Qualitative Outcome Data Research Articles

The Role of Propofol in Alcohol Withdrawal Syndrome: A Systematic Review.

The objective of this review was to evaluate the efficacy and safety of propofol in the treatment of critically ill patients diagnosed with alcohol withdrawal syndrome (AWS). A review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria, and Embase, MEDLINE (PubMed), Cochrane CENTRAL, and Web of Science were queried for results through June 2024. Studies providing efficacy or safety data associated with propofol with a reported diagnosis of AWS in critically ill patients were included. Studies evaluating pediatric patients, those without quantitative and qualitative outcome data, and those not readily translatable to English were excluded. Five retrospective cohort analyses of 218 patients were included in this systematic review. Patients were found to have both significant and non-significant increases in time to resolution of AWS symptoms when treated with propofol versus the AWS standard of care. Adjunct treatment with propofol was generally associated with reductions in total benzodiazepine use and increases in both ICU length of stay and duration of mechanical ventilation. The results of this systematic review provide the evidence necessary to support the use of propofol as an efficacious and safe medication in the management of severe and refractory AWS. Further investigation is required to determine optimal dosing strategies and durations of therapy. The results of this systematic review demonstrate the clinical utility of propofol as part of the management strategy for severe and refractory AWS.

Seeking Care for Children with Intellectual and/or Developmental Disabilities in the Emergency Department: A Mixed Methods Systematic Review of Parents' Experiences and Information Needs.

The objective of this review was to explore parents' experiences and information needs regarding management of their child with an intellectual and/or developmental disability (IDD) in the emergency department (ED). We searched six electronic databases and grey literature to identify primary studies in English published since 2000. We synthesized quantitative and qualitative outcome data simultaneously using a convergent integrated approach and used a Mixed Methods Appraisal Tool (MMAT) to assess methodological quality of the included studies. Nine articles derived from seven studies were included (3 qualitative, 3 quantitative, 1 mixed method). Four main themes related to parents' self-reported experiences were identified: 1) appropriateness of the ED to manage and support their child; 2) acknowledgement/recognition of their child's IDD and incorporation of those considerations into overall care and management; 3) managing and navigating the ED environment; and 4) decision to disclose their child's condition when visiting the ED. Two articles provided data relevant to information needs, highlighting parents' desire to have resources supporting ED orientation and access to services within and outside of the ED setting. From the limited number of studies, it was evident that parents wanted better communication with healthcare providers and a greater understanding by ED staff around physical space settings needed to support their child. Resources supporting ED staff and parents to communicate effectively and work together can ensure that children with IDDs care needs are met. Further research into understanding parents' experiences and information needs related to managing a child with an IDD in the ED is needed to guide the development of effective resources.

A Better Way to Care for Long Term Care (LTC) residents in Times of Medical Urgency: Improving Acute Care transfers for LTC Residents.

Background: Prior to the pandemic, every day approximately 28 long term care (LTC) residents were transferred to an emergency department (ED) in Alberta. This was placing increasing strain on healthcare resources and potentially negatively impacting the health and wellness of residents (e.g., exposure to iatrogenic harms). Many residents’ conditions could be managed within LTC if appropriate supports were provided. Poor communication between LTC and EDs can also lead to long ED lengths of stay, unnecessary resource utilization, sub-optimal health outcomes, and exposure to iatrogenic harms for LTC residents. Two INTERACT® tools (tools for early identification of acute medical issues) and a new care and referral pathway were implemented to help identify and address changes in health status among LTC residents sooner, improve communication between LTC and ED providers, and reduce unnecessary ED transfers. Methods: Between October 2019 and April 2022, 40 LTC homes and 4 EDs within the Calgary zone implemented the standardized LTC-to-ED care and referral pathway supported by a centralized telephone advice and transfer system for healthcare providers, community paramedics, and two INTERACT® tools (Stop and Watch for healthcare aides; Change in Condition Cards for nursing). Using a randomized stepped-wedge design, the pathway was implemented within 9 cohorts of (4-5) LTC facilities every 3 months, supported by an implementation coach. Three-hour train the trainer implementation sessions were conducted in-person or online with over 325 health practitioners in the enrolled LTC homes using strategies adapted to consider local context and barriers, as well as considering pandemic-related challenges. Evaluation Methods: Evaluation of the intervention involved both qualitative and quantitative methods. The primary study outcome is change in transfers from LTC to ED; secondary (quantitative) outcomes include hospital admissions, utilization of the centralized telephone advice and transfer system, and community paramedic visits. Analysis of these quantitative outcomes utilized negative binomial regression to estimate the incident rate with 95% confidence intervals (per 1000 residents), while adjusting for the different cohorts. The quantitative evaluation also included an economic analysis to determine potential cost savings. Interviews with healthcare providers were conducted to provide context to their experience with the intervention and ways it can be improved. These interviews will be interpreted with the involvement of members of our project resident and family advisory council. Results: Quantitative results demonstrate a reduction in the LTC-to-ED transfer rate [1.70 (95%CI 1.61-1.79) post-intervention) vs 1.91 (95%CI 1.84-2.00) pre-intervention], along with reduction in hospital admission rates [0.94 (95%CI 0.88-1.00) vs 1.08 (95%CI 1.03-1.14)]. There was an increase in utilization of the centralized telephone advice and transfer system [0.18 (95%CI 0.16-0.22) vs. 0.13 (95%CI 0.11-0.16)], but no increase in the number of community paramedic visits [2.05 (95%CI 1.94-2.16) vs 2.50 (95%CI 2.39-2.61)]. Cost and qualitative outcome data is pending. Advice and Lessons Learned: LTC staff education and use of early warning tools for identifying a change in resident health status (INTERACT® tools) and/or utilization of a centralized telephone advice and transfer system may have played a role in reducing ED transfers. We did not observe the expected relationship between community paramedic visits and reduced LTC-to-ED transfers, possibly as a result of the pandemic-related facility outbreak restrictions. Teams should tailor implementation sessions and materials to site specific needs and contexts to help address their unique barriers and facilitators. Partnerships with key stakeholders across the care continuum are essential to ensure adequate support and effective uptake and sustainability of the mutli-faceted change intervention.

Comparing People’s Experience of Therapy for Complex Trauma Across Three Modalities: Face-to-Face, Mixed, and Online

To compare client response to a 3-stage phased intervention for complex trauma, comparing (1) those who received face-to-face intervention with (2) those who received a hybrid of face-to-face moving mid-therapy to online intervention with (3) those who received online only. Comparing quantitative and qualitative outcome data from 3 consecutive groups (N=22) who participated in a 3-stage phased intervention for complex trauma (1) face-to-face intervention (n=7); (2) a mix of face-to-face and online intervention (n=6); (3) online only (n=9). Analysis of quantitative data indicated a reduction in trauma symptoms across all modes of delivery. Reliable change indices suggested that face-to-face intervention facilitated the greatest change. In response to questions, participants spoke about (1) having a positive experience of the intervention, (2) advice to future group members, (3) constructive feedback, and (4) the experience of engaging online. Responses indicated that the experience of all groups were broadly similar. Participants reported strong group connections and an increased understanding of trauma. Minor differences, specific to the practicalities of each group, were found in the constructive feedback offered. Comments regarding the online experience highlighted the accessibility of the modality and indicated a sense of diminished group cohesion. Overall, participants reported a preference for face-to-face engagement. The majority of participants benefitted from the intervention regardless of modality. However, there is tentative evidence that the online format was the delivery mode associated with poorer-performing clients. In the future, online engagement and client preference should be considered carefully.

Social prescribing: a nurse-led pilot project in a general practice setting

Social prescribing is a mechanism for promoting health and well-being whereby people are referred for non-clinical interventions to a range of services and groups in their local community. In social prescribing schemes, healthcare professionals and/or link workers connect people with community groups and services that can support them with a broad range of emotional, social and practical needs, ultimately enabling them to take ownership of their health. This article describes the development, implementation and outcomes of a nurse-led social prescribing pilot project conducted in a general practice in South Devon. There is evidence that social prescribing can result in improved health and well-being, but more robust and systematic evidence of its effectiveness is needed. Qualitative outcome data were collected as part of the pilot project, adding to the evidence base showing the benefits of social prescribing.

P0490 / #1769: THE CARING INTENSIVELY STUDY: FAMILY MEMBERS’ PERCEPTIONS OF PSYCHOLOGICAL OUTCOMES ONE YEAR FOLLOWING PEDIATRIC INTENSIVE CARE UNIT HOSPITALIZATION

Aims & Objectives: There is a dearth of research exploring family members’ perceptions of long-term psychological outcomes following PICU hospitalization. The aim of this study was to explore children and parents’ perceptions of long-term psychological and behavioral responses one year following PICU hospitalization. Methods: A secondary data analysis of qualitative outcome data collected as part of a Canadian mixed methods, multi-site prospective cohort study; the Caring Intensively Study. An interpretive descriptive design using semi-structured interviews with parents and children was conducted. Families were purposively selected to represent the larger cohort sample. Data were analyzed collectively to uncover themes within participants’ narratives. Results: We interviewed 16 mothers, 6 fathers, and 9 children (17 families). Participants reported their desire to re-establish a sense of family normalcy expressed in 5 themes: 1) PICU reminders and memories, 2) Changing perceptions of health and illness, 3) Re-establishing a family routine, 4) I am not the same, and 5) Altered relationships. Participants described significant emotional/behavioural changes during the year following hospital discharge. They experienced ongoing memories and reminders of the child’s PICU admission. Their experiences resulted in changed perceptions of their child’s health, with heightened vigilance regarding health and safety among parents and siblings. Participants described efforts to readapt to routine life once the child returned home, and found disruptions related to the illness and associated parental absence caused changes in family relationships. Conclusions: PICU hospitalization impacts the psychological well-being of all members of the family as they seek to re-establish a sense of normalcy one year following discharge.

The value of peer mentoring for the psychosocial wellbeing of junior doctors: a randomised controlled study.

To explore the value of a peer mentoring program for first year medical interns and to assess the demand for and benefits of such a program in an Australian hospital. Randomised controlled study of the impact on first year interns of peer-led mentoring by second and third year interns, undertaken during 2015 at the Royal Perth Hospital, a tertiary teaching hospital. Methods and main outcome measure: Interns were recruited and randomised 1:1 to being assigned or not assigned a mentor. Qualitative outcome data were collected in semi-structured interviews and focus groups at 12 months to assess psychosocial wellbeing and job satisfaction. Fifty-three of 79 interns (67%) applied to participate in the program. Twenty-six mentor-mentee pairs matched by sex and career preferences were established; 27 interns were allocated to the control group. Iterative data analysis identified two major themes related to the value of the mentorship program: aiding navigation through the complex health care system, and enhancing a sense of community. Participants with mentors reported high satisfaction with the program and a positive impact on stress levels, morale, sense of support, job satisfaction, and psychosocial wellbeing compared with participants without mentors. An optional peer mentoring program enhances junior doctor support structures, builds a sense of community, and helps participating interns navigate their new professional environment. Our trial provides a feasibility model that could be adapted to local conditions, regionally or nationally. Australian New Zealand Clinical Trials Registry, ACTRN12618000455268; 29 March 2018 (retrospective).

No data, no problem, no action: parenting programs in low-income countries. Making the social-emotional outcomes more visible.

Parenting programs are delivered in many low income countries in an effort to address the effects of insufficient cognitive stimulation, major social-emotional risk factors related to inadequate caregiver sensitivity and responsiveness, maternal depression, violence and biological risk factors. However, the outcomes of these programs are often untested because of methodological limitations in the existing evaluation tools available for cross-cultural research, and especially those related to social-emotional development and functioning. This study takes an approach that involves organizing data from focus groups collected following caregiver participation in a parenting program, Learning Through Play (LTP) delivered in 11 low income countries. The LTP program has as its aim to increase parent knowledge and influence parental practice regarding the essential components of early development of children aged birth to 6 years. The purpose of systematically organizing focus group data was to illustrate a means by which program developers worldwide can discuss outcomes of program participation, particularly in social-emotional domains that have been overlooked in past studies on parenting programs. The findings from this study suggest that qualitative outcome data can be organized to make the social-emotional outcomes of participation in parenting programs more visible.

An Australian hospital-based student training ward delivering safe, client-centred care while developing students’ interprofessional practice capabilities

Royal Perth Hospital, in partnership with Curtin University, established the first interprofessional student training ward in Australia, based on best practice from Europe. Evaluation of the student and client experience was undertaken. Feedback from all stakeholders was obtained regularly as a key element of the quality improvement process. An interprofessional practice program was established with six beds within a general medical ward. This provided the setting for 2- to 3-week clinical placements for students from medicine, nursing, physiotherapy, occupational therapy, social work, pharmacy, dietetics and medical imaging. Following an initial trial, the training ward began with 79 students completing a placement. An interprofessional capability framework focused on the delivery of high quality client care and effective teamwork underpins this learning experience. Quantitative outcome data showed not only an improvement in students’ attitudes towards interprofessional collaboration but also acquisition of a high level of interprofessional practice capabilities. Qualitative outcome data from students and clients was overwhelmingly positive. Suggestions for improvement were identified. This innovative learning environment facilitated the development of the students’ knowledge, skills and attitudes required for interprofessional, client centred collaborative practice. Staff reported a high level of compliance with clinical safety and quality.

Subtalar Joint Arthroereisis in the Management of Pediatric Flexible Flatfoot: A Critical Review of the Literature

Pediatric flexible flatfoot is a common deformity for which a small, but significant number undergo corrective surgery. Arthroereisis is a technique for treating flexible flatfoot by means of inserting a prosthesis into the sinus tarsi. The procedure divides opinion in respect of both its effectiveness and safety. A database search up until 2010 was used to find articles regarding arthroereisis in pediatric patients. We summarized the findings of this study. Seventy-six studies were identified. Eight of the nine radiographic parameters reported show significant improvement following arthroereisis reflecting both increased static arch height and joint congruency. Calcaneal inclination angle demonstrated the least change with only small increases following arthroereisis. Arthroereisis remains associated with a number of complications including sinus tarsi pain, device extrusion, and under-correction. Complication rates range between 4.8% and 18.6% with unplanned removal rates between 7.1% and 19.3% across all device types. Current evidence is limited to consecutive case series or ad hoc case reports. Limited evidence exists to suggest that devices may have a more complex mode of action than simple motion blocking or axis altering effects. The interplay between osseous alignment and dynamic stability within the foot may contribute to the effectiveness of this procedure. Although literature suggests patient satisfaction rates of between 79% to 100%, qualitative outcome data based on disease specific, validated outcome tools may improve current evidence and permit comparison of future study data.

Developing community health worker diabetes training

We designed, implemented and evaluated a 48-hour training program for community health workers (CHWs) deployed to diabetes care teams in community health centers (CHCs). The curriculum included core knowledge/skills with diabetes content to assist CHWs in developing patient self-management goals. Our qualitative evaluation included pre/post-knowledge outcomes and encounter data from the field. CHWs and their supervisors were interviewed providing qualitative outcome data of the training process and program implementation. There were statistically significant increases in the scores of CHWs' self-reported knowledge in 8 of 15 curricular domains. Qualitative analysis revealed that CHWs preferred skill-based and case-based teaching, shorter training days but more contact hours. CHWs reported that pre-deployment training alone is insufficient for successful integration into care teams. CHW supervisors reported that CHC's readiness to accept CHWs as members of the care team was as important to successful deployment as training. With respect to implementation, supervision by social workers was deemed more successful than nursing supervision. Field data showed that patient encounters lasted less than 30 min and self-management goals focused on appointment keeping, diet, exercise and glucose testing. Integration and analysis of qualitative and descriptive field data provide an opportunity to continuously evaluate the effectiveness of implementation.

The utility of expectational data: Firm-level evidence using matched qualitative–quantitative UK surveys

Qualitative expectational data from business surveys are widely used to construct forecasts. However, based typically on evaluation at the macroeconomic level, doubts persist about the utility of these data. This paper evaluates the ability of the underlying firm-level expectations to anticipate subsequent outcomes. Importantly, this evaluation is not hampered by only having access to qualitative outcome data obtained from subsequent business surveys. Quantitative outcome data are also exploited. This required access to a unique panel dataset which matches firms’ responses from the qualitative business survey with the same firms’ quantitative replies to a different survey carried out by the national statistical office. Nonparametric tests then reveal an apparent paradox. Despite evidence that the qualitative and quantitative outcome data are related, we find that the expectational data offer rational forecasts of the qualitative but not the quantitative outcomes. We discuss the role of “discretisation” errors and the loss function in explaining this paradox.

Outcomes of traditional Chinese medicine (traditional acupuncture) treatment for people with long-term conditions

A set of outcome questionnaires has been developed to measure the range of treatment effects of traditional acupuncture. In this descriptive outcome study we validated these questionnaires in a busy National Health Service funded acupuncture clinic serving communities of diverse socio-economic circumstances. Some of the questionnaires performed better than others in this setting but EQ-5D and MYMOP-qual both showed statistically and clinically significant improvement in physical and psychological health after six weeks and six months, in all categories of disease and degrees of chronicity. Both the written qualitative data and the Patient Enablement Instrument (PEI) demonstrated considerable patient enablement and, for some patients, the acquisition of new coping and self-care strategies.The questionnaires were feasible to administer, acceptable to patients and clinic staff, and provided robust and detailed quantitative and qualitative outcome data of use for service provision, future planning, and as a basis for further cost-effectiveness studies.

Vertebroplasty in Multiple Myeloma: Outcomes in a Large Patient Series

Despite the literature supporting the efficacy of vertebroplasty for treatment of osteoporotic vertebral compression fractures, few reports exist documenting its use in the treatment of compression fractures in multiple myeloma patients. Accordingly, we sought to characterize the imaging characteristics, clinical course, and outcomes in myeloma patients treated with vertebroplasty. We performed a retrospective review of clinical outcome data from 67 multiple myeloma patients treated with vertebroplasty since October 2000. Quantitative outcome data including the Roland Morris Disability Questionnaire (RDQ) and Visual Analog Scales for pain and qualitative outcome data (self-reported pain, mobility, and narcotic use) were collected preoperatively, immediately after vertebroplasty, and at 1 week, 1 month, 6 months, and 1 year after treatment. Significant improvements in all of the outcome measures were observed postoperatively and throughout the duration of follow-up. Quantitative outcome measures (RDQ, analog pain scale 0-10, with rest and activity) improved by 11.0 (48%; P < .0001), 2.7 (25%; P < .001), and 5.3 (48%; P < .0001) points, respectively, with persistent improvement at 1 year (P < .01; P < .03; P < .001). Eighty-two percent and 89% of patients experienced a significant improvement in subjective rest pain and activity pain, respectively. Subjective scores achieved durable improvements, with 65% of patients requiring fewer narcotics after vertebroplasty and 70% having improved mobility. Vertebroplasty provides significant and durable pain relief for patients with intractable spinal pain secondary to compression fractures resulting from multiple myeloma.

Telehealth home monitoring of solitary persons with mild dementia.

Medication safety is a special concern for the 30% to 40% of dementia patients who live alone at the time of diagnosis, and it plays an important part in relocation decisions. Televideo monitoring could improve medication self-administration accuracy and improve mood for persons with mild dementia who live alone or spend a significant amount of their day alone. The authors used 2-way interactive video technology to monitor medication compliance of 8 persons with mild dementia. They conducted more than 4000 contacts with these persons and found adequate technical outcome in 82% of calls. End medication compliance was 81% in the video-monitored group compared to 66% in the controls (P < .05). Comparison of compliance from initial to end ratings revealed that video-monitored participants' compliance remained stable while unmonitored patients' compliance fell 12 percentage points, consistent with expectations for dementia. This difference was also significant. Quantitative and qualitative outcome data from this project are presented.

Evaluating Web-supported Learning Versus Lecture-based Teaching: Quantitative and Qualitative Perspectives

A graduate level research methods and statistics course offered on the World-Wide Web was evaluated relative to the traditional lWith their consent, course members were randomly assigned to the two versions of the course for the first block of sessions. For the second block of sessions the groups crossed over to access the alternative version of the course. Quantitative and qualitative outcome data were collected to sample cognitive and affective domains. Improvements in knowledge and reductions in anxiety were apparent following both versions, with no significant differences between versions being detected. Analysis of course member comments indicated less satisfaction with the teaching input on the web-based version but more satisfaction with the peer collaboration that was stimulated. An activity theory framework is applied in conceptualising the findings and generating recommendations for further course development and evaluation.

A simple grading scale to assess ERCP technical difficulty: An attempt to produce qualitative outcome data

A simple grading scale to assess ERCP technical difficulty: An attempt to produce qualitative outcome data