BACKGROUND: The high number of unnecessary alarms in intensive care settings leads to alarm fatigue among staff and threatens patient safety. To develop and implement effective and sustainable solutions for alarm management in intensive care units (ICUs), an understanding of staff interactions with the patient monitoring system and alarm management practices is essential.
OBJECTIVE: This study investigated the interaction of nurses and physicians with the patient monitoring system, their perceptions of alarm management, and smart alarm management solutions.
METHODS: This explorative qualitative study with an ethnographic, multimethods approach was conducted in an ICU of a German university hospital. Using triangulation in data collection, 102 hours of field observations, 12 semistructured interviews with ICU staff members, and the results of a participatory task were analyzed. The data analysis followed an inductive, grounded theory approach.
RESULTS: Nurses and physicians reported interacting with the continuous vital sign monitoring system for most of their work time and tasks. There were no established standards for alarm management; instead, nurses and physicians stated that alarms were addressed through ad hoc reactions, a practice they viewed as problematic. Staff members\' perceptions of intelligent alarm management varied, but they highlighted the importance of understandable and traceable suggestions to increase trust and cognitive ease.
CONCLUSIONS: Staff members\' interactions with the omnipresent patient monitoring system and its alarms are essential parts of ICU workflows and clinical decision-making. Alarm management standards and workflows have been shown to be deficient. Our observations, as well as staff feedback, suggest that changes are warranted. Solutions for alarm management should be designed and implemented with users, workflows, and real-world data at the core.

As human activity accelerates the global crisis facing wildlife populations, private land conservation provides an example of wildlife management challenges in social-ecological systems. This study reports on the research phase of \'WildTracker\' - a co-created citizen science project, involving 160 landholders across three Tasmanian regions. This was a transdisciplinary collaboration between an environmental organisation, university researchers, and local landholders. Focusing on mammal and bird species, the project integrated diverse data types and technologies: social surveys, quantitative ecology, motion sensor cameras, acoustic recorders, and advanced machine-learning analytics. An iterative analytical methodology encompassed Pearson and point-biserial correlation for interrelationships, Non-Metric Multidimensional Scaling (NMDS) for clustering, and Random Forest machine learning for variable importance and prediction. Taken together, these analyses revealed complex relationships between wildlife populations and a suite of ecological, socio-economic, and land management variables. Both site-scale habitat characteristics and landscape-scale vegetation patterns were useful predictors of mammal and bird activity, but these relationships were different for mammals and birds. Four focal mammal species showed variation in their response to ecological and land management drivers. Unexpectedly, threatened species, such as the eastern quoll (Dasyurus viverrinus), favoured locations where habitat was substantially modified by human activities. The research provides actionable insights for landowners, and highlights the importance of \'messy,\' ecologically heterogeneous, mixed agricultural landscapes for wildlife conservation. The identification of thresholds in habitat fragmentation reinforced the importance of collaboration across private landscapes. Participatory research models such as WildTracker can complement efforts to address the wicked problem of wildlife conservation in the Anthropocene.

One Health is an integrative approach at the interface of humans, animals and the environment, which can be implemented as Research-Practice-Collaboration (RPC) for its interdisciplinarity and intersectoral focus on the co-production of knowledge. To exemplify this, the present commentary shows the example of the Forschungskolleg \"One Health and Urban Transformation\" funded by the Ministry of Culture and Science of the State Government of Nord Rhine Westphalia in Germany. After analysis, the factors identified for a better implementation of RPC for One Health were the ones that allowed for constant communication and the reduction of power asymmetries between practitioners and academics in the co-production of knowledge. In this light, the training of a new generation of scientists at the boundaries of different disciplines that have mediation skills between academia and practice is an important contribution with great implications for societal change that can aid the further development of RPC.
« Une Santé» (en anglais: One Health) est un approche intégratif situé à l’interface entre les humains, les animaux, et l’environnement, qui peut être implémenté tel qu’une collaboration entre recherche et pratique (CRP) grâce à son interdisciplinarité et son accent sur la cocréation du savoir. Pour illustrer ce point, cet article prend le Forschungskolleg « Une Santé et Transformation Urbaine» (en anglais: One Health and Urban Transformation) financé par le Ministère de la Culture et Sciences du gouvernement du Nord-Rhin Westphalie en Allemagne. D’après nos analyses, les facteurs identifiés comme soutenant une meilleure implémentation du CRP pour le programme One Health sont ceux qui permettent une communication constante et une réduction des asymétries causés par le pouvoir entre les praticiens et les entités académiques dans la cocréation du savoir. Sur ce point, l’éducation d’une nouvelle génération de scientifiques, à l’intersection des différentes disciplines et avec des fortes aptitudes à la médiation entre la pratique et le monde académique, est une contribution important avec des grandes implications pour le changement sociétal, et qui peut en outre soutenir le développement du CRP.

Background: Community participation in global health interventions may improve outcomes and solve complex health issues. Although numerous community participatory approaches have been developed and introduced, there has been little focus on \"how\" and \"who\" to involve in the implementation of community-based clinical trials where unequal distribution of power between implementers and communities pre-exists. Addressing how to achieve community-based solutions in a malaria elimination trial in The Gambia, we developed the Community Lab of Ideas for Health (CLIH): a participatory approach that enabled communities to shape trial implementation. Methods: As part of transdisciplinary research, we conducted qualitative research with in-depth interviews, discussions, and observations in 17 villages in the North Bank Region of The Gambia between March 2016 and December 2017. We designed an iterative research process involving ethnography, stakeholder-analysis, participatory-discussions, and qualitative monitoring and evaluation, whereby each step guided the next. We drew upon ethnographic results and stakeholder-analysis to identify key-informants who became participants in study design and implementation. The participatory-discussions provided a co-creative space for sharing community-centric ideas to tackle trial implementation challenges. The proposed strategies for trial implementation were continuously refined and improved through our monitoring and evaluation. Results: The CLIH incorporated communities\' insights, to co-create tailored trial implementation strategies including: village health workers prescribing and distributing antimalarial treatments; \"compounds\" as community-accepted treatment units; medicine distribution following compound micro-politics; and appropriate modes of health message delivery. Throughout the iterative research process, the researchers and communities set the common goal, namely to curtail the medical poverty trap by reducing malaria transmission and the burden thereof. This innovative collaborative process built trust among stakeholders and fully engaged researchers and communities in co-creation and co-implementation of the trial. Discussion: The CLIH approach succeeded in touching the local realities by incorporating a spectrum of perspectives from community-members and discerning project-derived knowledge from local-knowledge. This process allowed us to co-develop locally-oriented solutions and ultimately to co-establish an intervention structure that community-members were ready and willing to use, which resulted in high uptake of the intervention (92% adherence to treatment). Successfully, the CLIH contributed in bridging research and implementation.

Until recently, developing health technologies was time-consuming and expensive, and often involved patients, doctors, and other health care professionals only as passive recipients of the end product. So far, users have been minimally involved in the ideation and creation stages of digital health technologies. In order to best address users\' unmet needs, a transdisciplinary and user-led approach, involving cocreation and direct user feedback, is required. In this context, hackathon events have become increasingly popular in generating enthusiasm for user-centered innovation.
This case study describes preparatory steps and the performance of a health hackathon directly involving patients and health care professionals at all stages. Feasibility and outcomes were assessed, leading to the development of systematic recommendations for future hackathons as a vehicle for bottom-up innovation in health care.
A 2-day hackathon was conducted in February 2017 in Berlin, Germany. Data were collected through a field study. Collected field notes were subsequently discussed in 15 informal meetings among the research team. Experiences of conducting two further hackathons in December 2017 and November 2018 were included.
In total, 30 participants took part, with 63% (19/30) of participants between 25 and 34 years of age, 30% (9/30) between 35 and 44 years of age, and 7% (2/30) younger than 25 years of age. A total of 43% (13/30) of the participants were female. The participation rate of medical experts, including patients and health care professionals, was 30% (9/30). Five multidisciplinary teams were formed and each tackled a specific health care problem. All presented projects were apps: a chatbot for skin cancer recognition, an augmented reality exposure-based therapy (eg, for arachnophobia), an app for medical neighborhood connectivity, a doctor appointment platform, and a self-care app for people suffering from depression. Patients and health care professionals initiated all of the projects. Conducting the hackathon resulted in significant growth of the digital health community of Berlin and was followed up by larger hackathons. Systematic recommendations for conducting cost-efficient hackathons (n≤30) were developed, including aspects of community building, stakeholder engagement, mentoring, themes, announcements, follow-up, and timing for each step.
This study shows that hackathons are effective in bringing innovation to health care and are more cost- and time-efficient and potentially more sustainable than traditional medical device and digital product development. Our systematic recommendations can be useful to other individuals and organizations that want to establish user-led innovation in academic hospitals by conducting transdisciplinary hackathons.