1,720,993 research outputs found
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
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
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 textDealing 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
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
Psychiatry 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
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
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