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

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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

Lasten potilaskokemukset digitaalisten palveluiden kehittämisen lähtökohtana

Healthcare providers are increasingly paying attention to their customer’s experiences - meaning experiences of patients. This article reports a study which is part of a larger Lapsus research project. The aim of the project is to explore the perceptions and the experiences of child patients and their families about their visits to the hospital, about the given treatment and care, and about their everyday life with the illness. This article reports issues which children using special healthcare services consider as important and valuable in their experiences as patients. Basing on these issues the paper describes how digital services in the future can be incorporated in the patient paths of the children to enhance their patient experience. The study data was gathered from 10–16-year old chronically ill children with video diaries. All together 14 children participated in the study. The results show which issues are working fine and which still need improvements in the treatment of the children, as well as future wishes the children have regarding their care. These observations can be categorized into three themes: physical aspects, communication with the child and the family as well as ease and rationality of the care. Other things the children found valuable were practical and cosy spaces, individual and warm communication with professionals, continuity of care, and ease of visits and care. With these findings in mind, the improvement activities should focus on physical alterations, points of interaction in various phases of patient paths and digital services. In the future digital services may become a pivotal way to support better patient experience of children and their families.Peer reviewe

Intelligent Customer-driven Solution for Orthopedic and Pediatric Surgery Care (ICory): Final Report

This report summarizes main activities and achieved results of the ICory project, a co-innovation project funded by Business Finland and carried out during 2018-2021. ICory aimed at 1) co-creating an intelligent patient-centric digital solution for orthopedic and pediatric surgery care journeys; 2) assessing impact of the developed solution from both medical, patient, and business perspectives; 3) and developing ecosystemic business model for speeding up companies’ access to the international market. In ICory, the patient journey solutions were co-developed together with researchers, hospitals, and companies; effectiveness of the solutions were evaluated in two randomized controlled trials in Finland; Rehaboo! Exercise Game is being evaluated in a RCT in Singapore; a medicine delivery robot was developed and tested; research on business models was conducted; collaboration with three hospitals in Singapore and one Australian University was built. Results of the studies have been published in 27 scientific journal and conferences articles, and 2 doctoral dissertations were done during the project. The COVID-19 pandemic has affected functioning of the participating hospitals, delaying recruitment of patients and progression of the RCT studies. Analysis of the RCT data has started and the results will be published in several scientific articles after the project

Tekoälyä ja älytekoja : tekoälymenetelmät lääkärin päätöksenteon tukena

Vertaisarvioitu.Teema : tekoäly lääketieteessä

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