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PubMed2000

Faith among patients with advanced cancer. A pilot study on patients offered "no more than" palliation.

Spiritual wellbeing is an important topic in cancer care. Being religious is reported by patients facing dilemmas concerning the quality and meaning of life to be potentially helpful. However, the fear of death may be close to the surface and easily stimulated. The aim of this study was to clarify patients' attitudes to faith. Between February 1998 and February 1999, 20 patients aged 37-74 years and suffering from ten different incurable cancers were enrolled in the study. An interview technique focusing on the topic by way of an open question about faith was employed. The topic was only continued if the patient signalled a clear wish for this. Half the patients had a close relative present during the conversation, and an oncology nurse was present in all cases. Most patients (18, or 90%) intimated that the topic was of interest: 85% responded by saying they believed in God, and 75% reported that they prayed. A quarter (25%) mentioned that they had visited their local Lutheran pastor before their admission to hospital. One patient reported being a Jehovah's Witness and one, a member of the Norwegian Humanistically Ethical Association (HEA). Following the conversation, 4 patients requested a visit from the hospital chaplain, 1 asked for contact with the Salvation Army to be arranged, and 1 wanted to talk to the local leader of HEA. Following the conversation all patients were observed by a nurse, and no raised level of anxiety was reported. Sixteen of the patients died within a median of 18 (1-180) days after the conversation. In conclusion, most patients responded positively to a question about faith. The topic should be addressed in the treatment of patients with advanced disease. However, care must be taken to avoid frightening the patients. Patients' attitudes with regard to what death brings deserve respect.

Adult↗
PubMed1993

Safe working practices and HIV infection: knowledge, attitudes, perception of risk, and policy in hospital.

OBJECTIVES--To assess the knowledge, attitudes, and perceptions of risk of occupational HIV transmission in hospital in relation to existing guidelines. DESIGN--Cross sectional anonymous questionnaire survey of all occupational groups. SETTING--One large inner city teaching hospital. SUBJECTS--All 1530 staff working in the hospital in October 1991 and 22 managers. MAIN MEASURES--Knowledge of safe working practices and hospital guidelines; attitudes towards patients with AIDS; perception of risk of occupational transmission of HIV; availability of guidelines. RESULTS--The response rate in the questionnaire survey was 63% (958/1530). Although staff across all occupational groups knew of the potential risk of infection from needlestick injury (98%, 904/922), significantly more non-clinical staff (ambulance, catering, and domestic staff) than clinical staff (doctors, nurses, and paramedics) thought HIV could be transmitted by giving blood (38%, 153/404 v 12%, 40/346; chi 2 = 66.1 p < 0.001); one in ten clinical staff believed this. Except for midwives, half of staff in most occupational groups and 19% (17/91) of doctors and 22% (28/125) of nurses thought gloves should be worn in all contacts with people with AIDS. Most staff (62%, 593/958), including 38% (36/94) of doctors and 52% (67/128) of nurses thought patients should be routinely tested on admission, 17% of doctors and 19% of nurses thought they should be isolated in hospital. One in three staff perceived themselves at risk of HIV. Midwives, nurses, and theatre technicians were most aware of guidelines for safe working compared with only half of doctors, ambulance, and paramedical staff and no incinerator staff. CONCLUSIONS--Policy guidelines for safe working practices for patients with HIV infection and AIDS need to be disseminated across all occupational groups to reduce negative staff attitudes, improve knowledge of occupational transmission, establish an appropriate perception of risk, and create a supportive and caring hospital environment for people with HIV. IMPLICATIONS--Managers need to disseminate policy guidelines and information to all staff on an ongoing basis.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[The modified psychiatric interview: a study of reliability].

In order to estimate the prevalence of mental disorders in epidemiologic studies in the community, our department has designed the Modified Psychiatric Interview (MPI), a semi-structured interview derived from the Standardized Psychiatric Interview by Goldberg et al. This instrument confirms the presence of "psychiatric cases" and is applied by interviewers with clinical experience. The purpose of this article is to evaluate the degree of agreement between clinical interviewers (using an interviewer-observer design), utilizing MPI in an out-patient population attending a general hospital, as part of an investigation on prevalence of mental disorders at a 2nd. level of medical care. The degree of agreement was calculated in the different sections of the instrument by Pearson's product-moment correlation, Kappa statistic and Yule's "Y" coefficient. The results showed a high level of reliability among the clinical interviewers in each section of the MPI.

Evaluation Studies as Topic↗
PubMed2001

Applying Aristotle's doctrine of causation to Aboriginal and biomedical understanding of diabetes.

Aristotle's doctrine on causation identifies four distinct types of cause: formal, efficient, material, and final. Science is said to have differentiated itself from philosophy by concentrating solely on efficient causes. Nonetheless, when applied to narratives of causation, Aristotle's doctrine provides a useful heuristic to explore the issues such as Aboriginal and biomedical perceptions of causal factors for non-insulin dependent diabetes mellitus (NIDDM) on Manitoulin Island, Ontario. This paper also outlines two divergent causal stories for NIDDM and the associated moral positions regarding the 'righteous' pursuit of health. Biomedical narratives emphasize the role of lifestyle factors, particularly the impact of obesity, in causation. In the case of diabetes, the moral course of action is pursued through lifestyle choices. In contrast, Aboriginal narratives emphasize the role of genetics in causation. These narratives describe diabetes as collectively affecting Aboriginal people - thus identifying Aboriginal people as different. Aboriginal frameworks for health venture beyond the 'efficient' cause of biomedicine and thus the moral pursuit of health within this framework involves returning to an initial state of health and purity through traditional knowledge.

Anecdotes as Topic↗
PubMed2005

Children's responses to educators' questions in day care play groups.

An exploratory study examined adults' questions to small groups of children to determine how questions influenced their response rate and complexity of response. Thirteen educators of toddlers and 13 educators of preschoolers were videotaped during free-play. Both groups of educators used an equivalent frequency of open-ended and closed questions, but the preschool educators used more topic-continuing questions. Consistent with their developmental level, preschoolers responded more frequently than toddlers. Toddlers demonstrated few effects of question type. In contrast, preschoolers used more multiword utterances following open-ended questions and topic-continuing questions. Implications for in-service education for staff of early childhood settings include increasing the use of both open-ended and topic-continuing questions.

Adolescent↗
PubMed1992

The validation of interviews for estimating morbidity.

Health interview surveys have been widely used to measure morbidity in developing countries, particularly for infectious diseases. Structured questionnaires using algorithms which derive sign/symptom-based diagnoses seem to be the most reliable but there have been few studies to validate them. The purpose of validation is to evaluate the sensitivity and specificity of brief algorithms (combinations of signs/symptoms) which can then be used for the rapid assessment of community health problems. Validation requires a comparison with an external standard such as physician or serological diagnoses. There are several potential pitfalls in assessing validity, such as selection bias, differences in populations and the pattern of diseases in study populations compared to the community. Validation studies conducted in the community may overcome bias caused by case selection. Health centre derived estimates can be adjusted and applied to the community with caution. Further study is needed to validate algorithms for important diseases in different cultural settings. Community-based studies need to be conducted, and the utility of derived algorithms for tracking disease frequency explored further.

Algorithms↗
PubMedDate not supplied

Living with a child with fetal alcohol syndrome.

PURPOSE: To describe the experiences of foster parents who are living with a child diagnosed with Fetal Alcohol Syndrome (FAS). DESIGN AND METHOD: A qualitative approach was selected due to the paucity of knowledge on the topic. Eight foster mothers living with children with FAS were studied. These foster parents had parented a collective total of 17 children with FAS, ranging between the ages of 2 and 16. Each in-depth interview was unstructured and consisted of open-ended questions. Data were analyzed using content analysis. RESULTS: Foster parents described many difficult issues needing attention in children with FAS. Cognitive concerns included diminished memory/comprehension, lack of understanding of consequences, and the absence of fear. Behavioral management was a problem due to the frequent occurrence of hyperactivity, aggressiveness, destructiveness, and high pain tolerance. Parents also described problems in coping with daily realities of life with a child with FAS including the necessity of providing consistency, coping strategies, and fears for the child's future. CLINICAL IMPLICATIONS: Nurses need to understand the complex problems that face affected children and their families. Understanding the daily realities of living with children with FAS allows nurses to realistically assess childrens' abilities, maximize their development, and provide for their needs more effectively, as well as assisting families to cope with the behavior and cognitive issues so apparent in children with FAS.

Adolescent↗
PubMed2003

Standardizing DSM-IV diagnoses: the clinical applications of structured interviews.

Psychological assessments of Axis I and Axis II diagnoses are strongly enhanced by the use of structured interviews. Structured interviews standardize the clinical inquiries, sequencing of diagnostic issues, and criterion-based ratings. For a broad range of clinical settings, structured interviews can systematically assess changes in patient status, corroborative data from multiple sources, interrater and test-retest reliability, and diagnostic validity. This article outlines the potential uses of different diagnostic interviews that are tailored for or adapted to specific clinical purposes.

Diagnostic Errors↗
PubMedDate not supplied

[Acceptability of food supplements in pregnant or lactating women and children under 5 years of age].

OBJECTIVE: The present study explores the acceptance and consumption of nutritional supplements that form part of a governmental program to support nutritionally vulnerable groups. MATERIAL AND METHODS: Pregnant and lactating women, and mothers of malnourished toddlers, infants and children were interviewed. Data were collected, after introduction with an interview guide with an open-ended format, through face-to-face interviews conducted at home. Interviews were taped with previous informed consent. Analysis included topics and subtopics approached by the interviewed women. RESULTS: The studied population showed good acceptance to the supplement when offered as a drink. When considering benefits, pregnant women thought first of their baby's health than of their own and associated the possible advantages of the supplement to its "vitamin" contents. Acceptance of the flavors was largely influenced by previous contact to specific flavors. Children under 1 year of age preferred the liquid consistency and elderly children favored the puree. Most mothers considered that the offered amount was enough and there was the general impression that, as the time of the intervention elapsed, children showed greater appetite. The diet was not substituted by the supplement. CONCLUSIONS: Acceptance of the supplement may be improved by messages focusing on the well-being and health of the child and insisting on the benefits for the pregnant mother. Community health providers should be involved in supporting the program, recommending consumption and acceptance of the supplement. The identification by mothers of "vitamins" as part of the supplement may be used to reinforce the concept of beneficial effects associated to micronutrient supplementation. Qualitative evaluations should be performed as part of the assessment of community-based programs.

Child, Preschool↗
PubMed2000

Higher professional education for general medical practitioners: key informant interviews and focus group findings.

BACKGROUND: If higher professional education (HPE) for general practitioners (GPs) is to be implemented, then key stakeholders will need to be supportive. AIM: To investigate stakeholders' beliefs about the concept of HPE, its funding, and relationships to education and care. METHOD: Interviews were conducted using a topic guide with a health authority (HA) representative, the Local Medical Committee Chair, the Medical Audit Advisory Group Chair, a GP tutor from each of the six health authorities in the old South West region, and a senior member of the three academic GP departments and the two Royal College of General Practitioners faculties in the region. Focus groups were held with GP registrars on both vocational training schemes (VTSs) and on the one HPE course in the region. These were recorded, transcribed verbatim, and analysed for emergent themes that were triangulated with the ideas expressed in the focus groups; the same topic guide was used for both. RESULTS: Of 29 key informants, 24 were interviewed. Six focus groups were held (the one HPE group and five out of the nine VTSs), after which no new ideas emerged. There is a transition period, after becoming a new principal (NP) and before becoming a fully competent independent GP, during which NPs need support. Benefits would include receiving peer support to reduce stress during the transition, enhanced non-clinical competencies, becoming a better skilled GP, avoiding the negative personal impact of a career as a GP, and helping recruitment. To improve patient care there must be a link between education and service provision. Funding is the major consideration in setting HPE; mixed funding is best coming from top-sliced General Medical Services (GMS), the HA, and regional educational funds. Barriers might include NPs' practice workload, their enthusiasm, and their partners' attitudes. The other key is a local enthusiast to initiate a course and coordinate the 'players'. The curriculum would be principally non-clinical and should be agreed by learners and the course tutor together, taking advice from various interested parties. CONCLUSION: There is a need for HPE for new NPs. It will require funding external to individual practices or NPs and a local enthusiast. Top-slicing of GMS funds is one source of funding, with additional funds from regional education and HAs. HPE must be related to service provision, to NP needs, and to vocational training.

Career Choice↗