bluuebunny/crossref_metadata_2025 huggingface dataset:
Do Normal Leucocyte Count and C-Reactive Protein on Admission to Hospital Exclude a Life-Threatening Attack of Acute Pancreatitis?
Authors: Hämäläinen M. T. , Grönroos P. , Grönroos J. M.
Published: July 2017

Background and Aims:

The early severity assessment of an attack of acute pancreatitis is clinically of utmost importance. The aim of the present work was to study the role of leucocyte count and C-reactive protein (CRP) measurements on admission to hospital in assessing the severity of an attack of acute pancreatitis. In particular, patients with a life-threatening attack of acute pancreatitis but a normal leucocyte count and CRP level were sought.

Material and Methods:

A total of 1050 attacks of acute pancreatitis were treated at Turku University Central Hospital during the years 1995–1999. Leucocyte count and C-reactive protein (CRP) value were determined on admission to hospital. There were 58 life-threatening attacks of acute pancreatitis (group A). Fifty-eight consecutive mild attacks served as controls (group B). The number of patients with both values normal, only leucocyte count raised, only CRP level raised and both values raised were calculated in the groups A and B.

Results:

Both leucocyte count and CRP level were significantly ( P < 0.001 in both comparisons) higher on admission to hospital in patients with a life-threatening disease (group A) than in those with a mild disease (group B). Group A contained no patients with both values in the normal range. In group B, one fifth of the patients had both values normal.

Conclusion:

It is very unlikely that acute pancreatitis proves to be a life-threatening one when both the leucocyte count and CRP are normal on admission to hospital. In the present 1050 acute pancreatitis there were no patients with life-threatening disease but normal laboratory values on admission.
Epidemiology of Liver Injuries
Authors: Talving P. , Beckman M. , Häggmark T. , Iselius L.
Published: July 2017

Background and Aims:

The aim of this study was to investigate the epidemiology of liver injuries and to grade injuries according to the Organ Injury Scale in a population-based study in Stockholm County comprising 1.75 million inhabitants.

Material and Methods:

Cases were retrieved from the National Board of Forensic Medicine and Public Health and Medical Services Committee Register. Autopsy reports and patients files were studied for liver injuries, associated injuries, age, sex, trauma mechanism, location of the injury, description of the injury, diagnostic and treatment modalities when available.

Results:

The incidence of traumatic liver injury in 1996 and 1997 was 2.95/100 000 annually. Seventy seven autopsies with liver injuries revealed injury pattern of grade I in 6 cases (8 %), grade II in 10 cases (13 %), grade III in 21 cases (27 %), grade IV in 15 cases (19 %), grade V in 16 cases (21 %) and grade VI in 9 cases (12 %). Twenty four patients revealed injury pattern of grade II in 13 cases (46 %), grade III in 4 cases (14 %), grade IV in 5 cases (18 %) and grade V in 2 cases (7 %).

Conclusions:

The results demonstrate a low incidence of liver injuries in the studied population. Grade II and III injuries prevail. Surgical management of liver injuries is an infrequent treatment option in Stockholm County and simple operative measures were applied. No complex hepatic injuries were operated upon.
Outcome and Long Term Results of Surgical Resection for Gastrointestinal Stromal Tumors (GIST)
Authors: Besana-Ciani I. , Boni L. , Dionigi G. , Benevento A. , Dionigi R.
Published: July 2017

Background and Aims:

Gastrointestinal Stromal Tumors (GIST) are rare; diagnosis and prognosis of these tumors are often complex. We present short and long term results of surgical resection for GIST at the Department of Surgery, University of Insubria, during a period of 14 years.

Material and Methods:

All patients' data, tumor characteristics, surgical procedure and survival data were analyzed retrospectively. Tumors were divided in risk classes using a new classification proposed by Fletcher, based on tumor size and number of mitosis.

Results:

From 1987 to 2001 19 patients underwent surgical resection for GIST. Stomach was the most common site of localization. Complete resection was achieved in 78.9 cases, while in 21.1 % radical resection was not possible. The mean tumor size was 8.4 cm (1.2–30 cm): < 5 cm diameter in 11/19 cases (58 %), 5–10 cm in 4/19 (21 %) and > 10 cm in 4/19 (21 %). Mitotic count was < 10/50 HPF in 68.5 % (13/19) and > 10/50 in 31.5 % (6/19). Using Fletcher's classification, tumors were divided in very low (8/19, 42.2 %), low (3/19, 15.8 %), intermediate (4/19, 21 %) and high risk (4/19, 21 %). The 5 years overall survival was 63 % and 34 % respectively with a statistically significant difference between tumors < 5cm and > 10 cm in diameter and between complete and incomplete resection. High risk tumors have a significantly shorter survival than low or very low risk.

Conclusions:

Our experience confirms that GIST are uncommon and aggressive cancers which prognosis is strictly related to tumor size and number of mitosis. Although significant advances on new chemotherapic regimes have been made, to date, radical surgical removal is the only chance of long term survival.
Common Femoral Artery — Uncommon Aneurysms
Authors: Savolainen H. , Widmer M. K. , Heller G. , Gerber M. , Carrel T. P. , Schmidli J.
Published: July 2017

Background and Aims:

Femoral artery aneurysms are rare. Their natural history, tendency to embolize or rupture are not well known.

Material and Methods:

Data of all patients seen 1996–2002 with femoral artery aneurysms at the Swiss Cardiovascular Center were analysed. Nine patients with 13 aneurysms of the common femoral artery (CFA) were identified. Only true aneurysms with a diameter of at least 2.5 cm were included. All patients were male, mean age 70 years (range: 57–85 years). Four patients had bilateral femoral aneurysms. Risk factors included hypertension (9/9), smoking (7/9). One of the aneurysms was palpable in 5/9. Four patients were asymptomatic, 5 had Fontaine class II claudication. Five patients also had an aortic aneurysm (AAA), one a thoracic aneurysm; and 6/9 popliteal aneurysms. In all patients, diagnosis was confirmed with duplex scan. Angiography was performed preoperatively.

Results:

The aneurysms were operated on electively using aneurysm secclusion and interposition grafting. There were no significant perioperative complications. Median hospital stay was 8 days.

Conclusion:

CFA aneurysms are rare. They are palpable in nearly half of the cases. They rarely cause thrombotic or embolic complications, but are almost always connected to other aneurysms. Patients with CFA aneurysms should be screened with duplex scan. Operative therapy is straightforward, few complications can be expected. Postoperative follow-up with annual duplex scans is suggested.
Primary Vascular Access Surgery in a Well Defined Geographical Region: Long-Term Results of Autogenous Arteriovenous Fistulas
Authors: Suominen V. , Heikkinen M. , Saarinen J. , Zeitlin R. , Wirta O. , Salenius J.
Published: July 2017

Background and Aims:

Autogenous fistula should be constructed in a minimum of 50 of all new ESRD patients scheduled for haemodialysis. The radio-cephalic fistula described by Brescia and colleagues in 1966 is considered to be the access of choice due to its good patency and low complication rate. The aim of this study was to evaluate the outcome of primary access surgery in a well-defined geographical region in Finland.

Material and Methods:

All primary vascular access procedures between 1990–1999 were selected in the local vascular registry. Additional data was collected from patients' case records. Kaplan-Meier method was used to calculate fistula patency. Multivariate analysis of four variables (age, gender, diabetes mellitus, smoking) was done to determine their association with primary success

Results:

407 primary procedures were done during the 10-year period including 405 (99.5 %) autogenous fistulas and two prosthetic grafts (0.5 %). 230 (56.8 %) fistulas were used for haemodialysis during the study. Cumulative primary functional patency at one year was 84.1 %, at two years 75.2 % and at five years 50.1 %. An attempt to salvage failing or failed fistula was done in only 15 (6.5 %) cases with insignificant impact on outcome. None of the tested variables was associated with poor functional success.

Conclusions:

The strategy of using native radio-cephalic fistula as a first access site results in excellent early and long-term functional patency for ESRD patient.
Gamma Probe Localization in the Surgical Treatment of Osteoid Osteoma
Authors: Kettunen J. S. , Mäkelä E. A. , Kauppinen T. A.
Published: July 2017

Background:

Osteoid osteoma is a benign bone tumor typically inducing night pain. It has traditionally been treated with operative excision. An accurate localization and complete removal of the small lesion is difficult resulting in high recurrence rate and reoperations.

Aims:

The purpose of the present study was to examine the applicability of a handheld gamma probe in the intraoperative localization of an osteoid osteoma.

Material and Methods:

Five patients were examined and operated for osteoid osteoma. Dose of 740 MBq Technetium 99m was injected 3 hours before operation, and handheld gamma probe was used for the intraoperative detection of the lesion.

Results:

All patients were relieved their symptoms. A histologically confirmed, complete removal of the lesion was achieved in 4 of 5 patients. No recurrences has been seen in the follow-up of 6 years.

Conclusions:

The gamma probe is an useful tool in the surgical treatment of osteoid osteoma. The technique is rapid and simple resulting in more accurate excision of the small lesion.
Inherited Forms of Renal Cell Carcinoma
Authors: Kiuru M. , Kujala M. , Aittomäki K.
Published: July 2017

It is estimated that up to 2% of renal cell cancer (RCC) clusters in families. Several forms of hereditary RCC have been characterized with specific clinical, histopathological, and genetic features. The most common of these is von Hippel-Lindau (VHL) disease caused by mutations in the VHL gene and predisposing to clear cell RCC. Predisposition to papillary RCC is present in hereditary leiomyomatosis and renal cell cancer (HLRCC) and hereditary papillary renal cell carcinoma (HPRC). Identification of the genetic defects causing these diseases has enlightened the molecular pathogenesis of RCC, and moreover, provided means to improve patient management. Genetic testing enables early diagnosis of the disease, after which individuals at-risk can be guided to regular surveillance. Screening facilitates detection of presymptomatic early tumors broadening treatment options and potentially improving prognosis. Thus, identification of individuals with inherited cancer susceptibility is important as special management of these patients improves disease outcome. The purpose of this review is to provide clues for identification and management of hereditary renal cancer patients in clinical practice.
Systemic Therapy in Metastatic Renal Cell Carcinoma
Authors: Pyrhönen S. O.
Published: July 2017

During the last two decades considerable advances have been made in the understanding of the biology of RCC. Although the best therapeutic options for patients with metastatic RCC have not been defined, it is apparent that use of immunomodulating cytokines like interferon-alpha and interleukin-2 either alone or combined with chemotherapeutic agents provides the best available results in routine clinical practice. Numerous studies have confirmed that objective tumour responses are seen only in a small fraction of patients (averagely in 15–20%). In spite of a lot of evidence that these treatments prolong survival, expectations of only 5–10% long-term survivals with complete and durable regression of tumours are realistic. Recently, some new promising investigational approaches have been reported. These may already in near future further improve overall treatment results.
Vaccination Immunotherapy — An Update
Authors: Doehn C. , Jocham D.
Published: July 2017

Renal cell carcinoma is often regarded as an “immunogenic tumor”. Organ-confined tumors are best treated by operative removal. Adjuvant strategies, however, may improve the outcome after operative therapy. Recently, a phase-III trial using an autologous renal tumor cell vaccine was able to demonstrate a reduction of the risk of progression in patients after radical nephrectomy for renal cell carcinoma larger than 2.5 cm. These results were achieved with minimal side effects.

Patients with metastases have a poor prognosis. Thirty years ago autologous tumor cell vaccination resulted in remissions in a small number of patients. Almost all vaccination reports focus on patients with metastatic renal cell carcinoma. These reports differ considerably in their modes of preparation, stimulation, application route and intervals and other relevant parameters. More important, clinical response is limited in most studies. For metastatic renal cell carcinoma none of the various vaccination approaches are being currently investigated in phase-III trials. Ongoing efforts focus on development of more powerful vaccines. This review summarizes vaccination approaches for renal cell carcinomas published in the past 4 years.
Care Pathways and The New NHS
Authors: Norris A.C.
Published: July 2017

This paper begins by discussing a definition of integrated care pathways (ICPs) that reveals their main features. It then reviews the status of care pathways within the UK and presents the results of a survey of attitudes and usage immediately prior to the general election of 1997. The paper then demonstrates the striking similarity between these features and the detailed proposals for policy and change laid out in the incoming Labour government's new blueprint for the National Health Service, The New NHS: Modern, Dependable. The paper ends by outlining the potential barriers to the successful adoption and use of care pathways and suggests ways of overcoming these difficulties so that ICPs become a powerful tool in the implementation and realization of The New NHS.
Joint Disease Management Ventures in the UK
Authors: Mason Anne , Drummond Michael , Towse Adrian
Published: July 2017

A postal questionnaire was sent out to individuals in the National Health Service (NHS) and in the pharmaceutical industry known to be involved in joint disease management ventures, details of which were available in the public domain. The questionnaire was designed to uncover information about the roles played by the partners in the venture, the disease areas covered and the use of guidelines.

Of the 25 joint disease management questionnaires sent out, 14 responses were received, giving a response rate of 56%. The ventures covered a range of diseases, but concentrated on respiratory and cardiovascular disease. Three of the projects were concerned with sexual health. The pharmaceutical industry acted in an enabling role in all these projects, offering support in the areas of finance, research, and communication and information technology expertise. In no case did a pharmaceutical company both provide and finance care directly.

This is the only case known to the authors of an attempt to collate information on joint disease management ventures in the NHS. However, it should be noted that the results presented in this paper cover only one quarter to one half of all the current NHS joint venture activity.
Managed Care: A Framework for Resource Allocation in the NHS
Authors: Smith Judith
Published: July 2017

In this article, resource allocation in the NHS is examined from the perspective of US managed care. A distinction is drawn between the roles of payers, commissioners and providers of health care, and the emergence of UK-style ‘health maintenance organisations’ (HMOs) is identified. The key features of US managed care are applied to case study pre-Primary Care Group (PCG) primary care organisations, and the importance of the contracting relationship and of patient choice emerge as issues for resource allocation. This is followed by a checklist of questions for resource allocation in the emerging PCGs and Primary Care Trusts — the true UK ‘HMOs’. The vital role of the Health Authority as system regulator is underlined.
How Much Information is Too Much Information for Patients?
Authors: Scott Alison
Published: July 2017

An effective pre-operative information-giving strategy is important in day surgery units, where a low pain score is essential for early discharge home. Good post-operative recovery at home is of utmost importance, as it has to be remembered that one-day surgery does not mean one-day recovery. Integrated care pathways (ICPs) have recognised and well documented benefits, and an ICP which includes a patient information strategy was thought likely to benefit staff and patients in the day surgery setting, where it is essential that patients receive timely, appropriate and evidenced-based care and information.

The benefits of giving patients pre-operative information are well documented, and a large majority of patients in this study ( n=100) received written pre-operative information prior to their admission to an orthopaedic day surgery ward. However, it was found that 49% ( n = 42) of patients would have preferred more information. The post-operative pain scores of these patients were demonstrably higher than those of patients who were satisfied with the information they received.
The Importance of Information Technology: A Regional Guide to the Development, Implementation and Evaluation of Integrated Care Pathways. Part 2
Authors: McSherry Rob , Scott Marie , Williams Stephen
Published: July 2017

The first article in this series1 briefly outlined the background to this project, the role and responsibilities of the project team and reference group, how the clinical teams were recruited, and why sharing and disseminating information gathered by the production of a CD-ROM was important. This second article builds on the previous by detailing the key processes and outcomes of the project offering practical advice and guidance on developing, implementing and evaluating integrated care pathways (ICPs). The intention is to share and disseminate information gathered, so that our experiences and those of our colleagues can assist other professional teams in developing ICPs as a vehicle to promote evidence-based practice within the context of clinical governance. To ease the process of sharing and dissemination, the information is available on CD-ROM.
Generic Care Pathway for Acute Geriatric Care and Rehabilitation as a Tool for Care Management, Discharge Planning and Continuous Clinical Audit
Authors: Suman S , Lockington T J
Published: July 2017

Acute medicine for older people is characterised by major diversity in the impairments, disabilities and social contexts encountered. A novel structured generic care pathway is presented to accommodate this diversity, facilitate case management and multidisciplinary teamwork, whilst building an auditable and researchable description of a complex system of care and of the process of discharge planning.
An Integrated Care Pathway for the Last Two Days of Life: A Pathway for Implementing a Pathway
Authors: Fowell Andrew , Finlay Ilora , Johnstone Ros , Minto Lindsey
Published: July 2017

Aim of the Paper:

To offer colleagues a method of monitoring the process of implementing an integrated care pathway (ICP) on a local level or, across a wide area.

Background:

A training pack was developed to assist with the Wales-wide implementation of an ICP for the last two days of life. The training pack includes a workbook, which is structured around seven stages recognised as being essential to the effective implementation of the pathway. The workbook is formatted in the same way as the pathway and as such is complete with a variance sheet. The variance sheet is utilised to record instances when a desired goal is not achieved and the reason why. The workbook represents a ‘Pathway for Implementing a Pathway’, which can be used to monitor the progress of implementation and highlight inhibiting and facilitating factors.

Methods:

The Wales-wide implementation of the ICP for the last two days of life, utilised the workbook as a pro forma for assessing the progress of implementation. Analysis of the variance sheets from the workbooks permitted the identification of inhibiting and facilitating factors contributing to the successful implementation of the pathway on a local and national level.

Findings:

Inhibiting factors affecting the implementation of an ICP include: local politics, fear of failure and lack of motivation. Facilitating factors range from, ‘top-down approval’ or gaining management commitment for the pathway, to ‘bottom-up motivation’, which entails enthusing colleagues as to the benefits of implementing the care pathway.

Conclusions:

The ‘Pathway for Implementing a Pathway’ is a useful tool for implementing an ICP. Although primarily developed to accompany the implementation of an integrated care pathway for the last two days of life, it would be interesting to assess the transferability of the implementation pathway to other clinical areas.
Controlled Evaluation of a Care Pathway for An Acute Episode of Schizophrenia
Authors: Mynors-Wallis L , Rastogi S , Virgo N , Kosky N , Howard A , Brake G
Published: July 2017

Background:

Care pathways have been produced for medical and surgical patients with some evidence that standards of care can be improved. This paper evaluates the use of a care pathway for the treatment of patients with an acute episode of schizophrenia.

Aims:

The aim of the study was to evaluate the use of a care pathway for the treatment of patients with schizophrenia.

Method:

A multidisciplinary team drew up and piloted a care pathway for schizophrenia. The final care pathway involved 45 standards for the acute and stabilisation phases of a schizophrenic illness. The pathway was implemented in six adult clinical teams. Outcomes for patients being treated on the care pathway were compared with a control group of patients with schizophrenia being cared for in six teams not implementing the pathway.

Results:

There were few significant differences in the care received between the two groups. There were no differences in terms of clinical outcome as measured by the Brief Psychiatric Rating Scale, the Clinical Global Impression, or the Camberwell Assessment of Need. There was also no difference in the mean number of inpatient days between the two groups.

Conclusion:

The care pathway for an acute episode of schizophrenia did not result in significant changes for patients either in terms of care received or in terms of clinical outcome.
An Evaluation of the Quality of Integrated Care Pathway Development in the UK National Health Service
Authors: Croucher Michelle
Published: July 2017

An integrated care pathway (ICP) is an outline of planned care for a specific patient group. It highlights usual practice that is evidence-based, from which variations occur as health-care professionals use their professional judgement.

The objectives of the study were to identify the key elements within an ICP, to formulate a checklist utilizing the ICP key elements, and to evaluate ICPs available from the UK National electronic Library for Health (NeLH) against the checklist. An ICP key elements checklist was produced from a review of ICP literature.

In all, 90% of the ICPs evaluated contained a plan of anticipated care along some form of timeline, including processes and outcomes. Also, 70% of the ICPs evaluated did not contain a variance-recording framework. In addition, 70% of the ICPs evaluated did not contain any evidence of evidence-based best practice.

This study shows that there is wide variability in the quality of the ICPs being developed in the UK National Health Service (NHS), and that the development of ICPs in many health-care organizations is inadequate. Variability of the ICPs being developed will have a direct impact on the quality of patient care, and improvements in care and service delivery may not be identified, implemented or reviewed. It is recommended that a tool be produced, which would provide a standard framework for NHS staff to follow when developing ICPs.
Evaluation of the Current Knowledge and Awareness of the Integrated Care Pathway Tool in a Local Health Community
Authors: Croucher Michelle
Published: July 2017

An integrated care pathway (ICP) identifies the patient's anticipated progress and ensures that any activities delivered by health- and social-care professionals are signed off, and that any variation from the intended practice is documented. Analysis of the variances from the ICP allows continuous assessment of process and outcomes against guidelines or standards.

The objectives of this study were to establish the current knowledge and awareness of the ICP tool within the local health community, and to find out how it may be improved. A semi-structured questionnaire was sent to 15 representatives at a senior manager or director level in the local health community. A response rate of 67% was achieved. The questionnaire data were examined using ‘content analysis' and ‘constant comparison’ methodology.

In all, 80% of the questionnaire respondents did not identify that the variance framework was an essential element of the ICP tool. A high number of questionnaire respondents identified some, but not the majority, of the benefits that the ICP tool can offer. A total of 60% of the respondents identified resources to assist in the development of ICPs. None of the respondents identified the National Electronic Library for Health (NeLH) as a main resource where guidance was available. However, 100% of the respondents stated that it would be beneficial if standardized national guidance were made available to support ICP development.

In conclusion, this study demonstrated that there is variability in the current level of knowledge and awareness of the ICP tool. It is therefore recommended that national guidance be produced, which would provide a standard framework for National Health Services staff to follow when developing ICPs. It is also recommended that improved provision and distribution of information on how ICPs can be used can lead to effective quality improvement programmes.
Disseminating and Sustaining the Integrated Care Pathway for the Last Days of Life Throughout Wales
Authors: Fowell Andrew , Johnstone Ros , Finlay Ilora
Published: July 2017

Implementation of the integrated care pathway for the last days of life throughout Wales was expected to gradually disseminate the use of the pathway across care settings in each of the 38 original localities. In January 2004, a brief postal survey was circulated among the 38 participating sites across Wales. These sites reflected four care settings, acute care, specialist inpatient care, hospice care and care in the community, and crossed the statutory and voluntary boundaries. Initially there was a 42% (16) response rate; this exceeded the expected response rate of 30% for postal surveys reported in the literature. Telephone follow-up and local knowledge supplemented the response data, bringing the final response rate to 63%. Overall, the dissemination of the pathway into clinical settings other than the original sites is taking place. It would seem that frequent staff changes affected the progress of the dissemination process. The need for regular ‘refresher’ sessions was highlighted, as was the requirement for a lead person to ‘drive’ the dissemination of the pathway.
What Happens When There is No Weekend Urology Cover? An Audit and Formation of a New Care Pathway
Authors: Durai R , Subramonian K , Ravi R , Dickinson I K
Published: July 2017

Objective:

An audit was conducted to find out whether there is any unnecessary delay in discharging patients after transurethral resection of the prostate (TURP).

Methods:

About 94 patients who underwent elective TURP over a period of seven months between April 2002 and October 2002 at Darent Valley Hospital were selected. Details were collected from the case-notes retrospectively.

Results:

The mean age of patients was 72.71 (range 57–90) and the mean postoperative hospital stay was 4.7 days (range 2–20). In all, 30 patients stayed for less than three days and 64 (68.1%) patients stayed for longer duration. Among these 64, 37 had underlying reasons for their prolonged stay and 27 (42%) had no obvious reason for their delay in discharge. Among these 27 (mean stay − 4.42 days), 16 (59.25%) were operated upon on Friday, eight (29.62%) on Thursday, three (11%) on Wednesday and none were operated upon on Monday.

Discussion:

Patients undergoing operations on Thursday and Friday stayed longer because of lack of urological cover during the weekend. Complications such as urinary tract infection (UTI) and excess bleeding can be minimized by implementing strict preoperative urine culture, antibiotic prophylaxis and spending a little extra time on haemostasis. If a patient fails his trial without a catheter it should not be removed again during the same admission. An anticoagulation nurse can help to reduce the stay for patients on warfarin. Nurses and junior doctors should be taught about how to reduce postoperative stay after TURP. A new care pathway, which allows nurses to remove the catheter without waiting for instructions, may be useful. A prospective audit is recommended.
Developing Culturally Competent Health Knowledge: Issues of Data Analysis of Cross-Cultural, Cross-Language Qualitative Research
Authors: Tsai Jenny Hsin-Chun , Choe John H. , Lim Jeanette Mu Chen , Acorda Elizabeth , Chan Nadine L. , Taylor Vicky , Tu Shin-Ping
Published: July 2017

There is a growing awareness and interest in the development of culturally competent health knowledge. Drawing on experience using a qualitative approach to elicit information from Mandarin- or Cantonese-speaking participants for a colorectal cancer prevention study, the authors describe lessons learned through the analysis process. These lessons include benefits and drawbacks of the use of coders from the studied culture group, challenges posed by using translated data for analysis, and suitable analytic approaches and research methods for cross-cultural, cross-language qualitative research. The authors also discuss the implications of these lessons for the development of culturally competent health knowledge.
Making the Switch to Digital Audio
Authors: Mitchell Shannon Gwin , Peterson James A. , Kaya Serdar
Published: July 2017

In this article, the authors describe the process of converting from analog to digital audio data. They address the step-by-step decisions that they made in selecting hardware and software for recording and converting digital audio, issues of system integration, and cost considerations. The authors present a brief description of how digital audio is being used in their current research project and how it has enhanced the “quality” of their qualitative research.
Metaphors as a Bridge to Understanding Educational and Social Contexts
Authors: Jensen Devon
Published: July 2017

Educational researchers and practitioners are frequently asking questions about how better to understand educational theory and practice. Through the years, they have employed a variety of both quantitative and qualitative methods to elucidate the world of education. In this article, the author explores the epistemological legitimacy of metaphor analysis as a viable means for qualitative educational inquiry. In so doing, he explores the concepts of the theory of abduction, educational research and social constructivism, categories of metaphors, and metaphorical analysis in educational research. In addition, a review of the literature on educational research that uses metaphor analysis as the primary methodology revealed five major themes.
The Qualitative Research Interview: Participants' Responsive Participation in Knowledge Making
Authors: Knapik Mirjam
Published: July 2017

Discussions of qualitative research interviews have centered on promoting an ideal interactional style and articulating the researcher behaviors by which this might be realized. Although examining what researchers do in an interview continues to be valuable, this focus obscures the reflexive engagement of all participants in the exchange and the potential for a variety of possible styles of interacting. The author presents her analyses of participants' accounts of past research interviews and explores the implications of this for researchers' orientation to qualitative research interviews.
Discovering Voice: A Participatory Action Research Study with Nurses in Uganda
Authors: Fournier Bonnie , Mill Judy , Kipp Walter , Walusimbi Mariam
Published: July 2017

In this article the authors present findings from a qualitative research study carried out with Ugandan nurses from September 2003 until June 2004. They highlight the process and philosophical basis of participatory action research (PAR) by reflecting on the challenges, opportunities, outcomes, and ethical issues encountered during the conduct of the research. In this study PAR fostered a climate in which nurses could engage in collective reflection on their practice, make sense of their experiences, and thereby change their understanding of their work.
Moral Geography of Focus Groups with Participants Who Have Preexisting Relationships in the Workplace
Authors: Hofmeyer Anne T. , Scott Catherine M.
Published: July 2017

Focus group interviews have become increasingly popular in the past three decades, but ethical issues related to conducting focus groups with participants who have preexisting power relationships in workplaces has received scant attention in the methodological qualitative literature. In this paper the authors offer three propositions to strengthen the moral geographical space between researchers and participants: (a) prior to data collection: highlight the risks and benefits of the method and stress that confidentiality cannot be assured outside the group; (b) during data collection: document group dynamics and encourage participants to share insights after the session; and (c) ongoing: researchers to research and write about the dynamics of the moral space between researcher-participant.
How to Get Focus Groups Talking: New Ideas that will Stick
Authors: Peterson Elizabeth R. , Barron Kevin A.
Published: July 2017

In this article the authors outline an innovative way of using sticky notes, such as Post-its, within focus groups to help facilitators stimulate discussion, draw out reluctant participants, structure information, and help produce a group outcome that all members feel they own. They outline how sticky notes can be used to generate information, check for understanding, and group and sort ideas.
Fotonovela as a Research Tool in Image-Based Participatory Research with Immigrant Children
Authors: Kirova Anna , Emme Michael
Published: July 2017

In this article the authors explore the effect of word-image relationships on the collection of data and the reporting of research results for a study involving the development of a series of fotonovelas with immigrant children in an inner-city school. The central question explored in this article is Can experiences such as producing visual narratives in the form of fotonovelas stimulate multiple expressions of voice and position and bring awareness of embodied ways of communicating in a culture-rich school context? The processes involved in collaboratively developing the photographic narrative format of the fotonovela combine visual elements and structures and embodied, reflective performance together with written text. As a research method fotonovela does not merely translate verbal into visual representations but constructs a hybrid photo-image-text that opens new spaces for dialogue, resistance, and representation of a new way of knowing that changes the way of seeing and has the potential to change the author's and the reader's self-understanding.
Little Voices and Big Ideas: Lessons Learned from Children about Research
Authors: Moore Tim , McArthur Morag , Noble-Carr Debbie
Published: July 2017

Over the past three decades social researchers have increasingly engaged children in projects that explore their experiences, views, and understandings. In this paper the authors share the observations of children involved in a project exploring family homelessness, particularly about what they think is important when conducting research with children and ways in which their views were implemented in the design and delivery of the project.
Picturing Reality: Power, Ethics, and Politics in Using Photovoice
Authors: Harley Anne
Published: July 2017

This article considers research into barriers to learning (including HIV/AIDS) in a small, rural town in KwaZulu-Natal, South Africa. A variety of qualitative participatory research methods were used, including photovoice, a method in which research participants take photographs and then decode these together with the researchers. Rich, thick data was obtained using photovoice, and the researchers found this method particularly useful for dealing with the ‘unspoken’ and working with marginalised people. This method, particularly because of the emotive nature of photographs, is also a potentially powerful political tool in exposing and exploring deepening levels of poverty and crisis experienced by the marginalised in post-apartheid South Africa. Photovoice as a method, however, raises issues of ethics and researcher-researched power dynamics; in particular, whether it is ethically acceptable to use photographs from consenting participants in light of the imbalance of power between the subject and the researcher, particularly in the context of HIV/AIDS. This article explores ethical and power issues in using the photovoice method.
Reflections on Visual Field Research
Authors: Tunnell Kenneth D.
Published: July 2017

This article describes ongoing visual field research by focusing on its self-reflective and auto-ethnographic components. Photographs and field notes are presented and personal encounters from the field are described. Recognizing the symbiotic order of the personal and political, the author details confrontations and emotions from ongoing efforts at recording visually.
Methodological Reflections on the Use of Asynchronous Online Focus Groups in Health Research
Authors: Williams Sarah , Clausen Maria Giatsi , Robertson Ann , Peacock Susi , McPherson Kerri
Published: July 2017

The Internet is increasingly used as a tool in qualitative research. In particular, asynchronous online focus groups are used when factors such as cost, time, or access to participants can make conducting face-to-face research difficult. In this article we consider key methodological issues involved in using asynchronous online focus groups to explore experiences of health and illness. The written nature of Internet communication, the lack of physical presence, and the asynchronous, longitudinal aspects enable participants who might not normally contribute to research studies to reflect on their personal stories before disclosing them to the researcher. Implications for study design, recruitment strategies, and ethics should be considered when deciding whether to use this method.
Work-Identity in Ethnographic Research: Developing Field Roles in a Demanding Workplace Setting
Authors: Jansson Gunilla , Nikolaidou Zoe
Published: July 2017

In this article we problematize our field roles as two linguistic ethnographers who aim to study the communication and documentation practices drawn upon by care workers in elderly care facilities in Sweden. Our field roles are discussed in relation to the complex nature of care workers' knowledge and competence, which results from three different aspects of their work-identities: institutional, professional, and individual. As researchers, we found ourselves in constant dialogue with the research participants, and our field roles were continuously shaped and reshaped according to the individuals and the situations in which we became involved. Even aspects of our own identities taken into the field, such as our background and personal qualities, proved to be important in establishing good relations with the care staff. Coming closer to the participants' professional identity proved to be of utmost importance for interpreting their choices and decisions in the workplace. Identity negotiation is presented here as a constructive way of discussing ethnographic field roles in the research field.
Reconceptualizing the Member Check Interview
Authors: Koelsch Lori E.
Published: July 2017

The member check has been heralded as an important component of validation in qualitative research. Traditionally, the member check has been used in order to assess the accuracy with which a researcher has represented a participant's subjectivity. Some theorists, however, have argued that change, rather than representation, should be sought as a primary goal for qualitative research. The difference between using representation or change as a marker of validity has been described as a transactional/transformational divide. I argue that the member check can be utilized to span this divide in order to support a holistic view of validity. In particular, I assert that researchers should not expect participant subjectivities to remain static throughout the research process. Examples of the member check used in this manner are provided.
Dissolving Dualisms: How Two Positivists Engaged with Non-Positivist Qualitative Methodology
Authors: Oliver Carolyn , Nesbit Susan , Kelly Niamh
Published: July 2017

This is the story of how a chemical engineer and a medical microbiologist overcame their positivist training and deeply held disciplinary attitudes to engage with non-positivist qualitative methodology. Through a series of facilitated reflections they explored what helped and hindered their transition from positivist to non-positivist inquiry. To move forward they needed to acknowledge the extent and nature of the transition they were making, find metaphors to dissolve troubling dualisms, and balance a desire to reach out to others with the need to manage the very real sense of vulnerability that came with embracing subjectivity. Their experiences suggest that pragmatism may be a useful bridging framework for the growing number of academics from the science, technology, engineering, and math (STEM) disciplines turning to qualitative methodologists for help to move beyond positivist research.
Exploring the Discursive Positioning of a Schizophrenic Inpatient via Method Triangulation
Authors: Kupferberg Irit , Gilat Izhak , Dahan Eyal , Doron Adiel
Published: July 2017

The article examines the contribution of method triangulation to the study of the self-construction of a schizophrenic inpatient in several encounters with a psychiatrist. We used institutional conversation analysis to probe the data for interactional sequence organization, while a positioning analysis enabled us to explore different levels of interpersonal positioning. Positioning is defined as a process whereby interlocutors locate one or several dimensions of their self in relation to others. Using these analyses, we identified, described, and interpreted the inpatient's discursive attempts, successes, and failures to construct who she was in the psychiatrist-inpatient encounters. The theoretical, methodological, and method frameworks are presented in the first, second, third, and fourth sections. Then, illustrative data are presented and analyzed in the fifth and sixth sections. Finally, the insights gained from the analyses, as well as the contribution of method triangulation, are elaborated on in the discussion.
Conceptualizing Autoethnography as Assemblage: Accounts of Occupational Therapy Practice
Authors: Denshire Sally , Lee Alison
Published: July 2017

Drawing on theoretical work within ethnography and poststructuralism, this article discusses a conceptualization of autoethnography as assemblage. The concept of assemblage includes but goes beyond the literal bringing together of a range of heterogeneous elements in different modalities to offer different perspectives on a phenomenon. It challenges and displaces boundaries between the individual and the social through a focus on practice, which offers a new ontology of the social. These ideas are illustrated through excerpts from an autoethnographic study of an occupational therapist working with young people in a Sydney children's hospital in the mid-1980s. The article makes visible a material, relational, and affective landscape of remembered practice. Through successive displacements of the self as the primary site of experience and meaning, we seek to contribute new understandings about the potential for autoethnography to engage with professional practice as a space of multiplicity.
Object-Interviews: Folding, Unfolding, and Refolding Perceptions of Objects
Authors: Nordstrom Susan Naomi
Published: July 2017

This article describes the object-interview as a Deleuzian space in which subjects and objects, living and nonliving, entangle together. I developed the object-interview to understand the connections that 11 Midwestern family history genealogists made between objects (e.g., documents, photographs, and other artifacts) and their ancestors. The object-interview suggests an alternative way to think and do qualitative interviews informed by poststructural theories. The method draws on French philosopher Deleuze's concepts of the fold, events, and a life, as well as conventional qualitative interview literature. Deleuze's concepts offer a way to rethink objects and subjects as fibrous, connective, and folding entities in qualitative interviews. Such a rethinking offers an alternative to subject-centered conventional qualitative interviews in which subjects are teased apart from objects and subjects primarily produce knowledge. The object-interview, then, is a Deleuzian space in which the supposed distinctions between subjects and objects, as well as other binary divisions, become indistinct, or entangled, as both subjects and objects produce knowledge. That space enabled me to create the concept ensemble of life—a constantly shifting group of objects associated with a person's life. In this article, I describe the theoretical entanglement of the object-interview, the object-interview itself, the data it produced in my dissertation study, and the significance of the method to the field of qualitative research methods.
Stories Rather than Surveys: A Journey of Discovery and Emancipation
Authors: Kendall Elizabeth , Marshall Catherine A. , Barlow Lauraine
Published: July 2017

Empirical research, which has traditionally been privileged in Western health disciplines, has left notable gaps in the implementation of health interventions for Indigenous people and in the knowledge of and respect for Indigenous ways of knowing, both locally and globally. This article emphasizes the notion of pluralism in health research, and the responsibility of non-Indigenous researchers to collaborate respectfully and at a personal level with Indigenous people. It explores the value of unexpected forms of knowledge, and the need to recognize the stories and narratives of research participants as valuable in themselves, rather than as something to be dissected or reinterpreted out of context. Through the exploration of one data collection experience, we show how research collaboration, negotiation, and respect can transcend the boundaries between Indigenous and non-Indigenous people, researchers and non-researchers, those with and without disabilities, and between countries.