[Experiencing brain death, physician view-a phenomenological approach]

AIM

The aim of the study was to examine how physicians experience caring for (potentially) brain-dead patients.

METHODS

Episodic interviews were conducted. Their evaluation was based on Benner's interpretative phenomenology.

RESULTS

Eleven physicians were interviewed. The following phenomena were extracted from the data: (1) encounter with the relatives, (2) making relatives understand brain death, (3) brain death is death, (4) experience of the nurses and (5) burdens.

CONCLUSION

The results show the complexity that is perceived by physicians when caring for a (potentially) brain-dead patient. The transition from saving the patient's life to preserving organs or switching off the equipment and informing the relatives requires a high level of expertise on the part of the physicians. The patients' symptoms provide the physicians with clear diagnostic procedures and any remaining ambiguities in the (treatment) process should be resolved.

Parked on the verge: vocational rehabilitation of long-term unemployed citizens - a mixed methods study

BACKGROUND

Vocational rehabilitation programs (VRP) developing and improving work ability are used in Denmark to assist long-term unemployed citizens with complex problems. The aims of this study were to (1) describe VRP-participants in relation to general health, well-being, work ability and self-efficacy at baseline and one-year follow-up, (2) obtain an understanding of VRP-participants' personal development towards improving work ability, and (3) explore VRP-participants' hopes and thoughts about their future.

METHODS

In a mixed methods approach, data from a longitudinal survey and semi-structured interviews were collected. In the quantitative longitudinal survey, all participants completed paper questionnaires at baseline and one-year follow-up. For the qualitative semi-structured interviews, VRP participants were recruited with a maximum variation sampling strategy through VRP coordinators and personal contact. Data were analysed by descriptive statistics and systematic text condensation. Following analysis, data were merged and presented in combination according to identified themes.

RESULTS

At baseline and one-year follow-up 146 (response rate 34%) and 74 participants (response rate 52%) respectively, responded to the questionnaire. Seven participants were interviewed. The analysis revealed four themes: 1) Individual explanations of life situation and health; 2) Finding the path; 3) Work as giving meaning to life; 4) Hope for the future. Despite self-reported scores indicating poor general health, lack of well-being, low work ability and low self-efficacy, VRP-activities seemed to have assisted participants in finding meaning in life. VRP-components that may be drivers of successful recovery processes were identified.

CONCLUSIONS

VRP-participants experienced life situations that include multifactorial burdens, and low levels of general health, well-being, work ability, and self-efficacy at baseline and 1 year later. From the outset, most did not have a clear goal of employment, but over time, new goals were set as realistic opportunities for re-developing their work ability were explored. Successful core components of VRP were individually tailored programs and support, development of new relationships, and accommodated flexible internships and jobs.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02641704 , date of registration December 29, 2015.

Exploring why patients in heroin-assisted treatment are getting incarcerated-a qualitative study

BACKGROUND

Heroin-assisted treatment has proven effective in reducing criminal offenses in opioid dependent individuals. Few studies attempted to explain the observed crime reduction and the reasons why these patients keep offending and getting incarcerated have to date not been explored.

METHODS

Patients with a history of incarcerations during the time of participating in heroin-assisted treatment (n = 22) were invited to a semi-structured, narrative interview. Findings were evaluated with Mayring's qualitative content analysis framework. Additionally, the Montreal Cognitive Assessment test and the multiple-choice vocabulary intelligence test used to assess cognitive impairment and premorbid intelligence levels.

RESULTS

Three main categories emerged in patients' narratives on their incarcerations: cocaine use, impaired functioning, and financial constraints. Lifetime prevalence of cocaine use disorder was 95.5% and their cocaine use often led to patients getting incarcerated. Impaired functioning mainly constituted the inability to receive and open mail. Financial constraints led to incarcerations in lieu of payment in 16 participants (72.7%). Categories overlapped notably and often occurred in close temporal proximity. A fourth category on the likelihood of getting incarcerated again in the future was inhomogeneous and ranged from the strong conviction to complete rejection of the scenario. Average premorbid intelligence levels were found, whereas the cognitive assessment suggested severe cognitive impairment in our sample.

CONCLUSION

Participants mainly reported to have committed minor offenses and not being able to pay for resulting fines. The resulting prison sentences are an unconvincing practice from a medical and economic perspective alike. Public expenditure and the interruptions of the continuum of care could be reduced by legislatively protecting these marginalised patients.

Impact of recorded, asynchronous admissions interviews on holistic and academic interview scores

INTRODUCTION

Applications across colleges of pharmacy have decreased significantly over the last few years. Many applicants turn down an in-person interview due to the cost of travel or time restraints. Offering asynchronous virtual interviews may increase the number of applicants interviewed; however, they may also affect the candidate's interview score. The purpose of this study is to compare the interview scores of candidates who interviewed in the virtual asynchronous platform vs. candidates who interviewed in person on campus.

METHODS

Admission candidates participated in either an in-person interview or a virtual asynchronous interview. Virtual interviews were conducted asynchronously through audiovisual capture of interview responses. All interview questions were rated on a scale of one to four. The individual question scores were averaged with applicants receiving an overall academic and an overall holistic interview score.

RESULTS

One hundred and twenty-one interviews were included in the analysis. Of these interviews, 32 (26%) were conducted virtually and 89 (74%) were conducted in person. Students participating in virtual interviews scored significantly lower than their in-person peers for both academic (U = 782 [2.8 vs. 3.3], P < .01) and holistic interviews (U = 1040 [3 vs. 3.3], P = .02).

CONCLUSIONS

Asynchronous virtual interviews could be a convenient method to offer interviews to candidates who may not be able to interview in person due to travel costs or other contributing barriers. Although this method may be more convenient for the interviewer, it may result in a lower interview score compared to an in-person interview.

"This is hard to cope with": the lived experience and coping strategies adopted amongst Australian women with pelvic girdle pain in pregnancy

Background

Women with pregnancy-related pelvic girdle pain (PPGP) report diminished ability to perform physical activities and experience higher rates of mood disorders, such as anxiety and depression, than pregnant women without PPGP. Despite these physical and psychological impacts, little is known about the lived experiences of PPGP amongst Australian women and the ways in which they cope. Situated within biographical disruption and social support theories, this study sought to gain a conceptual understanding of the experience and impact of PPGP on daily life, and how women cope with this condition during pregnancy.

Methods

A qualitative research design, situated within a phenomenological framework, using individual, semi-structured interviews consisting of open-ended questions was used with a flexible and responsive approach. Purposive sampling of pregnant women attending a single hospital included 20 participants between 14 and 38 weeks gestation, classified with PPGP as per recommended guidelines, with a mean (SD) age of 31.37 (4.16) years. Thematic analysis was performed where interview data was transcribed, coded, grouped into meaningful categories and then constructed into broad themes.

Results

Three themes were identified: 1. a transformed biography; 2. coping strategies; and 3. what women want. The pain experienced created a dramatic change in women’s lives, making the pregnancy difficult to endure. Women utilised social support, such as family, to help them cope with pain, and a self-care approach to maintain a positive mindset and reduce stress. Although a few women received support from healthcare professionals, many reported a lack information on PPGP and limited societal recognition of the condition. Women wanted early education, personalised information and prompt referral to help them cope with PPGP.

Conclusions

Findings from this study highlighted the complexity of living with PPGP as women attempted to deal with the unexpected impact on daily life by seeking support from partners and families, while also struggling with societal expectations. Although women with PPGP used a number of coping strategies, they sought greater support from healthcare professionals to effectively manage PPGP. These findings have important implications for the provision of health care to women living with PPGP.

Trial registration

Australian New Zealand Clinical Trials Registry: ACTRN12618001423202.

Evaluation of two-year recall of self-reported pesticide exposure among Ugandan smallholder farmers

OBJECTIVES

To evaluate smallholder farmers' recall of pesticide use and exposure determinants over a two-year period in a low-income country context.

METHODS

The Pesticide Use in Tropical Settings (PESTROP) study in Uganda consists of 302 smallholder farmers who were interviewed in 2017. In the same season in 2019, these farmers were re-questioned concerning pesticide use (e.g., use of active ingredients) and exposure information (e.g., crops, personal protective equipment [PPE], hygienic behaviours) they had previously provided. The extent of recall bias was assessed by comparing responses at follow-up in 2019 with practices and behaviours reported from the baseline interview in 2017.

RESULTS

An 84% (n = 255) follow-up response rate was attained. We found instances of better recall (e.g., overall agreement >70% and Area Under the Curve (AUC) values > 0.7) for the use of some active ingredients, commonly used PPE items, and washing clothes after application, whereas only 13.3% could correctly recall their three major crops. We observed a trend where more individuals reported the use of active ingredients, while fewer reported the use of PPE items, two years later. In general, we found better agreement in the recall of years working with pesticides compared to hours per day or days per week in the field, with no apparent systematic over or under reporting by demographic characteristics.

CONCLUSIONS

While some of these findings provide consistency with those from high-income countries, more research is needed on recall in poorly educated agriculture communities in low- and middle-income settings to confirm these results.

Virtual Gastroenterology Fellowship Recruitment During COVID-19 and Its Implications for the Future

BACKGROUND AND AIMS

Amid the COVID-19 pandemic, medical education organizations endorsed a virtual recruitment format, representing a stark change from traditional in-person interviews. We aimed to identify the attitudes and perceptions of Gastroenterology Fellowship Program Directors (PDs) and applicants regarding the virtual interview experience and the role of virtual interviews (VI) in the future.

METHODS

We designed separate surveys targeting PDs and applicants using the Qualtrics software. At the end of the interview season, we e-mailed both survey links to all PDs and requested that they forward the applicant survey to their interviewed candidates. Surveys were voluntary and anonymous. Descriptive statistics were used to analyze the data with results presented as percentages.

RESULTS

A total of 29.7% of PDs completed the survey. Compared to traditional interviews, VI were viewed by 46.5% of PDs to be very suboptimal or suboptimal. Yet, 69.1% envisioned a role for VI in the future. A total of 14.2% of applicants completed the survey. Compared to traditional interviews, VI were viewed by 42.3% of applicants to be very suboptimal or suboptimal. However, 61.8% saw a future role for VI. While both applicants and PDs reported that establishing an interpersonal connection was a disadvantage with VI, applicants placed more emphasis on this need for connection (p = 0.001).

CONCLUSION

Overall, PDs and applicants report mixed views with regard to VI but anticipate that it may continue to have a future role. VI may augment future recruitment cycles with care taken to not disadvantage applicants, who rely heavily on the interview process to create personal connections with programs.

Can adults with cerebral palsy perform and benefit from ballistic strength training to improve walking outcomes? A mixed methods feasibility study

BACKGROUND

Power bursts of hips and ankle plantar flexors are prerequisites to walking propulsion. However, these power bursts are reduced during gait for persons with cerebral palsy (CP) and mainly in the ankle plantar flexors. Hence, task specific training, such as ballistic strength training, is suggested to increase muscle power in walking but not investigated in adults with CP. Therefore, the aim was to investigate if adults with CP could perform and benefit from ballistic strength training to improve walking, evaluated through physical measures and self-reported measures and interviews.

METHODS

In this mixed methods feasibility study, eight ambulatory adults (aged 24-56) with spastic CP conducted ballistic strength training on a glideboard targeting the ankle plantarflexors two times a week for eight weeks. The feasibility of the training was assessed through objectives described by Orsmond and Cohn. Before and after the intervention, physical measures (6-Minute Walk Test and the eight-item High-level Mobility Assessment Tool) and self-reported measures (Patient Global Impression of Change, Numeric Pain Rating Scale, Fatigue Impact and Severity Self-Assessment, and Walk-12) were collected. After the intervention, semi-structured interviews explored experiences of this training.

RESULTS

The participants experienced training the ankle plantar flexor as relevant but reported it took about four weeks to coordinate the exercises successfully. Although we observed no changes in the physical performance measures, most participants reported improvements; some felt steadier when standing, walking, and hopping.

CONCLUSION

This study demonstrated that ballistic strength training was feasible and suitable in adults with CP. However, guidance and a long (4 weeks) familiarization time were reported necessary to master the exercises. Most participants reported self-experienced improvements, although no physical performance measures improved. Thus, prolonged intervention may be required for perceived physical improvements to emerge. Also, other outcome measures sensitive to power output remains to be investigated.

Machine learning techniques and older adults processing of online information and misinformation: A covid 19 study

This study is informed by two research gaps. One, Artificial Intelligence's (AI's) Machine Learning (ML) techniques have the potential to help separate information and misinformation, but this capability has yet to be empirically verified in the context of COVID-19. Two, while older adults can be particularly susceptible to the virus as well as its online infodemic, their information processing behaviour amid the pandemic has not been understood. Therefore, this study explores and understands how ML techniques (Study 1), and humans, particularly older adults (Study 2), process the online infodemic regarding COVID-19 prevention and cure. Study 1 employed ML techniques to classify information and misinformation. They achieved a classification accuracy of 86.7% with the Decision Tree classifier, and 86.67% with the Convolutional Neural Network model. Study 2 then investigated older adults' information processing behaviour during the COVID-19 infodemic period using some of the posts from Study 1. Twenty older adults were interviewed. They were found to be more willing to trust traditional media rather than new media. They were often left confused about the veracity of online content related to COVID-19 prevention and cure. Overall, the paper breaks new ground by highlighting how humans' information processing differs from how algorithms operate. It offers fresh insights into how during a pandemic, older adults-a vulnerable demographic segment-interact with online information and misinformation. On the methodological front, the paper represents an intersection of two very disparate paradigms-ML techniques and interview data analyzed using thematic analysis and concepts drawn from grounded theory to enrich the scholarly understanding of human interaction with cutting-edge technologies.

How to choose an abdominal imaging fellowship

Radiologists in training draw from their early experiences in residency when choosing a fellowship. Once they have decided on an abdominal imaging fellowship, applicants must learn to navigate the interview process. During this challenging time, applicants explore the difference in clinical curricula and rotations, meet potential mentors and clinical faculty, consider potential academic interests and projects, and choose what location they would like to train for one year after residency. When in training, fellows undergo the challenge of finding employment while learning new skills and refining their abilities to become a well-rounded radiologist and clinician. This article summarizes key points potential applicants should consider when deciding on an abdominal imaging fellowship, how to prepare for the interview season, and how to plan their fellowship year before fellows take the next step to becoming attendings.

Interview and interior: Procedures of narrative surveys around 1900

In the spring of 1893, the Austrian writer and critic Hermann Bahr began interviewing various people on antisemitism, a subject of heated discussion in the European feuilleton around 1900. "Once again, I am travelling the world sounding out people's opinions and listening to what they have to say," he wrote in his introduction to a series of articles on that issue that appeared in the feuilleton of the Deutsche Zeitung between March and September 1893. A year later, the Berlin publishing house S. Fischer turned Bahr's articles into a book. Bahr conducted a total of thirty-eight interviews with prominent personages, such as August Bebel, Theodor Mommsen, Ernst Haeckel, Henrik Ibsen and Jules Simon. Bahr did not focus on the arguments in favour or against antisemitism. Instead, he set out explicitly to investigate the sentiments, perceptions and opinions on this topic within the cultured classes. Yet, as I will show in this article, Bahr tried to capture not only the "sentiments" [Empfindungen] aired by his interviewees, but also the settings and interiors in which the interviews took place. I argue that these descriptions of physical space served Bahr as authentication, as a three-dimensional certificate for the "facts of opinion" [Meinungstatsachen] he recorded.

A pilot project to introduce the multiple mini interview (MMI) at a Borneo medical school: The universiti Malaysia Sabah experience- a cross-sectional study

Introduction

The Multiple Mini Interview (MMI) demonstrates efficacy and superiority over traditional medical interviews in assessing non-cognitive domains during the recruitment of medical undergraduates. At Universiti Malaysia Sabah (UMS), a five-station MMI was piloted in 2019, featuring a mix of three examiner-driven stations (assessing professionalism, ethics, and motivation to study medicine), and two roleplayer-driven stations (assessing empathy and science communication specifically, and communication skills in general).

Methods

260 candidates were grouped into two separate geographical groups – urban and suburban/rural. Descriptive analysis, skewness and kurtosis were performed for normality assessment, whereas Cronbach's alpha, McDonald's omega, and Greatest lower bound assessed internal consistency. For validity measures, correlations were calculated between scores for separate stations, overall scores, urban and suburban/rural status. Also, exploratory factor analysis was performed on the five stations as validity measures. Difficulty and discrimination indices were calculated as quality measures. Qualitative analysis was performed on “red flag” comments detailing grossly unsuitable candidates.

Results

Roleplayer-driven stations yielded more red flags than examiner-driven stations. The three examiner-driven stations were significantly and moderately correlated (rho between 0.602 and 0.609, p < 0.001). The Empathy roleplayer-driven station was not correlated with two examiner-driven stations and only weakly correlated with the Ethics examiner-driven and the Science Communication roleplayer-driven station. Factor analysis suggests a three-factor model. The two roleplayer-driven stations stood as independent factors, and the three examiner-driven stations coalescing as one factor provided the best explanatory model. Quality measures suggest all five stations had suitable discriminatory properties (all >0.530), whereas the stations were distributed equally in difficulty index.

Conclusion

The UMS MMI has identified specific skillsets that may be in short supply in our incoming medical students. Also, it illustrates the yawning gap between academic knowledge and ‘translational’ scientific knowledge and communication skills.

•

The Multiple Mini Interview demonstrates superiority over traditional interviews during the recruitment of medical undergraduates.

•

At Universiti Malaysia Sabah, a five-station MMI was piloted in 2019.

•

The MMI featured a mix of three examiner-driven stations and two roleplayer-driven stations.

•

The UMS MMI has identified specific skillsets that may be in short supply in the incoming medical students.

•

It also illustrates the yawning gap between academic knowledge, “translational” scientific knowledge and communication skills.

Enablers of the successful implementation of simulation exercises: a qualitative study among nurse teachers in undergraduate nursing education

BACKGROUND

Simulation exercises are increasingly being used as a teaching method in the field of undergraduate nursing education. Thus, the present study sought to identify, describe and discuss enablers of the successful implementation of simulation exercises in undergraduate nursing education.

METHODS

This study had a qualitative descriptive design and involved individual interviews conducted between November and December 2018 with six nurse teachers from three different university campuses in Norway. The transcribed interviews were analysed by means of a qualitative thematic analysis.

RESULTS

The majority of the interviewees wanted to offer more simulation exercises as part of their respective undergraduate nursing education programmes. Moreover, creating a safe environment, facilitating student-centred learning and promoting reflection were all identified by the interviewees as enablers of the successful implementation of simulation exercises.

CONCLUSIONS

The findings of this study indicate that nurse teachers consider simulation to be a valuable teaching method for improving students' learning outcomes. In addition, the findings could guide the future implementation of simulation exercises in undergraduate nursing education.

TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT04063319 . Protocol ID: 52110 Nursing Students' Recognition of and Response to Deteriorating Patients.

Added value of physical food products as a stimulus during interviewing

Semi-structured interviews are an often-used method for researching consumer perceptions of food products. However, understanding detailed and in-depth how consumers perceive food products is challenging for researchers because it could be difficult for consumers to express their motives and perceptions. In our previous studies using semi-structured interviews, this difficulty to express perceptions was also recognized, especially when concepts like naturalness, sustainability and healthiness were discussed. However, in both studies physical food products were used as stimuli and there was an indication that there might be differences in the number and type of answers given before and after the use of these stimuli products. Therefore, the current research aimed at showing effects and the possible value of using physical food stimuli products during semi-structured interviews. Two different studies were used to reach this aim, one study about the health perception of mothers and the other study about the naturalness, sustainability and healthiness perception of adolescents, both using snack products as physical stimuli. In both studies, the use of physical stimuli products appeared to be effective and useful. The comparison of the answers with and without stimuli products showed that using stimuli products provides more, and more detailed answers on the perception of the products. Therefore, the results of this study could serve as a guideline on the use of food stimuli products during semi-structured interviews.

[Identifying the barriers to pulmonary rehabilitation for patients with COPD]

INTRODUCTION

Although pulmonary rehabilitation is a core treatment for chronic obstructive pulmonary disease (COPD) approved by the French National Authority for Health, there is no doubt that it is insufficiently used in France. Pulmonary rehabilitation consists of exercise training and patient education delivered in a multidisciplinary programme of care to reverse the downward spiral of deconditioning caused by the illness as well as improving patients' ability to self-manage. The aim of this study was to identify the obstacles that prevent the delivery of pulmonary rehabilitation, so as to understand its lack of use.

METHOD

A qualitative study was undertaken with semi-structured interviews in focus groups and individually, involving the different actors within COPD care pathways, including doctors, other healthcare professionals, and patients.

RESULTS

Three group interviews and nine individual interviews were analysed. From these, 13 issues appeared: the disease itself, the perception of the disease, the multidisciplinary work, the relationship between caregivers and the patient, motivation, smoking, the comorbidities, fear, geography, economy, the social, the temporality and the establishment of a pulmonary rehabilitation programme.

CONCLUSION

This work illustrates the many barriers that will be interesting to explore, in order to increase the use of pulmonary rehabilitation for patients with COPD.

Improving preoperative breast reconstruction consultations: a qualitative study on the impact of personalised audio-recordings

Background

To investigate the value of audio-recordings in aiding patient understanding and recall of preoperative breast reconstruction information.

Methods

This was a prospective cohort study. Participants were randomly allocated into either a recording group who were offered the opportunity to record their breast reconstruction explanation of surgery, or a standard information package group who received standard care. The value of having an audio-recording was assessed by semi-structured interviews and analysis of recurring themes.

Results

Between 21/2/19 and 19/3/20, 32 women attending consultations for breast reconstruction consented to participate in the study, 17 were randomly assigned to the recording group and 15 the standard information package group. Twenty-eight of the 32 participants completed qualitative interviews. All participants agreed that audio-recordings were a beneficial resource which allowed them to have a better understanding of the concepts discussed. Commonly reported themes included the ability to listen to the recording multiple times to refresh memory, as well as usefulness in helping to inform other family members. Participants also reported increased levels of trust in their clinician for allowing the audio-recordings. Very few participants raised any medico-legal implications of the recordings, their focus was more on the potential of the audio-recordings to alleviate the overwhelming nature of a pre-operative breast reconstruction consultation.

Conclusions

There was a positive response from participants to the use of audio-recordings in the setting of breast reconstruction consultations. These types of recordings could potentially be used in other complex appointments where detailed information is discussed, with similar success.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-021-01534-8.

Task shifting of intravitreal injections from physicians to nurses: a qualitative study

Background

Intravitreal injections of anti-vascular endothelial growth factor are high-volume procedures and represent a considerable workload on ophthalmology departments. Several departments have tried to meet this increase by shifting the task to nurses. To maintain high-quality patient care, we developed a training program for nurses that certifies them to administer injections. This qualitative study aimed to evaluate whether the nurses were confident and in control after participating in the training program and whether they were satisfied with the training and the new task.

Methods

Between 2014 and 2018, 12 registered nurses were trained in a tertiary hospital in central Norway. All the nurses were interviewed, either individually (n = 7) or in a group (n = 5). We analysed the interviews using Graneheim and Lundman’s qualitative content analysis.

Results

Eight subthemes were clustered within four main themes: 1) procedure and challenges, 2) motivation, 3) cooperation and confidence, and 4) evaluation. The nurses felt confident and in control when administering injections but experienced moments of insecurity. The new task gave the nurses a sense of achievement, and they highlighted improvement of patients’ lives as positive. A greater level of responsibility gave the nurses pride in their profession. They had suggestions that could improve training efficiency but were overall satisfied with the training program.

Conclusions

Our study showed that the nurses were satisfied with the training and that learning a new task led to higher self-esteem and increased respect from patients and colleagues. Suggestions to improve the training were identified; these should be considered before implementation by other departments.

Patients perspective on treatment and early rehabilitation after an ankle fracture: A longitudinal qualitative study

Worldwide, ankle fractures are among the most common fractures encountered in emergency departments. To inform healthcare professionals about what is important to patients when organizing an individualized, high-quality treatment plan, patient perspectives on treatment, care, and early rehabilitation are highly relevant. This longitudinal interview study aims to explore the perspectives of patients with surgically (ST) and conservatively (CT) treated ankle fractures within ten days and six weeks after an ankle fracture. Fourteen patients were interviewed using a semi-structured interview guide. Data were analyzed according to qualitative content analysis. Findings revealed themes regarding pain, independence, information, and worries about the future. Initially, all patients had a pragmatic attitude toward the future, but this attitude was significantly different after 6 weeks as many of the ST patients were still in pain and were more worried about the future. Patients' feelings of uncertainty were linked to a lack of information. Our findings indicate a need for further research to develop a more specific description of symptoms patients should expect as treatment progresses for patients with ankle fractures. With the goal of decreasing psycho-social concerns regarding mobility, autonomy, and working ability post fracture.

Pressing ethical issues in considering pediatric deep brain stimulation for obsessive-compulsive disorder

BACKGROUND

Refractory obsessive-compulsive disorder (OCD) among adults is the first psychiatric indication of deep brain stimulation (DBS) to receive an FDA Humanitarian Device Exemption (HDE). Given the HDE approval and encouraging evidence that has since emerged, exploration of DBS for OCD may expand to adolescents in the future. More than 100,000 adolescents in the U.S. suffer from refractory OCD, and there is already a precedent for the transition of DBS in adults to children in the case of dystonia. However, the risk-benefit analysis of pediatric DBS for OCD may be more complex and raise different ethical questions compared to pediatric DBS for dystonia.

OBJECTIVE

This study aimed to gain insight into pressing ethical issues related to using DBS in adolescents with OCD.

METHODS

Semi-structured interviews were conducted with clinicians (n = 25) caring for pediatric patients with refractory OCD. Interview transcripts were coded with MAXQDA 2018 software and analyzed using thematic content analysis to identify emergent themes.

RESULTS

Five central themes were identified in clinician responses, three of which were exacerbated in the pediatric DBS setting. Clinicians expressed concerns related to conditions of decision-making including adolescents' capacity to assent (80%), the lack of evidence about the outcomes and potential unknown effects of using DBS in adolescents with OCD (68%), and the importance of exhausting other treatment options before considering DBS (20%).

CONCLUSIONS

Strategies to address clinician concerns include implementation of validated decision support tools and further research into the outcomes of pediatric DBS for OCD to establish clear guidelines for patient selection.

Online follow-up with a mobile device improves incurable cancer patients' coping - A qualitative study

PURPOSE

To examine patients' experiences regarding the impact of support given by a mobile application on their ability to cope with incurable cancer.

METHOD

The qualitative research data of semi-structured, face-to-face interviews with 20 adult patients suffering from incurable cancer during disease-controlling chemotherapy or palliative care were analysed with inductive content analysis.

RESULTS

The majority of the interviewees viewed the mobile application as helpful for monitoring relevant symptoms and coping with the disease. The patients' sense of security was increased by their ability to contact the clinic at all times. As a communication channel, the mobile application was seen as more convenient than the telephone, and it provided a sense of freedom for the patients as contacting the clinic was not tied to time or place. The patients also experienced as well increased involvement with their own care and had a sense of staying abreast with their treatment. A minority of the interviewees reported that there was a certain disease-centredness in using the mobile application.

CONCLUSIONS

The present study extends the knowledge of patients using a mobile application as a part of their cancer care and assesses of the acceptance of using this application to provide supportive care. The patients reported that they were better able to cope with the disease when using the mobile application, although some described it as being too disease centred. Overall, this study indicates that the patients' sense of security and freedom increased when using the mobile application.

The impact of the COVID-19 pandemic on mental health and well-being of people living with a long-term physical health condition: a qualitative study

BACKGROUND

The COVID-19 pandemic and associated restrictions caused major global disruption. Individuals with long-term physical health conditions (LTCs) are at higher risk of severe illness and often subject to the strictest pandemic guidance, so may be disproportionally affected. The aim of this study was to qualitatively explore how living with a LTC during the COVID-19 pandemic affected people's mental health and wellbeing.

METHODS

Participants were people living with LTCs who participated in telephone/video call interviews based on a semi-structured topic guide. Key themes and subthemes were determined using deductive and inductive thematic analysis.

RESULTS

The sample included 32 participants with LTCs (most commonly cancer, respiratory conditions or cardiovascular diseases), mean age 57 (SD 13) years, 66% female and 72% white British. There were four overarching themes specific to living with a LTC. These were 1) high levels of fear and anxiety related to perceived consequences of catching COVID-19, 2) impact of shielding/isolation on mental health and wellbeing, 3) experience of healthcare during the pandemic and 4) anxiety created by uncertainty about the future. Fourteen subthemes were identified, including concerns about accessing essential supplies and the importance of social support. Individuals who lived alone and were advised to shield could be profoundly negatively affected.

CONCLUSIONS

This study found that there were a number of aspects of living with a LTC during the pandemic that had a significant impact on mental health and well-being. There should be focus on how best to provide practical and social support to people with LTCs during a pandemic, particularly if they have to shield or isolate.

Exploration of current challenges in rehabilitation from the perspective of healthcare professionals: Switzerland as a case in point

Rehabilitation is a health strategy with the potential to mitigate the negative health consequences of population ageing and the rise of noncommunicable diseases. Literature indicates that even in high-income countries rehabilitation services can be improved. The purpose of this study is to engage rehabilitation professionals in Switzerland in identifying and prioritizing current challenges in the development and delivery of rehabilitation services. We conducted a qualitative study consisting of interviews with key informants and a stakeholder consultation. Thirteen interviews were conducted and analysed using inductive thematic analysis. Identified challenges were refined, extended, and prioritized through multi-voting in a workshop attended by a wide range of rehabilitation professional organizations. Final results were subject to further analysis and member checking. We identified nineteen challenges, of which eight were viewed as highly important. Results suggest the need to revise the financing system for rehabilitation services, highlighted a poor integration of rehabilitation in primary care, a lack of academic rehabilitation training, and insufficient funding for research. Finally, we identified a perceived lack of awareness for rehabilitation among policy-makers and the public. This study provides a unique perspective on challenges in rehabilitation practice and policy and offers an opportunity for professionals, policy-makers, and other stakeholders, to influence and guide the rehabilitation service agenda both in Switzerland and in terms of mutual learning also in other countries.

[Relevance of different study types in benefit assessment: Results from expert interviews]

BACKGROUND

Careful evaluation of new interventions is essential. Randomized controlled trials (RCTs) and systematic reviews of RCTs provide the most reliable evidence base in comparative evaluations of treatments and interventions. Observational study designs are found at the lower levels of the classical evidence hierarchy. In light of policy efforts to accelerate the availability of innovations, the use of evidence from non-randomized studies for reimbursement decisions is being discussed. The present study addresses the question of the value and feasibility of RCTs and observational studies for benefit assessment after an intervention has been introduced into practice.

METHODS

Experts from German-speaking countries were interviewed using qualitative, semi-structured interviews. Participants included experts in health economics, health services and health services research, health communication, ethics, and health policy. The interviews were conducted by one researcher and then analyzed using a deductive approach. Main categories and subcategories were extracted.

RESULTS

Twenty-six experts were invited to participate, and 15 agreed to be interviewed. The duration of the individual interviews varied between 35 and 80minutes. The interviewed experts considered it possible and necessary to conduct RCTs when an intervention is already available in care in order to demonstrate that an intervention is more effective than existing alternatives. Experts considered good study design, methodological knowledge of those conducting the study, infrastructure, and funding as underlying conditions. They emphasized that the benefit of an intervention cannot be conclusively clarified on the basis of observational studies and that RCTs can therefore only be dispensed with in exceptional cases. Therefore, observational studies do not represent an alternative to RCTs in benefit assessment in general. In the opinion of the experts, the requirements for observational studies included sensible criteria and quality assurance measures. As alternatives to RCTs, the experts named studies based on routine data or high-quality, prospective, comparative cohort studies. Individual experts were very critical of studies based on data from registries.

DISCUSSION AND CONCLUSION

The results of the interviews are underlined by findings from the scientific literature. For example, international scientists advocate for conducting RCTs instead of observational studies and for a reduction in hurdles and barriers for conducting RCTs. In international methodological standards for the preparation of health technology assessments, RCTs are also generally preferred for benefit assessment. Nevertheless, there is still a need for research about the optimal use of observational studies, alternative RCT designs and the use of data from routine care or registries, as policy makers, among others, believe that observational studies should be used for benefit assessment. The results show that experts still adhere to the established principles of clinical epidemiology. Observational studies should only be used as an alternative to RCTs in exceptional cases to examine whether one intervention is more effective than existing alternatives.

Obstacles and risks in the traffic environment for users of powered wheelchairs in Sweden

OBJECTIVE

According to the European Union, fatal road accidents involving Vulnerable Road Users (VRUs) are equal in proportion to fatal car road accidents (46%). VRUs include individuals with mobility challenges such as the elderly and Powered Wheelchair (PWC) users. The aim of this interdisciplinary qualitative study was to identify obstacles and risks for PWC users by exploring their behaviour and experiences in traffic environments.

METHODS

Videos and in-depth interviews with 13 PWC users aged 20-66 were analysed for this study. The interviews and videos, which include real-life outdoor observations, originate from a qualitative study exploring experiences of PWC use on a daily basis in Sweden. Underlying causal factors to identified risks and obstacles were identified, based on human, vehicle (PWC) and environmental factors in accordance with the Haddon Matrix.

RESULTS

The results show significant potential for improvement within all three perspectives of the Haddon Matrix used in the analysis. Participants faced and dealt with various obstacles and risks in order to reach their destination. For example, this includes uneven surfaces, differences in ground levels, steep slopes, as well as interactions with other road users and the influence of weather conditions, resulting in PWC users constantly accommodating and coping with the shortcomings of the vehicle and the environment.

CONCLUSIONS

There are still major challenges with regard to preventing obstacles and risks in the traffic environment for PWC users. To discern PWC users in traffic accident and injury data bases, a start would be to register type of aid used for persons involved in an accident. Furthermore, to emphasise PWC users' role as VRUs, it may also be advantageous to describe them as drivers rather than users when navigating the traffic environment. Given the limited sample, further research covering more data from a broader perspective would be beneficial. By incorporating emerging knowledge of PWC users' prerequisites and needs, and including them in research and traffic planning, the society will grow safer and more inclusive, and become better prepared for meeting future demands on accessibility from an aging population.