Designantropologiske undersøgelser af Patient 2.0

’Den aktive patient’ har siden begyndelsen 90’erne været genstand for øget opmærksomhed. Det er en udbredt forståelse, at telemedicin kan forbedre samarbejdet mellem sundhedsprofessionelle og kroniske patienter og derved øge livskvaliteten og de økonomiske besparelser. Nyere etnografiske studier viser dog, at ansvarsflytning er indskrevet i teknologierne, og at forventninger om ’hjemmearbejde’ kolliderer med patienters sociale situation og håb for fremtiden. Patient 2.0 er en figur, der favner sådanne forskelligrettede virkeligheder og drømme. Med udgangspunkt i aktør-netværk teoriens princip om ’performativitet’ og det ontologiske skifte præsenterer jeg i denne artikel, hvordan metoder fra participatory design kan blive en ressource for antropologi og sociologi. Jeg tager fat i nyere diskurser, hvor design anses for at være en nøgle til at kunne undersøge moderne og mere dynamiske fænomener. Gennem en case fra forsknings- og udviklingsprojektet CITH viser jeg, hvordan vi gennem metode-eksperimenter og undersøgelser af patient 2.0 ender med skabe en designantropologisk modalitet, der er væsentlig forskellig fra etnografien. Jeg kalder denne modalitet for det udøvende aktør-netværk. Til sidst diskuterer jeg, hvad konsekvensen er for forskerens rolle og fremhæver nødvendigheden i hurtigt at kunne skifte mellem forskellige roller og at forhandle, interessere og mediere mellem hidtil uforbundne aktører for at skabe værdifulde effekter.Design Anthropological Inquiries into Patient 2.0:‘The active patient’ has since the early 90s attracted increased attention. It is a widespread idea that telemedicine can support collaboration between health professionals and patients with chronic diseases, thereby improving the quality of life and reducing clinical costs. Recent ethnographic studies show, however, that shifts in responsibilities are inscribed in the technologies and that expectations of ‘homework’ collides with patients’ social situation and hope for the future. Patient 2.0 is a figure that embraces such divergent realities and dreams. Based on actor-network theory’s principle of ‘performativity’ and the ontological turn happening in broader lines of social science, this article presents how methods from participatory design can be a resource for anthropological and sociological inquiry. The article departs on later discourses in which design practices are considered to be a key factor when exploring modern and more dynamic phenomena. Through a case study of Patient 2.0 on a research and development project, the CITH project, I show how we created a design anthropological modality that is significantly different from ethnography. I call this modality the performing actor-network. Finally, I discuss what the consequences are for the researcher’s role, and emphasise the need for being able to make quick shifts between different roles, negotiating interest, and mediate between previously unconnected actors to create valuable effects

Impact of device programming on the success of the first anti-tachycardia pacing therapy:An anonymized large-scale study

BackgroundAntitachycardia pacing (ATP) is an effective treatment for ventricular tachycardia (VT). We evaluated the efficacy of different ATP programs based on a large remote monitoring data set from patients with implantable cardioverter-defibrillators (ICDs).MethodsA dataset from 18,679 ICD patients was used to evaluate the first delivered ATP treatment. We considered all device programs that were used for at least 50 patients, leaving us with 7 different programs and a total of 32,045 episodes. We used the two-proportions z-test (α = 0.01) to compare the probability of success and the probability for acceleration in each group with the corresponding values of the default setting.ResultsOverall, the first ATP treatment terminated in 78.4%-97.5% of episodes with slow VT and 81.5%-91.1% of episodes with fast VT. The default setting of the ATP programs with the number of sequences S = 3 was applied to treat 30.1% of the slow and 36.6% of the fast episodes. Reducing the maximum number of sequences to S = 2 decreased the success rate for slow VT (P ConclusionWhile the default programs performed well, we found that increasing the number of sequences from 3 to 4 was a promising option to improve the overall ATP performance

Aligning Concerns in Telecare:Three Concepts to Guide the Design of Patient-Centred E-Health

The design of patient-centred e-health services embodies an inherent tension between the concerns of clinicians and those of patients. Clinicians’ concerns are related to professional issues to do with diagnosing and curing disease in accordance with accepted medical standards. In contrast, patients’ concerns typically relate to personal experience and quality of life issues. It is about their identity, their hopes, their fears and their need to maintain a meaningful life. This divergence of concerns presents a fundamental challenge for designers of patient-centred e-health services. We explore this challenge in the context of chronic illness and telecare. Based on insights from medical phenomenology as well as our own experience with designing an e-health service for patients with chronic heart disease, we emphasise the importance – and difficulty – of aligning the concerns of patients and clinicians. To deal with this, we propose a set of concepts for analysing concerns related to the design of e-health services: A concern is (1) meaningful if it is relevant and makes sense to both patients and clinicians, (2) actionable if clinicians or patients – at least in principle – are able to take appropriate action to deal with it, and (3) feasible if it is easy and convenient to do so within the organisational and social context. We conclude with a call for a more participatory and iterative approach to the design of patient-centred e-health services