Improving Management of Osteoarthritis: Patients’ Perceptions of a Surgical Readiness Interview Tool

Almost half of patients referred to orthopedic surgeons for Total Joint Arthroplasty (TJA) do not require TJA at that time or are not appropriate surgical candidates. The objective was to explore patients’ perspectives of a Surgical Readiness Interview Tool and its potential utility in the Osteoarthritis (OA) management process. Semi-structured qualitative interviews were conducted with a convenience sample of patients from arthroplasty clinics in Alberta. All interviews were digitally recorded and transcribed verbatim. Analysis was conducted iteratively, applying a constant comparison method. Nine patients were interviewed. Participants found the interview tool to be relevant and comprehensible. Suggestions were made on how to improve tool clarity and administration processes. Patient orientation versus that of the doctor, and expectation management emerged as salient factors in the meaningful application of the tool. As a result of the interviews, a revised tool was developed which incorporated the participant suggestions. Patients were positive about the interview tool and felt that it would lead to better care provision, particularly with incorporation of participants’ suggestions. The data suggest that the interview tool could improve the conversation on surgical readiness, conservative management, and addressing modifiable risk factors prior to TJA.

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Compilation and Analysis of Web-Based Orthopedic Personalized Predictive Tools: A Scoping Review

Journal of Personalized Medicine ◽

10.3390/jpm10040223 ◽

2020 ◽

Vol 10 (4) ◽

pp. 223

Author(s):

Patrick Curtin ◽

Alexandra Conway ◽

Liu Martin ◽

Eugenia Lin ◽

Prakash Jayakumar ◽

...

Keyword(s):

Scoping Review ◽

Orthopedic Surgery ◽

Surgical Planning ◽

Joint Arthroplasty ◽

High Impact ◽

Shared Decision ◽

Web Based ◽

Predictive Tools ◽

Orthopedic Surgeons ◽

Expectation Management

Web-based personalized predictive tools in orthopedic surgery are becoming more widely available. Despite rising numbers of these tools, many orthopedic surgeons may not know what tools are available, how these tools were developed, and how they can be utilized. The aim of this scoping review is to compile and synthesize the profile of existing web-based orthopedic tools. We conducted two separate PubMed searches—one a broad search and the second a more targeted one involving high impact journals—with the aim of comprehensively identifying all existing tools. These articles were then screened for functional tool URLs, methods regarding the tool’s creation, and general inputs and outputs required for the tool to function. We identified 57 articles, which yielded 31 unique web-based tools. These tools involved various orthopedic conditions (e.g., fractures, osteoarthritis, musculoskeletal neoplasias); interventions (e.g., fracture fixation, total joint arthroplasty); outcomes (e.g., mortality, clinical outcomes). This scoping review highlights the availability and utility of a vast array of web-based personalized predictive tools for orthopedic surgeons. Increased awareness and access to these tools may allow for better decision support, surgical planning, post-operative expectation management, and improved shared decision-making.

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The Development of a Surgical Readiness Interview Tool for Patients to Improve Conversation on Modifiable Risk Factors Prior to Total Joint Arthroplasty

10.21203/rs.3.rs-48889/v1 ◽

2020 ◽

Author(s):

Kristen I Barton ◽

Christopher E Hewison ◽

Ania Kania-Richmond

Keyword(s):

Risk Factors ◽

Primary Care ◽

Conservative Management ◽

Total Joint Arthroplasty ◽

Qualitative Interviews ◽

Joint Arthroplasty ◽

Care Physician ◽

Qualitative Inquiry ◽

Modifiable Risk Factors ◽

Study Participants

Abstract Background: Total joint arthroplasty (TJA) surgery is conducted forsevere hip and knee osteoarthritis (OA). However, a significant numberof patients referred to orthopedic surgeons with hip and knee OA are not appropriate surgical candidates.Further, many are sent back to their primary care physician because they had not yet exhausted non-surgical options, which suggests the importance surgeons place on exhausting conservative management before proceeding with TJA.The objective of this qualitative inquiry was to 1) explore patients’ perspectives of a surgical readiness interview tool and its potential utility in the management process for patients with OA, and 2) gain input from study participants to further refine the tool and ensure that it is reflective of the patients’ needs and perspectives. Methods: We used a diverse convenience sampling strategy to recruit TJA patients from the hip and knee arthroplasty clinics in Calgary, Alberta. Semi-structured qualitative interviews were conducted using a cognitive interviewing approach in order to elicit information regarding clarity and relevance of the interview tool. All interviews were digitally recorded and transcribed verbatim. Through an iterative process, a coding framework was developed and then applied in the analysis of all interviews. Results: Nine interviews were conducted (n=3 males and n=6), all of whom had a TJA within the previous 12 months. Participants found the questions in the interview tool to be clear and relevant, and nothing listed was unexpected. All participants expressed that they felt comfortable discussing the content of the interview tool with their doctors. The main themes that emerged from the interviews include 1) the need for clarifications, 2) patient-oriented changes, and 3) expectation management. While gaining insight from study participants, the qualitative inquiry confirmed utility of the tool improve the conversation about surgical readiness and utilizing conservative management prior to TJA. Conclusions: Overall, participants were positive about the interview tool and felt that it would lead to better care provision. We recommend the use of the interview tool in primary care settings to support the conversation on modifiable risk factors and non-surgical management strategies for OA prior to TJA.

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A qualitative exploration of the experience and quality of life of patients, and their family carers, admitted to a specialist eye hospital with microbial keratitis

10.21203/rs.2.9130/v3 ◽

2020 ◽

Author(s):

Shelley Anne Tranter ◽

Maria Cabreras-Aguas ◽

Mandy Riddell ◽

Joanna McCulloch ◽

Therese Riley ◽

...

Keyword(s):

Quality Of Life ◽

Qualitative Interviews ◽

Family Carers ◽

Microbial Keratitis ◽

Structured Interviews ◽

Post Discharge ◽

Convenience Sample ◽

Family Work ◽

Related Quality

Abstract Background: Microbial keratitis is a vision-threatening condition requiring intensive treatment. Understanding patients’ and carers’ experience during and after hospitalisation can inform improvements in care and outcomes. This study explored the vision-related quality of life, and the experiences of patients with microbial keratitis and their family carers when admitted to a quaternary referral eye hospital in AustraliaMethods: The study employed mixed methods, including qualitative interviews and a survey in hospital and a telephone interview post-discharge. A convenience sample was recruited of 33 patients with microbial keratitis who presented to hospital between March and October 2017, and 10 of their family carers. Semi-structured interviews were audiotaped, transcribed verbatim, coded and analysed using thematic analysis. Patient participants completed the National Eye Institute Visual Functioning Questionnaire – 25 (NEIVFQ-25).Results: Qualitative analyses identified two main themes: Saving sight, with subthemes of costs of saving sight, and travel and transportation; Safe-guarding home and normal life with subthemes of family, work and pastimes. A group mean NEIVFQ-25 score of 74 was similar to other ophthalmic disease groups but pain scores were higher.Conclusion: Findings provide insights into the experiences and often unspoken concerns of microbial keratitis patients and their family carers, revealing the priority and the associated costs of saving sight, and the implications for family and lifestyles. These patients reported similarly reduced vision-related quality of life but greater pain compared to other ophthalmic groups. Findings point to ways to improve their experience and potentially reduce the high rates of unplanned representations of this patient group.

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The situation of elderly with cognitive impairment living at home during lockdown in the Corona-pandemic in Germany

10.21203/rs.3.rs-65455/v3 ◽

2020 ◽

Author(s):

Jochen René Thyrian ◽

Friederike Kracht ◽

Angela Nikelski ◽

Melanie Boekholt ◽

Fanny Schumacher-Schönert ◽

...

Keyword(s):

Primary Care ◽

Health Care ◽

Cognitive Impairment ◽

Health Care Provision ◽

Social Activities ◽

Care Provision ◽

Convenience Sample ◽

Personal Impact ◽

The Impact ◽

At Home

Abstract Background: The outbreak of the Corona virus is a challenge for health care systems worldwide. The aim of this study is to analyze a) knowledge about, and feelings related to the Corona-pandemic. Describe b) loneliness, depression and anxiety and, c) the perceived, immediate impact of the lockdown on frequency of social contacts and quality of health care provision of people with cognitive impairment during social distancing and lockdown in the primary care system and living at home in Germany. Methods: This analysis is based on data of a telephone-based assessment in a convenience sample of n=141 people with known cognitive impairment in the primary care setting. Data on e.g. cognitive and psychological status prior to the pandemic was available. Attitudes, knowledge about and perceived personal impact of the pandemic, social support, loneliness, anxiety, depression, change in the frequency of social activities due to the pandemic and perceived impact of the pandemic on health care related services were assessed during the time of lockdown. Results: The vast majority of participants are sufficiently informed about Corona (85%) and most think that the measures taken are appropriate (64%). A total of 11% shows one main symptom of a depression according to DSM-5. The frequency of depressive symptoms has not increased between the time before pandemic and lockdown in almost all participants. The sample shows minimal (65.0%) or low symptoms of anxiety (25%). The prevalence of loneliness is 10%. On average seven activities have decreased in frequency due to the pandemic. Social activities related to meeting people, dancing or visiting birthdays have decreased significantly. Talking with friends by phone and activities like gardening have increased. Utilization of health care services like day clinics, relief services and prescribed therapies have been reported to have worsened due to the pandemic. Visits to general practitioners decreased. Conclusions: The study shows a small impact of the pandemic on psychological variables like depression, anxiety and loneliness in the short-term in Germany. There is a decrease in social activities as expected. The impact on health care provision is prominent. There is a need for qualitative, in-depth studies to further interpret the results.

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Influence of Islamic Traditions on Breastfeeding Beliefs and Practices Among African American Muslims in West Philadelphia: A Mixed-Methods Study

Journal of Human Lactation ◽

10.1177/0890334417705856 ◽

2017 ◽

Vol 34 (1) ◽

pp. 164-175 ◽

Cited By ~ 3

Author(s):

Camilia Kamoun ◽

Diane Spatz

Keyword(s):

African American ◽

Community Education ◽

Qualitative Interviews ◽

Healthcare Providers ◽

Community Leaders ◽

American Muslims ◽

Convenience Sample ◽

Beliefs And Practices ◽

Attitudes And Practices ◽

Breastfeeding Attitudes

Background: Little is known regarding the influence of religion on breastfeeding in African American communities. In particular, whether Islamic traditions influence breastfeeding beliefs and practices among African American Muslims has not been studied. Research aim: This study sought to gain understanding of breastfeeding attitudes, rates, and education among African American Muslims in West Philadelphia and to examine if engaging Islamic teachings in breastfeeding education can positively influence breastfeeding attitudes. Methods: Open-ended, in-person, digitally recorded qualitative interviews were conducted with 10 community leaders and analyzed by conventional content analysis. A study tool distributed to a convenience sample of 44 community members and 11 leaders was used to gather information about education received from community leaders, breastfeeding attitudes and practices, and the potential for Islamic teachings to positively affect breastfeeding attitudes and practices. To obtain further data on this last topic, preliminary data analysis guided the creation of an education pamphlet, about which feedback was gathered through another study tool. Results: Education surrounding Islamic perspectives on breastfeeding was not prevalent. African American Muslims in West Philadelphia view breastfeeding favorably and have higher rates of breastfeeding than African Americans as a whole. Community education about breastfeeding that engaged Islamic teachings improved respondents’ breastfeeding attitudes. Conclusion: Increasing education among providers and African American Muslims about Islamic perspectives on breastfeeding may improve breastfeeding exclusivity and duration. Healthcare providers who care for Muslim women should be aware of Islam’s tradition of positive attitudes toward breastfeeding and partner with Muslim leaders to improve breastfeeding rates and duration among such women.

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350. Outcomes for Joint Arthroplasty in Persons Living with HIV

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.423 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S185-S185

Author(s):

Charisse L Mandimika ◽

Lydia A Barakat ◽

Marjorie Golden

Keyword(s):

Risk Factors ◽

Total Joint Arthroplasty ◽

Academic Medical Center ◽

Joint Arthroplasty ◽

Adverse Outcomes ◽

Smoking History ◽

Modifiable Risk Factors ◽

Post Surgery ◽

Persons Living With Hiv ◽

Living With Hiv

Abstract Background Persons living with HIV (PLHIV) now have dramatically improved life-expectancy with age-related morbidities requiring total joint arthroplasties. We present here an institutional review of PLHIV who underwent total joint arthroplasty and prosthesis-related adverse outcomes at one year. Methods This was a retrospective chart review in a large academic medical center. Inclusion criteria were adult PLHIV undergoing total joint arthroplasty between 2013 and 2017. Arthroplasty-related adverse outcomes within the first-year post-surgery were recorded. Patients were identified using ICD-10 codes and classified as having a PJI using Infectious Diseases Society of America (IDSA) criteria. Results A total of 40 patients met the criteria. The median age was 59 years and 53% of patients were male. The median CD4 count and RNA viral load were 587 (range 94–1920) cells/mm3 and 0 (range 0—189,000) copies/mL, respectively. The most common procedure was hip replacement (55%) and the most common indication for arthroplasty was avascular necrosis (43%). Adverse outcomes including PJI, dislocation, prosthesis loosening, seroma and chronic pain were identified in 28% of patients. PJI occurred in two patients and both required surgical revision. Modifiable risk factors present in both patients were active smoking, history of substance use disorder, chronic pulmonary disease, depression and hepatitis C antibody positivity. Both patients had CD4 counts >600 cells/mm3. Both were on atazanavir containing antiretroviral regimens. Neither patient was screened for MRSA carriage. Causal organisms were MRSA and MSSA respectively and each patient received 6 weeks of antimicrobial therapy. Conclusion This study supports that when medically optimized, PLHIV have favorable outcomes. The two patients who developed PJI had multiple non-HIV modifiable risk factors predisposing them to PJI. In one case, the patient’s isolated organism was MRSA, for which the patient did not receive appropriate pre-operative antimicrobial prophylaxis. This highlights the importance of routine screening for appropriate pre-operative prophylaxis in patients undergoing joint arthroplasty, independent of HIV status. Disclosures All authors: No reported disclosures.

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Remote Health Care Provision in Care Homes in England: An Exploratory Mixed Methods Study of Yorkshire and the Humber

Technologies ◽

10.3390/technologies7010024 ◽

2019 ◽

Vol 7 (1) ◽

pp. 24 ◽

Cited By ~ 1

Author(s):

Louise Newbould ◽

Gail Mountain ◽

Steven Ariss ◽

Mark Hawley

Keyword(s):

Health Care ◽

Mixed Methods ◽

Urban Areas ◽

Health Care Services ◽

Qualitative Interviews ◽

Care Home ◽

Mixed Methods Study ◽

Care Homes ◽

Health Care Provision ◽

Care Provision

An increasing demand for care homes in the UK, has necessitated the evaluation of innovative methods for delivering more effective health care. Videoconferencing may be one way to meet this demand. However, there is a lack of literature on the provision of videoconferencing in England. This mixed-methods study aimed to map current attitudes, knowledge and provision of videoconferencing in the Yorkshire and Humber region of England. Qualitative interviews with care home managers, a scoping review and field notes from a Special Interest Group (SIG) informed the development of a descriptive convenience survey which was sent out to care home managers in the Yorkshire and Humber region of England. The survey had a 14% (n = 124) response rate. Of those who responded, 10% (n = 12) reported using videoconferencing for health care; with over 78% (n = 97) of respondents’ care homes being based in urban areas. Approximately 62% (n = 77) of the 124 respondents had heard of videoconferencing for health care provision. Of those who reported not using videoconferencing (n = 112), 39% (n = 48) said they would consider it but would need to know more. The top ranked reason for not introducing videoconferencing was the belief that residents would not be comfortable using videoconferencing to consult with a healthcare professional. The main reason for implementation was the need for speedier access to services. Those already using videoconferencing rated videoconferencing overall as being very good (50%) (n = 6) or good (42%) (n = 5). Those who were not using it in practice appeared sceptical before implementing videoconferencing. The main driver of uptake was the home’s current access to and satisfaction with traditionally delivered health care services.

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Doing the right things or doing things right?

Corporate Communications An International Journal ◽

10.1108/ccij-06-2015-0037 ◽

2016 ◽

Vol 21 (2) ◽

pp. 142-159 ◽

Cited By ~ 11

Author(s):

Jesper Falkheimer ◽

Mats Heide ◽

Charlotte Simonsson ◽

Ansgar Zerfass ◽

Piet Verhoeven

Keyword(s):

Qualitative Interviews ◽

Interview Study ◽

Corporate Communications ◽

Convenience Sample ◽

Content Type ◽

Business Goals ◽

Main Challenge ◽

Qualitative Interview Study ◽

Communication Goals ◽

Paradox Theory

Purpose – The purpose of this paper is to examine and analyze the prevailing form of rationality that governs the challenges, goals and roles of communication professionals. The authors will also explore alternative forms of rationality and discuss what these would imply. Design/methodology/approach – The paper is based on survey results from The European Communication Monitor (ECM) and qualitative interviews with communication managers in Sweden. First, the authors present the ECM data and the Swedish interview material, i.e. the authors depict the practitioners’ perceptions of what they understand as important work tasks and roles. The interviews focus on the actual practices of linking communication goals to business goals. Second, the results are challenged from a reflexive perspective, using theories from the paradox turn and questioning the “taken-for-granted thinking” in corporate communications. Findings – The ECM data show that the main challenge in practice is “linking business strategy and communication.” The Swedish respondents stand out when it comes to “building and maintaining trust” since this is considered to be almost as important. The qualitative interview study strengthens the results in the ECM. The interviewees seem to do their work according to the traditional management agenda – i.e. they break down overall business goals and translate these to measurable communication goals. The results are reflected upon using paradox theory. Two paradoxes are discussed: between managerialism and professionalism, and strategic generalists and operational specialists. Research limitations/implications – The study is based on survey data that have been collected through a convenience sample, and the interview study is a pilot study. Practical implications – The paper focuses conflicts between normative practitioner ideals and reality, and helps practitioners to reflect upon mainstream thinking. Originality/value – Based on the empirical findings in the ECM, the interviews and the theoretical framework, the authors conclude that if the idea of The Communicative Organization is to be fruitfully realized, it is necessary to depart from a multi-dimensional rationality and question ideas that are taken for granted. The use of paradox theory and concepts such as functional stupidity is rather original in corporate communication research. Additional research could further explore paradoxes in order to spark dialogue, which may undermine one-dimensional thinking and functional stupidity.

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“They Just Asked Me Why I Became Homeless”: “Failure to Ask” as a Barrier to Homeless Women’s Ability to Access Services Post-Victimization

Violence and Victims ◽

10.1891/0886-6708.vv-d-12-00121 ◽

2014 ◽

Vol 29 (6) ◽

pp. 952-966 ◽

Cited By ~ 6

Author(s):

Laura Huey ◽

Ryan Broll ◽

Danielle Hryniewicz ◽

Georgios Fthenos

Keyword(s):

Case Management ◽

Qualitative Interviews ◽

Psychological Services ◽

Homeless Women ◽

Violent Victimization ◽

Management Process ◽

Access To Services ◽

Shelter Workers ◽

Access Services ◽

Complete History

As “access brokers” to resources for their clients, homeless shelter workers are often in a position to aid victimized homeless women in securing medical and psychological services post-victimization. Given high rates of victimization within this population, we would expect that a routine part of a shelter’s case management process would involve queries regarding victimization. Through in-depth qualitative interviews with 42 victimized homeless women in Chicago and Detroit, we sought to discover the extent to which such queries were pursued by staff at their current shelter. What we found is that women are seldom asked to provide a complete history that includes experiences of violent victimization and its effects. From these results, we make several recommendations aimed at improving homeless victims’ access to services.

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Strategies of Caregivers for Encouraging Consumption of Small Quantity Lipid-Based Nutrient Supplement in 7 to 24-Month Old Children in Morelos, Mexico

Current Developments in Nutrition ◽

10.1093/cdn/nzaa053_018 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 813-813

Author(s):

Anabelle Bonvecchio ◽

Selene Pacheco Miranda ◽

Mónica Venosa ◽

Cloe Rawlinson ◽

Harriet Okronipa ◽

...

Keyword(s):

Focus Groups ◽

Urban Communities ◽

Comparison Method ◽

Global Alliance ◽

Convenience Sample ◽

Funding Sources ◽

Nutrient Supplement ◽

The Family ◽

Sustained Use ◽

Infants And Young Children

Abstract Objectives Small quantity lipid-based nutrient supplement (SQ-LNS) are widely used in the treatment for malnutrition among infants and young children during complementary feeding. However, its acceptability by the children is frequently mothers concern. We aimed to identify strategies used by caregivers to encourage consumption of SQ-LNS in 7–24 month-old children in Morelos, Mexico. Methods We conducted a 14-day home feeding trial with a convenience sample of 62 caregivers of children aged 7–24 months in semi-urban communities of Morelos, Mexico. Caregivers were instructed to offer children a daily a sachet of 20-g portion of the assigned version SQ-LNS mixed with 30 g of a food commonly fed to the children. After the trial, we conducted 6 focus groups with 24 caregivers to explore their experience with the use of SQ-LNS. The main topics of the focus group guide include general perception of the supplement and the acceptability of the child and the strategies to improve consumption of children that refused the supplement. The focus groups were audio-recorded, transcribed verbatim, and independently coded by two researchers using constant comparison method. We used Nvivo 12 to conduct the analysis. Results As some children refused SQ-LNS, caregivers used strategies to promote trying, eating some or the whole portion of the supplement. We grouped these strategies in 5 categories: i.Mixing the supplement with foods that masked the taste and/or consistencyii.Testing new ways of preparing the supplement (alone or mixing it with food to offer variety)iii.Trying various feeding practices (e.g., force feeding, self-feeding, requesting other members of the family to feed the child)iv.Offering the supplement at different points in time (e.g., as a snack, as part of lunch, after nape time, etc.)v.Other strategies (e.g., playing games, distracting children, making threats) The strategies did not vary by type of supplement. Conclusions Counseling and communication campaigns that anticipate these strategies to caregivers and include responsive feeding are needed in supplementation programs to contribute to improve acceptability and sustained use of the product. Funding Sources Global Alliance for Improved Nutrition (GAIN).

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