The use of advanced medical technologies at home: a ... · Methods: The study focused on advanced...

ten Haken et al. BMC Public Health (2018) 18:284 https://doi.org/10.1186/s12889-018-5123-4

RESEARCH ARTICLE Open Access

The use of advanced medical technologiesat home: a systematic review of theliterature
Ingrid ten Haken1*, Somaya Ben Allouch1 and Wim H. van Harten2,3
Abstract

Background: The number of medical technologies used in home settings has increased substantially over the last10–15 years. In order to manage their use and to guarantee quality and safety, data on usage trends and practicalexperiences are important. This paper presents a literature review on types, trends and experiences with the use ofadvanced 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 ofliterature was performed by searching the databases MEDLINE, Scopus and Cinahl. We included papers from 2000to 2015 and selected articles containing empirical material.

Results: The review identified 87 relevant articles, 62% was published in the period 2011–2015. Of the includedstudies, 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 withadvanced 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 alreadyknown on topics, such as user experiences; safety, risks, incidents and complications; and design and technologicaldevelopment. We also identified a lack of research exploring the views of nurses with regard to medical technologies forhomecare, such as user experiences of nurses with different technologies, training, instruction and education of nursesand 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

BackgroundAs a result of demographic changes and the rapidly in-creasing number of older patients, there is a need for costsavings and health reforms, which include an increasedmove 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 intohome settings was considerable and it is expected thatthere will be a further increase in the near future [1–7].

* Correspondence: [email protected] University of Applied Sciences, Research Group Technology, Health &Care (TH&C), P.O. Box 70.000, 7500 KB Enschede, The NetherlandsFull list of author information is available at the end of the article

© The Author(s). 2018 Open Access This articInternational License (http://creativecommonsreproduction in any medium, provided you gthe Creative Commons license, and indicate if(http://creativecommons.org/publicdomain/ze

When ‘an increase’ in the number of medical tech-nologies used at home is mentioned, it is not clear whichand how many technologies are involved. Today, thereare an estimated 500,000 different kinds and types ofmedical devices available on the world market [8, 9].The European Commission (EC) publishes data regard-ing legislation and regulations for medical devices, butthe actual figures for medical technologies in outpatientpractice are not available [10]. The U.S. National Centerfor Health Statistics (NCHS) stated that technologieshave shifted from hospitals into the home, but it toodoes not illustrate its findings with statistics [11]. Wesearched for data with regard to the actual number of

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medical technologies used in home settings and itproved difficult to find any systematic data sets availablethroughout the international landscape.An important condition for the application of medical

technology in the home setting is that quality of careand patient safety must be guaranteed [6]. From a his-torical perspective medical technologies were designedfor hospital settings [12, 13]. This means that specificfactors regarding the implementation and use at homenow 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 andin home settings [1, 6, 12]. For example, a major riskfactor is the number of users and handovers in the chainof care. In home settings, a sometimes impressive num-ber of different users of medical technology, often withvarious levels of training, instruction or education, areinvolved. Although patient empowerment moves controlto the patient and/or relatives, an important user groupis that of professional nurses. Understanding user expe-riences and information about adverse events and nearincidents are important aspects for developing know-ledge regarding implementation and use in home caresetting. Sharing this knowledge can support patients andcaregivers, and especially nurses in their professionalwork 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 canbe distinguished. Additional research questions arewhether there are any scientific data regarding particularuser experiences; training, instruction and education;safety and risks, and finally, what can be concludedabout the role of nurses in using medical technologies inthe home environment. The objective of this papertherefore is to present a systematic literature search onthe international state of art concerning various aspectsof the use of advanced medical technologies at home.

DefinitionsFirst, we want to clarify some definitions. In general,‘health technology’ refers to the application of organizedknowledge and skills in the form of devices, medicines,vaccines, procedures and systems developed to solve ahealth problem and improve quality of life [17]. TheWorld Health Organization [8] uses the definition of‘medical device’ as ‘An article, instrument, apparatus ormachine that is used in the prevention, diagnosis ortreatment of illness or disease, or for detecting, measur-ing, restoring, correcting or modifying the structure orfunction 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 environmentoutside of a professional healthcare facility. This includesdevices intended for use in both professional healthcarefacilities and homes’ [18].The landscape of medical devices is diverse with tech-

nologies varying from relatively simple to very complexdevices. Wagner et al. [19] stated that ‘high-techdependency’ (for children) matches with ‘technology-de-pendency’ if it concerns ‘a medical device to compensatefor the loss of a vital bodily function and substantial andongoing 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 toless frequent treatment and intermittent nursing care’[20]. Although patients dependent of advanced medicaltechnologies at home are often medically stable, theysometimes have high technical needs and may beexpected to need long-term recovery. They also requireskilled 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 arecomplex, provide critical patient data, or that directlyimplement pharmacologic or life-support processeswhereby inadvertent misuse or use error could present aknown probability of patient harm’ [23]. Examples of ad-vanced medical technologies used at home include venti-lators for respiratory support, systems for haemo- orperitoneal dialysis and infusion pumps to provide nutri-tion or medication.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 ispart of the technical skills in nursing and meets thefollowing conditions:

� technology that is advanced or high-tech, for exampleequipment with a plug, an on/off switch, an alarmbutton and a pause button;

� technology that had been applied formerly only inhospital care, but that is now also often applied inhome settings;

� technology that can be categorized as ‘supportingphysiological functions’, ‘administration’ or‘monitoring’.

Within the Dutch classification of advanced medicaltechnologies 19 different devices are identified (seeTable 1), which will be used in this review as a basis tocategorize the technologies. It is a classification formatin which specific advanced technologies are defined.

Table 1 Classification of advanced medical technologies in theNetherlands according to the National Institute for Public Healthand 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

19. Respiratory and circulatory monitoring


Terms as ‘advanced medical technology’ (from now onabbreviated as AMT) will be used consistently as syno-nyms for ‘complex medical technology’ and ‘high-techmedical technology’. The term ‘technology’ will be usedin the meaning of ‘device’ or ‘equipment’. The target ison technologies that are instrumental and ‘hands on’ useby 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.

MethodsEligibility and search strategyThe systematic review of the literature was conductedearly 2016. Key concepts for the review were ‘medicaltechnologies’ or ‘medical devices’, and ‘home settings’.The concept of ‘home settings’ is related to the terms‘home nursing’ and ‘home care service’, of which thestem is ‘home’. Combining the key concepts providedthe search string: (‘medical technology’ OR ‘medicaldevice’). As domotica is not part of the study, the searchstring was extended with: AND NOT (eHealth ORtelecare 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 weresearched electronically using the search string toobtain data.

Inclusion and exclusion criteriaCriteria for selection were defined prior to the searchprocess. 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 AMTinformation.

– The article is published in English, German, Frenchor Dutch/Flemish language.

– If medical technology is cited, it has to conform tothe definition of ‘advanced medical technology’ [24].

– The abstract or the article has to contain empiricalmaterial. For the purpose of this review, ‘empiricalmaterial’ has been defined as: AMT which is designedfor the home setting, or where the design or choicestook into account the setting of the home, or wherethe medical technology has been tested for the homeor if the medical technology is already on the marketand being used in the home setting.

For further selection, inclusion criteria related to thekey 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 Table1) has been taken as a basis to categorize technologies inthis review. Domotica and telemonitoring technologiesscored under ‘monitoring’, such as fetal cardiotocogra-phy, and respiratory and circulatory monitoring, wereleft out. If the abstract or article was about electronichealth records, ‘smart home’, ambient intelligence, perva-sive computing, software of devices, smartphone orsurgical 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 nursingprocess and these records were left out as well. Studiesconducted in the hospital, hospice or nursing home set-tings were also excluded. An overview of all inclusionand exclusion criteria can be found in Table 2.

Screening processThe search in the online databases using the searchstring, identified a total of 1287 references. After check-ing for duplicates, 1070 articles remained. Those articleswere reviewed by a reviewer for titles and abstracts onbasis of the inclusion and exclusion criteria. A doublecheck was performed by two reviewers, who

Table 2 Inclusion and exclusion criteria for title and abstractand/or

Inclusion Exclusion

Title Advanced medicaltechnology (−ies)Medical technology (−ies)Medical device(s)High-tech medicaltechnology (−ies)High-tech home careHomeHomecareHome health careHome-based careHome-basedtechnology (−ies)Home-centered health-enabling technology (−ies)Care at homeCare in the homeANDInclusion criteria for abstractbelow

eHealthTelehealthTelenursingTelemedicineTelemedical systemTelehomecareTelecareTeleconsultationAmbient assistedenvironmentiPad technologyVAD (ventricular assistdevice)Dental devicesECG (electrocardiogram)AED (automatic externaldefibrillator)HospitalHospiceNursing home

Abstractand/orarticle

Year of publication: 2000–20151. Respiratory support (RIVM)

RespiratorRespiratory supportRespiratory therapyVentilatorVentilator-assistedMechanical ventilationSupport ventilationInvasive ventilationNon-invasive ventilationNon-invasive mechanicalventilationContinuous positiveairway pressure (CPAP)Bilevel positive airwaypressure (BPAP, BiPAP)Negative pressureventilation (NVP)Mechanical in-exsufflation

2. Sleep apnea treatment (RIVM)Sleep apnea treatment device(Positive) airway pressuredevice (PAP)

3. Suction devices (RIVM)Suction machineSuction apparatusAirway suction deviceDigital suctionMucus removal

4. Oxygen therapy (RIVM)Oxygen therapyLong-term oxygen cylinderLong-term oxygen ventilatorSupplemental oxygenOxygen conserverOxygen concentratorOxygen tank

5. Dialysis (RIVM)Haemo dialysisHemo dialysisPeritoneal dialysisPeritoneal catheterdrainage systemPeritoneal automaticdelivery system

- If no abstract and noarticle available- If the title is in English,but the article is writtennot in English, German,French or Dutch/ Flemish.- If about medicaltechnologies, but notabout the application inthe setting of the home.- If the abstract or articlecontains no empiricalmaterial. For the purposeof this review, ‘empiricalmaterial’ is defined as:• medical technologywhich is designed forthe home setting, or• where the design orchoices took intoaccount the setting ofthe home, or• where the medicaltechnology has beentested for the home and• if the medicaltechnology is already onthe market or being usedin the home setting.- If the abstract or articleis about:• electronic health records• ‘smart home’• ambient intelligence• pervasive computing• software of devices• smart phone• (surgical) robots- If not conform thedefinition of RIVM (2013,page 15) of ‘complexmedical technology’.Advanced medicaltechnology or high-techtechnology in the homesetting is defined as

Table 2 Inclusion and exclusion criteria for title and abstractand/or (Continued)

Inclusion Exclusion

CAPD (Continuous AmbulatoryPeritoneal Dialysis)APD (AutomatedPeritoneal Dialysis)Dialysis machineSorbent dialysis

6. Vacuum assisted woundclosure (RIVM)Negative-pressure woundtherapy systemVAC- therapyNPWTVacuum assisted woundclosure

7. Decubitus treatment (RIVM)Pressure ulcer treatmentDecubitus treatmentDecubitus mattressPressure relief mattress

8. External electrostimulation(RIVM)(External) electrostimulationElectrical stimulationTENSNerve stimulationTranscutaneaous electricalstimulation to treatslow-transit constipation

9. Continuous passive motion(RIVM)Continuous passive motionMotion therapy

10.Skeletal traction (RIVM)(Skeletal) tractionTension

11.Patient lifting hoists (RIVM)Patient liftPatient hoistTransfer device

12. Infusion therapy (RIVM)Infusion pumpInfusion therapyCentral venous catheterCentral venous linePort a cathPICC (perifally insertedcentral catheter)Intravenous medicationIntravenous therapyIntravenous chemotherapyAnalgesia pumpPCA-pump (patient controlledanalgesia pump)Indwelling venous catheter

13. Insulin pump therapy (RIVM)Insulin pump therapyInsulin infusion

14. Parenteral nutrition (RIVM)Parenteral nutritionParenteral feedingIntravenous nutrition

15. Enteral nutrition (RIVM)Enteral nutritionTube feeding / feeding tubeFeeding pumpEnteral feeding

technology that is part ofthe technical skills innursing and meets thefollowing conditions:• technology that isadvanced or high-tech, i.e.equipment with a plug, aswitch on/off button, alarmbutton, pause button etc.;• technology that had beenapplied formerly in hospitalcare (‘intramural’), but thatis applied also often inhome settings nowadays;• technology that can becategorized as ‘supportingphysiological functions’,‘administration’ or‘monitoring’.


Table 2 Inclusion and exclusion criteria for title and abstractand/or (Continued)

Inclusion Exclusion

PEG-tube (percutaneousendoscopic gastrostomy)PEGJ-tube (percutaneousendoscopic gastrostomy,jejeunum)Percutaneous gastrostomytubeJejeunostomy tubeGastrostomy feeding

16. UV therapy (RIVM)UV therapyUltraviolet therapyPhototherapy

17. Nebulizer (RIVM)Nebulizer

18. Fetal cardiotocography(RIVM)Electronic fetalmonitoringFetal monitoringCardiotocography

19. Respiratory andcirculatory monitoring(RIVM)CapnographyRespiratory monitoringCirculatory monitoringPulse oximeterElectrocardiography


independently screened random samples of 20% of thearticles. There was an initial agreement of 88%. In caseof disagreement about the inclusion of an article, thedecision was based on a joint discussion by all three re-viewers to an agreement of 100% and the resultingscreening policy was applied to the rest of the abstracts.Based on the selected titles and/or abstracts, articleswere retrieved or requested in full text and assessed foreligibility. Some articles were excluded from furtherstudy, for reasons of ‘full text not available’ or the articlecontained no empirical material. Finally, 87 studiesremained which were included in the analysis (see Table 3).A graphical representation of the screening processhas been included in Fig. 1.

Appraisal of selected studiesTo conduct the systematic literature search on the inter-national state of art concerning various aspects of theuse of advanced medical technologies at home, severalsources are consulted. To guarantee a scientific stand-ard, only articles were retrieved from academic data-bases. MEDLINE refers to journals for biomedicalliterature from around the world; Cinahl contains anindex of nursing and research journals covering nursing,biomedicine, health sciences librarianship, alternativemedicine, 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 onregulations and safety of medical technologies, is alsoused to illustrate the background of the problem state-ment and describe definitions. The Classification of ad-vanced medical technologies in the Netherlandsaccording to the National Institute for Public Health andthe Environment (RIVM) has been used as a framework

to categorise the medical technologies in the selected ar-ticles. No methodological conditions of selected studieswere applied in advance and the quality criterion weapplied was that of the article had to contain empiricalmaterial, as we wanted to obtain an comprehensive over-view of published studies of any design and to get insightin a variety of contents.

ResultsCategorization of included articlesThe characteristics of the included articles are outlinedin Table 3. All included articles were categorized by yearof publication and the type of research, like the designs,methods and used instruments in the studies. Researchfeatures 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 individualinterview’ were both assigned to the category ‘interview’.For each study, the medical technology or technologies

on which the study was based was scored. Thecategorization was in accordance with the classification ofAMTs (see Table 1). For example, the devices ‘continuouspositive airway pressure (CPAP)’ and ‘negative pressureventilation (NPV) have both been categorized as ‘respira-tory support’; and the devices ‘jejeunostomy tube’ and‘gastronomy tube’ as ‘enteral nutrition’. With regard to thecategory ‘dialysis’, further subdivision was made by using‘haemo dialysis’ and ‘peritoneal dialysis’. If in an article amedical technology was mentioned as an example, but wasno 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 tothe medical technology as the subject of study, not if it hasbeen mentioned as an example. In some cases, an under-lying cause of diagnosis was indicated. For example, ‘chronicrespiratory failure due to congenital myopathy’, in itself aneurological disorder, has been scored as ‘neurologicaldisorder’. Diseases or disorders have been classified asmuch as possible under the overarching name. For example‘pneumonia’ and ‘cystic fibrosis’ are categorized under‘respiratory failure’, and ‘gastroparesis’ and ‘Crohnsdisease’ 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 experiences2. Training, instruction and education3. Safety, risks, incidents and complications

Table

3Characteristicsof

includ

edstud

ies

Stud

yCou

ntry

ofstud

yStud

yde

sign

andsample

Med

icaltechno

logies

Med

icaldiagno

sis

Con

tent

Agar,J.W

.M.,Perkins,A.,

Tjipto,A

.,2012.[96]

Australia

Separatelymetered

andserially

measuredindepend

entdraw

sof

each

dialysismachine

plus

reverse

osmosispairing

.n=4(hom

edialysiseq

uipm

ent

combinatio

ns)

Hem

odialysis

Nomed

icaldiagno

sis

men

tione

dEvaluatio

nof

solar-assisted

hemod

ialysis.

Alsaleh

,F.M.,Sm

ith,F.J.,

Thom

pson

,R.,Al-Saleh

,M.A.,

Taylor,K.M.,2014.[32]

UK

Cross-sectionalface-to-face

semi-structuredinterviews;

Qualitativeandqu

antitative

approaches

fordata

analysis

n=34

(patients,children/youn

gpe

ople)

n=38

(paren

ts)

Insulin

pumptherapy

Type

1diabetes

mellitus

Exam

inationof

theim

pact

ofsw

itching

from

multip

ledaily

injections

toinsulin

pumps

ontheglycaemic

controland

daily

lives

ofchildren/youn

gpe

opleand

theirfamilies.

Amin,R.S.,Fitton

,C.M.,

2003.[104]

USA

Long

-term

mechanical

ventilatio

n;Trache

ostomy

Chron

icrespiratory

failure

(CRF)

asindicatedby

hypo

xemia

andor

hype

rcapnia;

Chron

icprog

ressivelung

diseases;

Neuromusculardisorders;

Con

genitalm

usculardystroph

y;Non

-progressive

chronic

parenchymallung

disease;

Con

genitalcen

tral

hypo

ventilatio

nsynd

rome

(CCHS);

Multip

lege

netic

synd

romes

such

asmyelomen

ingo

cele

with

ArnoldChiarim

alform

ation,

skeletaldysplasia,Möb

ius

synd

rome,Joub

ertandPrader-W

illi

synd

romes,and

inbo

rnerrorsof

metabolism

such

aspyruvate

dehydrog

enasecomplex

deficiency,Leigh’sdisease,and

carnitine

deficiency,couldbe

associated

with

central

hypo

ventilatio

n;Bron

chop

ulmon

arydysplasia(BPD

);Che

stwalld

ysfunctio

nsuch

asasph

yxiatin

gthoracicdystroph

y,shortlim

bdw

arfism,g

iant

omph

alocele;

Idiopathicscoliosis

Anoverview

ofindicatio

nsforuseof

homemechanical

ventilatio

n,different

metho

dsandmod

esof

mechanicalven

tilation,

ventilatorsettings

and

outcom

esof

long

-term

mechanicalven

tilationin

children.


Table

3Characteristicsof

includ

edstud

ies(Con

tinued)

Stud

yCou

ntry

ofstud

yStud

yde

sign

andsample

Med

icaltechno

logies

Med

icaldiagno

sis

Con

tent

Ao,P.,Seb

astianski,M

.,Selvarajah,V.,

Gramlich,L.,2015.[83]

Canada

Retrospe

ctivechartreview

n=560(patients;n=64

J-tube

;n=496PEGtube

)

Percutaneo

usen

doscop

icgastrostom

y(PEG

)tub

es;

Jejuno

stom

ytube

s(J-tub

es)

Esop

hage

al/gastriccancer;

Headandne

ckcancer;

Stroke;

Neurologic;

Other

Com

parison

ofcomplication

rates,type

s,andaverage

tube

patencybe

tween

jejuno

stom

ytube

sand

percutaneo

usgastrostom

ytube

sin

aRegion

alHom

eEnteralN

utritionSupp

ort

Prog

ram.

Bezruczko,N.,Che

n,S.P.,

Hill,C

.D.,Che

sniak,J.M

.,2009.[45]

USA

Functio

nalC

areg

iving(FC);

Survey

metho

dsgu

ided

bya

caregiverconten

tmatrix

validated

byconten

tand

clinicalreview

s;Survey

form

s,qu

estio

nnaires

n=53

(mothe

rs)

Trache

ostomy;

Trache

ostomy/

ventilator;

BiPA

P/CPA

P

Nomed

icaldiagno

sismen

tione

dDevelop

men

tof

anob

jective,linearmeasure

ofmothe

rs’con

fiden

ceto

care

forchildrenassisted

with

med

icaltechno

logy

intheir

homes.

Bezruczko,N.,Che

n,S.P.,

Hill,C

.D.,Che

sniak,J.M

.,2011.[46]

USA

Functio

nalC

areg

iving(FC);

Survey

form

s,qu

estio

nnaires

n=53

(mothe

rs)

Trache

ostomy;

Trache

ostomy/

ventilator;

BiPA

P/CPA

P

Nomed

icaldiagno

sismen

tione

dDevelop

men

tof

anob

jective,linearmeasure

ofmothe

rs’con

fiden

ceto

care

forchildrenassisted

with

med

icaltechno

logy

intheir

homes.

Bortolussi,R.,Zo

tti,P.,

Con

te,M

.,Marson,R.,

Polesel,J.,Colussi,A

.,Piazza,D

.,Tabaro,G

.,Spazzapan,S.,2015.[33]

Italy

Prospe

ctiveob

servationalstudy;

Questionn

aire;

Structured

interview;

Mon

itorin

gform

(filledin

byanu

rse)

n=48

(patients)

Perip

herally

inserted

central

veno

uscatheters(PICCs);

Midlinecatheters

Pancreaticcancer;

Stom

achcancer;

Other

miscellane

ouscancer;

Non

-neo

plastic

diseases

Evaluatio

nof

distress

and

pain

perceivedby

patients

durin

gthepo

sitio

ning

ofa

PICCor

midlinecatheter,

both

intheho

meand

hospicesettings,and

the

perceivedqu

ality

oflife.

Bostelman,R.,Ryu,J.-C.,

Chang

,T.,John

son,J.,

Agraw

al,S.K.,2010.[93]

USA

Staticstability

tests;

Dynam

icstability

tests;

Metho

dforautono

mou

smaneuverstested

insimulation

andexpe

rimen

ts

Hom

eLift,Position

and

Rehabilitation(HLPR)

Chair

Nomed

icaldiagno

sismen

tione

dEvaluatio

nof

anadvanced

patient

liftandtransfer

device

fortheho

me.

Broo

ks,D

.,King

,A.,

Tonack,M

.,Simson,H.,

Gou

ld,M

.,Goldstein,R.,

2004.[29]

Canada

Stud

yde

sign

basedon

grou

nded

theo

ry;

Semi-structuredinterviews

n=26

(patients)

Long

-term

mechanical

ventilatio

nNeuromusculardiseases:

Polio;

Amyotrop

hiclateralsclerosis(ALS);

Cereb

ralp

alsy

(CP);

Duche

nnemusculardystroph

y(DMD);

Musculardystroph

y(M

D);

Spinalcord

injury

(SCI);

Spinalmuscularatroph

y(SMA);

Transverse

myelitis(TM)

Iden

tifyuser

perspe

ctives

ontheissues

that

impact

thequ

ality

ofthedaily

lives

ofventilator-assisted

individu

alslivingin

the

commun

ity.


Table

3Characteristicsof

includ

edstud

ies(Con

tinued)

Stud

yCou

ntry

ofstud

yStud

yde

sign

andsample

Med

icaltechno

logies

Med

icaldiagno

sis

Con

tent

Brow

n,K.A.,Bertolizio,G

.,Leon

e,M.,Dain,S.L.,

2012.[100]

Canada

Review

Non

invasive

ventilatio

n(NIV)

Chron

icstablerespiratory

failure;

Obstructivesleepapne

aAnoverview

ofthe

indicatio

nsforho

meNIV

therapy,of

themed

ical

devicescurren

tlyavailable

tode

liver

it,andaspecific

discussion

ofthe

managem

entconu

ndrums

confrontinganesthesiologists.

Buchman,A

.L.,Opilla,M

.,Kw

asny,M

.,Diamantid

is,T.G.,

Okamoto,R.,2014.[63]

USA

Retrospe

ctiveevaluatio

nof

patient

records

n=143(patients;n=125adults;

n=18

children)

Hom

eparenteralnu

trition

(HPN

)Shortbo

welsynd

rome(SBS);

Motility

disorders;

Other

Iden

tificationof

riskfactors

forthede

velopm

entof

catheter-related

bloo

dstream

infections

(CRBSI)in

patientsreceiving

homeparenteralnu

trition

.

Chatburn,R.L.,2009.[86]

USA

Review

Non

invasive

ventilatio

n(NIV)

Chron

icob

structivepu

lmon

ary

disease(COPD

);Acute

cardioge

nicpu

lmon

ary

edem

a;Hem

atolog

icmalignancy;

Bone

marrow

orsolid-organ

transplant;

AIDS

Provisionof

thebasisfora

simpleproced

urefor

selectingthemost

approp

riate

NIV

techno

logy

forthepatient

andthe

environm

entof

care.

Craig,G

.M.,Scam

bler,G

.,Spitz,L.,2003.[44]

UK

Qualitativeresearch

stud

y;Semi-structuredin-dep

thinterview

n=22

(paren

tsof

22children)

Gastrostomyfeed

ing

Severe

neuro-de

velopm

ental

disabilities:

Cereb

ralp

alsy;

Synd

romeof

chromosom

alor

gene

ticorigin;

Uncon

firmed

diagno

ses

Astud

yof

parental

percep

tions

ofgastrostom

yfeed

ingbe

fore

surgeryto

exam

inethefactorsparents

consider

whe

ngastrostom

yfeed

ingisrecommen

ded

andto

iden

tifythene

edfor

supp

ort.

Daven

port,A

.,2015.[64]

UK

Review

Hem

odialysis

Nomed

icaldiagno

sismen

tione

dCo

mplications

ofhemodialysis

treatmentsdueto

dialysate

contam

inationand

compositionerrors,and

how

torecognize

them

prom

ptly

toprovideappropriate

managem

entand

minimize

patient

harm

.

dosSantos-Fon

tes,R.L.,

Ferreiro

deAnd

rade

,K.N.,

Sterr,A.,Con

forto,A.B.,

2013.[62]

Brazil

Expe

rimen

tald

esign

Pilotrand

omized

doub

le-blinde

dclinicaltrial,

Perfo

rmtasksof

theJebsen

-Taylor

Test(JTT),Measuremen

tin

time,

Awrittenlogby

patients

n=20

(patients)

Repe

titivepe

riphe

raln

erve

stim

ulation(RPSS)

Stroke

Aproo

f-of-p

rinciplestud

y:Hom

e-basedne

rve

stim

ulationto

enhance

effectsof

motor

training

inpatientsin

thechronic

phaseafterstroke.


Table

3Characteristicsof

includ

edstud

ies(Con

tinued)

Stud

yCou

ntry

ofstud

yStud

yde

sign

andsample

Med

icaltechno

logies

Med

icaldiagno

sis

Con

tent

Dub

ois,P.,Béren

ger,E.,

2009.[95]

France

Review

Hom

eartificialven

tilation

(HAV)

Duche

nnemusculardystroph

y;Acute

anterio

rpo

liomyelitis;

Obe

sity

hypo

-ven

tilation

synd

rome;

Chron

icob

structivepu

lmon

ary

disease;

Kyph

oscoliosis;

Dilatatio

nof

thebron

chi;

Apn

ea;

Neuromuscularevolving

;Tube

rculosis;

Vario

usothe

r

Anoverview

ofpatientsto

bemon

itoredat

home,their

etiology,interfacesand

specificventilators

outstand

ingde

velopm

ents

andbe

nefitsfro

mtechno

logicalp

rogresses.

Egan,G

.M.,Siskin,G

.P.,

Weinm

ann,R.,

Galloway,M

.M.,2013.[72]

USA

Multicen

ter,prospe

ctive

postmarketstud

yn=68

(adu

ltpatients)

Perip

herally

inserted

central

catheters(PICCs)for

intraven

ous(IV)therapies

Activeinfection;

Diabe

tes;

Cancer;

Hum

anim

mun

odeficiency

virus(HIV);

Cystic

fibrosis

Astud

yto

evaluate

the

safety

andefficacyof

ane

wpe

riphe

rally

inserted

central

catheter

stabilizatio

nsystem

.

Faratro,R.,Jeffries,J.,

Nesrallah,G.E.,MacRae,J.M

.,2015.[68]

Canada

Hom

ehe

mod

ialysis(HD)

Nomed

icaldiagno

sismen

tione

dThearticleou

tline

scann

ulati

onop

tions

forpatientswith

arterio

veno

usaccess

and

describ

estrou

blesho

oting

techniqu

esforpo

tential

complications;strateg

iesare

sugg

estedto

help

patients

overcomefear

ofcann

ulationandaddress

prob

lemsassociated

with

difficultcann

ulation.

Farrington

,K.,

Green

woo

d,R.,2011.[87]

UK

Hom

ehaem

odialysis

End-stagekidn

eyfailure.

Anoverview

ofdevelopm

ents

andtrendsintechnology

for

homehaem

odialysis.

Fayemen

dy,P.,Sourisseau,H

.,Jesus,P.,D

espo

rt,J.C.,

2014.[58]

France

Ade

scrip

tiveprotocol

Balloon

gastrostom

yfeed

ingtube

sNomed

icaldiagno

sismen

tione

dTheprop

osalof

adescrip

tive

protocolof

therequ

ired

equipm

entandthedifferent

stepsof

thereplacem

entof

aballoon

gastrostom

yfeedingtube.

Feud

tner,C

.,Villareale,N.L.,

Morray,B.,Sharp,V.,Hays,R.M.,

Neff,J.M

.,2005.[99]

USA

Retrospe

ctivecoho

rtstud

yAstructured

hospitalization

chartreview

n=100(patients,children)

Gastrostomyand

jejeun

ostomytube

s;Cen

tral

veno

uscatheters;

Neb

ulizer;

Ventriculop

erito

neal

cerebrospinalfluid

shun

ts;

Trache

otom

ies

Cancer;

Respiratory

infections;

Asthm

a;Gastroe

nteritis;

App

endicitis;

Epilepsyor

seizures

Assessmento

fthe

proportion

ofchildrendischarged

from

achildren’shospitalw

hoare

judg

edto

betechnology-

dependent,anddeterm

ination

ofthemostcom

mon

devices

andnumbero

fprescription

medications

atthetim

eof

discharge.


Table

3Characteristicsof

includ

edstud

ies(Con

tinued)

Stud

yCou

ntry

ofstud

yStud

yde

sign

andsample

Med

icaltechno

logies

Med

icaldiagno

sis

Con

tent

Fex,A.,Ek,A

.-C.,Söde

rham

n,O.,

2009.[25]

Swed

enQualitativede

sign

Descriptiveph

enom

enolog

ical

metho

dology;

Interviews

n=10

(patients)

Long

-term

oxygen

therapy

from

aventilator;

Long

-term

oxygen

therapy

from

aoxygen

cylinde

r;Periton

ealand

haem

odialysis

Chron

icallysick

patientswith

respiratory

orkidn

eydisorders

Descriptio

nof

lived

expe

riences

ofself-care

amon

gpe

rson

susing

advanced

med

ical

techno

logy

atho

me.

Fex,A.,Flen

sner,G

.,Ek,A

.-C.,

Söde

rham

n,O.,2011a.[26]

Swed

enQualitativede

sign

;Ph

enom

enolog

ical

herm

eneuticalmetho

d;Interview

n=10

(patients)

Long

-term

oxygen

;Ventilator:

Haemod

ialysis;

Periton

eald

ialysis

Chron

icallyillpatientswith

respiratory

orkidn

eydisorders

Astudyto

elucidatemeanings

ofhealth–illnesstransition

experiences

amongadult

personsusingadvanced

medicaltechnology

athome.

Fex,A.,Flen

sner,G

.,Ek,A

.-C.,

Söde

rham

n,O.,2011b.

[42]

Swed

enQualitativestud

y;Hermen

eutic

approach;

Interpretiveph

enom

enolog

y;Interview;

Gadam

erianmetho

dology

n=11

(nextof

kin)

Long

-term

oxygen

from

acylinde

r;Long

-term

oxygen

from

aventilator;

Periton

eald

ialysis;

Haemodialysis

Chron

ickidn

eyor

respiratory

disorders

Gainadeeper

understand

ing

ofthemeaning

oflivingwith

anadultfam

ilymem

beru

sing

advanced

medicaltechnology

athome.

Fex,A.,Flen

sner,G

.,Ek,A

.-C.,

Söde

rham

n,O.,2012.[43]

Swed

enDescriptive,comparative,

cross-sectional,qu

antitative

design

;Questionn

aire;

Self-care

Age

ncyscale;

Anton

ovsky’ssenseof

cohe

rencescale

n=180(patients)

Long

-term

oxygen

;Ventilator:

Haemod

ialysis;

Periton

eald

ialysis

Nomed

icaldiagno

sismen

tione

dRepo

rtof

astud

yof

self-care

agency

andperceivedhealth

inagrou

pof

peop

leusing

advanced

medicaltechnology

athome.

François,K.,Faratro,R.,

d’Gam

a,C.,Won

g,E.,

Fung

,S.,Chan,C.T.,2015.[69]

Canada

Sing

le-cen

ter

retrospe

ctivecoho

rtstud

yn=84

(incide

ntho

me

hemod

ialysispatients);

n=56

(patientssurveyed

byabaselineho

mevisitaudit)

Hom

ehe

mod

ialysis

Diabe

tesmellitus;

Ischem

icne

phropathy;

Glomerulon

ephritis;

Other

Astud

yin

aun

iversity

hospital-b

ased

home

hemod

ialysisprog

ram

toevaluate

theeffectiven

ess

ofaho

mevisitaudittool.

Fu,M

.,Weick-Brady,M

.,Tann

o,E.,2012.[14]

USA

Ventilators;

Oxyge

n;Intraven

oustherapy.

Invasive

glucosesensor;

Implantablecardioverter

defib

rillators;

Ventricular

(assist)bypass

devices;

Insulin

infusion

pumps;

Piston

Syrin

ges;

Automaticimplantable

cardioverterd

efibrillators

with

cardiacresynchronization;

Periton

ealautom

atic

deliverysystem

;Mechanicalw

alkers;

Glucose

Mon

itors

Nomed

icaldiagno

sismen

tione

dTheroleof

theUSFood

and

DrugAdm

inistration(FDA)

regardingmed

icalde

vices

intheho

meandho

wto

supp

ortsafety

andsafe

use

intheho

meen

vironm

ent.


Table

3Characteristicsof

includ

edstud

ies(Con

tinued)

Stud

yCou

ntry

ofstud

yStud

yde

sign

andsample

Med

icaltechno

logies

Med

icaldiagno

sis

Con

tent

Fung

,C.H.,Igod

an,U

.,Alessi,C.,Martin

,J.L.,

Dzierzewski,J.M

.,Joseph

son,K.,

Kram

er,B.J.,2015.[49]

USA

Descriptivestud


thinterviews

n=19

(patients)

PositiveAirw

ayPressure

(PAP)

device

Obstructivesleepapne

a(OSA

)Explorationindetailofthetypes

ofdifficulties

experienced

bypatientswith

physical/sensory

impairm

entswho

usePAP

devices.

Gavish,L.,Barzilay,Y.,Koren

,C.,

Stern,A.,Weinrauch,L.,

Friedm

an,D

.J.,2015.[34]

Israel

Prospe

ctive,rand

omised

waitin

g-list-controlledtrial(RC

T);

Docum

entdaily

Num

ericratin

gscale(NRS)pain

scores;

Osw

estrydisabilityinde

x(ODI)

questio

nnairesin

adiaryby

participants

n=36

(patients)

Con

tinuo

uspassive

motionde

vice

Mild-to-mod

erate,no

n-specific,

chronicLower

Back

Pain

(LBP).

Evaluatio

nof

theefficacy

ofanovel,angular,continuous

passivemotiondevice

forself-

treatmentath

omeinpatients

with

mild-to-m

oderate,non-

specific,chroniclowback

pain.

Glade

r,L.J.,Palfrey,J.S.,

2009.[38]

USA

Nasog

astrictube

s;Gastron

omytube

s;Indw

ellingveno

uscatheters;

Invasive

andno

ninvasive

mechanicalven

tilation

Aninability

toconsum

e

adeq

uate

caloriesto

maintain

reason

ablenu

trition

alstatus;

Shortbo

welsynd

rome;

Malabsorptivestates;

Inflammatorybo

weldisease:

Severe

dysm

otility

states;

Otherlesscommon

gastrointestinal

disorders;

Pneumon

ia;

Chron

icrespiratory

failure;

Chron

iclung

disease;

Neuromusculardisease;

Cen

tralhypo

ventilatio

n;Upp

erairw

ayob

struction

Descriptionof

childrenwho

aredepend

ento

ntechno

logy,

common

indicatio

nsforand

complications

ofgastronomy

tubes,invasiveandnoninvasive

mechanicalventilationandthe

psychosocialeffectsofhaving

achild

dependento

ntechnology.

Graf,J.M

.,Mon

tagn

ino,B.A.,

Hueckel,R.,McPhe

rson

,M.L.,

2008.[59]

USA

Retrospe

ctivepilotcase

series

(chartreview

);n=70

(patients,childrenand

adolescents)

Trache

ostomies;

Positivepressure

ventilatio

nCon

genitalabn

ormalities;

Neurologicdiagno

ses;

Prim

arylung

disease

Descriptionof

aneducational

prog

ram

andtim

elineforthe

dischargeof

childrenwith

anewtracheostomyandthe

identificationof

common

impedimentsto

theeducation

anddischargeprocess.

Green

wald,

P.W.,Ru

therford,A

.F.,

Green

,R.A.,Giglio,J.,2004.[78]

USA

Retrospe

ctivecase

series

(chartreview

)n=23

(patients)

Oxyge

nconservers;

Ventilators;

Airw

aysuctioneq

uipm

ent

Nomed

icaldiagno

sismen

tione

dDuringawidespreadNorth

American

blackout,the

authors

identifiedaclustero

fpatients

presentin

gto

theirn

orthern

Manhattanem

ergency

departm

ent(ED

)with

complaints

relatedto

medicaldevice

failure.

Thecharacteristicsofthisgroup

aredescribed

inan

effortto

betterunderstandtheresource

needsofthispopulation.


http://www.scopus.com/authid/detail.uri?authorId=23004150600&eid=2-s2.0-84921438102






Table

3Characteristicsof

includ

edstud

ies(Con

tinued)

Stud

yCou

ntry

ofstud

yStud

yde

sign

andsample

Med

icaltechno

logies

Med

icaldiagno

sis

Con

tent

Grego

retti,C.,Navalesi,P.,

Ghann

adian,S.,C

arlucci,A.,

Pelosi,P.,2013.[85]

Italy

Mechanicalven

tilation

Manyform

sof

severe

chronic

respiratory

failure

Providinguseful

inform

ation

tohe

lpandgu

idethe

choice

ofde

vice

for

long

-term

mechanical

ventilatio

nin

theho

me

setting.

Han,Y.J.,Park,J.D

.,Lee,B.,

Cho

i,Y.H.,Suh,D.I.,

Lim,B.C.,

Chae,J.-H.,2015.[102]

South-Ko

rea

Retrospe

ctivemed

ical

record

review

n=57

(patients)

Hom

emechanical

ventilatio

nHered

itary

neuro-muscular

diseases

(NMDs):

Spinalmuscularatroph

y;Con

genitalm

yopathy;

Con

genitalm

usculardystroph

y;GSD

type

II(Pom

pedisease);

End-stagemyopathy,un

specified

Com

parison

ofthevario

usun

derlyingne

urom

uscular

diseases

andan

evaluatio

nof

homemechanical

ventilatio

nwith

regard

torespiratory

morbidity,the

prop

erindicatio

nsand

timingforits

use,andto

developapo

licyto

improve

thequ

ality

ofho

me

noninvasiveventilatio

n.

Hanada,E.,Kud

ou,T.,

2014.[94]

Japan

Med

icalde

viceson

lymen

tione

das

anexam

ple

Nomed

icaldiagno

sismen

tione

dThepape

rde

scrib

esthe

curren

tstatus

ofen

surin

gelectro

magnetic

compatibility

betweenmedicaldevicesand

wirelesscommunications

and

measuresagainst

electro

magnetic

noise.

Heaton,J.,Noyes,J.,Slop

er,P.,

Shah,R.,2005.[31]

UK

Qualitativemetho

ds;

Purposivesamplingstrategy

Face-to-face

semistructured

interviews;

n=36

(families)

Ventilators;

Feed

ingpu

mps;

Dialysismachine

s;Oxyge

ntherapy;Intraven

ousdrug

therapies;Trache

ostomies;

Suctionmachine

s

Neuro-disability;

Respiratory

disability;

Renald

isability;

Neuro-deg

enerativedisability;

Gastrointestin

aldisability;

Cardiac

disability;

Metabolicdisability;

Con

genitalabn

ormality

disability;

Haematolog

icaldisability

Families’experiences

ofcarin

gforatechno

logy-

depe

nden

tchild

were

exam

ined

,explorin

gthe

multiplerhythm

sandroutines

around

which

thefamilies’

lives

werevariouslystructured.

Hen

drickson

,E.,Corrig

an,

M.L.,2013.[106]

USA

Review

Hom

eparenteralnu

trition

(HPN

)Nomed

icaldiagno

sismen

tione

dProvidenu

trition

supp

ort

clinicians

know

ledg

eon

navigatin

gthroug

hthe

structured

requ

iremen

tsof

diagno

sisdriven

billing

toreceivereim

bursem

entfor

services

relatedto

HPN

,provideinform

ationon

coding

,provide

practical

tipsforsurvivingaMed

icare

billing

audit,anddiscuss

challeng

esof

Med

icare

guidelines

seen

inclinical

practice.


Table

3Characteristicsof

includ

edstud

ies(Con

tinued)

Stud

yCou

ntry

ofstud

yStud

yde

sign

andsample

Med

icaltechno

logies

Med

icaldiagno

sis

Con

tent

Hew

itt-Taylor,J.,2004.[56]

UK

Descriptivestud

y;Quantitativesurvey;

Initialfact

finding

;Questionn

aire

n=21

(staffcarin

gforchildren

requ

iring

assisted

ventilatio

n)

Long-term

assistedventilation;

Con

tinuo

usPo

sitiveAirw

ayPressure

(CPA

P);

BilevelP

ositive

Airw

ayPressure

(BiPAP).

Nomed

icaldiagno

sis

men

tione

dAstud

yof

thepe

rceived

educationandtraining

need

sof

staffwho

care

for

childrenwith

complex

needs,

includ

ingassistedventilatio

n,andtheirfam

ilies.

Hilbers,E.S.M.,

deVries,C.G.J.C.A.,

Geertsm

a,R.E.,2013.[75]

TheNethe

r-land

sDocum

entanalysis;

Questionn

aire

n=34

(techn

icaldo

cumen

ts;

n=18

infusion

pumps;n

=8

ventilators;n

=7dialysissystem

s)

Infusion

pumps;

Ventilators;

Dialysissystem

s

Nomed

icaldiagno

sismen

tione

dInvestigationofthetechnical

documentationof

manufacturerson

issuesof

safeuseoftheird

eviceina

homesetting.

Jayanti,A.,Wearden

,A.J.,

Morris,J.,Bren

chley,P.,

Abm

a,I.,Bayer,S.,

Barlo

w,J.,Mitra,S.,2013.[55]

UK

Integrated

mixed

metho

dology;

Con

vergen

t,paralleld

esign;

Quantitativemetho

ds;

Qualitativestud

y;Multicen

treprospe

ctive

observationalcoh

ortstud

yEthn

ograph

icinterviews;

Clinicalandbiom

arkers;

Psychosocialquantitativeassessments;

Neuropsycho

metric

tests

Econ

omicevaluatio

n;Questionn

aire

In-dep

thsemi-structured

interviews

Group

s/stud

yarms:

a.patient

b.organizatio

nc.carer

d.econ

omicevaluatio

n3Patient

stud

ycoho

rts

n=500(patients;n=200

pre-dialysis;n

=ho

spital

haem

odialysis;n=100ho

me

haem

odialysis)

Hom

ehaem

odialysis

(HHD)

Chron

ickidn

eydisease(CKD

)Endstagerenald

isease

(ESRD)

Acompreh

ensive

and

system

aticstud

yof

the

barriersto

anden

ablersof

successful

uptake

and

mainten

ance

ofHHDacross

multip

lecentreswith

low,

medium

andhigh

prevalence

ratesofhomeHD.Care

pathwaysofpredialysis,

incident

andprevalentd

ialysis

patientsarealso

investigated

underclinical,psychosocial

andorganisationaldom

ains.

Kaufman-Rivi,D.,Hazlett,A

.C.,

Hardy,M

.A.,Sm

ith,J.M.,

Seid,H

.B.,2013.[70]

USA

Descriptivestud

y;Exploratorystud

y;Semi-structuredqu

estio

nnaire

for

in-depth

interviewsandself-

administratio

n;Web

-based

survey

adaptedfro

msemi-structuredinstrumen

tQuestionn

aire:

n=22

(professionalh

ealth

care

providers)

Web

survey:

n=342(professionalh

ealth

care

providers)

Neg

ative-pressure

wou

ndtherapy(NPW

T)system

sNomed

icaldiagno

sismen

tione

dObtainadditionalinformation

aboutd

eviceissuesthat

healthcareprofessionalsface

inhomes

settingsandin

extended-carefacilities,as

well

aschallenges

thatcaregivers

might

encounteru

singthis

technology

athome.


Table

3Characteristicsof

includ

edstud

ies(Con

tinued)

Stud

yCou

ntry

ofstud

yStud

yde

sign

andsample

Med

icaltechno

logies

Med

icaldiagno

sis

Con

tent

Kaufman,D

.,Weick-Brady,M

.,2009.[71]

USA

Thereareno

techno

logies

specifically

men

tione

d,bu

treferenceismadeto

complex

med

icalde

vices

inge

neral.

Asan

exam

pleare

mentioned,e.g.infusion

pumps,intravascular

administrationsets,

continuous

ventilators,

Nomed

icaldiagno

sismen

tione

dThelaun

chof

theMed

ical

Prod

uctSafety

Network’s

(Med

Sun)

Subn

etwork,

Hom

eNet

[aprog

ram

spon

soredby

theU.S.Foo

dandDrugAdm

inistration

(FDA)C

enterforDevices

andRadiolog

icalHealth

(CDRH

)]ho

pesto

learn

abou

tandaddresspatient

safety

issues

asitrelatesto

expand

ingmed

icalde

vice

usagein

theho

mesetting.

Keilty,K.,C

ohen

,E.,Ho,M.,

Spalding

,K.,Stremler,R.,

2015.[39]

Canada

System

aticreview

;Qualitativeanalysis;

Results

presen

tedas

anarrative.

n=13

(studies)

Hom

emechanical

ventilatio

n;Non

-invasive

ventilatio

n;Insulin

pumptherapy;

Hom

een

teral(tube

)feeds;

Hom

eoxygen

;Trache

ostomy;

Gastrostomy

Bron

chop

ulmon

aryDysplasia

(BPD

);Cystic

fibrosis(CF);

Inhe

rited

metabolicdisorders

(IMD);

Neuromuscular(NM)

Thereview

system

atically

exam

ines

stud

iesrepo

rting

onsleepou

tcom

esin

family

caregiversof

techno

logy

depe

nden

tchildren.

Khirani,S.,Louis,B.,

Leroux,K.,Delord,

V.,

Faurou

x,B.,Lofaso,F.,

2013.[89]

France

Teston

alung

benchwith

different

circuitconfigurations

andwith

different

levelsof

unintentionalleaks.

n=7(ven

tilators)

Volumetargeted

pressure

supp

ortventilatio

n(VT-PSV)

Nomed

icaldiagno

sismen

tione

dDeterminationof

theability

ofho

meventilatorsto

maintainthepreset

minim

alVT

durin

gun

intentional

leaksin

aVT-PSV

mod

e.

Kirk,S.,2010.[27]

UK

Groun

dedtheo

ryapproach;

In-dep

thinterviews(paren

tswerepresen

t)n=28

(children/youn

gpe

ople)

Gastrostomy/

jejuno

stom

y;Intraven

ousdrug

therapies;

Mechanicalven

tilation;

Trache

ostomy;

Oxyge

ntherapy;

Parenteralnu

trition

;Periton

eald

ialysis

Nomed

icaldiagno

sismen

tione

dThestud

yexplores

how

childrenwho

need

the

supp

ortof

med

ical

techno

logy

fortheirsurvival

andwellbeing

expe

rience

andconstructmed

ical

techno

logy

andits

influen

ceon

theiriden

tityandsocial

relatio

nships.

Kirk

S,Glend

inning

C,

Callery

P.,2005.[47]

UK

Groun

dedtheo

rytechniqu

es;

Qualitativeresearch

metho

ds;

In-dep

thinterviews(som

eindividu

al,som

ewith

both

parents)

n=24

(children,parentsof

them

)

Trache

ostomy;

Oxyge

ntherapy;

Mechanicalven

tilation;

Intraven

ousdrug

s;Parenteralnu

trition

;Periton

eald

ialysis;

Others(e.g.g

astrostomy)

Med

icaldiagno

sesmen

tione

din

gene

ral:pre-term

infants,infants

with

cong

enitalimpairm

entsand

childrenwith

chronicillne

sses

and

cancer.N

omed

icaldiagno

ses

men

tione

din

thestud

yitself.

Astud

yexploringparents’

expe

riences

ofcarin

gfora

childwho

isde

pend

enton

med

icaltechno

logy,and

inparticular

ofpe

rform

ing

clinicalproced

ures

ontheir

ownchildren.


Table

3Characteristicsof

includ

edstud

ies(Con

tinued)

Stud

yCou

ntry

ofstud

yStud

yde

sign

andsample

Med

icaltechno

logies

Med

icaldiagno

sis

Con

tent

Krop

ff,J.,DelFavero,S.,

Place,J.,Toffanin,C.,

Visentin,R.,Mon

aro,M.,

Messori,M.,DiP

alma,F.,

Lanzola,G.,Farret,A

.,Bo

scari,F.,G

alasso,S.,

Magni,P.,Avogaro,A

.,Keith

-Hynes,P.,

Kovatche

v,B.P.,

Bruttomesso,D

.,Cob

elli,C.,

DeVries,J.H

.,Renard,E.,

Magni,L.,2015.[90]

France,Italy,

theNethe

r-land

sMultin

ationalrando

mised

crossovertrial(op

enlabe

lstudy)

n=32

(patients)

Insulin

pumptreatm

ent

Type

Idiabe

tes

Thestud

yassessed

theeffect

onglucosecontrolw

ithuse

ofan

artificialpancreas

duringtheeveningand

nigh

tplus

patient-m

anaged

sensor-aug

mentedpu

mp

therapy(SAP)

duringtheday,

versus

24huseof

patient-

managed

SAPon

ly,infree-

livingcond

ition

s.

Lee,A.D.W.,Galvao,F.H.F.,

Dias,M.C.G.,Cruz,M.E.,

Marin,M

.,Pedrol,C

.N.,

David,A

.I.,Pecora,R.A.A.,

Waitzbe

rg,D

.L.,

D'Albuq

uerque,L.A.C.,

2014.[103]

Brazil

Patientswereevaluatedfora

perio

dof

6mon

ths

n=128(patients)

Hom

eparenteralnu

trition

therapy(HPN

T)Intestinalfailure:

Mesen

teric

thrombo

sis;

Colon

cancer;

Non

-hod

gkin

lymph

oma;

Volvulus;

Pseudo

-obstructio

n;Trauma;

Crohn

disease;

Gardn

er’ssynd

rome;

Ape

ndicitis;

Periton

itis(+

dialisis);

Provoked

abortio

n

ThearticleprofilesaBrazilian

sing

le-cen

terexpe

rience

with

128casesof

HTPN

followed

forthelast30

yearsandappraise

the

referralforpo

tential

intestinalandmultivisceral

transplantation.

Lege

r,S.S.,2005.[84]

France

Review

Mechanicalven

tilation

Chron

icaldiseases

Thearticleaimsto

exam

ine

thedifferent

indicatio

nsof

ahu

midificatio

nsystem

inpatientswith

mechanical

ventilatio

nin

theho

me,to

review

theliteraturein

orde

rto

iden

tifythe

positiveresults

obtained

byhu

midificatio

nand,

finally,

tode

scrib

ethemost

efficient

type

sof

humidifiers.

Leho

ux,P.,2004.[48]

Canada

Qualitativestud

y,reliedon

the

triang

ulationof

threesources

ofdata:

1)interviewswith

patients

(n=16);

2)interviewswith

carers(n

=6);

3)directob

servationof

nursing

visitsof

adifferent

setof

patients

(n=16).

Intraven

oustherapy;

Parenteralnu

trition

;Periton

eald

ialysis;

Oxyge

ntherapy

Nomed

icaldiagno

sismen

tione

dDocum

entatio

n,fro

mthe

patient’sperspective,of

how

thelevelofu

ser-friendliness

ofmedicaltechno

logy

influencesits

integrationinto

theprivateandsociallives

ofpatients.Und

erstanding

what

makes

atechno

logy

user-

friendlyshou

ldhelpimprove

thedesig

nof

homecare

services.


http://www.scopus.com/authid/detail.url?authorId=8569929600&eid=2-s2.0-84906098170










Table

3Characteristicsof

includ

edstud

ies(Con

tinued)

Stud

yCou

ntry

ofstud

yStud

yde

sign

andsample

Med

icaltechno

logies

Med

icaldiagno

sis

Con

tent

Leho

ux,P.,Charland

,C.,

Richard,

L.,Pineault,R.,

St-Arnaud,

J.,2002.[5]

Canada

Postalqu

estio

nnaire

n=97

(localcen

ters)

Intraven

ouspu

mptherapy;

Oxyge

ntherapy;

Periton

eald

ialysis;

Haemodialysis;

Parenteralnu

trition

;

Nomed

icaldiagno

sismen

tione

dThearticlede

scrib

esvario

usmed

icaltechno

logies

that

areused

frequ

ently

inthe

homeandtherespon

sibility

oflocalcom

mun

ityservice

centersin

theregion

ofQuebe

c,Canada.

Leho

ux,P.,Saint-Arnaud,

J.,Richard,

L.,2004.[30]

Canada

Biog

raph

icalinterview,interview

questio

nnaire;

Direct

observations;

Docum

entanalysis

(patient

manuals,brochu

res,

leaflets)

n=16

(patients)

n=6(careg

ivers)

n=16

(hom

evisitsby

nurses)

n=26

(docum

ents)

Intraven

oustherapy,

Parenteralnu

trition

,Periton

eald

ialysis;

Oxyge

ntherapy

Patientswith

recurringinfections;

Chron

icob

structivepu

lmon

ary

disease;

Renalfailure

Determinationofhow

specialised

medicalequipm

ent

bypatientsathomewas

supp

osed

tobe

used

versus

howitwas

actuallyused.

Lemke,M

.R.,

Men

donca,R.J.,

2013.[50]

USA

Dialysis;

Intraven

oustherapies

Nomed

icaldiagno

sismen

tione

dThearticlede

scrib

esseveral

aspe

ctsof

accessibility

ofmed

icalde

vicesforho

me

healthcare

recipien

ts,

espe

ciallylayusers.

Lewarski,J.S.,Gay,P.C.,

2007.[22]

USA

Hom

emechanical

ventilatio

nMed

icaldiagno

seson

lymen

tione

das

anexam

ple.

Thearticleexplains

several

issues

inho

memechanical

ventilatio

n,such

aspo

licies

andpracticestandards,costs,

reimbu

rsem

entandcoverage

Matsui,K.,Kataoka,A

.,Yamam

oto,A.,Tano

ue,K.,

Kurosawa,K.,Shibasaki,J.,

Ohyam

a,M.,Aida,N.,

2014.[98]

Japan

Clinicaldata

review

/charts

review

n=10

(patients)

Suctionapparatus;

Tube

feed

ing;

Gastrostomy;

Trache

ostomy;

Oxyge

ntherapy;Ventilator

Möb

iussynd

rome

Investigationof

theou

tcom

eof

patientswith

Möb

ius

synd

rome,includ

ingthe

mortalityrate,rateofneonatal

intensivecareunit(NICU)

admission,neurological

findings,developm

ental

problems,andmedicalhome

careanddevice

needs.

McG

oldrick,M.,2010.[67]

USA

Articlepresentsevidence

based

guidelines

andrecommendations

onthepreferredmetho

ds.

Oxyge

nconcen

trators,

Ventilators;

Con

tinuo

uspo

sitive

airw

aypressure

(CPA

P);

Bilevelp

ositive

airw

aypressure

(BiPAP);

Nasalcann

ulas;

Trache

ostomytube

s;Trache

alsuctioncatheter;

Neb

ulizers

Anim

mun

e-comprom

ised

individu

alwith

achronic

unde

rlyingillne

ss

Thisarticlepresen

tseviden

cedbasedgu

idelines

andrecommen

datio

nson

thepreferredmetho

dsfor

managingrespiratory

equipm

entandsupp

lies

common

lyused

bypatients

intheho

mesettingand

cond

uctin

gsurveillance

activitiesto

ultim

ately

preven

trespiratoryinfections.


Table

3Characteristicsof

includ

edstud

ies(Con

tinued)

Stud

yCou

ntry

ofstud

yStud

yde

sign

andsample

Med

icaltechno

logies

Med

icaldiagno

sis

Con

tent

Michihata,N

.,Matsui,H.,

Fushim

i,K.,Yasun

aga,H.,

2015.[101]

Japan

Databaseanalysis

(The

Japane

seDiagn

osis

Proced

ureCom

binatio

n(DPC

)database)

n=4729

(patients)

Trache

ostomytube

;Gastrostomytube

;Hom

erespirator;

Hom

ecentralven

ous

alim

entatio

n

Chrom

osom

alanom

aly;

Malignancy;

Inbo

rnerrorof

metabolism

(IEM);

Con

genitalh

eartdisease(CHD);

Immun

ede

ficiency;

Endo

crinediseases;

Cereb

ralp

alsy;

Other

cong

enitalano

malies;

Epilepsy;

Other

diseases

Ischem

iche

artdiseases,including

angina

pectoris;

Acute

myocardialinfarction;

Cereb

rovascular

diseases;

Lung

,gastric,colon

,hep

atic,

breast,uterus,andprostate

cancer

Determinationof

theclinical

details

ofadultpatients

admitted

tope

diatric

wards

inJapane

seacute-care

hospitals.

Mun

ck,B.,Fridlund

,B.,

Mårtensson,J.,2011.[53]

Swed

enDescriptivede

sign

;Ph

enom

enog

raph

icapproach;

Qualitativestud

y;Semi-structuredinterview

n=16

(nurses)

Thereareno

technologies

specifically

mentionedin

thestudyitself,butreference

ismadeto

complex

medical

devicesaccordingto

adefinition

andexam

ples.

‘Med

icaltechno

logy

was

defined

andconfined

tothemoreadvanced

devices

that

may

bepresen

tin

the

home,such

asventilators,

suctiondevices,oxygen

andvarious

ports

andpumps’.

Nomed

icaldiagno

sismen

tione

dDescriptio

nof

districtnu

rses’

concep

tions

ofmed

ical

techno

logy

inpalliative

homecare.

Mun

ck,B.,Sand

gren

,A.,

Fridlund

,B.,

Mårtensson,J.,2012a.[36]

Swed

enExplorativede

scrip

tivede

sign

;Ph

enom

enog

raph

icapproach;

Qualitativestud

ySemi-structuredinterview

n=15

(next-of-kin)

Pain,nutritionandvolume

pumps;

Oxyge

nconcen

trators;

Suctions

andinhalatio

nde

vices;

Percutaneo

usen

doscop

icgastrono

my(PEG

);Subcutaneo

usvein

ports.

Nomed

icaldiagno

sismen

tione

dDescriptio

nof

next-of-kin’s

concep

tions

ofmed

ical

techno

logy

inpalliative

homecare.

Mun

ck,B.,Sand

gren

,A.,

Fridlund

,B.,

Mårtensson,J.,2012b.

[52]

Swed

enQualitativeanalysis;

Explorativede

scrip

tivede

sign

;Ph

enom

enog

raph

icapproach;

Interview

n=15

(patients)

Pain

pumps;

Nutritionandvolumepumps;

Intraven

ousinfusion

:Disetronic

penforsubcutaneo

usinjections;

Oxyge

nconcen

tratorsand

cylinde

rs;

Nep

hrostomycatheters;

Percutaneo

usen

doscop

icgastrono

my;

Subcutaneo

usveno

uspo

rtim

plantatio

n.

Differen

ttype

sof

cancer;

Amyotrop

hiclateralsclerosis(ALS);

Heartfailure;

Chron

icob

structivedisease.

Descriptio

nof

thepatients’

waysof

unde

rstand

ing

med

icaltechno

logy

inpalliativeho

mecare.


Table

3Characteristicsof

includ

edstud

ies(Con

tinued)

Stud

yCou

ntry

ofstud

yStud

yde

sign

andsample

Med

icaltechno

logies

Med

icaldiagno

sis

Con

tent

Nakayam

a,T.,Tanaka,S.,

Uem

atsu,M

.,Kikuchi,A.,

Hino-Fukuyo,N

.,Morim

oto,T.,Sakam

oto,O.,

Tsuchiya,S.,Ku

re,S.,

2014.[76]

Japan

Retrospe

ctivestud

y;Med

icalrecordswere

hand

-reviewed

toiden

tify

inpatients

Survey

byqu

estio

nnaire

n=24

(patients)

Ventilator;

Periton

eald

ialysis;

Oxyge

ncond

enser

Neurologicald

isorde

rs:

Perip

arturient

disorder;

Mito

chon

driald

isease;

Con

genitalm

yopathy;

Epilepsy;

Cereb

ralseq

uelaeof

acute

enceph

alop

athy;

PerizeusMerzbackdisease

Kidn

eydisorders:

Hypop

lastickidn

ey;

Nep

hroticsynd

rome

Others:

Diabe

tesmellitus

type

1;Long

QTsynd

rome;

Effectsfro

mbo

nemarrow

transplantation,chronic

respiratory

failure

Effectofablackout

inpediatric

patientswith

home

medicaldevicesduringthe

2011

easternJapanearth

quake

Padd

eu,E.M.,Giganti,F.,

Pium

elli,R.,D

eMasi,S.,

Filippi.L.,Vigg

iano

,M.P.,

Don

zelli,G

.,2015.[40]

Italy

Pittsburgh

SleepQualityInde

x(PSQ

I)qu

estio

nnaire;Epw

orth

Sleepine

ssScale(ESS);

Beck

Dep

ressionInventory

(BDI-II);

Beck

Anxiety

Inventory(BAI)

n=23

(paren

tsof

23children

with

CCHS)

n=23

(paren

tsof

23he

althychildren)

Mechanicalven

tilation(via

nasalm

askor

tracheostom

y)Con

genitalcen

tralhypo

ventilatio

nsynd

rome(CCHS)

Thedaily

challeng

esassociated

with

carin

gfor

techno

logy-dep

ende

ntchildrencanplaceprim

ary

caregiversun

dersign

ificant

stress,especially

atnigh

t.Thestud

yinvestigated

how

thiscond

ition

affects

mothe

rsandfathersby

prod

ucingpo

orsleep

quality,high-leveld

iurnal

sleepine

ss,anxiety,and

depression

.

Paul,J.,Otvos,T.,2006.[82]

Canada

Rand

omized

crossoverstud

y;Measuremen

tby

oxim

eter;

Questionn

aire

n=25

(patients)

Oxyge

ntherapy

Ex-smokerswith

severe

chronic

obstructivepu

lmon

arydisease

Com

parison

ofthe

perfo

rmance

ofane

woxygen

deliveryde

vice,the

OxyArm

(OA)

(Sou

thmed

icInc.,C

anada),

with

astandard

nasal

cann

ula(NC)

(Salter-Style1600,Salter

Labs,U

SA)forbo

thoxygen

deliveryand

patient

preferen

cein

patientson

long

-term

oxygen

therapy(LTO

T).


Table

3Characteristicsof

includ

edstud

ies(Con

tinued)

Stud

yCou

ntry

ofstud

yStud

yde

sign

andsample

Med

icaltechno

logies

Med

icaldiagno

sis

Con

tent

Pourrat,M.,Neuville,S.,2007.[73]

France

Survey;

questio

nnaire

n=12

(bylawauthorizedcentres)

n=6(service

providers)

n=0(custom-m

ademakers)

n=0(labo

ratories)

Hom

eparenteralnu

trition

Nomed

icaldiagno

sismen

tione

dForHom

eParenteral

Nutrition(HPN

),ph

armacy

hadto

deliver

somemed

ical

devicesanddrug

s.Itcomes

upthefollowingandtaking

care

ofincide

ntsthat’s

occurringat

homewith

thoseprod

ucts.The

article

describ

esan

inventoryon

vigilance’sorganizatio

n,incide

nt’sm

anagem

entand

assessmen

t,abou

tHPN

inFrance.

Pourtier,J.,2013.[97]

France

Patient-con

trolled

analge

siapu

mps.

Nomed

icaldiagno

sismen

tione

dTechno

logy

forim

proving

pain

managem

entin

the

home;vario

usaspe

cts

relatedto

analge

siapu

mps.

Pren

ton,S.,Ken

ney,L.P.,

Stapleton,C.,Coo

per,G.,

Reeves,M

.L.,Heller,B.W.,

Sobu

h,M.,Barker,A

.T.,

Healey,J.,Goo

d,T.R.,

Thies,S.B.,H

oward,

D.,

Williamson,T.,2014.[92]

UK

Feasibility

stud

yPu

rposivequ

estio

nnaires

Pape

rdiary

n=7(patients)

Functio

nalelectrical

stim

ulationsystem

Unilateralfoo

t-drop

ofcentral

neurolog

icorigin

(>6m

o)Investigationof

thefeasibility

ofun

supervise

dcommun

ityuseof

anarray-based

automated

setupfunctional

electricalstimulator

for

curren

tfoot-dropfunctio

nal

electricalstim

ulation(FES)

users.

Rajkom

ar,A

.,Farrington

,K.,

Mayer,A

.,Walker,D.,

Blandford,

A.,2014.[51]

UK

Qualitativemetho

dEthn

ograph

icob

servations;

Semi-structuredInterviews

n=19

(patientsandtheircarers)

Hom

ehaem

odialysis

techno

logy

Nomed

icaldiagno

sismen

tione

dAninventoryof

patients’

andcarers’experiences

ofinteractingwith

home

haem

odialysis(HHD)

techno

logy,interm

sof

user

expe

rience,ho

wthede

sign

ofthetechno

logy

supp

orts

safety

andfitswith

home

use,andho

wthebroade

rcontextof

serviceprovision

impactson

patients’useof

thetechno

logy.

Rajkom

ar,A

.,Mayer,A

.,Blandford,

A.,2015.[79]

UK

Ethn

ograph

icob

servations;

Semi-structuredinterviews;

Distributed

cogn

ition

for

team

workmetho

dology

Hom

ehe

mod

ialysis

techno

logy

(HHT)

Renalp

atients/kidn

eyfailure

Inthisstud

y,Distributed

Cog

nitio

n(Dcog)

was

appliedto

unde

rstand

renal

patients’interactions

with

Hom

eHem

odialysis

Techno

logy

(HHT),asan

exam

pleof

aho

memed

ical

device.


Table

3Characteristicsof

includ

edstud

ies(Con

tinued)

Stud

yCou

ntry

ofstud

yStud

yde

sign

andsample

Med

icaltechno

logies

Med

icaldiagno

sis

Con

tent

Rand

,D.A.,Men

er,D

.J.,

Lerner,E.B.,DeRob

ertis,N

.,2005.[77]

USA

Retrospe

ctivecase

series

(med

icalrecord

review

)n=83

(med

icalrecords)

Hom

erespiratory

equipm

ent;

Hom

ene

bulizers;

Oxyge

nde

vices

Nomed

icaldiagno

sismen

tione

dDescriptionoftheexperience

ofan

urban,commercial

ambulanceproviderduringthe

multistateAu

gust2003

electricalpow

eroutage

(EPO

)andto

identifyhowsuch

aneventcan

affectan

emergency

medicalservices

(EMS)system

.

Scala,R.,2004.[88]

Italy

n=29

(devices)

Bi-levelh

omeventilators

forno

ninvasive

positive

pressure

ventilatio

n

Chron

icrespiratory

failure

(due

tone

uro-musculardisorders);

COPD

;Severe

chestwalld

eformity;

Obe

sity

Theauthor

describ

esthe

technicalaspects,the

individu

alcharacteristics

andtheclinicalapplications

ofthemostcommon

used

bi-levelven

tilators.

Short,D.,Norwoo

d,J.,

2003.[108]

UK

Phase1:

Survey

(Sem

i-structuredinterview);

Phase2:

Casestud

yanalyses

(in-dep

thcase

stud

yanalyses

ofselected

districts)

n=98

(health

authorities)

Parenteralnu

trition

;Intraven

ousantib

iotics;

Intraven

ouschem

othe

rapy;

Con

tinuo

usam

bulatory

periton

eald

ialysis

Cystic

fibrosis;

Cancer

Thestud

yaddresses

questio

ns:W

hyishigh

-tech

healthcare

atho

me

purchasing

unde

rdevelop

edandwhatcouldbe

done

toim

proveit

Siew

ers,V.,H

olmøy,T.,

Frich,J.C

.,2013.[54]

Norway

Qualitativestud


thinterviews

n=5(patients)

Mechanicalinsufflatio

n–

exsufflation(M

I-E)

Amyotrop

hiclateralsclerosis(ALS)

Thestud

yexplores

patients’,

family

carers’and

health

profession

als’expe

riences

with

usingmechanical

insufflation–exsufflation

(MI-E)in

amyotrop

hiclateral

sclerosis(ALS)in

theho

me

setting.

Southe

y,D.,Pu

lling

er,D

.,Logg

os,S.,Ku

mari,N.,

Leng

yel,E.,M

organ,I.,Yiu,P.,

Nandi,J.,Luckraz,H.,

2015.[105]

UK

Observatio

nalstudy;

Datacollected

prospe

ctively

onthethoracicdatabase;

Datalogg

edin

aspecific

data

sheet

n=20

(patients)

Portabledigitalsuctio

nde

vice

‘Allpatientswho

unde

rwen

ta

thoracicproced

ureandwho

requ

iredsuctionpo

stop

eratively

forape

rsistent

airleak

anda

confirm

edair-spacewith

inthe

pleuralcavity’

Patientsun

dergoing

thoracic

surgicalprocedures

who

met

strictdischargecriteria

wereallowed

tocontinue

theirtreatmentatho

mewith

thedevice.Theywere

mon

itoredinadesig

nated

follow-upclinic.D

atawere

collected

toidentifythe

impactofthisserviceinrelation

tothedurationoffollow-up

required,bed-dayssaved,and

potentialcost/benefits.


Table

3Characteristicsof

includ

edstud

ies(Con

tinued)

Stud

yCou

ntry

ofstud

yStud

yde

sign

andsample

Med

icaltechno

logies

Med

icaldiagno

sis

Con

tent

Stieglitz,S.,Geo

rge,S.,

Priegn

itz,C

.,Hagmeyer,L.,

Rand

erath,W.,2013.[66]

Germany

Caseseries

n=3(patients)

Invasive

andno

n-invasive

ventilators

COPD

;Lung

cancer;

Chron

icventilatorfailure

asa

conseq

uenceof

chronic

obstructivepu

lmon

arydisease

Thearticlede

scrib

eslife-

threaten

ingeven

tsin

respiratory

med

icine:

misconn

ectio

nsof

invasive

andno

n-invasive

ventilatorsandInterfaces

Su,C

.-L.,Lee,C.-N

.,Che

n,H.-C

.,Feng

,L.-P.,

Lin,H.-W

.,Chiang,

L.-L.,

2014.[81]

Taiwan

Retrospe

ctive,cross-sectional,

observationalsurveyde

sign

;Questionn

aires;

Walking

test(patient

selfscore)

n=42

(patientsusingLO

G)

n=102(patientsusingOCG)

Long

-term

oxygen

therapy

Chron

icrespiratory

insufficien

cy;

Chron

icob

structivepu

lmon

ary

disease(COPD

);Restrictivelung

disease;

Neuromusculardiseases;

Cancer;

Interstitiallun

gdiseases

Thestud

ycomparedoxygen

usagebe

tweenpatients

from

aliquidoxygen

grou

p(LOG)andan

oxygen

concen

trator

grou

p(OCG

).Theauthorsalso

assessed

the

physiologicrespon

sesof

patientswith

chronic

obstructivepu

lmon

ary

disease(COPD

)toam

bulatory

oxygen

useathome.

Sunw

oo,B.Y.,Mulho

lland

,M.,

Rosen,I.M

.,Wolfe,L.F.,

2014.[57]

USA

Hom

eno

ninvasive

ventilatio

ntechno

logy

Neuromusculardisease(includ

ing

amyotrop

hiclateralsclerosisand

Duche

nnemusculardystroph

y);

Scoliosis;

Restrictivechestwalld

isease;

Restrictivethoracicdisorders;

COPD

/severeCOPD

;Theoverlapsynd

romeor

coexistin

gCOPD

andOSA

;Sleep-relatedbreathingdisorders;

Cen

tralor

complex

sleepapne

a;Obe

sity

hypo

ventilatio

nsynd

rome

(OHS);

Hypoven

tilationsynd

romes

Thearticleprovides

apracticemanagem

ent

perspe

ctiveforclinicians

providingho

meno

ninvasive

ventilatio

n,includ

ing

coverage

,cod

ing,

and

reim

bursem

entto

optim

ize

clinicalcare

andminim

ize

lostrevenu

e.

Szeinb

ach,S.L.,Pauline,J.,

Villa,K.F.,Com

merford,S.R.,

Collins,A.,Seoane

-Vazqu

ez,E.,

2015.[65]

USA

Retrospe

ctivechartreview

Qualitativestud

y(the

interview

part)

One

-on-on

einterviews

n=163(patients)

Hom

eparenteralnu

trition

Intestinalob

struction;

Acute

pancreatitis;

Hyperem

esismetabolism;

Region

alen

teritis;

Intestinaldisorders,ulceratio

n;Intestinalmalabsorptio

n;Enterocolitis;

Sepsis;

Stom

achulceratio

nwith

perfo

ratio

n;Acute

intestinalvascular

insufficien

cy;

Intestinalfistula;

Gastrop

aresis;

Persistent

vomiting

,pne

umon

itis;

Other

gastrointestinalissues,

disturbances;

Oncolog

y-relateddiagno

ses

Thearticledescrib

escatheter

complications

andou

tcom

esinpatientswho

received

homeparenteralnu

trition

(HPN

)therapy.


Table

3Characteristicsof

includ

edstud

ies(Con

tinued)

Stud

yCou

ntry

ofstud

yStud

yde

sign

andsample

Med

icaltechno

logies

Med

icaldiagno

sis

Con

tent

Tann

o,E.,2010.[74]

USA

n=6(hospitals)

Thereareno

techno

logies

specifically

men

tione

din

thestud

yitself,bu

treferenceismadeto

complex

med

icalde

vices

asan

exam

ple.

Nomed

icaldiagno

sismen

tione

dBecausepatients,who

use

homemed

icaltechno

logies,

areso

depe

nden

ton

these

devicesthey

bringthem

into

hospitalswhe

nthey

seek

treatm

ent.Many

hospitalshave

develope

dspecificprotocols,includ

ing

safety

inspectio

nsby

clinical

engine

ers,to

follow

whe

na

home-usede

vice

isbrou

ght

in.Thisarticlesummarizes

thepo

liciesthat

6ho

spitals

have

develope

dto

address

thissituation.

Tearl,D.K.,Cox,T.J.,

Hertzog

,J.H.,2006.[61]

USA

Dem

ograph

icdata

are

prospe

ctivelycollected

from

databases;

Surveyscond

uctedover

the

teleph

oneor

viafacsim

ilen=74

(patients)

Respiratory

techno

logy;

Ventilator;

Con

tinuo

uspo

sitiveairw

aypressure

(CPA

P);

Trache

ostomycollar;

Neg

ative-pressure

ventilator

(NVP);

Bi-levelp

ositive

airw

aypressure

(BiPAP)

Respiratory

failure:

Airw

ayob

struction;

Neuromuscular/Spinal-cord

injury

(SCI);

Bron

chop

ulmon

arydysplasia

(BPD

)

Prep

arationof

respiratory-

techno

logy-dep

ende

ntchildrenforho

spital

dischargepresen

tsmany

challeng

es.A

dequ

ate

training

anded

ucationof

parentalcaregivers,

dischargeplanning

,and

coordinatio

nwith

the

durable-med

ical-equ

ipmen

tandhome-nursingcompanies

mustb

ecompleted.The

role

ofadedicatedRespiratorycare

dischargecoordinatorh

asbeen

evaluatedinthisstudy.

Tenn

ankore,K.K.,D’Gam

a,C.,

Faratro,R.,Fun

g,S.,W

ong,

E.,

Chan,C.T.,2014.[80]

Canada

Retrospe

ctivecoho

rtstud

y(allcharacteristicscollected

basedon

iden

tificationin

electron

icrecordsand

patient

charts)

n=202(patients)

Hom

ehe

mod

ialysis

End-stagerenald

isease:

Diabe

tes;

Glomerulon

ephritis;

Polycystickidn

eydisease

Thestud

yde

scrib

esadverse

technicaleventsin

alarge

coho

rtof

homehemod

ialysis

patients.

Thom

son,R.,M

artin

,J.L.,

Sharples,S.,2013.[28]

UK

Qualitativestud

y;In-dep

thsemi-structured

interview

n=12

(patients)

Transcutaneo

uselectrical

nervestim

ulationde

vice;

Oxyge

nconcen

trator;

Con

tinuo

usam

bulatory

periton

eald

ialysis;

Stair-lift;

Neb

ulizer

Diabe

tes

Thearticlede

scrib

esthe

psycho

socialimpactof

home

usemedicaldeviceson

the

lives

ofolderp

eopleandhow

thedevicesareintegrated

into

theirlives.


Table

3Characteristicsof

includ

edstud

ies(Con

tinued)

Stud

yCou

ntry

ofstud

yStud

yde

sign

andsample

Med

icaltechno

logies

Med

icaldiagno

sis

Con

tent

Toly,V.B.,Musil,C.M.,Carl,J.C

.,2012.[37]

USA

Descriptive,correlational,

dross-sectionalstudy;

Structured

interview,face-to-face,

usingtheDem

ograph

icCh

aracteristicsQuestionn

aire,

theFunctio

nalStatusII–Revised

Scale,the

CenterforEpidemiological

Studies–DepressionScale,a

NormalizationScale

subscale,

andtheFeetham

Family

Functioning

Survey.

n=103(m

othe

rs)

Mechanicalven

tilation;

Intraven

ousnu

trition

/med

ication;

Respiratory/nu

trition

alsupp

ort;

Apn

eamon

itors;

Feed

ingtube

;Trache

ostomytube

;Supp

lemen

talo

xyge

n

Neuromuscular;

Respiratory

cond

ition

s;Gastrointestin

alcond

ition

s;Cardiac

cond

ition

s;Cystic

fybrosis;

Metabolicdisorders;

Renald

isorde

rs

Thestud

yde

scrib

esvario

usissues

relatedto

family

functio

ning

andno

rmalization

inmothe

rsof

children

depe

nden

ton

med

ical

techno

logy

followinginitiation

ofho

mecare.

Toly,V.B.,Musil,C.M.,

Zauszniewski,J.A

.,2014.[41]

USA

Long

itudinalrando

mized

controlledpilottrial;

Structured

interviews;

Semi-structuredexitInterviews

n=22

(mothe

rs)

Mechanicalven

tilation;

Intraven

ousnu

trition

/medication;

Respiratory/

nutrition

alsupp

ort.

Respon

dentsrecruitedfro

mpu

lmon

olog

yand

gastroen

terology

clinics

Thepu

rposeof

thestud

ywas

tode

term

inethefeasibility,

acceptability,and

efficacy

ofresourcefulnesstraining

(RT),

acogn

itive–b

ehavioral

interven

tion,am

ongmothe

rsoftechnology-dependent

children.

Wang,

K.-W

.K.,Barnard,

A.,

2004.[35]

Australia

Empiricalreview

Mechanicalven

tilation;

Trache

ostomy;

Oxyge

ntherapy;

Enteraln

utrition;

Parenteralnu

trition

;Intraven

ousdrug

therapies;

Periton

eald

ialysis;

Haemod

ialysis;

Suctionde

vices

Nomed

icaldiagno

sesmen

tione

d,on

lyas

anexam

ple.

Thepape

rprovides

acompreh

ensive

literaturereview

oncarin

gfortechno

logy-

depe

nden

tchildrenlivingat

hometo

gain

anun

derstand

ing

ofthede

velopm

entof

paed

iatricho

mecare,and

itsim

pact

ontechno

logy-

depend

entchildrenandtheir

families,and

socialimplications.

Weiler-Ravell,D.,

2002.[107]

Israel

Respiratory

supp

ort,

ventilators

Neuromuscularrespiratory

failure

Chron

icob

structivepu

lmon

ary

disease

Thearticlede

scrib

esthe

quandary

ofho

me-care

respiratory

managem

ent.

Won

g,J.,Eakin,J.,Migram,P.,

Cafazzo,J.A.,Halifax,N.V.D.,

Chan,C.T.,2009.[60]

Canada

Qualitativestud

y;Semi-structuredinterviews;

Focusgroup

n=23

(patients;15

interviews;

8focusgrou

p)

Hom

ehe

mod

ialysis

Endstagerenald

isease

(ESRD).

Thestud

yexplores

patient

training

expe

riences

with

learning

acomplex

med

ical

device

forthe

selfadm

inistratio

nof

nocturnalhem

odialysis

atho

me.

Yik,Y.I.,Ismail,K.A.,Hutson,J.M

.,Southw

ell,B.R.,2012.[91]

Australia

Prospe

ctivestud

y;Bo

weldiaries;

Questionn

aires;

Colon

ictransitstud

ies

n=32

(patients)

Transcutaneo

uselectrical

stim

ulation

Slow

-transitconstip

ation(STC

)Thearticlede

scrib

esthetest

oftheeffectiven

essof

home

transcutaneo

uselectrical

stim

ulation(TES)whe

npatientswith

slow

-transit

constip

ation(STC

)were

traine

dby

anaiveclinician.


Fig. 1 PRISMA flowchart


From an analysis of the articles, additional categoriesof content emerged:

4. Design and technological development5. Application with regard to certain diseases or

disorders, indication for and extent of use6. Policy and management

Types of medical technologies used, frequency of useand trendsIn four of the 87 articles (5%) there were no specificmedical technologies mentioned as a subject of study(see Table 4). Almost half of the studies (45%) consid-ered medical technologies for respiratory support and39% devices for dialysis, either haemo- (n = 18), periton-eal- (n = 15) or dialysis not specified (n = 1). Of the stud-ies, 29% reported on devices for oxygen therapy. Inaddition, there has been relatively more researchconducted on equipment for ‘infusion therapy’ (n = 19;22%), parenteral nutrition and enteral nutrition with ascore of 20% each (n = 17). Relatively little research hasbeen carried out on suction devices (8%), external elec-trostimulation (5%), nebulizer (5%), insulin pump ther-apy (3%), sleep apnea treatment (2%), patient liftinghoists (2%), vacuum assisted wound closure (1%) andcontinuous passive motion (1%). None of de studies

considered medical technologies with regard to decubi-tus treatment, skeletal traction or UV (ultraviolet)therapy.Table 4 shows that on the years 2000 and 2001 no

relevant articles on the subject were found. Over theperiod 2000–2005, 17 articles were published, the samenumber over 2006–2010, and there has been a substan-tial increase in the number of publications to 54 overthe years 2011–2015. In general, it can be concludedthat more frequent investigated technologies show afairly even distribution of publications over the years2000–2015. Technologies, on which little research hadbeen done, except for nebulizers, have been mainly in-vestigated since 2010. An increase of published articlesover the years 2000–2015 is apparent particularly forhaemo dialysis and to a lesser extent, for devices forenteral- and parenteral nutrition. As mentioned before,several studies reported on the increase of the numberof medical technologies used in home settings, butconcrete data are not available. However, the number ofstudies and the visible trends may be indicative of thefrequency of use.In 63% of the cases (n = 55), a medical diagnosis (or

diagnoses) was mentioned in the article. Where adiagnosis has been mentioned, in almost half of thestudies (n = 26; 47%) it concerned diagnoses in the fieldof respiratory failure (see Fig. 2). This is not surprising,since ‘respiratory support’ is the medical technologymost commonly found in the articles, similarly ‘oxygentherapy’ has also been considered relatively often. Diag-noses with regard to neurological disorders occurred in42% of the studies (n = 23). Just over a quarter of thestudies (27%) considered diagnoses ‘other’, such as‘sepsis’, ‘chromosomal anomaly’ or other not specifiedmedical disorders, nearly a quarter (24%) considered‘cancer’ and 22% kidney disorders (n = 12).An analysis of the used research designs identified that

64% (n = 56) of the studies used an observational (non-experimental) design and only a small part of the studies(n = 5; 6%) used an experimental design, such as aRandomized Control Trial (RCT). Of the included stud-ies 19 were reviews and 8 were essays. A quantitativedesign (n = 37) was used more frequently than a qualita-tive design (n = 25); and only one study applied ‘mixedmethods’ (quantitative and qualitative). Just over one-third of the studies (35%) used a descriptive design, anda similar number used a cross-sectional study (36%).Case series were used in 12% of the articles and acohort-study in 9%. A phenomenological approach wasapplied in 16% of the records. Research instrumentsmost frequently used were interviews (33%) and survey/questionnaires (21%). In 10% of the cases other instru-ments were used, including different types of assessmentsor tests.

Table 4 Trends in papers reporting on AMTs (n = 87, multiple answers possible), by year of publication (2000–2015)

No shading n = 0, up till the darkest shading n = 5


With regard to the categories of content, most researchhas been carried out on ‘user experiences’ (see Fig. 3): justover one-third of the articles (n = 31; 36%) focused on thistopic. Of these articles almost all studies focused on experi-ences of patients or informal caregivers (n = 29) and only asmall number (n = 2) considered the user experiences ofnurses or other professionals (see Table 5). More than halfof the studies (n = 19) used a qualitative research design; ofthese 13 used a phenomenological approach. The goal ofthese studies was to elicit the essence of human phenom-ena as experienced by the users. Seven studies used a quan-titative design and one an integrated mixed method. Threeof the studies applied a grounded theory approach and two

Fig. 2 Number of medical diagnoses mentioned in articles on AMTs(n = 87, multiple answers possible)

an experimental design (randomized controlled trial). Theresearch instruments in this content category to collect datawere interviews, either semi-structured or in-depth, and asurvey. About two-thirds of the articles regarding ‘user ex-periences’ were published in the period 2011–2015, with anaccent on the psychosocial impact of patients or informalcaregivers.Relatively little research was found on ‘training, in-

struction, education’ (n = 7), for the use of AMTs inhome settings. It was remarkable that all the studiesidentified as focusing on this topic, concentrated on onecategory of AMT. Respiratory support was the subject ofstudy in four instances and in the other three, the focuswas on technologies for enteral nutrition, haemo dialysisand external electro-stimulation. Four of the seven

Fig. 3 Number of articles on AMTs with main content categories (n=87)

Table 5 Subcateogories of content in selected articles on AMTs (n = 87) by year of publication (2000–2015)

No shading n = 0, up till the darkest shading n = 4


articles utilized quantitative methods, among whichthree of them used an observational non-experimentaldesign and one was an experimental randomizeddouble-blind clinical trial. Another study within the ini-tial seven articles used a qualitative observational non-experimental design, one was a review and another wasin essay format.In total, 22% of the articles discussed topics on safety,

risks, incidents and complications (n = 19). In the majorityof cases (n = 13) general aspects about the subject, for in-stance safe use, factors affecting safety, a safe transfer of theequipment and monitoring of assessing safety were consid-ered. One article described technological factors with re-gard to safety, three articles reported on environmentalfactors and two explored human factors. Safety aspectswere explored over a wide range of medical technologies.Five articles were reviews and one an essay. Quantitativemethods were used in ten of the cases, particularly formonitoring, evaluating and assessing safety, technologicaland environmental factors. Only three studies used a quali-tative design. Retrospective chart reviews or case serieswere used to collect data in some cases of unforeseenevents. Table 5 shows about a doubling of published articlesin the period 2011–2015 regarding this content category,compared to the previous period 2000–2010.

Approximately 20% of the selected articles considered thecontent category ‘design and technological development ofthe medical device’ (n = 17). The studies each focused ononly one type of AMT and treated a relative wide range ofeight different categories, such as ‘respiratory support’,‘oxygen therapy’, ‘haemo dialysis’, ‘infusion therapy’, ‘insulinpump therapy’ and ‘enteral nutrition’, but also ‘externalelectrostimulation’ and ‘patient lifting hoists’. Interestingly,in this group of articles, relatively often (n = 6) no medicaldiagnosis was mentioned. Around half of the studies (n = 8)referring to this topic were in review or essay format. Allother studies used a quantitative research design andthroughout the search no application of qualitative designswere found. Two studies used an experimental study design(randomized crossover trial) to obtain data and twodescribed a prospective cohort study. The majority ofpapers (n = 11) were published in the period 2011–2015and six in the preceding period up to and including 2010.Seven articles concerned the application of AMTs, all

of them devices with regard to at least respiratory sup-port and/or nutritional support. Five studies used a non-experimental quantitative design including the analysisof clinical data, such as record reviews or cohort studies,and two articles were reviews. Most articles on this sub-ject (n = 5) were published in the period 2012–2015.


Six articles described policy or management systemsin different countries regarding the use of AMTs athome. The majority of the articles (n = 4) were in essayor review format. The other papers concerned a qualitativecross-sectional case study analysis and an observationalquantitative study in which data are collected prospectivelyusing a database. The categories of content will now be dis-cussed in greater detail.

Content description and trends to secondary researchquestionsUser experiencesIn this category, 22 articles described the psychosocialimpact on patients or informal caregivers from the useof medical technologies at home. Living at home withthe assistance of medical technology needs a range ofadjustments. Fex et al. [25, 26] state that self-care ismore than mastering the technology, in terms of thehealth-illness transition, it requires ‘…. an active learningprocess of accepting, managing, adjusting and improvingtechnology’. When it comes to children, they have tolearn to incorporate disability, illness and technology ac-tively within their process of growing up [27]. It seemsthat the use of medical technologies in the home canhave both a positive and a negative psychosocial impacton patients and their families, which in turn causes am-bivalence in experiences [27, 28]. On the one hand, pa-tients in general gain more independence, an enhancedoverall health and a better quality of life [29–34]. On theother hand, for some patients the experience is one ofdependency on others for executing daily activities, andthese circumstances, to some extent, a social restrictedlive and perceived stigmatization [29, 30]. The situationin which patients need to use medical technology athome also affects family functioning and requires nextof kin responsibilities [35–37]. As a result, next of kincaregivers are frequently faced with poor sleep qualityand quantity, and/−or other significant psychosocial ef-fects [38–41]. Nevertheless, family members had a posi-tive attitude to the concept of bringing the technologyinto the home [42]. Knowledge of how to use the tech-nology and permanent access to support from healthcareprofessionals and significant others, enabled next of kincaregivers to take responsibility for providing necessarycare and to facilitate patients learning to provide self-care [25, 36, 42–44]. Bezruczko et al. [45, 46] developeda measure of mothers’ confidence to care for childrenassisted with medical technologies in their homes. Toprovide high quality sustainable care, nurses have torecognize and understand the psychosocial dimensionsfor both patients and family members which arise as aresult of changing role and providing care for the pa-tients. The need to provide emotional support andsupport with appropriate coping strategies is a key

professional role [25, 26, 47]. Insight into the psycho-social effects on those involved can be used to assist de-signers of medical devices to find strategies to betterfacilitate the integration of these technologies into thehome [28].Seven articles reported on the usability, barriers and ac-

cessibility experienced by patients or informal caregivers.Findings in these studies showed that several technologieswere rarely perceived as user-friendly and that home med-ical devices inadequately met the needs of individuals withphysical or sensory deficits [48, 49]. An accessible designwhich meets the diversity of individual user needs, charac-teristics and features would be better able to help patientsmanage their own treatment and so could contribute tothe quality of care and safety of patients and lay users [50,51]. Munck et al. [52] stated that restricted patients werereminded daily of the medical technology and were moredependent on assistance from healthcare professionalsthan masterful patients.In contrast to the group of patients or informal care-

givers, only two papers in this content category focusedon the user experiences of nurses or other professionalcaregivers. The review demonstrates that to maintain pa-tient safety, more education on application of medicaldevices for users is needed together with improvedawareness and understanding of how to use the medicaltechnology correctly in a patient-safe way [53, 54]. Morecollaboration between all involved ‘actors’ in the processof care is also requisite. Continuity among carers, trustbetween patient and carers and supportive communica-tion between informal and professional caregivers areimportant factors for the successful implementation ofmedical technologies in the home environment whilemaintaining patient safety [44, 51, 53–55].

Training, instruction and educationThree articles regarding this topic focused on nurses orother professionals and four on the patients or informalcaregivers. The results showed that successful use of ad-vanced medical technologies at home requires adequatestaff education and training programmes. Althoughmany topics in educational programmes are suitable fordifferent types of professionals in care provision, thefocus for the level and application of information canvary for Registered Nurses and unregistered care staff. Inaddition, for overall learning experiences to be of max-imum benefit there is a need for a clear focus on thespecific client groups [56]. According to Sunwoo et al.[57], in the case of home non-invasive ventilation thedegree of clinical support needed is extremely variablegiven the mixed indications for this respiratory support.A relatively simple procedure, such as the replacementof a feeding tube, can be performed by nurses, the pa-tient and informal caregivers, provided they are trained


well [58]. However, several studies revealed the complex-ity of the education needed by patients and informalcaregivers for the use of advanced medical technologiesat home [59, 60]. Nevertheless, the studies revealed thata structured education programme, specific training, orthe support of a dedicated discharge coordinator hasseveral advantages [59, 61, 62]. It was evident that goodpreparation by patients or informal caregivers may resultin a shorter length of stay in hospital, a better perform-ance with regard to the use of the equipment or less re-quests by patients and/or families for assistance.

Safety, risks, incidents and complicationsMost articles regarding this topic (n = 13) reported onsafety in general, like aspects of safe use, factors affectingsafety, complications and prevention of incidents in thehome. Some identified the risk factors and the complica-tions that may arise [63–65], where Stieglitz et al. [66]also emphasize that human error is the main reason forcritical incidents and that regular instruction for medicalstaff and patients is necessary. To prevent untoward andadverse events, evidence based guidelines, recommenda-tions on the preferred methods for managing the equip-ment, troubleshooting techniques for potentialcomplications and monitoring activities are necessary[67, 68]. Faratro et al. [68] added that key performanceand quality indicators are important mechanisms to en-sure patient safety when using a medical device in thehome. Methods to address or evaluate patient safetyissues are for example, a home visit audit tool, a nation-wide adverse event reporting system, programs such asthe Medical Product Safety Network HomeNet, or, inthe case of peripherally inserted central catheters(PICCs) a central catheter stabilization system [69–72].However, a study conducted by Pourrat and Neuville[73] in France found that there are very few internalmedical devices vigilance reports found within organiza-tions that deliver devices for home parenteral nutritionand that safety management could be improved. Thesafe transfer of medical devices from a hospital settingto the home and vice versa, comes with several chal-lenges regarding technological, environmental and hu-man factors [14]. While many hospitals have developedpolicies to control the pathways of home-used devices inthe hospitals, in case patients take them into the hospitalwhen they are admitted for treatment [74]. Improvementof the safety of devices intended for use in home set-tings, implies also improvement of safety when theirtransfer to the hospital settings is urgently needed.One article considered the technological factors, three

the environmental and two the human factors. An ex-ample of research on the technological factors of safetyrelated aspects of medical technologies used in homesettings by Hilbers et al. [75] found that manufacturers

pay insufficient attention to safety-related items in tech-nical documentation for the use in the home setting. Forinstance, the environmental factor of electricity blackoutleads to electrically powered medical devices failing.Studies show that this type of event causes a dramaticincrease in appeal for access to emergency or hospital fa-cilities, and that disaster preparation needs to includethe specific needs of patients reliant on electricallydriven devices [76–78]. Regarding human factorsimpacting on safety aspects, one article assessed the suit-ability of a particular theoretical framework for under-standing safety-critical interactions of patients usingmedical devices in the home [79], while Tennankoreet al. [80] described adverse events in home haemodialy-sis by the use of patients. It was remarkable that none ofthe articles focused on human factors with regard to theuse of medical technologies at home by nurses or otherprofessional caregivers.

Design and technological developmentOf those articles that focused on this topic, ten reportedon the comparison between different types of medicaltechnologies, or their advantages and disadvantages. Thecomparison of different devices for oxygen therapy wasmade by two articles [81, 82] and one reported on thecomparison of two types of enteral nutrition tubes [83].Some studies regarding respiratory support consideredthe process of making a choice between different typesof devices [84–86] while one paper considered the con-ditions for home-based haemo dialysis [87]. A minority,explored the individual characteristics and the clinicalapplications of several devices for respiratory support[88, 89] and one considered devices for insulin pumptherapy [90]. Seven papers discussed the technologicaldevelopment or effectiveness of medical technologies.The testing of devices for external electro-stimulationwas described in two papers [91, 92], with the testing ofa new design patient lift was subject of one study [93].Hanada and Kudou [94] explored the current status ofelectromagnetic interference with medical devices in thehome setting, an issue of importance as more devicesare considered for home use. The technological develop-ment of respiratory support for home use was part ofone study [95], as were the possibilities of solar-assistedhome haemo dialysis [96]. While the study by Pourtier[97] describes the advantages of analgesia pumps thatcan be read remotely by nurses, but also emphasizes thecentral position of a professional nurse in the transfer ofinformation within a multi-disciplinary team.

Application with regard to certain diseases or disorders,indications for and extent of useAll articles described several aspects that need to beconsidered for use, such as clinical characteristics of the


patients, indications for the use in the home setting, thetechnical availability of devices, the extent of their use athome or eventual complications and morbidity. It wasimportant to note that all but one article (n = 6) wereabout children or related to adults with what are usuallyregarded as paediatric diseases. Results show that theuse of AMTs at home among children after hospitaldischarge is common (in 20%–60% of cases), or is stand-ard for patients with some disorders [98–101]. Thetimely application of advanced home medical technologybenefits patients and can help to reduce respiratorymorbidity [102]. Nevertheless, the rate of death of pa-tients with Möbius syndrome using the devices at homewas high (30%) [98], as was that of patients with intes-tinal failure dependent on home parental nutrition ther-apy in Brazil (75% for 5 years) [103]. The averagecumulative survival of children needing home ventilationwas found to be between 75 and 90%, depending on themedical diagnosis [104].

Policy and managementThree of the papers were concerned with costs and/orreimbursement. The application of medical technologiesin the home environment can be cost-effective whencompared to institutionalized care [22, 105, 106]. Never-theless, successful employment of medical technologiesin the home necessitates medical guidelines for the indi-cators for use, careful identification of patients as well ascareful planning and attention to details [105–107]. Twostudies concerned the dilemma’s for implementation ofthe technologies in home healthcare and emphasized theimportance of cooperation in the chain of key stake-holders to maximize efficiency of high-tech healthcare athome, one with regard to the purchasing policy of med-ical technologies [108] and one with regard to the inter-ventions of local community service centres andhospitals supporting optimal use of these technologies inthe home setting [5].

DiscussionThe use of medical technologies in the home settinghas drawn increased attention in health care over thelast 15 years, as the feasibility of this type of medicalsupport has rapidly grown. This article systematicallyreviewed the international literature with regard to thestate of the art on this subject, in order to provide acomprehensive overview.Trend analysis over the period 2000–2015 shows that

most research has been conducted about respiratorysupport, dialysis and oxygen therapy; relatively littleabout vacuum assisted wound closure and continuouspassive motion, and no about decubitus treatment,skeletal traction and UV therapy. A substantial increasein publications was found in the period 2011–2015.

Although the number of studies on technologies is indica-tive of the extent to which they are used in home settings,however, no firm conclusions can be drawn about this.This review also identified that most research is con-

ducted with regard to ‘user experiences’ of medical tech-nologies in the home, ‘safety, risks, incidents andcomplications’, and ‘design and technological develop-ment of medical technologies’. There have been rela-tively few studies which have explored the topic oftraining, instruction and education. Content analysisshowed that the use of AMTs in the home setting canhave both a positive and a negative psychosocial impacton the patients and their families, and that it has be-come part of self-management and patient empower-ment. Successful use of advanced equipment requiresadequate education and training programmes for bothpatients, informal caregivers and nurses or other profes-sionals. When trying to maximize or assure safety,technological, environmental and human factors have tobe taken into account, and it is evident that human fac-tors are the main reason for critical incidents. Studies onthe design and technological development of medicaltechnologies emphasize that research is necessary to im-prove its possibilities and effectiveness. The researchfound on the application of the technologies focusedpredominantly on children and the results indicate thatthe rate of the use of home medical devices among chil-dren after hospital discharge is common. Also that whencompared to institutionalized care, the application ofmedical technologies in the home environment can becost-effective. Much is known, but information on sev-eral key issues is limited or lacking.An important finding was that in almost all the

reviewed articles, the study subjects were patients or in-formal caregivers with very few studies focused on therole and activities of nurses or other professionals asusers. This was unexpected as nurses are the main groupof users of AMTs at home and they have to transferknowledge and skills on how to use the devices to pa-tients and other caregivers. Nurses also have a key rolein setting up and maintaining collaboration between allactors involved in the process of care with regard to theuse of home medical technologies and in giving supportto patients and family members in this respect. There isneed to initiate further in depth research on AMTs useat home focusing on the role of specifically nurses.Another interesting result was that, despite the fact

that most adverse events with AMTs at home are causedby human factors, hardly any studies conducted on thissubject were found. None of the articles focused on re-lated human factors regarding the use by nurses or otherprofessional caregivers, although this is the main usergroup. Research on this area could contribute to im-proved patient safety and quality of care. The results also


revealed the tension between the advantages and disad-vantages of medical technologies as experienced by pa-tients at home. Important aspects needed to promotethe benefits include improving the user-friendliness ofthe devices and attuning their designs for the use inhome settings. This emphasizes the importance of pro-fessionals (and patient groups) working together withthe designers with regard to sharing knowledge and userexperiences of the use of AMTs at home in order to im-prove quality of care and patient safety. This collabor-ation emerged as of key importance in the successful useof AMTs in the home as well.Although all included articles were retrieved from aca-

demic databases and served our purpose, there was con-siderable heterogeneity of quality of the studies. Most ofthe studies have explicitly described their research de-sign, albeit to a greater or lesser extent. On the otherhand, there were a few studies that did not even mentiontheir methodological approach, though it could be de-rived from the description. Most included reviews are ofmoderate quality. Although findings are almost alwaysdescribed clearly, the search strategy and selection cri-teria used are often lacking. The quantitative studies aregenerally well described in different methodological as-pects, such as selection of respondents, research design,data collection methods and analyses. Studies of qualita-tive nature show more variation in the depth with whichthe design is described. However, almost all qualitativestudies have described the research instruments verywell, such as semi-structured interviews or question-naires. Despite the varying quality of the studies, we be-lieve that the whole of different methodologicalapproaches and the relatively large number of includedstudies (n = 87) has yielded a fairly reliable overview onthe international state of art concerning various aspectsof the use of advanced medical technologies at home.For future research, we recommend to emphasize thedevelopment of a more detailed methodological design,zooming in on specific technologies, using large data-bases or conducting large surveys, and focusing on spe-cific groups of respondents. Both in quantitative and inqualitative studies, a good definition of the researchquestion(s), selection of respondents, development of in-struments and analysis of findings, contributes to valid-ity, consistency and neutrality.Some limitations do have to be taken into account

with this review. Although we used the RIVM-definitionof ‘advanced medical technology’, not all devices are con-sidered as ‘complex devices’ by nurses in practice. Forexample, the use of an anti-decubitus mattress in thecontext of ‘decubitus treatment’ and ‘patient liftinghoists’ are considered by nurses as being of less or lowercomplexity. However, overall the RIVM-classificationwas found to be a good starting point, and provided a

practical and useful framework from which to work togain an insight and overview of available medical tech-nologies. Of some of the chosen technologies definedusing the RIVM-classification of AMTs, questions dohave to be asked as to whether they really are part of thetechnical skills in nursing process. For example, ‘externalelectrostimulation’ and ‘continuous passive motion’ aremainly applied by physiotherapists, although withappropriate training nurses can apply them. Then too,devices regarded as only ‘monitoring’ were excludedfrom the review.

ConclusionsThis systematic review study was designed to fill a gap inthe current research by investigating what is known aboutdifferent aspects of medical technologies used in thehome. From the results it is obvious that a wide and grow-ing range of medical technologies are used at home. Dif-ferent types of technologies have been subject of study,increasingly –also in scope- over the period 2011–2015.Professional nurses have a central role in the process

of homecare which has to be recognized when consider-ing use of AMTs at home. Nurses have to support pa-tients and family caregivers and in consequence have akey role in providing information for, and as a memberof multi-disciplinary teams. Closer collaboration by allactors involved in the process of care and feedback ofuser experiences to the designers is essential for theprovision of high quality of care and patient safety.This review also identified a lack of research exploring

the perspectives of nurses in the processes involved inintroducing and maintaining technology in homecare.Most of the research has been conducted regarding theexperiences of patient experience and how informalcaregivers perceive their role in using medical technolo-gies at home. The few studies that were found, demon-strate the need for more research focused on theexperiences of nurses working with advanced technologiesin the home. The same applies to research on training, in-struction and education to use medical technologies, as inthese areas too, there was limited available research sohere again there is need for further research. Despite thefact that most adverse events with medical technologies inhome settings are caused by human factors, our findingsalso identified a lack of research in this area for nurses.This study demonstrates that, although there is in-

creasing attention on and recognition of the need for theuse of medical technologies in the environment of thehome, the research has not kept pace with the advancesin care. Subjects such as user experiences of nurseswith different technologies, training, instruction andeducation of nurses and human factors by nurses inrisk management and patient safety urgently need tobe investigated by further research.


AbbreviationsAED: Automatic external defibrillator; AMT: Advanced medical technology;CPAP: Continuous positive airway pressure; EC: European Commission;IT: Information technology; NCHS: National Center for Health Statistics;NPV: Negative pressure ventilation; PICCs: Peripherally inserted centralcatheters; RCT: Randomized Control Trial; RIVM: National Institute for PublicHealth and the Environment; UV: Ultraviolet; VAD: Ventricular assist device;WHO: World Health Organization

AcknowledgementsThe authors thank Ronnie van de Riet, head of the Medical Technical CareTeam of the hospital ZiekenhuisGroep Twente, for his time and commitmentto this project.

FundingNot applicable.

Availability of data and materialsThe dataset generated and/or analyzed during the current study areavailable in Table 3.

Authors’ contributionsAll authors meet the criteria for authorship and all those entitled to authorshipare listed as authors. ITH made the conception and design of the study;acquisition, analysis and interpretation of data; and drafting the article. SBA andWVH have made substantial contributions to the conception and design of thestudy; the analysis and interpretation of data; and revising the article criticallyfor important intellectual content. All authors have approved the final article,this submission and its publication.

Author’s informationIngrid ten Haken is researcher in the research group Technology, Health &Care at Saxion University of Applied Sciences, Enschede, The Netherlands.Somaya Ben Allouch is head of the research group. Wim van Harten isprofessor at the University of Twente, Faculty Behavioural, Management andSocial Sciences, department Health Technology & Services Research and CEOof Rijnstate general hospital, Arnhem, The Netherlands.

Ethics approval and consent to participateNot applicable.

Consent for publicationNot applicable.

Competing interestsThe authors declare that they have no competing interests.

Publisher’s NoteSpringer Nature remains neutral with regard to jurisdictional claims inpublished maps and institutional affiliations.

Author details1Saxion University of Applied Sciences, Research Group Technology, Health &Care (TH&C), P.O. Box 70.000, 7500 KB Enschede, The Netherlands.2Department Health Technology & Services Research (HTSR), University ofTwente, Faculty Behavioural, Management and Social Sciences (BMS), Ravelijn5246, P.O. Box 217, 7500 AE Enschede, The Netherlands. 3Rijnstate GeneralHospital, Arnhem, The Netherlands.

Received: 3 October 2017 Accepted: 26 January 2018

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