Patient Seclusion and Restraint Practices in Psychiatric Hospitals - Towards Evidence Based Clinical Nursing

The overall goal of this study was to support evidence based clinical nursing regarding patient seclusion and restraint practices. This was done by ensuring professional competence through innovative learning methods. The data were collected in three phases between March 2007 and May 2009 on acute psychiatric wards. Firstly, psychiatric inpatients’ experiences and suggestions for seclusion and restraint practices were explored (n=30). Secondly, nursing and medical personnel’s perceptions of seclusion and restraint practices were explored (n=27). Thirdly, the impacts of a continuing vocational eLearning course on nurses’ professional competence was evaluated (n=158). Patients’ perspectives received insufficient attention during the seclusion and restraint process. Improvements and alternatives to seclusion and restraint as suggested by the patients focused on essential parts of clinical nursing, but were not extensively adopted. Also nursing and medical personnel thought that patients’ subjective perspective received little attention. Personnel proposed a number of alternatives to seclusion and restraint, and they expressed a need for education and support to adopt these in clinical nursing. Evaluation of impacts of eLearning course on nurses’ professional competence showed no statistical differences between an eLearning group and an education-as-usual group. This dissertation provides evidence based knowledge about the realization of seclusion and restraint practices and the impacts of eLearning course on nurses’ professional competence in psychiatric hospitals. In order to improve clinical nursing the patient perspective must be accentuated. To ensure personnel’s professional competence, there is a need for written clinical guidelines, education and support. Continuing vocational education should bring together written clinical guidelines, ethical and legal issues and the support for personnel. To achieve the ambitious goal of such integration, achievable and affordable educational programmes are required. This, in turn, yields a call for innovative learning methods.

Identification of grain areas replaced by sugarcane and analysis of the relationship with family farming production in the state of Goiás

In Brazil, the State of Goiás is one of sugarcane expansion's frontiers to meet the growing demand for biofuels. The objective of this study was to identify the municipalities where there were replacement of annual crops (mainly grains) by sugarcane in the state of Goiás, as well as indicate correlations between the sugarcane expansion and the family farming production, in the period between 2005 and 2010. For this purpose, grains crop mask and sugarcane crop mask, obtained from satellite images, were intersected using geoprocessing techniques. It was also used IBGE data of sugarcane production and planted area, and data of family farming production linked with the National Food Acquisition Program (PAA), in relation to the number of cooperatives and family farmers. The crops masks and data tables of the National Food Acquisition Program were provided by National Food Supply Agency. There were 95 municipalities that had crops replacement, totaling 281,554 hectares of grains converted to sugarcane. We highlight the municipalities of Santa Isabel, Iaciara, Maurilândia, and Itapaci, where this change represented more than half of their agricultural areas. In relation to family farming, the sugarcane expansion in the state of Goiás has not affected their activities during the period studied.

A Case Study of Agile Software Engineering Methods and Practices in the MeeGo Harmattan Open Source and Product Context

The aim of this master’s thesis is to study how Agile method (Scrum) and open source software are utilized to produce software for a flagship product in a complex production environment. The empirical case and the used artefacts are taken from the Nokia MeeGo N9 product program, and from the related software program, called as the Harmattan. The single research case is analysed by using a qualitative method. The Grounded Theory principles are utilized, first, to find out all the related concepts from artefacts. Second, these concepts are analysed, and finally categorized to a core category and six supported categories. The result is formulated as the operation of software practices conceivable in circumstances, where the accountable software development teams and related context accepts a open source software nature as a part of business vision and the whole organization supports the Agile methods.

Lymph node metastasis in early gastric cancer

OBJECTIVE: to evaluate the incidence of lymph node metastasis in early gastric cancer, identifying risk factors for its development. METHODS: we conducted a prospective study of patients with gastric cancer admitted to the Section of the Esophago-Gastric Surgery of the Surgery of Service HUCFF-UFRJ, from January 2006 to May 2012. RESULTS: the rate of early gastric cancer was 16.3%. The incidence of nodal metastases was 30.8% and occurred more frequently in patients with tumors with involvement of the submucosa (42.9%), in those poorly differentiated (36.4%), in tumors larger than 2 cm (33.3%) and in type III ulcerated lesions (43.8%). CONCLUSION: the incidence of lymph node metastases in patients was very high and suggests that one should keep the radicality of resection in early gastric cancer, particularly in relation to D2 lymphadenectomy, recommended for advanced gastric cancer. Conservative resections, with lymphadenectomies smaller than D2, should be performed only in selected cases, well-studied as for the risk factors of lymph node metastasis. Despite the small number of cases did not permit to relate the rate of lymph node metastasis to the risk factors considered, we noted a strong tendency for the occurrence of these metastases in the poorly differentiated, type III, larger than 2 cm tumors, and in the Lauren diffuse types.

Administration of Bifidobacterium animalis subsp. lactis BB-12 and xylitol with a novel pacifier in early childhood

Probiotic bifidobacteria are used in the prevention and treatment of childhood diseases. On the other hand, these bacteria are also connected to dental caries. The purpose of the present work was to test a food supplement containing Bifidobacterium animalis subsp. lactis BB-12 (B. lactis BB-12) and xylitol, and to investigate its health effects, properties and safety when used in a novel pacifier in early childhood. In a double-blind, placebo-controlled trial, newborn infants (n=163) were assigned randomly to receive B. lactis BB-12, xylitol, or sorbitol from the age of 1– 2 monthsto 2 years with a pacifier or a spoon. Children were followed up to four years of age. A part of the parents participating in the clinical trial evaluated the feasibility of the novel administration method. The pattern of tablet release from the pouch of the pacifier was tested in adults. The food supplement tablet containing B. lactis BB-12 and xylitol could be delivered in a safe and controlled way with the novel pacifier. The early administration of B. lactis BB-12 did not result in permanent oral colonization of this probiotic or affect the colonization of mutans streptococci in early childhood. Moreover, B. lactis BB-12 did not increase the occurrence of caries. Controlled administration of B. lactis BB-12 significantly reduced the incidence of respiratory infections during the first eight months of life in a Finnish population with breastfed infants. To conclude, administration of B. lactis BB-12 in early childhood is safe with regard to the future dental health of the child. In addition, B. lactis BB-12 may add to the protection against respiratory infections provided by human breast milk in infancy.

Evaluating the Maturity of Data Management Practices in a Major Energy Provider Company

Data is the most important asset of a company in the information age. Other assets, such as technology, facilities or products can be copied or reverse-engineered, employees can be brought over, but data remains unique to every company. As data management topics are slowly moving from unknown unknowns to known unknowns, tools to evaluate and manage data properly are developed and refined. Many projects are in progress today to develop various maturity models for evaluating information and data management practices. These maturity models come in many shapes and sizes: from short and concise ones meant for a quick assessment, to complex ones that call for an expert assessment by experienced consultants. In this paper several of them, made not only by external inter-organizational groups and authors, but also developed internally at a Major Energy Provider Company (MEPC) are juxtaposed and thoroughly analyzed. Apart from analyzing the available maturity models related to Data Management, this paper also selects the one with the most merit and describes and analyzes using it to perform a maturity assessment in MEPC. The utility of maturity models is two-fold: descriptive and prescriptive. Besides recording the current state of Data Management practices maturity by performing the assessments, this maturity model is also used to chart the way forward. Thus, after the current situation is presented, analysis and recommendations on how to improve it based on the definitions of higher levels of maturity are given. Generally, the main trend observed was the widening of the Data Management field to include more business and “soft” areas (as opposed to technical ones) and the change of focus towards business value of data, while assuming that the underlying IT systems for managing data are “ideal”, that is, left to the purely technical disciplines to design and maintain. This trend is not only present in Data Management but in other technological areas as well, where more and more attention is given to innovative use of technology, while acknowledging that the strategic importance of IT as such is diminishing.

Measuring the performance of corporate events : an empirical study of measuring practices in Finnish companies

Corporate events as an effective part of marketing communications strategy seem to be underestimated in Finnish companies. In the rest of the Europe and the USA, investments in events are increasing, and their share of the marketing budget is significant. The growth of the industry may be explained by the numerous advantages and opportunities that events provide for attendees, such as face-to-face marketing, enhancing corporate image, building relationships, increasing sales, and gathering information. In order to maximize these benefits and return on investment, specific measurement strategies are required, yet there seems to exist a lack of understanding of how event performance should be perceived or evaluated. To address this research gap, this research attempts to describe the perceptions of and strategies for evaluating corporate event performance in the Finnish events industry. First, corporate events are discussed in terms of definitions and characteristics, typologies, and their role in marketing communications. Second, different theories on evaluating corporate event performance are presented and analyzed. Third, a conceptual model is presented based on the literature review, which serves as a basis for the empirical research conducted as an online questionnaire. The empirical findings are to a great extent in line with the existing literature, suggesting that there remains a lack of understanding corporate event performance evaluation, and challenges arise in determining appropriate measurement procedures for it. Setting clear objectives for events is a significant aspect of the evaluation process, since the outcomes of events are usually evaluated against the preset objectives. The respondent companies utilize many of the individual techniques that were recognized in theory, such as calculating the number of sales leads and delegates. However, some of the measurement tools may require further investments and resources, thus restricting their application especially in smaller companies. In addition, there seems to be a lack of knowledge of the most appropriate methods in different contexts, which take into account the characteristics of the organizing party as well as the size and nature of the event. The lack of inhouse expertise enhances the need for third-party service-providers in solving problems of corporate event measurement.

Criteria for prediction of metastatic axillary lymph nodes in early-stage breast cancer

PURPOSE: To estimate the likelihood of axillary lymph node involvement for patients with early-stage breast cancer, based on a variety of clinical and pathological factors. METHODS: A retrospective analysis was done in hospital databases from 1999 to 2007. Two hundred thirty-nine patients were diagnosed with early-stage breast cancer. Predictive factors, such as patient age, tumor size, lymphovascular invasion, histological grade and immunohistochemical subtype were analyzed to identify variables that may be associated with axillary lymph node metastasis. RESULTS: Patients with tumors that are negative for estrogen receptor, progesterone receptor, and HER2 had approximately a 90% lower chance of developing lymph node metastasis than those with luminal A tumors (e.g., ER+ and/or PR+ and HER2-) - Odds Ratio: 0.11; 95% confidence interval: 0.01-0.88; p=0.01. Furthermore, the risk for lymph node metastasis of luminal A tumors seemed to decrease as patient age increased, and it was directly correlated with tumor size. CONCLUSION: The molecular classification of early-stage breast cancer using immunohistochemistry may help predicting the probability of developing axillary lymph node metastasis. Further studies are needed to optimize predictions for nodal involvement, with the aim of aiding the decision-making process for breast cancer treatment.

Theorizing Formal and Informal Feedback Practices in Management Accounting Through Three Dimensions

The purpose of this doctoral thesis is to widen and develop our theoretical frameworks for discussion and analyses of feedback practices in management accounting, particularly shedding light on its formal and informal aspects. The concept of feedback in management accounting has conventionally been analyzed within cybernetic control theory, in which feedback flows as a diagnostic or comparative loop between measurable outputs and pre-set goals (see e.g. Flamholtz et al. 1985; Flamholtz 1996, 1983), i.e. as a formal feedback loop. However, the everyday feedback practices in organizations are combinations of formal and informal elements. In addition to technique-driven feedback approaches (like budgets, measurement, and reward systems) we could also categorize social feedback practices that managers see relevant and effective in the pursuit of organizational control. While cybernetics or control theories successfully capture rational and measured aspects of organizational performance and offer a broad organizational context for the analysis, many individual and informal aspects remain vague and isolated. In order to discuss and make sense of the heterogeneous field of interpretations of formal and informal feedback, both in theory and practice, dichotomous approaches seem to be insufficient. Therefore, I suggest an analytical framework of formal and informal feedback with three dimensions (3D’s): source, time, and rule. Based on an abductive analysis of the theoretical and empirical findings from an interpretive case study around a business unit called Division Steelco, the 3Dframework and formal and informal feedback practices are further elaborated vis-á-vis the four thematic layers in the organizational control model by Flamholtz et al. (1985; Flamholtz 1996, 1983): core control system, organizational structure, organizational culture, and external environment. Various personal and cultural meanings given to the formal and informal feedback practices (“feedback as something”) create multidimensional interpretative contexts. Multidimensional frameworks aim to capture and better understand both the variety of interpretations and their implications to the functionality of feedback practices, important in interpretive research.

Mapping the translation needs and practices in development co-operation projects of NGOs

Tämän pro gradu -tutkielman aiheena on kääntäminen ja viestintä vieraalla kielellä Suomen ulkoasiainministeriön rahoittamissa kansalaisjärjestöjen kehitysyhteistyöhankkeissa. Tutkielman on tarkoitus kartoittaa kyseisten kehitysyhteistyöhankkeiden kääntämiseen ja vieraskieliseen viestintään liittyviä tarpeita ja -käytäntöjä. Aihetta ei ole tutkittu laajasti muutoin, joten empiirinen osuus on erityisen merkittävässä roolissa. Tutkielman alussa esitellään ulkoasiainministeriön laatimia suomalaisten kansalaisjärjestöjen kehitysyhteistyöhankkeiden ehtoja ja ohjeita, jotka ovat kyseiselle tutkimukselle olennaisia. Tutkielman teoreettinen osuus koostuu lähinnä metodologisesta pohdinnasta, koska aiempaa tutkimustietoa on vähän. Tutkimusmetodien analysointia on painotettu myös siksi, että empiirisellä osuudella on niin suuri merkitys. Tutkielman empiirinen aineisto on yhtäältä peräisin tutkijan havainnoista, jotka saatiin omia varhaisempia hankehallinnointikokemuksia hyödyntäen sekä osallistuvan havainnoinnin menetelmää käyttäen kahden opiskelijajärjestön kehitysyhteistyöhankkeista vuosien 2009 ja 2012 välisenä aikana. Toisaalta aineisto on kerätty kyselytutkimuksen vastauksista. Kysely lähetettiin 35 suomalaiselle kansalaisjärjestölle, joiden kehitysyhteistyöhankkeita Suomen ulkoasiainministeriö rahoittaa. Järjestöt valittiin satunnaisotannalla. Empiirisen aineiston analyysistä ilmeni muun muassa, että tutkijan alkuperäinen hypoteesi kehitysyhteistyöhön liittyvien tekstien kääntämisen yleisyydestä pitää osittain paikkansa, vaikka tekstejä käännettiinkin kansalaisjärjestöissä vähemmän kuin tutkija odotti. Tutkimusaineisto ei ole kuitenkaan tarpeeksi laaja, jotta tuloksia voitaisiin yleistää, sillä kansalaisjärjestöt, niiden hankkeet, käännöstarpeet ja asiantuntemus osoittautuivat odotetusti hyvin erilaisiksi. Tulokset sisältävät asiaa myös esimerkiksi järjestöissä kääntävien ja vieraalla kielellä viestivien taustoista. Jatkotutkimukset ovat kuitenkin tarpeen, ja mahdollisia tutkimusaiheita on runsaasti.

Metabolic evaluation of dairy cows submitted to three different strategies to decrease the effects of negative energy balance in early postpartum

In early lactation dairy cattle suffer metabolic alterations caused by negative energy balance, which predisposes to fatty liver and ketosis. The aim of this study was to evaluate the metabolic condition of high yielding dairy cows subjected to three treatments for preventing severe lipomobilization and ketosis in early lactation. Fifty four multiparous Holstein cows yielding >30 L/day were divided into four groups: control (CN= no treatment), glucose precursor (PG= propylene-glycol), hepatic protector (Mp= Mercepton®), and energy supplement with salts of linolenic and linoleic faty acids (Mg-E= Megalac-E®). Treatments were administrated randomly at moment of calving until 8 weeks postpartum. Blood samples were collected on days 1, 7, 14, 21, 28, 35, 42 and 49 postpartum. Body condition score (BCS) was evaluated at the same periods and milk yield was recorded at 2nd, 4th, 5th, 6th, 7th, and 8th weeks of lactation. Concentrations of non-esterified fatty acids (NEFA), albumin, AST, ß-hydroxybutyrate (BHBA), cholesterol, glucose, total protein, urea and triglycerides were analyzed in blood samples. Cut-off points for subclinical ketosis were defined when BHBA >1.4 mmol/L and NEFA >0.7 mmol/L. General occurrence of subclinical ketosis was 24% during the period. An ascendant curve of cholesterol and glucose was observed from the 1st to the 8th week of lactation, while any tendency was observed with BHBA and NEFA, although differences among treatments were detected (p<0.05). BCS decreased from a mean of 3.85 at 1st week to 2.53 at 8th week of lactation (p=0.001). Milk yield was higher in the Mg-E group compared with the other treatment groups (p<0.05) Compared with the CN group, the treatments with Mp and PG did not show significant differences in blood biochemistry and milk yield. Cows receiving PG and Mg-E showed higher values of BHBA and NEFA (P<0.05), indicating accentuated lipomobilization. Supplementation with Mg-E also resulted in significant higher concentrations of cholesterol, BHBA, urea, AST and lower values of glycemia. This performance may be explained by the highest milk yield observed with this treatment. Treatments with PG and Mp did not improve milk yield, compared with control cows, but did not show metabolic evidence of ketosis, fat mobilization or fatty liver. These results suggest that treatment with Mg-E improves milk production but induces a higher negative energy balance leading to moderated lipomobilization and ketone bodies production, increasing the risk of fatty liver.

Neurocognitive changes in early-stage Parkinson's disease : functional and structural brain correlates of memory and verbal functions

Resultaten påvisade små, men mätbara försämringar i minnes- och verbal förmåga hos personer som haft Parkinsons sjukdom under tre år. Jämfört med en kontrollgrupp uppvisade Parkinsonpatienter avvikande responser i hjärnans elektriska aktivitet under en korttidsminnesuppgift, och de presterade även sämre i olika typer av andra minnesuppgifter. Försämring i en specifik typ av minnesuppgift korrelerade med förminskad volym i höger hjärnhalva. Samband hittades också mellan sämre verbal förmåga och förminskad volym i djupa hjärnstrukturer. Förminskad hjärnvolym har tidigare påvisats hos dementa patienter i senare sjukdomsstadier. Forskningsresultaten bidrar med ny kunskap om kognitiva symptom och deras neurala bakgrund vid Parkinsons sjukdom. De tyder också på att tidig kognitiv funktionsnedsättning kan identifieras, vilket kan bidra till utvecklingen av sjukdomens behandling. Parkinsons sjukdom är den näst vanligaste neurogeriatriska sjukdomen efter Alzheimers sjukdom. Symptomen uppstår som följd av förminskad produktion av hjärnans transmittorämne dopamin. Parkinsons sjukdom har traditionellt betraktats som en progressiv motorisk sjukdom. Ny forskning tyder på att multipla hjärnsystem skadas, vilket resulterar i att även tankeprocesser påverkas. 75-80% uppskattas insjukna i demens 10-15 år efter diagnos, men det kognitiva sjukdomsförloppet och orsaken till demenssymptomen är tillsvidare okänd. I Finland uppskattas ca 10-12 000 personer ha Parkinsons sjukdom, varav ca 3 000 uppskattas ha demens. ----------------------------------------------------------------------------------------------------------------------------------------------------- Tutkimuksessa todettiin lieviä muutoksia muisti- ja kielellisissä toiminnoissa alle kolme vuotta sairastaneilla Parkinson-potilailla. Potilailla havaittiin poikkeavia aivosähkötoiminnan vasteita lyhytkestoista muistia mittaavan tehtävän aikana. Potilaat suoriutuivat myös verrokkiryhmää heikommin useissa muistitehtävissä. Heikentynyt tahaton muisti liittyi pienempään aivokuoren harmaan aineen paikalliseen tilavuuteen. Heikompi kielellinen suoriutuminen liittyi pienempään harmaan aineen tilavuuteen aivojen syvissä rakenteissa. Pienentyneitä aivorakenteiden tilavuuksia on aiemmin todettu dementoituneilla Parkinson-potilailla sairauden myöhemmissä vaiheissa. Tutkimustulokset tuovat uutta tietoa Parkinsonin taudin kognitiivisista oireista ja niiden aivoperäisestä taustasta. Tulosten perusteella on mahdollista tunnistaa jo varhaisia kognitiivisia muutoksia, mikä voi mahdollistaa tehokkaamman hoidon kohdentamisen. Parkinsonin tauti on Alzheimerin taudin jälkeen toiseksi yleisin neurogeriatrinen sairaus. Oirekuva liittyy aivojen dopaminergisen järjestelmän rappeutumiseen. Perinteisesti liikehäiriösairaudeksi luokiteltu sairaus vaurioittaa lukuisia muita aivojärjestelmiä aiheuttaen muutoksia myös mm. ajattelutoiminnoissa. Pitkään sairastaneista 75–80 prosentilla esiintyy dementiaoireita, mutta oireiden syy ja kehityskaari tunnetaan toistaiseksi huonosti. Suomessa on arviolta 10–12 000 Parkinson-potilasta, joista noin 3 000 arvioidaan kärsivän dementiaoireista.

Evaluation of an e-learning course: coercion practices in psychiatric nursing

The goal of the study was to evaluate an e-learning course entitled “Nursing interventions to manage distressed and disturbed patients” and intended for psychiatric nurses, using Kirkpatrick’s evaluation model. The aim was to describe nurses’ reactions, learning, behaviour change and impacts resulting from this e-learning course. This dissertation comprises four papers, and the data were collected 2008-2012 from three different sources; electronic databases, an e-learning platform and psychiatric hospitals. First, a systematic literature review was conducted to understand the effectiveness of e-learning. Second, an RCT study was implemented to investigate the impact of the e-learning course on nurses’ job-satisfaction, knowledge and attitudes (N=158). Third, to complete the picture of nurses views of the e-learning course related to knowledge transfer, the nurses’ perspective was studied (N=33). Lastly, the effects of the e-learning course from nursing managers’ perspective in psychiatric hospital organisations were studied (N=28). The systematic review showed that although the nurses were satisfied with the e-learning, no effects were found in the RCT study of nurses’ job satisfaction. The RCT study showed no effects on nurses’ learning related to knowledge increase, but there was change in attitudes. The managers described the changes in the nurses’ knowledge and attitudes. Among the nurses behaviour changed with knowledge transfer from the e-learning course to practice and they pointed out development issues related to their work. The final impacts of the e-learning course revealed advantages and disadvantages of the e-learning course and its implications for nurses’ work. This dissertation provides new insight into nurses’ reactions, learning, behaviour change and impacts resulting from an e-learning course in their continuing education. In order to improve nurses’ continuing education systematic evaluation is needed, for which Kirkpatrick’s evaluation model is a useful tool.