scholarly journals A grounded theory study: Exploring health care professionals decision making when managing end stage heart failure care

Author(s):  
Karen Higginbotham ◽  
Ian Jones ◽  
Martin Johnson
2019 ◽  
Vol 4 (2) ◽  
pp. 238146831986551
Author(s):  
Lisa Carey Lohmueller ◽  
Aakanksha Naik ◽  
Luke Breitfeller ◽  
Colleen K. McIlvennan ◽  
Manreet Kanwar ◽  
...  

Background. The decision to receive a permanent left ventricular assist device (LVAD) to treat end-stage heart failure (HF) involves understanding and weighing the risks and benefits of a highly invasive treatment. The goal of this study was to characterize end-stage HF patients across parameters that may affect their decision making and to inform the development of an LVAD decision support tool. Methods. A survey of 35 end-stage HF patients at an LVAD implant hospital was performed to characterize their information-seeking habits, interaction with physicians, technology use, numeracy, and concerns about their health. Survey responses were analyzed using descriptive statistics, grounded theory method, and Bayesian network learning. Results. Most patients indicated an interest in using some type of decision support tool (roadmap of health progression: 46%, n = 16; personal prognosis: 51%, n = 18; short videos of patients telling stories of their experiences with an LVAD: 57%, n = 20). Information patients desired in a hypothetical decision support tool fell into the following topics: prognoses for health outcomes, technical information seeking, expressing emotions, and treatment decisions. Desire for understanding their condition was closely related to whether they had difficult interpreting their electronic medical record in the past. Conclusions. Most patients reported interest in engaging in their health care decision making and seeing their prognosis and electronic health record information. Patients who were less interested in their own treatment decisions were characterized by having less success understanding their health information. Design of a decision support tool for potential LVAD patients should consider a spectrum of health literacy and include information beyond the technical specifications of LVAD support.


10.2196/10362 ◽  
2019 ◽  
Vol 21 (2) ◽  
pp. e10362 ◽  
Author(s):  
Ina Thon Aamodt ◽  
Edita Lycholip ◽  
Jelena Celutkiene ◽  
Anna Strömberg ◽  
Dan Atar ◽  
...  

2020 ◽  
Vol 34 (4) ◽  
pp. 371-388
Author(s):  
Kristy J. Cook ◽  
Kim L. Larson

Background and PurposeGlobally, five million women are affected by opioid use disorder (OUD). Women with OUD are less likely to breastfeed than the general population, increasing risk of neonatal withdrawal. Theoretical frameworks related to breastfeeding did not address women with OUD. The purpose of this study was to develop a conceptual model to better understand breastfeeding disparities among this vulnerable population.MethodsA grounded theory study was conducted from August 2018 to March 2019 to investigate concepts likely to influence breastfeeding decisions in women with OUD. In-depth interviews were conducted in North Carolina with 10 women in recovery who breastfed, and their six identified support persons. Data were analyzed through iterative coding. This article focuses on maternal perspectives of breastfeeding informed by support persons.ResultsThe overarching theme was breastfeeding decision-making in an addiction trajectory. Two antecedent pathways led to the recovery–relapse cycle. This cycle involved seeking, initiating, and maintaining recovery with episodic relapse. Perceived stigma linked the recovery–relapse cycle with breastworks. Breastworks, an emergent concept, was characterized by learning and knowing, good intentions, and health-care provider sensitivity.Implications for PracticeThis grounded theory model may inform clinicians in caring for women with OUD and support breastfeeding and newborn well-being. Strategies to address research and practice may include the development of a mobile application, having women in recovery on the health-care team, and incorporation of breastfeeding guidelines.


2015 ◽  
Vol 21 (2) ◽  
pp. 245 ◽  
Author(s):  
Bálint Vajta ◽  
Mette Holberg ◽  
Jane Mills ◽  
William J. H. McBride

Dengue fever, a mosquito-borne virus, is an ongoing public health issue in North Queensland. Importation of dengue fever by travellers visiting or returning to Australia can lead to epidemics. The mosquito can acquire the virus in the symptomatic viraemic phase, so timely recognition of cases is important to prevent epidemics. There is a gap in the literature about backpackers’ knowledge of dengue fever and the decision-making process they use when considering utilising the Australian health-care system. This study uses grounded theory methods to construct a theory that explains the process backpackers use when seeking health care. Fifty semi-structured interviews with backpackers, hostel receptionists, travel agents and pharmacists were analysed, resulting in identification of a core category: ‘weighing up the costs of seeking health care’. This core category has three subcategories: ‘self-assessment of health status’, ‘wait-and-see’ and ‘seek direction’. Findings from this study identified key areas where health promotion material and increased access to health-care professionals could reduce the risk of backpackers spreading dengue fever.


Author(s):  
Chi-Ming Wei ◽  
Margarita Bracamonte ◽  
Shi-Wen Jiang ◽  
Richard C. Daly ◽  
Christopher G.A. McGregor ◽  
...  

Nitric oxide (NO) is a potent endothelium-derived relaxing factor which also may modulate cardiomyocyte inotropism and growth via increasing cGMP. While endothelial nitric oxide synthase (eNOS) isoforms have been detected in non-human mammalian tissues, expression and localization of eNOS in the normal and failing human myocardium are poorly defined. Therefore, the present study was designed to investigate eNOS in human cardiac tissues in the presence and absence of congestive heart failure (CHF).Normal and failing atrial tissue were obtained from six cardiac donors and six end-stage heart failure patients undergoing primary cardiac transplantation. ENOS protein expression and localization was investigated utilizing Western blot analysis and immunohistochemical staining with the polyclonal rabbit antibody to eNOS (Transduction Laboratories, Lexington, Kentucky).


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