Koneellisen annosjakelupalvelun aloittaminen - lääkehoidon tarkistus ja sen vaikutus potilaan lääkehoitoon

Farmaseuttisilla palveluilla tarkoitetaan apteekkien palveluita, joissa hyödynnetään apteekin farmaseuttisen henkilökunnan tietoja ja taitoja. Farmaseuttiset palvelut voidaan jakaa farmaseuttisiin perus- ja erityispalveluihin. Farmaseuttiset peruspalvelut kattavat apteekkien lakisääteiset tehtävät, kun taas farmaseuttisilla erityispalveluilla pyritään ottamaan aktiivisempi rooli asiakkaan terveyden edistämisessä. Koneellinen annosjakelupalvelu on farmaseuttinen erityispalvelu. Koneellisessa annosjakelupalvelussa lääkkeet jaetaan kerta-annospusseihin annostusajankohdan mukaan. Kun uusi asiakas aloittaa koneellinen annosjakelupalvelun, tarkistetaan asiakkaan lääkitys yhteensopimattomien ja turhien lääkkeiden osalta. Palvelun aloitushetkellä huomioidaan myös lääkevalmisteiden sopivuus koneelliseen annosjakeluun sekä tarkistetaan valmisteiden annosteluajankohdat. Koneellisessa annosjakelupalvelussa asiakkaan lääkehoidosta muodostetaan lääkityskortti, josta kokonaislääkehoito on helppo tarkistaa. Erikoistyön tavoitteena oli selvittää millainen lääkehoidon arviointi tai tarkistus koneellisen annosjakelupalvelun aloittamisen yhteydessä tehdään ja miten palvelun aloittavien asiakkaiden kokonaislääkehoitotieto saadaan selvitettyä. Lisäksi selvitettiin millaisia muutoksia lääkehoitoihin tehdään palvelun aloittamisen yhteydessä, mitkä ovat muutosten syyt sekä millainen on asiakkaan kokonaislääkehoito. Kyselylomake lähetettiin kaikkiin apteekkeihin, jotka tilasivat koneellista annosjakelua sopimusvalmistuksena Espoonlahden apteekilta syyskuussa 2010. Tutkimus suoritettiin semistrukturoidulla kirjallisella kyselyllä, joka sisälsi sekä avoimia kysymyksiä että monivalintakysymyksiä. Kyselyyn saatiin 147 vastausta ja vastausprosentiksi muodostui 45. Vastauksia kyselyyn saatiin koko Mannersuomen alueelta ja kaikkien kokoluokkien apteekeilta. Koneellisen annosjakelupalvelun aloittavat henkilöt ovat pääasiassa iäkkäitä, jotka ovat kotihoidon piirissä, asuvat hoitokodissa tai palveluasumisen yksikössä. Asiakkaiden lääkitystietojen keräämisessä hyödynnetään lääkityskorttia, mutta lääkityskortin tietoja päivitetään myös muista lähteistä. Asiakkaiden lääkityksille tehdään useimmiten lääkehoidon tarkistus moniammatillisena yhteistyönä. Lääkehoidolle tehdyt muutokset johtuvat pääasiassa lääkevaihdosta, annosjakelukoneen lääkevalikoimasta tai puolittamisen välttämisestä. Lääkehoidoissa on vain vähän yhteisvaikutuksia, jotka johtavat lääkevalmisteen käytön lopettamiseen. Lääkehoidon tarkistuksella ei ollut suurta vaikutusta asiakkaiden käyttämien lääkevalmisteiden määrään. Palvelun aloittamisen jälkeen asiakkaalla on käytössään keskimäärin 11 lääkevalmistetta, joista seitsemää jaellaan koneellisesti. Lääkeaineryhmistä eniten käytettyjä ovat hermostoon vaikuttavat sekä sydän- ja verisuonisairauksien lääkkeet, joita kumpaakin on käytössä keskimäärin kolme jokaisella uudella koneellisen annosjakelupalvelun asiakkaalla sekä palvelun aloittamista ennen että sen jälkeen.

A participatory approach to tactical forest planning.

The paper examines the needs, premises and criteria for effective public participation in tactical forest planning. A method for participatory forest planning utilizing the techniques of preference analysis, professional expertise and heuristic optimization is introduced. The techniques do not cover the whole process of participatory planning, but are applied as a tool constituting the numerical core for decision support. The complexity of multi-resource management is addressed by hierarchical decision analysis which assesses the public values, preferences and decision criteria toward the planning situation. An optimal management plan is sought using heuristic optimization. The plan can further be improved through mutual negotiations, if necessary. The use of the approach is demonstrated with an illustrative example, it's merits and challenges for participatory forest planning and decision making are discussed and a model for applying it in general forest planning context is depicted. By using the approach, valuable information can be obtained about public preferences and the effects of taking them into consideration on the choice of the combination of standwise treatment proposals for a forest area. Participatory forest planning calculations, carried out by the approach presented in the paper, can be utilized in conflict management and in developing compromises between competing interests.

Tavallisuudesta tyylikkyyteen? : Sukupuoli ja maku kodinmuutosohjelmissa

The study focuses on the Finnish home makeover shows Inno (2004 , Nelonen) and Kodin kääntöpiiri (2001 2005; YLE TV2) and their episodes broadcast in spring 2004. The research material also includes the websites of both shows and messages concerning Inno from an online discussion forum. As people decorate their homes and reflect on them, they engage in negotiations of taste and in the construction of the ideal self. The main question of the study is: how are representations of the gendered self produced in home makeover shows? The broader theoretical and methodological context of the study is based on intersectionality, or simultaneous study of different identity categories. In this study, the main focus is on the intersections of gender, class and sexuality. Hence, the secondary research question is: how do ways of doing gender intersect with producing the ideas of class and sexuality in the representations of home makeover shows? The theoretical framework of the study combines Judith Butler s theory of gender performativity and Pierre Bourdieu s theory of taste. The analysis is founded upon a close reading focusing on the details and ambiguous meanings contained in the televisual representation. Home makeover shows are explored as a part of contemporary television culture, which is characterised by a significant increase in the number of both television channels and global television formats, as well as the hybridisation of programme types. Researchers on lifestyle television have paid attention to male designers and their ability to reconstruct meanings related to domesticity and home decoration as feminine spheres. The dissertation contributes to this discussion by analysing the representations of the male interior decorator in Inno and the four female interior decorators in Kodin kääntöpiiri. The focus is on the professional self and how it is both gendered and defined as an arbiter of taste. The programme concepts produce the impression that the makeover homes and their occupants are ordinary . The manufactured sense of ordinariness often conceals differences between the participants. One argument of the study is that the ordinariness of participants on lifestyle television should not be taken for granted without further reflection on the implications of labeling something as ordinary. Updating of interior decoration in home makeover shows can be interpreted as an area of doing gender that requires deliberation, effort, expert knowledge and a sufficient budget. The ideal lay decorator is portrayed as culturally omnivorous, brave and receptive to new ideas. The ability to reflect on ways of representing masculinity and femininity through decoration is also implied. In home makeover shows, greater self-awareness regarding the ways in which gender is produced does not lead to repeating gender differently. The idea of normative heterosexuality is in a hegemonic position in the representations of the participants. In Inno and Kodin kääntöpiiri questions of class are not made explicit. However, the idea of class is produced indirectly e.g. by describing the apartments and houses of the participants, by discussing their hobbies or interest in cultural products. In Inno, home decoration is primarily depicted as an individualistic consumer choice, while in Kodin kääntöpiiri it is often defined as a way to strengthen the ties of nuclear families. In Kodin kääntöpiiri, the ethos of familism is combined with pleasures gained from consumption and DIY activities. As a whole, the multidisciplinary study indicates a great number of differences between the two shows.

Professional Driving : An Emphasis on Organizational Safety Climate

According to the literature and statistical figures, professional drivers constitute a high-risk group in traffic and should be investigated in connection with the factors related to safe driving. However, safety-related behaviours and outcomes among professional drivers have attracted very little attention from safety researchers. In addition, comparing different professional and non-professional driver groups in terms of critical on-the-road characteristics and outcomes has been indicated in the literature as being necessary for a more comprehensive understanding of driver groups and the nature of driving itself. The aim of the present study was to investigate professional driving from a safety climate stand point in relation to predominant driving-related factors and by considering the differences between driver groups. Hence, four Sub-studies were conducted according to a framework emphasizing the relationships between safety climate, driver groups, driver stress, human factors (i.e., driver behaviour and performance) and accidents. Demographic information, as well as data for driver behaviour, performance, and driver stress was collected by questionnaire. The data was analysed using factor analysis, analysis of covariance as well as hierarchical and logistic regression analysis. The results revealed multi-dimensional factor structures for the safety climate measures. Considering the relationships between variables, differences were evidenced regarding on-the-road stress reactions, risky driver behaviours and penalties, between the various professional and non-professional driver groups. Driver stress was found to be related to accidents. The results also indicated that the safety climate has positive relationships with both driver behaviour and performance, and as well as involvement in accidents. The present study has a number of critical implications resulting from the fact that the way in which the effects of safety climate on professional driving were investigated, as well as the differences between professional and non-professional driver groups, was unique. Additionally, for the first time, a safety climate scale was developed specifically for professional drivers. According to the results of the study and to previous literature, a tentative model was proposed representing a possible route for the relationships between safety climate, human factors, driver stress, driver groups and accidents, by emphasizing the effects of safety climate.

Professional non-neutrality: criticising the third party in psychotherapy

Using audio-recorded data from cognitive-constructivist psychotherapy, the article shows a particular institutional context in which successful professional action does not adhere to the pattern of affective neutrality which Parsons saw as an inherent component of medicine and psychotherapy. In our data, the professional’s non-neutrality functions as a tool for achieving institutional goals. The analysis focuses on the psychotherapist’s actions that convey a critical stance towards a third party with whom the patient has experienced problems. The data analysis revealed two practices of this kind of critique: (1) the therapist can confirm the critique that the patient has expressed or (2) return to the critique from which the patient has focused away. These actions are shown to build grounds for the therapist’s further actions that challenge the patient’s dysfunctional beliefs. The article suggests that in the case of psychotherapy, actions that as such might be seen as apparent lapses from the neutral professional role can in their specific context perform the task of the institution at hand.

A note on the choice of interfacial friction angle

Estimates of interfacial friction angle (delta) are necessary for the design of retaining structures and deep foundations, Recommendations in the literature regarding delta values are often contradictory and are therefore not easy to apply in geotechnical design, A critical examination of past studies in terms of data generation techniques used and conclusions drawn indicates that two distinctly different test procedures/techniques have been evolved. The interfacial situation in practice can also be categorized into two broad types, These two types of interface problems in geotechnical engineering are (a) the structure is placed on the free surface of prepared fill (type A situation) and (b) the fill is placed against the material surface which functions as a confined boundary (type B situation), The friction angle delta depends on the surface roughness of the construction material, But in the type A situation, it is independent of density and its limiting maximum value (delta(lim)) is the critical state friction angle phi(cv). In the type B situation, it is dependent on density of the fill and its limiting maximum value is the peak angle of internal friction phi(p) of the fill.

Choice of Classifiers in Hierarchical Recognition of Online Handwritten Kannada and Tamil Aksharas

In this paper, we propose a novel dexterous technique for fast and accurate recognition of online handwritten Kannada and Tamil characters. Based on the primary classifier output and prior knowledge, the best classifier is chosen from set of three classifiers for second stage classification. Prior knowledge is obtained through analysis of the confusion matrix of primary classifier which helped in identifying the multiple sets of confused characters. Further, studies were carried out to check the performance of secondary classifiers in disambiguating among the confusion sets. Using this technique we have achieved an average accuracy of 92.6% for Kannada characters on the MILE lab dataset and 90.2% for Tamil characters on the HP Labs dataset.

Rural electrification: Optimising the choice between decentralised renewable energy sources and grid extension

The study presents an analysis aimed at choosing between off-grid solar photovoltaic, biomass gasifier based power generation and conventional grid extension for remote village electrification. The model provides a relation between renewable energy systems and the economical distance limit (EDL) from the existing grid point, based on life cycle cost (LCC) analysis, where the LCC of energy for renewable energy systems and grid extension will match. The LCC of energy feed to the village is arrived at by considering grid availability and operating hours of the renewable energy systems. The EDL for the biomass gasifier system of 25 kW capacities is 10.5 km with 6 h of daily operation and grid availability. However, the EDL for a similar 25 kW capacity photovoltaic system is 35 km for the same number of hours of operation and grid availability. The analysis shows that for villages having low load demand situated far away from the existing grid line, biomass gasification based systems are more cost competitive than photovoltaic systems or even compared to grid extension. (C) 2012 Elsevier Inc. All rights reserved.

Data-resolution based optimal choice of minimum required measurements for image-guided diffuse optical tomography

Image-guided diffuse optical tomography has the advantage of reducing the total number of optical parameters being reconstructed to the number of distinct tissue types identified by the traditional imaging modality, converting the optical image-reconstruction problem from underdetermined in nature to overdetermined. In such cases, the minimum required measurements might be far less compared to those of the traditional diffuse optical imaging. An approach to choose these optimally based on a data-resolution matrix is proposed, and it is shown that such a choice does not compromise the reconstruction performance. (C) 2013 Optical Society of America

A LSQR-type method provides a computationally efficient automated optimal choice of regularization parameter in diffuse optical tomography

Purpose: Developing a computationally efficient automated method for the optimal choice of regularization parameter in diffuse optical tomography. Methods: The least-squares QR (LSQR)-type method that uses Lanczos bidiagonalization is known to be computationally efficient in performing the reconstruction procedure in diffuse optical tomography. The same is effectively deployed via an optimization procedure that uses the simplex method to find the optimal regularization parameter. The proposed LSQR-type method is compared with the traditional methods such as L-curve, generalized cross-validation (GCV), and recently proposed minimal residual method (MRM)-based choice of regularization parameter using numerical and experimental phantom data. Results: The results indicate that the proposed LSQR-type and MRM-based methods performance in terms of reconstructed image quality is similar and superior compared to L-curve and GCV-based methods. The proposed method computational complexity is at least five times lower compared to MRM-based method, making it an optimal technique. Conclusions: The LSQR-type method was able to overcome the inherent limitation of computationally expensive nature of MRM-based automated way finding the optimal regularization parameter in diffuse optical tomographic imaging, making this method more suitable to be deployed in real-time. (C) 2013 American Association of Physicists in Medicine. http://dx.doi.org/10.1118/1.4792459]

Induction of Supramolecular Chirality in the Self-Assemblies of Lipophilic Pyrimidine Derivatives by Choice of the Amino Acid-Based Chiral Spacer

A new family of supramolecular organogelators, based on chiral amino acid derivatives of 2,4,6-trichloro-pyrimidine-5-carbaldehyde, has been synthesized. L-alanine was incorporated as a spacer between the pyrimidine core and long hydrocarbon tails to compare the effect of chirality and hydrogen bonding to that of the achiral analogue. The role of aromatic moiety on the chiral spacer was also investigated by introducing L-phenyl alanine moieties. The presence of intermolecular hydrogen-bonding leading to the chiral self-assembly was probed by concentration-dependent FTIR and UV/Vis spectroscopies, in addition to circular dichroism (CD) studies. Temperature and concentration-dependent CD spectroscopy ascribed to the formation of -sheet-type H-bonded networks. The morphology and the arrangements of the molecules in the freeze-dried gels were examined by scanning electron microscopy (SEM), transmission electron microscopy (TEM), atomic force microscopy (AFM), and X-ray diffraction (XRD) techniques. Calculation of the length of each molecular system by energy minimization in its extended conformation and comparison with the small-angle XRD pattern reveals that this class of gelator molecules adopts a lamellar organization. Polarized optical microscopy (POM) and differential scanning calorimetry (DSC) indicate that the solid state phase behavior of these molecules is totally dependent on the choice of their amino acid spacers. Structure-induced aggregation properties based on the H-bonding motifs and the packing of the molecule in three dimensions leading to gelation was elucidated by rheological studies. However, viscoelasticity was shown to depend only marginally on the H-bonding interactions; rather it depends on the packing of the gelators to a greater extent.