Integrating control of multiple assistive devices: a retrospective review

Advances in technology now allow individuals to operate multiple assistive devices through a single, integrated control. A retrospective review of clients at the Center for Applied Rehabilitation Technology (CART) was conducted to determine the factors that support the recommendation of integrated controls. A total of 290 client charts were reviewed; data from 87 clients met the study criteria and were included in the review. For each individual, information was obtained on available access sites, types of assistive technology controlled, and types of input devices used. Meetings were held with CART therapists to determine reasons for recommending specific access configurations for each individual. Twelve reasons falling into four general categories (i.e., performance, functional abilities, subjective, and external) were identified and used to code responses. The findings indicated that integrated controls may be useful in the following cases: 1) when an individual has a single, reliable access site; 2) when the optimum access method for each assistive device is the same; and 3) when the individual prefers integrated control for personal reasons (e.g., aesthetics). Integrated controls may not be appropriate in the following cases: 1) when performance on one or more assistive devices is severely compromised by integrating control; 2) when the individual wishes to operate an assistive device from a position other than from a powered wheelchair; 3) when physical, cognitive, or visual/perceptual limitations preclude integrating; 4) when it is the individual's personal preference to use separate controls; and 5) when external factors such as cost or technical limitations preclude the use of integrated controls.     

Integrating Control of Multiple Assistive Devices: A Retrospective Review

Advances in technology now allow individuals to operate multiple assistive devices through a single, integrated control. A retrospective review of clients at the Center for Applied Rehabilitation Technology (CART) was conducted to determine the factors that support the recommendation of integrated controls. A total of 290 client charts were reviewed; data from 87 clients met the study criteria and were included in the review. For each individual, information was obtained on available access sites, types of assistive technology controlled, and types of input devices used. Meetings were held with CART therapists to determine reasons for recommending specific access configurations for each individual. Twelve reasons falling into four general categories (i.e., performance, functional abilities, subjective, and external) were identified and used to code responses. The findings indicated that integrated controls may be useful in the following cases: 1) when an individual has a single, reliable access site; 2) when the optimum access method for each assistive device is the same; and 3) when the individual prefers integrated control for personal reasons (e.g., aesthetics). Integrated controls may not be appropriate in the following cases: 1) when performance on one or more assistive devices is severely compromised by integrating control; 2) when the individual wishes to operate an assistive device from a position other than from a powered wheelchair; 3) when physical, cognitive, or visual/perceptual limitations preclude integrating; 4) when it is the individual's personal preference to use separate controls; and 5) when external factors such as cost or technical limitations preclude the use of integrated controls.     

Advanced central venous access. Selection, catheters, devices, and nursing management

The increased need for intravascular access in the care of a variety of patients is, in part, responsible for the diversity of central venous access devices. Various nontunneled catheters, tunneled catheters and implantable ports are available on the health care market. As the availability of these devices increases, so must the nurse's knowledge base in order to provide optimal safe care to patients using different devices. Learning which device is best suited for each patient and which has the fewest known complications can be a tedious process for the nurse specialized in venous access care.     

Intraosseous access in the prehospital setting: literature review

BACKGROUND: Although the majority of Australian intensive care paramedics use the manual intraosseous infusion technique (MAN-IO), several other semiautomatic devices now are available, such as the bone injection gun (BIG) and the semiautomatic intraosseous infusion system (EZ-IO). Given the choice of devices now available, questions have been raised regarding success rates, accuracy, decay of skills, and adverse events. OBJECTIVES: Review the literature regarding the use of intraosseous (IO) devices in the prehospital setting. METHODS: Selected electronic databases (Medline, Embase, and CINAHL) were searched, and a hand search was conducted for grey-literature that included studies from the commencement of the process to the end of May 2010. Inclusion criteria were any study reporting intraosseous insertion and/or infusion (adult and pediatric) by paramedics in the prehospital setting. Findings The search located 2,100 articles; 20 articles met the inclusion criteria. The review also noted that use of IO access (regardless of technique) offers a safe and simple method for gaining access to the patients' vascular system. A number of studies found that the use of semiautomatic devices offers better and faster intraosseous access compared with the use of manual devices, and also were associated with fewer complications. The findings also suggest that the use of semiautomatic devices can reduce insertion times and the number of insertion attempts when contrasted with the use of manual insertion techniques. Despite these findings, statistically no specific IO device has proven clinical superiority. Conclusion While manual IO techniques currently are used by the majority of Australian paramedics, the currently available evidence suggests that semiautomatic devices are more effective. Further research, including cost-benefit analyses, is required at a national level to examine skill acquisition, adverse effects, and whether comparative devices offer clinically significant advantages. Olaussen A , Williams B . Intraosseous access in the prehospital setting: literature review. Prehosp Disaster Med. 2012;27(5):1-5.     

Administration of chemotherapeutic agents

Safe and pain-free vascular access is now the achievable goal for every patient receiving systemic chemotherapy. The discomfort and anxiety that used to accompany multiple (often unsuccessful) venipunctures can be avoided by placement of a longterm central-venous-access device as part of the patient's early treatment plan. In the United States, approximately 5x10⁵ such devices are now inserted each year. This review discusses and compares the different types of devices currently available, methods of insertion, and management of morbidity. Future studies should focus on the cost effectiveness of these devices, better selection of patients for the various types of access, and avoidance, recognition, and treatment of complications.Presented at the 6th International Symposium: Supportive Care in Cancer, New Orleans, La., 2–5 March 1994     

Assistive computing devices: a pilot study to explore nurses' preferences and needs

Healthcare errors among nurses are common because of the fast-paced work environment, in which extensive data must be analyzed and quick decision making is required. Assistive computing devices can help reduce nursing errors by providing timely access to client information and by assisting nurses with client monitoring, decision making, and bedside documentation. The purpose of this pilot study was to determine what assistive computing device features, functions, and input/output modalities nurses would find most useful as support for their nursing duties. Twenty nurses completed a questionnaire that examined their needs and preferences. Data analysis revealed a strong desire for capabilities related to facilitating information access and administering safe medication. The results of this study will be used to develop design criteria for an assistive computing device that will aim to improve the performance of nurses through appropriate information and data support.     

Personal data assistants: using new technology to enhance nursing practice

This article explains how the new technology of personal data assistants can be used to enhance and augment comprehensive nursing care. Nurses are constantly challenged in their need for current, reliable, and accurate information at the point of patient care. Professional books and journals, by the very nature of their print format, have been prepared long before they can be actually used in practice. More current information is available from the World Wide Web, but it is often impractical for a nurse to access a computer during a patient encounter. Personal data assistants [PDAs] allow clinicians to access and document absolutely current information at the moment the patient is being seen. There are many general applications for PDAs that nurses might use such as keeping electronic calendars, address books, and reminder lists. In addition, however, there are even more actual healthcare applications, including patient tracking systems, access to pharmacologic databases, and a variety of clinical decision-making support tools. This article describes the wide variety of PDAs, along with the factors a nurse should consider in the decision of whether to purchase a PDA, and which type of device is best suited for which application.     

Sentinel: towards an ambient mobility network

Purpose: We are concerned with aiding the mobility of visually impaired travellers around often complex and unfamiliar internal and urban environments. To do this we focus on a users interaction with ambient devices because these device types provide an easy entry point for visually impaired individuals to interact with their surroundings. By augmenting the physical environment with mobility focused ambient devices and making existing devices universally accessible our goal of easy, focused, and confident mobility can be achieved. Method: We identify, through paper reviews and studies of empirical and anecdotal evidence, the social and technical problems that have so far barred consistent and cohesive development of an ambient mobility-network. Results: We suggest that multi-model sensory-interaction with objects and assistive devices within an environment is the only way to accomplish easy, focused, and confident mobility for visually impaired travellers. We find that universal access to ambient devices does not exist when the user interface and the device functionality are conjoined. And we also suggest that this universal access will not occur if there are only benefits for one small minority user group. Conclusions: We conclude that to assist mobility we need to provide universal access to objects and devices within the environment. Also, to support the mobility of visually impaired travellers we must first support all travellers regardless of their mobility needs. And to accomplish this we must separate the user interface from the real purpose (the functionality) of the object/device.     

Vascular access problems revisited: the Multinational Association of Supportive Care in Cancer (MASCC) experience

 Despite the increased availability of vascular access devices, there is limited information regarding their pattern of use in the clinical setting or the criteria used for their utilization. To obtain this information, we sent questionnaires to MASCC members. Forty-five percent of the respondents stated that the decision to use vascular access devices depended on the drugs used at the beginning of therapy. Another 30% replied that the decision to use long-term vascular access devices depended on the status of the patient's veins at the beginning of therapy. Only 12% of those surveyed waited until all the veins were exhausted before considering using vascular access devices. Although more than half of the professionals surveyed used long-term vascular access devices in 50% or more of their patients with hematologic malignancies, only 20% used these devices in patients with solid tumors. Features considered most important when selecting long-term vascular access devices were durability of the device and ease of use for medical personnel. Major limitations of long-term vascular access devices were cost, closely followed by patient acceptance. The most common reasons for removal of vascular access devices were infection and thrombosis. We conclude that there is a lack of uniform criteria for the utilization of long-term vascular access devices. Cost is a major limitation to the wider use of this technology. More research is necessary to determine the optimal use of vascular access devices in patients with cancer.     

Nurses’ knowledge and self-assessment of their clinical experiences of intraosseous access: A multicentre cross-sectional study

BackgroundIntraosseous access is an effective and safe option when difficult vascular access occurs. The knowledge, competence, and clinical experience of nurses are collectively essential for the successful implementation of this approach in clinical practice. Education and clinical learning are the main pillars supporting this new practice to ensure patient safety. The aim of this study was to identify the nurses’ knowledge and clinical experience of intraosseous access and the factors associated with the adoption of this procedure.MethodsA cross-sectional study was carried out from October to December 2020. A convenience sample of 432 nurses from four Italian hospitals were involved. A structured questionnaire was used to assess the nurses’ knowledge of the intraosseous access guidelines and their clinical experience.ResultsMost participants were female (71.5%) with more than 10 years of experience (63.7%) working in an emergency (38.9%) and medical (37.7%) setting. Most of the participants demonstrated their knowledge of the use of a device e.g., it is used if vascular access is not rapidly achieved in a child (83.1%) and the boluses of liquids required in the intraosseous procedure (72.7%). A few participants reported having placed intraosseous access (3.5%). A higher level of educational preparation and working in emergency and paediatric settings were associated with increased knowledge.ConclusionsOur findings highlighted a sub-optimal level of knowledge of the IO procedure, little experience of this practice in clinical contexts, also associated with a lack of adequate protocols and devices available to nurses. Nurses need to develop their knowledge and practice the skill clinically to embed this practice. University and nurse educators should emphasise the relevance of this practice in nursing education and training, so as to improve the nursing care practice and level of patient safety.     

Mobile computing in critical care

Handheld computing devices are increasingly used by health care workers, and offer a mobile platform for point-of-care information access. Improved technology, with larger memory capacity, higher screen resolution, faster processors, and wireless connectivity has broadened the potential roles for these devices in critical care. In addition to the personal information management functions, handheld computers have been used to access reference information, management guidelines and pharmacopoeias as well as to track the educational experience of trainees. They can act as an interface with a clinical information system, providing rapid access to patient information. Despite their popularity, these devices have limitations related to their small size, and acceptance by physicians has not been uniform. In the critical care environment, the risk of transmitting microorganisms by such a portable device should always be considered.     

A guide to the use and care of vascular access devices in the palliative care setting

There has been a steady increase in the number and range of vascular access devices used in all areas of health care. With this increase there comes a requirement that health professionals dealing with these devices be aware of the range available, indications for use, and the most up to date guidance on the care and maintenance procedures. Care of the device is paramount to preventing complications. This article provides an overview of the types of venous access devices that may be encountered when a patient is transferred to palliative care services, as well as of the procedures for routine maintenance.     

Clinical Trials and Quality Control: Checkpoints in the Provision of Assistive Technology

Clinical trials and quality control measures are characterized by evaluation of assistive technology by users, and feedback to providers for the purpose of improving devices or service delivery. These processes recognize that consumer satisfaction is an important measure of device and service delivery effectiveness. In this article, types of clinical trials are reviewed, and both prospective and retrospective methods of quality control are presented. The authors take the position that rehabilitation engineering centers providing customized devices and adapted technology should implement quality control measures in order to improve services to their clients.     

Clinical trials and quality control: checkpoints in the provision of assistive technology

Clinical trials and quality control measures are characterized by evaluation of assistive technology by users, and feedback to providers for the purpose of improving devices or service delivery. These processes recognize that consumer satisfaction is an important measure of device and service delivery effectiveness. In this article, types of clinical trials are reviewed, and both prospective and retrospective methods of quality control are presented. The authors take the position that rehabilitation engineering centers providing customized devices and adapted technology should implement quality control measures in order to improve services to their clients.