Prioritized strategies to improve diagnosis and early management of cerebral palsy for both Maori and non-Maori families.

AIM: To identify prioritized strategies to support improvements in early health service delivery around the diagnosis and management of cerebral palsy (CP) for both Maori and non-Maori individuals. METHOD: Using a participatory approach, health care professionals and the parents of children with CP attended co-design workshops on the topic of early diagnosis and management of CP. Health design researchers facilitated two 'discovery' (sharing experiences and ideas) and two 'prototyping' (solution-focused) workshops in Aotearoa, New Zealand. A Maori health service worker co-facilitated workshops for Maori families. RESULTS: Between 7 and 13 participants (14 health care professionals, 12 parents of children with CP across all functional levels) attended each workshop. The discovery workshops revealed powerful stories about early experiences and needs within clinician-family communication and service provision. The prototyping workshops revealed priorities around communication, and when, what, and how information is provided to families; recommendations were co-created around what should be prioritized within a resource to aid health care navigation. INTERPRETATION: There is a critical need for improved communication, support, and guidance, as well as education, for families navigating their child with CP through the health care system. Further input from families and health care professionals partnering together will continue to guide strategies to improve health care service delivery using experiences as a mechanism for change.

Patients' perspectives on digital health tools.

Objective: Digital technology has changed the way healthcare is delivered and accessed. However, the focus is mostly on technology and clinical aspects. This review aimed to integrate and critically analyse the available knowledge regarding patients' perspectives on digital health tools and identify facilitators and barriers to their uptake. Methods: A narrative review was conducted using the Scopus and Google Scholar databases. Information related to facilitators and barriers to uptake was synthesised and interpreted using thematic and content analyses, respectively. Results: Seventy-one out of 1722 articles identified were eligible for inclusion. Patient empowerment, self-management, and personalisation were identified as the main factors that contributed to patient uptake in using digital health tools. Digital literacy, health literacy, and privacy concerns were identified as barriers to the uptake of digital health technology. Conclusion: Digital health technologies have changed the way healthcare is experienced by patients. Research highlights the disconnect between the development and implementation of digital health tools and the patients they are created for. This review may serve as the foundation for future research incorporating patients' perspectives to help increase patients' engagement with emerging technologies. Innovation: Participatory design approaches have the potential to support the creation of patient-centred digital health tools.

Ethical and practical challenges of conducting art-based research with children/young people in the public space of a children's outpatient department.

This article examines the ethical and practical challenges of undertaking a study using art-based methods with children/young people. It is argued that an important component of qualitative research and research with children/young people is researcher reflexivity and flexibility, particularly when the anticipated and actual implemented methods of a study differ. We draw on a study with 175 children/young people aged 5-16 years in a children's outpatients department where 'draw-and-tell' and 'letter writing' were used to elicit children/young people's perceptions of the outpatient environment. The challenges that arose during the study are critically reflected on including recruitment, the physical and social environment, time restrictions and interviewing. Recommendations for researchers using art-based methods to carry out research with children/young people are offered.

Background soundscapes influence the perception of ice-cream as indexed by electrophysiological measures.

Listening to specific soundscapes can influence multisensory flavour perception. In the present study, changes in people's perception of the flavour of ice-cream were tracked over time as they listened to a café soundscape, and when this soundscape was overlaid with either bird, machine, or forest soundscapes. In addition, emotions and electrophysiological measures were recorded in order to help understand any changes in taste/flavour perception. The results of Temporal Dominance of Sensation (TDS) analysis revealed that cocoa was dominant early in the consumption episode while listening to the control café soundscape. Sweetness and creaminess were dominant at the start of the consumption episode while listening to the café-forest soundscape. Creaminess was dominant at the start of the consumption episode while listening to the café-bird soundscape. Bitterness was perceived at the end of the consumption period while listening to the café control and café-machine soundscapes. These findings demonstrate the crossmodal influence of audition on perception in the chemical senses. As expected, negative emotions were significantly higher when listening to the machine soundscape, while positive emotions were significantly higher when listening to café-forest and café-bird soundscapes. Evaluating ice-cream while listening to the café-machine soundscape evoked negative emotions associated with bitterness and creaminess, that were also associated with increased heart rate (HR) and respiration rate (RESP). When listening to the café-forest soundscape, ice-cream was associated with sweetness, and positive emotions (e.g., love, satisfaction, happiness, amusement and enjoyment). This might have led to increased blood volume pulse (BVP) amplitude, which is itself indicative of a relaxed state. Enhancing eating experiences by means of atmospheric soundscapes that are designed specifically to accentuate specific aspects of multisensory taste/flavour perception is currently an area of interest in the food sciences literature and will likely lead to future commercial applications.

The use of a poster to reduce expectations to receive antibiotics for a common cold.

Many doctors prescribe antibiotics for a cold, to meet patient's expectations. As a result, patient's education about antibiotics and antibiotic resistance forms a major component of the WHO's Global Action Plan on Antimicrobial Resistance. However, it is not known whether simple educational material can change a person's attitudes about antibiotic therapy. We designed three posters about antibiotic treatment for "cold and flu". Hospital inpatients answered a baseline survey and then were asked to look at one of three randomly selected posters. The posters highlighted the futility of antibiotic treatment for colds (futility), the risk of adverse drug reactions from antibiotics (harm), and the issue of antimicrobial resistance (resistance). Participants then completed a follow-up survey. Participants' expectations to receive antibiotics for a "bad cold" reduced significantly after viewing a poster (82/299, 27% expected antibiotics in the baseline survey compared with 13% in the follow-up survey, P < 0.01). Continuing expectation to receive antibiotics after viewing one of the posters was associated with expectation to receive antibiotics in the baseline survey and the strong belief that colds were caused by bacteria. Participants who viewed the resistance poster were more likely to continue to expect antibiotics than participants who viewed the futility poster (OR 2.46, 95%CI 1.16-5.20, P = 0.02). Following discussion of the study, viewing a poster reduced participants' expectations to receive antibiotics for a hypothetical cold. Changing patients' expectations to receive antibiotics using simple educational material about antibiotic futility could lead to significant reductions in antibiotic prescription for viral upper respiratory tract infections.

Differing perspectives: Evaluation of a new IV pole by children and adults.

Involving children in the evaluation of hospital environments has been recognized as important. It is argued that this should extend to engaging children in the evaluation of medical products. A study was undertaken to evaluate how children, parents/caregivers and nurses viewed the design of a new intravenous (IV) pole compared to the existing IV pole currently used. Children and adults were asked to give their perspectives on mobility, safety, aesthetics and functionality of the new and existing IV poles. The findings suggest that children value different aspects of medical product design than adults. We conclude that designers, manufacturers and healthcare organizations should recognize the importance and benefit of involving children in the design of medical products that will ultimately be used by them.

Making space work: Staff socio-spatial practices in a paediatric outpatient department.

Studies of the characteristics of therapeutic landscapes have become common in medical geography. However, there is limited analysis of how therapeutic landscapes are produced. Based upon the qualitative theoretical thematic analysis of focus group data, this study examined the spatial work carried out by healthcare practitioners in a paediatric outpatients' department, turning unsatisfactory space into a therapeutic place. The study highlights the spatial strategies employed by staff to mitigate socio-spatial deficiencies in the healthcare environment. Staff perceived the task of making space work as an integral part of their duty of care to patients and an important facet of their professional identity. This study concludes that many of the spatial aspects of health care practice are often taken for granted. However this may hide the crucial role that health professionals have in producing places that heal.

Visual representation of medical information: the importance of considering the end-user in the design of medical illustrations.

This practice led research project explored visual representation through illustrations designed to communicate often complex medical information for different users within Auckland City Hospital, New Zealand. Media and tools were manipulated to affect varying degrees of naturalism or abstraction from reality in the creation of illustrations for a variety of real-life clinical projects, and user feedback on illustration preference gathered from both medical professionals and patients. While all users preferred the most realistic representations of medical information from the illustrations presented, patients often favoured illustrations that depicted a greater amount of information than professionals suggested was necessary.

A Systematic Review of Patient and Caregiver Experiences with a Tracheostomy.

BACKGROUND: A tracheostomy is a surgically created opening through the anterior neck tissues and the trachea, into which a tube is inserted. Despite its influence on basic human needs such as respiration, communication and nutrition, little is known about the impact of tracheostomy on patients and their caregivers or what could be done to enable better care and quality of life (QoL) for these individuals. OBJECTIVE: The aim of this review was to better understand the current knowledge related to the experience and QoL of adults living with a tracheostomy and their caregivers so as to be able to improve these experiences. METHOD: A systematic review of the English-language, peer-reviewed literature was conducted in PubMed, Scopus, PsychINFO, Google Scholar, and CINAHL databases. Articles were eligible if they included adult patient or lay caregiver-reported experiences of tracheostomy. RESULTS: Overall, 1080 articles were identified and 17 eligible for inclusion. Fourteen articles reported on experiences of tracheostomy patients, while three focused on those of their caregivers. Studies were conducted in the home setting (n = 5), on a hospital ward (n = 4), in an intensive care unit (n = 3), in an outpatient clinic (n = 3), in a rehab facility (n = 1), and online (n = 1). Patients and their caregivers reported a range of mostly negative experiences related to the care, support, and management of a tracheostomy, speech and communication, wellbeing and QoL, disfigurement and body image, and stigma and social withdrawal. CONCLUSION: Few studies have published data on the patient and caregiver experiences with tracheostomy, especially in the community setting. There is a need to better understand these experiences in order to be able to formulate strategies and provide resources to improve the quality of care and overall QoL of patients with a tracheostomy and their caregivers in-hospital and in the community.

Designing for Mild Cognitive Impairment (MCI): A Design Anthropological Perspective.

This paper will present a design anthropological perspective on an ongoing project called 'Living Well with Mild Cognitive Impairment (MCI)'. The project explores how people with MCI (and their families) manage and respond to changes in their memory and thinking. One of the primary aims of this project is to design an online resource that will support people to 'Live Well' within the context of possible cognitive decline. The resource was originally proposed to function as a kind of online community, where users could both share and learn about home-grown strategies for managing the cognitive changes associated with MCI in everyday life. Much of this project has been guided by the methodological approach of design anthropology, which encourages project researchers and stakeholders to critically examine underlying assumptions and conceptual frameworks, which in this case revolve around the disputed MCI category. In this paper we will provide some background to the Living Well project before highlighting a number of key insights attained from design anthropology.

Designing Situated Learning Experiences: Interdisciplinary Collaboration for Design Education in Healthcare.

This paper describes how the DHW Lab facilitates third mission activities, as well as advancing undergraduate pedagogy and post-graduate research. It suggests there are challenges and opportunities involved in creating a hybrid of two very different organizations, that need to be addressed to advance transdisciplinary education in the 'transformative university'.

Participatory art-based research with children to gain their perspectives on designing healthcare environments.

BACKGROUND: A study was designed to understand the experiences and needs of children within the public spaces of the Outpatients Department of New Zealand's national children's hospital, Starship Childrens' Directorate. AIM: To find out from children what they thought about the outpatient environment. DESIGN: A participatory art based methodology was used. METHODS: Based around the key areas of the physical environment, wayfinding, noise, and uniforms, art-based methods (draw and tell and letter writing) were used to collect data from 175 children ages 5-16 whilst they attended outpatient clinics. The drawings and letters were analysed using descriptive/thematic analysis. RESULTS: The findings show that children are very aware of their environment and are able to clearly voice what is important to them. Children appreciate environments that are child friendly, and inclusive of colour and artwork; however, wayfinding remains a challenge for many families. Although the environment was seen as important, children placed significant value on the people who demonstrated warmth and care within these environments. CONCLUSION: Participatory art based approaches offer a child centred approach to finding out what children perceive is important in the design of hospital environments.

Association of entomopathogenic fungi with exotic bark beetles in New Zealand pine plantations.

Hylastes ater and Hylurgus ligniperda are introduced pests of re-established Pinus radiata in New Zealand. Both species breed under the bark of stumps in recently harvested areas. Adult maturation feeding on pine seedlings planted in adjacent areas can significantly impact seedling growth, and in severe cases seedlings will die. Entomopathogenic fungi are important natural mortality factors in bark beetle populations, and Beauveria spp. are predominant. Here, we report on the isolation of other fungal species from H. ater in New Zealand. Based on morphological characteristics and sequencing data, two species, Metarhizium flavoviride var. pemphigi and Hirsutella guignardii, were recovered from H. ater. Both are new records for New Zealand and appear to be the first records of these species from bark beetles worldwide.

Beauveria caledonica is a naturally occurring pathogen of forest beetles.

In New Zealand, two introduced scolytid beetles, Hylastes ater and Hylurgus ligniperda (Curculionidae: Scolytinae) are pests in pine plantations. Investigation of the naturally occurring pathogens of these exotic pests revealed that both are attacked by Beauveria caledonica, a species originally isolated and described from soil in Scotland. The isolates in New Zealand were identical in morphology and conserved DNA region (rDNA, elongation factor alpha) sequence to isolates held in the USDA-ARS insect pathogens culture collection. In bioassay, the B. caledonica isolates were highly pathogenic to adults of H. ligniperda and larvae of Tenebrio molitor. Sporulation was observed on cadavers, confirming the species can utilise the cadavers. As both species were likely to have been introduced to New Zealand from Europe, a search was made for B. caledonica in the northern UK and Ireland. The fungus was found as a naturally-occurring pathogen of the weevil pest, Hylobius abietis (Curculionidae: Scolytinae), developing in spruce and other beetles in forests in both regions.