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Kreft K, Fanous M, Möckel V. The potential of three-dimensional printing for pediatric oral solid dosage forms. ACTA PHARMACEUTICA (ZAGREB, CROATIA) 2024; 74:229-248. [PMID: 38815205 DOI: 10.2478/acph-2024-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/04/2024] [Indexed: 06/01/2024]
Abstract
Pediatric patients often require individualized dosing of medicine due to their unique pharmacokinetic and developmental characteristics. Current methods for tailoring the dose of pediatric medications, such as tablet splitting or compounding liquid formulations, have limitations in terms of dosing accuracy and palatability. This paper explores the potential of 3D printing as a solution to address the challenges and provide tailored doses of medication for each pediatric patient. The technological overview of 3D printing is discussed, highlighting various 3D printing technologies and their suitability for pharmaceutical applications. Several individualization options with the potential to improve adherence are discussed, such as individualized dosage, custom release kinetics, tablet shape, and palatability. To integrate the preparation of 3D printed medication at the point of care, a decentralized manufacturing model is proposed. In this setup, pharmaceutical companies would routinely provide materials and instructions for 3D printing, while specialized compounding centers or hospital pharmacies perform the printing of medication. In addition, clinical opportunities of 3D printing for dose-finding trials are emphasized. On the other hand, current challenges in adequate dosing, regulatory compliance, adherence to quality standards, and maintenance of intellectual property need to be addressed for 3D printing to close the gap in personalized oral medication.
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Affiliation(s)
- Klemen Kreft
- 1Lek Pharmaceuticals d.d., a Sandoz Company, 1000 Ljubljana, Slovenia
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Kawu AA, Hederman L, O'Sullivan D, Doyle J. Patient generated health data and electronic health record integration, governance and socio-technical issues: A narrative review. INFORMATICS IN MEDICINE UNLOCKED 2022. [DOI: 10.1016/j.imu.2022.101153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Mars M, Scott RE. Electronic Patient-Generated Health Data for Healthcare. Digit Health 2022. [DOI: 10.36255/exon-publications-digital-health-patient-generated-health-data] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Man A, van Ballegooie C. Assessment of the Readability of Web-Based Patient Education Material From Major Canadian Pediatric Associations: Cross-sectional Study. JMIR Pediatr Parent 2022; 5:e31820. [PMID: 35293875 PMCID: PMC8968558 DOI: 10.2196/31820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 12/20/2021] [Accepted: 12/28/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Web-based patient education materials (PEMs) are frequently written above the recommended reading level in North America. Poor PEM readability limits the accessibility of medical information for individuals with average literacy levels or lower. Pediatric hospital and association websites have not only been shown to be a preferred source of information among caregivers but have also become a necessity during the COVID-19 pandemic. The readability of Canadian pediatric association websites has not yet been assessed. OBJECTIVE The aim of this study is to determine if the content of PEMs from Canadian pediatric associations is written at a reading level that the majority of Canadians can understand. METHODS A total of 258 PEMs were extracted from 10 Canadian pediatric associations and evaluated for their reading level using 10 validated readability scales. The PEMs underwent a difficult word analysis and comparisons between PEMs from different associations were conducted. RESULTS Web-based PEMs were identified from 3 pediatric association websites, where the reading level (calculated as a grade level) was found to be an average of 8.8 (SD 1.8) for the Caring for Kids website, 9.5 (SD 2.2) for the Pediatric Endocrine Group website, and 13.1 (SD 2.1) for the Atlantic Pediatric Society website. The difficult word analysis identified that 19.9% (SD 6.6%) of words were unfamiliar, with 13.3% (SD 5.3%) and 31.9% (SD 6.1%) of words being considered complex (≥3 syllables) and long (≥6 letters), respectively. CONCLUSIONS The web-based PEMs were found to be written above the recommended seventh-grade reading level for Canadians. Consideration should be made to create PEMs at an appropriate reading level for both patients and their caregivers to encourage health literacy and ultimately promote preventative health behaviors and improve child health outcomes.
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Affiliation(s)
- Alice Man
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Courtney van Ballegooie
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Experimental Therapeutics, British Columbia Cancer Research Institute, Vancouver, BC, Canada
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Catarino M, Charepe Z, Festas C. Promotion of Self-Management of Chronic Disease in Children and Teenagers: Scoping Review. Healthcare (Basel) 2021; 9:healthcare9121642. [PMID: 34946368 PMCID: PMC8701924 DOI: 10.3390/healthcare9121642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/09/2021] [Accepted: 11/09/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The scientific literature describes that self-management of chronic illness leads to improved health outcomes. Knowledge about interventions that promote self-management behaviors in children and teenagers has been poorly clarified. This study aims to map, in the scientific literature, the nature and extent of interventions that promote self-management of chronic disease, implemented and evaluated in contexts of health care provided to children and teenagers. METHODS The guidelines proposed by the Joanna Briggs Institute were followed. The survey was conducted in June 2021, with access to international databases and gray literature, in Portuguese, English, French, and Spanish. RESULTS Interventions that promote self-management of children and teenagers can be developed through a local contact or through technological means of support for health care. The use of online supports, such as applications or communication platforms, should be parameterized with health professionals, according to the needs of users. CONCLUSIONS The acquisition of self-management skills in pediatrics is a process supported by the family, health professionals and the community, in which the nurse, in partnership, can promote communication and health education through cognitive strategies, behavioral programs included in physical or online programs, adjusted to the patients' needs.
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Affiliation(s)
- Marta Catarino
- Health Department, Polytechnic Institute of Beja, 7800-111 Beja, Portugal
- Institute of Health Sciences (ICS), Universidade Católica Portuguesa, 1649-023 Lisboa, Portugal;
- Center for Interdisciplinary Research in Health (CIIS), Institute of Health Sciences (ICS), Universidade Católica Portuguesa, 1649-023 Lisboa, Portugal;
- Correspondence:
| | - Zaida Charepe
- Institute of Health Sciences (ICS), Universidade Católica Portuguesa, 1649-023 Lisboa, Portugal;
- Center for Interdisciplinary Research in Health (CIIS), Institute of Health Sciences (ICS), Universidade Católica Portuguesa, 1649-023 Lisboa, Portugal;
| | - Constança Festas
- Center for Interdisciplinary Research in Health (CIIS), Institute of Health Sciences (ICS), Universidade Católica Portuguesa, 1649-023 Lisboa, Portugal;
- Institute of Health Sciences (ICS), Universidade Católica Portuguesa, 4169-005 Porto, Portugal
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Hussain SA, Sezgin E, Krivchenia K, Luna J, Rust S, Huang Y. A natural language processing pipeline to synthesize patient-generated notes toward improving remote care and chronic disease management: a cystic fibrosis case study. JAMIA Open 2021; 4:ooab084. [PMID: 34604710 PMCID: PMC8480545 DOI: 10.1093/jamiaopen/ooab084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/08/2021] [Accepted: 09/14/2021] [Indexed: 11/12/2022] Open
Abstract
Objectives Patient-generated health data (PGHD) are important for tracking and monitoring out of clinic health events and supporting shared clinical decisions. Unstructured text as PGHD (eg, medical diary notes and transcriptions) may encapsulate rich information through narratives which can be critical to better understand a patient’s condition. We propose a natural language processing (NLP) supported data synthesis pipeline for unstructured PGHD, focusing on children with special healthcare needs (CSHCN), and demonstrate it with a case study on cystic fibrosis (CF). Materials and Methods The proposed unstructured data synthesis and information extraction pipeline extract a broad range of health information by combining rule-based approaches with pretrained deep-learning models. Particularly, we build upon the scispaCy biomedical model suite, leveraging its named entity recognition capabilities to identify and link clinically relevant entities to established ontologies such as Systematized Nomenclature of Medicine (SNOMED) and RXNORM. We then use scispaCy’s syntax (grammar) parsing tools to retrieve phrases associated with the entities in medication, dose, therapies, symptoms, bowel movements, and nutrition ontological categories. The pipeline is illustrated and tested with simulated CF patient notes. Results The proposed hybrid deep-learning rule-based approach can operate over a variety of natural language note types and allow customization for a given patient or cohort. Viable information was successfully extracted from simulated CF notes. This hybrid pipeline is robust to misspellings and varied word representations and can be tailored to accommodate the needs of a specific patient, cohort, or clinician. Discussion The NLP pipeline can extract predefined or ontology-based entities from free-text PGHD, aiming to facilitate remote care and improve chronic disease management. Our implementation makes use of open source models, allowing for this solution to be easily replicated and integrated in different health systems. Outside of the clinic, the use of the NLP pipeline may increase the amount of clinical data recorded by families of CSHCN and ease the process to identify health events from the notes. Similarly, care coordinators, nurses and clinicians would be able to track adherence with medications, identify symptoms, and effectively intervene to improve clinical care. Furthermore, visualization tools can be applied to digest the structured data produced by the pipeline in support of the decision-making process for a patient, caregiver, or provider. Conclusion Our study demonstrated that an NLP pipeline can be used to create an automated analysis and reporting mechanism for unstructured PGHD. Further studies are suggested with real-world data to assess pipeline performance and further implications.
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Affiliation(s)
- Syed-Amad Hussain
- IT Research and Innovation, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Emre Sezgin
- IT Research and Innovation, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Katelyn Krivchenia
- Department of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - John Luna
- IT Research and Innovation, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Steve Rust
- IT Research and Innovation, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Yungui Huang
- IT Research and Innovation, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
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McCauley L, Hayes R. From Florence to fossil fuels: Nursing has always been about environmental health. Nurs Outlook 2021; 69:720-731. [PMID: 34462138 DOI: 10.1016/j.outlook.2021.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/20/2021] [Accepted: 06/05/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Since its founding, professional nursing has applied an environmental lens to healing. METHODS This CANS 2020 Keynote article describes the history of nursing environmental science and nurses important contributions to the US Environmental Justice Movement. Starting with Florence Nightingale's Notes on Nursing, which established Environmental Theory, the paper introduces key figures throughout nursing history who have studied and advocated for environmental health and justice. FINDINGS The paper emphasizes that nursing has always been about environmental health and that, regardless of specialty or practice setting, all nurses are called to incorporate environmental science and translation into their research and practice. CONCLUSION This call to action is especially critical today in the context of urgent issues like climate change, environmental racism and racial health disparities, emerging infectious diseases like COVID-19, and chemical exposures in the home and workplace (among others).
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Affiliation(s)
- Linda McCauley
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA
| | - Rose Hayes
- Executive Communications and Engagement, Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA.
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Tiase VL, Wawrzynski SE, Sward KA, Del Fiol G, Staes C, Weir C, Cummins MR. Provider Preferences for Patient-Generated Health Data Displays in Pediatric Asthma: A Participatory Design Approach. Appl Clin Inform 2021; 12:664-674. [PMID: 34289505 PMCID: PMC8294945 DOI: 10.1055/s-0041-1732424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective There is a lack of evidence on how to best integrate patient-generated
health data (PGHD) into electronic health record (EHR) systems in a way that supports
provider needs, preferences, and workflows. The purpose of this study was to investigate
provider preferences for the graphical display of pediatric asthma PGHD to support
decisions and information needs in the outpatient setting. Methods In December 2019, we conducted a formative evaluation of information
display prototypes using an iterative, participatory design process. Using multiple types
of PGHD, we created two case-based vignettes for pediatric asthma and designed
accompanying displays to support treatment decisions. Semi-structured interviews and
questionnaires with six participants were used to evaluate the display usability and
determine provider preferences. Results We identified provider preferences for display features, such as the use
of color to indicate different levels of abnormality, the use of patterns to trend PGHD
over time, and the display of environmental data. Preferences for display content included
the amount of information and the relationship between data elements. Conclusion Overall, provider preferences for PGHD include a desire for greater
detail, additional sources, and visual integration with relevant EHR data. In the design
of PGHD displays, it appears that the visual synthesis of multiple PGHD elements
facilitates the interpretation of the PGHD. Clinicians likely need more information to
make treatment decisions when PGHD displays are introduced into practice. Future work
should include the development of interactive interface displays with full integration of
PGHD into EHR systems.
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Affiliation(s)
- Victoria L Tiase
- College of Nursing, University of Utah, Salt Lake City, Utah, United States.,The Value Institute, NewYork-Presbyterian Hospital, New York, New York, United States
| | - Sarah E Wawrzynski
- College of Nursing, University of Utah, Salt Lake City, Utah, United States
| | - Katherine A Sward
- College of Nursing, University of Utah, Salt Lake City, Utah, United States
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, United States
| | - Catherine Staes
- College of Nursing, University of Utah, Salt Lake City, Utah, United States
| | - Charlene Weir
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, United States
| | - Mollie R Cummins
- College of Nursing, University of Utah, Salt Lake City, Utah, United States
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