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Brown C, MacLeod A, Hawick L, Cleland J. Disembodied, dehumanised but safe and feasible: The social-spatial flow of a pandemic OSCE. MEDICAL EDUCATION 2024; 58:235-246. [PMID: 37517448 DOI: 10.1111/medu.15173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/19/2023] [Accepted: 07/05/2023] [Indexed: 08/01/2023]
Abstract
INTRODUCTION The Objective Structured Clinical Examination (OSCE) is a key feature of healthcare education assessment. Many aspects of the OSCE are well-investigated, but not so its sociomaterial assemblage. The Covid-19 pandemic provided a unique opportunity to (re)consider taken-for-granted OSCE practices. Drawing on Law's modes of ordering, our aim was to demonstrate the 'mangle of practice' between space and people; the spatialised and spatialising processes of an OSCE. METHODS We used a case study approach to critically examine a redesigned final year MBChB OSCE held during the pandemic. We used multiple sources of data to attune to human and non-human actors: OSCE documentation, photographs, field notes and semi-structured interviews with OSCE staff/organisers. Law's modes of ordering was used as an analytical lens to critically consider how people and things flowed through the adapted OSCE. FINDINGS The overarching ordering was the delivery of a 'pandemic safe' OSCE. This necessitated reordering of 'usual' process to deliver a socially distanced, safe flow of human and non-human actors through the assessment space. Each change had material and social 'knock on' effects. We identified three main interrelated orderings: Substituting technologies for bodies: Disembodied and dehumanised but feasible; Flow through space: Architectural affordances and one-way traffic; Barriers to flow: Time and technology. DISCUSSION Looking at the OSCE through a sociomaterial lens allows us to critically examine the OSCE's essential and complex processes and the restrictions and affordances of the spaces and props within the OSCE. In doing so, we open the possibility of considering alternative ways of doing OSCEs in the future. Moreover, conceptualising the OSCE as a living set of socially (human) and materially (nonhuman) enacted processes changes the social perception of the OSCE and highlights that an OSCE has agency on people, places and things.
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Affiliation(s)
- Craig Brown
- Institute of Education in Healthcare and Medical Sciences, University of Aberdeen, Aberdeen, UK
| | - Anna MacLeod
- Department of Continuing Professional Development and Medical Education, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lorraine Hawick
- Institute of Education in Healthcare and Medical Sciences, University of Aberdeen, Aberdeen, UK
| | - Jennifer Cleland
- Medical Education Research and Scholarship Unit, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Zhao DF, Xue L, Zhou XS, Jin WY, Zhou YJ, Tong SM, Wang PF, Li YX, Piro R, Qiao HM, Yu GX, Su CY, Li BH. Importance of timing and training to implement awake prone positioning in patients with COVID-19: a single-center prospective observational study. J Thorac Dis 2023; 15:6858-6867. [PMID: 38249881 PMCID: PMC10797349 DOI: 10.21037/jtd-23-1441] [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: 09/13/2023] [Accepted: 11/10/2023] [Indexed: 01/23/2024]
Abstract
Background Awake prone positioning (APP) is broadly implemented in patients with severe acute respiratory syndrome coronavirus 2 related disease [coronavirus disease 2019 (COVID-19)] admitted to hospital with severe respiratory distress syndrome. This prospective observational study aimed to explore the factors influencing the implementation of APP in patients with acute respiratory failure due to COVID-19. Methods Patients with COVID-19, all hospitalized with positive X-ray findings and oxygen supplementation requirement, in the Respiratory Step-Down Unit of the Peking University Third Hospital between January 6th, 2023, and January 20th, 2023, were included in this study. Data regarding basic information, activities of daily living (ADLs) scores, oxygen therapy, vital signs, and duration of APP were collected to investigate the factors influencing prone positioning. Results Among the 134 patients included, 55.2% showed an improvement in oxygen saturation 1 hour after APP. Logistic regression revealed that the pre-APP heart rate (HR) [odds ratio (OR) =1.032; P=0.046] and peripheral oxygen saturation (SpO2) (OR =0.720; P<0.001) were the associated factors of the improvement in SpO2 after treatment. Multiple linear regression revealed that the ADL scores and pre-APP respiratory rate (RR) were the associated factors of the duration of prone positioning (P<0.01). The APP technical steering group effectively improved duration of APP. Conclusions Patients with low SpO2 and increased HR before treatment showed greater improvement in oxygen saturation. Patients with lower tolerance to ADL but lower RRs were those to demonstrate a longer duration of prone positioning. This is pointing towards establishing the most favorable time window for APP during the course of COVID-19: after the ADLs have already decreased, but before significant tachypnea has appeared.
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Affiliation(s)
- Dong-Fang Zhao
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Lei Xue
- Department of Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Xiao-Shu Zhou
- Department of Nursing, Peking University Third Hospital, Beijing, China
| | - Wei-Yi Jin
- Department of Nursing, Peking University Third Hospital, Beijing, China
| | - Yu-Jie Zhou
- Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - Su-Mei Tong
- Department of Cardiology, Peking University Third Hospital, Beijing, China
| | - Pan-Feng Wang
- Department of Tumor Radiotherapy, Peking University Third Hospital, Beijing, China
| | - Yu-Xuan Li
- Department of Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Roberto Piro
- Pulmonology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Hong-Mei Qiao
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Gui-Xiang Yu
- Department of Cardiology, Peking University Third Hospital, Beijing, China
| | - Chun-Yan Su
- Department of Nephrology, Peking University Third Hospital, Beijing, China
| | - Bao-Hua Li
- Department of Nursing, Peking University Third Hospital, Beijing, China
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Higham R, Pini S, Quyn A, Kowal M, Helliwell J, Saman R, Lewthwaite P, Young N, Rousseau N. Rapid qualitative analysis in a mixed-methods evaluation of an infection prevention intervention in a UK hospital setting during the COVID-19 pandemic: A discussion of the CLEAN study methodology. FRONTIERS IN SOCIOLOGY 2022; 7:958250. [PMID: 36386858 PMCID: PMC9640776 DOI: 10.3389/fsoc.2022.958250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/28/2022] [Indexed: 06/01/2023]
Abstract
The COVID-19 pandemic created an urgent need for high-quality rapid research. One clinical challenge was how to minimise the risk of transmission in the hospital setting. The CLEAN study conducted a rapid evaluation of the potential utility of a spray-based disinfectant in a hospital setting. The study was undertaken between December 2020 and March 2021 and involved the implementation of the spray in 10 different clinical areas in one UK teaching hospital. A mixed-methods approach was adopted (including observations, surveys, and qualitative interviews) informed by the theories for understanding the implementation of new healthcare technologies. The evaluation found that while the spray had a number of perceived benefits when added to existing disinfection processes, other factors limited its potential utility. These findings informed a number of recommendations for future adoption within hospital settings. This paper describes and reflects on the rapid methodology that allowed us to undertake the study and deliver results in a short space of time. We experienced a number of pressures during set-up and fieldwork due to the challenging conditions caused by the pandemic, and the methodological approach had to evolve throughout the study because of the changing clinical context. The involvement of clinicians from the research setting as full members of the research team was key to the rapid delivery of the research. They provided an essential link to the implementation environment, and their experiential knowledge of the setting added an important perspective to the analysis. Balancing their involvement with their clinical roles was challenging, however, as was coordinating a large and diverse team of interviewers in such a short space of time. Overall, the study highlighted the value of rapid research to inform urgent healthcare decisions in a pandemic. Although our experience suggests that conducting such research requires some practical and methodological trade-offs, we found that there were also numerous benefits of using rapid methods and identified various opportunities to ensure their robustness.
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Affiliation(s)
- Ruchi Higham
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Simon Pini
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Aaron Quyn
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
- Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - Mikolaj Kowal
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
- Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | | | - Razan Saman
- Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | | | - Nicola Young
- Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - Nikki Rousseau
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
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Ip A, Black G, Vindrola-Padros C, Taylor C, Otter S, Hewish M, Bhuiya A, Callin J, Wong A, Machesney M, Green J, Oliphant R, Fulop NJ, Taylor C, Whitaker KL. Healthcare Professional and Patient Perceptions of Changes in Colorectal Cancer Care Delivery During the COVID-19 Pandemic and Impact on Health Inequalities. Cancer Control 2022; 29:10732748221114615. [PMID: 35989597 PMCID: PMC9393398 DOI: 10.1177/10732748221114615] [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] [Indexed: 11/20/2022] Open
Abstract
Background The COVID-19 pandemic changed the way in which people were diagnosed and
treated for cancer. We explored healthcare professional and patient
perceptions of the main changes to colorectal cancer delivery during the
COVID-19 pandemic and how they impacted on socioeconomic inequalities in
care. Methods In 2020, using a qualitative approach, we interviewed patients (n = 15) who
accessed primary care with colorectal cancer symptoms and were referred for
further investigations. In 2021, we interviewed a wide range of healthcare
professionals (n = 30) across the cancer care pathway and gathered national
and local documents/guidelines regarding changes in colorectal cancer
care. Results Changes with the potential to exacerbate inequalities in care, included: the
move to remote consultations; changes in symptomatic triage, new COVID
testing procedures/ways to access healthcare, changes in visitor policies
and treatment (e.g., shorter course radiotherapy). Changes that improved
patient access/convenience or the diagnostic process have the potential to
reduce inequalities in care. Discussion Changes in healthcare delivery during the COVID-19 pandemic have the ongoing
potential to exacerbate existing health inequalities due to changes in how
patients are triaged, changes to diagnostic and disease management
processes, reduced social support available to patients and potential
over-reliance on digital first approaches. We provide several
recommendations to help mitigate these harms, whilst harnessing the
gains.
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Affiliation(s)
- Athena Ip
- School of Health Sciences, 3660University of Surrey, Guildford, UK
| | - Georgia Black
- Department of Applied Health Research, 4919University College London, London, UK
| | | | - Claire Taylor
- Healthcare National Health Service (NHS) Trust, 3749London North West University, Harrow, UK
| | - Sophie Otter
- 3661Royal Surrey NHS Foundation Trust, Guildford, UK
| | | | - Afsana Bhuiya
- Hospitals NHS Foundation Trust, 8964University College London, London, UK
| | | | | | | | | | | | - Naomi J Fulop
- Department of Applied Health Research, 4919University College London, London, UK
| | - Cath Taylor
- School of Health Sciences, 3660University of Surrey, Guildford, UK
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Singh H, Tang T, Thombs R, Armas A, Nie JX, Nelson MLA, Gray CS. Methodological Insights From a Virtual, Team-Based Rapid Qualitative Method Applied to a Study of Providers' Perspectives of the COVID-19 Pandemic Impact on Hospital-To-Home Transitions. INTERNATIONAL JOURNAL OF QUALITATIVE METHODS 2022; 21:16094069221107144. [PMID: 35721871 PMCID: PMC9189180 DOI: 10.1177/16094069221107144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, rapid virtual qualitative methods have gained attention in applied health research to produce timely, actionable results while complying with the pandemic restrictions. However, rigour and analytical depth may be two areas of concern for rapid qualitative methods. METHODS In this paper, we present an overview of a virtual team-based rapid qualitative method within a study that explored health care providers' perspectives of how the COVID-19 pandemic has impacted hospital-to-home transitions, lessons learned in applying this method, and recommendations for changes. Using this method, qualitative data were collected and analyzed using the Zoom Healthcare videoconferencing platform and telephone. Visual summary maps were iteratively created from the audio recordings of each interview through virtual analytic meetings with the team. Maps representing similar settings (e.g. hospital providers and community providers) and Sites were combined to form meta-maps representing that group's experience. The combinations of data that best fit together were used to form the final meta-map through discussion. RESULTS This case example is used to provide a description of how to apply a virtual team-based rapid qualitative method. This paper also offers a discussion of the opportunities and challenges of applying this method, in particular how the virtual team-based rapid qualitative method could be modified to produce timely results virtually while attending to rigour and depth. CONCLUSIONS We contend that the virtual team-based rapid qualitative data collection and analysis method was useful for generating timely, rigorous, and in-depth knowledge about transitional care during the COVID-19 pandemic. The recommended modifications to this method may enhance its utility for researchers to apply to their qualitative research studies.
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Affiliation(s)
- Hardeep Singh
- Department of Occupational Science
& Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute,
Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- KITE, Toronto Rehabilitation
Institute, University Health
Network, Toronto, ON, Canada
| | - Terence Tang
- Institute for Better Health, Trillium Health
Partners, Mississauga, ON, Canada
| | - Rachel Thombs
- Bridgepoint Collaboratory for
Research and Innovation, Toronto, ON, Canada
- University of Toronto Institute of
Health Policy Management and Evaluation, Toronto, ON, Canada
| | - Alana Armas
- Bridgepoint Collaboratory for
Research and Innovation, Toronto, ON, Canada
- University of Toronto Institute of
Health Policy Management and Evaluation, Toronto, ON, Canada
| | - Jason X Nie
- Institute for Better Health, Trillium Health
Partners, Mississauga, ON, Canada
| | | | - Carolyn Steele Gray
- Bridgepoint Collaboratory for
Research and Innovation, Toronto, ON, Canada
- University of Toronto Institute of
Health Policy Management and Evaluation, Toronto, ON, Canada
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