Care in the Ostomates Programs: the multidisciplinary team’s perspective

Objective: to interpret the multidisciplinary team’s perspective on care for ostomates. Methods: qualitative study involving five professionals from the multidisciplinary team of the Ostomates Program, based on the Social Model of Disability. To collect the data, a focus group, participant and non-participant observation were used, along with a field diary, interpreted using the thematic analysis method. Results: the experience of this team was interpreted based on the theme Challenges for the implementation of the Ostomates Program and the respective thematic nuclei: In search of teamwork and Specialized care demands for intestinal ostomates, which evidenced the influences on the work and the need for improvements in care, infrastructure and human resources. Conclusion: the health professionals’ integration among different public healthcare levels and the ostomates and families’ participation influence the care for ostomates.

PP22 Box randomisation- a novel method for allocation in pre-hospital randomised controlled trials: the ACUTE study experience

BackgroundAllocation concealment is essential to avoid selection bias in randomised trials. The ACUTE pilot trial compared the effectiveness of pre-hospital CPAP vs standard oxygen therapy for acute respiratory failure (ARF). The randomisation schedule was implemented, and treatment allocation concealed, with a novel method using identical boxes.MethodsInvestigation of allocation concealment in the ACUTE trial proceeded in 4 stages. Firstly, the characteristics of recruited ACUTE trial patients were compared across arms. Secondly, the findings of a weekly trial box audit log were examined. Thirdly, allocation concealment was explored in paramedic focus groups and survey. Finally, a convenience sample of West Midlands and Yorkshire Ambulance Service paramedics were presented with a random pair of ACUTE boxes from each trial arm, and asked to identify any differences. If a difference was noted, they were asked to indicate which box contained CPAP and why.ResultsThe ACUTE study enrolled 77 participants (42 CPAP, 35 control). Baseline characteristics were similar, although patients in the CPAP arm appeared to have slightly more severe ARF. In week 10, audit of trial boxes revealed that intervention arm boxes were ‘rattling’, secondary to deflation of CPAP masks packaged under tension. All boxes were consequently re-packaged and resupplied. No comments in the paramedic survey, but a focus group participant stated that one box had appeared different when shaken. 278 paramedics participated in the observational study. 115 participants (41.4%) felt they were able to tell which box contained CPAP, predominantly due to weight difference. Of these, 81 paramedics (70%, p<0.05) were correct.ConclusionsAlthough the majority of paramedics were unable to determine box contents, a significant minority correctly determined the CPAP arm. Taken together with the development of a ‘rattle’ during the trial, and slight baseline imbalance in characteristics of trial participants, loss of allocation concealment cannot be excluded.

Improving Instructions to Stop the Bleed

The Stop The Bleed initiative was developed by the Department of Homeland Security to educate lay providers in bleeding reduction strategies. The current study evaluated: (1)three tourniquet instructions using a simulated tourniquet task and (2)participant confidence levels in tourniquet use and lay provider training. Thirty participants with limited clinical experience applied a tourniquet to a simulated limb using one of three instruction sets. Twelve of these participants (40%) participated in a tourniquet training session and focus group to discuss each instruction set. Participants preferred the most simple and pictoral instruction set, and identified opportunities for improvement in each set. Participant confidence in tourniquet use increased significantly following the task and the focus group. After the focus group, participant confidence in instructing lay providers on proper tourniquet use significantly increased. Adding key steps, contextual pictures, and indicators of success to instructions could support lay providers stop the bleed in life-threatening situations.

An analysis of articles on qualitative studies conducted by doctors published in scientific journals in Brazil between 2004 and 2013

We analyzed articles on studies carried out by doctors using qualitative methods. A literature search of articles published on the SciELO Brazil database between 2004 and 2013 was performed using the following keywords: qualitative research, interview, focus group, participant observation, content analysis, discourse analysis, social representation, and dialectical hermeneutics. The texts were analyzed using a theoretical framework based on the qualitative research review guidelines (RATS). Articles were grouped into the following categories: consistent, not very consistent, and inconsistent. A total of 135 articles were selected from 28 journals. The majority (64.4%) were considered consistent. The main weaknesses found were: lack of information on methodological path; superficial and descriptive analysis without reference to relevant literature; conclusions that did not advance beyond common sense; decontextualized results, and lack of study limitations. We concluded that the majority of the articles had scientific validity and suggest that journals covering the health field should provide specific norms for articles produced from qualitative studies.

Achieving Flex in the Inflexible: Dealing with Individual Differences in Highly Structured EFL Preparatory College Courses

This study explores a field-motivated concern among English as a Foregin Language (EFL) teachers at a college preparatory English language program. The course syllabus for this program is fixed and systematically paced over four, seven-week modules. Despite formal assessment measures that result in placing the learners into four levels of English language proficiency, it has been reported by teachers, that inside the classrooms, the learners are of varying degrees of language proficiencies and attitudes. This study utilized a focus group approach and case-study classroom observations to explore the extent to which teachers take any measures to address these variations in proficiency and affect in the classroom. Focus-group participant teachers showed a great deal of awareness of variations amongst students and expressed tendencies towards using teaching strategies that would address these variations. However, limitations of time and material, they reported, tend to hinder such efforts. Likewise, when observing two classrooms within the same context, the researchers identified some individual differences among teachers in terms of strategies that account for student individual differences in the classroom, but these strategies were limited in number and variation. It was concluded that in highly-structured courses, with fixed material and unified learning outcomes, there remains room for creating dynamic classroom practices that are sensitive and reactive to students’ needs and interests. The study calls for a larger scale investigation of this topic and advocates teaching approaches that have the potential to compensate for the unified syllabus and structured pacing of the courses.

Understanding the Customer Journey to Create Excellent Customer Experiences in Bookshops

<p>This study investigates the customer journey and identifies the drivers of excellent customer experience in bookshops. Five research methods—in-depth interview, focus group, participant observation, Zaltman metaphors elicitation technique, and collective stereographic photo essay—were run on eleven Italian bookshops involving more than 1 100 individuals overall. The contribution of this study is twofold. First, it illustrates the process to adopt when mapping the customer journey and analyzing the customer experience. Specifically, it proposes that customer experience can be deeply understood only via a broad research design involving several different profiles of participants, that are managers and booksellers, customers of different familiarity with bookshops (infrequent, frequent and loyal customers), people that were not familiar with the investigated bookshops but that have been invited on purpose, and people that have special interactions (café and events) with the bookshops. Second, results show three key aspects of the topic: (1) The customer experience world, based on rituals not on transactions; (2) The drivers of excellent customer experience in bookshops, which are customization, integration, and participation; (3) The complex role and broad competences of the ideal bookseller.</p>

Race, Ethnicity, and Pain Treatment: Striving to Understand the Causes and Solutions to the Disparities in Pain Treatment

would like for them to know that I am in pain or this part of my body hurts or the other part hurts — that I am not lying about it. To examine me and to cut down on the pain….And help me out.Patient with Sickle Cell Disease, Focus Group ParticipantPain in the United States is widely recognized to be undertreated; however, the capacity to treat pain has never been greater. The causes of this undertreatment are varied. As we focus on pain and why it is too often ineffectively treated, we also discover that this undertreatment afflicts some more than others. What divides the some from the others isn't limited to one factor, but one particularly disturbing factor is race and ethnicity. Racial and ethnic minority populations are at higher risk for oligoanalgesia, or the ineffective treatment of pain. Only through further study of the differences in pain treatment based on race and ethnicity can we develop strategies to reduce the disparities in care.