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

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

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A Qualitative Study of Developing Competency in Thyroid Surgery: A Resident’s Perspective With 5 Year Follow Up

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489421996918 ◽

2021 ◽

pp. 000348942199691

Author(s):

Gabriela DeVries ◽

Megan Rudolph ◽

Howard David Reines ◽

Philip E. Zapanta

Keyword(s):

Qualitative Study ◽

Learning Strategies ◽

Thyroid Surgery ◽

Washington Dc ◽

Structured Interviews ◽

Self Directed Learning ◽

Surgical Specialty ◽

Long Term Follow Up ◽

The Individual

Objectives: The Accreditation Council for Graduate Medical Education has guidelines on assessing surgical qualifications based on experience. Attending surgeons have various assumptions on how their trainees learn and acquire surgical skills. This study primarily investigates the resident’s perspective on gaining experience and achieving competency in thyroid surgical procedures. Methods: A qualitative study using semi-structured interviews was designed to derive themes that discuss the acquisition of competency in thyroid surgery. After IRB approval, data was collected from 2012 to 2014 at 4 academic centers in the Washington, DC area. Fourteen chief residents specializing in either general surgery or otolaryngology were interviewed until saturation was achieved. These semi-structured interviews were transcribed and broken up into codes utilizing Moustakas’ analysis. A comprehensive list of master themes in regards to achieving competency in thyroid surgery was developed. A follow up survey of the surgeons was undertaken at 5 years to determine if the perceptions during residency persisted in practice. Results: Surgical specialty residents experience and learn thyroid surgery in 5 learning themes: 1. Self—directed learning is significant during residency. 2. Repetition with graduated autonomy is key. 3. Effective mentors are competent surgeons who challenge residents and use positive teaching techniques. 4. Residents employ active learning through the “see one, do one, teach one” philosophy. 5. Learning from complexity is of importance to residency training. After several years in practice, the most important theme in learning after residency was repetition of cases. Conclusions: This study demonstrates how residents progress in approaching competency in thyroid surgery. Adult learning strategies are preferred, and programs should incorporate tailored techniques to meet the individual needs of the residents. Perceptions of what is most important shifted in long-term follow up. Further study is needed to assure competency in residency and in practice.

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Impact of Mobile Health Devices for the Detection of Atrial Fibrillation: Systematic Review

JMIR mhealth and uhealth ◽

10.2196/26161 ◽

2021 ◽

Vol 9 (4) ◽

pp. e26161

Author(s):

Tom E Biersteker ◽

Martin J Schalij ◽

Roderick W Treskes

Keyword(s):

Atrial Fibrillation ◽

Systematic Review ◽

Mobile Health ◽

Standard Care ◽

Detection Rate ◽

Increased Risk ◽

Study Results ◽

Statistical Heterogeneity ◽

Study Participants

Background Atrial fibrillation (AF) is the most common arrhythmia, and its prevalence is increasing. Early diagnosis is important to reduce the risk of stroke. Mobile health (mHealth) devices, such as single-lead electrocardiogram (ECG) devices, have been introduced to the worldwide consumer market over the past decade. Recent studies have assessed the usability of these devices for detection of AF, but it remains unclear if the use of mHealth devices leads to a higher AF detection rate. Objective The goal of the research was to conduct a systematic review of the diagnostic detection rate of AF by mHealth devices compared with traditional outpatient follow-up. Study participants were aged 16 years or older and had an increased risk for an arrhythmia and an indication for ECG follow-up—for instance, after catheter ablation or presentation to the emergency department with palpitations or (near) syncope. The intervention was the use of an mHealth device, defined as a novel device for the diagnosis of rhythm disturbances, either a handheld electronic device or a patch-like device worn on the patient’s chest. Control was standard (traditional) outpatient care, defined as follow-up via general practitioner or regular outpatient clinic visits with a standard 12-lead ECG or Holter monitoring. The main outcome measures were the odds ratio (OR) of AF detection rates. Methods Two reviewers screened the search results, extracted data, and performed a risk of bias assessment. A heterogeneity analysis was performed, forest plot made to summarize the results of the individual studies, and albatross plot made to allow the P values to be interpreted in the context of the study sample size. Results A total of 3384 articles were identified after a database search, and 14 studies with a 4617 study participants were selected. All studies but one showed a higher AF detection rate in the mHealth group compared with the control group (OR 1.00-35.71), with all RCTs showing statistically significant increases of AF detection (OR 1.54-19.16). Statistical heterogeneity between studies was considerable, with a Q of 34.1 and an I2 of 61.9, and therefore it was decided to not pool the results into a meta-analysis. Conclusions Although the results of 13 of 14 studies support the effectiveness of mHealth interventions compared with standard care, study results could not be pooled due to considerable clinical and statistical heterogeneity. However, smartphone-connectable ECG devices provide patients with the ability to document a rhythm disturbance more easily than with standard care, which may increase empowerment and engagement with regard to their illness. Clinicians must beware of overdiagnosis of AF, as it is not yet clear when an mHealth-detected episode of AF must be deemed significant.

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Telemedicine in The Context of Covid-19- A Qualitative Study of Cancer Patients and Clinicians

10.21203/rs.3.rs-149380/v1 ◽

2021 ◽

Author(s):

Dylan Chan Tai Kong ◽

Ashfaq Chauhan ◽

Anaïs Tiffany Ah Leung ◽

Melvin Chin

Keyword(s):

Qualitative Study ◽

Theory Approach ◽

Structured Interviews ◽

Hospital Data ◽

Metropolitan Regions ◽

Theoretical Sampling ◽

Proper Training ◽

Grounded Theory Approach

Abstract Background:Prior to the Covid-19 pandemic, telemedicine was only used to deliver health care to patients living in remote areas of Australia. However, the spread of the Covid-19 virus pushed the widespread uptake of telemedicine across Australia, including in metropolitan regions. This qualitative study will explore the medical oncology (MO) patient and clinician experience of telemedicine in a metropolitan setting as a result of Covid-19.Method:Participants were selected and invited to participate by theoretical sampling from MO clinicians and patients attending MO clinics at Prince of Wales Hospital. Data was collected by in-depth semi-structured interviews. Thematic analysis was performed to analyse the interview data. Transcripts were coded using the grounded theory approach to identify overarching themes.Results:Twelve participants were recruited to the study. Most participants viewed the adoption of telemedicine positively because it was considered as convenient, efficient and could be used in order to reduce the spread of Covid-19. Nonetheless, participants complained about the poor implementation of telemedicine, technical difficulties and lack of proper training. Finally, providers expressed mixed views over the lack of personal interaction and the lack of physical examination from telemedicine. However, both clinicians and patients viewed telemedicine as acceptable to be used in the context of routine follow-ups.Conclusion:Although some operational improvements are necessary, the role of telemedicine in the follow up of MO patients seems likely to continue beyond Covid-19.

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

Pilot and Feasibility Studies ◽

10.1186/s40814-021-00850-y ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Yanhong Jessika Hu ◽

Xudong Zhou ◽

Shanjuan Wang ◽

Merlin Willcox ◽

Colin Garner ◽

...

Keyword(s):

Controlled Trial ◽

Alternative Therapy ◽

Acute Diarrhoea ◽

Final Analysis ◽

Daily Practice ◽

Antibiotic Use ◽

Symptom Duration ◽

Structured Interviews ◽

Double Blind

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

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Management and outcomes of real-world use of non-vitamin-K oral anticoagulants (NOACs) in patients with atrial fibrillation: experience of a dedicated NOAC clinic

Netherlands Heart Journal ◽

10.1007/s12471-019-01330-y ◽

2019 ◽

Vol 27 (12) ◽

pp. 605-612 ◽

Cited By ~ 1

Author(s):

A. J. W. M. de Veer ◽

N. Bennaghmouch ◽

M. C. E. F. Wijffels ◽

J. M. ten Berg

Keyword(s):

Atrial Fibrillation ◽

Adverse Drug Reactions ◽

Vitamin K ◽

Real World ◽

Oral Anticoagulants ◽

Daily Practice ◽

Drug Reactions ◽

Real World Data ◽

First Choice

Abstract Background Current guidelines recommend non-vitamin‑K oral anticoagulants (NOACs) as the first-choice therapy for stroke prevention in patients with atrial fibrillation (AF). The use of drugs in a clinical trial setting differs from that in real-world populations. Real-world data are important to accrue more heterogeneous patient populations with respect to co-morbidities and co-medication use. The aim of this study was to evaluate the use of NOACs in daily practice in a large tertiary hospital in the Netherlands. Methods A single-centre prospective study was conducted among all patients with AF using a NOAC in the St. Antonius Hospital between 2013 and June 2017. The outcomes were the rates of any bleeding, stroke/transient ischaemic attack, mortality, discontinuation rate and adverse drug reactions. Results In total, 799 patients were enrolled with a mean follow-up of 1.7 years. Mean age was 69.8 (SD ± 11) and 61.2% were male. Mean CHA2DS2-VASc score was 2.8 (SD ± 1.6) and mean HAS-BLED score was 1.4 (SD ± 0.9). Bleeding occurred in 6.0, major bleeding in 1.8, stroke in 1.2 patients per 100 patient-years, and 87 patients (10.9%) died during the follow-up period. Adverse drug reactions were reported by 59 patients (7.4%). Finally, 249 patients (31.2%) reported a temporary interruption and 132 (16.5%) permanent discontinuation of NOAC treatment, of whom 33 (25%) patients switched to a vitamin‑K antagonist. Conclusions We observed low rates of bleeding and adverse drug reactions. However, rates of mortality and discontinuation were relatively high. These results could possibly be explained by the real-world nature of the data including higher-risk patients.

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Improving well-being in dementia care for clients and carers

Journal of Public Mental Health ◽

10.1108/jpmh-05-2020-0039 ◽

2020 ◽

Vol 19 (4) ◽

pp. 321-326

Author(s):

Rhonda Riachi ◽

Sally Markwell

Keyword(s):

Qualitative Study ◽

Well Being ◽

Dementia Care ◽

Theory Approach ◽

Structured Interviews ◽

Content Type ◽

Beneficial Effects ◽

Communication Techniques ◽

People With Dementia ◽

Care Workers

Purpose This paper aims to highlight the results and emerging themes from a study concerning the effect of communication techniques that were tailored to each client in relation to the extent of their dementia. Dementia was viewed by the care workers primarily as a memory disability. Design/methodology/approach A short qualitative study of the communication techniques of care workers in England, who had received training in dementia care and some training in the SPECAL® method (Specialised Early Care for Alzheimer’s),was conducted through semi-structured interviews. Resulting data were analysed using a constructivist grounded theory approach. Findings Continued application of the SPECAL techniques appeared to reinforced clients’ sense of well-being and produced benefits for care workers’ own well-being. Research limitations/implications This small qualitative study suggests there can be beneficial effects for both clients and the care team when care workers tailor their communication behaviour to the needs of people with dementia. Further research on communication techniques in dementia care is needed and how these benefits might be translated into institutional settings. Originality/value Few research studies have been made of the SPECAL dementia care method, and this study was the first to look explicitly at the communication techniques that the care workers used with clients. Public health professionals are less likely to be aware of the SPECAL method.

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“Those Plates That Save Me”: Experiences of Italian Patients With Implantable Cardioverter Defibrillator

Clinical Nursing Research ◽

10.1177/1054773820968036 ◽

2020 ◽

pp. 105477382096803

Author(s):

Ivana Maria Rosi ◽

Francesca Bombardieri ◽

Daniele Steri ◽

Mimma Sternativo ◽

Stefania Rancati

Keyword(s):

Qualitative Study ◽

Implantable Cardioverter Defibrillator ◽

Health Professionals ◽

Structured Interviews ◽

Cardioverter Defibrillator ◽

Life Conditions ◽

Lack Of Information

This study aimed to investigate and understand the experiences and feelings lived by people with an ICD. Qualitative study, semi-structured interviews were conducted with a sample of 16 patients, during the annual follow-up. A hermeneutical analysis of the interviews was carried out to identify the themes. Four main themes were classified: “My heart falls asleep,” highlighting a reduced awareness of the pathology and ICD installation; “But what is this thing. . .?” underlining the lack of information and fears related to the device and its functioning; “I cannot hug the microwave” which describes the changes brought about by the surgery; “And with this one I am alright for the rest of my life”, involving hopes and life expectations. This study highlighted the patients’ need for major support from health professionals while processing their new life conditions.

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Effect of reinforced, targeted in-person education using the Jessa Atrial fibrillation Knowledge Questionnaire in patients with atrial fibrillation: A randomized controlled trial

European Journal of Cardiovascular Nursing ◽

10.1177/1474515118804353 ◽

2018 ◽

Vol 18 (3) ◽

pp. 194-203 ◽

Cited By ~ 3

Author(s):

Lien Desteghe ◽

Lara Engelhard ◽

Johan Vijgen ◽

Pieter Koopman ◽

Dagmara Dilling-Boer ◽

...

Keyword(s):

Quality Of Life ◽

Atrial Fibrillation ◽

Standard Care ◽

Control Group ◽

Knowledge Level ◽

Symptom Profile ◽

Knowledge Questionnaire ◽

The Impact

Background: The knowledge level of atrial fibrillation patients about their arrhythmia, its consequences and treatment is poor. The best strategy to provide education is unknown. Aim: To investigate the effect of reinforced targeted in-person education using the Jessa Atrial fibrillation Knowledge Questionnaire (JAKQ). Methods: Sixty-seven atrial fibrillation patients were randomized to standard care (including brochures) or targeted education. Follow-up visits were scheduled after one, three, six and 12 months. Targeted education during each visit focused on the knowledge gaps revealed by the JAKQ. Patients completed two questionnaires to assess their quality of life and symptom profile. Adherence to non-vitamin K antagonist oral anticoagulants was measured using electronic monitoring. Results: Sixty-two patients (31 education; 31 standard care) completed follow-up. Median baseline score on the JAKQ was similar in education (62.5%) and standard care group (56.3%; p=0.815). The intervention group scored significantly better over time (one month: 75.0%, 12 months: 87.5%; p<0.001) whereas there was no significant improvement in the control group (one month: 62.5%, 12 months: 62.5%; p=0.085). Providing targeted education after completion of the JAKQ required on average 6.9±4.6 min. Some improvements in quality of life, symptom burden and adherence were shown, without significant differences between the two groups ( p-values between 0.282 and 0.677). Conclusion: The JAKQ is an effective tool for providing individualized education. A first targeted educational session significantly improved patients’ knowledge level. Additional educational sessions maintained and strengthened this effect. A larger scale study is warranted to evaluate the impact on adherence and outcome measures.

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Patient-reported outcome measures in the interaction between patient and clinician – a multi-perspective qualitative study

Journal of Patient-Reported Outcomes ◽

10.1186/s41687-019-0170-x ◽

2020 ◽

Vol 4 (1) ◽

Cited By ~ 2

Author(s):

Caroline Trillingsgaard Mejdahl ◽

Liv Marit Valen Schougaard ◽

Niels Henrik Hjollund ◽

Erik Riiskjær ◽

Kirsten Lomborg

Keyword(s):

Qualitative Study ◽

Patient Involvement ◽

Methodological Approach ◽

Patient Activation ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Phone Call ◽

Structured Interviews ◽

Patient Reported

Abstract Background This article addresses patient-reported outcome (PRO)-based follow-up used as a substitute for regularly scheduled follow-ups. In PRO-based follow-up, patients’ PRO data filled in by the patients at home are used by clinicians as a decision aid to identify those who need clinical attention based on an automated PRO algorithm, clinical attention being either a phone call or a physical consultation. A physical consultation in the outpatient clinic prompted by the patient’s PRO is termed a “PRO consultation.” In this multi-perspective qualitative study, we explored the influence of patients’ self-reported data on patient-clinician interaction during PRO consultations in epilepsy outpatient clinics. Interpretive description was the methodological approach, applying data from participant observations, informal interviews with clinicians, and semi-structured interviews with clinicians and patients. Results We found that application and deliberate use of patients’ PRO measures can affect patient-clinician interaction, promoting patient involvement in terms of improved communication and increased patient activation. These findings reflect the general patterns that have been reported in the literature. In addition, we found that PRO measures also may induce unmet expectations among some patients that can have a negative effect on patients’ experiences of the interaction and their follow-up experience in general. We extracted two thematic patterns that represent PRO measures’ potential for patient involvement in the patient-clinician interaction. The first pattern represents enablers, and the second pattern represents barriers for PRO measures to affect patient involvement. Conclusions Applying PRO measures in clinical practice does not automatically enhance the patient-clinician interaction. To strengthen the benefits of PRO measures, the following supplementary clinical initiatives are suggested: summarizing and reporting the PRO measures back to the patient, considering carefully which PRO measures to include, training clinicians and assuring that the patients’ introduction to PRO-based follow-up clarifies expectations.

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Strategies for Successful Recruitment and Retention of Parents in Pediatric Psychosocial eHealth Interventions: A Qualitative Study in Pediatric Oncology

Journal of Pediatric Psychology ◽

10.1093/jpepsy/jsaa013 ◽

2020 ◽

Vol 45 (5) ◽

pp. 530-539 ◽

Cited By ~ 1

Author(s):

Kimberly S Canter ◽

Gabriela Vega ◽

Alejandra Perez Ramirez ◽

Janet A Deatrick ◽

Anne E Kazak

Keyword(s):

Qualitative Study ◽

Intervention Program ◽

Structured Interviews ◽

Children With Cancer ◽

Engagement Strategies ◽

Successful Recruitment ◽

Ease Of Access ◽

Intervention Trials ◽

Ehealth Intervention

Abstract Objective Psychosocial intervention studies with parents often have difficulty with regard to participant recruitment, retention, and engagement. Prior to conducting a pilot test of the Electronic Surviving Cancer Competently Intervention Program (eSCCIP), a psychosocial eHealth intervention for parents of children with cancer, a qualitative study was designed to preemptively generate strategies to address potential difficulties in these domains. Methods Two focus groups and three semi-structured interviews were conducted with parents of children with cancer. Qualitative data were analyzed using the principles of thematic and content analysis. Themes were generated to describe results and inform the development of concrete recruitment, retention, and engagement strategies to be utilized in future intervention trials. Results Five themes emerged specific to recruitment, and three themes emerged related to retention and engagement. Parents highlighted a number of important potential recruitment, retention, and engagement strategies, including the importance of flexibility, ease of access and use, intervention timing, and pathways to follow-up care. Themes were linked to actionable recruitment, retention, and engagement strategies which can be utilized in future studies. Conclusion Results from the current study will be utilized when designing future eSCCIP intervention trials and will also be of use to the broader field of psychosocial eHealth intervention research in pediatric psychology. This study also underscores the importance of working with parent stakeholders at all phases of study design and implementation.

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