Intuboidun hengityslaitehoitoa saavan aikuisen tehohoitopotilaan suunhoidon kirjaaminen

Tutkimuksen tarkoituksena oli tutkia potilastietojärjestelmien suunhoitosivut kaikilla suomalaisilla teho-osastoilla, joissa oli käytössä Clinisoft® -potilastietojärjestelmä ja, joilla hoidettiin intuboituja, hengityslaitehoitoa saavia aikuisia tehohoitopotilaita. Lisäksi tutkimuksessa analysoitiin yhden yliopistosairaalan teho-osaston hoitajien suunhoidon kirjauksia potilastietojärjestelmän vuorohuomioraporteista. Tutkimusosion 1 aineisto koostui aikuispotilaita hoitavien teho-osastojen (N=15) Clinisoft® -potilastietojärjestelmien suunhoitosivuista. Tutkimusosion 2 aineisto koostui yhden yliopistosairaalan teho-osaston intuboitujen, hengityslaitehoitoa saaneiden aikuisen tehohoitopotilaiden suunhoidon kirjauksista (n=97). Vuonna 2008–2009 hoidetuista intuboiduista, hengityslaitehoitoa saaneista tehohoitopotilaista (N=1180) valittiin satunnaisotannalla 100 potilasta, joiden suunhoitoon liittyvät potilasasiakirjat otettiin mukaan analyysiin. Aineistot analysoitiin sisällön erittelyllä. Suunhoitosivujen aihesisällöistä muodostettiin 14 sisältöluokkaa. Vuorohuomiokirjaukset oli kirjattu yleensä hengitys tai happeutuminen otsakkeiden alle, josta löytyi yhteensä 589 alkuperäislausumaa. Hoitajat kirjasivat ensin potilaan hengityslaitehoidosta ja happeutumisesta. Alkuperäislausumista tehohoitopotilaan suunhoitoon liittyviä lausumia oli 61 % (n=357). Vuorohuomiokirjauksista muodostettiin 11 sisältöluokkaa. Potilastietojärjestelmän suunhoitosivujen rakenne ei ohjannut VAP:a ehkäisevään suunhoitoon ja tehohoitopotilaan suunhoitoa kirjattiin usealle sivulle. Kaikkien tehohoito-osastojen suunhoitosivupohjissa oli kohdat suun kunnon arvioinnille ja suunhoidolle, mutta sivuilta ei aina selvinnyt tehohoito-osaston suunhoitoon käytättämiä välineitä. Sivuissa oli nähtävissä yksittäisiä VAP:n ehkäisyyn liittyviä interventioita. Vuorohuomioraportteihin kirjaaminen oli päällekkäistä suunhoitosivuun kirjattavien tietojen kanssa. Hoitajat kirjasivat tehohoitopotilaan hengityslaitehoidosta ja potilaan happeutumisesta. Suunhoidosta hoitajat kirjasivat eniten eritteiden määrää ja laatua ja vähiten suunhoidossa käytetyistä välineistä sekä suunhoitoon liittyvästä arvioinnista. Tehohoitopotilaan suuta hoidettiin keskimäärin 2.93 kertaa vuorokaudessa, eniten aamuvuoroissa. Suun kuntoa arvioitiin 1.12 kertaa vuorokaudessa. Pro gradu -tutkielma tuo uutta tietoa intuboidun, hengityslaitehoidossa olevan aikuisen tehohoitopotilaan näyttöön perustuvasta suunhoidosta, potilastietojärjestelmien suunhoitosivujen rakenteesta ja tehohoitopotilaan suunhoidon kirjaamisesta Suomessa. Tutkimustulosten ja kansainvälisten suositusten avulla kehitettiin Clinisoft® -potilastietojärjestelmän mallisivu tehohoitopotilaan suunhoidon tarpeen määrittämisen, suunnittelun, toteutuksen ja arvioinnin tueksi.

Strategier som kan förbättra sjuksköterskors kommunikation vid överrapportering inom somatisk slutenvård : En litteraturöversikt

Bakgrund: Sjuksköterskor har i sitt dagliga arbete till uppgift att ge och ta emot rapport om patienterna hen vårdar. En god kommunikation krävs för att säkerställa att relevant information förmedlas och inte patientsäkerheten hotas. Syfte: Att beskriva strategier för hur kommunikationen kan förbättras vid överrapportering mellan sjuksköterskor inom den somatiska slutenvården. Metod: Litteraturöversikten är baserad på 15 vetenskapliga artiklar med kvalitativ, kvantitativ och mixad ansats. Artiklarna identifierades via sökningar i databaserna Cinahl, PubMed och Web of Science. Resultat: Tre strategier framkom: personlig överrapportering, användandet av standardiserade formulär och överrapportering vid patientens säng. Strategierna gav en effektivare, säkrare och mer tidssparande överrapportering. Slutsats: En god kommunikation mellan sjuksköterskorna är oerhört viktigt för att bibehålla en trygg och säker vård för patienterna. För att få en förbättrad kommunikation mellan sjuksköterskor vid överrapportering kan olika strategier användas. Då sjuksköterskorna ofta har en hög arbetsbelastning så krävs det att överrapporteringarna är strukturerade för att inte tappa bort viktig information.

National Institutes Of Health Consensus Development Project On Criteria For Clinical Trials In Chronic Graft-versus-host Disease: I. The 2014 Diagnosis And Staging Working Group Report.

The 2005 National Institutes of Health (NIH) Consensus Conference proposed new criteria for diagnosing and scoring the severity of chronic graft-versus-host disease (GVHD). The 2014 NIH consensus maintains the framework of the prior consensus with further refinement based on new evidence. Revisions have been made to address areas of controversy or confusion, such as the overlap chronic GVHD subcategory and the distinction between active disease and past tissue damage. Diagnostic criteria for involvement of mouth, eyes, genitalia, and lungs have been revised. Categories of chronic GVHD should be defined in ways that indicate prognosis, guide treatment, and define eligibility for clinical trials. Revisions have been made to focus attention on the causes of organ-specific abnormalities. Attribution of organ-specific abnormalities to chronic GVHD has been addressed. This paradigm shift provides greater specificity and more accurately measures the global burden of disease attributed to GVHD, and it will facilitate biomarker association studies.

Interim Report of the Steering Group on the Review of the Mental Health Act 2001

Interim Report of the Steering Group on the Review of the Mental Health Act 2001 There is a commitment in the Programme for Government to review the Mental Health Act 2001. In line with this, Minister Lynch appointed a Steering Group to review the Mental Health Act 2001. Their report is now with an Expert Group. The review takes accounts of the significant changes in thinking about the delivery of mental health services that have taken place in the last ten years (including the introduction of the UN Convention on the Rights of People with Disabilities (CRPD), the shift to community based services, the adoption of a recovery approach in every aspect of service delivery and the involvement of service users as partners in their own care and in the development of the service). Click here to download PDF 471kb

Title III-E Report YTD 1st Quarter-4th Quarter 2007

Family Caregiver Support Program (Title III-E) - The Administration on Aging (AoA) has determined that for Title III-E, the actual family caregiver is the client, not the older person receiving the services. Iowa NAPIS (National Aging Program Information System) collects and reports Title III-E service/performance data and related program management information to the federal and state government in a format like the other Title III services. The major shift in reporting relates to who is the client. As a result, this Title III-E Client/Service Unit Report shows the number of caregivers who receive services and the number of units by service category from the Title III-E funding of the Older Americans Act, the AoA, and limited state general fund dollars. Additionally, it shows the number of persons served by individual services and total "unduplicated" client count across all services. In other words, if you add the total number of clients (caregivers) from all services, it is higher than the actual number of persons served across all services because some people need and receive more than one service. (Please note: this is preliminary data, and may be subject to change.) Title III-E Report YTD 1st Quarter 2007 Title III-E Report YTD 2nd Quarter 2007 Title III-E Report YTD 3rd Quarter 2007 Title III-E Report YTD 4th Quarter 2007

Draft environmental report on Cape Verde

Faced with recurrent drought and famine during five centuries of human occupation, the small and densely populated Cape Verde Islands have a history of severe environmental problems. The arid climate and steep, rocky terrain provide scant resources for traditional subsistance farming under the best conditions, and in years of low rainfall the failure of rainfed crops causes massive food shortages. Agricultural use of steep slopes where rainfall is highest has led to soil erosion, as has removal of the island's vegetation for fuel and livestock. Pressure on the vegetation is particularly severe in dry years. International aid can provide relief from famine, and the introduction of modern agricultural and conservation techniques can improve the land and increase yield, but it is unlikely that Cape Verde can ever be entirely self -sufficient in food. Ultimately, the solution of Cape Verde's economic and environmental problems will probably require the development of productive urban jobs so the population can shift away from the intensive and destructive use of land for subsistance farming. In the meantime, the people of Cape Verde can best be served by instituting fundamental measures to conserve and restore the land so that it can be used to its fullest potential. The primary environmental problems in Cape Verde today are: 1. Soil degradation. Encouraged by brief but heavy rains and steep slopes, soil erosion is made worse by lack of vegetation. Soils are also low in organic matter due to the practice of completely removing crop plants and natural vegetation for food, fuel or livestock feed. 2. Water shortage. Brief and erratic rainfall in combination with rapid runoff makes surface water scarce and difficult to use. Groundwater supplies can be better developed but capabilities are poorly known and the complex nature of the geological substrate makes estimation difficult. Water is the critical limiting factor to the agricultural capability of the islands. 3. Fuel shortage. Demand for fuel is intense and has resulted in the virtual elimination of native vegetation. Fuelwood supplies are becoming more and more scarce and costly. Development of managed fuelwood plantations and alternate energy sources is required. 4. Inappropriate land use. Much of the land now used for raising crops or livestock is too steep or too arid for these purposes, causing erosion and destruction of vegetation. Improving yield in more appropriate areas and encouraging less damaging uses of the remaining marginal lands can help to alleviate this problem.

Iowa Community Colleges Student Enrollment Report, December 2000

Fall enrollment grew 1.2 percent to a record high of 88,104 unduplicated students in fiscal year 2009 (Table 1). College enrollment has grown for 11 consecutive years since enrollment slipped in fiscal year 1997. In the 44‐year history of the modern community college system, enrollment has only fallen four times (Figure 1). Enrollment growth was slightly slower than prior years. In 2006, enrollment grew over three percent, while enrollment grew 2.5 percent last year. Nevertheless, enrollment growth is outpacing the projected nationwide growth in community colleges (Hussar and Bailey, 2008: Table 16). For the second consecutive year, part‐time enrollment exceeded full‐time enrollment. Slightly over half, 50.9 percent, of students are enrolled in less than 12 credit hours. Last year, part‐time enrollment exceeded full‐time enrollment for the first time. The shift represents growing enrollment by working students and joint enrollment— high school students who enroll in community colleges.. Nationally, part‐time enrollment at public two‐year colleges has exceeded full‐time enrollment for more than 15 years. In 2006, part‐time students exceeded full‐time students by 60 percent (Hussar and Bailey, 2008: Table 16). Iowa’s enrollment growth has traditionally been consistent. Enrollment decreased four times—1976, 1983, 1984, and 1997—during the entire 44‐year history. Fulltime enrollment decreased nine times over the same period while part time enrollment only fell twice. The remainder of this report will break down credit enrollment by credit hours, student demographics, the programs in which students are enrolled, how the programs break down demographically, and joint enrollment.

1119-008 Lake Icaria Final Report

Lake Icaria is a 660 acre man-made lake in rural Adams County. Lake Icaria is a popular recreational attraction providing ample fishing, boating, and swimming opportunities. Constructed in 1977 for water supply, Lake lcaria continues to provide reliable drinking water to 1,900 households in Adams and Montgomery counties. No stranger to the water quality world, Lake Icaria was the primary lake in the 3Lakes Water Quality Project(1996-2004), an eight year water quality effort which came to be known as one oflowa's first great water quality successes. At time of construction the Lake Icaria watershed was primarily grass. A shift towards maximizing crop production in the 1980's brought about the end of dairy farms and a concern for sediment loss and how that would affect water quality. This change in land use set the stage for the first water quality project at Lake Icaria. Since the conclusion of the 3Lakes Water Quality Project in 2004land use in the watershed has made yet another monumental shift towards crop production. Nearly 2,000 acres ofland that was once in the conservation reserve program is now being planted to a crop. This change in land use has once again brought about serious concerns for the quality of water being provided by Lake Icaria.

Evaluation of Unbonded Ultrathin Whitetopping of Brick Streets, TR-466, Construction Report, 2002

Many cities in Iowa have retained the original brick street surfaces in downtown areas and in older residential areas as the base for modern driving surfaces. The original brick surfaces were not built to handle current and future traffic loadings. In recent years, these surfaces have tended to shift and become uneven, creating problems with safety. Asphaltic concrete overlays have been the typical rehabilitation technique in these situations. This has proven to be a successful rehabilitation technique in some cases; in other cases, the combination of movement of the brick and flexibility of the asphalt has proven to accentuate the original problems. Most of the existing literature on rehabilitation of brick streets shows the use of asphaltic concrete. Other rehabilitation methods include reconstruction of the brick surface and strengthening of the surface by placing asphaltic concrete or portland cement concrete, along with sand, underneath the brick layers. To date, little if anything has been done in the area of using portland cement concrete as an overlay of the brick surfaces. This final report documents the planning, construction, and performance of unbonded ultrathin whitetopping rehabilitation of a brick street in Oskaloosa, Iowa, in 2001. It also reports on a similar project in Des Moines that was constructed two years later in 2003.

Association of hepatic nuclear factor-4 in the apolipoprotein B promoter: a preliminary report

Previous studies have examined the arrangement of regulatory elements along the apolipoprotein B (apoB) promoter region (-3067 to +940) and a promoter fragment extending from nucleotides -150 to +124 has been demonstrated to be essential for transcriptional activation of the apoB gene in hepatic and intestinal cells. It has also been shown that transcriptional activation of apoB requires a synergistic interaction between hepatic nuclear factor-4 (HNF-4) and CCAAT/enhancer-binding protein a (C/EBPa) transcription factors. Here, we have examined the hypothesis that HNF-4 factor binding to DNA may induce a DNA helix bend, thus facilitating the communication with a C/EBPa factor located one helix turn from this HNF-4 factor in the apoB promoter. A gel electrophoretic mobility shift assay using wild type double-stranded oligonucleotides or modified wild type duplex oligonucleotides with 10 nucleotides inserted between HNF-4 and C/EBPa factor motifs showed similar retarded complexes, indicating that HNF-4 and C/EBPa factors interact independently of the distance between binding sites. However, when only one base, a thymidine, was inserted at the -71 position of the apoB promoter, the complex shift was completely abolished. In conclusion, these results regarding the study of the mechanisms involving the interaction between HNF-4 and C/EBPa factors in the apoB promoter suggest that the perfect 5'-CCCTTTGGA-3' motif is needed in order to facilitate the interaction between the two factors.