User involvement in healthcare technology development and assessment: Structured literature review

Purpose – Medical device users are one of the principal stakeholders of medical device technologies. User involvement in medical device technology development and assessment is central to meet their needs. Design/methodology/approach – A structured review of literature, published from 1980 to 2005 in peer-reviewed journals, was carried out from social science perspective to investigate the practice of user involvement in the development and assessment of medical device technologies. This was followed by qualitative thematic analysis. Findings – It is found that users of medical devices include clinicians, patients, carers and others. Different kinds of medical devices are developed and assessed by user involvement. The user involvement occurs at different stages of the medical device technology lifecycle and the degree of user involvement is in the order of design stage > testing and trials stage > deployment stage > concept stage. Methods most commonly used for capturing users’ perspectives are usability tests, interviews and questionnaire surveys. Research limitations/implications – We did not review the relevant literature published in engineering, medical and nursing fields, which might have been useful. Practical implications – Consideration of the users’ characteristics and the context of medical device use is critical for developing and assessing medical device technologies from users’ perspectives. Originality/value – This study shows that users of medical device technologies are not homogeneous but heterogeneous, in several aspects, and their needs, skills and working environments vary. This is important consideration for incorporating users’ perspectives in medical device technologies. Paper type: Literature review

Investigation of practices and procedures in the use of therapeutic diathermy: A study from the physiotherapists' health and safety perspective

Background and Purpose. The safe use of therapeutic diathermy requires practices and procedures that ensure compliance to professional guidelines and clinical evidence. Inappropriate use may expose physiotherapists and other people in the vicinity of operating diathermy devices to stray radiofrequency electromagnetic fields, which can be a source of risk and may lead to adverse health effects. The aim of the present study was to investigate practices and procedures for therapeutic diathermy from a health and safety perspective. Method. A cross-sectional research design was used, this included a postal survey using a self-administered questionnaire and semi-structured observational visits to 46 physiotherapy departments in National Health Service (NHS) hospitals located in the south-east and south-west of England, including Greater London. Results. Microwave diathermy was not available in the departments surveyed. Pulsed shortwave diathermy was available and was used more commonly than continuous shortwave diathermy. There were metallic objects in treatment cubicles used for pulsed shortwave diathermy and continuous shortwave diathermy. Shortwave diathermy devices created electromagnetic interference with a variety of electrical and medical devices. Physiotherapists reported that they did not stay in the treatment cubicle during the entire period of electrotherapy with pulsed shortwave diathermy or continous shortwave diathermy; pregnant physiotherapists reported that they did not use these devices. Electrotherapy with pulsed shortwave diathermy and continuous shortwave diathermy was not always administered on a wooden couch or chair. Electrotherapy was highest in those departments with the fewest physiotherapists. Conclusions. Departments report good practices and procedures regarding the use of therapeutic diathermy devices. However, field observations of practices and procedures, and the working environment, have identified issues with a potential to create health and safety problems, and these should be addressed. Copyright (c) 2007 John Wiley & Sons, Ltd

Availability and use of electrotherapy devices: a survey

This item is published and the copyright holder of this article is the International Journal of Therapy and Rehabilitation © 2010 MA Healthcare Limited, http://www.ijtr.co.uk/. The article is available here with the permission of the copyright holder. Any use of the article from this site for personal use is permitted; however, if it is to be used for any other purpose, or reproduced in part or in full, the copyright holder must be contacted.Electrophysical agents such as radiofrequency electromagnetic fields (shortwave and microwave), ultrasound, laser and electrical stimulation are used for therapeutic purpose in physiotherapy departments. They are primarily used for treating a wide range of musculoskeletal injuries. This study investigated the availability and use of therapeutic diathermy, ultrasound, laser, transcutaneous electrical nerve stimulation (TENS) and interferential equipment in 46 physiotherapy departments in NHS hospitals in the south of England, using a self-administered questionnaire. Results indicated that therapeutic ultrasound was the most commonly available and most often used modality by surveyed departments. Pulsed shortwave diathermy, interferential, and laser were available to a lesser degree and also used less often. Continuous shortwave diathermy was used rarely and only in larger departments. Microwave diathermy was not available in any of the surveyed departments. The level of non-use of equipment despite availability was highest for continuous shortwave diathermy followed by pulsed shortwave diathermy and then laser. The rare use and total non-use of some of the modalities, despite availability of equipment, may have implications for purchasers of this expensive equipment. While the findings of this study show a regional trend in NHS physiotherapy departments, this may not be generalizable to a national level.This study was funded by the Health and Safety Executive, UK, (Grant No. 4371/R47.022

Systematic literature review of adverse reproductive outcomes associated with physiotherapists' occupational exposures to non-ionising radiation

This article is available through open access and can be accessed at the link below.Objectives: To review empirical research on adverse health and pregnancy outcomes associated with physiotherapists' occupational exposure to radiofrequency electromagnetic fields (RF EMFs) from shortwave (SWD) and microwave (MWD) diathermy devices. Methods: A systematic review of peer reviewed literature published from 1990 to 2010 in the English language searched in eight online bibliographic databases: CINAHL, EBSCOhost, ISI Web of Knowledge, Medline, OSH UPDATE, PubMed Central, ScienceDirect, and Scopus. Results: Findings suggest that physiotherapists' occupational exposure to SWD was statistically significantly associated with delayed time to pregnancy (>6 months), still birth, altered gender ratio (low ratio of boys to girls), congenital malformations and low birth weight (<2,500 g) among physiotherapists' offspring. Physiotherapists' exposure to MWD was also found to be statistically significantly associated with spontaneous abortion. However, causal mechanisms for these statistical associations are unknown. The present systematic review has found these adverse reproductive outcomes and health effects associations with RF EMFs from therapeutic diathermy devices to be inconsistent. Conclusions: A number of studies did not find statistically significant results to replicate associations with such adverse outcomes, and therefore further research, preferably prospective studies of cohorts of physiotherapists, is warranted.This is extended version of a study funded by the Health and Safety Executive (Project No: R47.022

Medical device technologies: Who is the user?

A myriad of medical devices deployed by many users play an essential role in healthcare, and they, and their users, need to be defined, classified and coded effectively. This study provides definitions of terms frequently employed to describe the users of medical device technologies (MDT) as well as a classification of such users. Devices are widely used, developed and assessed by many others than clinicians. Thus, users of medical devices need to be classified in various relevant ways, such as primary and secondary users; user groups such as healthcare professionals, patients, carers, persons with disabilities, those with special needs, as well as professionals allied with healthcare. Proper definition and classification of MDT users is particularly important for integrating the users’ perspectives in the process of MDT development and assessment, as well as in relation to the regulatory, health and safety, and insurance perspectives concerning MDT

Benefits of and barriers to involving users in medical device technology development and evaluation

Objectives: This study investigated the benefits of, and barriers to user involvement in medical device technology development and evaluation. Methods: A structured review of published literature in peer-reviewed journals. Results: This review revealed that the main benefits of user involvement were an increased access to user needs, experiences and ideas; improvements in medical device designs and user interfaces; and an increase in the functionality, usability and quality of the devices. On the other hand, resource issues, particularly those of time and money were found the key impediments to involving users in the development and evaluation of medical device technologies. This study has categorised both the benefits and barriers to user involvement also. Conclusions: The involvement of users in MDTD&E requires resources, which are limited; however, it is essential from both users and manufacturers perspectives

Factors determining patients’ intentions to use point-of-care testing medical devices for self-monitoring: The case of international normalised ratio self-testing

This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. - Copyright @ 2012 Dove Medical Press LtdThis article has been made available through the Brunel Open Access Publishing Fund.Purpose: To identify factors that determine patients' intentions to use point-of-care medical devices, ie, portable coagulometer devices for self-testing of the international normalized ratio (INR) required for ongoing monitoring of blood-coagulation intensity among patients on long-term oral anticoagulation therapy with vitamin K antagonists, eg, warfarin. Methods: A cross-sectional study that applied the technology-acceptance model through a self-completed questionnaire, which was administered to a convenience sample of 125 outpatients attending outpatient anticoagulation services at a district general hospital in London, UK. Data were analyzed using descriptive statistics, factor analyses, and structural equation modeling. Results: The participants were mainly male (64%) and aged ≥ 71 years (60%). All these patients were attending the hospital outpatient anticoagulation clinic for INR testing; only two patients were currently using INR self-testing, 84% of patients had no knowledge about INR self-testing using a portable coagulometer device, and 96% of patients were never offered the option of the INR self-testing. A significant structural equation model explaining 79% of the variance in patients’ intentions to use INR self-testing was observed. The significant predictors that directly affected patients' intention to use INR self-testing were the perception of technology (β = 0.92, P < 0.001), trust in doctor (β = −0.24, P = 0.028), and affordability (β = 0.15, P = 0.016). In addition, the perception of technology was significantly affected by trust in doctor (β = 0.43, P = 0.002), age (β = −0.32, P < 0.001), and affordability (β = 0.23, P = 0.013); thereby, the intention to use INR self-testing was indirectly affected by trust in doctor (β = 0.40), age (β = −0.29), and affordability (β = 0.21) via the perception of technology. Conclusion: Patients’ intentions to use portable coagulometers for INR self-testing are affected by patients' perceptions about the INR testing device, the cost of device, trust in doctors/clinicians, and the age of the patient, which need to be considered prior to any intervention involving INR self-testing by patients. Manufacturers should focus on increasing the affordability of INR testing devices for patients’ self-testing and on the potential role of medical practitioners in supporting use of these medical devices as patients move from hospital to home testing.This study is funded by the Multidisciplinary Assessment of Technology Centre for Healthcare (MATCH) program (EPSRC grant EP/GO12393/1)

Hepatocyte-specific activation of NF-κB does not aggravate chemical hepatocarcinogenesis in transgenic mice

The NF-κB signalling pathway plays important roles in liver organogenesis and cardnogenesis. Mouse embryos deficient in IKKβ die in mid-gestation, due to excessive apoptosis of hepatoblasts. Although activation of the NF-κB signalling pathway has been demonstrated in human hepatocellular carcinoma, the role of NF-κB is controversial. Here, we have generated transgenic mice in which a constitutively active form of IKKβ was expressed in a hepatocyte-specific manner. Using electrophoretic mobility shift assay, we documented increased NF-κB activities and up-regulated levels of NF-κB downstream target genes, Bcl-xL and STAT5, in the transgenic mouse livers. These results confirmed that the NF-κB pathway was activated in the livers of the transgenic mice. However, there was no significant difference in tumour formation between transgenic and wild-type mice up to an age of 50 weeks. When we treated the transgenic mice with the chemical carcinogen diethylnitrosamine (DEN), we observed no significant differences in the incidence and size of liver tumours formed in these mice with and without DEN treatment at 35 weeks of age, suggesting that the activated NF-κB pathway in the livers of the transgenic mice did not enhance hepatocarcinogenesis. Interestingly, some of the transient transgenic embryos (E12.5) had abnormal excessive accumulation of nucleated red blood cells in their developing livers. In summary, NF-κB activation in hepatocytes did not significantly affect chemical hepatocarcinogenesis. In addition, the TTR/IKKCA transgenic mice may serve as a useful model for studying the role of NF-κB activation in hepatocarcinogenesis as well as inflammatory and metabolic diseases. Copyright © 2008 Pathological Society of Great Britain and Ireland.postprin

User needs elicitation via analytic hierarchy process (AHP). A case study on a Computed Tomography (CT) scanner

Background: The rigorous elicitation of user needs is a crucial step for both medical device design and purchasing. However, user needs elicitation is often based on qualitative methods whose findings can be difficult to integrate into medical decision-making. This paper describes the application of AHP to elicit user needs for a new CT scanner for use in a public hospital. Methods: AHP was used to design a hierarchy of 12 needs for a new CT scanner, grouped into 4 homogenous categories, and to prepare a paper questionnaire to investigate the relative priorities of these. The questionnaire was completed by 5 senior clinicians working in a variety of clinical specialisations and departments in the same Italian public hospital. Results: Although safety and performance were considered the most important issues, user needs changed according to clinical scenario. For elective surgery, the five most important needs were: spatial resolution, processing software, radiation dose, patient monitoring, and contrast medium. For emergency, the top five most important needs were: patient monitoring, radiation dose, contrast medium control, speed run, spatial resolution. Conclusions: AHP effectively supported user need elicitation, helping to develop an analytic and intelligible framework of decision-making. User needs varied according to working scenario (elective versus emergency medicine) more than clinical specialization. This method should be considered by practitioners involved in decisions about new medical technology, whether that be during device design or before deciding whether to allocate budgets for new medical devices according to clinical functions or according to hospital department

Linking notions of justice and project outcomes in carbon offset forestry projects: Insights from a comparative study in Uganda

Over the last 20 years, Uganda has emerged as a testing ground for the various modes of carbon forestry used in Africa. Carbon forestry initiatives in Uganda raise questions of justice, given that people with comparatively negligible carbon footprints are affected by land use changes initiated by the desire of wealthy people, firms, and countries to reduce their more extensive carbon footprints. This paper examines the notions of justice local people express in relation to two contrasting carbon forestry projects in Uganda, the Mount Elgon Uganda Wildlife Authority – Forests Absorbing Carbon Emissions (UWA-FACE) project and Trees for Global Benefit (TFGB). UWA-FACE closed down its initial operations at Mount Elgon after 10 years as a result of deep controversies and negative international publicity, whereas TFGB is regarded by many as an exemplary design for smallholder carbon forestry in Africa. Our approach builds upon an emerging strand in the literature, of empirical analyses of local people’s notions of justice related to environmental interventions. The main contribution of the paper is to examine how people’s notions of justice have influenced divergent project outcomes in these cases. In particular, we highlight the relative success of TFGB in the way it meets people’s primarily distributional concerns, apparently without significantly challenging prevalent expectations of recognition or procedural justice. In contrast, we illuminate how controversy across the range of justice dimensions in UWA-FACE at Mount Elgon ultimately led to the project’s decline. This paper therefore explores how attention to notions of justice can contribute to a fuller understanding of the reactions of people to carbon forestry projects, as well as the pathways and ultimate outcomes of such interventions