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Hazen ACM, Sloeserwij VM, de Groot E, de Gier JJ, de Wit NJ, de Bont AA, Zwart DLM. Non-dispensing pharmacists integrated into general practices as a new interprofessional model: a qualitative evaluation of general practitioners' experiences and views. BMC Health Serv Res 2024; 24:502. [PMID: 38654340 DOI: 10.1186/s12913-024-10703-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 02/09/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND A new interprofessional model incorporating non-dispensing pharmacists in general practice teams can improve the quality of pharmaceutical care. However, results of the model are dependent on the context. Understanding when, why and how the model works may increase chances of successful broader implementation in other general practices. Earlier theories suggested that the results of the model are achieved by bringing pharmacotherapeutic knowledge into general practices. This mechanism may not be enough for successful implementation of the model. We wanted to understand better how establishing new interprofessional models in existing healthcare organisations takes place. METHODS An interview study, with a realist informed evaluation was conducted. This qualitative study was part of the Pharmacotherapy Optimisation through Integration of a Non-dispensing pharmacist in primary care Teams (POINT) project. We invited the general practitioners of the 9 general practices who (had) worked closely with a non-dispensing pharmacist for an interview. Interview data were analysed through discussions about the coding with the research team where themes were developed over time. RESULTS We interviewed 2 general practitioners in each general practice (18 interviews in total). In a context where general practitioners acknowledge the need for improvement and are willing to work with a non-dispensing pharmacist as a new team member, the following mechanisms are triggered. Non-dispensing pharmacists add new knowledge to current general practice. Through everyday talk (discursive actions) both general practitioners and non-dispensing pharmacists evolve in what they consider appropriate, legitimate and imaginable in their work situations. They align their professional identities. CONCLUSIONS Not only the addition of new knowledge of non-dispensing pharmacist to the general practice team is crucial for the success of this interprofessional healthcare model, but also alignment of the general practitioners' and non-dispensing pharmacists' professional identities. This is essentially different from traditional pharmaceutical care models, in which pharmacists and GPs work in separate organisations. To induce the process of identity alignment, general practitioners need to acknowledge the need to improve the quality of pharmaceutical care interprofessionally. By acknowledging the aspect of interprofessionality, both general practitioners and non-dispensing pharmacists will explore and reflect on what they consider appropriate, legitimate and imaginable in carrying out their professional roles. TRIAL REGISTRATION The POINT project was pre-registered in The Netherlands National Trial Register, with Trial registration number NTR-4389.
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Affiliation(s)
- A C M Hazen
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMCU), Utrecht University, Universiteitsweg 100 3584 CG Utrecht. Postal address STR 6.131, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - V M Sloeserwij
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMCU), Utrecht University, Universiteitsweg 100 3584 CG Utrecht. Postal address STR 6.131, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - E de Groot
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMCU), Utrecht University, Universiteitsweg 100 3584 CG Utrecht. Postal address STR 6.131, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - J J de Gier
- Department of Pharmacotherapy, - Epidemiology and - Economics, University of Groningen, Antonius Deusinglaan 1, Building 3214, 9713 AV, Groningen, The Netherlands
| | - N J de Wit
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMCU), Utrecht University, Universiteitsweg 100 3584 CG Utrecht. Postal address STR 6.131, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - A A de Bont
- Tilburg School of Social and Behavioral Sciences, Warandelaan 2, 5037 AB, Tilburg, The Netherlands
| | - D L M Zwart
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMCU), Utrecht University, Universiteitsweg 100 3584 CG Utrecht. Postal address STR 6.131, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
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Johansen L, O'Hare F, Shepard ER, Ayton LN, Pelentsov LJ, Kearns LS, Galvin KL. Exploring the support needs of Australian parents of young children with Usher syndrome: a qualitative thematic analysis. Orphanet J Rare Dis 2024; 19:129. [PMID: 38515174 PMCID: PMC10956185 DOI: 10.1186/s13023-024-03125-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 03/03/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Advancements in genetic testing have led to Usher syndrome now being diagnosed at a much earlier age than in the past, enabling the provision of early intervention and support to children and families. Despite these developments, anecdotal reports suggest there are substantial gaps in the services and supports provided to parents of children with Usher syndrome. The current study investigated the support needs of parents of children with Usher syndrome Type 1 when their child was aged 0 to 5 years. METHOD Purposive sampling was used, and six semi-structured interviews were conducted with Australian parents of children with Usher syndrome, Type 1. Data was analysed using modified reflexive thematic analysis. RESULTS Four key themes were identified as being central to the support needs of parents of children with Usher syndrome aged 0 to 5 years. (1) Social Needs referred to parents' need for various sources of social support, (2) Informational Needs described the lack of information parents received regarding Usher syndrome from treating professionals, (3) Practical Needs included supports needed to assist parents in managing the day-to-day tasks of caring for a child with a disability, and (4) Emotional Needs represented the emotional support (both formal and informal) that parents needed to be a positive support to their child. CONCLUSIONS Findings provide rich information for relevant support groups, policy makers, individual healthcare professionals, and professional governing bodies regarding the education of stakeholders and the development and implementation of best-practice treatment guidelines.
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Affiliation(s)
- L Johansen
- UsherKids Australia, Mordialloc, VIC, Australia
| | - F O'Hare
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, VIC, Australia
- Centre for Eye Research Australia, East Melbourne, VIC, Australia
| | - E R Shepard
- UsherKids Australia, Mordialloc, VIC, Australia
| | - L N Ayton
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, VIC, Australia
- Department of Surgery (Ophthalmology), The University of Melbourne, Parkville, VIC, Australia
- Centre for Eye Research Australia, East Melbourne, VIC, Australia
| | - L J Pelentsov
- Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - L S Kearns
- Centre for Eye Research Australia, East Melbourne, VIC, Australia
- Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
| | - K L Galvin
- Department of Audiology and Speech Pathology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia.
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Gershater MA, Brenner J, Nordberg M, Hommel A. Nurse assistants' perception of caring for older persons who are dying in their own home : An interview study. BMC Palliat Care 2024; 23:70. [PMID: 38468298 DOI: 10.1186/s12904-024-01399-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 02/27/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND As the proportion of older persons in society increases, there is a growing trend towards providing end-of-life care in their homes. Palliative care is a complex and knowledge-demanding form of care, and nurse assistants are those who work closest to the older person at the end-of-life in their own homes. However, nurse assistants sometimes have low educational and insufficient levels of knowledge in palliative care, which can affect the quality of care they provide. Moreover, nurse assistants' experiences are relatively unexplored in this context. The purpose of the study was to illuminate nurse assistants' experiences in caring for dying older persons at home. METHOD An empirical, qualitative interview study was conducted with 14 nurse assistants with experience of palliative care in homecare. The material was analyzed using thematic content analysis. RESULTS From the nurse assistant's experiences, one main theme emerged: doing everything possible for the dying older person despite challenges. Moreover, three sub-themes emerged: making a difference at a crucial time, death awakens emotions, and balancing personal and professional relationships. The nurse assistants' saw their role primarily as relieving symptoms but also focusing on next of kin. The following are described as essential parts of their role: carrying out practical nursing tasks, focusing on the physical environment, working alone and seeking help from colleagues due to a physical distance to the other members of the multidisciplinary team. The nurse assistants experienced a lack of support as there was no structured guidance or debriefing available in difficult emotional situations. Furthermore, they disclosed that they were left alone to deal with their feelings. CONCLUSION This study demonstrates that nurse assistants strive to provide comprehensive care for dying older persons despite facing obstacles from their working conditions and work organization. They lack supervision and education in palliative care, but they rely on their experience-based knowledge to a large extent and provide care according to the four cornerstones of palliative care.
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Affiliation(s)
- Magdalena Annersten Gershater
- Department of Care Science, Faculty of Health and Society, Malmö University, Jan Waldenströms gata 25, Malmö, 206 05, Sweden.
| | - Josefin Brenner
- Department of Health and Social Care, Home Care Kungsparken, Malmö Municipality, Västra Kanalgatan 4, Malmö, 211 41, Sweden
| | - Malin Nordberg
- Department of Health and Social Care, Malmö Municipality, Villa Vikhem, Vikhems bygata 100, Staffanstorp, 245 46, Sweden
| | - Ami Hommel
- Department of Care Science, Faculty of Health and Society, Malmö University, Jan Waldenströms gata 25, Malmö, 206 05, Sweden
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Işık-Uslu AE, Çetin Z. Early intervention service needs of mothers with a child diagnosed with autism spectrum disorder in Turkey: A qualitative study. J Pediatr Nurs 2024; 75:e159-e168. [PMID: 38199934 DOI: 10.1016/j.pedn.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/06/2024] [Accepted: 01/06/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND Early intervention services play a crucial role in the prevention and management of Autism Spectrum Disorder (ASD). With the increasing prevalence of ASD, understanding the specific needs of mothers and their children is essential for the development of effective interventions and support systems. METHODS This interview study examines the early intervention service needs of Turkish mothers with children aged 2-6 who have been diagnosed with ASD. Semi-structured in-depth interviews were conducted with nine mothers. Thematic analysis was carried out following the guidance and six steps procedures described by Braun and Clarke. FINDINGS The study's findings reveal six distinct themes that encompass the needs expressed by the participating mothers: 1) psychological support needs, 2) social support needs, 3) financial support needs, 4) strengthening the family, 5) government-based enhancement, and 6) the need for social awareness. DISCUSSION The findings underscore the significance of comprehensive early intervention services tailored to address the needs of mothers. The stressors associated with the impact of ASD on families are highlighted, aligning with Guralnick's framework. The findings emphasize the need for holistic intervention programs and stress the importance of collaborative relationships among parents, educators, and service providers. APPLICATION TO PRACTICE The practical implications of this study benefit healthcare professionals, policymakers, educators, and stakeholders. The emphasis lies in aligning interventions with the ASD needs of both mothers and children, ultimately aiding in the development of effective policies and the enhancement of the quality of care for individuals with ASD in Turkey.
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Affiliation(s)
- A Elif Işık-Uslu
- Research assistant, Department of Child Development, Faculty of Health Sciences, Hacettepe University, Turkey.
| | - Zeynep Çetin
- Professor, Department of Child Development, Faculty of Health Sciences, Hacettepe University, Turkey
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Müller R, Klemmt M, Koch R, Ehni HJ, Henking T, Langmann E, Wiesing U, Ranisch R. "That's just Future Medicine" - a qualitative study on users' experiences of symptom checker apps. BMC Med Ethics 2024; 25:17. [PMID: 38365749 PMCID: PMC10874001 DOI: 10.1186/s12910-024-01011-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 02/06/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Symptom checker apps (SCAs) are mobile or online applications for lay people that usually have two main functions: symptom analysis and recommendations. SCAs ask users questions about their symptoms via a chatbot, give a list with possible causes, and provide a recommendation, such as seeing a physician. However, it is unclear whether the actual performance of a SCA corresponds to the users' experiences. This qualitative study investigates the subjective perspectives of SCA users to close the empirical gap identified in the literature and answers the following main research question: How do individuals (healthy users and patients) experience the usage of SCA, including their attitudes, expectations, motivations, and concerns regarding their SCA use? METHODS A qualitative interview study was chosen to clarify the relatively unknown experience of SCA use. Semi-structured qualitative interviews with SCA users were carried out by two researchers in tandem via video call. Qualitative content analysis was selected as methodology for the data analysis. RESULTS Fifteen interviews with SCA users were conducted and seven main categories identified: (1) Attitudes towards findings and recommendations, (2) Communication, (3) Contact with physicians, (4) Expectations (prior to use), (5) Motivations, (6) Risks, and (7) SCA-use for others. CONCLUSIONS The aspects identified in the analysis emphasise the specific perspective of SCA users and, at the same time, the immense scope of different experiences. Moreover, the study reveals ethical issues, such as relational aspects, that are often overlooked in debates on mHealth. Both empirical and ethical research is more needed, as the awareness of the subjective experience of those affected is an essential component in the responsible development and implementation of health apps such as SCA. TRIAL REGISTRATION German Clinical Trials Register (DRKS): DRKS00022465. 07/08/2020.
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Affiliation(s)
- Regina Müller
- Institute of Philosophy, University Bremen, Bremen, Germany.
| | - Malte Klemmt
- Institute of General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
| | - Roland Koch
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
| | - Hans-Jörg Ehni
- Institute of Ethics and History of Medicine, University Tübingen, Tübingen, Germany
| | - Tanja Henking
- Institute of Applied Social Science, University of Applied Science Würzburg- Schweinfurt, Würzburg, Germany
| | - Elisabeth Langmann
- Institute of Ethics and History of Medicine, University Tübingen, Tübingen, Germany
| | - Urban Wiesing
- Institute of Ethics and History of Medicine, University Tübingen, Tübingen, Germany
| | - Robert Ranisch
- Faculty of Health Science Brandenburg, University of Potsdam, Potsdam, Germany
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Rohwer E, Harth V, Mache S. "The magic triangle between bed, office, couch": a qualitative exploration of job demands, resources, coping, and the role of leadership in remote work during the COVID-19 pandemic. BMC Public Health 2024; 24:476. [PMID: 38360605 PMCID: PMC10868004 DOI: 10.1186/s12889-024-17995-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 02/05/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has necessitated many employees to work from home with immediate effect for several months, regardless of their workplace preference or situation at home. Against this backdrop, this study explores perceived job demands and resources as well as the role of leadership and coping strategies of employees and managers with little or no prior experience with working from home in the altered work environment. METHODS Based on the job demands-resources model, we developed an interview guide and conducted thirty-four semi-structured interviews. The interviews were transcribed and analyzed deductively-inductively using qualitative content analysis. RESULTS Experienced job demands include, e.g., challenging, insufficient digital communication, and lack of social exchange, while greater flexibility and work-life balance were identified as valuable resources. Regarding the role of leadership, signaling trust, keeping regular contact, and supporting employees are important. To cope with the unforeseen yet persistent work situation, participants applied creative strategies by setting up offices at home with what they had at disposal. Differences were observed between employee and managerial perceptions as well as over time during the pandemic. CONCLUSIONS The results expand our knowledge about healthy remote work by adding specific demands, resources, and coping strategies employees and managers experienced during the extreme situation of the COVID-19 pandemic to the picture as well as specifying the role of leadership. Moreover, our findings provide a foundation for guidelines for healthy remote work design and collaboration in times of abrupt change and crises.
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Affiliation(s)
- Elisabeth Rohwer
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Volker Harth
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Stefanie Mache
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
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Jonasson LL, Bångsbo A, Billhult A, Wolmesjö M. Older adults' experiences of participation in daily activities in Swedish assisted living. BMC Geriatr 2023; 23:762. [PMID: 37990295 PMCID: PMC10662507 DOI: 10.1186/s12877-023-04484-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 11/14/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND According to Swedish law, older adults in Sweden should be able to live a good, safe, and independent life with social and healthcare provided, based on their individual needs. In assisted living in Swedish eldercare the environment affects the older adults' ability to participate in decision-making and strengthens their ability to feel meaningfulness. The ability of staff working in social and healthcare to invite older adults to participate varies. It is important to examine how older adults perceive their situation, as caregivers in eldercare tend to focus on routine work and experience difficulties in meeting the individual needs of older adults. The aim of this study was to explore how older adults in assisted living experienced participation in daily activities. METHODS A qualitative interview study was conducted in two municipalities in the western part of Sweden. An exploratory and inductive design was used. Individual interviews were conducted with 11 older adults living in two different assisted living facilities. The data were analysed using thematic analysis. RESULTS The interviews resulted in three themes: Being involved, Sense of well-being, and Influenced by the context. The older adults' experiences of participation were interpreted as feelings of being involved in daily life activities, and how they felt involved in their own care and nursing. Participation created prerequisites for well-being. Sense of well-being could be related to feelings of security and social community. The organisation and work environment of the healthcare staff had a great impact on their ability to increase the participation of the older adults. The older adults were aware of the everyday work situation of the providers of social and healthcare and were Influenced by the context. DISCUSSION/CONCLUSION Important conditions for a good quality of life and participation for the older adults are to be treated with respect, receive information, and be able to choose. The older adults expressed several good ideas for improvements and a willingness to be involved in the development of the organisation at different levels. It is essential to invite older adults in assisted living to participate in the design of care and nursing.
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Affiliation(s)
- Lise-Lotte Jonasson
- Department of Nursing Science, School of Health and Welfare, Jönköping University, Jönköping, Sweden.
| | - Angela Bångsbo
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Annika Billhult
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Maria Wolmesjö
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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Henningsen MJ, Thorlacius-Ussing L, Jensen LG, Hansen K, Jacobsen C, Lou S, Villa C. 3D printed skulls in court - a benefit to stakeholders? Int J Legal Med 2023; 137:1865-1873. [PMID: 37391670 PMCID: PMC10567900 DOI: 10.1007/s00414-023-03054-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/20/2023] [Indexed: 07/02/2023]
Abstract
Forensic pathologists may use 3D prints as demonstrative aids when providing expert testimony in court of law, but the effects remain unclear despite many assumed benefits. In this qualitative study, the effects of using a 3D print, demonstrating a blunt force skull fracture, in court were explored by thematic analysis of interviews with judges, prosecutors, defence counsels, and forensic pathologists with the aim of improving the expert testimony. Five semi-structured focus groups and eight one-to-one interviews with a total of 29 stakeholders were transcribed ad verbatim and analysed using thematic analysis. The study found that a highly accurate 3D print of a skull demonstrated autopsy findings in detail and provided a quick overview, but sense of touch was of little benefit as the 3D print had different material characteristics than the human skull. Virtual 3D models were expected to provide all the benefits of 3D prints, be less emotionally confronting, and be logistically feasible. Both 3D prints and virtual 3D models were expected to be less emotionally confronting than autopsy photos. Regardless of fidelity, an expert witness was necessary to translate technical language and explain autopsy findings, and low-fidelity models may be equally suited as demonstrative aids. The court infrequently challenged the expert witnesses' conclusions and, therefore, rarely had a need for viewing autopsy findings in detail, therefore rarely needing a 3D print.
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Affiliation(s)
- Mikkel Jon Henningsen
- Section of Forensic Pathology, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Lykke Thorlacius-Ussing
- Section of Forensic Pathology, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lotte Groth Jensen
- DEFACTUM, Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark
| | - Kasper Hansen
- Department of Forensic Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Christina Jacobsen
- Section of Forensic Pathology, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Stina Lou
- DEFACTUM, Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark
| | - Chiara Villa
- Section of Forensic Pathology, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Turner R, Hart J, Ashiru-Oredope D, Atkins L, Eades C, Felton T, Howlett E, Rice S, Shallcross L, Lorencatto F, Byrne-Davis L. A qualitative interview study applying the COM-B model to explore how hospital-based trainers implement antimicrobial stewardship education and training in UK hospital-based care. BMC Health Serv Res 2023; 23:770. [PMID: 37468860 DOI: 10.1186/s12913-023-09559-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/16/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is a major global health threat caused by the inappropriate use of antimicrobials in healthcare and other settings. Antimicrobial stewardship (AMS) is a broad multi-component health services intervention that promotes and monitors the judicious use of antimicrobials to preserve their future effectiveness. A main component of AMS is education and training (E&T). However, there are often discrepancies in how such interventions are implemented and delivered in hospital-based care. The aim of this study was to explore the factors influencing the implementation of AMS E&T in UK hospitals. METHODS Semi-structured interviews were carried out with AMS E&T trainers in UK hospitals. The interview schedule was developed using the Capability, Opportunity, Motivation = Behaviour (COM-B) model. Participants were identified via professional networks and social media. Interviews were analysed using inductive thematic analysis, followed by deductive analysis using the COM-B model as a framework. RESULTS A total of 34 participants (26 antimicrobial pharmacists, 3 nurses, 1 advanced clinical practitioner, 2 infectious disease consultants, 1 microbiologist and 1 clinical scientist). responsible for designing, implementing and evaluating AMS E&T in UK hospitals (five from Northern Ireland, four from Wales, two from Scotland and 23 from England) took part in virtual interviews. Key themes were: (1) The organisational context, including system-level barriers to AMS included competing organisational targets (Reflective motivation and physical opportunity) and the impact of the COVID-19 pandemic on activity (Physical opportunity); (2) Healthcare professionals' roles and the wider multi-disciplinary team, such that AMS roles were defined and addressed poorly in E&T (Social opportunity); and (3) The individual perception of the need for AMS E&T in hospital-based care, manifest in a perceived lack of conviction of the wider threat of AMR and the resulting need for AMS E&T (Reflective motivation). CONCLUSION This study has identified factors influencing implementation of AMS E&T in UK hospitals and further identified where implemented, AMS E&T did not address real-world challenges. Current AMS E&T needs to be optimised to elicit practice change, with recommendations including training and engaging the wider work-force and drawing upon theoretically-informed intervention development frameworks to inform AMS E&T to better target AMS behaviour change.
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Affiliation(s)
- Rebecca Turner
- Division of Psychology and Mental Health, Faculty of Biology, Medicine & Health, the University of Manchester, Manchester, UK.
| | - Jo Hart
- Division of Medical Education, Faculty of Biology, Medicine & Health, the University of Manchester, Manchester, UK
| | | | - Lou Atkins
- Centre for Behaviour Change, University College London, London, UK
| | - Christopher Eades
- Department of Infectious Diseases, Manchester University NHS Foundation Trust, Manchester, UK
| | - Tim Felton
- Department of Critical Care Medicine, Wythenshawe Hospital, Manchester University NHS Foundation, Manchester, UK
| | - Emily Howlett
- Vocal, Manchester University NHS Foundation Trust, Manchester, UK
| | - Stephen Rice
- Population Health Sciences Institute, Faculty of Medical Sciences, the University of Newcastle Upon, Tyne, UK
| | - Laura Shallcross
- Institute of Health Informatics, University College London, London, UK
| | | | - Lucie Byrne-Davis
- Division of Medical Education, Faculty of Biology, Medicine & Health, the University of Manchester, Manchester, UK
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Ehrenzeller S, Kuehl R, Durovic A, Martinez AE, Battegay M, von Rotz M, Fringer A, Tschudin-Sutter S. A qualitative study on the perception of infection prevention and control measures among healthcare workers without patient contact during the SARS-CoV-2 pandemic. Antimicrob Resist Infect Control 2023; 12:43. [PMID: 37122021 PMCID: PMC10149153 DOI: 10.1186/s13756-023-01246-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/22/2023] [Indexed: 05/02/2023] Open
Abstract
We conducted a qualitative interview-based study to examine the perception of infection prevention and control (IPC) measures implemented during the COVID-19 pandemic among healthcare workers (HCWs) without patient contact in a tertiary academic care center. We compared these findings to those derived from interviews of HCWs with patient contact from the same institution using the same study design. The following main four themes were identified: (1) As for HCWs with patient contact, transparent communication strongly contributes to employees' sense of security. (2) Information on personal protective equipment (PPE) usage needs to be stratified according to different educational backgrounds and professions. (3) Consistency of IPC measures was positively perceived yet a desire for constant reminders to counteract the fatigue effect played a more significant role for HCWs without patient contact. (4) As compared to HCWs with patient contact, HCWs without patient contact preferred uniform digital training resources rather than more face-to-face training. This study shows that the needs of HCWs with and without patient contact differ and need to be considered in pandemic management.
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Affiliation(s)
- Selina Ehrenzeller
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Richard Kuehl
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Ana Durovic
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Aurélien Emmanuel Martinez
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Matthias von Rotz
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - André Fringer
- School of Health Professions, Institute of Nursing, Zürich University of Applied Sciences ZHAW, Winterthur, Switzerland
| | - Sarah Tschudin-Sutter
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland.
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.
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11
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Vähäkangas P, Nordquist H, Terkamo-Moisio A. Urgent hospital transfers - The experiences and required skills of paramedics. Int Emerg Nurs 2023; 67:101269. [PMID: 36812117 DOI: 10.1016/j.ienj.2023.101269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 01/03/2023] [Accepted: 01/27/2023] [Indexed: 02/19/2023]
Abstract
INTRODUCTION Global changes in the health and social care sector have centralized the treatment of emergency patients, leading to an increase of urgent hospital transfers. The aim of this study is to describe paramedics' experiences gained while working in prehospital emergency care, regarding urgent hospital transfers and the skills that performing urgent hospital transfers requires. METHODS Twenty paramedics with experience in urgent hospital transfers participated in this qualitative study. The data collected via individual interviews were analyzed using inductive content analysis. RESULTS Paramedics' experiences of urgent hospital transfers resulted in two upper categories: Factors related to paramedics, and factors related to transfer, conditions, and technology. The upper categories were grouped from six subcategories. Paramedics' experiences of skills required in urgent hospital transfers resulted in two upper categories: Professional competence, and interpersonal skills. The upper categories were grouped from six subcategories. CONCLUSIONS Organizations should support and promote training related to urgent hospital transfers to enhance the quality of care and patient safety. Paramedics play a key role in successful transfer and collaboration, and thus the required professional competences and interpersonal skills should be addressed in their education. Furthermore, developing standardized procedures is recommended to enhance patient safety.
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Affiliation(s)
- Piia Vähäkangas
- Wellbeing services county of South Karelia, Emergency medicine and services department, Valto Käkelän katu 1, 53130 Lappeenranta, Finland
| | - Hilla Nordquist
- South-Eastern Finland University of Applied Sciences, Department of Health Care and Emergency Care, Pääskysentie 1, 48220 Kotka, Finland.
| | - Anja Terkamo-Moisio
- University of Eastern Finland, Faculty of Health Sciences, Department of Nursing Science, P.O. Box 1627, 70211 Kuopio, Finland
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12
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Bijnsdorp FM, Onwuteaka-Philipsen BD, Boot CRL, van der Beek AJ, Pasman HRW. Caregiver's burden at the end of life of their loved one: insights from a longitudinal qualitative study among working family caregivers. Palliat Care 2022; 21:142. [PMID: 35945558 PMCID: PMC9364551 DOI: 10.1186/s12904-022-01031-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 07/25/2022] [Indexed: 12/03/2022] Open
Abstract
Background Growing numbers of people with advanced illnesses who wish to die at home, a concurrent decline in the accessibility of professional home care, and policies aiming at prolonging work participation are increasing the reliance on family caregivers. This study aimed to describe trajectories in burden of working family caregivers who care for patients with a life-threatening illness, and identify factors in work and care that are related to changes in burden over time. Methods Semi-structured interviews were held in one to four rounds between July 2018 and November 2020 with 17 working family caregivers of patients with a life-threatening illness living at home. Transcripts were analysed as a single unit to create timelines per participant. Next, individual burden trajectories were created and grouped based on the course of burden over time. Factors related to changes in burden were analysed, as well as similarities and differences between the groups. Results It was common for family caregivers who combine work and end-of-life care to experience a burden. Two trajectories of caregiver burden were identified; caregivers with a persistent level of burden and caregivers with an increasing burden over time. Family caregivers with a persistent level of burden seemed to be at risk for burnout throughout the illness trajectory, but were often able to cope with the situation by making arrangements in care or work. Caregivers with an increasing burden were unable to make sufficient adjustments, which often resulted in burnout symptoms and sick leave. In both groups, burden was mostly related to aspects of the care situation. The emotional burden, a decreasing burden after death and a different view on the trajectory in hindsight proved to be important overarching themes. Conclusions Providing care to a loved one nearing the end of life is often emotionally burdensome and intensive. To facilitate the combination of paid work and family care, and reduce the risk of burnout, more support is needed from employers and healthcare professionals during the illness trajectory and after death. Bereaved family caregivers also warrant more attention from their supervisors and occupational physicians in order to facilitate their return to work. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-01031-1.
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Affiliation(s)
- Femmy M Bijnsdorp
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Expertise Center for Palliative Care, Amsterdam, Netherlands.
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Expertise Center for Palliative Care, Amsterdam, Netherlands
| | - Cécile R L Boot
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Allard J van der Beek
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Expertise Center for Palliative Care, Amsterdam, Netherlands
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13
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Björkman I, Feldthusen C, Forsgren E, Jonnergård A, Lindström Kjellberg I, Wallengren Gustafsson C, Lundberg M. Person-centred care on the move - an interview study with programme directors in Swedish higher education. BMC Med Educ 2022; 22:589. [PMID: 35915496 PMCID: PMC9341055 DOI: 10.1186/s12909-022-03657-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 07/21/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND There is an increasing trend towards person-centred care (PCC) worldwide, suggesting that PCC should be mastered by future health care professionals. This study aims to explore programme directors' views on facilitators and barriers to implementing PCC in four of the largest national study programmes in Sweden training future health care professionals. METHODS A qualitative design was applied and interviews were conducted with 19 programme directors of Swedish national study programmes in medicine, nursing, occupational therapy and physiotherapy. The interviews were analysed using qualitative content analysis. Themes were sorted according to the Consolidated Framework for Implementation Research (CFIR) in an abductive approach. COREQ guidelines were applied. RESULTS The overarching theme, as interpreted from the programme directors' experiences, was 'Person-centred care is on the move at different paces.' The theme relates to the domains identified by the CFIR as outer setting, innovation, inner setting and process. PCC was understood as something familiar but yet new, and the higher education institutions were in a state of understanding and adapting PCC to their own contexts. The movement in the outer setting consists of numerous stakeholders advocating for increased patient influence, which has stirred a movement in the inner setting where the higher educational institutions are trying to accommodate these new demands. Different meanings and values are ascribed to PCC, and the concept is thus also 'on the move', being adapted to traditions at each educational setting. CONCLUSION Implementation of PCC in Swedish higher education is ongoing but fragmented and driven by individuals with a specific interest. There is uncertainty and ambiguity around the meaning and value of PCC and how to implement it. More knowledge is needed about the core of PCC as a subject for teaching and learning and also didactic strategies suitable to support students in becoming person-centred practitioners.
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Affiliation(s)
- I Björkman
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, P.O. Box 457, 40530, Gothenburg, Sweden.
| | - C Feldthusen
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - E Forsgren
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, P.O. Box 457, 40530, Gothenburg, Sweden
| | - A Jonnergård
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, P.O. Box 457, 40530, Gothenburg, Sweden
| | - I Lindström Kjellberg
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, P.O. Box 457, 40530, Gothenburg, Sweden
| | - C Wallengren Gustafsson
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, P.O. Box 457, 40530, Gothenburg, Sweden
| | - M Lundberg
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, P.O. Box 457, 40530, Gothenburg, Sweden
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
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14
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Åkesson KS, Sundén A, Hansson EE, Stigmar K. Physiotherapists' experiences of osteoarthritis guidelines in primary health care - an interview study. BMC Fam Pract 2021; 22:259. [PMID: 34969369 PMCID: PMC8717645 DOI: 10.1186/s12875-021-01611-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 12/13/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Osteoarthritis is a common joint disease, globally. Guidelines recommend information, exercise and, if needed, weight reduction as core treatment. There is a gap between evidence-based recommended care for osteoarthritis and clinical practice. To increase compliance to guidelines, implementation was conducted. The aim of the study was to explore physiotherapists' experiences of osteoarthritis guidelines and their experiences of implementation of the guidelines in primary health care in a region in southern Sweden. METHODS Eighteen individual, semi-structured interviews with physiotherapists in primary health care were analysed with inductive qualitative content analysis. RESULTS The analysis resulted in two categories and four subcategories. The physiotherapists were confident in their role as primary assessors for patients with osteoarthritis and the guidelines were aligned with their professional beliefs. The Supported Osteoarthritis Self-Management Programme, that is part of the guidelines, was found to be efficient for the patients. Even though the physiotherapists followed the guidelines they saw room for improvement since all patients with hip and/or knee osteoarthritis did not receive treatment according to the guidelines. Furthermore, the physiotherapists emphasised the need for management's support and that guidelines should be easy to follow. CONCLUSION The physiotherapists believed in the guidelines and were confident in providing first line treatment to patients with osteoarthritis. However, information about the guidelines probably needs to be repeated to all health care providers and management. Data from a national quality register on osteoarthritis could be used to a greater extent in daily clinical work in primary health care to improve quality of care for patients with osteoarthritis.
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Affiliation(s)
| | - Anne Sundén
- Department of Health Sciences, Lund University, Lund, Sweden
| | | | - Kjerstin Stigmar
- Department of Health Sciences, Lund University, Lund, Sweden.,Department of Research and Education, Skåne University Hospital, Lund, Sweden
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Briel M, Elger BS, McLennan S, Schandelmaier S, von Elm E, Satalkar P. Exploring reasons for recruitment failure in clinical trials: a qualitative study with clinical trial stakeholders in Switzerland, Germany, and Canada. Trials 2021; 22:844. [PMID: 34823582 PMCID: PMC8613940 DOI: 10.1186/s13063-021-05818-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 11/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Poor participant recruitment is the most frequent reason for premature discontinuation of randomized clinical trials (RCTs), particularly if they are investigator-initiated. The aims of this qualitative study were to investigate (1) the views of clinical trial stakeholders from three different countries regarding reasons for recruitment failure in RCTs and (2) how these compare and contrast with the causes identified in a previous systematic review of RCT publications. METHODS From August 2015 to November 2016, we conducted 49 semi-structured interviews with a purposive sample of clinical trial stakeholders. This included investigators based in Germany (n = 9), Switzerland (n = 6) and Canada (n = 1) with personal experience of a discontinued RCT and 33 other stakeholders (e.g., representatives of ethics committees, clinical trial units, pharmaceutical industry) in Switzerland. Individual semi-structured qualitative interviews were conducted and analyzed using thematic analysis. RESULTS Interviewees identified a total of 29 different reasons for recruitment failure. Overoptimistic recruitment estimates, too narrow eligibility criteria, lack of engagement of recruiters/trial team, lack of competence/training/experience of recruiters, insufficient initial funding, and high burden for trial participants were mentioned most frequently. The interview findings largely confirm the previous systematic review on published reasons for recruitment failure. However, eight new reasons for recruitment failure were identified in the interviews, which led to the checklist of reasons for recruitment failure being revised and a new category describing research environment-related factors being added. CONCLUSIONS This study highlights the diversity of often interlinked reasons for recruitment failure in RCTs. Integrating the findings of this interview study with a previous systematic review of RCT publications led to a comprehensive, structured checklist of empirically-informed reasons for recruitment failure. The checklist may be useful to guide further research on interventions to improve participant recruitment in RCTs and helpful for trial investigators, research ethics committees, and funding agencies when assessing trial feasibility with respect to recruitment.
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Affiliation(s)
- Matthias Briel
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University of Basel and University Hospital Basel, Spitalstrasse 12, 4031, Basel, Switzerland.
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
| | - Bernice S Elger
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
- Center for Legal Medicine, Unit for Health Law and Humanitarian Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Stuart McLennan
- Institute of History and Ethics in Medicine, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Stefan Schandelmaier
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University of Basel and University Hospital Basel, Spitalstrasse 12, 4031, Basel, Switzerland
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Erik von Elm
- Cochrane Switzerland, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Priya Satalkar
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University of Basel and University Hospital Basel, Spitalstrasse 12, 4031, Basel, Switzerland
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
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16
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Elton J, Stage K, Sternhagen Nielsen AB, Hjort Svendsen AL. The experience of Basic Body Awareness Therapy and its transfer to daily life amongst Danish military veterans with PTSD. J Bodyw Mov Ther 2021; 28:202-11. [PMID: 34776142 DOI: 10.1016/j.jbmt.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 06/28/2021] [Accepted: 07/12/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The prevalence of Post-Traumatic Stress Disorder (PTSD) among Danish military veterans is estimated to be around 10%, and treatment primarily consists of recommended psychological trauma-focused therapy. AIM The aim of the study was to explore veterans' experiences of their body and its potential transfer of that experience in their daily life after BBAT. METHODS A hermeneutic-phenomenological qualitative study using semi-structured individual interviews was used. A slightly modified Interpretive Phenomenological Analysis was applied in the data analysis. The participants were four Danish military veterans with PTSD who had completed 12 individual sessions of BBAT in addition to psychological trauma-focused therapy. RESULTS All participants found the BBAT treatment sessions calming and reported the overall treatment was a positive experience. Three participants experienced increased body awareness and were able to apply the exercises and principles of BBAT in their daily lives to varying degrees. All participants estimated the benefits would have been greater with more sessions. CONCLUSION BBAT showed potential for enhancing the bodily awareness of military veterans with PTSD experience and their ability to apply that awareness in their daily life. The degree of transfer of this skill to everyday life appeared to be dependent on the participants' mentalizing capacity. IMPLICATIONS OF THIS STUDY The results indicate a benefit in using body-oriented therapies such as BBAT in the treatment of military veterans with PTSD, as a supplement to trauma-focused treatment although it is hard to distinguish which treatment had which effect or if the combination of psychotherapy and BBAT had a joint effect. Future studies are needed due to the limited research in this field.
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Sudacka M, Adler M, Durning SJ, Edelbring S, Frankowska A, Hartmann D, Hege I, Huwendiek S, Sobočan M, Thiessen N, Wagner FL, Kononowicz AA. Why is it so difficult to implement a longitudinal clinical reasoning curriculum? A multicenter interview study on the barriers perceived by European health professions educators. BMC Med Educ 2021; 21:575. [PMID: 34772405 PMCID: PMC8588939 DOI: 10.1186/s12909-021-02960-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 09/27/2021] [Indexed: 05/28/2023]
Abstract
BACKGROUND Effective clinical reasoning is a core competency of health professionals that is necessary to assure patients' safety. Unfortunately, adoption of longitudinal clinical reasoning curricula is still infrequent. This study explores the barriers that hinder the explicit teaching of clinical reasoning from a new international perspective. METHODS The context of this study was a European project whose aim is to develop a longitudinal clinical reasoning curriculum. We collected data in semi-structured interviews with responders from several European countries who represent various health professions and have different backgrounds, roles and experience. We performed a qualitative content analysis of the gathered data and constructed a coding frame using a combined deductive/inductive approach. The identified themes were validated by parallel coding and in group discussions among project members. RESULTS A total of 29 respondents from five European countries participated in the interviews; the majority of them represent medicine and nursing sciences. We grouped the identified barriers into eight general themes: Time, Culture, Motivation, Clinical Reasoning as a Concept, Teaching, Assessment, Infrastructure and Others. Subthemes included issues with discussing errors and providing feedback, awareness of clinical reasoning teaching methods, and tensions between the groups of professionals involved. CONCLUSIONS This study provides an in-depth analysis of the barriers that hinder the teaching of explicit clinical reasoning. The opinions are presented from the perspective of several European higher education institutions. The identified barriers are complex and should be treated holistically due to the many interconnections between the identified barriers. Progress in implementation is hampered by the presence of reciprocal causal chains that aggravate this situation. Further research could investigate the perceptual differences between health professions regarding the barriers to clinical reasoning. The collected insights on the complexity and diversity of these barriers will help when rolling out a long-term agenda for overcoming the factors that inhibit the implementation of clinical reasoning curricula.
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Affiliation(s)
- Małgorzata Sudacka
- Department of Medical Education, Jagiellonian University Medical College, Krakow, Poland.
| | | | - Steven J Durning
- Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Samuel Edelbring
- Learning and Professional Development Group, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Ada Frankowska
- Department of Bioinformatics and Telemedicine, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Daniel Hartmann
- Medical Education Sciences, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Inga Hege
- Medical Education Sciences, Medical Faculty, University of Augsburg, Augsburg, Germany
- Institute for Medical Education, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany
| | - Sören Huwendiek
- Institute for Medical Education, University of Bern, Bern, Switzerland
| | - Monika Sobočan
- Centre for Medical Education, Faculty of Medicine, University of Maribor, Maribor, Slovenia
- Division of Gynecology and Perinatology, University Medical Centre Maribor, Maribor, Slovenia
| | - Nils Thiessen
- EDU - a degree smarter, Digital Education Holdings Ltd., Kalkara, Malta
| | | | - Andrzej A Kononowicz
- Department of Bioinformatics and Telemedicine, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
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Patel N, Lie X, Gwaltney C, Rokutanda N, Barzi A, Melisi D, Macarulla T, Ueno M, Kim ST, Meyers O, Workman C, Bachini M, Cohen G. Understanding Patient Experience in Biliary Tract Cancer: A Qualitative Patient Interview Study. Oncol Ther 2021; 9:557-573. [PMID: 34244955 PMCID: PMC8594245 DOI: 10.1007/s40487-021-00159-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/10/2021] [Indexed: 12/19/2022] Open
Abstract
Introduction Patients living with biliary tract cancer (BTC) experience a decline in health-related quality of life (HRQoL). This study aimed to obtain a comprehensive understanding of the patient experience of BTC-related signs/symptoms and the impacts of these on daily functioning and HRQoL. Methods Patients with BTC participated in qualitative semi-structured concept elicitation interviews. Signs/symptoms and impacts of BTC were initially explored by targeted literature searches and interviews with five clinicians. Patient interviews were transcribed and coded using qualitative research software. Concept saturation was assessed over five interview waves. A sign/symptom or impact was defined as “salient” if mentioned by ≥ 50% of patients, with a mean disturbance rating of ≥ 5 (0–10 scale). A conceptual model of the patient experience of BTC-related signs/symptoms and impacts was produced. Results Twenty-three patients from the USA (78% women; median age: 54 years), diagnosed as having early (n = 3), locally advanced (n = 11) or metastatic (n = 9) disease, were interviewed. Sixty-six signs/symptoms and 12 impacts were identified. Of these, 46 signs/symptoms and 8 impacts were not identified from the targeted literature or clinician interviews. Concept saturation was reached by the fourth of five interview waves. Fourteen disease-related signs/symptoms (including fatigue/lack of energy, abdominal pain, lack of appetite, insomnia and diarrhoea) and three impacts (physical, emotional and cognitive impacts) were deemed “salient”. The conceptual model included 50 signs/symptoms and 12 impacts. Conclusion Patients with BTC reported a range of signs/symptoms and impacts that negatively affect daily functioning and HRQoL. Supplementary Information The online version contains supplementary material available at 10.1007/s40487-021-00159-z.
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Affiliation(s)
- Nikunj Patel
- AstraZeneca, 1 Medimmune Way, Gaithersburg, MD, 20878, USA.
| | | | | | | | - Afsaneh Barzi
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Davide Melisi
- Digestive Molecular Clinical Oncology Unit, Università degli Studi di Verona, Verona, Italy.,Experimental Cancer Medicine Unit, Azienda Ospedaliera Integrata di Verona, Verona, Italy
| | - Teresa Macarulla
- Vall d'Hebron University Hospital, Barcelona, Spain.,Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Makoto Ueno
- Department of Gastroenterology, Kanagawa Cancer Center, Yokohama, Japan
| | - Seung Tae Kim
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Padda H, Wemette M, Safi AG, Beauvais W, Shapiro MA, Moroni P, Ivanek R. New York State dairy veterinarians' perceptions of antibiotic use and resistance: A qualitative interview study. Prev Vet Med 2021; 194:105428. [PMID: 34271474 DOI: 10.1016/j.prevetmed.2021.105428] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 06/30/2021] [Accepted: 07/07/2021] [Indexed: 11/17/2022]
Abstract
Antimicrobial resistance (AMR) limits the ability to prevent and treat infection, making AMR one of the foremost threats to human and animal health. Animal agriculture's large use of antibiotics in food animals is an important factor in AMR. As such, policies to reduce antibiotic use and combat AMR in animal agriculture in the United States (US) have been in place or are developed. One key to the success of these policies in the US is understanding how a major stakeholder - veterinarians treating dairy cattle - perceive the scale of antibiotic use, the threat of AMR and the utility of antibiotic use policies. We interviewed 9 dairy veterinarians in New York State and conducted an iterative thematic analysis of their responses, through which five themes were identified: 1. veterinarians' views of the frequency and reasons for antibiotic misuse, 2. their ideas on reducing antibiotic use, 3. perceptions of AMR within the dairy industry, 4. view of organic farming and how it relates to animal welfare, and 5. the impact of consumers' beliefs on the dairy industry. Participants viewed antibiotic overuse as largely due to farmers' concern for the welfare of their cattle and desire to treat ailments swiftly. Interviewees believed that it was possible to reduce antibiotic use through regulation, such as the Veterinary Feed Directive and improved herd management activities, such as better colostrum management, culture-based mastitis treatment, and improved housing conditions. They did not view the dairy industry as a significant contributor to AMR, particularly when compared to the human medical industry. Interviewees also offered their (unsolicited) opinion on organic dairy farming in the US and expressed frustration with the limited treatment options available in organic dairy farming and how this dynamic may potentially compromise animal welfare. Finally, they commented on the impact of consumers' beliefs on the dairy industry, expressing frustration with how misinformation about the dairy industry has led to consumer driven changes. As consumer beliefs have an impact on the dairy industry, this influence could be leveraged to further decrease antibiotic use. These findings can help guide future efforts in veterinarian-client communication and the development and implementation of effective policies in New York State. These results also highlight the need for more quantitative research on antibiotic use in the dairy industry, as without this data it will be difficult to ascertain the true impact of policy interventions.
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Affiliation(s)
- Hannah Padda
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States.
| | - Michelle Wemette
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
| | - Amelia Greiner Safi
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States; Department of Communication, College of Agriculture and Life Sciences, Cornell University, Ithaca, NY, United States
| | - Wendy Beauvais
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
| | - Michael A Shapiro
- Department of Communication, College of Agriculture and Life Sciences, Cornell University, Ithaca, NY, United States
| | - Paolo Moroni
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States; Università degli Studi di Milano, Dipartimento di Medicina Veterinaria, Via dell'Università, 6, 26900, Lodi, LO, Italy
| | - Renata Ivanek
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
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Andersen MR, Clausen A, Sternhagen Nielsen AB, Hjort Svendsen AL. Experiences with basic body awareness therapy as an add-on to cognitive behavioural therapy among Danish military veterans with PTSD: An interview study. J Bodyw Mov Ther 2021; 27:550-9. [PMID: 34391286 DOI: 10.1016/j.jbmt.2021.03.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 02/05/2021] [Accepted: 03/28/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND The Danish Veterans Centre offers a body-orientated therapy, Basic Body Awareness Therapy (BBAT), in addition to the psychological trauma-focused therapy to military veterans suffering from symptoms of post-traumatic stress disorder (PTSD). This study explored how the veterans a) experienced BBAT as a physiotherapeutic approach and as an add-on treatment to their usual Cognitive Behavioural Therapy (CBT) and b) whether it makes sense for the individual veteran to incorporate BBAT into their treatment. MATERIALS AND METHODS Individual semi-structured interviews with four veterans who had completed 12 BBAT sessions concurrently with their usual CBT treatment. Interviews were transcribed and analysed using Malterud's version of Giorgi's 4-step systematic text condensation. RESULTS Three main categories emerged: "Effects of treatment", "The setting of the treatment" and "Complementary nature of BBAT and CBT". Within each category were 2-5 underlying subgroups. Participants found it made sense to combine BBAT with their CBT since it benefitted them differently and addressed their bodily symptoms and improved body perception/awareness. CONCLUSION BBAT showed potential as a supplement to CBT and seemed to benefit the veterans through focusing on bodily symptoms and how to calm them. Future studies are needed because of the limited research on the topic.
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Vengberg S, Fredriksson M, Burström B, Burström K, Winblad U. Money matters - primary care providers' perceptions of payment incentives. J Health Organ Manag 2021; ahead-of-print. [PMID: 33522211 DOI: 10.1108/jhom-06-2020-0225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE Payments to healthcare providers create incentives that can influence provider behaviour. Research on unit-level incentives in primary care is, however, scarce. This paper examines how managers and salaried physicians at Swedish primary healthcare centres perceive that payment incentives directed towards the healthcare centre affect their work. DESIGN/METHODOLOGY/APPROACH An interview study was conducted with 24 respondents at 13 primary healthcare centres in two cities, located in regions with different payment systems. One had a mixed system comprised of fee-for-service and risk-adjusted capitation payments, and the other a mainly risk-adjusted capitation system. FINDINGS Findings suggested that both managers and salaried physicians were aware of and adapted to unit-level payment incentives, albeit the latter sometimes to a lesser extent. Respondents perceived fee-for-service payments to stimulate production of shorter visits, up-coding of visits and skimming of healthier patients. Results also suggested that differentiated rates for patient visits affected horizontal prioritisations between physician and nurse visits. Respondents perceived that risk-adjustments for diagnoses led to a focus on registering diagnosis codes, and to some extent, also up-coding of secondary diagnoses. PRACTICAL IMPLICATIONS Policymakers and responsible authorities need to design payment systems carefully, balancing different incentives and considering how and from where data used to calculate payments are retrieved, not relying too heavily on data supplied by providers. ORIGINALITY/VALUE This study contributes evidence on unit-level payment incentives in primary care, a scarcely researched topic, especially using qualitative methods.
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Affiliation(s)
- Sofie Vengberg
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Mio Fredriksson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Bo Burström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Burström
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Ulrika Winblad
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Wohlfart O, Trumler T, Wagner I. The unique effects of Covid-19 - A qualitative study of the factors that influence teachers' acceptance and usage of digital tools. Educ Inf Technol (Dordr) 2021; 26:7359-7379. [PMID: 34093066 PMCID: PMC8167829 DOI: 10.1007/s10639-021-10574-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/30/2021] [Indexed: 05/12/2023]
Abstract
The objective of this study is to examine the factors that influence teachers' acceptance of digital tools for undertaking distance teaching during the Covid-19 pandemic. Based on the variables of the technology acceptance model, we have conducted interviews with 15 secondary school teachers with varying degrees of professional experiences and combinations of subjects, from the federal state of Baden-Wuerttemberg in Germany and analyzed the same. The results indicate that, other than user motivation, three areas, namely "regulations and specifications," "technological infrastructure," and "heterogeneity of students and teachers," affect the adoption of digital tools. The Covid-19 pandemic, which inevitably led teachers to embrace digital tools, positively influenced the perception and immediate usefulness of digital tools. We assert that no other variable would have been able to universally influence technology usage and acceptance to such an extent as to replicate the findings of our study and simultaneously highlight the uniqueness of the current situation and the necessity for examining its impact.
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Affiliation(s)
- Olivia Wohlfart
- Center for Teacher Education, Karlsruhe Institute of Technology, Kaiserstraße 12, Geb. 20.52 (ZLB), 76131 Karlsruhe, Germany
| | - Tim Trumler
- Center for Teacher Education, Karlsruhe Institute of Technology, Kaiserstraße 12, Geb. 20.52 (ZLB), 76131 Karlsruhe, Germany
| | - Ingo Wagner
- Center for Teacher Education, Karlsruhe Institute of Technology, Kaiserstraße 12, Geb. 20.52 (ZLB), 76131 Karlsruhe, Germany
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Rasmussen EB. Rhetorical work and medical authority: Constructing convincing cases in insurance medicine. Soc Sci Med 2020; 264:113324. [PMID: 32920478 DOI: 10.1016/j.socscimed.2020.113324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/06/2020] [Accepted: 08/20/2020] [Indexed: 11/29/2022]
Abstract
This article explores general practitioners' (GPs) persuasive efforts in cases where biomedical evidence is absent but expected. Health insurance in Western countries is based on the biomedical ideal that legitimate complaints should have objective causes detectable by medical examination. For GPs responsible for assessing sickness and incapacity for work, the demand for objective evidence can be problematic: what if they as experts deem that a patient is in fact sick and eligible for benefits, but are unable to provide objective evidence to that fact? How can they convince bureaucrats in the insurance system to accept their judgment? Taking 'medically unexplained symptoms' as my case, I draw on focus group and follow-up interviews with GPs in Norway to explore how GPs attempt to persuade bureaucrats to accept their professional judgment. Proposing the concept of 'rhetorical work', I reconstruct a typology of such work that doctors engage in to influence bureaucratic decision-making and provide long-term health benefits for patients. I then discuss the potential societal implications of GPs' rhetorical practices and the applications of the concept of rhetorical work in future research.
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Affiliation(s)
- Erik Børve Rasmussen
- Department of Social Work, Child Welfare and Social Policy, Oslo Metropolitan University, Norway.
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24
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Kiefer P, Kirschner J, Pechmann A, Langer T. Experiences of caregivers of children with spinal muscular atrophy participating in the expanded access program for nusinersen: a longitudinal qualitative study. Orphanet J Rare Dis 2020; 15:194. [PMID: 32727502 PMCID: PMC7391692 DOI: 10.1186/s13023-020-01477-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 07/21/2020] [Indexed: 11/22/2022] Open
Abstract
Background Expanded access programs (EAPs) allow patients with serious, life-threatening conditions access to drugs prior to their formal approval. Despite the possible benefits for patients, EAPs present several challenges, including uncertainty regarding a drug’s efficacy and safety as well as inequities regarding access to treatment. Although the number of EAPs is growing, the experience of patients participating in EAPs has not yet been studied. In Germany, an EAP for the treatment of Spinal Muscular Atrophy (SMA) with nusinersen ran from December 2016 to May 2017). SMA is a rare, progressive neuromuscular disorder characterized by muscle atrophy and proximal muscle weakness. Insights into patients’ and caregivers’ experiences could help to improve future EAPs. Results We conducted a prospective study using semi-structured interviews with caregivers of children with Spinal Muscular Atrophy (SMA) Type 1who participated in the nusinersen EAP in Germany. Interviews were transcribed verbatim and analyzed using an inductive approach according to the principles of content analysis. Eight families participated in the study. Their children were between 2 and 28 months old. Six children received non-invasive ventilation. Participation in the EAP marked an important turning point in the caregivers’ experiences. Their perspective changed from a severely limited life expectancy and a palliative approach to a more optimistic view including hopes for a longer life and positive development of their children. However, participating in the EAP was also challenging for caregivers in several ways. Lack of information regarding the launch of the program and the enrollment procedures caused significant uncertainty and stress among caregivers prior to the actual treatment. Further, concerns persisted that nusinersen could not be approved or that the child could be excluded due to an insufficient treatment response. Good communication and trusting relationships with medical and non-medical staff at the hospital helped caregivers cope with the uncertainties associated with the treatment. Conclusion From the caregivers’ perspective, there was no alternative to participating in the EAP for nusinersen. All participants were positive regarding their decision to participate. However, this study suggests that developing procedures to increase speed and transparency and to ensure fairness could help to further improve the system of EAPs as a way to provide urgently needed care to highly vulnerable patients.
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Affiliation(s)
- Petra Kiefer
- Department of Neuropediatrics and Muscle Disorders, Center for Pediatrics, Faculty of Medicine, University of Freiburg, Mathildenstr. 1, 79106, Freiburg, Germany
| | - Janbernd Kirschner
- Department of Neuropediatrics and Muscle Disorders, Center for Pediatrics, Faculty of Medicine, University of Freiburg, Mathildenstr. 1, 79106, Freiburg, Germany.,Department of Neuropediatrics, University Children's Hospital Bonn, Bonn, Germany
| | - Astrid Pechmann
- Department of Neuropediatrics and Muscle Disorders, Center for Pediatrics, Faculty of Medicine, University of Freiburg, Mathildenstr. 1, 79106, Freiburg, Germany
| | - Thorsten Langer
- Department of Neuropediatrics and Muscle Disorders, Center for Pediatrics, Faculty of Medicine, University of Freiburg, Mathildenstr. 1, 79106, Freiburg, Germany.
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25
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Grau Canét-Wittkampf C, Eijkelboom C, Mol S, Zwart D, Hendriks I, de Groot E. Fostering patient-centredness by following patients outside the clinical setting: an interview study. BMC Med Educ 2020; 20:16. [PMID: 31941481 PMCID: PMC6963999 DOI: 10.1186/s12909-020-1928-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 01/06/2020] [Indexed: 05/21/2023]
Abstract
BACKGROUND Patient-centredness is considered a core competency for health professionals. To support faculty in designing courses focused on patient-centredness, an understanding of how educational interventions lead to patient-centredness is required. This study aims to show how learning mechanisms, which potentially contribute to patient-centredness, are triggered. METHODS Thirty-five third-year medical students at the UMC Utrecht followed four different patients for two years. The intervention took place in an out-of-hospital setting. Students visited patients in their home circumstances and accompanied them to clinical events. Twelve students were interviewed. The realist approach was used to construct configurations which relate components of the intervention to the context and learning mechanisms. RESULTS Following patients in their home circumstances for a prolonged period supported the development of meaningful relationships between students and patients and provided continuity. In the context of a meaningful relationship and continuity, mechanisms contributing to learning patient-centredness were triggered. The most important learning mechanisms found in this study were: reflecting, contextualising disease in a real persons' life, broadening perspectives and engaging with the patients. CONCLUSIONS Learning mechanisms are triggered by continuity and by meaningful student-patient relationships. These can be enhanced by an out-of-hospital setting and longitudinal contact. Thus, a relationship between students and patients is an important enabler for the development of patient-centredness.
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Affiliation(s)
- Christel Grau Canét-Wittkampf
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands.
| | - Charlotte Eijkelboom
- Wilhelmina Kinderziekenhuis, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Saskia Mol
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Dorien Zwart
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Iris Hendriks
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Esther de Groot
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
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Glasdam S, Bjerström C, Engberg de Carvalho C. Coping strategies among patients with malignant lymphoma- a qualitative study from the perspectives of Swedish patients. Eur J Oncol Nurs 2019; 44:101693. [PMID: 31783326 DOI: 10.1016/j.ejon.2019.101693] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/13/2019] [Accepted: 11/16/2019] [Indexed: 01/07/2023]
Abstract
PURPOSE There is a dearth of research on coping strategies of patients with malignant lymphoma. The aim of this article is to explore how these patients cope with cancer in everyday life. METHOD Semi-structured interviews were conducted with nine patients in Sweden. A thematic analysis was made, inspired by Antonovsky's theory of sense of coherence. The SRQR checklist was used. RESULTS Patient's coping strategies are shown within three themes: 'Life experiences supported coping strategies during treatment', 'Between completed treatment and (possible) cure', and 'Illness brought closeness and distance in social relationships'. Three different coping strategies were identified during treatment: trying to control the situation, seeing opportunities in difficulties, and doing other activities to limit thoughts about disease and treatment. Four different coping strategies were identified after treatment ended, namely projecting responsibility and anger onto the healthcare system, maintaining the outer facade as a strong person who had control over the situation, talking about disease, side effects and emotions and putting the focus on the future, and managing life by anticipating death. Family =and friends were a part of patients' coping strategies, but to different extents and in different ways. Diagnosis and treatment for malignant lymphoma brought closeness and distance in social relationships. CONCLUSION Patients with malignant lymphoma cope with cancer in different ways in everyday life influenced by their life experiences and life conditions. Further research should focus on cancer patients' coping strategies in a relational perspective, as coping and coping opportunities are embedded in social context and social relationships.
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Affiliation(s)
- Stinne Glasdam
- Department of Health Sciences, Faculty of Medicine, Lund University, Margaretavägen 1 B, S-222 41, Lund, Sweden.
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27
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Svedahl ER, Pape K, Toch-Marquardt M, Skarshaug LJ, Kaspersen SL, Bjørngaard JH, Austad B. Increasing workload in Norwegian general practice - a qualitative study. BMC Fam Pract 2019; 20:68. [PMID: 31113368 PMCID: PMC6530128 DOI: 10.1186/s12875-019-0952-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 04/26/2019] [Indexed: 01/08/2023]
Abstract
Background General practitioners (GPs) play a key role in securing and coordinating appropriate use of healthcare services, by providing primary and preventive healthcare and by acting as gatekeepers for secondary healthcare services. Historically, European GPs have reported high job satisfaction, attributed to high autonomy and good compatibility with family life. However, a trend of increasing workload in general practice has been seen in several European countries, including Norway, leading to recruitment problems and concerns about the well-being of both GPs and patients. This qualitative interview study with GPs and their co-workers aims to explore how they perceive and tackle their workload, and their experiences and reflections regarding explanations for and consequences of increased workload in Norwegian general practice. Methods We conducted seven focus groups and four individual interviews with GPs and their co-workers in seven GPs’ offices in Mid-Norway: three in rural locations and four in urban locations. Our study population consisted of 21 female and 12 male participants; 23 were GPs and 10 were co-workers. The interviews were analysed using systematic text condensation. Results The analysis identified three main themes: (1) Heavy and increasing workload – more trend than fluctuation?; (2) Explanations for high workload; (3) Consequences of high workload. Our findings show that both GPs and their co-workers experience heavy and increasing workload. The suggested explanations varied considerably among the GPs, but the most commonly cited reasons were legislative changes, increased bureaucracy related to documentation and management of a practice, and changes in patients’ expectations and help-seeking behaviour. Potential consequences were also perceived as varying, especially regarding consequences for patients and the healthcare system. The participants expressed concerns for the future, particularly in regards to GPs’ health and motivation, as well as the recruitment of new GPs. Conclusions This study found heavy and increasing workload in general practice in Norway. The explanations appear to be multi-faceted and many are difficult to reverse. The GPs expressed worries that they will not be able to provide the population with the expected care and services in the future.
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Affiliation(s)
- Ellen Rabben Svedahl
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Håkon Jarls gate 11, 7030, Trondheim, Norway.
| | - Kristine Pape
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Håkon Jarls gate 11, 7030, Trondheim, Norway
| | - Marlen Toch-Marquardt
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Håkon Jarls gate 11, 7030, Trondheim, Norway
| | - Lena Janita Skarshaug
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Håkon Jarls gate 11, 7030, Trondheim, Norway
| | - Silje-Lill Kaspersen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Håkon Jarls gate 11, 7030, Trondheim, Norway.,SINTEF Digital, Department of Health, Trondheim, Norway
| | - Johan Håkon Bjørngaard
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Håkon Jarls gate 11, 7030, Trondheim, Norway.,Forensic Department and Research Centre Bröset, St. Olav's University Hospital Trondheim, Trondheim, Norway
| | - Bjarne Austad
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Håkon Jarls gate 11, 7030, Trondheim, Norway
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Penn L, Goffe L, Haste A, Moffatt S. Management information systems for community based interventions to improve health: qualitative study of stakeholder perspectives. BMC Public Health 2019; 19:105. [PMID: 30674289 PMCID: PMC6343312 DOI: 10.1186/s12889-018-6363-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 12/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Community based providers are well place to deliver behavioural interventions to improve health. Good project management and reliable outcome data are needed to efficiently deliver and evaluate such interventions, and Management information systems (MIS) can facilitate these processes. We explored stakeholders perspectives on the use of MIS in community based behavioural interventions. METHODS Stakeholders, purposively selected to provide a range of MIS experience in the delivery of community based behavioural interventions to improve health (public health commissioners, intervention service managers, project officers, health researchers and MIS designers), were invited to participate in individual semi-structured interviews. We used a topic guide and encouraged stakeholders to reflect on their experiences.: Interviews were recorded, transcribed and analysed using five steps of Framework analysis. We applied an agreed coding framework and completed the interviews when no new themes emerged. RESULTS We interviewed 15 stakeholders. Key themes identified were: (i) MIS access; (ii) data and its function; (iii) MIS development and updating. Within these themes the different experiences, needs, use, training and expertise of stakeholders and the variation and potential of MIS were evidenced. Interviews advised the need to involve stakeholders in MIS design and development, build-in flexibility to accommodate MIS refinement and build on effective MIS. CONCLUSIONS Findings advised involving stakeholders, early in the design process. Designs should build on existing MIS of proven utility and ensure flexibility in the design, to incorporate adaptations and ongoing system development in response to early MIS use and evolving stakeholder needs.
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Affiliation(s)
- Linda Penn
- Institute of Health and Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK. .,Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK.
| | - Louis Goffe
- Institute of Health and Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK.,Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
| | - Anna Haste
- Institute of Health and Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK.,Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
| | - Suzanne Moffatt
- Institute of Health and Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK.,Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
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Opsomer S, Joossens S, De Wit C, Lauwerier E, Pype P. Couples coping with nutrition-related problems in advanced cancer: A qualitative study in primary care. Eur J Oncol Nurs 2018; 38:76-84. [PMID: 30717940 DOI: 10.1016/j.ejon.2018.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 12/18/2018] [Accepted: 12/20/2018] [Indexed: 01/12/2023]
Abstract
PURPOSE Nutrition-related problems are common in patients with advanced cancer. They can disrupt daily life and routines. This study aimed to explore how couples cope with this source of distress. METHODS A qualitative descriptive study design was adopted using semi-structured interviews. Seven couples, each consisting of an advanced cancer patient and his or her co-habiting life partner, participated. The Qualitative Analysis Guide of Leuven (QUAGOL) was used as a guide to facilitate the analysis process. RESULTS When a patient communicates nutrition-related problems to the partner, individual coping is often complemented by interactive couple-coping pathways, serving two resilient coping strategies: maintaining normality and creating a new normality. These pathways can have either a practical, an emotional or a distant orientation. Different couple-coping pathways can be observed in the same couple when they are dealing with either one or multiple nutrition-related problems. Some couples, however, seem to cope more rigidly, often those with less observed 'we-ness'. CONCLUSIONS Nutrition-related problems are inherent to advanced cancer and are perceived as health-threatening. Couple-coping with nutrition-related problems is a dynamic and interactive process leaning on different coping pathways. There is no evidence that one pathway is superior to another, as they all serve a resilient coping strategy. Our findings can assist homecare nurses and other professional caregivers in providing psychological support and advice to couples confronted with nutrition-related problems in advanced cancer. Future research should shed light on whether an unsuitable match in coping styles within a couple is one of the precursors of non-resilient outcomes.
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Affiliation(s)
- Sophie Opsomer
- University Colleges Leuven Limburg, Faculty of Health and Social Work, Herestraat 49, 3000, Leuven, Belgium; KULeuven, Department of Public Health and Primary Care, Kapucijnenvoer 33 Blok J, 3000 Leuven, Belgium.
| | - Sofie Joossens
- University Colleges Leuven Limburg, Faculty of Health and Social Work, Herestraat 49, 3000, Leuven, Belgium.
| | - Claudia De Wit
- University Colleges Leuven Limburg, Faculty of Health and Social Work, Herestraat 49, 3000, Leuven, Belgium
| | - Emelien Lauwerier
- Ghent University, Department of Family Medicine and Primary Health Care, Corneel Heymanslaan 10, B-9000, Ghent, Belgium; Ghent University, Faculty of Psychology and Educational Sciences, Henri Dunantlaan 2, 9000, Ghent, Belgium.
| | - Peter Pype
- Ghent University, Department of Family Medicine and Primary Health Care, Corneel Heymanslaan 10, B-9000, Ghent, Belgium; End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Belgium.
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Klop HT, Evenblij K, Gootjes JRG, de Veer AJE, Onwuteaka-Philipsen BD. Care avoidance among homeless people and access to care: an interview study among spiritual caregivers, street pastors, homeless outreach workers and formerly homeless people. BMC Public Health 2018; 18:1095. [PMID: 30185163 PMCID: PMC6126023 DOI: 10.1186/s12889-018-5989-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 08/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Because of their poor health and social vulnerability, homeless people require specific care. However, due to care avoidance, homeless people are often not involved in care. This study aims to get insights into reasons for and kinds of care avoidance among homeless people and to provide suggestions to reach this target group. METHODS Semi-structured individual interviews were conducted among street pastors (n = 9), spiritual caregivers (n = 9), homeless outreach workers (n = 7) and formerly homeless people (n = 3). Participants were recruited by purposive sampling in the four major cities in the Netherlands (Amsterdam, Utrecht, Rotterdam, The Hague). The verbatim transcripts were analysed using thematic analysis. RESULTS The term care avoidance was perceived as stigmatizing. Care avoidance is found to be related to characteristics of the homeless person (e.g. having complex problems, other priorities) as well as of the system (e.g. complex system, conditions and requirements of organizations). The person-related characteristics suggestions to involve homeless persons include tailoring care and building relationships, which might even be prioritised over starting care interventions. Setting limits on behaviour without rejecting the person, and an attitude reflecting humanity, dignity and equality were also important factors in making care more accessible and lasting. As regards system-related characteristics, the suggestions include clear information and communication to homeless people who avoid care as being crucial in order to make care more accessible. Other suggestions include quiet and less busy shelters, a non-threatening attitude and treatment by professionals, self-reflection by professionals and finally a change of policy and legislation regarding available time. CONCLUSIONS Reasons for care avoidance can be found in the interplay between both the individual and the system; measures to reduce care avoidance should be taken at both levels. These measures are centred on lowering the barriers to care inter alia by incorporating building trust and understanding into the care provided.
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Affiliation(s)
- Hanna T Klop
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, VU University Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, Netherlands.
| | - Kirsten Evenblij
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, VU University Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, Netherlands
| | | | - Anke J E de Veer
- Netherlands Institute for Health Services Research (NIVEL), P.O. Box 1568, 3500 BN, Utrecht, Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, VU University Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, Netherlands
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Abstract
Systematic review is a type of literature review designed to synthesize all available evidence on a given question. Systematic reviews require significant time and effort, which has led to the continuing development of computer support. This paper seeks to identify the gaps and opportunities for computer support. By interviewing experienced systematic reviewers from diverse fields, we identify the technical problems and challenges reviewers face in conducting a systematic review and their current uses of computer support. We propose potential research directions for how computer support could help to speed the systematic review process while retaining or improving review quality.
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Larsson H, Rämgård M, Bolmsjö I. Older persons' existential loneliness, as interpreted by their significant others - an interview study. BMC Geriatr 2017; 17:138. [PMID: 28693445 PMCID: PMC5502486 DOI: 10.1186/s12877-017-0533-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 07/04/2017] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND In order to better understand people in demanding medical situations, an awareness of existential concerns is important. Studies performed over the last twenty years conclude that when dying and death come closer, as in the case with older people who are stricken by infirmity and diseases, existential concerns will come to the fore. However, studies concerning experiences of existential loneliness (EL) are sparse and, in addition, there is no clear definition of EL. EL is described as a complex phenomenon and referred to as a condition of life, an experience, and a process of inner growth. Listening to someone who knows the older person well, as significant others often do, may be one way of learning more about EL. METHODS This study is part of a larger research project on EL, the LONE study, where EL is explored through interviews with frail older people, their significant others and health care professionals. The aim of this study was to explore frail older (>75) persons' EL, as interpreted by their significant others. The study is qualitative and based on eighteen narrative interviews with nineteen significant others of older persons. The data was analysed using Hsieh and Shannon's conventional content analysis. RESULTS According to the interpretation of significant others, the older persons experience EL (1) when they are increasingly limited in body and space, (2) when they are in a process of disconnecting, and (3) when they are disconnected from the outside world. CONCLUSION The result can be understood as if the frail older person is in a process of letting go of life. This process involves the body, in that the older person is increasingly limited in his/her physical abilities. The older person's long-term relationships are gradually lost, and finally the process entails the older person's increasingly withdrawing into him- or herself and turning off the outside world. The result of this study is consistent with previous research that has shown that EL is a complex phenomenon, but the implications of this research include a deepened understanding of EL. In addition, the study highlights the interpretations of significant others.
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Affiliation(s)
- Helena Larsson
- Faculty of Health and Society, Department of Care Science, Malmö University, SE 205 06 Malmö, Sweden
- Department of Health and Society, Kristianstad University, SE 291 88 Kristianstad, Sweden
| | - Margareta Rämgård
- Faculty of Health and Society, Department of Care Science, Malmö University, SE 205 06 Malmö, Sweden
| | - Ingrid Bolmsjö
- Faculty of Health and Society, Department of Care Science, Malmö University, SE 205 06 Malmö, Sweden
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Abstract
PURPOSE The purpose of this paper is to probe experiences of entrepreneurs in the social and health care service provision. DESIGN/METHODOLOGY/APPROACH Information was collected regarding entrepreneurs' views on the factors affecting the collaboration between public and private sectors. A sample of social and health care entrepreneurs was interviewed using open-ended questions. The interviews were transcribed and analysed using inductive content analysis. FINDINGS Three main categories of factors affecting the success of partnership were identified: the nature of partnership, business aspects and tension builders. Research LIMITATIONS/IMPLICATIONS: The research was undertaken in rural Finland and the sample consisted 13 entrepreneurs. The results must be considered as observations with more generalised conclusions. PRACTICAL implications - The results of this study support municipalities in their social and health care service strategy work and especially in consideration of how to also facilitate a fruitful public-private partnership (PPP)-framework, which will largely depend on mutual understanding and consensus. ORIGINALITY/VALUE The reform of the social and health care system has raised intensive public debate throughout Europe. Key issues include the reorganising of social and health care processes as well as PPPs in provision of services. This study observes the views and experiences of private entrepreneurs and points out where some potential problems and solutions of social and health care PPPs are.
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Affiliation(s)
- Janne Sinisammal
- Industrial Engineering and Management, University of Oulu, Oulu, Finland
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Bunnik EM, van Bodegom L, Pinxten W, de Beaufort ID, Vernooij MW. Ethical framework for the detection, management and communication of incidental findings in imaging studies, building on an interview study of researchers' practices and perspectives. BMC Med Ethics 2017; 18:10. [PMID: 28166795 PMCID: PMC5294804 DOI: 10.1186/s12910-017-0168-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 01/19/2017] [Indexed: 12/25/2022] Open
Abstract
Background As thousands of healthy research participants are being included in small and large imaging studies, it is essential that dilemmas raised by the detection of incidental findings are adequately handled. Current ethical guidance indicates that pathways for dealing with incidental findings should be in place, but does not specify what such pathways should look like. Building on an interview study of researchers’ practices and perspectives, we identified key considerations for the set-up of pathways for the detection, management and communication of incidental findings in imaging research. Methods We conducted an interview study with a purposive sample of researchers (n = 20) at research facilities across the Netherlands. Based on a qualitative analysis of these interviews and on existing guidelines found in the literature, we developed a prototype ethical framework, which was critically assessed and fine-tuned during a two-day international expert meeting with bioethicists and representatives from large population-based imaging studies from the United Kingdom, Germany, Sweden and Belgium (n = 14). Results Practices and policies for the handling of incidental findings vary strongly across the Netherlands, ranging from no review of research scans and limited feedback to research participants, to routine review of scans and the arrangement of clinical follow-up. Respondents felt that researchers do not have a duty to actively look for incidental findings, but they do have a duty to act on findings, when detected. The principle of reciprocity featured prominently in our interviews and expert meeting. Conclusion We present an ethical framework that may guide researchers and research ethics committees in the design and/or evaluation of appropriate pathways for the handling of incidental findings in imaging studies. The framework consists of seven steps: anticipation of findings, information provision and informed consent, scan acquisition, review of scans, consultation on detected abnormalities, communication of the finding, and further clinical management and follow-up of the research participant. Each of these steps represents a key decision to be made by researchers, which should be justified not only with reference to costs and/or logistical considerations, but also with reference to researchers’ moral obligations and the principle of reciprocity.
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Affiliation(s)
- Eline M Bunnik
- Department of Medical Ethics and Philosophy of Medicine, Erasmus MC, University Medical Centre Rotterdam, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands.
| | - Lisa van Bodegom
- Department of Medical Ethics and Philosophy of Medicine, Erasmus MC, University Medical Centre Rotterdam, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Wim Pinxten
- Department of Morphology, Hasselt University, Agoralaan Gebouw D, BE 3590, Diepenbeek, Belgium
| | - Inez D de Beaufort
- Department of Medical Ethics and Philosophy of Medicine, Erasmus MC, University Medical Centre Rotterdam, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Meike W Vernooij
- Department of Epidemiology, Erasmus MC, University Medical Centre Rotterdam, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Centre Rotterdam, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
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Nisbeth Jensen M, Fage-Butler AM. Antenatal group consultations: Facilitating patient-patient education. Patient Educ Couns 2016; 99:1999-2004. [PMID: 27497838 DOI: 10.1016/j.pec.2016.07.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 07/21/2016] [Accepted: 07/29/2016] [Indexed: 05/12/2023]
Abstract
OBJECTIVE This article investigates the perspectives of pregnant women attending antenatal group consultations to gain their understandings of whether and how peer learning is facilitated in this setting. METHODS We conducted semi-structured individual interviews with 16 women who had participated in group consultations at Aarhus University Hospital, Denmark, and analysed the data using qualitative content analysis. Our research design also included observations and patient guest book data. RESULTS Women who were pregnant for the first time greatly appreciated the experiential knowledge of multiparous women in the group. Group consultations provided new learning opportunities, as individuals' questions prompted learning within the groups, as well as questions and answers. There was more time for reflection in group consultations than in dyadic communication. Midwives played a key role in facilitating peer learning. Some topics were not deemed appropriate for discussion. CONCLUSION Antenatal group consultations can support learning, as individuals participate positively both in their own knowledge acquisition and that of others. We call such peer learning patient-patient education. PRACTICE IMPLICATIONS Our study indicates the strengths of group consultations for learning from the perspective of the group members. It highlights how learning may be facilitated in group consultations, and thus has broad practical relevance.
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Affiliation(s)
- Matilde Nisbeth Jensen
- Department of Business Communication, Jens Chr. Skous Vej 4, Aarhus University, 8000 Aarhus C, Denmark.
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Botje D, Ten Asbroek G, Plochg T, Anema H, Kringos DS, Fischer C, Wagner C, Klazinga NS. Are performance indicators used for hospital quality management: a qualitative interview study amongst health professionals and quality managers in The Netherlands. BMC Health Serv Res 2016; 16:574. [PMID: 27733194 PMCID: PMC5062914 DOI: 10.1186/s12913-016-1826-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 10/07/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hospitals are under increasing pressure to share indicator-based performance information. These indicators can also serve as a means to promote quality improvement and boost hospital performance. Our aim was to explore hospitals' use of performance indicators for internal quality management activities. METHODS We conducted a qualitative interview study among 72 health professionals and quality managers in 14 acute care hospitals in The Netherlands. Concentrating on orthopaedic and oncology departments, our goal was to gain insight into data collection and use of performance indicators for two conditions: knee and hip replacement surgery and breast cancer surgery. The semi-structured interviews were recorded and summarised. Based on the data, themes were synthesised and the analyses were executed systematically by two analysts independently. The findings were validated through comparison. RESULTS The hospitals we investigated collect data for performance indicators in different ways. Similarly, these hospitals have different ways of using such data to support their quality management, while some do not seem to use the data for this purpose at all. Factors like 'linking pin champions', pro-active quality managers and engaged medical specialists seem to make a difference. In addition, a comprehensive hospital data infrastructure with electronic patient records and robust data collection software appears to be a prerequisite to produce reliable external performance indicators for internal quality improvement. CONCLUSIONS Hospitals often fail to use performance indicators as a means to support internal quality management. Such data, then, are not used to its full potential. Hospitals are recommended to focus their human resource policy on 'linking pin champions', the engagement of professionals and a pro-active quality manager, and to invest in a comprehensive data infrastructure. Furthermore, the differences in data collection processes between Dutch hospitals make it difficult to draw comparisons between outcomes of performance indicators.
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Affiliation(s)
- Daan Botje
- Amphia Hospital, Langendijk 75, P.O. box 90157, 4800 RA, Breda, The Netherlands. .,NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
| | - Guus Ten Asbroek
- Ahti, Amsterdam Health & Technology Institute, Amsterdam, The Netherlands.,Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Thomas Plochg
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Netherlands Public Health Federation, Utrecht, The Netherlands
| | - Helen Anema
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Dionne S Kringos
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Cordula Wagner
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.,Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Niek S Klazinga
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Ziehm J, Farin E, Seibel K, Becker G, Köberich S. Health care professionals' attitudes regarding palliative care for patients with chronic heart failure: an interview study. BMC Palliat Care 2016; 15:76. [PMID: 27526940 PMCID: PMC4986383 DOI: 10.1186/s12904-016-0149-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 08/09/2016] [Indexed: 11/13/2022] Open
Abstract
Background Even though struggling with similar symptom burden, patients with chronic heart failure (CHF) receive less palliative care than patients suffering from malignant diseases. Researchers have found that this might be related to lack of knowledge about palliative care, insufficient interprofessional communication as well as the cyclic course of disease which makes accurate prognosis difficult. However, research findings have shown that patients with CHF benefit from palliative care. As there are no studies for the German health care system this study aimed to assess health care professionals’ attitudes regarding palliative care of CHF patients in order to identify barriers and facilitators for this patient group and hence to develop recommendations for improvement of CHF patients’ access to palliative care in Germany. Method Problem-centered interviews with 23 health care professionals involved in care of CHF patients (nurses: hospital, outpatient, heart failure, PC; physicians: hospital and resident cardiologists, general practitioners) were conducted and analysed according to Mayring’s qualitative content analysis. Results Most interviewees perceived a need for palliative care for CHF patients. Regarding barriers patients’, public’s, and professionals’ lack of knowledge of palliative care and CHF; shortcomings in communication and cooperation of different professional groups; inability of cardiology to accept medical limits; difficult prognosis of course of disease; and patients’ concerns regarding palliative care were described. Different attitudes regarding appropriate time of initiation of palliative care for CHF patients (late vs. early) were found. Furthermore, better communication and closer cooperation between different professional groups and medical disciplines as well as better education about palliative care and CHF for professionals, patients, and public were cited. Conclusions Palliative care for CHF patients is a neglected topic in both practice and research and should receive more attention. Barriers to palliative care for CHF patients might be overcome by: better education for the public, patients, and professionals, closer cooperation between the different professional groups involved as well as development of a joint agreement regarding the appropriate time to administer palliative care to CHF patients. Trial registration DRKS00007119. Electronic supplementary material The online version of this article (doi:10.1186/s12904-016-0149-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jeanette Ziehm
- Section of Health Care Research and Rehabilitation Research, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Erik Farin
- Section of Health Care Research and Rehabilitation Research, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Katharina Seibel
- Department of Palliative Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Gerhild Becker
- Department of Palliative Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stefan Köberich
- Section of Health Care Research and Rehabilitation Research, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Pflegedirektion, Heart Center University of Freiburg, Freiburg, Germany
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Dencker A, Premberg Å, Olander EK, McCourt C, Haby K, Dencker S, Glantz A, Berg M. Adopting a healthy lifestyle when pregnant and obese - an interview study three years after childbirth. BMC Pregnancy Childbirth 2016; 16:201. [PMID: 27473076 PMCID: PMC4967348 DOI: 10.1186/s12884-016-0969-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 07/14/2016] [Indexed: 01/03/2023] Open
Abstract
Background Obesity during pregnancy is increasing and is related to life-threatening and ill-health conditions in both mother and child. Initiating and maintaining a healthy lifestyle when pregnant with body mass index (BMI) ≥ 30 kg/m2 can improve health and decrease risks during pregnancy and of long-term illness for the mother and the child. To minimise gestational weight gain women with BMI ≥ 30 kg/m2 in early pregnancy were invited to a lifestyle intervention including advice and support on diet and physical activity in Gothenburg, Sweden. The aim of this study was to explore the experiences of women with BMI ≥ 30 kg/m2 regarding minimising their gestational weight gain, and to assess how health professionals’ care approaches are reflected in the women’s narratives. Methods Semi-structured interviews were conducted with 17 women who had participated in a lifestyle intervention for women with BMI ≥ 30 kg/m2 during pregnancy 3 years earlier. The interviews were digitally recorded and transcribed in full. Thematic analysis was used. Results The meaning of changing lifestyle for minimising weight gain and of the professional’s care approaches is described in four themes: the child as the main motivation for making healthy changes; a need to be seen and supported on own terms to establish healthy routines; being able to manage healthy activities and own weight; and need for additional support to maintain a healthy lifestyle. Conclusions To support women with BMI ≥ 30 kg/m2 to make healthy lifestyle changes and limit weight gain during pregnancy antenatal health care providers should 1) address women’s weight in a non-judgmental way using BMI, and provide accurate and appropriate information about the benefits of limited gestational weight gain; 2) support the woman on her own terms in a collaborative relationship with the midwife; 3) work in partnership to give the woman the tools to self-manage healthy activities and 4) give continued personal support and monitoring to maintain healthy eating and regular physical activity habits after childbirth involving also the partner and family.
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Affiliation(s)
- Anna Dencker
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden. .,Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Åsa Premberg
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.,Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Primary Health Care, Närhälsan, Gothenburg, Sweden
| | - Ellinor K Olander
- Centre for Maternal and Child Health Research, City University London, London, UK
| | - Christine McCourt
- Centre for Maternal and Child Health Research, City University London, London, UK
| | - Karin Haby
- Antenatal Health Care, Primary Health Care, Research and Development Unit, Närhälsan, Gothenburg, Sweden
| | - Sofie Dencker
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.,Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Glantz
- Primary Health Care, Närhälsan, Gothenburg, Sweden
| | - Marie Berg
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.,Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Paap MC, Lange L, van der Palen J, Bode C. Using the Three-Step Test Interview to understand how patients perceive the St. George's Respiratory Questionnaire for COPD patients (SGRQ-C). Qual Life Res 2016; 25:1561-70. [PMID: 26615616 DOI: 10.1007/s11136-015-1192-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2015] [Indexed: 01/29/2023]
Abstract
PURPOSE The aim of this study was to assess the experiences of patients with chronic obstructive pulmonary disease (COPD) while they were completing the St. George's Respiratory Questionnaire for COPD patients (SGRQ-C), using qualitative research methods. METHODS Twenty Dutch COPD patients were recruited through pulmonary physicians [13 women; mean age = 63.3 years (SD = 11.4)]. A trained interviewer applied the Three-Step Test Interview which allowed the interviewer to follow the thought process of the patient filling out the SGRQ-C. The official Dutch translation of the SGRQ-C was used. RESULTS Patients missed a recall period for the Symptoms subscale; were uncertain how to interpret specific words and phrases like "good days", "games", and "housework"; were confused by long-item stems that included a list of activities; and were frustrated by the dichotomous format used for the majority of SGRQ-C items (true/false). CONCLUSIONS Overall, patients were satisfied with the SGRQ-C. Nevertheless, making minor adjustments could further increase its quality. This includes reintroducing a recall period in the first set of items such as used in the previous version and splitting up items consisting of multiple activities. Furthermore, we recommend using the same response format (4 or 5 response categories) for all items.
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