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Ask two researchers to analyse a transcript and they will probably come up with very different results buy cheap wellbutrin sr depression definition vwl. This may be because they have studied different subjects cheap wellbutrin sr 150 mg with mastercard depression in men, 110 HOW TO ANALYSE YOUR DATA/ 111 or because they come from different political or methodo- logical standpoints discount 150 mg wellbutrin sr fast delivery depression and anxiety. It is for this reason that some re- searchers criticise qualitative methods as ‘unscientific’ or ‘unreliable’ cheap wellbutrin sr 150mg without a prescription mood disorder treatment centers. 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. However, during the three interviews she finds that the participants are raising issues that she has not thought about pre- viously. So she refines her interview schedule to include these issues for the next few interviews. She has thought about what has been said, analysed the words and refined her schedule accordingly. Thematic analysis When data is analysed by theme, it is called thematic ana- lysis. This type of analysis is highly inductive, that is, the themes emerge from the data and are not imposed upon it by the researcher. In this type of analysis, the data collec- 116 / PRACTICAL RESEARCH METHODS tion and analysis take place simultaneously. Even back- ground reading can form part of the analysis process, especially if it can help to explain an emerging theme. EXAMPLE 8: RICHARD Richard was interested in finding out what members of the public thought about higher education. During a fo- cus group with some library workers, he noticed that some people had very clear ideas about higher educa- tion, whereas others had very little idea. He asked the group why they thought this was the case and it emerged that the people who had clear ideas about higher education had either been to college or university themselves, or knew someone close to them who had been through higher education. Richard decided to follow it up by interviewing people who had never been to college or university to see how different their perceptions might be. Using this method, data from different people is com- pared and contrasted and the process continues until the researcher is satisfied that no new issues are arising. Com- parative and thematic analyses are often used in the same project, with the researcher moving backwards and for- wards between transcripts, memos, notes and the research literature. HOW TO ANALYSE YOUR DATA/ 117 EXAMPLE 9: RICHARD Once Richard had discovered that members of the pub- lic who had close contact with higher educational insti- tutions had clearer perceptions than those who had no contact, he felt two issues were important. First, he wanted to find out how close the contact had to be for people to have very clear perceptions of university, and second, he wanted to find out where perceptions came from for those people who had no contact with higher education. Through careful choice of intervie- wee, and through comparing and contrasting the data from each transcript, he was able to develop a sliding scale of contact with higher education. This ranged from no contact, ever, for any member of the family or friends, through to personal contact by the intervie- wee attending higher education. Having placed each interviewee somewhere on the scale, he then went back to the transcripts to look for hints about how their perceptions had been formed. At the same time he consulted existing research literature which addressed the issue of influences on personal per- ception to see if this would give him further insight into what was arising from his data.

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These factors will mean that the type buy wellbutrin sr 150 mg amex definition depression topographic map, amount and length of intervention will vary between clients order wellbutrin sr 150mg with mastercard depression symptoms break up. For example buy wellbutrin sr 150 mg line vertical depression definition, the development of independent living skills may be difficult in a hospital setting where meals and so on are provided cheap wellbutrin sr 150 mg amex depression symptoms recurring. Remember that goals set in conjunction with the client are more likely to be something that he or she feels is achievable. This will help avoid any duplication and ensure that goals complement rather than contradict each other. Again care pathways (or clinical pathways) provide a multidisciplinary perspective on the management of the client. For example, an objective about a client self-administering medication will be contraindicated in a setting where organisational or professional guidelines prohibit this. This is partly an unacceptable risk when compared with recognised best practice, and also what the individual client deems an unacceptable risk. Clients will vary in risk acceptance, and this will influence their decision making about treatment regimes. Therefore it must be made clear to the client about any likely risks or negative outcomes arising from intervention, for example the side effects of a specific drug regime. Careful explanation of these risks is required if clients are to make informed choices about their treatment. These choices will depend on the client understanding and accepting potential and actual risk. Such a discussion needs to be recorded in the notes in order to provide the clinician with protection from any future litigation. Recording clients’ decisions regarding consent to treatment It is essential that whenever possible, consent is obtained from the client before the start of treatment. Consent, whether it is given verbally, in writ­ ing or by implication, must be recorded in the notes. Your records also need to show not only that the client consented but also that he or she was capable of making this decision. The client must have sufficient informa­ tion to consider the benefits and the risks of the proposed treatment in or­ der to make a decision (Rodgers 2000). It is the clinician’s responsibility to make sure that the client under­ stands: ° the nature of any procedures ° the likely positive and negative outcomes ° the risks. Part of this explanation might include the option to ‘do nothing’ and the associated benefits and/or risks. A record of the information given to the RECORD KEEPING 57 client is therefore an important part of the health record and might be­ come a vital factor if litigation arises. There are various ways of noting the decision to consent: ° A narrative account is written directly into the progress notes. Regardless of which method you choose you will need to be specific about the actions to which the client is consenting. This will also include a refer­ ence to the period of time to which the consent applies. Children and young people Consent for children under the age of 16 is most likely to be given by an adult with parental responsibility, although, in some cases, it may be the child who gives consent to treatment (see ‘Use and Protection of Informa­ tion’ in Chapter 3). The above advice on providing information applies equally to this client group. The clinician must ensure that sufficient infor­ mation is given to the adult or child giving consent to treatment. Refusal of treatment A refusal by the client of proposed treatment needs to be noted. This ap­ plies whether it is the whole or only parts of the treatment with which the client refuses to proceed. Record the reasons for refusal using the client’s words wherever possible, and detail your advice to the client on the possi­ ble risks or negative outcomes of his or her decision. This will provide evi­ dence to help protect the clinician against any future litigation for negligence. It will also provide useful information for other health profes­ sionals on the client’s attitudes, beliefs and wishes. It is important to check organisational and professional guidelines on procedures, which should include directions about record keeping. Difficulties in obtaining consent In some cases there may be difficulties or barriers to communicating the necessary information to clients. Examples might include clients with a different language from the clinician, clients with a communication dis­ ability following a stroke or clients with a hearing loss. It may be necessary to use interpreters or advocates to help communicate information effec­ tively about treatment options. Whatever method is used it is important that the way in which the client’s consent was obtained is clearly recorded. Clients who are not competent to consent In certain circumstances it may not be possible to obtain consent from the client prior to giving treatment, for example an unconscious client in acci­ dent and emergency. The reason for not obtaining consent must always be recorded, along with information about how a client was deemed to be in­ competent to give consent. This is particularly important in the case of cli­ ents with a mental health problem, and special forms are available for these situations (NHS Executive 1990). Writing your objectives Use the following guidelines to help you set clear, realistic and measurable goals for your client. Such choices of language are important when careplans are being set with the client. Use specific statements in your objectives that contain information about quantifiable behaviours to be observed in the client. Springhouse (1998) suggests that such statements will include the fol­ lowing three key components: ° an observable behaviour ° a measure of that behaviour ° the condition under which that behaviour will occur. Behaviours may be classified as: ° a physical response (for example blood pressure) ° a psychological response (for example mood) ° a skill (for example speech) ° a personal habit (for example smoking) ° a social response (for example eye-contact). The following questions will help you find suitable measures: ° How often will it occur (frequency)? Examples of measurable objectives are: ‘weight loss of 7 kg at a rate of 1 kg a week’ ° behaviour = weight loss ° measure = 7 kg ° condition = 1 kg per week. This may or may not be the same as the review date for the careplan, as goals may be achieved at different points along the timeline. Often the clinician will be acting autonomously in choosing and im­ plementing interventions. Selecting the most appropriate action will be tempered by: ° the client characteristics ° the available resources (both staff and equipment) ° the available skill base (are the appropriately qualified staff available? In some circumstances, one health professional may be carrying out inter­ ventions prescribed by another.

The 25 Antibody and antigen WORLD OF MICROBIOLOGY AND IMMUNOLOGY arm-tip regions are typically those that bind to the antigen discount 150 mg wellbutrin sr visa depression test channel 4. See also Immune system; Immunoglobulins and immunoglob- These portions of the antibody are also known as the antigenic ulin deficiency syndromes; Laboratory techniques in determinants wellbutrin sr 150 mg for sale tropical depression weather definition, or the epitopes order wellbutrin sr with american express anxiety attack treatment. Hydrogen bonds are important in stabilizing the AAntibody and antigenNTIBODY AND ANTIGEN antibody-antigen association generic wellbutrin sr 150 mg with amex depression neurotransmitters. Antigens, which are usually proteins or polysaccha- The hydrogen bonds that are important in antigen-anti- rides, stimulate the immune system to produce antibodies. The body bonding form between amino acids of the antibody and antibodies inactivate the antigen and help to remove it from the antigen. While antigens can be the source of infections from antibody and the antigen create other hydrogen bonds. The pathogenic bacteria and viruses, organic molecules detrimen- formation of hydrogen bonds between other regions of the tal to the body from internal or environmental sources also act antibody and antigen, and the water molecules stabilizes the as antigens. Genetic engineering and the use of various muta- binding of the immune molecules. Frequently, the antibody molecule forms a pocket that is antigen specific regions of the antibody molecule. Such anti- the right size and shape to accommodate the target region of gen-specific regions are located at the extremes of the Y- the antigen. This phenomenon was initially described as the shaped immunglobulin-molecule. Once the immune system has created an antibody for an The exact configuration of the antibody-antigen binding antigen whose attack it has survived, it continues to produce site is dependent on the particular antigen. Such a region may be able to term memory of the immune system provides the basis for the fit into a pocket or groove in the antibody molecule. In this case, the bind- with its production of antibodies, has the ability to recognize, ing site may be more open or flatter. These various three dimensional structures for the bind- There are several types of simple proteins known as ing site are created by the sequence of amino acids that com- globulins in the blood: alpha, beta, and gamma. Some sequences are enriched in gamma globulins produced by B lymphocytes when antigens hydrophobic (water-loving) amino acids. Such regions will tend to form flat sheets, with all the amino acids exposed to enter the body. In medical literature they appear in the can contain both hydrophilic and hydrophobic (water-hating) abbreviated form as Ig. The latter will tend to bury themselves away of a specific antibody (Ig). These structural differences of amino body and antigen depends upon the number of hydrophilic and acids in each of the antibodies enable the individual antibody hydrophobic regions and their arrangement within the protein to recognize an antigen. In response to the antigen requires a specific three-dimensional configuration is antigen that has called it forth, the antibody wraps its two exploited in the design of some vaccines. These vaccines con- combining sites like a “lock” around the “key” of the antigen sist of an antibody to a region that is present on a so-called combining sites to destroy it. Antigens such as toxin molecules recognize An antibody’s mode of action varies with different types the receptor region and bind to it. With its two-armed Y-shaped structure, the anti- region is already occupied by an antibody, then the binding of body can attack two antigens at the same time with each arm. This is mainly due to the establish- an antibody surrounds a virus, such as one that causes ment of the various chemical bonds and interactions between influenza, it prevents it from entering other body cells. The visible clumping of the antibody-antigen Another mode of action by the antibodies is to call forth the complex seen in solutions and diagnostic tests such as the assistance of a group of immune agents that operate in what is Ochterlony test is an example of the irreversible nature of the known as the plasma complement system. This function is presently overextended in reacting and then removing them from the body. There are five different antibody types, each one having The presence of antibodies can be detected whenever a different Y-shaped configuration and function. They are the antigens such as bacteria or red blood cells are found to agglu- Ig G, A, M, D, and E antibodies. It is the chief tion, or where there has been a stimulation of the plasma Ig against microbes. Antibodies are also used in laboratory its removal by other immune system cells. It gives lifetime or tests for blood typing when transfusions are needed and in a long-standing immunity against infectious diseases. It is number of different types of clinical tests, such as the highly mobile, passing out of the blood stream and between Wassermann test for syphilis and tests for typhoid fever and cells, going from organs to the skin where it neutralizes sur- infectious mononucleosis. This mobil- By definition, anything that makes the immune system ity allows the antibody to pass through the placenta of the respond to produce antibodies is an antigen. Antigens are liv- mother to her fetus, thus conferring a temporary defense to the ing foreign bodies such as viruses, bacteria, and fungi that unborn child. Or they can be dust, chemicals, After birth, IgG is passed along to the child through the pollen grains, or food proteins that cause allergic reactions. But some of Antigens that cause allergic reactions are called aller- the Ig will still be retained in the baby from the placental trans- gens. A large percentage of any population, in varying mission until it has time to develop its own antibodies. It is an antibody that pro- the body or a blood transfusion that is not of the same blood vides a first line of defense against invading pathogens and type as itself. It is There are some substances such as nylon, plastic, or found in large quantities in the bloodstream and protects other Teflon that rarely display antigenic properties. While they have basic similarities, nonantigenic substances are used for artificial blood vessels, each IgA is further differentiated to deal with the specific component parts in heart pacemakers, and needles for hypo- types of invaders that are present at different openings of the dermic syringes. Practically everyone reacts to certain chemicals, for combines five Y-shaped units), it remains in the bloodstream example, the resin from the poison ivy plant, the venoms from where it provides an early and diffuse protection against insect and reptile bites, solvents, formalin, and asbestos. Viral invading antigens, while the more specific and effective IgG and bacterial infections also generally trigger an antibody antibodies are being produced by the plasma cells. For most people penicillin The ratio of IgM and IgG cells can indicate the various is not antigenic, but for some there can be an immunological stages of a disease. In an early stage of a disease there are response that ranges from severe skin rashes to death. The presence of a greater number of IgG Another type of antigen is found in the tissue cells of antibodies would indicate a later stage of the disease. If, for example, a kidney is transplanted, the antibodies usually form clusters that are in the shape of a star. These are called human leukocyte T-cells to help them in location of antigens.

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