From dialysis to transplantation, illness experience and patients' concerns about future: A longitudinal qualitative study

Background: Transplantation is the treatment of choice when compared to dialysis. Long-term evolution of patients is rarely comprehensively described. Thirty end-stage renal disease patient's experience of illness was explored from registration for transplantation until twenty-four months after transplantation. Methods: Longitudinal semi-structured interviews were conducted, and qualitative discourse analysis performed. Findings: Before transplantation loss of quality of life (QOL), emotional fragility related to dialysis constraints were reported, and increased with waiting-time. Six months after transplantation, recovered freedom was described but acute rejection, and life-dependency to immunosuppressants generated concerns. After twelve months, long-term survival of the graft, and possible return-to-dialysis were mentioned. After twenty months graft's dysfunction, co-morbidities, immunosuppressants side effects rose concerns even though QOL persisted. Most patients report positive transformations after transplantation, which are related to graft survival and limited co-morbidities. Discussion: As time passes, patients deal with changing illness constraints, and contemplate with anxiety possible new return to dialysis and/or transplantation.

Determination of the critical activities of a public-private intermediary organization with the help of value chain analysis

Tämän diplomityön tavoitteena oli selvittää arvoketjuanalyysin avulla toiminnot, joilla voittoatavoittelemattoman, julkisen osakeyhtiön toimintaa voitaisiin kuvata. Tarkoituksena oli selvittää mainitut toiminnot yleisesti ja luoda malli kohdeyrityksen arvoketjusta ja sen toiminnoista. Tutkielma jakautuu teoreettiseen ja empiiriseen osaan. Ensimmäinen pohjautuu aikaisempaan tutkimukseen ja kirjallisuuteen sidosryhmistä, arvon muodostumisesta ja arvoketjuanalyysistä. Jälkimmäinen on laadullista tapaustutkimusta. Empiriassa mallinnettiin Lappeenranta Innovation Oy:nsisäisiä toimintoja ja sidosryhmien odotuksia. Empiirinen tutkimus perustui kohdeyrityksen omistajille ja henkilöstölle tehtyihin haastatteluihin sekä yrityksen toiminnan päivittäiseen seurantaan. Johtopäätöksenätodettiin, että julkisen, voittoa tavoittelemattoman yrityksen toiminnot on mahdollista kuvata arvoketjuanalyysin avulla. Alan ja yrityksen asettamat erityispiirteet toivat haasteita määrittelylle, mutta silti arvoketju antoi selkeän tavan kohdeyrityksen toimintojen mallintamiselle.

Value chain analysis in graphical boards business

Tällä tutkielmalla oli kaksi tavoitetta. Ensimmäinen tavoite oli selvittää, kuinka valittujen tuotteiden arvoa asiakkaiden silmissä voisi lisätä. Toisena tavoitteena oli selvittää tuotteiden arvon lisääntyminen arvoketjun jokaisella portaalla kartonkitehtaaltaloppuasiakkaalle. Tutkimuksen kohteena oli kolme erilaista arvoketjua. Tutkimusoli luonteeltaan kvalitatiivinen ja tarvittavat tiedot kerättiin haastatteluilla. Tutkimuksen tuloksena voidaan mainita, että asiakkaat arvostavat laskua kustannuksissa enemmän kuin lisähyötyjä. Myös prosentuaalinen arvonlisäys valittuihintuotteisiin arvoketjun eri portaissa saatiin selville. Tästä työstä on tehty kaksi versiota; tämä versio, joka tulee julkiseksi neljän vuoden salassapitoajan jälkeen, ja toinen versio, joka sisältää arkaluontoisempaa kustannusinformaatiotaja on siitä syystä kokonaan salainen.

Market Opportunities Analysis for Logistics Solutions Provider Case Danzas Solutions

Tutkielman tavoitteena oli suunitella markkina-analyysi ja sitä käyttäen määritellä Danzasin Solutions liiketoimintayksikön mahdollisuuksia laajentaa toimintaansa Suomen terveydenhuolto/ lääke- ja elektroniikka/ telekommunikaatiosektoreilla. Danzas Solutions toimisi logistiikkaintegraattorina toimittamalla kokonaisvaltaisia logistisia ratkaisuja. Tutkimus tehtiin haastattelemalla neljää Danzasin asiakasta. Mahdollisimman laajan ja yleistettävän tuloksen saamiseksi haastateltavat valitiin logistiikan ulkoistamisasteeltaan vaihteleviksi. Tutkimus tehtiin ensin tutkimalla sekundääristä informaatiota markkinoilta ja täydentämällä sitä haastatteluista saadulla kvalitatiivisella primääri informaatiolla ja case yrityksen sisäisellä analyysillä. Painopiste tutkimuksessa oli selvittää yritysten ulkoistamiseen ja logistiikkakumppanin valintaan vaikuttavia kriteereitä. Logistiikkaintegraattorille suurimmat mahdollisuudet löytyvät elektroniikka/ telekommunikaatiosektorilta. Logistiikka tällä sektorilla on vaativaa ja yrityksillä ei ole resursseja hallita sitä itse. Terveydenhuolto/ lääkesektorilla yrityksillä on yleensä muut keinot jakeluketjun hallintaan ja ne eivät tarvitse logistiikkaintegraattorin palveluita.

Competitor Analysis on Mobile Application Developer Communities

Tulevaisuudessa telekommunikaatioala tulee keskittymään pitkälti langattomiin sovelluksiin ja lisäarvopalveluihin. Tuottaakseen näitä palveluja alan yritykset tekevät yhteistyötä laajan kehittäjäjoukon kanssa. Työn tavoitteena oli parantaa case-yrityksen jo olemassaolevaa toimintamallia, jota se soveltaa yhteistyössään kehittäjien kanssa. Tutkimus keskittyy mobiiliapplikaatiokehittäjiin. Toimintamalli kattaa pääasiassa palvelutarjonnan kehittäjä-allianssissa.Jotta toimintamalliin pystyttäisiin tekemään strategisia muutoksia, oli aluksi tärkeä tunnistaa kehittäjien tarpeet ja toiseksi tarkkailla ja analysoida ympäristöä ja sillä tavoin tunnistaa pääkilpailijat ja heidän tarjontansa mobiiliapplikaatiokehittäjille. Tutkimus toteutettiin suorittamalla postikysely kehittäjille ja toisaalta tekemällä laadullinen tutkimus kilpailijoista. Kilpailutilanteen luonne ja potentiaaliset kilpailijat olivat tunnistettavissa. Parannusehdotukset sisälsivät sekä yleisiä että palvelukohtaisia parannuksia.

Informing patients about limits to confidentiality: A qualitative study in prisons.

AIM: Confidentiality is important in healthcare practice, however, under certain circumstances, confidentiality is breached. In this paper, mental health professionals' (MHPs) practices related to informing imprisoned patients about confidentiality and its limits are presented. METHODS: Twenty-four MHPs working in Swiss prisons were interviewed. Data analysis involved qualitative thematic coding and was validated by discussing results with external experts and study participants. RESULTS: For expert evaluations and court-ordered therapies, participants informed patients that information revealed during these consultations is not bound by confidentiality rules. The practice of routinely informing patients about confidentiality and its limits became more complex in voluntary therapies, for which participants described four approaches and provided justifications in favour of or against their use. CONCLUSIONS: Further training and continued education are needed to improve physicians' ethical and legal knowledge about confidentiality disclosures. In order to promote ethical practices, it is important to understand and address existing motivations, attitudes and behaviours that impede appropriate patient information. Our study adds important new knowledge about the limits to confidentiality, particularly for providers working with vulnerable populations. Results from this study reflect typical ethical and practical dilemmas faced by and of interest to physicians working in forensic medicine and other related settings.

A qualitative study of adolescents with medically unexplained symptoms and their parents. Part 2: How is healthcare perceived?

Medically unexplained symptoms (MUS) are common among adolescents and an important cause of clinical visits. This study sought to understand the experiences with, and perceptions of, the healthcare of adolescents who have MUS and their parents. Using a qualitative approach, six focus groups and two individual interviews were conducted with a total of ten adolescents and sixteen parents. The participants were recruited in a university hospital in Switzerland. A thematic analysis was conducted in accordance with the Grounded Theory. Six main themes emerged: needing a label for the symptoms, seeking an etiology to explain the symptoms, negotiating the medical system, medication and treatments, interactions with doctors, and the inclusion of parents during consultations. Transcending these themes, however, was the need for good communication between the adolescents, their parents and the clinicians. When explaining the symptoms, clinicians should make sure to discuss the results, investigations and lack of organic origin.

A qualitative study of adolescents with medically unexplained symptoms and their parents. Part 1: Experiences and impact on daily life.

Medically unexplained symptoms (MUS) are common among adolescents and are frequently encountered in primary care. Our aim was to explore how these adolescents and their parents experience the condition and its impact on their daily lives and to provide recommendations for health professionals. Using a qualitative approach, six focus groups and two individual interviews were conducted. These involved a total of ten adolescents with different types of MUS and sixteen parents. The respondents were recruited in a university hospital in Switzerland. A thematic analysis was conducted according to the Grounded Theory. The analysis of the data highlighted four core themes: disbelief, being different, concealing symptoms, and priority to adolescent's health. Transcending these themes was a core issue regarding the discrepancy between the strategies that adolescents and their parents use to cope with the symptoms. Health professionals should be made aware of the emotional needs of these patients and their families.

Qualitative, quantitative and temporal study of cutting agents for cocaine and heroin over 9 years

Forensic laboratories mainly focus on the qualification and the quantitation of the illicit drug under analysis as both aspects are used for judiciary purposes. Therefore, information related to cutting agents (adulterants and diluents) detected in illicit drugs is limited in the forensic literature. This article discusses the type and frequency of adulterants and diluents detected in more than 6000 cocaine specimens and 3000 heroin specimens, confiscated in western Switzerland from 2006 to 2014. The results show a homogeneous and quite unchanging adulteration for heroin, while for cocaine it could be characterised as heterogeneous and relatively dynamic. Furthermore, the results indicate that dilution affects more cocaine than heroin. Therefore, the results provided by this study tend to reveal differences between the respective structures of production or distribution of cocaine and heroin. This research seeks to promote the systematic analysis of cutting agents by forensic laboratories. Collecting and processing data related to the presence of cutting agents in illicit drug specimens produces relevant information to understand and to compare the structure of illicit drug markets.

Building legitimacy by criticising the pharmaceutical industry: a qualitative study among prescribers and local opinion leaders.

PRINCIPLES: The literature has described opinion leaders not only as marketing tools of the pharmaceutical industry, but also as educators promoting good clinical practice. This qualitative study addresses the distinction between the opinion-leader-as-marketing-tool and the opinion-leader-as-educator, as it is revealed in the discourses of physicians and experts, focusing on the prescription of antidepressants. We explore the relational dynamic between physicians, opinion leaders and the pharmaceutical industry in an area of French-speaking Switzerland. METHODS: Qualitative content analysis of 24 semistructured interviews with physicians and local experts in psychopharmacology, complemented by direct observation of educational events led by the experts, which were all sponsored by various pharmaceutical companies. RESULTS: Both physicians and experts were critical of the pharmaceutical industry and its use of opinion leaders. Local experts, in contrast, were perceived by the physicians as critical of the industry and, therefore, as a legitimate source of information. Local experts did not consider themselves opinion leaders and argued that they remained intellectually independent from the industry. Field observations confirmed that local experts criticised the industry at continuing medical education events. CONCLUSIONS: Local experts were vocal critics of the industry, which nevertheless sponsor their continuing education. This critical attitude enhanced their credibility in the eyes of the prescribing physicians. We discuss how the experts, despite their critical attitude, might still be beneficial to the industry's interests.

Complexity of the Paradigms Present in Quality Criteria of Qualitative Research Grids

With qualitative methods being increasingly used in health science fields, numerous grids proposing criteria to evaluate the quality of this type of research have been produced. Expert evaluators deem that there is a lack of consensual tools to evaluate qualitative research. Based on the review of 133 quality criteria grids for qualitative research in health sciences, the authors present the results of a computerized lexicometric analysis, which confirms the variety of intra- and inter-grid constructions, including within the same field. This variety is linked to the authors' paradigmatic references underlying the criteria proposed. These references seem to be built intuitively, reflecting internal representations of qualitative research, thus making the grids and their criteria hard to compare. Consequently, the consensus on the definitions and the number of criteria becomes problematic. The paradigmatic and theoretical references of the grids should be specified so that users could better assess their contributions and limitations.

Pediatric advance care planning from the perspective of health care professionals: a qualitative interview study.

BACKGROUND: Pediatric advance care planning differs from the adult setting in several aspects, including patients' diagnoses, minor age, and questionable capacity to consent. So far, research has largely neglected the professionals' perspective. AIM: We aimed to investigate the attitudes and needs of health care professionals with regard to pediatric advance care planning. DESIGN: This is a qualitative interview study with experts in pediatric end-of-life care. A qualitative content analysis was performed. SETTING/PARTICIPANTS: We conducted 17 semi-structured interviews with health care professionals caring for severely ill children/adolescents, from different professions, care settings, and institutions. RESULTS: Perceived problems with pediatric advance care planning relate to professionals' discomfort and uncertainty regarding end-of-life decisions and advance directives. Conflicts may arise between physicians and non-medical care providers because both avoid taking responsibility for treatment limitations according to a minor's advance directive. Nevertheless, pediatric advance care planning is perceived as helpful by providing an action plan for everyone and ensuring that patient/parent wishes are respected. Important requirements for pediatric advance care planning were identified as follows: repeated discussions and shared decision-making with the family, a qualified facilitator who ensures continuity throughout the whole process, multi-professional conferences, as well as professional education on advance care planning. CONCLUSION: Despite a perceived need for pediatric advance care planning, several barriers to its implementation were identified. The results remain to be verified in a larger cohort of health care professionals. Future research should focus on developing and testing strategies for overcoming the existing barriers.

Who's fault is it ? : An analysis of the press coverage of football betting scandals in France and the United Kingdom

Sport betting is a lucrative business for bookmakers, for the lucky (or wise) punters, but also for governments and for sport. While not new or even recent, the deviances linked to sport betting, primarily match-fixing, have gained increased media exposure in the past decade. This exploratory study is a qualitative content analysis of the press coverage of sport betting-related deviances in football in two countries (UK and France), using in each case two leading national publications over a period of five years. Data analysis indicates a mounting coverage of sport betting scandals, with teams, players and criminals increasingly framed as culprits, while authorities and federations primarily assume a positive role. As for the origin of sport betting deviances, French newspapers tend to blame the system (in an abstract way); British newspapers, in contrast, focus more on individual weaknesses, notably greed. This article contributed to the growing body of literature on the importance of these deviances and on the way they are perceived by sport organizations, legislators and the public at large.

A qualitative study of adolescents with medically unexplained symptoms and their parents

Il est fréquent en médecine de premier recours de rencontrer des adolescents exprimant des symptômes somatiques pour lesquels aucune des investigations entreprises n'a permis de rendre compte d'une pathologie organique. De tels symptômes sont retrouvés dans la littérature sous la terminologie de symptômes médicalement inexpliqués (MUS) ou des troubles fonctionnels. Bien que la prévalence des adolescents souffrant de MUS est fréquente, les médecins éprouvent encore beaucoup de difficultés à prendre en charge et communiquer avec ces patients, principalement en raison d'une incompréhension de leurs besoins et préoccupations tant dans leur vie quotidienne que lors d'une consultation au cabinet. Le but de notre étude est de comprendre les expériences et vécus des adolescents avec des MUS ainsi que de leurs parents afin d'aider le praticien dans la compréhension de son patient dans sa globalité et ainsi d'améliorer sa prise en charge. Dans le premier article présenté, nous nous sommes intéressés à la vie quotidienne de ces adolescents en étudiant leurs relations avec leur famille et leur entourage ainsi que les répercussions sur leurs parcours scolaire et leurs activités extrascolaires. Dans le second article nous nous sommes penchés sur les relations qu'entretiennent ces adolescents et leurs parents avec le système de santé. Nous avons collecté des données qualitatives en moyennant des groupes focus incluant 16 adolescents atteints de troubles fonctionnels et leurs parents. L'analyse a permis de faire émerger les difficultés que ces jeunes et leurs familles vivent au quotidien et comment ils sont confrontés à la solitude dû principalement à l'incompréhension sociale. Les résultats mettent aussi en évidence l'insatisfaction de ces jeunes et de leurs parents par rapport à la prise en charge médical, notamment en raison d'un manque de communication. -- Medically unexplained symptoms (MUS) are common among adolescents and are frequently encountered in primary care. Our aim was to explore how these adolescents and their parents experience the condition and its impact on their daily lives and to provide recommendations for health professionals. Using a qualitative approach, six focus groups and two individual interviews were conducted. These involved a total of ten adolescents with different types of MUS and sixteen parents. The respondents were recruited in a university hospital in Switzerland. A thematic analysis was conducted according to the Grounded Theory. The analysis of the data highlighted four core themes: disbelief, being different, concealing symptoms, and priority to adolescent's health. Transcending these themes was a core issue regarding the discrepancy between the strategies that adolescents and their parents use to cope with the symptoms. Health professionals should be made aware of the emotional needs of these patients and their families.

Characterization of the antibiotic doripenem using physicochemical methods: chromatography, spectrophotometry, spectroscopy and thermal analysis

Doripenem was characterized through physicochemical and spectroscopic techniques, as well as thermal analysis. TLC (Rf = 0.62) and HPLC (rt = 7.4 min) were found to be adequate to identify the drug. UV and infrared spectra showed similar profile between doripenem bulk and standard. The ¹H and 13C NMR analysis revealed chemical shifts that allowed identifying the drug. Thermal analysis demonstrated three steps with mass loss, at 128, 178 and 276 ºC. The work was successfully applied to qualitative analysis of doripenem, showing the reported methods can be used for physicochemical characterization of doripenem