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The purpose of the thesis was to investigate the working ability literacy and working ability of migraine sufferers and the role of a supervisor in supporting them. The purpose was also to prepare coaching questions for the supervisors to improve the working ability literacy of employees with migraines and to produce a development proposal for the Finnish Migraine Association to support the working ability of migraine sufferers. The aim of the thesis was to promote migraine sufferers' own working ability literacy, to improve the interaction between migraine sufferers and supervisors through coaching questions, and to strengthen the agency of migraine sufferers in maintaining their ability to work. The thesis was implemented as a constructive study. The material for the research and development work was gathered with a combination of quantitative and qualitative methods and included the data obtained from a survey (266 replies), developmental teamwork and testing of the coaching questions. According to the results, migraine sufferers know how to read their ability to work quite well. Recognizing the variation of functional ability appears to be the basis of working ability literacy. Self-management skills are a major factor in promoting their working ability. The supervisor's role in supporting working ability can be significant, and the importance of proactive working ability management is considerable. Migraine is often a disease that strongly affects the ability to work. The coaching questions were designed and tested in this thesis to train the working ability literacy. These questions are estimated to improve the understanding between the supervisor and the migraine sufferer. They guide the migraine sufferer to explain and verbalize their individual symptoms and seek for a concrete solution and possible support together with the supervisor. The coaching questions can make the working ability discussion more informal, build trust, increase a proactive approach, and guide to find solutions that support ability to work in everyday life. Based on the entire thesis, a development proposal for the Finnish Migraine Association was also formulated. Based on the thesis, in supporting the ability to work, a comprehensive and proactive approach and strengthening the agency of the migraine sufferers are essential. In addition, the support systems for working ability require development.
Purpose: The purpose of this study was to investigate how often glaucoma and neovascular age-related macular degeneration (nAMD) occur in the same patient and to evaluate whether glaucoma progression is faster in eyes treated with intravitreal anti-VEGF medications for nAMD. Methods: This single-centre retrospective real-world data (RWD) consists of medical records of 6314 glaucoma and 2166 nAMD patients treated in 2008–2017 in Tays Eye Centre, Finland. To study glaucoma progression, changes in visual fields (mean deviation [MD], dB/year), IOP (mmHg/year) and fundus photographs (progression, yes/no) were compared in glaucoma eyes with and without anti-VEGF treatment for nAMD and ≥1 year follow-up. Results: During the 10-year period, 147 patients with glaucoma received intravitreal anti-VEGF treatment for nAMD corresponding to 2% of glaucoma and 7% of nAMD patients. The mean change in MD was −0.70 dB/year (SD 1.8) vs. −0.27 dB/year (SD 1.7) (p = 0.027) in glaucoma eyes with (n = 37) and without (n = 4304) anti-VEGF injections, respectively. In patients with bilateral glaucoma and unilateral nAMD treated with anti-VEGF injections (n = 20), MD declined at −0.62 dB/year (SD 1.9) vs 0.33 dB/year (SD 1.5) (p = 0.654), and glaucoma progression was detected in 14/20 vs 10/20 (p = 0.219) fundus photographs in eyes with anti-VEGF treatment compared with their untreated fellow eyes. Conclusion: nAMD and glaucoma were found co-existing in the same eye at rates that were similar to the age-corrected prevalence of the two diseases in the general population. Our results suggest that intravitreal anti-VEGF treatment for nAMD may accelerate glaucoma progression.
Purpose: As the first step in monitoring and evaluating day-to-day glaucoma care, this study reports all real-world data recorded during the first full year after the implementation of a prototype for glaucoma-specific structured electronic healthcare record (EHR). Methods: In 2019, 4618 patients visited Tays Medical Glaucoma Clinic at Tays Eye Centre, Tampere University Hospital, Finland, that serves a population of 0.53 M. Patient data were entered into a glaucoma-specific EHR by trained nurses to be checked by glaucoma specialists. Tays Eye Centre follows the Finnish Current Care Guideline for glaucoma in which glaucoma is defined using a ‘2 out of 3’ rule, that is, ≥2 findings evaluated as glaucomatous in optic nerve head (ONH), retinal nerve fibre layer (RNFL) and visual field (VF). Results: The clinical evaluations of ONH, RNFL and VF were recorded in 95%–100% of all eyes. ONH was evaluated as glaucomatous more often (44%) than RNFL (33%) and VF tests (30%). Progressive changes in any of the three tests were recorded in 35% of the ‘≥2/3 glaucoma group’ compared to 2%–9% in the other groups. The mean IOP at visit was 15 mmHg. The mean target IOP was 17 mmHg, and it was recorded in 94% of eyes. Conclusion: The developed structured data presentation enables comparisons between different population-based real-world glaucoma data sets and glaucoma clinics. Compared to a data set from the UK, the proportion of glaucoma suspicion-related visits was smaller in Tays Eye Centre and test intervals were longer.
Sote-uudistus koskettaa jokaista kansalaista ja sen toteutuminen vaatii kaikilta uudenlaista osaamista. Sosiaali- ja terveysalan henkilöstöltä vaaditaan muutoskestävyyttä sekä kykyä palvelujen arviointiin ja kehittämiseen laajalla rintamalla, yhdessä sosiaali- ja terveysalan asiakkaiden sekä muiden yhteistyötahojen kanssa. Tässä teoksessa pohditaan sote-uudistuksen nykytilaa ja tulevaisuutta asiakkaiden, sosiaali- ja terveysalan henkilöstön sekä koko muun yhteiskunnan näkökulmasta. Teoksessa esitetään sote-uudistukseen liittyviä hyviä käytänteitä ja työmenetelmiä, kuten digitaaliset palvelut ja liikkuvat lähipalvelut sekä green care -toiminta. Työmenetelmiä on kehitetty ja pilotoitu yhteistyössä Lapin ammattikorkeakoulun ja sen yhteistyötahojen kanssa. Kirjoittajat ovat Lapin ammattikorkeakoulun henkilöstöä, sosiaali- ja terveys-alan opiskelijoita sekä yhteistyötahojen edustajia.