Medical Device Design Education: Identifying Problems Through Observation and Hands-On Training

Experiential learning, which may include hands-on learning paired with observation and reflection, has been applied in several industries; however, the impact of experiential learning in design education is not well known. We investigated how the type of simulation-based learning could affect the acquisition of knowledge and the ability to synthesize that understanding into insights for medical design innovation. One workshop included observational learning and the other experiential learning with hands-on training. Each course included 14-16 multidisciplinary undergraduate and graduate students. During both workshops, we measured student comprehension of two procedures— infant resuscitation and management of maternal hemorrhage. We focused on the first two phases of design thinking: “Understanding” and “Defining the Problems”. Although the course focused on “medical device design”, we encouraged students to look beyond the tool to imagine how their design change could impact the entire system. We did not find a significant difference between the scores given to students in the two courses by industry experts. Although the quality of the ideas and execution were similar between both workshops, the instructors noticed that the integration of hands-on training into the second workshop created a higher level of excitement in the class. The methodology and the approach adopted may be relevant to many design problems. In order to better understand the impact of observational learning versus hands-on training, both workshops could be expanded into full quarter classes that allow students to expand their design thinking skills to prototype and test their ideas in the real world

Cross-sectional study on the utilization of the Pan American Health Organization/World Health Organization Policy on Research for Health

This report contributes towards the monitoring and evaluation of the Pan American Health Organization/World Health Organization (PAHO/WHO) Policy on Research for Health (CD49/10), specifically, how it has been used by Member States and how it has influenced their policies, strategies, research, and relevant stakeholders. This cross-sectional study examined the frequency, method of utilization, region of interest or “scope,” and rationale behind citing the Policy in PAHO/WHO documents, databases, government websites, and internal documents. The extent of utilization was measured through an ordinal scale; the country or region of interest was systematically extracted. Of the 993 documents that were identified through the search strategy, 95 met the inclusion criteria. There was a significant relationship between type of document and scope (χ2 = 69.5; P < 0.001), with web pages and scientific articles covering the Americas more frequently mentioning the Policy. The Policy was most often used at the country level in government documents and at the regional level in webpages and journal articles. Although the Policy has been utilized by several countries, many countries have yet to integrate it with their national health research initiatives. Additional research should focus on understanding why Policy utilization differs among countries. To promote better cohesion across sectors and levels of governance, researchers and policymakers should seize opportunities to integrate the Policy with the research process, research governance, and policy development. The protocol developed for this study can be applied to similar analyses of other PAHO/WHO policies to gain a greater understanding of their infuence

A prospective clinical study of Primo-Lacto: A closed system for colostrum collection.

BACKGROUND:Colostrum is the first nutritional liquid that comes out of the breast during lactation. Colostrum collection can be challenging due to the small volume produced, and because breast pumps are not designed for colostrum collection. Besides pumping colostrum, the generally accepted practice is to use any available container to hand-express colostrum. Transfer between containers may lead to contamination, higher chance of infection and loss of colostrum. Our aim was to understand if a dedicated colostrum collection system (Primo-Lacto, Maternal Life, LLC, Palo Alto, CA) is more effective than standard hospital practice. METHODS:Mothers who delivered preterm infants < 34 weeks gestation and mothers with non-latching infants were approached within 24 hours of delivery. Surveys were distributed to participating patients (n = 67), and nurses or lactation consultants (n = 89). Mothers compared ease of use, their confidence level and satisfaction with the amount collected during standard practice vs. the colostrum collection system. Nurses or lactation consultants compared ease of use, differences in colostrum loss and time invested collecting. Quantitative data were analyzed using the Wilcoxon signed rank test and qualitative data were analyzed with grounded theory methods. RESULTS:For mothers, ease of use and confidence were significantly better when they used the colostrum collection system than when they used the standard collection procedure, and this difference was true for both hand and pump expression (p<0.01). Nurses and lactation consultants perceived that ease of use was better, and percent of colostrum lost was significantly less with the colostrum collection system for both hand and pump expression. The collection times were not significantly different between the colostrum collection system and standard practice. CONCLUSION:The colostrum collection system is a tool to help facilitate successful colostrum collection and improve the experience both for clinicians and patients

Analyzing the heterogeneity of labor and delivery units: A quantitative analysis of space and design.

This study assessed labor and delivery (L&D) unit space and design, and also considered correlations between physical space measurements and clinical outcomes. Design and human factors research has increased standardization in high-hazard industries, but is not fully utilized in medicine. Emergency department and intensive care unit space has been studied, but optimal L&D unit design is undefined. In this prospective, observational study, a multidisciplinary team assessed physical characteristics of ten L&D units. Design measurements were analyzed with California Maternal Quality Care Collaborative (CMQCC) data from 34,161 deliveries at these hospitals. The hospitals ranged in delivery volumes (5000 annual deliveries) and cesarean section rates (19.6%-39.7%). Within and among units there was significant heterogeneity in labor room (LR) and operating room (OR) size, count, and number of configurations. There was significant homogeneity of room equipment. Delivery volumes correlated with unit size, room counts, and cesarean delivery rates. Relative risk of cesarean section was modestly increased when certain variables were above average (delivery volume, unit size, LR count, OR count, OR configuration count, LR to OR distance, unit utilization) or below average (LR size, OR size, LR configuration count). Existing variation suggests a gold standard design has yet to be adopted for L&D. A design-centered approach identified opportunities for standardization: 1) L&D unit size and 2) room counts based on current or projected delivery volume, and 3) LR and OR size and equipment. When combined with further human factors research, these guidelines could help design the L&D unit of the future

28 NICUs participating in a quality improvement collaborative targeting early-onset sepsis antibiotic use.

OBJECTIVE: There is widespread overuse of antibiotics in neonatal intensive care units (NICUs). The objective of this study was to safely reduce antibiotic use in participating NICUs by targeting early-onset sepsis (EOS) management. STUDY DESIGN: Twenty-eight NICUs participated in this statewide multicenter antibiotic stewardship quality improvement collaborative. The primary aim was to reduce the total monthly mean antibiotic utilization rate (AUR) by 25% in participant NICUs. RESULT: Aggregate AUR was reduced by 15.3% (p &lt; 0.001). There was a wide range in improvement among participant NICUs. There were no increases in EOS rates or nosocomial infection rates related to the intervention. CONCLUSION: Participation in this multicenter NICU antibiotic stewardship collaborative targeting EOS was associated with an aggregate reduction in antibiotic use. This study informs efforts aimed at sustaining improvements in NICU AURs