Human factors considerations in designing a personalized mobile dialysis device: An interview study

Cardiac resynchronization therapy (CRT) for the treatment of heart failure (HF) raises complex problems for informed consent. CRT with and without defibrillator backup has been demonstrated in clinical trials to improve symptoms from HF and decrease mortality.1–4 A CRT pacemaker (CRT-P) may improve symptoms and reduce mortality in selected patients, even without offering the specific protection from malignant arrhythmias afforded by a CRT defibrillator (CRT-D). Further, CRT-P may prevent disease progression even in earlier stages of HF.4,5 Implantable cardioverter-defibrillators (ICDs) alone are effective in preventing sudden cardiac death (SCD) in selected patients.6,7 Although most patients eligible for CRT-P will similarly meet guidelines for an ICD, the decision to include ICD backup with a CRT implant may not be straightforward.8 The decision for CRT-P or CRT-D implantation includes not only the medical facts, but also the important considerations based on values and principles. Patients and physicians may wrestle with fundamental questions about quality and quantity of life and struggle to come together toward a truly informed consent process. There are no formal guidelines or standards that argue for specific content to be included in the informed consent process for CRT. This article examines 4 categories of questions regarding CRT based on an understanding of autonomy and shared decision-making as elements of informed consent: (1) control over the manner of death, (2) quality versus quantity of life, (3) therapeutic flexibility, and (4) clinical uncertainty. This article may help to guide clinicians and patients by clarifying the clinical and moral considerations and the principles behind particular treatment decisions. Autonomy refers to an understanding and knowledge of available options and the ability to choose between them through rational deliberation.9,10 Respect for patient autonomy is the foundation of modern bioethics and, in …

The goal of this study is to identify ways to increase the usability of a mobile dialysis device through semi-structured interviews during the early stage of product development. We analyzed interview data using a mixed method of rank order and open-ended questions. The results from the open-ended questions showed that patients and care partners prefer the device being carried on patients’ backs, followed by the waist and the shoulder. We also identified 13 key categories of ideal features that the mobile dialysis device must hold. The results from the rank order question showed that the participants significantly preferred the Vest over the Backpack, Shoulder bag, and Distributed model. Accuracy of the device is more important compared to Safety, Ease of attachment, Comfort, Size, Operational simplicity, and Invisibility. The prioritized needs from patients and care partners provide designers and clinicians with better target solutions for designing a mobile dialysis device.

PurposeAlthough HIV is likely to be a couple-based issue among serodiscordant male couples due to cross-partner transmission, little is known about how they cope with HIV as a team. This study aimed to examine the dyadic coping process among serodiscordant couples.MethodsA dyadic daily diary study was used to answer our research questions. One hundred and forty-one Chinese HIV serodiscordant male couples completed measures of we-disease appraisal, common dyadic coping, quality of life, and relationship satisfaction for 14 consecutive days and ART adherence, attitudes toward PrEP, quality of life, and relationship satisfaction at a 2-month post-diary assessment. Computations were based on the common fate mediation model, using multilevel structural equation modeling.ResultsRegarding direct effect, we-disease appraisal was associated with both partners’ quality of life at the between-person level, post-diary quality of life, attitudes toward to PrEP, relationship satisfaction at both levels as well as post-diary relationship satisfaction. Common dyadic coping mediated the association between we-disease appraisal and both partners’ quality of life as well as relationship satisfaction at the within-person level. However, no mediating effects were observed at the between-person level.ConclusionsOur findings highlighted the importance of the daily dyadic coping process among HIV serodiscordant couples. Future interventions should direct resources toward fostering a shared disease appraisal and training couples in common dyadic coping strategies for their daily lives.

Objectives: Prostate cancer (PCa) stigma and its relationship to quality of life (QoL) is a relatively new finding. As the experiences of couples facing PCa are shared, the study examined the relationship between of PCa stigma, QoL, and relationship satisfaction of PCa survivors and their spouses.Design: A correlational design with dyadic data was used.Sample: Participants (N = 80 dyads) were PCa survivors and their spouses sampled from an oncology center and PCa support groups.Methods: Structural equation modeling was used to assess how stigma related to the QoL and relationship satisfaction of participants.Findings: Stigma had a negative association with QoL, but not relationship satisfaction. There were no significant demographic differences in regards to stigma.Conclusion: Overall, stigma has a relationship with the experience of couples, but not with every aspect of their experience.Implications for psychosocial providers: Implications for clinicians in regards to addressing PCa stigma with clients and areas for future research are discussed.

In the early stages of product development, designers need to take environmental performance into account together with traditional design objectives. Sustainable products are products that are fully compatible with nature throughout their entire life cycle. This paper presents a case study in which the integration of environmentally conscious quality function deployment (ECQFD) and life cycle assessment (LCA) has been applied to enable sustainable product development of an electric vehicle. In this study, ECQFD has been used to handle environmental and traditional quality requirements of the product, whereas LCA has been used for assessing the environmental impact of products and processes. A cost model has been developed by integrating production and environmental costs as well as the technical status of an old part product for reuse. The results obtained from the case study reveal that integration of ECQFD and LCA considers the equal importance of environmental requirements to the traditional requirements of cost and quality thereby ensuring sustainability in product design in an electric vehicle.

Aim. The purpose of the present study was to determine the relationship between job satisfaction, burnout level and quality of life of the nurses working at hospitals in Sivas, Turkey. It is thought that there is a relationship between job satisfaction, burnout levels and quality of life of nurses and that the direction of this relationship may have a positive or negative effect on care services they provide. For this reason, the measurement of the relationship between job satisfaction, burnout level and quality of life of nurses is important. Methods. Study sample included 439 nurses. The data was collected through Personal Information Form, Minnesota Satisfaction Questionnaire (MSQ), Maslach Burnout Inventory and Quality of Life Questionnaire (WHOQOL-BREF). The scores that the nurses received from the scales were presented in averages and in standard deviation. Correlation analysis was used for statistical analysis. Results. General job satisfaction average score of the nurses was 3.2±0.6. There was a positive and significant relationship between job satisfaction and all sub-dimensions of quality of life (p<0.01). Burnout sub-dimension average score of the nurses was 17.2±7.6, desensitization average score was 3.30±3.59 and personal achievement average score was 24.1±5.2. Quality of life average score of the nurses was 13.53±2. 7 in physical domain, 14.2±2 in psychological domain, 14.0±2.2 in social domain and 12.53±2.17 in environmental domain. There was a negative relationship between all sub-dimensions of quality of life and exhaustion and desensitization scores. It was found that there was a positive relationship between quality of life and personal achievement average scores (p<0.01). Conclusions. Quality of life of the nurses was slightly above average in all domains. As job satisfaction and personal achievements of the nurses increased, so did their quality of life. As the emotional exhaustion and desensitization levels of the nurses increased, their quality of life levels decreased. Keywords: Nurse, job satisfaction, burnout, quality of life Ozet Amac. Bu arastirma, Sivas ilindeki hastanelerde calisan hemsirelerin is doyumu, tukenme duzeyi ve yasam kaliteleri arasindaki iliskiyi belirlemek amaciyla yapilmistir. Hemsirelerin is doyumu, tukenme duzeyleri ve yasam kaliteleri arasinda bir iliski oldugu ve bu iliskinin yonunun onlarin sunduklari bakimin kalitesini de olumlu ya da olumsuz olarak etkileyebilecegi dusunulmektedir. Bu nedenle hemsirelerin is doyumu, tukenme duzeyi ve yasam kaliteleri arasindaki iliskinin olculmesi onemlidir. Yontem. Orneklem 439 hemsireden olustu. Veriler Kisisel Bilgi Formu, Minnesota Doyum Anketi (MSQ), Maslach Tukenmislik Envanteri ve Yasam Kalitesi Olcegi (WOHQQL-BREF) kullanilarak toplandi. Hemsirelerin olceklerden aldiklari puanlar ortalama ve standart sapma olarak sunulmus ve istatistiksel analizde korelasyon analizi kullanilmistir. Bulgular. Hemsirelerin genel is doyum puan ortalamasi 3,2±0,6 olup, is doyumu ile yasam kalitesinin tum alt boyutlari arasinda pozitif yonde anlamli bir iliski saptanmistir (p<0,01). Hemsirelerin tukenmisligin duygusal tukenme alt boyutu puan ortalamasi 17,2±7,6, duyarsizlasma puan ortalamasi 3,3±3,6 ve kisisel basari puan ortalamasi 24,1±5,2’dir. Hemsirelerin yasam kalitesi puan ortalamalari; fiziksel alanda 13,5±2,7, ruhsal alanda 14,2±2,3, sosyal alanda 14,0±2,2 ve cevre alaninda 12,5±2,2’dir. Yasam kalitesinin tum boyutlari ile duygusal tukenme ve duyarsizlasma puanlari arasinda negatif yonde, yasam kalitesi ile kisisel basari puan ortalamasi arasinda pozitif yonde anlamli bir iliski bulunmustur (p<0,01). Sonuc. Hemsirelerin yasam kaliteleri tum alanlarda ortanin biraz uzerindedir. Hemsirelerin is doyumlari ve kisisel basarilari arttikca yasam kaliteleri yukselmekte, duygusal tukenme ve duyarsizlasma duzeyleri attikca yasam kaliteleri dusmektedir. Anahtar sozcukler: Hemsire, is doyumu, tukenmislik, yasam kalitesi

Adolescents and young adults (AYAs) with advanced cancer identify maintaining a good quality of life (QoL) as a central goal of end-of-life care. QoL is a dynamic and subjective overarching concept that refers to an individual's relative satisfaction with their own life. Despite its importance to AYAs with advanced cancer, a patient-centered definition of QoL is lacking in this population. This qualitative secondary analysis of semistructured interviews was conducted across 3 institutions and 1 online support community among AYA patients with advanced cancer, family caregivers, and health care providers who cared for living or recently deceased AYAs. Interviewees were asked about priorities in receipt of care. Interviews were transcribed using NVivo software for primary analysis, and previously coded excerpts were screened for references to QoL. Relevant excerpts were sorted into organizing domains. Participants included 23 AYA patients, 28 family caregivers, and 29 health care providers (including physicians, nurses, nurse practitioners, social workers, and psychologists). Four domains of QoL were identified: psychosocial and physical well-being, dignity, normalcy, and personal and family relationships. Within each domain there was agreement across AYAs, caregivers, and health care providers, with nuanced perspectives provided by AYAs of different ages. Personal and family relationships was the most frequently referenced domain of QoL among all participants. A common feature of each domain was that adaptation to current circumstances impacted perspectives on QoL. Patients valued active participation in the development of a care plan that supported these domains. AYAs with advanced cancer, their caregivers, and health care providers agree on several broad domains of QoL in this population. To provide high-quality, patient-centered care, care plans should integrate these domains to enable AYAs to maximize their QoL throughout their advanced cancer care.

&lt;p dir="ltr"&gt;OBJECTIVE&lt;/p&gt;&lt;p dir="ltr"&gt;This study investigates the efficacy and feasibility of electrical stimulation (E-Stim) on sensory fibers of the plantar region during hemodialysis (HD) sessions, aiming to improve mobility in diabetes patients by providing a connection between electrical stimulation and enhanced mobility with minimal patient effort required.&lt;/p&gt;&lt;p dir="ltr"&gt;RESEARCH DESIGN AND METHODS&lt;/p&gt;&lt;p dir="ltr"&gt;Participants 18 and above, undergoing HD in the diabetes patients, and able to walk at least 10 meters with or without aid, were recruited and divided into an intervention group (IG) receiving 1-hour intradialytic E-Stim 3 times/week, and a control group (CG) using an identical non-functional device, for 12-week. Gait, physical activity, patient-reported outcomes, and the technology acceptance model were assessed to evaluate the intervention's effectiveness and acceptance.&lt;/p&gt;&lt;p dir="ltr"&gt;RESULTS&lt;/p&gt;&lt;p dir="ltr"&gt;Out of 117 initial participants, 97 completed the study. Significant improvements were observed in the IG compared to the CG in gait performance (stride time at dual-task and fast walking), physical activity (stand-to-walk and sit-to-stand), quality of life, plantar numbness, and cognitive function after 12-week. The IG showed magnitude of improvements on gait performance and physical activity metrics are associated with enhancements on quality of life and cognitive function, respectively. The IG also reported higher 'usefulness' and 'usage satisfaction', with a greater willingness to continue using E-Stim at home.&lt;/p&gt;&lt;p dir="ltr"&gt;CONCLUSIONS&lt;/p&gt;&lt;p dir="ltr"&gt;The 12-week intradialytic E-Stim intervention is a feasible and effective method to enhance gait performance, physical activity level, cognitive function and other patient-reported outcomes in HD patients, representing a practical, low-risk therapy option for those unable to engage in traditional exercise programs.&lt;/p&gt;

Although there is increasing interest in measuring the quality of life (QoL) of people with multiple sclerosis (MS), relatively little is known about the issues of importance to people severely affected by MS. In the first of two systematic reviews, we searched the literature to identify measures that have been used to assess health-related QoL in people with MS, and described their measurement properties in terms of validity, reliability, responsiveness to change, and appropriateness for QoL assessment in people severely affected by MS. In the second review, we identified care domains important to people with MS, by reviewing survey, focus group and interview studies involving people with MS and/or their caregivers. Forty-six studies evaluating 12 disease-specific and ten generic QoL measures for patients, and one disease-specific measure for caregivers, satisfied all inclusion criteria. Sixteen focus group or interview studies and 51 questionnaire-based studies evaluated domains of care important to people with MS, and seven qualitative and 11 questionnaire-based studies assessed domains of care important to their caregivers. From these studies, we identified 15 domains of care important to people with MS and 12 domains important to caregivers. QoL measures differed markedly in their coverage of these care domains. Moreover, each measure fulfilled some but not all criteria of validity, reliability, responsiveness, and appropriateness. Further work is needed to clarify the domains of care relevant to people with severe MS, and to measure health-related QoL in this population.

This study empirically assessed emotional and sexual functioning, reproductive concerns, and quality of life (QOL) of cancer-related infertile women in comparison to those without a cancer history and explored awareness of third-party reproduction options in cancer survivors. One hundred twenty-two cancer survivors (Gynecologic and Bone Marrow/Stem Cell Transplant) with cancer-related infertility and 50 non-cancer infertile women completed a self-report survey assessing: reproductive concerns (RCS), mood (CES D), distress (IES), sexual function (FSFI), menopause (SCL), QOL (SF 12), relationships (ADAS), and exploratory (reproductive options) items. Cancer survivors exhibited greater sexual dysfunction and lower physical QOL than non-cancer infertile women (P < 0.001). No significant group differences were identified for mood (CES-D), mental health QOL (SF-12), reproductive concerns (RCS), and relationship satisfaction (ADAS). All groups scored in the FSFI range of sexual dysfunction, and with RCS scores above published means. Multivariate comparisons showed comparable depression and distress levels for all groups, but cancer survivors had poorer physical QOL [F(5,146)=4.22, P < 0.01]. A significant effect was also found for knowledge of third-party reproductive options on depression and distress levels [F(3,97)=4.62,P < 0.01]. Adjusted means demonstrated higher depression and distress scores for women with perceived unmet informational needs. Overall, loss of fertility was an emotionally challenging experience for women regardless of its cause. Cancer survivors were found to have lower scores of physical QOL and sexual function than non-cancer infertile women. Unmet informational needs about reproductive options appeared to be associated with negative mood and increased distress in cancer survivors. Targeted interventions to increase knowledge about reproductive options could be of great assistance to women pursuing parenthood in cancer survivorship. Additionally, intervention studies to improve sexual functioning and QOL in women with cancer-related infertility should be a priority of future research.

One year quality of life measured with SEC-QoL in levonorgestrel 52 mg IUS users

Introduction: Type 1 diabetes mellitus (T1DM) is a chronic auto-immune disease in which loss of pancreatic islet β-cells leads to the deficiency of insulin in the body thus resulting in enhanced blood sugar levels. Effective blood glucose monitoring is crucial in T1DM management to prevent complications, particularly hypoglycemia. Method: The study adopted a cross-sectional survey to assess satisfaction and quality of life among T1DM patients using the freestyle libre continuous glucose monitoring (FSL-CGM), and a retrospective cohort study design to evaluate changes in HbA1c over a year. Result: The study involved 98 Saudi subjects, with 46.9% ( n = 46) being male. The results indicated a high level of user satisfaction, with more than 85% of the participants responding positively, yielding a total satisfaction score of 30.86. User satisfaction with FSL-CGM was found to be significantly associated with the level of education. The use of FSL-CGM was also found to significantly improve the patients’ quality of life. However, the levels of HbA1c had an impact on both satisfaction and quality of life. Before using the FSL-CGM system, the mean HbA1c was 9.83%, which significantly decreased to 8.63% after using the system ( P -value &lt;0.001). Conclusion: The study’s findings align with previous literature on satisfaction and quality of life, but there are conflicting results regarding the reduction of HbA1c levels using FSL-CGM. Given the limited sample size, future research could explore the topic more comprehensively, potentially utilizing a longitudinal study design to better measure changes in HbA1c level.

To compare patient satisfaction during surgery, postoperative pain and inflammation and quality of life between high-speed drilling with irrigation and low-speed drilling without irrigation for implant bed preparation. Sixty-six posterior single edentulous patients were included in a randomized controlled clinical trial. Implant beds were created using high-speed drilling with irrigation (control group) or low-speed drilling without irrigation (test group). Patient satisfaction during surgery (in relation to drilling-time perception, vibration, pressure, noise, comfort, and drowning sensation) and postoperative pain and inflammation were evaluated using a 100-mm visual analogue scale (VAS)-based questionnaire. Quality of life was analyzed with a Likert scale (in relation to mouth opening, chewing, speaking, sleeping, daily routine, and job). The follow-up period was 7 days. Patient satisfaction in relation to drilling-time perception, vibration, pressure, and noise did not show statistically significant differences (p > .05). The highest scores of drowning sensation (p < .05) were correlated (moderate correlation (r = .57)) with lowest scores of comfort (p < .005). Both postoperative pain and inflammation means were significantly higher in the control group than in the test group. No significant differences in quality of life were observed during the postoperative period (p > .05). Low-speed drilling without irrigation for single implant site preparation was more comfortable for patients than high-speed drilling with irrigation, due to the correlation between important drowning sensation and low perceived comfort. Postoperative pain and inflammation were lower for low-speed drilling without irrigation. Further studies are needed to validate or refute these results.

BackgroundNew parents face increased risks of emotional distress and relationship dissatisfaction. Digital interventions increase support access, but few preventive programs are optimized for both parents.ObjectiveThis study aims to conduct the first randomized controlled trial on universal self-guided digital programs to support positive perinatal adjustment of both mothers and fathers. Effects of childcare information (Baby Care) and information plus an interactive program (Baby Steps Wellbeing) were compared from the third trimester baseline to 3 and 6 months subsequently.MethodsThe study recruited 388 co-parenting male-female adult couples expecting their first single child (26-38 weeks’ gestation), using web-based registration. Most (337/388, 86.8%) were obtained from prenatal hospital classes. Couples’ randomization was automated and stratified by Edinburgh Postnatal Depression Scale (EPDS) scores (50% couples scored high if either mother >7, father >5). All assessments were web-based self-reports: the EPDS and psychosocial quality of life were primary outcomes; relationship satisfaction, social support, and self-efficacy for parenting and support provision were secondary. Linear mixed models provided intention-to-treat analyses, with linear and quadratic effects for time and random intercepts for participants and couples.ResultsSelection criteria were met by 63.9% (248/388) of couples, who were all randomized. Most participants were married (400/496, 80.6%), tertiary educated (324/496, 65.3%), employed full time (407/496, 82%), and born in Australia (337/496, 67.9%). Their mean age was 32.2 years, and average gestation was 30.8 weeks. Using an EPDS cutoff score of 13, 6.9% (18/248) of men, and 16.1% (40/248) of women screened positive for depression at some time during the 6 months. Retention of both partners was 80.6% (201/248) at the 6-month assessments, and satisfaction with both programs was strong (92% ≥50). Only 37.3% (185/496) of participants accessed their program more than once, with higher rates for mothers (133/248, 53.6%) than fathers (52/248, 20.9%; P<.001). The EPDS, quality of life, and social support did not show differential improvements between programs, but Baby Steps Wellbeing gave a greater linear increase in self-efficacy for support provision (P=.01; Cohen d=0.26) and lower reduction in relationship satisfaction (P=.03; Cohen d=0.20) than Baby Care alone. Mothers had greater linear benefits in parenting self-efficacy over time than fathers after receiving Baby Steps Wellbeing rather than Baby Care (P=.01; Cohen d=0.51). However, the inclusion of program type in analyses on parenting self-efficacy and relationship satisfaction did not improve model fit above analyses with only parent gender and time.ConclusionsThree secondary outcomes showed differential benefits from Baby Steps Wellbeing, but for one (parenting self-efficacy), the effect only occurred for mothers, perhaps reflecting their greater program use. Increased engagement will be needed for more definitive testing of the potential benefits of Baby Steps Wellbeing for perinatal adjustment.Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12614001256662; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367277

Lockdown restrictions during the COVID-19 pandemic exerted a strong impact on people's quality of life and increased loneliness. This study evaluates the effect of the pandemic on loneliness in patients with burning mouth syndrome (BMS) compared with the general population. 100 BMS patients versus 100 healthy controls (HC) were recruited in five Italian centers. The 12-Item General Health Questionnaire (GHQ-12), the Depression Anxiety Stress Scales-21 (DASS-21), the Insomnia Severity Index (ISI), the short-form UCLA Loneliness Scale-8 (ULS-8), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Suicidal Ideation Attribute Scale (SIDAS) were administered. BMS patients and HC showed high scores (16 [14-20.25] and 16 [14-18]) in the ULS-8. Statistically significant differences have been found considering the BMS patients lived with fewer relatives during the lockdown compared with the HC (2 [2-3] and 3 [2-4]; p: 0.012) with a lower level of satisfaction in relationships with relatives (4 [1.75-5] and 5 [4-5]; p < 0.001) and also in the DASS-21 total scores between the BMS patients and HC (16 [10-24.2] and 10 [4-17]; p < 0.001). The multivariate logistic regression revealed that age, education, DASS-21, and MSPSS were the most predictive variables and could explain 34.68% of the variance in the ULS-8 score (p < 0.001) in the BMS group. However, only the DASS-21 was significant in the HC group, explaining 10.11% of the variance of the ULS-8 (p: 0.033). Both the patients and controls experienced deep loneliness during the pandemic. However, in the BMS group, loneliness was significantly correlated with age, a higher level of education and stress, and a lower level of satisfaction in relationships with relatives and social support perceived compared with the controls.