Finnish University Hospitals Research Articles

The Quality of Genetic Counseling and Connected Factors as Evaluated by Male BRCA1/2 Mutation Carriers in Finland.

There is little written about the quality of genetic counseling for men with the BRCA1/2 mutation. The purpose of this study was to describe the quality of genetic counseling and connected factors according to Finnish male BRCA1/2 mutation carriers' (n = 35) perspectives and reasons for seeking genetic counseling. Data were collected from the Departments of Clinical Genetics at five Finnish university hospitals. The exploratory study design was conducted using a 51-item questionnaire based on a previously devised quality of counseling model and analyzed using non-parametric tests and principle content analysis. The satisfaction level with genetic counseling was high, especially with regard to the content of genetic counseling. The benefit of genetic counseling on the quality of life differed significantly (p < 0.001-0.009) from other factors. In particular, genetic counseling was in some cases associated to reduce the quality of life. Only 49% of the male carriers felt they received sufficient counseling on social support. Attention to individual psychosocial support was proposed as an improvement to genetic counseling. Primary and secondary reasons for seeking genetic counseling and background information, such as education, affected the perceived quality of genetic counseling. The results of the study could be used to tailor genetic counseling for male BRCA1/2 mutation carriers.

Laryngeal cancer in Finland: A 5-year follow-up study of 366 patients.

The purpose of this study was to acquire nationwide data on the management and outcome of laryngeal squamous cell carcinoma (SCC) in Finnish university hospitals over a 5-year posttreatment follow-up. All records of patients diagnosed and treated for primary laryngeal SCC during 2001 to 2005 were reviewed. Three hundred sixty-six patients with laryngeal cancer were identified, 360 of whom had laryngeal SCC. Three hundred forty-two patients with laryngeal SCC (95%) were treated with curative intent. Five-year disease-specific survival (DSS) for T1a, T1b, T2, T3, and T4 glottic SCC was 100%, 95%, 78%, 79%, and 53%, respectively. The corresponding figures for T1 to T4 supraglottic SCC were 68%, 54%, 72%, and 59%. Results of this nationwide study give a general overview of the outcome of unselected patients treated with unified guidelines. Patients with T2 tumors, usually treated with radiotherapy (RT), had a worse prognosis than expected. This patient group warrants further investigation and possibly treatment intensification.

PO-0744 Genome-wide Association Study Of Bronchopulmonary Dysplasia

<h3>Background and aims</h3> Bronchopulmonary dysplasia (BPD) is the most common chronic disease associated with very preterm birth. BPD has a significant genetic background but the predisposing genes are insufficiently known. The aim is to find genetic factors that predispose to moderate-severe BPD using a hypothesis-free, genome-wide approach. <h3>Methods</h3> The study populations included preterm infants (gestational age &lt;31 weeks) born during 1997–2013 in Oulu University Hospital and during 2010–2013 in other Finnish University Hospitals (Helsinki, K uopio, Tampere, Turku). DNA samples were genotyped using the Illumina HumanCoreExome BeadChip consisting of approximately 550,000 single-nucleotide polymorphisms (SNPs); after quality control, 60 cases (moderate-severe BPD) and 114 controls (no or mild BPD) remained for a genome-wide association study (GWAS). In the next step, approximately 200 SNPs showing suggestive signals are genotyped in additional infants (n = 116/232) to determine which associations are replicated. <h3>Results</h3> In GWAS, we detected suggestive association signals (p &lt; 1^–4) for several SNPs; many of these SNPs were located within or near genes that can be considered as plausible candidate genes for BPD (e.g. the <i>CRP</i> and <i>PTPN6</i> genes encoding C-reactive protein and protein-tyrosine phosphatase SHP-1, respectively). Some of the SNPs showing suggestive associations in two previous GWASs of BPD showed weak associations (e.g. those within the <i>PALM2</i> and <i>CTNNA3</i> genes). <h3>Conclusions</h3> In genome-wide association study of BPD, we detected several suggestive associations. These initial results require verification in subsequent studies, including replication in additional populations and functional studies of the arising candidate genes.

Self-assessed level of graduating nursing students’ nursing skills

Objective: To evaluate the level of nursing skills at the point of graduation based on students’ self-assessments and to identify possible related factors. Background: Nursing skills have been identified as one of the key factors in enhancing patient safety. Maintaining patient safety is a major concern for nurses, which is why the level of graduating nurses’ skills needs to be evaluated. Also, little is known about factors related to students’ nursing skills. Methods: Evaluation is based on graduating nursing students’ (n = 154, response rate 51%) self-assessments during final clinical placements in Finnish university hospitals in 2011. Descriptive statistics and inferential statistics such as paired T -test, Multifactor Analysis of Covariance and Pearson/Spearman correlation coefficients were used to analyse the data. Results: The overall level of nursing skills was self-assessed as good (75.4; VAS 0-100). Nursing skills related to the care of a dying patient was the only category assessed to be on moderate level (63.1; VAS>57-66.8). The more positively the students self-assessed their readiness for practice based on nurse education and the supervisory relationship in clinical placement, the higher was the self-assessed level of nursing skills. Conclusions: Students’ assessments of their level of nursing skills should be taken into account when planning orientation and mentorship programmes for practical work to ensure safe and qualified patient care. Nurse educators should ensure that students can practice nursing skills related to care of a dying person during nurse education. A knowledge test, observation, or comparing the students’ evaluations to assessments by mentors could provide a more comprehensive picture of the level of students’ nursing skills.

Benefits and barriers of clown care: A qualitative phenomenographical study of parents with children in clown care services

Clowning is a form of humour. It is an art form that invites play, interaction, and laughter. Clown Care is a programme in hospitals and medical centres involving visits from specially trained hospital clowns. The aim of this paper is to describe the benefits and barriers associated with the clown care programme. A qualitative phenomenographical study was performed using a semi-structured in-depth interview of twelve parents with children receiving clown care in various hospital wards in a Finnish University Hospital for children. Clown care creates a positive emotional state, promotes interaction between parents and child, and fosters affirmative environmental conditions. Barriers include psychological and emotional state, severity of medical condition, developmental level, and timing and context. The findings suggest that clown care integration in the care for family and child is useful in the promotion of emotional and psychosocial well-being.

From challenges to advanced practice registered nursing role development: Qualitative interview study.

The aim of this study is to describe the factors hindering and facilitating the implementation of the advanced practice registered nurses role at Finnish university hospitals, and to examine the implications for its future development. A descriptive qualitative approach, using thematic individual interviews, was conducted in 2011 with a sample of 11 advanced practice registered nurses. The data were analysed using qualitative content analysis. The advanced practice registered nurses role barriers had an impact on the role development needs. In turn, the facilitating factors helped encounter the challenges of the role, therefore having an impact on both the current role achievement, as well as contributing to the future role development. The factors hindering and facilitating the advanced practice registered nurses role need to be acknowledged to support the role implementation and planning of the future of the role.

Knowledge received by hospital patients—a factor connected with the patient‐centred quality of nursing care

The main purpose of this study was to evaluate and analyse the connection between the level of quality of nursing care and knowledge received by patients (N = 266, n = 226), response rate was 85%. The data were collected using two structured instruments: one measuring the quality of nursing care experienced by patients (The Good Nursing Care Scale, GNCS) and one measuring the received knowledge of hospital patients (RKHP). The data were collected at one (out of five) Finnish university hospitals, in all medical wards during 5 weeks in 2009. A clear association between the level of the quality of nursing care and the level of received knowledge was found: on the total level of instruments, correlation was strong (r = 0.705). Support of empowerment (GNCS) had statistically significant strong correlation between biophysiological knowledge (RKHP), (r = 0.718), and experiential knowledge (r = 0.633), (P ≤ 0.01). Furthermore, there was a strong correlation between nursing activities and biophysiological knowledge (r = 0.637). Higher age, sufficient advance information and better self-perceived health status were associated both with the level of the quality of nursing care and level of received knowledge. In the future, a special attention should be paid to the sufficient information for patients before their hospital stays.

Registered nurses' experiences of rewarding in a Finnish University Hospital - an interview study

The purpose was to describe Finnish registered nurses' experiences of rewarding. The aim was to gather detailed information on the rewarding of nurses to help nurse managers and leaders to update existing reward strategy and to develop an effective reward system. Rewarding has been found positively to influence nurses' occupational well-being and commitment to their work, and the attractiveness of the health care field. A series of focused interviews with 10 registered nurses was conducted in 2011. Qualitative content analysis method was used. The nurses reported positive experiences with rewarding in the form of monetary compensation and other benefits, the positive aspects of nursing work and opportunities for professional development. The experiences of unsatisfactory rewarding generally stemmed from negative emotional experiences, lacking rewards and inequality in rewarding. It is essential to listen to nurses and to provide appropriate acknowledgement and appreciation of their work in order to develop an effective reward system. It is important to listen to nurses' experiences of rewarding because it enables nurse managers to maintain and increase the attractiveness of nursing and health care work in general.

Toll‐like receptor 9 expression in mucoepidermoid salivary gland carcinoma may associate with good prognosis

Mucoepidermoid carcinoma (MEC) is the most common salivary gland malignancy. Although several biomarkers have been evaluated, histological grade remains the most valuable prognostic marker. Toll-like receptor 9 (TLR9) is an immune receptor recognizing microbial DNA. Its expression associates with prognosis or cancer properties in several cancers. This study examined the role of TLR9 in MEC. Sixty patients with salivary gland MEC were collected from two Finnish university hospitals, and tumor samples were stained for TLR9. Salivary gland high-grade MEC cell line (UT-MUC-1) was cultured to assess TLR9 and MMP-13 expression. The function of TLR9 was studied in vitro using traditional Matrigel(®) invasion assay and novel human myoma organotypic model. Cancer-specific survival was related with tumor grade (P = 0.01), and there were no deaths in patients with low-grade MEC. TLR9 was expressed in 56 of 60 (93%) tumors. High TLR9 expression indicated better survival in the patient series (P = 0.002) and showed a trend for association with lower disease stage (P = 0.06) and higher differentiation grade (P = 0.068). In multivariate analysis, TLR9 expression was prognostically insignificant due to heavy correlation to disease stage and higher gradus. Treating UT-MUC-1 cells with TLR9 ligand CpG in vitro induced MMP-13 expression and invasion in Matrigel(®) invasion assay, whereas decreased invasion was seen in myoma organotypic model. Functional TLR9 is present in salivary MEC, and high level of expression may indicate good prognosis. However, more studies are needed to evaluate biological consequences of TLR9 interaction in tumor cells.

Changes in Transformational Leadership and Empirical Quality Outcomes in a Finnish Hospital over a Two-Year Period: A Longitudinal Study.

This paper describes the changes in transformational leadership and quality outcomes that occurred between 2008 and 2011 in a Finnish university hospital that is aiming to meet the Magnet standards. Measurements were conducted in 2008-2009 and subsequently in 2010-2011 by surveying nursing staff and patients. Nursing staff were surveyed using web-based surveys to collect data on transformational leadership (n 1 = 499, n 2 = 498) and patient safety culture (n 1 = 234, n 2 = 512) and using both postal and web-based surveys to gather information on job satisfaction (n 1 = 1176, n 2 = 779). Questionnaires were used to collect data on care satisfaction from patients (n 1 = 678, n 2 = 867). Transformational leadership was measured using the 54-item TLS, job satisfaction with the 37-item KUHJSS, patient safety culture with the 42-item HSPSC, and patient satisfaction using the 42-item RHCS questionnaire. Transformational leadership, which was the weakest area, was at the same level between the two measurement occasions. Job satisfaction scores increased between 2008 and 2010, although they were generally excellent in 2008. The scores for nonpunitive responses to errors and events reported were also higher in the 2010-2011 surveys. The highest empirical outcome scores related to patient satisfaction. The project and the development initiatives undertaken since 2008 seem to have had positive effects on empirical quality outcomes.

Does Finnish hospital staff job satisfaction vary across occupational groups?

BackgroundJob satisfaction of staff is an essential outcome variable in research when describing the work environment of successful hospitals. Numerous studies have evaluated the topic, but few previous studies have assessed the job satisfaction of all staff in hospital settings. It is important to discover if there are any unsatisfied groups of people working in hospitals, the aspects they are unsatisfied with and why. The aim of this study was to evaluate job satisfaction of all staff working at a Finnish university hospital, identify differences in job satisfaction between staff groups, and explore the relationship between their self-evaluated quality of work and job satisfaction.MethodsData were collected from 1424 employees of the hospital using the web-based Kuopio University Job Satisfaction Scale survey instrument in autumn 2010. The research data were analysed by using SPSS 19.0 for Windows. Frequency and percentage distributions, as well as mean values, were used to describe the data. A non-parametric test (Kruskal–Wallis test) was used to determine the significance of differences in scores between different groups of staff members and between quality evaluations.ResultsThe overall job satisfaction of the employees was good. They rated both motivating factors of their work and work welfare as excellent. The areas causing most dissatisfaction were work demands and participation in decision making. Physicians formed the most satisfied group, nurses and maintenance staff were the least satisfied, and office and administrative staff were fairly satisfied. Staff who rated the quality of work in their units as high usually also considered their job satisfaction to be excellent.ConclusionsEvery staff member has an influence on job satisfaction in her/his unit. A culture of participation should be developed and maintained in the units and the whole hospital to ensure that all staff feel they play important roles in the hospital. A university hospital is a complex, continuously changing work environment. Managers of the hospital should continuously evaluate job satisfaction and quickly react to the results gained.

The method of nursing support in hospital and patients' and family members' experiences of the effectiveness of the support

Nurses are an important source of support for patients and family members during hospitalization. It is unclear, however, what kinds of support methods are used in hospitals and how the support affects the patient and family member(s). This study describes methods of nursing support in hospital and adult patients' and their family members' experiences of this support. The data were collected in spring 2009 through essays written by and group interviews with nurses (n = 11) working at a Finnish university hospital. The data from patients (n = 9) and family members (n = 7) were collected in individual and group interviews. The material was interpreted by inductive content analysis. In their interaction with patients and family members, the hospital nurses used the methods of emotional and informational support. Patients' and family members' experiences of the effectiveness of this support were related to the establishment of a care relationship, their future outlook, mental well-being and experiences of getting well. The evidence from this research will be useful in developing methods of nursing support for patients and family members and family-oriented care in hospital.

Early and Midterm Outcomes After Endovascular Treatment of Degenerative Aneurysms of the Descending Thoracic Aorta: A Finnish Multicenter Study

To evaluate results of endovascular stent-graft placement for aneurysms of the descending aorta in 3 Finnish university hospitals during 1998-2010. Among 158 consecutive patients treated with stent-graft placement for disease of the descending thoracic aorta, all 69 patients (58 men; mean age 71.7 years, range 54-90) with an aneurysm were included in the analysis. Medical records, radiological images, and national death records were collected and analyzed on an intention-to-treat basis. The 30-day mortality rate was 3.7% in 54 elective patients and 46.7% in 15 urgently treated acute patients. The paraparesis rate was 4.3%, and the major stroke rate was 4.3% after the operation. There were 4 aneurysm ruptures, all in the urgent group, two of whom had access failure. The other two died despite seemingly good initial results. The mean follow-up was 34.8±29 months. Two late ruptures occurred in patients who were lost to follow-up. In all, 12 type I (10 early, 2 late) and 1 late type III endoleaks were encountered in the observation period. Based on our findings, endovascular treatment of aneurysms of the descending aorta is relatively safe. To reduce the risk of postoperative complications, optimal preoperative imaging is mandatory. Postoperative regular imaging controls are indicated for early detection and prompt treatment of late type I or III endoleaks and to reduce the risk of late ruptures.

The impact of an empowering Internet‐based Breast Cancer Patient Pathway program on breast cancer patients' clinical outcomes: a randomised controlled trial

To evaluate the effect of the Breast Cancer Patient Pathway program on breast cancer patient's empowerment process. The results of earlier studies indicate that the use of tailored Internet-based patient education programs increased patient's knowledge level; however, other outcome measures differed. This randomised control trial studied the effect of the Internet-based patient educational program on breast cancer patients' empowerment. In this study, we measured the quality of life, anxiety and managing with treatment-related side effects as the outcomes of breast cancer patients' empowering process. Breast cancer patients who were Internet users in one Finnish university hospital during 2008-2010 were randomised to the control group (n=43) and the intervention group (n=47). Baseline data were collected first in the hospital and the following data seven times during the treatment process, the last time one year after breast cancer diagnosis. There were no statistically significant differences in the quality of life, anxiety or side effects of treatment between the groups. The amount of treatment-related side effects was connected to both physical and psychological well-being. In this study, the Breast Cancer Patient Pathway program did not decrease anxiety level or treatment-related side effects among breast cancer patients or improve subscales of quality of life when compared with controls. There is a need to relieve the side effects caused by patients' care with the help of patient education. Internet-based patient education programs need more focus when developing new patient education methods.

Medication errors: what hospital reports reveal about staff views

Nurses are generally responsible for administering medication to patients and are, therefore, able to monitor or report medication errors. However, nurses can sometimes be responsible for causing errors, so it is important that they understand the consequences of these mistakes and how to prevent them. This article reports the results of a study that analysed the views of nurses, pharmacists and physicians at a Finnish university hospital on the prevention of medication errors. The findings suggest errors can be prevented by improving work environments and allowing healthcare staff, particularly nurses, to concentrate on the task at hand when dealing with medicines.

Providing informational support to the families of TBI patients: a survey of nursing staff in Finland

Background: People with a traumatic brain injury (TBI) constitute a significant patient care population: every year almost 8 million brain injuries are diagnosed worldwide. Social support (informational, emotional and practical) has been identified as one of the essential factors that help TBI patients' families to cope with the severe situation. Aims: This paper reports on a study of how often nursing staff provide interventions of informational support and the level of competence needed by nursing staff working in all neurosurgical wards to support the families of TBI patients. Methods: The target group included all nursing staff (n=172) in all neurosurgical wards in Finland. Data was collected via a self-completion questionnaire in 2010. The participants were nurses (n=115; response rate 67%) working in the neurosurgical wards of all five Finnish university hospitals. The data were statistically analysed using SPSS version 19. Descriptive statistics, the Kolmogorov-Smirnov test, one-way ANOVA, two-way ANOVA, MANOVA and linear regression were used. Results: Overall, the nurses often provided informational support to TBI patients' families. They often told them about treatment and about their own responsibilities to family members; by contrast, they seldom informed family members about prevention of secondary injuries. There was a connection between the age and work experience of the nursing staff and the provision of information about secondary injuries. Conclusions: Nurses with less work experience may have limited competence in delivering information to family members. This should be taken into consideration when planning the staffing of shifts, ensuring that there are always enough experienced nurses on duty.

Finnish nurses’ views of support provided to families about traumatic brain injury patients’ daily activities and care

Background: Large numbers, almost eight million, of brain injuries are diagnosed worldwide annually. Social support (informational, emotional and practical) has been identified as essential for helping members of TBI patients’ families to cope with the severe situations these injuries cause. We have assessed nurses’ views of the support provided in Finland. Methods: The target group included all nursing staff (n = 172) of neurosurgical wards in Finland. Data were collected during 2010, from 115 of these nurses working in neurosurgical wards of all five Finnish university hospitals. The response rate was 67 %. The data were analysed (using SPSS version 17 software) by calculating descriptive statistics, applying Kolmogorov-Smirnov tests, and ANOVA (one- and two-way), MANOVA and linear regression analyses. Results: The results indicate that nurses’ education affects the practical support they provide to TBI patients' family members: registered nurses considered themselves most likely to take into account issues related to liaison with family members. The length of work experience was related to how often nurses reported discussing mood swings and other TBI symptoms with family members. Conclusions: Providing practical support to TBI patients’ family members requires nurses to possess multidimensional practical competences related to the symptoms caused by the brain injury.

Plasma copeptin in the assessment of febrile neutropenia

Copeptin, the surrogate marker of arginine vasopressin (AVP), has been suggested to be a useful biomarker in monitoring sepsis reflecting hemodynamic imbalance and stress state. This prospective study conducted at a hematology ward in a Finnish University Hospital aimed to investigate whether plasma copeptin predicts the development of complicated course of neutropenic fever (bacteremia or need for treatment at intensive care unit) in 100 hematological patients experiencing their first neutropenic fever episode after intensive chemotherapy for hematological malignancy. Contrary to study presumptions, not elevated copeptin but the lack of a proper initial increase of plasma copeptin (<0.02ng/mL from day 0 to day 1) predicted blood culture positive sepsis (p=0.023) and gram-negative bacteremia (p=0.045). No correlation was observed with plasma sodium, blood pressure or evaluated osmolality. Plasma copeptin correlated inversely with the same day pentraxin 3 on day 0–day 2 (all p-values <0.001) and with C-reactive protein on day 1 (p=0.015). In conclusion, copeptin did not correlate with disease severity, but the lack of a proper initial increase was associated with bacteremic complications of febrile neutropenia in hematological patients. The findings suggest the possibility of central dysregulation of AVP release and do not support the use of copeptin as a biomarker of septic complications in this patient group.

Does clinical supervision promote medical-surgical nurses’ well-being at work? A quasi-experimental 4-year follow-up study

The aim of the present paper is to report results of a quasi-experimental study exploring the effects of clinical supervision (CS) on the development of medical-surgical nurses' well-being at work over a 4-year period. Effective workplace interventions are needed to prevent stress and burnout. More robust scientific evidence is needed to confirm the restorative effects of CS in nursing. A questionnaire survey on the perceptions of work and health was conducted in 2003 and 2007 on 14 units of a Finnish university hospital where 19 CS group processes had been completed between 2004 and 2007. Improvement in job resources as well as reduction in professional inefficacy and psychological distress were found among nurses who received effective CS (n = 41), but were not present among the nurses who found their CS less effective (n = 43) or who did not attend CS (n = 82). The results provide robust evidence for the positive effects of CS on medical-surgical nurses' well-being at work. Stress is a developmental challenge in the professional growth of individual nurses. One option for management to sustain nurses' well-being at work is to develop a learning organization in the workplace making use of CS.

Hospital-Diagnosed Late Sequelae after Female Chlamydia trachomatis Infections in 1990–2006 in Turku, Finland

Background: Rather little is known about the late sequelae of previously detected female Chlamydia infections. Methods: The late sequelae of previous female Chlamydia infections detected during a 15-year period in a south-western Finnish university hospital were surveyed. Hospital records of women with positive laboratory diagnoses of Chlamydia trachomatis as a sign of genital infection were collected from the years 1990–2006 and subsequently linked to known or suspected in-hospital-treated late Chlamydia complications. Results: The annual number of late complications has increased in proportion to the increasing trend of detected Chlamydia cases. 239 late complications of the total of 4,920 previously detected Chlamydia-positive infections were observed. The most frequent in-hospital-treated complications were disturbances in early pregnancy (n = 72) and low abdominal pain (n = 67). The others were 45 genital tract or pelvic infections, 34 cases of tubal or unknown infertility and 21 complications of late pregnancy and delivery. Conclusion: The late sequelae of Chlamydia infections need increasing attention in hospitals.