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Edwards S, Puljević C, Dean JA, Gilks C, Boyd MA, Watts P, Howard C, Gartner CE. Perceptions of nicotine vaping products among Australians living with HIV. AIDS Care 2024:1-11. [PMID: 39102745 DOI: 10.1080/09540121.2024.2372718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 06/21/2024] [Indexed: 08/07/2024]
Abstract
People living with HIV (PLHIV) are two to three times more likely to smoke tobacco compared to the general community. Evidence from the general population suggests that nicotine vaping products (NVPs) can be acceptable and effective smoking cessation aids, but there is limited evidence on the extent to which this is the case among PLHIV. This manuscript reports findings from the Tobacco Harm Reduction with Vaporised Nicotine (THRiVe) trial, a mixed-methods study investigating the feasibility of NVPs as smoking cessation aids among 29 PLHIV who smoked tobacco. Surveys and semi-structured interviews explored participants' experiences and perceptions of NVPs, their features and functions, and support for various NVP regulatory policy options. Participants described seven reasons why NVPs were acceptable cessation aids: they satisfied nicotine cravings; differences between NVPs and cigarettes facilitated habit breaking; fewer adverse effects compared to traditional cessation aids; NVPs allowed for a "weaning process" rather than requiring abrupt abstinence; tobacco became increasingly unpleasant to smoke; NVPs provided an increased sense of control; and participants experienced a deeper understanding of personal smoking behaviours. This study provides valuable insight into the preferred features of NVPs among PLHIV and reasons why NVPs may be effective for promoting smoking cessation among PLHIV.
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Affiliation(s)
- Stephanie Edwards
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Australia
| | - Cheneal Puljević
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Australia
| | - Judith A Dean
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, Australia
| | - Charles Gilks
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Mark A Boyd
- Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, Australia
- Northern Adelaide Local Health Network (NALHN), Adelaide, Australia
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Peter Watts
- Queensland Positive People, Brisbane, Australia
| | | | - Coral E Gartner
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Australia
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Mandell RJ, Smith AR, Gifford KA, Hong BA, Goodrich NP, Mathur AK, Fava MA, Ojo AO, Merion RM. How Do Financial Obstacles Affect Decision-Making Among Potential Living Organ Donors? Prog Transplant 2024:15269248241268679. [PMID: 39090998 DOI: 10.1177/15269248241268679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
Introduction: Living donation increases the organ supply, but associated non-medical expenses can disincentivize donation. Programs aimed at increasing living donation need to better understand how financial obstacles, including lost wages, impact the decision to pursue donation. Methods/Approach: Forty-eight interviews were conducted and analyzed using a grounded theory approach. Findings: Three key themes were identified that influenced decision-making: emotional attachment, temporal flexibility, and job security. These themes emerged when dividing interview participants into 3 groups: close relationship donors, broader network donors, and non-directed donors, representing donation to a family member or friend, a specific person they do not know well or at all, or a non-specified individual, respectively. Most close relationship donors wanted to donate regardless of personal financial cost, based on emotional attachment to the recipient. Wage reimbursement did not typically affect their decision-making but could reduce stress. Since non-directed donors did not donate to a specific individual, they could wait to achieve financial stability before donating, if needed. While wage reimbursement might create more proximate stability, non-directed donors had the flexibility to postpone donations until they could independently achieve financial stability. Lacking emotional attachment and temporal flexibility, broader network donors were particularly active decision-makers and most influenced by wage reimbursement. Across all groups, donors with job security were more resolute about donating. Conclusion: The findings underscore the importance of lost wage reimbursement to facilitate donation and reduce stress, and policies to protect donor job security.
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Affiliation(s)
| | | | | | - Barry A Hong
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
| | | | | | - Melissa A Fava
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - Akinlolu O Ojo
- University of Kansas Medical Center, Kansas City, KS, USA
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Hansen K, Świderska A. Integrating open- and closed-ended questions on attitudes towards outgroups with different methods of text analysis. Behav Res Methods 2024; 56:4802-4822. [PMID: 37845422 PMCID: PMC11289311 DOI: 10.3758/s13428-023-02218-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 10/18/2023]
Abstract
Researchers in behavioral sciences often use closed-ended questions, forcing participants to express even complex impressions or attitudes through a set of predetermined answers. Even if this has many advantages, people's opinions can be much richer. We argue for assessing them using different methods, including open-ended questions. Manual coding of open-ended answers requires much effort, but automated tools help to analyze them more easily. In order to investigate how attitudes towards outgroups can be assessed and analyzed with different methods, we carried out two representative surveys in Poland. We asked closed- and open-ended questions about what Poland should do regarding the influx of refugees. While the attitudes measured with closed-ended questions were rather negative, those that emerged from open-ended answers were not only richer, but also more positive. Many themes that emerged in the manual coding were also identified in automated text analyses with Meaning Extraction Helper (MEH). Using Linguistic Inquiry and Word Count (LIWC) and Sentiment Analyzer from the Common Language Resources and Technology Infrastructure (CLARIN), we compared the difference between the studies in the emotional tone of the answers. Our research confirms the high usefulness of open-ended questions in surveys and shows how methods of textual data analysis help in understanding people's attitudes towards outgroup members. Based on our methods comparison, researchers can choose a method or combine methods in a way that best fits their needs.
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Affiliation(s)
- Karolina Hansen
- Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183, Warsaw, Poland.
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Wang J, Blair EM, Forman J, Zahuranec DB, Reale BK, Cao Z, Plassman BL, Welsh-Bohmer KA, Kollman CD, Levine DA. Patient and Care Partner Perspective on Potential Undertreatment of Patients With Mild Cognitive Impairment for Cardiovascular Disease. J Appl Gerontol 2024:7334648241253465. [PMID: 38805247 DOI: 10.1177/07334648241253465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Mild cognitive impairment (MCI) affects up to 22% of US older adults aged 65 and older. Research suggests that physicians may recommend less cardiovascular disease (CVD) treatment for older adults with MCI due to assumptions about their preferences. To delve into the disparity between patient preferences and physician assumptions in CVD treatment recommendations, we conducted a multi-site qualitative study to explore the underlying reasons for this discrepancy, providing insights into potential communication barriers and strategies to enhance patient-physician relationships. RESEARCH DESIGN AND METHODS Employing a descriptive qualitative approach, we conducted interviews with 20 dyads, comprising older adults with MCI (n = 11) and normal cognition NC (n = 9), and their respective care partners. During these interviews, participants were prompted to reflect on physicians recommending fewer guideline-concordant CVD treatments to older adults with MCI than those with NC and physicians presuming that older adults with MCI desired less care or treatment in general than those with NC. RESULTS We identified three primary themes: (1) Most participants had negative reactions to the data that physicians might undertreat patients with MCI for CVD; (2) Participants suggested that physicians may undertreat patients with MCI due to physician assumptions about treatment effectiveness, patient prognosis, value, and treatment adherence, and (3) Participants proposed that physicians may elicit less input from patients with MCI about treatments because of negative physician assumptions about patient decision-making capacity and physician time limitations. DISCUSSION AND IMPLICATIONS This study underscores the pressing need for person-centered communication and involvement of older adults with MCI and their care partners in the decision-making process to ensure that decisions are well-informed, reflecting patients' genuine preferences and values. Addressing these concerns has the potential to substantially enhance the quality of care and treatment outcomes for this vulnerable population, ultimately promoting their overall well-being.
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Affiliation(s)
- Jing Wang
- College of Health and Human Services, University of New Hampshire, Durham, NH, USA
| | - Emilie M Blair
- Department of Internal Medicine and Cognitive Health Services Research Program, U-M Medical School, Ann Arbor, MI, USA
| | - Jane Forman
- Department of Internal Medicine and Cognitive Health Services Research Program, U-M Medical School, Ann Arbor, MI, USA
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Institute for Social Research, U-M, Ann Arbor, MI, USA
| | | | - Bailey K Reale
- Department of Internal Medicine and Cognitive Health Services Research Program, U-M Medical School, Ann Arbor, MI, USA
- Lake Erie College of Osteopathic Medicine (LE-COM), Greensburg, PA, USA
| | - Zihao Cao
- School of Medicine, Fudan University, Shanghai, China
| | - Brenda L Plassman
- Department of Psychiatry and Behavioral Science, Duke University School of Medicine, Durham, NC, USA
| | - Kathleen A Welsh-Bohmer
- Department of Psychiatry and Behavioral Science, Duke University School of Medicine, Durham, NC, USA
| | | | - Deborah A Levine
- Department of Internal Medicine and Cognitive Health Services Research Program, U-M Medical School, Ann Arbor, MI, USA
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Gonzalez Bravo C, Sabree SA, Dukes K, Adeagbo MJ, Edwards S, Wainwright K, Schaeffer SE, Villa A, Wilks AD, Carvour ML. Diabetes care in the pandemic era in the Midwestern USA: a semi-structured interview study of the patient perspective. BMJ Open 2024; 14:e081417. [PMID: 38458805 DOI: 10.1136/bmjopen-2023-081417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2024] Open
Abstract
OBJECTIVES To understand patients' experiences with diabetes care during the COVID-19 pandemic, with an emphasis on rural, medically underserved, and/or minoritised racial and ethnic groups in the Midwestern USA. DESIGN Community-engaged, semi-structured interviews were conducted by medical student researchers trained in qualitative interviewing. Transcripts were prepared and coded in the language in which the interview was conducted (English or Spanish). Thematic analysis was conducted, and data saturation was achieved. SETTING The study was conducted in communities in Eastern and Western Iowa. PARTICIPANTS Adults with diabetes (n=20) who were fluent in conversational English or Spanish were interviewed. One-third of participants were residents of areas designated as federal primary healthcare professional shortage areas and/or medically underserved areas, and more than half were recruited from medical clinics that offer care at no cost. RESULTS Themes across both English and Spanish transcripts included: (1) perspectives of diabetes, care providers and care management; (2) challenges and barriers affecting diabetes care; and (3) participant feedback and recommendations. Participants reported major constraints related to provider availability, costs of care, access to nutrition counselling and mental health concerns associated with diabetes care during the pandemic. Participants also reported a lack of shared decision-making regarding some aspects of care, including amputation. Finally, participants recognised systems-level challenges that affected both patients and providers and expressed a preference for proactive collaboration with healthcare teams. CONCLUSIONS These findings support enhanced engagement of rural, medically underserved and minoritised groups as stakeholders in diabetes care, diabetes research and diabetes provider education.
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Affiliation(s)
- Carolina Gonzalez Bravo
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Shakoora A Sabree
- Medical Scientist Training Program, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Kimberly Dukes
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
- University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Morolake J Adeagbo
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, Iowa, USA
| | - Sarai Edwards
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, Iowa, USA
| | - Kasey Wainwright
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Sienna E Schaeffer
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Aneli Villa
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Aloha D Wilks
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Martha L Carvour
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
- University of Iowa College of Public Health, Iowa City, Iowa, USA
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Chapman HJ, Veras-Estévez BA. Exploring health gaps through qualitative designs. Perspect Public Health 2023; 143:186-189. [PMID: 37381915 DOI: 10.1177/17579139231180748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Affiliation(s)
- H J Chapman
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave NW, Washington, DC 20052, USA
| | - B A Veras-Estévez
- Faculty of Health Sciences, Universidad Católica del Cibao (UCATECI), La Vega, Dominican Republic
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A mixed-methods evaluation of the national implementation of the Hospital-Acquired Pneumonia Prevention by Engaging Nurses (HAPPEN) initiative. Infect Control Hosp Epidemiol 2023; 44:384-391. [PMID: 36039946 DOI: 10.1017/ice.2022.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To describe healthcare provider, veteran, and organizational barriers to, challenges to, and facilitators of implementation of the oral care Hospital-Acquired Pneumonia Prevention by Engaging Nurses (HAPPEN) initiative to prevent non-ventilator-associated hospital-acquired pneumonia (NV-HAP). DESIGN Concurrent mixed methods. Qualitative interviews of staff and patients were conducted in addition to a larger survey of VA employees regarding implementation. SETTING Medical surgical or extended care units in 6 high-complexity (01a-c) VA hospitals. PARTICIPANTS Between January 2020 and February 2021, we interviewed 7 staff and 7 veterans, and we received survey responses from 91 staff. INTERVENTION Provide education, support, and oral care supplies to prevent NV-HAP. RESULTS Barriers to HAPPEN implementation and tracking at the pilot sites included maintaining oral care supplies and completion of oral care documentation. Facilitators for HAPPEN implementation included development of supportive formal and informal nurse leaders, staff engagement, and shared beliefs in the importance of care quality and infection prevention. Nurses worked together as a team to provide consistent oral care. Oral care was viewed as an essential infection control practice (not just "a task") and was considered part of the "culture" and "mission" in caring for veterans. CONCLUSIONS Nurse leaders and direct-care staff were engaged throughout HAPPEN implementation, and most reported feeling supported and well prepared as they walked through the steps. Veterans reported positive experiences and increased knowledge about prevention of pneumonia. Lessons learned included building a community of practice and sharing expertise, which led to the successful replication of the HAPPEN initiative nationwide, improving patient safety and care quality and influencing health policy.
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Douno M, Rocha C, Borchert M, Nabe I, Müller SA. Qualitative assessment of hand hygiene knowledge, attitudes and practices among healthcare workers prior to the implementation of the WHO Hand Hygiene Improvement Strategy at Faranah Regional Hospital, Guinea. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001581. [PMID: 36963021 PMCID: PMC10021640 DOI: 10.1371/journal.pgph.0001581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/12/2023] [Indexed: 02/11/2023]
Abstract
Healthcare-associated infections are a serious burden globally. Few qualitative studies have explored healthcare workers' knowledge, attitudes and practices of hand hygiene. Prior to the implementation of the World Health Organization's Hand Hygiene Improvement Strategy at Faranah Regional Hospital in the Upper Region of Guinea in December 2018, we conducted a qualitative baseline assessment of knowledge, attitudes and practices of hand hygiene among healthcare workers to guide future hand hygiene interventions. The qualitative study consisted of direct observations, In-Depth Interviews (IDIs) and Focus Group Discussions (FGDs). We found that the 2013-16 Ebola outbreak had had a pivotal impact on healthcare workers' knowledge, attitudes and practices. The severity of the disease and the training provided for infection control were responsible for their knowledge acquisition and adoption of good attitudes and practices. However, negligence, resulting in poor hand hygiene practices, rose after the outbreak, once the "cue of fear" that had motivated workers for their own self-protection had waned. Our results suggest that local capacity building through training and availability of hand hygiene materials would be a sustainable approach to enhance hand hygiene culture at the hospital. Our study suggests that there is a need for a high and long-term commitment of authorities and healthcare workers at all levels for a sustainable hand hygiene culture.
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Affiliation(s)
- Moussa Douno
- Projet des Fièvres Hémorragiques en Guinée, Centre de Recherche en Virologie, Université Gamal Abdel Nasser de Conakry, Conakry, Guinée
| | - Carlos Rocha
- Center for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Matthias Borchert
- Center for International Health Protection, Robert Koch Institute, Berlin, Germany
| | | | - Sophie Alice Müller
- Center for International Health Protection, Robert Koch Institute, Berlin, Germany
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McKay KJ, Shaban RZ. Video based monitoring systems for hand hygiene compliance auditing: What do patients think? PLoS One 2023; 18:e0281895. [PMID: 36893120 PMCID: PMC9997901 DOI: 10.1371/journal.pone.0281895] [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: 07/04/2022] [Accepted: 02/02/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Compliance with hand hygiene by healthcare workers is a vital aspect of the quality and safety in healthcare. The current method of monitoring compliance, known as direct observation, has been questioned as have the various electronic measures proposed as alternatives. In our earlier work we established the capacity of video-based monitoring systems (VMS) to collect data with increased efficacy, efficiency and accuracy. However, the spectre of the approach being seen as an unacceptable invasion of patient privacy, was raised as a barrier to implementation by healthcare workers. METHODS In depth, semi structured interviews were conducted with 8 patients in order to explore their beliefs and options regarding the proposed approach. Interviews were transcribed and then thematic and content analysis was conducted in order to uncover themes from the data. RESULTS Despite healthcare worker predictions, patients were generally accepting of the use of video-based monitoring systems for the auditing of hand hygiene compliance. However, this acceptance was conditional. Four interconnected themes emerged from the interview data; quality and safety of care versus privacy, consumer Involvement-knowledge, understanding and consent, technical features of the system, and rules of operation. CONCLUSION The use of within zone VMS approaches to hand hygiene auditing has the potential to improve the efficacy, efficiency and accuracy of hand hygiene auditing and hence the safety and quality of healthcare. By combining a suite of technical and operational specifications with high level consumer engagement and information the acceptability of the approach for patients may be significantly enhanced.
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Affiliation(s)
- Katherine J. McKay
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Sydney Institute for Infectious Diseases, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- * E-mail:
| | - Ramon Z. Shaban
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Sydney Institute for Infectious Diseases, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- New South Wales Biocontainment Centre, Western Sydney Local Health District and New South Wales Health, Camperdown, NSW, Australia
- Communicable Disease Branch, Public Health Unit, Centre for Population Health, Western Sydney Local Health District, Westmead, North Parramatta, NSW, Australia
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Yehouenou CL, Abedinzadeh A, Houngnihin R, Baxerres C, Dossou FM, Simon A, Dalleur O. Understanding Hand Hygiene Behavior in a Public Hospital in Benin Using the Theoretical Domain Frameworks: The First Step for Designing Appropriate Interventions. Healthcare (Basel) 2022; 10:healthcare10101924. [PMID: 36292370 PMCID: PMC9602033 DOI: 10.3390/healthcare10101924] [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: 07/29/2022] [Revised: 09/15/2022] [Accepted: 09/28/2022] [Indexed: 11/04/2022] Open
Abstract
Background: Hand Hygiene (HH) is widely recognized to be one of the most successful and cost-effective measures for reducing the incidence of healthcare-associated infections (HAIs). The hand hygiene behavior of hospital healthcare workers (HCWs) is not well-documented in Benin. Therefore, Theoretical Domains Framework (TDF) was used to identify the behavioral determinants that may impact HCWs’ hand-hygiene compliance in a public hospital. Methods: A qualitative design comprising face-to-face semi-structured interviews with nine HCWs. The interviews included questions on transmission of infections, hand-hygiene practices, problems with their implementation; and ways to improve hand hygiene compliance. Two pharmacists independently coded interviews into behavioral domains using the TDF and then subdivided them into several themes. Interview transcripts were analyzed following 3-steps approach: coding, generation of specific beliefs, and identification of relevant domains. Results: Almost all interviewees have cited the environmental context and resources (such as lack of water) as a barrier to HH practice. They also believed that role models had a significant impact on the good practices of others HCWs. Fortunately, they were confident of their capabilities to perform appropriate HH behaviors. The majority (7/9) reported having the necessary knowledge and skills and believed they could carry out appropriate HH behavior. In all cases, the participants were motivated to carry out HH behavior, and it was recognized that HH remains the cornerstone to reduce health care associated infections. Conclusion: This study identified several behavioral constructs aligned with the TDF that can be targeted and help for the development of new hand-hygiene interventions. These may increase the likelihood of a successful intervention, thereby improving HH compliance and patient safety, especially in hospitals.
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Affiliation(s)
- Carine Laurence Yehouenou
- Clinical Pharmacy Research Group (CLIP), Louvain Drug Research Institute (LDRI), Université Catholique de Louvain, 1200 Brussels, Belgium
- Laboratoire de Référence des Mycobactéries (LRM), Cotonou BP 817, Benin
- Faculté des Sciences de la Santé (FSS), Université d’Abomey Calavi (UAC), Cotonou 01 BP 526, Benin
- Correspondence: or
| | - Aynaz Abedinzadeh
- Service de Pharmacie Clinique, Clinique Universitaires Saint-Luc, UCLouvain, 1200 Brussels, Belgium
| | - Roch Houngnihin
- Laboratoire d’Anthropologie Médicale Appliquée (LAMA), Université d’Abomey-Calavi, Cotonou 01 BP 188, Benin
| | - Carine Baxerres
- UMR261-MERIT, French National Research Institute for Sustainable Development (IRD), University of Paris, 75006 Paris, France
- UMR151-LPED, IRD, Aix Marseille Université, 13005 Marseille, France
| | - Francis M. Dossou
- Department of Surgery and Surgical Specialties, Faculty of Health Sciences, Campus Universitaire, Champs de Foire, Cotonou 01 BP 118, Benin
| | - Anne Simon
- Centres Hospitaliers Jolimont, Prévention et Contrôle des Infections, Groupe Jolimont Asbl, Rue Ferrer, 7100 Haine-Saint-Paul, Belgium
| | - Olivia Dalleur
- Clinical Pharmacy Research Group (CLIP), Louvain Drug Research Institute (LDRI), Université Catholique de Louvain, 1200 Brussels, Belgium
- Service de Pharmacie Clinique, Clinique Universitaires Saint-Luc, UCLouvain, 1200 Brussels, Belgium
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Cho HE, Billig JI, Byrnes ME, Haase SC, Waljee JF, Chung KC. Trust and Distrust in Opioid Decision-Making: A Qualitative Assessment of Patient-Doctor Relationship. J Hand Surg Am 2022; 47:151-159.e1. [PMID: 34916114 DOI: 10.1016/j.jhsa.2021.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 08/28/2021] [Accepted: 10/27/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Surgeons often prescribe opioid analgesics for pain management after surgery. However, we understand little about how patients perceive opioid prescribing and make decisions to use opioids for postoperative pain management. In this study, we aimed to gain an understanding of patients' decision-making process on postoperative opioid use. METHODS We conducted semi-structured interviews with 30 adult patients undergoing elective surgery at our institution. The interviews were content-coded for thematic analysis. We used trust in the medical setting as a conceptual framework to interpret and find the inherent theory in the data. RESULTS We found that participants based their opioid decisions on their trust or distrust toward various elements of their postoperative pain management. Participants believed that the surgeons "know," thereby, reinforcing their trust in surgeons' postoperative opioid prescribing to be in the participants' best interest. Moreover, the positive reputation of the institution strengthened the participants' trust. However, participants conveyed nuanced trust because of their distrust toward the opioid medications themselves, which were viewed as "suspicious," and the pharmaceutical companies, that were "despised." Despite this distrust, participants had confidence in their inherent ability to protect themselves from opioid use disorders. CONCLUSIONS Understanding how patients perceive and form decisions on postoperative opioid use based on their trust and distrust toward various factors involved in their care highlights the importance of the patient-doctor relationship and building trust to effectively address postoperative pain and reduce opioid-related harms. CLINICAL RELEVANCE Through a strengthened therapeutic alliance between patients and surgeons, we can improve our strategies to overcome the ongoing opioid epidemic through patient-centered approaches.
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Affiliation(s)
- Hoyune E Cho
- Department of Surgery, Michigan Medicine, Ann Arbor, MI; Department of Plastic Surgery, University of California, Irvine, School of Medicine, Orange, CA
| | - Jessica I Billig
- Department of Surgery, Michigan Medicine, Ann Arbor, MI; VA/National Clinician Scholars Program, VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Mary E Byrnes
- Department of Surgery, Michigan Medicine, Ann Arbor, MI; Center for Healthcare Outcomes and Policy, Ann Arbor, MI
| | | | - Jennifer F Waljee
- Department of Surgery, Michigan Medicine, Ann Arbor, MI; Center for Healthcare Outcomes and Policy, Ann Arbor, MI
| | - Kevin C Chung
- Department of Surgery, Michigan Medicine, Ann Arbor, MI.
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Porter-Stransky KA, Gallimore RM. Medical Student Attitudes and Perceptions on the Relevance of Neuroscience to Psychiatry: a Mixed Methods Study. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2022; 46:128-132. [PMID: 34499342 DOI: 10.1007/s40596-021-01525-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 08/10/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Many psychiatry residency programs are actively incorporating neuroscience training into their curricula; however, relatively little scholarship exploring neuroscience and psychiatry integration in undergraduate medical education has been conducted. This study investigated second-year, pre-clerkship medical students' perceptions on the relationship between neuroscience and psychiatry following foundational neuroscience and behavior instruction to identify their views before they enter clerkships. METHODS A mixed methods design combined qualitative analysis of medical students' essays in response to the prompt: "What is the relationship between neuroscience and psychiatry?" with quantitative analysis of survey responses on a 7-point scale. RESULTS Ninety-three percent of the class participated in the study (n = 77). Learners rated neuroscience as important for understanding and treating psychiatric disorders, albeit less important for psychiatric compared to neurological disorders. Using applied thematic analysis, the authors identified qualitative themes. Specifically, participants recognized neuroscience as a foundational science for psychiatry, but some emphasized that factors other than neuroscience are needed to explain psychiatric disorders. Some students perceived neuroscience and psychiatry as complementary approaches to understanding the brain and behavior. Others identified a role for neuroscience in reducing the stigma of psychiatric disorders and thereby improving access to psychiatric care. CONCLUSIONS The quantitative and qualitative findings reinforced each other and provided novel insight to pre-clerkship medical students' views on the relevance of neuroscience for psychiatry. Educating all medical students, not just psychiatry residents, on the neuroscience of psychiatric disorders may better equip the next generation of physicians, regardless of specialty, to care for their patients with psychiatric conditions.
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Affiliation(s)
| | - Rachel M Gallimore
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
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How can I Be as attractive as a Fitness YouTuber in the era of COVID-19? The impact of digital attributes on flow experience, satisfaction, and behavioral intention. JOURNAL OF RETAILING AND CONSUMER SERVICES 2022; 64:102778. [PMCID: PMC8445828 DOI: 10.1016/j.jretconser.2021.102778] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 07/27/2021] [Accepted: 09/13/2021] [Indexed: 05/31/2023]
Abstract
In the past decade, the social media platform has dramatically changed individuals’ daily activities in real life and on the Internet, including shopping, socialization, entertainment, study, and even health and fitness. In the era of COVID-19, particularly, consumers tend to rely more on digital attributes of social media platforms for their decision-making process by reducing the physical touchpoint. Responding to this ongoing trend, this study investigates how fitness YouTube channel attributes and fitness YouTuber attributes influence flow experience, satisfaction, and behavioral intention of YouTubers who work out at home via a fitness YouTube channel during the COVID-19 pandemic. Based on the social media literature and the cognitive appraisal theory, this research formulates a research model that specifies the influence of three dimensions of fitness YouTube channel attributes (i.e., social interaction, information quality, and visual content) and three dimensions of fitness YouTuber attributes (i.e., social attractiveness, physical attractiveness, and attitude homophily) on flow experience, YouTube channel satisfaction, and behavioral intention in the context of YouTube. This study recruited participants in the United States who currently work out via a fitness YouTube channel through three waves of data collection during the COVID-19 era. The empirical results revealed that flow experience was significantly affected by information quality, visual content, and physical attractiveness. Also, YouTube channel satisfaction was significantly affected by social interaction, information quality, and visual content. Lastly, behavioral intention was significantly affected by flow experience and YouTube channel satisfaction. Based on the findings, this study proposes meaningful implications for the extant literature and social media industry during the COVID-19 pandemic.
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Woods-Hill CZ, Xie A, Lin J, Wolfe HA, Plattner AS, Malone S, Chiotos K, Szymczak JE. OUP accepted manuscript. JAC Antimicrob Resist 2022; 4:dlab195. [PMID: 35098126 PMCID: PMC8794647 DOI: 10.1093/jacamr/dlab195] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Antimicrobial and diagnostic stewardship initiatives have become increasingly important in paediatric settings. The value of qualitative approaches to conduct stewardship work in paediatric patients is being increasingly recognized. This article seeks to provide an introduction to basic elements of qualitative study designs and provide an overview of how these methods have successfully been applied to both antimicrobial and diagnostic stewardship work in paediatric patients. A multidisciplinary team of experts in paediatric infectious diseases, paediatric critical care and qualitative methods has written a perspective piece introducing readers to qualitative stewardship work in children, intended as an overview to highlight the importance of such methods and as a starting point for further work. We describe key differences between qualitative and quantitative methods, and the potential benefits of qualitative approaches. We present examples of qualitative research in five discrete topic areas of high relevance for paediatric stewardship work: provider attitudes; provider prescribing behaviours; stewardship in low-resource settings; parents’ perspectives on stewardship; and stewardship work focusing on select high-risk patients. Finally, we explore the opportunities for multidisciplinary academic collaboration, incorporation of innovative scientific disciplines and young investigator growth through the use of qualitative research in paediatric stewardship. Qualitative approaches can bring rich insights and critically needed new information to antimicrobial and diagnostic stewardship efforts in children. Such methods are an important tool in the armamentarium against worsening antimicrobial resistance, and a major opportunity for investigators interested in moving the needle forward for stewardship in paediatric patients.
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Affiliation(s)
- Charlotte Z. Woods-Hill
- Division of Critical Care Medicine, The Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
- University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locust Walk # 210, Philadelphia, PA 19104, USA
- Corresponding author. E-mail:
| | - Anping Xie
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21205, USA
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, 750 E Pratt St., Baltimore, MD 21202, USA
| | - John Lin
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, 660 S Euclid Ave, St Louis, MO 63110, USA
| | - Heather A. Wolfe
- Division of Critical Care Medicine, The Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
- University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Alex S. Plattner
- Division of Pediatric Infectious Disease, Department of Pediatrics, Washington University School of Medicine, 660 S Euclid Ave, St Louis, MO 63110, USA
| | - Sara Malone
- Division of Pediatric Infectious Disease, Department of Pediatrics, Washington University School of Medicine, 660 S Euclid Ave, St Louis, MO 63110, USA
| | - Kathleen Chiotos
- Division of Critical Care Medicine, The Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
- University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Julia E. Szymczak
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locust Walk # 210, Philadelphia, PA 19104, USA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA
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Hines-Munson C, May S, Poon I, Holmes SA, Martin L, Trautner BW, Skelton F. Experiences of veterans with spinal cord injury related to annual urine screening and antibiotic use for urinary tract infections. PM R 2021; 13:1369-1375. [PMID: 33543579 PMCID: PMC8333194 DOI: 10.1002/pmrj.12568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/06/2020] [Accepted: 11/10/2020] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Antimicrobial-resistant bacterial infections are an increasing public health threat and people with spinal cord injury (SCI) are disproportionally at higher risk. National guidelines concerning urine testing after SCI are conflicting. Unnecessary urine testing in the SCI population (with high asymptomatic bacteriuria prevalence) leads to unnecessary antimicrobial use, propagating resistant infections, especially urinary tract infections (UTIs). OBJECTIVES (a) Describe UTI antimicrobial adherence in patients with SCI. (b) Explore SCI patient knowledge and attitudes toward current urine testing and treatment practices. DESIGN Mixed methods. SETTING Veterans Health Administration (VHA) patients with SCI. PARTICIPANTS Veterans identified as having SCI seen at a VHA facility nationwide. INTERVENTIONS N/A. MAIN OUTCOME MEASURES Self-reported medication adherence, patient beliefs and behaviors toward UTIs and antimicrobial use. RESULTS A total of 105 Morisky Medication Adherence Scale-8 (MMAS-8) surveys were completed out of 369 distributed surveys (28% response rate). Overall, patients reported high medication adherence (mean score of 7.2/8, with 8 being a perfect adherence score). Ten qualitative interviews were completed. Themes identified include generally high adherence to prescribed antimicrobial courses and high levels of patient satisfaction with current outpatient VHA SCI bladder care. The quantitative findings converge with these themes observed in the qualitative interviews; patients were satisfied with current urine testing and treatment practices. CONCLUSIONS Veterans with SCI are generally satisfied with their current UTI management and self-report taking antimicrobials for UTIs as prescribed. Veterans with SCI typically report high trust in their SCI providers and value their advice on bladder care management. Therefore, it is imperative for clinicians to provide evidence-based education to patients, as well as ensure that each prescribed course of antibiotics for UTI is clinically necessary. Information from this study will guide an intervention promoting appropriate urine testing and antimicrobial prescription practices by SCI providers.
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Affiliation(s)
- Casey Hines-Munson
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Sarah May
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Ivy Poon
- College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas, USA
| | - S Ann Holmes
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
| | | | - Barbara W Trautner
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Felicia Skelton
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
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Cameron KA, Cohen ER, Hertz JR, Wayne DB, Mitra D, Barsuk JH. Barriers and Facilitators to Central Venous Catheter Insertion: A Qualitative Study. J Patient Saf 2021; 17:e1296-e1306. [PMID: 29543666 DOI: 10.1097/pts.0000000000000477] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The aims of the study were to identify perceived barriers and facilitators to central venous catheter (CVC) insertion among healthcare providers and to understand the extent to which an existing Simulation-Based Mastery Learning (SBML) program may address barriers and leverage facilitators. METHODS Providers participating in a CVC insertion SBML train-the-trainer program, in addition to intensive care unit nurse managers, were purposively sampled from Veterans Administration Medical Centers located in geographically diverse areas. We conducted semistructured interviews to assess perceptions of barriers and facilitators to CVC insertion. Deidentified transcripts were analyzed using a grounded theory approach and the constant comparative method. We subsequently mapped identified barriers and facilitators to our SBML curriculum to determine whether or not the curriculum addresses these factors. RESULTS We interviewed 28 providers at six Veterans Administration Medical Centers, identifying the following five overarching factors of perceived barriers to CVC insertion: (1) equipment, (2) personnel/staff, (3) setting or organizational context, (4) patient or provider, and (5) time-related barriers. Three overarching factors of facilitators emerged: (1) equipment, (2) personnel, and (3) setting or organizational context facilitators. The SBML curriculum seems to address most identified barriers, while leveraging many facilitators; building on the commonly identified facilitator of nursing staff contribution by expanding the curriculum to explicitly include nurse involvement could improve team efficiency and organizational culture of safety. CONCLUSIONS Many identified facilitators (e.g., ability to use ultrasound, personnel confidence/competence) were also identified as barriers. Evidence-based SBML programs have the potential to amplify these facilitators while addressing the barriers by providing an opportunity to practice and master CVC insertion skills.
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Affiliation(s)
- Kenzie A Cameron
- From the Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Elaine R Cohen
- From the Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Joelle R Hertz
- Medical Error Reduction and Certification, Inc, Seattle, Washington
| | | | - Debi Mitra
- From the Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Methodological and technical considerations for video-based auditing of hand hygiene compliance in clinical practice: an exploratory study. Am J Infect Control 2021; 49:1384-1391. [PMID: 33940065 DOI: 10.1016/j.ajic.2021.04.081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/23/2021] [Accepted: 04/23/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Direct observation is the gold standard method for measuring hand hygiene compliance but its utility is increasingly being questioned. Various alternative electronic methods have been proposed, yet there is a paucity of research examining the use of these according to the World Health Organization's (WHO) '5 Moments for Hand Hygiene'. As a part of the process of developing a video-based monitoring system (VMS) capable of measuring hand hygiene compliance against the 5 moments criteria this paper reports methodological and technical issues that might arise from the use of a VMS for auditing in clinical practice. METHODS In-depth semi-structured interviews were conducted with 27 Australian content experts in hand hygiene auditing and infection prevention to explore their responses to proposed VMS auditing approaches. Transcripts were analyzed using thematic and content analysis. RESULTS Technical and methodological considerations for the use of VMS were interrelated and included concerns surrounding privacy, footage security, fears of surveillance and the potential for medico-legal consequences. Additionally, possible detrimental impacts on healthcare worker (HCW) -patient relationships, issues of cost versus benefits, HCW and patient safety and changes to feedback were also identified. CONCLUSIONS The primary methodological and technical issues to overcome in order to implement VMS for hand hygiene auditing in clinical practice, centered upon issues of acceptability to patients and health professionals, privacy, consent and liability. CHECKLIST COREQ.
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Pinedo M, Beltrán-Girón J, Correa Z, Valdez C. A Qualitative View of Migration-Related Stressors on the Mental Health of Latinx Americans in the Current Sociopolitical Climate of Hostility Towards Migrants. J Immigr Minor Health 2021; 23:1053-1064. [PMID: 33945077 PMCID: PMC8819974 DOI: 10.1007/s10903-021-01207-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 11/24/2022]
Abstract
This qualitative study aimed to elucidate and contextualize which and how migration-related stressors may influence Latinx Americans' (i.e., US-born; US-citizens) mental health status, including substance misuse. In 2019, a community sample of 22 Latinx Americans were recruited for an in-depth qualitative interview. Eligibility criteria included: being an adult, self-identify as Latinx, report a migration-related stressor, and report at least one symptom of a mental health or substance use problem. Open-ended questions focused on the migrant experience, perceptions and impacts of immigration enforcement, and how these experiences related to their mental health. Using a migration as a social determinant framework, we identified several migration-related stressors at the structural- and social-level of environmental influence that were related to participants' mental health. Findings highlight how migration-related stressors at the structural- and social-level of influence create systematic uncertainty by inducing fear into the daily lives of Latinx Americans.
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Affiliation(s)
- M Pinedo
- Department of Kinesiology & Health Education, College of Education, University of Texas At Austin, 2109 San Jacinto Blvd., Stop D3700, Austin, TX, USA.
| | - J Beltrán-Girón
- Critical Social/Personality Psychology Program, The Graduate Center, City University of New York, New York, USA
| | - Z Correa
- Department of Nutritional Sciences, College of Natural Sciences, University of Texas At Austin, Austin, USA
| | - C Valdez
- Department of Population Health, Dell Medical School, & Steve Hicks School of Social Work, University of Texas At Austin, Austin, USA
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19
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Fasugba O, McInnes E, Baye J, Cheng H, Gordon R, Middleton S. Barriers and enablers to implementinghospital-acquired urinary tract infection prevention strategies: a qualitative study using the Theoretical Domains Framework. J Hosp Infect 2021; 113:172-179. [PMID: 33839213 DOI: 10.1016/j.jhin.2021.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Consistent implementation of evidence-based hospital-acquired urinary tract infection (UTI) prevention strategies remains a challenge in acute and subacute care settings. Addressing the evidence-practice gap requires an understanding of factors affecting implementation of hospital-acquired UTI prevention strategies in this high-risk setting. AIM To identify the perceived barriers and enablers of clinicians to implementing hospital-acquired UTI prevention strategies in an Australian subacute hospital. METHODS Qualitative semi-structured virtual interviews, underpinned by the Theoretical Domains Framework (TDF), were conducted with purposively selected nurses (N = 8) and doctors (N = 2) at one subacute metropolitan hospital. Interview data were content-analysed using the TDF as the coding framework. FINDINGS Eight TDF domains were identified as important in understanding barriers and enablers to implementing hospital-acquired UTI prevention strategies: Knowledge, Skills, Beliefs about capabilities, Emotion, Professional role and identity, Environmental context and resources, Goals, and Behavioural regulation. Barriers were poor awareness of clinical practice guidelines for hospital-acquired UTI prevention; lack of training; staff shortages; competing workloads; lack of procedural equipment for urinary catheterization; difficulty with implementing prevention strategies in cognitively impaired patients; language barriers; and lack of feedback and use of incident reporting data to influence clinical practice. Presence of a proactive staff culture and positive team approach to work emerged as enablers. Audit and feedback, clinical champions, education, and patient information resources in languages other than English were identified as potential enablers. CONCLUSION The findings will inform development of theoretically informed behaviour change interventions to promote successful implementation of hospital-acquired UTI prevention strategies in the subacute setting.
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Affiliation(s)
- O Fasugba
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Darlinghurst, New South Wales, Australia.
| | - E McInnes
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Darlinghurst, New South Wales, Australia
| | - J Baye
- St Joseph's Hospital, Auburn, New South Wales, Australia
| | - H Cheng
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Darlinghurst, New South Wales, Australia
| | - R Gordon
- St Joseph's Hospital, Auburn, New South Wales, Australia
| | - S Middleton
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Darlinghurst, New South Wales, Australia
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Taylor J, Forgeron P, Vandyk A, Finley A, Lightfoot S. Pediatric Health Outcome Evaluation in Low-and Middle-Income Countries: A Scoping Review of NGO Practice. Glob Pediatr Health 2021; 8:2333794X21991011. [PMID: 33614849 PMCID: PMC7868502 DOI: 10.1177/2333794x21991011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 01/03/2021] [Accepted: 01/09/2021] [Indexed: 11/17/2022] Open
Abstract
Objective. The purpose of this study was to explore the research on the delivery and evaluation of pediatric health services by non-governmental organizations in low-and middle-income countries to better understand how they contribute to positive and sustainable health outcomes. Methods. A scoping review was completed using a 2-step study selection procedure. Results. Of the 5742 studies, 17 met criteria, including quantitative and mixed method designs, representing 10 different non-governmental organizations with programs in 33 low-and middle-income countries. Health outcomes were reported 89 times across the studies. A total of 56 different outcomes were identified in total, of which 24 were positive, 27 were negative, and 5 were unchanged. Conclusions. Widespread variation between non-governmental organizations exist, however, comprehensive pediatric health outcome evaluation is growing. Further emphasis should be given to adolescent specific research and robust measurement of quality of life.
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Affiliation(s)
| | | | | | - Allen Finley
- Dalhousie University & IWK Health Centre, Halifax, NS, Canada
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21
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Christine C, Marco C, Louis-Rachid S, Pierre C. Clinicians' views about the experience of disability due to low back pain. Results from a focus group study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:1953-1958. [PMID: 32436076 DOI: 10.1007/s00586-020-06463-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/10/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE For clinicians, treating the cause of non-pathological low back pain (LBP) is central. For patients, it is how LBP limits their activities of daily living. Little is known about clinicians' understanding of disability and the patient's perspective. We conducted a qualitative study to examine how clinicians involved in the care of patients with BP describe and define disability, its associated changes, and rehabilitation. METHODS Two focus groups (FGs) were conducted with spine specialists including eleven confirmed orthopedic surgeons and neurosurgeons, ten advanced residents, and five other clinicians. Participants were questioned about their views on disability, what it means to them and to the patients. Responses were collected by two independent observers using Metaplan techniques. Large stickers were used to collect participants' responses/ideas; the stickers were posted on billboards so the FGs could check them during the discussion. Metaplan was used to aggregate responses. RESULTS Disability was viewed as a major source of physical limitations, difficulties in performing daily activities, associated with emotional distress, and raising legitimacy issues. Changes in roles engaged the social component. Considered from the patients' perspective, negative emotions and social issues were emphasized, along with the patients' resources. For rehabilitation, the participants emphasized patient-centered care, teamwork, and objectives for care. CONCLUSION The participants pointed to disability as an umbrella term for impairments, activity limitations, and participation restrictions. They underlined the necessity for clinicians to help patients define their level of optimal functioning when faced with BP, utilizing adaptation and teamwork within the therapeutic relationship.
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Affiliation(s)
- Cedraschi Christine
- Division of General Medical Rehabilitation, Geneva Faculty of Medicine, Geneva University Hospitals, 4 Rue Gabrielle Perret-Gentil, 14, 1211, Geneva, Switzerland. .,Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Centre, University Hospitals, Geneva University, Geneva, Switzerland.
| | - Campello Marco
- NYU Hospital for Joint Diseases, Occupational and Industrial Orthopaedic Center (OIOC), New York University, 63 Downing St, New York, NY, 10014, USA.,NYU Robert I Grossman School of Medicine, New York, USA
| | - Salmi Louis-Rachid
- University Bordeaux, ISPED, Centre INSERM U1219 Bordeaux Population Health, Bordeaux, France.,INSERM, ISPED, Centre INSERM U1219 Bordeaux Population Health, 33000, Bordeaux, France.,CHU de Bordeaux, Pole de sante publique, Service d'information medicale, 33000, Bordeaux, France
| | - Côté Pierre
- Center for Disability Prevention and Rehabilitation,, University of Ontario Institute of Technology and Canadian Memorial Chiropractic College, Oshawa, ON, Canada.,Ontario Tech University, Oshawa, ON, Canada
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22
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Wang GH, Nesbit C, Rankin S. Voices of home-based palliative care community health workers in rural Malawi: A mixed methods study on factors affecting role and sustainability. PROGRESS IN PALLIATIVE CARE 2020. [DOI: 10.1080/09699260.2020.1760533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Grace H. Wang
- Kaiser Permanente Redwood City, Redwood City, CA, USA
| | - Casey Nesbit
- University of California, San Francisco/San Francisco State University Graduate Program in Physical Therapy, San Francisco, CA, USA
| | - Sally Rankin
- University of California, San Francisco School of Nursing, San Francisco, CA, USA
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Boye S, Shimakawa Y, Vray M, Giles-Vernick T. Limited Awareness of Hepatitis B but Widespread Recognition of Its Sequelae in Rural Senegal: A Qualitative Study. Am J Trop Med Hyg 2020; 102:637-643. [PMID: 31971148 DOI: 10.4269/ajtmh.19-0477] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
To achieve the WHO's global strategy of eliminating hepatitis B virus (HBV) infection, it is essential to ensure adequate understanding of hepatitis B disease to facilitate uptake of screening, linkage to care, and adherence to antiviral therapy. Sub-Saharan Africa has the world's highest prevalence of HBV infection, yet less than 1% of HBV-infected people have been diagnosed. Lay populations do not widely recognize "hepatitis B." Hypothesizing that visible signs and symptoms of chronic HBV infection sequelae (jaundice, ascites, or cachexia) might be more easily recognizable, we conducted a qualitative study to determine how rural populations in Senegal understood these sequelae. We led six focus groups and 149 individual interviews with lay populations and formal and informal health workers in three rural study sites in Senegal. Only a third of lay populations (30/105) had ever heard of "hepatitis B," nor did they evoke local language diagnostic terms resembling this illness. Nevertheless, more than two-thirds (71/105) recognized signs and symptoms of end-stage liver disease but considered these physical manifestations to be a consequence of the manipulation of occult forces. Lay populations also contended that traditional healers, not formal medical structures, should treat such illnesses. Formal and informal health workers had limited knowledge about hepatitis B and difficulties identifying terms in local languages to explain the disease. Communication strategies based on the population's widespread recognition of the hepatitis sequelae may enhance awareness of hepatitis, which is a crucial element to increase screening uptake, linkage to care, and commitment to lifelong treatment in African communities.
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Affiliation(s)
- Sokhna Boye
- Unité d'Epidémiologie des Maladies Infectieuses, Institut Pasteur de Dakar, Dakar, Senegal
| | - Yusuke Shimakawa
- Emerging Diseases Epidemiology Unit, Pasteur Institute, Paris, France
| | - Muriel Vray
- Unité d'Epidémiologie des Maladies Infectieuses, Institut Pasteur de Dakar, Dakar, Senegal.,National Institute of Health and Medical Research (INSERM), Paris, France
| | - Tamara Giles-Vernick
- Anthropology and Ecology of Disease Emergence Unit, Pasteur Institute, Paris, France
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Guzmán EM, Tezanos KM, Chang BP, Cha CB. Examining the impact of emergency care settings on suicidal patients: A call to action. Gen Hosp Psychiatry 2020; 63:9-13. [PMID: 30077397 DOI: 10.1016/j.genhosppsych.2018.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 07/15/2018] [Accepted: 07/19/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The emergency department (ED) offers a critical and unique opportunity to assess and intervene on suicide risk. Despite its potential benefits, the ED setting presents several potential sources of stress. The present paper calls attention to how suicidal patients may be especially vulnerable to stressful ED experiences. METHOD This research synthesis cites the growing literature on ED-related stressors, as they have been shown to affect both psychiatric and nonpsychiatric patient populations. RESULTS We identified specific interpersonal, physical, and temporal features of the ED that have been shown to affect multiple patient populations, including suicidal individuals. Beyond this, there appears to be broad underutilization of therapeutic care in ED settings. CONCLUSIONS It is important to consider how the ED setting may be both helpful and harmful toward suicidal patients. We conclude with recommended domains of study and methodological considerations when pursuing these future directions. The proposed research agenda would help address this known high risk period around hospitalization and discharge, and ultimately optimize suicide prevention efforts.
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Affiliation(s)
- Eleonora M Guzmán
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, United States of America
| | - Katherine M Tezanos
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, United States of America
| | - Bernard P Chang
- Department of Emergency Medicine, Columbia University Medical Center, United States of America
| | - Christine B Cha
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, United States of America.
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Böge K, Karadza A, Fuchs LM, Ehlen F, Ta TMT, Thomas N, Bajbouj M, Hahn E. Mindfulness-Based Interventions for In-Patients With Schizophrenia Spectrum Disorders-A Qualitative Approach. Front Psychiatry 2020; 11:600. [PMID: 32676042 PMCID: PMC7333646 DOI: 10.3389/fpsyt.2020.00600] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 06/10/2020] [Indexed: 12/25/2022] Open
Abstract
In recent years, mindfulness-based interventions (MBI) have gained clinical relevance in the treatment of patients with schizophrenia spectrum disorders (SSDs). High symptom burden, long durations of hospitalization and high rehospitalization rates demonstrate the severity and cost-intensity of these disorders. MBIs have shown promising treatment outcomes in a small number of trials, primarily taking place in English-speaking countries. The current study aims to explore mechanisms and processes as well as adverse effects of MBIs on in-patients with SSDs in a German university hospital setting. A qualitative design based on inductive thematic analysis accompanied by quantitative assessments was chosen. A semi-structured interview guide was developed by psychiatrists and psychologists to assess patient experiences, perceptions, thoughts, and feelings during and after taking part in a MBI. Twenty-seven interviews were conducted between September 2017 and October 2018 with in-patients who are diagnosed with schizophrenia or schizoaffective disorder. Rater-based questionnaires, such as the Positive and Negative Syndrome Scale (PANSS), Montgomery Asberg Depression Rating Scale (MADRS), and Psychotic Symptom Rating Scales-Auditory Hallucination (PSYRATS-AH) were administered at baseline to collect clinical outcomes. Qualitative analysis revealed two domains: content and function. In the first domain related to content with the core elements "detachment and rumination", "presence and getting lost", "non-judgment and judgment", and effects with "emotions", "cognition", and "symptom changes". A second domain related to function was extracted, including the relevance of perception of context and transfer to everyday life. Overall, improvements concerning cognition, distress, and psychopathology were detected, while no adverse effects, such as increased psychotic symptoms, were revealed. As the first study of its kind, mechanisms, processes, and the safety of MBIs were explored and confirmed in a sample of German in-patients with SSDs. The results of this qualitative study are in line with recent findings on MBIs amongst patients with psychotic disorders from other countries. Results lay the ground for future research to focus on the systematic study of MBIs in large samples, its treatment processes, outcomes, and effectiveness for in-patients with SSDs.
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Affiliation(s)
- Kerem Böge
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Almira Karadza
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Clinical Psychology and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
| | - Lukas M Fuchs
- Institute of Sociology, Freie Universität Berlin, Berlin, Germany
| | - Felicitas Ehlen
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Psychiatry, Jüdisches Krankenhaus, Berlin, Germany
| | - Thi Minh Tam Ta
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Neil Thomas
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Malek Bajbouj
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Eric Hahn
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Miah SJ, Gammack J, Hasan N. Methodologies for designing healthcare analytics solutions: A literature analysis. Health Informatics J 2019; 26:2300-2314. [PMID: 31876227 DOI: 10.1177/1460458219895386] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Healthcare analytics has been a rapidly emerging research domain in recent years. In general, healthcare solution design studies focus on developing analytic solutions that enhance product, process and practice values for clinical and non-clinical decision support. The objective of this study is to explore the scope of healthcare analytics research and in particular its utilisation of design and development methodologies. Using six prominent electronic databases, qualifying articles between 2010 and mid-2018 were sourced and categorised. A total of 52 articles on healthcare analytics solutions were selected for relevant content on public healthcare. The research team scrutinised the articles, using established content analysis protocols. Analysis identified that various methodologies have been used for developing analytics solutions, such as prototyping, traditional software engineering, agile approaches and others, but despite its clear advantages, few show the use of design science. Key topic areas are also identified throughout the content analysis suggesting topical research priorities in the field.
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Affiliation(s)
| | | | - Najmul Hasan
- Huazhong University of Science & Technology, China
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Goedken CC, Livorsi DJ, Sauder M, Vander Weg MW, Chasco EE, Chang NC, Perencevich E, Reisinger HS. "The role as a champion is to not only monitor but to speak out and to educate": the contradictory roles of hand hygiene champions. Implement Sci 2019; 14:110. [PMID: 31870453 PMCID: PMC6929350 DOI: 10.1186/s13012-019-0943-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 09/24/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Implementation science experts define champions as "supporting, marketing, and driving through an implementation, overcoming indifference or resistance that the intervention may provoke in an organization." Many hospitals use designated clinical champions-often called "hand hygiene (HH) champions"-typically to improve hand hygiene compliance. We conducted an ethnographic examination of how infection control teams in the Veterans Health Administration (VHA) use the term "HH champion" and how they define the role. METHODS An ethnographic study was conducted with infection control teams and frontline staff directly involved with hand hygiene across 10 geographically dispersed VHA facilities in the USA. Individual and group semi-structured interviews were conducted with hospital epidemiologists, infection preventionists, multi-drug-resistant organism (MDRO) program coordinators, and quality improvement specialists and frontline staff from June 2014 to September 2017. The team coded the transcripts using thematic content analysis content based on a codebook composed of inductive and deductive themes. RESULTS A total of 173 healthcare workers participated in interviews from the 10 VHA facilities. All hand hygiene programs at each facility used the term HH champion to define a core element of their hand hygiene programs. While most described the role of HH champions as providing peer-to-peer coaching, delivering formal and informal education, and promoting hand hygiene, a majority also included hand hygiene surveillance. This conflation of implementation strategies led to contradictory responsibilities for HH champions. Participants described additional barriers to the role of HH champions, including competing priorities, staffing hierarchies, and turnover in the role. CONCLUSIONS Healthcare systems should consider narrowly defining the role of the HH champion as a dedicated individual whose mission is to overcome resistance and improve hand hygiene compliance-and differentiate it from the role of a "compliance auditor." Returning to the traditional application of the implementation strategy may lead to overall improvements in hand hygiene and reduction of the transmission of healthcare-acquired infections.
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Affiliation(s)
- Cassie Cunningham Goedken
- Center for Access & Delivery Research and Evaluation, Iowa City VA Health Care System, 601 Hwy 6 West, Iowa City, 52246 USA
| | - Daniel J. Livorsi
- Center for Access & Delivery Research and Evaluation, Iowa City VA Health Care System, 601 Hwy 6 West, Iowa City, 52246 USA
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, 375 Newton Rd, Iowa City, IA 52242 USA
| | - Michael Sauder
- Department of Sociology, University of Iowa, 140 Seashore Hall West, Iowa City, IA 52242 USA
| | - Mark W. Vander Weg
- Center for Access & Delivery Research and Evaluation, Iowa City VA Health Care System, 601 Hwy 6 West, Iowa City, 52246 USA
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, 375 Newton Rd, Iowa City, IA 52242 USA
- Department of Psychological and Brain Sciences, University of Iowa, W311 Seashore Hall, Iowa City, IA 52242-1407 USA
| | - Emily E. Chasco
- Center for Access & Delivery Research and Evaluation, Iowa City VA Health Care System, 601 Hwy 6 West, Iowa City, 52246 USA
| | - Nai-Chung Chang
- University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132 USA
| | - Eli Perencevich
- Center for Access & Delivery Research and Evaluation, Iowa City VA Health Care System, 601 Hwy 6 West, Iowa City, 52246 USA
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, 375 Newton Rd, Iowa City, IA 52242 USA
| | - Heather Schacht Reisinger
- Center for Access & Delivery Research and Evaluation, Iowa City VA Health Care System, 601 Hwy 6 West, Iowa City, 52246 USA
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, 375 Newton Rd, Iowa City, IA 52242 USA
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Munthe-Kaas HM, Glenton C, Booth A, Noyes J, Lewin S. Systematic mapping of existing tools to appraise methodological strengths and limitations of qualitative research: first stage in the development of the CAMELOT tool. BMC Med Res Methodol 2019; 19:113. [PMID: 31164084 PMCID: PMC6549363 DOI: 10.1186/s12874-019-0728-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 04/09/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Qualitative evidence synthesis is increasingly used alongside reviews of effectiveness to inform guidelines and other decisions. To support this use, the GRADE-CERQual approach was developed to assess and communicate the confidence we have in findings from reviews of qualitative research. One component of this approach requires an appraisal of the methodological limitations of studies contributing data to a review finding. Diverse critical appraisal tools for qualitative research are currently being used. However, it is unclear which tool is most appropriate for informing a GRADE-CERQual assessment of confidence. METHODOLOGY We searched for tools that were explicitly intended for critically appraising the methodological quality of qualitative research. We searched the reference lists of existing methodological reviews for critical appraisal tools, and also conducted a systematic search in June 2016 for tools published in health science and social science databases. Two reviewers screened identified titles and abstracts, and then screened the full text of potentially relevant articles. One reviewer extracted data from each article and a second reviewer checked the extraction. We used a best-fit framework synthesis approach to code checklist criteria from each identified tool and to organise these into themes. RESULTS We identified 102 critical appraisal tools: 71 tools had previously been included in methodological reviews, and 31 tools were identified from our systematic search. Almost half of the tools were published after 2010. Few authors described how their tool was developed, or why a new tool was needed. After coding all criteria, we developed a framework that included 22 themes. None of the tools included all 22 themes. Some themes were included in up to 95 of the tools. CONCLUSION It is problematic that researchers continue to develop new tools without adequately examining the many tools that already exist. Furthermore, the plethora of tools, old and new, indicates a lack of consensus regarding the best tool to use, and an absence of empirical evidence about the most important criteria for assessing the methodological limitations of qualitative research, including in the context of use with GRADE-CERQual.
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Affiliation(s)
| | | | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Jane Noyes
- School of Social Sciences, Bangor University, Bangor, UK
| | - Simon Lewin
- Norwegian Institute of Public Health, Oslo, Norway
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
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Fritzen-Pedicini C, Bleasdale SC, Brosseau LM, Moritz D, Sikka M, Stiehl E, Jones RM. Utilizing the focused conversation method in qualitative public health research: a team-based approach. BMC Health Serv Res 2019; 19:306. [PMID: 31088551 PMCID: PMC6518626 DOI: 10.1186/s12913-019-4107-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 04/17/2019] [Indexed: 11/19/2022] Open
Abstract
Background Qualitative research studies are becoming increasingly necessary to understand the complex challenges in the healthcare setting. Successfully integrating interdisciplinary teams of investigators can be challenging, as investigators inherently view data through their disciplinary lens. Thus, new methods, such as focused conservation, are needed to facilitate qualitative data analysis by interdisciplinary teams. The purpose of this manuscript is to provide a clear description of how we implemented the focused conversation method to facilitate an organized data-driven discussion that responded to our study objectives and ensured participation of our interdisciplinary team. The focused conversation method has not, to our knowledge, been utilized for this purpose to date. Methods To better understand the experience of healthcare personnel (HCP) during preparations for the 2014–2015 Ebola Virus Disease (EVD) outbreak, we interviewed HCP who participated in decision making about EVD preparations and training of workers in the use of enhanced personal protective equipment ensembles in the metropolitan Chicagoland area of Illinois to attain a priori research objectives. We identified a systematic method – the focused conversation method – that enabled our interdisciplinary team to interactively contribute to the framing, analysis and interpretation of the data that would enable us to focus on our research objectives. Results The focused conversation developed to support our a priori research objective about the training of HCP in preparations included objective, reflective, interpretive and decisional questions. These questions grounded the conversation in the data, while leveraging discipline-specific lenses and professional experience in the analysis and interpretation. Insights from the conversation were reviewed later against interview transcripts to ensure validity. The conversation identified areas for future research directions and deficiencies in the interview instrument. Conclusions The focused conversation is an efficient, organized method for analysis of qualitative data by an interdisciplinary team.
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Affiliation(s)
- Charissa Fritzen-Pedicini
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago, 1603 W Taylor Street (M/C 923), Chicago, IL, 60612, USA
| | - Susan C Bleasdale
- Division of Infectious Diseases, College of Medicine, University of Illinois at Chicago, Chicago, USA
| | - Lisa M Brosseau
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago, 1603 W Taylor Street (M/C 923), Chicago, IL, 60612, USA
| | - Donna Moritz
- Division of Infectious Diseases, College of Medicine, University of Illinois at Chicago, Chicago, USA
| | - Monica Sikka
- Division of Infectious Diseases, College of Medicine, University of Illinois at Chicago, Chicago, USA
| | - Emily Stiehl
- Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, USA
| | - Rachael M Jones
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago, 1603 W Taylor Street (M/C 923), Chicago, IL, 60612, USA.
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Wilmont S, Hessels AJ, Kelly AM, Larson EL. Family Experiences and Perspectives on Infection Prevention in Pediatric Long-Term Care. Rehabil Nurs 2019; 43:307-314. [PMID: 30395556 PMCID: PMC6221461 DOI: 10.1097/rnj.0000000000000013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Residents of pediatric long-term care facilities (pLTCF) are particularly vulnerable to healthcare-associated infections. The aims of this qualitative study were to (a) explore perspectives on infection prevention among families visiting children in pLTCF and (b) identify facilitators of and barriers to optimal hand hygiene. DESIGN AND METHODS Semistructured, in-depth interviews with 10 family members visiting two New York City metropolitan area facilities were analyzed to identify themes. FINDINGS "Everyone follows the rules" and "infections are inevitable" were primary themes. Participants reported "common sense" as a facilitator and "distraction" as a major barrier to prevention practices. CONCLUSION Current education for visitors may be inadequate to improve infection prevention behaviors. CLINICAL RELEVANCE Nurse-led education strategies for infection prevention should be tested and modified for families visiting pLTCF.
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Affiliation(s)
- Sibyl Wilmont
- The Center for Interdisciplinary Research to Prevent Infections, Columbia University School of Nursing, New York
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Narat V, Kampo M, Heyer T, Rupp S, Ambata P, Njouom R, Giles-Vernick T. Using physical contact heterogeneity and frequency to characterize dynamics of human exposure to nonhuman primate bodily fluids in central Africa. PLoS Negl Trop Dis 2018; 12:e0006976. [PMID: 30589843 PMCID: PMC6307716 DOI: 10.1371/journal.pntd.0006976] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 11/05/2018] [Indexed: 12/18/2022] Open
Abstract
Emerging infectious diseases of zoonotic origin constitute a recurrent threat to global health. Nonhuman primates (NHPs) occupy an important place in zoonotic spillovers (pathogenic transmissions from animals to humans), serving as reservoirs or amplifiers of multiple neglected tropical diseases, including viral hemorrhagic fevers and arboviruses, parasites and bacteria, as well as retroviruses (simian foamy virus, PTLV) that are pathogenic in human beings. Hunting and butchering studies in Africa characterize at-risk human social groups, but overlook critical factors of contact heterogeneity and frequency, NHP species differences, and meat processing practices. In southeastern Cameroon, a region with a history of zoonotic emergence and high risk of future spillovers, we conducted a novel mixed-method field study of human physical exposure to multiple NHP species, incorporating participant-based and ecological methodologies, and qualitative interviews (n = 25). We find frequent physical contact across adult human populations, greater physical contact with monkeys than apes, especially for meat handling practices, and positive correlation of human exposure with NHP species abundance and proximity to human settlement. These fine-grained results encourage reconsideration of the likely dynamics of human-NHP contact in past and future NTD emergence events. Multidisciplinary social science and ecological approaches should be mobilized to generate more effective human and animal surveillance and risk communications around neglected tropical diseases. At a moment when the WHO has included "Disease X", a presumably zoonotic pathogen with pandemic potential, on its list of blueprint priority diseases as, new field-based tools for investigating zoonotic disease emergence, both known and unknown, are of critical importance.
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Affiliation(s)
- Victor Narat
- Institut Pasteur, Emerging Diseases Epidemiology Unit, Paris, France
- Eco-anthropologie et Ethnobiologie, CNRS/MNHN/Paris Diderot, France
| | - Mamadou Kampo
- Institut Pasteur, Emerging Diseases Epidemiology Unit, Paris, France
| | - Thibaut Heyer
- Institut Pasteur, Emerging Diseases Epidemiology Unit, Paris, France
| | - Stephanie Rupp
- City University of New York, Lehman College, Department of Anthropology, New York, New York, United States of America
| | - Philippe Ambata
- Ministry of Agriculture and Rural Development, Yaoundé, Cameroon
| | | | - Tamara Giles-Vernick
- Institut Pasteur, Emerging Diseases Epidemiology Unit, Paris, France
- Humans and the Microbiome Program, Canadian Institute for Advanced Studies, Toronto, Canada
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Thymi M, Rollman A, Visscher CM, Wismeijer D, Lobbezoo F. Experience with bruxism in the everyday oral implantology practice in the Netherlands: a qualitative study. BDJ Open 2018; 4:17040. [PMID: 30425840 PMCID: PMC6226535 DOI: 10.1038/s41405-018-0006-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 07/18/2018] [Accepted: 08/07/2018] [Indexed: 12/29/2022] Open
Abstract
Objective To explore how bruxism is dealt with by accredited oral implantologists within daily clinical practice. Materials and methods Nine semi-structured interviews of oral implantologists practicing in non-academic clinical practices in the Netherlands were performed, and thematic analysis was conducted using a framework-based approach. Results Oral implant treatments in bruxing patients were a generally well-accepted practice. Complications were often expected, with most being of minor impact. Contradictive attitudes emerged on the topic of bruxism being an etiologic factor for peri-implant bone loss and loss of osseointegration. Views on the ideal treatment plan varied, though the importance of the superstructure’s occlusion and articulation features was repeatedly pointed at. Similarly, views on protective splints varied, regarding their necessity and material choice. Bruxism was diagnosed mainly by clinical examination, alongside with patient anamnesis and clinician’s intuition. There was little attention for awake bruxism. Discussion Bruxism was generally not considered a contraindication for implantological treatments by accredited oral implantologists. Views on the interaction between bruxism and bone loss/loss of osseointegration varied, as did views on the ideal treatment plan. Conclusions There is a need for better understanding of the extent to which, and under which circumstances, sleep and/or awake bruxism can be seen as causal factors for the occurrence of oral implant complications.
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Affiliation(s)
- Magdalini Thymi
- 1Section of Oral Kinesiology, Department of Oral Health Sciences, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Annemiek Rollman
- 1Section of Oral Kinesiology, Department of Oral Health Sciences, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Corine M Visscher
- 1Section of Oral Kinesiology, Department of Oral Health Sciences, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Daniel Wismeijer
- 2Section of Oral Implantology and Prosthetic Dentistry, Department of Oral Health Sciences, Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Frank Lobbezoo
- 1Section of Oral Kinesiology, Department of Oral Health Sciences, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
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Georgiadis A, Duschinsky R, Perez J, Jones PB, Russo D, Knight C, Soneson E, Dixon-Woods M. Coproducing healthcare service improvement for people with common mental health disorders including psychotic experiences: a study protocol of a multiperspective qualitative study. BMJ Open 2018; 8:e026064. [PMID: 30413522 PMCID: PMC6231599 DOI: 10.1136/bmjopen-2018-026064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Some people, who have common mental health disorders such as depression and anxiety, also have some psychotic experiences. These individuals may experience a treatment gap: their symptoms neither reach the increasingly high threshold for secondary care, nor do they receive full benefit from current interventions offered by the Improving Access to Psychological Therapies (IAPT) programme. The result may be poorer clinical and functional outcomes. A new talking therapy could potentially benefit this group. Informed by principles of coproduction, this study will seek the views of service users and staff to inform the design and development of such a therapy. METHODS AND ANALYSIS Semistructured interviews will be conducted with IAPT service users, therapists and managers based in three different geographical areas in England. Our sample will include (1) approximately 15 service users who will be receiving therapy or will have completed therapy at the time of recruitment, (2) approximately 15 service users who initiated treatment but withdrew, (3) approximately 15 therapists each with at least 4-month experience in a step-3 IAPT setting and (4) three IAPT managers. Data analysis will be based on the constant comparative method. ETHICS AND DISSEMINATION The study has been approved by the London Harrow Research Ethics Committee (reference: 18/LO/0642), and all National Health Service Trusts have granted permissions to conduct the study. Findings will be published in peer-reviewed academic journals, and presented at academic conferences. We will also produce a 'digest' summary of the findings, which will be accessible, visual and freely available.
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Affiliation(s)
- Alexandros Georgiadis
- THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
| | - Robbie Duschinsky
- Applied Social Science Group, University of Cambridge, Cambridge, UK
| | - Jesus Perez
- CAMEO Early Intervention Services, Cambridgeshire andPeterborough NHS FoundationTrust, Cambridge, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Debra Russo
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Clare Knight
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Emma Soneson
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Mary Dixon-Woods
- THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
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Joshi SC, Diwan V, Joshi R, Sharma M, Pathak A, Shah H, Tamhankar AJ, Stålsby Lundborg C. "How Can the Patients Remain Safe, If We Are Not Safe and Protected from the Infections"? A Qualitative Exploration among Health-Care Workers about Challenges of Maintaining Hospital Cleanliness in a Resource Limited Tertiary Setting in Rural India. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15091942. [PMID: 30200603 PMCID: PMC6163563 DOI: 10.3390/ijerph15091942] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 09/01/2018] [Accepted: 09/03/2018] [Indexed: 02/06/2023]
Abstract
Background: Health care-associated infections (HAIs) result in treatment delays as well as failures and financial losses not only to patients but also to the treating hospital and overall health-care delivery system. Due to hospital-acquired infections, there are problems of increase in morbidity and mortality, additional diagnostic and therapeutic interventions and ultimately antimicrobial resistance. Proper understanding among health-care workers about the ill effects of HAIs is very important to address this issue. The present study is a qualitative exploration aimed at understanding various aspects of hospital environmental hygiene and Infection prevention control program, by exploring the staff perception regarding the challenges, facilitators and barriers as well as feasible measures towards improvement in a rural tertiary teaching hospital in central India. Method: A qualitative study was conducted using 10 focus group discussions (FGDs) among five different professional groups, which included hospital administrators, doctors, nurses, environmental cleaning staff, and undergraduate medical students. The FGD guide included the following topics: (1) opinion about the status of cleanliness, (2) concepts and actual practices prevailing of hospital environmental hygiene, (3) Barriers, constraints, and problems in maintaining hospital environmental hygiene, (4) Suggestions for improvements. The data were analyzed manually using the content (thematic) analysis method. Results: Two themes were identified: Theme 1: “Prevailing practices and problems related to hospital surface/object contamination and hospital infection control”. Theme 2: “Measures suggested for improving hospital cleanliness within the existing constraints”. The participants emphasized the influence of resource constraints and needed inputs. They brought up the consequent prevailing practices and problems related, on one hand, to various stakeholders (service consumers, hospital personnel including the management), on the other, to specific infection prevention and control processes. They also suggested various measures for improvement. Conclusions: The study has revealed prevailing practices, problems, and suggested measures related to hospital environmental hygiene, particularly hospital cleanliness and HAI prevention and control processes. These insights and assertions are important for developing future behavioral and structural interventions in resource-limited settings. This study recommends a nationwide reliable HAI surveillance system and a robust infection prevention and control program in each health-care institution.
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Affiliation(s)
- Sudhir Chandra Joshi
- Department of Community Medicine, R.D. Gardi Medical College, Ujjain 456006, India.
| | - Vishal Diwan
- Department of Public Health and Environment, R.D. Gardi Medical College, Ujjain 456006, India.
- International Centre for Health Research, Ujjain Charitable Trust Hospital and Research Centre, Ujjain 456001, India.
- Department of Public Health Sciences, Global Health, Health Systems and Policy (HSP): Medicines Focusing Antibiotics, Karolinska Institutet, 17177 Stockholm, Sweden.
| | - Rita Joshi
- Department of Microbiology, R.D. Gardi Medical College, Ujjain 456006, India.
| | - Megha Sharma
- Department of Public Health Sciences, Global Health, Health Systems and Policy (HSP): Medicines Focusing Antibiotics, Karolinska Institutet, 17177 Stockholm, Sweden.
- Department of Pharmacology, R.D. Gardi Medical College, Ujjain 456006, India.
| | - Ashish Pathak
- Department of Public Health Sciences, Global Health, Health Systems and Policy (HSP): Medicines Focusing Antibiotics, Karolinska Institutet, 17177 Stockholm, Sweden.
- Department of Pediatrics, R.D. Gardi Medical College, Ujjain 456006, India.
- Department of Women and Children's Health, International Maternal and Child Health Unit, Uppsala University, 75185 Uppsala, Sweden.
| | - Harshada Shah
- Department of Microbiology, R.D. Gardi Medical College, Ujjain 456006, India.
| | - Ashok J Tamhankar
- Department of Public Health Sciences, Global Health, Health Systems and Policy (HSP): Medicines Focusing Antibiotics, Karolinska Institutet, 17177 Stockholm, Sweden.
- Indian Initiative for Management of Antibiotic Resistance, Department of Environmental Medicine, R.D. Gardi Medical College, Ujjain 456006, India.
| | - Cecilia Stålsby Lundborg
- Department of Public Health Sciences, Global Health, Health Systems and Policy (HSP): Medicines Focusing Antibiotics, Karolinska Institutet, 17177 Stockholm, Sweden.
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Mather M, Hamilton D, Robalino S, Rousseau N. Going where other methods cannot: A systematic mapping review of 25 years of qualitative research in Otolaryngology. Clin Otolaryngol 2018; 43:1443-1453. [DOI: 10.1111/coa.13200] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 05/18/2018] [Accepted: 06/18/2018] [Indexed: 11/27/2022]
Affiliation(s)
- M.W. Mather
- Institute of Cellular Medicine; Newcastle University; Newcastle-upon-Tyne UK
- Freeman Hospital; Newcastle-upon-Tyne UK
| | - D. Hamilton
- Freeman Hospital; Newcastle-upon-Tyne UK
- Institute of Health & Society; Newcastle University; Newcastle-upon-Tyne UK
| | - S. Robalino
- Institute of Health & Society; Newcastle University; Newcastle-upon-Tyne UK
- Kaiser Permanente Research Affiliates Evidence-based Practice Center; Center for Health Research; Portland Oregon
| | - N. Rousseau
- Institute of Health & Society; Newcastle University; Newcastle-upon-Tyne UK
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Vaughn VM, Saint S, Krein SL, Forman JH, Meddings J, Ameling J, Winter S, Townsend W, Chopra V. Characteristics of healthcare organisations struggling to improve quality: results from a systematic review of qualitative studies. BMJ Qual Saf 2018; 28:74-84. [PMID: 30045864 PMCID: PMC6373545 DOI: 10.1136/bmjqs-2017-007573] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 06/11/2018] [Accepted: 06/24/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Identifying characteristics associated with struggling healthcare organisations may help inform improvement. Thus, we systematically reviewed the literature to: (1) Identify organisational factors associated with struggling healthcare organisations and (2) Summarise these factors into actionable domains. METHODS Systematic review of qualitative studies that evaluated organisational characteristics of healthcare organisations that were struggling as defined by below-average patient outcomes (eg, mortality) or quality of care metrics (eg, Patient Safety Indicators). Searches were conducted in MEDLINE (via Ovid), EMBASE, Cochrane Library, CINAHL, and Web of Science from database inception through February 8 2018. Qualitative data were analysed using framework-based synthesis and summarised into key domains. Study quality was evaluated using the Critical Appraisal Skills Program tool. RESULTS Thirty studies (33 articles) from multiple countries and settings (eg, acute care, outpatient) with a diverse range of interviewees (eg, nurses, leadership, staff) were included in the final analysis. Five domains characterised struggling healthcare organisations: poor organisational culture (limited ownership, not collaborative, hierarchical, with disconnected leadership), inadequate infrastructure (limited quality improvement, staffing, information technology or resources), lack of a cohesive mission (mission conflicts with other missions, is externally motivated, poorly defined or promotes mediocrity), system shocks (ie, events such as leadership turnover, new electronic health record system or organisational scandals that detract from daily operations), and dysfunctional external relations with other hospitals, stakeholders, or governing bodies. CONCLUSIONS Struggling healthcare organisations share characteristics that may affect their ability to provide optimal care. Understanding and identifying these characteristics may provide a first step to helping low performers address organisational challenges to improvement. SYSTEMATIC REVIEW REGISTRATION PROSPERO: CRD42017067367.
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Affiliation(s)
- Valerie M Vaughn
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Patient Safety Enhancement Program, Ann Arbor Veterans Affairs Medical Center/University of Michigan, Ann Arbor, Michigan, USA
| | - Sanjay Saint
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Patient Safety Enhancement Program, Ann Arbor Veterans Affairs Medical Center/University of Michigan, Ann Arbor, Michigan, USA
| | - Sarah L Krein
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Patient Safety Enhancement Program, Ann Arbor Veterans Affairs Medical Center/University of Michigan, Ann Arbor, Michigan, USA
| | - Jane H Forman
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Patient Safety Enhancement Program, Ann Arbor Veterans Affairs Medical Center/University of Michigan, Ann Arbor, Michigan, USA
| | - Jennifer Meddings
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Patient Safety Enhancement Program, Ann Arbor Veterans Affairs Medical Center/University of Michigan, Ann Arbor, Michigan, USA.,Departmentof Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jessica Ameling
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Patient Safety Enhancement Program, Ann Arbor Veterans Affairs Medical Center/University of Michigan, Ann Arbor, Michigan, USA
| | - Suzanne Winter
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Patient Safety Enhancement Program, Ann Arbor Veterans Affairs Medical Center/University of Michigan, Ann Arbor, Michigan, USA
| | - Whitney Townsend
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan, USA
| | - Vineet Chopra
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Patient Safety Enhancement Program, Ann Arbor Veterans Affairs Medical Center/University of Michigan, Ann Arbor, Michigan, USA
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Harris CA, Muller JM, Shauver MJ, Chung KC. Checkpoints to Progression: Qualitative Analysis of the Personal and Contextual Factors That Influence Selection of Upper Extremity Reconstruction Among Patients With Tetraplegia. J Hand Surg Am 2017; 42:495-505.e11. [PMID: 28669418 PMCID: PMC5753404 DOI: 10.1016/j.jhsa.2017.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 04/07/2017] [Accepted: 04/10/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Patients with tetraplegia consistently rank better use of the upper extremity as their top functional priority. Multiple case series have demonstrated that upper extremity reconstruction (UER) is well-tolerated and can produce substantial functional improvements for appropriate candidates; however, UER remains critically underutilized. The mechanisms that drive differences in provider practice and referral patterns have been studied, but comprehensive examination of the patient factors that influence UER decisions has not been performed for American patients. METHODS Nineteen patients with C4-8 cervical spinal injuries were selected using purposive sampling: 9 patients had undergone UER, 10 had not undergone UER. Semistructured interviews were conducted and transcripts evaluated using grounded theory methodology. RESULTS Our study yielded a conceptual model that describes the characteristics common to all patients who undergo UER. Patients who selected reconstruction proceeded stepwise through a shared sequence of steps: (1) functional dissatisfaction, (2) awareness of UER, and (3) acceptance of surgery. Patients' ability to meet these criteria was determined by 3 checkpoints: how well they coped, their access to information, and the acceptability of surgery. Extremely positive or negative coping prevented patients from moving from the Coping to the Information Checkpoint; thus, they remained unaware of UER and did not undergo surgery. A lack of knowledge regarding reconstruction was the strongest barrier to surgery among our participants. CONCLUSIONS We built a conceptual model that outlines how patients' personal and contextual factors drive their progression to UER. Moving from functional dissatisfaction to understanding that they were candidates for UER was a substantial barrier for participants, particularly those with very high and very low coping skills. CLINICAL RELEVANCE To improve utilization for all patients, interventions are needed to increase UER awareness. Standardizing introduction to UER during the rehabilitation process or improving e-content may represent key awareness access points.
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Affiliation(s)
- Chelsea A Harris
- Section of Plastic Surgery, The University of Michigan Health System, Ann Arbor, MI
| | - John-Michael Muller
- Section of Plastic Surgery, The University of Michigan Health System, Ann Arbor, MI
| | - Melissa J Shauver
- Section of Plastic Surgery, The University of Michigan Health System, Ann Arbor, MI
| | - Kevin C Chung
- Section of Plastic Surgery, The University of Michigan Health System, Ann Arbor, MI.
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Wrammert J, Sapkota S, Baral K, KC A, Målqvist M, Larsson M. Teamwork among midwives during neonatal resuscitation at a maternity hospital in Nepal. Women Birth 2017; 30:262-269. [DOI: 10.1016/j.wombi.2017.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 12/07/2016] [Accepted: 02/01/2017] [Indexed: 10/20/2022]
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Skelton F, Campbell B, Horwitz D, Krein S, Sales A, Gundlapalli A, Trautner BW. Developing a user-friendly report for electronically assisted surveillance of catheter-associated urinary tract infection. Am J Infect Control 2017; 45:572-574. [PMID: 28456323 PMCID: PMC7499359 DOI: 10.1016/j.ajic.2016.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 09/13/2016] [Accepted: 09/13/2016] [Indexed: 11/22/2022]
Abstract
Catheter-associated urinary tract infection (CAUTI) surveillance is labor intensive, generally involving manual medical record review. We developed a prototype automated report through iterative design. Surveys and qualitative interviews were administered to key stakeholders to assess the report design. We found that different provider types expressed different needs regarding report content and format. Therefore, determining the primary audience for reporting data on CAUTI a priori is critical to developing useful reports, particularly as this process becomes standardized and automated.
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Affiliation(s)
- Felicia Skelton
- Centers for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veteran Affairs Medical Center, Houston, TX; Baylor College of Medicine, Houston, TX
| | - Bryan Campbell
- Centers for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veteran Affairs Medical Center, Houston, TX
| | - Deborah Horwitz
- Centers for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veteran Affairs Medical Center, Houston, TX; Baylor College of Medicine, Houston, TX
| | - Sarah Krein
- Veteran Affairs Ann Arbor Healthcare System, Ann Arbor, MI; University of Michigan, Ann Arbor, MI
| | - Anne Sales
- Veteran Affairs Ann Arbor Healthcare System, Ann Arbor, MI; University of Michigan, Ann Arbor, MI
| | - Adi Gundlapalli
- University of Utah, Salt Lake City, UT; Veteran Affairs Salt Lake City Health Care System, Salt Lake City, UT
| | - Barbara W Trautner
- Centers for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veteran Affairs Medical Center, Houston, TX; Baylor College of Medicine, Houston, TX.
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Prävention von Infektionen, die von Gefäßkathetern ausgehen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 60:231-244. [DOI: 10.1007/s00103-016-2486-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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41
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Shachaf O, Aharony N, Baruchson S. The effects of information overload on reference librarians. LIBRARY & INFORMATION SCIENCE RESEARCH 2016. [DOI: 10.1016/j.lisr.2016.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ali S, Cushey K, Siddiqui A. Diversity and Dance: Exploring the Therapeutic Implications of World Dance. JOURNAL OF CREATIVITY IN MENTAL HEALTH 2016. [DOI: 10.1080/15401383.2016.1203855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Shainna Ali
- University of Central Florida, Orlando, Florida, USA
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Szymczak JE, Feemster KA, Zaoutis TE, Gerber JS. Pediatrician perceptions of an outpatient antimicrobial stewardship intervention. Infect Control Hosp Epidemiol 2016; 35 Suppl 3:S69-78. [PMID: 25222901 DOI: 10.1086/677826] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Inappropriate antibiotic prescribing commonly occurs in pediatric outpatients with acute respiratory tract infections. Antimicrobial stewardship programs are recommended for use in the hospital, but less is known about whether and how they will work in the ambulatory setting. Following a successful cluster-randomized trial to improve prescribing for common acute respiratory tract infections using education plus audit and feedback in a large, pediatric primary care network, we sought to explore the perceptions of the intervention and antibiotic overuse among participating clinicians. METHODS We conducted a qualitative study using semistructured interviews with 24 pediatricians from 6 primary care practices who participated in an outpatient antimicrobial stewardship intervention. All interviews were transcribed and analyzed using a modified grounded theory approach. RESULTS Deep skepticism of the audit and feedback reports emerged. Respondents ignored reports or expressed distrust about them. One respondent admitted to gaming behavior. When asked about antibiotic overuse, respondents recognized it as a problem, but they believed it was driven by the behaviors of nonpediatric physicians. Parent pressure for antibiotics was identified by all respondents as a major barrier to the more judicious use of antibiotics. Respondents reported that they sometimes "caved" to parent pressure for social reasons. CONCLUSIONS To improve the effectiveness and sustainability of outpatient antimicrobial stewardship, it is critical to boost the credibility of audit data, engage primary care pediatricians in recognizing that their behavior contributes to antibiotic overuse, and address parent pressure to prescribe antibiotics.
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Affiliation(s)
- Julia E Szymczak
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Hasahya OT, Berggren V, Sematimba D, Nabirye RC, Kumakech E. Beliefs, perceptions and health-seeking behaviours in relation to cervical cancer: a qualitative study among women in Uganda following completion of an HPV vaccination campaign. Glob Health Action 2016; 9:29336. [PMID: 26895145 PMCID: PMC4759844 DOI: 10.3402/gha.v9.29336] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 12/08/2015] [Accepted: 12/21/2015] [Indexed: 01/12/2023] Open
Abstract
Background Cervical cancer remains a leading cause of morbidity and mortality in Uganda. Despite earlier information campaigns to introduce human papilloma virus (HPV) vaccination, which also targeted cervical cancer, misinterpretation and misunderstanding of the subject remain high. Women in Uganda present with cervical cancer at an advanced stage due to poor health-seeking behaviours, with an associated high mortality rate. This project explored beliefs, attitudes, perceptions, and health-seeking behaviours in relation to cervical cancer among women in Uganda after an HPV vaccination project had been rolled out. Design A qualitative study design was used, with six focus group discussions (FGDs) that included 36 women, aged 25–49 years, with no previous history of cervical cancer symptoms or diagnosis. The women were interviewed in February and March 2013. The transcribed data was analysed using content analysis. Results Three themes emerged: feeling unprotected and unsafe, misbelief and wondering about cervical cancer, and fear of the testing procedure. Participating women had heard of cervical cancer but preferred to wait to access cervical cancer screening until symptom debut. Conclusions There are still barriers to cervical cancer screening among women in Uganda, where there is a need for culture-specific, sensitive information and interventions to address the issues of improving the cervical cancer screening uptake among these women. Societal context needs to be taken into account when implementing community-based health education.
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Affiliation(s)
- Olivia Topister Hasahya
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.,Gynecological, Breast and Sarcoma Cancer, Department of Oncology, Karolinska University Hospital, Solna, Sweden;
| | - Vanja Berggren
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.,Faculty of Health Sciences, Lund University, Lund, Sweden
| | - Douglas Sematimba
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.,Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Edward Kumakech
- Makerere University College of Health Sciences, Kampala, Uganda
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Reilly J, Currie K, Madeo M. Are you serious? From fist bumping to hand hygiene: Considering culture, context and complexity in infection prevention intervention research. J Infect Prev 2016; 17:29-33. [PMID: 28989450 PMCID: PMC5074182 DOI: 10.1177/1757177415605659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 08/16/2015] [Indexed: 11/16/2022] Open
Abstract
Infection prevention is an under-resourced research and development topic, with limited evidence for practice in the most basic of measures. A survey of IPS R&D members indicated that what might appear to be simple interactions and interventions in healthcare, such as hand shaking and hand hygiene, should be considered complex interventions taking account of behaviour at the individual and social level as well as contextual factors. Future studies need to be designed utilising comprehensive approaches, for example, the Medical Research Council complex interventions framework, tailored to the country and more local cultural context, if we are to be serious about evidence for infection prevention and control practice.
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Affiliation(s)
- J Reilly
- Glasgow Caledonian University, UK
- Health Protection Scotland
| | - K Currie
- Glasgow Caledonian University, UK
| | - M Madeo
- Doncaster & Bassetlaw NHS Hospitals, UK
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Balbale SN, Hill JN, Guihan M, Hogan TP, Cameron KA, Goldstein B, Evans CT. Evaluating implementation of methicillin-resistant Staphylococcus aureus (MRSA) prevention guidelines in spinal cord injury centers using the PARIHS framework: a mixed methods study. Implement Sci 2015; 10:130. [PMID: 26353798 PMCID: PMC4564999 DOI: 10.1186/s13012-015-0318-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 08/21/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To prevent methicillin-resistant Staphylococcus aureus (MRSA) in Spinal Cord Injury and Disorder (SCI/D) Centers, the "Guidelines for Implementation of MRSA Prevention Initiative in the Spinal Cord Injury Centers" were released in July 2008 in the Veterans Affairs (VA) Health Care System. The purpose of this study was to use the Promoting Action on Research Implementation in Health Systems (PARiHS) framework to evaluate the experiences of implementation of SCI/D MRSA prevention guidelines in VA SCI/D Centers approximately 2-3 years after the guidelines were released. METHODS Mixed methods were used across two phases in this study. The first phase included an anonymous, web-based cross-sectional survey administered to providers at all 24 VA SCI/D Centers. The second phase included semi-structured telephone interviews with providers at 9 SCI/D Centers. The PARiHS framework was used as the foundation of both the survey questions and semi-structured interview guide. RESULTS The survey was completed by 295 SCI/D providers (43.8 % response rate) from 22 of the 24 SCI/D Centers (91.7 % participation rate). Respondents included nurses (57.3 %), therapists (24.4 %), physicians (11.1 %), physician assistants (3.4 %), and other health care professionals (3.8 %). Approximately 36 % of the SCI/D providers surveyed had not seen, did not remember seeing, or had never heard of the MRSA SCI/D guidelines, whereas 42.3 % of providers reported that the MRSA SCI/D guidelines were fully implemented in their SCI/D Center. Data revealed numerous barriers and facilitators to guideline implementation. Facilitators included enhanced leadership support and provider education, focused guideline dissemination to reach SCI/D providers, and strong perceived evidence supporting the guidelines. Barriers included lack of awareness of the guidelines among physical therapists and physician assistants and challenges in cohorting/isolating MRSA-positive patients and following contact precautions. CONCLUSIONS Successful implementation of MRSA infection prevention guidelines in SCI/D settings requires (1) guideline dissemination that reaches the full range of SCI/D providers working in inpatient, outpatient, and other care settings, (2) provider education that is frequent and systematic, (3) strong leadership support, and (4) that barriers unique to the recommendations are addressed. These findings may be used to inform selection of implementation strategies and optimize infection prevention beyond MRSA as well as in other specialty care populations.
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Affiliation(s)
- Salva N Balbale
- Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines Jr. VA Hospital, US Department of Veterans Affairs, Hines, IL, USA. .,Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, US Department of Veterans Affairs, Hines, IL, USA. .,Center for Healthcare Studies, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Jennifer N Hill
- Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines Jr. VA Hospital, US Department of Veterans Affairs, Hines, IL, USA. .,Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, US Department of Veterans Affairs, Hines, IL, USA.
| | - Marylou Guihan
- Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines Jr. VA Hospital, US Department of Veterans Affairs, Hines, IL, USA. .,Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, US Department of Veterans Affairs, Hines, IL, USA. .,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, US Department of Veterans Affairs, Bedford, MA, USA. .,eHealth Quality Enhancement Research Initiative, National eHealth QUERI Coordinating Center, Edith Nourse Rogers Memorial Veterans Hospital, US Department of Veterans Affairs, Bedford, MA, USA. .,Division of Health Informatics and Implementation Science, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.
| | - Kenzie A Cameron
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. .,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Barry Goldstein
- Patient Care Services, Spinal Cord Injury/Disorders Services, US Department of Veterans Affairs, Seattle, WA, USA. .,Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA.
| | - Charlesnika T Evans
- Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines Jr. VA Hospital, US Department of Veterans Affairs, Hines, IL, USA. .,Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, US Department of Veterans Affairs, Hines, IL, USA. .,Center for Healthcare Studies, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. .,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Broodryk M, Pretorius C. Initial experiences of family caregivers of survivors of a traumatic brain injury. Afr J Disabil 2015; 4:165. [PMID: 28730028 PMCID: PMC5433476 DOI: 10.4102/ajod.v4i1.165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 05/20/2015] [Indexed: 11/09/2022] Open
Abstract
Background There seems to be a paucity of research on the initial subjective experiences of family caregivers of survivors of a traumatic brain injury (TBI). Objective To explore the challenges that family caregivers face during the initial stages of recovery of a relative who has sustained a TBI. Methods Thematic analysis was used to explore the findings from semi-structured interviews that were conducted with 12 female family caregivers of relatives who had sustained a TBI. Results Family caregivers recalled their initial experiences of the shock at hearing the news about their relative’s TBI, negative experiences in hospital and frustrating interactions with healthcare professionals as particularly challenging. Conclusion The findings of this study emphasise caregivers’ need for support, information and psycho-education, especially from healthcare professionals, from the very beginning stages of recovery from a TBI. Practical and physical needs with regard to admission to and care in the hospital were also highlighted. This research will hopefully contribute to creating awareness amongst healthcare professionals on how they can contribute to improvement of the services provided by the healthcare system based on the experiences of the caregivers who participated in this study.
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Affiliation(s)
- Mandi Broodryk
- Department of Psychology, Stellenbosch University, South Africa
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Whay HR, Dikshit AK, Hockenhull J, Parker RMA, Banerjee A, Hughes SI, Pritchard JC, Reix CE. Evaluation of changes in equine care and limb-related abnormalities in working horses in Jaipur, India, as part of a two year participatory intervention study. PLoS One 2015; 10:e0126160. [PMID: 26000967 PMCID: PMC4441452 DOI: 10.1371/journal.pone.0126160] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 03/30/2015] [Indexed: 11/19/2022] Open
Abstract
Background Previous studies have found the prevalence of lameness in working horses to be 90–100%. Risk factors for lameness in this important equine population, together with risk-reduction strategies adopted by their owners, are poorly understood. The objective was to uncover risk factors for lameness and limb abnormalities in working horses, by associating clinical lameness examination findings on three occasions over two years with owner reported changes in equine management and work practices over this period. Methodology/Principal Findings Twenty-one communities of horse owners in Jaipur, India, took part in a participatory intervention (PI) project aiming to reduce risk factors for poor welfare, particularly lameness and limb problems. Associations between quantitative measures of equine lameness/limb abnormalities and reported changes in management and work practices were compared with 21 control (C) communities of owners where no intervention had taken place. Key findings from ‘complete cases’, where the same horse stayed with the same owner for the whole study period (PI group = 73 owners of 83 horses, C group = 58 owners of 66 horses), were that more positive statements of change in equine management and work practices were made by PI group owners than C group owners. A mixed picture of potential risk factors emerged: some reported management improvements, for example reducing the weight of the load for cart animals, were associated with improved limbs and lameness, and others, such as making improvements in shoeing and increasing the age at which their animals started work, with negative outcomes. Conclusions/Significance This study illustrates the complexity and interacting nature of risk factors for lameness in working horses, and highlights the importance of longitudinal investigations that recognise and address this. PI group owners found the project useful and requested similar inputs in future. Our findings demonstrate the value of exploratory and participatory research methodology in the field of working horse welfare.
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Affiliation(s)
- Helen R. Whay
- School of Veterinary Sciences, University of Bristol, Langford House, North Somerset, United Kingdom
- * E-mail:
| | | | - Jo Hockenhull
- School of Veterinary Sciences, University of Bristol, Langford House, North Somerset, United Kingdom
| | - Richard M. A. Parker
- School of Veterinary Sciences, University of Bristol, Langford House, North Somerset, United Kingdom
| | - Anindo Banerjee
- Praxis Institute for Participatory Practices, C-75, South Extension, Part II, New Delhi, India
| | - Sue I. Hughes
- School of Veterinary Sciences, University of Bristol, Langford House, North Somerset, United Kingdom
| | - Joy C. Pritchard
- Animals in International Development, Banwell, North Somerset, United Kingdom
- The Brooke, Friars Bridge Court, London, United Kingdom
| | - Christine E. Reix
- School of Veterinary Sciences, University of Bristol, Langford House, North Somerset, United Kingdom
- The Brooke, Friars Bridge Court, London, United Kingdom
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Locatelli SM, LaVela SL, Gosch M. Health care workers' reported discomfort while wearing filtering face-piece respirators. Workplace Health Saf 2015; 62:362-8. [PMID: 25102476 DOI: 10.3928/21650799-20140804-03] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 06/25/2014] [Indexed: 11/20/2022]
Abstract
Filtering face-piece respirators (FFRs) are one method of protecting health care workers from airborne particles; however,research suggests adherence is poor, perhaps due to worker discomfort. Three separate focus groups were conducted at two Veterans Affairs health care facilities. Seventeen health care workers who reported using FFRs as part of their job duties were in the focus groups. Focus group transcripts were coded using qualitative descriptive coding techniques. Participants described experiences of discomfort and physical mask features they believed ,contributed to discomfort. Participants believed FFRs influenced patient care because some patients felt uneasy and changed healthcare workers' behaviors (e.g., doffing procedures, loss of concentration, rushed patient care, and avoidance of patients in isolation resulting from FFR discomfort). Assessment of comfort and tolerability should occur during fit-testing. These factors should also be taken into account by management when training employees on the proper use of FFRs, as well as in future research to improve comfort and tolerability.
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