Including the voice of paediatric patients: Cocreation of an engagement game

BackgroundEngaging patients in health care, research and policy is essential to improving patient‐important health outcomes and the quality of care. Although the importance of patient engagement is increasingly acknowledged, clinicians and researchers still find it difficult to engage patients, especially paediatric patients. To facilitate the engagement of children and adolescents in health care, the aim of this project is to develop an engagement game.MethodsA user‐centred design was used to develop a patient engagement game in three steps: (1) identification of important themes for adolescents regarding their illness, treatment and hospital care, (2) evaluation of the draft version of the game and (3) testing usability in clinical practice. Adolescents (12–18 years) were engaged in all steps of the development process through focus groups, interviews or a workshop. These were audio‐recorded, transcribed verbatim and analysed in MAXQDA.Results(1) The important themes for adolescents (N = 15) were included: visiting the hospital, participating, disease and treatment, social environment, feelings, dealing with staff, acceptation, autonomy, disclosure and chronically ill peers. (2) Then, based on these themes, the engagement game was developed and the draft version was evaluated by 13 adolescents. Based on their feedback, changes were made to the game (e.g., adjusting the images and changing the game rules). (3) Regarding usability, the pilot version was evaluated positively. The game helped adolescents to give their opinion. Based on the feedback of adolescents, some last adjustments (e.g., changing colours and adding a game board) were made, which led to the final version of the game, All Voices Count.ConclusionsWorking together with adolescents, All Voices Count, a patient engagement game was developed. This game provides clinicians with a tool that supports shared decision‐making to address adolescents'' wishes and needs.Patient or Public ContributionPaediatric patients, clinicians, researchers, youth panel of Fonds NutsOhra and patient associations (Patient Alliance for Rare and Genetic Diseases, Dutch Childhood Cancer Organization) were involved in all phases of the development of the patient engagement game—from writing the project plan to the final version of the game.     

Assessment of functioning in Dutch primary care: Development study of a consultation tool for patients with chronic conditions and multimorbidity

BackgroundIn primary care, a shift from a disease‐oriented approach for patients with multimorbidity towards a more person‐centred approach is needed.AimTo transform a self‐report questionnaire for patients with chronic conditions in primary care, the Primary Care Functioning Scale (PCFS), into an understandable, visually attractive and feasible consultation tool for patients and health care providers. The consultation tool consists of a web‐based version of the PCFS, which is filled in by the patient and is processed to a feedback report that summarizes and visualizes the main findings. The feedback report can be discussed with the patient to facilitate a more person‐centred conversation for patients with chronic conditions and multimorbidity in general practice.Design and SettingIn this qualitative study, we developed the consultation tool by using design thinking in a participatory developmental process.MethodsIn the first phase, we constructed five different feedback report templates to summarize and display the results of a completed PCFS questionnaire in a series of two expert meetings with patients and general practitioners (GPs). In the second phase, we performed an exploratory qualitative interview study involving dyads of patients with chronic conditions and their practice nurses. In an iterative process, we explored their experiences with the consultation tool.ResultsPatients, as well as GPs, preferred a clear manner of presenting the results of the questionnaire in a feedback report. In 18 interviews with patients and practice nurses during three different interview rounds, we adjusted the feedback report and consultation tool based on the input from patients and practice nurses. After the final interview round, patients and practice nurses consented that the consultation tool was useful for having a more in‐depth consultation about functioning and patients'' preferences when integrated into the regularly scheduled consultations.ConclusionWe were able to develop an understandable and feasible consultation tool that is applicable in already existing chronic disease management programmes in general practice in the Netherlands.Patient or Public ContributionTo increase the understandability and feasibility of the consultation tool, we collaborated with end‐users and actively involved patients, GPs and practice nurses in a participatory development process.     

A Comparative Evaluation of the Strain Transmitted through Prostheses on Implants with Two Different Macro-Structures and Connection during Insertion and Loading Phase: An In Vitro Study

Background: The purpose of this study was to measure and compare the strain levels in the peri-implant bone as generated by the blade-like implant (BLI) and the screw-type implant (STI) with two different internal connections (hexagonal and conical) and with a 1:1 and 2:1 crown/implant (C/I) ratio. Methods: The implants (BLI and STI) were placed into sawbones according to the manufacturer’s protocol. Two strain gauges, horizontal and vertical to the implant axis, were placed around each implant on the bone surface 1 mm from the cervical part. Each implant was loaded by a material testing machine at a force of 100 N. Micro-strains (με) generated in the surrounding bone were measured by a strain gauge and recorded. Results: Recorded micro-strains were not significant in both the insertion and loading phases (p < 0.0625). The average recorded micro-strain values were lower in the horizontal dimension of STI with hexagonal connection when the C/I ratio was 2:1 compared with BLI, 210 με and 443 με, respectively. Conclusion: Within the limitations of this study, implant design, implant-abutment connection and C/I ratio did not influence strain values in bone and there is no statistically significant effect of these parameters on bone.     

Quantitative Distribution Characterization and Correlation Study of Composition,Structure and Hardness of Rim Region in Railway Wheel

The railway wheel is the key component of high-speed railway train. To assure the safety in service, higher requirements are put forward in this study for the composition, microstructure uniformity, and comprehensive properties of wheel materials. In this paper, the high throughput quantitative distribution characterization methods of composition, microstructure, inclusions and Vickers hardness of high-speed railway wheel materials based on the spark source original position analysis technique, high throughput scanning electron microscope (SEM) combined with image batch processing technology, and automatic two-dimensional quantitative distribution analysis technique of inclusions and micro hardness have been studied. The distribution trend of the content of nine elements, size and quantity of sulfides and oxides, ferrite area fraction, and Vickers hardness from the wheel tread surface to the radial depth of about 50 mm below the surface has been discussed. The influence of inclusions distribution on the element segregation and the effect of rim-chilling process with different water spraying angle on the distribution of microstructure and micro hardness have been investigated. It was found that unsynchronized cooling on both sides of the rim altered the phase behavior of ferrite and pearlite and obvious inhomogeneity distribution of ferrite appeared, which led to the asymmetrical Vickers hardness in areas near or away from the flange. Based on the quantitative characterization of area fraction and micro hardness on the same location of wheel rim, a statistical mapping relationship between ferrite area fraction and Vickers hardness was established.     

Generative Design and Integrated 3D Printing Manufacture of Cross Joints

The integrated process of design and fabrication is invariably of particular interest and important to improve the quality and reduce the production cycle for structural joints, which are key components for connecting members and transferring loads in structural systems. In this work, using the generative design method, a pioneering idea was successfully realized to attain a reasonable configuration of the cross joints, which was then consecutively manufactured using 3D printing technology. Firstly, the initial model and generation conditions of a cross joint were constructed by the machine learning-based generative design algorithm, and hundreds of models were automatically generated. Then, based on the design objective and cost index of the cross joint, three representative joints were selected for further numerical analysis to verify the advantages of generative design. Finally, 3D printing was utilized to produce generative joints; the influences of printing parameters on the quality of 3D printing are further discussed in this paper. The results show that the cross joints from the generative design method have varied and innovative configurations and the best static behaviors. 3D printing technology can enhance the accuracy of cross joint fabrication. It is viable to utilize the integrated process of generative design and 3D printing to design and manufacture cross joints.     

Analytical Model for Early Design Stage of Cable-Stayed Suspension Bridges Based on Hellinger–Reissner Variational Method

The cable-stayed suspension bridge is one type of bridge that has been increasingly applied to bridge engineering, especially in cross-sea projects. However, the complex combined system of this type of bridge makes it quite difficult for researchers to make a quick decision of the parameter values during the design stage. The Hellinger–Reissner method is applied here to analyze the deformation and force of the structural members in the bridge. The advantage of this method is that the solving of deformation and force is independent of each other, which would enhance the accuracy of the final results. Different load conditions are also considered in the analysis. The results from the present method are compared with test results and finite element analysis, and show good agreements. It implies that the Hellinger–Reissner is a comparatively more efficient method to help designers choose the key parameters for cable-stayed suspension bridges.     

利用医院信息系统优化门诊就医流程

随着数字化医院建设的深入开展,利用现代化的技术手段,通过信息系统的建设。探讨重新整和、优化门诊就医流程,以“服务病人,服务临床一线,服务医院管理”为宗旨,解决门诊病人就医“七长一短”现象。     

医院物资管理存在的问题和解决方法

针对医院物流管理存在的问题,完善医院物资管理制度,建立包括科室需求、采购管理、订单管理、仓库管理、科室申领、消耗管理、统计分析等规范的物资管理流程,并建成医院物资管理平台,使有关数据和信息在每个管理环节互通共享,实现全院式的物资管理。