Artykuły w czasopismach na temat „Institutional and medical power”
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Vieira, Diego Mota. "Mudança Institucional Gradual e Transformativa: a Atuação de Stakeholders e Coalizões de Defesa no Caso da Usina Hidroelétrica de Belo Monte". Organizações & Sociedade 28, nr 97 (czerwiec 2021): 398–421. http://dx.doi.org/10.1590/1984-92302021v28n9707pt.
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Abstract This work analyzes the performance of stakeholders and advocacy coalitions in processes of gradual institutional change based on the case study of the Belo Monte hydroelectric power plant. The methodology adopts content analysis, using shorthand notes of hearings held in the National Congress, and other publicly available documents. In-depth semi-structured interviews were also conducted, collecting data from individuals involved in the history of the power plant. The study allowed to characterize stakeholders pro or against the enterprise, observing their degree of influence and the role played. In addition, the work used the Advocacy Coalition Framework to verify how stakeholders formed three advocacy coalitions and exerted the strategies of institutional change ‘displacement,’ ‘conversion,’ and ‘layering’ following the gradual and transformative institutional change model. Empirical evidence indicates that the composition of coalition members may determine the type of institutional change and that institutional changes can also result from learning among coalitions, as the incorporation of socio-environmental considerations that have altered the original design of the hydroelectric power plant.
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Currie, Graeme, Andy Lockett, Rachael Finn, Graham Martin i Justin Waring. "Institutional Work to Maintain Professional Power: Recreating the Model of Medical Professionalism". Organization Studies 33, nr 7 (lipiec 2012): 937–62. http://dx.doi.org/10.1177/0170840612445116.
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Vieira, Diego Mota. "Gradual and Transformative Institutional Change: the influence of stakeholders and advocacy coalitions at the Belo Monte Hydroelectric power plant". Organizações & Sociedade 28, nr 97 (czerwiec 2021): 398–421. http://dx.doi.org/10.1590/1984-92302021v28n9707en.
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Abstract This work analyzes the performance of stakeholders and advocacy coalitions in processes of gradual institutional change based on the case study of the Belo Monte hydroelectric power plant. The methodology adopts content analysis, using shorthand notes of hearings held in the National Congress, and other publicly available documents. In-depth semi-structured interviews were also conducted, collecting data from individuals involved in the history of the power plant. The study allowed to characterize stakeholders pro or against the enterprise, observing their degree of influence and the role played. In addition, the work used the Advocacy Coalition Framework to verify how stakeholders formed three advocacy coalitions and exerted the strategies of institutional change ‘displacement,’ ‘conversion,’ and ‘layering’ following the gradual and transformative institutional change model. Empirical evidence indicates that the composition of coalition members may determine the type of institutional change and that institutional changes can also result from learning among coalitions, as the incorporation of socio-environmental considerations that have altered the original design of the hydroelectric power plant.
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Sinadinovic, Danka. "The role of tag questions in medical encounters". Serbian Dental Journal 67, nr 4 (2020): 208–18. http://dx.doi.org/10.2298/sgs2004208s.
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The discourse of medical encounters is deemed to be an excellent example of both institutional talk and discourse of power. Asking questions is probably the most prominent characteristic of doctor- patient interaction and this paper deals with tag questions as one of the question types that can be found in almost every medical encounter. We will explore tag questions by reviewing current research results in the field of medical discourse and by comparing and discussing examples from transcribed medical encounters in English and Serbian. It will be discussed how often tag questions are used in both corpora, whether doctors and patients use them in the same way and what role these questions have in a medical encounter. Finally, having in mind that getting to ask any question in institutional talk requires a certain amount of power, we will also try to determine if using tag questions affects doctor and patient?s positions in a medical encounter.
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Mukandi, Bryan. "Being Seen by the Doctor: A Meditation on Power, Institutional Racism, and Medical Ethics". Journal of Bioethical Inquiry 18, nr 1 (15.01.2021): 33–44. http://dx.doi.org/10.1007/s11673-021-10087-2.
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Doudera, A. Edward. "Developing Issues in Medical Decision Making: The Durable Power of Attorney and Institutional Ethics Committees". Primary Care: Clinics in Office Practice 13, nr 2 (czerwiec 1986): 315–26. http://dx.doi.org/10.1016/s0095-4543(21)00982-9.
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Veitch, Kenneth. "Medical law and the power of life and death". International Journal of Law in Context 2, nr 2 (czerwiec 2006): 137–57. http://dx.doi.org/10.1017/s1744552306002023.
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The purpose of this article is to offer an analysis of the nature of contemporary legal power over the ending of human life in medical contexts. Drawing on Michel Foucault’s characterisations of power relations in the sphere of life and death in The History of Sexuality, Vol. I, it is argued that, in its current regulation of the ending of human life in this area, law displays elements of two of those modes, or forms, of power identified by Foucault – the juridical and the disciplinary. This argument is illustrated by reference to two recent cases – Re A (Children) and Re B (an adult: refusal of medical treatment) – and set against a background of shifting modes of governmentality (here, the movement from medicalisation to legalisation). Through an analysis of the forms of legal power in this particular context, the article also has a broader purpose – to advance an alternative approach to the question of power within the academic medical law field. Specifically, unlike the standard form of legal academic inquiry in this area – that is, one which is driven mainly by a concern for ethics and resolving ethical dilemmas – it is suggested that an appreciation of the importance that institutional context(s) and requirements play in medical law is necessary if we are to understand fully both the factors constitutive of legal power and the subtle, and often controversial, effects that flow from the manner in which it is exercised and asserted.
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Chiarello, Elizabeth. "Medical and Familial Claims to Long-Term Care: Institutional Gaps and Shifting Jurisdictions". Law & Social Inquiry 43, nr 01 (2018): 238–48. http://dx.doi.org/10.1111/lsi.12337.
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In light of the contemporary long-term care crisis, Sandra Levitsky's book Caring for Our Own examines why there has been no movement to secure state support for caregivers. Speaking to sociolegal and social movement audiences, Levitsky reveals how lack of collective identity, the power of family-based ideologies, and the separation of support organizations from political ones help to repress mobilization. In this essay I refract Levitsky's findings through the lens of organizational theory and medical sociology. I argue that the social problem of long-term care is caught in an institutional gap since it does not readily fall under the purview of either medicine or family. I also discuss the implications of lay caregivers' provision of sophisticated medical care for theories of professional jurisdictions and gatekeeping.
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Liang, Bryan A., i Tim MacKey. "Confronting Conflict: Addressing Institutional Conflicts of Interest in Academic Medical Centers". American Journal of Law & Medicine 36, nr 1 (marzec 2010): 136–87. http://dx.doi.org/10.1177/009885881003600103.
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Individual conflicts of interest are rife in healthcare, and substantial attention has been given to address them. Yet a more substantive concern-institutional conflicts of interest (“ICOIs”) in academic medical centers (“AMCs”) engaged in research and clinical care—have yet to garner sufficient attention, despite their higher stakes for patient safety and welfare. ICOIs are standard in AMCs, are virtually unregulated, and have led to patient deaths. Upon review of ICOIs, we find a clear absence of substantive efforts to confront these conflicts. We also assess the Jesse Gelsinger case, which resulted in the death of a study participant exemplifying a deep-seated culture of institutional indifference and complicity in unmanaged conflicts. Federal policy, particularly the Bayh-Dole Act, also creates and promotes ICOIs. Efforts to address ICOIs are narrow or abstract, and do not provide for a systemic infrastructure with effective enforcement mechanisms. Hence, in this paper, we provide a comprehensive proposal to address ICOIs utilizing a “Centralized System” model that would proactively review, manage, approve, and conduct assessments of conflicts, and would have independent power to evaluate and enforce any violations via sanctions. It would also manage any industry funds and pharmaceutical samples and be a condition of participation in public healthcare reimbursement and federal grant funding.The ICOI policy itself would provide for disclosure requirements, separate management of commercial enterprise units from academic units, voluntary remediation of conflicts, and education on ICOIs. Finally, we propose a new model of medical education—academic detailing—in place of current marketing-focused “education.” Using such a system, AMCs can wean themselves from industry reliance and promote a culture of accountability and independence from industry influence. By doing so, clinical research and treatment can return to a focus on patient care, not profits.
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Iqbal, Shazia, Shahzad Ahmad i Ian Willis. "Influencing Factors for Adopting Technology Enhanced Learning in the Medical Schools of Punjab, Pakistan". International Journal of Information and Communication Technology Education 13, nr 3 (lipiec 2017): 27–39. http://dx.doi.org/10.4018/ijicte.2017070103.
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As the successful establishment of technology supported educational systems requires wide investment in terms of finances and faculty time, this study explores the influencing factors in the adoption of Technology Enhanced Learning (TEL) and the main barriers encountered during the use of TEL in Punjab, Pakistan. Semi-structured interviews were conducted with medical educators and thematic analysis was carried out using Nvivo-10. The study participants were well aware of educational technologies and stated that the influencing factors for adoption of TEL were self-effort, motivation, a personal positive approach and departmental policy. The institutions were well equipped with resources but the main problem was the lack of faculty training and institutional support. The study concludes that pedagogy is the main driver for the use of educational technologies. At the national level, it is suggested that governing bodies can provide definite polices and guidelines for the implementation of TEL. Therefore, it is advocated that recognizing online courses can enhance potential learners' interest to enroll for e-learning programmes. At the institutional level, it is proposed to encourage the establishment of institutional policies and the organization of workshops for faculty training. At an individual level, it is stressed that there is a basic requirement to develop a technology-oriented culture partly by sharing the power and expertise among the department heads and faculty members.
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May, Carl, Christopher Dowrick i Michael Richardson. "The Confidential Patient: The Social Construction of Therapeutic Relationships in General Medical Practice". Sociological Review 44, nr 2 (maj 1996): 187–203. http://dx.doi.org/10.1111/j.1467-954x.1996.tb00421.x.
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The interpersonal relationship between doctor and patient is fundamental to general medical practice. In this paper we explore the ways in which general practitioners make sense of the changing political economy of this relationship, as it is restructured by ideas about the patient as consumer, and as it increasingly constitutes the consultation as a point of interaction that may be intrinsically therapeutic. In particular, we explore the ways in which the consultation is the site of negotiated power relations between doctor and patient, and is the site of the doctor's negotiation of powerful discourses of professional and institutional identity.
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Kirby, Emma, Alex Broom, Alexandra Gibson, Jennifer Broom, Trent Yarwood i Jeffrey Post. "Medical authority, managerial power and political will: A Bourdieusian analysis of antibiotics in the hospital". Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine 22, nr 5 (24.06.2017): 500–518. http://dx.doi.org/10.1177/1363459317715775.
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Antibiotic resistance poses a significant global threat, yet clinically inappropriate antibiotic use within hospitals continues despite the implementation of abatement strategies. Antibiotic use and the viability of existing antibiotic options now sit precariously at the nexus of political will, institutional governance and clinical priorities ‘at the bedside’. Yet no study has hitherto explored the perspectives of managers, instead of focusing on clinicians. In this article, drawing on qualitative interviews with hospital managers, we explore accounts of responding to antimicrobial resistance, managing antibiotic governance and negotiating clinical and managerial priorities. We argue that the managers’ accounts articulate the problematic nexus of measurement and accountability, the downflow effects of political will, and core tensions within the hospital between moral, managerial and medical authority. We apply Bourdieu’s theory of practice to argue that an understanding of the logics of practice within the ‘hospital management classes’ will be critical in efforts to protect antibiotics for future generations.
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Weiss, Richard M. "Overcoming Resistance to Surveillance: A Genealogy of the EAP Discourse". Organization Studies 26, nr 7 (lipiec 2005): 973–97. http://dx.doi.org/10.1177/0170840605054600.
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Through an examination of employee assistance programs we address Foucault’s contention that the pervasive surveillance characteristic of disciplinary control is facilitated by a discourse claiming therapeutic rather than punitive aims. By characterizing poor job performance as evidence of substance abuse or other ‘behavioral-medical’ illness, the EAP discourse endeavors to overcome the reluctance of supervisors to identify poor performers, for whom job loss is the frequent consequence of failure to improve. Following Foucault’s view that power effects occur without express intention to exercise power, we analyze the web of institutional and professional disciplinary mechanisms that effect heightened supervisory surveillance.
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Zahorskyy, Volodymyr. "Decentralization as an institutional mechanism for maintenance of investment processes". Regional Economy, nr 3 (2019): 115–23. http://dx.doi.org/10.36818/1562-0905-2019-3-12.
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The paper emphasizes that in current conditions of economic system functioning in Ukraine, it is impossible to achieve economic growth without an effective investment policy. An efficient national investment policy enables developing countries to avoid economic and technological dependency and to ensure solutions of key objectives of the sustainable development of the regions and the country as a whole, the growth of their economic capacity and raising standards of living for the population. Modern transformational processes and global trends in economic development are putting new demands for forming the policy of regulation by the investment process in Ukraine. The paper determines that one of the peculiarities of the modern national investment policy of Ukraine is that it is formed and implemented in the conditions of reforming of the public administration system. Decentralization of power and change of administrative and territorial structure in Ukraine by uniting communities and reforming local self-government in terms of redistribution of powers, competences and financial provision are some of the main directions of the public administration modernization. Decentralization provides new opportunities for harnessing investment potential of territories, promotes investment activity to increase the industrial-economic and socio-cultural capacity of territorial communities and accelerates the rates of renewable processes of tangible and intangible production. It is the prerequisite of public administration system modernization by the social development of regions. A clear understanding of the essence, models and principles of decentralization is the important factor for its successful implementation. Ensuring the development of investment activity in the region in conditions of decentralization is the effective mean for regional development, which provides not only the development of the economy as a whole, but also the development of cultural, medical, educational, and social spheres.
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Frable, William J. "Surgical Pathology—Second Reviews, Institutional Reviews, Audits, and Correlations: What's Out There? Error or Diagnostic Variation?" Archives of Pathology & Laboratory Medicine 130, nr 5 (1.05.2006): 620–25. http://dx.doi.org/10.5858/2006-130-620-sprira.
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Abstract Context.—A variety of methodologies have been used to report error rates in surgical pathology within the peer-reviewed medical literature. The media has selectively and superficially reported these error rates creating a climate of disinformation between physicians and the public. Objectives.—To review the medical literature on diagnostic error in surgical pathology and summarize and compare these data with selected reports in the print and broadcast media. Design.—A search of the medical literature from the National Library of Medicine database using the heading “Error and Pathology Diagnosis.” Results.—Three thousand nine hundred ninety-two citations were found, of which 83 directly measured in some manner errors in surgical and cytopathology. Major error rates ranged from 1.5% to 5.7% globally for institutional consults. Error rates were less, 0.26% to 1.2% for global in-house prospective review and 4.0% for in-house and retrospective blinded review. Error rates also varied by anatomic site: skin, institutional consult, 1.4%; prostate, institutional consult, 0.5%; and thyroid, institutional consult, 7.0%. Error rates reported in citations used by the Wall Street Journal were as follows: prostate, Gleason score changed by 1 point, 44% and resultant change in treatment for prostate cancer, 10%; for breast, altered lumpectomy or mastectomy plan, 8%; and diagnosis changed for thyroid lesions, 18%. Errors in second opinion on breast lesions (single pathologist author for the study) fall within the range of global reviews. Errors for second opinions on prostate cancer were principally 81% upgrades in Gleason score for prostate core needle biopsies. However, this resulted in an upgrade of patient risk category in only 10.8% of patients. Data for the article on change in diagnosis of thyroid lesions were incomplete. There appeared to be 3 significant diagnostic errors (4.5%). Conclusions.—Pathology is not immune to the power of the media to create concern about accuracy of diagnosis in surgical pathology and cytopathology. Detailed analysis of the medical literature cited by the media determines that painting the big picture and hitting the highlights can be profoundly misleading.
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TONIELO, EDENILSO, i GHENDY CARDOSO JUNIOR. "INSTALAÇÕES ELÉTRICAS DE EQUIPAMENTOS ELETROMÉDICOS: AVALIAÇÃO DOS IMPACTOS DA QUALIDADE DE ENERGIA EM INSTITUIÇÕES DE SAÚDE". Revista SODEBRAS 14, nr 158 (luty 2019): 41–46. http://dx.doi.org/10.29367/issn.1809-3957.14.2019.158.41.
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Agich, George J. "Authority in Ethics Consultation". Journal of Law, Medicine & Ethics 23, nr 3 (1995): 273–83. http://dx.doi.org/10.1111/j.1748-720x.1995.tb01363.x.
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Authority is an uneasy, political notion. Heard with modern ears, it calls forth images of oppression and power. In institutional settings, authority is everywhere present, and its use poses problems for the exercise both of individual autonomy and of responsibility. In medical ethics, the exercise of authority (along with power) has been located on the side of the physician or the health care institution, and it has usually been opposed by appeal to patient autonomy and rights. So, it is not surprising, though still ironic, that ethics consultation, which develops from this patient rights-dominated ethic, should itself bring forth questions of authority. Nonetheless, it does. Insofar as authority has been discussed in ethics consultations, it has been understandably approached from the broad perspective of legitimation and power, which are common themes in social and political treatments of authority. These treatments have dominated twentieth-century discussions of authority, which primarily view authority as legitimate power.
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Halfmann, Drew. "Political Institutions and the Comparative Medicalization of Abortion". Journal of Health and Social Behavior 60, nr 2 (25.04.2019): 138–52. http://dx.doi.org/10.1177/0022146519843935.
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Comparative-historical research on medicalization is rare and, perhaps for that reason, largely ignores political institutions, which tend to vary more across countries than within them. This article proposes a political-institutional theory of medicalization in which health care policy legacies, political decentralization, and constitutionalism shape the preferences, discourses, strategies, and influence of actors that seek or resist medicalization. The theory helps explain why abortion has been more medicalized in Britain than the United States. The analysis finds that the American medical profession, unlike its British counterpart, focused on defending private medicine rather than protecting its power to “diagnose” the medical necessity of abortions; that American political decentralization aided the establishment of abortion on request by encouraging strategic innovation and learning that shaped social movement strategies, medical issue avoidance, and the growth of nonhospital clinics; and finally, that constitutionalism promoted rights discourses that partially crowded out medical ones.
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Bradley, Elizabeth H., Barbara B. Blechner, Leslie C. Walker i Terrie T. Wetle. "Institutional Efforts to Promote Advance Care Planning in Nursing Homes: Challenges and Opportunities". Journal of Law, Medicine & Ethics 25, nr 2-3 (1997): 150–58. http://dx.doi.org/10.1111/j.1748-720x.1997.tb01890.x.
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During the past two decades, several reports have documented substantial support from clinicians, policy-makers, and the general public for the use of advance directives, yet studies continue to find that only a minority of individuals (10 to 25 percent) have completed these legal documents. Advance directives are written instructions, such as living wills or durable powers of attorney for health care, which describe an individual's medical treatment wishes in the event that individual becomes incapacitated in the future. The completion and use of advance directives is one of several components of the broader activity of advance care planning, that is, the overall planning and communication of personal wishes concerning future medical care.In December 1991, the federal Patient Self-Determination Act (PSDA) became effective. Promoted as a federal initiative to enhance an individual's control over medical treatment decision making and, therefore, patient autonomy and self-determination, PSDA placed several new requirements on health care organizations receiving Medicare or Medicaid payments.
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Zhukovsky, Donna S., Pamela T. Soliman, Boby Mathew, Sarah Mills, Diane Bodurka, Michael Frumovitz, Larissa A. Meyer i in. "Systematic Approach to Selecting and Preparing a Medical Power of Attorney in the Gynecologic Oncology Center". Journal of Oncology Practice 15, nr 12 (grudzień 2019): e1092-e1097. http://dx.doi.org/10.1200/jop.19.00109.
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PURPOSE: Advance care planning (ACP) supports national priorities of patient engagement, person-centered care, and safety. A systematic approach is uncommon in most care settings. Our institution offers all patients with cancer new to the institution an opportunity to select and prepare a medical decision maker (MDM) after social work counseling. The goals of this study were to determine the success of a systematic institutional process for selecting a prepared MDM. The primary objectives were that (1) 70% or more of new patients would have one or more documented social work ACP discussions by the third office visit within 4 months, and (2) there would be a two-fold increase in scanned medical power of attorney (MPOA) documents available in the electronic health record (EHR). The secondary objectives were (1) improved surrogate preparedness for medical decision making, and (2) to determine whether patients with metastatic disease demonstrated greater readiness for selection of an MDM than those with localized disease. MATERIALS AND METHODS: We conducted a retrospective chart review of consecutive gynecology oncology outpatients. RESULTS: Of 133 patients, 93 (70%) had metastatic disease. The median number of visits was two (one to three). Forty-seven patients (39.3%) met with social work by visit 3. Review of ACP notes suggested that most patients were in the early stages of selecting a prepared MDM. At visit 1, 39 (29.3%) reported having an advance directive document; 14 (10.5%) had an MPOA in the EHR. There was no increase by visit 3. Fewer patients with metastatic disease than those with localized cancer (32.3% v 67.5%; P = .001) had three visits; no other parameter, including presence of MPOA documents in the EHR, achieved statistical significance between groups. CONCLUSION: Current processes fail to engage patients in selecting and preparing an MDM.
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Belrhiti, Zakaria, Sara Van Belle i Bart Criel. "How medical dominance and interprofessional conflicts undermine patient-centred care in hospitals: historical analysis and multiple embedded case study in Morocco". BMJ Global Health 6, nr 7 (lipiec 2021): e006140. http://dx.doi.org/10.1136/bmjgh-2021-006140.
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BackgroundIn Morocco’s health systems, reforms were accompanied by increased tensions among doctors, nurses and health managers, poor interprofessional collaboration and counterproductive power struggles. However, little attention has focused on the processes underlying these interprofessional conflicts and their nature. Here, we explored the perspective of health workers and managers in four Moroccan hospitals.MethodsWe adopted a multiple embedded case study design and conducted 68 interviews, 8 focus group discussions and 11 group discussions with doctors, nurses, administrators and health managers at different organisational levels. We analysed what health workers (doctors and nurses) and health managers said about their sources of power, perceived roles and relationships with other healthcare professions. For our iterative qualitative data analysis, we coded all data sources using NVivo V.11 software and carried out thematic analysis using the concepts of ‘negotiated order’ and the four worldviews. For context, we used historical analysis to trace the development of medical and nursing professions during the colonial and postcolonial eras in Morocco.ResultsOur findings highlight professional hierarchies that counterbalance the power of formal hierarchies. Interprofessional interactions in Moroccan hospitals are marked by conflicts, power struggles and daily negotiated orders that may not serve the best interests of patients. The results confirm the dominance of medical specialists occupying the top of the professional hierarchy pyramid, as perceived at all levels in the four hospitals. In addition, health managers, lacking institutional backing, resources and decision spaces, often must rely on soft power when dealing with health workers to ensure smooth collaboration in care.ConclusionThe stratified order of care professions creates hierarchical professional boundaries in Moroccan hospitals, leading to partitioning of care and poor interprofessional collaboration. More attention should be placed on empowering health workers in delivering quality care by ensuring smooth interprofessional collaboration.
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Wake, Naoko. "Homosexuality and Psychoanalysis Meet at a Mental Hospital: An Early Institutional History". Journal of the History of Medicine and Allied Sciences 74, nr 1 (10.12.2018): 34–56. http://dx.doi.org/10.1093/jhmas/jry041.
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Abstract Psychoanalysis and homosexuality in the United States were both largely in flux between 1910 and 1935. This article sheds light on this unique historical moment by first exploring scholarly discussions of the era’s psychoanalysis and homosexuality, both of which emphasized the transitional nature of therapy and sexuality. By putting two bodies of scholarship into conversation, I also suggest how the historiography might move beyond two oft-cited arguments—that the psychoanalysis of the era had the power to form a person’s sexual identity negatively, and that sexual minorities formed their identities affirmatively by staying away from medical interventions. I argue that, instead, psychoanalysis was part of modern sexual identity-formation in surprisingly open-ended ways. The second half of the article continues to explore the interplay between therapy and sexuality by closely examining clinical practices at one of the leading mental hospitals of the era: Sheppard and Enoch Pratt Hospital in Towson, Maryland, where an eclectic mode of psychotherapy was actively employed to treat homosexuality. In particular, the work of Harry Stack Sullivan (1892-1949), a gay psychiatrist well-known for his interpersonal theory of mental illness, shows how male patients who experienced same-sex sexual relationships nurtured productive interdependency among men in their articulation of sexual identity. By carefully delineating this process, the article shows how analytic practices could, and sometimes did, offer a crucial space for self-reflection and articulation of male sexuality.
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Mondada, Lorenza. "Srikant Sarangi & Celia Roberts (eds.), Talk, work and institutional order: Discourse in medical, mediation, and management settings. Berlin: Mouton de Gruyter (Language, Power and Social Process Series), 1999. Pp. 530. Pb 24.00." Language in Society 30, nr 2 (kwiecień 2001): 292–95. http://dx.doi.org/10.1017/s0047404501292057.
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This very interesting and useful book proposes an interdisciplinary approach to professional talk and its constitutive role in various institutional settings. It aims at reviewing the available literature and at providing theoretical insights and methodological tools for further analyses, thereby building possible bridges between academic research and its practical relevance within institutions.
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Ortiz-Prado, Esteban, Jorge Ponce, Fernando Cornejo-Leon, Anna M. Stewart-Ibarra, Rodrigo Henríquez Trujillo, Estefanía Espín i Darío Ramírez. "Analysis of Health and Drug Access Associated with the Purchasing Power of the Ecuadorian Population". Global Journal of Health Science 9, nr 1 (19.05.2016): 201. http://dx.doi.org/10.5539/gjhs.v9n1p201.
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OBJECTIVE: To determine whether there is a relationship between access to health systems and out-of-pocket spending with socio demographic characteristics in Ecuador.METHODS: Retrospective analysis of national level data on household medical expenditure from the National Survey of Household Income and Expenditure in Urban and Rural Houses conducted by the Ecuadorian National Institute of Statistics and Census Databases as well as other scientific, institutional, technical-administrative datasets.RESULTS: Families in the lowest percentile of poverty spend proportionally more out-of-pocket on pharmaceutical drugs than wealthier families. Furthermore, the lowest income deciles have no access to private health coverage. Populations from the bigger cities have more access to health care services than smaller rural cities. In Ecuador, 71% of pharmaceutical products are imported and 8% of the total of drugs are generic.CONCLUSIONS: Despite efforts by the current government, health access remains uneven, as indicated by drug access and out-of-pocket expenses per family. Poorer families have higher relative health expenditures for drugs than families with higher incomes, although poorer families have no access to private insurances.
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Galmarini-Kabala, Maria Cristina. "Psychiatry, Violence, and the Soviet Project of Transformation: A Micro-History of the Perm΄ Psycho-Neurological School-Sanatorium". Slavic Review 77, nr 2 (2018): 307–32. http://dx.doi.org/10.1017/slr.2018.125.
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This article analyzes the interactions of medical experts, minor patients, and parents in a child psychiatric institution that operated in the Soviet city of Perm΄ between 1926 and 1929. Through a micro-history of this institution, the author raises questions about the nature of violence within the realm of psychiatric care, demonstrating the multidimensional flow of power within a particular institutional setting and adding complexity to our understanding of the asylum writ large. At the same time, the article engages the question of violence in Soviet society at the end of the NEP, suggesting that the historical actors involved in the Perm΄ institution used violence as a means to explain the crisis of their time.
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Badejo, Okikiolu, Helen Sagay, Seye Abimbola i Sara Van Belle. "Confronting power in low places: historical analysis of medical dominance and role-boundary negotiation between health professions in Nigeria". BMJ Global Health 5, nr 9 (wrzesień 2020): e003349. http://dx.doi.org/10.1136/bmjgh-2020-003349.
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IntroductionInterprofessional interaction is intrinsic to health service delivery and forms the basis of task-shifting and task-sharing policies to address human resources for health challenges. But while interprofessional interaction can be collaborative, professional hierarchies and discipline-specific patterns of socialisation can result in unhealthy rivalry and conflicts which disrupt health system functioning. A better understanding of interprofessional dynamics is necessary to avoid such negative consequences. We, therefore, conducted a historical analysis of interprofessional interactions and role-boundary negotiations between health professions in Nigeria.MethodsWe conducted a review of both published and grey literature to provide historical accounts and enable policy tracing of reforms related to interprofessional interactions. We used Nancarrow and Borthwick’s typology for thematic analysis and used medical dominance and negotiated order theories to offer explanations of the conditions that facilitated or constrained interprofessional collaboration.ResultsDespite an overall context of medical dominance, we found evidence of professional power changes (dynamics) and role-boundary shifts between health professions. These shifts occurred in different directions, but shifts between professions that are at different power gradients were more likely to be non-negotiable or conflictual. Conditions that facilitated consensual role-boundary shifts included the feasibility of simultaneous upward expansion of roles for all professions and the extent to which the delegating profession was in charge of role delegation. While the introduction of new medical diagnostic technology opened up occupational vacancies which facilitated consensual role-boundary change in some cases, it constrained professional collaboration in others.ConclusionsHealth workforce governance can contribute to better functioning of health systems and voiding dysfunctional interprofessional relations if the human resource for health interventions are informed by contextual understanding (informed by comparative institutional and health systems research) of conditions that facilitate or constrain effective interprofessional collaboration.
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Wren, Bernadette. "Ethical issues arising in the provision of medical interventions for gender diverse children and adolescents". Clinical Child Psychology and Psychiatry 24, nr 2 (kwiecień 2019): 203–22. http://dx.doi.org/10.1177/1359104518822694.
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The care of children and adolescents whose experience of the body is at odds with their gender feelings raises a number of questions that are as much ethical as medical or psychological. In this article I highlight some areas of ethical concern from the point of view of a senior clinician at the nationally commissioned UK Gender Identity Development Service (GIDS). I make the assumption that ethical deliberation is relational and grounded in the natural, social, political and institutional worlds in which the ethical questions arise. I try to show how matters of empirical fact, alongside an appreciation of broad social contexts, and historic and current power relations, provide an essential framework for the ways that ethical choices are framed by key groups of people as they take up different, sometimes opposing, ethical positions. I argue that practising ethically in such a service is not helpfully reduced to a single event, a treatment decision aimed at achieving the morally ‘right’ outcome, but an extended process in time. In the charged debate surrounding the recognition of these young people’s needs, we must do more to promote responsible debate about the scope of sound ethical practice.
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Weis, Christina. "Situational ethics in a feminist ethnography on commercial surrogacy in Russia: Negotiating access and authority when recruiting participants through institutional gatekeepers". Methodological Innovations 12, nr 1 (styczeń 2019): 205979911983185. http://dx.doi.org/10.1177/2059799119831853.
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In this article, I discuss methodological and ethical dilemmas when recruiting participants with the help of medical and institutional gatekeepers during my ethnographic fieldwork on commercial surrogacy in St Petersburg, Russia. Based on four case studies, I argue for the use of situational ethics. Solid up-front ethics that are approved by institutional advisory boards are important to ensure that the researcher has done their best to identify potential ethical issues prior to data collection and offer deontological safeguards. However, as empirical researchers, we are familiar with the unanticipated that is bound to happen once we commence data collection. In such cases, when the proposed and approved ethical conduct is no longer suited and researchers must make new ethical choices, situational ethics that take the immediate context into consideration are crucial. I further argue that situational ethics must not only be an extension of procedural ethics when the latter are no longer suited but an alternative to procedural ethics in order to make the research empowering, reciprocal and transformative of existing disadvantaging power relations. With this article, I contribute to the growing literature that argues in favour of situational ethics.
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Ko, Hsun-Kuei, Chi-Chun Chin, Min-Tao Hsu i Shu-Li Lee. "Phenomenon of moral distress through the aspect of interpretive interactionism". Nursing Ethics 26, nr 5 (15.04.2018): 1484–93. http://dx.doi.org/10.1177/0969733018766579.
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Background: Most previous studies on moral distress focused on the factors that cause moral distress, paying inadequate attention to the moral conflict of nurses’ values, the physician–nurse power hierarchy, and the influence of the culture. Research objective: To analyze the main causes for moral distress with interpretive interactionism. Research design: A qualitative study was adopted. Participants: Through purposeful sampling, 32 nurses from 12 different departments were chosen as the samples. Ethical considerations: Approval from the Institutional Review Board of the Kaohsiung Medical University Hospital. Findings: Moral distress is likely to occur in the following clinical situations: patients have no idea about their diseases; the medical decisions fail to meet the optimum benefit of patients; and patients with terminal cancers are not given a proper death. The reason why nurses become trapped in moral distress is that they fail to achieve moral goodness. Inadequate confidence, the physician–nurse power hierarchy, and the Oriental culture affect nurses’ goodness-based intention for patients, which deteriorates moral distress. Discussion: The main cause for moral distress is the moral goodness of nurses. If nurses’ goodness-based intention for patients is inconsistent with the moral objective of achieving optimum benefit for patients, it leads to moral distress. Culture is an essential background factor of care for patients. In the Oriental culture, family members influence patients’ right to know about their diseases, the choice of treatment, and patients’ autonomy of not receiving cardio-pulmonary resuscitation. This results in moral distress in medical care. Conclusion: The occurrence of moral distress demonstrates that nurses have moral characteristics such as goodness and caring. It is suggested that appropriate educational strategies can be adopted to weaken the power hierarchy between physicians and nurses and enhance nurses’ confidence and cultural sensitivity, so as to reduce the moral distress of nurses.
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Kwame, Abukari. "Integrating Traditional Medicine and Healing into the Ghanaian Mainstream Health System: Voices From Within". Qualitative Health Research 31, nr 10 (13.05.2021): 1847–60. http://dx.doi.org/10.1177/10497323211008849.
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In this study, I employed interpretive ethnographic qualitative design to explore perceptions of and proposals from traditional healers, biomedical practitioners, and health care consumers regarding integrating traditional medicine and healing in Ghana. Data were gathered through focus groups, in-depth individual interviews, and qualitative questionnaires and analyzed thematically. The results revealed positive attitudes toward integrating traditional medicine in Ghana and a discursive discourse of power relations. The power imbalance between biomedical and traditional practitioners regarding what integrative models to adopt is sanctioned by formal education and institutional structure. As a result, multiple approaches for integration were made, including patient co-referrals, collaborations between biomedical and traditional medical practitioners, and creating a unit for traditional medicine and healers at the outpatients’ department for patients to choose either biomedicine or traditional medicine. Incorporating aspects of traditional healing in the training of biomedical practitioners and creating a space for knowledge sharing were also proposed. These integrative models reflected the distinctive interests of healers and biomedical practitioners. Considering these findings, I recommended policy options for consideration toward achieving an integrative health care system in Ghana.
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Saayman, Gert. "South Africa: Vulnerable Persons and Groups in a Vulnerable Democracy — Can Forensic Medical Services Help to Ensure Justice in Critical Times?" Academic Forensic Pathology 7, nr 3 (wrzesień 2017): 434–43. http://dx.doi.org/10.23907/2017.036.
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The role and contribution of an objective and professional medicolegal death investigation service should be valued and strengthened, especially in countries and communities where institutional and governmental corruption, incompetence, and abuse of power may exist, and where there are weak civil watchdog agencies such as a free press. South Africa is a fledgling democracy and is now at a critical juncture from a sociopolitical perspective. A number of incidents and historical perspectives are presented, all of which have specific relevance to the forensic medical community and which serve to illustrate the importance of ensuring the protection of the rights of vulnerable groups and persons who may easily suffer from disregard and abuse by state agencies and their representatives and which may ultimately impact very negatively on the broader society. Strengthening the organizational and legislative framework within which forensic pathologists can function is vital to ensure effective investigation in matters such as deaths in custody and of institutionalized persons/patients as well as deaths associated with police action and mob killings, to name but a few.
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Brazier, Margaret, Jill Lovecy, Michael Moran i Margaret Potton. "Falling from a Tightrope: Doctors and Lawyers between the Market and the State". Political Studies 41, nr 2 (czerwiec 1993): 197–213. http://dx.doi.org/10.1111/j.1467-9248.1993.tb01402.x.
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The organization of the medical and legal professions in Britain has depended heavily on ideologies of self-regulation, and on different institutional creations inspired by those ideologies. Self-regulation balances professions between the market and the state. In recent years both medicine and the law have been subjected to greater competition in the market, and greater control by the state. Part of the explanation for change lies in conditions particular to medicine and law but the similarity in recent regulatory experiences can only be explained by the working of common external forces. Two are identified: the impact of long-term cultural change on a regulatory balancing act originally created in an undemocratic and hierarchical society; and the impact of a modernizing elite in British government seeking to use state power to reverse the decline in British competitiveness.
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Ursol, Grigorii, Alexandr Skrypnyk i Olha Vasylenko. "SWOT-ANALYSIS OF MODELS OF ORGANIZATION OF PROVISION OF PRIMARY HEALTH CARE IN THE UNITED TERRITORIAL COMMUNITIES". EUREKA: Health Sciences 6 (30.11.2019): 65–71. http://dx.doi.org/10.21303/2504-5679.2019.001052.
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The article analyzes the strengths, weaknesses, potential opportunities and threats in the process of forming and making appropriate management decisions to integrate health facilities into united territorial communities (UTC) infrastructure, or other options, in the process of decentralization. The basic package of new legislative and regulatory documents has been worked out, which envisages radical changes and systemic reforms, decentralization of power - transfer from the executive bodies to local self-government bodies of a considerable part of powers, resources and responsibilities. A number of reform changes have been identified, which may lead to the expected institutional, organizational and structural-functional changes of the existing public health management system in Ukraine and changes in the individual functional characteristics of the entities of this system. The differences between medical reforms in terms of administrative reform, the role of UTC in this process, in relation to a number of other European countries are considered. On this basis, possible options for the development of events in the context of territorial governance of these processes in the system of health in Ukraine have been proposed. In order to continue scientific research in this direction, the next stage of the evolution of the formation and adoption of appropriate management decisions in the UTC is to consider the cooperation of the UTC in the creation of joint infrastructure medical facilities, their governing bodies, implementation of projects of activity, financing and maintenance.
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Gulden, J., M. K. Stewart i C. E. Stewart. "(A134) Special Needs of the Elderly During Disasters – Suggested Strategies and Lessons Learned from the 2007 Tulsa, Oklahoma Ice Storm". Prehospital and Disaster Medicine 26, S1 (maj 2011): s38. http://dx.doi.org/10.1017/s1049023x1100135x.
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Special Needs of the Elderly During Disasters – Suggested Strategies and Lessons Learned from the 2007 Tulsa, Oklahoma Ice Storm. On the evening of December 7, 2007 an ice storm occurred in the south central United States causing severe power outages in Tulsa, Oklahoma. In Oklahoma alone, 900,000 people were without power for periods of up to 3 weeks. Approximately 13.2% of the population in Oklahoma aged 65 + live in institutional care (2000 US Census Report). There are 498 nursing home facilities in Oklahoma serving this majority of this population (a small percentage live in other types of care facilities). Of these facilities 143 lost electrical power for up to six days, 88 lost power but had generators available within 24 hours or less, and 55 had no alternative source of power. Of the 55 without power, 42 relocated residents. Critical infrastructure failures during natural disasters can create a cascade of direct and indirect losses due to a number of physical, social and economic interdependencies that exist (Rinaldi, Peerenboom & Kelly 2001). The elderly present some unique characteristics that make them more vulnerable during natural disasters. Chronic health problems, physical mobility and cognitive limitations make them unable to adequately prepare for disasters (Aldrich & Benson 2008) making them entirely dependent on the facilities. In the three years since the storm the Oklahoma Disaster Institute has focused its efforts on developing and implementing mitigation strategies to address power loss in nursing homes. These strategies included discussions with the Department of Health, Emergency Medical Services Authority and local hospital officials. As a result of these discussions, table-top exercises were conducted in multiple venues, and speakers from the Department of Health, EMSA, and emergency management were arranged in an Extended Care Facility Workshop. This paper will look at lessons learned, mitigation strategies and successes in protecting the elderly in nursing homes during natural disasters.
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Garner, Ana C., i Angela R. Michel. "“The Birth Control Divide”". Journalism & Communication Monographs 18, nr 4 (4.11.2016): 180–234. http://dx.doi.org/10.1177/1522637916672457.
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For more than 140 years, religious, medical, legislative, and legal institutions have contested the issue of contraception. In this conversation, predominantly male voices have attached reproductive rights to tangential moral and political matters, revealing an ongoing, systematic attempt to regulate human bodies, especially those of women. This analysis of 1873-2013 press coverage of contraception in the New York Times, the Los Angeles Times, and the Chicago Tribune shows a division between institutional ideology and real-life experience; women’s reproductive rights are negotiable. Although journalists often reported that contraception was a factor in the everyday life of women and men, press accounts also showed religious, medical, legislative, and legal institutions debating whether it should be. Contraception originally was predominately viewed as a practice of prostitutes (despite evidence to the contrary) but became a part of everyday life. The battle has slowly evolved into one about the Affordable Care Act, religious freedom, morality, and employer rights. What did not significantly change over the 140-year period are larger cultural and ideological structures; these continue to be dominated by men, who retain power over women’s bodies.
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Glasdam, Stinne, Charlotte Bredahl Jacobsen i Hanne Bess Boelsbjerg. "Nurses’ refusals of patient involvement in their own palliative care". Nursing Ethics 27, nr 8 (6.07.2020): 1618–30. http://dx.doi.org/10.1177/0969733020929062.
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Background: Ideas of patient involvement are related to notions of self-determination and autonomy, which are not always in alignment with complex interactions and communication in clinical practice. Aim: To illuminate and discuss patient involvement in routine clinical care situations in nursing practice from an ethical perspective. Method: A case study based on an anthropological field study among patients with advanced cancer in Denmark. Ethical considerations: Followed the principles of the Helsinki Declaration. Findings: Two cases illustrated situations where nurses refused patient involvement in their own case. Discussion: Focus on two ethical issues, namely ‘including patients’ experiences in palliative nursing care’ and ‘relational distribution of power and knowledge’, inspired primarily by Hannah Arendt’s concept of thoughtlessness and a Foucauldian perspective on the medical clinic and power. The article discusses how patients’ palliative care needs and preferences, knowledge and statements become part of the less significant background of nursing practice, when nurses have a predefined agenda for acting with and involvement of patients. Both structurally conditioned ‘thoughtlessness’ of the nurses and distribution of power and knowledge between patients and nurses condition nurses to set the agenda and assess when and at what level it is relevant to take up patients’ invitations to involve them in their own case. Conclusion: The medical and institutional logic of the healthcare service sets the framework for the exchange between professional and patient, which has an embedded risk that ‘thoughtlessness’ appears among nurses. The consequences of neglecting the spontaneous nature of human action and refusing the invitations of the patients to be involved in their life situation call for ethical and practical reflection among nurses. The conditions for interaction with humans as unpredictable and variable challenge nurses’ ways of being ethically attentive to ensure that patients receive good palliative care, despite the structurally conditioned logic of healthcare.
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Siregar, Feriza Yetti. "Perception of Public Islam on Performance and Providing Public Services in Padangsidempuan City". al-Lubb: Journal of Islamic Thought and Muslim Culture (JITMC) 2, nr 1 (29.12.2020): 78. http://dx.doi.org/10.51900/lubb.v2i1.8591.
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<p>Public service is a matter that is closely associated with bureaucracy. Five factors are related to mission, accountability, consequences, power, and culture. Mission will determine the public services system competence in responding to dynamics that occur in the community accurately and efficiently. Method in this research was qualitative method, which was designed with descriptive research and phenomenology approaches through interviews and observations. Based on the research, the results showas follow: First, the perception of Islamic society in Padangsidimpuan on performance of Dinas Kependudukan dan Pencatatan Sipil (DKPS) in providing public services in 2014 was still far from their hope, and it hasn’t met in their satisfaction category especially Islamic society. Second, factors that influence the achievement of DKPS Padang Sidimpuan in providing public services in 2014 are human resources and financial factors. Besides, there are some supporting factors: leadership, resources, culture ministry, institutional, and related regulation. Third, factor that hold up the performance of DKPS Padangsidimpuan in providing public services in 2014 is organization structure. The other factors are such as the lack of officers responding to society who need the information and the lack of officers’ hospitality when they communicate to public. Fourth, the solution is given from Islamic society to improve public services at DKPS Padangsidimpuan for the next year: education, experiences, training, motivation to the staff and officer at DKPS Padangsidimpuan.</p>
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Akter, Khaleda, Halima Akter, Fatema Nurjahan, Shamima Sultana i Shelina Begum. "Vitamin B12, Folic acid and Homocysteine Levels in female metabolic syndrome patients and their relationship with Heart rate variability." Journal of Bangladesh Society of Physiologist 16, nr 1 (26.06.2021): 24–32. http://dx.doi.org/10.3329/jbsp.v16i1.54349.
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Background: Metabolic syndrome (MeS) is a well-recognized risk factor for cardiovascular diseases. It is associated with hyperhomocysteinemia resulting from deficiency of vitamin B12 and folic acid. Both the MeS and hyperhomocysteinemia adversely affect heart rate variability. Objectives: To assess vitamin B12, folic acid and homocysteine levels in female metabolic syndrome patients and their relationship with heart rate variability. Methods: After taking ethical clearance from Institutional Review Board (IRB) of Bangabandhu Sheikh Mujib Medical University (BSMMU) this cross sectional study was conducted on 80 female subjects of 25-45 years of age. Among them 40 metabolic syndrome patients were included in the study group and 40 age matched apparently healthy female constituted control group. All the patients were enrolled from Outpatient Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh according to selection criteria. Serum vitamin B12, folic acid, homocysteine level was estimated by chemiluminescent immunoassay and frequency domain parameters of Heart Rate Variability (HRV) was recorded by a data acquisition device, Powerlab 8/35, AD instruments, Australia. Statistical aalysis was done by independent sample ‘t’ test and pearson correlation test. Results: In this study, among frequency domain HRV variables Total power(TP), low frequency power(LF), high frequency power (HF), HF normalized unit(nu) were significantly lower (p<0.05) and LF nu, LF/HF were significantly higher (p<0.05) in MS patients compared to those of control. In addition, no significant changes (p>0.05) were found in serum vitamin B12, folic acid and homocysteine levels between these two groups. But on correlation analysis only the folic acid level was significantly negatively correlated (p<0.05) with LF and HF power. Conclusion: The present study revealed that the folic acid level but not the vitamin B12 and homocysteine levels has significant negative correlation with heart rate variability in female MS. J Bngladesh Soc Physiol 2021;16(1): 24-32
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ADAIR, RICHARD, JOSEPH MELLING i BILL FORSYTHE. "Migration, family structure and pauper lunacy in Victorian England: admissions to the Devon County Pauper Lunatic Asylum, 1845–1900". Continuity and Change 12, nr 3 (grudzień 1997): 373–401. http://dx.doi.org/10.1017/s0268416097002981.
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The lunatic asylum remains one of the most remarkable institutional monuments of the modern world, dominating the social landscape of Victorian Britain and exercising a powerful attraction for social historians of medicine, an attraction almost as great as the spectre of the madhouse for contemporary novelists. Our image of the Victorian asylum is still pervaded to a surprising degree by the gloomy spectacle of the total institution presented by Michel Foucault, though it has been modified by a whole range of institutional and philosophical accounts undertaken in the past three decades. Pioneering studies by researchers such as Andrew Scull have illuminated not only the power exercised by the new asylum superintendents, armed with medical discourses of moral treatment and the early promise of curability, but also the continuing dominance of the ‘mad doctors’ in the sombre years of neo-Darwinian pessimism and eugenics doctrines. More recent contributions to the now enormous literature on the social history of insanity have shifted the focus of attention from earlier concerns with charting the rise of the asylum and the elaboration of medical discourses under the psychiatric gaze of physicians to a detailed reconstruction of the social environment of the asylum and especially to the interplay between familial circumstances and the way institutions responded to the insane. Such concerns were also clearly evident in important earlier studies by Walton, Scull, Digby and others, which drew on fundamental work by Anderson on the changing role of the family during industrialization. These scholars drew attention to the importance of family and kinship relations in the negotiation of a lunatic's passage to the Victorian asylum, as well as the role of wider forces of economic change, population growth and migration in shaping the environment in which decisions about the care of the mad were made.
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Khan, Javid Ahmad, i Dr Sarita Agrawal. "Economics of Health Human Capital in Jammu and Kashmir". Journal of Global Economy 14, nr 1 (8.11.2018): 58–74. http://dx.doi.org/10.1956/jge.v14i1.469.
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In this paper an attempt has been made to estimate and analysis the growth and performance of the human capital in Jammu and Kashmir. Given different components of the human capital only health human capital is estimated and analyzed. The health human capital as a proxy variable for human capital is analyzed for inputs and outputs. The proxy variables included total expenditure on health, health expenditure as percentage share of total expenditure and GSDP, quality variables like institutional availability and man power, medical attention received, life expectancy average, mortality rates by sex and residence, birth and death rates, natural growth rates, child mortality, total fertility. Both econometrics and non-econometrics methods were used for estimation. The study concludes that health human capital has increased in the state over time but pace and acceleration was low. Following the findings the study recommends the attention of government to increase the standard of health in Jammu and Kashmir. Substantial amount of government budgetary allocation should be directed towards the health sector and minimization of gap of urban rural access to health care is strongly recommended by increasing infrastructure. Â Last but not least the availability of institutions and increase in the man power engaged in health sector must be increased.
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Danda, Michelle. "What is Mental Health Nursing Anyway? Advantages and Issues of Utilizing Duoethnography to Understand Mental Health Nursing". Witness: The Canadian Journal of Critical Nursing Discourse 2, nr 2 (30.12.2020): 20–28. http://dx.doi.org/10.25071/2291-5796.71.
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In recent decades scholars have begun to question the value of mental health nursing. The term has lost both conceptual and explanatory power in the modern globalized world in which multidisciplinary teams now carry out many functions once unique to the specialization, yet its distinction persists. The purpose of this paper is to explore an emerging research methodology, duoethnography, as an avenue to revive mental health nursing, by subverting the dominant post-positivist, scientifically driven, medically framed, evidence-based practice perspective, to gain greater understanding of the nuances of mental health nursing practice. Duoethnography offers promise in challenging nursing research norms embedded in an empirically based medical model, however the newness of the method poses potential methodological issues. Duoethnography is a methodology well-suited to explore the question of whether mental health nursing is an outmoded tradition too deeply entrenched in the institutional past, or an emerging profession leading mental health care.
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Fischer, Markus. "Machiavelli's Political Psychology". Review of Politics 59, nr 4 (1997): 789–830. http://dx.doi.org/10.1017/s0034670500028333.
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Systematic analysis shows the psychological premises of Machiavelli's political theory to be fairly consistent and to transcend historical circumstance. Above all, the apparent contradiction between its rapacious and consensual sides can be resolved by unearthing his distinction between necessary properties and contingent attributesquahabits. Following medieval medical theory, necessary properties include: spirit that animates the body; mind with faculties of ingenuity, imagination, and memory; desires for preservation, glory, power, freedom, wealth, and sexual pleasure; and four humors received from the stars. While serving the desires, mind stimulates them to expand into the limitless ambition characteristic of Machiavellian individuals. Habituation to laws and gods makes possible the institutional life of republics, in that cooperative habits solve the collective-action problem faced by a multitude of self-ruling citizens. However, such republics are ultimately alliances for joint gain rather than structures of virtue—challenging the ascendant view of Machiavelli as a “civic humanist” and Aristotelian.
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Moore, Colin D. "Innovation without Reputation: How Bureaucrats Saved the Veterans’ Health Care System". Perspectives on Politics 13, nr 2 (czerwiec 2015): 327–44. http://dx.doi.org/10.1017/s1537592715000067.
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The Veterans Health Administration (VA) is among the most unusual and misunderstood institutions in the American welfare state. Unlike most American social services, veterans’ medical care continues to be administered directly by the state, contrary to the “antibureaucratic strategy” of “hidden” or “submerged” state-building that has dominated US social policy for decades. Drawing on extensive archival research, I attempt to make sense of the VA’s unique policy trajectory by exploring two puzzling episodes of institutional change in the delivery of veterans’ health care. Although many bureaucratic models predict large new undertakings initiated by agencies only when they benefit from the advantages of being well-regarded and relatively autonomous, both instances of institutional change occurred at the nadir of the VA’s reputation as a competent, innovative, and politically-powerful agency. To explain these unexpected transformations, I investigate the role of bureaucrats in shaping the development of the American welfare state and develop the concept of collaborative state-building to demonstrate how public-private partnerships may contribute to the expansion of social welfare programs in liberal states. Although public-private partnerships are usually seen as an erosion of state power or a way to hide the state’s role in the provision of social services, the case of the VA suggests that such partnerships may be used to support and expand such programs. I also focus on the VA’s many scandals and show how agency officials used these policy failures to expand the VA.
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Jia, Lena, Michael Kevin Rooney, Clare Jacobson, Kent A. Griffith, Reshma Jagsi i Merry Jennifer Markham. "Factors associated with endowed chair allocation in medical oncology divisions and departments in the United States." Journal of Clinical Oncology 39, nr 15_suppl (20.05.2021): 11044. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.11044.
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11044 Background: Despite an increasing number of female physicians in the workforce, a gender disparity remains in many leadership roles in medicine. Endowed chairs can provide a multitude of research and career opportunities; thus, they are coveted positions in academic medicine. We examined factors associated with holding endowed chairs in oncology across the US, with a focus on whether a gender difference existed, as has been demonstrated in top internal medicine departments more generally. Methods: In 2019, we identified 95 academic oncology divisions/departments in the US, using the Oncology Division Chiefs & Department Chairs listing in the American Society of Clinical Oncology (ASCO) myConnection forum to define the institutions included. We requested a list of full professors and endowed chairs in those divisions/departments, relying on public data on websites when an institution did not respond. Using public data (e.g., institutional websites, NIH reporter, Scopus, state licensing boards), we collected information on gender, degree, total NIH funding as PIs, H-indices, publication and citation numbers, and graduation year for these individuals. We then created a multivariable logistic regression model to examine if, after controlling for other variables, gender was independently associated with an increased likelihood of holding an endowed chair. Results: One thousand thirty-three oncology full professors were identified, 290 (25.6%) of whom held endowed chairs. Overall, and in an adjusted model, greater research productivity (as measured through publications, citations, and h-index) and greater levels of NIH funding were significantly associated with having an endowed chair. Gender was not significantly associated with endowed chair status (21.9% [95% CI:17.2-27.3] of females and 26.8% [23.8-29.9] for males held endowed chairs; p = 0.11) on bivariable analysis, nor was it significant in the adjusted multivariable model (p = 0.50). Power to detect the observed difference given the total number of professors and their gender distribution was found to be ̃53%, suggesting a 47% chance of failing to reject the null hypothesis of equal gender distributions in endowed chairs when the observed difference is as large as estimated. Conclusions: Among oncology full professors, gender was not significantly associated with endowed chair status, although the number of professors in this field is too small to definitively rule out a modest gender difference. This finding contrasts with prior work that revealed a more substantial difference by gender that remained significant after controlling for other factors in a study, including all divisions in the Departments of Internal Medicine at top medical institutions. Further work is necessary to understand what specialty-specific and institutional cultural factors may help mitigate challenges in the pursuit of equity, diversity, and inclusion.
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Averbuch, Tauben, Yousif Eliya i Harriette Gillian Christine Van Spall. "Systematic review of academic bullying in medical settings: dynamics and consequences". BMJ Open 11, nr 7 (lipiec 2021): e043256. http://dx.doi.org/10.1136/bmjopen-2020-043256.
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PurposeTo characterise the dynamics and consequences of bullying in academic medical settings, report factors that promote academic bullying and describe potential interventions.DesignSystematic review.Data sourcesWe searched EMBASE and PsycINFO for articles published between 1 January 1999 and 7 February 2021.Study selectionWe included studies conducted in academic medical settings in which victims were consultants or trainees. Studies had to describe bullying behaviours; the perpetrators or victims; barriers or facilitators; impact or interventions. Data were assessed independently by two reviewers.ResultsWe included 68 studies representing 82 349 respondents. Studies described academic bullying as the abuse of authority that impeded the education or career of the victim through punishing behaviours that included overwork, destabilisation and isolation in academic settings. Among 35 779 individuals who responded about bullying patterns in 28 studies, the most commonly described (38.2% respondents) was overwork. Among 24 894 individuals in 33 studies who reported the impact, the most common was psychological distress (39.1% respondents). Consultants were the most common bullies identified (53.6% of 15 868 respondents in 31 studies). Among demographic groups, men were identified as the most common perpetrators (67.2% of 4722 respondents in 5 studies) and women the most common victims (56.2% of 15 246 respondents in 27 studies). Only a minority of victims (28.9% of 9410 victims in 25 studies) reported the bullying, and most (57.5%) did not perceive a positive outcome. Facilitators of bullying included lack of enforcement of institutional policies (reported in 13 studies), hierarchical power structures (7 studies) and normalisation of bullying (10 studies). Studies testing the effectiveness of anti-bullying interventions had a high risk of bias.ConclusionsAcademic bullying commonly involved overwork, had a negative impact on well-being and was not typically reported. Perpetrators were most commonly consultants and men across career stages, and victims were commonly women. Methodologically robust trials of anti-bullying interventions are needed.LimitationsMost studies (40 of 68) had at least a moderate risk of bias. All interventions were tested in uncontrolled before–after studies.
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Chaney, Sarah. "‘No “Sane” Person Would Have Any Idea’: Patients’ Involvement in Late Nineteenth-century British Asylum Psychiatry". Medical History 60, nr 1 (10.12.2015): 37–53. http://dx.doi.org/10.1017/mdh.2015.67.
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In his 1895 textbook,Mental Physiology, Bethlem Royal Hospital physician Theo Hyslop acknowledged the assistance of three fellow hospital residents. One was a junior colleague. The other two were both patients: Walter Abraham Haigh and Henry Francis Harding. Haigh was also thanked in former superintendent George Savage’s bookInsanity and Allied Neuroses(1884). In neither instance were the patients identified as such. This begs the question: what role did Haigh and Harding play in asylum theory and practice? And how did these two men interpret their experiences, both within and outside the asylum? By focusing on Haigh and Harding’s unusual status, this paper argues that the notion of nineteenth-century ‘asylum patient’ needs to be investigated by paying close attention to specific national and institutional circumstances. Exploring Haigh and Harding’s active engagement with their physicians provides insight into this lesser-known aspect of psychiatry’s history. Their experience suggests that, in some instances, representations of madness at that period were the product of a two-way process of negotiation between alienist and patient. Patients, in other words, were not always mere victims of ‘psychiatric power’; they participated in the construction and circulation of medical notions by serving as active intermediaries between medical and lay perceptions of madness.
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Klimenko, Lyudmila V., i Oxana Yu Posukhova. "Gender Aspects of Reproduction of Professional Dynasties in Medicine". Journal of Institutional Studies 13, nr 3 (25.09.2021): 144–57. http://dx.doi.org/10.17835/2076-6297.2021.13.3.144-157.
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The number of female health workers is predominant in the current health care system. However, in terms of the distribution of power and authority, career trajectories, and the culture of relationships, medicine still remains gender-related to men. Reproduction processes of the professional structure of medicine, in which professional dynasties occupy a special place, is also marked by gender differences. Thus, the article addresses the gender specificities of the institutional reproduction of medical dynasties in modern Russia. Based on in-depth interviews with twenty representatives of multigenerational families of doctors from ten cities, gender scenarios for the transmission of professional positions and the gender specificity of using the social and symbolic capital of the dynasty in the context of their reproduction are analyzed. According to the empirical research findings, the dynastic model of marital status transfer maintains and reproduces gender inequality in the medical profession. There is low gender sensitivity in doctors’ dynasties, where women are more likely to be passive or under family pressure to pursue educational and work tracks. The choice of professional specialization is conditioned by gender stereotypes. Career and professional opportunities of women doctors are limited by an imbalance between work and home responsibilities. Dynasty social and symbolic capital investment strategies are less resourceful for women in clinical practice and more effective in academic medicine. The deconstruction of the traditional gender display in the profession is proceeding at a slow pace, while medical dynasties continue to rather reproduce the inequality and male ethics of the medical profession.
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Cao, Xuebing. "The Chinese Medical Doctor Association: A New Industrial Relations Actor in China’s Health Services?" Articles 66, nr 1 (28.06.2011): 74–97. http://dx.doi.org/10.7202/1005106ar.
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This research marks a new attempt to examine the development of new industrial relations actors in contemporary China. It appears that the CMDA has the potential to convert members’ common pursuit into action, albeit with different strengths and patterns compared with its Western counterparts. However, the process of mobilizing doctors is likely to be challenged by China’s unitary industrial relations system. For Chinese doctors, the question is how to convert constant work-related discontent and conflict into an institutional response, and how much freedom the CMDA can be given. Follow-up observation is needed to assess the impact of the CMDA’s continuous expansion in the industrial relations system in China’s health services. Findings suggest that currently the CMDA is neither an independent union organization, nor a new industrial relations actor within Chinese health services due to its structural weakness and political limitations. Unlike its Western counterparts, the CMDA does not have high levels of social and economic power to control licenses and access to the medical profession. However, the prospect remains that the CMDA may be more active within the industrial relations system if doctors’ social capital and group identity can be further strengthened. This paper examines possibilities and difficulties for the Chinese Medical Doctor Association (CMDA) to become a new industrial relations actor in China’s health services. It attempts to provide evidence on whether the CMDA functions in similar ways as its Western counterparts in mobilizing members. Aiming at filling the research gap in Chinese professional organizations’ involvement in the industrial relations process, this paper discusses the CMDA’s potential and the challenges of becoming a union organization. Data were collected through 39 semi-structured interviews with supplementation of documentary evidence from the government, doctors’ professional societies, hospitals and trade unions.
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Fuller, Katherine, Stephanie Malecki, Lisa Anselmo, Matthew E. Borrego, Bernadette Jakeman i Allison Burnett. "Once-Daily Versus Twice-Daily Enoxaparin for the Treatment of Acute Venous Thromboembolism in Cancer Patients". Annals of Pharmacotherapy 52, nr 3 (12.10.2017): 257–62. http://dx.doi.org/10.1177/1060028017737094.
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Background: No randomized controlled trials have investigated enoxaparin once versus twice daily for venous thromboembolism (VTE) treatment in cancer patients. Objective: To compare the safety and efficacy of enoxaparin 1 mg/kg twice daily versus enoxaparin 1.5 mg/kg/day for the treatment of acute VTE in cancer patients. Methods: This was a single-center, retrospective, observational cohort study. Adults with active cancer and an acute VTE were included. The primary outcome evaluated was the incidence of clinically relevant (major and nonmajor) bleeding (CRB) within 30 days of enoxaparin initiation. Secondary outcomes included the incidence of CRB, thrombosis, and death at 30, 90, and 180 days. The study protocol was approved by the institutional review board. Results: A total of 123 patients met inclusion criteria; 85 patients (69%) were treated with once-daily and 38 patients (31%) with twice-daily enoxaparin. CRB was numerically higher at 30 days in the twice-daily enoxaparin group compared with the once-daily group (5.3% vs 2.4%, P = 0.587). There was a nonsignificant higher incidence of CRB in the once-daily enoxaparin group compared with the twice-daily group at 90 days (8.3% vs 8%, P = 1.0) and 180 days (12.5% vs 7.1%, P = 1.0). The composite outcome of CRB, thrombosis, and death was higher at all time points with enoxaparin once daily. Conclusions: Lack of statistical power in this study precludes definitive conclusions. Clinicians may consider twice-daily enoxaparin because of potentially fewer adverse events but may be limited by patient preference and/or financial constraints.
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Heller, Debra S. "CD68 Immunostaining in the Evaluation of Chronic Histiocytic Intervillositis". Archives of Pathology & Laboratory Medicine 136, nr 6 (1.06.2012): 657–59. http://dx.doi.org/10.5858/arpa.2011-0328-oa.
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Context.—Chronic histiocytic intervillositis is an uncommon and poorly recognized lesion associated with poor perinatal outcomes, including intrauterine growth retardation and stillbirth. It has a high recurrence rate. Objective.—To evaluate utility of CD68 immunostaining in the evaluation of chronic histiocytic intervillositis. Design.—Institutional review board–approved retrospective review was performed. Cases were selected from the departmental archives of University Hospital, Newark, New Jersey, between 2002 and 2009. Controls were from second-trimester pregnancies with chromosomal abnormalities or multiple severe anomalies. Results.—There were 9 cases and 11 controls. The mean CD68+ count per high-power field for the cases was 88 ± 23 (range, 51–180) and for the controls, 8 ± 5 (range, 0–24), P < .001. Conclusions.—This study establishes a range for histiocyte counts in chronic histiocytic intervillositis and pregnancies without chronic histiocytic intervillositis, and suggests that CD68 staining may have utility in the diagnosis, particularly for nonperinatal pathologists, who may be less familiar with this lesion.