Understanding life experiences through a phenomenological approach to research.
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Anecdotes as Topic↗
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Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
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Designing a quality assurance system for dietary data in a multicenter clinical trial: Women's Intervention Nutrition Study.
Reliable dietary intake data are essential for determining outcomes in nutrition-related clinical trials. Nevertheless, systems for quality assurance of dietary intake data are often slighted in the design of such trials and not incorporated or monitored as the trials continue. The Women's Intervention Nutrition Study (WINS), a multicenter clinical trial investigating the effect of reduction of dietary fat intake together with adjuvant systemic therapy on recurrence rates in and survival of postmenopausal women with early stage, surgically treated, breast cancer, has developed a quality assurance system to minimize errors and to produce data that are complete and reliable. The system involves development of standardized procedures for data collection, a quality control program to evaluate the data collected, and continual monitoring and reevaluation. The WINS system is offered as a model for studies collecting dietary intake data, no matter how simple or complex the trial design.
Clinical Trials as Topic↗
Pregnancy, parenthood, and family leave during residency.
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Adaptation, Psychological↗
Life history: a qualitative method of research.
The life-history method of qualitative research is an alternative to empirical methods for identifying and documenting health patterns of individuals and groups. It allows the nurse researcher to explore a person's microhistorical (individual) experiences within a macrohistorical (history of the time) framework. Life-history information challenges the nurse to understand an individual's current attitudes and behaviours and how they may have been influenced by initial decisions made at another time and in another place. This paper describes a new direction in nursing research and identifies specific steps for using the life-history approach.
Autobiographies as Topic↗
Evaluation of American Cancer Society elementary school public education programs.
A comprehensive evaluation of two American Cancer Society (ACS) curriculum programs, An Early Start to Good Health (grades K-3) and Health Network (grades four-six), was conducted to assess the impact of the materials on student health knowledge, attitude, and behavior and to determine procedures and practices employed by teachers in utilizing the materials. The materials were tested with 26 classroom teachers and 660 children in grades K-6, and the material utilization practices of an additional 356 teachers in 27 schools were examined. Findings from the evaluation suggest that the two programs are effective in promoting child health education, but questions were raised concerning the ACS requirements for teacher training and the Usage Report Card system of documentation.
Adult↗
Audit in general practice: factors influencing participation.
OBJECTIVE: To identify the factors influencing participation in a single topic audit initiated by a medical audit advisory group. DESIGN: Interview and questionnaire survey of general practitioners who had been invited to take part in an audit of vitamin B-12. SETTING: All 147 general practices in Leicestershire. MAIN OUTCOME MEASURES: Aspects of structure, attitude, and behaviour that influenced participation or non-participation. RESULTS: 75 practices completed the audit, 49 withdrew after initial agreement, and 23 refused to take part at the outset. Participants were more likely than those who refused to view the advisory group as useful or a threat and to have positive thoughts about audit but less likely to have previously undertaken audit entailing implementation of change. Participants were more likely than those who withdrew to have positive thoughts about audit and to have discussed whether to take part within the practice but were less likely to view the advisory group as useful. The most common reason given for withdrawal was lack of time. CONCLUSIONS: Participation was influenced by attitudes towards audit in general and the advisory group in particular and by aspects of behaviour such as communication within the practice. Practical support and resources may help some practices undertake audit, but advisory groups must also deal with attitudes and unsatisfactory communication in practice teams.
Anemia, Pernicious↗
Age and patterns of HMO satisfaction.
Consumerism and increasing complexity in health care options highlight the importance of health care satisfaction. Patterns and sources of satisfaction are assessed for health maintenance organizations (HMOs), a relatively novel option, using national survey data. Particular attention is paid to age differences, because HMO Medicare coverage is a recent development and older people generally express little HMO familiarity or receptivity. Higher satisfaction is expressed by HMO members than by nonmembers for both younger and older persons. HMO satisfaction is higher for older than for younger members, a pattern at odds with nonmember attitudes about HMOs. Member satisfaction is a function of the nature of patient/provider ties and related attitudes, as it is among nonmembers. Importance of a "regular" provider is particularly evident among older HMO members. Patterns of HMO satisfaction among older members likely reflects both cohort differences and age-associated patterns of health and related attitudes.
Adult↗
Clinicians into management: the experience in context.
This paper interprets the experience of a sample of 60 clinicians becoming involved in formal management, mainly at hospital unit level, in the historical context of changing health service organisation. This includes the introduction of managerialism and the evolution of the NHS into a structured network based around purchaser/provider relationships. The conclusion is that these clinicians are becoming involved in management, and making the personal and social adjustments necessary for this, but in a way that leaves medical culture, and their allegiance to it, at the present largely intact. This is achieved largely through the organisational mechanism of clinical directorates, which promise to function as professional groups from the clinical point of view and as business units from the managerial perspective. An argument is put forward, based on a theoretical view compatible with the data from the clinicians' experience, that this mode of medical involvement in management may operate without undue conflict in the longer term if: (a) clinicians accept the degree of local professional regulation that this model applies; and (b) the conflict between medical need and available resource can be dealt with elsewhere in the system without passing it back to hospitals and clinical directorates. On the other hand it is possible that conflict will increase if the consequences of management control systems and objectives percolate down through the management hierarchy and cross into the medical domain, via clinical directorates.
Career Mobility↗
Qualitative research and the question of rigor.
In this article, the authors discuss the issue of rigor in relation to qualitative social research. It takes a critical focus on the inadequacy of applying a quantitative concept of rigor to evaluate qualitative research. Informed through the researchers' own experience, suggestions are made for a concept of rigor that meets the needs of qualitative research more adequately. Incorporating a notion of ethics, the authors develop a cluster of terms around which they argue that qualitative research can meaningfully speak about rigor: attentiveness, empathy, carefulness, sensitivity, respect, reflection, conscientiousness, engagement, awareness, and openness.
Anecdotes as Topic↗
Integration of theory, practitioner standards, literature findings, and baseline data: a case study in planning breast self-examination education.
Delineation of the planning process necessary for designing sound education programs aimed at changes in health behavior continues to be a primary concern of health educators. Careful planning will ultimately maximize the application of existing evidence and identify areas in need of further research and evaluation. This paper discusses the preliminary and refinement planning phases involved in the design of an educational program for a three-year breast self-examination demonstration/evaluation project. The initial phase involved review of empirical data of previous studies, and application of behavioral science theory and standards of professional practice. The refinement phase involved the application of results from a community diagnostic baseline survey of the target population. Factors found to correlate with BSE practice were integrated into the educational strategies: group sessions in classes and informal workshops, a breast exam clinic, and mass media activities.
Breast↗
Health education's new frontier in addressing corporate influences on health: an interview with Nicholas Freudenberg.
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Health Education↗
Embodied metaphor in women's narratives about their experiences with cancer.
Many scholars and medical professionals argue over the importance of metaphor in thinking about, and speaking of, cancer and other illnesses. Our study presents an analysis of the metaphors used by 6 women in their narratives of their experiences with cancer. We claim from our analyses that metaphorical talk about cancer reflects enduring metaphorical patterns of thought. Women used multiple, sometimes contradictory metaphors to conceptualize their complex cancer experiences. Many of their metaphors used to understand cancer are actually based on ordinary embodied experiences such that people still refer to the healthy body in trying to understand cancer even when their own bodies have been disrupted. We discuss the importance of our findings for understanding the relation between language and thought in regard to human illness.
Adult↗
Lead exposure and child behavior.
OBJECTIVES: Unlike cognitive impairments associated with lead exposure, lead-associated child behavior problems have been difficult to specify, particularly in young children. METHODS: The Child Behavior Checklist (CBCL) and the Center for Epidemiologic Studies Depression Scale were used as the outcome and confounding variables, respectively, of major interest. These measures were examined with respect to blood lead levels of 201 African-American children aged 2 through 5 years. RESULTS: In comparison with the low exposed group, the high exposed group (two consecutive blood lead levels greater than or equal to 15 micrograms/dL) had a significantly higher mean CBCL Total Behavior Problem Score (TBPS) and Internalizing and Externalizing scores; when other factors, including maternal depressive symptomatology, were controlled for, regression procedures indicated a .18-point TBPS increase for each unit increase in lead and a 5.1-point higher TBPS in the high exposed group; children in this group were 2.7 times more likely to have a TBPS in the clinical range. CONCLUSIONS: Through its use of a standardized parent-report measure of behavior and its consideration of maternal morale in multiple linear and logistic regression procedures, this study provides further evidence of lead's detrimental effect on child behavior at levels typical of present-day exposure.
Academies and Institutes↗
Hospital image and the positioning of service centers: an application in market analysis and strategy development.
The research confirms the coexistence of different images for hospitals, service centers within the same hospitals, and service programs offered by each of the service centers. The images of individual service centers are found not to be tied to the image of the host facility. Further, service centers and host facilities have differential rankings on the same service decision attributes. Managerial recommendations are offered for "image differentiation" between a hospital and its care centers.
Adult↗
Achieving the top: women in management.
Because of its unique structure, the health-care industry can take the lead in creating a responsive organizational environment where women can achieve top-level positions. This requires greater flexibility from both the organization and the individual. This article examines gender-related obstacles (e.g., a male-defined workplace and the inability of women to divorce themselves from family responsibilities) to career advancement and suggests some options to eliminate and overcome these obstacles (e.g., compressed and flexible time and mentoring).
Career Mobility↗
Professor Harold Risk on post-accident interviews.
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Accidents↗
Assessing the impact of community health information networks: a multisite field study of the Wisconsin Health Information Network.
Community health information networks (CHINs) have emerged as a promising new technology to generate cost reductions and support change in the health care industry. The proliferation of CHINs has been thwarted, however, by a conspicuous lack of evidence to support the claims of enhanced efficiency and effectiveness from CHIN participation. A recent study of the Wisconsin Health Information Network, the nation's first fully functioning CHIN, documents the benefits of this emerging technology. The findings reveal the potential for significant cost savings via electronic transmission of patient clinical and administrative information as well as enhancement of the quality of patient care.
Community Networks↗
Structural change in academic health centers.
In response to opportunities and threats in their environments, academic health centers (AHCs) are making important changes in their structure. Several AHCs have legally separated their university hospital from the university. In contrast, other AHCs are linking the university hospital more closely to the medical school by concentrating authority for key decisions in the office of an AHC executive. This article draws from a national study of AHCs and examines the advantages and disadvantages of such changes in AHC structure. An important reason for these changes is maximizing revenues from patient care; an important consequence is the increased salience of patient care among the multiple purposes of AHCs.
Academic Medical Centers↗