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Phenomenology as a paradigm of movement.

Phenomenology is a well-founded qualitative methodology that is frequently used by nurse researchers and considered of value when addressing research questions in nursing practice and nurse education. However, at present, nurse researchers using phenomenology tend to divide phenomenological methodology into the descriptive and interpretive formats. The nursing literature suggests that there is a deep divide between researchers following the methodological underpinnings and basic precepts pertaining to these two camps. If we are to reach a clearer understanding of the theory underlying phenomenological methods it would be more helpful if we started to recognise that there are also important associations between transcendental and interpretive phenomenology. One such association is that a paradigm of movement exists that is not unique to transcendental and interpretive phenomenology but is common to them, as well as being inherent within a variety of fields of study. If we consider the universality of such imagery, looking to examples through parallel texts, we can obtain insights into phenomenology and its transposition into a workable scientific method that can be of use to the nurse researcher.

Attitude to Health↗

Enhanced novelty-induced activity, reduced anxiety, delayed resynchronization to daylight reversal and weaker muscle strength in tenascin-C-deficient mice.

Tenascin-C (TNC) is an extracellular matrix protein with multiple and important functions during development and in the adult. We here present a study on the behaviour of TNC-deficient (knockout, KO) mice. Longitudinal experiments including tests for circadian activity, exploration, state and trait anxiety, motor coordination and cognition were performed. KO mice showed increased reactivity to explore a novel environment and decreased anxiety. Spontaneous circadian activity was unaffected, but KO mice showed delayed resynchronization to daylight reversal. TNC deficiency caused weaker muscle strength, whereas gait, coordination and motor learning were unaltered. Short- and long-term memory in the fear conditioning task and working memory in the spontaneous alternation test were normal in KO mice. KO mice showed impaired memory recall in the step-down, but not in the step-through, passive avoidance task. Ethological observation of mice behaviour and principal component analyses indicated that the higher novelty- and stress-induced active responses of KO mice account for their poorer performance in passive avoidance tasks, whereas cognitive abilities are unaltered. The present study extends and corrects previous results, and is an example of how an ethological approach allows a precise description and interpretation of the behavioural alterations of mutant mice.

Aggression↗

Adults' cognitive demands at home and at nursery school.

A study was made of the "cognitive demands" made of children during spontaneous conversations with their teachers at nursery school and their mothers at home. Social class differences were small compared with home/school differences. Teachers' talk contained a higher proportion of cognitive demands and "testing" demands than did mothers' talk; however, the hourly rate of these demands was higher in the mothers' talk. Teachers used more demands for attributes, simple descriptions and interpretations, whilst mothers used more demands for recall and explanation of motives and purposes. More demands were left unanswered at school than at home. The implications for nursery education are discussed.

Child Development↗

Non-uniform probabilities of quantal release at the crayfish neuromuscular junction.

1. Transmitter release at the neuromuscular junction of the crayfish walking leg has been found to deviate from binomial predictions immediately after the onset of repetitive stimulation of the presynaptic nerve at frequencies of at least 15 Hz. 2. After several minutes of continuous stimulation, and at lower rates of stimulation, however, the number of quanta released could be described quite well by binomial or Poisson statistics. 3. Deviations from the theoretical expectations were characterized by (a) fewer release failures than predicted, (b) occasions in which the number of quanta released was more than the estimated number of quanta available for release, and (c) a tendency for the data to be underdispersed. 4. Each of these three characteristics are consistent with the hypothesis that different releasable quanta may have different probabilities of responding to a nerve impulse. 5. Using two different methods, different values of the non-uniform probabilities were estimated from the data. At each synaptic site at least one of the estimated probabilities was very high. 6. The need for caution in interpreting statistical description of quantal release is emphasized.

Animals↗

A survey of validity and utility of electronic patient records in a general practice.

OBJECTIVE: To develop methods of measuring the validity and utility of electronic patient records in general practice. DESIGN: A survey of the main functional areas of a practice and use of independent criteria to measure the validity of the practice database. SETTING: A fully computerised general practice in Skipton, north Yorkshire. SUBJECTS: The records of all registered practice patients. MAIN OUTCOME MEASURES: Validity of the main functional areas of the practice clinical system. Measures of the completeness, accuracy, validity, and utility of the morbidity data for 15 clinical diagnoses using recognised diagnostic standards to confirm diagnoses and identify further cases. Development of a method and statistical toolkit to validate clinical databases in general practice. RESULTS: The practice electronic patient records were valid, complete, and accurate for prescribed items (99.7%), consultations (98.1%), laboratory tests (100%), hospital episodes (100%), and childhood immunisations (97%). The morbidity data for 15 clinical diagnoses were complete (mean sensitivity=87%) and accurate (mean positive predictive value=96%). The presence of the Read codes for the 15 diagnoses was strongly indicative of the true presence of those conditions (mean likelihood ratio=3917). New interpretations of descriptive statistics are described that can be used to estimate both the number of true cases that are unrecorded and quantify the benefits of validating a clinical database for coded entries. CONCLUSION: This study has developed a method and toolkit for measuring the validity and utility of general practice electronic patient records.

Databases, Factual↗

Mild head injury: reliability of early computed tomographic findings in triage for admission.

OBJECTIVE: To search the literature for case reports on adverse outcomes in patients with mild head injury where acute computed tomography (CT) findings had been normal. METHODS: Mild head injury was defined as head trauma involving amnesia or loss of consciousness, but where neurological findings are normal on arrival at hospital (GCS 15). The scientific literature was systematically searched for case reports where an early CT was normal and the patient deteriorated within two days. In these cases, early discharge despite a normal CT head scan would have been hazardous. RESULTS: Two prospective studies were found that investigated the safety of early CT in 3300 patients with mild head injury, as were 39 reports on adverse outcomes describing 821 patients. In addition, 52 studies containing over 62 000 patients with mild head injury were reviewed. In total, only three cases were deemed to have experienced an early adverse outcome despite a normal CT and GCS 15 on initial presentation. In another eight cases with incomplete descriptions, the interpretation was doubtful. Many reports of complications were not relevant to our question and excluded. These reports included cases with more severe head injury/not GCS 15 at presentation, complications that occurred after more than two days, or initial CT findings that were not fully normal. CONCLUSION: Very few cases were found where an early adverse event occurred after normal acute CT in patients with mild head injury. The strongest scientific evidence available at this time shows that a CT strategy is a safe way to triage patients for admission.

Craniocerebral Trauma↗

Tobacco document research reporting.

OBJECTIVE: To understand the use of internal tobacco industry documents in the peer reviewed health literature. DESIGN: Interpretive analysis of published research. SAMPLE: 173 papers indexed in Medline between 1995 and 2004 that cited tobacco industry documents. ANALYSIS: Information about year published, journal and author, and a set of codes relating to methods reporting, were managed in N*Vivo. This coding formed the basis of an interpretation of tobacco document research reporting. RESULTS: Two types of papers were identified. The first used tobacco documents as the primary data source (A-papers). The second was dedicated to another purpose but cited a small number of documents (B-papers). In B-papers documents were used either to provide a specific example or to support an expansive contention. A-papers contained information about purpose, sources, searching, analysis, and limitations that differed by author and journal and over time. A-papers had no clear methodological context, but used words from three major traditions--interpretive research, positivist research, and history--to describe analysis. INTERPRETATION: A descriptive mainstream form of tobacco document reporting is proposed, initially typical but decreasing, and a continuum of positioning of the researcher, from conduit to constructor. Reporting practices, particularly from experienced researchers, appeared to evolve towards researcher as constructor, with later papers showing more complex purposes, diverse sources, and detail of searching and analysis. Tobacco document research could learn from existing research traditions: a model for planning and evaluating tobacco document research is presented.

Authorship↗

Inner ear fluid volumes and the resolving power of magnetic resonance imaging: can it differentiate endolymphatic structures?

Magnetic resonance imaging (MRI) can accurately recognize minute volumes as small as 1 mm3. The volumes of the utricle and saccule of the inner ear are within the resolving power of MRI, but these structures cannot be recognized because the endolymph and perilymph signals are identical. To clarify the interpretation and description of inner ear structures on MRI, we measured and calculated the volumes of the perilymphatic and endolymphatic spaces of the human ear. We found the total volume of the bony labyrinth to be approximately 192.5 mm3 (endolymph, 34.0 mm3; perilymph, 158.5 mm3).

Ear, Inner↗

Prenatal care use among women of low income: a matter of "taking care of self".

The grounded theory study discussed in this article provides a theoretical explanation of prenatal care use among women of low income. The author recruited 26 women from two communities in Ontario, Canada, to participate in an individual or focus group interview and analyzed data using descriptive coding, interpretive coding, and constant comparison. Perceptions of the health care system were identified as important influences on usage behavior. This broad theme included two subthemes: (a) program and service attributes and (b) service provider characteristics. Within each subtheme, both barriers to and facilitative factors for prenatal care became apparent. The author examined relationships among categories to identify a unifying construct. Taking care of self emerged as the central phenomenon that explained usage behavior. Women weigh the pros and cons when deciding whether to access prenatal care, and then take charge, ultimately making a decision in terms of its meaning for self.

Adult↗

Classifying the findings in qualitative studies.

A key task in conducting research integration studies is determining what features to account for in the research reports eligible for inclusion. In the course of a methodological project, the authors found a remarkable uniformity in the way findings were produced and presented, no matter what the stated or implied frame of reference or method. They describe a typology of findings, which they developed to bypass the discrepancy between method claims and the actual use of methods, and efforts to ascertain its utility and reliability. The authors propose that the findings in journal reports of qualitative studies in the health domain can be classified on a continuum of data transformation as no finding, topical survey, thematic survey, conceptual/thematic description, or interpretive explanation.

Data Interpretation, Statistical↗

Intravenous magnesium therapy in acute myocardial infarction.

OBJECTIVE: To review the methods and summarize the findings of clinical trials evaluating the use of intravenous magnesium (Mg2+) in acute myocardial infarction (AMI); to discuss serum Mg2+ in AMI and the potential mechanisms by which intravenous Mg2+ may be effective. Tables are used extensively to provide detailed information about the various trials. DATA SOURCES: A MEDLINE search was used to identify pertinent literature. Additional references were obtained from the articles retrieved from that search. STUDY SELECTION: Studies randomized and/or placebo-controlled were selected for review. Additional relevant citations were used in the introductory material and discussion. DATA EXTRACTION: There were surprisingly few large, placebo-controlled trials. All clinical trials available at the time of publication were reviewed. Only eight trials enrolled sufficient numbers of patients and/or were of adequate design to make meaningful interpretations. The description of the methods and results of these articles are the basis of this review. Although additional controlled studies with more subjects are needed, the results to date form a foundation from which to make inferences regarding the utility of this therapeutic modality. DATA SYNTHESIS: Intravenous Mg2+ has been demonstrated, albeit inconclusively, to reduce immediate and long-term morbidity and mortality when given in the immediate postinfarction period. Six of the eight controlled trials discussed report a decrease in the overall incidence of arrhythmia or in the frequency of arrhythmia requiring treatment. Four of the eight reported statistical significance. Five of the six trials evaluating mortality reported a decrease in the mortality rate from intravenous Mg2+ administered post-MI. Four of the five reported statistical significance. The favorable effect of intravenous Mg2+ on the mortality rate appears to occur in the first 30 days post-MI and is maintained through at least one year. The effects appear to be independent of concurrent therapy and do not appear to relate to baseline serum Mg2+ concentrations. Intravenous Mg2+ appears to be safe and well tolerated. Flushing, hypotension, and atrioventricular (AV) node conduction abnormalities occur on occasion and seem related to the rate of administration. The exact dosage in this setting remains to be determined. CONCLUSIONS: Additional, well-designed, multicenter, controlled trials evaluating intravenous Mg2+ in AMI are needed. The pending Fourth International Study of Infarct Survival, with an anticipated 400,000 subjects, should clarify a number of unresolved issues regarding this therapy. Based on the information available to date, however, intravenous Mg2+ as a significant therapeutic modality for AMI shows promise. Pending further investigation, however, it should be avoided in patients with significant sinoatrial or AV conduction disturbances.

Arrhythmias, Cardiac↗

"I really should've gone to the doctor": older adults and family caregivers describe their experiences with community-acquired pneumonia.

BACKGROUND: Responding to acute illness symptoms can often be challenging for older adults. The primary objective of this study was to describe how community-dwelling older adults and their family members responded to symptoms of community-acquired pneumonia (CAP). METHODS: A qualitative study that used face-to-face semi-structured interviews to collect data from a purposeful sample of seniors aged 60+ and their family members living in a mid-sized Canadian city. Data analysis began with descriptive and interpretive coding, then advanced as the research team repeatedly compared emerging thematic categories to the raw data. Searches for disconfirming evidence and member checking through focus groups provided additional data and helped ensure rigour. RESULTS: Community-acquired pneumonia symptoms varied greatly among older adults, making decisions to seek care difficult for them and their family members. Both groups took varying amounts of time as they attempted to sort out what was wrong and then determine how best to respond. Even after they concluded something was wrong, older adults with confirmed pneumonia continued to wait for days, to over a week, before seeking medical care. Participants provided diverse reasons for this delay, including fear, social obligations (work, family, leisure), and accessibility barriers (time, place, systemic). Several older adults and family members regretted their delays in seeking help. CONCLUSION: Treatment-seeking delay is a variable, multi-phased decision-making process that incorporates symptom assessment plus psychosocial and situational factors. Public health and health care professionals need to educate older adults about the potential causes and consequences of unnecessary waits. Such efforts may reduce the severity of community-acquired pneumonia upon presentation at clinics and hospitals, and that, in turn, could potentially improve health outcomes.

Aged↗

A qualitative study of the transition to adulthood for youth with physical disabilities.

The purpose of this qualitative study was to explore the experiences, perceptions, and needs of youth with physical disabilities in transition from adolescence to adulthood. Purposeful sampling strategies were used to select 34 study participants who lived in three regions of south-central Ontario, Canada. Data collection methods were individual and focus group interviews, and were guided by a set of open-ended questions. An editing style of analysis sorted the text into codes for description and interpretation. Themes emerged about context, the transition process, needs, and services. Participants identified a poor fit between young persons with disabilities and the adult world they were entering. They recommended that services be focused on environmental supports to enable them to "build their own bridges" to the adult world. Community-based transition services need to be planned in collaboration with youth with disabilities and their parents. Concepts of person-environment fit and health promotion can be incorporated into services to enable young persons with disabilities to experience a smooth transition from adolescence to adulthood.

Adaptation, Physiological↗

How hard-of-hearing and deaf children learn their names.

Data from a qualitative study on the literacy development of preschool hard-of-hearing and deaf children were analyzed to discover how the children learned to read, write, and spell or fingerspell their names. The research was conducted for 9 months in two preschool classes for hard-of-hearing and deaf children. Four hard-of-hearing and three deaf children participated. Data sources included extensive descriptive and interpretive field notes on classroom observations of the children, and drawing and writing samples from the children. Analysis revealed that the children learned that names are powerful expressions of identity through teacher demonstrations, immersion in a literacy-rich environment, and numerous opportunities to explore written language.

Child, Preschool↗

[Competency for teaching and learning nursing diagnosis].

This is a qualitative, exploratory, descriptive and interpretative study. The objective of the study is to relate the conceptions that professors and students have over competencies with the teaching-learning process of nursing diagnosis. The study was carried out at the Nursing School of the Federal University of Rio Grande do Sul. The information was collected in two stages. The first one through eight semi-structured individual interviews and the second one through two focus groups. One of them was formed by students and the other group was formed by professors. Content analysis was used as analysis methodology. As a result three categories were found: relation with knowledge, teaching-learning strategies and institutional context of the course.

Education, Nursing↗

Breast imaging reporting and data system standardized mammography lexicon: observer variability in lesion description.

OBJECTIVE: The American College of Radiology has recommended the Breast Imaging Reporting and Data System (BI-RADS) as a standardized scheme for describing mammographic lesions. The objective of this study was to measure inter- and intraobserver variabilities of radiologists' descriptions of mammographic lesions with the BI-RADS standardized lexicon. MATERIALS AND METHODS: Sixty mammographic studies with abnormal findings were independently evaluated by five radiologists. Readers described each lesion by selecting a single term from the BI-RADS lexicon for each of eight morphologic categories: calcification distribution, number, and description; mass margin, shape, and density; associated findings; and special cases. Additionally, each reader assessed the significance of each lesion on a five-point scale. One observer read each case twice. Inter- and intraobserver variabilities for each description and interpretation category of the BI-RADS lexicon were determined with Cohen's kappa statistic. Radiologists' specific use of calcification descriptors was evaluated in detail. RESULTS: Substantial agreement was observed between readers for choosing terms to describe masses and calcifications (kappa value range, 0.50 +/- 0.02-0.77 +/- 0.03). Intraobserver agreement for these categories was similar (kappa value range, 0.57 +/- 0.07-0.84 +/- 0.09). Considerable inter- and intraobserver variabilities were noted for the "associated findings" and "special cases" categories (kappa value range, -0.02 +/- 0.14-0.38 +/- 0.12), a result that in part reflected the small number of cases to which these categories were assigned. Moderate interobserver variability and little intraobserver variability in the interpretation of lesion significance were noted when an assessment classification similar to that of BI-RADS was used. Use of terms to describe calcifications did not always conform to BI-RADS-defined levels of suspicion. CONCLUSION: BI-RADS is moderately successful in providing a standardized language for physicians to describe lesion morphology. Efforts to reevaluate specific terms and the diagnostic significance assigned to calcification descriptors may prove useful in maintaining the promise of improved quality with the BI-RADS standardized mammography lexicon.

Adult↗

[The quantification of tuberculous disease in an Italian area and the estimation of underreporting by means of record linkage].

The description and interpretation of tuberculosis spatial and temporal variations in Italy is rather difficult because of well-grounded suspicions of disease underestimation, related with the bad working of the compulsory notification system. In this study, the record-linkage technique was used to estimate the proportion of TB undernotification in an Italian area, in order to give a first quantitative estimate of tuberculosis at a geographical level. The area considered was the Local Health Agency of Florence (population in 1994: 803,588) in 1995. Information for record-linkage was taken from: the Regional TB Archive, Hospital Discharge files, Laboratories, Pathology Departments, the Regional AIDS Registry, the Regional Mortality Registry. The linkage among the different sources was based on first and last name, date and place of birth, or only on first and last name for the laboratories. Prevalent cases and relapses were excluded through comparison with various historical archives. Most cases signalled only in hospital discharges were re-evaluated through original medical records. In such a way, the original sample was reduced from 690 to 182 cases incident in 1995, diagnosed in the area considered, and mostly resident in the same area. Among these cases, 98 (53.8%) were unknown to the compulsory notification system. The most of them come from hospital departments (27 cases) and from laboratories (47 cases). Fourty-nine of the unknown cases concerned pulmonary TB. The notification rate in the area moves then from 10.5/1000 to 22.7/1000.

Disease Notification↗