Basics of qualitative research: Grounded theory procedures and techniques

Secret History: Return of the Black Death Channel 4, 7-8pm In 1348 the Black Death swept through London, killing people within days of the appearance of their first symptoms. Exactly how many died, and why, has long been a mystery. This Secret History documentary follows experts as they pick through the evidence and reveal why the plague killed on such a scale. And they ask, what might be coming next?

Medscape

Objective: The recent obesity epidemic has been accompanied by a parallel growth in chronic sleep deprivation. Physiologic studies suggest sleep deprivation may influence weight through effects on appetite, physical activity, and/or thermoregulation. This work reviews the literature regarding short sleep duration as an independent risk factor for obesity and weight gain.

Short sleep duration and weight gain : a systematic review

In diesem Beitrag verdeutliche ich meine Besorgnis uber zahlreiche Umformungen der Grounded Theory (GT), die mit deren Rezeption durch Methodologien der qualitative Datenanalyse (QDA) einhergehen, und hieraus folgende Erosionen. Ich skizziere zunachst einige Beispiele hierfur, um danach die essentiellen Bestandteile der klassischen GT-Methodologie zusammenzufassen. Ich hoffe, dass dieser Beitrag meine Besorgnis uber die wachsende, aber meines Erachtens missverstandene Einvernahme von GT durch QDA-Methodologien veranschaulicht und zugleich als einfuhrender Leitfaden fur Novizen und Novizinnen dient, die daran interessiert sind, die grundlegenden Prinzipien der GT nachzuvollziehen. \nURN: urn:nbn:de:0114-fqs040245

Remodeling Grounded Theory

Recent advances on the development of wound dressings for diabetic foot ulcer treatment--a review.

Introduction It is well documented that the prevalence of venous leg ulcers (VLUs) is increasing, coinciding with an ageing population. Accurate global prevalence of VLUs is difficult to estimate due to the range of methodologies used in studies and accuracy of reporting. (1) Venous ulceration is the most common type of leg ulceration and a significant clinical problem, affecting approximately 1% of the population and 3% of people over 80 years of age (2) in westernised countries. Moreover, the global prevalence of VLUs is predicted to escalate dramatically, as people are living longer, often with multiple comorbidities. Recent figures on the prevalence of VLUs are based on a small number of studies, conducted in Western countries, and the evidence is weak. However, it is estimated that 93% of VLUs will heal in 12 months, and 7% remain unhealed after five years. (3) Furthermore, the recurrence rate within 3 months after wound closure is as high as 70%. (4) (-6) Thus, cost-effective adjunct evidence-based treatment strategies and services are needed to help prevent these ulcers, facilitate healing when they occur and prevent recurrence. The impact of a VLU represents social, personal, financial and psychological costs on the individual and further economic drain on the health-care system. This brings the challenge of providing a standardised leg ulcer service which delivers evidence-based treatment for the patient and their ulcer. It is recognised there are variations in practice and barriers preventing the implementation of best practice. There are patients not receiving appropriate and timely treatment in the initial development of VLUs, effective management of their VLU and preventing recurrence once the VLU has healed. Health-care professionals (HCPs) and organisations must have confidence in the development process of clinical practice guidelines and have ownership of these guidelines to ensure those of the highest quality guide their practice. These systematic judgments can assist in policy development, and decision making, improve communication, reduce errors and improve patient outcomes. There is an abundance of studies and guidelines that are available and regularly updated, however, there is still variation in the quality of the services offered to patients with a VLU. There are also variations in the evidence and some recommendations contradict each other, which can cause confusion and be a barrier to implementation. (7) The difference in health-care organisational structures, management support and the responsibility of VLU management can vary in different countries, often causing confusion and a barrier to seeking treatment. These factors further complicate the guideline implementation process, which is generally known to be a challenge with many diseases. (8).

Management of Patients With Venous Leg Ulcers: Challenges and Current Best Practice

Background Adherence to medication is vital for disease management while simultaneously reducing healthcare expenditure. Older persons with cognitive impairment (CI) are at risk for non-adherence as cognitive processes are needed to manage medications. This systematic review focuses on the relationship between medication non-adherence and specific cognitive domains in persons with CI, and explores determinants of medication non-adherence. When available, relationships and factors are compared with cognitively intact populations. Methods A seven database systematic search of studies published between 1 January 1949–31 December 2015 examining medication non-adherence in community dwelling persons with CI or dementia was conducted. Articles reporting medication non-adherence in people with CI or dementia in the community, with or without caregiver supports were eligible for inclusion. Papers reporting adherence to treatments in cognitively intact populations, populations from hospital or institutional settings, for non-prescribed medication or those describing dementia as a factor predicting medication non-adherence were excluded. Data on study and population characteristics, research design, data sources and analysis, specific cognitive domains, non-adherence prevalence, measurement of adherence, salient findings, factors associated with adherence and strategies to improve medication adherence were extracted. Study limitations included inconsistencies between data sources and definitions, resulting in a loss of fidelity in the value and comprehensiveness of data, as well as exclusion of non-pharmacological treatments and regimens. Findings Fifteen studies met inclusion criteria. Adherence among CI subjects ranged from 10.7%-38% with better rates of adherence in non-CI individuals. Medication non-adherence definitions varied considerably. New-learning, memory and executive functioning were associated with improved adherence and formed the focus of most studies. Multiple factors were identified as modulators of non-adherence. Conclusion This review highlights a gap in knowledge on how specific cognitive domains contribute to medication non-adherence amongst CI populations, and demonstrates the current focus is limited to two domains: memory and executive functioning.

/pdf/a-systematic-review-of-medication-non-adherence-in-persons-36ksb230sf.pdf

A systematic review of medication non-adherence in persons with dementia or cognitive impairment.

Wound management is a significant and growing issue worldwide. Knowledge of dressing products and clinical expertise in dressing selection are two major components in holistic wound management to ensure evidence-based wound care. With expanding global market of dressing products, there is need to update clinician knowledge of dressing properties in wound care. Optimal wound management depends on accurate patient assessment, wound diagnosis, clinicians' knowledge of the wound healing process and properties of wound dressings. We conducted a comprehensive review of the physical properties of wound dressing products, including the advantages and disadvantages, indications and contraindications and effectiveness of first-line interactive/bioactive dressing groups commonly used in clinical practice. These include semipermeable films, foams, hydroactives, alginates, hydrofibers, hydrocolloids, and hydrogels. In making decisions regarding dressing product selection, clinicians need to ensure a holistic assessment of patient and wound etiology, and understand dressing properties when making clinical decisions using wound management guidelines to ensure optimal patient outcomes. This review has highlighted there is lack of high quality evidence and the need for future well designed trials.

/pdf/first-line-interactive-wound-dressing-update-a-comprehensive-14c65fmzjz.pdf

First-Line Interactive Wound Dressing Update: A Comprehensive Review of the Evidence.

The availability of different types of wound dressings has increased in the last decade. Wound care practitioners have at their disposal an extensive range of dressings. Emerging dressing types include interactive/bioactive dressings and tissue-engineered skin substitutes. There is no one dressing that is suitable for the management of all types of chronic wounds and few are suited for the treatment of a single wound during all stages of the healing cycle. Successful wound management depends on an understanding of the healing process combined with knowledge of the properties of the various dressings available. Without such knowledge and careful assessment of all the factors that effect healing, dressing selection is likely to be arbitrary and ineffective, wasteful both in terms of time and physical resources. This article is an overview of some of the first-line and second-line interactive/bioactive dressings available. A synopsis of wound assessment and wound bed preparation will aid in choosing the appropriate dressings. It will also touch on advanced technologies including tissue-engineered skin substitutes. J Pharm Pract Res 2006; 36: 318-24.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/j.2055-2335.2006.tb00640.x

Wound Dressings Update

Venous leg ulcers take weeks - or months - to heal, cause distress, and are very costly for health services. Although compression, using bandages or stockings, helps healing and prevents recurrence, many people do not adhere to compression therapy. Therefore, interventions that promote the wearing of compression should improve healing, and prevent recurrence of venous ulcers.
We found two studies of low quality evidence, so further studies may change the review findings.  
Leg Club®, a community-based clinic, may not significantly improve healing of venous leg ulcers or quality of life more than nurse home-visit care does, but probably results in less pain after six months.  Seventeen more people out of 100 were healed after participating in Leg Club (46/100 people in Leg Club healed compared with 29/100 people having usual home care). Leg Club participants rated their quality of life 0.85 points better than those receiving home care, assessed on a 10 point scale. Leg Club participants rated their pain at six months 12.75 points lower than the home care group, assessed on a 100 point scale. This trial did not report whether Leg Club clinics improve adherence to compression, time to healing, or prevent recurrence more than home care.
Lively Legs®, a community-based self-management programme, may not significantly improve healing of ulcers or decrease recurrence after 18 months any more than usual care in a wound clinic. Ten more people out of 100 were healed at 18 months after participating in Lively Legs (55/100 Lively Legs participants healed versus 45/100 people having usual care). Ten fewer people out of 100 had a recurrent leg ulcer 18 months after participating in Lively Legs (47/100 Lively Legs participants had recurrence compared with  57/100 people having usual care). The same number of people adhered to compression therapy after participating in Lively Legs (45/100 participants in both groups). The trial did not report whether the Lively Legs self-management programme clinics improve time to healing of ulcers, reduce pain, or improve quality of life any more than usual care in a wound clinic.

/pdf/interventions-for-helping-people-adhere-to-compression-zlr1atkvkn.pdf

Carolina D Weller

Papers

Management of Patients With Venous Leg Ulcers: Challenges and Current Best Practice

A systematic review of medication non-adherence in persons with dementia or cognitive impairment.

First-Line Interactive Wound Dressing Update: A Comprehensive Review of the Evidence.

Wound Dressings Update

Interventions for helping people adhere to compression treatments for venous leg ulceration.