The effect of new public management on intensive care unit staff
The NHS is largely dependent on two groups of professionals – medics and nurses. Recent government changes support the development of a central role for management. The impact of these changes on the roles and relationships of those working in the NHS must be understood in light of the structures already in place within it. Medical dominance in healthcare decision‐making, nursing power emanating from the strength of the medical‐nursing relationship and the hierarchies within and between the two professions all affect and are affected by recent management changes. In intensive care a key feature of the context, insularity, had already significantly modified these structures prior to recent reforms. This paper starts by discussing and contrasting the response of medics and nurses to these changes before highlighting the differences in the way these changes have impacted on staff in intensive care. Analysis is based on data from an observational study of the formation of a new directorate and interviews with senior nurses, medics and managers in intensive care.
A critical realist rationale for using a combination of quantitative and qualitative methods
This paper makes a valuable contribution to the growing debate on method(ology) mixing, and the focus on the epistemology/ontology of critical realism is very welcome and offers a constructive way forward in the ongoing discussion. In this review, however, I wish to focus on two questions the paper leaves largely unanswered. First, there is the question of terminology and, in particular, the use of the terms ‘method’ and ‘methodology’. Despite advocating an anti-conflationist position in which ‘a methodology should not be conflated with the technical aspects of a method’, the authors consistently fail to distinguish between the two. Indeed, in the first paragraph alone they use the term ‘method’ four times and ‘methodological’ twice, apparently interchangeably. The real problem with this mixing of terminology is that it encourages us to regard ‘focus groups, unstructured interviews, textual analysis and ethnographic case studies’ as of the same epistemological order. However, whereas the first two are methods for collecting data, and the third is a method for analysing the data collected by the first two, the final example is a methodology for structuring and rationalising the above methods. Thus, the methodology of the ethnographic case study might employ the data collection method of unstructured interviews and the data analysis method of textual analysis. To confuse the picture further, the authors sometimes use the term methodology to denote a much broader paradigmatic stance, such as in Table 1, where ‘hypothesis testing’ is referred to as a methodology. This rather cavalier approach to terminology makes it difficult at times to understand what the authors are arguing for. Clearly, mixing methods such as qualitative interviews and quantitative questionnaires is not usually considered problematic, and occurs regularly at all epistemological levels. Not only do certain methodologies such as case studies frequently employ a mixture of qualitative and quantitative methods, but even some data collection tools such as questionnaires often include a mixture of closed items which are coded quantitatively alongside free-text items which are coded qualitatively. The question that arises is therefore: at what level or levels is method(ology) mixing problematic? Are we faced with the same issues at the paradigm level of positivism, interpretivism and critical realism as we are at the level of research methodologies such as survey and phenomenology, and at the level of data collection methods such as questionnaires and interviews?
Reference values for some haematological, haematochemical, and electrophoretic parameters in the Girgentana goat
The purpose of this study was to determine haematolog ical, haematochemical, and electrophoretic reference values for the Girgentana goat in order to form a basis for clinical interpretation. The study included 348 female Girgentana goats aged from 1 to 6 years. The animals were divided into 3 groups: goats aged 1-2 years (group A), goats aged 3-4 years (group B), and goats aged 5-6 years (group C). Blood samples were collected from each animal every morning at the same time (0800) by means of jugular venipuncture, and red blood cell (RBC), white blood cell (WBC), neutrophil (NEU), lymphocyte (LYM), monocyte (MONO), eosinophil (EOS), and basophil (BASO) counts, and haemoglobin (Hb), packed cell volume percent (PCV), mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC), and red cell distribution width (RDW) were recorded. Additionally, the concentration of some haematochemical parameters, including alanine-aminotransferase (ALT), aspartate-aminotransferase (AST), γ-glutamine-transferase (γ-GT), creatinine, β-hydroxybutyrate, urea, non- esterified fatty acids (NEFA), potassium, sodium, and chloride, and the electrophoretic profile (albumin, α1-globulins, α2-globulins, β-globulins, γ-globulins, total proteins and albumin:globulins ratio) were determined. Statistical analysis (one-way analysis of variance (ANOVA)), followed by Bonferroni's test, showed that there were significant differences only in RBC, MCV, EOS, ALT, AST, creatinine, γ-GT, sodium, urea, NEFA, γ-globulins, and the albumin:globulins ratio (P < 0.05 was considered statistically significant). The values determined in the present study contribute to the knowledge of the reference ranges for the Girgentana goat and can be used for monitoring health and disease diagnosis.