Publications by authors named "Louise Moody"

24 Publications

  • Page 1 of 1

Processing of positive newborn screening results: a qualitative exploration of current practice in England.

BMJ Open 2020 12 12;10(12):e044755. Epub 2020 Dec 12.

Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK.

Objective: To explore current communication practices for positive newborn screening results from the newborn bloodspot screening (NBS) laboratory to clinicians to highlight differences, understand how the pathways are implemented in practice, identify barriers and facilitators and make recommendations for future practice and research.

Design: A qualitative exploratory design was employed using semi-structured interviews.

Setting: Thirteen NBS laboratories in England.

Participants: Seventy-one clinicians; 22 NBS laboratory staff across 13 laboratories and 49 members of relevant clinical teams were interviewed.

Results: Assurance of quality and consistency was a priority for all NBS laboratories. Findings indicated variation in approaches to communicating positive NBS results from laboratories to clinical teams. This was particularly evident for congenital hypothyroidism and was largely influenced by local arrangements, resources and the fact individual laboratories had detailed standard operating procedures for how they work. Obtaining feedback from clinical teams to the laboratory after the child had been seen could be challenging and time-consuming for those involved. Pathways for communicating carrier results for cystic fibrosis and sickle cell disease could be ambiguous and inconsistent which in turn could hamper the laboratories efforts to obtain timely feedback regarding whether or not the result had been communicated to the family. Communication pathways for positive NBS results between laboratories and clinical teams could therefore be time-consuming and resource-intensive.

Conclusion: The importance placed on ensuring positive NBS results were communicated effectively and in a timely fashion from the laboratory to the clinical team was evident from all participants. However, variation existed in terms of the processes used to report positive NBS results to clinical teams and the people involved. Variant practice identified may reflect local needs, but more often reflected local resources and a more consistent 'best practice' approach is required, not just in the UK but perhaps globally.

Trial Registration Number: ISRCTN15330120.
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http://dx.doi.org/10.1136/bmjopen-2020-044755DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7735110PMC
December 2020

Qualitative exploration of health professionals' experiences of communicating positive newborn bloodspot screening results for nine conditions in England.

BMJ Open 2020 10 1;10(10):e037081. Epub 2020 Oct 1.

Paediatrics, Institute of Child Health, Merseyside, UK.

Objective: To explore health professionals' experiences of communicating positive newborn bloodspot screening (NBS) results, highlight differences, share good practice and make recommendations for future research.

Design: Qualitative exploratory design was employed using semi-structured interviews SETTING: Three National Health Service provider organisations in England PARTICIPANTS: Seventeen health professionals involved in communicating positive newborn bloodspot screening results to parents for all nine conditions currently included in the newborn bloodspot screening programme in England.

Results: Findings indicated variation in approaches to communicating positive newborn bloodspot screening results to parents, largely influenced by resources available and the lack of clear guidance. Health professionals emphasised the importance of communicating results to families in a way that is sensitive to their needs. However, many challenges hindered communication including logistical considerations; difficulty contacting the family and other health professionals; language barriers; parental reactions; resource considerations; lack of training; and insufficient time.

Conclusion: Health professionals invest a lot of time and energy trying to ensure communication of positive newborn bloodspot screening results to families is done well. However, there continues to be great variation in the way these results are communicated to parents and this is largely influenced by resources available but also the lack of concrete guidance. How best to support health professionals undertaking this challenging and emotive task requires further exploration. We recommend evaluation of a more cohesive approach that meets the needs of parents and staff while being sensitive to the subtleties of each condition.

Trial Registration Number: ISRCTN15330120.
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http://dx.doi.org/10.1136/bmjopen-2020-037081DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7534703PMC
October 2020

Telemedicine in Middle Eastern countries: Progress, barriers, and policy recommendations.

Int J Med Inform 2020 09 15;141:104232. Epub 2020 Jul 15.

Centre for Arts, Memory and Communities, Coventry University, Coventry, UK.

Background: Despite attempts to reform the healthcare delivery system in the Middle East, expectations for its progress have been-and for some still are-somewhat slow.

Objective: This study reviewed progress in the use and adoption of telemedicine in Middle Eastern countries. The key dimensions affecting the progress of telemedicine in these countries were identified.

Method: A systematic review of the literature was conducted on 43 peer reviewed articles from 2010 to 2020. The review followed the scientific process of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines of identification, selection, assessment, synthesis, and interpretation of findings.

Results: The results showed that progress made in the utilization of telemedicine was insufficient and varies across Middle Eastern countries. Certain cultural, financial, organizational, individual, technological, legal, and regulatory challenges were found to prevent telemedicine from being fully used to the point where the full range of medical services can be provided. For example, doctor and patient resistance, poor infrastructure, lack of funding, poor system quality, and lack of information technology training were associated with the low adoption of telemedicine in the region.

Conclusion: This review provides a number of recommendations that will help policymakers to move toward the integration of innovative technologies in order to facilitate access to health information, health services, and training. It also recommends that health initiatives should focus on health education and health promotion in order to increase public awareness of the benefits of telemedicine services in the region.
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http://dx.doi.org/10.1016/j.ijmedinf.2020.104232DOI Listing
September 2020

Help to Overcome Problems Effectively for Cancer Survivors: Development and Evaluation of a Digital Self-Management Program.

J Med Internet Res 2020 05 19;22(5):e17824. Epub 2020 May 19.

Faculty Research Centre for Intelligent Healthcare, Faculty of Health and Life Sciences, Coventry University, Coventry, United Kingdom.

Background: People living with cancer face numerous psychosocial challenges, including cancer-related fatigue, fear of recurrence, and depression. There is a lack of digital interventions tailored to the needs of people living with all types of cancer. We developed a 6-week, digital, peer-delivered, self-management program: iHOPE (Help to Overcome Problems Effectively; where 'i' indicates the digital version of the program). The program is underpinned by positive psychology and cognitive behavioral therapy to meet these psychosocial challenges.

Objective: This study aimed to assess the feasibility of the iHOPE program among people living with cancer. Program adherence and satisfaction along with changes in psychological distress and positive well-being were measured.

Methods: A pre-post, acceptability, and feasibility design was used. People living with cancer (N=114) were recruited via a national cancer charity in the United Kingdom and were given access to the iHOPE program. Demographic and other participant characteristics were recorded. Participants completed digital measures at baseline and the end of the 6-week program for depression, anxiety, cancer-related fatigue, cancer worry or fear of cancer recurrence, positive mental well-being, hope, gratitude, and health status. The website's system recorded data on the usage of the program. Satisfaction with the program was also measured.

Results: A total of 114 participants completed the baseline questionnaires. Of these, 70 people (61.4%) participated in all 6 sessions. The mean number of sessions undertaken was 5.0 (SD 1.5). Moreover, 44.7% (51/114) of participants completed at least three sessions and end-of-program outcome measures. A total of 59 participants completed the satisfaction questionnaire, where ≥90% (54/58) of participants reported that the program was easy to navigate and was well managed by the peer facilitators, and that they found the social networking tools useful. Preliminary efficacy testing among the 51 participants who completed baseline and postprogram outcome measures showed that postprogram scores decreased for depression, anxiety, cancer-related fatigue, and fear of recurrence (all P<.001) and increased for positive mental well-being (P<.001), hope (both P<.001), and gratitude (P=.02).

Conclusions: The feasibility evidence is promising, showing that the peer-delivered digital iHOPE program is acceptable and practical. Implementation of the iHOPE program on a wider scale will incorporate further research and development to maximize the completion rates of the measures. Initial effectiveness data suggest positive impacts on important cancer-related quality of life and mental well-being outcomes. A randomized controlled trial design with a longer follow-up is needed to confirm the potential of the iHOPE program for improving mental and physical health outcomes for cancer survivors.
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http://dx.doi.org/10.2196/17824DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7268001PMC
May 2020

Stakeholder Requirements for an Ethical Framework to Sustain Multiple Research Projects in an Emerging Living Lab Involving Older Adults.

J Empir Res Hum Res Ethics 2020 07 18;15(3):111-127. Epub 2019 Sep 18.

University of the West of England, Bristol, UK.

Living Lab (LL) research should follow clear ethical guidelines and principles. While these exist in specific disciplinary contexts, there is a lack of tailored and specific ethical guidelines for the design, development, and implementation of LL projects. As well as the complexity of these dynamic and multi-faceted contexts, the engagement of older adults, and adults with reducing cognitive and physical capacity in LL research, poses additional ethical challenges. Semi-structured interviews were undertaken with 26 participants to understand multistakeholder experiences related to user engagement and related ethical issues in emerging LL research. The participants' experiences and concerns are reported and translated into an ethical framework to guide future LL research initiatives.
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http://dx.doi.org/10.1177/1556264619873790DOI Listing
July 2020

Rethinking Strategies for Positive Newborn Screening Result (NBS+) Delivery (ReSPoND): a process evaluation of co-designing interventions to minimise impact on parental emotional well-being and stress.

Pilot Feasibility Stud 2019 4;5:108. Epub 2019 Sep 4.

9Women's and Children's Health, University of Liverpool, Liverpool, L69 3BX UK.

Background: Newborn blood spot (NBS) screening seeks to prevent ill health, disability and death through early diagnosis and effective intervention. Each year, around 10,000 parents of babies born in England are given a positive NBS result indicating their child may be affected or carriers of one of the nine conditions currently screened for. Despite guidance, these results are inconsistently delivered to parents across geographical regions. There is evidence that many parents are dissatisfied with how NBS results are communicated to them and that poor communication practices can lead to various negative sequelae. The purpose of this study is to co-design, implement and undertake a process evaluation of new, co-designed interventions to improve delivery of initial positive NBS results to parents.

Methods: This mixed-methods study will use four phases with defined outputs. Family Systems Theory will form the theoretical basis for the study. The principles and methods of experience-based co-design will underpin intervention development. Normalisation Process Theory will underpin the process evaluation of the interventions co-designed to improve the delivery of positive NBS results to parents. An economic analysis will determine resource use and costs of current practice and of implementing the new co-designed interventions. The nominal group technique will be used to inform the selection of suitable outcome measures for a future evaluation study.

Discussion: The main output of the proposed study will be co-designed interventions for initial communication of positive NBS results to parents ready to be evaluated in a definitive evaluation study.The interventions, co-designed with parents, will help to minimise potential negative sequelae associated with poor communication practices by considering parental and staff experiences as well as healthcare challenges such as finite resources. In addition, information about indicative costs associated with different communication strategies will be determined.It is anticipated it may also be possible to extrapolate principles of good communication practices from the present study for the delivery of bad news to parents for children newly diagnosed with other conditions including cancer and other chronic conditions such as diabetes or epilepsy.

Trial Registration: ISRCTN 15330120 date of registration 17/01/2018.
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http://dx.doi.org/10.1186/s40814-019-0487-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6724281PMC
September 2019

Creativity and Innovation in Health Care: Tapping Into Organizational Enablers Through Human-Centered Design.

Nurs Adm Q 2018 Jan/Mar;42(1):62-75

Aspen Labs LLC, Denver, Colorado (Dr Zuber); Kaiser Permanente, Oakland, California (Dr Zuber); and School of Art and Design, Coventry University, Coventry, United Kingdom (Drs Zuber and Moody).

There is an increasing drive in health care for creativity and innovation to tackle key health challenges, improve quality and access, and reduce harm and costs. Human-centered design (HCD) is a potential approach to achieving organizational innovation. However, research suggests the nursing workforce feels unsupported to take the risks needed for innovation, and leaders may not understand the conditions required to fully support them. The aim of this study was to identify enabling conditions that support frontline nurses in their attempts to behave as champions of innovation and change. An HCD workshop was undertaken with 125 nurses employed in clinical practice at Kaiser Permanente. The workshop included empathy mapping and semistructured questions that probed participant experiences with innovation and change. The data were collated and thematic analysis undertaken through a Grounded Theory approach. The data were analyzed to identify key enabling conditions. Seven enablers emerged: personal need for a solution; challenges that have meaningful purpose; clarity of goal and control of resources; active experimentation; experiences indicating progress; positive encouragement and confidence; and provision of psychological safety. These enablers were then translated into pragmatic guidelines for leaders on how the tools of HCD may be leveraged for innovation and change in health care.
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http://dx.doi.org/10.1097/NAQ.0000000000000267DOI Listing
December 2017

Electronic Assisted Living Technology: Interim Systematic Review Results - The Evidence for Creative Methodologies.

Stud Health Technol Inform 2017 ;242:216-223

Faculty of Health and Life Sciences, Coventry University, United Kingdom.

Despite reported benefits of creative methodologies for the design and development of electronic Assisted Living Technologies (eALT), there exists a divide between design and health research, leaving health researchers wishing to pursue creative methods uninformed with regards choice of appropriate methods. This paper describes interim and emerging results from a systematic review which aimed to explore the value of creative methodologies for the design and development of eALT which may form part of the solution to the challenges of the ageing population.
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April 2018

Inclusive Smartphone Interface Design in Context: Co(Re)designing the PIS.

Stud Health Technol Inform 2017 ;242:195-198

Coventry University, Faculty of Health and Life Science, Coventry, UK.

User-context optimises smartphone interface-design. Neglect of user-context during development, delays or prevents marginalised-consumer benefit. Working with People with Learning Disability (PWLD) to develop interfaces refined by communication-need will improve User-Experience (UX). In research, a Participant Information Sheet (PIS) discloses planned study-activity. This paper explains co-creation of a PIS based on communication-need of PWLD.
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April 2018

Healthcare professionals' and parents' experiences of the confirmatory testing period: a qualitative study of the UK expanded newborn screening pilot.

BMC Pediatr 2017 05 8;17(1):121. Epub 2017 May 8.

Newborn Screening Laboratory, Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield, S10 2TH, UK.

Background: With further expansion of the number of conditions for which newborn screening can be undertaken, it is timely to consider the impact of positive screening results and the confirmatory testing period on the families involved. This study was undertaken as part of a larger programme of work to evaluate the Expanded Newborn Screening (ENBS) programme in the United Kingdom (UK). It was aimed to determine the views and experiences of healthcare professionals (HCPs) and parents on communication and interaction during the period of confirmatory testing following a positive screening result.

Methods: Semi-structured interviews were undertaken with parents of children who had received a positive ENBS result and HCPs who had been involved with the diagnosis and support of parents. Ten parents and 11 healthcare professionals took part in the in-depth interviews. Questions considered the journey from the positive screening result through confirmatory testing to a confirmed diagnosis and the communication and interaction between the parents and HCPs that they had been experienced. Key themes were identified through thematic analysis.

Results: The results point to a number of elements within the path through confirmatory testing that are difficult for parents and could be further developed to improve the experience. These include the way in which the results are communicated to parents, rapid turnaround of results, offering a consistent approach, exploring interventions to support family relationships and reviewing the workload and scheduling implications for healthcare professionals.

Conclusions: As technology enables newborn screening of a larger number of conditions, there is an increasing need to consider and mediate the potentially negative effects on families. The findings from this study point to a number of elements within the path through confirmatory testing that are difficult for parents and could be further developed to benefit the family experience.
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http://dx.doi.org/10.1186/s12887-017-0873-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5422997PMC
May 2017

An exploratory study of barriers to inclusion in the European workplace.

Disabil Rehabil 2017 10 24;39(20):2047-2054. Epub 2016 Sep 24.

d Ozara Service and Disability Company Ltd. , Ulica Heroja Saranovica 27 , Maribor , Slovenia.

Background: The European Disability Strategy (2010-2020) seeks to significantly raise the proportion of people with disabilities working in the open labour market. The ERGO WORK project is a collaboration of academic and industrial partners in six European countries, focused on understanding and tackling barriers to workplace inclusion for workers with disabilities.

Methods: This study sought to explore the perceptions and needs of stakeholders in terms of workplace adaptation to the needs of employees with disabilities. An exploratory online survey was completed by 480 participants across six countries.

Results: The analysis suggests that workplaces could be further improved to meet the needs of employees with considerable scope for training within companies to raise awareness about employees' needs, employers' obligations and workplace adaptation.

Conclusions: This snapshot suggests there is still a gap between intent and reality in workplace inclusion and further strategies are needed to improve the opportunities for employees with disabilities. The paper argues that ergonomics may have a key role to play in tackling these challenges and adapting the workplace environment and job design to suit the needs of individual employees. Implications for rehabilitation This study suggests there is considerable scope for workplace adaptation and improvements to meet the needs of employees with disabilities. Employers need and want further specialist practitioner guidance to facilitate workplace inclusion and support adaptation to individual needs. Organisations would benefit from training to raise awareness about potential solutions and approaches that would support more widespread employment of people with disabilities.
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http://dx.doi.org/10.1080/09638288.2016.1217072DOI Listing
October 2017

User-centred health design: reflections on D4D's experiences and challenges.

Authors:
Louise Moody

J Med Eng Technol 2014 ;39(7):395-403

a Department of Industrial Design , Coventry University , Priory Street , Coventry CV1 5FB , UK and.

There is increasing recognition of the importance of user-centred design and testing in the healthcare technology domain. Challenges associated with user and stakeholder involvement in designing solutions for healthcare are recognized in the literature and need to be addressed to facilitate the development of new technology that is usable and acceptable to the end-user. The Devices for Dignity Health Technology Cooperative (D4D) has been involved in a range of technology development projects with an underpinning approach of addressing unmet needs through user involvement. This paper provides practical examples of some of the challenges that occur at different stages during a user-centred design process including ethical approval processes; stakeholder and user recruitment and involvement; eliciting needs from users regarding sensitive and personal issues; and interdisciplinary working. The paper will describe some of the strategies that have been employed by D4D to overcome these challenges and facilitate technology development.
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http://dx.doi.org/10.3109/03091902.2015.1088086DOI Listing
May 2016

The development and testing of a system for wheelchair stability measurement.

Med Eng Phys 2015 Nov 26;37(11):1061-9. Epub 2015 Sep 26.

Coventry University, Priory St. , Coventry, CV1 5FB, UK.

Wheelchair stability has an impact on safety as well as wheelchair performance, propulsion and manoeuvrability. Wheelchair stability is affected by the addition of life-supporting heavy equipment, e.g. ventilators and oxygen cylinders, as well as the characteristics of the user e.g. limb amputations, obesity. The aim of the research described here was to develop and test a stability assessment system that would guide and support the adjustment of wheelchairs to individual needs, characteristics and lifestyles. The resulting system provides assessment of centre of gravity and wheelchair stability and calculates the wheelchair tipping angles. The system consists of a force platform that senses the weight distribution of the wheelchair and calculates the centres of the contact points of the wheels and the distances between them. The measurement data are transferred via a WiFi connection to a portable tablet computer where wheelchair stability parameters are calculated. A touchscreen GUI provides visualization of the stability results and navigation through the measurement modes. The developed new concept has been evaluated through technical laboratory-based testing to determine the validity of the data collected. Initial testing has been undertaken within the clinical setting in 3 large hospitals in the UK. Initial results suggest that Wheelsense® provides a valuable tool to support clinical judgement.
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http://dx.doi.org/10.1016/j.medengphy.2015.08.013DOI Listing
November 2015

Establishing user needs for a stability assessment tool to guide wheelchair prescription.

Disabil Rehabil Assist Technol 2017 01 3;12(1):47-55. Epub 2015 Jul 3.

b Health Design & Technology Institute, Coventry University , Coventry , UK.

Purpose: The WheelSense project aims to develop a system for assessing the stability and performance of wheelchairs through a user-centred design process. This study sought to capture user needs and define the specification for the system.

Method: A mixed methods approach was adopted. An online survey was completed by 98 participants working in wheelchair provision. The results were built upon through 10 semi-structured interviews and one focus group (n = 5) with professionals working in wheelchair provision in three NHS Trusts in the UK.

Results: The results provided a picture of the current UK practice in stability testing. Issues with the reliability and usefulness of the existing methods used to assess the stability and performance of wheelchairs were highlighted. Requirements for a new system were ascertained. These included improved accuracy of tipping angles, features to support record keeping, improved client/carer education support and ability to model or predict client-wheelchair system performance in different configurations.

Conclusions: The paper concludes that there is a need for improved tools to determine the stability of the client-wheelchair system and support the prescription process, to ensure client safety and optimum equipment performance. A list of requirements has been produced to guide the future development of WheelSense. Implications for Rehabilitation The results of this survey and interview-based study present a picture of wheelchair stability testing practices in the UK, and highlight the need for new, more informative methods for guiding wheelchair prescription. The requirements for the design of a new system, or further development of existing tools to support the stability testing and prescription of wheelchairs have been established.
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http://dx.doi.org/10.3109/17483107.2015.1063019DOI Listing
January 2017

Experiences of leg bag users and emerging design priorities.

J Wound Ostomy Continence Nurs 2015 Mar-Apr;42(2):176-82

Louise Moody, BSc (Hons), PhD, Director, Centre of Excellence in Product and Automotive Design, Department of Industrial Design, Coventry University, Coventry, United Kingdom. Avril McCarthy, BSc (Hons), PhD, HCPC (Healthcare Professions Council) Registered Clinical Scientist, Sheffield Teaching Hospitals NHS Foundation Trust and NIHR Devices for Dignity Healthcare Technology Co-operative, Sheffield, United Kingdom.

Purpose: The purpose of the study was to explore participants' experiences of urinary incontinence and leg bag use in order to identify priorities for product redesign.

Subjects And Setting: Twenty-nine leg bag users and 5 carers and healthcare professionals participated in the study. They were recruited through a UK hospital Trust and a UK-wide charity for people with bladder and bowel control problems.

Design: The study employed a descriptive design with qualitative and quantitative elements to determine current experiences with urinary drainage leg bags and identify potential ways to improve their design.

Methods: Data collection occurred during semistructured face-to-face and telephone semistructured interviews.

Results: Thematic analysis revealed that leg bag design and performance influenced users' relationships, confidence, and ability to socialize. The most significant issues related to leg bag use were reliable functioning without leakage, secure positioning, and discretion when worn under clothing. All participants reported having experienced significant urine leakage due to usability issues with the leg bags.

Conclusions: Respondents identified a number of design issues with current leg bags that need to be addressed to improve the ease of use and overall experience when using leg bags for containing urinary output. The findings have been used to define design requirements for further development of leg bags and their component parts.
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http://dx.doi.org/10.1097/WON.0000000000000084DOI Listing
September 2016

Web-based self-management for young cancer survivors: consideration of user requirements and barriers to implementation.

J Cancer Surviv 2015 Jun 19;9(2):188-200. Epub 2014 Sep 19.

Department of Industrial Design, Coventry School of Art and Design, Coventry University, Priory Street, Coventry, CV1 5FB, UK,

Purpose: As the population of young cancer survivors increases, there is a need to develop alternative ways of providing post-treatment support. Online systems potentially offer self-management and e-learning support following cancer treatment. This research aims to explore the self-management support needs of teenage and young adult cancer survivors and consider whether those needs can be met through a web-based self-management resource.

Methods: A mixed methods approach was adopted including an online survey (n = 24), focus groups and interviews with teenage and young adult cancer survivors (n = 7) and interviews with parents of survivors (n = 6), information technology specialists (n = 8) and clinical, nursing and social work professionals (n = 11).

Results: All stakeholders were supportive of web-based self-management to meet information and support needs that would supplement continued direct interaction with clinical staff. Barriers to implementation were identified in terms of risks to young people, governance issues and the challenges of providing a long-term service.

Conclusion: Computer access and use amongst teenagers and young adults is commonplace, and there is an expectation that self-management needs will be met at least partially online in the future. There is a desire for online social support through peer interaction as well personal developmental and clinical management. These elements may need to be run through different systems to cater for governance requirements.

Implications For Cancer Survivors: An online self-management system could provide support at a number of different levels. The barriers to implementation should be addressed, to ensure that survivors can be supported in this way in the future.
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http://dx.doi.org/10.1007/s11764-014-0400-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4441741PMC
June 2015

Improving wheelchair prescription: an analysis of user needs and existing tools.

Work 2012 ;41 Suppl 1:1980-4

Centre of Excellence in Product & Transport Design, Department of Industrial Design, Coventry University, Coventry CV1 5FB, UK.

Wheelchair users experience many situations that affect the stability and associated performance of their wheelchair. Stability is affected by user characteristics and abilities, environmental features and conditions, and wheelchair modification and accessories. Wheelchair prescribers need effective tools and methods to provide quantitative evaluation and prediction of the behavior of the user-wheelchair system in a variety of static and dynamic situations. Such information is very important to guide efficient management of associated risks and adjust chairs accordingly. This project involves a user-centered approach for design and evaluation of a load cell based wheelchair stability assessment system (Wheel-SAS). Here, the current methods for assessing stability are described, and their shortcomings explained. The user-centered design approach being applied to the development of the associated Wheel-SAS hardware and software is described. Future work including semi-structured interviews and an online survey with wheelchair prescribers and associated healthcare professionals for deriving user requirements and a design specification for a load cell system for measuring dynamic wheelchair stability are detailed.
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http://dx.doi.org/10.3233/WOR-2012-0418-1980DOI Listing
February 2014

Parental views on informed consent for expanded newborn screening.

Health Expect 2013 Sep 12;16(3):239-50. Epub 2011 Aug 12.

Department of Industrial Design, Coventry University, UK.

Background: An increasing array of rare inherited conditions can be detected as part of the universal newborn screening programme. The introduction and evaluation of these service developments require consideration of the ethical issues involved and appropriate mechanisms for informing parents and gaining consent if required. Exploration of parental views is needed to inform the debate and specifically consider whether more flexible protocols are needed to fit with the public perception of new developments in this context.

Objective: This study has been undertaken to explore perceptions and attitudes of parents and future parents to an expanded newborn screening programme in the United Kingdom and the necessary information provision and consent processes.

Design And Participants: A mixed methods study involving focus groups (n = 29) and a web-survey (n = 142) undertaken with parents and future parents.

Results And Conclusions: Parents want guaranteed information provision with clear decision-making powers and an awareness of the choices available to them. The difference between existing screening provision and expanded screening was not considered to be significant enough by participants to warrant formal written, informed consent for expanded screening. It is argued that the ethical review processes need to be more flexible towards the provision of information and consent processes for service developments in newborn screening.
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http://dx.doi.org/10.1111/j.1369-7625.2011.00710.xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5060664PMC
September 2013

Passive haptics in a knee arthroscopy simulator: is it valid for core skills training?

Clin Orthop Relat Res 2006 Jan;442:13-20

Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England.

Previous investigation of a cost-effective virtual reality arthroscopic training system, the Sheffield Knee Arthroscopy Training System (SKATS), indicated the desirability of including haptic feedback. A formal task analysis confirmed the importance of knee positioning as a core skill for trainees learning to navigate the knee arthroscopically. The system cost and existing limb interface, which permits knee positioning, would be compromised by the addition of commercial active haptic devices available currently. The validation results obtained when passive haptic feedback (resistance provided by physical structures) is provided indicate that SKATS has construct, predictive and face validity for navigation and triangulation training. When tested using SKATS, experienced surgeons (n = 11) performed significantly faster, located significantly more pathologies, and showed significantly shorter arthroscope path lengths than a less experienced surgeon cohort (n = 12). After SKATS training sessions, novices (n = 3) showed significant improvements in: task completion time, shorter arthroscope path lengths, shorter probe path lengths, and fewer arthroscope tip contacts. Main improvements occurred after the first two practice sessions, indicating rapid familiarization and a training effect. Feedback from questionnaires completed by orthopaedic surgeons indicates that the system has face validity for its remit of basic arthroscopic training.
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http://dx.doi.org/10.1097/01.blo.0000194678.10130.ffDOI Listing
January 2006

A flexible virtual reality tutorial for the training and assessment of arthroscopic skills.

Stud Health Technol Inform 2004 ;98:244-6

RISCU, Department of Statistics, University of Warwick, Coventry CV4 7AL, UK.

Through definition of a comprehensive tutorial model, the Warwick, Imperial and Sheffield Haptic Knee Arthroscopy Training System (WISHKATS) aims to provide independent, flexible and consistent training and assessment. The intention is to satisfy user acceptance by limiting the constraints by which the system can be utilised, as well as demonstrating validity and reliability. System use can either be under the guidance and feedback offered by the system or of a senior surgeon. Objective metrics are defined for performance feedback and formal assessment.
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December 2004

Ensuring the usability of a knee arthroscopy simulator.

Stud Health Technol Inform 2004 ;98:241-3

RISCU, Department of Statistics, University of Warwick, Coventry CV4 7AL, UK.

There is limited research considering the usability of medical virtual environments. Usability evaluation is an essential validation phase that considers the extent to which a product achieves its specific goals, with effectiveness, efficiency and satisfaction. A four-stage iterative approach is adopted to enhance usability in the development of a knee arthroscopy training system. This process has drawn attention to issues that may impede system usability for example non-conformity to platform conventions, and visibility of the system status. The process highlights features that computer scientists can overlook when working closely with a system but that are essential to user acceptance and effective application.
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December 2004

Objective surgical performance evaluation based on haptic feedback.

Stud Health Technol Inform 2002 ;85:304-10

Electronic, Electrical and Computer Engineering, The University of Birmingham, Edgbaston, UK B15 2TT.

In order to develop effective virtual reality training systems for surgery there is a need to provide appropriate sensory and performance feedback to the user. This paper aims to demonstrate a method by which performance data can be collected. This is used to investigate the effect of haptic feedback on performance. A PHANTOM desktop device was used in conjunction with a suturing simulation A pair of needle-holders was instrumented with strain gauges and attached to the stylus of the PHANTOM allowing the measurement of force application and time. Suturing performance was evaluated in terms of stitch completion time, peak force application, and the length and straightness of the stitch. The effect of the level of force feedback provided by the simulation and performance over time was considered. The results indicate that the presence of force feedback affected task completion time, peak force application and the straightness of the stitch. Task completion time was shown to increase with the level of force feedback provided. Performance was seen to improve over time in terms of task completion time and the accuracy ofthe stitch. The work has examined how the presence and level of force feedback affects performance of a simple task. The accuracy of haptic feedback is important in the design of surgical simulation systems to ensure effective training transfer. A data collection method by which objective performance evaluation can be made is demonstrated. The method can be applied to training using bench models, simulations and potentially in the operating theatre.
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November 2004

Engineering requirements for a haptic simulator for knee arthroscopy training.

Stud Health Technol Inform 2003 ;94:413-8

The Mechatronics in Medicine Laboratory, Department of Mechanical Engineering, Imperial College London, UK.

This paper describes the initial development of an innovative haptic device that will be integrated into an existing virtual reality training system for knee arthroscopy. The resulting system will be called WISHKATS (Warwick, Imperial, Sheffield Knee Arthroscopy Training System). This haptic device will enable the trainee to feel realistic forces on the probing tool and will work together with software, which will simulate tissue deformation. The proposed haptic system is a compact, multi-degree of freedom, motorised mechanism with force sensors, and will be used to simulate the diagnostic aspects of knee arthroscopy. There are a number of problems associated with the development of a suitable haptic system and this paper explores the engineering requirements of such a device.
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October 2004

A part-task approach to haptic knee arthroscopy training.

Stud Health Technol Inform 2003 ;94:216-8

RISCU, Department of Statistics, University of Warwick, Coventry CV4 7AL, UK.

This paper describes the research behind a part-task approach to both the development of, and the training offered, by a virtual reality simulator for knee arthroscopy. An ethnographic approach has been taken to examine the nature of task performance and the current training of the arthroscopic diagnosis of the knee. This Human Factors research is used to support the development of WISHKATS. The design addresses the challenge of technically producing haptic feedback for a knee surgery simulator whilst offering sufficient fidelity to train the necessary skills and conform to traditional surgical training.
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October 2004
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