How physiotherapists perceive,interpret, and respond to the ethical dimensions of practice: A qualitative study

The profile and reach of physiotherapy has expanded in areas of extended scope of practice, and broader engagement with population needs beyond the individual treatment encounter. These changes raise increasingly complex ethical challenges evidenced by growth in physiotherapy-based ethics studies and discussions. This paper examines how a broad cross section of Australian physiotherapists perceive, interpret, and respond to ethical challenges in their work contexts and how professional codes of conduct are used in their practice. Using an interpretive qualitative methodology, purposive sampling of 88 members of national clinical special interest groups were recruited for focus group discussions. Narrative-based and thematic data analysis identified ethical challenges as emerging from specific clinical contexts, and influenced by health organizations, funding policies, workplace relationships, and individually held perspectives. Five themes were developed to represent these findings: (1) the working environment, (2) balancing diverse needs and expectation, (3) defining ethics, (4) striving to act ethically, and (5) talking about ethics. The results portray a diverse and complex ethical landscape where therapists encounter and grapple with ethical questions emerging from the impact of funding models and policies affecting clinical work, expanding boundaries and scope of practice and changing professional roles and relationships. Codes of conduct were described as foundational ethical knowledge but not always helpful for “in the moment” ethical decision-making. Based on this research, we suggest how codes of conduct, educators, and professional associations could cultivate and nurture ethics capability in physiotherapy practitioners for these contemporary challenges.     

Die Bedeutung von Assessments in der Ausbildung diplomierter Rettungssanitäter

Learning and exams are closely interconnected. Test elements should accompany the learning process and not only serve to complete the training period. Examinations should be oriented toward the ideas learned and the forms of instruction used. However, the significance of examinations during the training period for emergency medical technicians is hardly ever addressed in the literature. All of the procedures that serve to evaluate the students’ performance are subsumed under the term “assessments.” This contribution presents the tasks of assessments and their requirements for occupational training of certified emergency medical technicians. It also offers a suggestion to develop a modern testing concept.     

Membrane transferrin receptor (TfR) and nuclear proliferation-associated Ki-67 expression in hemopoietic malignancies

The expression of membrane transferrin receptors (TfRs), as defined by monoclonal antibody OKT9, and the nuclear proliferation-associated antigen Ki-67 were examined in 159 cases of hematological malignancy. Of the "chronic" B and T cell leukemias studied (n = 85), 61% showed less than 5% OKT9-positive cells and only 7% of cases were TfR+ (defined as greater than 20% positive cells). For comparison, the acute leukemias (n = 62) showed higher (p less than 0.001) TfR expression with 39% TfR+ cases, although there was considerable variation within diagnostic subgroups. Nuclear Ki-67 expression was generally insignificant (less than 1%) in chronic leukemias (78 of 88 cases), although two of eight B cell-type prolymphocytic leukemia and four of four cases of plasma cell leukemia showed greater than 10% Ki-67+ components. In contrast, 47% (31 of 66) acute leukemias had greater than 10% Ki-67+ cells, although there appeared to be no relationship between Ki-67 expression and leukemic type. Combined assessments of TfR and Ki-67 expression revealed a Ki-67- TfR- phenotype in 82% of chronic leukemias, compared with 28% of acute type, and a Ki-67+ TfR+ pattern was found in 27% of acute proliferations but not in any case of chronic leukemia. The determination of membrane TfR expression appears to have little value in the diagnostic differentiation of leukemias, whereas Ki-67 is considered to be a useful supplementary investigation in defining high grade tumors, in the recognition of prognostically poor cases of otherwise well defined low grade malignancy, and of potential value in resolving discrepancies between morphological and immunophenotypic features in leukemias of "intermediate" type.     

Community-living older people’s interpretation of the Norwegian version of older people’s quality of life (OPQOL) questionnaire

The aim of this study is to investigate how community-living older people interpret the Norwegian version of Older People's Quality of Life (OPQOL) questionnaire. The original OPQOL questionnaire was translated based on guidelines for cross-cultural translation. The Three-Step Test-Interview instrument was adopted to investigate how community-living older people interpreted the questionnaire. Data were collected from 14 participants (72–89 years). The questionnaire was filled in under observation. Semi-structured interviews were then conducted to clarify the observational data and elicit the participants’ experiences and opinions. Lastly, data were analysed using a hermeneutic interpretation approach. Our findings indicate that most of the participants managed to complete the OPQOL questionnaire without problems. The data analysis resulted in four primary themes: relevance & applicability, formulation, consistency & accuracy and subjectivity. The questionnaire covered all aspects related to the participants’ quality of life. However, statements related to religion were found to be irrelevant to their quality of life. Most of the participants thought that religion, philosophy and culture should be separate rather than included in the same statement. The participants missed the option of ‘not applicable’ when the statements were irrelevant to them. The statements are formulated in both positive and negative ways, which was sometimes confusing to them. The participants perceived phases such as “around me” “local,” and “things” as ambiguous, and thus they raised concerns about whether the OPQOL questionnaire could capture consistent data regarding their quality of life. The results of this study pinpoint the issues that community-living older people faced when interpreting and answering the Norwegian version of OPQOL questionnaire. These issues were mostly caused by sociocultural differences. Our work provides an overview of the changes that must be made in the questionnaire in order to address these sociocultural differences while using the OPQOL questionnaire in the Norwegian context.     

Ploidy profile of morphologically normal squamous epithelium adjacent to high grade cervical intraepithelial neoplasia

We have investigated the ploidy profile of morphologically normal mucosa adjacent to high grade CIN (   n = 16  ) and also from normal cervix ( n = 18). DNA ploidy was assessed using flow cytometry and image analysis. All cases were diploid by both modalities. Our results show that morphologically normal squamous mucosa has a stable ploidy profile even when it lies adjacent to high grade CIN. This finding supports the view that high grade CIN is a neoplastic expansion of transformed cells rather than the result of a field change effect.