9,082 research outputs found
Computers and the general practice consultation
No full textThe introduction of desktop computing into primary healthcare over the past 30 years has been founded on the assumption that it would be accompanied by a clearly demonstrable benefit both to direct patient care, and to the development of administrative systems. While advances in primary care administration may be related to computerization, the evidence for improvements in direct patient care is more mixed. In this paper we critically discuss issues raised by the existing research literature in primary care computing, and especially note the difficulties posed by the absence of portable generic electronic patient records
The benefits of back pain
No full textBackground: Chronic lower back pain (CLBP), without definable cause, is a symptom commonly presented to GPs, accounting for a significant proportion of their workload; it is also a common reason for sickness absence, and thus of national economic importance. Objectives: This qualitative study aims to explore how sufferers of CLBP describe their pain and its impact on their lives, and how their problem is dealt with in the consultation with their family doctor. Method: Semi-structured interviews were carried out with a sample of attenders at a back pain clinic set up in general practice. Transcription and analysis was carried out using a grounded-theory approach. Results: Sufferers of CLBP describe withdrawal from normal social obligations, including work. They view their GP as being unable to help and, because of this, the doctor becomes a resource through which their social and economic inactivity can be legitimated. Conclusions: Presenting with CLBP permits the patient a good deal of power over the GP: it is difficult for the GP to challenge the patient's ideas without damaging the relationship. GPs are forced to collude with the patient's definition of ill-health, which may not be in the best interests of the patient or society
Comptonization of the cosmic microwave background by relativistic plasma
No full textWe investigate the spectral distortion of the cosmic microwave background (CMB) caused by relativistic plasma. Within the Thomson regime, an exact analytic expression for the photon scattering kernel of a momentum power-law electron distribution is given. The ultra-relativistic Sunyaev-Zeldovich (SZ) decrement measures the electron number and not the energy content. On the other hand, the relativistic SZ increment at higher frequencies depends strongly on the spectral shape of the electrons. We calculate the expected Comptonization due to the energy release of radio galaxies, which we estimate to be 3 × 1066 erg Gpc-3. We investigate Comptonization from (a) the part of the released energy which is thermalized and (b) the relativistic, remnant radio plasma, which may form a second, relativistic phase in the inter galactic medium, nearly unobservable for present day instruments (presence of so called 'radio ghosts'). We find a thermal Comptonization parameter due to (a) of y = 10-6 and (b) an optical depth of relativistic electrons in old radio plasma of τrel < 10-7. If a substantial fraction of the volume of clusters of galaxies is filled with such old radio plasma the SZ effect based determination of the Hubble constant is biased to lower values. Finally, it is shown that a supra-thermal population of electrons in the Coma cluster would produce a signature in the Wien-tail of the CMB, which is marginally detectable with a multifrequency measurement by the Planck satellite. Such a population is expected to exist, since its bremsstrahlung would explain Coma's recently reported high energy X-ray excess
Dealing with doubt how patients account for non-specific chronic low back pain
No full textObjective: To explore the ways that persons with long standing chronic low back pain respond to the problem of medical doubt about the presence of organic pathology.Method: Qualitative analysis of accounts provided by 12 persons attending a back pain rehabilitation clinic in NW England.Results: Subjects rejected the notion that they were culpable for their pain. They were not culpable for the onset of their pain. They argued that despite their cooperation, no sensible explanation of their pain was forthcoming from health professionals. Finally, they asserted that medical scepticism had been damaging and dispiriting.Conclusion: Patients dealt with clinical doubt by stressing their own expertise. They constituted their beliefs about the cause and trajectory of their pain and disability as accurate accounts of their disability. They resisted the suggestion that there might be psychological factors involved in their ill-health by locating culpability among clinicians, who were confused or uncertain about diagnosis and treatment.<br/
The burden of depression in primary care: a qualitative investigation of general practitioners' constructs of depressed people in the inner city
No full textDepression is a common problem, often being recurrent or becoming chronic. It has been stated that people with depression should continue to be predominantly managed in primary care. There is much evidence to suggest that the detection and management of depression by general practitioners (GPs) could be improved, but little work has focused on GPs' views on their work with depressed patients. This was a qualitative study exploring GPs' attitudes to the management of patients with depression. Semi-structured interviews were conducted with 22 GPs in north-west England. These GPs were practising in urban or inner-city areas and were all based in practices that participated in undergraduate teaching. The interviews were audiotaped and subsequently transcribed. Analysis was by constant comparison until category saturation was achieved. The subjects conceptualized depression as an everyday problem of practice rather than as an objective diagnostic category. Thematic coding of their accounts suggested a tension between three kinds of views of depressed people, namely (1) that depression is a common and normal response to socioeconomic disadvantage and that it reflects the medicalization of these conditions, (2) that the diagnosis of depression offers a degree of secondary gain to both patients and doctors and (3) that GPs experienced depressed people as an intractable interactional problem. It was concluded that depression is commonly presented to GPs who feel that its diagnosis often involves the separation of a normal reaction to a harsh environment and true illness. In addition, they felt ill-equipped to deal with the long-term management of such patients. They doubted that anything therapeutic occurs in review consultations with such patients. This has an important implication for the construction of educational interventions around improving the recognition and treatment of depression in primary care: doctors may be reluctant to recognize and respond to such patients in depth because of the much wider structural and social factors that we have suggested in this paper
Exploring community healthcare staff experiences of current screening and treatment practices for malnutrition – Baseline survey results from the Implementing Nutrition Screening in Community Care for Older People (INSCCOPe) process evaluation project
No full textPsychiatry by videophone: a trial service in North West England
No full textIn this paper we report on the use of a video link between two general practices and a hospital based mental health team in North West England to provide a trial telepsychiatry service for individuals with depression and anxiety related disorders. Patients (n = 16) took part in an evaluation of the service by both structured questionnaire and semi-structured interview. The results of the evaluation study suggest that patients may be highly critical of telemedicine systems and that they do so not simply on the grounds of the technical quality of video links, but also because the remote link increases the difficulty that the patient faces in expressing deep seated emotional and existential problems. It is not, therefore, simply a matter of technical quality in the link, but also a question of the quality of interpersonal relations perceived by the patient
Cercando di dimenticare Savigny
No full textIl presente scritto è un contributo alla discussione del libro di Aurelio Gentili, Il
diritto come discorso del 2013. Del predetto volume si approvano senza riserve
a) la critica alla concezione del vecchio positivismo, secondo il quale il giurista
non farebbe altro che esplorare un misterioso oggetto denominato “realtà
giuridica”, e b) l’interesse per le tecniche argomentative quali strumenti di
controllo interno dei discorsi. Sul piano propositivo, l’autore della recensione
ammette che la conoscenza dei significati normativi letterali, quando la si
ritiene rilevante, comporta a livello collettivo (ma assai meno al livello dei
singoli) un giudizio partecipante. Tali significati, del resto, lungi dall’essere
entità fisse, sono sempre in movimento. Ciò stabilito e con questi limiti,
occorre ammettere che non c’è solo un ordo ordinans imposto dai giuristi sui
confusi materiali estratti dalle fonti, ma si può scorgere, e si deve ritrovare,
anche un ordo ordinatus, frutto tanto dell’attività legislativa quanto delle precedenti interpretazioni, che il singolo interprete non può far a meno di
riconoscere. Insomma: tra i due ordini, fra le attività dei giuristi e i prodotti di
tali attività, si stabilisce un rapporto dialettico.This article is a contribution to the discussion regarding Aurelio Gentili’s 2013
book Il diritto come discorso. From the said volume, the author fully approves:
a) the criticism of the old positivism’s conception that a lawyer does nothing
but explore the misterious object that is “legal reality”, and b) the interest in
argumentative techniques as instruments for internal control of discourses. The
author of this article proposes admitting that the knowledge of literal normative
meanings, when believed to be relevant, requires at the level of the collective
(much less so at the individual level) a judgment, which demonstrates
participation. These meanings are, moreover, far from being fixed entities,
always changing. Within these limits, it should be admitted that there is not
only an ordo ordinans, made by the jurists, using the confused materials
extracted from the sources, but that we may also observe, and must rediscover,
an ordo ordinatus, which results from both legislative activity and previous
interpretations – that an individual interpreter cannot but recognize. In short, a
dialectic relationship between the two orders, between the activity of lawyers
and the products of these activities, is thus established
Solar sail mission applications and future advancement
No full textSolar sailing has long been envisaged as an enabling technology. The promise of open-ended missions allows consideration of radically new trajectories and the delivery of spacecraft to previously unreachable or unsustainable observation outposts. A mission catalogue is presented of an extensive range of potential solar sail applications, allowing identification of the key features of missions which are enabled, or significantly enhance, through solar sail propulsion. Through these considerations a solar sail application-pull technology development roadmap is established, using each mission as a technology stepping-stone to the next. Having identified and developed a solar sail application-pull technology development roadmap, this is incorporated into a new vision for solar sailing. The development of new technologies, especially for space applications, is high-risk. The advancement difficulty of low technology readiness level research is typically underestimated due to a lack of recognition of the advancement degree of difficulty scale. Recognising the currently low technology readiness level of traditional solar sailing concepts, along with their high advancement degree of difficulty and a lack of near-term applications a new vision for solar sailing is presented which increases the technology readiness level and reduces the advancement degree of difficulty of solar sailing. Just as the basic principles of solar sailing are not new, they have also been long proven and utilised in spacecraft as a low-risk, high-return limited-capability propulsion system. It is therefore proposed that this significant heritage be used to enable rapid, near-term solar sail future advancement through coupling currently mature solar sail, and other, technologies with current solar sail technology developments. As such the near-term technology readiness level of traditional solar sailing is increased, while simultaneously reducing the advancement degree of difficulty along the solar sail application-pull technology development roadmap
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