Appraising qualitative research for inclusion in systematic reviews:A quantitative and qualitative comparison of three methods

Objective: Qualitative research is increasingly valued as part of the evidence for policy and practice, but how it should be appraised is contested. Various appraisal methods, including checklists and other structured approaches, have been proposed but rarely evaluated. We aimed to compare three methods for appraising qualitative research papers that were candidates for inclusion in a systematic review of evidence on support for breast-feeding. Method: A sample of 12 research papers on support for breast-feeding was appraised by six qualitative reviewers using three appraisal methods: unprompted judgement, based on expert opinion; a UK Cabinet Office quality framework; and CASP, a Critical Appraisal Skills Programme tool. Papers were assigned, following appraisals, to 1 of 5 categories, which were dichotomized to indicate whether or not papers should be included in a systematic review. Patterns of agreement in categorization of papers were assessed quantitatively using κ statistics, and qualitatively using cross-case analysis. Results: Agreement in categorizing papers across the three methods was slight (κ =0.13; 95% CI 0.06-0.24). Structured approaches did not appear to yield higher agreement than that by unprompted judgement. Qualitative analysis revealed reviewers' dilemmas in deciding between the potential impact of findings and the quality of the research execution or reporting practice. Structured instruments appeared to make reviewers more explicit about the reasons for their judgements. Conclusions: Structured approaches may not produce greater consistency of judgements about whether to include qualitative papers in a systematic review. Future research should address how appraisals of qualitative research should be incorporated in systematic reviews. © The Royal Society of Medicine Press Ltd 2007.

Evaluating and developing project-based learning:an empirical approach to evaluating CDIO

As a global profession, engineering is integral to the maintenance and further development of society. Indeed, contemporary social problems requiring engineering solutions are not only a consequence of natural and ‘manmade’ disasters (such as the Japanese earthquake or the oil leakage in the Gulf of Mexico) but also encapsulate 21st Century dilemmas around sustainability, poverty and pollution [2,6,7]. Given the complexity of such problems and the constant need for innovation, the demand for engineering education to provide a ready supply of suitably qualified engineering graduates, able to make innovative decisions has never been higher [3,5]. Bearing this in mind, and taking account problems of attrition in engineering education [1,6,4] innovation in the way in which the curriculum is developed and delivered is crucial. CDIO [Conceive, Design, Implement, Operate] provides a potentially ground-breaking solution to such dilemmas. Aimed at equipping students with practical engineering skills supported by the necessary theoretical background, CDIO could potentially change the way engineering is perceived and experienced within higher education. Aston University introduced CDIO into its Mechanical Engineering and Design programmes in October 2011. From its induction, engineering education researchers have ‘shadowed’ the staff responsible for developing and teaching the programme. Utilising an Action Research Design, and adopting a mixed methodological research design, the researchers have worked closely with the teaching team to critically reflect on the processes involved in introducing CDIO into the curriculum. Concurrently, research has been conducted to capture students’ perspectives of CDIO. In evaluating the introduction of CDIO at Aston, the researchers have developed a distinctive research strategy with which to evaluate CDIO. It is the emergent findings from this research that form the basis of this paper. Although early-on in its development CDIO is making a significant difference to engineering education at the University. The paper draws attention to pedagogical, practical and professional issues – discussing each one in turn and in doing so critically analysing the value of CDIO from academic, student and industrial perspectives. The paper concludes by noting that whilst CDIO represents a forwardthinking approach to engineering education, the need for constant innovation in learning and teaching should not be forgotten. Indeed, engineering education needs to put itself at the forefront of pedagogic practice. Providing all-rounded engineers, ready to take on the challenges of the 21st Century!

The UK obesity epidemic:new steering instruments for a new public policy problematic?

Since the 1980s UK government enthusiasm for market reforms has reconfigured the nature and scope of public services. Initially the marketisation of public services changed how public services were provided, increasingly market reforms and pro business policies have also modified the formation and understanding of public policy problematics and how they ought to be resolved. This is particularly noticeable when markets work imperfectly or even fail. UK governments have shown their reluctance to employ regulatory instruments to change the behaviour of companies preferring instead to make use of softer interventions, by focusing on providing advice for consumers and urging individuals to act responsibly. The dilemmas of this approach are explored by discussing the UK's former Labour government's (1997–2010) response to the increase in the incidence of obesity and related health complications.

Reducing dependence on big brother:Higher Education looks for innovative funding opportunities

This paper presents innovative programs that business schools can utilize to reduce dependence on public funds. A review of the literature shows the theoretical and empirical foundation of higher education funding dilemmas. While higher education is moving towards a global ambition, scarcity hinders governments to fully support programs long-term; thus, cost-sharing and cost-shifting measures must occur for higher education to support current programs. In this study, we examine two universities (one U.S. and one U.K.) and provide practical summaries of programs that have provided additional funds. We show that diversity of funding sources is essential for survival of higher education institutions. Market forces require competition to reduce higher education operational costs while providing students and corporate clients an a la carte educational experience.

Author-itative interpretation in understanding accounting practice through case research

The way interviews are used in accounting research, and the way this research is written up, suggests that there is only one way to interpret these interviews. This invests the author(s) with great perceptive power and storytelling ability. What if different assumptions are used about how to interpret research, and how to present the ensuing findings? We give an illustration of what this might imply, using the notion of 'reflexivity'. The setting for our illustration concerns a series of interviews with management accountants on the dilemmas they face in their daily work. We apply Alvesson's ideas on how to use metaphors to open up the interpretation of interview accounts. The aim of the paper is to shed a different light on the way interviews can be used and interpreted in accounting research. We assert that allowing for reflexive accounts is likely to require substantially differently written research papers, in which the process of discovery is emphasized. © 2011 Elsevier Ltd.

Ethanol intake of paediatric intensive care patients

Background - Limiting the amount of alcohol in children's medicines is advisable but as alcohol is the second most common solvent used in liquid preparations, paediatric patients with increased medication intake may be exposed to a considerable alcohol intake. Few medicines are specifically designed for children in Paediatric Intensive Care (PICU), and therefore adult formulations are frequently administered, with high medication use further exposing a PICU patient to undesired alcohol intake. Aims - This small pilot study aimed to examiine the intake of a sample of PICU patients, highlight common medicines used on PICU containing alcohol, provide alternatives where possible and where alternatives are not possible, provide the prescriber with a list of the higher alcohol containing medicines. Method - A retrospective medication chart review was undertaken as a two point snap shot. Data collected included age, weight, medications prescribed and the formulations used at time of the study. The patients' sedation score was recorded. The electronic medicine compendium (EMC) was consulted for any ethanol content for the commercially available products. The manufacturer was contacted for ethanol content of all ‘specials’ and any commercial products found to contain ethanol from the EMC. The PICU patient's daily intake of ethanol was calculated. The calculation was converted to an adult equivalent alcohol unit intake and although this method of conversion is crude and does not take physiological differences of adult and children into account, it was done in order to provide the clinician with commonly used terminology in deciding the risk to the patient. Results - Twenty-eight patients were prescribed a range of 69 different medications. Of the 69 medicines, 12 products were found to contain ethanol. Patient ages ranged from a 26 week premature infant to 15 years old, weights ranges from 0.7 kg to 45 kg. Only 2 out of the 28 patients did not receive ethanol containing medications, and most patients were prescribed at least two medicines containing ethanol. Daily ethanol intake uncorrected for weight ranged from 0.006 ml to 2.18 ml (median 0.26 ml). Converting this to adult units per week, alcohol intake ranged from 0.07 to 15.2 units (median 1.4 units). The two patients receiving above 15 units/week adult equivalent were prescribed an oral morphine weaning regimen, therefore the high alcohol exposure was short term. The most common drugs prescribed containing alcohol were found to be nystatin, ranitidine, furosemide and morphine. No commercially available alcohol-free oral liquid preparations were found for ranitidine, furosemide or morphine at the time of the study. Correlation of the sedation score against ethanol intake was difficult to analyse as most patients were actively sedated. Conclusions - Polypharmacy in PICU patients increases the exposure to alcohol. Some commercially available medicines provide excessive ethanol intake, providing the clinician with ethical, potentially economical dilemmas of prescribing an unlicensed medicine to minimise ethanol exposure. Further research is required to evaluate the scope of the problem, effects of exposure and provision of alcohol free formulations.

Mixed methods research:don't "just do it"

Purpose The purpose of this paper is to identify some of the dilemmas involved in the debate on the how, when and why of mixed methods research. Design/methodology/approach The authors' starting point is formed by developments in the philosophy of science literature, and recent publications on mixed methods research outside of the management accounting domain. Findings Contrary to recent claims made in the management accounting literature, the authors assert that uncovering points of disagreement between methods may be as far as researchers can go by combining them. Being reflexive can help to provide a deeper understanding of the research process and the researcher's role in this process. Research limitations/implications The paper should extend the debate among management accounting researchers about mixed methods research. One of the lessons drawn is that researchers are actively immersed in the research process and cannot purge their own interests and views. Accepting this lesson casts doubt on what the act of research may imply and achieve. Practical implications The paper shows that combinations of research methods should not be made based on a "whatever works" attitude, since this approach ultimately is still infused with ontological and epistemological considerations that researchers have, and should try to explicate. Originality/value The value of this paper lies in the provision of philosophical underpinnings that have not been widely considered in the management accounting literature on mixed methods to date. © 2011 Emerald Group Publishing Limited. All rights reserved.

Focus group method and methodology:current practice and recent debate

This paper considers the contemporary use of focus groups as a method of data collection within qualitative research settings. The authors draw upon their own experiences of using focus groups in educational and 'community' user-group environments in order to provide an overview of recent issues and debates surrounding the deployment of focus group methods and to pick out specific areas of contention in relation to both their epistemological and practical implications. Accordingly, the paper reflects on some of the realities of 'doing' focus groups whilst, at the same time, highlighting common problems and dilemmas which beginning researchers might encounter in their application. In turn, the paper raises a number of related issues around which there appears to have been a lack of academic discussion to date.

Perspectives of carers on medication management in dementia:lessons from collaboratively developing a research proposal

Background: The need for carers to manage medication-related problems for people with dementia living in the community raises dilemmas, which can be identified by carers and people with dementia as key issues for developing carer-relevant research projects.A research planning Public Patient Involvement (PPI) workshop using adapted focus group methodology was held at the Alzheimer's Society's national office, involving carers of people with dementia who were current members of the Alzheimer's Society Research Network (ASRN) in dialogue with health professionals aimed to identify key issues in relation to medication management in dementia from the carer viewpoint. The group was facilitated by a specialist mental health pharmacist, using a topic guide developed systematically with carers, health professionals and researchers. Audio-recordings and field notes were made at the time and were transcribed and analysed thematically. The participants included nine carers in addition to academics, clinicians, and staff from DeNDRoN (Dementias and Neurodegenerative Diseases Research Network) and the Alzheimer's Society. Findings. Significant themes, for carers, which emerged from the workshop were related to: (1) medication usage and administration practicalities, (2) communication barriers and facilitators, (3) bearing and sharing responsibility and (4) weighing up medication risks and benefits. These can form the basis for more in-depth qualitative research involving a broader, more diverse sample. Discussion. The supported discussion enabled carer voices and perspectives to be expressed and to be linked to the process of identifying problems in medications management as directly experienced by carers. This was used to inform an agenda for research proposals which would be meaningful for carers and people with dementia. © 2014 Poland et al.; licensee BioMed Central Ltd.

Priming moral self-ambivalence heightens deliberative behaviour in self-ambivalent individuals

Background: Recent work on cognitive-behavioural models of obsessive-compulsive disorder has focused on the roles played by various aspects of self-perception. In particular, moral self-ambivalence has been found to be associated with obsessive-compulsive phenomena. Aims: In this study we used an experimental task to investigate whether artificially priming moral self-ambivalence would increase participants' deliberation on ethical problems, an index that might be analogous to obsessive-compulsive behaviour. Method: Non-clinical participants completed two online tasks designed to prime either moral self-ambivalence, general uncertainty, or neither. All participants then completed a task requiring them to consider solutions to moral dilemmas. We recorded the time participants took to respond to the dilemmas and the length of their responses; we then combined these variables to create a measure of deliberation. Results: Priming moral self-ambivalence led to increases in deliberation, but this was only significant among those participants who scored highly on a baseline measure of moral self-ambivalence. Priming general uncertainty had no significant effect upon deliberation. Conclusions: The results suggest that moral self-ambivalence may play a role in the maintenance of obsessive-compulsive behaviour. We propose that individuals who are morally self-ambivalent might respond to situations in which this ambivalence is made salient by exhibiting behaviour with obsessive-compulsive characteristics. These findings have implications for the incorporation of ideas about self-concept into theories of obsessive-compulsive disorder.

Thoughts on L2 listening pedagogy

In this paper, I discuss some of the ideas raised by Renandya and Farrell (ELT Journal 65/1) related to extensive listening (EL) and the teaching of listening strategies. Function of extensive listening :The concept of EL emanated from extensive reading, an approach that aims to improve a variety of reading skills through exposure to materials that approximately match proficiency level. According to Renandya and Farrell (2011: 56), ‘like reading, listening is best learnt through listening’. These authors support EL as the answer to the issue of how to teach listening in L2 classrooms. Complementary role : EL can play a supportive role in L2 listening pedagogy. Through exposure to extensive and various listening texts, learners gain opportunities to practise and refine their listening processes, recognize linguistic and lexical features, and increase cultural knowledge related to the target language. The value of EL in this practice-oriented capacity cannot be overstated. It is difficult, however, to accept EL as the main component of L2 listening pedagogy, as Renandya and Farrell suggest. With listening materials readily available online (see Renandya and Farrell’s useful list of websites, p. 58) and on CDs, there is no shortage of practice material. EL provides the practice, but a question we should ask is: ‘What exactly are learners practising?’ Extensive listening dilemmas: For EL to be the predominant element in L2 listening pedagogy, several matters may need to be resolved.

A jövő intelligens technológiai és menedzsmentkérdései-avagy semmilyen szél nem jó annak, aki nem tudja milyen kikötőbe tart (Managerial questions of the future intelligent technologies, or there is no good wind for those who do not know which port they want to sail)

Az elmúlt évtizedek felgyorsult technológiai fejlődése komoly kihívásokat jelent mind a cégeknek, mind az egyéneknek. Intézményesített „jövőkezelésre” és ennek menedzselésére van szükség. A szerzők tanulmányukban át kívánják tekinteni a jövőkutatás, a technológiamenedzsment, az innovációmenedzsment és egyéb megközelítések releváns alapjait, viszonyait és lehetséges integrációjukat. Be kívánják mutatni a meghatározó területeket és trendeket. Keresik azokat a menedzsment-alapkérdéseket, tanulságokat és dilemmákat, amelyek minden olyan vállalatnak érdekesek és hasznosak lehetnek, amelyek a fejlődő technológia lehetőségeit szeretnék kiaknázni, vagy csak egyszerűen szeretnének a követhetetlenül gyors fejlődésben talpon maradni. _____________ The fast pace technology development creates a serious challenge both for individuals and for companies. There is a concept which attempts to handle this challenge by “institutional future management”. In their paper the authors survey the relevant concepts of future studies, technology management and other areas, and explore their connections and integration possibilities. They also would like to introduce some key technology trends, and at the same time some basic managerial questions, dilemmas, conclusions which might have importance to those corporations which have to survive in an environment determined by accelerated technology based innovation.

A puha költségvetési korlát szindrómája a kórházi szektorban = The soft budget constraint syndrome in the hospital sector

A kutatások eddig főképpen azt vizsgálták, hogyan jelenik meg a puha költségvetési korlát szindrómája a vállalati szférában és a hitelrendszerben. A jelen cikk a kórházi szektorra összpontosítja a figyelmet. Leírja az események öt főszereplőjének, a betegnek, az orvosnak, a kórházigazgatónak, a politikusnak és a kórház tulajdonosának motivációit és magatartásuk ellentmondásos jellegét. A motivációk magyarázzák, miért olyan erőteljes a túlköltési hajlam és a költségvetési korlát felpuhulásának tendenciája. A döntési és finanszírozási folyamatok minden szintjén felfelé hárítják a túlköltés és eladósodás terheit. A cikk kitér a különböző tulajdonformák (állami, nonprofit és forprofit nem állami tulajdonformák) és a puha költségvetési korlát szindrómájának kapcsolatára. Végül normatív szempontból vizsgálja a jelenséget: melyek a költségvetési korlát megkeményítésének kedvező és kedvezőtlen következményei, és hogyan tükröződnek a normatív dilemmák az események résztvevőinek tudatában. ___________ Researches so far have examined mainly how the soft budget constraint syndrome appears in the corporate sphere and the credit system. This article concentrates on the hospital sector. It describes the motivations and the contradictory behaviour of the five main types of participant in the events: patients, doctors, hospital managers, politicians, and hospital owners. The motivations explain why the propensity to overspend and the tendency to soften the budget constraint are so strong. The burdens of overspending and indebtedness are pushed upwards at every level of the decision-making and funding processes. The article considers the connection between the soft budget constraint syn-drome and the various forms of ownership (state ownership and the non-profit and for-profit forms of non-state ownership). Finally, the phenomenon is examined from the normative point of view: what are the favourable and unfavourable consequences of hardening the budget constraint and how these are reflected in the consciousness of the participants in the normative dilemmas and events.

The cultural and geopolitical dimensions of nation-building in the Ukraine

Ukraine belongs among those young countries where the beginnings of democratisation and nation-building approximately coincided. While the development of nation states in Central Europe was usually preceded by the development of nations, the biggest dilemma in the Ukraine is whether a nation-state programme — parallel to the aim of state-building — is able to bring unfinished nation-building to completion. Ukraine sways between the EU and Russia with enormous amplitude. The alternating orientation between the West and the East can be ascribed to superpower ambitions reaching beyond Ukraine. Eventually, internal and external determinants are intertwined and mutually interact with one another. The aim of the paper is to explain the dilemmas arising from identity problems behind the Ukraine’s internal and external orientation.

Államadósság, optimális politika, finanszírozás (State Debt, Optimal Policy, and Financing)

A fejlett ipari országoknak is az államadósság csökkentése vagy akár szinten tartása okozza az egyik legfontosabb gazdaságpolitikai dilemmát. Az euróövezet tagállamai esetében is ez a kritérium tűnik a legkevésbé teljesíthetőnek, de Japán és az Egyesült Államok is leküzdhetetlennek tűnő államadóssággal birkózik. A tanulmány rövid áttekintést ad néhány meghatározó közgazdasági megközelítésről, amelyek az államadósság szintjének hosszú távú alakulása mögött meghúzódó tényezőket, gazdaságpolitikai lépéseket magyarázzák. Végül az elméletek alapján tanulságokat fogalmaz meg a magyar államadósság kezelését illetően az 1990–2010 közötti folyamatok ismeretében. _____ The macroeconomic developments of the last decade have confirmed that one of the most important dilemmas that even developed economies have to face is the reduction or even sustaining of the state debt. In case of the eurozone member states this criterion is the most difficult to be accomplished, furthermore the United States and Japan are among the global powers that have to cope with state debts which seems to be insurmountable. The aim of this paper is to provide a brief overview of some decisive economic approaches (Barro [1979], Lucas and Stokey [1983], Marcet and Scott [2007], Martin [2009] etc.) that explain the factors behind the formation of long-run state debt level and economic policy measures accompanying state debt management. The paper also attempts to draw some lessons for the Hungarian state debt management in view of the 1990-2010 processes.