765 resultados para Nurse-led Telephone Interventions


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This study aimed to identify the value components of nurse call solutions. The value creation of such systems was analyzed by using a framework that was created based on the existing customer value literature. The empirical part of the study was conducted as a multiple-case study by using qualitative research methods. The data for the analysis was gathered through structured interviews in ten Finnish eldercare centers. The results indicate that a nurse call solution creates value for eldercare centers by increasing the safety of the residents, and by improving the efficiency of the staff while also providing cost savings.

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Työssä tutkittiin Kemira Chemicals Oy:n Vaasan polyelektrolyyttitehtaalla led -tekniikan käyttöönottoa polyakryyliamidin valmistamisessa fotoinitiaatiolla. Led- tekniikan käyttöönoton seuraamisella ja erilaisten mittausten tekemisellä oli tarkoitus saada uudesta teknologiasta tietoa, jonka perusteella tulevaisuuden investointiesitykset voisivat olla paremmin perusteltavissa. Työn kirjallisuusosassa käytiin läpi valaistus- ja led -tekniikan perusteita sekä polymeerien perusteita. Lisäksi polyelektrolyyttien ominaisuudet ja käyttökohteet käytiin läpi. Kirjallisuusosan lopussa käytiin läpi polymerointia, fotoinitiaatiota ja vapaiden radikaalien toimintaa. Myös kustannuslaskentaa selvitettiin. Mittausten ja vertailujen perusteella voitiin todeta led -valojen vaikuttaneen positiivisesti prosessin toimintaan ja lopputuotteiden laatuun. Tämänlaisessa sovelluksessa led -tekniikka ei ole kuitenkaan vielä kilpailukykyistä vanhaan teknologiaan verrattuna puhtaasti taloudellisesti ajateltuna.

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Led-valaisun kehitys on mahdollistanut sen käytön kodin yleisvalaistuksessa. Työssä tutkitaan eri led-valaisuun soveltuvia teholähteitä, joista valitaan teknisiltä ominaisuuksiltaan sopivin kodin yleiskäyttöön. Tutkittavia teholähteitä ovat lineaariset ja hakkuriteholähteet. Teholähteiden ominaisuuksista tarkastellaan hyötysuhteita ja tehokertoimia, joista molempien perusteella sopivin teholähdetyyppi valitaan.

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Light emitting diode (LED) has been used in commercial poultry industry by presenting superior energy savings and providing feasibility on production process. The objective of this research was to evaluate performance and carcass yield of broiler chickens exposed to different LED colors compared with fluorescent lamps. For that, two experiments (E1 and E2) were performed and 2,646 Cobb® chickens were used. In experiment E1, male birds were exposed to 20 lux artificial lighting with red, yellow, blue, and white LED bulbs; and fluorescent bulb. In experiment E2, male and female birds were exposed to 15 lux artificial lighting with red and blue LED bulbs; and fluorescent bulb. Cumulative weight gain (kg), feed intake (kg), feed conversion, hot carcass weight (kg), carcass yield (%), and breast and thigh + drumstick yield (%) were used as response variables. Results showed no difference (p > 0.05) among treatments for performance, carcass yield, and cut yield in experiment E1. In experiment E2 there was only difference between genders (p < 0.05) and males showed higher total weight gain, feed intake, hot carcass weight and thigh + drumstick yield. Different LED color use had same effect as fluorescent lights on broiler performance and carcass yield.

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Foot health is a part of overall health in every age group and its importance increases during ageing. Health care professionals are in a vital position for preventing foot health problems, and identifying and caring them in older people. Despite the rather high number of studies conducted in the field of foot health in older people, reliable and valid nurse-administered foot health assessment instruments seem to be lacking. By identifying foot health in older people, it is possible to develop nursing interventions to enhance safe, independent living at home. The purpose of this three-phase study was to develop an instrument to assess the level of foot health in older people and evaluate foot care practices from the perspective of older people themselves and nurses in home care. The ultimate goal is to prevent foot health problems by increasing the attention paid to older people’s feet and recognizing those foot health problems which need further care; thus not focus on different foot health problems. The study was conducted in different phases and contexts. In phase 1, a descriptive design with a literature review from the Medline (R) and CINAHL databases to explore foot health in older people and nurses’ role in foot health care and pre-post design intervention study in nursing home with nursing staff (n=16) and older residents (n=43) were conducted. In phase 2, a descriptive and explorative study design was employed to develop an instrument for assessing foot health in older people (N=651, n=309, response rate 47%) and explore the psychometrics of the instrument. The data were collected from sheltered housing and home care settings. Finally, in phase 3, descriptive and explorative as well as cross-sectional correlational survey designs were used to assess foot health and evaluate the foot self-care activities of older people (N=651, n=309, response rate 47%) and to describe foot care knowledge and caring activities of nurses (N=651, n=322, response rate 50%) in home care in Finland. To achieve this, the Foot Health Assessment Instrument (FHAI) developed in phase 2 was used; at the same time, this large sample also was used for the psychometric evaluation of the FHAI. The data analysis methods used in this study were content analysis, descriptive and inferential statistics including factor and multivariate analysis. Many long-term diseases can manifest in feet. Therefore, the FHAI, developed in this study consisted of items relating to skin and nail health, foot structure and foot pain. The FHAI demonstrated acceptable preliminary psychometric properties. A great deal of different foot health problems in older people were found of which edema, dry skin, thickened and discoloured toenails and hallux valgus were the most prevalent foot health problems. Moreover, many older people had difficulties in performing foot self-care. Nurses’ knowledge of foot care was insufficient and revealed a need for more information and continuing education in matters relating to foot care in older people. Instead, nurses’ foot care activities were mainly adequate, though the findings indicate the need for updating foot care activities to correspond with the evidence found in the field of foot care. Practical implications are presented for nursing practice, education and administration. In future, research should focus on developing interventions for older people and nurses to promote foot health in older people and to prevent foot health problems, as well as for further development of the FHAI.

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Previous research on productivity is often associated with manufacturing or uses manufacturing definitions of productivity. Marketing research on services has not been satisfied with the manufacturing definitions. No universal definition for service productivity exists. The lack of a universal definition highlights the complexity entailed in the concept of productivity. The objective of this study was to investigate service productivity in situations, where traditional ways are in some cases even not possible or are not enough. In one definition of the productivity of service organisations there is the efficiency of the organisation on the input side and on the output side the customers’ perceived quality or value-in-use. To learn about value-in-use, many methods have been developed. A common practice is to make customer opinion surveys in the form of customer questionnaires and interviews. However, customers cannot always be asked directly, for example, because of impaired cognitive abilities. Such cases include the elderly and children. Furthermore, customer opinion surveys are time consuming. In addition, customers do not always know what kind of services they would benefit from. For the empirical part of the study, a business area was identified where traditional ways of measuring value-in-use are difficult or in some cases even not possible. This business area is safety telephone services. These services are most often used by the elderly. The way to define value-in-use here was to assess how well the services offered met customer expectations. Comparing the services customers asked for and the services provided to them indicated whether customer expectations were met. This study showed that customers had their ideas concerning the contents of the services but many times the services provided did not meet these expectations. Organisational efficiency aspirations can decrease customers’ value-in-use. This study found a solution, in which increasing organisational efficiency would go hand-in-hand with increasing customers’ value-in-use; the result being that the organisations’ needs and the service users’ expectations were in line. Value creation for customers produced organisational efficiency and thus increased productivity. In this study, customer expectations were observed by means of wellness technology. With the help of modern technology, customer expectations can be followed quickly and easily and customers can co-create with the organisation. This type of an approach could be useful even in the development of other services for other ages and in different contexts. If a service organisation decreases the number of personnel and, at the same time, tries to offer services to the same or a larger clientele, customers easily notice the change, which is often negative. To avoid harmful decrease in value-in-use, limitations to the aspiration of efficiency should be implemented – one of such is that the organisation is required to meet certain quality standards defined by experts. The aim is to secure that, as a result of efficiency aspirations in the organisation, the quality of the service offerings does not diminish below mutually agreed standards. Traditionally, when productivity in services has been estimated, organisational efficiency has not been combined with both customer expectations and an expert assessment of quality. This study contributes with novel thinking entitled ‘Relationship Management of the Elderly’. This study handles productivity, expert defined quality and value-in-use in an organisational context, which is practically untouched in previous research studies.

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Painolastivesien mukana kulkeutuvien lajien leviäminen on yksi vakavimmista globaaleista ympäristöuhkista. Kansainvälinen merenkulkujärjestö IMO määritteli vuonna 2004 kansainvälisen painolastivesiyleissopimuksen, jonka tarkoituksena on ehkäistä laivojen painolastivesien mukana kulkeutuvien lajien leviämistä. Sopimus velvoittaa aluksia käsittelemään niiden painolastivedet ja se sisältää myös käsittelyjärjestelmiltä edellytetyt vaatimukset. Vaikka sopimus ei ole vielä astunut voimaan, painolastivesien käsittelyyn löytyy markkinoilta jo useita kymmeniä IMO:n hyväksymiä käsittelyjärjestelmiä, jotka hyödyntävät erilaisia mekaanisia, fysikaalisia ja kemiallisia menetelmiä. Yksi yleisimmin käytetyistä menetelmistä on UV-säteilytys. UV-säteily tuotetaan elohopealampuilla, jotka kuitenkin kuluttavat paljon energiaa ja sisältävät myrkyllistä elohopeaa. Tämän työn tarkoituksena oli selvittää, voisiko elohopealamput korvata lähitulevaisuudessa UV-LED -lampuilla. UV-LED –lamppujen etuja ovat muun muassa energiatehokkuus, kestävä rakenne ja myrkyttömyys. Työn tärkeimpänä tavoitteena oli tutkia laboratoriomittausten avulla, millainen UV-annosmäärä 10-50 µm kokoisten kasviplanktonien inaktivoimiseen tarvitaan. Mittausjärjestelyt vastasivat suurelta osin IMO:n vaatimuksia. Laboratoriomittauksissa käytettiin 265 nm:n aallonpituudella toimivia UV-LED -lamppuja. Näytteiden analysoinnissa käytettiin sekä PAM-fluorometriä että virtaussytometriä. Saatujen tulosten perusteella tutkimuksessa käytettyjen lajien Asterionellopsis glacialis ja Thalassiosira sp. täydelliseen inaktivoitumiseen tarvittiin noin 600 mJ/cm2 suuruinen UV-annos. Tulos vastasi ennakko-odotuksia ja se oli vertailukelpoinen muiden aiheesta tehtyjen tutkimusten kanssa. Koska nykyisten UV-LED –lamppujen teho on hyvin alhainen, ne eivät vielä sovellu painolastivesien käsittelyyn. UV-LED –lamppujen kehitystyö on kuitenkin käynnissä ja on arvioitu, että niitä voitaisiin käyttää suurten virtaamien käsittelyssä 5-10 vuoden kuluttua.

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Veden riittämätön puhdistus aiheuttaa riskin veden käyttäjille. Miljoonia kuolemia vuosittain aiheuttavien vesiteitse leviävien sairauksien ehkäisemiseksi vaaditaan tehokkaita juomaveden desinfiointimenetelmiä. Kuivuuden ja väestönkasvun myötä veden tarve on lisääntynyt ja vedenkulutus tulee yhä kasvamaan. Tästä syystä mahdollisuus kierrättää vettä hyödyntäen sitä esimerkiksi kasteluun on saanut yhä enemmän huomiota. Kierrätettävä vesi on kuitenkin käsiteltävä huolellisesti sen sisältämän mikrobiologisen kontaminaatioriskin vuoksi. Ultraviolettisäteily luokitellaan fysikaaliseksi desinfiointimenetelmäksi. Sen tehokkuus perustuu mikro-organismien absorboimaan UV-säteilyyn, jonka aiheuttamien DNA:ssa tai RNA:ssa tapahtuvien muutoksien seurauksena mikro-organismi inaktivoituu ja estyy lisääntymästä. UV-desinfioinnissa on tyypillisesti käytetty elohopeahöyrylamppuja. Vaihtoehtoinen UV-säteilyn lähde ovat LEDit eli valoa emittoivat diodit. Matalapaine-elohopeahöyrylamppujen emittoima säteily on aallonpituudella 254 nm ja keskipaine-elohopeahöyrylamppujen emittoima säteily on laajakaistaista säteilyä. Energiatehokkuuden lisäksi LEDien etuna on, että niillä voidaan tuottaa kapeakaista säteilyä aallonpituudella, joka parhaiten absorboituu DNA:han. Tämän diplomityön tarkoituksena oli tutkia, onko UVC-alueen aallonpituuksien yhdistelmillä synergistisiä etuja LEDien desinfiointitehokkuuteen, kun desinfioidaan virtaavaa vettä useilla säteilyannoksilla ja indikaattorimikrobina käytetään kolibakteeria. Tavoitteena oli myös tutkia tällä hetkellä saatavissa olevien LEDien desinfiointitehokkuutta energiatehokkuuden näkökulmasta. Yksittäisistä aallonpituuksista desinfiointitehokkuudeltaan parhaimmaksi osoittautui 260 nm, aallonpituuksien yhdistelmistä tehokkain oli 265 nm:n ja 260 nm:n yhdistelmä. Muilla aallonpituuksien yhdistelmillä ei saavutettu odotettua parempaa desinfiointitehokkuutta. Optiselta teholtaan parhaimmat LEDit, 265 nm, 270 nm ja 275 nm olivat kokeiden perusteella myös energiatehokkuuden kannalta tarkasteltuina parhaimmat sekä yksittäin että yhdistelminä. UVC-aallonpituuksia emittoivien LEDien optisen tehokkuuden paraneminen on edellytys LEDien hyödyntämiselle desinfioinnissa.

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Background: Approximately 11,000 revascularization procedures, either percutaneous coronary interventions (PCI) or coronary artery bypass grafting surgery (CABG), are performed yearly in Finland for coronary artery disease. Periprocedural risk factors for mortality and morbidity as well as long-term outcome have been extensively studied in general populations undergoing revascularization. Treatment choice between PCI and CABG in many high risk groups and risk-stratification, however, needs clarification and there is still room for improvement in periprocedural outcomes. Materials and methods: Cohorts of patients from Finnish hospitals revascularized between 2001 and 2011 were retrospectively analyzed. Patient records were reviewed for baseline variables and postprocedural outcomes (stroke, myocardial infarction, quality of life measured by the EQ-5D –questionnaire, repeat revascularization, bleeding episodes). Data on date and mode of death was acquired from Statistics Finland. Statistical analysis was performed to identify predictors of adverse events and compare procedures. Results: Postoperative administration of blood products (red blood cells, fresh frozen plasma, platelets) after isolated CABG independently and dose-dependently increases the risk of stroke. Patients 80 years or older who underwent CABG had better survival at 5 years compared to those who underwent PCI. After adjusting for baseline differences survival was similar. Patients on oral anticoagulation (OAC) for atrial fibrillation (AF) treated with CABG had better survival and overall outcome at 3 years compared to PCI patients. There was no difference in incidence of stroke or bleeding episodes. Differences in outcome remained significant after adjusting for propensity score. Lower health-related quality of life (HRQOL) scores as measured by the visual analogue scale (VAS) of the EQ-5D questionnaire at 6 months after CABG predicted later major adverse cardiac and cerebrovascular events (MACCE). Deteriorating function and VAS scores between 0 and 6 months on the EQ-5D also independently predicted later MACCE. Conclusions: Administration of blood products can increase the risk of stroke after CABG and liberal use of transfusions should be avoided. In the frail subpopulations of patients on OAC and octogenarians CABG appears to offer superior long-term outcome as compared to PCI. Deteriorating HRQOL scores predict later adverse events after CABG. Keywords: percutaneous coronary intervention, coronary artery bypass grafting, age over 80, transfusion, anticoagulants, coronary artery disease, health-related quality of life, outcome.

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Työn tavoitteena oli tutkia, millä tavalla perusterveydenhuollon perinteisestä terveysasemamallista hyvinvointiasemamalliin siirtyminen vaikuttaa sosiaali- ja terveyspalvelujen tarjonnan kustannuksiin, mikäli vaikutus on havaittavissa. Toisaalta tavoitteena oli kartoittaa, millä keinoilla hyvinvointiasemien kustannustehokkuutta voitaisiin parantaa tulevaisuudessa ja mitä kustannushyötyjä tiiviimmällä sosiaali- ja terveystoimen yhteistyöllä on mahdollista saavuttaa. Tutkimuksessa käsiteltiin terveyden ja hyvinvoinnin edistämisen roolin merkitystä perusterveydenhuollossa, sähköistä asiointipalveluja ja terveydenhuollon ammattiryhmien välistä työnjakoa sekä edelleen, miten näillä voidaan vaikuttaa tuottavuuteen ja vaikuttavuuteen. Havaittiin, että sähköisellä asioinnilla ja työnjaolla on selkeä yhteys kustannuksiin. Työn empiirisessä osassa tarkasteltiin kolmea hyvinvointiasemamallin pilottihankkeessa mukana olevaa asemaa Lauritsalassa, Lemillä ja Ruokolahdella. Kustannusten tarkastelu keskittyi henkilöstö- ja tilakustannuksiin. Tutkittiin myös, miten sähköinen asiointi ja Eksoten alueen puhelinpalvelujen keskittäminen vaikuttaa edellä mainittuihin kustannuseriin. Tutkimuksen tuloksina havaittiin, että hyvinvointiasemamallin pilotointi ei ole tutkittavilla asemilla merkittävästi vaikuttanut kustannuksiin henkilöstön osalta; tilakustannukset olivat pienentyneet Lemillä ja Ruokolahdella. Laskelmien perusteella muodostettujen tavoitteiden mukaisesti on hyvinvointiasemilla kuitenkin pyrittävä vähintään noin 14 % tai enintään 32 % säästöön henkilöstö- ja tilakustannuksissa pilottivaiheen kustannuksiin verrattuna. Tulevaisuudessa olennaiseksi kustannusten hallinnan edellytykseksi havaittiin työnjaon muuttaminen hoitajavetoisemmaksi ja sähköisten asiointipalvelujen lisääntyvä tarjonta. Sähköisten asioinnin lisääntyvällä käytöllä on mahdollista vähentää hoitohenkilöstön tarvetta kokonaisuudessaan. Sekä sähköisen asioinnin käytön lisäämisellä että puhelinpalvelujen keskittämisellä tulevaisuudessa havaittiin olevan huomattava vaikutus henkilöstöresurssien käyttöön ja edelleen kustannustehokkuuteen.

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A rapid increase in allergic diseases in Western societies has led to the conclusion that our modern lifestyle is a risk factor for immune dysregulation. Potential culprits and benefactors are searched among early dietary and microbial exposures, which may act to program later allergic disease. The aim of this thesis was to investigate the role of early maternal and child nutrition in reducing the risk of child allergy. The study population comprised of 256 mother – child pairs from families with a history of allergy participating in a randomized controlled dietary counseling and probiotic intervention (Lactobacillus rhamnosus GG and Bifidobacterium lactis Bb12) study from early pregnancy onwards. The dietary counseling aimed for a diet complying with dietary recommendations for pregnant and lactating women, with special attention to fat quality. Maternal dietary counseling was reflected in cord blood fatty acids suggesting better essential fatty acid status in infants in the counseling group. Dietary counseling with probiotics or placebo had no effect on child allergy risk, but associations between maternal diet during pregnancy and breastfeeding and child allergic outcomes were found in secondary analyses. During pregnancy, milk intake was related to decreased and cheese intake to increased risk of child atopic eczema. During breastfeeding, intake of vitamin C was related to increased risk of asthma and intake of egg was related to decreased risk of atopic eczema. The timing of introduction of complementary foods to infant’s diet was not associated with risk of atopic eczema, when adjusted with parental opinion of child allergic symptoms (i.e., potential reverse causality). In conclusion, the results demonstrate that infant fatty acid supply can be modified via maternal dietary changes. In addition, interesting associations of maternal diet with child allergy risk were discovered. However, no difference in the incidence of allergic diseases with dietary counseling was observed. This suggests that more potent dietary interventions might be necessitated to induce clinical risk reduction of allergy. Highrisk families can safely adhere to dietary recommendations for pregnant and lactating women, and the results support the current conception that no additional benefit is gained with delaying introduction of complementary feeding.

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This thesis in caring science didactics is based on a thinking, where the fundamental basis for the didactic is science-based, i.e. it does not emanate from the nursing profession but brings forward a didactic that grows out of caring science and its core substance and ethos. This view on didactics arises from the caritative theory developed by Eriksson. The overall aim of the study is to clarify the meaning and essence of understanding, as well as to explore and deepen the understanding of student nurses' processes of understanding and becoming with the intention of developing a theory model for caring didactics. The overarching research questions are: What is the essence of understanding (of caring science knowledge)? What are the possibilities and importance of understanding in the appropriation of caring science? What characterizes and impels the process of becoming? The thesis consists of four sub studies and a summary section. The overall methodological approach is hermeneutic involving quantitative as well as qualitative methods. The data for the study has been collected through a longitudinal research project that followed student nurses at three universities during their entire education. The empirical sub studies form the basis for the interpreted knowledge that is formulated in the new understanding. This new understanding have, through additional theory-charging with the theory fragments from Gadamer, generated the heuristic synthesis which is illustrated in the theory model. The findings shows that understanding can be described as something unlimited, as an endless movement, which can be illustrated as a lying eighth, a lemniscate. The lemiscate of understanding is characterized by seeing, knowing and becoming and consists of seven differently named phases; the acquired horizon of understanding, the encounter of horizons, the dialogue of horizons, the fusion of horizons, application, reflection and shaping a new horizon of understanding. Bildung (formation), is the ultimate imprint of the endless spiral movement of understanding. Ethos and arête constitute the hubs around which the lemniscate of understanding circles. These include the spirit and driving force that the student carries within. The caring culture encloses the lemniscate of understanding. The caring culture provides the life space of understanding and the prevailing basic values are evinced in the culture.

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Coronary artery disease is an atherosclerotic disease, which leads to narrowing of coronary arteries, deteriorated myocardial blood flow and myocardial ischaemia. In acute myocardial infarction, a prolonged period of myocardial ischaemia leads to myocardial necrosis. Necrotic myocardium is replaced with scar tissue. Myocardial infarction results in various changes in cardiac structure and function over time that results in “adverse remodelling”. This remodelling may result in a progressive worsening of cardiac function and development of chronic heart failure. In this thesis, we developed and validated three different large animal models of coronary artery disease, myocardial ischaemia and infarction for translational studies. In the first study the coronary artery disease model had both induced diabetes and hypercholesterolemia. In the second study myocardial ischaemia and infarction were caused by a surgical method and in the third study by catheterisation. For model characterisation, we used non-invasive positron emission tomography (PET) methods for measurement of myocardial perfusion, oxidative metabolism and glucose utilisation. Additionally, cardiac function was measured by echocardiography and computed tomography. To study the metabolic changes that occur during atherosclerosis, a hypercholesterolemic and diabetic model was used with [18F] fluorodeoxyglucose ([18F]FDG) PET-imaging technology. Coronary occlusion models were used to evaluate metabolic and structural changes in the heart and the cardioprotective effects of levosimendan during post-infarction cardiac remodelling. Large animal models were used in testing of novel radiopharmaceuticals for myocardial perfusion imaging. In the coronary artery disease model, we observed atherosclerotic lesions that were associated with focally increased [18F]FDG uptake. In heart failure models, chronic myocardial infarction led to the worsening of systolic function, cardiac remodelling and decreased efficiency of cardiac pumping function. Levosimendan therapy reduced post-infarction myocardial infarct size and improved cardiac function. The novel 68Ga-labeled radiopharmaceuticals tested in this study were not successful for the determination of myocardial blood flow. In conclusion, diabetes and hypercholesterolemia lead to the development of early phase atherosclerotic lesions. Coronary artery occlusion produced considerable myocardial ischaemia and later infarction following myocardial remodelling. The experimental models evaluated in these studies will enable further studies concerning disease mechanisms, new radiopharmaceuticals and interventions in coronary artery disease and heart failure.

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In this article, we will review some behavioral, pharmacological and neurochemical studies from our laboratory on mice, which might contribute to our understanding of the complex processes of memory consolidation and reconsolidation. We discuss the post-training (memory consolidation) and post-reactivation (memory reconsolidation) effects of icv infusions of hemicholinium, a central inhibitor of acetylcholine synthesis, of intraperitoneal administration of L-NAME, a non-specific inhibitor of nitric oxide synthase, of intrahippocampal injections of an inhibitor of the transcription factor NF-κB, and the exposure of mice to a new learning situation on retention performance of an inhibitory avoidance response. All treatments impair long-term memory consolidation and retrieval-induced memory processes different from extinction, probably in accordance with the "reconsolidation hypothesis".