Diagnostic Work through Evidence-Based Guidelines: Avoiding Gaps Between Development and Implementation of a Guideline for Problem Behaviour in Elderly Care

Diagnostic work is the reflexive work of figuring out what issues are at stake and determining the scope for action. This work is not generally accommodated by evidence-based guidelines, which generally promote a uniform, predefined approach to solving healthcare problems that risk narrowing the opportunities for diagnostic work in healthcare practice. Consequently, guidelines are often criticised as too general to solve situated, individual healthcare problems and gaps between guidelines and their implementation are often reported. The Netherlands has developed a guideline for problem behaviour in elderly care, explicitly designed for diagnostic work, thus stimulating a situated approach. Relational problem behaviour is highly embedded in its context. The guideline stimulates diagnostic work, which helps to unravel problem behaviour and is opening alternatives in elderly care. Diagnostic work does not transfer guideline development problems to healthcare practice, but simply structures the decision-making process without giving a predefined answer. Diagnostic work is thus important to consider in order to avoid a gap between guideline development and implementation.     

‘In Earlier Days Everyone Could Discipline Children,Now They Have Rights’: Caregiving Dilemmas of Guidance and Control in Urban Tanzania

Caregiving practices in Tanzania are potentially affected by socio‐demographic change such as urbanization and globalization. The aim of this study is to explore adult caregivers' discourses regarding the responsibility of caregiving, related to guidance and control of children in Tanzania. Data was collected in focus group discussions with parents and grandparents in an urban area of Tanzania. The analysis found two interpretative repertoires: guidance and control as a community matter and guidance and control as a family matter. These repertoires are related to responsibility and to an ideological dilemma regarding parental authority and individual's rights. The findings are discussed in relation to the tendency to polarize between ideologically traditional versus modern societies. This illustrates how lived ideology of caregiving responsibility is historically and socially situated, in the local context and how the spread of Children's Rights ideology needs to be understood in this context. Copyright © 2013 John Wiley & Sons, Ltd.     

A Community‐Responsive Adaptation to Reach and Engage Latino Families Affected by Maternal Depression

As family researchers and practitioners seek to improve the quality and accessibility of mental health services for immigrant families, they have turned to culturally adapted interventions. Although many advancements have been made in adapting interventions for such families, we have yet to understand how the adaptation can ensure that the intervention is reaching families identified to be in greatest need within a local system of care and community. We argue that reaching, engaging, and understanding the needs of families entails a collaborative approach with multiple community partners to ensure that adaptations to intervention content and delivery are responsive to the sociocultural trajectory of families within a community. We describe a cultural adaptation framework that is responsive to the unique opportunities and challenges of identifying and recruiting vulnerable families through community partnerships, and of addressing the needs of families by incorporating multiple community perspectives. Specifically, we apply these principles to the cultural adaptation of an intervention originally developed for low‐income African American and White families facing maternal depression. The new intervention, Fortalezas Familiares (Family Strengths), was targeted to Latino immigrant families whose mothers were in treatment for depression in mental health and primary care clinics. We conclude with key recommendations and directions for how family researchers and practitioners can design the cultural adaptation of interventions to be responsive to the practices, preferences, and needs of underserved communities, including families and service providers.     

Filial ethics and judgments of filial behaviour in Taiwan and the United States

Parent-child relationships are fundamental human relationships in which specific norms govern proper parent-child interactions. Such norms, or filial ethics, have been observed in different cultures, including in the United States and Taiwan, but important differences may exist in how filial practices are viewed across cultures. From a traditional view of power as domination over others, if filial relationships are viewed to reflect power differentials between parents and children, actors who follow filial ethics should be viewed as less powerful than actors who do not follow filial ethics for maintaining or enhancing positive parent-child relationships. Alternatively, power can be conceptualized as the ability to meet one's needs (e.g., for communal care and trust), and actors who follow filial ethics should be viewed as more powerful and trustworthy than actors who do not follow filial ethics because they have the ability to maintain or enhance positive parent-child relationships. Based on a power-trust model, we compared American and Taiwanese perceptions of actors in an experiment using vignettes describing filial behaviours. We conducted a path analysis with a sample of 112 American and 74 Taiwanese participants to test the proposed relations. Results showed that both Taiwanese and Americans rated actors more favourably (i.e., as more powerful and trustworthy) when actors behaved according to filial ethics than when they did not. Some cross-cultural differences were also observed: Taiwanese attributed trust-traits to actors who performed filial practices to a larger degree than did Americans. We discuss implications for the implicit nature of filial relationships and conceptualization of power cross-culturally.     

Transnational Governance Arrangements: Legitimate Alternatives to Regulating Nanotechnologies?

In recent years, the development and the use of engineered nanomaterials have generated many debates on whether these materials should be part of the new or existing regulatory frameworks. The uncertainty, lack of scientific knowledge and rapid expansion of products containing nanomaterials have added even more to the regulatory dilemma with policy makers and public/private actors contenting periods of both under and over regulation. Responding to these regulatory challenges, as well as to the global reach of nanotechnology research and industrial needs, governance arrangements beyond the state have addressed the challenge head-on. This article focuses on the governance arrangements of the International Organization for Standardization (ISO), which has led to the development of numerous “horizontal anticipatory standards” with an important role in setting the foundation for science, technology and market development. During the course of its operation ISO has broadened its scope to address not only technical issues related to the concept and the size of nanomaterials but also broader aspects of the technology, including health, environment and safety issues. The increasing relevance of the ISO to regulate economic relations and achieve certain public policy goals has given rise to many concerns about its legitimacy. The important questions are whether these governance arrangements may be deemed as being legitimate and where this legitimacy is derived from? What are the main sources of legitimacy at the transnational level and how we can apply them to analyse nanotechnology standardization? This article provides concise answers to these questions. It focuses at the normative concepts of democratic and scientific legitimacy and explores the institutional structures and processes by which nanotechnology standards are established.     

Three Conceptual Models of Patient and Public Involvement in Standard-setting: From Abstract Principles to Complex Practice

Clinical practice guidelines have been critiqued for prescribing standardized care that neglects patients’ personal circumstances and knowledge in health care decisions. To make care more patient centred, standard-setters are urged to involve patients and the public in guideline development and use. Despite widespread principled support for such Patient and Public Involvement (PPI), the underlying principles guiding PPI in standardization of care are mired on confusion and contradiction. Based on the PPI literature in general, and informed by empirical research on guideline development, it is possible to identify three rationales that justify PPI in clinical standard setting. Each rationale gives rise to a conceptual model which outlines a distinct purpose of participation, who is to be included, and what they are expected to contribute. The Consumer Choice model aims to involve autonomous consumers to personalize clinical care. The Democratic Voice model aims for health care recommendations to better reflect collective values of citizens. The Lay Expertise model aims to re-contextualize universal evidence by including experiential patient knowledge. However, these models can and should not function as ‘Gold Standards’ to be consistently followed in practice. First, the models rely on two distinct types of representation, resulting in contradictory notions of how to be a good representative. Second, imposing models on practice requires a top-down control that is practically and politically problematic. Not only is control difficult to achieve, it may compromise the participatory ideal of participants co-determine practice, and may result in excluding the values and views of ‘real’ patients and public entirely.     

Multiple outcome measures and mixed methods for evaluating the effectiveness of theory-based behaviour-change interventions: a case study targeting health professionals' adoption of a national suicide prevention guideline

Interest in behaviour-change interventions targeting health professionals' adoption of clinical guidelines is growing. Recommendations have been made for interventions to have a theoretical base, explore the local context and to use mixed and multiple methods of evaluation to establish intervention effectiveness. This article presents a case study of a behaviour-change intervention delivered to community mental health professionals in one Primary Care Trust, aimed at raising adherence to a national suicide prevention guideline. A discussion of how the theory-base was selected, the local context explored, and how the intervention was developed and delivered is provided. Time series analysis, mediational analysis and qualitative process evaluation were used to evaluate and explore intervention effectiveness. The time series analysis revealed that the intervention was not effective at increasing adherence to the guideline. The mediational analysis indicates that the intervention failed to successfully target the key barrier to adoption of the guidance, and the qualitative process evaluation identified certain intervention components that were well received by the health professionals, and also identified weaknesses in the delivery of the intervention. It is recommended that future research should seek to further develop the evidence-base for linking specific intervention strategies to specific behavioural barriers, explore the potential of theories that take into account broader social and organisational factors that influence health professionals' practice and focus on the process of data synthesis for identifying key factors to target with tailored interventions. Multiple and mixed evaluation techniques are recommended not only to explore whether an intervention is effective or not but also why it is effective or not.     

Collaborative IT offshoring relationships and professional role identities: Reflections from a field study

While IT offshoring has generated heated debates both in scholarly circles and in the popular press, its impact on professional role identities and career experiences of situated individuals in both onshore and offshore locations has received much less attention. In this paper, we present a qualitative case study featuring a large global German technology firm and examine the multiple ways in which working within a collaborative offshoring arrangement has influenced the reconfiguration of German and Indian respondents' professional role identities. In light of these changes, the findings also highlight how emerging offshoring practices led to an ongoing reassessment of our respondents' career aspirations and strategies. In particular, our study draws attention to the often complex means deployed by individuals working in an offshoring environment to further their career prospects. From a practitioner perspective, we suggest several steps managers can take to help employees overcome the anxiety and insecurities, which inevitably seem to accompany the offshoring phenomenon.     

‘If something doesn’t look right,go find out why’: how intuitive decision making is accomplished in police first-response

ABSTRACT

Intuition is an important mechanism by which organizational actors make significant decisions; however, precisely how intuitive decisions are taken is not well understood and hence is worthy of closer scrutiny. First-response decisions, because of the conditions under which they are executed, offer researchers an interesting and relevant context for the study of intuitive decision making in organizations. We used qualitative methods to explore how “peak performing” police officers used intuition in first-response decisions. Our findings show that intuition’s role in first-response occurs in two differing but complementary ways: “recognition-based intuition” and “intuition-based inquiry”. This finding builds on previous intuition research and informs current debates in behavioural sciences regarding “default-intervention” versus “parallel-competitive” variants of dual-process theory; it also reveals how a complex and situated mix of intuition and analysis can guide effective decision making and support peak performance in uncertain, dynamic and complex environments that typify many organizational decision processes. Our findings contribute to intuition research by extending the current theory of “intuition-as-expertise” in going beyond a simple “recognize-and-respond” model. We propose a “Perceiving-Knowing-Enacting-Closing” framework which captures the complex role that intuition in combination with analysis plays in police first-response decisions, and discuss implications for decision-making policies and practices in organizations.     

Ecological and ethical issues in virtual reality research: A call for increased scrutiny

We argue that moral judgment studies currently conducted utilizing virtual reality (VR) devices must confront a dilemma as a result of how virtual environments are designed and how those environments are experienced. We first begin by describing the contexts present in paradigmatic cases of naturalistic moral judgments. We then compare these contexts to current traditional (vignette-based) and VR-based moral judgment research. We show that, contra to paradigmatic cases, vignette-based and VR-based moral judgment research often fails to accurately model the situational features of paradigmatic moral judgments. In particular, we compare and contrast six recent VR studies to support our view that only simulations high in context-realism and perspectival-fidelity can produce “virtually-real experiences.” After analyzing the constituents of a virtually-real experience, we go on to propose guidelines for the creation of VR studies. These guidelines serve two purposes. First, we aim to increase the ecological validity of such studies to advance our understanding of moral judgments. Second, we believe that such guidelines should inform how Institutional Review Boards assess VR research. We show that our guidelines are urgently needed, given the current lax review standards in place.     

解读《恶性肿瘤骨转移及骨相关疾病临床诊疗专家共识》

肿瘤专业工作者不仅要关注患者的抗癌治疗,同时也要关注他们的康复与姑息治疗,骨转移是肿瘤患者的常见转移病灶。《恶性肿瘤骨转移及骨相关疾病临床诊疗专家共识》（2007年版）适时地对恶性肿瘤骨转移及骨相关疾病提出了指导性意见,体现了肿瘤的综合治疗原则,其特点为：（1）多学科合作的结晶;（2）以高级别循证医学证据为基础;（3）突出了实践性和可操作性。和一切“诊断规范”一样,《共识》一方面对指导肿瘤科及其他相关科室医师们的临床实践发挥积极作用,同时又需要在实践中继续得到检验。     

Standards,Harmonization and Cultural Differences: Examining the Implementation of a European Stem Cell Clinical Trial

ABSTRACT

A complex set of European regulations aims to facilitate regenerative medicine, harmonizing good clinical and manufacturing standards and streamlining ethical approval procedures. The sociology of standardization has elaborated some of the effects of regulation but little is known about how such implementation works in practice across institutions and countries in regenerative medicine. The effects of transnational harmonization of clinical trial conduct are complex. A long-term ethnographic study alongside a multinational clinical trial finds a range of obstacles. Harmonization standardizes at one level, but implementing the standards brings to the fore new layers of difference between countries. Europe-wide harmonization of regulations currently disadvantages low-cost clinician-lead research in comparison to industry-sponsored clinical trials. Moreover, harmonized standards must be aligned with the cultural variations in everyday practice across European countries. Each clinical team must find its own way of bridging harmonized compulsory practice with how things are done where they are, respecting expectations from both patients and the local hospital ethics committee. Established ways of working must further be adapted to a range of institutional and cultural conventions that affect the clinical trial such as insurance practices and understandings of patient autonomy. An additional finding is that the specific practical roles of team members in the trial affect their evaluation of the importance of these challenges. Our findings lead to conclusions of wider significance for the sociology of standards concerning how regulation works and for medical sociology about how trial funding and research directions in stem cell medicine intersect.     

An Emergent Theory of Gatekeeping Practices in Counselor Education

This article summarizes findings from a qualitative study involving 8 counselor educators who taught in master's programs accredited by the Council for Accreditation of Counseling and Related Educational Programs (CACREP). Data analysis revealed an emergent theory of gatekeeping practices that includes 4 phases: preadmission, postadmission, remediation plan, and remediation outcome. The authors detail each phase and relate this process to counselor education. They outline implications of the findings for standards proposed by CACREP (2009) and American Counseling Association (2005) guidelines and offer suggestions for future research.     

Migration,gender, and emotions. A reflection on global care chains and circuits of care in the context of migration from Bolivia to Argentina

The intersection between the history of emotions and migration studies highlights how motherhood and care practices are transformed during migration. In this article, through the example of Bolivian migration to Argentina, we shed light on diverse emotional experiences around care work that cannot be understood if we analyze them through the classic approaches of global care chains and the circulation of care. In this study, we set out to analyze care practices and the emotional dynamics that are connected to them from a situated perspective that focuses on different geographic locations to those studied in these two classic approaches. We call into question essentialist views of motherhood, care, and emotions by conducting a historical analysis of human mobility between two countries in the Global South: the waves of migration from Bolivia to Argentina that took place between the 1970s and 1990s.     

MENTORING IN PARALLEL UNIVERSES

Mentoring plays a vital role in the academic context. The purpose of this qualitative study was to investigate the mentoring relationships I established with my students and to determine how my experiences and the mentoring I received from my university professors influence my mentoring practices. The results confirm the dynamic nature of the mentoring process, and the scenarios illustrate how my mentors influenced my practices but also show how I changed my approach when necessary to meet the needs of the students.     

Religious practices and networks of belonging in an immigrant congregation: the German-speaking Lutheran congregation in Dublin

This article explores how members of the German-speaking Lutheran church in Dublin develop their networks of belonging by taking part in social practices in their congregation. The article addresses the intersection of religious life, migration experience, and belonging. Based on qualitative fieldwork, we assess how social practices embedded in religious activities and beliefs reshape the sense of belonging among members of this congregation. We study the congregation through a material approach while paying attention to its actual religious and social life. The study observes how participation in the social life of the congregation enables its members to create multiple senses of belonging—ethno-cultural, religious, and social belonging. The social life of the congregation aids the preservation of immigrants’ ethno-cultural particularities, societal adaptation, and sense of belonging to their religious community.     

Treating Transgender Individuals in Inpatient and Residential Mental Health Settings

This article describes the need for specific guidelines regarding how to manage inpatient and residential mental health programming with respect to transgender individuals. The article discusses what is known about transgender mental health and how it is related to sociopolitical factors, how inpatient and residential programs can address the impact of sociopolitical factors on transgender individuals and send a welcoming message to prospective consumers, how programs can attend to policies and procedures in ways that create the best milieu for an inpatient or residential unit that provides care for one or more transgender individuals, and how providers and interdisciplinary teams can meet the unique clinical needs of transgender individuals. These guidelines are designed to assist providers in creating a safe environment that affords quality inpatient and residential mental health care to transgender individuals.     

Prayer,Patronage, and Personal Agency in Nicaraguan Accounts of Receiving International Aid

This article examines how religious beliefs and practices influence the reception of international relief and development aid in impoverished communities. Specifically, I explain how Nicaraguan recipients’ prayers both enhance and constrain their ability to assert themselves as “empowered” actors during aid interactions. Data come from observations and interviews over a two‐year period with 81 Nicaraguans in communities that receive aid from Christian development organizations. Compared to secular constructions of aid interactions, prayers provide space for Nicaraguans to position themselves as influential actors effecting change for themselves or their families. Through prayers, recipients portray themselves as influencing the actions of more powerful parties, including God and potential donors. They also pray for donors’ well‐being, thereby offering spiritual reciprocity for material gifts. However, the same prayers that empower individuals at the interpersonal level constrain their ability to envision transformation of social structures. These findings shape understandings of prayer as aligning actions, of the moral and social dimensions of receiving care from strangers, and of the complex and contradictory ways religious practices influence discourses of empowerment and development.     

Variation in scatterplot displays

Scatterplots are typically constructed for the purpose of showing the association between two variables. We argue that such scatterplots should not vary in ways that are unrelated to the degree of association. Noting that the publication standards for the preparation of scatterplots are minimal, we review empirical literature that shows that a number of arbitrary features of scatterplots influence the inferences drawn by users. We discuss nine such features. We also review the literature that recommends how scatterplots should be prepared, and we examine 221 scatterplots published in recent journals. There was considerable variation among those published scatterplots. This article concludes with a call for further standardization by way of flexible guidelines.