Defining moment. Interview by Drew Payne.
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Attitude of Health Personnel↗
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[December 1988: the last interview granted by Francesco Pocchiari. The enormous load of activities].
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History, 20th Century↗
Incidence of fecal and urinary incontinence following radical perineal and retropubic prostatectomy in a national population.
PURPOSE: Since 1991 we have performed more than 300 anatomical radical perineal prostatectomies at Brooke Army and Wilford Hall Medical Centers, and were initially aware of 8 patients who presented with unsolicited postoperative fecal incontinence. We determined the incidence of fecal and urinary incontinence following radical prostatectomy, defined parameters to identify patients at risk for fecal complaints following radical prostatectomy, and estimated the impact of fecal incontinence on lifestyle and activities. MATERIALS AND METHODS: Initially a validated 26-question telephone survey was used to evaluate 227 patients who had previously undergone radical prostatectomy at 1 of our 2 institutions. Based on results of the telephone survey a national survey was mailed to 1,200 radical prostatectomy patients randomly selected from a nationwide database of Department of Defense health care system beneficiaries. All patients had undergone radical perineal or retropubic prostatectomy at least 12 months before being contacted for the survey. RESULTS: Responses to the telephone survey from 227 patients revealed that fecal incontinence was a problem after radical retropubic (5%) and perineal (18%) prostatectomy and less than 50% of those with fecal incontinence had told the physician. Our mail survey (response rate 80% and 78% usable for analysis, 784 radical perineal and 123 perineal) strongly indicated that fecal incontinence after radical prostatectomy is a problem nationwide. Frequency of fecal incontinence (daily, weekly, monthly or less than monthly occurrences) was significantly higher among radical perineal (3, 9, 3 and 16%) compared to retropubic prostatectomy (2, 5, 3, and 8%) patients (p=0.002). Fecal incontinence had a significant negative effect on patient social or entertainment activities (p=0.029), and travel and vacation plans (p=0.043). Radical perineal compared to retropubic prostatectomy patients were more likely to wear a pad for stool leakage (p=0.013), experienced more accidents (p=0.001), had larger amounts of stool leakage (p=0.002) and had less formed stools (p=0.001). Of radical perineal prostatectomy patients only 14% and of retropubic only 7% with fecal incontinence had ever told a health care provider about it, even when the incontinence was severe. Responses to our survey concerning urinary incontinence showed that radical perineal prostatectomy patients had a lower rate of urinary incontinence immediately after prostatectomy compared to retropubic (79 versus 85%, p=0.043). A higher proportion of perineal patients reported that all urinary leakage had ceased, that is full continence had returned (perineal 70%, retropubic 53%, p=0.001). A smaller proportion of perineal patients found it necessary to wear a pad to protect from urinary incontinence (perineal 39%, retropubic 56%, p=0.004). CONCLUSIONS: Fecal incontinence following radical prostatectomy occurs more frequently than previously recognized. In general fecal incontinence among radical perineal and retropubic prostatectomy patients surpasses the expected incidence rate of 4% for this age group (60 to 70 years) but incidence is significantly higher for radical perineal prostatectomy patients. However, radical perineal prostatectomy patients have a significantly lower incidence of urinary incontinence than those treated with retropubic prostatectomy. Surgeons who perform radical retropubic and perineal prostatectomy should be aware of the possibility of fecal and/or urinary incontinence and associated symptoms.
Activities of Daily Living↗
Sample extensiveness in qualitative nutrition education research.
OBJECTIVE: Extensiveness represents the amount of information gathered in qualitative research. This study examined sample extensiveness in qualitative nutrition education research. DESIGN: Retrospective analysis was performed on articles published in the Journal of Nutrition Education (JNE) from 1969 to 1999 (Volumes 1 to 31). SUBJECTS: Content analysis was used to code articles and the studies they reported as units of analysis. OUTCOME MEASURES: Articles were coded to determine whether they included one or more studies using qualitative research and, if so, the types of qualitative studies performed, the sample extensiveness of each study, and mention of sample extensiveness limitations in the article. STATISTICAL ANALYSES: The statistics used were univariate (counts, percentages, means, medians, modes, ranges) and bivariate (chi-square, correlations). RESULTS: Of the published JNE articles, 71 (8%) used qualitative methods, and most (85%) qualitative articles were published in the 1990s. Some (19%) of these articles reported using multiple qualitative methods. The 30 studies using individual interviews interviewed an average of 45 people (range 15-155). The 38 studies using group interviews averaged 15 groups (range 1-180) and 141 people (range 9-900). Ten studies used observation/fieldwork, and eight used other types of qualitative research, with mixed [corrected] patterns of sample extensiveness in those studies. Few articles made specific statements about limitations based on sample extensiveness. IMPLICATIONS: Sample extensiveness in qualitative research in JNE varied considerably. Future qualitative research would benefit from more explicit attention to sample extensiveness.
Adult↗
A process model to guide selection of essential curriculum content.
The purpose of this qualitative study was to develop and test the usefulness of a process model to identify guidelines for selecting essential content in undergraduate nursing curricula from nursing and related disciplines. The study was designed to test the usefulness of the model. Usefulness was determined by evaluating the operationalization of the model and the product resulting from operationalization of the model. The criteria of practicality, purposiveness, realism, and judiciousness were used. The model consists of four steps. In Step 1, the content area is delineated. Step 2 consists of a review of the literature of both disciplines. Analysis and synthesis of this information results in guidelines, stated in conceptual terms and accompanied by brief rationale, for essential content. In Step 3, educators and clinicians are interviewed to determine reliability and validity of the guidelines. In Step 4, guidelines are revised based on comments obtained in Step 3. Operationalization of the model using nutrition content resulted in five content and three process guidelines. Both the process described by the model and the guidelines which resulted from that process were evaluated as useful. Suggestions for future research using the model are made.
Curriculum↗
A narratological methodology for identifying archetypal story patterns in autobiographical narratives.
Based on Jung's definition of archetype the concept 'archetypal story pattern' is developed as well as a research method drawing on narrative analysis and biographical research to identify these archetypal story patterns in life stories. Jung pointed out that personal myths, archetypal patterns found, e.g., in mythology, can govern the life course of individuals unconsciously. In the Theory of Narrative Identity comparable concepts have been mentioned but were never fully developed. In my research I try to combine Jung's concept of the archetype with the elaborated methodology of narrative analysis. Archetypes can manifest as narratives and the identity construction of a person via narrating the life story can be influenced or even totally structured by archetypal stories which give a specific form as well as a specific meaning to the person's identity. The method of extracting an underlying archetypal pattern from an autobiographical narrative is demonstrated. The results of the research on 20 autobiographical interviews and the inherent archetypal patterns are summarized. The major aim of this paper is to describe in detail the application of a well established method of the social sciences on a key concept of Jungian psychology to show that these concepts can be integrated into recent research frameworks of academic sciences. On the other hand it shows that Jungian concepts can be investigated through established and well defined research methods in empirical research settings.
Anecdotes as Topic↗
Guidelines for conducting a psychiatric evaluation of the unrelated kidney donor.
Living unrelated kidney donors have been increasingly sought out as potential resources for patients with end-stage renal disease. Several psychiatric issues must be factored into the presurgical evaluation of prospective donors. This paper describes a proposed guideline intended to assist clinicians in the psychiatric evaluation of prospective kidney donors. Topics covered in the interview include the prospective donor's stability and ability to make an informed decision, the donor's understanding of the recipient's illness and of the transplant surgery, and extenuating factors that may influence the decision to donate. While efficient and thorough, the guideline is intended to be flexible enough to address the variety of issues that can affect the prospective donor's decision to pursue surgery.
Female↗
Issues in qualitative research on sensitive topics.
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Data Collection↗
The community health clinics as a learning context for student nurses.
The purpose of the research study was to describe guidelines to improve the community health clinics as a learning context conductive to learning. The objectives of the study commenced by getting the perception of student nurses from a nursing college in Gauteng; community sisters from ten community health clinics in the Southern Metropolitan Local Council and college tutors from a college in Gauteng. The research design and method used, consisting of a qualitative, exploratory, descriptive and contextual approach and the design was divided into two phases. Phase one consisted of a field/empirical study and phase two of conceptualization. In all the samples follow-up focus group interviews were conducted to confirm the findings. To ensure trustworthiness, Lincoln and Guba's model (1985) was implemented and data analysis was according to Tesch's model (1990 in Creswell 1994:155) based on a qualitative approach. The conceptual framework discussed, indicating a body of knowledge, was based on the study and empirical findings from phase one to give clear meaning and understanding regarding the research study.
Attitude of Health Personnel↗
American Nursing. State-side story. Interview by Catharine Watson.
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Humans↗
Bosnian immigrants' perceptions of the United States health care system: a qualitative interview study.
During the 1990s, approximately 300,000 Bosnian immigrants came to the United States as a result of the Balkan wars. In contrast to immigrants from less developed countries, Bosnian refugees were typically older, had experienced significant war related trauma, and were accustomed to universal health insurance coverage. There is little information about Bosnian immigrants' transition to the U.S. health care system. As part of a related project, 12 Bosnian immigrants were interviewed about their perceptions of the U.S. health care system and their experiences as patients. Participants were universally critical of the U.S. system and described several core issues: confusion about insurance coverage, personalized quality of care, access to primary and specialty care; and a perception of U.S. health care as bureaucratic. Participants compared their experience with prewar Bosnian health care along these dimensions. Implications of the findings and suggestions for improving care to the Bosnian immigrant population are provided.
Adult↗
Medical students and psychiatric patients: an encounter of the first kind.
The use of psychiatric patients in teaching interview techniques to inexperienced medical students is a common practice. This report describes the impact of this training as assessed through questionnaire analysis of 35 patients and 32 medical students involved in an interview course for second-year medical students. The experience was viewed by both patients and students as useful, and more students reported it as being stressful than did patients. Patients valued it because they thought it would improve medical education, while students found it personally helpful. Most patients (94 percent) and all students indicated they would participate in a similar experience. Most patients felt that the students understood them well in contrast to the student's perception of not understanding the patient.
Attitude to Health↗
[Physician-patient interactions: a comparison of analysis systems].
OBJECTIVE: The medical interview has important diagnostic and therapeutic functions and requires the integration of doctor-centred and patient-centred interviewing techniques to collect accurate and complete biopsychosocial data from the patient. Analysis of the interaction between patient and doctors which occur during the medical interview allow to evaluate physicians' interview techniques and to eventually improve them. OBJECTIVE: 1. To review different Interaction Analysis Systems (IAS) used to describe doctor-patient communication in terms of clinical relevance, observational strategy, reliability and behavioural and verbal contents. 2. To critically evaluate these IASs on the basis of their relevant research outcomes. METHOD: Previous reviews on interaction and keywords for Medline research (HealthGate) listed above were utilised to collect the relevant literature. RESULTS: Seventeen classification systems were identified and ten were discussed in a chronological order. Starting from a general sociological or psycholinguistic approach, the IASs over the years have became more specific and detailed, focusing more on the medical interview and on specific topics, such as cancer or hospital medical consultations. CONCLUSIONS: When studying interactions in general practice medicine, it is important to define the significant units of interaction which allow to identify a "patient-centred approach", since this is relevant not only for obtaining reliable and complete medical and social data, but also for the recognition of patients with emotional disorders and their correct diagnosis. Listening to the patient and facilitating the expression of emotions is an important aspect of patient education too, as patients learn that talking about psychological problems to their physician is appropriate and may be therapeutic.
Attitude↗
Euthanasia and law in the Netherlands: reflections on Dutch perspectives.
During the summer of 1999, twenty-eight interviews with some of the leading authorities on the euthanasia policy were conducted in the Netherlands. The discussion begins with providing some background information on the guidelines for conducting euthanasia. Next, I explain the research methodology and move on to discuss the interviewees' responses to the question whether it is preferable to legislate euthanasia. The interviewees exhibited split views on the issue. Some were in favor of legislation for instrumental and symbolic reasons. Others utilized different instrumental and symbolic reasons to argue against legislation. Three interviewees preferred to wait for some years before changing the law.
Adult↗
The relationship between technology and changing professional roles in health care: A case-study in teledermatology.
Technology is often viewed as a way of bringing about change in professional roles in health care. While this was the case in the service that we studied, we would contend that there were organisational and cultural factors that were equally, if not more important. This was a qualitative study, using observation and interviews, of a relatively new service in teledermatology. Traditionally, patients with skin conditions that could not be managed by a primary care physician were referred to a hospital consultant dermatologist, often resulting in long waits for an outpatient appointment. This service replaced that system with referral to a specialist dermatology nurse, working in primary care. The nurses were supported by the option of a teledermatology referral to a hospital consultant, and the service was managed by a consultant nurse. We will discuss the movement in professional boundaries that we observed, how these movements were possible, why they took place, and the role that the technology played in this process.
Dermatology↗
Child sexual abuse.
Multiple obstacles can hinder the medical evaluation of suspected child sexual abuse in pediatric primary care. The need for diagnostic accuracy is high. Knowledge of sexual abuse risk factors, an understanding of the victimization process, and awareness of the varied clinical presentations of sexual abuse can be of assistance. Open-ended questioning of the suspected victim is the most critical component of the evaluation. Skillful medical interviewing requires time, training, patience, and practice. Pediatricians lacking any of these four requirements should defer interviewing in sexual abuse cases to other professionals. Abnormal physical findings from sexual abuse are uncommon. Colposcopy has assisted pediatricians greatly in reaching consensus regarding diagnostic physical findings. Cases of acute sexual assault require familiarity with the forensic rape examination, STD screening and prophylaxis, and pregnancy prevention. Victimization from sexual abuse continues long after the abusive acts end, often requiring long-term therapeutic intervention. An emerging standard of care for medical evaluations of suspected child sexual abuse recognizes the requirement for patience and compassion while retaining objectivity. The pediatrician's primary concern must be for the child's physical and emotional well-being.
Child↗
Designing and redesigning medical telecare services: a forces-oriented model.
OBJECTIVES: Medical telecare services' designing and redesigning still remains a challenging issue since it often depends on how a number of socio-technological issues are framed. This work has two key objectives; the former is to theoretically analyze the nature of a telecare environment by developing a model that reveals potential areas of analysis and the latter is to support designing and redesigning medical telecare services by formulating a strategy as well as a number of 'state of the art' guidelines. METHODS: We have extended Leavitt's diamond to develop a model capable of accurately reflecting the telecare environment building dimensions as well as their interactions. This model depends on the i) technology, ii) collaborators, iii) tasks, iv) structure, v) social forces, and the vi) procedure dimensions. Taking this model as a core element we have proposed a service designing and redesigning strategy formulating, in parallel, six scalable dimension-oriented guidelines. RESULT: During the two-year period (2003-2005) an enormous amount of data was collected (by active participating in two EU projects, by conducting semistructured interviews, by performing onsite observations as well as by reviewing 78 previous projects) and classified, structuring six guidelines. These guidelines can be considered as the 'state of the art' to support future services' design and redesign. CONCLUSIONS: This work considering the telecare environment as a multi-dimensional, operational organization has put the focus on accurate telecare services' design and redesign. The parameters are not limited, by any means, and are drawn from experience of designing services in a variety of telecare domains. The optimal parameter combination must be chosen according to the aim of each telecare procedure. Further research is needed to determine the minimum parameters to support telecare service design.
Computer Communication Networks↗
A qualitative study of GPs' views on modern genetics.
BACKGROUND: With rapid advances in genetics and increased public awareness of genetic testing for many hereditary diseases, the demand for genetic services may increase. We wondered how developments in genetics have impacted on general practice and the position general practitioners have taken in practising the new genetics. METHOD: A qualitative study using semi-structured interviews conducted during 2003-2004 with 15 GPs practising in Sydney (New South Wales) and the Australian Capital Territory. RESULTS: General practitioners reported that genetic services had minimal impact on their practice and the number of consultations related to genetic conditions was insignificant. They felt they were often not included in the 'referral loop' of such patients. Their knowledge of advances in genetics was limited. They were wary of the possible costs of testing and the time taken to provide genetic counselling. DISCUSSION: General practitioners' attitudes toward modern genetics seems to be disengaged, and they are ambivalent toward the role they now play, or will play, in genetic services.
Attitude of Health Personnel↗