Design trade-offs in self-management technology: the HeartMan case

ABSTRACT

Health self-management technology has the potential to significantly improve the Quality of Life of patients suffering from chronic diseases. However, designing the technology involves numerous highly context-dependent design decisions. In this paper, we analyse a case study of self-monitoring technology in the field of congestive heart failure. We analyse the design process of the technology from the perspective of design trade-offs. Three important trade-offs related to health self-monitoring technology are described in detail, related to patient autonomy, technology appropriation, and patient well-being. For each of the trade-offs, various mediating factors that influence design decisions are described in detail. On a practical level, this analysis can inform future developments in self-management technology. In addition, this design trade-off analysis provides intermediary knowledge that can contribute to a better theoretical understanding of health self-management technology.     

Medical savings accounts: opportunities for cost savings?

Interest in medical savings accounts (MSAs) as a potential tool to reduce healthcare costs has been widespread. A small number of countries have either implemented or run pilot programs of MSAs, and vigorous policy debates have taken place in several other countries about the potential merits of introducing MSAs as a method of paying for health care. In this paper we develop a model to assess the cost saving potential of MSAs in a publicly funded healthcare system. We assume that the public healthcare payer may choose between reimbursing healthcare expenditures through an MSA or through a form of third‐party payer insurance. We use the model to identify the conditions under which MSAs may reduce costs. We illustrate using data on healthcare expenditures from Canada.     

The Region 1 & 3 Broadcasting‐Satellite Service Plan after WRC‐03

The 1977 Broadcasting‐Satellite Service (BSS) Plan for Region 1 & 3 had been widely acknowledged to be out‐of‐date by the late 1980s. Development of digital modulation in the early 1990s provided an opportunity to update the technical provisions of the Plan to make it more economically viable. After a decade of work and three World Radiocommunication Conferences (WRCs), the revision of Region 1 & 3 BSS Plan was finally completed in 2003. The new Plan increased channel assignments from 5 to 10 analog‐equivalent channels for each country in Region 1, and from 4 to 12 channels for each country in Region 3. Yet, despite the increase in capacity, the new Plan is surprisingly similar to the original one in terms of the technical parameters. It is still based on national coverage, and the channel plan, orbital location, orbital spacing, and polarization are also the same. As a result, the new Plan is no more economically viable to implement than the old. To create economically viable BSS systems would most likely require modifications to the assignment in the Plan. Yet, modification procedures were made more difficult to apply after replanning. Less future implementation of BSS networks than would otherwise have occurred can be expected, and an inefficient usage of these frequency bands will likely result. On the other hand, less implemented systems will mean more capacity set aside for future use. This is important for countries that currently do not have satellite operations. In the end, BSS replanning reflects the eternal conflict between efficient usage and guaranteed future access. Copyright © 2005 John Wiley & Sons, Ltd.     

Treatment of depressive symptoms during short-term rehabilitation: An attempted replication of the DOUR project.

Objective: To replicate and extend P. A. Lichtenberg and colleagues' (1996) cross-disciplinary intervention to improve physical and mental health among older adults. Participants: 14 depressed older adults (6 treatment, 8 control). Setting: The short-term rehabilitation unit of an urban nursing home. Intervention: Occupational therapists were trained to treat depression using pleasant events and cognitive-behavioral therapies. Outcome Measures: Geriatric Depression Scale, the Short Form-12, and the Multi-Level Assessment Instrument: Activities of Daily Living. Results: No significant group differences were found in physical or mental health. However, more control group members (75%) than treatment group members (33%) were depressed at study completion. Conclusions: The treatment of depressive symptoms can be integrated with a nonmental health treatment modality. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Hemodialysis in the United Kingdom

Hemodialysis was a neglected aspect of nephrology in the UK. At the request of the Renal Association, the first UK Haemodialysis Masterclass was organized in 2007. The articles in this supplement arose from that meeting. Here, an overview of UK hemodialysis services and nephrology training is presented as background. Government‐funded dialysis should be provided to all UK citizens who require it. In 2005, there were 17,645 patients receiving hemodialysis, 5057 on peritoneal dialysis and 19,074 with kidney transplants, looked after by 359 nephrologists working in 73 National Health Service renal units. Renal replacement therapy incidence and prevalence remain comparatively low, at 108 and 694 per million population, respectively. Whether this represents inadequate provision or genuinely lower need remains unclear. The Renal Association sets clinical practice guidelines for dialysis, and audits performance via the UK Renal Registry. Postgraduate medical education is undergoing radical change in the UK. This is driven by the reduction in trainee doctors' working hours to 48 hr/week (mandated by the European Working Time Directive), and the governments' wish to reduce the duration of training, but also by a desire to formalize training, Our challenge is to continue to produce talented clinical nephrologists educated in breadth and depth, despite the reduced emphasis on clinical experience and omission of period of scientific research. The future for hemodialysis services in the UK is, however, promising with an expansion in the number of specialists and dialysis centers, and a growing interest in dialysis practice and research.     

Alternatives to standard hemodialysis

Survival of patients on hemodialysis remains poor, but the benefits of increasing urea clearance have probably been maximized within our current treatment schedules. Long dialysis sessions (8 hr) produce impressive outcomes, with mortality 53% to 55% lower than conventional schedules. Even increasing from 4 to 5 hr may improve survival. Increased frequency of dialysis (6 times weekly) produces impressive reductions in left ventricular mass and could conceivably be implemented in‐center. Preliminary data suggest a 61% reduction in mortality with increased frequency. Nightly dialysis combines longer sessions with increased frequency and has produced remarkable clinical gains in blood pressure, left ventricular mass, serum phosphate, and sleep apnea. However, the data are mainly from case series and impact on mortality remains unknown. Expansion of home hemodialysis would be necessary for this modality to grow. Convective therapies remove middle molecules more effectively, and observational data suggest hemodiafiltration has the potential to improve mortality by 35% to 36%. Hemodiafiltration has the advantage of being relatively easy to implement. The uremic milieu is complex and further investigation of the underlying pathophysiology is needed to inform future dialysis interventions. The survival data above are from observational studies, and hence benefits are likely to be exaggerated. Randomized trials of dialysis interventions are desperately needed. They remain difficult to perform, because of the complexity of both the patient population and the interventions, and because of limited available funding.     

家庭网络标准及其研究计划

家庭网络处于不断发展的过程中，家电／IT行业与电信行业对于家庭网络的理解和发展思路也不一样，因此无论国际和国内都有很多从事家庭网络标准化的组织，标准不统一。中国正在制订家庭网络相关标准的组织主要有3个，分别是信息设备资源共享协同服务标准工作组（IGRS）、e家佳和中国通信标准化协会（CCSA），目前都已有了一些研究成果。为了提高中国在家庭网络领域自主创新的能力，进一步加快中国家庭网络的标准化进程，3个标准化组织应该打破行业壁垒，加强合作，实现优势互补，以合作共赢的态度研究中国自主的家庭网络标准。     

基于网络的家电产品故障诊断系统研究

介绍了基于网络的家电产品故障诊断系统的硬件拓扑结构、软件平台及系统开发。系统在硬件上采用了多种网络平台搭建方式及综合连接技术，软件上采用了IDRS诊断模型和基于事例的最新诊断技术。这也是诊断研究和应用的新领域。     

Does the use of Solar Home Systems (SHS) contribute to climate protection?

The paper addresses planners and decision-makers in the field of international development cooperation and also institutions concerned with the impacts of project- and technology promotion. The primary aim of the dissemination of Solar Home Systems (SHS) in off grid areas in developing countries is to improve the living conditions of the population in a cost–effective manner. A large-scale dissemination is essential both for significant contributions to development and for climate effectiveness. However, the contribution of SHS to climate protection is disputed. This analysis presents the most important parameters affecting the contribution of SHS to climate protection and quantifies the influence of those parameters. The case considered presupposes the commercial dissemination of SHS. Greenhouse gas (GHG) emissions are affected by the marketing decisions of the supplier of SHS. With regard to the impact on GHG emissions, a comparison is made between traditional lighting with petroleum lamps and the use of dry cell batteries to operate small devices (baseline case) on the one hand and SHSs on the other. The comparison shows GHG savings of around 9 tonnes of CO₂ equivalent GHG emissions within a 20-year period of use of one single 50 Wp SHS compared with the baseline case. The result is robust with respect to variations in GHG-affecting variables. Petroleum consumption and dry cell batteries dominate GHG emissions balances to such an extent that scarcely any importance can be attached to GHG emissions from the transportation and manufacture of SHS. Therefore, it is permissible to use simplified GHG inventories which ignore the GHG emissions arising from the transportation and manufacture of SHS. Therefore the conclusion is, if SHS are commercially disseminated and used cost efficiently to substitute kerosene and dry cell batteries they reduce GHG emissions effectively. In that case SHS can make a significant contribution to climate protection by the dissemination of large numbers.