Understanding Iconography: a method to allow rich picture interpretation to improve.

Information Systems for complex situations often fail to adequately deliver quality and suitability. One reason for this failure is an inability to identify comprehensive user requirements. Seldom do all stakeholders, especially those "invisible‟ or "back room‟ system users, have a voice when systems are designed. If this is a global problem then it may impact on both the public and private sectors in terms of their ability to perform, produce and stay competitive. To improve upon this, system designers use rich pictures as a diagrammatic means of identifying differing world views with the aim of creating shared understanding of the organisation. Rich pictures have predominantly been used as freeform, unstructured tools with no commonly agreed syntax. This research has collated, analysed and documented a substantial collection of rich pictures into a single dataset. Attention has been focussed on three main research areas; how the rich picture is facilitated, how the rich picture is constructed and how to interpret the resultant pictures. This research highlights the importance of the rich picture tool and argues the value of adding levels of structure, in certain cases. It is shown that there are considerable benefits for both the interpreter and the creator by providing a pre-drawing session, a common key of symbols and a framework for icon understanding. In conclusion, it is suggested that there is some evidence that a framework which aims to support the process of the rich picture and aid interpretation is valuable.

A randomised controlled trial evaluating a rehabilitation complex intervention for patients following intensive care discharge: the RECOVER study.

Introduction: Patients who survive an intensive care unit admission frequently suffer physical and psychological morbidity for many months after discharge. Current rehabilitation pathways are often fragmented and little is known about the optimum method of promoting recovery. Many patients suffer reduced quality of life. Methods and analysis: The authors plan a multicentre randomised parallel group complex intervention trial with concealment of group allocation from outcome assessors. Patients who required more than 48 h of mechanical ventilation and are deemed fit for intensive care unit discharge will be eligible. Patients with primary neurological diagnoses will be excluded. Participants will be randomised into one of the two groups: the intervention group will receive standard ward-based care delivered by the NHS service with additional treatment by a specifically trained generic rehabilitation assistant during ward stay and via telephone contact after hospital discharge and the control group will receive standard ward-based care delivered by the current NHS service. The intervention group will also receive additional information about their critical illness and access to a critical care physician. The total duration of the intervention will be from randomisation to 3 months postrandomisation. The total duration of follow-up will be 12 months from randomisation for both groups. The primary outcome will be the Rivermead Mobility Index at 3 months. Secondary outcomes will include measures of physical and psychological morbidity and function, quality of life and survival over a 12-month period. A health economic evaluation will also be undertaken. Groups will be compared in relation to primary and secondary outcomes; quantitative analyses will be supplemented by focus groups with patients, carers and healthcare workers. Ethics and dissemination: Consent will be obtained from patients and relatives according to patient capacity. Data will be analysed according to a predefined analysis plan.