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Communal farmers and tick control--a field study in Zimbabwe.

Intensive dipping of cattle to control ticks and tick-borne diseases precludes development of endemic stability to the latter. Alternative control strategies have been recommended which reduce the frequency of dipping and permit the expression of tick resistance and endemic stability. However, such strategies imply acceptance by cattle owners of higher tick burdens. In this study the views of a group of communal farmers to tick control are described and the impact of these views upon adoption of other strategies is discussed.

Administration, Topical↗

The staple.

Explore the source record for details and available documents.

Anecdotes as Topic↗

Working in London hospitals: perceptions of place in nursing students' employment considerations.

During the past decade, a distinct body of research has started to investigate the dynamics between nursing and place. However, despite attention being paid to a wide-range of nursing subjects, few studies have engaged with the important topic of labour force recruitment. In this context, this study uses a combined questionnaire (n=650), interview (n=30) and focus group (n=7) survey of London-based students, and investigates the complex mix of experiences and perceptions that result in hospitals having varying degrees of popularity as potential workplaces. The findings suggest experiences and perceptions of institutions-often gained on clinical placements-to be important, particularly relating to feeling valued, the quality of patient care, clinical and educational opportunities and team cohesion. These are often combined with experiences and perceptions of locality, relating to factors such as cost of living, travel considerations and sense of personnel safety. The study demonstrates that place is relevant to employment decision-making on multiple scales from wards to regions. Furthermore, that perceptions of potential workplaces result from engagements with complex mixes of cultural, economic and physical features, many of which are the consequences of management. It is argued that in order to effectively unpack workplaces, geographical research of nursing labour may benefit from researching simultaneously both 'inside' institutions, focusing on their dominant cultures of production and sub-cultures, and 'outside', focusing on their local urban or rural contexts.

Adult↗

Issues of recruitment, retention, and compliance in community-based clinical trials with traditionally underserved populations.

Site-specific sociodemographic recruitment, retention, and compliance (RRC) data were solicited at two points in time from the 18 National Institutes of Health-funded Community Programs for Clinical Research on AIDS (CPCRA). Based on their experiences delivering primary care to human immunodeficiency virus-infected individuals, nurses at each site identified organizational and client-centered factors functioning as barriers to protocol participation. In addition, the clinicians described the nature, frequency, and relative success of strategies used to enhance recruitment, retention, and protocol compliance. CPCRA units where nurses had clearly identified RRC barriers related to protocol design also were the sites that had accrued the most research participants. This study suggests that as the CPCRA units evolve, the most successful programs will be those in which the clinical and research staff can identify and develop innovative strategies that will successfully overcome RRC barriers.

Acquired Immunodeficiency Syndrome↗

Exploring the emerging concept of precision rehabilitation: a qualitative study.

PURPOSE: This descriptive qualitative study explored knowledge users' perspectives on precision rehabilitation concepts, barriers, facilitators, and future directions as part of a convergent mixed methods scoping review. MATERIALS AND METHODS: Sixteen clinicians, administrators, and researchers from three North American tertiary care rehabilitation centers were recruited using convenience and snowball sampling to participate in individual semi-structured interviews. Conventional qualitative content analysis followed a deductive thematic approach based on predetermined categories. RESULTS: Analyses revealed three main themes: (1) Although precision rehabilitation shares foundational concepts with precision medicine, there are certain elements, such as personalization, that are uniquely expressed; (2) Rehabilitation-specific facilitators to precision approaches include the use of unobtrusive technology to collect large amounts of data in real-world contexts, while barriers include rehabilitation's typically small, heterogeneous sample sizes; and (3) The future of precision rehabilitation will require collaborative data-sharing to focus on determining care trajectories that enhance functional outcomes. CONCLUSION: Findings provide the first qualitative synthesis of knowledge users perspectives to complement quantitative evidence and inform the emerging field of precision rehabilitation.

Humans↗

Bringing ethics education to the clinical years: ward ethics sessions at the University of Washington.

PURPOSE: Although most medical schools teach medical ethics during preclinical years, incorporating these ethics into clinical training remains challenging. During clinical rotations, students' professional behaviors and attitudes are profoundly affected. This project was intended to develop an educational intervention to incorporate medical ethics training as a part of students' professional development within the context of clinical training. METHOD: "Ward Ethics" is a series of peer discussions guided by clinical faculty mentors trained in fostering issue identification and strategy development. The sessions described here were conducted during medicine and surgery rotations for third-year medical students at the University of Washington School of Medicine from 1998 to 2003. Thirty clinical faculty participated as facilitators. Written evaluations were collected from students and faculty at each session, and faculty interviews were conducted in 2001. RESULTS: The data reported are from 24 sessions and 15 faculty interviews from 1999 to 2001. The topics were consistent with prior reports of ethical issues that students encountered. Students reported a variety of learned strategies such as knowing how and when to speak up and transitioning from prioritizing evaluations to focusing on patient care, resulting in their feeling more confident. Faculty reported noticing positive results to their professional development as well. CONCLUSIONS: Medical students in the clinical years face ethically challenging situations. Some circumstances, if left unexamined, may erode students' abilities to maintain and develop appropriate professional behaviors. Students participating in this activity agreed that it served as a way to fight isolation, share stories, and exchange ideas for future problem solving.

Academic Medical Centers↗

Contracting for emergency room coverage by rural hospitals.

Obtaining adequate physician availability remains a challenge to many rural communities. To ensure 24-hour emergency room physician coverage, many rural hospitals contracted for emergency room services from out-of-area and/or local physician. Survey findings for 99 rural and rural referral Iowa hospitals addressing the nature, extent, and cost of contracting physician coverage of the emergency room are presented. While nearly two-thirds of the hospitals reported contracting for at least some emergency room coverage, the extent and costs of contracts vary widely. Advantages and disadvantages of contracting for emergency room services are discussed.

Contract Services↗

Nurses in resident evaluation. A qualitative study of the participants' perspectives.

This study complemented a large psychometric study using nurses to assess medical residents' humanistic behavior. It was designed to identify how nurses and residents defined humanistic qualities and behaviors and what factors affected their views of residents' performance and evaluation. The study also illustrates how qualitative methods were used to complement quantitative psychometric data and thereby yield a more complete assessment of the value of a new performance evaluation form. The results indicated that nurses' definitions of humanistic behavior often differed from residents', tending to reflect a broader perspective on the physician's role and responsibility in patient care. Nurses and residents disagreed about whether nurses were qualified to evaluate residents' humanistic behavior and about what nurses actually observed on the wards. Professional respect was an issue for both nurses and residents. The discussion section identifies some implications for resident training and nurse-resident relationships and supports the value of combining research strategies when evaluating complex human behavior.

Attitude of Health Personnel↗

Impact of direct mail intervention on knowledge, attitudes, and behavioral intentions regarding use of emergency medical services for symptoms of acute myocardial infarction.

This study evaluated a direct mail intervention called the "Call Fast, Call 911" campaign designed to increase use of emergency medical services for symptoms of acute myocardial infarction. The campaign was targeted at individuals over the age of 50. Persons over 50 years of age (N = 130,000) in King County, Washington, were randomly assigned to intervention or control groups. Individuals in the intervention groups received six direct mail pieces over a 1-year period encouraging them to call 911 quickly in response to chest pain. A postintervention telephone survey of a random sample of households (N = 434) assessed the impact of the campaign on knowledge, attitudes, and behavioral intentions regarding use of emergency medical services for symptoms of acute myocardial infarction. The results showed no significant differences between intervention and control groups in terms of knowledge of AMI. However, there were significant differences in beliefs and behavioral intentions to call 911 in a cardiac emergency.

Aged↗

Qualitative health research: challenges for the 21st century.

To understand complex human phenomena, it is necessary to triangulate the results of multiple separate projects that use diverse methods. Using the example of suffering, a research program emerging from studies exploring comfort was initiated. A model of enduring and emotional suffering (or releasing) was developed, and, using this model as a scaffold, eight subsequent projects explored the interaction of enduring and emotional suffering in various contexts and with different populations. Although there remains much to learn, the researcher argues that using this programmatic approach to explore new areas is an efficient and effective way to gain understanding of complex human phenomena.

Emotions↗

Evaluating family-centered programs in neonatal intensive care.

With the passage of P.L. 99-457 in October of 1986, the field of early intervention has been faced with the challenge of broadening its scope (Silber, 1989). This legislation expanded early intervention from a child-centered service to a service offered to families within a variety of contexts; from a service for children with special needs to a service available to families as soon as risks are identified. New programs are being designed and developed with an interagency focus which serve not only children with developmental disabilities but also their families in health, education and social services (Cornwell and Thurman, 1990). Current legislation suggests that services should be available to families as soon as their children are identified as being at-risk (Smith, 1987). In response to the legislation, states are developing definitions of "at-risk" based on criteria other than the child's test scores. Therefore, in many cases, early intervention services are being offered to families while their at-risk infants are still hospitalized and receiving intensive care. Evaluation of these innovative and complex service delivery programs is being addressed as these services are developed. With the broadening of the scope of early intervention comes the need to rethink the traditional methods of evaluating these programs. This paper will address some of the issues involved in evaluating family-centered programs which are based in neonatal intensive care units (NICU).

Child, Hospitalized↗

Effective internal marketing: the challenge of the 1990s.

Results of a recent public opinion study suggest that health care provider organizations are not taking advantage of several important public relations and internal marketing channels to educate the public through their employees. As increasing pressures on health care providers from other segments of the health care industry result in reduced revenues, lower margins, and downsizing, health care marketers and public relations managers should reassess their internal marketing efforts.

Chi-Square Distribution↗

Twelve-year follow-up of respondents in a sample survey in Peninsular Malaysia.

"This note reports the experience of an attempt to find and re-interview in late 1988 and early 1989, as part of the Second Malaysian Family Life Survey (MFLS-2), the female respondents to the 1976-77 Malaysian Family Life Survey (MFLS-1) and a sample of their adult children aged 18 or older.... We discuss the field methods used to track the panel members and their adult children, report follow-up rates and analyze the selectivity of attrition from the panel, using data from the MFLS-1 on characteristics of both the missing and the re-interviewed respondents and their families. We then discuss the degree to which these results might be generalized to other such attempts at re-contacting survey respondents."

Asia↗