'The obstacle is the way' : methodological challenges and opportunities for video-reflexive ethnography during COVID-19

The COVID-19 pandemic greatly impacted research. In this article, we explore the opportunities and challenges presented by the pandemic to a group of researchers using video-reflexive ethnography (VRE) – a methodology used to understand practices, grounded in: exnovation, collaboration, reflexivity, and care. To understand how the pandemic impacted researchers using VRE, we facilitated two focus groups with 12 members of the International Association of Video-Reflexive Ethnographers. The findings suggest the pandemic exacerbated existing methodological challenges, yet also provided an opportunity reflect on our own practices as researchers, namely: accessing sites, building relationships, facilitating reflexive sessions, and cultivating care. Due to public health measures, some researchers used insiders to access sites. While these insiders shouldered additional burdens, this shift might have empowered participants, increased the salience of the project, and enabled access to rural sites. The inability to access sites and reliance on insiders also impeded researcher ability to build relationships with participants and generate the ethnographic insights often associated with prolonged engagement at a site. In reflexive sessions, researchers had to learn how to manage the technological, logistical, and methodological challenges associated with either themselves or participants being remote. Finally, participants noted that while the transition to more digital methodologies might have increased project reach, there needed to be a mindfulness around cultivating practices of care in the digital world to ensure psychological safety and protect participants data. These findings reflect the opportunities and challenges a group of researchers using VRE had during the pandemic and can be used to stimulate future methodologic discussions

Preface

This is the preface of the special volume of Discrete Mathematics dedicated to Combinatorics 2008 we curated as guest editors

Communication and cognitive impairments and healthcare decision-making in MND: A narrative review

Rationale: Motor neurone disease (MND) is a neurodegenerative disease presenting with progressive weakness of voluntary muscles. For any condition, person-centred healthcare relies on the sharing of information and a mutual understanding of the person’s needs and preferences. Decision-making in MND becomes more complex as there is no cure and a high prevalence of co-morbid communication and/or cognitive difficulties. Objective: To identify the reported impact of communication and/or cognitive impairment on patient and carer involvement in healthcare decision-making in MND. Methods: A review and synthesis of studies addressing issues of communication impairment and/or cognitive impairment in relation to decision-making focussed on MND was conducted. Articles were excluded if they were reviews, case studies, conference papers or commentaries. To be included studies needed to address issues of communication impairment or cognitive impairment specifically in relation to decision-making. Relevant data was extracted verbatim and subjected to content analysis to support the narrative summary. Results: Seventy-six articles were identified and 35 articles screened. Six articles met inclusion criteria each describing examples of decision-making in MND. There was limited data related to communication and/or cognitive impairment and the impact these impairments may have on decision-making despite recognition that many people with MND may lose verbal communication or develop subtle cognitive impairments. The literature is primarily from the perspective of others. Conclusion: This review highlights that the current body of literature exploring decision-making within the MND population presents us with extremely limited insights into the impact of communication and/or cognitive impairments on healthcare decision-making. Extant literature focuses on interventions (namely ventilation and gastrostomy), the broad process of decision-making, or cognitive assessment of decision-making ability. Whilst most studies acknowledge that deficits in communication or cognition impact the decision-making process, this issue is not the focus of any study

The effect of natural organic matter on mercury methylation by Desulfobulbus propionicus 1pr3

Methylation of tracer and ambient mercury (200Hg and 202Hg, respectively) equilibrated with four different natural organic matter (NOM) isolates was investigated in vivo using the Hg-methylating sulfate-reducing bacterium Desulfobulbus propionicus 1pr3. Desulfobulbus cultures grown fermentatively with environmentally representative concentrations of dissolved NOM isolates, Hg[II], and HS− were assayed for absolute methylmercury (MeHg) concentration and conversion of Hg(II) to MeHg relative to total unfiltered Hg(II). Results showed the 200Hg tracer was methylated more efficiently in the presence of hydrophobic NOM isolates than in the presence of transphilic NOM, or in the absence of NOM. Different NOM isolates were associated with variable methylation efficiencies for either the 202Hg tracer or ambient 200Hg. One hydrophobic NOM, F1 HpoA derived from dissolved organic matter from the Florida Everglades, was equilibrated for different times with Hg tracer, which resulted in different methylation rates. A 5 day equilibration with F1 HpoA resulted in more MeHg production than either the 4 h or 30 day equilibration periods, suggesting a time dependence for NOM-enhanced Hg bioavailability for methylation

Selecting and implementing overview methods: implications from five exemplar overviews

This is the final version of the article. Available from BioMed Central via the DOI in this record.Background Overviews of systematic reviews are an increasingly popular method of evidence synthesis; there is a lack of clear guidance for completing overviews and a number of methodological challenges. At the UK Cochrane Symposium 2016, methodological challenges of five overviews were explored. Using data from these five overviews, practical implications to support methodological decision making of authors writing protocols for future overviews are proposed. Methods Methods, and their justification, from the five exemplar overviews were tabulated and compared with areas of debate identified within current literature. Key methodological challenges and implications for development of overview protocols were generated and synthesised into a list, discussed and refined until there was consensus. Results Methodological features of three Cochrane overviews, one overview of diagnostic test accuracy and one mixed methods overview have been summarised. Methods of selection of reviews and data extraction were similar. Either the AMSTAR or ROBIS tool was used to assess quality of included reviews. The GRADE approach was most commonly used to assess quality of evidence within the reviews. Eight key methodological challenges were identified from the exemplar overviews. There was good agreement between our findings and emerging areas of debate within a recent published synthesis. Implications for development of protocols for future overviews were identified. Conclusions Overviews are a relatively new methodological innovation, and there are currently substantial variations in the methodological approaches used within different overviews. There are considerable methodological challenges for which optimal solutions are not necessarily yet known. Lessons learnt from five exemplar overviews highlight a number of methodological decisions which may be beneficial to consider during the development of an overview protocol.The overview conducted by Pollock [19] was supported by a project grant from the Chief Scientist Office of the Scottish Government. The overview conducted by McClurg [21] was supported by a project grant by the Physiotherapy Research Foundation. The overview by Hunt [22] was supported as part of doctoral programme funding by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC). The overview conducted by Estcourt [20] was supported by an NIHR Cochrane Programme Grant for the Safe and Appropriate Use of Blood Components. The overview conducted by Brunton [23] was commissioned by the Department of Health as part of an ongoing programme of work on health policy research synthesis. Alex Pollock is employed by the Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, which is supported by the Chief Scientist Office of the Scottish Government. Pauline Campbell is supported by the Chief Nurses Office of the Scottish Government

Assessing collaborative efforts of making care fit for each patient – A systematic review

Introduction: For too many people, their care plans are designed without fully accounting for who they are, the lives they live, what matters to them or what they aspire to achieve. We aimed to summarize instruments capable of measuring dimensions of patient–clinician collaboration to make care fit. Methods: We systematically searched several databases (Medline, Embase, Cochrane, Scopus and Web of Science) from inception to September 2021 for studies using quantitative measures to assess, evaluate or rate the work of making care fit by any participant in real-life clinical encounters. Eligibility was assessed in duplicate. After extracting all items from relevant instruments, we coded them deductively on dimensions relevant to making care fit (as presented in a recent Making Care Fit Manifesto), and inductively on the main action described. Results: We included 189 papers, mostly from North America (N = 83, 44%) and in the context of primary care (N = 54, 29%). Half of the papers (N = 88, 47%) were published in the last 5 years. We found 1243 relevant items to assess efforts of making care fit, included within 151 instruments. Most items related to the dimensions ‘Patient-clinician collaboration: content’ (N = 396, 32%) and ‘Patient-clinician collaboration: manner’ (N = 382, 31%) and the least related to ‘Ongoing and iterative process’ (N = 22, 2%) and in ‘Minimally disruptive of patient lives’ (N = 29, 2%). The items referred to 27 specific actions. Most items referred to ‘Informing’ (N = 308, 25%) and ‘Exploring’ (N = 93, 8%), the fewest items referred to ‘Following up’, ‘Comforting’ and ‘Praising’ (each N = 3, 0.2%). Discussion: Measures of the work that patients and clinicians do together to make care fit focus heavily on the content of their collaborations, particularly on exchanging information. Other dimensions and actions previously identified as crucial to making care fit are assessed infrequently or not at all. The breadth of extant measures of making care fit and the lack of appropriate measures of this key construct limit both the assessment and the successful implementation of efforts to improve patient care. Patient Contribution: Patients and caregivers from the ‘Making care fit Collaborative’ were involved in drafting the dimensions relevant to patient–clinician collaboration

Changes in flavonoid content of grapefruit juice caused by thermal treatment and storage

The effect of conventional and microwave pasteurization on the main flavonoids present in grapefruit juice and their stability throughout 2 months of refrigerated and frozen storage was evaluated. Individual flavonoids were analyzed by HPLC. The results showed that naringin, narirutin, quercetin and naringenin were the most abundant flavonoids in grapefruit juice. In general, although every pasteurization treatment caused a significant reduction in the content of all the studied flavonoids, the treated samples were more stable during storage. While fresh squeezed juice (FS) and conventional pasteurized juice (CP) were better preserved under refrigeration conditions, microwave pasteurized juice (MP) conserved better when frozen stored. In fact, after 2 months, frozen MP samples showed the greatest flavonoid retention. From this point of view, microwave treatment can be considered a good alternative to conventional pasteurization. Industrial relevance: Flavonoids are polyphenolic compounds present in fruits and vegetables relevant not only in terms of quality, as they influence the visual appearance and taste, but also from a therapeutical point of view, as they appear to be associated with the prevention of degenerative diseases. The consumption of grapefruit juice is fairly widespread among the population. Traditionally, juices have been pasteurized by heat treatment to prolong their shelf life. However, this process may cause irreversible losses of nutritional quality and antioxidant activity and, in consequence, may affect their health-related properties. In this sense, the use of microwaves can be considered an alternative to conventional thermal pasteurization. Microwave energy was applied as alternative to conventional heating for grapefruit juice pasteurization. The results obtained in this study showed that when the effect of pasteurization process and storage is considered together, the use of microwave energy led to a greater retention of all the analyzed flavonoids, thereby representing a good alternative to conventional pasteurization. In this case, frozen storage of processed product would be recommended to better preserve these compounds. © 2011 Elsevier Ltd. All rights reserved.The authors wish to thank the Ministerio de Educacion y Ciencia and FEDER for their financial support throughout the Project AGL 2005-05994.Igual Ramo, M.; García Martínez, EM.; Camacho Vidal, MM.; Martínez Navarrete, N. (2011). Changes in flavonoid content of grapefruit juice caused by thermal treatment and storage. Innovative Food Science and Emerging Technologies. 12(2):153-162. https://doi.org/10.1016/j.ifset.2010.12.010S15316212

Humor During Clinical Practice: Analysis of Recorded Clinical Encounters

Objective: Little is known about humor’s use in clinical encounters, despite its many potential benefits. We aimed to describe humor during clinical encounters. Design: We analyzed 112 recorded clinical encounters. Two reviewers working independently identified instances of humor, as well as information surrounding the logistics of its use. Results: Of the 112 encounters, 66 (59%) contained 131 instances of humor. Humor was similarly frequent in primary care (36/61, 59%) and in specialty care (30/51, 59%), was more common in gender-concordant interactions (43/63, 68%), and was most common during counseling (81/112, 62%). Patients and clinicians introduced humor similarly (63 vs 66 instances). Typically, humor was about the patient’s medical condition (40/131, 31%). Discussion and Conclusion: Humor is used commonly during counseling to discuss the patient’s medical condition and to relate to general life events bringing warmth to the medical encounter. The timing and topic of humor and its use by all parties suggests humor plays a role in the social connection between patients and physicians and allows easier discussion of difficult topics. Further research is necessary to establish its impact on clinicians, patients, and outcomes. (J Am Board Fam Med 2018;31: 270–278.) Keywords: Humor, Patient-Centered Care, Primary Health Care, Physician-Patient Relations, Patient-Physician Communicatio