This graduation project consists of the journey of developing a context-specific training system for nurses to administer a paracervical block (PCB) using the medical Chloe Syringe Extension Device (SED). This six-month during project is being carried out on behalf of TU Delft and Chloe Company. The aim of the project is to enable nurses in sub-Saharan Africa (SSA) in low-resource settings (LRS) to competently use the Chloe device for pain management during Manual Vacuum Aspiration (MVA). The outcome of this project is a two-component training system: a job aid and a demonstration device designed to enhance the training experience and guidance for use.

The project approach was implemented using a context-driven design approach, consisting of Research & Analysis, Ideation, Conceptualisation and Evaluation. Literature research on the topic and its context is carried out, while further knowledge is gathered through contacts with sixteen Dutch and Kenyan medical professionals. In addition to individual interviews, two studies are conducted in the Dutch and Kenyan contexts. A six-week field trip to Kisumu, Kenya, during which ten medical professionals in three hospitals were visited, made it possible to ensure that the design truly fits its context. These medical professionals provided valuable input to the iterative design process and helped to shape the final concept design of the training system.

Further designing is enabled through prototyping, the use of decision-making methods and continuous iteration. This allowed new ideas to be generated, tested, and therefore new improvements to be made. Ultimately, new requirements could be identified, providing the opportunity to create even more valuable designs.

Future research should focus on further developing these designs, giving them an embodiment, and creating the possibility of actually implementing the training system in its intended context.

-What-

Medicines are used for all types of surgeries in the operating room (OR). They are needed to provide safe and effective care. However, the use of medicines also results in waste. Research conducted by Barbariol et al. (2021) highlighted that a substantial proportion, ranging from 20% to 50%, of medications prepared in the OR ultimately remain unused and are consequently discarded. The Leiden University Medical Centre (LUMC) and ‘Nationaal Netwerk de Groene OK’ aim to minimize the waste of medicines at the OR.

-Why -

The environmental impact of medicines

Research conducted last year by RIVM presented that the contribution of chemical products, including medicines in particular, is responsible for 41.2% of healthcare CO2

Medicine scarcity

The ‘Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie’ (KNMP), presened that last year in 2022 the highest number of medicine shortage ever occurred. They predict that these kind of issues will only grow more in the further, so it is important to stay mindful about medication prescription, use and disposal.

Ethical obligation

Medication waste raises ethical concerns within the healthcare context. The waste of medications contradicts the principles of equity and justice, as resources that could have been allocated to patients in need are wasted.

-How?-

DrugWise

Consequently, a final concept called ‘DrugWise’ was devised. This sustainable approach targets medicine waste prevention in the OR through a holistic approach. DrugWise consists of five critical steps:
1. Measure the waste to gain an understanding of the current situation.
2. Prioritize areas for action based on the measurements.
3. Raise awareness amongst OR staff regarding the extent and implications of medicine waste.
4. Initiate action in four key areas: medicine use, prescribing practices, stock management, and disposal.
5. Evaluate the effectiveness of the interventions implemented.

The target audience of the approach is the Anaesthesia Green Team. The DrugWise approach was developed in collaboration with the primary stakeholders involved in medication use - anesthesiologists and anaesthetic nurses. This collaboration ensured that the solution was rooted in their practical experience and professional knowledge.

-Future steps-

Looking ahead, LUMC will serve as the pilot hospital for the DrugWise approach. Upon successful implementation and review, the intention is to broaden the reach to other hospitals, advocating for a nationwide effort in reducing medicine wastage in the OR.

Featback is an online self-help program for people with eating problems. Someone has an eating disorder (ED) when their whole life revolves around food and body image (Saha et al., 2022). Featback is developed by GGZ Rivierduinen Eetstoornissen Ursula. It has proven to be effective in reducing ED symptoms (Aardoom et al., 2016a; Rohrbach et al., 2022). For eight weeks, users have to answer four questions per week. Based on these questions, they receive one of 1250 handwritten personal messages. Even though Featback is effective, not many people use it.

Project goal: Make Featback appeal to more adolescents who are struggling with a developing eating problem or eating disorder.
The target group is adolescents, as most people develop their eating disorder as a teen. It takes years before people seek help (de la Rie et al., 2008). However, the sooner someone gets help, the better the chance of recovery (Zipfel & et al., 2015). So, more adolescents must find Featback at the beginning of their eating problems.

Research questions are created to achieve the project goal. These are answered by using contextmapping and literature research.
People do not recognise an ED because of stigmas, denial and poor mental health literacy. Many believe only thin, young, white girls have EDs (Romano & Lipson, 2019). People with an ED do not recognise themselves in this image. Not even when they are extremely underweight. Additionally, people of all sizes, genders and ages can suffer from an ED.

Because it is found that people do not recognise an ED and thus are not looking for (online)help, the design must improve mental health literacy.
The design goal is: Create a website that helps adolescents who are developing an eating disorder improve their mental health literacy regarding eating disorders, to increase self-awareness, so that they will seek help sooner.

The redesign
In phase 1: Mental health literacy, users are educated on eating problems. They get presented with stories of situations related to eating problems. They are asked to judge these stories; his creates distance between the user and the story and creates an interactive experience.
In Phase 2: Recognition, users can do a self-test to create recognition for their eating problems. The self-test results guide them to Phase 3: Help.
In phase 3, users can make use of the online help. They can directly start with week one of the eightweek program without creating an account. In this way, users can experience the interaction without committing, lowering the threshold to use Featback.
The redesign is evaluated with ED patients and experts.

Conclusion
The redesign helps young people understand eating problem symptoms better and stimulates them to seek help. People with an ED feel seen by the website and can reflect on their own behaviour using the stories. The redesign must use other platforms like TikTok, Instagram, and Proud2Bme to attract people to the website. Finding help is hard for people with EDs; they need encouragement to do so. They often do not believe they deserve help. A safe space like fEATback can lower this threshold.

The healthcare system in the Netherlands has trouble finding solutions for its complexity and fragmentation. Until now challenges like shortages, long lead times and lack of communication between stakeholders led to less satisfied customers. Welzorg wants to be able to provide more sufficient service. The customer is often overlooked. So the main question is: What are the needs of the customer and how can we improve satisfaction?

WZ wants to tackle these problems. The target group analysed in this project are young families with children with a disability who request a manual wheelchair. Research findings in the user analysis show a distinction between functional and emotional needs. WZ can meet the functional needs but emotional needs are especially important for this target group and are understated.

WZ wants to be a leader in mobility and knows that this is only possible if they start thinking from the customer’s perspective. Hence the question of how to meet these emotional needs.

The exploration of the Customer Journey Maps and interviews with stakeholders (such as advisors and occupational therapists) led to the insight that the most important emotional needs are clarity, being listened to and having a say in the matter.

To get WZ aboard and more willing to change a vision and three horizons are created and integrated into a roadmap:

Horizon 1, a short-term concept: The Praatplaat, a tool to better inform and engage with the care givers via consultation at the occupational therapist or revalidation center. This makes it easier for the young families to keep track, be engaged and have an overview of the process. For WZ it is an opportunity to strengthen relationships with stakeholders and use attributes they already
possess: experience and expertise about the medical devices.

Horizon 2, a process optimization, in which information exchange between stakeholders (the advisor and the occupational therapist) is proposed for smoother cooperation and sharing of knowledge after conversations with customers. This results in the customer having a sense of recognition and not having to repeat itself every appointment.

Horizon 3, a long-term concept: setting up test-pilots with customers and new suppliers, to improve the product portfolio together and builing new relationships. The result is having the customer feel more understood and involved and for WZ to have validation of the added value to the portfolio.

In conclusion, the new proposals in the roadmap substantiate possibilities for
WZ to innovate and to play into the emotional needs of the customer. This is essential as the goal is to become a leader in the field of mobility and be a step closer to its customer focused vision by offering relevant products.

Understanding how medical-grade Chemical Sterilization and High-Level Disinfection (HLD), and usage of the device in context affect the integrity of the device within its expected lifetime, and to suggest material choice, manufacturing method and recommend design changes for a syringe extension device, to be used for Manual Vacuum Aspiration Procedures in East Africa.

This master thesis tackles the questions: How to involve child patients in their clinical tests and their test results in a child-centred way? How to enable and encourage them to participate in the discussions around their care?
It focuses on the not yet existing (July 2020) context of the Child Brain Lab, a clinical research project that is being set up at the Sophia Children’s Hospital. Here, child patients will undergo a wide variety of tests related to their brain that will take up several hours of their time. Their test results will then be discussed by the clinician and the child-patient family. Without the right supporting design, the Child Brain Lab (CBL) is subject to many of the issues that child patients generally face: Not being able to comprehend the conversations between parents and doctors, not getting the chance to voice their own needs and opinions and suffering anxiety about if, how and why clinical tests will be conducted. This project started with a broad context analysis. This included reviewing the literature, observing consultations, and interviewing a variety of healthcare professionals and child patients. This analysis revealed many possible reasons why child involvement is often limited. For example, it was found that by default, the child patients themselves typically take a rather passive role in discussing their care. These insights were then translated into design drivers that inspired several iterations of design ideas. Consequently, these ideas were used to learn from by discussing them with all main stakeholders of this project. This sparked a second iteration of design drivers that ultimately lead to the brain puzzle concept.
The brain puzzle concept is a collection of avatar-based, personalized puzzle pieces the child patient collects as it goes through the CBL. Each piece comes with a different function and serves a different phase of the CBL experience: The first type of pieces shows the sequence of tests that will be conducted while the second type shows which brain functions those tests investigate. Before the consultation, the child patients also receive an indication of their test results in the form of stickers, which can be placed on the corresponding puzzle piece. With these stickers, both the clinicians and the children can indicate which part they want to discuss. These pieces are then brought to the consultation as a discussion tool and to structure the conversation with more regard for the child’s perspective. To evaluate this concept, a prototype was made and evaluated with child-patients, their parents, and their clinicians in over 17 interviews. The results show that the participants were unanimously positive about the overall design and they would like to see it being implemented. Especially parents and clinicians indicated that the concept would playfully guide the children through the CBL and enable them to discuss what they want to discuss. This thesis concludes by listing areas for improvement of the concept and discusses those in the broader context of informing children about their test results.

This graduation project is on behalf of TU Delft and Zimmer Biomet in collaboration with Orthopedic surgeons from Bergman Clinics, Orthopedic Clinic, in Naarden. The aim of this master thesis was to design a product which could reduce the pollution of harmful noise during hip replacement surgery. Noisy workplaces and especially within this procedure carry a large risk of noise-induced hearing loss, as sound levels of more than 120 decibels are generated by the usage of (powered) instruments. In the analysis phase observations in the operating theatre and interviews with experts are conducted to get insights and background information about the total hip arthroplasty procedures. It was found that noise levels experienced during surgery generated levels above the human pain threshold, ranging between 120-130 decibels and caused temporary and long-term noise induced hearing loss. Via a design vision and a list of requirements multiple concepts where generated. In the embodiment and evaluation phase, cadaver and saw bone testing showed that the new instrument design functioned and implant parts and/or tools could be implanted successfully. The outcome of this project is a new surgical instrument, which can press-fit (impact) and extract various implant components used during surgery. The instrument has multiple unique selling points compared to the currently used mallet as it reduces the noise level with more than 15 decibels and scores better on aspects of safety when looking into the risks at musculoskeletal disorders by improving surgical ergonomics. The instrument could be improved further when looking at the design and the current surgical workflow. Further research and clinical testing is necessary to see if this product is suitable for hip replacement surgery.

This project was performed for the Dutch department of Johnson & Johnson Medical Bv. In order to complete their energy portfolio, Johnson & Johnson acquired Megadyne, a producer of electrosurgical devices. These devices are a new addition to the Johnson & Johnson portfolio, however already available on the Dutch market. The challenge was to come up with a marketing strategy to position Megadyne in the Johnson & Johnson portfolio and implement the Megadyne devices on the Dutch market. To fulfill this challenge, both Johnson & Johnson and Megadyne were analyzed, as well as the market and competitors. The insights of this analysis led to the creation of a marketing strategy. The strategy defines the objectives for Megadyne in 2023. It then elaborates on the targeting of hospitals, providing a list of potential hospitals. This is followed by plans for Megadyne promotion split into promotion for both user and buyer. Finally, the strategy offers pricing solutions and portfolio recommendations that in combination with the targeting and promotion solutions contribute to achieving the objectives.

Cancer is the second leading cause of death globally. Researchers are continuously investigating new ways to develop and improve cancer treatments. Currently, remarkable progress has been made in immunotherapy. This treatment uses monoclonal antibodies to enhance or recover the patient’s immune system to destroy the cancer cells. However, these new treatments are expensive and not tailored to the patient’s need.

As a solution, Prof. Schellekens, from the Pharmaceutical department at the university in Utrecht, and his colleagues, proposed to add the antibody manufacturing to the magistral preparation procedures in a pharmacy. This allows the pharmacist to produce medicine for only one individual patient which does not have to comply with the regulations commercially produced medicine have to. This would result in a less expensive medicine which can be adapted to the patient’s specific needs.

To realize this idea, pharmacists need to be able to manufacture those antibodies. Therefore, the concept arose for creating a manufacturing unit to enable pharmacists to produce personalized medicine for patient use. This concept is called: the Bio-Nespresso.

Through user, context and technology analysis, the vision arose for designing a machine that enables a hospital pharmacist’s assistant to manufacture 30 grams of monoclonal antibodies in a sterile and reliable way, without requiring any specific knowledge about antibody manufacturing. To realize this, a new party was introduced: The Supplier. This party delivers all antibody production-specific elements to the hospital pharmacy, enabling the pharmacist and pharmacist’s assistant to only focus on patient care and executing the production process.

This project resulted in a first design of the Bio-Nespresso. The machine provides the ability to produce different doses of medicines, up to an entire treatment. All production-specific elements are integrated into four disposable units, which together form a closed system to prevent contamination. The machine will guide and monitor the users actions when installing these disposables.

The design demonstrates what the stationing of the Bio-Nespresso at a hospital pharmacy should look like. This resulted in concrete challenges which can serve as a starting point for the development of the proof of concept.