A Process Framework for Embedded Systems Engineering

Objective: Our aim was to examine underserved women’s perceptions on mobile versus fixed mammography in Santa Clara, California through a focus group study.Background: Research has shown that medically underserved women have higher breast cancer mortality rates correlated with under-screening and a disproportional rate of late-stage diagnosis. The Community Health Partnership in Santa Clara County, California runs the Community Mammography Access Project (CMAP) that targets nearly 20,000 medically underserved women over the age of 40 in the county through the collaborative effort of an existing safety net of healthcare providers. However, little data exists on the advantages or disadvantages of mobile mammography units from the patient perspective. Methods: We assessed underserved women’s perspectives on mammography services in Santa Clara County through two focus groups from women screened at mobile or fixed site programs. Patients were recruited from both CMAP clinics and a county hospital, and focus group data were analyzed using content analysis.Results: We found that women from both the mobile and fixed sites shared similar motivating factors for getting a mammogram. Both groups recognized that screening was uncomfortable but necessary for good health and had positive feedback about their personal physicians. However, mobile participants, in particular, appreciated the atmosphere of mobile screening, reported shorter wait times, and remarked on the good communication from the clinic staff and empathetic treatment they received. However, mobile participants also expressed concern about the quality of films at mobile sites due to delayed initial reading of the films. Conclusions: Mobile mammography offers a unique opportunity for women of underserved populations to access high satisfaction screenings, and it encourages a model similar to CMAP in other underserved areas. However, emphasis should be placed on providing a warm and welcoming environment for patients and ensuring the quality of mammography images.

The Vermont Oxford Network is a group of health professionals who are committed to improving the quality and safety of medical care for newborn infants and their families. Neonatal Intensive Care Quality Improvement Collaborative Year 2000 (NIC/Q 2000) was the second in a series of multiorganization improvement collaboratives organized and administered by the Vermont Oxford Network. The objective of this collaborative was to make measurable improvements in the quality and safety of neonatal intensive care, develop new tools and resources for improvement specific to the neonatal intensive care unit setting, evaluate improvement progress, and disseminate the learning. The 34 centers that participated in NIC/Q 2000 learned and applied 4 key habits for improvement: the habit for change, the habit for evidence-based practice, the habit for systems thinking, and the habit for collaborative learning. A plan-do-study-act method of rapid-cycle improvement was an integral part of the habit for change. Multidisciplinary teams from the participating centers worked closely together in face-to-face meetings, conference calls, and dedicated e-mail listservs under the guidance of trained facilitators and expert faculty. Focus groups formed around specific improvement topics used critical appraisal of the published literature, detailed process analysis, benchmarking, and round-robin site visits to identify potentially better practices (PBPs). The focus groups developed a total of 51 PBPs. Each focus group has developed a "resource kit" summarizing its work. Many of these PBPs have been tested and implemented at the participating centers using rapid-cycle improvement. The PBPs and descriptions of individual center PDSA cycles are available to participants on NICQ.org, the dedicated Internet site for the collaborative. Collaborative quality improvement based on the 4 key habits can assist multidisciplinary neonatal intensive care unit teams in identifying, testing, and successfully implementing change.

BackgroundDuring Coronavirus Disease 2019 (COVID‐19) outbreak in Lombardia, people were recommended to avoid visiting emergency departments and attending routine clinic visits. In this context, it was necessary to understand the psychological reactions of patients with chronic diseases. We evaluated the psychological effects on patients with chronic respiratory conditions and inflammatory bowel disease (IBD) through the analysis of their spontaneous contacts with their referral centres.MethodsCross‐sectional study was conducted from February 23 to April 27, 2020 in patients, or their parents, who contacted their multidisciplinary teams (MDT). E‐mails and phone calls directed to the MDT of the centre for cystic fibrosis (CF) in Milano and for paediatric IBD in Bergamo, were categorised according to their contents as information on routine disease management, updates on the patient's health status, COVID‐19 news monitoring, empathy towards health professionals, positive feedback and concern of contagion during the emergency.ResultsOne thousand eight hundred and sixteen contacts were collected during the study period. In Milano, where the majority of patients were affected by CF, 88.7% contacted health professionals by e‐mail, with paediatricians receiving the largest volume of emails and phone calls compared with other professionals (P< .001). Compared with Milano, the centre for IBD in Bergamo recorded more expression of empathy towards health professionals and thanks for their activity in the COVID‐19 emergency (52.4% vs 12.7%, P< .001), as well as positive feedback (64.3% vs 2.7%, P = .003).ConclusionOne of the most important lessons we can learn from COVID‐19 is that it is not the trauma itself that can cause psychological consequences but rather the level of balance, or imbalance, between fragility and resources. To feel safe, people need to be able to count on the help of those who represent a bulwark against the threat. This is the role played, even remotely, by health professionals.

Population ageing is accompanied by a higher prevalence of chronic-degenerative diseases that require palliative care, particularly dementia. Elderly people with dementia need the help of formal or informal carers. These carers require a variety of guidelines to provide care. In this sense, the multidisciplinary team, which includes the occupational therapist, needs to be prepared in order to provide care. The occupational therapist works to support carers, mainly focusing on occupation and considering the cognitive, psychological and social factors involved in caring for patients with dementia. Strategies for training carers include psychoeducational, psychotherapeutic and psychosocial interventions such as support, education and therapeutic groups. Against this backdrop, this study aimed to understand and discuss the interventions of Brazilian Occupational Therapists with formal and informal carers of elderly people with dementia in palliative care. This is a qualitative study that collected data through focus groups and analyzed the results using the Reflective Thematic Analysis technique. Two focus groups were held. The participants were 13 occupational therapists living in the city of Belo Horizonte, Minas Gerais, Brazil, aged 25-62, with professional experience ranging from 2.5 to 37 years. Of those interviewed, 53.8% worked at home; 46.2% in long-term care institutions for the elderly; 38.5% in hospitals; 23.1% in outpatient clinics and 15.4% in primary care. After a thorough analysis of the data collected, two themes were developed: ‘Occupational therapy interventions for carers of people with dementia in palliative care’ and ‘Carer care strategies. In the first theme, the interviewees pointed to interventions such as providing guidance and training for carrying out activities, supporting the implementation of adaptations and positioning, and drawing up a care plan: ‘providing guidance to help the carer carry out daily activities in a safe way, without infantilizing the elderly person’ (Focus Group 1); ‘supporting the carer to help the elderly person carry out important and necessary activities’ (Focus Group 2). Support for carers was provided through verbal guidance, reports and booklets. In the second theme, the occupational therapists reported the promotion of interventions aimed at caring for the carers themselves, with a focus on overload and routines: ‘In order to support the carer and prevent them from becoming ill, we need to know: How is that carer's life? How is their routine organized? They are usually overloaded and neglect several important things (...) how is their performance?’ (Focus Group 2). The results revealed strategies for training carers to promote the active participation of older people in meaningful daily activities, as well as attention directed at the carers themselves to mitigate their overload. This study illustrates interventions that can support the practice of occupational therapists with carers of elderly people with dementia in palliative care. Moreover, it highlights the need to address such conditions in developing countries like Brazil.

A lack of high-quality provider education hinders the delivery of standard-of-care delirium detection and prevention practices in the intensive care unit (ICU). To fill this gap, we developed and validated an e-learning ICU Delirium Playbook consisting of eight videos and a 44-question knowledge assessment quiz. Given the increasing Spanish-speaking population worldwide, we translated and cross-culturally adapted the playbook from English into Spanish. To translate and culturally adapt the ICU Delirium Playbook into Spanish, the second most common native language worldwide. The translation and cross-cultural adaptation process included double forward and back translations and harmonization by a 14-person interdisciplinary team of ICU nurses and physicians, delirium experts, methodologists, medical interpreters, and bilingual professionals representing many Spanish-speaking global regions. After a preeducation quiz, a nurse focus group completed the playbook videos and posteducation quiz, followed by a semistructured interview. The ICU Delirium Playbook: Spanish Version maintained conceptual equivalence to the English version. Focus group participants posted mean (standard deviation) pre- and post-playbook scores of 63% (10%) and 78% (12%), with a 15% (11%) pre-post improvement (P = 0.01). Participants reported improved perceived competency in performing the Confusion Assessment Method for the ICU and provided positive feedback regarding the playbook. After translation and cultural adaptation, the ICU Delirium Playbook: Spanish Version yielded significant knowledge assessment improvements and positive feedback. The Spanish playbook is now available for public dissemination.

SAT0730-HPR DEVELOPMENT AND DESIGN OF SMARTPHONE APPLICATION FOR POSTURAL ALIGNMENT OF CERVICAL AND THORACIC SPINE FOR YOUNG ADULTS

The first part of this manuscript is an introduction to systems engineering and how it may be applied to health care and point of care testing (POCT). Systems engineering is an interdisciplinary field that seeks to better understand and manage changes in complex systems and projects as whole. Systems are sets of interconnected elements which interact with each other, are dynamic, change over time and are subject to complex behaviors. The second part of this paper reports on the results of the National Institute of Biomedical Imaging and Bioengineering (NIBIB) workshop exploring the future of point of care testing and technologies and the recognition that these new technologies do not exist in isolation. That they exist within ecosystems of other technologies and systems; and these systems influence their likelihood of success or failure and their effectiveness. In this workshop, a diverse group of individuals from around the country, from disciplines ranging from clinical care, engineering, regulatory affairs and many others to members of the three major National Institutes of Health (NIH) funded efforts in the areas the Centers for POCT for sexually transmitted disease, POCT for the future of Cancer Care, POCT primary care research network, gathered together for a modified deep dive workshop exploring the current state of the art, mapping probable future directions and developing longer term goals. The invitees were broken up into 4 thematic groups: Home, Outpatient, Public/shared space and Rural/global. Each group proceeded to explore the problem and solution space for point of care tests and technology within their theme. While each thematic area had specific challenges, many commonalities also emerged. This effort thus helped create a conceptual framework for POCT as well as identifying many of the challenges for POCT going forward. Four main dimensions were identified as defining the functional space for both point of care testing and treatment, these are: Time, Location, Interpretation and Tempo. A framework is presented in this paper. There were several current and future challenges identified through the workshop. These broadly fall into the categories of technology development and implementation. More specifically these are in the areas of: 1) Design, 2) Patient driven demand and technology, 3) Information Characteristics and Presentation, 4) Health Information Systems, 5) Connectivity, 6) Workflow and implementation, 7) Maintenance/Cost, and 8) Quality Control. Definitions of these challenge areas and recommendations to address them are provided.

Background: Body image typically improves following bariatric surgery. However, changes to body image are quite complex. Although patients are generally satisfied with the weight loss, they also experience negative body changes such as the development of excess skin. Methods: The current study used qualitative focus group research methods to gain an in‐depth understanding of changes in body image experienced by individuals who have undergone bariatric surgery. Four focus groups were held with a total of 15 participants. Results: Three main themes emerged from the data: (a) the impact of the external world on body image (e.g., negative feedback, positive feedback, stereotypes); (b) cognitive, emotional, and behavioral changes that occur in relation to body image (e.g., changes to body image, behavior changes in personal and social domains); and (c) coping mechanisms to mitigate the negative changes to body image (e.g., avoidance of negative body image triggers, social support, cognitive restructuring of body image). Participants reported that their body image was heavily impacted by the feedback they received from the outside world. After surgery, many changes took place to their perception of their bodies, the way the felt about their bodies, and how they behaved in relation to their bodies. Conclusions: Many positive changes occur to body image following bariatric surgery. However, negative changes also occur, most notably the development of excess skin. Patients use a variety of coping skills to mitigate the negative changes to body image. Implications of these findings for the optimal care of bariatric patients are discussed.

Purpose : Physical activity is beneficial for children’s health and well-being, but competing demands on schools has reduced the amount of time children are active. Integrating physical activity into the school curriculum has shown promise for improving educational outcomes including enjoyment, engagement, and perceived well-being. This study evaluated the feasibility of the Make Basketball Count program, which combined basketball skills with mathematics concepts. Methods : Grade 3 students ( n = 104, aged 9–11 years) from two schools participated in the program, consisting of six weekly physically active math lessons using basketball as a stimulus delivered by qualified teachers and a basketball development officer. Students and teachers completed program evaluation questionnaires. Students also completed semistructured interviews through focus groups. Results : Positive feedback was received regarding program enjoyment, engagement, and perceived benefits (health, well-being, and confidence). Discussion : This study provides preliminary evidence that the program was feasible for delivery in primary schools. A randomized controlled trial is recommended to determine the impact of the program.

The benefits of collaborative learning (CL) in teaching-learning have been well-documented. According to existing literature, it will help students and teachers learn from one another, develop good communication skills, foster a sense of community, trust and respect, and retain and apply the information in their future studies. Unfortunately, observation coupled with research shows that pre-service teachers’ participation in South Africa's rural universities is at its lowest ebb – a potential source of concern to education stakeholders given its futuristic implications in the light of CL benefits. Less pre-service teachers’ participation has been linked to cultural influence, environmental factors and students’ backgrounds and have negatively impacted students’ academic achievement. This paper seeks to typify CL as a panacea to pre-service teachers' apathy toward learning. In doing this, social constructivism theory (SCT) was adopted to underpin the study. Drawing from the principles of participatory action research, fifteen undergraduate students were randomly selected, and data was gathered with the instrumentation of semi-structured interviews and focus groups. The study revealed the think-peer-share strategy, group work strategy, micro-teaching strategy, positive feedback and encouragement, learner-centred method, and inquiry method as strategies for improving participation among pre-service teachers in rural universities. Recommendations were made in line with the findings of the study.

Temporal data are crucial in many research activities within Digital Humanities (DH) and Cultural Heritage (CH). At the same time, there is a growing need for visualization tools to explore events in Linked Data (LD). This article investigates LD visualization tools that address event data in association with temporal data for research purposes in DH and CH. We analyze the availability of Wikidata visualization tools capable of handling event data for DH and CH research and propose ways to improve visualization tools to better represent temporal data in Wikidata. We identified 14 requirements based on principles from the information visualization domain, as well as an analysis of previous studies and existing tools. We design and develop a Wikidata-centric tool to meet these requirements. This tool is then evaluated through focus groups and questionnaires with DH and CH experts. The results of the evaluation show overall positive feedback and highlight the implicit need and value of visualization tools that handle events in Wikidata for research in DH and CH. In addition, they indicate the improved accessibility and visualization capabilities of Wikidata through the seven time-related functionalities of the tool.

Nurses are one of the largest user groups of the electronic health record (EHR) system, relying on its tools to support patient care and nursing workflows. Recent studies suggested that the redesign of nursing documentation may reduce the time spent in the EHR system and improve nurse satisfaction. We aimed to assess nurses' perceptions of the redesigned EHR, evaluate the impact of documentation interventions, and identify future improvement needs. Guided by the American Nursing Informatics Association's Six Domains of Burden conceptual framework, this multimethod project combined both qualitative and quantitative approaches. Registered nurses across the academic health system were recruited via email invitations to participate in focus group discussions. The focus groups were conducted via a web conference and ranged from 60 to 90 minutes in duration. The focus group discussions were transcribed and analyzed through thematic analysis. The EHR vendor's time data were used to analyze nurses' time spent in documentation. In total, 20 registered nurses participated in the focus group discussions, and 17 nurses completed the demographic survey; 88% (15/17) of participants had ≥3 years of EHR experience at the academic health system, and 53% (9/17) self-reported being competent in the EHR system. The following six themes emerged: positive feedback, usability and workflow opportunities, nuisance, training and education, communication, and time spent in the system. EHR vendor time data revealed that the time spent in flowsheets averaged 31.11% per 12-hour shift. Overall, participants reported a positive experience and that the EHR supported patient care. There are opportunities to further reduce redundancies in documentation and implement programs that support continuous learning about EHR and health technology tools. Specific suggestions include optimizing the oral health assessment tool. Analyzing frontline nursing perspectives in the redesign of EHR workflows is imperative for identifying interventions that support nurses' satisfaction with the EHR.

AimsMental health issues in children and young people are a growing concern and the benefits of intervening early are well established for many mental health problems, but existing Child and Adolescent Mental Health Services (CAMHS) are often over-stretched with variable waiting times for assessment. Many children also have problems which do not reach the referral thresholds and parents are left to find advice elsewhere. Existing resources for parents are scattered across many different websites and therefore difficult to access both for parents and professionals working with young people. With this in mind, and in consultation with CAMHS Bristol and many other stake-holders (including parents themselves) we designed an easily navigable website intended as a single comprehensive portal of resources for parents of children with mental illness and difficulties.MethodQualitative research methods were used to gather information about how the website should be designed and also to gather feedback once the website was live. Focus groups were performed with parents/carers and stakeholder discussions took place to inform the design of the website. Once the website was live, surveys via a Survey Monkey link on the website and Google Analytics were used to evaluate the website.Result60,000 users have utilised the website since the launch in March 2019. Two thirds of users are women and one third are men. Most popular webpages that are visited are primary, secondary, help-in -a-crisis and self-help for young people. Positive feedback has been collected from both parents/carers and service providers. The website has continued to develop and is now a registered charity and has received community lottery funding, which will allow for further evaluation and developments.ConclusionHappyMaps has been successful in providing a single hub of information for parents/carers, GPs, CAMHS workers and teachers. Future work involves evaluating the website and attracting interest from other CAMHS teams and professionals in other areas of the UK so that they can create HappyMaps sections for their populations.

Objectives: To explore the influences and perceived benefits behind general practitioners’ willingness to participate in significant event analysis (SEA) and educational peer assessment. Design: Qualitative analysis of focus group transcripts....

The implantation and consolidation of Family Health Strategy (ESF) in a great urban center is a challenge. Matters of social historical dynamics of a great urban center influence the work process and the needs of health education perceived by the health professionals. Poverty, economic inequality, drugs and urban violence potentiate themselves through a cruel and positive feedback, what Campos called a crazy and contradictious information flow, a vicious cycle of values destruction influencing on the health professionals’ activities. This study aimed to analyse the perceptions of higher level professionals that work on Family Health Strategy about the influence of their work in a great urban center on the work process of the teams and educational needs of the professionals, particularly urban violence, drug addiction and drug trafficking. The study presents a qualitative approach on practical discourse of the health professionals, from focus groups and individual interviews, with the scope of analysis based on the Content Analysis method, applied through a thematic cathegorial analysis. Differences between Family Health Strategy in small and average cities and in the capital and its inherent difficulty of work were recurrent. Reflections about the urban violence problematic, drug addiction and drug trafficking are explicit on this study. Inherent risks and vulnerabilities of the matter arise as problematic to be faced by the professionals of Family Health Strategy: sexual promiscuity, early active sex life, unprotected sex activity, prostitution, negligence of children, family problems, negligence and mistreatment of the elderly, truancy, among others.