scholarly journals Two Years of Ethics Reflection Groups About the Use of Coercion. Changes Over Time in Employees’ Normative Attitudes Regarding the Use of Coercion, User Involvement, Team Cooperation and the Handling of Disagreement

2020 ◽  
Author(s):  
Bert Molewijk ◽  
Reidar Pedersen ◽  
Almar Kok ◽  
Reidun Førde ◽  
Olaf Aasland
Keyword(s):  
Clinical Practice ◽  
Evaluation Studies ◽  
User Involvement ◽  
Reflection Groups ◽  
Team Cooperation ◽  
Critical Attitude ◽  
Changes Over Time ◽  
The Impact ◽  
Over Time ◽  
Ethics Reflection

Abstract Background: Research on the impact of ethics reflection groups (ERG) or moral case deliberations (MCD) is complex and scarce. Within a larger study, ERG has been used as an intervention for stimulating critical ethical reflection and improved team cooperation while observing changes over time.Research question: Are there – during and after two years of ERGs - changes over time regarding employees’ normative attitudes regarding the use of coercion and how employees perceive user involvement, team cooperation and the handling of disagreement in teams?Methods: Repeated cross-sectional survey to multidisciplinary employees at seven wards within three Norwegian mental health care institutions (T0-T1-T2). Changes in normative attitudes over time were estimated using linear mixed models.Results: In total, 817 surveys (from employees that did and did not participate in ERG) were included in the analyses. Of these, 7.6 % (N=62) responded at all three points in time, 15.5% (N=127) at two points, and 76.8 % (N= 628) once. On average, over time, respondents who participated in ERG agreed less that coercion can be seen a form of care or security. ERG participants more often reported that they involved users and that they handled disagreement within the team constructively. Furthermore, more frequent ERG participation was associated with a more critical attitude towards coercion and higher scores for user involvement, the coercion competence of the team and the constructive handling of disagreement within their teams.Conclusions: Structural ERGs or MCDs seem to contribute to employees reporting a more critical attitude towards coercion, more user involvement around coercion and a more constructive handling of disagreement. Differences were generally small in absolute terms possibly due to the low amount of longitudinal data and the relative low frequency of ERG’s during the two years. Studying changes over time in clinical practice and trying to find a relationship between CES interventions and CES outcomes is difficult yet important and needs to be further developed in future CES evaluation studies. This explorative quantitative study may be a first step from qualitative evidence towards more robust quantitative evidence of the contribution of CES to clinical practice and quality of care.

Systematic Evaluation of Two Years of Ethics Reflection Groups. Changes Over Time Regarding Employees’ Attitudes, User Involvement, Team Cooperation and the Handling of Disagreement

2021 ◽  
Vol 66 (Special Issue) ◽  
pp. 126-127
Author(s):  
Bert Molewijk ◽  
◽  
Reidar Pedersen ◽  
Almar Kok ◽  
Reidun Førde ◽  
...  
Keyword(s):  
Health Care ◽  
Research Question ◽  
User Involvement ◽  
Systematic Evaluation ◽  
Reflection Groups ◽  
Team Cooperation ◽  
Changes Over Time ◽  
The Impact ◽  
Over Time ◽  
Ethics Reflection

"Background: Ethics reflection groups (ERG) or moral case deliberations (MCD) are increasingly used in health care as a form of clinical ethics support (CES). ERGs are often evaluated with a focus on evaluating ERG itself yet not on the impact of or change due to ERGs. Within a larger study implementation and impact of ERG was studied with use of various qualitative and qualitative research methodologies. In this presentation we present findings of the quantitative research. Research question: Are there changes over time after two years of ERG regarding employees’ normative attitudes with respect to the use of coercion, user involvement during the use of coercion, team cooperation and the handling of disagreement? Research methods: Repeated cross-sectional survey at seven wards within three different Norwegian mental health care institutions (T0-T1-T2). Results: In total, 817 surveys were included in the analyses. Of these, only 7.6 % (N= 62) have responded at all three points in time, while 76.8 % (N= 628) responded only once. Over time, adjusted for ward and profession, respondents agreed less that coercion is a form of care or security. Furthermore, respondents thought they involved patients and their family significantly more often in situations of coercion and they reported that the constructive of disagreement within the team significantly improved. More frequent ERG participation seemed associated with a more critical attitude towards the use of coercion and higher scores for user involvement, team cooperation and the constructive handling of disagreement, yet differences between ERG participation were generally small in absolute terms. Conclusion: Structural participation in ERG seems to contribute to changes in attitudes, user involvement and team cooperation. Studying changes over time and trying to find a relationship between CES interventions and outcome is difficult yet important and need to be further developed in future CES evaluation research. "

scholarly journals Hospital ethics reflection groups: a learning and development resource for clinical practice

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
H. Bruun ◽  
L. Huniche ◽  
E. Stenager ◽  
C. B. Mogensen ◽  
R. Pedersen
Keyword(s):  
Clinical Practice ◽  
General Hospital ◽  
Positive Impact ◽  
Reflection Group ◽  
Ethical Challenge ◽  
Ethical Challenges ◽  
Reflection Groups ◽  
Patient Admissions ◽  
The Impact ◽  
Ethics Reflection

Abstract Background An ethics reflection group (ERG) is one of a number of ethics support services developed to better handle ethical challenges in healthcare. The aim of this article is to evaluate the significance of ERGs in psychiatric and general hospital departments in Denmark. Methods This is a qualitative action research study, including systematic text condensation of 28 individual interviews and 4 focus groups with clinicians, ethics facilitators and ward managers. Short written descriptions of the ethical challenges presented in the ERGs also informed the analysis of significance. Results A recurring ethical challenge for clinicians, in a total of 63 cases described and assessed in 3 ethical reflection groups, is to strike a balance between respect for patient autonomy, paternalistic responsibility, professional responsibilities and institutional values. Both in psychiatric and general hospital departments, the study participants report a positive impact of ERG, which can be divided into three categories: 1) Significance for patients, 2) Significance for clinicians, and 3) Significance for ward managers. In wards characterized by short-time patient admissions, the cases assessed were retrospective and the beneficiaries of improved dialogue mainly future patients rather than the patients discussed in the specific ethical challenge presented. In wards with longer admissions, the patients concerned also benefitted from the dialogue in the ERG. Conclusion This study indicates a positive significance and impact of ERGs; constituting an interdisciplinary learning resource for clinicians, creating significance for themselves, the ward managers and the organization. By introducing specific examples, this study indicates that ERGs have significance for the patients discussed in the specific ethical challenge, but mostly indirectly through learning among clinicians and development of clinical practice. More research is needed to further investigate the impact of ERGs seen from the perspectives of patients and relatives.

scholarly journals Quality of life assessments in clinical practice using either the EORTC-QLQ-C30 or the SEIOQL-DW: a randomized study

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Åsa Kettis ◽  
Hanna Fagerlind ◽  
Jan-Erik Frödin ◽  
Bengt Glimelius ◽  
Lena Ring
Keyword(s):  
Quality Of Life ◽  
Clinical Practice ◽  
Significant Difference ◽  
Patient Reported ◽  
Health Related Qol ◽  
Health Related ◽  
Secondary Outcomes ◽  
The Impact ◽  
Over Time

Abstract Background Effective patient-physician communication can improve patient understanding, agreement on treatment and adherence. This may, in turn, impact on clinical outcomes and patient quality of life (QoL). One way to improve communication is by using patient-reported outcome measures (PROMs). Heretofore, studies of the impact of using PROMs in clinical practice have mostly evaluated the use of standardized PROMs. However, there is reason to believe that individualized instruments may be more appropriate for this purpose. The aim of this study is to compare the effectiveness of the standardized QoL-instrument, the European Organization for Research and Treatment of Cancer Quality of Life C-30 (EORTC-QOL-C30) and the individualized QoL instrument, the Schedule for the Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW), in clinical practice. Methods In a prospective, open-label, controlled intervention study at two hospital out-patient clinics, 390 patients with gastrointestinal cancer were randomly assigned either to complete the EORTC-QOL-C30 or the SEIQoL-DW immediately before the consultation, with their responses being shared with their physician. This was repeated in 3–5 consultations over a period of 4–6 months. The primary outcome measure was patients’ health-related QoL, as measured by FACIT-G. Patients’ satisfaction with the consultation and survival were secondary outcomes. Results There was no significant difference between the groups with regard to study outcomes. Neither intervention instrument resulted in any significant changes in health-related QoL, or in any of the secondary outcomes, over time. This may reflect either a genuine lack of effect or sub-optimization of the intervention. Since there was no comparison to standard care an effect in terms of lack of deterioration over time cannot be excluded. Conclusions Future studies should focus on the implementation process, including the training of physicians to use the instruments and their motivation for doing so. The effects of situational use of standardized or individualized instruments should also be explored. The effectiveness of the different approaches may depend on contextual factors including physician and patient preferences.

Remarriage among Jews and Christians

2010 ◽  
pp. 56-85
Author(s):  
Shaul Stampfer
Keyword(s):  
Nineteenth Century ◽  
Eastern Europe ◽  
Comparative Approach ◽  
Late Nineteenth Century ◽  
Russian Orthodox ◽  
Late Nineteenth ◽  
Changes Over Time ◽  
The Impact ◽  
Group Characteristics ◽  
Over Time

This chapter investigates the phenomenon of remarriage in nineteenth-century eastern Europe, demonstrating its significance in Jewish marital behaviour. Patterns of remarriage deserve attention for a number of reasons: they influenced fertility levels, affected family structure, played a role in networking, and served as an indicator of the importance of marriage in a given society. Remarriage is highly revealing of group characteristics and behaviour, but remarriage in late nineteenth-century eastern Europe merits attention for an additional reason. Patterns of remarriage and their changes over time significantly diverged among various population groups. Eastern Europe is thus an excellent context for examining the impact of significant variables on remarriage by means of a comparative approach. The chapter then evaluates modes of remarriage among four major religious-national groups: Russian Orthodox, Catholics, Protestants, and Jews. It also considers important differences between Jews and Christians in specific patterns of remarriage.

The impact of an invasive plant changes over time

2013 ◽  
Vol 16 (10) ◽  
pp. 1277-1284 ◽  
Author(s):  
Petr Dostál ◽  
Jana Müllerová ◽  
Petr Pyšek ◽  
Jan Pergl ◽  
Tereza Klinerová
Keyword(s):  
Invasive Plant ◽  
Changes Over Time ◽  
The Impact ◽  
Over Time

scholarly journals Histopathology of vasculitis

Reumatismo ◽  
2018 ◽  
pp. 155-164 ◽  
Author(s):  
G. Bajocchi ◽  
A. Cavazza
Keyword(s):  
Clinical Practice ◽  
Clinical Assessment ◽  
Gold Standard ◽  
Sampling Error ◽  
Systemic Vasculitis ◽  
Clinical Implications ◽  
Disease Evolution ◽  
Changes Over Time ◽  
Broad Complex ◽  
Over Time

The range of pathologies that are related to primitive vasculitis is broad, complex and not as typical as we would expect. Clinicians should be aware that several forms of primitive and systemic vasculitis, regardless of the size of the affected vessel, may exhibit identical histological alterations. This observation has important clinical implications as it means that cases of vasculitis do not correspond clinically and histologically. Thus, while histology remains the diagnostic gold standard, it can be used only as part of the most complete clinical assessment possible. Another point worth of the clinician’s attention is that vasculitis histology changes over time, as do disease evolution and activity, even without considering the masking effects of treatment and the possibility of sampling error due to the patchy occurrence of vasculitis. The purpose of this review is to identify the most common forms of vasculitis in clinical practice, and to provide guidance to the clinician on the pathology of the vessels.

Development of the concept

2018 ◽  
Author(s):  
Eric Taylor
Keyword(s):  
Clinical Practice ◽  
Clinical Utility ◽  
Historical Context ◽  
Hyperkinetic Disorder ◽  
The Social ◽  
Time Concepts ◽  
Observable Behaviour ◽  
The Moment ◽  
The Impact ◽  
Over Time

Over time, concepts have evolved from the idea of a constitutional basis for behavioural problems, through unitary neurological formulations, to the recognition of neurocognitive heterogeneity and the impact of the social environment. Diagnoses have altered accordingly. ADHD and hyperkinetic disorder have different historical traditions, and still generate international differences in practice; however, they have succeeded in keeping research and clinical practice in touch with each other. This chapter takes a historical approach to describe the influences on the development of the concepts. Concepts are still changing, in response both to the historical context and to improving scientific knowledge. It may well be that recognition of heterogeneity at neural, psychological, and genetic levels will lead to more and better differentiated behavioural concepts. For the moment, however, the clinical utility of diagnosis based on observable behaviour is likely to maintain ADHD as the dominant idea organizing the field.

scholarly journals Psychosocial Aspects of Bruxism: The Most Paramount Factor Influencing Teeth Grinding

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Mieszko Wieckiewicz ◽  
Anna Paradowska-Stolarz ◽  
Wlodzimierz Wieckiewicz
Keyword(s):  
Clinical Practice ◽  
Chronic Stress ◽  
Current Literature ◽  
Negative Influence ◽  
Psychosocial Aspects ◽  
Working Environment ◽  
Teeth Grinding ◽  
Environment And Development ◽  
The Impact ◽  
Over Time

In clinical practice, patients suffering from an occlusal parafunctional activity have increased. It can be observed that a negative influence of environment aggravates patient’s health. The aim of this paper is to present the impact of environment and development of human civilization on the prevalence of bruxism and the correlation between them. The authors grasp the most relevant aspects of psychological and anthropological factors changing over time as well as their interactions and describe a relationship between chronic stress and bruxism. Current literature shows how contemporary lifestyle, working environment, diet, and habits influence the patient’s psychoemotional situation and the way these factors affect the occluso-muscle condition.

The Experimental Study of Feature Recognition during the Standard Section Installation of Tower

2012 ◽  
Vol 482-484 ◽  
pp. 701-706
Author(s):  
Shi Jun Song ◽  
Lian Yu Song ◽  
Cai Feng Qiao ◽  
Long Long Hao
Keyword(s):  
Experimental Study ◽  
Background Subtraction ◽  
Feature Recognition ◽  
Background Modeling ◽  
Morphological Processing ◽  
Target Feature ◽  
Standard Section ◽  
Changes Over Time ◽  
The Impact ◽  
Over Time

In the installation process of lifting tower cranes, background is complex, the impact of light on the characteristics of the target also changes over time very differently, which led to the installation of monitoring is not easy identified from the characteristics of the separate target in the changing off context. Based on this, this paper presents a model using bitmap which is based on the model of background subtraction to approach to background modeling adding morphological processing; the target feature can be more obvious. This method can identify the characterized target well from the complex background.

scholarly journals Intellectual Capital Change Management in the Construction Industry—The Case of an Inter-Organisational Collaboration

2021 ◽  
Vol 7 (3) ◽  
pp. 199
Author(s):  
José Vale ◽  
Nádia Barbosa ◽  
Rui Bertuzi ◽  
Ana Maria Bandeira ◽  
Vera Teixeira Vale
Keyword(s):  
Construction Industry ◽  
Intellectual Capital ◽  
Competitive Advantages ◽  
Traditional Media ◽  
Intellectual Assets ◽  
Changes Over Time ◽  
The Impact ◽  
Over Time

Nowadays, due to the complexity of the relationships with external entities, along with the importance that traditional media and the innovative social media have in creating competitive advantages, it is necessary for companies to collaborate in order to create Intellectual Capital (IC). Although collaboration is crucial to create IC, there is a paucity in literature regarding the effects that a specific type of collaboration may have on the IC of an organisation, specifically a franchising with a mediatic actor. Moreover, literature addressing IC creation and destruction over time is scarce, especially when applied to the construction industry. This paper’s goal is twofold: understanding the longitudinal changes of a construction SME’s Intellectual Capital, regarding its creation and destruction; analysing the impact that a specific inter-organisational collaboration franchising—with a mediatic actor may have on such IC. A single in-depth case study was conducted, allowing to conclude that the actions of an organisation can develop both Intellectual Assets and Intellectual Liabilities. It was also concluded that inter-organisational collaboration, through a franchise with an actor with experience in communication, can generate, in the long term, positive and innovative effects regarding the different IC components, namely the Relational one. More specifically, the paper allowed to ascertain that an organisation’s IC changes over time in a dynamic fashion, i.e., Intellectual Liabilities which emerged before an innovative collaboration can be transformed into Intellectual Assets and create competitive advantages. This paper contributes to stress the importance of managing IC, not only when it is created, but namely in when it can be destroyed, in a context of inter-organisational collaborations applied to a construction SME.

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