scholarly journals Understanding decisions about antibiotic prescribing in ICU: an application of the Necessity Concerns Framework

2021 ◽  
pp. bmjqs-2020-012479
Author(s):  
Alyssa M Pandolfo ◽  
Robert Horne ◽  
Yogini Jani ◽  
Tom W Reader ◽  
Natalie Bidad ◽  
...  
Keyword(s):  
Focus Groups ◽  
Antibiotic Prescribing ◽  
Negative Consequences ◽  
Out Of Hours ◽  
Team Members ◽  
Clinical Vignettes ◽  
Molecular Microbiology ◽  
Semistructured Interviews ◽  
Decision Making Processes ◽  
The Individual

BackgroundAntibiotics are extensively prescribed in intensive care units (ICUs), yet little is known about how antibiotic-related decisions are made in this setting. We explored how beliefs, perceptions and contextual factors influenced ICU clinicians’ antibiotic prescribing.MethodsWe conducted 4 focus groups and 34 semistructured interviews with clinicians involved in antibiotic prescribing in four English ICUs. Focus groups explored factors influencing prescribing, whereas interviews examined decision-making processes using two clinical vignettes. Data were analysed using thematic analysis, applying the Necessity Concerns Framework.ResultsClinicians’ antibiotic decisions were influenced by their judgement of the necessity for prescribing/not prescribing, relative to their concerns about potential adverse consequences. Antibiotic necessity perceptions were strongly influenced by beliefs that antibiotics would protect patients from deterioration and themselves from the ethical and legal consequences of undertreatment. Clinicians also reported concerns about prescribing antibiotics. These generally centred on antimicrobial resistance; however, protecting the individual patient was prioritised over these societal concerns. Few participants identified antibiotic toxicity concerns as a key influencer. Clinical uncertainty often complicated balancing antibiotic necessity against concerns. Decisions to start or continue antibiotics often represented ‘erring on the side of caution’ as a protective response in uncertainty. This approach was reinforced by previous experiences of negative consequences (‘being burnt’) which motivated prescribing ‘just in case’ of an infection. Prescribing decisions were also context-dependent, exemplified by a lower perceived threshold to prescribe antibiotics out-of-hours, input from external team members and local prescribing norms.ConclusionEfforts to improve antibiotic stewardship should consider clinicians’ desire to protect with a prescription. Rapid molecular microbiology, with appropriate communication, may diminish clinicians’ fears of not prescribing or of using narrower-spectrum antibiotics.

scholarly journals Les joueurs sans problème de jeu de 55 ans et plus : événements, conséquences et caractéristiques structurelles et environnementales influençant les habitudes de jeu

2016 ◽  
pp. 89
Author(s):  
Isabelle Giroux ◽  
Francine Ferland ◽  
Cathy Savard ◽  
Christian Jacques ◽  
Priscilla Brochu ◽  
...  
Keyword(s):  
Content Analysis ◽  
Focus Groups ◽  
Life Events ◽  
Psychological Health ◽  
Qualitative Content Analysis ◽  
Individual Characteristics ◽  
Gambling Problems ◽  
Negative Consequences ◽  
The Individual

Gambling habits of people aged 55 years and over without gambling problems are rarely being investigated. In order to document life events and to identify the impacts of gambling on quality of life, 19 participants aged 55 to 74 years without gambling problems, male and female, were assembled in three focus groups. Qualitative content analysis of the groups reveals changes in gambling habits associated with transition to retirement and occurrence of health problems. The content analysis further reveals a variety of positive and negative consequences of gambling habits on finances, hobbies, social relationships, and psychological health. Although the focus groups did not target the structural or environmental characteristics of gambling that influence participants' gambling habits, those themes were brought up spontaneously. Results highlight the necessity to study life events from a larger perspective including, for example, protective and risk factors, in order to better understand the life contexts and the individual characteristics that may lead to an alteration or not of gambling habits.

scholarly journals Vulnerability and Stressors for Burnout Within a Population of Hospital Nurses: A Qualitative Descriptive Study

2019 ◽  
pp. 084456211987677 ◽  
Author(s):  
Nina Geuens ◽  
Erik Franck ◽  
Helena Verheyen ◽  
Sarah De Schepper ◽  
Leen Roes ◽  
...  
Keyword(s):  
Well Being ◽  
Hospital Nurses ◽  
Negative Consequences ◽  
The Past ◽  
Individual Vulnerability ◽  
Nurse Burnout ◽  
Semistructured Interviews ◽  
Qualitative Descriptive ◽  
Burnout Risk ◽  
The Individual

Background The multitude of negative consequences of nurse burnout calls for interventions to protect the well-being of the individual nurses, patients, and hospital organizations. However, much is still to be discovered about the development of this complex psychological syndrome. Purpose This study aimed to describe the development of nurse burnout for a population of Flemish hospital nurses while considering vulnerability and situational stressors as indicated by the vulnerability-stress model. Methods Ten registered nurses were enlisted for semistructured interviews through purposive sampling. All selected nurses were currently suffering from burnout, showed a burnout risk, or had gone through a burnout in the past. A descriptive thematic analysis was performed with themes inductively emerging from the data. Results Four main themes emerged: “being passionate about doing well or being good,” “teamwork,” “manager,” and “work and personal circumstances.” More specifically, it was the discrepancy between the first individual vulnerability factor and the three situational stressors that led to feelings of stress and burnout. Conclusions The essence of the development of nurse burnout was found in the discrepancy between individual vulnerability and situational stressors. Therefore, we recommend burnout prevention to target both factors.

Development of a German-Language Questionnaire to Measure Collective Orientation as an Individual Attitude

2017 ◽  
Vol 76 (3) ◽  
pp. 91-105 ◽  
Author(s):  
Vera Hagemann
Keyword(s):  
Team Performance ◽  
Reliability And Validity ◽  
Future Research ◽  
German Language ◽  
Team Members ◽  
Collective Orientation ◽  
Team Research ◽  
German Speaking ◽  
Individual Variables ◽  
The Individual

Abstract. The individual attitudes of every single team member are important for team performance. Studies show that each team member’s collective orientation – that is, propensity to work in a collective manner in team settings – enhances the team’s interdependent teamwork. In the German-speaking countries, there was previously no instrument to measure collective orientation. So, I developed and validated a German-language instrument to measure collective orientation. In three studies (N = 1028), I tested the validity of the instrument in terms of its internal structure and relationships with other variables. The results confirm the reliability and validity of the instrument. The instrument also predicts team performance in terms of interdependent teamwork. I discuss differences in established individual variables in team research and the role of collective orientation in teams. In future research, the instrument can be applied to diagnose teamwork deficiencies and evaluate interventions for developing team members’ collective orientation.

Navigating the health care system: perceptions of patients with chronic pain

2009 ◽  
Vol 29 (4) ◽  
pp. 162-168
Author(s):  
AL Dewar ◽  
K Gregg ◽  
MI White ◽  
J Lander
Keyword(s):  
Health Care ◽  
Chronic Pain ◽  
Health Care System ◽  
Health Care Professionals ◽  
Primary Care Physicians ◽  
Treatment Compliance ◽  
Care Utilization ◽  
Semistructured Interviews ◽  
The Individual ◽  
Care System

A new framework is needed for patients with chronic pain and their primary care physicians that acknowledges the individual’s experiences and provides evidence-informed education and better linkages to community-based resources. This study describes the experience of 19 chronic-pain sufferers who seek relief via the health care system. Their experiences were recorded through in-depth semistructured interviews and analyzed through qualitative methods. The participants reported early optimism, then disillusionment, and finally acceptance of living with chronic pain. Both individuals with chronic pain and their health care professionals need evidence-informed resources and information on best practices to assist them to manage pain. Empathetic communication between health care professionals and individuals with chronic pain is crucial because insensitive communication negatively affects the individual, reduces treatment compliance and increases health care utilization.

Tourism as a Tool for the Fulfilment of the Rights to Rest and Leisure Enshrined in Article No. 24 of the Universal Declaration of Human Rights

2019 ◽  
Vol 76 (3-4) ◽  
pp. 180-188
Author(s):  
Bianca Nicla Romano
Keyword(s):  
Human Rights ◽  
Legal System ◽  
Universal Declaration ◽  
Title V ◽  
Negative Consequences ◽  
Real Right ◽  
Right To Work ◽  
The Individual ◽  
The Right ◽  
Italian Constitution

Art. 24 of the 1948 Declaration of Human Rights recognises and protects the right of the individual to rest and leisure. This right has to be fully exercised without negative consequences on the right to work and the remuneration. Tourism can be considered one of the best ways of rest and leisure because it allows to enrich the personality of the individual. Even after the reform of the Title V this area is no longer covered by the Italian Constitution, the Italian legal system protects and guarantees it as a real right, so as to get to recognize its existence and the consequent compensation of the so-called “ruined holiday damage”. This kind of damage has not a patrimonial nature, but a moral one, and the Tourist-Traveler can claim for it when he has not been able to fully enjoy his holiday - the essential fulcrum of tourism - intended as an opportunity for leisure and/or rest, essential rights of the individual.

Behavioral Health Professionals’ Perceptions on Outcomes of Patient-Controlled Granular Information Sharing Study: Focus Groups and Survey (Preprint)

2020 ◽  
Author(s):  
Julia Ivanova ◽  
Tianyu Tang ◽  
Nassim Idouraine ◽  
Anite Murcko ◽  
Adela Grando ◽  
...  
Keyword(s):  
Focus Groups ◽  
Information Sharing ◽  
Behavioral Health ◽  
Health Professionals ◽  
Medical Information ◽  
Health Data ◽  
Health Record ◽  
Team Members ◽  
Patient Study ◽  
Actual Patient

BACKGROUND Granular information sharing studies rarely use actual patient electronic health record (EHR) information. In a previous study, behavioral health patients categorized their own EHR data into sensitive categories (e.g. mental health) and chose which care team members (e.g. pharmacists) should have access to those records. In this study, behavioral health professionals are provided access to the outcomes of a previous patient study to better understand the perspectives of health professionals on patient-controlled granular information sharing. OBJECTIVE Assess behavioral health professionals’: (1) perspectives on understanding and opinions about granular information sharing; (2) accuracy in assessing redacted medical information; (3) reactions to patient rationale for health data categorization, assignment of sensitivity, and sharing choices; and (4) recommendations on how to improve the process of granular health information sharing. METHODS Four two-hour focus groups and a pre- and post-survey were conducted at two integrated health facilities. During the focus groups, outcomes from a previous study on patients’ medical record sharing choices were shared. Thematic analysis and descriptive statistical analyses were conducted. RESULTS Twenty-eight professionals were initially unaware of or provided incorrect definitions of granular information sharing (56.0%). After having access to outcomes from a previous patient study, professionals increased their mixed perspectives (21.4% to 37.1%) on granular information sharing. A majority (81.3%) identified that key medical data had been redacted from the study case. Many (66.1%) stated they did not understand patient rationale for categorization or medical sharing preferences. Finally, participants recommended that a variety of educational approaches be incorporated to inform patients about granular information and health record sharing processes. CONCLUSIONS This study provides detailed insights from behavioral health professionals on patient-controlled granular information sharing. Health professionals accurately identified information gaps resulting from patient-directed data redaction, improved in their overall concept comprehension, underscored the fine line between patient safety and patient rights, and expressed a commitment to help patients appreciate the risks and benefits associated with granular information sharing. Outcomes will inform the development, deployment and evaluation of an electronic consent tool for granular health data sharing.

scholarly journals Trends in Antibiotic Prescribing in Out-of-Hours Primary Care in England from January 2016 to June 2020 to Understand Behaviours during the First Wave of COVID-19

Antibiotics ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 32
Author(s):  
Nina J. Zhu ◽  
Monsey McLeod ◽  
Cliodna A. M. McNulty ◽  
Donna M. Lecky ◽  
Alison H. Holmes ◽  
...  
Keyword(s):  
Primary Care ◽  
Time Series ◽  
Patient Outcomes ◽  
Broad Spectrum ◽  
Antibiotic Prescribing ◽  
Broad Spectrum Antibiotic ◽  
Out Of Hours ◽  
Broad Spectrum Antibiotics ◽  
National Quality ◽  
General Practices

We describe the trend of antibiotic prescribing in out-of-hours (OOH) general practices (GP) before and during England’s first wave of the COVID-19 pandemic. We analysed practice-level prescribing records between January 2016 to June 2020 to report the trends for the total prescribing volume, prescribing of broad-spectrum antibiotics and key agents included in the national Quality Premium. We performed a time-series analysis to detect measurable changes in the prescribing volume associated with COVID-19. Before COVID-19, the total prescribing volume and the percentage of broad-spectrum antibiotics continued to decrease in-hours (IH). The prescribing of broad-spectrum antibiotics was higher in OOH (OOH: 10.1%, IH: 8.7%), but a consistent decrease in the trimethoprim-to-nitrofurantoin ratio was observed OOH. The OOH antibiotic prescribing volume diverged from the historical trend in March 2020 and started to decrease by 5088 items per month. Broad-spectrum antibiotic prescribing started to increase in OOH and IH. In OOH, co-amoxiclav and doxycycline peaked in March to May in 2020, which was out of sync with seasonality peaks (Winter) in previous years. While this increase might be explained by the implementation of the national guideline to use co-amoxiclav and doxycycline to manage pneumonia in the community during COVID-19, further investigation is required to see whether the observed reduction in OOH antibiotic prescribing persists and how this reduction might influence antimicrobial resistance and patient outcomes.

Applications of Web-QFD and E-Delphi method in the higher education system

2004 ◽  
Vol 23 (4) ◽  
pp. 245-256
Author(s):  
Shun-Hsing Chen ◽  
Ching-Chow Yang
Keyword(s):  
Education System ◽  
Delphi Method ◽  
Quality Function Deployment ◽  
Decision Makers ◽  
The Internet ◽  
Total Quality ◽  
Web Based ◽  
Team Members ◽  
Higher Education System ◽  
The Individual

Quality function deployment (QFD) is an essential tool in implementing total quality management (TQM). This study applies a Web-QFD approach using group decision-making analysis in the Web environment to reduce the complicated data collection, aggregation and analysis processes. A Web-based questionnaire is designed by using an active service pages (ASP) involving the Internet relay chat (IRC) technique and the Delphi method with Internet (E-Delphi) to determine the importance degree of the customers' requirements. However, the traditional Delphi method is time-consuming mission. This study applies the proposed Web-QFD approach to efficiently gather the individual opinions of each team member, the requirements that are critical for customers, and then enables decision makers to accurately assess the priorities of these requirements. An empirical example of an education system in Taiwan is employed to demonstrate the practicability of the proposed Web-QFD model. This real world example involves team members communicating easily and quickly with other experts in the team through the Internet to accelerate the reaching of a consensus among multiple decision makers regardless of where their location. Customers' requirements can be rapidly prioritized based on the assessment results.

scholarly journals Implementing interventions to reduce antibiotic use: a qualitative study in high-prescribing practices

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Aleksandra J. Borek ◽  
◽  
Anne Campbell ◽  
Elle Dent ◽  
Christopher C. Butler ◽  
...  
Keyword(s):  
Focus Groups ◽  
Point Of Care ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Focus Group Study ◽  
Clinical Uncertainty ◽  
Reactive Protein ◽  
Clinical Tools ◽  
The Many

Abstract Background Trials have shown that delayed antibiotic prescriptions (DPs) and point-of-care C-Reactive Protein testing (POC-CRPT) are effective in reducing antibiotic use in general practice, but these were not typically implemented in high-prescribing practices. We aimed to explore views of professionals from high-prescribing practices about uptake and implementation of DPs and POC-CRPT to reduce antibiotic use. Methods This was a qualitative focus group study in English general practices. The highest antibiotic prescribing practices in the West Midlands were invited to participate. Clinical and non-clinical professionals attended focus groups co-facilitated by two researchers. Focus groups were audio-recorded, transcribed verbatim and analysed thematically. Results Nine practices (50 professionals) participated. Four main themes were identified. Compatibility of strategies with clinical roles and experience – participants viewed the strategies as having limited value as ‘clinical tools’, perceiving them as useful only in ‘rare’ instances of clinical uncertainty and/or for those less experienced. Strategies as ‘social tools’ – participants perceived the strategies as helpful for negotiating treatment decisions and educating patients, particularly those expecting antibiotics. Ambiguities – participants perceived ambiguities around when they should be used, and about their impact on antibiotic use. Influence of context – various other situational and practical issues were raised with implementing the strategies. Conclusions High-prescribing practices do not view DPs and POC-CRPT as sufficiently useful ‘clinical tools’ in a way which corresponds to the current policy approach advocating their use to reduce clinical uncertainty and improve antimicrobial stewardship. Instead, policy attention should focus on how these strategies may instead be used as ‘social tools’ to reduce unnecessary antibiotic use. Attention should also focus on the many ambiguities (concerns and questions) about, and contextual barriers to, using these strategies that need addressing to support wider and more consistent implementation.

scholarly journals A qualitative exploration of patients’ experiences, needs and expectations regarding online access to their primary care record

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e044221
Author(s):  
Brian McMillan ◽  
Gail Davidge ◽  
Lindsey Brown ◽  
Moira Lyons ◽  
Helen Atherton ◽  
...  
Keyword(s):  
Primary Care ◽  
Focus Groups ◽  
Negative Consequences ◽  
Face To Face ◽  
Primary Care Record ◽  
Online Access ◽  
Additional Support ◽  
The Uk ◽  
Records Access ◽  
Qualitative Exploration

ObjectivesPrimary care records have traditionally served the needs and demands of clinicians rather than those of the patient. In England, general practices must promote and offer registered patients online access to their primary care record, and research has shown benefits to both patients and clinicians of doing so. Despite this, we know little about patients’ needs and expectations regarding online access to their record. This study explored what patients and carers want from online access to their electronic primary care health record, their experiences of using it, how they would like to interact with their record and what support they may need.DesignFocus groups and semistructured interviews using purposive sampling to achieve a good sociodemographic spread. Interviews were digitally audiorecorded, transcribed and coded using an established thematic approach.SettingFocus groups and interviews were conducted in community settings in the UK.ParticipantsFifty-four individuals who were either eligible for the National Health Service Health Check, living with more than one long-term condition or caring for someone else.ResultsParticipants views regarding online access were categorised into four main themes: awareness, capabilities, consequences and inevitability. Participants felt online access should be better promoted, and suggested a number of additional functions, such as better integration with other parts of the healthcare system. It was felt that online access could improve quality of care (eg, through increased transparency) but also have potential negative consequences (eg, by replacing face to face contact). A move towards more online records access was considered inevitable, but participants noted a need for additional support and training in using the online record, especially to ensure that health inequalities are not exacerbated.ConclusionsDiscussions with patients and carers about their views of accessing online records have provided useful insights into future directions and potential improvements for this service.

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