Fecal calprotectin in juvenile idiopathic arthritis patients related to drug use

Background: Patients with juvenile idiopathic arthritis (JIA) on non-steroidal anti- inflammatory drugs (NSAIDs) may experience abdominal pain. In adults, NSAID use has been linked to an increase in fecal calprotectin (FC) levels, a surrogate marker for gut inflammation. In JIA, data on gut inflammation related to drug use is scarce. Methods: JIA patients followed up at the outpatient pediatric rheumatology clinic in Children's Hospital, Helsinki University Hospital, Helsinki, Finland were routinely assessed for FC if they complained about abdominal pain, had an elevated erythrocyte sedimentation rate (ESR) or used NSAIDs on a daily basis. The FC levels were related to the presence of abdominal pain, to ESR, and to the presence of HLA-B27. Results: Of the total group of 90 patients (median age 9.1 years; 45 JIA patients with disease modifying antirheumatic drugs (DMARDs), 25 without DMARD medication, and 20 arthralgia patients as controls), approximately 50% used NSAIDs, of whom 40% complained about abdominal pain. In patients with abdominal pain, one-third had elevated FC values (>100 mu g/g). The FC values, for the most part, declined along with the discontinuation or reduction of NSAIDs and after intensifying the DMARD medication, where after the pain disappeared. In patients with an elevated ESR, the FC values and ESR normalized in parallel. The presence of HLA-B27 was not associated with FC levels. Conclusion: In patients with JIA and abdominal pain, it may be useful to determine the FC when evaluating the need for further gastrointestinal examinations.Peer reviewe

Pitkäaikainen taantuma ja nollakorkorajoite – miten nollakorkorajoite vaikuttaa pitkäaikaisessa taantumassa?

Tutkimuksessani teen kirjallisuuskatsauksen keskuspankkien ohjauskoron nollakorkorajoitteen vaikutuksista pitkäaikaiseen taantumaan. Finanssikriisin 2007–2009 jälkeen pitkäaikaisen taantuman merkkejä on ollut havaittavissa, ja keskuspankkien ohjauskorot on laskettu lähelle nollaa. Sen myötä keskuspankkien tärkeintä rahapolitiikan keinoa, ohjauskoron muuttamista, ei ole voitu enää käyttää rahapolitiikan keventämiseen. Jos nollakorkorajoitetta pidetään sitovana, voidaan tämän hetkisessä taloudellisessa tilanteessa reaalikoron lasku saada aikaan vain inflaation avulla. Tässä ei ole onnistuttu finanssikriisin jälkeen toivotulla tavalla Yhdysvalloissa eikä euroalueella. Pohdin myös nollakorkorajoitteen sitovuuden vaikutuksia. Muutaman kymmenyksen negatiivinen ohjauskorko on toiminut toivotulla tavalla pienissä keskuspankeissa, mutta suurilla Euroopan keskuspankilla ja Yhdysvaltain keskuspankilla negatiivinen ohjauskorko voisi johtaa valuuttojen ja rahamarkkinarahastojen syöksyyn. Esitän, että useiden prosenttien negatiivinen korko on kuitenkin mahdoton käteisen rahan olemassaolon takia. Tutkimukseni auttaa ymmärtämään tämän hetkisen taloudellisen tilanteen vakavuutta ja vaikeutta

Asiakasosallistuminen idean kehitysvaiheissa

Companies are increasingly trying to improve their operative advantages to their compe- tition by involving more customers in their development work. In Business to business situation creating and maintaining customer relationships ca be a crucial differentiation that leads to long profitable partnerships. This thesis examines customer involvement in idea development steps as a case study for a global technology company. The results include current working models as well as prac- tical suggestions to improve customer involvement in development work. The research was done by conducting thematic interviews in the company, as well as with few custom- ers of the company. Current working methods indicate a change in customer involvement and reveal needs for future development and research. The studied company had noticed a trend in customer involvement in their field of work and were interested in utilizing customers more in their development work. Knowing the current status is important for the start of developing better methods and ways of work- ing. Involving customers in development work requires changes in culture, mindset and concrete working methods. The customers' role changes into co-operate partner. Behav- ioral changes from the customer will help with concern by the company in this new model of working. True partnership requires mutual commitment. Identifying the current ways of working was the starting point for the thesis. The analysis of these ways of working enabled discovery of the needs for better implementation and concerns of involving the customer in development work. The research data was gathered by semi-structured interviews inside the case company and three of their customers. The literature review goes through a few existing models of product development processes and customer involvement methods. This review creates an academical background that frames analysis and practical suggestions. As a result, five steps with distinct customer involvement were identified, and practical suggestions are given based on the findings. Practical suggestions provide help for specific needs as well as a general guide for customer involvement in development work. To im- prove and increase customer involvement, the next step is to follow the current work with more support and focus. For research, the next step should be an examination of identi- fied customer involvement steps in more detail by following ongoing projects.Yritykset yrittävät kasvavassa määrin parantaa toimintaansa ja etuaan kilpailijoihin näh- den lisäämällä asiakasosallistumista kehitystyössään. Business to business puolella asia- kassuhteiden luominen ja ylläpitäminen voi olla ratkaiseva eroavaisuus, joka johtaa pit- kiin ja tuottoisiin kumppanuuksiin. Tässä diplomityössä tarkastellaan asiakasosallistumista idean kehitysvaiheissa tapaustut- kimuksena globaalissa teknologiayrityksessä. Tulokset sisältävät nykyiset toimintamallit sekä käytännön ehdotuksia parantamaan asiakasosallistumista kehitystyössä. Tutkimus toteutettiin teemallisilla haastatteluilla kohdeyrityksessä sekä heidän muutamalla asiak- kaalla. Nykyiset toimintametodit indikoivat muutosta asiakasosallistumisessa ja paljasta- vat tarpeita tulevaisuuden kehitykseen sekä tutkimukseen. Kohdeyritys oli huomannut alalla trendin asiakasosallistumisessa, ja ovat halukkaita li- säämään asiakkaiden yhteistyötä kehitystyössä. Nykytilanteen tunteminen luo tärkeän pohjan kehittämään parempia metodeja ja työtapoja. Asiakkaiden sisällyttäminen kehi- tystyöhön vaatii muutosta kulttuurissa, ajattelutavassa, ja konkreettisissa työtavoissa. Asiakkaan rooli muuttuu yhteistyö partneriksi. Asiakas voi helpottaa uutta yhteistyötä omalla toiminnallaan. Yhteistyö vaatii molemminpuolista sitoutumista. Nykyisten toimintatapojen identifiointi toimi lähtökohtana tälle diplomityölle. Näiden työtapojen analysointi mahdollisti asiakasosallistumisen paremman implementaation tarpeiden ja huolien kartoittamisen. Tutkimus data kerättiin puolistrukturoiduilla haas- tatteluilla yrityksen sisällä, sekä kolmella heidän asiakkaallaan. Kirjallisuus käy läpi muu- taman mallin tuotekehitys prosessista, sekä asiakasosallistumismetodeja. Tarkastelu luo akateemisen pohjan, joka rajaa analyysiä sekä käytännön suosituksia. Tuloksina löydettiin viisi erillistä asiakasosallistumisen vaihetta, joihin käytännön suosi- tukset pohjautuvat. Käytännön suositukset antavat apua spesifisiin tarpeisiin, sekä toimi- vat yleisenä ohjeena asiakasosallistumiseen kehitystyössä. Asiakasosallistumisen lisää- miseksi ja parantamiseksi seuraava askel olisi seurata ja tukea nykyisiä toimintatapoja. Seuraavan tutkimuksen tulisi tarkastella tunnistettuja asiakasosallistumisen vaiheita yk- sityiskohtaisemmin, seuraamalla meneillään olevia projekteja

Measuring patient experiences in a Children's hospital with a medical clowning intervention : a case-control study

BackgroundBecause the healthcare sector is shifting to a customer-oriented approach, it is important to understand experiences of children as users of healthcare services. So far, studies that measure the influence of medical clowning on patient experiences are scarce. This study aims to measure experiences of children and their parents during day-surgery in hospital setting.MethodsA case-control study was conducted in a large Finnish children's hospital. Seventy children aged 4-17years coming for a minor operative procedure including pre-operative cannula insertion prior to surgery were included. Thirty-eight children were exposed to the medical clowning intervention and 32 children (the reference group) did not receive exposure to medical clowning. A novel digital survey tool was used to measure patient experiences before and after the insertion of a venous cannula needed for anaesthesia. The children were asked about their emotions, anxiety levels, the pain from the cannula insertion and the best and worst things about the hospital. The parents were asked about their emotions, expectations and the fluency of the procedure and the hospital day.ResultsBefore the procedure, 32% or 36% of the children in the intervention group and 44% or 28% of those in the reference group expressed positive or neutral emotions, respectively. After the procedure, 76% or 63% of children in the intervention group or reference group, respectively, expressed positive emotions. The intervention group rated the medical clowns as the best aspect of the hospital day. Both groups reported that the best aspects of the hospital day were related to the nurses and food and the worst were related to waiting and pain. Most commonly the parents felt uncertainty, anxiety or calmness before the procedure and relief afterwards. Their expectations towards the procedure related to its success and the certainty of the diagnosis.ConclusionsThe results show a trend towards more positive emotions in children with exposure to medical clowning. The digital survey tool was suitable for gathering information about the experiences of children and their parents. Information on emotions and expectations of children and parents during a procedure is useful when improving the quality of healthcare services.Trial registrationCurrent Controlled Trials NCT04312217, date of registration 17.03.2020.Retrospectively registered.Peer reviewe

A Focus Group Study about Oral Drug Administration Practices at Hospital Wards—Aspects to Consider in Drug Development of Age-Appropriate Formulations for Children

Oral drug administration to pediatric patients is characterized by a lack of age-appropriate drug products and the off-label use of medicines. However, drug administration practices at hospital wards is a scarcely studied subject. The aim of this study was to explore the oral drug administration practices at pediatric hospital wards, with a focus on experiences and challenges faced, methods used to mitigate existing problems, drug manipulation habits, perceptions about oral dosage forms and future needs of oral dosage forms for children. This was a qualitative study consisting of focus group discussions with physicians, nurses and clinical pharmacists in a tertiary university hospital with the objective of bringing forward a holistic view on this research topic. These healthcare professionals recognized different administration challenges that were classified as either dosage form-related or patient-related ones. A lack of depot formulations developed especially for children as well as oral pediatric dosage forms of drug substances currently available as intravenous dosage forms was recognized. The preferred oral dosage forms were oral liquids and orodispersible tablets. Patient-centered drug administration practices including factors facilitating drug administration both at hospital wards and at home after patient discharge were identified. Among all healthcare professionals, the efficient cooperation in drug prescribing and administration as well as in educating the child’s caregivers in correct administration techniques before discharge and improving the overall discharge process of patients was emphasized. This study complements the prevalent understanding that new dosage forms for children of varying ages and stages of development are still needed. It also brings a holistic view on different aspects of oral drug administration to pediatric patients and overall patient-centered drug administration practices

Development of the patient experience questionnaire for parents of pediatric patients (PEQP)

Patient experience (PX) is an important evaluation criterion for quality in healthcare. Compared to patient satisfaction, however less research has focused on the development of instruments to measure experiences of patients and their families. In the article, we describe the process of developing a PX questionnaire for the parents of pediatric patients in the context of children's hospital and illustrate the questionnaire items for measuring PX. The phases of the development process included retrospective interviews, description of the themes influencing PX and the metrics for measuring PX, as well as iterative development of three versions of questionnaires including data gathering and factor analysis. The final versions of the surveys suggested for implementation at the hospitals include eight PX statements for the outpatient clinic and five statements for the ward. Compared to satisfaction surveys, the developed surveys emphasize the aspects of parent's attitude towards the illness, support for families, and daily arrangements with a child patient. © 2019 American Psychological Association Inc. All rights reserved.Peer reviewe