1,720,993 research outputs found
Quality of life: assessing the impact and benefits of care to patients with fungating wounds
No full textFungating malignant wounds are caused by tumor infiltration of the skin. Unless amenable to anti-cancer treatments, the infiltration extends, the wounds advance, and the management goals are palliative. Palliative care optimizes quality of life (QoL) through the control of physical symptoms and attention to patients' psychosocial needs. Quality of life in the context of palliative care and fungating wounds may therefore be conceptualized in terms of focused outcomes of interventions, including dimensions, such as hope, meaning, and self-esteem. Two disease-specific measurement tools have been identified and can be used to assess and measure the outcomes of fungating wound management together with the impact of the condition on the individual: the Wound and Symptoms Self-Assessment Chart (WoSSAC) and Treatment Evaluation by LE Roux's method (TELER(R)). Both focus on the palliative management of fungating wounds, and although not located in the QoL literature, they address QoL issues. The tools differ fundamentally in their approaches to assessment and measurement, which center on the differences between generic and individualized models of measurement and include the generalization of attributes and use of fixed-item formats. The conceptual framework that underpins the TELER system relates to key themes drawn from the QoL literature. These themes focus on the individual, reconciliation of expectations and hopes, needs as defined by individuals with health-care professionals, and continuous QoL assessment
A methodology for evaluating wound care technologies in the context of treatment and care
No full textBackground: the question of whether particular methodologies can generate knowledge of a sufficiently rigorous and relevant standard to guide patients’ interventions is regularly debated. This debate tends to be polarised between those who advocate the randomised controlled trial (RCT) as the ultimate scientific methodology and those who find RCTs wanting in terms of the information derived and their limited generalisability beyond the immediate trial population. This paper argues for a suite of methodologies that can evaluate wound care interventions; it also details a novel methodology for use in complex chronic and palliative wound care.Aim: to outline a methodology that can evaluate the clinical performance of wound care products in the context of complex treatment and care.Methods: the methodology is informed by the UK Medical Research Council framework for the design of complex evaluations, and is an N-of-1 design.Results: a novel methodology for evaluating the effectiveness of wound care technologies in complex chronic wound care and palliative wound care has been proposed.Conclusion: the methodology requires validation in prospective studies. The purpose of this paper is to open a constructive debate.Conflict of interest: non
Solving methodological challenges using a theory-driven evaluation in the study of complex patient care
No full textThis article draws on two research designs, which were used in a study of the palliative management of malignant wounds, to demonstrate the inherent challenges in producing generalizable knowledge from a complex subject. The designs included quasi-experimentation and a form of theory-driven evaluation. The focus of the study was the performance of dressings to reduce the impact of the wounds on daily life. The convention for evaluating the outcomes of interventions is a controlled study design. This approach is considered the valid way of producing evidence that is generalizable. An experimental design was therefore adopted to conduct a series of n = 1 quasi-experiments on wound dressing performance with qualitative methods to explore individual experiences. Problems with the methods, in particular the failure to capture complex inter-relationships between clinical problems and patient experiences, forced the researcher to abandon the experimental design. An alternative approach to measurement was adopted to maintain the study focus, the TELER® system of treatment evaluation, which includes indicators of patient-centred outcomes of care. The philosophical position of the study was reviewed. Consensus emerged as an unalterable, major influence on the design and paradigmatic assumptions of the study. A 'system of reasoning' was adopted to overcome the inherent relativist position of knowledge derived from this approach. The system abstracts general issues from case study data to construct theoretical explanations that may be consistent with, or challenge, current knowledge. This article is based on the evolution of one particular study. However, it makes a more general contribution to evaluation research by explaining the rationale for a form of theory-driven evaluation that uses evidence, reason and theory to develop generalizable explanations from complex, individual case study data. The methodology is proposed for other complex situations where specific and rigorous evidence, capable of generalization is needed
The wound dressing supply chain within England's National Health Service: unravelling the context for users
No full textAim: to explore the representation of user needs (nurses and patients, both individuals and groups) at the industrial (wound dressing manufacture) and National Health Service interface.Main issues: the wound dressing supply chain is outlined, tracking organizational changes. The methods that are used to transfer user information between industries that produce dressings and those using the products are reviewed in terms of their ability to communicate what users need from dressings. Organizational policies and systems are outlined, with the focus on their role in facilitating the communication of user needs.Conclusion: methods for generating user information that can directly inform dressing design are needed together with interactive communication routes within the supply chain, specifically between users, manufacturers, purchasers and suppliers. This will facilitate dual benefits for nursing management through improvements in purchasing decisions and nurses’ management of wound car
Disconnection: the user voice within the wound dressing supply chain
No full textAim: this study examined the user voice in England’s National Health Service (NHS) wound dressing supply chain.Background: the impetus for this work came from involvement in a collaboration between industry and clinicians, entitled Woundcare Research for Appropriate Products. Experiences from that study highlighted the notable absence of research about the impact of the supply chain on the users of dressings.Method: interview data are presented following an outline of the grounded theory method used. These data were obtained from key stakeholders (n = 41) within the wound dressing supply chain such as nurses, manufacturers, distributors, professional organizations, government organizations and user groups.Results: the consequences of supply disconnection revealed haphazard supply, unmet user needs and lack of information transfer between player groups.Conclusions and implications for nursing management: these consequences explain the lack of user voice in the supply chain and have far-reaching implications for nursing management, through purchasing decisions and nurses’ management of wound car
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
A methodology for a structured survey of the healthcare literature related to medical device users
No full textThis article reports on the structured literature survey methodology, which was used to identify how and at what stage users of medical devices are engaged in the medical device technology cycle, including methods and tools for evaluating device outcomes.This was not a conventional systematic review of the literature.The stated purpose of the survey is broader than synthesizing best evidence to inform an area of practice and policy, as undertaken in a conventional systematic review.The survey was systematic in the sense that an explicit search strategy was used with inclusion and exclusion criteria to minimize sampling bias. An established qualitative methodology, framework analysis, was used to organize and synthesize major findings from a broad range of healthcare literature.The search strategy and thematic analysis are presented, to contribute to the literature on review strategies, together with the major findings concerning users and medical device
- …
