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How the physician healer works: three theories
Published in Michael Dixon, Kieran Sweeney, Sir Denis Pereira Gray, The Human Effect in Medicine, 2017
Michael Dixon, Kieran Sweeney, Sir Denis Pereira Gray
Both conditioning and expectancy theory would predict the cascade effect: that is to say the patient that is feeling slightly better will be expected via positive reinforcement and increased expectation to get better still. On a physiological level, the cascade effect can be seen in terms of positive feedback. The psychological effects of the healing process are mirrored by increased neurotransmitter output affecting, for instance, endocrine and immunological systems. Changes in these systems feedback to central and peripheral neurotransmitter receptors, and thereby amplify further any neurotransmitter output.
Labour: normal and abnormal
Published in Louise C Kenny, Jenny E Myers, Obstetrics, 2017
Good communication between the staff and the patient involved may help to clear up misunderstandings and minimize the chances of a formal complaint or legal action. ‘Root-cause analysis’ is a technique that serves to examine in detail a poor outcome or near-miss, so that every step of the patient-journey is scrutinized to see if the outcome could have been prevented. This approach allows assessment of both systemic (organizational) and individual (doctor/midwife) contribution to errors. In this way, lessons are learned for the future and Unit policies and guidelines can be adjusted accordingly. It is usually the case that a whole series of failings or errors need to occur together for a poor outcome to result (a cascade effect). Organizational systems as a whole often contribute, and one single individual is rarely solely responsible for a poor outcome.
Moral and ethical issues: Claims, consequences, and caveats
Published in Priya Hays, Advancing Healthcare Through Personalized Medicine, 2017
There is a cascade effect of medical technology. Incidental, ambiguous, false positive results lead to further tests and adverse effects. The questions remain: When is whole exome sequencing and targeted sequence testing the right test? Under what circumstances does genomic medicine help?
COVID-19, loneliness, social isolation and risk of dementia in older people: a systematic review and meta-analysis of the relevant literature
Published in International Journal of Psychiatry in Clinical Practice, 2022
Carlo Lazzari, Marco Rabottini
A psychosocial explanation suggests that persons who are less socially isolated have better health behaviours due to the positive encouragement of friends and family to assume a healthy regime in their life (Cacioppo and Hawkley 2003). Social links offer guidelines and general standards that regulate health behaviours with a cascade effect on physical health as health behaviours are emulated within peer groups (Umberson and Montez 2010). Social ties and social groups have norms in health behaviours; for instance, churches, schools, volunteer organisations promote a healthy lifestyle while those who are married engage in less health-risky conducts (Umberson et al. 2010). Religious affiliation is usually linked to more optimism and better temperament, impacting well-being and physical health (Green and Elliott 2010). Social isolation and loneliness are associated with augmented sedentary activity in older people, impacting physical health (Schrempft et al. 2019). The beneficial relationship between social support and well-being can be attributed more to the overall positive effect of support (primary- or direct-effect model) or to a support process that prevents individuals from potentially harmful consequences of stressful events (buffering model) (Cohen and Wills 1985) (Figure 1).
Delays to accessing healthcare and rehabilitation following trauma in Madagascar – a qualitative study
Published in Disability and Rehabilitation, 2021
H. N. Locke, V. Randriamarotsiresy, M. A. Chamberlain, R. J. O’Connor
One approach to tackling these barriers may be to improve health awareness through education programmes at a community level. Several professionals interviewed were already using their contact time with patients to improve awareness. The influence of family and social networks is important in Malagasy culture; by utilising each patient contact for education, a cascade effect can be achieved to spread the message to others in the community. Collaborating with community health workers and traditional healers to provide training on health education has been effective in other settings [14,15]. Traditional healers in Madagascar often occupy an influential position within their communities, particularly in the more rural setting, and are potentially an excellent resource if collaboration and training are done sensitively.
Overutilization in laboratory medicine: tackling the problem with quality improvement science
Published in Critical Reviews in Clinical Laboratory Sciences, 2021
Daniel R. Beriault, Julie A. Gilmour, Lisa K. Hicks
Another important negative consequence of over-testing is the risk of unhelpful, or sometimes frankly misleading, results. The reliability of laboratory tests is influenced by the clinical context, and specifically by the pretest probability of a condition. If tests are ordered in high numbers without regard to the clinical situation, the probability of false positive and/or false negative results can be unacceptably high. Consider, for instance, the example of ELISA testing for heparin-induced-thrombocytopenia (HIT). When clinical factors indicate that the pretest probability of HIT is moderate to high (as measured by the 4 T score), the HIT test can be very helpful in directing patient care. However, when the HIT test is done inappropriately in the context of a low pretest probability, the test becomes unreliable, and in some settings, the probability of a false positive test can approach or exceed the probability of a true positive [39]. False positive HIT tests can result in patients receiving unnecessary anticoagulation, which increases the risk of bleeding. Moreover, false positive tests can lead to further testing with downstream costs and further risk of adverse events. This phenomenon of inappropriate testing begetting more testing has been described as the “cascade effect” [40] and adds to the harm of overutilization.