Demystifying Theoretical Sampling in Grounded Theory Research

Theoretical sampling is a central tenet of classic grounded theory and is essential to the development and refinement of a theory that is ‘grounded’ in data. While many authors appear to share concurrent definitions of theoretical sampling, the ways in which the process is actually executed remain largely elusive and inconsistent. As such, employing and describing the theoretical sampling process can present a particular challenge to novice researchers embarking upon their first grounded theory study. This article has been written in response to the challenges faced by the first author whilst writing a grounded theory proposal. It is intended to clarify theoretical sampling for new grounded theory researchers, offering some insight into the practicalities of selecting and employing a theoretical sampling strategy. It demonstrates that the credibility of a theory cannot be dissociated from the process by which it has been generated and seeks to encourage and challenge researchers to approach theoretical sampling in a way that is apposite to the core principles of the classic grounded theory methodology

Deconstructing Caring and Authentic Measurement

Abstract Background: This paper explores a deconstruction of care through looking at hermeneutic methods and their role in a 'stripping back' or deconstruction of the processes and outcomes of care. The societal structures in which care is delivered and the undoubted 'power' operating downwards on both carer's and cared for is often overlooked in current research. Methodology: It is proposed that Foucauldian discourse analysis could be a useful tool in the deconstruction of care. Further methods based in interpretative phenomenology such as Interpretative Phenomenological Analysis could further deconstruct what it means to care at a more individual level within this wider societal context of caring. Results: More authentic measures would be obtained and measures based inherently in the wider 'lived experience' of carers and those they care for, moreover phenomenological analysis in itself could produce more authentic measures of care, through its emphasis on individual interpretation and 'meaning' and how this operates in the caring scenario. Conclusions: This process of deconstruction in order to get a more authentic picture of and measures of the meaning of caring would be useful in the training of management and front line care staff

How does patient experience fit into the overall healthcare picture?

Understanding the experience of patients provides insight into health care as well as being a crucial first step towards partnering with patients to drive improvement. Increasingly, health care organizations gain feedback from patients about their experience through surveys. Patients are also turning to other avenues, including the internet, to document their experiences. Although long recognised as a domain of quality, evidence of the link between patient experience and clinical outcomes has emerged more recently. Organizations that succeed in improving patient experience have adopted a strategic approach to patient focus that incorporates both patient feedback and consumer engagement. Adopting a patient perspective sees leading organizations moving beyond ‘episodic’ care approaches to an extended patient continuum. The use of patient portals and access to electronic records foster a much needed two-way communication. For the patient’s and provider’s perception of the care continuum to coincide, the ‘continuum’ definition needs to expand to complement population health management. Similarly health care delivery models and payment models will need to change to reflect the care continuum. Patient experience fits into the overall healthcare picture more today than it ever has. As population health management, accountable care, and healthcare reform mature, the efficacy of those efforts depend more and more on how well providers can integrate the design of patient experience and empowerment into the expanding care continuum

On-field identification and management of concussion in amateur rugby union

Background: Rugby is a popular team sport and due to its contact nature carries a relatively high potential for injury, including concussion. Moreover, it is estimated that as much as 50% of concussions are not reported due to a variety of reasons, including not considering the injury to be sufficiently serious or not wanting to miss game time. Objectives: The aim of this brief review was to investigate and summarise current best practice for on-field identification and on-field management of concussion in amateur rugby. Methods: PubMed and ClinicalKey were searched between September and December 2014 for articles in the five years preceding the search dates. The latest versions of the Consensus Statement for Concussion in Sports and World Rugby's concussion guidelines were also consulted. Results: Based on this search strategy, eight systematic reviews, one physician information article and four patient guidelines were investigated. Four reviews specifically described an "action plan" for on-field evaluation and management. Education of key stakeholders could reduce the number of unreported concussions. Once identified or suspected, concussions should be managed according to best practice procedures, which include removing the player from play immediately and consulting a medical doctor. If a medical doctor is not immediately available on the field tools such as the BokSmart on-field pocket "Concussion Guide", and World Rugby's "Pocket Concussion Recognition Tool", are freely available online. Conclusion: Stakeholder education (including players, parents, teachers, coaches, referees, spouses) on both the on-field identification and management of concussions could reduce under-reporting and improve the overall management of concussed rugby players

Charting the recovery of dysphagia in two complex cases of post-thermal burn injury: Physiological characteristics and functional outcomes

2 Charting the recovery of dysphagia in two complex cases of post-thermal burn injury: Physiological characteristics and functional outcomes 3 Abstract Purpose: The current study examined the physiological deficits, recovery pattern and outcomes observed clinically and instrumentally in two participants with dysphagia post thermal burn. Methods: Participants were followed prospectively using clinical and instrumental tools of assessment until dysphagia recovery. Clinical swallowing examinations were carried out every 1 to 2 days, or as clinically indicated. Instrumental assessment using fiberoptic endoscopic examination of swallowing was carried out at fortnightly intervals. Results: Despite variability in the achievement of oral intake milestones, both cases demonstrated protracted recovery from dysphagia contributed to by medical instability and lengthy periods of ventilation and intubation. Instrumental assessment confirmed silent aspiration in both participants, likely due to decreased laryngopharyngeal sensation. By discharge, participants had returned to their pre-morbid diets. Conclusions: This study highlights the protracted and complex recovery pattern associated with dysphagia following thermal burn injury. The presence of silent aspiration emphasizes the need for instrumental assessment to objectively assess aspiration risk and to facilitate dysphagia recovery within this population

Which clinical parameters predict a CSF diagnosis of meningitis in a population with high HIV prevalence?

Background. The HIV epidemic has changed the aetiology of meningitis in sub-Saharan Africa, and frontline clinicians are faced with a variety of meningitic presentations. Doctors working in resource-limited settings have the challenge of appropriately selecting patients for lumbar puncture (LP), a potentially risky procedure that requires laboratory analysis. Methods. In a rural South African hospital, the practice of performing LPs was audited against local guidelines. Data were collected retrospectively between February and June 2013. Symptoms and signs of meningitis, HIV status, investigations performed prior to LP and cerebrospinal fluid (CSF) results were recorded. With the aim of determining statistically significant clinical predictors of meningitis, parameters were explored using univariate and multivariate logistic regression analyses. Results. A total of 107 patients were included, of whom 43% had an abnormal CSF result. The majority (76%) of patients were HIV-positive (CD4 + cell count <200 cells/µl in 46%). Cryptococcal meningitis (CCM) was the most prevalent microbiological diagnosis, confirmed in 10 out of 12 patients. Of the non-microbiological diagnoses, lymphocytic predominance was the most common abnormality, present in 17 out of 33 patients. Confusion (p=0.011) was the most statistically significant predictor of an abnormal CSF result. Headache (p=0.355), fever (p=0.660) and photophobia (p=0.634) were not statistically predictive. Conclusion. The high incidence of CCM correlates with previous data from sub-Saharan Africa. In populations with high HIV prevalence, the classic meningitic symptoms of headache, fever and photophobia, while common presenting symptoms, are significantly less predictive of a meningitis diagnosis than confusion

Anthropometric indices as screening tools for cardiovascular risk factors in Singaporean women

Previous studies have suggested the need to revise the World Health Organization (WHO) cut-off values for the various indices of obesity and fat distribution in Singapore. The purpose of this study was to delineate cut-off points of body mass index (BMI), waist-hip ratio (WHR), waist circumference (WC), and waist-stature ratio (WSR) as screening tools for cardiovascular risk factors in Singaporean women. Anthropometric indices were measured in a cross sectional survey of 566 subjects (60% Chinese individuals, 28% Malay individuals and 12% Indian individuals). Cardiovascular risk factors were determined by measuring blood pressure, serum lipids, and fasting blood glucose levels. Receiver Operating Characteristic (ROC) curves were constructed to determine cut-off points. Forward logistic regression and area under curves (AUC) were used to determine the best anthropometric index. For at least one cardiovascular risk factor (hypertension, dyslipidaemia and diabetes mellitus), the cut-off points for BMI, WHR, WC and WSR were around 23.6kg/m 2 , 0.80, 77.8cm and 0.48 for Singaporean females. The AUC of WSR was the highest for all three risk factors in females (0.79 for hypertension, 0.70 for dyslipidaemia, 0.88 for diabetes mellitus). Regression analyses revealed that WSR was independently associated with all risk factors. For Singaporean female adults, the cut-off points were lower than the criteria suggested by the WHO, but were in agreement with those reported for Asians. BMI, WHR, WC and WSR may be used as screening tools for cardiovascular risk factors, of which WSR may be the best anthropometric index

Height and Mental Health and Health Utility Among Ethnic Chinese in a Polyclinic Sample in Singapore

Abstract Introduction: Whether fi nal height is associated with quality of life and mental health is a matter of epidemiological and medical concern. Both social and biological explanations have been previously proposed. This study aims to assess the associations in ethnic Chinese in Singapore. Materials and Methods: A cross-sectional study of 4414 respondents aged at least 21 years seen at a major polyclinic was performed. Socioeconomic and behavioural features of the sample and the Singapore population of similar ages were comparable. Height was measured by clinic nurses using an ultrasonic height senor. Participants were interviewed for socioeconomic, behavioural, health and quality of life information. Clinical morbidity data was collected from the participants' treating physicians. The SF-6D utility index and its Mental Health domain were the main endpoints. Linear and ordinal logistic regression models were used to analyse the utility index and the Mental Health scores, respectively. Results: Having adjusted for age and gender, the Mental Health domain (P <0.01) was associated with height but the utility index was not. Further adjustment for health, socioeconomic and behavioural covariates made little difference. Analyses based on height categories showed similar trends. Conclusion: Adult height has a positive association with mental health as measured by the SF-6D among ethnic Chinese in Singapore. Socioeconomic status and known physical health problems do not explain this association. Adult height had no association with SF-6D utility index scores