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By G. Eusebio. Clayton College and State University.

This may be because they have studied different subjects order extra super levitra 100mg online erectile dysfunction gay, 110 HOW TO ANALYSE YOUR DATA/ 111 or because they come from different political or methodo- logical standpoints buy generic extra super levitra 100 mg on-line erectile dysfunction 31 years old. It is for this reason that some re- searchers criticise qualitative methods as ‘unscientific’ or ‘unreliable’. This is often because people who come from quantitative backgrounds try to ascribe their methods and processes to qualitative research. For qualitative data, the researcher might analyse as the re- search progresses, continually refining and reorganising in light of the emerging results. For quantitative data, the analysis can be left until the end of the data collection process, and if it is a large survey, statistical software is the easiest and most efficient method to use. For this type of analysis time has to be put aside for the data input process which can be long and laborious. However, once this has been done the analysis is quick and efficient, with most software packages producing well presented graphs, pie charts and tables which can be used for the final report. QUALITATIVE DATA ANALYSIS To help you with the analysis of qualitative data, it is use- ful to produce an interview summary form or a focus group summary form which you complete as soon as possible after each interview or focus group has taken place. This includes practical details about the time and place, the participants, the duration of the interview or focus group, and details about the content and emerging themes (see Figures 2 and 3). It is useful to complete these forms as 112 / PRACTICAL RESEARCH METHODS soon as possible after the interview and attach them to your transcripts. The forms help to remind you about the contact and are useful when you come to analyse the data. The method you use will depend on your research topic, your personal preferences and the time, equipment and fi- nances available to you. Also, qualitative data analysis is a very personal process, with few rigid rules and procedures. It is for this reason that each type of analysis is best illu- strated through examples (see Examples 8–11 below). Formats for analysis However, to be able to analyse your data you must first of all produce it in a format that can be easily analysed. This might be a transcript from an interview or focus group, a series of written answers on an open-ended questionnaire, or field notes or memos written by the researcher. It is useful to write memos and notes as soon as you begin to collect data as these help to focus your mind and alert you to significant points which may be coming from the data. These memos and notes can be analysed along with your transcripts or questionnaires. You can think of the different types of qualitative data analysis as positioned on a continuum (see Fig. HOW TO ANALYSE YOUR DATA/ 113 Interviewee: ________________ D at e o f I n t erview:________________ P l ac e : ________________________ Time of Interview:________________ Duration of Interview: __________ Where did the interview take place? Did any issues arise which need to be added to the interview schedule for next time? Have I promised to send any information or supply them with the results or a copy of the transcript? Interview summary form 114 / PRACTICAL RESEARCH METHODS D at e : ________________________ Time:_________________________________ Ve n u e : ______________________ D u r at ion: ___________________________ G rou p : ______________________ Diagram of seating plan with participant codes: Where did the focus group take place? Does anything need to be added to the in- terview schedule for the next focus group? Have I promised to send any further informa- tion or the final report to anyone? Qualititative data analysis continuum For those at the highly qualitative end of the continuum, data analysis tends to be an on-going process, taking place throughout the data collection process. The researcher thinks about and reflects upon the emerging themes, adapt- ing and changing the methods if required. For example, a researcher might conduct three interviews using an inter- view schedule she has developed beforehand.

In fact generic 100mg extra super levitra otc erectile dysfunction 21 years old, in private buy 100 mg extra super levitra what causes erectile dysfunction in diabetes, many doctors in all specialities are doubtful of the value of much of the work of health promotion. However, recognising the strength of the health promotion consensus, solidly backed by government funding, medical vested interests and compliant journalists, they think it best to keep their reservations to themselves. Indeed, as any of the sceptics who have spoken out could testify, the price of making private reservations about fashionable health promotion interventions public is high. The intellectual insecurity underlying the health promotion consensus is expressed in a dogmatic intolerance of criticism and intense hostility towards any dissident opinion. Anybody who ventures criticism of these policies—or has the temerity to publish research revealing their ineffectiveness—can 66 SCREENING expect a tirade of abuse and little prospect of academic advance- ment. A spirit of ‘not in front of the children’ governs debate as medical science is subordinated to political expediency. The second theme that emerges from our discussion of health promotion interventions is the resulting restriction on individual liberty. This is not so much a matter of direct compulsion, but of the oppressive effect—well expressed by Bridget Jones in her eponymous diary—of living in constant awareness of the need to count cigarettes, calories and units of alcohol (Fielding 1997). When I first received a ‘health risk assessment’ report resulting from the sort of encounter that so incensed Ruth Lea of the Institute of Directors in the account quoted above, I expected that it would provoke a similar response from many patients annoyed by the intrusive and impertinent character of the questions and the patronising style of the advice. The attitude of most people to such procedures appears to have shifted from an earlier bemusement or indifference (combined with some irritation at the amount of time wasted) to a more recent positive enthusiasm for intervention. This outlook extends to patients (invariably, in my experience, fit young men) whose friends have had the full medical, but whose own employers do not stretch to the (considerable) expense. They turn up at the surgery, declaring that they ‘need a complete check-up’. The popularity of the notion that healthy young people require regular medical maintenance marks the triumph of the ideology of health promotion. As Bridget Jones also reflects, guilt is a more common response to health promotion initiatives than anger. When women have come in to the surgery worried about a breast lump, I have occasionally inquired whether they routinely carry out self-examination. The fact that even people who do not follow the dictates of the ‘awareness’ campaigns —in this case into an activity which most experts consider quite useless—still feel that they are in default of their personal and social responsibilities, reveals the impact of health promotion. The gloomy atmosphere of the smokers’ huddle confirms that who defy the injunctions of healthy living experience remorse rather than elation. Over the past twenty years personal behaviour has been exten- sively re-interpreted and reorganised around considerations of health. The very ubiquity of terms which link ‘health’ with some activity which had previously been regarded as a distinct and autonomous sphere indicates this trend—‘healthy lifestyle’, ‘health 67 SCREENING foods’, ‘healthy eating’, ‘sexual health’, ‘exercise for health’. Whereas feminists once rejected ‘women’s health’ as a form of male medical domination, their latter-day sisters have embraced ‘lesbian health’ as an affirmation of identity; in a common spirit of victimhood we now also have ‘men’s health’. The cult of exercise, pursued not for the enjoyment of sporting activity as such, but in the cause of improving physical fitness in the abstract, reflects the ascendancy of preoccupations about health over personal behaviour. The third theme is the transformation of the medical role and the emergence of new institutions that mediate between the individual and the state in the sphere of health. The change in the role of the doctor is most apparent in general practice, in many ways the front line of the advance of medical intervention in lifestyle. In the not-so- distant past, general practice was a demand-led service: patients came to the surgery complaining of illness and doctors offered diagnosis and treatment, care and concern, within the limits of their own abilities and those imposed by medical science and health service resources. Over the past decade, general practice has shifted to a more pro-active approach, inviting patients to attend for health checks and screening procedures and adopting a more interventionist role in relation to lifestyle issues, such as smoking and drinking, diet and exercise. Instead of serving their patients’ needs, GPs now serve the demands of government policy—and the dictates of government-imposed health promotion performance targets. New procedures, such as the routine check-up and the lifestyle questionnaire, allowing the systematic recording (now in a readily accessible computerised form) of intimate knowledge of the patient, have become a familiar feature of the doctor-patient relationship. Having taken on a major role in health promotion, the government has worked with the established organisations of the medical profession—the various royal colleges, the BMA and others—to push forward initiatives like the Health of the Nation campaigns of the early 1990s. It has also recognised the limitations of these traditionally conservative and inflexible bodies and has encouraged the development of a range of institutions to play a more dynamic role. An early example of this approach was the establishment of the Health Education Council in 1968; this was transformed into the Health Education Authority in the heat of the Aids crisis twenty years later and was finally wound up in 2000 as its functions were subsumed by New Labour’s Health Development Agency and other public health initiatives.

Patrick O’Reilley generic extra super levitra 100 mg with mastercard erectile dysfunction pills cost, a primary care doctor at a neighborhood health center purchase extra super levitra 100 mg without a prescription erectile dysfunction treatment after surgery, generally ignores what he sees as byzantine rules about prescrip- tions and approvals set by health insurers. If they kick out something I prescribe, then I’ll find out about it, but I just go ahead and do it. O’Reilley does worry about his patients, who are poor, being sent large bills by providers because their in- surer denies coverage and he didn’t follow rules. Of the insured people with various disabilities, including mobility problems, 28 percent report they have special needs that are not covered—for particular therapies, equipment, medications—compared to 7 percent of those without disabilities. Among those with very severe disabilities, 40 percent note un- covered special needs (Harris Interactive 2000, 56, 57). Overall, 19 percent of disabled persons report that they needed medical care within the last year but didn’t get it, compared to 6 percent of nondisabled persons (Harris In- teractive 2000, 60). Disabled people attribute these failures to lack of insur- ance coverage (35 percent), high cost (31 percent), difficulties or disagree- ments with physicians (8 percent), problems getting to physicians’ offices or clinics (7 percent), and inadequate transportation (4 percent). Department of Health and Human Services (2000, 6-5) recognizes that, “As a potentially underserved group, people with disabilities would be expected to experience disadvan- tages in health and well-being compared with the general population. When the canaries keeled over, the miners knew the air wasn’t good—they’d better get out. People with disabilities tend to be the most vulnerable persons in the health care system. Unless there’s a lot of advocacy, their needs tend to be put on the back burner and dealt with as an afterthought. Problems in the health care system hit people with disabilities first, but ultimately almost everyone is affected. Basic restructuring of our health-care sys- tem is essential, but intractable societal forces and cost concerns have, thus far, blocked fundamental reforms. While often maligned, public and private health insurance has protected much of the public from the full brunt of acute health-care costs, although uninsured and chronically ill people might tell different tales. As a country, we have not yet explicitly con- fronted what the health-care system should pay for and why. Even Christopher Reeve had trouble getting his private insurance com- pany to extend his stay in a rehabilitation facility and to purchase equip- ment. She lives in a low-income apartment, one of those little places like a motel room. Some friends raised the money and gave her an electric wheelchair—a real cheap one, but it allowed her to get out the door and up to a small park. On a nice spring day, she can go out and sit under a tree and come back in. So the wheelchair has now been folded up and is gathering dust in the corner. It’s been retired from use, and every time a home-health aide comes, she tries not to see it. What happens—and nobody from home health sees this—is that this team at her church comes and gets her on Sunday and packs her up and takes her over and then brings her home af- terward. Her friends rightly assumed that Medicare would refuse to purchase her power wheelchair since she does not need it within her tiny apartment—as for Erna Dodd, it would not have been deemed “medically necessary. The independence and ease conveyed by the power wheelchair, however, could put at risk her eligibility for home-based nursing care for her remaining leg ulcerated by diabetes: if Mary Jo leaves her apartment without considerable and taxing effort to sit under a tree in her power wheelchair, she might lose home-health care. Going to church is permitted, but neither Mary Jo nor her friends wish to risk a strict interpretation of Medicare’s rules, and so her power wheelchair sits unused. Remaining homebound when she could venture out diminishes Mary Jo’s quality of life and could compromise her overall health. To commemorate the twelfth anniversary of the ADA on 26 July 2002, President George W. Bush addressed one concern raised by Medicare’s homebound definition: that home-care coverage ceases if people go out for reasons other than health care or church services.

Brain 1986; 109: 1169-1178 Cross References Ataxia; Flaccidity; Hemiballismus; Hypertonia Hypotropia Hypotropia is a variety of heterotropia in which there is manifest downward vertical deviation of the visual axis of one eye generic extra super levitra 100 mg visa erectile dysfunction drugs insurance coverage. Using the cover test purchase 100mg extra super levitra fast delivery erectile dysfunction pump uk, this manifests as upward movement of the uncovered eye. Depending on the affected eye, this finding is often described as a “left- over-right” or “right-over-left. Improvement of ptosis is said to be specific for myas- thenia gravis: cold improves transmission at the neuromuscular junction (myasthenic patients often improve in cold as opposed to hot weather). A pooled analysis of several studies gave a test sensitivity of 89% and specificity of 100% with correspondingly high positive and negative likelihood ratios. Whether the ice pack test is also applicable to myasthenic diplopia has yet to be determined. International Journal of Clinical Practice 2004; 58: 887-888 Larner AJ, Thomas DJ. Postgraduate Medical Journal 2000; 76: 162-163 Cross References Diplopia; Fatigue; Ptosis Ideational Apraxia - see APRAXIA Ideomotor Apraxia (IMA) - see APRAXIA Illusion An illusion is a misinterpretation of a perception (cf. Illusions occur in normal people when they are tired, inat- tentive, in conditions of poor illumination, or if there is sensory impairment. They also occur in disease states, such as delirium, and psychiatric disorders (affective disorders, schizophrenia). Examples of phenomena which may be labeled illusory include: Visual: metamorphopsia, palinopsia, polyopia, telopsia, Pulfrich phenomenon, visual alloesthesia Auditory: palinacusis Vestibular: vertigo References Tekin S, Cummings JL. Oxford: OUP, 2003: 479-494 - 168 - Impersistence I Cross References Delirium; Delusion; Hallucination Imitation Behavior Imitation behavior is the reproduction by the patient of gestures (echopraxia) and/or utterances (echolalia) made by the examiner in front of the patient; these “echophenomena” are made by the patient without preliminary instructions to do so. They are consistent and have a compulsive quality to them, perhaps triggered by the equivo- cal nature of the situation. There may be accompanying primitive reflexes, particularly the grasp reflex, and sometimes utilization behavior. Imitation behavior occurs with frontal lobe damage; originally mediobasal disease was thought the anatomical correlate, but more recent studies suggest upper medial and lateral frontal cortex. Certainly imitation behavior never occurs with retrorolandic cortical lesions. A distinction has been drawn between “naïve” imitation behavior, which ceases after a direct instruction from the examiner not to imi- tate his/her gestures, which may be seen in some normal individuals; and “obstinate” imitation behavior which continues despite an instruction to stop; the latter is said to be exclusive to frontotemporal dementia. Journal of Neurology, Neurosurgery and Psychiatry 1996; 61: 396-400 Lhermitte F, Pillon B, Serdaru M. Part I: imitation and utilization behavior: a neuropsychological study of 75 patients. Obstinate imitation behavior in differentiation of frontotemporal dementia from Alzheimer’s disease. Lancet 1998; 352: 623-624 Cross References Echolalia; Echopraxia; Grasp reflex; Utilization behavior Imitation Synkinesis - see MIRROR MOVEMENTS Impersistence Impersistence is an inability to sustain simple motor acts, such as con- jugate gaze, eye closure, protrusion of the tongue, or keeping the mouth open. It is most commonly seen with lesions affecting the right hemisphere, especially central and frontal mesial regions, and may occur in association with left hemiplegia, neglect, anosognosia, hemi- anopia, and sensory loss. These patients may also manifest persevera- tion, echolalia and echopraxia. Impersistence is most often observed following vascular events but may also be seen in Alzheimer’s disease and frontal lobe dementias, and metabolic encephalopathies. Impersistence of tongue protrusion - 169 - I Inattention and hand grip may be seen in Huntington’s disease. Neuro- psychologically, impersistence may be related to mechanisms of directed attention which are needed to sustain motor activity. Journal of Nervous and Mental Disease 1956; 123: 201-218 Kertesz A, Nicholson I, Cancelliere A, Kassa K, Black SE. Neurology 1985; 35: 662-666 Cross References Anosognosia, Echolalia; Echopraxia; Hemianopia; Milkmaid’s grip; Neglect; Perseveration; Trombone tongue Inattention - see NEGLECT Incontinence Urinary incontinence may result from neurological disease. Neurological pathways subserving the appropriate control of micturi- tion encompass the medial frontal lobes, a micturition centre in the dorsal tegmentum of the pons, spinal cord pathways, Onuf’s nucleus in the spinal cord segments S2-S4, the cauda equina, and the pudendal nerves.

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