Using experience-based design to understand the patient and caregiver experience with delirium

Hospital-acquired delirium negatively affects clinical outcomes and the care experience for patients and family caregivers. Following the qualitative methods of experience-based design, we completed observations of hospital units and interviews of patients, caregivers (including family members and other companions), and hospital nurses and other staff regarding their experiences with delirium. In addition, we administered an experience-based design questionnaire to another 130 subjects from the same groups. Key findings included: there is a need for preparation of the patients and family caregivers for the possibility of delirium (particularly before surgery), and patients and caregivers lack understanding of delirium and its potential prolonged aftereffects. We identified that caregivers may both contribute and detract from delirium care as they: (1) often identify delirium early; (2) are invaluable for supporting patients during re-orientation after delirium episodes; (3) frequently lack the preparation and skills for adequate delirium detection and response; (4) may not be present at critical times; (5) can be challenging for the delirium management team, and (6) are frequently discussed as the person who best understands the patients’ baseline cognitive state and behavior. Experience-based design is an innovative framework to increase our qualitative understanding of the patient and caregiver experience during and following episodes of hospital acquired delirium

Transoral resection of pharyngeal cancer: Summary of a National Cancer Institute Head and Neck Cancer Steering Committee Clinical Trials Planning Meeting, November 6–7, 2011, Arlington, Virginia

Recent advances now permit resection of many pharyngeal tumors through the open mouth, an approach that can greatly reduce the morbidity of surgical exposure. These transoral techniques are being rapidly adopted by the surgical community and hold considerable promise. On November 6–7, 2011, the National Cancer Institute sponsored a Clinical Trials Planning Meeting to address how to further investigate the use of transoral surgery, both in the good prognosis human papillomavirus (HPV)–initiated oropharyngeal cancers, and in those with HPV‐unrelated disease. The proceedings of this meeting are summarized. © 2012 Wiley Periodicals, Inc. Head Neck, 2012Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/94490/1/23136_ftp.pd

Figurations of Digital Practice, Craft, and Agency in Two Mediterranean Fieldwork Projects

Archaeological practice is increasingly enacted within pervasive and invisible digital infrastructures, tools, and services that affect how participants engage in learning and fieldwork, and how evidence, knowledge, and expertise are produced. This article discusses the collective imaginings regarding the present and future of digital archaeological practice held by researchers working in two archaeological projects in the Eastern Mediterranean, who have normalized the use of digital tools and the adoption of digital processes in their studies. It is a part of E-CURATORS, a research project investigating how archaeologists in multiple contexts and settings incorporate pervasive digital technologies in their studies. Based on an analysis of qualitative interviews, we interpret the arguments advanced by study participants on aspects of digital work, learning, and expertise. We find that, in their sayings, participants not only characterize digital tools and workflows as having positive instrumental value, but also recognize that they may severely constrain the autonomy and agency of researchers as knowledge workers through the hyper-granularization of data, the erosion of expertise, and the mechanization of work. Participants advance a notion of digital archaeology based on do-it-yourself (DIY) practice and craft to reclaim agency from the algorithmic power of digital technology and to establish fluid, positional distribution of roles and agency, and mutual validation of expertise. Operating within discourses of labour vs efficiency, and technocracy vs agency, sayings, elicited within the archaeological situated practice in the wild, become doings, echoing archaeology's anxiety in the face of pervasive digital technology