Purpose: The aims of this study were to investigate how a variety of research methods is commonly employed to study technology and practitioner cognition. User-interface issues with infusion pumps were selected as a case because of its relevance to patient safety. Methods: Starting from a Cognitive Systems Engineering perspective, we developed an Impact Flow Diagram showing the relationship of computer technology, cognition, practitioner behavior, and system failure in the area of medical infusion devices. We subsequently conducted a systematic literature review on user-interface issues with infusion pumps, categorized the studies in terms of methods employed, and noted the usability problems found with particular methods. Next, we assigned usability problems and related methods to the levels in the Impact Flow Diagram. Results: Most study methods used to find user interface issues with infusion pumps focused on observable behavior rather than on how artifacts shape cognition and collaboration. A concerted and theorydriven application of these methods when testing infusion pumps is lacking in the literature. Detailed analysis of one case study provided an illustration of how to apply the Impact Flow Diagram, as well as how the scope of analysis may be broadened to include organizational and regulatory factors. Conclusion: Research methods to uncover use problems with technology may be used in many ways, with many different foci. We advocate the adoption of an Impact Flow Diagram perspective rather than merely focusing on usability issues in isolation. Truly advancing patient safety requires the systematic adoption of a systems perspective viewing people and technology as an ensemble, also in the design of medical device technology.
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Of all patients in a hospital environment, trauma patients may be particularly at risk for developing (device-related) pressure ulcers (PUs), because of their traumatic injuries, immobility, and exposure to immobilizing and medical devices. Studies on device-related PUs are scarce. With this study, the incidence and characteristics of PUs and the proportion of PUs that are related to devices in adult trauma patients with suspected spinal injury were described. From January–December 2013, 254 trauma patients were visited every 2 days for skin assessment. The overall incidence of PUs was 28⋅3% (n = 72/254 patients). The incidence of device-related PUs was 20⋅1% (n = 51), and 13% (n = 33) developed solely device-related PUs. We observed 145 PUs in total of which 60⋅7% were related to devices (88/145). Device-related PUs were detected 16 different locations on the front and back of the body. These results show that the incidence of PUs and the proportion of device-related PUs is very high in trauma patients
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Aims: Prescribing errors among junior doctors are common in clinical practice because many lack prescribing competence after graduation. This is in part due to inadequate education in clinical pharmacology and therapeutics (CP&T) in the undergraduate medical curriculum. To support CP&T education, it is important to determine which drugs medical undergraduates should be able to prescribe safely and effectively without direct supervision by the time they graduate. Currently, there is no such list with broad-based consensus. Therefore, the aim was to reach consensus on a list of essential drugs for undergraduate medical education in the Netherlands. Methods: A two-round modified Delphi study was conducted among pharmacists, medical specialists, junior doctors and pharmacotherapy teachers from all eight Dutch academic hospitals. Participants were asked to indicate whether it was essential that medical graduates could prescribe specific drugs included on a preliminary list. Drugs for which ≥80% of all respondents agreed or strongly agreed were included in the final list. Results: In all, 42 (65%) participants completed the two Delphi rounds. A total of 132 drugs (39%) from the preliminary list and two (3%) newly proposed drugs were included. Conclusions: This is the first Delphi consensus study to identify the drugs that Dutch junior doctors should be able to prescribe safely and effectively without direct supervision. This list can be used to harmonize and support the teaching and assessment of CP&T. Moreover, this study shows that a Delphi method is suitable to reach consensus on such a list, and could be used for a European list.
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Nowadays, there is particular attention towards the additive manufacturing of medical devices and instruments. This is because of the unique capability of 3D printing technologies for designing and fabricating complex products like bone implants that can be highly customized for individual patients. NiTi shape memory alloys have gained significant attention in various medical applications due to their exceptional superelastic and shape memory properties, allowing them to recover their original shape after deformation. The integration of additive manufacturing technology has revolutionized the design possibilities for NiTi alloys, enabling the fabrication of intricately designed medical devices with precise geometries and tailored functionalities. The AM-SMART project is focused on exploring the suitability of NiTi architected structures for bone implants fabricated using laser powder bed fusion (LPBF) technology. This is because of the lower stiffness of NiTi alloys compared to Ti alloys, closely aligning with the stiffness of bone. Additionally, their unique functional performance enables them to dissipate energy and recover the original shape, presenting another advantage that makes them well-suited for bone implants. In this investigation, various NiTi-based architected structures will be developed, featuring diverse cellular designs, and their long-term thermo-mechanical performance will be thoroughly evaluated. The findings of this study underscore the significant potential of these structures for application as bone implants, showcasing their adaptability for use also beyond the medical sector.
In revalidatie-behandelteams zijn ergotherapeuten de ‘primus inter pares’ voor advisering over hulpmiddelen; hulpmiddelen die mensen met beperkingen ondersteunen bij activiteiten in zelfverzorging, onderwijs, spel, arbeid en wonen. Behoud van deze expertrol vraagt van ergotherapeuten om de nieuwste technologieën te integreren in de praktijk. Een snelgroeiende ontwikkeling betreft technologie waarmee men zelfhulpmiddelen kan ontwikkelen, maken of aanpassen. Zogenaamde do-it-yourself-technologie (DIY) met 3D-printing als bekendste voorbeeld. Revalidatie-ergotherapeuten van Adelante, Libra en Sevagram willen met DIY-technologie aan de slag om hulpmiddelen meer op maat, goedkoper en sneller te vervaardigen in nauwe samenwerking met hun cliënten. Onduidelijk is echter hoe een revalidatiedienst met DIY-technologie eruit kan zien, hoe deze in te bedden is in de dagelijkse praktijk, en hoe doorontwikkeling bewerkstelligd kan worden. Maken van hulpmiddelen met DIY-technologie past bij de identiteit van de ergotherapeut, maar vraagt om nieuwe werkwijzen en samenwerkingsverbanden om nieuwe kennis over techniek, ontwerpen en over materialen. Daarnaast spelen vragen van medische, financiële, ethische en juridische aard een rol. Met de ergotherapeuten kwamen we tot de volgende hoofdvraag: Hoe maken we als ergotherapeuten DIY-technologie, zoals 3D-printen, tot een integraal onderdeel van onze praktijk om met onze cliënten tot maatwerk-hulpmiddelen te komen? Deze vraag wordt binnen de drie centra, in vier fasen (analyse, design/testen, implementatie, doorontwikkeling) opgepakt met actieonderzoek als centrale methode en een diversiteit aan kwalitatieve en kwantitatieve manieren van gegevensverzameling. Partners in deze projectaanvraag (revalidatie-professionals, kennisinstellingen, brancheorganisaties, cliëntenorganisaties en ondernemers) zijn overtuigd dat DIY-technologie meerwaarde biedt voor het aanbod aan hulpmiddelen en invloed heeft op de eigen regie en participatie van cliënten. Met ondersteuning van hun uitgebreide expertise wordt de nieuwe dienst beschreven en wordt een toolbox DIY-technologie ontwikkeld en geïmplementeerd. Ook wordt een database voor zelfgemaakte hulpmiddelen en een DIY-community gerealiseerd. Deze kennis wordt gebruikt in het onderwijs van ergotherapie, Healthcare Engineering en Communication and Multimedia-Design.
In this project, the AGM R&D team developed and refined the use of a facial scanning rig. The rig is a physical device comprising multiple cameras and lighting that are mounted on scaffolding around a 'scanning volume'. This is an area at which objects are placed before being photographed from multiple angles. The object is typically a person's head, but it can be anything of this approximate size. Software compares the photographs to create a digital 3D recreation - this process is called photogrammetry. The 3D model is then processed by further pieces of software and eventually becomes a face that can be animated inside in Unreal Engine, which is a popular piece of game development software made by the company Epic. This project was funded by Epic's 'Megagrant' system, and the focus of the work is on streamlining and automating the processing pipeline, and on improving the quality of the resulting output. Additional work has been done on skin shaders (simulating the quality of real skin in a digital form) and the use of AI to re/create lifelike hair styles. The R&D work has produced significant savings in regards to the processing time and the quality of facial scans, has produced a system that has benefitted the educational offering of BUas, and has attracted collaborators from the commercial entertainment/simulation industries. This work complements and extends previous work done on the VIBE project, where the focus was on creating lifelike human avatars for the medical industry.
