'What's your name?' A case study

We all know and appreciate the benefits of social interaction and peer support. Being in an environment with our peers and people who have similar abilities and needs as ourselves is reassuring and confidence building. We only have to look at the recent explosion in social networking on the internet to see that it is something which people value. As well as using these networks to communicate with existing friends it is also possible to join interest specific groups and meet people this way. Even though people met through these groups are often strangers, the shared interest/ ability means it seems safe to communicate with them. It is often daunting to be in a new social and work environment until we are able to establish a common interest with people, and then this allows us to relax. Social networks and peer support are obviously equally important to people with disabilities and interacting with people with similar disabilities or - as presented in this paper, similar aids - can be extremely important. Communication aid users may feel isolated or frustrated by a lack of peers or role models since it can be difficult to establish this peer environment if you are a minority group. Previous work has illustrated the benefits of both social networks and role models (Musselwhite 2005, Blackstone 2005, Clarke 2005). There has also been development of functions such as the ability to tell jokes (O’Mara and Waller 1999, 2003) or partake in small talk (Cantine) with a communication aid - so enhancing a person’s ability to interact in a more natural conversation. This paper describes an initiative which has organised communication mornings within Doncaster, Rotherham and Barnsley to give students using communication aids an opportunity to meet other users and interact in a real environment

Speech Driven Environmental Control System (SPECS) From Specification to Prototype

The SPECS project is designing a new speech driven environmental control to include use by people with dysathric speech. The project is funded by the National Institute for Health Research and is developing the device with a large UK assistive technology company. The aim is that the device will be designed in a user-centric way. The initial stage of the project involved performing detailed qualitative interviews of people currently using speech-driven environmental control systems and a focus group of professionals which discussed current speech-driven environmental control systems and ‘blue sky’ ideas. Data from these were rigorously analysed using a framework approach [1]. This enabled full specification of the proposed new device and the results of this stage have recently been published [2]. This paper will present the process undertaken to go from specification to prototype testing, how user involvement has been incorporated and will discuss the key findings to date. At the time of RAATE 2009 we will be nearing completion of the prototype testing

Users' Perceptions of Environmental Control Systems

This paper presents users' perceptions of the benefits and challenges of environmental control systems, the data having been collected as part of a project developing a new speech-driven environmental control system. The first stage of this project collected data from existing users of speech-driven environmental control systems and provided information for the specification for the new device. A secondary analysis of this data revealed perceptions about environmental control systems in general and the results are presented here. Independence and control emerged as a key aspect of environmental control systems. In addition it was possible to identify other themes around topics such as perceptions of service delivery and provision. It can be easy for a non disabled person to overlook the importance of being able to independently change the television channel or make a phone call and this data reinforces the importance of this to people who use environmental control systems

Speech-driven environmental control systems - a qualitative analysis of users' perceptions

Purpose. To explore users' experiences and perceptions of speech-driven environmental control systems (SPECS) as part of a larger project aiming to develop a new SPECS. The motivation for this part of the project was to add to the evidence base for the use of SPECS and to determine the key design specifications for a new speech-driven system from a user's perspective. Method. Semi-structured interviews were conducted with 12 users of SPECS from around the United Kingdom. These interviews were transcribed and analysed using a qualitative method based on framework analysis. Results. Reliability is the main influence on the use of SPECS. All the participants gave examples of occasions when their speech-driven system was unreliable; in some instances, this unreliability was reported as not being a problem (e.g., for changing television channels); however, it was perceived as a problem for more safety critical functions (e.g., opening a door). Reliability was cited by participants as the reason for using a switch-operated system as back up. Benefits of speech-driven systems focused on speech operation enabling access when other methods were not possible; quicker operation and better aesthetic considerations. Overall, there was a perception of increased independence from the use of speech-driven environmental control. Conclusions. In general, speech was considered a useful method of operating environmental controls by the participants interviewed; however, their perceptions regarding reliability often influenced their decision to have backup or alternative systems for certain functions

Speech driven assistive technology

This workshop is intended to give attendees the opportunity to explore the possibilities of speech access, particularly for people with disordered speech and specifically considering environmental control. The session will be structured such that it will introduce the principles of speech access and current successful and less successful speech access systems. Having discussed the current technology attendees will then have the opportunity to look at and evaluate the initial designs for the user interface of a new device being developed by the SPECS project in Barnsley. The last part of the session will enable attendees to feedback their opinions on the designs and features or issues they feel need to be developed further or incorporated

Structuring and coding in health care records: a qualitative analysis using diabetes as a case study

Background: Globally, diabetes mellitus presents a substantial burden to individuals and healthcare systems. Structuring and/or coding of medical records underpin attempts to improve information sharing and searching, potentially bringing clinical and secondary uses benefits. Aims and objectives: We investigated if, how and why records for adults with diabetes were structured and/or coded, and explored stakeholders’ perceptions of current practice. Methods: We carried out a qualitative, theoretically-informed case study of documenting healthcare information for diabetes patients in family practice and hospital settings, using semi-structured interviews, observations, systems demonstrations and documentary data. Results: We conducted 22 interviews and four on-site observations, and reviewed 25 documents. For secondary uses – research, audit, public health and service planning – the benefits of highly structured and coded diabetes data were clearly articulated. Reported clinical benefits in terms of managing and monitoring diabetes, and perhaps encouraging patient self-management, were modest. We observed marked differences in levels of record structuring and/or coding between settings, and found little evidence that these data were being exploited to improve information sharing between them. Conclusions: Using high levels of data structuring and coding in medical records for diabetes patients has potential to be exploited more fully, and lessons might be learned from successful developments elsewhere in the UK

The collection and utilisation of patient ethnicity data in general practices and hospitals in the United Kingdom: a qualitative case study

Background: Although the collection of patient ethnicity data is a requirement of publicly funded healthcare providers in the UK, recording of ethnicity is sub-optimal for reasons that remain poorly understood. Aims and objectives: We sought to understand enablers and barriers to the collection and utilisation of ethnicity data within electronic health records, how these practices have developed and what benefit this information provides to different stakeholder groups. Methods: We undertook an in-depth, qualitative case study drawing on interviews and documents obtained from participants working as academics, managers and administrators within the UK. Results: Information regarding patient ethnicity was collected and coded as administrative patient data, and/or in narrative form within clinical records. We identified disparities in the classification of ethnicity, approaches to coding and levels of completeness due to differing local, regional and national policies and processes. Most participants could not identify any clinical value of ethnicity information and many did not know if and when data were shared between services or used to support quality of care and research. Conclusions: Findings highlighted substantial variations in data classification, and practical challenges in data collection and usage that undermine the integrity of data collected. Future work needs to focus on explaining the uses of these data to frontline clinicians, identifying resources that can support busy professionals to collect standardised data and then, once collected, maximising the utility of these data

Academic Resilience

Undergraduate Applie

Anything but engaged:User involvement in the context of a national electronic health record implementation

ACKNOWLEDGEMENTS We are grateful to the participating hospitals for supporting this work and to all interviewees who kindly gave their time. Throughout the process of undertaking this work we have had helpful support from colleagues at the NHS Connecting for Health Evaluation Programme led by Richard Lilford and supported by Lee Priest, Nathalie Maillard and Jo Foster. Lee Priest also represented the funders on our independent project steering committee, whichUser involvement in a national EHR implementation 203 was chaired by David Bates. Other members of this committee included Martin Buxton, Antony Chuter, Ian Cowles and Kathy Mason. We also acknowledge the support of the National Institute for Health Research through the Comprehensive Clinical Research Network.Peer reviewedPublisher PD

The regulation of miRNAs by reconstituted high-density lipoproteins in diabetes-impaired angiogenesis

Diabetic vascular complications are associated with impaired ischaemia-driven angiogenesis. We recently found that reconstituted high-density lipoproteins (rHDL) rescue diabetes-impaired angiogenesis. microRNAs (miRNAs) regulate angiogenesis and are transported within HDL to sites of injury/repair. The role of miRNAs in the rescue of diabetes-impaired angiogenesis by rHDL is unknown. Using a miRNA array, we found that rHDL inhibits hsa-miR-181c-5p expression in vitro and using a hsa-miR-181c-5p mimic and antimiR identify a novel anti-angiogenic role for miR-181c-5p. miRNA expression was tracked over time post-hindlimb ischaemic induction in diabetic mice. Early post-ischaemia when angiogenesis is important, rHDL suppressed hindlimb mmu-miR-181c-5p. mmu-miR-181c-5p was not detected in the plasma or within HDL, suggesting rHDL specifically targets mmu-miR-181c-5p at the ischaemic site. Three known angiogenic miRNAs (mmu-miR-223-3p, mmu-miR-27b-3p, mmu-miR-92a-3p) were elevated in the HDL fraction of diabetic rHDL-infused mice early post-ischaemia. This was accompanied by a decrease in plasma levels. Only mmu-miR-223-3p levels were elevated in the hindlimb 3 days post-ischaemia, indicating that rHDL regulates mmu-miR-223-3p in a time-dependent and site-specific manner. The early regulation of miRNAs, particularly miR-181c-5p, may underpin the rescue of diabetes-impaired angiogenesis by rHDL and has implications for the treatment of diabetes-related vascular complications