Background: The number of medical technologies used in home settings has increased substantially over the last 10-15 years. In order to manage their use and to guarantee quality and safety, data on usage trends and practical experiences are important. This paper presents a literature review on types, trends and experiences with the use of advanced medical technologies at home. Methods: The study focused on advanced medical technologies that are part of the technical nursing process and 'hands on' processes by nurses, excluding information technology such as domotica. The systematic review of literature was performed by searching the databases MEDLINE, Scopus and Cinahl. We included papers from 2000 to 2015 and selected articles containing empirical material. Results: The review identified 87 relevant articles, 62% was published in the period 2011-2015. Of the included studies, 45% considered devices for respiratory support, 39% devices for dialysis and 29% devices for oxygen therapy. Most research has been conducted on the topic 'user experiences' (36%), mainly regarding patients or informal caregivers. Results show that nurses have a key role in supporting patients and family caregivers in the process of homecare with advanced medical technologies and in providing information for, and as a member of multi-disciplinary teams. However, relatively low numbers of articles were found studying nurses perspective. Conclusions: Research on medical technologies used at home has increased considerably until 2015. Much is already known on topics, such as user experiences; safety, risks, incidents and complications; and design and technological development. We also identified a lack of research exploring the views of nurses with regard to medical technologies for homecare, such as user experiences of nurses with different technologies, training, instruction and education of nurses and human factors by nurses in risk management and patient safety.
Aims: Prescribing errors among junior doctors are common in clinical practice because many lack prescribing competence after graduation. This is in part due to inadequate education in clinical pharmacology and therapeutics (CP&T) in the undergraduate medical curriculum. To support CP&T education, it is important to determine which drugs medical undergraduates should be able to prescribe safely and effectively without direct supervision by the time they graduate. Currently, there is no such list with broad-based consensus. Therefore, the aim was to reach consensus on a list of essential drugs for undergraduate medical education in the Netherlands. Methods: A two-round modified Delphi study was conducted among pharmacists, medical specialists, junior doctors and pharmacotherapy teachers from all eight Dutch academic hospitals. Participants were asked to indicate whether it was essential that medical graduates could prescribe specific drugs included on a preliminary list. Drugs for which ≥80% of all respondents agreed or strongly agreed were included in the final list. Results: In all, 42 (65%) participants completed the two Delphi rounds. A total of 132 drugs (39%) from the preliminary list and two (3%) newly proposed drugs were included. Conclusions: This is the first Delphi consensus study to identify the drugs that Dutch junior doctors should be able to prescribe safely and effectively without direct supervision. This list can be used to harmonize and support the teaching and assessment of CP&T. Moreover, this study shows that a Delphi method is suitable to reach consensus on such a list, and could be used for a European list.
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In this review article, the authors contextualize the contemporary practice of medical tourism in terms of the concept of worldmaking, which was introduced (in this journal) with two articles a year or two ago by Hollinshead. Here, the authors first contextualize medical tourism in terms of "worldmaking" per medium of the observations of the corporeal realms identified by Alexis de Tocqueville almost 200 years ago. In 1835, de Tocqueville wrote with enthusiasm tinged with nostalgic regret about the new world of American democracy that he then saw as the world of the future. A serious rupture in history took place of which he became a most relevant critic. But there have been (according to Mainil, Platenkamp, and Meulemans) many ruptures since then: that is, there have been short periods of "in-between worlds" that became ever more anchored in the timeline of Western history. Today, they argue that tourism as a field of expertise, practice, and knowledge is intertwined with several other networks of expertise. It is responsible (itself) for many small "ruptures" in these modern times. Mass tourism can be seen as such a shift. Sustainable tourism and the attention paid to climate change would be another such shift. And the authors of this review argue that an interesting and deep-seated case in this regard is medical tourism. They argue here that medical tourism has a great deal of worldmaking capacity, especially by means of the Internet and international marketing tools. It arises in the interstices of the interacting networks of a global world. It crosses borders in line with emerging power structures in a global network, but it also meets local resistance or regional obstacles that are related to other networks. In between these worlds of human experience, various interactions of perspectives on the concept of health itself come to the surface. Within the field of medical tourism different stakeholders play a role in a worldmaking process. Our reviewers from the Low Countries thereby argue that medical tourism itself is responsible for a Tocquevillean rupture within and across our global network society. In their view, medical tourism also constitutes a new hybrid-that is, as a hybrid medical paradigm that seems to be appearing within the performative and productive world of tourism.
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