scholarly journals How patients interpret early signs of foot problems and reasons for delays in care: Findings from interviews with patients who have undergone toe amputations

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248310
Author(s):  
Alyson J. Littman ◽  
Jessica Young ◽  
Megan Moldestad ◽  
Chin-Lin Tseng ◽  
Joseph R. Czerniecki ◽  
...  
Keyword(s):  
The United States ◽  
System Level ◽  
Care Seeking ◽  
Structured Interviews ◽  
Early Signs ◽  
Foot Problems ◽  
Male Patients ◽  
The Right ◽  
Distance To Care ◽  
Competing Priorities

Aims To describe how patients respond to early signs of foot problems and the factors that result in delays in care. Methods Semi-structured interviews were conducted with a large sample of Veterans from across the United States with diabetes mellitus who had undergone a toe amputation. Data were analyzed using inductive content analysis. Results We interviewed 61 male patients. Mean age was 66 years, 41% were married, and 37% had a high school education or less. The patient-level factors related to delayed care included: 1) not knowing something was wrong, 2) misinterpreting symptoms, 3) “sudden” and “unexpected” illness progression, and 4) competing priorities getting in the way of care-seeking. The system-level factors included: 5) asking patients to watch it, 6) difficulty getting the right type of care when needed, and 7) distance to care and other transportation barriers. Conclusion A confluence of patient factors (e.g., not examining their feet regularly or thoroughly and/or not acting quickly when they noticed something was wrong) and system factors (e.g., absence of a mechanism to support patient’s appraisal of symptoms, lack of access to timely and convenient-located appointments) delayed care. Identifying patient- and system-level interventions that can shorten or eliminate care delays could help reduce rates of limb loss.

scholarly journals Stakeholder views of podiatry services in the UK for people living with arthritis: a qualitative study

2020 ◽  
Vol 13 (1) ◽  
Author(s):  
Charlotte Dando ◽  
Dawn Bacon ◽  
Alan Borthwick ◽  
Catherine Bowen
Keyword(s):  
Health Services ◽  
Focus Groups ◽  
Health Needs ◽  
Mental Wellbeing ◽  
Structured Interviews ◽  
Foot Health ◽  
Geographical Variations ◽  
Foot Problems ◽  
The Uk ◽  
The Right

Abstract Background The aim of this study was to explore the views of stakeholders in podiatry services, patients, commissioners and general practitioners (GP), to further understand experiences of referral, access and provision of treatment in the National Health Service (NHS) for foot problems for patients living with arthritis. Method To explore in-depth individual views and experiences of stakeholders in podiatry services, 19 patients who had arthritis (osteoarthritis and/or rheumatoid arthritis) participated in one of four focus groups. In addition, seven commissioners and/or GPs took part in semi structured interviews. A purposive sampling strategy was adopted for all focus groups and semi structured interviews. To account for geographical variations, the focus groups and semi structured interviews were conducted across two predetermined regions of the United Kingdom (UK), Yorkshire and Hampshire. Data was rendered anonymous and transcribed verbatim. Thematic analysis was employed to identify key meanings and report patterns within the data. Results Five key themes derived from the focus groups and interviews suggest a variety of factors influencing referral, access and provision of treatment for foot problems within the UK. 1. Systems working together (navigation of different care pathways, access and referral opportunities for people with OA or RA, education around foot health services for people with OA or RA); 2.Finance (financial variations, different care systems, wasting resources); 3. Understanding what podiatry services have to offer (podiatrists are leaders in foot health services, service requirements in relation to training standards and health needs); 4. Person factors of foot pain (arthritis is invisible, affects quality of life, physical and mental wellbeing); 5. Facilitators of foot care (NICE guidelines, stakeholder events, supporting self-management strategies). Conclusion The findings indicate that patients, commissioners and GPs have very similar experiences of referral, access and provision of treatment for foot problems, for patients living with arthritis. Essentially, commissioners and GPs interviewed called for a transformational approach in current systems to include newer models of care that meet the footcare needs of individual patient circumstances. Patients interviewed called for better signposting and information about the different services available to help them manage their foot health needs. To address this, we have formulated a signposting pack for all stakeholders to help them facilitate access to appropriate clinicians ‘at the right time, in the right place’ to manage foot health problems.

Yoga as Entrée to Complementary and Alternative Medicine and Medically Pluralistic Practices

2012 ◽  
Vol 71 (4) ◽  
pp. 348-357 ◽  
Author(s):  
Jacqueline Sivén ◽  
Joanna Mishtal
Keyword(s):  
Health Care ◽  
Alternative Medicine ◽  
Complementary And Alternative Medicine ◽  
The United States ◽  
Health Care Seeking ◽  
Care Seeking ◽  
Structured Interviews ◽  
Complementary And Alternative ◽  
Yoga Practitioners

Yoga is increasingly ubiquitous in the United States and globally. The growth of yoga's popularity alongside Indian healing philosophies, including Ayurvedic medicine, makes yoga an important influence on conceptualization of health in holistic terms. Because of these philosophies, the growing use of yoga has implications for how healthcare is sought and utilized. Yoga practitioners are likely to engage in pluralistic health care-seeking practices, yet, the underlying perspectives that drive yoga practitioners to engage in particular health practices are poorly understood in anthropological and public health literature. This study examined perspectives on health care-seeking among long-term yoga practitioners in a yoga community in Florida. Based on semi-structured interviews conducted in 2010 with 26 adults in a Florida yoga center who have practiced yoga at least once per week for at least one year, the study found that long-term yoga practitioners utilized yoga and other systems of complementary and alternative medicine (CAM) to address health needs that were not met by biomedicine. Moreover, once individuals embarked on long-term yoga practice, they expanded their health care-seeking practices to other CAMs. This study contributes to understanding of the pluralization of health care-seeking practices, highlights concerns with the biomedical health system, and contributes to current debates on health care reform.

scholarly journals The logic of the slave patrol: the fantasy of black predatory violence and the use of force by the police

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Laurence Ralph
Keyword(s):  
Police Officer ◽  
Use Of Force ◽  
The United States ◽  
City Government ◽  
Structured Interviews ◽  
Murder Trial ◽  
The Right ◽  
Predatory Violence ◽  
The City

Abstract The background context for this study is the relationship between the right to bear arms and the role of policing in the United States. The fact that the second amendment guarantees the right to bear arms and the correlative right to form “a well-regulated militia” have long been central to the scholarly understanding of the role of guns in American society. Yet few social scientific studies have taken the friction between militias and the burgeoning police departments of the 1800s as a point of departure for present-day debates about the police’s use of force. For the early part of US history, many citizens feared that the police would attempt to supplant militias. In some southern cities, like New Orleans, residents argued that if the city government was going to let the police patrol the city, they should do so without guns. It was the threat of slave uprisings that ended the conflict between militias and the police. A major implication of this study is that rooting the contemporary understanding of police violence in early debates about the police’s use of force can help social scientists better understand how policing is understood and experienced today. Indeed, the African Americans interviewed for this study view the gun in the hands of a police officer as a technology that is rooted in the slave patrol. This is because it is the descendants of enslaved people who are disproportionately subject to police shootings. The article demonstrates this point by exploring a 2014 police shooting. The shooting of Laquan McDonald garnered national attention when, on October 20, 2014, Chicago police Officer, Jason Van Dyke, shot the 17-year-old Black teenager 16 times. The methods employed in this study include: archival data on the early use of force debate, discourse analysis of court testimony from Van Dyke’s 2018 first degree murder trial, and semi-structured interviews with Chicago residents who discuss this case. Ultimately, this study finds that in the McDonald shooting, the gun helps to reproduce the fantasy of Black predatory violence that is rooted in slavery.

scholarly journals Physicians’ perspectives on continuity of care for patients involved in the criminal justice system: A qualitative study

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254578
Author(s):  
Latasha Jennings ◽  
Carolina Fernández Branson ◽  
Andrea M. Maxwell ◽  
Tyler N. A. Winkelman ◽  
Rebecca J. Shlafer
Keyword(s):  
Criminal Justice ◽  
Health Care Providers ◽  
Continuity Of Care ◽  
Hybrid Approach ◽  
The United States ◽  
System Level ◽  
Care Providers ◽  
Structured Interviews ◽  
Criminal Justice Involvement ◽  
Care Plans

Background In 2016, over 11 million individuals were admitted to prisons and jails in the United States. Because the majority of these individuals will return to the community, addressing their health needs requires coordination between community and correctional health care providers. However, few systems exist to facilitate this process and little is known about how physicians perceive and manage these transitions. Objective The goal of this study was to characterize physicians’ views on transitions both into and out of incarceration and describe how knowledge of a patient’s criminal justice involvement impacts patient care plans. Methods Semi-structured interviews were conducted between October 2018 and May 2019 with physicians from three community clinics in Hennepin County, Minnesota. Team members used a hybrid approach of deductive and inductive coding, in which a priori codes were defined based on the interview guide while also allowing for data-driven codes to emerge. Results Four themes emerged related to physicians’ perceptions on continuity of care for patients with criminal justice involvement. Physicians identified disruptions in patient-physician relationships, barriers to accessing prescription medications, disruptions in insurance coverage, and problems with sharing medical records, as factors contributing to discontinuity of care for patients entering and exiting incarceration. These factors impacted patients differently depending on the direction of the transition. Conclusions Our findings identified four disruptions to continuity of care that physicians viewed as key barriers to successful transitions into and out of incarceration. These disruptions are unlikely to be effectively addressed at the provider level and will require system-level changes, which Medicaid and managed care organizations could play a leading role in developing.

scholarly journals BARRIERS TO ACCESS HEALTHCARE FOR MIDDLE AMERICAN MIGRANTS DURING TRANSIT IN MEXICO

2020 ◽  
Vol 7 (13) ◽  
Author(s):  
Yessica Elizabeth Llanes García ◽  
Tuur Ghys
Keyword(s):  
The United States ◽  
Right To Health ◽  
Policy Recommendations ◽  
Access To Information ◽  
Structured Interviews ◽  
Seguro Popular ◽  
Barriers To Access ◽  
Barriers To Healthcare ◽  
The Right ◽  
Physical Access

This paper draws attention to a little discussed aspect of access to healthcare for the hundreds of thousands of migrants that transit through Mexico to reach the United States, which in theory under the old system was covered via Seguro Popular. To inform future debates on the right to health of migrants, this paper analyses semi structured interviews of thirty-one transit migrants in Monterrey to understand the different barriers to healthcare that migrants faced under the former system. The results cover access to information, economic access, physical access, and discrimination. The paper concludes that these barriers are significant, with access to information standing out as the largest challenge. Our policy recommendations mainly center around improving the (information) outreach to migrants.

scholarly journals BARRIERS TO ACCESS HEALTHCARE FOR MIDDLE AMERICAN MIGRANTS DURING TRANSIT IN MEXICO

2020 ◽  
Vol 7 (13) ◽  
Author(s):  
Yessica Elizabeth Llanes García ◽  
Tuur Ghys
Keyword(s):  
The United States ◽  
Right To Health ◽  
Policy Recommendations ◽  
Access To Information ◽  
Structured Interviews ◽  
Seguro Popular ◽  
Barriers To Access ◽  
Barriers To Healthcare ◽  
The Right ◽  
Physical Access

This paper draws attention to a little discussed aspect of access to healthcare for the hundreds of thousands of migrants that transit through Mexico to reach the United States, which in theory under the old system was covered via Seguro Popular. To inform future debates on the right to health of migrants, this paper analyses semi structured interviews of thirty-one transit migrants in Monterrey to understand the different barriers to healthcare that migrants faced under the former system. The results cover access to information, economic access, physical access, and discrimination. The paper concludes that these barriers are significant, with access to information standing out as the largest challenge. Our policy recommendations mainly center around improving the (information) outreach to migrants.

Different Forms of Work Satisfaction

1998 ◽  
Vol 3 (3) ◽  
pp. 209-218 ◽  
Author(s):  
André Büssing ◽  
Thomas Bissels
Keyword(s):  
Work Satisfaction ◽  
Preliminary Evidence ◽  
Qualitative Approach ◽  
Extended Model ◽  
Work Situation ◽  
Structured Interviews ◽  
Global Satisfaction ◽  
Evaluative Processes ◽  
The Right ◽  
Level Of Aspiration

The extended model of different forms of work satisfaction ( Büssing, 1991 ), originally proposed by Bruggemann (1974) , is suggested as a distinctive qualitative approach to work satisfaction. Six forms of work satisfaction—progressive, stabilized, resigned satisfaction, constructive, fixated, resigned dissatisfaction—are derived from the constellation of four constituent variables: comparison of the actual work situation and personal aspirations, global satisfaction, changes in level of aspiration, controllability at work. Preliminary evidence from semi-structured interviews with 46 nurses shows that the dynamic model is headed in the right direction (qualitative differentiation of consistently high propertions of satisfied employees, uncovering processes of person-work situation interaction). Qualitative methods demonstrated their usefulness in accessing underlying cognitive and evaluative processes of the forms, which are often neglected by traditional attitude-based satisfaction research.

Lending to the Borrower from Hell

2017 ◽  
Author(s):  
Mauricio Drelichman ◽  
Hans-Joachim Voth
Keyword(s):  
United States ◽  
Sixteenth Century ◽  
Sovereign Debt ◽  
Risk Sharing ◽  
The United States ◽  
Philip Ii ◽  
Loan Contracts ◽  
The Right ◽  
Intelligent Model ◽  
New Evidence

Why do lenders time and again loan money to sovereign borrowers who promptly go bankrupt? When can this type of lending work? As the United States and many European nations struggle with mountains of debt, historical precedents can offer valuable insights. This book looks at one famous case—the debts and defaults of Philip II of Spain. Ruling over one of the largest and most powerful empires in history, King Philip defaulted four times. Yet he never lost access to capital markets and could borrow again within a year or two of each default. Exploring the shrewd reasoning of the lenders who continued to offer money, the book analyzes the lessons from this historical example. Using detailed new evidence collected from sixteenth-century archives, the book examines the incentives and returns of lenders. It provides powerful evidence that in the right situations, lenders not only survive despite defaults—they thrive. It also demonstrates that debt markets cope well, despite massive fluctuations in expenditure and revenue, when lending functions like insurance. The book unearths unique sixteenth-century loan contracts that offered highly effective risk sharing between the king and his lenders, with payment obligations reduced in bad times. A fascinating story of finance and empire, this book offers an intelligent model for keeping economies safe in times of sovereign debt crises and defaults.

Comparison of the Aditus ad Antrum Diameter on CT between Patients with Chronic Otitis Media and Healthy Individuals

2019 ◽  
Vol 15 (10) ◽  
pp. 990-993 ◽  
Author(s):  
Elif Gündoğdu ◽  
Uğur Toprak
Keyword(s):  
Computed Tomography ◽  
Otitis Media ◽  
Middle Ear ◽  
Healthy Subjects ◽  
Normal Values ◽  
Chronic Otitis Media ◽  
Healthy Individuals ◽  
Inner Diameter ◽  
Male Patients ◽  
The Right

Background: The middle ear cavity is ventilated through the aditus ad antrum. Aditus blockage contributes to the pathology of otitis media. Objective: To determine the normal values of the aditus ad antrum diameter on computed tomography and to investigate its relationship with chronic otitis media and related pathologies (tympanosclerosis and myringosclerosis). Methods: The temporal CT images of 162 individuals were evaluated retrospectively. In the axial sections, the inner diameter of the aditus was measured at the narrowest point at the cortex. The differences in diameter were compared between diseased and healthy ears. Results: In healthy individuals, the diameter was narrower in women. There was no difference between the right and left ears in healthy subjects. No correlation was found between age and diameter. In male patients with myringosclerosis, the diameter was slightly narrower on both sides but more marked on the left. In female patients with myringosclerosis, the diameter in both ears was slightly narrower. In cases of otitis media and tympanosclerosis, the diameter was less than that of healthy individuals, despite the lack of statistically significant result in all cases. Conclusion: The aditus ad antrum was narrower in diseased ears, indicating that a blocked aditus may contribute to the development of otitis media, as well as mucosal diseases.

Telemedicine for Patients with Inflammatory Bowel Disease (TELE-IBD) Clinical Trial: Qualitative Assessment of Participants’ Perceptions of the TELE-IBD Intervention (Preprint)

2019 ◽  
Author(s):  
Charlene C Quinn ◽  
Sarah Chard ◽  
Erin G Roth ◽  
J. Kevin Eckert ◽  
Katharine M Russman ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Disease Activity ◽  
Remote Monitoring ◽  
Standard Care ◽  
Disease Process ◽  
The United States ◽  
Qualitative Assessment ◽  
Structured Interviews ◽  
Treatment Groups ◽  
Inflammatory Bowel

BACKGROUND Inflammatory bowel diseases (IBD), comprising Crohn’s disease and ulcerative colitis, affects 1 to 3 million people in the United States. Telemedicine has shown promise in IBD. The objective of the parent study, TELE-IBD, was to compare disease activity and quality of life (QoL) in a one-year randomized clinical trial of IBD patients receiving telemedicine versus standard care. Treatment groups experienced improvements in disease activity and QoL but there was not significant differences between groups. Study adherence to the text-based intervention was less than the 80% of the targeted goal. OBJECTIVE To understand adherence to remote monitoring, the goal of this qualitative assessment was to obtain TELE-IBD trial participants’ perceptions of the TELE-IBD system, including their recommendations for future TELE-IBD monitoring. METHODS In the parent study, patients attending three tertiary referral centers with worsening IBD symptoms in the previous two years were eligible for randomization to remote monitoring via texts every other week (EOW), weekly (W) or standard care. Participants (n=348) were evenly enrolled in the treatment groups and 259 (74.4%) completed the study. For this study, a purposive sample of adherent (N=15) and non-adherent (N=14) patients was drawn from the TELE-IBD trial population. Adherence was defined as the completion of 80% or more of the W or EOW self-assessments. Semi-structured interviews conducted by phone surveyed 1) the strengths and benefits of TELE-IBD; 2) challenges associated with using TELE-IBD; and 3) how to improve the TELE-IBD intervention. Interviews were recorded, professionally transcribed, and coded based on a priori concepts and emergent themes with the aid of ATLAS.ti qualitative data analysis software. RESULTS Participants' discussions centered on three elements of the intervention: 1) self-assessment questions, 2) action plans, and 3) educational messages. Participants also commented on: text-based platform, depression and adherence, TELE-IBD system in place of office visit, and their recommendations for future TELE-IBD systems. Adherent and non-adherent participants prefer a flexible system that is personalized, including targeted education messages, and they perceive TELE-IBD as effective in facilitating IBD self-management. CONCLUSIONS Participants identified clear benefits to the TELE-IBD system, including obtaining a better understanding of the disease process, monitoring their symptoms, and feeling connected to their health care provider. Participants' perceptions obtained in this qualitative study will assist in improving the TELE-IBD system to be more responsive to patients with IBD. CLINICALTRIAL NCT01692743

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