Using the Delphi Method to Classify Medical Specialties

One medical specialty classification system applicable for research and career counseling is the person‐oriented versus technique‐oriented taxonomy. Given that the model was conceptualized in the 1960s, verification based on how medical specialties are practiced and viewed today is necessary. Five specialists in medical career development and advising verified the categorization of specialties. Based on their review, 100% consensus was reached regarding grouping of specialties. This outcome validates the taxonomy of medical specialties and supports its continued use for medical career specialty advising and choice.     

Designing Graphs that Promote Both Risk Understanding and Behavior Change

Graphs show promise for improving communications about different types of risks, including health risks, financial risks, and climate risks. However, graph designs that are effective at meeting one important risk communication goal (promoting risk‐avoidant behaviors) can at the same time compromise another key goal (improving risk understanding). We developed and tested simple bar graphs aimed at accomplishing these two goals simultaneously. We manipulated two design features in graphs, namely, whether graphs depicted the number of people affected by a risk and those at risk of harm (“foreground+background”) versus only those affected (“foreground‐only”), and the presence versus absence of simple numerical labels above bars. Foreground‐only displays were associated with larger risk perceptions and risk‐avoidant behavior (i.e., willingness to take a drug for heart attack prevention) than foreground+background displays, regardless of the presence of labels. Foreground‐only graphs also hindered risk understanding when labels were not present. However, the presence of labels significantly improved understanding, eliminating the detrimental effect of foreground‐only displays. Labels also led to more positive user evaluations of the graphs, but did not affect risk‐avoidant behavior. Using process modeling we identified mediators (risk perceptions, understanding, user evaluations) that explained the effect of display type on risk‐avoidant behavior. Our findings contribute new evidence to the graph design literature: unlike what was previously feared, we demonstrate that it is possible to design foreground‐only graphs that promote intentions for behavior change without a detrimental effect on risk understanding. Implications for the design of graphical risk communications and decision support are discussed.     

多渠道医疗门诊挂号的时间策略研究

现阶段多种门诊挂号方式并存时，根据患者特性制定不同的等待时间策略尤为重要。本文考虑门诊挂号的三种渠道：直接排队挂号渠道、电话预约挂号渠道与O2O预约挂号渠道。在价格外生前提下，综合考虑患者的渠道偏好程度、时间敏感性与提前支付敏感性，基于效用理论构建患者的渠道选择模型。根据该模型推导得出不同市场条件下医院的需求，医院再据此制定患者的等待时间策略以达到利润最大化的目的。研究发现：当医院仅开通单一挂号渠道时，若患者的时间敏感度越大、渠道偏好程度越小，等待时间均越小；开通某两种挂号渠道时，还需考虑患者对两种渠道的偏好比例，偏好某种渠道的患者比例增加，选择该渠道的患者等待时间增加，选择另一渠道的患者等待时间减小；同时开通三种渠道时，最偏好某渠道的患者比例越大，选择该渠道的患者的等待时间也越大；在所有情况下，患者对提前支付的敏感度均不影响最优等待时间的制定。     

Professional discretion and length of work experience: what findings from focus groups with care managers in elder care suggest

ABSTRACT

Research has explored how care managers in elder care – who often function as ‘street-level bureaucrats’ – regard professional discretion. The way in which length of work experience affects care managers’ use of professional discretion remains, however, unexplored. This article present findings from 12 focus groups with 60 care managers. By bringing attention to how care managers experience the needs assessment process, this article sheds light on how these ‘street-level bureaucrats’ struggle when they try to balance their clients’ needs against institutional frameworks and local guidelines. Length of work experience seems to play a role in how care managers claim to use professional discretion. Experienced care managers describe how they deviate from the guidelines at times in order to create an increased scope of action in their decision-making process. Those with less time in the profession describe greater difficulties in this respect. Findings suggest that research should explore if length of work experience plays a role in the actual way in which care managers assess needs and make decisions. As such, they contribute to our understanding of how needs assessment processes are navigated by professionals while also pointing towards the nature of professional discretion in gerontological social work.     

Peer relationships during late childhood in internationally adopted and institutionalized children

The aim of this study was to analyse the interpersonal relationships in the school context of children living in different care settings (adoptive families, residential care centres, birth families). Participants were 76 children between eight and fourteen years of age (M = 10.78, SD = 1.38), belonging to one of three groups: international adoptees, children living in residential care in Spanish institutions, and a comparison sample of Spanish children living with their birth families with no connection with child protection. Sociometric information was collected in the classroom of each child during school hours. Internationally adopted children from Russia showed considerable difficulties in their relationships with peers; they were more likely to be rejected and their peers described them as less prosocial and somewhat more aggressive. With a better sociometric position than the adoptees, children in residential care were rated by their peers as more aggressive and less prosocial than the normative population. Coordination and integrated work between the family, protection centres, schools, and other social services should be a strategic priority in the promotion of healthy social development in these groups of children.     

多元医疗背景下藏族民众择医实践的人类学分析——以甘孜藏族自治州C村为例

择医实践是指当一个人感到不适，为了证实是否有疾病和为了减少疾痛为目的寻求帮助的行为，是医学人类学研究主要课题之一。由于社会文化背景、地理条件等因素，藏族聚居地区医疗模式显现出多元共存，与之对应，当地民众的择医实践也呈现出一种多元状态。正是由于人们多元择医实践的诉求、固守与调适，才推进着多元医疗模式在发展中适应区域群体的文化变迁、需求改变而日趋完善，由此医疗模式与择医实践形成了互动、互构关系。     

Variables related to maternal satisfaction with intrapartum care in Northern Italy

BackgroundThe experience of labour and birth is complex, multidimensional and subjective and has the potential to affect the women and their families physically and emotionally. However, there is a lack of research around maternal satisfaction in Italy.AimTo evaluate mothers’ satisfaction with their childbirth experience in relation to socio-demographic characteristics, obstetric history and intrapartum care variables.MethodsA cross-sectional study involving 277 women who had given birth in a low risk maternity unit in Northern Italy was undertaken. Satisfaction with birth was measured using the Italian version of the Birth Satisfaction Scale-Revised (I-BSS-R). The scale comprises three Sub-Scales: quality of care provided, personal attributes of women and stress experienced during childbirth.FindingsNo socio-demographic variables were related to maternal satisfaction. Multiparous women had a higher satisfaction score (p = 0.020; CI:0.23;2.75). Antenatal class attendance was negatively associated with maternal satisfaction (p = 0.038; CI:−2.58; −0.07). Intrapartum variables that significantly reduced maternal satisfaction were: epidural usage (p = 0.000; CI:−4.66; −2.07), active phase >12 h (p = 0.000; CI:−6.01; −2.63), oxytocin administration (p = 0.000; CI:−5.08; −2.29) and vacuum assisted birth (p = 0.001; CI:−6.50; −1.58). Women with an intact perineum were more likely to be satisfied (p = 0.008; CI:−4.60; −0.69).DiscussionIn accordance with other research, we showed that intrapartum interventions are negatively associated with maternal outcomes and therefore also with maternal satisfaction with birth. The sub-scale that measured Quality of Care provided scored higher than the other two Sub-Scales.ConclusionFurther studies on maternal satisfaction in Italy should be conducted, using the I-BSS-R with the aim to compare outcomes and understand what matters to women during childbirth.     

Storifying routines and routinising stories: A dualistic subject positioning analysis of controversies about constraints on patient autonomy

This paper uses subject positioning theory to explore how conflicts between autonomy and protection are managed in the justification of controversial care arrangements for patients with mental/neurological illness. Its basic argument is twofold: firstly, to justify or propose care arrangements at strategic or contentious moments, actors position illness as an actant and make it present in talk‐in‐interaction, exploiting alignments and misalignments between the there and then of reported events and the above and beyond of shared societal discourses to say what matters and what's to be done here and now; secondly, the introduction of authoritative voices from elsewhere involves imbricating narrative and routine sequences in order to prioritise different subjectivities. Dilemmas opposing autonomy and protection may seem less intractable if we adopt a corresponding perspective interplay between narrative and routine situational readings.