Medical device design for adolescent adherence and developmental goals: a case study of a cystic fibrosis physiotherapy device

Purpose: This study investigates the psychosocial aspects of adolescent medical device use and the impact on adolescent adherence and goals for the transitional years between child and adulthood. Patients and methods: Interviews were carried out with 20 adolescents with cystic fibrosis, investigating adolescent medical device use and experiences in relation to their personal and social lives and development through the adolescent years. The qualitative dataset was thematically examined using a content analysis method. Results: The results show that adolescent users of medical technologies want their independence and capabilities to be respected. Adolescent adherence to medical device use was associated with short- and long-term motivations, where older adolescents were able to comprehend the longer-term benefits of use against short-term inconvenience more acutely than younger adolescents. It was suggested that medical devices could provide a tool for communication with families and clinicians and could support adolescents as they take responsibility for managing their condition. Themes of “fitting into teenage life” and “use in the community” were associated with adolescents' needs to form their own identity and have autonomy. Conclusion: This study shows that adolescent needs regarding medical device use are complex. It provides evidence to suggest that devices designed inclusively for adolescents may lead to improved adherence and also facilitate transition through the adolescent years and achievement of adolescent goals

What are the pros and cons of electronically monitoring inhaler use in asthma?: a multistakeholder perspective

Introduction Electronic monitoring devices (EMDs) are the optimal method for collecting objective data on inhaler use in asthma. Recent research has investigated the attitudes of patients with asthma towards these devices. However, no research to date has formally considered the opinions of stakeholders and decision-makers in asthma care. These individuals have important clinical requirements that need to be taken into account if EMDs are to be successfully provisioned, making collecting their opinions on the key barriers facing these devices a valuable process. Methods Three rounds of surveys in a Delphi format were used to assess the most important pros and cons of EMDs for asthma care in a sample of 31 stakeholders which included healthcare professionals and members of clinical commissioning groups. Results The respondents identified 29 pros and 32 cons. Pros that were rated as most important included new visual evidence to aid clinical discussions with a patient and an increase in patient involvement and motivation. The cons that were rated as most important included a need for more clinical evidence of the effectiveness of EMDs, as well as better clarity over who has responsibilities in managing, interpreting and discussing data with a patient. Conclusions The research provides a guide for EMD developers by highlighting where these devices may provide the most benefit as well as prioritising the key issues that need addressing if they are to be used effectively in everyday asthma care

Medical device design for adolescents

Adolescents have been identified as users of medical devices who are currently overlooked in the design and development of these products. This research presents a set of studies that investigate the non-clinical user requirements of adolescent medical device users. Interviews with a range of healthcare professionals provided guidance into chronic conditions and devices which are relevant to adolescent populations. Workshops involving healthy adolescents in schools were carried out to elicit adolescent perspectives of current medical device design. The results of this study showed that the range of medical devices presented did not satisfy adolescent user requirements and provided insight into factors which are important to this specific user group. The workshop also identified the acapella® physiotherapy device, used for chest and airway clearance in the treatment of cystic fibrosis, as a suitable case study for further evaluation with real adolescent users. Case study interviews were carried out with adolescents with cystic fibrosis: the users of the acapella®. The interviews identified a range of unmet requirements and expanded on the results from the workshops. In addition to the more general design factors, users of the acapella® highlighted the effect of device use on clinical effectiveness. The data from the workshops and case study interviews was used in a co-design project with an adolescent user of the device. A design specification was interpreted from the data to produce a visual representation of the adolescent requirements. The research has produced two outputs. The first is the development of a prototype tool for eliciting adolescent design priorities for medical devices - The Adolescent Medical Device Assessment Tool (AMDAT) The second deliverable is a set of guidelines which detail the specific requirements and goals of adolescent users of medical devices - Adolescent Medical Device Requirements. This guidance aims to facilitate the consideration of adolescent user requirements in the design and development of new medical devices. The research investigation has contributed new understanding to the fields of human factors and adolescent healthcare. The findings from these studies demonstrate how adolescent populations can be successfully engaged in research tasks. This research investigation has shown that adolescents have specific needs of medical devices and that meeting these needs through user-centred methods may lead to better adherence of use and improved health outcomes

Health Care Professionals’ Views on Using Remote Measurement Technology in Managing Central Nervous System Disorders: Qualitative Interview Study

Background: Remote measurement technologies (RMT) can be used to collect data on a variety of bio-behavioral variables, which may improve the care of patients with central nervous system disorders. Although various studies have explored their potential, prior work has highlighted a knowledge gap in health care professionals’ (HCPs) perceptions of the value of RMT in clinical practice.Objective: This study aims to understand HCPs’ perspectives on using RMT in health care practice for the care of patients with depression, epilepsy, or multiple sclerosis (MS).Methods: Semistructured interviews were conducted with 26 multidisciplinary primary and secondary care HCPs who care for patients with epilepsy, depression, or MS. Interviews were transcribed verbatim and analyzed using thematic analysis.Results: A total of 8 main themes emerged from the analysis: (1) potential clinical value of RMT data; (2) when to use RMT in care pathways; (3) roles of health care staff who may use RMT data; (4) presentation and accessibility of data; (5) obstacles to successful use of RMT; (6) limits to the role of RMT; (7) empowering patients; and (8) considerations around alert-based systems.Conclusions: RMT could add value to the system of care for patients with central nervous system disorders by providing clinicians with graphic summaries of data in the patient record. Barriers of both technical and human nature should be considered when using these technologies, as should the limits to the benefits they can offer

The use of vignettes for conducting healthcare research

Improving healthcare requires engaging with clinicians and patients in order to better understand their needs and expectations. Research methods that are used to conduct healthcare research are selected on the basis of study objectives and practicalities (i.e. finances, resources, time frame, etc.). The methodology of vignettes for conducting healthcare research consists of short descriptive scenarios and/or images to engage participants in hypothetical situations in which their emotional, psychological and sociological responses can be measured. They enable participants to feel comfortable in divulging responses that may be of a sensitive nature and provide insight to situations where they may have little or no experience. Two studies that used vignettes to conduct healthcare research will be discussed in terms of their objectives, conceptualisations, designs and developments, implementations, and outcomes. Validity of the vignettes as a methodology for conducting healthcare research will also be discussed

Healthcare professional views of implementing remote measurement technology in central nervous system disorders: A qualitative interview study (Preprint)

Background:Remote measurement technologies (RMTs) can be used to collect data on a variety of bio-behavioural variables, which may benefit the care of people with central nervous system disorders. While various studies have explored their potential, prior work has highlighted a knowledge gap concerning healthcare professional’s perception of the value of RMTs in clinical practice.Objective:To understand the perspectives of healthcare professionals on the implementation of RMT in healthcare practice for the care of people with depression, epilepsy or multiple sclerosis.Methods:Semi-structured interviews were conducted with 26 multidisciplinary primary and secondary care healthcare professionals managing people with epilepsy, depression or multiple sclerosis. Interviews were transcribed verbatim and analysed using thematic analysis.Results:Eight main themes emerged from the analysis. Healthcare professionals considered RMT data to be informative for the care of patients and empowering to patients in all three conditions. However, professionals indicated decisions about care should not be made exclusively on the basis of RMT data. Implementing RMTs may require new staff roles to manage incoming data if RMTs are used to alert services to signs of relapse. Results also indicate points in care pathways at which healthcare staff would most benefit from RMT data, and demonstrate that healthcare professionals are pragmatic about data security risks arising from using patients’ RMT data.Conclusions:RMTs could add value to the system of care for individual patients with central nervous system disorders through providing clinicians with graphic summaries of data in the patient record. Barriers of both technical and human nature should be considered when implementing these technologies, as should the limits to the benefits they can offer

Human factors multi-technique approach to teenage engagement in digital technologies health research

This chapter explores the use of multi-techniques for teenage HCI health research. Through four case studies we present information about adolescents as users of healthcare services and technologies, adolescent personal development and the human factors approaches through which teenagers have been involved in healthcare research projects. In each case study; comprising of the design or evaluation of a new digital technology for supporting health or well-being, the techniques used by researchers to involve teenagers are explored and analysed. The case studies examine various aspects of technology design and use including but not limited to usability, acceptability and learnability. The penultimate section of the chapter presents a ‘Schema for Multi-technique HCI Health Research with Teenagers’ and provides the supporting case for a multi method approach. The conclusions of the chapter reinforce the benefits that are specific to the implementation of multi-technique research with teenager participants. Consideration of the eight factors outlined in the ‘Schema’ within study designs should serve to unlock the potential of teenagers, ensuring reliable elicitation of their views and needs

Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017 : a systematic analysis for the Global Burden of Disease Study 2017

Background: The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk outcome pairs, and new data on risk exposure levels and risk outcome associations. Methods: We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017. Findings: In 2017,34.1 million (95% uncertainty interval [UI] 33.3-35.0) deaths and 121 billion (144-1.28) DALYs were attributable to GBD risk factors. Globally, 61.0% (59.6-62.4) of deaths and 48.3% (46.3-50.2) of DALYs were attributed to the GBD 2017 risk factors. When ranked by risk-attributable DALYs, high systolic blood pressure (SBP) was the leading risk factor, accounting for 10.4 million (9.39-11.5) deaths and 218 million (198-237) DALYs, followed by smoking (7.10 million [6.83-7.37] deaths and 182 million [173-193] DALYs), high fasting plasma glucose (6.53 million [5.23-8.23] deaths and 171 million [144-201] DALYs), high body-mass index (BMI; 4.72 million [2.99-6.70] deaths and 148 million [98.6-202] DALYs), and short gestation for birthweight (1.43 million [1.36-1.51] deaths and 139 million [131-147] DALYs). In total, risk-attributable DALYs declined by 4.9% (3.3-6.5) between 2007 and 2017. In the absence of demographic changes (ie, population growth and ageing), changes in risk exposure and risk-deleted DALYs would have led to a 23.5% decline in DALYs during that period. Conversely, in the absence of changes in risk exposure and risk-deleted DALYs, demographic changes would have led to an 18.6% increase in DALYs during that period. The ratios of observed risk exposure levels to exposure levels expected based on SDI (O/E ratios) increased globally for unsafe drinking water and household air pollution between 1990 and 2017. This result suggests that development is occurring more rapidly than are changes in the underlying risk structure in a population. Conversely, nearly universal declines in O/E ratios for smoking and alcohol use indicate that, for a given SDI, exposure to these risks is declining. In 2017, the leading Level 4 risk factor for age-standardised DALY rates was high SBP in four super-regions: central Europe, eastern Europe, and central Asia; north Africa and Middle East; south Asia; and southeast Asia, east Asia, and Oceania. The leading risk factor in the high-income super-region was smoking, in Latin America and Caribbean was high BMI, and in sub-Saharan Africa was unsafe sex. O/E ratios for unsafe sex in sub-Saharan Africa were notably high, and those for alcohol use in north Africa and the Middle East were notably low. Interpretation: By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning

Downregulation of duodenal SLC transporters and activation of proinflammatory signaling constitute the early response to high altitude in humans

Solute carrier (SLC) transporters mediate the uptake of biologically active compounds in the intestine. Reduced oxygenation (hypoxia) is an important factor influencing intestinal homeostasis. The aim of this study was to investigate the pathophysiological consequences of hypoxia on the expression and function of SLCs in human intestine. Hypoxia was induced in human intestinal epithelial cells (IECs) in vitro (0.2; 1% O2 or CoCl2). For human in vivo studies, duodenal biopsies and serum samples were obtained from individuals (n = 16) acutely exposed to 4,554 meters above sea levels. Expression of relevant targets was analyzed by quantitative PCR, Western blotting, or immunofluorescence. Serum levels of inflammatory mediators and nucleosides were determined by ELISA and LC/MS-MS, respectively. In the duodenum of volunteers exposed to high altitude we observed decreased mRNA levels of apical sodium-dependent bile acid transporter (ASBT), concentrative nucleoside transporters 1/2 (CNT1/2), organic anion transporting polypeptide 2B1 (OATP2B1), organic cation transporter 2 (OCTN2), peptide transporter 1 (PEPT1), serotonin transporter (SERT), and higher levels of IFN-γ, IL-6, and IL-17A. Serum levels of IL-10, IFN-γ, matrix metalloproteinase-2 (MMP-2), and serotonin were elevated, whereas the levels of uridine decreased upon exposure to hypoxia. Hypoxic IECs showed reduced levels of equilibrative nucleoside transporter 2 (ENT2), OCTN2, and SERT mRNAs in vitro, which was confirmed on the protein level and was accompanied by activation of ERK1/2, increase of hypoxia-inducible factor (HIF) proteins, and production of IL-8 mRNA. Costimulation with IFN-γ and IL-6 during hypoxia further decreased the expression of SERT, ENT2, and CNT2 in vitro. Reduced oxygen supply affects the expression pattern of duodenal SLCs that is accompanied by changes in serum levels of proinflammatory cytokines and biologically active compounds demonstrating that intestinal transport is affected during systemic exposure to hypoxia in humans