How Smart are Smart Materials? A Conceptual and Ethical Analysis of Smart Lifelike Materials for the Design of Regenerative Valve Implants

It may soon become possible not just to replace, but to re-grow healthy tissues after injury or disease, because of innovations in the field of Regenerative Medicine. One particularly promising innovation is a regenerative valve implant to treat people with heart valve disease. These implants are fabricated from so-called 'smart', 'lifelike' materials. Implanted inside a heart, these implants stimulate re-growth of a healthy, living heart valve. While the technological development advances, the ethical implications of this new technology are still unclear and a clear conceptual understanding of the notions 'smart' and 'lifelike' is currently lacking. In this paper, we explore the conceptual and ethical implications of the development of smart lifelike materials for the design of regenerative implants, by analysing heart valve implants as a showcase. In our conceptual analysis, we show that the materials are considered 'smart' because they can communicate with human tissues, and 'lifelike' because they are structurally similar to these tissues. This shows that regenerative valve implants become intimately integrated in the living tissues of the human body. As such, they manifest the ontological entanglement of body and technology. In our ethical analysis, we argue this is ethically significant in at least two ways: It exacerbates the irreversibility of the implantation procedure, and it might affect the embodied experience of the implant recipient. With our conceptual and ethical analysis, we aim to contribute to responsible development of smart lifelike materials and regenerative implants.

Experiences of frail older cardiac patients with a nurse-coordinated transitional care intervention - a qualitative study

BACKGROUND

Older cardiac patients are at high risk of readmission and mortality. Transitional care interventions (TCIs) might contribute to the prevention of adverse outcomes. The Cardiac Care Bridge program was a randomized nurse-coordinated TCI combining case management, disease management and home-based rehabilitation for hospitalized frail older cardiac patients. This qualitative study explored the experiences of patients' participating in this study, as part of a larger process evaluation as this might support interpretation of the neutral study outcomes. In addition, understanding these experiences could contribute to the design and application of future transitional care interventions for frail older cardiac patients.

METHODS

A generic qualitative approach was used. Semi-structured interviews were performed with 16 patients ≥70 years who participated in the intervention group. Participants were selected by gender, diagnosis, living arrangement and hospital of inclusion. Data were analysed using thematic analysis. In addition, quantitative data about intervention delivery were analysed.

RESULTS

Three themes emerged from the data: 1) appreciation of care continuity; 2) varying experiences with recovery and, 3) the influence of an existing care network. Participants felt supported by the transitional care intervention as they experienced post-discharge support and continuity of care. The perceived contribution of the program in participants' recovery varied. Some participants reported physical improvements while others felt impeded by comorbidities or frailty. The home visits by the community nurse were appreciated, although some participants did not recognize the added value. Participants with an existing healthcare provider network preferred to consult these providers instead of the providers who were involved in the transitional care intervention.

CONCLUSION

Our results contribute to an explanation of the neutral study of a nurse-coordinated transitional care intervention. For future purpose, it is important to identify which patients might benefit most from TCIs. Furthermore, the intensity and content of TCIs could be more personalized by tailoring interventions to older cardiac patients' needs, considering their frailty, self-management skills and existing formal and informal caregiver networks.

The experiences of cardiac surgery critical care clinicians with in-bed cycling in adult patients undergoing complex cardiac surgery

PURPOSE

In-bed cycling is a novel modality that permits the early initiation of rehabilitation in the intensive care unit. We explored clinicians' experiences and perceptions of in-bed cycling with critically ill cardiac surgery patients.

MATERIALS AND METHODS

We used an interpretive description methodology. All critical care clinicians who had been present for at least 2 cycling sessions were eligible. Data were collected using semi-structured, audio-recorded, face-to-face interviews transcribed verbatim. Content analysis was used to identify themes.

RESULTS

Nine clinicians were interviewed. Our sample was predominantly female (77.8%) with a median [IQR] age of 40 [21.5] years. Critical care experience ranged from <5 years to ≥30 years. Acceptability was influenced by previous cycling experiences, identifying the "ideal" patient, and the timing of cycling within a patient's recovery. Facilitators included striving towards a common goal and feeling confident in the method. Barriers included inadequate staffing, bike size, and the time to deliver cycling.

CONCLUSIONS

Clinicians supported the use of in-bed cycling. Concerns included appropriate patient selection and timing of the intervention. Teamwork was integral to successful cycling. Strategies to overcome the identified barriers may assist with successful cycling implementation in other critical care environments.IMPLICATIONS FOR REHABILITATIONIn-bed cycling is a relatively novel rehabilitation modality that can help initiate physical rehabilitation earlier in a patient's recovery and reduce the iatrogenic effects of prolonged admissions to an intensive care unit.Clinicians found in-bed cycling to be an acceptable intervention with a population of critically ill cardiac surgery patients.Teamwork and interprofessional communication are important considerations for successful uptake of a relatively new rehabilitation modality.Identified barriers to in-bed cycling can assist with developing strategies to encourage cycling uptake in similar critical care environments.

Identifying the active ingredients of cardiac rehabilitation: A behaviour change technique and qualitative analysis

OBJECTIVES

Despite evidence that cardiac rehabilitation (CR) can be effective, the active ingredients or behaviour change techniques (BCTs) constituting effective CR remain unclear. There is also a lack of research surrounding patient and facilitator perceptions of active ingredients. This study sought to identify the active ingredients of a community-based CR programme and explore patient and facilitator perceptions of the active ingredients.

DESIGN

A multimethod design conducted in two stages, a BCT coding stage and a qualitative stage.

METHODS

The BCT coding stage involved the observation and audio recording of ten sessions from a community-based CR programme and the collection of programme materials. Data were coded using the BCT Taxonomy version 1 (Ann Behav Med, 46, 2013, 81). During the qualitative stage, six focus groups were carried out separately with patients (n = 16) and facilitators (n = 4). Qualitative data were analysed using an inductive thematic analysis.

RESULTS

The BCT coding phase identified 34 BCTs, many of which were highlighted by patients and facilitators. Patients and facilitators felt the group effort, motivation provided by facilitators, individualized care, knowledge gained, acceptance, and fear reduction enabled change. The majority of BCTs identified in the qualitative stage were also identified in the BCT coding stage, excluding a component related to self-acceptance. Facilitators felt the programme was limited by duration and inadequate psychological support.

CONCLUSIONS

The study provides a comprehensive overview of objectively coded BCTs and perceived active ingredients of CR. The findings can be used to inform future refinement and improvement of CR.

A qualitative study of patient's perceptions of two cardiac rehabilitation models

BACKGROUND

Understanding patients' perceptions about rehabilitation can guide healthcare administrators on modifications of program elements, which can ultimately improve cardiac rehabilitation (CR) use, adherence of heart-health behaviors, and improvements in clinical outcomes.

OBJECTIVE

To examine the perception of patients about their participation in CR.

METHODS

Qualitative study using semi-structured interviews, performed in a public CR center in Brazil. Twenty-eight patients were interviewed 2-years following participation in two CR models: exercise-based and comprehensive CR.

RESULTS

Themes identified included: knowledge acquisition, improvement in functionality, and psychosocial well-being. It appeared that the perceived benefits of CR participation were overall positive and similar between the two models; however, those in the comprehensive CR identified additional subthemes: self-care need and knowledge transfer.

CONCLUSIONS

This study suggested that patients from two different CR models perceived in the long term that the CR participation positively impacted their disease-related knowledge, promoted functional gains, and improved psychosocial well-being. Structured educational interventions seemed to be associated with improved participants' perception about CR, which could contribute to long-term maintenance of heart-health behavior and better outcomes.

Patients' experiences of the complex trust-building process within digital cardiac rehabilitation

The development of digital solutions is becoming increasingly important in facing global challenges. Therefore, research on this topic is important in taking into account cardiac patients’ experiences of the rehabilitation process for the design of digital counseling solutions. The aim of the present qualitative study was to explore the different meanings that patients give to the rehabilitation process using a Glaserian grounded theory (GT) approach. Qualitative interviews were conducted with 30 participants from a rehabilitation center in Finland. The findings indicated a “complex trust-building process” core category comprising five categories of trust-building in rehabilitation: feeling that one has hit rock bottom, facing and coping in a crosscurrent, understanding together as a peer group, moving toward a healthier lifestyle with technology, and finding self-awareness. The complex process of trust-building involved interactions among emotion, cognition, and acceptance and support processes. Therefore, digital rehabilitation should be incorporated into counseling based on patients’ psychosocial, physical and emotional needs to help patients become aware of their own feelings and thoughts during the rehabilitation process.

The Process of Patient Engagement in Outpatient Cardiac Rehabilitation Programs

The primary aim of this study was to test the causal structure of the model of therapeutic engagement (MTE) for the first time, to examine whether the model assists in understanding the process of patient engagement in cardiac rehabilitation (CR) programs. This study used a prospective design, following up patients from the Gold Coast University Hospital Cardiology ward who attended Robina Cardiac Rehabilitation Clinic. A structural equation model of the interactions among the proposed variables within the three stages of the MTE (intention to engage in CR programs, CR initiation, and sustained engagement) revealed significant relationships among these variables in a dataset of 101 patients who attended a CR program. However, no relationship was discerned between outcome expectancies and patient intention to engage in CR. Patients’ willingness to consider the treatment also mediated the relationship between perceived self-efficacy and patient intention to engage in CR. These findings help clarify the process proposed by Lequerica and Kortte (2010) in the context of patient engagement in CR programs. The findings also reveal information on how patients engage in CR programs. Importantly, this provides new information for healthcare providers, enabling them to more effectively engage patients according to their stage of engagement.