scholarly journals Barriers-enablers-ownership approach: a mixed methods analysis of a social intervention to improve surgical antibiotic prescribing in hospitals

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e046685
Author(s):  
Jennifer Broom ◽  
Alex Broom ◽  
Chris Anstey ◽  
Katherine Kenny ◽  
Sharon Young ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Antibiotic Prophylaxis ◽  
Qualitative Interviews ◽  
Qualitative Evaluation ◽  
Antibiotic Prescribing ◽  
Time Points ◽  
Guideline Compliance ◽  
Surgical Antibiotic Prophylaxis ◽  
Time Periods ◽  
Surgical Teams

ObjectivesTo assess an intervention for surgical antibiotic prophylaxis (SAP) improvement within surgical teams focused on addressing barriers and fostering enablers and ownership of guideline compliance.DesignThe Queensland Surgical Antibiotic Prophylaxis (QSAP) study was a multicentre, mixed methods study designed to address barriers and enablers to SAP compliance and facilitate engagement in self-directed audit/feedback and assess the efficacy of the intervention in improving compliance with SAP guidelines. The implementation was assessed using a 24-month interrupted time series design coupled with a qualitative evaluation.SettingThe study was undertaken at three hospitals (one regional, two metropolitan) in Australia.ParticipantsSAP-prescribing decisions for 1757 patients undergoing general surgical procedures from three health services were included. Six bimonthly time points, pre-implementation and post implementation of the intervention, were measured. Qualitative interviews were performed with 29 clinical team members. SAP improvements varied across site and time periods.InterventionQSAP embedded ownership of quality improvement in SAP within surgical teams and used known social influences to address barriers to and enablers of optimal SAP prescribing.ResultsThe site that reported senior surgeon engagement showed steady and consistent improvement in prescribing over 24 months (prestudy and poststudy). Multiple factors, including resource issues, influenced engagement and sites/time points where these were present had no improvement in guideline compliance.ConclusionsThe barriers-enablers-ownership model shows promise in its ability to facilitate prescribing improvements and could be expanded into other areas of antimicrobial stewardship. Senior ownership was a predictor of success (or failure) of the intervention across sites and time periods. The key role of senior leaders in change leadership indicates the critical need to engage other specialties in the stewardship agenda. The influence of contextual factors in limiting engagement clearly identifies issues of resource distributions/inequalities within health systems as limiting antimicrobial optimisation potential.

scholarly journals Stress and Pain Before, During and After the First Wave of the COVID-19 Pandemic: An Exploratory Longitudinal Mixed Methods Study

2021 ◽  
Vol 2 ◽  
Author(s):  
M. Gabrielle Pagé ◽  
Lise Dassieu ◽  
Élise Develay ◽  
Mathieu Roy ◽  
Étienne Vachon-Presseau ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Physiological Stress ◽  
Pain Catastrophizing ◽  
Qualitative Interviews ◽  
Management Strategies ◽  
Subjective Feeling ◽  
Time Points ◽  
Pain Scores ◽  
Pain Status ◽  
Physiological Stress Response

Aims: This study explores the association between subjective feeling of stress and pain experience in the context of the COVID-19 pandemic with a focus on characteristics known to trigger a physiological stress response [sense of low control, threat to ego, unpredictability and novelty (STUN)].Methods: This exploratory longitudinal convergent mixed methods design consisted of online questionnaires over three time points (before, during and after the 1st wave of the COVID-19 pandemic) (N = 49) and qualitative interviews (N = 27) during the 1st wave of the pandemic on distinct samples of individuals living with chronic pain (CP). Both types of data sources were mixed upon integration using joint display.Results: Mean pain intensity scores remained stable across time points, while pain unpleasantness and pain interference scores significantly improved. Global impression of change scores measured during the first wave of the pandemic do not entirely concord with pain scores evolution. Two thirds of participants reported a global deterioration of their pain condition at the beginning of the pandemic. Stress and pain catastrophizing before the pandemic were associated with pain scores throughout the pandemic; while most specific measures of stress due to the novel, uncontrollable, unpredictable and threatening nature of the pandemic were not. Qualitative data demonstrated that the deterioration reported in pain status reflected additional dimensions, including spatial expansion of the painful area, reduced access to treatments and challenges in adapting pain management strategies.Conclusions: Helping individuals to negotiate stressful aspects of the pandemic might help offset the negative impacts of stress on pain status in this context or other important life events.

scholarly journals An observational study on the surgical antibiotic prophylaxis in the surgery ward of a tertiary care hospital

2019 ◽  
Vol 8 (7) ◽  
pp. 1647
Author(s):  
Aditi A. Kudchadkar ◽  
Sushama A. Bhounsule
Keyword(s):  
Observational Study ◽  
Antibiotic Prophylaxis ◽  
Tertiary Care ◽  
Tertiary Hospital ◽  
Antibiotic Prescribing ◽  
Care Hospital ◽  
National Guidelines ◽  
Surgical Prophylaxis ◽  
Significant Burden ◽  
Surgical Antibiotic Prophylaxis

Background: Surgical site infection (SSI) is the most common postoperative complication and represents a significant burden in terms of patient morbidity, mortality and cost to health services around the world. Appropriate antibiotic prophylaxis helps in reducing the incidence of SSIs. Appropriate surgical prophylaxis is a multifactorial process that depends on proper case selection, antibiotic selection including dosing and route of administration and duration of therapy.Methods: A prospective observational study was conducted over 3 months on 200 operated patients in surgery ward of a tertiary hospital. Patient details like demography, type of surgery performed and antibiotics prescribed pre and post-surgical procedure was collected and analysed using Microsoft excel.Results: Out of 200 patients 32.5% (65) were females and 67.5% (135) were males. Total number of prophylactic antibiotics prescribed were 368. The most commonly prescribed group of antibiotics was cephalosporins (44.29%) followed by metronidazole (26.5%) and ofloxacin (9.48%). Among the cephalosporins the most commonly prescribed was cefuroxime in 82 patients (50.3%) and cefoperazone in 79 patients (48.46%). SSI developed in 3 out of 200 patients (1.5%).Conclusions: There is an urgent requirement to promote rational antibiotic prescribing among surgeons. The need of the hour is developing and implementing national guidelines for surgical prophylaxis by a multidisciplinary group of experts.

scholarly journals Friend or Foe: Perceptions of Infectious Disease Specialists as Stewards and Social Determinants of Antimicrobial Prescribing

2020 ◽  
Vol 41 (S1) ◽  
pp. s236-s237
Author(s):  
Cora Constantinescu ◽  
Caitlyn Cook Furr ◽  
Joseph Vayalumkal ◽  
John Conly ◽  
Elaine Gilfoyle ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Social Determinants ◽  
Mixed Methods Research ◽  
Clinical Teaching ◽  
Qualitative Interviews ◽  
Inappropriate Prescribing ◽  
Antibiotic Prescribing ◽  
Duration Of Treatment ◽  
Prescribing Behavior ◽  
Antimicrobial Prescribing

Background: Inappropriate prescribing behavior can be associated with higher rates of antibiotic resistance, calling for detailed studies on how physicians make prescribing decisions. We conducted a mixed-methods study to investigate physician antibiotic prescribing behavior in a 141-bed pediatric hospital. Methods: We applied a mixed-methods research design. The quantitative phase was conducted over a 6-month period to identify cases of inappropriate prescribing. The qualitative phase comprised 22 qualitative interviews with clinical teaching units (CTU) and pediatric intensive care unit (PICU) team members (physicians and pharmacists). Two coders analyzed the data deductively using the theoretical domain framework (TDF), as well as the social determinants of antimicrobial prescribing (SDAP). Results: In 52.9% of the 36 identified cases in the CTU and 31.4% of the 37 cases in the PICU, an infectious diseases (ID) consultation occurred. Compliance rates with ID recommendations were 79% and 91% in the CTU and PICU, respectively. The CTU and PICU expressed appreciation for ID involvement when ID supported their de-escalation choices in complex cases and in cases in which less commonly known antibiotics were used. However, the ID service involvement was perceived as detrimental to antimicrobial prescribing decisions for CTU and PICU across 3 of the 4 SDAP domains (Fig. 1, qualitative research quotes). Relationship between clinicians: CTU physicians and pharmacists perceived ID involvement as negatively impacting the relationship of the team. Antimicrobial decisions were automatically defaulted to ID, whereas pharmacy involvement was disregarded and the decisions were delayed. Risk, fear, and emotion: These were experienced across all respondents’ groups that identified ID specialists’ egos and personalities as contrary to open collaborative discussion on antimicrobial decisions. (Mis)perception of the problem: ID physicians were identified as more conservative in their antimicrobial choices, leading to prolonged duration of treatment, broader choices, and longer hospitalizations. The CTU and pharmacy respondents felt that ID recommendations were inconsistent among physicians and deviated from guidelines with little justification. Conclusions: Although CTU and PICU teams tend to comply with ID prescribing recommendations and ID involvement with complicated cases, pharmacists, CTU physicians, and PICU physicians perceived ID consultations to negatively affect collaborative efforts for stewardship. These findings offer novel insights into how an ID service can improve its role to positively affect appropriate prescribing. CTU and PICU respondents called for a supportive and trusting relationship with the ID service as a major driver for behavioral change and enhanced stewardship.Funding: NoneDisclosures: None

A Mixed Methods Examination of Sleep Throughout the Alcohol Recovery Process Grounded in the Social Cognitive Theory: The Role of Self-Efficacy and Craving

2018 ◽  
Vol 46 (1) ◽  
pp. 126-136 ◽  
Author(s):  
Alyssa T. Brooks ◽  
Michael Krumlauf ◽  
Kenneth H. Beck ◽  
Craig S. Fryer ◽  
Li Yang ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Alcohol Use ◽  
Sleep Quality ◽  
Self Efficacy ◽  
Sleep Disturbances ◽  
Cognitive Theory ◽  
Qualitative Interviews ◽  
Alcohol Use Disorders ◽  
Personal Factors ◽  
Time Points

Sleep disturbances can accompany alcohol use disorders during various phases of the disease. This analysis utilized a mixed methods approach to assess whether sleep-related beliefs and/or behavior of individuals who are alcohol dependent were associated with sleep quality both pre- and postdischarge from a clinical research facility providing inpatient alcohol rehabilitation treatment. Individuals with higher self-efficacy for sleep (SE-S) reported better sleep quality at both time points. Individuals with fewer dysfunctional beliefs about sleep had poorer sleep quality at both time points. Individuals with higher unhealthy sleep-related safety behaviors had poorer sleep quality at both time points. In a linear regression model, only the difference in SE-S scores from pre- to postdischarge (β = −.396, p = .01) and the postdischarge Penn Alcohol Craving Score (β = .283, p = .019) significantly predicted the change in sleep quality. Thus, those whose SE-S scores increased and those with lower postdischarge craving scores were more likely to experience a decrease on Pittsburgh Sleep Quality Index scores from pre- to postdischarge even after controlling for covariates. References to behavior or personal factors were often discussed during the qualitative interviews in tandem with the environment. Participants reported both (1) self-medicating anxiety with alcohol and (2) self-medicating the inability to fall asleep with alcohol. Given the success of behavioral sleep interventions in various populations and the unique potential contributions of mixed methods approaches to examine sleep and alcohol use, assessing sleep-related cognitions and behaviors of individuals with severe alcohol use disorders may be important in understanding sleep quality and subsequent relapse.

scholarly journals Assessment of implementation of antibiotic stewardship program in surgical prophylaxis at a secondary care hospital in Ras Al Khaimah, United Arab Emirates

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hessa Saleh Alshehhi ◽  
Areeg Anwer Ali ◽  
Duaa Salem Jawhar ◽  
Essam Mahran Aly ◽  
Srinivas Swamy ◽  
...  
Keyword(s):  
Antibiotic Prophylaxis ◽  
United Arab Emirates ◽  
Antibiotic Stewardship ◽  
Secondary Care ◽  
Care Hospital ◽  
Surgical Prophylaxis ◽  
Patient Profile ◽  
Stewardship Program ◽  
Prescribing Practice ◽  
Surgical Antibiotic Prophylaxis

AbstractAntibiotic overuse is a major factor for causing antibiotic resistance globally. However, only few studies reported the implementation and evaluation of antimicrobial stewardship programs in Gulf Cooperation Council. This study was conducted within 8-months periods to evaluate the effect of the newly implemented antibiotic stewardship program on improving the prescribing practice of surgical antibiotic prophylaxis in a secondary care hospital in the United Arab Emirates by releasing local hospital guidelines. The data of 493 in patients were documented in the predesigned patient profile form and the prescribing practice of surgical antibiotic prophylaxis for clean and clean-contaminant surgical procedures was compared and analyzed two months’ prior (period A) and post (period B) the implementation of antibiotic stewardship program. The 347 patient’s data (PD) were analyzed during period A and 146 PD during period B. The prescription of piperacillin/tazobactam was decreased from 2.4% from all surgical prophylaxis antibiotic orders in period A to 0% in period B. The appropriateness of the antibiotic therapy was found to differ non significantly for the selection of prophylactic antibiotic (p = 0.552) and for the timing of first dose administration (p = 0.061) between A and B periods. The total compliance was decreased non significantly (P = 0.08) from 45.3 to 40.2%. Overall, the guidelines have improved the prescribing practice of antibiotics prior to surgery. However, further improvement can be achieved by initiating educational intervention via cyclic auditing strategy.

Management of e-resources in academic libraries in Ghana: Copyright implications

IFLA Journal ◽  
2021 ◽  
pp. 034003522110271
Author(s):  
Theresa L Adu ◽  
Thomas B van der Walt
Keyword(s):  
Distance Education ◽  
Mixed Methods ◽  
Distance Learning ◽  
Academic Libraries ◽  
Online Courses ◽  
Qualitative Interviews ◽  
Digital Resources ◽  
Mixed Methods Approach ◽  
Sequential Mixed Methods ◽  
Library Staff

This study investigated the copyright issues surrounding the management of e-resources in academic libraries in Ghana. Forty-seven library staff and head librarians from four academic libraries were engaged using questionnaires and qualitative interviews in a sequential mixed-methods approach to generate data for this study. The findings indicate that in all four institutions copyright issues arose with the provision of distance learning, online courses and e-reserves services. All the respondents stated that they or their colleagues had had faculty ask questions on copyright issues. However, the professional librarians indicated that the library was not consulted and the instructors for online courses or distance education programmes did not cooperate with librarians; rather, the department posting the materials made the decisions on copyright regarding the usage of digital resources for distance learning, online courses or e-reserves. This does not augur well for the management of copyright of e-resources in academic libraries in Ghana.

scholarly journals Advancing engagement and capacity for rural cancer control: a mixed-methods case study of a Community-Academic Advisory Board in the Appalachia region of Southwest Virginia

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Jamie M. Zoellner ◽  
Kathleen J. Porter ◽  
Donna-Jean P. Brock ◽  
Emma Mc Kim Mitchell ◽  
Howard Chapman ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Cancer Screening ◽  
Cancer Control ◽  
Value Added ◽  
Advisory Board ◽  
Comprehensive Cancer Control ◽  
Structured Interviews ◽  
Human Papillomavirus Vaccination ◽  
Time Points

Abstract Background The objectives are to: 1) describe engagement processes used to prioritize and address regional comprehensive cancer control needs among a Community-Academic Advisory Board (CAB) in the medically-underserved, rural Appalachian region, and 2) detail longitudinal CAB evaluation findings. Methods This three-year case study (2017–2020) used a convergent parallel, mixed-methods design. The approach was guided by community-based participatory research (CBPR) principles, the Comprehensive Participatory Planning and Evaluation process, and Nine Habits of Successful Comprehensive Cancer Control Coalitions. Meeting artifacts were tracked and evaluated. CAB members completed quantitative surveys at three time points and semi-structured interviews at two time points. Quantitative data were analyzed using analysis of variance tests. Interviews were audio recorded, transcribed, and analyzed via an inductive-deductive process. Results Through 13 meetings, Prevention and Early Detection Action Teams created causal models and prioritized four cancer control needs: human papillomavirus vaccination, tobacco control, colorectal cancer screening, and lung cancer screening. These sub-groups also began advancing into planning and intervention proposal development phases. As rated by 49 involved CAB members, all habits significantly improved from Time 1 to Time 2 (i.e., communication, priority work plans, roles/accountability, shared decision making, value-added collaboration, empowered leadership, diversified funding, trust, satisfaction; all p < .05), and most remained significantly higher at Time 3. CAB members also identified specific challenges (e.g., fully utilizing member expertise), strengths (e.g., diverse membership), and recommendations across habits. Conclusion This project’s equity-based CBPR approach used a CPPE process in conjunction with internal evaluation of cancer coalition best practices to advance CAB efforts to address cancer disparities in rural Appalachia. This approach encouraged CAB buy-in and identified key strengths, weaknesses, and opportunities that will lay the foundation for continued involvement in cancer control projects. These engagement processes may serve as a template for similar coalitions in rural, underserved areas.

The Path to Adulthood: A Mixed-Methods Approach to the Exploration of the Experiences of Unaccompanied Minors in Portugal

2021 ◽  
Author(s):  
Carla Moleiro ◽  
Sandra Roberto
Keyword(s):  
Young Adults ◽  
Mixed Methods ◽  
Residential Care ◽  
Host Country ◽  
Qualitative Interviews ◽  
Autobiographical Narratives ◽  
Unaccompanied Minors ◽  
Mixed Methods Approach ◽  
Age Of Majority ◽  
The Voice

Abstract Unaccompanied minors who reach the age of majority often experience this transition as a complex stage. Insecurity and helplessness may arise and, in some cases, survival without the support of the institutions and services that previously protected them as minors in the host country may mean becoming at risk for social exclusion. The objective of the present study was to characterize unaccompanied minors in Portugal (N = 67) and understand the processes of transition into the age of majority, using a mixed-methods approach. Quantitative (survey) and qualitative (interviews on autobiographical narratives) methodologies were used as a means of acknowledging the voice of minors/young adults in their trajectories and experiences. Two groups were included, with minors (in residential care) and youths who had already reached adulthood (living independently). Results illustrate diverse reasons for arrival in Portugal and distinct strengths and struggles in the integration experiences, with both positive and negative aspects being identified in the transition to autonomy.

scholarly journals A Qualitative Evaluation of Adverse Drug Reaction Reporting System in Pakistan: Findings from the Nurses’ Perspective

2020 ◽  
Vol 17 (9) ◽  
pp. 3039
Author(s):  
Rabia Hussain ◽  
Mohamed Azmi Hassali ◽  
Anees ur Rehman ◽  
Jaya Muneswarao ◽  
Muhammad Atif ◽  
...  
Keyword(s):  
Adverse Drug Reaction ◽  
Drug Reaction ◽  
Healthcare Professionals ◽  
Reporting System ◽  
Adverse Drug Reaction Reporting ◽  
Qualitative Interviews ◽  
Qualitative Evaluation ◽  
Adr Reporting ◽  
Willingness To Report ◽  
And Training

The contribution of all key healthcare professionals is vital to promote an efficient adverse drug reaction (ADR) reporting system. In this context, nurses are important as they are in a better position to observe a patient’s response regarding the drug therapy and to report an ADR. The aim of the study was to explore the perspectives of nurses about ADR reporting system in Lahore, Pakistan. A total of 21 nurses were interviewed. The thematic content analysis of the qualitative interviews yielded six major themes and eight subthemes. Major themes included: (1) Knowledge about the concept of the medication safety & the ADR; (2) Knowledge regarding pharmacovigilance activities; (3) Willingness to report; (4) Practices related to the ADR reporting; (5) Barriers to the ADR reporting; (6) Facilitators to the ADR reporting. The majority of the nurses were aware of medicine safety and ADRs, but in many cases, they were unable to report these ADRs. The study pointed out considerable concerns regarding the knowledge and practices of nurses about pharmacovigilance activities in their workplace, mainly due to increased workload, due to the absence of a reporting system and legal liability. The main challenges turned out to be the lack of knowledge and training, as well as the implementation of guidelines. Based on the findings, it is suggested that outcome of this study can serve as a guide to design policies that support ADR reporting by nurses in Pakistan.

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