[Do COPD patients lie about their smoking habit?]

OBJECTIVE

To determine the deception rate or concordance between the interview on smoking and cooximetry in COPD patients from a monographic consultation.

DESIGN

Prospective observational study to evaluate the concordance between the values of cooximetry and the response to a clinical interview on smoking.

SETTING

COPD monographic consultation, Pneumology, Seville.

PARTICIPANTS

Patients with a confirmed diagnosis of COPD in any degree.

INTERVENTIONS

Clinical interview and measurement of carbon monoxide by cooximetry.

MAIN MEASUREMENTS

Cooximetry values, responses on smoking, sociodemographic variables.

RESULTS

n: 169. 107 patients presented values less than or equal to 6 ppm compared to 62 with values greater than 6 ppm, determining a prevalence of active smoking of 36.7%. The deception rate was 19.5% of the total sample (24.3% of all those who claimed not to smoke), with a Cohen kappa of 0.48 and p < 0.000. 40% of patients confessed not having told the truth. No relationship of this data was found with age, accumulated tobacco consumption or FEV1. A significant relationship with sex was found (deception rate: 31.8% in women vs. 15.2% in men, p 0.017).

CONCLUSIONS

In spite of our attempts to make patients stop smoking, a considerable deception rate was found in our consultation; higher among women, recent ex-smokers or in the process of abandonment, so it would be essential to incorporate objective measures such as the cooximeter in the approach of this type of patient.

Improving peri-operative psychosocial interventions for children with autism spectrum disorder undergoing ENT procedures

OBJECTIVES

Children with autism spectrum disorder face a broad range of communication and sensory challenges. Many of these children also have chronic ENT issues. This study aims to better understand these challenges and improve our services for children with autism spectrum disorder.

METHODS

Questionnaires and semi-structured interviews were carried out with parents of children with autism spectrum disorder.

RESULTS

Thirty-four individuals participated, comprising 9 caregivers and 25 staff members. All parents recognised their critical roles in understanding their children's special needs and sensitivities. Parents and staff stressed the importance of a partnership role that inquired about unique needs, leading to environmental modifications for individual children.

CONCLUSION

The importance of listening to and involving caregivers is a fundamental tenet; parents must be recognised as the experts. Uncertainty must be kept to a minimum, with clear communication in a structured, low-arousal environment for these children. We have listened to parents and staff, and developed a social story.

Interviews with experts in rare diseases for the development of clinical decision support system software - a qualitative study

BACKGROUND

Patients with rare diseases (RDs) are often diagnosed too late or not at all. Clinical decision support systems (CDSSs) could support the diagnosis in RDs. The MIRACUM (Medical Informatics in Research and Medicine) consortium, which is one of four funded consortia in the German Medical Informatics Initiative, will develop a CDSS for RDs based on distributed clinical data from ten university hospitals. This qualitative study aims to investigate (1) the relevant organizational conditions for the operation of a CDSS for RDs when diagnose patients (e.g. the diagnosis workflow), (2) which data is necessary for decision support, and (3) the appropriate user group for such a CDSS.

METHODS

Interviews were carried out with RDs experts. Participants were recruited from staff physicians at the Rare Disease Centers (RDCs) at the MIRACUM locations, which offer diagnosis and treatment of RDs. An interview guide was developed with a category-guided deductive approach. The interviews were recorded on an audio device and then transcribed into written form. We continued data collection until all interviews were completed. Afterwards, data analysis was performed using Mayring's qualitative content analysis approach.

RESULTS

A total of seven experts were included in the study. The results show that medical center guides and physicians from RDC B-centers (with a focus on different RDs) are involved in the diagnostic process. Furthermore, interdisciplinary case discussions between physicians are conducted. The experts explained that RDs exist which cannot be fully differentiated, but rather described only by their overall symptoms or findings: diagnosis is dependent on the disease or disease group. At the end of the diagnostic process, most centers prepare a summary of the patient case. Furthermore, the experts considered both physicians and experts from the B-centers to be potential users of a CDSS. The experts also have different experiences with CDSS for RDs.

CONCLUSIONS

This qualitative study is a first step towards establishing the requirements for the development of a CDSS for RDs. Further research is necessary to create solutions by also including the experts on RDs.

Exploring the nausea experience among female patients with breast cancer; A pilot interview study

•

Nausea is a complicated symptom to report and measure in clinical trials.

•

Better understanding the nausea experience will improve clinical trial designs.

•

Patients have preferences for symptom definitions and nausea grading scales.

•

Patients experience different intensities of nausea.

•

Describing nausea sub-features like duration, timing and character is difficult.

Introduction

Nausea is a difficult symptom to report and measure in clinical trials. We conducted a pilot interview study to improve our understanding of the nausea experience.

Materials and methods

Female patients with breast cancer that had experienced nausea during radiation therapy and/or chemotherapy underwent semi-structured interviews that focused on patient-defined and standard definitions, preferences for nausea grading scales, and nausea sub-features: intensity, location, timing/duration, character, associated symptoms, precipitating/alleviating factors, impact on quality of life.

Results

10 patients were interviewed. Patients defined nausea more variably than vomiting and retching/dry heaving. An ordinal grading scale with a 0–10 intensity range was preferred over visual-analogue and qualitative scales. Patients had experienced different intensities of nausea and deemed reporting their worst, average and least intensities feasible. High-intensity episodes were deemed more problematic than low-intensity episodes regardless of their duration. The duration and character of nausea were difficult to describe. A range of associated symptoms, precipitating and alleviating factors were documented. Nausea had a detrimental impact on quality of life.

Conclusions

Nausea has a range of subjective and objective features. Our pilot study provided valuable information that will inform the design of a planned larger survey study. Creating an operational clinical trial definition for nausea appears feasible.

A health concept with a social potential: an interview study with nursing home residents

Background

A qualitative, interview-based study was embedded in a randomized intervention trial, the Older People Exercise and Nutrition (OPEN) study. Participants in the OPEN study were encouraged to conduct sessions of sit-to-stand (STS) exercises combined with Oral Nutritional Supplements (ONS) intake. The aim was to describe the older persons’ perceptions and experiences of being given the daily opportunity to perform the STS exercise and drink ONS.

Methods

In-depth interviews were conducted in six nursing homes with the participants using a semi-structured interview guide. One or two individual interviews were performed with each included participant. Twenty-three NH residents (16 women and 7 men) participated in the qualitative study. Their ages ranged between 76 and 96 years, and their Mini Mental State Examination (MMSE) scored between 8 and 29. The transcribed interviews and field notes written during the visits were analyzed inductively following a constant comparative method described in Grounded Theory.

Results

The exercise and nutritional intervention was described as highly practical by the NH residents, who claimed it also had a social aspect as they felt acknowledged and empowered to engage others in the combined intervention. Experiences of the intervention ranged from neutral to mainly positive and could be sorted into 5 categories: 1. Perceived hopes and expectations, 2. Health-related driving forces, 3. Appreciated daily activities, 4. A concept easy to perform and integrate into daily life, 5. A beneficial health concept for all. The intervention created perceived benefits on various health aspects due to participants feeling energized and stronger. An overall theme was identified as A health concept with a social potential, as participants feel acknowledged and strong enough to help others.

Conclusions

The intervention was described by participants as a health concept that could potentially be beneficial for a broader spectrum of NH residents. The findings indicate that health concepts, such as STS/ONS, might contribute to a more meaningful day for older people, even vulnerable NH residents approaching the end of life.

Trial registration

ClinicalTrials.govIdentifier: NCT02702037. Date of trial registration February 26, 2016.

Video Interviewing: A Review and Recommendations for Implementation in the Era of COVID-19 and Beyond

Due to the COVID-19 pandemic, it is very likely that many radiology residency and fellowship programs will adopt interactive videoconference interviewing for the 2020-2021 residency match cycle. Although video interviewing has become a common part of the hiring process for business, experience with video interviewing for resident and fellow selection has been limited. Advantages of video interviews over traditional on-site interviews include cost-savings to both applicants and residency programs, less disruption to an applicant's educational activities, and potential for training programs to access a wider pool of candidates. The loss of the casual interactions that occur during an on-site interview and the inability of candidates to evaluate training facilities and their surrounding environments in-person are among the obstacles posed by video interviews, but training programs can mitigate these challenges with enhanced website content and creative media solutions. Through a review of the existing literature and internet resources, this article recommends specific measures medical schools, applicants, and radiology residency and fellowship programs can take to optimize the virtual interview experience for all involved parties.

Transition to multiple mini interview (MMI) interviewing for medical school admissions

INTRODUCTION

The multiple mini interview (MMI) has been incorporated into the holistic review process in the selection of students to US medical schools. The MMI has been used to evaluate interpersonal and intrapersonal attributes which are deemed as necessary for future physicians. We hypothesized that there would be little difference in overall MMI evaluation data compared with traditional interview ratings.

METHODS

The University of North Carolina School of Medicine developed an interview process that included a traditional interview and MMI format during the 2019 admissions cycle. Evaluation data along with key demographic variables for 608 MD program applicants were analyzed using descriptive and inferential statistical analyses.

RESULTS

The MMI format slightly favored female over male applicants (p = 0.002) but did not select for or against applicants based on age, race/ethnicity, underserved/rural area upbringing, or indicators of disadvantage. Out of 608 applicants, 356 (59%) completed a post-interview survey in which the experience was positively rated.

DISCUSSION

Based on our experience, the use of a hybrid model of traditional interviews complemented with MMI stations provided greater details in the assessment of medical school applicants while obtaining equivalent data and acceptability amongst applicants.

How do family-caregivers of patients with advanced cancer provide symptom self-management support? A qualitative study

PURPOSE

The family-caregiver role is of critical importance to the success of symptom-related self-management of patients with advanced cancer. This study examined the perspectives of patients and family-caregivers regarding the role of the family-caregiver in symptom-related self-management support ( SMS).

METHODS

Semi-structured interviews were conducted in patients with advanced cancer experiencing significant symptom burden and their family-caregivers. An inductive content analysis approach was used to analyse data.

RESULTS

Eleven patients and ten family caregivers were included. Identified themes were 1) engaging in specific symptom-related SMS; 2) interacting with health care professionals; and 3) balancing patient need versus expectation. These themes were applicable to both the family-caregiver and patient cohorts, regardless of the individual symptom profile of each patient.

CONCLUSIONS

The role of family-caregivers of patients with advanced cancer is complex and varied in providing symptom-related SMS at home; often requiring family-caregivers to have diverse knowledge and skills in the management of a range of cancer-related symptoms. Health care professionals can support family-caregivers by anticipating needs, tailoring evidence-based information to those needs, and ensuring family-caregivers have an appropriate contact point for advice or help.

The Effects of a Life Stress Emotional Awareness and Expression Interview for Women with Chronic Urogenital Pain: A Randomized Controlled Trial

OBJECTIVE

Women with chronic urogenital pain (CUP) conditions have elevated rates of lifetime trauma, relational stress, and emotional conflicts, but directly assessing and treating psychological stress is rarely done in women's health care settings. We developed and tested the effects on patients' somatic and psychological symptoms of a life stress interview that encourages disclosure about stressors and uses experiential techniques to increase awareness of links between stress, emotions, and symptoms.

METHODS

In this randomized trial, women with CUP recruited at a multidisciplinary women's urology center received either a single 90-minute life stress interview (N = 37) or no interview (treatment-as-usual control; N = 25). Self-report measures of pain severity (primary outcome), pain interference, pelvic floor symptoms, and psychological symptoms (anxiety and depression) were completed at baseline and six-week follow-up.

RESULTS

Differences between the life stress interview and control conditions at follow-up were tested with analyses of covariance, controlling for baseline level of the outcome and baseline depression. Compared with the control condition, the interview resulted in significantly lower pain severity and pelvic floor symptoms, but the interview had no effect on pain interference or psychological symptoms.

CONCLUSIONS

An intensive life stress emotional awareness expression interview improved physical but not psychological symptoms among women with CUP seen in a tertiary care clinic. This study suggests that targeting stress and avoided emotions and linking them to symptoms may be beneficial for this complex group of patients.

Acceptability and feasibility of the mHealth intervention 'MyDayPlan' to increase physical activity in a general adult population

Background

Electronic health (eHealth) and mobile health (mHealth) interventions have the potential to tackle the worldwide problem of physical inactivity. However, they often suffer from large attrition rates. Consequently, feasibility and acceptability of interventions have become important matters in the creation of e- and mHealth interventions. The aim of this study was to evaluate participants’ opinions regarding acceptability and feasibility of a self-regulation, app-based intervention called ‘MyDayPlan’. ‘MyDayPlan’ provides an innovative daily cycle providing several self-regulation techniques throughout the day that guide users towards an active lifestyle via various self-regulation techniques.

Methods

Semi-structured interviews were conducted with 20 adults after using the app for 2 weeks. A directed content analysis was performed using NVivo Software.

Results

‘MyDayPlan’ was well-received and seems to be feasible and acceptable with inactive adults. The straightforward lay out and ease of use of the app were appreciated. Furthermore, the incorporation of the techniques ‘action planning’, and ‘prompting review of behavioral goals’ was positively evaluated. However, the users gave some recommendations: implementation of activity trackers to self-monitor physical activity could be of added value. Furthermore, increasing intuitiveness by minimizing text input and providing more preprogrammed options could further increase the ease of use. Finally, users indicated that they would benefit from more guidance during the “coping planning” component (barrier identification/problem solving), for example by receiving more tailored examples.

Conclusions

Based on these findings, adaptations will be made to the ‘MyDayPlan’ app before evaluating its effectiveness. Furthermore, involving potential end users and evaluating acceptability and feasibility during the development of an e- and mHealth intervention is key. Also, creating interventions with a large ease of use and straightforward layout that provides tailored support during action and coping planning is key.

Parents' and nurses' ideal collaboration in treatment-centered and home-like care of hospitalized preschool children - a qualitative study

Background

The hospitalization of children requires collaboration between parents and nurses in partnerships. This study examines parents’ and nurses’ experiences of ideal collaboration in treatment-centered and home-like care of hospitalized preschool children.

Methods

This qualitative study is part of a larger study of 12 parents and 17 nurses who were responsible for 11 hospitalized children. Data collection took place at a Norwegian general paediatric unit, and the data were gathered from observations of and qualitative interviews with the parents and nurses. The analysis was conducted in six steps, in alignment with Braun and Clarke.

Results

Two essential themes emerged from the analysis. (1) Treatment-centered care focuses on the following tasks in building relationships – gaining trust, securing – gaining voluntariness, distracting and comforting, and securing and gaining voluntariness. The purpose of treatment-centered care is to perform diagnostic procedures and offer treatment. (2) Home-like care, the purpose of which is to manage a child’s everyday situations in an unfamiliar environment, focuses on the following tasks: making familiar meals, maintaining normal sleeping patterns, adjusting to washing and dressing in new situations, and normalizing the time in between. From this pattern, we chose two narratives that capture the essence of ideal collaboration between parents and nurses.

Conclusion

The ideal collaboration between nurses and parents is characterized by flexibility and reciprocity, and is based on verbal and action dialogues. In treatment-centered care, parent-nurse collaboration was successful in its flow and dynamic, securing the children’s best interests. Meanwhile, the achievement of the children’s best interest within home-like care varied according to the level of collaboration, which in turn was related to the complexity of the children’s everyday situations.

Qualitative Interviews to Better Understand the Patient Experience and Evaluate Patient-Reported Outcomes (PRO) in RLBP1 Retinitis Pigmentosa (RLBP1 RP)

INTRODUCTION

RLBP1 RP is an autosomal recessive form of retinitis pigmentosa (RP), characterized by night blindness, prolonged dark adaptation, constricted visual fields and impaired macular function. This study aimed to better understand the patient experience of RLBP1 RP and evaluate the content validity of existing patient reported outcome (PRO) instruments in this condition.

METHODS

Semi-structured concept elicitation and cognitive debriefing interviews were conducted with RLBP1 RP patients in Canada and Sweden. Interviews started with open-ended concept elicitation questioning, and then patients were cognitively debriefed on The National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25), the Low Luminance Questionnaire (LLQ) and four light/dark adaptation items of the Visual Activities Questionnaire (VAQ). Qualitative interviews were also conducted with three expert clinicians. Anonymized, verbatim transcripts were analyzed using thematic analysis.

RESULTS

Twenty-one patients were interviewed (Canada n = 10; Sweden n = 11). Symptoms reported included night blindness (n = 21), difficulty adapting to changes in lighting (n = 21) and difficulties seeing in bright lighting (n = 18). Patients experienced substantial impacts on daily activities (n = 21) and physical functioning (n = 17). Patients had difficulty interpreting and selecting a response for some items in the NEI VFQ-25 and LLQ. Some items were not relevant to patients' disease experience. There were both gaps and overlaps in the conceptual coverage of the instruments.

CONCLUSIONS

Visual impairment due to RLBP1 RP has a substantial impact on physical functioning and daily activities. To adequately assess all important symptoms and associated functional impacts in RLBP1 RP, it is recommended to either modify one or more existing instruments or to develop a new non-syndromic RP specific instrument.

Giving a Voice to Gambling Addiction: Analysis of Personal Narratives

Gambling addiction (GA) is now considered a worldwide health issue. Although the topic of disorder awareness is a central issue in clinical practice, there are few studies examining this dimension in relation to GA. To bridge this gap, we conducted a qualitative study, administering interviews focused on awareness of GA and eliciting narratives of both the disorder and the whole life of participants. We adopted both qualitative and quantitative methods of research, using computer-aided content analysis. We administered to a sample of 15 treatment-seeking gamblers the Psychiatric Interview for Gambling Addiction and performed a qualitative analysis of the text using the T-Lab software. Five main thematic domains and four factors emerged, shedding light on specific aspects underlying the development of and recovery from GA. Specifically, the results suggested that dissociation processes, materialistic thinking and difficulties in social achievement underlie the subjective experience of GA. Moreover, closeness in interpersonal relationships and awareness of the disorder emerged as core features in the process of change. As a whole, the results highlight the specificities of disorder awareness in addicted gamblers. We discuss these results within the context of previous research and suggest clinical implications for the treatment of GA.

Night-shift nurses and drowsy driving: A qualitative study

BACKGROUND

Drowsy driving following the night shift is persistent among nurses resulting in elevated rates of vehicle crashes and crash-related injuries and deaths. While considerable effort has been dedicated to the development of countermeasures, implementation of these countermeasures in nursing has lagged behind other shift work oriented industries. Developing effective countermeasures for drowsy driving in nurses requires a thorough characterization of nurse's perceptions of drowsy driving and potential mitigations.

OBJECTIVE

The objective of this research was to elicit night shift nurses' perceptions of drowsy driving, countermeasures, and educational and technological interventions.

DESIGN

Perceptions were elicited through a semi-structured interview protocol. The protocol design was driven by previously identified research gaps. Questions focused on four topics: perceptions of drowsy driving, current practices and methods to mitigate drowsiness during the shift and commute, preferences and expectations for training on drowsiness management, and, preferences and expectations for technological mitigations.

SETTING

The data collection took place at a large urban hospital in Texas, USA.

PARTICIPANTS

Thirty night-shift nurses were recruited with voluntary sampling. No nurses declined to participate after initially consenting. The participants were male and female nurses who currently worked a 12 hour night shift. The nurses had between 1 and more than 20 years of experience and worked in a variety of units.

METHOD

The interview recordings were transcribed by the research team and entered into a qualitative data analysis software. Transcripts were analyzed by two independent coders with a grounded theory approach to identify common themes and subthemes across participants.

FINDINGS

Feelings of drowsiness typically manifested immediately following the shift or during the post work commute. Nurses responded to drowsiness by engaging in multiple ineffective countermeasures (e.g., listening to music) and effective countermeasures (e.g., naps) were used sparingly. Experiences and mitigation methods traversed through the nurses' social network although they did not always alter behavior. Nurses were uncertain but enthusiastic about educational and technological interventions preferring practical training and auditory interactive alerts.

CONCLUSIONS

The findings suggest a strong need for real time drowsiness interventions during or immediately prior to nurses' post work commutes. Nurses' enthusiasm for training and technology to prevent drowsy driving suggests high levels of readiness and acceptance for such interventions. Future work should focus on the development and implementation of practical training and technological interventions for drowsy driving in nurses.

Role of nurses in medication management at the end of life: a qualitative interview study

Background

Patients in the last phase of their lives often use many medications. Physicians tend to lack awareness that reviewing the usefulness of medication at the end of patients’ lives is important. The aim of this study is to gain insight into the perspectives of patients, informal caregivers, nurses and physicians on the role of nurses in medication management at the end of life.

Methods

Semi-structured interviews were conducted with patients in the last phase of their lives, in hospitals, hospices and at home; and with their informal caregivers, nurses and physicians. Data were qualitatively analyzed using the constant comparative method.

Results

Seventy-six interviews were conducted, with 17 patients, 12 informal caregivers, 15 nurses, 20 (trainee) medical specialists and 12 family physicians. Participants agreed that the role of the nurse in medication management includes: 1) informing, 2) supporting, 3) representing and 4) involving the patient, their informal caregivers and physicians in medication management. Nurses have a particular role in continuity of care and proximity to the patient. They are expected to contribute to a multidimensional assessment and approach, which is important for promoting patients’ interest in medication management at the end of life.

Conclusions

We found that nurses can and should play an important role in medication management at the end of life by informing, supporting, representing and involving all relevant parties. Physicians should appreciate nurses’ input to optimize medication management in patients at the end of life. Health care professionals should recognize the role the nurses can have in promoting patients’ interest in medication management at the end of life. Nurses should be reinforced by education and training to take up this role.

The nature of youth in the eyes of mental-health care workers: therapists' conceptualization of adolescents coming to therapy at others' initiative

Background

Adolescent clients often come to therapy at the initiative of others and show a higher drop-out rate compared to adult clients. Therapeutic relationships are critical for preventing drop-outs and attaining good outcomes, yet few empirical studies have investigated how therapists conceptualize and meet adolescent clients who come reluctantly to therapy.

Methods

We conducted ten focus-group interviews in this study with a total of 51 therapists at different Norwegian specialist outpatient clinics for children and adolescents with mental-health problems to explore how therapists view and understand adolescents who come to therapy at the initiative of someone else. We used a reflexive approach to thematic analysis to analyze the transcripts.

Results

We found five main themes, expressing variations in participants’ understanding: The hurt and distrustful adolescent; The adolescent lacking hope for the future; The adolescent engulfed in the burden of mental-health suffering; The adolescent as something more than a psychiatric patient; and The adolescent meeting a system with varying flexibility and space for engagement.

Conclusions

Several conceptualizations of the adolescent client coexist within and between clinics, resulting in variability of services for adolescents even within the frames of a strong welfare system.

Patients' perspectives of endometriosis-related fatigue: qualitative interviews

Background

Endometriosis-related fatigue is common and negatively impacts multiple areas of many women’s lives, particularly in day-to-day activities, social activities, physical activities, mood and emotions, relationships with family or partners, and work or school. Multiple studies have documented fatigue as a significant symptom of endometriosis. Additional research is needed to better understand endometriosis-related fatigue and its impacts on patients.

Methods

This qualitative study consisted of individual in-person semistructured interviews conducted with 22 adult females reporting moderate to severe endometriosis-related pain. Women with self-reported, surgically confirmed endometriosis and moderate to severe endometriosis-related pain were recruited from qualitative research firms in two locations in the United States. Qualified subjects participated in semistructured interviews that lasted approximately 45 min each. Interviews were audio recorded and transcribed for qualitative analysis.

Results

All 22 participants reported experiencing fatigue related to their endometriosis. While the degree of severity of their endometriosis-related fatigue varied, 21 of the 22 participants stated that it was at least “somewhat bothersome.” Most participants noted an impact from endometriosis-related fatigue on day-to-day activities, social activities, physical activities, mood and emotions, relationships with family or partner, and work or school.

Conclusions

The data presented here indicate that endometriosis-related fatigue has a pervasive impact on the functioning of women living with this condition. Future studies should measure any changes in fatigue that may be associated with treatment for endometriosis.

Exploring perceived benefits, motives, barriers, and recommendations for prescribing yoga exercises as a nonpharmacological intervention for patients with epilepsy: A qualitative study from Palestine

OBJECTIVES

Yoga is believed to play a role in stabilizing the electroencephalogram and the autonomic nervous system, thus might help control seizures in people with epilepsy (PWE). This qualitative study was conducted to explore experiences of Palestinian PWE with regard to benefits, motives, barriers, and recommendations of prescribing yoga exercises as a nonpharmacological intervention.

METHODS

Purposive and snowball sampling techniques were used to recruit PWE who practiced yoga. Semi-structured in-depth interviews (n = 18) were conducted with the study participants. The interpretive description method was used to qualitatively analyze the data collected during the interviews.

RESULTS

Following the thematic analysis adopted for this study, four major themes emerged. These themes were as follows: perceived benefits of yoga, motives to practice yoga, barriers to practice yoga, and recommendations on effective yoga practice for PWE. The perceived benefits included improvements in management of seizures, psychological, physical, and social well-being. People with epilepsy were motivated by the health benefits of yoga. Barriers of adherence to practice included personal and logistic factors. The interviewees recommended tailoring yoga sessions to the needs of PWE.

CONCLUSION

This explorative qualitative study reported perceived benefits, motives, barriers, and recommendations of yoga as a nonpharmacological intervention for PWE. People with epilepsy used yoga as a beneficial nonpharmacological intervention to improve their health and reduce the negative effects of epilepsy on their physical and psychosocial well-being. Future studies are needed to investigate the health benefits of yoga when sessions are tailored to the needs of PWE.

Understanding hand hygiene behaviour in the intensive care unit to inform interventions: an interview study

BACKGROUND

Improving hand hygiene (HH) compliance is one of the most important, but elusive, goals of infection control. The purpose of this study was to use the capability (C), opportunity (O), motivation (M), and behaviour (B; COM-B) model and the theoretical domains framework (TDF) to gain an understanding of the barriers and enablers of HH behaviours in an intensive care unit (ICU) in order to identify specific interventions to improve HH compliance.

METHODS

A semi-structured interview schedule was developed based upon the COM-B model. This schedule was used to interview a total of 26 ICU staff: 12 ICU nurses, 11 anaesthetic specialist registrars, and three anaesthetic senior house officers.

RESULTS

Participants were confident in their capabilities to carry out appropriate HH behaviours. The vast majority of participants reported having the necessary knowledge and skills, and believed they were capable of carrying out appropriate HH behaviours. Social influence was regarded as being important in encouraging HH compliance by the interviewees- particularly by nurses. The participants were motivated to carry out HH behaviours, and it was recognised that HH was an important part of their job and is important in preventing infection. It is recommended that staff are provided with targeted HH training, in which individuals receive direct and individualised feedback on actual performance and are provided guidance on how to address deficiencies in HH compliance at the bedside at the time at which the HH behaviour is performed. Modelling of appropriate HH behaviours by senior leaders is also suggested, particularly by senior doctors. Finally, appropriate levels of staffing are a factor that must be considered if HH compliance is to be improved.

CONCLUSIONS

This study has demonstrated that short interviews with ICU staff, founded on appropriate behavioural change frameworks, can provide an understanding of HH behaviour. This understanding can then be applied to design interventions appropriately tailored to the needs of a specific unit, which will have an increased likelihood of improving HH compliance.

Lived experience and attitudes of people with plantar heel pain: a qualitative exploration

Background

Plantar heel pain is a common source of pain and disability. Evidence-based treatment decisions for people with plantar heel pain should be guided by the best available evidence, expert clinical reasoning, and consider the needs of the patient. Education is a key component of care for any patient and needs to be tailored to the patient and their condition. However, no previous work has identified, far less evaluated, the approaches and content required for optimal education for people with plantar heel pain. The aim of this study was to gather the patients’ perspective regarding their lived experience, attitudes and educational needs in order to inform the content and provision of meaningful education delivery approaches.

Methods

Using a qualitative descriptive design, semi-structured interviews were conducted with participants with a clinical diagnosis of plantar heel pain. A topic guide was utilised that focused on the experience of living with plantar heel pain and attitudes regarding treatment and educational needs. Interviews were audio recorded, transcribed verbatim and analysed using the Framework approach. Each transcription, and the initial findings, were reported back to participants to invite respondent validation.

Results

Eighteen people with plantar heel pain were interviewed. Descriptive analysis revealed eight themes including perceptions of plantar heel pain, impact on self, dealing with plantar heel pain, source of information, patient needs, patient unmet needs, advice to others and interest in online education. Participants revealed doubt about the cause, treatment and prognosis of plantar heel pain. They also expressed a desire to have their pain eliminated and education individually tailored to their condition and needs. Respondent validation revealed that the transcripts were accurate, and participants were able to recognise their own experiences in the synthesised themes.

Conclusion

Plantar heel pain has a negative impact on health-related quality of life. Participants wanted their pain eliminated and reported that their expectations and needs were frequently unmet. Health professionals have an important role to be responsive to the needs of the patient to improve their knowledge and influence pain and behaviour. Our study informs the content needed to help educate people with plantar heel pain.

Development of a Conceptual Model of Chronic Hand Eczema (CHE) Based on Qualitative Interviews with Patients and Expert Dermatologists

INTRODUCTION

Chronic hand eczema (CHE) is a relapsing inflammatory dermatologic disease. Signs and symptoms can have a significant impact on patients' health-related quality of life (HRQoL). The aim of this study is to characterize the core signs, symptoms and impacts of CHE to develop a conceptual model.

METHODS

A structured literature search and qualitative interviews with 20 adult CHE patients in the US and 5 expert dermatologists were conducted to explore the patient experience of CHE signs, symptoms and impacts. Findings were used to support the development of a conceptual model.

RESULTS

There was a paucity of CHE qualitative research in the literature, supporting the need for the prospective qualitative research. The primary signs and symptoms identified from the literature review and interviews included itch, dryness, cracking, pain, thickened skin and bleeding. The most salient impacts included embarrassment and appearance concerns, frustration, impacts on work and sleep disturbance. Saturation was achieved for all signs, symptoms and impact concepts.

CONCLUSIONS

Findings from this literature review and in-depth qualitative interviews supported the development of a comprehensive conceptual model documenting the signs, symptoms and impacts relevant to CHE patients. Such a model is of considerable value given the lack of existing studies in the literature focused on the qualitative exploration of the CHE patient experience. Limitations included the patient sample being only from the US and not including some CHE subtypes.

Exercise promotion in physiotherapy: A qualitative study providing insights into German physiotherapists' practices and experiences

BACKGROUND

Although exercise promotion is a central task of physiotherapists, there is limited evidence about physiotherapists' experiences with exercise promotion and their promotion practices.

OBJECTIVES

To investigate how physiotherapists working in outpatient settings in Germany promote exercise and to explore their experiences with and views on exercise promotion.

DESIGN

Qualitative study with semi-structured interviews.

METHODS

We conducted qualitative semi-structured interviews with a purposive sample of physiotherapists. Data were analysed following Mayring's content analytical approach using deductive and inductive methods. Physiotherapists' methods of exercise promotion were classified using the behaviour change technique (BCT) taxonomy by Michie and colleagues. Further categories were formed in an inductive manner.

RESULTS

Six female and three male physiotherapists (age: 21-55 years, professional experience: 0.5-31 years) were interviewed. We identified the use of 17 distinct BCTs across the interviews (6-13 per interview), most commonly goal setting (behaviour), instruction on how to perform a behaviour and behavioural practice/rehearsal. Four inductive main categories were formed: "barriers and challenges", "facilitators", "responsibilities" and "dealing with setbacks". Lack of patient interest and motivation was named as a main challenge. While the therapists feel responsible for instructing exercise, not all of them regard it as their role to motivate patients. Resistance or lacking compliance lead therapists to either apply strategies to proceed or quit exercise promotion.

CONCLUSIONS

Our research implies substantial individual differences in exercise promotion between therapists. A more consistent approach, more competencies to support unmotivated patients as well as a clearer definition of physiotherapists' role in exercise promotion might be needed.

Do Parental Interviews for ASD Converge with Clinical Diagnoses? An Empirical Comparison of the 3di and the DISCO in Children with ASD, a Clinically-Referred Group, and Typically Developing Children

Two semi-structured parental interviews are available with algorithms developed to measure DSM-5 criteria of ASD, namely the Developmental, Dimensional and Diagnostic Interview (3di) and the Diagnostic Interview for Social and Communication Disorders (DISCO-11). The main aim of this study was to examine the agreement between classification according to both interviews, and their convergence with the clinical diagnosis. Therefore, the 3di and DISCO-11 were administered from three groups of parents of a 4-18 year old. Results showed 75% agreement between both instruments, but in the ASD group only 16% of the children scored above threshold on both instruments. Exploratory analyses suggested that the 3di failed to detect rigid and repetitive behaviors, whereas the DISCO-11 was insufficiently sensitive in detecting socio-communicative problems.

Eating disorder diagnostics in the digital era: validation of the Norwegian version of the Eating Disorder Assessment for DSM-5 (EDA-5)

OBJECTIVE

The Eating Disorder Assessment for DSM-5 (EDA-5) is an electronic, semi-structured interview developed to assess feeding and eating disorders following DSM-5 criteria. The original English version has strong psychometric properties, and previous research has shown high rates of agreement between diagnoses generated by the Eating Disorder Examination (EDE) interview and the EDA-5. The current study aimed to validate the Norwegian version of the EDA-5, and is the first international validation of this diagnostic tool.

METHOD

A total of 91 (87 females and 4 males) adult in- and out-patients were recruited from two of the largest eating disorder clinics in Norway. Diagnoses assigned using the EDA-5 were compared to diagnoses from the EDE interview (v. 17.0D).

RESULTS

Results showed that diagnoses assigned using EDE and EDA-5 were identical for 75 (82.4%) of the 91 cases. Among individual diagnostic categories, kappas ranged from moderate (.49) to perfect (1.00) agreement. The majority of discrepant cases occurred between full- and sub-threshold AN and BN. The EDA-5 was significantly quicker to administer compared to the EDE (22 vs. 54 min).

CONCLUSIONS

The Norwegian EDA-5 can quickly and efficiently generate DSM-5 diagnoses without compromising diagnostic accuracy. It is a promising alternative to existing diagnostic tools, and may help streamline the identification of feeding and eating disorders in clinical settings and in research.

The Child's Voice in Satisfaction with Hospital Care

PURPOSE

Patient satisfaction is a quality improvement indicator used to evaluate care. Ratings of patient satisfaction in pediatrics exclude the child voice. We tested the feasibility and acceptability of a new model that included both child and parent satisfaction ratings.

DESIGN AND METHODS

We executed a randomized, two-arm, unblinded cohort study comparing child (aged 7-17 years) and parent reports (Arm 1) to parent report only (Arm 2) among a convenience sample of inpatients at a single urban pediatric medical center. The primary (feasibility and acceptability) and secondary outcomes were assessed at the time of discharge (T1) and approximately 10 days following discharge (T2) (standard timing).

RESULTS

Of 672 screened families, 89.3% (n = 600) enrolled in the study; 362 children and parents were randomized to Arm 1 and 238 parents to Arm 2. Patients (98.6%) and parents (99.8%) indicated preference for providing satisfaction ratings at the time of discharge. Seventy-five percent of families (n = 488) completed T1 and T2; neither child nor parent ratings differed significantly between T1 and T2 nor did parent ratings differ between the two study arms. Nurse friendliness, courtesy, and feeling well cared for were among the highest rated items at T1 and T2 by both children and parents.

CONCLUSIONS

Children 7 to 17 years of age and their parents are willing and like to provide satisfaction with care ratings prior to hospital discharge.

PRACTICE IMPLICATIONS

This measurement model could yield valid findings representative of hospitalized children and their parents, and could become the basis for a new and needed measurement approach for pediatric satisfaction with hospital care.

How do pediatric patients perceive adverse drug events of anticonvulsant drugs? A survey

Anticonvulsant drugs have a high risk of adverse drug events. Little is known about the perception of those events by pediatric patients. We performed a survey in the neuropediatric departments of two university hospitals. Using a questionnaire, we interviewed patients aged 6-18 years with current anticonvulsant treatment regarding (i) their fears about potential adverse drug events, (ii) experienced adverse drug events, and (iii) perceived burden of experienced adverse drug events. One hundred patients took part in the interview. (i) 40 (40%) expressed fears that the medication could harm them. Eighteen of 40 (45%) named fears concerning specific adverse drug events. Of those, 12/18 (67%) feared neurologic or psychiatric symptoms. (ii) 37 (37%) of children described altogether 60 experienced adverse drug events. Of those, 38 (63%) concerned neurologic or psychiatric symptoms. (iii) 32/37 (82%) children who experienced adverse drug events felt bothered by the experienced event. Among others, they described an emotional burden (11/37, 30%), and restrictions in school performance (8/37, 22%) and favorite leisure activities (4/37, 11%).Conclusion: School-aged children are well able to describe adverse drug events of their anticonvulsant medication. Almost two thirds of the described events concern neurologic or psychiatric symptoms that cause an emotional burden and restrictions according to the patients. What is Known: • Anticonvulsants have a high potential of adverse drug events. • In an earlier survey, parents expressed fears of severe adverse drug events such as liver failure, which seldom occur, and reported a high number of neurological and psychological adverse drug events. What is New: • Many children fear that their anticonvulsants could harm them, and they fear and experience neurological and psychological adverse drug events. • According to the children, adverse drug events cause an emotional burden and restrictions in school performance and favorite leisure activities.

Stressors and strains of next of kin of patients with ARDS in intensive care: A qualitative interview study using a stress-strain approach

OBJECTIVES

This study aims to explore and analyse the stressors and strains of next of kin of acute respiratory distress syndrome (ARDS) patients during their stay in the intensive care unit utilising the stressors and strain approach as a theoretical framework.

METHODS

Data collection was performed as semi-standardised qualitative interviews. 35 families of patients with ARDS were approached when visiting the intensive care unit. Participants were recruited until thematic saturation was reached; finally, 17 persons (age ranging from 26 to 71 years, nine women) took part. Systematic content analysis was conducted on the theoretical foundations of the stressors and strain approach.

FINDINGS

Numerous stressors were identified; they can be divided into three main categories: in relation to organising the visit, occurring during the visit and arising at home. These stressors were reported highly consistently throughout participants. However, the strains resulting from these stressors were varying in manifestation and level.

CONCLUSIONS

This study explores the manifold stressors and strains of next of kin of a critically ill patient. Some stressors are inherent to the life-threatening condition of a family member; others arise from the health care system and could be modified. The level of strain experienced depends on social support, individual coping skills and life circumstances.

To dystrophin and beyond: an interview with Louis Kunkel

Louis Kunkel has devoted his career to understanding the causes, mechanisms and treatment of muscular dystrophies. Dr Kunkel is the past Director of the Genomics Program at Boston Children's Hospital and Professor of Genetics and Pediatrics at Harvard Medical School. In this interview, he talks about his discovery of dystrophin, including patients in preclinical research, and bearded irises.

The family practice of support-giving after a pediatric cancer diagnosis: A multi-family member interview analysis

PURPOSE

Pediatric cancer presents many challenges to the life of the child diagnosed with cancer and his/her family. Among the studies investigating risk and protective factors, social support has emerged as an important construct. However, little is known on how family members support each other in this particular context.

METHOD

In order to further explore this process, interviews were performed separately with mothers, fathers and siblings. For the purpose of this study (as this is part of a larger project), data from four families in which both parents and at least one sibling participated, were used. Multi Family Member Interview Analysis was used as the methodological framework to analyze the individual interviews, allowing a detailed and systematic analysis of shared family experiences.

RESULTS

The analysis of the data revealed three themes: Being together matters: the families identified the need of being physically together; Finding support in (not) talking: the complexity of sharing emotions was explained and Working together as a team: the families described working together as a team in order to get everything organized.

CONCLUSIONS

This study broadens our understanding of the interpersonal process of family support-giving when facing pediatric cancer. When meeting with families, families should be invited as a unit in order to best capture family level experiences. Also, clinicians should be sensitive to the different cancer-related communication needs within the family (i.e., the need to talk or not to talk) and incorporate this knowledge into their care.

Barriers and enablers to the use of venous leg ulcer clinical practice guidelines in Australian primary care: A qualitative study using the theoretical domains framework

BACKGROUND

Venous leg ulcers represent the most common chronic wound problem managed in Australian primary care. Despite the prevalence of the condition, there is an evidence-practice gap in both diagnosis and management of venous leg ulcers.

OBJECTIVE

We used the Theoretical Domains Framework to identify barriers and enablers perceived by primary care practitioners in implementing venous leg ulcer guidelines in clinical practice.

DESIGN

We collected data to explore the experiences of practice nurses and general practitioners related to their use of clinical practice guidelines in management of venous leg ulcers.

SETTING(S)

We recruited participants from primary care settings located in metropolitan and rural areas across Victoria, Australia.

PARTICIPANTS

We recruited general practitioners (15) and practice nurses (20).

METHODS

We conducted 35 semi-structured face-to-face and telephone interviews. Content analysis of health practitioners' statements was performed and barriers to implementing clinical practice guidelines were mapped across the Theoretical Domains Framework theoretical domains.

RESULTS

Six main domains from the Theoretical Domains Framework (Environmental context and resources, Knowledge, Skills, Social influences, Social/Professional Role and Identity and Belief about Capabilities) best explained these barriers and enablers. Many participants were not aware of venous leg ulcer clinical practice guidelines. Those that were aware, stated that finding and accessing guidelines was challenging and most participants relied on other sources of information. Venous leg ulcer management was greatly influenced by professional experience and suggestions from colleagues. Other barriers included busy clinical practice, absence of handheld Doppler ultrasonography, insufficient skills and a lack of confidence related to the use of technology to rule out arterial involvement prior to compression application, a particular skill related to venous leg ulcer management that will impact on healing outcomes.

CONCLUSIONS

We identified a number of barriers and the lack of enablers that influence the uptake of venous leg ulcer clinical practice guidelines in primary care. This paper adds a theoretically sound, systematic approach for understanding and addressing the behaviour change required to improve translation of venous leg ulcer clinical practice guidelines in clinical practice. Tweetable abstract: The need to optimise venous leg ulcer clinical practice guidelines (CPG) has never been greater as the current estimate of health cost is AUD3billion and increasing due to rising epidemics of diabetes and obesity. We found most primary care health practitioners are unaware of CPG and this will impact on health and healing outcomes in Australian primary care.

What Predicts Outstanding Orthopedic Residents among the Program?

BACKGROUND

An oversupply of qualified applicants leads to intense competition for the limited number of first year orthopedic residency positions. Therefore, program directors can be more selective in choosing their future residents. However, it is unclear if there are resident characteristics that correspond with trainee performance.

METHODS

We asked (1) what resident characteristics are associated with subjective residency performance score? and (2) what resident characteristics are associated with Orthopedic In-Training Examination (OITE) score?A total of 119 orthopedic residents accepted at the Harvard Combined Orthopedic Residency Program from 1999 - 2009 were included in this study. The current program director together with two former program directors in the selected time period defined the subjective residency performance score based on the clinical skills of the residents during training.

RESULTS

Former Olympic or varsity athlete (P=0.018) and Alpha Omega Alpha (AOA) status (P=0.014) were associated with a better subjective residency performance score. Higher USMLE step 1 score (P=0.0038), known person within faculty prior to the residency (did a research rotation, or local medical student) (P=0.041), and AOA (P=0.015) status were associated with a higher OITE score.

CONCLUSION

AOA status of the applicant for orthopedic residency is associated with both a higher OITE score and a better subjective residency performance score.

Understanding symptomatic experience, impact, and emotional response in recently diagnosed metastatic castration-resistant prostate cancer: a qualitative study

PURPOSE

We sought to explore the symptomatic experience of men recently told their castration-resistant prostate cancer has metastasized (mCRPC); the impact and emotional response to this; the emotional burden of monitoring development to metastatic status; and the emotional impact on the primary support person (PSP).

METHODS

Interviews were conducted with 25 men recently diagnosed with mCRPC from the United States (US), France, and Germany. We also interviewed 14 PSPs. Thematic analysis was conducted using Atlas.ti.

RESULTS

The mean age of patients was 72.2 years; mean time since metastasis 7.8 months. The most frequent symptoms were fatigue/tiredness, sexual dysfunction, and pain. Metastasis had a negative emotional impact on the patient and PSP. Some explicitly associated certain symptoms/impacts with metastasis, such as localized pain, diarrhea, blood in stool, and increased impact on activities of daily living. About 72% of patients highlighted the emotional impact of a metastatic diagnosis, reporting worry/anxiety/fear, low mood/depression, shock, increased burden on PSP, and strain on relationships. Monitoring prostate-specific antigen (PSA) values was important; ten patients explicitly discussed feeling fear/worry when PSA was rising, and glad/happy/excited when PSA was falling. Most reported that, if a medication had been available to them to delay metastasis, they would have taken it, even if they were asymptomatic.

CONCLUSIONS

Interviews highlighted the substantial burden of mCRPC to both patient and PSP. Development of metastasis was associated with symptoms worsening rather than the development of new symptoms, with physical and emotional impacts. Most patients were willing to take a medication to delay metastasis.

Students' perceptions of teaching factors that demotivate their learning in lectures and laboratory-based skills practice

Objectives

The objective of this paper is to report students' perceptions of factors that demotivated their learning in lectures and laboratory-based skills practice settings.

Methods

A total of 23 students were recruited from the Bachelor of Nursing courses at three Japanese universities, using purposive sampling. A semi-structured interview was conducted with each participant between November 2017 and January 2018 to elicit their perceptions about which aspects of the teaching context demotivated their engagement in learning. The results were analyzed using thematic analysis.

Results

Three themes were generated: a restrictive environment, discouraging attitudes and discouraging teaching approaches.

Conclusions

To prevent students from experiencing demotivation, teachers in the nursing faculty need to manage learning resources more effectively, create a quiet and focused atmosphere to allow students to concentrate, and be enthusiastic about teaching. They also need to add value to their classes, help students to follow lectures, and ensure that the workload they give their students is appropriate.

What do geriatric patients experience during an episode of delirium in acute care hospitals? : A qualitative study

BACKGROUND

Predispositions and triggers for delirium, such as noxious agents are known and behavior can be monitored; however, there is little to no information available regarding the experience of patients during delirium episodes. Not much is known about a person's world of experiences, which therefore mostly remains as a sort of black box.

OBJECTIVE

This study was motivated by the following question: "What do (Austrian) geriatric patients experience during an episode of delirium in an acute care hospital?" The main objective of this article is to present little snippets from the experiences and to allow geriatric patients to speak for themselves.

PATIENTS AND METHODS

From 2013 to 2016 interviews were carried out within the framework of a qualitative investigation. For data collection narrative interviews according to Fritz Schütze were employed and 10 interviews were conducted in a hospital setting with German-speaking Austrian patients aged between 75 and 90 years (mean age 80.2 years; 7 female and 3 male). The individual interviews lasted between 60 and 120 min. Primary data in the form of individual interpretation and interpretation groups from interview transcripts were marked and coded according to Mayring.

RESULTS

All patients who participated in the interviews subjectively recognized delirium as a negative experience. The data analysis led to three main categories with subcategories: changes in sensory perception, extraordinarily strong emotions and memories. It is important to differentiate between two very different types of memories: firstly, personal fate or life changes and secondly, those regarding experiences of war.

CONCLUSION

Scandinavian and Anglo-American literature describe different categories, such as a change in reality, strong emotions and dramatic episodes in the experience of delirium, which can be transferred to Austria. Others consider the biography of each individual patient in context with the sociocultural history of Austria, especially following developments after 1940.

At the heart of genetic disease: an interview with Elizabeth McNally

Elizabeth McNally is a human geneticist and a cardiologist whose research has been instrumental in understanding the mechanisms of inherited heart and skeletal muscle diseases. She is the Director of the Center for Genetic Medicine at Northwestern University's Feinberg School of Medicine. In this interview, Elizabeth talks about her first experiences in science, the importance of understanding complex genetic interactions and the effort we all need to make to facilitate diversity in science.

Qualitative investigation of the speech-language therapy experiences of individuals who covertly stutter

PURPOSE

Individuals who covertly stutter have a unique experience of stuttering that involves concealing the core behaviors of stuttering (e.g., repetitions, prolongations, and blocks). From the listener's perspective, covert stuttering results in minimum typical, overt stuttering behaviors. However, from the speaker's perspective, covert stuttering often increases the cognitive and emotional impact of stuttering. This study explores the speech-language therapy experiences of individuals who covertly stutter in order to improve treatment recommendations and best practice.

METHODS

This investigation is a qualitative analysis of individuals' speech-language therapy experiences as persons who covertly stutter. Real-time video interviews were conducted with the use of open-ended phenomenological interview questions. Interviews were transcribed and thematic analysis of interview transcripts was conducted to investigate the speech-language therapy experiences of the participants.

RESULTS

The participants indicated that stuttering therapy was most impactful when it included explicit goals and activities, personalized selection of therapy techniques or strategies beyond fluency techniques, encouraged self-education, and educated those in the person's environment.

CONCLUSION

The evidence suggests individualized therapy based on each client's unique manifestation of covert stuttering is beneficial; while, fluency-focused stuttering therapy is often incongruent with the needs of persons who covertly stutter. Therapeutic implications and recommendations for speech-language pathologists are discussed.

Exploring healthcare providers' mental models of the infection prevention "patient zone" - a concept mapping study

Background

Pathogen transmission plays a major role in the development of healthcare-associated infections. The “patient zone” concept developed as part of the World Health Organization’s “Five moments of hand hygiene” aims to distinguish surfaces primarily contaminated by flora of a single patient, i.e. inside the patient zone, from those outside the patient zone containing foreign and potentially harmful microorganisms. Discrepancies in healthcare provider (HCP) internal conceptual representations (i.e. mental models) of the patient zone may lead to missed infection prevention measures that could result in patient harm. We explored HCPs’ mental models of the patient zone that shape how they interact with the work environment.

Methods

We conducted individual concept mapping interviews supported by a card-sorting technique to examine HCPs’ mental models of the patient zone and compared these to IPC expert models. Ten participants (five nurses, five physicians) without IPC specialization and two IPC experts provided definitions of the patient zone and allocated 32 items to “inside” or “outside” the patient zone while verbalizing their thought processes. We calculated similarity as percent agreement among participants and accuracy as percent allocated consistently with expert consensus. A content analysis of interview recordings served to identify mental models underlying the allocation decisions.

Results

Our study revealed limited similarity among participants, with seven of 32 items allocated consistently among all participants. Overall, 68% of items were sorted accurately according to expert consensus. Identified mental models were categorized as follows: “Patient contact”, the patient zone defined according to objects having patient contact; “Sectors”, the patient zone as a defined physical space; “Disinfection”, the patient zone deduced based on need to disinfect hands and objects; and “Context-dependency”, the patient zone defined depending on the context of an object’s use.

Conclusions

Our study revealed ambiguity surrounding the patient zone concept as evidenced by low similarity between participants and important discrepancies between participant and expert mental models. Such ambiguity may lead to inconsistent application of the patient zone concept and represents a patient safety risk. Initiatives to improve understanding and application of the patient zone concept should focus on establishing consistent, theoretically founded mental models.

Interview Techniques Utilized in Radiology Resident Selection-A Survey of the APDR

RATIONALE AND OBJECTIVES

To evaluate interview techniques currently used in the selection of diagnostic radiology resident candidates and to identify factors influencing the use of alternative interview techniques.

MATERIALS AND METHODS

An anonymous 25 question e-mail survey was provided to 319 active members of the Association of Program Directors in Radiology. The survey included questions on residency demographics, organization of resident applicant interviews, types of interview techniques utilized, scoring and ranking of applicants, and facets of the interview/application felt most important to the selection process. Statistical analysis was performed to identify factors associated with the use of alternative interview techniques.

RESULTS

93.7% of responding programs use traditional interview techniques, with 92% using unblinded, unstructured interviews, 8% blinded, unstructured interviews. Structured interview questions were incorporated in 22%. Few programs used alternative techniques like the multiple mini-interview. None of the programs used written prompts during the interview, 3% used casual visual cognitive testing, 10% used panel interview techniques, and none used formal personality testing. For ranking candidates in the match, the most important facets considered were USMLE Step scores, performance on the interview, clinical course grades, and letters of reference. Factors associated with use of alternative techniques were domains associated with program size and number of faculty.

CONCLUSION

The majority of radiology training programs still rely upon the traditional unblinded interview technique. There is an opportunity for training programs to examine alternative techniques that reduce bias and may provide better insight into other aspects of the candidate that may not be as readily highlighted with the traditional, unblinded interview.

"We live as good a life as we can, in the situation we're in" - the significance of the home as perceived by persons with dementia

BACKGROUND

The coming years will see more persons with dementia living longer at home. However, "the home" is a complex concept with a multitude of meanings, varying among individuals and raising ethical and practical dilemmas in the support provided for this group. This study aims to increase the understanding of experiences and attitudes among persons with dementia related to living at home.

METHODS

Qualitative interviews were conducted with 12 persons, 69 to 89 years old, with a dementia diagnosis and living at home. Using a hermeneutical approach, the interviews were analysed as single texts, as parts of a set of texts and as a whole single text. The writings of care philosopher Kari Martinsen on "The home" were chosen as a framework for the theoretical interpretation of the findings.

RESULTS

The participants experienced a vital interconnectedness between the home and their lives, placing their home as a core foundation for life. Through stories of persisting love, they illuminated how their lived lives functioned as a foundation for their homes. Further, they described how progressing dementia disturbed rhythms of life at home, forcing them to adapt and change their routines and rhythms in life. Finally, in the hope of an enhanced future home the participants showed an acceptance of, but also a reluctance to, the prospect of having to move out of their homes at some future point.

CONCLUSION

The study suggests that the participants' home generated existential meaning for the participating persons with dementia. Their experience of being at home was based on a variety of individual factors working together in various ways. These findings imply a need to understand what factors are important for the individual, as well as how these factors interact in order to provide support for this group of people.

Patient Perceptions of Living with Severe Asthma: Challenges to Effective Management

BACKGROUND

The management of severe asthma poses many challenges related to treatment, adherence, and psychosocial morbidity. There is little direct data from the patient perspective to understand and negotiate the complexities of managing severe asthma.

OBJECTIVE

To explore the patient perceptions of living with severe asthma and the experience of managing severe asthma, in order to better understand the support that might promote more effective self-management for severe asthma.

METHODS

Participants were recruited from a specialist Difficult Asthma Service. Semistructured interviews were conducted by researchers independent of the patient's care. Interviews were transcribed verbatim and inductive thematic analysis was performed.

RESULTS

Twenty-nine participants (13 male: mean [standard deviation] age, 49.5 [13.6] years: mean Asthma Control Questionnaire 2.2 [1.2]) participated in an interview. Analysis resulted in 4 major themes describing the experience and challenges to managing severe asthma: understanding of severe asthma, emotional impact of living with severe asthma (subtheme: fear of hospitalization), public perceptions of asthma, and concerns about medications.

CONCLUSIONS

Health care professionals need to consider and discuss with patients their perceptions of severe asthma and the relevant treatments; particular attention should focus around education of disease control and actively exploring thoughts around hospitalization. Our data highlight the potential for psychological and social support to enhance self-management by directly addressing the wide-ranging individual challenges patients face. There is also a need for greater public awareness and education about severe asthma to minimize patient distress particularly in the work environment.

Attitudes of Iranian students about organ donation: a qualitative study

BACKGROUND

Organ donation is a life-saving process for patients suffering from an advanced organ failure. A disparity between donated organs and required organs for transplantation is one of the major problems in Iran. Since personal attitudes about organ donation is a main factor influencing willingness to donate organ, the present study sought to provide a deeper understanding of the attitudes of university students in Iran regarding organ donation.

METHODS

This qualitative study was conducted in 2016. Semi-structured interviews were held for collecting data from eighty five students from various universities in Hamadan city, Iran. Using a purposive sampling method, the students were selected based on the maximum variation. The content analysis method was used for data analysis by the research team and criteria for the study's rigor was considered.

RESULTS

Overall, the students had positive attitudes toward organ donation by brain-dead patients. Nevertheless, not of them stated that they would become an organ donor. During the data analysis, 376 primary codes, 13 categories, and 6 themes were developed. Themes were "cognitive readiness", "mediators of decision making", "beliefs and motivations", "interactions with the health system", "dependency", and "integrity of the body". Also, thirteen sub-themes were developed.

CONCLUSION

Many factors influence the students' attitudes toward organ donation. Identification and explanation of these factors can help healthcare managers and policymakers for planning and improving the organ donation culture in the society.

"I have got diabetes!" - interviews of patients newly diagnosed with type 2 diabetes

BACKGROUND

To be diagnosed with type 2 diabetes is a challenge for every patient. There are previous studies on patients' experience in general but not addressing the increased cardiovascular risk and multifactorial treatment. The aim of this study was to explore the thoughts, experiences and reactions of newly diagnosed patients with diabetes to this diagnosis and to the risk of developing complications.

METHODS

Ten adults (7 men/3 women, aged 50-79) diagnosed with type 2 diabetes within the last 12 months were interviewed at a primary health care center in Sweden. An interview guide was used in the semi-structured interviews that were transcribed verbatim. The analysis was qualitative and inspired by systematic text condensation (Malterud). The text was read several times and meaning units were identified. Related meaning units were sorted into codes and related codes into categories during several meetings between the authors. Finally, the categories were merged and formed themes.

RESULTS

We defined three main themes: Reaction to diagnosis, Life changes and Concerns about the future. Most patients reacted to the diagnosis without intensive feelings. Lifestyle changes were mainly accepted but hard to achieve. The patients' major concerns for the future were the consequences for daily life (being able to drive and read) and concerns for relatives rather than anxieties regarding medical issues such as laboratory tests. There were considerable differences in how much patients wanted to know about their future risks.

CONCLUSIONS

The results of this study might help to focus doctor-patient communication on issues highlighted by the patients and on the importance of individualizing information and recommendations for each patient.

The antibiotic knowledge, attitudes and behaviors of patients, doctors and pharmacists in the WHO Eastern European region - a qualitative, comparative analysis of the culture of antibiotic use in Armenia, Georgia, Kazakhstan, Moldova, Russia and Tajikistan

BACKGROUND

To reduce antimicrobial resistance (AMR), initiatives such as surveillance activities and activities to increase knowledge about how and why antibiotics (ABs) are (mis)used are needed. More surveillance systems are in place in the WHO Western European region than in the Eastern region, and only sparse knowledge exists about the current culture of AB use in the Eastern European countries.

OBJECTIVE

To investigate AB knowledge, attitudes and behaviors in countries in the WHO Eastern European region in order to identify overall similarities and differences across the region and how AB knowledge, attitudes and behavior patterns may be influenced by the national health care system.

METHODS

Semi-structured interviews were conducted in Armenia, Georgia, Kazakhstan, Moldova, Russia and Tajikistan with patients, doctors and pharmacists. In total, 80 interviews were carried out. A directed content analysis was applied, followed by a comparative analysis, identifying the similarities and differences in AB attitudes, knowledge and behaviors between the countries and discussing how the national health care systems might influence these patterns.

RESULTS

Cross-national patterns were identified regarding patients seeking ABs over-the-counter (OTC), patient variations in their requests for ABs when consulting doctors, and, finally, doctors and pharmacists appearing knowledgeable about ABs and their uses, with doctors displaying careful attitudes towards AMR. Indications of national differences between the countries included the ability of patients to afford ABs, prescribing practices of doctors and pharmacist attitudes towards selling ABs without prescriptions. Multiple aspects involved in patient and pharmacist AB decision making were detected, such as various rationales involved in buying/selling ABs OTC, implying that these processes are more complex than previously reported in the literature.

CONCLUSIONS

Similarities across the Eastern European region could be seen in patient needs and uses of antibiotics obtained OTC at community pharmacies, whereas doctors appeared more influenced by specific structures of the national healthcare system.

Multiple Mini-interview Consistency and Satisfactoriness for Residency Program Recruitment: Oman Evidence

Objectives

Standard interviews are used by most residency programs to assess non-cognitive skills, but variability in the interviewer’s skills, interviewer bias, and context specificity limit reliability. We sought to investigate the consistency and satisfactoriness of the multiple mini-interview (MMI) model for resident selection into an otorhinolaryngology head and neck surgery residency program.

Methods

This pilot study was done in an independent academic residency training center for 15 applicants, in seven eight-minute MMI stations with eight raters for the 2015–2016 academic year. The raters included the chief resident and education committee chairman in one of the stations. Candidates were assessed on two items: medical knowledge (two standardized case scenarios) and behavioral knowledge (personality and attitude, professionalism, communication, enthusiasm to the specialty, and English proficiency).

Results

Of 15 candidates, 10 (66.7%) were female and five (33.3%) were male; five were recommended for selection, and five were kept on the waiting list. The reliability, intraclass correlation coefficient (ICC), of the scores obtained from seven items of MMI was 0.36 (95% confidence interval (CI): -0.31–0.75; p = 0.110). However, the ICC of the medical interview was 0.54 (95% CI: 0.45–0.84; p = 0.090). The correlation between behavioral items score and MMI total score was r = 0.135 (p = 0.150).

Conclusions

The interview evaluation/survey form given to candidates and interviewers has shown that MMI is a fair and effective tool to evaluate non-cognitive traits. Both candidates and interviewers prefer MMI to standard interviews. The MMI process for residency interviews can generate reliable interview results using only seven stations and is acceptable and preferred over standard interview modalities by residency program applicants and faculty members.

Perceptions of medicine use among pregnant women: an interview-based study

Background When women are in a condition that requires medicines during pregnancy they have to balance the health benefits of the medical treatment against the potential risk of harming their unborn child. Too high teratogenic risk perceptions among pregnant women can lead them to stop taking the medicine, worsening the symptoms for the mother and even harming their foetus. Many women today who use over-the-counter and prescribed medicines have been shown to change their medical behaviour when they become pregnant. Objective To explore in depth the perceptions of medication use among women during their pregnancy. Setting The Capital Region of Denmark. Methods Participants were recruited from social network groups on Facebook and from participants in lectures and antenatal classes for pregnant women in two hospitals. Two focus groups interviews and three individual semi-structured interviews were conducted. The interview guides were based on existing literature and relatively unstructured, with an emphasis on open-ended questions. Interview transcripts were analysed using the phenomenological approach of meaning condensation. Main Outcome measure Pregnant women's' perceptions of medicine including aspects related to their safety feeling of medicines and perceived support from health care professionals. Results The women believed that it is less safe to take medicines during pregnancy, largely due to the risk of the child getting a disease in the future, but also due to the risk of malformation. Lack of clinical tests and uncertainty about how the unborn child reacts to medications were reported causes of these concerns. Most participants were concerned about using medicines and avoided them if possible, including over-the counter medicines. Conversations with physicians had a calming effect although the physicians appeared to be unclear in their guidance regarding dietary supplements. Some women received conflicting information on the Internet. Several suggestions were made about how to reduce uncertainties about the safety of taking medicines during pregnancy. Conclusion Many pregnant women are concerned about how to use medicines. To reduce these concerns and ensure the appropriate use of medicines during pregnancy, initiatives are needed to strengthen evidence-based advice from health care professionals, especially during the first trimester.

Do health care professionals worry about delirium? Relatives' experience of delirium in the intensive care unit: A qualitative interview study

OBJECTIVES

In intensive care units, there is a high incidence of delirium, which relates to the risk of complications. Engagement of relatives is an acknowledged part of handling delirium, but knowledge of relatives' perspectives is lacking.

AIM

To explore relatives' experiences of delirium in the critically ill patient admitted to an intensive care unit.

RESEARCH DESIGN

A qualitative design with a phenomenological approach. Semi-structured interviews with eleven relatives of critically ill patients who had delirium during admission to the intensive care unit.

SETTING

An intensive care unit in Denmark.

FINDINGS

Three categories emerged: 'Delirium is not the main concern', 'Communication with health-care professionals is crucial', and 'Delirium impacts on relatives'. Relatives had a lack of knowledge of delirium. Symptoms of delirium were thought of as a natural consequence of critical illness and seemed to be a secondary problem. Health-care professionals did not talk about delirium and information was requested. Delirium and the manifestation of it was experienced in different ways and brought different ways of coping.

CONCLUSION

Findings give a new insight into relatives' experience of delirium in the intensive care unit. Relatives need more information to better understand delirium. Future research must investigate the potential in helping relatives to cope with delirium, to the benefit of both patient and relatives.

Pregnant women's experiences and perceptions of participating in the EVERREST prospective study; a qualitative study

Background

The EVERREST Prospective Study is a multicentre observational cohort study of pregnancies affected by severe early-onset fetal growth restriction. The study recruits women with singleton pregnancies where the estimated fetal weight is less than the 3rd centile and below 600 g, between 20 + 0 and 26 + 6 weeks of pregnancy, in the absence of a known chromosomal, structural or infective cause.

Method

The reported study was retrospective descriptive qualitative interview study of women who had participated in the EVERREST Prospective Study. The aim of this study was to explore the experiences and perceptions of pregnant women taking part in research during a pregnancy affected by severe early-onset fetal growth restriction. Audio-recorded semi-structured telephone interviews were conducted with a purposive sample of 12 women, at least 1 year after delivery of their baby. Two of these pregnancies had ended in stillbirth and one in neonatal death, reflecting the outcomes seen in the EVERREST Prospective Study. Participants gave informed consent, were 16 years or older and were interviewed in English. A topic guide was used to ensure a consistent approach. Questions focused on pregnancy experiences, involvement with the EVERREST study and potential involvement in future research. Recordings were transcribed verbatim for thematic analysis using NVivo10.

Results

Four broad themes were identified; ‘before joining the EVERREST Prospective Study’, ‘participating in research’, ‘information and support’ and ‘looking back and looking forwards’. Each broad theme incorporated several subthemes. All participants recalled their reaction to being told their baby was smaller than expected. The way this news was given had a lasting impact. A range of benefits of participation in the EVERREST Prospective Study were described and the participants were positive about the way it was conducted. As a consequence, they were receptive to participating in future research. However, the findings suggest that research teams should be sensitive when approaching families at a difficult time or when they are already participating in other research.

Conclusions

This study highlights the willingness of pregnant women to participate in research and identifies strategies for researchers to engage participants.

Electronic supplementary material

The online version of this article (10.1186/s12884-019-2277-8) contains supplementary material, which is available to authorized users.

[Relocation decisions to nursing homes for older persons with intellectual disability]

BACKGROUND AND OBJECTIVE

A relevant number of older persons with intellectual disability (ID) moves from residential settings in the disability sector to nursing homes. The study analyzes from the perspective of self-determination, which factors lead to moves to nursing homes and to what extent older persons with ID and their relatives participate in decision-making.

MATERIAL AND METHODS

Quantitative telephone interviews and surveys were conducted in general and specialized nursing homes in Westphalia-Lippe. In three specialized nursing homes, qualitative interviews focused on relocation decisions from different perspectives.

RESULTS

Decisions to move were induced on one hand by the insufficient fit and adaptation of the support to the needs of older residents in settings of the disability sector. On the other hand, organizational interests of the nursing homes influenced the decisions. The counselling of residents and their relatives and the participation in decision making were inadequate.

CONCLUSION

Efforts should be taken to strengthen self-determined relocation decisions of older persons with ID. The specific function of specialized nursing homes for aged persons with ID has to be clarified.