Studying design and use of healthcare technologies in interaction: the social learning perspective in a Dutch quality improvement collaborative program

Designing technologies is a process that relies on multiple interactions between design and use contexts. These interactions are essential to the development and establishment of technologies. This article seeks to understand the attempts of healthcare organisations to integrate use contexts into the design of healthcare technologies following insights of the theoretical approaches of social learning and user representations. We present a multiple case study of three healthcare technologies involved in improving elderly care practice. These cases were part of a Dutch quality improvement collaborative program, which urged that development of these technologies was not “just” development, but should occur in close collaboration with other parts of the collaborative program, which were more focused on implementation. These cases illustrate different ways to develop technologies in interaction with use contexts and users. Despite the infrastructure of the collaborative program, interactions were not without problems. We conclude by arguing that interactions between design and use are not naturally occurring phenomena, but must be actively organised in order to create effect

Care synthese, kwaliteit van zorg en richtlijnen in de langdurende zorg

__Abstract__ De aandacht voor kwaliteit van zorg heeft de laatste decennia een grote vlucht genomen. Ook in de langdurende zorg is er een steeds meer aandacht gekomen voor kwaliteit van zorg. In dit kwaliteitsdenken in de gezondheidszorg zijn twee tendensen zichtbaar, die elkaar voornamelijk lijken tegen te werken in plaats van elkaar aan te vullen. Deze tendensen zijn: 1) het standaardiseren van zorg en 2) cliëntgerichte zorg. In het bijzonder in de langdurende zorg, meer nog dan in de kortdurende zorg (cure) is de spanning tussen deze beide tendensen merkbaar. Dit heeft onder andere te maken met een grotere diversiteit tussen zorgvragers en het, in het algemeen langdurende karakter van de zorgrelatie, waardoor het cliëntgerichte denken intensiever vorm en inhoud krijgt. Daarentegen bieden richtlijnen handvatten om complexe zorgvragen te kunnen aanpakken. Deze care synthese onderzoekt de spanning tussen beide tendensen en kijkt waar beiden elkaar kunnen versterken, aanvullen en van elkaar kunnen leren

Reflexive Standardization and Standardized Reflexivity

Healthcare is inevitably confronted by many kinds of variation. For example, patients have multiple conditions and wish specific treatment, influencing their care trajectory as this results in different options for treatment or diagnosis (Eddy, 1984). Or different cultural backgrounds between the elderly admitted to nursing homes and their care givers result in communication differences (The, 2008). Or ranking hospitals to gain insight into the best shows substantial variation, depend-ing on who decides the order, the ranking criteria and the publisher, such as the Dutch opinion weekly Elsevier and the newspaper AD (Bal, 2014; Dijkstra & Harverkamp, 2012). Variation is found on all levels of healthcare and, as with the graffiti ex-ample, not all of it is either good or bad. Two dominant developments in healthcare, aimed at improving quality, seem on first sight to ‘stand for’ either good or unwanted variation. The first, the standardization movement seems mainly aimed at reducing unwanted variation, while the second, patient-centred care seeks to allow more individualized care and is likely to be associated with endorsing good variation. As I intend to show in this thesis, labelling variation as good or unwanted depends upon who perceives it in a particular context. The two developments of standardization and patient-centred care do not a priori resemble either ‘unwanted’ or ‘good’ variation. In the rest of this section I will explain this proposition

Studying design and use of healthcare technologies in interaction: the social learning perspective in a Dutch quality improvement collaborative program

Designing technologies is a process that relies on multiple interactions between design and use contexts. These interactions are essential to the development and establishment of technologies. This article seeks to understand the attempts of healthcare organisations to integrate use contexts into the design of healthcare technologies following insights of the theoretical approaches of social learning and user representations. We present a multiple case study of three healthcare technologies involved in improving elderly care practice. These cases were part of a Dutch quality improvement collaborative program, which urged that development of these technologies was not “just” development, but should occur in close collaboration with other parts of the collaborative program, which were more focused on implementation. These cases illustrate different ways to develop technologies in interaction with use contexts and users. Despite the infrastructure of the collaborative program, interactions were not without problems. We conclude by arguing that interactions between design and use are not naturally occurring phenomena, but must be actively organised in order to create effect

Visually guided inspiration breath-hold facilitated with nasal high flow therapy in locally advanced lung cancer

Background and purpose Reducing breathing motion in radiotherapy (RT) is an attractive strategy to reduce margins and better spare normal tissues. The objective of this prospective study (NCT03729661) was to investigate the feasibility of irradiation of non-small cell lung cancer (NSCLC) with visually guided moderate deep inspiration breath-hold (IBH) using nasal high-flow therapy (NHFT). Material and methods Locally advanced NSCLC patients undergoing photon RT were given NHFT with heated humidified air (flow: 40 L/min with 80% oxygen) through a nasal cannula. IBH was monitored by optical surface tracking (OST) with visual feedback. At a training session, patients had to hold their breath as long as possible, without and with NHFT. For the daily cone beam CT (CBCT) and RT treatment in IBH, patients were instructed to keep their BH as long as it felt comfortable. OST was used to analyze stability and reproducibility of the BH, and CBCT to analyze daily tumor position. Subjective tolerance was measured with a questionnaire at 3 time points. Results Of 10 included patients, 9 were treated with RT. Seven (78%) completed the treatment with NHFT as planned. At the training session, the mean BH length without NHFT was 39 s (range 15-86 s), and with NHFT 78 s (range 29-223 s) (p = .005). NHFT prolonged the BH duration by a mean factor of 2.1 (range 1.1-3.9s). The mean overall stability and reproducibility were within 1 mm. Subjective tolerance was very good with the majority of patients having no or minor discomfort caused by the devices. The mean inter-fraction tumor position variability was 1.8 mm (-1.1-8.1 mm;SD 2.4 mm). Conclusion NHFT for RT treatment of NSCLC in BH is feasible, well tolerated and significantly increases the breath-hold duration. Visually guided BH with OST is stable and reproducible. We therefore consider this an attractive patient-friendly approach to treat lung cancer patients with RT in BH

The effects of an 8-week mindful eating intervention on anticipatory reward responses in striatum and midbrain

IntroductionAccumulating evidence suggests that increased neural responses during the anticipation of high-calorie food play an important role in the tendency to overeat. A promising method for counteracting enhanced food anticipation in overeating might be mindfulness-based interventions (MBIs). However, the neural mechanisms by which MBIs can affect food reward anticipation are unclear. In this randomized, actively controlled study, the primary objective was to investigate the effect of an 8-week mindful eating intervention on reward anticipation. We hypothesized that mindful eating would decrease striatal reward anticipation responses. Additionally, responses in the midbrain—from which the reward pathways originate—were explored.MethodsUsing functional magnetic resonance imaging (fMRI), we tested 58 healthy participants with a wide body mass index range (BMI: 19–35 kg/m2), motivated to change their eating behavior. During scanning they performed an incentive delay task, measuring neural reward anticipation responses to caloric and monetary cues before and after 8 weeks of mindful eating or educational cooking (active control).ResultsCompared with the educational cooking intervention, mindful eating affected neural reward anticipation responses, with reduced caloric relative to monetary reward responses. This effect was, however, not seen in the striatum, but only in the midbrain. The secondary objective was to assess temporary and long-lasting (1 year follow-up) intervention effects on self-reported eating behavior and anthropometric measures [BMI, waist circumference, waist-to-hip-ratio (WHR)]. We did not observe effects of the mindful eating intervention on eating behavior. Instead, the control intervention showed temporary beneficial effects on BMI, waist circumference, and diet quality, but not on WHR or self-reported eating behavior, as well as long-lasting increases in knowledge about healthy eating.DiscussionThese results suggest that an 8-week mindful eating intervention may have decreased the relative salience of food cues by affecting midbrain but not striatal reward responses, without necessarily affecting regular eating behavior. However, these exploratory results should be verified in confirmatory research.The primary and secondary objectives of the study were registered in the Dutch Trial Register (NTR): NL4923 (NTR5025)