Exploring two distinct gentamicin prescribing protocols in UK hospitals: a mixed-methods realist evaluation

ObjectivesGentamicin is the aminoglycoside antibiotic of choice in the UK. It has a narrow therapeutic index: underdosing results in inefficacy while overdosing is characterised by nephrotoxicity and ototoxicity. To improve patient safety, hospitals have protocols for the prescription of gentamicin, which vary in complexity and approach. This study aimed to explore two distinct protocols for prescribing gentamicin in hospital settings, in order to understand the mechanisms they trigger and the outcomes they achieve.SettingA mixed-methods realist evaluation explored gentamicin prescribing protocols in two hospital surgical admissions units in South West England between January and August 2018. Site 1 had a traditional, complex protocol, while site 2 took a simplified protocol.ParticipantsTesting the initial programme theory (IPT) involved semi-structured audio-recorded interviews of a volunteer sample of healthcare professionals (HCPs) involved in the prescribing and administering process, alongside a clinical audit reviewing accuracy of gentamicin prescribing.Outcome measuresThree sequential phases were used to identify factors in a successful protocol: IPT generation; testing; refinement of the IPT. The IPT was generated by literature search and analysis of existing protocols of sites 1 and 2. Refinement of the IPT synthesised the results of the quantitative and qualitative research to identify the key characteristics of a successful protocol.ResultsOne hundred gentamicin prescriptions were reviewed, with a mean accuracy of gentamicin prescribing at site 1 of 65.67% and at site 2 of 78.79% (p<0.01). Thirty HCPs were interviewed. Key contexts were identified including prescriptiveness, experience and availability of patient information. These triggered hidden mechanisms including uncertainty, fear, confidence and frustration leading to both intended outcomes but also unintended outcomes such as deviation from protocol and unnecessary gentamicin levels.ConclusionsA simplified prescribing protocol for gentamicin is better accepted by prescribers, leading to better adherence to protocol and more accurate prescribing.

A qualitative study on overdose response in the era of COVID-19 and beyond: how to spot someone so they never have to use alone

Background Spotting is an informal practice among people who use drugs (PWUD) where they witness other people using drugs and respond if an overdose occurs. During COVID-19 restrictions, remote spotting (e.g., using a telephone, video call, and/or a social media app) emerged to address physical distancing requirements and reduced access to harm reduction and/or sexually transmitted blood borne infection (STBBI’s) prevention services. We explored spotting implementation issues from the perspectives of spotters and spottees. Methods Research assistants with lived/living expertise of drug use used personal networks and word of mouth to recruit PWUD from Ontario and Nova Scotia who provided or used informal spotting. All participants completed a semi-structured, audio-recorded telephone interview about spotting service design, benefits, challenges, and recommendations. Recordings were transcribed and thematic analysis was used. Results We interviewed 20 individuals between 08/2020–11/2020 who were involved in informal spotting. Spotting was provided on various platforms (e.g., telephone, video calls, and through texts) and locations (e.g. home, car), offered connection and community support, and addressed barriers to the use of supervised consumption sites (e.g., location, stigma, confidentiality, safety, availability, COVID-19 related closures). Spotting calls often began with setting an overdose response plan (i.e., when and who to call). Many participants noted that, due to the criminalization of drug use and fear of arrest, they preferred that roommates/friends/family members be called instead of emergency services in case of an overdose. Both spotters and spottees raised concerns about the timeliness of overdose response, particularly in remote and rural settings. Conclusion Spotting is a novel addition to, but not replacement for, existing harm reduction services. To optimize overdose/COVID-19/STBBI’s prevention services, additional supports (e.g., changes to Good Samaritan Laws) are needed. The criminalization of drug use may limit uptake of formal spotting services.

Coping with Medical School: An Interpretive Phenomenological Study

Anecdotal evidence suggested that hopelessness and helplessness (HH) were often reported by undergraduate medical students. It is known that medical students are more susceptible to high levels of stress and depression than other student groups. There is currently concern about suicide rates in students and high drop-out rates in junior doctors. But what can be said of HH within this population? This study was aimed at eliciting medical students’ experiences of HH. An interpretive phenomenological approach was adopted. Participants were recruited from a single medical school. Loosely structured, audio-recorded interviews were carried out. Recordings were then transcribed verbatim, then underwent an interpretive phenomenological analysis. Three participants were recruited. Their stories report some devastating experiences – ranging from social isolation to homelessness and suicidal ideation. Our cases complement the existing literature. Awareness of the issues raised in these cases may help medical educators to better understand and support others in similar situations. These may also benefit those experiencing HH themselves. We hope that this exploratory project paves the way to further study.

Meaning of aging for caregivers of senile elderly people

ABSTRACT Objectives: to understand the meaning of aging for caregivers of senile elderly people. Methods: qualitative study carried out with 12 caregivers of elderly people registered in the Home Care Service, adopting the Explanatory Model of Kleinman’s Disease as a theoretical framework. Data were collected from April to June 2019, through semi-structured, audio-recorded interviews, carried out at home and submitted to content analysis. Results: taking care of senile elderly people triggers reflections on aging that sometimes lead to a new meaning of this process, besides stimulating the recognition of the factors that influence it, with emphasis on the life history, occupation and deleterious behaviors adopted throughout life. Final Considerations: the care experience influences the meaning attributed to aging, favoring: the identification of modifiable and non-modifiable aspects and behaviors that make it healthy; reflection on aging itself, with a new meaning of habits and behaviors to be adopted.

Perception of health professionals about shared care between primary care and home care

ABSTRACT Objective: to understand how health professionals perceive the shared care between the teams of Primary Health Care and Home Care Service. Method: descriptive study, with a qualitative approach, carried out with 17 professionals, in the municipality of Campo Grande, MS. Data were collected from August to October 2019, through semi-structured audio-recorded interviews and submitted to content analysis. Results: lack of knowledge, lack of qualification, lack of ordering of care and weakness in counter-referral were some of the challenges mentioned for shared care. However, interinstitutional visits, communication, discussion of cases, action planning, were perceived as strategies to carry it out. Final considerations: professionals perceive that home care is permeated by limitations and weaknesses in relation to the effectuation of shared care between the different health teams.

Women’s experiences of consenting to episiotomy: a qualitative interview study

Objective To explore how women undergoing episiotomy experience and perceive the consent process. Design Qualitative interview study. Setting A postnatal ward in a London teaching hospital. Sample 15 women who had recently undergone episiotomy. Methods Semi-structured, audio-recorded interviews were analysed using thematic analysis. Main outcome measures Themes derived from analysis of interview transcripts. Results Three themes emerged in relation to women’s experiences of the episiotomy consent process: 1) realities of episiotomy practice, 2) information provision and 3) voluntariness of consent. Practical realities such as time pressure, concern for the baby’s health and women’s state of exhaustion, constrained consent discussions. Minimal information on episiotomy was shared with participants, particularly concerning risks and alternatives. Participants consequently inferred that there was no other choice to episiotomy. Whilst some women were still happy to agree, others perceived the consent process to be illusory and disempowering, and subsequently experienced episiotomy as a distressing event. Conclusions Consent to episiotomy is not consistently informed and voluntary and more often takes the form of compliance. Information must be provided to women in a timelier fashion in order to fulfil legal requirements, and to facilitate a sense of genuine choice. Funding The study has not received grant funding. The research team are funded by the Higher Education Funding Council for England (HEFCE). Keywords Episiotomy, consent, women’s experiences, qualitative

Life's hard and then you die: the end-of-life priorities of people experiencing homelessness in the UK

Background: People experiencing homelessness often die young and without adequate support. In the UK, they fail to access palliative care services and their end-of-life priorities remain poorly understood. Aims: To explore the end-of-life concerns, fears, preferences and priorities of a sample of people experiencing homelessness in the UK. Methods: This is an interpretive phenomenology. Data collected through semi-structured, audio-recorded, face-to-face interviews with 21 homeless participants in the UK were analysed iteratively using thematic analysis. Findings have been interpreted through the lens of Merleau-Ponty's philosophy. Results: Eight themes are reported: spiritual concerns; practical concerns; fear of needing care; fear of being forgotten; preference for dying suddenly; preference for being somewhere comfortable where people know me; prioritising autonomy and self-determination; and prioritising authenticity. Conclusion: A strengths-based, trauma-informed, person-centred, collaborative ‘compassionate community’ approach to care is recommended for people experiencing homelessness at end of life.

Research Program

Chapter 5 presents the authors’ methods and discusses some challenges encountered. Data were collected from 103 educators of children (ages 6 to 12 years in first through sixth grades) at 43 public elementary schools in seven cities in four countries: Japan, Taiwan, South Korea, and the U.S. The authors purposely selected research sites and participants to yield data on a range of cultural understandings and responses to disabilities. Semi-structured, audio-recorded individual interviews lasting 20 to 60 minutes were conducted in participants’ native languages in private spaces such as conference rooms, offices, and classrooms after school. Interviews were inductively coded within each cultural group, and then common issues and their cultural nuances were identified in cross cultural analyses.

A qualitative study examining medical provider advice, barriers, and perceived effectiveness in addressing childhood obesity to patients and families from a low-income community health clinic

Objective: To examine medical provider (n = 16) perceptions in addressing and managing pediatric obesity with a diverse, low-income patient population. Methods: Semi-structured audio-recorded interviews were performed at three pediatric clinics. Transcripts were reviewed using content analysis and consensus was reached among authors for themes. Themes were grouped into categories including: (1) initiation of weight discussions, (2) advice and perceived effectiveness, and (3) barriers. Results: Most providers reported being comfortable addressing weight and use a variety of methods to initiate conversations; however, many challenges were reported, which include limited time and parent misperceptions of child’s weight. A broad range of lifestyle advice was utilized, but preference to discuss physical activity over nutrition was reported. Conclusion: Results suggest that successful management of children’s weight involves addressing issues at both the parent and the provider levels. Improved nutrition resources or training for providers is suggested; however, time must also be available for individualized counseling. Incorporation of registered dietitians may also reduce the burden.

English teachers’ identities concerning their knowledge of slang

Underpinned by a postmodern perspective of (teacher) identity, which characterizes it as unstable, multifaceted, unfinished, complex, dynamic, fluid, constructed in relation with others (Bauman, 2005; Bohn, 2005; Hall, 2006; Beijaard et al., 2011 among others), this qualitative research aims at exploring English language teachers’ identities concerning their knowledge of slang. For this purpose, a semi-structured, audio-recorded interview was conducted with three English teachers, from the three main language institutes in Cornelio Procópio, state of Paraná. Results reveal that on the one hand, teachers consider themselves to be fluent in English and confident of their language and teaching skills; on the other, they consider their knowledge of slang to be somewhat limited. Additionally, geographical boundaries are perceived as a hindrance to address such topic in class.