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Biomedical subjects

J Spiers

Publications and source records attributed to J Spiers.

9 recordsLinked to original sources
PubMed2000

New perspectives on vulnerability using emic and etic approaches.

New perspectives on vulnerability using emic and etic approaches The concept of vulnerability has not been developed theoretically from a nursing perspective. It has been viewed epidemiologically as population-based relative risk with little consideration of its experiential qualities. The purpose of this paper is to analyse critically the use of the term vulnerability using elements of concept clarification and a critical literature review. A new perspective of vulnerability is offered based on differentiating between the concepts of risk and experience. Risk consists of assumptions from etic or external evaluation of relative danger while lived experience informs an emic or personal interpretation. Assumptions related to the etic view include normative social values, objective harm and endangerment, and social sanction for intervention. An emic view of vulnerability is based on experiential perception of challenge to personal integrity and the universal and mutual nature of the phenomenon. Questions about the evaluation of harm, potential for growth, subjectivity and objectivity, social sanction and capacity for action, can help clarify the range between these two dimensions.

Anthropology, Cultural↗
PubMed1996

Three's a crowd.

Where do patients' rising expectations fit into the purchaser/provider relationship? John Spiers, Harry Burns and Michael Richards look at this question from a patient, purchase, and provider perspective.

Health Care Rationing↗
PubMed1996

A phase II study in advanced breast cancer: ZD1694 ('Tomudex') a novel direct and specific thymidylate synthase inhibitor.

ZD1694 ('Tomudex'), a novel, direct and specific thymidylate synthase (TS) inhibitor, was developed in a collaborative research programme between Zeneca Pharmaceuticals and the Institute of Cancer Research (UK) and entered clinical trials in 1991; phase II studies began in 1992, using 3.0 mg m-2 every 3 weeks as a short 15 min infusion. Forty-six patients entered a phase II study of ZD1694 in advanced breast cancer. A total of 74% of patients had received prior systemic therapy (either as adjuvant cytotoxic or hormonal therapy or hormone therapy for advanced disease); 39% had received prior adjuvant cytotoxic chemotherapy. All patients had measurable disease and 50% had liver metastases. In all 43 patients were evaluable for response. Of these patients 26% achieved complete (CR) or partial response (PR) (95% Cl 14-42%). A response rate of 44% was seen in liver metastases. Two patients achieved CR of 265 and 301 days' duration respectively, one in locoregional disease, and one in liver metastases. The most common grade 3/4 adverse events were nausea and vomiting (11%), diarrhoea (11%) and leucopenia (20%). Grade 3/4, self-limited and reversible increases in transaminases were seen in 22% of patients. ZD1694 has useful single agent activity in patients with hormone-refractory advanced breast cancer, comparable with that reported for other anti-metabolites, with acceptable tolerability.

Adult↗
PubMed1996

The invisible hospital--or, what patients experience but managers often don't see.

This paper is an extract from The Invisible Hospital and the Secret Garden--an Insider's Commentary on NHS Reforms and is based on a paper presented at The Royal Society of Medicine in London on 11 April 1994. The author discusses the need to identify the invisible hospital--what patients experience but managers often don't see--through Non-Executive Directors, for it is perhaps only they, he maintains, who, if more active and influential, can fulfill the potential of the reforms to change it. In addition to justifying the author's (now widely-discussed) visit to a hospital as a wheelchair patient, the paper is drawn primarily from Mr. Spier's own experience of Chairman of Brighton Health Care NHS Trust and the implementation--or not--of his own initiatives.

Hospital Administrators↗
PubMedDate not supplied

"Lose not an hour": patient decision-making and improving quality services through the prism of renal care.

This paper will discuss the scarcest resource in the world--the days of people's lives. And how to help all to live to the fullest. There is some room, of course, for patients and professionals to disagree. Sometimes there might be too much emphasis on the professional view. Disagree? Well, we should remember that though the "Titanic" was built by professionals, the "Ark" was built by amateurs! Society needs to find new answers for empowering patient decision making about the quantity, quality and access to care. Without changes in financial structures there is little prospect of empowering patients to make decisions for themselves and empowering professionals to do the job as they hope to do it.

Decision Making↗