The perceptions of danish physiotherapists on the ethical issues related to the physiotherapist-patient relationship during the first session: a phenomenological approach

Background: In the course of the last four decades, the profession of physiotherapy has progressively expanded its scope of responsibility and its focus on professional autonomy and evidence-based clinical practice. To preserve professional autonomy, it is crucial for the physiotherapy profession to meet society's expectations and demands of professional competence as well as ethical competence. Since it is becoming increasingly popular to choose a carrier in private practice in Denmark this context constitutes the frame of this study. Physiotherapy in private practice involves mainly a meeting between two partners: the physiotherapist and the patient. In the meeting, power asymmetry between the two partners is a condition that the physiotherapist has to handle. The aim of this study was to explore whether ethical issues rise during the first physiotherapy session discussed from the perspective of the physiotherapists in private practice. Methods: A qualitative approach was chosen and semi-structured interviews with 21 physiotherapists were carried out twice and analysed by using a phenomenological framework. Results: Four descriptive themes emerged: general reflections on ethics in physiotherapy; the importance of the first physiotherapy session; the influence of the clinical environment on the first session and; reflections and actions upon beneficence towards the patient within the first session. The results show that the first session and the clinical context in private practice are essential from an ethical perspective. Conclusions: Ethical issues do occur within the first session, the consciousness about ethical issues differs in Danish physiotherapy private practice, and reflections and acts are to a lesser extent based on awareness of ethical theories, principles and ethical guidelines. Beneficence towards the patient is a fundamental aspect of the physiotherapists' understanding of the first session. However, if the physiotherapist lacks a deeper ethical awareness, the physiotherapist may reason and/or act ethically to a varying extent: only an ethically conscious physiotherapist will know when he or she reflects and acts ethically. Further exploration of ethical issues in private practice is recommendable, and as management policy is deeply embedded within the Danish public sector there are reasons to explore public contexts of physiotherapy as well

Calcipotriene and Betamethasone Dipropionate PAD-Cream Demonstrates Greater Treatment Efficacy in Patients with Moderate-to-Severe Psoriasis Compared to Topical Suspension/Gel: A Subgroup Analysis of Two Phase 3 Studies

INTRODUCTION: Psoriasis ranges from mild to severe with the majority of patients having mild disease. Mild to moderate disease is often treated with topical therapies while photo-, oral, and biologic therapies are generally reserved for moderate-to-severe disease. There is a strong scientific rationale for the combination of calcipotriene (CAL) and betamethasone dipropionate (BDP) with respect to mode of action, efficacy, and safety and CAL/BDP has shown an inhibitory effect on key pathogenic cytokines in psoriasis including tumor necrosis factor-α, interleukin (IL)-17, and IL-23. METHODS: The objective of this pooled post hoc analysis is to investigate the efficacy of CAL/BDP polyaphron dispersion (PAD)-cream in subgroups of patients with moderate-to-severe psoriasis from two completed phase 3 studies conducted in the USA and Europe. RESULTS: The proportion of patients achieving Physician Global Assessment (PGA) treatment success as well as a modified Psoriasis Area and Severity Index (mPASI)75 response was higher in the subgroup with a body surface area \u3e 10% and mPASI \u3e 10 and Dermatology Life Quality Index \u3e 10 at baseline compared to the overall patient population. Furthermore, the numerical difference in treatment efficacy between CAL/BDP PAD-cream and CAL/BDP topical suspension/gel increased in patient subgroups with higher baseline severity. Similar patterns were shown for the patient-reported outcomes. CONCLUSION: In this subgroup analysis, patients who had higher disease severity at baseline achieved greater efficacy than the total patient population when treated with 8 weeks of CAL/BDP PAD-cream as compared to a currently marketed active comparator. Additionally, as indicated by this analysis, CAL/BDP PAD-cream treatment may also be more convenient and less greasy, which may reduce the burden of daily treatment and improve adherence to therapy. TRIAL REGISTRATION: NCT03308799 and NCT03802344

Practicing physiotherapy in Danish private practice: an ethical perspective.

Despite an increasingly growth of professional guidelines, textbooks and research about ethics in health care, awareness about ethics in Danish physiotherapy private practice seen vague. This article explores how physiotherapists in Danish private practice, from an ethical perspective, perceive to practice physiotherapy. The empirical data consists of interviews with twenty-one physiotherapists. The interviews are analysed from a hermeneutic approach, inspired by Ricoeur's textual interpretation of distanciation. The analysis follows three phases: naïve reading, structural analysis and comprehensive analysis. Four main themes are constructed: Beneficence as the driving force; Disciplining the patient through the course of physiotherapy; Balancing between being a trustworthy professional and a businessperson; The dream of a code of practice. Private practice physiotherapy is embedded in a structural frame directed by both political and economical conditions that shape the conditions for practicing physiotherapy. It means that beneficence in practice is a balance between the patient, the physiotherapists themselves and the business. Beneficence towards the patient is expressed as an implicit demand. Physiotherapeutic practice is expressed as being an integration of professionalism and personality which implies that the physiotherapists also have to benefit themselves. Private practice seems to be driven by a paternalistic approach towards the patient, where disciplining the patient is a crucial element of practice, in order to optimise profit. Physiotherapists wish for a more beneficent practice in the future by aiming at bridging 'to be' and 'ought to be'

Physiotherapists demonstrate weight stigma: a cross-sectional survey of Australian physiotherapists

Question: Do physiotherapists demonstrate explicit and implicit weight stigma? Design: Cross-sectional survey with partial blinding of participants. Participants responded to the Anti-Fat Attitudes questionnaire and physiotherapy case studies with body mass index (BMI) manipulated (normal or overweight/obese). The Anti-Fat Attitudes questionnaire included 13 items scored on a Likert-type scale from 0 to 8. Any score greater than zero indicated explicit weight stigma. Implicit weight stigma was determined by comparing responses to case studies with people of different BMI categories (where responses were quantitative) and by thematic and count analysis for free-text responses. Participants: Australian physiotherapists (n = 265) recruited via industry networks. Results: The mean item score for the Anti-Fat Attitudes questionnaire was 3.2 (SD 1.1), which indicated explicit weight stigma. The Dislike (2.1, SD 1.2) subscale had a lower mean item score than the Fear (3.9, SD 1.8) and Willpower (4.9, SD 1.5) subscales. There was minimal indication from the case studies that people who are overweight receive different treatment from physiotherapists in clinical parameters such as length of treatment time (p = 0.73) or amount of hands-on treatment (p = 0.88). However, there were indications of implicit weight stigma in the way participants discussed weight in free-text responses about patient management. Conclusion: Physiotherapists demonstrate weight stigma. This finding is likely to affect the way they communicate with patients about their weight, which may negatively impact their patients. It is recommended that physiotherapists reflect on their own attitudes towards people who are overweight and whether weight stigma influences treatment focus

Physiotherapy in a Danish private context - a social and ethical practice

Physiotherapy is a social and ethical practice which unfolds under specific historical, political, socio-cultural and economic circumstances. Danish physiotherapy in a private context is practiced, administered and managed within a neoliberal ideology which generates challenges for both physiotherapists and their patients. This thesis aims to explore how physiotherapy in a Danish private context socially and ethically is practiced from the perspective of physiotherapists. The thesis, which consists of four parts, is based on the same empirical material consisting of interviews with twenty-one physiotherapists and observation notes on the physical environments. The specific research aims in the studies have successively been developed through different epistemological approaches and analysis strategies. The main findings show that physiotherapists in Danish private practice have a general interest in ethics which primarily is based on personal common sense arguments and intuitive feelings of ethics. The physiotherapists’ practices are ethically grounded which are shown in many situations. Their consciousness on ethical issues is discursively constructed in the first sessions as these sessions arouse both ethical and economic considerations to keep the client. Further ethical issues arise when the physiotherapists’ clientele are regarded as being at risk: in the meetings with the so-called ‘difficult’ patients as these situations do not just flow, they require ethical reflections and pedagogical strategies in order to keep them in the business. Beneficence is seen as the core value and as having importance in different relationships: towards the patient, the physiotherapists themselves and their businesses. To secure beneficence a paternalistic approach emerges towards the patient, where disciplining the patient into their ‘regimes of truth’ becomes a crucial element of practice in order to exploit the politically defined frames for optimising profit, showing how being beneficent seem to be led by structures of the neoliberal ideology which work behind the backs of the physiotherapists. Physiotherapy private practice in Denmark seems to reproduce the Western medical logic and practices whereby the physiotherapists unconsciously oppose their own political intentions to be an autonomous profession. Thus, physiotherapy in private practice inscribes itself as a ’wanna-be’ profession. The thesis has several limitations as it built solely on Danish physiotherapists’ articulations of their practices, their understandings of these and the researcher’s observation notes. This means that choosing a specific context for the thesis the findings can only be transferred to similar contexts and neither to other private or public physiotherapeutic contexts in Denmark nor to other Western countries

Sjöfartsplan för Cybersäkerhet

Cybersecurity management within the maritime industry is unfortunately still a widely overlooked topic. This project examines the current cybersecurity status from a technological perspective and then identifies the need for a Maritime Computer Incident Response Team (MCIRT), this work provides a complete template for constructing such a team with emphasis on shipping organisations which includes a fleet of vessels. This study continues with providing a generic Maritime CyberSecurity Strategy (MCSS) both these entities will be designed for the maritime industry and shipping corporations in particularly. This includes all the vital steps to both initiate, implement, evaluate and continue to evolve such a strategy. The results concludes that in all cases, education must be considered the most vital ingredient for a successful MCIRT and MCSS

Sjöfartsplan för Cybersäkerhet

Cybersecurity management within the maritime industry is unfortunately still a widely overlooked topic. This project examines the current cybersecurity status from a technological perspective and then identifies the need for a Maritime Computer Incident Response Team (MCIRT), this work provides a complete template for constructing such a team with emphasis on shipping organisations which includes a fleet of vessels. This study continues with providing a generic Maritime CyberSecurity Strategy (MCSS) both these entities will be designed for the maritime industry and shipping corporations in particularly. This includes all the vital steps to both initiate, implement, evaluate and continue to evolve such a strategy. The results concludes that in all cases, education must be considered the most vital ingredient for a successful MCIRT and MCSS

Hjemmesygeplejersken som konsulent - et kompetenceudviklingsprojekt

The community nurse as consultant – a skills development project. In consequence of the municipality reform and the consequent sliding of services from hospital to primary healthcare, a Danish municipal wished to strengthen their community nurses professional competences, fellow-feeling and collegiate spirit by taking starting point in their newly developed ‘profile for community nurses’. This article presents a concept for reflection on practice which consists of a competence-developmental project. The project takes origin in Wacherhausen's theory of reflection on practice, in ‘Appreciative Inquiry’, comprising appreciatory communication, and in the method ‘The narrative team-reflection’. The concept is about the community nurses in practicing and analyzing appreciatory communication here and now and in giving and receiving constructive mono- and interprofessional feedback. In conclusion, the developed concept for reflection on practice generates fellow-feeling, strengthen the community nurses’ professional competences and promote collegiate spirit and engagement. The concept can easily be applied to other professionals and/or to other themes for practice development

Ethical issues in physiotherapy - Reflected from the perspective of physiotherapists in private practice.

Background: An important aspect of physiotherapy professional autonomy is the ethical code of the profession, both collectively and for the individual member of the profession. The aim of this study is to explore and add additional insight into the nature and scope of ethical issues as they are understood and experienced by Danish physiotherapists in outpatient, private practice. Methods: A qualitative approach was chosen and semi-structured interviews with 21 physiotherapists were carried out twice and analyzed, using a phenomenological hermeneutic framework. Results: One main theme emerged: The ideal of being beneficent toward the patient. Here, the ethical issues uncovered in the interviews were embedded in three code-groups: 1) ethical issues related to equality; 2) feeling obligated to do one's best; and 3) transgression of boundaries. Conclusions: In an ethical perspective, physiotherapy in private practice is on a trajectory toward increased professionalism. Physiotherapists in private practice have many reflections on ethics and these reflections are primarily based on individual common sense arguments and on deontological understandings. As physiotherapy by condition is characterized by asymmetrical power encounters where the parties are in close physical and emotional contact, practiced physiotherapy has many ethical issues embedded. Some physiotherapists meet these issues in a professional manner, but others meet them in unconscious or unprofessional ways. An explicit ethical consciousness among Danish physiotherapists in private practice seems to be needed. A debate of how to understand and respect the individual physiotherapist's moral versus the ethics of the profession needs to be addressed