COVID-19 testing in English care homes and implications for staff and residents

Introduction: Care home residents are at high risk of dying from coronavirus disease 2019 (COVID-19). Regular testing, producing rapid and reliable results is important in this population because infections spread quickly, and presentations are often atypical or asymptomatic. This study evaluated current testing pathways in care homes to explore the role of point-of-care tests (POCTs). Methods: A total of 10 staff from eight care homes, purposively sampled to reflect care organisational attributes that influence outbreak severity, underwent a semi-structured remote videoconference interview. Transcripts were analysed using process mapping tools and framework analysis focussing on perceptions about, gaps within and needs arising from current pathways. Results: Four main steps were identified in testing: infection prevention, preparatory steps, swabbing procedure and management of residents. Infection prevention was particularly challenging for mobile residents with cognitive impairment. Swabbing and preparatory steps were resource-intensive, requiring additional staff resource. Swabbing required flexibility and staff who were familiar to the resident. Frequent approaches to residents were needed to ensure they would participate at a suitable time. After-test management varied between sites. Several homes reported deviating from government guidance to take more cautious approaches, which they perceived to be more robust. Conclusion: Swab-based testing is organisationally complex and resource-intensive in care homes. It needs to be flexible to meet the needs of residents and provide care homes with rapid information to support care decisions. POCT could help address gaps but the complexity of the setting means that each technology must be evaluated in context before widespread adoption in care homes

Equal Lives: Parenthood and Caring in the Workplace

Equal Lives reveals that men and women have very similar attitudes and desires in relation to balancing work and caring responsibilities. During 2018, over 10,000 employees told us about their experiences, attitudes and aspirations in relation to balancing professional employment with personal caring responsibilities for both children and adults. Equal Lives shows that caring responsibilities outside of work impacts how engaged employees are at work, their ability to progress and impetus to leave, as well as relationships within teams at work. It suggests that if employers are to create healthy and productive workplace cultures they will need to recognise individual employee needs and aspirations outside of work; taking steps to reduce the gap between their employees’ attitudes and the reality of day-to-day organisational behaviours. Currently, in the UK, nine in ten households with dependent children have working parents

Zebrafish Models for Dyskeratosis Congenita Reveal Critical Roles of p53 Activation Contributing to Hematopoietic Defects through RNA Processing

Dyskeratosis congenita (DC) is a rare bone marrow failure syndrome in which hematopoietic defects are the main cause of mortality. The most studied gene responsible for DC pathogenesis is DKC1 while mutations in several other genes encoding components of the H/ACA RNP telomerase complex, which is involved in ribosomal RNA(rRNA) processing and telomere maintenance, have also been implicated. GAR1/nola1 is one of the four core proteins of the H/ACA RNP complex. Through comparative analysis of morpholino oligonucleotide induced knockdown of dkc1 and a retrovirus insertion induced mutation of GAR1/nola1 in zebrafish, we demonstrate that hematopoietic defects are specifically recapitulated in these models and that these defects are significantly reduced in a p53 null mutant background. We further show that changes in telomerase activity are undetectable at the early stages of DC pathogenesis but rRNA processing is clearly defective. Our data therefore support a model that deficiency in dkc1 and nola1 in the H/ACA RNP complex likely contributes to the hematopoietic phenotype through p53 activation associated with rRNA processing defects rather than telomerase deficiency during the initial stage of DC pathogenesis

Is the LITE version of the usability metric for user experience (UMUX-LITE) a reliable tool to support rapid assessment of new healthcare technology?

Objective: To ascertain the reliability of a standardised, short-scale measure of satisfaction in the use of new healthcare technology i.e., the LITE version of the usability metric for user experience (UMUX-LITE). Whilst previous studies have demonstrated the reliability of UMUX-LITE, and its relationship with measures of likelihood to recommend a product, such as the Net Promoter Score (NPS) in other sectors no such testing has been undertaken with healthcare technology. Materials and methods: Six point-of-care products at different stages of development were assessed by 120 healthcare professionals. UMUX-LITE was used to gather their satisfaction in use, and NPS to declare their intention to promote the product. Inferential statistics were used to: i) ascertain the reliability of UMUX-LITE, and ii) assess the relationship between UMUX-LITE and NPS at different stages of products development. Results: UMUX-LITE showed an acceptable reliability (α = 0.7) and a strong positive correlation with NPS (r = 0.455, p < .001). This is similar to findings in other fields of application. The level of product development did not affect the UMUX-LITE scores, while the stage of development was a significant predictor (R2 = 0.49) of the intention to promote. Discussion and conclusion: Practitioners may apply UMUX-LITE alone, or in combination with the NPS, to complement interview and ‘homemade’ scales to investigate the quality of new products at different stages of development. This shortened scale is appropriate for use in the context of healthcare in which busy professionals have a minimal amount of time to support innovation

The Lean and Agile Multi-dimensional Process (LAMP) – a new framework for rapid and iterative evidence generation to support healthcare technology design and development

Introduction: Health technology assessments (HTA) are tools for policymaking and resource allocation. Early HTAs are increasingly used in design and development of new technologies. Conducting early HTAs is challenging, due to a lack of evidence and significant uncertainties in the technology and the market. A multi-disciplinary approach is considered essential. However, an operational framework that can enable the integration of multi-dimensional evidence into commercialization remains lacking. Areas covered: We developed the Lean and Agile Multi-dimensional Process (LAMP), an early HTA framework, for embedding commercial decision-making in structured evidence generation activities, divided into phases. Diverse evidence in unmet needs, user acceptance, cost-effectiveness, and market competitiveness are being generated in increasing depth. This supports the emergence of design and value propositions that align technology capabilities and clinical and user needs. Expert opinion: We have been applying LAMP to working with medical device and diagnostic industry in the UK. The framework can be adapted to suit different technologies, decision needs, time scales, and resources. LAMP offers a practical solution to the multi-disciplinary approach. Methodologists drive the process by performing evidence generation and synthesis as and by enabling interactions between manufacturers, designers, clinicians, and other key stakeholders

Trust and Human Factors in the Design of Healthcare Technology

Every day people use multiple technologies to perform complex tasks, such as buying products online, informing their decision making, or supporting their work activities. In many cases, as in healthcare, high risk processes are dependent on the technology to deliver the appropriate service - e.g. diagnostics outcomes, deliver treatments to patients. Hence there is a need for the users and stakeholders of healthcare technologies to trust that these produce accurate and reliable results. Research suggests that trust is: (i) a set of beliefs that a person has before they use or the experience a technology or system; (ii) built throughout the relationship between user and system, and (iii) dependent on the cumulative experience with a specific system. This paper explores the current studies on trust, and its relationship with the concept of user experience. The main contribution is to: (i) propose a definition of Trust Towards Systems (TTS) to bridge the concept of trust and experience; (ii) highlight the importance of TTS given findings for research on trust in other (non-health) settings and to show how design can be used to change perceptions of trust