R E S E A R C H A R T I C L E
Open Access
The use of advanced medical technologies
at home: a systematic review of the
literature
Ingrid ten Haken
1*, Somaya Ben Allouch
1and Wim H. van Harten
2,3Abstract
Background: The number of medical technologies used in home settings has increased substantially over the last 10–15 years. In order to manage their use and to guarantee quality and safety, data on usage trends and practical experiences are important. This paper presents a literature review on types, trends and experiences with the use of advanced medical technologies at home.
Methods: The study focused on advanced medical technologies that are part of the technical nursing process and ‘hands on’ processes by nurses, excluding information technology such as domotica. The systematic review of literature was performed by searching the databases MEDLINE, Scopus and Cinahl. We included papers from 2000 to 2015 and selected articles containing empirical material.
Results: The review identified 87 relevant articles, 62% was published in the period 2011–2015. Of the included studies, 45% considered devices for respiratory support, 39% devices for dialysis and 29% devices for oxygen therapy. Most research has been conducted on the topic‘user experiences’ (36%), mainly regarding patients or informal caregivers. Results show that nurses have a key role in supporting patients and family caregivers in the process of homecare with advanced medical technologies and in providing information for, and as a member of multi-disciplinary teams. However, relatively low numbers of articles were found studying nurses perspective.
Conclusions: Research on medical technologies used at home has increased considerably until 2015. Much is already known on topics, such as user experiences; safety, risks, incidents and complications; and design and technological development. We also identified a lack of research exploring the views of nurses with regard to medical technologies for homecare, such as user experiences of nurses with different technologies, training, instruction and education of nurses and human factors by nurses in risk management and patient safety.
Keywords: Home health nursing, Medical technologies, Patient safety, Quality of health care, Systematic review, Trends
Background
As a result of demographic changes and the rapidly in-creasing number of older patients, there is a need for cost savings and health reforms, which include an increased move from inpatient to outpatient care in most industrial-ized countries over the last 10–15 years [1,2]. As a conse-quence, the transfer of advanced medical devices into home settings was considerable and it is expected that there will be a further increase in the near future [1–7].
When ‘an increase’ in the number of medical tech-nologies used at home is mentioned, it is not clear which and how many technologies are involved. Today, there are an estimated 500,000 different kinds and types of medical devices available on the world market [8, 9]. The European Commission (EC) publishes data regard-ing legislation and regulations for medical devices, but the actual figures for medical technologies in outpatient practice are not available [10]. The U.S. National Center for Health Statistics (NCHS) stated that technologies have shifted from hospitals into the home, but it too does not illustrate its findings with statistics [11]. We searched for data with regard to the actual number of
* Correspondence:i.tenhaken@saxion.nl
1Saxion University of Applied Sciences, Research Group Technology, Health &
Care (TH&C), P.O. Box 70.000, 7500 KB Enschede, The Netherlands Full list of author information is available at the end of the article
© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
medical technologies used in home settings and it proved difficult to find any systematic data sets available throughout the international landscape.
An important condition for the application of medical technology in the home setting is that quality of care and patient safety must be guaranteed [6]. From a his-torical perspective medical technologies were designed for hospital settings [12, 13]. This means that specific factors regarding the implementation and use at home now need to be taken into account [7, 14, 15]. In gen-eral, risks with medical technologies can be classified re-garding (a) environmental factors; (b) human factors and (c) technological factors [16]. Human factors, however, are very important in patient safety in both hospital and in home settings [1, 6, 12]. For example, a major risk factor is the number of users and handovers in the chain of care. In home settings, a sometimes impressive num-ber of different users of medical technology, often with various levels of training, instruction or education, are involved. Although patient empowerment moves control to the patient and/or relatives, an important user group is that of professional nurses. Understanding user expe-riences and information about adverse events and near incidents are important aspects for developing know-ledge regarding implementation and use in home care setting. Sharing this knowledge can support patients and caregivers, and especially nurses in their professional work and will also contribute to patient safety and qual-ity of care.
Therefore, there is a need to address the question first, which types of technologies are used at home; second, how frequently are they used and third, what trends can be distinguished. Additional research questions are whether there are any scientific data regarding particular user experiences; training, instruction and education; safety and risks, and finally, what can be concluded about the role of nurses in using medical technologies in the home environment. The objective of this paper therefore is to present a systematic literature search on the international state of art concerning various aspects of the use of advanced medical technologies at home. Definitions
First, we want to clarify some definitions. In general, ‘health technology’ refers to the application of organized knowledge and skills in the form of devices, medicines, vaccines, procedures and systems developed to solve a health problem and improve quality of life [17]. The World Health Organization [8] uses the definition of ‘medical device’ as ‘An article, instrument, apparatus or machine that is used in the prevention, diagnosis or treatment of illness or disease, or for detecting, measur-ing, restormeasur-ing, correcting or modifying the structure or function of the body for some health purpose …….’. A
specification for a home use medical device is: ‘A med-ical device intended for users in any environment outside of a professional healthcare facility. This includes devices intended for use in both professional healthcare facilities and homes’ [18].
The landscape of medical devices is diverse with tech-nologies varying from relatively simple to very complex devices. Wagner et al. [19] stated that ‘high-tech dependency’ (for children) matches with ‘technology-de-pendency’ if it concerns ‘a medical device to compensate for the loss of a vital bodily function and substantial and ongoing nursing care to avert death or further disability’. ‘The needs of these patients may vary from the continu-ous assistance of a device and highly trained caretaker to less frequent treatment and intermittent nursing care’ [20]. Although patients dependent of advanced medical technologies at home are often medically stable, they sometimes have high technical needs and may be expected to need long-term recovery. They also require skilled nursing [21] and a considerable degree of ad-vanced decision making, planning, training and oversight [22]. An overall definition of ‘advanced medical technol-ogy’ is: ‘Medical devices and software systems that are complex, provide critical patient data, or that directly implement pharmacologic or life-support processes whereby inadvertent misuse or use error could present a known probability of patient harm’ [23]. Examples of ad-vanced medical technologies used at home include venti-lators for respiratory support, systems for haemo- or peritoneal dialysis and infusion pumps to provide nutri-tion or medicanutri-tion.
In the Netherlands, the National Institute for Public Health and the Environment (RIVM) [24] uses the fol-lowing definition:
Advanced medical technology or high-tech technology in the home setting is defined as technology that is part of the technical skills in nursing and meets the following conditions:
technology that is advanced or high-tech, for example equipment with a plug, an on/off switch, an alarm button and a pause button;
technology that had been applied formerly only in hospital care, but that is now also often applied in home settings;
technology that can be categorized as‘supporting physiological functions’, ‘administration’ or ‘monitoring’.
Within the Dutch classification of advanced medical technologies 19 different devices are identified (see Table 1), which will be used in this review as a basis to categorize the technologies. It is a classification format in which specific advanced technologies are defined.
Terms as ‘advanced medical technology’ (from now on abbreviated as AMT) will be used consistently as syno-nyms for ‘complex medical technology’ and ‘high-tech medical technology’. The term ‘technology’ will be used in the meaning of ‘device’ or ‘equipment’. The target is on technologies that are instrumental and‘hands on’ use by nurses in the care for patients. This means that infor-mation technology (IT) based technologies as domotica (automation for a home) are not part of the study. Methods
Eligibility and search strategy
The systematic review of the literature was conducted early 2016. Key concepts for the review were ‘medical technologies’ or ‘medical devices’, and ‘home settings’. The concept of ‘home settings’ is related to the terms ‘home nursing’ and ‘home care service’, of which the stem is ‘home’. Combining the key concepts provided the search string: (‘medical technology’ OR ‘medical device’). As domotica is not part of the study, the search string was extended with: AND NOT (eHealth OR telecare OR telemedicine). The exact search string is (“medical technology” OR “medical devices”) AND home
AND NOT (ehealth OR telecare OR telemedicine). Online databases MEDLINE, Scopus and Cinahl were searched electronically using the search string to obtain data.
Inclusion and exclusion criteria
Criteria for selection were defined prior to the search process. General criteria for inclusion were:
– Year of publication: 2000–2015.
– An abstract or an article (with or without abstract) has to be available, containing reference to AMT information.
– The article is published in English, German, French or Dutch/Flemish language.
– If medical technology is cited, it has to conform to the definition of ‘advanced medical technology’ [24]. – The abstract or the article has to contain empirical
material. For the purpose of this review,‘empirical material’ has been defined as: AMT which is designed for the home setting, or where the design or choices took into account the setting of the home, or where the medical technology has been tested for the home or if the medical technology is already on the market and being used in the home setting.
For further selection, inclusion criteria related to the key concepts for title and abstract were applied, such as ‘advanced medical technology’, ‘high-tech medical tech-nology’, ‘home-centred health-enabling technology’ and ‘care at home’. The classification of the RIVM (see Table 1) has been taken as a basis to categorize technologies in this review. Domotica and telemonitoring technologies scored under ‘monitoring’, such as fetal cardiotocogra-phy, and respiratory and circulatory monitoring, were left out. If the abstract or article was about electronic health records,‘smart home’, ambient intelligence, perva-sive computing, software of devices, smartphone or surgical robots, the article was also removed from selec-tion. Technologies as ‘VAD (ventricular assist device)’, ‘dental devices’ and ‘AED (automatic external defibrilla-tor)’ were not seen as part of the technical nursing process and these records were left out as well. Studies conducted in the hospital, hospice or nursing home set-tings were also excluded. An overview of all inclusion and exclusion criteria can be found in Table2.
Screening process
The search in the online databases using the search string, identified a total of 1287 references. After check-ing for duplicates, 1070 articles remained. Those articles were reviewed by a reviewer for titles and abstracts on basis of the inclusion and exclusion criteria. A double check was performed by two reviewers, who Table 1 Classification of advanced medical technologies in the
Netherlands according to the National Institute for Public Health and the Environment (RIVM) [24]
Technologies with regard to: Supporting physiological functions:
1. Respiratory support 2. Sleep apnea treatment 3. Suction devices 4. Oxygen therapy 5. Dialysis
6. Vacuum assisted wound closure 7. Decubitus treatment
8. External electrostimulation 9. Continuous passive motion 10. Skeletal traction 11. Patient lifting hoists Administration:
12. Infusion therapy 13. Insulin pump therapy 14. Parenteral nutrition 15. Enteral nutrition 16. UV therapy 17. Nebulizer Monitoring: 18. Fetal cardiotocography
Table 2 Inclusion and exclusion criteria for title and abstract and/or
Inclusion Exclusion
Title Advanced medical
technology (−ies)
Medical technology (−ies)
Medical device(s) High-tech medical
technology (−ies)
High-tech home care Home
Homecare Home health care Home-based care Home-based
technology (−ies)
Home-centered
health-enabling technology (−ies)
Care at home Care in the home AND
Inclusion criteria for abstract below eHealth Telehealth Telenursing Telemedicine Telemedical system Telehomecare Telecare Teleconsultation Ambient assisted environment iPad technology VAD (ventricular assist device)
Dental devices ECG (electrocardiogram) AED (automatic external defibrillator) Hospital Hospice Nursing home Abstract and/or article Year of publication: 2000–2015
1. Respiratory support (RIVM) Respirator Respiratory support Respiratory therapy Ventilator Ventilator-assisted Mechanical ventilation Support ventilation Invasive ventilation Non-invasive ventilation Non-invasive mechanical ventilation Continuous positive airway pressure (CPAP) Bilevel positive airway pressure (BPAP, BiPAP) Negative pressure ventilation (NVP) Mechanical in-exsufflation 2. Sleep apnea treatment (RIVM)
Sleep apnea treatment device (Positive) airway pressure device (PAP)
3. Suction devices (RIVM) Suction machine Suction apparatus Airway suction device Digital suction Mucus removal 4. Oxygen therapy (RIVM)
Oxygen therapy
Long-term oxygen cylinder Long-term oxygen ventilator Supplemental oxygen Oxygen conserver Oxygen concentrator Oxygen tank 5. Dialysis (RIVM) Haemo dialysis Hemo dialysis Peritoneal dialysis Peritoneal catheter drainage system Peritoneal automatic delivery system - If no abstract and no article available - If the title is in English, but the article is written not in English, German, French or Dutch/ Flemish. - If about medical technologies, but not about the application in the setting of the home. - If the abstract or article contains no empirical material. For the purpose
of this review,‘empirical
material’ is defined as:
• medical technology which is designed for the home setting, or • where the design or choices took into account the setting of the home, or • where the medical technology has been tested for the home and • if the medical technology is already on the market or being used in the home setting. - If the abstract or article is about:
• electronic health records • ‘smart home’ • ambient intelligence • pervasive computing • software of devices • smart phone • (surgical) robots - If not conform the definition of RIVM (2013,
page 15) of‘complex
medical technology’.
Advanced medical technology or high-tech technology in the home setting is defined as
Table 2 Inclusion and exclusion criteria for title and abstract and/or (Continued)
Inclusion Exclusion
CAPD (Continuous Ambulatory Peritoneal Dialysis)
APD (Automated Peritoneal Dialysis) Dialysis machine Sorbent dialysis 6. Vacuum assisted wound
closure (RIVM)
Negative-pressure wound therapy system VAC- therapy NPWT
Vacuum assisted wound closure
7. Decubitus treatment (RIVM) Pressure ulcer treatment Decubitus treatment Decubitus mattress Pressure relief mattress 8. External electrostimulation (RIVM) (External) electrostimulation Electrical stimulation TENS Nerve stimulation Transcutaneaous electrical stimulation to treat slow-transit constipation 9. Continuous passive motion
(RIVM)
Continuous passive motion Motion therapy
10.Skeletal traction (RIVM) (Skeletal) traction
Tension
11.Patient lifting hoists (RIVM) Patient lift
Patient hoist Transfer device 12. Infusion therapy (RIVM)
Infusion pump Infusion therapy Central venous catheter Central venous line Port a cath
PICC (perifally inserted central catheter) Intravenous medication Intravenous therapy Intravenous chemotherapy Analgesia pump
PCA-pump (patient controlled analgesia pump)
Indwelling venous catheter 13. Insulin pump therapy (RIVM)
Insulin pump therapy Insulin infusion 14. Parenteral nutrition (RIVM)
Parenteral nutrition Parenteral feeding Intravenous nutrition 15. Enteral nutrition (RIVM)
Enteral nutrition
Tube feeding / feeding tube Feeding pump
Enteral feeding
technology that is part of the technical skills in nursing and meets the following conditions: • technology that is advanced or high-tech, i.e. equipment with a plug, a switch on/off button, alarm button, pause button etc.; • technology that had been applied formerly in hospital
care (‘intramural’), but that
is applied also often in home settings nowadays; • technology that can be
categorized as‘supporting
physiological functions’,
‘administration’ or ‘monitoring’.
independently screened random samples of 20% of the articles. There was an initial agreement of 88%. In case of disagreement about the inclusion of an article, the decision was based on a joint discussion by all three re-viewers to an agreement of 100% and the resulting screening policy was applied to the rest of the abstracts. Based on the selected titles and/or abstracts, articles were retrieved or requested in full text and assessed for eligibility. Some articles were excluded from further study, for reasons of ‘full text not available’ or the article contained no empirical material. Finally, 87 studies remained which were included in the analysis (see Table3). A graphical representation of the screening process has been included in Fig. 1.
Appraisal of selected studies
To conduct the systematic literature search on the inter-national state of art concerning various aspects of the use of advanced medical technologies at home, several sources are consulted. To guarantee a scientific stand-ard, only articles were retrieved from academic data-bases. MEDLINE refers to journals for biomedical literature from around the world; Cinahl contains an index of nursing and research journals covering nursing, biomedicine, health sciences librarianship, alternative medicine, allied health and more. These databases re-lated to discipline have been supplemented with Scopus, which is considered to be the largest abstract and cit-ation database of peer-reviewed literature. Grey litera-ture, such as national and international reports on regulations and safety of medical technologies, is also used to illustrate the background of the problem state-ment and describe definitions. The Classification of ad-vanced medical technologies in the Netherlands according to the National Institute for Public Health and the Environment (RIVM) has been used as a framework
to categorise the medical technologies in the selected ar-ticles. No methodological conditions of selected studies were applied in advance and the quality criterion we applied was that of the article had to contain empirical material, as we wanted to obtain an comprehensive over-view of published studies of any design and to get insight in a variety of contents.
Results
Categorization of included articles
The characteristics of the included articles are outlined in Table3. All included articles were categorized by year of publication and the type of research, like the designs, methods and used instruments in the studies. Research features were synthesized where possible into overarch-ing categories. For example,‘systematic review’ and ‘nar-rative review’ were scored as ‘review’ and instruments as ‘semi-structured interview’ and ‘in-depth individual interview’ were both assigned to the category ‘interview’.
For each study, the medical technology or technologies on which the study was based was scored. The categorization was in accordance with the classification of AMTs (see Table1). For example, the devices‘continuous positive airway pressure (CPAP)’ and ‘negative pressure ventilation (NPV) have both been categorized as ‘respira-tory support’; and the devices ‘jejeunostomy tube’ and ‘gastronomy tube’ as ‘enteral nutrition’. With regard to the category ‘dialysis’, further subdivision was made by using ‘haemo dialysis’ and ‘peritoneal dialysis’. If in an article a medical technology was mentioned as an example, but was no subject of study, then the technology was not scored.
‘Medical diagnosis (or diagnoses)’ as mentioned in the studies, was included in the analysis only if it was related to the medical technology as the subject of study, not if it has been mentioned as an example. In some cases, an under-lying cause of diagnosis was indicated. For example,‘chronic respiratory failure due to congenital myopathy’, in itself a neurological disorder, has been scored as ‘neurological disorder’. Diseases or disorders have been classified as much as possible under the overarching name. For example ‘pneumonia’ and ‘cystic fibrosis’ are categorized under ‘respiratory failure’, and ‘gastroparesis’ and ‘Crohns disease’ under ‘gastrointestinal disorder’. The category ‘other’ contains diagnoses which occur only once, such as ‘chromosomal anomaly’, or which are not yet determined, like‘chronic diseases’ or ‘congenital abnormalities’.
In relation to the research questions, articles were classified regarding one of the following categories and, where appropriate, into subcategories:
1. User experiences
2. Training, instruction and education 3. Safety, risks, incidents and complications
Table 2 Inclusion and exclusion criteria for title and abstract and/or (Continued) Inclusion Exclusion PEG-tube (percutaneous endoscopic gastrostomy) PEGJ-tube (percutaneous endoscopic gastrostomy, jejeunum) Percutaneous gastrostomy tube Jejeunostomy tube Gastrostomy feeding 16. UV therapy (RIVM) UV therapy Ultraviolet therapy Phototherapy 17. Nebulizer (RIVM) Nebulizer 18. Fetal cardiotocography (RIVM) Electronic fetal monitoring Fetal monitoring Cardiotocography 19. Respiratory and circulatory monitoring (RIVM) Capnography Respiratory monitoring Circulatory monitoring Pulse oximeter Electrocardiography
Table 3 Characteristics of included studies Study Country of study Stud y desig n and sam ple Medi cal te chnolog ies Medi cal diagnosis Conten t Agar , J.W.M., Perkins, A., Tjipto, A., 20 12. [ 96 ] Australia Se p ar at e ly m e te re d an d se ri al ly m e as ured ind e pend ent d raw s of e ach di aly sis m achine p lus rev erse o sm o si s p ai ri ng . n = 4 (hom e dia lysis eq uipmen t com binations) Hemo dialysis N o medi cal dia gnosi s men tioned Evaluation of sola r-assisted hemo dialysis. Alsale h, F.M., Sm ith, F.J. , Thom pson, R., Al-S aleh, M.A. , Tayl or, K.M., 2014. [ 32 ] U K Cr oss-sectional fa ce-to-fa ce se mi-structu re d intervi ews ; Q ualitative and qua ntitative app roac hes for data analy sis n = 3 4 (patients, chi ldren/youn g pe ople) n = 3 8 (parents) Insuli n pump the rapy Type 1 dia betes mell itus Exami nation of the impact of switch ing from mult iple daily injec tions to insu lin pumps o n the glyc aemic control and daily lives of children/you ng pe ople and their fam ilies. Amin , R.S., Fitt on, C.M. , 2003. [ 104 ] USA Long-t erm mecha nical ventil ation; Trache osto my Chro nic respiratory failu re (CRF) as indicate d by hyp oxemia and or hypercapnia; Chro nic progressive lung disea ses; Neurom uscu lar diso rders; Con genital muscular dy strophy ; Non-p rogre ssive chroni c pare nchym al lung disea se; Con genital centr al hyp oventil ation syn drome (CCHS ); Mult iple ge netic syndrom es such as my elomen ingoce le with Arno ld Chiar i malformation, skel etal dysplasia, Möb ius syn drome, Joub ert an d Prad er-Willi syn dromes , and inborn errors of meta bolism such as pyruvate de hydroge nase compl ex de ficiency , Leigh ’s disea se, an d car nitine de ficiency , could be ass ociated with central hyp oventil ation; Bronc hopul monary dysplasia (B PD); Ches t wall dysfunc tion such as asp hyxiat ing thoracic d ystrophy , short limb dwa rfism, giant omp haloc ele; Idio pathic scolios is An overview o f indications for use of home mecha nical ventilation, diff erent method s an d mod es of mecha nical ventilation, ventilator setting s an d outcom es of long-te rm mecha nical ventilation in children.
Table 3 Characteristics of included studies (Continued) Study Country of study Stud y desig n and sam ple Medi cal te chnolog ies Medi cal diagnosis Conten t Ao, P. , Sebastians ki, M., Selva rajah, V., Gramlich, L., 2015 . [ 83 ] Canad a R e trospective char t revi ew n = 560 (pat ients ; n = 64 J-t ube; n = 496 PE G tube) Perc utaneou s end osco pic gastros tomy (PEG) tubes; Jeju nostomy tu bes (J-tube s) Eso phageal/gastric cance r; Hea d an d neck canc er; Strok e; Neurol ogic; Othe r Comparison of com plicati on rates, types, and average tube patenc y betw een jejunos tomy tu bes an d percutaneou s gas trostom y tubes in a Regi onal Home Enter al Nutriti on Support Program. Bezruc zko, N., Chen, S. P., Hill, C.D ., Chesniak, J.M., 2009. [ 45 ] USA Fu nctional Care giving (FC); Su rvey me thods guided by a car egiver cont ent matrix vali dated by cont ent and clinic al review s; Su rvey form s, questionnaire s n = 53 (mothers ) Trache osto my; Trache osto my/ ventil ator; BiPAP /CPAP No medi cal dia gnosi s men tioned Develop ment of an objec tive, linear me asure of mothers ’confid ence to care for children ass isted with medi cal techno logy in the ir home s. Bezruc zko, N., Chen, S. P., Hill, C.D ., Chesniak, J.M., 2011. [ 46 ] USA Fu nctional Care giving (FC); Su rvey form s, questionnaire s n = 53 (mo thers) Trache osto my; Trache osto my/ ventil ator; BiPAP /CPAP No medi cal dia gnosi s men tioned Develop ment of an objec tive, linear me asure of mothers ’confid ence to care for children ass isted with medi cal techno logy in the ir home s. Borto lussi, R. , Zotti, P., Conte, M., Mar son, R., Polesel, J. , Colussi, A., Piaz za, D., Tabaro , G., Spaz zapan, S., 20 15. [ 33 ] Italy Pros pective obse rvational study; Q uestionn aire; Struc tured intervi ew; Moni tori ng form (fille d in by a nurs e) n = 4 8 (patients) Perip herally insert ed centr al venou s cathe ters (P ICCs); Midline cathe ters Panc reatic canc er; Stoma ch cancer; Othe r mi scellane ous cance r; Non-n eoplastic disea ses Evaluation of dis tress and pain pe rceived by pat ients during the positio ning of a PICC or mi dline catheter, both in the home an d hospice se ttings, an d the perceived quality of life. Boste lman, R., Ryu, J.-C., Chang, T., Johnson, J., Agra wal, S. K., 20 10. [ 93 ] USA Stat ic stability te sts; Dynami c stability te sts; Me thod for aut onomous mane uvers tested in simulat ion an d exper iment s Home Lift, Positi on and Rehabi litation (HL PR) Chair No medi cal dia gnosi s men tioned Evaluation of an advanced patien t lift and trans fer device for the home . Brooks, D ., King, A., Tonack , M., Si mson , H., Gould, M., Goldste in, R., 2004. [ 29 ] Canad a Stud y desig n based on grounde d the ory; Semi -struct ured interview s n = 26 (pat ients ) Long-t erm mecha nical ventil ation Neurom uscu lar disea ses: Polio ; Amyo trophic lateral scle rosis (ALS); Cer ebral pal sy (CP); Duc henne mu scular dystro phy (DMD) ; Musc ular dystroph y (MD); Spinal cord injury (SCI ); Spinal muscul ar atrophy (SM A); Tra nsverse mye litis (TM) Ident ify user pe rspectives on the issues that impact the quality of the daily lives of ventil ator-assisted individ uals liv ing in the comm unity .
Table 3 Characteristics of included studies (Continued) Study Country of study Stud y desig n and sam ple Medi cal te chnolog ies Medi cal diagnosis Conten t Brow n, K. A., Be rtolizio, G., Leone , M., Dain, S.L., 2012. [ 100 ] Canad a R e view Noninv asive ventilation (NIV) Chro nic stable respiratory failu re; Obstru ctive slee p apne a An overview o f the indications for home NIV therapy, of the medi cal devices curre ntly available to de liver it, and a spec ific discuss ion of the managemen t conu ndrums conf ro nt ing anesth esiolo g ists. Buchm an, A.L ., Opilla, M., Kwas ny, M., Diaman tidis, T.G. , Oka moto, R. , 2014. [ 63 ] USA Re trospective eva luati on of pat ient reco rds n = 143 (pat ients ; n = 125 adu lts; n = 18 chi ldren) Home pare nteral nut rition (HPN ) Short bowe l syn drom e (SBS); Motil ity diso rders; Othe r Ident ification of risk facto rs for the devel opm ent of cathe ter-related blood stream infect ions (CRBSI ) in pat ients rece iving home pare nteral nut rition. Chat burn, R.L., 2009. [ 86 ] USA Re view Noninv asive ventilation (NIV) Chro nic obstructive pulmonary disea se (COPD) ; Ac ute cardiog enic pulmonary ed ema; Hem atologic malignancy; Bone marrow o r solid-org an trans plant; AIDS Provision of the bas is for a simple proced ure for selecting the most appro priate NIV te chnol ogy for the patie nt and the enviro nment of care. Craig, G. M., Scam bler, G., Spitz, L., 2003. [ 44 ] UK Q ualitative research study; Semi -struct ured in-depth intervi ew n = 2 2 (parents of 22 children) Gastrostomy feed ing Seve re neu ro-developme ntal disabi lities: Cer ebral pal sy; Syndrom e of chromo somal or gen etic origin; Un confirme d dia gnoses A st udy of parental perceptions of gas trostom y feeding before surge ry to exami ne the fact ors pare nts conside r whe n gastros tomy feeding is recom mende d and to ident ify the need for support . Dave nport, A., 20 15. [ 64 ] U K R e view Hemo dialysis N o medi cal dia gnosi s men tioned C o m p lic at io n s o f h em o d ia ly si s treatments due to d ialysate cont ami n at io n an d composit ion er ror s, an d h ow to recog n ize th em pro mptly to provide app ropr iate management and minimize patient h arm. dos Sant os-Fon tes, R.L., Ferre iro de Andrade , K.N., Ster r, A., Co nforto, A.B ., 2013. [ 62 ] Brazil Exp eriment al de sign Pilo t random ized doub le-blinde d clinic al trial, Pe rform tasks of the Jebsen-Tay lor Test (JTT) , Measureme nt in time, A writt en log by pat ients n = 20 (pat ients ) Repe titive pe ripheral nerve stim ulation (RPS S) Strok e A proo f-of-princ iple st udy: Home-based nerve stimulation to enhance effect s of mot or training in patien ts in the chroni c phase after stroke.
Table 3 Characteristics of included studies (Continued) Study Country of study Stud y desig n and sam ple Medi cal te chnolog ies Medi cal diagnosis Conten t Dub ois, P. , Béreng er, E., 2009. [ 95 ] France Re view Home artif icial ventil ation (HAV) Duc henne mu scular dystro phy; Ac ute anterior polio mye litis; Obe sity hypo -ventilation syn drome; Chro nic obstructive pulmonary disea se; Kyp hosco liosis; Dila tation of the bronc hi; Apne a; Neurom uscu lar evol ving; Tube rculos is; Vario us othe r An overview o f patients to be monito red at home , their etiolog y, interf aces and specific vent ilators outstan ding devel opment s and be nefits from technol ogical progr es ses. Egan, G.M., Sisk in, G.P., Weinm ann, R., Galloway, M.M., 2013 . [ 72 ] USA Mu lticenter , prospective post market st udy n = 68 (adult pat ients ) Perip herally insert ed centr al cathe ters (PIC Cs) for intravenous (IV) the rapies Ac tive infect ion; Diab etes; Canc er; Hum an immun odefici ency viru s (HIV); Cyst ic fibrosis A st udy to evaluate the safety and efficac y of a new peripherally insert ed centr al cathe ter st abilization syst em. Faratro, R. , Jeffries , J., Nesrallah, G.E., MacR ae, J.M., 2015. [ 68 ] Canad a Home hem odialysis (HD) No medi cal dia gnosi s men tioned The article out lines cannulati on opt ions for pat ients with arteriovenou s acce ss and describ es troubleshooting techni ques for pot ential compl ication s; st rategies are suggest ed to help patie nts overcom e fear of cannulat ion and add ress problems asso ciated with difficul t cannulat ion. Farringt on, K ., Gree nwood, R. , 2011. [ 87 ] UK Home ha emodi alysis End -stage kidne y failure. A n o ve rv ie w o f d ev el o p m en ts an d tr ends in tec h n o logy for home haemodialysis. Fayeme ndy, P., Sou risseau, H., Jesu s, P., Despo rt, J.C., 2014. [ 58 ] France A desc riptive pro tocol Balloo n gas trostom y feeding tubes No medi cal dia gnosi s men tioned Th e p ro p o sa l o f a d e sc ri p ti ve p ro to col of th e re q u ir e d equ ipm ent and th e d ifferent step s o f the rep lacement o f a b al lo on g as tr o st o m y feedi n g tub e. Feud tner, C., Villar eale, N.L., Morray, B. , Sharp, V., Hay s, R.M., Neff, J.M., 2005. [ 99 ] USA Re trospective coho rt study A structured hospitalization char t review n = 100 (pat ients , children) Gastrostomy an d jeje unostom y tube s; Central venou s cathe ters; Nebu lizer; Ventri culoperitone al cere brospinal fl uid shunt s; Trache otom ies Canc er; Resp iratory inf ection s; Asth ma; Gastroent eritis; App endic itis; Epileps y or seizure s Assessment o f the proportion of children d ischa rged fr o m a children ’s h ospital who ar e judged to b e technology-dependent, and d etermination o f th e m ost commo n d ev ice s and n umber o f p rescr iption medica tions at th e time o f dischar g e.
Table 3 Characteristics of included studies (Continued) Study Country of study Stud y desig n and sam ple Medi cal te chnolog ies Medi cal diagnosis Conten t Fex, A., Ek, A.-C., Söd erhamn , O., 2009. [ 25 ] Swed en Q ualitative design Des criptive phe nome nologi cal me thodolo gy; Intervi ew s n = 10 (pat ients ) Long-t erm oxyge n therapy from a ventilator; Long-t erm oxyge n therapy from a oxyge n cylinde r; Per itoneal and h aemod ia lys is Chro nically sick pat ients with respirator y o r kidney disorders Description of lived exper iences of self-c are among pe rsons usi ng advanced me dical technol ogy at home . Fex, A., Flens ner, G., Ek, A.-C ., Söd erhamn, O., 2011a. [ 26 ] Swed en Q ualitative design ; Phe nome nologi cal herm eneut ical method ; Intervi ew n = 10 (pat ients ) Long-t erm oxyge n; Venti lator: Hae modialysis; Perito neal dialy sis Chro nically ill pat ients with respirator y o r kidney disorders A study to eluc idate meanings of hea lth –illness tra nsition experienc es among adult per son s u sing ad va n ced medica lt echnology at home. Fex, A., Flens ner, G., Ek, A.-C ., Söd erhamn, O., 2011b. [ 42 ] Swed en Q ualitative study; Herm eneutic app roac h; Interp retive phe nome nology ; Intervi ew ; Gad amerian method ology n = 11 (next of kin) Long-t erm oxyge n from a cylinde r; Long-t erm oxyge n from a ventilator; Perito neal dialy sis; Hae mo dia lysis Chro nic kidney or res piratory diso rders G ain a d ee p e r u nd er st an d ing of th e m ea n ing of liv ing w ith an ad ul t fami ly memb er u si ng adva nced medical tech no log y at home. Fex, A., Flens ner, G., Ek, A.-C ., Söd erhamn, O., 2012. [ 43 ] Swed en Des criptive , comparative, cros s-sectional, quan titative de sign; Q uestionn aire; Self -care Age ncy sc ale; An tonovs ky ’s se nse of cohe rence scale n = 180 (pat ients ) Long-t erm oxyge n; Venti lator: Hae modialysis; Perito neal dialy sis No medi cal dia gnosi s men tioned R e p or t o f a st u d y o f se lf-ca re ag ency and p erceived health in a g ro up of people usin g adva nced medical tech no log y at home. François, K., Faratro, R. , d’ Gam a, C., Won g, E., Fung, S. , Chan, C.T. , 2015 . [ 69 ] Canad a Si ngle-cent er retro spective cohort study n = 84 (incide nt home hem odialysis patien ts); n = 56 (pat ients sur veyed by a bas eline home visit audit ) Home hem odialysis Diab etes mell itus; Ische mic nep hro pathy; Glo merulo nephr itis; Othe r A st udy in a univers ity hospital-base d home hemo dialysis progr am to evaluate the effective ness of a home vis it aud it tool. Fu, M. , Weick -Brady, M., Tanno, E. , 2012. [ 14 ] USA Venti lators; Oxy gen; Intravenous therapy. Invas ive glucose se nsor; Implantable car dioverter defibri llators ; Ventri cular (assi st) bypas s devices; Insuli n infusion pum ps; Piston Syringes ; Automatic implantable cardioverter defibrillators with ca rd iac resy n chroniz ation; Perito neal automatic delivery sy stem; Mec hanical walkers; Gluco se Monitors No medi cal dia gnosi s men tioned The role of the US Food and Drug Adm inistrati on (FDA) regarding me dical devic es in the hom e and how to support safe ty and safe use in the hom e enviro nmen t.
Table 3 Characteristics of included studies (Continued) Study Country of study Stud y desig n and sam ple Medi cal te chnolog ies Medi cal diagnosis Conten t Fung, C.H ., Igodan , U., Aless i, C., Mar tin, J. L., Dzierzewsk i, J. M., Josephs on, K., Kram er, B.J., 2015 . [ 49 ] USA Des criptive study; Semi -struct ured in-depth intervi ew s n = 19 (pat ients ) Positive Airway Pre ssure (PAP ) device Obstru ctive slee p apne a (OS A) Ex p lo ra tio n in d et ai lo f th e ty p es of di fficu lti es exp erie nc ed b y pati ents wit h p h ys ical/ sens o ry im pa irme nts w ho use PA P de vi ces . Gavish, L ., Barzi lay, Y ., Koren, C ., Ster n, A ., Weinrau ch, L ., Fried man, D.J ., 2015. [ 34 ] Israel Pros pective, random ised wai ting-li st-contro lled trial (RCT); Do cumen t daily Nume ric rating sc ale (NRS ) pain sco res; O swestry disabi lity index (ODI) quest ionnaires in a dia ry by part icipants n = 3 6 (patients) Conti nuous passive motion de vice Mild-to-mo derate, non-spec ific, chroni c Lowe r Back Pain (LBP ). Evaluation of the eff icacy o f a n ov el ,a ngul ar ,c o n tinuo u s passive mot ion device for self-tr ea tm en t at h o m e in p at ie n ts wi th mil d -to-moderate, non -sp ec ific ,c hro n ic lo w b ac k p ai n. Glade r, L.J., Palfrey, J.S., 2009. [ 38 ] USA Naso gastric tu bes; Gastronomy tu bes; Indw elling venou s cathe ters; Invas ive and noni nvasive mec hanical ventilation An inability to cons ume ade quate calorie s to mai ntain reaso nable nutrition al status; Short bowe l syn drom e; Malabsorptive st ates; Inflam matory bo wel dis ease: Seve re dysm otility st ates; Other less common g astroint es tinal diso rders; Pne umon ia; Chro nic respiratory failu re; Chro nic lung disea se; Neurom uscu lar disea se; Central hypo ventilation; Upp er airw ay obstruction D e sc ri p ti o no f ch ild re nw h o ar e d ependen t on technology, com m o n ind ica tion s fo r an d co mplica tio ns of ga stro no my tubes, in vasiv e and n o n in vasive mec ha nica lv en tila tion an d th e psyc ho social ef fects o f h avin g a ch ild dependen t o n te chn olo g y. Graf, J.M., Montagni no, B.A., Huec kel, R., McP herso n, M.L., 2008. [ 59 ] USA Re trospective pil ot case se ries (chart review); n = 7 0 (patients, chi ldren and adolescen ts) Trache osto mies; Positive press ure ventilation Con genital abnorm alities; Neurol ogic diagn oses; Primary lung dis ease D e sc ri p ti o no f ane d u ca ti o n al progra m and timeline for the dis charge o f child re n w ith a new tra cheo st omy and the iden ti fication of common impediments to the education and d isc h ar ge pr ocess . Gree nwald, P.W., Ru therfo rd, A.F., Gree n, R.A., Gigli o, J., 20 04. [ 78 ] USA Re trospective cas e series (chart review) n = 23 (pat ients ) Oxy gen cons ervers; Venti lators; Airway suction equip ment No medi cal dia gnosi s men tioned Durin g a widespre ad Nort h Am eri can bl acko ut ,t h e au th o rs ide n ti fied a clu ster of pat ients presenti n g to their n o rthern Ma nh att an em erge n cy de pa rt ment (ED) with complaints relat ed to m edical device failure. Th e cha ra ct er istic s of th is gr o u p are d es cribed in an effort to better u nderstand the resourc e n eeds o f thi s p opu lat ion .
Table 3 Characteristics of included studies (Continued) Study Country of study Stud y desig n and sam ple Medi cal te chnolog ies Medi cal diagnosis Conten t Gregoretti, C., Nav alesi , P., Ghannadia n, S., Carlucci, A., Pelosi , P., 2013 . [ 85 ] Italy Mec hanical ventilation Many forms of severe chron ic respirator y failure Providing useful info rmation to help and guide the choice of de vice for long-te rm me chanical ventilation in the home setting . Han, Y. J., Park, J. D., Lee, B., Choi, Y.H ., Su h, D.I., Lim , B.C., Chae , J.-H., 2015. [ 102 ] South-Korea Re trospective me dical reco rd review n = 5 7 (patients) Home me chanical ventil ation Hered itary neuro-muscu lar disea ses (NMDs): Spinal muscul ar atrophy; Con genital myopat hy; Con genital muscular dy strophy ; GSD type II (Pomp e disea se); End -stage myopat hy, unspecified Comparison of the variou s underlying neuro muscul ar disea ses an d an eva luation of home mecha nical ventilation with regard to respiratory morb idity, the proper indications and timin g for it s use, and to develo p a policy to im prove the quality of home nonin vasive vent ilation. Hanada, E., Kudou, T. , 2014. [ 94 ] Japan Medi cal de vices only menti oned as an examp le No medi cal dia gnosi s men tioned The paper describ es the current status of ens uring ele ctromagnet ic comp atibilit y betwee n medical devices and wireless co mmun ica tion s and measures aga inst ele ctr oma g net ic n o ise. Hea ton, J., Noy es, J., Sloper, P., Shah, R., 2005. [ 31 ] UK Q ualitative method s; Pu rposive sam pling strat egy Face -to-face semi struc tured intervi ew s; n = 36 (fam ilies) Venti lators; Feeding pumps; Dialys is machine s; Oxyge n therapy; Intravenous dru g therapies; Tra cheost omies ; Suction machine s Neuro-dis ability; Resp iratory dis ability ; Ren al disabi lity; Neuro-de generative dis ability ; Gastroint estinal disability; Card iac disability; Met abolic dis ability; Con genital abnorm ality disabi lity; Hae matolog ical disability Familie s’ experie nces of caring for a technol ogy-depe ndent child we re exami ned, explori ng the multiple rh ythms and routines around w h ich the families ’ lives were var iously structured. Hend rickson, E., Corrigan, M.L., 2013. [ 106 ] USA Re view Home pare nteral nut rition (HPN ) No medi cal dia gnosi s men tioned Provide nut rition support clinicians know ledge on navigating throu gh the structured req uirem ents of diagno sis driv en bil ling to receive rei mburs ement for services related to H PN, provide information on coding, provi de pract ical tips for sur viving a Medicare billing aud it, and discuss challen ges of Medicare guidelines seen in clinical practic e.
Table 3 Characteristics of included studies (Continued) Study Country of study Stud y desig n and sam ple Medi cal te chnolog ies Medi cal diagnosis Conten t Hewit t-Taylor, J. , 2004. [ 56 ] U K Des criptive study; Q uantitative survey; Init ial fact finding; Q uestionn aire n = 2 1 (staff caring for children req uiring assiste d ventil ation) Long-t erm assisted ventilation; Conti nuous Positive Airway Press ure (CPAP); Bilev el Positive Airw ay Press ure (BiPAP ). No medi cal dia gnosi s men tioned A st udy of the perceived education and trai ning needs of staff who car e for child ren w ith compl ex need s, inclu d ing ass isted ve n ti la tion, and th eir fa mi lies . Hilbe rs, E.S.M., de Vries , C.G.J.C.A., Geer tsma, R.E., 20 13. [ 75 ] The Nether-l ands Do cumen t analysi s; Q uestionn aire n = 34 (techni cal docum ents; n = 1 8 infusion pum ps; n =8 vent ilators ; n = 7 dialysis system s) Infusion pumps; Venti lators; Dialys is systems No medi cal dia gnosi s men tioned In ve st ig at io n o f th e te ch n ic al d o cu m en ta tio n o f manuf ac turers o n issues of safe us e o f their device in a ho me settin g. Jayant i, A., We arden, A.J., Morris, J. , Brenc hley, P., Abma, I., Baye r, S., Barlow, J., Mitra , S., 20 13. [ 55 ] UK Integ rated mixed metho dology; Con vergent, parallel design ; Q uantitative method s; Q ualitative study; Mu lticentre prospective obse rvational cohort study Eth nographic intervi ews; Cli nical an d biom arkers; Psychosocial q ua ntitativ e assessments; Ne uropsy chometri c tests Eco nomic evaluation; Q uestionn aire In-de pth semi -struct ured intervi ew s Grou ps/ study arms: a. patient b. or ganization c. carer d. eco nomic evaluation 3 Patient study coho rts n = 500 (pat ients ; n = 200 pre -dialysis; n = hospital ha emodi alysis; n = 100 home ha emodi alysis) Home ha emodi alysis (HHD ) Chro nic kidney disease (C KD) End st age renal disea se (ESRD) A com prehens ive and systemat ic study o f the barriers to and enab lers of successful uptake an d mainte nance of HHD acr oss multiple centr es with low, medium and high prevalence rates o f h ome H D .C are pathw ays of predialysis, incident an d p rev alent dialysis patients are also investigated under clinica l, p sychosocial an d o rg an is at iona ld o m ai n s. Kaufm an-Rivi, D ., Haz lett, A.C ., Hardy, M. A., Sm ith, J.M. , Seid , H.B., 2013. [ 70 ] USA Des criptive study; Exp loratory st udy; Semi-structur e d q uestionna ir e for in -d ep th in te rv ie w s an d se lf-administration; We b-base d survey adap ted from se mi-structured instrument Q uestionn aire: n = 2 2 (professional heal thcare provi ders) We b sur vey: n = 342 (pro fessional healthc are provi ders) Negative-p ressure wo und therapy (NPW T) syst ems No medi cal dia gnosi s men tioned O b ta in ad d iti o n al in fo rm at io n about d evic e issues that h ea lthca re pr of ession als fac e in ho mes settin g s and in extended-car e facilities, as well as cha lle n g es that caregiv ers migh t enc oun ter using th is te chnology at home.
Table 3 Characteristics of included studies (Continued) Study Country of study Stud y desig n and sam ple Medi cal te chnolog ies Medi cal diagnosis Conten t Kaufm an, D., We ick-Brady, M., 2009. [ 71 ] USA There are no technol ogies specif ically me ntioned, but referenc e is mad e to compl ex medi cal devices in general. As an example ar e mentioned, e.g. infusion pumps, intra vascular ad ministr ation sets, continuous ventilators, No medi cal dia gnosi s men tioned The launch of the Medi cal Produc t Safety Netw ork ’s (MedS un) Subne twork, HomeN et [a progr am spons ored by the U.S. Food and D rug Admini strat ion (FDA) Cente r for Devices and Rad iolog ical Hea lth (CDRH )] hop es to learn abou t and add ress patien t safety issue s as it relates to expandi ng medical d e vice usage in the home se tting . Keilt y, K., Coh en, E., Ho, M., Spald ing, K., Streml er, R. , 2015. [ 39 ] Canad a Syst ematic review ; Q ualitative analysis; Re sults presen ted as a narrat ive. n = 13 (studi es) Home me chanical ventil ation; Non-i nvasive ventilation; Insuli n pump the rapy; Home ent eral (tube) feeds; Home oxyg en; Trache osto my; Gastrostomy Bronc hopul monary Dyspl asia (BPD); Cyst ic fibrosis (C F); Inher ited me tabolic disorde rs (IMD); Neurom uscu lar (NM ) The review syst ematic ally exami nes studies rep orting on slee p out comes in family careg ivers of technol ogy depe ndent children. Khirani, S., Lo uis, B., Leroux, K., Delord, V., Fauroux, B ., Lofaso, F., 2013. [ 89 ] France Test on a lung be nch wit h diff erent circ uit conf iguration s an d with differ ent level s of unint entional leaks. n = 7 (ventilators) Volum e targ eted press ure support vent ilation (VT-PSV) No medi cal dia gnosi s men tioned Deter minatio n of the ability ofhom e ventil ators to maintain the preset mi nim al VT during uninte ntiona l leaks in a VT-PSV mod e. Kirk, S., 2010. [ 27 ] UK Grou nde d theo ry appro ach; In-de pth intervi ews (parents we re prese nt) n = 28 (childre n/young people) Gastrostomy / jejunos tomy; Intravenous drug therapies; Mec hanical ventilation; Trache osto my; Oxy gen therapy; Parent eral nutrit ion; Perito neal dialy sis No medi cal dia gnosi s men tioned The study explore s how children who nee d the support of medical technol ogy for the ir survival and we llbein g exp erience and cons truc t medi cal technol ogy and its inf luence on their ident ity and social relation ships. Kirk S, Glendinn ing C, Caller y P., 20 05. [ 47 ] UK Grou nde d theo ry techni ques; Q ualitative research method s; In-de pth intervi ews (some indi vidual, som e with bot h pare nts) n = 24 (childre n, paren ts of them) Trache osto my; Oxy gen therapy; Mec hanical ventilation; Intravenous drugs; Parent eral nutrit ion; Perito neal dialy sis; Othe rs (e.g. gas trostom y) Medi cal diagnose s men tioned in ge neral: pre -term infan ts, inf ants with cong enital im pairme nts and chi ldren with chroni c illnesse s and cance r. No medi cal dia gnoses men tioned in the study itse lf. A st udy exp loring paren ts ’ exper iences of caring for a childw ho is depe ndent on medi cal techno logy, and in particular of performing clinical proc edure s on the ir own children.
Table 3 Characteristics of included studies (Continued) Study Country of study Stud y desig n and sam ple Medi cal te chnolog ies Medi cal diagnosis Conten t Kropff, J., D e l Favero, S., Place, J., Toff anin, C., Vise ntin, R., Monaro, M., Messo ri, M., Di Palma, F., Lanzo la, G., Farret , A., Boscari, F., Galass o, S., Magn i, P. , Avogaro, A., Keith-H ynes, P. , Kovatchev, B. P., Brutto messo , D., Cobell i, C., DeVrie s, J.H., Renard, E., Magn i, L., 2015 . [ 90 ] France, Italy, the Nether-l ands Mu ltination al random ised cros sover trial (open label study) n = 3 2 (patients) Insuli n pump treat men t Type I diabete s Th e st u d y as se ss e d th e e ff e ct on glucose con tr ol with use o f an ar tifi cial pa n crea s during th e e ve nin g an d night p lus p at ient-m an aged sensor-augmented pump therapy (SAP) d u ri ng the d ay, ve rsu s 24 h u se of p ati ent-man age d SAP on ly, in fre e-liv ing condi tions. Lee, A.D. W ., Galvao , F.H.F ., Dias, M.C.G ., Cruz, M.E ., Marin, M ., Pedrol , C.N ., David , A.I ., Pecor a, R.A.A ., Waitzberg, D.L ., D'Alb uquerque, L.A.C ., 2014. [ 103 ] Brazil Pat ients were evaluated for a pe riod of 6 month s n = 128 (pat ients ) Home pare nteral nut rition therapy (HPN T) Intes tinal failure: Mese nteric throm bosis; Colon cance r; Non-h odgkin ly mpho ma; Volv ulus; Ps eudo-obstruction; Tra uma; Croh n dis ease; Gar dner ’s syn drome; Ape ndicitis; Perit onitis (+ dialis is); Provok ed abortion The article prof iles a Brazi lian single -center experie nce with 128 cases o f HTPN followe d for the las t 30 years and appraise the referral for potent ial intes tinal an d m u ltivisceral transpl antation. Leger, S.S., 20 05. [ 84 ] France Re view Mec hanical ventilation Chro nical dis eases The article aim s to exami ne the differ ent indications of a hum idific ation syst em in patien ts wit h mecha nical ventilation in the home, to review the lite rature in order to ide ntify the positive results obt ained by humidi fication and, finall y, to de scribe the most efficie nt types of hum idifier s. Lehou x, P., 20 04. [ 48 ] Canad a Q ualitative study, relie d on the tri angulat ion of three sour ces of data: 1) intervi ews with patien ts (n = 16); 2) intervi ews with carers (n = 6); 3 ) d irect obse rvati o n o f n ursing visits of a d ifferent set o f p atients (n =1 6 ). Intravenous therapy; Parent eral nutrit ion; Perito neal dialy sis; Oxy gen therapy No medi cal dia gnosi s men tioned Docume ntation, from the pa tient ’sp e rs p e ct iv e ,o fh o w the level of us er-fri endli n ess of medica l techno lo gy influe n ces its integra tion into the p ri va te and socia l liv es of patients .U nd ers tand ing what makes a techno lo gy user -fri e ndly sh o u ld help imp rov e th ed e si g no fh o m ec ar e servi ces.
Table 3 Characteristics of included studies (Continued) Study Country of study Stud y desig n and sam ple Medi cal te chnolog ies Medi cal diagnosis Conten t Lehou x, P., Ch arland, C., Richard, L., Pineau lt, R., St-Arnaud, J., 2002 . [ 5 ] Canad a Postal questionna ire n = 9 7 (local centers ) Intravenous pump the rapy; Oxy gen therapy; Perito neal dialy sis; Hae mo dia lysis; Parent eral nutrit ion; No medi cal dia gnosi s men tioned The article de scribes variou s medi cal techno logies that are used frequ ently in the home an d the respon sibility of local comm unity se rvice centers in the reg ion of Quebe c, Can ada. Lehou x, P., Sai nt-Arn aud, J., Richard, L., 2004. [ 30 ] Canad a Biog raphi cal intervi ew , intervi ew quest ionnaire; Dire ct obse rvations; Document analysis (pa tient man u al s, brochures, le af le ts ) n = 16 (pat ients ) n = 6 (caregi vers) n = 16 (hom e vis its by nurs es) n = 2 6 (documents) Intravenous therapy, Parent eral nutrit ion, Perito neal dialy sis; Oxy gen therapy Patie nts with recurring infect ions; Chro nic obstructive pulmonary disea se; Ren al failu re Determination o f h ow spec ialised me d ic al equ ip me nt by p atients at home was suppose d to be use d ve rsus ho w it w as actually used. Lemk e, M. R., Mendon ca, R. J., 2013. [ 50 ] USA Dialys is; Intravenous therapies No medi cal dia gnosi s men tioned The article de scribes se veral aspects o f accessibility of medi cal de vices for home healthc are recipie nts, especi ally lay users . Lewarski, J. S., Gay, P.C., 2007. [ 22 ] USA Home me chanical ventil ation Medi cal diagnose s only men tioned as an examp le. The article exp lains several issues in home mecha nical ventilation, such as policies an d p ra ctice sta n d ar ds ,c o sts, rei m bu rs emen t an d co ve ra ge Matsui, K., Kata oka, A., Yamam oto, A., Tanou e, K., Kuros awa, K., Shibasaki, J., Ohyam a, M., Aid a, N., 2014. [ 98 ] Japan Cli nical dat a revi ew/ char ts revi ew n = 1 0 (patients) Suction app aratus; Tube feed ing; Gastrostomy; Trache osto my; Oxy gen therapy; Ventilat or Möb ius syndrom e In ve st ig at io n o f th e o u tc o m e of pa tients with Möbius sy nd rom e ,i n clu di ng th e mort alit y rat e, rat e of neonatal intensive ca re u nit (NICU) admission, n eu rological findings, d ev elopment al problems, and medical home ca re and d evice n eeds. McGo ldrick, M., 20 10. [ 67 ] U SA Ar ticle p re sent s evidenc e b ased gu idelines and re commendations o n th e p referr ed meth o d s. Oxy gen conce ntrators, Venti lators; Conti nuous positi ve airway pressure (C PAP); Bilev el positive airw ay press ure (BiPAP ); Nasal cannulas ; Trache osto my tu bes; Trache al suct ion cath eter; Nebu lizers An immu ne-com prom ised indi vidual with a chroni c unde rlying illnes s This article pre sents eviden ced bas ed guidelines and rec ommend ation s on the preferre d metho ds for managing respiratory equipment and suppl ies comm only used by patien ts in the hom e setting and cond ucting surveillance activit iesto ultimat ely prevent respirator yinfec tions.
Table 3 Characteristics of included studies (Continued) Study Country of study Stud y desig n and sam ple Medi cal te chnolog ies Medi cal diagnosis Conten t Michi hata, N., Matsui, H ., Fushim i, K ., Yas unag a, H., 2015. [ 101 ] Japan Data bas e analysi s (Th e Japanes e Diag nosis Proc edure Comb ination (DP C) dat abase) n = 4729 (pat ients) Trache osto my tu be; Gastrostomy tube ; Home res pirator; Home cen tralvenous alime ntation Chro moso mal anomal y; Malig nancy; Inborn error of meta bolism (IEM) ; Con genital heart disea se (CHD); Im mune deficiency ; End ocrine disea ses; Cer ebral pal sy; Othe r cong enital anomal ies; Epileps y; Othe r dis eases Ische mic heart dis eases, including angina pectoris ; Ac ute myo cardial infarc tion; Cer ebrovascular dis eases; Lung , gas tric, colon , hepati c, bre ast, uteru s, an d prostate cance r Deter minatio n of the clinical details of adult patie nts admitte d to pe diatri c wards in Jap anese acute-care hospitals. Munck, B., Fridl und, B., Mårte nsson, J., 20 11. [ 53 ] Swed en Des criptive de sign; Phe nome nographic app roach; Q ualitative study; Semi -struct ured interview n = 16 (nu rses) Th ere ar e no tec h n o log ies specifical ly m entioned in the st u dy itself, b ut reference is ma de to complex m edical devices acco rding to a definition an d ex ample s. ‘Me dical technol ogy was defin ed and conf ined to the more advanced devices that may be presen t in the home , such as vent ilators, suction d evices, o xygen and va rious ports and p u mps ’. No medi cal dia gnosi s men tioned Description of distr ict nurs es ’ conce ptions of medi cal technol ogy in palliative home care. Munck, B., Sand gren, A., Fridl und, B., Mårte nsson, J., 20 12a. [ 36 ] Swed en Exp lorative desc riptive design; Phe nome nographic app roach; Q ualitative study Semi -struct ured interview n = 15 (next-o f-kin) Pain , nutrition an d volu me pumps; Oxy gen conce ntrators; Suctions and inhalation devices; Perc utaneou s end osco pic gastrono my (PEG); Subcut aneou s vein port s. No medi cal dia gnosi s men tioned Description of next-of -kin ’s conce ptions of medi cal technol ogy in palliative home care. Munck, B., Sand gren, A., Fridl und, B., Mårte nsson, J., 20 12b. [ 52 ] Swed en Q ualitative analysis; Exp lorative desc riptive design; Phe nome nographic app roach; Intervi ew n = 15 (pat ients ) Pain pumps; Nutriti o n and volume p u mps; Intravenous infusion : Diset ronic pen for subcut aneous injecti ons; Oxy gen conce ntrators and cylinde rs; Nephros tom y cathe ters; Perc utaneou s end osco pic gastrono my; Subcut aneou s venou s port implantation. Diff erent type s of canc er; Amyo trophic lateral scle rosis (ALS); Hea rt failure; Chro nic obstructive disease. Description of the patien ts ’ ways of understanding medi cal techno logy in palliative home care.
Table 3 Characteristics of included studies (Continued) Study Country of study Stud y desig n and sam ple Medi cal te chnolog ies Medi cal diagnosis Conten t Nakayam a, T., Tanaka, S., Uemat su, M. , Kikuch i, A., Hino-F ukuyo, N., Morimot o, T., Sakamo to, O., Tsuch iya, S., Kure , S., 2014. [ 76 ] Japan Re trospective st udy; Me dical records w e re ha nd-revie wed to ident ify inpatient s Su rvey by quest ionnaire n = 2 4 (patients) Venti lator; Perito neal dialy sis; Oxy gen cond enser Neurol ogical disorde rs: Perip arturient disorde r; Mitoc hondrial dis ease; Con genital myopat hy; Epileps y; Cer ebral se quelae of acut e encep halopathy; Perize us Merz back disea se Kidne y disorde rs: Hyp oplastic kidne y; Nephro tic syndro me Othe rs: Diab etes mell itus type 1; Lon g QT syndrom e; Effect s from bon e mar row trans plantation , chroni c respirator y failure Ef fect of a b lack out in pediatric p atients w ith h ome medica ldevices d uring the 2011 eastern Japan earth quake Padde u, E.M., Gigant i, F., Pium elli, R., De Mas i, S., Filippi. L., Viggian o, M.P. , Don zelli, G., 2015 . [ 40 ] Italy Pitt sburgh Sleep Quality Index (PSQ I) questionna ire; Ep worth Sl eepin ess Scal e (ES S); Be ck Dep ression Inventory (BD I-II); Be ck Anxie ty Inve ntory (BAI ) n = 23 (pare nts of 23 chi ldren with CCHS ) n = 2 3 (parents of 23 heal thy children) Mec hanical ventilation (via na sal m ask o r tracheost omy) Con genital centr al hyp oventil ation syn drome (CCHS) The daily chal lenge s associ atedwit h caring for technol ogy-de pende nt children can place primary careg ivers unde r sign ificant stress, espe cially at night. The study investigated how this condit ion affe cts mothers an d fathe rs by produc ing poo r slee p quality , high-l evel diurn al sleepine ss, an xiety, and depre ssion. Paul, J., Otvos, T., 2006. [ 82 ] Canad a Rand omi zed cros sover study; Me asurement by oxim eter ; Q uestionn aire n = 25 (pat ients ) Oxy gen therapy Ex-smokers with severe chroni c obstructive pulmon ary disease Comparison of the performance of a new oxyge n delivery de vice, the OxyArm (OA) (Southm ed ic Inc ., Canada), with a st andard nasal cannula (NC) (Salter-Style 1600, Sal ter Labs, U SA) for bot h oxyge n delivery and patien t prefere nce in patien ts on long-te rm oxyge n therapy (LTOT ).
Table 3 Characteristics of included studies (Continued) Study Country of study Stud y desig n and sam ple Medi cal te chnolog ies Medi cal diagnosis Conten t Pou rrat, M., Neuville, S. , 2007. [ 73 ] France Su rvey; quest ionnaire n = 12 (by la w aut hor iz ed cent res) n = 6 (service providers) n = 0 (custom-made make rs) n = 0 (laboratori es) Home pare nteral nut rition No medi cal dia gnosi s men tioned For Ho me Parent eral Nutritio n (HPN), pharm acy had to deliver som e medi cal devices an d dru gs. It com es up the followi ng and taki ng care of inciden ts that ’s occurring at home with those produc ts. The artic le describ es an inven tory on vigilance ’s organization, inciden t’ smanage ment an d assessment, abo ut H P N in France . Pou rtier, J., 2013. [ 97 ] France Patien t-cont rolled analg esia pum ps. No medi cal dia gnosi s men tioned Technol ogy for im proving pain manage ment in the home ; various aspects related to analg esia pum ps. Prenton, S., Kenne y, L.P., Staplet on, C., Coope r, G., Reeves , M.L., Hel ler, B.W. , Sob uh, M., Barke r, A.T., Hea ley, J., Good , T.R., Thies , S.B., H oward, D., Williamson, T., 2014. [ 92 ] UK Feasi bility st udy Pu rposive que stionnaires Pap er dia ry n = 7 (patients) Function al electr ical stim ulation sy stem Un ilateral foot -drop of central neu rologic origin (>6mo) Inve stig ati o n o f the fea sib ili ty of u n sup e rv is ed comm unity use o f an array-b as ed au to m ate d set u p fu n cti ona l elect rical st imu lator for current foot-drop functional electr ical stim ulation (FES) users. Rajkom ar, A., Farringto n, K., Maye r, A., Wal ker, D., Blan dford, A., 2014. [ 51 ] UK Q ualitative method Eth nographic observations ; Semi -struct ured Interview s n = 1 9 (patients and their car ers) Home ha emodi alysis technol ogy No medi cal dia gnosi s men tioned An inventory of patien ts ’ and car ers ’exp erience s of interact ing with home haemo dialysis (HH D) technol ogy, in term s of user exper ience, how the design of the technol ogy sup ports safety and fits with home use, and how the broad er contex t of se rvice provi sion impacts o n pat ients ’use of the technol ogy. Rajkom ar, A., Mayer, A., Blan dford, A., 2015. [ 79 ] UK Eth nographic observations ; Semi -struct ured interview s; Distri bute d cog nition for team work me thodolo gy Home hem odialysis technol ogy (HH T) Ren al patie nts / kidne y failu re In this study, Distributed Cogni tion (Dcog) was applied to unde rstand renal patien ts ’interac tions with Home Hemo dialysis Technol ogy (HH T), as an examp le of a home me dical device.
Table 3 Characteristics of included studies (Continued) Study Country of study Stud y desig n and sam ple Medi cal te chnolog ies Medi cal diagnosis Conten t Rand , D.A., Men er, D.J., Lerner, E.B., DeRo bertis, N., 2005. [ 77 ] USA Re trospective cas e series (me dical reco rd review ) n = 8 3 (medical records) Home res piratory equip ment; Home neb ulizers ; Oxy gen devices No medi cal dia gnosi s men tioned D es cr ip tio n o f th e ex p er ie n ce of an urban, co mmercial ambulance p rov ider d uring the multist at e Aug u st 2003 ele ctrical power o ut age (EPO) an d to identify h o w such an event can af fect an emergency medica lservices (EMS) system. Scal a, R., 2004 . [ 88 ] Italy n = 2 9 (devices) Bi-le vel home ventil ators for non invasive posi tive press ure ventilation Chro nic respiratory failu re (due to neu ro-musc ular disorde rs); COP D; Seve re chest wal l de formity ; Obe sity The autho r de scribes the techni cal asp ects, the individ ual characteristi cs and the clinical app lications of the mos t comm on used bi-level vent ilators . Short, D., Norwo od, J., 2003. [ 108 ] UK Phas e 1: Su rvey (Se mi-struc tured intervi ew); Phas e 2: Cas e study analy ses (in -depth case study analyses of selecte d dis tricts) n = 98 (health auth orities) Parent eral nutrit ion; Intravenous antibiotics; Intravenous chemoth erapy ; Conti nuous ambul atory perito neal dialy sis Cyst ic fibrosis; Canc er The study addres ses questions: Why is high-t ech healthc are at home purchas ing unde rdeveloped and wh at could be done to improve it Siew ers, V., Holmø y, T., Frich, J.C., 2013. [ 54 ] Norw ay Q ualitative study; Semi -struct ured in-depth intervi ew s n = 5 (patients) Mec hanical insufflation – exsuff lation (MI-E) Amyo trophic lateral scle rosis (ALS) The study explore s patie nts ’, family car ers ’an d heal th professionals ’exper ience s with using mecha nical insufflation – exs ufflation (MI-E) in amyotro phic lateral sclerosis (A LS) in the home setting . Southe y, D ., Pu llinge r, D., Loggos, S., Kum ari, N., Leng yel, E., Morgan , I., Yiu , P., Nand i, J., Luck raz, H., 2015. [ 105 ] UK O bservational study; Data collecte d prospe ctively on the thoracic database; Data logged in a specific dat a she et n = 2 0 (patients) Portabl e digit al suction device ‘All patien ts wh o underwent a thorac ic pro cedure an d who req uired suction post operatively for a pe rsistent air le ak and a conf irmed air-space within the pleur al cav ity ’ Patients un d e rgoing thora cic surgi cal p roced ures w h o met stric t d is ch ar ge criteria were allow e d to continue their tr e atment at home w ith the d evice. They were monitor e d in a desi gna ted follow-up clinic. D at a w ere collect ed to id entify the impact of th is service in re la tion to the d ur ation o f follow -up required, b ed-day s saved, and potent ial cost/benefits.
Table 3 Characteristics of included studies (Continued) Study Country of study Stud y desig n and sam ple Medi cal te chnolog ies Medi cal diagnosis Conten t Stiegl itz, S. , George , S., Prieg nitz, C., Hagm eyer , L., Rand erath, W., 2013. [ 66 ] Germ any Cas e se ries n = 3 (patients) Invas ive and non-invas ive ventil ators COP D; Lung cancer; Chro nic ventilator failure as a cons eque nce of chroni c obstructive pulmon ary disease The article de scribes life -threat ening event s in respiratory me dicine: misco nnectio ns of invasive and non-invas ive ventilators and Interf aces Su, C.-L., Lee, C.-N. , Chen, H.-C ., Fe ng, L.-P., Lin, H.-W., Chiang , L.-L., 2014. [ 81 ] Taiwan Re trospective, cross-s ection al, obse rvational survey desig n; Q uestionn aires; Wal king test (patient self score) n = 4 2 (patients using LOG) n = 102 (pat ients usi ng O CG) Long-t erm oxyge n therapy Chro nic respiratory insu fficienc y; Chro nic obstructive pulmonary disea se (COPD) ; Rest rictive lung dis ease; Neurom uscu lar disea ses; Canc er; Inters titial lung disea ses The study compared oxyge n usage be tween patie nts from a liq uid ox ygen gro up (LOG) and an oxyge n conce ntrator group (OC G). The authors al so assessed the physiol ogic responses of patien ts wit h chronic obstructive pulmonary disease (C O PD ) to ambulator y oxy g en use at h ome. Sunwo o, B.Y. , Mulholl and, M., Rosen, I.M., Wol fe, L.F., 2014. [ 57 ] USA Home noni nvasive ventil ation technol ogy Neurom uscu lar disea se (including amyo trophic lateral sc lerosis and Duc henne mu scular dystro phy); Scoli osis; Rest rictive che st wal l dis ease; Rest rictive thorac ic disorders; COP D/seve re COP D; The overl ap syn drome or coexis ting COP D an d OSA ; Slee p-related bre athing disorde rs; Central or compl ex sleep apne a; Obe sity hypo ventilation syndrom e (OH S); Hyp oventil ation syndrom es The article provi de s a practic e manageme nt perspective for cl inicians providing home noni nvasive ventilation, inc luding coverag e, coding, and reimb ursement to optim ize clinical car e and minim ize lost revenue. Szeinbach, S.L., Pauline, J., Villa, K.F., Comme rfor d, S.R., Collins, A., Seoan e-Vazqu ez, E., 2015. [ 65 ] USA Re trospective char t revi ew Q ualitative study (the intervi ew part ) O ne-on-one interview s n = 163 (pat ients ) Home pare nteral nut rition Intes tinal obstruction; Ac ute panc reatitis; Hyp eremes is meta bolism; Regi onal enterit is; Intes tinal disorde rs, ulcerat ion; Intes tinal malabs orption; Enter ocol itis; Seps is; Stoma ch ulcerat ion wit h pe rforatio n; Ac ute intes tinal vascular insufficiency ; Intes tinal fistula; Gastropare sis; Persi stent vomi ting, pne umo nitis; Othe r gas troin testinal issue s, distu rbances; On cology -related dia gnose s Th e art ic le d e scr ib e s cat he te r complications and o u tcomes in patients w h o rece ive d ho m e par e n ter al nutritio n (HP N ) therapy.
Table 3 Characteristics of included studies (Continued) Study Country of study Stud y desig n and sam ple Medi cal te chnolog ies Medi cal diagnosis Conten t Tanno, E. , 2010. [ 74 ] USA n = 6 (hospitals) There are no technol ogies specif ically me ntioned in the study itself, but referenc e is mad e to compl ex medi cal devices as an exa mple . No medi cal dia gnosi s men tioned Because patie nts, wh o use home me dical technol ogies, are so depen dent on these devices the y bring them into hospi tals wh en the y seek treatme nt. Many hospitals have develo ped specific prot ocols, inc luding safety insp ections by clinical enginee rs, to follow whe n a home -use de vice is brought in. This article sum marizes the policies that 6 hospitals have de velope d to address this situation. Tearl, D.K., Cox, T.J., Hertzo g, J.H., 2006. [ 61 ] USA Dem ograp hic data are prospe ctively collecte d from dat abases; Su rveys cond ucted over the tele phone or via facsim ile n = 7 4 (patients) Resp iratory techno logy; Venti lator; Conti nuous positi ve airway press ure (CPAP) ; Trache osto my col lar; Negative-p ressure vent ilator (NVP) ; Bi-le vel positive airw ay press ure (BiPAP ) Resp iratory fai lure: Airw ay obstruction; Neurom uscu lar/ Spinal-cord inju ry (SCI); Bronc hopul monary dysplasia (BPD) Preparation of res piratory-technol ogy-de pende nt children for hos pital discha rge presen ts many challen ges. Adequ ate training and ed ucation of parental car egivers, discha rge plannin g, and coord ination with the durable-me dical-eq uipment an dh o m e-n u rs in gc o m p an ie s must b e complet ed. The role of a d edicated Respiratory ca re disch arge coo rdin at or ha s been evaluated in this study. Tenn ankore, K.K. , D ’Gama, C., Faratro, R. , Fung, S., Wong , E., Chan, C.T., 2014 . [ 80 ] Canad a R e trospective coho rt study (all characteristi cs col lected bas ed on iden tification in el ectron ic records and pat ient char ts) n = 202 (pat ients ) Home hem odialysis End -stage renal disea se: Diab etes; Glo merulo nephr itis; Polyc ystic kidne y disea se The study describ es adverse techni cal eve nts in a large coh o rt of ho m e hemodia lysis patients . Thom son, R., Martin, J.L., Sharples, S., 2013. [ 28 ] UK Q ualitative study; In-de pth semi -struct ured intervi ew n = 12 (pat ients ) Transcutaneous el ectrical nerve stim ulation d e vice; Oxy gen conce ntrator; Conti nuous ambul atory perito neal dialy sis; Stair -lift; Nebu lizer Diab etes The article de scribes the psyc h o so cia l impa ct of home use m edi cal d e vices o n the lives of old er p eople an d ho w the d evices are int egrated into their lives.
Table 3 Characteristics of included studies (Continued) Study Country of study Stud y desig n and sam ple Medi cal te chnolog ies Medi cal diagnosis Conten t Toly, V.B. , Musil, C.M. , Carl , J.C., 2012. [ 37 ] USA Des criptive , correlational, dross-s ectional study; St ruct ure d interview, face-to-face, u si n g the D e m o g ra p hi c C h ar act e ri stics Q u e sti o n n ai re , the Functional Stat u s II– Revise d Scale, the C en te r for Ep ide m iological St udies –Depre ssion Scale, a Normalizati o n Scale subscale, an d the Feeth am Famil y Func tion in g Survey . n = 103 (mo thers) Mec hanical ventilation; Intravenous nutrition / medi cation; Resp iratory / nutrit ional support ; Apne a monit ors; Feeding tube ; Trache osto my tu be; Supplemen tal oxyge n Neurom uscu lar; Resp iratory cond ition s; Gastroint estinal cond itions; Card iac condit ions; Cyst ic fybrosis ; Met abolic dis orders; Ren al diso rders The study describ es various issues related to family functioni ng and nor malizat ion in mot hers of chi ldren depe ndent on medi cal technol ogy followi ng initiation of home care. Toly, V.B. , Musil, C.M. , Zaus zniewski, J. A., 20 14. [ 41 ] USA Lo ngitudinal random ized cont rolled pilot trial; Struc tured intervi ews; Semi -struct ured exit Intervi ews n = 22 (mo thers) Mec hanical ventilation; Intravenous nutrition / medication; Resp iratory / nutrit ional suppo rt. Resp ondent s recru ited from pulmon ology and gas troentero logy clinics The purpose of the study was to de term ine the feas ibility, accept ability, and eff icacy ofresou rcefulness trai ning (RT), a cog nitive –be havioral interven tion, among mot hers of tech no lo gy-dependent ch ildren. Wang , K.-W.K., Barnard, A., 2004. [ 35 ] Australia Em pirical review Mec hanical ventilation; Trache osto my; Oxy gen therapy; Enter al nut rition; Parent eral nutrit ion; Intravenous drug therapies; Perito neal dialy sis; Hae modialysis; Suction devic es No medi cal dia gnoses menti oned, only as an examp le. The paper provides a compre hensive lite rature revi ew on caring for technol ogy -depe ndent children living at home to gain an understand ing of the devel opm ent of paediatric home car e, and it s impact on technol ogy-dependent children and their fam ilie s, an d socia l im p licati o n s. Weil er-Ravell , D., 2002. [ 107 ] Israel Resp iratory sup port, ventil ators Neurom uscu lar respirator y failure Chro nic obstructive pulmonary disea se The article de scribes the quan dary of home -care respiratory manage ment. Wong , J., Eakin, J., Migram , P., Cafazzo, J.A., Hali fax, N.V. D., Chan, C.T., 2009 . [ 60 ] Canad a Q ualitative study; Semi -struct ured interview s; Foc usgroup n = 23 (pat ients ; 15 intervi ews; 8 focus group) Home hem odialysis End st age renal disea se (ESRD). The study explore s patie nt training exper iences with learning a com plex medical device for the selfadministr ation of noctur n al hemodia lysis at ho m e . Yik, Y.I., Ismail, K.A., Hutson, J.M., Southw ell, B. R., 2012. [ 91 ] Australia Pros pective st udy; Bowe l dia ries; Q uestionn aires; Colon ic transit studies n = 32 (pat ients ) Transcutaneous el ectrical stim ulation Slo w-transi t cons tipation (STC) The article de scribes the te st of the effect iven ess of home transcutaneou s electr ical stimulation (TE S) whe n patien ts wit h slow-transit consti pation (STC) we re trained by a naive clinician.
