Ann Dewey

The sociogram: a useful tool in the analysis of focus groups.

Background: Focus groups are being utilized increasingly in health services research; however, methods of analyzing focus groups to acknowledge group processes are still under development. Objectives: To explore the use of sociograms as a tool in focus group analyses. Methods: Sociograms are presented for two focus groups which were conducted to complement a randomized controlled trial on the use of audiovisual distraction during minor surgery. The sociograms are interpreted to accentuate issues that may arise during focus group research. Results and Discussion: Sociograms offer a useful method of conceptualizing group dynamics, drawing comparisons between focus groups, and reflecting on moderator technique. The sociogram is a useful aid for displaying and interpreting data from focus group discussions when used in combination with further qualitative inquiry.

Moving Forward: A Qualitative Research Inquiry to Inform the Development of a Resource Pack for Women Following Primary Breast Cancer Treatment

While the UK charity Breast Cancer Care has extensive resources for women with breast cancer, this research partnership developed the first resource driven and informed by primary research with these women, exploring their needs and developing the resource according to need. Data were collected from focus groups with breast cancer survivors and telephone interviews with health professionals and experts, which explored the needs of women after primary cancer treatment, and were analyzed using thematic analysis. As well as information, these women needed resources to help them regain control over life, adapt to a changed body, and restore lost confidence.

Use of baked milk challenges and milk ladders in clinical practice: a worldwide survey of healthcare professionals

In previous years, the cornerstone of the management of Cows Milk Allergy (CMA) was solely based on the strict avoidance of all cows milk (CM) and foods containing CM from the patients diet [1]. More recently, the importance of baked milk (BM) introduction into the diet of children with CMA has become well-recognised as a part of CMA management. Current research suggests that 75% of children become tolerant to baked/heated forms of CM such as muffin and waffles before they become tolerant to pure/uncooked forms of CM [2]. This article is protected by copyright. All rights reserved.

Early qualitative analysis to enhance trial processes

The LASER Trial is an RCT of the effectiveness of the use of a Temperature-controlled Laminar Airflow (TLA) device in adults with severe allergic asthma. The trial is funded by the NIHR-HTA. The trial aims to determine whether home-based nocturnal treatment with a TLA device can reduce the frequency of asthma exacerbations over a one year period. In order to inform decisions about implementation of the device should it be shown to be effective, participants experience of using the TLA device is being assessed by means of qualitative interviews. We conducted telephone interviews with 10 trial participants in the first 4 months of the trial in order to determine participants thoughts, values and opinions of trial processes and the treatment device. This early qualitative evaluation as part of the larger experimental study has provided us with an opportunity to address different questions (What is happening? How is it happening?) than otherwise would be possible with quantitative data collection alone. We have been able to provide feedback to develop and enhance subsequent trial processes including recruitment and retention of participants. Experience from conducting this early evaluation is that the qualitative interviews and subsequent analysis have provided a useful insight into the difficulties that patients have experienced and what is important to them. As a result we have a better understanding and this has resulted in an informed plan of how to address these learning points with actions to enhance the experience of taking part in the trial for future participants.

Nutritional supplementation for hip fracture aftercare in older people

Older people with hip fractures are often malnourished at the time of fracture and may have poor food intake while treated in hospital (Lumbers et al., 2001). Malnutrition can lead to mental apathy, reduce mobility and increase the tendency to develop postoperative complications such as wound, respiratory or urine infections, pressure sores and deep vein thrombosis. Prolonged stay in hospital is undesirable and costly to provide. Long-term rehabilitation and support in the community will add to the burdens of costs. It is possible that nutritional supplements may provide a convenient way to improve the intake of energy, protein, vitamins and minerals.

006 Tuning fork testing on ankle injuries: does it improve the accuracy of the Ottawa ankle rules?

Objectives and Backgrounds Ankle injuries account for 8% of all minor injuries attending EDs in the UK. The Ottawa ankle rules (OARs) were introduced to assess the need for x-ray in the 1990s (Stiell et al 1992). Although they are said to have reduced the number of ankle x-rays requested many unnecessary ankle x-rays are still taken, and although the sensitivity of the OARs 95–100% the specificity is consistently low. A vibrating tuning fork has been shown to increase the specificity of the OARs while maintaining the high sensitivity on a pilot study on simple twisting ankle injuries and resulted in a 66% reduction in the number of ankle x-rays requested (Dissman and Han 2006). However, this study had a strict inclusion criteria and the tuning fork test was carried out by a single-operator, reducing the generalisability of the results. This study aims to assess whether the tuning fork test can increase the diagnostic accuracy of the OARs when used on twisting ankle injuries by multiple operators in multiple emergency care settings. Methods A two part multi-site study was undertaken across three EDs in within Hampshire UK. The first part of the study consisted of a diagnostic test using the tuning fork test on patients already known to be OARs positive and therefore due to receive an x-ray of their ankle. Patients were invited to take part if they were aged 12 years or over and had injured their ankle as a result of a simple twisting mechanism. Patients were excluded if there was obvious deformity to the ankle. After assessing for bony tenderness a vibrating tuning fork was placed at the site of maximal tenderness and 6 cm proximal to this site. In order to form a control group the patients uninjured ankle was also assessed with the tuning fork. Patients were randomised as to which ankle was assessed with the tuning fork first. The results of the tuning fork test and the x-ray (which was interpreted blind of the tuning fork test) were compared and the number of times they agreed and disagreed recorded. The second part of the test included a series of focus groups where participants and clinicians involved in the study were asked about their views on the use of the tuning fork test in clinical practice. Data were analysed using thematic analysis. A total of 1300 participants were required in order to detect a specificity of 95% (±3%) with a 95% CI where the injury under test had a prevalence in the population of 15%. The study was funded by the CCF Research for Patient Benefit scheme, and sponsored by the Portsmouth Hospitals NHS Trust. Southampton and SW Hampshire (A) ethics committee approved the study. Results Patients have been recruited into the study since June 2009. Part 1 of the study is still in progress, but as of 21st April 2011 a total of 1245 participants have been recruited. The data has not yet been analysed but this is expected to take place during June 2011. The Data collection phase of part 2 of the study is complete and although full analysis of the data is yet to take place provisional analysis of the qualitative data using thematic analysis identifies that patients accept the use of the tuning fork test. Patients stated they were intrigued when the use of the tuning fork was first discussed with them. Patients also rated spending less time in the ED as more important than receiving an x-ray, which is in contrast to the clinicians who claimed that the majority of patients expect an x-ray for their ankle injury. As well as reducing exposure to radiation saving the NHS money by reducing unnecessary x-rays was one of the main advantages raised by patients. Conclusions The results of the study are yet to be fully analysed. However it is anticipated that the tuning fork test will improve the diagnostic accuracy of the OARs when used on simple twisting ankle injuries. The tuning fork test is quick and easy to learn and initial analysis of the qualitative data reveals that its use would be accepted by patients and clinicians alike. This presentation outlines independent research commissioned by the National Institute for Health Research (NIHR) under its RfPB Programme (Grant Reference PB-PG-1207-15022).

Acetic acid-guided biopsies in Barrett’s surveillance for neoplasia detection versus non-targeted biopsies (Seattle protocol): A feasibility study for a randomized tandem endoscopy trial. The ABBA study

Background and study aims  Barrett’s esophagus is a potentially pre-cancerous condition, affecting 375,000 people in the UK. Patients receive a 2-yearly endoscopy to detect cancerous changes, as early detection and treatment results in better outcomes. Current treatment requires random mapping biopsies along the length of Barrett’s, in addition to biopsy of visible abnormalities. As only 13 % of pre-cancerous changes appear as visible nodules or abnormalities, areas of dysplasia are often missed. Acetic acid chromoendoscopy (AAC) has been shown to improve detection of pre-cancerous and cancerous tissue in observational studies, but no randomized controlled trials (RCTs) have been performed to date. Patients and methods  A “tandem” endoscopy cross-over design. Participants will be randomized to endoscopy using mapping biopsies or AAC, in which dilute acetic acid is sprayed onto the surface of the esophagus, highlighting tissue through an whitening reaction and enhancing visibility of areas with cellular changes for biopsy. After 4 to 10 weeks, participants will undergo a repeat endoscopy, using the second method. Rates of recruitment and retention will be assessed, in addition to the estimated dysplasia detection rate, effectiveness of the endoscopist training program, and rates of adverse events (AEs). Qualitative interviews will explore participant and endoscopist acceptability of study design and delivery, and the acceptability of switching endoscopic techniques for Barretts surveillance. Results  Endoscopists’ ability to diagnose dysplasia in Barrett’s esophagus can be improved. AAC may offer a simple, universally applicable, easily-acquired technique to improve detection, affording patients earlier diagnosis and treatment, reducing endoscopy time and pathology costs. The ABBA study will determine whether a crossover “tandem” endoscopy design is feasible and acceptable to patients and clinicians and gather outcome data to power a definitive trial.

Awareness and understanding of dementia in South Asians: A synthesis of qualitative evidence

Background Despite a growing elderly South Asian population, little is known about the experience of diagnosis and care for those living with dementia. There have been a number of individual qualitative studies exploring the experiences of South Asian people living with dementia and their carers across different contexts. There has also been a growing interest in synthesizing qualitative research to systematically integrate qualitative evidence from multiple studies to tell us more about a topic at a more abstract level than single studies alone. The aim of this qualitative synthesis was to clearly identify the gaps in the literature and produce new insights regarding the knowledge and understanding of the attitudes, perceptions, and beliefs of the South Asian community about dementia. Methods Following a systematic search of the literature, included qualitative studies were assessed by two independent reviewers for methodological quality. Data were extracted and pooled using the Joanna Briggs Institute Qualitative Assessment and Review Instrument (QARI). Findings were synthesized using the Joanna Briggs Institute approach to qualitative synthesis by meta-aggregation. Results Seventeen papers were critically appraised, with 13 meeting the inclusion criteria. Participants were mostly of South Asians of Indian background; followed by Pakistani with a few Sri Lankans. Missing South Asian countries from the current evidence base included those from Bangladesh, Bhutan, Maldives, and Nepal. Three meta-synthesis themes emerged from the analysis: (1) a poor awareness and understanding of dementia, (2) the experience of caregiving, and (3) the attitudes toward dementia care provision. Conclusions A consistent message from this qualitative synthesis was the limited knowledge and understanding of dementia amongst the South Asians. Whilst symptoms of dementia such as ‘memory loss’ were believed to be a part of a normal ageing process, some South Asian carers viewed dementia as demons or God’s punishments. Most studies reported that many South Asians were explicit in associating stigmas with dementia.

The SENSOR Study: Protocol for a Mixed-Methods Study of Self-Management Checks to Predict Exacerbations of Pseudomonas Aeruginosa in Patients with Long-Term Respiratory Conditions

Background There are an estimated three million people in the United Kingdom with chronic obstructive pulmonary disease (COPD), and the incidence of bronchiectasis is estimated at around 0.1% but is more common in COPD and severe asthma. Both COPD and bronchiectasis are characterized by exacerbations in which bacteria play a central role. Pseudomonas aeruginosa is isolated from sputum samples from 4% to 15% of adults with COPD and is more likely to be isolated from patients with severe disease. Earlier detection of exacerbations may improve morbidity and mortality by expediting treatment. Aseptika Ltd has developed a system for patients to self-monitor important physiological measurements including levels of physical activity, peak flow, forced expiratory volume (FEV1), and biomarkers for P aeruginosa in sputum. Objective We aim to test this system in 20 participants with P aeruginosa colonization and 10 controls with Haemophilus influenzae. Methods We plan to recruit 30 adult participants with COPD or non-CF bronchiectasis who have cultured P aeruginosa or H influenzae during an exacerbation in the last 6 months. They must produce sputum on most days and should have been stable for 4 weeks prior to entry. Daily data collected will include symptoms, health care usage, medication, weight, FEV1, physical activity level, blood pressure, oxygen saturation, and temperature. Sputum and urine samples will be provided daily. These data will be analyzed to assess predictive value in detecting upcoming exacerbations. Qualitative data will be gathered through self-administered questionnaires and semistructured interviews to gather information on participant coping and their use of the technology involved. Results Recruitment has been completed and results from the study should be available at the end of 2017. Conclusions The SENSOR study aims to test a home-monitoring system in people with chronic airway infection and is currently underway.

Modern Innovative Solutions in Improving Outcomes in Chronic Obstructive Pulmonary Disease (MISSION COPD): A Comparison of Clinical Outcomes Before and After the MISSION Clinic

Background Chronic obstructive pulmonary disorder (COPD) affects over 1 million people in the United Kingdom, and 1 person dies from COPD every 20 minutes. The cost to people with COPD and the National Health Service is huge – more than 24 million working days lost a year and the annual expenditure on COPD is £810 million and £930 million a year. Objective We aim to identify patients with COPD who are at risk of exacerbations and hospital admissions as well as those who have not been formally diagnosed, yet remain at risk. Methods This mixed-methods study will use both data and interviews from patients and health care professionals. The project Modern Innovative SolutionS in Improving Outcomes iN COPD (MISSION COPD) will hold multidisciplinary carousel style clinics to rapidly assess the patients’ COPD and related comorbidities, and enhance patient knowledge and skills for self-management. Results This study is ongoing. Conclusions This research will capture quantitative and qualitative outcomes to accompany a program of quality improvement through delivery of novel care models.