Lisa C DePaoli | University of Pittsburgh (original) (raw)
Papers by Lisa C DePaoli
American Journal of Respiratory and Critical Care Medicine, 2020
Rationale: Patients receiving prolonged mechanical ventilation experience low survival rates and ... more Rationale: Patients receiving prolonged mechanical ventilation experience low survival rates and incur high healthcare costs. However, little is known about how to optimally organize and manage their care. Objectives: To identify a set of effective care practices for patients receiving prolonged mechanical ventilation. Methods: We performed a focused ethnographic evaluation at eight long-term acute care hospitals in the United States ranking in either the lowest or highest quartile of risk-adjusted mortality in at least four of the five years between 2007 and 2011. Measurements and Main Results: We conducted 329 hours of direct observation, 196 interviews, and 39 episodes of job shadowing. Data were analyzed using thematic content analysis and a positive-negative deviance approach. We found that high-and lowperforming hospitals differed substantially in their approach to care. High-performing hospitals actively promoted interdisciplinary communication and coordination using a range of organizational practices, including factors related to leadership (e.g., leaders who communicate a culture of quality improvement), staffing (e.g., lower nurse-to-patient ratios and ready availability of psychologists and spiritual care providers), care protocols (e.g., specific yet flexible respiratory therapy-driven weaning protocols), team meetings (e.g., interdisciplinary meetings that include direct care providers), and the physical plant (e.g., large workstations that allow groups to interact). These practices were believed to facilitate care that is simultaneously goal directed and responsive to individual patient needs, leading to more successful liberation from mechanical ventilation and improved survival. Conclusions: High-performing long-term acute care hospitals employ several organizational practices that may be helpful in improving care for patients receiving prolonged mechanical ventilation.
This project investigates the relationship between autochthonous people and immigrants in a valle... more This project investigates the relationship between autochthonous people and immigrants in a valley of southern Ecuador, specifically in terms of climate change and related moves toward sustainable development. The landscape and environment are frequent topics of conversation, especially concerning the increasingly dry climate. Engagements between individuals often result in dynamic relationships in which people take active steps to curtail human impacts, such as developing new land-use and livelihood strategies. Southern Ecuador has historically experienced the effects of periodic drought, and land degradation is exacerbating the problem. This and other factors, including the relative isolation and lack of rural development in Loja province and the overall economic situation in Ecuador, has resulted in large-scale migration of Ecuadorians from the province of Loja. Paradoxically, the valley in which fieldwork was carried out is also known as the Valley of Longevity and has attracted immigrants from various other countries. Some of these expatriates have lived in the valley for long periods of time and have developed working relationships with Ecuadorians that have proved beneficial in terms of development. This dissertation is the result of 13 months of ethnographic fieldwork that included participant observation, formal and informal interviews, and the analysis of written materials. The project focused specifically on how the local-nonlocal relationship impacts livelihoods, land use change, sustainability, and the perception of and attention to issues surrounding climate change. These themes help us to understand the distributional consequences of changes in agri-food systems, and have led to concern over where food is going to come from because, as some informants have said, “no podemos comer billetes” (we can’t eat dollar bills). Research shows that the social heterogeneity of the valley fosters mutual learning and benefits and contributes to more varied views of the natural environment and of the use of natural resources. This project demonstrates how responses to climate change and land degradation may be integrated into emerging sustainable development strategies, particularly important because human activity will both drive and mediate the impact of climate change during the next century.
Ethics in the Field: Contemporary Challenges, an edited volume by Jeremy MacClancy and Agustín Fu... more Ethics in the Field: Contemporary Challenges, an edited volume by Jeremy MacClancy and Agustín Fuentes, brings together eleven contributions from researchers across the US, UK, and Japan, drawing from anthropology, behavioral ecology, and sociology. It illustrates well that ethical issues often cannot be anticipated. Many times, there are ethical concerns relevant to the particular context that do not become apparent until the research has commenced. It also refers to research that was done both before and after the mid-1990s, when formalized university ethics approval became a requirement. Before this time, there were only disciplinary guidelines on ethical practice.
American Journal of Respiratory and Critical Care Medicine, 2020
Rationale: Patients receiving prolonged mechanical ventilation experience low survival rates and ... more Rationale: Patients receiving prolonged mechanical ventilation experience low survival rates and incur high healthcare costs. However, little is known about how to optimally organize and manage their care. Objectives: To identify a set of effective care practices for patients receiving prolonged mechanical ventilation. Methods: We performed a focused ethnographic evaluation at eight long-term acute care hospitals in the United States ranking in either the lowest or highest quartile of risk-adjusted mortality in at least four of the five years between 2007 and 2011. Measurements and Main Results: We conducted 329 hours of direct observation, 196 interviews, and 39 episodes of job shadowing. Data were analyzed using thematic content analysis and a positive-negative deviance approach. We found that high-and lowperforming hospitals differed substantially in their approach to care. High-performing hospitals actively promoted interdisciplinary communication and coordination using a range of organizational practices, including factors related to leadership (e.g., leaders who communicate a culture of quality improvement), staffing (e.g., lower nurse-to-patient ratios and ready availability of psychologists and spiritual care providers), care protocols (e.g., specific yet flexible respiratory therapy-driven weaning protocols), team meetings (e.g., interdisciplinary meetings that include direct care providers), and the physical plant (e.g., large workstations that allow groups to interact). These practices were believed to facilitate care that is simultaneously goal directed and responsive to individual patient needs, leading to more successful liberation from mechanical ventilation and improved survival. Conclusions: High-performing long-term acute care hospitals employ several organizational practices that may be helpful in improving care for patients receiving prolonged mechanical ventilation.
This project investigates the relationship between autochthonous people and immigrants in a valle... more This project investigates the relationship between autochthonous people and immigrants in a valley of southern Ecuador, specifically in terms of climate change and related moves toward sustainable development. The landscape and environment are frequent topics of conversation, especially concerning the increasingly dry climate. Engagements between individuals often result in dynamic relationships in which people take active steps to curtail human impacts, such as developing new land-use and livelihood strategies. Southern Ecuador has historically experienced the effects of periodic drought, and land degradation is exacerbating the problem. This and other factors, including the relative isolation and lack of rural development in Loja province and the overall economic situation in Ecuador, has resulted in large-scale migration of Ecuadorians from the province of Loja. Paradoxically, the valley in which fieldwork was carried out is also known as the Valley of Longevity and has attracted immigrants from various other countries. Some of these expatriates have lived in the valley for long periods of time and have developed working relationships with Ecuadorians that have proved beneficial in terms of development. This dissertation is the result of 13 months of ethnographic fieldwork that included participant observation, formal and informal interviews, and the analysis of written materials. The project focused specifically on how the local-nonlocal relationship impacts livelihoods, land use change, sustainability, and the perception of and attention to issues surrounding climate change. These themes help us to understand the distributional consequences of changes in agri-food systems, and have led to concern over where food is going to come from because, as some informants have said, “no podemos comer billetes” (we can’t eat dollar bills). Research shows that the social heterogeneity of the valley fosters mutual learning and benefits and contributes to more varied views of the natural environment and of the use of natural resources. This project demonstrates how responses to climate change and land degradation may be integrated into emerging sustainable development strategies, particularly important because human activity will both drive and mediate the impact of climate change during the next century.
Ethics in the Field: Contemporary Challenges, an edited volume by Jeremy MacClancy and Agustín Fu... more Ethics in the Field: Contemporary Challenges, an edited volume by Jeremy MacClancy and Agustín Fuentes, brings together eleven contributions from researchers across the US, UK, and Japan, drawing from anthropology, behavioral ecology, and sociology. It illustrates well that ethical issues often cannot be anticipated. Many times, there are ethical concerns relevant to the particular context that do not become apparent until the research has commenced. It also refers to research that was done both before and after the mid-1990s, when formalized university ethics approval became a requirement. Before this time, there were only disciplinary guidelines on ethical practice.