Using family and staff experiences of a botulinum toxin-A service to improve service quality.

BACKGROUND: The decision for families to proceed with botulinum toxin-A (BoNT-A) injections for managing childhood conditions involving hypertonia can be complex. Family-centred care is a service model that facilitates supporting families in this decision-making process. Understanding families' experiences of services is critical to developing family-centred care. The aim of this project was therefore to increase understanding of the experiences of families of children attending a BoNT-A service in order to improve the service and its family-centred approach to care. METHOD: Sixteen staff of a BoNT-A service participated in a patient journey mapping exercise. Nine families of the service participated in in-depth interviews. Interviews were audio-recorded and transcribed verbatim. Data from the staff session and interviews were analysed independently using grounded, hermeneutic thematic analysis. RESULTS: Staff sessions revealed 5 core themes that related to impacting on the family experience. Family interviews revealed 4 core themes, with 7 subthemes and 1 latent theme. CONCLUSIONS: Areas of importance identified by families relating to BoNT-A treatment included acknowledgement of individual needs, care coordination, empowerment of families and patients, consistency in service delivery, and the distressing nature of appointment and decision-making. Comparison of the data from the staff patient journey mapping and family interviews suggested that staff have a good but incomplete understanding of the factors important to families, highlighting the need for consumer engagement in establishing family-centred care. The themes identified can guide the provision of family-centred BoNT-A injection clinics.

Creating pure nanostructures from electron-beam-induced deposition using purification techniques: a technology perspective.

The creation of functional nanostructures by electron-beam-induced deposition (EBID) is becoming more widespread. The benefits of the technology include fast 'point-and-shoot' creation of three-dimensional nanostructures at predefined locations directly within a scanning electron microscope. One significant drawback to date has been the low purity level of the deposition. This has two independent causes: (1) partial or incomplete decomposition of the precursor molecule and (2) contamination from the residual chamber gas. This frequently limits the functionality of the structure, hence it is desirable to improve the decomposition and prevent the inclusion of contaminants. In this contribution we review and compare for the first time all the techniques specifically aimed at purifying the as-deposited impure EBID structures. Despite incomplete and scattered data, we observe some general trends: application of heat (during or after deposition) is usually beneficial to some extent; working in a favorable residual gas (ultra-high vacuum set-ups or plasma cleaning the chamber) is highly recommended; gas mixing approaches are extremely variable and not always reproducible between research groups; and carbon-free precursors are promising but tend to result in oxygen being the contaminant species rather than carbon. Finally we highlight a few novel approaches.