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Biomedical subjects

P Tovey

Publications and source records attributed to P Tovey.

13 recordsLinked to original sources
PubMed2004

Complementary and alternative medicine (CAM), cancer and group-based action: a critical review of the literature.

Interest in complementary and alternative medicine (CAM) continues to grow at an exponential rate despite the advances made by conventional medicine. Complementary and alternative medicine use is increasingly manifest across a wide range of health care settings, and is particularly prevalent in cancer and palliative care. In these arenas, patient groups and self-help organizations play a significant supportive role. There is evidence that they are a key informative and pragmatic resource in the provision of CAM services to patients. However, there is a significant paucity of research dealing with the functional aspects of these groups and the way in which they advocate, promote and supply CAM. In this paper we provide a critical review of the literature pertaining to themes around CAM provision and cancer care, and suggest that for a more complete picture of the field, the impact of group mediation of CAM needs to be addressed, and attention focused on the social and interactional dynamics that underpin these groups and organizations.

Complementary Therapies↗
PubMed2001

Primary care as intersecting social worlds.

An enhanced role for primary health care (PHC) is currently a matter of political priority in the UK. This higher profile is drawing attention to a range of unresolved challenges and issues, relating to both the structure and content of provision, which currently permeate the system. Running in parallel with this is a recognition that: to date, PHC has been under-researched; that, as a result, our understanding of it is frequently poor; and that, as a consequence, fresh perspectives are needed in order to effectively research this uncertain, evolving and increasingly important healthcare sector. In this paper we argue that social worlds theory (SWT) provides, albeit in a suitably modified form, an ideal conceptual framework for the analysis of contemporary primary care. SWT is an approach which assumes complexity and constant evolution, and its core concepts are directed towards unravelling the consequences of encounters between different interest groups--something which is of particular utility at this time given the increasing attention to user participation, and an ongoing questioning of established patterns of professional authority. It is an approach which has rarely been employed empirically, even beyond medicine. In order to illustrate the wide relevance of the approach, we discuss how it can facilitate research at all levels of PHC: i.e., in relation to aspects of medical practice (the case of medically unexplained symptoms); shifts in service organisation (changing professional roles and the introduction of policy reforms); and issues which straddle both organisation and content (the increasing use of complementary medicine in primary care). In each case the approach is able to embrace the complexity of situations characterised by the intersection of professional and lay social worlds and is able to provide the conceptual tools through which resultant processes can be tracked and investigated.

Colonic Diseases, Functional↗
PubMed2001

Nurses' use of professional distancing in the appropriation of CAM: a text analysis.

Despite the depth of interest in complementary and alternative medicines (CAM) within the nursing community, the intersection between nurses, nursing and CAM has largely avoided sociological analysis. This paper presents findings from one part of an ongoing exploratory study of how nurses present and interpret the apparent affinity of their profession with CAM. A text analysis of papers published from within the nursing community on CAM was conducted. Within the broad area of professional identity, differentiation and development, two dominant themes emerged from the analysis. Firstly, the use of professional distancing to underpin the legitimacy of the nursing/CAM axis; and second, the potential offered by the relationship for a reconstruction of lines of professional authority. As one dimension of the way in which nursing's intersection with CAM is being constructed and perpetuated, the relationship with medicine appears to be of significance and requires further attention.

Attitude of Health Personnel↗
PubMed1999

Individuals with low back pain: how do they view physical activity?

BACKGROUND: Recent guidelines for those with acute low back pain have advocated early resumption of normal activity and increased physical activity. Little is known about the relationship between low back pain and physical activity, and on the impact of that relationship on the promotion of increased levels of physical activity within a general practice population. OBJECTIVES: We aimed to explore associations between factors that influence changes in physical activity and the way individuals perceive and behave with their low back pain, and the impact of those perceptions and behaviour on physical activity. METHODS: Twenty-seven informants were chosen using a purposive sample from a larger group of individuals who, because of their low back trouble, had been referred by their GPs to a community-based, single-blind, randomized controlled trial (RCT) at the University of York, which is evaluating the effectiveness and cost-effectiveness of a progressive exercise programme. Fifty-four interviews were conducted with this subgroup of the RCT; four informants were interviewed once, 19 twice and four of them three times. Interviews were transcribed and analysed using manual and computer-aided approaches. RESULTS: Physical activity was perceived as (i) activities of daily living, (ii) activities causing breathlessness that they went out of the way to do and (iii) more competitive-type activity. The avoidance of physical activity and fear of pain returning were the two main factors directly associated with informants' backs and changes in physical activity. These two factors hindered increases in physical activity, even though the majority of informants believed strongly that being physically active helped ease their low back pain. CONCLUSIONS: When advocating that individuals with acute low back pain return to or increase physical activity, it is important that clinicians identify avoidance of physical activity and/or fear of pain at the earliest stage in order to tailor advice and reassurance appropriately. If avoidance of activity and fear of pain is identified and clinicians want to encourage patients to take up and sustain increased physical activity, they should explore issues of fear of pain, and avoidance of and confidence to do physical activities, in addition to other factors influencing physical activity.

Adult↗
PubMed1998

Narrative and knowledge development in medical ethics.

The role of individual life accounts has been promoted--largely through what has come to be described as narrative ethics-as important to the practice of medical ethics for a number of years. Beyond this the apparent incompatibility of personal stories with scientific procedure has limited their use. In this article I will argue that this represents a serious under-utilisation of a valuable method for researching ethical dilemmas and the settings in which these dilemmas are played out. Life stories need not simply provide a stimulus to scientific research but can in themselves yield intellectually robust evidence on the general as well as the particular. By drawing on the rigorous methods developed elsewhere, personal accounts not only allow us to "enter the world of the sick person" but allow us to do so in such a way as to contribute to empirical and theoretical knowledge.

Data Collection↗
PubMed1998

Oscillating saw injuries during removal of plaster.

The aim of this study was to assess the incidence of injuries to patients who have had a plaster cast removed by oscillating circular saw at the Alexandra Hospital, Redditch, and to recommend measures to avoid such injuries. The record of each patient who had his/her plaster removed was kept in the plaster room and later studied. Over a 12-month period (1995-96), 3875 plaster casts were removed; 28 patients (0.72%) sustained abrasions or burns over the skin. Recently there has been a sudden rise in the number of cases who sustained injury or burns by oscillating saw following plaster cast removal and a few patients have demanded compensation from the hospital. These incidences prompted the start of this study. The identified cause of injury was the removal of a plaster cast by an inexperienced, ill-trained user or blunt saw blade. Strict protocols were required and have been introduced at the Alexandra Hospital to avoid litigation.

Burns↗
PubMed1997

Contingent legitimacy: U.K. alternative practitioners and inter-sectoral acceptance.

Although alternative medicine has achieved an increasingly high profile in recent years, surprisingly little social research has been conducted in the area. This is noticeably the case when considering inter-sectoral contact and collaboration. This paper fills that gap by drawing on evidence from a large-scale study of non-orthodox practitioners in the U.K. By examining the lived experience of interaction the study aimed to discover the level of professional legitimacy which alternative practitioners routinely enjoy or are denied by mainstream practitioners. Results show that the last decade has been characterised by an increasing liberalisation of attitude toward inter-sectoral collaboration throughout the mainstream. However, the evidence also shows that this cannot be equated with the existence of a generalised acceptance of alternative practitioners, professional legitimacy. There is a schism within orthodoxy on this issue and that schism is occupationally based: at the extremes, consultants remain characteristically dismissive of alternative practitioners, nurses overwhelmingly enthusiastic. The nature of the non-orthodox practice being considered was of little significance. It is argued that the identification of differentiation within orthodoxy on this issue marks a significant point in developing an understanding of relations between the "sectors" and its component parts. There is a clear potential for conflicting developmental paths of action between orthodox groups, and for differing conceptions of who and what constitute a legitimate part of the medical totality. Cross-sectoral alignments, which challenge the state sanctioned dichotomy of mainstream/alternative, are viewed in quite different ways throughout orthodoxy. Knowledge of this intra-sectoral differentiation is essential to an understanding of emerging patterns of inter-sectoral relations.

Complementary Therapies↗
PubMed1997

Autonomy and practice: the case of complementary practitioners in the UK.

OBJECTIVE: 1. To identify the level of acceptance of the principle of British Medical Association (BMA) participation in the formulation of practice guidelines for complementary medicine amongst currently active non-orthodox practitioners in the UK. 2. To identify the level of support for individual BMA proposals. 3. To identify similarities and differences of attitude to the proposals between practitioners of selected non-orthodox therapies. DESIGN: A postal survey of 1000 practitioners of complementary medicine. SETTING: The UK between late 1993 and early 1994. STUDY PARTICIPANTS: One thousand currently practising UK complementary therapists from 4 groups-chiropractic, "lay" homeopathy, medical herbalism and reflexology. Systematic sampling (every nth practitioner) was used to select 250 respondents from membership lists of relevant representative bodies. The reponse rate was 57%. RESULTS: The principle of BMA participation in policy formation was accepted by the vast majority of respondents, although 87.7% stipulated that this should not constitute a major role. Each of the individual BMA proposals received majority support. Acceptance rates varied from 59.7% to 92.9%. Statistically significant differentiation between therapies was recorded on certain proposals. DISCUSSION: The revised stance of the BMA is finding a potentially receptive audience amongst UK complementary practitioners. There is a large amount of common ground between the proposals and what is acceptable to practitioners. However, the situation is complicated by intra-sectoral differentiation. Particular therapy and issue-specific barriers exist to the universal utilization of the kind of measures proposed.

Attitude of Health Personnel↗