scholarly journals A mixed methods protocol to evaluate the effectiveness and acceptability of COVID-19 Community Assessment Hubs

2021 ◽  
Vol 4 ◽  
pp. 16
Author(s):  
Sophie Mulcahy Symmons ◽  
Robert Fox ◽  
Marese Mannion ◽  
David Joyce ◽  
Aoife De Brún ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Multinomial Logistic Regression ◽  
Care Plan ◽  
Community Assessment ◽  
Structured Interviews ◽  
Clinical Patient ◽  
Acute Hospitals ◽  
Additional Strain ◽  
Isolation Facilities ◽  
The Impact

Background: Ireland’s health system has been under significant strain due to staff shortages and inadequate capacity. Critical care bed capacity per capita in Ireland is among the lowest in Europe, thus, the coronavirus disease 2019 (COVID-19) pandemic has put additional strain on an over-stretched system. COVID-19 Community Assessment Hubs (CAHs) were established to mitigate unnecessary admission to acute hospitals, and reduce infection spread by supporting COVID-19 positive or suspected positive patients to isolate at home, or in isolation facilities. There is some evidence that similar assessment centres may be a successful triage strategy to reduce burden on hospital and acute care. Aim: The aim of this study is to evaluate the impact of COVID-19 Community Assessment Hubs on service delivery in one region in Ireland. Methods: A mixed-methods approach will be used, incorporating co-design to engage stakeholders and ensure informed data capture and analysis. Online surveys will assess CAH patients’ experiences of access to and quality of care. Clinical patient data from CAHs will be collected and analysed using multinomial logistic regression to check for association with patient demographics and COVID-19 symptoms, and CAH early warning scores and outcomes (Transfer to Emergency Department, Transfer to isolation unit, Sent home with care plan). Semi-structured interviews will be conducted with: patients to elicit an in-depth understanding of experiences and acceptability of attending CAHs; and staff to understand challenges, benefits, and effectiveness of CAHs. Interview data will be analysed using a thematic analysis approach. Discussion: This study will provide valuable insights from both patient and staff perspectives on the operation of CAHs. We will evaluate the effectiveness and acceptability of CAHs and propose areas for improvement of the service. This will contribute to international literature on the use of community assessment centres during infectious disease pandemics.

scholarly journals A mixed methods protocol to evaluate the effectiveness and acceptability of COVID-19 Community Assessment Hubs

2021 ◽  
Vol 4 ◽  
pp. 16
Author(s):  
Sophie Mulcahy Symmons ◽  
Robert Fox ◽  
Marese Mannion ◽  
David Joyce ◽  
Aoife De Brún ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Multinomial Logistic Regression ◽  
Care Plan ◽  
Community Assessment ◽  
Structured Interviews ◽  
Clinical Patient ◽  
Acute Hospitals ◽  
Additional Strain ◽  
Isolation Facilities ◽  
The Impact

Background: Ireland’s health system has been under significant strain due to staff shortages and inadequate capacity. Critical care bed capacity per capita in Ireland is among the lowest in Europe, thus, the coronavirus disease 2019 (COVID-19) pandemic has put additional strain on an over-stretched system. COVID-19 Community Assessment Hubs (CAHs) were established to mitigate unnecessary admission to acute hospitals, and reduce infection spread by supporting COVID-19 positive or suspected positive patients to isolate at home, or in isolation facilities. There is some evidence that similar assessment centres may be a successful triage strategy to reduce burden on hospital and acute care. Aim : The aim of this study is to evaluate the impact of COVID-19 Community Assessment Hubs on service delivery in two regions in Ireland during the pandemic. Methods: A mixed-methods approach will be used, incorporating co-design to engage stakeholders and ensure informed data capture and analysis. Online surveys will assess CAH patients’ experiences of access to and quality of care. Clinical patient data from CAHs will be collected and analysed using multinomial logistic regression to check for association with patient demographics and COVID-19 symptoms, and CAH early warning scores and outcomes (Transfer to Emergency Department, Transfer to isolation unit, Sent home with care plan). Semi-structured interviews will be conducted with: patients to elicit an in-depth understanding of experiences and acceptability of attending CAHs; and staff to understand challenges, benefits, and effectiveness of CAHs. Interview data will be analysed using thematic analysis. Discussion: This study will provide valuable insights from both patient and staff perspectives on the operation of CAHs. We will evaluate the effectiveness and acceptability of CAHs and propose areas for improvement of the service. This will contribute to international literature on the use of community assessment centres during infectious disease pandemics.

scholarly journals Prevalence vs impact: a mixed methods study of survivorship issues in colorectal cancer

2021 ◽  
Author(s):  
Amanda Drury ◽  
Sheila Payne ◽  
Anne-Marie Brady
Keyword(s):  
Mixed Methods ◽  
Unmet Need ◽  
Bowel Dysfunction ◽  
Structured Interviews ◽  
Daily Lives ◽  
Negative Body Image ◽  
Cross Domain ◽  
Cancer Support ◽  
Need Support ◽  
The Impact

Abstract Purpose This study aims to explore the prevalence of CRC survivorship issues and their impact on survivors’ quality of life (QoL). Methods This study utilised a mixed methods sequential explanatory design. Adult CRC survivors between 6- and 60-months post-diagnosis (n = 304) were purposively recruited from three hospitals and twenty-one cancer support centres in Ireland. QoL was evaluated using the EuroQol and FACT-C questionnaires and results compared to population norms. 22 survey participants took part in semi-structured interviews exploring the impact of survivorship issues on their daily lives. Results While CRC survivors reported QoL outcomes comparable to or better than normative populations, 54% were dissatisfied with their QoL. The most common survivorship issues reported included negative body image (74%), fatigue (68%), sexual dysfunction (66%) and sleep disturbance (59%). Thematic analysis of the qualitative data illustrated survivors’ attempts to live with the impact of cancer and its treatment (loss, fear, impact) and striving to contextualise, reframe and understand the consequences of cancer and its treatment (control, vigilance, benefit). Within these themes, the cross-domain impact of less prevalent symptoms including bowel dysfunction (28–57%) and peripheral neuropathy (47%) were widely discussed. Conclusions Although cancer survivors report positive QoL outcomes, many experience distressing physical, psychological and social effects. The findings suggest less common and difficult to manage symptoms are the greatest source of distress and unmet need. Support and information must be tailored to address survivors’ individual needs and preferences for support, informed by holistic person-centred assessment.

scholarly journals The impact of the Safer Anaesthesia from Education (SAFE) Obstetric Anaesthesia training course in Ethiopia: A mixed methods longitudinal cohort study

2020 ◽  
Vol 48 (4) ◽  
pp. 297-305
Author(s):  
Jolene N Moore ◽  
Wayne W Morriss ◽  
Gebrehiwot Asfaw ◽  
Gosa Tesfaye ◽  
Aaliya R Ahmed ◽  
...  
Keyword(s):  
Cohort Study ◽  
Mixed Methods ◽  
Maternal Mortality ◽  
Longitudinal Cohort Study ◽  
Structured Interviews ◽  
Middle Income ◽  
Longitudinal Cohort ◽  
Obstetric Anaesthesia ◽  
The Impact

Summary Reducing maternal mortality remains a global priority, particularly in low- and middle-income countries (LMICs). The Safer Anaesthesia from Education (SAFE) Obstetric Anaesthesia (OB) course is a three-day refresher course for trained anaesthesia providers addressing common causes of maternal mortality in LMICs. This aim of this study was to investigate the impact of SAFE training for a cohort of anaesthesia providers in Ethiopia. We conducted a mixed methods longitudinal cohort study incorporating a behavioural questionnaire, multiple-choice questionnaires (MCQs), structured observational skills tests and structured interviews for anaesthesia providers who attended one of four SAFE-OB courses conducted in two regions of Ethiopia from October 2017 to May 2018. Some 149 participants from 60 facilities attended training. Behavioural questionnaires were completed at baseline ( n = 101, 69% response rate). Pre- and post-course MCQs ( n = 121, n = 123 respectively) and pre- and post-course skills tests ( n = 123, n = 105 respectively) were completed, with repeat MCQ and skills tests, and semi-structured interviews completed at follow-up ( n = 88, n = 76, n = 49 respectively). The mean MCQ scores for all participants improved from 80.3% prior to training to 85.4% following training ( P < 0.0001) and skills test scores improved from 56.5% to 83.2% ( P < 0.0001). Improvements in MCQs and skills were maintained at follow-up 3–11 months post-training compared to baseline ( P = 0.0006, < 0.0001 respectively). Participants reported improved confidence, teamwork and communication at follow-up. This study suggests that the SAFE-OB course can have a sustained impact on knowledge and skills and can improve the confidence of anaesthesia providers and communication within surgical teams.

The Opportunity Cost of Changing Clinical Practice in Anticipation of a Surge of Covid-19 patients – A Convergent Mixed Methods Study Protocol

2020 ◽  
Vol 8 (3) ◽  
pp. 301
Author(s):  
Veena Manja ◽  
James Wiedeman ◽  
Jeffrey S Hoch ◽  
Diana Lee Farmer
Keyword(s):  
Mixed Methods ◽  
Teaching And Learning ◽  
Mixed Methods Study ◽  
Case Mix ◽  
Negative Consequences ◽  
Structured Interviews ◽  
Case Volume ◽  
Quantitative Phase ◽  
Trade Offs ◽  
The Impact

Background: The rapid rise of COVID-19 infections has strained the capacity of healthcare systems worldwide. Many organizations are changing practice to make room for a surge in patients with COVID-19 infections. Cancelling and rescheduling elective procedures is one strategy advocated and used by many. This process may result in negative consequences for the patients who need procedures and have negative teaching and economic implications.Rationale and Study Design: This convergent mixed-methods study includes analysis of surgical databases to evaluate differences in case-volume and case-mix before and after the emergence of COVID-19 pandemic (quantitative phase), prospective observational study of patients impacted by the delayed scheduling of surgical procedures (quantitative phase) and 1:1 semi-structured interviews with patients, physicians and administrators to understand the impact of operational changes as a result on COVID-19 infection on patient care, teaching and learning and fiscal outcomes.Methods: The quantitative phase will consist of a review of the surgical database to quantify the differences in case-volume and case-mix during 2019 and 2020. In addition a prospective cohort of patients impacted by the delay in these procedures will be followed for 6 months to assess changes in patient important outcomes due to changes in scheduling procedures. The qualitative phase will consist of 1:1 semi-structured interviews to gain a depth of understanding of the trade-offs due to a change in practice related to COVID-19. The interviews will be analyzed using qualitative description.Discussion: The COVID-19 pandemic has caused worldwide disruption in the practice of healthcare, current focus on increasing capacity in preparation for a COVID-19 surge may have unforeseen consequences for patients who need non-COVID-19 related care. Studying the impact prospectively will provide information on the trade-offs associated with change in healthcare priorities. These results may be helpful in informing optimal healthcare practices and resource allocation in the future. 

scholarly journals Extent of Groin Dissection in Melanoma: A Mixed-Methods, Population-Based Study of Practice Patterns and Outcomes

2021 ◽  
Vol 28 (6) ◽  
pp. 5422-5433
Author(s):  
Suzana Küpper ◽  
Janice L. Austin ◽  
Brittany Dingley ◽  
Yuan Xu ◽  
Kristine Kong ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Practice Patterns ◽  
Population Based ◽  
Oncologic Outcomes ◽  
Structured Interviews ◽  
Cancer Specific Survival ◽  
Melanoma Metastases ◽  
Significant Difference ◽  
Inguinal Dissection ◽  
The Impact

Melanoma metastases to the groin are frequently managed by therapeutic lymph node dissection. Evidence is lacking regarding the extent of dissection required. Thus, we sought to describe practice patterns for the use of inguinal vs. ilioinguinal dissection, as well as the perioperative/oncologic outcomes of each procedure. A mixed-methods approach was employed to evaluate surgical practice patterns. A retrospective review of three multi-site databases was carried out, together with semi-structured interviews of melanoma surgeons. A total of 347 patients who underwent dissection were reviewed. The main indications stated for adding a “deep” ilioinguinal dissection were palpable or radiologically positive disease. There was no significant difference in complications, length of stay or lymphedema between patients having inguinal vs. ilioinguinal dissection, irrespective of method of diagnosis. There was also no significant difference in recurrence, cancer-specific survival or overall survival between groups. In conclusion, ilioinguinal dissection is a safe and well-tolerated procedure, with no significant added morbidity relative to an inguinal dissection. The indications for ilioinguinal dissection currently in use produce an appropriate deep node positivity rate and ilioinguinal dissection should continue to be used selectively. Randomized data are needed to clarify the impact of ilioinguinal dissection on regional control and survival.

scholarly journals Physiotherapists perceived role in managing anxiety in patients with Relapsing-Remitting Multiple Sclerosis: a mixed-methods study.

2021 ◽  
Author(s):  
Lauren Lucas ◽  
Jack Parker
Keyword(s):  
Mixed Methods ◽  
Clinical Supervision ◽  
Management Practices ◽  
Training Needs ◽  
Outpatient Rehabilitation ◽  
Structured Interviews ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Physiotherapy Practice ◽  
The Impact

ABSTRACT Objectives: To explore how physiotherapists manage anxiety in patients with RRMS in community and outpatient settings. To identify further training and research to better develop physiotherapy practice. Design: A mixed-methods design, combining a cross-sectional survey and semi-structured interviews with UK-physiotherapists. Participants: Sixteen UK-registered physiotherapists: 11 in the survey, 5 in the interviews. Methods: To inform the qualitative study, a cross-sectional survey collected data from physiotherapists working in neurology to understand the impact and management of anxiety in people with MS (PwMS) during rehabilitation. Analysis used descriptive statistics and the findings formed the interview guide. Semi-structured interviews with specialist physiotherapists explored barriers and facilitators to managing anxiety, physiotherapy training needs and offered suggestions to develop physiotherapy research and practice. Themes were derived inductively. Results: The survey suggested how PwMS present with anxiety, its impact during rehabilitation, physiotherapy management practices, and physiotherapist skills and training needs. Five semi-structured interviews with specialist physiotherapists expanded on the survey findings and identified five main themes: Understanding the MS journey, modifying assessment and treatment, anxiety management toolbox, lagging behind Musculoskeletal Physiotherapy, and gaining knowledge and skills. Conclusion: Physiotherapists encounter anxiety in PwMS in community and outpatient rehabilitation and perceive they have a role in managing it as it presents. Facilitators included communication, listening skills and opportunities to develop strong therapeutic relationships. Poor training and support, lack of clinical guidelines and limited research evidence were considered barriers. Clinically relevant learning opportunities, interprofessional working, and greater support through clinical supervision is recommended to better develop physiotherapy practice.

scholarly journals Barriers and Facilitators of Following Perioperative Internal Medicine Recommendations by Surgical Teams: A Sequential, Explanatory Mixed-methods Study

2020 ◽  
Author(s):  
Kristin Flemons ◽  
Michael Bosch ◽  
Sarah Coakeley ◽  
Bushra Muzammal ◽  
Rahim Kachra ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Patient Outcomes ◽  
Theoretical Domains Framework ◽  
Medical Consultation ◽  
Mixed Methods Study ◽  
Role Clarity ◽  
Structured Interviews ◽  
Chart Audit ◽  
Anticoagulation Management ◽  
The Impact

Abstract Background: Preoperative medical consultations add expense and burden for patients and the impact of these consults on patient outcomes is conflicting. Previous work suggests that 10-40% of preoperative medical consult recommendations are not followed. This limits measurement of the effect of perioperative medical consultation on patient outcomes and represents a quality gap, given the patient time and healthcare cost associated with consultation. We aimed to measure, characterize, and understand reasons for missed recommendations from preoperative medical consultation.Methods: This explanatory, sequential mixed methods study used chart audits followed by semi-structured interviews. Chart audit of consecutive patients seen in preoperative medical clinic were reviewed to measure the proportion and characterize the type of recommendations that were not completed (‘missed’). This phase informed the interview participants and questions. The interview guide was developed using the Consolidated Framework for Implementation Research and the Theoretical Domains Framework. Template analysis was used to understand drivers and barriers of missed recommendationsResults: Chart audit included 295 patients (n=188, 63.7% female) seen in preadmission clinic between April 1 and April 30th, 2019. 51.8% of patients all recommendations followed (n=142). Postoperative anticoagulation management and postoperative cardiac biomarker surveillance recommendations were least commonly followed (45.2%; n=28, and 64.1%; n=84, respectively). Eighteen surgical team members were interviewed. Missed recommendations were both unintentional and intentional, and the key drivers differed by these categories. Unintentionally missed recommendations occurred due to individual-level factors (drivers: knowledge of the consultation note, lack of routine for reviewing the consultation note, and competing demands on time) and systems-level factors (drivers: lack of role clarity). Intentionally missed recommendations occurred due to user error due (drivers: lack of knowledge of guidelines or evidence) and appropriate modifications (drivers: need to adapt a preoperative plan for a complicated postoperative course).Conclusions: Only 51.8% of consult notes had all recommendations followed, suggesting a quality gap in perioperative medical care. Qualitative data suggests multiple drivers of missed recommendations that should be targeted to improve the efficiency of care for these patients.

The Perceptions of Nurses About the Behavioral Needs for Daylighting and View to the Outside in Inpatient Facilities

2019 ◽  
Vol 13 (1) ◽  
pp. 191-205
Author(s):  
Arsalan Gharaveis ◽  
Hamed Yekita ◽  
Gholamreza Shamloo
Keyword(s):  
Mixed Methods ◽  
Nursing Staff ◽  
Medical Error ◽  
Behavioral Responses ◽  
Structured Interviews ◽  
Mixed Methods Approach ◽  
Behavioral Needs ◽  
Extensive Body ◽  
Nurses Perceptions ◽  
The Impact

Objectives: This research aims to explore the perceptions of nursing staff regarding the effects of daylighting on behavioral factors including mood, stress, satisfaction, medical error, and efficiency. Background: In spite of an extensive body of literature seeking to investigate the impact of daylighting on patients, a limited number of studies have been done for the sake of nurses’ perceptions and behavioral responses. Method: A mixed-methods approach, comprised of qualitative explorations (structured interviews) and a validated survey, was applied and the results were compared and triangulated. Five nurses were interviewed and 156 nurses volunteered for a lighting survey from six departments of three inpatient facilities in Iran. Results: The findings of this study are consistent with the existing evidence that daylighting and view to the outside enhance nurses’ perceptions regarding satisfaction, mood, stress, medical error, and alertness, while reducing fatigue and stress. Conclusion: Patient rooms and work stations are the most crucial areas to provide daylighting from nurses’ perspectives.

The Resilience Songwriting Program for Adolescent Bereavement: A Mixed Methods Exploratory Study

2019 ◽  
Vol 56 (4) ◽  
pp. 348-380 ◽  
Author(s):  
Katherine Myers-Coffman ◽  
Felicity A Baker ◽  
Brian P Daly ◽  
Robert Palisano ◽  
Joke Bradt
Keyword(s):  
Mixed Methods ◽  
Emotional Expression ◽  
Exploratory Study ◽  
Meaning Making ◽  
Self Esteem ◽  
Structured Interviews ◽  
Lyric Analysis ◽  
Study Sites ◽  
And Coping ◽  
The Impact

Abstract Music therapy research with youth who are grieving often reports on a combination of interventions, such as lyric analysis, improvisation, and/or songwriting. Unfortunately, the lack of theoretical transparency in how and why these interventions affect targeted outcomes limits interpretation and application of this important research. In this exploratory study, the authors evaluated the impact of an 8-session, theory-driven group songwriting program on protective factors in adolescent bereavement, and also sought to better understand adolescents' experiences of the program. Using a single-group, pretest-posttest convergent mixed methods design, participants were enrolled from three study sites and included 10 adolescents (five girls and five boys), ages 11–17 years, who self-identified as grieving a loss. Outcomes measured included grief, coping, emotional expression, self-esteem, and meaning making. Qualitative data were captured through in-session journaling and semi-structured interviews. There were no statistically significant improvements for grief, self-esteem, coping, and meaning making. Individual score trends suggested improvements in grief. The majority of the participants reported greater inhibition of emotional expression, and this was statistically significant. Thematic findings revealed that the program offered adolescents a sense of togetherness, a way to safely express grief-related emotions and experiences verbally and nonverbally, and opportunities for strengthening music and coping skills. These findings suggest that engaging in collaborative therapeutic songwriting with grieving peers may decrease levels of grief, enhance creative expression, and provide social support. More research is needed on measuring self-esteem, emotional expression, coping, and meaning making outcomes in ways that are meaningful to adolescents.

Does participatory ergonomics reduce musculoskeletal pain in sonographers? A mixed methods study

Ultrasound ◽  
2021 ◽  
pp. 1742271X2110239
Author(s):  
Kristie Sweeney ◽  
Karen Ginn ◽  
Jacqueline Spurway ◽  
Jillian Clarke ◽  
Martin Mackey
Keyword(s):  
Mixed Methods ◽  
Musculoskeletal Pain ◽  
Work Conditions ◽  
Preliminary Evidence ◽  
Mixed Methods Study ◽  
Local Health ◽  
Structured Interviews ◽  
Participatory Ergonomics ◽  
Pain Prevalence ◽  
The Impact

Introduction Sonographers in the Western New South Wales Local Health District (WNSWLHD) reported a musculoskeletal pain prevalence rate of 95%. Participatory ergonomics, where workers are consulted about improving work conditions, was utilised to identify work-related musculoskeletal disorder (WMSD) risks and potential solutions. The aim of this study was to compare the prevalence of WMSD in a cohort of sonographers before and after implementation of ergonomic changes that were driven by recommendations from a participatory ergonomics approach. Methods This observational mixed methods study analysed the impact of participatory ergonomic-driven interventions on changes on musculoskeletal pain in a cohort of sonographers employed within the WNSWLHD. A retrospective analysis of 10 sonographer WMSD pain surveys over five sites was completed, along with semi-structured interviews regarding which interventions were perceived as useful, which interventions were not implemented and any barriers to implementation. Results Installation of patient monitors, use of ergonomic scanning techniques and job rotation were perceived as responsible for decreased musculoskeletal pain. Taking lunch breaks and microbreaks, use of antifatigue mats and having two sonographers perform mobile exams were not fully implemented. No interventions were perceived as responsible for increased pain. Conclusion This small study provides preliminary evidence that a participatory ergonomics approach facilitated identification of occupation and site-specific risks for WMSD in the WNSWLHD, allowing implementation of ergonomic changes to be tailored to the workplace, resulting in a safer work environment for sonographers.

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