China
Africa
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Patients as Ethnographers*
Published in John Launer, Reflective Practice in Medicine and Multi-Professional Healthcare, 2022
Our imaginary research study was brief, highly selective, and had many obvious limitations, including the fact that we were both known by almost everyone to be doctors. At the same time, I suggest that clinical units or hospitals might want to use the idea as the basis for a more formal project: namely to invite patients to keep written observations on the human activity around them, if their health permitted and they were willing to do so. Participants would need guidance on how to record these observations in a way that was descriptive rather than judgemental, and lead to useful interpretation rather than complaints. Formalising such a study would also require considerable ethical and legal safeguards. Assuming these could be set up, however, our own experience indicates that patient-led ethnography could be a rich source of information for improving healthcare.
Model Checking in Meta-Analysis
Published in Christopher H. Schmid, Theo Stijnen, Ian R. White, Handbook of Meta-Analysis, 2020
Finally, it is important to examine whether one or more studies exert a disproportionally large influence on the conclusions of a meta-analysis. If we find that certain findings hinge on only one or two studies being present in our dataset, then this may call into question the robustness of the findings, in which case the corresponding conclusions should be framed more cautiously. An important tool in this context is to examine how the removal of studies from the dataset would alter the results. We will therefore consider a variety of diagnostic measures on the basis of this idea.
Psychiatric Disorders
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
The diagnostic process in psychiatry generally begins with the psychiatric interview. Similar to any other medical interview or the process of taking a medical history, the objective is to gather the information needed for an accurate diagnosis and the determination of effective treatment. Questioning, however, usually takes an open-ended approach, eliciting from the patient those aspects that seem relevant, since the relationship of ideas and events may have some bearing on diagnosis. Included in the interview is a careful history, but the focus is primarily on the psychiatric difficulty and the symptoms it expresses. Care should be taken to avoid many of the medical terms of psychiatry or to use them in the sense that the patient may (mis)understand, since the terminology is broadly used in society with sometimes very different meanings than in medicine.
What an IDEA! Inclusion, Diversity, Equity, and Access in the Spinal Cord Injury Community
Published in The Journal of Spinal Cord Medicine, 2022
Ellia Ciammaichella, Samantha Harfenist, Sigmund Hough, Jeffrey Jaramillo, Katharine Tam, Florian P. Thomas, Jillian Walker
The purpose of the IDEA Committee is to: Ensure awareness and advocacy, education, and scholarship related to IDEA within ASCIP’s activities, operations, policies, communications, services, products, research, and outcome measures;Establish an organizational culture where IDEA are understood, agreed upon, respected, and applied to enhance opportunities for learning and self-growth; andDevelop and make available pragmatic and pioneering strategies that assist in the realization of the mission statement.In alignment with the IDEA Committee’s purpose to increase awareness and to encourage meaningful change in diversity, equity, and inclusion (DEI) as it relates to SCI/D as IDEA, the IDEA Committee is also tasked with granting an award to collaborator(s) who are working toward incorporating IDEA through scholarly work. The goal is to highlight the voices of professionals who are focused on incorporating IDEA into SCI/D patient care and to spotlight changes that are needed to ensure health equity and access. Proposals for the IDEA award are considered when an abstract for the annual ASCIP conference is submitted by the abstract deadline and marked for consideration for the IDEA award.
Lifecycle evidence requirements for high-risk implantable medical devices: a European perspective
Published in Expert Review of Medical Devices, 2020
Rosanna Tarricone, Oriana Ciani, Aleksandra Torbica, Werner Brouwer, Georges Chaloutsos, Michael F Drummond, Nicolas Martelli, Ulf Persson, Reiner Leidl, Les Levin, Laura Sampietro-Colom, Rod S Taylor
Different approaches have been proposed, and in some cases endorsed, by regulatory bodies. This is the case, for instance, of the Total-Product-Life-Cycle (TPLC) by the US Food and Drug Administration (FDA) [17] that combines data from various Center for Devices and Radiological Health (CDRH) databases to present an integrated record of premarket and post-market activity for MDs. The main disadvantage of the TPLC approach is that it encourages linearity on our thinking, in that it portrays a series of steps in product development, in a particular order, each requiring a particular type of clinical evidence. This approach works fairly well as a model for pharmaceutical product development, but the development of MDs is often more unpredictable. For example, it is possible for MDs to enter into regular clinical practice with relatively little clinical evidence, the evidence being predominantly gained through actual use of the device in clinical practice [18], as opposed to a research setting [19,20]. The adaptation of the IDEAL (Idea, Development, Exploration, Assessment, Long term study) framework to medical devices [21] is another attempt to inform a continuous evidence generation for devices although the proposal is awaiting empirical implementation and fuller consideration by regulatory and HTA bodies.
Minor Patient, Major Decisions: Caring for a Rural Child With Gender Dysphoria
Published in The American Journal of Bioethics, 2019
Seth desperately wants to take gender-affirming hormones, especially as puberty is starting (he is currently in Tanner stage II). His pediatrician, Dr. Walker, is open to the idea, but does not feel comfortable prescribing such medication herself. A pediatric endocrinologist from the children’s hospital 150 miles away comes to a satellite clinic in Hilltop twice a month. Seth has seen him a few times, and Dr. Jessup has consistently refused to prescribe hormone blockers to aid in puberty suppression, instead suggesting Seth see a therapist. Seth’s parents had been trying to find time to take him to the main children’s hospital campus for a second opinion when they heard that a new pediatric endocrinologist had taken over half of Dr. Jessup’s visits to Hilltop. They took Seth to see him, and Dr. Nash agreed that hormone blockers were appropriate for Seth.