Subset Of Survey Respondents Research Articles

Uptake of Transanal Total Mesorectal Excision in North America: Initial Assessment of a Structured Training Program and the Experience of Delegate Surgeons.

Transanal total mesorectal excision is a new approach to curative-intent rectal cancer surgery. Training and surgeon experience with this approach has not been assessed previously in America. The purpose of this study was to characterize a structured training program and to determine the experience of delegate surgeons. Data were assimilated from an anonymous, online survey delivered to attendees on course completion. Data on surgeon performance during hands-on cadaveric dissection were collected prospectively. This study was conducted at a single tertiary colorectal surgery referral center, and cadaveric hands-on training was conducted at a specialized surgeon education center. The main outcome measurement was the use of the course and surgeon experience posttraining. During a 12-month period, eight 2-day transanal total mesorectal excision courses were conducted. Eighty-one colorectal surgeons successfully completed the course. During cadaveric dissection, 71% achieved a complete (Quirke 3) specimen; 26% were near complete (Quirke 2), and 3% were incomplete (Quirke 1). A total of 9.1% demonstrated dissection in the incorrect plane, whereas 4.5% created major injury to the rectum or surrounding structures, excluding the prostate. Thirty eight (46.9%) of 81 surgeon delegates responded to an online survey. Of survey respondents, 94.6% believed training should be required before performing transanal total mesorectal excision. Posttraining, 94.3% of surgeon delegates planned to use transanal total mesorectal excision for distal-third rectal cancers, 74.3% for middle-third cancers, and 8.6% for proximal-third cancers. The most significant complication reported was urethral injury; 5 were reported by the subset of survey respondents who had performed this operation postcourse. The study was limited by inherent reporting bias, including observer and recall biases. Although this structured training program for transanal total mesorectal excision was found to be useful by the majority of respondents, the risk of iatrogenic injury after training remains high, suggesting that this training pedagogy alone is insufficient. See Video Abstract at http://links.lww.com/DCR/A335.

The health status and well-being of low-resource, housing-unstable, single-parent families living in violent neighbourhoods in Philadelphia, Pennsylvania.

The health and well-being of single-parent families living in violent neighbourhoods in US cities who participate in housing programmes is not well described. This two-phase, mixed-methods study explores the health status of families who were participants in a housing-plus programme in Philadelphia, Pennsylvania between 2011 and 2013 and the relationship between the characteristics of the neighbourhoods in which they lived and their perceptions of well-being and safety. In phase 1, data collected with standardised health status instruments were analysed using descriptive statistics and independent sample t-tests to describe the health of single parents and one randomly selected child from each parent's household in comparison to population norms. In a subset of survey respondents, focus groups were conducted to generate an in-depth understanding of the daily lives and stressors of these families. Focus group data were analysed using content analysis to identify key descriptive themes. In phase 2, daily activity path mapping, surveys and interviews of parent-child dyads were collected to assess how these families perceive their health, neighbourhood and the influence of neighbourhood characteristics on the families' day-to-day experience. Narratives and activity maps were combined with crime data from the Philadelphia Police Department to analyse the relationship between crime and perceptions of fear and safety. Phase 1 data demonstrated that parent participants met or exceeded the national average for self-reported physical health but fell below the national average across all mental health domains. Over 40% reported moderate to severe symptoms of depression. Parents described high levels of stress resulting from competing priorities, financial instability, and concern for their children's well-being and safety. Analysis of phase 2 data demonstrated that neighbourhood characteristics exert influence over parents' perceptions of their environment and how they permit their children to move within it. This research suggests the need for robust research, programmatic and policy interventions to support housing-unstable families who live in neighbourhoods with high levels of violence.

Capacity Building and Training Needs for Community Health Workers Working in Health Care Organizations

Members of the community health worker (CHW) workforce have new opportunities to work within the health care system. These opportunities come with questions and challenges about the roles CHWs can play and their specific capacity building and training needs. We use a mixed methods approach including a cross sectional survey of 265 CHWs and qualitative interviews with a sub-set of survey respondents (n=23) to gather perspectives from CHWs about workforce capacity building needs for CHWs working within transformative health care organizations. Eighty percent of CHWs agreed or strongly agreed that they feel well trained to carry out their duties as CHWs. CHWs ranked communication, advocacy, assurance of services, and culturally competent services as priority roles. In addition, creating a learning environment for CHWs working in health care settings is essential to support capacity building for CHWs. Understanding training needs for CHWs can help improve the relationship and understanding between CHWs and other care team members. Capacity building efforts through appropriate training and supervision of CHWs assists with CHW integration and enhances the fidelity of information CHWs deliver to patients.

Growing pains: work-life impacts in small-to-medium sized construction firms

Purpose – The purpose of this paper is to compare the quality of work-life experiences of workers in construction firms of differing sizes and explored the work conditions and circumstances that impact upon the work-life experiences of workers in small-to-medium sized enterprises (SMEs) in the Australian construction industry. Design/methodology/approach – Data were collected in two stages. First, data from a sub-set of construction industry workers were extracted from a large scale survey of workers in Victoria, Australia (the VicWAL survey). The survey measured work-life interference using the Australian Work and Life Index (AWALI). Next a subset of survey respondents was identified and interviewed to gain more detailed explanatory information and insight into work-life experiences. Findings – The survey results indicated that respondents who reported working for a construction firm with between 16 and 99 employees reported significantly higher AWALI scores (indicating high work-life interference) than workers in organisations employing 15 or less or more than 100 workers. The follow-up interviews revealed that workers in small construction organisations were managed directly and personally by the business owner/manager and able to access informal work-life supports that were provided on an “as needs” basis. In comparison workers in medium-sized firms perceived higher levels of work pressure and an expectation that work would be prioritised over family life. Research limitations/implications – The research shows that the findings of work-life balance research undertaken in large construction organisations cannot be generalised to SMEs. Organisation size should also be treated as an important variable in work-life balance research in construction. Practical implications – The research suggests that a better understanding of how workers in SME construction firms experience work-life balance is important in the design and development of work-life balance programs. In particular the challenges faced by workers as companies grow from SMEs require careful consideration and management. Originality/value – Previous research has focused on the work-life balance experiences of employees in large construction firms. Little was previously known about the experiences of workers in SME construction firms. The research provides new insight into the work-life experiences of construction workers in organisations of varying sizes.

Public Transit Catchment Areas

The coordination of bicycle and transit modes has received close attention from public transit planners and researchers in recent years as transit agencies around the world have installed bicycle racks on transit vehicles, implemented bicycles-on-trains policies, and made other efforts to facilitate bicycle-transit integration. Many planners presume that the catchment area for transit is enlarged by these efforts, but geographic changes in the size of catchment areas have not been documented effectively. The research project reported in this paper assessed the distances traveled on bicycle by cycle-transit users (CTUs) and included (a) those who used bicycles as a means of access to transit stops and stations and (b) those who bicycled to and traveled on transit with their bicycles. A mixed-methods approach was employed, with a literature review; a survey of CTUs in Philadelphia, Pennsylvania, and San Francisco, California; and telephone interviews with a subset of survey respondents. Responses in the two cities made it possible to define CTU characteristics and behavior in detail. The responses highlighted two intriguing findings. First, transit catchment areas could be much larger for CTUs than for traditional transit users who accessed transit buses and rail on foot. Second, the concept of a cycle—transit catchment area was seen to be complex because of the variety of travel opportunities that cycle-transit coordination policies presented to transit riders. CTUs took advantage of larger catchment areas to reduce their travel costs, and they used those catchment areas in curious and less predictable ways.

THE ATTITUDES AND PRACTICES OF NEONATAL NURSES IN THE USE OF KANGAROO CARE

Objectives: To survey the attitudes and practices of Australian neonatal nurses in the use of kangaroo care (KC) and identify possible concerns with promoting KC in the neonatal intensive care unit (NICU). Design: A two-phase research approach was used that included a descriptive survey followed by in-depth interviews with a subset of survey respondents. Sample: Thirty four nurses working in the NICU of a large public hospital in Melbourne completed a survey questionnaire. Four respondents were subsequently selected for follow-up interview to explore in greater depth issues associated with promoting KC in the NICU. Outcome measures: Quantitative data were analysed to describe the attitudes, practices and role of the neonatal nurse in promoting KC. Analysis of qualitative responses to survey questions and interviews were coded and major themes identified. Results: All neonatal nurses surveyed assisted and encouraged parents to provide KC and the majority agreed on the benefits of KC for both infant and parents. There was a general acceptance that KC can be practiced with low birth weight infants requiring intubation and all but two nurses found facilitating KC professionally satisfying. Results also identified practical concerns with the practice of KC and some uncertainty that KC promotes breastfeeding. Notable constraints to promoting KC in the NICU were heavy staff workloads, insufficient education, lack of organisational support and the absence of clear protocols, especially for low birth weight infants. Conclusions: This study confirms neonatal nurses strongly support the use of KC in the NICU. Although the majority of nurses reported positive attitudes and practices, they did identify a number of educational and practical concerns that need to be addressed to ensure KC with low birth weight infants is safe and effective.