A generative co-design framework for healthcare innovation: development and application of an end-user engagement framework.

Background Continual improvements to health systems, products, and services are necessary for improvements in health. However, many of these improvements are not incorporated into everyday practice. When designing new health systems, products, and services, involving members of the healthcare community and the public with personal healthcare experience can help to make sure that improvements will be useful and relevant to others like them. Methods Together with healthcare workers and family members with healthcare experience, we developed and applied a step-by-step guide to involving those with personal experience in the design of health system improvements. Results Our guide has three phases- 'Pre-Design', 'Co-Design', and 'Post-Design'. This paper describes each of these phases and illustrates how we applied them to our own project, which is to use virtual healthcare methods to improve care for children with chronic healthcare conditions and their families. In our own work, we found that healthcare workers and family members with personal healthcare experiences were able to use their knowledge and creativity to help us imagine how to improve care for children with chronic healthcare conditions and their families. We have created action items from these family member- and healthcare worker-identified needs, which we will use to shape our virtual healthcare system. Conclusions This paper may be useful for those seeking to involve members of the healthcare community and the public in the creation of better healthcare systems, products, and services. Background Challenges with the adoption, scale, and spread of health innovations represent significant gaps in the evidence-to-practice cycle. In the health innovation design process, a lack of attention paid to the needs of end-users, and subsequent tailoring of innovations to meet these needs, is a possible reason for this deficit. In the creative field of health innovation, which includes the design of healthcare products, systems (governance and organization mechanisms), and services (delivery mechanisms), a framework for both soliciting the needs of end-users and translating these needs into the design of health innovations is needed. Methods To address this gap, our team developed and applied a seven-step methodological framework, called A Generative Co-Design Framework for Healthcare Innovation. This framework was developed by an interdisciplinary team that included patient partners. Results This manuscript contributes a framework and applied exemplar for those seeking to engage end-users in the creative process of healthcare innovation. Through the stages of 'Pre-Design', 'Co-Design', and 'Post-Design', we were able to harness the creative insights of end-users, drawing on their experiences to shape a future state of care. Using an expository example of our own work, the DigiComp Kids project, we illustrate the application of each stage of the Framework. Conclusions A Generative Co-Design Framework for Healthcare Innovation provides healthcare innovators, applied health science researchers, clinicians, and quality improvement specialists with a guide to eliciting and incorporating the viewpoints of end-users while distilling practical considerations for healthcare innovation and design.

[Neonatal lupus syndrome: Literature review]. / « Lupus néonatal ¼ : revue de la littérature.

Neonatal lupus syndrome is associated with transplacental passage of maternal anti-SSA/Ro and anti-SSB/La antibodies. Children display cutaneous, hematological, liver or cardiac features. Cardiac manifestations include congenital heart block (CHB); endocardial fibroelastosis and dilated cardiomyopathy. The prevalence of CHB in newborns of anti-Ro/SSA positive women with known connective tissue disease is between 1 and 2% and the risk of recurrence is around 19%. Skin and systemic lesions are transient, whereas CHB is definitive and associated with significant morbidity and a mortality of 18%. A pacemaker must be implanted in 2/3 of cases. Myocarditis may be associated or appear secondly. Mothers of children with CHB are usually asymptomatic or display Sjogren's syndrome or undifferentiated connective tissue disease. In anti-Ro/SSA positive pregnant women, fetal echocardiography should be performed at least every 2 weeks from the 16th to 24th week gestation. An electrocardiogram should be performed for all newborn babies. The benefit of fluorinated corticosteroid therapy for CHB detected in utero remains unclear. Maternal use of hydroxychloroquine may be associated with a decreased recurrent CHB risk in a subsequent offspring. A prospective study is actually ongoing to confirm these findings.

Temperature and food quality effects on growth, consumption and post-ingestive utilization efficiencies of the forest tent caterpillar Malacosoma disstria (Lepidoptera: Lasiocampidae).

Temperature and food quality can both influence growth rates, consumption rates, utilization efficiencies and developmental time of herbivorous insects. Gravimetric analyses were conducted during two consecutive years to assess the effects of temperature and food quality on fourth instar larvae of the forest tent caterpillar Malacosoma disstria Hübner. Larvae were reared in the laboratory at three different temperatures (18, 24 and 30 degrees C) and on two types of diet; leaves of sugar maple trees Acer saccharum Marsh. located at the forest edge (sun-exposed leaves) or within the forest interior (shade-exposed leaves). In general, larvae reared at 18 degrees C had lower growth rates and lower consumption rates than larvae reared at the warmer temperatures (24 and 30 degrees C). Moreover, the duration of the instar decreased significantly with increasing temperatures. Type of diet also affected the growth rates and amount of food ingested by larvae but did not affect the duration of the instar. Larvae fed sun-exposed leaves consumed more food and gained higher biomasses. Values of approximate digestibility and efficiency of conversion of ingested food were also higher when larvae were fed sun-exposed leaves. Higher growth rates with increasing temperatures were primarily the result of the shorter stadium duration. The higher growth rates of larvae fed sun-exposed leaves were possibly the result of stimulatory feeding and consequently greater food intake and also a more efficient use of food ingested. This study suggests that the performance of M. disstria caterpillars could be enhanced by warmer temperatures and higher leaf quality.

Evolutionary conservation and chromosomal localization of flvi-1.

A locus in feline DNA, termed flvi-1, has been identified as harboring retroviral integrations commonly found in natural feline lymphomas induced by infection with feline leukemia virus (FeLV). Southern blot analysis of human and murine DNA using restriction fragments representing flvi-1 demonstrates its phylogenetic conservation among mammals, flvi-1 is localized to murine chromosome 2, proximal portion of band E, by in situ hybridization to metaphase chromosomes. This position is adjacent to that of another putative proto-oncogene, sfpi-1, although probes representing flvi-1 and sfpi-1 do not cross-hybridize. The repeated implication of flvi-1 in natural feline leukemogenesis, its evolutionary conservation and its chromosomal position support the hypothesis that flvi-1 may represent a previously unidentified protooncogene.

flvi-1, a common integration domain of feline leukemia virus in naturally occurring lymphomas of a particular type.

A locus in feline DNA, termed flvi-1, which may play an important role in the natural induction of lymphomas by feline leukemia virus (FeLV) was identified. Examination of a bank of 21 naturally occurring FeLV-positive feline lymphomas revealed that FeLV proviral integration occurs at flvi-1 in four independent tumors (19%). Independent integrations occurred within a 2.4-kilobase region of flvi-1, the probability of which by random chance can be estimated as 10(-16). Several lines of evidence, including sequence analysis of the long terminal repeat, demonstrated that proviruses integrated at flvi-1 are exogenously acquired and are oriented in the same transcriptional direction with respect to the locus. Molecularly cloned flvi-1 did not hybridize with probes representing several previously described proviral integration domains or with probes representing 10 oncogenes. The natural feline lymphomas examined in this study were heterogeneous with respect to tissue of origin, cell type, and number of monoclonal proviral integrations. The four tumors in which flvi-1 is interrupted were classified as members of a phenotypic subgroup containing seven lymphomas, i.e., at least four (57%) of seven lymphomas of this type contained FeLV proviral integration at flvi-1. Members of this phenotypic subgroup are non-T-cell lymphomas isolated from the spleen and contain an average of three proviruses, compared with an average of eight among all of the tumors examined. The small number of proviral integrations in tumors of this subgroup suggests that an early proviral integration event into flvi-1 can induce malignant change.

Bacterial contamination of pressurized inhalers.

The objective of this project was to determine the incidence, location, and potential transmission of bacteria from pressurized inhalers contaminated during normal use by pediatric patients. Patients' inhaler usage and cleaning patterns also were evaluated. Fifteen inhalers from 12 children were cultured at three separate sites: the mouthpiece, spray portal, and the spray itself. The patient and/or parent were interviewed to determine usage and cleaning patterns. No bacterial growth was found from any of the cultured sites or aerosol of the control inhalers. All of the mouthpieces and portals of the patient-used inhalers were positive for growth, which is significant (p less than 0.01). One patient-used inhaler was positive for bacterial growth from the aerosol, which is not significant (p greater than 0.05). These results demonstrate that despite inhaler contamination, bacteria are not significantly transmitted by the aerosol. Routine cleaning of inhalers to remove accumulated debris is recommended to prevent disruption of drug delivery.