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PubMed2002

Too many choices? Hospital and community staff reflect on the future of prenatal screening.

Promoting informed choice is commonly recognised as the chief purpose and benefit of prenatal screening, its very presence being viewed as a key way in which the process can be distanced from eugenics. As the number of conditions and features which can potentially be screened for rises, dilemmas about how to achieve informed choice can only increase. Seventy hospital and community staff working in or attached to two English hospitals were interviewed individually on topics which included their views on genetic developments and moral beliefs and values, and how these affected their daily work. The majority then took part in small discussion groups led by an ethicist. The research identified a paradox. On the one hand, participants recognised the centrality of informed choice to prenatal screening, although they had many doubts about whether it could be achieved. On the other hand, most saw the expansion of screening, which might further compromise informed choice, as an inevitable and inexorable process over which they had little, if any, control. This was despite the fact that many of them decided, managed or implemented prenatal screening policies within their hospitals. The paper explores the factors which staff themselves identified as responsible for this perceived inevitable expansion. It then discusses more generally how the expansion of medical technologies can appear as inexorable to those involved. Finally, the paper calls for more inclusive, integrated and collaborative debate and research around the whole area of prenatal screening. This is to ensure that as far as possible, the wider consequences and implications of any proposed expansion to prenatal screening-both the promises and the potential side-effects-are debated ahead of their implementation, and also to help ensure that public policy represents and serves contemporary society.

Attitude of Health Personnel↗
PubMed1999

Defecation practices of young children in a Peruvian shanty town.

Little is known about feces disposal practices, their determinants and feasibility for change, despite their importance in the control of diarrheal diseases. We report here the results of formative research for the development of an intervention to promote sanitary disposal of feces of young children. The study was conducted in a densely populated shanty town area of Lima, where water and sanitation systems are scarce. In-depth interviews were undertaken with mothers, husbands and community leaders. Group discussions were held with mothers in order to validate findings from the interviews, investigate particular topics further and explore reactions to possible intervention strategies. The principal defecation sites for young children were diapers, potties, the ground in or near the home, the hill, latrines and flush toilets. The main determinants found were the age of the child, the effort required by the method, perceptions of dirtiness and the availability of resources. Almost all children under one year of age use diapers but the high resource cost of diaper washing is a strong motivation for mothers to move their children on as early as possible. Potties were considered the most socially acceptable and 'hygienic' defecation method for children between one and three years of age. Nevertheless, defecation directly onto the ground is common at this age. Potty training is deemed to be quite difficult and the long term achievements are determined by the initial training success. In most cases, the training process is authoritative and inconsistent. The use of latrines and flush toilets is not considered appropriate for children until they are three to four years old. Based on these initial findings, a micro-trial was conducted to assess the feasibility and acceptability of promoting greater use of potties and associated practices. The results of the trial were very encouraging and provided valuable information for the design of a community-wide intervention. Our findings help explain why the emphasis given in most sanitation projects, where efforts have been concentrated on the promotion of latrines, has failed to induce their utilization by small children. Sanitation projects should incorporate interventions that will promote hygienic defecation and stool clearance practices for infants and small children.

Child↗
PubMed2006

Qualitative evaluation of a form for standardized information exchange between orthopedic surgeons and occupational physicians.

BACKGROUND: Both occupational physicians and orthopedic surgeons can be involved in the management of work relevant musculoskeletal disorders. These physicians hardly communicate with each other and this might lead to different advice to the patient. Therefore, we evaluated a standardized information exchange form for the exchange of relevant information between the orthopedic surgeon and the occupational physician. The main goals of this qualitative study are to evaluate whether the form improved information exchange, whether the form gave relevant information, and to generate ideas to further improve this information exchange. METHODS: The information exchange form was developed in two consensus meetings with five orthopedic surgeons and five occupational physicians. To evaluate the information exchange form, a qualitative evaluation was set up. Structured telephone interviews were undertaken with the patients, interviews with the physicians were face-to-face and semi-structured, based on a topic list. These interviews were recorded and literally transcribed. Each interview was analyzed separately in Atlas-Ti. RESULTS: The form was used for 8 patients, 7 patients agreed to participate in the qualitative evaluation. All three orthopedic surgeons involved and three of the six involved occupational physicians agreed to be interviewed. The form was transferred to 4 occupational physicians, the other 3 patients recovered before they visited the occupational physician. The information on the form was regarded to be useful. All orthopedic surgeons agreed that the occupational physician should take the initiative. Most physicians felt that the form should not be filled out for each patient visiting an orthopedic surgeon, but only for those patients who do not recover as expected. Orthopedic surgeons suggested that a copy of the medical information provided to the general practitioner could also be provided to occupational physicians. CONCLUSION: The information exchange form was regarded to be useful and could be used in practice. The occupational physician should take the initiative for using this form and most physicians felt the information should only be exchanged for patients who do not recover as expected. That means that the advantage of giving information early in the treatment is lost.

Adolescent↗
PubMed2006

Satisfaction with mental health services. A user participation approach.

User participation in the delivery and evaluation of mental health services has become an important policy element in the development of these services. An important area where user involvement could be especially useful concerns satisfaction with care, which has become considered an important indicator of service excellence. The overall aim of this study was to investigate user satisfaction with mental health services in a county in southern Sweden. The study design used persons with own experience from being a patient or a close relative to a patient as active participants in the data collection. A group of 20 persons with experience from being users or relatives to users were recruited and trained to be interviewers in the study. Together they performed 227 interviews focusing user satisfaction regarding both inpatient and outpatient care. The interview had one quantitative part and one qualitative part. The interviewers' experiences from participation in the project were evaluated through focus groups. In these groups, the topics were the interviewers' impression of the content of their interviews and their experience from being an interviewer. The analysis showed a high satisfaction with care in the quantitative part. In the qualitative part a significant dissatisfaction with many aspects of the care were expressed. The focus group evaluation largely supported the findings from the analyses of the dataset. Experiences of being user and interviewer were generally positive and perceived as rewarding.

Adult↗
PubMed1997

Automated direct-from-patient information collection for evidence-based diabetes care.

BACKGROUND: Computer-based clinical decision support tools can improve physician performance in ambulatory care settings. Acquiring and entering the patient-specific information necessary to take advantage of this technology, however, can often be a major impediment. OBJECTIVE: To develop and evaluate a self-administered electronic questionnaire for acquiring patient-specific information to be used for generating diabetes-related evidence-based care recommendations. METHODS: An initial paper questionnaire was developed that evaluated current diabetes management, complications, and screening interventions. This was then coded for electronic presentation using software that can also analyze patient responses and produce personal feedback. To evaluate the electronic questionnaire, 47 patients completed it using a small laptop computer and also responded to a personal interview that assessed similar topics. RESULTS: Patients required between 7-29 minutes to complete the questionnaire (mean: 15 min.). For 21 of the 23 topic assessed, the agreement between the electronic questionnaire and the personal interview was 80% or higher. CONCLUSIONS: An electronic, self-administered questionnaire can be used to acquire information for generating patient-specific care recommendations.

Data Collection↗
PubMed2002

HIV medicine after Barcelona conference: interview with Howard Grossman, M.D. Interview by John S. James.

We asked a leading HIV physician to summarize some of the treatment issues that clinicians are now looking at after the Barcelona conference. Topics in this interview include: Tenofovir, including first-line therapy; The shift from protease inhibitors to non-nucleoside RT inhibitors, for many but not all patients; Benefits of once-a-day regimens; Lipodystrophy, and strategies for avoiding or reducing it; Viral resistance testing; T-20; Prevention--including danger of superinfection with a new HIV strain.

Anti-HIV Agents↗
PubMed2001

["However we are different"--research of nursing experience at migrants on the background of a dynamic culture understanding].

At the beginning of this study was the assumption that cultural differences have hardly been taken into consideration in Germany. How do people from a different cultural background experience nursing in German hospitals? The actual relationship with some group of patients from another cultural background in the hospital ward is to be described vividly and properly. Therefore this study is following the applied phenomenology that nursing experience should be examined by problem oriented interviews. The results should be discussed in the context of present-day literature on science of nursing. The dominating topic of the interviews is "being different"-"being foreign". Perception and acceptance of foreign understanding of reality is the starting point for culturally adapted nursing. Professional nursing means individually planned nursing, considering the given context and environment. Therefore professional nurses have to grasp and conduct according to the individual experience of reality of patients.

Cross-Cultural Comparison↗
PubMed2003

A comparison between parents' and therapists' views of their child's individual seating systems.

Children with cerebral palsy are often prescribed adaptive seating systems for use in their wheelchairs for the purposes of improving posture and to help prevent the development of long-term deformity. However, clinical experience indicates that parents and the therapists who advocate the use of these systems do not always agree about the wheelchairs. This study discusses the development of questionnaires for both parents and therapists to measure differences in their opinions about the wheelchairs. The questions were developed through clinical experience, validation was through interviews to discuss topics important to the participants, and repeated application of the questionnaire ensured consistency. The reliability of the questions appears satisfactory and the interview responses demonstrate that the questions selected are important to both groups of stakeholders. However, it was found that parental concerns over their children's seating systems concentrated on functional and day-to-day management issues, whereas therapist concerns focused on technical issues and postural management. Both groups of stakeholders agreed that the questionnaires would be a useful precursor to attending a seating clinic appointment, as it could aid communication between the parent and provider and improve the efficiency and satisfaction of such an appointment. It appears the questionnaire has potential as an outcome measurement tool.

Attitude↗
PubMed1996

Diabetic adolescents' compliance with health regimens and associated factors.

Fifty-one young diabetics responded to a questionnaire concerning compliance and were interviewed on two topics: the meaning of care to the subjects and the nature of their support system. Diabetes control was measured by glycosylated haemoglobin (GHB). Interview data were analysed by continuous comparative analyses. The categories obtained were quantified and the relationship between variables analysed by cross tabulation, chi-square test and discriminant analysis. Those who responded with a good compliance showed good control of diabetes as indicated by GHB values and reported sufficient energy and will-power to implement the health regimens. Those young people who reported that they had sufficient energy and will-power considered care important, received encouragement, felt that care brings well-being and had no fears of complications.

Adolescent↗
PubMed1991

Doctor-patient communication and the quality of care.

In this article a comparison is made between three independent sources of assessment of medical consultations. A panel of 12 experienced general practitioners rated 103 consultations with hypertensive patients on the quality of psychosocial care. There was a wide consensus between the judges, resulting in a high reliability score. Two contrasting groups were formed: consultations that were rated high and those rated low in quality of psychosocial care. A comparison was made between this general assessment of the quality of psychosocial care and a more detailed assessment of the same consultations on nine much used communication variables made by trained psychologists. Knowledge about doctor-patient communication proved to predict very well as to which quality group the consultations belonged. A very high percentage (95%) was predicted accurately, solely on the basis of these nine communication variables. Affective behaviour, and especially nonverbal affective behaviour had the strongest predictive power. In the last part of the study a third source of assessment, i.e. patients' satisfaction was compared with both other sources. Much lower relationships were found, although most were in the predicted direction. Affective behavior seems to be the most important in determining patient's satisfaction. The implications of these findings are discussed.

Adult↗
PubMed2003

Priority setting in a hospital drug formulary: a qualitative case study and evaluation.

Dramatically rising costs for new drugs are posing major challenges for hospital budgets. In response to these pressures, hospitals must set priorities for which drugs they will list on their formularies. While there have been studies relevant to decision making in hospitals regarding drugs, none have described how priority setting for drugs in hospitals is done and evaluated it against a framework of how it should be done. In this paper we describe the process of priority setting for new drugs in a hospital formulary and evaluate it using a leading conceptual framework for healthcare priority setting--Daniels and Sabin's 'accountability for reasonableness'. The findings from this study provide an evidence base for developing strategies to improve this hospital's priority setting regarding its drug formulary. The process we utilized here, describing using case study methods and evaluating using 'accountability for reasonableness', is a generalizable process for improving the fairness of priority setting in hospital drug formularies.

Data Collection↗
PubMed2003

What are the initial perceptions of multidisciplinary personnel new to integrated care pathway development?

Initial perceptions of programmatic shifts are important to gauge if organizational change is to be successful. We used qualitative methods to understand the perceptions of multidisciplinary team members who were responsible for developing integrated care pathways for chronic heart disease in an attempt to improve continuity of care. Members viewed continuity of care as problematic and perceived ICPs as a template for increasing knowledge and enhancing communication. Numerous barriers to ICP use were noted. Information collected in this study may assist others who are developing integrated care pathways.

Canada↗
PubMed1998

Conducting a narrative analysis.

This paper describes the process of narrative analysis as undertaken within a nursing study on scholars and scholarship. If follows an earlier paper titled: Theoretical perspectives on narrative inquiry that described the influencing ideas of Bruner (1987) and Roof (1994) upon the same study. Analysis procedures are described here in sufficient detail for other researchers wishing to implement a similar approach to do so. The process as described has two main components: (A) strategies of 'core story creation' and 'employment'; and (B) issues and dilemmas of narrative analysis, especially relating to rigour. The ideas of Polkinghorne (1988), Mishler (1986), and Labov (in Mishler 1986a) are introduced in so far as they impinge upon the analysis process. These relate especially to the development of key terms, and to the analysis strategies of core story creation and employment. Outcomes of the study in question are termed 'Signposting the lived-world of scholarship'.

Attitude of Health Personnel↗
PubMed2002

Nurse of the year 2002. An interview with Amanda Howarth.

Dawn Freshwater interviews Nurse of the Year (2002) Amanda Howarth and asks her about her work as a Clinical Nurse Specialist in Pain Management where she is using Complementary Therapies to help patients with Multiple Sclerosis cope with chronic pain.

Complementary Therapies↗