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Ambiguity, Entanglement, Equality
Full text linkI consider, tentatively, the possible contribution that De Beauvoir’s philosophical insights can bring to substantive equality jurisprudence, maybe also to jurisprudence in general. I focus mainly on De Beauvoir’s reflections on becoming, freedom, ambiguity and judgement, which are all interrelated. My contention is that the main thing that is lacking in how courts, and much of the scholarship on substantive equality, approach equality, is ambiguity. One might have expected that an approach that places difference at the centre of its analysis will have a sense of ambiguity, and of the impossibility of making grand claims. However, it seems to have turned out quite the opposite. Drawing on De Beauvoir and the extent to which substantive equality scholarship hasn’t relied on her insights, I contemplate the question whether and how ambiguity could come into the picture. I read entanglement alongside ambiguity to consider if, instead of relying so strongly on difference, substantive equality may benefit by entanglement as ‘a term which may gesture towards a relationship or set of social relationships that is complicated, ensnaring, in a tangle, but with also a human foldedness’ (Nuttal 2009:1). At the heart of entanglement lies for me an ambiguity that highlights the flaws in the certainty of one-dimensional grand narratives
Reasonable adjustments for people with learning disabilities under the care of mental health services: a scoping review.
Full text linkBackground: Reasonable adjustments are the removal of a barrier or the provision of an auxiliary aid to prevent people with any protected characteristic from being disadvantaged. They are required by the Equality Act 2010 and are needed to ensure the accessibility of health care for all patients, including people with learning disabilities. Although several studies have explained why reasonable adjustments may be needed in psychiatric care, there is little guidance on how this should be done, and which reasonable adjustments are most effective. The author’s aim was to perform a scoping review of the current research to identify which reasonable adjustments have been implemented and, if possible, which have the most positive outcomes.
Methods: PubMed, PsycINFO, EMBASE, and CINAHL were searched to obtain articles that met the inclusion criteria. The researcher screened the abstracts of the papers selected and extracted the data from each selected paper, supported by the project supervisor. Data was extracted on the methods, location of research, and study results. A six-step thematic analysis was performed.
Results: 17 articles from 2010 to 2024 were included. Thematic analysis carried out on these papers identified four themes: “Easy read,” “Psychosocial interventions,” “One size does not fit all,” and “Gaps in the evidence base.” Several promising reasonable adjustments were identified, including providing easy read clinic letters and leaflets, the involvement of caregivers in psychosocial interventions, the use of roleplay as a teaching device, and an increased number of CBT sessions. Several barriers to the implementation of reasonable adjustments have been identified. Often, there is little guidance on how to adapt existing treatments for people with learning disabilities, and many studies highlighted that management was not encouraging reasonable adjustments or supporting the clinicians that were implementing them.
Conclusions: Overall, the most effective reasonable adjustment is likely the inclusion of caregivers in psychosocial interventions. However, there are several limitations to this, such as the lack of other studies assessing reasonable adjustments individually and only a few studies measuring the effect of reasonable adjustments on clinical outcomes. Some reasonable adjustments have been implemented, and many are being piloted. However, most are only being suggested or are being implemented on an individual level rather than on an organisation level, with adjustments for everyone using the service. For research on this topic to improve, more quantitative studies on the effects of reasonable adjustments are required, and comparative studies between reasonable adjustments will help to determine which is the most effective
The widening gap: A service evaluation to map the treatment pathway of 100 consecutive patients diagnosed with breast cancer between August and July 2023 to investigate potential treatment disparities in BAME patients at A Secondary Care Breast Unit.
Full text linkBackground: The UK has an 18% BAME (Black, Asian and Ethnic Minority) population, 4% identify as Black, Black British, Black Welsh, Caribbean or African (Diversity UK, 2023). This group makes up a small proportion of the population, yet significant disparities exist in incidence and mortality rates between ethnic communities and their White counterparts (Yedjou et al., 2019). People from BAME groups tend to have lower uptake of breast cancer (BC) screening compared to the White population (Jack et al., 2014). The United Kingdom's healthcare system, the National Health Service (NHS), is government-funded and should provide equitable care to the service users (GOV.UK, 2023). The evidence of racial and ethnic disparities highlights the need for alterations in the current provision of NHS services. This project aimed to address any racial disparity in the treatment of BC and suggests reasonable accommodations based on found modifiable variables and those stated in the literature.
Methods: This study used a quantitative ex-post-facto method consisting of a service evaluation and literature review to examine the correlational factors associated with racial disparity in the outcomes of Black women (BW) with BC compared to White women with BC (WW). Non-probability sampling was used to gather 100 patients diagnosed with invasive BC between August and July 2023. Patient data regarding race, age, tumour characteristics, diagnostic imaging and initial treatment were collected. Patients’ self-reported race was used to separate patients into two groups: White and BAME. Data was collected from cancer databases at a secondary care Trust and was analysed using descriptive analytics.
Results: This service evaluation found a 3-day difference in the average diagnostic interval between the two patient groups. Both groups did not reach the 31-day target set out by NHS Cancer Waiting Times (2023). Specific patient characteristics, such as age at diagnosis, were compared between the same groups. This data showed that there was a difference in the diagnostic interval depending on what type of initial treatment the patient was having; the fastest was endocrine treatment with an average 23-day wait, and the longest was systemic anti-cancer treatment (SACT) with a 41.7 day wait from diagnosis to first treatment appointment.
Conclusions: This service evaluation did find a disparity between the diagnostic intervals of the White group and the BAME group. This suggested that a systematic issue or racial bias may be present in the diagnostic or treatment pathway, which could explain the results. However, this study had limitations, such as the small sample size of the BAME group. Therefore, results cannot be reliably extrapolated to settings outside this study
Does annual surveillance mammography for B3 ‘indeterminate’ lesions detect early recurrent disease after treatment: An audit of 5 years of practice at Maidstone and Tunbridge Wells NHS Trust.
Full text linkBackground: This clinical audit aimed to review the management of indeterminate (B3) breast lesions. Current UK and European guidelines recommend that B3 lesions should be removed via vacuum assisted excision (VAE) and entered into a 5-year surveillance pathway if cellular atypia is diagnosed. Previously, these lesions had been managed by surgical excision without surveillance.
Methods: Fifty patients with B3 lesions at a single NHS Acute Trust were retrospectively identified and followed for 5 years.
Results: Of the 50 patients assessed, 28 were managed surgically and 22 were managed via VAE. One patient incurred a recurrence of malignant disease which was discovered via surveillance which equates to 5% of the B3 with atypia cohort. The rate of cancer detection in the NHS national breast screening programme in 2020-2021 was 0.91%.
Conclusions: This audit therefore supports the current surveillance protocol and suggest that B3 patients are at increased risk of malignancy when compared to the average population. Future work will be needed to statistically confirm this observation in a larger study to enable comparisons between the surgically and VAE managed patients
How can critical and feminist scholars respond to the decision in 'For Women Scotland'?
Full text linkEditorial introduction to the special section on Interrogating 'For Women Scotland v The Scottish Ministers
Current research on Patient-Reported Outcome Measures (PROMs): A Scoping Review
Full text linkBackground: Patient- reported outcome measures (‘PROMs’), a quality-of-life reporting tool, is routinely used pre- and post-operatively over a vast array of medical and surgical specialities. Current research is highly specific for total knee and/or total hip arthroplasty, many of which are country specific. There is very little research into the true challenges and benefits of PROMs use in elective orthopaedic surgery on a generalised global scale. This scoping review was completed to determine these benefits and challenges, among other areas, and to provide recommendations for future practice.
Methods: The PRISMA Extension for Scoping Review (PRISMA-ScR) checklist was utilised for this scoping review. The initials steps identified key words and their relevant synonyms, which were combined with Boolean Operators, producing a vast array of journal articles across three databases. The articles were rigorously reviewed against eligibility criteria, and the final papers put through a 6-step process to generate major and minor themes in a thematic analysis ensuring all data was extracted.
Results: A total of 892 journal articles were discovered from the keyword search string across three data sites. These articles were filtered against the inclusion and exclusion criteria from which 7 final papers were included in this scoping review. The inclusion criteria consisted of papers that were published in English, within the last ten years and papers relating to PROMs data from orthopaedics specifically, among others.
The exclusion criteria included papers which were systematic reviews or pilot review, papers published for a specific country and papers focussing on a specific patient subgroup, alongside other criteria.
The majority of the papers were published around 2020, but there was a vast array of article genres with no clear predominance. These papers included randomised control trials and narrative reviews, among others.
The final 7 papers were coded, from which major and minor themes were drawn. The major themes in the final scoping review are the application of PROMs, PROMs in the digital age and PROMs on a global scale. The two aforementioned major themes were further explored with 4 minor themes each.
Conclusions: This scoping review examined the current global and generalised literature on PROMs, an area which has expanded in research. Three major themes were identified, which included the application of PROMS, PROMs in the digital age and finally PROMS on a global scale. The application of PROMs and PROMS in a digital age were further expanded with four minor themes each. The papers found several benefits, challenges and patient and clinician engagement factors when applying PROMs to practice. For example, the shortened versions of PROMS which have been designed to increase completion and engagement from patients. The digital era of PROMs was examined, yielding results which highlighted the status of electronic PROMS (e-PROMs) and their benefits, challenges and future steps. The international standpoint for PROMs integration requires further investigation as there was limited information presented. Ultimately, the research surrounding PROMs is vital to the current shift in medical practice whereby patients and their experiences are the focus, and prospective studies should draw on conclusions in published literature to further their development and integration.
Keywords: Elective Orthopaedic Surgery | Patient Reported Outcome Measure
The Emergence of AI-Generated Deepfakes as a New Tool for Gender-Based Violence Against Women: A Brief Narrative Review of Evidence and the Implications of the Techno-Feminist Perspective
Full text linkTechnology facilitates crime. Perpetrators use technology to commit new crimes or old crimes in new ways. The advancement of technology has spawned several cybersexual crimes that affect women disproportionately. The emergence of deepfakes has brought a new dimension to women’s cyber sexual victimization. There is little empirical research on deepfakes and women’s sexual abuse. Therefore, for this comment piece we reviewed existing peer-reviewed articles and data from websites to show that deepfakes have become a new tool for gender-based violence against women. We use a techno-feminist perspective to argue that deepfake technology is an addition to the tools that are used to form a patriarchal-capitalist society. Like other cybercrimes, cybercrimes using deepfakes affect women disproportionately and deepfakes have become a tool to control and subjugate women. Also, we contend that techno-feminism has ignored the masculine aspects of new technologies. There is a need for more research on the role of deepfake technology in women’s sexual abuse to prevent gender-based violence against women
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