Essential nursing care of the critically ill patient

This chapter is about essential nursing care. Because it is often referred to as basic nursing, nurses may not always perceive it as deserving of priority. Yet, how well patients are cared for has a direct effect on their sense of wellbeing and their recovery. ‘Interventional patient hygiene’ is a systematic, evidence-based approach to nursing actions designed to improve patient outcomes using a framework of hygiene, catheter care, skin care, mobility and oral care.1 This chapter focuses on the physical care, infection control, preventative therapies and transport of critically ill patients. The first two areas are closely linked: poor-quality physical care increases the risk of infection. The final areas are essential features of critical care nursing.

Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF) is a valid screening tool in chemotherapy outpatients

Purpose In the oncology population where malnutrition prevalence is high, more descriptive screening tools can provide further information to assist triaging and capture acute change. The Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF) is a component of a nutritional assessment tool which could be used for descriptive nutrition screening. The purpose of this study was to conduct a secondary analysis of nutrition screening and assessment data to identify the most relevant information contributing to the PG-SGA SF to identify malnutrition risk with high sensitivity and specificity. Methods This was an observational, cross-sectional study of 300 consecutive adult patients receiving ambulatory anti-cancer treatment at an Australian tertiary hospital. Anthropometric and patient descriptive data were collected. The scored PG-SGA generated a score for nutritional risk (PG-SGA SF) and a global rating for nutrition status. Receiver operating characteristic curves (ROC) were generated to determine optimal cut-off scores for combinations of the PG-SGA SF boxes with the greatest sensitivity and specificity for predicting malnutrition according to scored PG-SGA global rating. Results The additive scores of boxes 1–3 had the highest sensitivity (90.2 %) while maintaining satisfactory specificity (67.5 %) and demonstrating high diagnostic value (AUC = 0.85, 95 % CI = 0.81–0.89). The inclusion of box 4 (PG-SGA SF) did not add further value as a screening tool (AUC = 0.85, 95 % CI = 0.80–0.89; sensitivity 80.4 %; specificity 72.3 %). Conclusions The validity of the PG-SGA SF in chemotherapy outpatients was confirmed. The present study however demonstrated that the functional capacity question (box 4) does not improve the overall discriminatory value of the PG-SGA SF.

Patient exposure monitoring and radiation qualities in two-dimensional digital x-ray imaging

The methods for estimating patient exposure in x-ray imaging are based on the measurement of radiation incident on the patient. In digital imaging, the useful dose range of the detector is large and excessive doses may remain undetected. Therefore, real-time monitoring of radiation exposure is important. According to international recommendations, the measurement uncertainty should be lower than 7% (confidence level 95%). The kerma-area product (KAP) is a measurement quantity used for monitoring patient exposure to radiation. A field KAP meter is typically attached to an x-ray device, and it is important to recognize the effect of this measurement geometry on the response of the meter. In a tandem calibration method, introduced in this study, a field KAP meter is used in its clinical position and calibration is performed with a reference KAP meter. This method provides a practical way to calibrate field KAP meters. However, the reference KAP meters require comprehensive calibration. In the calibration laboratory it is recommended to use standard radiation qualities. These qualities do not entirely correspond to the large range of clinical radiation qualities. In this work, the energy dependence of the response of different KAP meter types was examined. According to our findings, the recommended accuracy in KAP measurements is difficult to achieve with conventional KAP meters because of their strong energy dependence. The energy dependence of the response of a novel large KAP meter was found out to be much lower than with a conventional KAP meter. The accuracy of the tandem method can be improved by using this meter type as a reference meter. A KAP meter cannot be used to determine the radiation exposure of patients in mammography, in which part of the radiation beam is always aimed directly at the detector without attenuation produced by the tissue. This work assessed whether pixel values from this detector area could be used to monitor the radiation beam incident on the patient. The results were congruent with the tube output calculation, which is the method generally used for this purpose. The recommended accuracy can be achieved with the studied method. New optimization of radiation qualities and dose level is needed when other detector types are introduced. In this work, the optimal selections were examined with one direct digital detector type. For this device, the use of radiation qualities with higher energies was recommended and appropriate image quality was achieved by increasing the low dose level of the system.

Patient doses in ct, dental cone beam ct and projection radiography in Finland, with emphasis on paediatric patients

Diagnostic radiology represents the largest man-made contribution to population radiation doses in Europe. To be able to keep the diagnostic benefit versus radiation risk ratio as high as possible, it is important to understand the quantitative relationship between the patient radiation dose and the various factors which affect the dose, such as the scan parameters, scan mode, and patient size. Paediatric patients have a higher probability for late radiation effects, since longer life expectancy is combined with the higher radiation sensitivity of the developing organs. The experience with particular paediatric examinations may be very limited and paediatric acquisition protocols may not be optimised. The purpose of this thesis was to enhance and compare different dosimetric protocols, to promote the establishment of the paediatric diagnostic reference levels (DRLs), and to provide new data on patient doses for optimisation purposes in computed tomography (with new applications for dental imaging) and in paediatric radiography. Large variations in radiation exposure in paediatric skull, sinus, chest, pelvic and abdominal radiography examinations were discovered in patient dose surveys. There were variations between different hospitals and examination rooms, between different sized patients, and between imaging techniques; emphasising the need for harmonisation of the examination protocols. For computed tomography, a correction coefficient, which takes individual patient size into account in patient dosimetry, was created. The presented patient size correction method can be used for both adult and paediatric purposes. Dental cone beam CT scanners provided adequate image quality for dentomaxillofacial examinations while delivering considerably smaller effective doses to patient compared to the multi slice CT. However, large dose differences between cone beam CT scanners were not explained by differences in image quality, which indicated the lack of optimisation. For paediatric radiography, a graphical method was created for setting the diagnostic reference levels in chest examinations, and the DRLs were given as a function of patient projection thickness. Paediatric DRLs were also given for sinus radiography. The detailed information about the patient data, exposure parameters and procedures provided tools for reducing the patient doses in paediatric radiography. The mean tissue doses presented for paediatric radiography enabled future risk assessments to be done. The calculated effective doses can be used for comparing different diagnostic procedures, as well as for comparing the use of similar technologies and procedures in different hospitals and countries.

Metabolomic and proteomic analysis of breast cancer patient samples suggests that glutamate and 12-HETE in combination with CA15-3 may be useful biomarkers reflecting tumour burden

Evaluation of protein and metabolite expression patterns in blood using mass spectrometry and high-throughput antibody-based screening platforms has potential for the discovery of new biomarkers for managing breast cancer patient treatment. Previously identified blood-based breast cancer biomarkers, including cancer antigen 15.3 (CA15-3) are useful in combination with imaging (computed tomography scans, magnetic resonance imaging, X-rays) and physical examination for monitoring tumour burden in advanced breast cancer patients. However, these biomarkers suffer from insufficient levels of accuracy and with new therapies available for the treatment of breast cancer, there is an urgent need for reliable, non-invasive biomarkers that measure tumour burden with high sensitivity and specificity so as to provide early warning of the need to switch to an alternative treatment. The aim of this study was to identify a biomarker signature of tumour burden using cancer and non-cancer (healthy controls/non-malignant breast disease) patient samples. Results demonstrate that combinations of three candidate biomarkers from Glutamate, 12-Hydroxyeicosatetraenoic acid, Beta-hydroxybutyrate, Factor V and Matrix metalloproteinase-1 with CA15-3, an established biomarker for breast cancer, were found to mirror tumour burden, with AUC values ranging from 0.71 to 0.98 when comparing non-malignant breast disease to the different stages of breast cancer. Further validation of these biomarker panels could potentially facilitate the management of breast cancer patients, especially to assess changes in tumour burden in combination with imaging and physical examination.

Perspektiv på språkprocessering

Automatisk språkprocessering har efter mer än ett halvt sekel av forskning blivit ett mycket viktigt område inom datavetenskapen. Flera vetenskapligt viktiga problem har lösts och praktiska applikationer har nått programvarumarknaden. Disambiguering av ord innebär att hitta rätt betydelse för ett mångtydigt ord. Sammanhanget, de omkringliggande orden och kunskap om ämnesområdet är faktorer som kan användas för att disambiguera ett ord. Automatisk sammanfattning innebär att förkorta en text utan att den relevanta informationen går förlorad. Relevanta meningar kan plockas ur texten, eller så kan en ny, kortare text genereras på basen av fakta i den ursprungliga texten. Avhandlingen ger en allmän översikt och kort historik av språkprocesseringen och jämför några metoder för disambiguering av ord och automatisk sammanfattning. Problemområdenas likheter och skillnader lyfts fram och metodernas ställning inom datavetenskapen belyses.

Word-of-mouth-forskning – Från ett beteendevetenskapligt perspektiv mot ett företagsperspektiv

Syftet med denna artikel är att systematisera och analysera litteratur som anknyter till word-of-mouth-kommunikation (hädanefter WOM). Med konsumentdominerad marknadskommunikation avses att konsumenterna sinsemellan oberoende av företaget söker och sprider marknadsinformation. Den enda motsvarande litteraturanalys som förefaller att finnas publicerad är fyrtio år gammal (Arndt 1967). Sedan dess har det tillkommit en ansenlig mängd företagsekonomisk forskning som tydligt avviker från Johan Arndts, vilken huvudsakligen baserade sig den beteendevetenskapliga litteraturen.

Att äta eller inte äta, att äta nu eller senare. En studie i ätstörningar ur ett samhällsvetenskapligt perspektiv

Tiivistelmä – Referat – Abstract Anorexi ses i Finland som en psykisk sjukdom med en psykopatologi, som bland andra innefattar rädsla för att bli fet. I min undersökning har jag fått fram tre huvudteman, som förutom andra bakomliggande omständigheter, bidragit till ett insjuknande. De handlar om anorexi som livsstil, bantning och viljan att leva sunt och äta rätt. Med den vaknande sexualiteten väcks intresset för det andra könet och för kroppens utseende i övrigt. I bakgrunden finns känslor av bl.a. ensamhet, ett sökande efter den egna personligheten, ångest och depression. Jag har byggt min studie på patienternas egna berättelser om sitt liv. Perspektivet är samhällsinriktat, och som analysmetod har jag använt mig av narrativet. Jag har lånat idéer både från Vilma Hänninens (1999), Gerhard Riemann och Fritz Schützes (1991) narrativa modeller, och rör mig mellan dem båda. Jag har i första hand intresserat mig för tiden före insjuknandet och de bakomliggande orsaker, som kan tänkas befrämja insjuknandet. Jag har speglat anorektikernas problematik i bl.a. Anthony Giddens (1997) och Zygmund Baumans (1999) teorier om det postmoderna samhället, och ser ätstörningar som en uttrycksform för dåligt befinnande. Samhällsklimatet har blivit hårdare och omsorgen om personer i omgivningen har glömts bort. Vi lever, enligt Giddens (1997), i en skenande värld, viket betyder att förändringarna påverkar existerande beteendemönster i större omfattning och på ett djupare plan än tidigare. Enligt Pennanen (2000) är målsättningen för ätstörningspatienter stressande, svåruppnådd och svårkontrollerbar. Mina informanter berättar om höga målsättningar, prestationskrav, dålig självkänsla och skam över sina kroppar. För att tillfriskna behövs stöd. Men det vikigaste är att personen själv vill bli frisk, och själv ta ansvar för sitt tillfrisknande. Sjukdomen är individuell. Varje person, upplever sin sjukdom personligt men anorektikerna har också många styrkor i sin sjukdom. Avainsanat – Nyckelord – Keywords ätstörningar, anorexi, bulimi