Rachel Hilliam

Quantitative Analysis of Qualitative Information From Interviews A Systematic Literature Review

Background: A systematic literature review was conducted on mixed methods area. Objectives: The overall aim was to explore how qualitative information from interviews has been analyzed using quantitative methods. Methods: A contemporary review was undertaken and based on a predefined protocol. The references were identified using inclusion and exclusion criteria and specific key terms in 11 search databases. Results: Evidence was synthesized from 14 references that included the methods used for quantifying qualitative information, analyzing it statistically and the rationale behind this. Gaps in the existing literature and recommendations for future research were identified. Conclusions: This review highlights the need for a new mixed method based on advanced statistical modeling method that will explore complex relationships arising from qualitative information.

Effectiveness of a care bundle to reduce surgical site infections in patients having open colorectal surgery.

Introduction In 2010 a care bundle was introduced by the Department of Health (DH) to reduce surgical site infections (SSIs) in England. To date, use of the care bundle has not been evaluated despite incorporating interventions with resource implications. The aim of this study was to evaluate the DH SSI care bundle in open colorectal surgery. Methods A prospective cohort design was used at two teaching hospitals in England. The baseline group consisted of 127 consecutive patients having colorectal surgery during a 6-month period while the intervention group comprised 166 patients in the subsequent 6 months. SSI and care bundle compliance data were collected using dedicated surveillance staff. Results Just under a quarter (24%) of the patients in the baseline group developed a SSI compared with just over a quarter (28%) in the care bundle group (p>0.05). However, compliance rates with individual interventions, both before and after the implementation of the bundle, were similar. Interestingly, in only 19% of cases was there compliance with the total care bundle. The single intervention that showed an associated reduction in SSI was preoperative warming (p=0.032). Conclusions The DH care bundle did not reduce SSIs after open colorectal surgery. Despite this, it is not possible to state that the bundle is ineffective as compliance rates before and after bundle implementation were similar. All studies evaluating the effectiveness of care bundles must include data for compliance with interventions both before and after implementation of the care bundle; poor compliance may be one of the reasons for the lower than expected reduction of SSIs.

Levine-Katz (Boston) Questionnaire analysis: means, medians or grouped totals?

were prescribed oral antibiotics on discharge. Those patients who were admitted (n1⁄4 12) were admitted to the plastic surgery or orthopaedic surgery units, with a majority being received in plastic surgery (50 from 51 patients). This is mainly attributable to the proportion of days on call for hand trauma (6:1). Of those patients who were admitted, two were transferred to the children’s hospital due to their age. Surgical exploration was performed exclusively in the emergency theatres, under general anaesthesia and tourniquet. Specialist registrars performed 100% of cases. Structural damage was revealed in 83% of cases. The injuries were flexor tendon laceration (n1⁄4 6), digital nerve damage (n1⁄4 4) or both tendon and nerve damage (n1⁄4 2). The majority of admissions were for injuries to zones II and III (5 and 6 admissions respectively). One patient presented with a laceration to the skin overlying the mandible. Oral antibiotics were prescribed on discharge to 10 patients; all were admitted patients who underwent surgery during their admission, with amoxicillin clavulanic acid (Augmentin Duo ) the antimicrobial of choice (n1⁄4 9). Fourteen patients were reviewed at least once postoperatively. Mean follow up was 8.4 weeks (range 1 to 36 weeks). Five of these patients dropped out of follow up and the remaining nine were discharged by the reviewing doctor. Six individuals, all with flexor tendon injury, were referred for physiotherapy. Longterm subjective complaints were seen in two individuals. One patient complained of stiffness and one patient complained of numbness associated with severed superficial digital nerve branch. Two flexor tendon repairs were lost to follow up. Longer follow up will be required for any meaningful conclusion to be drawn. To our knowledge, this is the first large study to clinically document the epidemiology and pathology of hand injuries caused by corrugated iron fences. The results indicate that the majority of the injuries are of a superficial nature, not particularly different from those caused by knives, glass and saws. Such injuries require similar treatment, consisting in repair of damaged structures. The majority of cases can be managed on an outpatient basis.

A fresh look at preoperative body washing

National guidelines do not support preoperative body washing to reduce surgical site infections, instead recommending bathing or showering with soap. Yet preoperative body washing continues to be widely used in many hospitals across Europe. This paper suggests that existing trials of preoperative body washing, upon which guidelines are based, are dated and proposes a new investigation of preoperative body washing using modern definitions of surgical site infection with standardised patient follow up, modern surgical techniques and well designed trials. This paper provides a critique of existing guidelines and describes a randomised trial with 60 participants to compare the effect of soap and two antiseptic washing products on colony forming units (CFUs) for up to six hours. Chlorhexidine gluconate and octenidine were significantly more effective than soap in reducing CFUs in the underarm, and chlorhexidine was significantly more effective than soap in reducing CFUs in the groin.

Analysis of rewarming curves in Raynaud’s phenomenon of various aetiologies

This study investigated whether a modified Cold Provocation Test could distinguish between 86 normal subjects and 31 patients with Raynaud’s phenomenon or 59 with hand arm vibration syndrome (HAVS). Of the HAVS subjects, 56 were seen for medical reports as they were involved in litigation. Their assessments were done in a different location but the same protocol was used. A standardised cold stress was used to reduce the finger temperature to 15°C or less without inducing reflex hyperaemia. This test had acceptable repeatability for subjects without HAVS with an intra-class correlation of 0.7. Baseline temperature, temperature rise in the first 30 seconds and the time taken to rewarm by 5°C were measured. Patients with Raynaud’s phenomenon and HAVS had cooler hands than controls. HAVS patients rewarmed most in the first 30 seconds. Patients with Raynaud’s phenomenon take longer to rewarm by 5°C than controls or those with HAVS (P<0.001). A baseline difference of >7.5°C between the temperature of the digit and that of the room is unlikely to occur in patients with Raynaud’s phenomenon or HAVS. A temperature gain of ≥2.2°C in the first 30 seconds on rewarming combined with a low baseline temperature strongly suggests HAVS. This modified cold provocation test may differentiate between patients with Raynaud’s phenomenon, HAVS and controls but this observation requires independent verification in subjects not involved in litigation and tested in the same facility.

Access to medicines by child refugees in the East Midlands region of England: a cross-sectional study

Objectives To explore access to primary healthcare and drug therapy by refugee children in the East Midlands region of England. Design Interviews with refugees with children and a control group of British parents with children. Setting East Midlands region of England. Participants 50 refugees with children and a control group of 50 parents with children. Main outcome measures Number of medicines used by children in the last month and the past 6 months. Health of parents and children. Registration with a general practitioner (GP). Results All families in both groups were registered with a GP. There was no difference in the number of children in the two groups experiencing illnesses .In the last month, 30 refugee children received 60 medicines and 31 control children 63 medicines. In the past 6 months, 48 refugee children received 108 medicines and 43 control children 96 medicines. There was no difference between the two groups of children in relation to the likelihood of receiving any medicines in either the last month (P=0.839) or the past 6 months (p=0.81). Children in the refugee group were more likely to receive prescribed medicines for the last month (p=0.008) and the past 6 months (p<0.001). They were also less likely to receive over the counter (OTC) medicines in the past 6 months (p=0.009). Conclusions The refugee children in this study in the East Midlands had access to primary healthcare, medicines and a family doctor. They were more likely to receive prescribed medicines and less likely to receive OTC medicines, especially paracetamol.

The dynamics and statistics of bivariate chaotic maps in communications modeling

Statistical and dynamical properties of bivariate (two-dimensional) maps are less understood than their univariate counterparts. This paper gives a synthesis of extended results with exemplifications by bivariate logistic maps, the bivariate Arnold cat map and a bivariate Chebyshev map. The use of synchronization from bivariate maps in communication modeling is exemplified by an embryonic chaos shift keying system.

A novel device for preoperative skin preparation to reduce the risk of injury and surgical site infection during lower limb surgery.

Surgical site infection (SSI) continues to be a feared complication of surgery but especially orthopaedic surgery where a superficial SSI has been estimated to add nine days to the hospital stay and an average of £2500 to the cost. Despite the efficacy of all skin preparation agents being maximal at around 10 minutes no current system, apart from the double prep method attributed to Sir John Charnley, allows adequate control of bacteria. Current techniques of skin preparation require lifting of the limb with an associated risk of injury to theatre operatives. In order to provide for longer duration of contact, potentially better antisepsis and to remove the dangers inherent in lifting the limb we developed a novel system for limb antisepsis prior to surgery. To demonstrate efficacy we performed a single blind randomised controlled trial powered to demonstrate non-inferiority. We demonstrated a significant benefit of the device in terms of bactericidal effect. Whilst only recently entering full production, we would recommend the system as a significant improvement over current techniques of limb antisepsis.

Interactive statistics for a diverse student population

Abstract Students from many different subject areas are required to study statistics as part of their qualification. The Open University developed a statistics module which could simultaneously be studied by students from a variety of different disciplines, by engaging them with topics which are of interest to everyone, namely money, education and health, rather than being based in the student’s own discipline. The module attracts students from a wide variety of backgrounds and has one of the highest retention and pass rates of any OU module at level one. In addition, it has succeeded in successfully teaching a highly visual subject, which includes a wide range of online resources, to all students, including widening participation priority groups. It is hoped this can provide a model for other large service teaching courses, together with providing career and professional development for professional bodies.

Mothers’ and grandmothers’ perceptions relating to causality, treatment and support for families of a child with a diagnosis of attention deficit hyperactivity disorder: Applying Enosis, an alternative mixed methods approach

Abstract Background: A systemic research project was conducted to explore the views and experiences of parents and grandparents within families who have a child with a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD). Secondary analysis was applied and is presented in this article based upon a novel mixed methods approach, termed ‘Enosis.’ Methods: Themes, which were developed through the original Interpretive Phenomenology Analysis of 11 matched interviews, were quantified using ‘proportion’ scoring system. Scores per family and per participant were analysed using structural equation modeling. Results: The number of children in household, the number of living grandparents, reported grandmothers’ and mothers’ Strengths and Difficulties scores were significantly related with families’ perceptions about causality of ADHD. The grandmothers’ views were significantly different to the mothers’ regarding their experiences of professional treatment and support for ADHD. A child’s age, number of grandchildren and participants’ scores for affect of ADHD on a family’s life together with a child’s strengths and difficulties were significantly related to participants’ and families’ views about the grandmothers’ support as well as reported pains and pleasures regarding their relationship with the child. Conclusion: Secondary analysis of qualitative data based on the ‘Enosis’ method added another dimension to interpretation of the original study results and aims. Hypotheses were supported, strengthened or challenged in relation to the original study results and further triangulation was enabled with regards to existing literature.