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Despite growing recognition of the need for qualitative methods in health services research, there have been few attempts to define quality standards for assessing the results. This article acknowledges the desirability of a plurality of standards. However, it is argued that three interrelated criteria can be identified as the foundation of good qualitative health research: interpretation of subjective meaning, description of social context, and attention to lay knowledge. These criteria can be examined in relation to different dimensions of any research report, including theoretical basis, sampling strategy, scope of data collection, description of data collected, and concern with generalizability or typicality. But if the concern is with the appropriateness of care and with understanding the factors that shape lay and clinical behavior, then these criteria must form the basis of a hierarchy of qualitative research evidence.
This article reports one aspect of a phenomenological study that described the lived experience of mothering a child hospitalized with acute illness or injury. The significance for mothers that nurses do the 'little things' emerged in considering the implications of this study's findings for nurses in practice. Seven mothers whose child had been hospitalized in the 12 months prior to the first interview agreed to share their stories. The resulting data were analysed and interpreted using van Manen's interpretation of phenomenology. This description of mothering in a context of crisis is useful in the potential contribution it makes to nurses' understanding of mothers' experience of the hospitalization of their children. It supports the philosophy of family-centred care and highlights the ability of individual nurses to make a positive difference to a very stressful experience by acknowledging and doing 'little things', because it is the little things that matter to the mothers of children in hospital.
A radiological study has been made of the colon in 64 human fetuses between 11 and 20 weeks gestation (64-160 mm crown rump (CR) length). A dynamic picture of colon development was obtained from analysis of the radiographs. The findings challenge textbook descriptions, but can be interpreted in terms of the ultimate morphology of the colon. According to the morphology of the proximal (pre-splenic) part of the colon, there are three types of colon. In Type 1 it lies transversely, in Type 2 it is oblique in direction, and Type 3 has a postnatal form with ascending and transverse elements. Although the Type 1 predominates in smaller fetuses and the type 3 is most common in larger fetuses, there is some overlap in their distribution. The ileocaecal junction does not descend, but actually slightly ascends as the fetus grows. The splenic flexure grows in a distinctly cranial direction, and at almost three times the rate of the ileocaecal junction. Thus, as the fetus develops, the ileocaecal junction and splenic flexure grow further apart, and this determines the change from a Type 1 to a Type 2 colon. The divergence of the ileocaecal junction and splenic flexure appears to be related to different rates of growth in the colon, the distal (post-splenic) part growing almost half as fast again as the proximal (pre-splenic) part. The more mature (Type 3) form of colon appears to result from conversion of the Type 2 following early adhesion between the proximal colon and the second part of the duodenum.
The aim of the RNA Ontology Consortium (ROC) is to create an integrated conceptual framework-an RNA Ontology (RO)-with a common, dynamic, controlled, and structured vocabulary to describe and characterize RNA sequences, secondary structures, three-dimensional structures, and dynamics pertaining to RNA function. The RO should produce tools for clear communication about RNA structure and function for multiple uses, including the integration of RNA electronic resources into the Semantic Web. These tools should allow the accurate description in computer-interpretable form of the coupling between RNA architecture, function, and evolution. The purposes for creating the RO are, therefore, (1) to integrate sequence and structural databases; (2) to allow different computational tools to interoperate; (3) to create powerful software tools that bring advanced computational methods to the bench scientist; and (4) to facilitate precise searches for all relevant information pertaining to RNA. For example, one initial objective of the ROC is to define, identify, and classify RNA structural motifs described in the literature or appearing in databases and to agree on a computer-interpretable definition for each of these motifs. To achieve these aims, the ROC will foster communication and promote collaboration among RNA scientists by coordinating frequent face-to-face workshops to discuss, debate, and resolve difficult conceptual issues. These meeting opportunities will create new directions at various levels of RNA research. The ROC will work closely with the PDB/NDB structural databases and the Gene, Sequence, and Open Biomedical Ontology Consortia to integrate the RO with existing biological ontologies to extend existing content while maintaining interoperability.
We have reviewed the literature on the anatomy of the posteromedial peripheral ligamentous structures of the knee and found differing descriptions. Our aim was to clarify the differing descriptions with a simplified interpretation of the anatomy and its contribution to the stability of the knee. We dissected 20 fresh-frozen cadaver knees and the anatomy was recorded using video and still digital photography. The anatomy was described by dividing the medial collateral ligament (MCL) complex into thirds, from anterior to posterior and into superficial and deep layers. The main passive restraining structures of the posteromedial aspect of the knee were found to be superficial MCL (parallel, longitudinal fibres), the deep MCL and the posteromedial capsule (PMC). In the posterior third, the superficial and deep layers blend. Although there are oblique fibres (capsular condensations) running posterodistally from femur to tibia, no discrete ligament was seen. In extension, the PMC appears to be an important functional unit in restraining tibial internal rotation and valgus. Our aim was to clarify and possibly simplify the anatomy of the posteromedial structures. The information would serve as the basis for future biomechanical studies to investigate the contribution of the posteromedial structures to joint stability.
The age-time patterns of excess cancer risk among A-bomb survivors followed up by the Radiation Effects Research Foundation inevitably carry implications regarding the mechanisms of radiation-related cancer. It has recently been found, quite surprisingly and in contrast to impressions given by the relative risks, that for most solid cancers the excess incidence rates themselves depend very little on age at exposure or time since exposure, but mainly on attained age. This paper investigates a mechanistic model that conforms to these age-time patterns. The essence of the model, which is highly idealized, is that: (a) a cancer is caused by mutations that accumulate in a stem cell throughout life, essentially the Armitage-Doll multistage model, and (b) radiation is a general mutagen that can cause virtually any of these mutations. Although postulate (b) departs from previous modeling considerations, the extent to which it explains various aspects of the data in substantial detail is remarkable. A strength of the model is that, similarly to the Armitage-Doll multistage model but differently from many others, it predicts characteristic age-time patterns of excess rates rather independently of its parameter values. The consequence of (a) is that, in Armitage-Doll fashion, background rates increase throughout life as a power of age. The consequence of (b) is that excess absolute rates do not depend on age at exposure and increase with age to a power one less than that of the background rates. Thus the excess relative risk, which is the ratio of these rates, decreases throughout life as 1/age with no dependence on age at exposure. Although this age pattern of relative risks corresponds closely to the RERF data for solid cancer, the interpretation of such a description is quite different from the usual one in which age at exposure plays a primary role.
On each trial a target object and a fragment of the target (or a control stimulus) were presented briefly enough to be integrated together. The stimuli were masked, and identification accuracy was measured. The fragments were large or small in size scale, and were presented early in processing (fragment before target) or late in processing (fragment after target). When presented early, large-scale fragments tended to facilitate identification more than small-scale fragments, but when presented late, small-scale fragments facilitated more than large-scale fragments. Facilitation effects from common feature fragments supported the idea of a spatiotemporal dependency, in which the efficiency of processing a piece of information depends on other pieces of information that have been processed. This is a strong type of global-to-local processing and can be interpreted within a structural description framework.
OBJECTIVE: Variation in dental service provision over time has been related to changes in factors such as oral health and demographics. Dentist factors such as age and cohort effects are also potential sources of influence. The aim of the study was to examine the operation of age, period, and cohort factors on variation in service rates. BASIC RESEARCH DESIGN: data were collected by a mailed survey of a random sample of 10% of male and 40% of female dentists from each state/territory of Australia in 1983-84, 1988-89. and 1993-94 with response rates of 73, 75 and 74% respectively. MAIN OUTCOME MEASURES: Data on main areas of service were obtained from a log of service items provided on a typical day. RESULTS: Poisson regressions of rates for the 10 main areas of service over time showed increased rates over the study period for diagnostic, preventive, endodontic, crown and bridge, general/miscellaneous and orthodontic services, and decreased rates of prosthodontic services. Goodness-of-fit tests indicated that models for periodontal and endodontic services had a good fit. However, only endodontic services were readily interpretable in terms of descriptive trends. While the age-period-cohort model was preferred, age-period and age-cohort models were also examined because of problems of identification with age-period-cohort models. Endodontic rates were higher among younger dentist birth cohorts, and increased over the 10-year study period for most cohorts of dentists. CONCLUSIONS: If these effects for dentist cohorts were extrapolated over the next 10-year interval, the distribution of services would alter, with endodontic services emerging as a dominant area behind restorative, diagnostic, and preventive services.
The purpose of this study was to examine individual determinants of use of publicly funded home-care nursing and housework assistance by Canadians 18 years and older from 1994 to 1999. Andersen and Newman's Behavioural Model of Health Services Use guided the selection of variables, analyses, and interpretation of the findings. Descriptive, correlation, and multiple logistic regression analyses were completed in each of the first 3 cross-sectional cycles of Statistics Canada's National Population Health Surveys. The determinants of use of housework assistance were older age, female, living alone, lower income, activity restriction, needing help with housework, not hospitalized in the previous year, and having at least 1 chronic condition. The determinants for home nursing tended to be the opposite of those for housework assistance. Between 1994 and 1999, use of housework assistance appeared to decrease and use of nursing services appeared to remain relatively stable. The findings underscore the need to target these 2 discrete subgroups of home-care users and ensure that funding is directed at support services as well as nursing services.
INTRODUCTION: Geography is considered a determinant of health because people living in rural and remote areas, compared with those in urban areas, have poorer health status and more difficulty accessing health care. PURPOSE: To examine the characteristics associated with the use of publicly funded home care services among rural and urban Canadians 18 years of age and over. METHODS: The Andersen and Newman Behavioural Model of Health Services Use guided the selection of variables, analyses and interpretation of the findings. Descriptive, correlation and multiple logistic regression analyses were completed on 2 cross-sectional cycles of Statistics Canada's National Population Health Surveys. RESULTS AND CONCLUSION: This research revealed that rural residents are increasingly less likely to receive personal care assistance, and rural home care users appear to have more resources (e.g., higher levels of education, sense of coherence) that likely influence their ability to access and receive home care services, than their urban counterparts. Rural residents without these resources may be less likely to receive home care services.
OBJECTIVE: The purpose of this study was to assess the effectiveness of the Aquaflex Gel Pad in the transmission of acoustic energy. DESIGN AND SETTING: This was a comparative study that utilized descriptive statistics for result interpretation. The independent variables included ultrasound intensity, interposed materials, and trials. The dependent variable was peak-to-peak voltage output recorded via an oscilloscope. The study was conducted in a ventilated research laboratory. MEASUREMENTS: Three trials were conducted with six combinations of material interposed between a conducting (1 MHz) and a receiving sound head. The interposed materials were as follows: 1) ultrasound gel, 2) gel plus a gel pad, 3) gel plus a gel pad and pig tissue sample (0.90 cm of subcutaneous fat), 4) gel plus a gel pad and a pig tissue sample (1.8 cm of subcutaneous fat), 5) gel plus thin pig tissue sample, and 6) gel plus thick pig tissue sample. Each interposed material combination was tested at the intensities (W/cm(2)) as follows: 0.10, 0.25, 0.50, 1.00, 1.50, and 2.50. RESULTS: The gel pad proved to be an efficient couplant in the delivery of high-frequency acoustic energy. Using ultrasound gel as the base line (100% transmissivity) it was concluded that the gel pad transmitted more acoustic energy at every intensity except at 0.1 W/cm(2). The gel pad used with the two thicknesses of subcutaneous fat gave comparable results. Gel used with the two thicknesses of subcutaneous fat yielded results that warrant further investigation. CONCLUSIONS: I believe gel pads are a practical choice for clinical applications of ultrasound over uneven surfaces. The reusable gel pads offer the clinician a convenient and reliable method for delivering ultrasound energy to the patient. I believe it is preferable to use the gel pad with ultrasound gel directly applied to the patient and at the sound head-gel pad interface as opposed to using the traditional water bath immersion method.
By means of the conscription data of the Austrian Army the variability of the height of 18 years old men from the age-classes 1962 and 1964, who come from three different Austrian provinces (Vienna, Niederösterreich and Burgenland) was analysed. In spite of the extensive data material it was nearly impossible to establish a causal interpretation beyond a pure description, because too many external additional informations are lacking. In all the three provinces a definite trend of acceleration was ascertained. Known social-anthropological facts could as well be confirmed, like the dependency of the height from school education in all the three provinces.
A leading lamella is part of every translocative cell, irrespective of nature and origin. The morphological aspect of this cytoplasmic extension, however, varies and, among the different cell types, locomotive blood cells show the greatest diversity with regard to position, size and shape. In this communication, SE micrographs of benign and malignant blood cells of different classes are presented. The dynamic interpretation attempted for the description of the static photographs is based on analyses of time-lapse films which show the activities of the live cells.
The current practice of monitoring brain electrical activity with single channel recordings during ECT induced seizures does not meet contemporary EEG standards. Multichannel recordings are essential for artifact identification, determination of seizure endpoint, and assessment of electrophysiological features in different brain regions. Careful attention to technical aspects and detailed descriptions are important for interpretation and for scientific communication. Standardized procedures for EEG monitoring during ECT should be developed for general clinical use and for research and training applications.
A rise in the number of adenocarcinomas of the lung and a fall in squamous cell carcinomas are seen in Denmark since 1978; a change based on a growing number of lung cancers among women with an excess of adenocarcinomas. A fall in the frequency of autopsies in Denmark will entail the loss of an essential control of the quality of diagnosis of lung cancer, primary or secondary, and make future descriptive studies difficult to interpret. The validity of morphologic diagnosis of lung cancer as recorded by the Danish Cancer Registry during 1943-1986 was assessed. We extracted a stratified random sample of 5% of all recorded cases prior to 1978, these were then recorded according to the ICD-O classification. Cases after 1978 were originally coded in the Registry according to ICD-O, here we checked the coding against the original reports. The information on morphology prior to 1978 was too inprecise to merit evaluation of trends and proportionate distributions by morphology. After 1978 data was adequate, and after 1983 very precise.
BACKGROUND: Lyme borreliosis is not usually diagnosed in Spanish patients since before 1987. The aim of this study was to know the clinical spectrum of infection by Borrelia burgdorferi in Spain by a prospective epidemiologic study. METHODS: The period of collection of cases was from 1987 to 1989 and the follow-up period was of 2 years following diagnosis. Detection of serum antibodies was performed by indirect immunofluorescence and ELISA to patients with clinical suspicion of Lyme borreliosis established in 17 Spanish hospitals. The clinical and serologic data and the possibility of other disease which could justify the symptoms were evaluated with the doctor responsible for the patient. RESULTS: Fifty-four patients with clinical manifestations and serologic data indicative of the disease and in whom other diagnosis were excluded were detected. Other diseases which could be the cause of the symptomatology were diagnosed in 26 patients with positive serology. Sixty-three percent of the patients had neurologic symptoms, 46% articular symptoms, 44% cutaneous symptoms and 9% cardiac symptoms. CONCLUSIONS: Lyme borreliosis is not exceptional in Spain. Its clinical spectrum may be situated half way between American and European epidemiologic descriptions. Serology must be interpreted by the clinical manifestations.
The purpose of this research was to conduct a study of the art of caring in nursing administration. By means of a phenomenologic-hermeneutic approach, the caring experiences of six nurse administrators were revealed and analyzed. Essential themes emerged from their descriptions of their experiences. Interpretation of the data served as the lens through which the expressions of the art of caring related to archetypical philosophies of art: living form, imitation, and expression. An ethical theory, Existential Authenticity, was uncovered as the unity of meaning of nursing administrative caring art. This unity of meaning embodied statespersonship, which was viewed by Plato as the highest form of art. Implications for the transformation of nursing administrative practice as an ethical caring enterprise by the manifestation of statespersonship are presented.