Evidence map›Paper›PMID 37726754›Full record

ArticleJournal of foot and ankle research2023

Hospital clinicians' perceptions and experiences of care pathways for chronic limb-threatening ischaemia: a qualitative study.

Eleanor Atkins, Ian Kellar, Panagiota Birmpili, Jonathan R Boyle, Arun D Pherwani, Ian Chetter, David A Cromwell

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of foot and ankle research, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
0.6field-weighted citation impact, top 29% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 2 citations in OpenAlex.

  1. Article
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 5 institutions in 2 countries.

Eleanor AtkinsClinical Effectiveness Unit, Royal College of Surgeons of England, 38-43 Lincoln's Inn Fields, Holborn, London, WC2A 3PE, UK. Eleanor.atkins@nhs.net.ORCID http://orcid.org/0000-0002-9455-6960
Ian KellarUniversity of Sheffield, Sheffield, UK.
Panagiota BirmpiliClinical Effectiveness Unit, Royal College of Surgeons of England, 38-43 Lincoln's Inn Fields, Holborn, London, WC2A 3PE, UK.
Jonathan R BoyleDepartment of Vascular Surgery, Cambridge University Hospitals, Cambridge, UK.
Arun D PherwaniStaffordshire & South Cheshire Vascular Network, Royal Stoke University Hospital, Stoke-On-Trent, UK.
Ian ChetterHull York Medical School, Hull, UK.
David A CromwellClinical Effectiveness Unit, Royal College of Surgeons of England, 38-43 Lincoln's Inn Fields, Holborn, London, WC2A 3PE, UK.
The Honourable Society of Lincoln's Inn · GBCambridge University Hospitals NHS Foundation Trust · GBHull York Medical School · GBRoyal Stoke University Hospital · GBUniversity of Sheffield · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundChronic limb-threatening ischaemia (CLTI) is a condition associated with significant risks of lower limb loss and mortality, which increase with delays in management. Guidance recommends urgent referral and assessment, but delays are evident at every stage of the CLTI patient pathway. This study uses qualitative methods to explore hospital clinicians' experiences and perceptions of the existing CLTI pathway.

methodsA qualitative interview study was conducted. Semi-structured interviews were undertaken with 13 clinicians involved in the assessment of patients referred to hospital with suspected CLTI, identified via purposive sampling from English vascular surgery units. Clinicians included podiatrists, vascular specialist nurses and doctors. Reflexive thematic analysis was performed on the data from a critical realist position.

resultsThe need for speed was the single overarching theme identified. Four linked underlying themes were also identified; 1. Vascular surgery as the poor relation (compared to cancer and other specialties), with a sub-theme of CLTI being a challenging diagnosis. 2. Some patients are more equal than others, with sub-themes of diabetes vs. non-diabetes, hub vs. spoke and frailty vs. non-frail. 3. Life in the National Health Service (NHS) is tough, with sub-themes of lack of resource and we're all under pressure. 4. Non-surgeons can help.

conclusionsThe underlying themes generated from the rich interview data describe barriers to timely referral, assessment and management of CLTI, as well as the utility of non-surgical roles such as podiatrists and vascular specialist nurses as a potential solution for delays. The overarching theme of the need for speed highlights the meaning given to adverse consequences of delays in management of CLTI by clinicians involved in its assessment. Future improvement projects aimed at the CLTI pathway should take these findings into account.

Indexed as

Chronic Limb-Threatening IschemiaCritical PathwaysHospitalsHumansQualitative ResearchState MedicineChronic limb threatening ischaemiaReferral and consultationVascular surgery

Identifiers

PMID37726754
PMCPMC10507819
OpenAlexW4386859986

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.