1,721,136 research outputs found
Negotiating palliative care expertise in the medical world
No full textThis paper explores the relationship between palliative medicine and the wider medical world. It draws on data from a focus group study in which doctors from a range of specialties talked about developing palliative care for patients with heart failure. In outlining views of the organisation of care, participants engaged in a process of negotiation about the roles and expertise of their own, and other, specialties. Our analysis considers the expertise of palliative medicine with reference to its technical and indeterminate components. It shows how these are used to promote and challenge boundaries between medical specialities and with nursing. The boundaries constructed on palliative medicine's technical contribution to care are regarded as particularly coherent within orthodox medicine. In contrast, its indeterminate expertise, represented by the ‘holistic’ and ‘psychosocial’ agendas, is potentially compromising in a medical world that prizes science and rationality. We show how the coherence of both kinds of expertise is contested by moves to extend palliative care beyond its traditional temporal (end-of-life) and pathological (cancer) fields of practice
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Sugar industry influence on the scientific agenda of the National Institute of Dental Research's 1971 National Caries Program: a historical analysis of internal documents.
Full text linkIn 1966, the National Institute of Dental Research (NIDR) began planning a targeted research program to identify interventions for widespread application to eradicate dental caries (tooth decay) within a decade. In 1971, the NIDR launched the National Caries Program (NCP). The objective of this paper is to explore the sugar industry's interaction with the NIDR to alter the research priorities of the NIDR NCP.We used internal cane and beet sugar industry documents from 1959 to 1971 to analyze industry actions related to setting research priorities for the NCP. The sugar industry could not deny the role of sucrose in dental caries given the scientific evidence. They therefore adopted a strategy to deflect attention to public health interventions that would reduce the harms of sugar consumption rather than restricting intake. Industry tactics included the following: funding research in collaboration with allied food industries on enzymes to break up dental plaque and a vaccine against tooth decay with questionable potential for widespread application, cultivation of relationships with the NIDR leadership, consulting of members on an NIDR expert panel, and submission of a report to the NIDR that became the foundation of the first request for proposals issued for the NCP. Seventy-eight percent of the sugar industry submission was incorporated into the NIDR's call for research applications. Research that could have been harmful to sugar industry interests was omitted from priorities identified at the launch of the NCP. Limitations are that this analysis relies on one source of sugar industry documents and that we could not interview key actors.The NCP was a missed opportunity to develop a scientific understanding of how to restrict sugar consumption to prevent tooth decay. A key factor was the alignment of research agendas between the NIDR and the sugar industry. This historical example illustrates how industry protects itself from potentially damaging research, which can inform policy makers today. Industry opposition to current policy proposals-including a World Health Organization guideline on sugars proposed in 2014 and changes to the nutrition facts panel on packaged food in the US proposed in 2014 by the US Food and Drug Administration-should be carefully scrutinized to ensure that industry interests do not supersede public health goals
Patients' and nurses' views of nurse-led heart failure clinics in general practice: a qualitative study
No full textObjectives: To ascertain nurses' and patients' views and experiences of a nurse-led heart failure clinic provided in general practice. Methods: The study was set in eight general practices in the North-West of England. Semi-structured interviews were devised and administered, with all the nurses providing the clinics and a purposive sample of patients attending the clinics. The interviews were tape-recorded and transcribed. Constant comparative analysis was used to identify key issues and themes. Results: Nurses felt that the self-care advice provided had empowered patients to manage their condition. Explaining why a medication had been prescribed, and how it controlled heart failure, was felt to increase compliance. Although communication was deemed good, some patients were reticent about asking questions. Patients were knowledgeable about their prescribed heart failure medications, but some did not recall having discussed their medications. Also, medication inserts led some patients to question their prescription. Patients remained confused about the purpose and outcome of investigations. Furthermore, many patients suggested that they had problems adhering to or remembering the advice given. Discussion: There are practical benefits to be obtained from attending a nurse-led heart failure clinic in primary care. However, patients and healthcare providers may have quite divergent views about such a service and its benefits, emphasizing the potential value of consumer involvement and feedback when developing and delivering such services
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
A better understanding of recent coronary heart disease mortality trends and determinants
No full textIntroduction
Coronary heart disease (CHD) is one of the leading global causes of morbidity and mortality. The underlying biological mechanisms are well understood, and a host of causal risk factors for the disease have been identified, mainly related to diet, smoking and physical activity. Evidence-based treatments for the disease are also available, reducing mortality and improving quality of life.
The decline in CHD mortality rates observed in most developed countries since the 1960s represents a most remarkable epidemiological phenomenon. However, this decline is not universal, and may now be in jeopardy. Thus, the mortality decline has recently plateaued in young adults in the United States. Furthermore, the absolute burden of disease is set to increase mainly because of an increasingly ageing population, and will represent a heavy burden to high, middle and low income countries alike. Furthermore, CHD incidence may rise in future because of recent adverse trends in major CHD risk factors, namely the worldwide increases in obesity and diabetes prevalence observed since the 1980s. Moreover, new technology and improved treatments are decreasing case fatality in CHD patients, increasing life expectancy and thus expanding the pool of patients surviving with clinically apparent disease. Finally, and crucially, important socioeconomic inequalities persist, perhaps reflecting disease determinants. The complex interplay of these factors and potential changes over time together suggest that the CHD epidemic may still be evolving. Further attention is therefore essential.
The analysis of time trends in disease specific mortality can thus potentially help us to understand the population dynamic of diseases such as CHD, warn about key changes and perhaps offer some novel insights for better prevention and control. However, most previous analyses have been focused on age-adjusted rates that might conceal important differences by age or by socioeconomic status, which might provide further understanding of trend drivers.
Aims and objectives:
My aim is to study recent coronary heart disease mortality time trends in different countries, in order to better understand the current state of the CHD epidemic. Furthermore, I will analyze the relative importance of CHD treatments and risk factors as drivers of the mortality trends. Finally, I will consider the Public Health implications of my findings.
My objectives therefore are:
1. To summarize our current understanding of Coronary Heart Disease (CHD) causation
2. To describe recent CHD mortality time trends focusing on age and gender specific trends by identifying periods with similar rate of change in diverse populations (England & Wales, the Netherlands, Poland and Australia).
3. To describe recent CHD mortality time trends by Socio-Economic Status in England and Scotland.
4. To quantify the role of risk factors and evidence-based treatments as drivers of the CHD mortality trends, first using a modelling approach in Poland, and then in England while also considering socioeconomic factors.
5. To consider the public health policy implications of dynamic trends in coronary heart disease mortality.
Methods
CHD mortality trends were analysed using the joinpoint regression approach. Widely used in cancer epidemiology, but rarely in CHD, this method explores trend data to find points in time (“joinpoints”) that define segments where the trend has a constant pace of change. The key strength of this technique is objectivity- (it avoids the detection of potentially biased patterns when trends are described using time intervals defined subjectively by the researcher). Joinpoint avoids this potential bias by essentially removing the observer from the selection process, instead using a formal and objective exploration of the time-series data. My analysis therefore focused on age-adjusted rates, then age and gender specific rates. The analysis for Scotland and England also considered socio-economic status (using area-based measures of material deprivation).
The contributions of risk factors and treatments to the observed CHJD mortality trends in Poland were studied using the IMPACT model, a comprehensive, population-based model of CHD epidemiology. The model goal is to quantify the decline in coronary heart disease deaths in the Polish population between 1991 and 2005 which might be explained by risk factor changes and by treatments. The model is comprehensive, incorporating all usual treatments for coronary heart disease and heart failure plus all major cardiovascular risk factors, including smoking, blood pressure, cholesterol, diabetes, obesity and physical activity.
Similar analyses but also exploring the socio-economic differences were conducted in England, using a modified IMPACT model (IMPACTsec). That was used to estimate the contribution of risk factors and evidence based treatments to the observed decline in mortality in England between 2000 and 2007, for each quintile of the index of multiple deprivation.
Results
Age-adjusted trends in England and Wales, Scotland, Australia and the Netherlands conceal important recent age specific patterns. In these countries, the age-adjusted rates show continuing declines; however, among young adults a recent period of slowing down of the rate of decline in CHD mortality has been observed. Furthermore, trends are very dynamic, and the patterns can change surprisingly quickly. In the Netherlands, the sustained period of minimal change in young adults was followed by a period of further decline. Poland offers a strikingly different example of trend dynamism. After a period of constant increase, Poland showed a sudden, sharp decline in CHD mortality rates within a period of a very few years. This decline occurred in all age and gender groups, and still continues.
The recent mortality trends are probably attributable more to changes in risk factors rather than medical treatments. For example, using the IMPACT model to study the decline phase of the Polish CHD epidemic, approximately 55% of the observed fall in mortality might be attributed to changes in risk factors, and only about a third to evidence based therapies.
Because of the social patterning of risk factors levels, further insights on the role of risk factors as major contributors to trend changes can be obtained by studying trends in levels stratified by socioeconomic circumstances. Scotland and England offer particular opportunities for detailed studies of trends in CHD mortality using high quality data including socioeconomic status. The resulting picture is complex. The recent flattening in CHD mortality trends observed in young adults was confined to the most deprived groups in Scotland, but was more uniform in England. A marked deterioration of medical care is implausible, meaning that the most likely explanation for this recent flattening of CHD mortality must be adverse trends in major cardiovascular risk factors.
The CHD mortality modelling in England produced intriguing results. As expected, socio-economic patterning of risk factor changes were observed. For example, decline in smoking levels contributed more to the observed decline amongst the more deprived groups. Social patterning was less clear among young adults in England. Moreover, the IMPACT SEC model analysis suggested that approximately half the CHD mortality fall was attributable to improved treatment uptake, with benefits occurring surprisingly equitably across all social groups. A similar analysis of the Scottish trends is therefore urgently needed to gain better insights on the drivers of the socioeconomic patterning underlying the observed trends.
Conclusions
The recent flattening in CHD mortality in young adults seen in many countries experiencing an overall decline in deaths strongly suggests that favourable trends can reverse. Furthermore, the rapid reversal observed in some age groups in the Netherlands and in the entire population in Poland suggests that recovery can occur very quickly.
These rapid mortality changes have been observed in many countries and cannot easily be dismissed as artefact. There is a strong case to mainly attribute these trends to changes in cardiovascular risk factors, since marked deterioration of medical care in these affluent countries appears implausible. This interpretation is also consistent with evidence from the rapid risk reductions observed in randomised drug and diet trials. Furthermore, several populations experienced “natural experiments” when socio-economic events producing beneficial effects on cardiovascular risk factors were rapidly followed by dramatic changes in CHD mortality.
These rapid mortality changes challenge some aspects of our current understanding of CHD causation. Specifically that the temporal relationship between changes in risk factors and changes in fatal outcomes are probably operating over much shorter timescales than previously assumed, within a few years rather than decades.
The public health implications of these findings are thus clear: large changes in CHD burden can be achieved quickly, probably reflecting trends in dietary and other cardiovascular risk factors. Population level prevention interventions might therefore be both powerful and rapid
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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