Changing social relationships.
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Anorexia Nervosa↗
Biomedical subjects
N J Fox
Publications and source records attributed to N J Fox.
The 'expert patient': empowerment or medical dominance? The case of weight loss, pharmaceutical drugs and the Internet.
Do 'informed' or 'expert' patients challenge dominant traditions in biomedicine or simply adopt these as conventional ways of thinking about body shape and size, illness and health? This paper examines this question in relation to the use of the weight-loss drug Xenical by participants in an Internet forum for obese and overweight people. Ethnographic and interview data from the forum provides evidence that participants share information and support each other as they use Xenical, and in the process emerge as 'expert patients' in relation to their body shape and its treatment. However, it is argued that while an 'expert patient' can be perceived as desirable, enabling the democratisation of healthcare, it can also be constraining. The exchanges between the users in the forum perpetuate a biomedical model of overweight as a condition to be overcome. The discussion critically considers a number of options for the development of the expert patient, including the emergence of an 'informed consumer'.
Adult↗
Power, control and resistance in the timing of health and care.
In the modern period, time has been commodified and can be bought, sold and bartered. This paper argues that this means that while time may be a tool of power and control, it is also a site for resistance to power. Four case studies are evaluated from this perspective. A day-case surgery unit is examined to identify the routinization of health care, with time as a tool of control. Decisions over discharge from hospital following surgery demonstrate how time may be 'sold' to 'buy' future time. The disruption of routines during surgery suggest how time may be used as a means of resisting power, while in residential homes, old people find time on their hands as it is transformed into something which must be filled. It is argued that resistance is not achieved by recourse to 'natural' (as opposed to cultural) time, but by rethinking time creatively.
Australia↗
The WISDOM project: training primary care professionals in informatics in a collaborative 'virtual classroom'.
OBJECTIVES: The WISDOM project applies Internet technologies to create a virtual classroom in health informatics for primary care professionals. Participants use a facilitated E-mail discussion list supported by a web site which provides on-line resources and an archive of teaching materials. DESIGN: The project took an adult-learning model in which participants identify their learning needs, emphasized using informatics skills in practice, and focused on skills likely to enhance evidence-based practice. The paper describes the project and an evaluation of the first programme which ran in 1997 with 28 participants. Pre- and post-intervention questionnaires were used to assess perceived skills in informatics and evidence-based practice. SETTING: University of Sheffield. SUBJECTS: Primary care professionals. RESULTS: Participants reported statistically significant increases in eight informatics skills. There were no significant changes in evidence-based practice skills. The web-site, seminar programme and discussion list were highly rated as useful in delivering informatics training. CONCLUSIONS: The WISDOM approach is effective for the delivery of informatics training to primary care professionals, and may be used more widely for other subjects and professional groups. There is a need for further research into facilitating virtual classrooms.
Education, Medical, Graduate↗
Cisplatin, etoposide, and paclitaxel in the treatment of patients with extensive small-cell lung carcinoma.
PURPOSE: The combination of cisplatin, etoposide, and paclitaxel was studied in patients with extensive small-cell lung cancer in a phase I component followed by a phase II trial to determine the maximum-tolerated dose (MTD), characterize toxicity, and estimate response and median survival rates. PATIENTS AND METHODS: Forty-one patients were treated between October 1993 and April 1997. Doses for the initial cohort were cisplatin 75 mg/m(2) on day 1, etoposide 80 mg/m(2)/d on days 1 to 3, and paclitaxel 130 mg/m(2) on day 1 over 3 hours. Cycles were repeated every 3 weeks for up to six cycles. The MTD was reached in the first six patients. In these six patients and in the next 35 patients, who were entered onto the phase II trial, response and survival were estimated. RESULTS: At the initial dose level, one of six patients developed febrile neutropenia, and five of six achieved targeted neutropenia (nadir absolute granulocyte count, 100 to 1,000/microL) without any other dose-limiting toxicity, defining this level as the MTD. Grade 4 neutropenia was observed in 88 (47%) of 188 total courses administered at or less than the MTD. Neutropenia was associated with fever in only 17 (9%) of 188 courses, but two patients experienced neutropenic sepsis that was fatal. Nonhematologic toxicity greater than grade 2 was observed in 10 (5%) of 188 total courses, with fatigue, peripheral neuropathy, and nausea/vomiting most common. The overall objective response rate was 90% of 38 assessable patients: six complete responses (16%) and 28 partial responses(74%). Median progression-free and overall survival durations were 31 and 47 weeks, respectively. CONCLUSION: The combination of cisplatin, etoposide, and paclitaxel produced response and survival rates similar to those of other combinations and was well tolerated.
Adult↗
Space, sterility and surgery: circuits of hygiene in the operating theatre.
The spaces of the surgical operating theatre (ST) and associated built environment are analysed, to explore what the physical layout means for the interactions which take place. Three "circuits of hygiene" of surgical staff, surgical instruments, and patients are documented, and analysis of these physical movements through the surgical spaces examined for their contribution to sterility. It is concluded that the built environment of the ST contributes reminders to staff to fulfil the necessary procedures of aseptic technique, to ensure the safe passage of the patient through surgery into a condition where s/he may be designated as "healed".
Asepsis↗
An information technology course in the medical curriculum.
This paper concerns the information technology course now running in year 1 of the undergraduate curriculum of the medical school of Leeds University. The background and objectives of the course are described, and the course content is outlined in terms of knowledge and practical skills. By the end of the course, 95% of students could successfully accomplish 95% of the skill tasks taught. As regards attitudes to IT, independent studies comparing two randomly selected groups suggested students who had taken the course (a) used IT more frequently, and (b) viewed IT more favourably than their counterparts.
Attitude↗
A postgraduate course in primary and community care: impact on an academic department.
An impact evaluation was undertaken to ascertain the effects of starting a Master's programme in Primary and Community Care in the University of Sheffield Department of General Practice in terms of workload, use of resources, opportunity costs and general experiences of staff members. Total staff estimates of additional workload amounted to 2758 h during the first year of the course, of which the greater part fell upon the core staff (the course director and the administrative secretary). Staff reported opportunity costs in terms of time devoted to research. Core staff reported additional responsibility, and concomitantly, increased stress. Staff also reported that the introduction of the course had provided opportunities to develop new skills and new knowledge bases, and considered that the presence of postgraduates within the department had given it a 'lift' and raised academic standards.
Community Medicine↗
Family attachments and medical sociology: a valuable partnership for student learning.
This paper reports association within a curriculum of a theoretical programme in medical sociology for undergraduate medical students with a practical family attachment. These two components constitute the 'sociology' element of a course in behavioural science, and have equal weight for assessment purposes. Recognition of, on one hand, the mutuality of the two elements, and on the other, their similar but distinct theoretical underpinnings, suggests that such an association has the benefit of retaining the individual contributions of each component to student learning, while enabling theoretical and practical components to inform each other. Both are administered from the Department of General Practice of the University of Sheffield, UK. The consequences of such an educational provision are discussed.
Education, Medical, Undergraduate↗
Medical education and the GCSE generation--a transferable activity-skills programme in medical sociology.
The first major intake of medical students who studied the new GCSE occurred in Autumn 1990. These students have experienced a range of student-centred educational approaches to learning, but medical education in the UK remains committed to teacher-centred approaches. This mismatch of expectations is discussed. An innovative course in medical sociology at the University of Sheffield is reported, which illustrates student-centred learning approaches including transferable activity-skills development and self-assessment profiling. An innovative approach to course evaluation is discussed.
Adolescent↗
Sociology in the British medical curriculum: a survey.
A survey conducted among convenors of sociology courses in British medical schools showed a wide variation in course length, with two medical schools having no course, and two schools providing over 60 hours per year. A mean length of 32 hours was found, but there was considerable variation by region. London schools had a mean of 38.5 hours, compared with 40.5 hours in Scotland, and 22.3 hours in English provincial and Welsh schools. The latter group demonstrated a strong correlation between length of time the course had existed and the hours of tuition provided (r = 0.74, P = 0.007). No correlation was found at a significant level for London or Scottish courses. It is concluded that the London University edict making sociology compulsory in the medical curriculum has ensured a reasonable level of provision. Outside London, no such pressure has been available, and sociology has been squeezed as more subjects vie for curriculum time. Attitudes of non-sociology staff are reviewed and found to be predominantly negative. The recent report of the General Medical Council is noted, and it is suggested that the need for such a lobbyist outside London is necessary to ensure sociology attains a more secure and substantial place in the medical curriculum.
Attitude of Health Personnel↗
Scientific theory choice and social structure: the case of Joseph Lister's antisepsis, humoral theory and asepsis.
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Communicable Disease Control↗
Persistently elevated polychlorinated biphenyl levels from residual contamination of workplace surfaces.
A short-term follow-up study was performed on 55 workers in a gear plant exposed to PCB that contaminated the work surfaces. Current work did not involve the use of PCBs. Exposure was to residual PCB left behind by a capacitor company which formerly used the site. Elevated PCB levels were found in production area workers; these elevations persisted on retesting 1 year later. Efforts should be made to identify potentially toxic materials left behind on work surfaces of buildings before remodeling or reuse.
Environmental Exposure↗