Towards digital counselling in primary care management of symptomatic knee osteoarthritis: a qualitative descriptive study in Finnish primary care

Digital counselling may improve patients’ health outcomes, when eHealth solutions are accessible and tailored to the patients’ needs, which is especially important for people with chronic and long-term conditions such as knee osteoarthritis. This study aims to identify patients’ eHealth needs to improve the quality of digital counselling in a primary care management of symptomatic knee osteoarthritis. A qualitative study was used to collect patients’ eHealth needs through semi-structured interviews in a single outpatient clinic in Finland between August 2020 and November 2020. The data was analyzed using both deductive and inductive content analysis approaches. The study was reported in accordance with the Consolidated Criteria for Reporting Qualitative research checklist to improve the transparency of the study. Analysis of the data revealed five main categories to be considered when implementing digital counselling in patients with symptomatic knee osteoarthritis: background factors (functional impairments, health literacy, digital literacy, cost-related access barriers), resources (digital methods and materials), sufficiency (knee osteoarthritis-related knowledge and skills), implementation (simplicity, trust, patient-centeredness), and benefits (self-care capabilities, confidence). According to our findings, both health and digital literacy seems to be important contributors to the adoption of digital counselling in a primary care management of symptomatic knee osteoarthritis. New eHealth solutions should not replace the first visit in the outpatient clinic. Instead, the use of eHealth solutions should be based on the first visit, during which a trusting relationship between patients and healthcare providers is established. In future, the level of health and digital literacy in patients with symptomatic knee osteoarthritis should be taken account

Diagnostic and prognostic prediction models in ventilator-associated pneumonia: Systematic review and meta-analysis of prediction modelling studies

Machine learning; Mechanical ventilation; Prognostic modelAprenentatge automàtic; Ventilació mecànica; Model pronòsticAprendizaje automático; Ventilacion mecanica; Modelo pronósticoPurpose Existing expert systems have not improved the diagnostic accuracy of ventilator-associated pneumonia (VAP). The aim of this systematic literature review was to review and summarize state-of-the-art prediction models detecting or predicting VAP from exhaled breath, patient reports and demographic and clinical characteristics. Methods Both diagnostic and prognostic prediction models were searched from a representative list of multidisciplinary databases. An extensive list of validated search terms was added to the search to cover papers failing to mention predictive research in their title or abstract. Two authors independently selected studies, while three authors extracted data using predefined criteria and data extraction forms. The Prediction Model Risk of Bias Assessment Tool was used to assess both the risk of bias and the applicability of the prediction modelling studies. Technology readiness was also assessed. Results Out of 2052 identified studies, 20 were included. Fourteen (70%) studies reported the predictive performance of diagnostic models to detect VAP from exhaled human breath with a high degree of sensitivity and a moderate specificity. In addition, the majority of them were validated on a realistic dataset. The rest of the studies reported the predictive performance of diagnostic and prognostic prediction models to detect VAP from unstructured narratives [2 (10%)] as well as baseline demographics and clinical characteristics [4 (20%)]. All studies, however, had either a high or unclear risk of bias without significant improvements in applicability. Conclusions The development and deployment of prediction modelling studies are limited in VAP and related outcomes. More computational, translational, and clinical research is needed to bring these tools from the bench to the bedside.The project is supported by the Academy of Finland (project number 326291) and the University of Oulu

Identified gamification opportunities for digital patient journey solution during an arthroplasty journey : secondary analysis of patients' interviews

Aim: The use of gameful design for supporting health-related behaviours has been one of the major trends in health technology. An opportunity to increase engagement and motivation in a given health behaviour and the possibility of reaching improved outcomes through continued or consistent behaviour could be provided by gamification. This study aimed to identify gamification opportunities for digital patient journey solutions to increase patients' engagement and motivation for health-related behaviour during an arthroplasty journey. Design: A secondary analysis. Method: Semistructured interviews were performed among 20 elective primary total hip and knee arthroplasty patients in a single joint-replacement centre in Finland during autumn 2018. NVivo software was used for deductive content analysis. The study was conducted among 20 patients in a single joint replacement centre during 2018. Results: Several opportunities for gamification were identified for digital patient journey solutions, which could be used in advanced care to increase patients' engagement and motivation for health-related behaviour during the arthroplasty journey. These opportunities were identified related to five dimensions: accomplishment, challenge, guided, playfulness and social experience. Clear, scheduled, progressive and personalized goals with an activity tracking, real-time timespan visualization and social networking with peers, support networks and healthcare providers could be provided. Opportunities for competition and immersion were not identified.publishedVersionPeer reviewe

Parental Experiences of the Pediatric Day Surgery Pathway and the Needs for a Digital Gaming Solution : Qualitative Study

Background: The parents of hospitalized children are often dissatisfied with waiting times, fasting, discharge criteria, postoperative pain relief, and postoperative guidance. Parents' experiences help care providers to provide effective, family-centered care that responds to parents' needs throughout the day surgery pathway. Objective: The objective of our study was to describe parental experiences of the pediatric day surgery pathway and the needs for a digital gaming solution in order to facilitate the digitalization of these pathways. Methods: This was a descriptive qualitative study. The participants (N=31) were parents whose children were admitted to the hospital for the day surgical treatments or magnetic resonance imaging. The data were collected through an unstructured, open-ended questionnaire; an inductive content analysis was conducted to analyze the qualitative data. Reporting of the study findings adheres to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Results: Parental experiences of the children's day surgery pathway included 3 main categories: (1) needs for parental guidance, (2) needs for support, and (3) child involved in his or her own pathway (eg, consideration of an individual child and preparation of child for treatment). The needs for a digital gaming solution were identified as 1 main category-the digital gaming solution for children and families to support care. This main category included 3 upper categories: (1) preparing children and families for the day surgery via the solution, (2) gamification in the solution, and (3) connecting people through the solution. Conclusions: Parents need guidance and support for their children's day surgery care pathways. A digital gaming solution may be a relevant tool to support communication and to provide information on day surgeries Families are ready for and are open to digital gaming solutions that provide support and guidance and engage children in the day surgery pathways.Peer reviewe

Prevention of ventilator-associated pneumonia through care bundles: A systematic review and meta-analysis

Hospital-acquired pneumonia; Prevention; Quality improvement interventionNeumonía adquirida en el hospital; Prevención; Intervención de mejora de la calidadPneumònia adquirida a l'hospital; Prevenció; Intervenció de millorar de la qualitatBackground Ventilator-associated pneumonia (VAP) represents a common hospital-acquired infection among mechanically ventilated patients. We summarized evidence concerning ventilator care bundles to prevent VAP. Methods A systematic review and meta-analysis were performed. Randomized controlled trials and controlled observational studies of adults undergoing mechanical ventilation (MV) for at least 48 h were considered for inclusion. Outcomes of interest were the number of VAP episodes, duration of MV, hospital and intensive care unit (ICU) length of stay, and mortality. A systematic search was conducted in the MEDLINE, the Cochrane Library, and the Web of Science between 1985 and 2022. Results are reported as odds ratio (OR) or mean difference (MD) with 95% confidence intervals (CI). The PROSPERO registration number is CRD42022341780. Results Thirty-six studies including 116,873 MV participants met the inclusion criteria. A total of 84,031 participants underwent care bundles for VAP prevention. The most reported component of the ventilator bundle was head-of-bed elevation (n=83,146), followed by oral care (n=80,787). A reduction in the number of VAP episodes was observed among those receiving ventilator care bundles, compared with the non-care bundle group (OR=0.42, 95% CI: 0.33, 0.54). Additionally, the implementation of care bundles decreased the duration of MV (MD=−0.59, 95% CI: −1.03, −0.15) and hospital length of stay (MD=−1.24, 95% CI: −2.30, −0.18) in studies where educational activities were part of the bundle. Data regarding mortality were inconclusive. Conclusions The implementation of ventilator care bundles reduced the number of VAP episodes and the duration of MV in adult ICUs. Their application in combination with educational activities seemed to improve clinical outcomes.This work was supported by CIBERES, Instituto de Salud Carlos III, Madrid, Spain (grant number: Fondos FEDER: CB06-06-036)

Jaloittelu- ja ulkotarhoista aiheutuvan vesistökuormituksen vähentäminen vaikeaa

Nautojen jaloittelu- ja ulkotarhat sekä hevostarhat ovat yleistyneet viime vuosina. Syynä on mm. parsinavetoissaolevien lehmien ja hiehojen laidunnussäännös, joka voidaan korvata jaloittelulla tarhassa.Myös suurten pihattonavettojen yhteyteen usein rakennetaan tarha, vaikka varsinaista ulkoilupakkoapihatossa pidettävillä eläimillä ei ole. Ulkotarhoissa kasvatetaan osan vuotta tai ympäri vuoden emolehmiäja lihanautoja. Viime vuosina hevosten määrän lisääntyessä on rakennettu uusia talleja ja tarhoja.Varsinaisissa jaloittelutarhoissa eläimet jaloittelevat muutaman tunnin kerrallaan, mutta ulkotarhoissane ovat ympäri vuoden. Tarhat ovat maapohjaisia, vaihtopohjaisia tai tiivispohjaisia (asfaltistatai betonista valettuja tai sementillä stabiloituja). Osa tarhoista on perustettu metsään. Tarhoista aiheutuvaanravinnekuormitukseen vaikuttavat monet asiat. Eläintiheys on niistä tärkein – mitä enemmäneläimiä on tarha-alaa kohti, sitä suurempi on kuormitus. Kun eläimet ovat koko vuorokauden tarhassa,kuormitus on suurempi, kuin jos ne jaloittelisivat tarhassa vain muutaman tunnin päivässä. Ruokinta-,juotto- ja makuualueiden lähiympäristössä ravinnekuormitus on suuri, olipa tarha-alaa kuinka paljontahansa.Peltoviljelyn aiheuttamaa vesistökuormitusta on pyritty vähentämään monilla eri toimenpiteillä.Erityisesti on kiinnitetty huomiota lannan levitysmääriin, -ajankohtaan ja -tapaan. Kasvipeitteettömässätarhassa eläinpaine saattaa olla suuri (yli 80 nautayksikkövuorokautta hehtaarilla vuodessa;ny vrk/ha v), kun suositusten mukaan karjatilalla saa olla 1,5 lypsylehmää peltohehtaaria kohden.Sonnan ja virtsan käsittely tarhassa saattaa olla puutteellista, jolloin ravinteita voi kulkeutua sade- taivalumaveden mukana ympäristöön. Tarhavesissä ravinteiden ja ulostemikrobien pitoisuudet saattavatolla moninkertaiset pellon valumavesiin verrattuna. Tarhavedet voivat pilata lähikaivoja ja heikentäärantavesien hygieniaa sekä osaltaan lisätä vesien rehevöitymistä aina leväkukinnoiksi asti. Nautojentarhoista aiheutuvaa ravinne- ja mikrobikuormitusta vesiin ja kuormituksen vähentämistä on tutkittuMTT:ssä kymmenisen vuotta.Sonnan säännöllinen poisto tarhasta vähentää ravinteiden joutumista vesiin. Tiivispohjaisesta tarhastaon helpompi poistaa sonta ja kerätä valumavedet kuin maa- tai vaihtopohjaisesta tarhasta. Josmaa- tai vaihtopohjainen tarha on salaojitettu, osa vesistä saadaan kerättyä. Maa- ja vaihtopohjaisistatarhoista valumavesiä muodostuu vähemmän ja niissä on yleensä myös vähemmän fosforia, typpeä jamikrobeja kuin tiivispohjaisen tarhan vesissä, sillä maapohja suodattaa osan epäpuhtauksista. Tiivispohjaistentarhojen vedet suositellaankin kerättäväksi ja levitettäväksi pellolle. Maa- ja vaihtopohjaistentarhojen vesiä ei myöskään tulisi laskea suoraan ympäristöön. Niitä voidaan puhdistaa esim. erilaisillapienpuhdistamoilla, suodattimilla, kosteikossa tai niiden yhdistelmillä