자연주의적 탐구조사(Naturalistic Inquiry)

A compelling ethical rationale supports patient engagement in healthcare research. It is also assumed that patient engagement will lead to research findings that are more pertinent to patients’ concerns and dilemmas. However; it is unclear how to best conduct this process. In this systematic review we aimed to answer 4 key questions: what are the best ways to identify patient representatives? How to engage them in designing and conducting research? What are the observed benefits of patient engagement? What are the harms and barriers of patient engagement? We searched MEDLINE, EMBASE, PsycInfo, Cochrane, EBSCO, CINAHL, SCOPUS, Web of Science, Business Search Premier, Academic Search Premier and Google Scholar. Included studies were published in English, of any size or design that described engaging patients or their surrogates in research design. We conducted an environmental scan of the grey literature and consulted with experts and patients. Data were analyzed using a non-quantitative, meta-narrative approach. We included 142 studies that described a spectrum of engagement. In general, engagement was feasible in most settings and most commonly done in the beginning of research (agenda setting and protocol development) and less commonly during the execution and translation of research. We found no comparative analytic studies to recommend a particular method. Patient engagement increased study enrollment rates and aided researchers in securing funding, designing study protocols and choosing relevant outcomes. The most commonly cited challenges were related to logistics (extra time and funding needed for engagement) and to an overarching worry of a tokenistic engagement. Patient engagement in healthcare research is likely feasible in many settings. However, this engagement comes at a cost and can become tokenistic. Research dedicated to identifying the best methods to achieve engagement is lacking and clearly needed.

/pdf/patient-engagement-in-research-a-systematic-review-iwdizvcicm.pdf

Patient engagement in research: a systematic review

세계화가 과연 하나의 독립변수로 사용하기에 충분할 정도로 그 의미가 명확하게 규명된 과학적 개념인가의 여부는 학계의 지속적인 의문으로 남아 있다. 특히 최근에는 현저하게 드러나고 있는 각종 반세계화 현상을 바탕으로 세계화에 대한 반론이 거세지고 있으며 일부 세계화론 주창자들조차 ‘현실’로서 세계화 현상에 대한 회의적 시각을 표출하고 있어 그 의문은 더욱 커지고 있다. 이에 따라 세계화를 설명 변수로 삼는 모든 연구 영역에서 세계화의 의미와 세계화와 관련된 연구 성과를 반추해 볼 필요성도 커지고 있다. 본 연구의 목적은 세계화의 의미 분석을 바탕으로 세계화를 안보환경 변화의 독립변수로 삼는 연구의 동향을 분석하고 연구의 방향을 제시하는데 있다. 세계화는 그 설명적 가치와 규범적 판단을 둘러싸고 논란이 계속되고 있는 개념이다. 세계화는 세계화론자를 중심으로 발전되어 온 개념이지만 이들 사이에서도 개념에 대한 합의는 존재하지 않는다. 세계화는 가장 단순하게는 하나의 현상 혹은 사건으로 간주되기도 하지만, 세계화의 본질을 규명하려는 입장에서는 세계화의 원인과 영향에 대한 인과관계는 물론 사회관계 본질이나 권력관계 변화를 적시하는 개념으로 취급하여 왔다. 그러나 세계화를 개념화하려는 노력은 수많은 하부 현상을 단일 요소로 설명해야 하며, 역으로 개념 속에 혼재되어 있는 세계화의 원인, 결과, 설명 및 규범적 판단 요소를 단순화해야 한다는 과제를 안고 있다. 특히 원인과 결과가 혼재되어 있는 세계화 개념은 현상 분석을 위한 설명체제 구성에 가장 큰 장애요인이 되고 있다. 세계화와 안보와의 관계를 다루는 연구는 대체로 세계화에 관한 중도론적 입장에서 안보에 관한 낙관론을 피하고 새로운 위협을 제시하는데 초점을 맞추는데, 이러한 경향은 안보연구에서 세계화를 가장 단순한 수준에서 정의하는 데에서 비롯된다. 그러나 지나치게 단순한 세계화 개념을 적용하는 안보연구는 질적으로 새로운 현상인 세계화를 여전히 국가중심적 시각에서 다루고 모든 안보위협을 테러리즘의 문제로 축소하려는 환원주의의 문제를 야기한다. 이러한 문제를 극복하기 위해서는 세계화 개념의 불완전성을 염두에 둔 세계화 개념에 대한 접근과 일관된 세계화 개념 적용이 요구된다. 또한 세계화 현상으로부터 직접적인 안보 사안을 도출하는 노력에서 한 차원 더 나아가 안보연구의 새로운 방향을 제시해 줄 수 있는 안보환경 변화의 전체적 특성을 분석하는 포괄적 연구가 요구된다.

세계화(globalization)와 안보 연구

Whose Reality Counts?: Putting the first last

Abstract There is a growing acknowledgement that micro-credit programs have potential for equitable and sustainable development. However, my anthropological research on the micro-credit program of the Grameen Bank shows that bank workers are expected to increase disbursement of loans among their members and press for high recovery rates to earn profit necessary for economic viability of the institution. To ensure timely repayment in the loan centers bank workers and borrowing peers inflict an intense pressure on women clients. In the study community many borrowers maintain their regular payment schedules through a process of loan recycling that considerably increases the debt-liability on the individual households, increases tension and frustration among household members, produces new forms of dominance over women and increases violence in society.

Micro-credit initiatives for equitable and sustainable development : who pays?; a case study of the Grameen Bank Program in rural Bangladesh

Primary health care facilities offer an entry point to the health care system in Malawi. Challenges experienced by these facilities include limited resources (both material and human), poor or inadequate knowledge, skills and attitudes of health care workers in emergency management, and delay in referral from primary care level to other levels of care. These contribute to poor outcomes including children dying within the first 24 hours of hospital admission. Training of health care workers and support staff in Emergency Triage Assessment and Treatment (ETAT) at primary care levels can help improve care of children with acute and severe illnesses. Health care workers and support staff in the primary care settings were trained in pediatric ETAT. The training package for health care workers was adapted from the Ministry of Health ETAT training for district and tertiary health care. Content for support staff focused on non-technical responsibility for lifesaving in emergency situations. The primary health care facilities were provided with a minimum treatment package comprising emergency equipment, supplies and drugs. Supportive supervisory visits were conducted quarterly. The training manual for health care workers was adapted from the Ministry of Health package and the support staff training manual was developed from the adapted package. Eight hundred and seventy-seven participants were trained (336 health care workers and 541 support staff). Following the training, triaging of patients improved and patients were managed as emergency, priority or non-urgent. This reduced the number of referral cases and children were stabilized before referral. Capacity building of health care workers and support staff in pediatric ETAT and the provision of a basic health center package improved practice at the primary care level. The practice was sustained through institutional mentorship and pre-service and in-service training. The practice of triage and treatment including stabilization of children with dangerous signs at the primary health care facility improves emergency care of patients, reduces the burden of patients on referral hospitals and increases the number of successful referrals.

Capacity Building for Health Care Workers and Support Staff in Pediatric Emergency Triage Assessment and Treatment (ETAT) at Primary Health Care Level in Resource Limited Settings: Experiences from Malawi.

https://tghncollections.pubpub.org/pub/yjibxswg/download/pdf

Nicola Desmond

Papers

Capacity Building for Health Care Workers and Support Staff in Pediatric Emergency Triage Assessment and Treatment (ETAT) at Primary Health Care Level in Resource Limited Settings: Experiences from Malawi.

Enhanced health systems to improve uptake of early infant diagnosis of HIV among post-partum women in primary health care in Blantyre, District Malawi