Digi-HTA: Health technology assessment framework for digital healthcare services

Health technology assessment (HTA) refers to the systematic evaluation of the properties, effects, and/or impacts of health technology. The main purpose of the assessment is to inform decisionmakers in order to better support the introduction of new health technologies. New digital healthcare solutions like mHealth, artificial intelligence (AI), and robotics have brought with them a great potential to further develop healthcare services, but their introduction should follow the same criteria as that of other healthcare methods. They must provide evidence-based benefits and be safe to use, and their impacts on patients and organizations need to be clarified. The first objective of this study was to describe the state-of-the-art HTA methods for mHealth, AI, and robotics. The second objective of this study was to evaluate the domains needed in the assessment. The final aim was to develop an HTA framework for digital healthcare services to support the introduction of novel technologies into Finnish healthcare. In this study, the state-of-the-art HTA methods were evaluated using a literature review and interviews. It was noted that some good practices already existed, but the overall picture showed that further development is still needed, especially in the AI and robotics fields. With the cooperation of professionals, key aspects and domains that should be taken into account to make fast but comprehensive assessments were identified. Based on this information, we created a new framework which supports the HTA process for digital healthcare services. The framework was named Digi-HTA.Health technology assessment (HTA) refers to the systematic evaluation of the properties, effects, and/or impacts of health technology. The main purpose of the assessment is to inform decisionmakers in order to better support the introduction of new health technologies. New digital healthcare solutions like mHealth, artificial intelligence (AI), and robotics have brought with them a great potential to further develop healthcare services, but their introduction should follow the same criteria as that of other healthcare methods. They must provide evidence-based benefits and be safe to use, and their impacts on patients and organizations need to be clarified. The first objective of this study was to describe the state-of-the-art HTA methods for mHealth, AI, and robotics. The second objective of this study was to evaluate the domains needed in the assessment. The final aim was to develop an HTA framework for digital healthcare services to support the introduction of novel technologies into Finnish healthcare. In this study, the state-of-the-art HTA methods were evaluated using a literature review and interviews. It was noted that some good practices already existed, but the overall picture showed that further development is still needed, especially in the AI and robotics fields. With the cooperation of professionals, key aspects and domains that should be taken into account to make fast but comprehensive assessments were identified. Based on this information, we created a new framework which supports the HTA process for digital healthcare services. The framework was named Digi-HTA

Short learning curve in transition from laparoscopic to robotic-assisted rectal cancer surgery : a prospective study from a Finnish Tertiary Referral Centre

The narrow pelvis causes special challenges in surgery, and robotic-assisted surgery has been proven beneficial in these circumstances. While robotic surgery has some specific advantages in rectal cancer surgery, there is still limited evidence of the learning curve of the technique involved. The aim here was to study the transition from laparoscopic to robotic-assisted surgery among experienced laparoscopic surgeons. The data for this study were collected from a prospectively compiled register that includes patients operated on by the Da Vinci Xi robot in Tampere University Hospital. Each consecutive rectal cancer patient was included. The information on the surgical and oncological outcomes was analysed. The learning curve was assessed using cumulative sum (CUSUM) analysis. CUSUM already demonstrated an overall positively sloped curve at the beginning of the study, with neither the conversion rate nor morbidity reaching unacceptable thresholds. Conversions (4%) and postoperative complications (Clavien–Dindo III–IV 15%, no intraoperative complications) were rare. One patient died within one month and the death was not procedure-associated. While surgical and oncological outcomes were similar among all surgeons, the console times showed a decreasing trend and were shorter among those with more experience in laparoscopic rectal cancer surgery. Robotic-assisted rectal cancer surgery can be safely adapted by experienced laparoscopic colorectal surgeons.Peer reviewe

Earlier life leisure-time physical activity in relation to age-related frailty syndrome

Background: frailty syndrome is common amongst older people. Low physical activity is part of frailty, but long-term prospective studies investigating leisure-time physical activity (LTPA) during the life course as a predictor of frailty are still warranted. The aim of this study is to investigate whether earlier life LTPA predicts frailty in older age. Methods: the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) included older adults (aged 60-77 years) from the general population who were at increased risk of cognitive decline. Frailty was assessed for 1,137 participants at a baseline visit using a modified version of Fried's phenotype, including five criteria: weight loss, exhaustion, weakness, slowness and low physical activity. Self-reported data on earlier life LTPA were available from previous population-based studies (average follow-up time 13.6 years). A binomial logistic regression analysis was used to investigate the association between earlier life LTPA and pre-frailty/frailty in older age. Results: the prevalence of frailty and pre-frailty was 0.8% and 27.3%, respectively. In the analyses, pre-frail and frail groups were combined. People who had been physically very active (OR 0.37, 95% CI 0.23-0.60) or moderately active (OR 0.45, 95% CI 0.32-0.65) earlier in life had lower odds of becoming pre-frail/frail than individuals who had been sedentary. Conclusions: frailty was rare in this relatively healthy study population, but almost a third of the participants were pre-frail. Earlier life LTPA was associated with lower levels of pre-frailty/frailty. The results highlight the importance of physical activity when aiming to promote healthy old age.Peer reviewe

Proficiency Test 09/2022 : Drinking water analyses

Proftest Syke carried out the proficiency test (PT) for analyses of synthetic samples and drinking water as well as raw water samples in September 2022. In total, there were 37 participants in the PT. Either the calculated concentration or the robust mean of the reported results was used as the assigned values for the measurands. The overall performance of the participants was evaluated by using z scores. In this PT 86% of the results were satisfactory when total deviation of 0.2 pH units for pH values and 5–20% for the other measurands was accepted from the assigned value. Warm thanks to all participants in this proficiency test! Pätevyyskoe 09/2022: Talousvesimääritykset Proftest Syke järjesti syyskuussa 2022 pätevyyskokeen talousvesiä analysoiville laboratorioille synteettisestä vesinäytteestä sekä talous- ja raakavesinäytteistä. Pätevyyskokeeseen osallistui yhteensä 37 laboratoriota. Testisuureiden vertailuarvoina käytettiin joko laskennallista pitoisuutta tai osallistujien tulosten robustia keskiarvoa. Osallistujien pätevyyden arviointi tehtiin z-arvojen avulla. Koko tulosaineistossa oli z-arvoilla arvioituna 86 % hyväksyttäviä tuloksia, kun vertailuarvosta sallittiin pH-määrityksissä 0,2 pH-yksikön ja muissa määrityksissä 5–20 %:n poikkeama. Kiitos pätevyyskokeen osallistujille

Pätevyyskoe 03/2022: Jätevesimääritykset I

Pätevyyskoe 03/2022: Jätevesimääritykset I Proftest SYKE järjesti maalis-huhtikuussa 2022 pätevyyskokeen jätevesiä analysoiville laboratorioille. Pätevyyskokeessa testattiin BOD7, CODCr, CODMn, kiintoaine, Na ja TOC synteettisestä näytteestä ja jätevedestä sekä BOD7 ja CODMn luonnonvedestä. Pätevyyskokeeseen osallistui yhteensä 53 laboratoriota. Testisuureiden vertailuarvoina käytettiin joko laskennallista pitoisuutta tai osallistujien tulosten robustia keskiarvoa. Osallistujien pätevyyden arviointi tehtiin z-arvojen avulla. Koko tulosaineistossa oli 91 % hyväksyttäviä tuloksia, kun tulosten sallittiin vaihdella 10–25 % vertailuarvosta. Kiitos päte-vyyskokeen osallistujille!Proficiency Test 01/2022: Wastewater analyses I In March-April 2022, Proftest SYKE carried out the proficiency test (PT) for analysis of BOD7, CODCr, CODMn, Na, suspended solids, and TOC in wastewaters. Additionally, a natural water sample for BOD7 and CODMn determinations was provided. In total, there were 53 participants in the PT. Either the calculated concentration or the robust mean of the reported results was used as the assigned values for the measurands. The overall performance of the participants was evaluated by using z scores. In this PT 91 % of the results were satisfactory when total deviation of 10–25 % was accepted from the assigned value. Warm thanks to all participants in this proficiency test!Kompetensprövning 03/2022: Avloppsvattenanalyser I Under mars-april 2022 genomförde Proftest SYKE en kompetensprövning, som omfattade bestämningen av BOD7, CODCr, CODMn, Na, suspenderat material och TOC i avsloppsvatten. För BOD7- och CODMn-bestämningen fanns också i naturvatten. Denna kompetensprövning hade totalt 53 deltagarna. Som referensvärde av analytens koncentration användes antingen det teoretiska värdet eller robust medelvärdet av deltagarnas resultat. Resultaten värderades med hjälp av z-värden. I denna kompetensprövning var 91 % av resultaten acceptabla. Resultatet var acceptabel, om det devierade mindre än 10–25 % från referensvärdet. Ett varmt tack till alla deltagarna i testet

Enhanced Eating Competence Is Associated with Improved Diet Quality and Cardiometabolic Profile in Finnish Adults with Increased Risk of Type 2 Diabetes

Eating competence (EC) is characterized by positive attitudes towards food and eating, having regular meals, eating a variety of foods, and internally regulated eating. We investigated the associations of changes in EC with changes in lifestyle, anthropometrics and biomarkers of glucose and lipid metabolism in 2291 adults at increased risk of type 2 diabetes as part of the StopDia study conducted in primary healthcare. EC and diet quality were assessed with validated digital questionnaires. During the intervention, the participants received either (1) the digital lifestyle intervention, (2) the combined digital and face-to-face group-based lifestyle intervention, or (3) standard care. EC increased among the participants independent of the intervention type. Increase in EC was associated with an increase in diet quality, high-density lipoprotein (HDL) cholesterol, and with a decrease in body mass index and waist circumference, regardless of baseline EC. Of the subdomains of EC, the contextual skills, food acceptance and eating attitudes were associated with various of these changes. Our results thus suggest that EC could be a potential target in lifestyle interventions aiming to improve the cardiometabolic health of people at type 2 diabetes risk.publishedVersionPeer reviewe

InDEx – Industrial Data Excellence

InDEx, the Industrial Data Excellence program, was created to investigate what industrial data can be collected, shared, and utilized for new intelligent services in high-performing, reliable and secure ways, and how to accomplish that in practice in the Finnish manufacturing industry.InDEx produced several insights into data in an industrial environment, collecting data, sharing data in the value chain and in the factory environment, and utilizing and manipulating data with artificial intelligence. Data has an important role in the future in an industrial context, but data sources and utilization mechanisms are more diverse than in cases related to consumer data. Experiences in the InDEx cases showed that there is great potential in data utili zation.Currently, successful business cases built on data sharing are either company-internal or utilize an existing value chain. The data market has not yet matured, and third-party offerings based on public and private data sources are rare. In this program, we tried out a framework that aimed to securely and in a controlled manner share data between organizations. We also worked to improve the contractual framework needed to support new business based on shared data, and we conducted a study of applicable business models. Based on this, we searched for new data-based opportunities within the project consortium. The vision of data as a tradeable good or of sharing with external partners is still to come true, but we believe that we have taken steps in the right direction.The program started in fall 2019 and ended in April 2022. The program faced restrictions caused by COVID-19, which had an effect on the intensity of the work during 2020 and 2021, and the program was extended by one year. Because of meeting restrictions, InDEx collaboration was realized through online meetings. We learned to work and collaborate using digital tools and environments. Despite the mentioned hindrances, and thanks to Business Finland’s flexibility, the extension time made it possible for most of the planned goals to be achieved.This report gives insights in the outcomes of the companies’ work within the InDEx program. DIMECC InDEx is the first finalized program by the members of the Finnish Advanced Manufacturing Network (FAMN, www.famn.fi).</p

LongITools: Dynamic longitudinal exposome trajectories in cardiovascular and metabolic noncommunicable diseases

The current epidemics of cardiovascular and metabolic noncommunicable diseases have emerged alongside dramatic modifications in lifestyle and living environments. These correspond to changes in our “modern” postwar societies globally characterized by rural-to-urban migration, modernization of agricultural practices, and transportation, climate change, and aging. Evidence suggests that these changes are related to each other, although the social and biological mechanisms as well as their interactions have yet to be uncovered. LongITools, as one of the 9 projects included in the European Human Exposome Network, will tackle this environmental health equation linking multidimensional environmental exposures to the occurrence of cardiovascular and metabolic noncommunicable diseases.</p

Joutsenmerkki ravintola Kesäkartanolle

Tämän opinnäytetyön tarkoitus oli selvittää Kartano Golf Oy:n klubiravintola Kesäkartanon mahdollisuuksia saavuttaa pohjoismainen ympäristömerkki eli Joutsenmerkki. Ympäristömerkinnällä ravintola pyrkii toteuttamaan yrityksen ympäristövastuuta sekä erottumaan kilpailijoista. Opinnäytetyössä kartoitetaan ravintola Kesäkartanon nykytilanne eli kuinka hyvin Joutsenmerkille määritellyt kriteerit nykyisellään täyttyvät ja ehdotetaan toimenpiteitä, joilla Joutsenmerkin saaminen mahdollistuu. Opinnäytetyön teoriaosuudessa käsitellään Kartano Golf Oy:tä ja ravintola Kesäkartanoa, ympäristövastuullista liiketoimintaa, virallisia ympäristömerkkejä sekä Joutsenmerkkiä kriteereineen. Teoriaosuuteen on haettu tietoa aiheeseen liittyvästä kirjallisuudesta sekä internetistä. Tutkimusaineisto on kerätty haastattelemalla Kartano Golf Oy:n toimitusjohtajaa Petteri Ruuskasta sekä klubiravintola Kesäkartanon ravintolapäällikköä Sinikka Räisästä. Tutkimusmenetelmänä on käytetty sekä strukturoitua haastattelua että teemahaastattelua. Opinnäytetyön tutkimustuloksista käy ilmi, että Joutsenmerkin saaminen ravintola Kesäkartanolle ei ravintolan nykyisillä toimintatavoilla ole mahdollista. Joutsenmerkin vaatimukset täyttyvät parhaiten ravintola Kesäkartanossa tällä hetkellä Joutsenmerkin kriteeristön osioissa ruoka ja juoma. Tässä osiossa ravintolan tulee ainoastaan lisätä luomutuotteiden käyttöä. Osio kemialliset tuotteet ja käyttötuotteet vaatii enimmäkseen helposti toteutettavia muutoksia: ravintolan on vaihdettava käyttämänsä kemialliset tuotteet ympäristöystävällisiksi. Osiossa jätteet ja niiden kierrätys merkittävimmät muutokset ravintolan tulee tehdä jätteiden lajitteluun, jota tulee monipuolistaa. Suurimpia toimenpiteitä vaatii Joutsenmerkin osio energia ja vesi. Vaaditut toimenpiteet aiheuttavat myös suurehkoja kustannuksia, mutta toisaalta nämä voidaan nähdä investointeina, jotka tuottavat pitkällä aikavälillä säästöjä. Myös ympäristöjohtamisen osio vaatii paljon toimenpiteitä, sillä Joutsenmerkkiin liittyviin käytäntöihin ollaan vasta tutustumassa ravintolassa. Nämä toimenpiteet ovat kustannuksiltaan pieniä, mutta vaativat paljon työtä johdolta. Tutkimus osoitti, ettei Joutsenmerkin saavuttaminen ole ravintola Kesäkartanolle helppoa, mutta toisaalta kävi myös ilmi, että kaikki toimenpiteet, joita Joutsenmerkin saaminen ravintola Kesäkartanolta edellyttää, ovat täysin toteutettavissa, ja näiden muutosten jälkeen ravintolalla on hyvät mahdollisuudet saada Joutsenmerkki. Toteutettuaan muutokset ravintola Kesäkartano aikoo hakea Joutsenmerkkiä kevään 2013 aikana.The goal of this thesis was to examine the potential of Kartano Golf Ltd’s club restaurant Kesäkartano to achieve the Nordic Ecolabel, the Swan label. The restaurant pursues the Swan label because the company wants to act environmentally responsibly and stand out from competitors. In this thesis the restaurant’s current state was exa-mined i.e. how well the criteria of the Nordic ecolabel are met at the moment. On the basis of the current state measures and changes are proposed to help the restaurant achieve the Swan label. The theoretical part of the thesis deals with Kartano Golf Ltd and restaurant Kesäkartano, environmentally responsible business, the official ecolabels, as well as the criteria of the Swan label. Background facts were searched from the related literature and Internet sources. The study of the restaurant’s current state is based on interviews of Kartano Golf Ltd’s managing director Petteri Ruuskanen and the restaurant Kesäkartano’s restaurant manager Sinikka Räisänen. The research methods in the study were structured interview and theme interview. The research results show that achieving the Swan label is not possible at the moment for restaurant Kesäkartano. The Swan label’s requirements are currently met best in the sections of food and beverage. In this section, the restaurant will only need to increase the use of organic products. The section of chemical products requires mostly changes that are easy to implement: the restaurant has to start using only environmentally friendly chemicals. In the section of waste and recycling the most important change required is diversifying the sorting of waste. The most significant measures are required in the section of energy and water. The changes required come also at fairly large cost, but on the other hand, these can be seen as investments, which in the long run will lead to savings. Also, the section of environmental management requires a lot of work, because the restaurant is not yet familiar with the practices of the Swan label. These measures do not cost a lot, but require a lot of work from the management. The study showed that achieving the Nordic Ecolabel is not easy for restaurant Kesäkartano, but on the other hand it also became clear that all the changes needed to achieve the Swan label, can be done and after these changes, the restaurant has a good chance of achieving the Swan label. After having carried out the changes restaurant Kesäkartano intends to apply for the Swan label in spring 2013.Liite 2. Hakulomake Joutsenmerkille Liite 3. Joutsenmerkin kriteeri