Mia Bierbaum

Incidence and cost of hospitalisation of children with injuries from playground equipment falls in New South Wales, Australia: New South Wales playground fall injuries

To describe the epidemiological profile and cost of hospitalised injuries caused by playground equipment falls of children aged 0–14 years, in New South Wales, Australia.

Women’s Perceptions of Journeying Toward an Unknown Future With Breast Cancer: The “Lives at Risk Study”:

Breast cancer risk classifications are useful for prognosis, yet little is known of their effect on patients. This study clarified women’s understandings of risk as they “journeyed” through the health care system. Breast cancer patients and women undergoing genetic investigation were recruited (N = 25) from a large UK Health Board, 2014–2015, completing a “Book of Experience,” and Bio-photographic elicitation interviews. Stakeholder and Participant Feedback Forums were undertaken with key stakeholders, including patients, oncologists, funders, and policy developers, to inform team understanding. Thematic and visual frameworks from multidisciplinary analysis workshops uncovered two themes: “Subjective Understandings of Risk” and “Journeying Toward an Unknown Future.” Breast cancer patients and women undergoing investigation experienced risk intuitively. Statistical formulations were often perplexing, diverting attention away from concrete life-and-death facts. Following risk classification, care must be co-defined to reduce patients’ foreboding about an unknown future, taking into consideration personal risk management strategies and aspirations for a cancer-free future.

Schema analysis of qualitative data: a team-based approach

Schema analysis is a novel, qualitative data analysis technique that uses a nsummative approach to make sense of complex, nuanced, textual data. It aims nto ensure that key features of a text, or essential elements, are revealed before nany interpretation of those key elements takes place, based on the assertion that ndata should be handled in a principled, informed, and strategic manner to achieve nphenomenal clarity. Teamwork is a central element of schema analysis, enabling nresearchers to effectively co-create meaning across disciplinary boundaries nthrough consensus-driven strategies. The research team’s shared accountability for interpretive decisions is clearly linked to a study’s original questions and the nresearch team’s desire to be rigorous in their collaborative stance and equally nvocal. Schema analysis can be used in the context of a wide range of qualitative nstudies or can sit alongside outputs from other mixed-methods studies to add nsubstance to their findings. The technique has been successfully developed and nrefined by the lead author, to suit a wide variety of healthcare scenarios, nevidenced by published research projects from UK and Australian contexts. In nthis chapter, the method is presented in detail, step by step. An example of the use nof schema analysis in practice is offered up from a recent Australian study that nexamined multidisciplinary team-working practices in oncology. Study data from nan interview with an oncology psychologist working as part of an oncological nmultidisciplinary team is considered, to reveal how healthcare professionals npresent information about risk to women with breast cancer. The chapter considers methodological implications for achieving validity and rigor, upholding ntrustworthiness in data, and creating data that are transferable to different settings. nTo conclude, the chapter reflects on future opportunities for the method’s use in nqualitative research.

Unwarranted clinical variation in the care of children and young people hospitalised for injury: a population-based cohort study

INTRODUCTIONnInjury is a leading cause of death and disability among children and young people. Recovery may be negatively affected by unwarranted clinical variation such as representation to an emergency department (ED), readmission to a hospital, and mortality. The aim of this study was to examine unwarranted clinical variation across providers of care of children and young people who were hospitalised for injury in New South Wales (NSW).nnnMATERIALS AND METHODSnRetrospective population-based cohort study using linked ED, hospital, and mortality data of all children and young people aged ≤25 years who were injured and hospitalised during 1 January 2010-30 June 2014 in NSW. Unwarranted clinical variation across providers was examined using three indicators. That is, for each hospital that treated ≥100 cases per year, risk standardised ratios were calculated with 95% and 99.8% confidence limits using the number of observed and expected events of (1) representations to ED within 72u202fh, (2) unplanned readmissions to hospital within 28 days, and (3) all-cause mortality within 30 days.nnnRESULTSnThere were 189,990 injury-related hospitalisations of children and young people. Of these, 4.4% represented to an ED, 8.7% were readmitted to hospital, and 0.2% died. Of the 45 public hospitals that treated ≥100 cases per year, higher than expected rates of ED representations, hospital readmissions, and mortality were observed in eleven, six, and two hospitals, respectively.nnnCONCLUSIONnThe rates of ED representations, hospital readmissions, and mortality among children and young people hospitalised for injury in NSW were similar to the rates reported in other countries. However, unwarranted clinical variation across public hospitals was observed for all three indicators. These findings suggest that by improving routine follow-up support services post-discharge for children and young people and their families, it may be possible to reduce unwarranted clinical variation and improve health outcomes.

Incidence and severity of head injury hospitalisations in Australian children over a 10-year period

ISSUE ADDRESSEDnChild head injuries can cause life-long disability and are a major cause of mortality globally. The incidence and impact of child head injuries in Australia is unknown. This study aimed to quantify the incidence, characteristics and treatment cost and to identify factors associated with the severity of hospitalisations of head injuries in Australian children.nnnMETHODSnLinked hospitalisation and mortality data were used to retrospectively examine hospitalisation trends for head injury in children aged ≤16xa0years and associated factors, in Australia, from 1 July 2002 to 30 June 2012.nnnRESULTSnThere were 164xa0126 hospitalisations of children for head injury during the 10-year period, commonly male (65.5%), or aged ≤5xa0years (48.3%). The incidence among children aged <1xa0year and 1-5xa0years significantly increased by 1.7% (95% CI 0.9-2.6; Pxa0<xa00.0001) and 1.5% (95% CI 1.1-1.9; Pxa0<xa00.0001) annually during the study period, respectively. The most common injury mechanisms across all age groups were falls (45.2%) and road trauma (16.0%). Head injury hospitalisations cost

Qualitative, multimethod study of behavioural and attitudinal responses to cochlear implantation from the patient and healthcare professional perspective in Australia and the UK: study protocol

468.9 million, with the higher costs found for children aged 11-16xa0years, and for the most severe injuries.nnnCONCLUSIONnHead injury hospitalisations cost the Australian health system close to half a billion dollars over a 10-year period, with the most serious injuries resulting in lifelong health implications. SO WHAT?: Targeted health promotion strategies such as the promotion of helmet wearing during scooter use, the introduction of cycleways, and impact absorbing surfaces on playgrounds, need to be implemented to reduce the occurrence of head injuries in children.

Relational autonomy in breast diseases care: a qualitative study of contextual and social conditions of patients’ capacity for decision-making

Introduction The growing prevalence of adults with ‘severe or greater’ hearing loss globally is of great concern, with hearing loss leading to diminished communication, and impacting on an individual’s quality of life (QoL). Cochlear implants (CI) are a recommended device for people with severe or greater, sensorineural hearing loss, who obtain limited benefits from conventional hearing aids (HA), and through improved speech perception, CIs can improve the QoL of recipients. Despite this, utilisation of CIs is low. Methods and analysis This qualitative, multiphase and multimethod dual-site study (Australia and the UK) explores patients’ and healthcare professionals’ behaviours and attitudes to cochlear implantation. Participants include general practitioners, audiologists and older adults with severe or greater hearing loss, who are HA users, CI users and CI candidates. Using purposive time frame sampling, participants will be recruited to take part in focus groups or individual interviews, and will each complete a demographic questionnaire and a qualitative proforma. The study aims to conduct 147 data capture events across a sample of 49 participants, or until data saturation occurs. Schema and thematic analysis with extensive group work will be used to analyse data alongside reporting of demographic and participant characteristics. Ethics and dissemination Ethics approval for this study was granted by Macquarie University (HREC: 5201700539), and the study will abide by Australian National Health and Medical Research Council ethical guidelines. Study findings will be published through peer-reviewed journal articles, and disseminated through public and academic conference presentations, participant information sheets and a funders’ final report.

Communicating risk in active surveillance of localised prostate cancer: a protocol for a qualitative study

BackgroundA relational approach to autonomy refers to the way in which social conditions and relationships shape a person’s self-identity and capacity in decision-making. This article provides an empirical account of how treatment choices for women undergoing breast diseases care are fostered within the dynamics of their relationships with clinicians, family members, and other aspects of their social environment.MethodsThis qualitative study recruited ten women undergoing treatment at a breast programme, and eight clinicians supporting their care, in a private teaching hospital in New South Wales, Australia. Fourteen patient-clinician consultation observations and 17 semi-structured interviews were conducted. Schema analysis of interview transcripts were undertaken by a team of researchers and corroborated by observational fieldnotes.ResultsRelational identities of patients influenced the rationale for treatment decision-making. Patients drew on supportive resources from family and medical advice from clinicians to progress with treatment goals. While clinicians held much social power over patients as the medical experts, patients highlighted the need for clinicians to earn their trust through demonstrated professionalism. Information exchange created a communicative space for clinicians and patients to negotiate shared values, promoting greater patient ownership of treatment decisions. As treatment progressed, patients’ personal experiences of illness and treatment became a source of self-reflection, with a transformative impact on self-confidence and assertiveness.ConclusionPatients’ confidence and self-trust can be fostered by opportunities for communicative engagement and self-reflection over the course of treatment in breast disease, and better integration of their self-identity and social values in treatment decisions.

Qualitative research in healthcare: modern methods, clear translation: a white paper

Introduction One in five men is likely to receive a diagnosis of prostate cancer (PCa) by the age of 85 years. Men diagnosed with low-risk PCa may be eligible for active surveillance (AS) to monitor their cancer to ensure that any changes are discovered and responded to in a timely way. Communication of risk in this context is more complicated than determining a numerical probability of risk, as patients wish to understand the implications of risk on their lives in concrete terms. Our study will examine how risk for PCa is perceived, experienced and communicated by patients using AS with their health professionals, and the implications for treatment and care. Methods and analysis This is a proof of concept study, testing out a multimethod, qualitative approach to data collection in the context of PCa for the first time in Australia. It is being conducted from November 2016 to December 2017 in an Australian university hospital urology clinic. Participants are 10 men with a diagnosis of localised PCa, who are using an AS protocol, and 5 health professionals who work with this patient group (eg, urologists and Pca nurses). Data will be collected using observations of patient consultations with health professionals, patient questionnaires and interviews, and interviews with healthcare professionals. Analysis will be conducted in two stages. First, observational data from consultations will be analysed thematically to encapsulate various dimensions of risk classification and consultation dialogue. Second, interview data will be coded to derive meaning in text and analysed thematically. Overarching themes will represent patient and health professional perspectives of risk communication. Ethics and dissemination Ethical approval for the study has been granted by Macquarie University Human Research Ethics Committee, approval 5201600638. Knowledge translation will be achieved through publications, reports and conference presentations to patients, families, clinicians and researchers.