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

Metronidazole and ursodeoxycholic acid for primary sclerosing cholangitis : A randomized placebo-controlled trial

No effective medical therapy is currently available for primary sclerosing cholangitis (PSC). Ursodeoxycholic acid (UDCA) improves liver enzymes, but its effect on liver histology is controversial. Metronidazole (MTZ) prevents PSC-like liver damage in animal models and reduces intestinal permeability. We recruited 80 patients with PSC into a randomized placebo-controlled study to evaluate the effect of UDCA and MTZ (UDCA/MTZ) compared with UDCA/placebo on the progression of PSC. Patients (41 UDCA/placebo and 39 UDCA/ MTZ) were followed every third month. Assessment of liver function test, histological stage and grade, and cholangiography (via ERCP) at baseline showed no differences between the groups. After 36 months, serum aminotransferases gamma-glutamyltransferase, and alkaline phosphatase (ALP) decreased markedly in both groups, serum ALP more significantly in the UDCA/MTZ group (-337 +/- 54 U/L, PPeer reviewe

A gamified mobile health intervention for children in day surgery care : Protocol for a randomized controlled trial

Publisher Copyright: © 2021 The Authors. Nursing Open published by John Wiley & Sons Ltd.Aims: To describe a study protocol for a randomized controlled trial which will evaluate the effectiveness of a gamified mobile health intervention for children in whole day surgery care. Design: A study protocol for a two-arm randomized controlled trial. Methods: Participants will be randomly assigned to the intervention group (N = 62), in which patients receive routine care and play a mobile game designed for children or the control group (N = 62), in which patients receive routine care, including a mobile phone application that supports parents during the care path. The primary outcome is children's pre-operative anxiety, while the secondary outcome measures included fear and postoperative pain, along with parental satisfaction and anxiety. Data collection started in August 2020. Results: The results of the ongoing randomized controlled trial will determine whether the developed gamified mobile health intervention can be recommended for hospital use, and whether it could be used to educate children about their surgical treatment to decrease anxiety.Peer reviewe

Unexpectedly High Prevalence of Common Variable Immunodeficiency in Finland

Background: Common variable immunodeficiency (CVID) is the most common primary immunodeficiency. Prevalence varies greatly between countries and studies. Most diagnostic criteria include hypogammaglobulinemia and impaired vaccine response. Aim: To evaluate the minimum prevalence as well as the clinical and immunological phenotypes of CVID in Southern Finland. Methods: We performed a cross-sectional study to assess all adult CVID patients followed up in three hospital districts in Southern and South-Eastern Finland between April 2007 and August 2015. CVID diagnosis was based, with a minor modification, on the ESID/PAGID criteria for primary CVID. Antipolysaccharide responses to Pneumovax (R) were defined as impaired only if 50% or more of the serotypes did not reach a level of 0.35 mu g/mL after vaccination. We further characterized the patients' B cell phenotypes and complications associated with CVID. Results: In total, 9 patients were excluded due to potential secondary causes before diagnosis. ESID/PAGID criteria were met by 132 patients (males 52%), of whom, 106 had "probable" and 26 "possible CVID." Based on the population statistics in the three hospital districts, the minimum adult prevalence per 100,000 inhabitants in Finland for all CVID ("probable CVID," respectively) patients was 6.9 (5.5). In the highest prevalence district (Helsinki and Uusimaa), the prevalence was 7.7 (6.1). CVID patients suffer from frequent complications. Ten patients died during follow-up. Of probable CVID patients, 73% had more than one clinical phenotype. Intriguingly, gradual B cell loss from peripheral blood during follow-up was seen in as many as 16% of "Xprobable CVID" patients. Patients with possible CVID displayed somewhat milder clinical and laboratory phenotypes than probable CVID patients. We also confirm that large granular lymphocyte lymphoproliferation is a CVID-associated complication. Conclusion: The prevalence of CVID in Finland appears the highest recorded, likely reflecting the genetic isolation and potential founder effects in the Finnish population. Studies to discover potential gene variants responsible for the high prevalence in Finland thus seem warranted. Increased awareness of CVID among physicians would likely lead to earlier diagnosis and improved quality of care.Peer reviewe

Short-term effects of a digital patient journey solution on patient-reported outcomes and health care utilization in arthroplasty : a pragmatic randomized controlled trial

Mobile health solutions for patient support have been proposed as promising and safe alternatives to usual care in adults undergoing primary total hip and knee arthroplasty. Studies of such applications, however, have produced conflicting results and only moderate- to low-quality evidence. This study aims to evaluate the short-term effects of a digital patient journey solution on patient-reported outcomes and health care utilization in patients undergoing total hip and knee arthroplasty using a pragmatic randomized controlled trial design. Randomly allocated patients in the control arm (n = 35, 64 ± 9 years) received usual care, while patients in the intervention arm (n = 34, 62 ± 11 years) received the digital patient journey solution in addition to usual care. The primary outcome was health-related quality of life as measured by the EuroQol EQ-5D-5L scale. Secondary outcomes included functional recovery, pain, self-efficacy, patient experience, adherence to fast-track protocol, and health care utilization. Participants were followed from a preoperative surgical visit until a postoperative follow-up visit at 6–12 weeks. The health-related quality of life, functional recovery, pain, patient experience, adherence to the fast-track protocol, and health care utilization did not differ between the arms. During the study, however, the self-efficacy to use digital health services (p=0.027) increased in the intervention arm. The use of the digital patient journey solution was not superior to usual care in terms of patient-reported outcomes and health care utilization. However, the solution improved the self-efficacy of patients to use digital health services, which may lead to greater demand for similar digital offerings as patient become more familiar with mobile health solutions.Peer reviewe

Tilaelementtitekniikan hyödyntäminen rivitalotuotannossa

The aim of this study was to find out how to utilize prefabricated building unit technology in NCC Rakennus Oy terraced house production, and to visualize the changes in the construction process utilizing the prefabricated building units in the construction company's operation system. This study was a literary study which started by getting familiar with the literary sources and proceeded to negotiations with the prefabricated box unit suppliers, and on to the company visits together with the NCC Rakennus Oy staff members. The major outcome of this study was the time saved in the construction process which explains an estimated 66 % of the saving potential in the operating and total costs. From the orderer's point of view, the use of prefabricated box units will be worthwhile if the saving in the operating and total costs is more than the gross margin of the supplier of the prefabricated box units. When the construction work is done in a stable industrial environment it will both enhance work safety and the actual building in the construction site will approach assembly work. As a result, a suitable partner was found for the research project. The expertise of the supplier has, in its part, supported the actual visualization processes in the prefabricated box unit projects. Some further research could be carried out on the energy efficiency of a construction site utilizing prefabricated box unit technology, and on the structural technology to enable different kinds of room space possibilities, and some architectural research, in order to discover new floor plans and facade solutions.Tutkimuksen tavoitteena oli selvittää tilaelementtitekniikan hyödyntämismahdollisuudet kohdeyrityksen pientalotuotannossa, sekä kuvata muutokset yrityksen toimintajärjestelmän mukaiseen rakennusprosessiin tilaelementtirakentamisessa. Tutkimusmenetelmä oli kirjallisuusselvitys, jossa perehdyin alan lähdekirjallisuuteen ja etenin sitä kautta tilaelementtitoimittajaneuvotteluihin ja yritysvierailuihin yhdessä kohdeyrityksen henkilöstön kanssa. Tutkimuksen merkittävin tulos on työmaan rakentamisaikataulun lyhentyminen, johon perustuu arvioitu 66 % käyttö- ja yhteiskustannusten säästöpotentiaali. Tilaajan näkökulmasta tilaelementtirakentamisesta tulee karkeasti laskien kannattavaa, jos käyttö- ja yhteiskustannusten säästö ylittää tilaelementtitoimittajan katteen. Rakentamisen siirtyessä vakaisiin tehdasolosuhteisiin työturvallisuus paranee ja työmaalla tapahtuva rakentaminen muuttuu lähemmäksi kokoonpanoa. Työn tuloksena löydettiin myös sopiva yhteistyökumppani tutkimushankkeen toteutukseen. Toimittajan asiantuntemus on osaltaan tukenut prosessikuvausten laadintaa tilaelementtirakennehankkeissa. Jatkotutkimuksena voisi selvittää tilaelementtikohteen rakennusfysiikkaa energiatehokkuuden näkökulmasta, rakennetekniikkaa eri huonetilaratkaisujen mahdollistamiseksi sekä arkkitehtitutkimusta erilaisten pohja- ja julkisivuratkaisujen löytämiseksi