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Purpose: Patients often undergo repeat surgery for endometriosis, due to recurrent or residual disease. Previous surgery is often considered a risk factor for worse surgical outcome. However, data are scarce concerning the influence of subsequent endometriosis surgery. Methods: A retrospective study in a centre of expertise for endometriosis was conducted. All endometriosis subtypes and intra-operative steps were included. Detailed information regarding surgical history of patients was collected. Surgical time, intra-operative steps and major post-operative complications were obtained as outcome measures. Results: 595 patients were included, of which 45.9% had previous endometriosis surgery. 7.9% had major post-operative complications and 4.4% intra-operative complications. The patient journey showed a median of 3 years between previous endometriosis surgeries. Each previous therapeutic laparotomic surgery resulted on average in 13 additional minutes (p = 0.013) of surgical time. Additionally, it resulted in more frequent performance of adhesiolysis (OR 2.96, p < 0.001) and in a higher risk for intra-operative complications (OR 1.81, p = 0.045), however no higher risk for major post-operative complications (OR 1.29, p = 0.418). Previous therapeutic laparoscopic endometriosis surgery, laparotomic and laparoscopic non-endometriosis surgery showed no association with surgical outcomes. Regardless of previous surgery, disc and segmental bowel resection showed a higher risk for major post-operative complications (OR 3.64, p = 0.017 respectively OR 3.50, p < 0.001). Conclusion: Previous therapeutic laparotomic endometriosis surgery shows an association with longer surgical time, the need to perform adhesiolysis, and more intra-operative complications in the subsequent surgery for endometriosis. However, in a centre of expertise with experienced surgeons, no increased risk of major post-operative complications was observed., Medical Instruments & Bio-Inspired Technology

This workshop will explore future work in the area of intelligent, conversational, data-driven health interfaces both from patients’ and health care professionals’ perspectives. We aim to bring together a diverse set of experts and stakeholders to jointly discuss the opportunities and challenges at the intersection of public health care provisioning, patient and caretaker empowerment, monitoring provisioning of health care and its quality. This will require AI-supported, conversational decision-making interfaces that adhere to ethical and privacy standards and address issues around agency, control, engagement, motivation, and accessibility. The goal of the workshop is to create a community around intelligent data-driven interfaces and create a road map for their future research.

In dieser Folge ist Alfred Angerer wieder im Gespräch mit dem Digital Manager der Schulthess Klinik, Stefan Lienhard. Die Digitalisierung kann den Spitalaufenthalt mit vielen nützlichen, spannenden, aber auch unnötigen Technologien bereichern. Stefan Lienhard erklärt, wie man die Bedürfnisse und Emotionen der Patientinnen und Patienten ermittelt und mit welchen Mitteln man darauf reagiert.

Der zweite Lean-Experte, welcher heute zu Gast in der Podcast Reihe «Lean Healthcare mit Alfred und Patrick» ist, ist Christian Baum, der Leiter für Prozesse und Qualität im Spitalzentrum Biel AG. Hier profitiert er als Lean-Manager unter anderem von seiner langjährigen Erfahrung bei der SBB, bei der er feststellte, dass es die kleinen Veränderungen sind, welche das Grosse nachhaltig und entscheidend beeinflussen sowie von seiner Arbeit mit Japanern, den Gründungsvätern von Lean, welche ihm die Lean- und Kaizen Philosophie noch einmal aus einer anderen Perspektive eröffnet haben. Für Christian Baum gilt dabei folgender Grundsatz: Für gute Resultate braucht es gute Prozesse. Für gute Prozesse braucht es wiederum gute Mitarbeitende und für diese wiederum gute Vorgesetzte. Vorgesetzte entwickeln demnach ihre Mitarbeitenden und nicht die Prozesse. Der Lean-Experte berichtet dabei von seinem ganz persönlichen Lieblingstool – dem Kaizenboard, welches als gutes Hilfsmittel zum Ideenmanagement für Prozessverbesserungen eingesetzt werden kann und sollte, um eben diesen Grundsatz zu realisieren. Hören Sie in diese Podcast-Episode und erfahren Sie, wie das Spitalzentrum Biel AG Lean und Kaizen in der täglichen Praxis einsetzt, um wertstrom- und prozessorientiert zu arbeiten und die Versorgung des Patienten entlang des Patientenpfades zu optimieren. Und werfen Sie ein Blick in diese Lieblings-Lean-Bücher von Christian Baum: «Die angstfreie Organisation» (2020) von Amy C. Edmondson und «Toyotas Geheimrezepte für die Problemlösung» (2019) von Prof. Dr. Constantin May. Auch diese Inputs könnten für Sie interessant sein: «Das Ziel – Ein Roman über Prozessoptimierung» (2013) von Eliyahu M. Goldratt und Jeff Cox sowie die Publikation «Lean Management – Eine Quantifizierung des Nutzens» (2017) von Gutzeit und Kollegen.

Vor nun einem Jahr wurde die erste Episode des Podcasts «Marktplatz Gesundheitswesen» abgespielt und seither waren viele interessante Gäste mit spannenden Themen bei Alfred Angerer und Stefan Lienhard zu Gast – so auch diese Woche zur Jubiläumsfolge. Daniel Rochat ist Leiter des Departements Leistungen bei der SWICA und greift auf eine 25 Jahre lange Erfahrung im Gesundheitswesen zurück. Aus der Perspektive einer Krankenversicherung gibt er in diesem Podcast wichtige Einblicke über den Einfluss von Digital Health auf Patientenpfade und -erlebnisse und darüber, wie auch Krankenversicherungen aktiv Einfluss nehmen können. Anders als früher, geht es heute nicht mehr nur darum, als Kasse Rechnungen zu kontrollieren und zu zahlen. Heute sind Krankenversicherungen Dienstleistungsunternehmen, die versuchen, die gesamte Patient Journey zu begleiten. Den Patientinnen und Patienten sollen Lösungen und Dienstleistungen zu Gesundheit und Krankheit geboten werden und ein selbstbestimmteres Leben ermöglicht werden. Digital Health kann ihnen dabei helfen. Welche Lösungen die SWICA bietet, hören Sie in diesem Podcast.

The transformations the healthcare sector is undergoing can be divided into three types of changes; gradual change, sudden change and expected change. The ageing population represents the gradual change. The ageing population brings an increased demand for care, while also an increasing need for cost control and a decrease in available capacity is noticeable in the healthcare sector. The Covid19 pandemic is an example of a sudden change, an unexpected change on which needs to be acted fast. Digitalisation is a representative for an expected change in the healthcare sector. Especially since the recent Covid19 pandemic there is a growing interest among hospital organisations in digitalisation. To be able to maintain to deliver the highest quality of care under the current circumstances, new innovative strategies and lean processes need to be developed. To accommodate these transformations the real estate of the hospital will have to change. Due to the pressure on hospitals to reduce costs and improve health service accessibility, there is an increasing demand for outpatient services. With the growing interest among hospital organisations in digitalisation and the lack of research on a real estate strategy for hospitals that includes smart tools, this research focuses on to what extent smart tools can optimise the use of scarce resources in the outpatient department of the hospital, taking into account the layout of the outpatient department. The following question is formulated to be answered: “To what extent can smart tools and layout contribute to the efficient and effective use of the scarce resources in the outpatient department of a Dutch hospital?“ To be able to answer this research question, a qualitative approach is chosen to work with. Research on the use of smart tools in the outpatient department of a Dutch hospital is still very rare, therefore a qualitative approach is recommendable. The literature review acts as the backbone of the research. The case, Architecture, Urbanism and Building Sciences | Management in the Built Environment

Gast der 4. Episode in der Spezial-Reihe «Lean Healthcare mit Alfred und Patrick» ist Fabian Bischof. Der Head of Competence Center Hospital Planning bei Walker Project war viele Jahre Patrick Betz’ Kollege und ist sowohl Experte für Lean als auch Design Thinking. Heute beschäftigt er sich vor allem mit der Thematik Spitalbau und wie man bei einem Neubau das Spital mit Blick auf die zugrundeliegenden Prozesse optimal planen kann. Passend dazu stellt der Walker Project Berater eines seiner Lieblingsinstrumente des Lean dar – bekannt unter der Bezeichnung A3-Methode – und erklärt den Zuhörenden Schritt für Schritt und anhand vieler Beispiele, wie man von einem einfachen A3-Papier zu einer erfolgreichen Problemlösung nach Lean gelangen kann. Hinter A3 verbirgt sich dabei eine visuelle Hilfestellung, um Problemsituationen nachhaltig anzugehen, die sich am PDCA-Zyklus orientiert. Hören Sie in diese Podcast-Episode und erfahren Sie, wie diese Methode beispielsweise dabei helfen kann, Wartezeiten im Spital zu kürzen und auch Lösungen für viele weitere Problemstellungen bereithält.

To identify the parameters associated with self-reported diagnostic delay (DD) in axial spondyloarthritis (axSpA) patients across Europe

Aim: The use of gameful design for supporting health-related behaviours has been one of the major trends in health technology. An opportunity to increase engagement and motivation in a given health behaviour and the possibility of reaching improved outcomes through continued or consistent behaviour could be provided by gamification. This study aimed to identify gamification opportunities for digital patient journey solutions to increase patients’ engagement and motivation for health-related behaviour during an arthroplasty journey. Design: A secondary analysis. Method: Semistructured interviews were performed among 20 elective primary total hip and knee arthroplasty patients in a single joint-replacement centre in Finland during autumn 2018. NVivo software was used for deductive content analysis. The study was conducted among 20 patients in a single joint replacement centre during 2018. Results: Several opportunities for gamification were identified for digital patient journey solutions, which could be used in advanced care to increase patients’ engagement and motivation for health-related behaviour during the arthroplasty journey. These opportunities were identified related to five dimensions: accomplishment, challenge, guided, playfulness and social experience. Clear, scheduled, progressive and personalized goals with an activity tracking, real-time timespan visualization and social networking with peers, support networks and healthcare providers could be provided. Opportunities for competition and immersion were not identified.

Subject: Towards Patient and Public Involvement and Engagement (PPIE) in imaging diagnostics of prostate cancerProblem: Rapid diagnosis of prostate cancer provides the basis for further therapy. In addition to PSA tests and biopsy, imaging diagnostics play a key role in diagnosing prostate cancer. In order to identify areas for improvements, patients were asked to share their experiences regarding (imaging) diagnostics. By capturing their voices as a prerequisite for improvement, a unique insight into the patient journey could be achieved.Research question: What do people affected by prostate cancer experience before, during and after their diagnosis? Where are areas for future improvements from the perspective of those affected?Method: Problem-centered individual interviews were conducted via Zoom and mobile phone with three co-creators from the project Patient Involvement in Oncology (PATIO), who have been diagnosed with prostate cancer. Prior to the interview, a guide was developed containing the four main topics: suspicion of cancer, path of diagnosis, the diagnosis itself and future improvements. The interview material was evaluated using the method of content structuring with deductive categorization formation according to MAYRING.Results: Suspicion of cancer: Various circumstances led to suspected prostate cancer. Path of diagnosis: General satisfaction with imaging diagnostics and patient education on diagnostic methods was expressed by the interviewees, except long waiting time for PSMA-PET-CT. The use of ionizing radiation was either not a major topic of concern for patients or was considered necessary for diagnosis. The diagnosis: The coping of people in direct social environment of patients is often difficult. Statements about lack of empathy in the communication between patients and physicians were obtained. The expression of insufficient public awareness regarding prostate cancer aroused among the interviewees. The offer of psychological support was ei

To identify the parameters associated with self-reported diagnostic delay (DD) in axial spondyloarthritis (axSpA) patients across Europe

Coinciding with the global pandemic of SARS-CoV-2 and the resulting global public health crisis caused by COVID-19, artificial intelligence methods started playing an ever more important role in Infectious Medicine. On one hand this was a result of a continuous digital transformation of Infectious Medicine—a trend started decades ago. On the other hand, the pandemic catalyzed the adoption of artificial intelligence and other digital and quantitative techniques by Infectious Medicine. In this chapter we review recent works touching upon aspects of COVID-19 patient journey and how it interconnects with big data and artificial intelligence. These include early and clinical research, epidemiology and detection, diagnostics, clinical care and decision support, as well as long-term care and prevention. We cross-compare the published works and assess their maturity. Finally, we provide a conclusion on the state of artificial intelligence in the Infectious Medicine of COVID-19 and attempt a future perspective.

To identify the parameters associated with self-reported diagnostic delay (DD) in axial spondyloarthritis (axSpA) patients across Europe

Spondyloarthritis are chronic inflammatory diseases affecting spine, peripheral joints and enthesis, as well as extra-articular sites (bowel, eyes, skin). Diagnosis of spondyloarthritis often is slow and requires a multidisciplinary approach. The "Early SpA Clinic" project aimed at improving the patient care and journeys, by solving some organizational issues existing in Rheumatology Clinics. The "Early SpA Clinic" involved 19 Italian Rheumatology Centers using in-depth organizational analyses to identify areas for improvement. From the results of the analyses, some organizational solutions were suggested, and their impact measured at the end of the project through specific KPI. With the implementation of the suggested organizational solutions, Centers achieved relevant results, positively impacting on all the phases of the patient journey: decrease in waiting lists (-23%) and in the time length to transit the Center (-22%), increase in the percentage of new diagnoses (+20%), in the saturation of outpatient clinic capacity (+16%), and in the patient satisfaction (+4%). Centers involved in the "Early SpA Clinic" implemented several organizational actions based on an overall assessment of their activities and on solutions that required no additional resources. Overall, the Centers achieved the "Early SpA Clinic" objectives in terms of better management of resources, personnel, spaces, equipment, in relation to the volumes of patients.

To identify the parameters associated with self-reported diagnostic delay (DD) in axial spondyloarthritis (axSpA) patients across Europe

Gast der 4. Episode in der Spezial-Reihe «Lean Healthcare mit Alfred und Patrick» ist Fabian Bischof. Der Head of Competence Center Hospital Planning bei Walker Project war viele Jahre Patrick Betz’ Kollege und ist sowohl Experte für Lean als auch Design Thinking. Heute beschäftigt er sich vor allem mit der Thematik Spitalbau und wie man bei einem Neubau das Spital mit Blick auf die zugrundeliegenden Prozesse optimal planen kann. Passend dazu stellt der Walker Project Berater eines seiner Lieblingsinstrumente des Lean dar – bekannt unter der Bezeichnung A3-Methode – und erklärt den Zuhörenden Schritt für Schritt und anhand vieler Beispiele, wie man von einem einfachen A3-Papier zu einer erfolgreichen Problemlösung nach Lean gelangen kann. Hinter A3 verbirgt sich dabei eine visuelle Hilfestellung, um Problemsituationen nachhaltig anzugehen, die sich am PDCA-Zyklus orientiert. Hören Sie in diese Podcast-Episode und erfahren Sie, wie diese Methode beispielsweise dabei helfen kann, Wartezeiten im Spital zu kürzen und auch Lösungen für viele weitere Problemstellungen bereithält.

In dieser Folge ist Alfred Angerer wieder im Gespräch mit dem Digital Manager der Schulthess Klinik, Stefan Lienhard. Die Digitalisierung kann den Spitalaufenthalt mit vielen nützlichen, spannenden, aber auch unnötigen Technologien bereichern. Stefan Lienhard erklärt, wie man die Bedürfnisse und Emotionen der Patientinnen und Patienten ermittelt und mit welchen Mitteln man darauf reagiert.

Der zweite Lean-Experte, welcher heute zu Gast in der Podcast Reihe «Lean Healthcare mit Alfred und Patrick» ist, ist Christian Baum, der Leiter für Prozesse und Qualität im Spitalzentrum Biel AG. Hier profitiert er als Lean-Manager unter anderem von seiner langjährigen Erfahrung bei der SBB, bei der er feststellte, dass es die kleinen Veränderungen sind, welche das Grosse nachhaltig und entscheidend beeinflussen sowie von seiner Arbeit mit Japanern, den Gründungsvätern von Lean, welche ihm die Lean- und Kaizen Philosophie noch einmal aus einer anderen Perspektive eröffnet haben. Für Christian Baum gilt dabei folgender Grundsatz: Für gute Resultate braucht es gute Prozesse. Für gute Prozesse braucht es wiederum gute Mitarbeitende und für diese wiederum gute Vorgesetzte. Vorgesetzte entwickeln demnach ihre Mitarbeitenden und nicht die Prozesse. Der Lean-Experte berichtet dabei von seinem ganz persönlichen Lieblingstool – dem Kaizenboard, welches als gutes Hilfsmittel zum Ideenmanagement für Prozessverbesserungen eingesetzt werden kann und sollte, um eben diesen Grundsatz zu realisieren. Hören Sie in diese Podcast-Episode und erfahren Sie, wie das Spitalzentrum Biel AG Lean und Kaizen in der täglichen Praxis einsetzt, um wertstrom- und prozessorientiert zu arbeiten und die Versorgung des Patienten entlang des Patientenpfades zu optimieren. Und werfen Sie ein Blick in diese Lieblings-Lean-Bücher von Christian Baum: «Die angstfreie Organisation» (2020) von Amy C. Edmondson und «Toyotas Geheimrezepte für die Problemlösung» (2019) von Prof. Dr. Constantin May. Auch diese Inputs könnten für Sie interessant sein: «Das Ziel – Ein Roman über Prozessoptimierung» (2013) von Eliyahu M. Goldratt und Jeff Cox sowie die Publikation «Lean Management – Eine Quantifizierung des Nutzens» (2017) von Gutzeit und Kollegen.

Vor nun einem Jahr wurde die erste Episode des Podcasts «Marktplatz Gesundheitswesen» abgespielt und seither waren viele interessante Gäste mit spannenden Themen bei Alfred Angerer und Stefan Lienhard zu Gast – so auch diese Woche zur Jubiläumsfolge. Daniel Rochat ist Leiter des Departements Leistungen bei der SWICA und greift auf eine 25 Jahre lange Erfahrung im Gesundheitswesen zurück. Aus der Perspektive einer Krankenversicherung gibt er in diesem Podcast wichtige Einblicke über den Einfluss von Digital Health auf Patientenpfade und -erlebnisse und darüber, wie auch Krankenversicherungen aktiv Einfluss nehmen können. Anders als früher, geht es heute nicht mehr nur darum, als Kasse Rechnungen zu kontrollieren und zu zahlen. Heute sind Krankenversicherungen Dienstleistungsunternehmen, die versuchen, die gesamte Patient Journey zu begleiten. Den Patientinnen und Patienten sollen Lösungen und Dienstleistungen zu Gesundheit und Krankheit geboten werden und ein selbstbestimmteres Leben ermöglicht werden. Digital Health kann ihnen dabei helfen. Welche Lösungen die SWICA bietet, hören Sie in diesem Podcast.

For hemophilia patients, a simple fall or injury can cause excessive bleeding, which if not handled properly can cause major disabilities and in extreme situations even death. Due to the insufficient blood coagulation factors in their system, a fun day can easily end in the emergency room. Children, by nature, are still learning how to move and navigate the world. Where an adult may know the consequences of their actions, a child may not be able to see that, and therefore are an especially vulnerable group. With many challenges in their daily life, children with hemophilia have a complex experience with the disease. In collaboration with Partitura and the Sophia Childrens Hospital, the goal of the project is to analyze the experience of severe hemophilia patients aged 0 to 8, visualize this in the form of a patient journey built from their perspective and find opportunities and patterns in the experience to eventually create a proposal for an intervention to improve quality of life. A patient journey was created, in order to visualize this complex experience. The journey showed that there were definitely opportunities for improvement, giving an overview of the different touchpoints the patient goes through in the 3 main phases, (1) diagnosis, (2) treatment and (3) living with hemophilia. The patient journey, as well as various methods of research including a literature review, observations in the outpatient clinic and interviews with healthcare professionals, parents and patients showed that children want to feel more in control of their disease, and have more structure/predicability in their experience with hemophilia. Especially the 3 main contact areas of the patient, (1) home, (2) the outpatient clinic and (3) the emergency room, provided room for these needs to be met. Based on the research outcomes, a design goal was formulated for the creation of an intervention: To design an intervention for children with severe hemophilia aged wit, Design for Interaction | Medisign

The transformations the healthcare sector is undergoing can be divided into three types of changes; gradual change, sudden change and expected change. The ageing population represents the gradual change. The ageing population brings an increased demand for care, while also an increasing need for cost control and a decrease in available capacity is noticeable in the healthcare sector. The Covid19 pandemic is an example of a sudden change, an unexpected change on which needs to be acted fast. Digitalisation is a representative for an expected change in the healthcare sector. Especially since the recent Covid19 pandemic there is a growing interest among hospital organisations in digitalisation. To be able to maintain to deliver the highest quality of care under the current circumstances, new innovative strategies and lean processes need to be developed. To accommodate these transformations the real estate of the hospital will have to change. Due to the pressure on hospitals to reduce costs and improve health service accessibility, there is an increasing demand for outpatient services. With the growing interest among hospital organisations in digitalisation and the lack of research on a real estate strategy for hospitals that includes smart tools, this research focuses on to what extent smart tools can optimise the use of scarce resources in the outpatient department of the hospital, taking into account the layout of the outpatient department. The following question is formulated to be answered: “To what extent can smart tools and layout contribute to the efficient and effective use of the scarce resources in the outpatient department of a Dutch hospital?“ To be able to answer this research question, a qualitative approach is chosen to work with. Research on the use of smart tools in the outpatient department of a Dutch hospital is still very rare, therefore a qualitative approach is recommendable. The literature review acts as the backbone of the research. The case, Architecture, Urbanism and Building Sciences | Management in the Built Environment

BackgroundTenosynovial giant cell tumor (TGCT) is a rare, locally aggressive neoplasm arising from the synovium of joints, bursae, and tendon sheaths affecting small and large joints. It represents a wide spectrum ranging from minimally symptomatic to massively debilitating. Most findings to date are mainly from small, retrospective case series, and thus the morbidity and actual impact of this rare disease remain to be elucidated. This study prospectively explores the management of TGCT in tertiary sarcoma centers.MethodsThe TGCT Observational Platform Project registry was a multinational, multicenter, prospective observational study involving 12 tertiary sarcoma centers in 7 European countries, and 2 US sites. This study enrolled for 2 years all consecutive ≥ 18 years old patients, with histologically diagnosed primary or recurrent cases of diffuse-type TGCT. Patient demographic and clinical characteristics were collected at baseline and every 6 months for 24 months. Quality of life questionnaires (PROMIS-PF and EQ-5D) were also administered at the same time-points. Here we report baseline patient characteristics.Results166 patients were enrolled between November 2016 and March 2019. Baseline characteristics were: mean age 44 years (mean age at disease onset: 39 years), 139/166 (83.7%) had prior treatment, 71/166 patients (42.8%) had ≥ 1 recurrence after treatment of their primary tumor, 76/136 (55.9%) visited a medical specialist ≥ 5 times, 66/116 (56.9%) missed work in the 24 months prior to baseline, and 17/166 (11.6%) changed employment status or retired prematurely due to disease burden. Prior treatment consisted of surgery (i.e., arthroscopic, open synovectomy) (128/166; 77.1%) and systemic treatments (52/166; 31.3%) with imatinib (19/52; 36.5%) or pexidartinib (27/52; 51.9%). Treatment strategies at baseline visits consisted mainly of watchful waiting (81/166; 48.8%), surgery (41/166; 24.7%), or targeted systemic therapy (3

Skin cancer is the most common form of cancer in the Netherlands, often caused by having too much exposure to UV radiation from the sun. An effect of this is that the part of the body that is exposed the most to the sun is also the body part where skin cancer is seen more often; the head. When the skin cancer gets removed surgically, the defect is sometimes so big that reconstructive surgery has to take place. This treatment is impactful for patients, since their face can abruptly change, impacting their social interactions. This project explores the patient experience that facial skin cancer patients have throughout their treatment and how augmented reality (AR) could contribute in this treatment, to ultimately bring about a better quality of life (QoL). In the first phase of this project qualitative research was conducted. Interviews with healthcare professionals (HCPs) and observations in the hospital helped to understand the context for patients. Contextmapping interviews with patients gave insights on the patient journey they went through. It was found that this journey can best be explained as an emotional roller coaster with a long recovery phase. In the second phase of this project the final concept “Face it” came about through experimentation with AR software and co-creation with HCPs using the patient journey as a basis. A final interactive mock-up was created and tested with ex patients to evaluate the concept as a whole. The final concept Face it is a tool that helps patients to look at themselves in three different ways during the recovery phase of their treatment; the current selves, back in the past and the future selves. This is done by taking photos, keeping track with photos and looking to the future phases of the recovery in AR. The final concept was evaluated as a good example of digitalization to evoke patient engagement in their own care and with that patient empowerment. This design research show, Design for Interaction | Medisign

Duurzame gedragsverandering is moeilijk, zelfs wanneer het huidige gedrag een groot risico vormt voor de gezondheid. Gedragsverandering wordt gemakkelijker als het nieuwe gedrag past bij hoe een individu zichzelf ziet (identiteit). Virtuele coaching is veelbelovend om gedrags- en identiteitsverandering te ondersteunen, omdat het altijd beschikbaar is in de eigen omgeving en optimaal kan worden gepersonaliseerd., Interactive Intelligence

Die Transformation zu Value-Based Healthcare (VBHC) steht bei Schweizer Spitälern aktuell ganz oben auf der Prioritätenliste. Dies beinhaltet die Ausrichtung der Leistungserbringung an den Präferenzen, Ergebniserwartungen und Kompetenzen der Patientinnen und Patienten. Damit ist eine optimale Patient Experience ein zentraler Gradmesser für die Umsetzung von VBHC. Ein Team aus Expertinnen und Experten der Unternehmensberatung APP AG, des Winterthurer Instituts für Gesundheitsökonomie und der Schulthess Klinik präsentiert in diesem Whitepaper eine Roadmap zur Optimierung der Patient Experience, die mittels Design Thinking entstanden ist. Die Roadmap zeigt das Vorgehen beispielhaft an einem Fallbeispiel aus der Schulthess Klinik auf. Jeder Schritt auf dem Weg zur Optimierung wird anwendungsorientiert nach einem festen Schema anschaulich erläutert. Es werden das einzelne Vorgehen, sinnvolle Tools, wichtige Herausforderungen sowie die Interdependenzen zwischen den Schritten beschrieben. Das Whitepaper richtet sich an Spitalverantwortliche, die sich ein Grundverständnis der Thematik an-eignen wollen oder ein Projekt zur Verbesserung der Patient Experience planen. Das Studium dieses Whitepapers ermöglicht einen schnellen und effektiven Wissensaufbau und hilft bei der Umsetzung.

The current pandemic has drastically changed the primary care field. Suddenly, GP practices had to implement more digital or ‘care at a distance’ methods to keep interacting with patients. This was reflected by the strong increase in telephone consults and practices that used video calling for the first time. However, the sudden digital experience is not welcomed with open arms by patients and caregivers. 47% of the patient express that they are not positive about ‘care at a distance’ modalities (Meurs, 2020b), and approximately only a quarter of caregivers want to intensify e-consultation methods after the pandemic (Keuper, 2020). It is quite likely that after this pandemic, both groups return to the previous status quo, regardless of the benefits that eHealth and e-consultation can provide. The goal of this graduation project was to increase the adoption of e-consultation in primary care together with IZER. The graduation project followed the roadmapping process, starting with an analysis consisting of a literature study, qualitative interviews, and observations. During the research, caregivers and patients were thoroughly analysed to search for trends and wishes about (digital) primary care. The major discovered trends were the need for higher efficiency in the process due to the high effort of digitalisation, the demanded shift in control to the patient, the need for accessibility for the patient, the wish for digital to support the process, and the need for good communication. The result is DagKo: the Data-driven complaint support for patients in primary care (Data-gedreven Klacht Ondersteuning). DagKo is a software service that supports patients to do their triage independently and guides them towards the best next step concerning their complaint and medical history. The service uses data from previous patients with similar situations to analyse the most efficient and effective methods in a specific situation. Additionally, new consultation options are added t, Strategic Product Design

Human-centered design is about understanding human needs and how design can respond to these needs. With its systemic humane approach and creativity, human-centered design can play an essential role in dealing with today's care challenges. 'Design' refers to both the process of designing and the outcome of that process, which includes physical products, services, procedures, strategies and policies. In this article, we address the three key characteristics of human-centered design, focusing on its implementation in health care: (1) developing an understanding of people and their needs; (2) engaging stakeholders from early on and throughout the design process; (3) adopting a systems approach by systematically addressing interactions between the micro-, meso- and macro-levels of sociotechnical care systems, and the transition from individual interests to collective interests., Applied Ergonomics and Design, Human-Centered Design

BackgroundTenosynovial giant cell tumor (TGCT) is a rare, locally aggressive neoplasm arising from the synovium of joints, bursae, and tendon sheaths affecting small and large joints. It represents a wide spectrum ranging from minimally symptomatic to massively debilitating. Most findings to date are mainly from small, retrospective case series, and thus the morbidity and actual impact of this rare disease remain to be elucidated. This study prospectively explores the management of TGCT in tertiary sarcoma centers.MethodsThe TGCT Observational Platform Project registry was a multinational, multicenter, prospective observational study involving 12 tertiary sarcoma centers in 7 European countries, and 2 US sites. This study enrolled for 2 years all consecutive ≥ 18 years old patients, with histologically diagnosed primary or recurrent cases of diffuse-type TGCT. Patient demographic and clinical characteristics were collected at baseline and every 6 months for 24 months. Quality of life questionnaires (PROMIS-PF and EQ-5D) were also administered at the same time-points. Here we report baseline patient characteristics.Results166 patients were enrolled between November 2016 and March 2019. Baseline characteristics were: mean age 44 years (mean age at disease onset: 39 years), 139/166 (83.7%) had prior treatment, 71/166 patients (42.8%) had ≥ 1 recurrence after treatment of their primary tumor, 76/136 (55.9%) visited a medical specialist ≥ 5 times, 66/116 (56.9%) missed work in the 24 months prior to baseline, and 17/166 (11.6%) changed employment status or retired prematurely due to disease burden. Prior treatment consisted of surgery (i.e., arthroscopic, open synovectomy) (128/166; 77.1%) and systemic treatments (52/166; 31.3%) with imatinib (19/52; 36.5%) or pexidartinib (27/52; 51.9%). Treatment strategies at baseline visits consisted mainly of watchful waiting (81/166; 48.8%), surgery (41/166; 24.7%), or targeted systemic therapy (3

Introduction/objectives: To evaluate the journey to diagnosis, disease characteristics and burden of disease in male and female patients with axial spondyloarthritis (axSpA) across Europe. Method: Data from 2846 unselected patients participating in the European Map of Axial Spondyloarthritis (EMAS) study through an online survey (2017–2018) across 13 countries were analysed. Sociodemographic characteristics, lifestyle, diagnosis, disease characteristics and patient-reported outcomes (PROs) [disease activity –BASDAI (0–10), spinal stiffness (3–12), functional limitations (0–54) and psychological distress (GHQ-12)] were compared between males and females using chi-square (for categorical variables) and student t (for continuous variables) tests. Results: In total, 1100 (38.7%) males and 1746 (61.3%) females participated in the EMAS. Compared with males, females reported considerable longer diagnostic delay (6.1 ± 7.4 vs 8.2 ± 8.9 years; p < 0.001), higher number of visits to physiotherapists (34.5% vs 49.5%; p < 0.001) and to osteopaths (13.3% vs 24.4%; p < 0.001) before being diagnosed and lower frequency of HLA-B27 carriership (80.2% vs 66.7%; p < 0.001). In addition, females reported higher degree of disease activity in all BASDAI aspects and greater psychological distress through GHQ-12 (4.4 ± 4.2 vs 5.3 ± 4.1; p < 0.001), aswell as a greater use of alternative therapies. Conclusion: The patient journey to diagnosis of axSpA is much longer and arduous in females, which may be related to physician bias and lower frequency of HLA-B27 carriership. Regarding PROs, females experience higher disease activity and poorer psychological health compared with males. These results reflect specific unmet needs in females with axSpA needing particular attention.

Introduction/objectives: To evaluate the journey to diagnosis, disease characteristics and burden of disease in male and female patients with axial spondyloarthritis (axSpA) across Europe. Method: Data from 2846 unselected patients participating in the European Map of Axial Spondyloarthritis (EMAS) study through an online survey (2017–2018) across 13 countries were analysed. Sociodemographic characteristics, lifestyle, diagnosis, disease characteristics and patient-reported outcomes (PROs) [disease activity –BASDAI (0–10), spinal stiffness (3–12), functional limitations (0–54) and psychological distress (GHQ-12)] were compared between males and females using chi-square (for categorical variables) and student t (for continuous variables) tests. Results: In total, 1100 (38.7%) males and 1746 (61.3%) females participated in the EMAS. Compared with males, females reported considerable longer diagnostic delay (6.1 ± 7.4 vs 8.2 ± 8.9 years; p < 0.001), higher number of visits to physiotherapists (34.5% vs 49.5%; p < 0.001) and to osteopaths (13.3% vs 24.4%; p < 0.001) before being diagnosed and lower frequency of HLA-B27 carriership (80.2% vs 66.7%; p < 0.001). In addition, females reported higher degree of disease activity in all BASDAI aspects and greater psychological distress through GHQ-12 (4.4 ± 4.2 vs 5.3 ± 4.1; p < 0.001), aswell as a greater use of alternative therapies. Conclusion: The patient journey to diagnosis of axSpA is much longer and arduous in females, which may be related to physician bias and lower frequency of HLA-B27 carriership. Regarding PROs, females experience higher disease activity and poorer psychological health compared with males. These results reflect specific unmet needs in females with axSpA needing particular attention.

Introduction/objectives: To evaluate the journey to diagnosis, disease characteristics and burden of disease in male and female patients with axial spondyloarthritis (axSpA) across Europe. Method: Data from 2846 unselected patients participating in the European Map of Axial Spondyloarthritis (EMAS) study through an online survey (2017–2018) across 13 countries were analysed. Sociodemographic characteristics, lifestyle, diagnosis, disease characteristics and patient-reported outcomes (PROs) [disease activity –BASDAI (0–10), spinal stiffness (3–12), functional limitations (0–54) and psychological distress (GHQ-12)] were compared between males and females using chi-square (for categorical variables) and student t (for continuous variables) tests. Results: In total, 1100 (38.7%) males and 1746 (61.3%) females participated in the EMAS. Compared with males, females reported considerable longer diagnostic delay (6.1 ± 7.4 vs 8.2 ± 8.9 years; p < 0.001), higher number of visits to physiotherapists (34.5% vs 49.5%; p < 0.001) and to osteopaths (13.3% vs 24.4%; p < 0.001) before being diagnosed and lower frequency of HLA-B27 carriership (80.2% vs 66.7%; p < 0.001). In addition, females reported higher degree of disease activity in all BASDAI aspects and greater psychological distress through GHQ-12 (4.4 ± 4.2 vs 5.3 ± 4.1; p < 0.001), aswell as a greater use of alternative therapies. Conclusion: The patient journey to diagnosis of axSpA is much longer and arduous in females, which may be related to physician bias and lower frequency of HLA-B27 carriership. Regarding PROs, females experience higher disease activity and poorer psychological health compared with males. These results reflect specific unmet needs in females with axSpA needing particular attention.

Introduction/objectives: To evaluate the journey to diagnosis, disease characteristics and burden of disease in male and female patients with axial spondyloarthritis (axSpA) across Europe. Method: Data from 2846 unselected patients participating in the European Map of Axial Spondyloarthritis (EMAS) study through an online survey (2017–2018) across 13 countries were analysed. Sociodemographic characteristics, lifestyle, diagnosis, disease characteristics and patient-reported outcomes (PROs) [disease activity –BASDAI (0–10), spinal stiffness (3–12), functional limitations (0–54) and psychological distress (GHQ-12)] were compared between males and females using chi-square (for categorical variables) and student t (for continuous variables) tests. Results: In total, 1100 (38.7%) males and 1746 (61.3%) females participated in the EMAS. Compared with males, females reported considerable longer diagnostic delay (6.1 ± 7.4 vs 8.2 ± 8.9 years; p < 0.001), higher number of visits to physiotherapists (34.5% vs 49.5%; p < 0.001) and to osteopaths (13.3% vs 24.4%; p < 0.001) before being diagnosed and lower frequency of HLA-B27 carriership (80.2% vs 66.7%; p < 0.001). In addition, females reported higher degree of disease activity in all BASDAI aspects and greater psychological distress through GHQ-12 (4.4 ± 4.2 vs 5.3 ± 4.1; p < 0.001), aswell as a greater use of alternative therapies. Conclusion: The patient journey to diagnosis of axSpA is much longer and arduous in females, which may be related to physician bias and lower frequency of HLA-B27 carriership. Regarding PROs, females experience higher disease activity and poorer psychological health compared with males. These results reflect specific unmet needs in females with axSpA needing particular attention.

Die Transformation zu Value-Based Healthcare (VBHC) steht bei Schweizer Spitälern aktuell ganz oben auf der Prioritätenliste. Dies beinhaltet die Ausrichtung der Leistungserbringung an den Präferenzen, Ergebniserwartungen und Kompetenzen der Patientinnen und Patienten. Damit ist eine optimale Patient Experience ein zentraler Gradmesser für die Umsetzung von VBHC. Ein Team aus Expertinnen und Experten der Unternehmensberatung APP AG, des Winterthurer Instituts für Gesundheitsökonomie und der Schulthess Klinik präsentiert in diesem Whitepaper eine Roadmap zur Optimierung der Patient Experience, die mittels Design Thinking entstanden ist. Die Roadmap zeigt das Vorgehen beispielhaft an einem Fallbeispiel aus der Schulthess Klinik auf. Jeder Schritt auf dem Weg zur Optimierung wird anwendungsorientiert nach einem festen Schema anschaulich erläutert. Es werden das einzelne Vorgehen, sinnvolle Tools, wichtige Herausforderungen sowie die Interdependenzen zwischen den Schritten beschrieben. Das Whitepaper richtet sich an Spitalverantwortliche, die sich ein Grundverständnis der Thematik an-eignen wollen oder ein Projekt zur Verbesserung der Patient Experience planen. Das Studium dieses Whitepapers ermöglicht einen schnellen und effektiven Wissensaufbau und hilft bei der Umsetzung.

Duurzame gedragsverandering is moeilijk, zelfs wanneer het huidige gedrag een groot risico vormt voor de gezondheid. Gedragsverandering wordt gemakkelijker als het nieuwe gedrag past bij hoe een individu zichzelf ziet (identiteit). Virtuele coaching is veelbelovend om gedrags- en identiteitsverandering te ondersteunen, omdat het altijd beschikbaar is in de eigen omgeving en optimaal kan worden gepersonaliseerd., Interactive Intelligence

Human-centered design is about understanding human needs and how design can respond to these needs. With its systemic humane approach and creativity, human-centered design can play an essential role in dealing with today's care challenges. 'Design' refers to both the process of designing and the outcome of that process, which includes physical products, services, procedures, strategies and policies. In this article, we address the three key characteristics of human-centered design, focusing on its implementation in health care: (1) developing an understanding of people and their needs; (2) engaging stakeholders from early on and throughout the design process; (3) adopting a systems approach by systematically addressing interactions between the micro-, meso- and macro-levels of sociotechnical care systems, and the transition from individual interests to collective interests., Applied Ergonomics and Design, Human-Centered Design

Skin cancer is the most common form of cancer in the Netherlands, often caused by having too much exposure to UV radiation from the sun. An effect of this is that the part of the body that is exposed the most to the sun is also the body part where skin cancer is seen more often; the head. When the skin cancer gets removed surgically, the defect is sometimes so big that reconstructive surgery has to take place. This treatment is impactful for patients, since their face can abruptly change, impacting their social interactions. This project explores the patient experience that facial skin cancer patients have throughout their treatment and how augmented reality (AR) could contribute in this treatment, to ultimately bring about a better quality of life (QoL). In the first phase of this project qualitative research was conducted. Interviews with healthcare professionals (HCPs) and observations in the hospital helped to understand the context for patients. Contextmapping interviews with patients gave insights on the patient journey they went through. It was found that this journey can best be explained as an emotional roller coaster with a long recovery phase. In the second phase of this project the final concept “Face it” came about through experimentation with AR software and co-creation with HCPs using the patient journey as a basis. A final interactive mock-up was created and tested with ex patients to evaluate the concept as a whole. The final concept Face it is a tool that helps patients to look at themselves in three different ways during the recovery phase of their treatment; the current selves, back in the past and the future selves. This is done by taking photos, keeping track with photos and looking to the future phases of the recovery in AR. The final concept was evaluated as a good example of digitalization to evoke patient engagement in their own care and with that patient empowerment. This design research show, Design for Interaction | Medisign

The current pandemic has drastically changed the primary care field. Suddenly, GP practices had to implement more digital or ‘care at a distance’ methods to keep interacting with patients. This was reflected by the strong increase in telephone consults and practices that used video calling for the first time. However, the sudden digital experience is not welcomed with open arms by patients and caregivers. 47% of the patient express that they are not positive about ‘care at a distance’ modalities (Meurs, 2020b), and approximately only a quarter of caregivers want to intensify e-consultation methods after the pandemic (Keuper, 2020). It is quite likely that after this pandemic, both groups return to the previous status quo, regardless of the benefits that eHealth and e-consultation can provide. The goal of this graduation project was to increase the adoption of e-consultation in primary care together with IZER. The graduation project followed the roadmapping process, starting with an analysis consisting of a literature study, qualitative interviews, and observations. During the research, caregivers and patients were thoroughly analysed to search for trends and wishes about (digital) primary care. The major discovered trends were the need for higher efficiency in the process due to the high effort of digitalisation, the demanded shift in control to the patient, the need for accessibility for the patient, the wish for digital to support the process, and the need for good communication. The result is DagKo: the Data-driven complaint support for patients in primary care (Data-gedreven Klacht Ondersteuning). DagKo is a software service that supports patients to do their triage independently and guides them towards the best next step concerning their complaint and medical history. The service uses data from previous patients with similar situations to analyse the most efficient and effective methods in a specific situation. Additionally, new consultation options are added t, Strategic Product Design

[Background] Tenosynovial giant cell tumor (TGCT) is a rare, locally aggressive neoplasm arising from the synovium of joints, bursae, and tendon sheaths affecting small and large joints. It represents a wide spectrum ranging from minimally symptomatic to massively debilitating. Most findings to date are mainly from small, retrospective case series, and thus the morbidity and actual impact of this rare disease remain to be elucidated. This study prospectively explores the management of TGCT in tertiary sarcoma centers., [Methods] The TGCT Observational Platform Project registry was a multinational, multicenter, prospective observational study involving 12 tertiary sarcoma centers in 7 European countries, and 2 US sites. This study enrolled for 2 years all consecutive ≥ 18 years old patients, with histologically diagnosed primary or recurrent cases of diffuse-type TGCT. Patient demographic and clinical characteristics were collected at baseline and every 6 months for 24 months. Quality of life questionnaires (PROMIS-PF and EQ-5D) were also administered at the same time-points. Here we report baseline patient characteristics., [Results] 166 patients were enrolled between November 2016 and March 2019. Baseline characteristics were: mean age 44 years (mean age at disease onset: 39 years), 139/166 (83.7%) had prior treatment, 71/166 patients (42.8%) had ≥ 1 recurrence after treatment of their primary tumor, 76/136 (55.9%) visited a medical specialist ≥ 5 times, 66/116 (56.9%) missed work in the 24 months prior to baseline, and 17/166 (11.6%) changed employment status or retired prematurely due to disease burden. Prior treatment consisted of surgery (i.e., arthroscopic, open synovectomy) (128/166; 77.1%) and systemic treatments (52/166; 31.3%) with imatinib (19/52; 36.5%) or pexidartinib (27/52; 51.9%). Treatment strategies at baseline visits consisted mainly of watchful waiting (81/166; 48.8%), surgery (41/166; 24.7%), or targeted systemic therapy (37/166; 22.3%). Patients indicated for treatment reported more impairment compared to patients indicated for watchful waiting: worst stiffness NRS 5.16/3.44, worst pain NRS 6.13/5.03, PROMIS-PF 39.48/43.85, and EQ-5D VAS 66.54/71.85., [Conclusion] This study confirms that diffuse-type TGCT can highly impact quality of life. A prospective observational registry in rare disease is feasible and can be a tool to collect curated-population reflective data in orphan diseases., [Name of registry] Tenosynovial Giant Cell Tumors (TGCT) Observational Platform Project (TOPP)., [Trial registration number] NCT02948088., [Date of registration] 10 October 2016., [URL of Trial registry record] https://clinicaltrials.gov/ct2/show/NCT02948088?term=NCT02948088&draw=2.

In Deutschland erkranken jährlich circa 500.000 Menschen neu an Krebs, wovon sich nur 3% auf junge Erwachsene und Heranwachsende zwischen 15 - 39 Jahren verteilen (Freund, 2017, S. 3; Robert Koch Institut, 2019, S. 6). Trotz altersspezifischer Besonderheiten die diese Zielgruppe hinsichtlich Betreuung und Behandlung verkörpert, erhält sie wenig Aufmerksamkeit in der Gesundheitsinfrastruktur. Das Ziel der vorliegenden Masterarbeit war deshalb die Untersuchung der Informationsbedarfe junger Erwachsener mit Krebs in Deutschland. In 14 teilstrukturierten Leitfadeninterviews wurden Betroffene gebeten über ihre subjektiven Erfahrungen zu berichten. Mit Hilfe der thematic analysis nach Braun et al. (2006) konnten zehn Themen erkannt werden, in die sich die Informations-, Dienstleistungs- und Pflegebedarfe der jungen Erwachsenen gliedern. Zusätzlich konnte durch Anwendung des Konzeptes der patient journey (Brailsford et al., 2004) ein Wandel der Bedarfe abhängig der zu durchlaufenden Phase vor, während und nach der Krankheit erkannt werden. Durch eine Analyse des Umgangs mit den erkannten Bedarfen wurden abschließend Verbesserungswünsche zusammengefasst.

Advanced and metastatic cancer has a complex diagnostic and management profile that places a heavy long-term burden on patients and healthcare systems. Little attention has been given to patients’ experiences across their entire clinical journey. Using a qualitative, longitudinal methodology over a ten-month period, we examined the symptom-to-outcome trajectories of seven people attending a medical oncology clinic at a large, public tertiary referral center in Sydney, Australia. Rather than care being experienced as a largely linear progression through diagnosis, treatment and onto surveillance in which life may return to ‘normal’, participants are embedded in a cyclical clinical pathway. Recurrence or metastases are not a matter of ‘if’ but ‘when’. This model of the patient journey points to a need for longitudinal, person-centered services to support the growing population of people with melanoma.

In this article, we focus on the design method of mapping the patient journey in order to support the inclusion of the patient perspective into care service innovations. Increasingly, designers in health use the patient journey approach, however, its method is relatively poorly documented. To ground the activities of the patient journey method, we conducted an in-depth case study of integrated service design with impact on improved patient satisfaction – the case of gastrointestinal diagnose service with video endoscopy technology. The results revealed four distinct activities of the patient journey method: (1) Analyse the care service system; (2) Experience the journey yourself, observe and sketch it; (3) Co-design the patient journey: craft the journey toolkit, interview and synthesize; (4) Evaluate the patient journey for integrated service design., Methodology and Organisation of Design, Applied Ergonomics and Design

Healthcare-Associated Infections (HAI) can occur when microorganisms spread between hospitalized patients. To prevent highly contagious or resistant microorganisms from spreading from one patient to the other, isolation precautions such as contact isolation are applied when patients carry such a microorganism. The first part of this theses describes how contact isolation has a negative impact on well-being on patients. The experience during contact isolation can improve by establishing an open healthcare environment and providing information during the full isolation process. Collective action theories appear to have potential to be applied to the context of infection prevention. The contribution of patients, healthcare providers and visitors to infection prevention can be stimulated by increasing community feeling, establishing connections between individuals and providing information about past actions of other individuals. Context research has been conducted in VUmc and results on the current patient experience are gathered in a patient journey. Conclusions on the current patient experience during isolation are as following: 1. a shattered sense of responsibility amongst different actors 2. different patient persona’s experience contact isolation differently 3. a difference in experience and behaviour of first time isolation patients and readmitted patients. To improve the patient experience during contact isolation, the second part of this thesis focusses on creating a solution. By combining the conclusions and the literature, a design vision is formulated: I want to increase the feeling of community amongst all actors in the contact isolation process, so that all individuals experience a sense of shared responsibility towards infection prevention in VUmc. A first step towards the design vision is created with the guidance of the following design goal: I want patients to develop a favourable attitude towards contact isolation during the first time into contact i, Design for Interaction

Objectives Our objectives were to characterise the nature and extent of delay times to essential surgical care in a developing nation by measuring the actual stages of delay for patients receiving Bellwether procedures. Setting The study was conducted at Timor Leste's national referral hospital in Dili, the country's capital. Participants All patients requiring a Bellwether procedure over a 2-month period were included in the study. Participants whose procedure was undertaken more than 24 hours from initial hospital presentation were excluded. Primary and secondary outcome measures Data pertaining to the patient journey from onset of symptoms to emergency procedure was collected by interview of patients, their treating surgeons or anaesthetists and the medical records. Timelines were then calculated against the Three Delays Framework. Results Fifty-six patients were entered into the study. Their mean delay from symptom onset to entering the anaesthesia bay for a procedure was 32.3 hours (+/-11.6). The second delay (4.1+/-2.5 hours) was significantly less than the first (20.9+/-11.5 hours; p<0.005) and third delays (7.2+/-1.2 hours; p<0.05). Additionally, patients with acute abdominal pain (of which 18/20 ultimately had open appendicectomy and two emergency laparotomies) had a delay time of 53.3 hours (+/-21.3), significantly more than that for emergency caesarean (22.9+/-18.6 hours; p<0.05) or management of an open long-bone fracture (15.5+/-5.56 hours; p<0.05). Conclusions Substantial delays were observed for all three stages and each Bellwether procedure. This study methodology could be used to measure access and the three delays to emergency surgical care in low/middle-income countries, although the actual reasons for delay may vary between regions and countries and would require a qualitative study.

This graduation project is related to macular degeneration. Macular degeneration affects the macula, a central pit on the retina which is responsible for the highest visual acuity due to the densely packed cone photoreceptors. Symptoms of macular degeneration can vary in the early stage from blurred vision to abnormal dark adaptation (Jager et al., 2008) however in late stage macular degeneration symptoms can be much more invasive including partial and complete loss of the central vision. In order to cope with the loss of central vision patients could prescribe to what is called eccentric viewing. Eccentric viewing is a technique where the peripheral vision is used to see. Using eccentric viewing as a method to cope with macular degeneration requires, for optimal results, practice. This can be done through training. This project was originally aimed at designing a training method for eccentric viewing with the use of motivating game elements. By speaking to experts from Visio and Bartimeus as well as patients throughout the research phase it became apparent that eccentric viewing was not deemed necessary. Instead other problems were addressed which had a higher priority in solving. These problems include the lack of provided information after the official diagnosis, the attitude of the ophthalmologist during the diagnosis and the perceived gap between the diagnosis and the Low-Vision clinics. By creating a patient journey and examining the different problems that occur during that journey a choice was made to focus on a combination of the lack of information after the diagnosis and the gap between the diagnosis and the Low-Vision clinics. Six different topics of information were defined which play part in the lack of information. These six topics are: information about the condition, information about aids, make it easier, information about peer support, training / revalidation support and information about involved instances. Together these six topics cover most of, Design for Interaction

Autosomal-dominant polycystic kidney disease (ADPKD) is the leading genetic cause of end-stage renal disease (ESRD) worldwide. The number of ADPKD patients who are listed for transplantation or receive a kidney transplant is continuously increasing over time. AIRP conducted a survey to investigate the ADPKD patient journey, meaning the personal experience and expectations of people regarding kidney transplantation as therapeutic option of end-stage renal failure. The survey was conducted on 381 people with ADPKD, using computer-assisted web interviewing (CAWI). The results confirm that there are problems that need to be addressed before listing an ADPKD patient for a kidney transplantation, namely the patient’s comorbidities, the complexity of pre-transplant assessments and the shortage of organs. Pre-emptive transplantation from cadaver donor is a rare event in our country but it is a valid option, especially in case of living donation. Immunosuppression is well tolerated in a high percentage of subjects, but a follow-up is necessary to monitor negative side effects. Despite these problems, the outcome of kidney transplantation is optimal in these patients. Also, the relationship between patients and Nephrologists and/or Transplant Centers is important to ensure a positive outcome., Autosomal-dominant polycystic kidney disease (ADPKD) is the leading genetic cause of end-stage renal disease (ESRD) worldwide. The number of ADPKD patients who are listed for transplantation or receive a kidney transplant is continuously increasing over time. AIRP conducted a survey to investigate the ADPKD patient journey, meaning the personal experience and expectations of people regarding kidney transplantation as therapeutic option of end-stage renal failure. The survey was conducted on 381 people with ADPKD, using computer-assisted web interviewing (CAWI). The results confirm that there are problems that need to be addressed before listing an ADPKD patient for a kidney transplantation, namely the patient’s comorbidities, the complexity of pre-transplant assessments and the shortage of organs. Pre-emptive transplantation from cadaver donor is a rare event in our country but it is a valid option, especially in case of living donation. Immunosuppression is well tolerated in a high percentage of subjects, but a follow-up is necessary to monitor negative side effects. Despite these problems, the outcome of kidney transplantation is optimal in these patients. Also, the relationship between patients and Nephrologists and/or Transplant Centers is important to ensure a positive outcome.

Autosomal-dominant polycystic kidney disease (ADPKD) is the leading genetic cause of end-stage renal disease (ESRD) worldwide. The number of ADPKD patients who are listed for transplantation or receive a kidney transplant is continuously increasing over time. AIRP conducted a survey to investigate the ADPKD patient journey, meaning the personal experience and expectations of people regarding kidney transplantation as therapeutic option of end-stage renal failure. The survey was conducted on 381 people with ADPKD, using computer-assisted web interviewing (CAWI). The results confirm that there are problems that need to be addressed before listing an ADPKD patient for a kidney transplantation, namely the patient’s comorbidities, the complexity of pre-transplant assessments and the shortage of organs. Pre-emptive transplantation from cadaver donor is a rare event in our country but it is a valid option, especially in case of living donation. Immunosuppression is well tolerated in a high percentage of subjects, but a follow-up is necessary to monitor negative side effects. Despite these problems, the outcome of kidney transplantation is optimal in these patients. Also, the relationship between patients and Nephrologists and/or Transplant Centers is important to ensure a positive outcome., Autosomal-dominant polycystic kidney disease (ADPKD) is the leading genetic cause of end-stage renal disease (ESRD) worldwide. The number of ADPKD patients who are listed for transplantation or receive a kidney transplant is continuously increasing over time. AIRP conducted a survey to investigate the ADPKD patient journey, meaning the personal experience and expectations of people regarding kidney transplantation as therapeutic option of end-stage renal failure. The survey was conducted on 381 people with ADPKD, using computer-assisted web interviewing (CAWI). The results confirm that there are problems that need to be addressed before listing an ADPKD patient for a kidney transplantation, namely the patient’s comorbidities, the complexity of pre-transplant assessments and the shortage of organs. Pre-emptive transplantation from cadaver donor is a rare event in our country but it is a valid option, especially in case of living donation. Immunosuppression is well tolerated in a high percentage of subjects, but a follow-up is necessary to monitor negative side effects. Despite these problems, the outcome of kidney transplantation is optimal in these patients. Also, the relationship between patients and Nephrologists and/or Transplant Centers is important to ensure a positive outcome.

Background: Fast-track and outpatient arthroplasty methodologies combine evidence-based clinical features with organizational optimization resulting in a streamlined pathway from admission to discharge and beyond. This qualitative study explored perceived problems of healthcare professionals during fast-track hip and knee arthroplasty. Methods: Semi-structured interviews were conducted with four surgeons, two anesthesiologists, ten nurses, and four physiotherapists. An inductive content analysis was used to analyze the data. NVivo qualitative data analysis software was used. Results: Analysis of the data revealed eight main categories of problems: patient selection, referrals, meeting the Health Care Guarantee, patient flow, homecare, patient counseling, transparency of the journey, and receiving feedback. In addition, problems related to information flows and communication, responsibilities between different stakeholders, and existing information systems were identified. Conclusions: The study revealed that healthcare professionals perceived several problems during the fast-track journey that reduce its effectiveness and make it more difficult to meet the Health Care Guarantee. Problems could be alleviated by changing internal and external organizational practices, as well as by developing new information and communication technologies that would provide up-to-date communication channels for healthcare professionals and patients. In addition, new collaboration mechanisms should be developed in order to solve the problems that occur across different organizations.

In this article, we focus on the design method of mapping the patient journey in order to support the inclusion of the patient perspective into care service innovations. Increasingly, designers in health use the patient journey approach, however, its method is relatively poorly documented. To ground the activities of the patient journey method, we conducted an in-depth case study of integrated service design with impact on improved patient satisfaction – the case of gastrointestinal diagnose service with video endoscopy technology. The results revealed four distinct activities of the patient journey method: (1) Analyse the care service system; (2) Experience the journey yourself, observe and sketch it; (3) Co-design the patient journey: craft the journey toolkit, interview and synthesize; (4) Evaluate the patient journey for integrated service design., Methodologie en Organisatie van Design, Applied Ergonomics and Design