Combining qualitative and quantitative data collection and analysis methods in understanding multiple sclerosis fatigue management

Combining qualitative inquiry with quantitative frequency data in a mixed methods research approach was valuable in understanding the strategies that people with Multiple Sclerosis (MS) used to manage their fatigue. Understanding its management is important because fatigue is often described by people with MS as their most disabling symptom and can pervade all aspects of a person’s life. This research aimed to identify how often people used particular fatigue management strategies and the factors that influenced their use in the context of daily life. The methodology was Qualitative Description with phenomenological overtones using convenience sampling, interviews with semi-structured and structured components, and frequencies combined with typology development. Thirty-one people with MS from Chicago, Ill and Brisbane, Queensland in Australia who experienced fatigue were interviewed and asked to sort 15 cards with common fatigue management strategies into 3 categories, indicating whether they used them regularly, sometimes or never. Frequency counts were used to identify the number of participants who placed a specific strategy in a particular category. Frequencies were used to develop a typology with which to code the qualitative data. The strategies placed most frequently in each category were: Plan / organize the day used regularly, Ask someone for help used sometimes, and Use mobility devices never used. Mixed methods research techniques enabled us to explore the participants’ fatigue management in greater depth. Each data type (i.e., qualitative and quantitative data) complemented the other and led to a richer understanding than either could provide in isolation

Mechanistic interplay between ceramide and insulin resistance

Recent research adds to a growing body of literature on the essential role of ceramides in glucose homeostasis and insulin signaling, while the mechanistic interplay between various components of ceramide metabolism remains to be quantified. We present an extended model of C16:0 ceramide production through both the de novo synthesis and the salvage pathways. We verify our model with a combination of published models and independent experimental data. In silico experiments of the behavior of ceramide and related bioactive lipids in accordance with the observed transcriptomic changes in obese/diabetic murine macrophages at 5 and 16 weeks support the observation of insulin resistance only at the later phase. Our analysis suggests the pivotal role of ceramide synthase, serine palmitoyltransferase and dihydroceramide desaturase involved in the de novo synthesis and the salvage pathways in influencing insulin resistance versus its regulation

Development of the student placement evaluation form: A tool for assessing student fieldwork performance

Evaluation of students undertaking fieldwork education placements is a critical process in the health professions. As training programs and practice evolve, systems for assessing students need to be reviewed and updated constantly. In 1995, staff of the occupational therapy training program at the University of Queensland, Australia decided to develop a new tool for assessing student fieldwork performance. Using an action research methodology, a team developed the Student Placement Evaluation Form, a flexible and comprehensive criterion-referenced evaluation tool. The present paper examines action research as an appropriate methodology for considering real-life organisational problems in a systematic and participatory manner. The action research cycles undertaken, including preliminary information gathering, tool development, trial stages and current use of the tool, are detailed in the report. Current and future development of the tool is also described

Am I being understood? Veterinary students' perceptions of the relationship between their language background, communication ability, and clinical learning

During clinical workplace learning, effective communication between veterinary students and clinical staff is of paramount importance to facilitating learning, assessment, and patient care. Although studies in health sciences education have indicated that students may experience communication difficulties as a result of linguistic, cultural, and other factors and that these difficulties can affect clinical learning and academic outcomes, this has not yet been explored in veterinary clinical educational contexts. In this study, the authors sought to identify whether final-year veterinary students perceived that their communication ability influenced their clinical learning and, if so, whether language background was of significance. Seventy-one students from a final-year cohort at an Australian veterinary school completed a student perception survey at the end of their clinical training. Exploratory factor analysis was used to investigate the extent to which learners perceived that their communication ability influenced their clinical learning. Two factors explained 72.3% of total variance. Factor 1 related to communication ability as a source of concern; Factor 2 related to comprehending and contributing to clinical conversations. Communication ability as a source of concern differed significantly ( p < .001) between students who did and did not have an English-speaking background, but there was no significant difference between these two student groups for Factor 2. Although language background was associated with self-perceived communication ability, evidence also emerged that students may experience communication challenges during clinical learning, irrespective of their language background

Information used by an expert paediatric occupational therapist when making clinical decisions

Background. Occupational therapists use a range of types and sources of information when making clinical decisions. It is unclear how this information is integrated. Purpose. This paper describes an exploratory qualitative case study that identified the types and sources of information accessed by one experienced paediatric therapist and how this information was combined and prioritised when making clinical decisions. Methods. Data were collected using observations of therapy sessions, key informant interviews, and semi-structured interviews. Data were analysed thematically. Findings. To inform clinical decisions, the participant prioritised information about each child in his or her context when making decisions. Other types of information from text books and journals, professional development activities and professional and personal experience, expanded her unique body of knowledge over time. Implications. Re-conceptualisation of how information use supports clinical decision making and expands a therapist's unique body of knowledge over time can support client-centred practice in occupational therapy

The experiences and needs of people who cease driving after stroke

Driving cessation can result in a range of negative consequences, including impacts on identity, mood, and life satisfaction. The aims of this study were to explore the needs and experiences of people who cease driving following a stroke, with the aim of informing clinical practice. Method: Using a qualitative phenomenological approach, semi-structured, audiotaped interviews were conducted to gain an understanding of the needs and experiences of 24 participants (17 male, 7 female, mean of 5.5 years post driving cessation) who had ceased driving following a stroke. Results: After constant comparative analysis, four themes emerged from the data. These were labelled ‘life without driving’, ‘key times of need’, ‘alternatives and other ways’, and ‘carer support and assistance’. Most participants found stopping driving after their stroke to be a sudden, unexpected and intense experience and raised issues, including the loss of numerous life-roles, challenges associated with arranging alternative transport, and reliance on carers and the need for more information throughout the process. Conclusion: Individuals who cease driving following a stroke have unmet needs and difficult experiences throughout the process. Key times of particular need have been identified in this study. These findings have important implications for health professionals that include providing more information and support with driving cessation and alternatives to driving

Acid Sphingomyelinase Deficiency Prevents Diet-induced Hepatic Triacylglycerol Accumulation and Hyperglycemia in Mice*

Acid sphingomyelinase plays important roles in ceramide homeostasis, which has been proposed to be linked to insulin resistance. To test this association in vivo, acid sphingomyelinase deletion (asm–/–) was transferred to mice lacking the low density lipoprotein receptor (ldlr–/–), and then offsprings were placed on control or modified (enriched in saturated fat and cholesterol) diets for 10 weeks. The modified diet caused hypercholesterolemia in all genotypes; however, in contrast to asm+/+/ldlr–/–, the acid sphingomyelinase-deficient littermates did not display hepatic triacylglyceride accumulation, although sphingomyelin and other sphingolipids were substantially elevated, and the liver was enlarged. asm–/–/ldlr–/– mice on a modified diet did not accumulate body fat and were protected against diet-induced hyperglycemia and insulin resistance. Experiments with hepatocytes revealed that acid sphingomyelinase regulates the partitioning of the major fatty acid in the modified diet, palmitate, into two competitive and inversely related pools, triacylglycerides and sphingolipids, apparently via modulation of serine palmitoyltransferase, a rate-limiting enzyme in de novo sphingolipid synthesis. These studies provide evidence that acid sphingomyelinase activity plays an essential role in the regulation of glucose metabolism by regulating the hepatic accumulation of triacylglycerides and sphingolipids during consumption of a diet rich in saturated fats