The presence of stigmatizing language in the electronic health record (EHR) has been used to measure implicit biases that underlie health inequities. The purpose of this study was to identify the presence of stigmatizing language in the clinical notes of pregnant people during the birth admission. We conducted a qualitative analysis on N = 1117 birth admission EHR notes from two urban hospitals in 2017. We identified stigmatizing language categories, such as Disapproval (39.3%), Questioning patient credibility (37.7%), Difficult (...) patient (21.3%), Stereotyping (1.6%), and Unilateral decisions (1.6%) in 61 notes (5.4%). We also defined a new stigmatizing language category indicating Power/privilege. This was present in 37 notes (3.3%) and signaled approval of social status, upholding a hierarchy of bias. The stigmatizing language was most frequently identified in birth admission triage notes (16%) and least frequently in social work initial assessments (13.7%). We found that clinicians from various disciplines recorded stigmatizing language in the medical records of birthing people. This language was used to question birthing people's credibility and convey disapproval of decision‐making abilities for themselves or their newborns. We reported a Power/privilege language bias in the inconsistent documentation of traits considered favorable for patient outcomes (e.g., employment status). Future work on stigmatizing language may inform tailored interventions to improve perinatal outcomes for all birthing people and their families. (shrink)

The current study evaluates qualitatively how the mathematical dimension of gambling is reflected in the content of gambling websites. A number of gambling websites have been reviewed for their content in that respect. A statistical analysis recorded the presence of the mathematical dimension of gambling and its forms in the content of the participating websites, and a qualitative research study analyzed and assessed the quality of the content with respect to that dimension. The technical reports associated with this (...) study describe the methods used in the processes of review and content analysis, details of the processes, and the specific challenges and difficulties that they posed. (shrink)

This second technical report shows some partial results for the variables of the proposed statistical analysis and a discussion about some changes in sampling. In what concerns the qualitative analysis of content, the report presents the general predominant tendencies that get contoured with the first two samples.

Qualitative Analysis of Physical Problems ...

Ethics consultation is a commonly applied mechanism to address clinical ethical dilemmas. However, there is little information on the viewpoints of health care providers towards the relevance of ethics committees and appropriate application of ethics consultation in clinical practice. We sought to use qualitative methodology to evaluate free-text responses to a case-based survey to identify thematically the views of health care professionals towards the role of ethics committees in resolving clinical ethical dilemmas. Using an iterative and reflexive model we (...) identified themes that health care providers support a role for ethics committees and hospitals in resolving clinical ethical dilemmas, that the role should be one of mediation, rather than prescription, but that ultimately legal exposure was dispositive compared to ethical theory. The identified theme of legal fears suggests that the mediation role of ethics committees is viewed by health care professionals primarily as a practical means to avoid more worrisome medico-legal conflict. (shrink)

In this qualitative study, we aimed to identify and compare the ethical problems perceived by physicians and nurses in intensive care units at Baskent University hospitals in Turkey. A total of 21 physicians and 22 nurses were asked to describe ethical problems that they frequently encounter in their practice. The data were analyzed using an interactive model. The core problem for both physicians and nurses was end-of-life decisions (first level). In this category, physicians were most frequently concerned with euthanasia (...) while nurses were more concerned with do-not-resuscitate orders (second level). At the third level, we saw that almost all of the participants’ responses related to negative perceptions about euthanasia. Communication and hierarchical problems were the second most reported main category. Nurses were more likely to cite problems with hierarchy than physicians. At the third level, a large percentage of nurses described communication problems with authority and hierarchical problems with physicians. In the same category, physicians were most often concerned with communication problems with patients’ relatives. The ethical problems were reported at different frequencies by physicians and nurses. We asked the participants about ethical decision-making styles. The results show that nurses and physicians do not follow a systematic pattern of ethical decision making. (shrink)

Previous studies have shown that misperceptions and illusory experiences can occur if sensory stimulation is withdrawn or becomes invariant even for short periods of time. Using a perceptual deprivation paradigm, we created a monotonous audiovisual environment and asked participants to verbally report any auditory, visual or body-related phenomena they experienced. The data (analysed using a variant of interpretative phenomenological analysis) revealed two main themes: (1) reported sensory phenomena have different spatial characteristics ranging from simple percepts to the feeling of (...) immersion in a complex multisensory environment and (2) the active contribution of the perceiver where participants report engaging in exploratory processes even when there is nothing to find. Detailed analysis of the qualitative data further showed that participants who reported more perceptual phenomena were more likely to report internal bodily sensations, move more during the experiment and score higher on the Revised Hallucination Scale than those reporting fewer percepts explicitly linking perceptual deprivation to somatic phenomena. The results demonstrate how the variety of sensory experiences induced by perceptual deprivation can give further insight into the factors mediating conscious awareness and may suggest ways in which the brain imposes meaning on the environment under invariant sensory conditions. (shrink)

The article describes an approach of systematic, rule guided qualitative text analysis, which tries to preserve some methodological strengths of quantitative content analysis and widen them to a concept of qualitative procedure. First the development of content analysis is delineated and the basic principles are explained (units of analysis, step models, working with categories, validity and reliability). Then the central procedures of qualitative content analysis, inductive development of categories and deductive application of (...) categories, are worked out. The possibilities of computer programs in supporting those qualitative steps of analysis are shown and the possibilities and limits of the approach are discussed. (shrink)

Purpose The manner in which people, businesses and governments perform is changing because of the spread of technology. Digitalization of governments can be considered a necessity as we are now entering the era of the Internet-of-Things. The advantages and disadvantages of electronic governments have been examined in several research studies. This study aims to examine the attitudes of decision-makers towards e-government. The research aims are as follows: to determine the problems related with e-government usage, to establish the factors which decrease (...) the usage of e-government services and to propose recommendations for the effective application of e-government practices. Design/methodology/approach Qualitative research has been used for the study. Participants were chosen by the snowball sampling method, and face-to-face in-depth interviews were conducted with all decision-makers. In-depth interviews are more efficient and enable the acquisition of better qualitative information, in-depth knowledge and statistics, as the distance between the interviewer and interviewee is reduced. Questions asked can be categorized under two sections, where the questions in the first section are related to the decision-maker’s management style/managerial proposition, and in the second section, technological questions are asked in terms of the preferred communication method and the decision-makers’ attitudes towards e-government practices. Findings Decision-makers perceive electronic government to be important, while the level of importance is observed to be different among the decision-makers. Chronic problems exist in many countries, such as nepotism, where the decision-makers have conflicting arguments about e-government and the resulting effect on nepotism. Furthermore, the study also indicates that decision-makers are aware of the importance of mobile government, although they acknowledge that more time is required, as their country is still developing. Electronic voting is also perceived to be important, although the decision-makers believe that security and privacy issues need to be solved before related projects can be initiated. Originality/value This research can be a benchmark study for the decision-makers of small island developing states by means of e-government. The impediments preventing the effective application of e-government practices are also discussed in the study. This study will be useful to highlight the triggers and obstacles for e-government development in the context of a developing country. Internet penetration has increased significantly since the 2000s, and therefore, decision-makers need to consider the shift in citizens’ behaviour, such as the high usage of smartphones and the emergence of the Internet-of-Things. (shrink)

Power and organizational hierarchies are ubiquitous to social institutions that form the foundation of modern society. Power differentials may act to constrain or enhance people’s ability to make good ethical decisions. However, little scholarly work has examined perceptions of this important topic. The present effort seeks to address this issue by interviewing academics about hypothetical ethical problems that involve power differences among those involved. Academics discussed what they would do in these scenarios, often drawing on their own experiences. Using a (...) think-aloud protocol, participants were prompted to discuss their reasoning and thinking behind their ethical decisions. These interview data were content analyzed using a semantic analysis program that identified a number of distinct ways that academics think about power differences and abuses in ethical situations. Implications of these findings are discussed. (shrink)

Based on the control-value theory, this study qualitatively investigated the relationship between control-value appraisals, achievement emotions, and English-as-a-foreign-language performance, and explored other antecedents of achievement emotions in addition to control-value appraisals. Data were collected from six Chinese high school students through two semi-structured interviews and one focus group discussion. With thematic analysis, data were analyzed under the framework of the CVT using NVivo 11.0. Results indicate that high perceived control, high perceived extrinsic, and intrinsic values were interactively associated with (...) enjoyment, pride, and hope. Low perceived control, high perceived extrinsic value, and low perceived intrinsic value were interactively associated with fewer positive achievement emotions and more negative achievement emotions like fear. High perceived control, high perceived extrinsic value, and low perceived intrinsic value were interactively associated with fewer positive achievement emotions, and more negative achievement emotions like anguish. Besides, positive achievement emotions were positively associated with EFL performance, while negative achievement emotions were negatively associated with EFL performance. Moreover, factors inside the classroom, factors outside the classroom, and personal factors were found to be the antecedents of achievement emotions in EFL learning. (shrink)

Numerous instruments have been developed to elicit numerical values that represent the strength of preference for different health states. However, relatively few studies have attempted to analyse the reasoning processes that people employ when they are asked to answer questions based on these elicitation methods. The lottery equivalents method is a preference elicitation instrument that has recently received some attention in the literature. This study attempts a qualitative analysis of the use of this instrument on a group of (...) 25 relatively highly educated respondents. For each of three health states considered in the study, a substantial number of respondents refused to trade the chance of survival for a possible improvement in the health state. Therefore, many respondents violated an assumption that is necessary for the lottery equivalents instrument to generate cardinal health state values. These findings place a question mark against the usefulness of the lottery equivalents method, and add weight to the suspicion that ‘preferences’ are constructed according to how questions are framed. (Published Online July 31 2007). (shrink)

In this article, we take a closer look at the possible effects of adopting the IAS/fifrs standards around the globe. In order to determine what the IASB opinion regarding this impact is, we turned to the concerns of trustees. Using 3 interviews conducted with three of the trustees of IFRS on the possibility of creating a global accounting language, we realized a content analysis of the responses given. The results obtained after auto coding the responses of the trustees in (...) NVivo, a program used in qualitative analysis, highlighted that standards adoption is an important part of the accounting process in multiple countries, national experiences being significant to the board of trustees in order to make improvements to standards at a global level. (shrink)

The use of student evaluations of teaching (SET) has become a widespread practice in higher education despite inconclusive evidence reported in the literature around its validity. Not surprisingly, the question of the validity of SET continues to be a current debate in higher education, pointing to the need for more research in this area. This paper is a part of a larger scale study, which aims to contribute to broadening the knowledge and understanding of SET validity by analysing the process (...) within the South East European University (SEEU) in North Macedonia in order to determine whether student evaluations are objective and critical. A likert scale questionnaire, containing 9 questions, was designed for the purpose of the analysis. The questionnaire was sent to all students from the five (5) Faculties: Business and Economics, Law, Contemporary Sciences and Technologies, Contemporary Social Sciences and Faculty of Languages, Cultures and Communications, in both campuses, Tetovo and Skopje. Three hundred and thirty three (333) students participated in the survey. Statistical Package for Social Science (SPSS) was used for analysing the results. Findings revealed that the information students received about the reputation, experience and qualifications of the professors had the highest influence on their perceptions, which in turn influenced the evaluations. As an addition, the present paper also compares two methods on a data set of actual SET. For illustrative purposes, only data from one faculty have been analysed. It is shown that the traditional method of considering the average values can misrepresent a teacher’s performance as it can be highly sensitive to any extreme grades, being either very positive or very negative. (shrink)

As the use of automated social media analysis tools surges, concerns over accuracy of analytics have increased. Some tentative evidence suggests that sarcasm alone could account for as much as a 50% drop in accuracy when automatically detecting sentiment. This paper assesses and outlines the prevalence of sarcastic and ironic language within social media posts. Several past studies proposed models for automatic sarcasm and irony detection for sentiment analysis; however, these approaches result in models trained on training data (...) of highly questionable quality, with little qualitative appreciation of the underlying data. To understand the issues and scale of the problem, we are the first to conduct and present results of a focused manual semantic annotation analysis of two datasets of Twitter messages, associated with; hashtags commonly employed in automated sarcasm and irony detection approaches, and tweets relating to 25 distinct events, including, scandals, product releases, cultural events, accidents, terror incidents, etc. We also highlight the contextualised use of multi-word hashtags in the communication of humour, sarcasm and irony, pointing out that many sentiment analysis tools simply fail to recognise such hashtag-based expressions. Our findings also offer indicative evidence regarding the quality of training data used for automated machine learning models in sarcasm, irony and sentiment detection. Worryingly only 15% of tweets labelled as sarcastic were truly sarcastic. We highlight the need for future research studies to rethink their approach to data preparation and a more careful interpretation of sentiment analysis. (shrink)

A diffusive predator-prey system with both the additive Allee effect and the fear effect in the prey subject to Neumann boundary conditions is considered in this paper. Firstly, non-negative and non-trivial solution a priori estimations are shown. Furthermore, for specific parameter ranges, the absence of non-constant positive solutions is demonstrated. Secondly, we use the linearized theory to investigate the stability of non-negative constant solutions. The spatially homogeneous and non-homogeneous periodic solutions, as well as non-constant steady state solutions, are next investigated (...) by using Allee effect parameters as the bifurcation parameter. Finally, numerical simulation is used to illustrate some theoretical results. (shrink)

The current technical report presents the partial results of the quantitative analysis of the research project, after the review of 247 gambling websites. It is focused on and discusses the usage of the math terms specific to gambling in the reviewed sample. In particular, the fifth technical report discusses the usage of math terms associated with the game of slots, as found in the reviewed sample.

Human Research Ethics Committee (HREC) reviewers often provide similar feedback across applications, which suggests that the problem lies in researcher awareness of key issues rather than novel, unsolvable challenges. If common problems can be addressed before lodgement by applicants referencing clear evidence-based supports (e.g., FAQs on common application shortcomings), it would improve efficiency for HREC members and expedite approvals. We aim to inform such supports by analysing the patterns in the most frequent feedback made by HREC members during review processes. (...) We collected every instance (N = 4,195) of feedback made on N = 197 ‘low-risk’ protocols by all HREC staff (N = 16) at one institution over the course of a full year (2019). Reflexive thematic analysis to identify themes (and content analysis to determine relative frequency) revealed that the top three themes are consistent with existing literature: Consent, Administrative, and Methodological concerns. However, we identified important new themes that are not captured in previous research, including ‘Risk to Researchers’, ‘Commercial benefit, scope and scale’, ‘Diversity’ (covering issues of cultural sensitivity, language and accessibility), as well as fair right to a complaints process. Our thorough exploration of information-rich primary data marks an important methodological improvement over previous studies and offers a theoretical contribution to understanding themes that have heretofore been overlooked in the ethics review process. By identifying the common challenges experienced in HREC review we can better inform tailored supports to applicants (by extension reducing workload burdens on HREC systems) and reduce their perceived barriers to engaging in challenging but meaningful research. (shrink)

Purpose As Big Data and Artificial Intelligence (AI) proliferate, calls have emerged for ethical reflection. Ethics guidelines have played a central role in this respect. While quantitative research on the ethics guidelines of AI/Big Data has been undertaken, there has been a dearth of systematic qualitative analyses of these documents. Design/methodology/approach Aiming to address this research gap, this paper analyses 70 international ethics guidelines documents from academia, NGOs and the corporate realm, published between 2017 and 2020. Findings The article (...) presents four key findings: existing ethics guidelines (1) promote a broad spectrum of values; (2) focus principally on AI, followed by (Big) Data and algorithms; (3) do not adequately define the term “ethics” and related terms; and (4) have most frequent recourse to the values of “transparency,” “privacy,” and “security.” Based on these findings, the article argues that the guidelines corpus exhibits discernible utilitarian tendencies; guidelines would benefit from greater reflexivity with respect to their ethical framework; and virtue ethical approaches have a valuable contribution to make to the process of guidelines development. Originality/value The paper provides qualitative insights into the ethical discourse surrounding AI guidelines, as well as a concise overview of different types of operative translations of theoretical ethical concepts vis-à-vis the sphere of AI. These may prove beneficial for (applied) ethicists, developers and regulators who understand these guidelines as policy. (shrink)

The aim of this article is to show that statistical analysis and hermeneutics are not mutually exclusive. Although statistical analysis may capture some patterns and regularities, statistical methods may themselves generate different types of interpretation and, in turn, give rise to even more interpretations. The discussion is lodged within the context of a quantitative analysis of dream content. I attempted to examine the dialogical texts of reported dreams monologically, but soon found myself returning to dialogic contexts to (...) make sense of statistical patterns. One could cogently argue that the reported statistical relationships in this study, rather than pointing to any interaction among the "signifieds," speak only to the relationships among the "signifiers" that were being played out through various actors on the analytic or scientific stage, since all of the constructs used in theorizing about, interpreting, and telling dreams come from the same discursive system. (shrink)

The arrival of refugee pupils in UK schools has presented significant challenges to staff, pupils and families. The aim of this study was to record and analyse the views of teaching staff regarding their experiences of integrating these pupils into schools in Newcastle upon Tyne. A questionnaire was sent to 53 schools in the city known to have pupils who are refugees or asylum seekers. Questions focused on key issues identified by the Local Education Authority Working Group for Refugees and (...) Asylum Seekers, including the dissemination of information prior to the arrival of new pupils, staff training and the response of the school community as a whole. Twenty?four questionnaires were completed (response rate 45.3%), from two nurseries, 13 primary schools, seven secondary schools and one special school. The overwhelming need identified was for improved access to interpreting services, and more reliable information about pupils? backgrounds. It was evident that integration is approached differently by individual schools depending on their overall ethnic mix and the availability of resources and support networks. (shrink)

Many Western nations are emphasizing the importance of population health across health care delivery organizations and education systems. Despite significant momentum to integrate population health into nursing practice, a parallel effort to examine how these efforts impact practicing nurses' views of their professional role and work identity has not occurred. This secondary qualitative analysis, employing an abductive approach, explored processes public health nurses use in creating and maintaining their work identity through three organizing themes: narrative self‐identity, mandated identity, (...) and identity as struggle. The analysis was based on interview data collected from 30 US public health nurses residing in 17 states. ‘Being a real nurse’ describes public health nurses' efforts to balance a contradictory work identity where at times they are expected to focus on populations and at other times, on individuals. The identity work revealed through this study should be further explicated and specific strategies developed for stabilizing a work identity for public health nurses, as well as for any nurse charged with a population health role. (shrink)

Next SectionBackground: Physicians face ethical difficulties daily, yet they seek ethics consultation infrequently. To date, no systematic data have been collected on the strategies they use to resolve such difficulties when they do so without the help of ethics consultation. Thus, our understanding of ethical decision making in day to day medical practice is poor. We report findings from the qualitative analysis of 310 ethically difficult situations described to us by physicians who encountered them in their practice. When (...) facing such situations, the physicians sought to avoid conflict, obtain assistance, and protect the integrity of their conscience and reputation, as well as the integrity of the group of people who participated in the decisions. These goals could conflict with each other, or with ethical goals, in problematic ways. Being aware of these potentially conflicting goals may help physicians to resolve ethical difficulties more effectively. This awareness should also contribute to informing the practice of ethics consultation. Objective: To identify strategies used by physicians in dealing with ethical difficulties in their practice. Design, setting, and participants: National survey of internists, oncologists, and intensive care specialists by computer assisted telephone interviews (n = 344, response rate = 64%). As part of this survey, we asked physicians to tell us about a recent ethical dilemma they had encountered in their medical practice. Transcripts of their open-ended responses were analysed using coding and analytical elements of the grounded theory approach. Main measurements: Strategies and approaches reported by respondents as part of their account of a recent ethical difficulty they had encountered in their practice. Results: When faced with ethical difficulties, the physicians avoided conflict and looked for assistance, which contributed to protecting, or attempting to protect, the integrity of their conscience and reputation, as well as the integrity of the group of people who participated in the decisions. These efforts sometimes reinforced ethical goals, such as following patients’ wishes or their best interests, but they sometimes competed with them. The goals of avoiding conflict, obtaining assistance, and protecting the respondent’s integrity and that of the group of decision makers could also compete with each other. Conclusion: In resolving ethical difficulties in medical practice, internists entertained competing goals that they did not always successfully achieve. Additionally, the means employed were not always the most likely to achieve those aims. Understanding these aspects of ethical decision making in medical practice is important both for physicians themselves as they struggle with ethical difficulties and for the ethics consultants who wish to help them in this process. (shrink)

Summary The purpose of this study was to illustrate and analyze the organizational change the Swedish voluntary sports club IF Björklöven went through in connection with the corporation formation of its representative team. The study was made with institutional theory as a theoretical frame of reference. Particularly important for the shaping of the study was a theoretical model by Greenwood and Hinings. The data was collected using semi-structured interviews with seven respondents representing different parts of the organization. The results show (...) that the change process was driven and enabled for the most part by the offer of SEK 22.5 million from an external financier. The restructuring has brought about a change in the way Björklöven thinks about the outcome, purpose, structure and goals of the organization, now that the organization is moving towards a more market-oriented way of organizing. (shrink)

Evidential pluralists, like Federica Russo and Jon Williamson, argue that causal claims should be corroborated by establishing both the existence of a suitable correlation and a suitable mechanism complex. At first glance, this fits well with mixed method research in the social sciences, which often involves a pluralist combination of statistical and mechanistic evidence. However, statistical evidence concerns a population of cases, while mechanistic evidence is found in individual case studies. How should researchers combine such general statistical evidence and specific (...) mechanistic evidence? This article discusses a very recent answer to this question, ‘multi-method large-N qualitative analysis’ or multi-method LNQA, popular in political science and international relations studies of rare events like democratic transitions and cease-fire agreements. Multi-method LNQA combines a comprehensive study of all relevant event cases with statistical analysis, in an attempt to solve the issues of generalization faced by other types of qualitative research, such as selection bias and lack of representativeness. I will argue that the kind of general causal claim that multi-method LNQA is after, however, is crucially different from the average treatment effect found in statistical analysis and can in fact only be supported with mechanistic evidence. I conclude from this that mixed method research, and thereby evidential pluralism, may be inappropriate in this context. (shrink)

The increasing interconnectedness of academic research and external industry has left research vulnerable to conflicts of interest. These conflicts have the potential to undermine the integrity of scientific research as well as to threaten public trust in scientific findings. The present effort sought to identify themes in the perspectives of faculty researchers regarding conflicts of interest. Think-aloud interview responses were qualitatively analyzed in an effort to provide insights with regard to appropriate ways to address the threat of conflicts of interest (...) in research. Themes in participant responses included disclosure of conflicts of interest, self-removal from situations where conflict exists, accommodation of conflict, denial of the existence of conflict, and recognition of complexity of situations involving conflicts of interest. Moral disengagement operations are suggested to explain the appearance of each identified theme. In addition, suggestions for best practices regarding addressing conflicts of interest given these themes in faculty perspectives are provided. (shrink)

Corporate sustainability reports are supposed to provide a complete and balanced picture of corporate sustainability performance. They are, however, usually voluntary and thus prone to interpretation and even greenwashing tendencies. To overcome this problem, the Global Reporting Initiative (GRI) provides standardized reporting guidelines challenging companies to report positive and negative aspects of an organization’s sustainability performance. However, the reporting of “negative aspects” in particular can endanger corporate legitimacy if perceived by the stakeholders as not being in line with societal norms (...) and values. Starting from the theoretical lenses of economics-based disclosure theories and socio-political theories of disclosure, the focus of this study therefore was to analyze the communicative legitimation strategies companies use to report “negative aspects,” i.e., negative ecological and social impact caused by corporate activity. Using qualitative content analysis of GRI-oriented sustainability reports from companies listed on the US Dow Jones Industrial Average Index and on the German DAX Index, we identified six legitimation strategies. We discuss these strategies regarding to symbolic and substantial management of legitimacy. We show that symbolic legitimation strategies aiming at modifying the perception of legitimizing stakeholders dominate in the reports at hand. Such persuasion, however, does not meet the requirement of impartiality as postulated by the GRI guidelines. Building upon this conclusion we propose a concise characterization of “negative aspects” and develop a GRI-compliant schema of reporting about them. In doing so, we offer a way to improve the overall “balance” of sustainability reporting contributing to a true and fair view in sustainability disclosure. (shrink)

The current technical report of the research project investigating how the mathematical dimension of gambling is reflected in the communication and texts associated with the gambling industry raises the problem of the adequacy of sampling and proposes a new approach in this respect. The qualitative analysis of the reviewed websites is extended to a deeper analysis of language and also to the organization and structure of websites’ content. Although not stated as a goal of the initial project, (...) the research will also try to identify relationships between the specificity of content relative to the mathematical dimension of gambling, and the management and marketing of the website. An overview of the results of the statistical analysis of the current sample is also presented. (shrink)

Deep brain stimulation of the subthalamic nucleus for the treatment of Parkinson’s disease can lead to the development of neuropsychiatric symptoms. These can include harmful changes in mood and behaviour that alienate family members and raise ethical questions about personal responsibility for actions committed under stimulation-dependent mental states. Qualitative interviews were conducted with twenty participants following subthalamic DBS at a movement disorders centre, in order to explore the meaning and significance of stimulation-related neuropsychiatric symptoms amongst a purposive sample of (...) persons with PD and their spousal caregivers. Interview transcripts underwent inductive thematic analysis. Clinical and experiential aspects of post-DBS neuropsychiatric symptoms were identified. Caregivers were highly burdened by these symptoms and both patients and caregivers felt unprepared for their consequences, despite having received information prior to DBS, desiring greater family and peer engagement prior to neurosurgery. Participants held conflicting opinions as to whether emergent symptoms were attributable to neurostimulation. Many felt that they reflected aspects of the person’s “real” or “younger” personality. Those participants who perceived a close relationship between stimulation changes and changes in mental state were more likely to view these symptoms as inauthentic and uncontrollable. Unexpected and troublesome neuropsychiatric symptoms occurred despite a pre-operative education programme that was delivered to all participants. This suggests that such symptoms are difficult to predict and manage even if best practice guidelines are followed by experienced centres. Further research aimed at predicting these complications may improve the capacity of clinicians to tailor the consent process. (shrink)

Background Patients with chronic pain face significant barriers in finding clinicians to manage long-term opioid therapy (LTOT). For patients on LTOT, it is increasingly common to have them sign opioid treatment agreements (OTAs). OTAs enumerate the risks of opioids, as informed consent documents would, but also the requirements that patients must meet to receive LTOT. While there has been an ongoing scholarly discussion about the practical and ethical implications of OTA use in the abstract, little is known about how clinicians (...) use them and if OTAs themselves modify clinician prescribing practices.Objective To determine how clinicians use OTAs and the potential impacts of OTAs on opioid prescribing.Design We conducted qualitative analysis of four focus groups of clinicians from a large Midwestern academic medical center. Groups were organized according to self-identified prescribing patterns: two groups for clinicians who identified as prescribers of LTOT, and two who did not.Participants 17 clinicians from General Internal Medicine, Family Medicine, and Palliative Care were recruited using purposive, convenience sampling.Approach Discussions were recorded, transcribed, and analyzed for themes using reflexive thematic analysis by a multidisciplinary team.Key Results Our analysis identified three main themes: (1) OTAs did not influence clinicians’ decisions whether to use LTOT generally but did shape clinical decision-making for individual patients; (2) clinicians feel OTAs intensify the power they have over patients, though this was not uniformly judged as harmful; (3) there is a potential misalignment between the intended purposes of OTAs and their implementation.Conclusion This study reveals a complicated relationship between OTAs and access to pain management. While OTAs seem not to impact the clinicians’ decisions about whether to use LTOT generally, they do sometimes influence prescribing decisions for individual patients. Clinicians shared complex views about OTAs’ purposes, which shows the need for more clarity about how OTAs could be used to promote shared decision-making, joint accountability, informed consent, and patient education. (shrink)

BackgroundFew studies have paid attention to ethical responsibility related to malnutrition in elder care. The aim was to illuminate whether politicians and civil servants reason about malnutrition in elder care in relation to ethical responsibility, and further about possible causes and how to address them.MethodEighteen elected politicians and appointed civil servants at the municipality and county council level from two counties in Sweden were interviewed. They worked at a planning, control and executive level, with responsibility for both the elder care (...) budget and quality of care. Qualitative method was used for the data analysis.ResultsTwo themes emerged from their reasoning about malnutrition related to ethical responsibility. The theme assumed role involves the subthemes quality of care and costs, competent staff and govern at a distance. Old and ill patients were mentioned as being at risk for malnutrition. Caregivers were expected to be knowledgeable and stated primary responsible for providing adequate nutritional care. Extended physician responsibility was requested owing to patients' illnesses. Little was reported on the local management's role or on their own follow-up routines. The theme moral perception includes the subthemes discomfort, trust and distrust. Feelings of discomfort concerned caregivers having to work in a hurried, task-oriented manner. Trust meant that they believed for the most part that caregivers had the competence to deal appropriately with nutritional care, but they felt distrust when nutritional problems reappeared on their agenda. No differences could be seen between the politicians and civil servants.ConclusionNew knowledge about malnutrition in elder care related to ethical responsibility was illuminated by persons holding top positions. Malnutrition was stressed as an important dimension of the elder care quality. Governing at a distance meant having trust in the staff, on the one hand, and discomfort and distrust when confronted with reports of malnutrition, on the other. Distrust was directed at caregivers, because despite the fact that education had been provided, problems reappeared. Discomfort was felt when confronted with examples of poor nutritional care and indicates that the participants experienced failure in their ethical responsibility because the quality of nutritional care was at risk. (shrink)

Background Although it is the moral duty of physicians to protect vulnerable patients, there are no data on how vulnerability is perceived in clinical practice. This study explores how physicians classify someone as “vulnerable”. Method Thirty-three physicians were initially questioned about resource allocation problems in their work. The results of these interviews were examined with qualitative study software to identify characteristics associated with vulnerability in patients. Data were conceptualized, classified and cross-linked to highlight the major determinants of vulnerability. The (...) findings revealed the principal factors that make patients vulnerable in clinical practice, according to our definition of vulnerability: the likelihood of having one’s interests unjustly considered. Results Vulnerability can arise as a result of a mismatch between the characteristics of patients and physicians, the healthcare system, the treatment, or the communication between physicians and patients. Vulnerability appears as a gap between a patient’s needs and the means intended to meet them. Vulnerability can further be the result of doing too little or too much for patients. This result suggests that structures provided by healthcare systems are not as differentiated as they should be to cover all situations. Our initial definition of vulnerability was illustrated and supported by our results, showing that it encompasses all factors involved, not solely personal characteristics, indicating the need for a more pragmatic approach for use in clinical practice. Conclusion Vulnerability is not due to a single factor but appears under certain circumstances when there is a discrepancy between a patient’s interests and the care provided, despite existing compensation systems. (shrink)

As the field of clinical ethics consultation sets standards and moves forward with the Quality Attestation process, questions should be raised about what ethical issues really do arise in practice. There is limited data on the type and number of ethics consultations conducted across different settings. At Loyola University Medical Center, we conducted a retrospective review of our ethics consultations from 2008 through 2013. One hundred fifty-six cases met the eligibility criteria. We analyzed demographic data on these patients and conducted (...) a content analysis of the ethics consultation write-ups coding both the frequency of ethical issues and most significant, or key, ethical issue per case. Patients for whom ethics consultation was requested were typically male, white, between 50 and 69 years old, of non-Hispanic origin, and of Roman Catholic faith. Nearly half were in the intensive care unit and 44.2 % died in the hospital. The most frequent broad ethical categories were decision-making, goals of care/treatment, and end-of-life. More specifically, capacity, patient’s wishes/autonomy, and surrogate decision maker were the most frequent particular ethical issues. The most common key ethical issues were withdrawing/withholding treatment, patient wishes/autonomy, and capacity. Our findings provide additional data to inform the training of clinical ethics consultants regarding the ethical issues that arise in practice. A wider research agenda should be formed to collect and compare data across institutions to improve education and training in our field. (shrink)