In the field of participatory health research (PHR) and related action research paradigms, limitations of standard ethical codes and institutional review processes have been identified. PHR is highly situational and relational, part of a hierarchical health care context and therefore ethics of care has been suggested as a helpful theoretical approach that emphasises responsibilities and relationships. The purpose of this article is to explore the value of Tronto's second-generation ethics of care for reflection on ethical challenges experienced by academic researchers. Using the design of a collaborative auto-ethnography, this article starts from a story of a researcher who deals with dilemmas in responsibility to care for co-researchers with lived experiences during a PHR study in the field of acute psychiatric care. By analysing the challenges together with all co-researchers, using a framework of ethics of care, we discovered the importance of self-care and existential safety for an ethical PHR practice. The reflexive meta-narrative shows that the ethics of care lens is useful to untangle moral dilemmas in all participatory researchrelated paradigms for all engaged.

Background: During labour, remifentanil patient-controlled analgesia is used as an alternative to neuraxial analgesia. Remifentanil is associated with hypoventilation and respiratory depression but the frequency of serious maternal and neonatal adverse events is unknown. The aim of this study was to estimate the number of serious adverse events attributed to the use of remifentanil patient-controlled analgesia during labour in The Netherlands and to investigate the circumstances (e.g. monitoring, practice deviations) of these events and the subsequent management. Methods: In a nationwide survey among obstetricians, anaesthetists and clinical midwives the frequency of serious adverse events was assessed. A questionnaire was sent by email to

Our study suggests that STAN, when compared to EFM alone, can be a cost-effective strategy from both a maternal and neonatal perspective.

Objective: Product Information Leaflets (PILs) are an important source of information for patients on their medication, but may cause confusion and questions. Patients then may seek clarification, for instance from pharmacy technicians. The aim of this study was to explore which questions pharmacy technicians get about PIL-related issues, why and when, and how they handle such questions. Methods: an online survey in a panel of 785 Dutch pharmacy technicians. Key results: Net response rate was 37%. PIL-related questions frequently concerned drug actions, problems with use, side effects, intolerances and pregnancy and lactation. Patients who received generic alternatives instead of the branded product they had received previously, also came more often to pharmacy staff with PIL-related questions. The requested information could not always be found in the PIL itself, not even by the pharmacy technicians themselves. They mentioned that the PIL is not easy to read, understand or recall. Conclusions: Pharmacy staff is often approached by patients having difficulties in understanding PILs. Even pharmacy technicians find PILs difficult to read and often use other sources of information. PIL layout and contents should become more standardized and easier to read and understand.

Background Audit and feedback informs healthcare providers and may affect professional practice and patient outcomes. The Primary Care Practice Report (PCPR) is a web based personalized feedback instrument for general practitioners (GPs) in the Netherlands, based on claims data. Its yearly uptake is limited. In order to improve the use and usability of the report this study aims to identify key criteria that GPs deem important for audit and feedback.Methods A qualitative interpretative approach was used. We interviewed 12 GPs about their use of the practice report. These interviews followed the Three-Step Test-Interview method. Thematic content analysis was used to investigate the perception of the GP on the report and their perspective on the usability. The interviews resulted in critical items for audit and feedback, on which all tables and graphs in the report were systematically assessed.Results From the interviews with GPs recurring criteria emerged that were identified as decisive for the effectiveness of performance feedback: content, reliability, validity and usability. The 34 tables and graphs of the PCPR were assessed using factual characteristics. Content analysis shows that the PCPR has a strong focus on costs. Assessment on validity indicates that casemix correction is always performed if relevant, but explanatory notes hardly clarify which (sub)population is measured (3/34), therefore GP’s in general have difficulty interpreting the results. Assessment on usability shows that, although benchmark figures are almost always presented based on national references, the formulation of goals or any specific attention for an action perspective is lacking because the perceived comparability with the patient group of the GP is limited.Conclusions The current PCPR does not meet key criteria for effective audit and feedback, as defined by GPs. It has a strong focus on costs instead of clinical behavior and is poorly understood when it comes to the specific population the data reflect. The results are in line with theoretical perspectives on learning and improvement of professionals. Improvement of the PCPR requires information on aspects of clinical behavior that are recognizable for GPs and they actually can influence. First steps are made to improve the method of case-mix correction in the benchmarking.