Day-case anaesthesia in adult knee arthroscopy : With special reference to recovery and cost-effectiveness after general and spinal anaesthesia

AbstractThe number of ambulatory surgical procedures is increasing throughout the world. This is partly due to the development of a number of new anaesthetic, analgesic and adjuvant drugs, each with more rapid onset and shorter duration of action, over the past two decades. An interest in the issues discussed in this thesis arose out a desire to improve the quality of anaesthesia for patients who undergo day-case surgery. A second aim was to compare the different anaesthetic methods in terms of recovery from anaesthesia and costs.A total of 233 patients undergoing day-case knee arthroscopy under either 2% or 5% lidocaine spinal anaesthesia or general anaesthesia with desflurane, isoflurane, propofol or sevoflurane were investigated in two prospective, randomised clinical trials. The overall aims were to find the most suitable, satisfactory and economically feasible method for adult ambulatory knee arthroscopy and to assess the factors that affect the immediate postoperative period and the one-week recovery profile at home.The patients were highly satisfied with all the methods of anaesthesia. There was a slight tendency in favour of general anaesthesia compared to spinal anaesthesia. The general level of pain after ambulatory knee surgery was low after the first few hours postoperatively and continued to be low during the first postoperative week. After short-acting general anaesthesia with desflurane, isoflurane and propofol, home readiness was achieved over two hours earlier than after 5% lidocaine spinal anaesthesia. Home readiness was significantly delayed after 2% lidocaine spinal anaesthesia compared to sevoflurane inhalation anaesthesia. General anaesthesia with isoflurane was cheaper than the other general anaesthetics, i.e. desflurane, sevoflurane, propofol, or 2% and 5% lidocaine spinal anaesthesias. Propofol anaesthesia was the most expensive. The spinal anaesthesia patients had a higher incidence of headache, backache and lower leg pain during the first postoperative week than the patients who had had general anaesthesia.In busy ambulatory surgery units, remarkable savings may be achieved by using short-acting general anaesthetics, i.e. desflurane and isoflurane, instead of propofol or sevoflurane general anaesthesias or lidocaine spinal anaesthesia. This is due to the lower costs of desflurane and isoflurane compared to sevoflurane and propofol and the shorter time needed for postoperative care compared to spinal anaesthesia. Academic Dissertation to be presented with the assent of the Faculty of Medicine, University of Oulu, for public discussion in the Auditorium 1 of the University Hospital of Oulu, on September 13th, 2002, at 12 noon.Abstract The number of ambulatory surgical procedures is increasing throughout the world. This is partly due to the development of a number of new anaesthetic, analgesic and adjuvant drugs, each with more rapid onset and shorter duration of action, over the past two decades. An interest in the issues discussed in this thesis arose out a desire to improve the quality of anaesthesia for patients who undergo day-case surgery. A second aim was to compare the different anaesthetic methods in terms of recovery from anaesthesia and costs. A total of 233 patients undergoing day-case knee arthroscopy under either 2% or 5% lidocaine spinal anaesthesia or general anaesthesia with desflurane, isoflurane, propofol or sevoflurane were investigated in two prospective, randomised clinical trials. The overall aims were to find the most suitable, satisfactory and economically feasible method for adult ambulatory knee arthroscopy and to assess the factors that affect the immediate postoperative period and the one-week recovery profile at home. The patients were highly satisfied with all the methods of anaesthesia. There was a slight tendency in favour of general anaesthesia compared to spinal anaesthesia. The general level of pain after ambulatory knee surgery was low after the first few hours postoperatively and continued to be low during the first postoperative week. After short-acting general anaesthesia with desflurane, isoflurane and propofol, home readiness was achieved over two hours earlier than after 5% lidocaine spinal anaesthesia. Home readiness was significantly delayed after 2% lidocaine spinal anaesthesia compared to sevoflurane inhalation anaesthesia. General anaesthesia with isoflurane was cheaper than the other general anaesthetics, i.e. desflurane, sevoflurane, propofol, or 2% and 5% lidocaine spinal anaesthesias. Propofol anaesthesia was the most expensive. The spinal anaesthesia patients had a higher incidence of headache, backache and lower leg pain during the first postoperative week than the patients who had had general anaesthesia. In busy ambulatory surgery units, remarkable savings may be achieved by using short-acting general anaesthetics, i.e. desflurane and isoflurane, instead of propofol or sevoflurane general anaesthesias or lidocaine spinal anaesthesia. This is due to the lower costs of desflurane and isoflurane compared to sevoflurane and propofol and the shorter time needed for postoperative care compared to spinal anaesthesia

Encountering Change: Job Satisfaction of Sign Language Interpreters in Finland

The organizational system for providing Finnish sign language interpreter services has recently changed, and this change has influenced the whole interpretation service industry. It poses major challenges for the maintenance of job satisfaction among sign language professionals. The level of job satisfaction of sign language interpreters (in this study, N = 135) was surveyed by means of an online questionnaire. While examining this phenomenon, this study mainly addresses the systemic factors in employment conditions. According to the results, the level of job satisfaction among interpreters is quite high; however, it remains clearly lower than the average for Finnish workers. The key factors in job satisfaction are working conditions, changes in the amount of work and the way that it has been organized. Many of these problems are seen to be the result of the recently reformed Kela2-led interpreter booking system and the interpreting service’s bidding system. As a conclusion, we note that, in future, more attention should be paid to the working conditions and job satisfaction of Finnish sign language interpreters. If the level of job satisfaction continues to decrease, not only will interpreters’ health and well-being be at risk, but the quality of service provided to clients may also be impacted

Prehospital and hospital delays for stroke patients treated with thrombolysis : A retrospective study from mixed rural-urban area in Northern Finland

AbstractBackground: Thrombolysis improves stroke outcome, but efficacy of the treatment is limited by time. Therefore, recognition of stroke symptoms by dispatch centres and by emergency medical services (EMS) is crucial, as is minimization of pre-hospital delays. We investigated the pre-hospital delays in patients with stroke treated with thrombolysis and compared the delays between rural and urban patients.Methods: Patients that had received thrombolysis at Oulu University Hospital (OUH) between 1 January 2013 and 31 December 2015 were identified. Patients were divided into urban and rural based on the site of the EMS mission. Pre-hospital charts and medical records were reviewed. Onset-to-dispatch, dispatch-to-arrival of EMS, on-scene, transport and door-to-needle times were studied.Results: Three hundred one stroke patients were treated with thrombolysis at OUH, and 232 of them were included in the study. Positive Face Arm Speech Test (FAST) findings, priority dispatch code and transport code were associated with shorter transport delays. The priority dispatch was not used in 12.5% of stroke patients treated with thrombolysis. The rural patients had a four minutes longer dispatch-to-arrival delay and 50 (34, 74) minutes longer transport time. The door-to-needle time was 8 (5, 14) minutes shorter in rural patients than in urban patients.Conclusions: Positive FAST findings and the use of priority dispatch code and priority transport code were associated with shorter transport delays. There is room for improvement in door-to-needle time and in stroke recognition by the dispatch centre and EMS providers. For the rural population, helicopter transportation could reduce the long pre-hospital time.Abstract Background: Thrombolysis improves stroke outcome, but efficacy of the treatment is limited by time. Therefore, recognition of stroke symptoms by dispatch centres and by emergency medical services (EMS) is crucial, as is minimization of pre-hospital delays. We investigated the pre-hospital delays in patients with stroke treated with thrombolysis and compared the delays between rural and urban patients. Methods: Patients that had received thrombolysis at Oulu University Hospital (OUH) between 1 January 2013 and 31 December 2015 were identified. Patients were divided into urban and rural based on the site of the EMS mission. Pre-hospital charts and medical records were reviewed. Onset-to-dispatch, dispatch-to-arrival of EMS, on-scene, transport and door-to-needle times were studied. Results: Three hundred one stroke patients were treated with thrombolysis at OUH, and 232 of them were included in the study. Positive Face Arm Speech Test (FAST) findings, priority dispatch code and transport code were associated with shorter transport delays. The priority dispatch was not used in 12.5% of stroke patients treated with thrombolysis. The rural patients had a four minutes longer dispatch-to-arrival delay and 50 (34, 74) minutes longer transport time. The door-to-needle time was 8 (5, 14) minutes shorter in rural patients than in urban patients. Conclusions: Positive FAST findings and the use of priority dispatch code and priority transport code were associated with shorter transport delays. There is room for improvement in door-to-needle time and in stroke recognition by the dispatch centre and EMS providers. For the rural population, helicopter transportation could reduce the long pre-hospital time

Pre-hospital management protocols and perceived difficulty in diagnosing acute heart failure

Aim To illustrate the pre-hospital management arsenals and protocols in different EMS units, and to estimate the perceived difficulty of diagnosing suspected acute heart failure (AHF) compared with other common pre-hospital conditions. Methods and results A multinational survey included 104 emergency medical service (EMS) regions from 18 countries. Diagnostic and therapeutic arsenals related to AHF management were reported for each type of EMS unit. The prevalence and contents of management protocols for common medical conditions treated pre-hospitally was collected. The perceived difficulty of diagnosing AHF and other medical conditions by emergency medical dispatchers and EMS personnel was interrogated. Ultrasound devices and point-of-care testing were available in advanced life support and helicopter EMS units in fewer than 25% of EMS regions. AHF protocols were present in 80.8% of regions. Protocols for ST-elevation myocardial infarction, chest pain, and dyspnoea were present in 95.2, 80.8, and 76.0% of EMS regions, respectively. Protocolized diagnostic actions for AHF management included 12-lead electrocardiogram (92.1% of regions), ultrasound examination (16.0%), and point-of-care testings for troponin and BNP (6.0 and 3.5%). Therapeutic actions included supplementary oxygen (93.2%), non-invasive ventilation (80.7%), intravenous furosemide, opiates, nitroglycerine (69.0, 68.6, and 57.0%), and intubation 71.5%. Diagnosing suspected AHF was considered easy to moderate by EMS personnel and moderate to difficult by emergency medical dispatchers (without significant differences between de novo and decompensated heart failure). In both settings, diagnosis of suspected AHF was considered easier than pulmonary embolism and more difficult than ST-elevation myocardial infarction, asthma, and stroke. Conclusions The prevalence of AHF protocols is rather high but the contents seem to vary. Difficulty of diagnosing suspected AHF seems to be moderate compared with other pre-hospital conditions

Isätyön kehittäminen Oulun seurakuntayhtymässä : menetelmiä isien osallisuuden lisäämiseksi

TIIVISTELMÄ Janita Kekkonen Matti Martikainen Jade Tikkanen Mari Väisänen Isätyön kehittäminen Oulun seurakuntayhtymässä. Menetelmiä isien osallisuuden lisäämiseksi. 64 sivua, 4 liitettä Syksy, 2024 Diakonia-ammattikorkeakoulu, Helsinki Sosiaali- ja terveysalan ammattikorkeakoulututkinto Sairaanhoitaja (AMK) Sairaanhoitaja (AMK), diakoninen hoitotyö Perinteinen isän rooli on aikaisemmin koettu etäisenä, mutta uusien sukupolvien jälkeen on siirrytty kohti osallistuvampaa isän mallia. Aktiivinen isyys on yhteydessä isän psyykkiseen ja fyysiseen hyvinvointiin. Lapsen kehitykselle isän osallisuus on tärkeää ja vaikuttaa koko perheen hyvinvointiin. Opinnäytetyön tarkoituksena oli kehittää isätyötä Oulun seurakuntayhtymässä. Tavoitteena oli luoda menetelmiä, joiden avulla isien osallisuutta voidaan jatkossa parantaa seurakuntien lapsiperhepalveluissa. Opinnäytetyön yhteistyökumppanina toimi MILAVA-hanke. Opinnäytetyö toteutettiin kehittämispainotteisena, jossa tiedonkeruun menetelmänä käytettiin isäasiakkaille ja työntekijöille suunnattuja kyselylomakkeita. Kyselyt toteutettiin anonyymisti verkossa ja koostuivat avoimista sekä monivalintakysymyksistä. Vastaukset analysoitiin jakamalla ne erilaisiin teemoihin: toiminnan järjestäminen ja osallisuus, kohtaaminen, viestintä sekä isien osallisuuden ja vanhemmuuden tukemisen jatkokehittämien. Vastauksissa nousi esiin viestinnän teema. Kehitystyönä tehtiin kartoitus- ja palautelomakepohjat, joilla työntekijät voivat kerätä asiakkailta palautetta toiminnan alkaessa ja päättyessä. Palautteiden avulla voidaan lisätä vuorovaikutusta työntekijöiden ja asiakkaiden välillä sekä parantaa isien vaikutusmahdollisuutta. Näiden pohjalta toimintaa voidaan kehittää isiä huomioivammaksi ja osallistavammaksi. Lisäksi laadittiin kehitysidea Isä-lapsiparkkitoiminnalle suunnatusta Instagram-tilistä, jolla voidaan lisätä tietoisuutta sekä mahdollistaa isejä saamaan vertaistukea. Tutkitun tiedon valossa isät pitävät vähemmän perhevapaita. Perhevapaauudistuksen myötä tulevaisuudessa isät ovat todennäköisesti enemmän lapsen kanssa kotona, jolloin isien osuus lapsiperhepalveluiden käyttäjinä mahdollisesti kasvaa. Isät osallistuvat helpommin suoraan heille suunnattuun toimintaan ja siksi palveluita olisi hyvä kohdentaa suoraan iseille. Asiasanat: Isyys, isätyö, osallisuus, perhetyö, seurakunta, sosiaalinen medi

Varsinais-Suomen maahanmuuttostrategia 2020-luvulle

Varsinais-Suomen ELY-keskuksen toimeksiannosta Siirtolaisuusinstituutti on vastannut Varsinais-Suomen maahanmuuttostrategia 2020-luvulle laatimisesta. Se nojaa osaksi aiemman, vuonna 2007 julkaistun Monikulttuurinen Varsinais-Suomi: Varsinais-Suomen maahanmuuttopoliittinen ohjelma vuoteen 2015 -ohjelman toimintamalliin ja toteuttamisesta saatuihin kokemuksiin. Maahanmuuttostrategia on eri toimijoille annettava suositus siitä, millä keinoin maahanmuutto tukee Varsinais-Suomen kasvua ja kehittämistä kaikkia osapuolia hyödyttävänä kokonaisuutena. Tavoitteena on riittävän ja osaavan työvoiman saannin turvaaminen maakunnan työnantajille sekä toisaalta lisätä Varsinais-Suomen vetovoimaisuutta. Sen pohjana on yritysten ja julkisen hallinnon asiantuntijoiden haastattelut, työpajat ja kyselyt. Niiden pohjalta on tunnistettu eri alojen rekrytointitarpeita sekä maahanmuuttajien kotoutumisen ja työllistymisen keskeisiä kehittämistarpeita tulevalla vuosikymmenellä.Maahanmuuttostrategian päätavoitteet ovat 1) osaavan työvoiman saatavuuden varmistaminen, 2) vetovoiman ja pitovoiman lisääminen sekä 3) hyvien väestösuhteiden edistäminen. Päätavoitteet jakautuvat 15:een eri toimenpiteeseen. Varsinais-Suomen alueellisista eroista johtuen toimenpiteet on muotoiltu niin, että ne ovat mahdollisimman joustavasti toteutettavissa paikallisesti. Maahanmuuttostrategian toimenpiteiden taustalla on ajatus, että jokainen yritys ja kunta voivat hyödyntää niitä omien tarpeidensa mukaisesti. Tavoitteena on, että julkisen sektorin toimijat, yritykset ja muut toimijat tunnistavat omat vahvuutensa ja haasteensa ja näistä lähtökohdista toteuttavat strategian toimenpiteitä soveltuvin osin yhteistyössä muiden toimijoiden kanssa. </p

Lääkärien päivystysmallien kehittämis- ja arviointitutkimus - Päivystysmallit ja työkuormitus

Tutkimushankkeen n:o 112241 loppuraportti Työsuojelurahastoll

Tuhansia turhia kuljetuksia? : Uudet teknologiaratkaisut ja toimintatavat ensihoitoon ja päivystykseen

TiivistelmäLähtökohdat: Ensihoitopalvelujen kysyntä kasvaa. Kiireettömät tehtävät kuormittavat yhä enemmän.Menetelmät: Ensihoidon, päivystyksen ja geriatrian asiantuntijoita haastattelemalla selvitettiin, onko tulevaisuuden teknologioista apua hoidossa.Tulokset: Kiireettömien potilaiden hoidossa on kehitettävä kotimittauksia, datan yhdistämistä ja tekoälyyn pohjautuvia päätöksenteon tukijärjestelmiä. Teknologiaa hyödyntävissä palvelupoluissa korostuu asiantuntijoiden välinen tiedonsiirto ja kommunikaatio.Päätelmät: Teknologiset ratkaisut ja sähköiset palvelut voivat tukea kotona asumista ja hoidontarpeen ar­viointia. Jos ne saadaan käyttöön laajasti, ensihoito voi hoitaa yhä useammat potilaat hälytyskohteessa ilman kuljetusta tai päivystyskäyntiä.Tiivistelmä Lähtökohdat: Ensihoitopalvelujen kysyntä kasvaa. Kiireettömät tehtävät kuormittavat yhä enemmän. Menetelmät: Ensihoidon, päivystyksen ja geriatrian asiantuntijoita haastattelemalla selvitettiin, onko tulevaisuuden teknologioista apua hoidossa. Tulokset: Kiireettömien potilaiden hoidossa on kehitettävä kotimittauksia, datan yhdistämistä ja tekoälyyn pohjautuvia päätöksenteon tukijärjestelmiä. Teknologiaa hyödyntävissä palvelupoluissa korostuu asiantuntijoiden välinen tiedonsiirto ja kommunikaatio. Päätelmät: Teknologiset ratkaisut ja sähköiset palvelut voivat tukea kotona asumista ja hoidontarpeen ar­viointia. Jos ne saadaan käyttöön laajasti, ensihoito voi hoitaa yhä useammat potilaat hälytyskohteessa ilman kuljetusta tai päivystyskäyntiä

Pre-hospital management protocols and perceived difficulty in diagnosing acute heart failure

Aim To illustrate the pre-hospital management arsenals and protocols in different EMS units, and to estimate the perceived difficulty of diagnosing suspected acute heart failure (AHF) compared with other common pre-hospital conditions. Methods and results A multinational survey included 104 emergency medical service (EMS) regions from 18 countries. Diagnostic and therapeutic arsenals related to AHF management were reported for each type of EMS unit. The prevalence and contents of management protocols for common medical conditions treated pre-hospitally was collected. The perceived difficulty of diagnosing AHF and other medical conditions by emergency medical dispatchers and EMS personnel was interrogated. Ultrasound devices and point-of-care testing were available in advanced life support and helicopter EMS units in fewer than 25% of EMS regions. AHF protocols were present in 80.8% of regions. Protocols for ST-elevation myocardial infarction, chest pain, and dyspnoea were present in 95.2, 80.8, and 76.0% of EMS regions, respectively. Protocolized diagnostic actions for AHF management included 12-lead electrocardiogram (92.1% of regions), ultrasound examination (16.0%), and point-of-care testings for troponin and BNP (6.0 and 3.5%). Therapeutic actions included supplementary oxygen (93.2%), non-invasive ventilation (80.7%), intravenous furosemide, opiates, nitroglycerine (69.0, 68.6, and 57.0%), and intubation 71.5%. Diagnosing suspected AHF was considered easy to moderate by EMS personnel and moderate to difficult by emergency medical dispatchers (without significant differences between de novo and decompensated heart failure). In both settings, diagnosis of suspected AHF was considered easier than pulmonary embolism and more difficult than ST-elevation myocardial infarction, asthma, and stroke. Conclusions The prevalence of AHF protocols is rather high but the contents seem to vary. Difficulty of diagnosing suspected AHF seems to be moderate compared with other pre-hospital conditions.Peer reviewe