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Design, When Everybody Designs
In a changing world everyone designs: each individual person and each collective subject, from enterprises to institutions, from communities to cities and regions, must define and enhance alife project. Sometimes these projects generate unprecedented solutions; sometimes they converge on common goals and realize larger transformations. As Ezio Manzini describes in this book, we are witnessing a wave of social innovations as these changes unfold -- an expansive open co-design process in which new solutions are suggested and new meanings are created. Manzini distinguishes betweendiffuse design(performed by everybody) andexpert design(performed by those who have been trained as designers) and describes how they interact. He maps what design experts can do to trigger and support meaningful social changes, focusing on emerging forms of collaboration. These range from community-supported agriculture in China to digital platforms for medical care in Canada; from interactive storytelling in India to collaborative housing in Milan. These cases illustrate how expert designers can support these collaborations -- making their existence more probable, their practice easier, their diffusion and their convergence in larger projects more effective. Manzini draws the first comprehensive picture of design for social innovation: the most dynamic field of action for both expert and nonexpert designers in the coming decades.
eBook
Enhancing the experience and outcomes of children with complex care needs in acute paediatric settings: a realist review protocol
IntroductionThe number of babies, children and young people with complex care needs (henceforth children with complex care needs (CCCN)) in England has increased in recent decades, and this has also been recognised globally. CCCN may have frequent and lengthy hospital admissions, but during these episodes, their needs are not always met, potentially resulting in suboptimal experiences and outcomes. Despite increased numbers of CCCN accessing acute care and displaying greater complexity, much of the contemporary literature has focused on primary care coordination between health, education and social care. Research specifically focused on CCCN in the acute care setting is largely absent. This realist review aims to understand how optimal experience and outcomes are achieved for CCCN during acute care, in different settings, for whom and why.Methods and analysisThis realist review will proceed through six steps: (1) clarifying the scope of the review, (2) searching for evidence, (3) data selection and quality appraisal, (4) data extraction, (5) analysis and synthesis and (6) dissemination. We will search Medline, Cumulated Index in Nursing and Allied Health Literature and PsycINFO, alongside grey literature and other sources and will carry out citation tracking. Patient and public involvement and engagement have aided in the development of this protocol and will be maintained through regular consultations with a stakeholder group throughout the review. The review will result in a programme theory which will include context-mechanism-outcome configurations and provide data to support claims of generative causation.Ethics and disseminationEthical approval is not required for this review as it does not involve primary research. The programme theory developed will be disseminated through peer-reviewed publications and relevant conferences. It will subsequently inform the development of an intervention to improve acute care for CCCN.PROSPERO registration numberCRD42024591231.
Journal Article
Comparing the Effects of Collagen Hydrolysate and Dairy Protein on Recovery from Eccentric Exercise: A Double Blind, Placebo-Controlled Study
Background: Consuming collagen hydrolysate (CH) may improve symptoms of exercise-induced muscle damage (EIMD); however, its acute effects have not been compared to dairy protein (DP), the most commonly consumed form of protein supplement. Therefore, this study compared the effects of CH and DP on recovery from EIMD. Methods: Thirty-three males consumed either CH (n = 11) or DP (n = 11), containing 25 g of protein, or an isoenergetic placebo (n = 11) immediately post-exercise and once daily for three days. Indices of EIMD were measured before and 30 min and 24, 48, and 72 h after 30 min of downhill running on a −15% slope at 80% of VO2max speed. Results: Downhill running induced significant EIMD, with time effects (all p < 0.001) for the delayed onset of muscle soreness (visual analogue scale), countermovement jump height, isometric midthigh pull force, maximal voluntary isometric contraction force, running economy, and biomarkers of muscle damage (creatine kinase) and inflammation (interleukin-6, high-sensitivity C-reactive protein). However, no group or interaction effects (all p > 0.05) were observed for any of the outcome measures. Conclusions: These findings suggest that the post-exercise consumption of CH or DP does not improve indices of EIMD during the acute recovery period in recreationally active males.
Journal Article
Assessing risk of self-harm in acute paediatric settings: a multicentre exploratory evaluation of the CYP-MH SAPhE instrument
ObjectiveTo psychometrically assess the Children and Young People-Mental Health Self-harm Assessment in Paediatric healthcare Environments (CYP-MH SAPhE) instrument for the identification of immediate risk of self-harm in CYP, aged 10–19 years, in acute paediatric wards or emergency departments.DesignThe CYP-MH SAPhE Instrument was developed through a robust scoping review and Delphi consensus with 30 clinicians/topic experts. To evaluate the psychometric properties, a multicentre exploratory study was conducted.SettingThree acute hospitals in the UK.Participants163 CYP presenting at acute hospital settings with primary mental health (cases) or physical health (non-cases) conditions.Primary and secondary outcome measuresPsychometric properties of the CYP-MH SAPhE instrument were evaluated through Principle Axis Factoring (PAF) with Oblimin (Kaiser normalisation) alongside measures of internal consistency (Cronbach’s α), convergent, discriminant and face validity.ResultsPAF of the dichotomous items (n=9) loaded onto three factors (1) behaviours and intentions; (2) suicidality and (3) self-harm. Factors 1 (Cronbach’s α=0.960) and 3 (Cronbach’s α=1) had high internal consistency. There was: good level of agreement between raters (kappa=0.65); a moderately positive correlation between the CYP-MH SAPhE instrument and the Columbia-Suicide Severity Rating Scale; and discrimination between cases and non-cases across the three factors (factor 1: m=88 vs 70; factor 2: m=102 vs 70; factor 3: m=104 vs 68). Assessment of face validity resulted in six items being removed, culminating in an eight question, rapid assessment instrument.ConclusionsThe results support the CYP-MH SAPhE Tool as a potentially reliable and valid instrument to identify immediate risk of self-harm in CYP presenting to acute paediatric healthcare environments, which is a burgeoning and significant global health issue.
Journal Article
A qualitative, exploratory study of nurses’ decision-making when interrupted during medication administration within the Paediatric Intensive Care Unit
In the paediatric intensive care unit (PICU), medication administration is challenging. Empirical studies demonstrate that interruptions occur frequently and that nurses are fundamental in the delivery of medication. However, little is known about nurse’s decision making when interrupted during medication administration. Therefore, the objective is to understand decision making when interrupted during medication administration within the PICU.
A qualitative study incorporating non-participant observation and audio recorded semi-structured interviews. A convenience sample of ten PICU nurses were interviewed. Each interview schedule was informed by two hours of observation which involved a further 29 PICU nurses. Data was analysed using Framework Analysis.
A regional PICU located in a university teaching hospital in the United Kingdom.
Analysis resulted in four overarching themes:
(1) Guiding the medication process,
(2) Concentration, focus and awareness,
(3) Influences on interruptions
(4) Impact and recovery
Medication administration within the PICU is an essential but complex activity. Interruptions can impact on focus and concentration which can contribute to patient harm. Decision making by PICU nurses is influenced by interruption awareness, fluctuating levels of concentration, and responding to critically ill patient and families’ needs.
Journal Article
Extent of investigation and management of cases of ‘unexplained’ mismatch repair deficiency (u-dMMR): a UK Cancer Genetics Group consensus
BackgroundMismatch repair deficiency (dMMR) is a characteristic feature of cancers linked to Lynch syndrome. However, in most cases, it results from sporadic somatic events rather than hereditary factors. The term ‘Lynch-like syndrome’ (LLS) has been used to guide colorectal cancer surveillance for relatives of individuals with a dMMR tumour when somatic and germline genomic testing is uninformative. As the assessment of mismatch repair through immunohistochemistry and/or microsatellite instability is increasingly applied across various tumour types for treatment planning, dMMR is increasingly detected in tumours where suspicion of hereditary aetiology is low. Our objective was to establish current practices and develop national guidance for investigating, and managing relatives of, patients with cancers demonstrating unexplained dMMR.MethodsThis was achieved through a virtual consensus meeting involving key stakeholders from the UK, through premeeting surveys, structured discussions and in-meeting polling to formulate best practice guidance.ResultsWe identified variability in the availability of diagnostic technologies across specialist centres. It was agreed that equitable access to baseline testing is required, acknowledging the need for a pragmatic approach to investigating dMMR cancers not traditionally associated with Lynch syndrome. Factors such as family history, age, tumour type, protein loss pattern and extent of the investigation were deemed crucial in guiding family management. The term ‘unexplained dMMR’ was recommended over LLS.ConclusionDecisions regarding investigations and future cancer risk management in patients and relatives should be nuanced, considering factors like clinical suspicion of hereditary predisposition to allocate limited resources efficiently and avoid unnecessary investigations in low-suspicion families.
Journal Article
The PS4-likelihood ratio calculator: flexible allocation of evidence weighting for case-control data in variant classification
BackgroundThe 2015 American College of Medical Genetics/Association of Molecular Pathology (ACMG/AMP) variant classification framework specifies that case-control observations can be scored as ‘strong’ evidence (PS4) towards pathogenicity.MethodsWe developed the PS4-likelihood ratio calculator (PS4-LRCalc) for quantitative evidence assignment based on the observed variant frequencies in cases and controls. Binomial likelihoods are computed for two models, each defined by prespecified OR thresholds. Model 1 represents the hypothesis of association between variant and phenotype (eg, OR≥5) and model 2 represents the hypothesis of non-association (eg, OR≤1).ResultsPS4-LRCalc enables continuous quantitation of evidence for variant classification expressed as a likelihood ratio (LR), which can be log-converted into log LR (evidence points). Using PS4-LRCalc, observed data can be used to quantify evidence towards either pathogenicity or benignity. Variants can also be evaluated against models of different penetrance. The approach is applicable to balanced data sets generated for more common phenotypes and smaller data sets more typical in very rare disease variant evaluation.ConclusionPS4-LRCalc enables flexible evidence quantitation on a continuous scale for observed case-control data. The converted LR is amenable to incorporation into the now widely used 2018 updated Bayesian ACMG/AMP framework.
Journal Article
FAST MRI: DYAMOND trial protocol (can an abbreviated MRI scan detect breast cancers missed by mammography for screening clients with average mammographic density attending their first screening mammogram?)—a diagnostic yield study within the NHS population-risk breast screening programme
IntroductionFirst post-contrAst SubtracTed (FAST) MRI, an abbreviated breast MRI scan, has high sensitivity for sub-centimetre aggressive breast cancer and short acquisition and interpretation times. These attributes promise effective supplemental screening. Until now, FAST MRI research has focused on women above population-risk of breast cancer (high mammographic density or personal history). DYAMOND aims to define the population within the population-risk NHS Breast Screening Programme (NHSBSP) likely to benefit from FAST MRI. The study population is the 40% of screening clients aged 50–52 who have average mammographic density (BI-RADS (Breast Imaging Reporting and Data System) B) on their first screening mammogram. DYAMOND will answer whether sufficient numbers of breast cancers, missed by mammography, can be detected by FAST MRI to justify the inclusion of this group in a future randomised controlled trial.Methods and analysisProspective, multicentre, diagnostic yield, single-arm study with an embedded qualitative sub-study: all recruited participants undergo a FAST MRI. An internal pilot will assess the willingness of sites and screening clients to participate in the study. Screening clients aged 50–52, with a clear first NHSBSP mammogram and BI-RADS B mammographic density (by automated measurement) will be invited to participate (recruitment target: 1000). The primary outcome is the number of additional cancers detected by FAST MRI (missed by screening mammography). A Fleming’s two-stage design will be used as this allows for early stopping after stage 1, to save participants, funding costs and time continuing to the end of the study if the question can be answered earlier.Ethics and disseminationThe NHSBSP Research and Innovation Development Advisory Committee and the Yorkshire and Humber–Sheffield Research Ethics Committee (23/YH/0268, study ID (IRAS): 330059) approved this research protocol. Participation involves a two-stage informed consent process, enabling screening for eligibility through automated mammographic density measurement. Patients with breast cancer helped shape the study design and co-produced participant-facing documents. They will disseminate the results to the public in a clear and meaningful way. Results will be published with open access in international peer-reviewed scientific journals.Trial registration numberISRCTN74193022
Journal Article
Educating children’s nurses for communicating bad news
Some parents are unhappy with the way news is broken to them. This article seeks to educate and inform the reflective practitioner on a series of communication strategies to enhance their skills. This is important because the way news is disclosed can affect the way news is accepted and the level of support the family will require. The importance of clarity, honesty and empathy is emphasised.
Journal Article