Benefits and barriers of technologies supporting working carers—A scoping review

Combining work and care can be very challenging. If not adequately supported, carers’ employment, well-being and relationships may be at risk. Technologies can be potential solutions. We carried out a scoping review to find out what is already known about technologies used by working carers. The search included academic and grey literature published between January 2000 and June 2020. Sixteen relevant publications were analysed and discussed in the context of the broader discourse on work-care reconciliation. Technologies discussed can be classified as: (a) web-based technologies; (b) technologies for direct communication; (c) monitoring technologies; and (d) task-sharing tools. Technologies can help to make work-care reconciliation more manageable and alleviate psychosocial and emotional stress. General barriers to using technology include limited digital skills, depending on others to use technologies, privacy and data protection, cost, limited technological capabilities, and limited awareness regarding available technologies. Barriers specific to some technologies include work disruptions, limited perceived usefulness, and lacking time and energy to use technologies. More research into technologies that can address the needs of working carers and how they are able to use them at work is needed.     

Ageing with telecare: care or coercion in austerity?

In recent years images of independence, active ageing and staying at home have come to characterise a successful old age in western societies. ‘Telecare’ technologies are heavily promoted to assist ageing‐in‐place and a nexus of demographic ageing, shrinking healthcare and social care budgets and technological ambition has come to promote the ‘telehome’ as the solution to the problem of the ‘age dependency ratio’. Through the adoption of a range of monitoring and telecare devices, it seems that the normative vision of independence will also be achieved. But with falling incomes and pressure for economies of scale, what kind of independence is experienced in the telehome? In this article we engage with the concepts of ‘technogenarians’ and ‘shared work’ to illuminate our analysis of telecare in use. Drawing on European‐funded research we argue that home‐monitoring based telecare has the potential to coerce older people unless we are able to recognise and respect a range of responses including non‐use and ‘misuse’ in daily practice. We propose that re‐imagining the aims of telecare and redesigning systems to allow for creative engagement with technologies and the co‐production of care relations would help to avoid the application of coercive forms of care technology in times of austerity.     

Countershock and Pacemaking in Cardiac Arrhythmias

Application of electric current to the management of cardiac arrhythmias is the single most important factor in today's vastly improved survival of patients with acute myocardial infarction. But although defibrillators and pacemakers have become more sophisticated, problems still remain. Discussed here are the development of the devices, indications for their use, and pacemaker complications such as wire breakage.     

Pacemaker explosions in crematoria: problems and possible solutions

The number of artificial cardiac pacemakers is increasing, as is the number of bodies being cremated. Because of the explosive potential of pacemakers when heated, a statutory question on the cremation form asks whether the deceased has a pacemaker and if so whether it has been removed. We sent a questionnaire to all the crematoria in the UK enquiring about the frequency, consequences and prevention of pacemaker explosions. We found that about half of all crematoria in the UK experience pacemaker explosions, that pacemaker explosions may cause structural damage and injury and that most crematoria staff are unaware of the explosive potential of implantable cardiac defibrillators. Crematoria staff rely on the accurate completion of cremation forms, and doctors who sign cremation forms have a legal obligation to provide such information.     

Thinking with care infrastructures: people,devices and the home in home blood pressure monitoring

The growing consumer market in health monitoring devices means that technologies that were once the preserve of the clinic are moving into spaces such as homes and workplaces. We consider how one such device, blood pressure monitors, comes to be integrated into everyday life. We pursue the concept of ‘care infrastructure’, drawing on recent scholarship in STS and medical sociology, to illuminate the work and range of people, things and spaces involved in self‐monitoring. Drawing on a UK study involving observations and interviews with 31 people who have used a consumer blood pressure monitor, we apply the concept beyond chronic illness, to practices involving consumer devices – and develop a critical account of its value. We conclude that the care infrastructure concept is useful to highlight the socio‐material arrangements involved in self‐monitoring, showing that even for ostensibly personal devices, monitoring may be a shared practice that expresses care for self and for others. The concept also helps draw attention to links between different objects and spaces that are integral to the practice, beyond the device alone. Care infrastructure draws attention to the material, but ensures that analytic attention engages with both material and social elements of practice and their connections.     

The rise and uncertain future of cath labs

Few places have the potential to dramatically change the clinical and financial landscape."Cath labs are turning hospitals and health care upside down right now" says Skip Meador, director of cardiology for Centra Health, Lynchburg, Va."It's sure a different animal now than it was even seven or eight years ago" Cardiovascular programs--which increasingly rely on procedures performed in the cath lab--have long been the linchpin of hospital profitability, and have tended to prop up other money-losing areas. But critical issues threaten that profitability, such as the cost of technology, operating expenses and payer reimbursement. Likewise, such other technology as implantable cardiac defibrillators, biventricular pacemakers and ventricular assist devices bring more potential to change the landscape of cardiac care delivery. A case in point: the advent of primary angioplasty.     

Exploring new packaging and delivery options for the immunization supply chain

A variety of vaccine packaging and delivery technologies may benefit the immunization supply chain. These include alternative primary packaging, such as blow-fill-seal polymer containers, and novel delivery technologies, such intradermal delivery devices, microarray patches, and sublingual formulations of vaccines, and others in development. The potential timeline to availability of these technologies varies and depends on their stage of development and the type of data necessary to achieve licensure. Some new delivery devices are anticipated to be introduced in 2017, such as intradermal devices for delivery of inactivated poliovirus vaccine to stretch vaccine supplies due to a supply limitation. Other new technologies requiring vaccine reformulation, such as microarray patches and sublingual vaccines, may become available in the long term (2021 and beyond). Development of many new technologies requires partnership between vaccine and technology manufacturers and identification of the applicable regulatory pathway. Interaction with public-sector stakeholders early on (through engagement with forums such as the World Health Organization’s Immunization Practices Advisory Committee Delivery Technologies Working Group) is important to ensure suitability for immunization program use. Key considerations for programmatic suitability of a new vaccine, packaging, and delivery device include cold chain volume, costs, and health impact.     

构建我国医疗器械安全警戒系统的探讨

引入医疗器械警戒系统的概念．建立我国医疗器械警戒制度是当前加强医疗器械监管的一项紧迫的工作。我国的制度建设应定位于国际接轨高度，尽可能直接采用国际市场中成熟的经验。根据国内的具体情况，讨论了不良事件的报告范围和各责任主体的关系．强调了这一制度的核心应围绕如何发现不良事件，将不良事件纳入属地化监管的体系并与现有其他法规的挂钩，在建立医疗器械不良事件报告制度的同时，应充分重视不良事件的处理。对植入器械的追踪在我国应尽快推广条形码技术。     

Electromagnetic compatibility of WLAN adapters with life-supporting medical devices

This paper investigates the electromagnetic compatibility of 45 critical care medical devices (infusion pumps, defibrillators, monitors, lung ventilators, anesthesia machines and external pacemakers) with various types of wireless local area network (WLAN, IEEE 802.11 b/g, 2.45 GHz, 100 mW) adapters. Interference is evaluated by performing ad-hoc tests according to the ANSI C63.18 recommended practice. The behavior of the devices during the tests was monitored using patient simulators/device testers specific for each device class. Electromagnetic interference cases were observed in three of 45 devices at a maximum distance of 5 cm. In two cases the interference caused malfunctions that may have clinical consequences for the patient. The authors' findings show that the use of these wireless local area network adapters can be considered reasonably safe, although interference may occur if they are operated at very close distance (<10 cm) to the medical devices.     

The process of incorporating insulin pumps into the everyday lives of people with Type 1 diabetes: A critical interpretive synthesis

Background

Insulin pump therapy (IPT) is a technological advancement that has been developed to help people manage Type 1 diabetes (T1D). However, ways of managing diabetes requiring the implementation of health technologies bring new complexities and a need to understand the factors which enable people with T1D to incorporate a novel device. This new comprehension could provide an exemplar for people with long‐term conditions to incorporate new technologies more generally.

Objective

To determine what influences the incorporation, adaptation and use of IPT into the everyday lives of people living with diabetes.

Design

Critical interpretive synthesis (CIS) using systematic searches undertaken in 7 electronic databases of literature, published 2008 onwards.

Results

A total of 4998 titles were identified, 274 abstracts reviewed, 39 full articles retrieved and 22 papers selected for analysis. Three themes emerged which were of relevance to the introduction and use of IPT; Tensions between expectations and experiences in adoption and early adaptation; Negotiation of responsibility and accessing support; Reflexivity, active experimentation and feedback.

Conclusions

This CIS builds on earlier reviews on lived experiences of IPT. Novel insights are offered through examination of the experiences of pump users from children through to adults, their families and health‐care professionals. Expectations of what the device can do to improve self‐management impacts on the early stages of adoption as the reality of the technology requires substantial thought and action. Areas for intervention to improve IPT incorporation include establishing who is responsible for management tasks of the device and enabling navigation to further means of support and resources.     

Shedding new light on the (in)compatibility of chronic disease management with everyday life – social practice theory,mobile technologies and the interwoven time‐spaces of teenage life

This article uses a socio‐material approach, social practice theory, to provide new insights into the self‐management of chronic illness. It demonstrates how this theory can bridge arguments about the respective roles of social and individual influences, and how it can foreground an oft‐overlooked aspect of the issue – the demands of self‐care technologies and consequences for participation in social life. Drawing on interviews and focus groups with 25 young type‐1 diabetes outpatients in London, UK, the study points to the conflicts that occur when disease management technologies compete for time and space with the social practices of everyday life, and when self‐care tasks threaten to interrupt the flow of social life and make people feel ‘left behind’. The paper concludes that young people are disabled by the contingent position of self‐care activities in daily life, which oblige them to compromise either their physical health or their immersion in the social world. This disabling effect would be mitigated if social practices were reorganised to make them more amenable to the time‐space requirements of disease management. A social practice theory lens can help throw light onto this issue and make a valuable contribution to the study of the self‐management of chronic illness.     

Psycho-social factors and the technologies of work

This paper examines the probable association between use of complex technologies in the work setting and psycho-social factors believed to impact upon human health. The analysis is set within two long-standing philosophical perspectives on technology, one which holds that technology controls human choice and action, and the other which sees technology as a useful tool for extending human capabilities. Research evidence linking technologies of work to health are reviewed. On the basis of this literature, the authors conclude that, in general, among blue collar and clerical workers, technology is often a controlling element, to the detriment of health; but among professionals and managers, technology can be an aid to work and may therefore facilitate positive health. Strategies are offered toward the prevention and detection of, and intervention into work environments which, through the use of high technology, may pose a threat to health.     

How children and young people construct and negotiate living with medical technology

Increasing numbers of children need the support of medical technology for their survival and wellbeing, yet little is known about their experiences of living technology-assisted lives. This study aimed to explore how this group of children experience and construct medical technology and its influence on their identity and social relationships. Using a Grounded Theory approach, 28 children/young people aged between 8 and 19 years old and using different types of medical devices were recruited via nursing services in England. Data were collected by in-depth interviews conducted in children's homes. The medical technology occupied an ambivalent position in children's lives being seen as having both an enabling and disabling presence. Children actively engaged in work to incorporate the technology into their lives and bodies by developing strategies to manage their condition, the technology and their identities. This body work appeared to be driven by a desire to 'normalise' their bodies and their lives. Technologies were shaped to integrate them into everyday life and children managed their self-presentation and controlled information about their condition. This work was ongoing, responding to changing social contexts and relationships. For these children the process of 'growing up' involves incorporating disability, illness and technology. This study contributes to knowledge by examining how medical technology is constructed by children whose lives are dependent on it and illuminating the resources and strategies they use to manage their identity and negotiate peer culture interactions and norms.     

Family food practices: relationships,materiality and the everyday at the end of life

This article draws on data from a research project that combined participant observation with in‐depth interviews to explore family relationships and experiences of everyday life during life‐threatening illness. In it I suggest that death has often been theorised in ways that make its ‘mundane’ practices less discernible. As a means to foreground the everyday, and to demonstrate its importance to the study of dying, this article explores the (re)negotiation of food and eating in families facing the end of life. Three themes that emerged from the study's broader focus on family life are discussed: ‘food talk’ and making sense of illness; food, family and identity; and food ‘fights’. Together the findings illustrate the material, social and symbolic ways in which food acts relationally in the context of dying, extending conceptual work on materiality in death studies in novel directions. The article also contributes new empirical insights to a limited sociological literature on food, families and terminal illness, building on work that theorises the entanglements of materiality, food, bodies and care. The article concludes by highlighting the analytical value of everyday materialities such as food practices for future research on dying as a relational experience.     

Aging society and gerontechnology: A solution for an independent living?

Recent studies report that the majority of older adults wish to live in their own homes, for as long as possible. This creates a growing interest in technologies to enable older people to remain living independently at home. The purpose of this article is to provide a narrative review of current technology appropriate for older adults’ home use. The key research questions were as follow: 1- What is the evidence demonstrating that gerontechnologies are effective in enabling independent living? 2- What are devices designed specifically for frail elderly persons ? Several publications were identified about devices targeting social isolation (videophonic communication, affective orthotic devices or companion-type robots, personal emergency response systems [security]), autonomy loss (technologies for maintenance of autonomy in the activities of daily living) and cognitive disorders (cognitive orthotics, wandering management systems, telemonitoring). Very few articles dealt specifically with the frail older person. In particular, there was extremely limited evidence on use and efficacy of these devices within this population. There is a need to obtain a consensus on definition of the technologies, and also to revisit work strategies and develop innovative business models. To meet this goal, we need to create a network of technological companies, aging services organizations, end-users, academics, and government representatives to explore the real needs of the frail older population and to develop and validate new devices promoting aging at home.     

'I take a small amount of the real product': Elevated cholesterol and everyday medical reasoning in liminal space

The medical consequences of elevated cholesterol are widely known, as are the medical regimens to control and manage it. At the same time, elevated cholesterol is bereft of bodily signs. Being symptomless places the condition in a no man's land: people with elevated cholesterol are assessed as medically sick but their bodies signal wellness. In this article I refer to this ambiguous grey area, betwixt and between being healthy and being sick, as liminal space . The aim of this article is to show how people manage the symptomless condition of elevated cholesterol in liminal space. Particular attention is paid to everyday medical reasoning in that space. Based on interviews with people with elevated cholesterol, I show that medical regimens are 'up against' - challenged by - a variety of competing conditions in everyday life, illustrating ambiguity. Facing this dilemma between medicine and everyday life, they ongoingly need to navigate - edit, modify, adjust - medical regimens against everyday conditions. This navigating work can be seen as ritualized strategies to sort ambiguity. People with elevated cholesterol do not so much act 'against medical regimens' as they simultaneously need to take account of other matters they are up against in trying to stay healthy. Medical regimens are sometimes central, sometimes peripheral. Adapting medical regimens to the situation at hand, people continuously comply with medical regimens, producing and reproducing medical regimens in moral contexts of everyday life.     

Perceived difficulty in everyday technology use among older adults with or without cognitive deficits

This study's purpose was comparing perceived relevance of and difficulty in use of everyday technology such as remote controls, cell phones, and microwave ovens, in older adults with/without cognitive deficits. Three groups included 157 participants; 34 had mild-stage dementia, 30 had mild cognitive impairment (MCI), and 93 lacked known cognitive impairments. Data were collected in structured interviews with the Everyday Technology Use Questionnaire (ETUQ). Analyses revealed that participants with no known cognitive deficits (Group 3) considered a higher proportion of technologies relevant to their life situation than participants with mild-stage dementia (Group 1) and those with MCI (Group 2). Furthermore, participants with no known cognitive deficits reported the lowest mean level of perceived difficulty in everyday technology use, followed by those with MCI and those with mild-stage dementia. All three groups differed significantly (p <0.01; p <0.001) in perceived difficulty using technology, indicating that measurement of perceived difficulty in everyday technology use may sensitively detect changes resulting from MCI/dementia. Findings indicate that perceived difficulty in using everyday technology increases in people with MCI and is accentuated in mild-stage dementia. This calls for increased attention to these issues when assessing functional ability in daily activities of older adults with possible MCI/dementia, and for further research.     

The causes and control of anxiety

The 20th century has been described as the age of anxiety. Many have claimed that the pressures of a modern technological and competitive society are too great. Anxiety is a normal part of reaction to threats created by life situations especially when control is low. Some people perpetuate constant anxiety by oversensitivity to environmental events. Anxiety can reduce daily efficiency and become self-enhancing. Biological mechanisms may also sustain anxiety further. Treatments include addressing both the cognitive and the biological aspects of the state. Training people to cope with life and to find forms of control may be the most beneficial in the long term.