1,720,960 research outputs found
Why do GPs continue inappropriate hospital prescriptions of proton pump inhibitors? A qualitative study
No full textBackground: Inappropriate prescriptions of Proton pump inhibitors (PPIs) initiated in hospitals are frequently continued in primary care. No research has explored why general practitioners (GPs) continue or discontinue inappropriate drug therapy. Objectives: This study aims to describe factors and motives associated with the continuation of inappropriate prescriptions of PPIs in primary care. Methods: Semi-structured qualitative interviews on basis of a purposive sampling of five GPs who often continued inappropriate prescriptions and five GPs who frequently discontinued inappropriate drug therapy with PPIs (10 GPs total, of which four were female and six male). Results: Although all GPs enrolled in the study were enthusiastic about the effectiveness of PPIs, differences between the continuing and discontinuing GPs exists in three areas: The two groups varied (1) in awareness of indications and general attitudes towards prescribing (2) in perception of the hospital physicians' competence in prescribing and (3) appreciation of general prescribing conditions in hospitals. Conclusion: Differences between the continuing and discontinuing GPs were found in their level of knowledge and their perceptions of the hospital physicians' competence and the threshold to prescribing in hospitals. Financial pressure and possible adverse effects demand a more balanced and evidence-based prescribing of PPIs. Attempts to change behaviour should focus on the GPs 'awareness of indications for PPIs, NSAID risks, and prescribing approaches in hospitals. Default prescribing in hospital demands critical examination.German Federal Ministry of Education and Research [01GK0711
Experiences of food abstinence in patients with type 2 diabetes: a qualitative study
No full textObjective: People with type 2 diabetes often report pressure to abstain from many of life's pleasures. We tried to reconstruct these patients' sense of pressure to better understand how people with diabetes make sense of, and integrate, these feelings into their life. Design, setting and participants: A secondary analysis of narrative interviews with 14 patients with type 2 diabetes who are part of a website project. Main outcome measures: Grounded theory-based analysis of narrative interviews, consisting of open, axial and selective coding. Results: People with type 2 diabetes felt obliged to give up many pleasures and live a life of abstinence. They perceived a pressure to display a modest culinary lifestyle via improved laboratory test results and weight. Their verbal efforts to reassure and distance themselves from excessiveness indicate a high moral pressure. With regard to the question of how to abstain, food and behaviour were classified into healthy and unhealthy. Personal rules sometimes led to surprising experiences of freedom. Conclusions: People with diabetes have internalised that their behaviour is a barrier to successful treatment. They experience an intensive pressure to show abstinence and feel misjudged when their efforts have no visible effect. Taking into account this moral pressure, and listening to patients' personal efforts and strategies to establish healthy behaviours, might help to build a trusting relationship with healthcare providers
GPs' experiences of managing non-specific neck pain--a qualitative study
No full textBackground. Non-specific neck pain is a common complaint in general practice. Little is known about GPs' experiences of managing non-specific neck pain. Objective. This qualitative study aims to elucidate GPs' opinions on the cause, diagnosis and management of non-specific neck pain and their experiences with patients suffering from this complaint. Methods. A purposive sample of 19 German GPs was interviewed. Analysis was guided by predefined research questions and the general principles of grounded theory. We condensed the data into three key themes. Results. The first key theme was the aetiology of neck pain and the patients' difficulty in accepting psychological explanations. GPs reported that their patients asked for definite and expensive forms of therapy. Though GPs preferred cost-efficient forms of therapy, fulfilment of patient expectations was the second key theme. Some felt that satisfying patient wishes may facilitate a trusting relationship so that psychological explanations or advice to adopt an active physical lifestyle would be accepted by patients more open-mindedly. The third key theme was the GPs' view on orthopaedic surgeons. Sometimes specialist diagnoses helped to reinforce the GPs findings. But many GPs had doubts as to whether an orthopaedic surgeon could tackle psychosomatic aspects of this complaint. Conclusions. In the case of non-specific neck pain, GPs often feel confronted with patients that demand dubious therapies and fail to consider psychological influences. The prescription of non-evidence-based therapies or referrals does not necessarily reflect a lack of knowledge but the GPs' strategic decision to improve the doctor-patient relationship.German Ministry of Education and Research (BMBF) [01 GK 0516]; BMB
Type 2 diabetes patients’ perspectives on lifestyle counselling and weight management in general practice: a qualitative study
No full textBackground: Lifestyle counselling is a pivotal aspect of diabetes care. But general practitioners (GPs) often have problems in finding their role in patients' weight management. The aims of this study were to investigate the experiences of type 2 diabetes patients with lifestyle counselling from their GPs and to explore how patients' preferences regarding counselling are embedded in the context of self-management and wider cultural aspects of nutrition. Methods: Narrative interviews were conducted with 35 people with type 2 diabetes aged between 35 and 77 years. The interviews were transcribed verbatim and analysed using the thematic framework method. Results: Many patients had a strong feeling of personal responsibility for weight reduction as integral to diabetes self-management but found it difficult to integrate the changes their disease requires into their self-management activities. They attached great importance to their GPs' advice on diet. While some patients appreciated direct communication, others regarded dramatic pictures as either unhelpful or offending. A serious problem was the incompatibility of the dietary recommendations with daily life resulting in a reluctance to adjust the whole diet to the needs of diabetes care. Conclusions: Ambivalence towards patient self-management and tensions between the necessary changes to patients' lifestyles and their culture, makes the GP's role difficult and full of conflict. Instead of focusing exclusively on the guidelines of diabetes management and provision of information, GPs should explore the patients' capabilities of self-management through open communication and accept their patients' wishes to protect nutrition as part of their culture
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
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