Social connectedness through ICT and the influence on wellbeing: the case of the CareRabbit

The CareRabbit has been introduced as a technological innovation in the care for children, enabling family and friends to stay in touch while the child is\ud hospitalized. This study addresses influence of this innovation on the wellbeing of the children, and uses the validated KINDL questionnaire, eliciting information from children and parents at the end of hospitalization. A baseline and an experimental measurement are compared. The children in the CareRabbit group scored slightly higher on the KINDL questionnaire than children in the control group. For young children (age 4-7) the difference was large. Initial findings indicate that CareRabbit has a positive influence on wellbeing, although sample size and measured differences limit the support for this conclusion. The measured difference suggests that CareRabbit may be more valuable for younger children

Exploring the issues in knowledge management

This paper introduces a general, formal treatment of dynamic constraints, i.e., constraints on the state changes that are allowed in a given state space. Such dynamic constraints can be seen as representations of "real world" constraints in a managerial context. The notions of transition, reversible and irreversible transition, and transition relation will be introduced. The link with Kripke models (for modal logics) is also made explicit. Several (subtle) examples of dynamic constraints will be given. Some important classes of dynamic constraints in a database context will be identified, e.g. various forms of cumulativity, non-decreasing values, constraints on initial and final values, life cycles, changing life cycles, and transition and constant dependencies. Several properties of these dependencies will be treated. For instance, it turns out that functional dependencies can be considered as "degenerated" transition dependencies. Also, the distinction between primary keys and alternate keys is reexamined, from a dynamic point of view.

Niche development after caesarean section:Impact and preventive strategies

Chapter 1 provides an introduction on niches after caesarean section (CS). A niche can be the result of impaired healing of the uterus and may have clinical consequences for subsequent pregnancies, but could also result in menstrual disorders or fertility-related problems. Chapter 2 presents a qualitative study with patients who were treated for niche-related problems. Fifteen themes were reported in four domains (physical, psychological, social and environment). 3/5 prioritized themes were studied in literature very often: abnormal uterine bleeding, subfertility and abdominal pain. However, 2/5 of the prioritized themes were hardly studied in literature: sexuality and (lack of) self-esteem. In chapter 3 we present the results of a study in which we assessed the changes in QoL after a laparoscopic niche resection. After one year, the subdomains bodily pain, mental health and social functioning improved statistically significantly. Women with ‘symptom relief’ as main goal of the intervention benefit more from laparoscopic niche resection in terms of physical health than women with ‘restoring anatomy’ as main goal of the intervention. Chapter 4 is a comment on a systematic review. Chapter 5 presents the results of a systematic review and meta-analysis. We included 20 studies on three variations in uterine closure technique. Double-layer closure and unlocked suturing resulted in a thicker residual myometrium compared to single-layer closure and locked suturing. Inclusion of the decidua resulted in a lower prevalence of large niches. We concluded that double-layer unlocked uterine closure including the decidua could possibly result in better sonographic outcomes. Long-term clinical outcomes were reported very infrequently. Chapter 6 describes the study protocol for the evaluation of the (cost-)effectiveness of double- versus single-layer uterine closure after a first CS: the 2Close study, a multicenter, randomised controlled superiority trial. Women aged over 18 years who underwent a first planned or unplanned CS were assessed for eligibility. We calculated that 2290 women had to be included to show superiority. We randomised women to single-layer unlocked closure with the decidua in- or excluded in the suture, or double-layer unlocked closure including the decidua. Chapter 7 presents the results of the 2Close study. 2292 women were included and randomised to single-layer (n=1144) or double-layer closure (n=1148). The mean number of postmenstrual spotting days was not different at 9 months follow-up. Operative time was slightly shorter, and niche prevalence was slightly lower after single-layer closure. Quality of life and sexual functioning did not differ between groups. Since we observed no difference in prevalence of large niches and residual myometrium thickness, we do not expect long-term outcomes to be different. However, this has to be confirmed in our long-term follow-up after three years. Based on our results, we concluded that none of the techniques should be advocated in clinical guidelines. In chapter 8 the results of the cost-effectiveness analysis are described. Total societal costs and total healthcare costs were not different between groups. Additionally, the cost utility analysis showed that double-layer closure did not improve quality-adjusted life-years (QALY). The probability of the intervention being cost-effective compared with standard care was low. We concluded that there is no reason to advocate double-layer closure in any clinical guideline. Chapter 9 describes the development and internal validation of a prediction model for the development of a niche. We describe univariate analysis of these factors on the outcome ‘niche’ (indentation ≥2 mm). The strongest predictors were gestational age, twin pregnancy, double-layer closure, less surgical experience, smoking (risk factors) and multiparity and vicryl suture material (protective factors). It remains very difficult to predict who will develop a niche and who will not and we have probably not taken into account all possible predictors

Towards a better understanding of the e-health user: comparing USE IT and Requirements study for an Electronic Patient Record.

This paper compares a traditional requirements study with 22 interviews for the design of an electronic patient record (EPR) and a USE IT analysis with 17 interviews trying to understand the end- user of an EPR. Developing, implementing and using information technology in organizations is a complex social activity. It is often characterized by ill-defined problems or vague goals, conflicts and disruptions that result from organizational change. Successfully implementing information systems in healthcare organizations appears to be a difficult task. Information Technology is regarded as an enabler of change in healthcare organizations but (information) technology adoption decisions in healthcare are complex, because of the uncertainty of benefits and the rate of change of technology. (Job) Relevance is recognized as an important determinant for IS success but still does not find its way into a systems design process

CONCEPTUAL MODELING AND CLUSTER ANALYSIS: DESIGN STRATEGIES FOR INFORMATION ARCHITECTURES

An information architecture (IA) specification is given for a dutch organization, the CBR (Central Bureau for certificates of driving proficiency). A discussion of the specification process shows that other issues are taken into account than those tackled by the information planning method used. However, this is done in an informal and intuitive manner. We argue that the specification of alternative information architectures can give a more solid basis to this process. In order to generate these alternative architectures, various design strategies are needed. A generalization of design strategies can be found in cluster analysis. The application of cluster analysis calls for an appropriate problem representation. This is achieved by using a model hierarchy as a conceptual model of the data being handled in an information planning process. The model hierarchy also serves as the basis of a decision support system for information architecture specification, which is described briefly. To demonstrate the feasibility of our approach, we compare the original CBR architecture with an information architecture generated by the decision support system. It turns out that the new architecture performs better with respect to the decentralization perspective of the organization