Lost and misplaced items and assistive devices in nursing homes: Identifying problems and technological opportunities through participatory design research.

INTRODUCTION: Modern healthcare, including nursing home care, goes together with the use of technologies to support treatment, the provision of care and daily activities. The challenges concerning the implementation of such technologies are numerous. One of these emerging technologies are location technologies (RTLS or Real-Time Location Systems). that can be utilized in the nursing home for monitoring the use and location of assets. METHODOLOGY: This paper describes a participatory design study of RTLS based on context mapping, conducted in two nursing home organizations. Rather than investigating the technological possibilities, this study investigates the needs and wishes from the perspective of the care professional. RESULTS: The study identified semantic themes that relate to the practicalities of lost and misplaced items in the nursing home, as well as latent themes that cover the wishes regarding technology in the nursing homes. The organizational culture and building typology may play a role in losing items. CONCLUSION: The participants in this study indicated that RTLS can provide a solution to some of the challenges that they encounter in the workplace. However, the implementation of new technologies should be done with care and should be integrated into existing ICT systems in order to minimize additional training and posing a burden on the workload.

Association between motor timing and treatment outcomes in patients with alcohol and/or cocaine use disorder in a rehabilitation program.

BACKGROUND: Individuals with Substance Use Disorders (SUDs) have disruptions in the brain's dopaminergic (DA) system and the functioning of its target neural substrates (striatum and prefrontal cortex). These substrates are important for the normal processing of reward, inhibitory control and motivation. Cognitive deficits in attention, impulsivity and working memory have been found in individuals with SUDs and are predictors of poor SUD treatment outcomes and relapse in alcohol and cocaine dependence specifically. Furthermore, the DA system and accompanying neural substrates play a key role in the timing of motor acts (motor timing). Motor timing deficits have been found in DA system related disorders and more recently also in individuals with SUDs. Motor timing is found to correlate with attention, impulsivity and working memory deficits. To our knowledge motor timing, with regards to treatment outcome and relapse, has not been investigated in populations with SUDs. METHODS/DESIGN: This study aims to investigate motor timing and its relation to treatment response (at 8 weeks) and relapse (at 12 months) in cocaine and/or alcohol dependent individuals. The tested sensitivity values of motor timing parameters will be compared to a battery of neurocognitive tests, owing to the novelty of the motor task battery, the confounding effects of attention and working memory on motor timing paradigms, and high impulsivity levels found in individuals with SUDs. DISCUSSION: This research will contribute to current knowledge of neuropsychological deficits associated with treatment response in SUDs and possibly provide an opportunity to individualize and modify currently available treatments through the possible prognostic value of motor task performance in cocaine and/or alcohol dependent individuals.

A three perspective study of the sense of home of nursing home residents: the views of residents, care professionals and relatives.

BACKGROUND: The sense of home of nursing home residents is a multifactorial phenomenon which is important for the quality of living. This purpose of this study is to investigate the factors influencing the sense of home of older adults residing in the nursing home from the perspective of residents, relatives and care professionals. METHODS: A total of 78 participants (n = 24 residents, n = 18 relatives and n = 26 care professionals) from 4 nursing homes in the Netherlands engaged in a qualitative study, in which photography was as a supportive tool for subsequent interviews and focus groups. The data were analyzed based on open ended coding, axial coding and selective coding. RESULTS: The sense of home of nursing home residents is influenced by a number of jointly identified factors, including the building and interior design; eating and drinking; autonomy and control; involvement of relatives; engagement with others and activities; quality of care are shared themes. Residents and relatives stressed the importance of having a connection with nature and the outdoors, as well as coping strategies. Relatives and care professionals emphasized the role the organization of facilitation of care played, as well as making residents feel like they still matter. CONCLUSIONS: The sense of home of nursing home residents is influenced by a multitude of factors related to the psychology of the residents, and the social and built environmental contexts. A holistic understanding of which factors influence the sense of home of residents can lead to strategies to optimize this sense of home. This study also indicated that the nursing home has a dual nature as a place of residence and a place where people are supported through numerous care strategies.

Forty years of Fanger's model of thermal comfort: comfort for all?

UNLABELLED: The predicted mean vote (PMV) model of thermal comfort, created by Fanger in the late 1960s, is used worldwide to assess thermal comfort. Fanger based his model on college-aged students for use in invariant environmental conditions in air-conditioned buildings in moderate thermal climate zones. Environmental engineering practice calls for a predictive method that is applicable to all types of people in any kind of building in every climate zone. In this publication, existing support and criticism, as well as modifications to the PMV model are discussed in light of the requirements by environmental engineering practice in the 21st century in order to move from a predicted mean vote to comfort for all. Improved prediction of thermal comfort can be achieved through improving the validity of the PMV model, better specification of the model's input parameters, and accounting for outdoor thermal conditions and special groups. The application range of the PMV model can be enlarged, for instance, by using the model to assess the effects of the thermal environment on productivity and behavior, and interactions with other indoor environmental parameters, and the use of information and communication technologies. Even with such modifications to thermal comfort evaluation, thermal comfort for all can only be achieved when occupants have effective control over their own thermal environment. PRACTICAL IMPLICATIONS: The paper treats the assessment of thermal comfort using the PMV model of Fanger, and deals with the strengths and limitations of this model. Readers are made familiar to some opportunities for use in the 21st-century information society.

[An imbalance between drive and guidance. A new model for the pathogenesis of schizophrenia]. / Een disbalans tussen kracht en sturing. Een nieuw model voor de pathogenese van schizofrenie.

BACKGROUND: We still do not know how genetic and environmental factors cause schizophrenia. The pathogenesis of this illness is unknown. AIM: To develop a pathogenetic model that has greater explanatory power than the existing hypotheses concerning schizophrenia. METHOD: We searched the literature with the help of Medline (from 1966) using the search terms 'schizophrenia', 'basal ganglia', 'striatum' and 'cerebellum'. We also consulted recent manuals on schizophrenia, evolutionary psychiatry and neuroanatomy. RESULTS: The analysis showed that during the phylogenesis and ontogenesis of the brain two mechanisms, which are primarily motor-control mechanisms, are applied to the intentional level of functioning; one of these initiates and delivers power to intentions (the drive mechanism), whereas the other steers and guides intentions (the guidance mechanism). As a result of the repeated application of these two mechanisms an imbalance to the detriment of the drive mechanism in the end manifests itself as schizophrenia. The model clarifies the clinical and epidemiological findings and the course of the illness. CONCLUSION: The model provides a more comprehensive explanation for existing clinical and epidemiological data than do current alternatives. The model is compliable with the main prevailing views of psychiatrists on schizophrenia and it places the genesis of schizophrenia in an evolutionary perspective.

[Psychomotor retardation in depression assessed by visuomotor tasks. Overview and achievements of ten years' research]. / Psychomotorische vertraging bij depressie, gemeten met visuomotorische taken. Overzicht en plaatsbepaling van tien jaar onderzoek.

BACKGROUND: A new line of research into psychomotor retardation in patients with a major depressive disorder began about ten years ago. The purpose of the research was twofold: to obtain a clearer understanding of psychomotor retardation in patients with a major depressive disorder and to assess the importance of psychomotor retardation for the diagnosis and treatment. AIM: To present an overview of the results of these studies in which psychomotor retardation of these patients was investigated. METHOD: The patients had to perform visuomotor tasks involving pen movements. The psychomotor retardation was measured by recording their pen movements objectively and accurately by means of a computer and digitiser. RESULTS: Patients with major depressive disorder showed pronounced psychomotor retardation in the visuomotor tasks. The psychomotor retardation appeared to be of both a cognitive and motor nature. The treatment study which examined the effect of fluoxetine on psychomotor retardation revealed that the cognitive retardation disappeared but the motor retardation remained. It was particularly the more retarded patient who responded well to fluoxetine. The research that compared the psychomotor retardation in various subtypes of depression revealed that patients with major depressive disorder showed pronounced retardation but dysthymic patients did not show any retardation. Psychomotor retardation was more severe in patients with major depressive disorder with melancholic features. CONCLUSION: Psychomotor retardation can play an important role in the diagnosis and treatment of depressive disorders.

The Factors Influencing the Sense of Home in Nursing Homes: A Systematic Review from the Perspective of Residents.

Purpose. To provide an overview of factors influencing the sense of home of older adults residing in the nursing home. Methods. A systematic review was conducted. Inclusion criteria were (1) original and peer-reviewed research, (2) qualitative, quantitative, or mixed methods research, (3) research about nursing home residents (or similar type of housing), and (4) research on the sense of home, meaning of home, at-homeness, or homelikeness. Results. Seventeen mainly qualitative articles were included. The sense of home of nursing home residents is influenced by 15 factors, divided into three themes: (1) psychological factors (sense of acknowledgement, preservation of one's habits and values, autonomy and control, and coping); (2) social factors (interaction and relationship with staff, residents, family and friends, and pets) and activities; and (3) the built environment (private space and (quasi-)public space, personal belongings, technology, look and feel, and the outdoors and location). Conclusions. The sense of home is influenced by numerous factors related to the psychology of the residents and the social and built environmental contexts. Further research is needed to determine if and how the identified factors are interrelated, if perspectives of various stakeholders involved differ, and how the factors can be improved in practice.

Losing Items in the Psychogeriatric Nursing Home: The Perspective of Residents and Their Informal Caregivers.

Introduction: Losing items is a time-consuming occurrence in nursing homes that is ill described. An explorative study was conducted to investigate which items got lost by nursing home residents, and how this affects the residents and family caregivers. Method: Semi-structured interviews and card sorting tasks were conducted with 12 residents with early-stage dementia and 12 family caregivers. Thematic analysis was applied to the outcomes of the sessions. Results: The participants stated that numerous personal items and assistive devices get lost in the nursing home environment, which had various emotional, practical, and financial implications. Significant amounts of time are spent on trying to find items, varying from 1 hr up to a couple of weeks. Numerous potential solutions were identified by the interviewees. Discussion: Losing items often goes together with limitations to the participation of residents. Many family caregivers are reluctant to replace lost items, as these items may get lost again.

Aspects of seat modelling for seating comfort analysis.

The development of more comfortable seats is an important issue in the automotive industry. However, the development of new car seats is very time consuming and costly since it is typically based on experimental evaluation using prototypes. Computer models of the human-seat interaction could accelerate this process. The objective of this paper is to establish a protocol for the development of seat models using numerically efficient simulation techniques. The methodology is based on multi-body techniques: arbitrary surfaces, providing an accurate surface description, are attached to rigid bodies. The bodies are connected by kinematic joints, representing the seat back recliner and head restraint joint. Properties of the seat foam and frame have been lumped together. Further, experiments have been defined to characterise the mechanical properties required for the seat model for comfort applications. The protocol has been exemplified using a standard car seat. The seat model has been validated based on experiments with rigid loading devices with human-like shapes in terms of force-deflection characteristics. The response of the seat model agrees well with the experimental results. Therefore the presented method can be a useful tool in the seat development process, especially in early stages of the design process.

Picture Your Nursing Home: Exploring the Sense of Home of Older Residents through Photography.

The quality of the built environment can impact the quality of life and the sense of home of nursing home residents. This study investigated (1) which factors in the physical and social environment correlate with the sense of home of the residents and (2) which environmental factors are most meaningful. Twelve participants engaged in a qualitative study, in which photography was as a supportive tool for subsequent interviews. The data were analysed based on the six phases by Braun and Clarke. The four themes identified are (1) the physical view; (2) mobility and accessibility; (3) space, place, and personal belongings; and (4) the social environment and activities. A holistic understanding of which features of the built environment are appreciated by the residents can lead to the design and retrofitting of nursing homes that are more in line with personal wishes.

Exploring Innovative Solutions for Quality of Life and Care of Bed-Ridden Nursing Home Residents through Codesign Sessions.

Bed-ridden nursing home residents are in need of environments which are homelike and facilitate the provision of care. Design guidance for this group of older people is limited. This study concerned the exploration and generation of innovative environmental enrichment scenarios for bed-ridden residents. This exploration was conducted through a combination of participatory action research with user-centred design involving 56 professional stakeholders in interactive work sessions. This study identified numerous design solutions, both concepts and products that are available on the marketplace and that on a higher level relate to improvements in resident autonomy and the supply of technological items and architectural features. The methodology chosen can be used to explore the creative potential of stakeholders from the domain of healthcare in product innovation.

Immunological parameters during treatment with ditiocarb (Imuthiol).

OBJECTIVES: To examine the effect of ditiocarb (DTC) treatment on immunological parameters of HIV infection. Immunophenotyping included CD4+ T-cell counting and the analysis of activation markers on CD8+ T cells. Anti-CD3-induced proliferation and anti-CD3-mediated cytotoxicity were monitored as indexes of T-cell function. In addition to the clinical evolution, HIV antigen and anti-p24 levels were monitored during treatment. DESIGN: In this double-blind, placebo-controlled study, 50 HIV-seropositive patients belonging to all clinical disease stages were randomized to treatment with DTC or placebo and followed for 4 months. METHODS: Immunophenotyping on whole blood was performed by flow cytometry, using combinations of anti-CD8 with anti-CD4, anti-HLA-DR, anti-CD38, anti-CD45RO and anti-CD57. Patient lymphocytes were freshly assayed for cytolytic capacity against OKT3-coated targets. T-cell proliferation was measured after 3 days of OKT3-stimulation. RESULTS: No effect was observed on CD4 and CD8+ T-cell counts or on CD8+ T-cell activation markers, except for a selective increase in HLA-DR expressing CD8 cells in the DTC-treated group. Decline in anti-CD3-induced T-cell proliferation and rise in anti-CD3-mediated T-cell cytotoxicity were observed in the DTC and placebo groups. No effect on HIV antigen and anti-p24 antibody titres was observed. The incidence of clinical complications was similar in each group. CONCLUSION: No beneficial immunomodulatory effect of DTC was demonstrated.

Haloperidol and cognitive shifting.

In this study haloperidol appeared to affect the performance on a selected category of cognitive tasks considered to represent shifting aptitude. A pretest--post-test design was used with two groups of subjects: 17 patients suffering from idiopathic spasmodic torticollis, and 17 controls who were matched for age and intelligence. The results are discussed in relation to previous findings on haloperidol and cognition, shifting disorder in Parkinson's disease and changes in behavioural organization found in animals with an experimentally induced dopaminergic hypoactivity.

On the presence of proteolytic activity in glycosaminoglycan-degrading enzyme preparations.

A solid-phase protease assay has been used to screen different commercial preparations of glycosaminoglycan-degrading enzymes for the presence of proteolytic activity. Proteases cannot be detected in preparations of testicular hyaluronidase and of chondroitinase at the concentration used for histochemical purposes. Commercial Streptomyces hyaluronidase contains proteolytic contaminants detectable at the concentration used for histochemistry. At higher concentrations, all preparations appear to be contaminated with proteases. The results obtained using this assay suggest that addition of a mixture of proteinase inhibitors containing N-ethylmaleimide, EDTA, pepstatin, and phenylmethanesulfonylfluoride or soybean trypsin inhibitor has little effect on the proteolytic activity of the glycosaminoglycan-degrading enzyme preparations, irrespective of the pH used. Moreover, the use of EDTA in this mixture is questionable. This study also describes two testicular hyaluronidase preparations that may be particularly useful in functional studies of the living organism, as they are only slightly contaminated.

Psychomotor slowing and planning deficits in schizophrenia.

The relative contribution of cognitive and motor processing to psychomotor slowing in schizophrenia was investigated using three tasks: a simple line-copying task and a more complex figure-copying task, both following a reaction paradigm, and a standard psychomotor test, the Digit Symbol Test (DST). Various movement variables of the task performances were derived from recordings made with the aid of a digitizing tablet. The patients with schizophrenia appeared to be about one-third slower in their total performance time on all three tasks when compared with healthy controls, which suggests a general psychomotor slowing in this group. When itemized over the various movement variables, this slowing was found in both initiation time and movement time in the copying tasks and in the DST in the time to match the symbol and the digit, but not in writing the digit. Furthermore, in the figure-copying task it was found that increased figure complexity or decreased familiarity prolonged the initiation time. These latency increases were not significantly larger for the schizophrenia group as a whole, but only for a subgroup of patients with higher scores on negative symptoms. Regarding reinspection time, the effects of familiarity were larger in the schizophrenia group as a whole. These group findings suggest that patients tend to plan their actions less in advance, which, in the case of the more complex or unfamiliar task conditions, is a less sophisticated planning strategy. Given the longer latencies in patients with more severe negative symptoms, it seems that these patients have problems with turning a plan into action. The present study provides evidence of psychomotor slowing and planning deficits in schizophrenia.

Development of a multiplex PCR assay for the simultaneous detection and identification of Arcobacter butzleri, Arcobacter cryaerophilus and Arcobacter skirrowii.

A multiplex PCR assay with five primers targeting the 16S and 23S rRNA genes was developed for the simultaneous detection and identification of Arcobacter butzleri, Arcobacter cryaerophilus and Arcobacter skirrowii. The selected primers amplify a 257-bp fragment from A. cryaerophilus, a 401-bp fragment from A. butzleri and a 641-bp fragment from A. skirrowii. No PCR product was generated for closely related bacteria including Campylobacter and Helicobacter species. The assay was useful to identify cultures after in vitro cultivation and to detect and identify A. butlzeri and A. cryaerophilus from poultry samples present in 24-h old enrichment in Arcobacter broth with cefoperazone, amphotericin and teicoplanin (CAT)-supplement.

Fine motor retardation and depression.

New computerized techniques allow the precise measurement of psychomotor retardation in patients with a major depressive episode (MDE). One such technique is the analysis of writing and drawing behaviour during figure copying tasks. In the present study, 22 inpatients with an MDE were compared to 22 normal controls. Three tasks were used: the drawing of lines and simple figures, the copying of complex figures and a task in which figures had to be rotated. Objectives were to provide support for earlier findings that the patients were slower than the controls and to explore the cognitive and motor processes involved. Two strategies were applied: analysis of the reaction time and movement time and their different components, and manipulation of the cognitive and motor demands. Patients showed considerable retardation with most of the kinematic variables. Motor deficits and cognitive slowing down contributed to this retardation. Cognitive difficulties increased with increasing complexity of the task.

Differentiation of cognitive and motor slowing in the Digit Symbol Test (DST): differences between depression and schizophrenia.

Schizophrenia and depression have an overlap in symptomatology, namely a slowing in both motor and mental activities, denoted in depression as 'psychomotor retardation' and in schizophrenia as 'psychomotor poverty'. By means of a new technique that allows the measurement of psychomotor speed and the computerized analysis of writing movements recorded during the performance of the Digit Symbol Test, it indeed proved to be possible to observe a slowing in both disorders. In addition, a different structure of slowing in the two patient groups could be identified.

Spasmodic torticollis: the problem of pathophysiology and assessment.

In 17 patients with idiopathic spasmodic torticollis (ST) quantitative indices for both signs (extent and direction of the head deflexions) and complaints (of deflexion, shaking and pain) were collected. In the literature deflexion in the horizontal plane is most frequently considered, but analysis of the data shows that deflexion in the coronal and sagittal planes is also important. Furthermore, it is found that especially the deflexions in the coronal and sagittal plane covariate with the patients' complaints, but not with horizontal deflexion. On the basis of these and related data, it is suggested that we are dealing with at least two subtypes of ST. Finally, the patient's neuroticism and depression scale values are within the normal range and do not show significant correlations with ST duration. The present study provides no evidence that ST is a psychogenic disorder. ST should be regarded as a central nervous system disorder of unknown aetiology.

Figure drawing and psychomotor retardation: preliminary report.

Psychomotor retardation, a general slowing of activity which is one of the central characteristics of depression, was investigated by measuring reaction time and movement duration in drawing tasks. Twenty depressive patients and 20 normal controls participated in two tasks in which either simple or more complex figures had to be copied as fast as possible on a digitizer. In general, patients needed more time to complete the drawing tasks than controls, and they performed them differently. Six patients, who could be tested before and after treatment, showed changes in drawing speed that correlated with clinical improvement. These results suggest that psychomotor retardation might be fruitfully studied by measuring the kinematic aspects of drawing and might provide objective parameters to measure progress in therapy.