Clinical Work Practice Research Articles

The everyday phenomenology of bedside insight: Response to Paley's critique of phenomenological research in nursing.

The quality of phenomenological research in nursing has been a subject of long-standing debate and critique, but conversation took a particularly contentious turn following publication of John Paley's 2017 Phenomenology as Qualitative Research (Routledge), which elicited strong reactions. Faculty in nursing doctoral programs now face a challenge: in light of current controversies, what can we teach that is appropriately labeled phenomenological, and is there a way to present philosophical concepts that might equip students to avoid the most egregious mistakes of the past? In this article, I suggest that ordinary clinical nursing practice is an inherently phenomenological enterprise, and creative bedside insights belong at the center of our teaching, as they embody an everyday phenomenology which exemplifies core elements of the phenomenological method. Instead of following ever-more-precisely elaborated instructional manuals, I propose, our students should begin their studies of phenomenology by returning attention to the way creative insight emerges during routine care. Bedside insights have been rendered invisible by our discipline's valuing of technical proceduralism over artistry in research and by the turn to evidence-based practice in clinical work, but they are a valuable pathway to learning and should be part of our response to the current crisis.

Effective Treatments for Abductor Vocal Cord Paralysis: A Comprehensive Review.

Abductor vocal cord paralysis (AVCP) is a disabling disorder that affects the voice and the quality of life of a patient, and hence, there is importance in providing a detailed knowledge of its aetiology and management. In this review article, we offer an implicational definition of AVCP and a discussion of its background, viewed as potentially affecting voice production and health. Finally, we explore modalities of diagnosis by medical history and physical examination, visualization techniques like laryngoscopy and stroboscopy, and radiographic imaging such as computed tomography (CT) and magnetic resonance imaging (MRI) scans. The article reviews and categorizes approaches into operative and non-operative treatments, including injection laryngoplasty, voice therapy, botulinum toxin injections, and the management of Reinke's edema. Surgical approaches, like arytenoid adduction, cordotomy, and posterior cordotomy, are also scrutinized taking their indication, efficacy, and complication profile into consideration. Learning about the advantages and drawbacks of the following experimental yet promising directions like nerve-muscle pedicle implantation, nerve reinnervation, and engineering of tissues is therefore highly necessitated. In conclusion, the review details the measures that have shown to be useful in the treatment process and their impact on the future practice of clinical work, calling for a more clarified structure of the organization of diagnostic, therapeutic, and rehabilitative activities. Future research directions are outlined based on the gaps which include the development of new treatment approaches, the evaluation of treatment for long-term effects, and the need for interdisciplinary cooperation in the medical field for the benefit of the patients.

Healthcare Providers’ Readiness to Address Medical Device Cybersecurity within the Irish Healthcare System

Medical devices that can diagnose and treat critically ill patients have become sophisticated and complex. Device manufacturers have been developing these systems to meet market requirements as technology evolves. Combining medical devices and ICT into a distributed medical device IT system can be a solution to incorporating continuous monitoring from the patient bedside to interoperability with a clinical information system. These technology innovations aim to manage patient data and configure medical devices into networked systems that can provide functionality and safety. The implementation of a medical device network solution allows a healthcare provider to take advantage of managing the flow of information to improve clinical work practices and implement a system that can be interoperable with other clinical information systems. International Electrotechnical Commission (IEC) 80001-1 was developed to assist healthcare providers in identifying and managing the risks associated with medical devices sharing the same IT network with other systems and software. This standard defines roles, responsibilities, and activities in relation to the management of risk with medical devices on an IT network. This study aims to determine if the standard International Electrotechnical Commission (IEC) 80001-1 is being implemented and determine familiarity with regulations and appropriate standards and guidance for an effective medical device security risk-management program with Irish healthcare providers. A literature review highlighted the restrictions healthcare providers face in adopting and implementing IEC 80001-1 and the security threats and risks present when integrating medical devices and IT networks. The study research was conducted with clinical engineering members of the Biomedical and Clinical Engineering Association of Ireland (BEAI). This survey targeted BEAI members due to their wealth of experience, knowledge, and skill level in supporting complex medical device systems. An online anonymous survey was created to determine knowledge, awareness, and familiarity with IEC 80001-1 and other medical device security risk-management guidelines. The study research results revealed low knowledge, awareness, and familiarity among research participants with IEC 80001-1 and guidelines on medical device security risk management. These results were consistent with the literature review that a key to the success of standard adoption is collaboration between stakeholders and a multidisciplinary approach to compliance.

Early Experiences of Integrating an Artificial Intelligence-Based Diagnostic Decision Support System into Radiology Settings: A Qualitative Study.

Artificial Intelligence (AI) based clinical decision support systems to aid diagnosis are increasingly being developed and implemented but with limited understanding of how such systems integrate with existing clinical work and organizational practices. We explored the early experiences of stakeholders using an AI-based e-learning imaging software tool Veye Lung Nodules (VLN) aiding the detection, classification, and measurement of pulmonary nodules in computed tomography scans of the chest. We performed semi-structured interviews and observations across early adopter deployment sites with clinicians, strategic decision-makers, suppliers, patients with long-term chest conditions, and academics with expertise in the use of diagnostic AI in radiology settings. We coded the data using the Technology, People, Organizations and Macro-environmental factors framework (TPOM). We conducted 39 interviews. Clinicians reported VLN to be easy to use with little disruption to the workflow. There were differences in patterns of use between experts and novice users with experts critically evaluating system recommendations and actively compensating for system limitations to achieve more reliable performance. Patients also viewed the tool positively. There were contextual variations in tool performance and use between different hospital sites and different use cases. Implementation challenges included integration with existing information systems, data protection, and perceived issues surrounding wider and sustained adoption, including procurement costs. Tool performance was variable, affected by integration into workflows and divisions of labor and knowledge, as well as technical configuration and infrastructure. These under-researched factors require attention and further research.

Early experiences of integrating an artificial intelligence-based diagnostic decision support system into radiology settings: a qualitative study.

Artificial intelligence (AI)-based clinical decision support systems to aid diagnosis are increasingly being developed and implemented but with limited understanding of how such systems integrate with existing clinical work and organizational practices. We explored the early experiences of stakeholders using an AI-based imaging software tool Veye Lung Nodules (VLN) aiding the detection, classification, and measurement of pulmonary nodules in computed tomography scans of the chest. We performed semistructured interviews and observations across early adopter deployment sites with clinicians, strategic decision-makers, suppliers, patients with long-term chest conditions, and academics with expertise in the use of diagnostic AI in radiology settings. We coded the data using the Technology, People, Organizations, and Macroenvironmental factors framework. We conducted 39 interviews. Clinicians reported VLN to be easy to use with little disruption to the workflow. There were differences in patterns of use between experts and novice users with experts critically evaluating system recommendations and actively compensating for system limitations to achieve more reliable performance. Patients also viewed the tool positively. There were contextual variations in tool performance and use between different hospital sites and different use cases. Implementation challenges included integration with existing information systems, data protection, and perceived issues surrounding wider and sustained adoption, including procurement costs. Tool performance was variable, affected by integration into workflows and divisions of labor and knowledge, as well as technical configuration and infrastructure. The socio-organizational factors affecting performance of diagnostic AI are under-researched and require attention and further research.

Wade in the Water: Suggestions for Centering Reproductive Justice in Social Work Education, Practice, and Organizing

ABSTRACTIn this article, we grapple with how social work educators and practitioners should hold and respond to the Supreme Court’s ruling to overturn Roe v. Wade. We begin by outlining what is at stake for the social work field by mapping the impact on the safety and well-being of individuals, families, and communities of color. Our analysis also makes visible the ways in which the Court’s decision has enacted epistemic violence to decades of reproductive justice-based theorizing and organizing spearheaded by women of color. Applying a reproductive justice (RJ) framework to the Council for Social Work Education (CSWE) Competencies, we identify areas within micro-, mezzo-, and macro-level practice for social workers to disrupt patterns of reproductive oppression, including restrictions on abortion. We believe that every social worker is situated to play a unique role in creating liberatory clinical social work practices. By centering reproductive justice and decolonial thinking in social work education and practice, we can begin to ask different questions and try new strategies to build safe and more supportive environments.

Exploring navigation of gender in a sample of clinically referred young people attending the gender identity development service

BackgroundGender-diverse young people experience a cisnormative world and are subject to unique minority stressors, which have been found to contribute to adverse mental health. This research aims to understand the social and personal context unique to gender-diverse people that young people navigate prior to attending specialised services.MethodsThe baseline measure of a newly developed questionnaire, the GIDS Gender Questionnaire (GIDS-GQ), was sent to all young people (or caregivers for those aged under 12) attending the Gender Identity Development Service (GIDS). Eighty-four young people and caregivers completed the questionnaire, with eighty-one included in the final sample (M = 15.77 years, SD = 1.83, range = 9–17; assigned female at birth = 72, assigned male at birth = 9). Questionnaires were emailed to participants via an online survey between one and three appointments with the Service. Data were collected between April 2021 and February 2022.ResultsAll young people had initiated a social transition, with 75.3% categorised as fully socially transitioned. More young people reported experiencing transphobic bullying (64.2%) and a lack of acceptance of their gender identity (85.1%) in the past (lifetime) than in the 6 months prior to attending the service (transphobic bullying: 12.3%; non-acceptance: 49.4%). 94.5% of the sample reported disliked body parts, most commonly breasts (80.8%), genitals (37%), and hips (31.5%). Participants most commonly reported a decrease in their mood (61.25%) and most areas of social connectedness.ConclusionsThe majority of this sample had socially transitioned, were supported in their identification, and had experienced less transphobic bullying and non-acceptance prior to commencing services. However, young people continued to dislike their bodies, and experience low mood and social connectedness. Future research is needed to understand how clinical support can help reduce the impact of these external/distal minority stressors by promoting social connectedness, incorporating such learnings into clinical practice and subsequent policy in clinical work with gender-diverse young people.

The impact of the COVID-19 pandemic on palliative care practice: A survey of clinical oncologists.

Palliative care is an essential intervention to improve the quality of life for patients with cancer, whereas the ongoing COVID-19 pandemic poses a challenge to supportive and palliative care providers. This survey aims to explore the current status of palliative care practice for cancer and the influence of COVID-19, from the perspective of oncologists. The semi-structure electronic questionnaire was designed. Mixed-mode surveys including electronic questionnaires, face-to-face interactions, and telephone interviews were adopted according to the willingness of respondents. Face-to-face and telephone interviews were based on same questions in the online questionnaire. Participants working in cancer-related departments with frontline palliative care experience during the COVID-19 outbreak were included. Surveys covered experiences and perspectives regarding the impact of COVID-19 on clinical work, personal lives, and palliative care practice. Suggestions on coping strategies were further proposed and qualitatively analyzed. Thirty-seven oncologists participated in this study from September 2021 to January 2022. The majority of them believed COVID-19 significantly and negatively affected their clinical work routines (75.7%), personal daily lives (67.6%), and palliative care practice (64.9%). Most specialists considered that currently the palliative care system remained underdeveloped (73.0%), and other factors besides COVID-19 were associated with this situation (78.4%). Seventeen participants further made suggestions on how to promote palliative care during COVID-19, and three themes emerged through the qualitative analysis: (1) Remote or online service (88.2%); (2) Publicity, education, or shared decision-making for patients (29.4%); (3) Guidelines, training, or programs for care providers (23.6%). Oncologists consider that COVID-19 has an adverse impact on their palliative care practice and daily routine. In addition to COVID-19, other factors affecting palliative care should not be neglected. Corresponding measures are warranted to encourage palliative care practice during COVID-19.

Assimilating problematic life script themes in clinical supervision: The case of Adam

ABSTRACT In transactional analysis theory, life script themes are archaic patterns of experience and interaction, which can emerge during clinical work and impact practice. This study examined whether a newly qualified therapist’s problematic life script themes were detectable in supervision, how they were addressed, and whether addressing them led to assimilation of these themes. Seven consecutive supervision sessions with a recently-qualified male therapist (pseudonym Adam) were transcribed and analyzed using a qualitative theory-building approach. The assimilation of problematic experiences sequence (APES) was used to track changes in Adam’s life script themes. Life script themes were evident in all seven supervision sessions. They centered on two interconnected themes of abuse and rejection. Discussions of these themes in supervision focused on over-identification, protectiveness, and self-disclosure. The supervisor’s interventions included didactic work appropriate for a beginning clinician and facilitative work in supporting development of assimilation of problematic themes. Reflective supervision including exploration of the therapist’s personal process when it is triggered can enhance practice development, and be an important part of the supervision process, providing it respect teach/treat boundary. Comparisons with previous research suggested that script themes emerged differently in supervision of relatively inexperienced supervisees as opposed to experienced ones.

EP10.01-009 The Impact of the COVID-19 Pandemic on Palliative Care for Cancer: A Preliminary Cross-Country Survey of Clinical Oncologists

IntroductionPalliative care is a crucial intervention to improve the quality of life for patients with cancer, although the impacts of the COVID-19 pandemic on palliative care remain unclear. This preliminary survey across China aims to investigate the influence of COVID-19 on palliative care, from the perspective of oncologists.MethodsElectronic questionnaire surveys were distributed to clinicians in China. Participants working in cancer-related departments are eligible. Data was collected including demographic characteristics, subjective perception, and personal suggestions.ResultsA total of 37 oncologists participated in the survey, 78% of whom were male. The median age was 40 (22-56). A large proportion of them have doctor degrees (68%) currently working in urban areas (81%). One-third participants are from the department of radiation oncology (33%) and 24% from medical oncology. They usually practice palliative care in professional medical centres or hospitals (70%), yet 57% had only non-accredited training experience. Most agree that COVID-19 has a significant negative impact on their clinical work (76%) and palliative care practice (65%). 73% of them believe the current palliative care system is underdeveloped in China, and 78% think other factors besides COVID-19 relate to this inadequacy. Participants further tabled suggestions (Figure 1), such as more online guidance on palliative care for patients (35%), strengthening remote multidisciplinary cooperation (29%), promoting home-based palliative care (18%), and involving more information on COVID-19 in palliative care guidelines (6%).ConclusionsKeywordsPalliative care, COVID-19, Cancer IntroductionPalliative care is a crucial intervention to improve the quality of life for patients with cancer, although the impacts of the COVID-19 pandemic on palliative care remain unclear. This preliminary survey across China aims to investigate the influence of COVID-19 on palliative care, from the perspective of oncologists. Palliative care is a crucial intervention to improve the quality of life for patients with cancer, although the impacts of the COVID-19 pandemic on palliative care remain unclear. This preliminary survey across China aims to investigate the influence of COVID-19 on palliative care, from the perspective of oncologists. MethodsElectronic questionnaire surveys were distributed to clinicians in China. Participants working in cancer-related departments are eligible. Data was collected including demographic characteristics, subjective perception, and personal suggestions. Electronic questionnaire surveys were distributed to clinicians in China. Participants working in cancer-related departments are eligible. Data was collected including demographic characteristics, subjective perception, and personal suggestions. ResultsA total of 37 oncologists participated in the survey, 78% of whom were male. The median age was 40 (22-56). A large proportion of them have doctor degrees (68%) currently working in urban areas (81%). One-third participants are from the department of radiation oncology (33%) and 24% from medical oncology. They usually practice palliative care in professional medical centres or hospitals (70%), yet 57% had only non-accredited training experience. Most agree that COVID-19 has a significant negative impact on their clinical work (76%) and palliative care practice (65%). 73% of them believe the current palliative care system is underdeveloped in China, and 78% think other factors besides COVID-19 relate to this inadequacy. Participants further tabled suggestions (Figure 1), such as more online guidance on palliative care for patients (35%), strengthening remote multidisciplinary cooperation (29%), promoting home-based palliative care (18%), and involving more information on COVID-19 in palliative care guidelines (6%). A total of 37 oncologists participated in the survey, 78% of whom were male. The median age was 40 (22-56). A large proportion of them have doctor degrees (68%) currently working in urban areas (81%). One-third participants are from the department of radiation oncology (33%) and 24% from medical oncology. They usually practice palliative care in professional medical centres or hospitals (70%), yet 57% had only non-accredited training experience. Most agree that COVID-19 has a significant negative impact on their clinical work (76%) and palliative care practice (65%). 73% of them believe the current palliative care system is underdeveloped in China, and 78% think other factors besides COVID-19 relate to this inadequacy. Participants further tabled suggestions (Figure 1), such as more online guidance on palliative care for patients (35%), strengthening remote multidisciplinary cooperation (29%), promoting home-based palliative care (18%), and involving more information on COVID-19 in palliative care guidelines (6%). Conclusions KeywordsPalliative care, COVID-19, Cancer Palliative care, COVID-19, Cancer

Unearthing the Learning of Genomic Medicine in the Workplace: a Qualitative Study

Workplace learning is fundamental in contextualizing theoretical concepts into practice, making it opportune for professionals to learn emerging concepts. With genomic testing transitioning from the research space into healthcare, there are more opportunities to engage with workplace learning related to genomic medicine. We therefore aimed to unearth how genomics was being learnt in the workplace and the opportunities and factors that influenced these learning experiences. Qualitative secondary analysis was applied to a purposive sample of interviews with non-genetic physicians who had reflected on their genomic medicine practice and education. Thematic analysis, guided by Billett’s co-participation at work theory, was conducted to identify workplace learning opportunities related to genomic medicine and any influencing factors. A coding framework was developed and iteratively refined until consensus was reached. Various workplace learning opportunities related to genomic medicine were identified from interviews with 29 physicians. Engagement occurred through established clinical work practice, contextual affordances, and agentic pursuits. Barriers and facilitators influenced participants’ experiences and access with opportunities. Some participants recognized these learning opportunities as “informal”; however, most did not. Opportunities to engage with workplace learning beyond formal training are essential to ensure the medical workforce has the knowledge and confidence to engage with practice-related developments. However, ‘work’ activities were not often recognized as ‘learning’ opportunities. With continued efforts to integrate genomics and other innovations into routine healthcare and help reduce the theory–practice gap, this study adds to our understanding of how workplace learning occurs and offers a platform on which to build a robust model for continuing education.

Learning From Experience- Confronting Challenges and Adapting to Change in a Large Academic Abdominal Radiology Practice: Insights From a Faculty Retreat

RationaleSubstantial organizational changes, increasing clinical volumes, and the COVID-19 pandemic presented compound stressors to faculty radiologists in our large academic abdominal radiology division and necessitated multiple changes in our practice. MethodsTo address the challenges and establish group consensus, we conducted a virtual divisional faculty retreat centered on themes of team building, clinical work, trainee education, and faculty mentorship. A pre-retreat survey evaluated satisfaction with aspects of professional life and clinical work practices and invited personal reflections. Survey data were presented in the retreat segments focused on each theme, and subsequent discussion was facilitated in small group breakouts. ResultsResponses to the team-building survey revealed common values and sources of gratitude, including health, family and meaningful work and relationships. Faculty reported a strong sense of personal accomplishment, but with varied emotional exhaustion scores. Faculty were satisfied with remote work assignments but identified opportunities to improve the clinical work schedule including reversion of some remote assignments to in-person and increased interventional radiology shift staggering. Compared to pre-COVID practice, faculty respondents perceived giving lower quality and less frequent feedback to trainees; evolving educational resource needs were identified. A more formal approach to faculty mentoring was sought. A post-retreat survey revealed high participant satisfaction. OutcomesIn the future, we plan to continue divisional retreat activities to respond to evolving challenges and further improve team building, clinical workflow, trainee education, and faculty mentorship.

A survey study on self-reported practice and work environment among anesthetist trainees in Nigeria

CONTEXT: The safe practice of anesthesia encompasses professionalism, equipment, monitoring, medications, and conduct of anesthesia. Therefore, standard training is sine qua non to guarantee good surgical outcomes in a specialty associated with delicate and high-risk cases.AIMS: The aims are to survey the work practices among anesthetist trainees from different centers across Nigeria.SETTINGS AND DESIGN: A descriptive cross-sectional survey study conducted at the Department of Anaesthesia, University College Hospital, Ibadan, Nigeria.SUBJECTS AND METHODS: Anesthetist trainees were administered structured questionnaires following informed consent.STATISTICAL ANALYSIS USED: The Statistical Package for the Social Sciences (IBM SPSS version 23.0®) was used to analyze the obtained data. Results were presented using a frequency and percentage table, with a bar graph.RESULTS: Out of the 76 respondents, there were 57 (75.0%) male and 19 (25.0%) female trainees who were mostly >30 years (90.8%). Mean residency duration was 1.4 ± 0.6 years, with many within 1–2 years of postgraduate training (67.1%). Many were junior registrars 71 (93.4%) and mostly (64.5%) work for >8 h. On clinical work practices, all the respondents reported that they always discuss the risks, purpose, and benefits of anesthesia (100.0%), 77.6% always discuss patient management with superior, 57.9% always provide postanesthetic care, and 88.2% always obtain informed consent. Only 6 out of the 13 anesthetic techniques listed had ≥50% positive responses with confirmation of their abilities to perform these techniques.CONCLUSIONS: Most of the anesthetist trainees reported considerable abilities concerning clinical work practices in anesthesia. However, we observed significant limitations in the provisioning of some anesthetic techniques among many junior registrar trainees and this was not unexpected considering their current level of training.

Knowledge and practices of universal safety precautions among interns and first year resident doctors in a tertiary care hospital

Background: Universal safety precautions also known as standard precautions are a set of evidence based clinical work practices published by Centers for Disease Control and Prevention (CDC) in 1996 and updated in 2007; the extension of blood and body-fluid precautions to all patients is referred to as universal precautions. Despite detail guidelines, the knowledge and understanding of universal safety precautions among health-care workers is found inadequate.Methods: This was a cross-sectional study carried out among interns and first year resident doctors in medical college attached to a tertiary care hospital. Around 200 doctors are enrolled in this study.Results: In our study, correct knowledge about hand hygiene found in interns was 84.1% and clinical residents 93.3% and this knowledge was practiced by 83.6%% interns and 84.1% clinical resident. The knowledge about the importance of wearing the gloves was 95.5% among interns and 95.4% among residents and facemask, eye wear was 78.5% among interns and 92% among residents, but in practice 78.5% interns and 71.5% residents were seen to use gloves and apron. Knowledge about needle stick injury was 95.5% among interns and 97.1% among resident doctors. The knowledge of interns was 81.25% for disposal of gloves and 70.5% for disposal of sharps whereas among resident doctors, it was 72.7% for gloves and 70.4% for sharps.Conclusions: In this study, we observed that overall knowledge regarding importance of hand washing, wearing gloves, risk of needle stick injury, disposal of biomedical waste were satisfactory. There was poor response regarding the steps of hand washing and recapping of needles.

The health and wellbeing of transgender and gender non‐conforming people of colour in the United States: A systematic literature search and review

AbstractTransgender and gender non‐conforming people (TGNC), individuals whose gender identity differs from the sex they were assigned at birth, experience unique stressors, discrimination, and barriers to health and wellbeing. TGNC People of Colour (POC) navigate the nexus of racism, cisgenderism (and often homophobia) in their daily lives, resulting in uniquely intersecting forms of discrimination, and pronounced disparities in their health and well‐being. In order to examine the current state of knowledge about the health and wellbeing of TGNC POC, we conducted a systematic search and review of peer‐reviewed journal articles published between 1 January 2010 and 1 May 2020 that focused on this population. A systematic search identified (3,575) papers, with 76 of those meeting full inclusion criteria. In our review, we were able to identify physical health and psychological wellbeing (which included resilience), as core clusters of research focused on TGNC POC. We identified specific factors that hindered physical and psychological health (what we call “push” factors) as well as those that promoted it (what we call “pull” factors). Leveraging these findings, we offer ways forward for best practice in clinical work and carrying out research with this population. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement.

Analysis of Clinical Characteristics of Patients with Heart Failure and Intracardiac Thrombosis

Aims Our study summarized and analyzed the clinical characteristics and thrombosis distribution of patients diagnosed with both Heart failure(HF) and intracardiac thrombosis, and explored the clinical characteristics of this kind of patients. Methods Patients who were diagnosed HF combined with intracardiac thrombosis and admitted in Fuwai Hospital from October 2008 to May 2018 were enrolled in this study. Demographics characteristics, vital signs, complications, laboratory tests, data about thrombosis, echocardiography data and medication usage were collected. The relationship between the baseline characteristics, basic heart disease, cardiac function and thrombosis distribution were analyzed. At the same time, the application of anticoagulant drugs in this population was analyzed and summarized. Results A total of 1248 patients were enrolled in this study, of which 72.2% were male. The incidence of left ventricular thrombosis is the highest (66.8%). Besides, thrombi located in the left heart were more common than that in right heart. And there were more ventricular thrombi than atrial thrombi. The most common complications were coronary atherosclerotic heart disease (57.5%), followed by hypertension (39.4%), non-ischemic heart disease (36.2%), and atrial fibrillation/atrial flutter (35%). Transthoracic cardiac ultrasound was the main way to diagnose HF combined with intracardiac thrombosis (75.1%). The rate of anticoagulant usage in these patients was 56.8%, and warfarin was the most commonly used (45.1%). The location of thrombosis was related to the basic heart disease and cardiac function. In the HF patients with coronary heart disease, noncompaction of ventricular myocardium and dilated cardiomyopathy, intracardiac thrombosis mostly occurred in the left ventricle. In the HF patients with atrial fibrillation/atrial flutter, hypertrophic cardiomyopathy, restrictive cardiomyopathy and valvular heart disease, the main site of intracardiac thrombosis was the left atrium. Patients with HF and restrictive cardiomyopathy had the highest incidence of right atrial thrombosis. The lower the LVEF, the higher the incidence of left ventricular and left atrium thrombosis (p Conclusion It is common in patients with HF to develop intracardiac thrombosis, and the distribution characteristics of intracardiac thrombosis have certain rules. The left ventricle is the most common site of thrombosis in patients with HF, and should be paid more attention to in clinical work practice.

Improving staff safety with checklists during novel coronavirus disease (COVID-19) pandemic: A quasi-experiment study in vascular surgical department.

Novel coronavirus disease (COVID-19) emerged in Wuhan in December 2019, has spread in many countries affected people globally. In response to the economic requirement of the nation and meet the need of patient's, a momentous event was going back to work step by step as fighting against COVID-19. Safety in clinical work is of priority as elective surgery in the department of surgery progressing. We used checklists based on our experiences on COVID-19 control and reality of clinical work from February to March in the West China Hospital, involving events of screening patient, chaperonage, and healthcare workers. Checklist summarized the actual clinical nursing work and management practices, hope to provide a reference for the order of surgery during the epidemic prevention and control, and standardize the clinical nursing work of surgery during pandemic.

‘You’re opening yourself up to new and different ideas’: Clinical psychologists’ understandings and experiences of using reflective practice in clinical work: an interpretative phenomenological analysis

ABSTRACT Reflective practice is an essential competency in clinical psychology training and practice. However, evidence is limited to support the role of reflection in clinical practice. This study investigated the lived experiences of clinical psychologists’ use of reflective practice in the context of their clinical work. Seven clinical psychologists completed reflective diaries and semi-structured interviews to facilitate in-depth reflections on clinical events. Interview transcripts were analyzed using interpretative phenomenological analysis. Three superordinate themes and six subthemes were developed from the data: Exploratory Questioning (gaining a different perspective, new insight, and opening new possibilities), Containment of own Thoughts and Feelings in Practice, and Human Survival (managing the emotional impact, self-sustaining and leaving work at work). Consideration of these findings suggested that reflective practice plays a key role in clinical psychologists’ perspective-taking abilities; allowing them to maintain an open and curious clinical perspective. Reflective practice enables containment, which impacts the building and maintaining of therapeutic relationships. Reflective practice relieves discomfort and promotes personal resilience. Further research on clinician use of reflective practice can contribute to understanding this core competency which is highly relevant to the training and ongoing development of clinical psychologists.

Patient-Reported Outcome Measures of Utilizing Person-Generated Health Data in the Case of Simulated Stroke Rehabilitation: Development Method.

BackgroundPerson-generated health data (PGHD) are health data that people generate, record, and analyze for themselves. Although the health benefits of PGHD use have been reported, there is no systematic way for patients to measure and report the health effects they experience from using their PGHD. Patient-reported outcome measures (PROMs) allow patients to systematically self-report their outcomes of a health care service. They generate first-hand evidence of the impact of health care services and are able to reflect the real-world diversity of actual patients and management approaches. Therefore, this paper argues that a PROM of utilizing PGHD, or PROM-PGHD, is necessary to help build evidence-based practice in clinical work with PGHD.ObjectiveThis paper aims to describe a method for developing PROMs for people who are using PGHD in conjunction with their clinical care—PROM-PGHD, and the method is illustrated through a case study.MethodsThe five-step qualitative item review (QIR) method was augmented to guide the development of a PROM-PGHD. However, using QIR as a guide to develop a PROM-PGHD requires additional socio-technical consideration of the PGHD and the health technologies from which they are produced. Therefore, the QIR method is augmented for developing a PROM-PGHD, resulting in the PROM-PGHD development method.ResultsA worked example was used to illustrate how the PROM-PGHD development method may be used systematically to develop PROMs applicable across a range of PGHD technology types used in relation to various health conditions.ConclusionsThis paper describes and illustrates a method for developing a PROM-PGHD, which may be applied to many different cases of health conditions and technology categories. When applied to other cases of health conditions and technology categories, the method could have broad relevance for evidence-based practice in clinical work with PGHD.

Organizational diagnostics: a systematic approach to identifying technology and workflow issues in clinical settings.

ObjectivesHealthcare organizations need to rapidly adapt to new technology, policy changes, evolving payment strategies, and other environmental changes. We report on the development and application of a structured methodology to support technology and process improvement in healthcare organizations, Systematic Iterative Organizational Diagnostics (SIOD). SIOD was designed to evaluate clinical work practices, diagnose technology and workflow issues, and recommend potential solutions.Materials and MethodsSIOD consists of five stages: (1) Background Scan, (2) Engagement Building, (3) Data Acquisition, (4) Data Analysis, and (5) Reporting and Debriefing. Our team applied the SIOD approach in two ambulatory clinics and an integrated ambulatory care center and used SIOD components during an evaluation of a large-scale health information technology transition.ResultsDuring the initial SIOD application in two ambulatory clinics, five major analysis themes were identified, grounded in the data: putting patients first, reducing the chaos, matching space to function, technology making work harder, and staffing is more than numbers. Additional themes were identified based on SIOD application to a multidisciplinary clinical center. The team also developed contextually grounded recommendations to address issues identified through applying SIOD.DiscussionThe SIOD methodology fills a problem identification gap in existing process improvement systems through an emphasis on issue discovery, holistic clinic functionality, and inclusion of diverse perspectives. SIOD can diagnose issues where approaches as Lean, Six Sigma, and other organizational interventions can be applied.ConclusionThe complex structure of work and technology in healthcare requires specialized diagnostic strategies to identify and resolve issues, and SIOD fills this need.