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Al-Yateem N, Mottershead R, Refaat Ahmad F, Arsyad Subu M. A reflection on the use of virtual nominal group technique in health policy and research priority consensus studies. Nurse Res 2024; 32:35-41. [PMID: 38932484 DOI: 10.7748/nr.2024.e1933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Nominal group technique (NGT) is widely used in healthcare research to facilitate decision-making and consensus-building. Traditional NGT requires face-to-face interaction and its limitations include potential biases, logistical challenges and high costs. The COVID-19 pandemic necessitated a shift to virtual methods, which led to the development of virtual nominal group technique (vNGT). Aim To reflect on the use of vNGT, particularly in the context of Ghader et al (2023 ), to understand its effectiveness in overcoming the limitations of traditional NGT and on its applicability in pandemic-affected scenarios. METHOD This paper reviews and discusses literature on the use and effectiveness of NGT compared to other consensus-building methods and examines the emergence of vNGT in overcoming the limitations of traditional NGT. The authors also reflect on their use of vNGT in a study to identify cardiovascular research priorities in the UAE and provide details of its implementation. DISCUSSION vNGT bridges the gap between the localised nature of traditional NGT and the global reach of the Delphi technique. It allows for the inclusion of diverse participants, saves costs and offers time-efficiency. The study demonstrated vNGT's adaptability, with participants engaging in idea generation, discussion and prioritisation using online tools. However, challenges persist with vNGT, including reduced accessibility for certain demographics, timing issues across time zones and technical difficulties. CONCLUSION vNGT successfully integrates the interactive, consensus-building aspects of NGT with the broad reach of Delphi. It can be valuable in research and decision-making, especially in an era of increased remote collaboration. IMPLICATIONS FOR PRACTICE vNGT can significantly impact healthcare research and policy formulation by enabling more inclusive, cost-effective and timely consensus-building processes. However, considerations for accessibility and technical support are crucial for its wider adoption and effectiveness.
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Affiliation(s)
- Nabeel Al-Yateem
- Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Richard Mottershead
- Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Fatma Refaat Ahmad
- Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Muhammad Arsyad Subu
- Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
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Iyer AS, Wells RD, Bechthold AC, Armstrong M, O'Beirne R, Byun JY, Coffee-Dunning J, Odom JN, Buhr RG, Suen AO, Kotwal AA, Witt LJ, Brown CJ, Dransfield MT, Bakitas MA. Identifying priority challenges of older adults with COPD: A multiphase intervention refinement study. J Am Geriatr Soc 2024. [PMID: 39215557 DOI: 10.1111/jgs.19158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 07/22/2024] [Accepted: 08/01/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Identifying priority challenges of older adults with chronic obstructive pulmonary disease (COPD) is critical to designing interventions aimed at improving their well-being and independence. OBJECTIVE To prioritize challenges of older adults with COPD and those who care for them to guide refinement of a telephonic nurse coach intervention for patients with COPD and their family caregivers (EPIC: Empowering People to Independence in COPD). DESIGN Multiphase study guided by Baltes Theory of Successful Aging and the 5Ms Framework: Phase 1: Nominal group technique (NGT), a structured process of prioritizing responses to a question through group consensus. Phase 2: Rapid qualitative analysis. Phase 3: Intervention mapping and refinement. SETTING Ambulatory, virtual. PARTICIPANTS Older adults with COPD, family caregivers, clinic staff (nurses, respiratory therapists), clinicians (physicians, nurse practitioners), and health system leaders. RESULTS NGT sessions were conducted by constituency group with 37 participants (n = 7 patients, n = 6 family caregivers, n = 8 clinic staff, n = 9 clinicians, n = 7 health system leaders) (Phase 1). Participants generated 92 statements across five themes (Phase 2): (1) "Barriers to care", (2) "Family caregiver needs", (3) "Functional status and mobility issues", (4) "Illness understanding", and (5) "COPD care complexities". Supplemental oxygen challenges emerged as a critical problem, and prioritized challenges differed by group. Patients and clinic staff prioritized "Functional status and mobility issues", family caregivers prioritized "Family caregiver needs", and clinicians and health system leaders prioritized "COPD care complexities". Intervention mapping (Phase 3) guided EPIC refinement focused on meeting patient priorities of independence and mobility but accounting for all priorities. CONCLUSIONS Diverse constituency groups identified priority challenges for older adults with COPD. Functional status and mobility issues, particularly related to supplemental oxygen, emerged as patient prioritized challenges. IMPLICATIONS Patient-centered interventions for older adults with COPD must account for their prioritized functional and supplemental oxygen needs and explore diverse constituent perspectives to facilitate intervention enrichment.
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Affiliation(s)
- Anand S Iyer
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Palliative and Supportive Care, Birmingham, Alabama, USA
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA
| | - Rachel D Wells
- Center for Palliative and Supportive Care, Birmingham, Alabama, USA
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Avery C Bechthold
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Margaret Armstrong
- Center for Palliative and Supportive Care, Birmingham, Alabama, USA
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ronan O'Beirne
- Division of Continuing Medical Education, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jun Y Byun
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jazmine Coffee-Dunning
- Center for Palliative and Supportive Care, Birmingham, Alabama, USA
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - J Nicholas Odom
- Center for Palliative and Supportive Care, Birmingham, Alabama, USA
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Russell G Buhr
- Division of Pulmonary & Critical Care Medicine, University of California, Los Angeles, California, USA
- Department of Health Policy & Management, University of California, Los Angeles, California, USA
- Center for the Study of Healthcare Innovation, Implementation, and Policy, Greater Los Angeles VA Healthcare System, Los Angeles, California, USA
| | - Angela O Suen
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California, San Francisco, California, USA
| | - Ashwin A Kotwal
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Leah J Witt
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California, San Francisco, California, USA
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
| | - Cynthia J Brown
- Department of Internal Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Mark T Dransfield
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA
| | - Marie A Bakitas
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Palliative and Supportive Care, Birmingham, Alabama, USA
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Katzmarzyk PT, Myers CA, Nelson MR, Denstel KD, Mire EF, Newton RL, Broyles ST, Kirwan JP. Exploring barriers to SARS-CoV-2 testing uptake in underserved black communities in Louisiana. Am J Hum Biol 2023; 35:e23879. [PMID: 36807397 PMCID: PMC10591290 DOI: 10.1002/ajhb.23879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/27/2023] [Accepted: 02/02/2023] [Indexed: 02/22/2023] Open
Abstract
OBJECTIVE To collect qualitative data on approaches that can potentially reduce barriers to, and create strategies for, increasing SARS-CoV-2 testing uptake in underserved Black communities in Louisiana. METHODS A series of eight focus groups, including 41 participants, were conducted in primarily Black communities. The Nominal Group Technique (NGT) was used to determine perceptions of COVID-19 as a disease, access to testing, and barriers limiting testing uptake. RESULTS Common barriers to SARS-CoV-2 testing were identified as lack of transportation, misinformation/lack of information, lack of time/long wait times, fear of the test being uncomfortable and/or testing positive, the cost of testing, and lack of computer/smartphone/internet. The most impactful approaches identified to increase testing uptake included providing testing within the local communities; testing specifically in heavily traveled areas such as supermarkets, churches, schools, and so forth; providing incentives; engaging local celebrities; and providing information to the community through health fairs, or through churches and schools. The strategies that were deemed to be the easiest to implement revolved around communication about testing, with suggested strategies involving churches, local celebrities or expert leaders, social media, text messages, public service announcements, post cards, or putting up signs in neighborhoods. Providing transportation to testing sites, providing incentives, and bringing the testing to neighborhoods and schools were also identified as easy to implement strategies. CONCLUSIONS Several strategies to increase testing uptake were identified in this population. These strategies need to be tested for effectiveness in real-world settings using experimental and observational study designs.
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Affiliation(s)
| | - Candice A. Myers
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Michelle R. Nelson
- Surgeons Group of Baton Rouge, Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, USA
| | - Kara D. Denstel
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Emily F. Mire
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Robert L. Newton
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | | | - John P. Kirwan
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
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Verheijden M, Giroldi E, van den Eertwegh V, Luijkx M, van der Weijden T, de Bruin A, Timmerman A. Identifying characteristics of a skilled communicator in the clinical encounter. MEDICAL EDUCATION 2023; 57:418-429. [PMID: 36223270 DOI: 10.1111/medu.14953] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 09/21/2022] [Accepted: 10/08/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND In medical communication research, there has been a shift from 'communication skills' towards 'skilled communication', the latter implying the development of flexibility and creativity to tailor communication to authentic clinical situations. However, a lack of consensus currently exists what skilled communication entails. This study therefore aims to identify characteristics of a skilled communicator, hereby contributing to theory building in communication research and informing medical training. METHOD In 2020, six nominal group technique (NGT) sessions were conducted in the context of the general practitioner (GP) training programme engaging 34 stakeholders (i.e. GPs, GP residents, faculty members and researchers) based on their experience and expertise in doctor-patient communication. Participants in each NGT session rank-ordered a 'Top 7' of characteristics of a skilled communicator. The output of the NGT sessions was analysed using mixed methods, including descriptive statistics and thematic content analysis during an iterative process. RESULTS Rankings of the six sessions consisted of 191 items in total, which were organised into 41 clusters. Thematic content analysis of the identified 41 clusters revealed nine themes describing characteristics of a skilled communicator: (A) being sensitive and adapting to the patient; (B) being proficient in applying interpersonal communication; (C) self-awareness, learning ability and reflective capacity; (D) being genuinely interested; (E) being proficient in applying patient-centred communication; (F) goal-oriented communication; (G) being authentic; (H) active listening; and (I) collaborating with the patient. CONCLUSIONS We conceptualise a skilled communication approach based on the identified characteristics in the present study to support learning in medical training. In a conceptual model, two parallel processes are key in developing adaptive expertise in communication: (1) being sensitive and adapting communication to the patient and (2) monitoring communication performance in terms of self-awareness and reflective capacity. The identified characteristics and the conceptual model provide a base to develop a learner-centred programme, facilitating repeated practice and reflection. Further research should investigate how learners can be optimally supported in becoming skilled communicators during workplace learning.
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Affiliation(s)
- Michelle Verheijden
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Educational Development and Research, School of Health Professions Educations (SHE), Maastricht University, Maastricht, The Netherlands
| | - Esther Giroldi
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Educational Development and Research, School of Health Professions Educations (SHE), Maastricht University, Maastricht, The Netherlands
| | - Valerie van den Eertwegh
- Skillslab, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Marscha Luijkx
- Department of Family Medicine, School for Public Health and Primary Care, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Anique de Bruin
- Department of Educational Development and Research, School of Health Professions Educations (SHE), Maastricht University, Maastricht, The Netherlands
| | - Angelique Timmerman
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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Soto E, Lewis M, Estrada CA, de la Torre JI, O'Beirne R, Martin C, Corey B. Barriers and Facilitators for Under-Represented in Medicine (URiM) Medical Students Interested in Surgical Sub-specialties. Am J Surg 2023; 225:660-666. [PMID: 37455798 PMCID: PMC10344418 DOI: 10.1016/j.amjsurg.2022.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Little is known on drivers and detractors underrepresented in medicine (URiM) medical students face. Methods Using the nominal group technique (NGT), we explored experiences that strengthen or weaken the enthusiasm to pursue a career in surgery among URiM medical students (October 2021- April 2022); participants voted on the three most important experiences (weight of 3= top rated, = 1 for the lowest rated). Responses from NGT with at least one vote were weighted, ranked, and categorized. Results Seventeen students participated. Experiences that strengthen enthusiasm (36 responses with at least one vote) involved mentorship and role models (weighted sum percentage, 35%), demonstrating grit (15%), lifestyle (15%), patient interactions (14%), technical skills (11%), community and team (10%), and intellectual stimulation (1%). Experiences that weaken enthusiasm (33 responses with at least one vote) include the minority experience (weighted sum percentage, 51%), quality of life (25%), toxic environment (13%), lack of information (7%), and finances (5%). Conclusions Mentorship, demonstrating grit, and feeling a sense of community were important positive experiences or attitudes. The minority experience, toxic environment, perceptions of self-worth, and lifestyle misconceptions perceived by URiM must be addressed to increase diversity, equity, and inclusion.
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Affiliation(s)
- Edgar Soto
- University of Alabama at Birmingham Marnix E. Heersink School of Medicine; Birmingham, Alabama
| | - Marshall Lewis
- University of Alabama at Birmingham Marnix E. Heersink School of Medicine; Birmingham, Alabama
| | - Carlos A Estrada
- Division of General Internal Medicine, Department of Medicine, University of Alabama at Birmingham Marnix E. Heersink School of Medicine; Birmingham, Alabama
- Birmingham Veterans Affairs Medical Center; Birmingham, Alabama
| | - Jorge I de la Torre
- Birmingham Veterans Affairs Medical Center; Birmingham, Alabama
- Division of Plastic Surgery, Department of Surgery, University of Alabama at Birmingham Marnix E. Heersink School of Medicine; Birmingham, Alabama
| | - Ronan O'Beirne
- Office of Continuing Medical Education, University of Alabama at Birmingham Marnix E. Heersink School of Medicine; Birmingham, Alabama
| | - Colin Martin
- Division of Pediatric Surgery, Department of Surgery, University of Alabama at Birmingham Marnix E. Heersink School of Medicine; Birmingham, Alabama
| | - Britney Corey
- Birmingham Veterans Affairs Medical Center; Birmingham, Alabama
- Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham Marnix E. Heersink School of Medicine; Birmingham, Alabama
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Kleman C, Magnus JM, Andrews M, Meyer K, Lutz BJ. The work of managing a chronic illness: A job description. J Eval Clin Pract 2023; 29:166-180. [PMID: 36031800 PMCID: PMC10087252 DOI: 10.1111/jep.13754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/03/2022] [Accepted: 08/10/2022] [Indexed: 01/18/2023]
Abstract
RATIONALE Self-management of a chronic illness is a struggle for many patients. There is substantial evidence that patients are not as successful as they and their providers would like. Considering patient self-management through an innovative and diverse lens could help patients, providers and the health care system to consider novel changes to improve success. AIMS AND OBJECTIVES To provide a complete view of patient work by utilizing the human resources management practice of job analysis to develop an initial job description for patients suffering from chronic illness. METHODS Study design was descriptive qualitative with analysis aiming to identify those reoccurring ideas from the data. Thirty patients, with at least one chronic illness, in three focus groups were assembled for this study. Verbatim recordings and notes were used to categorize the data provided. Five coders analyzed the data independently, and jointly met to discuss the themes identified. Demographic data was collected via surveys. RESULTS Patients with chronic illness engage in five primary 'job' duties including self-care (actions taken to effectively manage physical and psychological symptoms), managing relationships (effective management of relationships with employers, family, friends and providers to ensure the best outcomes), managing resources (understanding and managing finances, health and prescription medication insurance), coordination (managing and scheduling visits to providers) and research/education (gathering information and conducting research relative to all aspects of managing one's illness). Relevant knowledge, skills, abilities (KSAs) and other resources were identified that are necessary for patients to effectively perform the five job duties. CONCLUSIONS Creating a job description for the 'job' of patient is a crucial step in understanding the work chronically ill patients undertake. Knowing the duties, their associated tasks and KSAs, and resources required to perform those tasks enables patients and their providers and advocates to better identify ways to assist, relieve and encourage these patients in order to maximize patient success.
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Affiliation(s)
- Carolyn Kleman
- College of Health & Human Services School of Nursing, University of North Carolina Wilmington, Wilmington, North Carolina, USA
| | - Jessica Mesmer Magnus
- Department of Management Chair, Cameron School of Business, University of North Carolina Wilmington, Wilmington, North Carolina, USA
| | - Martha Andrews
- Cameron School of Business, University of North Carolina Wilmington, Wilmington, North Carolina, USA
| | - Kori Meyer
- Department of Psychology, University of North Carolina Wilmington, Wilmington, North Carolina, USA
| | - Barbara J Lutz
- College of Health & Human Services School of Nursing, University of North Carolina Wilmington, Wilmington, North Carolina, USA
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Singh JA. Disease modification in gout: a qualitative study of gout expert rheumatologists. Rheumatol Adv Pract 2022; 6:rkab107. [PMID: 35028499 DOI: 10.1093/rap/rkab107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 12/17/2021] [Indexed: 01/21/2023] Open
Abstract
Objective The aim was to examine the views of health-care providers regarding disease modification in gout, with the potential to derive a provisional set of domains for disease modification in gout. Methods A qualitative nominal group study was performed with 20 gout experts (15 expert/expert panel members of the 2012 and/or 2020 ACR gout guidelines and/or 2015 ACR/EULAR gout classification criteria) about what constitutes disease modification in gout: 'What sorts of things do you think constitute a change in the course of disease in gout? (positive); what are all the ways in which gout as a disease can be modified?' Results Decrease in gout flares was rated number one rank in all six nominal groups as indicative of disease modification in gout, followed by serum urate lowering, which was rated number one rank in one of the six nominal groups (tied score with flares in one nominal group). Other components of gout disease modification were to improve quality of life/productivity; restore function; reduce/eliminate pain; reduce tophi burden; and joint preservation or resolution of joint damage. Potential additional components that were not ranked in the top three votes within each nominal group were: decreasing health-care cost/utilization; reducing cardiovascular/renal morbidity/mortality; and stopping formation of urate crystals. Conclusion This qualitative study provides a provisional set of domains for disease modification in gout. Future studies for the development of thresholds for disease modification domains and wider consensus on this definition are needed.
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Affiliation(s)
- Jasvinder A Singh
- Medicine Service, Birmingham VA Medical Center.,Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama, Birmingham, AL, USA
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Singh JA. "I wish it had a place to go": a nominal group study of barriers to the effectiveness of non-surgical treatments for knee osteoarthritis inclusive of minority populations. Arthritis Res Ther 2021; 23:291. [PMID: 34852836 PMCID: PMC8633910 DOI: 10.1186/s13075-021-02676-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 11/09/2021] [Indexed: 11/30/2022] Open
Abstract
Objective To examine patient experience, views, and opinions regarding the ineffectiveness of the current knee osteoarthritis (OA) treatments. Methods Nominal groups were conducted with consecutive clinic patients with knee OA, oversampling African Americans. Patients discussed and rank-ordered their concerns. Results Fourteen nominal groups with 48 knee OA patients were conducted with a mean age of 60.6 years (standard deviation, 9.8) and a knee OA duration of 7.8 years (sd, 5.4); 25% were men, and 54% were African American. The most frequently cited highly ranked concerns for the ineffectiveness of current knee OA treatments were as follows: (1) medication-related—(A) side effects (3 groups; 4% vote), (B) limited efficacy (5 groups; 11% vote), (C) medication not targeting underlying disease (7 groups; 16% vote), (D) lack of personalized medication use (3 groups; 4% vote), (E) temporary benefit (3 groups; 6% vote), and (F) fear of addiction/natural treatment preference (2 groups; 3% vote); (2) exercise/physical therapy-related—(G) exacerbation of joint pain (1 group; 3% vote), (H) difficulty in doing exercises (2 groups; 2% vote), (I) lack of motivation (8 groups; 12% vote), (J) technical challenges/lack of personalized exercise regimens (1 group; 1% vote), and (K) cost (2 groups; 3% vote); and (3) weight loss-related—(L) difficulty in achieving weight loss (4 groups; 6% vote) and (M) motivation (1 group; 1% vote). Conclusions A representative sample of participants with knee OA identified several barriers to the effectiveness of current knee OA treatments. This new knowledge provides insights for making the current treatment options potentially more usable and/or more effective. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-021-02676-8.
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Affiliation(s)
- Jasvinder A Singh
- Medicine Service, Birmingham VA Medical Center, Birmingham, AL, USA. .,Department of Medicine at School of Medicine, Division of Epidemiology at School of Public Health, University of Alabama, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL, 35294, USA.
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Havsteen-Franklin D, Oley M, Sellors SJ, Eagles D. Drawing on Dialogues in Arts-Based Dynamic Interpersonal Therapy (ADIT) for Complex Depression: A Complex Intervention Development Study Using the Medical Research Council (UK) Phased Guidance. Front Psychol 2021; 12:588661. [PMID: 33679511 PMCID: PMC7930381 DOI: 10.3389/fpsyg.2021.588661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 01/15/2021] [Indexed: 11/30/2022] Open
Abstract
Aim: The aim of this paper is to present the development and evaluation of an art psychotherapy brief treatment method for complex depression for patients referred to mental health services. Background: Art Psychotherapy literature describes a range of processes of relational change through the use of arts focused and relationship focused interventions. Complex depression has a prevalence of 3% of the population in the West and it is recorded that in 2016 only 28% of that population were receiving psychological treatment. This study was developed to test the hypothesis of whether an accessible and acceptable approach to the treatment of complex depression could be developed in relation to existing evidence-based practice within mental health services. Method: The United Kingdom Medical Research Council phased guidance for complex intervention development was used (Phases I and II) to develop the intervention. The process included producing a literature overview, systematic description of clinical practice, including a logic model and a clinical protocol. The art psychotherapy protocol described an arts-based dynamic interpersonal therapy approach (ADIT), offered 1:1 over 24 sessions. Further to this the intervention was tested for referrer acceptability. The intervention is in the early stages of evaluation, using changes to the patient's depression and anxiety measured pre- and post-treatment with a follow-up measure at 3 months following completion of treatment. Results: Phase I of the study provided a good basis for developing a logic model and protocol. The authors found that there was good clinical consensus about the use of a structured clinical art psychotherapy method (ADIT) and the literature overview was used to support specific examples of good practice. The verification of clinical coherence was represented by a logic model and clinical protocol for delivering the intervention. The acceptability study demonstrated very high levels of acceptability for referrers reporting that (i) ADIT was acceptable for patients with complex/major depression, (ii) that they were likely to refer to ADIT in the future (iii) that the use of arts was likely to improve accessibility (iv) the use of arts was likely to improve outcomes and (v) that offering ADIT was an effective use of mental health resources. Discussion: Phase I of this intervention development study (following MRC guidance) demonstrated theoretical and practice coherence resulting in a clinical protocol and logic model. Whilst Phase II of this study showed promising results, Phase II would need to be sufficiently scaled up to a full trial to further test the intervention and protocol.
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Affiliation(s)
- Dominik Havsteen-Franklin
- Mental Health Services, CNWL NHS Foundation Trust, London, United Kingdom.,Brunel University London, Uxbridge, United Kingdom
| | - Mary Oley
- Mental Health Services, CNWL NHS Foundation Trust, London, United Kingdom
| | - Sarah Jane Sellors
- Mental Health Services, CNWL NHS Foundation Trust, London, United Kingdom
| | - Diane Eagles
- Mental Health Services, CNWL NHS Foundation Trust, London, United Kingdom
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Kennedy BM, Davison G, Fowler LA, Rodriguez-Guzman E, Collins ML, Baker A, Cook S, Lindros J, Wilfley DE, Zebrick AJ, Staiano AE. Perceptions of a Pragmatic Family-Centered Approach to Childhood Obesity Treatment. Ochsner J 2021; 21:30-40. [PMID: 33828424 PMCID: PMC7993422 DOI: 10.31486/toj.19.0126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: Few studies have examined both parent and child preferences regarding family-based weight management programs (WMPs) delivered in primary care settings, especially among racial minority populations. The purpose of this study was to determine the perceptions that parents and their children/adolescents have about the components that should be included in a family-based WMP and to identify perceived preferences, benefits, and/or barriers to participation. Methods: A sample of 60 participants (30 parents and 30 children/adolescents) participated in 1 of 5 separate structured focus groups, using probing questions and the nominal group technique (NGT). Parents reported demographics for themselves and their children/adolescents. Themes from probing questions were identified using thematic analysis. Results: Parents were primarily African American (93%) and diverse in income. NGT sessions revealed that parents across all groups perceived that education on healthy eating, parental involvement, and effective program leaders are most important and have the greatest impact, while parental involvement was perceived as the easiest method to implement in a family-based WMP for childhood obesity. Children/adolescents perceived that education on healthy eating and exercise would have the greatest impact, while healthy eating and meal plans were perceived as the easiest methods to implement with a family. Parents and children/adolescents also identified improved psychological well-being (eg, decreased bullying, increased self-esteem, and motivation) as a desired program outcome. Conclusion: Parents and their children/adolescents highlighted the importance of physical and psychological health as targets in treatment. Feedback from patients can inform the design and implementation of family-based WMPs delivered in primary care settings.
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Affiliation(s)
| | - Genevieve Davison
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Lauren A. Fowler
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | | | | | | | - Stephen Cook
- Department of Research, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY
| | | | - Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
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Singh JA, Tornberg H, Goodman SM. Important determinants of the patient choice between TNF- vs. non-TNF Biologic disease-modifying anti-rheumatic drugs (DMARDs) for active rheumatoid arthritis (RA). Joint Bone Spine 2020; 87:307-313. [DOI: 10.1016/j.jbspin.2020.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 02/25/2020] [Indexed: 12/31/2022]
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Singh JA. Gout and sexual function: patient perspective of how gout affects personal relationships and intimacy. BMC Rheumatol 2019; 3:8. [PMID: 30886996 PMCID: PMC6396531 DOI: 10.1186/s41927-019-0056-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 01/25/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In absence of previous studies, we assessed how gout impacts relationship and intimacy with spouse/significant other. METHODS We enrolled a convenience sample of consecutive patients with doctor-diagnosed gout from a community-based outpatient clinic. Nominal groups were conducted until saturation was achieved. Responses were collected verbatim, discussed and then rank-ordered by each participant with votes. RESULTS Forty-four patients with gout participated in 14 nominal groups, seven male only groups, six female only groups and one group had people with both sexes. Overall, the mean age was 61.7 years (SD, 12.2), mean gout duration was 11.8 years (SD, 11.8), 50% were men, 68% African-American, 43% retired, 48% currently married, 94% were using either allopurinol and/or febuxostat, and 39% had had no gout flares in the last 6 months. The top five responses accounted for 75% of all votes and included physical (28%) or emotional impact (17.4%) on intimacy, disability (12.9%), issues with trust/understanding (10.6%) and social life interference (6.8%). When examining the top-rated concern for each nominal group, physical impact on intimacy was ranked top by eight nominal groups; and emotional impact on intimacy, physical function limitation, trust issues/understanding by two nominal groups each. There were no differences evident by patient gender in the concern that was top-ranked. CONCLUSIONS Gout significantly impacts relationship and intimacy with spouse/significant other. Our observation of the physical and emotional impact of gout on intimacy should lead to studies to understand this further and assess if more optimal gout control can improve sex lives of people with gout.
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Affiliation(s)
- Jasvinder A. Singh
- Medicine Service, Birmingham VA Medical Center, 700 19th St S, Birmingham, AL 35233 USA
- Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama at Birmingham, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL 35294-0022 USA
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Goals of gout treatment: a patient perspective. Clin Rheumatol 2018; 37:2557-2566. [PMID: 30078087 DOI: 10.1007/s10067-018-4243-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 07/14/2018] [Accepted: 07/25/2018] [Indexed: 01/13/2023]
Abstract
To assess the goals of gout treatment from a patient perspective, a convenience sample of consecutive patients with doctor-diagnosed gout seen at a community-based outpatient clinic were invited. Sex-stratified nominal groups were conducted until saturation was achieved. Responses were collected verbatim, discussed, and rank-ordered by each participant. Thirty-six patients with doctor-diagnosed gout participated in 12 nominal groups: 6 male only, 5 female only, and 1 group with both. Mean age was 61.9 years (SD, 12.3); mean gout duration was 13.3 years (SD, 12.5); 53% were men, 64% African-American, 42% retired, 47% currently married, 87% were using either allopurinol and/or febuxostat, and 40% had had no gout flares in the last 6 months. The top 5 treatment goals accounted for 91% of all votes and included the following: (1) prevent and better manage flare-ups and improve function (25%), (2) eliminate flare-ups/disease remission (30%), (3) diet and activity modification/lifestyle change (13%), (4) patient education and public awareness (12%), and (5) medication management and minimization of side effects (11%). When examining the top-rated concern for each nominal group, the first two goals were nominated by four groups each, diet/activity modification and medication management by 1 group each, and patient education by 3 groups. There were no differences evident by sex in top-ranked treatment goal. People with gout identified and rank-ordered treatment goals relevant to them. Providers of gout care need to be cognizant of these goals. Disease management concordant with these treatment goals might lead to a more satisfied, informed patient.
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Phillips R, Williams D, Bowen D, Morris D, Grant A, Pell B, Sanders J, Taylor A, Choy E, Edwards A. Reaching a consensus on research priorities for supporting women with autoimmune rheumatic diseases during pre-conception, pregnancy and early parenting: A Nominal Group Technique exercise with lay and professional stakeholders. Wellcome Open Res 2018; 3:75. [PMID: 30191184 PMCID: PMC6092904 DOI: 10.12688/wellcomeopenres.14658.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2018] [Indexed: 02/01/2023] Open
Abstract
Background:Women with autoimmune rheumatic diseases (ARDs) find it difficult to get information and support with family planning, pregnancy, and early parenting. A systematic approach to prioritising research is required to accelerate development and evaluation of interventions to meet the complex needs of this population. Methods:A Nominal Group Technique (NGT) exercise was carried out with lay and professional stakeholders (n=29). Stakeholders were prepared for debate through presentation of available evidence. Stakeholders completed three tasks to develop, individually rank, and reach consensus on research priorities: Task 1 - mapping challenges and services using visual timelines; Task 2 - identifying research topics; Task 3 - individually ranking research topics in priority order. Results of the ranking exercise were fed back to the group for comment. Results:The main themes emerging from Task 1 were the need for provision of information, multi-disciplinary care, and social and peer support. In Task 2, 15 research topics and 58 sub-topics were identified around addressing the challenges and gaps in care identified during Task 1. In Task 3, a consensus was reached on the ten research topics that should be given the highest priority. These were individually ranked, resulting in the following order of priorities (from 1 - highest to 10 - lowest): 1. Shared decision-making early in the care pathway; 2. Pre-conception counseling; 3. Information about medication use during pregnancy/breastfeeding; 4. Personalised care planning; 5. Support for partners/family members; 6. Information about local support/disease specific issues; 7. Shared decision-making across the care pathway; 8. Peer-support; 9. Social inequalities in care, and; 10. Guidance on holistic/alternative therapies. Conclusions:This systematic approach to identification of research priorities from a multi-disciplinary and lay perspective indicated that activities should focus on development and evaluation of interventions that increase patient involvement in clinical decision-making, multi-disciplinary models of care, and timely provision of information.
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Affiliation(s)
| | - Denitza Williams
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Daniel Bowen
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Delyth Morris
- University Library Service, Cardiff University, Cardiff, UK
| | - Aimee Grant
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Bethan Pell
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Julia Sanders
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Ann Taylor
- Centre for Medical Education, Cardiff University, Cardiff, UK
| | - Ernest Choy
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
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Singh JA. Any sleep is a dream far away: a nominal group study assessing how gout affects sleep. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/kex535] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jasvinder A Singh
- Medicine Service, Birmingham VA Medical Center, University of Alabama, Birmingham, AL, USA
- Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama, Birmingham, AL, USA
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Singh JA. Gout and comorbidity: a nominal group study of people with gout. Arthritis Res Ther 2017; 19:204. [PMID: 28915838 PMCID: PMC5603046 DOI: 10.1186/s13075-017-1416-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 09/04/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Comorbidities are common in patients with gout, yet qualitative research is lacking. The study objective was to examine the impact of gout on comorbidities. METHODS Nine nominal groups were conducted. Patients with gout discussed and rank-ordered their concerns in response to the question, "How does gout or its treatment affect your other conditions and their treatment?" RESULTS Nine nominal groups had 45 gout patients, with mean age 61 years (standard deviation (SD) 10.7) and mean gout duration 14.9 years (SD 12). Of these, 62% were men, 45% African-American, 51% married and 63% were currently using allopurinol. The most frequently cited highly ranked concerns among the nine nominal groups were: (1) interaction of gout medication with medications for other medical conditions (three groups); (2) worsening of other medical comorbidities, including hospitalizations (seven groups); (3) worsening of anxiety and depression (three groups); (4) significant dietary changes for gout that contrasted with diet for other conditions (three groups); (5) new diseases diagnosed due to gout (three groups); (6) irreversible joint damage (three groups); (7) inability to exercise and weight gain (four groups); and (8) gout misdiagnosed as another health condition (three groups). Other domains ranked highly were: (1) impact of gout on daily life and activities, including the ability to work and social activities (six groups); (2) medication side effects, real and perceived (nine groups); (3) weight loss due to gout related to frequent flares (one group); and (4) cost and burden (three groups). CONCLUSIONS Gout and the medications used for its treatment have a significant effect on comorbidities and their management. These findings provide insights into potential targets for improving outcomes in patients with gout.
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Affiliation(s)
- Jasvinder A Singh
- Medicine Service, Birmingham VA Medical Center, Birmingham, AL, USA. .,Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama at Birmingham, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL, 35294, USA.
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Kronish IM, Kent S, Moise N, Shimbo D, Safford MM, Kynerd RE, O'Beirne R, Sullivan A, Muntner P. Barriers to conducting ambulatory and home blood pressure monitoring during hypertension screening in the United States. ACTA ACUST UNITED AC 2017; 11:573-580. [PMID: 28734798 DOI: 10.1016/j.jash.2017.06.012] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/14/2017] [Accepted: 06/22/2017] [Indexed: 12/23/2022]
Abstract
In 2015, the US Preventive Services Task Force updated their hypertension recommendations to advise that adults with elevated office blood pressure (BP) undergo out-of-office BP measurement to exclude white coat hypertension before diagnosis. Our goal was to determine the most important barriers to primary care providers' ordering ambulatory and home BP monitoring in the United States. We enrolled 63 primary care providers into nominal group panels in which participants iteratively listed and ranked barriers to ambulatory and home BP monitoring. Top-ranked barriers to ambulatory BP monitoring were challenges in accessing testing, costs of testing, concerns about the willingness or ability of patients to successfully complete tests, and concerns about the accuracy and benefits of testing. Top-ranked barriers to home BP monitoring were concerns about compliance with the correct test protocol, accuracy of tests results, out-of-pocket costs of home BP devices, and time needed to instruct patients on home BP monitoring protocol. Efforts to increase the use of ambulatory and home BP monitoring by primary care providers in the United States should prioritize increasing the financial and personnel resources available for testing and addressing provider concerns about patients' ability to conduct high-quality tests.
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Affiliation(s)
- Ian M Kronish
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA.
| | - Shia Kent
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nathalie Moise
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA
| | - Daichi Shimbo
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA
| | - Monika M Safford
- Divison of General Internal Medicine, Department of Medicine, Weill-Cornell Medical College, New York, NY, USA; Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert E Kynerd
- Department of Family and Community Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ronan O'Beirne
- Division of Continuing Medical Education, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alexandra Sullivan
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
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Kennedy BM, Jaligam V, Conish BK, Johnson WD, Melancon B, Katzmarzyk PT. Exploring Patient, Caregiver, and Healthcare Provider Perceptions of Caring for Patients With Heart Failure: What Are the Implications? Ochsner J 2017; 17:93-102. [PMID: 28331455 PMCID: PMC5349645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Heart failure (HF) is an incurable and frequently progressive disease. Symptoms of HF may impair the ability of patients to perform daily living activities. As HF progresses, patients typically increase their reliance on caregivers. The purpose of this study was to determine what roles patients and caregivers perceive and desire for themselves in managing HF and to compare and contrast these roles with those perceived by healthcare providers. METHODS A purposive sample (60 patients, 22 caregivers, and 11 healthcare providers) was enrolled in the study. Patients and caregivers individually participated in semistructured interviews, and healthcare providers participated in 1 of 2 focus groups. RESULTS Four key themes evolved from interviews with patients and caregivers-education on disease specifics, guidance to enhance quality of life, learning to cope with HF, and future outlook and care decisions-that may guide the development of caregiver interventions in HF. Healthcare providers in both structured focus groups regardless of rank order selected knowledge is powerful, adherence to treatment plan, and compliance with medication as the top 3 issues likely to have the greatest impact, and they identified education on the disease (knowledge is powerful) as the easiest strategy to implement for patients and caregivers in the management of HF. CONCLUSION Interventions among caregivers of patients with HF are needed and should focus on education in family structures, family functioning, and skills training in family assessment and engagement.
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Affiliation(s)
| | - Vijayendra Jaligam
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA
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Kennedy BM, Kennedy KB, Sarpong DF, Katzmarzyk PT. Perceptions of Obesity Treatment Options Among Healthcare Providers and Low-Income Primary Care Patients. Ochsner J 2016; 16:158-165. [PMID: 27303227 PMCID: PMC4896661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Primary care is a key component of medical care delivery and has a role to play in reducing obesity in the United States. The purpose of this study was to explore attitudes and perceptions about obesity in low-income primary care patients and to identify preferences for weight management interventions from the patient and healthcare provider perspectives. METHODS A convenience sample of 28 patients and 6 healthcare providers from across the state of Louisiana participated in 1 of 5 structured focus groups. Demographic information was collected from both the patients and healthcare providers using survey instruments. RESULTS Patients and healthcare providers were more similar than dissimilar in their perceptions of obesity in that both groups selected referral to a nutritionist, use of medication, and prescribed exercise as the top 3 strategies that would have the greatest impact on losing weight. Referral to a nutritionist was selected as the easiest strategy to implement. CONCLUSION Receiving feedback from both patients and healthcare providers gives researchers the opportunity to acquire useful knowledge that may be beneficial in designing and conducting interventions suitable for patients desiring to lose weight, especially those in primary care settings.
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Affiliation(s)
| | | | - Daniel F. Sarpong
- College of Pharmacy, Xavier University of Louisiana, New Orleans, LA
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Coombs MA, Darlington AS, Long-Sutehall T, Richardson A. Transferring critically ill patients home to die: developing a clinical guidance document. Nurs Crit Care 2015; 20:264-70. [DOI: 10.1111/nicc.12169] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 01/13/2015] [Accepted: 01/22/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Maureen A Coombs
- Graduate School of Nursing, Midwifery and Health, Victoria University of Wellington, Capital and Coast District Health Board; Wellington New Zealand
| | | | | | - Alison Richardson
- University Hospital Southampton NHS Foundation Trust & University of Southampton; Southampton UK
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Huff NG, Roy B, Estrada CA, Centor RM, Castiglioni A, Willett LL, Shewchuk RM, Cohen S. Teaching behaviors that define highest rated attending physicians: a study of the resident perspective. MEDICAL TEACHER 2014; 36:991-996. [PMID: 25072844 DOI: 10.3109/0142159x.2014.920952] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Better understanding teaching behaviors of highly rated clinical teachers could improve training for teaching. We examined teaching behaviors demonstrated by higher rated attending physicians. METHODS Qualitative and quantitative group consensus using the nominal group technique (NGT) among internal medicine residents and students on hospital services (2004-2005); participants voted on the three most important teaching behaviors (weight of 3 = top rated, 1 = lowest rated). Teaching behaviors were organized into domains of successful rounding characteristics. We used teaching evaluations to sort attending physicians into tertiles of overall teaching effectiveness. RESULTS Participants evaluated 23 faculty in 17 NGT sessions. Participants identified 66 distinct teaching behaviors (total sum of weights [sw] = 502). Nineteen items had sw ≥ 10, and these were categorized into the following domains: Teaching Process (n = 8; sw = 215, 42.8%), Learning Atmosphere (n = 5; sw = 145, 28.9%), Role Modeling (n = 3; sw = 74, 14.7%) and Team Management (n = 3; sw = 65, 12.9%). Attendings in the highest tertile received a larger number of votes for characteristics within the Teaching Process domain (56% compared to 39% in lowest tertile). CONCLUSIONS The most effective teaching behaviors fell into two broad domains: Teaching Process and Learning Atmosphere. Highest rated attending physicians are most recognized for characteristics in the Teaching Process domain.
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Kennedy BM, Cerise F, Horswell R, Griffin WP, Willis KH, Moody-Thomas S, Besse JA, Katzmarzyk PT. Obtaining the Patient's Voice from within Three Patient-Centered Medical Homes. Clin Transl Sci 2014; 8:367-75. [PMID: 25066616 DOI: 10.1111/cts.12192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The purpose of this qualitative program was to determine if a trend exists across three LSU medical homes according to patient feedback concerning their experiences within the medical home for ongoing disease management and quality healthcare; and to obtain recommendations for the most effective way to involve patients in shaping system policies, procedures, and practices consistent with patient and family-centered care principles. A total of 94 adult patients participated in either cognitive interviews (n = 45) or structured focus groups (n = 49) using the Nominal Group Technique (NGT). Exit surveys collected demographic information and feedback from patients about opportunities for their involvement in shaping medical homes. Cognitive interviews and NGT sessions both revealed some patient-perceived gratifications (i.e., friendliness and helpfulness of the clinic staff), and deficiencies (i.e., improving scheduling of appointments and reducing wait time in the clinic) within these medical homes. However, the perceived gratifications far exceeded the deficiencies found within each of three LSU medical homes.
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Affiliation(s)
- Betty M Kennedy
- The Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Frederick Cerise
- The LSU Health Sciences Center School of Medicine, New Orleans, Louisiana, USA
| | - Ronald Horswell
- The Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Willene P Griffin
- The Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Kathleen H Willis
- The LSU Health System Lallie Kemp Medical Center, Independence, Louisiana, USA
| | - Sarah Moody-Thomas
- The Louisiana State University (LSU) Health Sciences Center School of Public Health, New Orleans, Louisiana, USA
| | - Jay A Besse
- The LSU Health Care Services Division, Louisiana, USA
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The impact of gout on patient's lives: a study of African-American and Caucasian men and women with gout. Arthritis Res Ther 2014; 16:R132. [PMID: 24961941 PMCID: PMC4230273 DOI: 10.1186/ar4589] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 05/29/2014] [Indexed: 12/22/2022] Open
Abstract
Introduction The aim of this study was to examine the impact of gout on quality of life (QOL) and study differences by gender and race. Methods Ten race- and sex-stratified nominal groups were conducted, oversampling for African-Americans and women with gout. Patients presented, discussed, combined and rank-ordered their concerns. Results A total of 62 patients with mean age 65.1 years, 60% men, 64% African-American, participated in 10 nominal groups: African-American men (n = 23; 3 groups); African-American women (n = 18; 3 groups); Caucasian men (n = 15; 3 groups); and Caucasian women (n = 6; 1 group). The most frequently cited high-ranked concerns among the ten nominal groups were: (1) effect of gout flare on daily activities (n = 10 groups); (2) work disability (n = 8 groups); (3) severe pain (n = 8 groups); (4) joint swelling and tenderness (n = 6 groups); (5) food restrictions (n = 6 groups); (6) medication related issues (n = 6 groups); (7) dependency on family and others (n = 5 groups); (8) emotional Impact (n = 5 groups); (9) interference with sexual function (n = 4 groups); (10) difficulty with shoes (n = 4 groups); and (11) sleep disruption (n = 4 groups). Compared with men, women ranked the following concerns high more often: problems with shoes (n = 4 versus n = 0 groups); dependency (n = 3 versus n = 2 groups); and joint/limb deformity (n = 2 versus n = 0 group). Compared with Caucasians, African-Americans ranked the following concerns high more often: dietary restrictions (n = 6 versus n = 0 groups); severe pain (n = 6 versus n = 2 groups); gout bringing the day to a “halt” (n = 2 versus n = 0 group); effect on emotional health (n = 4 versus n = 1 groups); and the need for canes/crutches during flares (n = 2 versus n = 0 group). Conclusions Gout has a significant impact on a patient’s QOL. Important differences in the impact of gout by gender and race were noted.
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Baheiraei A, Khoori E, Ahmadi F, Rahimi Foroushani A, Ghofranipour F. Health concerns of Iranian adolescents: protocol for a mixed methods study. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e6715. [PMID: 25068061 PMCID: PMC4102994 DOI: 10.5812/ircmj.6715] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Revised: 05/27/2013] [Accepted: 04/05/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND Adolescents have particular health and developmental needs that suggest they should neither be treated as older children nor younger adults. OBJECTIVES The aim of this paper is to report the protocol for a mixed methods study that set out to investigate the health concerns of Iranian adolescents and their sources of health information with the goal of identifying suitable strategies to address their health concerns. MATERIALS AND METHODS This mixed methods study consists of an explanatory sequential design to be conducted in two phases. The first phase was a population-based cross-sectional survey of 915, 14-18 year old adolescents who were selected by stratified cluster random sampling method from the 22 main municipal sectors of Tehran, Iran. They completed a series of self-administered questionnaires which were analyzed using quantitative approaches. The second phase was a qualitative study in which adolescents were selected using purposeful sampling for individual in-depth semi-structured interviews on the basis of the quantitative findings from the first phase. These data, together with a literature review and data obtained through nominal group technique, would then be used to in the development of strategies to reduce adolescents' health concerns. RESULTS The findings of this mixed methods sequential explanatory study are expected to provide unique information about the health concerns of Iranian adolescents and their sources of information, which to date have received little attention. CONCLUSIONS These data will provide a rich source of information that can be used by intervention programs, health professionals and policy makers in addressing the health concerns of adolescents, with the goal of facilitating a successful passage to adult life.
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Affiliation(s)
- Azam Baheiraei
- Department of Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, IR Iran
- Community Based Participatory Research Center, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Elham Khoori
- Department of Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Elham Khoori, Department of Midwifery, Golestan University of Medical Sciences, Gorgan, IR Iran. Tel: +98-1714426900, Fax:+98-1714425171, E-mail:
| | - Fazlollah Ahmadi
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, IR Iran
| | - Abbas Rahimi Foroushani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Fazlollah Ghofranipour
- Department of Health Education, School of Medical Sciences, Tarbiat Modares University, Tehran, IR Iran
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Singh JA. Facilitators and barriers to adherence to urate-lowering therapy in African-Americans with gout: a qualitative study. Arthritis Res Ther 2014; 16:R82. [PMID: 24678765 PMCID: PMC4060486 DOI: 10.1186/ar4524] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 03/17/2014] [Indexed: 12/22/2022] Open
Abstract
Introduction Limited literature exists for qualitative studies of medication adherence in gout, especially in African-Americans. The aim of this study was to examine the facilitators and barriers to adherence to urate-lowering therapy (ULT) in African-Americans with gout. Methods In this study, nine nominal groups lasting 1 to 1.5 hours each were conducted in African-Americans with gout, six with low ULT and three with high ULT adherence (medication possession ratios of <0.80 or ≥0.80, respectively). Patients presented, discussed, combined and rank ordered their concerns. A qualitative analysis was performed. Results This study included 43 patients with mean age 63.9 years (standard deviation, 9.9), 67% men, who participated in nine nominal groups (seven in men, two in women): African-American men (n = 30); African-American women (n = 13). The main facilitators to ULT adherence (three groups) were the recognition of the need to take ULT regularly to prevent gout flares, prevent pain from becoming chronic/severe and to have less dietary restriction; the lack of side effects from ULT; trust in physicians; and avoiding the need to seek emergent/urgent care for flares. Patients achieved high ULT adherence by organizing their pills using the pillbox and the incorporation of ULT intake into their routine to prevent forgetting. The main barriers to optimal ULT adherence were (six groups): doubts about effectiveness of ULT, concerns about cost and side effects, concomitant medications, forgetfulness, refilling the prescriptions on time, pill size and difficulty in swallowing, competing priorities, patient preference for alternative medicines (that is, cherry juice) and frequent travel. Conclusions Identification of facilitators and barriers to high ULT adherence in African-Americans with gout in this study lays the foundation for designing interventions to improve ULT adherence in racial minorities.
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Abstract
PURPOSE To elucidate barriers and facilitators related to glaucoma medication adherence among African Americans (AA) with glaucoma and to elicit input from a community-based participatory research team to guide the development of a culturally informed health promotion program for improving glaucoma medication adherence among AAs. METHODS The nominal group technique (NGT), a highly structured focus group methodology, was implemented with 12 separate groups of AA patients with glaucoma (N = 89) to identify barriers and facilitators related to glaucoma medication usage. Participant rank-ordering votes were summed across groups and categorized into themes. Next, an individually and culturally targeted health promotion program promoting appropriate medication adherence was developed based on focus group results and input from a community-based participatory research team. RESULTS The top five barriers included problems with forgetfulness, side effects, cost/affordability, eyedrop administration, and the eyedrop schedule. The most salient top five facilitators were fear or thoughts about the consequences of not taking eyedrops; use of memory aids, cues, or strategies; maintaining a regular routine or schedule for eyedrop administration; ability to afford eyedrops; and keeping eyedrops in the same area. The resulting health promotion program was based on a multicomponent empowerment framework that included glaucoma education, motivational interviewing, and problem-solving training to improve glaucoma medication adherence. CONCLUSIONS Barriers and facilitators related to glaucoma medication adherence among AAs are multifactorial. Based on the NGT themes and input from the community-based participatory research team, a culturally informed health promotion program was designed and holds great promise for improving medication adherence among this vulnerable population.
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Coker J, Castiglioni A, Stanford Massie F, Russell SW, Shaneyfelt T, Willett LL, Estrada CA, Kraemer RR, Morris JL, Rodriguez M. Evaluation of an Advanced Physical Diagnosis Course Using Consumer Preferences Methods: The Nominal Group Technique. Am J Med Sci 2014; 347:199-205. [DOI: 10.1097/maj.0b013e3182831798] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mantell P, Hartwell LP, Branowicki PA. Development of an outcome measure to monitor the effectiveness of pain management. Clin J Oncol Nurs 2014; 18:30-2. [PMID: 24476723 DOI: 10.1188/14.cjon.30-32] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Attention to the pain that occurs during treatments and procedures for pediatric patients with cancer continues to be a priority. This article describes the development of a pain effectiveness outcome measure at an academic pediatric medical center in order to inform about the implementation of quality improvement strategies and evaluate the effect of these pain interventions within the hospital setting.
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Affiliation(s)
- Patricia Mantell
- Medicine Patient Services, Boston Children's Hospital in Massachusetts
| | - Lauren P Hartwell
- Medicine Quality Improvement, Boston Children's Hospital in Massachusetts
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Parahoo K. Interviews. Nurs Res 2014. [DOI: 10.1007/978-1-137-28127-2_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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30
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Cooley ME, Lobach DF, Johns E, Halpenny B, Saunders TA, Del Fiol G, Rabin MS, Calarese P, Berenbaum IL, Zaner K, Finn K, Berry DL, Abrahm JL. Creating computable algorithms for symptom management in an outpatient thoracic oncology setting. J Pain Symptom Manage 2013; 46:911-924.e1. [PMID: 23680580 PMCID: PMC4096777 DOI: 10.1016/j.jpainsymman.2013.01.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 01/12/2013] [Accepted: 01/28/2013] [Indexed: 10/26/2022]
Abstract
CONTEXT Adequate symptom management is essential to ensure quality cancer care, but symptom management is not always evidence based. Adapting and automating national guidelines for use at the point of care may enhance use by clinicians. OBJECTIVES This article reports on a process of adapting research evidence for use in a clinical decision support system that provided individualized symptom management recommendations to clinicians at the point of care. METHODS Using a modified ADAPTE process, panels of local experts adapted national guidelines and integrated research evidence to create computable algorithms with explicit recommendations for management of the most common symptoms (pain, fatigue, dyspnea, depression, and anxiety) associated with lung cancer. RESULTS Small multidisciplinary groups and a consensus panel, using a nominal group technique, modified and subsequently approved computable algorithms for fatigue, dyspnea, moderate pain, severe pain, depression, and anxiety. The approved algorithms represented the consensus of multidisciplinary clinicians on pharmacological and behavioral interventions tailored to the patient's age, comorbidities, laboratory values, current medications, and patient-reported symptom severity. Algorithms also were reconciled with one another to enable simultaneous management of several symptoms. CONCLUSION A modified ADAPTE process and nominal group technique enabled the development and approval of locally adapted computable algorithms for individualized symptom management in patients with lung cancer. The process was more complex and required more time and resources than initially anticipated, but it resulted in computable algorithms that represented the consensus of many experts.
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Affiliation(s)
- Mary E Cooley
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
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Suzuki J, Meyer F, Wasan AD. Characteristics of medical inpatients with acute pain and suspected non-medical use of opioids. Am J Addict 2013; 22:515-20. [PMID: 23952900 DOI: 10.1111/j.1521-0391.2013.12016.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 02/07/2012] [Accepted: 08/20/2012] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The purpose of this study was to characterize medical inpatients with acute pain suspected of non-medical opioid use. METHOD Medical inpatients treated with opioids for acute pain referred for psychiatric consultation were administered questionnaires including the Screener and Opioid Assessment for Pain Patients (SOAPP) and the Hospital Misuse Checklist (HMC), developed for this study. RESULTS The nine subjects referred for evaluation of possible non-medical opioid use, compared to the 23 subjects referred for other reasons, were younger (37.7 vs. 51.3, t = 2.81, p = .012), more likely to score positive on the SOAPP (100% vs. 47.8%, Fisher's p < .05) and report lifetime histories of any substance use disorder (SUD) (88.9% vs. 30.4%, χ² = 9.7, p = .002). No differences were found on items on the HMC. CONCLUSIONS The results of this preliminary study indicate that medical inpatients with suspected non-medical use of opioids resemble chronic pain outpatients misusing opioids. Further research is needed to better characterize this patient population and to validate the HMC measure.
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Affiliation(s)
- Joji Suzuki
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts 02115,
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