Using the Functional Resonance Analysis Method to explore how elastic compression therapy is organised and could be improved from a multistakeholder perspective

ObjectivesElastic compression stocking (ECS) therapy is an important treatment for patients with deep venous thrombosis (DVT) and chronic venous insufficiency (CVI). This study aimed to provide insight into the structure and variability of the ECS therapy process, its effects on outcomes, and to elicit improvement themes from a multiple stakeholder perspective.DesignThirty semi-structured interviews with professionals and patients were performed. The essential functions for the process of ECS therapy were extracted to create two work-as-done models using the Functional Resonance Analysis Method (FRAM). These findings were used to guide discussion between stakeholders to identify improvement themes.SettingTwo regions in the Netherlands, region Limburg and region North-Holland, including an academic hospital and a general hospital and their catchment region.ParticipantsThe interviewees were purposely recruited and included 25 healthcare professionals (ie, general practitioners, internists, dermatologists, nurses, doctor’s assistants, occupational therapists, home care nurses and medical stocking suppliers) and 5 patients with DVT or CVI.ResultsTwo FRAM models were created (one for each region). The variability of the functions and their effect on outcomes, as well as interdependencies between functions, were identified. These were presented in stakeholder meetings to identify the structure of the process and designated variable and uniform parts of the process and its outcomes. Ultimately, six improvement themes were identified: dissemination of knowledge of the entire process; optimising and standardising initial compression therapy; optimising timing to contact the medical stocking supplier (when oedema has disappeared); improving the implementation of assistive devices; harmonising follow-up duration for patients with CVI; personalising follow-up and treatment duration in patients with DVT.ConclusionsThis study provided a detailed understanding of how ECS therapy is delivered in daily practice by describing major functions and variability in performances and elicited six improvement themes from a multistakeholder perspective.

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Diarrhoea Management using Over-the-counter Nutraceuticals in Daily practice (DIAMOND): a feasibility RCT on alternative therapy to reduce antibiotic use

Pilot and Feasibility Studies ◽

10.1186/s40814-021-00850-y ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Yanhong Jessika Hu ◽

Xudong Zhou ◽

Shanjuan Wang ◽

Merlin Willcox ◽

Colin Garner ◽

...

Keyword(s):

Controlled Trial ◽

Alternative Therapy ◽

Acute Diarrhoea ◽

Final Analysis ◽

Daily Practice ◽

Antibiotic Use ◽

Symptom Duration ◽

Structured Interviews ◽

Double Blind

Abstract Background Although rarely indicated, antibiotics are commonly used for acute diarrhoea in China. We conducted a randomised, double blind exploratory clinical trial of loperamide, berberine and turmeric for treatment of acute diarrhoea. Methods Adults with acute uncomplicated diarrhoea aged 18 to 70 were randomised to 4 groups: (A) loperamide; (B) loperamide and berberine; (C) loperamide and turmeric; (D) loperamide, berberine and turmeric. All participants were given rescue ciprofloxacin for use after 48 h if symptoms worsened or were unimproved. Primary endpoints were feasibility and ciprofloxacin use during the 2-week follow-up period. Semi-structured interviews were conducted following recruitment and were analysed thematically. Recruiting doctors, delivery pharmacists and research assistants were blinded to treatment allocation. Results Only 21.5% (278/1295) of patients screened were deemed eligible, and 49% (136/278) of these consented and were entered into the final analysis. Most participants had mild symptoms, because most patients with moderate or severe symptoms wanted to be given antibiotics. Follow-up was good (94% at 2 weeks). Only three participants used rescue antibiotics compared to 67% of acute diarrhoea patients in the hospital during the recruitment period. The median symptom duration was 14 h in group B (interquartile range (IQR) 10-22), 16 h in group D (IQR 10-22), 18 h in group A (IQR 10-33) and 20 h in group C (IQR 16-54). Re-consultation rates were low. There were no serious treatment-related adverse events. Most interviewed participants said that although they had believed antibiotics to be effective for diarrhoea, they were surprised by their quick recovery without antibiotics in this trial. Conclusion Although recruitment was challenging because of widespread expectations for antibiotics, patients with mild diarrhoea accepted trying an alternative. The three nutraceuticals therapy require further evaluation in a fully powered, randomised controlled trial among a broader sample. Trial registration ChiCTR-IPR-17014107

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Job Stress in Occupational Therapy: Coping Strategies, Stress Management Techniques and Recommendations for Change

British Journal of Occupational Therapy ◽

10.1177/030802269305600409 ◽

1993 ◽

Vol 56 (4) ◽

pp. 140-145 ◽

Cited By ~ 16

Author(s):

Grace M Sweeney ◽

Keith A Nichols ◽

Maggie Cormack

Keyword(s):

Occupational Therapy ◽

Coping Strategies ◽

Social Services ◽

Job Stress ◽

Occupational Therapists ◽

Postal Survey ◽

Structured Interviews ◽

District Health ◽

Management Techniques

This article, the second in a series of two on job stress in occupational therapy, reports the results of 30 semi-structured interviews with a random sample of occupational therapists from the Bath District Health Authority and selected local authority social services departments. All 30 subjects had participated in a larger study which set out to identify the factors contributing to job stress in this professional group,1 and the follow-up interviews aimed to examine coping strategies which were used by the subjects in their work situation. This is an applied article, where the attempt is to distil the main findings of the combined studies (the postal survey and the interviews) to recover information that can be made available to occupational therapy managers and to clinical occupational therapists.

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Implementing Structured Follow-Up of Neonatal and Paediatric Patients: An Evaluation of Three University Hospital Case Studies Using the Functional Resonance Analysis Method

10.21203/rs.3.rs-408416/v2 ◽

2021 ◽

Author(s):

Véronique Bos ◽

Daniëlle Roorda ◽

Eleonore de Sonnaville ◽

Menne van Boven ◽

Jaap Oosterlaan ◽

...

Keyword(s):

Intensive Care ◽

Analysis Method ◽

Long Term Outcomes ◽

Resonance Analysis ◽

Follow Up Care ◽

Long Term Follow Up ◽

And Performance ◽

Programme Effectiveness

Abstract Background: In complex neonatal and paediatric clinical practice, little is known about long-term patient outcomes and what follow-up care is most valuable for patients. Emma Children’s Hospital, Amsterdam UMC (Netherlands), implemented a follow-up programme called Follow Me for neonatal and paediatric patient groups, to gain more insight into long-term outcomes and to use such outcomes to implement a learning cycle for clinical practice, improve follow-up care and facilitate research. Three departments initiated re-engineering and change processes. Each introduced multidisciplinary approaches to long-term follow-up, including regular standardised check-ups for defined age groups, based on medical indicators, developmental progress, and psychosocial outcomes in patients and their families. This research evaluates the implementation of the three follow-up programmes, comparing predefined procedures (work-as-imagined) with how the programmes were implemented in practice (work-as-done). Methods: This study was conducted in 2019–2020 in the outpatient settings of the neonatal intensive care, paediatric intensive care and paediatric surgery departments of Emma Children’s Hospital. It focused on the organisational structure of the follow-up care. The functional resonance analysis method (FRAM) was applied, using documentary analysis, semi-structured interviews, observations and feedback sessions.Results: One work-as-imagined model and four work-as-done models were described. The results showed vast data collection on medical, developmental and psychosocial indicators in all work-as-done models; however, process indicators for programme effectiveness and performance were missing. In practice there was a diverse allocation of roles and responsibilities and their interrelations to create a multidisciplinary team; there was no one-size-fits-all. Although control and feedback loops for long-term outcomes were specified with respect to the follow-up groups within the programmes, they were found to overlap and misalign with other internal and external long-term outcome monitoring practices. Conclusion: Implementing structured long-term follow-up may provide insights for improving daily practice and follow-up care, with the precondition of standardised measurements. Lessons learned from practice are (1) to address fragmentation in data collection and storage, (2) to incorporate the diverse ways to create a multidisciplinary team in practice, and (3) to include timely actionable indicators on programme effectiveness and performance, alongside medical, developmental and psychosocial indicators.

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Can using the functional resonance analysis method, as an intervention, improve patient safety in hospitals?: a stepped wedge design protocol

BMC Health Services Research ◽

10.1186/s12913-021-07244-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Liselotte M. van Dijk ◽

Meggie D. Meulman ◽

Linda van Eikenhorst ◽

Hanneke Merten ◽

Bernadette C. F. M. Schutijser ◽

...

Keyword(s):

Patient Safety ◽

Healthcare Professionals ◽

Improve Patient Safety ◽

Organisational Change ◽

Daily Practice ◽

Analysis Method ◽

Stepped Wedge ◽

Stepped Wedge Design ◽

Resonance Analysis ◽

Hospital Protocols

Abstract Background Healthcare professionals are sometimes forced to adjust their work to varying conditions leading to discrepancies between hospital protocols and daily practice. We will examine the discrepancies between protocols, ‘Work As Imagined’ (WAI), and daily practice ‘Work As Done’ (WAD) to determine whether these adjustments are deliberate or accidental. The discrepancies between WAI and WAD can be visualised using the Functional Resonance Analysis Method (FRAM). FRAM will be applied to three patient safety themes: risk screening of the frail older patients; the administration of high-risk medication; and performing medication reconciliation at discharge. Methods A stepped wedge design will be used to collect data over 16 months. The FRAM intervention consists of constructing WAI and WAD models by analysing hospital protocols and interviewing healthcare professionals, and a meeting with healthcare professionals in each ward to discuss the discrepancies between WAI and WAD. Safety indicators will be collected to monitor compliance rates. Additionally, the potential differences in resilience levels among nurses before and after the FRAM intervention will be measured using the Employee Resilience Scale (EmpRes) questionnaire. Lastly, we will monitor whether gaining insight into differences between WAI and WAD has led to behavioural and organisational change. Discussion This article will assess whether using FRAM to reveal possible discrepancies between hospital protocols (WAI) and daily practice (WAD) will improve compliance with safety indicators and employee resilience, and whether these insights will lead to behavioural and organisational change. Trial registration Netherlands Trial Register NL8778; https://www.trialregister.nl/trial/8778. Registered 16 July 2020. Retrospectively registered.

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Diarrhoea Antibiotic Management Using Over-the-Counter Nutraceuticals in Daily Practice (DIAMOND): A Feasibility RCT on Alternative Therapy to Reduce Antibiotic Use

10.20944/preprints202010.0280.v1 ◽

2020 ◽

Author(s):

Yanhong Jessika Hu ◽

Xudong Zhou ◽

Shanjuan Wang ◽

Merlin Willcox ◽

Colin Garner ◽

...

Keyword(s):

Controlled Trial ◽

Alternative Therapy ◽

Acute Diarrhoea ◽

Final Analysis ◽

Daily Practice ◽

Antibiotic Use ◽

Symptom Duration ◽

Structured Interviews ◽

Double Blind

Background: Although rarely indicated, antibiotics are commonly used for acute diarrhoea in China. We conducted a randomized, double blind exploratory clinical trial of loperamide, berberine and turmeric for treatment of acute diarrhoea. Methods: Adults with acute uncomplicated diarrhoea were randomized to 4 groups: (A) loperamide; (B) loperamide and berberine; (C) loperamide and turmeric; (D) loperamide, berberine and turmeric. All participants were given rescue ciprofloxacin for use after 48 hours if symptoms worsened or were unimproved. Primary endpoints were feasibility and ciprofloxacin use during the 2 week follow-up period. Semi-structured interviews were conducted following recruitment. Results: Only 21.5% (278/1295) of patients screened were deemed eligible, and 49% (136/278) of these consented and entered into the final analysis. Most participants had mild symptoms, because most patients with moderate or severe symptoms wanted to be given antibiotics. Follow-up was good (94% at 2 weeks). Only two participants used rescue antibiotics compared to 65% of acute diarrhoea patients in the hospital during the recruitment period. The median symptom duration was: 14 hours in group B (IQR 10-22), 16 hours in group D (IQR 10-22), 18 hours in group A (IQR 10-33), 20 hours in group C (IQR 16-54). Re-consultation rates were low. There were no serious treatment-related adverse events. Most interviewed participants said the treatment was effective. Conclusion: Although recruitment was challenging because of widespread expectations for antibiotics, patients with mild diarrhoea accepted to try an alternative. This therapy requires further evaluation in a fully powered, randomised controlled trial among a broader sample.

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Experiences with screening for atrial fibrillation: a qualitative study in general care

BJGP Open ◽

10.3399/bjgpo.2021.0126 ◽

2021 ◽

pp. BJGPO.2021.0126

Author(s):

Steven Bernard Uittenbogaart ◽

Stéphanie JE Becker ◽

Maartje Hoogsteyns ◽

Henk van Weert ◽

Wim AM Lucassen

Keyword(s):

Atrial Fibrillation ◽

Qualitative Study ◽

Nurse Practitioners ◽

Standard Care ◽

Daily Practice ◽

Structured Interviews ◽

Care Workers ◽

Pulse Palpation ◽

Blood Pressure Measure

Background/IntroductionGuidelines recommend screening for atrial fibrillation (AF). Currently screening is not considered standard care among general practitioners (GPs).AimTo explore the experiences of primary care workers with different methods of screening for AF and with implementation in daily practice.Design & settingA qualitative study using semi-structured interviews with GPs, nurses and assistants, experienced with implementation of different methods of screening.MethodTwo independent researchers audio recorded and analysed interviews using a thematic approach. They asked participants about their experiences with the different methods used for screening AF and which obstacles they faced with implementing screening in daily practice.ResultsIn total 15 GPs, nurse practitioners and assistants from 7 different practices were interviewed. The GP’s office is suited for screening for AF, which ideally should be integrated with standard care. Participants considered pulse palpation, automated sphygmomanometer with AF detection and single-lead electrocardiography (ECG) as practical tests. Participants trusted pulse palpation over the algorithm of the devices. The follow-up of a positive test with a time-consuming 12-lead ECG hindered integration of screening. The single-lead ECG device reduces the need for immediate follow-up, because it can record a rhythm strip. The extra workload of screening and lack of financial coverage form obstacles for implementation.ConclusionsPulse palpation, automated blood pressure measure monitors with AF detection and single-lead ECGs might facilitate screening in a GP setting. When implementing screening, focus should lie on how to avoid disruption of consultation hours by unplanned 12-lead ECGs.

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Implementing structured follow-up of neonatal and paediatric patients: an evaluation of three university hospital case studies using the functional resonance analysis method

10.21203/rs.3.rs-408416/v1 ◽

2021 ◽

Author(s):

Véronique Bos ◽

Daniëlle Roorda ◽

Eleonore De Sonnaville ◽

Menne Van Boven ◽

Jaap Oosterlaan ◽

...

Keyword(s):

Intensive Care ◽

Analysis Method ◽

Long Term Outcomes ◽

Resonance Analysis ◽

Follow Up Care ◽

Long Term Follow Up ◽

And Performance ◽

Programme Effectiveness

Abstract Background In complex neonatal and paediatric clinical practice, little is known about long-term patient outcomes and what follow-up care is most valuable for patients. Emma Children’s Hospital, Amsterdam UMC (Netherlands), implemented a follow-up programme called Follow Me for neonatal and paediatric patient groups, to gain more insight into long-term outcomes and to use such outcomes to implement a learning cycle for clinical practice, improve follow-up care and facilitate research. Three departments initiated re-engineering and change processes. Each introduced multidisciplinary approaches to long-term follow-up, including regular standardised check-ups for defined age groups, based on medical indicators, developmental progress, and psychosocial outcomes in patients and their families. This research evaluates the implementation of the three follow-up programmes, comparing predefined procedures ( work-as-imagined ) with how the programmes were implemented in practice ( work-as-done ). Methods This study was conducted in 2019–2020 in the outpatient settings of the neonatal intensive care, paediatric intensive care and paediatric surgery departments of Emma Children’s Hospital. It focused on the organisational structure of the follow-up care. The functional resonance analysis method (FRAM) was applied, using documentary analysis, semi-structured interviews, observations and feedback sessions. Results One work-as-imagined model and four work-as-done models were described. The results showed vast data collection on medical, developmental and psychosocial indicators in all work-as-done models; however, process indicators for programme effectiveness and performance were missing. In practice there was a diverse allocation of roles and responsibilities and their interrelations to create a multidisciplinary team; there was no one-size-fits-all. Although control and feedback loops for long-term outcomes were specified with respect to the follow-up groups within the programmes, they were found to overlap and misalign with other internal and external long-term outcome monitoring practices. Conclusion Implementing structured long-term follow-up may provide insights for improving daily practice and follow-up care, with the precondition of standardised measurements. Lessons learned from practice are (1) to address fragmentation in data collection and storage, (2) to incorporate the diverse ways to create a multidisciplinary team in practice, and (3) to include timely actionable indicators on programme effectiveness and performance, alongside medical, developmental and psychosocial indicators.

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Predicting Post-Thrombotic Syndrome with Ultrasonographic Follow-Up after Deep Vein Thrombosis: A Systematic Review and Meta-Analysis

Thrombosis and Haemostasis ◽

10.1055/s-0038-1666859 ◽

2018 ◽

Vol 118 (08) ◽

pp. 1428-1438 ◽

Cited By ~ 5

Author(s):

C. E. A. Dronkers ◽

G. C. Mol ◽

G. Maraziti ◽

M. A. van de Ree ◽

M. V. Huisman ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Compression Therapy ◽

Daily Basis ◽

Compression Stocking ◽

Vein Thrombosis ◽

Post Thrombotic Syndrome ◽

Standardized Treatment ◽

Abstract Screening

Background Post-thrombotic syndrome (PTS) is a common and potential severe complication of deep venous thrombosis (DVT). Elastic compression stocking therapy may prevent PTS if worn on a daily basis, but stockings are cumbersome to apply and uncomfortable to wear. Hence, identification of predictors of PTS may help physicians to select patients at high risk of PTS. Aims This article identifies ultrasonography (US) parameters assessed during or after treatment of DVT of the leg, that predict PTS. Methods This is a systematic review and meta-analysis study. Databases were searched for prospective studies including consecutive patients with DVT who received standardized treatment, had an US during follow-up assessing findings consistent with vascular damage after DVT and had a follow-up period of at least 6 months for the occurrence of PTS assessed by a standardized protocol. Results The literature search revealed 1,156 studies of which 1,068 were irrelevant after title and abstract screening by three independent reviewers. After full-text screening, 12 relevant studies were included, with a total of 2,684 analysed patients. Two US parameters proved to be predictive of PTS: residual vein thrombosis, for a pooled odds ratio (OR) of 2.17 (95% confidence interval [CI], 1.79–2.63) and venous reflux at the popliteal level, for a pooled OR of 1.34 (95% CI, 1.03–1.75). Conclusion The US features reflux and residual thrombosis measured at least 6 weeks after DVT predict PTS. Whether these features may be used to identify patients who may benefit from compression therapy remains to be assessed in further studies.

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Lymphedema and lipedema - an overview of conservative treatment

VASA ◽

10.1024/0301-1526/a000115 ◽

2011 ◽

Vol 40 (4) ◽

pp. 271-279 ◽

Cited By ~ 21

Author(s):

Wagner

Keyword(s):

Conservative Treatment ◽

General Practitioners ◽

Subcutaneous Tissue ◽

Compression Therapy ◽

Compression Stocking ◽

Lymph Drainage ◽

Intensive Phase ◽

Manual Lymph Drainage ◽

Causal Therapy

Lymphedema and lipedema are chronic progressive disorders for which no causal therapy exists so far. Many general practitioners will rarely see these disorders with the consequence that diagnosis is often delayed. The pathophysiological basis is edematization of the tissues. Lymphedema involves an impairment of lymph drainage with resultant fluid build-up. Lipedema arises from an orthostatic predisposition to edema in pathologically increased subcutaneous tissue. Treatment includes complex physical decongestion by manual lymph drainage and absolutely uncompromising compression therapy whether it is by bandage in the intensive phase to reduce edema or with a flat knit compression stocking to maintain volume.

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Treatment of varicose tributaries with sclerotherapy with polidocanol 0.5 % foam

VASA ◽

10.1024/0301-1526/a000023 ◽

2010 ◽

Vol 39 (2) ◽

pp. 169-174 ◽

Cited By ~ 7

Author(s):

Reich-Schupke ◽

Weyer ◽

Altmeyer ◽

Stücker

Keyword(s):

Scientific Evidence ◽

Daily Practice ◽

Severe Adverse Effect ◽

Safe Procedure ◽

Efficacy And Safety ◽

Foam Sclerotherapy ◽

History Of ◽

One Year ◽

Additional Therapy

Background: Although foam sclerotherapy of varicose tributaries is common in daily practice, scientific evidence for the optimal sclerosant-concentration and session-frequency is still low. This study aimed to increase the knowledge on foam sclerotherapy of varicose tributaries and to evaluate the efficacy and safety of foam sclerotherapy with 0.5 % polidocanol in tributaries with 3-6 mm in diameter. Patients and methods: Analysis of 110 legs in 76 patients. Injections were given every second or third day. A maximum of 1 injection / leg and a volume of 2ml / injection were administered per session. Controls were performed approximately 6 months and 12 months after the start of therapy. Results: 110 legs (CEAP C2-C4) were followed up for a period of 14.2 ± 4.2 months. Reflux was eliminated after 3.4 ± 2.7 injections per leg. Insufficient tributaries were detected in 23.2 % after 6.2 ± 0.9 months and in 48.2 % after 14.2 ± 4.2 months, respectively. Only 30.9 % (34 / 110) of the legs required additional therapy. In 6.4 % vein surgery was performed, in 24.5 % similar sclerotherapy was repeated. Significantly fewer sclerotherapy-sessions were required compared to the initial treatment (mean: 2.3 ± 1.4, p = 0.0054). During the whole study period thrombophlebitis (8.2 %), hyperpigmentation (14.5 %), induration in the treated region (9.1 %), pain in the treated leg (7.3 %) and migraine (0.9 %) occurred. One patient with a history of thrombosis developed thrombosis of a muscle vein (0.9 %). After one year there were just hyperpigmentation (8.2 %) and induration (1.8 %) left. No severe adverse effect occurred. Conclusions: Foam sclerotherapy with injections of 0.5 % polidocanol every 2nd or 3rd day, is a safe procedure for varicose tributaries. The evaluation of efficacy is difficult, as it can hardly be said whether the detected tributaries in the controls are recurrent veins or have recently developed in the follow-up period. The low number of retreated legs indicates a high efficacy and satisfaction of the patients.

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