Product design to support creative ageing for people with dementia: a practice-based inquiry

The practice-based research presented in this thesis was an exploration into the impact, context, and potential of co creation to affect the lives of People with Dementia. I present transferrable insight from a year-long Embedded Ethnographic engagement in a Residential Care Home, spent working alongside Participatory Artists, building critical insight into the aesthetic and sensory context of Care. Insights from this Ethnographic research are developed and situated through Research through Design (RtD) practice in two further empirical design studies. Firstly, the co creative development of physical material tools to support Creative Ageing practice. Secondly, the design of co creative activities to allow People with Dementia to individualise elements of the designed environment. My thesis highlights ways in which Product Design expertise can contribute to Creative Ageing practice and extends means by which People with Dementia can engage in the creation of individualised design outcomes, by contributing new methods and a new conceptual lens to the paradigm of Parametric Design, characterised by a questioning, generative and critical approach

Which method is best for the induction of labour?: A systematic review, network meta-analysis and cost-effectiveness analysis

Background: More than 150,000 pregnant women in England and Wales have their labour induced each year. Multiple pharmacological, mechanical and complementary methods are available to induce labour. Objective: To assess the relative effectiveness, safety and cost-effectiveness of labour induction methods and, data permitting, effects in different clinical subgroups. Methods: We carried out a systematic review using Cochrane methods. The Cochrane Pregnancy and Childbirth Group’s Trials Register was searched (March 2014). This contains over 22,000 reports of controlled trials (published from 1923 onwards) retrieved from weekly searches of OVID MEDLINE (1966 to current); Cochrane Central Register of Controlled Trials (The Cochrane Library); EMBASE (1982 to current); Cumulative Index to Nursing and Allied Health Literature (1984 to current); ClinicalTrials.gov; the World Health Organization International Clinical Trials Registry Portal; and hand-searching of relevant conference proceedings and journals. We included randomised controlled trials examining interventions to induce labour compared with placebo, no treatment or other interventions in women eligible for third-trimester induction. We included outcomes relating to efficacy, safety and acceptability to women. In addition, for the economic analysis we searched the Database of Abstracts of Reviews of Effects, and Economic Evaluations Databases, NHS Economic Evaluation Database and the Health Technology Assessment database. We carried out a network meta-analysis (NMA) using all of the available evidence, both direct and indirect, to produce estimates of the relative effects of each treatment compared with others in a network. We developed a de novo decision tree model to estimate the cost-effectiveness of various methods. The costs included were the intervention and other hospital costs incurred (price year 2012–13). We reviewed the literature to identify preference-based utilities for the health-related outcomes in the model. We calculated incremental cost-effectiveness ratios, expected costs, utilities and net benefit. We represent uncertainty in the optimal intervention using cost-effectiveness acceptability curves. Results: We identified 1190 studies; 611 were eligible for inclusion. The interventions most likely to achieve vaginal delivery (VD) within 24 hours were intravenous oxytocin with amniotomy [posterior rank 2; 95% credible intervals (CrIs) 1 to 9] and higher-dose (≥ 50 μg) vaginal misoprostol (rank 3; 95% CrI 1 to 6). Compared with placebo, several treatments reduced the odds of caesarean section, but we observed considerable uncertainty in treatment rankings. For uterine hyperstimulation, double-balloon catheter had the highest probability of being among the best three treatments, whereas vaginal misoprostol (≥ 50 μg) was most likely to increase the odds of excessive uterine activity. For other safety outcomes there were insufficient data or there was too much uncertainty to identify which treatments performed ‘best’. Few studies collected information on women’s views. Owing to incomplete reporting of the VD within 24 hours outcome, the cost-effectiveness analysis could compare only 20 interventions. The analysis suggested that most interventions have similar utility and differ mainly in cost. With a caveat of considerable uncertainty, titrated (low-dose) misoprostol solution and buccal/sublingual misoprostol had the highest likelihood of being cost-effective. Limitations: There was considerable uncertainty in findings and there were insufficient data for some planned subgroup analyses. Conclusions: Overall, misoprostol and oxytocin with amniotomy (for women with favourable cervix) is more successful than other agents in achieving VD within 24 hours. The ranking according to safety of different methods was less clear. The cost-effectiveness analysis suggested that titrated (low-dose) oral misoprostol solution resulted in the highest utility, whereas buccal/sublingual misoprostol had the lowest cost. There was a high degree of uncertainty as to the most cost-effective intervention

Making In The Moment: Insight from Participatory Arts for Co-Design Practice in Dementia Care Settings

Design for dementia literature calls for greater degrees of personalisation and participation for people living with dementia, while acknowledging that ‘alternatives are also needed to the one-on-one approaches, often used in the development of highly personalized outcomes’ (Kenning 2018, 2). We respond to these provocations by reporting on a qualitative study in a care home setting that informed Inclusive Design directions for dementia care. The professional practice of conducting participatory arts workshops in this setting was empirically observed and analysed, to deliver transferable insights that may advance co-design methodology for dementia care design contexts. This paper presents an autoethnographicaccount taken from a year-long participant observation in a residential care home in Northern England, by a designer volunteering for a creative ageing charity that runs participatory arts workshops. In presenting the designer’s account about his involvement in the development of a large-scale participatory artwork with this charity, and his facilitation of 30 workshops, the paper captures empirical insight and learning from working alongside experienced creative professionals. We critically reflect on this insight, discussing its relevance to co-design practices in residential care contexts, and calling for designers to draw their strategic focus away from identifying notions of ‘good; or ‘bad’ design outcomes, and towards celebrating the act of creative intent and voice-giving through co-design practice. We offer methodological insight for Design4Health that is grounded in a recognition of the importance of authorship and autonomy of people with dementia: the facilitation of creative expression should ensure that there is reciprocity within co-design methods, between those who are involved with creative practice in the form of one-to-many, or many-to-many