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The politics of technocratic change
Published in Rudolf Klein, The New Politics of the NHS, 2019
The Hospital Plan was thus the child of a marriage between professional aspirations and the new faith in planning: between what might be called medical expertise and administrative technology. It was designed to promote both efficiency and equity: to bring about uniform standards throughout the NHS. But, it is important to stress, the detailed recommendations of the Plan – the basic vision of what a hospital service should be like – were almost entirely determined by the medical consensus: to caricature only slightly, the vision was designed to maximise the quality of medical care being delivered. Within the Ministry the issue of determining norms and the pattern of hospitals was defined largely as a matter for the medical experts: ‘a purely scientific thing, where you accept the advice of your medicos’, as one of the administrators put it. There is no indication in the Hospital Plan of other possible criteria being considered, such as accessibility for patients or the effect of hospital size on staff morale or recruitment. The domination of the professional definition of the problem being tackled was all the greater for being implicit and unargued.
Cost containment in the EU: an overview
Published in Elias Mossialos, Julian Le Grand, Health Care and Cost Containment in the European Union, 2019
Elias Mossialos, Julian Le Grand
Examination of profiles of doctors' work and prescriptions thus seems to have only a limited effect; but the extent of the effect may depend on what sanctions are applied and how often they are imposed. In France the scope of practice guidelines is small, but presumably it will expand. It is an attempt to bind doctors into what is judged to be rational prescribing. In so far as some doctors in all countries do not prescribe rationally, practice guidelines are directed at the source of considerable waste, providing the references are well chosen. But how far can the system be extended and where does valid evidence support the chosen therapy? In France the references for particular conditions are agreed with doctors' representatives, so there is a risk that they will be based on a medical consensus rather than evidence. Indeed, some medical references in France have been criticized as being weak recommendations that offer no firm conclusions that could help the physician and therefore unlikely to have any impact on clinical practice.155
Sociocultural aspects of concussion
Published in Gordon A. Bloom, Jeffrey G. Caron, Psychological Aspects of Sport-Related Concussions, 2019
Building on what has only been a relatively recent recognition that sociocultural factors are significant in mediating the experience and management of concussion (McCrory et al., 2017), this chapter has sought to provide an overview of how concussion must be conceived of as impacting across a range of social domains—from cultural representations to public health, medical knowledge, medical practice, and athlete experience. Specifically, this chapter has identified how the peculiar social relations which form sports cultures shape the attitudes and behaviors of both the athletes and clinicians who negotiate the identification and management of concussion injuries. It has further examined how such social relations influence the construction and dissemination of medical knowledge (in relation to concussion) and how an awareness of sociocultural factors can enhance our design and delivery of public health messages designed to reduce the incidence and health costs of this particular sports injury. Noting how the populations’ understanding of concussion is literally mediated through broader narratives of cultural representation reminds us of the interconnectedness of these apparently diverse social domains. Public perceptions, clinicians’ actions, and even medical consensus statements do not develop in a vacuum. This point underscores the ultimate promise of a sociocultural approach; to provide a more comprehensive and systematic understanding of what is clearly a complex medical and social problem.
The impact of a pressure ulcer prevention educational program based on the health belief model for persons with spinal cord injury
Published in The Journal of Spinal Cord Medicine, 2022
Natiara Mohamad Hashim, Julia Patrick Engkasan, Nazirah Hasnan
As a summary, based on the earlier discussion and aforementioned pitfalls, the education program lacked individualization in addressing problems unique to every participant.12 The duration of the education sessions was not sufficient to delve thoroughly into specific barriers especially during the sharing and practical sessions. As discussed above, there was difficulty maintaining homogeneity of information during the sharing session, as the 4 sessions were conducted separately with different participants present. While we also acknowledged the role of peers in delivering education,12 there was lack of standardization of peer-led support groups to ensure that the information aligned with the general medical consensus. Chronic SCI participants often adapted behaviors which conformed to and fulfilled their needs and lifestyles.25 Nonetheless, these methods may not follow or agree with conventional medical advice.
Post-concussion driving management among athletic trainers
Published in Brain Injury, 2019
Julianne D. Schmidt, Landon B. Lempke, Hannes Devos, Robert C. Lynall
Athletic trainers that never recommended that individuals with concussion refrain from driving endorsed several reasons. A majority had “never really given driving restrictions much thought” or selected that they had not begun the practice because “driving restrictions have not been emphasized in most publications and/or directives”. Post-concussion driving recommendations have not been emphasized in prior consensus or position statements regarding concussion management (13,14). Introducing evidence-based recommendations for managing post-concussion driving is necessary to garner medical consensus to guide the practices of ATs as well as other health-care providers. Given the potential dangers of post-concussion driving, research aimed at identifying deficits during on-road driving performance and when a patient is fit to safely drive is greatly needed.
Dimensions of Ethical Direct-to-Consumer Neurotechnologies
Published in AJOB Neuroscience, 2019
Previous commentators in the neuroethics literature have argued that validity and effectiveness are requirements for ethical neurotechnologies. Eaton and Illes (2007, 395), for instance, state that “[i]t is the duty of the company to introduce to the market only those products and services that have been fully validated and for which the […] efficacy [has] been corroborated by scientific and medical consensus.” While this requirement is certainly appropriate for technology that is intended for clinical applications, it is too strong for consumer products that the FDA has declined to regulate. In a market place in which consumers have access to all sorts of unvalidated goods and services, from Shake Weight (Consumer Research 2016) to psychics, it seems untenable to require that these consumer products adhere to the most rigorous validation criteria. However, this does not imply that consumers may be misled as to whether a product they consider buying is effective or has been validated. As such, rigorous standards of transparency with respect to the effectiveness (and safety) of any product should be met.