Medicine and Health Sciences Commons^™

Interprofessional Information Work: Innovations In The Use Of The Chart On Internal Medicine Teams, Lorelei Lingard, Lesley Conn, Ann Russell, Scott Reeves, Karen-Lee Miller, Chris Kenaszchuk, Merrick Zwarenstein

Lorelei Lingard

An abundance of evidence suggests that communication in interprofessional healthcare teams is a complex endeavour. Even relatively simple communication processes involving information work - the gathering, storage, retrieval and discussion of patient information - may be fraught with pitfalls, and yet teams manage to conduct their daily information work, often with a high degree of effectiveness. In this article, we explore one commonplace dimension of information work - the use of patient charts to foster collaborative decision-making and care enactment - towards building an elaborated understanding of how teams innovate in the face of daily complexities in their information work …

Co-Management In Healthcare: Negotiating Professional Boundaries, Catherine Schryer, Olga Gladkova, Marlee Spafford, Lorelei Lingard

Lorelei Lingard

This article investigates discursive practices associated with the co-management of patients between healthcare providers. Specifically, we focus on two genres (38 referral letters and 37 consultant reports) written by optometrists and ophthalmologists — two groups who are experiencing interprofessional tension over their scopes of practice. In our analysis we foreground four kinds of modality associated with verbs — epistemic, deontic, phatic and subjective. We found that these healthcare providers shared in the epistemic resources used to hedge their sense of clinical certainty, and that ophthalmologists used deontic resources to control future action. However, we also noted that both professions used …

Systematic Review Of Baseline Low-Dose Ct Lung Cancer Screening., Michael Lock

Michael Lock

The purpose of this systematic review was to provide physicians and patients with a synthesis of the available data and an assessment of the operating characteristics associated with baseline LDCT screening for lung cancer. Various databases, meeting abstracts, clinical trials in progress, and major textbooks for relevant data from 1966 to 2006 were searched for relevant studies. The median value of sensitivity, specificity, positive predictive value and negative predictive value were 81%, 81%, 8% and 99%, respectively. Of the studies that compared LDCT with other lung cancer screening maneuvers, it was found that LDCT detected a greater number of cancerous …

Rural Utility Cooperative (Ruc) Final Evaulation Report: Alaska Native Tribal Health Consortium (Anthc), R. Konkel

Steve Konkel

The Rural Utility Cooperative (RUC) Final Evaluation is designed to answer several interrelated

questions:

• Is the RUC working as envisioned?

• Is it making an impact in the RUC Communities?

• Are the RUC Communities better off than the Non-RUC communities?

Qualitative Research In The Rime Community: Critical Reflections And Future Directions, Lorelei Lingard

Lorelei Lingard

No abstract provided.

Implementation Of The Intervention-Based Family Assessment Procedure: A Case Study, Jeanne Jenkins, Audrey Ellenwood

Jeanne E. Jenkins

Chronic illness is a worldwide phenomenon impacting the emotional stability and daily functioning of families across cultures. Families with a chronically ill member are in need of interventions and therapy, yet, time constraints and care-taking demands make it difficult for families to seek traditional family therapy services. The objectives of this article are to (1) overview the Intervention-Based Family Assessment Procedure (IBFA) and (2) present a case vignette demonstrating the implementation of the procedure. The IBFA is an effective diagnostic tool and intervention strategy to help family therapists alter the dysfunctional and rigid structural dynamics of families with a chronically …

Questioning Competence: A Discourse Analysis Of Attending Physicians' Use Of Questions To Assess Trainee Competence, Tara Kennedy, Lorelei Lingard

Lorelei Lingard

BACKGROUND: Attending physicians (APs) must constantly assess trainees' competence to act independently, to promote learning while ensuring quality of care. This study aimed to explore, through discourse analysis of case presentations, the process of competence assessment for case-specific clinical independence.

METHOD: Twenty-six case presentations in emergency medicine were observed and audiorecorded. A discourse analysis was conducted, focusing on APs' use of questioning strategies.

RESULTS: Questioning strategies involved clarifying questions (to ensure APs' understanding of the case), probing questions (to probe trainees' understanding of a case or their underlying knowledge), and challenging questions (to challenge presuppositions). Case-related probing questions and challenging …

Seeing And Listening: A Visual And Social Analysis Of Optometric Record-Keeping Practices, Lara Varpio, Marlee Spafford, Catherine Schryer, Lorelei Lingard

Lorelei Lingard

This article investigates the contribution visual rhetoric and rhetorical genre studies (RGS) can make to health care education and communication genres. Through a visual rhetorical analysis of a patient record used in an optometry teaching clinic, this article illustrates that a genre's visual representations provide significant insights into the social action of that genre. These insights are deepened by an insider analysis of the patient record that highlights how content analyses of visual designs need to be elaborated by contextual considerations. A combined visual rhetoric and RGS analysis shows that clinical novices learn to interpret the record's visual cues to …

Assessment Of Indirect Cost-Of-Illness In A Subsistence Farming Society By Using Different Valuation Methods, Tin Su

Tin Tin Su

Indirect costs or productive labour time lost are the largest share of household economic burden of illness. However, the estimate of household indirect cost can vary depending on the valuation methods used. We therefore estimated household indirect cost in a subsistence farming society in Burkina Faso based on daily production value. These results were validated by using willingness-to-pay method and current wage rate. Among the three methods, the value of a day lost for adults assessed by willingness-to-pay method was considerably higher than other methods. There were no significant differences in indirect costs estimated by daily production value and wage …

Feminism And Profit In American Hospitals: The Corporate Construction Of Women's Health Centers, Jan Thomas

Jan Thomas

No abstract provided.

Unbalancing The Effects Of Chronic Illness: Non-Traditional Family Therapy Assessment And Intervention Approach, Jeanne Jenkins, Audrey Ellenwood

Jeanne E. Jenkins

Chronic illness is a major life-altering experience that impacts families around the world. In this article, a nontraditional, culturally appropriate family therapy assessment procedure is presented that can serve as a catalyst for creating change in families with a chronically ill member. As an ecological and holistic assessment tool, the Intervention Based Family Assessment Procedure (IBFA) helps to build a family's story by identifying needs, exploring sources of stress, assessing coping strategies, and determining how support systems are activated to help the family with the care of a chronically ill family member

Best Practices In Intercultural Health; Five Case Studies In Latin America, J. Mignone, J. Bartlett, J. O'Nwil, Treena Orchard

Dr. Treena Orchard

The practice of integrating western and traditional indigenous medicine is fast becoming an accepted and more widely used approach in health care systems throughout the world. However, debates about intercultural health approaches have raised significant concerns. This paper reports findings of five case studies on intercultural health in Chile, Colombia, Ecuador, Guatemala, and Suriname. It presents summary information on each case study, comparatively analyzes the initiatives following four main analytical themes, and examines the case studies against a series of the best practice criteria.

Scrub Typhus Serologic Testing With The Indirect Immunofluorescence Method As A Diagnostic Gold Standard: A Lack Of Consensus Leads To A Lot Of Confusion, Stuart Blacksell, Naomi Bryant, Daniel Paris, Jenny Doust, Yoshihiro Sakoda, Nicholas Day

Jenny Doust

A review was performed to determine the evidence base for scrub typhus indirect immunofluorescence assay (IFA) methodologies and the criteria for positive results. This review included a total of 109 publications, which comprised 123 eligible studies for analysis (14 publications included 2 substudies). There was considerable underreporting of the IFA methodology and seropositivity criteria used, with most studies using a defined cutoff titer rather than an increase in the titer in paired samples. The choice of positivity cutoff titer varied by country and purpose of the IFA test. This variation limits the comparability of seroprevalence rates between studies and, more …

In This Life: The Impact Of Gender And Tradition On Sexuality And Relationships For Devadasi Sex Workers In Rural India, Treena Orchard

Dr. Treena Orchard

In the popular imagination and certain academic fields, sex workers' experiences of sexuality and intimate relationships are often "naturalized," to the point where they are assumed to be deviant or completely different than those of women in mainstream society. Researchers and sex worker organizations are challenging these reified constructions by examining more diverse and representative models of sexuality and relationships. However, the experiences of women selling sex in the "third world" are consistently portrayed as violent, non-pleasurable, and oppressive, characteristics often applied universally to "third world women". Using data from ethnographic fieldwork with girls and women who belong to the …

Girl, Woman, Lover, Mother: Towards A New Understanding Of Child Prostitution Among Young Devadasi Sex Workers In Rural Karnataka, India, Treena Orchard

Dr. Treena Orchard

The emotive issue of child prostitution is at the heart of international debates over ‘trafficking’ in women and girls, the “new slave trade”, and how these phenomena are linked with globalization, sex tourism, and expanding transnational economies. However, young sex workers, particularly those in the ‘third world’, are often represented through tropes of victimization, poverty, and “backwards” cultural traditions, constructions that rarely capture the complexity of the girls’ experiences and the role that prostitution plays in their lives. Based on ethnographic fieldwork with girls and young women who are part of the Devadasi (servant/slave of the God) system of sex …

Determining Client Need In A Multi-State Fetal Alcohol Syndrome Consortium: From Training To Practice, Suzanne Christopher, Tim Dunnagan, George Haynes, Lili Stiff

Tim Dunnagan

Background: A multi-state consortium was developed in the US to conduct baseline data collection and intervention research on fetal alcohol syndrome. Each state employed support specialists whose job it was to reduce or eliminate alcohol consumption in women who were at high risk for drinking alcohol during their pregnancy. The purpose of this paper is to report how support specialists in three primarily rural/frontier states were trained to assess client need and how client need was actually assessed in the field.

Methods: A qualitative process evaluation was conducted using semi-structured interviews. Interviews were conducted with state staff involved in support …