study of this research discovered a wide range of positive and negative emotions, which denotes that a severe life situation does not prevent the feeling of positive emotions. Furthermore, by combining the empirical findings to the theoretical background, this study concludes that recognizing and treating the patient family as a partner and value creator is essential. The high quality technical aspect of care is vital, but it is not the sole attribute for service quality, as the interpersonal communication plays a large role in the customer’s overall assessment of the health care performance. The patients and their families largely evaluate the service encounter based on their perceptions, thus emotions play a significant role. Depending on the service experience, value maybe created or destructed. Hence, this study posits emotion at the core of the service encounter, indicating towards the importance of active assessment of customer perceptions and the recognition of the emotional states

International nursing : cultivating a culture of empowerment

International nursing has been a growing phenomenon throughout the globe. International nurses have been found to be an asset to healthcare organizations and an important part of the health care team. However, growing concern for the plight of international nurses facing obstacles such as professional stagnation and exploitation has spurred the development of strategies to mitigate and ameliorate the experiences of nurses working abroad. In this respect, the purpose of this study was to explore the management-influenced factors and the nurse team-influenced factors that promote the empowerment of the international nurse in the health care setting. The methodology used in this study was a systemic review. After a rigorous search for relevant empirical studies using OVID database, eight empirical research studies were selected using systematic review methodology to collect, analyze and synthesize data. The selected eight empirical studies were then subjected to a content analysis. The results suggested that the empowerment of an international nurse is inseparable from the empowerment of the health care organization. Based on the findings in this study, strategies to promote international nurses were found to mirror strategies evidenced to empower the nursing organization. Some of the management-influenced factors which were found to facilitate empowerment included a diversity rich work culture, transformational leadership at the management level, and a responsibility to foster the values of the organization. The team-influenced factors which were found to contribute to the empowerment of the international nurse included a united mutually-interdependent nurse team, shared accountability among the members of the nurse team, and the building of trust in work relationships. To conlude, this study indicates that efforts to empower international nurses without considering the work culture and the organization as a whole are futile because empowerment cannot take place in an environment that lacks antecedent conditions. Strategies to empower the international nurse should not focus on the deficits and special needs of the international nurse, but should focus on the similarities and commonalities of the nursing body. Empowerment of the international nurse mean open honest communication, supportive work environment, and a firm policy to quell disruptive elements that threaten the organization's values, mission, and philosophy of care.

Patient-perceived health-related quality of life during recovery after total hip arthroplasty – a 6-month follow-up study

Potilaiden käsitys terveyteen liittyvästä elämänlaadusta lonkan tekonivelleikkauksen jälkeisenä toipumisaikana – kuuden kuukauden seurantatutkimus Tässä kaksivaiheisessa seurantatutkimuksessa tarkasteltiin potilaiden käsitystä terveyteen liittyvästä elämänlaadusta lonkan tekonivelleikkauksen jälkeisenä toipumisaikana. Tutkimuksen ensimmäisessä vaiheessa tarkoituksena oli sekä kuvailla potilaiden kokemuksia potilaana olosta, saamastaan hoidosta ja terveyspalveluorganisaatiosta että analysoida aikaisempien tutkimusten perusteella leikkauksen tuloksia potilaan kannalta. Toisessa vaiheessa tarkoituksena oli arvioida potilaiden kokemaa elämänlaatua leikkauksen jälkeen, ja sitä vaikuttivatko primaaritulokset (fyysinen toimintakyky, kipu, ahdistus) tai taloudelliset seuraukset (potilaiden itsensämaksamat kustannukset, palvelujen käyttö) terveyteen liittyvään elämänlaatuun. Tutkimuksen tavoitteena oli löytää mahdolliset kriittiset ajankohdat tai tekijät, jotka saattavat hidastaa toipumista ja siten huonontaa potilaiden elämänlaatua. Tätä tietoa voidaan käyttää hoitotyössä kun suunnitellaan sopivaa hoitoa ja tukea toipumisajalle. Tutkimuksen ensimmäisessä vaiheessa primaarileikkaukseen tulevat potilaat (n = 17) kuvailivat teemahaastatteluissa kokemuksiaan kahdesti leikkauksen jälkeen. Haastatteluaineisto analysoitiin induktiivisella sisällönanalyysilla. Lisäksi 17 tutkimusartikkelista analysoitiin deduktiivisella sisällönanalyysilla leikkauksen tuloksia potilaalle, tuloksiin vaikuttavia tekijöitä ja käytetyt tutkimusmetodit. Toisessa vaiheessa primaari- tai revisioleikkaukseen tulevat potilaat (n = 100) arvioivat leikkauksen tuloksia kuuden kuukauden ajan leikkauksen jälkeen: terveyteen liittyvää elämänlaatua, primaarituloksia ja taloudellisia seurauksia. Aineisto kerättiin erilaisilla mittareilla: Sickness Impact Profile, Finnish Version, Stait-Trait Anxiety Inventory, ja Numeric Rating Scale. Lisäksi käytettiin tätä tutkimusta varten tehtyjä kyselylomakkeita: Fyysinen toimintakyky-mittari, Palvelujen käyttö-mittari ja Kustannusmittari. Tutkimuksen toiseen vaiheen tulokset analysoitiin tilastollisilla menetelmillä. Potilaiden terveyteen liittyvä elämänlaatu parani ja kipu lievittyi leikkauksen jälkeen ja fyysinen toimintakyky lisääntyi toipumisaikana. Positiivisista muutoksista huolimatta potilaat kokivat ahdistusta samassa määrin kuin ennen leikkaustakin. Palvelujen käyttö vaihteli toipumisajan kuluessa ja potilaiden maksamissa kustannuksissa oli suuria vaihteluita. Fyysisen toimintakyvyn lisääntyminen ja kivun lieveneminen paransivat terveyteen liittyvää elämänlaatua. Sen sijaan huonompi elämänlaatu toipumisaikana oli yhteydessä suurempaan palvelujen käyttöön, kun taas kustannuksilla ei ollut yhteyttä elämänlaatuun. Potilaiden ominaispiirteet tulisi ottaa enemmän huomioon suunniteltaessa sopivaa leikkauksenjälkeistä hoitoa ja tukea. Potilaat tarvitsevat yksilöllisiä ohjeita, sillä monet taustatekijät (esim. ikä, sukupuoli, preoperatiivinen kipu, siviilisääty, ja leikkaustyyppi) vaikuttavat toipumiseen.

Dementoituneiden asiakkaiden hoidon laadun havainnointi- pilottitutkimus Dementia Care Mapping -menetelmällä

Summary: Assessment of the quality of care of people with dementia - Dementia Care Mapping pilot

Interfacing Health Care Information Systems Design and Implementation

Terveydenhuollossa käytetään nykyisin informaatioteknologian (IT) mahdollisuuksia parantamaan hoidon laatua, vähentämään hoitoon liittyviä kuluja sekä yksinkertaistamaan ja selkeyttämään laakareiden työnkulkua. Tietojärjestelmät, jotka edustavat jokaisen IT-ratkaisun ydintä, täytyy kehittää täyttämään lukuisia vaatimuksia, ja yksi niistä on kyky integroitua saumattomasti toisten tietojärjestelmien kanssa. Järjestelmäintegraatio on kuitenkin yhä haastava tehtävä, vaikka sita varten on kehitetty useita standardeja. Tässä työssä kuvataan vastakehitetyn lääketieteellisen tietojärjestelmän liittymäratkaisu. Työssä pohditaan vaatimuksia, jotka tällaiselle sovellukselle asetetaan, ja myös tapa, jolla vaatimukset toteutuvat on esitetty. Liittymaratkaisu on jaettu kahteen osaan, tietojärjestelmaliittymään ja "liittymakoneeseen" (interfacing engine). Edellinen on käsittää perustoiminnallisuuden, jota tarvitaan vastaanottamaan ja lähettämään tietoa toisiin järjestelmiin, kun taas jälkimmäinen tarjoaa tuen tuotantoympäristössa käytettäville standardeille. Molempien osien suunnitelu on esitelty perusteellisesti tässä työssä. Ongelma ratkaistiin modulaarisen ja geneerisen suunnittelun avulla. Tämä lähestymistapa osoitetaan työssä kestäväksi ja joustavaksi ratkaisuksi, jota voidaan käyttää tarkastelemaan laajaa valikoimaa liittymäratkaisulle asetettuja vaatimuksia. Lisaksi osoitetaan kuinka tehty ratkaisu voidaan joustavuutensa ansiosta helposti mukauttaa vaatimuksiin, joita ei ole etukäteen tunnistettu, ja siten saavutetaan perusta myös tulevaisuuden tarpeille

Two-photon excitation fluorometry in detection of infectious diseases

Because of the heavily overlapping symptoms, pathogen-specific diagnosis and treatment of infectious diseases is difficult based on clinical symptoms alone. Therefore, patients are often treated empirically. More efficient treatment and management of infectious diseases would require rapid point-of-care compatible in vitro diagnostic methods. However, current point-of-care methods are unsatisfactory in performance and in cost structure. The lack of pointof- care methods results in unnecessary use of antibiotics, suboptimal use of virus-specific drugs, and compromised patient care. In this thesis, the applicability of a two-photon excitation fluorometry is evaluated as a tool for rapid detection of infectious diseases. New separation-free immunoassay methodologies were developed and validated for the following application areas: general inflammation markers, pathogen-specific antibodies, pathogen-specific antigens, and antimicrobial susceptibility testing. In addition, dry-reagent methodology and nanoparticulate tracers are introduced in context to the technique. The results show that the new assay technique is a versatile tool for rapid detection of infectious diseases in many different application areas. One particularly attractive area is rapid multianalyte testing of respiratory infections, where the technique was shown to allow simple assay protocols and comparable performance to the state-of-the-art laboratory methods. If implemented in clinical diagnostic use, the new methods could improve diagnostic testing routines, especially in rapid testing of respiratory tract infections.