Background: Non-technical errors, such as insufficient communication or leadership, are a major cause of medical failures during trauma resuscitation. Research on staffing variation among trauma teams on teamwork is still in their infancy. In this study, the extent of variation in trauma team staffing was assessed. Our hypothesis was that there would be a high variation in trauma team staffing. Methods: Trauma team composition of consecutive resuscitations of injured patients were evaluated using videos. All trauma team members that where part of a trauma team during a trauma resuscitation were identified and classified during a one-week period. Other outcomes were number of unique team members, number of new team members following the previous resuscitation and new team members following the previous resuscitation in the same shift (Day, Evening, Night). Results: All thirty-two analyzed resuscitations had a unique trauma team composition and 101 unique members were involved. A mean of 5.71 (SD 2.57) new members in teams of consecutive trauma resuscitations was found, which was two-third of the trauma team. Mean team members present during trauma resuscitation was 8.38 (SD 1.43). Most variation in staffing was among nurses (32 unique members), radiology technicians (22 unique members) and anesthetists (19 unique members). The least variation was among trauma surgeons (3 unique members) and ER physicians (3 unique members). Conclusion: We found an extremely high variation in trauma team staffing during thirty-two consecutive resuscitations at our level one trauma center which is incorporated in an academic teaching hospital. Further research is required to explore and prevent potential negative effects of staffing variation in trauma teams on teamwork, processes and patient related outcomes.
Ambient intelligence technologies are a means to support ageing-in-place by monitoring clients in the home. In this study, monitoring is applied for the purpose of raising an alarm in an emergency situation, and thereby, providing an increased sense of safety and security. Apart from these technological solutions, there are numerous environmental interventions in the home environment that can support people to age-in-place. The aim of this study was to investigate the needs and motives, related to ageing-in-place, of the respondents receiving ambient intelligence technologies, and to investigate whether, and how, these technologies contributed to aspects of ageing-in-place. This paper presents the results of a qualitative study comprised of interviews and observations of technology and environmental interventions in the home environment among 18 community-dwelling older adults with a complex demand for care.
Dit proefschrift presenteert twee theoretische kaders voor het ontwerpen van games en beschrijft hoe game designers deze kunnen inzetten om het game ontwerpproces te stroomlijnen. Er bestaan op dit moment meerdere ontwerptheorie¨en voor games, maar geen enkele kan rekenen op een breed draagvlak binnen de game industrie. Vooral academische ontwerptheorie¨en hebben regelmatig een slechte reputatie. Het eerste kader dat game designers inzicht biedt in spelregels en hun werking heet Machinations en maakt gebruik van dynamische, interactieve diagrammen. Het tweede theoretische kader van dit proefschrift, Mission/Space, richt zich op level-ontwerp en spelmechanismen die de voortgang van een speler bepalen. In tegenstelling tot bestaande modellen voor level-ontwerp, bouwt Mission/Space voort op het idee dat er in een level twee verschillende structuren bestaan. Mission-diagrammen worden gebruikt om de structuur van taken en uitdagingen voor de speler te formaliseren, terwijl space-diagrammen de ruimtelijke constructie formaliseren. Beide constructies zijn aan elkaar gerelateerd, maar zijn niet hetzelfde. De verschillende wijzen waarop missies geprojecteerd kunnen worden op een bepaalde ruimte speelt uiteindelijk een belangrijke rol in de totstandkoming van de spelervaring.
