A qualitative study of GP, nurse and practice manager views on using targeted case-finding to identify patients with COPD in primary care

‘Finding the missing millions’ with chronic obstructive pulmonary disease became part of the Department of Health strategy for England in 2010. Targeted case-finding within primary care is one potential pro-active strategy, but currently little is known about the views of healthcare professionals on this approach. In this study, 36 healthcare professionals (12 GPs, 14 nurses, and 10 practice managers) from 34 UK practices participated in semi-structured telephone interviews about targeted case-finding. Interviews followed an interview guide, were audio-recorded, transcribed verbatim, coded and analysed using ‘Framework Approach’. Most of those interviewed practiced opportunistic case-finding. The main perceived barriers to wider case-finding programmes were the resource implications associated with running such programmes and identifying more chronic obstructive pulmonary disease patients. Financial incentives, support from specialist clinicians, and comprehensive guidance were viewed as facilitators. While targeted case-finding is conceptually accepted by primary care staff, scepticism surrounding (1) the value of identifying those with mild disease and (2) the availability of effective targeted case-finding methods, may lead some to favour an opportunistic approach. Key concerns were a lack of unequivocal evidence for the relative benefits vs. disadvantages of diagnosing patients earlier, and resource constraints in an already over-burdened system. Barriers to practical implementation of case-finding studies may be addressed with financial, human and educational resources, such as additional staff to undertake searches and perform spirometry tests, and practical and educational support from specialist teams

Understanding the meaning of medications for patients: The medication experience

Objective: To understand and describe the meaning of medications for patients. Methods: A metasynthesis of three different, yet complementary qualitative research studies, was conducted by two researchers. The first study was a phenomenological study of patients’ medication experiences that used unstructured interviews. The second study was an ethnographic study of pharmaceutical care practice, which included participant observation, in-depth interviews and focus groups with patients of pharmaceutical care. The third was a phenomenological study of the chronic illness experience of medically uninsured individuals in the United States and included an explicit aim to understand the medication experience within that context. The two researchers who conducted these three qualitative studies that examined the medication experience performed the meta-synthesis. The process began with the researchers reviewing the themes of the medication experience for each study. The researchers then aggregated the themes to identify the overlapping and similar themes of the medication experience and which themes are sub-themes within another theme versus a unique theme of the medication experience. The researchers then used the analytic technique, “free imaginative variation” to determine the essential, structural themes of the medication experience. Results: The meaning of medications for patients was captured as four themes of the medication experience: a meaningful encounter; bodily effects; unremitting nature; and exerting control. The medication experience is an individual’s subjective experience of taking a medication in his daily life. It begins as an encounter with a medication. It is an encounter that is given meaning before it occurs. The experience may include positive or negative bodily effects. The unremitting nature of a chronic medication often causes an individual to question the need for the medication. Subsequently, the individual may exert control by altering the way he takes the medication and often in part because of the gained expertise with the medication in his own body. Conclusion: The medication experience is a practice concept that serves to understand patients’ experiences and to understand an individual patient’s medication experience and medication-taking behaviors in order to meet his or her medication-related needs

Terugkeer en re-integratie van ex-Syriëgangers

ARIKELEN: Inleiding Ruth Kats, Beatrice de Graaf en Pauline Jacobs - Terroristen in detentie. Een overzicht van de ontwikkeling en discussie over de terroristenafdelingen in Nederland, 2004-2022 Ruth Kats, Beatrice de Graaf en Pauline Jacobs - Terroristen voor de rechter. Hoe strafrechters een verblijf op de terroristenafdeling meenemen in hun beslissingen (of niet) Hanne Cuyckens - De repatriëring van Nederlandse Syriëgangers. Een verplichting voor de staat van oorsprong? Tamara Buruma en Frederieke Dölle - Vrouwelijke terugkeerders uit Syrië. Het perspectief van de verdediging Elanie Rodermond - Het leven na een terroristisch misdrijf. Recidive en re-integratie van extremistische ex-gedetineerden Chrisje Sandelowsky-Bosman en Ton Liefaard - Waarom Nederland zijn uitreizigers en hun kinderen in Noord-Syrië moet ophalen SAMENVATTING: Twintig jaar nadat het debat over terrorisme in Nederland juridische gevolgen kreeg in wet- en regelgeving, is het tijd om de balans op te maken. Hoe hebben het recht, de rechtspraak en de omgang met terrorismeverdachten in Nederland zich ontwikkeld? Waar staan we als het gaat om de berechting en detentie van terrorismeverdachten en geradicaliseerden? In dit themanummer van Justitiële verkenningen worden diverse aspecten van dit juridische complex aangesneden. De vraag van dit themanummer is inventariserend (waar staan we?), beschrijvend (hoe zijn de ontwikkelingen verlopen?), analyserend (wat is het effect van detentie?) en gedeeltelijk ook wel normatief/proscriptief (wat zou de wenselijke richting zijn van de ontwikkelingen?). De artikelen behandelen het vraagstuk van detentie, strafmaat, recidive, repatriëring, resocialisatie en rehabilitatie van terrorismeverdachten en -veroordeelden en denken kritisch mee met de doorontwikkeling van deze praktijken. Een rode draad in dit themanummer is, dat er wordt gepleit voor meer maatvoering, minder boude, politiek gekleurde en algemene maatregelen (‘het is nu eenmaal terrorisme’), en voor een perspectief op terrorisme dat boven het strikt strafrechtelijke uitstijgt. Terrorisme is – omdat het vaak over nog niet begane strafdaden, over preventie en risico gaat – een categorie dreiging die soms moeilijk in het binaire koppel van schuldig-onschuldig te vangen is. Terrorisme – en zeker radicalisering – is ook een psychologisch, pedagogisch, en soms sociaaleconomisch fenomeen, dat meer in die bredere context en minder als een strikt strafrechtelijke kwestie kan en moet worden afgedaan

A qualitative review of migrant women's perceptions of their needs and experiences related to pregnancy and childbirth

Aim: A synthesis of the evidence of migrant women's perceptions of their needs and experiences in relation to pregnancy and childbirth. Background: Despite the fact that all European Union member states have ratified human rights-based resolutions aimed at non-discrimination, there is a relationship between social inequality and access to pre-, intra-, and postpartum care. Design: A qualitative systematic review of studies from European countries. Data sources: A search was made for relevant articles published between January 1996–June 2010. Review methods: Data were analysed by means of thematic synthesis. Results: Sixteen articles were selected, analysed, and synthesized. One overall theme; ‘Preserving one's integrity in the new country’ revealed two key aspects; ‘Struggling to find meaning’ and ‘Caring relationships’. ‘Struggling to find meaning’ comprised four sub-themes; ‘Communication and connection’, ‘Striving to cope and manage’, ‘Struggling to achieve a safe pregnancy and childbirth’, and ‘Maintaining bodily integrity’. ‘Caring relationships’ was based on the following three sub-themes: ‘Sources of strength’, ‘Organizational barriers to maternity care’, and ‘The nature and quality of caring relationships’. Conclusion: The results of this review demonstrate that migrant women are in a vulnerable situation when pregnant and giving birth and that their access to health services must be improved to better meet their needs. Research is required to develop continuity of care and improve integrated maternal care