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

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

Examining the Role of Diagnosis in the Emergency Department Experience

Study Objective: To explore the social, functional, and emotional needs that patients want addressed when seeking a diagnosis at their ED visit.https://jdc.jefferson.edu/cwicposters/1037/thumbnail.jp

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

Reliability and Measurement error of Active Knee extension Range of Motion in a Modified slump Test Position: A Pilot study

Abstract: The slump test is a tool to assess the mechanosensitivity of the neuromeningeal structures within the vertebral canal. While some studies have investigated the reliability of aspects of this test within the same day, few have assessed the reliability across days. Therefore, the purpose of this pilot study was to investigate reliability when measuring active knee extension range of motion (AROM) in a modified slump test position within trials on a single day and across days. Ten male and ten female asymptomatic subjects, ages 20-49 (mean age 30.1, SD 6.4) participated in the study. Knee extension AROM in a modified slump position with the cervical spine in a flexed position and then in an extended position was measured via three trials on two separate days. Across three trials, knee extension AROM increased significantly with a mean magnitude of 2° within days for both cervical spine positions (P>0.05). The findings showed that there was no statistically significant difference in knee extension AROM measurements across days (P>0.05). The intraclass correlation coefficients for the mean of the three trials across days were 0.96 (lower limit 95% CI: 0.90) with the cervical spine flexed and 0.93 (lower limit 95% CI: 0.83) with cervical extension. Measurement error was calculated by way of the typical error and 95% limits of agreement, and visually represented in Bland and Altman plots. The typical error for the cervical flexed and extended positions averaged across trials was 2.6° and 3.3°, respectively. The limits of agreement were narrow, and the Bland and Altman plots also showed minimal bias in the joint angles across days with a random distribution of errors across the range of measured angles. This study demonstrated that knee extension AROM could be reliably measured across days in subjects without pathology and that the measurement error was acceptable. Implications of variability over multiple trials are discussed. The modified set-up for the test using the Kincom dynamometer and elevated thigh position may be useful to clinical researchers in determining the mechanosensitivity of the nervous system

Practice and research in Australian massage therapy: a national workforce survey

Background: Massage is the largest complementary medicine profession in Australia, in terms of public utilisation, practitioner distribution, and number of practitioners, and is being increasingly integrated into the Australian health care system. However, despite the increasing importance of massage therapists in Australian health care delivery, or the increased practice and education obligations this may entail, there has been little exploration of practice, research, and education characteristics of the Australian massage therapist workforce.Purpose: To identify practice, research, and education characteristics among the Australian massage therapist workforce.Settings: The Australian massage therapy profession.Participants: 301 randomly selected members of the Association of Massage Therapists (Australia).Research Design: A 15-item, cross-sectional telephone survey.Main Outcomes Measures: Massage therapists’ demographic information, practice characteristics, and education and research characteristics.Results: Most respondents (73.8%) worked 20 hours per week or less practising massage, nearly half of all respondents (46.8%) treated fewer than 10 massage clients per week, and over three-quarters (81.7%) of respondents were self-employed. Massage therapy was the sole source of income for just over half (55.0%) of the study respondents. Only 5.7% of respondents earned over the average wage ($50,000) through their massage activities. Nearly half of all respondents (43.3%) reported regularly exceeding their continuing professional education (CPE) quota mandated by their professional association. However, 21.1% reported struggling to achieve their CPE quota each year. Over one-third of respondents (35.6%) were not interested in acquiring further CPE points beyond minimum requirements. Respondents were significantly more likely to have an active approach to research if they had higher income (p = .015). Multivariate analysis showed factors associated with access to CPE to be the only significant predictors for increased CPE.Conclusions: The massage profession in Australia remains largely part-time and practitioners earn less than the average Australian wage. The factors that underlie research and education involvement appear to be highly individualised and, therefore, policies targeting specific groups may be arbitrary and ineffective

Negotiating the Maze: Case based, Collaborative Distance Learning in Dentistry

The module was developed as an elective to give motivated senior dental students an opportunity to expand their horizons in planning oral rehabilitation. It comprised one tutor and 12 students, from five universities world-wide, communicating on the World Wide Web (WWW), to develop oral rehabilitation plans for simulated patients. Trigger material came from one of two Case Profiles and consisted of diagnostic casts and details of the clinical and radiographic examination in WWW/CD-ROM form. No background material was supplied as to the "patient's" age, sex, history or main concern(s). Students worked in groups of three, each student from a different location. Individual students were given a role within the group: "Patient", who developed a "personal background" belonging to the trigger examination material, "Academic" who identified state-of-the-art treatment options available for the dental treatment needs identified by the group and "General Practitioner" who tailored these options to the "patient's" needs and wants. Student feedback focused on their perception of their experience with the program in response to a questionnaire comprising 11 structured and four "open" questions. All students felt that the program increased their confidence in planning oral rehabilitation. Ten students felt that the "best thing about the program" was the interaction with students from other universities and the exposure to different philosophies from the different schools. Eight students mentioned their increased awareness of the importance of patient input into holistic planning. Under the heading "What was the worst thing", students cited some technical hitches and the snowball effect of two sluggish students who were not identified early enough and thus impacted negatively on the working of their groups. Student feedback showed that the module succeeded in its aims but needed modification to improve the logistics of working with an extended campu

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