scholarly journals A qualitative study exploring risk perception in congenital cardiac surgery: the perspective of UK surgeons

2021 ◽  
pp. 1-7
Author(s):  
Robyn R Lotto ◽  
Sarah E Seaton ◽  
Ian D Jones ◽  
Attilio A Lotto
Keyword(s):  
Clinical Care ◽  
Survival Rates ◽  
Comparative Approach ◽  
Moral Obligations ◽  
Structured Interviews ◽  
Care Needs ◽  
Managing Risk ◽  
Cardiac Surgeons ◽  
The Impact ◽  
The Way

Abstract Introduction: Managing risk is central to clinical care, yet most research focuses on patient perception, as opposed to how risk is enacted within the clinical setting by healthcare professionals. Aim: To explore how surgical risk is perceived, encountered, and managed by congenital cardiac surgeons. Methods: Semi-structured interviews were conducted with 20 congenital cardiac surgeons representing every unit across England and Wales. All interviews were transcribed verbatim, with analysis based on the constant comparative approach. Findings: Three themes were identified, reflecting the interactions between personal, institutional, and political context in which risk is encountered and managed. First, “communicating risk” highlights the complexity and variability in methods employed by surgeons to balance legal/moral obligations with parental need and expectations. Universally, surgeons described the need for flexibility in their approach in order to meet the needs of individual patients. Second, “scrutiny and accountability” captures the spectrum of opinion arising from the binary nature of the outcomes collated and the way in which they are perceived to be interpreted. Third, “nature of the job” highlights the personal and professional implications of conveying and managing risk and the impact of recent policy changes on the way this is enacted. Conclusion: Variations in approaches to communicating risk demonstrate a lack of consensus, compounded by insufficient evidence to determine or monitor a “best-care” approach. With current surgical outcomes suggesting little room for increasing survival rates, future care needs should shift to the “soft skills” in order to continue to drive improvements in parental and patient experience.

scholarly journals COVD-07. THE IMPACT OF COVID-19 ON PATIENTS AND CAREGIVERS AFFECTED BY BRAIN TUMORS: THE PATIENT NAVIGATOR PERSPECTIVE

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii22-ii22
Author(s):  
Kyle Walsh
Keyword(s):  
Clinical Trials ◽  
Brain Tumor ◽  
Clinical Care ◽  
Structured Interview ◽  
Patient Navigator ◽  
Structured Interviews ◽  
Social Distancing ◽  
Tumor Patient ◽  
Patient Navigators ◽  
The Impact

Abstract BACKGROUND Preliminary evidence indicates that glioma patients are at higher risk for COVID-19 complications due to systemic immunosuppression. Interruptions in cancer care may exacerbate patient and caregiver anxiety, but surveying patients/caregivers about their COVID-19 experiences is often limited by attainable sample sizes and over-reliance upon single-institution experiences. METHODS To explore how COVID-19 is impacting brain tumor patients/caregivers across the U.S., we performed semi-structured interviews with brain tumor patient navigators employed by two different 501(c)3 nonprofit organizations. A semi-structured interview guide was used, utilizing prompts and open-ended questions to facilitate dialogue. A core set of COVID-19 topics were covered, including: financial issues, coping strategies, geographic variability, variability by tumor grade/histology, disruptions in care continuity, accessing clinical trials, psychosocial issues, and end-of-life care. Interviews were audio-recorded, transcribed, and organized by discussion topic to identify emerging themes. Inductive sub-coding was completed using the constant comparison method, within and between transcripts. RESULTS/CONCLUSIONS Ten patient navigators were interviewed between April 15th and May 8th, with interviews lasting approximately one hour (range 38-77minutes). Navigators reported having contact with 183 unique brain tumor families during the pandemic (range 7–38 families per navigator). High concordance emerged across narratives, revealing important considerations for the neuro-oncology workforce. The most prominent theme was increased caregiver burden, attributed to maintaining social distancing by reducing visits from home-health aides and friends/family. A related theme that applied to both patients and caregivers was increased social isolation due to social distancing, suspension of in-person support groups, and church/temple closures. Accessing clinical trials was a recurrent issue, exacerbated by patients’ increasing unwillingness to travel. Glioblastoma patients, especially those with recurrent tumors, expressed greater reluctance to travel. Access to standard-of-care treatment was rarely interrupted, but reduced access to supportive services – especially physical and occupational therapy – was identified as an emerging COVID-related deficiency in clinical care.

scholarly journals Evidence-based implementation of normal childbirth: what are the obstacles? (qualitative study)

2020 ◽  
Vol 3 (2) ◽  
pp. 115-126
Author(s):  
Rizki Amalia ◽  
Moch. Hakimi ◽  
Herlin Fitriani
Keyword(s):  
Clinical Care ◽  
Sampling Technique ◽  
Obstetric Care ◽  
Evidence Based ◽  
Independent Practice ◽  
Structured Interviews ◽  
Delivery Assistance ◽  
Quality Of Obstetric Care ◽  
The Impact

Evidence-based is a very effective strategy to improve the quality of midwifery services. One of the most frequently problems faced is the gap between midwifery practices that are in accordance with the procedures (based on evidence-based) with clinical care practices that occur in the clinic. The purpose of this study was to explore in-depth the obstacles to the implementation of evidence-based normal childbirth, which are the position of delivery, monitoring and documenting delivery by using partographs in the Independent Practice of Midwives of Gunungkidul District, Yogyakarta.This research was a qualitative research with a phenomenological descriptive approach. The participants of this study were midwives who had the Independent Midwife Practice (PMB) consisting of 7 informants. Participant selection in this study used a purposive sampling technique with convenience sampling and identification of obstacles used was the Consolidated Framework for Implementation Research (CFIR). Data collection used was semi-structured interviews and observations. Data analysis used was a thematic analysis.The interview and observation of delivery assistance is done at the Independent Midwife Practice Center (PMB). The position of delivery that was often used by patients was lithotomy and left slant, and the application of evidence-based monitoring and documentation using partograph was still not optimal. This was because there were several obstacles in its application, which were obstacles from patients, families, midwives, and obstacles from the organization. The impact of these obstacles was that it can reduce the quality of obstetric care in patients according to evidence-based. The evaluation of clinical practice based on evidence-based by the organization and the existence of feedback from patients to midwives are expected to improve the quality of service to patients.    

scholarly journals Risk, uncertainty and medical practice: changes in the medical professions following disaster

2020 ◽  
Vol 16 (2) ◽  
pp. 285-303
Author(s):  
Sudeepa Abeysinghe ◽  
Claire Leppold ◽  
Akihiko Ozaki ◽  
Mariko Morita
Keyword(s):  
Medical Practice ◽  
Radiation Risk ◽  
Medical Professionals ◽  
Structured Interviews ◽  
Medical Work ◽  
Medical Expertise ◽  
Professional Boundaries ◽  
And Shifts ◽  
The Impact ◽  
The Way

Risk and uncertainty can destabilise and reconstruct the relationships between medicine, policy and publics. Through semi-structured interviews with medical staff following the Fukushima 3.11 Disaster, this paper demonstrates the way in which disruption (caused by disaster), coupled with uncertainty (in this case, around radiation risk) can serve to transform medical practices. After Fukushima, a deficit in publicly-trusted approaches to disaster management meant that the role and status of key medical professionals was transformed. This reorganisation of medical work included the development of new forms of expertise, the stretching of expertise beyond previously well-defined professional boundaries, and shifts in the way in which medical professionals understand and interact with publics. These changes signified the rise of new relationships between the medical workers and their community, as well as adjustments in what were regarded as the boundaries of medical work. Given both the ubiquitous threat of disasters and calls for increased engagement between the medicine and the public, this case study provides insight into the forms which such engagements can take, especially when bound by conditions of uncertainty. The paper draws upon the theoretical literature around the impact of uncertainty on policy, and combines this with medical sociological literature on the nature of medical expertise. The paper examines the shifting of medical expertise towards mode 2 forms, and evidences the impact of a democratised science of risk on the roles and functions of medical practice.

scholarly journals Lessons from the COVID-19 pandemic for improving outpatient neuropalliative care: A qualitative study of patient and caregiver perspectives

2021 ◽  
pp. 026921632110173
Author(s):  
Zachary A Macchi ◽  
Roman Ayele ◽  
Megan Dini ◽  
Jensine Lamira ◽  
Maya Katz ◽  
...  
Keyword(s):  
Palliative Care ◽  
Qualitative Study ◽  
Care Delivery ◽  
Healthcare Delivery ◽  
Psychosocial Needs ◽  
Structured Interviews ◽  
Supportive Services ◽  
Care Needs ◽  
Survey Responses ◽  
The Impact

Background: COVID-19 has impacted persons with serious illness, including those with chronic, neurodegenerative conditions. While there are several reports on COVID-19’s impact on inpatient palliative care, literature is limited about the impact on outpatient care which may be more relevant for these patients. Aim: To generate a person-centered description of the impact of COVID-19 from the perspectives of patients living with neurodegenerative disease and caregivers to improve outpatient palliative care delivery. Design: This qualitative study used rapid analysis via matrix design to identify emergent themes related to participant perspectives on the challenges of COVID-19. Data sources included semi-structured interviews, open-ended survey responses, medical record documentation and participant-researcher communications. Setting/Participants: Data was collected from 108 patients with Parkinson’s disease, Alzheimer’s disease or related disorders and 90 caregivers enrolled in a multicenter, clinical trial of community-based, outpatient palliative care between March 20, 2020 and August 8, 2020 (NCT03076671). Results: Four main themes emerged: (1) disruptions to delivery of healthcare and other supportive services; (2) increased symptomatic and psychosocial needs; (3) increased caregiver burden; (4) limitations of telecommunications when compared to in-person contact. We observed that these themes interacted and intersected. Conclusions: Patients and caregivers have unmet care needs because of the pandemic, exacerbated by social isolation. While telemedicine has helped improve access to healthcare, patients and caregivers perceive clear limitations compared to in-person services. Changes in society and healthcare delivery in response to COVID-19 highlight ongoing and novel gaps that must be addressed to optimize future outpatient palliative care for neurologic illness.

scholarly journals Pre-transplant Psoas Muscle Density as a Ready-to-Use and Low-cost Predictor of Patient Survival After Liver Transplant

2021 ◽  
Vol 21 (4) ◽  
Author(s):  
Valentina Rosa Bertuzzo ◽  
Matteo Renzulli ◽  
Alfredo Clemente ◽  
Alessandro Cucchetti ◽  
Lorenzo Maroni ◽  
...  
Keyword(s):  
Liver Transplant ◽  
Low Cost ◽  
Clinical Care ◽  
Survival Rates ◽  
Postoperative Mortality ◽  
Psoas Muscle ◽  
Postoperative Outcome ◽  
Muscle Density ◽  
Explanted Liver ◽  
The Impact

Background: Sarcopenia, defined as low muscle mass with reduced function, is frequently encountered in cirrhotic patients and is a major predictor of adverse events, including post-liver transplant (LT) outcome. Objectives: This study assessed the impact of sarcopenia using computed tomography (CT)-based measurements on post-LT mortality and complications. Methods: From January 2008 to June 2016, 646 adult patients underwent 613 LTs at our institution. We analyzed the postoperative outcome of 287 patients who had pathologically proven cirrhosis on the explanted liver and who had performed a CT examination three months before LT. Psoas muscle density (PMD) was detected for every patient using standard instruments present in the radiological workstation and was related to postoperative survival rates and complications. Statistical analysis was carried out using the appropriate tests. Results: Postoperative mortality was 6.3%. At least one grade III-IV postoperative complication was experienced by 121 patients. Respiratory and infective complications occurred in 30 and 32 patients, respectively. Also, PMD was an independent predictor of postoperative mortality (P = 0.021), respiratory complications (P = 0.015), and infections (P = 0.010). The ROC analysis identified a PMD ≤ 43.72 HU as the best cutoff value for predicting 90-day mortality after LT. Conclusions: Psoas muscle density accurately predicted post-LT mortality and complications. Its ease and low-cost determination can allow widespread use of this parameter to improve clinical care and help with the decision to give these patients some priority on the transplant waiting list.

scholarly journals Decolonizing Diabetes

2019 ◽  
Vol 14 (2) ◽  
pp. 252-275
Author(s):  
Roger Stephen Pilon ◽  
Monique Benoit ◽  
Marion Maar ◽  
Sheila Cote ◽  
Fern Assinewe ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Lived Experience ◽  
Indigenous Peoples ◽  
Research Question ◽  
Structured Interviews ◽  
Northern Ontario ◽  
Main Research ◽  
The Impact ◽  
The Way

This article presents insights into the colonial experience of Indigenous Peoples living with type 2 diabetes within seven First Nation communities in Northern Ontario. A constructivist grounded theory methodology, guided by a decolonizing and participatory action approach to conducting research with Indigenous Peoples, was utilised in this study. Twenty-two individuals with type 2 diabetes were interviewed. The main research question explored the impact of colonization on the lived experience and perceptions about developing type 2 diabetes for Indigenous Peoples.  Using semi-structured interviews, the three main categories that emerged from the analysis of the interview transcripts were changing ways of eating, developing diabetes, and choosing your medicine.  A substantive theory was developed that suggests that Indigenous Peoples, with type 2 diabetes, often live with the perception that there is ‘no going back’ to the way things once were prior to European contact. As a result, they have adapted the way they live with diabetes which can, at times, be at odds with Indigenous world views. An adaptation that considers a complementary approach to the way individuals live and manage diabetes including both Traditional and Western ways may provide a framework for a decolonized model of type 2 diabetes care for Indigenous Peoples.

scholarly journals N27 What people want! Exploring inflammatory bowel disease patients’ perspectives on healthcare professionals addressing sexual well-being

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S669-S670
Author(s):  
S Fourie ◽  
W Czuber-Dochan ◽  
C Norton
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Healthcare Professionals ◽  
Clinical Care ◽  
Holistic Approach ◽  
Well Being ◽  
Structured Interviews ◽  
Time Space ◽  
Inflammatory Bowel ◽  
The Impact

Abstract Background Inflammatory bowel disease (IBD) affects every aspect of one’s life, yet no routine assessment for the impact on sexuality is made. Our aim was to explore patients’ perspective on healthcare professionals (HCPs) addressing sexuality/sexual well-being concerns. Methods This was a qualitative narrative study. Inclusion criteria were any sexual orientation and with known IBD for longer than 18 months. Data were collected via semi structured interviews and anonymous narrative accounts submitted via Google Forms. Thematic analysis was used to analyse the data. Results Fourteen adults, 4 male and 10 female, took part. Eleven participants were from the UK, one from the USA of America and one for South Africa. The following main themes and subthemes were identified: I cannot imagine talking about my sex life (a difficult topic; there is not enough time), Those who talked about sex, talked badly (nobody volunteered information; badly handled conversations), Still living whilst unwell (sex is an important part of my life; sex issues break down relationships, medicalised body), IBD ruined my sex life (feeling unattractive; feelings of shame and embarrassment), I feel unheard (HCPs don’t open the discussion; sex not taken seriously), I’m a person, not my IBD (holistic approach to care; time, space and ways to talk about sex). The findings reflect the importance of sexual well-being to those living with IBD, the experiences of such conversations, barriers to conversations with HCPs on sexual well-being, and suggestions on how HCPs should address their unmet needs. The importance of discussing intimacy and sexuality was emphasised, as participants felt their sexual well-being was considerably affected by IBD. The majority reported that HCPs did not initiate discussions on sexual well-being, nor did they understand the impact of IBD on sexual well-being, with a distinct accent on the perceived lack of a holistic approach to their care. Therefore, participants made suggestions for practice, such as provision of information related to sexual well-being in the form of leaflets, additionally to HCPs raising the issue. Conclusion Our findings indicate that communicating on sexuality/sexual well-being is a problematic area of IBD care. HCPs must be cognisant of the sexual well-being concerns and needs of those living with IBD, who want this topic discussed routinely, as part of a holistic approach to their clinical care.

scholarly journals Mixed methods evaluation of the impact of the COVID-19 ICU remote-learning rehabilitation course for frontline health professionals during the COVID-19 pandemic in the UK

2021 ◽  
pp. 175114372110430
Author(s):  
Evelyn J Corner ◽  
Xiaoxi Zhang ◽  
Zoe Van Willigen ◽  
Kate Tatam ◽  
Matthew Camilleri ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Mixed Methods ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Clinical Care ◽  
Real Term ◽  
Structured Interviews ◽  
The Impact ◽  
Rehabilitation Strategies ◽  
Remote Learning

Background Optimising outcomes for critically ill patients with COVID-19 patients requires early interdisciplinary rehabilitation. As admission numbers soared through the pandemic, the redeployed workforce needed rapid, effective training to deliver these rehabilitation interventions. Methods The COVID-19 ICU Remote-Learning Rehab Course (CIRLC-rehab) is a one-day interdisciplinary course developed after the success of CIRLC-acute. The aim of CIRLC-rehab was to rapidly train healthcare professionals to deliver physical, nutritional and psychological rehabilitation strategies in the ICU/acute setting. The course used blended learning with interactive tutorials delivered by shielding critical care professionals. CIRLC-rehab was evaluated through a mixed-methods approach, including questionnaires, and follow-up semi-structured interviews to evaluate perceived impact on clinical practice. Quantitative data are reported as n (%) and means (SD). Inductive descriptive thematic analysis with methodological triangulation was used to analyse the qualitative data from the questionnaires and interviews. Results 805 candidates completed CIRLC-rehab. 627 (78.8%) completed the post-course questionnaire. 95% ( n = 596) found CIRLC-rehab extremely or very useful and 96.0% ( n = 602) said they were very likely to recommend the course to colleagues. Overall confidence rose from 2.78/5 to 4.14/5. The course promoted holistic and humanised care, facilitated informal networks, promoted interdisciplinary working and equipped the candidates with practical rehabilitation strategies that they implemented into clinical practice. Conclusion This pragmatic solution to educating redeployed staff during a pandemic increased candidates’ confidence in the rehabilitation of critically ill patients. There was also evidence of modifications to clinical care utilising learning from the course that subjectively facilitated holistic and humanised rehabilitation, combined with the importance of recognising the humanity, of those working in ICU settings themselves. Whilst these data are self-reported, we believe that this work demonstrates the real-term benefits of remote, scalable and rapid educational delivery.

Utility of Schwartz Center Rounds in fostering compassion, communication, teamwork, and caregiver support

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e20640-e20640
Author(s):  
P. Mann ◽  
L. Schapira ◽  
T. Lynch ◽  
R. Penson
Keyword(s):  
Patient Care ◽  
Social Issues ◽  
Clinical Care ◽  
Cancer Center ◽  
Clinical Aspects ◽  
Structured Interviews ◽  
Caregiver Support ◽  
Emotional Issues ◽  
The Impact ◽  
Insight Into

e20640 Background: Schwartz Center Rounds are a multidisciplinary forum where clinicians discuss difficult emotional and social issues that arise in caring for patients with the goal of improving the patient-caregiver relationship. Rounds were initiated at the MGH Cancer Center in 1997 and have since grown to include 165 sites including 24 cancer centers nationwide. We report on a recent evaluation of the impact of Rounds. Methods: The Schwartz Center Rounds evaluation focused on three major research questions: 1) Do professional caregivers have increased insight into the non-clinical aspects of care after attendance at Rounds? 2) Is there increased teamwork among caregivers after attendance? 3) Do caregivers perceive increased support after attendance at Rounds? The evaluation included a retrospective survey of 256 caregivers at six sites where Rounds had existed for ≥ 3 years; 44 semi-structured interviews with participants at these sites; and pre/post surveys of 222 caregivers from ten hospitals newly implementing Rounds. Results: The highest percentage of attendees were nurses (35%), followed by physicians (23%), social workers (15%), psychologists (4%), physical therapists (6%) and clergy (5%). After attending Rounds, participants reported increased insight into psychosocial aspects of care; enhanced compassion; increased ability to respond to patients’ social and emotional issues; enhanced communication amongst caregivers; greater appreciation of colleagues’ roles and contributions. Attendees reported decreased feelings of stress and isolation and a greater sense of teamwork. Participants reported that Rounds discussions led to changes in institutional practices or policies. Conclusions: Schwartz Center Rounds provide a forum for discussion of challenging psychosocial and emotional issues arising during clinical care. Evaluation data suggests this educational strategy may enhance compassion, professional support, communication, teamwork, and instigate institutional changes that enhance patient care. We are currently exploring other outcomes, including but not limited to the impact of rounds on quality of patient care and patient safety. [Table: see text]

scholarly journals An exploration of the experiences of GP registrar supervisors in small rural communities: a qualitative study

2019 ◽  
Author(s):  
Danielle Couch ◽  
Belinda O’Sullivan ◽  
Deborah Russell ◽  
Matthew McGrail ◽  
Glen Wallace ◽  
...  
Keyword(s):  
Rural Communities ◽  
Rural Areas ◽  
Clinical Care ◽  
Rural Practice ◽  
Structured Interviews ◽  
Training Systems ◽  
Potential Factor ◽  
Access To Primary Care ◽  
The Impact

Abstract Background: In Australia registrar training to become a general practitioner (GP) involves three to four years of supervised learning with at least 50% of GP registrars training wholly in rural areas. These rural placements are important for developing the broad skills needed for effective rural practice. Having enough rural GP supervisors is essential to enable rural GP training to occur. We aimed to explore what makes GPs’ participate in supervising or not, their experiences of supervising, and the impact of their practice context. Methods: Semi-structured interviews were undertaken with 25 GPs based in rural Tasmania, all in towns of <25,000 population, to explore the GPs’ professional backgrounds, their experiences of supervising GP registrars, their practice context and their decisions about supervising GP registrars or not. Thematic analysis was undertaken; key ideas, concepts and experiences were identified and then reviewed and further refined to core themes. Results: Supervising was perceived to positively impact on quality of clinical care, reduce busy-ness and improve patient access to primary care. It was energising for GPs working in rural contexts. Rural GPs noted business factors as impacting both the decision to participate in supervision and the experience of participating: including uncertainty of registrar supply, discontinuity of registrar supply within rotational training systems, registrar competence and business income generation. Conclusions: Supervising is strongly positive for rural GPs and a potential factor related to their work satisfaction but increasing supervision capacity in rural areas may depend on supervision policies and systems which promote more viable supervision models tailored to the business needs of rural GPs and their practice context.

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