How do parents of child patients compare consultations with homeopaths and physicians? A qualitative study

Objective

How do parents of child patients experience and compare consultations with homeopaths and physicians, and how do they describe an ideal consultation.

Methods

A qualitative study with interviews of parents to 16 children who had consulted both a homeopaths and a physicians.

Results

Comparing consultations with physicians and homeopaths, the parents experienced the homeopathic consultations to a greater extent to have a whole person approach, also described as a core factor in an ideal consultation. This approach included exhaustive questioning, longer consultations, more interaction with the child and looking for the underlying cause.

Conclusion

The parents in this study perceived that the homeopathic consultation had a whole person approach while consultations with most physicians focused on the symptoms. The homeopathic consultation was said to be more in line with what the parents perceived to be an ideal consultation for their children than consultation with physicians.

Practice implications

Treatment philosophy and the aim of the consultation are likely to play a larger part than the technical aspects in determining the form and content of a consultation. Training in communication could benefit from including discussions on how the practitioner's treatment philosophy influences the consultation behavior.     

How do social firms contribute to recovery from mental illness? A qualitative study

Background: A definition of recovery drawn from qualitative literature and the ‘consumer/survivor’ movement suggests that recovery should be seen as a way of developing satisfaction and purpose in life, whether or not symptoms of mental illness are present. A qualitative review suggested that meaningful activity may facilitate recovery by providing a sense of purpose in life. Social firms may be well placed to offer this activity due to their ethos of empowerment, their community integration and their similarity to ‘recovery‐oriented services’. Aims: The aim of this study was to explore experiences of recovery from mental illness in the context of two emerging social firms. Method: A social constructionist version of grounded theory was used to develop a model of recovery through participation in the emerging social firms. Multiple coding, triangulation and respondent validation were used to increase the rigour of study findings. Findings: A model of recovery in the context of the emerging social firms was constructed. This was influenced by characteristics such as a flexible structure, a meaningful and diverse activity, an accepting social group and an inclusive leadership. Conclusion: Social firms may provide an important model for ‘recovery‐oriented services’. Clinical, research and policy implications of findings are discussed. Copyright © 2010 John Wiley & Sons, Ltd. Key Practitioner Message:

• Social firms are a form of enterprise that employs people who are disadvantaged in the labour market by their disability.
• Social firms promote a model of community integration and empowerment for their employees.
• We found that individuals recovering from a mental illness experience social firms as providing a flexible environment which promotes feelings of belonging, success, competence and individuality.
• We interpret these findings as social firms providing secure base for recovery.

     

How do non-geneticist physicians deal with genetic tests? A qualitative analysis

Genetic testing is accepted to be a common practice in many medical specialties. These genetic tests raise issues such as respect for basic rights, how to handle results and uncertainty and how to balance concerns for medical confidentiality with the rights of third parties. Physicians need help to deal with the rapid development of genomic medicine as most of them have received no specific training on the medical, ethical, and social issues involved. Analyzing how these professionals integrate genetic testing into the patient-provider relationship is essential to paving the way for a better use of genomics by all. We conducted a qualitative study comprising a series of focus groups with 21 neurologists and endocrinologists about their genetic testing practices in the western part of France. The interviews were transcribed and analyzed for major themes. We identified an automated care management procedure of genetic testing that affects patient autonomy. The simple fact of having a written consent cannot justify a genetic test given the stakes associated with the results. We also suggest orienting practices toward a systemic approach using a multidisciplinary team or network to provide resources for dealing with uncertainties in interpreting results or situations that require additional technical or clinical skills and, if necessary, to allow for joint consultations with both a geneticist and a non-geneticist medical specialist.Subject terms: Ethics, Genetics research, Genetic testing     

Osteoarthritis of the knee: Why does exercise work? A qualitative study of the literature

The effectiveness of exercise to reduce pain and improve functioning in osteoarthritis of the knee (OAk) is well substantiated. Underlying mechanisms are still under debate and better understanding of the pathways involved may contribute to more targeted treatment strategies. The present qualitative analysis of the literature aims to provide an overview of theoretical models that are put forward to explain the beneficial treatment effects of exercise in OAk. An inductive qualitative approach, based on the ‘grounded theory’ of Glaser and Straus, was used. Twenty-two studies emphasizing on exercise therapy for OAk, collected from three Cochrane reviews and nine guidelines of the Physiotherapy Evidence Database (PEDRO) published between 2000 and 2012, were included. The introduction and discussion parts of these papers were screened for explanations of exercise-induced benefits in OAk patients. Seventy-three key points were identified which were subdivided into 16 core theoretical concepts. Finally, 5 categories were formed: neuromuscular, peri-articular, intra-articular, psychosocial components, and general fitness and health. We referred to scientific evidence that was used in the included studies to describe and categorize the concepts. Future research on exercise in OAk should allow distinguishing the contribution of different potential pathways to the treatment effects.     

How do patients with rheumatic disease experience their relationship with their doctors? A qualitative study of experiences of stress and support in the doctor-patient relationship

This study is evaluated what patients with rheumatic disease perceive as important in their medical encounters. We interviewed two groups of patients: one with a well-defined inflammatory condition (rheumatoid arthritis (RA) or ankylosing spondylitis) (n = 12) and one with non-inflammatory widespread chronic pain such as fibromyalgia (n = 14). Both groups focused on their relationship to their doctor. Two central themes emerged as of importance: 'to be seen' and 'to be believed'. However, these themes had different connotations for the two groups. For the patients with inflammatory conditions, 'to be seen' implied being seen as an individual and not as a mere diagnosis, and 'to be believed' as far as pain and suffering were concerned. For patients with non-inflammatory chronic pain 'to be seen' and 'to be believed' primarily implied being able to obtain a useful somatic diagnosis. Practical implications of these findings are discussed.     

Why do young people drink? A review of drinking motives

This article reviews evidence of adolescent and young adult drinking motives and their relation to possible consequences over the last 15 years. To this end, a computer-assisted search of relevant articles was conducted. Results revealed that most young people reported drinking for social motives, some indicated enhancement motives, and only a few reported coping motives. Social motives appear to be associated with moderate alcohol use, enhancement with heavy drinking, and coping motives with alcohol-related problems. However, an enormous heterogeneity was found in terms of how motives were measured: 10 to 40 items were grouped into between 2 and 10 dimensions and sometimes the same items occurred under different dimensions. Future studies should therefore use well-defined, theoretically based, homogenous instruments to disentangle cultural from measurement differences across surveys.     

How do research participants perceive “uncertainty” in genome sequencing?

PurposeThe scope of uncertainty in genome sequence information has no rival in health-care delivery. We present data from adults participating in a National Institutes of Health study using this technology, in which perceptions of uncertainty are hypothesized to be key in predicting decisions to learn and act on genome health information.MethodsWe conducted six professionally moderated focus groups with 39 randomly selected ClinSeq participants varying on whether they had coronary heart disease and had received prior sequence results. We elicited perceptions of the uncertainties associated with genome sequencing using written prompts.ResultsParticipants perceived uncertainty as a quality of genome information. The majority of participants characterized uncertainty of sequencing information as “changing, fluid, developing, or ground breaking.” These responses led to anticipation of more optimistic future outcomes. Fewer participants described uncertainty as “questionable, less accurate, limited, or poorly understood.” These perceptions seemed to undermine participants’ faith in genome information, leading to feelings of disillusionment.ConclusionOur findings suggest that perceptions of uncertainty are related to epistemological beliefs that inform expectations for the information. Interventions that promote realistic expectations of genome sequencing may mitigate negative responses to uncertainty.Genet Med16 12, 977–980.     

Is the risk of bipolar disorder in twins equal to the risk in singletons? A nationwide register-based study

BACKGROUND: A previous study demonstrated a higher rate of schizophrenia in dizygotic twins than in the general population, and a higher rate of schizophrenia in siblings of dizygotic twins than in siblings of monozygotic twins and singletons, pointing to a common genetic predisposition for dizygotic twinning and schizophrenia. The aim of the present study was to investigate whether these findings also apply to bipolar disorder. METHODS: Through record linkage between The Danish Twin Register, The Danish Psychiatric Central Register and The Danish Civil Registration System, the rate of bipolar disorder (diagnosed for the first time during admission to hospital) in dizygotic and monozygotic twins was compared with the rate in singletons, and the rate in siblings and parents of twins was compared with the rate in siblings and parents of singletons. RESULTS: The rate of bipolar disorder was the same in dizygotic twins, monozygotic twins and singletons as well as for parents and siblings of dizygotic twins, monozygotic twins and singletons. LIMITATIONS: The study is a register-based study, only including hospitalized patients. CONCLUSION: This study shows that there is an equal rate of bipolar disorder in twins and in singletons. Assuming that DZ twinning is under some genetic influence, a differential relationship between schizophrenia and DZ twinning on one hand and bipolar disorder and DZ twinning on the other hand may suggest differences in the genetic basis of the two diseases. The finding that the rate of bipolar disorder in monozygotic twins is the same as the rate of bipolar disorder in singletons supports studies finding no association between bipolar disorder and obstetric complications.     

How do pathogens drive the evolution of paired receptors?

Paired receptors are families of membrane proteins characterized by similar extracellular regions but different transmembrane and cytoplasmic regions, meaning that some members can give inhibitory signals and others activating signals. Well‐characterized examples include the KIR, SIRP, Ly49, Nkpr, and Siglec families. The difference in the repertoire of these genes in mouse and man indicates that these families have evolved rapidly. For example, KIRs are found in humans and not mice, and Ly49 shows the converse. These genes are often very polymorphic, e.g. KIR and the number of genes can vary as shown for Ly49 in different mouse strains. Paired receptors are expressed mainly on NK and myeloid cells and their evolution is thought to be pathogen driven. In this article, we review various receptor families for which pathogen interactions are known and discuss the possible molecular mechanisms driving their evolution.     

How do homeless adults change their lives after completing an intensive job‐skills program? A prospective study

Among people experiencing homelessness, difficulty securing housing is often compounded by concurrent challenges including unemployment, chronic illness, criminal justice involvement, and victimization. The Moving Ahead Program (MAP) is a vocational rehabilitation program that seeks to help adults facing these challenges secure competitive employment. We prospectively studied how MAP graduates (N = 97) changed from the beginning of MAP to about 6 months after graduation. We observed a variety of positive outcomes in not just employment and housing but also health, substance use, and criminal justice involvement. However, these gains were not universal; for instance, participants were less likely to report positive outcomes at follow‐up if they started MAP with a serious mental illness, made relatively small gains in work skills, or did not seek mental health treatment during the 6 months after they completed MAP. These findings might encourage program staff to devote additional resources toward supporting at‐risk students.     

How I do it…. How infection doctors approach the PJI MDT

The management of prosthetic joint infection (PJI) requires discussion between experts working towards the aims and expectations of the patient. Each discipline typically does not offer a single-minded approach, but instead collectively weighs up the strengths and weaknesses of different management options. At a basic level, the infection specialist provides antimicrobial solutions based on laboratory results. During multi-disciplinary team (MDT) discussions however, they can offer additional insights into how the microbiology could influence the surgical decisions, respond to the surgical debate by designing a rational approach to antimicrobials and contribute to an option-appraisal that can be presented to the patient. In this short opinion piece, we describe some of the thoughts we have during MDT discussions to ultimately recommend an optimised treatment plan for the individual patient: is there infection? what is the pathogen? where did it come from? (and where else has it gone), and what is the best treatment strategy?     

Valid or voodoo? A qualitative study of attorney perceptions of risk assessment in sentencing and plea bargaining

Prior research largely has explored judicial perceptions of risk assessment in sentencing. Little is known about how other court actors, specifically, prosecutors and defense attorneys, perceive risk assessments in the sentencing process. Here, we report a qualitative study on the use of risk assessment by prosecutors and defense attorneys in Virginia. A prior survey (n = 70) pointed to a statistically significant difference in how prosecutors and defense attorneys view the role of recidivism risk in sentencing. On the basis of the results of this quantitative study, we collected follow-up qualitative data via interview (n = 30) to explain this unexpected difference. Analysis confirmed the survey findings that prosecutors and defense attorneys differ in their perceptions of risk assessment in sentencing. Results suggest that court actor perceptions vary as a function of professional role in the service of the identified client (the community or the defendant) and their interests. Although perceptions diverged on utility risk assessment in sentencing, both prosecutors and defense attorneys were outspoken in their skepticism of the Nonviolent Risk Assessment instrument that is used to predict recidivism risk in Virginia. This latter finding identifies obstacles that may emerge as jurisdictions adopt a risk-based approach to sentencing. We conclude with recommendations for addressing these barriers that may provide useful guidance on the implementation process.