Biomedical subjects
Publications and source records attributed to A Laitinen.
The aim of this study was to examine how the services of the gynaecological outpatient department meet the requirements, needs and expectations of the infertility patients. The infertility patients' experiences of the quality and contents of service process are analyzed.
Sulphidopeptide leukotrienes are potent bronchoconstrictors and increase bronchial hyperreactivity, one of the hallmarks of asthma. We have demonstrated that leukotriene LTE4, the most stable of the sulphidopeptide leukotrienes, elicited an increase in the numbers of eosinophils and neutrophils in the lamina propria of the airway mucosa 4 h after inhalation in 4 asthmatic subjects. The numbers of eosinophils were, on average, 10-fold greater than those of neutrophils. There was no significant change in numbers of lymphocytes, plasma cells, mast cells, or macrophages. Since LTE4 recruits granulocytes, the potential of antisulphidopeptide leukotriene drugs as anti-inflammatory and "steroid-sparing" agents should be tested.
Explore the source record for details and available documents.
We have studied bronchial biopsies from 14 patients with newly diagnosed asthma (four men and 10 women), who had had asthma symptoms, on average, 7.4 months (range, 2 to 12 months) and from four control subjects. The patients had not received corticosteroids, disodium cromoglycate, or theophylline before the study. The bronchial biopsies were taken, using a rigid-tube bronchoscope under local anaesthesia, from two different airway levels: (1) inside the right upper lobe bronchus, and (2) at the opening of the right middle lobe. The specimens were prepared for both light and electron microscopy. The use of Slot grids 1 x 2 mm enabled a large area of the thin sections to be photographed and analyzed by applying a graphic Autocad program. There was an increase in the numbers of mast cells (p < 0.001), eosinophils (p < 0.05), lymphocytes (p < 0.05), and macrophages (p < 0.05) in the epithelium of patients with newly diagnosed asthma as compared with those in control subjects. In the lamina propria, these asthmatic patients had more eosinophils (p < 0.001), lymphocytes (p < 0.001), macrophages (p < 0.001), and plasma cells (p < 0.001) than did the control subjects. We conclude that, in asthma, an airway inflammatory process is present even at a clinically early stage of the disease. In the asthmatic airways, there are signs of a general inflammatory response caused by more than one cell type.
The quality of health care is largely discussed issue among health care professionals in Finland. The purpose of this article is to point out some relations between the quality of nursing and the economical costs. The theme is mostly ignored in the published articles and books about quality of nursing and health care. In the previous studies of quality of nursing four main approaches have been introduced 1) practical approach, 2) professionalism, 3) client orientation and 4) research orientation. An important weakness in the approaches is that they are carried out from a point of view of a single profession at the time. Really multiprofessional projects are the exception. Additionally, economic costs have not been included in nursing quality concept or evaluation criterion. The need for quality in any health services is urgent, including nursing. That is because of decreasing resources and changing market oriented steering mechanisms in the Finnish health care system. In this situation the quality of nursing may arise as one important competition factor in the organizations and the units. The costs of poor quality of nursing are not well recognized among professionals. Collaboration between different professionals is a key issue to solve these kind of problems. We need more research about the relations between economic factors and quality of nursing and other health services.
We compared the effect of an inhaled corticosteroid, budesonide, and an inhaled beta 2-agonist, terbutaline, on clinical symptoms, lung function, and airway inflammation in 14 adult patients with newly diagnosed asthma. The study was conducted as a randomized, double-blind, parallel-group trial. Seven patients inhaled 600 micrograms, twice daily, of budesonide, the other seven patients inhaled 375 micrograms, twice daily, of terbutaline via identical metered-dose inhalers with a spacer. Bronchial biopsy specimens, obtained before randomization and after 3 months of treatment, were analyzed by electron microscopy. Both groups improved clinically budesonide was more effective than terbutaline in improving morning and evening peak expiratory flow rates, as well as bronchial responsiveness to inhaled histamine. Treatment with budesonide was accompanied by increased numbers of ciliated airway cells and intraepithelial nerves and fewer inflammatory cells, including eosinophils, especially in the epithelium, these changes were not observed in specimens from terbutaline-treated patients. We conclude that, in contrast to inhaled terbutaline, inhaled budesonide improved lung function and bronchial hyperreactivity in adult subjects with asthma treated for 3 months and that this corticosteroid was more effective in ameliorating abnormalities of the bronchial epithelium and decreasing inflammation in the airways.
The purpose of this article is to describe what kind of nursing standards have been written in Finland. The quality assurance process of nursing includes setting of nursing standards. They express the desired quality level of nursing. They would also guide the practice of nursing. The analysed nursing standards were collected from five university hospitals, 15 central hospitals and nine health centers. The standards were collected with the questionnaire studying the present situation of quality assurance of nursing in Finland. The total number of analysed nursing standards was 190. According to the results the standards were mostly set to evaluate and characterize the quality of nursing of the certain patient group (e.g. new born child, dying patient, cancer patient in chemotherapy) and to evaluate the realization of nursing principles. Safety and individuality of nursing and independence and autonomy of patient were the most often appeared nursing principles in the analysed standards. The standards were written in passive and the level of quality was the ideal optimum. The nursing standards were expressed often abstractively and in such a form that the measurement and evaluation of reached level of the standard is a very difficult task.
We have compared the inflammatory changes in the bronchial mucosa and the increase in the airway hyperresponsiveness in an asthmatic patient during the deterioration of symptoms. A striking increase in the number of bronchial epithelial eosinophils was associated with an increase in both airway hyperresponsiveness and asthma symptoms. During 16 wk of treatment with the inhaled corticosteroid, budesonide, the patient's clinical status and airway hyperresponsiveness improved. This was accompanied by an improvement in the ultrastructure of bronchial mucosa and a decrease in the number of epithelial eosinophils.
Explore the source record for details and available documents.
So far, little information is available on the usefulness of the biopsy method in drug intervention studies in COAD and CB. Quantitation studies at electron microscopical level are time consuming. Comparative studies between and within the patient groups are needed to attain basic and clinically relevant information. Pathology studies may lead to a better understanding of basic pathophysiological mechanisms behind the diseases. The sequences of cellular events could be revealed so that morphology may be useful in intervention studies.
In humans a rich network of capillaries runs subepithelially from the central airways to the level of the peripheral bronchioles, where it anastomoses with the alveolar capillaries. The tracheobronchial capillaries converge to form venules extending to a deeper plexus of larger venules and arterioles. Transmission electronmicroscopy shows capillaries very close to the epithelial basement membrane, but not in the epithelium itself. There are two main differences in the bronchial mucosal vascular bed between healthy controls and asthmatics. In 60% of asthmatics there are endothelial gaps in the bronchial mucosal microvasculature compared to none in controls. Half of asthmatics have eosinophils adhered in the bronchial mucosal venules and capillaries, but none are seen in controls. Neutrophils are even more common than eosinophils in the bronchial mucosal capillaries and venules, but they are also found in the venules of one control out of four. The finding of inflammatory cells in the bronchial vessels suggests possible chemotaxis in asthmatics.
Explore the source record for details and available documents.
The purpose of this study is to describe the present situation in quality assurance in nursing in Finnish hospitals and health centers. The data was collected by questionnaires from the nurse leaders in 20 hospitals and in 28 health centers around Finland during the autumn 1987 and spring 1988. They were asked what has been done in their organizations in quality assurance in nursing; methods, areas, co-operators and problems they faced in their quality assurance programmes. Quality assurance in nursing is in the beginning. The nurses are discussing about the concepts of quality, quality assessment, quality assurance and measurements of quality in nursing. In 67% of organizations belonging to this study the nurses have begun to write the standards and criterias in nursing practice. Only in one hospital and in one health center nurses had measured the quality of nursing with some method.
The effect of steroids on the ciliogenesis of bronchial epithelium has not previously been studied in asthmatics. Bronchial biopsies were taken during bronchoscopy from five asthmatics before and after oral steroid treatment, and studied by transmission electron microscopy. Two untreated healthy subjects served as controls. After treatment, ciliogenesis was abundant in all patients.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.