Design-thinking, making, and innovating: Fresh tools for the physician\u27s toolbox

Medical school education should foster creativity by enabling students to become \u27makers\u27 who prototype and design. Healthcare professionals and students experience pain points on a daily basis, but are not given the tools, training, or opportunity to help solve them in new, potentially better ways. The student physician of the future will learn these skills through collaborative workshops and having dedicated \u27innovation time.\u27 This pre-clinical curriculum would incorporate skills centered on (1) Digital Technology and Small Electronics (DTSE), (2) Textiles and Medical Materials (TMM), and (3) Rapid Prototyping Technologies (RPT). Complemented by an on-campus makerspace, students will be able to prototype and iterate on their ideas in a fun and accessible space. Designing and making among and between patients and healthcare professionals would change the current dynamic of medical education, empowering students to solve problems in healthcare even at an early stage in their career. By doing so, they will gain empathy, problem-solving abilities, and communication skills that will extend into clinical practice. Our proposed curriculum will equip medical students with the skills, passion, and curiosity to impact the future of healthcare

AIDS Behav

Mobile health (mHealth) technology can be a valuable tool in the management of chronic illnesses, including HIV. Qualitative research methods were used to identify the desired content and features of a mobile app for meeting and improving the healthcare needs of persons living with HIV (PLWH). We conducted six focus group sessions with 50 English-or Spanish-speaking PLWH in New York City. To inform data analysis and to illustrate how mHealth technology can be used as a persuasive strategy for improving the health of PLWH, we integrated Fogg's functional role triad for computing technology model with the self-determination theory to illustrate how mHealth technology can be used as a persuasive strategy for improving the health of PLWH. Participants suggested several tools for meeting their healthcare needs, including: reminders/alerts, lab results tracking, and notes on health status. mHealth technology can function as a social actor by providing chat boxes/forums, testimonials of lived experiences, and personal outreach. Examples of media that can be used as a persuasive technology include games/virtual rewards, coding of health tasks, and simulations on how to connect with PLWH. Findings from these focus groups can be used to design a mobile app for PLWH\uc2\ua0that is targeted to meet their healthcare needs.1U01PS00371501/PS/NCHHSTP CDC HHS/United StatesK12 RR017648/RR/NCRR NIH HHS/United States2016-06-01T00:00:00Z25572830PMC449793

Co-diseñar un sistema de monitoreo y alerta temprana de hambre estacional relacionado a variabilidad climática en Guatemala

In Guatemala, seasonal acute food insecurity related to extended dry periods is a recurrent phenomenon. Public response is often too late and ineffective. One principal obstacle for decision-makers lays in the absence of timely, reliable and relevant information at the right scale. The impact of drought on the ground depends on different socio-economic, agronomic and climatic factors and might differ significantly between communities. The Guatemalan Secretariat for Food and Nutrition Security (SESAN) thus is promoting the development and implementation of a community-based food security monitoring and early warning system to fill this information gap. CCAFS supported SESAN through a participatory co-design process. This report describes the methodology applied, outlines the principal results of the process and describes the information system. The report is aimed at practitioners, policy-decision maker and researchers that want to support similar processes. En Guatemala, la inseguridad alimentaria aguda tiene un carácter recurrente y estacional y está relacionada con períodos secos prolongados. La respuesta pública es a menudo demasiado tarde e inefectiva. Un obstáculo principal para quienes toman las decisiones es la falta de información oportuna, confiable y relevante en la escala correcta. El impacto de la sequía sobre el terreno depende de diferentes factores socioeconómicos,agronómicos y climáticos y puede diferir significativamente entre las comunidades. La Secretaría de Seguridad Alimentaria y Nutricional de Guatemala (SESAN) está promoviendo el desarrollo e implementación de un sistema de vigilancia y alerta temprana del hambre estacional basado en la comunidad para llenar este vacío de información. CCAFS apoyó a SESAN a través de un proceso de co-diseño participativo. Este informe describe la metodología aplicada, los principales resultados del proceso y el sistema de información. El informe está dirigido a profesionales, tomadores de decisiones de políticas e investigadores que desean apoyar procesos similares

Clinician-Driven Design of VitalPAD–An Intelligent Monitoring and Communication Device to Improve Patient Safety in the Intensive Care Unit

The pediatric intensive care unit (ICU) is a complex environment, in which a multidisciplinary team of clinicians (registered nurses, respiratory therapists, and physicians) continually observe and evaluate patient information. Data are provided by multiple, and often physically separated sources, cognitive workload is high, and team communication can be challenging. Our aim is to combine information from multiple monitoring and therapeutic devices in a mobile application, the VitalPAD, to improve the efficiency of clinical decision-making, communication, and thereby patient safety. We observed individual ICU clinicians, multidisciplinary rounds, and handover procedures for 54 h to identify data needs, workflow, and existing cognitive aid use and limitations. A prototype was developed using an iterative participatory design approach; usability testing, including general and task-specific feedback, was obtained from 15 clinicians. Features included map overviews of the ICU showing clinician assignment, patient status, and respiratory support; patient vital signs; a photo-documentation option for arterial blood gas results; and team communication and reminder functions. Clinicians reported the prototype to be an intuitive display of vital parameters and relevant alerts and reminders, as well as a user-friendly communication tool. Future work includes implementation of a prototype, which will be evaluated under simulation and real-world conditions, with the aim of providing ICU staff with a monitoring device that will improve their daily work, communication, and decision-making capacity. Mobile monitoring of vital signs and therapy parameters might help improve patient safety in wards with single-patient rooms and likely has applications in many acute and critical care settings.This work was supported by the Canadian Institutes of Health Research under Grant PJT-149042

mHealth Technology: Towards a New Persuasive Mobile Application for Caregivers That Addresses Motivation and Usability

With the increasing use of mobile technologies and smartphones, new methods of promoting personal health have been developed. For example, there is now software for recording and tracking one\u27s exercise activity or blood pressure. Even though there are already many of these services, the mobile health field still presents many opportunities for new research. One apparent area of need would be software to support the efforts of caregivers for the elderly, especially those who suffer from multiple chronic conditions, such as cognitive impairment, chronic heart failure or diabetes. Very few mobile applications (apps) have been created that target caregivers of the elderly and most seem to be limited to a single condition or to creating generic to-do lists or tracking medications. None seem to address the complex tracking of multiple chronic conditions, nor one of the key difficulties found with written checklists for this population, namely that caregivers quit recording health information regularly as time passes. This dissertation will explore methods for improving the consistency of usage of health tracking software for the caregivers of the elderly with multiple chronic conditions by creating designs that explicitly address the context and motivations of caregivers. This work will assess a number of existing approaches and provide a design and a prototype for a new motivating application to help the caregivers of patients with multiple chronic conditions. It will assess how well the tool seems to address factors associated with intrinsic motivation (e.g. autonomy, competence, relatedness, and feedback). The overall usability of the software application will also be addressed, following guidelines from ISO standards and Nielsen’s theories

Participatory development of decision support systems: which features of the process lead to improved uptake and better outcomes?

Decision support systems (DSSs) are important in decision-making environments with conflicting interests. Many DSSs developed have not been used in practice. Experts argue that these tools do not respond to real user needs and that the inclusion of stakeholders in the development process is the solution. However, it is not clear which features of participatory development of DSSs result in improved uptake and better outcomes. A review of papers, reporting on case studies where DSSs and other decision tools (information systems, software and scenario tools) were developed with elements of participation, was carried out. The cases were analysed according to a framework created as part of this research; it includes criteria to evaluate the development process and the outcomes. Relevant aspects to consider in the participatory development processes include establishing clear objectives, timing and location of the process; keeping discussions on track; favouring participation and interaction of individuals and groups; and challenging creative thinking of the tool and future scenarios. The case studies that address these issues show better outcomes; however, there is a large degree of uncertainty concerning them because developers have typically neither asked participants about their perceptions of the processes and resultant tools nor have they monitored the use and legacy of the tools over the long term.The authors would like to thank COST Action FP0804-Forest Management Decision Support Systems (FORSYS) for financing a three month Short-Term Scientific Mission (STSM) in Forest Research (Roslin, UK) in 2012, making possible this research; Spanish Ministry of Economy and Competitiveness for supporting the project Multicriteria Techniques and Participatory Decision-Making for Sustainable Management (Ref. ECO2011-27369) where the leading author is involved; and the Regional Ministry of Education, Culture and Sports (Valencia, Spain) for financing a research fellowship (Ref. ACIF/2010/248).Valls Donderis, P.; Ray, D.; Peace, A.; Stewart, A.; Lawrence, A.; Galiana, F. 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Using multi-perspective methodologies to study users’ interactions with the prototype front end of a guideline-based decision support system for diabetic foot care. International Journal of Medical Informatics, 78(7), 482-493. doi:10.1016/j.ijmedinf.2009.02.008Pretty, J. N. (1995). Participatory learning for sustainable agriculture. World Development, 23(8), 1247-1263. doi:10.1016/0305-750x(95)00046-fReed MS. 2008. Stakeholder participation for environmental management: a literature review. Sustainability Research Institute, School of Earth and Environment, University of Leeds.Reed, M. S., & Dougill, A. J. (2010). Linking degradation assessment to sustainable land management: A decision support system for Kalahari pastoralists. Journal of Arid Environments, 74(1), 149-155. doi:10.1016/j.jaridenv.2009.06.016Rowe, G., & Frewer, L. J. (2000). Public Participation Methods: A Framework for Evaluation. 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Implication des utilisateurs dans le développement des innovations médicales : une analyse sociotechnique de la collaboration et de ses enjeux pour l’organisation des soins

Les changements technologiques ont des effets structurants sur l’organisation des soins dans notre système de santé. Les professionnels de la santé et les patients – les principaux utilisateurs des innovations médicales – sont des acteurs clés dans les trajectoires suivies par les nouvelles technologies en santé. Pour développer des technologies médicales plus efficaces, sécuritaires et conviviales, plusieurs proposent d’intensifier la collaboration entre les utilisateurs et les développeurs. Cette recherche s’intéresse à cette prémisse sur la participation des utilisateurs dans les processus d’innovation médicale. L'objectif général de cette recherche est de mieux comprendre la collaboration entre les utilisateurs et les développeurs impliqués dans la transformation des innovations médicales. Adoptant un cadre d’analyse sociotechnique, cette thèse par articles s’articule autour de trois objectifs : 1) décrire comment la littérature scientifique définit les objectifs, les méthodes et les enjeux de l’engagement des utilisateurs dans le développement des innovations médicales; 2) analyser les perspectives d’utilisateurs et de développeurs de technologies médicales quant à leur collaboration dans le processus d’innovation; et 3) analyser comment sont mobilisés, en pratique, des utilisateurs dans le développement d’une innovation médicale. Le premier objectif s’appuie sur une synthèse structurée des écrits scientifiques (n=101) portant sur le phénomène de la participation des utilisateurs dans les processus d’innovation médicale. Cette synthèse a dégagé les méthodes appliquées ou proposées pour faire participer les utilisateurs, les arguments normatifs véhiculés ainsi que les principaux enjeux soulevés. Le deuxième objectif repose sur l’analyse de trois groupes de discussion délibératifs et d'une plénière impliquant des utilisateurs et des développeurs (n=19) de technologies médicales. L’analyse a permis d’examiner leurs perspectives à l'égard de diverses approches de collaboration dans les processus d'innovation. Le troisième objectif implique l’étude d’une innovation en électrophysiologie lors de la phase de recherche clinique. Cette étude de cas unique s'appuie sur une analyse qualitative d'études cliniques (n=57) et des éditoriaux et synthèses de connaissances dans des revues médicales spécialisées (n=15) couvrant une période de dix ans (1999 à 2008) ainsi que des entrevues semi-dirigées avec des acteurs clés impliqués dans le processus d’innovation (n=3). Cette étude a permis de mieux comprendre comment des utilisateurs donne un sens, s’approprient et légitiment une innovation médicale en contexte de recherche clinique. La contribution générale de cette thèse consiste en une meilleure compréhension de l’apport des utilisateurs dans les processus d’innovation médicale et de sa capacité à aligner plus efficacement le développement technologique avec les objectifs du système de santé.Technological changes have major effects on health care organization. Health professionals and patients – the main users of medical innovations – are key actors in the ongoing development and refinement of new medical technologies. To develop more efficient, safe and user-friendly medical technologies, many propose enhancing collaboration between technology users and developers. This research investigates the premise of involving users in the medical innovation process. The main objective of this research is to better understand the collaboration between users and developers involved in the transformation of medical innovations. Adopting a sociotechnical approach, this thesis by article has three objectives: 1) Describe how the literature defines the objectives, methods and issues of engaging users in the development of medical innovations; 2) Analyze the perspectives of users and developers of medical technologies with regards to their collaboration in the innovation process; and 3) Analyze how users are mobilized in practice in the development of medical innovation. The first objective is addressed by a narrative synthesis of the scientific literature (n=101) on user involvement in the medical innovation process. This synthesis has identified the methods used or proposed, normative arguments conveyed, and the main issues raised by involving users. Analysis of data from three deliberative focus groups and a plenary involving users and developers (n=19) of medical technology were employed to address the second objective. The analysis details their perspectives on various modes of collaboration in the innovation process. The third objective involves a case study of an innovation in electrophysiology at the clinical research phase. This case study is based on a qualitative analysis of clinical studies (n=57), editorials and reviews in medical journals (n=15) covering a ten year period (1999-2008) and semi-structured interviews with key actors involved in the innovation process (n=3). This study provides insight into how users make sense of, appropriate and legitimize medical innovation in the context of clinical research. The overall contribution of this thesis is a better understanding of user involvement in the medical innovation process and how to more effectively align technological development with the objectives of the health system