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PubMed1999

Towards an understanding of the cultural roots of homophobia in order to provide a better midwifery service for lesbian clients.

Research has indicated that homophobia amongst health professionals, including midwives, has negative consequences for the care received by lesbian clients. Social scientists recognise that homophobia is neither inevitable nor universal, rather it is culturally specific and culturally constructed. This recognition is potentially very positive, since it suggests that homophobia in midwifery practice may successfully be theorised and critiqued in order to support the development of better services for lesbian clients. In this paper discourse analysis methodology from the cultural and social sciences is used to interrogate textual evidence of the nature of homophobia in British and North American culture. The analysis results in the identification of five 'themes' underlying cultural expressions of homophobia: anxiety about sexual difference, fear of female sexuality, the sexualisation of lesbianism, the characterisation of lesbianism as 'sick' or 'unnatural', and the inability to identify lesbians with any certainty. In the context of midwifery, these themes emerge as particularly powerful, suggesting that, while the deep-rooted nature of homophobia is resistant to rapid change, midwives may be uniquely well placed to develop appropriate professional services for the growing minority of their clients who are lesbian.

Attitude of Health Personnel↗

PubMedDate not supplied

Emerging technology: remote analysis of traumatic musculoskeletal radiographs transmitted by electronic mail.

OBJECTIVES: To determine whether remote analysis of radiographs via electronic mail (e-mail) had an impact on treatment decision-making. DESIGN: Prospective. SETTING: Level I trauma center. PATIENTS/PARTICIPANTS: Twenty-five cases randomly selected from previous emergency room consultation. INTERVENTION: Textual descriptions obtained from emergency medicine physicians were compared with computer-digitized images of radiographs sent via e-mail and with the actual radiographs. Four board-certified orthopaedic surgeons reviewed all three forms of data to determine fracture diagnosis and treatment plans. MAIN OUTCOME ASSESSMENT: Diagnosis and treatment plans were obtained via written questionnaire after review of each group of data (textual, digitized image, and actual radiograph). Results were then compared across groups to determine whether digitized images were better than textual descriptions and equivalent to actual radiographs. RESULTS: Statistical analysis revealed a significant improvement in the frequency of correct diagnosis and treatment planning when digitized images were used (91 percent) compared with textual descriptions alone (48 percent) (p < 0.001). The difference in correct diagnosis and treatment plans between digitized images and actual radiographs was not statistically significant (p = 0.27). CONCLUSION: Digitized radiographs sent via e-mail can significantly improve accuracy of diagnosis and treatment compared with a simple verbal description.

Computer Communication Networks↗

PubMed1986

The use of organizational strategies to improve memory for prose passages.

Previous studies have shown that incidental memory for the material increases when older adults are forced to analyze material to the extent necessary to impose an organizational structure. The present experiment sought to extend this finding by examining the effects of enforced organizational strategies on the memory of older adults for textual material. Young and old adults were required to sort the scrambled sentences of a prose passage into the correct order. A subsequent incidental memory test showed that, when older adults were required to make an in-depth analysis to sort the material, their incidental memory for the textual information was approximately equal to that of their younger counterparts. Additional analysis revealed that, although older adults spent more time sorting the material than did younger adults, it was only when required to analyze the material to a sufficient degree that the older adults showed any improvement in memory.

Adolescent↗

PubMed2001

Qualitative research: standards, challenges, and guidelines.

Qualitative research methods could help us to improve our understanding of medicine. Rather than thinking of qualitative and quantitative strategies as incompatible, they should be seen as complementary. Although procedures for textual interpretation differ from those of statistical analysis, because of the different type of data used and questions to be answered, the underlying principles are much the same. In this article I propose relevance, validity, and reflexivity as overall standards for qualitative inquiry. I will discuss the specific challenges in relation to reflexivity, transferability, and shared assumptions of interpretation, which are met by medical researchers who do this type of research, and I will propose guidelines for qualitative inquiry.

Guidelines as Topic↗

PubMed1992

Assessing the qualitative data component in large-scale quantitative surveys: computer aided qualitative survey data management, retrieval and analysis.

In a large-scale survey the qualitative component of the interview is often used either to refine the quantitative coding categories or to get a 'general feel' for the respondents' comments with no attempt at analysis. This article reports on an approach which has been developed for solving some of the problems of linkage of qualitative and quantitative components at the survey analysis stage. This approach is dependent on efficient methods of data management and text retrieval, and presupposes a system of data collection that produces computer-based text files to store the verbatim comments of study participants. The size of the data set necessitated using a mainframe computer for data management, text retrieval and analysis. The article provides illustrations of how the analysis of 11 000 files consisting of textual data was facilitated.

Adolescent↗

PubMed1997

Importance of textual data in multimodality monitoring.

OBJECTIVES: The use of multimodality monitoring of patients in the intensive care unit (ICU) and the subsequent collection and analysis of such data are increasing. The aim of this work was to assess the importance of recording complementary textual data referring to patient care maneuvers, calibrations, and other incidents, in addition to the raw numerical values. DESIGN: A retrospective analysis of multimodality monitoring data, which included comments entered concurrently at the bedside, collected from head-injured patients admitted to an ICU. PATIENTS: One hundred forty-seven patients with a postresuscitation Glasgow Coma Scale score of < or = 12 were monitored for a total of nearly 1 million minutes on up to eight commonly used channels. MEASUREMENTS AND MAIN RESULTS: Approximately 13,000 comments were added to the raw data at the time of collection. The data were subsequently validated using these comments as indicators of artifactual values. The comments were classified into a surprisingly small number of important categories, with the most frequent referring to monitor calibrations and regular ICU care maneuvers. The difference between validated and unvalidated data on the quantity of secondary insult observed was in some cases nearly 50%. CONCLUSIONS: This work demonstrates that such textual information should be recorded concurrently with the raw monitoring values to ensure proper interpretation of the data in any retrospective analysis. Furthermore, it also suggests that a small number of prespecified categories could be used in the on-line validation of such data.

Craniocerebral Trauma↗

PubMed1982

Models and practice in medicine: menopause as syndrome or life transition?

Biomedical knowledge, like scientific knowledge in general, is a product of a social and culture milieu. Moreover, in the analysis of biomedicine a distinction must be maintained between textual and clinical knowledge. Through examination of medical texts and of social science literature, the susceptibility of menopause to numerous interpretations is demonstrated. The generation of clinical models from current information available to physicians is examined and it is suggested that these can be thought of as folk models. Several current clinical models of menopause are presented and the implications for sociological analysis of the subject discussed.

Adult↗

PubMedDate not supplied

Exploratory analysis of the medical record.

Current patient information systems such as SCAMP have the capacity to store not only highly-structured information such as problem codes, drug lists and laboratory values, but also richer, clinically-descriptive information such as comprehensive natural language problem summaries and other textual data that retain the full clinical information used by physicians in managing their patients. The clinical importance, richness, and extensiveness of this information suggest that techniques which allow computers to process textual data may play a helpful role in clinical research. The analysis programs of the SCAMP system have been developed to explore the potential of this approach.

Ambulatory Care Information Systems↗

PubMed1992

Discourse analysis: a new methodology for understanding the ideologies of health and illness.

Discourse analysis is an interdisciplinary field of inquiry which has been little employed by public health practitioners. The methodology involves a focus upon the sociocultural and political context in which text and talk occur. Discourse analysis is, above all, concerned with a critical analysis of the use of language and the reproduction of dominant ideologies (belief systems) in discourse (defined here as a group of ideas or patterned way of thinking which can both be identified in textual and verbal communications and located in wider social structures). Discourse analysis adds a linguistic approach to an understanding of the relationship between language and ideology, exploring the way in which theories of reality and relations of power are encoded in such aspects as the syntax, style and rhetorical devices used in texts. This paper argues that discourse analysis is pertinent to the concerns of public health, for it has the potential to lay bare the ideological dimension of such phenomena as lay health beliefs, the doctor-patient relationship, and the dissemination of health information in the entertainment mass media. This dimension is often neglected by public health research. The method of discourse analysis is explained, and examples of its use in the area of public health given.

Communication↗

PubMedDate not supplied

The CODATA/IUIS Hybridoma Data Bank: development of a hybrid system to handle complex data relationships.

System design for the Hybridoma Data Bank, a database of comprehensive information on immunoreagents for use by scientists in diverse disciplines, is described. Unique problems include: use of nomenclature from diverse fields that is neither static nor standard; the need for two representations of the database--textual for readability and numeric for complex search capabilities, analysis and data compression; and a method of translating between the two representations of the database.

Animals↗

PubMed2001

Procedure manuals and textually mediated death.

The procedure manual as a document represents the practice of nursing care. Analysis of such manuals allows us to explore discourses of nursing and the ways in which they frame nursing practice. A critical analysis of a hospital procedure manual using discourse analysis was undertaken. A specific excerpt concerning 'Last offices' is used as an example of the institutionalisation of organisational values and beliefs as these influence nursing care. 'Last offices' directs nursing practices related to the death of a patient, and the laying out as preparation for the funeral director or coroner. The analysis shows that procedure manuals reproduce hegemonic ideologies of nursing. The analysis also shows how nursing practices are constituted by intersecting forces of differing locations such as the hospital as an organisation, the healthcare system and the wider society within which these function.

Attitude to Death↗

PubMedDate not supplied

Temporal image database design for outcome analysis of lung nodule.

This paper presents the design of a temporal image database system and its application in thoracic imaging. The design of this information system is based on the client/server architecture. The system consists of a chest imaging database server, a library of image processing modules, a link to the picture archiving and communication system (PACS) archive, and a low end client workstation with motif-based graphic user interface (GUI). The database system can be used to aid the radiologists in quantitating solitary or multiple long nodules and in assessing effectiveness of therapeutic procedures for these lung cancers. The GUI allows a user to retrieve any patient study from PACS. After a nodule is visually identified, it will be segmented automatically to obtain relevant features, such as the center of mass, volume, and surface area. Such 3D nodule information, together with the patient textual information, is subsequently organized in the chest imaging database to facilitate outcome analysis.

Breast Neoplasms↗

PubMed1990

On studying the discourse of medical encounters. A critique of quantitative and qualitative methods and a proposal for reasonable compromise.

Studies of doctor-patient communication, although leading to diverse findings, have not lent themselves to replication and also have not captured important features of medical discourse. Quantitative methods alone do not deal with the complexities of medical encounters, usually are not helpful in analyzing the social context of discourse, do not clarify underlying themes and structures, and are costly and tedious to use. With qualitative methods, the selection of discourse for analysis is not straightforward, quality of interpretation is difficult to evaluate, and textual presentation is not clear-cut. Several criteria of an appropriate method offer reasonable compromises in dealing with medical discourse: 1) discourse should be selected through a sampling procedure, preferably a randomized technique; 2) recordings of sampled discourse should be available for review by other observers; 3) standardized rules of transcription should be used; 4) the reliability of transcription should be assessed by multiple observers; 5) procedures of interpretation should be decided in advance, should be validated in relation to theory, and should address both content and structure of texts; 6) the reliability of applying interpretive procedures should be assessed by multiple observers; 7) a summary and excerpts from transcripts should accompany the interpretation, but full transcripts should also be available for review; and 8) texts and interpretations should convey the variability of content and structure across sampled texts. An ongoing study applies these criteria to research on ideology and social control in medical encounters.

Communication↗

PubMed1996

Dworkin and Casey on abortion.

This article responds to two important recent treatments of abortion rights. I will mainly discuss Ronald Dworkin's recent writings concerning abortion: his article "Unenumerated rights: whether and how Roe should be overruled," and his book Life's Dominion. In these writings Dworkin presents a novel view of what the constitutional and moral argument surronding abortion is really about. Both debates actually turn, he argues, on the question of how to interpret the widely shared idea that human life is sacred. At the heart of the abortion debate is the essentially religious notion that human life has value which transcends its value to any particular person; abortion is therefore at bottom a religious issue. Dworkin hopes to use this analysis to show that the religion clauses of the First Amendment provide a "textual home" for a woman's right to choose abortion. I wish to scrutinize this suggestion here; I want to probe the precise consequences for abortion rights of such an understanding of their basis. I will argue that the consequences are more radical than Dworkin seems to realize. The other work I will examine here is the important 1992 Supreme Court decision on abortion, Planned Parenthood v. Casey. The controlling opinion in that case, written jointly by Justices Kennedy, O'Connor, and Souter, strongly reaffirmed Roe v. Wade, but also upheld most of the provisions of a Pennsylvania statute that had mandated various restrictions on abortion. The justices' basis for upholding these restictions was their introduction of a new constitutional standard for abortion regulations, an apparently weaker standard than those that had governed previous Supreme Court abortion decisions. I think there is a flaw in Casey's new constitutional test for abortion regulations, and I will explain, when we turn to Casey, what it is and why it bears a close relation to Dworkin's reluctance to carry his argument as far as it seems to go.

Abortion, Induced↗

PubMed1996

The Irma dream, self-analysis, and self-supervision.

The Irma dream has special historical significance. Erikson and others have placed it in historical, social, and cultural context. The manifest dream was elaborated in terms of analytic surface with analysis of form and content, patterns and movement in time and space, etc. There are, however, limits to textual reinterpretations. Further psychobiographic consideration of the Irma dream highlights issues of transference, countertransference and their sources in unconscious conflict and trauma. The Irma dream was initially a secret dream which represented the initiation of a self-analytic and supervisory process. Freud's revealing the dream and imagining the commemoration of the discovery of "the secret of the dream" marked the termination of formal self-analysis within analysis interminable.

Countertransference↗

PubMed1996

[The "Tractatus de balneis Germaniae" by Caspar Schober (around 1530). On the status of early balneology in Germany between mineral source analysis and corresponding reports].

Caspar Schober, an Austrian physician of the early 16th century, wrote a treatise concerning the most famous German spas. In this treatise he describes a method to analyse the hot springs in Gastein to know their therapeutic effects. With this description he is one of the first scientific authors in Germany dealing with the modern analysis of hot springs used by the Italian balneologists; in fact he is writing in the same textual paradigm as Menghus Blanchellus in his "Consilium de balneo Villae'. The second part of his treatise about the spas of Baden near Vienna, Markgrafenbad, Wiesbaden, Aachen, Wildbad in the Black Forest, Pfäfers and Baden in Switzerland depends on a hitherto unknown latin redaction of the "Tractatus de balneis naturalibus' of Felix Hemmerli, probably written by the Munich physician Johannes Hartlieb.

Austria↗

PubMedDate not supplied

The clinical application of the nursing process in selected acute care settings: a professional mirage.

The nursing process is the problem solving framework purported to be used in a multiplicity of health care settings. Although its use is widespread in educational and clinical settings, some nurse clinicians display negative attitudes towards its use and state that it is incongruent with nursing practice. To date, there has been no study cited that has examined it use within clinical settings to determine the substance of these claims. Using grounded theory methodology, this study examined the clinical application of the nursing process in acute care hospital settings. Data were obtained from semi-structured interviews with predominantly nurse clinicians (n = 27), participant field observations of nurse clinicians, and in-depth audits of patient records. Textual data were managed using NUD-IST and analysed using constant comparative method. Data generation and analysis proceeded simultaneously using open coding, theoretical coding, and selective coding techniques until saturation was achieved. Nurses in this study experienced the basic social problem of being in a state of "Unknowing" that was linked to a number of factors, such as, the existence of a fragmented and inconsistent method of determining and communicating patient care and work conditions of immense change and uncertainty. The findings revealed several problems with the clinical application of the nursing process and illustrated that the espoused theory was unable to be clinically applied.

Acute Disease↗

PubMed1995

Free text analysis.

In the context of hospital information systems (HIS) medical free text analysis is reviewed with respect to current automated approaches to literature retrieval, case retrieval and fact retrieval from textual data in the patient record. The Unified Medical Language System (UMLS) project has enormously stimulated current research. It is expected that UMLS knowledge sources and SNOMED III (which need a translation into other languages as soon as possible) as well as the conceptual graphs formalism, could become standards to utilize free text information contained in HIS databases.

Abstracting and Indexing↗